124 STAT. 357 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(i) IN GENERAL.—The Secretary shall specify a value-based incentive payment percentage for a hos- pital for a fiscal year. ‘‘(ii) REQUIREMENTS.—In specifying the value- based incentive payment percentage for each hospital for a fiscal year under clause (i), the Secretary shall ensure that— ‘‘(I) such percentage is based on the hospital performance score of the hospital under paragraph (5); and ‘‘(II) the total amount of value-based incentive payments under this paragraph to all hospitals in such fiscal year is equal to the total amount available for value-based incentive payments for such fiscal year under paragraph (7)(A), as esti- mated by the Secretary. ‘‘(7) FUNDING FOR VALUE-BASED INCENTIVE PAYMENTS.— ‘‘(A) AMOUNT.—The total amount available for value- based incentive payments under paragraph (6) for all hos- pitals for a fiscal year shall be equal to the total amount of reduced payments for all hospitals under subparagraph (B) for such fiscal year, as estimated by the Secretary. ‘‘(B) ADJUSTMENT TO PAYMENTS.— ‘‘(i) IN GENERAL.—The Secretary shall reduce the base operating DRG payment amount (as defined in subparagraph (D)) for a hospital for each discharge in a fiscal year (beginning with fiscal year 2013) by an amount equal to the applicable percent (as defined in subparagraph (C)) of the base operating DRG pay- ment amount for the discharge for the hospital for such fiscal year. The Secretary shall make such reduc- tions for all hospitals in the fiscal year involved, regardless of whether or not the hospital has been determined by the Secretary to have earned a value- based incentive payment under paragraph (6) for such fiscal year. ‘‘(ii) NO EFFECT ON OTHER PAYMENTS.—Payments described in items (aa) and (bb) of subparagraph (D)(i)(II) for a hospital shall be determined as if this subsection had not been enacted. ‘‘(C) APPLICABLE PERCENT DEFINED.—For purposes of subparagraph (B), the term ‘applicable percent’ means— ‘‘(i) with respect to fiscal year 2013, 1.0 percent; ‘‘(ii) with respect to fiscal year 2014, 1.25 percent; ‘‘(iii) with respect to fiscal year 2015, 1.5 percent; ‘‘(iv) with respect to fiscal year 2016, 1.75 percent; and ‘‘(v) with respect to fiscal year 2017 and succeeding fiscal years, 2 percent. ‘‘(D) BASE OPERATING DRG PAYMENT AMOUNT DEFINED.— ‘‘(i) IN GENERAL.—Except as provided in clause (ii), in this subsection, the term ‘base operating DRG payment amount’ means, with respect to a hospital for a fiscal year— ‘‘(I) the payment amount that would otherwise be made under subsection (d) (determined without
