H.R. 6545

Physician Fee Schedule Update and Improvements Act

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I

118th CONGRESS

1st Session

H. R. 6545

IN THE HOUSE OF REPRESENTATIVES

December 1, 2023

Mrs. Miller-Meeks (for herself, Mr. Bucshon, Ms. Schrier, Ms. Kelly of Illinois, Mr. Burgess, Mr. Murphy, Mr. Wenstrup, Mr. Bera, Mr. Cárdenas, and Mr. Ruiz) 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 make improvements to the physician fee schedule under the Medicare program.

1.

Short title

This Act may be referred to as the Physician Fee Schedule Update and Improvements Act.

2.

Extending floor for work geographic index

Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking January 20, 2024 and inserting January 1, 2025.

3.

Increasing support for physicians and other practitioners in adjusting to Medicare payment changes

Section 1848(t)(1)(D) of the Social Security Act (42 U.S.C. 1395w–4(t)(1)(D)) is amended by striking 1.25 percent and inserting 3 percent.

4.

Extending incentive payments for participation in eligible alternative payment models

(a)

In general

Section 1833(z) of the Social Security Act (42 U.S.C. 1395l(z)) is amended—

(1)

in paragraph (1)—

(A)

in subparagraph (A)—

(i)

by striking In the case and inserting Subject to subparagraph (E), in the case;

(ii)

by striking ending with 2025 and inserting ending with 2026; and

(iii)

by inserting and 2026 after with respect to 2025; and

(B)

by adding at the end the following new subparagraph:

(E)

Special payment rule for 2026

(i)

In general

Subject to clause (ii), with respect to an amount payable under subparagraph (A) for 2026 to an eligible professional who is a qualifying APM participant for such year, such amount shall be reduced, in the case such participant has received payment under such subparagraph—

(I)

for at least 4 years but fewer than 7 years, by 34 percent; or

(II)

for 7 years, by 67 percent.

(ii)

Exception

If an eligible professional described in clause (i) increased such professional’s financial risk (as specified by the Secretary) with respect to the furnishing of items and services during the most recent period for which data are available (which may be less than a year) for 2026 as compared to such professional’s financial risk with respect to the furnishing of such items and services during the most recent period for which data were available (which may be less than a year) for 2025, the Secretary may reduce the amount payable under subparagraph (A) for 2026 to such professional by a percentage that is less than the percentage otherwise applicable to such amount under clause (i) (and which may include 0 percent).

;

(2)

in paragraph (2)—

(A)

in subparagraph (B)—

(i)

in the subparagraph heading, by striking 2025 and inserting 2026; and

(ii)

in the matter preceding clause (i), by striking 2025 and inserting 2026;

(B)

in subparagraph (C)—

(i)

in the subparagraph heading, by striking 2026 and inserting 2027; and

(ii)

in the matter preceding clause (i), by striking 2026 and inserting 2027; and

(C)

in subparagraph (D), by striking 2024, and 2025 and inserting 2024, 2025, and 2026; and

(3)

in paragraph (4)(B), by striking 2025 and inserting 2025 and 2026.

(b)

Conforming amendments

Section 1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(C)(iii) is amended—

(1)

in subclause (II), by striking 2025 and inserting 2026; and

(2)

in subclause (III), by striking 2026 and inserting 2027.

5.

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.

.

6.

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)) is amended by adding at the end the following new clause:

(vii)

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.

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