[Congressional Record Volume 149, Number 26 (Wednesday, February 12, 2003)]
[Senate]
[Pages S2362-S2363]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself and Mr. Thomas):
  S. 379. A bill to amend title XVIII of the Social Security Act to 
improve the medicare incentive payment program; to the Committee on 
Finance.

[[Page S2363]]

  Mr. BINGAMAN. Mr. President, the legislation I am introducing today 
with Senators Thomas, Lincoln, and Johnson entitled ``The Medicare 
Incentive Payment Program Improvement Act of 2003'' is designed to 
improve the flow of needed bonus payments to physicians serving 
Medicare patients in Health Professions Shortage Areas, HPSA.
  The Medicare Incentive Payment Program, MIPP, created by the Omnibus 
Budget Reconciliation Act of 1987, was meant to assist physicians in 
defraying the higher costs and burdens of serving Medicare patients in 
shortage areas. Rural areas are know to suffer from physician 
shortages, both primary care and specialty physicians. In fact, even 
though 20 percent of America lives in a rural area, less than 11 
percent of physicians in the U.S., practice in rural areas.
  In my own State, the ongoing loss of physicians from underserved 
areas has affected both primary care and in particular, specialty 
services. In many areas, the shortage of specialists exceeds that of 
the primary care physicians. The New Mexico Health Policy Commission 
reported in its year 2000 report that 22 percent of residents in Los 
Alamos and Santa Fe were unable to receive needed specialist care.
  While the national ratio of physicians per population is 198 doctors 
per 100,000 persons, New Mexico ranks 33rd in the country with only 170 
physicians per 100,000 population. We are not in a position to ``grow 
our own doctors'' either as New Mexico ranks 37th among the 46 States 
with medical schools in graduating physicians per capita.
  New Mexico, like many other States with large numbers health 
profession shortage areas, or HPSAs, must rely on its ability to 
recruit and retain physicians in underserved areas to meet the health 
care needs of its citizens. It was the original intent of the MIPP to 
do this, by allowing for physicians in underserved areas to receive an 
additional 10 percent add-on in payments for services rendered. These 
10 percent ``bonuses'' are meant to be an essential component in our 
ongoing effort to ensure Medicare beneficiaries access to medical 
services, particularly in underserved areas.
  Unfortunately, the Medicare Incentive Payment Program has fared 
poorly, with few providers choosing to receive the payments. In fact, 
the total annual physician payments have never exceeded $100 million, 
because of a series of disincentives in the legislation.
  The program requires a provider to do a number of things to obtain 
the bonus payments. First, providers must be aware that MIPP payments 
are available to them. Many providers are unaware of the program's 
existence. Next, physicians must find out if the patient's medical care 
occurred in a shortage area. Following this, a unique code must be 
attached to the Medicare claim, which is then forwarded to the carrier. 
Finally, after all these steps, providers are subjected to automatic 
Medicare audits, just for applying for the very payments for which they 
are eligible.
  Providers committed to serving Medicare patients in underserved areas 
deserve the support assured by the original legislation's intent.
  The Medicare Incentive Payment Improvement Act of 2003 addresses and 
improves shortcomings in the original legislation by: Placing the 
burden for determining the bonus eligibility on the Medicare carrier. 
Eliminating automatic provider audits. Directing the Center for 
Medicare and Medicaid Services to establish a Medicare Incentive 
Payment Program Educational Program for Providers. Establishing an 
ongoing analysis of the programs, ability to improve Medicare 
beneficiaries' access to physician services. Continue to provide the 
original 10 percent add-on bonus for Part B physician payments in 
Health Provider Shortage Areas.
  Medicare carriers are the logical arbiters to determine whether 
physician services occurred in a shortage area. Physicians, already 
overworked, lack sufficient time, resources and training to research 
and determine whether a service was provided in a HPSA. By placing the 
responsibility on carriers, with their sophisticated information 
systems, the physician's administrative burdens will be reduced.
  The automatic audits triggered by this program, which are costly, 
time intensive, and unwarranted, will be lifted under our legislation. 
By placing the responsibility on carriers to determine payment 
eligibility the need for provider audits is eliminated.
  While the MIPP program is intended to improve beneficiaries' access 
to physician services, there is no measure of the program's effect on 
physician availability. The legislation offered today directs CMS to 
perform an ongoing analysis as to whether these payments actually do 
improve beneficiaries' access to physician services.
  I believe these improvements, in addition to others listed above, 
will greatly improve patient's access to care.
  The following organizations have expressed support for this 
legislation: American College of Physicians/American Society of 
Internal Medicine, and the National Rural Health Association.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                  S. 3

       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 ``Medicare Incentive Payment 
     Program Improvement Act of 2003''.

     SEC. 2. PROCEDURES FOR SECRETARY, AND NOT PHYSICIANS, TO 
                   DETERMINE WHEN BONUS PAYMENTS UNDER MEDICARE 
                   INCENTIVE PAYMENT PROGRAM SHOULD BE MADE.

       Section 1833(m) of the Social Security Act (42 U.S.C. 
     1395l(m)) is amended--
       (1) by inserting ``(1)'' after ``(m)''; and
       (2) by adding at the end the following new paragraph:
       ``(2) The Secretary shall establish procedures under which 
     the Secretary, and not the physician furnishing the service, 
     is responsible for determining when a payment is required to 
     be made under paragraph (1).''.

     SEC. 3. EDUCATIONAL PROGRAM REGARDING THE MEDICARE INCENTIVE 
                   PAYMENT PROGRAM.

       The Secretary of Health and Human Services shall establish 
     and implement an ongoing educational program to provide 
     education to physicians under the medicare program on the 
     medicare incentive payment program under section 1833(m) of 
     the Social Security Act (42 U.S.C. 1395l(m)).

     SEC. 4. ONGOING STUDY AND ANNUAL REPORT ON THE MEDICARE 
                   INCENTIVE PAYMENT PROGRAM.

       (a) Ongoing Study.--The Secretary of Health and Human 
     Services shall conduct an ongoing study on the medicare 
     incentive payment program under section 1833(m) of the Social 
     Security Act (42 U.S.C. 1395l(m)). Such study shall focus on 
     whether such program increases the access of medicare 
     beneficiaries who reside in an area that is designated (under 
     section 332(a)(1)(A) of the Public Health Service Act (42 
     U.S.C. 254e(a)(1)(A))) as a health professional shortage area 
     to physicians' services under the medicare program.
       (b) Annual Reports.--Not later than 1 year after the date 
     of enactment of this Act, and annually thereafter, the 
     Secretary of Health and Human Services shall submit to 
     Congress a report on the study conducted under subsection 
     (a), together with recommendations for such legislation and 
     administrative actions as the Secretary considers 
     appropriate.
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