II 111th CONGRESS 1st Session S. 1380 IN THE SENATE OF THE UNITED STATES June 25, 2009 Mr. Rockefeller 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 create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy.

1.

Short title

This Act may be cited as the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009.

2.

Renaming and reforming the Medicare Payment Advisory Commission

(a)

Amendment to title

(1)

In general

Section 1805 of the Social Security Act (42 U.S.C. 1395b–6) is amended— (A)in the heading, by striking Medicare payment advisory commission and inserting Medicare payment and access commission; and (B)in subsection (a), by striking Medicare Payment Advisory Commission and inserting Medicare Payment and Access Commission (or MedPAC). (2)

References

Any reference to the Medicare Payment Advisory Commission shall be deemed a reference to the Medicare Payment and Access Commission. (b)

Establishment as executive agency

Section 1805 of the Social Security Act (42 U.S.C. 1395b–6) is amended— (1)in subsection (a)— (A)by striking Establishment.—There is and inserting “Establishment.— (i)

In general

There is ; (B)in clause (i), as added by subparagraph (A), by striking agency of Congress and inserting independent establishment (as defined in section 104 of title 5, United States Code); and (C)by adding at the end the following new clause: (ii)

Purpose

(I)

In general

The purpose of the Commission is to act as the regulatory authority for payment and coverage policies under the program under this title and to implement policies that improve health outcomes, promote greater quality and efficiency, improve beneficiary access to necessary and evidence-based items and services, maintain coverage affordability, and improve the long-term solvency of the program under this title. (II)

Specific responsibilities

The specific responsibilities of the Commission fall into the following 3 categories: (aa)

Reimbursement policy

The Commission shall determine payment policies, methodologies, and rates under this title, including units of payment and the amount of payment, so as to ensure maximum efficiency and quality and in a manner that is financially sustainable. (bb)

Coverage policy

The Commission shall determine coverage policies and methodologies, including national coverage determinations (as defined in section 1869(f)(1)(B)), in a manner that provides stable premiums and maximum beneficiary access to medically necessary and appropriate care in the appropriate setting at the appropriate time. (cc)

Financial Stability

The Commission shall improve the overall financial stability of the program under this title, by using payment policies, methodologies, and rates and coverage policies and methodologies to reasonably reduce the growth in expenditures under this title without sacrificing current or future beneficiary access to medically necessary and appropriate care in the appropriate setting at the appropriate time. (III)

Carrying out responsibilities

In carrying out its responsibilities under this section, the Commission shall do so in a manner that serves the interests of current and future beneficiaries. ; (2)in subsection (c)— (A)in paragraph (1)— (i)by striking Appointment.—The Commission and inserting “Appointment.— (A)

In general

The Commission ; (ii)in subparagraph (A), as inserted by clause (i)— (I)by striking 17 and inserting 11; (II)by inserting the Secretary and the Administrator of the Centers for Medicare & Medicaid Services, who shall each serve as non-voting members of the Commission, and after composed of; and (III)by striking Comptroller General and inserting President, by and with the advice and consent of the Senate; and (iii)by adding at the end the following new subparagraphs: (B)

Limitation on number of terms served

An individual may not be appointed as a member of the Commission for more than 2 consecutive terms. (C)

Members currently appointed

(i)

In general

Any individual serving as a member of the Commission as of the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 may continue to serve as a member until the earlier of— (I)the remainder of the term for which the member was appointed; or (II)April 30, 2010. (ii)

Clarification regarding vacancies

Any vacancy in the Commission on or after such date of enactment shall be filled as provided in accordance with subparagraph (A). ; and (B)in paragraph (2), by striking subparagraph (D) and inserting the following new subparagraph: (D)

Additional qualifications

In addition to the qualifications described in the succeeding provisions of this paragraph, the President shall consider the political balance of the membership of the Commission and the needs of individuals entitled to (or enrolled for) benefits under part A or enrolled under part B who are entitled to medical assistance under a State plan under title XIX. . (C)in paragraph (3)— (i)by amending subparagraph (A) to read as follows: (A)

In general

The terms of members of the Commission shall be for 6 years except that, of the members first appointed— (i)four shall be appointed for terms of 5 years; (ii)four shall be appointed for terms of 3 years; and (iii)three shall be appointed for terms of 1 year. ; and (ii)in subparagraph (B), in the third sentence, by striking A vacancy and inserting Except as provided in paragraph (1)(C), a vacancy; (D)by amending paragraph (4) to read as follows: (4)

Compensation

Membership in the Commission shall be a full-time position. A member of the Commission shall be entitled to compensation at the rate payable for level IV of the Executive Schedule under section 5316 of title 5, United States Code. The Commission shall determine and prescribe the manner in which its obligations shall be incurred and its disbursements and expenses allowed and paid and the salaries of its members and employees, whose employment, compensation, leave, and expenses shall be governed solely by the provisions of this section and rules and regulations of the Commission not inconsistent therewith. ; (E)by amending paragraph (5) to read as follows: (5)

Chairman; vice chairman

The President shall designate a member of the Commission, at the time of appointment of the member by and with the advice and consent of the Senate, as Chairman and a member of the Commission, at the time of appointment of the member by and with the advice and consent of the Senate, as Vice Chairman, except that in the case where the Chairman or the Vice Chairman is not able to be present (including in the case of vacancy), a majority of the Commission may designate another member for the period of such absence. ; and (F)by adding at the end the following new paragraph: (7)

Nonapplicability of Federal Advisory Committee Act

The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to any advisory committee established or utilized by the Commission. ; (3)in subsection (d), in the matter preceding paragraph (1), by striking Subject to such review as the Comptroller General deems necessary to assure the efficient administration of the Commission, the Commission and inserting The Commission; (4)by amending subsection (f) to read as follows: (f)

Authorization of appropriations

There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section. Sixty percent of such appropriations shall be payable from the Federal Hospital Insurance Trust Fund, and 40 percent of such appropriation shall be payable from the Federal Supplementary Medical Insurance Trust Fund. ; and (5)by adding at the end the following new subsection: (g)

References

Any reference to the Medicare Payment Advisory Commission or MedPAC shall be deemed a reference to the Medicare Payment and Access Commission. . (c)

Authority To determine payment and coverage and routine evaluation of payment rates under the medicare program

(1)

In general

Section 1805(b) of the Social Security Act (42 U.S.C. 1395b–6(b)) is amended— (A)in paragraph (1)(B), by inserting , determine payment policies, methodologies, and rates under this title in accordance with paragraph (9)(A), and determine coverage policies and methodologies under this title in accordance with paragraph (9)(B) before the semicolon at the end; and (B)by adding at the end the following new paragraphs: (9)

Authority to determine payment and coverage under this title

(A)

Determination of payment policies, methodologies, and rates

(i)

In general

Notwithstanding any other provision of law, subject to subparagraph (C), the Commission shall determine payment policies, methodologies, and rates for items and services, providers of services, and suppliers under this title. (ii)

Timeline for determinations with respect to payment policies, methodologies, and rates for physicians and hospitals

The Commission shall make a determination under this subparagraph with respect to payment policies, methodologies, and rates— (I)for physicians (as defined in section 1861(r)(1)), not later than December 1 of each year (beginning with 2012); and (II)for hospitals, not later than March 1 of each year (beginning with 2013). (iii)

Implementation of payment policies, methodologies, and rates

(I)

Authority of secretary

Notwithstanding any other provision of law, the Secretary shall promulgate regulations to implement any payment policy, methodology, or rate determined by the Commission under this subparagraph. (II)

Regulations currently in effect

Any payment policies, methodologies, and rates for items and services, providers of services, or suppliers under this title as of the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 or regulation promulgated by the Secretary relating to such payment policies, methodologies, and rates prior to such date of enactment shall remain in effect until the Secretary promulgates regulations under subclause (I) to implement a payment policy, methodology, or rate determined by the Commission with respect to the item or service, provider of services, or supplier. (B)

Determination of coverage policies and methodologies

(i)

In general

Notwithstanding any other provision of law, subject to subparagraph (C), the Commission shall determine coverage policies and methodologies for items and services furnished under this title. (ii)

Implementation of coverage policies and methodologies

(I)

Authority of secretary

Notwithstanding any other provision of law, the Secretary shall promulgate regulations to implement any coverage policies and methodologies determined by the Commission under this subparagraph. (II)

Regulations currently in effect

Any coverage policy or methodology for items and services furnished under this title as of the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 or regulation promulgated by the Secretary relating to such coverage policy or methodology prior to such date of enactment shall remain in effect until the Secretary promulgates regulations under subclause (I) to implement a coverage policy or methodology determined by the Commission with respect to the item or service. (C)

Use of authority

(i)

In general

In making a determination under subparagraph (A) or (B), the Commission shall do so in a manner that— (I)is consistent with the provisions of sections 1801 and 1802; (II)is in the best interest of beneficiaries, including improving beneficiary access to care; and (III)improves the future viability of the program under this title, including protecting the short-term and long-term solvency of the program under this title. (ii)

Limitation

A determination under subparagraph (A) or (B) shall not limit beneficiary access under this title to items and services that are medically necessary. (D)

Limitation on judicial review

Any determination of the Commission under subparagraph (A) or (B) shall be a final agency action of the Commission and shall not be subject to judicial review. (E)

Annual report

Not later than March 15 of each year (beginning with 2012), the Commission shall submit to Congress a report on any determinations made under subparagraph (A) or (B) during the preceding year, including the performance of the Secretary in implementing such determinations by promulgating regulations under subparagraph (A)(iii) or (B)(ii) and any changes in coverage policies or methodologies, including any national coverage determinations (as defined in section 1869(f)(1)(B)) made during the preceding year. (F)

Definitions

(i)

Coverage policies and methodologies

In this section, the term coverage policies and methodologies means the application of any requirements for coverage of items and services under this title, including the determination of the most appropriate way to provide and pay for such items and services consistent with the requirements of this title, the application of any exclusion from coverage under this title (including whether an item or service is reasonable and necessary for purposes of section 1862(a)(1)(A)) and national coverage determinations (as defined in section 1869(f)(1)(B)). (ii)

Payment policies, methodologies, and rates

In this section, the term payment policies, methodologies, and rates means the application of any requirements for payment for items and services furnished under this title, including the amount of such payment and the methodology for determining such payment amount, including any annual updates to such payment under this title. (G)

Clarification

Nothing in this paragraph shall affect any requirement under this title to cover an item or service. (10)

Routine evaluation of payment policies, methodologies, and rates

The Commission shall review the payment policies, methodologies, and rates for each item and service, provider of services, and supplier under this title not less frequently than every 5 years in order to determine whether the Commission should make a determination under paragraph (9)(A) to update such payment policy, methodology, or rate. . (2)

GAO study and annual report on determination and implementation of payment and coverage policies under the medicare program

(A)

Study

The Comptroller General of the United States shall conduct a study on changes to payment policies, methodologies, and rates and coverage policies and methodologies under the Medicare Program under title XVIII of the Social Security Act as a result of the amendments made by this subsection, including an analysis of— (i)any determinations made by the Medicare Payment and Access Commission under subparagraph (A) or (B) of section 1805(b)(9) of such Act, as added by paragraph (1), during the preceding year; (ii)any regulations promulgated by the Secretary of Health and Human Services under subparagraph (A)(iii) or (B)(ii) of such section during the preceding year; (iii)the process for— (I)making such determinations (including the evidence to support any such determination); (II)promulgating such regulations (including the capacity of the Secretary of Health and Human Services to promulgate such regulations); and (iv)the ability of the Centers for Medicare & Medicaid Services to fulfill its responsibilities in carrying out such regulations. (B)

Report

Not later than December 31 of each year (beginning with 2012), the Comptroller General shall submit to Congress a report containing the results of the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Secretary determines appropriate. (d)

Congressional action

Section 1805 of the Social Security Act (42 U.S.C. 1395b–6), as amended by subsection (b), is amended— (1)by redesignating subsections (f) and (g), respectively, as subsections (g) and (h); and (2)by inserting after subsection (e) the following new subsection: (f)

Congressional action

(1)

In general

Notwithstanding any other provision of law, it shall only be in order in the Senate or the House of Representatives to consider any measure that would overrule a determination of the Commission under subparagraph (A) or (B) of subsection (d)(9) if 3/5 of the Members, duly chosen and sworn, of the Senate or the House of Representatives agree to such consideration. (2)

Rules of the senate and house of representatives

This subsection is enacted by Congress— (A)as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and is deemed to be part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a measure described in paragraph (1), and it supersedes other rules only to the extent that it is inconsistent with such rules; and (B)with full recognition of the constitutional right of either House to change the rules (so far as they relate to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House. . (e)

Research and information access

Section 1805(e) of the Social Security Act (42 U.S.C. 1395b–6(e)) is amended by adding at the end the following new paragraphs: (5)

Authority to inform research priorities for data collection

The Commission may advise the Secretary (through the Director of the Agency for Healthcare Research and Quality and the Director of the National Institutes of Health) on priorities for health services research, particularly as such priorities pertain to necessary changes and issues regarding payment reforms under this title. (6)

Expanded authority to access federal data and reports

In addition to data obtained under paragraph (1), the Commission shall have priority access to all raw data and research conducted or funded by the Federal Government, including data and research produced by the Centers for Medicare & Medicaid Services, the National Institutes of Health, and the Agency for Healthcare Research and Quality. (7)

Electronic access

The National Director for Health Information Technology, in coordination with the Secretary, the Administrator of the Centers for Medicare & Medicaid Services, and the Commission, shall establish a direct electronic link for raw data, including claims data under this title, to be accessed by the Commission for the purposes of evaluating and determining recommendations under this title, in accordance with applicable privacy laws and data use agreements. (8)

Access to biannual reports

Not less frequently than on a biannual basis, the National Institutes of Health and the Agency for Healthcare Research and Quality shall submit to the Commission a report containing information on any research conducted by the National Institutes of Health and the Agency for Healthcare Research and Quality, respectively, which has relevance for the determinations and recommendations being considered by the Commission. Such information shall be provided to the Commission in electronic form. . (f)

Additional resources To carry out duties

(1)

In general

Section 1805(d) of the Social Security Act (42 U.S.C. 1395b–6(d)) is amended— (A)in paragraph (1), by inserting (including an attorney) after such other personnel; and (B)in paragraph (5), by striking and at the end; (C)in paragraph (6), by striking the period at the end and inserting ; and; and (D)by adding at the end the following new paragraph: (7)establish a public affairs office. . (2)

Office of the ombudsman

Section 1805(e) of the Social Security Act (42 U.S.C. 1395b–6(e)), as amended by subsection (e), is amended by adding at the end the following new paragraph: (10)

Office of the ombudsman

(A)

In general

The Commission shall establish an office of the ombudsman to handle complaints regarding the implementation of regulations under subsection (a)(9)(B). (B)

Duties

The office of the ombudsman shall— (i)act as a liaison between the Commission and any entity or individual affected by the implementation of such a regulation; and (ii)ensure that the Commission has established safeguards— (I)to encourage such entities and individuals to submit complaints to the office of the ombudsman; and (II)to protect the confidentiality of any entity or individual who submits such a complaint. . (g)

MACPAC technical amendments

Section 1900(b) of the Social Security Act (42 U.S.C. 1396) is amended— (1)in paragraph (1)(D), by striking June 1 and inserting June 15; and (2)by adding at the end the following: (10)

Consultation with MedPAC

MACPAC shall regularly consult with the Medicare Payment and Access Commission (in this paragraph referred to as MedPAC) established under section 1805 in carrying out its duties under this section. . (h)

Lobbying cooling-off period for members of the Medicare Payment Advisory Commission

Section 207(c) of title 18, United States Code, is amended by inserting at the end the following: (3)

Members of the Medicare Payment Advisory Commission

(A)

In general

Paragraph (1) shall apply to a member of the Medicare Payment Advisory Commission who was appointed to such Commission as of the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009. (B)

Agencies and Congress

For purposes of paragraph (1), the agency in which the individual described in subparagraph (A) served shall be considered to be the Medicare Payment and Access Commission established under section 1805 of the Social Security Act, the Department of Health and Human Services, and the relevant committees of jurisdiction of Congress. .

3.

Establishment of council of health and economic advisers, consumer advisory council, and federal health advisory council

Section 1805(b) of the Social Security Act (42 U.S.C. 1395b–6(b)), as amended by section 2(c), is amended by adding at the end the following new paragraph: (11)

Council of health and economic advisers, consumer advisory council, and federal health advisory council

(A)

Council of health and economic advisers

(i)

In general

The Commission shall establish a council of health and economic advisers to advise the Commission on its development, analyses, and implementation of payment policies under this title. (ii)

Membership

(I)

In general

The council of health and economic advisers shall be composed of acknowledged experts in health care and economics selected by the Commission. (II)

Initial inclusion of former members of Medicare Payment Advisory Commission

The members initially selected for the council of health and economic advisers under subclause (I) shall include those individuals who were members of the Medicare Payment Advisory Commission as of the day before the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009. (B)

Consumer Advisory Council

(i)

In general

There is established a consumer advisory council to advise the Commission on the impact of payment policies under this title on consumers. (ii)

Membership

(I)

Number and appointment

The consumer advisory council shall be composed of 10 consumer representatives appointed by the Comptroller General of the United States, 1 from among each of the 10 regions established by the Secretary as of the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009. (II)

Qualifications

The membership of the council shall represent the interests of consumers and particular communities. (iii)

Duties

The consumer advisory council shall, subject to the call of the Commission, meet not less frequently than 2 times each year in the District of Columbia. (iv)

Open meetings

Meetings of the consumer advisory council shall be open to the public. (v)

Election of officers

Members of the consumer advisory council shall elect their own officers. (C)

Federal health advisory council

(i)

In general

There is established a Federal health advisory council to consult with and provide advice to the Commission on all matters within the jurisdiction of the Commission. (ii)

Membership

The Federal health advisory council shall be composed of 10 representatives from the health care industry appointed by the Comptroller General of the United States, 1 from among each of the 10 regions established by the Secretary as of the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009. (iii)

Terms

(I)

In general

The terms of members of the Federal health advisory council shall be for 1 year. (II)

Limitation on number of terms served

An individual may not be appointed as a member of the Federal health advisory council for more than 3 terms. (iv)

Duties

The Federal health advisory council shall, subject to the call of the Commission, meet not less frequently than 2 times each year in the District of Columbia. (v)

Open meetings

Meetings of the Federal health advisory council shall be open to the public. (vi)

Election of officers

Members of the Federal health advisory council shall elect their own officers. (D)

Limitation on funding

Out of amounts appropriated under subsection (g), the Commission may use not more than $300,000 each fiscal year to carry out this paragraph. .

4.

Cost containment in medicare

Section 1805(b) of the Social Security Act (42 U.S.C. 1395b–6(b)), as amended by section 3, is amended by adding at the end the following new paragraph: (12)

Spending reductions

(A)

In general

(i)

Implementation by the commission

Notwithstanding any other provision of law, effective beginning on January 1, 2012, subject to clause (ii) and the succeeding provisions of this paragraph, the Commission shall implement payment policies, methodologies, and rates and coverage policies and methodologies which are estimated to reduce expenditures under this title by not less than 1.5 percent annually. (ii)

Fail safe mechanism

Notwithstanding any other provision of law, effective beginning on January 1, 2013, subject to the succeeding provisions of this paragraph, in the case where the Chief Actuary of the Centers for Medicare & Medicaid Services finds that the payment policies, methodologies, and rates and coverage policies and methodologies implemented under clause (i) for a given year will not reduce annual expenditures under this title by not less than 1.5 percent, the Secretary shall implement an automatic reduction in reimbursement for providers of services and suppliers under the original Medicare fee-for-service program under parts A and B in order to achieve such 1.5 percent reduction. Such reduction shall be cumulative, may vary depending on the provider of services or supplier involved, and may be zero based on initiatives implemented by the Secretary for including no reduction. (B)

Requirements

In carrying out subparagraph (A), the following requirements shall apply: (i)Any reductions in reimbursement for items and services furnished under this title which are subject to a competitive bidding process shall apply in the year following the year in which the Commission or the Secretary determines that such reduction shall be implemented. (ii)Any reductions in reimbursement to a Medicare Advantage organization offering a Medicare Advantage plan under part C shall be reflected in the MA area-specific non-drug monthly benchmark amount computed under section 1853(j) for months in the year following the year in which the Commission or the Secretary determines that such reduction shall be implemented. (iii)The amount of a reduction in reimbursement to a provider of services or a supplier under this title during a year shall not be greater than 5 percent of the amount of payment that would otherwise apply under this title. (iv)In the case where the amount of any savings to the program under this title during a year as a result of the provisions of subparagraph (A) exceeds 1.5 percent of the amount of expenditures that would otherwise be made under this title, the amount of such excess shall be deposited, in such proportion as the Commission determines appropriate, in the Federal Hospital Insurance Trust Fund established under section 1817 and the Federal Supplementary Medical Insurance Trust Fund established under section 1841. (C)

Analysis

The Chief Actuary of the Centers for Medicare & Medicaid Services shall— (i)analyze such payment polices, methodologies, and rates and coverage policies and methodologies prospectively, in order to determine the amount of such estimated reduction in expenditures for a year; and (ii)include such analysis in the annual report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplementary Medical Insurance Trust Funds for the year. (D)

Third party verification

The analysis under subparagraph (C) shall be verified by an independent, third party actuary. (E)

GAO audit and annual report

(i)

Audit

The Comptroller General of the United States shall audit the procedures used to determine such estimated reduction in expenditures. (ii)

Annual report

The Comptroller General shall submit to Congress an annual report containing the results of the audit conducted under clause (i). (F)

Inclusion of interim payment and coverage policies

Any savings or additional expenditures as a result of payment policies, methodologies, and rates and coverage policies and methodologies under any health reform legislation enacted on or after the date of enactment of the Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 shall be included in the determination of whether expenditures under this title have been reduced by not less than 1.5 percent for a year. (G)

Non-application during years when solvency has been determined

This paragraph shall not apply for a year in the case where the Chief Actuary of the Centers for Medicare & Medicaid Services determines, as part of the annual report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplementary Medical Insurance Trust Funds for the preceding year, that the program under this title is solvent, according to the short range test for financial adequacy of the Chief Actuary of the Centers for Medicare & Medicaid Services. .

5.

Establishment of joint committee on medicare

(a)

In general

There is hereby established the Joint Committee on Medicare (in this section referred to as the Joint Committee). (b)

Membership

The Joint Committee shall be composed of 11 members appointed as follows: (1)5 members shall be appointed by the President pro tempore of the Senate, on the recommendation of the majority and minority leaders of the Senate, from among the members of the Committee on Finance of the Senate, 3 of whom shall be from the majority on the Committee and 2 of whom shall be from the minority on the Committee; and (2)6 members shall be appointed by the Speaker of the House of Representatives, in consultation with the minority leader of the House of Representatives— (A)3 from among the members of the Committee on Ways and Means of the House of Representatives, 2 of whom shall be from the majority on the Committee and 1 of whom shall be from the minority on the Committee; and (B)3 from among the members of the Committee on Energy and Commerce of the House of Representatives, 2 of whom shall be from the majority on the Committee and 1 of whom shall be from the minority on the Committee. (c)

Duties

The Joint Committee shall— (1)study the operation and effects of any changes proposed by Congress to the Medicare Program under title XVIII of the Social Security Act, and other matters relating to the Medicare Program that the Joint Committee determines appropriate; (2)submit reports to the Committee on Finance of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives containing the results of any studies conducted under paragraph (1), including recommendations for such legislation and administrative action as the Joint Committee determines appropriate; (3)prepare pamphlets for hearings conducted by such Committees, reports of such Committees, and conference reports accompanying any legislation enacted by Congress relating to the Medicare Program; (4)assist members of Congress in drafting legislative language relating to the Medicare Program; (5)assist members of Congress with the development and analysis of proposed legislation relating to the Medicare Program; and (6)prepare impact estimates of all legislation relating to the Medicare Program that is considered by Congress. (d)

Hearings

(1)

In general

The Joint Committee or, at the direction of the Joint Committee, any subcommittee or member of the Joint Committee, may, for the purpose of carrying out this Act— (A)hold such hearings, meet and act at such times and places, take such testimony, receive such evidence, and administer such oaths; and (B)require, by subpoena or otherwise, the attendance and testimony of such witnesses and the production of such books, records, correspondence, memoranda, papers, documents, tapes, and materials; as the Joint Committee or such subcommittee or member considers advisable.(2)

Issuance and enforcement of subpoenas

(A)

Issuance

A subpoena issued under paragraph (1) shall— (i)bear the signature of the Chairperson of the Joint Committee; and (ii)be served by any person or class of persons designated by the Chairperson for that purpose. (B)

Enforcement

In the case of contumacy or failure to obey a subpoena issued under paragraph (1)(B), the United States district court for the district in which the subpoenaed person resides, is served, or may be found may issue an order requiring the person to appear at any designated place to testify or to produce documentary or other evidence. (C)

Noncompliance

Any failure to obey the order of the court may be punished by the court as a contempt of court. (3)

Witness allowances and fees

(A)

In general

Section 1821 of title 28, United States Code, shall apply to a witness requested or subpoenaed to appear at a hearing of the Joint Committee. (B)

Expenses

The per diem and mileage allowances for a witness shall be paid from funds available to pay the expenses of the Joint Committee. (e)

Information from Federal agencies

(1)

In general

The Joint Committee may secure directly from a Federal agency such information as the Joint Committee considers necessary to carry out this Act, including any data relating to the Medicare Program (including Medicare claims data). (2)

Provision of information

On request of the Joint Committee, the head of the agency shall provide the information to the Joint Committee. (f)

Postal services

The Joint Committee may use the United States mails in the same manner and under the same conditions as other agencies of the Federal Government. (g)

Printing and binding, other necessary expenditures

The Joint Committee may make necessary expenditures, including the procurement of printing and binding services, as the Joint Committee determines appropriate. (h)

Joint Committee personnel matters

(1)

Compensation of members

A member of the Joint Committee shall serve without compensation in addition to the compensation received for the services of the member as an officer or employee of the Federal Government. (2)

Travel expenses

A member of the Joint Committee shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for an employee of an agency under subchapter I of chapter 57 of title 5, United States Code, while away from the home or regular place of business of the member in the performance of the duties of the Joint Committee. (3)

Staff

(A)

In general

The Chairperson of the Joint Committee may, without regard to the civil service laws (including regulations), appoint and terminate an executive director and such other additional personnel as are necessary to enable the Joint Committee to perform the duties of the Joint Committee. (B)

Confirmation of executive director

The employment of an executive director shall be subject to confirmation by the Joint Committee. (C)

Compensation

(i)

In general

Except as provided in subparagraph (B), the Chairperson of the Joint Committee may fix the compensation of the executive director and other personnel without regard to the provisions of chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule pay rates. (ii)

Maximum rate of pay

The rate of pay for the executive director and other personnel shall not exceed the rate payable for level V of the Executive Schedule under section 5316 of title 5, United States Code. (4)

Detail of Federal Government employees

(A)

In general

An employee of the Federal Government may be detailed to the Joint Committee without reimbursement. (B)

Civil service status

The detail of the employee shall be without interruption or loss of civil service status or privilege. (5)

Procurement of temporary and intermittent services

The Chairperson of the Joint Committee may procure temporary and intermittent services in accordance with section 3109(b) of title 5, United States Code, at rates for individuals that do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of that title. (6)

Nonpartisan staff

Personnel of the Joint Committee shall provide objective and confidential technical analysis and assistance on legislation relating to the Medicare Program. Such personnel— (A)shall not operate as personnel solely for the majority or the minority in Congress; (B)shall not be responsible for representing a particular point of view on any issue relating to the Medicare Program; and (C)shall examine critically policies under the Medicare Program, including the long-range effects of such policies.

6.

Revisions to process for conduct of demonstration projects

(a)

In general

Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section:

1899.

Conduct of demonstration projects

(a)

In general

(1)

Renaming and transfer of Office of Research, Development and Information

Effective beginning January 1, 2011, the Office of Research, Development and Information shall be— (A)transferred from the Administrator of the Centers for Medicare & Medicaid Services to the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services; and (B)renamed the Office of Research, Development and Information of the Department of Health and Human Services. (2)

Authority to design and evaluate demonstration projects

The Office of Research, Development and Information of the Department of Health and Human Services (in this section referred to as the Office) shall have sole authority to design and evaluate demonstration projects under this title, including demonstration projects to test new and innovative methods of reimbursement under the Medicare program to improve the quality and efficiency of health care and reduce costs under the Medicare program. (3)

Implementation

The Secretary of Health and Human Services (in this section referred to as the Secretary) shall maintain all responsibility for implementing demonstration projects under this title, including for implementing the process through which providers of services and suppliers are reimbursed for items and services furnished under the demonstration projects. (4)

Authority to expand successful demonstration projects

(A)

Expansion

Notwithstanding any other provision of law, the Secretary may expand the duration and scope of a demonstration project under this title, to an extent determined appropriate by the Secretary, if the Secretary determines that such expansion is appropriate. (B)

Audits and reports

(i)

Audits

The Inspector General of the Department of Health and Human Services shall conduct an annual audit of any expansion under subparagraph (A) to determine whether the funding of and process for such expansion is consistent with Congressional intent and serves the best interest of beneficiaries. (ii)

Reports

The Inspector General shall submit to Congress an annual report containing the results of any audits conducted under clause (i), together with recommendations for such legislation and administrative action as the Inspector General determines appropriate. (C)

Website

The Office shall establish a publicly available Internet website that contains current information regarding demonstration projects under this title, including a description of the demonstration projects and the status, location, points of contact, and any midterm or final evaluation of the demonstration projects. (b)

Advisory committee

(1)

Establishment

There is hereby established an advisory committee to consult with the Office on existing and proposed demonstration projects under this title. (2)

Membership

The advisory committee shall be composed of the following members: (A)The Chairman of the Medicare Payment and Access Commission established under section 1805. (B)The Director of the Agency for Healthcare Research and Quality. (C)The Administrator of the Centers for Medicare & Medicaid Services. (D)The National Coordinator for Health Information Technology. (E)The Director of the Office of Management and Budget. (3)

Duties

Not less frequently than 2 times each year, the advisory committee shall meet with the Office to consult on demonstration projects under this title. (c)

Elimination of budget neutral implementation requirement for demonstration projects

Notwithstanding any other provision of law, the Secretary, in conducting a demonstration project under this title, shall not be required to ensure that the aggregate payments made by the Secretary under this title do not exceed the amount which the Secretary would have paid under this title if the demonstration project was not implemented. (d)

Authorization of appropriations

There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section. Sixty percent of such appropriation shall be payable from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i), and 40 percent of such appropriation shall be payable from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act (42 U.S.C. 1395t). Out of amounts appropriated under the preceding sentence, the Secretary may use not more than $500,000,000 each fiscal year to conduct demonstration projects to test new and innovative methods of reimbursement under the Medicare program that seek to improve quality and efficiency of health care reduce costs under the Medicare program.

. (b)

Biannual communications by MedPAC to the Secretary and Congress

Section 1805(b) of the Social Security Act (42 U.S.C. 1395b–6(b)), as amended by section 4, is amended by adding at the end the following new paragraph: (13)Not later than 30 days after each meeting of the advisory committee established under section 1899(b), the Commission shall send a detailed letter to the Secretary and to Congress providing feedback on the following: (A)Recommendations for demonstration projects being conducted under this title as of the date of such biannual meeting that should be expanded on a program-wide basis. (B)Recommendations for such demonstration projects that should be eliminated. (C)Recommendations for potential changes to improve, expand, or otherwise alter such demonstration projects. (D)Recommendations for new ideas to test through demonstration projects conducted under this title. .