§1395ee — Title 42 The Public Health and Welfare | U.S. Code

Summary

Create a Council for Technology and Innovation inside CMS. The Council will include senior CMS staff and clinicians and will be led by an Executive Coordinator for Technology and Innovation. The Secretary must appoint a noncareer Executive Coordinator who reports to the CMS Administrator, chairs the Council, runs its work, and serves as the one main contact for outside groups about coverage, coding, and payment for new technologies and procedures, including new drug therapies. The Council must help coordinate CMS’s work on coverage, coding, and payment for new technologies and share information with other organizations that make similar decisions. Set up a temporary Physician-Focused Payment Model Technical Advisory Committee with 11 members chosen by the Comptroller General. Members must be nationally recognized experts in physician-focused payment models, not be federal employees, and no more than 5 may be providers or provider representatives. The Comptroller General must create a public system for members to disclose financial conflicts. Initial appointments must be made within 180 days after April 16, 2015. Members serve 3-year terms (with staggered starts), fill vacancies only for the rest of a term, and may stay on until a successor is named. The Committee will meet as needed to review model proposals from people and groups, give feedback, and send recommendations to the Secretary. The Secretary must set model criteria by November 1, 2016, using notice-and-comment rulemaking after asking for information, and may update those criteria later. Committee members are unpaid but get travel pay. The Assistant Secretary for Planning and Evaluation will support the Committee, the CMS Office of the Actuary will help with actuarial work, and up to $5,000,000 may be transferred each year from the Federal Supplementary Medical Insurance Trust Fund to run the Committee. One statute (section 1013 of title 5) does not apply to the Committee. Nothing here stops development or testing of other models under related parts of the law.

Title 42, §1395ee

The Public Health and Welfare — Source: USLM XML via OLRC

(a)

(b)(1)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)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)The Council shall coordinate the activities of coverage, coding, and payment processes under this subchapter 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)The Secretary shall appoint (or designate) a noncareer appointee (as defined in section 3132(a)(7) of title 5) 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 subchapter.

(c)(1)(A)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)(i)The Committee shall be composed of 11 members appointed by the Comptroller General of the United States.

(ii)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)A member of the Committee shall not be an employee of the Federal Government.

(iv)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 subchapter I of chapter 131 of title 5.

(v)The initial appointments of members of the Committee shall be made by not later than 180 days after April 16, 2015.

(C)(i)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)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)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)(i)Except as provided in clause (ii), a member of the Committee shall serve without compensation.

(ii)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 while away from the home or regular place of business of the member in the performance of the duties of the Committee.

(F)(i)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)The Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1395t of this title, 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)Section 1013 of title 5 shall not apply to the Committee.

(2)(A)(i)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)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)The Secretary may update the criteria established under this subparagraph through rulemaking.

(B)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)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)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.

(D)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)Nothing in this subsection shall be construed to impact the development or testing of models under this subchapter or subchapters XI, XIX, or XXI.

Notes & Related Subsidiaries

Editorial Notes

Prior Provisions

A prior section 1395ee, act Aug. 14, 1935, ch. 531, title XVIII, § 1868, as added July 30, 1965, Pub. L. 89–97, title I, § 102(a), 79 Stat. 329, provided for creation of a National Medical Review Committee, functions of such Committee, including submission of annual reports to the Secretary and Congress, employment of technical assistance, and for availability of assistance and data, prior to repeal by Pub. L. 90–248, title I, § 164(c), Jan. 2, 1968, 81 Stat. 874.

Amendments

2022—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).” 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.)”. 2018—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.” 2015—Subsec. (c). Pub. L. 114–10 added subsec. (c). 2010—Subsec. (a). Pub. L. 111–148 struck out subsec. (a) which related to the Practicing Physicians Advisory Council. 2003—Pub. L. 108–173, § 942(a)(1), inserted “; Council for Technology and Innovation” in section catchline. 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. Subsec. (b). Pub. L. 108–173, § 942(a)(5), added subsec. (b). Former subsec. (b) redesignated par. (2) of subsec. (a). Subsec. (c). Pub. L. 108–173, § 942(a)(4), redesignated subsec. (c) as par. (3) of subsec. (a).

Statutory Notes and Related Subsidiaries

Termination of Advisory CouncilsAdvisory councils established after Jan. 5, 1973, to terminate not later than the expiration of the 2-year period beginning on the date of their establishment, unless, in the case of a council established by the President or an officer of the Federal Government, such council is renewed by appropriate action prior to the expiration of such 2-year period, or in the case of a council established by Congress, its duration is otherwise provided by law. See section 1001(2) and 1013 of Title 5, Government Organization and Employees.

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