1002 
•AMDT. NO. 2786 
‘‘(3) by requiring the Secretary to implement 
such proposals unless Congress enacts legislation 
pursuant to this section. 
‘‘(c) BOARD PROPOSALS.— 
‘‘(1) DEVELOPMENT.— 
‘‘(A) IN GENERAL.—The Board shall de-
velop detailed and specific proposals related to 
the Medicare program in accordance with the 
succeeding provisions of this section. 
‘‘(B) 
ADVISORY
REPORTS.—Beginning 
January 15, 2014, the Board may develop and 
submit to Congress advisory reports on matters 
related to the Medicare program, regardless of 
whether or not the Board submitted a proposal 
for such year. Such a report may, for years 
prior to 2020, include recommendations regard-
ing improvements to payment systems for pro-
viders of services and suppliers who are not oth-
erwise subject to the scope of the Board’s rec-
ommendations in a proposal under this section. 
Any advisory report submitted under this sub-
paragraph shall not be subject to the rules for 
congressional consideration under subsection 
(d). 
‘‘(2) PROPOSALS.— 
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•AMDT. NO. 2786 
‘‘(A) 
REQUIREMENTS.—Each 
proposal 
submitted under this section in a proposal year 
shall meet each of the following requirements: 
‘‘(i) If the Chief Actuary of the Cen-
ters for Medicare & Medicaid Services has 
made a determination under paragraph 
(7)(A) in the determination year, the pro-
posal shall include recommendations so 
that the proposal as a whole (after taking 
into 
account 
recommendations 
under 
clause (v)) will result in a net reduction in 
total Medicare program spending in the 
implementation year that is at least equal 
to the applicable savings target established 
under paragraph (7)(B) for such imple-
mentation year. In determining whether a 
proposal meets the requirement of the pre-
ceding sentence, reductions in Medicare 
program spending during the 3-month pe-
riod immediately preceding the implemen-
tation year shall be counted to the extent 
that such reductions are a result of the im-
plementation of recommendations con-
tained in the proposal for a change in the 
payment rate for an item or service that 
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•AMDT. NO. 2786 
was effective during such period pursuant 
to subsection (e)(2)(A). 
‘‘(ii) The proposal shall not include 
any recommendation to ration health care, 
raise revenues or Medicare beneficiary pre-
miums under section 1818, 1818A, or 
1839, increase Medicare beneficiary cost- 
sharing (including deductibles, coinsur-
ance, and copayments), or otherwise re-
strict benefits or modify eligibility criteria. 
‘‘(iii) In the case of proposals sub-
mitted prior to December 31, 2018, the 
proposal 
shall 
not 
include 
any 
rec-
ommendation that would reduce payment 
rates for items and services furnished, 
prior to December 31, 2019, by providers 
of services (as defined in section 1861(u)) 
and suppliers (as defined in section 
1861(d)) 
scheduled, 
pursuant 
to 
the 
amendments made by section 3401 of the 
Patient Protection and Affordable Care 
Act, to receive a reduction to the infla-
tionary payment updates of such providers 
of services and suppliers in excess of a re-
duction due to productivity in a year in 
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•AMDT. NO. 2786 
which such recommendations would take 
effect. 
‘‘(iv) As appropriate, the proposal 
shall include recommendations to reduce 
Medicare payments under parts C and D, 
such as reductions in direct subsidy pay-
ments to Medicare Advantage and pre-
scription drug plans specified under para-
graph (1) and (2) of section 1860D–15(a) 
that are related to administrative expenses 
(including profits) for basic coverage, deny-
ing high bids or removing high bids for 
prescription drug coverage from the cal-
culation of the national average monthly 
bid amount under section 1860D–13(a)(4), 
and reductions in payments to Medicare 
Advantage plans under clauses (i) and (ii) 
of section 1853(a)(1)(B) that are related 
to administrative expenses (including prof-
its) and performance bonuses for Medicare 
Advantage plans under section 1853(n). 
Any such recommendation shall not affect 
the base beneficiary premium percentage 
specified under 1860D–13(a). 
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•AMDT. NO. 2786 
‘‘(v) The proposal shall include rec-
ommendations with respect to administra-
tive funding for the Secretary to carry out 
the recommendations contained in the pro-
posal. 
‘‘(vi) The proposal shall only include 
recommendations related to the Medicare 
program. 
‘‘(B) ADDITIONAL
CONSIDERATIONS.—In 
developing and submitting each proposal under 
this section in a proposal year, the Board shall, 
to the extent feasible— 
‘‘(i) give priority to recommendations 
that extend Medicare solvency; 
‘‘(ii) include recommendations that— 
‘‘(I) improve the health care de-
livery system and health outcomes, in-
cluding by promoting integrated care, 
care coordination, prevention and 
wellness, and quality and efficiency 
improvement; and 
‘‘(II) protect and improve Medi-
care beneficiaries’ access to necessary 
and evidence-based items and services, 
including in rural and frontier areas; 
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•AMDT. NO. 2786 
‘‘(iii) include recommendations that 
target reductions in Medicare program 
spending to sources of excess cost growth; 
‘‘(iv) consider the effects on Medicare 
beneficiaries of changes in payments to 
providers of services (as defined in section 
1861(u)) and suppliers (as defined in sec-
tion 1861(d)); 
‘‘(v) consider the effects of the rec-
ommendations on providers of services and 
suppliers with actual or projected negative 
cost margins or payment updates; and 
‘‘(vi) consider the unique needs of 
Medicare beneficiaries who are dually eligi-
ble for Medicare and the Medicaid program 
under title XIX. 
‘‘(C) NO INCREASE IN TOTAL MEDICARE 
PROGRAM SPENDING.—Each proposal submitted 
under this section shall be designed in such a 
manner that implementation of the rec-
ommendations contained in the proposal would 
not be expected to result, over the 10-year pe-
riod starting with the implementation year, in 
any increase in the total amount of net Medi-
care program spending relative to the total 
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•AMDT. NO. 2786 
icaid and CHIP Payment and Access Commis-
sion under section 1900. 
‘‘(3) TRANSMISSION OF BOARD PROPOSAL TO 
PRESIDENT.— 
‘‘(A) IN GENERAL.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided 
in 
clause 
(ii) 
and 
subsection 
(f)(3)(B), the Board shall transmit a pro-
posal under this section to the President 
on January 15 of each year (beginning 
with 2014). 
‘‘(ii) EXCEPTION.—The Board shall 
not submit a proposal under clause (i) in 
a proposal year if the year is— 
‘‘(I) a year for which the Chief 
Actuary of the Centers for Medicare & 
Medicaid Services makes a determina-
tion in the determination year under 
paragraph (6)(A) that the growth rate 
described in clause (i) of such para-
graph does not exceed the growth rate 
described in clause (ii) of such para-
graph; 
‘‘(II) a year in which the Chief 
Actuary of the Centers for Medicare & 
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•AMDT. NO. 2786 
Medicaid Services makes a determina-
tion in the determination year that 
the projected percentage increase (if 
any) for the medical care expenditure 
category of the Consumer Price Index 
for All Urban Consumers (United 
States city average) for the implemen-
tation year is less than the projected 
percentage increase (if any) in the 
Consumer Price Index for All Urban 
Consumers (all items; United States 
city average) for such implementation 
year; or 
‘‘(III) for proposal year 2019 and 
subsequent proposal years, a year in 
which the Chief Actuary of the Cen-
ters for Medicare & Medicaid Services 
makes a determination in the deter-
mination year that the growth rate 
described in paragraph (8) exceeds 
the growth rate described in para-
graph (6)(A)(i). 
‘‘(iii) START-UP PERIOD.—The Board 
may not submit a proposal under clause (i) 
prior to January 15, 2014. 
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•AMDT. NO. 2786 
‘‘(B) 
REQUIRED
INFORMATION.—Each 
proposal submitted by the Board under sub-
paragraph (A)(i) shall include— 
‘‘(i) the recommendations described in 
paragraph (2)(A)(i); 
‘‘(ii) an explanation of each rec-
ommendation contained in the proposal 
and the reasons for including such rec-
ommendation; 
‘‘(iii) an actuarial opinion by the 
Chief Actuary of the Centers for Medicare 
& Medicaid Services certifying that the 
proposal meets the requirements of sub-
paragraphs (A)(i) and (C) of paragraph 
(2); 
‘‘(iv) a legislative proposal that imple-
ments the recommendations; and 
‘‘(v) other information determined ap-
propriate by the Board. 
‘‘(4) PRESIDENTIAL
SUBMISSION
TO
CON-
GRESS.—Upon receiving a proposal from the Board 
under paragraph (3)(A)(i) or the Secretary under 
paragraph (5), the President shall immediately sub-
mit such proposal to Congress. 
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•AMDT. NO. 2786 
‘‘(5) CONTINGENT
SECRETARIAL
DEVELOP-
MENT OF PROPOSAL.—If, with respect to a proposal 
year, the Board is required, to but fails, to submit 
a proposal to the President by the deadline applica-
ble under paragraph (3)(A)(i), the Secretary shall 
develop a detailed and specific proposal that satisfies 
the requirements of subparagraphs (A) and (C) 
(and, to the extent feasible, subparagraph (B)) of 
paragraph (2) and contains the information required 
paragraph (3)(B)). By not later than January 25 of 
the year, the Secretary shall transmit— 
‘‘(A) such proposal to the President; and 
‘‘(B) a copy of such proposal to the Medi-
care Payment Advisory Commission for its re-
view. 
‘‘(6) PER CAPITA GROWTH RATE PROJECTIONS 
BY CHIEF ACTUARY.— 
‘‘(A) IN GENERAL.—Subject to subsection 
(f)(3)(A), not later than April 30, 2013, and 
annually thereafter, the Chief Actuary of the 
Centers for Medicare & Medicaid Services shall 
determine in each such year whether— 
‘‘(i) the projected Medicare per capita 
growth rate for the implementation year 
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•AMDT. NO. 2786 
(as determined under subparagraph (B)); 
exceeds 
‘‘(ii) the projected Medicare per capita 
target growth rate for the implementation 
year (as determined under subparagraph 
(C)). 
‘‘(B) MEDICARE
PER
CAPITA
GROWTH 
RATE.— 
‘‘(i) IN
GENERAL.—For purposes of 
this section, the Medicare per capita 
growth rate for an implementation year 
shall be calculated as the projected 5-year 
average (ending with such year) of the 
growth in Medicare program spending per 
unduplicated enrollee. 
‘‘(ii) REQUIREMENT.—The projection 
under clause (i) shall— 
‘‘(I) to the extent that there is 
projected to be a negative update to 
the single conversion factor applicable 
to payments for physicians’ services 
under section 1848(d) furnished in 
the proposal year or the implementa-
tion year, assume that such update 
for such services is 0 percent rather 
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•AMDT. NO. 2786 
than the negative percent that would 
otherwise apply; and 
‘‘(II) take into account any deliv-
ery system reforms or other payment 
changes that have been enacted or 
published in final rules but not yet 
implemented as of the making of such 
calculation. 
‘‘(C) MEDICARE
PER
CAPITA
TARGET 
GROWTH RATE.—For purposes of this section, 
the Medicare per capita target growth rate for 
an implementation year shall be calculated as 
the projected 5-year average (ending with such 
year) percentage increase in— 
‘‘(i) with respect to a determination 
year that is prior to 2018, the average of 
the projected percentage increase (if any) 
in— 
‘‘(I) the Consumer Price Index 
for All Urban Consumers (all items; 
United States city average); and 
‘‘(II) the medical care expendi-
ture category of the Consumer Price 
Index for All Urban Consumers 
(United States city average); and 
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•AMDT. NO. 2786 
month period immediately preceding the imple-
mentation year shall be counted to the extent 
that such reductions are a result of the imple-
mentation provisions in the committee amend-
ment for a change in the payment rate for an 
item or service that was effective during such 
period pursuant to such amendment. 
‘‘(C) 
COMMITTEE
JURISDICTION.—Not-
withstanding rule XV of the Standing Rules of 
the Senate, a committee amendment described 
in subparagraph (A) may include matter not 
within the jurisdiction of the Committee on Fi-
nance if that matter is relevant to a proposal 
contained in the bill submitted under subsection 
(c)(3). 
‘‘(D) DISCHARGE.—If, with respect to the 
House involved, the committee has not reported 
the bill by the date required by subparagraph 
(A), the committee shall be discharged from 
further consideration of the proposal. 
‘‘(3) LIMITATION ON CHANGES TO THE BOARD 
RECOMMENDATIONS.— 
‘‘(A) IN
GENERAL.—It shall not be in 
order in the Senate or the House of Represent-
atives to consider any bill, resolution, or amend-
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1020 
•AMDT. NO. 2786 
ment, pursuant to this subsection or conference 
report thereon, that fails to satisfy the require-
ments of subparagraphs (A)(i) and (C) of sub-
section (c)(2). 
‘‘(B) LIMITATION
ON
CHANGES
TO
THE 
BOARD RECOMMENDATIONS IN OTHER LEGISLA-
TION.—It shall not be in order in the Senate or 
the House of Representatives to consider any 
bill, resolution, amendment, or conference re-
port (other than pursuant to this section) that 
would repeal or otherwise change the rec-
ommendations of the Board if that change 
would fail to satisfy the requirements of sub-
paragraphs (A)(i) and (C) of subsection (c)(2). 
‘‘(C) LIMITATION
ON
CHANGES
TO
THIS 
SUBSECTION.—It shall not be in order in the 
Senate or the House of Representatives to con-
sider any bill, resolution, amendment, or con-
ference report that would repeal or otherwise 
change this subsection. 
‘‘(D) WAIVER.—This paragraph may be 
waived or suspended in the Senate only by the 
affirmative vote of three-fifths of the Members, 
duly chosen and sworn. 
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1021 
•AMDT. NO. 2786 
‘‘(E) APPEALS.—An affirmative vote of 
three-fifths of the Members of the Senate, duly 
chosen and sworn, shall be required in the Sen-
ate to sustain an appeal of the ruling of the 
Chair on a point of order raised under this 
paragraph. 
‘‘(4) EXPEDITED PROCEDURE.— 
‘‘(A) CONSIDERATION.—A motion to pro-
ceed to the consideration of the bill in the Sen-
ate is not debatable. 
‘‘(B) AMENDMENT.— 
‘‘(i) TIME
LIMITATION.—Debate in 
the Senate on any amendment to a bill 
under this section shall be limited to 1 
hour, to be equally divided between, and 
controlled by, the mover and the manager 
of the bill, and debate on any amendment 
to an amendment, debatable motion, or ap-
peal shall be limited to 30 minutes, to be 
equally divided between, and controlled by, 
the mover and the manager of the bill, ex-
cept that in the event the manager of the 
bill is in favor of any such amendment, 
motion, or appeal, the time in opposition 
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•AMDT. NO. 2786 
thereto shall be controlled by the minority 
leader or such leader’s designee. 
‘‘(ii) GERMANE.—No amendment that 
is not germane to the provisions of such 
bill shall be received. 
‘‘(iii) ADDITIONAL
TIME.—The lead-
ers, or either of them, may, from the time 
under their control on the passage of the 
bill, allot additional time to any Senator 
during the consideration of any amend-
ment, debatable motion, or appeal. 
‘‘(iv) AMENDMENT NOT IN ORDER.— 
It shall not be in order to consider an 
amendment that would cause the bill to re-
sult in a net reduction in total Medicare 
program spending in the implementation 
year that is less than the applicable sav-
ings target established under subsection 
(c)(7)(B) for such implementation year. 
‘‘(v) WAIVER
AND
APPEALS.—This 
paragraph may be waived or suspended in 
the Senate only by the affirmative vote of 
three-fifths of the Members, duly chosen 
and sworn. An affirmative vote of three- 
fifths of the Members of the Senate, duly 
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•AMDT. NO. 2786 
chosen and sworn, shall be required in the 
Senate to sustain an appeal of the ruling 
of the Chair on a point of order raised 
under this section. 
‘‘(C) CONSIDERATION
BY
THE
OTHER 
HOUSE.— 
‘‘(i) IN
GENERAL.—The expedited 
procedures provided in this subsection for 
the consideration of a bill introduced pur-
suant to paragraph (1) shall not apply to 
such a bill that is received by one House 
from the other House if such a bill was not 
introduced in the receiving House. 
‘‘(ii) BEFORE PASSAGE.—If a bill that 
is introduced pursuant to paragraph (1) is 
received by one House from the other 
House, after introduction but before dis-
position of such a bill in the receiving 
House, then the following shall apply: 
‘‘(I) The receiving House shall 
consider the bill introduced in that 
House through all stages of consider-
ation up to, but not including, pas-
sage. 
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•AMDT. NO. 2786 
‘‘(II) The question on passage 
shall be put on the bill of the other 
House as amended by the language of 
the receiving House. 
‘‘(iii) AFTER PASSAGE.—If a bill in-
troduced pursuant to paragraph (1) is re-
ceived by one House from the other House, 
after such a bill is passed by the receiving 
House, then the vote on passage of the bill 
that originates in the receiving House shall 
be considered to be the vote on passage of 
the bill received from the other House as 
amended by the language of the receiving 
House. 
‘‘(iv) DISPOSITION.—Upon disposition 
of a bill introduced pursuant to paragraph 
(1) that is received by one House from the 
other House, it shall no longer be in order 
to consider the bill that originates in the 
receiving House. 
‘‘(v) LIMITATION.—Clauses (ii), (iii), 
and (iv) shall apply only to a bill received 
by one House from the other House if the 
bill— 
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•AMDT. NO. 2786 
‘‘(I) is related only to the pro-
gram under this title; and 
‘‘(II) satisfies the requirements 
of subparagraphs (A)(i) and (C) of 
subsection (c)(2). 
‘‘(D) SENATE LIMITS ON DEBATE.— 
‘‘(i) IN
GENERAL.—In the Senate, 
consideration of the bill and on all debat-
able motions and appeals in connection 
therewith shall not exceed a total of 30 
hours, which shall be divided equally be-
tween the majority and minority leaders or 
their designees. 
‘‘(ii) MOTION TO FURTHER LIMIT DE-
BATE.—A motion to further limit debate 
on the bill is in order and is not debatable. 
‘‘(iii) MOTION OR APPEAL.—Any de-
batable motion or appeal is debatable for 
not to exceed 1 hour, to be divided equally 
between those favoring and those opposing 
the motion or appeal. 
‘‘(iv) FINAL DISPOSITION.—After 30 
hours of consideration, the Senate shall 
proceed, without any further debate on any 
question, to vote on the final disposition 
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•AMDT. NO. 2786 
thereof to the exclusion of all amendments 
not then pending before the Senate at that 
time and to the exclusion of all motions, 
except a motion to table, or to reconsider 
and one quorum call on demand to estab-
lish the presence of a quorum (and mo-
tions required to establish a quorum) im-
mediately before the final vote begins. 
‘‘(E) CONSIDERATION IN CONFERENCE.— 
‘‘(i) IN
GENERAL.—Consideration in 
the Senate and the House of Representa-
tives on the conference report or any mes-
sages between Houses shall be limited to 
10 hours, equally divided and controlled by 
the majority and minority leaders of the 
Senate or their designees and the Speaker 
of the House of Representatives and the 
minority leader of the House of Represent-
atives or their designees. 
‘‘(ii) TIME
LIMITATION.—Debate in 
the Senate on any amendment under this 
subparagraph shall be limited to 1 hour, to 
be equally divided between, and controlled 
by, the mover and the manager of the bill, 
and debate on any amendment to an 
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•AMDT. NO. 2786 
amendment, debatable motion, or appeal 
shall be limited to 30 minutes, to be equal-
ly divided between, and controlled by, the 
mover and the manager of the bill, except 
that in the event the manager of the bill 
is in favor of any such amendment, mo-
tion, or appeal, the time in opposition 
thereto shall be controlled by the minority 
leader or such leader’s designee. 
‘‘(iii) FINAL DISPOSITION.—After 10 
hours of consideration, the Senate shall 
proceed, without any further debate on any 
question, to vote on the final disposition 
thereof to the exclusion of all motions not 
then pending before the Senate at that 
time or necessary to resolve the differences 
between the Houses and to the exclusion of 
all other motions, except a motion to table, 
or to reconsider and one quorum call on 
demand to establish the presence of a 
quorum (and motions required to establish 
a quorum) immediately before the final 
vote begins. 
‘‘(iv) 
LIMITATION.—Clauses 
(i) 
through (iii) shall only apply to a con-
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•AMDT. NO. 2786 
ference report, message or the amendments 
thereto if the conference report, message, 
or an amendment thereto— 
‘‘(I) is related only to the pro-
gram under this title; and 
‘‘(II) satisfies the requirements 
of subparagraphs (A)(i) and (C) of 
subsection (c)(2). 
‘‘(F) VETO.—If the President vetoes the 
bill debate on a veto message in the Senate 
under this subsection shall be 1 hour equally di-
vided between the majority and minority leaders 
or their designees. 
‘‘(5) RULES OF THE SENATE AND HOUSE OF 
REPRESENTATIVES.—This subsection and subsection 
(f)(2) are enacted by Congress— 
‘‘(A) as an exercise of the rulemaking 
power of the Senate and the House of Rep-
resentatives, respectively, and is deemed to be 
part of the rules of each House, respectively, 
but applicable only with respect to the proce-
dure to be followed in that House in the case 
of bill under this section, and it supersedes 
other rules only to the extent that it is incon-
sistent with such rules; and 
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•AMDT. NO. 2786 
‘‘(B) with full recognition of the constitu-
tional right of either House to change the rules 
(so far as they relate to the procedure of that 
House) at any time, in the same manner, and 
to the same extent as in the case of any other 
rule of that House. 
‘‘(e) IMPLEMENTATION OF PROPOSAL.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary shall, except as pro-
vided in paragraph (3), implement the recommenda-
tions contained in a proposal submitted by the Presi-
dent to Congress pursuant to this section on August 
15 of the year in which the proposal is so submitted. 
‘‘(2) APPLICATION.— 
‘‘(A) IN GENERAL.—A recommendation de-
scribed in paragraph (1) shall apply as follows: 
‘‘(i) In the case of a recommendation 
that is a change in the payment rate for 
an item or service under Medicare in which 
payment rates change on a fiscal year 
basis (or a cost reporting period basis that 
relates to a fiscal year), on a calendar year 
basis (or a cost reporting period basis that 
relates to a calendar year), or on a rate 
year basis (or a cost reporting period basis 
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•AMDT. NO. 2786 
that relates to a rate year), such rec-
ommendation shall apply to items and 
services furnished on the first day of the 
first fiscal year, calendar year, or rate year 
(as the case may be) that begins after such 
August 15. 
‘‘(ii) In the case of a recommendation 
relating to payments to plans under parts 
C and D, such recommendation shall apply 
to plan years beginning on the first day of 
the first calendar year that begins after 
such August 15. 
‘‘(iii) In the case of any other rec-
ommendation, such recommendation shall 
be addressed in the regular regulatory 
process timeframe and shall apply as soon 
as practicable. 
‘‘(B) INTERIM FINAL RULEMAKING.—The 
Secretary may use interim final rulemaking to 
implement any recommendation described in 
paragraph (1). 
‘‘(3) EXCEPTION.—The Secretary shall not be 
required to implement the recommendations con-
tained in a proposal submitted in a proposal year by 
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•AMDT. NO. 2786 
the President to Congress pursuant to this section 
if— 
‘‘(A) prior to August 15 of the proposal 
year, Federal legislation is enacted that in-
cludes the following provision: ‘This Act 
supercedes the recommendations of the Board 
contained in the proposal submitted, in the year 
which includes the date of enactment of this 
Act, to Congress under section 1899A of the 
Social Security Act.’; and 
‘‘(B) in the case of implementation year 
2020 and subsequent implementation years, a 
joint resolution described in subsection (f)(1) is 
enacted not later than August 15, 2017. 
‘‘(4) NO
AFFECT
ON
AUTHORITY
TO
IMPLE-
MENT CERTAIN PROVISIONS.—Nothing in paragraph 
(3) shall be construed to affect the authority of the 
Secretary to implement any recommendation con-
tained in a proposal or advisory report under this 
section to the extent that the Secretary otherwise 
has the authority to implement such recommenda-
tion administratively. 
‘‘(5) LIMITATION ON REVIEW.—There shall be 
no administrative or judicial review under section 
1869, section 1878, or otherwise of the implementa-
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•AMDT. NO. 2786 
tion by the Secretary under this subsection of the 
recommendations contained in a proposal. 
‘‘(f) JOINT
RESOLUTION
REQUIRED
TO
DIS-
CONTINUE THE BOARD.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(e)(3)(B), a joint resolution described in this para-
graph means only a joint resolution— 
‘‘(A) that is introduced in 2017 by not 
later than February 1 of such year; 
‘‘(B) which does not have a preamble; 
‘‘(C) the title of which is as follows: ‘Joint 
resolution approving the discontinuation of the 
process for consideration and automatic imple-
mentation of the annual proposal of the Inde-
pendent Medicare Advisory Board under section 
1899A of the Social Security Act’; and 
‘‘(D) the matter after the resolving clause 
of which is as follows: ‘That Congress approves 
the discontinuation of the process for consider-
ation and automatic implementation of the an-
nual proposal of the Independent Medicare Ad-
visory Board under section 1899A of the Social 
Security Act.’. 
‘‘(2) PROCEDURE.— 
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•AMDT. NO. 2786 
‘‘(A) REFERRAL.—A joint resolution de-
scribed in paragraph (1) shall be referred to the 
Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House 
of Representatives and the Committee on Fi-
nance of the Senate. 
‘‘(B) DISCHARGE.—In the Senate, if the 
committee to which is referred a joint resolution 
described in paragraph (1) has not reported 
such joint resolution (or an identical joint reso-
lution) at the end of 20 days after the joint res-
olution described in paragraph (1) is intro-
duced, such committee may be discharged from 
further consideration of such joint resolution 
upon a petition supported in writing by 30 
Members of the Senate, and such joint resolu-
tion shall be placed on the calendar. 
‘‘(C) CONSIDERATION.— 
‘‘(i) IN
GENERAL.—In the Senate, 
when the committee to which a joint reso-
lution is referred has reported, or when a 
committee is discharged (under subpara-
graph (C)) from further consideration of a 
joint resolution described in paragraph (1), 
it is at any time thereafter in order (even 
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•AMDT. NO. 2786 
though a previous motion to the same ef-
fect has been disagreed to) for a motion to 
proceed to the consideration of the joint 
resolution to be made, and all points of 
order against the joint resolution (and 
against consideration of the joint resolu-
tion) are waived, except for points of order 
under the Congressional Budget act of 
1974 or under budget resolutions pursuant 
to that Act. The motion is not debatable. 
A motion to reconsider the vote by which 
the motion is agreed to or disagreed to 
shall not be in order. If a motion to pro-
ceed to the consideration of the joint reso-
lution is agreed to, the joint resolution 
shall remain the unfinished business of the 
Senate until disposed of. 
‘‘(ii) DEBATE
LIMITATION.—In the 
Senate, consideration of the joint resolu-
tion, and on all debatable motions and ap-
peals in connection therewith, shall be lim-
ited to not more than 10 hours, which 
shall be divided equally between the major-
ity leader and the minority leader, or their 
designees. A motion further to limit debate 
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•AMDT. NO. 2786 
is in order and not debatable. An amend-
ment to, or a motion to postpone, or a mo-
tion to proceed to the consideration of 
other business, or a motion to recommit 
the joint resolution is not in order. 
‘‘(iii) PASSAGE.—In the Senate, im-
mediately following the conclusion of the 
debate on a joint resolution described in 
paragraph (1), and a single quorum call at 
the conclusion of the debate if requested in 
accordance with the rules of the Senate, 
the vote on passage of the joint resolution 
shall occur. 
‘‘(iv) APPEALS.—Appeals from the de-
cisions of the Chair relating to the applica-
tion of the rules of the Senate to the pro-
cedure relating to a joint resolution de-
scribed in paragraph (1) shall be decided 
without debate. 
‘‘(D) OTHER HOUSE ACTS FIRST.—If, be-
fore the passage by 1 House of a joint resolu-
tion of that House described in paragraph (1), 
that House receives from the other House a 
joint resolution described in paragraph (1), 
then the following procedures shall apply: 
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•AMDT. NO. 2786 
‘‘(i) The joint resolution of the other 
House shall not be referred to a com-
mittee. 
‘‘(ii) With respect to a joint resolution 
described in paragraph (1) of the House 
receiving the joint resolution— 
‘‘(I) the procedure in that House 
shall be the same as if no joint resolu-
tion had been received from the other 
House; but 
‘‘(II) the vote on final passage 
shall be on the joint resolution of the 
other House. 
‘‘(E) EXCLUDED DAYS.—For purposes of 
determining the period specified in subpara-
graph (B), there shall be excluded any days ei-
ther House of Congress is adjourned for more 
than 3 days during a session of Congress. 
‘‘(F) MAJORITY
REQUIRED
FOR
ADOP-
TION.—A joint resolution considered under this 
subsection shall require an affirmative vote of 
three-fifths of the Members, duly chosen and 
sworn, for adoption. 
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•AMDT. NO. 2786 
‘‘(3) TERMINATION.—If a joint resolution de-
scribed in paragraph (1) is enacted not later than 
August 15, 2017— 
‘‘(A) the Chief Actuary of the Medicare & 
Medicaid Services shall not— 
‘‘(i) make any determinations under 
subsection (c)(6) after May 1, 2017; or 
‘‘(ii) provide any opinion pursuant to 
subsection (c)(3)(B)(iii) after January 16, 
2018; 
‘‘(B) the Board shall not submit any pro-
posals or advisory reports to Congress under 
this section after January 16, 2018; and 
‘‘(C) the Board and the consumer advisory 
council under subsection (k) shall terminate on 
August 16, 2018. 
‘‘(g) BOARD
MEMBERSHIP; TERMS
OF
OFFICE; 
CHAIRPERSON; REMOVAL.— 
‘‘(1) MEMBERSHIP.— 
‘‘(A) IN GENERAL.—The Board shall be 
composed of— 
‘‘(i) 15 members appointed by the 
President, by and with the advice and con-
sent of the Senate; and 
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•AMDT. NO. 2786 
‘‘(ii) the Secretary, the Administrator 
of the Center for Medicare & Medicaid 
Services, and the Administrator of the 
Health Resources and Services Administra-
tion, all of whom shall serve ex officio as 
nonvoting members of the Board. 
‘‘(B) QUALIFICATIONS.— 
‘‘(i) IN
GENERAL.—The appointed 
membership of the Board shall include in-
dividuals with national recognition for 
their expertise in health finance and eco-
nomics, actuarial science, health facility 
management, health plans and integrated 
delivery systems, reimbursement of health 
facilities, allopathic and osteopathic physi-
cians, and other providers of health serv-
ices, and other related fields, who provide 
a mix of different professionals, broad geo-
graphic representation, and a balance be-
tween urban and rural representatives. 
‘‘(ii) 
INCLUSION.—The 
appointed 
membership of the Board shall include 
(but not be limited to) physicians and 
other health professionals, experts in the 
area of pharmaco-economics or prescrip-
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•AMDT. NO. 2786 
tion drug benefit programs, employers, 
third-party payers, individuals skilled in 
the conduct and interpretation of bio-
medical, health services, and health eco-
nomics research and expertise in outcomes 
and effectiveness research and technology 
assessment. Such membership shall also 
include representatives of consumers and 
the elderly. 
‘‘(iii) MAJORITY NONPROVIDERS.—In-
dividuals who are directly involved in the 
provision or management of the delivery of 
items and services covered under this title 
shall not constitute a majority of the ap-
pointed membership of the Board. 
‘‘(C) ETHICAL
DISCLOSURE.—The Presi-
dent shall establish a system for public disclo-
sure by appointed members of the Board of fi-
nancial and other potential conflicts of interest 
relating to such members. Appointed members 
of the Board shall be treated as officers in the 
executive branch for purposes of applying title 
I of the Ethics in Government Act of 1978 
(Public Law 95–521). 
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•AMDT. NO. 2786 
‘‘(D) CONFLICTS OF INTEREST.—No indi-
vidual may serve as an appointed member if 
that individual engages in any other business, 
vocation, or employment. 
‘‘(E) CONSULTATION WITH CONGRESS.—In 
selecting individuals for nominations for ap-
pointments to the Board, the President shall 
consult with— 
‘‘(i) the majority leader of the Senate 
concerning the appointment of 3 members; 
‘‘(ii) the Speaker of the House of 
Representatives concerning the appoint-
ment of 3 members; 
‘‘(iii) the minority leader of the Sen-
ate concerning the appointment of 3 mem-
bers; and 
‘‘(iv) the minority leader of the House 
of Representatives concerning the appoint-
ment of 3 members. 
‘‘(2) TERM OF OFFICE.—Each appointed mem-
ber shall hold office for a term of 6 years except 
that— 
‘‘(A) a member may not serve more than 
2 full consecutive terms (but may be re-
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•AMDT. NO. 2786 
appointed to 2 full consecutive terms after 
being appointed to fill a vacancy on the Board); 
‘‘(B) a member appointed to fill a vacancy 
occurring prior to the expiration of the term for 
which that member’s predecessor was appointed 
shall be appointed for the remainder of such 
term; 
‘‘(C) a member may continue to serve after 
the expiration of the member’s term until a suc-
cessor has taken office; and 
‘‘(D) of the members first appointed under 
this section, 5 shall be appointed for a term of 
1 year, 5 shall be appointed for a term of 3 
years, and 5 shall be appointed for a term of 
6 years, the term of each to be designated by 
the President at the time of nomination. 
‘‘(3) CHAIRPERSON.— 
‘‘(A) IN GENERAL.—The Chairperson shall 
be appointed by the President, by and with the 
advice and consent of the Senate, from among 
the members of the Board. 
‘‘(B) DUTIES.—The Chairperson shall be 
the principal executive officer of the Board, and 
shall exercise all of the executive and adminis-
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•AMDT. NO. 2786 
trative functions of the Board, including func-
tions of the Board with respect to— 
‘‘(i) the appointment and supervision 
of personnel employed by the Board; 
‘‘(ii) the distribution of business 
among personnel appointed and supervised 
by the Chairperson and among administra-
tive units of the Board; and 
‘‘(iii) the use and expenditure of 
funds. 
‘‘(C) GOVERNANCE.—In carrying out any 
of the functions under subparagraph (B), the 
Chairperson shall be governed by the general 
policies established by the Board and by the de-
cisions, findings, and determinations the Board 
shall by law be authorized to make. 
‘‘(D) REQUESTS FOR APPROPRIATIONS.— 
Requests or estimates for regular, supple-
mental, or deficiency appropriations on behalf 
of the Board may not be submitted by the 
Chairperson without the prior approval of a ma-
jority vote of the Board. 
‘‘(4) REMOVAL.—Any appointed member may 
be removed by the President for neglect of duty or 
malfeasance in office, but for no other cause. 
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•AMDT. NO. 2786 
‘‘(h) VACANCIES; QUORUM; SEAL; VICE CHAIR-
PERSON; VOTING ON REPORTS.— 
‘‘(1) VACANCIES.—No vacancy on the Board 
shall impair the right of the remaining members to 
exercise all the powers of the Board. 
‘‘(2) QUORUM.—A majority of the appointed 
members of the Board shall constitute a quorum for 
the transaction of business, but a lesser number of 
members may hold hearings. 
‘‘(3) SEAL.—The Board shall have an official 
seal, of which judicial notice shall be taken. 
‘‘(4) VICE CHAIRPERSON.—The Board shall an-
nually elect a Vice Chairperson to act in the absence 
or disability of the Chairperson or in case of a va-
cancy in the office of the Chairperson. 
‘‘(5) VOTING ON PROPOSALS.—Any proposal of 
the Board must be approved by the majority of ap-
pointed members present. 
‘‘(i) POWERS OF THE BOARD.— 
‘‘(1) HEARINGS.—The Board may hold such 
hearings, sit and act at such times and places, take 
such testimony, and receive such evidence as the 
Board considers advisable to carry out this section. 
‘‘(2) AUTHORITY TO INFORM RESEARCH PRIOR-
ITIES FOR DATA COLLECTION.—The Board may ad-
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•AMDT. NO. 2786 
vise the Secretary on priorities for health services re-
search, particularly as such priorities pertain to nec-
essary changes and issues regarding payment re-
forms under Medicare. 
‘‘(3) OBTAINING OFFICIAL DATA.—The Board 
may secure directly from any department or agency 
of the United States information necessary to enable 
it to carry out this section. Upon request of the 
Chairperson, the head of that department or agency 
shall furnish that information to the Board on an 
agreed upon schedule. 
‘‘(4) POSTAL SERVICES.—The Board may use 
the United States mails in the same manner and 
under the same conditions as other departments and 
agencies of the Federal Government. 
‘‘(5) GIFTS.—The Board may accept, use, and 
dispose of gifts or donations of services or property. 
‘‘(6) OFFICES.—The Board shall maintain a 
principal office and such field offices as it deter-
mines necessary, and may meet and exercise any of 
its powers at any other place. 
‘‘(j) PERSONNEL MATTERS.— 
‘‘(1) COMPENSATION OF MEMBERS AND CHAIR-
PERSON.—Each appointed member, other than the 
Chairperson, shall be compensated at a rate equal to 
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•AMDT. NO. 2786 
the annual rate of basic pay prescribed for level III 
of the Executive Schedule under section 5315 of title 
5, United States Code. The Chairperson shall be 
compensated at a rate equal to the daily equivalent 
of the annual rate of basic pay prescribed for level 
II of the Executive Schedule under section 5315 of 
title 5, United States Code. 
‘‘(2) TRAVEL EXPENSES.—The appointed mem-
bers shall be allowed travel expenses, including per 
diem in lieu of subsistence, at rates authorized for 
employees of agencies under subchapter I of chapter 
57 of title 5, United States Code, while away from 
their homes or regular places of business in the per-
formance of services for the Board. 
‘‘(3) STAFF.— 
‘‘(A) IN GENERAL.—The Chairperson may, 
without regard to the civil service laws and reg-
ulations, appoint and terminate an executive di-
rector and such other additional personnel as 
may be necessary to enable the Board to per-
form its duties. The employment of an executive 
director shall be subject to confirmation by the 
Board. 
‘‘(B) COMPENSATION.—The Chairperson 
may fix the compensation of the executive direc-
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•AMDT. NO. 2786 
tor and other personnel without regard to chap-
ter 51 and subchapter III of chapter 53 of title 
5, United States Code, relating to classification 
of positions and General Schedule pay rates, ex-
cept that the rate of pay for the executive direc-
tor and other personnel may not exceed the rate 
payable for level V of the Executive Schedule 
under section 5316 of such title. 
‘‘(4) DETAIL OF GOVERNMENT EMPLOYEES.— 
Any Federal Government employee may be detailed 
to the Board without reimbursement, and such de-
tail shall be without interruption or loss of civil serv-
ice status or privilege. 
‘‘(5) PROCUREMENT
OF
TEMPORARY
AND 
INTERMITTENT
SERVICES.—The Chairperson may 
procure temporary and intermittent services under 
section 3109(b) of title 5, United States Code, at 
rates for individuals which do not exceed the daily 
equivalent of the annual rate of basic pay prescribed 
for level V of the Executive Schedule under section 
5316 of such title. 
‘‘(k) CONSUMER ADVISORY COUNCIL.— 
‘‘(1) IN GENERAL.—There is established a con-
sumer advisory council to advise the Board on the 
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•AMDT. NO. 2786 
impact of payment policies under this title on con-
sumers. 
‘‘(2) MEMBERSHIP.— 
‘‘(A) NUMBER
AND
APPOINTMENT.—The 
consumer advisory council shall be composed of 
10 consumer representatives appointed by the 
Comptroller General of the United States, 1 
from among each of the 10 regions established 
by the Secretary as of the date of enactment of 
this section. 
‘‘(B) QUALIFICATIONS.—The membership 
of the council shall represent the interests of 
consumers and particular communities. 
‘‘(3) DUTIES.—The consumer advisory council 
shall, subject to the call of the Board, meet not less 
frequently than 2 times each year in the District of 
Columbia. 
‘‘(4) OPEN MEETINGS.—Meetings of the con-
sumer advisory council shall be open to the public. 
‘‘(5) ELECTION OF OFFICERS.—Members of the 
consumer advisory council shall elect their own offi-
cers. 
‘‘(6) APPLICATION OF FACA.—The Federal Ad-
visory Committee Act (5 U.S.C. App.) shall apply to 
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•AMDT. NO. 2786 
the consumer advisory council except that section 14 
of such Act shall not apply. 
‘‘(l) DEFINITIONS.—In this section: 
‘‘(1) BOARD; CHAIRPERSON; MEMBER.—The 
terms ‘Board’, ‘Chairperson’, and ‘Member’ mean 
the Independent Medicare Advisory Board estab-
lished under subsection (a) and the Chairperson and 
any Member thereof, respectively. 
‘‘(2) MEDICARE.—The term ‘Medicare’ means 
the program established under this title, including 
parts A, B, C, and D. 
‘‘(3) 
MEDICARE
BENEFICIARY.—The 
term 
‘Medicare beneficiary’ means an individual who is 
entitled to, or enrolled for, benefits under part A or 
enrolled for benefits under part B. 
‘‘(4) MEDICARE
PROGRAM
SPENDING.—The 
term ‘Medicare program spending’ means program 
spending under parts A, B, and D net of premiums. 
‘‘(m) FUNDING.— 
‘‘(1) IN GENERAL.—There are appropriated to 
the Board to carry out its duties and functions— 
‘‘(A) for fiscal year 2012, $15,000,000; 
and 
‘‘(B) for each subsequent fiscal year, the 
amount appropriated under this paragraph for 
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•AMDT. NO. 2786 
defined in section 4 of the Indian Health Care 
Improvement Act), or any other entity identi-
fied by the Secretary; and 
‘‘(B) shall have demonstrated expertise in 
providing information and technical support 
and assistance to health care providers regard-
ing quality improvement. 
‘‘(2) IMPLEMENTATION AWARD.—To be eligible 
to receive an implementation grant or contract 
under subsection (a)(2), an entity— 
‘‘(A) may be a hospital or other health 
care provider or consortium or providers, as de-
termined by the Secretary; and 
‘‘(B) shall have demonstrated expertise in 
providing information and technical support 
and assistance to health care providers regard-
ing quality improvement. 
‘‘(c) APPLICATION.— 
‘‘(1) TECHNICAL ASSISTANCE AWARD.—To re-
ceive a technical assistance grant or contract under 
subsection (a)(1), an eligible entity shall submit an 
application to the Secretary at such time, in such 
manner, and containing— 
‘‘(A) a plan for a sustainable business 
model that may include a system of— 
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E:\BILLS\H3590.AS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS