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103D CONGRESS

1ST SESSION H. R. 3170

To amend title XVIII of the Social Security Act to require the Secretary

of Health and Human Services to consult with representatives of physicians and to use the most recent available data in making geographic

adjustments to the payment rates for physicians’ services under part

B of the medicare program, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 29, 1993

Mr. CHAPMAN introduced the following bill; which was referred jointly to the

Committees on Energy and Commerce and Ways and Means

A BILL

To amend title XVIII of the Social Security Act to require

the Secretary of Health and Human Services to consult

with representatives of physicians and to use the most

recent available data in making geographic adjustments

to the payment rates for physicians’ services under part

B of 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. MODIFICATIONS TO GEOGRAPHIC COST OF

2 PRACTICE INDEX UNDER MEDICARE PHYSI3 CIAN FEE SCHEDULE.

4 (a) REQUIRING CONSULTATION WITH REPRESENTA5 TIVES OF PHYSICIANS IN REVIEWING GEOGRAPHIC AD6 JUSTMENT FACTORS.—Section 1848(e)(1)(C) of the So7 cial Security Act (42 U.S.C. 1395w–4(e)(1)(C)) is amend8 ed by striking ‘‘shall review’’ and inserting ‘‘shall, in con9 sultation with appropriate representatives of physicians,

10 review’’.

11 (b) USE OF MOST RECENT DATA IN GEOGRAPHIC

12 ADJUSTMENT.—Section 1848(e)(1) of such Act (42

13 U.S.C. 1395w–4(e)(1)) is amended by adding at the end

14 the following new subparagraph:

15 ‘‘(D) USE OF RECENT DATA.—In estab16 lishing indices and index values under this

17 paragraph, the Secretary shall use the most re18 cent data available relating to practice ex19 penses, malpractice expenses, and physician

20 work effort in different fee schedule areas.’’.

21 (c) DEADLINE FOR INITIAL REVIEW AND REVI22 SION.—The Secretary of Health and Human Services

23 shall first review and revise geographic adjustment factors

24 under section 1848(e)(1)(C) of the Social Security Act by

25 not later than January 1, 1995. Not later than April 1,

26 1994, the Secretary shall study and report to the Commit-
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1 tee on Finance of the Senate and the Committee on Ways

2 and Means and the Committee on Energy and Commerce

3 of the House of Representatives on the construction of the

4 geographic cost of practice index under section

5 1848(e)(1)(A)(i) of such Act.

6 (d) REPORT ON REVIEW PROCESS.—Not later than

7 1 year after the date of the enactment of this Act, the

8 Secretary of Health and Human Services shall study and

9 report to the Committee on Finance of the Senate and

10 the Committee on Ways and Means and the Committee

11 on Energy and Commerce of the House of Representatives

12 on—

13 (1) the data necessary to review and revise the

14 indices established under section 1848(e)(1)(A) of

15 the Social Security Act, including—

16 (A) the shares allocated to physicians’

17 work effort, practice expenses (other than mal18 practice expenses), and malpractice expenses;

19 (B) the weights assigned to the input com20 ponents of such shares; and

21 (C) the index values assigned to such com22 ponents;

23 (2) any limitations on the availability of data

24 necessary to review and revise such indices at least

25 every three years;
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1 (3) ways of addressing such limitations, with

2 particular attention to the development of alternative

3 data sources for input components for which current

4 index values are based on data collected less fre5 quently than every three years; and

6 (4) the costs of developing more accurate and

7 timely data.

8 (e) DEVELOPMENT OF CRITERIA FOR USE IN DE9 TERMINING PAYMENT LOCALITIES.—The Physician Pay10 ment Review Commission shall conduct a study to develop

11 criteria that would be used to refine the fee schedule areas

12 that are used within States, in applying geographic adjust13 ment factors for computing payment amounts, under sec14 tion 1848 of the Social Security Act. The Commission

15 shall include a report on such study in its recommenda16 tions submitted to the Congress under section 1845(b) of

17 such Act in 1994.

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