section be program instruction or otherwise. 211. Floor on the Medicare area wage index for hospitals in all-urban States (a) In general Section 1886(d)(3)(E) of the Social Security Act ( 42 U.S.C. 1395ww(d)(3)(E) ) is amended— (1) in clause (i), in the first sentence, by striking or (iii) and inserting , (iii), or (iv)