,i #aadth ,,congress #ast ,session ,h4 ,r4 #ajab ,,in ,,the ,,house ,,of ,,representatives ,february #ag1 #bjae ,mr4 ,smith of ,washington 7for himself1 ,mr4 ,heck of ,washington1 ,mr4 ,mc,dermott1 and ,mr4 ,kilmer7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 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 improve the provision of items and services provided to ,medicare beneficiaries residing in rural areas1 and for other purposes4 #a4 ,short ,title ,this ,act may be cited as the ,medi,fair ,act of #bjae4 #b4 ,findings ,congress makes the following findings3 7#a7 ,regional inequities in ,medicare reimbursement have created barriers to care for seniors and the disabled4 7#b7 ,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 care4 7#c7 ,comparatively1 in #bjjg1 the average per capita spending under traditional ,medicare was #h1fhb for beneficiaries in the ,united ,states1 #g1cbj for beneficiaries in ,seattle1 #aa1cjc for those in ,los ,angeles1 and #ag1bgd for those in ,miami4 7#d7 ,over a lifetime1 regional inequities can mean as much as a #abe1jjj difference in the cost of care provided per beneficiary4 7#e7 ,regional inequities have resulted in creating very different ,medicare programs and amount of care received for seniors and the disabled based on where they live4 7#f7 ,because the ,medicare ,advantage rate is based on the fee-for-service reimbursement rate1 regional inequities have allowed some ,medicare beneficiaries access to ,medicare ,advantage plans with significantly more benefits and reduced cost sharing4 ,beneficiaries in ,states with lower ,medicare ,advantage reimbursement rates have not benefitted to the same degree as beneficiaries in other parts of the country4 7#g7 ,regional inequities in ,medicare reimbursement have created an unfair competitive advantage for hospitals and other health care providers in ,states that receive above average payments4 ,higher payments mean that those providers can pay higher salaries in a tight1 competitive market4 7#h7 ,regional inequities in ,medicare reimbursement1 if left unchecked1 will reduce access to ,medicare services and impact healthy outcomes for beneficiaries4 #c4 ,improving fairness of payments to providers under the medicare fee-for-service program ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,,improving ,,payment ,,equity ,,under ,,the ,,original ,,medicare ,,fee-,,for-,,service ,,program 7a7 ,in ,general ,notwithstanding any other provision of law1 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 ,b4 7b7 ,system requirements 7#a7 ,increase for states below the national average ,under the system established under subsection 7a71 if a ,state average per beneficiary amount for a year is less than the national average per beneficiary amount for such year1 then the ,secretary 7beginning in #bjag7 shall increase the amount of applicable payments in such a manner as will result 7as estimated by the ,secretary7 in the ,state average per beneficiary amount for the subsequent year being equal to the national average per beneficiary amount for such subsequent year4 7#b7 ,reduction for certain states above the national average to enhance quality care and maintain budget neutrality 7,a7 ,in general ,the ,secretary shall ensure that the increase in payments under paragraph 7#a7 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 determines has-- 7i7 a ,state average per beneficiary amount for a year that is greater than the national average per beneficiary amount for such year2 and 7ii7 healthy outcome measurements or quality care measurements that indicate that a reduction in applicable payments would encourage more efficient use of1 and reduce overuse of1 items and services for which payment is made under this title4 7,b7 ,limitation ,the ,secretary shall not reduce applicable payments under subparagraph 7,a7 to a ,state that-- 7i7 has a ,state average per beneficiary amount for a year that is greater than the national average per beneficiary amount for such year2 and 7ii7 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 care4 7#c7 ,determination of averages 7,a7 ,state average per beneficiary amount ,each year 7beginning in #bjag71 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 ,state4 7,b7 ,national average per beneficiary amount ,each year 7beginning in #bjag71 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 7,a7 for the year4 7#d7 ,definitions ,in this section3 7,a7 ,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 ,state4 7,b7 ,state ,the term ,state has the meaning given such term in section #baj7;h74 7c7 ,beneficiaries held harmless ,the provisions of this section shall not affect-- 7#a7 the entitlement to items and services of a beneficiary under this title1 including the scope of such items and services2 or 7#b7 any liability of the beneficiary with respect to such items and services4 7d7 ,regulations 7#a7 ,in general ,the ,secretary1 in consultation with the ,medicare ,payment ,advisory ,commission1 shall promulgate regulations to carry out this section4 7#b7 ,protecting rural communities ,in promulgating the regulations pursuant to paragraph 7#a71 the ,secretary shall give special consideration to rural areas4 4 #d4 ,medpac recommendations on healthy outcomes and quality care 7a7 ,recommendations ,the ,medicare ,payment ,advisory ,commission established under section #ahje of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#f7 shall develop recommendations on policies and practices that1 if implemented1 would encourage-- 7#a7 healthy outcomes and quality care under the ,medicare program in ,states with respect to which payments are reduced under section #ahii;,b7b77#b7 of such ,act 7as added by section #c72 and 7#b7 the efficient use of payments made under the ,medicare program in such ,states4 7b7 ,submission ,not later than the date that is #i months after the date of the enactment of this ,act1 the ,commission shall submit to ,congress the recommendations developed under subsection 7a74