; and (II) with respect to air ambulance services furnished by a supplier or provider of air ambulance services during a consequence year after the third consequence year, the Secretary applies a percentage point adjustment to the percentage increase determined under paragraph (3)(B), after application of paragraphs (3)(C) and (18), in a manner that provides for differential payment to a supplier or provider of air ambulance services based upon the quality of care furnished (as determined under subparagraph (B)) during a performance period with respect to such consequence year (with such percentage point adjustment ranging from an increase of 5 percentage points for such services furnished in a consequence year by such a provider or supplier with the highest demonstrated performance in the performance period for such year to a decrease of 5 percentage points for such services furnished in the consequence year by such a provider or supplier with the lowest demonstrated performance for the performance period for such year). (ii) Special rule The application of this subparagraph may result in such percentage increase being less than 0.0 for a year, and may result in payment rates under the fee schedule under this subsection for a year being less than such payment rates for the preceding year. (iii) Noncumulative application Any adjustment under this subparagraph shall apply only with respect to the year involved and the Secretary shall not take into account such adjustment in computing the payment amount under the fee schedule under this subsection for a subsequent year. (iv) Treatment of new Medicare suppliers and providers of air ambulance services In the case of a supplier or provider of air ambulance services that first becomes a Medicare enrolled supplier or provider of air ambulance services during the performance period for a consequence year (and had not previously submitted claims under this title such as a person or entity or under a different billing number or tax identifier), the adjustment under clause