PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-35 (vi) in paragraph (8)(D)— (I) in the first sentence, by striking "for hospitals located in an urban area", and (II) by striking the second sentence. (3) EFFECTIVE DATE. — The amendments made by paragraph (1) and paragraph (2)(A) shall apply to payments for discharges occurring on or after January 1, 1991, and the amendments made by paragraph (2)(B) shall take effect October 1, 1994. (d) AREA WAGE INDEX.— (1) DETERMINATION OF AREA WAGE INDEX. — (A) For purposes of section 1886(d)(3)(E) of the Social Security Act for discharges occurring on or after January 1, 1991, and before October 1, 1993, the Secretary of Health and Human Services shall apply an area wage index determined using the survey of the 1988 wages and wage-related costs of hospitals in the United States conducted under such section. (B) The Secretary shall apply the wage index described in subparagraph (A) without regard to a previous survey of wages and wage-related costs. (2) STUDY OF AREA WAGE INDEX ADJUSTMENTS BASED ON PROFES- SIONAL OCCUPATIONAL COMPONENT. — (A) STUDY.— The Prospective Payment Assessment Commission shall examine available data from States and other sources measuring earnings and paid hours of employment of hospital workers by occupational category, and shall include in such examination an analysis of the impact of variation in occupational mix on the computation of the area wage index determined under section 1886(d)(3)(E) of the Social Security Act. (B) REPORT TO CONGRESS. —In its March 1991 report, the Commission shall include recommendations regarding the feasibility and desirability of modifying such area wage index to take into account occupational mix, including variations in occupational mix resulting from differences in State codes and requirements. (e) EXTENSION OF REGIONAL FLOOR ON STANDARDIZED AMOUNTS.— (1) IN GENERAL.— Section 1886(d)(l)(A)(iii) (42 U.S.C. 1395ww(d)(l)(A)(iii)) is amended by striking "beginning on or after" and all that follows through "1990" and inserting "beginning on or after April 1, 1988, and ending on September 30, 1993,". (2) STUDY. —(A) The Secretary of Health and Human Services shall collect sufficient data on the input prices associated with the non-wage-related portion of the adjusted average standardized amounts established under section 1886(d)(3) of the Social Security Act to identify the extent to which variations in such amounts among hospitals located in different geographic areas are attributable to differences in such prices. (B) Not later than June 1, 1993, the Secretary shall submit a report to Congress analyzing such data, and shall include in such report recommendations regarding a methodology for adjusting such average standardized amounts to reflect such variations. (C) The provisions of chapter 35 of title 44, United States Code, shall not apply to data collected by the Secretary under subparagraph (A). 42 USC 1395WW note. 42 USC 1395WW note. 42 USC 1395WW note.
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