Page:United States Statutes at Large Volume 124.djvu/435

124 STAT. 409 PUBLIC LAW 111–148—MAR. 23, 2010 a medicare-dependent, small rural hospital (with respect to discharges occurring during fiscal years 2012 and 2013) or a sole community hospital, in applying subparagraph (A)(i), the payment amount that would otherwise be made under subsection (d) shall be deter- mined without regard to subparagraphs (I) and (L) of subsection (b)(3) and subparagraphs (D) and (G) of subsection (d)(5). ‘‘(ii) HOSPITALS PAID UNDER SECTION 1814.—In the case of a hospital that is paid under section 1814(b)(3), the Secretary may exempt such hospitals provided that States paid under such section submit an annual report to the Secretary describing how a similar program in the State for a participating hospital or hospitals achieves or surpasses the measured results in terms of patient health outcomes and cost savings established herein with respect to this section. ‘‘(3) ADJUSTMENT FACTOR.— ‘‘(A) IN GENERAL.—For purposes of paragraph (1), the adjustment factor under this paragraph for an applicable hospital for a fiscal year is equal to the greater of— ‘‘(i) the ratio described in subparagraph (B) for the hospital for the applicable period (as defined in paragraph (5)(D)) for such fiscal year; or ‘‘(ii) the floor adjustment factor specified in subparagraph (C). ‘‘(B) RATIO.—The ratio described in this subparagraph for a hospital for an applicable period is equal to 1 minus the ratio of— ‘‘(i) the aggregate payments for excess readmis- sions (as defined in paragraph (4)(A)) with respect to an applicable hospital for the applicable period; and ‘‘(ii) the aggregate payments for all discharges (as defined in paragraph (4)(B)) with respect to such applicable hospital for such applicable period. ‘‘(C) FLOOR ADJUSTMENT FACTOR.—For purposes of subparagraph (A), the floor adjustment factor specified in this subparagraph for— ‘‘(i) fiscal year 2013 is 0.99; ‘‘(ii) fiscal year 2014 is 0.98; or ‘‘(iii) fiscal year 2015 and subsequent fiscal years is 0.97. ‘‘(4) AGGREGATE PAYMENTS, EXCESS READMISSION RATIO DEFINED.—For purposes of this subsection: ‘‘(A) AGGREGATE PAYMENTS FOR EXCESS READMIS- SIONS.—The term ‘aggregate payments for excess readmis- sions’ means, for a hospital for an applicable period, the sum, for applicable conditions (as defined in paragraph (5)(A)), of the product, for each applicable condition, of— ‘‘(i) the base operating DRG payment amount for such hospital for such applicable period for such condi- tion; ‘‘(ii) the number of admissions for such condition for such hospital for such applicable period; and ‘‘(iii) the excess readmissions ratio (as defined in subparagraph (C)) for such hospital for such applicable period minus 1. Reports. Deadline.