124 STAT. 960 PUBLIC LAW 111–148—MAR. 23, 2010 (2) WAIVING BUDGET NEUTRALITY.—Section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)), as amended by subsection (a), is amended in the third sentence by inserting ‘‘and the amendments made by section 10324(a)(1) of the Patient Protection and Affordable Care Act’’ after ‘‘2003’’. (b) FLOOR ON AREA WAGE ADJUSTMENT FACTOR FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES IN FRONTIER STATES.—Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), as amended by section 3138, is amended— (1) in paragraph (2)(D), by striking ‘‘the Secretary’’ and inserting ‘‘subject to paragraph (19), the Secretary’’; and (2) by adding at the end the following new paragraph: ‘‘(19) FLOOR ON AREA WAGE ADJUSTMENT FACTOR FOR HOS- PITAL OUTPATIENT DEPARTMENT SERVICES IN FRONTIER STATES.— ‘‘(A) IN GENERAL.—Subject to subparagraph (B), with respect to covered OPD services furnished on or after January 1, 2011, the area wage adjustment factor applicable under the payment system established under this subsection to any hospital outpatient department which is located in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) may not be less than 1.00. The pre- ceding sentence shall not be applied in a budget neutral manner. ‘‘(B) LIMITATION.—This paragraph shall not apply to any hospital outpatient department located in a State that receives a non-labor related share adjustment under section 1886(d)(5)(H).’’. (c) FLOOR FOR PRACTICE EXPENSE INDEX FOR PHYSICIANS’ SERV- ICES FURNISHED IN FRONTIER STATES.—Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)), as amended by section 3102, is amended— (1) in subparagraph (A), by striking ‘‘and (H)’’ and inserting ‘‘(H), and (I)’’; and (2) by adding at the end the following new subparagraph: ‘‘(I) FLOOR FOR PRACTICE EXPENSE INDEX FOR SERVICES FURNISHED IN FRONTIER STATES.— ‘‘(i) IN GENERAL.—Subject to clause (ii), for pur- poses of payment for services furnished in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) on or after January 1, 2011, after calculating the practice expense index in subparagraph (A)(i), the Secretary shall increase any such index to 1.00 if such index would otherwise be less that 1.00. The preceding sen- tence shall not be applied in a budget neutral manner. ‘‘(ii) LIMITATION.—This subparagraph shall not apply to services furnished in a State that receives a non-labor related share adjustment under section 1886(d)(5)(H).’’. SEC. 10325. REVISION TO SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM. (a) TEMPORARY DELAY OF RUG–IV.—Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, prior to October 1, 2011, implement Version 4 of the Resource Utilization Groups (in this subsection refereed to as ‘‘RUG–IV’’) published in the Federal Register on August 11, 2009, entitled ‘‘Prospective Payment System and Consolidated Billing for Implementation dates.
