[Congressional Record Volume 153, Number 126 (Thursday, August 2, 2007)]
[Senate]
[Pages S10806-S10807]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN:
  S. 1964. A bill to amend title XVIII of the Social Security Act to 
establish new separate fee schedule areas for physicians' services in 
States with multiple fee schedule areas to improve Medicare physician 
geographic payment accuracy, and for other purposes; to the Committee 
on Finance.
  Mrs. FEINSTEIN. Mr. President, I rise to introduce legislation to 
correct a longstanding flaw in the Medicare Geographic Practice Cost 
Index, GPCI, system that negatively impacts physicians in California 
and several other states.
  This legislation will allow counties that are underpaid by at least 5 
percent to be reclassified into a payment locality that reflects their 
own geographic costs.
  It holds harmless the counties, predominately rural ones, whose 
locality average would otherwise drop as other counties are 
reclassified.
  Finally, this legislation is fully offset by requiring that 
independent diagnostic laboratories comply with state and federal 
regulations. This will allow the Centers for Medicare and Medicaid 
services, CMS, to take action against unscrupulous operators, 
predominately in California, that seek Medicare reimbursements for 
inaccurate and unnecessary diagnostic testing.
  This legislation would benefit physicians who are currently underpaid 
in 10 States: California, Florida, Georgia, Illinois, Maryland, 
Massachusetts, Michigan, Missouri, Texas, and Washington.
  Congressman Sam Farr has introduced companion legislation, H.R. 2484, 
in the House of Representatives, which now has 12 cosponsors.
  The Medicare Geographic Practice Cost Index measures the cost of 
providing a Medicare covered service in a geographic area. Medicare 
payments are supposed to reflect the varying costs of rent, malpractice 
insurance, and other expenses necessary to operate a medical process. 
Counties are assigned to ``payment localities'' that are supposed to 
accurately capture these costs.
  Here is the problem: some of these payment localities have not 
changed since 1997. Others have been in place since 1966. Many areas 
that were rural even 10 years have experienced significant population 
growth, as metropolitan areas and suburbs have spread. Many counties 
now find themselves in payment localities that do not accurately 
reflect their true practice costs.
  These payment discrepancies have a real and serious impact on 
physicians and the Medicare beneficiaries they are unable to serve. My 
home State of California has been hit particularly hard.
  San Diego County physicians are underpaid by 5.5 percent. A number of 
physicians have left the county and 60 percent of remaining San Diego 
physicians report that they cannot recruit new doctors to their 
practices.
  Santa Cruz County receives a 10.2 percent underpayment, and as a 
result, no physicians are accepting new Medicare patients. Instead, 
they are moving to neighboring Santa Clara, which has similar practice 
cost expense, but is reimbursed at a rate that is at least 22 percent 
higher. This means that seniors often need to travel at least 20 miles 
to see a physician.
  Sacramento County, a major metropolitan area, is underpaid by 4.6 
percent. The county's population has grown by 9.6 percent, while the 
number of physicians has declined by 11 percent.
  Sonoma County physicians are paid at least 8 percent less than their 
geographic practice costs. They have experienced at 10 percent decline 
in specialists and a 9 percent decline in primary care physicians.
  Seniors' Medicare cards are of no value if physicians in their 
community cannot afford to provide them with health care.
  The underpayment problem grows more severe every year, and the longer 
we wait to address it, the more drastic the solution will need to be. 
This legislation provides a common sense solution, increasing payment 
for those facing the most drastic underpayments, while protecting other 
counties from cuts in the process.
  This is an issue of equity. It costs more to provide health care in 
expensive areas, and physicians serving our seniors must be fairly 
compensated.
  I urge my colleagues to support this legislation. I ask unanimous 
consent that the text of the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1964

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

[[Page S10807]]

     SECTION 1. ESTABLISHMENT OF NEW SEPARATE MEDICARE PHYSICIAN 
                   FEE SCHEDULE AREAS IN STATES WITH MULTIPLE FEE 
                   SCHEDULE AREAS TO IMPROVE MEDICARE PHYSICIAN 
                   GEOGRAPHIC PAYMENT ACCURACY.

       (a) In General.--Section 1848(e) of the Social Security Act 
     (42 U.S.C. 1395w-4(e)) is amended by adding at the end the 
     following new paragraph:
       ``(6) Establishment of separate fee schedule areas in 
     states with multiple fee schedule areas to improve physician 
     geographic payment accuracy.--For purposes of computing and 
     applying the geographic adjustment factor under subsection 
     (b)(1)(C) and this subsection in the case of a State that 
     includes more than one fee schedule area--
       ``(A) the Secretary shall establish as a separate fee 
     schedule area each county or equivalent fee schedule area the 
     geographic adjustment factor for which would (if such 
     separate areas are established and before taking into account 
     the adjustment under this subparagraph) be 5 percent or more 
     above the geographic adjustment factor for such revised 
     locality; and
       ``(B) for such a locality from which a separate fee 
     schedule area is established under subparagraph (A), the 
     geographic adjustment factor indices shall in no case be less 
     than the geographic adjustment factor otherwise computed if 
     this paragraph did not apply.

     The Secretary shall first apply the previous sentence to 
     services furnished during 2008 and shall again apply it each 
     third year thereafter.''.
       (b) Offsetting Funding Through Requirement for Annual 
     Certification of Compliance With State Licensure Requirements 
     for Independent Diagnostic Testing Facilities (IDTF).--
       (1) In general.--Section 1862(a) of the Social Security Act 
     (42 U.S.C. 1395y(a)) is amended--
       (A) by striking ``or'' at the end of paragraph (21);
       (B) by striking the period at the end of paragraph (22) and 
     inserting ``; or''; and
       (C) by inserting after paragraph (22) the following new 
     paragraph:
       ``(23) where such expenses are for a diagnostic laboratory 
     test under section 1861(s)(3) performed in an independent 
     diagnostic testing facility in a State or locality described 
     in section 1861(s)(16) unless within the previous 12 months 
     the State or locality (whichever is or are applicable) has 
     certified that the facility is in compliance with all 
     applicable State (or local) licensure requirements.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply to tests performed on or after January 1, 2008.
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