PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-171 ity, or intermediate care facility for the mentally retarded to reimburse the hospital or facility for the costs attributable to taxes imposed by the State soley ^^ with respect to hospitals or facilities. ". (c) EFFECTIVE DATES.— The amendment made by subsection (b) 42 USC 1396b shall take effect on January 1, 1991. note. SEC, 4702. DISPROPORTIONATE SHARE HOSPITALS: COUNTING OF IN- PATIENT DAYS. (a) CLARIFICATION OF MEDICAID DISPROPORTIONATE SHARE ADJUST- MENT CALCULATION. —Section 1923(b)(2) (42 U.S.C. 1396r-4(b)(2)) is amended by adding at the end the following new sentence: "In this paragraph, the term 'inpatient day' includes each day in which an individual (including a newborn) is an inpatient in the hospital, whether or not the individual is in a specialized ward and whether or not the individual remains in the hospital for lack of suitable placement elsewhere.". (b) EFFECTIVE DATE. —The amendment made by subsection (a) 42 USC l396r-4 shall take effect on July 1, 1990. °^- SEC. 4703. DISPROPORTIONATE SHARE HOSPITALS: ALTERNATIVE STATE PAYMENT ADJUSTMENTS AND SYSTEMS. (a) ALTERNATIVE STATE PAYMENT ADJUSTMENTS.— Section 1923(c) (42 U.S.C. 1396r-4(c)) is amended— (1) by striking "or" at the end of paragraph (1); (2) by adding "or" at the end of paragraph (2); and (3) by inserting after paragraph (2) the following new paragraph: "(3) provide for a minimum specified additional payment amount (or increased percentage payment) that varies according to type of hospital under a methodology that— "(A) applies equally to all hospitals of each type; and "(B) results in an adjustment for each type of hospital that is reasonably related to the costs, volume, or proportion of services provided to patients eligible for medical assistance under a State plan approved under this title or to low-income patients.". (b) CLARIFICATION OF SPECIAL RULE FOR STATE USING HEALTH INSURING ORGANIZATION.— Section 1923(e)(2) (42 U.S.C. 1396r-4(e)(2)) is amended by striking "during the 3-year period". (c) CONFORMING AMENDMENT.—Section 1923(c)(2) (42 U.S.C. 1396r- 4(c)(2)) is amended by inserting after "State" "or the hospital's lowincome utilization rate (as defined in paragraph (b)(3))". (d) EFFECTIVE DATE. — The amendments made by this section shall 42 USC l396r-4 take effect as if included in the enactment of section 412(a)(2) of the »<>*». Omnibus Budget Reconciliation Act of 1987. SEC. 4704. FEDERALY 45 QUALIFIED HEALTH CENTERS. (a) CLARIFICATION OF USE OF MEDICARE PAYMENT METHODOLOGY. — Section 1902(a)(13)(E) (42 U.S.C. 1396a(a)(13)(E)) is amended— (1) by striking "may prescribe" the first place it appears and inserting "prescribes", and (2) by striking "on such tests of reasonableness as the Secretary may prescribe in regulations under this subparagraph" and inserting "on the same methodology used under section 1833(a)(3)". ' So in original. Probably should be "solely". ' So in original. Probably should be "FEDERALLY"