II 

115TH CONGRESS 

1ST SESSION S. 1825 

To amend title XVIII of the Social Security Act to improve the accuracy 

of geographic adjustment factors under the Medicare program and to 

permanently extend certain adjustments to such factors for certain localities, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 18, 2017 

Mr. GRASSLEY (for himself, Ms. BALDWIN, Mrs. ERNST, and Mr. JOHNSON) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to improve 

the accuracy of geographic adjustment factors under the 

Medicare program and to permanently extend certain 

adjustments to such factors for certain localities, 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, 

3 SECTION 1. IMPROVING THE ACCURACY OF GEOGRAPHIC 

4 ADJUSTMENT FACTORS. 

5 Section 1848(e)(1)(D) of the Social Security Act (42 

6 U.S.C. 1395w–4(e)(1)(D)) is amended to read as follows: 

7 ‘‘(D) USE OF ACCURATE DATA.— 


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1 ‘‘(i) IN GENERAL.—In establishing in2 dices and index values under this para3 graph, the Secretary shall use the most re4 cent data available relating to practice ex5 penses, malpractice expenses, and physi6 cian work effort in each fee schedule area. 

7 ‘‘(ii) PRACTICE EXPENSE AND WORK

8 INDICES.—In establishing indices and 

9 index values under clause (i) or (iii) of 

10 subparagraph (A), the Secretary shall— 

11 ‘‘(I) use the most recent market 

12 data available on physician wages, or 

13 if available, actual cost data for physi14 cian labor; and 

15 ‘‘(II) not use nonphysician pro16 fessional wage data as a proxy for 

17 physician wage data. 

18 ‘‘(iii) PRACTICE EXPENSE CALCULA19 TION.—In calculating index values under 

20 clause (i) of subparagraph (A), the Sec21 retary shall use the most recent office rent 

22 data available or data from Federally 

23 qualified health centers (as defined in sec24 tion 1861(aa)(4)) expense reports.’’. 


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1 SEC. 2. FLOOR FOR WORK AND PRACTICE EXPENSE GEO2 GRAPHIC INDICES FOR SERVICES FUR3 NISHED IN WISCONSIN AND IOWA. 

4 (a) WORK GEOGRAPHIC INDEX.—Section 

5 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 

6 1395w–4(e)(1)(D)) is amended to read as follows: 

7 ‘‘(E) FLOOR AT 1.0 ON WORK GEOGRAPHIC

8 INDEX.— 

9 ‘‘(i) FOR 2004 THROUGH 2017.—After 

10 calculating the work geographic index in 

11 subparagraph (A)(iii), for purposes of pay12 ment for services furnished on or after 

13 January 1, 2004, and before January 1, 

14 2018, the Secretary shall increase the work 

15 geographic index to 1.00 for any locality 

16 for which such work geographic index is 

17 less than 1.00. 

18 ‘‘(ii) FOR 2018 AND SUBSEQUENT

19 YEARS.—After calculating the work geo20 graphic index in subparagraph (A)(iii), for 

21 purposes of payment for services furnished 

22 in Wisconsin or Iowa on or after January 

23 1, 2018, the Secretary shall increase any 

24 such index to 1.00 if such index would oth25 erwise be less than 1.00.’’. 


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1 (b) PRACTICE EXPENSE GEOGRAPHIC INDICES.— 

2 Section 1848(e)(1) of the Social Security Act (42 U.S.C. 

3 1395w–4(e)(1)) is amended— 

4 (1) in subparagraph (A), by striking ‘‘(B), (C), 

5 (E), (G), (H), and (I)’’ and inserting ‘‘(B), (C), (E), 

6 (G), (H), (I), and (J)’’; and 

7 (2) by adding at the end the following new sub8 paragraph: 

9 ‘‘(J) FLOOR FOR PRACTICE EXPENSE GEO10 GRAPHIC INDICES FOR SERVICES FURNISHED IN

11 WISCONSIN OR IOWA.—For purposes of pay12 ment for services furnished in Wisconsin or 

13 Iowa on or after January 1, 2018, after calcu14 lating the practice expense index in subpara15 graph (A)(i), the Secretary shall increase any 

16 such index to 1.00 if such index would other17 wise be less that 1.00.’’. 

Æ 


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