§ 1395ee. Practicing Physicians Advisory Council; Council for Technology and Innovation

Legislative history

Reconstructed from this section’s Code source credit and amendment notes, resolved against the local Statutes at Large. Editorial notes are evidence, not the law that made the change.

1. 1935

   Omnibus Budget Reconciliation Act of 1990

   Pub. L. 101–508 title IV § 4112 · 104 Stat. 1388

   Enacted · 42 U.S.C. § 1395ee

   Aug. 14, 1935, ch. 531, title XVIII, § 1868, as added Pub. L. 101–508, title IV, § 4112, Nov. 5, 1990, 104 Stat. 1388–64

   Source evidence

   Code source credit
   Aug. 14, 1935, ch. 531, title XVIII, § 1868, as added Pub. L. 101–508, title IV, § 4112, Nov. 5, 1990, 104 Stat. 1388–64

   Enacted provision · exact public law section
   SEC. 4112. PRACTICING PHYSICIANS ADVISORY COUNCIL. Title XVIII of the Social Security Act is amended by inserting after section 1867 the following new section: “Sec. 1868. “practicing physicians advisory council (a) The Secretary shall appoint, based upon nominations submitted by medical organizations representing physicians, a Practicing Physicians Advisory Council (in this section referred to as the ‘Council’) to be composed of 15 physicians, each of whom has submitted at least 250 claims for physicians’ services under this title in the previous year. At least 11 of the members of the Council shall be physicians described in section 1861(r)(D and the members of the Council shall include both participating and non participating physicians and physicians practicing in rural areas and underserved urban areas. “(b) The Council shall meet once during each calendar quarter to discuss certain proposed changes in regulations and carrier manual instructions related to physician services identified by the Secretary. To the extent feasible and consistent with statutory dead-lines, such consultation shall occur before the publication of such proposed changes. “(c) Members of the Council shall be entitled to receive reimbursement of expenses and per diem in lieu of subsistence in the same manner as other members of advisory councils appointed by the Secretary are provided such reimbursement and per diem under this title.”.

2. 2003

   Medicare Prescription Drug, Improvement, and Modernization Act of 2003

   Pub. L. 108–173 § 942(a)(1) · 117 Stat. 2066

   Inserted · 42 U.S.C. § 1395ee

   Pub. L. 108–173, § 942(a)(1), inserted “; Council for Technology and Innovation” in section catchline

   Source evidence

   Code amendment note
   Pub. L. 108–173, § 942(a)(1), inserted “; Council for Technology and Innovation” in section catchline.

   Enacted provision · exact public law section
   (1) by adding at the end of the heading the following: “; council for technology and innovation”;

3. 2003

   Medicare Prescription Drug, Improvement, and Modernization Act of 2003

   Pub. L. 108–173 § 942(a)(2) · 117 Stat. 2066

   1. Inserted · 42 U.S.C. § 1395ee(a)

      Pub. L. 108–173, § 942(a)(2)–(4), inserted subsec. heading

   2. Redesignated · 42 U.S.C. § 1395ee(a)

      Pub. L. 108–173, § 942(a)(2)–(4), redesignated existing provisions as par. (1)

   3. Substituted · 42 U.S.C. § 1395ee(a)

      Pub. L. 108–173, § 942(a)(2)–(4), substituted “in this subsection” for “in this section”

   4. Redesignated · 42 U.S.C. § 1395ee(a)

      Pub. L. 108–173, § 942(a)(2)–(4), redesignated former subsecs. (b) and (c) as pars. (2) and (3), respectively

   Source evidence

   Code amendment note
   Subsec. (a). Pub. L. 108–173, § 942(a)(2)–(4), inserted subsec. heading, redesignated existing provisions as par. (1), substituted “in this subsection” for “in this section”, and redesignated former subsecs. (b) and (c) as pars. (2) and (3), respectively.

   Enacted provision · exact public law section
   (2) by inserting “Practicing Physicians Advisory Council.—(1)” after “(a)”;

4. 2003

   Medicare Prescription Drug, Improvement, and Modernization Act of 2003

   Pub. L. 108–173 § 942(a)(5) · 117 Stat. 2066

   Redesignated · 42 U.S.C. § 1395ee(b)

   Pub. L. 108–173, § 942(a)(5), added subsec. (b). Former subsec. (b) redesignated par. (2) of subsec. (a)

   Source evidence

   Code amendment note
   Subsec. (b). Pub. L. 108–173, § 942(a)(5), added subsec. (b). Former subsec. (b) redesignated par. (2) of subsec. (a).

   Enacted provision · exact public law section
   (5) by adding at the end the following new subsection: “(b) Council for Technology and Innovation.— “(1) Establishment.— The Secretary shall establish a Council for Technology and Innovation within the Centers for Medicare & Medicaid Services (in this section referred to as ‘CMS’). “(2) Composition.— The Council shall be composed of senior CMS staff and clinicians and shall be chaired by the Executive Coordinator for Technology and Innovation (appointed or designated under paragraph (4)). “(3) Duties.— The Council shall coordinate the activities of coverage, coding, and payment processes under this title with respect to new technologies and procedures, including new drug therapies, and shall coordinate the exchange of information on new technologies between CMS and other entities that make similar decisions. “(4) Executive coordinator for technology and innovation.— The Secretary shall appoint (or designate) a noncareer appointee (as defined in section 3132(a)(7) of title 5, United States Code) who shall serve as the Executive Coordinator for Technology and Innovation. Such executive coordinator shall report to the Administrator of CMS, shall chair the Council, shall oversee the execution of its duties, and shall serve as a single point of contact for outside groups and entities regarding the coverage, coding, and payment processes under this title.” .

5. 2003

   Medicare Prescription Drug, Improvement, and Modernization Act of 2003

   Pub. L. 108–173 § 942(a)(4) · 117 Stat. 2066

   Redesignated · 42 U.S.C. § 1395ee(c)

   Pub. L. 108–173, § 942(a)(4), redesignated subsec. (c) as par. (3) of subsec. (a)

   Source evidence

   Code amendment note
   Subsec. (c). Pub. L. 108–173, § 942(a)(4), redesignated subsec. (c) as par. (3) of subsec. (a).

   Enacted provision · exact public law section
   (4) by redesignating subsections (b) and (c) as paragraphs (2) and (3), respectively; and

6. 2010

   Patient Protection and Affordable Care Act

   Pub. L. 111–148 title III § 3134(b)(2) · 124 Stat. 119

   Struck · 42 U.S.C. § 1395ee(a)

   Pub. L. 111–148 struck out subsec. (a) which related to the Practicing Physicians Advisory Council

   Source evidence

   Code amendment note
   Subsec. (a). Pub. L. 111–148 struck out subsec. (a) which related to the Practicing Physicians Advisory Council.

   Enacted provision · exact public law section
   (2) Focusing cms resources on potentially overvalued codes.—Section 1868(a) of the Social Security Act (42 U.S.C. 1395ee(a)) is repealed.

7. 2015

   Medicare Access and CHIP Reauthorization Act of 2015

   Pub. L. 114–10 title I § 101(e)(1) · 129 Stat. 87

   Added · 42 U.S.C. § 1395ee(c)

   Pub. L. 114–10 added subsec. (c)

   Source evidence

   Code amendment note
   Subsec. (c). Pub. L. 114–10 added subsec. (c).

   Enacted provision · exact public law section
   (1) Increasing transparency of physician-focused payment models.— Section 1868 of the Social Security Act (42 U.S.C. 1395ee) is amended by adding at the end the following new subsection: “(c) Physician-Focused Payment Models.— “(1) Technical advisory committee.— “(A) Establishment.— There is established an ad hoc committee to be known as the ‘Physician-Focused Payment Model Technical Advisory Committee’ (referred to in this subsection as the ‘Committee’). “(B) Membership.— “(i) Number and appointment.— The Committee shall be composed of 11 members appointed by the Comptroller General of the United States. “(ii) Qualifications.— The membership of the Committee shall include individuals with national recognition for their expertise in physician-focused payment models and related delivery of care. No more than 5 members of the Committee shall be providers of services or suppliers, or representatives of providers of services or suppliers. “(iii) Prohibition on federal employment.— A member of the Committee shall not be an employee of the Federal Government. “(iv) Ethics disclosure.— The Comptroller General shall establish a system for public disclosure by members of the Committee of financial and other potential conflicts of interest relating to such members. Members of the Committee shall be treated as employees of Congress for purposes of applying title I of the Ethics in Government Act of 1978 (Public Law 95–521). “(v) Date of initial appointments.— The initial appointments of members of the Committee shall be made by not later than 180 days after the date of enactment of this subsection. “(C) Term; vacancies.— “(i) Term.— The terms of members of the Committee shall be for 3 years except that the Comptroller General shall designate staggered terms for the members first appointed. “(ii) 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 Committee shall be filled in the manner in which the original appointment was made. “(D) Duties.— The Committee shall meet, as needed, to provide comments and recommendations to the Secretary, as described in paragraph (2)(C), on physician-focused payment models. “(E) Compensation of members.— “(i) In general.— Except as provided in clause (ii), a member of the Committee shall serve without compensation. “(ii) Travel expenses.— A member of the Committee shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for an employee of an agency under subchapter I of chapter 57 of title 5, United States Code, while away from the home or regular place of business of the member in the performance of the duties of the Committee. “(F) Operational and technical support.— “(i) In general.— The Assistant Secretary for Planning and Evaluation shall provide technical and operational support for the Committee, which may be by use of a contractor. The Office of the Actuary of the Centers for Medicare & Medicaid Services shall provide to the Committee actuarial assistance as needed. “(ii) Funding.— The Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, such amounts as are necessary to carry out this paragraph (not to exceed $5,000,000) for fiscal year 2015 and each subsequent fiscal year. Any amounts transferred under the preceding sentence for a fiscal year shall remain available until expended. “(G) Application.— Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Committee. “(2) Criteria and process for submission and review of physician-focused payment models.— “(A) Criteria for assessing physician-focused payment models.— “(i) Rulemaking.— Not later than November 1, 2016, the Secretary shall, through notice and comment rulemaking, following a request for information, establish criteria for physician-focused payment models, including models for specialist physicians, that could be used by the Committee for making comments and recommendations pursuant to paragraph (1)(D). “(ii) MedPAC submission of comments.— During the comment period for the proposed rule described in clause (i), the Medicare Payment Advisory Commission may submit comments to the Secretary on the proposed criteria under such clause. “(iii) Updating.— The Secretary may update the criteria established under this subparagraph through rulemaking. “(B) Stakeholder submission of physician-focused payment models.— On an ongoing basis, individuals and stakeholder entities may submit to the Committee proposals for physician-focused payment models that such individuals and entities believe meet the criteria described in subparagraph (A). “(C) Committee review of models submitted.— The Committee shall, on a periodic basis, review models submitted under subparagraph (B), prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph (A), and submit such comments and recommendations to the Secretary. “(D) Secretary review and response.— The Secretary shall review the comments and recommendations submitted by the Committee under subparagraph (C) and post a detailed response to such comments and recommendations on the Internet website of the Centers for Medicare & Medicaid Services. “(3) Rule of construction.— Nothing in this subsection shall be construed to impact the development or testing of models under this title or titles XI, XIX, or XXI.” .

8. 2018

   Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act

   Pub. L. 115–123 div. E title X § 51003(b) · 132 Stat. 64

   Amended · 42 U.S.C. § 1395ee(c)(2)(C)

   Pub. L. 115–123 amended subpar. (C) generally. Prior to amendment, text read as follows: “The Committee shall, on a periodic basis, review models submitted under subparagraph (B), prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph (A), and submit such comments and recommendations to the Secretary.”

   Source evidence

   Code amendment note
   Subsec. (c)(2)(C). Pub. L. 115–123 amended subpar. (C) generally. Prior to amendment, text read as follows: “The Committee shall, on a periodic basis, review models submitted under subparagraph (B), prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph (A), and submit such comments and recommendations to the Secretary.”

   Enacted provision · exact public law section
   (b) Physician-focused Payment Model Technical Advisory Committee Provision of Initial Proposal Feedback.— Section 1868(c)(2)(C) of the Social Security Act (42 U.S.C. 1395ee(c)(2)(C)) is amended to read as follows: “(C) Committee review of models submitted.— The Committee, on a periodic basis— “(i) shall review models submitted under subparagraph (B); “(ii) may provide individuals and stakeholder entities who submitted such models with— “(I) initial feedback on such models regarding the extent to which such models meet the criteria described in subparagraph (A); and “(II) an explanation of the basis for the feedback provided under subclause (I); and “(iii) Recommenda- tions. shall prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph (A) and submit such comments and recommendations to the Secretary.” .

9. 2022

   Pub. L. 117–286 § 4(c)(42) · 136 Stat. 4196

   Substituted · 42 U.S.C. § 1395ee(c)(1)(B)(iv)

   Pub. L. 117–286, § 4(c)(42), substituted “subchapter I of chapter 131 of title 5.” for “title I of the Ethics in Government Act of 1978 (Public Law 95–521).”

   Source evidence

   Code amendment note
   Subsec. (c)(1)(B)(iv). Pub. L. 117–286, § 4(c)(42), substituted “subchapter I of chapter 131 of title 5.” for “title I of the Ethics in Government Act of 1978 (Public Law 95–521).”

   Enacted provision · exact public law section
   (42) Section 1868(c)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395ee(c)(1)(B)(iv)) is amended by striking “title I of the Ethics in Government Act of 1978 (Public Law 95–521).” and inserting “subchapter I of chapter 131 of title 5, United States Code.”.

10. 2022

    Pub. L. 117–286 § 4(a)(255) · 136 Stat. 4196

    Substituted · 42 U.S.C. § 1395ee(c)(1)(G)

    Pub. L. 117–286, § 4(a)(255), substituted “Section 1013 of title 5” for “Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.)”

    Source evidence

    Code amendment note
    Subsec. (c)(1)(G). Pub. L. 117–286, § 4(a)(255), substituted “Section 1013 of title 5” for “Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.)”.

    Enacted provision · exact public law section
    (255) Section 1868(c)(1)(G) of the Social Security Act (42 U.S.C. 1395ee(c)(1)(G)) is amended by striking “Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.)” and inserting “Section 1013 of title 5, United States Code,”.

13 of 13 references resolved to an enrolled provision