I 110thcongress H.R.7148 2dSession ToamendtitleXVIIIoftheSocialSecurityActtoclarifytheuseofprivate contractsbyMedicarebeneficiariesforprofessionalservicesandtoallow individualstochoosetooptoutoftheMedicarepartAbenefits. IN THE HOUSE OF REPRESENTATR^S September26,2008 Mr. SamJohnsonofTexas(forhmiself,Mr.RyanofWisconsin,Mr.LlN- DER, Mr. BradyofTexas, Mr. Herger, Mr. CampofMichigan, Ms. Granger,Mr.Thornberry,Mr.Carter,Mr.Neugebauer,andMr. Paul)introducedthefollowingbill;whichwasreferredtotheCommittee on"WaysandMeans,andinadditiontotheCommitteeonEnergv'and Commerce, foraperiodtobesubsequentlydeterminedbythe Speaker, ineachcaseforconsiderationofsuchprovisionsasfallwithinthejuris- dictionofthecommitteeconcerned A BILL To amend title X\T;II of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional senices and to allow individuals to choosetooptoutoftheMedicarepartAbenefits. 1 BeitenactedbytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE. 4 ThisActmaybecited asthe "Medicare Beneficiary 5 FreedomtoChooseActof2008". — 2 1 SEC.2.USEOFPRIVATECONTRACTSBYMEDICAREBENE- 2 FICIARIESFORPROFESSIONALSERVICES. — 3 (a)InGeneral. Section 1802(b) oftheSocialSe- 4 curityAct (42 U.S.C. 1395a) is amendedto readasfol- 5 lows: 6 "(b) Clarification of Use of Prwate Con- 7 TRACTS BY MEDICARE BENEFICIARIES FOR PROFES- 8 SIONALSER\aCES. — 9 "(1) In GENERAL. Nothing in this title shall 10 prohibitamedicarebeneficiary'from enteringinto a 11 private contract with a physician or health care 12 practitioner for the pro\ision of medicare covered 13 professional services (as defined in paragraph 14 (5)(C))if— 15 "(A) the services are covered under a pri- 16 vate contract that is between the beneficiary 17 andthephysicianorpractitionerandmeetsthe 18 requirementsofparag:raph(2); 19 "(B) under the private contract no claim 20 forpa\Tiientforsendeescoveredunderthecon- 21 tractistobesubmitted (andnopaynnentmade) 22 underpartAorB,underacontractundersec- 23 tion 1876, orunderan]\IAplan (otherthanan 24 MSAplan); and 25 "(C)(i) the Secretary' has been pro\ided 26 \vith the minimum information necessary^ to •HR7148m 3 1 avoidanypa^iiieiitunderpartAorB forserv- 2 icescoveredunderthecontract,or 3 "(ii) in the case of an indi\idual en- 4 rolledundera contractundersection 1876 5 or an ]\IAplan (otherthan an MSAplan) 6 under part C, the eli^ble organization 7 underthecontractortheMAorganization 8 offering the plan has been provided the 9 minimum information necessary to avoid 10 any pavTnent under such contract or plan 11 forsenicescoveredunderthecontract. 12 "(2) Requirements for private con- — 13 TRACTS. The requirements in this paragraph for a 14 private contractbetween a medicarebeneficiary^and 15 a physician or health care practitioner are as fol- 16 lows: — 17 "(A) General form of contract. The 18 contractisinwritingandissignedbythemedi- 19 carebeneficiarj'. 20 "(B) No CLAIMS to be submitted for — 21 co\"ERED SER\aCES. The contract provides 22 thatnopartyto the contract (andno entityon 23 behalfof any party to the contract) shall sub- 24 mit any claim for (or request) pajment for 25 services covered under the contract under part •HR7148IH — — 4 1 A or B, under a contract under section 1876, 2 or under an ]\IA plan (other than an I\ISA 3 plan). — 4 "(C) Scope of SEmacES. The contract 5 identifies the medicare covered professional 6 ser^^ees and the period (if any) to be covered 7 underthecontract,butdoesnotcoveranyserv- 8 icesfurnished 9 "(i) before the contract is entered 10 into;or 11 "(ii) for the treatment of an emer- 12 gencymedicalcondition (as definedin sec- 13 tion 1867(e)(1)(A)), unless the contract 14 was entered into before the onset of the 15 emergencymedicalcondition. — 16 "(D) Cleardisclosureofterms. The 17 contract clearly indicates that by siting the 18 contractthemedicarebeneficiars' 19 "(i) agr-ees not to submit a claim (or 20 to request that anyone submit a claim) 21 underpartAorB (orunder section 1876 22 orunderan ]\IAplan, otherthan an MSA 23 plan) for services covered under the con- 24 tract; •HR7148IH "(ii) agreestobe responsible,whether through insurance or otherwise, for pay- ment for such sendees and understands that no reimbursement wiW be pro\ided undersuchpart, contract, orplanforsuch services; ''(iii) acknowledges that no limits under this title (including hmits under paragraphs (1) and(3) ofsection 1848(g)) willapplytoamountsthatmaybecharged forsuchservices; "(iv) acknowledgesthatmedicaresup- plemental policies under section 1882 do not, and other supplemental health plans and pohcies may elect not to, make pay- mentsforsuchservicesbecausepajnuentis notmadeunderthistitle;and "(v) acknowledgesthatthebeneficiary has the right to have such services pro- ^^ded by (or under the supervision of) other physicians or health care practi- tioners forwhom payment would be made undersuchpart,contract,orplan. — 6 1 Suchcontractshallalsoclearlyindicatewhether 2 the physician or practitioner involved is ex- 3 eludedfromparticipationunderthistitle. — 4 "(3) Modifications. Thepartiesto a private 5 contract maymutually a^ee at anytime to modify 6 or terminate the contract on a prospective basis, 7 consistentwiththepro^^sionsofparagraphs (1) and 8 (2). 9 "(4) No REQUIREMENTS FOR SERVICES FUR- — 10 NISHED TO MSA PLAN ENROLLEES. The require- 11 mentsofparagraphs (1) and (2) donotapplytoany 12 contractorarrangementfortheprovisionofservices 13 to a medicare beneficiarv^ enrolled in an MA plan 14 underpartC. — 15 "(5)Definitions. Inthissubsection: — 16 "(A) Health care practitioner. The 17 term 'health care practitioner' means a practi- 18 tionerdescribedinsection 1842(b)(18)(C). — 19 "(B) Medicare beneficiary. The term 20 'medicare beneficiar\^' means an indi\idualwho 21 isenrolledunderpartB. 22 "(C) Medicare co\^red professional — 23 services. Theterm 'medicarecoveredprofes- 24 sionalservices'means •HR7148IH 7 1 "(i) physicians' services (asdefinedin 2 section 1861(q), and includingsendees de- 3 scribedinsection 1861(s)(2)(A)),and 4 'Hii) professional senices of health 5 care practitioners, including services de- 6 scribedinsection 1842(b)(18)(D), 7 forwhich pa^iuent maybe made underpartA 8 or B, under a contract under section 1876, or 9 underaMedicare+Choiceplanbutforthepro- 10 \dsions ofaprivate contract that meets the re- 11 quirementsofparagraph (2). — 12 "(D) PLAN; MSA PLAN. The terms 13 ']MA plan' and 'MSA plan' have the meanings 14 givensuchtermsinsection 1859. — 15 "(E) Physicl;\.n. The term 'physician' 16 has the meaning given such term in section 17 1861(r).". 18 (b) Conforming Amendments Clarifying Ex- 19 EMPTiONFromLimitingChargeandFromRequire- — 20 ment for Submission of Claims. Section 1848(g) of 21 theSocialSecurityAct(42U.S.C. 1395w-4(g))isamend- 22 ed— 23 (1) in paragraph (1)(A), by striking "In" and 24 inserting"Subjecttoparagraph (8),in"; •HR7148IH — 8 1 (2) inparag:raph (3)(A),bystriking"PajTiient" 2 and inserting "Subject to paragraph (8), payment"; 3 (3) inparagraph (4)(A), bystriking"For" and 4 inserting"Subjecttoparagraph (8),for"; and 5 (4) by adding at the end the follov^dng new 6 paragraph: 7 "(8) Exemption from requirements for 8 services furnished under private con- 9 TRACTS. — 10 "(A) In general. Pursuant to section 11 1802(b)(1),paragraphs (1), (3), and (4) donot 12 apply with respect to physicians' services (and 13 sendeesdescribedinsection 1861(s)(2)(A))fur- 14 nishedto an individualby (orunderthe super- 15 visionof) aphysicianiftheconditionsdescribed 16 in section 1802(b)(1) are met with respect to 17 theservices. 18 "(B) No RESTRICTIONS FOR ENROLLEES — 19 IN MSAPLANS. Suchparagraphs do not apply 20 withrespectto servicesfurnishedto individuals 21 enrolledwithMSAplansunderpart C, \dthout 22 regard to whether the conditions described in 23 subparagraphs (A) through (C) of section 24 1802(b)(1) aremet. •HR7148IH 1 "(C) Application to enrollees in — 2 OTHER PLANS. Subject to subparagraph (B) 3 and section 1852(k)(2), the pro\isions of sub- 4 paragraph (A) shall applyin the case ofan in- 5 di\idualenrolledundera contractundersection 6 1876orunderan]\IAplan (otherthananMSA 7 plan)underpartC,inthesamemannerasthey 8 apply to indi\iduals not enrolled under such a 9 contractorplan.". — 10 (c) Conforming Amendments. (1) Section 11 1842(b)(18) of the Social Security Act (42 U.S.C. 12 1395u(b)(18)) is amended by adding at the end the fol- 13 lowing: 14 "(E) The provisions of section 1848(g)(8) 15 shallapply\\ithrespecttoexemptionfromlimi- 16 tations on charges and from billing require- 17 ments for services of health care practitioners 18 describedinthisparagraphinthesamemanner 19 as suchpro\dsions applyto exemptionfromthe 20 requirements referred to in section 21 1848(g)(8)(A)forphysicians'senices.". 22 (2) Section 1866(a)(l)(0) of such Act (42 U.S.C. 23 1395cc(a)(l)(0)) isamendedbystriking"enrolled^^^tha 24 Medicare+Choiceorganizationunderpart C" andinsert- •HK7148IH — 10 1 ing "enrolled with an IVIA organization under part C 2 (otherthanunderanMSAplan)". — 3 (d) Effectr^ Date. The amendments made by 4 thissection shalltakeeffectonthedatethatis 6 months 5 afterthe date ofthe enactment ofthisAct and applyto 6 contractsenteredintoonorafterthatdate. 7 SEC.3.ALLOWINGINDIVIDUALSTOCHOOSETOOPTOUT 8 OFTHEMEDICARE PARTABENEFIT;ELIGI- 9 BILITYFORHEALTHSAVINGSACCOUNTS. — 10 (a) InGeneral. Notwithstandinganyotherprovi- 11 sionoflaw,nopro\dsionoflaworregulationshallbecon- 12 strued as preventingan indi\idualwho is otherwise enti- 13 tied tobenefitsunderpartAoftitleX\T;II ofthe Social 14 SecurityActfromelecting,inaformandmannerspecified 15 by the Secretary' of Health and Human Services, from 16 wai\ingthe rights to such benefits and otherwise opting 17 outofrightofreceivingbenefitsundersuchpart. 18 (b) Individuals Opting Out of Medicare Part 19 AEligible forHealth SavingsAccounts.—Section 20 223 ofthe InternalRevenue Code of1986 isamended 21 (1) insubsection(b),bystrikingparagraph (7), 22 and 23 (2) in subsection (d)(2)(C)(iv), by inserting 24 "and who has not waived the rights to benefits •HR7148m