,,ii #aai? ,,congress #b;d ,session ,s4 #eahj ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,july #cj1 #bjbf,mr4 ,boozman 7= himself1 ,mr4 ,wel*1 ,mr4 ,m>%all1 ,mr4 ,k+1 ,mr4 ,tillis1 & ,mrs4 ,%ahe57 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to ensure /ability = provid] paym5ts "u ! ,m$ic>e program4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,provid] ,reimbursem5t ,/ability ,act ( #bjbf4 #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 p>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 #bjbh1 #bj1jjj1jjj2 7,,bb7 = #bjbh1 #eg1fdj1jjj2 & 7,,cc7 = #bjbi & ea* subsequ5t ye>1 ! am\nt specifi$ 9 ?is item = ! prec$+ ye>4 7cc7 ,index+ limitation on annual adju/m5ts ,= #bjcc & e subsequ5t fif? ye>1 ! ,secret>y %all increase ! am\nt specifi$ 9 item 7bb7 = su* ye> by ! cumulative p]c5tage increase 9 ! ,,mei 7z def9$ 9 section #ahdb7;i77#c77 applicable to physicians' s]vices = ea* ye> occurr+ dur+ ! #e-ye> p]iod end+ on ! la/ day ( ! prec$+ ye>4 4 #c4 ,budget neutrality corrections relat+ to e/imat$ 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 relat+ to e/imat$ utilization 7,i7 ,9 g5]al ,9 ! case ( a budget neutrality adju/m5t appli$ pursuant to clause 7ii77,,ii7 = a ye> 7beg9n+ ) #bjbi7 t is det]m9$ 9 "p us+ e/imat$ utilization 7z def9$ 9 subclause 7,,ii77bb77 ) respect to a specifi$ s]vice 7z def9$ 9 subclause 7,,ii77cc771 ! ,secret>y %all1 z "p ( ! f9al rule e/abli%+ ! physician fee s*$ule "u ?is section = ! assumption correction p]iod 7z def9$ 9 subclause 7,,ii77aa77 ) respect to su* ye>-- 7aa7 det]m9e ! diff]5ce betwe5 exp5ditures = su* s]vice 9 su* ye> us+ e/imat$ utilization & actual utilization = su* s]vice 79 a mann] det]m9$ appropriate by ! ,secret>y72 & 7bb7 9 ! case t ! ,secret>y det]m9es ! diff]5ce describ$ 9 item 7aa7 is great] ?an ! ?re%old am\nt 7z def9$ 9 subclause 7,,ii77dd77 = su* ye>1 adju/ ! conv]sion factor "u ?is section = su* assumption correction p]iod by su* am\nt to reconcile su* diff]5ce 7:i* may be positive or negative71 z det]m9$ by ! ,secret>y4 7,,ii7 ,def9itions ,= purposes ( ?is clause3 7aa7 ,assumption correction p]iod ,! t]m assumption correction p]iod means1 ) respect to a ye>1 ! second ye> beg9n+ aft] su* ye>4 7bb7 ,e/imat$ utilization ,! t]m e/imat$ utilization means an e/imate ( utilization us$ = purposes ( apply+ clause 7ii77,,ii74 7cc7 ,specifi$ s]vice ,! t]m specifi$ s]vice means1 ) respect to a ye>1 a s]vice-- 7,,aa7 ) expect$ exp5ditures = su* ye> "u ?is section bas$ on e/imat$ utilization t exce$ ! ?re%old am\nt 7z def9$ 9 item 7dd77 = su* ye>2 & 7,,bb7 = :i* paym5t _h be5 bundl$ into paym5t = ano!r s]vice dur+ ! prec$+ ye> & = :i* a sep>ate paym5t or add-on paym5t is made dur+ su* ye>4 7dd7 ,?re%old am\nt ,! t]m ?re%old am\nt means1 ) respect to a ye>1 #j4a p]c5t ( ! total e/imat$ exp5ditures "u ?is "p = s]vices furni%$ "u ?is section dur+ su* ye>4 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$-- 7#a7 9 clause 7iv7-- 7,a7 9 subclause 7,v71 by /rik+ & at ! end2 7,b7 9 subclause 7,,vi71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subclause3 7,,vii7 clause 7vii77,i77bb7 = an assumption correction p]iod 7z def9$ 9 clause 7vii77,,ii77 %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$uctions attributable to an assumption correction ,= an assumption correction p]iod 7z def9$ 9 clause 7vii77,,ii771 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 lat] ?an #e ye>s aft] ! date ( ! enactm5t ( ?is clause1 & n less (t5 ?an e #e ye>s !reaft]1 update ! prices & rates1 z applicable1 on a category-wide basis = ea* ( ! categories ( direct co/ 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 categories ( direct co/ inputs describ$ 9 su* subclause4 7,,ii7 ,direct co/ inputs categories describ$ ,= purposes ( ?is clause1 ! categories ( direct co/ inputs describ$ 9 ?is subclause are cl9ical /aff wage rates1 prices ( m$ical supplies1 prices ( equipm5t1 & any o!r category ( su* inputs us$ 9 ! me?odology describ$ 9 subclause 7,i7 7z specifi$ by ! ,secret>y74 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 ,beg9n+ ) #bjbh1 ! ,secret>y may n1 = purposes ( comply+ ) clause 7ii77,,ii71 apply a budget neutrality adju/m5t to a conv]sion factor e/abli%$ "u subsection 7d7 = su* ye> t w\ld cause su* factor1 n tak+ into acc\nt any adju/m5t to su* factor = su* ye> provid$ "u su* subsection1 to v>y by m ?an #b4e p]c5t comp>$ to su* factor s e/abli%$ = ! prec$+ ye>4 7,,ii7 ,cont9u$ applicability ( budget neutrality requirem5t ,no?+ 9 subclause 7,i7 may be con/ru$ to alt] ! requirem5t describ$ 9 clause 7ii77,,ii74 4