I 
112TH CONGRESS 
1ST SESSION 
H. R. 560 
To amend titles XVIII and XIX of the Social Security Act to ensure propor-
tional representation of rural interests on the Medicare Payment Advisory 
Commission and the Medicaid and CHIP Payment and Access Commis-
sion, and to provide for greater transparency in proceedings of those 
Commissions. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2011 
Mr. WALDEN (for himself, Mr. THOMPSON of California, Mr. ROSS of Arkan-
sas, Mrs. MCMORRIS RODGERS, and Mr. MATHESON) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to ensure proportional representation of rural interests 
on the Medicare Payment Advisory Commission and the 
Medicaid and CHIP Payment and Access Commission, 
and to provide for greater transparency in proceedings 
of those Commissions. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Representation 
and Transparency Improvement Act’’. 
SEC. 2. ENSURING PROPORTIONAL REPRESENTATION OF 
INTERESTS OF RURAL AREAS ON THE MEDI-
CARE 
PAYMENT 
ADVISORY 
COMMISSION 
(MEDPAC) AND GREATER TRANSPARENCY OF 
MEDPAC PROCEEDINGS. 
(a) RURAL REPRESENTATION.—Paragraph (2) of 
section 1805(c) of the Social Security Act (42 U.S.C. 
1395b–6(c)) is amended— 
(1) in subparagraph (A), by inserting ‘‘con-
sistent with subparagraph (E)’’ after ‘‘rural rep-
resentatives’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(E) PROPORTIONAL REPRESENTATION OF 
INTERESTS OF RURAL AREAS.—In order to pro-
vide a balance between urban and rural rep-
resentatives under subparagraph (A), the pro-
portion of members of the Commission who rep-
resent the interests of health care providers and 
Medicare beneficiaries located in rural areas 
shall be no less than the proportion of the total 
number of Medicare beneficiaries who reside in 
rural areas.’’. 
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(b) GREATER TRANSPARENCY OF PROCEEDINGS.— 
Such section is further amended by adding at the end the 
following new paragraph: 
‘‘(7) 
GREATER
TRANSPARENCY
OF
PRO-
CEEDINGS.—The Commission shall provide through 
the Internet or such easy public access to and full 
and timely public disclosure of its proceedings, such 
as through the posting of audio or video coverage of 
its proceedings and of transcripts of its proceedings, 
as may be practicable within the resources available 
to the Commission.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to appointments to the Medicare 
Payment Advisory Commission made after the date of en-
actment of this Act and the amendment made by sub-
section (b) shall apply to proceedings occurring on or after 
the date that is 6 months after the date of the enactment 
of this Act. 
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SEC. 3. ENSURING PROPORTIONAL REPRESENTATION OF 
INTERESTS OF RURAL AREAS ON THE MED-
ICAID AND CHIP PAYMENT AND ACCESS COM-
MISSION (MACPAC) AND GREATER TRANS-
PARENCY OF MACPAC PROCEEDINGS. 
(a) RURAL REPRESENTATION.—Paragraph (2) of 
section 1900(c) of the Social Security Act (42 U.S.C. 
1396(c)) is amended— 
(1) in subparagraph (A), by inserting ‘‘con-
sistent with subparagraph (E)’’ after ‘‘rural rep-
resentation’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(E) PROPORTIONAL REPRESENTATION OF 
INTERESTS OF RURAL AREAS.—In order to pro-
vide a balance between urban and rural rep-
resentation under subparagraph (A), the pro-
portion of members of MACPAC who represent 
the interests of health care providers and Med-
icaid beneficiaries located in rural areas shall be 
no less than the proportion of the total number 
of Medicaid beneficiaries who reside in rural 
areas.’’. 
(b) GREATER TRANSPARENCY OF PROCEEDINGS.— 
Such section is further amended by adding at the end the 
following new paragraph: 
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‘‘(7) 
GREATER
TRANSPARENCY
OF
PRO-
CEEDINGS.—The MACPAC shall provide through 
the Internet for such easy public access to and full 
and timely public disclosure of its proceedings, such 
as through the posting of audio or video coverage of 
its proceedings and of transcripts of its proceedings, 
as may be practicable within the resources available 
to MACPAC.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to appointments to the Medicaid 
and CHIP Payment and Access Commission made after 
the date of enactment of this Act and the amendment 
made by subsection (b) shall apply to proceedings occur-
ring on or after the date that is 6 months after the date 
of the enactment of this Act. 
Æ 
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