; (ii) in the case an estimate is unable to be determined pursuant to subclause (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 an estimate is unable to be determined pursuant to subclause (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 clause (i), except by substituting 2021 through 2023 for 2024 through 2026 ; and (ii) three years after the date specified in subclause (I), and every three years thereafter, submit a report to the Secretary in accordance with such clause (i), except by substituting the coverage years for the previous report with coverage years that are three years later. (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 one 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; and (B) for a medical service or technology which is furnished as a part of ALS-related services for which, as determined by the Secretary— (i) payment for the service or technology as part of ALS-related services under this section was not being made in the preceding coverage year