Page:United States Statutes at Large Volume 104 Part 2.djvu/449

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PUBLIC LAW 101-508 —NOV. 5, 1990 104 STAT. 1388-41 pitals (as defined in section 1886(d)(l)(B) of the Social Security Act) receive payment for the operating and capital-related costs of inpatient hospital services under part A of the medicare program or a proposal to replace such system with a system under which such payments would be made on the basis of nationally-determined average standardized amounts. In developing any proposal under this paragraph to replace the current system with a prospective payment system, the Secretary shall— (A) take into consideration the need to provide for appropriate limits on increases in expenditures under the medicare program; (B) provide for adjustments to prospectively determined rates to account for changes in a hospital's case mix, severity of illness of patients, volume of cases, and the development of new technologies and standards of medical practice; (C) take into consideration the need to increase the pay- ment otherwise made under such system in the case of services provided to patients whose length of stay or costs of treatment greatly exceed the length of stay or cost of treatment provided for under the applicable prospectively determined payment rate; (D) take into consideration the need to adjust payments under the system to take into account factors such as a disproportionate share of low-income patients, costs related to graduate medical education programs, differences in wages and wage-r6lated costs among hospitals located in various geographic areas, and other factors the Secretary considers appropriate; and (E) provide for the appropriate allocation of operating and capital-related costs of hospitals not subject to the new prospective payment system and distinct units of such hospitals that would be paid under such system. (2) REPORTS. — (A) By not later than April 1, 1992, the Secretary shall submit the proposal developed under paragraph (1) to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. (B) By not later than June 1, 1992, the Prospective Payment Assessment Commission shall submit an analysis of and comments on the proposal developed under paragraph (1) to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. (c) APPEALS OF TARGET AMOUNTS.— (1) DEADUNES FOR REVIEW AND DECISION. —(A) Section 1816(f) (42 U.S.C. 1395h(f)) is amended— (i) by striking "(1)" and "(2)" and inserting "(A)" and "(B)"; (ii) by striking "(f)" and inserting "(f)(1)"; and (iii) by striking "Such standards and criteria" and all that follows and inserting the following: "(2) The standards and criteria established under paragraph (1) shall include— "(A) with respect to claims for services furnished under this part by any provider of services other than a hospital— "(i) whether such agency or organization is able to process 75 percent of reconsiderations within 60 days (except in 39-194O-91- 15:QL3Part2