113 STAT. 1501A-370 PUBLIC LAW 106-113—APPENDIX F (2) by striking "published in the Federal Register on January 3, 1980" and inserting "described in clause (ii)"; and (3) by adding at the end the following new clause: "(ii) The standards described in this clause for cost reporting periods beginning in a fiscal year— "(I) before fiscal year 2003, are the standards published in the Federal Register on January 3, 1980, or, at the election of the hospital with respect to fiscal years 2001 and 2002, standards so published on March 30, 1990; and "(II) after fiscal year 2002, are the standards published in the Federal Register by the Director of the Office of Management and Budget based on the most recent available decennial population data. Subparagraphs (C) and (D) shall not apply with respect to the application of subclause (I).". (b) EFFECTIVE DATE. —The amendments made by subsection (a) apply with respect to discharges occurring during cost reporting periods beginning on or after October 1, 1999. SEC. 403. IMPROVEMENTS IN THE CRITICAL ACCESS HOSPITAL (CAH) PROGRAM. (a) APPLYING 96-HOUR LIMIT ON AN ANNUAL, AVERAGE BASIS. — (1) IN GENERAL.— Section 1820(c)(2)(B)(iii) (42 U.S.C. 1395i-4(c)(2)(B)(iii)) is amended by striking "for a period not to exceed 96 hours" and all that follows and inserting "for a period that does not exceed, as determined on an annual, average basis, 96 hours per patient;". (2) EFFECTIVE DATE.— The amendment made by paragraph (1) takes effect on the date of the enactment of this Act. (b) PERMITTING FOR-PROFIT HOSPITALS TO QUALIFY FOR DES- IGNATION AS A CRITICAL ACCESS HOSPITAL. —Section 1820(c)(2)(B)(i) (42 U.S.C. 1395i-4(c)(2)(B)(i)) is amended in the matter preceding subclause (I), by striking "nonprofit or public hospital" and inserting "hospital". (c) ALLOWING CLOSED OR DOWNSIZED HOSPITALS TO CONVERT TO CRITICAL ACCESS HOSPITALS.—Section 1820(c)(2) (42 U.S.C. 1395i-4(c)(2)) is amended— (1) in subparagraph (A), by striking "subparagraph (B)" and inserting "subparagraphs (B), (C), and (D)"; and (2) by adding at the end the following new subparagraphs: "(C) RECENTLY CLOSED FACILITIES.— A State may designate a facility as a critical access hospital if the facility— "(i) was a hospital that ceased operations on or after the date that is 10 years before the date of the enactment of this subparagraph; and "(ii) as of the effective date of such designation, meets the criteria for designation under subparagraph (B). "(D) DOWNSIZED FACILITIES. —^A State may designate a health clinic or a health center (as defined by the State) as a critical access hospital if such clinic or center— "(i) is licensed by the State as a health clinic or a health center; "(ii) was a hospital that was downsized to a health clinic or health center; and
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