I 

112TH CONGRESS 

2D SESSION H. R. 5730 

To amend title XVIII of the Social Security Act to make publicly available 

on the official Medicare Internet site medicare payment rates for frequently reimbursed hospital inpatient procedures, hospital outpatient procedures, and physicians’ services. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 10, 2012 

Mr. HUIZENGA of Michigan 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 amend title XVIII of the Social Security Act to make 

publicly available on the official Medicare Internet site 

medicare payment rates for frequently reimbursed hospital inpatient procedures, hospital outpatient procedures, and physicians’ services. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Payment 

5 Rate Disclosure Act of 2012’’. 


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1 SEC. 2. PUBLIC INTERNET AVAILABILITY OF MEDICARE 

2 PAYMENT RATES FOR FREQUENTLY REIM3 BURSED PROCEDURES AND SERVICES. 

4 Title XVIII of the Social Security Act is amended by 

5 adding at the end the following new section: 

6 ‘‘SEC. 1899B. PUBLIC INTERNET AVAILABILITY OF MEDI7 CARE PAYMENT RATES FOR FREQUENTLY 

8 REIMBURSED PROCEDURES AND SERVICES. 

9 ‘‘(a) IN GENERAL.— 

10 ‘‘(1) INITIAL POSTING.—During the initial pe11 riod beginning on a date not later than 120 days 

12 after the date of the enactment of this section and 

13 ending on the date that is 240 days after such start14 ing date, the Secretary shall make publicly available 

15 on the official Medicare Internet site the following: 

16 ‘‘(A) PAYMENT RATES FOR HOSPITAL IN17 PATIENT PROCEDURES.—For each procedure 

18 selected under subsection (b)(1)(A)(i) and for 

19 each Metropolitan Statistical Area or other pay20 ment area used for purposes of section 1886(d), 

21 the average rate of payment under such section 

22 for the procedure, determined without regard to 

23 the application of any deduction or coinsurance 

24 amount or any adjustment under subparagraph 

25 (B), (D), (F), or (G) of paragraph (5) of such 

26 section. 


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1 ‘‘(B) PAYMENT RATES FOR HOSPITAL OUT2 PATIENT PROCEDURES.—For each procedure 

3 selected under subsection (b)(1)(A)(ii) and for 

4 each county or other payment area used for 

5 purposes of section 1833(t), the average rate of 

6 payment under such section for the procedure, 

7 determined without regard to the application of 

8 any deductible or coinsurance. 

9 ‘‘(C) PHYSICIAN PAYMENT RATES FOR

10 PHYSICIANS’ SERVICES.—For each physicians’ 

11 service selected under subsection (b)(1)(A)(iii) 

12 and for each fee schedule area under section 

13 1848, the average payment amount determined 

14 under the fee schedule under such section for 

15 the service, determined without regard to the 

16 application of any deductible or coinsurance. 

17 ‘‘(D) PERIOD FOR WHICH PAYMENT RATES

18 ARE APPLICABLE.—A description of the period 

19 for which each payment rate or amount under 

20 subparagraph (A), (B), or (C) is applicable. 

21 ‘‘(E) SERVICES INCLUDED IN PROCE22 DURES.—A description of the items and serv23 ices included in each procedure selected under 

24 clauses (i) and (ii) of subsection (b)(1)(A). 


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1 ‘‘(F) NOTICE.—A statement that the aver2 age payment rates and average payment 

3 amounts described in subparagraphs (A) 

4 through (C) are only applicable to the Medicare 

5 program under this title and may not be avail6 able for an individual who is not purchasing 

7 such a procedure or service under such pro8 gram. 

9 ‘‘(2) POSTING OF EXPANDED SELECTION.— 

10 During the period beginning on the date that is one 

11 day after the last day of the initial period described 

12 in paragraph (1), the Secretary shall make publicly 

13 available on the official Medicare Internet site the 

14 following: 

15 ‘‘(A) PAYMENT RATES FOR HOSPITAL IN16 PATIENT PROCEDURES.—For each procedure 

17 selected under subsection (b)(1)(B)(i) and for 

18 each Metropolitan Statistical Area or other pay19 ment area used for purposes of section 1886(d), 

20 the average rate of payment described in para21 graph (1)(A) for the procedure. 

22 ‘‘(B) PAYMENT RATES FOR HOSPITAL OUT23 PATIENT PROCEDURES.—For each procedure 

24 selected under subsection (b)(1)(B)(ii) and for 

25 each county or other payment area used for 


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1 purposes of section 1833(t), the average rate of 

2 payment described in paragraph (1)(B) for the 

3 procedure. 

4 ‘‘(C) PHYSICIAN PAYMENT RATES FOR

5 PHYSICIANS’ SERVICES.—For each physicians’ 

6 service selected under subsection (b)(1)(B)(iii) 

7 and for each fee schedule area under section 

8 1848, the average payment amount described in 

9 paragraph (1)(C) for the physicians’ service. 

10 ‘‘(D) PERIOD FOR WHICH PAYMENT RATES

11 ARE APPLICABLE.—A description of the period 

12 for which each payment rate or amount under 

13 subparagraph (A), (B), or (C) is applicable. 

14 ‘‘(E) SERVICES INCLUDED IN PROCE15 DURES.—A description of the items and serv16 ices included in each procedure selected under 

17 clauses (i) and (ii) of subsection (b)(1)(B). 

18 ‘‘(F) NOTICE.—A statement that the aver19 age payment rates and average payment 

20 amounts described in subparagraphs (A) 

21 through (C) are only applicable to the Medicare 

22 program under this title and may not be avail23 able for an individual who is not purchasing 

24 such a procedure or service under such pro25 gram. 


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1 ‘‘(b) SELECTION OF PROCEDURES AND SERVICES.— 

2 ‘‘(1) IN GENERAL.— 

3 ‘‘(A) INITIAL SELECTION.—For purposes 

4 of subsection (a)(1) and based on the most re5 cent national data available, the Secretary shall 

6 select the following: 

7 ‘‘(i) At least the 30 hospital inpatient 

8 procedures for which payment is most fre9 quently provided under section 1886(d). 

10 ‘‘(ii) At least the 30 hospital out11 patient procedures for which payment is 

12 most frequently provided under section 

13 1833(t). 

14 ‘‘(iii) At least the 30 physicians’ serv15 ices (as defined in section 1861(q)) for 

16 which payment is most frequently provided 

17 under section 1848. 

18 ‘‘(B) EXPANDED SELECTION.—For pur19 poses of subsection (a)(2) and based on the 

20 most recent national data available, the Sec21 retary shall select the following: 

22 ‘‘(i) At least the 100 hospital inpa23 tient procedures for which payment is most 

24 frequently provided under section 1886(d). 


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1 ‘‘(ii) At least the 100 hospital out2 patient procedures for which payment is 

3 most frequently provided under section 

4 1833(t). 

5 ‘‘(iii) At least the 100 physicians’ 

6 services (as defined in section 1861(q)) for 

7 which payment is most frequently provided 

8 under section 1848. 

9 ‘‘(2) UPDATING EXPANDED SELECTION.—The 

10 Secretary shall periodically update the procedures 

11 and services selected under paragraph (1)(B). 

12 ‘‘(3) FURTHER EXPANSION OF SELECTION.— 

13 The Secretary shall expand the number of proce14 dures and services selected under paragraph (1)(B) 

15 to include as many procedures and services as may 

16 be useful for an individual not entitled to benefits 

17 under part A or enrolled under part B in the pur18 chase of such procedures and services. 

19 ‘‘(c) AUTHORITY TO POST ADDITIONAL INFORMA20 TION.—The Secretary may make publicly available on the 

21 official Medicare website such information on the payment 

22 rate or payment amount under this title for a procedure, 

23 item, or service not selected under subsection (b) as may 

24 be useful for an individual not entitled to benefits under 

25 part A or enrolled under part B in the purchase of the 


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1 procedure, item, or service. To the extent practicable, such 

2 information shall be provided for each payment area in3 volved. 

4 ‘‘(d) ADMINISTRATIVE PROVISIONS.— 

5 ‘‘(1) USE OF MOST RECENT NATIONAL DATA.— 

6 The information described in paragraph (1) of sub7 section (b) and subsection (c) shall be based on the 

8 most recent national data available. 

9 ‘‘(2) ACCESSIBILITY BY ZIP CODE.—Such infor10 mation for an applicable payment area shall be ac11 cessible by any zip code included in such area.’’. 

Æ 


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