104 STAT. 1388-92 PUBLIC LAW 101-508—NOV. 5, 1990 nished during 1991, the localities used under section 1842(b)) for purposes of computing payments for physicians' services that are anesthesia services; "(iii) the geographic adjustment factors to be applied to the conversion factor under clause (i) for services in a fee schedule area or locality is— "(I) in the case of services furnished in 1991, the geographic work index value and the geographic practice cost index value specified in section 1842(q)(l)(B) for physicians' services that are anesthesia services furnished in the area or locality, and "(II) in the case of services furnished after 1991, the geographic work index value, the geographic practice cost index value, and the geographic malpractice index value used for determining payments for physicians' services that are anesthesia services under section 1848, with 70 percent of the conversion factor treated as attributable to work and 30 percent as attributable to overhead for services furnished in 1991 (and the portions attributable to work, practice expenses, and malpractice expenses in 1992 and thereafter being the same as is applied under section 1848). "(B)(i) Except as provided in clause (ii) and subparagraph (D), in determining the amount paid under the fee schedule under this subsection for services furnished on or after January 1, 1991, by a certified registered nurse anesthetist who is medically directed, the Secretary shall apply the same methodology specified in subparagraph (A). "(ii) The conversion factor used under clause (i) shall be— "(I) for services furnished in 1991, $10.50, "(II) for services furnished in 1992, $10.75, " (III) for services furnished in 1993, $11.00, "(IV) for services furnished in 1994, $11.25, "(V) for services furnished in 1995, $11.50, "(VI) for services furnished in 1996, $11.70, and "(VII) for services furnished in calendar years after 1997, the previous year's conversion factor increased by the update determined under section 1848(d)(3) for physician anesthesia services for that year. "(C) Notwithstanding subclauses (I) through (V) of subparagraph (A)(i)- "(i) in the case of a 1990 conversion factor that is greater than $16.50, the conversion factor for a calendar year after 1990 and before 1996 shall be the 1990 conversion factor reduced by the product of the last digit of the calendar year and one-fifth of the amount by which the 1990 conversion factor exceeds $16.50; and "(ii) in the case of a 1990 conversion factor that is greater than $15.49 but less than $16.51, the conversion factor for a calendar year after 1990 and before 1996 shall be the greater of— "(I) the 1990 conversion factor, or "(II) the conversion factor specified in subparagraph (A)(i) for the year involved. "(D) Notwithstanding subparagraph (C), in no case may the conversion factor used to determine payment for services in a fee schedule area or locality under this subsection, as adjusted by the adjustment factors specified in subparagraphs (A)(iii), exceed the
�
