,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #cfgd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #be1 #bjbc,mr4   
,bilirakis 7= himself1 ,mr4 ,crd5as1    
,mr4 ,murphy1 & ,mr4 ,davis ( ,ill9ois7 
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to increase !    
nonfacility practice exp5se relative    
value units = specifi$ s]vices furni%$  
"u ! ,m$ic>e program4  #a4 ,%ort title  
,?is ,act may be cit$ z ! ,provid+      
,relief & ,/ability = ,m$ic>e ,pati5ts  
,act ( #bjbc4  #b4 ,increas+ !          
nonfacility practice exp5se relative    
value units = specifi$ s]vices furni%$  
"u ! ,m$ic>e program  7a7 ,9 g5]al      
,section #ahdh7;c77#b7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#aciew-#d7;c77#b77 is am5d$ by add+ at !
 end ! foll[+ subp>agraph3  7,p7        
,increase ( nonfacility practice exp5se 
relative value units = specifi$ s]vices 
7i7 ,9 g5]al ,! ,secret>y %all increase 
! nonfacility practice exp5se relative  
value units appli$ to a specifi$ s]vice 
7z def9$ 9 clause 7ii77 furni%$ 9-- 7,i7
 #bjbd1 by #aj p]c5t ( ! numb] (        
nonfacility practice exp5se relative    
value units t w\ld o!rwise apply to su* 
s]vice furni%$ 9 su* ye> )\t application
 ( ?is clause2 &  7,,ii7 #bjbe1 by #ae  
p]c5t ( ! numb] ( nonfacility practice  
exp5se relative value units t w\ld      
o!rwise apply to su* s]vice furni%$ 9   
su* ye> )\t application ( ?is clause4   
7ii7 ,specifi$ s]vice def9$ ,= purposes 
( ?is subp>agraph1 ! t]m specifi$ s]vice
 means1 ) respect to a s]vice furni%$ 9 
a ye>1 a s]vice ) a nonfacility practice
 exp5se relative value unit t 0         
calculat$ = su* ye> 7)\t application (  
?is subp>agraph7 bas$ on #fe p]c5t or m 
( ! s]vice's direct practice exp5se co/ 

be+ attribut$ to equipm5t & supply co/s4
  7iii7 ,fund+ ,!re %all be transf]r$ f 
! ,g5]al ,fund ( ! ,treasury to ! ,f$]al
 ,supplem5t>y ,m$ical ,insurance ,tru/  
,fund "u section #ahda su* sums z !     
,secret>y det]m9es are necess>y =       
purposes ( increas+ paym5t am\nts       
pursuant to ?is subp>agraph1 to rema9   
available until exp5d$4  4  7b7         
,nonapplication ( budget neutrality     
,section #ahdh7;c77#b77;,b77iv7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7;c77#b77;,b77iv77 is am5d$--  
7#a7 9 subclause 7,,iv71 by /rik+ 2 & & 
ins]t+ a semicolon2  7#b7 9 subclause   
7,v71 by /rik+ ! p]iod at ! end & ins]t+
 2 &2 &  7#c7 by add+ at ! end ! foll[+ 
new subclause3  7,,vi7 subp>agraph 7,p7 
%all n be tak5 into acc\nt 9 apply+     
clause 7ii77,,ii74  4  7c7 ,report ,n   
lat] ?an #a ye> aft] ! date ( ! enactm5t
 ( ?is ,act1 ! ,comptroll] ,g5]al ( !   
,unit$ ,/ates %all submit to ,congress a
 report on ! ,m$ic>e physician fee      
s*$ule & pati5t access1 includ+-- 7#a7  

an analysis ( ! numb] ( heal? c>e       
provid]s furni%+ specifi$ s]vices 7z    
def9$ 9 section #ahdh7;c77#b77,p7 ( !   
,social ,security ,act1 z add$ by       
subsection 7a77 9 a nonfacility sett+ "u
 ! ,m$ic>e program ov] ! #bj ye> p]iod  
end+ on su* date ( enactm5t1 includ+ a  
description ( any *anges 9 volume ( su* 
s]vices furni%$ "u su* program & !      
availability ( su* s]vices "u su*       
program & a description ( wait-times1   
decreas$ h\rs1 o!r factors t c\ld imp$e 
a pati5t's access to su* s]vices 7su* z 
increas$ co/ %>+72  7#b7 an analysis (  
any *ange 9 ! proportion ( s]vices      
payable "u su* s*$ule furni%$ 9         
nonfacility sett+s comp>$ to !          
proportion ( su* s]vices furni%$ at o!r 
sites ( s]vice ov] su* p]iod1 includ+ an
 analysis ( ! impact ( any su* *ange on 
heal? sy/em consolidation1 und]s]v$ &   
rural populations1 quality ( c>e (      
,m$ic>e b5efici>ies1 & increas$ co/ to !
 ,m$ic>e program2  7#c7 an analysis (   
:e!r significant annual *anges 9 provid]

 reimbursem5t are a cause ( any *ange   
describ$ 9 p>agraph 7#b71 disruptions 9 
pati5t access to s]vices1 & increas$ co/
 %>+2 &  7#d7 tak+ into acc\nt !        
analyses describ$ 9 p>agraphs 7#a7 ?r\gh
 7#c71 recomm5dations = improv+ ,m$ic>e 
pati5t access to specifi$ s]vices 7z    
def9$ 9 section #ahdh7;c77#b77,p7 ( !   
,social ,security ,act1 z add$ by       
subsection 7a77 & m9imiz+ heal? sy/em   
consolidation4