[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6545 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 6545
To amend title XVIII of the Social Security Act to make improvements to
the physician fee schedule under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 1, 2023
Mrs. Miller-Meeks (for herself, Mr. Bucshon, Ms. Schrier, Ms. Kelly of
Illinois, Mr. Burgess, Mr. Murphy, Mr. Wenstrup, Mr. Bera, Mr.
Cardenas, and Mr. Ruiz) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to make improvements to
the physician fee schedule under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be referred to as the ``Physician Fee Schedule Update
and Improvements Act''.
SEC. 2. EXTENDING FLOOR FOR WORK GEOGRAPHIC INDEX.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``January 20, 2024'' and inserting
``January 1, 2025''.
SEC. 3. INCREASING SUPPORT FOR PHYSICIANS AND OTHER PRACTITIONERS IN
ADJUSTING TO MEDICARE PAYMENT CHANGES.
Section 1848(t)(1)(D) of the Social Security Act (42 U.S.C. 1395w-
4(t)(1)(D)) is amended by striking ``1.25 percent'' and inserting ``3
percent''.
SEC. 4. EXTENDING INCENTIVE PAYMENTS FOR PARTICIPATION IN ELIGIBLE
ALTERNATIVE PAYMENT MODELS.
(a) In General.--Section 1833(z) of the Social Security Act (42
U.S.C. 1395l(z)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A)--
(i) by striking ``In the case'' and
inserting ``Subject to subparagraph (E), in the
case'';
(ii) by striking ``ending with 2025'' and
inserting ``ending with 2026''; and
(iii) by inserting ``and 2026'' after
``with respect to 2025''; and
(B) by adding at the end the following new
subparagraph:
``(E) Special payment rule for 2026.--
``(i) In general.--Subject to clause (ii),
with respect to an amount payable under
subparagraph (A) for 2026 to an eligible
professional who is a qualifying APM
participant for such year, such amount shall be
reduced, in the case such participant has
received payment under such subparagraph--
``(I) for at least 4 years but
fewer than 7 years, by 34 percent; or
``(II) for 7 years, by 67 percent.
``(ii) Exception.--If an eligible
professional described in clause (i) increased
such professional's financial risk (as
specified by the Secretary) with respect to the
furnishing of items and services during the
most recent period for which data are available
(which may be less than a year) for 2026 as
compared to such professional's financial risk
with respect to the furnishing of such items
and services during the most recent period for
which data were available (which may be less
than a year) for 2025, the Secretary may reduce
the amount payable under subparagraph (A) for
2026 to such professional by a percentage that
is less than the percentage otherwise
applicable to such amount under clause (i) (and
which may include 0 percent).'';
(2) in paragraph (2)--
(A) in subparagraph (B)--
(i) in the subparagraph heading, by
striking ``2025'' and inserting ``2026''; and
(ii) in the matter preceding clause (i), by
striking ``2025'' and inserting ``2026'';
(B) in subparagraph (C)--
(i) in the subparagraph heading, by
striking ``2026'' and inserting ``2027''; and
(ii) in the matter preceding clause (i), by
striking ``2026'' and inserting ``2027''; and
(C) in subparagraph (D), by striking ``2024, and
2025'' and inserting ``2024, 2025, and 2026''; and
(3) in paragraph (4)(B), by striking ``2025'' and inserting
``2025 and 2026''.
(b) Conforming Amendments.--Section 1848(q)(1)(C)(iii) of the
Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(iii) is amended--
(1) in subclause (II), by striking ``2025'' and inserting
``2026''; and
(2) in subclause (III), by striking ``2026'' and inserting
``2027''.
SEC. 5. UPDATING THE BUDGET NEUTRALITY THRESHOLD.
Section 1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C.
1395w-4(c)(2)(B)(ii)(II)) is amended--
(1) by striking ``Subject to'' and inserting the following:
``(aa) In general.--Subject
to'';
(2) in item (aa), as inserted by subparagraph (A), by
striking ``$20,000,000'' and inserting ``the amount specified
in item (bb) for such year''; and
(3) by adding at the end the following new items:
``(bb) Amount specified.--
For purposes of item (aa),
subject to item (cc), the
amount specified in this item
is--
``(AA) for years
before 2025,
$20,000,000;
``(BB) for 2025,
$53,000,000; and
``(CC) for 2026 and
each subsequent year,
the amount specified in
this item for the
preceding year.
``(cc) Indexing limitation
on annual adjustments.--For
2030 and every subsequent fifth
year, the Secretary shall
increase the amount specified
in item (bb) for such year by
the cumulative increase in the
MEI (as defined in section
1842(i)(3)) applicable to
physicians' services over the
5-year period ending on the
last day of the preceding
year.''.
SEC. 6. TIMELY UPDATES TO DIRECT COSTS USED TO CALCULATE PRACTICE
EXPENSE RVUS.
Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)) is amended by adding at the end the following new clause:
``(vii) Timely updates to direct costs used
to calculate practice expense relative value
units.--
``(I) Simultaneous updates to
direct cost inputs at least once every
5 years.--The Secretary shall, not less
often than every 5 years, update the
prices and rates, as applicable, for
each of the direct costs inputs
described in subclause (II) used in the
methodology for calculating the
practice expense relative value units
under this subsection for physicians'
services. Updates made pursuant to the
previous sentence shall be made in the
same year for all direct cost inputs
described in such subclause.
``(II) Direct costs input
categories described.--For purposes of
this clause, the direct costs inputs
described in this subclause are
clinical staff wage rates, prices of
medical supplies, and prices of
equipment.
``(III) Consultation.--In making
the updates under this clause, the
Secretary shall consult with relevant
stakeholders, including physician
specialty societies.''.
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