; and (2) by adding at the end the following new subparagraphs: (D) 2018 and subsequent years payment rates for ventilators For purposes of subparagraph (B)(v), the payment rate determined under this subparagraph for a ventilator described in subparagraph (A) is the following: (i) 2018 For 2018, the payment amount specified in subparagraph (B) for an item or device furnished on or after July 1, 2017, and before January 1, 2018, increased by the covered item update for 2018. (ii) 2019 For 2019, the rate determined under clause (i) for 2018— (I) increased by the covered item update for 2019; and (II) if applicable, increased by the budget neutrality adjustment under subparagraph (E). (iii) 2020 and subsequent years For 2020 and subsequent years, the rate determined under this subparagraph for an item or device furnished on December 31 of the previous year, increased by the covered item update for the year. (E) Budget neutrality adjustment of payment rates for ventilators for 2019 (i) In general Subject to the succeeding clauses of this subparagraph, the Secretary shall implement the provisions of subparagraphs (B)(v) and (D) in a budget neutral manner and any budget neutrality adjustment under this subparagraph shall be limited to payments for a ventilator described in subparagraph (A) furnished during 2019. (ii) Computation of aggregate budget neutrality adjustment The aggregate budget neutrality adjustment under this subparagraph shall be an amount equal to the difference (if any) between— (I) aggregate payments under this part for ventilators described in subparagraph (A) furnished during 2017, as adjusted under subclause (I) of clause (iii); and (II) aggregate payments under this part for such ventilators furnished during 2018, as adjusted under subclause (II) of such clause. (iii) Adjustments For purposes of clause (ii)— (I) payments described in subclause (I) of such clause shall be increased by the covered item update for 2018