subsection (d) hospital
(1) (A) Notwithstanding section 1395f(b) of this title but subject to the provisions of section 1395e of this title , the amount of the payment with respect to the operating costs of inpatient hospital services (as defined in subsection (a)(4)) of a subsection (d) hospital (as defined in subparagraph (B)) for inpatient hospital discharges in a cost reporting period or in a fiscal year— (i) beginning on or after October 1, 1983 , and before October 1, 1984 , is equal to the sum of— (I) the target percentage (as defined in subparagraph (C)) of the hospital’s target amount for the cost reporting period (as defined in subsection (b)(3)(A) of this section, but determined without the application of subsection (a)), and (II) the DRG percentage (as defined in subparagraph (C)) of the regional adjusted DRG prospective payment rate determined under paragraph (2) for such discharges; (ii) beginning on or after October 1, 1984 , and before October 1, 1987 , is equal to the sum of— (I) the target percentage (as defined in subparagraph (C)) of the hospital’s target amount for the cost reporting period (as defined in subsection (b)(3)(A), but determined without the application of subsection (a)), and (II) the DRG percentage (as defined in subparagraph (C)) of the applicable combined adjusted DRG prospective payment rate determined under subparagraph (D) for such discharges; or (iii) beginning on or after April 1, 1988 , is equal to— (I) the national adjusted DRG prospective payment rate determined under paragraph (3) for such discharges, or (II) for discharges occurring during a fiscal year ending on or before September 30, 1996 , the sum of 85 percent of the national adjusted DRG prospective payment rate determined under paragraph (3) for such discharges and 15 percent of the regional adjusted DRG prospective payment rate determined under such paragraph, but only if the average standardized amount (described in clause (i)(I) or clause (ii)(I) of paragraph (3)(D)) for hospitals within the region of, and in the same large urban or other area (or, for discharges occurring during a fiscal year ending on or before September 30, 1994 , the same large urban or other area) as, the hospital is greater than the average standardized amount (described in the respective clause) for hospitals within the United States in that type of area for discharges occurring during such fiscal year. (B) As used in this section, the term “subsection (d) hospital” means a hospital located in one of the fifty States or the District of Columbia other than— (i) a psychiatric hospital (as defined in section 1395x(f) of this title ), (ii) a rehabilitation hospital (as defined by the Secretary), (iii) a hospital whose inpatients are predominantly individuals under 18 years of age, (iv) a hospital which has an average inpatient length of stay (as determined by the Secretary) of greater than 25 days, (v) (I) a hospital that the Secretary has classified, at any time on or before December 31, 1990 , (or, in the case of a hospital that, as of December 19, 1989 , is located in a State operating a demonstration project under section 1395f(b) of this title , on or before December 31, 1991 ) for purposes of applying exceptions and adjustments to payment amounts under this subsection, as a hospital involved extensively in treatment for or research on cancer, (II) a hospital that was recognized as a comprehensive cancer center or clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of April 20, 1983 , that is located in a State which, as of December 19, 1989 , was not operating a demonstration project under section 1395f(b) of this title , that applied and was denied, on or before December 31, 1990 , for classification as a hospital involved extensively in treatment for or research on cancer under this clause (as in effect on the day before August 5, 1997 ), that as of August 5, 1997 , is licensed for less than 50 acute care beds, and that demonstrates for the 4-year period ending on December 31, 1996 , that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E), or (III) a hospital that was recognized as a clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of February 18, 1998 , that has never been reimbursed for inpatient hospital services pursuant to a reimbursement system under a demonstration project under section 1395f(b) of this title , that is a freestanding facility organized primarily for treatment of and research on cancer and is not a unit of another hospital, that as of December 21, 2000 , is licensed for 162 acute care beds, and that demonstrates for the 4-year period ending on June 30, 1999 , that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E), or (vi) a hospital that first received payment under this subsection in 1986 which has an average inpatient length of stay (as determined by the Secretary) of greater than 20 days and that has 80 percent or more of its annual medicare inpatient discharges with a principal diagnosis that reflects a finding of neoplastic disease in the 12-month cost reporting period ending in fiscal year 1997; and, in accordance with regulations of the Secretary, does not include a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital (as defined by the Secretary). A hospital that was classified by the Secretary on or before September 30, 1995 , as a hospital described in clause (iv) (as in effect as of such date) shall continue to be so classified (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) notwithstanding that it is located in the same building as, or on the same campus as, another hospital. (C) For purposes of this subsection, for cost reporting periods beginning— (i) on or after October 1, 1983 , and before October 1, 1984 , the “target percentage” is 75 percent and the “DRG percentage” is 25 percent; (ii) on or after October 1, 1984 , and before October 1, 1985 , the “target percentage” is 50 percent and the “DRG percentage” is 50 percent; (iii) on or after October 1, 1985 , and before October 1, 1986 , the “target percentage” is 45 percent and the “DRG percentage” is 55 percent; and (iv) on or after October 1, 1986 , and before October 1, 1987 , the “target percentage” is 25 percent and the “DRG percentage” is 75 percent. (D) For purposes of subparagraph (A)(ii)(II), the “applicable combined adjusted DRG prospective payment rate” for discharges occurring— (i) on or after October 1, 1984 , and before October 1, 1986 , is a combined rate consisting of 25 percent of the national adjusted DRG prospective payment rate, and 75 percent of the regional adjusted DRG prospective payment rate, determined under paragraph (3) for such discharges; and (ii) on or after October 1, 1986 , and before October 1, 1987 , is a combined rate consisting of 50 percent of the national adjusted DRG prospective payment rate, and 50 percent of the regional adjusted DRG prospective payment rate, determined under paragraph (3) for such discharges. (E) For purposes of subclauses (II) and (III) of subparagraph (B)(v) only, the term “principal finding of neoplastic disease” means the condition established after study to be chiefly responsible for occasioning the admission of a patient to a hospital, except that only discharges with ICD–9–CM principal diagnosis codes of 140 through 239, V58.0, V58.1, V66.1, V66.2, or 990 will be considered to reflect such a principal diagnosis.