1426
PUBLIC LAW 92-603-OCT. 30, 1972
[86 STAT.
after discharge from such hospital, or (B) within 28 days after such discharge, in the case of an individual who was unable to be admitted to a skilled nursing facility within such 14 days because of a shortage of appropriate bed space m the geographic area in which he resides, or (^C) within such time as it would be medically appropriate to begin an active course of treatment, in the case of an individual whose condition is such that skilled nursing facility care would not be medically appropriate within 14 days after discharge from a hospital;" REIMBURSEMENT RATES FOR SKILLED N U R S I N G A N D INTERMEDIATE CARE FACILITIES
SEC. 249. (a) Section 1902(a) (13) of the Social Security Act, as Ante, p. 1410. amended by section 221(c)(5) of this Act, is further amended— (1) by inserting "and" at the end of subparagraph (D), and (2) by inserting after subparagraph (D) the following new paragraph: " (E) effective July 1, 1976, for payment of the skilled nursing facility and intermediate care facility services provided under the plan on a reasonable cost related basis, as determined in accordance with methods and standards which shall be developed by the State on the basis of cost-finding methods approved and verified by the Secretary;". (b) Section 1861(v)(l) of such Act, as amended by sections 223 Ante, p. 1405. ^nd 227 of this Act, is further amended by inserting after subparagraph (D) the following new subparagraph: " (E) Such regulations may, in the case of skilled nursing facilities in any State, provide for the uses of rates, developed by the State in which such facilities are located, for the payment of the cost of skilled nursing facility services furnished under the State's plan approved 42 USC 1396. under title X IX (and such rates may be increased by the Secretary on a class or size of institution or on a geographical basis by a percentage factor not in excess of 10 percent to take into account determinable items or services or other requirements under this title not otherwise included in the computation of such State rates), if the Secretary finds that such rates are reasonably related to (but not necessarily limited to) analyses undertaken by such State of costs of care in comparable facilities in such State; except that the foregoing provisions of this subparagraph shall not apply to any skilled nursing facility in such State if— " (i) such facility is a distinct part of or directly operated by a hospital, or "(ii) such facility operates in a close, formal satellite relationship (as defined in regulations of the Secretary) with a participating hospital or hospitals. Xotwithstanding the previous provisions of this paragraph in the case of a facility specified in clause (ii) of this subparagraph, the reasonable cost or any services furnished by such facility as determined by the Secretary under this subsection shall not exceed 150 percent of the costs determined by the application of this subparagraph (without regard to such clause (ii)).". MEDICAID CERTIFICATION A N D APPROVAL OF SKILLED NURSING FACILITIES
SEC. 249A. (a) Title X IX of the Social Security Act is amended by adding at the end thereof (after the new section 1909 added by Ante, p. 1420. ^\^\^ Act) the following new section:
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