Page:United States Statutes at Large Volume 108 Part 5.djvu/913

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PUBLIC LAW 103-432—OCT. 31, 1994 108 STAT. 4403 (i) by redesignating subsection (k) as subsection (l);and (ii) by inserting after subsection (j) the following new subsection: "(k) ELIGIBILITY OF HOSPITALS NOT LOCATED IN PARTICIPATING STATES.— Notwithstanding any other provision of this section— "(1) for purposes of including a hospital or facility as a member institution of a rural health network, a State may designate a hospital or facility that is not located in the State as an essential access community hospital or a rural primary care hospital if the hospital or facility is located in an adjoining State and is otherwise eligible for designation as such a hospital; "(2) the Secretary may designate a hospital or facility that is not located in a State receiving a grant under subsection (a)(1) as an essential access community hospital or a rural primary care hospital if the hospital or facility is a member institution of a rural health network of a State receiving a grant under such subsection; and "(3) a hospital or facility designated pursuant to this subsection shall be eligible to receive a grant under subsection (a)(2).". (B) CONFORMING AMENDMENTS.— (i) Section 1820(c)(1) (42 U.S.C. 1395i-4(c)(l)) is amended by striking "paragraph (3)" and inserting "paragraph (3) or subsection (k)". (ii) Paragraphs (1)(A) and (2)(A) of section 1820(i) (42 U.S.C. 1395i-4(i)) are each amended— (I) in clause (i), by striking "(a)(1)" and inserting "(a)(1) (except as provided in subsection (k))", and (II) in clause (ii), by striking "subparagraph (B)" and inserting "subparagraph (B) or subsection (k)". (c) SKILLED NURSING SERVICES IN RURAL PRIMARY CARE HOS- PITALS.—Section 1820(f)(3) (42 U.S.C. 1395i-4(f)(3)) is amended by striking "because the facility" and all that follows and inserting the following: "because, at the time the facility applies to the State for designation as a rural primary care hospital, there is in effect an agreement between the facility and the Secretary under section 1883 under which the facility's inpatient hospital facilities are used for the furnishing of extended care services, except that the number of beds used for the furnishing of such services may not exceed the total number of licensed inpatient beds at the time the facility applies to the State for such designation (minus the number of inpatient beds used for providing inpatient care pursuant to paragraph (1)(F)). For purposes of the previous sentence, the number of beds of the facility used for the furnishing of extended care services shall not include any beds of a unit of the facility that is licensed as a distinct-part skilled nursing facility at the time the facility applies to the State for designation as a rural primary care hospital.". (d) DEADLINE FOR DEVELOPMENT OF PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT RURAL PRIMARY CARE HOSPITAL SERVICES.— Section 1814(1)(2) (42 U.S.C. 1395fi:i)(2)) is amended by striking "January 1, 1993" and inserting "January 1, 1996". (e) PAYMENT FOR OUTPATIENT RURAL PRIMARY CARE HOSPITAL^ SERVICES.— (1) IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM. — Section 1834(g) (42 U.S.C. 1395m(g)) is amended—