[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3284 Reported in House (RH)]
<DOC>
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.
Bilirakis) 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 jurisdiction 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,
committed 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]
_______________________________________________________________________
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 consolidation.
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 ``Providers and Payers COMPETE Act''.
SEC. 2. ANNUAL REPORT ON THE IMPACT OF CERTAIN MEDICARE REGULATIONS ON
PROVIDER AND PAYER CONSOLIDATION; PUBLIC COMMENT ON
PROVIDER AND PAYER CONSOLIDATION FOR CERTAIN PROPOSED
RULES.
(a) Annual Report.--Not later than December 31, 2026, and annually
thereafter, the Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall submit to Congress a report on
the impact in the aggregate on provider and payer consolidation with
respect to regulations and rules for parts A, B, C, and D of title
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) implemented
in the calendar year immediately prior to such report. Such report
shall include regulations and rules that--
(1) implement a change to an applicable payment system, a
rate schedule, or another payment system under parts A, B, C,
or D of such title; or
(2) result in a significant rule effecting provider or
payer consolidation.
(b) Public Comment on Impact to Provider and Payer Consolidation.--
Beginning for 2025, as part of any notice and comment rulemaking
process that could result in a significant rule affecting provider or
payer consolidation with respect to a proposed rule for parts A, B, C,
and D of title XVIII of the Social Security Act (42 U.S.C. 1395c et
seq.), the Secretary shall seek public comment on the potential impact
of such proposed rule on provider and payer consolidation in the
aggregate.
(c) Definitions.--In this section:
(1) Provider and payer consolidation.--The term ``provider
and payer consolidation'' includes the vertical or horizontal
integration among providers of services (as defined in
subsection (u) of section 1861 of the Social Security Act (42
U.S.C. 1395x)), suppliers (as defined in subsection (d) of such
section), accountable care organizations under section 1899 of
the Social Security Act (42 U.S.C. 1395jjj), Medicare Advantage
organizations, PDP sponsors, pharmacy benefit managers,
pharmacies, and integrated delivery systems.
(2) Applicable payment system.--The term ``applicable
payment system'' includes--
(A) with respect to outpatient hospital services,
the prospective payment system for covered OPD services
established under section 1833(t) of such Act (42
U.S.C. 1395(l)); and
(B) with respect to physicians' services, the
physician fee schedules established under section 1848
of such Act (42 U.S.C. 1395w-4).
SEC. 3. CONSIDERATION OF EFFECTS ON PROVIDER AND PAYER CONSOLIDATION
WITH RESPECT TO CMI MODELS.
(a) In General.--Section 1115A(b)(4)(A) of the Social Security Act
(42 U.S.C. 1315a(b)(4)(A)) is amended--
(1) in clause (i), by striking at the end ``and'';
(2) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) the extent to which, and how, the
model has affected and could affect provider
and payer consolidation, which includes the
vertical or horizontal integration among
providers of services (as defined in subsection
(u) of section 1861), suppliers (as defined in
subsection (d) of such section), and
accountable care organizations under section
1899, or pursuant to models under this
section.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to models tested on or after January 1, 2025.
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Providers and Payers COMPETE Act''.
SEC. 2. ANNUAL REPORT ON THE IMPACT OF CERTAIN MEDICARE REGULATIONS ON
PROVIDER AND PAYER CONSOLIDATION; PUBLIC COMMENT ON
PROVIDER AND PAYER CONSOLIDATION FOR CERTAIN PROPOSED
RULES.
(a) Annual Report.--Not later than December 31, 2026, and annually
thereafter, the Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall submit to Congress a report on
the impact in the aggregate on provider and payer consolidation with
respect to regulations and rules for parts A, B, C, and D of title
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) implemented
in the calendar year immediately prior to such report. Such report
shall include regulations and rules that--
(1) implement a change to an applicable payment system, a
rate schedule, or another payment system under parts A, B, C,
or D of such title; or
(2) result in a significant rule effecting provider or
payer consolidation.
(b) Public Comment on Impact to Provider and Payer Consolidation.--
Beginning for 2025, as part of any notice and comment rulemaking
process that could result in a significant rule affecting provider or
payer consolidation with respect to a proposed rule for parts A, B, C,
and D of title XVIII of the Social Security Act (42 U.S.C. 1395c et
seq.), the Secretary shall seek public comment on the potential impact
of such proposed rule on provider and payer consolidation in the
aggregate.
(c) Definitions.--In this section:
(1) Provider and payer consolidation.--The term ``provider
and payer consolidation'' includes the vertical or horizontal
integration among providers of services (as defined in
subsection (u) of section 1861 of the Social Security Act (42
U.S.C. 1395x)), suppliers (as defined in subsection (d) of such
section), accountable care organizations under section 1899 of
the Social Security Act (42 U.S.C. 1395jjj), Medicare Advantage
organizations, PDP sponsors, pharmacy benefit managers,
pharmacies, and integrated delivery systems.
(2) Applicable payment system.--The term ``applicable
payment system'' includes--
(A) with respect to outpatient hospital services,
the prospective payment system for covered OPD services
established under section 1833(t) of such Act (42
U.S.C. 1395(l)); and
(B) with respect to physicians' services, the
physician fee schedules established under section 1848
of such Act (42 U.S.C. 1395w-4).
SEC. 3. CONSIDERATION OF EFFECTS ON PROVIDER AND PAYER CONSOLIDATION
WITH RESPECT TO CMI MODELS.
(a) In General.--Section 1115A(b)(4)(A) of the Social Security Act
(42 U.S.C. 1315a(b)(4)(A)) is amended--
(1) in clause (i), by striking at the end ``and'';
(2) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) the extent to which, and how, the
model has affected and could affect provider
and payer consolidation, which includes the
vertical or horizontal integration among
providers of services (as defined in subsection
(u) of section 1861), suppliers (as defined in
subsection (d) of such section), and
accountable care organizations under section
1899, or pursuant to models under this
section.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to models tested on or after January 1, 2025.
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 impact of certain Medicare regulations on provider
and payer consolidation.
_______________________________________________________________________
December 5, 2024
Reported with an amendment, committed to the Committee of the Whole
House on the State of the Union, and ordered to be printed