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1 eliminate the effect of geographic adjustments
2 in payment rates.
3 ‘‘(B) IDENTIFICATION OF COUNTIES
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1 such counties or areas as part of the proposed
2 and final rule to implement the physician fee
3 schedule under section 1848 for the applicable
4 year. The Secretary shall post the list of coun-
5 ties identified under this paragraph on the
6 Internet website of the Centers for Medicare &
7 Medicaid Services.’’.
8 SEC. 1124. MODIFICATIONS TO THE PHYSICIAN QUALITY
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1 than January 1, 2011, the Secretary shall es-
2 tablish and have in place an informal process
3 for eligible professionals to appeal the deter-
4 mination that an eligible professional did not
5 satisfactorily submit data on quality measures
6 under this subsection.’’.
7 (c) INTEGRATION OF PHYSICIAN QUALITY REPORT-
8 ING AND EHR REPORTING.—Section 1848(m) of such
9 Act is amended by adding at the end the following new
10 paragraph:
11 ‘‘(7) INTEGRATION OF PHYSICIAN QUALITY RE-
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1 ‘‘(B) The collection of health data to iden-
2 tify deficiencies in the quality and coordination
3 of care for individuals eligible for benefits under
4 this part.
5 ‘‘(C) Such other activities as specified by
6 the Secretary.’’.
7 (d) EXTENSION OF INCENTIVE PAYMENTS.—Section
8 1848(m)(1) of such Act (42 U.S.C. 1395w–4(m)(1)) is
9 amended—
10 (1) in subparagraph (A), by striking ‘‘2010’’
11 and inserting ‘‘2012’’; and
12 (2) in subparagraph (B)(ii), by striking ‘‘2009
13 and 2010’’ and inserting ‘‘for each of the years 2009
14 through 2012’’.
15 SEC. 1125. ADJUSTMENT TO MEDICARE PAYMENT LOCAL-
16 ITIES.
22 ‘‘(A) IN GENERAL.—
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1 nished on or after January 1, 2011, the
2 Secretary shall revise the fee schedule
3 areas used for payment under this section
4 applicable to the State of California using
5 the Metropolitan Statistical Area (MSA)
6 iterative Geographic Adjustment Factor
7 methodology as follows:
8 ‘‘(I) The Secretary shall con-
9 figure the physician fee schedule areas
10 using the Core-Based Statistical
11 Areas-Metropolitan Statistical Areas
12 (each in this paragraph referred to as
13 an ‘MSA’), as defined by the Director
14 of the Office of Management and
15 Budget, as the basis for the fee sched-
16 ule areas. The Secretary shall employ
17 an iterative process to transition fee
18 schedule areas. First, the Secretary
19 shall list all MSAs within the State by
20 Geographic Adjustment Factor de-
21 scribed in paragraph (2) (in this para-
22 graph referred to as a ‘GAF’) in de-
23 scending order. In the first iteration,
24 the Secretary shall compare the GAF
25 of the highest cost MSA in the State
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1 to the weighted-average GAF of the
2 group of remaining MSAs in the
3 State. If the ratio of the GAF of the
4 highest cost MSA to the weighted-av-
5 erage GAF of the rest of State is 1.05
6 or greater then the highest cost MSA
7 becomes a separate fee schedule area.
8 ‘‘(II) In the next iteration, the
9 Secretary shall compare the MSA of
10 the second-highest GAF to the weight-
11 ed-average GAF of the group of re-
12 maining MSAs. If the ratio of the sec-
13 ond-highest MSA’s GAF to the
14 weighted-average of the remaining
15 lower cost MSAs is 1.05 or greater,
16 the second-highest MSA becomes a
17 separate fee schedule area. The
18 iterative process continues until the
19 ratio of the GAF of the highest-cost
20 remaining MSA to the weighted-aver-
21 age of the remaining lower-cost MSAs
22 is less than 1.05, and the remaining
23 group of lower cost MSAs form a sin-
24 gle fee schedule area, If two MSAs
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1 have identical GAFs, they shall be
2 combined in the iterative comparison.
3 ‘‘(ii) TRANSITION.—For services fur-
4 nished on or after January 1, 2011, and
5 before January 1, 2016, in the State of
6 California, after calculating the work, prac-
7 tice expense, and malpractice geographic
8 indices described in clauses (i), (ii), and
9 (iii) of paragraph (1)(A) that would other-
10 wise apply through application of this
11 paragraph, the Secretary shall increase any
12 such index to the county-based fee sched-
13 ule area value on December 31, 2009, if
14 such index would otherwise be less than
15 the value on January 1, 2010.
16 ‘‘(B) SUBSEQUENT REVISIONS.—
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1 Budget and the iterative methodology de-
2 scribed in subparagraph (A)(i).
3 ‘‘(ii) LINK WITH GEOGRAPHIC INDEX
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