SEC. 413. MEDICARE INCENTIVE PAYMENT PROGRAM IMPROVEMENTS
FOR PHYSICIAN SCARCITY.
(a) ADDITIONAL INCENTIVE PAYMENT FOR CERTAIN
PHYSICIAN SCARCITY AREAS- Section 1833 (42 U.S.C. 1395l) is amended by adding
at the end the following new subsection:
`(u) INCENTIVE PAYMENTS FOR PHYSICIAN SCARCITY AREAS-
`(1) IN GENERAL- In the case of physicians' services furnished on or
after January 1, 2005, and before January 1, 2008--
`(A) by a primary care physician in a primary care scarcity county
(identified under paragraph (4)); or
`(B) by a physician who is not a primary care physician in a
specialist care scarcity county (as so identified),
in addition to the amount of payment that would otherwise be made for
such services under this part, there also shall be paid an amount equal to 5
percent of the payment amount for the service under this part.
`(2) DETERMINATION OF RATIOS OF PHYSICIANS TO MEDICARE BENEFICIARIES IN
AREA- Based upon available data, the Secretary shall establish for each
county or equivalent area in the United States, the following:
`(A) NUMBER OF PHYSICIANS PRACTICING IN THE AREA- The number of
physicians who furnish physicians' services in the active practice of
medicine or osteopathy in that county or area, other than physicians whose
practice is exclusively for the Federal Government, physicians who are
retired, or physicians who only provide administrative services. Of such
number, the number of such physicians who are--
`(i) primary care physicians; or
`(ii) physicians who are not primary care physicians.
`(B) NUMBER OF MEDICARE BENEFICIARIES RESIDING IN THE AREA- The number
of individuals who are residing in the county and are entitled to benefits
under part A or enrolled under this part, or both (in this subsection
referred to as `individuals').
`(C) DETERMINATION OF RATIOS-
`(i) PRIMARY CARE RATIO- The ratio (in this paragraph referred to as
the `primary care ratio') of the number of primary care physicians
(determined under subparagraph (A)(i)), to the number of individuals
determined under subparagraph (B).
`(ii) SPECIALIST CARE RATIO- The ratio (in this paragraph referred
to as the `specialist care ratio') of the number of other physicians
(determined under subparagraph (A)(ii)), to the number of individuals
determined under subparagraph (B).
`(3) RANKING OF COUNTIES- The Secretary shall rank each such county or
area based separately on its primary care ratio and its specialist care
ratio.
`(4) IDENTIFICATION OF COUNTIES-
`(A) IN GENERAL- The Secretary shall identify--
`(i) those counties and areas (in this paragraph referred to as
`primary care scarcity counties') with the lowest primary care ratios
that represent, if each such county or area were weighted by the number
of individuals determined under paragraph (2)(B), an aggregate total of
20 percent of the total of the individuals determined under such
paragraph; and
`(ii) those counties and areas (in this subsection referred to as
`specialist care scarcity counties') with the lowest specialist care
ratios that represent, if each such county or area were weighted by the
number of individuals determined under paragraph (2)(B), an aggregate
total of 20 percent of the total of the individuals determined under
such paragraph.
`(B) PERIODIC REVISIONS- The Secretary shall periodically revise the
counties or areas identified in subparagraph (A) (but not less often than
once every three years) unless the Secretary determines that there is no
new data available on the number of physicians practicing in the county or
area or the number of individuals residing in the county or area, as
identified in paragraph (2).
`(C) IDENTIFICATION OF COUNTIES WHERE SERVICE IS FURNISHED- For
purposes of paying the additional amount specified in paragraph (1), if
the Secretary uses the 5-digit postal ZIP Code where the service is
furnished, the dominant county of the postal ZIP Code (as determined by
the United States Postal Service, or otherwise) shall be used to determine
whether the postal ZIP Code is in a scarcity county identified in
subparagraph (A) or revised in subparagraph (B).
`(D) JUDICIAL REVIEW- There shall be no administrative or judicial
review under section 1869, 1878, or otherwise, respecting--
`(i) the identification of a county or area;
`(ii) the assignment of a specialty of any physician under this
paragraph;
`(iii) the assignment of a physician to a county under paragraph
(2); or
`(iv) the assignment of a postal ZIP Code to a county or other area
under this subsection.
`(5) RURAL CENSUS TRACTS- To the extent feasible, the Secretary shall
treat a rural census tract of a metropolitan statistical area (as determined
under the most recent modification of the Goldsmith Modification, originally
published in the Federal Register on February 27, 1992 (57 Fed. Reg. 6725)),
as an equivalent area for purposes of qualifying as a primary care scarcity
county or specialist care scarcity county under this subsection.
`(6) PHYSICIAN DEFINED- For purposes of this paragraph, the term
`physician' means a physician described in section 1861(r)(1) and the term
`primary care physician' means a physician who is identified in the
available data as a general practitioner, family practice practitioner,
general internist, or obstetrician or gynecologist.
`(7) PUBLICATION OF LIST OF COUNTIES; POSTING ON WEBSITE- With respect
to a year for which a county or area is identified or revised under
paragraph (4), the Secretary shall identify such counties or areas as part
of the proposed and final rule to implement the physician fee schedule under
section 1848 for the applicable year. The Secretary shall post the list of
counties identified or revised under paragraph (4) on the Internet website
of the Centers for Medicare & Medicaid Services.'.
(b) IMPROVEMENT TO MEDICARE INCENTIVE PAYMENT
PROGRAM-
(1) IN GENERAL- Section 1833(m) (42
U.S.C. 1395l(m)) is amended--
(A) by inserting `(1)' after
`(m)';
(B) in paragraph (1), as designated
by subparagraph (A)--
(i) by inserting `in
a year' after `In the case of physicians' services furnished'; and
(ii) by inserting
`as identified by the Secretary prior to the beginning of such year' after
`as a health professional shortage area'; and
(C) by adding at the end the
following new paragraphs:
`(2) For each health professional shortage area identified in paragraph
(1) that consists of an entire county, the Secretary shall provide for the
additional payment under paragraph (1) without any requirement on the
physician to identify the health professional shortage area involved. The
Secretary may implement the previous sentence using the method specified in
subsection (u)(4)(C).
`(3) The Secretary shall post on the Internet website of the Centers for
Medicare & Medicaid Services a list of the health professional shortage
areas identified in paragraph (1) that consist of a partial county to
facilitate the additional payment under paragraph (1) in such areas.
`(4) There shall be no administrative or judicial review under section
1869, section 1878, or otherwise, respecting--
`(A) the identification of a county or area;
`(B) the assignment of a specialty of any physician under this
paragraph;
`(C) the assignment of a physician to a county under this subsection;
or
`(D) the assignment of a postal ZIP Code to a county or other area under
this subsection.'.
(2) EFFECTIVE DATE- The amendments
made by paragraph (1) shall apply to physicians' services furnished on or
after January 1, 2005.
(c) GAO Study of Geographic Differences in
Payments for Physicians' Services-
(1) STUDY- The Comptroller General
of the United States shall conduct a study of differences in payment amounts
under the physician fee schedule under section 1848 of the Social Security
Act (42 U.S.C. 1395w-4) for physicians' services in different geographic areas.
Such study shall include--
(A) an assessment of the validity
of the geographic adjustment factors used for each component of the fee
schedule;
(B) an evaluation of the measures
used for such adjustment, including the frequency of revisions;
(C) an evaluation of the methods
used to determine professional liability insurance costs used in computing
the malpractice component, including a review of increases in professional
liability insurance premiums and variation in such increases by State and
physician specialty and methods used to update the geographic cost of practice
index and relative weights for the malpractice component; and
(D) an evaluation of the effect
of the adjustment to the physician work geographic index under section 1848(e)(1)(E)
of the Social Security Act, as added by section 412, on physician location
and retention in areas affected by such adjustment, taking into account--
(i) differences in
recruitment costs and retention rates for physicians, including specialists,
between large urban areas and other areas; and
(ii) the mobility
of physicians, including specialists, over the last decade.
(2) REPORT- Not later than 1 year after
the date of the enactment of this Act, the Comptroller General shall submit
to Congress a report on the study conducted under paragraph (1). The report
shall include recommendations regarding the use of more current data in computing
geographic cost of practice indices as well as the use of data directly representative
of physicians' costs (rather than proxy measures of such costs).
