130
(such as code additions, corrections, or revi-
sions) for the application of quality meas-
ures previously published under clause (i), 
but may not, under this clause, change the 
quality measures under the reporting sys-
tem. 
‘‘(iii) 
IMPLEMENTATION.—Notwith-
standing any other provision of law, the 
Secretary may implement by program in-
struction or otherwise this subsection for 
2007. 
‘‘(B) FOR 2008.—
‘‘(i) IN GENERAL.—For purposes of re-
porting data on quality measures for cov-
ered professional services furnished during 
2008, the quality measures specified under 
this paragraph for covered professional serv-
ices shall be measures that have been adopt-
ed or endorsed by a consensus organization 
(such as the National Quality Forum or 
AQA), that include measures that have been 
submitted by a physician specialty, and 
that the Secretary identifies as having used 
a consensus-based process for developing 
such measures. Such measures shall include
131
structural measures, such as the use of elec-
tronic health records and electronic pre-
scribing technology. 
‘‘(ii) PROPOSED SET OF MEASURES.—
Not later than August 15, 2007, the Sec-
retary shall publish in the Federal Register 
a proposed set of quality measures that the 
Secretary determines are described in clause 
(i) and would be appropriate for eligible 
professionals to use to submit data to the 
Secretary in 2008. The Secretary shall pro-
vide for a period of public comment on such 
set of measures. 
‘‘(iii) FINAL SET OF MEASURES.—Not 
later than November 15, 2007, the Secretary 
shall publish in the Federal Register a final 
set of quality measures that the Secretary 
determines are described in clause (i) and 
would be appropriate for eligible profes-
sionals to use to submit data to the Sec-
retary in 2008. 
‘‘(3) COVERED PROFESSIONAL SERVICES AND EL-
IGIBLE PROFESSIONALS DEFINED.—For purposes of 
this subsection:
132
‘‘(A) COVERED PROFESSIONAL SERVICES.—
The term ‘covered professional services’ means 
services for which payment is made under, or is 
based on, the fee schedule established under this 
section and which are furnished by an eligible 
professional. 
‘‘(B) ELIGIBLE PROFESSIONAL.—The term 
‘eligible professional’ means any of the following: 
‘‘(i) A physician. 
‘‘(ii) A practitioner described in sec-
tion 1842(b)(18)(C). 
‘‘(iii) A physical or occupational ther-
apist or a qualified speech-language pathol-
ogist. 
‘‘(4) USE OF REGISTRY-BASED REPORTING.—As 
part of the publication of proposed and final quality 
measures for 2008 under clauses (ii) and (iii) of 
paragraph (2)(B), the Secretary shall address a mech-
anism whereby an eligible professional may provide 
data on quality measures through an appropriate 
medical registry (such as the Society of Thoracic Sur-
geons National Database), as identified by the Sec-
retary. 
‘‘(5) IDENTIFICATION
UNITS.—For purposes of 
applying this subsection, the Secretary may identify
133
eligible professionals through billing units, which may 
include the use of the Provider Identification Number, 
the unique physician identification number (described 
in section 1833(q)(1)), the taxpayer identification 
number, or the National Provider Identifier. For pur-
poses of applying this subsection for 2007, the Sec-
retary shall use the taxpayer identification number as 
the billing unit. 
‘‘(6) EDUCATION
AND
OUTREACH.—The Sec-
retary shall provide for education and outreach to eli-
gible professionals on the operation of this subsection. 
‘‘(7) LIMITATIONS ON REVIEW.—There shall be 
no administrative or judicial review under section 
1869, section 1878, or otherwise, of the development 
and implementation of the reporting system under 
paragraph (1), including identification of quality 
measures under paragraph (2) and the application of 
paragraphs (4) and (5). 
‘‘(8) IMPLEMENTATION.—The Secretary shall 
carry out this subsection acting through the Adminis-
trator of the Centers for Medicare & Medicaid Serv-
ices.’’. 
(c) TRANSITIONAL BONUS INCENTIVE PAYMENTS FOR 
QUALITY REPORTING IN 2007.—
134
(1) IN GENERAL.—With respect to covered profes-
sional services furnished during a reporting period 
(as defined in paragraph (6)(C)) by an eligible pro-
fessional, if—
(A) there are any quality measures that 
have been established under the physician report-
ing system that are applicable to any such serv-
ices furnished by such professional for such pe-
riod, and 
(B) the eligible professional satisfactorily 
submits (as determined under paragraph (2)) to 
the Secretary data on such quality measures in 
accordance with such reporting system for such 
reporting period, 
in addition to the amount otherwise paid under part 
B of title XVIII of the Social Security Act, subject to 
paragraph (3), there also shall be paid to the eligible 
professional (or to an employer or facility in the cases 
described in clause (A) of section 1842(b)(6) of the So-
cial Security Act (42 U.S.C. 1395u(b)(6))) from the 
Federal Supplementary Medical Insurance Trust 
Fund established under section 1841 of such Act (42 
U.S.C. 1395t) an amount equal to 1.5 percent of the 
Secretary’s estimate (based on claims submitted not 
later than two months after the end of the reporting
135
period) of the allowed charges under such part for all 
such covered professional services furnished during the 
reporting period. 
(2) SATISFACTORY REPORTING DESCRIBED.—For 
purposes of paragraph (1), an eligible professional 
shall be treated as satisfactorily submitting data on 
quality measures for covered professional services for 
a reporting period if quality measures have been re-
ported as follows: 
(A) THREE OR FEWER QUALITY MEASURES 
APPLICABLE.—If there are no more than 3 qual-
ity measures that are provided under the physi-
cian reporting system and that are applicable to 
such services of such professional furnished dur-
ing the period, each such quality measure has 
been reported under such system in at least 80 
percent of the cases in which such measure is re-
portable under the system. 
(B) FOUR OR MORE QUALITY MEASURES AP-
PLICABLE.—If there are 4 or more quality meas-
ures that are provided under the physician re-
porting system and that are applicable to such 
services of such professional furnished during the 
period, at least 3 such quality measures have 
been reported under such system in at least 80
136
percent of the cases in which the respective meas-
ure is reportable under the system. 
(3) PAYMENT LIMITATION.—
(A) IN GENERAL.—In no case shall the total 
payment made under this subsection to an eligi-
ble professional (or to an employer or facility in 
the cases described in clause (A) of section 
1842(b)(6) of the Social Security Act) exceed the 
product of—
(i) the total number of quality meas-
ures for which data are submitted under the 
physician reporting system for covered pro-
fessional services of such professional that 
are furnished during the reporting period; 
and 
(ii) 300 percent of the average per 
measure payment amount specified in sub-
paragraph (B). 
(B) AVERAGE
PER
MEASURE
PAYMENT 
AMOUNT SPECIFIED.—The average per measure 
payment amount specified in this subparagraph 
is an amount, estimated by the Secretary (based 
on claims submitted not later than two months 
after the end of the reporting period), equal to—
137
(i) the total of the amount of allowed 
charges under part B of title XVIII of the 
Social Security Act for all covered profes-
sional services furnished during the report-
ing period on claims for which quality 
measures are reported under the physician 
reporting system; divided by 
(ii) the total number of quality meas-
ures for which data are reported under such 
system for covered professional services fur-
nished during the reporting period. 
(4) FORM
OF
PAYMENT.—The payment under 
this subsection shall be in the form of a single consoli-
dated payment. 
(5) APPLICATION.—
(A) 
PHYSICIAN
REPORTING
SYSTEM 
RULES.—Paragraphs (5), (6), and (8) of section 
1848(k) of the Social Security Act, as added by 
subsection (b), shall apply for purposes of this 
subsection in the same manner as they apply for 
purposes of such section. 
(B) COORDINATION
WITH
OTHER
BONUS 
PAYMENTS.—The provisions of this subsection 
shall not be taken into account in applying sub-
sections (m) and (u) of section 1833 of the Social
138
Security Act (42 U.S.C. 1395l) and any pay-
ment under such subsections shall not be taken 
into account in computing allowable charges 
under this subsection. 
(C) 
IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement by program instruction or otherwise 
this subsection. 
(D) VALIDATION.—
(i) IN GENERAL.—Subject to the suc-
ceeding provisions of this subparagraph, for 
purposes of determining whether a measure 
is applicable to the covered professional 
services of an eligible professional under 
paragraph (2), the Secretary shall presume 
that if an eligible professional submits data 
for a measure, such measure is applicable to 
such professional. 
(ii) METHOD.— The Secretary shall 
validate (by sampling or other means as the 
Secretary determines to be appropriate) 
whether measures applicable to covered pro-
fessional services of an eligible professional 
have been reported.
139
(iii) DENIAL
OF
PAYMENT
AUTHOR-
ITY.—If the Secretary determines that an 
eligible professional has not reported meas-
ures applicable to covered professional serv-
ices of such professional, the Secretary shall 
not pay the bonus incentive payment. 
(E) LIMITATIONS ON REVIEW.—
(i) IN
GENERAL.—There shall be no 
administrative or judicial review under sec-
tion 1869 or 1878 of the Social Security Act 
or otherwise of—
(I) the determination of measures 
applicable to services furnished by eli-
gible professionals under this sub-
section; 
(II) the determination of satisfac-
tory reporting under paragraph (2); 
(III) the determination of the 
payment limitation under paragraph 
(3); and 
(IV) the determination of the 
bonus incentive payment under this 
subsection. 
(ii) 
TREATMENT
OF
DETERMINA-
TIONS.—A determination under this sub-