[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4078 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 4078

To amend part B of title XVIII of the Social Security Act to establish 
a floor for Medicare physician payment rates for 2006 at the level for 
                                 2005.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 19, 2005

 Mr. Norwood (for himself and Mr. Whitfield) 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 part B of title XVIII of the Social Security Act to establish 
a floor for Medicare physician payment rates for 2006 at the level for 
                                 2005.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``Maintaining 
Medicare Access Act of 2005''.
    (b) Findings.--Congress finds the following:
            (1) The Medicare physician fee schedule is updated on an 
        annual basis according to a formula specified by statute (in 
        this subsection referred to as the ``SGR formula''). The SGR 
        formula requires the Centers for Medicare & Medicaid Services 
        to adjust the update depending on how actual expenditures 
        compare to a target rate, called the sustainable growth rate.
            (2) The report of the trustees of the Medicare trust funds 
        states that under the SGR formula, physicians will receive 
        negative payment updates for each year from 2006 through 2012 
        and it is projected that physician payment rates will not 
        return to their 2002 level until after 2013.
            (3) The report of the trustees of the Medicare trust funds 
        further states that under the SGR formula physician 
        reimbursement rates could be reduced by more than 30 percent 
        during the period between 2006 and 2013. However, the cost of 
        providing services will rise by an estimated 20 percent during 
        that period.
            (4) Such reductions of the physician reimbursement rates 
        will inhibit physicians from providing needed services to 
        Medicare beneficiaries because physicians will be unable to 
        afford to treat their current Medicare patients or treat new 
        Medicare patients.
            (5) Physician practices tend to be small businesses that do 
        not have the resources necessary to absorb continued negative 
        updates in payment for their Medicare patients.
            (6) Lack of timely Congressional action to prevent a 
        reduction in reimbursement rate from the 2005 rate could 
        jeopardize Medicare patients' ability to promptly obtain care.
            (7) Instability in next year's physician reimbursement rate 
        will prevent access to quality care for Medicare beneficiaries.
            (8) Congress should replace the SGR formula with a system 
        that properly accounts for the cost of delivering health care 
        services to Medicare patients.
            (9) The Medicare Payment Advisory Commission has found that 
        an update in physician reimbursement rates that is based on the 
        Medicare Economic Index (MEI) is more predictable than the SGR 
        formula, recognizes the true costs of providing physician 
        services to Medicare patients, recognizes inflation in 
        physician practice costs and general wage levels, and should 
        replace the SGR formula.
    (c) Purpose.--The purpose of this Act is to provide a floor for the 
Medicare physician reimbursement rate for 2006.

SEC. 2. MEDICARE PHYSICIAN PAYMENT RATE FLOOR FOR 2006.

    (a) In General.--Section 1848(d)(1) of the Social Security Act (42 
U.S.C. 1395w-4(d)(1)) is amended--
            (1) in subparagraph (A), by striking ``The conversion 
        factor'' and inserting ``Except as otherwise provided in this 
        subsection, the conversion factor''; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) Floor for 2006.--Except as provided in 
                subparagraph (D), the single conversion factor for 2006 
                under this subsection shall in no case be less than the 
                single conversion factor for 2005. The previous 
                sentence shall not apply in determining the single 
                conversion factor for any subsequent year.''.
    (b) Not Treated as Change in Law and Regulation in Sustainable 
Growth Rate Determination.--The amendments made by subsection (a) shall 
not be treated as a change in law for purposes of applying section 
1848(f)(2)(D) of the Social Security Act (42 U.S.C. 1395w-4(f)(2)(D)).
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