[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1310 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 1310

To amend title XVIII of the Social Security Act to establish a Medicare 
   payment option for patients and eligible professionals 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

                             March 21, 2013

 Mr. Price of Georgia (for himself, Mr. Roe of Tennessee, Mr. Tiberi, 
Mr. Harris, Mr. Poe of Texas, and Mr. Bonner) 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 eligible professionals 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 of 
2013''.

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 an eligible 
        professional 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 supplier (as defined in section 1842(h)(1)) in the 
        payment area where the eligible professional covered by the 
        contract resides. Payment made under this title for any item or 
        service provided under the contract shall not render the 
        eligible professional a participating or non-participating 
        physician or supplier, and as such, requirements of this title 
        that may otherwise apply to a participating or non-
        participating physician or supplier 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 eligible 
                        professional, and establishes all terms of the 
                        contract (including specific payment for items 
                        and 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 eligible professional 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 
                eligible professional 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 eligible professional 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 eligible professional 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 eligible professional from 
        maintaining an election and acting as a participating or non-
        participating physician or supplier 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) Eligible professional.--The term `eligible 
                professional' has the meaning given such term in 
                section 1848(k)(3)(B).
                    ``(C) 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.
                    ``(D) 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 SERVICES BY AN 
              ELIGIBLE PROFESSIONAL.

    (a) In General.--No State may impose a limit on the amount of 
charges for services, furnished by an eligible professional, 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>