Page:United States Statutes at Large Volume 117.djvu/2294

 PUBLIC LAW 108–173—DEC. 8, 2003

117 STAT. 2275

SEC. 413. MEDICARE INCENTIVE PAYMENT PROGRAM IMPROVEMENTS FOR PHYSICIAN SCARCITY.

(a) ADDITIONAL INCENTIVE PAYMENT FOR CERTAIN PHYSICIAN SCARCITY AREAS.—Section 1833 (42 U.S.C. 1395l) is amended by adding at the end the following new subsection: ‘‘(u) INCENTIVE PAYMENTS FOR PHYSICIAN SCARCITY AREAS.— ‘‘(1) IN GENERAL.—In the case of physicians’ services furnished on or after January 1, 2005, and before January 1, 2008— ‘‘(A) by a primary care physician in a primary care scarcity county (identified under paragraph (4)); or ‘‘(B) by a physician who is not a primary care physician in a specialist care scarcity county (as so identified), in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid an amount equal to 5 percent of the payment amount for the service under this part. ‘‘(2) DETERMINATION OF RATIOS OF PHYSICIANS TO MEDICARE BENEFICIARIES IN AREA.—Based upon available data, the Secretary shall establish for each county or equivalent area in the United States, the following: ‘‘(A) NUMBER OF PHYSICIANS PRACTICING IN THE AREA.— The number of physicians who furnish physicians’ services in the active practice of medicine or osteopathy in that county or area, other than physicians whose practice is exclusively for the Federal Government, physicians who are retired, or physicians who only provide administrative services. Of such number, the number of such physicians who are— ‘‘(i) primary care physicians; or ‘‘(ii) physicians who are not primary care physicians. ‘‘(B) NUMBER OF MEDICARE BENEFICIARIES RESIDING IN THE AREA.—The number of individuals who are residing in the county and are entitled to benefits under part A or enrolled under this part, or both (in this subsection referred to as ‘individuals’). ‘‘(C) DETERMINATION OF RATIOS.— ‘‘(i) PRIMARY CARE RATIO.—The ratio (in this paragraph referred to as the ‘primary care ratio’) of the number of primary care physicians (determined under subparagraph (A)(i)), to the number of individuals determined under subparagraph (B). ‘‘(ii) SPECIALIST CARE RATIO.—The ratio (in this paragraph referred to as the ‘specialist care ratio’) of the number of other physicians (determined under subparagraph (A)(ii)), to the number of individuals determined under subparagraph (B). ‘‘(3) RANKING OF COUNTIES.—The Secretary shall rank each such county or area based separately on its primary care ratio and its specialist care ratio. ‘‘(4) IDENTIFICATION OF COUNTIES.— ‘‘(A) IN GENERAL.—The Secretary shall identify— ‘‘(i) those counties and areas (in this paragraph referred to as ‘primary care scarcity counties’) with the lowest primary care ratios that represent, if each such county or area were weighted by the number

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