Page:United States Statutes at Large Volume 124.djvu/507

124 STAT. 481 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(I) the excess (if any) of— ‘‘(aa) the total percentage of the non-elderly insured population for the preceding fiscal year (based on the most recent estimates available from the Director of the Congres- sional Budget Office before a vote in either House on the Patient Protection and Affordable Care Act that, if deter- mined in the affirmative, would clear such Act for enroll- ment); over ‘‘(bb) the total percentage of the non-elderly insured population for such preceding fiscal year (as estimated by the Secretary); exceeds ‘‘(II) 5 percentage points.’’. (b) SKILLED NURSING FACILITIES.—Section 1888(e)(5)(B) of the Social Security Act (42 U.S.C. 1395yy(e)(5)(B)) is amended— (1) by striking ‘‘PERCENTAGE.—The term’’ and inserting ‘‘PERCENTAGE.— ‘‘(i) IN GENERAL.—Subject to clause (ii), the term’’; and (2) by adding at the end the following new clause: ‘‘(ii) ADJUSTMENT.—For fiscal year 2012 and each subsequent fiscal year, after determining the percent- age described in clause (i), the Secretary shall reduce such percentage by the productivity adjustment described in section 1886(b)(3)(B)(xi)(II). The applica- tion of the preceding sentence may result in such percentage being less than 0.0 for a fiscal year, and may result in payment rates under this subsection for a fiscal year being less than such payment rates for the preceding fiscal year.’’. (c) LONG-TERM CARE HOSPITALS.—Section 1886(m) of the Social Security Act (42 U.S.C. 1395ww(m)) is amended by adding at the end the following new paragraphs: ‘‘(3) IMPLEMENTATION FOR RATE YEAR 2010 AND SUBSEQUENT YEARS.— ‘‘(A) IN GENERAL.—In implementing the system described in paragraph (1) for rate year 2010 and each subsequent rate year, any annual update to a standard Federal rate for discharges for the hospital during the rate year, shall be reduced— ‘‘(i) for rate year 2012 and each subsequent rate year, by the productivity adjustment described in sec- tion 1886(b)(3)(B)(xi)(II); and ‘‘(ii) for each of rate years 2010 through 2019, by the other adjustment described in paragraph (4). ‘‘(B) SPECIAL RULE.—The application of this paragraph may result in such annual update being less than 0.0 for a rate year, and may result in payment rates under the system described in paragraph (1) for a rate year being less than such payment rates for the preceding rate year. ‘‘(4) OTHER ADJUSTMENT.— ‘‘(A) IN GENERAL.—For purposes of paragraph (3)(A)(ii), the other adjustment described in this paragraph is— ‘‘(i) for each of rate years 2010 and 2011, 0.25 percentage point; and ‘‘(ii) subject to subparagraph (B), for each of rate years 2012 through 2019, 0.2 percentage point.