Section 13515(b) of the Omnibus Budget Reconciliation Act of 1993, referred to in subsecs. (a)(2)(B)(ii)(I), (c)(2)(A)(i), and (i)(1)(B), is section 13515(b) of Pub. L. 103–66, which is set out as a note under section 1395u of this title.

Section 6105(b) of the Omnibus Budget Reconciliation Act of 1989, referred to in subsec. (a)(2)(D)(ii), (iii), is section 6105(b) of Pub. L. 101–239, which is set out as a note under section 1395m of this title.

Section 4048(b) of the Omnibus Budget Reconciliation Act of 1987, referred to in subsec. (b)(2)(B), is section 4048(b) of Pub. L. 100–203, which is set out as a note under section 1395u of this title.

Section 13514(a) of the Omnibus Budget Reconciliation Act of 1993, referred to in subsec. (c)(2)(F), is section 13514(a) of Pub. L. 103–66, which amended subsec. (b)(3) of this section. See 1993 Amendment note below.

Section 212 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, referred to in subsec. (c)(2)(H)(i), (I)(ii)(I), is section 1000(a)(6) [title II, § 212] of Pub. L. 106–113, which is set out as a note under this section.

The Balanced Budget Act of 1997, referred to in subsec. (d)(1)(C), is Pub. L. 105–33, Aug. 5, 1997, 111 Stat. 251. Chapter 1 of subtitle F of title IV of the Act is chapter 1 (§§ 4501–4513) of subtitle F of title IV of Pub. L. 105–33, which amended this section and sections 1395a, 1395k, 1395l, 1395u, 1395x, 1395y, 1395cc, and 1395yy of this title and enacted provisions set out as notes under this section and sections 1395a, 1395k, 1395l, 1395x, and 1395ww of this title. For complete classification of this Act to the Code, see Tables.

Section 225(c)(1) and section 524 of the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2008, referred to in subsec. (l)(2)(A)(ii)(I), (II), are sections 225(c)(1) of title II and 524 of title V of div. G of Pub. L. 110–161, Dec. 26, 2007, 121 Stat. 2190, 2212. Section 225(c)(1) is not classified to the Code and section 524 amended this section.

Section 2(d) of the Improving Medicare Post-Acute Care Transformation Act of 2014, referred to in subsec. (q)(1)(G)(i), is section 2(d) of Pub. L. 113–185, which is set out as a note under section 1395lll of this title.

The text of section 101(c) of Pub. L. 109–432, div. B, title I, Dec. 20, 2006, 120 Stat. 2977, as amended by Pub. L. 110–173, title I, § 101(b)(2), Dec. 29, 2007, 121 Stat. 2494, which was formerly set out as a note under this section, was transferred to subsec. (m) of this section and amended by Pub. L. 110–275.

2024—Subsec. (e)(1)(E). Pub. L. 118–42, § 303, substituted “January 1, 2025” for “March 9, 2024”.

Pub. L. 118–35 substituted “March 9, 2024” for “January 20, 2024”.

Subsec. (q)(1)(C)(iii)(II). Pub. L. 118–42, § 304(b)(1), substituted “2026” for “2025” in introductory provisions.

Subsec. (q)(1)(C)(iii)(III). Pub. L. 118–42, § 304(b)(2), substituted “2027” for “2026” in introductory provisions.

Subsec. (t)(1)(D). Pub. L. 118–42, § 305(2)(A), substituted “March 9, 2024” for “January 1, 2025”.

Subsec. (t)(1)(E). Pub. L. 118–42, § 305(1), (2)(B), (3), added subpar. (E).

2023—Subsec. (e)(1)(E). Pub. L. 118–22 substituted “January 20, 2024” for “January 1, 2024”.

2022—Subsec. (b)(12). Pub. L. 117–328, § 4123(a)(1), added par. (12).

Subsec. (c)(2)(B)(iv)(V). Pub. L. 117–328, § 4112(1), substituted “2021, 2022, 2023, or 2024” for “2021 or 2022”.

Subsec. (c)(2)(B)(iv)(VI). Pub. L. 117–328, § 4123(a)(2), added subcl. (VI).

Subsec. (q)(1)(C)(iii)(II). Pub. L. 117–328, § 4111(b)(1), substituted “2025” for “2024” in introductory provisions.

Subsec. (q)(1)(C)(iii)(III). Pub. L. 117–328, § 4111(b)(2), substituted “2026” for “2025” in introductory provisions.

Subsec. (t). Pub. L. 117–328, § 4112(2)(A), substituted “2021 through 2024” for “2021 and 2022” in heading.

Subsec. (t)(1). Pub. L. 117–328, § 4112(2)(B)(i), substituted “during 2021, 2022, 2023, and 2024” for “during 2021 and 2022” in introductory provisions.

Subsec. (t)(1)(C), (D). Pub. L. 117–328, § 4112(2)(B)(ii)–(iv), added subpars. (C) and (D).

Subsec. (t)(2)(C). Pub. L. 117–328, § 4112(2)(C), substituted “2021 through 2024” for “2021 and 2022” in heading and “for services furnished in 2021, 2022, 2023, or 2024” for “for services furnished in 2021 or 2022” and “, 2022, 2023, or 2024, respectively” for “or 2022, respectively” in text.

2021—Subsec. (c)(2)(B)(iv)(V). Pub. L. 117–71, § 3(a)(1), substituted “2021 or 2022” for “2021”.

Subsec. (t). Pub. L. 117–71, § 3(a)(2)(A), substituted “2021 and 2022” for “2021” in heading.

Subsec. (t)(1). Pub. L. 117–71, § 3(a)(2)(B), substituted “during 2021 and 2022” for “during 2021” and “payment amounts for—” and subpars. (A) and (B) for “payment amounts for such services furnished on or after January 1, 2021, and before January 1, 2022, by 3.75 percent.”

Subsec. (t)(2)(C). Pub. L. 117–71, § 3(a)(2)(C), substituted “2021 and 2022” for “2021” in heading and, in text, inserted “for services furnished in 2021 or 2022” after “under this subsection” and “or 2022, respectively” before period at end.

2020—Subsec. (c)(2)(B)(iv)(V). Pub. L. 116–260, § 101(b), added subcl. (V).

Subsec. (e)(1)(E). Pub. L. 116–260 substituted “January 1, 2024” for “December 19, 2020”.

Pub. L. 116–215 substituted “December 19, 2020” for “December 12, 2020”.

Pub. L. 116–159 substituted “December 12, 2020” for “December 1, 2020”.

Pub. L. 116–136 substituted “December 1, 2020” for “May 23, 2020”.

Subsec. (q)(1)(C)(iii)(II). Pub. L. 116–260, § 114(b)(1), substituted “each of 2021 through 2024” for “2021 and 2022” in introductory provisions.

Subsec. (q)(1)(C)(iii)(III). Pub. L. 116–260, § 114(b)(2), substituted “2025” for “2023” in introductory provisions.

Subsec. (q)(2)(B)(iii)(IV). Pub. L. 116–260, § 119(c), inserted at end “This subcategory shall include as an activity, for performance periods beginning on or after January 1, 2022, use of a real-time benefit tool as described in section 1395w–104(o) of this title. The Secretary may establish this activity as a standalone or as a component of another activity.”

Subsec. (t). Pub. L. 116–260, § 101(a), added subsec. (t).

2019—Subsec. (e)(1)(E). Pub. L. 116–94 substituted “May 23, 2020” for “January 1, 2020”.

2018—Subsec. (b)(11). Pub. L. 115–123, § 51009(1), substituted “2017, 2018, and 2019” for “2017 and 2018”.

Subsec. (c)(2)(K)(iv). Pub. L. 115–123, § 51009(2), substituted “2017, 2018, and 2019” for “2017 and 2018”.

Subsec. (d)(18). Pub. L. 115–123, § 53106, substituted “paragraph (1)(C)—” for “paragraph (1)(C) for the period beginning on July 1, 2015, and ending on December 31, 2015, shall be 0.5 percent.” and added subpars. (A) and (B).

Subsec. (e)(1)(E). Pub. L. 115–123, § 50201, substituted “January 1, 2020” for “January 1, 2018”.

Subsec. (o)(2)(A). Pub. L. 115–123, § 50413, struck out “by requiring more stringent measures of meaningful use selected under this paragraph” after “health care quality over time” in concluding provisions.

Subsec. (q)(1)(B). Pub. L. 115–123, § 51003(a)(1)(A)(i), substituted “covered professional services (as defined in subsection (k)(3)(A))” for “items and services”.

Subsec. (q)(1)(C)(iv)(I). Pub. L. 115–123, § 51003(a)(1)(A)(ii)(I), amended subcl. (I) generally. Prior to amendment, subcl. (I) read as follows: “The minimum number (as determined by the Secretary) of individuals enrolled under this part who are treated by the eligible professional for the performance period involved.”

Subsec. (q)(1)(C)(iv)(II). Pub. L. 115–123, § 51003(a)(1)(A)(ii)(II), substituted “covered professional services (as defined in subsection (k)(3)(A))” for “items and services”.

Subsec. (q)(1)(C)(iv)(III). Pub. L. 115–123, § 51003(a)(1)(A)(ii)(III), amended subcl. (III) generally. Prior to amendment, subcl. (III) read as follows: “The minimum amount (as determined by the Secretary) of allowed charges billed by such professional under this part for such performance period.”

Subsec. (q)(5)(D)(i)(I). Pub. L. 115–123, § 51003(a)(1)(B)(i), inserted “subject to clause (iii),” after “clauses (i) and (ii) of paragraph (2)(A),”.

Subsec. (q)(5)(D)(iii). Pub. L. 115–123, § 51003(a)(1)(B)(ii), added cl. (iii).

Subsec. (q)(5)(E)(i)(I)(bb). Pub. L. 115–123, § 51003(a)(1)(C)(i), substituted “First 5 years” for “First 2 years” in heading and “each of the first through fifth years” for “the first and second years” in text.

Subsec. (q)(5)(E)(i)(II)(bb). Pub. L. 115–123, § 51003(a)(1)(C)(ii), substituted “5 years” for “2 years” in heading and “For each of the second, third, fourth, and fifth years for which the MIPS applies to payments, not less than 10 percent and not more than 30 percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A). Nothing in the previous sentence shall be construed, with respect to a performance period for a year described in the previous sentence, as preventing the Secretary from basing 30 percent of such score for such year with respect to the category described in such clause (ii), if the Secretary determines, based on information posted under subsection (r)(2)(I) that sufficient resource use measures are ready for adoption for use under the performance category under paragraph (2)(A)(ii) for such performance period.” for “For the second year for which the MIPS applies to payments, not more than 15 percent of such score shall be based on performance with respect to the category described in clause (ii) of paragraph (2)(A).” in text.

Subsec. (q)(6)(D)(i). Pub. L. 115–123, § 51003(a)(1)(D)(i), substituted “Subject to clauses (iii) and (iv), such performance threshold” for “Such performance threshold”.

Subsec. (q)(6)(D)(ii). Pub. L. 115–123, § 51003(a)(1)(D)(ii), in introductory provisions, inserted “(beginning with 2019 and ending with 2024)” after “for each year of the MIPS” and “subject to clause (iii),” after “For each such year,”.

Subsec. (q)(6)(D)(iii). Pub. L. 115–123, § 51003(a)(1)(D)(iii), substituted “5” for “2” in heading and “five years” for “two years” in introductory provisions.

Subsec. (q)(6)(D)(iv). Pub. L. 115–123, § 51003(a)(1)(D)(iv), added cl. (iv).

Subsec. (q)(6)(E). Pub. L. 115–123, § 51003(a)(1)(E), in introductory provisions, substituted “In the case of covered professional services (as defined in subsection (k)(3)(A))” for “In the case of items and services” and “under this part with respect to such covered professional services” for “under this part with respect to such items and services”.

Subsec. (q)(7). Pub. L. 115–123, § 51003(a)(1)(F), substituted “covered professional services (as defined in subsection (k)(3)(A))” for “items and services”.

Subsec. (r)(2)(I). Pub. L. 115–123, § 51003(a)(2), added subpar. (I).

Subsec. (s)(5)(B). Pub. L. 115–123, § 51003(a)(3), which directed amendment of subpar. (B) by substituting “section 1395l(z)(3)(D)” for “section 1395l(z)(2)(C)”, was executed by making the substitution for “Section 1395l(z)(2)(C)” to reflect the probable intent of Congress.

2016—Subsec. (a)(7)(B). Pub. L. 114–255, § 4002(b)(1)(A), inserted after first sentence “The Secretary shall exempt an eligible professional from the application of the payment adjustment under subparagraph (A) with respect to a year, subject to annual renewal, if the Secretary determines that compliance with the requirement for being a meaningful EHR user is not possible because the certified EHR technology used by such professional has been decertified under a program kept or recognized pursuant to section 300jj–11(c)(5) of this title.”

Subsec. (a)(7)(D). Pub. L. 114–255, § 16003, substituted “hospital-based and ambulatory surgical center-based eligible professionals” for “hospital-based eligible professionals” in heading, designated existing provisions as cl. (i), inserted cl. (i) heading, and added cls. (ii) to (iv).

Subsec. (o)(2)(D). Pub. L. 114–255, § 4002(b)(1)(B), inserted at end “The provisions of subparagraphs (B) and (D) of subsection (a)(7), shall apply to assessments of MIPS eligible professionals under subsection (q) with respect to the performance category described in subsection (q)(2)(A)(iv) in an appropriate manner which may be similar to the manner in which such provisions apply with respect to payment adjustments made under subsection (a)(7)(A).”

2015—Subsec. (a)(7)(A)(i). Pub. L. 114–10, § 101(b)(1)(A)(i), substituted “each of 2015 through 2018” for “2015 or any subsequent payment year”.

Subsec. (a)(7)(A)(ii)(III). Pub. L. 114–10, § 101(b)(1)(A)(ii), substituted “2018” for “each subsequent year”.

Subsec. (a)(7)(A)(iii). Pub. L. 114–10, § 101(b)(1)(A)(iii), struck out “and subsequent years” after “for 2018” in heading and “and each subsequent year” after “For 2018” and “, but in no case shall the applicable percent be less than 95 percent” after “in the preceding year” in text.

Subsec. (a)(7)(B). Pub. L. 114–115, § 4(a), inserted “(and, with respect to the payment adjustment under subparagraph (A) for 2017, for categories of eligible professionals, as established by the Secretary and posted on the Internet website of the Centers for Medicare & Medicaid Services prior to December 15, 2015, an application for which must be submitted to the Secretary by not later than March 15, 2016)” after “case-by-case basis”.

Subsec. (a)(8)(A)(i). Pub. L. 114–10, § 101(b)(2)(A)(i), substituted “each of 2015 through 2018” for “2015 or any subsequent year”.

Subsec. (a)(8)(A)(ii)(II). Pub. L. 114–10, § 101(b)(2)(A)(ii), substituted “, 2017, and 2018” for “and each subsequent year”.

Subsec. (a)(9). Pub. L. 114–10, § 523(b), added par. (9).

Subsec. (b)(8). Pub. L. 114–10, § 103(a), added par. (8).

Subsec. (b)(9). Pub. L. 114–113, § 502(a)(1)(A), added par. (9).

Subsec. (b)(10). Pub. L. 114–113, § 502(a)(2)(A), added par. (10).

Subsec. (b)(11). Pub. L. 114–115, § 3(a)(1), added par. (11).

Subsec. (c)(2)(B)(v)(X). Pub. L. 114–113, § 502(a)(1)(B), added subcl. (X).

Subsec. (c)(2)(B)(v)(XI). Pub. L. 114–113, § 502(a)(2)(B), added subcl. (XI).

Subsec. (c)(2)(K)(iv). Pub. L. 114–115, § 3(a)(2), added cl. (iv).

Subsec. (c)(8). Pub. L. 114–10, § 523(a), added par. (8).

Subsec. (d)(1)(A). Pub. L. 114–10, § 101(a)(1)(A)(i), (2)(A), inserted “and ending with 2025” after “beginning with 2001”, “or a subsequent paragraph” after “paragraph (4)”, and “There shall be two separate conversion factors for each year beginning with 2026, one for items and services furnished by a qualifying APM participant (as defined in section 1395l(z)(2) of this title) (referred to in this subsection as the ‘qualifying APM conversion factor’) and the other for other items and services (referred to in this subsection as the ‘nonqualifying APM conversion factor’), equal to the respective conversion factor for the previous year (or, in the case of 2026, equal to the single conversion factor for 2025) multiplied by the update established under paragraph (20) for such respective conversion factor for such year.” at end.

Subsec. (d)(1)(D). Pub. L. 114–10, § 101(a)(2)(B), inserted “(or, beginning with 2026, applicable conversion factor)” after “single conversion factor”.

Subsec. (d)(4). Pub. L. 114–10, § 101(a)(1)(A)(ii)(I), inserted “and ending with 2014” after “years beginning with 2001” in heading.

Subsec. (d)(4)(A). Pub. L. 114–10, § 101(a)(1)(A)(ii)(II), inserted “and ending with 2014” after “a year beginning with 2001” in introductory provisions.

Subsec. (d)(16) to (20). Pub. L. 114–10, § 101(a)(2)(C), added pars. (16) to (20) and struck out former par. (16) which related to update for January through March of 2015.

Subsec. (e)(1)(E). Pub. L. 114–10, § 201, substituted “January 1, 2018” for “April 1, 2015”.

Subsec. (f)(1)(B). Pub. L. 114–10, § 101(a)(1)(B)(i), inserted “through 2014” after “of each succeeding year”.

Subsec. (f)(2). Pub. L. 114–10, § 101(a)(1)(B)(ii), inserted “and ending with 2014” after “beginning with 2000” in introductory provisions.

Subsec. (k)(9). Pub. L. 114–10, § 101(b)(2)(B)(i), added par. (9).

Subsec. (m)(3)(C)(ii). Pub. L. 114–10, § 101(d)(1)(A), inserted “and, for 2016 and subsequent years, may provide” after “shall provide”.

Subsec. (m)(3)(D). Pub. L. 114–10, § 101(d)(1)(B), inserted “and, for 2016 and subsequent years, subparagraph (A) or (C)” after “subparagraph (A)”.

Subsec. (m)(5)(F). Pub. L. 114–10, § 101(d)(2), substituted “through reporting periods occurring in 2015” for “and subsequent years” and inserted “and, for reporting periods occurring in 2016 and subsequent years, the Secretary may establish” after “shall establish”.

Subsec. (m)(7) to (9). Pub. L. 114–10, § 101(b)(2)(B)(ii), redesignated par. (7) relating to additional incentive payment as (8) and added par. (9).

Subsec. (n)(11). Pub. L. 114–10, § 101(d)(3), added par. (11).

Subsec. (o)(2)(A). Pub. L. 114–10, § 101(b)(1)(B)(i), in introductory provisions, substituted “An” for “For purposes of paragraph (1), an” and inserted “, or pursuant to subparagraph (D) for purposes of subsection (q), for a performance period under such subsection for a year” after “under such subsection for a year”.

Subsec. (o)(2)(A)(ii). Pub. L. 114–10, § 106(b)(2)(A), inserted “, and the professional demonstrates (through a process specified by the Secretary, such as the use of an attestation) that the professional has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology” before period at end.

Subsec. (o)(2)(A)(iii). Pub. L. 114–10, § 101(d)(4), inserted “and subsection (q)(5)(B)(ii)(II)” after “Subject to subparagraph (B)(ii)”.

Subsec. (o)(2)(D). Pub. L. 114–10, § 101(b)(1)(B)(ii), added subpar. (D).

Subsec. (p)(2)(C). Pub. L. 114–10, § 101(b)(3)(B)(i), added subpar. (C).

Subsec. (p)(3). Pub. L. 114–10, § 101(b)(3)(B)(ii), inserted at end “With respect to 2019 and each subsequent year, the Secretary shall, in accordance with subsection (q)(1)(F), carry out this paragraph for purposes of subsection (q).”

Subsec. (p)(4)(B)(iii). Pub. L. 114–10, § 101(b)(3)(A), amended cl. (iii) generally. Prior to amendment, text read as follows: “The Secretary shall apply the payment modifier established under this subsection for items and services furnished—

“(I) beginning on January 1, 2015, with respect to specific physicians and groups of physicians the Secretary determines appropriate; and

“(II) beginning not later than January 1, 2017, with respect to all physicians and groups of physicians.”

Subsec. (q). Pub. L. 114–10, § 101(c)(1), added subsec. (q).

Subsec. (r). Pub. L. 114–10, § 101(f), added subsec. (r).

Subsec. (s). Pub. L. 114–10, § 102, added subsec. (s).

2014—Subsec. (c)(2)(B)(ii)(I). Pub. L. 113–93, § 220(e)(2)(A), substituted “subclause (II) and paragraph (7)” for “subclause (II)”.

Subsec. (c)(2)(B)(v)(VIII). Pub. L. 113–295, § 202(1)(A), substituted “2016” for “2017” in subcl. (VIII) relating to reductions for misvalued services if target not met.

Pub. L. 113–93, § 220(d)(2), added subcl. (VIII) relating to reductions for misvalued services if target not met.

Pub. L. 113–93, § 218(a)(2)(B), added subcl. (VIII) relating to reduced expenditures attributable to application of quality incentives for computed tomography.

Subsec. (c)(2)(B)(v)(IX). Pub. L. 113–295, § 202(1)(B), redesignated subcl. (VIII) relating to reductions for misvalued services if target not met as (IX).

Subsec. (c)(2)(C)(i). Pub. L. 113–93, § 220(f)(1), substituted “the service or group of services” for “the service” in two places.

Subsec. (c)(2)(C)(ii). Pub. L. 113–93, § 220(f)(2), inserted “or group of services” after “furnishing the service” the first time appearing in concluding provisions.

Subsec. (c)(2)(C)(iii). Pub. L. 113–93, § 220(f)(1), substituted “the service or group of services” for “the service” wherever appearing.

Subsec. (c)(2)(K)(ii). Pub. L. 113–93, § 220(c), amended cl. (ii) generally. Prior to amendment, text read as follows: “For purposes of identifying potentially misvalued services pursuant to clause (i)(I), the Secretary shall examine (as the Secretary determines to be appropriate) codes (and families of codes as appropriate) for which there has been the fastest growth; codes (and families of codes as appropriate) that have experienced substantial changes in practice expenses; codes for new technologies or services within an appropriate period (such as 3 years) after the relative values are initially established for such codes; multiple codes that are frequently billed in conjunction with furnishing a single service; codes with low relative values, particularly those that are often billed multiple times for a single treatment; codes which have not been subject to review since the implementation of the RBRVS (the so-called ‘Harvard-valued codes’); and such other codes determined to be appropriate by the Secretary.”

Subsec. (c)(2)(K)(iii)(VI). Pub. L. 113–93, § 220(e)(2)(B), substituted “provisions of subparagraph (B)(ii)(II) and paragraph (7)” for “provisions of subparagraph (B)(ii)(II)” and “under subparagraph (B)(ii)(I)” for “under subparagraph (B)(ii)(II)”.

Subsec. (c)(2)(M). Pub. L. 113–93, § 220(a)(1), added subpar. (M).

Subsec. (c)(2)(N). Pub. L. 113–93, § 220(b), added subpar. (N).

Subsec. (c)(2)(O). Pub. L. 113–295, § 202(2)(A), substituted “2016 through 2018” for “2017 through 2020” in introductory provisions.

Pub. L. 113–93, § 220(d)(1), added subpar. (O).

Subsec. (c)(2)(O)(iii). Pub. L. 113–295, § 202(2)(B), substituted “2016” for “2017”.

Subsec. (c)(2)(O)(v). Pub. L. 113–295, § 202(2)(C), inserted “(or, for 2016, 1.0 percent)” after “0.5 percent”.

Subsec. (c)(7). Pub. L. 113–295, § 202(3), substituted “2016” for “2017”.

Pub. L. 113–93, § 220(e)(1), added par. (7).

Subsec. (d)(15). Pub. L. 113–93, § 101(1)(A), struck out “January through March of” before “2014” in heading.

Subsec. (d)(15)(A). Pub. L. 113–93, § 101(1)(B), struck out “for the period beginning on January 1, 2014, and ending on March 31, 2014” after “2014”.

Subsec. (d)(15)(B). Pub. L. 113–93, § 101(1)(C), struck out “remaining portion of 2014 and” before “subsequent years” in heading and “the period beginning on April 1, 2014, and ending on December 31, 2014, and for” before “2015” in text.

Subsec. (d)(16). Pub. L. 113–93, § 101(2), added par. (16).

Subsec. (e)(1)(E). Pub. L. 113–93, § 102, substituted “April 1, 2015” for “April 1, 2014”.

Subsec. (e)(6). Pub. L. 113–93, § 220(h)(1), added par. (6).

Subsec. (i)(1)(F). Pub. L. 113–93, § 220(a)(2), added subpar. (F).

Subsec. (j)(2). Pub. L. 113–93, § 220(h)(2), substituted “Except as provided in subsection (e)(6)(D), the term” for “The term”.

2013—Subsec. (b)(4)(C). Pub. L. 112–240, § 635(1), substituted “, 2012, and 2013” for “and subsequent years” and inserted at end “With respect to fee schedules established for 2014 and subsequent years, in such methodology, the Secretary shall use a 90 percent utilization rate.”

Subsec. (b)(7). Pub. L. 112–240, § 633(a), substituted “2011, and before April 1, 2013,” for “2011,” and inserted at end “In the case of such services furnished on or after April 1, 2013, and for which payment is made under such fee schedules, instead of the 25 percent multiple procedure payment reduction specified in such final rule, the reduction percentage shall be 50 percent.”

Subsec. (c)(2)(B)(v)(III). Pub. L. 112–240, § 635(2), substituted “changes in the utilization rate applicable to 2011 and 2014, as described in the first and second sentence, respectively, of” for “change in the utilization rate applicable to 2011, as described in”.

Subsec. (d)(14). Pub. L. 112–240, § 601(a), added par. (14).

Subsec. (d)(15). Pub. L. 113–67, § 1101, added par. (15).

Subsec. (e)(1)(E). Pub. L. 113–67, § 1102, substituted “April 1, 2014” for “January 1, 2014”.

Pub. L. 112–240, § 602, substituted “before January 1, 2014” for “before January 1, 2013”.

Subsec. (m)(3)(D) to (F). Pub. L. 112–240, § 601(b)(1), added subpars. (D) and (E) and redesignated former subpar. (D) as (F).

2012—Subsec. (d)(13). Pub. L. 112–96, § 3003(a)(1), substituted “2012” for “first two months of 2012” in heading.

Subsec. (d)(13)(A). Pub. L. 112–96, § 3003(a)(2), substituted “2012” for “the period beginning on January 1, 2012, and ending on February 29, 2012”.

Subsec. (d)(13)(B). Pub. L. 112–96, § 3003(a)(3), (4), substituted “2013” for “remaining portion of 2012” in heading and “for 2013” for “for the period beginning on March 1, 2012, and ending on December 31, 2012, and for 2013” in text.

Subsec. (e)(1)(E). Pub. L. 112–96, § 3004(a), substituted “before January 1, 2013” for “before March 1, 2012”.

2011—Subsec. (b)(4)(B), (6). Pub. L. 112–78, § 309(1), substituted “, 2011, and the first 2 months of 2012” for “and 2011” wherever appearing.

Subsec. (c)(2)(B)(iv)(IV). Pub. L. 112–78, § 309(2), substituted “, 2011, or the first 2 months of 2012” for “or 2011”.

Subsec. (d)(13). Pub. L. 112–78, § 301, added par. (13).

Subsec. (e)(1)(E). Pub. L. 112–78, § 303, substituted “before March 1, 2012” for “before January 1, 2012”.

2010—Subsec. (a)(8). Pub. L. 111–148, § 3002(b), added par. (8).

Subsec. (b)(1). Pub. L. 111–148, § 3007(1), inserted “subject to subsection (p),” after “1998,” in introductory provisions.

Subsec. (b)(4)(B). Pub. L. 111–152, § 1107(1)(A), substituted “subparagraph (A)” for “this paragraph”.

Pub. L. 111–148, § 3135(a)(1)(A), substituted “this paragraph” for “subparagraph (A)”.

Pub. L. 111–148, § 3111(a)(1)(A)(i), inserted “, and for 2010 and 2011, dual-energy x-ray absorptiometry services (as described in paragraph (6))” before the period.

Subsec. (b)(4)(C). Pub. L. 111–152, § 1107(1)(B), amended subpar. (C) generally. Prior to amendment, text read as follows: “Consistent with the methodology for computing the number of practice expense relative value units under subsection (c)(2)(C)(ii) with respect to advanced diagnostic imaging services (as defined in section 1395m(e)(1)(B) of this title) furnished on or after January 1, 2010, the Secretary shall adjust such number of units so it reflects—

“(i) in the case of services furnished on or after January 1, 2010, and before January 1, 2013, a 65 percent (rather than 50 percent) presumed rate of utilization of imaging equipment;

“(ii) in the case of services furnished on or after January 1, 2013, and before January 1, 2014, a 70 percent (rather than 50 percent) presumed rate of utilization of imaging equipment; and

“(iii) in the case of services furnished on or after January 1, 2014, a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment.”

Pub. L. 111–148, § 3135(a)(1)(B), added subpar. (C).

Subsec. (b)(4)(D). Pub. L. 111–148, § 3135(b)(1), added subpar. (D).

Subsec. (b)(6). Pub. L. 111–148, § 3111(a)(1)(A)(ii), added par. (6).

Subsec. (b)(7). Pub. L. 111–286, § 3(a), added par. (7).

Subsec. (c)(2)(B)(iv)(IV). Pub. L. 111–148, § 3111(a)(1)(B), added subcl. (IV).

Subsec. (c)(2)(B)(v)(III) to (V). Pub. L. 111–152, § 1107(2), added subcl. (III) and struck out former subcls. (III) to (V), which read as follows:

“(III) Change in presumed utilization level of certain advanced diagnostic imaging services for 2010 through 2012.—Effective for fee schedules established beginning with 2010 and ending with 2012, reduced expenditures attributable to the presumed rate of utilization of imaging equipment of 65 percent under subsection (b)(4)(C)(i) instead of a presumed rate of utilization of such equipment of 50 percent.

“(IV) Change in presumed utilization level of certain advanced diagnostic imaging services for 2013.—Effective for fee schedules established for 2013, reduced expenditures attributable to the presumed rate of utilization of imaging equipment of 70 percent under subsection (b)(4)(C)(ii) instead of a presumed rate of utilization of such equipment of 50 percent.

“(V) Change in presumed utilization level of certain advanced diagnostic imaging services for 2014 and subsequent years.—Effective for fee schedules established beginning with 2014, reduced expenditures attributable to the presumed rate of utilization of imaging equipment of 75 percent under subsection (b)(4)(C)(iii) instead of a presumed rate of utilization of such equipment of 50 percent.”

Pub. L. 111–148, § 3135(a)(2), added subcls. (III) to (V).

Subsec. (c)(2)(B)(v)(VI). Pub. L. 111–148, § 3135(b)(2), added subcl. (VI).

Subsec. (c)(2)(B)(v)(VII). Pub. L. 111–286, § 3(b), added subcl. (VII).

Subsec. (c)(2)(B)(vii). Pub. L. 111–148, § 5501(c), which directed the addition of cl. (vii), was repealed by Pub. L. 111–148, § 10501(h). As enacted, text read as follows: “Fifty percent of the additional expenditures under this part attributable to subsections (x) and (y) of section 1395l of this title for a year (as estimated by the Secretary) shall be taken into account in applying clause (ii)(II) for 2011 and subsequent years. In lieu of applying the budget-neutrality adjustments required under clause (ii)(II) to relative value units to account for such costs for the year, the Secretary shall apply such budget-neutrality adjustments to the conversion factor otherwise determined for the year. For 2011 and subsequent years, the Secretary shall increase the incentive payment otherwise applicable under section 1395l(m) of this title by a percent estimated to be equal to the additional expenditures estimated under the first sentence of this clause for such year that is applicable to physicians who primarily furnish services in areas designated (under section 254e(a)(1)(A) of this title) as health professional shortage areas.”

Subsec. (c)(2)(K), (L). Pub. L. 111–148, § 3134(a), added subpars. (K) and (L).

Subsec. (d)(10). Pub. L. 111–192, § 101(a)(1), substituted “January through May” for “portion” in heading.

Pub. L. 111–148, § 3101, which directed the addition of par. (10) relating to update for 2010, was repealed by Pub. L. 111–148, § 10310. As enacted, text read as follows:

“(A) In general.—Subject to paragraphs (7)(B), (8)(B), and (9)(B), in lieu of the update to the single conversion factor established in paragraph (1)(C) that would otherwise apply for 2010, the update to the single conversion factor shall be 0.5 percent.

“(B) No effect on computation of conversion factor for 2011 and subsequent years.—The conversion factor under this subsection shall be computed under paragraph (1)(A) for 2011 and subsequent years as if subparagraph (A) had never applied.”

Subsec. (d)(10)(A). Pub. L. 111–157, § 4(1), substituted “May 31, 2010” for “March 31, 2010”.

Pub. L. 111–144, § 5(1), substituted “March 31, 2010” for “February 28, 2010”.

Subsec. (d)(10)(B). Pub. L. 111–157, § 4(2), substituted “June 1, 2010” for “April 1, 2010”.

Pub. L. 111–144, § 5(2), substituted “April 1, 2010” for “March 1, 2010”.

Subsec. (d)(11). Pub. L. 111–286, § 2(1), substituted “December” for “November” in heading.

Pub. L. 111–192, § 101(a)(2), added par. (11).

Subsec. (d)(11)(A). Pub. L. 111–286, § 2(2), substituted “December 31” for “November 30”.

Subsec. (d)(11)(B). Pub. L. 111–286, § 2(3), substituted “2011” for “remaining portion of 2010” in heading and struck out “the period beginning on December 1, 2010, and ending on December 31, 2010, and for” before “2011 and subsequent years” in text.

Subsec. (d)(12). Pub. L. 111–309, § 101, added par. (12).

Subsec. (e)(1)(A). Pub. L. 111–148, § 10324(c)(1), substituted “(H), and (I)” for “and (H)” in introductory provisions.

Pub. L. 111–148, § 3102(b)(1), substituted “(G), and (H)” for “and (G)” in introductory provisions.

Subsec. (e)(1)(E). Pub. L. 111–309, § 103, substituted “before January 1, 2012” for “before January 1, 2011”.

Pub. L. 111–148, § 3102(a), substituted “before January 1, 2011” for “before January 1, 2010”.

Subsec. (e)(1)(H). Pub. L. 111–148, § 3102(b)(2), added subpar. (H).

Subsec. (e)(1)(H)(i). Pub. L. 111–152, § 1108, substituted “½” for “¾”.

Subsec. (e)(1)(I). Pub. L. 111–148, § 10324(c)(2), added subpar. (I).

Subsec. (j)(3). Pub. L. 111–148, § 4103(c)(2), inserted “(2)(FF) (including administration of the health risk assessment),” after “(2)(EE),”.

Subsec. (k)(4). Pub. L. 111–148, § 3002(c)(1), inserted “or through a Maintenance of Certification program operated by a specialty body of the American Board of Medical Specialties that meets the criteria for such a registry” after “Database)”.

Subsec. (m)(1)(A). Pub. L. 111–148, § 3002(a)(1)(A), substituted “2014” for “2010” in introductory provisions.

Subsec. (m)(1)(B)(iii), (iv). Pub. L. 111–148, § 3002(a)(1)(B), added cls. (iii) and (iv).

Subsec. (m)(3)(A). Pub. L. 111–148, § 3002(a)(2)(A), inserted “(or, for purposes of subsection (a)(8), for the quality reporting period for the year)” after “reporting period” in introductory provisions.

Subsec. (m)(3)(C)(i). Pub. L. 111–148, § 3002(a)(2)(B), inserted “, or, for purposes of subsection (a)(8), for a quality reporting period for the year” after “(a)(5), for a reporting period for a year”.

Subsec. (m)(5)(E). Pub. L. 111–148, § 3002(f)(1), substituted “Except as provided in subparagraph (I), there shall” for “There shall” in introductory provisions.

Subsec. (m)(5)(E)(iv). Pub. L. 111–148, § 3002(a)(3), substituted “paragraphs (5)(A) and (8)(A) of subsection (a)” for “subsection (a)(5)(A)”.

Subsec. (m)(5)(H), (I). Pub. L. 111–148, § 3002(e), (f)(2), added subpars. (H) and (I).

Subsec. (m)(6)(C)(i)(II). Pub. L. 111–148, § 3002(a)(4)(A), substituted “and subsequent years” for “, 2009, 2010, and 2011”.

Subsec. (m)(6)(C)(iii). Pub. L. 111–148, § 3002(a)(4)(B), inserted “(a)(8)” after “(a)(5)” and substituted “under subsection (a)(5)(D)(iii) or the quality reporting period under subsection (a)(8)(D)(iii), respectively” for “under subparagraph (D)(iii) of such subsection”.

Subsec. (m)(7). Pub. L. 111–148, § 10327(a), added par. (7) relating to additional incentive payment.

Pub. L. 111–148, § 3002(d), added par. (7) relating to integration of physician quality reporting and EHR reporting.

Subsec. (n)(1)(A). Pub. L. 111–148, § 3003(a)(1)(A), designated existing provisions as cl. (i), inserted heading, substituted “the ‘Program’).” for “the ‘Program’) under which the Secretary shall use claims data under this subchapter (and may use other data) to provide confidential reports to physicians (and, as determined appropriate by the Secretary, to groups of physicians) that measure the resources involved in furnishing care to individuals under this subchapter. If determined appropriate by the Secretary, the Secretary may include information on the quality of care furnished to individuals under this subchapter by the physician (or group of physicians) in such reports.”, and added cls. (ii) and (iii).

Subsec. (n)(1)(B). Pub. L. 111–148, § 3003(a)(1)(B), substituted “subparagraph (A)(ii)” for “subparagraph (A)” in introductory provisions.

Subsec. (n)(4). Pub. L. 111–148, § 3003(a)(2)(B), inserted “initial” after “focus the” in introductory provisions.

Pub. L. 111–148, § 3003(a)(2)(A), inserted “initial” after “focus” in heading.

Subsec. (n)(6). Pub. L. 111–148, § 3003(a)(3), inserted at end “For adjustments for reports on utilization under paragraph (9), see subparagraph (D) of such paragraph.”

Subsec. (n)(9), (10). Pub. L. 111–148, § 3003(a)(4), added pars. (9) and (10).

Subsec. (o)(1)(C)(ii). Pub. L. 111–157, § 5(a)(1), substituted “inpatient or emergency room setting” for “setting (whether inpatient or outpatient)”.

Subsec. (p). Pub. L. 111–148, § 3007(2), added subsec. (p).

2009—Subsec. (a)(5)(A)(i). Pub. L. 111–5, § 4101(f)(1)(A), substituted “, 2013 or 2014” for “or any subsequent year”.

Subsec. (a)(5)(A)(ii)(III). Pub. L. 111–5, § 4101(f)(1)(B), struck out “and each subsequent year” after “2014”.

Subsec. (a)(7). Pub. L. 111–5, § 4101(b), added par. (7).

Subsec. (d)(10). Pub. L. 111–118 added par. (10).

Subsec. (m)(2)(A). Pub. L. 111–5, § 4101(f)(2)(A), substituted “Subject to subparagraph (D), for 2009” for “For 2009”.

Subsec. (m)(2)(D). Pub. L. 111–5, § 4101(f)(2)(B), added subpar. (D).

Subsec. (o). Pub. L. 111–5, § 4101(a), added subsec. (o).

2008—Subsec. (a)(4)(A). Pub. L. 110–275, § 139(a)(1), inserted “except as provided in paragraph (5),” after “anesthesia cases,”.

Subsec. (a)(5). Pub. L. 110–275, § 132(b), added par. (5).

Subsec. (a)(6). Pub. L. 110–275, § 139(a)(2), added par. (6).

Subsec. (b)(5). Pub. L. 110–275, § 144(a)(2)(B), added par. (5).

Subsec. (c)(2)(B)(vi). Pub. L. 110–275, § 133(b), added cl. (vi).

Subsec. (d)(8). Pub. L. 110–275, § 131(a)(1)(A)(i), struck out “a portion of” before “2008” in heading.

Subsec. (d)(8)(A). Pub. L. 110–275, § 131(a)(1)(A)(ii), struck out “for the period beginning on January 1, 2008, and ending on June 30, 2008,” after “for 2008,”.

Subsec. (d)(8)(B). Pub. L. 110–275, § 131(a)(1)(A)(iii), struck out “the remaining portion of 2008 and” before “2009” in heading and “for the period beginning on July 1, 2008, and ending on December 31, 2008, and” before “for 2009” in text.

Subsec. (d)(9). Pub. L. 110–275, § 131(a)(1)(B), added par. (9).

Subsec. (e)(1)(A). Pub. L. 110–275, § 134(c), amended Pub. L. 108–173, § 602(1). See 2003 Amendment note below.

Subsec. (e)(1)(E). Pub. L. 110–275, § 134(a), substituted “before January 1, 2010” for “before July 1, 2008”.

Subsec. (e)(1)(G). Pub. L. 110–275, § 134(b), inserted at end “For purposes of payment for services furnished in the State described in the preceding sentence on or after January 1, 2009, after calculating the work geographic index in subparagraph (A)(iii), the Secretary shall increase the work geographic index to 1.5 if such index would otherwise be less than 1.5”.

Subsec. (j)(3). Pub. L. 110–275, § 152(b)(1)(C), inserted “(2)(EE),” after “(2)(DD),”.

Pub. L. 110–275, § 144(a)(2)(A), inserted “(2)(DD),” after “(2)(AA),”.

Subsec. (k)(2)(C), (D). Pub. L. 110–275, § 131(b)(1), added subpars. (C) and (D).

Subsec. (k)(3)(B)(iv). Pub. L. 110–275, § 131(b)(4)(A), added cl. (iv).

Subsec. (l)(2)(A)(i)(III). Pub. L. 110–275, § 131(a)(3)(C)(i)(I), struck out subcl. (III) which read as follows: “For expenditures during 2013, an amount equal to $4,670,000,000.”

Pub. L. 110–252, § 7002(c)(1)(A), substituted “$4,670,000,000” for “$4,960,000,000”.

Subsec. (l)(2)(A)(i)(IV). Pub. L. 110–275, § 131(a)(3)(C)(i)(I), struck out subcl. (IV) which read as follows: “For expenditures during 2014, an amount equal to $290,000,000.”

Pub. L. 110–252, § 7002(c)(1)(B), added subcl. (IV).

Subsec. (l)(2)(A)(ii)(III). Pub. L. 110–275, § 131(a)(3)(C)(i)(II), struck out subcl. (III). Text read as follows: “The amount available for expenditures during 2013 shall only be available for an adjustment to the update of the conversion factor under subsection (d) for that year.”

Subsec. (l)(2)(A)(ii)(IV). Pub. L. 110–275, § 131(a)(3)(C)(i)(II), struck out subcl. (IV). Text read as follows: “The amount available for expenditures during 2014 shall only be available for an adjustment to the update of the conversion factor under subsection (d) for that year.”

Pub. L. 110–252, § 7002(c)(2), added subcl. (IV).

Subsec. (l)(2)(B). Pub. L. 110–275, § 131(a)(3)(C)(ii), inserted “and” at end of cl. (i), substituted period for semicolon at end of cl. (ii), and struck out cls. (iii) and (iv) which read as follows:

“(iii) 2013 for payment with respect to physicians’ services furnished during 2013; and

“(iv) 2014 for payment with respect to physicians’ services furnished during 2014.”

Subsec. (l)(2)(B)(iv). Pub. L. 110–252, § 7002(c)(3), added cl. (iv).

Subsec. (m). Pub. L. 110–275, § 131(b)(2), (3)(A), transferred subsec. (c) of section 101 of title I of div. B of Pub. L. 109–432 to subsec. (m) of this section and amended heading generally. Prior to amendment, heading read “Transitional Bonus Incentive Payments for Quality Reporting in 2007 and 2008”. See Codification note above.

Subsec. (m)(1). Pub. L. 110–275, § 131(b)(3)(B), added par. (1) and struck out former par. (1) which provided for an additional payment for certain covered professional services furnished by an eligible professional.

Subsec. (m)(2). Pub. L. 110–275, § 132(a)(1), added par. (2). Former par. (2) redesignated (3).

Subsec. (m)(3). Pub. L. 110–275, §132(a)(2)(A), inserted “and successful electronic prescriber” after “reporting” in heading.

Pub. L. 110–275, § 131(b)(3)(D)(i), (ii), designated existing provisions as subpar. (A) and inserted heading, redesignated former subpars. (A) and (B) as cls. (i) and (ii), respectively, of subpar. (A), and realigned margins.

Pub. L. 110–275, § 131(b)(3)(C), redesignated par. (2) as (3) and struck out former par. (3) which provided for payment limitation.

Subsec. (m)(3)(A). Pub. L. 110–275, § 131(b)(3)(D)(iii), inserted concluding provisions.

Subsec. (m)(3)(B). Pub. L. 110–275, § 132(a)(2)(B), added subpar. (B). Former subpar. (B) redesignated cl. (i) of subpar. (A).

Subsec. (m)(3)(C), (D). Pub. L. 110–275, § 131(b)(3)(D)(iv), added subpars. (C) and (D).

Subsec. (m)(5)(A). Pub. L. 110–275, § 131(b)(5)(A)(i), substituted “subsection (k)” for “section 1848(k) of the Social Security Act, as added by subsection (b),” and “such subsection” for “such section”.

Subsec. (m)(5)(B). Pub. L. 110–275, § 131(b)(5)(A)(ii), struck out “of the Social Security Act (42 U.S.C. 1395l)” before “and any payment”.

Subsec. (m)(5)(C). Pub. L. 110–275, § 131(b)(3)(E)(i), inserted “for 2007, 2008, and 2009,” after “provision of law,”.

Subsec. (m)(5)(D)(i). Pub. L. 110–275, § 131(b)(3)(E)(ii)(I), which directed amendment of cl. (i) by inserting “for 2007 and 2008” after “under this subsection” and then substituting “this subsection” for “paragraph (2)”, was executed by substituting “under this subsection for 2007 and 2008” for “under paragraph (2)” to reflect the probable intent of Congress.

Subsec. (m)(5)(D)(ii). Pub. L. 110–275, § 131(b)(3)(E)(ii)(II), substituted “may establish procedures to” for “shall”.

Subsec. (m)(5)(D)(iii). Pub. L. 110–275, § 131(b)(3)(E)(ii)(III), inserted “(or, in the case of a group practice under paragraph (3)(C), the group practice)” after “an eligible professional”, substituted “incentive payment under this subsection” for “bonus incentive payment”, and inserted at end “If such payments for such period have already been made, the Secretary shall recoup such payments from the eligible professional (or the group practice).”

Subsec. (m)(5)(E). Pub. L. 110–275, § 131(b)(5)(A)(iii), substituted “1395ff of this title, section 1395oo of this title, or otherwise” for “1869 or 1878 of the Social Security Act or otherwise”.

Pub. L. 110–275, § 131(b)(3)(E)(iii)(I)–(III), struck out cl. (i) designation and heading before “There shall be”, redesignated subcls. (I) to (IV) as cls. (i) to (iv), respectively, and struck out former cl. (ii). Prior to amendment, text of cl. (ii) read as follows: “A determination under this subsection shall not be treated as a determination for purposes of section 1869 of the Social Security Act.”

Subsec. (m)(5)(E)(ii). Pub. L. 110–275, § 131(b)(3)(E)(iii)(IV), substituted “this subsection” for “paragraph (2)”.

Subsec. (m)(5)(E)(iii). Pub. L. 110–275, § 132(a)(3), added cl. (iii) and struck out former cl. (iii) which read as follows: “the determination of the payment limitation under paragraph (3); and”.

Subsec. (m)(5)(E)(iv). Pub. L. 110–275, § 131(b)(3)(E)(iii)(V), substituted “any” for “the bonus” and inserted “and the payment adjustment under subsection (a)(5)(A)” before period at end.

Subsec. (m)(5)(F). Pub. L. 110–275, § 131(b)(3)(E)(iv), (5)(A)(iv), substituted “subsequent years,” for “2009, paragraph (3) shall not apply, and”, “this subsection” for “paragraph (2)”, “subsection (k)(2)(B)” for “paragraph (2)(B) of section 1848(k)” of the Social Security Act (42 U.S.C. 1395w–4(k))”, and “subsection (k)(4)” for “paragraph (4) of such section”.

Subsec. (m)(5)(G). Pub. L. 110–275, § 131(b)(3)(E)(v), added subpar. (G).

Subsec. (m)(6)(A). Pub. L. 110–275, § 131(b)(5)(B)(i), substituted “subsection (k)(3)” for “section 1848(k)(3) of the Social Security Act, as added by subsection (b)”.

Subsec. (m)(6)(B). Pub. L. 110–275, § 131(b)(5)(B)(ii), substituted “subsection (k)” for “section 1848(k) of the Social Security Act, as added by subsection (b)”.

Subsec. (m)(6)(C). Pub. L. 110–275, § 131(b)(3)(F), added subpar. (C) and struck out former subpar. (C). Prior to amendment, text read as follows: “The term ‘reporting period’ means—

“(i) for 2007, the period beginning on July 1, 2007, and ending on December 31, 2007; and

“(ii) for 2008, all of 2008.”

Subsec. (m)(6)(D). Pub. L. 110–275, § 131(b)(5)(C), struck out subpar. (D). Text read as follows: “The term ‘Secretary’ means the Secretary of Health and Human Services.”

Subsec. (n). Pub. L. 110–275, § 131(c)(1), added subsec. (n).

2007—Subsec. (d)(4)(B). Pub. L. 110–173, § 101(a)(1)(A), substituted “and the succeeding paragraphs of this subsection” for “and paragraphs (5) and (6)” in introductory provisions.

Subsec. (d)(8). Pub. L. 110–173, § 101(a)(1)(B), added par. (8).

Subsec. (e)(1)(E). Pub. L. 110–173, § 103, substituted “before July 1, 2008” for “before January 1, 2008”.

Subsec. (k)(2)(B). Pub. L. 110–173, § 101(b)(1), in heading and cl. (i), inserted “and 2009” after “2008”, and, in cls. (ii) and (iii), substituted “of each of 2007 and 2008” for “, 2007” and inserted “or 2009, as applicable” after “2008”.

Subsec. (l)(2)(A). Pub. L. 110–173, § 101(a)(2)(A)(i), added subpar. (A) and struck out former subpar. (A), which read as follows: “There shall be available to the Fund for expenditures an amount equal to $1,200,000,000, as reduced by section 524 and section 225(c)(1)(A) of the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2008 (division G of the Consolidated Appropriations Act, 2008). In addition, there shall be available to the Fund for expenditures during 2009 an amount equal to $325,000,000, as reduced by section 225(c)(1)(B) of such Act, and for expenditures during or after 2013 an amount equal to $60,000,000.”

Pub. L. 110–161, § 524, which directed amendment of subpar. (A) by reducing the dollar amount in the first sentence by $150,000,000, was executed by substituting “$1,200,000,000” for “$1,350,000,000” in first sentence.

Pub. L. 110–161, § 225(c)(2), inserted, in first sentence, “, as reduced by section 524 and section 225(c)(1)(A) of the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2008 (division G of the Consolidated Appropriations Act, 2008)” after “$1,350,000,000” and, in second sentence, “, as reduced by section 225(c)(1)(B) of such Act,” after “$325,000,000”.

Pub. L. 110–90, § 6(1), inserted at end: “In addition, there shall be available to the Fund for expenditures during 2009 an amount equal to $325,000,000 and for expenditures during or after 2013 an amount equal to $60,000,000.”

Subsec. (l)(2)(B). Pub. L. 110–173, § 101(a)(2)(A)(ii), substituted “entire amount available for expenditures, after application of subparagraph (A)(ii), during—” and cls. (i) to (iii) for “entire amount specified in the first sentence of subparagraph (A) for payment with respect to physicians’ services furnished during 2008 and for the obligation of the entire first amount specified in the second sentence of such subparagraph for payment with respect to physicians’ services furnished during 2009 and of the entire second amount so specified for payment with respect to physicians’ services furnished on or after January 1, 2013.”

Pub. L. 110–90, § 6(2), in heading, struck out “furnished during 2008” after “services” and, in text, substituted “specified in the first sentence of subparagraph (A)” for “specified in subparagraph (A)” and inserted “and for the obligation of the entire first amount specified in the second sentence of such subparagraph for payment with respect to physicians’ services furnished during 2009 and of the entire second amount so specified for payment with respect to physicians’ services furnished on or after January 1, 2013” after “furnished during 2008”.

2006—Subsec. (b)(4). Pub. L. 109–171, § 5102(b)(1), added par. (4).

Subsec. (c)(2)(B)(ii)(II). Pub. L. 109–171, § 5102(a)(1), substituted “clauses (iv) and (v)” for “clause (iv)”.

Subsec. (c)(2)(B)(iv). Pub. L. 109–171, § 5102(a)(2), inserted “of certain additional expenditures” after “Exemption” in heading.

Subsec. (c)(2)(B)(v). Pub. L. 109–171, § 5102(a)(3), added cl. (v).

Subsec. (c)(2)(B)(v)(II). Pub. L. 109–171, § 5102(b)(2), added subcl. (II).

Subsec. (d)(4)(B). Pub. L. 109–171, § 5104(a)(1), substituted “paragraphs (5) and (6)” for “paragraph (5)” in introductory provisions.

Subsec. (d)(6). Pub. L. 109–171, § 5104(a)(2), added par. (6).

Subsec. (d)(7). Pub. L. 109–432, § 101(a), added par. (7).

Subsec. (e)(1)(E). Pub. L. 109–432, § 102, substituted “2008” for “2007”.

Subsec. (j)(3). Pub. L. 109–171, § 5112(c), inserted “(2)(AA),” after “(2)(W),”.

Subsec. (k). Pub. L. 109–432, § 101(b), added subsec. (k).

Subsec. (l). Pub. L. 109–432, § 101(d), added subsec. (l).

2003—Subsec. (c)(2)(B)(ii)(II). Pub. L. 108–173, § 303(a)(1)(A)(i), substituted “Subject to clause (iv), the adjustments” for “The adjustments”.

Subsec. (c)(2)(B)(iv). Pub. L. 108–173, § 303(a)(1)(A)(ii), added cl. (iv).

Subsec. (c)(2)(H) to (J). Pub. L. 108–173, § 303(a)(1)(B), added subpars. (H) to (J).

Subsec. (d)(4)(B). Pub. L. 108–173, § 601(a)(2), inserted “and paragraph (5)” after “subparagraph (D)” in introductory provisions.

Subsec. (d)(5). Pub. L. 108–173, § 601(a)(1), added par. (5).

Subsec. (e)(1)(A). Pub. L. 108–173, § 602(1), as amended by Pub. L. 110–275, § 134(c), substituted “subparagraphs (B), (C), (E), and (G)” for “subparagraphs (B), (C), and (E)”.

Pub. L. 108–173, § 412(1), substituted “subparagraphs (B), (C), and (E)” for “subparagraphs (B) and (C)”.

Subsec. (e)(1)(E). Pub. L. 108–173, § 412(2), added subpar. (E).

Subsec. (e)(1)(G). Pub. L. 108–173, § 602(2), added subpar. (G).

Subsec. (f)(2)(C). Pub. L. 108–173, § 601(b)(1), substituted “annual average” for “projected” and “during the 10-year period ending with the applicable period involved” for “from the previous applicable period to the applicable period involved”.

Subsec. (i)(1)(B). Pub. L. 108–173, § 303(g)(2), substituted “subsections (c)(2)(F), (c)(2)(H), and (c)(2)(I)” for “subsection (c)(2)(F)”.

Subsec. (i)(1)(C). Pub. L. 108–7 amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows: “the determination of conversion factors under subsection (d) of this section,”.

Subsec. (i)(3)(A). Pub. L. 108–173, § 736(b)(10), substituted “comparable services” for “a comparable services”.

Subsec. (j)(3). Pub. L. 108–173, § 611(c), inserted “(2)(W),” after “(2)(S),”.

2000—Subsec. (j)(3). Pub. L. 106–554 inserted “(13),” after “(4),”.

1999—Subsec. (d)(1)(A). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(a)(3)(A)(i)], inserted “(for years before 2001) and, for years beginning with 2001, multiplied by the update (established under paragraph (4)) for the year involved” before period at end.

Subsec. (d)(1)(E). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(a)(2)(A)], amended heading and text of subpar. (E) generally. Prior to amendment, text read as follows: “The Secretary shall cause to have published in the Federal Register, during the last 15 days of October of—

“(i) 1991, the conversion factor which will apply to physicians’ services for 1992, and the update determined under paragraph (3) for 1992; and

“(ii) each succeeding year, the conversion factor which will apply to physicians’ services for the following year and the update determined under paragraph (3) for such year.”

Subsec. (d)(3). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(a)(1)(A)(i)], inserted “for 1999 and 2000” after “Update” in heading.

Subsec. (d)(3)(A). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(a)(1)(A)(ii)], substituted “1999 and 2000” for “a year beginning with 1999” in introductory provisions.

Subsec. (d)(3)(C). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(a)(1)(A)(iii)], inserted “and paragraph (4)” after “For purposes of this paragraph” in introductory provisions.

Subsec. (d)(4). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(a)(1)(B)], added par. (4).

Subsec. (f)(1). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(b)(1)], amended heading and text of par. (1) generally. Prior to amendment, text read as follows: “The Secretary shall cause to have published in the Federal Register the sustainable growth rate for each fiscal year beginning with fiscal year 1998. Such publication shall occur by not later than August 1 before each fiscal year, except that such rate for fiscal year 1998 shall be published not later than November 1, 1997.”

Subsec. (f)(2). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(b)(2)(A)], substituted “fiscal year 1998 and ending with fiscal year 2000) and a year beginning with 2000” for “fiscal year 1998)” in introductory provisions.

Subsec. (f)(2)(A). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(b)(2)(B)], substituted “applicable period” for “fiscal year”.

Subsec. (f)(2)(B), (C). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(b)(2)(B)], substituted “applicable period” for “fiscal year” in two places.

Subsec. (f)(2)(D). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(a)(3)(A)(ii), (b)(2)(B)], substituted “applicable period” for “fiscal year” in two places and “subsection (d)(3)(B) or (d)(4)(B), as the case may be” for “subsection (d)(3)(B)”.

Subsec. (f)(3). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(b)(5)], added par. (3). Former par. (3) redesignated (4).

Subsec. (f)(3)(C). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(b)(3)], added subpar. (C).

Subsec. (f)(4). Pub. L. 106–113, § 1000(a)(6) [title II, § 211(b)(4)], redesignated par. (3) as (4).

Subsec. (j)(3). Pub. L. 106–113, § 1000(a)(6) [title III, § 321(k)(5)], substituted “section 1395x(oo)(2) of this title)” for “section 1395x(oo)(2) of this title,”, “(B),” for “(B),”, and “, and (15)” for “and (15)”.

1997—Subsec. (b)(1). Pub. L. 105–33, § 4644(d), substituted “Before November 1 of the preceding year, for each year beginning with 1998” for “Before January 1 of each year beginning with 1992” in introductory provisions.

Subsec. (c)(2)(B)(iii). Pub. L. 105–33, § 4022(b)(2)(C), substituted “Medicare Payment Advisory Commission” for “Physician Payment Review Commission”.

Subsec. (c)(2)(C)(ii). Pub. L. 105–33, § 4505(b)(1)(A), which directed an amendment striking the comma at the end of cl. (ii) and inserting a period and the following: “For 1999, such number of units shall be determined based 75 percent on such product and based 25 percent on the relative practice expense resources involved in furnishing the service. For 2000, such number of units shall be determined based 50 percent on such product and based 50 percent on such relative practice expense resources. For 2001, such number of units shall be determined based 25 percent on such product and based 75 percent on such relative practice expense resources. For a subsequent year, such number of units shall be determined based entirely on such relative practice expense resources.”, was executed by making the insertion at end of cl. (ii) to reflect the probable intent of Congress, because cl. (ii) ended with a period rather than a comma.

Pub. L. 105–33, § 4505(a)(1), substituted “1999” for “1998” in two places.

Subsec. (c)(2)(C)(iii). Pub. L. 105–33, § 4505(f)(1)(A), inserted “for the service for years before 2000” before “equal” in introductory provisions, substituted comma for period at end of subcl. (II), and inserted concluding provisions.

Subsec. (c)(2)(G). Pub. L. 105–33, § 4505(e), added subpar. (G).

Subsec. (c)(3)(C)(ii). Pub. L. 105–33, § 4505(b)(2), substituted “2002” for “1999” in introductory provisions.

Pub. L. 105–33, § 4505(a)(2), substituted “1999” for “1998” in introductory provisions.

Subsec. (c)(3)(C)(iii). Pub. L. 105–33, § 4505(f)(1)(B), substituted “For years before 1999, the malpractice” for “The malpractice” in introductory provisions.

Subsec. (d)(1)(A). Pub. L. 105–33, § 4501(b)(1), (2), struck out “(or factors)” after “conversion factor” in two places and struck out “or updates” after “update”.

Subsec. (d)(1)(C). Pub. L. 105–33, § 4504(a)(1), substituted “Except as provided in subparagraph (D), the single conversion factor” for “The single conversion factor”.

Pub. L. 105–33, § 4501(a)(2), added subpar. (C). Former subpar. (C) redesignated (D).

Subsec. (d)(1)(D). Pub. L. 105–33, § 4504(a)(3), added subpar. (D). Former subpar. (D) redesignated (E).

Pub. L. 105–33, § 4501(b)(1), (3), struck out “(or updates)” after “update” in two places and struck out “(or factors)” after “conversion factor” in cl. (ii).

Pub. L. 105–33, § 4501(a)(1), redesignated subpar. (C) as (D).

Subsec. (d)(1)(E). Pub. L. 105–33, § 4504(a)(2), redesignated subpar. (D) as (E).

Subsec. (d)(2). Pub. L. 105–33, § 4502(b), struck out heading and text of par. (2) which related to recommendation of update.

Subsec. (d)(2)(F). Pub. L. 105–33, § 4022(b)(1)(B)(i), struck out heading and text of subpar. (F). Text read as follows: “The Physician Payment Review Commission shall review the report submitted under subparagraph (A) in a year and shall submit to the Congress, by not later than May 15 of the year, a report including its recommendations respecting the update (or updates) in the conversion factor (or factors) for the following year.”

Subsec. (d)(3). Pub. L. 105–33, § 4502(a)(1), amended heading and text generally. Prior to amendment, text related to updates of conversion factor based on index and made provision for adjustments in update.

Subsec. (f). Pub. L. 105–33, § 4503(b), amended subsec. heading and heading and text of par. (1) generally. Prior to amendment, par. (1) related to process for establishing medicare volume performance standard rates of increase.

Subsec. (f)(1)(B). Pub. L. 105–33, § 4022(b)(2)(B)(ii), struck out heading and text of subpar. (B). Text read as follows: “The Physician Payment Review Commission shall review the recommendation transmitted during a year under subparagraph (A) and shall make its recommendation to Congress, by not later than May 15 of the year, respecting the performance standard rates of increase for the fiscal year beginning in that year.”

Subsec. (f)(2). Pub. L. 105–33, § 4503(a), added par. (2) and struck out heading and text of former par. (2) which related to specification of performance standard rates of increase for physician services for fiscal years beginning in 1991.

Subsec. (f)(3). Pub. L. 105–33, § 4503(a), added par. (3) and struck out heading and text of former par. (3). Text read as follows: “The Secretary shall establish procedures for providing, on a quarterly basis to the the Congressional Budget Office, the Congressional Research Service, the Committees on Ways and Means and Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate, information on compliance with performance standard rates of increase established under this subsection.”

Pub. L. 105–33, § 4022(b)(2)(B)(iii), struck out “Physician Payment Review Commission,” before “the Congressional Budget Office”.

Subsec. (f)(4), (5). Pub. L. 105–33, § 4503(a), struck out heading and text of par. (4) which related to separate group-specific performance standard rates of increase and par. (5) which defined “physicians’ services” and “HMO enrollee”.

Subsec. (g)(3)(A). Pub. L. 105–33, § 4714(b)(2), inserted before period at end “and the provisions of section 1396a(n)(3)(A) of this title apply to further limit permissible charges under this section”.

Subsec. (g)(6)(C), (7)(C). Pub. L. 105–33, § 4022(b)(2)(C), substituted “Medicare Payment Advisory Commission” for “Physician Payment Review Commission”.

Subsec. (j)(1). Pub. L. 105–33, § 4501(b)(4), substituted “For services furnished before January 1, 1998, the term” for “The term”.

Subsec. (j)(3). Pub. L. 105–33, § 4106(b), substituted “(4), (14)” for “(4) and (14)” and inserted “and (15)” after “1395x(nn)(2) of this title)”.

Pub. L. 105–33, § 4105(a)(2), inserted “(2)(S),” before “(3)”.

Pub. L. 105–33, § 4103(d), inserted “(2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1395x(oo)(2) of this title,” after “(2)(G)”.

Pub. L. 105–33, §§ 4102(d), 4104(d), inserted “(2)(R) (with respect to services described in subparagraphs (B) , (C), and (D) of section 1395x(pp)(1) of this title),” before “(3)” and substituted “(4) and (14) (with respect to services described in section 1395x(nn)(2) of this title)” for “and (4)”.

1994—Subsec. (a)(2)(D)(iii). Pub. L. 103–432, § 126(b)(6), struck out “that are subject to section 6105(b) of the Omnibus Budget Reconciliation Act of 1989” after “nuclear medicine services” and substituted “provided under section 6105(b) of the Omnibus Budget Reconciliation Act of 1989” for “provided under such section”.

Subsec. (c)(2)(C)(ii). Pub. L. 103–432, § 121(b)(1), inserted “for the service for years before 1998” before “equal to” in introductory provisions, substituted comma for period at end of subcl. (II), and inserted “and for years beginning with 1998 based on the relative practice expense resources involved in furnishing the service.” as closing provisions.

Subsec. (c)(3)(C)(ii). Pub. L. 103–432, § 121(b)(2), substituted “For years before 1998, the practice” for “The practice”.

Subsec. (c)(4). Pub. L. 103–432, § 126(g)(6), made technical amendment to directory language of Pub. L. 101–508, § 4118(f)(1)(D). See 1990 Amendment note below.

Subsec. (e)(1)(C). Pub. L. 103–432, § 126(g)(5), inserted “date of the” before “last previous adjustment”.

Pub. L. 103–432, § 122(a), substituted “shall, in consultation with appropriate representatives of physicians, review” for “shall review”.

Subsec. (e)(1)(D). Pub. L. 103–432, § 122(b), added subpar. (D).

Subsec. (f)(2)(A)(i). Pub. L. 103–432, § 126(g)(7), made technical amendment to directory language of Pub. L. 101–508, § 4118(f)(1)(N)(ii). See 1990 Amendment note below.

Subsec. (f)(2)(C). Pub. L. 103–432, § 126(g)(2)(B), inserted heading.

Subsec. (g)(1). Pub. L. 103–432, § 123(a)(1), amended heading and text of par. (1) generally. Prior to amendment, text read as follows: “If a nonparticipating physician or nonparticipating supplier or other person (as defined in section 1395u(i)(2) of this title) knowingly and willfully bills on a repeated basis for physicians’ services (including services which the Secretary excludes pursuant to subsection (j)(3) of this section, furnished with respect to an individual enrolled under this part on or after January 1, 1991) an actual charge in excess of the limiting charge described in paragraph (2) and for which payment is not made on an assignment-related basis under this part, the Secretary may apply sanctions against such physician, supplier, or other person in accordance with section 1395u(j)(2) of this title. In applying this subparagraph, any reference in such section to a physician is deemed also to include a reference to a supplier or other person under this subparagraph.”

Subsec. (g)(3)(B). Pub. L. 103–432, § 123(a)(2), inserted after first sentence “No person is liable for payment of any amounts billed for such a service in violation of the previous sentence.” and in last sentence substituted “first sentence” for “previous sentence”.

Subsec. (g)(6)(B). Pub. L. 103–432, § 123(d), inserted “information on the extent to which actual charges exceed limiting charges, the number and types of services involved, and the average amount of excess charges and information” after “report to the Congress”.

Subsec. (i)(3). Pub. L. 103–432, § 126(g)(10)(A), struck out space before the period at end.

1993—Subsec. (a)(2)(B)(ii)(I). Pub. L. 103–66, § 13515(c)(1), inserted “and under section 13515(b) of the Omnibus Budget Reconciliation Act of 1993” after “subsection (c)(2)(F)(ii)”.

Pub. L. 103–66, § 13514(c)(1), inserted “and as adjusted under subsection (c)(2)(F)(ii)” after “for 1994”.

Subsec. (a)(3). Pub. L. 103–66, § 13517(a)(1), in heading inserted “and suppliers” after “physicians” and in text inserted “or a nonparticipating supplier or other person” after “nonparticipating physician” and inserted at end “In the case of physicians’ services (including services which the Secretary excludes pursuant to subsection (j)(3)) of a nonparticipating physician, supplier, or other person for which payment is made under this part on a basis other than the fee schedule amount, the payment shall be based on 95 percent of the payment basis for such services furnished by a participating physician, supplier, or other person.”

Subsec. (a)(4). Pub. L. 103–66, § 13516(a)(1), added par. (4).

Pub. L. 103–66, § 13515(a)(1), struck out heading and text of par. (4). Text read as follows: “In the case of physicians’ services furnished by a physician before the end of the physician’s first full calendar year of furnishing services for which payment may be made under this part, and during each of the 3 succeeding years, the fee schedule amount to be applied shall be 80 percent, 85 percent, 90 percent, and 95 percent, respectively, of the fee schedule amount applicable to physicians who are not subject to this paragraph. The preceding sentence shall not apply to primary care services or services furnished in a rural area (as defined in section 1395ww(d)(2) of this title) that is designated under section 249(a)(1)(A) of this title as a health manpower shortage area.”

Subsec. (b)(3). Pub. L. 103–66, § 13514(a), amended heading and text of par. (3) generally. Prior to amendment, text read as follows: “If payment is made under this part for a visit to a physician or consultation with a physician and, as part of or in conjunction with the visit or consultation there is an electrocardiogram performed or ordered to be performed, no payment may be made under this part with respect to the interpretation of the electrocardiogram and no physician may bill an individual enrolled under this part separately for such an interpretation. If a physician knowingly and willfully bills one or more individuals in violation of the previous sentence, the Secretary may apply sanctions against the physician or entity in accordance with section 1395u(j)(2) of this title.”

Subsec. (c)(2)(A)(i). Pub. L. 103–66, § 13515(c)(2), inserted before period at end “and section 13515(b) of the Omnibus Budget Reconciliation Act of 1993”.

Pub. L. 103–66, § 13514(c)(2), inserted at end “Such relative values are subject to adjustment under subparagraph (F)(i).”

Subsec. (c)(2)(E). Pub. L. 103–66, § 13513, added subpar. (E).

Subsec. (c)(2)(F). Pub. L. 103–66, § 13514(b), added subpar. (F).

Subsec. (d)(3)(A)(i). Pub. L. 103–66, § 13511(a)(1)(A), substituted “clauses (iii) through (v)” for “clause (iii)”.

Subsec. (d)(3)(A)(iv) to (vi). Pub. L. 103–66, § 13511(a)(1)(B), added cls. (iv) to (vi).

Subsec. (d)(3)(B)(ii). Pub. L. 103–66, § 13512(b), substituted “1994” for “1994 or 1995” in subcl. (II) and “5” for “3” in subcl. (III).

Subsec. (f)(2)(B). Pub. L. 103–66, § 13512(a), added cls. (iii) to (v) and struck out former cl. (iii) which read as follows: “for each succeeding year is 2 percentage points.”

Subsec. (g)(1). Pub. L. 103–66, § 13517(a)(2)(C), (D), inserted “, supplier, or other person” after “such physician” and inserted at end “In applying this subparagraph, any reference in such section to a physician is deemed also to include a reference to a supplier or other person under this subparagraph.”

Pub. L. 103–66, § 13517(a)(2)(B), which directed insertion of “including services which the Secretary excludes pursuant to subsection (j)(3) of this section,” after “physician’s services (”, was executed by making the insertion after “physicians’ services (” to reflect the probable intent of Congress.

Pub. L. 103–66, § 13517(a)(2)(A), inserted “or nonparticipating supplier or other person (as defined in section 1395u(i)(2) of this title)” after “nonparticipating physician”.

Subsec. (g)(2)(C). Pub. L. 103–66, § 13517(a)(3), inserted “or for nonparticipating suppliers or other persons” after “nonparticipating physicians”.

Subsec. (g)(2)(D). Pub. L. 103–66, § 13517(a)(4), inserted “(or, if payment under this part is made on a basis other than the fee schedule under this section, 95 percent of the other payment basis)” after “subsection (a)”.

Subsec. (h). Pub. L. 103–66, § 13517(a)(5), inserted “or nonparticipating supplier or other person furnishing physicians’ services (as defined in subsection (j)(3))” after “each physician”, inserted “, supplier, or other person” after “by the physician”, and inserted “, suppliers, and other persons” after “notices to physicians”.

Subsec. (i)(1)(B). Pub. L. 103–66, § 13515(c)(3), inserted “and section 13515(b) of the Omnibus Budget Reconciliation Act of 1993” after “subsection (c)(2)(F)”.

Pub. L. 103–66, § 13514(c)(3), inserted at end “including adjustments under subsection (c)(2)(F),”.

Subsec. (j)(1). Pub. L. 103–66, § 13511(a)(2), substituted “Secretary and including anesthesia services), primary care services (as defined in section 1395u(i)(4) of this title),” for “Secretary)”.

Subsec. (j)(3). Pub. L. 103–66, § 13518(a), inserted “(2)(G),” after “(2)(D),”.

Pub. L. 103–66, § 13517(a)(6), inserted “, except for purposes of subsections (a)(3), (g), and (h)” after “tests and”.

1990—Subsec. (a)(1). Pub. L. 101–508, § 4104(b)(2), struck out “or 1395m(f)” after “section 1395m(b)” in introductory provisions.

Subsec. (a)(2)(C). Pub. L. 101–508, § 4102(b), inserted “and radiology” after “Special rule for anesthesia” in heading and inserted at end “With respect to radiology services, ‘109 percent’ and ‘9 percent’ shall be substituted for ‘115 percent’ and ‘15 percent’, respectively, in subparagraph (A)(ii).”

Subsec. (a)(2)(D)(ii). Pub. L. 101–508, § 4102(g)(2)(A), inserted “, but excluding nuclear medicine services that are subject to section 6105(b) of the Omnibus Budget Reconciliation Act of 1989” after “section 1395m(b)(6) of this title)”.

Subsec. (a)(2)(D)(iii). Pub. L. 101–508, § 4102(g)(2)(B), added cl. (iii).

Subsec. (a)(4). Pub. L. 101–508, § 4106(b)(1), added par. (4).

Subsec. (b)(3). Pub. L. 101–508, § 4109(a), added par. (3).

Subsec. (c)(1)(B). Pub. L. 101–508, § 4118(f)(1)(A), struck out at end “In this subparagraph, the term ‘practice expenses’ includes all expenses for furnishing physicians’ services, excluding malpractice expenses, physician compensation, and other physician fringe benefits.”

Subsec. (c)(3). Pub. L. 101–508, § 4118(f)(1)(C), redesignated par. (3), relating to ancillary policies, as (4).

Subsec. (c)(3)(C)(ii)(II), (iii)(II). Pub. L. 101–508, § 4118(f)(1)(B), struck out “by” before “the proportion”.

Subsec. (c)(4). Pub. L. 101–508, § 4118(f)(1)(D), as amended by Pub. L. 103–432, § 126(g)(6), substituted “section” for “subsection”.

Pub. L. 101–508, § 4118(f)(1)(C), redesignated par. (3), relating to ancillary policies, as (4). Former par. (4) redesignated (5).

Pub. L. 101–508, § 4118(d), struck out “only for services furnished on or after January 1, 1993” after “visits and consultations”.

Subsec. (c)(5), (6). Pub. L. 101–508, § 4118(f)(1)(C), redesignated pars. (4) and (5) as (5) and (6), respectively.

Subsec. (d)(1)(A). Pub. L. 101–508, § 4118(f)(1)(E), (F)(i)(III), amended subpar. (A) identically, substituting “paragraph (3)” for “subparagraph (C)”.

Pub. L. 101–508, § 4118(f)(1)(F)(i)(I), (II), substituted “conversion factor (or factors)” for “conversion factor” in two places and “update or updates” for “update”.

Subsec. (d)(1)(C)(i). Pub. L. 101–508, § 4118(f)(1)(F)(ii)(I), substituted “conversion factor” for “conversion factor (or factors)”.

Subsec. (d)(1)(C)(ii). Pub. L. 101–508, § 4118(f)(1)(F)(ii)(II), inserted “the conversion factor (or factors) which will apply to physicians’ services for the following year and” before “the update (or updates)” and substituted “such year” for “the following year”.

Subsec. (d)(2)(A). Pub. L. 101–508, § 4118(f)(1)(G), (I), substituted “physicians’ services (as defined in subsection (f)(5)(A) of this section)” for “physicians’ services” in first sentence and “proportion of individuals who are enrolled under this part who are HMO enrollees” for “proportion of HMO enrollees” in last sentence.

Subsec. (d)(2)(A)(ii). Pub. L. 101–508, § 4118(f)(1)(H), substituted “and for the services involved” for “(as defined in subsection (f)(5)(A) of this section)” and “such services” for “all such physicians’ services”.

Subsec. (d)(2)(E)(i). Pub. L. 101–508, § 4118(f)(1)(J), inserted “the” before “most recent”.

Subsec. (d)(2)(E)(ii)(I). Pub. L. 101–508, § 4118(f)(1)(K), substituted “payments for physicians’ services” for “physicians’ services”.

Subsec. (d)(3)(A)(i). Pub. L. 101–508, § 4105(a)(3)(A), inserted “except as provided in clause (iii),” after “subparagraph (B),”.

Subsec. (d)(3)(A)(iii). Pub. L. 101–508, § 4105(a)(3)(B), added cl. (iii).

Subsec. (d)(3)(B)(i). Pub. L. 101–508, § 4118(f)(1)(L)(i)(II), which directed amendment of cl. (i) by substituting “services in such category” for “physicians’ services (as defined in subsection (f)(5)(A))”, was executed by making the substitution for “physicians’ services (as defined in section (f)(5)(A))” to reflect the probable intent of Congress.

Pub. L. 101–508, § 4118(f)(1)(L)(i)(I), substituted “update for a category of physicians’ services for a year” for “update for a year”.

Subsec. (d)(3)(B)(ii). Pub. L. 101–508, § 4118(f)(1)(L)(ii), inserted “more than” after “decrease of” in introductory provisions and struck out “more than” before “2 percentage points” in subcl. (I).

Subsec. (e)(1)(A). Pub. L. 101–508, § 4118(c)(1), substituted “subparagraphs (B) and (C)” for “subparagraph (B)” in introductory provisions.

Subsec. (e)(1)(C). Pub. L. 101–508, § 4118(c)(2), added subpar. (C).

Subsec. (f)(1)(C). Pub. L. 101–508, § 4105(c)(1), substituted “1991” for “1990” after “beginning with”.

Subsec. (f)(1)(D)(i). Pub. L. 101–508, § 4118(f)(1)(M), substituted “portions of calendar years” for “calendar years”.

Subsec. (f)(2)(A). Pub. L. 101–508, § 4118(b)(1), (f)(1)(N)(i), in introductory provisions, substituted “the performance standard rate of increase, for all physicians’ services and for each category of physicians’ services,” for “each performance standard rate of increase” and “product” for “sum”.

Pub. L. 101–508, § 4118(b)(6), substituted “minus 1, multiplied by 100, and reduced” for “reduced” in concluding provisions.

Subsec. (f)(2)(A)(i). Pub. L. 101–508, § 4118(f)(1)(N)(ii), as amended by Pub. L. 103–432, § 126(g)(7), substituted “all physicians’ services or for the category of physicians’ services, respectively,” for “physicians’ services (as defined in subsection (f)(5)(A) of this section)”.

Pub. L. 101–508, § 4118(f)(1)(M), substituted “portions of calendar years” for “calendar years”.

Pub. L. 101–508, § 4118(b)(2), (3), substituted “1 plus the Secretary’s” for “the Secretary’s” and “percentage increase (divided by 100)” for “percentage increase”.

Subsec. (f)(2)(A)(ii). Pub. L. 101–508, § 4118(b)(2), (4), substituted “1 plus the Secretary’s” for “the Secretary’s” and inserted “(divided by 100)” after “decrease”.

Subsec. (f)(2)(A)(iii). Pub. L. 101–508, § 4118(f)(1)(N)(iii), substituted “all physicians’ services or of the category of physicians’ services, respectively,” for “physicians’ services”.

Pub. L. 101–508, § 4118(b)(2), (5), substituted “1 plus the Secretary’s” for “the Secretary’s” and inserted “(divided by 100)” after “percentage growth”.

Subsec. (f)(2)(A)(iv). Pub. L. 101–508, § 4118(e), (f)(1)(N)(iv), substituted “all physicians’ services or of the category of physicians’ services, respectively,” for “physicians’ services (as defined in subsection (f)(5)(A) of this section)” and inserted “including changes in law and regulations affecting the percentage increase described in clause (i)” after “law or regulations”.

Pub. L. 101–508, § 4118(b)(2), (4), substituted “1 plus the Secretary’s” for “the Secretary’s” and “decrease (divided by 100)” for “decrease”.

Subsec. (f)(2)(C). Pub. L. 101–508, § 4105(c)(2), added subpar. (C).

Subsec. (f)(4)(A). Pub. L. 101–508, § 4118(f)(1)(O), substituted “subparagraph (B)” for “paragraph (B)”.

Subsec. (f)(4)(B). Pub. L. 101–508, § 4118(f)(1)(P), substituted “specifically approved by law” for “Congress specifically approves the plan”.

Subsec. (g)(2)(A). Pub. L. 101–508, § 4118(f)(1)(Q), inserted “other than radiologist services subject to section 1395m(b) of this title,” after “during 1991,” in introductory provisions.

Pub. L. 101–508, § 4116, inserted at end “In the case of evaluation and management services (as specified in section 1395u(b)(16)(B)(ii) of this title), the preceding sentence shall be applied by substituting ‘40 percent’ for ‘25 percent’.”

Subsec. (g)(2)(B). Pub. L. 101–508, § 4118(f)(1)(Q), inserted “other than radiologist services subject to section 1395m(b) of this title,” after “during 1992,” in introductory provisions.

Subsec. (i)(1)(A). Pub. L. 101–508, § 4118(f)(1)(R), substituted “adjusted historical payment basis (as defined in subsection (a)(2)(D)(i)” for “historical payment basis (as defined in subsection (a)(2)(C)(i)”.

Subsec. (i)(2). Pub. L. 101–508, § 4107(a)(1), added par. (2).

Subsec. (i)(3). Pub. L. 101–508, § 4118(k), added par. (3).

Subsec. (j)(1). Pub. L. 101–508, § 4118(f)(1)(S), which directed the amendment of par. (1) by substituting “(as defined by the Secretary) and all other physicians’ services” for “, and such other” and all that follows through the period was executed by making the substitution for “, and such other category or categories of physicians’ services as the Secretary, from time to time, defines in regulation.” to reflect the probable intent of Congress.

References to Medicare+Choice deemed to refer to Medicare Advantage or MA, subject to an appropriate transition provided by the Secretary of Health and Human Services in the use of those terms, see section 201 of Pub. L. 108–173, set out as a note under section 1395w–21 of this title.

Pub. L. 114–10, title I, § 106(b)(2)(C), Apr. 16, 2015, 129 Stat. 140, provided that: “The amendments made by this subsection [amending this section and section 1395ww of this title] shall apply to meaningful EHR users [which term has the meaning given under 42 U.S.C. 1395f(l)(3), 42 U.S.C. 1395w–4(o), 42 U.S.C. 1395w–23(l), (m), and 42 U.S.C. 1395ww(n)] as of the date that is one year after the date of the enactment of this Act [Apr. 16, 2015].”

Pub. L. 111–157, § 5(b), Apr. 15, 2010, 124 Stat. 1117, provided that: “The amendments made by subsection (a) [amending this section and section 1396b of this title] shall be effective as if included in the enactment of the HITECH Act [Pub. L. 111–5, div. A, title XIII, div. B, title IV] (included in the American Recovery and Reinvestment Act of 2009 (Public Law 111–5)).”

Pub. L. 111–152, title I, § 1108, Mar. 30, 2010, 124 Stat. 1050, provided that the amendment made by section 1108 is effective as if included in the enactment of the Patient Protection and Affordable Care Act (Pub. L. 111–148).

Pub. L. 111–148, title III, § 3002(c)(2), Mar. 23, 2010, 124 Stat. 365, provided that: “The amendment made by paragraph (1) [amending this section] shall apply for years after 2010.”

Amendment by section 4103(c)(2) of Pub. L. 111–148 applicable to services furnished on or after Jan. 1, 2011, see section 4103(e) of Pub. L. 111–148, set out as a note under section 1395l of this title.

Pub. L. 110–275, title I, § 144(a)(3), July 15, 2008, 122 Stat. 2547, provided that: “The amendments made by this subsection [amending this section and section 1395x of this title] shall apply to items and services furnished on or after January 1, 2010.”

Pub. L. 110–275, title I, § 152(b)(2), July 15, 2008, 122 Stat. 2553, provided that: “The amendments made by this subsection [amending this section and sections 1395x and 1395y of this title] shall apply to services furnished on or after January 1, 2010.”

Pub. L. 110–173, title I, § 101(a)(2)(B), Dec. 29, 2007, 121 Stat. 2494, provided that:

Amendment by section 5112(c) of Pub. L. 109–171 applicable to services furnished on or after Jan. 1, 2007, see section 5112(f) of Pub. L. 109–171, set out as a note under section 1395l of this title.

Pub. L. 108–173, title VI, § 601(b)(2), Dec. 8, 2003, 117 Stat. 2301, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to computations of the sustainable growth rate for years beginning with 2003.”

Pub. L. 108–173, title VI, § 611(e), Dec. 8, 2003, 117 Stat. 2304, provided that: “The amendments made by this section [amending this section and sections 1395x and 1395y of this title] shall apply to services furnished on or after January 1, 2005, but only for individuals whose coverage period under part B [probably means part B of title XVIII of the Social Security Act, 42 U.S.C. 1395j et seq.] begins on or after such date.”

Amendment by Pub. L. 106–554 applicable with respect to screening mammographies furnished on or after Jan. 1, 2002, see section 1(a)(6) [title I, § 104(c)] of Pub. L. 106–554, set out as a note under section 1395m of this title.

Pub. L. 106–113, div. B, § 1000(a)(6) [title II, § 211(d)], Nov. 29, 1999, 113 Stat. 1536, 1501A–350, provided that: “The amendments made by this section [amending this section and sections 1395b–6 and 1395l of this title] shall be effective in determining the conversion factor under section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)) for years beginning with 2001 and shall not apply to or affect any update (or any update adjustment factor) for any year before 2001.”

Amendment by section 1000(a)(6) [title III, § 321(k)(5)] of Pub. L. 106–113 effective as if included in the enactment of the Balanced Budget Act of 1997, Pub. L. 105–33, except as otherwise provided, see section 1000(a)(6) [title III, § 321(m)] of Pub. L. 106–113, set out as a note under section 1395d of this title.

Amendment by section 4022(b)(2)(B), (C) of Pub. L. 105–33 effective Nov. 1, 1997, the date of termination of the Prospective Payment Assessment Commission and the Physician Payment Review Commission, see section 4022(c)(2) of Pub. L. 105–33 set out as an Effective Date; Transition; Transfer of Functions note under section 1395b–6 of this title.

Amendment by section 4102(d) of Pub. L. 105–33 applicable to items and services furnished on or after Jan. 1, 1998, see section 4102(e) of Pub. L. 105–33, set out as a note under section 1395l of this title.

Amendment by section 4103(d) of Pub. L. 105–33 applicable to items and services furnished on or after Jan. 1, 2000, see section 4103(e) of Pub. L. 105–33, set out as a note under section 1395l of this title.

Amendment by section 4104(d) of Pub. L. 105–33 applicable to items and services furnished on or after Jan. 1, 1998, see section 4104(e) of Pub. L. 105–33, set out as a note under section 1395l of this title.

Amendment by section 4105(a)(2) of Pub. L. 105–33 applicable to items and services furnished on or after July 1, 1998, see section 4105(d)(1) of Pub. L. 105–33, set out as a note under section 1395m of this title.

Amendment by section 4106(b) of Pub. L. 105–33 applicable to bone mass measurements performed on or after July 1, 1998, see section 4106(d) of Pub. L. 105–33, set out as a note under section 1395x of this title.

Pub. L. 105–33, title IV, § 4502(a)(2), Aug. 5, 1997, 111 Stat. 433, provided that: “The amendment made by this subsection [amending this section] shall apply to the update for years beginning with 1999.”

Pub. L. 105–33, title IV, § 4504(b), Aug. 5, 1997, 111 Stat. 435, provided that: “The amendments made by subsection (a) [amending this section] shall apply to services furnished on or after January 1, 1998.”

Amendment by section 4714(b)(2) of Pub. L. 105–33 applicable to payment for (and with respect to provider agreements with respect to) items and services furnished on or after Aug. 5, 1997, see section 4714(c) of Pub. L. 105–33, set out as a note under section 1396a of this title.

Amendment by section 123(a) of Pub. L. 103–432 applicable to services furnished on or after Oct. 31, 1994, but inapplicable to services of nonparticipating supplier or other person furnished before Jan. 1, 1995, see section 123(f)(1) of Pub. L. 103–432, set out as a note under section 1395l of this title.

Pub. L. 103–432, title I, § 123(f)(5), Oct. 31, 1994, 108 Stat. 4413, provided that: “The amendment made by subsection (d) [amending this section] shall apply to reports for years beginning with 1995.”

Amendment by section 126(b)(6), (g)(2)(B), (5)–(7), (10)(A) of Pub. L. 103–432 effective as if included in the enactment of Pub. L. 101–508, see section 126(i) of Pub. L. 103–432, set out as a note under section 1395m of this title.

Pub. L. 103–66, title XIII, § 13511(b), Aug. 10, 1993, 107 Stat. 581, provided that: “The amendments made by this section [amending this section] shall apply to services furnished on or after January 1, 1994; except that amendment made by subsection (a)(2) shall not apply—

Pub. L. 103–66, title XIII, § 13514(d), Aug. 10, 1993, 107 Stat. 583, provided that: “The amendments made by this section [amending this section] shall apply to services furnished on or after January 1, 1994.”

Amendment by section 13515(a)(1) of Pub. L. 103–66 applicable to services furnished on or after Jan. 1, 1994, see section 13515(d) of Pub. L. 103–66, set out as a note under section 1395u of this title.

Pub. L. 103–66, title XIII, § 13517(c), Aug. 10, 1993, 107 Stat. 586, provided that: “The amendments made by subsection (a) [amending this section] shall apply to services furnished on or after January 1, 1994.”

Pub. L. 103–66, title XIII, § 13518(c), Aug. 10, 1993, 107 Stat. 586, provided that: “The amendment made by subsection (a) [amending this section] shall apply to services furnished on or after January 1, 1995.”

Amendment by section 4102(b), (g)(2) of Pub. L. 101–508 applicable to services furnished on or after Jan. 1, 1991, see section 4102(i)(1) of Pub. L. 101–508, set out as a note under section 1395m of this title.

Amendment by section 4104(b)(2) of Pub. L. 101–508 applicable to services furnished on or after Jan. 1, 1991, see section 4104(d) of Pub. L. 101–508, set out as a note under section 1395l of this title.

Amendment by section 4106(b)(1) of Pub. L. 101–508 applicable to services furnished after 1991, see section 4106(d)(2) of Pub. L. 101–508, set out as a note under section 1395u of this title.

Pub. L. 101–508, title IV, § 4107(a)(2), Nov. 5, 1990, 104 Stat. 1388–62, as amended by Pub. L. 103–432, title I, § 126(d)(2), Oct. 31, 1994, 108 Stat. 4415, provided that: “Section 1848(i)(2) of the Social Security Act [42 U.S.C. 1395w–4(i)(2)], as added by the amendment made by paragraph (1), shall apply to services furnished in 1991 in the same manner as it applies to services furnished after 1991. In applying the previous sentence, the prevailing charge shall be substituted for the fee schedule amount. In applying section 1848(g)(2)(D) of the Social Security Act for services of an assistant-at-surgery furnished during 1991, the recognized payment amount shall not exceed the maximum amount specified under section 1848(i)(2)(A) of such Act (as applied under this paragraph in such year).”

Pub. L. 101–508, title IV, § 4107(c), Nov. 5, 1990, 104 Stat. 1388–63, as amended by Pub. L. 103–432, title I, § 126(d)(1), Oct. 31, 1994, 108 Stat. 4415, provided that: “The amendment made by subsection (a)(1) [amending this section] shall apply with respect to services furnished on or after January 1, 1992.”

Pub. L. 101–508, title IV, § 4109(b), Nov. 5, 1990, 104 Stat. 1388–63, provided that: “The amendment made by subsection (a) [amending this section] shall apply to services furnished on or after January 1, 1992. In applying section 1848(d)(1)(B) of the Social Security Act [42 U.S.C. 1395w–4(d)(1)(B)] (in computing the initial budget-neutral conversion factor for 1991), the Secretary shall compute such factor assuming that section 1848(b)(3) of such Act (as added by the amendment made by subsection (a)) had applied to physicians’ services furnished during 1991.”

Physician Payment Review Commission (PPRC) was terminated and its assets and staff transferred to the Medicare Payment Advisory Commission (MedPAC) by section 4022(c)(2), (3) of Pub. L. 105–33, set out as a note under section 1395b–6 of this title. Section 4022(c)(2), (3) further provided that MedPAC was to be responsible for preparation and submission of reports required by law to be submitted by PPRC, and that, for that purpose, any reference in law to PPRC was to be deemed, after the appointment of MedPAC, to refer to MedPAC.

For termination, effective May 15, 2000, of provisions of law requiring submittal to Congress of any annual, semiannual, or other regular periodic report listed in House Document No. 103–7 (in which item 8 on page 94 identifies a reporting provision which, as subsequently amended, is contained in subsec. (g)(6)(B) of this section and in which item 9 on page 94 identifies a reporting provision which is contained in subsec. (g)(7)(B) of this section), see section 3003 of Pub. L. 104–66, as amended, set out as a note under section 1113 of Title 31, Money and Finance.

Pub. L. 117–328, div. FF, title IV, § 4123(b)–(e), Dec. 29, 2022, 136 Stat. 5907, 5908, provided that:

Pub. L. 116–260, div. CC, title I, § 113, Dec. 27, 2020, 134 Stat. 2947, provided that:

Pub. L. 114–115, § 4(c), Dec. 28, 2015, 129 Stat. 3133, provided that: “Notwithstanding any other provision of law, the Secretary of Health and Human Services shall implement the provisions of, and the amendments made by, subsections (a) and (b) [amending this section and section 1395ww of this title] by program instruction, such as through information on the Internet website of the Centers for Medicare & Medicaid Services.”

Pub. L. 114–10, title I, § 103(b)(1), Apr. 16, 2015, 129 Stat. 132, provided that:

Pub. L. 114–10, title I, § 106(b)(1), Apr. 16, 2015, 129 Stat. 138, provided that:

[As used in section 106(b)(1) of Pub. L. 114–10, set out above, “certified EHR technology” has the meaning given in 42 U.S.C. 1395w–4(o)(4); “meaningful EHR user” has the meaning given under the “Medicare EHR incentive programs”, which term means the incentive programs under 42 U.S.C. 1395f(l)(3), 42 U.S.C. 1395w–4(o), 42 U.S.C. 1395w–23(l), (m), and 42 U.S.C. 1395ww(n); and “Medicaid EHR incentive program” means the incentive program under 42 U.S.C. 1396b(a)(3)(F), (t). See Pub. L. 114–10, title I, § 106(b)(4), Apr. 16, 2015, 129 Stat. 140.]

Pub. L. 113–93, title II, § 220(i), Apr. 1, 2014, 128 Stat. 1076, which required the Secretary of Health and Human Services to make publicly available information used to establish the multiple procedure payment reduction policy to the professional component of imaging services in the final rule published in the Federal Register on Nov. 16, 2012, was repealed by Pub. L. 114–113, div. O, title V, § 502(a)(2)(C), Dec. 18, 2015, 129 Stat. 3019.

Pub. L. 113–67, div. B, § 1002, Dec. 26, 2013, 127 Stat. 1195, provided that: “In order to support the provision of quality care for our nation’s seniors, Congress finds it appropriate to reform physician reimbursements under the Medicare program. SGR reform legislation provides such an opportunity, but not until next year. In order to facilitate such reform, Congress finds that the Centers for Medicare & Medicaid Services should continue to focus its efforts on the following areas:

Pub. L. 111–157, § 5(c), Apr. 15, 2010, 124 Stat. 1118, provided that: “Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section [amending this section and section 1396b of this title and enacting provisions set out as a note under this section] by program instruction or otherwise.”

Pub. L. 111–148, title III, § 3111(a)(2), Mar. 23, 2010, 124 Stat. 421, provided that: “Notwithstanding any other provision of law, the Secretary may implement the amendments made by paragraph (1) [amending this section] by program instruction or otherwise.”

Pub. L. 111–148, title III, § 3134(b)(1), Mar. 23, 2010, 124 Stat. 435, as amended by Pub. L. 117–286, § 4(a)(253), Dec. 27, 2022, 136 Stat. 4333, provided that: