I 111th CONGRESS 1st Session H. R. 2919 IN THE HOUSE OF REPRESENTATIVES June 17, 2009 Mr. Blumenauer 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 provide Medicare physician incentive payments for efficient areas.

1.

Short title

This Act may be cited as the Medicare Efficiency Incentive Act of 2009.

2.

Payments for efficient physicians

Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection: (x)

Incentive payments for efficient physicians

(1)

In general

In the case of physicians’ services furnished on or after January 1, 2010, and before January 1, 2014, by a participating physician in an efficient area (as identified under paragraph (2)), in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid an amount equal to 5 percent of the payment amount for the services under this part. (2)

Identification of efficient areas

(A)

In general

Based upon available data, the Secretary shall identify those counties or equivalent areas in the United States in the lowest fifth percentile of utilization based on per capita spending for services provided in 2007 under this part and part A. (B)

Identification of counties where service is furnished

For purposes of paying the additional amount specified in paragraph (1), if the Secretary uses the 5-digit postal ZIP Code where the service is furnished, the dominant county of the postal ZIP Code (as determined by the United States Postal Service, or otherwise) shall be used to determine whether the postal ZIP Code is in a county described in subparagraph (A). (C)

Judicial review

There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting— (i)the identification of a county or other area under subparagraph (A); or (ii)the assignment of a postal ZIP Code to a county or other area under subparagraph (B). (D)

Publication of list of counties; posting on website

With respect to a year for which a county or area is identified under this paragraph, the Secretary shall identify such counties or areas as part of the proposed and final rule to implement the physician fee schedule under section 1848 for the applicable year. The Secretary shall post the list of counties identified under this paragraph on the Internet website of the Centers for Medicare & Medicaid Services. .