PG 260 Line 1125 Fed Government will adjust Medicare Payment Localities for California based on Census. ACORN?

SEC. 1125. ADJUSTMENT TO MEDICARE PAYMENT LOCALITIES.
(a) IN GENERAL.—Section 1848(e) of the Social Security Act (42 U.S.C.1395w–4(e)) is amended by adding at the end the following new paragraph:
(6) TRANSITION TO USE OF MSAS AS FEE SCHEDULE AREAS IN CALIFORNIA.—
(A) IN GENERAL.—
(i) REVISION.—Subject to clause (ii) and notwithstanding the previous provisions of this subsection, for services furnished on or after January 1, 2011, the Secretary shall revise the fee schedule areas used for payment under this section applicable to the State of California using the Metropolitan Statistical Area (MSA) iterative Geographic Adjustment Factor methodology as follows:
(I) The Secretary shall configure the physician fee schedule areas using the Core-Based Statistical Areas-Metropolitan Statistical Areas (each in this paragraph referred to as an ‘MSA’), as defined by the Director of the Office of Management and Budget, as the basis for the fee schedule areas. The Secretary shall employ an iterative process to transition fee schedule areas. First, the Secretary shall list all MSAs within the State by Geographic Adjustment Factor described in paragraph (2) (in this paragraph referred to as a ‘GAF’) in descending order. In the first iteration, the Secretary shall compare the GAF of the highest cost MSA in the State to the weighted-average GAF of the group of remaining MSAs in the State. If the ratio of the GAF of the highest cost MSA to the weighted-average GAF of the rest of State is 1.05 or greater then the highest cost MSA becomes a separate fee schedule area.
(II) In the next iteration, the Secretary shall compare the MSA of the second-highest GAF to the weighted-average GAF of the group of remaining MSAs. If the ratio of the second-highest MSA’s GAF to the weighted-average of the remaining lower cost MSAs is 1.05 or greater, the second-highest MSA becomes a separate fee schedule area. The iterative process continues until the ratio of the GAF of the highest-cost remaining MSA to the weighted-average of the remaining lower-cost MSAs is less than 1.05, and the remaining group of lower cost MSAs form a single fee schedule area, If two MSAs have identical GAFs, they shall be combined in the iterative comparison.

PG 265 Line 1131 Government mandates & controls productivity for private HealthCare industries.

SEC. 1131. INCORPORATING PRODUCTIVITY IMPROVEMENTS INTO MARKET BASKET UPDATES THAT DO NOT ALREADY INCORPORATE SUCH IMPROVEMENTS.
(a) OUTPATIENT HOSPITALS.—
(1) IN GENERAL.—The first sentence of section 1833(t)(3)(C)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(3)(C)(iv)) is amended—
(A) by inserting ‘‘(which is subject to the productivity adjustment described in subclause (II) of such section)’’ after ‘‘1886(b)(3)(B)(iii)’’; and
(B) by inserting ‘‘(but not below 0)’’ after ‘‘reduced’’.
(2) EFFECTIVE DATE.—The amendments made by paragraph (1) shall apply to increase factors for services furnished in years beginning with 2010.
(b) AMBULANCE SERVICES.—Section 1834(l)(3)(B) of such Act (42 U.S.C. 1395m(l)(3)(B))) is amended by inserting before the period at the end the following: ‘‘and, in the case of years beginning with 2010, subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II)’’.
(c) AMBULATORY SURGICAL CENTER SERVICES.—Section 1833(i)(2)(D) of such Act (42 U.S.C. 1395l(i)(2)(D)) is amended—
(1) by redesignating clause (v) as clause (vi); and
(2) by inserting after clause (iv) the following new clause: (v) In implementing the system described in clause (i), for services furnished during 2010 or any subsequent year, to the extent that an annual percentage change factor applies, such factor shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).’’.
(d) LABORATORY SERVICES.—Section 1833(h)(2)(A) of such Act (42 U.S.C. 1395l(h)(2)(A)) is amended—
(1) in clause (i), by striking ‘‘for each of years 2009 through 2013’’ and inserting ‘‘for 2009’’; and
(2) clause (ii)—
(A) by striking ‘‘and’’ at the end of subclause (III);
(B) by striking the period at the end of subclause (IV) and inserting ‘‘; and’’; and
(C) by adding at the end the following new subclause:
(V) the annual adjustment in the fee schedules determined under clause (i) for years beginning with 2010 shall be subject to the productivity adjustment described in section 1886(b)(3)(B)(iii)(II).’’.

PG 268 Line 1141 Fed Government regulates rental & purchase of power driven wheelchairs.

SEC. 1141. RENTAL AND PURCHASE OF POWER-DRIVEN WHEELCHAIRS.
(a) IN GENERAL.—Section 1834(a)(7)(A)(iii) of the Social Security Act (42 U.S.C. 1395m(a)(7)(A)(iii)) is amended—
(1) in the heading, by inserting ‘‘CERTAIN COMPLEX REHABILITATIVE’’ after ‘‘OPTION FOR’’; and
(2) by striking ‘‘power-driven wheelchair’’ and inserting ‘‘complex rehabilitative power-driven wheelchair recognized by the Secretary as classified within group 3 or higher’’.

PG 265 Line 1131 Government mandates & controls productivity for private HealthCare industries.

PART 2—MARKET BASKET UPDATES
2 SEC. 1131. INCORPORATING PRODUCTIVITY IMPROVE3
MENTS INTO MARKET BASKET UPDATES
4 THAT DO NOT ALREADY INCORPORATE SUCH
5 IMPROVEMENTS.
6 (a) OUTPATIENT HOSPITALS.—
7 (1) IN GENERAL.—The first sentence of section
8 1833(t)(3)(C)(iv) of the Social Security Act (42
9 U.S.C. 1395l(t)(3)(C)(iv)) is amended—
10 (A) by inserting ‘‘(which is subject to the
11 productivity adjustment described in subclause
12 (II) of such section)’’ after
13 ‘‘1886(b)(3)(B)(iii)’’; and
14 (B) by inserting ‘‘(but not below 0)’’ after
15 ‘‘reduced’’.
16 (2) EFFECTIVE DATE.—The amendments made
17 by paragraph (1) shall apply to increase factors for
18 services furnished in years beginning with 2010.
19 (b) AMBULANCE SERVICES.—Section 1834(l)(3)(B)
20 of such Act (42 U.S.C. 1395m(l)(3)(B))) is amended by
21 inserting before the period at the end the following: ‘‘and,
22 in the case of years beginning with 2010, subject to the
23 productivity adjustment described in section
24 1886(b)(3)(B)(iii)(II)’’.

1 (c) AMBULATORY SURGICAL CENTER SERVICES.—
2 Section 1833(i)(2)(D) of such Act (42 U.S.C.
3 1395l(i)(2)(D)) is amended—
4 (1) by redesignating clause (v) as clause (vi);
5 and
6 (2) by inserting after clause (iv) the following
7 new clause:
8 ‘‘(v) In implementing the system described in clause
9 (i), for services furnished during 2010 or any subsequent
10 year, to the extent that an annual percentage change fac11
tor applies, such factor shall be subject to the productivity
12 adjustment described in section 1886(b)(3)(B)(iii)(II).’’.
13 (d) LABORATORY SERVICES.—Section
14 1833(h)(2)(A)) of such Act (42 U.S.C. 1395l(h)(2)(A)) is
15 amended—
16 (1) in clause (i), by striking ‘‘for each of years
17 2009 through 2013’’ and inserting ‘‘for 2009’’; and
18 (2) clause (ii)—
19 (A) by striking ‘‘and’’ at the end of sub20
clause (III);
21 (B) by striking the period at the end of
22 subclause (IV) and inserting ‘‘; and’’; and
23 (C) by adding at the end the following new
24 subclause:

1 ‘‘(V) the annual adjustment in the fee schedules
2 determined under clause (i) for years beginning with
3 2010 shall be subject to the productivity adjustment
4 described in section 1886(b)(3)(B)(iii)(II).’’.
5 (e) CERTAIN DURABLE MEDICAL EQUIPMENT.—Sec6
tion 1834(a)(14) of such Act (42 U.S.C. 1395m(a)(14))
7 is amended—
8 (1) in subparagraph (K), by inserting before
9 the semicolon at the end the following: ‘‘, subject to
10 the productivity adjustment described in section
11 1886(b)(3)(B)(iii)(II)’’;
12 (2) in subparagraph (L)(i), by inserting after
13 ‘‘June 2013,’’ the following: ‘‘subject to the produc14
tivity adjustment described in section
15 1886(b)(3)(B)(iii)(II),’’;
16 (3) in subparagraph (L)(ii), by inserting after
17 ‘‘June 2013’’ the following: ‘‘, subject to the produc18
tivity adjustment described in section
19 1886(b)(3)(B)(iii)(II)’’; and
20 (4) in subparagraph (M), by inserting before
21 the period at the end the following: ‘‘, subject to the
22 productivity adjustment described in section
23 1886(b)(3)(B)(iii)(II)’’.