I 
110TH CONGRESS 
2D SESSION 
H. R. 6386 
To amend title XVIII of the Social Security Act to extend and revise incentive 
payments for physician scarcity areas under part B of the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 26, 2008 
Mr. MCCARTHY of California introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee 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 title XVIII of the Social Security Act to extend 
and revise incentive payments for physician scarcity 
areas under part B of 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. EXTENSION AND REVISION OF MEDICARE IN-
CENTIVE PAYMENTS FOR PHYSICIAN SCAR-
CITY AREAS. 
(a) 5-YEAR EXTENSION.—Paragraph (1) of section 
1833(u) of the Social Security Act (42 U.S.C. 1395l(u)) 
is amended by striking ‘‘2008’’ and inserting ‘‘2012’’. 
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(b) CHANGE IN ELIGIBILITY CRITERIA.—Such sec-
tion is further amended— 
(1) in paragraph (1)(A)— 
(A) by inserting ‘‘or paragraph (8), as the 
case may be’’ after ‘‘paragraph (4)’’; and 
(B) by inserting ‘‘(or 2.5 percent in the 
cases specified in paragraph (8))’’ after ‘‘5 per-
cent’’; 
(2) in each of clauses (i) and (ii) of paragraph 
(2)(C), by inserting ‘‘and paragraph (8)’’ after ‘‘in 
this paragraph’’; 
(3) in paragraph (3), by striking ‘‘The Sec-
retary’’ and inserting ‘‘For years before 2009, the 
Secretary’’; 
(4) in paragraph (4)(A), by striking ‘‘The Sec-
retary’’ and inserting ‘‘For years before 2009, the 
Secretary’’; and 
(5) by adding at the end the following new 
paragraph: 
‘‘(8) NEW RULES FOR SCARCITY AREAS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B)(ii), in applying paragraph (1) in the 
case of physicians’ services furnished on or 
after July 1, 2008— 
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‘‘(i) the term ‘primary care scarcity 
county’ means a county (or equivalent 
area) which the Secretary identifies as hav-
ing a primary care ratio (as determined 
under paragraph (2)(C)(i)) of less than 1 
to 150; 
‘‘(ii) the term ‘specialist care scarcity 
county’ means a county (or equivalent 
area) which the Secretary identifies as hav-
ing a specialist care ratio (as determined 
under paragraph (2)(C)(ii)) of less than 1 
to 150; 
‘‘(iii) for physicians’ services furnished 
by a primary care physician in a primary 
care scarcity county (as defined in clause 
(i)) which the Secretary identifies under 
such clause as having a primary care ratio 
of more than 1 to 300, ‘2.5 percent’ shall 
be substituted for ‘5 percent’ in paragraph 
(1); and 
‘‘(iv) for physicians’ services furnished 
by a physician, who is not a primary care 
physician, in a specialist care scarcity 
county (as defined in clause (ii)) which the 
Secretary identifies under such clause as 
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having a specialist care ratio of more than 
1 to 300, ‘2.5 percent’ shall be substituted 
for ‘5 percent’ in paragraph (1). 
The provisions of subparagraphs (B) through 
(D) of paragraph (4) shall apply to identifica-
tion of counties under this subparagraph in the 
same manner as they apply to the identification 
of counties under subparagraph (A) of para-
graph (4). 
‘‘(B) REVIEW OF RATIOS.— 
‘‘(i) STUDY.—The Secretary, in con-
sultation with the Medicare Payment Advi-
sory Commission and the Comptroller Gen-
eral of the United States, shall conduct a 
study to better determine whether the pri-
mary and specialist care ratios applied 
under subparagraph (A) are appropriate to 
provide the proper incentive payments for 
physician scarcity areas. 
‘‘(ii) AUTHORITY
TO
APPLY
DIF-
FERENT
RATIOS.—In the case of physi-
cians’ services furnished on or after such 
date (no earlier than January 1, 2012) as 
the Secretary may specify, if the Secretary 
determines based on the study conducted 
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