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PUBLIC LAW 103-66—AUG. 10, 1993 107 STAT. 583 (1) in subsection (aX2XBXiiXI), by inserting "and as adjusted under subsection (cX2XFXiir after "for 1994**; (2) in subsection (cX2XAXi), by adding at the end the following: "Such relative values are subject to ac^ustment under subparagraph (FXi)."; and (3) in subsection (iXlXB), by adding at the end "including adjustments under subsection (cX2XF),''. (d) EFFECTIVE DATE.—^The amendments made by this section shall apply to services furnished on or after January 1, 1994. SEC. 13515. PAYMENTS FOR NEW PHYSICIANS AND PRACTITIONERS. (a) EQUAL TREATMENT OF NEW PHYSICIANS AND PRACTITION- ERS.—(1) Section 1848(a) (42 U.S.C. 1395w-^a)) is amended by striking paragraph (4). (2) Section 1842(bX4) (42 U.S.C. 1395u(bX4)) is amended by strUdng subparagraph (F). (b) BUDGET NEUTRALITY ADJUSTMENT.—^Notwithstanding any other provision of law, the Secretary of Health and Human Services shall reduce the following values and amounts for 1994 (to be applied for that year and subsequent years) by such uniform percentage as the Secretary determines to be required to assure that the amendments made by subsection (a) will not result in expenditures under part B of title XVIH of the Social Security Act in 1994 that exceed the amount of such expenditures that would have been made if such amendments had not been made: (1) The relative values established under section 1848(c) of such Act for services (other than anesthesia services) and, in the case of anesthesia services, the conversion factor estab- lished imder section 1848 of such Act for such services. (2) The amounts determined under section 1848(aX2XBXiiXI) of such Act. (3) llie prevailing charges or fee schedule amounts to be applied under such part for services of a health care practitioner (as defined in section 1842(bX4XFXiiXI) of such Act, as in effect before the date of the enactment of this Act). (c) CONFORMING AMENDMENTS.—Section 1848 (42 U.S.C. 1395w-4), as amended by section 13514(c), is amended— (1) in subsection (aX2XBXiiXI), by inserting "and imder section 13515(b) of the Omnibus Budget Reconciliation Act of 1993" after "subsection (cX2XFXii)''; (2) in subsection (cX2XAXi), by inserting "and section 13515(b) of the Omnibiis Budget Reconciliation Act of 1993" after "imder subparagraph (FXi/*; and (3) in subsection (iXlXB), b^ inserting "and section 13515(b) of the Omnibus Budget Reconciliation Act of 1993" after "under subsection (cX2XF)". (d) EFFECTIVE DATE.—^The amendments made by subsection (a) shall apply to services furnished on or after January 1, 1994. SEC. 13516. PAYMENTS FOR ANESTHESIA. (a) PAYMENT TO A PHYSICIAN FOR MEDICAL DIRECTION.— (1) IN GENERAL.—Section 1848(a) (42 U.S.C. 1395w-4(a)), as amended bv section 13515(aXl), is amended by adding at the end the following new paragraph: "(4) SPECIAL RULE FOR MEDICAL DIRECTION.— "(A) IN GENERAL.—^With respect to physicians' services furnished on or after January 1, 1994, and consisting of medical direction of two, three, or four concurrent anesthe- 42 u s e 1395W-4 note. 42 u s e 1395u note. 42 use 1395u note. 69-194 O - 94 - 20 : QL. 3 Part 1