Accuracy in Medicare Physician Payment Act of 2015

Accuracy in Medicare Physician Payment Act of 2015

Amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services to establish and appoint an expert outside advisory panel for purposes of providing oversight to the processes relating to valuation of physicians' services.

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2614 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 2614

   To amend title XVIII of the Social Security Act to provide for an 
expert advisory panel regarding relative value scale process used under 
      the Medicare physician fee schedule, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 2, 2015

Mr. McDermott 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 provide for an 
expert advisory panel regarding relative value scale process used under 
      the Medicare physician fee schedule, and for other purposes.

    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 ``Accuracy in Medicare Physician 
Payment Act of 2015''.

SEC. 2. EXPERT ADVISORY PANEL REGARDING RELATIVE VALUE SCALE PROCESS 
              USED IN MEDICARE PHYSICIAN FEE SCHEDULE.

    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:
                    ``(P) Use of expert advisory panel regarding 
                relative value scale process used.--
                            ``(i) In general.--For purposes of 
                        providing oversight to the processes (including 
                        the process described in subparagraph (K)) 
                        relating to valuation of physicians' services, 
                        not later than 90 days after the date of the 
                        enactment of this subparagraph, the Secretary 
                        shall establish and appoint an expert outside 
                        advisory panel (in this subparagraph referred 
                        to as the `panel').
                            ``(ii) Composition of panel.--The panel 
                        shall be composed of individuals with expertise 
                        in the valuation of physicians' services, such 
                        as individuals who are medical directors for 
                        carriers, experts in medical economics and 
                        technology diffusion, and private payer plan 
                        representatives, and shall include a mix of 
                        physicians in different specialty areas, 
                        particularly physicians who are not directly 
                        affected by changes in the valuation of 
                        physicians' services under this section (such 
                        as retired physicians and physicians who are 
                        employed by managed care organizations or 
                        academic medical centers), as well as 
                        representatives of individuals enrolled under 
                        this part.
                            ``(iii) Duties.--
                                    ``(I) In general.--The panel shall 
                                provide oversight to the processes of 
                                identifying, reviewing, and adjusting 
                                valuations for physicians' services 
                                under this section, including 
                                activities described in the succeeding 
                                provisions of this clause.
                                    ``(II) Establishment of screens.--
                                The panel may establish screens (in 
                                addition to the screens identified 
                                under subparagraph (K)(ii)) and other 
                                means for identifying physicians' 
                                services for which there are 
                                potentially misvalued codes for review, 
                                such as services that have experienced 
                                substantial changes in length of stay, 
                                site of service, volume, practice 
                                expense, and other factors that may 
                                indicate changes in physician work.
                                    ``(III) Data collection.--The panel 
                                may collect data and develop supporting 
                                evidence relating to the valuation of 
                                physicians' services.
                                    ``(IV) Surveys.--The panel may 
                                conduct surveys of suppliers of 
                                physicians' services and may conduct 
                                time and motion studies relating to 
                                such valuations.
                                    ``(V) Transmitting codes for review 
                                and recommendations.--The panel may 
                                transmit with supporting evidence codes 
                                for review and recommendations through 
                                the means described in subclauses (I) 
                                through (III) of subparagraph (K)(iii).
                                    ``(VI) Evaluation of 
                                recommendations submitted.--The panel 
                                shall evaluate any recommendations 
                                submitted through such means (whether 
                                pursuant to the solicitation under 
                                subclause (V) or otherwise) and report 
                                to the Secretary on such evaluation.
                                    ``(VII) Use of contracts.--The 
                                panel's activities under subclauses 
                                (III) and (IV) may be conducted 
                                directly or through contracts with 
                                appropriate, qualified entities.
                            ``(iv) Application of faca.--The Federal 
                        Advisory Committee Act (5 U.S.C. App.) shall 
                        apply to the panel, except that section 14 of 
                        such Act shall not apply.
                            ``(v) Funding.--The Secretary shall provide 
                        for the transfer of not to exceed $10,000,000 
                        for each fiscal year (beginning with fiscal 
                        year 2016) from the Federal Medical 
                        Supplementary Medical Insurance Trust Fund 
                        established in section 1841 to the Centers for 
                        Medicare & Medicaid Services Program Management 
                        Account to carry out this subparagraph, 
                        including for the management and staffing of 
                        the panel and the conduct of activities 
                        described in clause (iii).''.
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