113 STAT. 1501A-344 PUBLIC LAW 106-113—APPENDIX F " (H) No EFFECT ON COPAYMENTS. —Nothing in this paragraph shall be construed to affect the unadjusted copayment amount described in paragraph (3)(B) or the copayment amount under paragraph (8). "(I) APPLICATION WITHOUT REGARD TO BUDGET NEU- TRALITY.— The additional payments made under this paragraph— "(i) shall not be considered an adjustment under paragraph (2)(E); and "(ii) shall not be implemented in a budget neutral manner.", (b) EFFECTIVE DATE. —The amendments made by this section shall be effective as if included in the enactment of BBA. SEC. 203. STUDY AND REPORT TO CONGRESS REGARDING THE SPE- CIAL TREATMENT OF RURAL AND CANCER HOSPITALS IN PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUT- PATIENT DEPARTMENT SERVICES. (a) STUDY. — (1) IN GENERAL.—The Medicare Payment Advisory Commission (referred to in this section as "MedPAC") shall conduct a study to determine the appropriateness (and the appropriate method) of providing pa5mrients to hospitals described in paragraph (2) for covered OPD services (as defined in paragraph (1)(B) of section 1833(t) of the Social Security Act (42 U.S.C. 13951(t))) based on the prospective payment system established by the Secretary in accordance with such section. (2) HOSPITALS DESCRIBED.— The hospitals described in this paragraph are the following: (A) A medicare-dependent, small rural hospital (as defined in section 1886(d)(5)(G)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)(iv))). (B) A sole community hospital (as defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))). (C) Rural health clinics (as defined in section 1861(aa)(2) of such Act (42 U.S.C. 1395x(aa)(2)). (D) Rural referral centers (as so classified under section 1886(d)(5)(C) of such Act (42 U.S.C. 1395ww(d)(5)(C)). (E) Any other rural hospital with not more than 100 beds. (F) Any other rural hospital that the Secretary determines appropriate. (G) A hospital described in section 1886(d)(l)(B)(v) of such Act (42 U.S.C. 1395ww(d)(l)(B)(v)). (b) REPORT. — Not later than 2 years after the date of the enactment of this Act, MedPAC shall submit a report to the Secretary of Health and Human Services and Congress on the study conducted under subsection (a), together with any recommendations for legislation that MedPAC determines to be appropriate as a result of such study. (c) COMMENTS. — Not later than 60 days after the date on which MedPAC submits the report under subsection (b) to the Secretary of Health and Human Services, the Secretary shall submit comments on such report to Congress.
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