2201 112th CONGRESS
H. R. 2201
To amend title XVIII of the Social Security
Act to improve the provision of items and services provided to Medicare beneficiaries
residing in rural areas.IN THE HOUSE OF REPRESENTATIVES
Mr. SMITH of Washington (for himself, Mr. DICKS, Mr.
LARSEN of Washington, and Mr. MCDERMOTT) 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
amend title XVIII of the Social Security Act to improve the provision of items
and services provided to Medicare beneficiaries residing in rural areas.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
1. SHORT TITLE.
This Act may be cited as the `MediFair Act of
SEC. 2. FINDINGS.
Congress makes the following
(1) Regional inequities in Medicare reimbursement
have created barriers to care for seniors and the disabled.
(2) The regional inequities in Medicare reimbursement penalize States that have
cost-effective health care delivery systems and reward those States with high
utilization rates and that provide inefficient care.
(3) Comparatively, in 2007, the average per capita spending under traditional
Medicare was $8,682 for beneficiaries in the United States, $7,320 for beneficiaries
in Seattle, $11,303 for those in Los Angeles, and $17,274 for those in Miami.
(4) Over a lifetime, regional inequities can mean as much as a $125,000 difference
in the cost of care provided per beneficiary.
inequities have resulted in creating very different Medicare programs and amount
of care received for seniors and the disabled based on where they live.
(6) Because the Medicare Advantage rate is based on the fee-for-service reimbursement
rate, regional inequities have allowed some Medicare beneficiaries access to Medicare
Advantage plans with significantly more benefits and reduced cost sharing. Beneficiaries
in States with lower Medicare Advantage reimbursement rates have not benefitted
to the same degree as beneficiaries in other parts of the country.
(7) Regional inequities in Medicare reimbursement have created an unfair competitive
advantage for hospitals and other health care providers in States that receive
above average payments. Higher payments mean that those providers can pay higher
salaries in a tight, competitive market.
inequities in Medicare reimbursement, if left unchecked, will reduce access to
Medicare services and impact healthy outcomes for beneficiaries.
3. IMPROVING FAIRNESS OF PAYMENTS TO PROVIDERS UNDER THE MEDICARE FEE-FOR-SERVICE
Title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) is amended by adding at the end the following new section:
PAYMENT EQUITY UNDER THE ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM
`Sec. 1899B. (a) In General- Notwithstanding any other provision of law, the Secretary
shall establish a system for making adjustments to the amount of payment made
to entities and individuals for items and services provided under the original
Medicare fee-for-service program under parts A and B.
`(1) INCREASE FOR STATES BELOW THE NATIONAL
AVERAGE- Under the system established under subsection (a), if a State average
per beneficiary amount for a year is less than the national average per beneficiary
amount for such year, then the Secretary (beginning in 2012) shall increase the
amount of applicable payments in such a manner as will result (as estimated by
the Secretary) in the State average per beneficiary amount for the subsequent
year being equal to the national average per beneficiary amount for such subsequent
`(2) REDUCTION FOR CERTAIN STATES ABOVE THE NATIONAL
AVERAGE TO ENHANCE QUALITY CARE AND MAINTAIN BUDGET NEUTRALITY-
`(A) IN GENERAL- The Secretary shall ensure that the increase in payments under
paragraph (1) does not cause the estimated amount of expenditures under this title
for a year to increase or decrease from the estimated amount of expenditures under
this title that would have been made in such year if this section had not been
enacted by reducing the amount of applicable payments in each State that the Secretary
`(i) a State average per
beneficiary amount for a year that is greater than the national average per beneficiary
amount for such year; and
outcome measurements or quality care measurements that indicate that a reduction
in applicable payments would encourage more efficient use of, and reduce overuse
of, items and services for which payment is made under this title.
`(B) LIMITATION- The Secretary shall not reduce applicable payments under subparagraph
(A) to a State that--
`(i) has a State average
per beneficiary amount for a year that is greater than the national average per
beneficiary amount for such year; and
`(ii) has healthy outcome measurements or quality care measurements that indicate
that the applicable payments are being used to improve the access of beneficiaries
to quality care.
`(3) DETERMINATION OF AVERAGES-
`(A) STATE AVERAGE PER BENEFICIARY AMOUNT- Each year (beginning in 2012), the
Secretary shall determine a State average per beneficiary amount for each State
which shall be equal to the Secretary's estimate of the average amount of expenditures
under the original Medicare fee-for-service program under parts A and B for the
year for a beneficiary enrolled under such parts that resides in the State.
`(B) NATIONAL AVERAGE PER BENEFICIARY AMOUNT- Each year (beginning in 2012), the
Secretary shall determine the national average per beneficiary amount which shall
be equal to the average of the State average per beneficiary amount determined
under subparagraph (A) for the year.
In this section:
`(A) APPLICABLE PAYMENTS- The term
`applicable payments' means payments made to entities and individuals for items
and services provided under the original Medicare fee-for-service program under
parts A and B to beneficiaries enrolled under such parts that reside in the State.
`(B) STATE- The term `State' has the meaning given such term in section 210(h).
`(c) Beneficiaries Held Harmless- The provisions of this section shall not affect--
`(1) the entitlement to items and services of a beneficiary under this title,
including the scope of such items and services; or
any liability of the beneficiary with respect to such items and services.
`(1) IN GENERAL- The Secretary, in consultation
with the Medicare Payment Advisory Commission, shall promulgate regulations to
carry out this section.
`(2) PROTECTING RURAL COMMUNITIES-
In promulgating the regulations pursuant to paragraph (1), the Secretary shall
give special consideration to rural areas.'.
SEC. 4. MEDPAC
RECOMMENDATIONS ON HEALTHY OUTCOMES AND QUALITY CARE.
The Medicare Payment Advisory Commission established under section 1805 of the
Social Security Act (42 U.S.C. 1395b-6) shall develop recommendations on policies
and practices that, if implemented, would encourage--
healthy outcomes and quality care under the Medicare program in States with respect
to which payments are reduced under section 1899B(b)(2) of such Act (as added
by section 3); and
(2) the efficient use of payments
made under the Medicare program in such States.
Not later than the date that is 9 months after the date of enactment of this Act,
the Commission shall submit to Congress the recommendations developed under subsection