,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #afia  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #bb1 #bjbc,mr4   
,w5/rup 7= himself1 ,ms4 ,del,bene1 ,mr4
 ,bilirakis1 ,mr4 ,crd5as1 ,mr4 ,moore (
 ,utah1 ,ms4 ,sewell1 ,mr4 ,gu?rie1 &   
,ms4 ,e%oo7 introduc$ ! foll[+ bill2 :i*
 0 ref]r$ to ! ,committee on ,ways &    
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
ensure prompt cov]age ( break?r\gh      
devices "u ! ,m$ic>e program1 & = o!r   
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,ensur+ ,pati5t ,access to 
,critical ,break?r\gh ,products ,act (  
#bjbc4  #b4 ,cov]age & paym5t =         
break?r\gh devices "u ! ,m$ic>e program 
7a7 ,9 g5]al ,"p ,e ( title ,,xviii ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciex et seq47 is am5d$ by add+ at !   

end ! foll[+ new section3  #ahii;,c4    
,cov]age ( break?r\gh devices  7a7      
,break?r\gh devices ,= purposes ( ?is   
section1 ! t]m break?r\gh device means a
 m$ical device t is a device 7z def9$ 9 
section #bja ( ! ,f$]al ,food1 ,drug1 & 
,cosmetic ,act7 & t is-- 7#a7 provid$ ) 
review priority by ! ,secret>y "u       
subsection 7d77#e7 ( section #eae ( su* 
,act2 &  7#b7 approv$ or cle>$ pursuant 
to section #eaj7k71 #eac7;f71 or #eae ( 
su* ,act = use 9 treat+ an indication on
 or aft] ,m>* #ae1 #bjba4  ,su* t]m also
 includes a break?r\gh device t is a    
specifi$ break?r\gh device 7z def9$ 9   
subsection 7e77#a77;,b77 approv$ or     
cle>$ pursuant to section #eaj7k71      
#eac7;f71 or #eae ( su* ,act = use 9    
treat+ an indication on or aft] ,m>*    
#ae1 #bjba4  7b7 ,cov]age  7#a7         
,transitional cov]age  7,a7 ,9 g5]al    
,dur+ ! transitional cov]age p]iod 7z   
def9$ 9 subp>agraph 7,b77 a break?r\gh  
device %all be-- 7i7 deem$ to be        
reasonable & necess>y = purposes (      

section #ahfb7;a77#a77;,a72  7ii7 deem$ 
to be approv$ = an additional paym5t "u 
section #ahhf7;d77#e77,k7 7o!r ?an )    
respect to ! co/ crit]ion "u clause     
7ii77,i7 ( su* section72  7iii7 deem$ to
 be approv$ = pass-?r\gh paym5t "u      
section #ahcc7t77#f7 & section #ahcc7;i7
 7o!r ?an ) respect to ! co/ crit]ion "u
 section #ahcc7t77#f77;,a77iv772 &  7iv7
 ins(> z su* break?r\gh device may be   
furni%$ 9 a sett+ = :i* paym5t is made  
"u an applicable paym5t sy/em describ$ 9
 subp>agraphs 7,d7 ?r\gh 7,i7 (         
subsection 7c77#d71 deem$ eligible = an 
additional paym5t or paym5t adju/m5t1 z 
! case may be1 pursuant to subsection   
7d77#c7 :5 furni%$ 9 a sett+ = :i*      
paym5t is made "u su* an applicable     
paym5t sy/em dur+ su* transitional      
cov]age p]iod4  7,b7 ,transitional      
cov]age p]iod def9$ ,z us$ 9 ?is        
section1 ! t]m transitional cov]age     
p]iod means1 ) respect to a break?r\gh  
device1 ! p]iod t-- 7i7 beg9s on ! date 
( ! approval "u section #eae ( ! ,f$]al 

,food1 ,drug1 & ,cosmetic ,act or ( !   
cle>ance "u section #eaj7k7 ( su* ,act1 
z applicable1 ( su* device by !         
,secret>y = ! indication describ$ 9     
subsection 7a77#a72 &  7ii7 ends on !   
la/ day ( ! #d-ye> p]iod t beg9s on !   
date t ! ,secret>y1 pursuant to         
subsection 7c77#b71 updates ! relevant  
applicable paym5t sy/em 7z def9$ 9      
subsection 7c77#d77 to recognize !      
unique tempor>y or p]man5t code or codes
 assign$ "u subsection 7c77#a7 to su*   
break?r\gh device1 except z provid$ 9   
subsections 7d77#a77;,b7 & 7d77#b77;,b74
  7,c7 ,data us$ to meet ! ,,ntap &     
pass-?r\gh co/ crit]ia ,9 det]m9+ :e!r a
 break?r\gh device qualifies = an       
additional paym5t "u section            
#ahhf7;d77#e77,k7 or = pass-?r\gh paym5t
 "u section #ahcc7t77#f7 or section     
#ahcc7;i71 ! ,secret>y %all use ! mo/   
rec5tly available data & in=mation on ! 
co/s ( su* break?r\gh device1 :i* may   
include li/ prices & invoice prices *>g$
 = su* break?r\gh device4  7#b7 ,process

 = regul> cov]age ,= purposes ( !       
application ( section #ahfb7;a77#a77;,a7
 to a break?r\gh device furni%$ aft] !  
transitional cov]age p]iod 7z def9$ 9   
p>agraph 7#a77;,b77 = su* device1 !     
,secret>y %all e/abli% a process = !    
cov]age ( su* break?r\gh devices "u ?is 
title aft] su* p]iod z foll[s3 7,a7     
,id5tification ( additional evid5ce  7i7
 ,9 g5]al ,) respect to a break?r\gh    
device1 n lat] ?an #a ye> aft] ! date ( 
! approval ( su* device "u section #eae 
( ! ,f$]al ,food1 ,drug1 & ,cosmetic    
,act or ( ! cle>ance ( su* device "u    
section #eaj7k7 ( su* ,act1 z           
applicable1 ! ,secret>y %all id5tify    
:e!r any additional data or evid5ce is  
requir$ ) respect to any indications =  
su* device = purposes ( ! application ( 
su* section #ahfb7;a77#a77;,a7 to su*   
device = su* indications4  7ii7         
,non-duplication ( data reque/s ,9 c>ry+
 out clause 7i7 ) respect to a          
break?r\gh device1 ! ,secret>y %all     
ensure t data or evid5ce id5tifi$-- 7,i7

 does n duplicate data requir$ to be    
collect$ by ! ,food & ,drug             
,adm9i/ration ) respect to su*          
break?r\gh device2  7,,ii7 m9imizes !   
adm9i/rative burd5s ( data collection & 
report+ on provid]s ( s]vices1 suppli]s1
 & manufactur]s ( break?r\gh devices2 & 
7,,iii7 is n o!rwise unnecess>y or      
r$undant4  7,b7 ,proposal = cov]age aft]
 ! transitional cov]age p]iod ,n lat]   
?an #b ye>s aft] ! date ( ! approval or 
cle>ance ( a break?r\gh device by !     
,food & ,drug ,adm9i/ration1 ! ,secret>y
 %all develop a proposal = cov]age "u   
?is title ( su* break?r\gh device = su* 
indications z ! ,secret>y det]m9es to be
 appropriate1 bas$ on ! data & evid5ce  
collect$ "u subp>agraph 7,a71 = su*     
devices furni%$ aft] ! transitional     
cov]age p]iod "u p>agraph 7#a7 = su*    
device4 ,if ! ,secret>y does n1 on a    
date t is be=e ! end ( su* two-ye>      
p]iod1 take action to modify !          
indications = :i* cov]age ( a break?r\gh
 device may be provid$ "u ?is title aft]

 su* p]iod1 = purposes ( section        
#ahfb7;a77#a77;,a7 cov]age "u ?is title 
( su* break?r\gh device %all be made =  
all indications = :i* su* device is     
approv$ "u section #eae ( ! ,f$]al      
,food1 ,drug1 & ,cosmetic ,act or cle>$ 
"u section #eaj7k7 ( su* ,act4  7#c7    
,rules ( con/ruction ,no?+ 9 ?is section
 %all be con/ru$ to-- 7,a7 affect !     
ability ( ! manufactur] ( a break?r\gh  
device to seek approval = pass-?r\gh    
paym5t /atus "u section #ahcc7t77#f7 or 
to seek approval = an additional paym5t 
"u section #ahhf7;d77#e77,k7 ins(> z su*
 break?r\gh device does n qualify =     
transitional cov]age "u p>agraph 7#a72  
7,b7 affect ! application & approval    
process = pass-?r\gh paym5t /atus "u    
section #ahcc7t77#f7 or = an additional 
paym5t "u section #ahhf7;d77#e77,k7 9 ! 
case ( a m$ical device t is n approv$ by
 ! ,food & ,drug ,adm9i/ration z a      
break?r\gh device2 or  7,c7 prohibit !  
,secret>y f us+ exi/+ au?ority "u ?is   
title to susp5d or t]m9ate cov]age ( a  

break?r\gh device if ! ,secret>y1 bas$  
on cl9ical evid5ce1 det]m9es t-- 7i7 su*
 break?r\gh device (f]s no cl9ical      
b5efit to ,m$ic>e b5efici>ies2 or  7ii7 
furni%+ su* break?r\gh device to ,m$ic>e
 b5efici>ies causes1 or may cause1 s]i\s
 h>m to ,m$ic>e b5efici>ies4  7c7 ,cod+ 
7#a7 ,prompt assignm5t ,n lat] ?an ?ree 
mon?s aft] ! date ( approval or cle>ance
 ( a break?r\gh device by ! ,food &     
,drug ,adm9i/ration1 ! ,secret>y %all   
assign a unique tempor>y or p]man5t code
 or codes = purposes ( cov]age & paym5t 
= su* break?r\gh device "u ! applicable 
paym5t sy/ems 7describ$ 9 p>agraph      
7#d774  7#b7 ,updates  7,a7 ,,ipps ,!   
,secret>y %all provide = semiannual     
updates "u ! applicable paym5t sy/em    
describ$ 9 p>agraph 7#d77;,a7 7relat+ to
 ! inpati5t hospital prospective paym5t 
sy/em7 to recognize ! code or codes     
assign$ "u p>agraph 7#a74  7,b7 ,,opps  
,! ,secret>y %all provide = qu>t]ly     
updates "u ! applicable paym5t sy/em    
describ$ 9 p>agraph 7#d77;,b7 7relat+ to

 ! outpati5t hospital prospective paym5t
 sy/em7 to recognize ! code or codes    
assign$ "u p>agraph 7#a74  7,c7 ,o!r    
paym5t sy/ems ,! ,secret>y %all provide 
= semiannual or qu>t]ly updates1 z !    
case may be1 "u ! applicable paym5t     
sy/ems describ$ 9 subp>agraphs 7,c7     
?r\gh 7,l7 ( p>agraph 7#d7 to recognize 
! code or codes assign$ "u p>agraph     
7#a74  7#c7 ,transp>5cy ,! process = !  
assignm5t ( a code or codes "u ?is      
subsection %all provide = public notice 
& a mean+ful opportunity = public comm5t
 f affect$ p>ties4  7#d7 ,applicable    
paym5t sy/ems describ$ ,= purposes ( ?is
 subsection1 ! t]m applicable paym5t    
sy/ems means-- 7,a7 ) respect to        
inpati5t hospital s]vices1 ! prospective
 paym5t sy/em = inpati5t hospital       
s]vices e/abli%$ "u section #ahhf7;d72  
7,b7 ) respect to outpati5t hospital    
s]vices1 ! prospective paym5t sy/em =   
cov]$ ,,opd s]vices e/abli%$ "u section 
#ahcc7t72  7,c7 ) respect to ambulatory 
surgical c5t] s]vices1 ! fee s*$ule =   

su* s]vices e/abli%$ "u #ahcc7;i72  7,d7
 ) respect to physicians' s]vices1 !    
physician fee s*$ules e/abli%$ "u       
section #ahdh2  7,e7 ) respect to cov]$ 
items ( durable m$ical equipm5t1 !      
applicable fee s*$ules e/abli%$ "u      
section #ahcd2  7,f7 ) respect to       
diagno/ic laboratory te/s1 ! paym5t     
am\nts "u section #ahcd;,a & ! fee      
s*$ules e/abli% "u section #ahdh1 z !   
case may be2  7,g7 ) respect to inpati5t
 hospital s]vices furni%$ by            
rehabilitation facilities1 ! prospective
 paym5t sy/em e/abli%$ "u section       
#ahhf7;j72  7,h7 ) respect to inpati5t  
hospital s]vices furni%$ by long-t]m c>e
 hospitals1 ! prospective paym5t sy/em  
"u section #ahhf7m72  7,i7 ) respect to 
inpati5t hospital s]vices furni%$ by    
psy*iatric hospitals & psy*iatric units1
 ! prospective paym5t sy/em "u section  
#ahhf7s72  7,j7 ) respect to home heal? 
s]vices1 ! prospective paym5t sy/em "u  
section #ahie2 &  7,k7 ) respect to     
items & s]vices1 or a provid] ( s]vices 

or suppli]1 n describ$ 9 subp>agraphs   
7,a7 ?r\gh 7,i71 ! paym5t sy/em e/abli%$
 "u ?is title = su* items & s]vices :5  
furni%$ by su* provid] ( s]vices or     
suppli]4  7d7 ,paym5t  7#a7 ,inpati5t   
hospital prospective paym5t sy/em3 deem$
 eligibility = break?r\gh paym5t ,!     
,secret>y %all deem ea* break?r\gh      
device z approv$ = an additional paym5t 
"u section #ahhf7;d77#e77,k7 = ! #d-ye> 
p]iod t beg9s-- 7,a7 except z provid$ 9 
subp>agraph 7,b71 on ! date t !         
,secret>y1 pursuant to subsection       
7c77#b77;,a71 updates ! paym5t sy/em "u 
section #ahhf7;d7 to recognize ! unique 
tempor>y or p]man5t code or codes       
assign$ "u subsection 7c77#a7 to su*    
break?r\gh device2 or  7,b7 9 ! case ( a
 device t has n receiv$ approval or     
cle>ance z a break?r\gh device by !     
,food & ,drug ,adm9i/ration be=e su*    
paym5t sy/em is updat$ "u subsection    
7c77#b77;,a7 to recognize ! unique      
tempor>y or p]man5t code or codes       
assign$ "u subsection 7c77#a7 to su*    

device1 on ! date ( su* approval or     
cle>ance4  ,no?+ 9 ?is p>agraph %all be 
con/ru$ to affect ! au?ority ( !        
,secret>y to use claims data to e/abli% 
new diagnosis or proc$ure codes =       
break?r\gh devices or to id5tify        
appropriate diagnosis-relat$ gr\ps = !  
assignm5t ( break?r\gh devices "u annual
 rulemak+ to c>ry out section           
#ahhf7;d77#e77,k74  7#b7 ,outpati5t     
prospective paym5t sy/em3 deem$         
eligibility = pass-?r\gh paym5t ,!      
,secret>y %all deem ea* break?r\gh      
device z approv$ = pass-?r\gh paym5t "u 
section #ahcc7t77#f7 7includ+ = purposes
 ( section #ahcc7;i77#b77;,d77 dur+ !   
#d-ye> p]iod t beg9s-- 7,a7 except z    
provid$ 9 subp>agraph 7,b71 on ! date t 
! ,secret>y1 pursuant to subsection     
7c77#b77;,b71 updates ! paym5t sy/em "u 
section #ahcc7t7 to recognize ! unique  
tempor>y or p]man5t code or codes       
assign$ "u subsection 7c77#a7 to su*    
break?r\gh device2 or  7,b7 9 ! case ( a
 device t has n receiv$ approval or     

cle>ance z a break?r\gh device by !     
,food & ,drug ,adm9i/ration be=e su*    
paym5t sy/em is updat$ "u subsection    
7c77#b77;,b7 to recognize ! unique      
tempor>y or p]man5t code or codes       
assign$ "u subsection 7c77#a7 to su*    
device1 on ! date ( su* approval or     
cle>ance4  ,no?+ 9 ?is p>agraph %all be 
con/ru$ to affect ! au?ority ( !        
,secret>y to use claims data to e/abli% 
new ambulatory paym5t classification    
gr\ps = break?r\gh devices or to revise 
su* gr\ps to take into acc\nt break?r\gh
 devices "u annual rulemak+ to c>ry out 
section #ahcc7t74  7#c7 ,o!r paym5t     
sy/ems  7,a7 ,9 g5]al ,9 ! case ( a     
break?r\gh device t is furni%$ & = :i*  
paym5t may be made "u ! paym5t sy/em    
e/abli%$ "u section #ahcd1 #ahcd;,a1    
#ahdh1 #ahhf7;j71 #ahhf7m71 #ahhf7s71 or
 #ahie or any o!r provision ( ?is title 
7o!r ?an sections #ahcc7;i71 #ahcc7t71 &
 #ahhf7;d771 ! ,secret>y %all provide = 
an additional paym5t = su* break?r\gh   
device "u su* applicable paym5t sy/em or

 an adju/m5t to su* applicable paym5t   
sy/em1 z ! case may be4 ,! paym5t basis 
= su* additional paym5t or adju/m5t1 z !
 case may be1 %all equal an am\nt t !   
,secret>y det]m9es cov]s ! co/s ( su*   
break?r\gh device4  7,b7 ,co/ in=mation 
,9 det]m9+ ! co/s ( a break?r\gh device 
= purposes ( det]m9+ an additional      
paym5t or paym5t adju/m5t "u subp>agraph
 7,a71 ! ,secret>y %all use ! mo/       
rec5tly available data & in=mation on ! 
co/s ( su* break?r\gh device1 :i* may   
include li/ prices & invoice prices *>g$
 = su* break?r\gh device4  7,c7 ,rule ( 
con/ruction ,no?+ 9 ?is p>agraph %all be
 con/ru$ to affect ! au?ority ( !       
,secret>y to use claims data to e/abli% 
new or modify exi/+ ambulatory paym5t   
classification gr\ps1 diagnosis-relat$  
gr\ps1 level ,,ii ,,hcpcs codes or su*  
o!r gr\ps or codes z ! ,secret>y may    
e/abli% "u ! annual rulemak+ au?ority "u
 ! provisions ref]r$ to 9 subp>agraph   
7,a74  7,d7 ,cl9ical diagno/ic          
laboratory te/s ,an additional paym5t or

 paym5t adju/m5t "u subp>agraph 7,a7 = a
 break?r\gh device "u ! applicable      
paym5t sy/em e/abli%$ 9 section #ahcd;,a
 may be 9 ! =m ( an increase to ! am\nt 
det]m9$ = ! break?r\gh device us+       
cross-walk+ "u section                  
#ahcd;,a7c77#a77;,a71 an ext5sion ( !   
initial p]iod ( paym5t applicable to    
advance diagno/ic laboratory te/s "u    
section #ahcd;,a7d77#a77;,a71 & 9 su*   
o!r =m or mann] z ! ,secret>y det]m9es  
reflects ! co/s = su* break?r\gh device 
"u ! relevant provisions ( section      
#ahcd;,a4  7#d7 ,paym5t = break?r\gh    
devices aft] ! transitional cov]age     
p]iod ,paym5t = a break?r\gh device t is
 furni%$ aft] ! conclusion ( !          
transitional cov]age p]iod "u subsection
 7b77#a7 = su* device %all be made      
pursuant to ! applicable paym5t sy/em   
involv$1 tak+ into acc\nt ! additional  
evid5ce & data collect$ "u subsection   
7b77#b74  7e7 ,special rules = c]ta9    
break?r\gh devices  7#a7 ,cov]age (     
specifi$ break?r\gh devices  7,a7 ,9    

g5]al ,subject to ! succe$+ provisions (
 ?is subsection & not)/&+ any o!r       
provision ( law1 ! ,secret>y %all       
provide = cov]age & paym5t pursuant to  
?is section ( a specifi$ break?r\gh     
device 7z def9$ 9 subp>agraph 7,b774    
7,b7 ,specifi$ break?r\gh device def9$  
,9 ?is section1 ! t]m specifi$          
break?r\gh device means a break?r\gh    
device ) respect to :i* no ,m$ic>e      
b5efit category exi/s4  7#b7 ,p]iod (   
transitional cov]age  7,a7 ,9 g5]al     
,subject to subp>agraph 7,c71 !         
provisions ( subsection 7b77#a7 7relat+ 
to ! transitional cov]age p]iod & paym5t
 = break?r\gh devices1 includ+ ! use ( !
 mo/ rec5tly available data & in=mation 
on co/s7 %all apply to a specifi$       
break?r\gh device 9 ! same mann] z su*  
provisions apply to a break?r\gh device4
 ,! ,secret>y may use me?odologies "u   
exi/+ paym5t sy/ems e/abli%$ "u ?is     
title1 may provide = appropriate        
adju/m5ts to su* me?odologies1 or may   
e/abli% a new paym5t me?odology "u ?is  

title1 to provide = paym5t = a specifi$ 
break?r\gh device to ensure ! paym5t    
basis = su* paym5t cov]s co/s ( !       
specifi$ break?r\gh device are cov]$ by 
su* paym5t4  7,b7 ,report  7i7 ,9 g5]al 
,) respect to ea* specifi$ break?r\gh   
device1 ! ,secret>y %all submit to      
,congress a report on ! cov]age ( &     
paym5t = su* specifi$ break?r\gh device 
"u ?is section t includes ! foll[+      
in=mation3 7,i7 ,! mann] 9 :i* cov]age  
is provid$ & paym5t is made = ! specifi$
 break?r\gh device1 includ+ h[ su*      
device 0 classifi$ 7su* z an item (     
durable m$ical equipm5t or o!rwise7 & ! 
paym5t me?odology ! ,secret>y appli$ )  
respect to su* device4  7,,ii7 ,! impact
 ( ! availability ( ! specifi$          
break?r\gh device to ,m$ic>e            
b5efici>ies1 includ+ impacts on !       
quality ( pati5t c>e1 pati5t outcomes1 &
 pati5t exp]i5ce4  7,,iii7 ,! impact ( !
 availability ( ! specifi$ break?r\gh   
device to ,m$ic>e b5efici>ies on program
 exp5ditures "u ?is title4  7,,iv7 ,su* 

o!r in=mation z ! ,secret>y det]m9es to 
be appropriate4  7ii7 ,deadl9e  7,i7 ,9 
g5]al ,except z provid$ 9 subclause     
7,,ii71 ! ,secret>y %all submit a report
 requir$ "u ?is subp>agraph no lat] ?an 
! end ( ! transitional p]iod ( cov]age &
 paym5t applicable to su* specifi$      
break?r\gh device4  7,,ii7 ,ext5sion to 
g5]ate additional data ,if ! ,secret>y  
det]m9es t additional data or evid5ce is
 requir$ to complete a report requir$ "u
 ?is subp>agraph ) respect to a specifi$
 break?r\gh device1 ! deadl9e "u ?is    
clause may be ext5d$ = an additional two
 ye>s4  7,c7 ,additional p]iod (        
transitional cov]age to develop         
additional data ,ins(> z ! ,secret>y    
det]m9es t additional data or evid5ce is
 requir$ to complete a report requir$ "u
 subp>agraph 7,b7 ) respect to a        
specifi$ break?r\gh device1 !           
transitional cov]age p]iod ( cov]age &  
paym5t = su* device %all be ext5d$ by ! 
less] (-- 7i7 two ye>s2 or  7ii7 ! am\nt
 ( additional "t requir$ = ! submission 

( ! report ) respect to su* device4     
7#c7 ,cov]age & paym5t aft] !           
transitional p]iod ,! ,secret>y may     
cont9ue to provide = cov]age ( & paym5t 
= a specifi$ break?r\gh device aft] !   
end ( ! transitional p]iod ( cov]age &  
paym5t = break?r\gh devices ?r\gh !     
national cov]age det]m9ation process if 
! ,secret>y det]m9es t ! specifi$       
break?r\gh device-- 7,a7 improves !     
quality ( c>e & pati5t outcomes2  7,b7  
improves ! deliv]y ( c>e2 or  7,c7      
r$uces sp5d+ "u ?is title )\t r$uc+ !   
quality ( c>e4  4  7b7 ,con=m+ am5dm5ts 
7#a7 ,inpati5t prospective paym5t sy/em 
,section #ahhf7;d77#e77,k7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77,k77 is am5d$ by add+ at 
! end ! foll[+ new clause3  7x7         
,effective = dis*>ges occurr+ on or aft]
 ,octob] #a1 #bjai1 9 ! case ( a new    
m$ical s]vice or te*nology t is a       
break?r\gh device 7z def9$ 9 section    
#ahii;,c7a771 ! additional paym5t       
e/abli%$ = su* break?r\gh device "u ?is 

subp>agraph %all be made = ! #d-ye>     
p]iod applicable to su* break?r\gh      
device "u section #ahii;,c7d77#a74 ,9   
det]m9+ ! am\nt ( ! additional paym5t = 
a break?r\gh device "u ?is subp>agraph  
dur+ su* #d-ye> p]iod1 ! ,secret>y %all 
apply section #dab4hh7;b7 ( title #db1  
,code ( ,f$]al ,regulations1 z 9 effect 
on ! date ( ! enactm5t ( ?is clause1    
except z if ! ref]5ce 9 su* section to  
#fe p]c5t 7 a ref]5ce to #fe p]c5t 7or  
su* great] p]c5t specifi$ by !          
,secret>y74  4  7#b7 ,outpati5t         
prospective paym5t sy/em ,section       
#ahcc7t77#f77;,c7 ( su* ,act 7#db       
,u4,s4,c4 #aciel7t77#f77;,c77 is am5d$  
by add+ at ! end ! foll[+ new clause3   
7iii7 ,special rule = break?r\gh devices
 ,not)/&+ clause 7i7 or 7ii71 or any o!r
 provision ( ?is p>agraph to ! contr>y1 
9 ! case ( a break?r\gh device 7z def9$ 
9 section #ahii;,c7a77 t is furni%$ on  
or aft] ,janu>y #a1 #bjbj1 paym5t "u ?is
 p>agraph = su* break?r\gh device %all  
be made = ! #d-ye> p]iod applicable to  

su* break?r\gh device "u section        
#ahii;,c7d77#b74 ,! provisions ( ?is    
clause %all also apply = purposes (     
transitional pass-?r\gh paym5t "u       
section #ahcc7;i77#b77;,d74  4  7c7     
,effective date ,?is section1 & !       
am5dm5ts made by ?is section1 %all take 
effect on ! date ( ! enactm5t ( ?is ,act
 &1 unless o!rwise specifi$ 9 ?is       
section 7or 9 an am5dm5t made by ?is    
section71 %all apply to break?r\gh      
devices 7z def9$ 9 section #ahii;,c7a7 (
 ! ,social ,security ,act1 z add$ by    
subsection 7a771 approv$ or cle>$ on or 
aft] ,july #a1 #bjai1 or1 9 ! case ( a  
specifi$ break?r\gh device 7z def9$ 9   
su* section z s add$71 approv$ or cle>$ 
on or aft] ,decemb] #a1 #bjah4