107 STAT. 574 PUBLIC LAW 103-66—AUG. 10, 1993 in fiscal year 1993 increased by the applicable percentage increase under subparagraph (B)(iv).". (3) REDUCTION IN FEDERAL PORTION OF CAPITAL PAYMENT RATE.—Section 1886(g)(l)(A) (42 U.S.C. 1395ww(g)(l)(A)) is amended by adding at the end the following new sentence: Tor discharges occurring after September 30, 1993, the Secretary shall reduce by 7.4 percent the unadjusted standard Federal capital payment rate (as described in 42 CFR 412.308(c), as in effect on the date of the enactment of the Omnibus Budget Reconciliation Act of 1993) and shall (for hospital cost reporting periods beginning on or after October 1, 1993) redetermine which payment methodology is applied to the hospital under such system to take into account such reduction.. (b) WAGE INDEX HOLD HARMLESS PROTECTION.— (1) IN GENERAL. —Section 1886(d)(8)(C) (42 U.S.C. 1395ww(d)(8)(C)) is amended by adding at the end the following new clause: "(iv) The application of subparagraph (B) or a decision of the Medicare (xeographic Classification Review Board or of the Secretary under paragraph (1) may not result in a reduction in an urban area's wage index if— "(I) the urban area has a wa^e index below the wage index for rural areas in the State m which it is located; or "(11) the urban area is located in a State that is composed of a single urban area.". 42 USC 1395WW (2) NO STANDARDIZED AMOUNT ADJUSTMENT.—The Sec- "°^- retary of Health and Human Services shall not revise the fiscal year 1992 or fiscal year 1993 standardized amounts pursuant to subsections (d)(3)(B) and (d)(8)(D) of section 1886 of the Social Security Act to account for the amendment made by paragraph (1). 42 USC 1395WW (3) EFFECTIVE DATE.—The amendment made by paragraph "°*®- (1) shall apply to discharges occurring on or after October 1, 1991. (c) TRANSITION FOR HOSPITAL OUTLIER THRESHOLDS.— Section 1886(d)(5)(A) (42 U.S.C. 1395ww(d)(5)(A)) is amended— (1) in clause (i), by striking The Secretary^ and inserting Tor discharges occurring during fiscal years ending on or before September 30, 1997, the Secret«uy; (2) in clause (ii), by striking the period at the end and inserting the following: ", or, for discharges in fiscal years beginning on or after October 1, 1994, exceed the applicable DRG prospective payment rate plus a fixed dollar amount determined b]^ the Secretary."; (3) in clause (iii), by striking "shall approximate" and inserting "shall (except as payments under clause (i) are required to be reduced to take mto account the requirements of clause (v)) approximate"; and (4) by adding at the end the following new clauses: "(v) The Secretary shall provide that— "(I) the day outlier percentage for fiscal year 1995 shall be 75 percent of the day outlier percentage for fiscal year 1994; "(II) the day outlier percentage for fiscal year 1996 shall be 50 percent of the day outlier percentage for fiscal year 1994; and
�
