S.Amdt. 2860

SA 2860. Mr. FEINGOLD submitted an amendment intended to be proposed
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 797, strike line 11 and all that follows
through page 801, line 4, and insert the following:

SEC. 3102A. ELIMINATION OF GEOGRAPHIC PHYSICIAN WORK
ADJUSTMENT FACTOR FROM GEOGRAPHIC INDICES USED
TO ADJUST PAYMENTS UNDER THE PHYSICIAN FEE
SCHEDULE.

(a) Findings.--Congress finds the following:
(1) Variations in the geographic physician work adjustment
factors under section 1848(e) of the Social Security Act (42
U.S.C. 1395w-4(e)) result in inequity between localities in
payments under the Medicare physician fee schedule.
(2) Beneficiaries under the Medicare program that reside in
areas where such adjustment factors are high have relatively
more access to services that are paid based on such fee
schedule.
(3) There are a number of studies indicating that the
market for health care professionals has become nationalized
and historically low labor costs in rural and small urban
areas have disappeared.
(4) Elimination of the adjustment factors described in
paragraph (1) would equalize the reimbursement rate for
services reimbursed under the Medicare physician fee schedule
while remaining budget-neutral.
(b) Elimination.--Section 1848(e) of the Social Security
Act (42 U.S.C. 1395w-4(e)) is amended--
(1) in paragraph (1)(A)(iii), by striking ``an index'' and
inserting ``for services provided before January 1, 2010, an
index''; and
(2) in paragraph (2), by inserting ``, for services
provided before January 1, 2010,'' after ``paragraph (4)),
and''.
(c) Budget Neutrality Adjustment for Elimination of
Geographic Physician Work Adjustment Factor.--Section 1848(d)
of the Social Security Act (42 U.S.C. 1395w-4(d)) is
amended--
(1) in paragraph (1)(A), by striking ``The conversion'' and
inserting ``Subject to paragraph (10), the conversion''; and
(2) by adding at the end the following new paragraph:
``(10) Budget neutrality adjustment for elimination of
geographic physician work adjustment factor.--Before applying
an update for a year under this subsection, the Secretary
shall (if necessary) provide for an adjustment to the
conversion factor for that year to ensure that the aggregate
payments under this part in that year shall be equal to
aggregate payments that would have been made under such part
in that year if the amendments made by section 3102A(b) of
the Patient Protection and Affordable Care Act had not been
enacted.''.

SEC. 3102B. CLINICAL ROTATION DEMONSTRATION PROJECT.

(a) Establishment.--Not later than 6 months after the date
of enactment of this Act, the Secretary shall establish a
demonstration project that provides for demonstration grants
designed to provide financial or other incentives to
hospitals to attract educators and clinical practitioners so
that hospitals that serve beneficiaries under the Medicare
program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) who are residents of underserved areas
may host clinical rotations.
(b) Duration of Project.--The demonstration project shall
be conducted over a 5-year period.
(c) Waiver.--The Secretary shall waive such provisions of
titles XI and XVIII of the Social Security Act (42 U.S.C.
1301 et seq. and 1395 et seq.) as may be necessary to conduct
the demonstration project under this section.
(d) Reports.--The Secretary shall submit to the appropriate
committees of Congress interim reports on the demonstration
project and a final report on such project within 6 months
after the conclusion of the project, together with
recommendations for such legislation or administrative action
as the Secretary determines to be appropriate.
(e) Funding.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the
Secretary to carry out this section, $20,000,000.
(f) Definitions.--In this section:
(1) Hospital.--The term ``hospital'' means a subsection (d)
hospital (as defined in section 1886(d)(1)(B) of the Social
Security Act (42 U.S.C. 1395ww(d)(1)(B))) that had indirect
or direct costs of medical education during the most recent
cost reporting period preceding the date of enactment of this
Act.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(3) Underserved area.--The term ``underserved area'' means
such medically underserved urban areas and medically
underserved rural areas as the Secretary may specify.

SEC. 3102C. MEDICARE RURAL HEALTH CARE QUALITY IMPROVEMENT
DEMONSTRATION PROJECTS.

(a) Establishment.--
(1) In general.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall establish not more that 10 demonstration projects to
provide for improvements, as recommended by the Institute of
Medicine, in the quality of health care provided to
individuals residing in rural areas.
(2) Activities.--Activities under the projects may include
public health surveillance, emergency room videoconferencing,
virtual libraries, telemedicine, electronic health records,
data exchange networks, and any other activities determined
appropriate by the Secretary.
(3) Consultation.--The Secretary shall consult with the
Office of Rural Health Policy of the Health Resources and
Services Administration, the Agency for Healthcare Research
and Quality, and the Centers for Medicare & Medicaid Services
in carrying out the provisions of this section.
(b) Duration.--Each demonstration project under this
section shall be conducted over a 4-year period.
(c) Demonstration Project Sites.--The Secretary shall
ensure that the demonstration projects under this section are
conducted at a variety of sites representing the diversity of
rural communities in the United States.
(d) Waiver.--The Secretary shall waive such provisions of
titles XI and XVIII of the

[[Page S12335]]

Social Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.)
as may be necessary to conduct the demonstration projects
under this section.
(e) Independent Evaluation.--The Secretary shall enter into
an arrangement with an entity that has experience working
directly with rural health systems for the conduct of an
independent evaluation of the demonstration projects
conducted under this section.
(f) Reports.--The Secretary shall submit to the appropriate
committees of Congress interim reports on each demonstration
project and a final report on such project within 6 months
after the conclusion of the project. Such reports shall
include recommendations regarding the expansion of the
project to other areas and recommendations for such other
legislative or administrative action as the Secretary
determines appropriate.
(g) Funding.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the
Secretary to carry out this section, $50,000,000.

SEC. 3102D. ENSURING PROPORTIONAL REPRESENTATION OF INTERESTS
OF RURAL AREAS ON THE MEDICARE PAYMENT ADVISORY
COMMISSION.

(a) In General.--Section 1805(c)(2) of the Social Security
Act (42 U.S.C. 1395b-6(c)(2)) is amended--
(1) in subparagraph (A), by inserting ``consistent with
subparagraph (E)'' after ``rural representatives''; and
(2) by adding at the end the following new subparagraph:
``(E) Proportional representation of interests of rural
areas.--In order to provide a balance between urban and rural
representatives under subparagraph (A), the proportion of
members who represent the interests of health care providers
and Medicare beneficiaries located in rural areas shall be no
less than the proportion, of the total number of Medicare
beneficiaries, who reside in rural areas.''.
(b) Effective Date.--The amendments made by subsection (a)
shall apply with respect to appointments made to the Medicare
Payment Advisory Commission after the date of the enactment
of this Act.

SEC. 3102E. IMPLEMENTATION OF GAO RECOMMENDATIONS REGARDING
GEOGRAPHIC ADJUSTMENT INDICES UNDER THE
MEDICARE PHYSICIAN FEE SCHEDULE.

Not later than 180 days after the date of enactment of this
Act, the Secretary of Health and Human Services shall
implement the recommendations contained in the March 2005 GAO
report 05-119 entitled ``Medicare Physician Fees: Geographic
Adjustment Indices are Valid in Design, but Data and Methods
Need Refinement.''.
______