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United States Code (Last Updated: May 24, 2014) |
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Title 42. THE PUBLIC HEALTH AND WELFARE |
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Chapter 7. SOCIAL SECURITY |
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SubChapter XVIII. HEALTH INSURANCE FOR AGED AND DISABLED |
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Part E. Miscellaneous Provisions |
§ 1395kkk. Independent Payment Advisory Board
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(a) Establishment There is established an independent board to be known as the “Independent Payment Advisory Board”.
(b) Purpose It is the purpose of this section to, in accordance with the following provisions of this section, reduce the per capita rate of growth in Medicare spending— (1) by requiring the Chief Actuary of the Centers for Medicare & Medicaid Services to determine in each year to which this section applies (in this section referred to as “a determination year”) the projected per capita growth rate under Medicare for the second year following the determination year (in this section referred to as “an implementation year”); (2) if the projection for the implementation year exceeds the target growth rate for that year, by requiring the Board to develop and submit during the first year following the determination year (in this section referred to as “a proposal year”) a proposal containing recommendations to reduce the Medicare per capita growth rate to the extent required by this section; and (3) by requiring the Secretary to implement such proposals unless Congress enacts legislation pursuant to this section. (c) Board proposals (1) Development (A) In general The Board shall develop detailed and specific proposals related to the Medicare program in accordance with the succeeding provisions of this section.
(B) Advisory reports Beginning
January 15, 2014 , the Board may develop and submit to Congress advisory reports on matters related to the Medicare program, regardless of whether or not the Board submitted a proposal for such year. Such a report may, for years prior to 2020, include recommendations regarding improvements to payment systems for providers of services and suppliers who are not otherwise subject to the scope of the Board’s recommendations in a proposal under this section. Any advisory report submitted under this subparagraph shall not be subject to the rules for congressional consideration under subsection (d). In any year (beginning with 2014) that the Board is not required to submit a proposal under this section, the Board shall submit to Congress an advisory report on matters related to the Medicare program.(2) Proposals (A) Requirements Each proposal submitted under this section in a proposal year shall meet each of the following requirements: (i) If the Chief Actuary of the Centers for Medicare & Medicaid Services has made a determination under paragraph (7)(A) in the determination year, the proposal shall include recommendations so that the proposal as a whole (after taking into account recommendations under clause (v)) will result in a net reduction in total Medicare program spending in the implementation year that is at least equal to the applicable savings target established under paragraph (7)(B) for such implementation year. In determining whether a proposal meets the requirement of the preceding sentence, reductions in Medicare program spending during the 3-month period immediately preceding the implementation year shall be counted to the extent that such reductions are a result of the implementation of recommendations contained in the proposal for a change in the payment rate for an item or service that was effective during such period pursuant to subsection (e)(2)(A). (ii) The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1395i–2, 1395i–2a, or 1395r of this title, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria. (iii) In the case of proposals submitted prior to December 31, 2018 , the proposal shall not include any recommendation that would reduce payment rates for items and services furnished, prior toDecember 31, 2019 , by providers of services (as defined in section 1395x(u) of this title) and suppliers (as defined in section 1395x(d) of this title) scheduled, pursuant to the amendments made by section 3401 of the Patient Protection and Affordable Care Act, to receive a reduction to the inflationary payment updates of such providers of services and suppliers in excess of a reduction due to productivity in a year in which such recommendations would take effect.(iv) As appropriate, the proposal shall include recommendations to reduce Medicare payments under parts C and D, such as reductions in direct subsidy payments to Medicare Advantage and prescription drug plans specified under paragraph of 1974 or under budget resolutions pursuant to that Act. The motion is not debatable. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. If a motion to proceed to the consideration of the joint resolution is agreed to, the joint resolution shall remain the unfinished business of the Senate until disposed of. (ii) Debate limitation In the Senate, consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be limited to not more than 10 hours, which shall be divided equally between the majority leader and the minority leader, or their designees. A motion further to limit debate is in order and not debatable. An amendment to, or a motion to postpone, or a motion to proceed to the consideration of other business, or a motion to recommit the joint resolution is not in order.
(iii) Passage In the Senate, immediately following the conclusion of the debate on a joint resolution described in paragraph (1), and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the Senate, the vote on passage of the joint resolution shall occur.
(iv) Appeals Appeals from the decisions of the Chair relating to the application of the rules of the Senate to the procedure relating to a joint resolution described in paragraph (1) shall be decided without debate.
(D) Other House acts first If, before the passage by 1 House of a joint resolution of that House described in paragraph (1), that House receives from the other House a joint resolution described in paragraph (1), then the following procedures shall apply: (i) The joint resolution of the other House shall not be referred to a committee. (ii) With respect to a joint resolution described in paragraph (1) of the House receiving the joint resolution— (I) the procedure in that House shall be the same as if no joint resolution had been received from the other House; but (II) the vote on final passage shall be on the joint resolution of the other House. (E) Excluded days For purposes of determining the period specified in subparagraph (B), there shall be excluded any days either House of Congress is adjourned for more than 3 days during a session of Congress.
(F) Majority required for adoption A joint resolution considered under this subsection shall require an affirmative vote of three-fifths of the Members, duly chosen and sworn, for adoption.
(3) Termination If a joint resolution described in paragraph (1) is enacted not later than August 15, 2017 —(A) the Chief Actuary of the Medicare & Medicaid Services shall not— (i) make any determinations under subsection (c)(6) after May 1, 2017 ; or(ii) provide any opinion pursuant to subsection (c)(3)(B)(iii) after January 16, 2018 ;(B) the Board shall not submit any proposals, advisory reports, or advisory recommendations under this section or produce the public report under subsection (n) after January 16, 2018 ; and(C) the Board and the consumer advisory council under subsection (k) shall terminate on August 16, 2018 .(g) Board membership; terms of office; Chairperson; removal (1) Membership (A) In general The Board shall be composed of— (i) 15 members appointed by the President, by and with the advice and consent of the Senate; and (ii) the Secretary, the Administrator of the Center for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration, all of whom shall serve ex officio as nonvoting members of the Board. (B) Qualifications (i) In general The appointed membership of the Board 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.
(ii) Inclusion The appointed membership of the Board shall include (but not be limited to) physicians and other health professionals, experts in the area of pharmaco-economics or prescription drug benefit programs, 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.
(iii) 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 appointed membership of the Board.
(C) Ethical disclosure The President shall establish a system for public disclosure by appointed members of the Board of financial and other potential conflicts of interest relating to such members. Appointed members of the Board shall be treated as officers in the executive branch for purposes of applying title I of the Ethics in Government Act of 1978 (Public Law 95–521).
(D) Conflicts of interest No individual may serve as an appointed member if that individual engages in any other business, vocation, or employment.
(E) Consultation with Congress In selecting individuals for nominations for appointments to the Board, the President shall consult with— (i) the majority leader of the Senate concerning the appointment of 3 members; (ii) the Speaker of the House of Representatives concerning the appointment of 3 members; (iii) the minority leader of the Senate concerning the appointment of 3 members; and (iv) the minority leader of the House of Representatives concerning the appointment of 3 members. (2) Term of office Each appointed member shall hold office for a term of 6 years except that— (A) a member may not serve more than 2 full consecutive terms (but may be reappointed to 2 full consecutive terms after being appointed to fill a vacancy on the Board); (B) a member appointed to fill a vacancy occurring prior to the expiration of the term for which that member’s predecessor was appointed shall be appointed for the remainder of such term; (C) a member may continue to serve after the expiration of the member’s term until a successor has taken office; and (D) of the members first appointed under this section, 5 shall be appointed for a term of 1 year, 5 shall be appointed for a term of 3 years, and 5 shall be appointed for a term of 6 years, the term of each to be designated by the President at the time of nomination. (3) Chairperson (A) In general The Chairperson shall be appointed by the President, by and with the advice and consent of the Senate, from among the members of the Board.
(B) Duties The Chairperson shall be the principal executive officer of the Board, and shall exercise all of the executive and administrative functions of the Board, including functions of the Board with respect to— (i) the appointment and supervision of personnel employed by the Board; (ii) the distribution of business among personnel appointed and supervised by the Chairperson and among administrative units of the Board; and (iii) the use and expenditure of funds. (C) Governance In carrying out any of the functions under subparagraph (B), the Chairperson shall be governed by the general policies established by the Board and by the decisions, findings, and determinations the Board shall by law be authorized to make.
(D) Requests for appropriations Requests or estimates for regular, supplemental, or deficiency appropriations on behalf of the Board may not be submitted by the Chairperson without the prior approval of a majority vote of the Board.
(4) Removal Any appointed member may be removed by the President for neglect of duty or malfeasance in office, but for no other cause.
(h) Vacancies; quorum; seal; Vice Chairperson; voting on reports (1) Vacancies No vacancy on the Board shall impair the right of the remaining members to exercise all the powers of the Board.
(2) Quorum A majority of the appointed members of the Board shall constitute a quorum for the transaction of business, but a lesser number of members may hold hearings.
(3) Seal The Board shall have an official seal, of which judicial notice shall be taken.
(4) Vice Chairperson The Board shall annually elect a Vice Chairperson to act in the absence or disability of the Chairperson or in case of a vacancy in the office of the Chairperson.
(5) Voting on proposals Any proposal of the Board must be approved by the majority of appointed members present.
(i) Powers of the Board (1) Hearings The Board may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the Board considers advisable to carry out this section.
(2) Authority to inform research priorities for data collection The Board may advise the Secretary on priorities for health services research, particularly as such priorities pertain to necessary changes and issues regarding payment reforms under Medicare.
(3) Obtaining official data The Board 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 Chairperson, the head of that department or agency shall furnish that information to the Board on an agreed upon schedule.
(4) Postal services The Board may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.
(5) Gifts The Board may accept, use, and dispose of gifts or donations of services or property.
(6) Offices The Board shall maintain a principal office and such field offices as it determines necessary, and may meet and exercise any of its powers at any other place.
(j) Personnel matters (1) Compensation of members and Chairperson Each appointed member, other than the Chairperson, shall be compensated at a rate equal to the annual rate of basic pay prescribed for level III of the Executive Schedule 2 under section 5315 of title 5. The Chairperson shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level II of the Executive Schedule 2 under section 5315 of title 5.
(2) Travel expenses The appointed members shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5 while away from their homes or regular places of business in the performance of services for the Board.
(3) Staff (A) In general The Chairperson may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such other additional personnel as may be necessary to enable the Board to perform its duties. The employment of an executive director shall be subject to confirmation by the Board.
(B) Compensation The Chairperson may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5 relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title.
(4) Detail of Government employees Any Federal Government employee may be detailed to the Board without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services The Chairperson may procure temporary and intermittent services under section 3109(b) of title 5 at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.
(k) Consumer advisory council (1) In general There is established a consumer advisory council to advise the Board on the impact of payment policies under this subchapter on consumers.
(2) Membership (A) Number and appointment The consumer advisory council shall be composed of 10 consumer representatives appointed by the Comptroller General of the United States, 1 from among each of the 10 regions established by the Secretary as of
March 23, 2010 .(B) Qualifications The membership of the council shall represent the interests of consumers and particular communities.
(3) Duties The consumer advisory council shall, subject to the call of the Board, meet not less frequently than 2 times each year in the District of Columbia.
(4) Open meetings Meetings of the consumer advisory council shall be open to the public.
(5) Election of officers Members of the consumer advisory council shall elect their own officers.
(6) Application of FACA The Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the consumer advisory council except that section 14 of such Act shall not apply.
(l) Definitions In this section: (1) Board; Chairperson; Member The terms “Board”, “Chairperson”, and “Member” mean the Independent Payment Advisory Board established under subsection (a) and the Chairperson and any Member thereof, respectively.
(2) Medicare The term “Medicare” means the program established under this subchapter, including parts A, B, C, and D.
(3) Medicare beneficiary The term “Medicare beneficiary” means an individual who is entitled to, or enrolled for, benefits under part A or enrolled for benefits under part B.
(4) Medicare program spending The term “Medicare program spending” means program spending under parts A, B, and D net of premiums.
(m) Funding (1) In general There are appropriated to the Board to carry out its duties and functions— (A) for fiscal year 2012, $15,000,000; and (B) for each subsequent fiscal year, the amount appropriated under this paragraph for the previous fiscal year increased by the annual percentage increase in the Consumer Price Index for All Urban Consumers (all items; United States city average) as of June of the previous fiscal year. (2) From trust funds Sixty percent of amounts appropriated under paragraph (1) shall be derived by transfer from the Federal Hospital Insurance Trust Fund under section 1395i of this title and 40 percent of amounts appropriated under such paragraph shall be derived by transfer from the Federal Supplementary Medical Insurance Trust Fund under section 1395t of this title.
(n) Annual public report (1) In general Not later than
July 1, 2014 , and annually thereafter, the Board shall produce a public report containing standardized information on system-wide health care costs, patient access to care, utilization, and quality-of-care that allows for comparison by region, types of services, types of providers, and both private payers and the program under this subchapter.(2) Requirements Each report produced pursuant to paragraph (1) shall include information with respect to the following areas: (A) The quality and costs of care for the population at the most local level determined practical by the Board (with quality and costs compared to national benchmarks and reflecting rates of change, taking into account quality measures described in section 1395aaa(b)(7)(B) of this title). (B) Beneficiary and consumer access to care, patient and caregiver experience of care, and the cost-sharing or out-of-pocket burden on patients. (C) Epidemiological shifts and demographic changes. (D) The proliferation, effectiveness, and utilization of health care technologies, including variation in provider practice patterns and costs. (E) Any other areas that the Board determines affect overall spending and quality of care in the private sector. (o) Advisory recommendations for non-Federal health care programs (1) In general Not later than January 15, 2015 , and at least once every two years thereafter, the Board shall submit to Congress and the President recommendations to slow the growth in national health expenditures (excluding expenditures under this subchapter and in other Federal health care programs) while preserving or enhancing quality of care, such as recommendations—(A) that the Secretary or other Federal agencies can implement administratively; (B) that may require legislation to be enacted by Congress in order to be implemented; (C) that may require legislation to be enacted by State or local governments in order to be implemented; (D) that private sector entities can voluntarily implement; and (E) with respect to other areas determined appropriate by the Board. (2) Coordination In making recommendations under paragraph (1), the Board shall coordinate such recommendations with recommendations contained in proposals and advisory reports produced by the Board under subsection (c).
(3) Available to public The Board shall make recommendations submitted to Congress and the President under this subsection available to the public.
References In Text
The Patient Protection and Affordable Care Act, referred to in subsec. (c)(2)(A)(iii), is Pub. L. 111–148,
Parts A, B, C, and D, referred to in subsecs. (c)(2)(A)(iv), (6)(B)(i), (e)(2)(A)(ii), and (l)(2)–(4), are classified to sections 1395c et seq., 1395j et seq., 1395w–21 et seq., and 1395w–101 et seq., respectively, of this title.
Section 1395w–23(n) of this title, referred to in subsec. (c)(2)(A)(iv), as relating to performance bonuses for Medicare Advantage plans, was repealed by Pub. L. 111–152, title I, § 1102(a),
Section 1899A of the Social Security Act, referred to in subsecs. (e)(3)(A)(i), (f)(1)(C), (D), is section 1899A of act
The Congressional Budget Act of 1974, referred to in subsec. (f)(2)(C)(i), is titles I through IX of Pub. L. 93–344,
The Ethics in Government Act of 1978, referred to in subsec. (g)(1)(C), is Pub. L. 95–521,
Levels II and III of the Executive Schedule, referred to in subsec. (j)(1), are set out in sections 5313 and 5314, respectively, of Title 5, Government Organization and Employees.
The Federal Advisory Committee Act, referred to in subsec. (k)(6), is Pub. L. 92–463,
Amendments
2010—Subsec. (c)(1)(B). Pub. L. 111–148, § 10320(a)(1)(A), inserted at end “In any year (beginning with 2014) that the Board is not required to submit a proposal under this section, the Board shall submit to Congress an advisory report on matters related to the Medicare program.”
Subsec. (c)(2)(A)(iv). Pub. L. 111–148, § 10320(a)(1)(B)(i), inserted “or the full premium subsidy under section 1395w–114(a) of this title” before period at end of the last sentence.
Subsec. (c)(2)(A)(vii). Pub. L. 111–148, § 10320(a)(1)(B)(ii), added cl. (vii).
Subsec. (c)(2)(B)(vii). Pub. L. 111–148, § 10320(a)(1)(C), added cl. (vii).
Subsec. (c)(3). Pub. L. 111–148, § 10320(a)(1)(D)(i), substituted “Submission of Board proposal to Congress and the President” for “Transmission of Board proposal to President” in heading.
Subsec. (c)(3)(A)(i). Pub. L. 111–148, § 10320(a)(1)(D)(ii), substituted “submit a proposal under this section to Congress and the President” for “transmit a proposal under this section to the President”.
Subsec. (c)(3)(A)(ii). Pub. L. 111–148, § 10320(a)(1)(D)(iii), inserted “or” at end of subcl. (I), substituted a period for “; or” at end of subcl. (II), and struck out subcl. (III), which read as follows: “for proposal year 2019 and subsequent proposal years, a year in which the Chief Actuary of the Centers for Medicare & Medicaid Services makes a determination in the determination year that the growth rate described in paragraph (8) exceeds the growth rate described in paragraph (6)(A)(i).”
Subsec. (c)(4). Pub. L. 111–148, § 10320(a)(1)(E), struck out “the Board under paragraph (3)(A)(i) or” before “the Secretary” and substituted “within 2 days” for “immediately”.
Subsec. (c)(5). Pub. L. 111–148, § 10320(a)(1)(F), in introductory provisions, substituted “but” for “to but” and inserted “Congress and” after “submit a proposal to”.
Subsec. (c)(6)(B)(i). Pub. L. 111–148, § 10320(a)(1)(G), substituted “(calculated as the sum of per capita spending under each of parts A, B, and D)” for “per unduplicated enrollee”.
Subsec. (d)(1)(A). Pub. L. 111–148, § 10320(a)(2)(A), inserted “the Board or” after “a proposal is submitted by” and “subsection (c)(3)(A)(i) or” after “the Senate under”.
Subsec. (d)(2)(A). Pub. L. 111–148, § 10320(a)(2)(B), inserted “the Board or” after “a proposal is submitted by”.
Subsec. (e)(1). Pub. L. 111–148, § 10320(a)(3)(A), inserted “the Board or” after “a proposal submitted by”.
Subsec. (e)(3). Pub. L. 111–148, § 10320(a)(3)(B), substituted “Exceptions” for “Exception” in par. heading, designated existing provisions as subpar. (A) and inserted heading, substituted “The Secretary shall not implement the recommendations contained in a proposal submitted in a proposal year by the Board or” for “The Secretary shall not be required to implement the recommendations contained in a proposal submitted in a proposal year by”, redesignated former subpars. (A) and (B) as cls. (i) and (ii), respectively, of subpar. (A) and realigned margins, and added subpar. (B).
Subsec. (f)(3)(B). Pub. L. 111–148, § 10320(a)(4), substituted “, advisory reports, or advisory recommendations” for “or advisory reports to Congress” and inserted “or produce the public report under subsection (n)” after “this section”.
Subsecs. (n), (o). Pub. L. 111–148, § 10320(a)(5), added subsecs. (n) and (o).
Change Of Name
Pub. L. 111–148, title X, § 10320(b),
Miscellaneous
Pub. L. 111–148, title X, § 10320(c),