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(3) a description of the costs associated with or 
savings related to provision of language access serv-
ices. 
SEC. 237. DEFINITIONS. 
In this subtitle: 
(1) BILINGUAL.—The term ‘‘bilingual’’ with re-
spect to an individual means a person who has suffi-
cient degree of proficiency in two languages and can 
ensure effective communication can occur in both 
languages. 
(2) COMPETENT INTERPRETER SERVICES.—The 
term ‘‘competent interpreter services’’ means a 
trans-language rendition of a spoken message in 
which the interpreter comprehends the source lan-
guage and can speak comprehensively in the target 
language to convey the meaning intended in the 
source language. The interpreter knows health and 
health-related terminology and provides accurate in-
terpretations by choosing equivalent expressions that 
convey the best matching and meaning to the source 
language and captures, to the greatest possible ex-
tent, all nuances intended in the source message. 
(3) COMPETENT TRANSLATION SERVICES.—The 
term ‘‘competent translation services’’ means a 
trans-language rendition of a written document in 
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which the translator comprehends the source lan-
guage and can write comprehensively in the target 
language to convey the meaning intended in the 
source language. The translator knows health and 
health-related terminology and provides accurate 
translations by choosing equivalent expressions that 
convey the best matching and meaning to the source 
language and captures, to the greatest possible ex-
tent, all nuances intended in the source document. 
(4) EFFECTIVE
COMMUNICATION.—The term 
‘‘effective communication’’ means an exchange of in-
formation between the provider of health care or 
health care-related services and the limited English 
proficient recipient of such services that enables lim-
ited English proficient individuals to access, under-
stand, and benefit from health care or health care- 
related services. 
(5) 
INTERPRETING/INTERPRETATION.—The 
terms ‘‘interpreting’’ and ‘‘interpretation’’ mean the 
transmission of a spoken message from one language 
into another, faithfully, accurately, and objectively. 
(6) 
HEALTH
CARE
SERVICES.—The 
term 
‘‘health care services’’ means services that address 
physical as well as mental health conditions in all 
care settings. 
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(7) HEALTH
CARE-RELATED
SERVICES.—The 
term ‘‘health care-related services’’ means human or 
social services programs or activities that provide ac-
cess, referrals or links to health care. 
(8) LANGUAGE ACCESS.—The term ‘‘language 
access’’ means the provision of language services to 
an LEP individual designed to enhance that individ-
ual’s access to, understanding of or benefit from 
health care or health care-related services. 
(9) LANGUAGE
SERVICES.—The term ‘‘lan-
guage services’’ means provision of health care serv-
ices directly in a non-English language, interpreta-
tion, translation, and non-English signage. 
(10) LIMITED
ENGLISH
PROFICIENT.—The 
term ‘‘limited English proficient’’ or ‘‘LEP’’ with re-
spect to an individual means an individual who 
speaks a primary language other than English and 
who cannot speak, read, write or understand the 
English language at a level that permits the indi-
vidual to effectively communicate with clinical or 
nonclinical staff at an entity providing health care or 
health care related services. 
(11) MEDICARE PROGRAM.—The term ‘‘Medi-
care program’’ means the programs under parts A 
through D of title XVIII of the Social Security Act. 
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(12) SERVICE PROVIDER.—The term ‘‘service 
provider’’ includes all suppliers, providers of services, 
or entities under contract to provide coverage, items 
or services under any part of title XVIII of the So-
cial Security Act. 
TITLE III—PHYSICIANS’ SERVICE 
PAYMENT REFORM 
SEC. 301. ESTABLISHMENT OF SEPARATE TARGET GROWTH 
RATES FOR SERVICE CATEGORIES. 
(a) ESTABLISHMENT
OF SERVICE CATEGORIES.— 
Subsection (j) of section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) is amended by adding at the end 
the following new paragraph: 
‘‘(5) SERVICE CATEGORIES.—For services fur-
nished on or after January 1, 2008, each of the fol-
lowing categories of physicians’ services shall be 
treated as a separate ‘service category’: 
‘‘(A) Evaluation and management services 
for primary care (including new and established 
patient office visits delivered by physicians who 
the Secretary determines provide accessible, 
continuous, coordinated, and comprehensive 
care for Medicare beneficiaries, emergency de-
partment visits, and home visits), and for pre-
ventive services (including screening mammog-
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raphy, colorectal cancer screening, and other 
services as defined by the Secretary, limited to 
the recommendations of the United States Pre-
ventive Services Task Force). 
‘‘(B) Evaluation and management services 
not described in subparagraph (A). 
‘‘(C) Imaging services (as defined in sub-
section (b)(4)(B)) and diagnostic tests (other 
than clinical diagnostic laboratory tests) not de-
scribed in subparagraph (A). 
‘‘(D) Procedures that are subject (under 
regulations promulgated to carry out this sec-
tion) to a 10-day or 90-day global period (in 
this paragraph referred to as ‘major proce-
dures’), except that the Secretary may reclas-
sify as minor procedures under subparagraph 
(F) any procedures that would otherwise be in-
cluded in this category if the Secretary deter-
mines that such procedures are not major pro-
cedures. 
‘‘(E) Anesthesia services that are paid on 
the basis of the separate conversion factor for 
anesthesia services determined under subsection 
(d)(1)(D). 
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‘‘(F) Minor procedures and any other phy-
sicians’ services that are not described in a pre-
ceding subparagraph.’’. 
(b) ESTABLISHMENT
OF SEPARATE CONVERSION 
FACTORS
FOR EACH SERVICE CATEGORY.—Subsection 
(d)(1) of section 1848 of the Social Security Act (42 
U.S.C. 1395w–4) is amended— 
(1) in subparagraph (A)— 
(A) by designating the sentence beginning 
‘‘The conversion factor’’ as clause (i) with the 
heading ‘‘APPLICATION OF SINGLE CONVERSION 
FACTOR.—’’ and with appropriate indentation; 
(B) by striking ‘‘The conversion factor’’ 
and inserting ‘‘Subject to clause (ii), the con-
version factor’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(ii) APPLICATION OF MULTIPLE CON-
VERSION
FACTORS
BEGINNING
WITH 
2008.— 
‘‘(I) IN
GENERAL.—In applying 
clause (i) for years beginning with 
2008, separate conversion factors 
shall be established for each service 
category of physicians’ services (as de-
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fined in subsection (j)(5)) and any 
reference in this section to a conver-
sion factor for such years shall be 
deemed to be a reference to the con-
version factor for each of such cat-
egories. 
‘‘(II) INITIAL CONVERSION FAC-
TORS; 
SPECIAL
RULE
FOR
ANES-
THESIA SERVICES.—Such factors for 
2008 shall be based upon the single 
conversion factor for 2007 multiplied 
by the update established under para-
graph (8) for such category for 2008. 
In the case of the service category de-
scribed in subsection (j)(5)(F) (relat-
ing to anesthesia services), the conver-
sion factor for 2008 shall be based on 
the separate conversion factor speci-
fied in subparagraph (D) for 2007 
multiplied by the update established 
under paragraph (8) for such category 
for 2008. 
‘‘(III) UPDATING
OF
CONVER-
SION
FACTORS.—Such factor for a 
service category for a subsequent year 
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shall be based upon the conversion 
factor for such category for the pre-
vious year and adjusted by the update 
established for such category under 
paragraph (8) for the year involved.’’; 
and 
(2) in subparagraph (D), by inserting ‘‘(before 
2008)’’ after ‘‘for a year’’. 
(c) ESTABLISHING UPDATES FOR CONVERSION FAC-
TORS FOR SERVICE CATEGORIES.—Section 1848(d) of the 
Social Security Act (42 U.S.C. 1395w–4(d)) is amended— 
(1) in paragraph (4)(B), by striking ‘‘and (6)’’ 
and inserting ‘‘, (6), (8), and (9)’’; 
(2) in paragraph (4)(C)(iii), by striking ‘‘The 
allowed’’ and inserting ‘‘Subject to paragraph 
(8)(B), the allowed’’; 
(3) in paragraph (4)(D), by striking ‘‘The up-
date’’ and inserting ‘‘Subject to paragraph (8)(E), 
the update’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(8) UPDATES FOR SERVICE CATEGORIES BE-
GINNING WITH 2008 AND ENDING WITH 2012.— 
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‘‘(A) IN GENERAL.—In applying paragraph 
(4) for a year beginning with 2008 and ending 
with 2012, the following rules apply: 
‘‘(i) APPLICATION OF SEPARATE UP-
DATE ADJUSTMENTS FOR EACH SERVICE 
CATEGORY.—Pursuant 
to 
paragraph 
(1)(A)(ii)(I), the update shall be made to 
the conversion factor for each service cat-
egory (as defined in subsection (j)(5)) 
based upon an update adjustment factor 
for the respective category and year and 
the update adjustment factor shall be com-
puted, for a year, separately for each serv-
ice category. 
‘‘(ii) COMPUTATION OF ALLOWED AND 
ACTUAL EXPENDITURES BASED ON SERV-
ICE CATEGORIES.—In computing the prior 
year adjustment component and the cumu-
lative adjustment component under clauses 
(i) and (ii) of paragraph (4)(B), the fol-
lowing rules apply: 
‘‘(I) APPLICATION
BASED
ON 
SERVICE
CATEGORIES.—The allowed 
expenditures and actual expenditures 
shall be the allowed and actual ex-
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penditures for the service category, as 
determined under subparagraph (B). 
‘‘(II) LIMITATION TO PHYSICIAN 
FEE-SCHEDULE
SERVICES.—Actual 
expenditures shall only take into ac-
count expenditures for services fur-
nished under the physician fee sched-
ule. 
‘‘(III) APPLICATION
OF
CAT-
EGORY
SPECIFIC
TARGET
GROWTH 
RATE.—The 
growth 
rate 
applied 
under clause (ii)(II) of such para-
graph shall be the target growth rate 
for the service category involved under 
subsection (f)(5). 
‘‘(IV) ALLOCATION
OF
CUMU-
LATIVE
OVERHANG.—There shall be 
substituted for the difference de-
scribed in subparagraph (B)(ii)(I) of 
such paragraph the amount described 
in subparagraph (C)(i) for the service 
category involved. 
‘‘(B) DETERMINATION
OF
ALLOWED
EX-
PENDITURES.—In applying paragraph (4) for a 
year beginning with 2008, notwithstanding sub-
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paragraph (C)(iii) of such paragraph, the al-
lowed expenditures for a service category for a 
year is an amount computed by the Secretary 
as follows: 
‘‘(i) FOR 2008.—For 2008: 
‘‘(I) TOTAL
2007
ALLOWED
EX-
PENDITURES FOR ALL SERVICES IN-
CLUDED
IN
SGR
COMPUTATION.— 
Compute total allowed expenditures 
for physicians’ services (as defined in 
subsection (f)(4)(A)) for 2007 that 
would otherwise be calculated under 
subsection (d) but for this paragraph. 
‘‘(II) TOTAL 2007 ALLOWED EX-
PENDITURES
FOR
PHYSICIAN
FEE 
SCHEDULE SERVICES.—Compute total 
allowed expenditures for services fur-
nished under the physician fee sched-
ule for 2007 by subtracting, from the 
total allowed expenditures computed 
under subclause (I), the Secretary’s 
estimate of the amount of the actual 
expenditures for 2007 for services in-
cluded in such subclause for which 
payment is not made under the fee 
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schedule established pursuant to this 
section. 
‘‘(III) ALLOCATION OF 2007 AL-
LOWED
EXPENDITURES
TO
SERVICE 
CATEGORY.—Compute 
allowed 
ex-
penditures for the service category in-
volved for 2007 by multiplying the 
total allowed expenditures computed 
under subclause (II) by the overhang 
allocation factor for the service cat-
egory (as defined in subparagraph 
(C)(iii)). 
‘‘(IV) INCREASE
BY
GROWTH 
RATE TO OBTAIN 2008 ALLOWED EX-
PENDITURES
FOR
SERVICE
CAT-
EGORY.—Compute allowed expendi-
tures for the service category for 2008 
by increasing the allowed expenditures 
for the service category for 2007 com-
puted under subclause (III) by the 
target growth rate for such service 
category under subsection (f) for 
2008. 
‘‘(ii) FOR SUBSEQUENT YEARS.—For 
a subsequent year, take the amount of al-
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lowed expenditures for such category for 
the preceding year (under clause (i) or this 
clause) and increase it by the target 
growth rate determined under subsection 
(f) for such category and year. 
‘‘(C) COMPUTATION AND APPLICATION OF 
CUMULATIVE
OVERHANG
AMONG
CAT-
EGORIES.— 
‘‘(i) IN
GENERAL.—For purposes of 
applying paragraph (4)(B)(ii)(II) under 
clause (ii)(IV), the amount described in 
this clause for a year (beginning with 
2008) is the sum of the following: 
‘‘(I) 
PRE-2008 
CUMULATIVE 
OVERHANG.—The amount of the pre- 
2008 cumulative excess spending (as 
defined in clause (ii)) multiplied by 
the overhang allocation factor for the 
service category (under clause (iii)). 
‘‘(II) POST-2007 
CUMULATIVE 
AMOUNTS.—For a year beginning 
with 2009, the difference (which may 
be positive or negative) between the 
amount of the allowed expenditures 
for physicians’ services (as determined 
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under paragraph (4)(C)) in the serv-
ice category from January 1, 2008, 
through the end of the prior year and 
the amount of the actual expenditures 
for such services in such category dur-
ing that period. 
‘‘(ii) PRE-2008 CUMULATIVE EXCESS 
SPENDING
DEFINED.—For purposes of 
clause (i)(I), the term ‘pre-2008 cumu-
lative excess spending’ means the dif-
ference 
described 
in 
paragraph 
(4)(B)(ii)(I) as determined for the year 
2008, taking into account expenditures 
through December 31, 2007. Such dif-
ference takes into account expenditures in-
cluded in subsection (f)(4)(A). 
‘‘(iii) OVERHANG
ALLOCATION
FAC-
TOR.—For purposes of this paragraph, the 
term ‘overhang allocation factor’ means, 
for a service category, the proportion, as 
determined by the Secretary of total actual 
expenditures under this part for items and 
services in such category during 2007 to 
the total of such actual expenditures for all 
the service categories. In calculating such 
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proportion, the Secretary shall only take 
into account services furnished under the 
physician fee schedule. 
‘‘(D) UPDATES FOR 2008 AND 2009.—The 
update to the conversion factors for each service 
category for each of 2008 and 2009 shall be 
equal to 0.5 percent. 
‘‘(E) CHANGE IN RESTRICTION ON UPDATE 
ADJUSTMENT FACTOR FOR 2010 AND 2011.—The 
update adjustment factor determined under 
subparagraph (4)(B), as modified by this para-
graph, for a service category for a year (begin-
ning with 2010 and ending with 2011) may be 
less than ¥0.07, but may not be less than 
¥0.14. 
‘‘(9) NO
UPDATE
FOR
SERVICE
CATEGORIES 
BEGINNING WITH 2013.—The update to the conver-
sion factor for each of the service categories estab-
lished under paragraph (8) for 2013 and each suc-
ceeding year shall be 0 percent.’’. 
(d) APPLICATION OF SEPARATE TARGET GROWTH 
RATES FOR EACH CATEGORY.— 
(1) IN GENERAL.—Section 1848(f) of the Social 
Security Act (42 U.S.C. 1395w–4(f)) is amended by 
adding at the end the following new paragraph: 
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‘‘(5) APPLICATION
OF
SEPARATE
TARGET 
GROWTH RATES FOR EACH SERVICE CATEGORY BE-
GINNING WITH 2008.—The target growth rate for a 
year beginning with 2008 shall be computed and ap-
plied separately under this subsection for each serv-
ice category (as defined in subsection (j)(5)) and 
shall be computed using the same method for com-
puting the sustainable growth rate except for the fol-
lowing: 
‘‘(A) The reference in paragraphs (2)(A) 
and (2)(D) to ‘all physicians’ services’ is 
deemed a reference to the physicians’ services 
included in such category but shall not take 
into account items and services included in phy-
sicians’ services through the operation of para-
graph (4)(A). 
‘‘(B) The factor described in paragraph 
(2)(C) for the service category described in sub-
section (j)(5)(A) shall be increased by 0.025. 
‘‘(C) A national coverage determination (as 
defined in section 1869(f)(1)(B)) shall be treat-
ed as a change in regulation described in para-
graph (2)(D).’’. 
(2) USE OF TARGET GROWTH RATES.—Section 
1848 of such Act is further amended— 
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(A) in subsection (d)— 
(i) in paragraph (1)(E)(ii), by insert-
ing ‘‘or target’’ after ‘‘sustainable’’; and 
(ii) in paragraph (4)(B)(ii)(II), by in-
serting ‘‘or target’’ after ‘‘sustainable’’; 
and 
(B) in subsection (f)— 
(i) in the heading by inserting ‘‘; TAR-
GET GROWTH RATE’’ after ‘‘SUSTAINABLE 
GROWTH RATE’’; 
(ii) in paragraph (1)— 
(I) by striking ‘‘and’’ at the end 
of subparagraph (A); 
(II) in subparagraph (B), by in-
serting ‘‘before 2008’’ after ‘‘each 
succeeding year’’ and by striking the 
period at the end and inserting ‘‘; 
and’’; and 
(III) by adding at the end the 
following new subparagraph: 
‘‘(C) November 1 of each succeeding year 
the target growth rate for such succeeding year 
and each of the 2 preceding years.’’; and 
(iii) in paragraph (2), in the matter 
before subparagraph (A), by inserting after 
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