,,ii  #aae? ,,congress  #a/ ,session    
,s4 #ahbe  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #ah1         
#bjag,mr4 ,grassley 7= himself1 ,ms4    
,baldw91 ,mrs4 ,ern/1 & ,mr4 ,johnson7  
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve ! accuracy ( geographic adju/m5t
 factors "u ! ,m$ic>e program & to      
p]man5tly ext5d c]ta9 adju/m5ts to su*  
factors = c]ta9 localities1 & = o!r     
purposes4  #a4 ,improv+ ! accuracy (    
geographic adju/m5t factors ,section    
#ahdh7;e77#a77;,d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#d7;e77#a77;,d77 is am5d$ to read
 z foll[s3  7,d7 ,use ( accurate data   
7i7 ,9 g5]al ,9 e/abli%+ indices & index
 values "u ?is p>agraph1 ! ,secret>y    
%all use ! mo/ rec5t data available     
relat+ to practice exp5ses1 malpractice 
exp5ses1 & physician "w ef=t 9 ea* fee  
s*$ule area4  7ii7 ,practice exp5se & "w

 indices ,9 e/abli%+ indices & index    
values "u clause 7i7 or 7iii7 (         
subp>agraph 7,a71 ! ,secret>y %all--    
7,i7 use ! mo/ rec5t m>ket data         
available on physician wages1 or if     
available1 actual co/ data = physician  
labor2 &  7,,ii7 n use nonphysician     
pr(essional wage data z a proxy =       
physician wage data4  7iii7 ,practice   
exp5se calculation ,9 calculat+ index   
values "u clause 7i7 ( subp>agraph 7,a71
 ! ,secret>y %all use ! mo/ rec5t (fice 
r5t data available or data f ,f$]ally   
qualifi$ heal? c5t]s 7z def9$ 9 section 
#ahfa7;aa77#d77 exp5se reports4  4  #b4 
,floor = "w & practice exp5se geographic
 indices = s]vices furni%$ 9 ,wiscons9 &
 ,i[a  7a7 ,"w geographic index ,section
 #ahdh7;e77#a77;,e7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;e77#a77;,d77 is am5d$ to read
 z foll[s3  7,e7 ,floor at #a4j on "w   
geographic index  7i7 ,= #bjjd ?r\gh    
#bjag ,aft] calculat+ ! "w geographic   
index 9 subp>agraph 7,a77iii71 =        

purposes ( paym5t = s]vices furni%$ on  
or aft] ,janu>y #a1 #bjjd1 & be=e       
,janu>y #a1 #bjah1 ! ,secret>y %all     
increase ! "w geographic index to #a4jj 
= any locality = :i* su* "w geographic  
index is less ?an #a4jj4  7ii7 ,= #bjah 
& subsequ5t ye>s ,aft] calculat+ ! "w   
geographic index 9 subp>agraph          
7,a77iii71 = purposes ( paym5t = s]vices
 furni%$ 9 ,wiscons9 or ,i[a on or aft] 
,janu>y #a1 #bjah1 ! ,secret>y %all     
increase any su* index to #a4jj if su*  
index w\ld o!rwise be less ?an #a4jj4  4
  7b7 ,practice exp5se geographic       
indices ,section #ahdh7;e77#a7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7;e77#a77 is am5d$-- 7#a7 9    
subp>agraph 7,a71 by /rik+ 7,b71 7,c71  
7,e71 7,g71 7,h71 & 7,i7 & ins]t+ 7,b71 
7,c71 7,e71 7,g71 7,h71 7,i71 & 7,j72 & 
7#b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,j7 ,floor = practice    
exp5se geographic indices = s]vices     
furni%$ 9 ,wiscons9 or ,i[a ,= purposes 
( paym5t = s]vices furni%$ 9 ,wiscons9  

or ,i[a on or aft] ,janu>y #a1 #bjah1   
aft] calculat+ ! practice exp5se index 9
 subp>agraph 7,a77i71 ! ,secret>y %all  
increase any su* index to #a4jj if su*  
index w\ld o!rwise be less t #a4jj4  4