§ 1395ww. Payments to hospitals for inpatient hospital services

Section 302 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, referred to in subsec. (d)(2)(C)(i), is section 1(a)(6) [title III, § 302] of Pub. L. 106–554, which amended this section and enacted provisions set out as a note under this section.

Section 6003(c) of the Omnibus Budget Reconciliation Act of 1989, referred to in subsec. (d)(2)(C)(iv), is section 6003(c) of Pub. L. 101–239, which amended this section and enacted provisions set out below.

Section 4002(b) of the Omnibus Budget Reconciliation Act of 1990, referred to in subsec. (d)(2)(C)(iv), is section 4002(b) of Pub. L. 101–508, which amended this section and enacted provisions set out below.

Section 303 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, referred to in subsec. (d)(2)(C)(iv), is section 1(a)(6) [title III, § 303] of Pub. L. 106–554, which amended this section and enacted provisions set out as notes under this section.

Section 9104 of the Medicare and Medicaid Budget Reconciliation Amendments of 1985, referred to in subsec. (d)(3)(C)(ii), is section 9104 of Pub. L. 99–272, which amended subsec. (d)(2)(C)(i), (3)(C), (D)(i)(I), (ii)(I), and (5)(B) of this section.

Section 4003(a)(1) of the Omnibus Budget Reconciliation Act of 1987, referred to in subsec. (d)(3)(C)(ii), is section 4003(a)(1) of Pub. L. 100–203, which amended subsec. (d)(5)(B)(ii) of this section.

The Omnibus Budget Reconciliation Act of 1990, referred to in subsec. (d)(3)(C)(ii), is Pub. L. 101–508, Nov. 5, 1990, 104 Stat. 1388. For complete classification of this Act to the Code, see Tables.

The Patient Protection and Affordable Care Act, referred to in subsecs. (d)(3)(E)(i) and (r)(2)(B)(i)(I), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119. Section 10324(a)(1) of the Act amended this section. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables.

Section 9831(a) of the American Rescue Plan Act of 2021, referred to in subsec. (d)(3)(E)(i), is section 9831(a) of Pub. L. 117–2, which amended subsec. (d)(3)(E)(i), (iv) of this section.

Section 9304 of the Omnibus Budget Reconciliation Act of 1986, referred to in subsec. (e)(1)(C)(ii), is section 9304 of Pub. L. 99–509, which enacted subsecs. (d)(9) and (e)(1)(C) of this section and amended subsec. (d)(5)(C)(i)(I), (ii) of this section.

Section 4628 of the Balanced Budget Act of 1997, referred to in subsec. (h)(6)(C)(iii), is section 4628 of Pub. L. 105–33, which is set out as a note below.

Section 402 of Public Law 90–248, referred to in subsec. (h)(7)(B)(vi), (8)(A)(ii)(II), is section 402 of Pub. L. 90–248, title IV, Jan. 2, 1968, 81 Stat. 930, which enacted section 1395b–1 of this title and amended section 1395ll of this title.

Such section 332(a)(1)(A), referred to in subsec. (h)(8)(D)(ii)(I), probably means section 332(a)(1)(A) of the Public Health Service Act, which is classified to section 254e(a)(1)(A) of this title.

Section 4005(e) of the Omnibus Budget Reconciliation Act of 1987, referred to in subsec. (i), is section 4005(e) of Pub. L. 100–203, which is set out below.

Section 123 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, referred to in subsec. (m)(1), is section 1000(a)(6) [title I, § 123] of Pub. L. 106–113, which enacted provisions set out as a note under this section.

Section 307(b) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, referred to in subsec. (m)(1), is section 1(a)(6) [title III, § 307(b)] of Pub. L. 106–554, which enacted provisions set out as a note under this section.

The Health Care and Education Reconciliation Act of 2010, referred to in subsec. (r)(2)(B)(i)(I), is Pub. L. 111–152, Mar. 30, 2010, 124 Stat. 1029. For complete classification of this Act to the Code, see Short Title of 2010 Amendment note set out under section 1305 of this title and Tables.

Section 124 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, referred to in subsec. (s)(1), (5)(D)(i), (6)(A), is section 1000(a)(6) [title I, § 124] of Pub. L. 106–113, which enacted provisions set out as a note under this section.

Amendments

2025—Subsec. (b)(3)(D). Pub. L. 119–37, § 6202(b)(1)(A), substituted “January 31, 2026” for “October 1, 2025” in introductory provisions.

Pub. L. 119–4, § 2202(b)(1)(A), substituted “October 1, 2025” for “April 1, 2025” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 119–37, § 6202(b)(1)(B), inserted “and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026” after “through fiscal year 2025”.

Pub. L. 119–4, § 2202(b)(1)(B), substituted “2025” for “2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025”.

Subsec. (d)(5)(G)(i). Pub. L. 119–37, § 6202(a)(1), substituted “January 31, 2026” for “October 1, 2025”.

Pub. L. 119–4, § 2202(a)(1), substituted “October 1, 2025” for “April 1, 2025”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 119–37, § 6202(a)(2), substituted “January 31, 2026” for “October 1, 2025”.

Pub. L. 119–4, § 2202(a)(2), substituted “October 1, 2025” for “April 1, 2025”.

Subsec. (d)(12)(B). Pub. L. 119–37, § 6201(a)(1), substituted “during the portion of fiscal year 2026 beginning on January 31, 2026, and ending on September 30, 2026, and in fiscal year 2027” for “in fiscal year 2026” in introductory provisions.

Pub. L. 119–4, § 2201(a)(1), struck out “during the portion of fiscal year 2025 beginning on April 1, 2025, and ending on September 30, 2025, and” after “occurring” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 119–37, § 6201(a)(2)(A), in introductory provisions, inserted “or portion of a fiscal year” after “for a fiscal year” and “and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026” after “through 2025”.

Pub. L. 119–4, § 2201(a)(2)(A), in introductory provisions, struck out “or portion of a fiscal year” after “for a fiscal year” and substituted “2025” for “2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025”.

Subsec. (d)(12)(C)(i)(III). Pub. L. 119–37, § 6201(a)(2)(B), inserted “and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026” after “through 2025”.

Pub. L. 119–4, § 2201(a)(2)(B), substituted “2025” for “2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025”.

Subsec. (d)(12)(C)(i)(IV). Pub. L. 119–37, § 6201(a)(2)(C), substituted “the portion of fiscal year 2026 beginning on January 31, 2026, and ending on September 30, 2026, and fiscal year 2027” for “fiscal year 2026”.

Pub. L. 119–4, § 2201(a)(2)(C), struck out “the portion of fiscal year 2025 beginning on April 1, 2025, and ending on September 30, 2025, and” before “fiscal year 2026”.

Subsec. (d)(12)(D). Pub. L. 119–37, § 6201(a)(3)(A), inserted “or during the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026” after “through 2025” in introductory provisions.

Pub. L. 119–4, § 2201(a)(3)(A), substituted “2025” for “2024 or during the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025” in introductory provisions.

Subsec. (d)(12)(D)(ii). Pub. L. 119–37, § 6201(a)(3)(B), inserted “and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026” after “through 2025”.

Pub. L. 119–4, § 2201(a)(3)(B), substituted “2025” for “2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025”.

2024—Subsec. (b)(3)(D). Pub. L. 118–158, § 3202(b)(1)(A), substituted “April 1, 2025” for “January 1, 2025” in introductory provisions.

Pub. L. 118–42, § 307(b)(1)(A), substituted “January 1, 2025” for “October 1, 2024” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 118–158, § 3202(b)(1)(B), substituted “March 31, 2025” for “December 31, 2024”.

Pub. L. 118–42, § 307(b)(1)(B), inserted “and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024,” after “fiscal year 2024”.

Subsec. (d)(5)(G)(i). Pub. L. 118–158, § 3202(a)(1), substituted “April 1, 2025” for “January 1, 2025”.

Pub. L. 118–42, § 307(a)(1), substituted “January 1, 2025” for “October 1, 2024”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 118–158, § 3202(a)(2), substituted “April 1, 2025” for “January 1, 2025”.

Pub. L. 118–42, § 307(a)(2), substituted “January 1, 2025” for “October 1, 2024”.

Subsec. (d)(12)(B). Pub. L. 118–158, § 3201(a)(1), substituted “April 1, 2025” for “January 1, 2025” in introductory provisions.

Pub. L. 118–42, § 306(a)(1), substituted “during the portion of fiscal year 2025 beginning on January 1, 2025, and ending on September 30, 2025, and in fiscal year 2026 and subsequent fiscal years” for “in fiscal year 2025 and subsequent fiscal years” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 118–158, § 3201(a)(2)(A), substituted “March 31, 2025” for “December 31, 2024” in introductory provisions.

Pub. L. 118–42, § 306(a)(2)(A), inserted “or portion of a fiscal year” after “for a fiscal year” and “and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “through 2024” in introductory provisions.

Subsec. (d)(12)(C)(i)(III). Pub. L. 118–158, § 3201(a)(2)(B), substituted “March 31, 2025” for “December 31, 2024”.

Pub. L. 118–42, § 306(a)(2)(B), inserted “and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “through 2024”.

Subsec. (d)(12)(C)(i)(IV). Pub. L. 118–158, § 3201(a)(2)(C), substituted “April 1, 2025” for “January 1, 2025”.

Pub. L. 118–42, § 306(a)(2)(C), substituted “the portion of fiscal year 2025 beginning on January 1, 2025, and ending on September 30, 2025, and fiscal year 2026” for “fiscal year 2025”.

Subsec. (d)(12)(D). Pub. L. 118–158, § 3201(a)(3)(A), substituted “March 31, 2025” for “December 31, 2024” in introductory provisions.

Pub. L. 118–42, § 306(a)(3)(A), inserted “or during the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “through 2024” in introductory provisions.

Subsec. (d)(12)(D)(ii). Pub. L. 118–158, § 3201(a)(3)(B), substituted “March 31, 2025” for “December 31, 2024”.

Pub. L. 118–42, § 306(a)(3)(B), inserted “and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “through 2024”.

2023—Subsec. (j)(7)(E). Pub. L. 117–341 designated existing provisions as cl. (i), inserted heading, and added cls. (ii) to (vii).

2022—Subsec. (b)(3)(D). Pub. L. 117–328, § 4102(b)(1)(A), substituted “October 1, 2024” for “December 24, 2022” in introductory provisions.

Pub. L. 117–229, § 102(b)(1)(A), substituted “December 24, 2022” for “December 17, 2022” in introductory provisions.

Pub. L. 117–180, § 102(b)(1)(A), substituted “December 17, 2022” for “October 1, 2022” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 117–328, § 4102(b)(1)(B), substituted “fiscal year 2024” for “fiscal year 2022 and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022,”.

Pub. L. 117–229, § 102(b)(1)(B), substituted “December 23, 2022” for “December 16, 2022,”.

Pub. L. 117–180, § 102(b)(1)(B), inserted “and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 16, 2022,” after “through fiscal year 2022”.

Subsec. (d)(5)(B)(v). Pub. L. 117–328, § 4122(b)(1), substituted “(h)(9), and (h)(10)” for “and (h)(9)”.

Subsec. (d)(5)(B)(xii). Pub. L. 117–328, § 4122(b)(2), realigned margins.

Subsec. (d)(5)(B)(xiii). Pub. L. 117–328, § 4122(b)(3), added cl. (xiii).

Subsec. (d)(5)(G)(i). Pub. L. 117–328, § 4102(a)(1), substituted “October 1, 2024” for “December 24, 2022”.

Pub. L. 117–229, § 102(a)(1), substituted “December 24, 2022” for “December 17, 2022”.

Pub. L. 117–180, § 102(a)(1), substituted “December 17, 2022” for “October 1, 2022”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 117–328, § 4102(a)(2), substituted “October 1, 2024” for “December 24, 2022”.

Pub. L. 117–229, § 102(a)(2), substituted “December 24, 2022” for “December 17, 2022”.

Pub. L. 117–180, § 102(a)(2), substituted “December 17, 2022” for “October 1, 2022”.

Subsec. (d)(12)(B). Pub. L. 117–328, § 4101(a)(1), substituted “in fiscal year 2025” for “during the portion of fiscal year 2023 beginning on December 24, 2022, and ending on September 30, 2023, and in fiscal year 2024” in introductory provisions.

Pub. L. 117–229, § 101(a)(1), substituted “December 24, 2022” for “December 17, 2022” in introductory provisions.

Pub. L. 117–180, § 101(a)(1), substituted “during the portion of fiscal year 2023 beginning on December 17, 2022, and ending on September 30, 2023, and in fiscal year 2024 and subsequent fiscal years” for “in fiscal year 2023 and subsequent fiscal years” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 117–328, § 4101(a)(2)(A)(ii), which directed the substitution of “through 2024” for “through 2022 and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022’ ” in introductory provisions, was executed by making the substitution for “through 2022 and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022”, to reflect the probable intent of Congress.

Pub. L. 117–328, § 4101(a)(2)(A)(i), struck out “or portion of a fiscal year” after “for a fiscal year” in introductory provisions.

Pub. L. 117–229, § 101(a)(2)(A), substituted “December 23, 2022” for “December 16, 2022” in introductory provisions.

Pub. L. 117–180, § 101(a)(2)(A), inserted “or portion of a fiscal year” after “for a fiscal year” and “and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 16, 2022” after “through 2022” in introductory provisions.

Subsec. (d)(12)(C)(i)(III). Pub. L. 117–328, § 4101(a)(2)(B), which directed the substitution of “through 2024” for “through 2022 and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022’ ”, was executed by making the substitution for “through 2022 and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022”, to reflect the probable intent of Congress.

Pub. L. 117–229, § 101(a)(2)(B), which directed the substitution of “December 23, 2022” for “December 16, 2022’ ”, was executed by making the substitution for “December 16, 2022” to reflect the probable intent of Congress.

Pub. L. 117–180, § 101(a)(2)(B), inserted “and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 16, 2022” after “through 2022”.

Subsec. (d)(12)(C)(i)(IV). Pub. L. 117–328, § 4101(a)(2)(C), substituted “fiscal year 2025” for “the portion of fiscal year 2023 beginning on December 24, 2022, and ending on September 30, 2023, and fiscal year 2024”.

Pub. L. 117–229, § 101(a)(2)(C), substituted “December 24, 2022” for “December 17, 2022”.

Pub. L. 117–180, § 101(a)(2)(C), substituted “the portion of fiscal year 2023 beginning on December 17, 2022, and ending on September 30, 2023, and fiscal year 2024” for “fiscal year 2023”.

Subsec. (d)(12)(D). Pub. L. 117–328, § 4101(a)(3)(A), which directed the substitution of “through 2024” for “through 2022 or during the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022’ ” in introductory provisions, was executed by making the substitution for “through 2022 or during the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022”, to reflect the probable intent of Congress.

Pub. L. 117–229, § 101(a)(3)(A), which directed the substitution of “December 23, 2022” for “December 16, 2022’ ” in introductory provisions, was executed by making the substitution for “December 16, 2022” to reflect the probable intent of Congress.

Pub. L. 117–180, § 101(a)(3)(A), inserted “or during the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 16, 2022” after “through 2022” in introductory provisions.

Subsec. (d)(12)(D)(ii). Pub. L. 117–328, § 4101(a)(3)(B), which directed the substitution of “through 2024” for “through 2022 and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022’ ”, was executed by making the substitution for “through 2022 and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 23, 2022”, to reflect the probable intent of Congress.

Pub. L. 117–229, § 101(a)(3)(B), which directed the substitution of “December 23, 2022” for “December 16, 2022’ ”, was executed by making the substitution for “December 16, 2022” to reflect the probable intent of Congress.

Pub. L. 117–180, § 101(a)(3)(B), inserted “and the portion of fiscal year 2023 beginning on October 1, 2022, and ending on December 16, 2022” after “through 2022”.

Subsec. (h)(3)(D)(iii). Pub. L. 117–328, § 4143(b), inserted at end “In applying the preceding sentence for each of 2010 through 2019, the Secretary shall not take into account any increase in the total amount of such additional payment amounts for such nursing and allied health education for portions of cost reporting periods occurring in the year pursuant to the application of paragraph (2)(B)(ii) of such subsection.”

Subsec. (h)(4)(F)(i). Pub. L. 117–328, § 4122(a)(1), substituted “(9), and (10)” for “and (9)”.

Subsec. (h)(4)(H)(i)(I). Pub. L. 117–328, § 4122(a)(2), substituted “(9), and (10)” for “and (9)”.

Subsec. (h)(7)(E). Pub. L. 117–328, § 4122(c), inserted “paragraph (10),” after “paragraph (8),”.

Subsec. (h)(10). Pub. L. 117–328, § 4122(a)(3), added par. (10).

Subsec. (l)(2)(B). Pub. L. 117–328, § 4143(a), designated existing provisions as cl. (i), inserted heading, substituted “Subject to clause (ii), such ratio” for “Such ratio”, and added cl. (ii).

Subsec. (s)(4)(A)(i). Pub. L. 117–328, § 4125(b)(1)(A), substituted “subparagraphs (C) and (E)” for “subparagraph (C)”.

Subsec. (s)(4)(D)(iv). Pub. L. 117–328, § 4125(c)(1), added cl. (iv).

Subsec. (s)(4)(E). Pub. L. 117–328, § 4125(b)(1)(C), added subpar. (E). Former subpar. (E) redesignated (F).

Subsec. (s)(4)(F). Pub. L. 117–328, § 4125(c)(2), which directed amendment of subpar. (E) by inserting “, including the quality measure of patients’ perspective on care described in subparagraph (D)(iv),” after “shall report quality measures”, was executed by making the insertion in subpar. (F) to reflect the probable intent of Congress and intervening amendment by Pub. L. 117–328, § 4125(b)(1)(B). See below.

Pub. L. 117–328, § 4125(b)(1)(B), (D), redesignated subpar. (E) as (F) and substituted “subparagraphs (C) and (F)” for “subparagraph (C)”.

Subsec. (s)(5). Pub. L. 117–328, § 4125(a), added par. (5).

Subsec. (s)(6). Pub. L. 117–328, § 4125(b)(2), added par. (6).

2021—Subsec. (d)(3)(E)(i). Pub. L. 117–2, § 9831(b), substituted “, the amendments” for “and the amendments” and inserted “, and the amendments made by section 9831(a) of the American Rescue Plan Act of 2021” after “the Patient Protection and Affordable Care Act”.

Pub. L. 117–2, § 9831(a)(1), substituted “, (iii), or (iv)” for “or (iii)”.

Subsec. (d)(3)(E)(iv). Pub. L. 117–2, § 9831(a)(2), added cl. (iv).

2020—Subsec. (d)(4)(C)(iv). Pub. L. 116–136 added cl. (iv).

Subsec. (d)(5)(B)(v). Pub. L. 116–260, § 126(b)(1), substituted “(h)(8), and (h)(9)” for “and (h)(8)”.

Subsec. (d)(5)(B)(viii). Pub. L. 116–260, § 131(c)(1), substituted “paragraphs (2)(F)(iv) and (4)(H) of subsection (h)” for “subsection (h)(4)(H)”.

Subsec. (d)(5)(B)(x), (xi). Pub. L. 116–260, § 126(b)(2), redesignated cl. (x), relating to determining the hospital’s number of full-time equivalent residents, as (xi) and realigned margins.

Subsec. (d)(5)(B)(xii). Pub. L. 116–260, § 126(b)(3), added cl. (xii).

Subsec. (h)(2)(F). Pub. L. 116–260, § 131(a), designated existing provisions as cl. (i) and added cls. (ii) to (v).

Subsec. (h)(4)(F)(i). Pub. L. 116–260, § 126(a)(1), substituted “paragraphs (7), (8), and (9)” for “paragraphs (7) and (8)”.

Subsec. (h)(4)(H)(i). Pub. L. 116–260, § 131(b), designated existing provisions as subcl. (I) and added subcls. (II) to (V).

Pub. L. 116–260, § 126(a)(2), substituted “paragraphs (7), (8), and (9)” for “paragraphs (7) and (8)”.

Subsec. (h)(4)(H)(iv). Pub. L. 116–260, § 127, substituted “Training programs in rural areas” for “Nonrural hospitals operating training programs in rural areas” in heading, designated existing provisions as subcl. (I), inserted heading, and substituted “For cost reporting periods beginning before October 1, 2022, in the case of” for “In the case of”, and added subcl. (II). Substitution in cl. (iv) heading was executed by striking “hospitals” instead of “hospital” as directed, to reflect the probable intent of Congress.

Subsec. (h)(4)(H)(iv)(I). Pub. L. 116–260, § 131(c)(2)(A), substituted “a rural area or has” for “an rural area or has”.

Subsec. (h)(7)(E). Pub. L. 116–260, § 131(c)(2)(B), substituted “under this paragraph, paragraph (8), clause (i), (ii), (iii), or (v) of paragraph (2)(F), or clause (i) or (vi) of paragraph (4)(H).” for “under this this paragraph, paragraph (8), paragraph (9), or paragraph (4)(H)(vi).”

Pub. L. 116–260, § 126(a)(3), (c), which amended subpar. (E) identically by inserting “paragraph (9),” after “paragraph (8),”, was effectively undone by the subsequent amendment made by Pub. L. 116–260, § 131(c)(2)(B). See above.

Subsec. (h)(9). Pub. L. 116–260, § 126(a)(4), added par. (9).

2019—Subsec. (a)(4). Pub. L. 116–94, § 108(1), in introductory provisions, inserted “for cost reporting periods beginning on or after October 1, 2020, costs related to hematopoietic stem cell acquisition for the purpose of an allogeneic hematopoietic stem cell transplant (as described in subsection (d)(5)(M)),” after “October 1, 1987),”.

Subsec. (d)(4)(C)(iii). Pub. L. 116–94, § 108(2)(A), inserted “or payments under paragraph (5)(M) (beginning with fiscal year 2021)” after “fiscal year 1991)” and “or payments under paragraph (5)(M)” before period at end.

Subsec. (d)(5)(M). Pub. L. 116–94, § 108(2)(B), added subpar. (M).

2018—Subsec. (b)(3)(B)(viii)(XII). Pub. L. 115–271, § 6104(a), added subcl. (XII).

Subsec. (b)(3)(D). Pub. L. 115–123, § 50205(b)(1)(A), substituted “October 1, 2022” for “October 1, 2017” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 115–123, § 50205(b)(1)(B), substituted “through fiscal year 2022” for “through fiscal year 2017”.

Subsec. (d)(5)(G)(i). Pub. L. 115–123, § 50205(a)(1), substituted “October 1, 2022” for “October 1, 2017”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 115–123, § 50205(a)(2), substituted “October 1, 2022” for “October 1, 2017”.

Subsec. (d)(5)(G)(iv). Pub. L. 115–123, § 50205(a)(4), inserted concluding provisions.

Subsec. (d)(5)(G)(iv)(I). Pub. L. 115–123, § 50205(a)(3), added subcl. (I) and struck out former subcl. (I) which read as follows: “located in a rural area,”.

Subsec. (d)(5)(J)(ii)(IV), (V). Pub. L. 115–123, § 53109(a)(1), added subcl. (IV) and redesignated former subcl. (IV) as (V).

Subsec. (d)(5)(J)(iv). Pub. L. 115–123, § 53109(a)(2)(A), inserted “The Secretary shall include in the proposed rule published for fiscal year 2019, a description of the effect of clause (ii)(IV).” after “this subparagraph.” in introductory provisions.

Subsec. (d)(5)(J)(iv)(I). Pub. L. 115–123, § 53109(a)(2)(B), substituted “(III), and, in the case of proposed and final rules for fiscal year 2019 and subsequent fiscal years, (IV)” for “and (III)”.

Subsec. (d)(12)(B). Pub. L. 115–123, § 50204(a)(1), substituted “fiscal year 2023” for “fiscal year 2018” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 115–123, § 50204(a)(2)(A), substituted “through 2022, 15 road miles) from another subsection (d) hospital and has—” for “through 2017, 15 road miles) from another subsection (d) hospital and has less than 800 discharges (or, with respect to fiscal years 2011 through 2017, 1,600 discharges of individuals entitled to, or enrolled for, benefits under part A) during the fiscal year or portion of fiscal year.” and added subcls. (I) to (IV).

Subsec. (d)(12)(C)(ii). Pub. L. 115–123, § 50204(a)(2)(B), substituted “subparagraphs (B) and (D)” for “subparagraph (B)” and inserted “(except as provided in clause (i)(II) and subparagraph (D)(i))” after “regardless”.

Subsec. (d)(12)(C)(iii). Pub. L. 115–141 added cl. (iii).

Subsec. (d)(12)(D). Pub. L. 115–123, § 50204(a)(3), substituted “through 2022” for “through 2017”, “hospitals—

“(i) with respect to each of fiscal years 2011 through 2018, with 200 or fewer”

for “hospitals with 200 or fewer”, and “fiscal year or portion of fiscal year; and” for “fiscal year.”, and added cl. (ii).

Subsec. (m)(6)(B)(i)(I). Pub. L. 115–123, § 51005(a)(1), substituted “fiscal years 2016 through 2019” for “fiscal year 2016 or fiscal year 2017”.

Subsec. (m)(6)(B)(i)(II). Pub. L. 115–123, § 51005(a)(2), substituted “2020” for “2018”.

Subsec. (m)(6)(B)(ii). Pub. L. 115–123, § 51005(b)(1), substituted “Subject to clause (iv), in this paragraph” for “In this paragraph” in introductory provisions.

Subsec. (m)(6)(B)(iv). Pub. L. 115–123, § 51005(b)(2), added cl. (iv).

Subsec. (n)(3)(A). Pub. L. 115–123, § 50413, struck out “by requiring more stringent measures of meaningful use selected under this paragraph” after “quality over time” in concluding provisions.

Subsec. (o)(2)(B)(iii). Pub. L. 115–271, § 6104(b), added cl. (iii).

2016—Subsec. (b)(3)(B)(ix)(II). Pub. L. 114–255, § 4002(b)(2), inserted after first sentence “The Secretary shall exempt an eligible hospital from the application of the payment adjustment under subclause (I) with respect to a fiscal year, subject to annual renewal, if the Secretary determines that compliance with the requirement for being a meaningful EHR user is not possible because the certified EHR technology used by such hospital is decertified under a program kept or recognized pursuant to section 300jj–11(c)(5) of this title.”

Subsec. (d)(1)(B). Pub. L. 114–255, § 15008(b), in concluding provisions, inserted “(as in effect as of such date)” after “clause (iv)” and “(or, in the case of a hospital described in clause (iv)(II), as so in effect, shall be classified under clause (vi) on and after the effective date of such clause (vi) and for cost reporting periods beginning on or after January 1, 2015, shall not be subject to subsection (m) as of the date of such classification)” after “so classified”.

Subsec. (d)(1)(B)(iv). Pub. L. 114–255, § 15008(a), struck out subcl. (I) designation before “a hospital” and redesignated subcl. (II) as cl. (vi).

Subsec. (d)(1)(B)(vi). Pub. L. 114–255, § 15008(a)(2), redesignated subcl. (II) of cl. (iv) as cl. (vi).

Subsec. (m)(5)(F)(i), (ii). Pub. L. 114–255, § 15008(d)(2), substituted “(d)(1)(B)(vi)” for “(d)(1)(B)(iv)(II)”.

Subsec. (m)(6)(A)(i). Pub. L. 114–255, § 15010(a)(1), substituted “(F), and (G)” for “and (F)”.

Pub. L. 114–255, § 15009(a)(1), substituted “, (E), and (F)” for “and (E)”.

Subsec. (m)(6)(E)(i)(I)(aa). Pub. L. 114–255, § 15010(a)(2), substituted “the last sentence of subsection (d)(1)(B)” for “the amendment made by section 4417(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww note, Public Law 105–33)”.

Subsec. (m)(6)(F). Pub. L. 114–255, § 15009(a)(2), added subpar. (F).

Subsec. (m)(6)(G). Pub. L. 114–255, § 15010(a)(3), added subpar. (G).

Subsec. (m)(7). Pub. L. 114–255, § 15004(b), added par. (7).

Subsec. (q)(3)(A). Pub. L. 114–255, § 15002(a)(1), inserted “subject to subparagraph (D),” after “purposes of paragraph (1),”.

Subsec. (q)(3)(D), (E). Pub. L. 114–255, § 15002(a)(2), (b), added subpars. (D) and (E).

Subsec. (t). Pub. L. 114–255, § 15001, added subsec. (t).

2015—Subsec. (b)(3)(B)(ix)(I). Pub. L. 114–115, § 4(b)(1), which directed substitution of “(n)(6)” for “(n)(6)(A)”, was executed by making the substitution for “(n)(6)(B)” to reflect the probable intent of Congress and the intervening amendment by Pub. L. 114–113, § 602(b)(1)(A). See below.

Pub. L. 114–113, § 602(b)(1)(A), substituted “(n)(6)(B)” for “(n)(6)(A)”.

Subsec. (b)(3)(B)(ix)(II). Pub. L. 114–115, § 4(b)(2), inserted “(and, with respect to the application of subclause (I) for fiscal year 2017, for categories of subsection (d) hospitals, as established by the Secretary and posted on the Internet website of the Centers for Medicare & Medicaid Services prior to December 15, 2015, an application for which must be submitted to the Secretary by not later than April 1, 2016)” after “case-by-case basis”.

Pub. L. 114–113, § 602(b)(1)(B), substituted “an eligible hospital” for “a subsection (d) hospital”.

Subsec. (b)(3)(D). Pub. L. 114–10, § 205(b)(1)(A), substituted “October 1, 2017” for “April 1, 2015” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 114–10, § 205(b)(1)(B), substituted “through fiscal year 2017” for “through fiscal year 2014 and the portion of fiscal year 2015 before April 1, 2015”.

Subsec. (d)(5)(G)(i). Pub. L. 114–10, § 205(a)(1), substituted “October 1, 2017” for “April 1, 2015”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 114–10, § 205(a)(2), substituted “October 1, 2017” for “April 1, 2015”.

Subsec. (d)(9)(E)(iv). Pub. L. 114–113, § 601(2)(A), inserted “and before January 1, 2016,” after “2004,”.

Subsec. (d)(9)(E)(v). Pub. L. 114–113, § 601(1), (2)(B), (3), added cl. (v).

Subsec. (d)(12)(B). Pub. L. 114–10, § 204(1), substituted “in fiscal year 2018 and subsequent fiscal years” for “in fiscal year 2015 (beginning on April 1, 2015), fiscal year 2016, and subsequent fiscal years” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 114–10, § 204(2), substituted “fiscal years 2011 through 2017,” for “fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),” in two places.

Subsec. (d)(12)(D). Pub. L. 114–10, § 204(3), substituted “fiscal years 2011 through 2017,” for “fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),”.

Subsec. (j)(3)(C)(i). Pub. L. 114–10, § 411(b)(1)(A), substituted “clauses (ii) and (iii)” for “clause (ii)”.

Subsec. (j)(3)(C)(ii). Pub. L. 114–10, § 411(b)(1)(B), substituted “Subject to clause (iii), after” for “After” in introductory provisions.

Subsec. (j)(3)(C)(iii). Pub. L. 114–10, § 411(b)(1)(C), added cl. (iii).

Subsec. (j)(7)(A)(i). Pub. L. 114–10, § 411(b)(2), substituted “subparagraphs (C)(iii) and (D) of paragraph (3)” for “paragraph (3)(D)”.

Subsec. (m)(3)(A). Pub. L. 114–10, § 411(e)(1), substituted “Subject to subparagraph (C), in implementing” for “In implementing” in introductory provisions.

Subsec. (m)(3)(C). Pub. L. 114–10, § 411(e)(2), added subpar. (C).

Subsec. (m)(6)(A)(i). Pub. L. 114–113, § 231(1), substituted “subparagraphs (C) and (E)” for “subparagraph (C)”.

Subsec. (m)(6)(E). Pub. L. 114–113, § 231(2), added subpar. (E).

Subsec. (n)(3)(A)(ii). Pub. L. 114–10, § 106(b)(2)(B), inserted before period at end “, and the hospital demonstrates (through a process specified by the Secretary, such as the use of an attestation) that the hospital has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology”.

Subsec. (n)(6)(B). Pub. L. 114–113, § 602(a), substituted “hospital that is a subsection (d) hospital or a subsection (d) Puerto Rico hospital” for “subsection (d) hospital”.

2014—Subsec. (b)(3)(D). Pub. L. 113–93, § 106(b)(1)(A), substituted “April 1, 2015” for “April 1, 2014” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 113–93, § 106(b)(1)(B), substituted “through fiscal year 2014 and the portion of fiscal year 2015 before April 1, 2015” for “through fiscal year 2013 and the portion of fiscal year 2014 before April 1, 2014”.

Subsec. (d)(5)(G)(i). Pub. L. 113–93, § 106(a)(1), substituted “April 1, 2015” for “April 1, 2014”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 113–93, § 106(a)(2), substituted “April 1, 2015” for “April 1, 2014”.

Subsec. (d)(12)(B). Pub. L. 113–93, § 105(1), substituted “in fiscal year 2015 (beginning on April 1, 2015), fiscal year 2016, and subsequent fiscal years” for “in the portion of fiscal year 2014 beginning on April 1, 2014, fiscal year 2015, and subsequent fiscal years” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 113–93, § 105(2), substituted “fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),” for “fiscal years 2011, 2012, and 2013, and the portion of fiscal year 2014 before” in two places.

Subsec. (d)(12)(D). Pub. L. 113–93, § 105(3), substituted “fiscal years 2011 through 2014 and fiscal year 2015 (before April 1, 2015),” for “fiscal years 2011, 2012, and 2013, and the portion of fiscal year 2014 before April 1, 2014,”.

Subsec. (j)(7)(A)(i). Pub. L. 113–185, § 2(c)(2)(A), substituted “subparagraphs (C) and (F)” for “subparagraph (C)”.

Subsec. (j)(7)(C). Pub. L. 113–185, § 2(c)(2)(B), substituted “Subject to subparagraph (G), for fiscal year 2014 and each subsequent fiscal year” for “For fiscal year 2014 and each subsequent rate year”.

Subsec. (j)(7)(E). Pub. L. 113–185, § 2(c)(2)(C), inserted “and subparagraph (F)(i)” after “subparagraph (C)”.

Subsec. (j)(7)(F), (G). Pub. L. 113–185, § 2(c)(2)(D), added subpars. (F) and (G).

Subsec. (m)(5)(A)(i). Pub. L. 113–185, § 2(c)(3)(A), substituted “subparagraphs (C) and (F)” for “subparagraph (C)”.

Subsec. (m)(5)(C). Pub. L. 113–185, § 2(c)(3)(B), substituted “Subject to subparagraph (G), for rate year” for “For rate year”.

Subsec. (m)(5)(E). Pub. L. 113–185, § 2(c)(3)(C), inserted “and subparagraph (F)(i)” after “subparagraph (C)”.

Subsec. (m)(5)(F), (G). Pub. L. 113–185, § 2(c)(3)(D), added subpars. (F) and (G).

Subsec. (m)(6)(C)(iv). Pub. L. 113–93, § 112(a), substituted “Medicare fee-for-service discharges” for “discharges” in subcls. (I) and (II).

2013—Subsec. (b)(3)(D). Pub. L. 113–67, § 1106(b)(1)(A), substituted “April 1, 2014” for “October 1, 2013” in introductory provisions.

Pub. L. 112–240, § 606(b)(1)(A), substituted “October 1, 2013” for “October 1, 2012” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 113–67, § 1106(b)(1)(B), inserted “and the portion of fiscal year 2014 before April 1, 2014” after “through fiscal year 2013”.

Pub. L. 112–240, § 606(b)(1)(B), substituted “through fiscal year 2013” for “through fiscal year 2012”.

Subsec. (d)(5)(G)(i). Pub. L. 113–67, § 1106(a)(1), substituted “April 1, 2014” for “October 1, 2013”.

Pub. L. 112–240, § 606(a)(1), substituted “October 1, 2013” for “October 1, 2012”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 113–67, § 1106(a)(2), substituted “April 1, 2014” for “October 1, 2013”.

Pub. L. 112–240, § 606(a)(2), substituted “October 1, 2013” for “October 1, 2012”.

Subsec. (d)(12)(B). Pub. L. 113–67, § 1105(1), substituted “the portion of fiscal year 2014 beginning on April 1, 2014, fiscal year 2015, and subsequent fiscal years” for “fiscal year 2014 and subsequent fiscal years” in introductory provisions.

Pub. L. 112–240, § 605(1), substituted “2014” for “2013” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 113–67, § 1105(2), inserted “and the portion of fiscal year 2014 before” after “and 2013,” in two places and “or portion of fiscal year” after “during the fiscal year”.

Pub. L. 112–240, § 605(2), substituted “, 2012, and 2013” for “and 2012” in two places.

Subsec. (d)(12)(D). Pub. L. 113–67, § 1105(3)(B), which directed insertion of “or the portion of fiscal year” after “in the fiscal year”, was executed by making the insertion after “in the fiscal year” both places appearing to reflect the probable intent of Congress.

Pub. L. 113–67, § 1105(3)(A), inserted “and the portion of fiscal year 2014 before April 1, 2014,” after “and 2013,”.

Pub. L. 112–240, § 605(3), substituted “, 2012, and 2013” for “and 2012”.

Subsec. (m)(5)(D)(iv). Pub. L. 113–67, § 1206(c), added cl. (iv).

Subsec. (m)(6). Pub. L. 113–67, § 1206(a)(1), added par. (6).

2011—Subsec. (f)(2). Pub. L. 112–40 substituted “quality improvement” for “utilization and quality control peer review” in introductory provisions.

2010—Subsec. (a)(4). Pub. L. 111–192, § 102(a)(1), inserted “In applying the first sentence of this paragraph, the term ‘other services related to the admission’ includes all services that are not diagnostic services (other than ambulance and maintenance renal dialysis services) for which payment may be made under this subchapter that are provided by a hospital (or an entity wholly owned or operated by the hospital) to a patient—” after “hemophilia.” and added subpars. (A) and (B).

Subsec. (b)(3)(B)(i)(XX). Pub. L. 111–148, § 3401(a)(1), substituted “clauses (viii), (ix), (xi), and (xii)” for “clause (viii)”.

Subsec. (b)(3)(B)(viii)(I). Pub. L. 111–148, § 3401(a)(2), inserted “of such applicable percentage increase (determined without regard to clause (ix), (xi), or (xii))” after “one-quarter”.

Subsec. (b)(3)(B)(viii)(II). Pub. L. 111–148, § 3001(a)(2)(A), inserted at end “The Secretary may require hospitals to submit data on measures that are not used for the determination of value-based incentive payments under subsection (o).”

Subsec. (b)(3)(B)(viii)(V). Pub. L. 111–148, § 3001(a)(2)(B), substituted “for fiscal years 2008 through 2012” for “beginning with fiscal year 2008”.

Subsec. (b)(3)(B)(viii)(VII). Pub. L. 111–148, § 3001(a)(2)(C), substituted “information regarding measures submitted” for “data submitted”.

Subsec. (b)(3)(B)(viii)(VIII) to (XI). Pub. L. 111–148, § 3001(a)(2)(D), added subcls. (VIII) to (XI).

Subsec. (b)(3)(B)(ix)(I). Pub. L. 111–148, § 3401(a)(3), inserted “(determined without regard to clause (viii), (xi), or (xii))” after “otherwise applicable under clause (i)”.

Subsec. (b)(3)(B)(x). Pub. L. 111–148, § 3001(a)(3), added cl. (x).

Subsec. (b)(3)(B)(xi), (xii). Pub. L. 111–148, § 3401(a)(4), added cls. (xi) and (xii).

Subsec. (b)(3)(B)(xii)(I). Pub. L. 111–148, § 10319(a)(1), struck out “and” at end.

Subsec. (b)(3)(B)(xii)(II). Pub. L. 111–152, § 1105(a)(1)(A), placed subcl. (II), which was directed to be added by Pub. L. 111–148, § 10319(a)(3), after subcl. (I) and struck out “and” at end. See Amendment note below.

Pub. L. 111–148, § 10319(a)(3), which directed addition of subcl. (II) “after subclause (II)”, could not be executed. See Amendment note above. Former subcl. (II) redesignated (III).

Subsec. (b)(3)(B)(xii)(III). Pub. L. 111–152, § 1105(a)(1)(B), added subcl. (III) and struck out former subcl. (III) which read “subject to clause (xiii), for each of fiscal years 2014 through 2019, by 0.2 percentage point.”

Pub. L. 111–148, § 10319(a)(2), (4), redesignated subcl. (II) as (III) and substituted “2014” for “2012”.

Subsec. (b)(3)(B)(xii)(IV), (V). Pub. L. 111–152, § 1105(a)(1)(B), added subcls. (IV) and (V).

Subsec. (b)(3)(B)(xiii). Pub. L. 111–152, § 1105(a)(2), struck out cl. (xiii) which read as follows: “Clause (xii) shall be applied with respect to any of fiscal years 2014 through 2019 by substituting ‘0.0 percentage points’ for ‘0.2 percentage point’, if for such fiscal year—

“(I) the excess (if any) of—

“(aa) the total percentage of the non-elderly insured population for the preceding fiscal year (based on the most recent estimates available from the Director of the Congressional Budget Office before a vote in either House on the Patient Protection and Affordable Care Act that, if determined in the affirmative, would clear such Act for enrollment); over

“(bb) the total percentage of the non-elderly insured population for such preceding fiscal year (as estimated by the Secretary); exceeds

“(II) 5 percentage points.”

Pub. L. 111–148, § 3401(a)(4), added cl. (xiii).

Subsec. (b)(3)(D). Pub. L. 111–148, § 3124(b)(1)(A), substituted “October 1, 2012” for “October 1, 2011” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 111–148, § 3124(b)(1)(B), substituted “through fiscal year 2012” for “through fiscal year 2011”.

Subsec. (d)(3)(E)(i). Pub. L. 111–148, § 10324(a)(2), which directed the amendment of the third sentence of subsec. (d)(3)(E) by inserting “and the amendments made by section 10324(a)(1) of the Patient Protection and Affordable Care Act” after “2003”, was executed by making the insertion in the fifth sentence of cl. (i) to reflect the probable intent of Congress.

Pub. L. 111–148, § 10324(a)(1)(A), substituted “clause (ii) or (iii)” for “clause (ii)”.

Subsec. (d)(3)(E)(iii). Pub. L. 111–148, § 10324(a)(1)(B), added cl. (iii).

Subsec. (d)(5)(B)(iv). Pub. L. 111–148, § 5504(b), designated existing provisions as subcl. (I), inserted “, and before July 1, 2010” after “1997”, and added subcl. (II).

Subsec. (d)(5)(B)(v). Pub. L. 111–148, § 5506(b), which directed substitution of “subsections (h)(4)(H)(vi), (h)(7), and (h)(8)” for “subsections (h)(7) and (h)(8)” in second sentence, was executed by making the substitution in the third sentence to reflect the probable intent of Congress.

Pub. L. 111–148, § 5503(b)(1), which directed the substitution, in second sentence, of “subsections (h)(7) and (h)(8)” for “subsection (h)(7)” and “they apply” for “it applies”, was executed by making the substitution in the third sentence to reflect the probable intent of Congress.

Subsec. (d)(5)(B)(x). Pub. L. 111–148, § 5505(b), added cl. (x) relating to determining the hospital’s number of full-time equivalent residents.

Pub. L. 111–148, § 5503(b)(2), added cl. (x) relating to indirect teaching adjustment factor for additional payment amount attributable to resident positions.

Subsec. (d)(5)(F)(i). Pub. L. 111–148, § 3133(1), substituted “Subject to subsection (r), for” for “For” in introductory provisions.

Subsec. (d)(5)(G)(i). Pub. L. 111–148, § 3124(a)(1), substituted “October 1, 2012” for “October 1, 2011”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 111–148, § 3124(a)(2), substituted “October 1, 2012” for “October 1, 2011”.

Subsec. (d)(7)(C). Pub. L. 111–192, § 102(a)(2), added subpar. (C).

Subsec. (d)(12)(A). Pub. L. 111–148, § 3125(1), inserted “or (D)” after “subparagraph (B)”.

Subsec. (d)(12)(B). Pub. L. 111–148, § 3125(2), substituted “For discharges occurring in fiscal years 2005 through 2010 and for discharges occurring in fiscal year 2013 and subsequent fiscal years, the Secretary” for “The Secretary” in introductory provisions.

Subsec. (d)(12)(C)(i). Pub. L. 111–148, § 10314(1), substituted “1,600 discharges” for “1,500 discharges”.

Pub. L. 111–148, § 3125(3), inserted “(or, with respect to fiscal years 2011 and 2012, 15 road miles)” after “25 road miles” and “(or, with respect to fiscal years 2011 and 2012, 1,500 discharges of individuals entitled to, or enrolled for, benefits under part A)” after “800 discharges”.

Subsec. (d)(12)(D). Pub. L. 111–148, § 10314(2), substituted “1,600 discharges” for “1,500 discharges”.

Pub. L. 111–148, § 3125(4), added subpar. (D).

Subsec. (h)(4)(E). Pub. L. 111–148, § 5505(a)(1)(A), substituted “Subject to subparagraphs (J) and (K), such rules” for “Such rules” in introductory provisions.

Pub. L. 111–148, § 5504(a), substituted “shall be counted and that—” for “shall be counted and that all the time”, inserted cl. (i) designation and “effective for cost reporting periods beginning before July 1, 2010, all the time;” before “so spent”, substituted “; and” for period at end, added cl. (ii), and inserted concluding provisions.

Subsec. (h)(4)(F)(i). Pub. L. 111–148, § 5503(a)(1), substituted “paragraphs (7) and (8)” for “paragraph (7)”.

Subsec. (h)(4)(H)(i). Pub. L. 111–148, § 5503(a)(2), substituted “paragraphs (7) and (8)” for “paragraph (7)”.

Subsec. (h)(4)(H)(vi). Pub. L. 111–148, § 5506(a), added cl. (vi).

Subsec. (h)(4)(J), (K). Pub. L. 111–148, § 5505(a)(1)(B), added subpars. (J) and (K).

Subsec. (h)(5)(K). Pub. L. 111–148, § 5505(a)(2), added subpar. (K).

Subsec. (h)(7)(E). Pub. L. 111–148, § 5506(e), substituted “this paragraph, paragraph (8), or paragraph (4)(H)(vi)” for “paragraph or paragraph (8)”.

Pub. L. 111–148, § 5503(a)(3), inserted “or paragraph (8)” before period at end.

Subsec. (h)(8). Pub. L. 111–148, § 5503(a)(4), added par. (8).

Subsec. (h)(8)(I). Pub. L. 111–309 added subpar. (I).

Subsec. (j)(3)(C). Pub. L. 111–148, § 3401(d)(1), designated existing provisions as cl. (i), inserted heading and “subject to clause (ii)” after “establish an increase factor” in text, and added cl. (ii).

Subsec. (j)(3)(D). Pub. L. 111–152, § 1105(c)(3), struck out cl. (i) designation and heading, redesignated subcls. (I) to (V) of former cl. (i) as cls. (i) to (v), respectively, and realigned margins.

Pub. L. 111–148, § 3401(d)(2), added subpar. (D).

Subsec. (j)(3)(D)(i)(I). Pub. L. 111–148, § 10319(c)(1), struck out “and” at end.

Subsec. (j)(3)(D)(i)(II). Pub. L. 111–152, § 1105(c)(1)(A), placed subcl. (II), which was directed to be added by Pub. L. 111–148, § 10319(c)(3), after subcl. (I) and struck out “and” at end. See Amendment note below.

Pub. L. 111–148, § 10319(c)(3), which directed addition of subcl. (II) “after subclause (II)”, could not be executed. See Amendment note above. Former subcl. (II) redesignated (III).

Subsec. (j)(3)(D)(i)(III). Pub. L. 111–152, § 1105(c)(1)(B), added subcl. (III) and struck out former subcl. (III) which read as follows: “subject to clause (ii), for each of fiscal years 2014 through 2019, 0.2 percentage point.”

Pub. L. 111–148, § 10319(c)(2), (4), redesignated subcl. (II) as (III) and substituted “2014” for “2012”.

Subsec. (j)(3)(D)(i)(IV), (V). Pub. L. 111–152, § 1105(c)(1)(B), added subcls. (IV) and (V).

Subsec. (j)(3)(D)(ii). Pub. L. 111–152, § 1105(c)(2), struck out cl. (ii). Text read as follows: “Clause (i)(II) shall be applied with respect to any of fiscal years 2014 through 2019 by substituting ‘0.0 percentage points’ for ‘0.2 percentage point’, if for such fiscal year—

“(I) the excess (if any) of—

“(aa) the total percentage of the non-elderly insured population for the preceding fiscal year (based on the most recent estimates available from the Director of the Congressional Budget Office before a vote in either House on the Patient Protection and Affordable Care Act that, if determined in the affirmative, would clear such Act for enrollment); over

“(bb) the total percentage of the non-elderly insured population for such preceding fiscal year (as estimated by the Secretary); exceeds

“(II) 5 percentage points.”

Subsec. (j)(7), (8). Pub. L. 111–148, § 3004(b), added par. (7) and redesignated former par. (7) as (8).

Subsec. (m)(3), (4). Pub. L. 111–148, § 3401(c), added pars. (3) and (4).

Subsec. (m)(4)(A). Pub. L. 111–152, § 1105(b)(3), struck out subpar. (A) designation and heading before “For purposes”, redesignated cl. (i) as subpar. (A), and realigned margin.

Subsec. (m)(4)(A)(i). Pub. L. 111–148, § 10319(b)(1)(A), substituted “rate year 2010” for “each of rate years 2010 and 2011” and struck out “and” at end.

Subsec. (m)(4)(A)(ii), (iii). Pub. L. 111–152, § 1105(b)(3), redesignated cls. (ii) and (iii) as subpars. (B) and (C), respectively, and realigned margins.

Pub. L. 111–148, § 10319(b)(1), (C), added cls. (ii) and (iii). Former cl. (ii) redesignated (iv).

Subsec. (m)(4)(A)(iv). Pub. L. 111–152, § 1105(b)(3), redesignated cl. (iv) as subpar. (D) and realigned margin.

Pub. L. 111–152, § 1105(b)(1), added cl. (iv) and struck out former cl. (iv), which read as follows: “subject to subparagraph (B), for each of rate years 2014 through 2019, 0.2 percentage point.”

Pub. L. 111–148, § 10319(b)(1)(B), (D), redesignated cl. (ii) as (iv) and substituted “2014” for “2012”.

Subsec. (m)(4)(A)(v), (vi). Pub. L. 111–152, § 1105(b)(3), redesignated cls. (v) and (vi) as subpars. (E) and (F), respectively, and realigned margins.

Pub. L. 111–152, § 1105(b)(1)(B), added cls. (v) and (vi).

Subsec. (m)(4)(B). Pub. L. 111–152, § 1105(b)(3), redesignated cl. (ii) of former subpar. (A) as subpar. (B) and realigned margin.

Pub. L. 111–152, § 1105(b)(2), struck out subpar. (B). Prior to amendment, text read as follows: “Subparagraph (A)(iv) shall be applied with respect to any of rate years 2014 through 2019 by substituting ‘0.0 percentage points’ for ‘0.2 percentage point’, if for such rate year—

“(i) the excess (if any) of—

“(I) the total percentage of the non-elderly insured population for the preceding rate year (based on the most recent estimates available from the Director of the Congressional Budget Office before a vote in either House on the Patient Protection and Affordable Care Act that, if determined in the affirmative, would clear such Act for enrollment); over

“(II) the total percentage of the non-elderly insured population for such preceding rate year (as estimated by the Secretary); exceeds

“(ii) 5 percentage points.”

Pub. L. 111–148, § 10319(b)(2), substituted “(A)(iv)” for “(A)(ii)” in introductory provisions.

Subsec. (m)(4)(C) to (F). Pub. L. 111–152, § 1105(b)(3), redesignated cls. (iii) to (vi) of former subpar. (A) as subpars. (C) to (F), respectively, and realigned margins.

Subsec. (m)(5). Pub. L. 111–148, § 3004(a), added par. (5).

Subsec. (o). Pub. L. 111–148, § 3001(a)(1), added subsec. (o).

Subsec. (o)(2)(A). Pub. L. 111–148, § 10335, inserted “, other than measures of readmissions,” after “shall select measures”.

Subsec. (p). Pub. L. 111–148, § 3008(a), added subsec. (p).

Subsec. (q). Pub. L. 111–148, § 3025(a), added subsec. (q).

Subsec. (q)(1). Pub. L. 111–148, § 10309, in introductory provisions, substituted “the Secretary shall make payments (in addition to the payments described in paragraph (2)(A)(ii)) for such a discharge to such hospital under subsection (d) (or section 1395f(b)(3) of this title, as the case may be) in an amount equal to the product of” for “the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1395f(b)(3) of this title, as the case may be) for such a discharge by an amount equal to the product of”.

Subsec. (r). Pub. L. 111–148, § 3133(2), added subsec. (r).

Subsec. (r)(1). Pub. L. 111–152, § 1104(1), substituted “2014” for “2015”.

Subsec. (r)(2). Pub. L. 111–152, § 1104(2)(A), substituted “2014” for “2015” in introductory provisions.

Subsec. (r)(2)(B)(i). Pub. L. 111–152, § 1104(2)(B)(i), (ii), (iv), inserted “2014,” after “years” in heading and “2014,” after “each of fiscal years” in introductory provisions and substituted “minus 0.1 percentage points for fiscal year 2014 and minus 0.2 percentage points for each of fiscal years 2015, 2016, and 2017” for “minus 1.5 percentage points” in concluding provisions.

Pub. L. 111–148, § 10316(1)(A), (D), struck out “(divided by 100)” after “change” in introductory provisions and inserted concluding provisions.

Subsec. (r)(2)(B)(i)(I). Pub. L. 111–152, § 1104(2)(B)(iii), substituted “on the Health Care and Education Reconciliation Act of 2010” for “on such Act”.

Pub. L. 111–148, § 10316(1)(B), substituted “2013” for “2012”.

Subsec. (r)(2)(B)(i)(II). Pub. L. 111–148, § 10316(1)(C), substituted comma for period at end.

Subsec. (r)(2)(B)(ii). Pub. L. 111–152, § 1104(2)(C), substituted “minus 0.2 percentage points for each of fiscal years 2018 and 2019” for “and, for each of 2018 and 2019, minus 1.5 percentage points” in concluding provisions.

Pub. L. 111–148, § 10316(2), struck out “(divided by 100)” after “change” in introductory provisions, substituted “2013” for “2012” in subcl. (I), substituted comma for period at end of subcl. (II), and inserted concluding provisions.

Subsec. (s). Pub. L. 111–148, § 3401(f), added subsec. (s).

Subsec. (s)(3). Pub. L. 111–152, § 1105(d)(3), struck out subpar. (A) designation and heading, redesignated cls. (i) to (v) of former subpar. (A) as subpars. (A) to (E), respectively, and realigned margins.

Subsec. (s)(3)(A)(i). Pub. L. 111–148, § 10319(e)(1), struck out “and” at end.

Subsec. (s)(3)(A)(ii). Pub. L. 111–152, § 1105(d)(1)(A), placed cl. (ii), which was directed to be added by Pub. L. 111–148, § 10319(e)(3), after cl. (i) and struck out “and” at end. See Amendment note below.

Pub. L. 111–148, § 10319(e)(3), which directed addition of cl. (ii) “after clause (ii)”, could not be executed. See Amendment note above. Former cl. (ii) redesignated (iii).

Subsec. (s)(3)(A)(iii). Pub. L. 111–152, § 1105(d)(1)(B), added cl. (iii) and struck out former cl. (iii) which read as follows: “subject to subparagraph (B), for each of the rate years beginning in 2014 through 2019, 0.2 percentage point.”

Pub. L. 111–148, § 10319(e)(2), (4), redesignated cl. (ii) as (iii) and substituted “2014” for “2012”.

Subsec. (s)(3)(A)(iv), (v). Pub. L. 111–152, § 1105(d)(1)(B), added cls. (iv) and (v).

Subsec. (s)(3)(B). Pub. L. 111–152, § 1105(d)(2), struck out subpar. (B). Prior to amendment, text read as follows: “Subparagraph (A)(ii) shall be applied with respect to any of rate years 2014 through 2019 by substituting ‘0.0 percentage points’ for ‘0.2 percentage point’, if for such rate year—

“(i) the excess (if any) of—

“(I) the total percentage of the non-elderly insured population for the preceding rate year (based on the most recent estimates available from the Director of the Congressional Budget Office before a vote in either House on the Patient Protection and Affordable Care Act that, if determined in the affirmative, would clear such Act for enrollment); over

“(II) the total percentage of the non-elderly insured population for such preceding rate year (as estimated by the Secretary); exceeds

“(ii) 5 percentage points.”

Subsec. (s)(4). Pub. L. 111–148, § 10322(a), added par. (4).

2009—Subsec. (b)(3)(B)(viii)(I). Pub. L. 111–5, § 4102(b)(1)(A), inserted “(or, beginning with fiscal year 2015, by one-quarter)” after “2.0 percentage points”.

Subsec. (b)(3)(B)(ix). Pub. L. 111–5, § 4102(b)(1)(B), added cl. (ix).

Subsec. (n). Pub. L. 111–5, § 4102(a)(1), added subsec. (n).

2008—Subsec. (b)(3)(C). Pub. L. 110–275, § 122(b)(1), substituted “subparagraphs (I) and (L)” for “subparagraph (I)” in introductory provisions.

Subsec. (b)(3)(I)(i). Pub. L. 110–275, § 122(b)(2), substituted “Subject to subparagraph (L), for” for “For” in introductory provisions.

Subsec. (b)(3)(L). Pub. L. 110–275, § 122(a), added subpar. (L).

2007—Subsec. (h)(4)(H)(v). Pub. L. 110–161, § 225(a), added cl. (v).

Subsec. (h)(7)(D), (E). Pub. L. 110–161, § 225(b)(1), added subpar. (D) and redesignated former subpar. (D) as (E).

Subsec. (j)(3)(C). Pub. L. 110–173, § 115(a)(1), inserted at end “The increase factor to be applied under this subparagraph for each of fiscal years 2008 and 2009 shall be 0 percent.”

Subsec. (m). Pub. L. 110–173, § 114(e)(1), added subsec. (m).

2006—Subsec. (b)(3)(B)(i)(XIX). Pub. L. 109–171, § 5001(a)(1)(A), substituted “2006” for “2007”.

Subsec. (b)(3)(B)(i)(XX). Pub. L. 109–171, § 5001(a)(1)(B), substituted “for each subsequent fiscal year, subject to clause (viii),” for “for fiscal year 2008 and each subsequent fiscal year,”.

Subsec. (b)(3)(B)(vii)(I). Pub. L. 109–171, § 5001(a)(2)(A), substituted “for fiscal years 2005 and 2006” for “for each of fiscal years 2005 through 2007”.

Subsec. (b)(3)(B)(vii)(II). Pub. L. 109–171, § 5001(a)(2)(B), substituted “For fiscal years 2005 and 2006, each” for “Each”.

Subsec. (b)(3)(B)(viii). Pub. L. 109–432, § 205(b)(1), realigned margins.

Pub. L. 109–171, § 5001(a)(3), added cl. (viii).

Subsec. (b)(3)(B)(viii)(III). Pub. L. 109–432, § 109(a)(2), inserted “(including medication errors)” after “quality of care”.

Subsec. (b)(3)(D). Pub. L. 109–171, § 5003(b)(1), inserted “subject to subparagraph (K),” after “(d)(5)(G)),” in introductory provisions.

Pub. L. 109–171, § 5003(a)(2)(A)(i), substituted “occurring” for “beginning” and “October 1, 2011” for “October 1, 2006” in introductory provisions.

Subsec. (b)(3)(D)(iv). Pub. L. 109–171, § 5003(a)(2)(A)(ii), substituted “through fiscal year 2011” for “through fiscal year 2005”.

Subsec. (b)(3)(K). Pub. L. 109–171, § 5003(b)(2), added subpar. (K).

Subsec. (d)(4)(C)(iv). Pub. L. 109–432, § 106(c)(1), struck out cl. (iv) which read as follows: “The Secretary shall include recommendations with respect to adjustments to weighting factors under clause (i) in the annual report to Congress required under subsection (e)(3)(B) of this section.”

Subsec. (d)(4)(D). Pub. L. 109–171, § 5001(c)(1), added subpar. (D).

Subsec. (d)(5)(F)(vi). Pub. L. 109–171, § 5002(a), inserted concluding provisions.

Subsec. (d)(5)(F)(xiv)(II). Pub. L. 109–171, § 5003(d), inserted “or, in the case of discharges occurring on or after October 1, 2006, as a medicare-dependent, small rural hospital under subparagraph (G)(iv)” before period at end.

Subsec. (d)(5)(G)(i). Pub. L. 109–171, § 5003(a)(1)(A), substituted “October 1, 2011” for “October 1, 2006”.

Subsec. (d)(5)(G)(ii)(II). Pub. L. 109–171, § 5003(c), inserted “(or 75 percent in the case of discharges occurring on or after October 1, 2006)” after “50 percent”.

Pub. L. 109–171, § 5003(a)(1)(B), substituted “October 1, 2011” for “October 1, 2006” and inserted “or for discharges in the fiscal year” after “for the cost reporting period”.

Subsec. (d)(7)(B). Pub. L. 109–171, § 5001(c)(2), inserted “, including the selection and revision of codes under paragraph (4)(D)” before period at end.

Subsec. (e)(3). Pub. L. 109–432, § 106(c)(2), struck out par. (3) which read as follows: “The Secretary, not later than April 1, 1987, for fiscal year 1988 and not later than March 1 before the beginning of each fiscal year (beginning with fiscal year 1989), shall report to the Congress the Secretary’s initial estimate of the percentage change that the Secretary will recommend under paragraph (4) with respect to that fiscal year.”

2003—Subsec. (b)(3)(B)(i)(XIX), (XX). Pub. L. 108–173, § 501(a), added subcls. (XIX) and (XX) and struck out former subcl. (XIX) which read as follows: “for fiscal year 2004 and each subsequent fiscal year, the market basket percentage increase for hospitals in all areas.”

Subsec. (b)(3)(B)(vii). Pub. L. 108–173, § 501(b), added cl. (vii).

Subsec. (b)(3)(I)(i)(I). Pub. L. 108–173, § 736(a)(9), substituted “the amount” for “the the amount”.

Subsec. (b)(3)(I)(iii). Pub. L. 108–173, § 407(a), added cl. (iii).

Subsec. (d)(2)(C)(i). Pub. L. 108–173, § 502(b), substituted “1999,” for “1999 or” and inserted “, or the Medicare Prescription Drug, Improvement, and Modernization Act of 2003” before comma at end.

Subsec. (d)(2)(C)(iv). Pub. L. 108–173, § 402(b)(2), struck out “or” before “the enactment of section 303” and inserted “, or the enactment of section 402(a)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003” before period at end.

Subsec. (d)(3). Pub. L. 108–173, § 401(b)(2)(A), inserted “, for fiscal years before fiscal year 1997,” before “a regional adjusted DRG prospective payment rate” in introductory provisions.

Subsec. (d)(3)(A)(iii). Pub. L. 108–173, § 401(b)(3), substituted “in an urban area” for “in an other urban area”.

Subsec. (d)(3)(A)(iv). Pub. L. 108–173, § 401(a), designated existing provisions as subcl. (I), substituted “Subject to subclause (II), for discharges” for “For discharges”, and added subcl. (II).

Subsec. (d)(3)(D). Pub. L. 108–173, § 401(b)(1)(A), (B), (2)(B), in heading, struck out “in different areas” after “hospitals” and, in introductory provisions, inserted “, for fiscal years before fiscal year 1997,” before “a regional DRG prospective payment rate” and struck out “, each of” before “which is equal—”.

Subsec. (d)(3)(D)(i). Pub. L. 108–173, § 401(b)(1)(C)(i), inserted “for fiscal years before fiscal year 2004,” before “for hospitals” in introductory provisions.

Subsec. (d)(3)(D)(i)(II). Pub. L. 108–173, § 401(b)(1)(C)(ii), struck out “and” at end.

Subsec. (d)(3)(D)(ii). Pub. L. 108–173, § 401(b)(1)(D)(i), inserted “for fiscal years before fiscal year 2004,” before “for hospitals” in introductory provisions.

Subsec. (d)(3)(D)(ii)(II). Pub. L. 108–173, § 401(b)(1)(D)(ii), substituted “; and” for period at end.

Subsec. (d)(3)(D)(iii). Pub. L. 108–173, § 401(b)(1)(E), added cl. (iii).

Subsec. (d)(3)(E). Pub. L. 108–173, § 403(a), designated existing provisions as cl. (i), inserted cl. heading, substituted “Except as provided in clause (ii), the Secretary” for “The Secretary”, inserted at end “The Secretary shall apply the previous sentence for any period as if the amendments made by section 403(a)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 had not been enacted.”, and added cl. (ii).

Subsec. (d)(5)(B)(ii). Pub. L. 108–173, § 422(b)(1)(A), substituted “Subject to clause (ix), for discharges” for “For discharges” in introductory provisions.

Subsec. (d)(5)(B)(ii)(VI). Pub. L. 108–173, § 502(a)(1), struck out “and” at end.

Subsec. (d)(5)(B)(ii)(VII). Pub. L. 108–173, § 502(a)(2), inserted “and before April 1, 2004,” after “on or after October 1, 2002,” and substituted semicolon for period at end.

Subsec. (d)(5)(B)(ii)(VIII) to (XII). Pub. L. 108–173, § 502(a)(3), added subcls. (VIII) to (XII).

Subsec. (d)(5)(B)(v). Pub. L. 108–173, § 422(b)(1)(B), inserted at end “The provisions of subsection (h)(7) shall apply with respect to the first sentence of this clause in the same manner as it applies with respect to subsection (h)(4)(F)(i).”

Subsec. (d)(5)(B)(ix). Pub. L. 108–173, § 422(b)(1)(C), added cl. (ix).

Subsec. (d)(5)(F)(iv)(II) to (VI). Pub. L. 108–173, § 402(b)(1)(A), inserted “subject to clause (xiv) and” before “for discharges occurring”.

Subsec. (d)(5)(F)(viii). Pub. L. 108–173, § 402(b)(1)(B), substituted “Subject to clause (xiv), the formula” for “The formula”.

Subsec. (d)(5)(F)(x) to (xiii). Pub. L. 108–173, § 402(b)(1)(C), substituted “Subject to clause (xiv), for purposes” for “For purposes” in introductory provisions.

Subsec. (d)(5)(F)(xiv). Pub. L. 108–173, § 402(a), added cl. (xiv).

Subsec. (d)(5)(K)(i). Pub. L. 108–173, § 503(b)(2)(A), inserted at end “Such mechanism shall be modified to meet the requirements of clause (viii).”

Subsec. (d)(5)(K)(ii)(I). Pub. L. 108–173, § 503(b)(1), inserted “(applying a threshold specified by the Secretary that is the lesser of 75 percent of the standardized amount (increased to reflect the difference between cost and charges) or 75 percent of one standard deviation for the diagnosis-related group involved)” after “is inadequate”.

Subsec. (d)(5)(K)(ii)(III). Pub. L. 108–173, § 503(d)(1), struck out “subject to paragraph (4)(C)(iii),” before “provide for additional payment”.

Subsec. (d)(5)(K)(vii). Pub. L. 108–173, § 503(a), added cl. (vii).

Subsec. (d)(5)(K)(viii). Pub. L. 108–173, § 503(b)(2)(B), added cl. (viii).

Subsec. (d)(5)(K)(ix). Pub. L. 108–173, § 503(c), added cl. (ix).

Subsec. (d)(7)(A). Pub. L. 108–173, § 406(b), inserted “or the determination of the applicable percentage increase under paragraph (12)(A)(ii)” after “to subsection (e)(1)”.

Subsec. (d)(9)(A). Pub. L. 108–173, § 401(c)(1)(B), added cl. (ii) and concluding provisions and struck out former cl. (ii) which read as follows: “for discharges beginning in a fiscal year beginning on or after October 1, 1997, 50 percent (and for discharges between October 1, 1987, and September 30, 1997, 25 percent) of the discharge-weighted average of—

“(I) the national adjusted DRG prospective payment rate (determined under paragraph (3)(D)) for hospitals located in a large urban area,

“(II) such rate for hospitals located in other urban areas, and

“(III) such rate for hospitals located in a rural area,

for such discharges, adjusted in the manner provided in paragraph (3)(E) for different area wage levels. As used in this section, the term ‘subsection (d) Puerto Rico hospital’ means a hospital that is located in Puerto Rico and that would be a subsection (d) hospital (as defined in paragraph (1)(B)) if it were located in one of the fifty States.”

Subsec. (d)(9)(A)(i). Pub. L. 108–173, §§ 401(c)(1)(A), 504(1)(A), substituted “the applicable Puerto Rico percentage (specified in subparagraph (E))” for “for discharges beginning on or after October 1, 1997, 50 percent (and for discharges between October 1, 1987, and September 30, 1997, 75 percent)” and struck out “and” at end.

Subsec. (d)(9)(A)(ii). Pub. L. 108–173, § 504(1)(B), which directed the substitution of “the applicable Federal percentage (specified in subparagraph (E))” for “for discharges beginning in a fiscal year beginning on or after October 1, 1997, 50 percent (and for discharges between October 1, 1987, and September 30, 1997, 25 percent)”, could not be executed because of the amendment by Pub. L. 108–173, § 401(c)(1)(B). See above.

Subsec. (d)(9)(C)(i). Pub. L. 108–173, § 401(c)(2)(A), designated existing provisions as subcl. (I), substituted “For discharges in a fiscal year after fiscal year 1988 and before fiscal year 2004, the Secretary” for “The Secretary”, and added subcl. (II).

Subsec. (d)(9)(C)(ii). Pub. L. 108–173, § 401(c)(2)(B), inserted “(or for fiscal year 2004 and thereafter, the average standardized amount)” after “each of the average standardized amounts”.

Subsec. (d)(9)(C)(iii)(I). Pub. L. 108–173, § 401(c)(2)(C), struck out “for hospitals located in an urban or rural area, respectively” after “reduced under clause (ii))”.

Subsec. (d)(9)(C)(iv). Pub. L. 108–173, § 403(b), designated existing provisions as subcl. (I), substituted “paragraph (3)(E)(i)” for “paragraph (3)(E)”, and added subcl. (II).

Subsec. (d)(9)(E). Pub. L. 108–173, § 504(2), added subpar. (E).

Subsec. (d)(12). Pub. L. 108–173, § 406(a), added par. (12).

Subsec. (d)(13). Pub. L. 108–173, § 505(a), added par. (13).

Subsec. (g)(3)(B). Pub. L. 108–173, § 736(a)(15), inserted closing parenthesis after “(as defined in subsection (d)(5)(D)(iii)”.

Subsec. (h)(2)(D)(iv)(I). Pub. L. 108–173, § 711(1), in heading, inserted “and 2004 through 2013” after “and 2002” and, in text, inserted “or during the period beginning with fiscal year 2004 and ending with fiscal year 2013” after “during fiscal year 2001 or fiscal year 2002”.

Subsec. (h)(2)(D)(iv)(II). Pub. L. 108–173, § 711(2), substituted “For the” for “For a” and struck out “fiscal year 2004, or fiscal year 2005,” after “during fiscal year 2003,”.

Subsec. (h)(3)(D)(ii)(III). Pub. L. 108–173, § 736(c)(6), struck out “and” at end.

Subsec. (h)(4)(F)(i). Pub. L. 108–173, § 422(a)(1), inserted “subject to paragraph (7),” after “October 1, 1997,”.

Subsec. (h)(4)(H)(i). Pub. L. 108–173, § 422(a)(2), inserted “and subject to paragraph (7)” after “subparagraphs (F) and (G)”.

Subsec. (h)(7). Pub. L. 108–173, § 422(a)(3), added par. (7).

2000—Subsec. (b)(3)(B)(i)(XVI). Pub. L. 106–554, § 1(a)(6) [title III, § 301(a)(1)], substituted “for hospitals in all areas,” for “minus 1.1 percentage points for hospitals (other than sole community hospitals) in all areas, and the market basket percentage increase for sole community hospitals,”.

Subsec. (b)(3)(B)(i)(XVII). Pub. L. 106–554, § 1(a)(6) [title III, § 301(a)(2)(B)], struck out “and” at end.

Pub. L. 106–554, § 1(a)(6) [title III, § 301(a)(2)(A)], which directed amendment of subcl. (XVII) by “striking ‘minus 1.1 percentage points’ and inserting ‘minus 0.55 percentage points; and”, was executed as if an end quotation mark for the inserted material followed “points”, to reflect the probable intent of Congress.

Subsec. (b)(3)(B)(i)(XVIII). Pub. L. 106–554, § 1(a)(6) [title III, § 301(a)(5)], added subcl. (XVIII). Former subcl. (XVIII) redesignated (XIX).

Subsec. (b)(3)(B)(i)(XIX). Pub. L. 106–554, § 1(a)(6) [title III, § 301(a)(3), (4)], redesignated subcl. (XVIII) as (XIX) and substituted “fiscal year 2004” for “fiscal year 2003”.

Subsec. (b)(3)(H)(ii)(III). Pub. L. 106–554, § 1(a)(6) [title III, § 307(a)(1)(A)], inserted “subject to subparagraph (J),” after “2002,”.

Subsec. (b)(3)(I)(i). Pub. L. 106–554, § 1(a)(6) [title II, § 213(a)(1)], in introductory provisions, substituted “there shall be substituted for the amount otherwise determined under subsection (d)(5)(D)(i), if such substitution results in a greater amount of payment under this section for the hospital” for “that for its cost reporting period beginning during 1999 is paid on the basis of the target amount applicable to the hospital under subparagraph (C) and that elects (in a form and manner determined by the Secretary) this subparagraph to apply to the hospital, there shall be substituted for such target amount”.

Subsec. (b)(3)(I)(i)(I). Pub. L. 106–554, § 1(a)(6) [title II, § 213(a)(2)], substituted “the amount otherwise applicable to the hospital under subsection (d)(5)(D)(i) (referred to in this clause as the ‘subsection (d)(5)(D)(i) amount’)” for “target amount otherwise applicable to the hospital under subparagraph (C) (referred to in this clause as the ‘subparagraph (C) target amount’)”.

Subsec. (b)(3)(I)(i)(II), (III). Pub. L. 106–554, § 1(a)(6) [title II, § 213(a)(3)], substituted “subsection (d)(5)(D)(i) amount” for “subparagraph (C) target amount”.

Subsec. (b)(3)(J). Pub. L. 106–554, § 1(a)(6) [title III, § 307(a)(1)(B)], added subpar. (J).

Subsec. (d)(1)(B)(v)(III). Pub. L. 106–554, § 1(a)(4) [div. B, title I, § 152(a)], added subcl. (III).

Subsec. (d)(1)(E). Pub. L. 106–554, § 1(a)(4) [div. B, title I, § 152(b)], substituted “For purposes of subclauses (II) and (III) of subparagraph (B)(v)” for “For purposes of subparagraph (B)(v)(II)”.