Improved Health Care at Lower Cost Act of 2013 - Amends title XVIII (Medicare) and XI of the Social Security Act with respect to the prohibition against certain (potential financial conflict-of-interest) physician referrals.
Excepts from the physician self-referral prohibition any monetary incentive payments made by hospitals to physicians under certain incentive payment programs designed to align incentives among hospitals and physicians (through techniques such as product standardization, the substitution of lower cost products, and care coordination initiatives that encourage medically appropriate decreases in length of stay) to improve efficiency and decrease costs while maintaining or improving quality.
Exempts such monetary incentive payments (creates a safe harbor for them) from federal criminal antikickback and other sanctions.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1487 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 1487
To amend titles XVIII and XI of the Social Security Act to establish an
exception from the physician self-referral prohibition and a safe
harbor from Federal antikickback and other sanctions for incentive
payments made by hospitals to physicians under certain incentive
payment programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 11, 2013
Mr. McDermott 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 titles XVIII and XI of the Social Security Act to establish an
exception from the physician self-referral prohibition and a safe
harbor from Federal antikickback and other sanctions for incentive
payments made by hospitals to physicians under certain incentive
payment programs.
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 ``Improved Health Care at Lower Cost
Act of 2013''.
SEC. 2. EXCEPTION AND SAFE HARBOR FROM FEDERAL SANCTIONS FOR INCENTIVE
PAYMENTS FROM HOSPITALS TO PHYSICIANS UNDER CERTAIN
INCENTIVE PAYMENT PROGRAMS.
(a) Findings.--Congress finds the following:
(1) The Department of Health and Human Services has been
engaged in approving, on a project-by-project basis, gain-
sharing arrangements under demonstration authority for nearly a
decade. Based on the knowledge gained from such demonstration
projects, the Department is capable of developing and applying
standards for permitting such arrangements more generally
without the use of such authority.
(2) The Inspector General of the Department of Health and
Human Services has issued a special advisory bulletin in July
1999 that indicates that there is no general authority for
waiving sanctions for any gain-sharing arrangements between
physicians and hospitals.
(3) Due to lack of capitalization, size limitations, risk
characteristics, and other factors, many hospitals and
physicians have been unable or unwilling to enter into gain-
sharing types of arrangements that meet the requirements of the
shared savings program.
(b) Purpose.--The purpose of this section is to establish general
statutory authority within the Department of Health and Human Services
to recognize gain-sharing and other incentive payment programs, other
than the shared savings program, that align incentives among hospitals
and physicians to improve efficiency and decrease costs while
maintaining or improving quality care.
(c) Exception From Physician Self-Referral Prohibition.--Section
1877(e) of the Social Security Act (42 U.S.C. 1395nn(e)) is amended by
adding at the end the following new paragraph:
``(9) Payments under certain incentive payment programs
between hospitals and physicians.--
``(A) In general.--In the case of a monetary
incentive payment which is made by a hospital to a
physician under an incentive payment program (as
defined in subparagraph (B)) that meets requirements
established by the Secretary in consultation with the
Attorney General and the Inspector General of the
Department of Health and Human Services for purposes of
this paragraph.
``(B) Incentive payment program defined.--In this
paragraph, the term `incentive payment program' means a
program that is designed to align incentives among
hospitals and physicians (through techniques such as
product standardization, the substitution of lower cost
products, and care coordination initiatives that
encourage medically appropriate decreases in length of
stay) to improve efficiency and decrease costs while
maintaining or improving quality.''.
(d) Safe Harbor From Antikickback and Other Federal Sanctions.--
(1) Section 1128B(b)(3) of the Social Security Act (42
U.S.C. 1320a-7b(b)(3)) is amended--
(A) by striking ``and'' at the end of subparagraph
(I);
(B) in subparagraph (J), by moving the indentation
2 ems to the left and by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(K) any monetary incentive payment which is made by a
hospital to a physician under an incentive payment program (as
defined in subparagraph (B) of section 1877(e)(9)) that meets
requirements established by the Inspector General of the
Department of Health and Human Services in consultation with
the Attorney General for purposes of applying this subparagraph
(which requirements needs not be the same as those established
under subparagraph (A) of such section).''.
(2) Section 1128A(b)(1) of the Social Security Act (42
U.S.C. 1320a-7a(b)(1)) is amended by inserting ``(other than a
monetary incentive payment described in section
1128B(b)(3)(K))'' after ``makes a payment''.
(e) Publication of Guidance.--The Secretary of Health and Human
Services and the Inspector General of the Department of Health and
Human Services--
(1) not later than 6 months after the date of the enactment
of this Act, shall jointly publish a solicitation of comments
to carry out the amendments made by this section; and
(2) not later than 12 months after such date of enactment,
shall publish, jointly or separately, such guidance or rules,
which may be effective on an interim, final basis, as may be
necessary to carry out such amendments in a timely manner.
(f) Construction.--Nothing in this section (or the amendments made
by this section) shall be construed as affecting the operation of the
shared savings program.
(g) Shared Savings Program Defined.--In this section, the term
``shared savings program'' means such program under section 1899 of the
Social Security Act (42 U.S.C. 1395jjj).
<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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