104 STAT. 1388-40 PUBLIC LAW 101-508 —NOV. 5, 1990 (C) the hospital receives a benefit for the support it furnishes to such program through the provision of clinical services by nursing or allied health students participating in such program; and (D) the costs incurred by the hospital for such program do not exceed the costs that would be incurred by the hospital if it operated the program itself. (3) PROHIBITION AGAINST RECOUPMENT OF COSTS BY SEC- RETARY. — (A) IN GENERAL.—The Secretary of Health and Human Services may not recoup payments from (or otherwise reduce or adjust payments under part A of title XVIII of the Social Security Act to) a hospital because of alleged overpayments to such hospital under such title due to a determination that costs which were reported by the hospital on its medicare cost reports for cost reporting periods beginning on or after October 1, 1983, and before October 1, 1990, relating to approved nursing and allied health education programs did not meet the requirements for allowable nursing and allied health education costs (as developed by the Secretary pursuant to section 1861(v) of such Act). (B) REFUND OF AMOUNTS RECOUPED. — If, prior to the date of the enactment of this Act, the Secretary has recouped payments from (or otherwise reduced or adjusted payments under part A of title XVIII of the Social Security Act to) a hospital because of overpayments described in subparagraph (A), the Secretary shall refund the amount recouped, reduced, or adjusted from the hospital. (4) SPECIAL AUDIT TO DETERMINE COSTS. —In determining the amount of costs incurred by, claimed by, and reimbursed to, a hospital for purposes of this subsection, the Secretary shall conduct a special audit (or use such other appropriate mechanism) to ensure the accuracy of such past claims and payments. (5) EFFECTIVE DATE.—Except as provided in paragraph (3), the provisions of this subsection shall apply to cost reporting periods beginning on or after October 1, 1990. SEC. 4005. PPS-EXEMPT HOSPITALS. (a) ADJUSTMENT TO PAYMENT AMOUNTS.— (1) IN GENERAL.— Section 1886(b)(1)(B) (42 U.S.C. 1395ww(b)(l)(B)) is amended by striking "(ii) in the case of and all that follows through the semicolon and inserting the following: "(ii) in the case of cost reporting periods beginning on or after October 1, 1991, an additional amount equal to 50 percent of the amount by which the operating costs exceed the target amount (except that such additional amount may not exceed 10 percent of the target amount) after any exceptions or adjustments are made to such target amount for the cost reporting period;". 42 USC 1395ww (2) EFFECTIVE DATE. —The amendment made by paragraph (1) ^o*®- shall apply to cost reporting periods beginning on or after October 1, 1991. 42 USC 1395WW (b) DEVELOPMENT OF NATIONAL PROSPECTIVE PAYMENT RATES FOR note. CURRENT NON-PPS HOSPITALS. — (1) DEVELOPMENT OF PROPOSAL. — The Secretary of Health and Human Services shall develop a proposal to modify the current system under which hospitals that are not subsection (d) hos-
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