100 STAT. 1984
PUBLIC LAW 99-509—OCT. 21, 1986 reason of the classifications required by such paragraph or amendment. (4) RURAL SECONDARY SPECIALTY DEMONSTRATION PROJECT.—
Minnesota.
42 USC 1395. 42 USC 1395c.
42 USC 1395WW.
Puerto Rico.
(A) ESTABLISHMENT.—The Secretary of Health and Human Services (in this paragraph referred to as the "Secretary") shall enter into an agreement with Lake Region tK, Hospital and Nursing Home at Fergus Falls, Minnesota, for the purpose of conducting a rural secondary specialty center demonstration project (in this paragraph referred to as the "project") under title XVIII of the Social Security Act. (B) PURPOSE.—The purpose of this project shall be to determine the effect that a modified system of making payments under part A of such title to rural secondary specialty centers would have on— (i) total expenditures under such part, and
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(ii) the access of medicare beneficiaries located in ' ^ rural areas to quality health care. (C) PAYMENTS.—During the period of the demonstration project, payments under part A of such title shall be made under the project on the basis of average standardized ^ amounts computed for urban areas in the region in which the project is conducted, as adjusted by a rural wage index. (D) DURATION.—The project shall be of a maximum duration of three years. (E) REPORTS.—The Secretary shall submit a final report to the Congress on the project not later than six months after the completion of the project. (e) MISCELLANEOUS PROVISIONS.— (1) ANNUAL ADJUSTMENT.—Section 1886(d)(4)(C) of such Act is
amended by striking "in fiscal year 1986 and at least every four fiscal years" and inserting "in fiscal year 1988 and at least annually". (2) CLARIFYING AUTHORITY TO VARY RATES.—Section 1886(e)(4) of such Act is amended by adding at the end the following new sentence: "The percentage change shall be the same for all subsection (d) hospitals and subsection (d) Puerto Rico hospitals, but may be different from that for other hospitals (and units not i " included as such hospitals) and may vary among such other hospitals and units.". (3) NOTICE OF EARLIER PROMULGATION OF PERCENTAGE IN-
Reports.
<: CREASE.—Section 1886(e)(3) of such Act is amended— (A) by inserting "(A)" after "(3)", and (B) by adding at the end the following new subparagraph: "(B) The Secretary, not later than April 1, 1987, for fiscal year 1988 and not later than March 1 before the beginning of each fiscal year (beginning with fiscal year 1989), shall report to the Congress the Secretary's initial estimate of the percentage change that the Secretary will recommend or determine under paragraph (4) with respect to that fiscal year.". (4) EXTENSION OF SOLE COMMUNITY PROVIDER PROVISION.—Sec-
tion 1886(d)(5)(C)(ii) of such Act is amended by striking "1986" and inserting "1988". 42 USC 1395WW note.
(f) PROMULGATION OF N E W RATE.—The Secretary of Health and
Human Services shall provide, within 30 days after the date of the enactment of this Act, for the publication of the payments rates that will apply under section 1886 of the Social Security Act, for dis-
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