I 
115TH CONGRESS 
1ST SESSION H. R. 3817 
To amend title XVIII of the Social Security Act to improve the accuracy 
of geographic adjustment factors under the Medicare program and to 
permanently extend certain adjustments to such factors for certain local-
ities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 21, 2017 
Mr. YOUNG of Iowa (for himself, Mr. KIND, Mr. BLUM, Mr. DUFFY, Mr. 
LOEBSACK, Mr. POCAN, and Mr. GALLAGHER) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Ways and Means, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
the accuracy of geographic adjustment factors under the 
Medicare program and to permanently extend certain 
adjustments to such factors for certain localities, and 
for other purposes. 
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. IMPROVING THE ACCURACY OF GEOGRAPHIC 
ADJUSTMENT FACTORS. 
Section 1848(e)(1)(D) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(D)) is amended to read as follows: 
‘‘(D) USE OF ACCURATE DATA.— 
‘‘(i) IN GENERAL.—In establishing in-
dices and index values under this para-
graph, the Secretary shall use the most re-
cent data available relating to practice ex-
penses, malpractice expenses, and physi-
cian work effort in each fee schedule area. 
‘‘(ii) PRACTICE EXPENSE AND WORK 
INDICES.—In 
establishing 
indices 
and 
index values under clause (i) or (iii) of 
subparagraph (A), the Secretary shall— 
‘‘(I) use the most recent market 
data available on physician wages, or 
if available, actual cost data for physi-
cian labor; and 
‘‘(II) not use nonphysician pro-
fessional wage data as a proxy for 
physician wage data. 
‘‘(iii) PRACTICE
EXPENSE
CALCULA-
TION.—In calculating index values under 
clause (i) of subparagraph (A), the Sec-
retary shall use the most recent office rent 
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data available or data from Federally 
qualified health centers (as defined in sec-
tion 1861(aa)(4)) expense reports.’’. 
SEC. 2. FLOOR FOR WORK AND PRACTICE EXPENSE GEO-
GRAPHIC 
INDICES 
FOR 
SERVICES 
FUR-
NISHED IN WISCONSIN AND IOWA. 
(a) 
WORK
GEOGRAPHIC
INDEX.—Section 
1848(e)(1)(E) of the Social Security Act (42 U.S.C. 
1395w–4(e)(1)(D)) is amended to read as follows: 
‘‘(E) FLOOR AT 1.0 ON WORK GEOGRAPHIC 
INDEX.— 
‘‘(i) FOR 2004 THROUGH 2017.—After 
calculating the work geographic index in 
subparagraph (A)(iii), for purposes of pay-
ment for services furnished on or after 
January 1, 2004, and before January 1, 
2018, the Secretary shall increase the work 
geographic index to 1.00 for any locality 
for which such work geographic index is 
less than 1.00. 
‘‘(ii) FOR
2018
AND
SUBSEQUENT 
YEARS.—After calculating the work geo-
graphic index in subparagraph (A)(iii), for 
purposes of payment for services furnished 
in Wisconsin or Iowa on or after January 
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