108 STAT. 4402 PUBLIC LAW 103-432—OCT. 31, 1994 the previous year in which the designation was in effect exceeded 72 hours. In determining the compliance of a facility with the requirement of the previous sentence, there shall not be taken into account periods of stay of inpatients in excess of 72 hours to the extent such periods exceed 72 hours because transfer to a hospital is precluded because of inclement weather or other emergency conditions.". (3) CONFORMING AMENDMENT.— Section 1814(a)(8) (42 U.S.C. 1395fla)(8)) is amended by striking "such services" and all that follows and inserting "the individual may reasonably be expected to be discharged or transferred to a hospital within 72 hours after admission to the rural primary care hospital.". 42 USC l395i-4 (4) GAO REPORTS. — Not later than 2 years after the date ^°^- of the enactment of this Act, the Comptroller General shall submit reports to Congress on— (A) the application of the requirements under section 1820(f) of the Social Security Act (as amended by this subsection) that rural primary care hospitals provide inpatient care only to those individuals whose attending physicians certify may reasonably be expected to be discharged within 72 hours after admission and maintain an average length of inpatient stay during a year that does not exceed 72 hours; and (B) the extent to which such requirements have resulted in such hospitals providing inpatient care beyond their capabilities or have limited the ability of such hospitals to provide needed services. (b) DESIGNATION OF HOSPITALS.— (1) PERMITTING DESIGNATION OF HOSPITALS LOCATED IN URBAN AREAS. — (A) IN GENERAL.— Section 1820 (42 U.S.C. 1395i-4) is amended— (i) by striking paragraph (1) of subsection (e) and redesignating paragraphs (2) through (6) as paragraphs (1) through (5); (ii) in subsection (e)(1)(A) (as redesignated by subparagraph (A))— (I) by striking "is located" and inserting "except in the case of a hospital located in an urban area, is located", (II) by striking ", (ii)" and inserting "or (ii)", and (III) by striking "or (iii)" and all that follows through "section,"; and (iii) in subsection (i)(l)(B), by striking "paragraph (3)" and inserting "paragraph (2)". (B) No CHANGE IN MEDICARE PROSPECTIVE PAYMENT. — Section 1886(d)(5)(D) (42 U.S.C. 1395ww(d)(5)(D)) is amended— (i) in clause (iii)(III), by inserting "located in a rural area and" after "that is", and (ii) in clause (v), by inserting "located in a rural area and" after "in the case of a hospital". (2) PERMITTING HOSPITALS LOCATED IN ADJOINING STATES TO PARTICIPATE IN STATE PROGRAM. — (A) IN GENERAL.— Section 1820 (42 U.S.C. 1395i-4) is amended—
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