117 STAT. 2264
PUBLIC LAW 108–173—DEC. 8, 2003 (2) APPLICATION BASED
ON
LARGE
OF PUERTO RICO STANDARDIZED AMOUNT URBAN AREAS.—Section 1886(d)(9)(C) (42
U.S.C. 1395ww(d)(9)(C)) is amended— (A) in clause (i)— (i) by striking ‘‘(i) The Secretary’’ and inserting ‘‘(i)(I) For discharges in a fiscal year after fiscal year 1988 and before fiscal year 2004, the Secretary’’; and (ii) by adding at the end the following new subclause: ‘‘(II) For discharges occurring in a fiscal year (beginning with fiscal year 2004), the Secretary shall compute an average standardized amount for hospitals located in any area of Puerto Rico that is equal to the average standardized amount computed under subclause (I) for fiscal year 2003 for hospitals in a large urban area (or, beginning with fiscal year 2005, for all hospitals in the previous fiscal year) increased by the applicable percentage increase under subsection (b)(3)(B) for the fiscal year involved.’’; (B) in clause (ii), by inserting ‘‘(or for fiscal year 2004 and thereafter, the average standardized amount)’’ after ‘‘each of the average standardized amounts’’; and (C) in clause (iii)(I), by striking ‘‘for hospitals located in an urban or rural area, respectively’’. (d) IMPLEMENTATION.— (1) IN GENERAL.—The amendments made by subsections (a), (b), and (c)(1) of this section shall have no effect on the authority of the Secretary, under subsection (b)(2) of section 402 of Public Law 108–89, to delay implementation of the extension of provisions equalizing urban and rural standardized inpatient hospital payments under subsection (a) of such section 402. (2) APPLICATION OF PUERTO RICO STANDARDIZED AMOUNT BASED ON LARGE URBAN AREAS.—The authority of the Secretary referred to in paragraph (1) shall apply with respect to the amendments made by subsection (c)(2) of this section in the same manner as that authority applies with respect to the extension of provisions equalizing urban and rural standardized inpatient hospital payments under subsection (a) of such section 402, except that any reference in subsection (b)(2)(A) of such section 402 is deemed to be a reference to April 1, 2004. SEC. 402. ENHANCED DISPROPORTIONATE SHARE HOSPITAL (DSH) TREATMENT FOR RURAL HOSPITALS AND URBAN HOSPITALS WITH FEWER THAN 100 BEDS.
(a) DOUBLING THE CAP.—Section 1886(d)(5)(F) (42 U.S.C. 1395ww(d)(5)(F)) is amended by adding at the end the following new clause: ‘‘(xiv)(I) In the case of discharges occurring on or after April 1, 2004, subject to subclause (II), there shall be substituted for the disproportionate share adjustment percentage otherwise determined under clause (iv) (other than subclause (I)) or under clause (viii), (x), (xi), (xii), or (xiii), the disproportionate share adjustment percentage determined under clause (vii) (relating to large, urban hospitals). ‘‘(II) Under subclause (I), the disproportionate share adjustment percentage shall not exceed 12 percent for a hospital that is not classified as a rural referral center under subparagraph (C).’’.
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