Page:United States Statutes at Large Volume 111 Part 1.djvu/328

 Ill STAT. 304 PUBLIC LAW 105-33—AUG. 5, 1997 1997 to the total national average annual per capita rate of payment for parts A and B for 1997, and "(II) for part B services shall be 100 percent minus the ratio described in subclause (I); "(iii) for part A services, 70 percent of payments attributable to such services shall be adjusted by the index used under section 1886(d)(3)(E) to adjust pay- ment rates for relative hospital wage levels for hospitals located in the payment area involved; "(iv) for part B services— "(I) 66 percent of pa5anents attributable to such services shall be adjusted by the index of the geographic area factors under section 1848(e) used to adjust pa5anent rates for physicians' services furnished in the payment area, and "(II) of the remaining 34 percent of the amount of such payments, 40 percent shall be adjusted by the index described in clause (iii); and "(v) the index values shall be computed based only on the beneficiary population who are 65 years of age or older and who are not determined to have end stage renal disease. The Secretary may continue to apply the rules described in this subparagraph (or similar rules) for 1999. " (5) PAYMENT ADJUSTMENT BUDGET NEUTRALITY FACTOR. — For purposes of paragraph (1)(A), for each year, the Secretary shall determine a budget neutrality adjustment factor so that the aggregate of the payments under this part shall equal the aggregate payments that would have been made under this part inpayment were based entirely on area-specific capitation rates. " (6) NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH PERCENTAGE DEFINED.— "(A) IN GENERAL. —In this part, the 'national per capita Medicare+Choice growth percentage' for a year is the percentage determined by the Secretary, by March 1st before the beginning of the year involved, to reflect the Secretary's estimate of the projected per capita rate of growth in expenditures under this title for an individual entitled to benefits under part A and enrolled under part B, reduced by the number of percentage points specified in subparagraph (B) for the year. Separate determinations may be made for aged enrollees, disabled enrollees, and enrollees with end-stage renal disease. "(B) ADJUSTMENT. —The number of percentage points specified in this subparagraph is— "(i) for 1998, 0.8 percentage points, "(ii) for 1999, 0.5 percentage points, "(iii) for 2000, 0.5 percentage points, "(iv) for 2001, 0.5 percentage points, "(v) for 2002, 0.5 percentage points, and "(vi) for a year after 2002, 0 percentage points. "(C) ADJUSTMENT FOR OVER OR UNDER PROJECTION OF NATIONAL PER CAPITA MEDICARE+CHOICE GROWTH PERCENT- AGE.—Beginning with rates calculated for 1999, before computing rates for a year as described in paragraph (1),

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