Medicare Beneficiary Freedom to Choose Act of 2009 - Amends title XVIII (Medicare) to revise requirements for the use of private contracts by Medicare beneficiaries under which no Medicare claims shall be made. Requires any such contract to be in writing and signed by the Medicare beneficiary.
Allows individuals to choose to opt out of the Medicare part A (Hospital Insurance), and makes them eligible for health savings accounts.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3356 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 3356
To amend title XVIII of the Social Security Act to clarify the use of
private contracts by Medicare beneficiaries for professional services
and to allow individuals to choose to opt out of the Medicare part A
benefits.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 28, 2009
Mr. Sam Johnson of Texas (for himself, Mr. Brady of Texas, and Mr.
Reichert) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to clarify the use of
private contracts by Medicare beneficiaries for professional services
and to allow individuals to choose to opt out of the Medicare part A
benefits.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Beneficiary Freedom to
Choose Act of 2009''.
SEC. 2. USE OF PRIVATE CONTRACTS BY MEDICARE BENEFICIARIES FOR
PROFESSIONAL SERVICES.
(a) In General.--Section 1802(b) of the Social Security Act (42
U.S.C. 1395a) is amended to read as follows:
``(b) Clarification of Use of Private Contracts by Medicare
Beneficiaries for Professional Services.--
``(1) In general.--Nothing in this title shall prohibit a
medicare beneficiary from entering into a private contract with
a physician or health care practitioner for the provision of
medicare covered professional services (as defined in paragraph
(5)(C)) if--
``(A) the services are covered under a private
contract that is between the beneficiary and the
physician or practitioner and meets the requirements of
paragraph (2);
``(B) under the private contract no claim for
payment for services covered under the contract is to
be submitted (and no payment made) under part A or B,
under a contract under section 1876, or under an MA
plan (other than an MSA plan); and
``(C)(i) the Secretary has been provided with the
minimum information necessary to avoid any payment
under part A or B for services covered under the
contract, or
``(ii) in the case of an individual
enrolled under a contract under section 1876 or
an MA plan (other than an MSA plan) under part
C, the eligible organization under the contract
or the MA organization offering the plan has
been provided the minimum information necessary
to avoid any payment under such contract or
plan for services covered under the contract.
``(2) Requirements for private contracts.--The requirements
in this paragraph for a private contract between a medicare
beneficiary and a physician or health care practitioner are as
follows:
``(A) General form of contract.--The contract is in
writing and is signed by the medicare beneficiary.
``(B) No claims to be submitted for covered
services.--The contract provides that no party to the
contract (and no entity on behalf of any party to the
contract) shall submit any claim for (or request)
payment for services covered under the contract under
part A or B, under a contract under section 1876, or
under an MA plan (other than an MSA plan).
``(C) Scope of services.--The contract identifies
the medicare covered professional services and the
period (if any) to be covered under the contract, but
does not cover any services furnished--
``(i) before the contract is entered into;
or
``(ii) for the treatment of an emergency
medical condition (as defined in section
1867(e)(1)(A)), unless the contract was entered
into before the onset of the emergency medical
condition.
``(D) Clear disclosure of terms.--The contract
clearly indicates that by signing the contract the
medicare beneficiary--
``(i) agrees not to submit a claim (or to
request that anyone submit a claim) under part
A or B (or under section 1876 or under an MA
plan, other than an MSA plan) for services
covered under the contract;
``(ii) agrees to be responsible, whether
through insurance or otherwise, for payment for
such services and understands that no
reimbursement will be provided under such part,
contract, or plan for such services;
``(iii) acknowledges that no limits under
this title (including limits under paragraphs
(1) and (3) of section 1848(g)) will apply to
amounts that may be charged for such services;
``(iv) acknowledges that medicare
supplemental policies under section 1882 do
not, and other supplemental health plans and
policies may elect not to, make payments for
such services because payment is not made under
this title; and
``(v) acknowledges that the beneficiary has
the right to have such services provided by (or
under the supervision of) other physicians or
health care practitioners for whom payment
would be made under such part, contract, or
plan.
Such contract shall also clearly indicate whether the
physician or practitioner involved is excluded from
participation under this title.
``(3) Modifications.--The parties to a private contract may
mutually agree at any time to modify or terminate the contract
on a prospective basis, consistent with the provisions of
paragraphs (1) and (2).
``(4) No requirements for services furnished to msa plan
enrollees.--The requirements of paragraphs (1) and (2) do not
apply to any contract or arrangement for the provision of
services to a medicare beneficiary enrolled in an MSA plan
under part C.
``(5) Definitions.--In this subsection:
``(A) Health care practitioner.--The term `health
care practitioner' means a practitioner described in
section 1842(b)(18)(C).
``(B) Medicare beneficiary.--The term `medicare
beneficiary' means an individual who is enrolled under
part B.
``(C) Medicare covered professional services.--The
term `medicare covered professional services' means--
``(i) physicians' services (as defined in
section 1861(q), and including services
described in section 1861(s)(2)(A)), and
``(ii) professional services of health care
practitioners, including services described in
section 1842(b)(18)(D),
for which payment may be made under part A or B, under
a contract under section 1876, or under a Medicare
Advantage plan but for the provisions of a private
contract that meets the requirements of paragraph (2).
``(D) MA plan; msa plan.--The terms `MA plan' and
`MSA plan' have the meanings given such terms in
section 1859.
``(E) Physician.--The term `physician' has the
meaning given such term in section 1861(r).''.
(b) Conforming Amendments Clarifying Exemption From Limiting Charge
and From Requirement for Submission of Claims.--Section 1848(g) of the
Social Security Act (42 U.S.C. 1395w-4(g)) is amended--
(1) in paragraph (1)(A), by striking ``In'' and inserting
``Subject to paragraph (8), in'';
(2) in paragraph (3)(A), by striking ``Payment'' and
inserting ``Subject to paragraph (8), payment'';
(3) in paragraph (4)(A), by striking ``For'' and inserting
``Subject to paragraph (8), for''; and
(4) by adding at the end the following new paragraph:
``(8) Exemption from requirements for services furnished
under private contracts.--
``(A) In general.--Pursuant to section 1802(b)(1),
paragraphs (1), (3), and (4) do not apply with respect
to physicians' services (and services described in
section 1861(s)(2)(A)) furnished to an individual by
(or under the supervision of) a physician if the
conditions described in section 1802(b)(1) are met with
respect to the services.
``(B) No restrictions for enrollees in msa plans.--
Such paragraphs do not apply with respect to services
furnished to individuals enrolled with MSA plans under
part C, without regard to whether the conditions
described in subparagraphs (A) through (C) of section
1802(b)(1) are met.
``(C) Application to enrollees in other plans.--
Subject to subparagraph (B) and section 1852(k)(2), the
provisions of subparagraph (A) shall apply in the case
of an individual enrolled under a contract under
section 1876 or under an MA plan (other than an MSA
plan) under part C, in the same manner as they apply to
individuals not enrolled under such a contract or
plan.''.
(c) Conforming Amendments.--(1) Section 1842(b)(18) of the Social
Security Act (42 U.S.C. 1395u(b)(18)) is amended by adding at the end
the following:
``(E) The provisions of section 1848(g)(8) shall
apply with respect to exemption from limitations on
charges and from billing requirements for services of
health care practitioners described in this paragraph
in the same manner as such provisions apply to
exemption from the requirements referred to in section
1848(g)(8)(A) for physicians' services.''.
(2) Section 1866(a)(1)(O) of such Act (42 U.S.C. 1395cc(a)(1)(O))
is amended by striking ``enrolled with a Medicare Advantage
organization under part C'' and inserting ``enrolled with an MA
organization under part C (other than under an MSA plan)''.
(d) Effective Date.--The amendments made by this section shall take
effect on the date that is 6 months after the date of the enactment of
this Act and apply to contracts entered into on or after that date.
SEC. 3. ALLOWING INDIVIDUALS TO CHOOSE TO OPT OUT OF THE MEDICARE PART
A BENEFIT.
(a) In General.--Any individual who is otherwise entitled to
benefits under part A of title XVIII of the Social Security Act may
elect (in such form and manner as may be specified by the Secretary of
Health and Human Services) to waive such entitlement.
(b) Individuals Opting Out of Medicare Part A Eligible for Health
Savings Accounts.--Section 223 of the Internal Revenue Code of 1986 is
amended--
(1) in subsection (b), by striking paragraph (7), and
(2) in subsection (d)(2)(C)(iv), by inserting ``and who has
not waived the rights to benefits under part A of title XVIII
of such Act'' after ``Social Security Act''.
<all>
Introduced in House
Introduced in House
Referred to House Ways and Means
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Energy and Commerce
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line