,,ii #aaith ,,congress #b;d ,session ,s4 #eahj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #cj1 #bjbf,mr4 ,boozman 7for himself1 ,mr4 ,welch1 ,mr4 ,marshall1 ,mr4 ,king1 ,mr4 ,tillis1 and ,mrs4 ,shaheen7 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 ensure stability for provider payments under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,provider ,reimbursement ,stability ,act of #bjbf4 #b4 ,updating the budget neutrality threshold ,section #ahdh7;c77#b77;,b77ii77,,ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77ii77,,ii77 is amended-- 7#a7 by striking ,subject to and inserting the following3 7aa7 ,in general ,subject to 2 7#b7 in item 7aa71 as inserted by paragraph 7#a71 by striking #bj1jjj1jjj and inserting the amount specified in item 7bb7 for such year2 and 7#c7 by adding at the end the following new items3 7bb7 ,amount specified ,for purposes of item 7aa71 subject to item 7cc71 the amount specified in this item is-- 7,,aa7 for years before #bjbh1 #bj1jjj1jjj2 7,,bb7 for #bjbh1 #eg1fdj1jjj2 and 7,,cc7 for #bjbi and each subsequent year1 the amount specified in this item for the preceding year4 7cc7 ,indexing limitation on annual adjustments ,for #bjcc and every subsequent fifth year1 the ,secretary shall increase the amount specified in item 7bb7 for such year by the cumulative percentage increase in the ,,mei 7as defined in section #ahdb7;i77#c77 applicable to physicians' services for each year occurring during the #e-year period ending on the last day of the preceding year4 4 #c4 ,budget neutrality corrections relating to estimated utilization 7a7 ,in general ,section #ahdh7;c77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77 is amended by adding at the end the following new clause3 7vii7 ,budget neutrality corrections relating to estimated utilization 7,i7 ,in general ,in the case of a budget neutrality adjustment applied pursuant to clause 7ii77,,ii7 for a year 7beginning with #bjbi7 that is determined in part using estimated utilization 7as defined in subclause 7,,ii77bb77 with respect to a specified service 7as defined in subclause 7,,ii77cc771 the ,secretary shall1 as part of the final rule establishing the physician fee schedule under this section for the assumption correction period 7as defined in subclause 7,,ii77aa77 with respect to such year-- 7aa7 determine the difference between expenditures for such service in such year using estimated utilization and actual utilization for such service 7in a manner determined appropriate by the ,secretary72 and 7bb7 in the case that the ,secretary determines the difference described in item 7aa7 is greater than the threshold amount 7as defined in subclause 7,,ii77dd77 for such year1 adjust the conversion factor under this section for such assumption correction period by such amount to reconcile such difference 7which may be positive or negative71 as determined by the ,secretary4 7,,ii7 ,definitions ,for purposes of this clause3 7aa7 ,assumption correction period ,the term assumption correction period means1 with respect to a year1 the second year beginning after such year4 7bb7 ,estimated utilization ,the term estimated utilization means an estimate of utilization used for purposes of applying clause 7ii77,,ii74 7cc7 ,specified service ,the term specified service means1 with respect to a year1 a service-- 7,,aa7 with expected expenditures for such year under this section based on estimated utilization that exceed the threshold amount 7as defined in item 7dd77 for such year2 and 7,,bb7 for which payment had been bundled into payment for another service during the preceding year and for which a separate payment or add-on payment is made during such year4 7dd7 ,threshold amount ,the term threshold amount means1 with respect to a year1 #j4a percent of the total estimated expenditures under this part for services furnished under this section during such year4 4 7b7 ,nonapplication of budget neutrality to reconciliation adjustments ,section #ahdh7;c77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77 is amended-- 7#a7 in clause 7iv7-- 7,a7 in subclause 7,v71 by striking and at the end2 7,b7 in subclause 7,,vi71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new subclause3 7,,vii7 clause 7vii77,i77bb7 for an assumption correction period 7as defined in clause 7vii77,,ii77 shall not be taken into account in applying clause 7ii77,,ii7 with respect to such period4 2 and 7#b7 in clause 7v71 by adding at the end the following new subclause3 7,,xii7 ,reductions attributable to an assumption correction ,for an assumption correction period 7as defined in clause 7vii77,,ii771 reduced expenditures attributable to application of clause 7vii77,i77bb7 with respect to such period4 4 #d4 ,timely updates to direct costs used to calculate practice expense ,r,v,us ,section #ahdh7;c77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b771 as amended by section #c1 is further amended by adding at the end the following new clause3 7viii7 ,timely updates to direct costs used to calculate practice expense relative value units 7,i7 ,simultaneous updates to direct cost inputs at least once every #e years ,the ,secretary shall1 not later than #e years after the date of the enactment of this clause1 and not less often than every #e years thereafter1 update the prices and rates1 as applicable1 on a category-wide basis for each of the categories of direct cost inputs described in subclause 7,,ii7 used in the methodology for calculating the practice expense relative value units under this subsection for physicians' services4 ,updates made pursuant to the previous sentence shall be made in the same year for all categories of direct cost inputs described in such subclause4 7,,ii7 ,direct cost inputs categories described ,for purposes of this clause1 the categories of direct cost inputs described in this subclause are clinical staff wage rates1 prices of medical supplies1 prices of equipment1 and any other category of such inputs used in the methodology described in subclause 7,i7 7as specified by the ,secretary74 7,,iii7 ,consultation ,in making the updates under this clause1 the ,secretary shall consult with relevant stakeholders1 including physician specialty societies4 4 #e4 ,limitation on year-to-year conversion factor variance ,section #ahdh7;c77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b771 as amended by sections #c and #d1 is further amended by adding at the end the following new clause3 7ix7 ,limitation on conversion factor variance 7,i7 ,in general ,beginning with #bjbh1 the ,secretary may not1 for purposes of complying with clause 7ii77,,ii71 apply a budget neutrality adjustment to a conversion factor established under subsection 7d7 for such year that would cause such factor1 not taking into account any adjustment to such factor for such year provided under such subsection1 to vary by more than #b4e percent compared to such factor so established for the preceding year4 7,,ii7 ,continued applicability of budget neutrality requirement ,nothing in subclause 7,i7 may be construed to alter the requirement described in clause 7ii77,,ii74 4