I 
118TH CONGRESS 
1ST SESSION H. R. 6371 
To provide for certain adjustments to the physician fee schedule under the 
Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 13, 2023 
Mr. MURPHY (for himself, Mr. BURGESS, Mr. WENSTRUP, Ms. KELLY of Illi-
nois, Mr. BUCSHON, Mr. VAN DREW, Mrs. MILLER-MEEKS, Mr. HARRIS, 
Mr. BABIN, Mr. JOYCE of Pennsylvania, Mr. JACKSON of Texas, Mr. 
MCCORMICK, Mr. FERGUSON, Mr. DUNN of Florida, and Mr. CARTER of 
Georgia) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee 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 provide for certain adjustments 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 cited as the ‘‘Provider Reimburse-
ment Stability Act of 2023’’. 
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SEC. 2. 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— 
‘‘(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. 
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‘‘(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. 3. BUDGET NEUTRALITY CORRECTIONS FOR OVER-
ESTIMATES AND UNDERESTIMATES IN UTILI-
ZATION. 
(a) IN GENERAL.—Section 1848(c)(2)(B) of the So-
cial Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is amend-
ed by adding at the end the following new clause: 
‘‘(vii) BUDGET NEUTRALITY CORREC-
TIONS FOR OVERESTIMATES AND UNDER-
ESTIMATES IN UTILIZATION.— 
‘‘(I) IN GENERAL.—In the case 
of a budget neutrality adjustment ap-
plied pursuant to clause (ii)(II) for an 
adjustment application year (as de-
fined in clause (viii)(I)) beginning 
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adjustment application year; 
and 
‘‘(bb) in the case that the 
Secretary determines under sub-
clause (I)(bb) that the difference 
between the estimated utilization 
and such actual utilization af-
fected the amount of the budget 
neutrality adjustment applied for 
such adjustment application year, 
the Secretary shall adjust the 
amount of payment made under 
this section for services furnished 
during the adjustment correction 
period (as defined in clause 
(viii)(II)) with respect to such 
year by such amount as deter-
mined necessary by the Secretary 
to reconcile the difference (which 
may be positive or negative) be-
tween— 
‘‘(AA) the budget neu-
trality adjustment that had 
been applied for such appli-
cation 
adjustment 
year, 
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using the estimated utiliza-
tion; and 
‘‘(BB) the budget neu-
trality 
adjustment 
that 
would have been applied for 
such year if such adjustment 
had been calculated using 
such actual utilization. 
‘‘(II) DEFINITIONS.—For pur-
poses of this clause: 
‘‘(aa) ADJUSTMENT
APPLI-
CATION
YEAR.—The term ‘ad-
justment application year’ means, 
with respect to an adjustment to 
relative value units made under 
clause (ii)(I) for which a budget 
neutrality 
adjustment 
under 
clause (ii)(II) is required, the 
year for which such adjustments 
are applied. 
‘‘(bb) 
ADJUSTMENT
COR-
RECTION
PERIOD.—The 
term 
‘adjustment 
correction 
period’ 
means, with respect to an adjust-
ment application year, the second 
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year beginning after such adjust-
ment application year. 
‘‘(cc) ESTIMATED
UTILIZA-
TION.—The term ‘estimated utili-
zation’ means, with respect to an 
adjustment to relative value units 
made under clause (ii)(I), an es-
timate of utilization associated 
with such adjustment used for 
purposes 
of 
applying 
clause 
(ii)(II).’’. 
(b) NONAPPLICATION OF BUDGET NEUTRALITY TO 
RECONCILIATION ADJUSTMENTS.—Section 1848(c)(2)(B) 
of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)) 
is amended— 
(1) in clause (iv)— 
(A) in subclause (V), by striking ‘‘and’’ at 
the end; 
(B) in subclause (VI), by striking the pe-
riod and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(VII) clause (vii)(I)(bb) for an 
adjustment correction period shall not 
be taken into account in applying 
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clause (ii)(II) with respect to such pe-
riod.’’; and 
(2) in clause (v), by adding at the end the fol-
lowing new subclause: 
‘‘(XII) 
REDUCTIONS
ATTRIB-
UTABLE TO AN ADJUSTMENT CORREC-
TION.—For an adjustment correction 
period, reduced expenditures attrib-
utable 
to 
application 
of 
clause 
(vii)(I)(bb) with respect to such pe-
riod.’’. 
SEC. 4. 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)), as amended by section 3, is 
further amended by adding at the end the following new 
clause: 
‘‘(viii) 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-
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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 
Secretary shall consult with relevant 
stakeholders, including physician spe-
cialty societies.’’. 
SEC. 5. LIMITATION ON YEAR-TO-YEAR CONVERSION FAC-
TOR VARIANCE. 
Section 1848(c)(2)(B) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)(B)), as amended by sections 3 and 
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4, is further amended— by adding at the end the following 
new clause: 
‘‘(ix) LIMITATION
ON
CONVERSION 
FACTOR VARIANCE.— 
‘‘(I) IN GENERAL.—In the case 
that application of clause (ii)(II) for a 
year (beginning with 2025) would re-
sult in a conversion factor established 
under subsection (d) for such year, 
not taking into account any adjust-
ment provided under such subsection, 
to vary by more than 2.5 percent com-
pared to such factor so established for 
the preceding year (in this subclause 
referred to as the ‘preceding year’s 
conversion 
factor’), 
the 
Secretary 
shall— 
‘‘(aa) if such application 
would result in a decrease in 
such conversion factor, modify 
any budget neutrality adjustment 
applied to such conversion factor 
pursuant to such clause such 
that such conversion factor is de-
creased by 2.5 percent, not tak-
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ing into account any adjustment 
provided under such subsection, 
compared to the preceding year’s 
conversion factor; and 
‘‘(bb) if such application 
would result in an increase in 
such conversion factor, modify 
any budget neutrality adjustment 
applied to such conversion factor 
pursuant to such clause such 
that such conversion factor is in-
creased by 2.5 percent, not tak-
ing into account any adjustment 
provided under such subsection, 
compared to the preceding year’s 
conversion factor. 
‘‘(II) SPECIAL RULE FOR 2025.— 
In applying subclause (I) with respect 
to the conversion factor established 
under subsection (d) for 2025, in de-
termining whether the application of 
clause (ii)(II) for such year would re-
sult in such conversion factor varying 
by more than 2.5 percent compared to 
such factor so established for 2024, 
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the Secretary shall take into account 
the increase to such conversion factor 
so established for 2024 provided 
under subsection (t). 
‘‘(III) CLARIFICATION RELATING 
TO
TRANSITION
TO
MULTIPLE
CON-
VERSION FACTORS.—For 2026, in ap-
plying subclause (I) with respect to 
the qualifying APM conversion factor 
(as described in subsection (d)(1)(A)) 
and the nonqualifying APM conver-
sion factor (as so described) estab-
lished under subsection (d) for such 
year, each reference in such subclause 
to the ‘preceding year’s conversion 
factor’ shall be deemed to be a ref-
erence to ‘the single conversion factor 
(as described in subsection (d)(1)(A)) 
so established for 2025’.’’. 
Æ 
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