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Section 5501

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.

[c] Budget-neutrality Adjustment- Section 1848[c][2][B] of the Social Security Act [42 U.S.C. 1395w-4[c][2][B]] is amended by adding at the end the following new clause:

'[vii] ADJUSTMENT FOR CERTAIN PHYSICIAN INCENTIVE PAYMENTS- Fifty percent of the additional expenditures under this part attributable to subsections [x] and [y] of section 1833 for a year [as estimated by the Secretary] shall be taken into account in applying clause [ii][II] for 2011 and subsequent years. In lieu of applying the budget-neutrality adjustments required under clause [ii][II] to relative value units to account for such costs for the year, the Secretary shall apply such budget-neutrality adjustments to the conversion factor otherwise determined for the year. For 2011 and subsequent years, the Secretary shall increase the incentive payment otherwise applicable under section 1833[m] by a percent estimated to be equal to the additional expenditures estimated under the first sentence of this clause for such year that is applicable to physicians who primarily furnish services in areas designated [under section 332[a][1][A] of the Public Health Service Act] as health professional shortage areas.'.