PUBLIC LAW 98-21—APR. 20, 1983 97 STAT. 167 for inpatient hospital services on a prospective basis as under such section; (iii) the appropriateness of the factors used under paragraph (5)(A) of such section to compensate hospitals for the additional expenses of outlier cases, and the application of severity of illness, intensity of care, or other modifications to the diagnosis- related groups, and the advisability and feasibility of providing for such modifications; (iv) the feasibility and desirability of applying the payment methodology under such section to payment by all payors for inpatient hospital services; and (v) the impact of such section on hospital admissions and the feasibility of making a volume adjustment in the DRG prospec- tive payment rates or requiring preadmission certification in order to minimize the incentive to increase admissions. Such report shall specifically include, with respect to the item described in clause (iv), consideration of the extent of cost-shifting to non-Federal payors and the impact of such cost-shifting on health insurance costs and premiums borne by employers and employees. (D) In the annual report to Congress under subparagraph (A) for 1986, the Secretary shall include the results of a study examining the overall impact of State systems of hospital payment (either approved under section 1886(c) of the Social Security Act or under a waiver approved under section 402(a) of the Social Security Amend- ments of 1967 or section 222(a) of the Social Security Amendments of 1972), particularly assessing such systems' impact not only on the medicare program but also on the medicaid program, on payments and premiums under private health insurance plans, and on tax expenditures. (3)(A) The Secretary shall complete a study and make legislative recommendations to the Congress with respect to an equitable method of reimbursing sole community hospitals which takes into account their unique vulnerability to substantial variations in occupancy. (B) In addition, the Secretary shall examine ways to coordinate an information transfer between parts A and B of title XVIII of the Social Security Act, particularly with respect to those cases where a denial of coverage is made under part A of such title and no adjustment is made in the reimbursement to the admitting physi- cian or physicians. (C) The Secretary shall also report on the appropriate treatment of uncompensated care costs, and adjustments that might be appro- priate for large teaching hospitals located in rural areas. (D) The Secretary shall also report on the advisability of having hospitals make available information on the cost of care to patients financed by both public programs and private payors. (E) The studies and reports described in this paragraph shall be completed and submitted not later than April 1, 1985. (4) The Secretary shall complete a study and make recommenda- tions to the Congress, before April 1, 1984, with respect to a method for including hospitals located outside of the fifty States and the District of Columbia under a prospective payment system. (b)(1) Except as provided in paragraph (2), the amendments made by this title shall not affect the authority of the Secretary to develop, carry out, or continue experiments and demonstration projects. 96 Stat. 331. 42 USC 1395WW. 42 USC 1395b-l. 42 USC 1395b-l note. Study and recommendations. 42 USC 1395c, 1395J. Study and recommendations. Effective date. 42 USC 1395b-l note.
�
