PUBLIC LAW 106-113—APPENDIX F 113 STAT. 1501A-345 SEC. 204. LIMITATION ON OUTPATIENT HOSPITA];. COPAYMENT FOR A PROCEDiniE TO THE HOSPITAL DEDUCTIBLE AMOUNT. (a) IN GENERAL. —Section 1833(t)(8) (42 U.S.C. 13951(t)(8)), as redesignated by sections 201(a)(1) and 202(a)(2), is amended— (1) in subparagraph (A), by striking "subparagraph (B)" and inserting "subparagraphs (B) and (C)"; (2) by redesignating subparagraphs (C) and (D) as subparagraphs (D) and (E), respectively; and (3) by inserting after subparagraph (B) the following new subparagraph: " (C) LIMITING COPAYMENT AMOUNT TO INPATIENT HOS- PITAL DEDUCTIBLE AMOUNT.— In no case shall the copayment amount for a procedure ptyformed in a year exceed the amount of the inpatient hospital deductible established under section 1813(b) for that year.". (b) INCREASE IN PAYMENT TO REFLECT REDUCTION IN COPAYMENT.— Section 1833(t)(4)(C) (42 U.S.C. 13951(t)(4)(C)) is amended by inserting ", plus the amount of any reduction in the copayment amount attributable to paragraph (8)(C)" before the period at the end. (c) EFFECTIVE DATE. —The amendments made by this section apply as if included in the enactment of BBA and shall only apply to procedures performed for which payment is made on the basis of the prospective payment system under section 1833(t) of the Social Security Act. Subtitle B—Physician Services SEC 211. MODIFICATION OF UPDATE ADJUSTMENT FACTOR PROVI- SIONS TO REDUCE UPDATE OSCILLATIONS AND REQUIRE ESTIMATE REVISIONS. (a) UPDATE ADJUSTMENT FACTOR. — (1) IN GENERAL.— Section 1848(d) (42 U.S.C. 1395w-4(d)) is amended— (A) in paragraph (3)— (i) in the heading, by inserting "FOR 1999 AND 2000" after "UPDATE"; (ii) in subparagraph (A), by striking "a year beginning with 1999" and inserting "1999 and 2000"; and (iii) in subparagraph (C), by inserting "and paragraph (4)" after "For purposes of this paragraph"; and (B) by adding at the end the following new paragraph: "(4) UPDATE FOR YEARS BEGINNING WITH 2001. — "(A) IN GENERAL. — Unless otherwise provided by law, subject to the budget-neutrality factor determined by the Secretary under subsection (c)(2)(B)(ii) and subject to adjustment under subparagraph (F), the update to the single conversion factor established in paragraph (1)(C) for a year beginning with 2001 is (jqual to the product of— "(i) 1 plus the Secretary's estimate of the percentage increase in the MEI (as defined in section 1842(i)(3)) for the year (divided by 100); and "(ii) 1 plus the Secretary's estimate of the update adjustment factor under subparagraph (B) for the year.
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