Page:United States Statutes at Large Volume 100 Part 3.djvu/220

 100 STAT. 2028 Ante, p. 192. 42 USC 1395u note.

42 USC 1395J.

42 USC 1395u note.

PUBLIC LAW 99-509—OCT. 21, 1986

Secretary reports to Congress, under section 1845(e)(3), on the development of the relative value scale under section 1845.". (c) REVIEW OF PROCEDURES.—Not later than October 1, 1987, the Secretary of Health and Human Services shall review the inherent reasonableness of the reasonable charges for at least 10 of the most costly procedures with respect to which payment is made under part B of title XVIII of the Social Security Act (determined on the basis of the aggregate annual payments under such part with respect to each such procedure). (d) EFFECTIVE DATE.—The amendments made by this section shall take effect on the date of the enactment of this Act. SEC. 9334. PAYMENT FOR CATARACT SURGICAL PROCEDURES.

Sanctions.

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(a) LIMITATIONS.—Section 1842(b)(ll) of the Social Security Act (42 U.S.C. 1395u(b)(ll)), as redesignated by section 9333(b), is amended— (1) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, ,,...- ,, (2) by inserting "(A)" after "(11)", and (3) by adding at the end the following new subparagraphs: "(B)(i) In determining the reasonable charge under paragraph (3) for a cataract surgical procedure, subject to clause (ii), the prevailing charge for such procedure otherwise recognized for participating and nonparticipating physicians shall be reduced by 10 percent with respect to procedures performed in 1987 and shall be further reduced by 2 percent with respect to procedures performed in 1988. A reduced prevailing charge under this subparagraph shall become the prevailing charge level for subsequent years for purposes of applying the economic index under the fourth sentence of paragraph (3). "(ii) In no case shall the reduction under clause (i) for a surgical procedure result in a prevailing charge in a locality for a year which is less than 75 percent of the weighted national average of such prevailing charges for such procedure for all the localities in the United States for 1986. "(C)(i) In the case of a reduction in the reasonable charge for a physicians' service under subparagraph (B), if a nonparticipating physician furnishes the service to an individual entitled to benefits under this part after the effective date of such reduction (subject to clause (iv)), the physician may not charge the individual more than the limiting charge (as defined in clause (ii)) plus (for services furnished during the 12-month period beginning on the effective date of the reduction) Vz of the amount by which the physician's actual charges for the service for the previous 12-month period exceeds the limiting charge. "(ii) In clause (i), the term 'limiting charge' means, with respect to a service, 125 percent of the prevailing charge for the service after the reduction referred to in clause (i). "(iii) If a physician knowingly and willfully imposes charges in violation of clause (i), the Secretary may apply sanctions against such physician in accordance with subsection (j)(2). "(iv) "This subparagraph 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 development of the relative value scale under section 1845.". Qo) RATIFICATION OF REGULATIONS.—

42 USC 1395u note.

(1) IN GENERAL.—The Congress hereby ratifies the final regulation of the Secretary of Health and Human Services published

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