Page:United States Statutes at Large Volume 100 Part 3.djvu/212

 100 STAT. 2020

PUBLIC LAW 99-509—OCT. 21, 1986

"(iv) For purposes of determining the maximum allowable actual charge under clauses (i) and (ii) for 1987, in the case of a physicians' service for which the physician has actual charges for the calendar quarter beginning on April 1, 1984, the 'maximum allowable actual charge' for 1986 is the physician's actual charge for such service furnished during such quarter. "(v) For purposes of determining the maximum allowable actual charge under clauses (i) and (ii) for a year after 1987, in the case of a
 * )8IA !.t» physicians' service for which the physician has no actual charges for

the calendar quarter beginning on April 1, 1984, and for which a maximum allowable actual charge has not been previously established under this clause, the 'maximum allowable actual charge' for the previous year shall be the 50th percentile of the customary charges for the service (weighted by frequency of the service) performed by nonparticipating physicians in the locality during the 12month period ending June 30 of that previous year. "(vi) For purposes of this subparagraph and subparagraph (B), a 'physician's actual charge' for a physicians' service furnished in a year or other period is the weighted average (or, at the option of the Secretary for a service furnished in the calendar quarter beginning April 1, 1984, the median) of the physician's charges for such service furnished in the year or other period.". (2) PROVISION OF ACTUAL CHARGE INFORMATION BY CARRIER TO

42 USC 1395u.

42 USC 1395u note. 42 USC 1395u note. 42 USC 1395J.

NONPARTICIPATING PHYSICIANS.—Section 1842(b)(3) of such Act is amended— (A) by striking "and" at the end of subparagraph (E), ^,,,,., (B) by inserting "and" at the end of subparagraph (F), and (C) by inserting after subparagraph (F) the following new subparagraph: ^^ "(G) will provide to each nonparticipating physician, at the beginning of each year, a list of the physician's maximum allowable actual charges (established under subsection (j)(l)(C)) for the year for the physicians' services mostly commonly furnished by that physician;". (3) CONFORMING AMENDMENT.—Section 1842(b)(4)(D) of such Act is amended by adding at the end the following new clause: "(iv) In determining the customary charges for a physicians' service furnished on or after January 1, 1988, if a physician was a nonparticipating physician in a previous year (beginning with 1987), the Secretary shall not recognize any amount of such actual charges (for that service furnished during such previous year) that exceeds the maximum allowable actual charge for such service established under subsection (j)(l)(C).". (4) EFFECTIVE DATE.—The amendments made by this subsection shall apply to services furnished on or after January 1, 1987. (c) MEDICARE ECONOMIC INDEX.—

(1) FOR 1987.—Notwithstanding any other provision of law, for purposes of part B of title XVIII of the Social Security Act for physicians' services furnished in 1987, the percentage increase in the MEI (as defined in section 1842(b)(4)(E)(ii) of the Social Security Act) shall be 3.2 percent. (2) PROHIBITING RETROACTIVE ADJUSTMENT OF MEDICARE ECO-

NOMIC INDEX.—The Secretary of Health and Human Services is not authorized to revise the MEI in a manner that provides, for any period before January 1, 1985, for the substitution of a

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