I 

112TH CONGRESS 

2D SESSION H. R. 5707 

To amend part B of title XVIII of the Social Security Act to reform Medicare 

payment for physicians’ services by eliminating the sustainable growth 

rate system and providing incentives for the adoption of innovative payment and delivery models to improve quality and efficiency. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 9, 2012 

Ms. SCHWARTZ (for herself, Mr. HECK, Mrs. CHRISTENSEN, and Mr. COURTNEY) introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committees on Ways 

and Means and the Budget, 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 part B of title XVIII of the Social Security 

Act to reform Medicare payment for physicians’ services 

by eliminating the sustainable growth rate system and 

providing incentives for the adoption of innovative payment and delivery models to improve quality and efficiency. 

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


tjames on DSK6SPTVN1PROD with BILLS
2 

•HR 5707 IH

1 SECTION 1. SHORT TITLE; PURPOSE. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Medicare Physician Payment Innovation Act of 2012’’. 

4 (b) PURPOSE.—The purpose of this Act is to reform 

5 the system of Medicare payment for physicians’ services— 

6 (1) by ending the application of the sustainable 

7 growth rate (SGR) system; 

8 (2) to stabilize payments for 2013; 

9 (3) to promote the rapid development and im10 plementation of alternative improved payment and 

11 delivery models that incentivize high quality, high12 value care; and 

13 (4) to provide continuing incentives for physi14 cian adoption of such alternative payment and deliv15 ery models. 

16 SEC. 2. MEDICARE PHYSICIAN PAYMENT REFORM. 

17 (a) REPEAL OF SGR PAYMENT METHODOLOGY.— 

18 Section 1848 of the Social Security Act (42 U.S.C. 

19 1395w–4) is amended— 

20 (1) in subsection (d)— 

21 (A) in paragraph (1)(A), by inserting ‘‘or 

22 a subsequent paragraph’’ after ‘‘paragraph 

23 (4)’’; and 

24 (B) in paragraph (4)— 


tjames on DSK6SPTVN1PROD with BILLS
3 

•HR 5707 IH

1 (i) in the heading, by striking ‘‘YEARS

2 BEGINNING WITH 2001’’ and inserting 

3 ‘‘2001, 2002, AND 2003’’; and 

4 (ii) in subparagraph (A), by striking 

5 ‘‘a year beginning with 2001’’ and insert6 ing ‘‘2001, 2002, and 2003’’; and 

7 (2) in subsection (f)— 

8 (A) in paragraph (1)(B), by inserting 

9 ‘‘through 2012’’ after ‘‘of such succeeding 

10 year’’ ; and 

11 (B) in paragraph (2), by inserting ‘‘and 

12 ending with 2012’’ after ‘‘beginning with 

13 2000’’. 

14 (b) STABILIZING 2013 PAYMENT RATES AT CUR15 RENT LEVEL.— 

16 (1) IN GENERAL.—Subsection (d) of section 

17 1848 of the Social Security Act (42 U.S.C. 1395w– 

18 4) is amended by adding at the end the following 

19 new paragraph: 

20 ‘‘(14) UPDATE FOR 2013.—In lieu of the update 

21 to the single conversion factor established in para22 graph (1)(C) that would otherwise apply for 2013, 

23 the update to the single conversion factor shall be 0 

24 percent for 2013.’’. 


tjames on DSK6SPTVN1PROD with BILLS
4 

•HR 5707 IH

1 (2) TECHNICAL AMENDMENT.—Effective for 

2 years beginning with 2013, section 1848(m)(7)(C)(i) 

3 of the Social Security Act (42 U.S.C. 1395w– 

4 4(m)(7)(C)(i)) is amended by inserting ‘‘, the pro5 gram of Osteopathic Continuous Certification of the 

6 American Osteopathic Association,’’ after ‘‘Special7 ties Maintenance of Certification program’’. 

8 (c) ESTABLISHMENT OF DIFFERENTIAL UPDATES

9 BEGINNING WITH 2014 TO PROMOTE ACCESS TO PRI10 MARY CARE SERVICES.— 

11 (1) ESTABLISHMENT OF SERVICE CAT12 EGORIES.—Subsection (j) of section 1848 of the So13 cial Security Act (42 U.S.C. 1395w–4) is amended 

14 by adding at the end the following new paragraphs: 

15 ‘‘(5) SERVICE CATEGORIES.— 

16 ‘‘(A) IN GENERAL.—For services furnished 

17 on or after January 1, 2014, each of the fol18 lowing categories of services shall be treated as 

19 a separate ‘service category’: 

20 ‘‘(i) PRIMARY CARE.—Primary care 

21 services (as defined in subparagraph (B)) 

22 furnished by a qualifying practitioner. 

23 ‘‘(ii) OTHER SERVICES.—Other physi24 cians’ services. 


tjames on DSK6SPTVN1PROD with BILLS
5 

•HR 5707 IH

1 ‘‘(B) PRIMARY CARE SERVICES.—In this 

2 subsection, the term ‘primary care services’ 

3 means services identified, as of April 1, 2012, 

4 with the following HCPCS codes (and as subse5 quently modified by the Secretary): 

6 ‘‘(i) OFFICE AND OUTPATIENT VIS7 ITS.—99201 through 99215. 

8 ‘‘(ii) HOSPITAL OBSERVATIONAL

9 SERVICES.—99217 through 99220. 

10 ‘‘(iii) HOSPITAL INPATIENT VISITS

11 SERVICES.—99221 through 99239. 

12 ‘‘(iv) NURSING HOME, DOMICILIARY, 

13 REST HOME OR CUSTODIAL CARE VISITS.— 

14 99304 through 99340. 

15 ‘‘(v) HOME SERVICE VISITS.—99341 

16 through 99350. 

17 ‘‘(vi) WELCOME TO MEDICARE

18 VISIT.—G0402. 

19 ‘‘(vii) ANNUAL WELLNESS VISITS.— 

20 G0438 and G0439. 

21 ‘‘(C) INCLUSION OF PREVENTIVE SERV22 ICES.—Such term also includes preventive serv23 ices described in section 1861(ddd)(3) and addi24 tional preventive services described in section 

25 1861(ddd)(1). 


tjames on DSK6SPTVN1PROD with BILLS
6 

•HR 5707 IH

1 ‘‘(D) INCLUSION OF ADDITIONAL SERV2 ICES.—Such term also includes services, such 

3 as care coordination services, telemedicine serv4 ices, non-face-to-face care management services, 

5 preparation and supervision of long-term care 

6 plans, home care plan oversight services, and 

7 similar services that the Secretary identifies, by 

8 regulation, as being similar to the services de9 scribed in subparagraph (B) or (C). 

10 ‘‘(6) QUALIFYING PRACTITIONER.—The term 

11 ‘qualifying practitioner’ means, with respect to the 

12 furnishing of primary care services, an individual— 

13 ‘‘(A) for whom primary care services has 

14 accounted for at least 60 percent of the allowed 

15 charges under this part (not counting any such 

16 charges attributable to in-office clinical labora17 tory services) in a prior period as determined by 

18 the Secretary; or 

19 ‘‘(B) who does not have claims under this 

20 part during such a prior period and whom the 

21 Secretary determines is likely to meet the re22 quirement of subparagraph (A) for the subse23 quent period.’’. 

24 (2) ESTABLISHMENT OF SEPARATE CONVER25 SION FACTORS FOR EACH SERVICE CATEGORY.—SecVerDate Mar 15 2010 01:07 May 13, 2012 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5707.IH H5707

tjames on DSK6SPTVN1PROD with BILLS
7 

•HR 5707 IH

1 tion 1848(d)(1) of the Social Security Act (42 

2 U.S.C. 1395w–4(d)(1)) is amended— 

3 (A) in subparagraph (A)— 

4 (i) by designating the sentence begin5 ning ‘‘The conversion factor’’ as clause (i) 

6 with the heading ‘‘APPLICATION OF SIN7 GLE CONVERSION FACTOR.—’’ and with 

8 appropriate indentation; 

9 (ii) by striking ‘‘The conversion fac10 tor’’ and inserting ‘‘Subject to clause (ii), 

11 the conversion factor’’; and 

12 (iii) by adding at the end the fol13 lowing new clause: 

14 ‘‘(ii) APPLICATION OF MULTIPLE CON15 VERSION FACTORS BEGINNING WITH

16 2014.— 

17 ‘‘(I) IN GENERAL.—In applying 

18 clause (i) for each year beginning with 

19 2014, separate conversion factors 

20 shall be established for each service 

21 category of physicians’ services (as de22 fined in subsection (j)(5)(A)) and any 

23 reference in this section to a conver24 sion factor for such years shall be 


tjames on DSK6SPTVN1PROD with BILLS
8 

•HR 5707 IH

1 deemed a reference to the conversion 

2 factor for each of such categories. 

3 ‘‘(II) INITIAL CONVERSION FAC4 TORS.—Such factors for 2014 shall be 

5 based upon the single conversion fac6 tor for the previous year multiplied by 

7 the update established under para8 graph (15) for such category for 

9 2014. 

10 ‘‘(III) UPDATING OF CONVER11 SION FACTORS.—Such factor for a 

12 service category for a subsequent year 

13 shall be based upon the conversion 

14 factor for such category for the pre15 vious year and adjusted by the update 

16 established for such category under 

17 paragraph (15) or a subsequent para18 graph for the year involved.’’; and 

19 (B) in subparagraph (D), by striking 

20 ‘‘other physicians’ services’’ and inserting ‘‘for 

21 physicians’ services in the service category de22 scribed in subsection (j)(5)(A)(ii))’’. 

23 (3) ESTABLISHMENT OF SEPARATE UPDATES

24 FOR CONVERSION FACTORS FOR EACH SERVICE CAT25 EGORY.—Section 1848(d) of the Social Security Act 


tjames on DSK6SPTVN1PROD with BILLS
9 

•HR 5707 IH

1 (42 U.S.C. 1395w–4(d)), as amended by subsection 

2 (b), is amended by adding at the end the following 

3 new paragraph: 

4 ‘‘(15) UPDATES BY SERVICE CATEGORY BEGIN5 NING WITH 2014; UPDATES FOR 2014 THROUGH

6 2017.—In applying paragraph (4) for each year be7 ginning with 2014, the following rules apply: 

8 ‘‘(A) APPLICATION OF SEPARATE UPDATE

9 ADJUSTMENTS FOR EACH SERVICE CAT10 EGORY.—Pursuant to paragraph (1)(A)(ii)(I), 

11 for each year beginning with 2013, the update 

12 shall be made to the conversion factor for each 

13 service category (as defined in subsection 

14 (j)(5)(A)). 

15 ‘‘(B) UPDATES FOR 2014 THROUGH 2017.— 

16 The updates for 2014, 2015, 2016, and 2017 

17 for the conversion factor for the services cat18 egory described in— 

19 ‘‘(i) subsection (j)(5)(A)(i) shall be 

20 2.5 percent; and 

21 ‘‘(ii) subsection (j)(5)(A)(ii) shall be 

22 0.5 percent.’’. 

23 (d) PROMOTING TESTING AND EVALUATION OF NEW

24 PAYMENT AND DELIVERY MODELS (PHASE I).— 


tjames on DSK6SPTVN1PROD with BILLS
10 

•HR 5707 IH

1 (1) EXPANSION OF TESTING IN MULTIPLE GEO2 GRAPHIC REGIONS.—Section 1115A(a)(5) of the So3 cial Security Act (42 U.S.C. 1315a(a)(5)) is amend4 ed by inserting before the period at the end the fol5 lowing: ‘‘, but shall (to the maximum extent feasible) 

6 including testing of each such model in geographic 

7 areas in at least 3 regions’’. 

8 (2) INCLUSION OF PHYSICIAN IMPLEMENTA9 TION COSTS IN EVALUATIONS.—Section 

10 1115A(b)(4)(A) of the Social Security Act (42 

11 U.S.C. 1315a(b)(4)(A)) is amended— 

12 (A) by striking ‘‘and’’ at the end of clause 

13 (i); 

14 (B) by striking the period at the end of 

15 clause (ii) and inserting ‘‘; and’’; and 

16 (C) by adding at the end the following new 

17 clause: 

18 ‘‘(iii) the average cost, per physician, 

19 of implementation of the model.’’. 

20 (3) ACCELERATING TESTING AND EVALUATION

21 PROCESS.—Section 1115A(b) of the Social Security 

22 Act (42 U.S.C. 1315a(b)) is amended by adding at 

23 the end the following new paragraph: 

24 ‘‘(5) TIMING.—The Secretary, acting through 

25 the Center, shall conduct activities under this subVerDate Mar 15 2010 01:07 May 13, 2012 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5707.IH H5707

tjames on DSK6SPTVN1PROD with BILLS
11 

•HR 5707 IH

1 section in such a timely manner so that evaluations 

2 of initial models can be initially completed so that 

3 physicians can begin to transition to implementation 

4 of such models beginning not later than January 1, 

5 2017.’’. 

6 (4) INVOLVEMENT OF PROVIDER GROUPS IN SE7 LECTION OF MODELS.—Section 1115A(b)(4) of such 

8 Act is amended by adding at the end the following 

9 subparagraph: 

10 ‘‘(D) INVOLVEMENT OF PROVIDER GROUPS

11 IN MODEL SELECTION.—The Secretary shall 

12 consult and work closely with physician and 

13 other provider groups in the selection of models 

14 under this subsection and subsection (c).’’. 

15 (5) USE OF OTHER MODELS.—Section 1115A 

16 of such Act is further amended— 

17 (A) by adding at the end of subsection 

18 (b)(4) the following new subparagraph: 

19 ‘‘(E) USE OF OTHER MODELS.—Nothing 

20 in this section shall be construed as preventing 

21 the Secretary from selecting, for expansion 

22 under subsection (c), a model that was not test23 ed under this subsection.’’; and 

24 (B) in subsection (c), by inserting ‘‘or 

25 other model’’ after ‘‘section 1866C’’. 


tjames on DSK6SPTVN1PROD with BILLS
12 

•HR 5707 IH

1 (6) GAO REVIEW AND STUDY.—The Comp2 troller General of the United States shall conduct a 

3 study of the evaluations made under subsection (b) 

4 of section 1115A of the Social Security Act, as 

5 amended by this section. Such study shall include an 

6 analysis of the alternative payment and delivery 

7 models identified under such section for payment for 

8 physicians’ services (and other services) under the 

9 Medicare program. Not later than April 1, 2016, the 

10 Comptroller General shall submit a report to Con11 gress on such study and shall include in the report 

12 such recommendations as the Comptroller General 

13 deems appropriate for— 

14 (A) changes in the development and imple15 mentation process under such section; and 

16 (B) alternative payment and delivery mod17 els identified under such section as being appro18 priate for expansion under subsection (c) of 

19 such section. 

20 (7) PUBLICATION OF LIST OF SUCCESSFUL

21 MODELS.—Beginning on October 1, 2016, and each 

22 year thereafter, the Secretary of Health and Human 

23 Services shall publicly release a comprehensive list of 

24 such health care delivery and payment models identi25 fied, under section 1115A of the Social Security Act 


tjames on DSK6SPTVN1PROD with BILLS
13 

•HR 5707 IH

1 or otherwise, as meeting (or likely to meet) the re2 quirements of subsection (c)(1) of such section. Such 

3 list shall include at least 4 health care delivery and 

4 payment models and may include models not tested 

5 under subsection (b) of such section. 

6 (8) CONSIDERATIONS.—The Comptroller Gen7 eral in making recommendations under paragraph 

8 (6) and the Secretary in releasing the list of models 

9 under paragraph (7) shall take into account vari10 ations among providers in size, specialty mix, case 

11 mix, and patient demographics, as well as regional 

12 health care infrastructure variations and variations 

13 in cost of living among areas, and shall specifically 

14 consider appropriate variations that take into ac15 count the special circumstances of providers in rural 

16 and other underserved areas. 

17 (e) IMPLEMENTATION OF PAYMENT AND DELIVERY

18 MODEL OPTIONS (PHASE II).— 

19 (1) IN GENERAL.—Based on the report of the 

20 Comptroller General under subsection (d)(4) and not 

21 later than October 1, 2016, the Secretary of Health 

22 and Human Services shall provide information to 

23 physicians, nurse practitioners, group practices and 

24 institutions employing Medicare part B providers on 

25 how best to transition to alternative health care deVerDate Mar 15 2010 01:07 May 13, 2012 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H5707.IH H5707

tjames on DSK6SPTVN1PROD with BILLS
14 

•HR 5707 IH

1 livery and payment models that are aimed at im2 proving the coordination, quality and efficiency of 

3 health care, including those developed under section 

4 1115A or 1866E of the Social Security Act (42 

5 U.S.C. 1315a, 1395cc–5). 

6 (2) INCREASING FLEXIBILITY IN IMPLEMENTA7 TION.—Section 1115A(c) of the Social Security Act 

8 (42 U.S.C. 1315a(c)) is amended by inserting after 

9 ‘‘through rulemaking’’ the following: ‘‘(which may 

10 include the issuance of interim, final rules) or 

11 through publication of a directive or other guid12 ance’’. 

13 (3) TIMING.—Such section is further amended 

14 by adding at the end the following: ‘‘The Secretary 

15 shall seek to effect such expansion to the maximum 

16 extent feasible so that physicians may begin to tran17 sition to implementation of such models beginning 

18 not later than January 1, 2017.’’. 

19 (f) TRANSITION DURING 2018.— 

20 (1) FREEZE IN FEE SCHEDULE FOR 2018.— 

21 Subsection (d) of section 1848 of the Social Security 

22 Act (42 U.S.C. 1395w–4), as amended by sub23 sections (b) and (c)(3), is amended by adding at the 

24 end the following new paragraph: 


tjames on DSK6SPTVN1PROD with BILLS
15 

•HR 5707 IH

1 ‘‘(15) UPDATE FOR 2018.—The update to both 

2 of the conversion factors for 2018 shall be 0 per3 cent.’’. 

4 (2) EXPANDED ASSISTANCE THROUGH RE5 GIONAL EXTENSION CENTERS AND OTHER QUALI6 FIED ENTITIES.—Section 1115A(d) of the Social Se7 curity Act (42 U.S.C. 1315a(d)) is amended by add8 ing at the end the following new paragraph: 

9 ‘‘(4) ASSISTANCE IN IMPLEMENTATION.— 

10 ‘‘(A) IN GENERAL.—Using funds available 

11 under subsection (f)(1) and consistent with this 

12 paragraph, the Secretary shall enter into con13 tracts and agreements with regional extension 

14 centers, in coordination with the National Coor15 dinator for Health Information Technology, and 

16 other appropriate entities to provide guidance 

17 and assistance on how physicians may transi18 tion to implementation of alternative health 

19 care delivery models identified as representing 

20 best practices under this section. 

21 ‘‘(B) DEDICATED FUNDING.— 

22 ‘‘(i) IN GENERAL.—Of the amounts 

23 available under subsection (f)(1)(B), the 

24 Secretary shall make $720,000,000 avail25 able to the Office of the National CoordiVerDate Mar 15 2010 01:07 May 13, 2012 Jkt 019200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5707.IH H5707

tjames on DSK6SPTVN1PROD with BILLS
16 

•HR 5707 IH

1 nator for Health Information Technology 

2 for the awarding of grants and incentive 

3 payments under a competitive process to 

4 regional extension centers (receiving fund5 ing under section 3012(c) of the Public 

6 Health Service Act) and other qualified en7 tities for activities described in subpara8 graph (A). Such grants and payments shall 

9 not be available for assistance after De10 cember 31, 2018. 

11 ‘‘(ii) PROCESS.—Under clause (i), the 

12 Office shall— 

13 ‘‘(I) establish a competitive selec14 tion process for the selection of re15 gional extension centers (and other 

16 qualified entities) in the third quarter 

17 of 2014; and 

18 ‘‘(II) provide for the initial dis19 tribution of funds to such centers and 

20 entities by January 1, 2015. 

21 ‘‘(iii) COLLABORATION.—The Center 

22 shall collaborate with the Office in pro23 viding direction to such centers and enti24 ties in conducting activities under this 

25 paragraph, including the development of 


tjames on DSK6SPTVN1PROD with BILLS
17 

•HR 5707 IH

1 performance benchmarks based on provider 

2 participation and progress toward integra3 tion. 

4 ‘‘(iv) PRIORITY.—The grants and in5 centive payments under this subparagraph 

6 shall be directed to target assistance to 

7 solo and small specialty practices as well as 

8 community health centers and similar pro9 viders of primary care services.’’. 

10 (g) CONTINUING INCENTIVES FOR PHYSICIANS PRO11 VIDING HIGH-QUALITY, HIGH-VALUE CARE.— 

12 (1) FEE SCHEDULE ADJUSTMENTS.—Sub13 section (d) of section 1848 of the Social Security Act 

14 (42 U.S.C. 1395w–4), as amended by subsections 

15 (b), (c)(3), and (f), is amended by adding at the end 

16 the following: 

17 ‘‘(17) UPDATES FOR 2019 THROUGH 2022.— 

18 ‘‘(A) IN GENERAL.—Except as provided in 

19 this paragraph, the update to each of the con20 version factors— 

21 ‘‘(i) for 2019 shall be minus 2 per22 cent; 

23 ‘‘(ii) for 2020 shall be minus 3 per24 cent; 


tjames on DSK6SPTVN1PROD with BILLS
18 

•HR 5707 IH

1 ‘‘(iii) for 2021 shall be minus 4 per2 cent; and 

3 ‘‘(iv) for 2022 shall be minus 5 per4 cent. 

5 ‘‘(B) TREATMENT OF SERVICES PAID

6 USING ALTERNATIVE PAYMENT AND DELIVERY

7 MODELS.—In the case of physicians’ services 

8 for which payment is covered under an alter9 native payment and delivery model, such as 

10 those implemented under section 1115A, sub11 paragraph (A) does not apply. 

12 ‘‘(C) GENERAL EXEMPTION.—The Sec13 retary shall, by regulation, exempt a provider 

14 from the application of the negative payment 

15 update specified in subparagraph (A) for a year 

16 if the Secretary determines that— 

17 ‘‘(i) the provider— 

18 ‘‘(I) is a meaningful EHR user 

19 (as determined under subsection 

20 (o)(2) with respect to the year); and 

21 ‘‘(II) meets the qualifications 

22 under subparagraph (B) of subsection 

23 (m)(7) (relating to additional incen24 tive payments) for an additional in25 centive payment under subparagraph 


tjames on DSK6SPTVN1PROD with BILLS
19 

•HR 5707 IH

1 (A) of such subsection (which includes 

2 satisfactory participation in the qual3 ity reporting system and participation 

4 in an approved Maintenance of Cer5 tification program); or 

6 ‘‘(ii) the payment modifier for the 

7 provider under subsection (p), which is 

8 based upon the performance of the pro9 vider on measures of quality of care fur10 nished compared to cost and which is ex11 pressed as a percentage of payment, is 

12 within the top 25 percent of such payment 

13 modifiers for providers within the same fee 

14 schedule area, as determined by the Sec15 retary. 

16 ‘‘(D) CASE-BY-CASE HARDSHIP EXEMP17 TION.—The Secretary may, on a case-by-case 

18 basis, exempt a provider from the application of 

19 the negative payment update specified in sub20 paragraph (A) for a year if the Secretary deter21 mines, subject to annual renewal, that because 

22 of limitations in the nature of a medical prac23 tice, limitations in the number of Medicare 

24 beneficiaries that may be served by the pro25 vider, or other special circumstances, imposing 


tjames on DSK6SPTVN1PROD with BILLS
20 

•HR 5707 IH

1 a financial disincentive under such subpara2 graph for failure to adopt an alternative pay3 ment and delivery model referred to in subpara4 graph (B) would result in a significant hardship 

5 to the provider. 

6 ‘‘(18) UPDATES BEGINNING WITH 2023.— 

7 ‘‘(A) IN GENERAL.—The update to both of 

8 the conversion factors for each year beginning 

9 with 2023 shall be 0 percent. 

10 ‘‘(B) TREATMENT OF SERVICES PAID

11 USING ALTERNATIVE PAYMENT AND DELIVERY

12 MODELS.—In the case of physicians’ services 

13 for which payment is covered under an alter14 native payment and delivery model, such as 

15 those implemented under section 1115A, sub16 paragraph (A) does not apply.’’. 

17 (2) CONSIDERATIONS IN PROMULGATING

18 GROWTH RATES FOR ALTERNATIVE PAYMENT AND

19 DELIVERY MODELS.— 

20 (A) IN GENERAL.—In determining the 

21 growth rates to be recognized beginning with 

22 2019 for alternative payment and delivery mod23 els under the Medicare program that cover phy24 sicians’ services, such as those implemented 

25 under section 1115A of the Social Security Act, 


tjames on DSK6SPTVN1PROD with BILLS
21 

•HR 5707 IH

1 the Secretary of Health and Human Services 

2 shall consider (among other factors) the fol3 lowing: 

4 (i) Ensuring access to primary care 

5 and specialty services, including participa6 tion of primary care practitioners and spe7 cialists and newly graduating practitioners. 

8 (ii) Restraining spending growth. 

9 (iii) Ensuring access to services for 

10 vulnerable populations. 

11 (B) LIMITATIONS.—In no case shall the 

12 growth factor determined under this paragraph 

13 for a year— 

14 (i) be less than 1 percent; or 

15 (ii) be greater than the percentage in16 crease in the MEI (as defined in section 

17 1842(i)(3) of the Social Security Act, 42 

18 U.S.C. 1395u(i)(3)) for such year. 

19 (C) APPLICATION OF CONGRESSIONAL RE20 VIEW ACT.—Chapter 8 of title 5, United States 

21 Code, applies with respect to the promulgation 

22 of a growth factor under this paragraph for a 

23 year. 

24 (h) IMPACT REPORT.—Not later than January 1, 

25 2022, the Secretary of Health and Human Services shall 


tjames on DSK6SPTVN1PROD with BILLS
22 

•HR 5707 IH

1 submit to Congress a report the impact on spending and 

2 on access to services under title XVIII of the Social Secu3 rity Act, including under part A of such title, resulting 

4 from changes to Medicare delivery and payment systems, 

5 including under the amendments made by this section. 

6 SEC. 3. SAVINGS FROM OVERSEAS CONTINGENCY AND RE7 LATED ACTIVITIES. 

8 (a) IN GENERAL.—Section 251(b)(2) of the Balanced 

9 Budget and Emergency Deficit Control Act of 1985 (2 

10 U.S.C. 901(b)(2)) is amended by adding at the end the 

11 following new subparagraph: 

12 ‘‘(E) OVERSEAS CONTINGENCY AND RE13 LATED ACTIVITIES.— 

14 ‘‘(i) CAP ADJUSTMENT.—If a bill or 

15 joint resolution making appropriations for 

16 a fiscal year is enacted that specifies an 

17 amount for overseas contingency and re18 lated activities for that fiscal year after 

19 taking into account any other bills or joint 

20 resolutions enacted for that fiscal year that 

21 specify an amount for overseas contingency 

22 and related activities, but do not exceed in 

23 the aggregate the amounts specified in 

24 clause (ii), then the adjustments for that 

25 fiscal year shall be the additional new 


tjames on DSK6SPTVN1PROD with BILLS
23 

•HR 5707 IH

1 budget authority provided in that Act for 

2 such activities for that fiscal year. 

3 ‘‘(ii) LEVELS.—The levels for overseas 

4 contingency and related activities specified 

5 in this subparagraph are as follows: 

6 ‘‘(I) For fiscal year 2013, 

7 $83,000,000,000 in budget authority. 

8 ‘‘(II) For fiscal year 2014, 

9 $50,000,000,000 in budget authority. 

10 ‘‘(III) For fiscal year 2015, 

11 $50,000,000,000 in budget authority. 

12 ‘‘(IV) For fiscal year 2016, 

13 $50,000,000,000 in budget authority. 

14 ‘‘(V) For fiscal year 2017, 

15 $50,000,000,000 in budget authority. 

16 ‘‘(VI) For fiscal year 2018, 

17 $50,000,000,000 in budget authority. 

18 ‘‘(VII) For fiscal year 2019, 

19 $50,000,000,000 in budget authority. 

20 ‘‘(VIII) For fiscal year 2020, 

21 $50,000,000,000 in budget authority. 

22 ‘‘(IX) For fiscal year 2021, 

23 $50,000,000,000 in budget author24 ity.’’. 


tjames on DSK6SPTVN1PROD with BILLS
24 

•HR 5707 IH

1 (b) BREACH.—Section 251(a)(2) of such Act (2 

2 U.S.C. 901(a)(2)) is amended to read as follows: 

3 ‘‘(2) ELIMINATING A BREACH.— 

4 ‘‘(A) IN GENERAL.—Each non-exempt ac5 count within a category shall be reduced by a 

6 dollar amount calculated by multiplying the en7 acted level of sequestrable budgetary resources 

8 in that account by the uniform percentage nec9 essary to eliminate a breach within that cat10 egory. 

11 ‘‘(B) OVERSEAS CONTINGENCIES.—Any 

12 amount of budget authority for overseas contin13 gency operations and related activities for fiscal 

14 years 2013 through 2021 in excess of the levels 

15 set in subsection 251(b)(2)(E) shall be counted 

16 in determining whether a breach has occurred 

17 in the security category and the nonsecurity 

18 category on a proportional basis to the total 

19 spending for overseas contingency operations in 

20 the security category and the nonsecurity cat21 egory.’’. 

22 (c) CONFORMING AMENDMENT.—Section 

23 251(b)(2)(A) of such Act (2 U.S.C. 901(b)(2)(A)) is 

24 amended to read as follows: 


tjames on DSK6SPTVN1PROD with BILLS
25 

•HR 5707 IH

1 ‘‘(A) EMERGENCY APPROPRIATIONS.—If, 

2 for any fiscal year, appropriations for discre3 tionary accounts are enacted that the Congress 

4 designates as emergency requirements in stat5 ute on an account by account basis and the 

6 President subsequently so designates, the ad7 justment shall be the total of such appropria8 tions in discretionary accounts designated as 

9 emergency requirements.’’. 

Æ 


tjames on DSK6SPTVN1PROD with BILLS