I 
111TH CONGRESS 
1ST SESSION H. R. 2919 
To amend part B of title XVIII of the Social Security Act to provide 
Medicare physician incentive payments for efficient areas. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 17, 2009 
Mr. BLUMENAUER 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 provide Medicare physician incentive payments 
for efficient areas. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Efficiency 
Incentive Act of 2009’’. 
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SEC. 2. PAYMENTS FOR EFFICIENT PHYSICIANS. 
Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by adding at the end the following new 
subsection: 
‘‘(x) INCENTIVE PAYMENTS FOR EFFICIENT PHYSI-
CIANS.— 
‘‘(1) IN GENERAL.—In the case of physicians’ 
services furnished on or after January 1, 2010, and 
before January 1, 2014, by a participating physician 
in an efficient area (as identified under paragraph 
(2)), in addition to the amount of payment that 
would otherwise be made for such services under this 
part, there also shall be paid an amount equal to 5 
percent of the payment amount for the services 
under this part. 
‘‘(2) IDENTIFICATION OF EFFICIENT AREAS.— 
‘‘(A) IN GENERAL.—Based upon available 
data, the Secretary shall identify those counties 
or equivalent areas in the United States in the 
lowest fifth percentile of utilization based on 
per capita spending for services provided in 
2007 under this part and part A. 
‘‘(B) 
IDENTIFICATION
OF
COUNTIES 
WHERE SERVICE IS FURNISHED.—For purposes 
of paying the additional amount specified in 
paragraph (1), if the Secretary uses the 5-digit 
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postal ZIP Code where the service is furnished, 
the dominant county of the postal ZIP Code (as 
determined by the United States Postal Service, 
or otherwise) shall be used to determine wheth-
er the postal ZIP Code is in a county described 
in subparagraph (A). 
‘‘(C) JUDICIAL
REVIEW.—There shall be 
no administrative or judicial review under sec-
tion 1869, 1878, or otherwise, respecting— 
‘‘(i) the identification of a county or 
other area under subparagraph (A); or 
‘‘(ii) the assignment of a postal ZIP 
Code to a county or other area under sub-
paragraph (B). 
‘‘(D) PUBLICATION OF LIST OF COUNTIES; 
POSTING ON WEBSITE.—With respect to a year 
for which a county or area is identified under 
this paragraph, the Secretary shall identify 
such counties or areas as part of the proposed 
and final rule to implement the physician fee 
schedule under section 1848 for the applicable 
year. The Secretary shall post the list of coun-
ties identified under this paragraph on the 
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Internet website of the Centers for Medicare & 
Medicaid Services.’’. 
Æ 
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