I

103D CONGRESS

2D SESSION H. R. 4689

To amend title XVIII of the Social Security Act to increase the bonus

payment provided for physicians’ services furnished under part B of

the medicare program in a health professional shortage area to 20

percent in the case of primary care services, to establish updates for

1995 in the conversion factors used to determine the amount of payment

made for physicians’ services under the medicare program, and for other

purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 30, 1994

Ms. LAMBERT introduced the following bill; which was referred jointly to the

Committees on Ways and Means and Energy and Commerce

A BILL

To amend title XVIII of the Social Security Act to increase

the bonus payment provided for physicians’ services furnished under part B of the medicare program in a health

professional shortage area to 20 percent in the case

of primary care services, to establish updates for 1995

in the conversion factors used to determine the amount

of payment made for physicians’ services under the medicare program, 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. BONUS PAYMENT FOR PHYSICIAN SERVICES

2 PROVIDED IN HEALTH PROFESSIONAL

3 SHORTAGE AREAS.

4 (a) INCREASE IN AMOUNT OF PAYMENT FOR PRI5 MARY CARE SERVICES.—Section 1833(m) of the Social

6 Security Act (42 U.S.C. 1395l(m)) is amended by insert7 ing after ‘‘10 percent’’ the following: ‘‘(or, in the case of

8 primary care services defined in section 1842(i)(4), 20

9 percent)’’.

10 (b) EXTENSION TO CERTAIN NONPHYSICIAN PRO11 VIDERS AND OTHER MEDICARE-DEPENDENT PROVID12 ERS.—Section 1833(m) of such Act (42 U.S.C. 1395l(m))

13 is amended—

14 (1) by striking ‘‘(m)’’ and inserting ‘‘(m)(1)’’;

15 (2) by inserting ‘‘described in paragraph (2)’’

16 after ‘‘physicians’ services’’;

17 (3) by striking ‘‘in an area’’ and all that follows

18 through ‘‘shortage area,’’;

19 (4) by striking ‘‘the physician’’ and inserting

20 ‘‘the provider of the service’’; and

21 (5) by adding at the end the following new

22 paragraph:

23 ‘‘(2) In paragraph (1), physicians’ services described

24 in this paragraph are services—
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1 ‘‘(A) furnished in an area designated (under

2 section 332(a)(1)(A) of the Public Health Service

3 Act) as a health professional shortage area; or

4 ‘‘(B) furnished during a year by a provider with

5 respect to whom not less than 75 percent of the pa6 tients for whom the provider furnishes such services

7 during the year are individuals—

8 ‘‘(i) who are entitled to benefits under this

9 title;

10 ‘‘(ii) who are eligible for medical assistance

11 under a State plan approved under title XIX;

12 or

13 ‘‘(iii) with respect to whom the provider

14 did not receive any payment for the service.’’.

15 (c) EFFECTIVE DATE.—The amendments made by

16 subsections (a) and (b) shall apply to services furnished

17 on or after January 1, 1995.

18 SEC. 2. ESTABLISHMENT OF UPDATE TO CONVERSION FAC19 TOR FOR SERVICES FURNISHED IN 1995.

20 Section 1848(d)(3)(A) of the Social Security Act (42

21 U.S.C. 1395w–4(d)(3)(A)) is amended—

22 (1) by amending clause (v) to read as follows:

23 ‘‘(v) ESTABLISHMENT OF PERCENT24 AGE INCREASE FOR 1995.—In applying

25 clause (i) for services furnished in 1995,
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1 the percentage increase in the appropriate

2 update index shall be equal to—

3 ‘‘(I) 10.7 percentage points for

4 services included in the category of

5 surgical services (as defined for pur6 poses of subsection (j)(1)),

7 ‘‘(II) 10.1 percentage points for

8 services included in the category of

9 primary care services (as defined for

10 purposes of subsection (j)(1)), and

11 ‘‘(III) 7.4 percentage points for

12 any services not described in

13 subclause (I) or subclause (II).’’; and

14 (2) in clause (vi), by striking ‘‘Clauses (iv) and

15 (v)’’ and inserting ‘‘Clause (iv)’’.

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