104 STAT. 1388-60 PUBLIC LAW 101-508—NOV. 5, 1990 section for the 9-month period beginning April 1, 1990. In a case in which subparagraph (F) applies (relating to new physicians) so as to limit the customary charges of a physician during 1990 to a percent of prevailing charges, the previous sentence shall not prevent such limit on customary charges under such subparagraph from increasing in 1991 to a higher percent of such prevailing charges.". (3) CHANGE IN PAYMENT FOR YEARS AFTER 1991.— Section 1848 of such Act (42 U.S.C. 1395w-4) is amended in subsection (d)(3)(A)- (A) in clause (i), by inserting "except as provided in clause (iii)," after "subparagraph (B),", and (B) by adding at the end the following new clause: "(iii) ADJUSTMENT IN PERCENTAGE INCREASE. — In applying clause (i) for services furnished in 1992 for which the appropriate update index is the index described in clause (ii)(I), the percentage increase in the appropriate update index shall be reduced by 0.4 percentage points.". (b) INCREASE IN PREVAILING CHARGE FLOOR FOR PRIMARY CARE SERVICES (1) IN GENERAL.—Section 1842(b)(4)(A)(vi) of such Act (42 U.S.C. 1395u(b)(4)(A)(vi)) is amended by striking "50 percent" and inserting "60 percent". 42 USC 1395W-4 (2) BUDGET NEUTRAL IMPLEMENTATION.— In computing the note. conversion factor under section 1848(d)(1)(B) of the Social Security Act for 1992, the Secretary of Health and Human Services shall determine the estimated aggregate amount of payments under part B of title XVIII of such Act for physicians' services in 1991 assuming that the amendments made by this subsection did not apply. 42 USC I395u (3) EFFECTIVE DATE.—The amendments made by paragraphs note. (1) and (2) shall apply to services furnished on or after January 1, 1991. (c) VOLUME PERFORMANCE STANDARD FOR FISCAL YEAR 1991. — Section 1848(f) (42 U.S.C. 1395w-4(f)) is amended— (1) in paragraph (1)(C), by striking "1990" the first place it appears and inserting "1991, and (2) by adding at the end of paragraph (2) the following: "(C) Notwithstanding subparagraph (A), the performance standard rate of increase for a category of physicians' services for fiscal year 1991 shall be the sum of— "(i) the Secretary's estimate of the percentage by which actual expenditures for the category of physicians' services under this part for fiscal year 1991 exceed actual expenditures for such category of services in fiscal year 1990 (determined without regard to the amendments made by the Omnibus Budget Reconciliation Act of 1990), and "(ii) the Secretary's estimate of the percentage increase or decrease in expenditures for the category of services in fiscal year 1991 (compared with fiscal year 1990) that will result from changes in law and regulations (including the Omnibus Budget Reconciliation Act of 1990), reduced by 2 percentage points.". 42 USC 1395W-4 (d) Not later than 45 days after the date of the enactment of this note. Act, the Secretary of Health and Human Services, based on the most recent data available, shall estimate and publish in the Federal
�
