Hospital Competition Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8098 To address hospital consolidation and promote hospital price transparency, and for other purposes. IN THE HOUSE OF REPRESENTATIVES AUGUST 25, 2020 Mr. BANKS 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 committee concerned A BILL To address hospital consolidation and promote hospital price transparency, 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 2020’’. 5 SEC. 2. HOSPITAL CONSOLIDATION. 6 (a) AUTHORIZATION OF APPROPRIATIONS.—There is 7 authorized to be appropriated $160,000,000 to the Fed- 8 eral Trade Commission to hire staff to investigate, as con- 9 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8098 IH sistent with the Sherman Antitrust Act and other relevant 1 Federal laws, anti-competitive mergers and practices 2 under such laws to the extent such mergers and practices 3 relate to providers of inpatient and outpatient health care 4 services, as defined by the Secretary of Health and 5 Human Services. 6 (b) MEDICARE ADVANTAGE RATES APPLIED TO CER- 7 TAIN HHI HOSPITALS.— 8 (1) IN GENERAL.—Section 1866(a) of the So- 9 cial Security Act (42 U.S.C. 1395cc(a)) is amend- 10 ed— 11 (A) in paragraph (1)— 12 (i) in subparagraph (X), by striking 13 ‘‘and’’ at the end; 14 (ii) in subparagraph (Y), by striking 15 the period at the end and inserting ‘‘; 16 and’’; and 17 (iii) by inserting after subparagraph 18 (Y) the following new subparagraph: 19 ‘‘(Z) subject to paragraph (4), in the case 20 of a hospital located in a county whose popu- 21 lation density is above the median population 22 density for all counties in the United States 23 with respect to which there is a Herfindahl- 24 Hirschman Index (HHI) of greater than 4,000, 25 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8098 IH to apply the average reimbursement rate with 1 respect to individuals (regardless of whether 2 such an individual is entitled to or eligible for 3 benefits under this title, but excluding individ- 4 uals eligible for medical assistance under a 5 State plan under title XIX) furnished items and 6 services at such hospital that would be billable 7 under this title for such items and services if 8 furnished by such hospital to an individual en- 9 rolled under part C.’’; and 10 (B) by adding at the end the following new 11 paragraph: 12 ‘‘(4)(A) The requirement under paragraph 13 (1)(Z) shall not apply in the case of a hospital in a 14 hospital referral region if— 15 ‘‘(i) the HRR market share of such hos- 16 pital (as determined under subparagraph (B)) 17 is less than 0.15; or 18 ‘‘(ii) the hospital is located in a rural area 19 (as defined in section 1886(d)(2)(D)); 20 ‘‘(B) For purposes of subparagraph (A), the 21 HRR market share of a hospital in a hospital refer- 22 ral region is equal to— 23 ‘‘(i) the total revenue of the hospital, di- 24 vided by 25 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8098 IH ‘‘(ii) the total revenue of all hospital in the 1 hospital referral region.’’. 2 (2) EFFECTIVE DATE.—The amendments made 3 by this subsection shall apply with respect to items 4 and services furnished on or after January 1, 2021. 5 (c) GRANTS FOR HOSPITAL INFRASTRUCTURE IM- 6 PROVEMENT.— 7 (1) IN GENERAL.—The Secretary of Health and 8 Human Services shall carry out a grant program 9 under which the Secretary shall provide grants to el- 10 igible States, in accordance with this subsection. 11 (2) USES.—An eligible State receiving a grant 12 under this subsection may use such grant to improve 13 the State hospital infrastructure and to supplement 14 any other funds provided for a purpose authorized 15 under a State or local hospital grant programs 16 under State law. 17 (3) ELIGIBILITY.— 18 (A) IN GENERAL.—An eligible State may 19 receive not more than one grant under this sub- 20 section with respect to each qualifying criterion 21 described in subparagraph (B) that is met by 22 the State. 23 (B) ELIGIBLE STATE.—For purposes of 24 this subsection, the term ‘‘eligible State’’ means 25 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8098 IH a State that meets any one or more of the fol- 1 lowing qualifying criteria: 2 (i) The State does not have in effect 3 any State certificate of need law that re- 4 quires a health care provider to provide to 5 a regulatory body a certification that the 6 community needs the services provided by 7 the health care provider. 8 (ii) The State has in effect State 9 scope of practice laws that— 10 (I) allow advanced practice pro- 11 viders (such as nurse practitioners, 12 advanced practice registered nurses, 13 clinical nurse specialists, and physi- 14 cian assistants) to evaluate patients; 15 diagnose, order, and interpret diag- 16 nostic tests; and initiate and manage 17 treatments; or 18 (II) provide that the only jus- 19 tification for limiting the scope of 20 practice of a health care provider is 21 safety to the public. 22 (iii) The State does not have in effect 23 any State laws that require managed care 24 plans to accept into the network of such 25 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8098 IH plan any qualified provider who is willing 1 to accept the terms and conditions of the 2 managed care plan. 3 (iv) The State does not have in effect 4 any Certificate of Public Advantage laws 5 that clearly articulate the State’s intent to 6 displace competition in favor of regulation 7 or that violate State or Federal antitrust 8 laws. 9 (v) The State does not have in effect 10 any network adequacy laws regulating a 11 health plan’s ability to deliver benefits by 12 providing reasonable access to a sufficient 13 number of in-network primary care and 14 specialty physicians, as well as all health 15 care services included under the terms of 16 an insuree’s contract with a health insurer. 17 (4) FUNDING.—There is authorized to be ap- 18 propriated to carry out this subsection 19 $1,000,000,000 for each of the fiscal years 2021 20 through 2030. Funds appropriated under this para- 21 graph shall remain available until expended. 22 (d) CRITICAL ACCESS HOSPITAL REIMBURSEMENT 23 RATES.— 24 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8098 IH (1) PART A.—Section 1814(l)(1) of the Social 1 Security Act (42 U.S.C. 1395f(l)(1)) is amended by 2 inserting ‘‘(or, for 2021, 102, plus 1 percentage 3 point for each subsequent year through 2029, and 4 110 for each subsequent year thereafter)’’ after 5 ‘‘101’’. 6 (2) PART B.—Section 1834(g)(1) of such Act 7 (42 U.S.C. 1395m(g)(1)) is amended by inserting 8 ‘‘(or, for 2021, 102, plus 1 percentage point for each 9 subsequent year through 2029, and 110 for each 10 subsequent year thereafter)’’ after ‘‘101’’. 11 SEC. 3. PRICE TRANSPARENCY. 12 Section 1866 of the Social Security Act (42 U.S.C. 13 1395cc), as amended by section 401, is further amended— 14 (1) in subsection (a)(1)— 15 (A) in subparagraph (Y), by striking 16 ‘‘and’’ at the end; 17 (B) in subparagraph (Z), by striking the 18 period at the end and inserting ‘‘; and’’; and 19 (C) by inserting after subparagraph (Z) 20 the following new subparagraph: 21 ‘‘(AA) in the case of a hospital, to comply with 22 the requirement under subsection (l).’’; and 23 (2) by adding at the end the following new sub- 24 section: 25 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8098 IH ‘‘(l) REQUIREMENT RELATING TO PUBLISHING CER- 1 TAIN HOSPITAL PRICES.— 2 ‘‘(1) IN GENERAL.—For purposes of subsection 3 (a)(1)(AA), the requirement described in this sub- 4 section is, with respect to a hospital and year (begin- 5 ning with 2021), for the hospital to publicly post, 6 through the system established under paragraph (3), 7 for each commonly shoppable service included in the 8 list published under paragraph (2) for such year, the 9 volume-weighted average price charged by the hos- 10 pital to— 11 ‘‘(A) individuals enrolled during such year 12 in group health plans or health insurance cov- 13 erage offered in the individual or group market 14 (as such terms are defined in section 2791 of 15 the Public Health Service Act); and 16 ‘‘(B) individuals who are not enrolled in 17 any health insurance coverage or health benefits 18 plan and individuals who are enrolled in such 19 coverage or plan but such coverage or plan does 20 not provide benefits for the service. 21 ‘‘(2) COMMONLY SHOPPABLE SERVICES.—For 22 purposes of subsection (a)(1)(AA) and this sub- 23 section, the Secretary shall, for 2021 and each sub- 24 sequent year, publish a list of the 100 commonly 25 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8098 IH shoppable services that are the most highly utilized 1 in a hospital-based setting. 2 ‘‘(3) STANDARDIZED DIGITAL REPORTING SYS- 3 TEM.—Not later than January 1, 2021, the Sec- 4 retary shall establish a standardized digital system 5 for purposes of paragraph (1).’’. 6 SEC. 4. REPEALING ELIGIBILITY OF CERTAIN ACOS. 7 (a) IN GENERAL.—Section 1899(b)(1) of the Social 8 Security Act (42 U.S.C. 1395jjj(b)(1)) is amended by 9 striking subparagraphs (C) through (E). 10 (b) EFFECTIVE DATE.—The amendment made by 11 subsection (a) shall take effect on January 1, 2021. 12 SEC. 5. OFF-CAMPUS PROVIDER-BASED DEPARTMENT 13 MEDICARE SITE NEUTRAL PAYMENT. 14 (a) IN GENERAL.—Section 1834 of the Social Secu- 15 rity Act (42 U.S.C. 1395m) is amended by adding at the 16 end the following new subsection: 17 ‘‘(x) OFF-CAMPUS PROVIDER-BASED DEPARTMENT 18 SITE NEUTRAL PAYMENT.— 19 ‘‘(1) IN GENERAL.—With respect to items and 20 services furnished in an off-campus provider-based 21 department, payment under this section for such 22 items and services shall be the amount determined 23 under the fee schedule under section 1848 for such 24 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 8098 IH items and services furnished if furnished in a physi- 1 cian office setting. 2 ‘‘(2) OFF-CAMPUS PROVIDER-BASED DEPART- 3 MENT.—For purposes of this subsection, the term 4 ‘off-campus provider-based department’ has such 5 meaning as specified by the Secretary.’’. 6 (b) EFFECTIVE DATE.—The amendment made by 7 subsection (a) shall apply with respect to items and serv- 8 ices furnished on or after January 1, 2021. 9 SEC. 6. REPEAL OF HEALTH CARE REFORM PROVISIONS 10 LIMITING MEDICARE EXCEPTION TO THE 11 PROHIBITION ON CERTAIN PHYSICIAN RE- 12 FERRALS FOR HOSPITALS. 13 Sections 6001 and 10601 of the Patient Protection 14 and Affordable Care Act (Public Law 111–148; 124 Stat. 15 684, 1005) and section 1106 of the Health Care and Edu- 16 cation Reconciliation Act of 2010 (Public Law 111–152; 17 124 Stat. 1049) are repealed and the provisions of law 18 amended by such sections are restored as if such sections 19 had never been enacted. 20 SEC. 7. ADVISORY GROUP ON REDUCING BURDEN OF HOS- 21 PITAL ADMINISTRATIVE REQUIREMENTS. 22 (a) IN GENERAL.—Not later than January 1, 2021, 23 the Secretary of Health and Human Services shall convene 24 an advisory group to provide, in accordance with this sec- 25 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 8098 IH tion, recommendations on ways the Federal Government 1 could reduce the burden of administrative requirements on 2 hospitals. 3 (b) RECOMMENDATIONS.—Not later than January 1, 4 2022, the advisory board convened under this section 5 shall— 6 (1) submit to the Secretary of Health and 7 Human Services recommendations described under 8 subsection (a) for executive action and any rec- 9 ommendations for State actions for potential consid- 10 eration in making grants under section 2(c) to 11 States; and 12 (2) submit to Congress recommendations de- 13 scribed under subsection (a) for legislative proposals. 14 (c) MEMBERSHIP.—The advisory board under this 15 section shall consist of the following members: 16 (1) Three representatives of companies that 17 have— 18 (A) geographically distributed workforces; 19 (B) at least 10,000 employees; and 20 (C) no more than 10 percent of such em- 21 ployees in any single State. 22 (2) Three representatives of health insurance 23 issuers and health plans, consisting of— 24 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H8098.IH H8098 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 8098 IH (A) one representative of for-profit health 1 insurance issuers and health plans with at least 2 20,000,000 enrollees in the employer-sponsored 3 market; 4 (B) one representative of non-profit health 5 insurance issuers and health plans operating in 6 at least 5 States; and 7 (C) one representative of non-profit health 8 insurance issuers and health plans operating in 9 a rural State (as defined by the Census Bu- 10 reau). 11 (3) Seven public policy experts in the field of 12 hospital consolidation. 13 SEC. 8. AUTHORITY OF FEDERAL TRADE COMMISSION 14 OVER CERTAIN TAX-EXEMPT ORGANIZA- 15 TIONS. 16 Section 4 of the Federal Trade Commission Act (15 17 U.S.C. 44) is amended, in the undesignated paragraph re- 18 lating to the definition of the term ‘‘Corporation’’— 19 (1) by striking ‘‘, and any’’ and inserting ‘‘, 20 any’’; and 21 (2) by inserting before the period at the end the 22 following: ‘‘, and any organization described in sec- 23 tion 501(c)(3) of the Internal Revenue Code of 1986 24 VerDate Sep 11 2014 00:30 Sep 06, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 665 [Text truncated for display. Full text available on Congress.gov.]