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Healthcare Competition Act


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Senator Fitzgerald, with thanks to Mr. Banks, introduces

A BILL

To amend title XVIII of the Social Security Act to increase hospital competition, and for other purposes.

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 “Healthcare Competition Act”.

SEC. 2. HOSPITAL CONSOLIDATION.

(a) Authorization Of Appropriations.—There is authorized to be appropriated $160,000,000 to the Federal Trade Commission to hire staff to investigate, as consistent with the Sherman Antitrust Act and other relevant Federal laws, anti-competitive mergers and practices under such laws to the extent such mergers and practices relate to providers of inpatient and outpatient health care services, as defined by the Secretary of Health and Human Services.

(b) Medicare Rates Applied To Certain HHI Hospitals.—

(1) IN GENERAL.—Section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)) is amended—

(A) in paragraph (1)—

(i) in subparagraph (X), by striking “and” at the end;

(ii) in subparagraph (Y), by striking the period at the end and inserting “; and”; and

(iii) by inserting after subparagraph (Y) the following new subparagraph:


“(Z) subject to paragraph (4), in the case of a hospital in an urban area and with respect to which there is a Herfindahl-Hirschman Index (HHI) of greater than 4,000 and in the case of a hospital in a rural area and with respect to which there is Herfindahl-Hirschman Index (HHI) of greater than 5,000, to apply the reimbursement rate with respect to individuals (regardless of whether such an individual is entitled to or eligible for benefits under this title, but excluding individuals eligible for medical assistance under a State plan under title XIX) furnished items and services at such hospital that would be billable under this title for such items and services if furnished by such hospital to an individual entitled to or enrolled for benefits under this title.”; and

(B) by adding at the end the following new paragraph:


“(4) (A) The requirement under paragraph (1)(Z) shall not apply in the case of a hospital in a hospital referral region if the HRR market share of such hospital (as determined under subparagraph (B)) is less than 0.15.

“(B) For purposes of subparagraph (A), the HRR market share of a hospital in a hospital referral region is equal to—

“(i) the total revenue of the hospital, divided by

“(ii) the total revenue of all hospital in the hospital referral region.”.

(2) EFFECTIVE DATE.—The amendments made by this subsection shall apply with respect to items and services furnished on or after January 1, 2025.

(c) Grants For Hospital Infrastructure Improvement.—

(1) IN GENERAL.—The Secretary of Health and Human Services shall carry out a grant program under which the Secretary shall provide grants to eligible States, in accordance with this subsection.

(2) USES.—An eligible State receiving a grant under this subsection may use such grant to improve the State hospital infrastructure and to supplement any other funds provided for a purpose authorized under a State or local hospital grant programs under State law.

(3) ELIGIBILITY.—

(A) IN GENERAL.—An eligible State may receive not more than one grant under this subsection with respect to each qualifying criterion described in subparagraph (B) that is met by the State.

(B) ELIGIBLE STATE.—For purposes of this subsection, the term “eligible State” means a State that meets any one or more of the following qualifying criteria:

(i) The State does not have in effect any State certificate of need law that requires a health care provider to provide to a regulatory body a certification that the community needs the services provided by the health care provider.

(ii) The State has in effect State scope of practice laws that—

(I) allow advanced practice providers (such as nurse practitioners, advanced practice registered nurses, clinical nurse specialists, and physician assistants) to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments; or

(II) provide that the only justification for limiting the scope of practice of a health care provider is safety to the public.

(iii) The State does not have in effect any State laws that require managed care plans to accept into the network of such plan any qualified provider who is willing to accept the terms and conditions of the managed care plan.

(iv) The State does not have in effect a law that prohibits health insurers from directing policy-holders to lower-cost options through unsolicited recommendations.

(4) FUNDING.—There is authorized to be appropriated to carry out this subsection $1,000,000,000 for each of the fiscal years 2024 through 2033. Funds appropriated under this paragraph shall remain available until expended.

SEC. 3. OFF-CAMPUS PROVIDER-BASED DEPARTMENT MEDICARE SITE NEUTRAL PAYMENT.

(a) In General.—Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:


“(x) Off-Campus Provider-Based Department Site Neutral Payment.—

“(1) IN GENERAL.—With respect to items and services furnished in an off-campus provider-based department, payment under this section for such items and services shall be the amount determined under the fee schedule under section 1848 for such items and services furnished if furnished in a physician office setting.

“(2) OFF-CAMPUS PROVIDER-BASED DEPARTMENT.—For purposes of this subsection, the term ‘off-campus provider-based department’ has such meaning as specified by the Secretary.”.

(b) Effective Date.—The amendment made by subsection (a) shall apply with respect to items and services furnished on or after January 1, 2025.

SEC. 4. REPEALING SHARED SAVINGS INCENTIVES FROM MEDICARE SHARED SAVINGS PROGRAM.

(a) In General.—Section 1899 of the Social Security Act (42 U.S.C. 1395jjj) is amended—

(1) in subsection (a)(1)—

(A) by striking subparagraph (B); and

(B) by striking such program—

“(A) groups of providers” and inserting

such program, groups of providers”;
(2) in subsection (b)(2)—

(A) in subparagraph (C), by striking “that would allow the organization to receive and distribute payments for shared savings under subsection (d)(2) to participating providers of services and suppliers”; and

(B) in subparagraph (E)—

(i) by striking “the implementation” and inserting “and the implementation”; and

(ii) by striking “, and the determination of payments for shared savings under subsection (d)(2)”;

(3) in subsection (d)—

(A) in paragraph (1)—

(i) in subparagraph (A), by striking “except” and all that follows through the period at the end; and

(ii) by striking subparagraph (B); and

(B) by striking paragraph (2); and

(4) in subsection (g), by striking paragraph (4) and redesignating paragraphs (5) and (6) as paragraphs (4) and (5), respectively.

(b) Effective Date.—The amendments made by subsection (a) shall take effect on January 1, 2021.

SEC. 5. PRICE TRANSPARENCY.

Section 1866 of the Social Security Act (42 U.S.C. 1395cc), as amended by section 2, is further amended—

(1) in subsection (a)(1)—

(A) in subparagraph (Y), by striking “and” at the end;

(B) in subparagraph (Z), by striking the period at the end and inserting “; and”; and

(C) by inserting after subparagraph (Z) the following new subparagraph:


“(AA) in the case of a hospital, to comply with the requirement under subsection (l).”; and

(2) by adding at the end the following new subsection:

“(l) Requirement Relating To Publishing Certain Hospital Prices.—

“(1) IN GENERAL.—For purposes of subsection (a)(1)(AA), the requirement described in this subsection is, with respect to a hospital and year (beginning with 2021), for the hospital to publicly post, through the system established under paragraph (3), for each service included in the list published under paragraph (2) for such year, the volume-weighted average price charged by the hospital to—

“(A) individuals enrolled during such year in group health plans or health insurance coverage offered in the individual or group market (as such terms are defined in section 2791 of the Public Health Service Act); and

“(B) individuals who are not enrolled in any health insurance coverage or health benefits plan and individuals who are enrolled in such coverage or plan but such coverage or plan does not provide benefits for the service.

“(2) SERVICES.—For purposes of subsection (a)(1)(AA) and this subsection, the Secretary shall, for 2021 and each subsequent year, publish a list of the 100 services that are the most highly utilized in a hospital-based setting.

“(3) STANDARDIZED DIGITAL REPORTING SYSTEM.—Not later than January 1, 2025, the Secretary shall establish a standardized digital system for purposes of paragraph (1).”.

SEC. 6. REPEAL OF HEALTH CARE REFORM PROVISIONS LIMITING MEDICARE EXCEPTION TO THE PROHIBITION ON CERTAIN PHYSICIAN REFERRALS FOR HOSPITALS.

Sections 6001 and 10601 of the Patient Protection and Affordable Care Act (Public Law 111–148; 124 Stat. 684, 1005) and section 1106 of the Health Care and Education Reconciliation Act of 2010 (Public Law 111–152; 124 Stat. 1049) are repealed and the provisions of law amended by such sections are restored as if such sections had never been enacted.

PES: 

This bill establishes a series of programs and requirements relating to hospital costs, payments, and infrastructure.

Among other things, the bill requires hospitals, as a condition of Medicare participation, to (1) in the case of hospitals that meet specified market concentration thresholds, apply Medicare reimbursement rates regardless of whether the individual receiving services is entitled to or enrolled in Medicare; and (2) publish the prices charged for specified services that are highly utilized.

The bill also repeals (1) performance incentives under the Medicare Shared Savings Program for accountable care organizations, and (2) provisions under the Stark law (i.e., the Physician Self-Referral Law) that prohibit physician-owned hospitals from expanding facility capacity.

Edited by TexAgRepublican

Former President Kyle Fitzgerald

Three-Time Republican Nominee

Nobel Peace Prize Winner

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  • TexAgRepublican changed the title to Healthcare Competition Act
  • 4 weeks later...

Voting Bloc Total Aye Nay Present
Nationalist Republicans 47 47 0 0
Evangelical Republicans 48 48 0 0
Business Republicans 45 45 0 0
Moderate Conservative Republicans 60 60 0 0
Moderate LiberalRepublicans 17 14 2 0
Moderate Conservative Independents 2 2 0 0
Moderate Liberal Independents 2 2 0 0
SJW Democrats 53 0 53 0
Progressive Democrats 58 0 58 0
Environmentalist Democrats 48 0 48 0
Moderate Liberal Democrats 46 0 46 0
Moderate Conservative Democrats 9 3 5 0
  221 212 0

Christopher Drake

Republican, NY-2

Speaker of the United States House of Representatives

Former Chief Administrator - Rounds 4 & 5, Evil Arch-Conservative, Frequent Republican Player

 

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Aye 27
Nay 23
Present 0
 
Senate Votes
State Senator Philosophy Vote
Alabama Tommy Tuberville Nationalist Aye
Alaska Holly Hawthorne Nationalist Aye
Arizona Mick McGuire Nationalist Aye
Arkansas Tom Cotton Nationalist Aye
California Dianne Feinstein Progressive Nay
Colorado John Hickenlooper Moderate Liberal Nay
Connecticut Chris Murphy Progressive Nay
Delaware Tom Carper Moderate Liberal Nay
Florida Marco Rubio Evangelical Aye
Georgia Raphael Warnock Social Justice Warrior Nay
Hawaii Mazie Hirono Environmentalist Nay
Idaho Mike Crapo Evangelical Aye
Illinois Dick Durbin Progressive Nay
Indiana Mike Braun Evangelical Aye
Iowa Chuck Grassley Business Aye
Kansas Jerry Moran Business Aye
Kentucky Mitch McConnell Business Aye
Louisiana John Kennedy Evangelical Aye
Maine Susan Collins Moderate Conservative Aye
Maryland Larry Hogan Moderate Conservative Aye
Massachusetts Elizabeth Warren Progressive Nay
Michigan Debbie Stabenow Environmentalist Nay
Minnesota Amy Klobuchar Moderate Liberal Nay
Mississippi Roger Wicker Evangelical Aye
Missouri Josh Hawley Nationalist Aye
Montana Jon Tester Moderate Liberal Nay
Nebraska Ben Sasse Evangelical Aye
Nevada Catherine Cortez Masto Social Justice Warrior Nay
New Hampshire Jeanne Shaheen Moderate Liberal Nay
New Jersey Cory Booker Progressive Nay
New Mexico Martin Heinrich Environmentalist Nay
New York Chuck Schumer Moderate Liberal Nay
North Carolina Richard Burr Business Aye
North Dakota John Hoeven Evangelical Aye
Ohio Tim Ryan Moderate Liberal Nay
Oklahoma Jim Inhofe Evangelical Aye
Oregon Alek Skarlatos Nationalist Aye
Pennsylvania Bob Casey Jr Moderate Liberal Nay
Rhode Island Sheldon Whitehouse Environmentalist Nay
South Carolina Lindsey Graham Business Aye
South Dakota John Thune Business Aye
Tennessee Marsha Blackburn Nationalist Aye
Texas Ted Cruz Evangelical Aye
Utah Mitt Romney Business Aye
Vermont Bernie Sanders Progressive Nay
Virginia Tim Kaine Moderate Liberal Nay
Washington Patty Murray Environmentalist Nay
West Virginia Kyle Fitzgerald Nationalist Aye
Wisconsin Mandela Barnes Progressive Nay
Wyoming John Barrasso Evangelical Aye
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