
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)[544(b)]]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)[214]]
[CITE: 42USC1395b-6]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
Sec. 1395b-6. Medicare Payment Advisory Commission


(a) Establishment

    There is hereby established the Medicare Payment Advisory Commission 
(in this section referred to as the ``Commission'').

(b) Duties

          (1) Review of payment policies and annual reports

        The Commission shall--
            (A) review payment policies under this subchapter, including 
        the topics described in paragraph (2);
            (B) make recommendations to Congress concerning such payment 
        policies;
            (C) by not later than March 1 of each year (beginning with 
        1998), submit a report to Congress containing the results of 
        such reviews and its recommendations concerning such policies; 
        and
            (D) by not later than June 1 of each year (beginning with 
        1998), submit a report to Congress containing an examination of 
        issues affecting the medicare program, including the 
        implications of changes in health care delivery in the United 
        States and in the market for health care services on the 
        medicare program and including a review of the estimate of the 
        conversion factor submitted under section 1395w-4(d)(1)(E)(ii) 
        of this title.

                 (2) Specific topics to be reviewed

        (A) Medicare+Choice program

            Specifically, the Commission shall review, with respect to 
        the Medicare+Choice program under part C of this subchapter, the 
        following:
                (i) The methodology for making payment to plans under 
            such program, including the making of differential payments 
            and the distribution of differential updates among different 
            payment areas.
                (ii) The mechanisms used to adjust payments for risk and 
            the need to adjust such mechanisms to take into account 
            health status of beneficiaries.
                (iii) The implications of risk selection both among 
            Medicare+Choice organizations and between the 
            Medicare+Choice option and the original medicare fee-for-
            service option.
                (iv) The development and implementation of mechanisms to 
            assure the quality of care for those enrolled with Medicare+
            Choice organizations.
                (v) The impact of the Medicare+Choice program on access 
            to care for medicare beneficiaries.
                (vi) Other major issues in implementation and further 
            development of the Medicare+Choice program.

        (B) Original medicare fee-for-service system

            Specifically, the Commission shall review payment policies 
        under parts A and B of this subchapter, including--
                (i) the factors affecting expenditures for services in 
            different sectors, including the process for updating 
            hospital, skilled nursing facility, physician, and other 
            fees,
                (ii) payment methodologies, and
                (iii) their relationship to access and quality of care 
            for medicare beneficiaries.

        (C) Interaction of medicare payment policies with health care 
                delivery generally

            Specifically, the Commission shall review the effect of 
        payment policies under this subchapter on the delivery of health 
        care services other than under this subchapter and assess the 
        implications of changes in health care delivery in the United 
        States and in the general market for health care services on the 
        medicare program.

             (3) Comments on certain secretarial reports

        If the Secretary submits to Congress (or a committee of 
    Congress) a report that is required by law and that relates to 
    payment policies under this subchapter, the Secretary shall transmit 
    a copy of the report to the Commission. The Commission shall review 
    the report and, not later than 6 months after the date of submittal 
    of the Secretary's report to Congress, shall submit to the 
    appropriate committees of Congress written comments on such report. 
    Such comments may include such recommendations as the Commission 
    deems appropriate.

                  (4) Agenda and additional reviews

        The Commission shall consult periodically with the chairmen and 
    ranking minority members of the appropriate committees of Congress 
    regarding the Commission's agenda and progress towards achieving the 
    agenda. The Commission may conduct additional reviews, and submit 
    additional reports to the appropriate committees of Congress, from 
    time to time on such topics relating to the program under this 
    subchapter as may be requested by such chairmen and members and as 
    the Commission deems appropriate.

                     (5) Availability of reports

        The Commission shall transmit to the Secretary a copy of each 
    report submitted under this subsection and shall make such reports 
    available to the public.

               (6) Appropriate committees of Congress

        For purposes of this section, the term ``appropriate committees 
    of Congress'' means the Committees on Ways and Means and Commerce of 
    the House of Representatives and the Committee on Finance of the 
    Senate.

(c) Membership

                     (1) Number and appointment

        The Commission shall be composed of 17 members appointed by the 
    Comptroller General.

                         (2) Qualifications

        (A) In general

            The membership of the Commission shall include individuals 
        with national recognition for their expertise in health finance 
        and economics, actuarial science, health facility management, 
        health plans and integrated delivery systems, reimbursement of 
        health facilities, allopathic and osteopathic physicians, and 
        other providers of health services, and other related fields, 
        who provide a mix of different professionals, broad geographic 
        representation, and a balance between urban and rural 
        representatives.

        (B) Inclusion

            The membership of the Commission shall include (but not be 
        limited to) physicians and other health professionals, 
        employers, third-party payers, individuals skilled in the 
        conduct and interpretation of biomedical, health services, and 
        health economics research and expertise in outcomes and 
        effectiveness research and technology assessment. Such 
        membership shall also include representatives of consumers and 
        the elderly.

        (C) Majority nonproviders

            Individuals who are directly involved in the provision, or 
        management of the delivery, of items and services covered under 
        this subchapter shall not constitute a majority of the 
        membership of the Commission.

        (D) Ethical disclosure

            The Comptroller General shall establish a system for public 
        disclosure by members of the Commission of financial and other 
        potential conflicts of interest relating to such members.

                              (3) Terms

        (A) In general

            The terms of members of the Commission shall be for 3 years 
        except that the Comptroller General shall designate staggered 
        terms for the members first appointed.

        (B) Vacancies

            Any member appointed to fill a vacancy occurring before the 
        expiration of the term for which the member's predecessor was 
        appointed shall be appointed only for the remainder of that 
        term. A member may serve after the expiration of that member's 
        term until a successor has taken office. A vacancy in the 
        Commission shall be filled in the manner in which the original 
        appointment was made.

                          (4) Compensation

        While serving on the business of the Commission (including 
    traveltime), a member of the Commission shall be entitled to 
    compensation at the per diem equivalent of the rate provided for 
    level IV of the Executive Schedule under section 5315 of title 5; 
    and while so serving away from home and the member's regular place 
    of business, a member may be allowed travel expenses, as authorized 
    by the Chairman of the Commission. Physicians serving as personnel 
    of the Commission may be provided a physician comparability 
    allowance by the Commission in the same manner as Government 
    physicians may be provided such an allowance by an agency under 
    section 5948 of title 5, and for such purpose subsection (i) of such 
    section shall apply to the Commission in the same manner as it 
    applies to the Tennessee Valley Authority. For purposes of pay 
    (other than pay of members of the Commission) and employment 
    benefits, rights, and privileges, all personnel of the Commission 
    shall be treated as if they were employees of the United States 
    Senate.

                     (5) Chairman; Vice Chairman

        The Comptroller General shall designate a member of the 
    Commission, at the time of appointment of the member as Chairman and 
    a member as Vice Chairman for that term of appointment, except that 
    in the case of vacancy of the Chairmanship or Vice Chairmanship, the 
    Comptroller General may designate another member for the remainder 
    of that member's term.

                            (6) Meetings

        The Commission shall meet at the call of the Chairman.

(d) Director and staff; experts and consultants

    Subject to such review as the Comptroller General deems necessary to 
assure the efficient administration of the Commission, the Commission 
may--
        (1) employ and fix the compensation of an Executive Director 
    (subject to the approval of the Comptroller General) and such other 
    personnel as may be necessary to carry out its duties (without 
    regard to the provisions of title 5 governing appointments in the 
    competitive service);
        (2) seek such assistance and support as may be required in the 
    performance of its duties from appropriate Federal departments and 
    agencies;
        (3) enter into contracts or make other arrangements, as may be 
    necessary for the conduct of the work of the Commission (without 
    regard to section 5 of title 41);
        (4) make advance, progress, and other payments which relate to 
    the work of the Commission;
        (5) provide transportation and subsistence for persons serving 
    without compensation; and
        (6) prescribe such rules and regulations as it deems necessary 
    with respect to the internal organization and operation of the 
    Commission.

(e) Powers

                     (1) Obtaining official data

        The Commission may secure directly from any department or agency 
    of the United States information necessary to enable it to carry out 
    this section. Upon request of the Chairman, the head of that 
    department or agency shall furnish that information to the 
    Commission on an agreed upon schedule.

                         (2) Data collection

        In order to carry out its functions, the Commission shall--
            (A) utilize existing information, both published and 
        unpublished, where possible, collected and assessed either by 
        its own staff or under other arrangements made in accordance 
        with this section,
            (B) carry out, or award grants or contracts for, original 
        research and experimentation, where existing information is 
        inadequate, and
            (C) adopt procedures allowing any interested party to submit 
        information for the Commission's use in making reports and 
        recommendations.

                  (3) Access of GAO to information

        The Comptroller General shall have unrestricted access to all 
    deliberations, records, and nonproprietary data of the Commission, 
    immediately upon request.

                         (4) Periodic audit

        The Commission shall be subject to periodic audit by the 
    Comptroller General.

(f) Authorization of appropriations

                   (1) Request for appropriations

        The Commission shall submit requests for appropriations in the 
    same manner as the Comptroller General submits requests for 
    appropriations, but amounts appropriated for the Commission shall be 
    separate from amounts appropriated for the Comptroller General.

                          (2) Authorization

        There are authorized to be appropriated such sums as may be 
    necessary to carry out the provisions of this section. Sixty percent 
    of such appropriation shall be payable from the Federal Hospital 
    Insurance Trust Fund, and 40 percent of such appropriation shall be 
    payable from the Federal Supplementary Medical Insurance Trust Fund.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1805, as added Pub. L. 105-
33, title IV, Sec. 4022(a), Aug. 5, 1997, 111 Stat. 350; amended Pub. L. 
105-277, div. J, title V, Sec. 5202(a), Oct. 21, 1998, 112 Stat. 2681-
917; Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, 
Sec. 211(a)(2)(B)], Nov. 29, 1999, 113 Stat. 1536, 1501A-347.)

                       References in Text

    Parts A, B, and C of this subchapter, referred to in subsec. 
(b)(2)(A), (B), are classified to sections 1395c et seq., 1395j et seq., 
and 1395w-21 et seq., respectively, of this title.
    The provisions of title 5 governing appointments in the competitive 
service, referred to in subsec. (d)(1), are classified generally to 
section 3301 et seq. of Title 5, Government Organization and Employees.


                               Amendments

    1999--Subsec. (b)(1)(D). Pub. L. 106-113 inserted ``and including a 
review of the estimate of the conversion factor submitted under section 
1395w-4(d)(1)(E)(ii) of this title'' before period at end.
    1998--Subsec. (c)(1). Pub. L. 105-277 substituted ``17'' for ``15''.


                    Effective Date of 1999 Amendment

    Amendment by Pub. L. 106-113 effective in determining conversion 
factor under section 1395w-4(d) of this title for years beginning with 
2001 and not applicable to or affecting any update (or any update 
adjustment factor) for any year before 2001, see section 1000(a)(6) 
[title II, Sec. 211(d)] of Pub. L. 106-113, set out as a note under 
section 1395w-4 of this title.


            Effective Date; Transition; Transfer of Functions

    Section 4022(c) of Pub. L. 105-33 provided that:
    ``(1) In general.--The Comptroller General shall first provide for 
appointment of members to the Medicare Payment Advisory Commission (in 
this subsection referred to as `MedPAC') by not later than September 30, 
1997.
    ``(2) Transition.--As quickly as possible after the date a majority 
of members of MedPAC are first appointed [Oct. 1, 1997, see 62 FR 
52131], the Comptroller General, in consultation with the Prospective 
Payment Assessment Commission (in this subsection referred to as 
`ProPAC') and the Physician Payment Review Commission (in this 
subsection referred to as `PPRC'), shall provide for the termination of 
the ProPAC and the PPRC. As of the date of termination of the respective 
Commissions [Nov. 1, 1997, see 62 FR 59356], the amendments made by 
paragraphs (1) and (2), respectively, of subsection (b) [amending 
sections 1395w-4, 1395y, and 1395ww of this title and repealing section 
1395w-1 of this title] become effective. The Comptroller General, to the 
extent feasible, shall provide for the transfer to the MedPAC of assets 
and staff of the ProPAC and the PPRC, without any loss of benefits or 
seniority by virtue of such transfers. Fund balances available to the 
ProPAC or the PPRC for any period shall be available to the MedPAC for 
such period for like purposes.
    ``(3) Continuing responsibility for reports.--The MedPAC shall be 
responsible for the preparation and submission of reports required by 
law to be submitted (and which have not been submitted by the date of 
establishment of the MedPAC) by the ProPAC and the PPRC, and, for this 
purpose, any reference in law to either such Commission is deemed, after 
the appointment of the MedPAC, to refer to the MedPAC.''


  MedPAC Study on Complexity of Medicare Program and Levels of Burdens 
             Placed on Providers Through Federal Regulations

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 229(c)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-357, provided that:
    ``(1) Study.--The Medicare Payment Advisory Commission shall 
undertake a comprehensive study to review the regulatory burdens placed 
on all classes of health care providers under parts A and B of the 
medicare program under title XVIII of the Social Security Act [this 
subchapter] and to determine the costs these burdens impose on the 
nation's health care system. The study shall also examine the complexity 
of the current regulatory system and its impact on providers.
    ``(2) Report.--Not later than December 31, 2001, the Commission 
shall submit to Congress one or more reports on the study conducted 
under paragraph (1). The report shall include recommendations 
regarding--
        ``(A) how the Health Care Financing Administration can reduce 
    the regulatory burdens placed on patients and providers; and
        ``(B) legislation that may be appropriate to reduce the 
    complexity of the medicare program, including improvement of the 
    rules regarding billing, compliance, and fraud and abuse.''


                              MedPAC Report

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title III, Sec. 312(c)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-365, provided that: ``The Medicare 
Payment Advisory Commission shall include in its report submitted to 
Congress in March of 2001 recommendations regarding the appropriateness 
of the initial residency period used under section 1886(h)(5)(F) of the 
Social Security Act (42 U.S.C. 1395ww(h)(5)(F)) for other residency 
training programs in a specialty that require preliminary years of study 
in another specialty.''


                     MedPAC Study of Rural Providers

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title IV, Sec. 411], Nov. 
29, 1999, 113 Stat. 1536, 1501A-377, provided that:
    ``(a) Study.--The Medicare Payment Advisory Commission shall conduct 
a study of rural providers furnishing items and services for which 
payment is made under title XVIII of the Social Security Act [this 
subchapter]. Such study shall examine and evaluate the adequacy and 
appropriateness of the categories of special payments (and payment 
methodologies) established for rural hospitals under the medicare 
program, and the impact of such categories on beneficiary access and 
quality of health care services.
    ``(b) Report.--Not later than 18 months after the date of the 
enactment of this Act [Nov. 29, 1999], the Medicare Payment Advisory 
Commission shall submit to Congress a report on the study conducted 
under subsection (a).''


                      Quality Improvement Standards

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title V, Sec. 520(c)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-386, provided that:
    ``(1) Study.--The Medicare Payment Advisory Commission shall conduct 
a study on the appropriate quality improvement standards that should 
apply to--
        ``(A) each type of Medicare+Choice plan described in section 
    1851(a)(2) of the Social Security Act (42 U.S.C. 1395w-21(a)(2)), 
    including each type of Medicare+Choice plan that is a coordinated 
    care plan (as described in subparagraph (A) of such section); and
        ``(B) the original medicare fee-for-service program under parts 
    A and B [sic] title XVIII of such Act (42 U.S.C. 1395 et seq.) 
    [parts A and B of this subchapter].
    ``(2) Considerations.--Such study shall specifically examine the 
effects, costs, and feasibility of requiring entities, physicians, and 
other health care providers that provide items and services under the 
original medicare fee-for-service program to comply with quality 
standards and related reporting requirements that are comparable to the 
quality standards and related reporting requirements that are applicable 
to Medicare+Choice organizations.
    ``(3) Report.--Not later than 2 years after the date of the 
enactment of this Act [Nov. 29, 1999], such Commission shall submit a 
report to Congress on the study conducted under this subsection, 
together with any recommendations for legislation that it determines to 
be appropriate as a result of such study.''


                   Initial Terms of Additional Members

    Pub. L. 105-277, div. J, title V, Sec. 5202(b), Oct. 21, 1998, 112 
Stat. 2681-917, provided that:
    ``(1) In general.--For purposes of staggering the initial terms of 
members of the Medicare Payment Advisory Commission (under section 
1805(c)(3) of such Act (42 U.S.C. 1395b-6(c)(3))[)], the initial terms 
of the two additional members of the Commission provided for by the 
amendment under subsection (a) [amending this section] are as follows:
        ``(A) One member shall be appointed for one year.
        ``(B) One member shall be appointed for two years.
    ``(2) Commencement of terms.--Such terms shall begin on May 1, 
1999.''


             Information Included in Annual Recommendations

    Section 4804(c) of Pub. L. 105-33 provided that: ``The Medicare 
Payment Advisory Commission shall include in its annual report under 
section 1805(b)(1)(B) of the Social Security Act [subsec. (b)(1)(B) of 
this section] recommendations on the methodology and level of payments 
made to PACE providers under sections 1894(d) and 1934(d) of such Act 
[sections 1395eee(d) and 1396u-4(d) of this title] and on the treatment 
of private, for-profit entities as PACE providers.''
