I 111th CONGRESS 1st Session H. R. 1384 IN THE HOUSE OF REPRESENTATIVES March 9, 2009 Mr. Price of Georgia 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 part B of title XVIII of the Social Security Act to remove limiting charges under the Medicare Program for non-participating physicians with beneficiary notice and to preempt State laws that prohibit balance billing.

1.

Removing limitations on balance billing with beneficiary notice

(a)

In general

Section 1848(g) of the Social Security Act (42 U.S.C. 1395w–4(g)) is amended— (1)in paragraph (1)(A), in the matter before clause (i), by inserting , subject to subparagraph (D), after enrolled under this part; (2)in paragraph (1), by adding at the end the following new subparagraph: (D)

Exception

Subparagraph (A) shall not apply with respect to physicians’ services furnished to an individual if the individual furnishing such services provides the advance notice of such non-participation and non-acceptance of assignment under paragraph (8). ; and (3)by adding at the end the following new paragraph: (8)

Notice of non-participation and non-acceptance of assignment

For purposes of paragraph (1)(D), the advance notice of non-participation and non-acceptance of assignment shall be, with respect to an item or service furnished under this part by (or under the supervision of) a physician, a notice (that may be in the form of a posting in a conspicuous place in a physician’s office or on patient information forms) that is posted or otherwise furnished in a manner so as to inform the individual receiving the item or service that— (A)the physician furnishing (or supervising the furnishing of) the items or service is not a participating physician and does not accept assignment with respect to the service; and (B)because of such non-acceptance, in the case of physicians’ services furnished to an individual, the charge imposed is not limited and may exceed the limiting charge described in paragraph (2). . (b)

Conforming amendment to private contract provisions

Section 1802 of such Act (42 U.S.C. 1395a) is amended by adding at the end the following new paragraph: (6)

Exception

The previous provisions of this subsection shall not apply to physicians’ services furnished to an individual if the advance notice described in section 1848(g)(8) has been provided. . (c)

Conforming amendment to participation provisions

Section 1842(h) of such Act (42 U.S.C. 1395u) is amended by adding at the end the following new paragraph: (9)The previous provisions of this subsection, insofar as they limit the charges that a participating physician may impose, shall not apply to physicians’ services furnished to an individual if the advance notice described in section 1848(g)(8) has been provided. . (d)

Effective date

The amendments made by this section shall apply to services furnished on or after the date of the enactment of this Act.

2.

Preemption of State laws limiting charges for physicians’ services

(a)

In general

No State may impose a limit on the amount of charges, in relation to recognized payment amounts under any health plan or otherwise, a physician (as defined in section 1861(r)(1) of the Social Security Act) may impose for services furnished by the physician 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.