Hospital Competition Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 506 To amend title XVIII of the Social Security Act to increase hospital competition, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JANUARY 11, 2019 Mr. BANKS (for himself and Mr. WESTERMAN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and the Judiciary, 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 com- mittee concerned 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Hospital Competition 4 Act of 2019’’. 5 SEC. 2. HOSPITAL CONSOLIDATION. 6 (a) AUTHORIZATION OF APPROPRIATIONS.—There is 7 authorized to be appropriated $160,000,000 to the Fed- 8 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 506 IH eral Trade Commission to hire staff to investigate, as con- 1 sistent with the Sherman Antitrust Act and other relevant 2 Federal laws, anti-competitive mergers and practices 3 under such laws to the extent such mergers and practices 4 relate to providers of inpatient and outpatient health care 5 services, as defined by the Secretary of Health and 6 Human Services. 7 (b) MEDICARE RATES APPLIED TO CERTAIN HHI 8 HOSPITALS.— 9 (1) IN GENERAL.—Section 1866(a) of the So- 10 cial Security Act (42 U.S.C. 1395cc(a)) is amend- 11 ed— 12 (A) in paragraph (1)— 13 (i) in subparagraph (X), by striking 14 ‘‘and’’ at the end; 15 (ii) in subparagraph (Y), by striking 16 the period at the end and inserting ‘‘; 17 and’’; and 18 (iii) by inserting after subparagraph 19 (Y) the following new subparagraph: 20 ‘‘(Z) subject to paragraph (4), in the case of a 21 hospital in an urban area and with respect to which 22 there is a Herfindahl-Hirschman Index (HHI) of 23 greater than 4,000 and in the case of a hospital in 24 a rural area and with respect to which there is 25 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 506 IH Herfindahl-Hirschman Index (HHI) of greater than 1 5,000, to apply the reimbursement rate with respect 2 to individuals (regardless of whether such an indi- 3 vidual is entitled to or eligible for benefits under this 4 title, but excluding individuals eligible for medical 5 assistance under a State plan under title XIX) fur- 6 nished items and services at such hospital that 7 would be billable under this title for such items and 8 services if furnished by such hospital to an indi- 9 vidual entitled to or enrolled for benefits under this 10 title.’’; and 11 (B) by adding at the end the following new 12 paragraph: 13 ‘‘(4)(A) The requirement under paragraph (1)(Z) 14 shall not apply in the case of a hospital in a hospital refer- 15 ral region if the HRR market share of such hospital (as 16 determined under subparagraph (B)) is less than 0.15. 17 ‘‘(B) For purposes of subparagraph (A), the HRR 18 market share of a hospital in a hospital referral region 19 is equal to— 20 ‘‘(i) the total revenue of the hospital, divided by 21 ‘‘(ii) the total revenue of all hospital in the hos- 22 pital referral region.’’. 23 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 506 IH (2) EFFECTIVE DATE.—The amendments made 1 by this subsection shall apply with respect to items 2 and services furnished on or after January 1, 2021. 3 (c) GRANTS FOR HOSPITAL INFRASTRUCTURE IM- 4 PROVEMENT.— 5 (1) IN GENERAL.—The Secretary of Health and 6 Human Services shall carry out a grant program 7 under which the Secretary shall provide grants to el- 8 igible States, in accordance with this subsection. 9 (2) USES.—An eligible State receiving a grant 10 under this subsection may use such grant to improve 11 the State hospital infrastructure and to supplement 12 any other funds provided for a purpose authorized 13 under a State or local hospital grant programs 14 under State law. 15 (3) ELIGIBILITY.— 16 (A) IN GENERAL.—An eligible State may 17 receive not more than one grant under this sub- 18 section with respect to each qualifying criterion 19 described in subparagraph (B) that is met by 20 the State. 21 (B) ELIGIBLE STATE.—For purposes of 22 this subsection, the term ‘‘eligible State’’ means 23 a State that meets any one or more of the fol- 24 lowing qualifying criteria: 25 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 506 IH (i) The State does not have in effect 1 any State certificate of need law that re- 2 quires a health care provider to provide to 3 a regulatory body a certification that the 4 community needs the services provided by 5 the health care provider. 6 (ii) The State has in effect State 7 scope of practice laws that— 8 (I) allow advanced practice pro- 9 viders (such as nurse practitioners, 10 advanced practice registered nurses, 11 clinical nurse specialists, and physi- 12 cian assistants) to evaluate patients; 13 diagnose, order, and interpret diag- 14 nostic tests; and initiate and manage 15 treatments; or 16 (II) provide that the only jus- 17 tification for limiting the scope of 18 practice of a health care provider is 19 safety to the public. 20 (iii) The State does not have in effect 21 any State laws that require managed care 22 plans to accept into the network of such 23 plan any qualified provider who is willing 24 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 506 IH to accept the terms and conditions of the 1 managed care plan. 2 (iv) The State does not have in effect 3 a law that prohibits health insurers from 4 directing policy-holders to lower-cost op- 5 tions through unsolicited recommendations. 6 (4) FUNDING.—There is authorized to be ap- 7 propriated to carry out this subsection 8 $1,000,000,000 for each of the fiscal years 2019 9 through 2028. Funds appropriated under this para- 10 graph shall remain available until expended. 11 SEC. 3. OFF-CAMPUS PROVIDER-BASED DEPARTMENT 12 MEDICARE SITE NEUTRAL PAYMENT. 13 (a) IN GENERAL.—Section 1834 of the Social Secu- 14 rity Act (42 U.S.C. 1395m) is amended by adding at the 15 end the following new subsection: 16 ‘‘(x) OFF-CAMPUS PROVIDER-BASED DEPARTMENT 17 SITE NEUTRAL PAYMENT.— 18 ‘‘(1) IN GENERAL.—With respect to items and 19 services furnished in an off-campus provider-based 20 department, payment under this section for such 21 items and services shall be the amount determined 22 under the fee schedule under section 1848 for such 23 items and services furnished if furnished in a physi- 24 cian office setting. 25 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 506 IH ‘‘(2) OFF-CAMPUS PROVIDER-BASED DEPART- 1 MENT.—For purposes of this subsection, the term 2 ‘off-campus provider-based department’ has such 3 meaning as specified by the Secretary.’’. 4 (b) EFFECTIVE DATE.—The amendment made by 5 subsection (a) shall apply with respect to items and serv- 6 ices furnished on or after January 1, 2021. 7 SEC. 4. REPEALING SHARED SAVINGS INCENTIVES FROM 8 MEDICARE SHARED SAVINGS PROGRAM. 9 (a) IN GENERAL.—Section 1899 of the Social Secu- 10 rity Act (42 U.S.C. 1395jjj) is amended— 11 (1) in subsection (a)(1)— 12 (A) by striking subparagraph (B); and 13 (B) by striking ‘‘such program— 14 ‘‘(A) groups of providers’’ and inserting 15 ‘‘such program, groups of providers’’; 16 (2) in subsection (b)(2)— 17 (A) in subparagraph (C), by striking ‘‘that 18 would allow the organization to receive and dis- 19 tribute payments for shared savings under sub- 20 section (d)(2) to participating providers of serv- 21 ices and suppliers’’; and 22 (B) in subparagraph (E)— 23 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 506 IH (i) by striking ‘‘the implementation’’ 1 and inserting ‘‘and the implementation’’; 2 and 3 (ii) by striking ‘‘, and the determina- 4 tion of payments for shared savings under 5 subsection (d)(2)’’; 6 (3) in subsection (d)— 7 (A) in paragraph (1)— 8 (i) in subparagraph (A), by striking 9 ‘‘except’’ and all that follows through the 10 period at the end; and 11 (ii) by striking subparagraph (B); and 12 (B) by striking paragraph (2); and 13 (4) in subsection (g), by striking paragraph (4) 14 and redesignating paragraphs (5) and (6) as para- 15 graphs (4) and (5), respectively. 16 (b) EFFECTIVE DATE.—The amendments made by 17 subsection (a) shall take effect on January 1, 2021. 18 SEC. 5. PRICE TRANSPARENCY. 19 Section 1866 of the Social Security Act (42 U.S.C. 20 1395cc), as amended by section 2, is further amended— 21 (1) in subsection (a)(1)— 22 (A) in subparagraph (Y), by striking 23 ‘‘and’’ at the end; 24 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 506 IH (B) in subparagraph (Z), by striking the 1 period at the end and inserting ‘‘; and’’; and 2 (C) by inserting after subparagraph (Z) 3 the following new subparagraph: 4 ‘‘(AA) in the case of a hospital, to comply with 5 the requirement under subsection (l).’’; and 6 (2) by adding at the end the following new sub- 7 section: 8 ‘‘(l) REQUIREMENT RELATING TO PUBLISHING CER- 9 TAIN HOSPITAL PRICES.— 10 ‘‘(1) IN GENERAL.—For purposes of subsection 11 (a)(1)(AA), the requirement described in this sub- 12 section is, with respect to a hospital and year (begin- 13 ning with 2021), for the hospital to publicly post, 14 through the system established under paragraph (3), 15 for each service included in the list published under 16 paragraph (2) for such year, the volume-weighted 17 average price charged by the hospital to— 18 ‘‘(A) individuals enrolled during such year 19 in group health plans or health insurance cov- 20 erage offered in the individual or group market 21 (as such terms are defined in section 2791 of 22 the Public Health Service Act); and 23 ‘‘(B) individuals who are not enrolled in 24 any health insurance coverage or health benefits 25 VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 506 IH plan and individuals who are enrolled in such 1 coverage or plan but such coverage or plan does 2 not provide benefits for the service. 3 ‘‘(2) SERVICES.—For purposes of subsection 4 (a)(1)(AA) and this subsection, the Secretary shall, 5 for 2021 and each subsequent year, publish a list of 6 the 100 services that are the most highly utilized in 7 a hospital-based setting. 8 ‘‘(3) STANDARDIZED DIGITAL REPORTING SYS- 9 TEM.—Not later than January 1, 2021, the Sec- 10 retary shall establish a standardized digital system 11 for purposes of paragraph (1).’’. 12 SEC. 6. REPEAL OF HEALTH CARE REFORM PROVISIONS 13 LIMITING MEDICARE EXCEPTION TO THE 14 PROHIBITION ON CERTAIN PHYSICIAN RE- 15 FERRALS FOR HOSPITALS. 16 Sections 6001 and 10601 of the Patient Protection 17 and Affordable Care Act (Public Law 111–148; 124 Stat. 18 684, 1005) and section 1106 of the Health Care and Edu- 19 cation Reconciliation Act of 2010 (Public Law 111–152; 20 124 Stat. 1049) are repealed and the provisions of law 21 amended by such sections are restored as if such sections 22 had never been enacted. 23 Æ VerDate Sep 11 2014 22:25 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H506.IH H506 pamtmann on DSKBFK8HB2PROD with BILLS