,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #fcga  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #ac1         
#bjbc,mr4 ,murphy 7= himself1 ,mr4      
,burgess1 ,mr4 ,w5/rup1 ,ms4 ,kelly (   
,ill9ois1 ,mr4 ,buc%on1 ,mr4 ,van ,drew1
 ,mrs4 ,mill]-,meeks1 ,mr4 ,h>ris1 ,mr4 
,bab91 ,mr4 ,joyce ( ,p5nsylvania1 ,mr4 
,jackson ( ,texas1 ,mr4 ,mc,cormick1    
,mr4 ,f]guson1 ,mr4 ,dunn ( ,florida1 & 
,mr4 ,c>t] ( ,georgia7 introduc$ !      
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committee on ,ways &     
,means1 = 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 provide = c]ta9 adju/m5ts  
to ! physician fee s*$ule "u ! ,m$ic>e  
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,provid] ,reimbursem5t      
,/ability ,act ( #bjbc4  #b4 ,updat+ !  
budget neutrality ?re%old ,section      
#ahdh7;c77#b77;,b77ii77,,ii7 ( ! ,social

 ,security ,act 7#db ,u4,s4,c4          
#aciew-#d7;c77#b77;,b77ii77,,ii77 is    
am5d$--  7#a7 by /rik+ ,subject to &    
ins]t+ ! foll[+3  7aa7 ,9 g5]al ,subject
 to  2  7#b7 9 item 7aa71 z ins]t$ by   
subp>agraph 7,a71 by /rik+ #bj1jjj1jjj &
 ins]t+ ! am\nt specifi$ 9 item 7bb7 =  
su* ye>2 &  7#c7 by add+ at ! end !     
foll[+ new items3  7bb7 ,am\nt specifi$ 
,= purposes ( item 7aa71 subject to item
 7cc71 ! am\nt specifi$ 9 ?is item is-- 
7,,aa7 = ye>s be=e #bjbe1 #bj1jjj1jjj2  
7,,bb7 = #bjbe1 #ec1jjj1jjj2 & 7,,cc7 = 
#bjbf & ea* subsequ5t ye>1 ! am\nt      
specifi$ 9 ?is item = ! prec$+ ye>4     
7cc7 ,index+ limitation on annual       
adju/m5ts ,= #bjcj & e subsequ5t fif?   
ye>1 ! ,secret>y %all increase ! am\nt  
specifi$ 9 item 7bb7 = su* ye> by !     
cumulative increase 9 ! ,,mei 7z def9$ 9
 section #ahdb7;i77#c77 applicable to   
physicians' s]vices ov] ! #e-ye> p]iod  
end+ on ! la/ day ( ! prec$+ ye>4  4    
#c4 ,budget neutrality corrections =    
ov]e/imates & und]e/imates 9 utilization

  7a7 ,9 g5]al ,section                 
#ahdh7;c77#b77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#d7;c77#b77;,b77 is am5d$ by add+
 at ! end ! foll[+ new clause3  7vii7   
,budget neutrality corrections =        
ov]e/imates & und]e/imates 9 utilization
  7,i7 ,9 g5]al ,9 ! case ( a budget    
neutrality adju/m5t appli$ pursuant to  
clause 7ii77,,ii7 = an adju/m5t         
application ye> 7z def9$ 9 clause       
7viii77,i77 beg9n+ ) #bjbe1 ) respect to
 an adju/m5t to relative value units    
made "u clause 7ii77,i71 t is det]m9$   
us+ e/imat$ utilization 7z def9$ 9      
clause 7viii77,,iii77-- 7aa7 ! ,secret>y
 %all1 by n lat] ?an ,septemb] #a ( !   
subsequ5t ye>-- 7,,aa7 comp>e su*       
e/imat$ utilization to actual           
utilization occurr+ dur+ su* adju/m5t   
application ye> ) respect to ! adju/m5t 
to ! relative value units made "u clause
 7ii77,i72 & 7,,bb7 if applicable1      
det]m9e ! ext5t to :i*1 if any1 !       
diff]5ce betwe5 ! e/imat$ utilization & 

su* actual utilization affect$ ! am\nt (
 su* budget neutrality adju/m5t appli$ =
 su* adju/m5t application ye>2 &  7bb7 9
 ! case t ! ,secret>y det]m9es "u       
subclause 7,i77bb7 t ! diff]5ce betwe5 !
 e/imat$ utilization & su* actual       
utilization affect$ ! am\nt ( ! budget  
neutrality adju/m5t appli$ = su*        
adju/m5t application ye>1 ! ,secret>y   
%all adju/ ! am\nt ( paym5t made "u ?is 
section = s]vices furni%$ dur+ !        
adju/m5t correction p]iod 7z def9$ 9    
clause 7viii77,,ii77 ) respect to su*   
ye> by su* am\nt z det]m9$ necess>y by !
 ,secret>y to reconcile ! diff]5ce 7:i* 
may be positive or negative7 betwe5--   
7,,aa7 ! budget neutrality adju/m5t t _h
 be5 appli$ = su* application adju/m5t  
ye>1 us+ ! e/imat$ utilization2 & 7,,bb7
 ! budget neutrality adju/m5t t w\ld h  
be5 appli$ = su* ye> if su* adju/m5t _h 
be5 calculat$ us+ su* actual            
utilization4  7,,ii7 ,def9itions ,=     
purposes ( ?is clause3  7aa7 ,adju/m5t  
application ye> ,! t]m adju/m5t         

application ye> means1 ) respect to an  
adju/m5t to relative value units made "u
 clause 7ii77,i7 = :i* a budget         
neutrality adju/m5t "u clause 7ii77,,ii7
 is requir$1 ! ye> = :i* su* adju/m5ts  
are appli$4  7bb7 ,adju/m5t correction  
p]iod ,! t]m adju/m5t correction p]iod  
means1 ) respect to an adju/m5t         
application ye>1 ! second ye> beg9n+    
aft] su* adju/m5t application ye>4  7cc7
 ,e/imat$ utilization ,! t]m e/imat$    
utilization means1 ) respect to an      
adju/m5t to relative value units made "u
 clause 7ii77,i71 an e/imate (          
utilization associat$ ) su* adju/m5t us$
 = purposes ( apply+ clause 7ii77,,ii74 
4  7b7 ,nonapplication ( budget         
neutrality to reconciliation adju/m5ts  
,section #ahdh7;c77#b77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;c77#b77;,b77 is am5d$--  7#a7
 9 clause 7iv7-- 7,a7 9 subclause 7,v71 
by /rik+ & at ! end2  7,b7 9 subclause  
7,,vi71 by /rik+ ! p]iod & ins]t+ 2 &2 &
  7,c7 by add+ at ! end ! foll[+ new    

subclause3  7,,vii7 clause 7vii77,i77bb7
 = an adju/m5t correction p]iod %all n  
be tak5 into acc\nt 9 apply+ clause     
7ii77,,ii7 ) respect to su* p]iod4  2 & 
7#b7 9 clause 7v71 by add+ at ! end !   
foll[+ new subclause3  7,,xii7          
,r$uctions attributable to an adju/m5t  
correction ,= an adju/m5t correction    
p]iod1 r$uc$ exp5ditures attributable to
 application ( clause 7vii77,i77bb7 )   
respect to su* p]iod4  4  #d4 ,timely   
updates to direct co/s us$ to calculate 
practice exp5se ,r,v,us ,section        
#ahdh7;c77#b77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#d7;c77#b77;,b771 z am5d$ by     
section #c1 is fur!r am5d$ by add+ at ! 
end ! foll[+ new clause3  7viii7 ,timely
 updates to direct co/s us$ to calculate
 practice exp5se relative value units   
7,i7 ,simultane\s updates to direct co/ 
inputs at lea/ once e #e ye>s ,!        
,secret>y %all1 n less (t5 ?an e #e     
ye>s1 update ! prices & rates1 z        
applicable1 = ea* ( ! direct co/s inputs

 describ$ 9 subclause 7,,ii7 us$ 9 !    
me?odology = calculat+ ! practice exp5se
 relative value units "u ?is subsection 
= physicians' s]vices4 ,updates made    
pursuant to ! previ\s s5t5ce %all be    
made 9 ! same ye> = all direct co/      
inputs describ$ 9 su* subclause4  7,,ii7
 ,direct co/s input categories describ$ 
,= purposes ( ?is clause1 ! direct co/s 
inputs describ$ 9 ?is subclause are     
cl9ical /aff wage rates1 prices ( m$ical
 supplies1 & prices ( equipm5t4  7,,iii7
 ,consultation ,9 mak+ ! updates "u ?is 
clause1 ! ,secret>y %all consult )      
relevant /akehold]s1 includ+ physician  
specialty societies4  4  #e4 ,limitation
 on ye>-to-ye> conv]sion factor v>iance 
,section #ahdh7;c77#b77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;c77#b77;,b771 z am5d$ by     
sections #c & #d1 is fur!r am5d$-- by   
add+ at ! end ! foll[+ new clause3  7ix7
 ,limitation on conv]sion factor v>iance
  7,i7 ,9 g5]al ,9 ! case t application 
( clause 7ii77,,ii7 = a ye> 7beg9n+ )   

#bjbe7 w\ld result 9 a conv]sion factor 
e/abli%$ "u subsection 7d7 = su* ye>1 n 
tak+ into acc\nt any adju/m5t provid$ "u
 su* subsection1 to v>y by m ?an #b4e   
p]c5t comp>$ to su* factor s e/abli%$ = 
! prec$+ ye> 79 ?is subclause ref]r$ to 
z ! prec$+ ye>'s conv]sion factor71 !   
,secret>y %all-- 7aa7 if su* application
 w\ld result 9 a decrease 9 su*         
conv]sion factor1 modify any budget     
neutrality adju/m5t appli$ to su*       
conv]sion factor pursuant to su* clause 
su* t su* conv]sion factor is decreas$  
by #b4e p]c5t1 n tak+ into acc\nt any   
adju/m5t provid$ "u su* subsection1     
comp>$ to ! prec$+ ye>'s conv]sion      
factor2 &  7bb7 if su* application w\ld 
result 9 an increase 9 su* conv]sion    
factor1 modify any budget neutrality    
adju/m5t appli$ to su* conv]sion factor 
pursuant to su* clause su* t su*        
conv]sion factor is increas$ by #b4e    
p]c5t1 n tak+ into acc\nt any adju/m5t  
provid$ "u su* subsection1 comp>$ to !  
prec$+ ye>'s conv]sion factor4  7,,ii7  

,special rule = #bjbe ,9 apply+         
subclause 7,i7 ) respect to ! conv]sion 
factor e/abli%$ "u subsection 7d7 =     
#bjbe1 9 det]m9+ :e!r ! application (   
clause 7ii77,,ii7 = su* ye> w\ld result 
9 su* conv]sion factor v>y+ by m ?an    
#b4e p]c5t comp>$ to su* factor s       
e/abli%$ = #bjbd1 ! ,secret>y %all take 
into acc\nt ! increase to su* conv]sion 
factor s e/abli%$ = #bjbd provid$ "u    
subsection 7t74  7,,iii7 ,cl>ification  
relat+ to transition to multiple        
conv]sion factors ,= #bjbf1 9 apply+    
subclause 7,i7 ) respect to ! qualify+  
,,apm conv]sion factor 7z describ$ 9    
subsection 7d77#a77;,a77 & ! nonqualify+
 ,,apm conv]sion factor 7z s describ$7  
e/abli%$ "u subsection 7d7 = su* ye>1   
ea* ref]5ce 9 su* subclause to ! prec$+ 
ye>'s conv]sion factor %all be deem$ to 
be a ref]5ce to ! s+le conv]sion factor 
7z describ$ 9 subsection 7d77#a77;,a77 s
 e/abli%$ = #bjbe4  4