Sec. 613. Ensuring accurate valuation of services under the Medicare physician fee schedule

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Section 1848(c)(2) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2) ) is amended by adding at the end the following new subparagraph: Not later than one year after the date of enactment of this subparagraph, the Secretary shall establish, document, and make publicly available, in consultation with the Office of Primary Health Care, a standardized process for reviewing the relative values of physicians' services under this paragraph. The standardized process shall include, at a minimum, methods and criteria for identifying services for review, prioritizing the review of services, reviewing stakeholder recommendations, and identifying additional resources to be considered during the review process. .

Section 1848(c)(2)(M) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(M) ) is amended by adding at the end the following new clause: For each fiscal year (beginning with the first fiscal year beginning on or after the date of enactment of this clause), the Secretary shall provide to Congress a written plan for using the funds provided under clause

(ix)to collect and use information on physicians’ services in the determination of relative values under this subparagraph. . Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress a proposed plan for systematically and internally tracking the Secretary’s review of the relative values of physicians' services, such as by establishing an internal database, under section 1848(c)(2) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2) ), as amended by this section. The proposal shall include, at a minimum, plans and a timeline for achieving the ability to systematically and internally track the following: When, how, and by whom services are identified for review. When services are reviewed or reviewed or when new services are added. The resources, evidence, data, and recommendations used in reviews. When relative values are adjusted. The rationale for final relative value decisions. Section 1848(c)(2) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2) ) is amended— in subparagraph (B)(i), by striking 5 and inserting 4 ; and in subparagraph (K)(i)(I), by striking periodically and inserting annually . Section 1848(c)(2) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2) ) is amended— in subparagraph (B)(i), by inserting in consultation with the Medicare Payment Advisory Commission, after The Secretary, ; and in subparagraph (K)(i)(I), as amended by subsection (d)(2), by inserting , in coordination with the Medicare Payment Advisory Commission, after annually . Section 1805 of the Social Security Act ( 42 U.S.C. 1395b–6 ) is amended— in subsection (b)(1)(A), by inserting the following before the semicolon at the end: and including coordinating with the Secretary in accordance with section 1848(c)(2) to systematically review the relative values established for physicians' services, identify potentially misvalued services, and propose adjustments to the relative values for physicians' services ; and in subsection (e)(1), in the second sentence, by inserting or the Ranking Minority Member after the Chairman . Section 1848(c)(2) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2) ), as amended by subsection (a), is amended by adding at the end the following new subparagraph: The Comptroller General of the United States (in this subsection referred to as the Comptroller General ) shall periodically audit the review by the Secretary of relative values established under this paragraph for physicians' services. The Comptroller General shall have unrestricted access to all deliberations, records, and data related to the activities carried out under this paragraph, in a timely manner, upon request. .

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42 USC 1395w–4(c)(2)
42 USC 1395w–4(c)(2)(M)
42 USC 1395b–6

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Sec. 613

Ensuring accurate valuation of services under the Medicare physician fee schedule

Cite42 USC 1395w–4(c)(2)

Cite42 USC 1395w–4(c)(2)(M)

Cite42 USC 1395b–6

Cites 3Cited by 0 across 0 sources