123STA T . 3 540CON C UR R E NT RESO L UT I ONS — A P R.2 9, 2009 andlim i ts int h is re s o l u tion f or le g islation w hi c h has recei v ed final C ongressional a p proval in the same form by the H ouse of R epresentatives and the S enate , but has yet to be presented to or signed by the P resident at the time of final consideration of this resolution .SEC.41 4. ADJU S TM E N TST OR E FL ECT C H AN G ES I N CONCE P TS AND DEFINITIONS. U pon the enactment of a bill or j oint resolution providing for a change in concepts or definitions, the chairman of the Senate Committee on the B udget may ma k e adjustments to the levels and allocations in this resolution in accordance with section 251( b ) of the Balanced Budget and E mergency D eficit Control A ctof1 98 5 (as in effect prior to September 30 , 2002). SEC. 41 5 .E X ERCISE OF RULEMA K ING PO W ERS. T he Senate adopts the provisions of this subtitle — (1)asane x ercise of the rulemaking power of the Senate, and as such they shall be considered as part of the rules of the Senate and such rules shall supersede other rules only to the extent that they are inconsistent with such other rules
and (2) with full recognition of the constitutional right of the Senate to change those rules at any time, in the same manner, and to the same extent as is the case of any other rule of the Senate. Subti t leB—Ho u s e Enf o rc e m ent P ro v isions SEC. 4 2 1. ADJUSTMENTS FOR DIRECT SPENDING AND RE V ENUES. (a) A DJUSTMEN TS FOR CURRENT PO LICY .— (1) I N G ENER A L.— F or the policies set forth in and not to exceed the amounts in paragraph (2), and subject to the condition specified in paragraph (3), when the chairman of the House Committee on the Budget evaluates the budgetary effects of any provision in a bill, joint resolution, amendment, or conference report for the purposes of the Congressional Budget Act of 19 74 , this concurrent resolution, or the Rules of the House of Representatives relative to baseline estimates consistent with section 257 of the Balanced Budget and Emer - gency Deficit Control Act of 1985, he may exclude from his evaluation the budgetary effects of such provisions if such effects would have been reflected in a baseline adjusted for current policy. (2) POLICIES AND AMOUNTS.—Paragraph (1) shall apply only to the following provisions
(A) M EDICARE IM P RO V EMENTS.—An increase in the def- icit of not to exceed $ 38,000,000,000 in fiscal years 2010 through 2014 and of not to exceed $38,000,000,000 in fiscal years 2010 through 2019 by reforming the Medicare pay- ment system for physicians to— (i) change incentives to encourage efficiency and higher q uality care in a way that supports fiscal sustainability; (ii) improve payment accuracy to encourage effi- cient use of resources and ensure that primary care receives appropriate compensation;
