I 
111TH CONGRESS 
1ST SESSION H. R. 2718 
To amend title XVIII of the Social Security Act to create a sensible infra-
structure for delivery system reform by renaming the Medicare Payment 
Advisory Commission, making the Commission an executive branch agen-
cy, and providing the Commission new resources and authority to imple-
ment Medicare payment policy. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 4, 2009 
Mr. COOPER introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to create 
a sensible infrastructure for delivery system reform by 
renaming the Medicare Payment Advisory Commission, 
making the Commission an executive branch agency, and 
providing the Commission new resources and authority 
to implement Medicare payment policy. 
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 ‘‘Medicare Payment Ad-
visory Commission (MedPAC) Reform Act of 2009’’. 
SEC. 2. RENAMING AND REFORMING THE MEDICARE PAY-
MENT ADVISORY COMMISSION. 
(a) AMENDMENT TO TITLE.— 
(1) IN GENERAL.—Section 1805 of the Social 
Security Act (42 U.S.C. 1395b–6) is amended— 
(A) in the heading, by striking ‘‘MEDI-
CARE
PAYMENT
ADVISORY
COMMISSION’’ 
and inserting ‘‘MEDICARE
PAYMENT
AND 
ACCESS COMMISSION’’; and 
(B) in subsection (a), by striking ‘‘Medi-
care Payment Advisory Commission’’ and in-
serting ‘‘Medicare Payment and Access Com-
mission (or ‘MedPAC’)’’. 
(2) REFERENCES.—Any reference to the Medi-
care Payment Advisory Commission shall be deemed 
a reference to the Medicare Payment and Access 
Commission. 
(b) ESTABLISHMENT AS EXECUTIVE AGENCY.—Sec-
tion 1805 of the Social Security Act (42 U.S.C. 1395b– 
6) is amended— 
(1) in the heading, by striking ‘‘ADVISORY’’; 
(2) in subsection (a)— 
(A) by striking ‘‘Advisory’’; and 
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(iii) by adding at the end the fol-
lowing new subparagraphs: 
‘‘(B) LIMITATION ON NUMBER OF TERMS 
SERVED.—An individual may not be appointed 
as a member of the Commission for more than 
2 consecutive terms. 
‘‘(C) MEMBERS CURRENTLY APPOINTED.— 
‘‘(i) IN
GENERAL.—Any individual 
serving as a member of the Commission as 
of the date of enactment of the Medicare 
Payment Advisory Commission (MedPAC) 
Reform Act of 2009 may continue to serve 
as a member until the earlier of— 
‘‘(I) the remainder of the term 
for which the member was appointed; 
or 
‘‘(II) April 30, 2010. 
‘‘(ii) CLARIFICATION REGARDING VA-
CANCIES.—Any vacancy in the Commission 
on or after such date of enactment shall be 
filled as provided in accordance with sub-
paragraph (A).’’; and 
(B) in paragraph (2), by striking subpara-
graph (D) and inserting the following new sub-
paragraph: 
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‘‘(D) ADDITIONAL
QUALIFICATIONS.—In 
addition to the qualifications described in the 
succeeding provisions of this paragraph, the 
President shall consider the political balance of 
the membership of the Commission and the 
needs of individuals entitled to (or enrolled for) 
benefits under part A or enrolled under part B 
who are entitled to medical assistance under a 
State plan under title XIX.’’. 
(C) in paragraph (3)— 
(i) by amending subparagraph (A) to 
read as follows: 
‘‘(A) IN GENERAL.—The terms of mem-
bers of the Commission shall be for 6 years ex-
cept that, of the members first appointed— 
‘‘(i) four shall be appointed for terms 
of 5 years; 
‘‘(ii) four shall be appointed for terms 
of 3 years; and 
‘‘(iii) three shall be appointed for 
terms of 1 year.’’; and 
(ii) in subparagraph (B), in the third 
sentence, by striking ‘‘A vacancy’’ and in-
serting ‘‘Except as provided in paragraph 
(1)(C), a vacancy’’; 
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(D) by amending paragraph (4) to read as 
follows: 
‘‘(4) 
COMPENSATION.—Membership 
in 
the 
Commission shall be a full-time position. A member 
of the Commission shall be entitled to compensation 
at the rate payable for level IV of the Executive 
Schedule under section 5316 of title 5, United 
States Code.’’. 
(E) by amending paragraph (5) to read as 
follows: 
‘‘(5) CHAIRMAN; VICE CHAIRMAN.—The Presi-
dent shall designate a member of the Commission, at 
the time of appointment of the member by and with 
the advice and consent of the Senate, as Chairman 
and a member of the Commission, at the time of ap-
pointment of the member by and with the advice and 
consent of the Senate, as Vice Chairman, except that 
in the case where the Chairman or the Vice Chair-
man is not able to be present (including in the case 
of vacancy), a majority of the Commission may des-
ignate another member for the period of such ab-
sence.’’; 
(4) in subsection (d), in the matter preceding 
paragraph (1), by striking ‘‘Subject to such review 
as the Comptroller General deems necessary to as-
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sure the efficient administration of the Commission, 
the Commission’’ and inserting ‘‘The Commission’’; 
(5) by amending subsection (f) to read as fol-
lows: 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out the provisions of this section. Sixty 
percent of such appropriations shall be payable from the 
Federal Hospital Insurance Trust Fund, and 40 percent 
of such appropriation shall be payable from the Federal 
Supplementary Medical Insurance Trust Fund.’’; and 
(6) by adding at the end the following new sub-
section: 
‘‘(g) REFERENCES.—Any reference to the Medicare 
Payment Advisory Commission or MedPAC shall be 
deemed a reference to the Medicare Payment and Access 
Commission.’’. 
(c) AUTHORITY TO DETERMINE PAYMENT RATES 
AND ROUTINE EVALUATION OF PAYMENT RATES UNDER 
THE MEDICARE PROGRAM.— 
(1) IN GENERAL.—Section 1805(b) of the So-
cial Security Act (42 U.S.C. 1395b–6(b)) is amend-
ed— 
(A) in paragraph (1)(B), by inserting ‘‘and 
determine payment rates for items and services 
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furnished under this title in accordance with 
paragraph (9)’’ before the semicolon at the end; 
and 
(B) by adding at the end the following new 
paragraphs: 
‘‘(9) AUTHORITY
TO
DETERMINE
PAYMENT 
RATES UNDER THIS TITLE.— 
‘‘(A) 
DETERMINATION
OF
PAYMENT 
RATES.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of law, the Commission 
shall determine payment rates for items 
and services furnished under this title. In 
determining such payment rates, the Com-
mission shall do so in a manner that is 
consistent with the provisions of sections 
1801 and 1802. 
‘‘(ii) TIMELINE FOR DETERMINATIONS 
WITH RESPECT TO PAYMENT POLICIES FOR 
PHYSICIANS
AND
HOSPITALS.—The Com-
mission shall make a determination under 
this subparagraph with respect to payment 
policies— 
‘‘(I) for physicians (as defined in 
section 1861(r)(1)), not later than 
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December 1 of each year (beginning 
with 2012); and 
‘‘(II) for hospitals, not later than 
March 1 of each year (beginning with 
2013). 
‘‘(B) 
IMPLEMENTATION
OF
PAYMENT 
RATES.— 
‘‘(i) AUTHORITY
OF
SECRETARY.— 
Notwithstanding any other provision of 
law, the Secretary shall promulgate regula-
tions to implement any payment rates de-
termined by the Commission under sub-
paragraph (A). 
‘‘(ii) PAYMENT RATES AND REGULA-
TIONS CURRENTLY IN EFFECT.—Any pay-
ment rate for items and services furnished 
under this title as of the date of enactment 
of the Medicare Payment Advisory Com-
mission (MedPAC) Reform Act of 2009 or 
regulation promulgated by the Secretary 
relating to such payments prior to such 
date of enactment shall remain in effect 
until the Secretary promulgates regulations 
under clause (ii) to implement a payment 
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rate determined by the Commission with 
respect to the item or service. 
‘‘(C) LIMITATION ON JUDICIAL REVIEW.— 
Any determination of the Commission relating 
to payment rates for items and services fur-
nished under this title shall be a final agency 
action of the Commission and shall not be sub-
ject to judicial review. 
‘‘(D) ANNUAL
REPORT.—Not later than 
March 15 of each year (beginning with 2012), 
the Commission shall submit to Congress a re-
port on any payment rates determined under 
subparagraph (A) during the preceding year, 
including the performance of the Secretary in 
implementing such payment rates by promul-
gating regulations under subparagraph (B). 
‘‘(10) ROUTINE
EVALUATION
OF
PAYMENT 
RATES.—The Commission shall review the payment 
rate for each item and service furnished under this 
title not less frequently than every 5 years in order 
to determine whether the Commission should make 
a determination under paragraph (9) to update such 
payment rate.’’. 
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(2) GAO STUDY AND ANNUAL REPORT ON DE-
TERMINATION AND IMPLEMENTATION OF PAYMENT 
RATES.— 
(A) STUDY.—The Comptroller General of 
the United States shall conduct a study on 
changes to payment policies under the Medicare 
program under title XVIII of the Social Secu-
rity Act as a result of the amendments made by 
this subsection, including an analysis of— 
(i) any determinations made by the 
Medicare Payment and Access Commission 
under 
subparagraph 
(A) 
of 
section 
1805(b)(9) of such Act, as added by para-
graph (1), during the preceding year; 
(ii) any regulations promulgated by 
the Secretary of Health and Human Serv-
ices under subparagraph (B) of such sec-
tion during the preceding year; 
(iii) the process for— 
(I) making such determinations 
(including the evidence to support any 
such determination); 
(II) promulgating such regula-
tions (including the capacity of the 
Secretary of Health and Human Serv-
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ices to promulgate such regulations); 
and 
(iv) the ability of the Centers for 
Medicare & Medicaid Services to fulfill its 
responsibilities in carrying out such regula-
tions. 
(B) REPORT.—Not later than December 
31 of each year (beginning with 2012), the 
Comptroller General shall submit to Congress a 
report containing the results of the study con-
ducted under subparagraph (A), together with 
recommendations for such legislation and ad-
ministrative action as the Secretary determines 
appropriate. 
(d) CONGRESSIONAL ACTION.—Section 1805 of the 
Social Security Act (42 U.S.C. 1395b–6), as amended by 
subsection (b), is amended— 
(1) by redesignating subsections (f) and (g), re-
spectively, as subsections (g) and (h); and 
(2) by inserting after subsection (e) the fol-
lowing new subsection: 
‘‘(f) CONGRESSIONAL ACTION.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, it shall only be in order in the Sen-
ate or the House of Representatives to consider any 
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measure that would overrule a determination of the 
Commission with respect to payments for items and 
services furnished under this title if 3⁄5 of the Mem-
bers, duly chosen and sworn, of the Senate or the 
House of Representatives agree to such consider-
ation. 
‘‘(2) RULES OF THE SENATE AND HOUSE OF 
REPRESENTATIVES.—This subsection is enacted by 
Congress— 
‘‘(A) as an exercise of the rulemaking 
power of the Senate and House of Representa-
tives, respectively, and is deemed to be part of 
the rules of each House, respectively, but appli-
cable only with respect to the procedure to be 
followed in that House in the case of a measure 
described in paragraph (1), and it supersedes 
other rules only to the extent that it is incon-
sistent with such rules; and 
‘‘(B) with full recognition of the constitu-
tional right of either House to change the rules 
(so far as they relate to the procedure of that 
House) at any time, in the same manner, and 
to the same extent as in the case of any other 
rule of that House.’’. 
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(e) RESEARCH, INFORMATION ACCESS, AND DEM-
ONSTRATION PROJECTS.—Section 1805(e) of the Social 
Security Act (42 U.S.C. 1395b–6(e)) is amended by add-
ing at the end the following new paragraphs: 
‘‘(5) AUTHORITY TO INFORM RESEARCH PRIOR-
ITIES
FOR
DATA
COLLECTION.—The Commission 
may advise the Secretary (through the Director of 
the Agency for Healthcare Research and Quality and 
the Director of the National Institutes of Health) on 
priorities for health services research, particularly as 
such priorities pertain to necessary changes and 
issues regarding payment reforms under this title. 
‘‘(6) EXPANDED AUTHORITY TO ACCESS FED-
ERAL DATA AND REPORTS.—In addition to data ob-
tained under paragraph (1), the Commission shall 
have priority access to all raw data and research 
conducted or funded by the Federal Government, in-
cluding data and research produced by the Centers 
for Medicare & Medicaid Services, the National In-
stitutes of Health, and the Agency for Healthcare 
Research and Quality. 
‘‘(7) ELECTRONIC ACCESS.—The National Di-
rector for Health Information Technology, in coordi-
nation with the Secretary, the Administrator of the 
Centers for Medicare & Medicaid Services, and the 
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Commission, shall establish a direct electronic link 
for raw data, including claims data under this title, 
to be accessed by the Commission for the purposes 
of evaluating and determining recommendations 
under this title, in accordance with applicable pri-
vacy laws and data use agreements. 
‘‘(8) ACCESS TO BIANNUAL REPORTS.—Not less 
frequently than on a biannual basis, the National In-
stitutes of Health and the Agency for Healthcare 
Research and Quality shall submit to the Commis-
sion a report containing information on any research 
conducted by the National Institutes of Health and 
the Agency for Healthcare Research and Quality, re-
spectively, which has relevance for the determina-
tions and recommendations being considered by the 
Commission. Such information shall be provided to 
the Commission in electronic form. 
‘‘(9) REVISIONS TO PROCESS FOR CONDUCT OF 
DEMONSTRATION
PROJECTS
RELATING
TO
PAY-
MENTS
UNDER
THIS
TITLE.—Effective beginning 
January 1, 2011, the Commission shall have sole au-
thority to design and evaluate demonstration 
projects relating to payments under this title which 
are authorized by section 402 of the Social Security 
Amendments of 1967 or under a waiver under sec-
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tion 1115. The Secretary shall maintain all responsi-
bility for implementing such demonstration projects, 
including for implementing the process through 
which providers are reimbursed for items and serv-
ices furnished under the demonstration projects. 
Nothing in this paragraph shall affect the authority 
of the Secretary with respect to demonstration 
projects under this title not relating to such pay-
ments.’’. 
(f) ADDITIONAL RESOURCES TO CARRY OUT DU-
TIES.— 
(1) IN GENERAL.—Section 1805(d) of the So-
cial Security Act (42 U.S.C. 1395b–6(d)) is amend-
ed— 
(A) in paragraph (1), by inserting ‘‘(in-
cluding an attorney)’’ after ‘‘such other per-
sonnel’’; and 
(B) in paragraph (5), by striking ‘‘and’’ at 
the end; 
(C) in paragraph (6), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(7) establish a public affairs office.’’. 
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(2) OFFICE
OF
THE
OMBUDSMAN.—Section 
1805(e) of the Social Security Act (42 U.S.C. 
1395b–6(e)), as amended by subsection (e), is 
amended by adding at the end the following new 
paragraph: 
‘‘(10) OFFICE OF THE OMBUDSMAN.— 
‘‘(A) IN GENERAL.—The Commission shall 
establish an office of the ombudsman to handle 
complaints regarding the implementation of 
regulations under subsection (a)(9)(B). 
‘‘(B) DUTIES.—The office of the ombuds-
man shall— 
‘‘(i) act as a liaison between the Com-
mission and any entity or individual af-
fected by the implementation of such a 
regulation; and 
‘‘(ii) ensure that the Commission has 
established safeguards— 
‘‘(I) to encourage such entities 
and individuals to submit complaints 
to the office of the ombudsman; and 
‘‘(II) to protect the confiden-
tiality of any entity or individual who 
submits such a complaint.’’. 
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(g) USE OF FUNDING.—Section 1805(g) of the Social 
Security Act (42 U.S.C. 1395b–6(g)), as amended by sub-
section (b) and redesignated by subsection (d), is amended 
by adding at the end the following new sentence: ‘‘Out 
of amounts appropriated under the preceding sentence, 
the Commission may use not more than $500,000,000 
each fiscal year to test new methods of reimbursement 
under this title.’’. 
(h) MACPAC TECHNICAL AMENDMENTS.—Section 
1900(b) of the Social Security Act (42 U.S.C. 1396) is 
amended— 
(1) in paragraph (1)(D), by striking ‘‘June 1’’ 
and inserting ‘‘June 15’’; and 
(2) by adding at the end the following: 
‘‘(10) 
CONSULTATION
WITH
MEDPAC.— 
MACPAC shall regularly consult with the Medicare 
Payment and Access Commission (in this paragraph 
referred to as ‘MedPAC’) established under section 
1805 in carrying out its duties under this section.’’. 
(i) LOBBYING COOLING-OFF PERIOD FOR MEMBERS 
OF THE MEDICARE PAYMENT ADVISORY COMMISSION.— 
Section 207(c) of title 18, United States Code, is amended 
by inserting at the end the following: 
‘‘(3) MEMBERS OF THE MEDICARE PAYMENT 
ADVISORY COMMISSION.— 
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‘‘(A) IN
GENERAL.—Paragraph (1) shall 
apply to a member of the Medicare Payment 
Advisory Commission who was appointed to 
such Commission as of the day before the date 
of enactment of the Medicare Payment Advisory 
Commission (MedPAC) Reform Act of 2009. 
‘‘(B) AGENCIES AND CONGRESS.—For pur-
poses of paragraph (1), the agency in which the 
individual described in subparagraph (A) served 
shall be considered to be the Medicare Payment 
and Access Commission established under sec-
tion 1805 of the Social Security Act, the De-
partment of Health and Human Services, and 
the relevant committees of jurisdiction of Con-
gress.’’. 
SEC. 3. ESTABLISHMENT OF COUNCIL OF HEALTH AND 
ECONOMIC ADVISERS, CONSUMER ADVISORY 
COUNCIL, AND FEDERAL HEALTH ADVISORY 
COUNCIL. 
Section 1805(b) of the Social Security Act (42 U.S.C. 
1395b–6(b)), as amended by section 2(c), is amended by 
adding at the end the following new paragraph: 
‘‘(11) COUNCIL OF HEALTH AND ECONOMIC AD-
VISERS, CONSUMER ADVISORY COUNCIL, AND FED-
ERAL HEALTH ADVISORY COUNCIL.— 
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‘‘(A) COUNCIL OF HEALTH AND ECONOMIC 
ADVISERS.— 
‘‘(i) IN GENERAL.—The Commission 
shall establish a council of health and eco-
nomic advisers to advise the Commission 
on its development, analyses, and imple-
mentation of payment policies under this 
title. 
‘‘(ii) MEMBERSHIP.— 
‘‘(I) IN GENERAL.—The council 
of health and economic advisers shall 
be composed of acknowledged experts 
in health care and economics selected 
by the Commission. 
‘‘(II) 
INITIAL
INCLUSION
OF 
FORMER MEMBERS OF MEDICARE PAY-
MENT
ADVISORY
COMMISSION.—The 
members initially selected for the 
council of health and economic advis-
ers under subclause (I) shall include 
those individuals who were members 
of the Medicare Payment Advisory 
Commission as of the day before the 
date of enactment of the Medicare 
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Payment 
Advisory 
Commission 
(MedPAC) Reform Act of 2009. 
‘‘(B) CONSUMER ADVISORY COUNCIL.— 
‘‘(i) IN
GENERAL.—There is estab-
lished a consumer advisory council to ad-
vise the Commission on the impact of pay-
ment policies under this title on con-
sumers. 
‘‘(ii) MEMBERSHIP.— 
‘‘(I) NUMBER
AND
APPOINT-
MENT.—The consumer advisory coun-
cil shall be composed of 10 consumer 
representatives 
appointed 
by 
the 
Comptroller General of the United 
States, 1 from among each of the 10 
regions established by the Secretary 
as of the date of enactment of the 
Medicare Payment Advisory Commis-
sion (MedPAC) Reform Act of 2009. 
‘‘(II) 
QUALIFICATIONS.—The 
membership of the council shall rep-
resent the interests of consumers and 
particular communities. 
‘‘(iii) DUTIES.—The consumer advi-
sory council shall, subject to the call of the 
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Commission, meet not less frequently than 
2 times each year in the District of Colum-
bia. 
‘‘(iv) OPEN MEETINGS.—Meetings of 
the consumer advisory council shall be 
open to the public. 
‘‘(v) ELECTION OF OFFICERS.—Mem-
bers of the consumer advisory council shall 
elect their own officers. 
‘‘(C) FEDERAL HEALTH ADVISORY COUN-
CIL.— 
‘‘(i) IN
GENERAL.—There is estab-
lished a Federal health advisory council to 
consult with and provide advice to the 
Commission on all matters within the ju-
risdiction of the Commission. 
‘‘(ii) 
MEMBERSHIP.—The 
Federal 
health advisory council shall be composed 
of 10 representatives from the health care 
industry appointed by the Comptroller 
General of the United States, 1 from 
among each of the 10 regions established 
by the Secretary as of the date of enact-
ment of the Medicare Payment Advisory 
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Commission (MedPAC) Reform Act of 
2009. 
‘‘(iii) TERMS.— 
‘‘(I) IN GENERAL.—The terms of 
members of the Federal health advi-
sory council shall be for 1 year. 
‘‘(II) LIMITATION
ON
NUMBER 
OF
TERMS
SERVED.—An individual 
may not be appointed as a member of 
the Federal health advisory council for 
more than 3 terms. 
‘‘(iv) DUTIES.—The Federal health 
advisory council shall, subject to the call of 
the Commission, meet not less frequently 
than 2 times each year in the District of 
Columbia. 
‘‘(v) OPEN
MEETINGS.—Meetings of 
the Federal health advisory council shall be 
open to the public. 
‘‘(vi) ELECTION OF OFFICERS.—Mem-
bers of the Federal health advisory council 
shall elect their own officers. 
‘‘(D) LIMITATION ON FUNDING.—Out of 
amounts appropriated under subsection (g), the 
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jbell on PROD1PC69 with BILLS
Commission may use not more than $300,000 
each fiscal year to carry out this paragraph.’’. 
Æ 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
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E:\BILLS\H2718.IH
H2718
jbell on PROD1PC69 with BILLS