I 
118TH CONGRESS 
1ST SESSION H. R. 6545 
To amend title XVIII of the Social Security Act to make improvements 
to the physician fee schedule under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 1, 2023 
Mrs. MILLER-MEEKS (for herself, Mr. BUCSHON, Ms. SCHRIER, Ms. KELLY 
of Illinois, Mr. BURGESS, Mr. MURPHY, Mr. WENSTRUP, Mr. BERA, Mr. 
CA´RDENAS, and Mr. RUIZ) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to make 
improvements to the physician fee schedule under the 
Medicare program. 
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 referred to as the ‘‘Physician Fee 
Schedule Update and Improvements Act’’. 
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SEC. 2. EXTENDING FLOOR FOR WORK GEOGRAPHIC 
INDEX. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-
ary 20, 2024’’ and inserting ‘‘January 1, 2025’’. 
SEC. 3. INCREASING SUPPORT FOR PHYSICIANS AND 
OTHER PRACTITIONERS IN ADJUSTING TO 
MEDICARE PAYMENT CHANGES. 
Section 1848(t)(1)(D) of the Social Security Act (42 
U.S.C. 1395w–4(t)(1)(D)) is amended by striking ‘‘1.25 
percent’’ and inserting ‘‘3 percent’’. 
SEC. 4. EXTENDING INCENTIVE PAYMENTS FOR PARTICIPA-
TION IN ELIGIBLE ALTERNATIVE PAYMENT 
MODELS. 
(a) IN GENERAL.—Section 1833(z) of the Social Se-
curity Act (42 U.S.C. 1395l(z)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘In the case’’ and in-
serting ‘‘Subject to subparagraph (E), in 
the case’’; 
(ii) by striking ‘‘ending with 2025’’ 
and inserting ‘‘ending with 2026’’; and 
(iii) by inserting ‘‘and 2026’’ after 
‘‘with respect to 2025’’; and 
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(B) by adding at the end the following new 
subparagraph: 
‘‘(E) SPECIAL PAYMENT RULE FOR 2026.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), with respect to an amount payable 
under subparagraph (A) for 2026 to an eli-
gible professional who is a qualifying APM 
participant for such year, such amount 
shall be reduced, in the case such partici-
pant has received payment under such sub-
paragraph— 
‘‘(I) for at least 4 years but 
fewer than 7 years, by 34 percent; or 
‘‘(II) for 7 years, by 67 percent. 
‘‘(ii) EXCEPTION.—If an eligible pro-
fessional described in clause (i) increased 
such professional’s financial risk (as speci-
fied by the Secretary) with respect to the 
furnishing of items and services during the 
most recent period for which data are 
available (which may be less than a year) 
for 2026 as compared to such profes-
sional’s financial risk with respect to the 
furnishing of such items and services dur-
ing the most recent period for which data 
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were available (which may be less than a 
year) for 2025, the Secretary may reduce 
the amount payable under subparagraph 
(A) for 2026 to such professional by a per-
centage that is less than the percentage 
otherwise applicable to such amount under 
clause (i) (and which may include 0 per-
cent).’’; 
(2) in paragraph (2)— 
(A) in subparagraph (B)— 
(i) in the subparagraph heading, by 
striking ‘‘2025’’ and inserting ‘‘2026’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2025’’ and inserting ‘‘2026’’; 
(B) in subparagraph (C)— 
(i) in the subparagraph heading, by 
striking ‘‘2026’’ and inserting ‘‘2027’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2026’’ and inserting ‘‘2027’’; 
and 
(C) in subparagraph (D), by striking 
‘‘2024, and 2025’’ and inserting ‘‘2024, 2025, 
and 2026’’; and 
(3) in paragraph (4)(B), by striking ‘‘2025’’ 
and inserting ‘‘2025 and 2026’’. 
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(b) 
CONFORMING
AMENDMENTS.—Section 
1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 
1395w–4(q)(1)(C)(iii) is amended— 
(1) in subclause (II), by striking ‘‘2025’’ and 
inserting ‘‘2026’’; and 
(2) in subclause (III), by striking ‘‘2026’’ and 
inserting ‘‘2027’’. 
SEC. 5. UPDATING THE BUDGET NEUTRALITY THRESHOLD. 
Section 1848(c)(2)(B)(ii)(II) of the Social Security 
Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)(II)) is amended— 
(1) by striking ‘‘Subject to’’ and inserting the 
following: 
‘‘(aa) IN
GENERAL.—Sub-
ject to’’; 
(2) in item (aa), as inserted by subparagraph 
(A), by striking ‘‘$20,000,000’’ and inserting ‘‘the 
amount specified in item (bb) for such year’’; and 
(3) by adding at the end the following new 
items: 
‘‘(bb) 
AMOUNT
SPECI-
FIED.—For purposes of item 
(aa), subject to item (cc), the 
amount specified in this item 
is— 
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‘‘(AA) for years before 
2025, $20,000,000; 
‘‘(BB) 
for 
2025, 
$53,000,000; and 
‘‘(CC) for 2026 and 
each subsequent year, the 
amount specified in this 
item for the preceding year. 
‘‘(cc) INDEXING LIMITATION 
ON ANNUAL ADJUSTMENTS.—For 
2030 and every subsequent fifth 
year, the Secretary shall increase 
the amount specified in item (bb) 
for such year by the cumulative 
increase in the MEI (as defined 
in section 1842(i)(3)) applicable 
to physicians’ services over the 5- 
year period ending on the last 
day of the preceding year.’’. 
SEC. 6. TIMELY UPDATES TO DIRECT COSTS USED TO CAL-
CULATE PRACTICE EXPENSE RVUS. 
Section 1848(c)(2)(B) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)(B)) is amended by adding at the 
end the following new clause: 
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‘‘(vii) TIMELY
UPDATES
TO
DIRECT 
COSTS USED TO CALCULATE PRACTICE EX-
PENSE RELATIVE VALUE UNITS.— 
‘‘(I) SIMULTANEOUS UPDATES TO 
DIRECT COST INPUTS AT LEAST ONCE 
EVERY 5 YEARS.—The Secretary shall, 
not less often than every 5 years, up-
date the prices and rates, as applica-
ble, for each of the direct costs inputs 
described in subclause (II) used in the 
methodology for calculating the prac-
tice expense relative value units under 
this subsection for physicians’ serv-
ices. Updates made pursuant to the 
previous sentence shall be made in the 
same year for all direct cost inputs 
described in such subclause. 
‘‘(II) DIRECT COSTS INPUT CAT-
EGORIES
DESCRIBED.—For purposes 
of this clause, the direct costs inputs 
described in this subclause are clinical 
staff wage rates, prices of medical 
supplies, and prices of equipment. 
‘‘(III) CONSULTATION.—In mak-
ing the updates under this clause, the 
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Secretary shall consult with relevant 
stakeholders, including physician spe-
cialty societies.’’. 
Æ 
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