Page:United States Statutes at Large Volume 124.djvu/512

 124 STAT. 486 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(I) for each of 2010 and 2011, 0.25 percentage point; and ‘‘(II) subject to clause (ii), for each of 2012 through 2019, 0.2 percentage point. ‘‘(ii) REDUCTION OF OTHER ADJUSTMENT.—Clause (i)(II) shall be applied with respect to any of 2014 through 2019 by substituting ‘0.0 percentage points’ for ‘0.2 percentage point’, if for such year— ‘‘(I) the excess (if any) of— ‘‘(aa) the total percentage of the non- elderly insured population for the preceding year (based on the most recent estimates avail- able from the Director of the Congressional Budget Office before a vote in either House on the Patient Protection and Affordable Care Act that, if determined in the affirmative, would clear such Act for enrollment); over ‘‘(bb) the total percentage of the non- elderly insured population for such preceding year (as estimated by the Secretary); exceeds ‘‘(II) 5 percentage points.’’. (j) AMBULANCE SERVICES.—Section 1834(l)(3) of the Social Secu- rity Act (42 U.S.C. 1395m(l)(3)) is amended— (1) in subparagraph (A), by striking ‘‘and’’ at the end; (2) in subparagraph (B)— (A) by inserting ‘‘, subject to subparagraph (C) and the succeeding sentence of this paragraph,’’ after ‘‘increased’’; and (B) by striking the period at the end and inserting ‘‘; and’’; (3) by adding at the end the following new subparagraph: ‘‘(C) for 2011 and each subsequent year, after deter- mining the percentage increase under subparagraph (B) for the year, reduce such percentage increase by the produc- tivity adjustment described in section 1886(b)(3)(B)(xi)(II).’’; and (4) by adding at the end the following flush sentence: ‘‘The application of subparagraph (C) may result in the percent- age increase under subparagraph (B) being less than 0.0 for a year, and may result in payment rates under the fee schedule under this subsection for a year being less than such payment rates for the preceding year.’’. (k) AMBULATORY SURGICAL CENTER SERVICES.—Section 1833(i)(2)(D) of the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) is amended— (1) by redesignating clause (v) as clause (vi); and (2) by inserting after clause (iv) the following new clause: ‘‘(v) In implementing the system described in clause (i) for 2011 and each subsequent year, any annual update under such system for the year, after application of clause (iv), shall be reduced by the productivity adjustment described in section 1886(b)(3)(B)(xi)(II). The application of the preceding sentence may result in such update being less than 0.0 for a year, and may result in payment rates under the system described in clause (i) for a year being less than such payment rates for the preceding year.’’.