mr GREG NYCZ

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

and would be regulated by the DOL rather than the state. Implementation of the Patient Safety and Quality Improvement Act of 2005 (HR 3205) introduced by Rep. Michael Bilirakis (R-FLA) was enacted as Public Law 109-41 on 7/29/2005. This law Amended the Public Health Service Act to designate patient safety work product as privileged and not subject to: (1) a subpoena or discovery in a civil, criminal, or administrative disciplinary proceeding against a provider; (2) disclosure under the Freedom of Information Act (FOIA) or a similar law; (3) admission as evidence in any civil, criminal, or administrative proceeding; or (4) admission in a professional disciplinary proceeding. Defines "patient safety work product" as any data, reports, records, memoranda, analysis, or written or oral statements which: (1) are assembled or developed by a provider for reporting to a patient safety organization (PSO); (2) are developed by a PSO for patient safety activities and which could result in improved patient safety or health care quality or outcomes; or (3) identify or constitute the deliberations or analysis of, or identify the fact of reporting pursuant to, a patient safety evaluation system. Medical Liability HR 5, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2005 introduced by Rep. Phil Gingrey (R-GA) - Sets forth provisions regulating lawsuits for health care liability claims concerning the provision of health care goods or services or any medical product affecting interstate commerce. Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, or should have discovered the injury. Limits noneconomic damages to $250,000. Requires court supervision over payment arrangements to protect against conflicts of interest that may reduce the amount of damages awarded that are actually paid to claimants. Allows the court to restrict the payment of attorney contingency fees. HR 534, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2005, introduced by Rep. Chris Cox in the House and S. 354 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. The Health Insurance Marketplace Modernization and Affordability Act, (S 1955), enables the formation of small business health plans (SBHPs), which are group health plans sponsored by trade, industry, or similar business associations that meet ERISA certification requirements

and would be regulated by the DOL rather than the state. Implementation of the Patient Safety and Quality Improvement Act of 2005 (HR 3205) introduced by Rep. Michael Bilirakis (R-FLA) was enacted as Public Law 109-41 on 7/29/2005. This law Amended the Public Health Service Act to designate patient safety work product as privileged and not subject to: (1) a subpoena or discovery in a civil, criminal, or administrative disciplinary proceeding against a provider; (2) disclosure under the Freedom of Information Act (FOIA) or a similar law; (3) admission as evidence in any civil, criminal, or administrative proceeding; or (4) admission in a professional disciplinary proceeding. Defines "patient safety work product" as any data, reports, records, memoranda, analysis, or written or oral statements which: (1) are assembled or developed by a provider for reporting to a patient safety organization (PSO); (2) are developed by a PSO for patient safety activities and which could result in improved patient safety or health care quality or outcomes; or (3) identify or constitute the deliberations or analysis of, or identify the fact of reporting pursuant to, a patient safety evaluation system. Medical Liability HR 5, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2005 introduced by Rep. Phil Gingrey (R-GA) - Sets forth provisions regulating lawsuits for health care liability claims concerning the provision of health care goods or services or any medical product affecting interstate commerce. Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, or should have discovered the injury. Limits noneconomic damages to $250,000. Requires court supervision over payment arrangements to protect against conflicts of interest that may reduce the amount of damages awarded that are actually paid to claimants. Allows the court to restrict the payment of attorney contingency fees. HR 534, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2005, introduced by Rep. Chris Cox in the House and S. 354 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. The Health Insurance Marketplace Modernization and Affordability Act, (S 1955), enables the formation of small business health plans (SBHPs), which are group health plans sponsored by trade, industry, or similar business associations that meet ERISA certification requirements

the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, medical liability reform, prescription drug benefits. Provisions in the President FY 2007 Budget and related appropriations legislation including public health programs in health and wellness and prevention; plant and animal inspections and programs; bioterrorism preparedness -- human, food, animal; human, animal and plant laboratory networks and response networks; Johnes research and eradication; Chronic Wasting Disease eradication and diagnosis; Avian flu; syndromic surveillance; National Institutes of Health research funding; research on childhood agricultural safety and health; waterborne disease research. Labor HHS Appropriations, HR 5647, Appropriations for Community Health Centers, Increased Funding for Tele-health Activities Defense Appropriations HR 5631 support for funding for Optical Gene Mapping of Engineered Biological Warfare Agents Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, medical liability reform, prescription drug benefits. Provisions in the President FY 2007 Budget and related appropriations legislation including public health programs in health and wellness and prevention; plant and animal inspections and programs; bioterrorism preparedness -- human, food, animal; human, animal and plant laboratory networks and response networks; Johnes research and eradication; Chronic Wasting Disease eradication and diagnosis; Avian flu; syndromic surveillance; National Institutes of Health research funding; research on childhood agricultural safety and health; waterborne disease research. Labor HHS Appropriations, HR 5647, Appropriations for Community Health Centers, Increased Funding for Tele-health Activities Defense Appropriations HR 5631 support for funding for Optical Gene Mapping of Engineered Biological Warfare Agents Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, medical liability reform, prescription drug benefits. Provisions in the President FY 2007 Budget and related appropriations legislation including public health programs in health and wellness and prevention; plant and animal inspections and programs; bioterrorism preparedness -- human, food, animal; human, animal and plant laboratory networks and response networks; Johnes research and eradication; Chronic Wasting Disease eradication and diagnosis; Avian flu; syndromic surveillance; National Institutes of Health research funding; research on childhood agricultural safety and health; waterborne disease research. Labor HHS Appropriations, HR 5647, Appropriations for Community Health Centers, Increased Funding for Tele-health Activities Defense Appropriations HR 5631 support for funding for Optical Gene Mapping of Engineered Biological Warfare Agents Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, medical liability reform, prescription drug benefits. Provisions in the President FY 2007 Budget and related appropriations legislation including public health programs in health and wellness and prevention; plant and animal inspections and programs; bioterrorism preparedness -- human, food, animal; human, animal and plant laboratory networks and response networks; Johnes research and eradication; Chronic Wasting Disease eradication and diagnosis; Avian flu; syndromic surveillance; National Institutes of Health research funding; research on childhood agricultural safety and health; waterborne disease research. Labor HHS Appropriations, HR 5647, Appropriations for Community Health Centers, Increased Funding for Tele-health Activities Defense Appropriations HR 5631 support for funding for Optical Gene Mapping of Engineered Biological Warfare Agents Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed during the coming year, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. Reform proposals include reimbursement updated on a market basket basis, removal of prescription drugs from the calculation of Medicare Part B costs, and rebasing Part B to reflect current rather than cumulative costs. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act of 2005, would replace projected Medicare payment cuts with positive updates in each of the next two years. The bill would provide an update of not less than 2.7% in 2006 and an update in 2007 that reflects physician practice cost inflation, which is expected to be about 2.6%. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for performance Currently the prevailing methods of paying for health care in the US neither incent nor reward providing high quality care. The rising costs of care coupled with the increasing awareness of poor quality care have made clear the need for a transformation in the way health care is financed. In the fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the unanticipated, but now recognized effect of economically stimulating growth in the numbers of services provided by physicians. Medicare must implement quality based payments for physician services, and capture the data on performance measures utilizing available claims-based data recoverable through enhanced IT functions. S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. Information Technology Under current law the capital and operating expenses of installing and maintaining an electronic medical record are assumed to be part of the overhead expense of a medical practice. Since no more than 5 –10% of the physician population has installed EMRs, CMS’ measurement of current physician practice expenses reflect minimal expense associated with IT. Congress should provide incentives for EMR adoption, and should establish standards to facilitate the sharing and exchange of data. Payment Fairness The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data and assumptions regarding the cost and organization of medical practice. CMS must administratively revise its measurements of the costs of practice to assure the validity and fairness of payments. Payment Equity Before MMA 03, Medicare’s payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blended payments. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1 2005. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. On March 4, 2005 CMS published a proposed rule that would enable Competitive Acquisition of Outpatient Drugs and Biologicals Under Medicare Part B. The proposed rule would implement provisions of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 that require the implementation of a competitive acquisition program for certain Medicare Part B drugs not paid on a cost or prospective payment system basis. Beginning January 1, 2006, physicians will generally be given a choice between obtaining these drugs from vendors selected through a competitive bidding process or directly purchasing these drugs and being paid under the average sales price system. Oppose limits on the laboratory CPI update. On April 4, 2005, the HHS Secretary’s Advisory Committee on Genetics, Health, and Society (SACGHS) published a Request for Public Comment in the Federal Register on a draft report on coverage and reimbursement of genetic tests and services. SACGHS is proposing to make the following recommendations: Medicare beneficiaries who lack current signs, symptoms, or personal histories of illness stand to clinically benefit from predictive and predispositional genetic tests and services. As such, SACGHS recommends that preventive services, including predispositional genetic tests and services, meeting evidence standards should be covered under Medicare. Reforming Medicaid Potential changes that will make Medicaid a more cost-effective and high quality program include the following: · Prescription Drug Improvements. The goal of reducing both state and federal expenditures will require policy changes that impact all segments of the pharmaceutical marketplace, including increased rebates from manufacturers, reforms to the Average Wholesale Price (AWP), and tiered, enforceable co-pays for beneficiaries. · Asset Policy. Many individuals are utilizing Medicaid estate planners or other means in order to shelter or transfer assets and therefore qualify for Medicaid funded long-term care services. Medicaid reform must include changes that increase the penalties for inappropriate transfers, restrict the types of assets that can be transferred, and encourage reverse mortgages, as well as other policies that encourage individuals and their families to self-finance care rather than rely on Medicaid. · Cost Sharing. Medicaid’s cost-sharing rules, which have not been updated since 1982, prevent states from utilizing market forces and personal responsibility to improve health care delivery. These provisions should be modified to make Medicaid look more like the State Children’s Health Insurance Program (SCHIP), where states have broad discretion to establish enforceable premiums, deductibles, or co-pays. · Benefit Package Flexibility. The Medicaid benefits package remains “one-size-fits-all.” Many states have found that the flexibility built into the SCHIP program allows for greater efficiencies without compromising quality of care. Extension of this flexibility to services for appropriate Medicaid populations would allow states to provide more targeted services while managing the program in a way that prevents sweeping cuts in the future. · Comprehensive Waiver Reforms. Reforms are needed to increase efficiency and reduce costs, increase the ease with which states obtain current waivers, expand the ability to seek new types of changes, and change the federal statute to eliminate the need for many waivers altogether. · Judicial Reforms. The right of states to locally manage the optional Medicaid categories is clearly defined in both policy and law, and the federal government should remove legal barriers that impede this fundamental management tool.

Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed during the coming year, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. Reform proposals include reimbursement updated on a market basket basis, removal of prescription drugs from the calculation of Medicare Part B costs, and rebasing Part B to reflect current rather than cumulative costs. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act of 2005, would replace projected Medicare payment cuts with positive updates in each of the next two years. The bill would provide an update of not less than 2.7% in 2006 and an update in 2007 that reflects physician practice cost inflation, which is expected to be about 2.6%. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for performance Currently the prevailing methods of paying for health care in the US neither incent nor reward providing high quality care. The rising costs of care coupled with the increasing awareness of poor quality care have made clear the need for a transformation in the way health care is financed. In the fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the unanticipated, but now recognized effect of economically stimulating growth in the numbers of services provided by physicians. Medicare must implement quality based payments for physician services, and capture the data on performance measures utilizing available claims-based data recoverable through enhanced IT functions. S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. Information Technology Under current law the capital and operating expenses of installing and maintaining an electronic medical record are assumed to be part of the overhead expense of a medical practice. Since no more than 5 –10% of the physician population has installed EMRs, CMS’ measurement of current physician practice expenses reflect minimal expense associated with IT. Congress should provide incentives for EMR adoption, and should establish standards to facilitate the sharing and exchange of data. Payment Fairness The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data and assumptions regarding the cost and organization of medical practice. CMS must administratively revise its measurements of the costs of practice to assure the validity and fairness of payments. Payment Equity Before MMA 03, Medicare’s payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blended payments. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1 2005. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. On March 4, 2005 CMS published a proposed rule that would enable Competitive Acquisition of Outpatient Drugs and Biologicals Under Medicare Part B. The proposed rule would implement provisions of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 that require the implementation of a competitive acquisition program for certain Medicare Part B drugs not paid on a cost or prospective payment system basis. Beginning January 1, 2006, physicians will generally be given a choice between obtaining these drugs from vendors selected through a competitive bidding process or directly purchasing these drugs and being paid under the average sales price system. Oppose limits on the laboratory CPI update. On April 4, 2005, the HHS Secretary’s Advisory Committee on Genetics, Health, and Society (SACGHS) published a Request for Public Comment in the Federal Register on a draft report on coverage and reimbursement of genetic tests and services. SACGHS is proposing to make the following recommendations: Medicare beneficiaries who lack current signs, symptoms, or personal histories of illness stand to clinically benefit from predictive and predispositional genetic tests and services. As such, SACGHS recommends that preventive services, including predispositional genetic tests and services, meeting evidence standards should be covered under Medicare. Reforming Medicaid Potential changes that will make Medicaid a more cost-effective and high quality program include the following: · Prescription Drug Improvements. The goal of reducing both state and federal expenditures will require policy changes that impact all segments of the pharmaceutical marketplace, including increased rebates from manufacturers, reforms to the Average Wholesale Price (AWP), and tiered, enforceable co-pays for beneficiaries. · Asset Policy. Many individuals are utilizing Medicaid estate planners or other means in order to shelter or transfer assets and therefore qualify for Medicaid funded long-term care services. Medicaid reform must include changes that increase the penalties for inappropriate transfers, restrict the types of assets that can be transferred, and encourage reverse mortgages, as well as other policies that encourage individuals and their families to self-finance care rather than rely on Medicaid. · Cost Sharing. Medicaid’s cost-sharing rules, which have not been updated since 1982, prevent states from utilizing market forces and personal responsibility to improve health care delivery. These provisions should be modified to make Medicaid look more like the State Children’s Health Insurance Program (SCHIP), where states have broad discretion to establish enforceable premiums, deductibles, or co-pays. · Benefit Package Flexibility. The Medicaid benefits package remains “one-size-fits-all.” Many states have found that the flexibility built into the SCHIP program allows for greater efficiencies without compromising quality of care. Extension of this flexibility to services for appropriate Medicaid populations would allow states to provide more targeted services while managing the program in a way that prevents sweeping cuts in the future. · Comprehensive Waiver Reforms. Reforms are needed to increase efficiency and reduce costs, increase the ease with which states obtain current waivers, expand the ability to seek new types of changes, and change the federal statute to eliminate the need for many waivers altogether. · Judicial Reforms. The right of states to locally manage the optional Medicaid categories is clearly defined in both policy and law, and the federal government should remove legal barriers that impede this fundamental management tool.

The Patient Safety and Quality Improvement Act of 2005 (S. 544) introduced by Sen. James Jeffords. This bill creates a new voluntary medical error reporting system, in which HHS would certify a number of private and public organizations to act as patient safety organizations. These PSOs would analyze data on medical errors, determine their causes, and develop and disseminate evidence-based information to providers to help them implement changes that would improve patient safety. To ensure reporting, data would be privileged against disclosure. Medical Liability The State of Wisconsin has successfully limited the escalation of liability insurance costs by implementing MICRA style medical liability reforms that include limits on non-economic damages, collateral source rules and limits on attorney’s contingency fees. This proven mechanism for restraining liability insurance costs should be made widely available throughout the country. HR 534, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2005, introduced by Rep. Chris Cox in the House and S. 354 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S. 306, the Genetic Information Nondiscrimination Act of 2005, introduced by Senator Olympia Snowe. And HR 1227 introduced by Rep. Judy Biggert in the House. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

The Patient Safety and Quality Improvement Act of 2005 (S. 544) introduced by Sen. James Jeffords. This bill creates a new voluntary medical error reporting system, in which HHS would certify a number of private and public organizations to act as patient safety organizations. These PSOs would analyze data on medical errors, determine their causes, and develop and disseminate evidence-based information to providers to help them implement changes that would improve patient safety. To ensure reporting, data would be privileged against disclosure. Medical Liability The State of Wisconsin has successfully limited the escalation of liability insurance costs by implementing MICRA style medical liability reforms that include limits on non-economic damages, collateral source rules and limits on attorney’s contingency fees. This proven mechanism for restraining liability insurance costs should be made widely available throughout the country. HR 534, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2005, introduced by Rep. Chris Cox in the House and S. 354 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S. 306, the Genetic Information Nondiscrimination Act of 2005, introduced by Senator Olympia Snowe. And HR 1227 introduced by Rep. Judy Biggert in the House. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

Provisions of the President’s FY2006 Budget and related appropriations legislation (H Con Res 95, S Con Res 18) related to implementation of MMA, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, medical liability reform, prescription drug benefits. Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations for 2006. Appropriations for Community Health Centers Appropriations for the Family Health Center to provide dental services Appropriations for rural telehealth grant programs in HRSA and HRSA rural health outreach grants. Appropriations for Laboratory Response Network in CDC. Appropriations for Personalized Medicine Research Programs in NIH. Appropriations for the Laird Center for Applied Sciences S 4, The Healthy America Act of 2005, To be introduced by Senator Bill Frist, (R-TN) calls for changes to make health care more affordable through medical liability reform, implementation of electronic health records, patient safety and voluntary error reporting; S 4 also expands access through tax deductions for the purchase of long term care insurance, and incentives for group purchasing arrangements for individuals; S 4 also strengthens the safety net by funding additional Community and Rural Health Centers, promoting chronic disease management, promoting care coordination by funding for integrated health systems, and expanding liability protection for health professionals who provide safety net services.

The Patient Safety and Quality Improvement Act of 2005 (S. 544) introduced by Sen. James Jeffords. This bill creates a new voluntary medical error reporting system, in which HHS would certify a number of private and public organizations to act as patient safety organizations. These PSOs would analyze data on medical errors, determine their causes, and develop and disseminate evidence-based information to providers to help them implement changes that would improve patient safety. To ensure reporting, data would be privileged against disclosure. Medical Liability The State of Wisconsin has successfully limited the escalation of liability insurance costs by implementing MICRA style medical liability reforms that include limits on non-economic damages, collateral source rules and limits on attorney’s contingency fees. This proven mechanism for restraining liability insurance costs should be made widely available throughout the country. HR 534, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2005, introduced by Rep. Chris Cox in the House and S. 354 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S. 306, the Genetic Information Nondiscrimination Act of 2005, introduced by Senator Olympia Snowe. And HR 1227 introduced by Rep. Judy Biggert in the House. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173 (Sec. 106) Establishes a State Pharmaceutical Assistance Transition Commission to develop a proposal for addressing the unique transitional issues facing State pharmaceutical assistance programs as a result of the enactment of this Act. (Sec. 108) Authorizes the Secretary to make grants to physicians for the purpose of assisting them to implement electronic prescription drug programs that comply with appropriate standards. Authorizes appropriations. Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blend. Increases minimum percentage increase to national growth rate. Requires the Secretary to submit to Congress a report that describes the impact of additional financing provided under this Act and other Acts on the availability on Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans. Subtitle C: Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition - (Sec. 221) Directs the Secretary to establish regional plans to encourage private plans to serve Medicare beneficiaries in from 10 to 50 regions, including in rural areas, within the 50 States and the District of Columbia beginning not later than January 1, 2005. Includes risk corridors for plans during the first two years of the program in 2006 and 2007; a stabilization fund to encourage plan entry and limit plan withdrawals; a blended benchmark that will allow plan bids to influence the benchmark amount; and network adequacy stabilization payments to assist plans in forming adequate networks, particularly in rural areas. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Heatlh Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. Title III: Combatting Waste, Fraud, and Abuse - (Sec. 302) Directs the Secretary to conduct a demonstration project on the application of competitive acquisition to clinical diagnostic laboratory tests. (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule; (2) require the Secretary to use the survey data submitted to the Secretary as of January 1, 2003, by a certain physician specialty organization; and (3) require the Secretary, beginning in 2005, to use supplemental survey data to adjust practice expense relative value units for certain drug administration services in the physician fee schedule if that supplemental survey data includes information on the expenses associated with administering drugs and biologicals the administration of drugs and biologicals, the survey meets criteria for acceptance, and the survey is submitted by March 1, 2004, for 2005, or March 1, 2005, for 2006. Requires the Secretary to: (1) promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption; (2) make adjustments to the nonphysician work pool methodology for the determination of practice expense relative value units under the physician fee schedule so that practice expense relative value units for services determined under such methodology are not affected relative to the practice expense relative value units of services not determined under such methodology; and (3) review and appropriately modify Medicare's payment policy in effect on October 1, 2003, for the administration of more than one drug or biological to an individual on a single day through the push technique. Makes the increase in expenditures resulting from this provision exempt from the budget-neutrality requirement in 2004. Requires a transitional adjustment or additional payment for services furnished from January 1, 2004, through December 31, 2005, to be made for drug administration services. Requires the part B payment to be made to the physician and equal a percentage of the payment otherwise made. Directs the MEDPAC to review the payment changes made under this section insofar as they affect payments under Medicare part B for items and services furnished by oncologists and for drug administration services furnished by other specialists. Requires the Commission to submit a report to the Secretary and Congress and for the Secretary to make appropriate payment adjustments on the basis of such report. Provides that the following drugs and biologicals are to be paid at 95 percent of the average wholesale price (AWP): (1) a drug or biological furnished before January 1, 2004; (2) blood clotting factors furnished during 2004; (3) a drug or biological furnished during 2004 that was not available for part B payment as of April 1, 2003; (3) pneumoccal influenza and hepatitus B vaccines furnished on or after January 1, 2004; and (4) a drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities. Provides in general that payments for other drugs furnished in 2004 will equal 85 percent of the AWP (determined as of April 1, 2003). Provides that, beginning in 2005, drugs or biologicals, except for pneumococcal, influenza, and hepatitis B vaccines and those associated with certain renal dialysis services, will be paid using either the average sales price methodology or through the competitive acquisition program. Provides that infusion drugs furnished through covered durable medical equipment starting January 1, 2004, will be paid at 95 percent of the AWP in effect on October 1, 2003, and that those infusion drugs which may be furnished in a competitive area starting January 1, 2007, will be paid on the competitive price. Provides that intravenous immune globulin will be paid at 95 percent of the AWP in 2004 and paid according to the average sales price method in 2005. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. (Sec. 417) Amends the Balanced Budget Act of 1997 to extend the telemedicine demonstration project by 4 years and to increase total funding for the project. Subtitle D: (Sec. 432) Amends SSA title VII to expand the functions of the Office of Rural Health Policy to include administering grants, cooperative agreements, and contracts to provide technical assistance and other necessary activities to support activities related to improving health care in rural areas. (Sec. 433) Directs the MEDPAC to conduct a study of specified rural provisions of this title for various reports to Congress. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services - Amends SSA title XVIII with respect to payment for physicians' services to: (1) provide that the update to the conversion factor for 2004 and 2005 will not be less than 1.5 percent; (2) modify the formula for calculating the sustainable growth rate to provide that the gross domestic product factor will be based on the annual average change over the preceding 10 years (a 10-year rolling average); (Sec. 604) Directs the Comptroller General to conduct a study for a report to Congress on access of Medicare beneficiaries to physician's services under the Medicare program. (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. Requires the Secretary to select two physician payment localities for such purposes, one to be a rural area and the other one will be a statewide locality that includes both urban and rural areas. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. Provides that upon implementation of the new ASC payment system, the Secretary will no longer be required to update ASC rates based on a survey of the actual audited costs incurred by a representative sample of ASCs every five years. Provides that subject to recommendations by the General Accounting Office, the Secretary will implement a revised payment system for payment of surgical services furnished in ASCs. Requires the new system to be implemented so that it is first effective on or after January 1, 2006, and not later than January 1, 2008. Requires the Comptroller General to conduct a study for a report to Congress that compares the relative costs of procedures furnished in ambulatory surgical centers to the relative costs of procedures furnished in hospital outpatient departments. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 648) Directs the Secretary to establish demonstration projects under which the Secretary is required to evaluate methods that improve the quality of care provided to individuals with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of such individuals for such chronic conditions. Requires the Secretary to conduct a demonstration project in at least one area that the Secretary determines has a population of individuals entitled to benefits under Medicare part A, and enrolled under Medicare part B, with a rate of incidence of diabetes that significantly exceeds the national average rate of all areas. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title VII: Provisions Relating to Parts A and B - Subtitle C: Chronic Care Improvement - (Sec. 721) Amends SSA title XVIII to require the Secretary to provide for the phased-in development, testing, evaluation, and implementation of chronic care improvement programs. Requires the programs to be designed to improve clinical quality and beneficiary satisfaction and achieve spending targets with respect to expenditures under Medicare for targeted beneficiaries with one or more threshold conditions. Makes necessary appropriations. (Sec. 722) Requires each Medicare Advantage organization to have an ongoing quality improvement program for improving the quality of care provided to enrollees in each MA plan offered by such organization (other than an MA private fee-for-service plan or an MSA plan) effective for contract years beginning January 1, 2006. Requires as part of the quality improvement program for each MA organization to have a chronic care improvement program. Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Requires the report to examine the stability and predictability of such updates and rate and alternatives for the use of such rate in the updates; and (2) all aspects of physician compensation for services furnished under Medicare and how those aspects interact and the effect on appropriate compensation for physician services. Subtitle B: Miscellaneous (Sec. 1012) Directs the Secretary to establish the Commission on Systemic Interoperability to develop a comprehensive strategy for the adoption and implementation of health care information technology standards, that includes a timeline and prioritization for such adoption and implementation. Authorizes appropriations. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Request for an advisory opinion regarding the “Stark Law” Section 1877(g)(6) of the Social Security Act and Sections 411.370 et seq. of Title 42 of the Code of Federal Regulations. Whether Marshfield Clinic's physician-shareholders have an ownership or investment interest in Marshfield Clinic for purposes of the Stark Law. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. S 2061 A bill to improve women's health access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the delivery of obstetrical and gynecological services – introduced by Senator Judd Gregg. S 2207 A bill to improve women's access to health care services, and the access of all individuals to emergency and trauma care services, by reducing the excessive burden the liability system places on the delivery of such services – introduced by Senator Judd Gregg. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Provisions of the President’s FY2004 Budget (H Con Res 95) related to Medicare reform, the provision of Medicare services and benefits to patients, physician reimbursement, medical liability reform, prescription drug benefits. Demonstration grant programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions. HR 2660, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2004. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. Appropriations for rural telehealth grant programs in HRSA and HRSA rural health outreach grants. Appropriations for Laboratory Response Network in CDC. Appropriations for Personalized Medicine Research Programs in NIH.

Provisions of the President’s FY2004 Budget (H Con Res 95) related to Medicare reform, the provision of Medicare services and benefits to patients, physician reimbursement, medical liability reform, prescription drug benefits. Demonstration grant programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions. HR 2660, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2004. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. Appropriations for rural telehealth grant programs in HRSA and HRSA rural health outreach grants.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

S. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Opposing Provisions of Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

S. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Opposing Provisions of Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

S. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Opposing Provisions of Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

S. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Opposing Provisions of Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. HR 623 Medical Laboratory Personnel Shortage Act of 2003 introduced by Rep. Schimkus- Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), through scholarships and loans for health professional training that may be modeled after the National Health Service Corps' scholarship and loan repayment programs, to alleviate the shortage of medical laboratory personnel where needed. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, introduced by Rep. James Greenwood in the House and S. 607 by Senator John Ensign in the Senate to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. HR663, the Patient Safety and Quality Improvement Act, introduced by Rep. Michael Bilirakis in the House Amends the Public Health Service Act to make patient safety work product privileged information. Defines "patient safety work product" as a record concerning patient information either reported to a patient safety organization by a health care provider (doctor, hospital, etc.) or created by a patient safety organization. Defines a "patient safety organization" as an organization, certified under this Act, that collects such information with the goal of improving patient safety and the quality of health care delivery. HR 877: The Patient Safety Improvement Act introduced by Rep. Nancy Johnson Amends title XI of the Social Security Act to add a new part D (Patient Safety Improvements) to provide for voluntary reporting to the Secretary of Health and Human Services of patient safety data. Prescribes confidentiality and peer review protections for such data. Directs the Secretary to ensure that the Center for Quality Improvement and Patient Safety supports public and private sector initiatives to improve patient safety for items and services furnished through health care providers. S. 1053, the Genetic Information Nondiscrimination Act of 2003, introduced by Senator Olympia Snowe. Amends the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to prohibit health discrimination on the basis of genetic information or services. Defines genetic information as genetic tests of an individual or family member or occurrence of a disease or disorder in family members used to predict risk of disease in asymptomatic or undiagnosed individuals. Defines genetic services as health services provided for genetic education and counseling.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Medicare part B physician payment provisions of the omnibus appropriations bill HJR 2. S. 1054, Jobs and Growth Tax Relief Reconciliation Act of 2003, introduced by Senator Grassley. Specifically, amendment No. 594, To amend title XVIII of the Social Security Act to enhance beneficiary access to quality health care services in rural areas under the Medicare program. All provisions improving the reimbursement of physician in rural areas. Save this template.Issue Template Text BUD budget/appropriations OrS. 1, Prescription Drug and Medicare Improvement Act of 2003'introduced by Senators Grassley and Baucus. Provisions calling for a statutory increase in Medicare physician payments for 2004-2005; provisions equalizing payments for physicians in rural areas for 2004?2007 by implementing a floor of 1.0 for the geographic adjustment of physician work, and practice expense. Incentive payments for physicians in underserved areas. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. Regulatory reform of CMS. Specific provisions include: Sec. 108, Protecting seniors with cancer; Sec. 203, Payments to MedicareAdvantage organizations; Sec. 421, Establishment of floor on geographic adjustments of payments for physicians' services; Sec. 422, Medicare incentive payment program improvements; Sec. 431, Application of coinsurance and deductible for clinical diagnostic laboratory tests. Sec. 432, Basing Medicare payments for covered outpatient drugs on market prices; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 441, Medicare health care quality demonstration programs. Sec. 442, Medicare complex clinical care management payment demonstration. Sec. 443, Medicare fee-for-service care coordination demonstration program; Sec. 444, GAO study of geographic differences in payments for physicians' services; Sec. 453, Clarifications to certain exceptions to Medicare limits on physician referrals; Sec. 455, MEDPAC study on Medicare payments and efficiencies in the health care system; Sec. 464, Sense of the Senate concerning Medicare payment update for physicians and other health professionals; Sec. 504. Streamlining and simplification of Medicare regulations. HR 2473, Medicare Prescription Drug and Modernization Act of 2003, introduced by Rep. Bill Thomas, to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program. HR 1, Medicare Prescription Drug and Modernization Act of 2003, introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 1.5% Medicare Part B conversion factor update in 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; Full reimbursement of Medicare Allowed Costs under Medicare Part B; preservation of floor payments in rural areas under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. Specific provisions include: Sec. 241. Application of FEHBP-style competitive reform beginning in 2010. Sec. 303. Competitive acquisition of covered outpatient drugs and biologicals. Sec. 413. GAO study of geographic differences in payments for physicians' services; Sec. 417, Medicare incentive payment program improvements for physician scarcity; Sec. 505. MedPAC report on specialty hospitals; Sec. 601 Revision of updates for physicians' services; Sec. 602. Studies on access to physicians' services; Sec. 603. MedPAC report on payment for physicians' services; Sec. 605. Establishment of floor on work geographic adjustment; Sec. 611. Coverage of an initial preventive physical examination; Sec. 625. Adjustment to payments for services furnished in ambulatory surgical centers; Sec. 941. Policy development regarding evaluation and management (E & M) documentation guidelines. Federal reimbursement of telehealth grant programs through Medicaid and Medicare. Modification of Medicare physician fee schedule geographic work adjustor. HR 33, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 881, by Bingaman Rural Equity Payment Index Reform Act of 2003 to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the medicare program S. 36, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. HR 810, Medicare Regulatory and Contracting Reform Act of 2003, introduced by Rep. Nancy Johnson (Sec. 501) Prohibits the Secretary from implementing any new documentation guidelines for, or clinical examples of, evaluation and management physician services under Medicare unless the Secretary: has developed the guidelines in collaboration with practicing physicians (including both generalists and specialists) and provided for an assessment of the proposed guidelines by the physician community; has established a program to educate physicians on the use of such guidelines. Requires the Secretary to make changes to the manner in which existing evaluation and management documentation guidelines are implemented to reduce paperwork burdens on physicians. S. 1148 Medicare Quality Improvement Act' by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. HR 1539, the Hospital Investment Act of 2003, introduced by Rep. G. Kleczka, amends title XVIII (Medicare) of the Social Security Act to limit the hospital ownership exception to physician self-referral restrictions to interests purchased on terms generally available to the public HR 1622, the Quality Cancer Care Preservation Act, introduced by Rep. Charles Norwood and Lois Capps, to amend title XVIII of the Social Security Act and otherwise revise the Medicare Program to reform the method of paying for covered drugs, drug administration services, and chemotherapy support services. HR 2161, the Prescription Value Act introduced by Rep. Doug Bereuter, which would require the Agency for Healthcare Research and Quality (AHRQ) to collect and assess scientific evidence regarding the value of prescription drugs frequently used by Medicare or Medicaid beneficiaries. On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and remains in contact with the Centers for Medicare and Medicaid Services regarding the proposal. HR 883 Medicare Laboratory Services Access Act of 2003 introduced by Rep English, Phil - Amends title XVIII (Medicare) of the Social Security Act (SSA) to specify as $5.42 for 2004, adjusted for inflation in each subsequent year, the nominal fee for collecting specimens for clinical diagnostic laboratory tests under Medicare. Oppose limits on the laboratory CPI update.

Privacy Regulation -- On August 14, 2002, the DHHS Office of the Secretary published a final rule establishing Standards for Privacy of Individually Identifiable Health Information. The Privacy Rule makes optional the requirement that providers obtain a patient’s signed consent before using or disclosing a patient’s protected health information; requires covered entities to make reasonable efforts to limit the use and disclosure of and request for, protected health information to the minimum necessary to accomplish the intended purpose; requires covered entities to have contracts with their business associates to ensure the business associates protect the privacy of the information; requires covered entities to first obtain the individual’s specific authorization before sending them any marketing materials; simplifies provisions of the existing rule to more closely follows the requirements of the “Common Rule,” which governs federally-funded research. HR 3323, that would extend the deadline for entities to be in compliance with the transaction standards of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) by one year. Liability and prompt payment provisions of the various Patients’ Bill of Rights: S. 899, the Bipartisan Patients’ Bill of Rights Act of 2001, introduced by Senators Bill Frist (R-TN), John Breaux (D-LA), and James Jeffords (R-VT) treatment of health plan and employer liability creating a limited right for patients to sue their health plans in federal court if they feel they have been improperly denied care. S. 1052 “Bipartisan Patient Protection Act” introduced by Sens. John McCain (R-AZ), John Edwards (D-NC), and Edward Kennedy (D-MA). The bill includes a broad range of patient protections nearly universally available throughout the states enabling access to pediatricians, obstetricians, emergency room services, and rights to appeal health plan decisions. HR 2563, the Bipartisan Patient Protection Act introduced by Rep. Charlie Norwood and Rep. Bill Thomas offering a compromise on the treatment of health plan and employer liability creating a limited right for patients to sue their health plans. S. 2590: Introduced by Senator Jim Jeffords. A bill to amend title IX of the Public Heath Service Act to provide for the improvement of patient safety and to reduce the incidence of events that adversely effect patient safety. HR 4889: The Patient Safety and Quality Improvement Act introduced by Rep. Nancy Johnson to provide for the improvement of patient safety and reduce the incidence of events that adversely effect patient safety. HR 4600: Introduced by Rep. James Greenwood to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system.

Privacy Regulation -- On December 28, 2000, the DHHS Office of the Secretary published a final rule establishing Standards for Privacy of Individually Identifiable Health Information. On March 27, the Secretary published a NPRM This rule includes standards, which apply to health plans, health care clearinghouses, and health care providers, establishing the rights of individuals who are the subjects of this information, procedures for the exercise of those rights, and the authorized and required uses and disclosures of this information. The rule implements the privacy requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996. On March 27 HHS published a rule proposing modifications to the Standards for Privacy of Individually Identifiable Health Information. The Privacy Rule makes optional the requirement that providers obtain a patient’s signed consent before using or disclosing a patient’s protected health information; requires covered entities to make reasonable efforts to limit the use and disclosure of and request for, protected health information to the minimum necessary to accomplish the intended purpose; requires covered entities to have contracts with their business associates to ensure the business associates protect the privacy of the information; requires covered entities to first obtain the individual’s specific authorization before sending them any marketing materials; simplifies provisions of the existing rule to more closely follows the requirements of the “Common Rule,” which governs federally-funded research. HR 3323, that would extend the deadline for entities to be in compliance with the transaction standards of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) by one year. Liability and prompt payment provisions of the various Patients’ Bill of Rights: S. 899, the Bipartisan Patients’ Bill of Rights Act of 2001, introduced by Senators Bill Frist (R-TN), John Breaux (D-LA), and James Jeffords (R-VT) treatment of health plan and employer liability creating a limited right for patients to sue their health plans in federal court if they feel they have been improperly denied care. S. 1052 “Bipartisan Patient Protection Act” introduced by Sens. John McCain (R-AZ), John Edwards (D-NC), and Edward Kennedy (D-MA). The bill includes a broad range of patient protections nearly universally available throughout the states enabling access to pediatricians, obstetricians, emergency room services, and rights to appeal health plan decisions. HR 2563, the Bipartisan Patient Protection Act introduced by Rep. Charlie Norwood and Rep. Bill Thomas offering a compromise on the treatment of health plan and employer liability creating a limited right for patients to sue their health plans. S. 2590: Introduced by Senator Jim Jeffords. A bill to amend title IX of the Public Heath Service Act to provide for the improvement of patient safety and to reduce the incidence of events that adversely effect patient safety. HR 4889: The Patient Safety and Quality Improvement Act introduced by Rep. Nancy Johnson to provide for the improvement of patient safety and reduce the incidence of events that adversely effect patient safety. HR 4600: Introduced by Rep. James Greenwood to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system.

The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR 4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Save this template.Issue Template Text ACC accounting Or S. 3018, by Senators Baucus and Grassley, the Beneficiary Access to Care and Medicare Equity Act of 2002. Provisions calling for a statutory increase in medicare physician payments for 2003-2005; provisions equalizing payments for physicians in rural areas for 2003?2005 by implementing a floor of 1.0 for the geographic adjustment of physician work, holding all other areas harmless. Incentive payments for physicians in underserved areas. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. On September 27, the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs HR 5063, a bill extending unemployment benefits, but also including a provision written by Ways and Means Committee Chairman Bill Thomas (R-CA) granting the Centers for Medicare and Medicaid Services (CMS) immunity from “retroactive lawsuits” for Medicare+Choice overestimates and accounting mistakes made in 1998 and 1999 in the calculation of Medicare physician fees.

On November 1, the Centers for Medicare & Medicaid Services published in the Federal Register a final rule entitled, “Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002.” This final rule made significant changes affecting Medicare Part B payment to reflect changes in medical practice and the relative value of services including interim RVUs for new and revised procedure codes for calendar year (CY) 2002, and a revised physician fee schedule update for CY 2002 and a revised conversion factor for CY 2002. The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953 Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. Section 437. BIPA requires GAO to conduct a study on the post-payment audit process for physicians services. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs

On November 1, the Centers for Medicare & Medicaid Services published in the Federal Register a final rule entitled, “Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002.” This final rule made significant changes affecting Medicare Part B payment to reflect changes in medical practice and the relative value of services including interim RVUs for new and revised procedure codes for calendar year (CY) 2002, and a revised physician fee schedule update for CY 2002 and a revised conversion factor for CY 2002. The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953 Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. Section 437. BIPA requires GAO to conduct a study on the post-payment audit process for physicians services. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs

The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR 4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Save this template.Issue Template Text ACC accounting Or S. 3018, by Senators Baucus and Grassley, the Beneficiary Access to Care and Medicare Equity Act of 2002. Provisions calling for a statutory increase in medicare physician payments for 2003-2005; provisions equalizing payments for physicians in rural areas for 2003?2005 by implementing a floor of 1.0 for the geographic adjustment of physician work, holding all other areas harmless. Incentive payments for physicians in underserved areas. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. On September 27, the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs HR 5063, a bill extending unemployment benefits, but also including a provision written by Ways and Means Committee Chairman Bill Thomas (R-CA) granting the Centers for Medicare and Medicaid Services (CMS) immunity from “retroactive lawsuits” for Medicare+Choice overestimates and accounting mistakes made in 1998 and 1999 in the calculation of Medicare physician fees.

Provisions of the President’s FY2003 Budget: including $190 billion in net additional spending for improving Medicare, adding a prescription drug benefit; reforming the current system paying average wholesale price for outpatient drugs to reduce costs to the Medicare program; modifying the Medicare+Choice (M+C) payment formula to reflect actual healthcare cost increases and allocate additional resources in 2003 to counties that have received only minimum updates over the last few years; and proposing incentive payments for new types of plans that enter Medicare+Choice to encourage a variety of new managed care plans (e.g., PPOs) to participate in Medicare+Choice; proposed reductions in the budget of AHRQ, that might interfere with the improvement of patient safety research. On Dec 6, 2001, the Health Resources and Services Administration, (HRSA) published a revised Statement of Organization, and Delegations of Authority in the Federal Register transferring the Office for the Advancement of Telehealth (OAT) at from the Office of the Administrator of HRSA to the HIV/AIDS Bureau at HRSA. Conferees on the Labor HHS appropriations bill, HR 3061, took issue with this transfer of authority, and included language in the conference report stipulating that sufficient funds were provided to continue the operations of OAT as a component of the HRSA Office of the Administrator. The Conference Report accompanying H.R. 3338, made appropriations for the Department of Defense for FY ending September 30, 2002 and for other purposes, provided funding to the Department of Health and Human Services, Office of the Secretary for public health and social services emergency fund for administering assistance for enhancing laboratory capacity by requesting the Centers for Disease Control to ensure that funds are made available, to the greatest extent possible, to all laboratories participating in the Laboratory Response Network. The S. 2766 regarding appropriations for the Departments of Labor, Health and Human Services, and Education and Related Agencies for FY 2003 provides funding for: · HRSA for Office for the Advancement of Telehealth, · research and program grant programs to the National Institute for Occupational Safety and Health, · rural health, · National Children's Center for Rural Agriculture Health and Safety, · Centers for Disease Control (public health and social services emergency fund for administering assistance for enhancing laboratory capacity by requesting the Centers for Disease Control to ensure that funds are made available, to the greatest extent possible, to all laboratories participating in the Laboratory Response Network), · health services to medically under-served populations and rural residents including techniques for developing emerging genomic sequencing applications in the patient care setting. · pursue the development of the next generation of genomic tools and technologies needed to study the human genome and understand its role in human health and disease and develop new applications in medicine -- · The National Human Genome Research Institute (NHGRI), The National Heart Lung and Blood Institute (NHLBI), · The National Institute for Arthritis and Musculoskeletal Diseases (NIAMSD), · The National Institute of Diabetes Digestive and Kidney Diseases (NIDDKD), · The National Institute Neurological Disorders and Stroke (NINDS). · programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions · chronic wasting disease research and laboratory services Demonstration grant programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions.

Provisions of the President’s FY2003 Budget: including $190 billion in net additional spending for improving Medicare, adding a prescription drug benefit; reforming the current system paying average wholesale price for outpatient drugs to reduce costs to the Medicare program; modifying the Medicare+Choice (M+C) payment formula to reflect actual healthcare cost increases and allocate additional resources in 2003 to counties that have received only minimum updates over the last few years; and proposing incentive payments for new types of plans that enter Medicare+Choice to encourage a variety of new managed care plans (e.g., PPOs) to participate in Medicare+Choice; proposed reductions in the budget of AHRQ, that might interfere with the improvement of patient safety research. The Conference Report accompanying H.R. 3338, made appropriations for the Department of Defense for FY ending September 30, 2002 and for other purposes, provided funding to the Department of Health and Human Services, Office of the Secretary for public health and social services emergency fund for administering assistance for enhancing laboratory capacity by requesting the Centers for Disease Control to ensure that funds are made available, to the greatest extent possible, to all laboratories participating in the Laboratory Response Network. The bill, S. 2766, regarding appropriations for the Departments of Labor, Health and Human Services, and Education and Related Agencies for FY 2003 provides funding for: · HRSA for Office for the Advancement of Telehealth, · research and program grant programs to the National Institute for Occupational Safety and Health, · rural health, · National Children's Center for Rural Agriculture Health and Safety, · Centers for Disease Control (public health and social services emergency fund for administering assistance for enhancing laboratory capacity by requesting the Centers for Disease Control to ensure that funds are made available, to the greatest extent possible, to all laboratories participating in the Laboratory Response Network), · health services to medically under-served populations and rural residents including techniques for developing emerging genomic sequencing applications in the patient care setting. · pursue the development of the next generation of genomic tools and technologies needed to study the human genome and understand its role in human health and disease and develop new applications in medicine -- · The National Human Genome Research Institute (NHGRI), The National Heart Lung and Blood Institute (NHLBI), · The National Institute for Arthritis and Musculoskeletal Diseases (NIAMSD), · The National Institute of Diabetes Digestive and Kidney Diseases (NIDDKD), · The National Institute Neurological Disorders and Stroke (NINDS). · programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions · chronic wasting disease research and laboratory services Demonstration grant programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions

Provisions of the President’s FY2003 Budget: including $190 billion in net additional spending for improving Medicare, adding a prescription drug benefit; reforming the current system paying average wholesale price for outpatient drugs to reduce costs to the Medicare program; modifying the Medicare+Choice (M+C) payment formula to reflect actual healthcare cost increases and allocate additional resources in 2003 to counties that have received only minimum updates over the last few years; and proposing incentive payments for new types of plans that enter Medicare+Choice to encourage a variety of new managed care plans (e.g., PPOs) to participate in Medicare+Choice; proposed reductions in the budget of AHRQ, that might interfere with the improvement of patient safety research. On Dec 6, 2001, the Health Resources and Services Administration, (HRSA) published a revised Statement of Organization, and Delegations of Authority in the Federal Register transferring the Office for the Advancement of Telehealth (OAT) at from the Office of the Administrator of HRSA to the HIV/AIDS Bureau at HRSA. Conferees on the Labor HHS appropriations bill, HR 3061, took issue with this transfer of authority, and included language in the conference report stipulating that sufficient funds were provided to continue the operations of OAT as a component of the HRSA Office of the Administrator. The Conference Report accompanying H.R. 3338, made appropriations for the Department of Defense for FY ending September 30, 2002 and for other purposes, provided funding to the Department of Health and Human Services, Office of the Secretary for public health and social services emergency fund for administering assistance for enhancing laboratory capacity by requesting the Centers for Disease Control to ensure that funds are made available, to the greatest extent possible, to all laboratories participating in the Laboratory Response Network. The S. 2766 regarding appropriations for the Departments of Labor, Health and Human Services, and Education and Related Agencies for FY 2003 provides funding for: · HRSA for Office for the Advancement of Telehealth, · research and program grant programs to the National Institute for Occupational Safety and Health, · rural health, · National Children's Center for Rural Agriculture Health and Safety, · Centers for Disease Control (public health and social services emergency fund for administering assistance for enhancing laboratory capacity by requesting the Centers for Disease Control to ensure that funds are made available, to the greatest extent possible, to all laboratories participating in the Laboratory Response Network), · health services to medically under-served populations and rural residents including techniques for developing emerging genomic sequencing applications in the patient care setting. · pursue the development of the next generation of genomic tools and technologies needed to study the human genome and understand its role in human health and disease and develop new applications in medicine -- · The National Human Genome Research Institute (NHGRI), The National Heart Lung and Blood Institute (NHLBI), · The National Institute for Arthritis and Musculoskeletal Diseases (NIAMSD), · The National Institute of Diabetes Digestive and Kidney Diseases (NIDDKD), · The National Institute Neurological Disorders and Stroke (NINDS). · programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions · chronic wasting disease research and laboratory services Demonstration grant programs to increase patient safety through the application of computerized prescriber order entry systems to reduce preventable adverse drug reactions.

The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR 4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Save this template.Issue Template Text ACC accounting Or S. 3018, by Senators Baucus and Grassley, the Beneficiary Access to Care and Medicare Equity Act of 2002. Provisions calling for a statutory increase in medicare physician payments for 2003-2005; provisions equalizing payments for physicians in rural areas for 2003?2005 by implementing a floor of 1.0 for the geographic adjustment of physician work, holding all other areas harmless. Incentive payments for physicians in underserved areas. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. On September 27, the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs HR 5063, a bill extending unemployment benefits, but also including a provision written by Ways and Means Committee Chairman Bill Thomas (R-CA) granting the Centers for Medicare and Medicaid Services (CMS) immunity from “retroactive lawsuits” for Medicare+Choice overestimates and accounting mistakes made in 1998 and 1999 in the calculation of Medicare physician fees.

On November 1, the Centers for Medicare & Medicaid Services published in the Federal Register a final rule entitled, “Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002.” This final rule made significant changes affecting Medicare Part B payment to reflect changes in medical practice and the relative value of services including interim RVUs for new and revised procedure codes for calendar year (CY) 2002, and a revised physician fee schedule update for CY 2002 and a revised conversion factor for CY 2002. The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953 Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. Section 437. BIPA requires GAO to conduct a study on the post-payment audit process for physicians services. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs

The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953, Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR 4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Save this template.Issue Template Text ACC accounting Or S. 3018, by Senators Baucus and Grassley, the Beneficiary Access to Care and Medicare Equity Act of 2002. Provisions calling for a statutory increase in medicare physician payments for 2003-2005; provisions equalizing payments for physicians in rural areas for 2003?2005 by implementing a floor of 1.0 for the geographic adjustment of physician work, holding all other areas harmless. Incentive payments for physicians in underserved areas. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. On September 27, the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs HR 5063, a bill extending unemployment benefits, but also including a provision written by Ways and Means Committee Chairman Bill Thomas (R-CA) granting the Centers for Medicare and Medicaid Services (CMS) immunity from “retroactive lawsuits” for Medicare+Choice overestimates and accounting mistakes made in 1998 and 1999 in the calculation of Medicare physician fees.

On November 1, the Centers for Medicare & Medicaid Services published in the Federal Register a final rule entitled, “Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002.” This final rule made significant changes affecting Medicare Part B payment to reflect changes in medical practice and the relative value of services including interim RVUs for new and revised procedure codes for calendar year (CY) 2002, and a revised physician fee schedule update for CY 2002 and a revised conversion factor for CY 2002. The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953 Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. Section 437. BIPA requires GAO to conduct a study on the post-payment audit process for physicians services. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs

On November 1, the Centers for Medicare & Medicaid Services published in the Federal Register a final rule entitled, “Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002.” This final rule made significant changes affecting Medicare Part B payment to reflect changes in medical practice and the relative value of services including interim RVUs for new and revised procedure codes for calendar year (CY) 2002, and a revised physician fee schedule update for CY 2002 and a revised conversion factor for CY 2002. The Medicare Physician Payment Fairness Act of 2001, S. 1707 and HR 3351, introduced by Senator James Jeffords and Rep. Michael Bilirakis to reduce an across the board cut of 5.4% in Medicare payments to physicians and set the conversion factor (update) for payments under the Medicare physician fee schedule for 2002 at 0.9 percent less than the conversion factor for 2001. The bills also direct the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on replacing the use of the sustainable growth rate as a factor in determining the update for such payments with a factor that more fully accounts for changes in the unit costs of providing physicians' services. Modification of Medicare physician fee schedule geographic work adjustor. HR 3569, the Rural Equity Payment Index Reform Act (REPAIR) introduced by Rep. Doug Bereuter, would lessen the disparity in Medicare physician payment that currently exists between urban and rural areas. S. 1953 Feingold legislation to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the Medicare physician fee schedule. S. 2752 by Jeffords authorizing the Centers for Medicare and Medicaid Services to conduct research demonstrations to examine health delivery factors that encourage the delivery of improved quality in patient care. S. 2555, the “Revitalizing Underserved Rural Areas and Localities (RURAL) Act of 2002” introduced by Senator Baucus with provisions to increase the geographic adjustment of physician reimbursement in low payment areas. The Medicare Modernization and Prescription Drug Act (HR4954) introduced by Reps. Thomas, Tauzin, Johnson and Bilirakis, provisions establishing a 2% Medicare Part B conversion factor update in 2003, 2004 and 2005; provisions instructing GAO to examine the impact of the geographic adjustment factor on physician payments under the Medicare physician fee schedule; increasing Medicare+Choice payments; and delaying “Lock-in” requirements for one year; establishing competitive bidding for certain Part B services. The Medical Excellence Demonstration Program Act of 2001 (S. 1756 introduced by Senator Jeffords, and HR 3746 introduced by Rep. Houghton) to establish demonstration projects to examine health care delivery factors that encourage improved quality of care. The conference report on HR 3448 the Public Health Security and Bioterrorism Preparedness and Response Act changed the Medicare+Choice “lock-in” provisions governing marketing and enrollment in M+C plans. The new provisions would postpone for three years limits determining when Medicare beneficiaries can switch health plans. These provisions also set limits on the period when M+C enrollment could be marketed to beneficiaries. Full reimbursement of Medicare Allowed Costs under Medicare Part B. Acceleration of Risk Adjustment implementation under Medicare+Choice. Preservation of floor payments in rural areas under Medicare+Choice. Waiver and or delay of Medicare+Choice “lock-in” enrollment limitations for 2002-2005. Extension of the New Entry bonus under Medicare+Choice. Demonstration programs under Medicare to increase beneficiary and plan participation in the Medicare +Choice Program. “Medicare Equity” concepts developed by Senate Finance Committee taking incremental steps towards Medicare reform, including restructuring CMS, improving Medicare+Choice, increasing the number of plans in rural areas, and easing payment inequities between urban and rural providers. HHS Initiative on Rural Communities, DHHS Secretary Thompson's call for a department-wide examination of federal health programs and how the federal programs respond to the needs of rural areas. Regulatory reform of CMS, through select provisions of the Medicare Education and Regulatory Fairness Act (S. 452, H.R. 858), H.R. 3046, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act (The Medicare RACER Act) and the H.R. 2768, the “Medicare Regulatory And Contract Reform Act of 2001,” and H.R. 3391, The Medicare Regulatory and Contracting Reform Act” HR 3584, “The Medicare+Choice Improvement and Stabilization Act of 2001” legislation that would revise the payment structure of the Medicare managed care program for the year 2003 and make other changes to the program basing M+C payment on 100 percent of fee-for-service costs for 2003 only. Plans would then be paid based on whichever option was greatest: 100 percent of fee-for-service; a modified blend that re-weights the national average using M+C enrollment; floor payments as enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; or a 2 percent minimum increase. The bill would also delay the onset of the “lock-in” period by one year and enable demonstration projects for preferred provider organizations and disease management programs. Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, HR 5661. Section 412. HHS will be required to conduct a Physician Group Practice Demonstration to test, and expand the use of incentives to health care groups participating under Medicare. Section 429. BIPA requires GAO to study and submit a report to Congress and the Secretary on the reimbursement for drugs and biologicals and related services under Medicare. Section 437. BIPA requires GAO to conduct a study on the post-payment audit process for physicians services. The Comptroller General would also be required to conduct a study of the aggregate effects of regulatory, audit, oversight and paperwork burdens on physicians and other health care providers participating in Medicare. Medicare reimbursement for recovery care center services. Medicare Evaluation and Management Documentation Coding. Clarification of Medicare Formatting of Advance Beneficiary Notices. Medicare coverage of injected drugs