[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3569 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 3569
To amend title XVIII of the Social Security Act to establish a minimum
geographic cost-of-practice index value for physicians' services
furnished under the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 20, 2001
Mr. Bereuter (for himself, Mr. Foley, Mr. Hall of Texas, Mr. McHugh,
Mr. Frost, Mr. Hefley, Mr. Leach, Mr. Peterson of Pennsylvania, Mr.
Osborne, Mr. McIntyre, Mr. Sandlin, Mr. Bass, Mr. Gordon, Mr. McInnis,
Mr. Latham, Mr. Green of Wisconsin, Mr. Petri, Mr. Hilliard, Mrs.
Emerson, Mr. Towns, Mr. Schaffer, Mrs. Cubin, Mr. Terry, and Mr.
Turner) 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 subsequently 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 establish a minimum
geographic cost-of-practice index value for physicians' services
furnished under the Medicare Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Rural Equity Payment Index Reform
Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Variations in the physician work adjustment factors
under section 1848(e) of the Social Security Act (42 U.S.C.
1395w-4w(e)) result in a physician work payment inequity
between urban and rural localities under the medicare physician
fee schedule.
(2) The amount the medicare program spends on its
beneficiaries varies substantially across the country, far more
than can be accounted for by differences in the cost of living
or differences in health status.
(3) Since beneficiaries and others pay into the program on
the basis of income and wages and beneficiaries pay the same
premium for Part B services, these payments result in
substantial crosssubsidies from people living in low payment
States with conservative practice styles or beneficiary
preferences to people living in higher payment States with
aggressive practice styles or beneficiary preferences.
(4) Congress has been mindful of these variations when it
comes to capitation payments made to managed care plans in
Medicare+Choice and has put in place floors that increase
monthly payments by more than one-third in some of the lowest
payment counties over what would otherwise occur. But this
change addresses only a very small fraction of medicare
beneficiaries who are presently enrolled in Medicare+Choice
plans operating in low payment counties.
(5) Unfortunately, Congress has only begun to address the
underlying problem of substantial geographic variations in fee-
for-service spending under traditional medicare.
(6) Improvements in rural hospital payment systems under
Medicare help to reduce aggregate per capita payment variation
as rural hospitals are in large part located in low payment
counties.
(7) Many rural communities have great difficulty attracting
and retaining physicians and other skilled health
professionals.
(8) Targeted efforts to provide relief to rural doctors in
low payment localities would further reduce variation by
improving access to primary and tertiary services along with
more equitable payment.
(9) Geographic adjustment factors in medicare's resource-
based relative value scale unfairly suppress fee-for-service
payments to rural providers.
(10) Actual costs are not presently being measured
accurately and payments do not reflect the costs of providing
care.
(11) Unless something is done about medicare payment in
rural areas, as the baby boom cohort ages into medicare, the
financial demands on rural communities to subsidize care for
their aged and disabled medicare beneficiaries will progress
from difficult to impossible in another 10 years.
(12) The impact on rural health care infrastructure will be
first felt in economically depressed rural areas where the
ability to shift costs is already limited.
SEC. 3. PHYSICIAN FEE SCHEDULE WAGE INDEX REVISION.
Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)) is amended by adding at the end the following new
subparagraph:
``(D) Floor for work geographic indices.--
``(i) In general.--Notwithstanding the work
geographic index otherwise calculated under
subparagraph (A)(iii), no such index applied
for payment under this section shall be less
than--
``(I) 0.976 for services furnished
during 2002;
``(II) 0.987 for services furnished
during 2003;
``(III) 0.995 for services
furnished during 2004; and
``(IV) 1.000 for services furnished
during 2005 and subsequent years.
``(ii) Exemption from limitation on annual
adjustments.--The increase in expenditures
attributable to clause (i) shall not be taken
into account in applying subsection
(c)(2)(B)(ii)(II).''.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR H10939, H10948-10949)
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Sponsor introductory remarks on measure. (CR H4296)
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