[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5730 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 5730
To amend title XVIII of the Social Security Act to make publicly
available on the official Medicare Internet site medicare payment rates
for frequently reimbursed hospital inpatient procedures, hospital
outpatient procedures, and physicians' services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 10, 2012
Mr. Huizenga of Michigan introduced the following bill; which was
referred to the Committee on Ways and Means, and in addition to the
Committee on Energy and Commerce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to make publicly
available on the official Medicare Internet site medicare payment rates
for frequently reimbursed hospital inpatient procedures, hospital
outpatient procedures, and physicians' services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Payment Rate Disclosure Act
of 2012''.
SEC. 2. PUBLIC INTERNET AVAILABILITY OF MEDICARE PAYMENT RATES FOR
FREQUENTLY REIMBURSED PROCEDURES AND SERVICES.
Title XVIII of the Social Security Act is amended by adding at the
end the following new section:
``SEC. 1899B. PUBLIC INTERNET AVAILABILITY OF MEDICARE PAYMENT RATES
FOR FREQUENTLY REIMBURSED PROCEDURES AND SERVICES.
``(a) In General.--
``(1) Initial posting.--During the initial period beginning
on a date not later than 120 days after the date of the
enactment of this section and ending on the date that is 240
days after such starting date, the Secretary shall make
publicly available on the official Medicare Internet site the
following:
``(A) Payment rates for hospital inpatient
procedures.--For each procedure selected under
subsection (b)(1)(A)(i) and for each Metropolitan
Statistical Area or other payment area used for
purposes of section 1886(d), the average rate of
payment under such section for the procedure,
determined without regard to the application of any
deduction or coinsurance amount or any adjustment under
subparagraph (B), (D), (F), or (G) of paragraph (5) of
such section.
``(B) Payment rates for hospital outpatient
procedures.--For each procedure selected under
subsection (b)(1)(A)(ii) and for each county or other
payment area used for purposes of section 1833(t), the
average rate of payment under such section for the
procedure, determined without regard to the application
of any deductible or coinsurance.
``(C) Physician payment rates for physicians'
services.--For each physicians' service selected under
subsection (b)(1)(A)(iii) and for each fee schedule
area under section 1848, the average payment amount
determined under the fee schedule under such section
for the service, determined without regard to the
application of any deductible or coinsurance.
``(D) Period for which payment rates are
applicable.--A description of the period for which each
payment rate or amount under subparagraph (A), (B), or
(C) is applicable.
``(E) Services included in procedures.--A
description of the items and services included in each
procedure selected under clauses (i) and (ii) of
subsection (b)(1)(A).
``(F) Notice.--A statement that the average payment
rates and average payment amounts described in
subparagraphs (A) through (C) are only applicable to
the Medicare program under this title and may not be
available for an individual who is not purchasing such
a procedure or service under such program.
``(2) Posting of expanded selection.--During the period
beginning on the date that is one day after the last day of the
initial period described in paragraph (1), the Secretary shall
make publicly available on the official Medicare Internet site
the following:
``(A) Payment rates for hospital inpatient
procedures.--For each procedure selected under
subsection (b)(1)(B)(i) and for each Metropolitan
Statistical Area or other payment area used for
purposes of section 1886(d), the average rate of
payment described in paragraph (1)(A) for the
procedure.
``(B) Payment rates for hospital outpatient
procedures.--For each procedure selected under
subsection (b)(1)(B)(ii) and for each county or other
payment area used for purposes of section 1833(t), the
average rate of payment described in paragraph (1)(B)
for the procedure.
``(C) Physician payment rates for physicians'
services.--For each physicians' service selected under
subsection (b)(1)(B)(iii) and for each fee schedule
area under section 1848, the average payment amount
described in paragraph (1)(C) for the physicians'
service.
``(D) Period for which payment rates are
applicable.--A description of the period for which each
payment rate or amount under subparagraph (A), (B), or
(C) is applicable.
``(E) Services included in procedures.--A
description of the items and services included in each
procedure selected under clauses (i) and (ii) of
subsection (b)(1)(B).
``(F) Notice.--A statement that the average payment
rates and average payment amounts described in
subparagraphs (A) through (C) are only applicable to
the Medicare program under this title and may not be
available for an individual who is not purchasing such
a procedure or service under such program.
``(b) Selection of Procedures and Services.--
``(1) In general.--
``(A) Initial selection.--For purposes of
subsection (a)(1) and based on the most recent national
data available, the Secretary shall select the
following:
``(i) At least the 30 hospital inpatient
procedures for which payment is most frequently
provided under section 1886(d).
``(ii) At least the 30 hospital outpatient
procedures for which payment is most frequently
provided under section 1833(t).
``(iii) At least the 30 physicians'
services (as defined in section 1861(q)) for
which payment is most frequently provided under
section 1848.
``(B) Expanded selection.--For purposes of
subsection (a)(2) and based on the most recent national
data available, the Secretary shall select the
following:
``(i) At least the 100 hospital inpatient
procedures for which payment is most frequently
provided under section 1886(d).
``(ii) At least the 100 hospital outpatient
procedures for which payment is most frequently
provided under section 1833(t).
``(iii) At least the 100 physicians'
services (as defined in section 1861(q)) for
which payment is most frequently provided under
section 1848.
``(2) Updating expanded selection.--The Secretary shall
periodically update the procedures and services selected under
paragraph (1)(B).
``(3) Further expansion of selection.--The Secretary shall
expand the number of procedures and services selected under
paragraph (1)(B) to include as many procedures and services as
may be useful for an individual not entitled to benefits under
part A or enrolled under part B in the purchase of such
procedures and services.
``(c) Authority To Post Additional Information.--The Secretary may
make publicly available on the official Medicare website such
information on the payment rate or payment amount under this title for
a procedure, item, or service not selected under subsection (b) as may
be useful for an individual not entitled to benefits under part A or
enrolled under part B in the purchase of the procedure, item, or
service. To the extent practicable, such information shall be provided
for each payment area involved.
``(d) Administrative Provisions.--
``(1) Use of most recent national data.--The information
described in paragraph (1) of subsection (b) and subsection (c)
shall be based on the most recent national data available.
``(2) Accessibility by zip code.--Such information for an
applicable payment area shall be accessible by any zip code
included in such area.''.
<all>