Page:United States Statutes at Large Volume 100 Part 3.djvu/211

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 2019

"(ii) The term 'percentage increase in the MEI' means, with respect to physicians' services furnished in a year, the percentage increase in the medicare economic index (referred to in the fourth sentence of paragraph (3)) appHcable to such services furnished as of the first day of that year.", (4) EFFECTIVE DATE.—The amendments made by this subsection shall apply to services furnished on or after January 1, 1987. (b) GENERAL LIMIT ON ACTUAL CHARGES FOR NONPARTICIPATING PHYSICIANS.—

42 USC 1395u note. 42 USC 1395u.

(1) IN GENERAL.—Section 1842(j)(l) of such Act is amended— (A) by inserting "(A)" after "(j)(D". and (B) by adding at the end the following new subparagraph: "(B)(i) During any period (on or after January 1, 1987, and before Sanctions. the date specified in clause (ii)), during which a physician is a nonparticipating physician, the Secretary shall monitor each such physician's actual charges for physicians' services furnished to individuals enrolled under this part. If such physician knowingly and willfully bills for such a service a physician's actual charge (as defined in subparagraph (C)(vi) in excess of the maximum allowable actual charge determined under subparagraph (C) for that service, the Secretary may apply sanctions against such physician in accordance with paragraph (2). "(ii) Clause (i) shall not apply to services furnished after the earlier of (I) December 31, 1990, or (II) one-year after the date the Secretary reports to Congress, under section 1845(e)(3), on the devel- Ante, p. 190. opment of the relative value scale under section 1845. "(C)(i) For a particular physicians' service furnished by a nonparticipating physician to individuals enrolled under this part during a year, for purposes of subparagraph (B), the maximum allowable actual charge is determined as follows: If the physician's actual charge for that service in the previous year was— "(I) less than 115 percent of the prevailing charge for the year involved for such service furnished by nonparticipating physicians, the maximum allowable actual charge for the year involved is the greater of the maximum allowable actual charge described in subclause (II) or the charge described in clause (ii), or "(II) equal to, or greater than, 115 percent of the prevailing charge for the year involved for such service furnished by nonparticipating physicians, the maximum allowable actual charge is 101 percent of the physician's maximum allowable actual charge for the service for the previous year. "(ii) For purposes of clause (i)(I), the charge described in this ix^QK clause for a particular physicians' service furnished in a year is the maximum allowable actual charge for the service of the physician for the previous year plus the product of (I) the applicable fraction (as defined in clause (iii)) and (II) the amount by which 115 percent of the prevailing charge for the year involved for such service furnished by nonparticipating physicians, exceeds the physician's maximum allowable actual charge for the service for the previous year. "(iii) In clause (ii), the 'applicable fraction' is— "(I) for 1987, VA, "(II) for 1988, Va, "(III) for 1989, ¥2, and .'. "(IV) for any subsequent year, 1.

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