[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4822 Introduced in House (IH)]







108th CONGRESS
  2d Session
                                H. R. 4822

To amend title XVIII of the Social Security Act to clarify the right of 
Medicare beneficiaries to enter into private contracts with physicians 
    and other health care professionals for the provision of health 
  services for which no payment is sought under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 13, 2004

  Mr. Sam Johnson of Texas (for himself, Mr. Norwood, and Mr. Crane) 
 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 right of 
Medicare beneficiaries to enter into private contracts with physicians 
    and other health care professionals for the provision of health 
  services for which no payment is sought under the Medicare Program.

    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 
Contract Act of 2004''.

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 a 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 a 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 a 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 a 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 paragraph 
                        (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 MA 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+Choice 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 a 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+Choice organization 
under part C'' and inserting ``enrolled with a 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.
                                 <all>