; (ii) in the case that an estimate is unable to be determined pursuant to clause (i), by health insurance issuers and group health plans (as such terms are defined in section 2791 of the Public Health Service Act) and MA plans under part C for such a service, based on such data from whichever single coverage year from 2021 through 2023 has the highest per patient utilization of ALS-related services; and (iii) in the case that an estimate is unable to be determined pursuant to clause (ii), based on the recommendation of the Specialty Society Relative Value Scale Update Committee of the American Medical Association or the estimate of the Comptroller General for such a service. (E) Subsequent reports For the purpose of subparagraph (C)(ii)(I), the Comptroller General shall, not later than— (i) January 1, 2028, submit a report to the Secretary in accordance with subparagraph (D), except such subparagraph shall be applied by substituting 2024 through 2026 for 2021 through 2023 each place it appears; and (ii) January 1, 2031, and every 3 years thereafter, submit a report to the Secretary in accordance with subparagraph (D), after application of clause (i), except clause (i) shall be applied by substituting coverage years that are 3 years later than the coverage years previously applicable for reports under clause (i) or this clause for 2024 through 2026 . (3) Payment adjustments The payment system under this subsection shall include a payment adjustment— (A) for a qualified provider that is participating in at least 1 clinical trial identified on the clinicaltrials.gov database (or any successor database) of the National Institutes of Health to account for the increased costs borne by such a qualified provider during such a clinical trial