‘‘(C) B UDGET NEUTRALITY .—The payment modifier established under this subsection shall be implemented in a budget neutral manner. ‘‘(5) S YSTEMS - BASED CARE .—The Secretary shall, as appro- priate, apply the payment modifier established under this sub- section in a manner that promotes systems-based care. ‘‘(6) C ONSIDERATION OF SPECIAL CIRCUMSTANCES OF CERTAIN PROVIDERS .—In applying the payment modifier under this sub- section, the Secretary shall, as appropriate, take into account the special circumstances of physicians or groups of physicians in rural areas and other underserved communities. ‘‘(7) A PPLICATION .—For purposes of the initial application of the payment modifier established under this subsection during the period beginning on January 1, 2015, and ending on December 31, 2016, the term ‘physician’ has the meaning given such term in section 1861(r). On or after January 1, 2017, the Secretary may apply this subsection to eligible profes- sionals (as defined in subsection (k)(3)(B)) as the Secretary determines appropriate. ‘‘(8) D EFINITIONS .—For purposes of this subsection: ‘‘(A) C OSTS .—The term ‘costs’ means expenditures per individual as determined appropriate by the Secretary. In making the determination under the preceding sentence, the Secretary may take into account the amount of growth in expenditures per individual for a physician compared to the amount of such growth for other physicians. ‘‘(B) P ERFORMANCE PERIOD .—The term ‘performance period’ means a period specified by the Secretary. ‘‘(9) C OORDINATION WITH OTHER VALUE - BASED PURCHASING REFORMS .—The Secretary shall coordinate the value-based pay- ment modifier established under this subsection with the Physi- cian Feedback Program under subsection (n) and, as the Sec- retary determines appropriate, other similar provisions of this title.
H. R. 3590—258 ‘‘(10) L IMITATIONS ON REVIEW .—There shall be no adminis- trative or judicial review under section 1869, section 1878, or otherwise of— ‘‘(A) the establishment of the value-based payment modifier under this subsection; ‘‘(B) the evaluation of quality of care under paragraph (2), including the establishment of appropriate measures of the quality of care under paragraph (2)(B); ‘‘(C) the evaluation of costs under paragraph (3), including the establishment of appropriate measures of costs under such paragraph; ‘‘(D) the dates for implementation of the value-based payment modifier; ‘‘(E) the specification of the initial performance period and any other performance period under paragraphs (4)(B)(ii) and (8)(B), respectively; ‘‘(F) the application of the value-based payment modi- fier under paragraph (7); and ‘‘(G) the determination of costs under paragraph (8)(A).’’.
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- Spring '09
- Health Care Law, Sec.