Page:United States Statutes at Large Volume 104 Part 2.djvu/475

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PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-67 Revised September 20, 1989, prepared by the Physician Payment Review Commission"; (D) in subparagraph (C)(iii), by striking "The 'percent change' specified in this clause, for a physicians' service specified in clause (i), is the percent change specified for the service in table #2 in the Joint Explanatory Statement" and inserting "The 'percentage change' specified in this clause, for a physicians' service specified in clause (i), is the percent difference (but expressed as a positive number) specified for the service in the list"; and (E) in subparagraph (C)(iv), by striking "such value specified for the locality in table # 3 in the Joint Explanatory Statement referred to in clause (i)" and inserting "the Geographic Overhead Costs Index specified for the locality in table 1 of the September 1989 Supplement to the Geographic Medicare Economic Index: Alternative Approaches (prepared by the Urban Institute and the Center for Health Economics Research)". (2) Section 1842(b)(4)(E)(iv)(I) of such Act (42 U.S.C. 1395u(b)(4)(E)(iv)(I)) is amended by striking "Table #2" and all that Allows through "101st Congress" and inserting "the list referred to in paragraph (14)(C)(i)'. (3) The amendments made by paragraphs (1) and (2) apply to 42 USC 1395u services furnished after March 1990. "°**- 03) MVPS AS MULTIPLICATIVE, NOT ADDITIVE.— Section 1848(f)(2)(A) (42 U.S.C. 1395w-4(f)(2)(A)) is amended— (1) in the matter preceding clause (i) by striking "sum" and inserting "product"; (2) in clauses (i) through (iy), by inserting "1 plus" before "the- Secretary's" each place it appears, ^ (3) in clause (i), by inserting "(divided by 100)" after "percentage increase", ' (4) in clauses (ii) and (iv), by inserting "(divided by 100)" after "decrease", ® (5) in clause (iii), by inserting "(divided by 100)" after "percentage growttf,^ and (6) in the matter following clause (iv), by striking "reduced" and inserting "minus 1, multiplied by 100, and reduced". (c) PERIODIC REVIEW OF GEOGRAPHIC ADJUSTMENT FACTORS. — Section 1848(e)(1) of such Act is amended— (1) in subparagraph (A), by striking "subparagraph (B)" and inserting "subparagraphs (B) and (C)", and (2) by adding at the end the following new subparagraph: "(C) PERIODIC REVIEW AND ADJUSTMENTS IN GEOGRAPHIC ADJUSTMENT FACTORS.— The Secretary, not less often than every 3 years, shall review the indices established under subparagraph (A) and the geographic index values applied under this subsection for all fee schedule areas. Based on such review, the Secretary may revise such index and adjust such index values, except that, if more than 1 year has elasped since the last previous adjustment, the adjustment to be applied in the first year of the next adjustment shall be Vz of the adjustment that otherwise would be made.". (d) ELIMINATION OF RESTRICTION ON INCORPORATION OF TIME IN VISIT CODES.—Section 1848(c)(4) (42 U.S.C. 1395w-4(c)(4)) is amended by striking "only for services furnished on or after January 1, 1993".

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