PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 401 SEC. 4407. CERTAIN HOSPITAL DISCHARGES TO POST ACUTE CARE. Section 1886(d)(5) (42 U.S.C. 1395ww(d)(5)) is amended— (1) in subparagraph (I)(ii) by inserting "not taking in account the effect of subparagraph (J)," after "in a fiscal year, "; and (2) by adding at the end the following new subparagraph: "(J)(i) The Secretary shall treat the term 'transfer case' (as defined in subparagraph (I)(ii)) as including the case of a qualified discharge (as defined in clause (ii)), which is classified within a diagnosis-related group described in clause (iii), and which occurs on or after October 1, 1998. In the case of a qualified discharge for which a substantial portion of the costs of care are incurred in the early days of the inpatient stay (as defined by the Secretary), in no case may the payment amount otherwise provided under this subsection exceed an amount equal to the sum of— "(I) 50 percent of the amount of payment under this subsection for transfer cases (as established under subparagraph (I)(i)),and "(II) 50 percent of the amount of payment which would have been made under this subsection with respect to the qualified discharge if no transfer were involved, "(ii) For purposes of clause (i), subject to clause (iii), the term 'qualified discharge' means a discharge classified with a diagnosisrelated group (described in clause (iii)) of an individual from a subsection (d) hospital, if upon such discharge the individual— "(I) is admitted as an inpatient to a hospital or hospital unit that is not a subsection (d) hospital for the provision of inpatient hospital services; "(II) is admitted to a skilled nursing facility; "(III) is provided home health services from a home health agency, if such services relate to the condition or diagnosis for which such individual received inpatient hospital services from the subsection (d) hospital, and if such services are provided within an appropriate period (as determined by the Secretary); or "(IV) for discharges occurring on or after October 1, 2000, the individual receives post discharge services described in clause (iv)(I). "(iii) Subject to clause (iv), a diagnosis-related group described in this clause is— "(I) 1 of 10 diagnosis-related groups selected by the Secretary based upon a high volume of discharges classified within such groups and a disproportionate use of post discharge services described in clause (ii); and "(II) a diagnosis-related group specified by the Secretary under clause (iv)(II). "(iv) The Secretary shall include in the proposed rule published under subsection (e)(5)(A) for fiscal year 2001, a description of the effect of this subparagraph. The Secretary may include in the proposed rule (and in the final rule published under paragraph (6)) for fiscal year 2001 or a subsequent fiscal year, a description of— "(I) post-discharge services not described in subclauses (I), (II), and (III) of clause (ii), the receipt of which results in a qualified discharge; and "(II) diagnosis-related groups described in clause (iii)(I) in addition to the 10 selected under such clause.".
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