[Congressional Record Volume 149, Number 25 (Tuesday, February 11, 2003)]
[Senate]
[Page S2205]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. NELSON of Florida (for himself, Mr. Kennedy, Mr. Graham of 
        Florida, Mr. Edwards, and Mr. Sarbanes):
  S. 345. A bill to amend the title XVIII of the Social Security Act to 
prohibit physicians and other health care practitioners from charging 
membership or other incidental fee (or requiring purchase of other 
items or services) as a prerequisite for the provision of an item or 
service to a medicare beneficiary; to the Committee on Finance.
  Mr. NELSON of Florida. Mr. President, I rise today to introduce the 
Equal Access to Medicare Act to combat the growing practice of 
``concierge care'' medical practices. As my colleagues may recall I 
introduced similar legislation last Congress to deal with the growing 
problem of doctors shutting down their practices and opening new ones, 
only accepting those patients willing to pay a membership fee. These 
fees range from $1,500 to $20,000 annually. By charging these dues, or 
requiring patients to purchase non-Medicare covered services, doctors 
have been able to shrink their patient load and maintain high profit 
margins while continuing to bill Medicare, all on the backs of low- and 
middle-income beneficiaries.
  This is a dangerous model that causes significant disparities in the 
care available to Medicare beneficiaries. A doctor receiving Medicare 
reimbursement should not be allowed to turn away those Medicare 
beneficiaries who cannot, or choose not to pay a membership fee. My 
bill simply prevents Medicare from reimbursing doctors who charge 
membership fees or require the purchase of non-Medicare covered 
services as a condition for the provision of care.
  Since the introduction of this bill in 2001, the practice has been 
rapidly expanding with versions in many states. As an increasing number 
of Medicare beneficiaries voice their concerns, it is time for Congress 
to act. I hope that as we debate Medicare modernization this year, 
Congress will agree to put an end to this egregious practice.
  In addition to the concerns of seniors, health care advocacy groups 
have begun to weigh in as well. Both the American Academy of Family 
Physicians and the American Medical Association have expressed concern 
about the ``. . . risks associated with the spread of this model'', 
AMA, June 2002 report. Should this practice proliferate, a doctor 
shortage for low- and middle-income Medicare beneficiaries is likely, 
exacerbating an already ailing health care marketplace.
  I must emphasize: this bill does not interfere with a doctor's 
ability to set up a practice with a limited number of patients while 
remaining adequately compensated. Nor would doctors who participate in 
Medicare be prevented from contracting privately with patients for non-
Medicare covered services. It simply provides that doctors who 
participate in the Medicare program may not select patients based upon 
willingness or ability to pay a fee for other services. This is the 
same standard that private insurance companies apply to their 
providers.
  I hope my colleagues will join me in helping Medicare keep its 
promise of accessibility to seniors who have paid a lifetime of 
``premiums.''
  I ask unanimous consent that the text of this legislation be printed 
in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 345

       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 ``Equal Access to Medicare Act 
     of 2003''.

     SEC. 2. PROHIBITION OF INCIDENTAL FEES AND REQUIRED PURCHASE 
                   OF NONCOVERED ITEMS OR SERVICES UNDER MEDICARE.

       (a) In General.--Section 1842 of the Social Security Act 
     (42 U.S.C. 1395u) is amended by adding at the end the 
     following new subsection:
       ``(u) Prohibition of Incidental Fees or Requiring Purchase 
     of Noncovered Items or Services.--
       ``(1) In general.--A physician, practitioner (as described 
     in section 1842(b)(18)(C)), or other individual may not--
       ``(A) charge a membership fee or any other incidental fee 
     to a medicare beneficiary (as defined in section 
     1802(b)(5)(A)); or
       ``(B) require a medicare beneficiary (as so defined) to 
     purchase a noncovered item or service,
     as a prerequisite for the provision of a covered item or 
     service to the beneficiary under this title.
       ``(2) Construction.--Nothing in this subsection shall be 
     construed to apply the prohibition under paragraph (1) to a 
     physician, practitioner, or other individual described in 
     such subsection who does not accept any funds under this 
     title.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to membership fees and other charges made, or 
     purchases of items and services required, on or after the 
     date of enactment of this Act.
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