```

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6545 Introduced in House (IH)]

<DOC>

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. 
   Cardenas, 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.

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

SECTION 1. SHORT TITLE.

    This Act may be referred to as the ``Physician Fee Schedule Update 
and Improvements Act''.

SEC. 2. EXTENDING FLOOR FOR WORK GEOGRAPHIC INDEX.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``January 20, 2024'' and inserting 
``January 1, 2025''.

SEC. 3. INCREASING SUPPORT FOR PHYSICIANS AND OTHER PRACTITIONERS IN 
              ADJUSTING TO MEDICARE PAYMENT CHANGES.

    Section 1848(t)(1)(D) of the Social Security Act (42 U.S.C. 1395w-
4(t)(1)(D)) is amended by striking ``1.25 percent'' and inserting ``3 
percent''.

SEC. 4. EXTENDING INCENTIVE PAYMENTS FOR PARTICIPATION IN ELIGIBLE 
              ALTERNATIVE PAYMENT MODELS.

    (a) In General.--Section 1833(z) of the Social Security Act (42 
U.S.C. 1395l(z)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)--
                            (i) by striking ``In the case'' and 
                        inserting ``Subject to subparagraph (E), in the 
                        case'';
                            (ii) by striking ``ending with 2025'' and 
                        inserting ``ending with 2026''; and
                            (iii) by inserting ``and 2026'' after 
                        ``with respect to 2025''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(E) Special payment rule for 2026.--
                            ``(i) In general.--Subject to clause (ii), 
                        with respect to an amount payable under 
                        subparagraph (A) for 2026 to an eligible 
                        professional who is a qualifying APM 
                        participant for such year, such amount shall be 
                        reduced, in the case such participant has 
                        received payment under such subparagraph--
                                    ``(I) for at least 4 years but 
                                fewer than 7 years, by 34 percent; or
                                    ``(II) for 7 years, by 67 percent.
                            ``(ii) Exception.--If an eligible 
                        professional described in clause (i) increased 
                        such professional's financial risk (as 
                        specified by the Secretary) with respect to the 
                        furnishing of items and services during the 
                        most recent period for which data are available 
                        (which may be less than a year) for 2026 as 
                        compared to such professional's financial risk 
                        with respect to the furnishing of such items 
                        and services during the most recent period for 
                        which data were available (which may be less 
                        than a year) for 2025, the Secretary may reduce 
                        the amount payable under subparagraph (A) for 
                        2026 to such professional by a percentage that 
                        is less than the percentage otherwise 
                        applicable to such amount under clause (i) (and 
                        which may include 0 percent).'';
            (2) in paragraph (2)--
                    (A) in subparagraph (B)--
                            (i) in the subparagraph heading, by 
                        striking ``2025'' and inserting ``2026''; and
                            (ii) in the matter preceding clause (i), by 
                        striking ``2025'' and inserting ``2026'';
                    (B) in subparagraph (C)--
                            (i) in the subparagraph heading, by 
                        striking ``2026'' and inserting ``2027''; and
                            (ii) in the matter preceding clause (i), by 
                        striking ``2026'' and inserting ``2027''; and
                    (C) in subparagraph (D), by striking ``2024, and 
                2025'' and inserting ``2024, 2025, and 2026''; and
            (3) in paragraph (4)(B), by striking ``2025'' and inserting 
        ``2025 and 2026''.
    (b) Conforming Amendments.--Section 1848(q)(1)(C)(iii) of the 
Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(iii) is amended--
            (1) in subclause (II), by striking ``2025'' and inserting 
        ``2026''; and
            (2) in subclause (III), by striking ``2026'' and inserting 
        ``2027''.

SEC. 5. UPDATING THE BUDGET NEUTRALITY THRESHOLD.

    Section 1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C. 
1395w-4(c)(2)(B)(ii)(II)) is amended--
            (1) by striking ``Subject to'' and inserting the following:
                                            ``(aa) In general.--Subject 
                                        to'';
            (2) in item (aa), as inserted by subparagraph (A), by 
        striking ``$20,000,000'' and inserting ``the amount specified 
        in item (bb) for such year''; and
            (3) by adding at the end the following new items:
                                            ``(bb) Amount specified.--
                                        For purposes of item (aa), 
                                        subject to item (cc), the 
                                        amount specified in this item 
                                        is--

                                                    ``(AA) for years 
                                                before 2025, 
                                                $20,000,000;

                                                    ``(BB) for 2025, 
                                                $53,000,000; and

                                                    ``(CC) for 2026 and 
                                                each subsequent year, 
                                                the amount specified in 
                                                this item for the 
                                                preceding year.

                                            ``(cc) Indexing limitation 
                                        on annual adjustments.--For 
                                        2030 and every subsequent fifth 
                                        year, the Secretary shall 
                                        increase the amount specified 
                                        in item (bb) for such year by 
                                        the cumulative increase in the 
                                        MEI (as defined in section 
                                        1842(i)(3)) applicable to 
                                        physicians' services over the 
                                        5-year period ending on the 
                                        last day of the preceding 
                                        year.''.

SEC. 6. TIMELY UPDATES TO DIRECT COSTS USED TO CALCULATE PRACTICE 
              EXPENSE RVUS.

    Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)) is amended by adding at the end the following new clause:
                            ``(vii) Timely updates to direct costs used 
                        to calculate practice expense relative value 
                        units.--
                                    ``(I) Simultaneous updates to 
                                direct cost inputs at least once every 
                                5 years.--The Secretary shall, not less 
                                often than every 5 years, update the 
                                prices and rates, as applicable, for 
                                each of the direct costs inputs 
                                described in subclause (II) used in the 
                                methodology for calculating the 
                                practice expense relative value units 
                                under this subsection for physicians' 
                                services. Updates made pursuant to the 
                                previous sentence shall be made in the 
                                same year for all direct cost inputs 
                                described in such subclause.
                                    ``(II) Direct costs input 
                                categories described.--For purposes of 
                                this clause, the direct costs inputs 
                                described in this subclause are 
                                clinical staff wage rates, prices of 
                                medical supplies, and prices of 
                                equipment.
                                    ``(III) Consultation.--In making 
                                the updates under this clause, the 
                                Secretary shall consult with relevant 
                                stakeholders, including physician 
                                specialty societies.''.
                                 <all>
```