42 USC 1396 - Adjustment in payment for inpatient hospital services furnished by disproportionate share hospitals

1 So in original. Probably should be “subsection”.

(span)(3)); or

2 So in original. Probably should be preceded by “a”.

in fiscal year 2012 described in clause (i) that is in excess of 30 percent of the DSH allotment for the State for such fiscal year or period determined pursuant to clause (i).

Editorial Notes

References in Text

Section 6008 of the Families First Coronavirus Response Act, referred to in subsec. (f)(3)(F), is section 6008 of Puspan. L. 116–127, which amended section 1396d of this title and enacted provisions set out as a note under section 1396d of this title.

Section 4721(e) of the Balanced Budget Act of 1997, and amended by section 607 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106–113), referred to in subsec. (g)(3), is Puspan. L. 105–33, title IV, § 4721(e), Aug. 5, 1997, 111 Stat. 514, as amended by Puspan. L. 106–113, div. B, § 1000(a)(6) [title VI, § 607(a)], Nov. 29, 1999, 113 Stat. 1536, 1501A–396, which is set out as a note under this section.

Codification

Prior to redesignation by Puspan. L. 100–360, section 4112 of Puspan. L. 100–203, cited in the credits to this section, was classified as a note under section 1396a of this title.

Prior Provisions

A prior section 1923 of act Aug. 14, 1935, was renumbered section 1939 and is classified to section 1396v of this title.

Amendments

2024—Subsec. (f)(7)(A). Puspan. L. 118–42, in introductory provisions of cl. (i), substituted “For the period beginning January 1, 2025, and ending September 30, 2025, and for each of fiscal years 2026” for “For the period beginning March 9, 2024, and ending September 30, 2024, and for each of fiscal years 2025” and, in cl. (ii), substituted “January 1, 2025, and ending September 30, 2025, and for each of fiscal years 2026” for “March 9, 2024, and ending September 30, 2024, and for each of fiscal years 2025”.

Puspan. L. 118–35 substituted “March 9, 2024” for “January 20, 2024” in introductory provisions of cl. (i) and in cl. (ii).

2023—Subsec. (f)(7)(A)(i). Puspan. L. 118–22, § 301(1), substituted “January 20, 2024” for “November 18, 2023” in introductory provisions.

Puspan. L. 118–15, § 2341(1), substituted “For the period beginning November 18, 2023, and ending September 30, 2024, and for each of fiscal years 2025 through 2027” for “For each of fiscal years 2024 through 2027” in introductory provisions and inserted “or period” after “the fiscal year” wherever appearing in subcls. (I) and (II).

Subsec. (f)(7)(A)(ii). Puspan. L. 118–22, § 301(2), substituted “January 20, 2024” for “November 18, 2023”.

Puspan. L. 118–15, § 2341(2), substituted “for the period beginning November 18, 2023, and ending September 30, 2024, and for each of fiscal years 2025 through 2027.” for “for each of fiscal years 2024 through 2027”.

2021—Subsec. (f)(3)(A). Puspan. L. 117–2, § 9819(a)(1), substituted “subparagraphs (E) and (F)” for “subparagraph (E)”.

Subsec. (f)(3)(F). Puspan. L. 117–2, § 9819(a)(2), added subpar. (F).

Subsec. (g)(3). Puspan. L. 117–7 added par. (3).

2020—Subsec. (f)(7)(A)(i). Puspan. L. 116–260, § 201(1)(A), substituted “For each of fiscal years 2024 through 2027,” for “For the period beginning December 19, 2020, and ending September 30, 2021, and for each of fiscal years 2022 through 2025” in introductory provisions.

Puspan. L. 116–215 substituted “December 19, 2020” for “December 12, 2020” in introductory provisions.

Puspan. L. 116–159, § 2303(1), substituted “December 12, 2020” for “December 1, 2020” in introductory provisions.

Puspan. L. 116–136, § 3813(1), substituted “December 1, 2020, and ending September 30, 2021, and for each of fiscal years 2022” for “May 23, 2020, and ending September 30, 2020, and for each of fiscal years 2021” in introductory provisions.

Subsec. (f)(7)(A)(ii). Puspan. L. 116–260, § 201(1)(B), substituted “equal to $8,000,000,000 for each of fiscal years 2024 through 2027” for “equal to—

“(I) $4,000,000,000 for the period beginning December 19, 2020, and ending September 30, 2021; and

“(II) $8,000,000,000 for each of fiscal years 2022 through 2025.”

Subsec. (f)(7)(A)(ii)(I). Puspan. L. 116–215 substituted “December 19, 2020” for “December 12, 2020”.

Puspan. L. 116–159, § 2303(2), substituted “December 12, 2020” for “December 1, 2020”.

Puspan. L. 116–136, § 3813(2)(A), substituted “December 1, 2020, and ending September 30, 2021” for “May 23, 2020, and ending September 30, 2020”.

Subsec. (f)(7)(A)(ii)(II). Puspan. L. 116–136, § 3813(2)(B), substituted “2022” for “2021”.

Subsec. (f)(8). Puspan. L. 116–260, § 201(2), substituted “2027” for “2025”.

Subsec. (g). Puspan. L. 116–260, § 203(a), amended subsec. (g) generally. Prior to amendment, subsec. (g) related to limit on amount of payment to hospital.

2019—Subsec. (f)(7)(A). Puspan. L. 116–94 substituted “May 23, 2020” for “December 21, 2019” in cls. (i) and (ii)(I).

Puspan. L. 116–69 substituted “December 21, 2019” for “November 22, 2019” in cls. (i) and (ii)(I).

Subsec. (f)(7)(A)(i). Puspan. L. 116–59, § 1303(1), in introductory provisions, substituted “For the period beginning November 22, 2019, and ending September 30, 2020, and for each of fiscal years 2021 through 2025” for “For each of fiscal years 2020 through 2025”.

Subsec. (f)(7)(A)(ii)(I). Puspan. L. 116–59, § 1303(2), substituted “for the period beginning November 22, 2019, and ending September 30, 2020” for “for fiscal year 2020”.

2018—Subsec. (f)(7)(A)(i). Puspan. L. 115–123, § 53101(1), substituted “2020” for “2018” in introductory provisions.

Subsec. (f)(7)(A)(ii)(I) to (VIII). Puspan. L. 115–123, § 53101(2), added subcls. (I) and (II) and struck out former subcls. (I) to (VIII) which related to fiscal years 2018 to 2025, respectively.

2015—Subsec. (f)(6)(A)(vi). Puspan. L. 114–10, § 219, added cl. (vi).

Subsec. (f)(7)(A)(i). Puspan. L. 114–10, § 412(1)(A), substituted “2018 through 2025” for “2017 through 2024” in introductory provisions.

Subsec. (f)(7)(A)(ii). Puspan. L. 114–10, § 412(1)(B), added cl. (ii) and struck out former cl. (ii) which related to aggregate reductions for fiscal years 2017 to 2024.

Subsec. (f)(7)(A)(v). Puspan. L. 114–10, § 412(1)(C), added cl. (v).

Subsec. (f)(8). Puspan. L. 114–10, § 412(2), substituted “2025” for “2024”.

2014—Subsec. (f)(7)(A)(i). Puspan. L. 113–93, § 221(a)(1)(A), substituted “2017 through 2024” for “2016 through 2020” in introductory provisions.

Subsec. (f)(7)(A)(ii)(I) to (VIII). Puspan. L. 113–93, § 221(a)(1)(B), added subcls. (I) to (VIII) and struck out former subcls. (I) to (IV) which related to amounts for fiscal years 2016 to 2019.

Subsec. (f)(8). Puspan. L. 113–93, § 221(a)(2), added par. (8) and struck out former par. (8) which related to special rules for calculating DSH allotments for certain fiscal years.

2013—Subsec. (f)(7)(A)(i). Puspan. L. 113–67, § 1204(a)(1)(A), substituted “2016” for “2014” in introductory provisions.

Subsec. (f)(7)(A)(ii). Puspan. L. 113–67, § 1204(a)(1)(B), redesignated subcls. (III) to (VII) as subcls. (I) to (V), respectively, in subcl. (I), substituted “$1,200,000,000” for “$600,000,000”, and struck out former subcls. (I) and (II) which read as follows:

“(I) $500,000,000 for fiscal year 2014;

“(II) $600,000,000 for fiscal year 2015;”.

Subsec. (f)(8). Puspan. L. 112–240 amended par. (8) generally. Prior to amendment, text read as follows: “With respect to fiscal year 2021, for purposes of applying paragraph (3)(A) to determine the DSH allotment for a State, the amount of the DSH allotment for the State under paragraph (3) for fiscal year 2020 shall be equal to the DSH allotment as reduced under paragraph (7).”

Subsec. (f)(8)(C), (D). Puspan. L. 113–67, § 1204(a)(2), added subpar. (C) and redesignated former subpar. (C) as (D), and in subpar. (D), substituted “fiscal year 2023” for “fiscal year 2022”.

2012—Subsec. (f)(3)(A). Puspan. L. 112–96, § 3203(2), substituted “paragraphs (6), (7), and (8)” for “paragraphs (6) and (7)”.

Subsec. (f)(8), (9). Puspan. L. 112–96, § 3203(1), (3), added par. (8) and redesignated former par. (8) as (9).

2010—Subsec. (f)(1). Puspan. L. 111–148, § 2551(a)(1), substituted “, (3), and (7)” for “and (3)”.

Subsec. (f)(3)(A). Puspan. L. 111–148, § 2551(a)(2), substituted “paragraphs (6) and (7)” for “paragraph (6)”.

Subsec. (f)(6). Puspan. L. 111–148, § 10201(e)(1)(A)(i), substituted “Allotment adjustments” for “Allotment adjustments for fiscal years 2007 through 2011 and the first calendar quarter of fiscal year 2012” in span.

Subsec. (f)(6)(A)(v). Puspan. L. 111–152, § 1203(span), added cl. (v).

Subsec. (f)(6)(B)(iii). Puspan. L. 111–152, § 1203(a)(1), struck out “or paragraph (7)” after “paragraph (2)” in introductory provisions.

Puspan. L. 111–148, § 10201(e)(1)(A)(ii), added cl. (iii).

Subsec. (f)(7). Puspan. L. 111–152, § 1203(a)(2), added par. (7) and struck out former par. (7) which related to reduction of State DSH allotments once reduction in uninsured threshold reached.

Puspan. L. 111–148, § 2551(a)(4), added par. (7). Former par. (7) redesignated (8).

Subsec. (f)(7)(A). Puspan. L. 111–148, § 10201(e)(1)(B)(i), substituted “subparagraphs (E) and (G)” for “subparagraph (E)” in introductory provisions.

Subsec. (f)(7)(B)(i). Puspan. L. 111–148, § 10201(e)(1)(B)(ii)(I), added subcls. (I) to (IV) and struck out former subcls. (I) and (II) which read as follows:

“(I) if the State is a low DSH State described in paragraph (5)(B), the applicable percentage is equal to 25 percent; and

“(II) if the State is any other State, the applicable percentage is 50 percent.”

Subsec. (f)(7)(B)(ii). Puspan. L. 111–148, § 10201(e)(1)(B)(ii)(II), added subcls. (I) to (IV) and struck out former subcls. (I) and (II) which read as follows:

“(I) if the State is a low DSH State described in paragraph (5)(B), the applicable percentage is equal to the product of the percentage reduction in uncovered individuals for the fiscal year from the preceding fiscal year and 25 percent; and

“(II) if the State is any other State, the applicable percentage is equal to the product of the percentage reduction in uncovered individuals for the fiscal year from the preceding fiscal year and 50 percent.”

Subsec. (f)(7)(E). Puspan. L. 111–148, § 10201(e)(1)(B)(ii)(III), which directed amendment of par. (7)(B) by substituting “50 percent” for “35 percent” in subpar. (E), was executed by making the substitution in par. (7)(E) to reflect the probable intent of Congress.

Subsec. (f)(7)(G). Puspan. L. 111–148, § 10201(e)(1)(B)(ii)(IV), which directed amendment of par. (7)(B) by adding subpar. (G) at the end, was executed by adding subpar. (G) at end of par. (7) to reflect the probable intent of Congress.

Subsec. (f)(8). Puspan. L. 111–148, § 2551(a)(3), redesignated par. (7) as (8).

2009—Subsec. (f)(3)(A). Puspan. L. 111–5, § 5002(1), substituted “paragraph (6) and subparagraph (E)” for “paragraph (6)”.

Subsec. (f)(3)(E). Puspan. L. 111–5, § 5002(2), added subpar. (E).

Subsec. (f)(6). Puspan. L. 111–3, § 616(1), substituted “2011 and the first calendar quarter of fiscal year 2012” for “2009 and the first calendar quarter of fiscal year 2010” in span.

Subsec. (f)(6)(A)(i). Puspan. L. 111–3, § 616(2)(A), in concluding provisions, substituted “fiscal years 2008, 2009, 2010, and 2011, the DSH allotment for Tennessee for” for “fiscal years 2008 and 2009, the DSH allotment for Tennessee for such portion of” and “2012 for the period ending on December 31, 2011” for “2010 for the period ending on December 31, 2009”.

Subsec. (f)(6)(A)(ii). Puspan. L. 111–3, § 616(2)(B), substituted “2010, 2011, or for period in fiscal year 2012” for “or for a period in fiscal year 2010”.

Subsec. (f)(6)(A)(iv). Puspan. L. 111–3, § 616(2)(C)(i), substituted “2011 and the first calendar quarter of fiscal year 2012” for “2009 and the first calendar quarter of fiscal year 2010” in span.

Subsec. (f)(6)(A)(iv)(I), (II). Puspan. L. 111–3, § 616(2)(C)(ii), substituted “2010, 2011, or for a period in fiscal year 2012” for “or for a period in fiscal year 2010”.

Subsec. (f)(6)(B)(i). Puspan. L. 111–3, § 616(3)(A), substituted “2007 through 2011” for “2007 through 2009” and “2012 for the period ending on December 31, 2011” for “2010 for the period ending on December 31, 2009”.

2008—Subsec. (f)(6). Puspan. L. 110–275, § 202(1), substituted “fiscal years 2007 through 2009 and the first calendar quarter of fiscal year 2010” for “for fiscal year 2007 and portions of fiscal year 2008” in span.

Subsec. (f)(6)(A)(i). Puspan. L. 110–275, § 202(2)(A), in concluding provisions, substituted “fiscal years 2008 and 2009” for “fiscal year 2008 for the period ending on June 30, 2008”, struck out “¾ of” before “the amount specified in the previous sentence”, and inserted “Only with respect to fiscal year 2010 for the period ending on December 31, 2009, the DSH allotment for Tennessee for such portion of the fiscal year, notwithstanding such table or terms, shall be ¼ of the amount specified in the first sentence for fiscal year 2007.” at end.

Subsec. (f)(6)(A)(ii). Puspan. L. 110–275, § 202(2)(B), substituted “, 2008, 2009, or for a period in fiscal year 2010” for “or for a period in fiscal year 2008”.

Subsec. (f)(6)(A)(iv). Puspan. L. 110–275, § 202(2)(C), substituted “fiscal years 2007 through 2009 and the first calendar quarter of fiscal year 2010” for “fiscal year 2007 and fiscal year 2008” in span and “, 2008, 2009, or for a period in fiscal year 2010” for “or for a period in fiscal year 2008” in subcls. (I) and (II).

Subsec. (f)(6)(B)(i). Puspan. L. 110–275, § 202(3), substituted “each of fiscal years 2007 through 2009” for “fiscal year 2007” in first sentence, inserted last sentence, and struck out former last sentence which read as follows: “Only with respect to fiscal year 2008 for the period ending on June 30, 2008, the DSH allotment for Hawaii for such portion of the fiscal year, notwithstanding the table set forth in paragraph (2), shall be $7,500,000.”

2007—Subsec. (f)(6). Puspan. L. 110–173, § 204(1), inserted “and portions of fiscal year 2008” after “fiscal year 2007” in span.

Subsec. (f)(6)(A)(i). Puspan. L. 110–173, § 204(2)(A), inserted concluding provisions.

Subsec. (f)(6)(A)(ii). Puspan. L. 110–173, § 204(2)(B), inserted “or for a period in fiscal year 2008 described in clause (i)” after “fiscal year 2007” and “or period” after “such fiscal year”.

Subsec. (f)(6)(A)(iv). Puspan. L. 110–173, § 204(2)(C), inserted “and fiscal year 2008” after “fiscal year 2007” in span, “or for a period in fiscal year 2008 described in clause (i)” after “fiscal year 2007” in subcls. (I) and (II), “or period” after “for such fiscal year” in subcl. (I), and “or period” after “such fiscal year” in two places in subcl. (II).

Subsec. (f)(6)(B)(i). Puspan. L. 110–173, § 204(3), inserted at end “Only with respect to fiscal year 2008 for the period ending on June 30, 2008, the DSH allotment for Hawaii for such portion of the fiscal year, notwithstanding the table set forth in paragraph (2), shall be $7,500,000.”

2006—Subsec. (f)(2). Puspan. L. 109–171 under each of the columns for FY 00, FY 01, and FY 02, substituted “49” for “32” in the entry for the District of Columbia.

Subsec. (f)(6). Puspan. L. 109–432 amended span and text of par. (6) generally, substituting provisions relating to allotment adjustments for fiscal year 2007 in Tennessee and Hawaii for provisions relating to allotment adjustments with respect to fiscal year 2004 or 2005 in any State if a statewide waiver had been revoked or terminated before the end of either such fiscal year and there had been no DSH allotment for the State.

2003—Subsec. (f)(3)(A). Puspan. L. 108–173, § 1001(a)(1), (c)(1), substituted “Except as provided in paragraph (6), the DSH” for “The DSH” and “subparagraphs (B) and (C)” for “subparagraph (B)”.

Subsec. (f)(3)(C), (D). Puspan. L. 108–173, § 1001(a)(2), added subpars. (C) and (D).

Subsec. (f)(5). Puspan. L. 108–173, § 1001(span)(1), (2), (4), struck out “extremely” before “low DSH States” in span, designated existing provisions as subpar. (A) and inserted subpar. span, and added subpar. (B).

Subsec. (f)(5)(A). Puspan. L. 108–173, § 1001(span)(3), which directed insertion of “before fiscal year 2004” after “In subsequent years”, was executed by making the insertion after “In subsequent fiscal years” to reflect the probable intent of Congress.

Subsec. (f)(6), (7). Puspan. L. 108–173, § 1001(c)(2), (3), added par. (6) and redesignated former par. (6) as (7).

Subsec. (j). Puspan. L. 108–173, § 1001(d), added subsec. (j).

2000—Subsec. (a)(2)(D). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(span)(2)(A)], inserted “(including such patients who receive benefits through a managed care entity)” after “the proportion of low-income and medicaid patients”.

Subsec. (span)(2). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(span)(2)(B)], inserted “(regardless of whether such patients receive medical assistance on a fee-for-service basis or through a managed care entity)” after “a State plan approved under this subchapter in a period”.

Subsec. (span)(3)(A)(i)(I). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(span)(2)(C)], inserted “(regardless of whether the services were furnished on a fee-for-service basis or through a managed care entity)” after “under a State plan under this subchapter”.

Subsec. (f)(2). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(a)(1)(A)(i)], substituted “Subject to paragraph (4), the DSH allotment” for “The DSH allotment” in introductory provisions.

Subsec. (f)(3)(A). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(a)(2)(B)], inserted “and paragraph (5)” after “subparagraph (B)”.

Subsec. (f)(4). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(a)(1)(A)(iii)], added par. (4). Former par. (4) redesignated (6).

Subsec. (f)(5). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(a)(2)(A)], added par. (5).

Subsec. (f)(6). Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(a)(1)(A)(ii)], redesignated par. (4) as (6).

1999—Subsec. (c)(3)(B). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(s)], substituted comma for period at end.

Subsec. (f)(2). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 601(a)], under each of the columns for FY 00, FY 01, and FY 02, substituted “32” for “23” in the entry for the District of Columbia, “33” for “16” in the entry for Minnesota, “9” for “5” in the entry for New Mexico, and “0.1” for “0” in the entry for Wyoming.

1997—Subsec. (a)(1). Puspan. L. 105–33, § 4711(c)(2), substituted “1396a(a)(13)(A)(iv)” for “1396a(a)(13)(A)”.

Subsec. (a)(2)(D). Puspan. L. 105–33, § 4721(c), added subpar. (D).

Subsec. (e)(1). Puspan. L. 105–33, § 4711(c)(2), substituted “1396a(a)(13)(A)(iv)” for “1396a(a)(13)(A)”.

Subsec. (f). Puspan. L. 105–33, § 4721(a)(1), amended span and text of subsec. (f) generally. Prior to amendment, subsec. (f) related to denial of Federal financial participation for payments in excess of certain limits.

Subsec. (h). Puspan. L. 105–33, § 4721(span), added subsec. (h).

Subsec. (i). Puspan. L. 105–33, § 4721(d), added subsec. (i).

1993—Subsec. (a)(1)(A). Puspan. L. 103–66, § 13621(a)(1)(A), substituted “requirements” for “requirement”.

Subsec. (span)(1). Puspan. L. 103–66, § 13621(a)(1)(B), substituted “requirements” for “requirement” in introductory provisions.

Subsec. (c). Puspan. L. 103–66, § 13621(span)(2)(A), substituted “subsections (f) and (g)” for “subsection (f)” in introductory provisions.

Subsec. (d). Puspan. L. 103–66, § 13621(a)(1)(C), substituted “Requirements” for “Requirement” in span.

Subsec. (d)(3). Puspan. L. 103–66, § 13621(a)(1)(D), added par. (3).

Subsec. (e)(1)(C). Puspan. L. 103–66, § 13621(a)(1)(E), added cl. (C).

Subsec. (e)(2)(A). Puspan. L. 103–66, § 13621(a)(1)(F)(i), inserted “(other than the last sentence of subsection (c))” before “shall not apply”.

Subsec. (e)(2)(C). Puspan. L. 103–66, § 13621(a)(1)(F)(ii)–(iv), added subpar. (C).

Subsec. (e)(2)(D). Puspan. L. 103–66, § 13621(span)(2)(B), added subpar. (D).

Subsec. (g). Puspan. L. 103–66, § 13621(span)(1), added subsec. (g).

1991—Subsec. (a)(2)(B). Puspan. L. 102–234, § 3(span)(2)(A)(i), substituted “subsections (c) and (f)” for “subsection (c)”.

Subsec. (span)(4). Puspan. L. 102–234, § 3(c), added par. (4).

Subsec. (c). Puspan. L. 102–234, § 3(span)(2)(A)(ii), substituted “Subject to subsection (f), in order” for “In order”.

Subsec. (f). Puspan. L. 102–234, § 3(span)(1), added subsec. (f).

1990—Subsec. (span)(2). Puspan. L. 101–508, § 4702(a), inserted at end “In this paragraph, the term ‘inpatient day’ includes each day in which an individual (including a newborn) is an inpatient in the hospital, whether or not the individual is in a specialized ward and whether or not the individual remains in the hospital for lack of suitable placement elsewhere.”

Subsec. (c)(2). Puspan. L. 101–508, § 4703(c), inserted before semicolon at end “or the hospital’s low-income utilization rate (as defined in paragraph (span)(3))”.

Subsec. (c)(3). Puspan. L. 101–508, § 4703(a), added par. (3).

Subsec. (e)(2). Puspan. L. 101–508, § 4703(span), struck out “during the 3-year period” before “beginning on”.

1989—Subsec. (e)(1). Puspan. L. 101–239 designated portion of existing provisions as cls. (A) and (B), and in cl. (A) designated existing provisions as subcl. (i) and added subcl. (ii).

1988—Puspan. L. 100–360, § 411(k)(6)(A)–(B)(ix), as amended by Puspan. L. 100–485, § 608(d)(26)(F), amended Puspan. L. 100–203, § 4112, so as to redesignate section 4112 of Puspan. L. 100–203 as this section.

Subsec. (a). Puspan. L. 100–360, § 411(k)(6)(B)(iv), struck out “of Health and Human Services” after “to the Secretary” wherever appearing in pars. (1) and (2).

Subsec. (a)(1). Puspan. L. 100–360, § 411(k)(6)(B)(ii), (iii), substituted “A State plan under this subchapter” for “A State’s plan under title XIX of the Social Security Act”, and made technical amendment to reference to section 1396a(a)(13)(A) of this title involving underlying provisions of original act.

Subsec. (a)(2)(A). Puspan. L. 100–360, § 411(k)(6)(A)(i), substituted “April 1, 1989” for “such date” and inserted before period at end “, effective for inpatient hospital services provided on or after July 1, 1989”.

Subsec. (a)(2)(B). Puspan. L. 100–360, § 411(k)(6)(A)(ii), substituted “April 1, 1990” for “such date” and inserted before period at end “, effective for inpatient hospital services provided on or after July 1, 1990”.

Subsec. (a)(2)(C). Puspan. L. 100–485, § 608(d)(15)(C), realigned the margin of subpar. (C).

Puspan. L. 100–360, § 302(span)(2), added subpar. (C).

Subsec. (a)(3). Puspan. L. 100–360, § 411(k)(6)(A)(iii), inserted par. (3) designation and substituted “90 days after the date a State submits an amendment” for “June 30 of each year in which the State is required to submit an amendment”.

Subsec. (a)(4). Puspan. L. 100–360, § 411(k)(6)(A)(iii)(II), (III), (B)(v), inserted par. (4) designation and made technical amendment to reference to section 1396n(span)(4) of this title involving underlying provisions of original act.

Subsec. (span)(2). Puspan. L. 100–360, § 411(k)(6)(A)(iv), substituted “a State plan” for “the State plan”.

Puspan. L. 100–360, § 411(k)(6)(B)(vi), as amended by Puspan. L. 100–485, § 608(d)(26)(F), substituted “under this subchapter” for “under subchapter XIX of this chapter”.

Subsec. (span)(3). Puspan. L. 100–360, § 411(k)(6)(B)(vi), as amended by Puspan. L. 100–485, § 608(d)(26)(F), substituted “under this subchapter” for “under subchapter XIX of this chapter” in last sentence.

Subsec. (span)(3)(A)(i). Puspan. L. 100–360, § 411(k)(6)(B)(vi), as amended by Puspan. L. 100–485, § 608(d)(26)(F), substituted “under this subchapter” for “under subchapter XIX of this chapter”.

Subsec. (span)(3)(B)(i). Puspan. L. 100–485, § 608(d)(26)(D), inserted “of subparagraph (A)” after “clause (i)(II)”.

Puspan. L. 100–360, § 411(k)(6)(A)(v), inserted “, less the portion of any cash subsidies described in clause (i)(II) in the period reasonably attributable to inpatient hospital services” after “charity care in a period”.

Subsec. (c). Puspan. L. 100–485, § 608(d)(26)(E), substituted “this subsection” for “subsection (c)” in concluding provisions.

Puspan. L. 100–360, § 411(k)(6)(A)(vi)(I), (II), (V), in concluding provisions, substituted “paragraphs (1)(B) and (2)(A) of subsection (a)” for “paragraphs (2)(A) and (2)(B)”, “such paragraph (1)(B)” for “paragraph (2)(A)”, and “such paragraph (2)(A)” for “paragraph (2)(B)” and inserted “at least” before “one-third” and “two-thirds”.

Puspan. L. 100–360, § 411(k)(6)(A)(vi)(VI), inserted at end “In the case of a hospital described in subsection (d)(2)(A)(i) (relating to children’s hospitals), in computing the hospital’s disproportionate share adjustment percentage for purposes of paragraph (1)(B) of this subsection, the disproportionate patient percentage (defined in section 1395ww(d)(5)(F)(vi) of this title) shall be computed by substituting for the fraction described in subclause (I) of such section the fraction described in subclause (II) of that section. If a State elects in a State plan amendment under subsection (a) to provide the payment adjustment described in paragraph (2), the State must include in the amendment a detailed description of the specific methodology to be used in determining the specified additional payment amount (or increased percentage payment) to be made to each hospital qualifying for such a payment adjustment and must publish at least annually the name of each hospital qualifying for such a payment adjustment and the amount of such payment adjustment made for each such hospital.”

Subsec. (c)(1). Puspan. L. 100–360, § 411(k)(6)(A)(vi)(III), inserted “at least” after “equal to”.

Subsec. (c)(2). Puspan. L. 100–360, § 411(k)(6)(A)(vi)(IV), as amended by Puspan. L. 100–485, § 608(d)(26)(A), inserted “(without regard to whether the hospital is described in subparagraph (A) or (B) of subsection (span)(1))” after “payment) and”.

Subsec. (d)(1). Puspan. L. 100–360, § 411(k)(6)(B)(vi), as amended by Puspan. L. 100–485, § 608(d)(26)(F), substituted “under this subchapter” for “under subchapter XIX of this chapter”.

Subsec. (d)(2)(B). Puspan. L. 100–360, § 411(k)(6)(B)(vii), made technical amendment to reference to section 1395ww of this title involving underlying provisions of original Act.

Subsec. (e). Puspan. L. 100–360, § 411(k)(6)(A)(vii), as amended by Puspan. L. 100–485, § 608(d)(26)(B), (C), designated existing provisions as par. (1), inserted “based on a pooling arrangement involving a majority of the hospitals participating under the plan” after first reference to “payment adjustments”, added par. (2) and substituted “statewide” for “Statewide” in par. (2).

Statutory Notes and Related Subsidiaries

Effective Date of 2021 Amendment

Puspan. L. 117–7, § 2(span), Apr. 14, 2021, 135 Stat. 252, provided that the amendment made by section 2(span) is effective as if included in the enactment of section 203(a) of title II of division CC of Public Law 116–260.

Puspan. L. 117–2, title IX, § 9819(span), Mar. 11, 2021, 135 Stat. 218, provided that: “The amendment made by subsection (a) [amending this section] shall take effect and apply as if included in the enactment of the Families First Coronavirus Response Act (Public Law 116–127).”

Effective Date of 2020 Amendment

Puspan. L. 116–260, div. CC, title II, § 203(span), Dec. 27, 2020, 134 Stat. 2979, provided that: “The amendment made by this section [amending this section] shall take effect on October 1, 2021, and shall apply to payment adjustments made under section 1923 of the Social Security Act (42 U.S.C. 1396r–4) during fiscal years beginning on or after such date.”

Effective Date of 2013 Amendment

Puspan. L. 113–67, div. B, title II, § 1204(span), Dec. 26, 2013, 127 Stat. 1199, provided that: “The amendments made by subsection (a) [amending this section] shall be effective as of October 1, 2013.”

Effective Date of 2010 Amendment

Puspan. L. 111–148, title II, § 2551(span), Mar. 23, 2010, 124 Stat. 314, which provided that the amendments made by subsection (a), amending this section, were effective on Oct. 1, 2011, was repealed by Puspan. L. 111–148, title X, § 10201(f), Mar. 23, 2010, 124 Stat. 922.

Effective Date of 2009 Amendment

Amendment by Puspan. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see section 3 of Puspan. L. 111–3, set out as an Effective Date note under section 1396 of this title.

Effective Date of 2006 Amendment

Puspan. L. 109–171, title VI, § 6054(span), Fespan. 8, 2006, 120 Stat. 96, provided that: “The amendments made by subsection (a) [amending this section] shall take effect as if enacted on October 1, 2005, and shall only apply to disproportionate share hospital adjustment expenditures applicable to fiscal year 2006 and subsequent fiscal years made on or after that date.”

Effective Date of 2000 Amendment

Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(a)(3)], Dec. 21, 2000, 114 Stat. 2763, 2763A–570, provided that: “The amendments made by paragraphs (1) and (2) [amending this section] take effect on the date the final regulation required under section 705(a) [114 Stat. 2763A–575] (relating to the application of an aggregate upper payment limit test for State medicaid spending for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services provided by government facilities that are not State-owned or operated facilities) is published in the Federal Register.”[The final regulation was published Jan. 12, 2001, 66 Fed. Reg. 3147.]

Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(span)(3)(B)], Dec. 21, 2000, 114 Stat. 2763, 2763A–571, provided that: “The amendments made by paragraph (2) [amending this section] shall apply to payments made on or after January 1, 2001.”

Effective Date of 1999 Amendment

Puspan. L. 106–113, div. B, § 1000(a)(6) [title VI, § 601(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–394, provided that: “The amendments made by subsection (a) [amending this section] take effect on October 1, 1999, and applies [sic] to expenditures made on or after such date.”

Amendment by section 1000(a)(6) [title VI, § 608(s)] of Puspan. L. 106–113 effective Nov. 29, 1999, see section 1000(a)(6) [title VI, § 608(bspan)] of Puspan. L. 106–113, set out as a note under section 1396a of this title.

Effective Date of 1997 Amendment

Amendment by section 4711(c)(2) of Puspan. L. 105–33 effective Aug. 5, 1997, and applicable to payment for items and services furnished on or after Oct. 1, 1997, see section 4711(d) of Puspan. L. 105–33, set out as a note under 1396a of this title.

Puspan. L. 105–33, title IV, § 4721(a)(2), Aug. 5, 1997, 111 Stat. 512, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to payment adjustments attributable to DSH allotments for fiscal years beginning with fiscal year 1998.”

Effective Date of 1993 Amendment

Puspan. L. 103–66, title XIII, § 13621(a)(2), Aug. 10, 1993, 107 Stat. 629, provided that:

“The amendments made by this subsection [amending this section] shall apply to payments to States under section 1903(a) of the Social Security Act [42 U.S.C. 1396span(a)] for payments to hospitals made under State plans after—

“(A) the end of the State fiscal year that ends during 1994, or

“(B) in the case of a State with a State legislature which is not scheduled to have a regular legislative session in 1994, the end of the State fiscal year that ends during 1995;

without regard to whether or not final regulations to carry out such amendments have been promulgated by either such date.”

Puspan. L. 103–66, title XIII, § 13621(span)(3), Aug. 10, 1993, 107 Stat. 631, provided that:

“(A)In general.—Except as provided in subparagraph (B), the amendments made by this subsection [amending this section] shall apply to payments to States under section 1903(a) of the Social Security Act [42 U.S.C. 1396span(a)] for payments to hospitals made under State plans after—

“(i) the end of the State fiscal year that ends during 1994, or

“(ii) in the case of a State with a State legislature which is not scheduled to have a regular legislative session in 1994, the end of the State fiscal year that ends during 1995;

without regard to whether or not final regulations to carry out such amendments have been promulgated by either such date.

“(B)Delay in implementation for private hospitals.—With respect to a hospital that is not owned or operated by a State (or by an instrumentality or a unit of government within a State), the amendments made by this subsection shall apply to payments to States under section 1903(a) for payments to hospitals made under State plans for State fiscal years that begin during or after 1995, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.”

Effective Date of 1991 Amendment

Amendments by Puspan. L. 102–234 effective Jan. 1, 1992, see section 3(e)(1) of Puspan. L. 102–234, set out as a note under section 1396a of this title.

Effective Date of 1990 Amendment

Puspan. L. 101–508, title IV, § 4702(span), Nov. 5, 1990, 104 Stat. 1388–171, provided that: “The amendment made by subsection (a) [amending this section] shall take effect on July 1, 1990.”

Puspan. L. 101–508, title IV, § 4703(d), Nov. 5, 1990, 104 Stat. 1388–171, provided that: “The amendments made by this section [amending this section] shall take effect as if included in the enactment of section 412(a)(2)[4112(a)(2)] of the Omnibus Budget Reconciliation Act of 1987 [Puspan. L. 100–203, enacting this section].”

Effective Date of 1988 Amendment

Amendment by Puspan. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Puspan. L. 100–360, see section 608(g)(1) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Amendment by section 302(span)(2) of Puspan. L. 100–360 effective July 1, 1988, see section 302(f)(2) of Puspan. L. 100–360, set out as a note under section 1396a of this title.

Except as specifically provided in section 411 of Puspan. L. 100–360, amendment by section 411(k)(6)(A)–(B)(ix) of Puspan. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, effective as if included in the enactment of that provision in Puspan. L. 100–203, see section 411(a) of Puspan. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.

Application of Medicaid DSH Transition Rule to Public Hospitals in All States

Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(c)], Dec. 21, 2000, 114 Stat. 2763, 2763A–571, provided that:

“(1)In general.—During the period described in paragraph (3), with respect to a State, section 4721(e) of the Balanced Budget Act of 1997 (Public Law 105–33; 111 Stat. 514) [set out as a note below], as amended by section 607 of BBRA [Puspan. L. 106–113, § 1000(a)(6) [title VI, § 607(a)]] (113 Stat. 1501A–396), shall be applied as though—

“(A) ‘September 30, 2002’ were substituted for ‘July 1, 1997’ each place it appears;

“(B) ‘hospitals owned or operated by a State (as defined for purposes of title XIX of such Act [42 U.S.C. 1396 et seq.]), or by an instrumentality or a unit of government within a State (as so defined)’ were substituted for ‘the State of California’;

“(C) paragraph (3) were redesignated as paragraph (4);

“(D) ‘and’ were omitted from the end of paragraph (2); and

“(E) the following new paragraph were inserted after paragraph (2):

‘(3) “(as defined in subparagraph (B) but without regard to clause (ii) of that subparagraph and subject to subsection (d))” were substituted for “(as defined in subparagraph (B))” in subparagraph (A) of such section; and’.

“(2) Special rule.—With respect to California, section 4721(e) of the Balanced Budget Act of 1997 (Public Law 105–33; 111 Stat. 514), as so amended, shall be applied without regard to paragraph (1).

“(3) Period described.—The period described in this paragraph is the period that begins, with respect to a State, on the first day of the first State fiscal year that begins after September 30, 2002, and ends on the last day of the succeeding State fiscal year.

“(4) Application to waivers.—With respect to a State operating under a waiver of the requirements of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) under section 1115 of such Act (42 U.S.C. 1315), the amount by which any payment adjustment made by the State under title XIX of such Act (42 U.S.C. 1396 et seq.), after the application of section 4721(e) of the Balanced Budget Act of 1997 under paragraph (1) to such State, exceeds the costs of furnishing hospital services provided by hospitals described in such section shall be fully reflected as an increase in the baseline expenditure limit for such waiver.”

Assistance for Certain Public Hospitals

Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(d)], Dec. 21, 2000, 114 Stat. 2763, 2763A–571, provided that:

“(1)In general.—Beginning with fiscal year 2002, notwithstanding section 1923(f) of the Social Security Act (42 U.S.C. 1396r–4(f)) and subject to paragraph (3), with respect to a State, payment adjustments made under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to a hospital described in paragraph (2) shall be made without regard to the DSH allotment limitation for the State determined under section 1923(f) of that Act (42 U.S.C. 1396r–4(f)).

“(2)Hospital described.—A hospital is described in this paragraph if the hospital—

“(A) is owned or operated by a State (as defined for purposes of title XIX of the Social Security Act [42 U.S.C. 1396 et seq.]), or by an instrumentality or a unit of government within a State (as so defined);

“(B) as of October 1, 2000—

“(i) is in existence and operating as a hospital described in subparagraph (A); and

“(ii) is not receiving disproportionate share hospital payments from the State in which it is located under title XIX of such Act [42 U.S.C. 1396 et seq.]; and

“(C) has a low-income utilization rate (as defined in section 1923(span)(3) of the Social Security Act (42 U.S.C. 1396r–4(span)(3))) in excess of 65 percent.

“(3)Limitation on expenditures.—

“(A)In general.—With respect to any fiscal year, the aggregate amount of Federal financial participation that may be provided for payment adjustments described in paragraph (1) for that fiscal year for all States may not exceed the amount described in subparagraph (B) for the fiscal year.

“(B)Amount described.—The amount described in this subparagraph for a fiscal year is as follows:

“(i) For fiscal year 2002, $15,000,000.

“(ii) For fiscal year 2003, $176,000,000.

“(iii) For fiscal year 2004, $269,000,000.

“(iv) For fiscal year 2005, $330,000,000.

“(v) For fiscal year 2006 and each fiscal year thereafter, $375,000,000.”

DSH Payment Accountability Standards

Puspan. L. 106–554, § 1(a)(6) [title VII, § 701(e)], Dec. 21, 2000, 114 Stat. 2763, 2763A–572, provided that: “Not later than September 30, 2002, the Secretary of Health and Human Services shall implement accountability standards to ensure that Federal funds provided with respect to disproportionate share hospital adjustments made under section 1923 of the Social Security Act (42 U.S.C. 1396r–4) are used to reimburse States and hospitals eligible for such payment adjustments for providing uncompensated health care to low-income patients and are otherwise made in accordance with the requirements of section 1923 of that Act.”

DSH Allotments for Specific Years

Puspan. L. 105–277, div. A, § 101(f) [title VII, § 702], Oct. 21, 1998, 112 Stat. 2681–337, 2681–389, provided that: “The amount of the DSH allotment for the State of Minnesota for fiscal year 1999, specified in the table under section 1923(f)(2) of the Social Security Act [42 U.S.C. 1396r–4(f)(2)] (as amended by section 4721(a)(1) of Public Law 105–33) is deemed to be $33,000,000.”

Similar provisions were contained in the following prior appropriations act:

Puspan. L. 105–78, title VI, § 601, Nov. 13, 1997, 111 Stat. 1519.

Puspan. L. 105–277, div. A, § 101(f) [title VII, § 703], Oct. 21, 1998, 112 Stat. 2681–337, 2681–389, provided that: “The amount of the DSH allotment for the State of New Mexico for fiscal year 1999, specified in the table under section 1923(f)(2) of the Social Security Act [42 U.S.C. 1396r–4(f)(2)] (as amended by section 4721(a)(1) of Public Law 105–33) is deemed to be $9,000,000.”

Puspan. L. 105–277, div. A, § 101(f) [title VII, § 704], Oct. 21, 1998, 112 Stat. 2681–337, 2681–389, provided that: “Notwithstanding section 1923(f)(2) of the Social Security Act (42 U.S.C. 1396r–4(f)(2)) (as amended by section 4721(a)(1) of the Balanced Budget Act of 1997 (Public Law 105–33; 111 Stat. 511)[)], the amount of the DSH allotment for Wyoming for fiscal year 1999 is deemed to be $95,000.”

Similar provisions were contained in the following prior appropriations act:

Puspan. L. 105–78, title VI, § 602, Nov. 13, 1997, 111 Stat. 1519.

California Transition Rule

Puspan. L. 105–33, title IV, § 4721(e), Aug. 5, 1997, 111 Stat. 514, as amended by Puspan. L. 106–113, div. B, § 1000(a)(6) [title VI, § 607(a)], Nov. 29, 1999, 113 Stat. 1536, 1501A–396, provided that: “Effective July 1, 1997, section 1923(g)(2) of the Social Security Act (42 U.S.C. 1396r–4(g)(2)) shall be applied to the State of California as though—

“(1) ‘(or that begins on or after July 1, 1997)’ were inserted in subparagraph (A) of such section after ‘January 1, 1995,’;

“(2) ‘(or 175 percent in the case of a State fiscal year that begins on or after July 1, 1997)’ were inserted in subparagraph (A) of such section after ‘200 percent’; and

“(3) effective for State fiscal years that begin on or after July 1, 1999, ‘or (span)(1)(B)’ were inserted in section 1923(g)(2)(B)(ii)(I) after ‘(span)(1)(A)’.”

[Puspan. L. 106–113, div. B, § 1000(a)(6) [title VI, § 607(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–396, provided that: “The amendments made by subsection (a) [amending section 4721(e) of Puspan. L. 105–33, set out above] shall take effect as if included in the enactment of section 4721(e) of BBA [the Balanced Budget Act of 1997, Puspan. L. 105–33].”]

Study of DSH Payment Adjustments

Puspan. L. 102–234, § 3(d), Dec. 12, 1991, 105 Stat. 1803, directed Prospective Payment Assessment Commission to conduct a study concerning feasibility and desirability of establishing maximum and minimum payment adjustments under subsec. (c) of this section for hospitals deemed disproportionate share hospitals under State medicaid plans, and criteria (other than criteria described in clause (i) or (ii) of subsec. (f)(1)(D)) that are appropriate for the designation of disproportionate share hospitals under this section, specified items to be included in study, and directed that, not later than Jan. 1, 1994, Commission submit a report on the study to Committee on Finance of Senate and Committee on Energy and Commerce of House of Representatives, such report to include such recommendations respecting designation of disproportionate share hospitals and the establishment of maximum and minimum payment adjustments for such hospitals under this section as may be appropriate.