\ PUBLIC LAW 103-66—AUG. 10, 1993 107 STAT. 629 that begins after the date of the enactment of this Act. For purposes of the preceding sentence, in the case of a State that has a 2- year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature. (2) The amendments made by this section shall not apply to individuals who died before October 1, 1993. PART in—PAYMENTS SEC. 13621. ASSURING PROPER PAYMENTS TO DISPROPORTIONATE SHARE HOSPITALS. (a) DISPROPORTIONATE SHARE HOSPITALS REQUIRED TO PROVIDE MINIMUM LEVEL OF SERVICES TO MEDICAID PATIENTS.— (1) IN GENERAL.— Section 1923 (42 U.S.C. 1396r-4) is amended— (A) in subsection (a)(l)(A), by striking requirement" and inserting 'Vequirements"; (B) in subsection (b)(D, by striking "requirement" and inserting **requirements"; (C) in the heading to subsection (d), by striking "REQUIREMENT" and inserting "REQUIREMENTS"; (D) by adding at the end of subsection (d) the following new paragraph: "(3) No hospital may be defined or deemed as a disproportionate share hospital under a State plan under this title or under subsection (b) or (e) of this section unless the hospital has a medicaid inpatient utilization rate (as defined in subsection (b)(2)) of not less than 1 percent."; (E) in subsection (e)(l)— (i) by striking "and" before "(B)", and (ii) by inserting before the period at the end the following: ", ^dr (C) the plan meets the requirement of subsectioiv<dX3) and such payment a4justments are made consistent with the last sentence of subsection (c)"; and (F) in subsection (e)(2)— (i) in subparagraph (A), by inserting "(other than the last sentence of subsection (c))" after "(c)", (ii) by striking "and" at the end of subparagraph (A), (iii) by striking the period at the end of subparagraph (B) and inserting ", and", and (iv) by adding at the end the following new subparagraph: "(C) subsection (d)(3) shall apply.". (2) EFFECTIVE DATE.The amendments made by this sub- 42 USC i396r-4 section shall apply to payments to States under section 1903(a) of the Social Security Act for payments to hospitals made under State plans after— (A) the end of the State fiscal year that ends during 1994, or (B) in the case of a State with a State legislature which is not scheduled to have a regular legislative session in 1994, the end of the State fiscal year that ends during 1995; note.
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