PUBLIC LAW 103-432—OCT. 31, 1994 108 STAT. 4401 (2) Section 1886(d)(10) (42 U.S.C. 1395ww(d)(10)) is amended— (A) in subparagraph (C)(i)(II), by striking "the area wage index appHcable" and inserting "the factor used to adjust the DRG prospective payment rate for area differences in hospital wage levels that applies"; and (B) in subparagraph (D)— (i) by redesignating clause (ii) as clause (iii), and (ii) by inserting after clause (i) the following new clause: "(ii) Notwithstanding clause (i), if the Secretary uses a method for making adjustments to the DRG prospective payment rate for area differences in hospital wage levels under paragraph (3)(E) that is not based on the use of Metropolitan Statistical Area classifications, the Secretary may revise the guidelines published under clause (i) to the extent such guidelines are used to determine the appropriateness of the geographic area in which the hospital is determined to be located for purposes of making such adjustments.". (c) ADJUSTMENT OF LABOR AND NON-LABOR PORTIONS OF STANDARDIZED AMOUNTS.— Section 1886(d)(3)(A)(iii) (42 U.S.C. 1395ww(d)(3)(A)(iii)) is amended by adding at the end the following: "For discharges occurring on or after October 1, 1994, the Secretary shall adjust the ratio of the labor portion to non-labor portion of each average standardized amount to equal such ratio for the national average of all standardized amounts.". SEC. 102. ESSENTIAL ACCESS COMMUNITY HOSPITAL (EACH) AMENDMENTS. (a) TREATMENT OF INPATIENT HOSPITAL SERVICES PROVIDED IN RURAL PRIMARY CARE HOSPITALS.— (1) IN GENERAI..— Section 1820(f)(1)(F) (42 U.S.C. 13951- 4(f)(1)(F)) is amended to read as follows: "(F) subject to paragraph (4), provides not more than 6 inpatient beds (meeting such conditions as the Secretary may establish) for providing inpatient care to patients requiring stabilization before discharge or transfer to a hospital, except that the facility may not provide any inpatient hospital services— "(i) to any patient whose attending physician does not certify that the patient may reasonably be expected to be discharged or transferred to a hospital within 72 hours of admission to the facility; or "(ii) consisting of surgery or any other service requiring the use of general anesthesia (other than surgical procedures specified by the Secretary under section 1833(i)(l)(A)), unless the attending physician certifies that the risk associated with transferring the patient to a hospital for such services outweighs the benefits of transferring the patient to a hospital for such services.". (2) LIMITATION ON AVERAGE LENGTH OF STAY. —Section 1820(f) (42 U.S.C. 13951-4(0) is amended by adding at the end the following new paragraph: "(4) LIMITATION ON AVERAGE LENGTH OF INPATIENT STAYS. — The Secretary may terminate a designation of a rural primary care hospital under paragraph (1) if the Secretary finds that the average length of stay for inpatients at the facility during
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