Amends title XVIII (Medicare) of the Social Security Act to revise requirements for determining the relative value of physicians' services for fee payment purposes.
Directs the Secretary of Health and Human Services (HHS) to provide for a 4-year transition applicable in the case of codes (for services) for which: (1) a single code is used for payment for services for which multiple codes were previously used; and (2) a change in relative value units results in a reduction in such units of 10% or more. Applies this 4-year transition to the number of percentage points of the reduction in excess of 10%.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6459 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 6459
To amend section 1848 of the Social Security Act to provide for a 4-
year transition in reductions in relative value units for certain newly
bundled services to allow physician practice time to adjust to new
payment rates.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 30, 2010
Mr. Gonzalez 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 section 1848 of the Social Security Act to provide for a 4-
year transition in reductions in relative value units for certain newly
bundled services to allow physician practice time to adjust to new
payment rates.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. 4-YEAR TRANSITION IN REDUCTION IN RELATIVE VALUE UNITS FOR
CODES FOR CERTAIN SERVICES.
(a) In General.--Section 1848(c)(2) of the Social Security Act (42
U.S.C. 1395w-4(c)(2)) is amended by adding at the end the following new
subparagraph:
``(M) 4-year transition for reductions in relative
value units for codes for certain services.--
``(i) In general.--In the case of codes
(for services) described in clause (ii) for
which a change in relative value units results
in a reduction in such units of 10 percent or
more, the Secretary shall provide for a 4-year
transition consistent with clause (iii).
``(ii) Applicable codes (for services).--
For purposes of clause (i), the codes (for
services) described in this clause are codes
(for services) for which a single code is used
for payment for services for which multiple
codes were previously used.
``(iii) Transition.--The 4-year transition
under clause (i) shall apply to the number of
percentage points of the reduction in excess of
10 percent.''.
(b) Effective Date.--
(1) In general.--Except as provided in paragraphs (2) and
(3), subparagraph (M) of section 1848(c)(2) of the Social
Security Act, as added by the amendment made by subsection (a),
shall apply to relative value units for codes applicable to
services furnished on or after January 1, 2012.
(2) Exception for new codes in 2010.--In the case of
relative value units for which codes described in clause (ii)
of such subparagraph first applied to services furnished on or
after January 1, 2010, the following rules shall apply:
(A) 2011.--Such subparagraph shall apply to such
codes for services furnished during 2011 (on or after
April 1, 2011) and the second year of a 4-year
transition shall be applied to relative value units for
codes for such services in a manner as if the
transition period began in 2010.
(B) 2012.--In applying such subparagraph to
services furnished during 2012, the third year of a 4-
year transition shall be applied to relative value
units for codes for such services in a manner as if the
transition period began in 2010.
(C) 2013.--In applying such subparagraph to
services furnished during 2013, the fourth year of a 4-
year transition shall be applied to relative value
units for codes for services furnished during 2013 in a
manner as if the transition period began in 2010.
(3) Exception for new codes after 2011.--In the case of
relative value units for codes described in clause (ii) of such
subparagraph first applied to services furnished on or after
January 1, 2011, the following rules shall apply with respect
to such amendment:
(A) 2011.--Such subparagraph shall apply to such
codes for services furnished during 2011 (on or after
April 1, 2011) and first year of a 4-year transition
shall be applied to relative value units for codes for
such services in a manner as if the transition period
began in 2011.
(B) 2012.--In applying such subparagraph to
services furnished during 2012, the second year of a 4-
year transition shall be applied to relative value
units for codes for such services in a manner as if the
transition period began in 2011.
(C) 2013.--In applying such subparagraph to
services furnished during 2013, the third year of a 4-
year transition shall be applied to relative value
units for codes for services furnished during 2013 in a
manner as if the transition period began in 2011.
(4) Application of budget neutrality.--Nothing in this
subsection shall be construed as waiving the application of the
budget-neutrality requirement of section 1848(c)(2)(B)(ii) of
the Social Security Act (42 U.S.C. 1395(c)(2)(B)(ii)) that
otherwise applies, including for the period during 2011
beginning on April 1, 2011.
<all>
Introduced in House
Introduced in House
Referred to House Energy and Commerce
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 House Ways and Means
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