[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6371 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 6371
To provide for certain adjustments to the physician fee schedule under
the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 13, 2023
Mr. Murphy (for himself, Mr. Burgess, Mr. Wenstrup, Ms. Kelly of
Illinois, Mr. Bucshon, Mr. Van Drew, Mrs. Miller-Meeks, Mr. Harris, Mr.
Babin, Mr. Joyce of Pennsylvania, Mr. Jackson of Texas, Mr. McCormick,
Mr. Ferguson, Mr. Dunn of Florida, and Mr. Carter of Georgia)
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 provide for certain adjustments to the physician fee schedule 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 ``Provider Reimbursement Stability Act
of 2023''.
SEC. 2. UPDATING THE BUDGET NEUTRALITY THRESHOLD.
Section 1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C.
1395w-4(c)(2)(B)(ii)(II)) is amended--
(1) by striking ``Subject to'' and inserting the following:
``(aa) In general.--Subject
to'';
(2) in item (aa), as inserted by subparagraph (A), by
striking ``$20,000,000'' and inserting ``the amount specified
in item (bb) for such year''; and
(3) by adding at the end the following new items:
``(bb) Amount specified.--
For purposes of item (aa),
subject to item (cc), the
amount specified in this item
is--
``(AA) for years
before 2025,
$20,000,000;
``(BB) for 2025,
$53,000,000; and
``(CC) for 2026 and
each subsequent year,
the amount specified in
this item for the
preceding year.
``(cc) Indexing limitation
on annual adjustments.--For
2030 and every subsequent fifth
year, the Secretary shall
increase the amount specified
in item (bb) for such year by
the cumulative increase in the
MEI (as defined in section
1842(i)(3)) applicable to
physicians' services over the
5-year period ending on the
last day of the preceding
year.''.
SEC. 3. BUDGET NEUTRALITY CORRECTIONS FOR OVERESTIMATES AND
UNDERESTIMATES IN UTILIZATION.
(a) In General.--Section 1848(c)(2)(B) of the Social Security Act
(42 U.S.C. 1395w-4(c)(2)(B)) is amended by adding at the end the
following new clause:
``(vii) Budget neutrality corrections for
overestimates and underestimates in
utilization.--
``(I) In general.--In the case of a
budget neutrality adjustment applied
pursuant to clause (ii)(II) for an
adjustment application year (as defined
in clause (viii)(I)) beginning with
2025, with respect to an adjustment to
relative value units made under clause
(ii)(I), that is determined using
estimated utilization (as defined in
clause (viii)(III))--
``(aa) the Secretary shall,
by not later than September 1
of the subsequent year--
``(AA) compare such
estimated utilization
to actual utilization
occurring during such
adjustment application
year with respect to
the adjustment to the
relative value units
made under clause
(ii)(I); and
``(BB) if
applicable, determine
the extent to which, if
any, the difference
between the estimated
utilization and such
actual utilization
affected the amount of
such budget neutrality
adjustment applied for
such adjustment
application year; and
``(bb) in the case that the
Secretary determines under
subclause (I)(bb) that the
difference between the
estimated utilization and such
actual utilization affected the
amount of the budget neutrality
adjustment applied for such
adjustment application year,
the Secretary shall adjust the
amount of payment made under
this section for services
furnished during the adjustment
correction period (as defined
in clause (viii)(II)) with
respect to such year by such
amount as determined necessary
by the Secretary to reconcile
the difference (which may be
positive or negative) between--
``(AA) the budget
neutrality adjustment
that had been applied
for such application
adjustment year, using
the estimated
utilization; and
``(BB) the budget
neutrality adjustment
that would have been
applied for such year
if such adjustment had
been calculated using
such actual
utilization.
``(II) Definitions.--For purposes
of this clause:
``(aa) Adjustment
application year.--The term
`adjustment application year'
means, with respect to an
adjustment to relative value
units made under clause (ii)(I)
for which a budget neutrality
adjustment under clause
(ii)(II) is required, the year
for which such adjustments are
applied.
``(bb) Adjustment
correction period.--The term
`adjustment correction period'
means, with respect to an
adjustment application year,
the second year beginning after
such adjustment application
year.
``(cc) Estimated
utilization.--The term
`estimated utilization' means,
with respect to an adjustment
to relative value units made
under clause (ii)(I), an
estimate of utilization
associated with such adjustment
used for purposes of applying
clause (ii)(II).''.
(b) Nonapplication of Budget Neutrality to Reconciliation
Adjustments.--Section 1848(c)(2)(B) of the Social Security Act (42
U.S.C. 1395w-4(c)(2)(B)) is amended--
(1) in clause (iv)--
(A) in subclause (V), by striking ``and'' at the
end;
(B) in subclause (VI), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(VII) clause (vii)(I)(bb) for an
adjustment correction period shall not
be taken into account in applying
clause (ii)(II) with respect to such
period.''; and
(2) in clause (v), by adding at the end the following new
subclause:
``(XII) Reductions attributable to
an adjustment correction.--For an
adjustment correction period, reduced
expenditures attributable to
application of clause (vii)(I)(bb) with
respect to such period.''.
SEC. 4. TIMELY UPDATES TO DIRECT COSTS USED TO CALCULATE PRACTICE
EXPENSE RVUS.
Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by section 3, is further amended by adding at
the end the following new clause:
``(viii) Timely updates to direct costs
used to calculate practice expense relative
value units.--
``(I) Simultaneous updates to
direct cost inputs at least once every
5 years.--The Secretary shall, not less
often than every 5 years, update the
prices and rates, as applicable, for
each of the direct costs inputs
described in subclause (II) used in the
methodology for calculating the
practice expense relative value units
under this subsection for physicians'
services. Updates made pursuant to the
previous sentence shall be made in the
same year for all direct cost inputs
described in such subclause.
``(II) Direct costs input
categories described.--For purposes of
this clause, the direct costs inputs
described in this subclause are
clinical staff wage rates, prices of
medical supplies, and prices of
equipment.
``(III) Consultation.--In making
the updates under this clause, the
Secretary shall consult with relevant
stakeholders, including physician
specialty societies.''.
SEC. 5. LIMITATION ON YEAR-TO-YEAR CONVERSION FACTOR VARIANCE.
Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by sections 3 and 4, is further amended-- by
adding at the end the following new clause:
``(ix) Limitation on conversion factor
variance.--
``(I) In general.--In the case that
application of clause (ii)(II) for a
year (beginning with 2025) would result
in a conversion factor established
under subsection (d) for such year, not
taking into account any adjustment
provided under such subsection, to vary
by more than 2.5 percent compared to
such factor so established for the
preceding year (in this subclause
referred to as the `preceding year's
conversion factor'), the Secretary
shall--
``(aa) if such application
would result in a decrease in
such conversion factor, modify
any budget neutrality
adjustment applied to such
conversion factor pursuant to
such clause such that such
conversion factor is decreased
by 2.5 percent, not taking into
account any adjustment provided
under such subsection, compared
to the preceding year's
conversion factor; and
``(bb) if such application
would result in an increase in
such conversion factor, modify
any budget neutrality
adjustment applied to such
conversion factor pursuant to
such clause such that such
conversion factor is increased
by 2.5 percent, not taking into
account any adjustment provided
under such subsection, compared
to the preceding year's
conversion factor.
``(II) Special rule for 2025.--In
applying subclause (I) with respect to
the conversion factor established under
subsection (d) for 2025, in determining
whether the application of clause
(ii)(II) for such year would result in
such conversion factor varying by more
than 2.5 percent compared to such
factor so established for 2024, the
Secretary shall take into account the
increase to such conversion factor so
established for 2024 provided under
subsection (t).
``(III) Clarification relating to
transition to multiple conversion
factors.--For 2026, in applying
subclause (I) with respect to the
qualifying APM conversion factor (as
described in subsection (d)(1)(A)) and
the nonqualifying APM conversion factor
(as so described) established under
subsection (d) for such year, each
reference in such subclause to the
`preceding year's conversion factor'
shall be deemed to be a reference to
`the single conversion factor (as
described in subsection (d)(1)(A)) so
established for 2025'.''.
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