Medicare Patient Empowerment Act - Amends title XVIII (Medicare) of the Social Security Act to allow any Medicare beneficiary to enter into a contract with a non-participating (as well as with a participating) physician or practitioner for any item or service covered by Medicare. Allows such beneficiaries to submit a claim for Medicare payment in the amount that would otherwise apply if the claim had been filed by a participating physician or practitioner in the payment area where the physician or practitioner covered by the contract resides.
Requires a Medicare beneficiary to agree in writing in such a contract to: (1) pay the physician or practitioner for a Medicare-covered item or service; and (2) submit (in lieu of the physician or practitioner) a claim for Medicare payment. Allows a beneficiary, however, to negotiate, as a term of the contract, for the physician or practitioner to file such claims on the beneficiary's behalf.
Preempts state laws from limiting the amount of charges for physician and practitioner services for which Medicare payment is made.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1700 Introduced in House (IH)]
112th CONGRESS
1st Session
H. R. 1700
To amend title XVIII of the Social Security Act to establish a Medicare
payment option for patients and physicians or practitioners to freely
contract, without penalty, for Medicare fee-for-service items and
services, while allowing Medicare beneficiaries to use their Medicare
benefits.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 3, 2011
Mr. Price of Georgia (for himself and Mr. Sessions) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, 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 establish a Medicare
payment option for patients and physicians or practitioners to freely
contract, without penalty, for Medicare fee-for-service items and
services, while allowing Medicare beneficiaries to use their Medicare
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 Patient Empowerment Act''.
SEC. 2. GUARANTEEING FREEDOM OF CHOICE AND CONTRACTING FOR PATIENTS.
(a) In General.--Section 1802 of the Social Security Act (42 U.S.C.
1395a) is amended to read as follows:
``freedom of choice and contracting by patient guaranteed
``Sec. 1802. (a) Basic Freedom of Choice.--Any individual entitled
to insurance benefits under this title may obtain health services from
any institution, agency, or person qualified to participate under this
title if such institution, agency, or person undertakes to provide that
individual such services.
``(b) Freedom to Contract by Medicare Beneficiaries.--
``(1) In general.--Subject to the provisions of this
subsection, nothing in this title shall prohibit a Medicare
beneficiary from entering into a contract with a participating
or non-participating physician or practitioner for any item or
service covered under this title.
``(2) Submission of claims.--Any Medicare beneficiary that
enters into a contract under this section shall be permitted to
submit a claim for payment under this title, and such payment
shall be made in the amount that would otherwise apply under
this title if such claim had been filed by a participating
physician or practitioner (as defined in section 1842(i)(2)) in
the payment area where the physician or practitioner covered by
the contract resides. Payment made under this title for any
item or service provided under the contract shall not render
the physician a participating or non-participating physician,
and as such, requirements of this title that may otherwise
apply to a participating or non-participating physician would
not apply with respect to any items or services furnished under
the contract.
``(3) Beneficiary protections.--
``(A) In general.--Paragraph (1) shall not apply to
any contract unless--
``(i) the contract is in writing, is signed
by the Medicare beneficiary and the physician
or practitioner, and establishes all terms of
the contract (including specific payment for
physicians' services covered by the contract)
before any item or service is provided pursuant
to the contract, and the beneficiary shall be
held harmless for any subsequent payment
charged for a service in excess of the amount
established under the contract during the
period the contract is in effect;
``(ii) the contract contains the items
described in subparagraph (B); and
``(iii) the contract is not entered into at
a time when the Medicare beneficiary is facing
an emergency medical condition or urgent health
care situation.
``(B) Items required to be included in contract.--
Any contract to provide items and services to which
paragraph (1) applies shall clearly indicate to the
Medicare beneficiary that by signing such contract the
beneficiary--
``(i) agrees to be responsible for payment
to such physician or practitioner for such
items or services under the terms of and
amounts established under the contract;
``(ii) agrees to be responsible for
submitting claims under this title to the
Secretary, and to any other supplemental
insurance plan that may provide supplemental
insurance, for such items or services furnished
under the contract if such items or services
are covered by this title, unless otherwise
provided in the contract under subparagraph
(C)(i); and
``(iii) acknowledges that no limits or
other payment incentives that may otherwise
apply under this title (such as the limits
under subsection (g) of section 1848 or
incentives under subsection (a)(5), (m), (q),
and (p) of such section) shall apply to amounts
that may be charged, or paid to a beneficiary
for, such items or services.
Such contract shall also clearly indicate whether the
physician or practitioner is excluded from
participation under the Medicare program under section
1128.
``(C) Beneficiary elections under the contract.--
Any Medicare beneficiary that enters into a contract
under this section may elect to negotiate, as a term of
the contract, a provision under which--
``(i) the physician or practitioner shall
file claims on behalf of the beneficiary with
the Secretary and any supplemental insurance
plan for items or services furnished under the
contract if such items or services are covered
under this title or under the plan; and
``(ii) the beneficiary assigns payment to
the physician for any claims filed by, or on
behalf of, the beneficiary with the Secretary
and any supplemental insurance plan for items
or services furnished under the contract.
``(D) Exclusion of dual eligible individuals.--
Paragraph (1) shall not apply to any contract if a
beneficiary who is eligible for medical assistance
under title XIX is a party to the contract.
``(4) Limitation on actual charge and claim submission
requirement not applicable.--Section 1848(g) shall not apply
with respect to any item or service provided to a Medicare
beneficiary under a contract described in paragraph (1).
``(5) Construction.--Nothing in this section shall be
construed to prohibit any physician or practitioner from
maintaining an election and acting as a participating or non-
participating physician or practitioner with respect to any
patient not covered under a contract established under this
section.
``(6) Definitions.--In this subsection:
``(A) Medicare beneficiary.--The term `Medicare
beneficiary' means an individual who is entitled to
benefits under part A or enrolled under part B.
``(B) Physician.--The term `physician' has the
meaning given such term by paragraphs (1), (2), (3),
and (4) of section 1861(r).
``(C) Practitioner.--The term `practitioner' means
a practitioner described in section 1842(b)(18)(C).
``(D) Emergency medical condition.--The term
`emergency medical condition' means a medical condition
manifesting itself by acute symptoms of sufficient
severity (including severe pain) such that a prudent
layperson, with an average knowledge of health and
medicine, could reasonably expect the absence of
immediate medical attention to result in--
``(i) serious jeopardy to the health of the
individual or, in the case of a pregnant woman,
the health of the woman or her unborn child;
``(ii) serious impairment to bodily
functions; or
``(iii) serious dysfunction of any bodily
organ or part.
``(E) Urgent health care situation.--The term
`urgent health care situation' means services furnished
to an individual who requires services to be furnished
within 12 hours in order to avoid the likely onset of
an emergency medical condition.''.
SEC. 3. PREEMPTION OF STATE LAWS LIMITING CHARGES FOR PHYSICIAN AND
PRACTITIONER SERVICES.
(a) In General.--No State may impose a limit on the amount of
charges for services, furnished by a physician or practitioner, for
which payment is made under section 1848 of the Social Security Act (42
U.S.C. 1395w-4), and any such limit is hereby preempted.
(b) State.--In this section, the term ``State'' includes the
District of Columbia, Puerto Rico, the Virgin Islands, Guam, and
American Samoa.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 the Subcommittee on Health.
Referred to the Subcommittee on Health.
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