I 

118TH CONGRESS 

1ST SESSION H. R. 6371 

To provide for certain adjustments to the physician fee schedule under the 

Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 13, 2023 

Mr. MURPHY (for himself, Mr. BURGESS, Mr. WENSTRUP, Ms. KELLY of Illinois, Mr. BUCSHON, Mr. VAN DREW, Mrs. MILLER-MEEKS, Mr. HARRIS, 

Mr. BABIN, Mr. JOYCE of Pennsylvania, Mr. JACKSON of Texas, Mr. 

MCCORMICK, Mr. FERGUSON, Mr. DUNN of Florida, and Mr. CARTER of 

Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, 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 provide for certain adjustments to the physician fee 

schedule under the Medicare program. 

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 ‘‘Provider Reimburse5 ment Stability Act of 2023’’. 


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1 SEC. 2. UPDATING THE BUDGET NEUTRALITY THRESHOLD. 

2 Section 1848(c)(2)(B)(ii)(II) of the Social Security 

3 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)(II)) is amended— 

4 (1) by striking ‘‘Subject to’’ and inserting the 

5 following: 

6 ‘‘(aa) IN GENERAL.—Sub7 ject to’’; 

8 (2) in item (aa), as inserted by subparagraph 

9 (A), by striking ‘‘$20,000,000’’ and inserting ‘‘the 

10 amount specified in item (bb) for such year’’; and 

11 (3) by adding at the end the following new 

12 items: 

13 ‘‘(bb) AMOUNT SPECI14 FIED.—For purposes of item 

15 (aa), subject to item (cc), the 

16 amount specified in this item 

17 is— 

18 ‘‘(AA) for years before 

19 2025, $20,000,000; 

20 ‘‘(BB) for 2025, 

21 $53,000,000; and 

22 ‘‘(CC) for 2026 and 

23 each subsequent year, the 

24 amount specified in this 

25 item for the preceding year. 


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1 ‘‘(cc) INDEXING LIMITATION

2 ON ANNUAL ADJUSTMENTS.—For 

3 2030 and every subsequent fifth 

4 year, the Secretary shall increase 

5 the amount specified in item (bb) 

6 for such year by the cumulative 

7 increase in the MEI (as defined 

8 in section 1842(i)(3)) applicable 

9 to physicians’ services over the 5- 

10 year period ending on the last 

11 day of the preceding year.’’. 

12 SEC. 3. BUDGET NEUTRALITY CORRECTIONS FOR OVER13 ESTIMATES AND UNDERESTIMATES IN UTILI14 ZATION. 

15 (a) IN GENERAL.—Section 1848(c)(2)(B) of the So16 cial Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is amend17 ed by adding at the end the following new clause: 

18 ‘‘(vii) BUDGET NEUTRALITY CORREC19 TIONS FOR OVERESTIMATES AND UNDER20 ESTIMATES IN UTILIZATION.— 

21 ‘‘(I) IN GENERAL.—In the case 

22 of a budget neutrality adjustment ap23 plied pursuant to clause (ii)(II) for an 

24 adjustment application year (as de25 fined in clause (viii)(I)) beginning 


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1 with 2025, with respect to an adjust2 ment to relative value units made 

3 under clause (ii)(I), that is deter4 mined using estimated utilization (as 

5 defined in clause (viii)(III))— 

6 ‘‘(aa) the Secretary shall, by 

7 not later than September 1 of the 

8 subsequent year— 

9 ‘‘(AA) compare such es10 timated utilization to actual 

11 utilization occurring during 

12 such adjustment application 

13 year with respect to the ad14 justment to the relative 

15 value units made under 

16 clause (ii)(I); and 

17 ‘‘(BB) if applicable, de18 termine the extent to which, 

19 if any, the difference be20 tween the estimated utiliza21 tion and such actual utiliza22 tion affected the amount of 

23 such budget neutrality ad24 justment applied for such 


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1 adjustment application year; 

2 and 

3 ‘‘(bb) in the case that the 

4 Secretary determines under sub5 clause (I)(bb) that the difference 

6 between the estimated utilization 

7 and such actual utilization af8 fected the amount of the budget 

9 neutrality adjustment applied for 

10 such adjustment application year, 

11 the Secretary shall adjust the 

12 amount of payment made under 

13 this section for services furnished 

14 during the adjustment correction 

15 period (as defined in clause 

16 (viii)(II)) with respect to such 

17 year by such amount as deter18 mined necessary by the Secretary 

19 to reconcile the difference (which 

20 may be positive or negative) be21 tween— 

22 ‘‘(AA) the budget neu23 trality adjustment that had 

24 been applied for such appli25 cation adjustment year, 


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1 using the estimated utiliza2 tion; and 

3 ‘‘(BB) the budget neu4 trality adjustment that 

5 would have been applied for 

6 such year if such adjustment 

7 had been calculated using 

8 such actual utilization. 

9 ‘‘(II) DEFINITIONS.—For pur10 poses of this clause: 

11 ‘‘(aa) ADJUSTMENT APPLI12 CATION YEAR.—The term ‘ad13 justment application year’ means, 

14 with respect to an adjustment to 

15 relative value units made under 

16 clause (ii)(I) for which a budget 

17 neutrality adjustment under 

18 clause (ii)(II) is required, the 

19 year for which such adjustments 

20 are applied. 

21 ‘‘(bb) ADJUSTMENT COR22 RECTION PERIOD.—The term 

23 ‘adjustment correction period’ 

24 means, with respect to an adjust25 ment application year, the second 


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1 year beginning after such adjust2 ment application year. 

3 ‘‘(cc) ESTIMATED UTILIZA4 TION.—The term ‘estimated utili5 zation’ means, with respect to an 

6 adjustment to relative value units 

7 made under clause (ii)(I), an es8 timate of utilization associated 

9 with such adjustment used for 

10 purposes of applying clause 

11 (ii)(II).’’. 

12 (b) NONAPPLICATION OF BUDGET NEUTRALITY TO

13 RECONCILIATION ADJUSTMENTS.—Section 1848(c)(2)(B) 

14 of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)) 

15 is amended— 

16 (1) in clause (iv)— 

17 (A) in subclause (V), by striking ‘‘and’’ at 

18 the end; 

19 (B) in subclause (VI), by striking the pe20 riod and inserting ‘‘; and’’; and 

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

22 subclause: 

23 ‘‘(VII) clause (vii)(I)(bb) for an 

24 adjustment correction period shall not 

25 be taken into account in applying 


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1 clause (ii)(II) with respect to such pe2 riod.’’; and 

3 (2) in clause (v), by adding at the end the fol4 lowing new subclause: 

5 ‘‘(XII) REDUCTIONS ATTRIB6 UTABLE TO AN ADJUSTMENT CORREC7 TION.—For an adjustment correction 

8 period, reduced expenditures attrib9 utable to application of clause 

10 (vii)(I)(bb) with respect to such pe11 riod.’’. 

12 SEC. 4. TIMELY UPDATES TO DIRECT COSTS USED TO CAL13 CULATE PRACTICE EXPENSE RVUS. 

14 Section 1848(c)(2)(B) of the Social Security Act (42 

15 U.S.C. 1395w–4(c)(2)(B)), as amended by section 3, is 

16 further amended by adding at the end the following new 

17 clause: 

18 ‘‘(viii) TIMELY UPDATES TO DIRECT

19 COSTS USED TO CALCULATE PRACTICE EX20 PENSE RELATIVE VALUE UNITS.— 

21 ‘‘(I) SIMULTANEOUS UPDATES TO

22 DIRECT COST INPUTS AT LEAST ONCE

23 EVERY 5 YEARS.—The Secretary shall, 

24 not less often than every 5 years, up25 date the prices and rates, as applicaVerDate Sep 11 2014 02:37 Nov 15, 2023 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6371.IH H6371

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1 ble, for each of the direct costs inputs 

2 described in subclause (II) used in the 

3 methodology for calculating the prac4 tice expense relative value units under 

5 this subsection for physicians’ serv6 ices. Updates made pursuant to the 

7 previous sentence shall be made in the 

8 same year for all direct cost inputs 

9 described in such subclause. 

10 ‘‘(II) DIRECT COSTS INPUT CAT11 EGORIES DESCRIBED.—For purposes 

12 of this clause, the direct costs inputs 

13 described in this subclause are clinical 

14 staff wage rates, prices of medical 

15 supplies, and prices of equipment. 

16 ‘‘(III) CONSULTATION.—In mak17 ing the updates under this clause, the 

18 Secretary shall consult with relevant 

19 stakeholders, including physician spe20 cialty societies.’’. 

21 SEC. 5. LIMITATION ON YEAR-TO-YEAR CONVERSION FAC22 TOR VARIANCE. 

23 Section 1848(c)(2)(B) of the Social Security Act (42 

24 U.S.C. 1395w–4(c)(2)(B)), as amended by sections 3 and 


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1 4, is further amended— by adding at the end the following 

2 new clause: 

3 ‘‘(ix) LIMITATION ON CONVERSION

4 FACTOR VARIANCE.— 

5 ‘‘(I) IN GENERAL.—In the case 

6 that application of clause (ii)(II) for a 

7 year (beginning with 2025) would re8 sult in a conversion factor established 

9 under subsection (d) for such year, 

10 not taking into account any adjust11 ment provided under such subsection, 

12 to vary by more than 2.5 percent com13 pared to such factor so established for 

14 the preceding year (in this subclause 

15 referred to as the ‘preceding year’s 

16 conversion factor’), the Secretary 

17 shall— 

18 ‘‘(aa) if such application 

19 would result in a decrease in 

20 such conversion factor, modify 

21 any budget neutrality adjustment 

22 applied to such conversion factor 

23 pursuant to such clause such 

24 that such conversion factor is de25 creased by 2.5 percent, not takVerDate Sep 11 2014 02:37 Nov 15, 2023 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6371.IH H6371

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1 ing into account any adjustment 

2 provided under such subsection, 

3 compared to the preceding year’s 

4 conversion factor; and 

5 ‘‘(bb) if such application 

6 would result in an increase in 

7 such conversion factor, modify 

8 any budget neutrality adjustment 

9 applied to such conversion factor 

10 pursuant to such clause such 

11 that such conversion factor is in12 creased by 2.5 percent, not tak13 ing into account any adjustment 

14 provided under such subsection, 

15 compared to the preceding year’s 

16 conversion factor. 

17 ‘‘(II) SPECIAL RULE FOR 2025.— 

18 In applying subclause (I) with respect 

19 to the conversion factor established 

20 under subsection (d) for 2025, in de21 termining whether the application of 

22 clause (ii)(II) for such year would re23 sult in such conversion factor varying 

24 by more than 2.5 percent compared to 

25 such factor so established for 2024, 


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1 the Secretary shall take into account 

2 the increase to such conversion factor 

3 so established for 2024 provided 

4 under subsection (t). 

5 ‘‘(III) CLARIFICATION RELATING

6 TO TRANSITION TO MULTIPLE CON7 VERSION FACTORS.—For 2026, in ap8 plying subclause (I) with respect to 

9 the qualifying APM conversion factor 

10 (as described in subsection (d)(1)(A)) 

11 and the nonqualifying APM conver12 sion factor (as so described) estab13 lished under subsection (d) for such 

14 year, each reference in such subclause 

15 to the ‘preceding year’s conversion 

16 factor’ shall be deemed to be a ref17 erence to ‘the single conversion factor 

18 (as described in subsection (d)(1)(A)) 

19 so established for 2025’.’’. 

Æ 


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