Summary
Provides for an extension of the 1.0 work geographic practice cost index (GPCI) floor through 2010 and limits variations in the practice expense (PE) GPCI with a hold harmless for areas that would otherwise lose funding.
Implementation Status
The work GPCI floor was extended by section 602 of the American Taxpayer Relief Act of 2012 (ATRA) through 2013. The PE GPCI changes were implemented by CMS in the final CY12 Medicare Physician Fee Schedule Rule.
P.L. 113-93, the Protecting Access to Medicare Act of 2014 (i.e., the “doc fix”), which was signed into law on April 1, contains a provision at section 102 that extends the Medicare GPCI floor through April 1, 2015.
Statutory Text
SEC. 3102. EXTENSION OF THE WORK GEOGRAPHIC INDEX FLOOR AND REVISIONS TO THE PRACTICE EXPENSE GEOGRAPHIC ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE. (a) EXTENSION OF WORK GPCI FLOOR.—Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘before January 1, 2010’’ and inserting ‘‘before January 1, 2011’’. (b) PRACTICE EXPENSE GEOGRAPHIC ADJUSTMENT FOR 2010 AND SUBSEQUENT YEARS.—Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w4(e)(1)) is amended— (1) in subparagraph (A), by striking ‘‘and (G)’’ and inserting ‘‘(G), and (H)’’; and (2) by adding at the end the following new subparagraph: ‘‘(H) PRACTICE EXPENSE GEOGRAPHIC ADJUSTMENT FOR 2010 AND SUBSEQUENT YEARS.— ‘‘(i) FOR 2010.—Subject to clause (iii), for services furnished during 2010, the employee wage and rent portions of the practice expense geographic index described in subparagraph (A)(i) shall reflect 1⁄2 of the difference between the relative costs of employee wages and rents in each of the different fee schedule areas and the national average of such employee wages and rents. øAs revised by section 1108 of HCERA¿ ‘‘(ii) FOR 2011.—Subject to clause (iii), for services furnished during 2011, the employee wage and rent portions of the practice expense geographic index described in subparagraph (A)(i) shall reflect 1⁄2 of the difference between the relative costs of employee wages and rents in each of the different fee schedule areas and the national average of such employee wages and rents. ‘‘(iii) HOLD HARMLESS.—The practice expense portion of the geographic adjustment factor applied in a fee schedule area for services furnished in 2010 or 2011 shall not, as a result of the application of clause (i) or (ii), be reduced below the practice expense portion of the geographic adjustment factor under subparagraph (A)(i) (as calculated prior to the application of such clause (i) or (ii), respectively) for such area for such year. ‘‘(iv) ANALYSIS.—The Secretary shall analyze current methods of establishing practice expense geographic adjustments under subparagraph (A)(i) and evaluate data that fairly and reliably establishes distinctions in the costs of operating a medical practice in the different fee schedule areas. Such analysis shall include an evaluation of the following: ‘‘(I) The feasibility of using actual data or reliable survey data developed by medical organizations on the costs of operating a medical practice, including office rents and non-physician staff wages, in different fee schedule areas. ‘‘(II) The office expense portion of the practice expense geographic adjustment described in subparagraph (A)(i), including the extent to which types of office expenses are determined in local markets instead of national markets. ‘‘(III) The weights assigned to each of the categories within the practice expense geographic adjustment described in subparagraph (A)(i). ‘‘(v) REVISION FOR 2012 AND SUBSEQUENT YEARS.— As a result of the analysis described in clause (iv), the Secretary shall, not later than January 1, 2012, make appropriate adjustments to the practice expense geographic adjustment described in subparagraph (A)(i) to ensure accurate geographic adjustments across fee schedule areas, including— ‘‘(I) basing the office rents component and its weight on office expenses that vary among fee schedule areas; and ‘‘(II) considering a representative range of professional and non-professional personnel employed in a medical office based on the use of the American Community Survey data or other reliable data for wage adjustments. Such adjustments shall be made without regard to adjustments made pursuant to clauses (i) and (ii) and shall be made in a budget neutral manner.’’. øSection 10324(c) of PPACA, p. 869, provided for amendments to section 1848(e)(1) of Social Security Act providing a floor on practice expense index for services in frontier States.