Providers and Payers COMPETE Act

IB Union Calendar No. 672 118TH CONGRESS 2D SESSION H. R. 3284 [Report No. 118–765, Parts I and II] To require the Secretary of Health and Human Services to submit an annual report on the impact of certain Medicare regulations on provider and payer consolidation. IN THE HOUSE OF REPRESENTATIVES MAY 15, 2023 Mr. BURGESS (for himself, Mrs. DINGELL, Mr. FERGUSON, and Mr. BILI- RAKIS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the juris- diction of the committee concerned NOVEMBER 22, 2024 Reported from the Committee on Energy and Commerce with an amendment [Strike out all after the enacting clause and insert the part printed in italic] NOVEMBER 22, 2024 Referral to the Committee on Ways and Means extended for a period ending not later than December 19, 2024 DECEMBER 5, 2024 Additional sponsor: Ms. LEE of Nevada DECEMBER 5, 2024 Reported from the Committee on Ways and Means with an amendment, com- mitted to the Committee of the Whole House on the State of the Union, and ordered to be printed [Strike out all after the enacting clause and insert the part printed in boldface roman] [For text of introduced bill, see copy of bill as introduced on May 15, 2023] VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 2 •HR 3284 RH A BILL To require the Secretary of Health and Human Services to submit an annual report on the impact of certain Medicare regulations on provider and payer consolida- tion. VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 3 •HR 3284 RH 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 ‘‘Providers and Payers 4 COMPETE Act’’. 5 SEC. 2. ANNUAL REPORT ON THE IMPACT OF CERTAIN 6 MEDICARE REGULATIONS ON PROVIDER AND 7 PAYER CONSOLIDATION; PUBLIC COMMENT 8 ON PROVIDER AND PAYER CONSOLIDATION 9 FOR CERTAIN PROPOSED RULES. 10 (a) ANNUAL REPORT.—Not later than December 31, 11 2026, and annually thereafter, the Secretary of Health and 12 Human Services (in this section referred to as the ‘‘Sec- 13 retary’’) shall submit to Congress a report on the impact 14 in the aggregate on provider and payer consolidation with 15 respect to regulations and rules for parts A, B, C, and D 16 of title XVIII of the Social Security Act (42 U.S.C. 1395c 17 et seq.) implemented in the calendar year immediately 18 prior to such report. Such report shall include regulations 19 and rules that— 20 (1) implement a change to an applicable pay- 21 ment system, a rate schedule, or another payment sys- 22 tem under parts A, B, C, or D of such title; or 23 (2) result in a significant rule effecting provider 24 or payer consolidation. 25 VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 4 •HR 3284 RH (b) PUBLIC COMMENT ON IMPACT TO PROVIDER AND 1 PAYER CONSOLIDATION.—Beginning for 2025, as part of 2 any notice and comment rulemaking process that could re- 3 sult in a significant rule affecting provider or payer con- 4 solidation with respect to a proposed rule for parts A, B, 5 C, and D of title XVIII of the Social Security Act (42 6 U.S.C. 1395c et seq.), the Secretary shall seek public com- 7 ment on the potential impact of such proposed rule on pro- 8 vider and payer consolidation in the aggregate. 9 (c) DEFINITIONS.—In this section: 10 (1) PROVIDER AND PAYER CONSOLIDATION.—The 11 term ‘‘provider and payer consolidation’’ includes the 12 vertical or horizontal integration among providers of 13 services (as defined in subsection (u) of section 1861 14 of the Social Security Act (42 U.S.C. 1395x)), sup- 15 pliers (as defined in subsection (d) of such section), 16 accountable care organizations under section 1899 of 17 the Social Security Act (42 U.S.C. 1395jjj), Medicare 18 Advantage organizations, PDP sponsors, pharmacy 19 benefit managers, pharmacies, and integrated delivery 20 systems. 21 (2) APPLICABLE PAYMENT SYSTEM.—The term 22 ‘‘applicable payment system’’ includes— 23 (A) with respect to outpatient hospital serv- 24 ices, the prospective payment system for covered 25 VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 5 •HR 3284 RH OPD services established under section 1833(t) of 1 such Act (42 U.S.C. 1395(l)); and 2 (B) with respect to physicians’ services, the 3 physician fee schedules established under section 4 1848 of such Act (42 U.S.C. 1395w–4). 5 SEC. 3. CONSIDERATION OF EFFECTS ON PROVIDER AND 6 PAYER CONSOLIDATION WITH RESPECT TO 7 CMI MODELS. 8 (a) IN GENERAL.—Section 1115A(b)(4)(A) of the So- 9 cial Security Act (42 U.S.C. 1315a(b)(4)(A)) is amended— 10 (1) in clause (i), by striking at the end ‘‘and’’; 11 (2) in clause (ii), by striking the period at the 12 end and inserting ‘‘; and’’; and 13 (3) by adding at the end the following new 14 clause: 15 ‘‘(iii) the extent to which, and how, the 16 model has affected and could affect provider 17 and payer consolidation, which includes the 18 vertical or horizontal integration among 19 providers of services (as defined in sub- 20 section (u) of section 1861), suppliers (as 21 defined in subsection (d) of such section), 22 and accountable care organizations under 23 section 1899, or pursuant to models under 24 this section.’’. 25 VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 6 •HR 3284 RH (b) EFFECTIVE DATE.—The amendments made by sub- 1 section (a) shall apply with respect to models tested on or 2 after January 1, 2025. 3 SECTION 1. SHORT TITLE. 4 This Act may be cited as the ‘‘Providers 5 and Payers COMPETE Act’’. 6 SEC. 2. ANNUAL REPORT ON THE IMPACT OF CERTAIN 7 MEDICARE REGULATIONS ON PROVIDER AND 8 PAYER CONSOLIDATION; PUBLIC COMMENT 9 ON PROVIDER AND PAYER CONSOLIDATION 10 FOR CERTAIN PROPOSED RULES. 11 (a) ANNUAL REPORT.—Not later than De- 12 cember 31, 2026, and annually thereafter, the 13 Secretary of Health and Human Services (in 14 this section referred to as the ‘‘Secretary’’) 15 shall submit to Congress a report on the im- 16 pact in the aggregate on provider and payer 17 consolidation with respect to regulations and 18 rules for parts A, B, C, and D of title XVIII of 19 the Social Security Act (42 U.S.C. 1395c et 20 seq.) implemented in the calendar year imme- 21 diately prior to such report. Such report shall 22 include regulations and rules that— 23 (1) implement a change to an applica- 24 ble payment system, a rate schedule, or 25 VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6202 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 7 •HR 3284 RH another payment system under parts A, 1 B, C, or D of such title; or 2 (2) result in a significant rule effect- 3 ing provider or payer consolidation. 4 (b) PUBLIC COMMENT ON IMPACT TO PRO- 5 VIDER AND PAYER CONSOLIDATION.—Beginning 6 for 2025, as part of any notice and comment 7 rulemaking process that could result in a sig- 8 nificant rule affecting provider or payer con- 9 solidation with respect to a proposed rule for 10 parts A, B, C, and D of title XVIII of the Social 11 Security Act (42 U.S.C. 1395c et seq.), the Sec- 12 retary shall seek public comment on the po- 13 tential impact of such proposed rule on pro- 14 vider and payer consolidation in the aggre- 15 gate. 16 (c) DEFINITIONS.—In this section: 17 (1) PROVIDER AND PAYER CONSOLIDA- 18 TION.—The term ‘‘provider and payer con- 19 solidation’’ includes the vertical or hori- 20 zontal integration among providers of 21 services (as defined in subsection (u) of 22 section 1861 of the Social Security Act (42 23 U.S.C. 1395x)), suppliers (as defined in 24 subsection (d) of such section), account- 25 VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6202 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 8 •HR 3284 RH able care organizations under section 1 1899 of the Social Security Act (42 U.S.C. 2 1395jjj), Medicare Advantage organiza- 3 tions, PDP sponsors, pharmacy benefit 4 managers, pharmacies, and integrated 5 delivery systems. 6 (2) APPLICABLE PAYMENT SYSTEM.—The 7 term ‘‘applicable payment system’’ in- 8 cludes— 9 (A) with respect to outpatient 10 hospital services, the prospective 11 payment system for covered OPD 12 services established under section 13 1833(t) of such Act (42 U.S.C. 1395(l)); 14 and 15 (B) with respect to physicians’ 16 services, the physician fee schedules 17 established under section 1848 of 18 such Act (42 U.S.C. 1395w–4). 19 SEC. 3. CONSIDERATION OF EFFECTS ON PROVIDER AND 20 PAYER CONSOLIDATION WITH RESPECT TO 21 CMI MODELS. 22 (a) IN GENERAL.—Section 1115A(b)(4)(A) of 23 the Social Security Act (42 U.S.C. 24 1315a(b)(4)(A)) is amended— 25 VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6202 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS 9 •HR 3284 RH (1) in clause (i), by striking at the end 1 ‘‘and’’; 2 (2) in clause (ii), by striking the pe- 3 riod at the end and inserting ‘‘; and’’; and 4 (3) by adding at the end the following 5 new clause: 6 ‘‘(iii) the extent to which, and 7 how, the model has affected and 8 could affect provider and payer 9 consolidation, which includes the 10 vertical or horizontal integration 11 among providers of services (as 12 defined in subsection (u) of sec- 13 tion 1861), suppliers (as defined 14 in subsection (d) of such section), 15 and accountable care organiza- 16 tions under section 1899, or pur- 17 suant to models under this sec- 18 tion.’’. 19 (b) EFFECTIVE DATE.—The amendments 20 made by subsection (a) shall apply with re- 21 spect to models tested on or after January 1, 22 2025. 23 VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6202 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS Union Calendar No. 672 118TH CONGRESS 2D SESSION H. R. 3284 [Report No. 118–765, Parts I and II] A BILL To require the Secretary of Health and Human Services to submit an annual report on the im- pact of certain Medicare regulations on provider and payer consolidation. DECEMBER 5, 2024 Reported with an amendment, committed to the Com- mittee of the Whole House on the State of the Union, and ordered to be printed VerDate Sep 11 2014 01:27 Dec 06, 2024 Jkt 059200 PO 00000 Frm 00010 Fmt 6651 Sfmt 6651 E:\BILLS\H3284.RH H3284 ssavage on LAPJG3WLY3PROD with BILLS