Provides for a temporary increase for: (1) home health services furnished in a rural area; (2) certain services furnished by small rural hospitals under the Medicare prospective payment system for OPD services; and (3) ground ambulance services furnished in a rural area.
Amends SSA title XVIII to provide for: (1) exclusion of certain rural health clinic and Federally qualified health center services from the Medicare PPS for skilled nursing facilities; and (2) Medicare incentive program changes.
Provides for two-year treatment of certain clinical diagnostic laboratory tests furnished by a sole community hospital.
Amends SSA title XVIII to provide for establishment of a floor on geographic adjustments of payments for physicians' services.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2175 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 2175
To amend title XVIII of the Social Security Act to enhance beneficiary
access in rural areas to quality health care services under the
Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 20, 2003
Mr. Sandlin (for himself, Mr. Berry, Mr. McIntyre, Mr. Ross, and Mr.
Turner of Texas) introduced the following bill; which was referred to
the Committee on Ways and Means, and in addition to the Committee on
Energy and Commerce, 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 enhance beneficiary
access in rural areas to quality health care services 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 Healthcare Access Improvement
Act of 2003''.
SEC. 2. EQUALIZING URBAN AND RURAL STANDARDIZED PAYMENT AMOUNTS UNDER
THE MEDICARE INPATIENT HOSPITAL PROSPECTIVE PAYMENT
SYSTEM.
(a) In General.--Section 1886(d)(3)(A)(iv) of the Social Security
Act (42 U.S.C. 1395ww(d)(3)(A)(iv)) is amended--
(1) by striking ``(iv) For discharges'' and inserting
``(iv)(I) Subject to subclause (II), for discharges''; and
(2) by adding at the end the following new subclause:
``(II) For discharges occurring in a fiscal year beginning
with fiscal year 2004, the Secretary shall compute a
standardized amount for hospitals located in any area within
the United States and within each region equal to the
standardized amount computed for the previous fiscal year under
this subparagraph for hospitals located in a large urban area
(or, beginning with fiscal year 2005, for hospitals located in
any area) increased by the applicable percentage increase under
subsection (b)(3)(B)(i) for the fiscal year involved.''.
(b) Conforming Amendments.--
(1) Computing drg-specific rates.--Section 1886(d)(3)(D) of
the Social Security Act (42 U.S.C. 1395ww(d)(3)(D)) is
amended--
(A) in the heading, by striking ``in different
areas'';
(B) in the matter preceding clause (i), by striking
``, each of'';
(C) in clause (i)--
(i) in the matter preceding subclause (I),
by inserting ``for fiscal years before fiscal
year 2004,'' before ``for hospitals''; and
(ii) in subclause (II), by striking ``and''
after the semicolon at the end;
(D) in clause (ii)--
(i) in the matter preceding subclause (I),
by inserting ``for fiscal years before fiscal
year 2004,'' before ``for hospitals''; and
(ii) in subclause (II), by striking the
period at the end and inserting ``; and''; and
(E) by adding at the end the following new clause:
``(iii) for a fiscal year beginning after fiscal
year 2003, for hospitals located in all areas, to the
product of--
``(I) the applicable standardized amount
(computed under subparagraph (A)), reduced
under subparagraph (B), and adjusted or reduced
under subparagraph (C) for the fiscal year; and
``(II) the weighting factor (determined
under paragraph (4)(B)) for that diagnosis-
related group.''.
(2) Technical conforming sunset.--Section 1886(d)(3) of the
Social Security Act (42 U.S.C. 1395ww(d)(3)) is amended--
(A) in the matter preceding subparagraph (A), by
inserting ``, for fiscal years before fiscal year
1997,'' before ``a regional adjusted DRG prospective
payment rate''; and
(B) in subparagraph (D), in the matter preceding
clause (i), by inserting ``, for fiscal years before
fiscal year 1997,'' before ``a regional DRG prospective
payment rate for each region,''.
SEC. 3. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE HOSPITAL (DSH)
ADJUSTMENT FOR RURAL HOSPITALS.
(a) Equalizing DSH Payment Amounts.--
(1) In general.--Section 1886(d)(5)(F)(vii) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(F)(vii)) is amended by
inserting ``, and, after October 1, 2003, for any other
hospital described in clause (iv),'' after ``clause (iv)(I)''
in the matter preceding subclause (I).
(2) Conforming amendments.--Section 1886(d)(5)(F) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) is amended--
(A) in clause (iv)--
(i) in subclause (II)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (xiii)'';
(ii) in subclause (III)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (xii)'';
(iii) in subclause (IV)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (x) or
(xi)'';
(iv) in subclause (V)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (xi)'';
and
(v) in subclause (VI)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (x)'';
(B) in clause (viii), by striking ``The formula''
and inserting ``For discharges occurring before October
1, 2003, the formula''; and
(C) in each of clauses (x), (xi), (xii), and
(xiii), by striking ``For purposes'' and inserting
``With respect to discharges occurring before October
1, 2003, for purposes''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to discharges occurring on or after October 1, 2003.
SEC. 4. MEDICARE INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR LOW-VOLUME
HOSPITALS.
Section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) is
amended by adding at the end the following new paragraph:
``(12) Payment adjustment for low-volume hospitals.--
``(A) Payment adjustment.--
``(i) In general.--Notwithstanding any
other provision of this section, for each cost
reporting period (beginning with the cost
reporting period that begins in fiscal year
2005), the Secretary shall provide for an
additional payment amount to each low-volume
hospital (as defined in clause (iii)) for
discharges occurring during that cost reporting
period to increase the amount paid to such
hospital under this section for such discharges
by the applicable percentage increase
determined under clause (ii).
``(ii) Applicable percentage increase.--The
Secretary shall determine a percentage increase
applicable under this paragraph that ensures
that--
``(I) no percentage increase in
payments under this paragraph exceeds
25 percent of the amount of payment
that would otherwise be made to a low-
volume hospital under this section for
each discharge (but for this
paragraph);
``(II) low-volume hospitals that
have the lowest number of discharges
during a cost reporting period receive
the highest percentage increase in
payments due to the application of this
paragraph; and
``(III) the percentage increase in
payments due to the application of this
paragraph is reduced as the number of
discharges per cost reporting period
increases.
``(iii) Low-volume hospital defined.--For
purposes of this paragraph, the term `low-
volume hospital' means, for a cost reporting
period, a subsection (d) hospital (as defined
in paragraph (1)(B)) other than a critical
access hospital (as defined in section
1861(mm)(1)) that--
``(I) the Secretary determines had
an average of less than 2,000 dis-
charges (determined with respect to all patients and not just
individuals receiving benefits under this title) during the 3 most
recent cost reporting periods for which data are available that precede
the cost reporting period to which this paragraph applies; and
``(II) is located at least 15 miles
from a similar hospital (or is deemed
by the Secretary to be so located by
reason of such factors as the Secretary
determines appropriate, including the
time required for an individual to
travel to the nearest alternative
source of appropriate inpatient care
(taking into account the location of
such alternative source of inpatient
care and any weather or travel
conditions that may affect such travel
time)).
``(B) Prohibiting certain reductions.--
Notwithstanding subsection (e), the Secretary shall not
reduce the payment amounts under this section to offset
the increase in payments resulting from the application
of subparagraph (A).''.
SEC. 5. ADJUSTMENT TO THE MEDICARE INPATIENT HOSPITAL PPS WAGE INDEX TO
REVISE THE LABOR-RELATED SHARE OF SUCH INDEX.
(a) In General.--Section 1886(d)(3)(E) of the Social Security Act
(42 U.S.C. 1395ww(d)(3)(E)) is amended--
(1) by striking ``wage levels.--The Secretary'' and
inserting ``wage levels.--
``(i) In general.--Except as provided in clause
(ii), the Secretary''; and
(2) by adding at the end the following new clause:
``(ii) Alternative proportion to be adjusted
beginning in fiscal year 2004.--
``(I) In general.--Except as provided in
subclause (II), for discharges occurring on or
after October 1, 2003, the Secretary shall
substitute `62 percent' for the proportion
described in the first sentence of clause (i).
``(II) Hold harmless for certain
hospitals.--If the application of subclause (I)
would result in lower payments to a hospital
than would otherwise be made, then this
subparagraph shall be applied as if this clause
had not been enacted.''.
(b) Waiving Budget Neutrality.--Section 1886(d)(3)(E) of the Social
Security Act (42 U.S.C. 1395ww(d)(3)(E)), as amended by subsection (a),
is amended by adding at the end of clause (i) the following new
sentence: ``The Secretary shall apply the previous sentence for any
period as if the amendments made by section 5(a) of the Rural
Healthcare Access Improvement Act of 2003 had not been enacted.''.
SEC. 6. ONE-YEAR EXTENSION OF HOLD HARMLESS PROVISIONS FOR SMALL RURAL
HOSPITALS AND TEMPORARY TREATMENT OF CERTAIN SOLE
COMMUNITY HOSPITALS TO LIMIT DECLINE IN PAYMENT UNDER THE
OPD PPS.
(a) Hold Harmless Provisions.--Section 1833(t)(7)(D)(i) of the
Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)) is amended--
(1) in the heading, by striking ``small'' and inserting
``certain'';
(2) by inserting ``or a sole community hospital (as defined
in section 1886(d)(5)(D)(iii)) located in a rural area'' after
``100 beds''; and
(3) by striking ``2004'' and inserting ``2005''.
(b) Effective Date.--The amendment made by subsection (a)(2) shall
apply with respect to payment for OPD services furnished on and after
January 1, 2004.
SEC. 7. CRITICAL ACCESS HOSPITAL (CAH) IMPROVEMENTS.
(a) Permitting Hospitals To Allocate Swing Beds and Acute Care
Inpatient Beds Subject to a Total Limit of 25 Beds.--
(1) In general.--Section 1820(c)(2)(B)(iii) of the Social
Security Act (42 U.S.C. 1395i-4(c)(2)(B)(iii)) is amended to
read as follows:
``(iii) provides not more than a total of
25 extended care service beds (pursuant to an
agreement under subsection (f)) or acute care
inpatient beds (meeting such standards as the
Secretary may establish) for providing
inpatient care for a period that does not
exceed, as determined on an annual, average
basis, 96 hours per patient;''.
(2) Conforming amendment.--Section 1820(f) of the Social
Security Act (42 U.S.C. 1395i-4(f)) is amended by striking
``and the number of beds used at any time for acute care
inpatient services does not exceed 15 beds''.
(b) Elimination of the Isolation Test for Cost-Based CAH Ambulance
Services.--
(1) In general.--Section 1834(l)(8) of the Social Security
Act (42 U.S.C. 1395m(l)(8)), as added by section 205(a) of the
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (114 Stat. 2763A-482), as enacted into
law by section 1(a)(6) of Public Law 106-554 (114 Stat. 2763),
is amended by striking the comma at the end of subparagraph (B)
and all that follows and inserting a period.
(2) Technical correction.--Section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)) is amended by redesignating
paragraph (8), as added by section 221(a) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of
2000 (114 Stat. 2763A-486), as enacted into law by section
1(a)(6) of Public Law 106-554 (114 Stat. 2763), as paragraph
(9).
(c) Coverage of Costs for Certain Emergency Room On-Call
Providers.--
(1) In general.--Section 1834(g)(5) of the Social Security
Act (42 U.S.C. 1395m(g)(5)) is amended--
(A) in the heading--
(i) by inserting ``certain'' before
``emergency''; and
(ii) by striking ``physicians'' and
inserting ``providers'';
(B) by striking ``emergency room physicians who are
on-call (as defined by the Secretary)'' and inserting
``physicians, physician assistants, nurse
practitioners, and clinical nurse specialists who are
on-call (as defined by the Secretary) to provide
emergency services''; and
(C) by striking ``physicians' services'' and
inserting ``services covered under this title''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply with respect to costs incurred for services
provided on or after January 1, 2004.
(d) Authorization of Periodic Interim Payment (PIP).--
(1) In general.--Section 1815(e)(2) of the Social Security
Act (42 U.S.C. 1395g(e)(2)) is amended--
(A) in subparagraph (C), by striking ``and'' after
the semicolon at the end;
(B) in subparagraph (D), by adding ``and'' after
the semicolon at the end; and
(C) by inserting after subparagraph (D) the
following new subparagraph:
``(E) inpatient critical access hospital services,''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply with respect to payments for inpatient critical
access hospital services furnished on or after January 1, 2004.
(e) Exclusion of New CAHs From PPS Hospital Wage Index
Calculation.--Section 1886(d)(3)(E)(i) of the Social Security Act (42
U.S.C. 1395ww(d)(3)(E)(i)), as amended by section 5, is amended by
inserting after the first sentence the following new sentence: ``In
calculating the hospital wage levels under the preceding sentence
applicable with respect to cost reporting periods beginning on or after
January 1, 2004, the Secretary shall exclude the wage levels of any
hospital that became a critical access hospital prior to the cost
reporting period for which such hospital wage levels are calculated.''.
SEC. 8. TEMPORARY INCREASE FOR HOME HEALTH SERVICES FURNISHED IN A
RURAL AREA.
(a) In General.--In the case of home health services furnished in a
rural area (as defined in section 1886(d)(2)(D) of the Social Security
Act (42 U.S.C. 1395ww(d)(2)(D))) on or after October 1, 2003, and
before October 1, 2005, the Secretary of Health and Human Services
shall increase the payment amount otherwise made under section 1895 of
such Act (42 U.S.C. 1395fff) for such services by 10 percent.
(b) Waiving Budget Neutrality.--The Secretary of Health and Human
Services shall not reduce the standard prospective payment amount (or
amounts) under section 1895 of the Social Security Act (42 U.S.C.
1395fff) applicable to home health services furnished during a period
to offset the increase in payments resulting from the application of
subsection (a).
(c) No Effect on Subsequent Periods.--The payment increase provided
under subsection (a) for a period under such subsection, shall not
apply to episodes and visits ending after such period, and shall not be
taken into account in calculating the payment amounts applicable for
episodes and visits occurring after such period.
SEC. 9. TEMPORARY INCREASE IN PAYMENTS FOR CERTAIN SERVICES FURNISHED
BY SMALL RURAL HOSPITALS UNDER MEDICARE PROSPECTIVE
PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT
SERVICES.
(a) Increase.--
(1) In general.--In the case of an applicable covered OPD
service (as defined in paragraph (2)) that is furnished by a
hospital described in paragraph (7)(D)(i) of section 1833(t) of
the Social Security Act (42 U.S.C. 1395l(t)) on or after
January 1, 2004, and before January 1, 2007, the Secretary of
Health and Human Services (in this section referred to as the
``Secretary'') shall increase the medicare OPD fee schedule
amount (as determined under paragraph (4)(A) of such section)
that is applicable for such service in that year (determined
without regard to any increase under this section in a previous
year) by 5 percent.
(2) Applicable covered opd services defined.--For purposes
of this section, the term ``applicable covered OPD service''
means a covered clinic or emergency room visit that is
classified within the groups of covered OPD services (as
defined in paragraph (1)(B) of section 1833(t) of the Social
Security Act (42 U.S.C. 1395l(t))) established under paragraph
(2)(B) of such section.
(b) No Effect on Copayment Amount.--The Secretary shall compute the
copayment amount for applicable covered OPD services under section
1833(t)(8)(A) of the Social Security Act (42 U.S.C. 1395l(t)(8)(A)) as
if this section had not been enacted.
(c) No Effect on Increase Under Hold Harmless or Outlier
Provisions.--The Secretary shall apply the temporary hold harmless
provision under paragraph (7)(D)(i) of section 1833(t) of the Social
Security Act (42 U.S.C. 1395l(t)) and the outlier provision under
paragraph (5) of such section as if this section had not been enacted.
(d) Waiving Budget Neutrality and No Revision or Adjustments.--The
Secretary shall not make any revision or adjustment under subparagraph
(A), (B), or (C) of section 1833(t)(9) of the Social Security Act (42
U.S.C. 1395l(t)(9)) because of the application of subsection (a)(1).
(e) No Effect on Payments After Increase Period Ends.--The
Secretary shall not take into account any payment increase provided
under subsection (a)(1) in determining payments for covered OPD
services (as defined in paragraph (1)(B) of section 1833(t) of the
Social Security Act (42 U.S.C. 1395l(t))) under such section that are
furnished after January 1, 2007.
(f) Findings.--The Congress finds the following:
(1) The medicare program has a responsibility to pay enough
for beneficial new technologies in order to ensure that
medicare beneficiaries have access to care; however, such
program must also be a prudent purchaser of health care items
and services.
(2) The 2003 Medicare Hospital Outpatient Prospective
Payment System Regulation may have resulted in limiting
beneficiary access to care.
(3) A methodology should be developed under the medicare
outpatient prospective payment system under section 1833(t) of
the Social Security Act (42 U.S.C. 1395l(t)) with appropriate
resources and such methodology should be implemented January 1,
2004. This will ensure that all hospitals are appropriately
reimbursed for the drugs and biologics that are used in the
outpatient setting which in turn will ensure patient access to
new technologies.
(g) Technical Amendment.--Section 1833(t)(2)(B) (42 U.S.C.
1395l(t)(2)(B)) is amended by inserting ``(and periodically revise such
groups pursuant to paragraph (9)(A))'' after ``establish groups''.
SEC. 10. TEMPORARY INCREASE FOR GROUND AMBULANCE SERVICES FURNISHED IN
A RURAL AREA.
Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), as
amended by section 7(b)(2), is amended by adding at the end the
following new paragraph:
``(10) Temporary increase for ground ambulance services
furnished in a rural area.--
``(A) In general.--Notwithstanding any other
provision of this subsection, in the case of ground
ambulance services furnished on or after January 1,
2004, and before January 1, 2007, for which the
transportation originates in a rural area described in
paragraph (9) or in a rural census tract described in
such paragraph, the fee schedule established under this
section shall provide that the rate for the service
otherwise established, after application of any
increase under such paragraph, shall be increased by 5
percent.
``(B) Application of increased payments after
2006.--The increased payments under subparagraph (A)
shall not be taken into account in calculating payments
for services furnished on or after the period specified
in such subparagraph.''.
SEC. 11. EXCLUSION OF CERTAIN RURAL HEALTH CLINIC AND FEDERALLY
QUALIFIED HEALTH CENTER SERVICES FROM THE MEDICARE PPS
FOR SKILLED NURSING FACILITIES.
(a) In General.--Section 1888(e) of the Social Security Act (42
U.S.C. 1395yy(e)) is amended--
(1) in paragraph (2)(A)(i)(II), by striking ``clauses (ii)
and (iii)'' and inserting ``clauses (ii), (iii), and (iv)'';
and
(2) by adding at the end of paragraph (2)(A) the following
new clause:
``(iv) Exclusion of certain rural health
clinic and federally qualified health center
services.--Services described in this clause
are--
``(I) rural health clinic services
(as defined in paragraph (1) of section
1861(aa)); and
``(II) Federally qualified health
center services (as defined in
paragraph (3) of such section);
that would be described in clause (ii) if such
services were furnished by a physician or
practitioner not affiliated with a rural health
clinic or a Federally qualified health
center.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to services furnished on or after January 1, 2004.
SEC. 12. MEDICARE INCENTIVE PAYMENT PROGRAM IMPROVEMENTS.
(a) Procedures for Secretary, and Not Physicians, To Determine When
Bonus Payments Under Medicare Incentive Payment Program Should Be
Made.--Section 1833(m) of the Social Security Act (42 U.S.C. 1395l(m))
is amended--
(1) by inserting ``(1)'' after ``(m)''; and
(2) by adding at the end the following new paragraph:
``(2) The Secretary shall establish procedures under which the
Secretary, and not the physician furnishing the service, is responsible
for determining when a payment is required to be made under paragraph
(1).''.
(b) Educational Program Regarding the Medicare Incentive Payment
Program.--The Secretary shall establish and implement an ongoing
educational program to provide education to physicians under the
medicare program on the medicare incentive payment program under
section 1833(m) of the Social Security Act (42 U.S.C. 1395l(m)).
(c) Ongoing Study and Annual Report on the Medicare Incentive
Payment Program.--
(1) Ongoing study.--The Secretary shall conduct an ongoing
study on the medicare incentive payment program under section
1833(m) of the Social Security Act (42 U.S.C. 1395l(m)). Such
study shall focus on whether such program increases the access
of medicare beneficiaries who reside in an area that is
designated (under section 332(a)(1)(A) of the Public Health
Service Act (42 U.S.C. 254e(a)(1)(A))) as a health professional
shortage area to physicians' services under the medicare
program.
(2) Annual reports.--Not later than 1 year after the date
of enactment of this Act, and annually thereafter, the
Secretary shall submit to Congress a report on the study
conducted under paragraph (1), together with recommendations
for such legislation and administrative action as the Secretary
considers appropriate.
SEC. 13. TWO-YEAR TREATMENT OF CERTAIN CLINICAL DIAGNOSTIC LABORATORY
TESTS FURNISHED BY A SOLE COMMUNITY HOSPITAL.
Notwithstanding subsections (a)(1)(D) and (h) of section 1833 of
the Social Security Act (42 U.S.C. 1395l) and section 1834(d)(1) of
such Act (42 U.S.C. 1395m(d)(1)), in the case of a clinical diagnostic
laboratory test covered under part B of title XVIII of such Act that is
furnished in 2004 or 2005 by a sole community hospital (as defined in
section 1886(d)(5)(D)(iii) of such Act (42 U.S.C.
1395ww(d)(5)(D)(iii))) as part of services provided to patients of the
hospital, the following rules shall apply:
(1) Payment based on reasonable costs.--The amount of
payment for such test shall be 100 percent of the reasonable
costs of the hospital in furnishing such test.
(2) No beneficiary cost-sharing.--No coinsurance,
deductible, copayment, or other cost-sharing otherwise
applicable under such part B shall apply with respect to such
test.
SEC. 14. ESTABLISHMENT OF FLOOR ON GEOGRAPHIC ADJUSTMENTS OF PAYMENTS
FOR PHYSICIANS' SERVICES.
Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)) is amended--
(1) in subparagraph (A), by striking ``subparagraphs (B)
and (C)'' and inserting ``subparagraphs (B), (C), and (E)'';
and
(2) by adding at the end the following new subparagraph:
``(E) Floor for practice expense, malpractice, and
work geographic indices.--For purposes of payment for
services furnished on or after January 1, 2004, 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 1.00 for any locality
for which such index is less than 1.00.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 Ways and Means, and in addition to the Committee on Energy and Commerce, 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 Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Sponsor introductory remarks on measure. (CR E1011)
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line