I 
109TH CONGRESS 
1ST SESSION H. R. 4078 
To amend part B of title XVIII of the Social Security Act to establish 
a floor for Medicare physician payment rates for 2006 at the level 
for 2005. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 19, 2005 
Mr. NORWOOD (for himself and Mr. WHITFIELD) 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 subse-
quently 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 establish a floor for Medicare physician payment 
rates for 2006 at the level for 2005. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS; PURPOSE. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Maintaining Medicare Access Act of 2005’’. 
(b) FINDINGS.—Congress finds the following: 
(1) The Medicare physician fee schedule is up-
dated on an annual basis according to a formula
specified by statute (in this subsection referred to as 
the ‘‘SGR formula’’). The SGR formula requires the 
Centers for Medicare & Medicaid Services to adjust 
the update depending on how actual expenditures 
compare to a target rate, called the sustainable 
growth rate. 
(2) The report of the trustees of the Medicare 
trust funds states that under the SGR formula, phy-
sicians will receive negative payment updates for 
each year from 2006 through 2012 and it is pro-
jected that physician payment rates will not return 
to their 2002 level until after 2013. 
(3) The report of the trustees of the Medicare 
trust funds further states that under the SGR for-
mula physician reimbursement rates could be re-
duced by more than 30 percent during the period be-
tween 2006 and 2013. However, the cost of pro-
viding services will rise by an estimated 20 percent 
during that period. 
(4) Such reductions of the physician reimburse-
ment rates will inhibit physicians from providing 
needed services to Medicare beneficiaries because 
physicians will be unable to afford to treat their cur-
rent Medicare patients or treat new Medicare pa-
tients.
(5) Physician practices tend to be small busi-
nesses that do not have the resources necessary to 
absorb continued negative updates in payment for 
their Medicare patients. 
(6) Lack of timely Congressional action to pre-
vent a reduction in reimbursement rate from the 
2005 rate could jeopardize Medicare patients’ ability 
to promptly obtain care. 
(7) Instability in next year’s physician reim-
bursement rate will prevent access to quality care 
for Medicare beneficiaries. 
(8) Congress should replace the SGR formula 
with a system that properly accounts for the cost of 
delivering health care services to Medicare patients. 
(9) The Medicare Payment Advisory Commis-
sion has found that an update in physician reim-
bursement rates that is based on the Medicare Eco-
nomic Index (MEI) is more predictable than the 
SGR formula, recognizes the true costs of providing 
physician services to Medicare patients, recognizes 
inflation in physician practice costs and general 
wage levels, and should replace the SGR formula. 
(c) PURPOSE.—The purpose of this Act is to provide 
a floor for the Medicare physician reimbursement rate for 
2006.
SEC. 2. MEDICARE PHYSICIAN PAYMENT RATE FLOOR FOR 
2006. 
(a) IN GENERAL.—Section 1848(d)(1) of the Social 
Security Act (42 U.S.C. 1395w–4(d)(1)) is amended— 
(1) in subparagraph (A), by striking ‘‘The con-
version factor’’ and inserting ‘‘Except as otherwise 
provided in this subsection, the conversion factor’’; 
and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) FLOOR
FOR
2006.—Except as pro-
vided in subparagraph (D), the single conver-
sion factor for 2006 under this subsection shall 
in no case be less than the single conversion 
factor for 2005. The previous sentence shall not 
apply in determining the single conversion fac-
tor for any subsequent year.’’. 
(b) NOT TREATED AS CHANGE IN LAW AND REGULA-
TION
IN
SUSTAINABLE
GROWTH
RATE
DETERMINA-
TION.—The amendments made by subsection (a) shall not 
be treated as a change in law for purposes of applying 
section 1848(f)(2)(D) of the Social Security Act (42 
U.S.C. 1395w–4(f)(2)(D)). 
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