I 111th CONGRESS 1st Session H. R. 4371 IN THE HOUSE OF REPRESENTATIVES December 16, 2009 Mr. Gonzalez (for himself, Mr. Ortiz, Mr. Boren, Mr. Griffith, Mr. Thornberry, Mr. Meek of Florida, Mr. Courtney, Mr. Garrett of New Jersey, Mr. Arcuri, Mr. Carnahan, Mr. Hall of Texas, Mr. Ruppersberger, Mr. Moran of Virginia, Mr. Scott of Georgia, Mr. Akin, Mr. Pitts, Mr. Cuellar, Mr. Kagen, Mr. McIntyre, Mr. Grayson, Mrs. McCarthy of New York, Mr. Bishop of Georgia, Mr. Cummings, Mr. Massa, Mr. Bartlett, Mr. Cohen, Mr. Peters, Mr. Berry, Mr. Himes, Ms. McCollum, Mr. Bishop of New York, Mrs. Lowey, Mr. Maffei, Mr. Clay, Mr. Murphy of New York, Mrs. Christensen, Mr. Kratovil, Mr. Roe of Tennessee, Mr. Wittman, Mr. Butterfield, Mr. Israel, Mr. Luetkemeyer, Mr. Rush, Mr. Marchant, Mr. Hill, Ms. Wasserman Schultz, Mr. Lincoln Diaz-Balart of Florida, Ms. Norton, Mr. LoBiondo, Ms. Kosmas, Mr. Dent, Mr. Faleomavaega, Mrs. Biggert, Mr. Adler of New Jersey, Mr. Gerlach, and Mr. Paul) 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 continue using 2009 Medicare practice expense relative value units for certain cardiology services.

1.

Continued use of 2009 Medicare practice expense relative value units for certain cardiology services

Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is amended by adding at the end the following new subparagraph: (K)

Continued use of 2009 practice expense relative value units for certain cardiology services

(i)

In general

Notwithstanding any other provision of law, including provisions contained in the final rule published in the Federal Register on November 25, 2009 (74 Fed. Reg. 61737), relating to CY 2010 relative value units, subject to clause (iii) and the second sentence of clause (iv), in determining the practice expense payment under this paragraph for services performed predominantly by cardiologists and furnished on or after January 1, 2010, the Secretary shall continue practice expense relative value units at the levels for CY 2009 for such services. For purposes of the previous sentence, the services performed predominantly by cardiologists include (as determined by the Secretary) cardiac monitoring services, services performed primarily for the diagnosis or treatment of heart disease, and other services at least 50 percent of which are performed under this part by cardiologists. (ii)

Inclusion of specific cardiac codes

In determining practice expense relative value units under this paragraph for myocardial perfusion imaging (CPT codes 78451–78454) for services furnished on or after January 1, 2010, subject to clause (iii) and the second sentence of clause (iv), the Secretary shall use the 2009 practice expense relative value units for the previous codes that were combined to create such CPT codes. (iii)

New cpt code implementation permitted

Nothing in clause (i) or (ii) shall be construed to prevent new category I CPT codes related to cardiovascular computed tomography and cardiovascular magnetic resonance imaging, published in the rule referred to in clause (i), from taking effect on January 1, 2010. (iv)

Study and report on practice expense methodology

The Secretary, in consultation with medical specialty society stakeholders and other affected stakeholders, shall enter into a contract with an independent entity— (I)to conduct a study of the practice expense methodology used to determine relative value units under this paragraph to determine whether the cost finding, indirect cost allocation, scaling, and budget neutrality methodologies used are consistent with generally accepted accounting principles, distribute the burden of any necessary budget neutrality adjustments proportionally among all physicians’ services, comparison to other payment methodologies, and result in allowances that accurately reflect the relative direct and indirect resources involved in the provision of various physicians’ services; and (II)to submit to the Secretary and Congress no later than January 1, 2011, a report on such study that includes recommendations for determining practice expense under this subsection. Upon completion of such study, the Secretary may adjust the practice expense relative value units described in clause (i) and the codes described in clause (ii) for services furnished on or after such date (not earlier than January 1, 2012) as the Secretary may specify.(v)

No budget neutrality adjustment

The Secretary shall not make any reduction in relative value units or other budget neutrality adjustments pursuant to the application of the previous provisions of this subparagraph. .