Ill STAT. 376 PUBLIC LAW 105-33—AUG. 5, 1997 (D) by adding after clause (iii) the following new clause: "(iv) with respect to discharges occurring during fiscal year 1998 through fiscal year 2000, the target amount for the preceding year increased by the applicable percentage increase under subparagraph (B)(iv).". 42 USC 1395WW (3) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION. — note. Section 13501(e)(2) of OBRA-93 (42 U.S.C. 1395ww note) is amended by striking "or fiscal year 1994" and inserting ", fiscal year 1994, fiscal year 1998, fiscal year 1999, or fiscal year 2000". 42 USC 1395WW (b) EFFECTIVE DATE.— The amendments made by subsection note. (a) shall apply with respect to discharges occurring on or after October 1, 1997. SEC. 4205. RURAL HEALTH CLINIC SERVICES. (a) PER-VISIT PAYMENT LIMITS FOR PROVIDER-BASED CLINICS. — (1) EXTENSION OF LIMIT.— (A) IN GENERAL.— The matter in section 1833(f) (42 U.S.C. 13951(f)) preceding paragraph (1) is amended by striking "independent rural health clinics" and inserting "rural health clinics (other than such clinics in rural hospitals with less than 50 beds)". 42USG1395Z (B) EFFECTIVE DATE. — The amendment made by note. subparagraph (A) applies to services furnished on or after January 1, 1998. (2) TECHNICAL CLARIFICATION.— Section 1833(f)(1) (42 U.S.C. 13951(f)(1)) is amended by inserting "per visit" after "$46". (b) ASSURANCE OF QUALITY SERVICES.— (1) IN GENERAL. — Subparagraph (I) of the first sentence of section 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) is amended to read as follows: "(I) has a quality assessment and performance improvement program, and appropriate procedures for review of utilization of clinic services, as the Secretary may specify,". 42 USC I395x (2) EFFECTIVE DATE. — The amendment made by paragraph note. (1) shall take effect on January 1, 1998. (c) WAIVER OF CERTAIN STAFFING REQUIREMENTS LIMITED TO CLINICS IN PROGRAM.— (1) IN GENERAL.— Section 1861(aa)(7)(B) (42 U.S.C. 1395x(aa)(7)(B)) is amended by inserting before the period ", or if the facility has not yet been determined to meet the requirements (including subparagraph (J) of the first sentence of paragraph (2)) of a rural health clinic". 42 USC I395x (2) EFFECTIVE DATE. — The amendment made by paragraph note. (1) applies to waiver requests made on or after January 1, 1998. (d) REFINEMENT OF SHORTAGE AREA REQUIREMENTS.— (1) DESIGNATION REVIEWED TRIENNIALLY.— Section 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) is amended in the second sentence, in the matter in clause (i) preceding subclause (I)— (A) by striking "and that is designated" and inserting "and that, within the previous 3-year period, has been designated"; and (B) by striking "or that is designated" and inserting "or designated".
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