ADD-ON.—Section 1886(d)(5)(K)(ii)(IV) of such Act 
(42 U.S.C. 1395ww(d)(5)(K)(ii)(IV)) is amended by 
striking ‘‘or existing’’. 
(6) LIMIT
ON
AGGREGATE
ANNUAL
ADJUST-
MENT.—Section 1886(d)(5) of such Act (42 U.S.C. 
1395ww(d)(5)) is amended by adding at the end the 
following new subparagraph: 
‘‘(M) LIMIT ON AGGREGATE ANNUAL AD-
JUSTMENT.— 
‘‘(i) IN GENERAL.—The total of the 
additional payments made under subpara-
graphs (K) and (L) for covered services 
furnished for discharges in a fiscal year (as 
estimated by the Secretary before the be-
ginning of the fiscal year) may not exceed 
the applicable percentage (specified in 
clause (ii)) of the total program payments 
estimated to be made under this subsection 
for all covered services furnished for dis-
charges in that fiscal year. If this clause is 
first applied to less than a full fiscal year, 
the previous sentence shall apply only to 
the portion of such fiscal year. 
‘‘(ii) APPLICABLE PERCENTAGE.—For 
purposes of clause (i), the term ‘‘applicable 
VerDate Sep 11 2014 
00:52 Dec 20, 2017
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4679.IH
H4679
lotter on DSKBCFDHB2PROD with BILLS
percentage’’ for fiscal year 2019 and each 
subsequent fiscal year, is a percentage 
specified by the Secretary up to (but not to 
exceed) 2.0 percent. 
‘‘(iii) UNIFORM PROSPECTIVE REDUC-
TION IF AGGREGATE LIMIT PROJECTED TO 
BE EXCEEDED.—If the Secretary estimates 
before the beginning of a fiscal year that 
the amount of the additional payments 
under subparagraphs (K) and (L) for the 
fiscal year (or portion thereof) as deter-
mined under clause (i) without regard to 
this clause will exceed the limit established 
under such clause (i), the Secretary shall 
reduce pro rata the amount of each of the 
additional payments under this paragraph 
for that fiscal year (or portion thereof) in 
order to ensure that the aggregate addi-
tional payments under subparagraphs (K) 
and (L) (as so estimated) do not exceed 
such limit.’’. 
(7) EFFECTIVE DATE.—The amendments made 
by paragraphs (2), (3), (4), (5), and (6) shall take 
effect on the date of the enactment of this Act and 
shall apply with respect to hospital discharges occur-
VerDate Sep 11 2014 
00:52 Dec 20, 2017
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4679.IH
H4679
lotter on DSKBCFDHB2PROD with BILLS
ring on or after October 1, 2018, for inpatient hos-
pital services for which payment is made under sec-
tion 1886(d) of the Social Security Act (42 U.S.C. 
1395ww). 
(b) IMPROVEMENTS
TO
PAYMENT
ADJUSTMENT 
UNDER THE MEDICARE OUTPATIENT PROSPECTIVE PAY-
MENT SYSTEM FOR CERTAIN DRUGS AND DEVICES ELIGI-
BLE OR PREVIOUSLY ELIGIBLE FOR PASS-THROUGH.— 
(1) REQUIRING SEPARATE AMBULATORY PAY-
MENT
CLASSIFICATION
FOR
CERTAIN
DRUGS
AND 
DEVICES PREVIOUSLY ELIGIBLE FOR PASS-THROUGH 
PAYMENTS.—Section 1833(t) of the Social Security 
Act (42 U.S.C. 1395l(t)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (G), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (H), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(I) the Secretary shall create additional 
groups of covered OPD services that classify 
separately procedures and services that employ 
medical devices and drugs described in a sub-
VerDate Sep 11 2014 
00:52 Dec 20, 2017
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4679.IH
H4679
lotter on DSKBCFDHB2PROD with BILLS
paragraph of paragraph (22), in accordance 
with such paragraph.’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(22) 
SEPARATE
ADDITIONAL
PAYMENT 
GROUPS FOR CERTAIN DRUGS AND DEVICES PRE-
VIOUSLY
ELIGIBLE
FOR
PASS-THROUGH
PAY-
MENTS.—For purposes of paragraph (2)(I), the fol-
lowing shall apply: 
‘‘(A) IN GENERAL.—For payments under 
this subsection for services furnished on or 
after January 1, 2020, the Secretary shall, in 
accordance with subparagraph (B), create addi-
tional groups of covered OPD services to clas-
sify separately from other covered OPD services 
the following: 
‘‘(i) EXISTING PASS-THROUGH DRUGS 
AND DEVICES.—Medical devices and drugs 
that met the requirements of paragraph 
(6)(A)(iv) and were receiving payment 
under paragraph (6) by reason of satis-
fying such requirements beginning on or 
after the date of enactment of this para-
graph. 
VerDate Sep 11 2014 
00:52 Dec 20, 2017
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4679.IH
H4679
lotter on DSKBCFDHB2PROD with BILLS
‘‘(ii) RETIRED PASS-THROUGH DRUGS 
AND DEVICES.—Medical devices and drugs 
that had met the requirements of para-
graph (6)(A)(iv) and were receiving pay-
ment under paragraph (6) by reason of 
satisfying such requirements before the 
date of enactment of this paragraph but 
after January 1, 2010. 
‘‘(B) CONSIDERATIONS.—In carrying out 
subparagraph (A), the Secretary shall— 
‘‘(i) bundle procedures and services 
that employ a device to which such sub-
paragraph applies with all relevant diag-
nostic tests and surgical procedures, as ap-
plicable; 
‘‘(ii) bundle procedures and services 
that employ a drug, with respect to which 
payment is not made on or after the date 
specified in subparagraph (A) in accord-
ance with the methodology under section 
1847A and to which such subparagraph 
applies, with all relevant diagnostic tests 
and surgical procedures, as applicable; and 
‘‘(iii) include such relevant diagnostic 
tests and surgical procedures in more than 
VerDate Sep 11 2014 
00:52 Dec 20, 2017
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4679.IH
H4679
lotter on DSKBCFDHB2PROD with BILLS
one group created under such subpara-
graph, as necessary.’’. 
(2) 
REVISION
TO
PASS-THROUGH
PERIOD 
UNDER OPPS.—Section 1833(t)(6) of the Social Se-
curity Act (42 U.S.C. 1395l(t)(6)) is amended— 
(A) in subparagraph (B)(iii), by striking 
‘‘at least 2 years, but not more than 3 years’’ 
and inserting ‘‘5 years’’; and 
(B) in subparagraph (C)(i), by striking ‘‘at 
least 2 years, but not more than 3 years’’ and 
inserting ‘‘5 years’’. 
(3) APPEALS PROCESS.—Section 1833(t)(6) of 
the Social Security Act (42 U.S.C. 1395l(t)(6)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(F) APPEALS PROCESS.— 
‘‘(i) IN GENERAL.—An individual or 
entity that submits an application for addi-
tional payment under this paragraph for a 
new technology shall be entitled to admin-
istrative review of an adverse determina-
tion by the Secretary with respect to such 
application. 
‘‘(ii) PROCESS.—The Secretary shall 
establish a process for administrative re-
VerDate Sep 11 2014 
00:52 Dec 20, 2017
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4679.IH
H4679
lotter on DSKBCFDHB2PROD with BILLS
view for purposes of clause (i). Under such 
process, administrative review shall be con-
ducted by the Departmental Appeals 
Board of the Department of Health and 
Human Services. Under such process, the 
Department official involved shall complete 
administrative review within 90 days of re-
ceipt of a request for such review.’’. 
(4) EFFECTIVE DATE.—The amendments made 
by paragraphs (2) and (3) shall take effect on the 
date of enactment of this Act and shall apply with 
respect to items and services furnished on or after 
January 1, 2020. 
Æ 
VerDate Sep 11 2014 
00:52 Dec 20, 2017
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6301
E:\BILLS\H4679.IH
H4679
lotter on DSKBCFDHB2PROD with BILLS