Page:United States Statutes at Large Volume 111 Part 1.djvu/472

 Ill STAT. 448 PUBLIC LAW 105-33 —AUG. 5, 1997 the amount of the deductible under section 1833(b), to the extent applicable. " (C) APPLY PAYMENT PROPORTION TO REMAINDER. —The amount of payment is the amount so determined under subparagraph (B) multiplied by the pre-deductible payment percentage (as determined under paragraph (3)(E)) for the service or group and year involved. " (5) COPAYMENT AMOUNT.— "(A) IN GENERAL.— Except as provided in subparagraph (B), the copayment amount under this subsection is the amount by which the amount described in paragraph (4)(B) exceeds the amount of payment determined under paragraph (4)(C). " (B) ELECTION TO OFFER REDUCED COPAYMENT Procedures. AMOUNT. —The Secretary shall establish a procedure under which a hospital, before the beginning of a year (beginning with 1999), may elect to reduce the copayment amount otherwise established under subparagraph (A) for some or all covered OPD services to an amount that is not less than 20 percent of the medicare OPD fee schedule amount (computed under paragraph (3)(D)) for the service involved. Under such procedures, such reduced copayment amount may not be further reduced or increased during the year involved and the hospital may disseminate information on the reduction of copayment amount effected under this subparagraph. "(C) No IMPACT ON DEDUCTIBLES. —Nothing in this paragraph shall be construed as affecting a hospital's authority to waive the charging of a deductible under section 1833(b). " (6) PERIODIC REVIEW AND ADJUSTMENTS COMPONENTS OF PROSPECTIVE PAYMENT SYSTEM. — "(A) PERIODIC REVIEW. —The Secretary may periodically review and revise the groups, the relative payment weights, and the wage and other adjustments described in paragraph (2) to take into account changes in medical practice, changes in technology, the addition of new services, new cost data, and other relevant information and factors. "(B) BUDGET NEUTRALITY ADJUSTMENT.— I f the Secretary makes adjustments under subparagraph (A), then the adjustments for a year may not cause the estimated amount of expenditures under this part for the year to increase or decrease from the estimated amount of expenditures under this part that would have been made if the adjustments had not been made. "(C) UPDATE FACTOR. — If the Secretary determines under methodologies described in paragraph (2)(F) that the volume of services paid for under this subsection increased beyond amounts established through those methodologies, the Secretary may appropriately adjust the update to the conversion factor otherwise applicable in a subsequent year. "(7) SPECL\L RULE FOR AMBULANCE SERVICES. —The Secretary shall pay for hospital outpatient services that are ambulance services on the basis described in the matter in subsection (a)(1) preceding subparagraph (A), or, if applicable, the fee schedule established under section 1834(1).

�