Page:United States Statutes at Large Volume 113 Part 2.djvu/857

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PUBLIC LAW 106-113—APPENDIX F 113 STAT. 1501A-339 "(i) IN GENERAL.— The total of the additional pay- ments made under this paragraph for covered OPD services furnished in a year (as estimated by the Secretary before the beginning of the year) may not exceed the applicable percentage (specified in clause (ii)) of the total program payments estimated to be made under this subsection for all covered OPD services furnished in that year. If this paragraph is first applied to less than a full year, the previous sentence shall apply only to the portion of such year. " (ii) APPLICABLE PERCENTAGE.— For purposes of clause (i), the term 'applicable percentage' means— "(I) for a year (or portion of a year) before 2004, 2.5 percent; and "(II) for 2004 and thereafter, a percentage specified by the Secretary up to (but not to exceed) 2.0 percent. "(iii) UNIFORM PROSPECTIVE REDUCTION IF AGGRE- GATE LIMIT PROJECTED TO BE EXCEEDED. — If the Secretary estimates before the beginning of a year that the amount of the additional payments under this paragraph for the year (or portion thereof) as determined under clause (i) without regard to this clause will exceed the limit established under such clause, the Secretary shall reduce pro rata the amount of each of the additional payments under this paragraph for that year (or portion thereof) in order to ensure that the aggregate additional payments under this paragraph (as so estimated) do not exceed such limit.". (c) APPLICATION OF NEW ADJUSTMENTS ON A BUDGET NEUTRAL BASIS.— Section 1833(t)(2)(E) (42 U.S.C. 13951(t)(2)(E)) is amended by striking "other adjustments, in a budget neutral manner, as determined to be necessary to ensure equitable payments, such as outlier adjustments or" and inserting ", in a budget neutral manner, outlier adjustments under paragraph (5) and transitional pass-through payments under paragraph (6) and other adjustments as determined to be necessary to ensure equitable payments, such as. (d) LIMITATION ON JUDICIAL REVIEW FOR NEW ADJUSTMENTS. — Section 1833(t)(ll), as redesignated by subsection (a)(1), is amended— (1) by striking "and" at the end of subparagraph (C); (2) by striking the period at the end of subparagraph (D) and inserting "; and"; and (3) by adding at the end the following: "(E) the determination of the fix<jd multiple, or a fixed dollar cutofi" amount, the marginal cost of care, or applicable percentage under paragraph (5) or the determination of insignificance of cost, the; duration of the additional payments (consistent with paragraph (6)(B)), the portion of the medicare OPD fee schedule amount associated with particular devices, drugs, or biologicals, and the application of any pro rata reduction under paragraph (6).". (e) INCLUSION OF CERTAIN IMPLANTABLE ITEMS UNDER SYSTEM.— (1) IN GENERAL.— Section 1833(t) (42 U.S.C. 13951(t)) is amended—