Text: H.R.6459 — 111th Congress (2009-2010)All Bill Information (Except Text)

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Introduced in House (11/30/2010)


111th CONGRESS
2d Session
H. R. 6459

To amend section 1848 of the Social Security Act to provide for a 4-year transition in reductions in relative value units for certain newly bundled services to allow physician practice time to adjust to new payment rates.


IN THE HOUSE OF REPRESENTATIVES
November 30, 2010

Mr. Gonzalez 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 section 1848 of the Social Security Act to provide for a 4-year transition in reductions in relative value units for certain newly bundled services to allow physician practice time to adjust to new payment rates.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. 4-year transition in reduction in relative value units for codes for certain services.

(a) In general.—Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is amended by adding at the end the following new subparagraph:

“(M) 4-YEAR TRANSITION FOR REDUCTIONS IN RELATIVE VALUE UNITS FOR CODES FOR CERTAIN SERVICES.—

“(i) IN GENERAL.—In the case of codes (for services) described in clause (ii) for which a change in relative value units results in a reduction in such units of 10 percent or more, the Secretary shall provide for a 4-year transition consistent with clause (iii).

“(ii) APPLICABLE CODES (FOR SERVICES).—For purposes of clause (i), the codes (for services) described in this clause are codes (for services) for which a single code is used for payment for services for which multiple codes were previously used.

“(iii) TRANSITION.—The 4-year transition under clause (i) shall apply to the number of percentage points of the reduction in excess of 10 percent.”.

(b) Effective date.—

(1) IN GENERAL.—Except as provided in paragraphs (2) and (3), subparagraph (M) of section 1848(c)(2) of the Social Security Act, as added by the amendment made by subsection (a), shall apply to relative value units for codes applicable to services furnished on or after January 1, 2012.

(2) EXCEPTION FOR NEW CODES IN 2010.—In the case of relative value units for which codes described in clause (ii) of such subparagraph first applied to services furnished on or after January 1, 2010, the following rules shall apply:

(A) 2011.—Such subparagraph shall apply to such codes for services furnished during 2011 (on or after April 1, 2011) and the second year of a 4-year transition shall be applied to relative value units for codes for such services in a manner as if the transition period began in 2010.

(B) 2012.—In applying such subparagraph to services furnished during 2012, the third year of a 4-year transition shall be applied to relative value units for codes for such services in a manner as if the transition period began in 2010.

(C) 2013.—In applying such subparagraph to services furnished during 2013, the fourth year of a 4-year transition shall be applied to relative value units for codes for services furnished during 2013 in a manner as if the transition period began in 2010.

(3) EXCEPTION FOR NEW CODES AFTER 2011.—In the case of relative value units for codes described in clause (ii) of such subparagraph first applied to services furnished on or after January 1, 2011, the following rules shall apply with respect to such amendment:

(A) 2011.—Such subparagraph shall apply to such codes for services furnished during 2011 (on or after April 1, 2011) and first year of a 4-year transition shall be applied to relative value units for codes for such services in a manner as if the transition period began in 2011.

(B) 2012.—In applying such subparagraph to services furnished during 2012, the second year of a 4-year transition shall be applied to relative value units for codes for such services in a manner as if the transition period began in 2011.

(C) 2013.—In applying such subparagraph to services furnished during 2013, the third year of a 4-year transition shall be applied to relative value units for codes for services furnished during 2013 in a manner as if the transition period began in 2011.

(4) APPLICATION OF BUDGET NEUTRALITY.—Nothing in this subsection shall be construed as waiving the application of the budget-neutrality requirement of section 1848(c)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395(c)(2)(B)(ii)) that otherwise applies, including for the period during 2011 beginning on April 1, 2011.