expected costs

(2) (A) Except as provided in subparagraph (E), in addition to the payment computed under paragraph (1), in the case of an eligible hospital (described in subparagraph (B)) for a cost reporting period beginning on or after October 1, 1997 , the amount of payment on a per discharge basis under paragraph (1) shall be increased by the lesser of— (i) 50 percent of the amount by which the operating costs are less than the expected costs (as defined in subparagraph (D)) for the period; or (ii) 1 percent of the target amount for the period. (B) For purposes of this paragraph, an “eligible hospital” means with respect to a cost reporting period, a hospital— (i) that has received payments under this subsection for at least 3 full cost reporting periods before that cost reporting period, and (ii) whose operating costs for the period are less than the least of its target amount, its trended costs (as defined in subparagraph (C)), or its expected costs (as defined in subparagraph (D)) for the period. (C) For purposes of subparagraph (B)(ii), the term “trended costs” means for a hospital cost reporting period ending in a fiscal year— (i) in the case of a hospital for which its cost reporting period ending in fiscal year 1996 was its third or subsequent full cost reporting period for which it receives payments under this subsection, the lesser of the operating costs or target amount for that hospital for its cost reporting period ending in fiscal year 1996, or (ii) in the case of any other hospital, the operating costs for that hospital for its third full cost reporting period for which it receives payments under this subsection, increased (in a compounded manner) for each succeeding fiscal year (through the fiscal year involved) by the market basket percentage increase for the fiscal year. (D) For purposes of this paragraph, the term “expected costs”, with respect to the cost reporting period ending in a fiscal year, means the lesser of the operating costs of inpatient hospital services or target amount per discharge for the previous cost reporting period updated by the market basket percentage increase (as defined in paragraph (3)(B)(iii)) for the fiscal year. (E) (i) In the case of an eligible hospital that is a hospital or unit that is within a class of hospital described in clause (ii) with a 12-month cost reporting period beginning before November 29, 1999 , in determining the amount of the increase under subparagraph (A), the Secretary shall substitute for the percentage of the target amount applicable under subparagraph (A)(ii)— (I) for a cost reporting period beginning on or after October 1, 2000 , and before September 30, 2001 , 1.5 percent; and (II) for a cost reporting period beginning on or after October 1, 2001 , and before September 30, 2002 , 2 percent. (ii) For purposes of clause (i), each of the following shall be treated as a separate class of hospital: (I) Hospitals described in clause (i) of subsection (d)(1)(B) and psychiatric units described in the matter following clause (v) of such subsection. (II) Hospitals described in clause (iv) of such subsection.

Source

42 USC § 1395ww(b)(2)


Scoping language

For purposes of this paragraph
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