PUBLIC LAW 103-66 -AUG. 10, 1993 107 STAT. 581 ices included in the category of primary care services (as defined for purposes of subsection (j)(l))."; and (2) in subsection (i)(l), by striking "Secretary)" and inserting "Secretary and including anesthesia services), primary care services (as defined in section 1842(i)(4)),. (b) EFFECTIVE DATES. —The amendments made by this section 42 USC i395w-4 shall apply to services furnished on or after January 1, 1994; "°*® except that amendment made by subsection (a)(2) shall not apply— (1) to voliune performance standard rates of increase established under section 1848(f) of the Social Security Act for fiscal years before fiscal year 1994, and (2) to acijustment in updates in the conversion factors for physicians' services under section 1848(d)(3)(B) of such Act for physicians' services to be fiimished in c£dendar years before 1996. SEC. 13512. REDUCTION IN PERFORMANCE STANDARD RATE OF INCREASE AND INCREASE IN MAXIMUM REDUCTION PERMITTED IN DEFAULT UPDATE. (a) REDUCTION IN PERFORMANCE STANDARD FACTOR.— Section 1848(f)(2)(B) (42 U.S.C. 1395w-4(£X2XB)) is amended— (1) by striking "and" at the end of clause (ii), and (2) by striking clause (iii) and inserting the following: "(iii) for 1993 is 2 percentage points, "(iv) for 1994 is 3V2 percentage points, and "(v) for each succeeding year is 4 percentage points.". (b) INCREASE IN MAXIMUM REDUCTION PERMITTED IN DEFAULT UPDATE.- Section 1848(d)(3)(B)(ii) (42 U.S.C. 1395w-4(d)(3)(B)(ii)) is amended— (1) in subclause (II), by striking "or 1995", and (2) in subclause (III), by striking "3" and inserting "5". SEC. 13613. PRACTICE EXPENSE RELATIVE VALUE UNITS. Section 1848(c)(2) (42 U.S.C. 1395w-4(c)(2)) is amended by adding at the end the following new subparagraph: "(E) REDUCTION IN PRACTICE EXPENSE RELATIVE VALUE UNITS FOR CERTAIN SERVICES. — "(i) IN GENERAL.—Subject to clause (ii), the Secretary shall reduce the practice expense relative value units applied to services described in clause (iii) furnished in— "(I) 1994, by 25 percent of the number by which the number of practice expense relative value units (determined for 1994 without regard to tiiis subparagraph) exceeds the number of work relative value units determined for 1994, "(II) 1995, by an additional 25 percent of such excess, and "(III) 1996, by an additional 25 percent of such excess. "(ii) FLOOR ON REDUCTIONS.— The practice expense relative value units for a physician's service shall not be reduced under this subparagraph to a number less ihan 128 percent of the number or work relative value units. "(iii) SERVICES COVERED.— For purposes of clause (i), the services described in this clause are physicians'
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