aggregate approved amount

(3) Hospital payment amount per resident (A) In general The payment amount, for a hospital cost reporting period beginning on or after July 1, 1985 , is equal to the product of— (i) the aggregate approved amount (as defined in subparagraph (B)) for that period, and (ii) the hospital’s medicare patient load (as defined in subparagraph (C)) for that period. (B) Aggregate approved amount As used in subparagraph (A), the term “aggregate approved amount” means, for a hospital cost reporting period, the product of— (i) the hospital’s approved FTE resident amount (determined under paragraph (2)) for that period, and (ii) the weighted average number of full-time-equivalent residents (as determined under paragraph (4)) in the hospital’s approved medical residency training programs in that period. The Secretary shall reduce the aggregate approved amount to the extent payment is made under subsection (k) for residents included in the hospital’s count of full-time equivalent residents. (C) Medicare patient load As used in subparagraph (A), the term “medicare patient load” means, with respect to a hospital’s cost reporting period, the fraction of the total number of inpatient-bed-days (as established by the Secretary) during the period which are attributable to patients with respect to whom payment may be made under part A. (D) Payment for managed care enrollees (i) In general For portions of cost reporting periods occurring on or after January 1, 1998 , the Secretary shall provide for an additional payment amount under this subsection for services furnished to individuals who are enrolled under a risk-sharing contract with an eligible organization under section 1395mm of this title and who are entitled to part A or with a Medicare+Choice organization under part C. The amount of such a payment shall equal, subject to clause (iii), the applicable percentage of the product of— (I) the aggregate approved amount (as defined in subparagraph (B)) for that period; and (II) the fraction of the total number of inpatient-bed days (as established by the Secretary) during the period which are attributable to such enrolled individuals. (ii) Applicable percentage For purposes of clause (i), the applicable percentage is— (I) 20 percent in 1998, (II) 40 percent in 1999, (III) 60 percent in 2000, (IV) 80 percent in 2001, and (V) 100 percent in 2002 and subsequent years. (iii) Proportional reduction for nursing and allied health education The Secretary shall estimate a proportional adjustment in payments to all hospitals determined under clauses (i) and (ii) for portions of cost reporting periods beginning in a year (beginning with 2000) such that the proportional adjustment reduces payments in an amount for such year equal to the total additional payment amounts for nursing and allied health education determined under subsection (l) for portions of cost reporting periods occurring in that year. (iv) Special rule for hospitals under reimbursement system The Secretary shall establish rules for the application of this subparagraph to a hospital reimbursed under a reimbursement system authorized under section 1395f(b)(3) of this title in the same manner as it would apply to the hospital if it were not reimbursed under such section.

Source

42 USC § 1395ww(h)(3)


Scoping language

None identified, default scope is assumed to be the parent (part E) of this section.
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