1.Short
title; table of contents
(a)This Act may be cited as the Rural Medicare Equity Act of
2009
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Elimination of geographic physician work adjustment
factor from geographic indices used to adjust payments under the physician fee
schedule.
Sec. 3. Clinical rotation demonstration project.
Sec. 4. Medicare rural health care quality improvement
demonstration projects.
Sec. 5. Ensuring proportional representation of interests of
rural areas on the Medicare Payment Advisory Commission.
Sec. 6. Implementation of GAO recommendations regarding
geographic adjustment indices under the Medicare physician fee
schedule.
2.Elimination of
geographic physician work adjustment factor from geographic indices used to
adjust payments under the physician fee schedule
(a)Congress
finds the following:
(1)Variations in the
geographic physician work adjustment factors under section 1848(e) of the
Social Security Act (42 U.S.C. 1395w–4(e)) result in inequity between
localities in payments under the Medicare physician fee schedule.
(2)Beneficiaries
under the Medicare program that reside in areas where such adjustment factors
are high have relatively more access to services that are paid based on such
fee schedule.
(3)There are a
number of studies indicating that the market for health care professionals has
become nationalized and historically low labor costs in rural and small urban
areas have disappeared.
(4)Elimination of
the adjustment factors described in paragraph (1) would equalize the
reimbursement rate for services reimbursed under the Medicare physician fee
schedule while remaining budget-neutral.
(b)Section
1848(e) of the Social Security Act (42 U.S.C. 1395w–4(e)) is amended—
(1)in paragraph
(1)(A)(iii), by striking an index
and inserting for
services provided before January 1, 2010, an index
; and
(2)in paragraph (2),
by inserting , for services provided before January 1, 2010,
after paragraph (4)), and
.
(c)Budget
neutrality adjustment for elimination of geographic physician work adjustment
factorSection 1848(d) of the Social Security Act (42 U.S.C.
1395w–4(d)) is amended—
(1)in paragraph
(1)(A), by striking The conversion
and inserting Subject
to paragraph (10), the conversion
; and
(2)by adding at the
end the following new paragraph:
(10)Budget
neutrality adjustment for elimination of geographic physician work adjustment
factorBefore applying an update for a year under this
subsection, the Secretary shall (if necessary) provide for an adjustment to the
conversion factor for that year to ensure that the aggregate payments under
this part in that year shall be equal to aggregate payments that would have
been made under such part in that year if the amendments made by section 2(b)
of the Rural Medicare Equity Act of 2009 had not been
enacted.
.
3.Clinical
rotation demonstration project
(a)Not
later than 6 months after the date of enactment of this Act, the Secretary
shall establish a demonstration project that provides for demonstration grants
designed to provide financial or other incentives to hospitals to attract
educators and clinical practitioners so that hospitals that serve beneficiaries
under the Medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) who are residents of underserved areas may host clinical
rotations.
(b)The demonstration project shall be conducted over a
5-year period.
(c)The
Secretary shall waive such provisions of titles XI and XVIII of the Social
Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.) as may be necessary to
conduct the demonstration project under this section.
(d)The
Secretary shall submit to the appropriate committees of Congress interim
reports on the demonstration project and a final report on such project within
6 months after the conclusion of the project, together with recommendations for
such legislation or administrative action as the Secretary determines to be
appropriate.
(e)Out
of any funds in the Treasury not otherwise appropriated, there are appropriated
to the Secretary to carry out this section, $20,000,000.
(f)In
this section:
(1)The
term hospital means a subsection (d) hospital (as defined in
section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)))
that had indirect or direct costs of medical education during the most recent
cost reporting period preceding the date of enactment of this Act.
(2)The
term Secretary means the Secretary of Health and Human
Services.
(3)The term underserved area means such medically
underserved urban areas and medically underserved rural areas as the Secretary
may specify.
4.Medicare rural
health care quality improvement demonstration projects
(a)
(1)Not later than 6 months after the date of enactment of
this Act, the Secretary of Health and Human Services (in this section referred
to as the Secretary
) shall establish not more that 10
demonstration projects to provide for improvements, as recommended by the
Institute of Medicine, in the quality of health care provided to individuals
residing in rural areas.
(2)Activities
under the projects may include public health surveillance, emergency room
videoconferencing, virtual libraries, telemedicine, electronic health records,
data exchange networks, and any other activities determined appropriate by the
Secretary.
(3)The
Secretary shall consult with the Office of Rural Health Policy of the Health
Resources and Services Administration, the Agency for Healthcare Research and
Quality, and the Centers for Medicare & Medicaid Services in carrying out
the provisions of this section.
(b)Each
demonstration project under this section shall be conducted over a 4-year
period.
(c)Demonstration
project sitesThe Secretary shall ensure that the demonstration
projects under this section are conducted at a variety of sites representing
the diversity of rural communities in the United States.
(d)The
Secretary shall waive such provisions of titles XI and XVIII of the Social
Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.) as may be necessary to
conduct the demonstration projects under this section.
(e)The Secretary shall enter into an arrangement with an
entity that has experience working directly with rural health systems for the
conduct of an independent evaluation of the demonstration projects conducted
under this section.
(f)The
Secretary shall submit to the appropriate committees of Congress interim
reports on each demonstration project and a final report on such project within
6 months after the conclusion of the project. Such reports shall include
recommendations regarding the expansion of the project to other areas and
recommendations for such other legislative or administrative action as the
Secretary determines appropriate.
(g)Out
of any funds in the Treasury not otherwise appropriated, there are appropriated
to the Secretary to carry out this section, $50,000,000.
5.Ensuring
proportional representation of interests of rural areas on the Medicare Payment
Advisory Commission
(a)Section 1805(c)(2) of the Social Security Act (42 U.S.C.
1395b–6(c)(2)) is amended—
(1)in subparagraph
(A), by inserting consistent with subparagraph (E)
after
rural representatives
; and
(2)by adding at the
end the following new subparagraph:
(E)Proportional
representation of interests of rural areasIn order to provide a
balance between urban and rural representatives under subparagraph (A), the
proportion of members who represent the interests of health care providers and
Medicare beneficiaries located in rural areas shall be no less than the
proportion, of the total number of Medicare beneficiaries, who reside in rural
areas.
.
(b)The amendments made by subsection (a) shall apply with
respect to appointments made to the Medicare Payment Advisory Commission after
the date of the enactment of this Act.
6.Implementation
of GAO recommendations regarding geographic adjustment indices under the
Medicare physician fee scheduleNot later than 180 days after the date of
enactment of this Act, the Secretary of Health and Human Services shall
implement the recommendations contained in the March 2005 GAO report 05–119
entitled Medicare Physician Fees: Geographic Adjustment Indices are
Valid in Design, but Data and Methods Need Refinement.
.