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Statutory Text

SEC. 5501. EXPANDING ACCESS TO PRIMARY CARE SERVICES AND
GENERAL SURGERY SERVICES.
(a) INCENTIVE PAYMENT PROGRAM FOR PRIMARY CARE SERVICES.—
(1) IN GENERAL.—Section 1833 of the Social Security Act
(42 U.S.C. 1395l) is amended by adding at the end the following
new subsection:
‘‘(x) INCENTIVE PAYMENTS FOR PRIMARY CARE SERVICES.—
‘‘(1) IN GENERAL.—In the case of primary care services furnished
on or after January 1, 2011, and before January 1,
2016, by a primary care practitioner, in addition to the amount
of payment that would otherwise be made for such services
under this part, there also shall be paid (on a monthly or quarterly
basis) an amount equal to 10 percent of the payment
amount for the service under this part.
‘‘(2) DEFINITIONS.—In this subsection:
‘‘(A) PRIMARY CARE PRACTITIONER.—The term ‘primary
care practitioner’ means an individual—
‘‘(i) who—
‘‘(I) is a physician (as described in section
1861(r)(1)) who has a primary specialty designation
of family medicine, internal medicine, geriatric
medicine, or pediatric medicine; or
‘‘(II) is a nurse practitioner, clinical nurse specialist,
or physician assistant (as those terms are
defined in section 1861(aa)(5)); and
‘‘(ii) for whom primary care services accounted for
at least 60 percent of the allowed charges under this
part for such physician or practitioner in a prior period
as determined appropriate by the Secretary.
‘‘(B) PRIMARY CARE SERVICES.—The term ‘primary care
services’ means services identified, as of January 1, 2009,
by the following HCPCS codes (and as subsequently modified
by the Secretary):
‘‘(i) 99201 through 99215.
‘‘(ii) 99304 through 99340.
‘‘(iii) 99341 through 99350
‘‘(3) COORDINATION WITH OTHER PAYMENTS.—The amount
of the additional payment for a service under this subsection
and subsection (m) shall be determined without regard to any
additional payment for the service under subsection (m) and
this subsection, respectively.
‘‘(4) LIMITATION ON REVIEW.—There shall be no administrative
or judicial review under section 1869, 1878, or otherwise,
respecting the identification of primary care practitioners
under this subsection.’’.
(2) CONFORMING AMENDMENT.—Section 1834(g)(2)(B) of the
Social Security Act (42 U.S.C. 1395m(g)(2)(B)) is amended by
adding at the end the following sentence: ‘‘Section 1833(x) shall
not be taken into account in determining the amounts that
would otherwise be paid pursuant to the preceding sentence.’’.
(b) INCENTIVE PAYMENT PROGRAM FOR MAJOR SURGICAL PROCEDURES
FURNISHED IN HEALTH PROFESSIONAL SHORTAGE AREAS.—
(1) IN GENERAL.—Section 1833 of the Social Security Act
(42 U.S.C. 1395l), as amended by subsection (a)(1), is amended
by adding at the end the following new subsection:
‘‘(y) INCENTIVE PAYMENTS FOR MAJOR SURGICAL PROCEDURES
FURNISHED IN HEALTH PROFESSIONAL SHORTAGE AREAS.—
‘‘(1) IN GENERAL.—In the case of major surgical procedures
furnished on or after January 1, 2011, and before January 1,
2016, by a general surgeon in an area that is designated
(under section 332(a)(1)(A) of the Public Health Service Act) as
a health professional shortage area as identified by the Secretary
prior to the beginning of the year involved, in addition
to the amount of payment that would otherwise be made for
such services under this part, there also shall be paid (on a
monthly or quarterly basis) an amount equal to 10 percent of
the payment amount for the service under this part.
‘‘(2) DEFINITIONS.—In this subsection:
‘‘(A) GENERAL SURGEON.—In this subsection, the term
‘general surgeon’ means a physician (as described in section
1861(r)(1)) who has designated CMS specialty code
02–General Surgery as their primary specialty code in the
physician’s enrollment under section 1866(j).
‘‘(B) MAJOR SURGICAL PROCEDURES.—The term ‘major
surgical procedures’ means physicians’ services which are
surgical procedures for which a 10-day or 90-day global period
is used for payment under the fee schedule under section
1848(b).
‘‘(3) COORDINATION WITH OTHER PAYMENTS.—The amount
of the additional payment for a service under this subsection
and subsection (m) shall be determined without regard to any
additional payment for the service under subsection (m) and
this subsection, respectively.
‘‘(4) APPLICATION.—The provisions of paragraph (2) and (4)
of subsection (m) shall apply to the determination of additional
payments under this subsection in the same manner as such
provisions apply to the determination of additional payments
under subsection (m).’’.
(2) CONFORMING AMENDMENT.—Section 1834(g)(2)(B) of the
Social Security Act (42 U.S.C. 1395m(g)(2)(B)), as amended by
subsection (a)(2), is amended by striking ‘‘Section 1833(x)’’ and
inserting ‘‘Subsections (x) and (y) of section 1833’’ in the last
sentence.
øSubsection (c) repealed by section 10501(h)