832 
HR 3590 EAS/PP 
‘‘(A) Any estimate of the Secretary for pur-
poses of determining the factors described in 
paragraph (2). 
‘‘(B) Any period selected by the Secretary 
for such purposes.’’. 
SEC. 3134. MISVALUED CODES UNDER THE PHYSICIAN FEE 
SCHEDULE. 
(a) IN GENERAL.—Section 1848(c)(2) of the Social Se-
curity Act (42 U.S.C. 1395w–4(c)(2)) is amended by add-
ing at the end the following new subparagraphs: 
‘‘(K) POTENTIALLY MISVALUED CODES.— 
‘‘(i) 
IN
GENERAL.—The 
Secretary 
shall— 
‘‘(I) periodically identify services 
as being potentially misvalued using 
criteria specified in clause (ii); and 
‘‘(II) review and make appro-
priate adjustments to the relative val-
ues established under this paragraph 
for services identified as being poten-
tially misvalued under subclause (I). 
‘‘(ii) IDENTIFICATION OF POTENTIALLY 
MISVALUED CODES.—For purposes of iden-
tifying potentially misvalued services pur-
suant to clause (i)(I), the Secretary shall ex-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00832
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
833 
HR 3590 EAS/PP 
amine (as the Secretary determines to be 
appropriate) codes (and families of codes as 
appropriate) for which there has been the 
fastest growth; codes (and families of codes 
as appropriate) that have experienced sub-
stantial changes in practice expenses; codes 
for new technologies or services within an 
appropriate period (such as 3 years) after 
the relative values are initially established 
for such codes; multiple codes that are fre-
quently billed in conjunction with fur-
nishing a single service; codes with low rel-
ative values, particularly those that are 
often billed multiple times for a single treat-
ment; codes which have not been subject to 
review since the implementation of the 
RBRVS 
(the 
so-called 
‘Harvard-valued 
codes’); and such other codes determined to 
be appropriate by the Secretary. 
‘‘(iii) REVIEW AND ADJUSTMENTS.— 
‘‘(I) The Secretary may use exist-
ing processes to receive recommenda-
tions on the review and appropriate 
adjustment of potentially misvalued 
services described in clause (i)(II). 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00833
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
834 
HR 3590 EAS/PP 
‘‘(II) The Secretary may conduct 
surveys, other data collection activities, 
studies, or other analyses as the Sec-
retary determines to be appropriate to 
facilitate the review and appropriate 
adjustment described in clause (i)(II). 
‘‘(III) The Secretary may use 
analytic contractors to identify and 
analyze services identified under clause 
(i)(I), conduct surveys or collect data, 
and make recommendations on the re-
view and appropriate adjustment of 
services described in clause (i)(II). 
‘‘(IV) The Secretary may coordi-
nate the review and appropriate ad-
justment described in clause (i)(II) 
with the periodic review described in 
subparagraph (B). 
‘‘(V) As part of the review and 
adjustment described in clause (i)(II), 
including with respect to codes with 
low relative values described in clause 
(ii), the Secretary may make appro-
priate 
coding 
revisions 
(including 
using existing processes for consider-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00834
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
835 
HR 3590 EAS/PP 
ation of coding changes) which may 
include consolidation of individual 
services into bundled codes for payment 
under the fee schedule under subsection 
(b). 
‘‘(VI) The provisions of subpara-
graph (B)(ii)(II) shall apply to adjust-
ments to relative value units made 
pursuant to this subparagraph in the 
same manner as such provisions apply 
to adjustments under subparagraph 
(B)(ii)(II). 
‘‘(L) 
VALIDATING
RELATIVE
VALUE 
UNITS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
establish a process to validate relative value 
units under the fee schedule under sub-
section (b). 
‘‘(ii) COMPONENTS AND ELEMENTS OF 
WORK.—The process described in clause (i) 
may include validation of work elements 
(such as time, mental effort and profes-
sional judgment, technical skill and phys-
ical effort, and stress due to risk) involved 
with furnishing a service and may include 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00835
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
836 
HR 3590 EAS/PP 
validation of the pre-, post-, and intra-serv-
ice components of work. 
‘‘(iii) SCOPE OF CODES.—The valida-
tion of work relative value units shall in-
clude a sampling of codes for services that 
is the same as the codes listed under sub-
paragraph (K)(ii). 
‘‘(iv) METHODS.—The Secretary may 
conduct the validation under this subpara-
graph using methods described in subclauses 
(I) through (V) of subparagraph (K)(iii) as 
the Secretary determines to be appropriate. 
‘‘(v) ADJUSTMENTS.—The Secretary 
shall make appropriate adjustments to the 
work relative value units under the fee 
schedule under subsection (b). The provi-
sions of subparagraph (B)(ii)(II) shall 
apply to adjustments to relative value units 
made pursuant to this subparagraph in the 
same manner as such provisions apply to 
adjustments 
under 
subparagraph 
(B)(ii)(II).’’. 
(b) IMPLEMENTATION.— 
(1) ADMINISTRATION.— 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00836
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
837 
HR 3590 EAS/PP 
(A) Chapter 35 of title 44, United States 
Code and the provisions of the Federal Advisory 
Committee Act (5 U.S.C. App.) shall not apply 
to this section or the amendment made by this 
section. 
(B) Notwithstanding any other provision of 
law, the Secretary may implement subpara-
graphs (K) and (L) of 1848(c)(2) of the Social 
Security Act, as added by subsection (a), by pro-
gram instruction or otherwise. 
(C) Section 4505(d) of the Balanced Budget 
Act of 1997 is repealed. 
(D) Except for provisions related to con-
fidentiality of information, the provisions of the 
Federal Acquisition Regulation shall not apply 
to this section or the amendment made by this 
section. 
(2) FOCUSING CMS RESOURCES ON POTENTIALLY 
OVERVALUED CODES.—Section 1868(a) of the Social 
Security Act (42 U.S.C. 1395ee(a)) is repealed. 
SEC. 3135. MODIFICATION OF EQUIPMENT UTILIZATION 
FACTOR FOR ADVANCED IMAGING SERVICES. 
(a) ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT 
HIGHER PRESUMED UTILIZATION.—Section 1848 of the 
Social Security Act (42 U.S.C. 1395w–4) is amended— 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00837
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
838 
HR 3590 EAS/PP 
(1) in subsection (b)(4)— 
(A) in subparagraph (B), by striking ‘‘sub-
paragraph (A)’’ and inserting ‘‘this paragraph’’; 
and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(C) ADJUSTMENT IN PRACTICE EXPENSE 
TO REFLECT HIGHER PRESUMED UTILIZATION.— 
Consistent with the methodology for computing 
the number of practice expense relative value 
units under subsection (c)(2)(C)(ii) with respect 
to advanced diagnostic imaging services (as de-
fined in section 1834(e)(1)(B)) furnished on or 
after January 1, 2010, the Secretary shall adjust 
such number of units so it reflects— 
‘‘(i) in the case of services furnished on 
or after January 1, 2010, and before Janu-
ary 1, 2013, a 65 percent (rather than 50 
percent) presumed rate of utilization of im-
aging equipment; 
‘‘(ii) in the case of services furnished 
on or after January 1, 2013, and before 
January 1, 2014, a 70 percent (rather than 
50 percent) presumed rate of utilization of 
imaging equipment; and 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00838
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
839 
HR 3590 EAS/PP 
‘‘(iii) in the case of services furnished 
on or after January 1, 2014, a 75 percent 
(rather than 50 percent) presumed rate of 
utilization of imaging equipment.’’; and 
(2) in subsection (c)(2)(B)(v), by adding at the 
end the following new subclauses: 
‘‘(III) CHANGE IN PRESUMED UTI-
LIZATION
LEVEL
OF
CERTAIN
AD-
VANCED
DIAGNOSTIC
IMAGING
SERV-
ICES FOR 2010 THROUGH 2012.—Effec-
tive for fee schedules established begin-
ning with 2010 and ending with 2012, 
reduced expenditures attributable to the 
presumed rate of utilization of imaging 
equipment of 65 percent under sub-
section (b)(4)(C)(i) instead of a pre-
sumed rate of utilization of such equip-
ment of 50 percent. 
‘‘(IV) CHANGE IN PRESUMED UTI-
LIZATION
LEVEL
OF
CERTAIN
AD-
VANCED
DIAGNOSTIC
IMAGING
SERV-
ICES FOR 2013.—Effective for fee sched-
ules established for 2013, reduced ex-
penditures attributable to the presumed 
rate of utilization of imaging equip-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00839
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
840 
HR 3590 EAS/PP 
ment of 70 percent under subsection 
(b)(4)(C)(ii) instead of a presumed 
rate of utilization of such equipment of 
50 percent. 
‘‘(V) CHANGE IN PRESUMED UTI-
LIZATION
LEVEL
OF
CERTAIN
AD-
VANCED
DIAGNOSTIC
IMAGING
SERV-
ICES
FOR
2014
AND
SUBSEQUENT 
YEARS.—Effective for fee schedules es-
tablished beginning with 2014, reduced 
expenditures attributable to the pre-
sumed rate of utilization of imaging 
equipment of 75 percent under sub-
section (b)(4)(C)(iii) instead of a pre-
sumed rate of utilization of such equip-
ment of 50 percent.’’. 
(b) ADJUSTMENT IN TECHNICAL COMPONENT ‘‘DIS-
COUNT’’ ON SINGLE-SESSION IMAGING TO CONSECUTIVE 
BODY PARTS.—Section 1848 of the Social Security Act (42 
U.S.C. 1395w–4), as amended by subsection (a), is amend-
ed— 
(1) in subsection (b)(4), by adding at the end the 
following new subparagraph: 
‘‘(D) ADJUSTMENT IN TECHNICAL COMPO-
NENT DISCOUNT ON SINGLE-SESSION IMAGING IN-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00840
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
841 
HR 3590 EAS/PP 
VOLVING CONSECUTIVE BODY PARTS.—For serv-
ices furnished on or after July 1, 2010, the Sec-
retary shall increase the reduction in payments 
attributable to the multiple procedure payment 
reduction applicable to the technical component 
for imaging under the final rule published by the 
Secretary in the Federal Register on November 
21, 2005 (part 405 of title 42, Code of Federal 
Regulations) from 25 percent to 50 percent.’’; 
and 
(2) in subsection (c)(2)(B)(v), by adding at the 
end the following new subclause: 
‘‘(VI) ADDITIONAL REDUCED PAY-
MENT FOR MULTIPLE IMAGING PROCE-
DURES.—Effective for fee schedules es-
tablished beginning with 2010 (but not 
applied for services furnished prior to 
July 1, 2010), reduced expenditures at-
tributable to the increase in the mul-
tiple procedure payment reduction 
from 25 to 50 percent (as described in 
subsection (b)(4)(D)).’’. 
(c) ANALYSIS BY THE CHIEF ACTUARY OF THE CEN-
TERS FOR MEDICARE & MEDICAID SERVICES.—Not later 
than January 1, 2013, the Chief Actuary of the Centers for 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00841
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
842 
HR 3590 EAS/PP 
Medicare & Medicaid Services shall make publicly available 
an analysis of whether, for the period of 2010 through 2019, 
the cumulative expenditure reductions under title XVIII of 
the Social Security Act that are attributable to the adjust-
ments under the amendments made by this section are pro-
jected to exceed $3,000,000,000. 
SEC. 3136. REVISION OF PAYMENT FOR POWER-DRIVEN 
WHEELCHAIRS. 
(a) IN GENERAL.—Section 1834(a)(7)(A) of the Social 
Security Act (42 U.S.C. 1395m(a)(7)(A)) is amended— 
(1) in clause (i)— 
(A) in subclause (II), by inserting ‘‘sub-
clause (III) and’’ after ‘‘Subject to’’; and 
(B) by adding at the end the following new 
subclause: 
‘‘(III) SPECIAL RULE FOR POWER- 
DRIVEN WHEELCHAIRS.—For purposes 
of payment for power-driven wheel-
chairs, subclause (II) shall be applied 
by substituting ‘15 percent’ and ‘6 per-
cent’ for ‘10 percent’ and ‘7.5 percent’, 
respectively.’’; and 
(2) in clause (iii)— 
(A) in the heading, by inserting ‘‘COMPLEX, 
REHABILITATIVE’’ before ‘‘POWER-DRIVEN’’; and 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00842
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
843 
HR 3590 EAS/PP 
(B) by inserting ‘‘complex, rehabilitative’’ 
before ‘‘power-driven’’. 
(b) 
TECHNICAL
AMENDMENT.—Section 
1834(a)(7)(C)(ii)(II) of the Social Security Act (42 U.S.C. 
1395m(a)(7)(C)(ii)(II)) is amended by striking ‘‘(A)(ii) 
or’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), the 
amendments made by subsection (a) shall take effect 
on January 1, 2011, and shall apply to power-driven 
wheelchairs furnished on or after such date. 
(2) APPLICATION
TO
COMPETITIVE
BIDDING.— 
The amendments made by subsection (a) shall not 
apply to payment made for items and services fur-
nished pursuant to contracts entered into under sec-
tion 1847 of the Social Security Act (42 U.S.C. 
1395w–3) prior to January 1, 2011, pursuant to the 
implementation of subsection (a)(1)(B)(i)(I) of such 
section 1847. 
SEC. 3137. HOSPITAL WAGE INDEX IMPROVEMENT. 
(a) EXTENSION OF SECTION 508 HOSPITAL RECLASSI-
FICATIONS.— 
(1) IN GENERAL.—Subsection (a) of section 106 
of division B of the Tax Relief and Health Care Act 
of 2006 (42 U.S.C. 1395 note), as amended by section 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00843
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
844 
HR 3590 EAS/PP 
117 of the Medicare, Medicaid, and SCHIP Extension 
Act of 2007 (Public Law 110–173) and section 124 
of the Medicare Improvements for Patients and Pro-
viders Act of 2008 (Public Law 110–275), is amended 
by striking ‘‘September 30, 2009’’ and inserting 
‘‘September 30, 2010’’. 
(2) USE OF PARTICULAR WAGE INDEX IN FISCAL 
YEAR 2010.—For purposes of implementation of the 
amendment made by this subsection during fiscal 
year 2010, the Secretary shall use the hospital wage 
index that was promulgated by the Secretary in the 
Federal Register on August 27, 2009 (74 Fed. Reg. 
43754), and any subsequent corrections. 
(b) PLAN FOR REFORMING THE MEDICARE HOSPITAL 
WAGE INDEX SYSTEM.— 
(1) IN GENERAL.—Not later than December 31, 
2011, the Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall 
submit to Congress a report that includes a plan to 
reform the hospital wage index system under section 
1886 of the Social Security Act. 
(2) DETAILS.—In developing the plan under 
paragraph (1), the Secretary shall take into account 
the goals for reforming such system set forth in the 
Medicare Payment Advisory Commission June 2007 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00844
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
845 
HR 3590 EAS/PP 
report entitled ‘‘Report to Congress: Promoting Great-
er Efficiency in Medicare’’, including establishing a 
new hospital compensation index system that— 
(A) uses Bureau of Labor Statistics data, or 
other data or methodologies, to calculate relative 
wages for each geographic area involved; 
(B) minimizes wage index adjustments be-
tween and within metropolitan statistical areas 
and statewide rural areas; 
(C) includes methods to minimize the vola-
tility of wage index adjustments that result from 
implementation of policy, while maintaining 
budget neutrality in applying such adjustments; 
(D) takes into account the effect that imple-
mentation of the system would have on health 
care providers and on each region of the country; 
(E) addresses issues related to occupational 
mix, such as staffing practices and ratios, and 
any evidence on the effect on quality of care or 
patient safety as a result of the implementation 
of the system; and 
(F) provides for a transition. 
(3) CONSULTATION.—In developing the plan 
under paragraph (1), the Secretary shall consult with 
relevant affected parties. 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00845
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
865 
HR 3590 EAS/PP 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii) and subparagraphs (C) and (D), the 
service area for an MA local plan in an 
urban area shall be the Core Based Statis-
tical Area (in this paragraph referred to as 
a ‘CBSA’) or, if applicable, a conceptually 
similar alternative classification, as defined 
by the Director of the Office of Management 
and Budget. 
‘‘(ii) CBSA COVERING MORE THAN ONE 
STATE.—In the case of a CBSA (or alter-
native classification) that covers more than 
one State, the Secretary shall divide the 
CBSA (or alternative classification) into 
separate service areas with respect to each 
State covered by the CBSA (or alternative 
classification). 
‘‘(B) RURAL AREAS.—Subject to subpara-
graphs (C) and (D), the service area for an MA 
local plan in a rural area shall be a county that 
does not qualify for inclusion in a CBSA (or al-
ternative classification), as defined by the Direc-
tor of the Office of Management and Budget. 
‘‘(C) REFINEMENTS TO SERVICE AREAS.— 
For 2015 and succeeding years, in order to re-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00865
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS