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‘‘(iii) an actuarial opinion by the 
Chief Actuary of the Centers for Medicare & 
Medicaid Services certifying that the pro-
posal meets the requirements of subpara-
graphs (A)(i) and (C) of paragraph (2); 
‘‘(iv) a legislative proposal that imple-
ments the recommendations; and 
‘‘(v) other information determined ap-
propriate by the Board. 
‘‘(4) 
PRESIDENTIAL
SUBMISSION
TO
CON-
GRESS.—Upon receiving a proposal from the Board 
under paragraph (3)(A)(i) or the Secretary under 
paragraph (5), the President shall immediately sub-
mit such proposal to Congress. 
‘‘(5) CONTINGENT
SECRETARIAL
DEVELOPMENT 
OF PROPOSAL.—If, with respect to a proposal year, 
the Board is required, to but fails, to submit a pro-
posal to the President by the deadline applicable 
under paragraph (3)(A)(i), the Secretary shall de-
velop a detailed and specific proposal that satisfies 
the requirements of subparagraphs (A) and (C) (and, 
to the extent feasible, subparagraph (B)) of paragraph 
(2) and contains the information required paragraph 
(3)(B)). By not later than January 25 of the year, 
the Secretary shall transmit— 
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‘‘(A) such proposal to the President; and 
‘‘(B) a copy of such proposal to the Medi-
care Payment Advisory Commission for its re-
view. 
‘‘(6) PER CAPITA GROWTH RATE PROJECTIONS 
BY CHIEF ACTUARY.— 
‘‘(A) IN
GENERAL.—Subject to subsection 
(f)(3)(A), not later than April 30, 2013, and an-
nually thereafter, the Chief Actuary of the Cen-
ters for Medicare & Medicaid Services shall de-
termine in each such year whether— 
‘‘(i) the projected Medicare per capita 
growth rate for the implementation year (as 
determined under subparagraph (B)); ex-
ceeds 
‘‘(ii) the projected Medicare per capita 
target growth rate for the implementation 
year (as determined under subparagraph 
(C)). 
‘‘(B) MEDICARE
PER
CAPITA
GROWTH 
RATE.— 
‘‘(i) IN
GENERAL.—For purposes of 
this section, the Medicare per capita growth 
rate for an implementation year shall be 
calculated as the projected 5-year average 
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(ending with such year) of the growth in 
Medicare 
program 
spending 
per 
unduplicated enrollee. 
‘‘(ii) REQUIREMENT.—The projection 
under clause (i) shall— 
‘‘(I) to the extent that there is 
projected to be a negative update to the 
single conversion factor applicable to 
payments 
for 
physicians’ 
services 
under section 1848(d) furnished in the 
proposal year or the implementation 
year, assume that such update for such 
services is 0 percent rather than the 
negative percent that would otherwise 
apply; and 
‘‘(II) take into account any deliv-
ery system reforms or other payment 
changes that have been enacted or pub-
lished in final rules but not yet imple-
mented as of the making of such cal-
culation. 
‘‘(C) 
MEDICARE
PER
CAPITA
TARGET 
GROWTH RATE.—For purposes of this section, the 
Medicare per capita target growth rate for an 
implementation year shall be calculated as the 
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projected 5-year average (ending with such year) 
percentage increase in— 
‘‘(i) with respect to a determination 
year that is prior to 2018, the average of 
the projected percentage increase (if any) 
in— 
‘‘(I) the Consumer Price Index for 
All Urban Consumers (all items; 
United States city average); and 
‘‘(II) the medical care expenditure 
category of the Consumer Price Index 
for All Urban Consumers (United 
States city average); and 
‘‘(ii) with respect to a determination 
year that is after 2017, the nominal gross 
domestic product per capita plus 1.0 per-
centage point. 
‘‘(7) SAVINGS REQUIREMENT.— 
‘‘(A) IN GENERAL.—If, with respect to a de-
termination year, the Chief Actuary of the Cen-
ters for Medicare & Medicaid Services makes a 
determination under paragraph (6)(A) that the 
growth rate described in clause (i) of such para-
graph exceeds the growth rate described in clause 
(ii) of such paragraph, the Chief Actuary shall 
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establish an applicable savings target for the im-
plementation year. 
‘‘(B) APPLICABLE
SAVINGS
TARGET.—For 
purposes of this section, the applicable savings 
target for an implementation year shall be an 
amount equal to the product of— 
‘‘(i) the total amount of projected 
Medicare program spending for the proposal 
year; and 
‘‘(ii) the applicable percent for the im-
plementation year. 
‘‘(C) APPLICABLE PERCENT.—For purposes 
of subparagraph (B), the applicable percent for 
an implementation year is the lesser of— 
‘‘(i) in the case of— 
‘‘(I) implementation year 2015, 
0.5 percent; 
‘‘(II) implementation year 2016, 
1.0 percent; 
‘‘(III) implementation year 2017, 
1.25 percent; and 
‘‘(IV) implementation year 2018 
or any subsequent implementation 
year, 1.5 percent; and 
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‘‘(ii) the projected excess for the imple-
mentation year (expressed as a percent) de-
termined under subparagraph (A). 
‘‘(8) PER CAPITA RATE OF GROWTH IN NATIONAL 
HEALTH
EXPENDITURES.—In each determination 
year (beginning in 2018), the Chief Actuary of the 
Centers for Medicare & Medicaid Services shall 
project the per capita rate of growth in national 
health expenditures for the implementation year. 
Such rate of growth for an implementation year shall 
be calculated as the projected 5-year average (ending 
with such year) percentage increase in national 
health care expenditures. 
‘‘(d) CONGRESSIONAL CONSIDERATION.— 
‘‘(1) INTRODUCTION.— 
‘‘(A) IN GENERAL.—On the day on which a 
proposal is submitted by the President to the 
House of Representatives and the Senate under 
subsection (c)(4), the legislative proposal (de-
scribed in subsection (c)(3)(B)(iv)) contained in 
the proposal shall be introduced (by request) in 
the Senate by the majority leader of the Senate 
or by Members of the Senate designated by the 
majority leader of the Senate and shall be intro-
duced (by request) in the House by the majority 
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posal is submitted by the President to Congress 
under this section, the Committee on Ways and 
Means and the Committee on Energy and Com-
merce of the House of Representatives and the 
Committee on Finance of the Senate may report 
the bill referred to the Committee under para-
graph (1)(D) with committee amendments re-
lated to the Medicare program. 
‘‘(B) 
CALCULATIONS.—In 
determining 
whether a committee amendment meets the re-
quirement of subparagraph (A), the reductions 
in Medicare program spending during the 3- 
month period immediately preceding the imple-
mentation year shall be counted to the extent 
that such reductions are a result of the imple-
mentation provisions in the committee amend-
ment for a change in the payment rate for an 
item or service that was effective during such pe-
riod pursuant to such amendment. 
‘‘(C) COMMITTEE JURISDICTION.—Notwith-
standing rule XV of the Standing Rules of the 
Senate, a committee amendment described in 
subparagraph (A) may include matter not with-
in the jurisdiction of the Committee on Finance 
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if that matter is relevant to a proposal contained 
in the bill submitted under subsection (c)(3). 
‘‘(D) DISCHARGE.—If, with respect to the 
House involved, the committee has not reported 
the bill by the date required by subparagraph 
(A), the committee shall be discharged from fur-
ther consideration of the proposal. 
‘‘(3) LIMITATION ON CHANGES TO THE BOARD 
RECOMMENDATIONS.— 
‘‘(A) IN GENERAL.—It shall not be in order 
in the Senate or the House of Representatives to 
consider any bill, resolution, or amendment, pur-
suant to this subsection or conference report 
thereon, that fails to satisfy the requirements of 
subparagraphs (A)(i) and (C) of subsection 
(c)(2). 
‘‘(B) LIMITATION
ON
CHANGES
TO
THE 
BOARD RECOMMENDATIONS IN OTHER LEGISLA-
TION.—It shall not be in order in the Senate or 
the House of Representatives to consider any bill, 
resolution, amendment, or conference report 
(other than pursuant to this section) that would 
repeal or otherwise change the recommendations 
of the Board if that change would fail to satisfy 
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the requirements of subparagraphs (A)(i) and 
(C) of subsection (c)(2). 
‘‘(C) LIMITATION
ON
CHANGES
TO
THIS 
SUBSECTION.—It shall not be in order in the 
Senate or the House of Representatives to con-
sider any bill, resolution, amendment, or con-
ference report that would repeal or otherwise 
change this subsection. 
‘‘(D) WAIVER.—This paragraph may be 
waived or suspended in the Senate only by the 
affirmative vote of three-fifths of the Members, 
duly chosen and sworn. 
‘‘(E) APPEALS.—An affirmative vote of 
three-fifths of the Members of the Senate, duly 
chosen and sworn, shall be required in the Sen-
ate to sustain an appeal of the ruling of the 
Chair on a point of order raised under this 
paragraph. 
‘‘(4) EXPEDITED PROCEDURE.— 
‘‘(A) CONSIDERATION.—A motion to pro-
ceed to the consideration of the bill in the Senate 
is not debatable. 
‘‘(B) AMENDMENT.— 
‘‘(i) TIME LIMITATION.—Debate in the 
Senate on any amendment to a bill under 
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this section shall be limited to 1 hour, to be 
equally divided between, and controlled by, 
the mover and the manager of the bill, and 
debate on any amendment to an amend-
ment, debatable motion, or appeal shall be 
limited to 30 minutes, to be equally divided 
between, and controlled by, the mover and 
the manager of the bill, except that in the 
event the manager of the bill is in favor of 
any such amendment, motion, or appeal, 
the time in opposition thereto shall be con-
trolled by the minority leader or such lead-
er’s designee. 
‘‘(ii) GERMANE.—No amendment that 
is not germane to the provisions of such bill 
shall be received. 
‘‘(iii) ADDITIONAL TIME.—The leaders, 
or either of them, may, from the time under 
their control on the passage of the bill, allot 
additional time to any Senator during the 
consideration of any amendment, debatable 
motion, or appeal. 
‘‘(iv) AMENDMENT NOT IN ORDER.—It 
shall not be in order to consider an amend-
ment that would cause the bill to result in 
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a net reduction in total Medicare program 
spending in the implementation year that is 
less than the applicable savings target estab-
lished under subsection (c)(7)(B) for such 
implementation year. 
‘‘(v) WAIVER
AND
APPEALS.—This 
paragraph may be waived or suspended in 
the Senate only by the affirmative vote of 
three-fifths of the Members, duly chosen and 
sworn. An affirmative vote of three-fifths of 
the Members of the Senate, duly chosen and 
sworn, shall be required in the Senate to 
sustain an appeal of the ruling of the Chair 
on a point of order raised under this sec-
tion. 
‘‘(C) 
CONSIDERATION
BY
THE
OTHER 
HOUSE.— 
‘‘(i) IN GENERAL.—The expedited pro-
cedures provided in this subsection for the 
consideration of a bill introduced pursuant 
to paragraph (1) shall not apply to such a 
bill that is received by one House from the 
other House if such a bill was not intro-
duced in the receiving House. 
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‘‘(ii) BEFORE PASSAGE.—If a bill that 
is introduced pursuant to paragraph (1) is 
received by one House from the other House, 
after introduction but before disposition of 
such a bill in the receiving House, then the 
following shall apply: 
‘‘(I) The receiving House shall 
consider the bill introduced in that 
House through all stages of consider-
ation up to, but not including, pas-
sage. 
‘‘(II) The question on passage 
shall be put on the bill of the other 
House as amended by the language of 
the receiving House. 
‘‘(iii) AFTER PASSAGE.—If a bill in-
troduced pursuant to paragraph (1) is re-
ceived by one House from the other House, 
after such a bill is passed by the receiving 
House, then the vote on passage of the bill 
that originates in the receiving House shall 
be considered to be the vote on passage of 
the bill received from the other House as 
amended by the language of the receiving 
House. 
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‘‘(ii) MOTION TO FURTHER LIMIT DE-
BATE.—A motion to further limit debate on 
the bill is in order and is not debatable. 
‘‘(iii) MOTION OR APPEAL.—Any de-
batable motion or appeal is debatable for 
not to exceed 1 hour, to be divided equally 
between those favoring and those opposing 
the motion or appeal. 
‘‘(iv) FINAL
DISPOSITION.—After 30 
hours of consideration, the Senate shall pro-
ceed, without any further debate on any 
question, to vote on the final disposition 
thereof to the exclusion of all amendments 
not then pending before the Senate at that 
time and to the exclusion of all motions, ex-
cept a motion to table, or to reconsider and 
one quorum call on demand to establish the 
presence of a quorum (and motions required 
to establish a quorum) immediately before 
the final vote begins. 
‘‘(E) CONSIDERATION IN CONFERENCE.— 
‘‘(i) IN
GENERAL.—Consideration in 
the Senate and the House of Representatives 
on the conference report or any messages be-
tween Houses shall be limited to 10 hours, 
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equally divided and controlled by the major-
ity and minority leaders of the Senate or 
their designees and the Speaker of the 
House of Representatives and the minority 
leader of the House of Representatives or 
their designees. 
‘‘(ii) TIME LIMITATION.—Debate in the 
Senate on any amendment under this sub-
paragraph shall be limited to 1 hour, to be 
equally divided between, and controlled by, 
the mover and the manager of the bill, and 
debate on any amendment to an amend-
ment, debatable motion, or appeal shall be 
limited to 30 minutes, to be equally divided 
between, and controlled by, the mover and 
the manager of the bill, except that in the 
event the manager of the bill is in favor of 
any such amendment, motion, or appeal, 
the time in opposition thereto shall be con-
trolled by the minority leader or such lead-
er’s designee. 
‘‘(iii) FINAL
DISPOSITION.—After 10 
hours of consideration, the Senate shall pro-
ceed, without any further debate on any 
question, to vote on the final disposition 
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thereof to the exclusion of all motions not 
then pending before the Senate at that time 
or necessary to resolve the differences be-
tween the Houses and to the exclusion of all 
other motions, except a motion to table, or 
to reconsider and one quorum call on de-
mand to establish the presence of a quorum 
(and motions required to establish a 
quorum) immediately before the final vote 
begins. 
‘‘(iv) LIMITATION.—Clauses (i) through 
(iii) shall only apply to a conference report, 
message or the amendments thereto if the 
conference report, message, or an amend-
ment thereto— 
‘‘(I) is related only to the pro-
gram under this title; and 
‘‘(II) satisfies the requirements of 
subparagraphs (A)(i) and (C) of sub-
section (c)(2). 
‘‘(F) VETO.—If the President vetoes the bill 
debate on a veto message in the Senate under 
this subsection shall be 1 hour equally divided 
between the majority and minority leaders or 
their designees. 
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‘‘(5) RULES OF THE SENATE AND HOUSE OF 
REPRESENTATIVES.—This subsection and subsection 
(f)(2) are enacted by Congress— 
‘‘(A) as an exercise of the rulemaking power 
of the Senate and the House of Representatives, 
respectively, and is deemed to be part of the rules 
of each House, respectively, but applicable only 
with respect to the procedure to be followed in 
that House in the case of bill under this section, 
and it supersedes other rules only to the extent 
that it is inconsistent 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. 
‘‘(e) IMPLEMENTATION OF PROPOSAL.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary shall, except as pro-
vided in paragraph (3), implement the recommenda-
tions contained in a proposal submitted by the Presi-
dent to Congress pursuant to this section on August 
15 of the year in which the proposal is so submitted. 
‘‘(2) APPLICATION.— 
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‘‘(A) IN GENERAL.—A recommendation de-
scribed in paragraph (1) shall apply as follows: 
‘‘(i) In the case of a recommendation 
that is a change in the payment rate for an 
item or service under Medicare in which 
payment rates change on a fiscal year basis 
(or a cost reporting period basis that relates 
to a fiscal year), on a calendar year basis 
(or a cost reporting period basis that relates 
to a calendar year), or on a rate year basis 
(or a cost reporting period basis that relates 
to a rate year), such recommendation shall 
apply to items and services furnished on the 
first day of the first fiscal year, calendar 
year, or rate year (as the case may be) that 
begins after such August 15. 
‘‘(ii) In the case of a recommendation 
relating to payments to plans under parts 
C and D, such recommendation shall apply 
to plan years beginning on the first day of 
the first calendar year that begins after 
such August 15. 
‘‘(iii) In the case of any other rec-
ommendation, such recommendation shall 
be addressed in the regular regulatory proc-
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ess timeframe and shall apply as soon as 
practicable. 
‘‘(B) INTERIM
FINAL
RULEMAKING.—The 
Secretary may use interim final rulemaking to 
implement any recommendation described in 
paragraph (1). 
‘‘(3) EXCEPTION.—The Secretary shall not be re-
quired to implement the recommendations contained 
in a proposal submitted in a proposal year by the 
President to Congress pursuant to this section if— 
‘‘(A) prior to August 15 of the proposal 
year, Federal legislation is enacted that includes 
the following provision: ‘This Act supercedes the 
recommendations of the Board contained in the 
proposal submitted, in the year which includes 
the date of enactment of this Act, to Congress 
under section 1899A of the Social Security Act.’; 
and 
‘‘(B) in the case of implementation year 
2020 and subsequent implementation years, a 
joint resolution described in subsection (f)(1) is 
enacted not later than August 15, 2017. 
‘‘(4) NO AFFECT ON AUTHORITY TO IMPLEMENT 
CERTAIN
PROVISIONS.—Nothing in paragraph (3) 
shall be construed to affect the authority of the Sec-
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retary to implement any recommendation contained 
in a proposal or advisory report under this section to 
the extent that the Secretary otherwise has the author-
ity to implement such recommendation administra-
tively. 
‘‘(5) LIMITATION ON REVIEW.—There shall be no 
administrative or judicial review under section 1869, 
section 1878, or otherwise of the implementation by 
the Secretary under this subsection of the rec-
ommendations contained in a proposal. 
‘‘(f) JOINT RESOLUTION REQUIRED TO DISCONTINUE 
THE BOARD.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(e)(3)(B), a joint resolution described in this para-
graph means only a joint resolution— 
‘‘(A) that is introduced in 2017 by not later 
than February 1 of such year; 
‘‘(B) which does not have a preamble; 
‘‘(C) the title of which is as follows: ‘Joint 
resolution approving the discontinuation of the 
process for consideration and automatic imple-
mentation of the annual proposal of the Inde-
pendent Medicare Advisory Board under section 
1899A of the Social Security Act’; and 
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‘‘(D) the matter after the resolving clause of 
which is as follows: ‘That Congress approves the 
discontinuation of the process for consideration 
and automatic implementation of the annual 
proposal of the Independent Medicare Advisory 
Board under section 1899A of the Social Secu-
rity Act.’. 
‘‘(2) PROCEDURE.— 
‘‘(A) REFERRAL.—A joint resolution de-
scribed in paragraph (1) shall be referred to the 
Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House of 
Representatives and the Committee on Finance 
of the Senate. 
‘‘(B) DISCHARGE.—In the Senate, if the 
committee to which is referred a joint resolution 
described in paragraph (1) has not reported such 
joint resolution (or an identical joint resolution) 
at the end of 20 days after the joint resolution 
described in paragraph (1) is introduced, such 
committee may be discharged from further con-
sideration of such joint resolution upon a peti-
tion supported in writing by 30 Members of the 
Senate, and such joint resolution shall be placed 
on the calendar. 
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‘‘(C) CONSIDERATION.— 
‘‘(i) IN
GENERAL.—In the Senate, 
when the committee to which a joint resolu-
tion is referred has reported, or when a 
committee is discharged (under subpara-
graph (C)) from further consideration of a 
joint resolution described in paragraph (1), 
it is at any time thereafter in order (even 
though a previous motion to the same effect 
has been disagreed to) for a motion to pro-
ceed to the consideration of the joint resolu-
tion to be made, and all points of order 
against the joint resolution (and against 
consideration of the joint resolution) are 
waived, except for points of order under the 
Congressional Budget act of 1974 or under 
budget resolutions pursuant to that Act. The 
motion is not debatable. A motion to recon-
sider the vote by which the motion is agreed 
to or disagreed to shall not be in order. If 
a motion to proceed to the consideration of 
the joint resolution is agreed to, the joint 
resolution shall remain the unfinished busi-
ness of the Senate until disposed of. 
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‘‘(ii) DEBATE
LIMITATION.—In the 
Senate, consideration of the joint resolution, 
and on all debatable motions and appeals 
in connection therewith, shall be limited to 
not more than 10 hours, which shall be di-
vided equally between the majority leader 
and the minority leader, or their designees. 
A motion further to limit debate is in order 
and not debatable. An amendment to, or a 
motion to postpone, or a motion to proceed 
to the consideration of other business, or a 
motion to recommit the joint resolution is 
not in order. 
‘‘(iii) PASSAGE.—In the Senate, imme-
diately following the conclusion of the de-
bate on a joint resolution described in para-
graph (1), and a single quorum call at the 
conclusion of the debate if requested in ac-
cordance with the rules of the Senate, the 
vote on passage of the joint resolution shall 
occur. 
‘‘(iv) APPEALS.—Appeals from the de-
cisions of the Chair relating to the applica-
tion of the rules of the Senate to the proce-
dure relating to a joint resolution described 
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in paragraph (1) shall be decided without 
debate. 
‘‘(D) OTHER HOUSE ACTS FIRST.—If, before 
the passage by 1 House of a joint resolution of 
that House described in paragraph (1), that 
House receives from the other House a joint reso-
lution described in paragraph (1), then the fol-
lowing procedures shall apply: 
‘‘(i) The joint resolution of the other 
House shall not be referred to a committee. 
‘‘(ii) With respect to a joint resolution 
described in paragraph (1) of the House re-
ceiving the joint resolution— 
‘‘(I) the procedure in that House 
shall be the same as if no joint resolu-
tion had been received from the other 
House; but 
‘‘(II) the vote on final passage 
shall be on the joint resolution of the 
other House. 
‘‘(E) EXCLUDED DAYS.—For purposes of de-
termining the period specified in subparagraph 
(B), there shall be excluded any days either 
House of Congress is adjourned for more than 3 
days during a session of Congress. 
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‘‘(F) MAJORITY
REQUIRED
FOR
ADOP-
TION.—A joint resolution considered under this 
subsection shall require an affirmative vote of 
three-fifths of the Members, duly chosen and 
sworn, for adoption. 
‘‘(3) TERMINATION.—If a joint resolution de-
scribed in paragraph (1) is enacted not later than 
August 15, 2017— 
‘‘(A) the Chief Actuary of the Medicare & 
Medicaid Services shall not— 
‘‘(i) make any determinations under 
subsection (c)(6) after May 1, 2017; or 
‘‘(ii) provide any opinion pursuant to 
subsection (c)(3)(B)(iii) after January 16, 
2018; 
‘‘(B) the Board shall not submit any pro-
posals or advisory reports to Congress under this 
section after January 16, 2018; and 
‘‘(C) the Board and the consumer advisory 
council under subsection (k) shall terminate on 
August 16, 2018. 
‘‘(g) BOARD MEMBERSHIP; TERMS OF OFFICE; CHAIR-
PERSON; REMOVAL.— 
‘‘(1) MEMBERSHIP.— 
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