Page:United States Statutes at Large Volume 111 Part 1.djvu/327

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 303 adjustment that would have been made under clause (i) if the hospitals had not been reimbursed under such section. " (D) TREATMENT OF AREAS WITH HIGHLY VARIABLE PAY- MENT RATES.—In the case of a Medicare+Choice payment area for which the annual per capita rate of payment determined under section 1876(a)(1)(C) for 1997 varies by more than 20 percent from such rate for 1996, for purposes of this subsection the Secretary may substitute for such rate for 1997 a rate that is more representative of the costs of the enrollees in the area. "(4) INPUT-PRICE-ADJUSTED ANNUAL NATIONAL MEDICARE+CHOICE CAPITATION RATE.— "(A) IN GENERAL.— For purposes of paragraph (1)(A), the input-price-adjusted annual national Medicare+Choice capitation rate for a Medicare+Choice payment area for a year is equal to the sum, for all the types of medicare services (as classified by the Secretary), of the product (for each such type of service) of— "(i) the national standardized annual Medicare+Choice capitation rate (determined under subparagraph (B)) for the year, "(ii) the proportion of such rate for the year which is attributable to such type of services, and "(iii) an index that reflects (for that year and that type of services) the relative input price of such services in the area compared to the national average input price of such services. In applying clause (iii), the Secretary may, subject to subparagraph (C), apply those indices under this title that are used in applying (or updating) national payment rates for specific areas and localities. " (B) NATIONAL STANDARDIZED ANNUAL MEDICARE+CHOICE CAPITATION RATE.— In Subparagraph (A)(i), the 'national standardized annual Medicare+Choice capitation rate' for a year is equal to— "(i) the sum (for all Medicare+Choice payment areas) of the product of— "(I) the annual area-specific Medicare+Choice capitation rate for that year for the area under paragraph (3), and "(II) the average number of medicare beneficiaries residing in that area in the year, multiplied by the average of the risk factor weights used to adjust payments under subsection (a)(1)(A) for such beneficiaries in such area; divided by "(ii) the sum of the products described in clause (i)(II) for all areas for that year. "(C) SPECIAL RULES FOR 1998. —In applying this paragraph for 1998— "(i) medicare services shall be divided into 2 types of services: part A services and part B services; "(ii) the proportions described in subparagraph (A)(ii)- "(I) for part A services shall be the ratio (expressed as a percentage) of the national average annual per capita rate of payment for part A for

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