I 

113TH CONGRESS 

1ST SESSION H. R. 574 

To amend part B of title XVIII of the Social Security Act to reform Medicare 

payment for physicians’ services by eliminating the sustainable growth 

rate system and providing incentives for the adoption of innovative payment and delivery models to improve quality and efficiency. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 6, 2013 

Ms. SCHWARTZ (for herself, Mr. HECK of Nevada, Mr. BLUMENAUER, Mrs. 

CHRISTENSEN, Mr. CARNEY, Mr. COURTNEY, Mr. POLIS, Mr. FATTAH, 

and Ms. CASTOR of Florida) 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 part B of title XVIII of the Social Security 

Act to reform Medicare payment for physicians’ services 

by eliminating the sustainable growth rate system and 

providing incentives for the adoption of innovative payment and delivery models to improve quality and efficiency. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; PURPOSE. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Medicare Physician Payment Innovation Act of 2013’’. 

4 (b) PURPOSE.—The purpose of this Act is to reform 

5 the system of Medicare payment for physicians’ services— 

6 (1) by ending the application of the sustainable 

7 growth rate (SGR) system; 

8 (2) to stabilize payments for 2014; 

9 (3) to promote the rapid development and im10 plementation of alternative improved payment and 

11 delivery models that incentivize high quality, high12 value care; and 

13 (4) to provide continuing incentives for adop14 tion of such alternative payment and delivery models 

15 by physicians and other providers. 

16 SEC. 2. MEDICARE PHYSICIAN PAYMENT REFORM. 

17 (a) REPEAL OF SGR PAYMENT METHODOLOGY.— 

18 Section 1848 of the Social Security Act (42 U.S.C. 

19 1395w–4) is amended— 

20 (1) in subsection (d)— 

21 (A) in paragraph (1)(A), by inserting ‘‘or 

22 a subsequent paragraph’’ after ‘‘paragraph 

23 (4)’’; and 

24 (B) in paragraph (4)— 


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1 (i) in the heading, by striking ‘‘YEARS

2 BEGINNING WITH 2001’’ and inserting 

3 ‘‘2001, 2002, AND 2003’’; and 

4 (ii) in subparagraph (A), by striking 

5 ‘‘a year beginning with 2001’’ and insert6 ing ‘‘2001, 2002, and 2003’’; and 

7 (2) in subsection (f)— 

8 (A) in paragraph (1)(B), by inserting 

9 ‘‘through 2013’’ after ‘‘of such succeeding 

10 year’’; and 

11 (B) in paragraph (2), by inserting ‘‘and 

12 ending with 2013’’ after ‘‘beginning with 

13 2000’’. 

14 (b) STABILIZING 2014 PAYMENT RATES AT CUR15 RENT LEVEL.— 

16 (1) IN GENERAL.—Subsection (d) of section 

17 1848 of the Social Security Act (42 U.S.C. 1395w– 

18 4), as amended by section 601 of the American Tax19 payer Relief Act of 2012 (Public Law 112–240), is 

20 amended by adding at the end the following new 

21 paragraph: 

22 ‘‘(15) UPDATE FOR 2014.—In lieu of the update 

23 to the single conversion factor established in para24 graph (1)(C) that would otherwise apply for 2014, 


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1 the update to the single conversion factor shall be 0 

2 percent for 2014.’’. 

3 (2) TECHNICAL AMENDMENT.—Effective for 

4 years beginning with 2014, subparagraph (C)(i) of 

5 paragraph (7) of section 1848(m) of the Social Se6 curity Act (42 U.S.C. 1395w–4(m)(7)(C)(i); relating 

7 to additional incentive payment) is amended by in8 serting ‘‘, the program of Osteopathic Continuous 

9 Certification of the American Osteopathic Associa10 tion,’’ after ‘‘Specialties Maintenance of Certification 

11 program’’. 

12 (c) ESTABLISHMENT OF DIFFERENTIAL UPDATES

13 BEGINNING WITH 2015 TO PROMOTE ACCESS TO PRI14 MARY CARE SERVICES.— 

15 (1) ESTABLISHMENT OF SERVICE CAT16 EGORIES.—Subsection (j) of section 1848 of the So17 cial Security Act (42 U.S.C. 1395w–4) is amended 

18 by adding at the end the following new paragraphs: 

19 ‘‘(5) SERVICE CATEGORIES.— 

20 ‘‘(A) IN GENERAL.—For services furnished 

21 on or after January 1, 2015, each of the fol22 lowing categories of services shall be treated as 

23 a separate ‘service category’: 


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1 ‘‘(i) PRIMARY CARE.—Primary care 

2 services (as defined in subparagraph (B)) 

3 furnished by a qualifying practitioner. 

4 ‘‘(ii) OTHER SERVICES.—Other physi5 cians’ services. 

6 ‘‘(B) PRIMARY CARE SERVICES.—In this 

7 subsection, the term ‘primary care services’ 

8 means services identified, as of April 1, 2013, 

9 with the following HCPCS codes (and as subse10 quently modified by the Secretary): 

11 ‘‘(i) OFFICE AND OUTPATIENT VIS12 ITS.—99201 through 99215. 

13 ‘‘(ii) HOSPITAL OBSERVATIONAL

14 SERVICES.—99217 through 99220. 

15 ‘‘(iii) HOSPITAL INPATIENT VISITS

16 SERVICES.—99221 through 99239. 

17 ‘‘(iv) NURSING HOME, DOMICILIARY, 

18 REST HOME OR CUSTODIAL CARE VISITS.— 

19 99304 through 99340. 

20 ‘‘(v) HOME SERVICE VISITS.—99341 

21 through 99350. 

22 ‘‘(vi) WELCOME TO MEDICARE

23 VISIT.—G0402. 

24 ‘‘(vii) ANNUAL WELLNESS VISITS.— 

25 G0438 and G0439. 


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1 ‘‘(C) INCLUSION OF PREVENTIVE SERV2 ICES.—Such term also includes preventive serv3 ices described in section 1861(ddd)(3) and addi4 tional preventive services described in section 

5 1861(ddd)(1). 

6 ‘‘(D) INCLUSION OF ADDITIONAL SERV7 ICES.—Such term also includes services, such 

8 as care coordination services, telemedicine serv9 ices, non-face-to-face care management services, 

10 preparation and supervision of long-term care 

11 plans, home care plan oversight services, and 

12 similar services that the Secretary identifies, by 

13 regulation, as being similar to the services de14 scribed in subparagraph (B) or (C). 

15 ‘‘(6) QUALIFYING PRACTITIONER.—The term 

16 ‘qualifying practitioner’ means, with respect to the 

17 furnishing of primary care services, an individual— 

18 ‘‘(A) for whom primary care services has 

19 accounted for at least 60 percent of the allowed 

20 charges under this part (not counting any such 

21 charges attributable to in-office clinical labora22 tory services) in a prior period as determined by 

23 the Secretary; or 

24 ‘‘(B) who does not have claims under this 

25 part during such a prior period and whom the 


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1 Secretary determines is likely to meet the re2 quirement of subparagraph (A) for the subse3 quent period.’’. 

4 (2) ESTABLISHMENT OF SEPARATE CONVER5 SION FACTORS FOR EACH SERVICE CATEGORY.—Sec6 tion 1848(d)(1) of the Social Security Act (42 

7 U.S.C. 1395w–4(d)(1)), as amended by subsection 

8 (a)(1)(A), is further amended— 

9 (A) in subparagraph (A)— 

10 (i) by designating the sentence begin11 ning ‘‘The conversion factor’’ as clause (i) 

12 with the heading ‘‘APPLICATION OF SIN13 GLE CONVERSION FACTOR.—’’ and with 

14 appropriate indentation; 

15 (ii) by striking ‘‘The conversion fac16 tor’’ and inserting ‘‘Subject to clause (ii), 

17 the conversion factor’’; and 

18 (iii) by adding at the end the fol19 lowing new clause: 

20 ‘‘(ii) APPLICATION OF MULTIPLE CON21 VERSION FACTORS BEGINNING WITH

22 2015.— 

23 ‘‘(I) IN GENERAL.—In applying 

24 clause (i) for each year beginning with 

25 2015, separate conversion factors 


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1 shall be established for each service 

2 category of physicians’ services (as de3 fined in subsection (j)(5)(A)) and any 

4 reference in this section to a conver5 sion factor for such years shall be 

6 deemed a reference to the conversion 

7 factor for each of such categories. 

8 ‘‘(II) INITIAL CONVERSION FAC9 TORS.—Such factors for 2015 shall be 

10 based upon the single conversion fac11 tor for the previous year multiplied by 

12 the update established under para13 graph (16) for such category for 

14 2015. 

15 ‘‘(III) UPDATING OF CONVER16 SION FACTORS.—Such factor for a 

17 service category for a subsequent year 

18 shall be based upon the conversion 

19 factor for such category for the pre20 vious year and adjusted by the update 

21 established for such category under 

22 paragraph (16) or a subsequent para23 graph for the year involved.’’; and 

24 (B) in subparagraph (D), by striking 

25 ‘‘other physicians’ services’’ and inserting ‘‘for 


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1 physicians’ services in the service category de2 scribed in subsection (j)(5)(A)(ii))’’. 

3 (3) ESTABLISHMENT OF SEPARATE UPDATES

4 FOR CONVERSION FACTORS FOR EACH SERVICE CAT5 EGORY.—Section 1848(d) of the Social Security Act 

6 (42 U.S.C. 1395w–4(d)), as amended by subsection 

7 (b), is amended by adding at the end the following 

8 new paragraph: 

9 ‘‘(16) UPDATES BY SERVICE CATEGORY BEGIN10 NING WITH 2015; UPDATES FOR 2015 THROUGH

11 2018.—In applying paragraph (4) for each year be12 ginning with 2015, the following rules apply: 

13 ‘‘(A) APPLICATION OF SEPARATE UPDATE

14 ADJUSTMENTS FOR EACH SERVICE CAT15 EGORY.—Pursuant to paragraph (1)(A)(ii)(I), 

16 for each year beginning with 2014, the update 

17 shall be made to the conversion factor for each 

18 service category (as defined in subsection 

19 (j)(5)(A)). 

20 ‘‘(B) UPDATES FOR 2015 THROUGH 2018.— 

21 The updates for 2015, 2016, 2017, and 2018 

22 for the conversion factor for the services cat23 egory described in— 

24 ‘‘(i) subsection (j)(5)(A)(i) shall be 

25 2.5 percent; and 


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1 ‘‘(ii) subsection (j)(5)(A)(ii) shall be 

2 0.5 percent.’’. 

3 (d) PROMOTING TESTING AND EVALUATION OF NEW

4 PAYMENT AND DELIVERY MODELS (PHASE I).— 

5 (1) EXPANSION OF TESTING IN MULTIPLE GEO6 GRAPHIC REGIONS.—Section 1115A(a)(5) of the So7 cial Security Act (42 U.S.C. 1315a(a)(5)) is amend8 ed by inserting before the period at the end the fol9 lowing: ‘‘, but shall (to the maximum extent feasible) 

10 including testing of each such model in geographic 

11 areas in at least 3 regions’’. 

12 (2) INCLUSION OF PHYSICIAN IMPLEMENTA13 TION COSTS IN EVALUATIONS.—Section 

14 1115A(b)(4)(A) of the Social Security Act (42 

15 U.S.C. 1315a(b)(4)(A)) is amended— 

16 (A) by striking ‘‘and’’ at the end of clause 

17 (i); 

18 (B) by striking the period at the end of 

19 clause (ii) and inserting ‘‘; and’’; and 

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

21 clause: 

22 ‘‘(iii) the average cost, per physician, 

23 of implementation of the model with re24 spect to physicians’ services.’’. 


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1 (3) ACCELERATING TESTING AND EVALUATION

2 PROCESS.—Section 1115A(b) of the Social Security 

3 Act (42 U.S.C. 1315a(b)) is amended by adding at 

4 the end the following new paragraph: 

5 ‘‘(5) TIMING.—The Secretary, acting through 

6 the CMI, shall conduct activities under this sub7 section in such a timely manner so that evaluations 

8 of initial models can be initially completed so that 

9 physicians and other providers can begin to transi10 tion to implementation of such models with respect 

11 to services for which payment is made under section 

12 1848 beginning not later than January 1, 2018.’’. 

13 (4) INVOLVEMENT OF PROVIDER GROUPS IN SE14 LECTION OF MODELS.—Section 1115A(b)(4) of such 

15 Act is amended by adding at the end the following 

16 subparagraph: 

17 ‘‘(D) INVOLVEMENT OF PROVIDER GROUPS

18 IN MODEL SELECTION.—The Secretary shall 

19 consult and work closely with physician and 

20 other provider groups in the selection of models 

21 under this subsection and subsection (c).’’. 

22 (5) USE OF OTHER MODELS.—Section 1115A 

23 of such Act is further amended— 

24 (A) by adding at the end of subsection 

25 (b)(2)(B) the following new clause: 


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1 ‘‘(xxi) Providing payment for out2 patient therapy services and speech lan3 guage pathology services on the basis of a 

4 treatment session, an episode of care, or 

5 other bundled payment methodology that 

6 takes into account varying levels of severity 

7 and complexity of patient diagnoses, condi8 tions, and comorbidities and the varying 

9 intensity of services needed for effective 

10 treatment of patients.’’; and 

11 (B) in subsection (c), in the matter pre12 ceding paragraph (1), by— 

13 (i) striking ‘‘or’’ after ‘‘tested under 

14 subsection (b)’’ and inserting a comma; 

15 and 

16 (ii) by inserting ‘‘, or other model (in17 cluding a model that was not tested under 

18 subsection (b))’’ after ‘‘section 1866C’’. 

19 (6) GAO REVIEW AND STUDY.—The Comp20 troller General of the United States shall conduct a 

21 study of the evaluations made under subsection (b) 

22 of section 1115A of the Social Security Act, as 

23 amended by this section. Such study shall include an 

24 analysis of the alternative payment and delivery 

25 models identified under such section for payment for 


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1 physicians’ services (and other services) under the 

2 Medicare program. Not later than April 1, 2017, the 

3 Comptroller General shall submit a report to Con4 gress on such study and shall include in the report 

5 such recommendations as the Comptroller General 

6 deems appropriate for— 

7 (A) changes in the development and imple8 mentation process under such section; and 

9 (B) alternative payment and delivery mod10 els identified under such section as being appro11 priate for expansion under subsection (c) of 

12 such section. 

13 (7) PUBLICATION OF LIST OF SUCCESSFUL

14 MODELS.—Beginning on October 1, 2017, and each 

15 year thereafter, the Secretary of Health and Human 

16 Services shall publicly release a comprehensive list of 

17 such health care delivery and payment models identi18 fied, under section 1115A of the Social Security Act 

19 or otherwise, as meeting (or likely to meet) the re20 quirements of subsection (c)(1) of such section. Such 

21 list shall include at least 4 health care delivery and 

22 payment models and may include models not tested 

23 under subsection (b) of such section. 

24 (8) CONSIDERATIONS.—The Comptroller Gen25 eral in making recommendations under paragraph 


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1 (6) and the Secretary in releasing the list of models 

2 under paragraph (7) shall take into account vari3 ations among providers in size, specialty mix, case 

4 mix, and patient demographics, as well as regional 

5 health care infrastructure variations and variations 

6 in cost of living among areas, and shall specifically 

7 consider appropriate variations that take into ac8 count the special circumstances of providers in rural 

9 and other underserved areas. 

10 (e) IMPLEMENTATION OF PAYMENT AND DELIVERY

11 MODEL OPTIONS (PHASE II).— 

12 (1) IN GENERAL.—Based on the report of the 

13 Comptroller General under subsection (d)(4) and not 

14 later than October 1, 2017, the Secretary of Health 

15 and Human Services shall provide information to 

16 physicians (and nurse practitioners and other pro17 viders for which payment is determined based on the 

18 fee schedule under section 1848 of the Social Secu19 rity Act) or group practices and institutions employ20 ing Medicare part B providers on how best to transi21 tion to alternative health care delivery and payment 

22 models that are aimed at improving the coordina23 tion, quality and efficiency of health care, including 

24 those developed under section 1115A or 1866E of 


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1 the Social Security Act (42 U.S.C. 1315a, 1395cc– 

2 5). 

3 (2) INCREASING FLEXIBILITY IN IMPLEMENTA4 TION.—Section 1115A(c) of the Social Security Act 

5 (42 U.S.C. 1315a(c)), as amended by subsection 

6 (c)(5), is further amended, in the matter preceding 

7 paragraph (1), by inserting, after ‘‘through rule8 making’’, the following: ‘‘(which may include the 

9 issuance of interim final rules) or through publica10 tion of a directive or other guidance’’. 

11 (3) TIMING.—Section 1115A of such Act is fur12 ther amended by adding at the end the following: 

13 ‘‘The Secretary shall seek to effect such expansion 

14 to the maximum extent feasible so that physicians 

15 (and other providers paid in amounts determined 

16 based on the fee schedule under section 1848) may 

17 begin to transition to implementation of such models 

18 beginning not later than January 1, 2018.’’. 

19 (f) TRANSITION DURING 2019.— 

20 (1) FREEZE IN FEE SCHEDULE FOR 2019.— 

21 Subsection (d) of section 1848 of the Social Security 

22 Act (42 U.S.C. 1395w–4), as amended by sub23 sections (b) and (c)(3), is amended by adding at the 

24 end the following new paragraph: 


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1 ‘‘(17) UPDATE FOR 2019.—The update to both 

2 of the conversion factors for 2019 shall be 0 per3 cent.’’. 

4 (2) EXPANDED ASSISTANCE THROUGH RE5 GIONAL EXTENSION CENTERS AND OTHER QUALI6 FIED ENTITIES.—Section 1115A(d) of the Social Se7 curity Act (42 U.S.C. 1315a(d)) is amended by add8 ing at the end the following new paragraph: 

9 ‘‘(4) ASSISTANCE IN IMPLEMENTATION.— 

10 ‘‘(A) IN GENERAL.—Using funds available 

11 under subsection (f)(1) and consistent with this 

12 paragraph, the Secretary shall enter into con13 tracts and agreements with regional extension 

14 centers, in coordination with the National Coor15 dinator for Health Information Technology, and 

16 other appropriate entities to provide guidance 

17 and assistance on how physicians (and other 

18 providers paid in amounts determined based on 

19 the fee schedule under section 1848) may tran20 sition to implementation of alternative health 

21 care delivery models identified as representing 

22 best practices under this section. 

23 ‘‘(B) DEDICATED FUNDING.— 

24 ‘‘(i) IN GENERAL.—Of the amounts 

25 available under subsection (f)(1)(B), the 


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1 Secretary shall make $720,000,000 avail2 able to the Office of the National Coordi3 nator for Health Information Technology 

4 for the awarding of grants and incentive 

5 payments under a competitive process to 

6 regional extension centers (receiving fund7 ing under section 3012(c) of the Public 

8 Health Service Act) and other qualified en9 tities for activities described in subpara10 graph (A). Such grants and payments shall 

11 not be available for assistance after De12 cember 31, 2019. 

13 ‘‘(ii) PROCESS.—Under clause (i), the 

14 Office shall— 

15 ‘‘(I) establish a competitive selec16 tion process for the selection of re17 gional extension centers (and other 

18 qualified entities) in the third quarter 

19 of 2015; and 

20 ‘‘(II) provide for the initial dis21 tribution of funds to such centers and 

22 entities by January 1, 2016. 

23 ‘‘(iii) COLLABORATION.—The Center 

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1 ties in conducting activities under this 

2 paragraph, including the development of 

3 performance benchmarks based on provider 

4 participation and progress toward integra5 tion. 

6 ‘‘(iv) PRIORITY.—The grants and in7 centive payments under this subparagraph 

8 shall be directed to target assistance to 

9 solo and small specialty practices as well as 

10 community health centers and similar pro11 viders of primary care services.’’. 

12 (g) CONTINUING INCENTIVES FOR PROVIDING HIGH13 QUALITY, HIGH-VALUE CARE.— 

14 (1) FEE SCHEDULE ADJUSTMENTS.—Sub15 section (d) of section 1848 of the Social Security Act 

16 (42 U.S.C. 1395w–4), as amended by subsections 

17 (b), (c)(3), and (f), is amended by adding at the end 

18 the following: 

19 ‘‘(18) UPDATES FOR 2020 THROUGH 2023.— 

20 ‘‘(A) IN GENERAL.—Except as provided in 

21 this paragraph, the update to each of the con22 version factors— 

23 ‘‘(i) for 2020 shall be minus 2 per24 cent; 


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1 ‘‘(ii) for 2021 shall be minus 3 per2 cent; 

3 ‘‘(iii) for 2022 shall be minus 4 per4 cent; and 

5 ‘‘(iv) for 2023 shall be minus 5 per6 cent. 

7 ‘‘(B) TREATMENT OF SERVICES PAID

8 USING ALTERNATIVE PAYMENT AND DELIVERY

9 MODELS.—In the case of physicians’ services 

10 for which payment is covered under an alter11 native payment and delivery model, such as 

12 those implemented under section 1115A, sub13 paragraph (A) does not apply. 

14 ‘‘(C) GENERAL EXEMPTION.—The Sec15 retary shall, by regulation, exempt a provider 

16 from the application of the negative payment 

17 update specified in subparagraph (A) for a year 

18 if the Secretary determines that— 

19 ‘‘(i) the provider— 

20 ‘‘(I) is a meaningful EHR user 

21 (as determined under subsection 

22 (o)(2) with respect to the year); and 

23 ‘‘(II) meets the qualifications 

24 under subparagraph (B) of subsection 

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1 tive payments) for an additional in2 centive payment under subparagraph 

3 (A) of such subsection (which includes 

4 satisfactory participation in the qual5 ity reporting system and participation 

6 in an approved Maintenance of Cer7 tification program); 

8 ‘‘(ii) the payment modifier for the 

9 provider under subsection (p), which is 

10 based upon the performance of the pro11 vider on measures of quality of care fur12 nished compared to cost and which is ex13 pressed as a percentage of payment, is 

14 within the top 25 percent of such payment 

15 modifiers for providers within the same fee 

16 schedule area, as determined by the Sec17 retary; or 

18 ‘‘(iii) in the case of outpatient therapy 

19 services, the provider of such services ad20 heres to a comprehensive list of cost, qual21 ity, and outcome measures as dem22 onstrated by— 

23 ‘‘(I) participation in a certified 

24 registry; 


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1 ‘‘(II) if applicable, participation 

2 in the physician quality reporting sys3 tem under subsection (k); 

4 ‘‘(III) use of an approved patient 

5 assessment tool; 

6 ‘‘(IV) current certification as a 

7 physical therapist clinical specialist by 

8 the American Physical Therapy Asso9 ciation (APTA), an occupational ther10 apist by the American Occupational 

11 Therapy Association, or as an audiol12 ogist or a speech-language pathologist 

13 by the American Speech-Language14 Hearing Association; or 

15 ‘‘(V) compliance with comparable 

16 functional measures reporting require17 ments as recognized by the Secretary. 

18 ‘‘(D) CASE-BY-CASE HARDSHIP EXEMP19 TION.—The Secretary may, on a case-by-case 

20 basis, exempt a provider from the application of 

21 the negative payment update specified in sub22 paragraph (A) for a year if the Secretary deter23 mines, subject to annual renewal, that because 

24 of limitations in the nature of a medical prac25 tice, limitations in the number of Medicare 


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1 beneficiaries that may be served by the pro2 vider, or other special circumstances, imposing 

3 a financial disincentive under such subpara4 graph for failure to adopt an alternative pay5 ment and delivery model referred to in subpara6 graph (B) would result in a significant hardship 

7 to the provider. 

8 ‘‘(19) UPDATES BEGINNING WITH 2024.— 

9 ‘‘(A) IN GENERAL.—The update to both of 

10 the conversion factors for each year beginning 

11 with 2024 shall be 0 percent. 

12 ‘‘(B) TREATMENT OF SERVICES PAID

13 USING ALTERNATIVE PAYMENT AND DELIVERY

14 MODELS.—In the case of physicians’ services 

15 for which payment is covered under an alter16 native payment and delivery model, such as 

17 those implemented under section 1115A, sub18 paragraph (A) does not apply.’’. 

19 (2) CONSIDERATIONS IN PROMULGATING

20 GROWTH RATES FOR ALTERNATIVE PAYMENT AND

21 DELIVERY MODELS.— 

22 (A) IN GENERAL.—In determining the 

23 growth rates to be recognized beginning with 

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1 sicians’ services, such as those implemented 

2 under section 1115A of the Social Security Act, 

3 the Secretary of Health and Human Services 

4 shall consider (among other factors) the fol5 lowing: 

6 (i) Ensuring access to primary care 

7 and specialty services, including participa8 tion of primary care practitioners and spe9 cialists and newly graduating practitioners. 

10 (ii) Restraining spending growth. 

11 (iii) Ensuring access to services for 

12 vulnerable populations. 

13 (B) LIMITATIONS.—In no case shall the 

14 growth factor determined under this paragraph 

15 for a year— 

16 (i) be less than 1 percent; or 

17 (ii) be greater than the percentage in18 crease in the MEI (as defined in section 

19 1842(i)(3) of the Social Security Act, 42 

20 U.S.C. 1395u(i)(3)) for such year. 

21 (C) APPLICATION OF CONGRESSIONAL RE22 VIEW ACT.—Chapter 8 of title 5, United States 

23 Code, applies with respect to the promulgation 

24 of a growth factor under this paragraph for a 

25 year. 


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1 (h) IMPACT REPORT.—Not later than January 1, 

2 2023, the Secretary of Health and Human Services shall 

3 submit to Congress a report on the impact on spending 

4 and on access to services under title XVIII of the Social 

5 Security Act, including under part A of such title, result6 ing from changes to Medicare delivery and payment sys7 tems, including under the amendments made by this sec8 tion. 

Æ 


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