H. R. 1—235
(d) EFFECTIVE DATE.—The amendments made by this section
shall apply to services provided by a hospice program on or after
January 1, 2005.
SEC. 513. STUDY ON PORTABLE DIAGNOSTIC ULTRASOUND SERVICES
FOR BENEFICIARIES IN SKILLED NURSING FACILITIES.
(a) STUDY.—The Comptroller General of the United States shall
conduct a study of portable diagnostic ultrasound services furnished
to medicare beneficiaries in skilled nursing facilities. Such study
shall consider the following:
(1) TYPES OF EQUIPMENT; TRAINING.—The types of portable
diagnostic ultrasound services furnished to such beneficiaries,
the types of portable ultrasound equipment used to furnish
such services, and the technical skills, or training, or both,
required for technicians to furnish such services.
(2) CLINICAL APPROPRIATENESS.—The clinical appropriate-
ness of transporting portable diagnostic ultrasound diagnostic
and technicians to patients in skilled nursing facilities as
opposed to transporting such patients to a hospital or other
facility that furnishes diagnostic ultrasound services.
(3) FINANCIAL IMPACT.—The financial impact if Medicare
were make a separate payment for portable ultrasound diag-
nostic services, including the impact of separate payments—
(A) for transportation and technician services for resi-
dents during a resident in a part A stay, that would other-
wise be paid for under the prospective payment system
for covered skilled nursing facility services (under section
1888(e) of the Social Security Act (42 U.S.C. 1395yy(e));
and
(B) for such services for residents in a skilled nursing
facility after a part A stay.
(4) CREDENTIALING
REQUIREMENTS.—Whether the Sec-
retary should establish credentialing or other requirements for
technicians that furnish diagnostic ultrasound services to medi-
care beneficiaries.
(b) REPORT.—Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under subsection (a),
and shall include any recommendations for legislation or adminis-
trative change as the Comptroller General determines appropriate.
TITLE VI—PROVISIONS RELATING TO
PART B
Subtitle A—Provisions Relating to
Physicians’ Services
SEC. 601. REVISION OF UPDATES FOR PHYSICIANS’ SERVICES.
(a) UPDATE FOR 2004 AND 2005.—
(1) IN GENERAL.—Section 1848(d) (42 U.S.C. 1395w–4(d))
is amended by adding at the end the following new paragraph:
‘‘(5) UPDATE FOR 2004 AND 2005.—The update to the single
conversion factor established in paragraph (1)(C) for each of
2004 and 2005 shall be not less than 1.5 percent.’’.
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(2) CONFORMING AMENDMENT.—Paragraph (4)(B) of such
section is amended, in the matter before clause (i), by inserting
‘‘and paragraph (5)’’ after ‘‘subparagraph (D)’’.
(3) NOT TREATED AS CHANGE IN LAW AND REGULATION IN
SUSTAINABLE GROWTH RATE DETERMINATION.—The amendments
made by this subsection shall not be treated as a change
in law for purposes of applying section 1848(f)(2)(D) of the
Social Security Act (42 U.S.C. 1395w–4(f)(2)(D)).
(b) USE OF 10-YEAR ROLLING AVERAGE IN COMPUTING GROSS
DOMESTIC PRODUCT.—
(1) IN GENERAL.—Section 1848(f)(2)(C) (42 U.S.C. 1395w–
4(f)(2)(C)) is amended—
(A) by striking ‘‘projected’’ and inserting ‘‘annual aver-
age’’; and
(B) by striking ‘‘from the previous applicable period
to the applicable period involved’’ and inserting ‘‘during
the 10-year period ending with the applicable period
involved’’.
(2) EFFECTIVE DATE.—The amendments made by paragraph
(1) shall apply to computations of the sustainable growth rate
for years beginning with 2003.
SEC. 602. TREATMENT OF PHYSICIANS’ SERVICES FURNISHED IN
ALASKA.
Section 1848(e)(1) (42 U.S.C. 1395w–4(e)(1)), as amended by
section 421, is amended—
(1) in subparagraph (A), by striking ‘‘subparagraphs (B),
(C), (E), and (F)’’ and inserting ‘‘subparagraphs (B), (C), (E),
(F) and (G)’’; and
(2) by adding at the end the following new subparagraph:
‘‘(G) FLOOR FOR PRACTICE EXPENSE, MALPRACTICE, AND
WORK
GEOGRAPHIC
INDICES
FOR
SERVICES
FURNISHED
IN
ALASKA.—For purposes of payment for services furnished
in Alaska on or after January 1, 2004, and before January
1, 2006, after calculating the practice expense, malpractice,
and work geographic indices in clauses (i), (ii), and (iii)
of subparagraph (A) and in subparagraph (B), the Secretary
shall increase any such index to 1.67 if such index would
otherwise be less than 1.67.’’.
SEC. 603. INCLUSION OF PODIATRISTS, DENTISTS, AND OPTOMETRISTS
UNDER PRIVATE CONTRACTING AUTHORITY.
Section 1802(b)(5)(B) (42 U.S.C. 1395a(b)(5)(B)) is amended by
striking ‘‘section 1861(r)(1)’’ and inserting ‘‘paragraphs (1), (2), (3),
and (4) of section 1861(r)’’.
SEC. 604. GAO STUDY ON ACCESS TO PHYSICIANS’ SERVICES.
(a) STUDY.—The Comptroller General of the United States shall
conduct a study on access of medicare beneficiaries to physicians’
services under the medicare program. The study shall include—
(1) an assessment of the use by beneficiaries of such serv-
ices through an analysis of claims submitted by physicians
for such services under part B of the medicare program;
(2) an examination of changes in the use by beneficiaries
of physicians’ services over time; and
(3) an examination of the extent to which physicians are
not accepting new medicare beneficiaries as patients.
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(b) REPORT.—Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under subsection (a).
The report shall include a determination whether—
(1) data from claims submitted by physicians under part
B of the medicare program indicate potential access problems
for medicare beneficiaries in certain geographic areas; and
(2) access by medicare beneficiaries to physicians’ services
may have improved, remained constant, or deteriorated over
time.
SEC. 605. COLLABORATIVE DEMONSTRATION-BASED REVIEW OF
PHYSICIAN PRACTICE EXPENSE GEOGRAPHIC ADJUST-
MENT DATA.
(a) IN GENERAL.—Not later than January 1, 2005, the Secretary
shall, in collaboration with State and other appropriate organiza-
tions representing physicians, and other appropriate persons, review
and consider alternative data sources than those currently used
in establishing the geographic index for the practice expense compo-
nent under the medicare physician fee schedule under section
1848(e)(1)(A)(i) of the Social Security Act (42 U.S.C. 1395w–
4(e)(1)(A)(i)).
(b) SITES.—The Secretary shall select two physician payment
localities in which to carry out subsection (a). One locality shall
include rural areas and at least one locality shall be a statewide
locality that includes both urban and rural areas.
(c) REPORT AND RECOMMENDATIONS.—
(1) REPORT.—Not later than January 1, 2006, the Secretary
shall submit to Congress a report on the review and consider-
ation conducted under subsection (a). Such report shall include
information on the alternative developed data sources consid-
ered by the Secretary under subsection (a), including the
accuracy and validity of the data as measures of the elements
of the geographic index for practice expenses under the medi-
care physician fee schedule as well as the feasibility of using
such alternative data nationwide in lieu of current proxy data
used in such index, and the estimated impacts of using such
alternative data.
(2) RECOMMENDATIONS.—The report submitted under para-
graph (1) shall contain recommendations on which data sources
reviewed and considered under subsection (a) are appropriate
for use in calculating the geographic index for practice expenses
under the medicare physician fee schedule.
SEC. 606. MEDPAC REPORT ON PAYMENT FOR PHYSICIANS’ SERVICES.
(a) PRACTICE EXPENSE COMPONENT.—Not later than 1 year
after the date of the enactment of this Act, the Medicare Payment
Advisory Commission shall submit to Congress a report on the
effect of refinements to the practice expense component of payments
for physicians’ services, after the transition to a full resource-
based payment system in 2002, under section 1848 of the Social
Security Act (42 U.S.C. 1395w–4). Such report shall examine the
following matters by physician specialty:
(1) The effect of such refinements on payment for physi-
cians’ services.
(2) The interaction of the practice expense component with
other components of and adjustments to payment for physicians’
services under such section.
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(3) The appropriateness of the amount of compensation
by reason of such refinements.
(4) The effect of such refinements on access to care by
medicare beneficiaries to physicians’ services.
(5) The effect of such refinements on physician participation
under the medicare program.
(b) VOLUME OF PHYSICIANS’ SERVICES.—Not later than 1 year
after the date of the enactment of this Act, the Medicare Payment
Advisory Commission shall submit to Congress a report on the
extent to which increases in the volume of physicians’ services
under part B of the medicare program are a result of care that
improves the health and well-being of medicare beneficiaries. The
study shall include the following:
(1) An analysis of recent and historic growth in the compo-
nents that the Secretary includes under the sustainable growth
rate (under section 1848(f) of the Social Security Act (42 U.S.C.
1395w–4(f))).
(2) An examination of the relative growth of volume in
physicians’ services between medicare beneficiaries and other
populations.
(3) An analysis of the degree to which new technology,
including coverage determinations of the Centers for Medicare
& Medicaid Services, has affected the volume of physicians’
services.
(4) An examination of the impact on volume of demographic
changes.
(5) An examination of shifts in the site of service or services
that influence the number and intensity of services furnished
in physicians’ offices and the extent to which changes in
reimbursement rates to other providers have effected these
changes.
(6) An evaluation of the extent to which the Centers for
Medicare & Medicaid Services takes into account the impact
of law and regulations on the sustainable growth rate.
Subtitle B—Preventive Services
SEC. 611. COVERAGE OF AN INITIAL PREVENTIVE PHYSICAL EXAMINA-
TION.
(a) COVERAGE.—Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is
amended—
(1) in subparagraph (U), by striking ‘‘and’’ at the end;
(2) in subparagraph (V)(iii), by inserting ‘‘and’’ at the end;
and
(3) by adding at the end the following new subparagraph:
‘‘(W) an initial preventive physical examination (as defined
in subsection (ww));’’.
(b) SERVICES DESCRIBED.—Section 1861 (42 U.S.C. 1395x) is
amended by adding at the end the following new subsection:
‘‘Initial Preventive Physical Examination
‘‘(ww)(1) The term ‘initial preventive physical examination’
means physicians’ services consisting of a physical examination
(including measurement of height, weight, and blood pressure, and
an electrocardiogram) with the goal of health promotion and disease