I 

118TH CONGRESS 

1ST SESSION H. R. 6545 

To amend title XVIII of the Social Security Act to make improvements 

to the physician fee schedule under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 1, 2023 

Mrs. MILLER-MEEKS (for herself, Mr. BUCSHON, Ms. SCHRIER, Ms. KELLY

of Illinois, Mr. BURGESS, Mr. MURPHY, Mr. WENSTRUP, Mr. BERA, Mr. 

CA ́RDENAS, and Mr. RUIZ) 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 amend title XVIII of the Social Security Act to make 

improvements 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 referred to as the ‘‘Physician Fee 

5 Schedule Update and Improvements Act’’. 


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1 SEC. 2. EXTENDING FLOOR FOR WORK GEOGRAPHIC 

2 INDEX. 

3 Section 1848(e)(1)(E) of the Social Security Act (42 

4 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu5 ary 20, 2024’’ and inserting ‘‘January 1, 2025’’. 

6 SEC. 3. INCREASING SUPPORT FOR PHYSICIANS AND 

7 OTHER PRACTITIONERS IN ADJUSTING TO 

8 MEDICARE PAYMENT CHANGES. 

9 Section 1848(t)(1)(D) of the Social Security Act (42 

10 U.S.C. 1395w–4(t)(1)(D)) is amended by striking ‘‘1.25 

11 percent’’ and inserting ‘‘3 percent’’. 

12 SEC. 4. EXTENDING INCENTIVE PAYMENTS FOR PARTICIPA13 TION IN ELIGIBLE ALTERNATIVE PAYMENT 

14 MODELS. 

15 (a) IN GENERAL.—Section 1833(z) of the Social Se16 curity Act (42 U.S.C. 1395l(z)) is amended— 

17 (1) in paragraph (1)— 

18 (A) in subparagraph (A)— 

19 (i) by striking ‘‘In the case’’ and in20 serting ‘‘Subject to subparagraph (E), in 

21 the case’’; 

22 (ii) by striking ‘‘ending with 2025’’ 

23 and inserting ‘‘ending with 2026’’; and 

24 (iii) by inserting ‘‘and 2026’’ after 

25 ‘‘with respect to 2025’’; and 


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1 (B) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(E) SPECIAL PAYMENT RULE FOR 2026.— 

4 ‘‘(i) IN GENERAL.—Subject to clause 

5 (ii), with respect to an amount payable 

6 under subparagraph (A) for 2026 to an eli7 gible professional who is a qualifying APM 

8 participant for such year, such amount 

9 shall be reduced, in the case such partici10 pant has received payment under such sub11 paragraph— 

12 ‘‘(I) for at least 4 years but 

13 fewer than 7 years, by 34 percent; or 

14 ‘‘(II) for 7 years, by 67 percent. 

15 ‘‘(ii) EXCEPTION.—If an eligible pro16 fessional described in clause (i) increased 

17 such professional’s financial risk (as speci18 fied by the Secretary) with respect to the 

19 furnishing of items and services during the 

20 most recent period for which data are 

21 available (which may be less than a year) 

22 for 2026 as compared to such profes23 sional’s financial risk with respect to the 

24 furnishing of such items and services dur25 ing the most recent period for which data 


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1 were available (which may be less than a 

2 year) for 2025, the Secretary may reduce 

3 the amount payable under subparagraph 

4 (A) for 2026 to such professional by a per5 centage that is less than the percentage 

6 otherwise applicable to such amount under 

7 clause (i) (and which may include 0 per8 cent).’’; 

9 (2) in paragraph (2)— 

10 (A) in subparagraph (B)— 

11 (i) in the subparagraph heading, by 

12 striking ‘‘2025’’ and inserting ‘‘2026’’; and 

13 (ii) in the matter preceding clause (i), 

14 by striking ‘‘2025’’ and inserting ‘‘2026’’; 

15 (B) in subparagraph (C)— 

16 (i) in the subparagraph heading, by 

17 striking ‘‘2026’’ and inserting ‘‘2027’’; and 

18 (ii) in the matter preceding clause (i), 

19 by striking ‘‘2026’’ and inserting ‘‘2027’’; 

20 and 

21 (C) in subparagraph (D), by striking 

22 ‘‘2024, and 2025’’ and inserting ‘‘2024, 2025, 

23 and 2026’’; and 

24 (3) in paragraph (4)(B), by striking ‘‘2025’’ 

25 and inserting ‘‘2025 and 2026’’. 


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1 (b) CONFORMING AMENDMENTS.—Section 

2 1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 

3 1395w–4(q)(1)(C)(iii) is amended— 

4 (1) in subclause (II), by striking ‘‘2025’’ and 

5 inserting ‘‘2026’’; and 

6 (2) in subclause (III), by striking ‘‘2026’’ and 

7 inserting ‘‘2027’’. 

8 SEC. 5. UPDATING THE BUDGET NEUTRALITY THRESHOLD. 

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

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

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

12 following: 

13 ‘‘(aa) IN GENERAL.—Sub14 ject to’’; 

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

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

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

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

19 items: 

20 ‘‘(bb) AMOUNT SPECI21 FIED.—For purposes of item 

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

23 amount specified in this item 

24 is— 


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1 ‘‘(AA) for years before 

2 2025, $20,000,000; 

3 ‘‘(BB) for 2025, 

4 $53,000,000; and 

5 ‘‘(CC) for 2026 and 

6 each subsequent year, the 

7 amount specified in this 

8 item for the preceding year. 

9 ‘‘(cc) INDEXING LIMITATION

10 ON ANNUAL ADJUSTMENTS.—For 

11 2030 and every subsequent fifth 

12 year, the Secretary shall increase 

13 the amount specified in item (bb) 

14 for such year by the cumulative 

15 increase in the MEI (as defined 

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

17 to physicians’ services over the 5- 

18 year period ending on the last 

19 day of the preceding year.’’. 

20 SEC. 6. TIMELY UPDATES TO DIRECT COSTS USED TO CAL21 CULATE PRACTICE EXPENSE RVUS. 

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

23 U.S.C. 1395w–4(c)(2)(B)) is amended by adding at the 

24 end the following new clause: 


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1 ‘‘(vii) TIMELY UPDATES TO DIRECT

2 COSTS USED TO CALCULATE PRACTICE EX3 PENSE RELATIVE VALUE UNITS.— 

4 ‘‘(I) SIMULTANEOUS UPDATES TO

5 DIRECT COST INPUTS AT LEAST ONCE

6 EVERY 5 YEARS.—The Secretary shall, 

7 not less often than every 5 years, up8 date the prices and rates, as applica9 ble, for each of the direct costs inputs 

10 described in subclause (II) used in the 

11 methodology for calculating the prac12 tice expense relative value units under 

13 this subsection for physicians’ serv14 ices. Updates made pursuant to the 

15 previous sentence shall be made in the 

16 same year for all direct cost inputs 

17 described in such subclause. 

18 ‘‘(II) DIRECT COSTS INPUT CAT19 EGORIES DESCRIBED.—For purposes 

20 of this clause, the direct costs inputs 

21 described in this subclause are clinical 

22 staff wage rates, prices of medical 

23 supplies, and prices of equipment. 

24 ‘‘(III) CONSULTATION.—In mak25 ing the updates under this clause, the 


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1 Secretary shall consult with relevant 

2 stakeholders, including physician spe3 cialty societies.’’. 

Æ 


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