Page:United States Statutes at Large Volume 124.djvu/519

124 STAT. 493 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(ii) an explanation of each recommendation con- tained in the proposal and the reasons for including such recommendation; ‘‘(iii) an actuarial opinion by the Chief Actuary of the Centers for Medicare & Medicaid Services certi- fying that the proposal meets the requirements of sub- paragraphs (A)(i) and (C) of paragraph (2); ‘‘(iv) a legislative proposal that implements the recommendations; and ‘‘(v) other information determined appropriate by the Board. ‘‘(4) PRESIDENTIAL SUBMISSION TO CONGRESS.—Upon receiving a proposal from the Board under paragraph (3)(A)(i) or the Secretary under paragraph (5), the President shall imme- diately submit such proposal to Congress. ‘‘(5) CONTINGENT SECRETARIAL DEVELOPMENT OF PRO- POSAL.—If, with respect to a proposal year, the Board is required, to but fails, to submit a proposal to the President by the deadline applicable under paragraph (3)(A)(i), the Sec- retary shall develop a detailed and specific proposal that satis- fies the requirements of subparagraphs (A) and (C) (and, to the extent feasible, subparagraph (B)) of paragraph (2) and contains the information required paragraph (3)(B)). By not later than January 25 of the year, the Secretary shall transmit— ‘‘(A) such proposal to the President; and ‘‘(B) a copy of such proposal to the Medicare Payment Advisory Commission for its review. ‘‘(6) PER CAPITA GROWTH RATE PROJECTIONS BY CHIEF ACTUARY.— ‘‘(A) IN GENERAL.—Subject to subsection (f)(3)(A), not later than April 30, 2013, and annually thereafter, the Chief Actuary of the Centers for Medicare & Medicaid Services shall determine in each such year whether— ‘‘(i) the projected Medicare per capita growth rate for the implementation year (as determined under subparagraph (B)); exceeds ‘‘(ii) the projected Medicare per capita target growth rate for the implementation year (as deter- mined under subparagraph (C)). ‘‘(B) MEDICARE PER CAPITA GROWTH RATE.— ‘‘(i) IN GENERAL.—For purposes of this section, the Medicare per capita growth rate for an implementation year shall be calculated as the projected 5-year average (ending with such year) of the growth in Medicare program spending per unduplicated enrollee. ‘‘(ii) REQUIREMENT.—The projection under clause (i) shall— ‘‘(I) to the extent that there is projected to be a negative update to the single conversion factor applicable to payments for physicians’ services under section 1848(d) furnished in the proposal year or the implementation year, assume that such update for such services is 0 percent rather than the negative percent that would otherwise apply; and Deadlines. Determination. Deadline. Transmission.