I 

111TH CONGRESS 

1ST SESSION H. R. 1384 

To amend part B of title XVIII of the Social Security Act to remove 

limiting charges under the Medicare Program for non-participating physicians with beneficiary notice and to preempt State laws that prohibit 

balance billing. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 9, 2009 

Mr. PRICE of Georgia 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 

A BILL 

To amend part B of title XVIII of the Social Security 

Act to remove limiting charges under the Medicare Program for non-participating physicians with beneficiary 

notice and to preempt State laws that prohibit balance 

billing. 

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

3 SECTION 1. REMOVING LIMITATIONS ON BALANCE BILLING 

4 WITH BENEFICIARY NOTICE. 

5 (a) IN GENERAL.—Section 1848(g) of the Social Se6 curity Act (42 U.S.C. 1395w–4(g)) is amended— 


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1 (1) in paragraph (1)(A), in the matter before 

2 clause (i), by inserting ‘‘, subject to subparagraph 

3 (D),’’ after ‘‘enrolled under this part’’; 

4 (2) in paragraph (1), by adding at the end the 

5 following new subparagraph: 

6 ‘‘(D) EXCEPTION.—Subparagraph (A) 

7 shall not apply with respect to physicians’ serv8 ices furnished to an individual if the individual 

9 furnishing such services provides the advance 

10 notice of such non-participation and non-accept11 ance of assignment under paragraph (8).’’; and 

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

13 paragraph: 

14 ‘‘(8) NOTICE OF NON-PARTICIPATION AND NON15 ACCEPTANCE OF ASSIGNMENT.—For purposes of 

16 paragraph (1)(D), the advance notice of non-partici17 pation and non-acceptance of assignment shall be, 

18 with respect to an item or service furnished under 

19 this part by (or under the supervision of) a physi20 cian, a notice (that may be in the form of a posting 

21 in a conspicuous place in a physician’s office or on 

22 patient information forms) that is posted or other23 wise furnished in a manner so as to inform the indi24 vidual receiving the item or service that— 


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1 ‘‘(A) the physician furnishing (or super2 vising the furnishing of) the items or service is 

3 not a participating physician and does not ac4 cept assignment with respect to the service; and 

5 ‘‘(B) because of such non-acceptance, in 

6 the case of physicians’ services furnished to an 

7 individual, the charge imposed is not limited 

8 and may exceed the limiting charge described in 

9 paragraph (2).’’. 

10 (b) CONFORMING AMENDMENT TO PRIVATE CON11 TRACT PROVISIONS.—Section 1802 of such Act (42 

12 U.S.C. 1395a) is amended by adding at the end the fol13 lowing new paragraph: 

14 ‘‘(6) EXCEPTION.—The previous provisions of 

15 this subsection shall not apply to physicians’ services 

16 furnished to an individual if the advance notice de17 scribed in section 1848(g)(8) has been provided.’’. 

18 (c) CONFORMING AMENDMENT TO PARTICIPATION

19 PROVISIONS.—Section 1842(h) of such Act (42 U.S.C. 

20 1395u) is amended by adding at the end the following new 

21 paragraph: 

22 ‘‘(9) The previous provisions of this subsection, inso23 far as they limit the charges that a participating physician 

24 may impose, shall not apply to physicians’ services furVerDate Nov 24 2008 21:04 Mar 10, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1384.IH H1384

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1 nished to an individual if the advance notice described in 

2 section 1848(g)(8) has been provided.’’. 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to services furnished on or after 

5 the date of the enactment of this Act. 

6 SEC. 2. PREEMPTION OF STATE LAWS LIMITING CHARGES 

7 FOR PHYSICIANS’ SERVICES. 

8 (a) IN GENERAL.—No State may impose a limit on 

9 the amount of charges, in relation to recognized payment 

10 amounts under any health plan or otherwise, a physician 

11 (as defined in section 1861(r)(1) of the Social Security 

12 Act) may impose for services furnished by the physician 

13 and any such limit is hereby preempted. 

14 (b) STATE.—In this section, the term ‘‘State’’ in15 cludes the District of Columbia, Puerto Rico, the Virgin 

16 Islands, Guam, and American Samoa. 

Æ 


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