Budget neutrality corrections relating to estimated utilization

(a) In general Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is amended by adding at the end the following new clause: (vii) Budget neutrality corrections relating to estimated utilization (I) In general In the case of a budget neutrality adjustment applied pursuant to clause (ii)(II) for a year (beginning with 2029) that is determined in part using estimated utilization (as defined in subclause (II)(bb)) with respect to a specified service (as defined in subclause (II)(cc)), the Secretary shall, as part of the final rule establishing the physician fee schedule under this section for the assumption correction period (as defined in subclause (II)(aa)) with respect to such year— (aa) determine the difference between expenditures for such service in such year using estimated utilization and actual utilization for such service (in a manner determined appropriate by the Secretary); and (bb) in the case that the Secretary determines the difference described in item (aa) is greater than the threshold amount (as defined in subclause (II)(dd)) for such year, adjust the conversion factor under this section for such assumption correction period by such amount to reconcile such difference (which may be positive or negative), as determined by the Secretary. (II) Definitions For purposes of this clause: (aa) Assumption correction period The term assumption correction period means, with respect to a year, the second year beginning after such year. (bb) Estimated utilization The term estimated utilization means an estimate of utilization used for purposes of applying clause (ii)(II). (cc) Specified service The term specified service means, with respect to a year, a service— (AA) with expected expenditures for such year under this section based on estimated utilization that exceed the threshold amount (as defined in item (dd)) for such year; and (BB) for which payment had been bundled into payment for another service during the preceding year and for which a separate payment or add-on payment is made during such year. (dd) Threshold amount The term threshold amount means, with respect to a year, 0.1 percent of the total estimated expenditures under this part for services furnished under this section during such year.. (b) Nonapplication of budget neutrality to reconciliation adjustments Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is amended— (1) in clause (iv)— (A) in subclause (V), by striking and at the end; (B) in subclause (VI), by striking the period and inserting; and; and (C) by adding at the end the following new subclause: (VII) clause (vii)(I)(bb) for an assumption correction period (as defined in clause (vii)(II)) shall not be taken into account in applying clause (ii)(II) with respect to such period.; and (2) in clause (v), by adding at the end the following new subclause: (XII) Reductions attributable to an assumption correction For an assumption correction period (as defined in clause (vii)(II)), reduced expenditures attributable to application of clause (vii)(I)(bb) with respect to such period..