PUBLIC LAW 98-21 —APR. 20, 1983 97 STAT. 155 tion (a) by regulation; and the term 'rural area* means any area outside such an area or similar area. "(E) REDUCING FOR VALUE OF OUTUER PAYMENTS.— The Secre- tary shall reduce each of the average standardized amounts determined under subparagraph (D) by a proportion equal to the proportion (estimated by the Secretary) of the amount of payments under this subsection based on DRG prospective pay- ment rates which are additional payments described in para- graph (5)(A) (relating to outlier payments). "(F) MAINTAINING BUDGET NEUTRAUTY. — The Secretary shall adjust each of such average standardized amounts as may be required under subsection (e)(l)(B) for that fiscal year. (G) COMPUTING DRG-SPECIFIC RATES FOR URBAN AND RURAL HOSPITALS IN THE UNITED STATES AND IN EACH REGION.— For each discharge classified within a diagnosis-related group, the Secre- tary shall establish a national DRG prospective payment rate and shall establish a regional DRG prospective payment rate for each re^on, each of which is equal—
- Xi) for hospitals located in an urban area in the United
States or that region (respectively), to the product of— "(I) the average standardized amount (computed under subparagraph (D), reduced under subparagraph (E), and adjusted under subparagraph (F)) for hospitals located in an urban area in the United States or that region, and (II) the weighting factor (determined under para- graph (4)(B)) for that diagnosis-related group; and "(ii) for hospitals located in a rural area in the United States or that region (respectively), to the product of— "(I) the average standardized amount (computed under subparagraph (D), reduced under subparagraph (E), and adjusted under subparagraph (F)) for hospitals located in a rural area in the United States or that region, and (II) the weighting factor (determined under para- graph (4)(B)) for that diagnosis-related group. "(H) ADJUSTING FOR DIFFERENT AREA WAGE LEVELS.— The Sec- retary shall adjust the proportion, (as estimated by the Secre- tary from time to time) of hospitals' costs which are attributable to wages and wage-related costs, of the national and regional DRG prospective payment rates computed under subparagraph (G) for area differences in hospital wage levels by a factor (established by the Secretary) reflecting the relative hospital wage level in the geographic area of the hospital compared to the national average hospital wage level. "(3) The Secretary shall determine a national adjusted DRG pros- pective payment rate, for each inpatient hospital discharge in a fiscal year after fiscal year 1984 involving inpatient hospital services of a subsection (d) hospital in the United States, and shall determine a regional adjusted DRG prospective payment rate for such dis- charges in each region for which payment may be made under part A of this title. Each such rate shall be determined for hospitals located in urban or rural areas within the United States and within each such region, respectively, as follows: "(A) UPDATING PREVIOUS STANDARDIZED AMOUNTS.— The Secre- tary shall compute an average standardized amount for hospi- tals located in an urban area and for hospitals located in a rural "Rural area."
�
