Title IV, SEC. 4115. MEDICARE INCENTIVES FOR PHYSICIANS TO PROVIDE PRIMARY CARE. (a) Resource-Based Practice Expense Relative Value Units. (1) Increase in practice expense relative value units for certain services. Section 1848(c)(2) (42 U.S.C. 1395w 4(c)(2)), as amended by sections 13513 and 13514 of OBRA 93, is amended by adding at the end the following new subparagraph: ``(G) Increase in practice expense relative value units for certain services. The Secretary shall increase the practice expense relative value units applied in primary care services, as defined in section 1842(i)(4), by 10 percent, beginning with 1996.''. (2) Assuring budget neutrality. Section 1842(c)(2)(F) (42 U.S.C. 1395u(c)(2)(F)), as added by section 13513 and amended by section 13514 of OBRA 93, is amended by adding at the end the following new clause: ``(iii) shall reduce the relative values for all services (other than anesthesia services and primary care services, as defined in section 1842(i)(4)) established under this paragraph (and, in the case of anesthesia services, the conversion factor established by the Secretary for such services) by such percentage as the Secretary determines to be necessary so that, beginning in 1996, the amendment made by section 4115(a)(1) of the Health Security Act would not result in expenditures under this section that exceed the amount of such expenditures that would have been made if such amendment had not been made.''. (3) Study. The Secretary of Health and Human Services shall (A) develop a methodology for implementing in 1997 a resource-based system for determining practice expense relative values unit for each physician's service, and (B) transmit a report by June 30, 1996, on the methodology developed under paragraph (1) to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and the Committee on Fiance of the Senate. The reported shall include a presentation of the data utilized in developing the methodology and an explanation of the methodology. (b) Office Visit Pre- and Post-Time. (1) Increase in work relative value units for office visits. Section 1848(c)(2) (42 U.S.C. 1395w 4(c)(2)) is amended by adding at the end the following new subparagraph: ``(H) Increase in work relative value units for certain services. The Secretary shall increase the work relative value units applied to office visits by 10 percent, beginning with 1996.''. (2) Assuring budget neutrality. Section 1842(c)(2)(F)(iii) is amended by striking ``section 4115(a)'' and substituting ``sections 4115(a)(1) and (b)(1)''. (c) Office Consultations. Section 1848(c)(2) (42 U.S.C. 1395w 4(c)(2)) is amended by adding at the end the following new subparagraph: ``(1) Amendment in relative values for office consultations. The Secretary shall reduce the work, practice expense and malpractice relative value components of office consultations to be equal to the work, practice expense and malpractice relative value components for comparable office visits beginning with 1996. In making such adjustment, the Secretary shall apply the savings from such reduction to increase each of the relative value components for office visits in a manner that would not result in expenditures under this section that exceed the amount of such expenditures that would have been made if such amendment had not been made.''. (d) Outlier Intensity Relative Value Adjustments. (1) Adjustment of outlier intensity of relative values. Section 1848(c)(2) (42 U.S.C. 1395w 4(c)(2)) is amended by adding at the end the following new subparagraph: ``(J) Adjustment of outlier intensity of relative values. Beginning with 1996, the Secretary shall reduce the work relative value components of procedures, or classes of procedures, where the intensity exceeds thresholds established by the Secretary. In the previous sentence, intensity shall mean the work relative value units for the procedure divided by the time for the procedure. The Secretary shall apply the savings from such reductions to increase the work relative value components of primary care services, as defined in section 1842(i)(4), such that the changes made by this subsection would not result in expenditures under this section that exceed the amount of such expenditures that would have been made if such amendment had not been made.''. (e) Changes In Underserved Area Bonus Payments. (1) Section 1833(m) (42 U.S.C. 1395l(m)) is amended by (A) striking ``10 percent'' and inserting ``a percent'', (B) striking ``service'' the last time it appears and inserting ``services'', and (C) adding the following new sentence: ``The percent referred to in the previous sentence is 20 percent in the case of primary care services, as defined in section 1842(i)(4), and 10 percent for services other than primary care services furnished in health professional shortage areas located in rural areas as defined in section 1886(d).''. (2) The amendments made by subparagraph (A) are effective for services furnished on or after January 1, 1996.