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House Committee on Energy and CommerceHealthHouse Committee on Ways and MeansHealthIntroducedFebruary 6th, 2013
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Medicare Physician Payment Innovation Act of 2013
To amend part B of title XVIII of the Social Security Act to reform Medicare payment for physicians' services by eliminating the sustainable growth rate system and providing incentives for the adoption of innovative payment and delivery models to improve quality and efficiency.
Medicare Physician Payment Innovation Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to revise requirements for payments for physician's services to eliminate the sustainable growth rate system from the formula for determination of the fee schedules for such services. Sets at 0.0 the 2014 update to the single conversion factor in such formula. Establishes updates for separate primary care and other service categories beginning January 1, 2015, as well as separate conversion factors and separate updates through 2018 for each service category. Directs the Secretary, through the Center for Medicare and Medicaid Innovation, to: (1) expand testing of each innovative payment and service delivery model in at least three geographic regions; and (2) include analysis of average implementation costs, per physician, in evaluations of models in phase 1 testing. Specifies as such a model, subject to testing, payment for outpatient therapy services and speech language pathology services on the basis of a treatment session, an episode of care, or other bundled payment methodology as a model to be tested during phase 1 testing. Directs the Comptroller General to study the evaluations of each model tested. Directs the Secretary to release to the public a comprehensive list of such health care delivery models identified as likely to: (1) reduce spending without reducing quality of care, or (2) improve the quality of patient care without increasing spending. Requires the Secretary to inform physicians, nurse practitioners, group practices, and institutions employing Medicare part B (Supplementary Medical Insurance) providers on how best to transition to alternative health care delivery and payment models aimed at improving the coordination, quality, and efficiency of health care. Freezes the physician fee schedule for 2019 by requiring 0.0 updates to the relevant conversion factors. Directs the Secretary to: (1) contract and agree with regional extension centers to provide guidance and assistance on how physicians may transition to implementation of alternative health care delivery models identified as represernting best practices; and (2) make certain funding available to the Office of the National Coordinator for Health Care Technology to award grants and incentive payments under a competitive process to regional extension centers and other qualified entities for such activities. Requires the Office to: (1) establish a process for the competitive selection of regional extension centers (and other qualified entities) in the third quarter of 2015, and (2) authorize the initial distribution of funds to such centers and entities. Prescribes updates to conversion factors for 2020-2023, but freezes them again beginning in 2024. Requires the Secretary to consider certain factors in determining the growth rates to be recognized beginning with 2020 for alternative payment and delivery models. Directs the Secretary to report to Congress on the impact on spending and on access to services under Medicare resulting from changes to the Medicare delivery and payments systems, including those made by this Act.