I 

108TH CONGRESS 

1ST SESSION H. R. 3396

To direct the Secretary of Health and Human Services to establish a process 

under which a provider of services or other health care provider under 

the Medicare Program may petition the Secretary for an adjustment 

of the rate of payment made to that provider under the Medicare Program based on a significant inequity between the rate of payment applicable to that provider, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 29, 2003

Mr. KING of Iowa introduced the following bill; which was referred to the 

Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 direct the Secretary of Health and Human Services to 

establish a process under which a provider of services 

or other health care provider under the Medicare Program may petition the Secretary for an adjustment of 

the rate of payment made to that provider under the 

Medicare Program based on a significant inequity between the rate of payment applicable to that provider, 

and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicare Inequity Ad3 justment Act’’. 

4 SEC. 2. CORRECTION OF SIGNIFICANT MEDICARE PAY5 MENT INEQUITIES. 

6 (a) FINDINGS.—Congress finds that inequities exist 

7 in medicare’s legacy reimbursement formulas and in the 

8 evaluations of reports that promote and perpetuate dis9 parate compensation rates for similar services. 

10 (b) ADJUSTMENT AUTHORITY.—

11 (1) IN GENERAL.—The Secretary of Health and 

12 Human Services shall establish a process under 

13 which a provider of services or other health care pro14 vider under the medicare program may petition the 

15 Secretary for an adjustment of the rate of payment 

16 made to that provider under the medicare program 

17 based on a significant inequity between the rate of 

18 payment applicable to that provider and the rate of 

19 payment applicable to similar providers located in 

20 adjoining areas. Under such process the provider 

21 shall have the right to compile records and present 

22 to the Secretary empirical evidence of such inequi23 ties. The Secretary shall make a determination on 

24 such a petition and notify the provider of such deter25 mination. 
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1 (2) ADJUSTMENT.—Based upon a petition 

2 under paragraph (1), the Secretary, notwithstanding 

3 any other provision of law, shall provide for such ad4 justment of payment rate as is necessary to correct 

5 significant inequities. 

6 (3) TAKING QUALITY INTO ACCOUNT.—In pro7 viding an adjustment under paragraph (2), the Sec8 retary shall take into account and provide for a 

9 higher payment adjustment, insofar as reliable data 

10 are available, a provider that is a high quality, cost11 effective provider. 

12 (4) JUDICIAL REVIEW.—Notwithstanding any 

13 other provision of law, if a provider is dissatisfied 

14 with a determination under paragraph (1), or the 

15 amount of any adjustment effected under paragraph 

16 (2), the provider shall have the right to a review of 

17 such determination in an action before an appro18 priate district court of the United States and the 

19 court shall hear such action de novo and shall not 

20 give deference to any findings of fact or conclusions 

21 of law of the Secretary. 

22 (5) NO BUDGET NEUTRALITY OR OTHER AD23 JUSTMENT FOR OTHER PROVIDERS.—Nothing in 

24 this section shall be construed as authorizing the 

25 Secretary to reduce medicare payment rates to any 
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1 providers as a result of a payment adjustment made 

2 to other providers under this section.

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