Ill STAT. 434 PUBLIC LAW 105-33—AUG. 5, 1997 "(B) 1 plus the Secretary's estimate of the percentage change (divided by 100) in the average number of individuals enrolled under this part (other than Medicare+Choice plan enrollees) from the previous fiscal year to the fiscal year involved, "(C) 1 plus the Secretary's estimate of the projected percentage growth in real gross domestic product per capita (divided by 100) from the previous fiscal year to the fiscal year involved, and "(D) 1 plus the Secretary's estimate of the percentage change (divided by 100) in expenditures for all physicians' services in the fiscal year (compared with the previous fiscal year) which will result from changes in law and regulations, determined without taking into account estimated changes in expenditures resulting from the update adjustment factor determined under subsection (d)(3)(B), minus 1 and multiplied by 100. "(3) DEFINITIONS.—In this subsection: " (A) SERVICES INCLUDED IN PHYSICIANS' SERVICES.— The term 'physicians' services' includes other items and services (such as clinical diagnostic laboratory tests and radiology services), specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to a Medicare+Choice plan enrollee. "(B) MEDICARE+CHOICE PLAN ENROLLEE.—The term 'Medicare+Choice plan enrollee' means, with respect to a fiscal year, an individual enrolled under this part who has elected to receive benefits under this title for the fiscal year through a Medicare+Choice plan offered under part C, and also includes an individual who is receiving benefits under this part through enrollment with an eligible organization with a risk-sharing contract under section 1876.". (b) CONFORMING AMENDMENT.—So much of section 1848(f) (42 U.S.C. 1395w-4(f)) as precedes paragraph (2) is amended to read as follows: "(f) SUSTAINABLE GROWTH RATE. — Federal Register, "(1) PUBLICATION. —The Secretary shall cause to have pubpublication, lished in the Federal Register the sustainable growth rate for each fiscal year beginning with fiscal year 1998. Such publication shall occur by not later than August 1 before each fiscal year, except that such rate for fiscal year 1998 shall be published not later than November 1, 1997.". SEC. 4504. PAYMENT RULES FOR ANESTHESIA SERVICES. (a) IN GENERAL.—Section 1848(d)(1) (42 U.S.C. 1395w-4(d)(l)), as amended by section 4501(a), is amended— (1) in subparagraph (C), by striking "The single" and inserting "Except as provided in subparagraph (D), the single"; (2) by redesignating subparagraph (D) as subparagraph (E);and (3) by inserting after subparagraph (C) the following new subparagraph: "(D) SPECIAL RULES FOR ANESTHESIA SERVICES.— The separate conversion factor for anesthesia services for a year shall be equal to 46 percent of the single conversion
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