Page:United States Statutes at Large Volume 124.djvu/516

124 STAT. 490 PUBLIC LAW 111–148—MAR. 23, 2010 include recommendations regarding improvements to pay- ment systems for providers of services and suppliers who are not otherwise subject to the scope of the Board’s rec- ommendations in a proposal under this section. Any advisory report submitted under this subparagraph shall not be subject to the rules for congressional consideration under subsection (d). ‘‘(2) PROPOSALS.— ‘‘(A) REQUIREMENTS.—Each proposal submitted under this section in a proposal year shall meet each of the following requirements: ‘‘(i) If the Chief Actuary of the Centers for Medicare & Medicaid Services has made a determination under paragraph (7)(A) in the determination year, the pro- posal shall include recommendations so that the pro- posal as a whole (after taking into account rec- ommendations under clause (v)) will result in a net reduction in total Medicare program spending in the implementation year that is at least equal to the applicable savings target established under paragraph (7)(B) for such implementation year. In determining whether a proposal meets the requirement of the pre- ceding sentence, reductions in Medicare program spending during the 3-month period immediately pre- ceding the implementation year shall be counted to the extent that such reductions are a result of the implementation of recommendations contained in the proposal for a change in the payment rate for an item or service that was effective during such period pursu- ant to subsection (e)(2)(A). ‘‘(ii) The proposal shall not include any rec- ommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost- sharing (including deductibles, coinsurance, and copay- ments), or otherwise restrict benefits or modify eligi- bility criteria. ‘‘(iii) In the case of proposals submitted prior to December 31, 2018, the proposal shall not include any recommendation that would reduce payment rates for items and services furnished, prior to December 31, 2019, by providers of services (as defined in section 1861(u)) and suppliers (as defined in section 1861(d)) scheduled, pursuant to the amendments made by sec- tion 3401 of the Patient Protection and Affordable Care Act, to receive a reduction to the inflationary payment updates of such providers of services and suppliers in excess of a reduction due to productivity in a year in which such recommendations would take effect. ‘‘(iv) As appropriate, the proposal shall include recommendations to reduce Medicare payments under parts C and D, such as reductions in direct subsidy payments to Medicare Advantage and prescription drug plans specified under paragraph (1) and (2) of section 1860D–15(a) that are related to administrative expenses (including profits) for basic coverage, denying high bids or removing high bids for prescription drug