ommendation, and MACPAC shall include, by mem-
ber, the results of that vote in the report containing 
the recommendation. 
‘‘(9) 
EXAMINATION
OF
BUDGET
CON-
SEQUENCES.—Before making any recommendations, 
MACPAC shall examine the budget consequences of 
such recommendations, directly or through consulta-
tion with appropriate expert entities. 
‘‘(c) MEMBERSHIP.— 
‘‘(1) NUMBER AND APPOINTMENT.—MACPAC 
shall be composed of 17 members appointed by the 
Comptroller General of the United States. 
‘‘(2) QUALIFICATIONS.— 
‘‘(A) IN
GENERAL.—The membership of 
MACPAC shall include individuals who have 
had direct experience as enrollees or parents of 
enrollees in Medicaid or CHIP and individuals 
with national recognition for their expertise in 
Federal safety net health programs, health fi-
nance and economics, actuarial science, health 
facility management, health plans and inte-
grated delivery systems, reimbursement of 
health facilities, health information technology, 
pediatric physicians, dentists, and other pro-
viders of health services, and other related 
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fields, who provide a mix of different profes-
sionals, broad geographic representation, and a 
balance between urban and rural representa-
tives. 
‘‘(B) INCLUSION.—The membership of 
MACPAC shall include (but not be limited to) 
physicians and other health professionals, em-
ployers, third-party payers, and individuals with 
expertise in the delivery of health services. Such 
membership shall also include consumers rep-
resenting children, pregnant women, the elderly, 
and individuals with disabilities, current or 
former representatives of State agencies respon-
sible for administering Medicaid, and current or 
former representatives of State agencies respon-
sible for administering CHIP. 
‘‘(C) MAJORITY NONPROVIDERS.—Individ-
uals who are directly involved in the provision, 
or management of the delivery, of items and 
services covered under Medicaid or CHIP shall 
not constitute a majority of the membership of 
MACPAC. 
‘‘(D) ETHICAL DISCLOSURE.—The Comp-
troller General of the United States shall estab-
lish a system for public disclosure by members 
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of MACPAC of financial and other potential 
conflicts of interest relating to such members. 
Members of MACPAC shall be treated as em-
ployees of Congress for purposes of applying 
title I of the Ethics in Government Act of 1978 
(Public Law 95–521). 
‘‘(3) TERMS.— 
‘‘(A) IN GENERAL.—The terms of mem-
bers of MACPAC shall be for 3 years except 
that the Comptroller General of the United 
States shall designate staggered terms for the 
members first appointed. 
‘‘(B) VACANCIES.—Any member appointed 
to fill a vacancy occurring before the expiration 
of the term for which the member’s predecessor 
was appointed shall be appointed only for the 
remainder of that term. A member may serve 
after the expiration of that member’s term until 
a successor has taken office. A vacancy in 
MACPAC shall be filled in the manner in which 
the original appointment was made. 
‘‘(4) COMPENSATION.—While serving on the 
business of MACPAC (including travel time), a 
member of MACPAC shall be entitled to compensa-
tion at the per diem equivalent of the rate provided 
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for level IV of the Executive Schedule under section 
5315 of title 5, United States Code; and while so 
serving away from home and the member’s regular 
place of business, a member may be allowed travel 
expenses, as authorized by the Chairman of 
MACPAC. Physicians serving as personnel of 
MACPAC may be provided a physician comparability 
allowance by MACPAC in the same manner as Gov-
ernment physicians may be provided such an allow-
ance by an agency under section 5948 of title 5, 
United States Code, and for such purpose subsection 
(i) of such section shall apply to MACPAC in the 
same manner as it applies to the Tennessee Valley 
Authority. For purposes of pay (other than pay of 
members of MACPAC) and employment benefits, 
rights, and privileges, all personnel of MACPAC 
shall be treated as if they were employees of the 
United States Senate. 
‘‘(5) CHAIRMAN; VICE CHAIRMAN.—The Comp-
troller General of the United States shall designate 
a member of MACPAC, at the time of appointment 
of the member as Chairman and a member as Vice 
Chairman for that term of appointment, except that 
in the case of vacancy of the Chairmanship or Vice 
Chairmanship, the Comptroller General of the 
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United States may designate another member for 
the remainder of that member’s term. 
‘‘(6) MEETINGS.—MACPAC shall meet at the 
call of the Chairman. 
‘‘(d) DIRECTOR AND STAFF; EXPERTS AND CON-
SULTANTS.—Subject to such review as the Comptroller 
General of the United States deems necessary to assure 
the efficient administration of MACPAC, MACPAC 
may— 
‘‘(1) employ and fix the compensation of an Ex-
ecutive Director (subject to the approval of the 
Comptroller General of the United States) and such 
other personnel as may be necessary to carry out its 
duties (without regard to the provisions of title 5, 
United States Code, governing appointments in the 
competitive service); 
‘‘(2) seek such assistance and support as may 
be required in the performance of its duties from ap-
propriate Federal departments and agencies; 
‘‘(3) enter into contracts or make other ar-
rangements, as may be necessary for the conduct of 
the work of MACPAC (without regard to section 
3709 of the Revised Statutes (41 U.S.C. 5)); 
‘‘(4) make advance, progress, and other pay-
ments which relate to the work of MACPAC; 
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‘‘(5) provide transportation and subsistence for 
persons serving without compensation; and 
‘‘(6) prescribe such rules and regulations as it 
deems necessary with respect to the internal organi-
zation and operation of MACPAC. 
‘‘(e) POWERS.— 
‘‘(1) OBTAINING
OFFICIAL
DATA.—MACPAC 
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 
Chairman, the head of that department or agency 
shall furnish that information to MACPAC on an 
agreed upon schedule. 
‘‘(2) DATA COLLECTION.—In order to carry out 
its functions, MACPAC shall— 
‘‘(A) utilize existing information, both pub-
lished and unpublished, where possible, collected 
and assessed either by its own staff or under 
other arrangements made in accordance with 
this section; 
‘‘(B) carry out, or award grants or con-
tracts for, original research and experimen-
tation, where existing information is inad-
equate; and 
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‘‘(C) adopt procedures allowing any inter-
ested 
party 
to 
submit 
information 
for 
MACPAC’s use in making reports and rec-
ommendations. 
‘‘(3) ACCESS OF GAO TO INFORMATION.—The 
Comptroller General of the United States shall have 
unrestricted access to all deliberations, records, and 
nonproprietary data of MACPAC, immediately upon 
request. 
‘‘(4) PERIODIC AUDIT.—MACPAC shall be sub-
ject to periodic audit by the Comptroller General of 
the United States. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) 
REQUEST
FOR
APPROPRIATIONS.— 
MACPAC shall submit requests for appropriations 
in the same manner as the Comptroller General of 
the United States submits requests for appropria-
tions, but amounts appropriated for MACPAC shall 
be separate from amounts appropriated for the 
Comptroller General of the United States. 
‘‘(2) AUTHORIZATION.—There are authorized to 
be appropriated such sums as may be necessary to 
carry out the provisions of this section.’’. 
(b) DEADLINE FOR INITIAL APPOINTMENTS.—Not 
later than January 1, 2009, the Comptroller General of 
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the United States shall appoint the initial members of the 
Medicaid and CHIP Payment and Access Commission es-
tablished under section 1900 of the Social Security Act 
(as added by subsection (a)). 
TITLE III—MEDICARE 
PROVISIONS 
Subtitle A—Primary Care 
SEC. 301. REFORMING PAYMENT SYSTEMS UNDER MEDI-
CARE TO SUPPORT PRIMARY CARE. 
(a) INCREASING
BUDGET
NEUTRALITY
LIMITS 
UNDER THE PHYSICIAN FEE SCHEDULE TO ACCOUNT 
FOR ANTICIPATED SAVINGS RESULTING FROM PAYMENTS 
FOR CERTAIN SERVICES
AND
THE COORDINATION
OF 
BENEFICIARY CARE.—Section 1848(c)(2)(B) of the Social 
Security Act (42 U.S.C. 1395w–4(c)(2)(B)), as amended 
by section 133 of the Medicare Improvements for Patients 
and Providers Act of 2008 (Public Law 110–275), is 
amended— 
(1) in clause (ii)(II), by striking ‘‘(iv) and (v)’’ 
and inserting ‘‘(iv), (v), and (vii)’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(vii) INCREASE
IN
LIMITATION
TO 
ACCOUNT FOR CERTAIN ANTICIPATED SAV-
INGS.— 
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‘‘(I) IN GENERAL.—Effective for 
fee schedules established beginning 
with 2009, the Secretary shall in-
crease the limitation on annual ad-
justments under clause (ii)(II) by an 
amount equal to the anticipated sav-
ings under parts A, B, and D (includ-
ing any savings with respect to items 
and services for which payment is not 
made under this section) which are a 
result of payments for designated pri-
mary care services and comprehensive 
care coordination services under sec-
tion 1834(m) and the coverage of pa-
tient-centered medical home services 
under section 1861(s)(2)(FF) (as de-
termined by the Secretary). 
‘‘(II) MECHANISM
TO
DETER-
MINE
APPLICATION
OF
INCREASE.— 
The Secretary shall establish a mecha-
nism for determining which relative 
value units established under this 
paragraph for physicians’ services 
shall be subject to an adjustment 
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under clause (ii)(I) as a result of the 
increase under subclause (I). 
‘‘(III) ADDITIONAL FUNDING AS 
DETERMINED
NECESSARY
BY
THE 
SECRETARY.—In 
addition 
to 
any 
funding that may be made available 
as a result of an increase in the limi-
tation on annual adjustments under 
subclause (I), there shall also be avail-
able to the Secretary, for purposes of 
making payments under this title for 
new services and capabilities to im-
prove care provided to individuals 
under this title and to generate effi-
ciencies under this title, such addi-
tional funds as the Secretary deter-
mines are necessary.’’. 
(b) SEPARATE
MEDICARE
PAYMENT
FOR
DES-
IGNATED PRIMARY CARE SERVICES AND COMPREHENSIVE 
CARE COORDINATION SERVICES.— 
(1) IN GENERAL.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection: 
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‘‘(m) PAYMENT FOR DESIGNATED PRIMARY CARE 
SERVICES
AND COMPREHENSIVE CARE COORDINATION 
SERVICES.— 
‘‘(1) IN GENERAL.—The Secretary shall pay for 
designated primary care services and comprehensive 
care coordination services furnished to an individual 
enrolled under this part. 
‘‘(2) PAYMENT AMOUNT.—The Secretary shall 
determine the amount of payment for designated 
primary care services and comprehensive care co-
ordination services under this subsection. 
‘‘(3) DOCUMENTATION
REQUIREMENTS.—The 
Secretary shall propose appropriate documentation 
requirements to justify payments for designated pri-
mary care services and comprehensive care coordina-
tion services under this subsection. 
‘‘(4) DEFINITIONS.— 
‘‘(A) COMPREHENSIVE
CARE
COORDINA-
TION SERVICES.—The term ‘comprehensive care 
coordination services’ means care coordination 
services with procedure codes established by the 
Secretary (as appropriate) which are furnished 
to an individual enrolled under this part by a 
primary or principal care physician. 
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(2) EFFECTIVE DATE.—The amendment made 
by this section shall apply to items and services fur-
nished on or after January 1, 2009. 
SEC. 302. COVERAGE OF PATIENT-CENTERED MEDICAL 
HOME SERVICES. 
(a) IN GENERAL.—Section 1861(s)(2) of the Social 
Security Act (42 U.S.C. 1395x(s)(2)), as amended by sec-
tion 152 of the Medicare Improvements for Patients and 
Providers Act of 2008 (Public Law 110–275), is amend-
ed— 
(1) in subparagraph (DD), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (EE), by inserting ‘‘and’’ 
at the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(FF) patient-centered medical home services 
(as defined in subsection (hhh)(1));’’. 
(b) DEFINITION OF PATIENT-CENTERED MEDICAL 
HOME SERVICES.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x), as amended by such section 152, 
is amended by adding at the end the following new sub-
section: 
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