TECHNICAL CORRECTIONS.

SEC. 4118. TECHNICAL CORRECTIONS. (a) Overvalued Procedures.— (1) Section 1842(b)(14) of the Social Security Act (42 U.S.C. 1395u(b)(14)) is amended— (A) in subparagraph (B)(iii)(D, by striking “practice expense ratio for the service (specified in table #1 in the Joint Explanatory Statement referred to in subparagraph (C)(i))” and inserting “practice expense component (percent), divided by 100, specified in appendix A (pages 187 through 194) of the Report of the Medicare and Medicaid Health Budget Reconciliation Amendments of 1989, prepared by the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, (Committee Print 101-M, 101st Congress, 1st Session) for the service”; (B) in subparagraph (B)(iii)(II), by striking “practice expense ratio” and inserting “practice expense component (percent), divided by 100”; (C) in subparagraph (C)(i), by striking “physicians” services specified in Table #2 in the Joint Explanatory Statement of the Committee of Conference submitted with the Conference Report to accompany H.R. 3299 (the ‘Omnibus Budget Reconciliation Act of 1989’), 101st Congress, and inserting “procedures specified (by code and description) in the Overvalued Procedures List for Finance Committee,104 STAT. 1388–67 Revised September 20, 1989, prepared by the Physician Payment Review Commission”; (D) in subparagraph (C)(iii), by striking “The ‘percent change’ specified in this clause, for a physicians’ service specified in clause (i), is the percent change specified for the service in table #2 in the Joint Explanatory Statement” and inserting “The ‘percentage change’ specified in this clause, for a physicians’ service specified in clause (i), is the percent difference (but expressed as a positive number) specified for the service in the list”; and (E) in subparagraph (C)(iv), by striking “such value specified for the locality in table #3 in the Joint Explanatory Statement referred to in clause (i)” and inserting “the Geographic Overhead Costs Index specified for the locality in table 1 of the September 1989 Supplement to the Geographic Medicare Economic Index: Alternative Approaches (prepared by the Urban Institute and the Center for Health Economics Research)”. (2) Section 1842fb)(4)(E)(iv)(I) of such Act (42 U.S.C. 1395u(b)(4)(E)(iv)(D) is amended by striking “Table #2” and all that follows through “101st Congress” and inserting “the list referred to in paragraph (14)(C)(i)”. (3) The amendments made by paragraphs (1) and (2) apply to services furnished after March 1990. (b) MVPS as Multiplicative, Not Additive.—Section 1848(f)(2)(A) (42 U.S.C. 1395w–4(f)(2)(A)) is amended— (1) in the matter preceding clause (i) by striking “sum” and inserting “ product”; (2) in clauses (i) through (iy), by inserting “1 plus” before “the Secretary” each place it appears, 66So in original. Probably should be “;”. (3) in clause (i), by inserting “(divided by 100)” after “percentage increase”, 77So in original. Probably should be “;”. (4) in clauses (ii) and (iv), by inserting “(divided by 100)” after “decrease”, 88So in original. Probably should be “;”. (5) in clause (iii), by inserting “(divided by 100)” after “percentage growth”,99So in original. Probably should be “;”. and (6) in the matter following clause (iv), by striking “reduced” and inserting “minus 1, multiplied by 100, and reduced”. (c) Periodic Review of Geographic Adjustment Factors.—Section 1848(e)(1) of such Act is amended— (1) in subparagraph (A), by striking “subparagraph (B)” and inserting “subparagraphs (B) and (C)”, and (2) by adding at the end the following new subparagraph: “(C) Periodic review and adjustments in geographic adjustment factors.—The Secretary, not less often than every 3 years, shall review the indices established under subparagraph (A) and the geographic index values applied under this subsection for all fee schedule areas. Based on such review, the Secretary may revise such index and adjust such index values, except that, if more than 1 year has elapsed since the last previous adjustment, the adjustment to be applied in the first year of the next adjustment shall be ½ of the adjustment that otherwise would be made.”. (d) Elimination of Restriction on Incorporation of Time in Visit Codes.—Section 1848(c)(4) (42 U.S.C. 1395w–4(c)(4)) is amended by striking “only for services furnished on or after January 1, 1993”. 104 STAT. 1388–68 (e) Treatment of Price Increase in Determining Performance Standard Rates of Increase.—Section 1848(fi(2)(A)(iv) (42 U.S.C. 1395w-4(f)(2)(A)(iv)) is amended by inserting “including changes in law and regulations affecting the percentage increase described in clause (i)” after “law or regulations”. (f) Miscellaneous Fee Schedule Corrections.— (1) Changes in section 1848.— Section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended— (A) in subsection (c)(I)(B), by striking the last sentence; (B) in subsections (c)(S)(C)(h)(II) and (c)(3)(C)(iii)(H), by striking “by” the first place it appears in each respective subsection,1010So in original. Probably should be “;”. (C) in subsection (c), by redesignating the second paragraph (3), and paragraphs (4) and (5), as paragraphs (4) through (6), respectively; (D) in subsection (c)(4), as redesignated by subparagraph (C),is amended by striking “subsection” and inserting “section”; (E) in subsection (d)(1)(A), by striking “subparagraph (C)” and inserting “paragraph (3)”; (F) in subsection (d)(1)— (i) in subparagraph (A)— (I) by inserting “(or factors)” after “conversion factor” each place it appears, (II) by inserting “or updates” after “update”, and (III) by striking “subparagraph (C) )” and inserting “ paragraph (3)”; and (ii) in subparagraph (C)— (I) in clause (i), by striking “(or factors)”, and (II) in clause (ii), by inserting “the conversion factor (or factors) which will apply to physicians’ services for the following year and” before “the update (or updates)”, and by striking “the following” and inserting “such”; (G) in subsection (d)(2)(A), in the matter preceding clause (i), by striking “services” the first place it appears and inserting “services (as defined in subsection (fi(5)(A))”; (H) in subsection (d)(2)(A)(ii)— (i) by striking “(as defined in subsection (f)(5)(A))” and inserting “and for the services involved”, and (ii) by striking “all such physicians’” and inserting “such”; and (I) in the last sentence of subsection (d)(2)(A), by striking “proportion of HMO enrollees” and inserting “proportion of individuals who are enrolled under this part who are HMO enrollees”; (J) in subsection (d)(2)(E)(D, by inserting “the” after “as set forth in”; (K) in subsection (d)(2)(E)(ii)(I), by inserting “payments for” after “under this part for”; (L) in subsection (d)(3)(B)— (i) in clause (i)— (I) by striking “update for” and inserting “update for a category of physicians’ services for”; and . 104 STAT. 1388–69 (II) by striking “physicians’ services (as defined in subsection (f)(5)(A))” and inserting “services in such category”; (ii) in clause (ii)— (I) by inserting “more than” after “decrease of”; and (II) in subclause (I), by striking “more than”; (M) in paragraphs (1)(D)(D and (2)(A)(D of subsection (0, by striking “calendar years” and inserting “portions of calendar years”; (N) in subsection (D(2)(A)— (i) by striking “each performance standard rate of increase” and inserting “the performance standard rate of increase, for all physicians’ services and for each category of physicians’ services,”, (ii) in clause (i), by striking “physicians’ services (as defined in subsection (f)(S)(A)1111So in original. Probably should be “(A))”.” and inserting “all physicians’ services or for the category of physicians’ services, respectively,”, (iii) in clause (iii), by striking “physicians’ services” and inserting “all physicians’ services or of the category of physicians’ services, respectively,”, and (iv) in clause (iv), by striking “physicians’ services (as defined in subsection (f)(5)(A))” and inserting “all physicians’ services or of the category of physicians’ services, respectively,”; (O) in subsection (f)(4)(A), by striking “paragraph (B)” and inserting “subparagraph (B)”; (P) in subsection (f)(4)(B), by striking “Congress specifically approves the plan” and inserting “specifically approved by law”; (Q) in subparagraphs (A) and (B) of subsection (g)(2), by inserting “other than radiologist services subject to section 1834(b),” after “during 1991,” and after “during 1992,”, respectively; (R) in subsection (i)(1)(A), by striking “historical payment basis (as defined in subsection (a)(2)(C)(i))” and inserting “adjusted historical payment basis (as defined in subsection (a)(2)(D)(i))”; and (S) in subsection (j)(l), by striking “, and such other” and all that follows through the period and inserting “(as defined by the Secretary) and all other physicians’ services.”. (2) Miscellaneous.— (A) Effective as if included in the Omnibus Budget Reconciliation Act of 1989, section 6102(e)(4) of such Act is amended by inserting “determined” after “prevailing charge rate”. (B) Effective January 1, 1991, section 1842(b)(3)(G) of the Social Security Act, as amended by section 6102(e)(2) of Omnibus Budget Reconciliation Act of 1989, is amended by striking “subsection (j)(l)(O” and inserting “section 1848(g)(2)”. (C) Section 1842(bK12)(A)(ii)(II) of the Social Security Act, as amended by section 6102(e)(4) of the Omnibus Budget Reconciliation Act of 1989, is amended by striking “, as the case may be”. 104 STAT. 1388–70 (D) Section 1833(a)(l)(H) of the Social Security Act, as amended by section 6102(e)(5) of the Omnibus Budget Reconciliation Act of 1989, is amended by striking “, as the case may be”. (E) Section 6102(e)(H) of the Omnibus Budget Reconciliation Act of 1989 is amended by inserting “of Health and Human Services” after “Secretary”. (F) Effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989, section 922(d)(1) of the Public Health Service Act (42 U.S.C. 299c—1(d)(1)) is amended— (i) by inserting “(other than of dissemination activities)” after “evaluations”, and (ii) by inserting “research, demonstration projects, or evaluations of” after “applications with respect to”. (g) Repeal of Reports No Longer Required.— (1) Subsection (b) of section 4043 of the Omnibus Budget Reconciliation Act of 1987 is repealed. (2) Subsection (c) of section 4048 of such Act is repealed. (3) Section 4049(b)(D of such Act is amended by striking “, and shall report” and all that follows up to the period at the end. (4) Section 4056(a)(1) of such Act, as redesignated by section 411(0(14} of the Medicare Catastrophic Coverage Act of 1988, is amended by striking the last sentence. (5) Section 4056(b)(2) of such Act is amended by striking the second sentence. (h) Adjustment of Effective Dates —Effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1987— (1) section 4048(b) of such Act is amended by striking “January 1, 1989” and inserting “March 1, 1989”, and (2) section 4049(b)(2) of such Act is amended by striking “January 1, 1989” and inserting “April 1, 1989”. (i) Transfer of Provision Into Title XVIII.— (1) Section 1842 of the Social Security Act (42 U.S.C. 1395u) is amended by adding at the end the following new subsection: “(r) The Secretary shall establish a system which provides for a unique identifier for each physician who furnishes services for which payment may be made under this title.”. (2) Section 9202 of the Consolidated Omnibus Budget Reconciliation Act of 1985 is amended by striking subsection (g). (j) PPRC.— (1) Section 1845 of such Act (42 U.S.C. 1395w–l) is amended— (A) in subsection (a)(3), by striking “include physicians” and inserting “include (but need not be limited to) physicians”; (B) by striking subsection (b)(3); (C) in subsection (b)(2)—. (i) by striking “and” at the end of subparagraph (H), (ii) by striking the period at the end of subparagraph (1) and inserting a semicolon, (iii) by striking subparagraphs (A), (B), (C), and (F), (iv) by redesignating subparagraphs (D), (E), (G), (H), and (I) as subparagraphs (A), (B), (C), CD), and CE), and (v) by adding at the end the following new subparagraphs: “(F) make recommendations regarding major issues in the implementation of the resource-based relative value scale established under section 1848(c); 104 STAT. 1388–71 “(G) make recommendations regarding further development of the volume performance standards established under section 1848(f), including the development of State-based programs; “(H) consider policies to provide payment incentives to in-crease patient access to primary care and other physician services in large urban and rural areas, including policies regarding payments to physicians pursuant to title XIX; “(I) review and consider the number and practice specialties of physicians in training and payments under this title for graduate medical education costs; “(J) make recommendations regarding issues relating to utilization review and quality of care, including the effectiveness of peer review procedures and other quality assurance programs applicable to physicians and providers under this title and physician certification and licensing standards and procedures; “(K) make recommendations regarding options to help con-strain the costs of health insurance to employers, including incentives under this title; “(L) comment on the recommendations affecting physician payment under the medicare program that are included in the budget submitted by the President pursuant to section 1105 of title 31, United States Code; and “(M) make recommendations regarding medical malpractice liability reform and physician certification and licensing standards and procedures.”; and (D) by striking subsection (e) and redesignating subsection (f) as subsection (e). (2) In section 1842(b)(2)(A) is amended by striking “section 1845(0(2)” and inserting “section 1845(e)(2)”. (k) Prohibition of Certain Adjustments.—Section 1848(i) is amended by adding at the end the following new paragraph: “(3) No comparability adjustment.— For physicians’ services for which payment under this part is determined under this section— “(A) a carrier may not make any adjustment in the payment amount under section 1842(b)(3)(B) on the basis that the payment amount is higher than the charge applicable, for a 1212So in original, “a” probably should be omitted. comparable services and under comparable circumstances, to the policyholders and subscribers of the carrier, “(B) no payment adjustment may be made under section 1842(b)(8), and “(C) section 1842(b)(9) shall not apply.”.