# H.R. 3200/Division B/Title I/Subtitle B/Part 2
## PART 2 — MARKET BASKET UPDATES
### Sec. 1131. Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.

    (a) Outpatient Hospitals.—
          (1) In General.—
             The first sentence of section 1833(t)(3)(C)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(3)(C)(iv)) is amended—
                (A) by inserting ``(which is subject to the productivity adjustment described in subclause (II) of such section)´´ after ``1886(b)(3)(B)(iii)´´; and
                (B) by inserting ``(but not below 0)´´ after ``reduced´´.
          (2) Effective Date.—
             The amendments made by paragraph (1) shall apply to increase factors for services furnished in years beginning with 2010.
    (b) Ambulance Services.—
       Section 1834(l)(3)(B) of such Act (42 U.S.C. 1395m(l)(3)(B))) is amended by inserting before the period at the end the following: ``and, in the case of years beginning with 2010, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)´´.
    (c) Ambulatory Surgical Center Services.—
       Section 1833(i)(2)(D) of such 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 services furnished during 2010 or any subsequent year, to the extent that an annual percentage change factor applies, such factor shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).´´.
    (d) Laboratory Services.—
       Section 1833(h)(2)(A) of such Act (42 U.S.C. 1395l(h)(2)(A)) is amended—
          (1) in clause (i), by striking ``for each of years 2009 through 2013´´ and inserting ``for 2009´´; and
          (2) clause (ii)—
                (A) by striking ``and´´ at the end of subclause (III);
                (B) by striking the period at the end of subclause (IV) and inserting ``; and´´; and
                (C) by adding at the end the following new subclause:
                   ``(V) the annual adjustment in the fee schedules determined under clause (i) for years beginning with 2010 shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).´´.
    (e) Certain durable medical equipment.—
       Section 1834(a)(14) of such Act (42 U.S.C. 1395m(a)(14)) is amended—
          (1) in subparagraph (K), by inserting before the semicolon at the end the following: ``, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)´´;
          (2) in subparagraph (L)(i), by inserting after ``June 2013,´´ the following: ``subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II),´´;
          (3) in subparagraph (L)(ii), by inserting after ``June 2013´´ the following: ``, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)´´; and
          (4) in subparagraph (M), by inserting before the period at the end the following: ``, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)´´.