covered item update

(14) Covered item update In this subsection, the term “covered item update” means, with respect to a year— (A) for 1991 and 1992, the percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June of the previous year reduced by 1 percentage point; (B) for 1993, 1994, 1995, 1996, and 1997, the percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June of the previous year; (C) for each of the years 1998 through 2000, 0 percentage points; (D) for 2001, the percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June 2000; (E) for 2002, 0 percentage points; (F) for 2003, the percentage increase in the consumer price index for all urban consumers (U.S. urban average) for the 12-month period ending with June of 2002; (G) for 2004 through 2006— (i) subject to clause (ii), in the case of class III medical devices described in section 360c(a)(1)(C) of title 21 , the percentage increase described in subparagraph (B) for the year involved; and (ii) in the case of covered items not described in clause (i), 0 percentage points; (H) for 2007— (i) subject to clause (ii), in the case of class III medical devices described in section 360c(a)(1)(C) of title 21 , the percentage change determined by the Secretary to be appropriate taking into account recommendations contained in the report of the Comptroller General of the United States under section 302(c)(1)(B) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and (ii) in the case of covered items not described in clause (i), 0 percentage points; (I) for 2008— (i) subject to clause (ii), in the case of class III medical devices described in section 360c(a)(1)(C) of title 21 , the percentage increase described in subparagraph (B) (as applied to the payment amount for 2007 determined after the application of the percentage change under subparagraph (H)(i)); and (ii) in the case of covered items not described in clause (i), 0 percentage points; (J) for 2009— (i) in the case of items and services furnished in any geographic area, if such items or services were selected for competitive acquisition in any area under the competitive acquisition program under section 1395w–3(a)(1)(B)(i)(I) of this title before July 1, 2008 , including related accessories but only if furnished with such items and services selected for such competition and diabetic supplies but only if furnished through mail order, - 9.5 percent; or (ii) in the case of other items and services, the percentage increase in the consumer price index for all urban consumers (U.S. urban average) for the 12-month period ending with June 2008; (K) for 2010, the percentage increase in the consumer price index for all urban consumers (U.S. urban average) for the 12-month period ending with June of the previous year; and (L) for 2011 and each subsequent year— (i) the percentage increase in the consumer price index for all urban consumers (United States city average) for the 12-month period ending with June of the previous year, reduced by— (ii) the productivity adjustment described in section 1395ww(b)(3)(B)(xi)(II) of this title . The application of subparagraph (L)(ii) may result in the covered item update under this paragraph being less than 0.0 for a year, and may result in payment rates under this subsection for a year being less than such payment rates for the preceding year.

Source

42 USC § 1395m(a)(14)


Scoping language

None identified. Default scope is assumed to be the entire title.
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