; and (2) by adding at the end the following new paragraph: (23) Floor on area wage adjustment factor for hospital outpatient department services With respect to covered OPD services furnished on or after January 1, 2024, 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 0.85. The preceding sentence shall not be implemented in a budget neutral manner. .