[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 3318 Introduced in Senate (IS)]







110th CONGRESS
  2d Session
                                S. 3318

    To amend title XVIII of the Social Security Act to provide for 
 recognition of equality of physician work in all geographic areas and 
   revisions to the practice expense geographic adjustment under the 
                    Medicare physician fee schedule.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 23, 2008

 Mr. Grassley introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to provide for 
 recognition of equality of physician work in all geographic areas and 
   revisions to the practice expense geographic adjustment under the 
                    Medicare physician fee schedule.

    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 ``Medicare Physician Payment Equity 
Act of 2008''.

SEC. 2. RECOGNITION OF EQUALITY OF PHYSICIAN WORK IN ALL GEOGRAPHIC 
              AREAS UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.

    Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by striking ``subparagraphs (B)'' through ``the 
        Secretary'' and inserting ``the succeeding provisions of this 
        paragraph, the Secretary''; and
            (2) by inserting after subparagraph (E) the following new 
        subparagraph:
                    ``(F) Recognition of equality of physician work in 
                all geographic areas.--In recognition of the fact that 
                the physician work for a service is the same in all 
                geographic areas, and should be similarly valued under 
                this title, for services furnished on or after January 
                1, 2010, the geographic index for physician work under 
                subparagraph (A)(iii) shall be 1.0 in all fee schedule 
                areas.''.

SEC. 3. REVISIONS TO THE PRACTICE EXPENSE GEOGRAPHIC ADJUSTMENT UNDER 
              THE MEDICARE PHYSICIAN FEE SCHEDULE.

    (a) Establishment of Floor.--Section 1848(e)(1) of the Social 
Security Act (42 U.S.C. 1395w-4(e)(1)) is amended by adding at the end 
the following new subparagraph:
                    ``(H) Floor at 1.0 on practice expense geographic 
                index.--After calculating the practice expense 
                geographic index in subparagraph (A)(i), for purposes 
                of payment for services furnished in 2009, the 
                Secretary shall increase the practice expense 
                geographic index to 1.0 for any locality for which such 
                practice expense geographic index is less than 1.0.''.
    (b) More Appropriate Recognition of Practice Expense Differences in 
Employee Wages and Office Rents Among Geographic Areas.--Section 
1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)), as 
amended by subsection (a), is amended by adding at the end the 
following new subparagraph:
                    ``(I) More appropriate recognition of differences 
                in employee wages and office rents among areas.--
                            ``(i) In general.--In recognition of the 
                        limitations on available data (as described in 
                        clause (ii)) for use as the employee wage and 
                        office rent proxies in the practice expense 
                        geographic index described in subparagraph 
                        (A)(i), and in order to more appropriately 
                        reflect differences among different fee 
                        schedule areas, for services furnished on or 
                        after January 1, 2010, such practice expense 
                        geographic index shall be an index which 
                        reflects \1/2\ of the difference between the 
                        relative costs of employee wages and rents in 
                        each of the different fee schedule areas and 
                        the national average of such employee wages and 
                        rents.
                            ``(ii) Limitations on available data.--The 
                        limitations on available data described in this 
                        clause are the following:
                                    ``(I) The need to use proxy data to 
                                reflect differences in employee wages 
                                and rents among areas.
                                    ``(II) Wages for some categories of 
                                employees being determined in national 
                                markets.
                                    ``(III) Physicians having to 
                                compete for some employees in market 
                                areas that cross fee schedule areas.
                                    ``(IV) Physicians in rural areas 
                                frequently having to locate their 
                                offices close to urban areas and 
                                competing with urban rent markets.''.
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