,,ii  #aaeth ,,congress  #ast ,session  
,s4 #ahbe  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #ah1
 #bjag,mr4 ,grassley 7for himself1 ,ms4 
,baldwin1 ,mrs4 ,ernst1 and ,mr4        
,johnson7 introduced the following bill2
 which was read twice and referred to   
the ,committee on ,finance  ,a ,,bill   
,to amend title ,,xviii of the ,social  
,security ,act to improve the accuracy  
of geographic adjustment factors under  
the ,medicare program and to permanently
 extend certain adjustments to such     
factors for certain localities1 and for 
other purposes4  #a4 ,improving the     
accuracy of geographic adjustment       
factors ,section #ahdh7;e77#a77;,d7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#d7;e77#a77;,d77 is    
amended to read as follows3  7,d7 ,use  
of accurate data  7i7 ,in general ,in   
establishing indices and index values   
under this paragraph1 the ,secretary    
shall use the most recent data available
 relating to practice expenses1         

malpractice expenses1 and physician work
 effort in each fee schedule area4  7ii7
 ,practice expense and work indices ,in 
establishing indices and index values   
under clause 7i7 or 7iii7 of            
subparagraph 7,a71 the ,secretary       
shall--  7,i7 use the most recent market
 data available on physician wages1 or  
if available1 actual cost data for      
physician labor2 and  7,,ii7 not use    
nonphysician professional wage data as a
 proxy for physician wage data4  7iii7  
,practice expense calculation ,in       
calculating index values under clause   
7i7 of subparagraph 7,a71 the ,secretary
 shall use the most recent office rent  
data available or data from ,federally  
qualified health centers 7as defined in 
section #ahfa7;aa77#d77 expense reports4
  4  #b4 ,floor for work and practice   
expense geographic indices for services 
furnished in ,wisconsin and ,iowa  7a7  
,work geographic index ,section         
#ahdh7;e77#a77;,e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           

#aciew-#d7;e77#a77;,d77 is amended to   
read as follows3  7,e7 ,floor at #a4j on
 work geographic index  7i7 ,for #bjjd  
through #bjag ,after calculating the    
work geographic index in subparagraph   
7,a77iii71 for purposes of payment for  
services furnished on or after ,january 
#a1 #bjjd1 and before ,january #a1      
#bjah1 the ,secretary shall increase the
 work geographic index to #a4jj for any 
locality for which such work geographic 
index is less than #a4jj4  7ii7 ,for    
#bjah and subsequent years ,after       
calculating the work geographic index in
 subparagraph 7,a77iii71 for purposes of
 payment for services furnished in      
,wisconsin or ,iowa on or after ,january
 #a1 #bjah1 the ,secretary shall        
increase any such index to #a4jj if such
 index would otherwise be less than     
#a4jj4  4  7b7 ,practice expense        
geographic indices ,section             
#ahdh7;e77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77  
is amended-- 7#a7 in subparagraph 7,a71 

by striking 7,b71 7,c71 7,e71 7,g71     
7,h71 and 7,i7 and inserting 7,b71 7,c71
 7,e71 7,g71 7,h71 7,i71 and 7,j72 and  
7#b7 by adding at the end the following 
new subparagraph3  7,j7 ,floor for      
practice expense geographic indices for 
services furnished in ,wisconsin or     
,iowa ,for purposes of payment for      
services furnished in ,wisconsin or     
,iowa on or after ,january #a1 #bjah1   
after calculating the practice expense  
index in subparagraph 7,a77i71 the      
,secretary shall increase any such index
 to #a4jj if such index would otherwise 
be less that #a4jj4  4