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 committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to increase 

hospital competition, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Hospital Competition 

5 Act of 2019’’. 

6 SEC. 2. HOSPITAL CONSOLIDATION. 

7 (a) AUTHORIZATION OF APPROPRIATIONS.—There is 

8 authorized to be appropriated $160,000,000 to the FedVerDate 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

1 eral Trade Commission to hire staff to investigate, as con2 sistent with the Sherman Antitrust Act and other relevant 

3 Federal laws, anti-competitive mergers and practices 

4 under such laws to the extent such mergers and practices 

5 relate to providers of inpatient and outpatient health care 

6 services, as defined by the Secretary of Health and 

7 Human Services. 

8 (b) MEDICARE RATES APPLIED TO CERTAIN HHI 

9 HOSPITALS.— 

10 (1) IN GENERAL.—Section 1866(a) of the So11 cial Security Act (42 U.S.C. 1395cc(a)) is amend12 ed— 

13 (A) in paragraph (1)— 

14 (i) in subparagraph (X), by striking 

15 ‘‘and’’ at the end; 

16 (ii) in subparagraph (Y), by striking 

17 the period at the end and inserting ‘‘; 

18 and’’; and 

19 (iii) by inserting after subparagraph 

20 (Y) the following new subparagraph: 

21 ‘‘(Z) subject to paragraph (4), in the case of a 

22 hospital in an urban area and with respect to which 

23 there is a Herfindahl-Hirschman Index (HHI) of 

24 greater than 4,000 and in the case of a hospital in 

25 a rural area and with respect to which there is 


pamtmann on DSKBFK8HB2PROD with BILLS
3 

•HR 506 IH

1 Herfindahl-Hirschman Index (HHI) of greater than 

2 5,000, to apply the reimbursement rate with respect 

3 to individuals (regardless of whether such an indi4 vidual is entitled to or eligible for benefits under this 

5 title, but excluding individuals eligible for medical 

6 assistance under a State plan under title XIX) fur7 nished items and services at such hospital that 

8 would be billable under this title for such items and 

9 services if furnished by such hospital to an indi10 vidual entitled to or enrolled for benefits under this 

11 title.’’; and 

12 (B) by adding at the end the following new 

13 paragraph: 

14 ‘‘(4)(A) The requirement under paragraph (1)(Z) 

15 shall not apply in the case of a hospital in a hospital refer16 ral region if the HRR market share of such hospital (as 

17 determined under subparagraph (B)) is less than 0.15. 

18 ‘‘(B) For purposes of subparagraph (A), the HRR 

19 market share of a hospital in a hospital referral region 

20 is equal to— 

21 ‘‘(i) the total revenue of the hospital, divided by 

22 ‘‘(ii) the total revenue of all hospital in the hos23 pital referral region.’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•HR 506 IH

1 (2) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply with respect to items 

3 and services furnished on or after January 1, 2021. 

4 (c) GRANTS FOR HOSPITAL INFRASTRUCTURE IM5 PROVEMENT.— 

6 (1) IN GENERAL.—The Secretary of Health and 

7 Human Services shall carry out a grant program 

8 under which the Secretary shall provide grants to el9 igible States, in accordance with this subsection. 

10 (2) USES.—An eligible State receiving a grant 

11 under this subsection may use such grant to improve 

12 the State hospital infrastructure and to supplement 

13 any other funds provided for a purpose authorized 

14 under a State or local hospital grant programs 

15 under State law. 

16 (3) ELIGIBILITY.— 

17 (A) IN GENERAL.—An eligible State may 

18 receive not more than one grant under this sub19 section with respect to each qualifying criterion 

20 described in subparagraph (B) that is met by 

21 the State. 

22 (B) ELIGIBLE STATE.—For purposes of 

23 this subsection, the term ‘‘eligible State’’ means 

24 a State that meets any one or more of the fol25 lowing qualifying criteria: 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

•HR 506 IH

1 (i) The State does not have in effect 

2 any State certificate of need law that re3 quires a health care provider to provide to 

4 a regulatory body a certification that the 

5 community needs the services provided by 

6 the health care provider. 

7 (ii) The State has in effect State 

8 scope of practice laws that— 

9 (I) allow advanced practice pro10 viders (such as nurse practitioners, 

11 advanced practice registered nurses, 

12 clinical nurse specialists, and physi13 cian assistants) to evaluate patients; 

14 diagnose, order, and interpret diag15 nostic tests; and initiate and manage 

16 treatments; or 

17 (II) provide that the only jus18 tification for limiting the scope of 

19 practice of a health care provider is 

20 safety to the public. 

21 (iii) The State does not have in effect 

22 any State laws that require managed care 

23 plans to accept into the network of such 

24 plan any qualified provider who is willing 


pamtmann on DSKBFK8HB2PROD with BILLS
6 

•HR 506 IH

1 to accept the terms and conditions of the 

2 managed care plan. 

3 (iv) The State does not have in effect 

4 a law that prohibits health insurers from 

5 directing policy-holders to lower-cost op6 tions through unsolicited recommendations. 

7 (4) FUNDING.—There is authorized to be ap8 propriated to carry out this subsection 

9 $1,000,000,000 for each of the fiscal years 2019 

10 through 2028. Funds appropriated under this para11 graph shall remain available until expended. 

12 SEC. 3. OFF-CAMPUS PROVIDER-BASED DEPARTMENT 

13 MEDICARE SITE NEUTRAL PAYMENT. 

14 (a) IN GENERAL.—Section 1834 of the Social Secu15 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 items and services furnished if furnished in a physi25 cian office setting. 


pamtmann on DSKBFK8HB2PROD with BILLS
7 

•HR 506 IH

1 ‘‘(2) OFF-CAMPUS PROVIDER-BASED DEPART2 MENT.—For purposes of this subsection, the term 

3 ‘off-campus provider-based department’ has such 

4 meaning as specified by the Secretary.’’. 

5 (b) EFFECTIVE DATE.—The amendment made by 

6 subsection (a) shall apply with respect to items and serv7 ices furnished on or after January 1, 2021. 

8 SEC. 4. REPEALING SHARED SAVINGS INCENTIVES FROM 

9 MEDICARE SHARED SAVINGS PROGRAM. 

10 (a) IN GENERAL.—Section 1899 of the Social Secu11 rity Act (42 U.S.C. 1395jjj) is amended— 

12 (1) in subsection (a)(1)— 

13 (A) by striking subparagraph (B); and 

14 (B) by striking ‘‘such program— 

15 ‘‘(A) groups of providers’’ and inserting 

16 ‘‘such program, groups of providers’’; 

17 (2) in subsection (b)(2)— 

18 (A) in subparagraph (C), by striking ‘‘that 

19 would allow the organization to receive and dis20 tribute payments for shared savings under sub21 section (d)(2) to participating providers of serv22 ices and suppliers’’; and 

23 (B) in subparagraph (E)— 


pamtmann on DSKBFK8HB2PROD with BILLS
8 

•HR 506 IH

1 (i) by striking ‘‘the implementation’’ 

2 and inserting ‘‘and the implementation’’; 

3 and 

4 (ii) by striking ‘‘, and the determina5 tion of payments for shared savings under 

6 subsection (d)(2)’’; 

7 (3) in subsection (d)— 

8 (A) in paragraph (1)— 

9 (i) in subparagraph (A), by striking 

10 ‘‘except’’ and all that follows through the 

11 period at the end; and 

12 (ii) by striking subparagraph (B); and 

13 (B) by striking paragraph (2); and 

14 (4) in subsection (g), by striking paragraph (4) 

15 and redesignating paragraphs (5) and (6) as para16 graphs (4) and (5), respectively. 

17 (b) EFFECTIVE DATE.—The amendments made by 

18 subsection (a) shall take effect on January 1, 2021. 

19 SEC. 5. PRICE TRANSPARENCY. 

20 Section 1866 of the Social Security Act (42 U.S.C. 

21 1395cc), as amended by section 2, is further amended— 

22 (1) in subsection (a)(1)— 

23 (A) in subparagraph (Y), by striking 

24 ‘‘and’’ at the end; 


pamtmann on DSKBFK8HB2PROD with BILLS
9 

•HR 506 IH

1 (B) in subparagraph (Z), by striking the 

2 period at the end and inserting ‘‘; and’’; and 

3 (C) by inserting after subparagraph (Z) 

4 the following new subparagraph: 

5 ‘‘(AA) in the case of a hospital, to comply with 

6 the requirement under subsection (l).’’; and 

7 (2) by adding at the end the following new sub8 section: 

9 ‘‘(l) REQUIREMENT RELATING TO PUBLISHING CER10 TAIN HOSPITAL PRICES.— 

11 ‘‘(1) IN GENERAL.—For purposes of subsection 

12 (a)(1)(AA), the requirement described in this sub13 section is, with respect to a hospital and year (begin14 ning with 2021), for the hospital to publicly post, 

15 through the system established under paragraph (3), 

16 for each service included in the list published under 

17 paragraph (2) for such year, the volume-weighted 

18 average price charged by the hospital to— 

19 ‘‘(A) individuals enrolled during such year 

20 in group health plans or health insurance cov21 erage offered in the individual or group market 

22 (as such terms are defined in section 2791 of 

23 the Public Health Service Act); and 

24 ‘‘(B) individuals who are not enrolled in 

25 any health insurance coverage or health benefits 


pamtmann on DSKBFK8HB2PROD with BILLS
10 

•HR 506 IH

1 plan and individuals who are enrolled in such 

2 coverage or plan but such coverage or plan does 

3 not provide benefits for the service. 

4 ‘‘(2) SERVICES.—For purposes of subsection 

5 (a)(1)(AA) and this subsection, the Secretary shall, 

6 for 2021 and each subsequent year, publish a list of 

7 the 100 services that are the most highly utilized in 

8 a hospital-based setting. 

9 ‘‘(3) STANDARDIZED DIGITAL REPORTING SYS10 TEM.—Not later than January 1, 2021, the Sec11 retary shall establish a standardized digital system 

12 for purposes of paragraph (1).’’. 

13 SEC. 6. REPEAL OF HEALTH CARE REFORM PROVISIONS 

14 LIMITING MEDICARE EXCEPTION TO THE 

15 PROHIBITION ON CERTAIN PHYSICIAN RE16 FERRALS FOR HOSPITALS. 

17 Sections 6001 and 10601 of the Patient Protection 

18 and Affordable Care Act (Public Law 111–148; 124 Stat. 

19 684, 1005) and section 1106 of the Health Care and Edu20 cation Reconciliation Act of 2010 (Public Law 111–152; 

21 124 Stat. 1049) are repealed and the provisions of law 

22 amended by such sections are restored as if such sections 

23 had never been enacted. 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS