107 STAT. 630 PUBLIC LAW 103-66—AUG. 10, 1993 without regard to whether or not final regulations to carry out such amendments have been promulgated by either such date. (b) LIMITING AMOUNT OF HOSPITAL PAYMENT ADJUSTMENT TO UNCOVERED COSTS. — (1) IN GENERAL. —Section 1923 (42 U.S.C. 1396r-4) is amended by adding at the end the following new subsection: "(g) LIMIT ON AMOUNT OF PAYMENT TO HOSPITAL. — "(1) AMOUNT OP ADJUSTMENT SUBJECT TO UNCOMPENSATED COSTS. — "(A) IN GENERAL. —^A payment adjustment during a fiscal year shall not be considered to be consistent with subsection (c) with respect to a hospital if the payment adjustment exceeds the costs incurred during the year of furnishing hospital services (as determined by the Secretary and net of payments under this title, other than under this section, and by iminsiired patients) by the hospital to individuals who either are eligible for medical assistance under the State plan or have no health insurance (or other source of third party coverage) for services provided during the year. For purposes of the preceding sentence, payments made to a hospital for services provided to indigent patients made by a State or a imit of local government within a State shall not be considered to be a source of third party payment. "(B) LIMIT TO PUBLIC HOSPITALS DURING TRANSITION PERIOD.—With respect to payment adjustments during a State fiscal year that begins before January 1, 1995, subparagraph (A) shall apply only to hospitals owned or operated by a State (or by an instrumentality or a unit of government within a State). "(C) MODIFICATIONS FOR PRIVATE HOSPITALS. —With respect to hospitals that are not owned or operated by a State (or by an instrumentality or a imit of government within a State), the Secretary may make such modifications to the manner in which the limitation on payment adjustments is applied to such hospitals as the Secretary considers appropriate. "(2) ADDITIONAL AMOUNT DURING TRANSITION PERIOD FOR CERTAIN HOSPITALS WITH HIGH DISPROPORTIONATE SHARE. — "(A) IN GENERAL. — In the case of a hospital with high disproportionate share (as defined in subparagraph (B)), a payment adjustment during a State fiscal year that begins before January 1, 1995, shall be considered consistent with subsection (c) if the payment adjustment does not exceed 200 percent of the costis of fiunishing hospital services described in paragraph (I)(A) during the year, but only if the Governor of the State certifies to the satisfaction of the Secretary that the hospitel's applicable minimum amount is used for health services during the year. In determining the amount that is used for such services during a year, there shall be excluded any amounts received under the Public Health Service Act, title V, title XVIII, or fix)m third party payors (not including the State plan under this title) that are used for providing such services during the year.
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