I 

109TH CONGRESS 

1ST SESSION H. R. 1627 

To amend title XVIII of the Social Security Act to provide geographic equity 

in fee-for-service reimbursement for providers under the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 13, 2005 

Mr. WU introduced the following bill; which was referred to the Committee 

on Ways and Means, and in addition to the Committee on Energy and 

Commerce, 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 provide 

geographic equity in fee-for-service reimbursement for 

providers 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 ‘‘Medicare Equity and 

5 Fairness in Fee-for-Service Reimbursement Act of 2005’’. 
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1 SEC. 2. IMPROVING FAIRNESS OF PAYMENTS TO PRO2 VIDERS UNDER THE MEDICARE FEE-FOR3 SERVICE PROGRAM. 

4 Title XVIII of the Social Security Act is amended by 

5 adding at the end the following new section: 

6 ‘‘IMPROVING FAIRNESS OF PAYMENTS UNDER THE

7 ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM

8 ‘‘SEC. 1898. (a) ESTABLISHMENT OF SYSTEM.—Not9 withstanding any other provision of law, the Secretary 

10 shall establish a system for making adjustments to the 

11 amount of payment made to providers of services and 

12 health care professionals for services provided under the 

13 original medicare fee-for-service program under parts A 

14 and B. 

15 ‘‘(b) SYSTEM REQUIREMENTS.— 

16 ‘‘(1) ADJUSTMENTS.—Under the system de17 scribed in subsection (a), the Secretary (beginning in 

18 fiscal year 2006 or calendar year 2006, as the Sec19 retary determines appropriate for the type of serv20 ices involved) shall make the following adjustments: 

21 ‘‘(A) STATES ABOVE NATIONAL AVER22 AGE.—Subject to subparagraph (C), if a State 

23 average per beneficiary amount, but for the ap24 plication of this section, for a year is greater 

25 than 100 percent of the national average per 

26 beneficiary amount for such year, then the Sec-
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1 retary shall reduce the amount of applicable 

2 payments in such a manner as will result (as 

3 estimated by the Secretary) in the State aver4 age per beneficiary amount for the subsequent 

5 year being at 100 percent of the national aver6 age per beneficiary amount for such subsequent 

7 year. 

8 ‘‘(B) STATES BELOW NATIONAL AVER9 AGE.—Subject to subparagraph (C), if such a 

10 State average per beneficiary amount for a year 

11 is less than 100 percent of the national average 

12 per beneficiary amount for such year, then the 

13 Secretary shall increase the amount of applica14 ble payments in such a manner as will result 

15 (as estimated by the Secretary) in the State av16 erage per beneficiary amount for the subse17 quent year being at 100 percent of the national 

18 average per beneficiary amount for such subse19 quent year. 

20 ‘‘(C) 3-YEAR PHASE IN.—In applying this 

21 paragraph for— 

22 ‘‘(i) fiscal year 2006 or calendar year 

23 2006, the amount of any increase or de24 crease under subparagraph (A) or (B) 
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1 shall be 25 percent of the amount of the 

2 increase or decrease otherwise provided; 

3 ‘‘(ii) fiscal year 2007 or calendar year 

4 2007, the amount of any increase or de5 crease under subparagraph (A) or (B) 

6 shall be 50 percent of the amount of the 

7 increase or decrease otherwise provided; 

8 and 

9 ‘‘(iii) fiscal year 2008 or calendar 

10 year 2008, the amount of any increase or 

11 decrease under subparagraph (A) or (B) 

12 shall be 75 percent of the amount of the 

13 increase or decrease otherwise provided. 

14 ‘‘(2) DETERMINATION OF AVERAGES.— 

15 ‘‘(A) STATE AVERAGE PER BENEFICIARY

16 AMOUNT.—Each year (beginning in 2005), the 

17 Secretary shall determine a State average per 

18 beneficiary amount for each State which shall 

19 be equal to the Secretary’s estimate of the aver20 age amount of expenditures under the original 

21 medicare fee-for-service program under parts A 

22 and B for the year for a beneficiary enrolled 

23 under such parts that resides in the State. 

24 ‘‘(B) NATIONAL AVERAGE PER BENE25 FICIARY AMOUNT.—Each year (beginning in 
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1 2005), the Secretary shall determine the na2 tional average per beneficiary amount which 

3 shall be equal to the average of the State aver4 age per beneficiary amounts determined under 

5 subparagraph (B) for the year. 

6 ‘‘(3) APPLICABLE PAYMENTS DEFINED.—In 

7 this section, the term ‘applicable payments’ means 

8 payments made to providers of services and health 

9 care professionals for services provided under the 

10 original medicare fee-for-service program under 

11 parts A and B to beneficiaries enrolled under such 

12 parts that reside in the State. 

13 ‘‘(c) BENEFICIARIES HELD HARMLESS.—The provi14 sions of this section shall not effect— 

15 ‘‘(1) the entitlement to items and services of a 

16 beneficiary under this title, including the scope of 

17 such items and services; or 

18 ‘‘(2) any liability of the beneficiary with respect 

19 to such items and services. 

20 ‘‘(d) REGULATIONS.—The Secretary, in consultation 

21 with the Medicare Payment Advisory Commission, shall 

22 promulgate regulations to carry out this section.’’. 

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