105 STAT. 1800 PUBLIC LAW 102-234—DEC. 12, 1991 "(i) in fiscal year 1992 (beginning on or after January 1, 1992), unless— "(I) the payment adjustments are made— "(a) in accordance with the State plan in effect or amendments submitted to the Secretary by September 30, 1991, "(b) in accordance with the State plan in effect or amendments submitted to the Secretary by November 26, 1991, or modification thereof, if the amendment designates only disproportionate share hospitals with a medicaid or low-income utilization percentage at or above the Statewide arithmetic mean, or "(c) in accordance with a payment methodology which was established and in effect as of September 30, 1991, or in accordance with legislation or regulations enacted or adopted as of such date; or "(II) the payment adjustments are the minimum adjustments required in order to meet the requirements of subsection (c)(1); or "(ii) in a subsequent fiscal year, to the extent that the total of such payment adjustments exceeds the State disproportionate share hospital (in this subsection referred to as 'DSH') allotment for the year (as specified in paragraph (2)). "(B) NATIONAL DSH PAYMENT LIMIT. —The national DSH payment limit for a fiscal year is equal to 12 percent of the total amount of expenditures under State plans under this title for medical assistance during the fiscal year. "(C) PUBLICATION OF STATE DSH ALLOTMENTS AND NA- TIONAL DSH PAYMENT LIMIT.—Before the beginning of each fiscal year (beginning with fiscal year 1993), the Secretary shall, consistent with section 1903(d), estimate and publish— "(i) the national DSH payment limit for the fiscal year, and "(ii) the State DSH allotment for each State for the year. " (D) CONDITIONAL EXCEPTION FOR CERTAIN STATES. —Subject to subparagraph (E), beginning with payments for quarters beginning on or after January 1, 1996, and at the option of a State, subparagraph (A) shall not apply in the case of a State which defines a hospital as a disproportionate share hospital under subsection (a)(1) only if the hospital meets any of the following requirements: "(i) The hospital's medicaid inpatient utilization rate (as defined in subsection (b)(2)) is at or above the mean medicaid inpatient utilization rate for all hospitals in the State. "(ii) The hospital's low-income utilization rate (as defined in subsection (b)(3)) is at or above the mean lowincome utilization rate for all hospitals in the State, "(iii) The number of inpatient days of the hospital attributable to patients who (for such days) were eligible for medical assistance under the State plan is
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