Sec. 612. Payments to individual providers through fee-for-service
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Not later than 1 year after the date of the enactment of this Act, and in consultation with providers and regional office directors, the Secretary shall establish and annually update a national fee schedule that establishes amounts for items and services payable under this Act, furnished by— individual providers; providers in group practices who are not receiving payments on a salaried basis described in section 611(a)(3); providers of home- and community-based services; and any other provider not described in section 611.
In establishing the fee schedule under paragraph (1), the Secretary shall take into account— the amounts payable for such items and services under title XVIII of the Social Security Act and other Federal health programs; and the expertise of providers and the value of items and services furnished by such providers. Except as otherwise provided in this section, the Secretary shall establish, and shall annually update by regulation, the fee schedule under subsection
(a)in a manner that is documented, is transparent, allows for public comment, and, to the greatest extent practicable, is consistent with processes for determining, revising, and making payments for items and services under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ), including the application of the provisions of, and amendments made by, section 613. The Secretary shall establish a uniform national system for electronic billing for purposes of making payments under this section. To the extent the Secretary determines such application is necessary to ensure a smooth and fair transition, the Secretary may apply payment reform activities planned or implemented with respect to such title XVIII as of the date of the enactment of this Act, including demonstrations, waivers, or any other provider payment agreements, to benefits under this Act, provided that the Secretary sets forth a process for reviewing such applications and making such determinations that is reasonable, transparent, and documented, and allows for public comment. Each director of a regional office, in consultation with representatives of physicians practicing in that region, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician-delivered items and services. The use of mechanisms that discriminate against people with disabilities is prohibited for use in any value or cost-effectiveness assessments.
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Sec. 612
Payments to individual providers through fee-for-service
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