[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6371 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 6371

To provide for certain adjustments to the physician fee schedule under 
                         the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 13, 2023

   Mr. Murphy (for himself, Mr. Burgess, Mr. Wenstrup, Ms. Kelly of 
Illinois, Mr. Bucshon, Mr. Van Drew, Mrs. Miller-Meeks, Mr. Harris, Mr. 
Babin, Mr. Joyce of Pennsylvania, Mr. Jackson of Texas, Mr. McCormick, 
     Mr. Ferguson, Mr. Dunn of Florida, and Mr. Carter of Georgia) 
 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 provide for certain adjustments to the physician fee schedule under 
                         the Medicare program.

    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 ``Provider Reimbursement Stability Act 
of 2023''.

SEC. 2. UPDATING THE BUDGET NEUTRALITY THRESHOLD.

    Section 1848(c)(2)(B)(ii)(II) of the Social Security Act (42 U.S.C. 
1395w-4(c)(2)(B)(ii)(II)) is amended--
            (1) by striking ``Subject to'' and inserting the following:
                                            ``(aa) In general.--Subject 
                                        to'';
            (2) in item (aa), as inserted by subparagraph (A), by 
        striking ``$20,000,000'' and inserting ``the amount specified 
        in item (bb) for such year''; and
            (3) by adding at the end the following new items:
                                            ``(bb) Amount specified.--
                                        For purposes of item (aa), 
                                        subject to item (cc), the 
                                        amount specified in this item 
                                        is--

                                                    ``(AA) for years 
                                                before 2025, 
                                                $20,000,000;

                                                    ``(BB) for 2025, 
                                                $53,000,000; and

                                                    ``(CC) for 2026 and 
                                                each subsequent year, 
                                                the amount specified in 
                                                this item for the 
                                                preceding year.

                                            ``(cc) Indexing limitation 
                                        on annual adjustments.--For 
                                        2030 and every subsequent fifth 
                                        year, the Secretary shall 
                                        increase the amount specified 
                                        in item (bb) for such year by 
                                        the cumulative increase in the 
                                        MEI (as defined in section 
                                        1842(i)(3)) applicable to 
                                        physicians' services over the 
                                        5-year period ending on the 
                                        last day of the preceding 
                                        year.''.

SEC. 3. BUDGET NEUTRALITY CORRECTIONS FOR OVERESTIMATES AND 
              UNDERESTIMATES IN UTILIZATION.

    (a) In General.--Section 1848(c)(2)(B) of the Social Security Act 
(42 U.S.C. 1395w-4(c)(2)(B)) is amended by adding at the end the 
following new clause:
                            ``(vii) Budget neutrality corrections for 
                        overestimates and underestimates in 
                        utilization.--
                                    ``(I) In general.--In the case of a 
                                budget neutrality adjustment applied 
                                pursuant to clause (ii)(II) for an 
                                adjustment application year (as defined 
                                in clause (viii)(I)) beginning with 
                                2025, with respect to an adjustment to 
                                relative value units made under clause 
                                (ii)(I), that is determined using 
                                estimated utilization (as defined in 
                                clause (viii)(III))--
                                            ``(aa) the Secretary shall, 
                                        by not later than September 1 
                                        of the subsequent year--

                                                    ``(AA) compare such 
                                                estimated utilization 
                                                to actual utilization 
                                                occurring during such 
                                                adjustment application 
                                                year with respect to 
                                                the adjustment to the 
                                                relative value units 
                                                made under clause 
                                                (ii)(I); and

                                                    ``(BB) if 
                                                applicable, determine 
                                                the extent to which, if 
                                                any, the difference 
                                                between the estimated 
                                                utilization and such 
                                                actual utilization 
                                                affected the amount of 
                                                such budget neutrality 
                                                adjustment applied for 
                                                such adjustment 
                                                application year; and

                                            ``(bb) in the case that the 
                                        Secretary determines under 
                                        subclause (I)(bb) that the 
                                        difference between the 
                                        estimated utilization and such 
                                        actual utilization affected the 
                                        amount of the budget neutrality 
                                        adjustment applied for such 
                                        adjustment application year, 
                                        the Secretary shall adjust the 
                                        amount of payment made under 
                                        this section for services 
                                        furnished during the adjustment 
                                        correction period (as defined 
                                        in clause (viii)(II)) with 
                                        respect to such year by such 
                                        amount as determined necessary 
                                        by the Secretary to reconcile 
                                        the difference (which may be 
                                        positive or negative) between--

                                                    ``(AA) the budget 
                                                neutrality adjustment 
                                                that had been applied 
                                                for such application 
                                                adjustment year, using 
                                                the estimated 
                                                utilization; and

                                                    ``(BB) the budget 
                                                neutrality adjustment 
                                                that would have been 
                                                applied for such year 
                                                if such adjustment had 
                                                been calculated using 
                                                such actual 
                                                utilization.

                                    ``(II) Definitions.--For purposes 
                                of this clause:
                                            ``(aa) Adjustment 
                                        application year.--The term 
                                        `adjustment application year' 
                                        means, with respect to an 
                                        adjustment to relative value 
                                        units made under clause (ii)(I) 
                                        for which a budget neutrality 
                                        adjustment under clause 
                                        (ii)(II) is required, the year 
                                        for which such adjustments are 
                                        applied.
                                            ``(bb) Adjustment 
                                        correction period.--The term 
                                        `adjustment correction period' 
                                        means, with respect to an 
                                        adjustment application year, 
                                        the second year beginning after 
                                        such adjustment application 
                                        year.
                                            ``(cc) Estimated 
                                        utilization.--The term 
                                        `estimated utilization' means, 
                                        with respect to an adjustment 
                                        to relative value units made 
                                        under clause (ii)(I), an 
                                        estimate of utilization 
                                        associated with such adjustment 
                                        used for purposes of applying 
                                        clause (ii)(II).''.
    (b) Nonapplication of Budget Neutrality to Reconciliation 
Adjustments.--Section 1848(c)(2)(B) of the Social Security Act (42 
U.S.C. 1395w-4(c)(2)(B)) is amended--
            (1) in clause (iv)--
                    (A) in subclause (V), by striking ``and'' at the 
                end;
                    (B) in subclause (VI), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(VII) clause (vii)(I)(bb) for an 
                                adjustment correction period shall not 
                                be taken into account in applying 
                                clause (ii)(II) with respect to such 
                                period.''; and
            (2) in clause (v), by adding at the end the following new 
        subclause:
                                    ``(XII) Reductions attributable to 
                                an adjustment correction.--For an 
                                adjustment correction period, reduced 
                                expenditures attributable to 
                                application of clause (vii)(I)(bb) with 
                                respect to such period.''.

SEC. 4. TIMELY UPDATES TO DIRECT COSTS USED TO CALCULATE PRACTICE 
              EXPENSE RVUS.

    Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by section 3, is further amended by adding at 
the end the following new clause:
                            ``(viii) Timely updates to direct costs 
                        used to calculate practice expense relative 
                        value units.--
                                    ``(I) Simultaneous updates to 
                                direct cost inputs at least once every 
                                5 years.--The Secretary shall, not less 
                                often than every 5 years, update the 
                                prices and rates, as applicable, for 
                                each of the direct costs inputs 
                                described in subclause (II) used in the 
                                methodology for calculating the 
                                practice expense relative value units 
                                under this subsection for physicians' 
                                services. Updates made pursuant to the 
                                previous sentence shall be made in the 
                                same year for all direct cost inputs 
                                described in such subclause.
                                    ``(II) Direct costs input 
                                categories described.--For purposes of 
                                this clause, the direct costs inputs 
                                described in this subclause are 
                                clinical staff wage rates, prices of 
                                medical supplies, and prices of 
                                equipment.
                                    ``(III) Consultation.--In making 
                                the updates under this clause, the 
                                Secretary shall consult with relevant 
                                stakeholders, including physician 
                                specialty societies.''.

SEC. 5. LIMITATION ON YEAR-TO-YEAR CONVERSION FACTOR VARIANCE.

    Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)(B)), as amended by sections 3 and 4, is further amended-- by 
adding at the end the following new clause:
                            ``(ix) Limitation on conversion factor 
                        variance.--
                                    ``(I) In general.--In the case that 
                                application of clause (ii)(II) for a 
                                year (beginning with 2025) would result 
                                in a conversion factor established 
                                under subsection (d) for such year, not 
                                taking into account any adjustment 
                                provided under such subsection, to vary 
                                by more than 2.5 percent compared to 
                                such factor so established for the 
                                preceding year (in this subclause 
                                referred to as the `preceding year's 
                                conversion factor'), the Secretary 
                                shall--
                                            ``(aa) if such application 
                                        would result in a decrease in 
                                        such conversion factor, modify 
                                        any budget neutrality 
                                        adjustment applied to such 
                                        conversion factor pursuant to 
                                        such clause such that such 
                                        conversion factor is decreased 
                                        by 2.5 percent, not taking into 
                                        account any adjustment provided 
                                        under such subsection, compared 
                                        to the preceding year's 
                                        conversion factor; and
                                            ``(bb) if such application 
                                        would result in an increase in 
                                        such conversion factor, modify 
                                        any budget neutrality 
                                        adjustment applied to such 
                                        conversion factor pursuant to 
                                        such clause such that such 
                                        conversion factor is increased 
                                        by 2.5 percent, not taking into 
                                        account any adjustment provided 
                                        under such subsection, compared 
                                        to the preceding year's 
                                        conversion factor.
                                    ``(II) Special rule for 2025.--In 
                                applying subclause (I) with respect to 
                                the conversion factor established under 
                                subsection (d) for 2025, in determining 
                                whether the application of clause 
                                (ii)(II) for such year would result in 
                                such conversion factor varying by more 
                                than 2.5 percent compared to such 
                                factor so established for 2024, the 
                                Secretary shall take into account the 
                                increase to such conversion factor so 
                                established for 2024 provided under 
                                subsection (t).
                                    ``(III) Clarification relating to 
                                transition to multiple conversion 
                                factors.--For 2026, in applying 
                                subclause (I) with respect to the 
                                qualifying APM conversion factor (as 
                                described in subsection (d)(1)(A)) and 
                                the nonqualifying APM conversion factor 
                                (as so described) established under 
                                subsection (d) for such year, each 
                                reference in such subclause to the 
                                `preceding year's conversion factor' 
                                shall be deemed to be a reference to 
                                `the single conversion factor (as 
                                described in subsection (d)(1)(A)) so 
                                established for 2025'.''.
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