110 HR 5545 IH: Ensuring the Future Physician
U.S. House of Representatives
2008-03-06
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the Ensuring the Future Physician
Workforce Act of 2008
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Payment and Quality Incentives
Sec. 101. Resetting to 2007 the base year for application of
sustainable growth rate formula; elimination of sustainable growth rate formula
in 2010.
Sec. 102. Quality incentives.
TITLE II—Health Information Technology Incentives
Sec. 201. Health information technology (HIT) payment
incentive.
Sec. 202. Safe harbors to antikickback, civil penalties, and
criminal penalties for provision of health information technology and training
services.
Sec. 203. Exception to limitation on certain physician
referrals (under Stark) for provision of Health Information Technology and
training services to health care professionals.
Sec. 204. Rules of construction regarding use of
consortia.
TITLE III—Information and Reports
Sec. 301. Information for physicians on Medicare
billings.
Sec. 302. Information for beneficiaries on Medicare
expenditures.
Sec. 303. Collection of data on Medicare savings from
physicians’ services diversion.
Sec. 304. Trustees’ ongoing examination of Medicare
funding.
Sec. 305. Independent study on Medicare Relative Value Unit
Scale Update Committee (RUC) process.
Sec. 306. Study of reporting requirements on health care
disparities.
<enum>I</enum><header>Payment and
Quality Incentives</header>
<section id="H43F2B0613B1D47C6A6E94E6FBF220095"><enum>101.</enum><header>Resetting to
2007 the base year for application of sustainable growth rate formula;
elimination of sustainable growth rate formula in 2010</header>
<subsection id="H29C6BD9615114223BFF65886520054C2"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1848(d) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(d)</external-xref>), as amended by section 101 of
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>),
is amended—</text>
<paragraph id="HCDE73D28A8CD4F25924CE57743008875"><enum>(1)</enum><text>in paragraph
(4)—</text>
<subparagraph id="HC916787A05784C63AEC1734214452E13"><enum>(A)</enum><text>in subparagraph
(B), by striking <quote>subparagraph (D)</quote> and inserting
<quote>subparagraphs (D) and (G)</quote>; and</text>
</subparagraph><subparagraph id="H37F4924FFB444529A3A98C5DCABF8672"><enum>(B)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H379C7602CA904C80938185CF8110FD62" style="OLC">
<subparagraph id="H541AC8E6845643468457B5DBA416825C"><enum>(G)</enum><header>Rebasing to 2007
for update adjustments beginning with July 1, 2008</header><text>In determining
the update adjustment factor under subparagraph (B) for 2008, for the period
beginning on July 1, 2008, and ending on December 31, 2008, and 2009—</text>
<clause id="HFD2018866EF74D789C6B657517897474"><enum>(i)</enum><text>the allowed
expenditures for 2007 shall be equal to the amount of the actual expenditures
for physicians’ services during 2007;</text>
</clause><clause id="H184677B1D2BA48E99927A8FA94CD0947"><enum>(ii)</enum><text>subparagraph
(B)(ii) shall not apply to 2008, for the period beginning on July 1, 2008, and
ending on December 31, 2008; and</text>
</clause><clause id="HA0F7A0466F5E4BF2B92F746FB368ABFC"><enum>(iii)</enum><text display-inline="yes-display-inline">the reference in subparagraph (B)(ii)(I) to
<quote>April 1, 1996</quote> shall be treated, beginning with 2009, as a
reference to <quote>January 1,
2007</quote>.</text>
</clause></subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HBC6BA63843124326B408312E00FF0000"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H0A6B9C8401AA4D1584F127AE88E4A992" style="OLC">
<paragraph id="H5CAC9EC0A9F645ADB3D291AC3C1D2782"><enum>(9)</enum><header>Updating
beginning with 2010</header><text>The update to the single conversion factor
for each year beginning with 2010 shall be the percentage increase in the MEI
(as defined in section 1842(i)(3)) for that
year.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HD3B9B9A1E37A4F169BEB21C5DBEC717C"><enum>(b)</enum><header>Conforming
sunset</header><text display-inline="yes-display-inline">Section 1848(f)(1)(B)
of such Act is amended by inserting <quote>(ending with 2008)</quote> after
<quote>each succeeding year</quote>.</text>
</subsection></section><section id="H81B98D859991487493F5978CE770A5B6"><enum>102.</enum><header>Quality
incentives</header>
<subsection id="HD7B744819EF949AA85EB4507A0E9FED"><enum>(a)</enum><header>Extension of
current transitional bonus incentive payments for 2009</header><text>Section
101(c) of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C.
1395w–4 note), as amended by section 101 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended—</text>
<paragraph id="H8814D0063DED4469A371D766F9D5ECEA"><enum>(1)</enum><text>in the heading, by
striking <quote><header-in-text level="subsection" style="OLC">and
2008</header-in-text></quote> and inserting <quote><header-in-text level="subsection" style="OLC">, 2008, and
2009</header-in-text></quote>;</text>
</paragraph><paragraph id="HFFC7FF8835C74F11AC5800276100F98C"><enum>(2)</enum><text>in paragraph (1),
by inserting <quote>(or 3 percent in the case of the reporting periods
beginning after December 31, 2008)</quote> after <quote>1.5 percent</quote>;
and</text>
</paragraph><paragraph id="H23D2400D98A94A0600DC4F0000D0FF52"><enum>(3)</enum><text>in paragraph
(6)(C)—</text>
<subparagraph id="HBF8C3379DABE4E8CA85C0100F029FBD2"><enum>(A)</enum><text>in clause (i), by
striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="HC0E92402C8C54071B2DEDD876004F04E"><enum>(B)</enum><text>in clause (ii), by
striking the period at the end and inserting <quote>; and</quote>; and</text>
</subparagraph><subparagraph id="HD2067122164F47339ECE60F312E27764"><enum>(C)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="HF688F28266B24781BAD59ECFEBAE074" style="OLC">
<subparagraph id="H549DAD97307F4B7BAE8288FB47FAA254"><enum>(III)</enum><text>for 2009, all of
2009.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="HA23F5CF8D9AF4C1EA41334C0D731EC86"><enum>(b)</enum><header>Establishment of
new quality incentive system effective in 2010</header>
<paragraph id="H2EF925A400AB4987ADCC4849B06B864D"><enum>(1)</enum><header>In
general</header><text>Section 1848 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w">42 U.S.C. 1395w</external-xref>)
is amended by striking subsection (k) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H62A9CF5073F44C4586AB00B86025732" style="OLC">
<subsection id="HC5FDA84451154C3DBC83D4BED478C19"><enum>(k)</enum><header>Physician quality
incentive system</header>
<paragraph id="H5ABC5FA56B404D8A95F8F8DF233083B"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish a reporting system (in this
subsection referred to as the <quote>Physician Quality Incentive System</quote>
or <quote>System</quote>) for quality measures relating to physicians’ services
that focuses on disease-specific high cost conditions. Not later than January
1, 2010, the Secretary shall—</text>
<subparagraph id="HC375F1D4A5E0434D9664BBE97961B780"><enum>(A)</enum><text display-inline="yes-display-inline">identify the 10 health conditions that have
the highest proportion of spending under this part, due in part to a gap in
patient care, and for which reporting measures are feasible; and</text>
</subparagraph><subparagraph id="HB068577A490F4CCEAB7197AAA4EFCFF"><enum>(B)</enum><text>adopt reporting
measures on these conditions, based on measures developed by the Physician
Consortium of the American Medical Association.</text>
</subparagraph></paragraph><paragraph id="H683007BAE91049EB8B556018CD4C8559"><enum>(2)</enum><header>Add-on
payment</header>
<subparagraph id="HFFE2DA2701BA4CA1B4DE6DDD1FA100C"><enum>(A)</enum><header>In
general</header><text>The Secretary shall provide, in a form and manner
specified by the Secretary, for a bonus or other add-on payment for physicians
that submit information required on the conditions identified under paragraph
(1).</text>
</subparagraph><subparagraph id="H4A4C4011CF9947519F00E50065622D7C"><enum>(B)</enum><header>Amount</header><text>Such
a bonus or add-on payment shall be equal to 1.0 percent of the payment amount
otherwise computed under this section.</text>
</subparagraph><subparagraph id="HD7B6341AA6074896A5E6A55E11A4DD09"><enum>(C)</enum><header>Timely
payments</header><text>Such a payment shall be made, with respect to
information submitted for a month, by not later than 30 days after the date the
information is submitted for such month.</text>
</subparagraph><subparagraph id="HF1ABC8A4C77B438DAA08085ED5497313"><enum>(D)</enum><header>Deductible and
coinsurance not applicable</header><text>Such payment shall not be subject to
the deductible or coinsurance otherwise applicable to physicians’ services
under this part.</text>
</subparagraph><subparagraph id="HCD2C6EB601DC4CDD8FAE19007093AC6D"><enum>(E)</enum><header>Use of
registry</header><text display-inline="yes-display-inline">In carrying out
subparagraph (A), the Secretary shall allow the submission of the required
information through an appropriate medical registry identified by the
Secretary.</text>
</subparagraph></paragraph><paragraph id="H6DCF21496D0F4CD6B6F9500E227A2D9"><enum>(3)</enum><header>Monitoring</header><text display-inline="yes-display-inline">The Secretary shall monitor and report to
Congress on an annual basis physician participation in the Physician Quality
Incentive System, administrative burden encountered by participants, barriers
to participation, as well as savings accrued to the Medicare program due to
quality care improvements based on measures established under the Physician
Quality Incentive
System.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H3BCB98756A2E4077A2A0C46EA543315C"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by paragraph (1) shall apply to payment
for physicians’ services for services furnished in years beginning with
2010.</text>
</paragraph></subsection></section><enum>II</enum><header>Health
Information Technology Incentives</header>
<section id="HAAD7A76476FA4D2600C5EC69574D2CE1"><enum>201.</enum><header>Health
information technology (HIT) payment incentive</header><text display-inline="no-display-inline">Section 1848 of the Social Security Act is
amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HA7048D7F31D3415DB939D7B7E6527218" style="OLC">
<subsection id="HEEB2112353534D20ACE270CE19E1173F"><enum>(m)</enum><header>Health
information technology payment incentives</header>
<paragraph id="HA9536EBA3AEC4972A6DD9EDB7881649F"><enum>(1)</enum><header>Standards</header><text display-inline="yes-display-inline">Not later than January 1, 2009, the
Secretary shall create standards for the certification of health information
technology used in the furnishing of physicians’ services.</text>
</paragraph><paragraph id="H5A1FE4737E25451E8EAF45FDF6BC2FF"><enum>(2)</enum><header>Add-on
payment</header><text>The Secretary shall provide for a bonus or other add-on
payment for physicians that implement a health information technology system
that is certified under paragraph (1). Such a bonus shall be equal to 3.0
percent of the payment amount otherwise computed under this section, except
that—</text>
<subparagraph id="H4E8E021ABA2A4D5D9D3DFAA2F7FEE1C9"><enum>(A)</enum><text>in no case may the
total of such bonus and the bonus provided under subsection (k)(2) exceed 6
percent of such payment amount; and</text>
</subparagraph><subparagraph id="H689053EFF42A493497E96963889CBFBA"><enum>(B)</enum><text>such payments with
respect to a physician shall only apply to physicians’ services furnished
during a period of 36 consecutive months beginning with the first day of the
first month after the date of such certification.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The bonus
payment under this paragraph shall not be subject to the deductible or
coinsurance otherwise applicable to physicians’ services under this
part.</continuation-text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section display-inline="no-display-inline" id="H3AFC1ABFE958464600A306E5EB45357" section-type="subsequent-section"><enum>202.</enum><header>Safe harbors to
antikickback, civil penalties, and criminal penalties for provision of health
information technology and training services</header>
<subsection id="H2BD3BFBC9E9D40A392595B71D597495D"><enum>(a)</enum><header>For Civil
Penalties</header><text>Section 1128A of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1320a-7a">42 U.S.C. 1320a–7a</external-xref>) is
amended—</text>
<paragraph id="H81520E02BEDE406B8019F982DF1EB338"><enum>(1)</enum><text>in subsection (b),
by adding at the end the following new paragraph:</text>
<quoted-block id="H1A044A33127B4714A98553352413F34C" style="OLC">
<paragraph id="HDDBC79CB3086418EB2F4BD44739ED324" indent="up1"><enum>(4)</enum><text>For purposes of this subsection,
inducements to reduce or limit services described in paragraph (1) shall not
include the practical or other advantages resulting from health information
technology or related installation, maintenance, support, or training
services.</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="H7702201AA32942A3BE121832E39B57B4"><enum>(2)</enum><text>in subsection (i),
by adding at the end the following new paragraph:</text>
<quoted-block id="H51661C49A81040598F08016547D1E700" style="OLC">
<paragraph id="HF30EABD85452486C8727C800BB1DFCE5"><enum>(8)</enum><text>The term
<term>health information technology</term> means hardware, software, license,
right, intellectual property, equipment, or other information technology
(including new versions, upgrades, and connectivity) designed or provided
primarily for the electronic creation, maintenance, or exchange of health
information to better coordinate care or improve health care quality,
efficiency, or
research.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H23A64DCFA0D444FBBFACF883B1C4400"><enum>(b)</enum><header>For Criminal
Penalties</header><text>Section 1128B of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320a-7b">42 U.S.C. 1320a–7b</external-xref>) is
amended—</text>
<paragraph id="H5C873FD253DE4C8EA261DAD554663269"><enum>(1)</enum><text>in subsection
(b)(3)—</text>
<subparagraph id="HE69893DB2BF241A3848B49DD36EE3825"><enum>(A)</enum><text>in subparagraph
(G), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="H8F53376621FC4654B743B279E388071E"><enum>(B)</enum><text>in the
subparagraph (H) added by section 237(d) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (<external-xref legal-doc="public-law" parsable-cite="pl/108/173">Public Law 108–173</external-xref>; 117 Stat.
2213)—</text>
<clause id="H4568164C5E634368BB4FD5E3862D6DC9"><enum>(i)</enum><text>by
moving such subparagraph 2 ems to the left; and</text>
</clause><clause id="H28587E0F18664A7788061CD5C7E6C66"><enum>(ii)</enum><text>by
striking the period at the end and inserting a semicolon;</text>
</clause></subparagraph><subparagraph id="H01D4D57522604AC19CA7BADFC45625E8"><enum>(C)</enum><text>in the
subparagraph (H) added by section 431(a) of such Act (117 Stat. 2287)—</text>
<clause id="H6327E6627AEC4D15B9C875FD3102EFF"><enum>(i)</enum><text>by
redesignating such subparagraph as subparagraph (I);</text>
</clause><clause id="HD2EB186BD25B4CA59EE2EF00EC32D20"><enum>(ii)</enum><text>by
moving such subparagraph 2 ems to the left; and</text>
</clause><clause id="HFF1A11D69D594DEEBF8440F2A1027BE5"><enum>(iii)</enum><text>by
striking the period at the end and inserting <quote>; and</quote>; and</text>
</clause></subparagraph><subparagraph id="H2744E9D59EB04BBB951654ECB531A466"><enum>(D)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H11D94D9B86134E2D94BCE84411805868" style="OLC">
<subparagraph id="HB1531A653B61407CA12CE66D4D26A200" indent="up1"><enum>(J)</enum><text>any nonmonetary remuneration (in the
form of health information technology, as defined in section 1128A(i)(8), or
related installation, maintenance, support, or training services) made to a
person by a specified entity (as defined in subsection (g)) if—</text>
<clause id="H1DF81F1BDFFE40A4BC41C237D48ED2AA"><enum>(i)</enum><text>the provision of such remuneration
is without an agreement between the parties or legal condition that—</text>
<subclause id="H15501074536F4481ADD90600C9ABBE90"><enum>(I)</enum><text>limits or restricts the use of the health
information technology to services provided by the physician to individuals
receiving services at the specified entity;</text>
</subclause><subclause id="H4BEDEE17273B40CF826DE14F9FE4FB66"><enum>(II)</enum><text>limits or restricts the use of the
health information technology in conjunction with other health information
technology; or</text>
</subclause><subclause id="H470103684A9D4B38BFC6DC57A8A41565"><enum>(III)</enum><text>conditions the provision of such
remuneration on the referral of patients or business to the specified
entity;</text>
</subclause></clause><clause id="H1AB91E9A3E7D4963AE237496A931A820"><enum>(ii)</enum><text>such remuneration is arranged for
in a written agreement that is signed by the parties involved (or their
representatives) and that specifies the remuneration solicited or received (or
offered or paid) and states that the provision of such remuneration is made for
the primary purpose of better coordination of care or improvement of health
quality, efficiency, or research; and</text>
</clause><clause id="HE277E51C2A814A008700336C868F78D8"><enum>(iii)</enum><text>the specified entity providing
the remuneration (or a representative of such entity) has not taken any action
to disable any basic feature of any hardware or software component of such
remuneration that would permit
interoperability.</text>
</clause></subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H8A013E69EBA74A869739E7B100CD83F6"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block id="H6C582F2824EE4F34B6FCE35BC36071B7" style="OLC">
<subsection id="H55498860964740B88C9700AB18169500"><enum>(g)</enum><header>Specified Entity
Defined</header><text>For purposes of subsection (b)(3)(J), the term
<term>specified entity</term> means an entity that is a hospital, group
practice, prescription drug plan sponsor, a Medicare Advantage organization, or
any other such entity specified by the Secretary, considering the goals and
objectives of this section, as well as the goals to better coordinate the
delivery of health care and to promote the adoption and use of health
information
technology.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HFDE2598070904366AB2B1048D300B06"><enum>(c)</enum><header>Effective Date
and Effect on State Laws</header>
<paragraph id="H1B0368C264DB4454B22C4EE737A33921"><enum>(1)</enum><header>Effective
date</header><text>The amendments made by subsections (a) and (b) shall take
effect on the date that is 120 days after the date of the enactment of this
Act.</text>
</paragraph><paragraph id="HFBBEDF47809B4775B451A7CC7802FAB"><enum>(2)</enum><header>Preemption of
state laws</header><text>No State (as defined in section 1101(a) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1301(a)) for purposes of title XI of such Act) shall have in effect a State law
that imposes a criminal or civil penalty for a transaction described in section
1128A(b)(4) or section 1128B(b)(3)(J) of such Act, as added by subsections
(a)(1) and (b), respectively, if the conditions described in the respective
provision, with respect to such transaction, are met.</text>
</paragraph></subsection><subsection id="HB5F0CCFEC47548B383157200A1583000"><enum>(d)</enum><header>Study and Report
To Assess Effect of Safe Harbors on Health System</header>
<paragraph id="HF9A2F28A430B473C006F00C49B71D76C"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall conduct
a study to determine the impact of each of the safe harbors described in
paragraph (3). In particular, the study shall examine the following:</text>
<subparagraph id="HDA76E7B39C0D49CCB371AEB1AE85373E"><enum>(A)</enum><text>The effectiveness
of each safe harbor in increasing the adoption of health information
technology.</text>
</subparagraph><subparagraph id="HBF4EC974F10744448E3603A6C5A35340"><enum>(B)</enum><text>The types of
health information technology provided under each safe harbor.</text>
</subparagraph><subparagraph id="H09686715967E44F6BB9D8FEEB2FD743F"><enum>(C)</enum><text>The extent to
which the financial or other business relationships between providers under
each safe harbor have changed as a result of the safe harbor in a way that
adversely affects or benefits the health care system or choices available to
consumers.</text>
</subparagraph><subparagraph id="HB874D57B90F2470090275727B44603B5"><enum>(D)</enum><text>The impact of the
adoption of health information technology on health care quality, cost, and
access under each safe harbor.</text>
</subparagraph></paragraph><paragraph id="H20C33C34F02246CBAFB5C5A100F5BCC6"><enum>(2)</enum><header>Report</header><text>Not
later than three years after the effective date described in subsection (c)(1),
the Secretary of Health and Human Services shall submit to Congress a report on
the study under paragraph (1).</text>
</paragraph><paragraph id="H350CD67327D145E900D7BEF1AF85AE72"><enum>(3)</enum><header>Safe harbors
described</header><text>For purposes of paragraphs (1) and (2), the safe
harbors described in this paragraph are—</text>
<subparagraph id="H26258B4B920E45B0B068E08739C69552"><enum>(A)</enum><text>the safe harbor
under section 1128A(b)(4) of such Act (42 U.S.C. 1320a–7a(b)(4)), as added by
subsection (a)(1); and</text>
</subparagraph><subparagraph id="HFD2230B3E0704990BA940329BF41C00"><enum>(B)</enum><text>the safe harbor
under section 1128B(b)(3)(J) of such Act (42 U.S.C. 1320a–7b(b)(3)(J)), as
added by subsection (b).</text>
</subparagraph></paragraph></subsection></section><section id="H130A6D6678E44C88AC60CA589D4D5808"><enum>203.</enum><header>Exception to
limitation on certain physician referrals (under Stark) for provision of Health
Information Technology and training services to health care
professionals</header>
<subsection id="H14518B3964254CABB4B935E154A300C5"><enum>(a)</enum><header>In
General</header><text>Section 1877(b) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395nn">42 U.S.C. 1395nn(b)</external-xref>) is
amended by adding at the end the following new paragraph:</text>
<quoted-block act-name="Social" id="H004F7989707343B28E348313F480996E" style="OLC">
<paragraph id="H39BAA51B845F4C17AE019CEAC386BA3"><enum>(6)</enum><header>Information
technology and training services</header>
<subparagraph id="H2D1C7F485828454FBA9C92577FEFBE21"><enum>(A)</enum><header>In
general</header><text>Any nonmonetary remuneration (in the form of health
information technology or related installation, maintenance, support or
training services) made by a specified entity to a physician if—</text>
<clause id="HE31920793C844BDA8E2B3C42F7A75EBF"><enum>(i)</enum><text>the provision of
such remuneration is without an agreement between the parties or legal
condition that—</text>
<subclause id="H9FA5A7C66B484929B954D21200789D00"><enum>(I)</enum><text>limits or
restricts the use of the health information technology to services provided by
the physician to individuals receiving services at the specified entity;</text>
</subclause><subclause id="HC795F197B0194CAB825FFBC12A00071"><enum>(II)</enum><text>limits or
restricts the use of the health information technology in conjunction with
other health information technology; or</text>
</subclause><subclause id="H793E74941CFC4C28B65C1C3FB860D1A4"><enum>(III)</enum><text>conditions the
provision of such remuneration on the referral of patients or business to the
specified entity;</text>
</subclause></clause><clause id="HB9EF441399574640A6530257D292F1F6"><enum>(ii)</enum><text>such remuneration
is arranged for in a written agreement that is signed by the parties involved
(or their representatives) and that specifies the remuneration made and states
that the provision of such remuneration is made for the primary purpose of
better coordination of care or improvement of health quality, efficiency, or
research; and</text>
</clause><clause id="HDC1D04BC77524733A989548FEB1DC9FD"><enum>(iii)</enum><text>the specified
entity (or a representative of such entity) has not taken any action to disable
any basic feature of any hardware or software component of such remuneration
that would permit interoperability.</text>
</clause></subparagraph><subparagraph id="H7691E0A64E634083979EDE4CC11F89DD"><enum>(B)</enum><header>Health
information technology defined</header><text>For purposes of this paragraph,
the term <term>health information technology</term> means hardware, software,
license, right, intellectual property, equipment, or other information
technology (including new versions, upgrades, and connectivity) designed or
provided primarily for the electronic creation, maintenance, or exchange of
health information to better coordinate care or improve health care quality,
efficiency, or research.</text>
</subparagraph><subparagraph id="H4066293E9F5B48D1A4C3A83DB8F08216"><enum>(C)</enum><header>Specified entity
defined</header><text>For purposes of this paragraph, the term <term>specified
entity</term> means an entity that is a hospital, group practice, prescription
drug plan sponsor, a Medicare Advantage organization, or any other such entity
specified by the Secretary, considering the goals and objectives of this
section, as well as the goals to better coordinate the delivery of health care
and to promote the adoption and use of health information
technology.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HAD7E7341F5684C3FB84314B900BB4E01"><enum>(b)</enum><header>Effective Date;
Effect on State Laws</header>
<paragraph id="H6B6B31AD7D7C4795AFAC7561C9014723"><enum>(1)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall take effect on
the date that is 120 days after the date of the enactment of this Act.</text>
</paragraph><paragraph id="HD50F4BE00C5548D29527359F67008BDD"><enum>(2)</enum><header>Preemption of
state laws</header><text>No State (as defined in section 1101(a) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1301(a)) for purposes of title XI of such Act) shall have in effect a State law
that imposes a criminal or civil penalty for a transaction described in section
1877(b)(6) of such Act, as added by subsection (a), if the conditions described
in such section, with respect to such transaction, are met.</text>
</paragraph></subsection><subsection id="H8FB295D356974232A333041387455655"><enum>(c)</enum><header>Study and Report
To Assess Effect of Exception on Health System</header>
<paragraph id="HD249EDC18DD040CD91EECD72A27F18D6"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall conduct
a study to determine the impact of the exception under section 1877(b)(6) of
such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395nn">42 U.S.C. 1395nn(b)(6)</external-xref>), as added by subsection (a). In particular,
the study shall examine the following:</text>
<subparagraph id="HABF86F71ABBE408584955EDEC235DEE6"><enum>(A)</enum><text>The effectiveness
of the exception in increasing the adoption of health information
technology.</text>
</subparagraph><subparagraph id="HAEBA04A14F674B06A5BFA178FFC41DC9"><enum>(B)</enum><text>The types of
health information technology provided under the exception.</text>
</subparagraph><subparagraph id="H9CAE96AAB7C942EAB2E07633ABD8AABE"><enum>(C)</enum><text>The extent to
which the financial or other business relationships between providers under the
exception have changed as a result of the exception in a way that adversely
affects or benefits the health care system or choices available to
consumers.</text>
</subparagraph><subparagraph id="H7C2F45360160486394C5923D81761C02"><enum>(D)</enum><text>The impact of the
adoption of health information technology on health care quality, cost, and
access under the exception.</text>
</subparagraph></paragraph><paragraph id="HCC350AC390314A2F911ECC3E406CD32C"><enum>(2)</enum><header>Report</header><text>Not
later than three years after the effective date described in subsection (b)(1),
the Secretary of Health and Human Services shall submit to Congress a report on
the study conducted under paragraph (1).</text>
</paragraph></subsection></section><section id="H61728779B3434E1A897FF4BFEEF6117"><enum>204.</enum><header>Rules of
construction regarding use of consortia</header>
<subsection id="H7557C92041A84AF7B6F03E667B8FC2F8"><enum>(a)</enum><header>Application to
Safe Harbor From Criminal Penalties</header><text>Section 1128B(b)(3) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1320a–7b(b)(3)) is amended by adding after and below subparagraph (J), as added
by section 202(b)(1), the following: <quote>For purposes of subparagraph (J),
nothing in such subparagraph shall be construed as preventing a specified
entity, consistent with the specific requirements of such subparagraph, from
forming a consortium composed of health care providers, payers, employers, and
other interested entities to collectively purchase and donate health
information technology, or from offering health care providers a choice of
health information technology products in order to take into account the
varying needs of such providers receiving such products.</quote>.</text>
</subsection><subsection id="HC61E8CA5AAF94E88863BD9D7CFE6F7A9"><enum>(b)</enum><header>Application to
Stark Exception</header><text>Paragraph (6) of section 1877(b) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395nn(b)), as added by section 203(a), is amended by adding at the end the
following new subparagraph:</text>
<quoted-block act-name="Social" id="HC9B9EAE7974D41D8B999657B90007BA0" style="OLC">
<subparagraph id="H8BA1914AB9FD4AC599A298005B472673"><enum>(D)</enum><header>Rule of
construction</header><text>For purposes of subparagraph (A), nothing in such
subparagraph shall be construed as preventing a specified entity, consistent
with the specific requirements of such subparagraph, from—</text>
<clause id="HB668B5994A4549BCBDAAC478BCF06E01"><enum>(i)</enum><text>forming a
consortium composed of health care providers, payers, employers, and other
interested entities to collectively purchase and donate health information
technology; or</text>
</clause><clause id="H7C19D9ABB4ED401F93035D63C110EDE"><enum>(ii)</enum><text>offering health
care providers a choice of health information technology products in order to
take into account the varying needs of such providers receiving such
products.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><enum>III</enum><header>Information and
Reports</header>
<section id="HF0ED6ACAD1434E928FCA9EE8CFE3AE5C"><enum>301.</enum><header>Information for
physicians on Medicare billings</header>
<subsection id="H1E7118A3919C4D6FADE658BE74E5DADF"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1848 of the
Social Security Act, as amended by section 201, is amended by adding at the end
the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HA92DD2FB1EDB4FE08BDC29882ECACBA" style="OLC">
<subsection id="H25CDD43ECC1F46E4A48D5F56F0C198B"><enum>(n)</enum><header>Annual reporting
of information to physicians</header>
<paragraph id="HD4F761B422E7432FB6120432FBFB7BBB"><enum>(1)</enum><header>In
general</header><text>The Secretary shall annually report to each physician
information on total billings by the physician (including laboratory tests and
other items and services ordered by the physician) under this title. Such
information shall be provided in a comparative format by code, weighting for
practice size, number of Medicare patients treated, and relative number of
Medicare beneficiaries in the geographical area.</text>
</paragraph><paragraph id="H9A9BBC7B6104403C83F4C92513BFF99D"><enum>(2)</enum><header>Confidentiality</header><text>Information
reported under paragraph (1) is confidential and shall not be disclosed to
anyone other than the physician to whom the information relates.</text>
</paragraph><paragraph id="HA202BFB5B9E84326ADE4371FD3AD0879"><enum>(3)</enum><header>Report not to be
used in determining reimbursement rates for a specific
physician</header><text>The Secretary shall not use information contained in a
report under this subsection with respect to a physician in determining
reimbursement rates under this part for items and services furnished by that
physician.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HB26AA8579A2941BFA5EF882FC06C1746"><enum>(b)</enum><header>Effective
date</header><text>The Secretary of Health and Human Services shall first
provide for reporting of information under the amendment made by subsection (a)
for billings during 2007.</text>
</subsection></section><section id="H09C1C85A88D14EDBA3C052C66E1C521"><enum>302.</enum><header>Information for
beneficiaries on Medicare expenditures</header>
<subsection id="HDA45A3A1C05B41B68C979E99EFA88B5"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1804 of the
Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-2">42 U.S.C. 1395b–2</external-xref>) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H20ECC332910241E9910261CC5CEB36C8" style="OLC">
<subsection id="HB58E6219735C40A19DAE9249005BD5EF"><enum>(d)</enum><header>Annual report on
individual resource utilization</header><text display-inline="yes-display-inline">The Secretary shall provide for the
reporting, on an annual basis, to each individual entitled to benefits under
part A or enrolled under part B, on the amount of payments made to or on behalf
of the individual under this title during the year involved. Such information
shall be provided in a format that compares such amount with the average per
capita expenditures in the region or area
involved.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H694B9B08C7D64A20BEA23C7F19B1005D"><enum>(b)</enum><header>Effective
date</header><text>The Secretary of Health and Human Services shall first
provide for reporting of information under the amendment made by subsection (a)
for payments made during 2007.</text>
</subsection></section><section id="HCA0CCB499CF34934AE4EDDE2C9253ED"><enum>303.</enum><header>Collection of
data on Medicare savings from physicians’ services diversion</header>
<subsection id="H8EF5BA6812B44B41841CD8A498F4A814"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services shall collect data on annual savings in expenditures
in the Medicare program due to physicians’ services that resulted in hospital
or in-patient diversion.</text>
</subsection><subsection id="H1437628071D24C07BFB22EDFDE3E9FA1"><enum>(b)</enum><header>Report</header><text>The
Secretary shall transmit to Congress annually a summary of the data collected
under subsection (a).</text>
</subsection></section><section id="HE7A6E9446C164BCBA659D0D390B33EB3"><enum>304.</enum><header>Trustees’
ongoing examination of Medicare funding</header>
<subsection id="HDCD3F2776F4740F0B212EA47C63085AF"><enum>(a)</enum><header>Examination by
board of trustees</header><text>The Board of Trustees of the Federal Hospital
Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C.
1395i) and of the Federal Supplementary Medical Insurance Trust Fund under
section 1841 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>) shall monitor and examine the extent
to which the different funding mechanisms under parts A, B, and D of title
XVIII of such Act provide an appropriate alignment with the program goals of
the respective parts. Such examination shall include an analysis of each of the
following:</text>
<paragraph id="H0586E5E5361046F0B39B89009826E6C"><enum>(1)</enum><text>The extent to
which, as the volume of services increases in physician settings under such
part B, there is a corresponding reduction in similar services provided in a
hospital setting under such part A.</text>
</paragraph><paragraph id="H92C81001A40F4AAE005FB22DD531E85D"><enum>(2)</enum><text>The extent to
which, as a result of increased coordination between physicians and the
delivery of prescription drugs under such part D, particularly with respect to
individuals with chronic conditions, there will be a decrease in
hospitalizations under such part A.</text>
</paragraph><paragraph id="HF39EB722BD9F4450A100384B00CC0AC"><enum>(3)</enum><text>The extent to which
other changes in physician or other health care practice results in a shifting
of expenditures among the various parts of such title XVIII.</text>
</paragraph></subsection><subsection id="H1E26C58A606745F893EECA9879B9ED3F"><enum>(b)</enum><header>Inclusion in
annual reports</header><text>In each annual report submitted to the Congress
after the date of the enactment of this Act under section 1817(b)(2) or section
1841(b)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i(b)(2)</external-xref>, 1395t(b)(2)),
such Board of Trustees shall include information on the matters described in
subsection (a).</text>
</subsection></section><section id="H1077E9A854BE48D4BDC9A106DFE6E43"><enum>305.</enum><header>Independent
study on Medicare Relative Value Unit Scale Update Committee (RUC)
process</header>
<subsection id="H074346E1D99443049CE5A249BFCE10CF"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services shall enter into an arrangement with an appropriate
independent entity to conduct a study of price inputs and relative values for
physicians’ services recommended by the AMA/Specialty Society Relative Value
Unit Scale Update Committee (RUC) process. The study shall examine (and make
recommendations on) how to improve accuracy in pricing the mix of physicians’
services and how such process could improve value weighting as new services
become available.</text>
</subsection><subsection id="HE154E70EB2974B938955E1F300E4338"><enum>(b)</enum><header>Report</header><text>The
Secretary shall provide for completion of the study under subsection (a) by
January 1, 2010, and shall provide for a report to Congress on the results of
the study.</text>
</subsection></section><section id="HB27343C57ABA40C8ACBDDDDCF47C15D4"><enum>306.</enum><header>Study of
reporting requirements on health care disparities</header>
<subsection id="H0825CFF1B7034882B26F573053F2E7DC"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services shall provide for a study of health care disparities
in high-risk health condition areas and minority communities about the impact
reporting requirements may have on physician penetration in such
communities.</text>
</subsection><subsection id="H5D9AA8FD5E3E452BBBDD33D6D6FDBBE8"><enum>(b)</enum><header>Report</header><text>The
Secretary shall provide for the completion of the study conducted under
subsection (a) by not later than January 1, 2011, and shall submit to Congress
a report on the study upon its completion.</text>
</subsection></section>