; and (2) by adding at the end the following new paragraph: (22) Floor on area wage adjustment factor for hospital outpatient department services in areas other than in frontier States (A) In general With respect to covered OPD services furnished on or after January 1, 2018, the area wage adjustment factor applicable under the payment system established under this subsection to any hospital outpatient department which is not located in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) may not be less than 0.874. (B) Ensuring budget neutrality In order to ensure that the aggregate payments made under this subsection for a year (beginning with 2018) are not greater than the aggregate payments that would have been made under this subsection for such year without the application of subparagraph (A), as estimated by the Secretary, the Secretary shall establish pursuant to rulemaking a maximum area wage adjustment factor to apply under the payment system established under this subsection to any hospital outpatient department which is not located in a frontier State (as defined in clause (iii)(II)). (C) No impact for hospitals with an area wage adjustment factor between the floor and the maximum factor Subparagraphs (A) and (B) shall have no effect on the area wage adjustment factor applicable in a year to a hospital with an area wage adjustment factor that is greater than the floor under subparagraph (A) but less than the maximum area wage adjustment factor established under subparagraph (B) for the year. .