PUBLIC LAW 103-432—OCT. 31, 1994
108 STAT. 4401
(2) Section 1886(d)(10) (42 U.S.C. 1395ww(d)(10)) is amended—
(A) in subparagraph (C)(i)(II), by striking "the area wage
index appHcable" and inserting "the factor used to adjust the
DRG prospective payment rate for area differences in hospital
wage levels that applies"; and
(B) in subparagraph (D)—
(i) by redesignating clause (ii) as clause (iii), and
(ii) by inserting after clause (i) the following new
clause:
"(ii) Notwithstanding clause (i), if the Secretary uses a method
for making adjustments to the DRG prospective payment rate for
area differences in hospital wage levels under paragraph (3)(E)
that is not based on the use of Metropolitan Statistical Area classifications, the Secretary may revise the guidelines published under
clause (i) to the extent such guidelines are used to determine
the appropriateness of the geographic area in which the hospital
is determined to be located for purposes of making such
adjustments.".
(c) ADJUSTMENT OF LABOR AND NON-LABOR PORTIONS OF
STANDARDIZED AMOUNTS.— Section 1886(d)(3)(A)(iii) (42 U.S.C.
1395ww(d)(3)(A)(iii)) is amended by adding at the end the following:
"For discharges occurring on or after October 1, 1994, the Secretary
shall adjust the ratio of the labor portion to non-labor portion
of each average standardized amount to equal such ratio for the
national average of all standardized amounts.".
SEC. 102. ESSENTIAL ACCESS COMMUNITY HOSPITAL (EACH)
AMENDMENTS.
(a) TREATMENT OF INPATIENT HOSPITAL SERVICES PROVIDED
IN RURAL PRIMARY CARE HOSPITALS.—
(1) IN GENERAI..— Section 1820(f)(1)(F) (42 U.S.C. 13951-
4(f)(1)(F)) is amended to read as follows:
"(F) subject to paragraph (4), provides not more than
6 inpatient beds (meeting such conditions as the Secretary
may establish) for providing inpatient care to patients
requiring stabilization before discharge or transfer to a
hospital, except that the facility may not provide any
inpatient hospital services—
"(i) to any patient whose attending physician does
not certify that the patient may reasonably be expected
to be discharged or transferred to a hospital within
72 hours of admission to the facility; or
"(ii) consisting of surgery or any other service
requiring the use of general anesthesia (other than
surgical procedures specified by the Secretary under
section 1833(i)(l)(A)), unless the attending physician
certifies that the risk associated with transferring the
patient to a hospital for such services outweighs the
benefits of transferring the patient to a hospital for
such services.".
(2) LIMITATION ON AVERAGE LENGTH OF STAY. —Section
1820(f) (42 U.S.C. 13951-4(0) is amended by adding at the
end the following new paragraph:
"(4) LIMITATION ON AVERAGE LENGTH OF INPATIENT STAYS. —
The Secretary may terminate a designation of a rural primary
care hospital under paragraph (1) if the Secretary finds that
the average length of stay for inpatients at the facility during
�
