I 

113TH CONGRESS 

1ST SESSION H. R. 1310 

To amend title XVIII of the Social Security Act to establish a Medicare 

payment option for patients and eligible professionals to freely contract, 

without penalty, for Medicare fee-for-service items and services, while 

allowing Medicare beneficiaries to use their Medicare benefits. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 21, 2013 

Mr. PRICE of Georgia (for himself, Mr. ROE of Tennessee, Mr. TIBERI, Mr. 

HARRIS, Mr. POE of Texas, and Mr. BONNER) 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 title XVIII of the Social Security Act to establish 

a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing 

Medicare beneficiaries to use their Medicare benefits. 

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 ‘‘Medicare Patient Em5 powerment Act of 2013’’. 


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1 SEC. 2. GUARANTEEING FREEDOM OF CHOICE AND CON2 TRACTING FOR PATIENTS. 

3 (a) IN GENERAL.—Section 1802 of the Social Secu4 rity Act (42 U.S.C. 1395a) is amended to read as follows: 

5 ‘‘FREEDOM OF CHOICE AND CONTRACTING BY PATIENT

6 GUARANTEED

7 ‘‘SEC. 1802. (a) BASIC FREEDOM OF CHOICE.—Any 

8 individual entitled to insurance benefits under this title 

9 may obtain health services from any institution, agency, 

10 or person qualified to participate under this title if such 

11 institution, agency, or person undertakes to provide that 

12 individual such services. 

13 ‘‘(b) FREEDOM TO CONTRACT BY MEDICARE BENE14 FICIARIES.— 

15 ‘‘(1) IN GENERAL.—Subject to the provisions of 

16 this subsection, nothing in this title shall prohibit a 

17 Medicare beneficiary from entering into a contract 

18 with an eligible professional for any item or service 

19 covered under this title. 

20 ‘‘(2) SUBMISSION OF CLAIMS.—Any Medicare 

21 beneficiary that enters into a contract under this 

22 section shall be permitted to submit a claim for pay23 ment under this title, and such payment shall be 

24 made in the amount that would otherwise apply 

25 under this title if such claim had been filed by a par26 ticipating physician or supplier (as defined in section 


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1 1842(h)(1)) in the payment area where the eligible 

2 professional covered by the contract resides. Pay3 ment made under this title for any item or service 

4 provided under the contract shall not render the eli5 gible professional a participating or non-partici6 pating physician or supplier, and as such, require7 ments of this title that may otherwise apply to a 

8 participating or non-participating physician or sup9 plier would not apply with respect to any items or 

10 services furnished under the contract. 

11 ‘‘(3) BENEFICIARY PROTECTIONS.— 

12 ‘‘(A) IN GENERAL.—Paragraph (1) shall 

13 not apply to any contract unless— 

14 ‘‘(i) the contract is in writing, is 

15 signed by the Medicare beneficiary and the 

16 eligible professional, and establishes all 

17 terms of the contract (including specific 

18 payment for items and services covered by 

19 the contract) before any item or service is 

20 provided pursuant to the contract, and the 

21 beneficiary shall be held harmless for any 

22 subsequent payment charged for a service 

23 in excess of the amount established under 

24 the contract during the period the contract 

25 is in effect; 


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1 ‘‘(ii) the contract contains the items 

2 described in subparagraph (B); and 

3 ‘‘(iii) the contract is not entered into 

4 at a time when the Medicare beneficiary is 

5 facing an emergency medical condition or 

6 urgent health care situation. 

7 ‘‘(B) ITEMS REQUIRED TO BE INCLUDED

8 IN CONTRACT.—Any contract to provide items 

9 and services to which paragraph (1) applies 

10 shall clearly indicate to the Medicare beneficiary 

11 that by signing such contract the beneficiary— 

12 ‘‘(i) agrees to be responsible for pay13 ment to such eligible professional for such 

14 items or services under the terms of and 

15 amounts established under the contract; 

16 ‘‘(ii) agrees to be responsible for sub17 mitting claims under this title to the Sec18 retary, and to any other supplemental in19 surance plan that may provide supple20 mental insurance, for such items or serv21 ices furnished under the contract if such 

22 items or services are covered by this title, 

23 unless otherwise provided in the contract 

24 under subparagraph (C)(i); and 


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1 ‘‘(iii) acknowledges that no limits or 

2 other payment incentives that may other3 wise apply under this title (such as the 

4 limits under subsection (g) of section 1848 

5 or incentives under subsection (a)(5), (m), 

6 (q), and (p) of such section) shall apply to 

7 amounts that may be charged, or paid to 

8 a beneficiary for, such items or services. 

9 Such contract shall also clearly indicate whether 

10 the eligible professional is excluded from par11 ticipation under the Medicare program under 

12 section 1128. 

13 ‘‘(C) BENEFICIARY ELECTIONS UNDER

14 THE CONTRACT.—Any Medicare beneficiary 

15 that enters into a contract under this section 

16 may elect to negotiate, as a term of the con17 tract, a provision under which— 

18 ‘‘(i) the eligible professional shall file 

19 claims on behalf of the beneficiary with the 

20 Secretary and any supplemental insurance 

21 plan for items or services furnished under 

22 the contract if such items or services are 

23 covered under this title or under the plan; 

24 and 


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1 ‘‘(ii) the beneficiary assigns payment 

2 to the eligible professional for any claims 

3 filed by, or on behalf of, the beneficiary 

4 with the Secretary and any supplemental 

5 insurance plan for items or services fur6 nished under the contract. 

7 ‘‘(D) EXCLUSION OF DUAL ELIGIBLE INDI8 VIDUALS.—Paragraph (1) shall not apply to 

9 any contract if a beneficiary who is eligible for 

10 medical assistance under title XIX is a party to 

11 the contract. 

12 ‘‘(4) LIMITATION ON ACTUAL CHARGE AND

13 CLAIM SUBMISSION REQUIREMENT NOT APPLICA14 BLE.—Section 1848(g) shall not apply with respect 

15 to any item or service provided to a Medicare bene16 ficiary under a contract described in paragraph (1). 

17 ‘‘(5) CONSTRUCTION.—Nothing in this section 

18 shall be construed to prohibit any eligible profes19 sional from maintaining an election and acting as a 

20 participating or non-participating physician or sup21 plier with respect to any patient not covered under 

22 a contract established under this section. 

23 ‘‘(6) DEFINITIONS.—In this subsection: 

24 ‘‘(A) MEDICARE BENEFICIARY.—The term 

25 ‘Medicare beneficiary’ means an individual who 


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1 is entitled to benefits under part A or enrolled 

2 under part B. 

3 ‘‘(B) ELIGIBLE PROFESSIONAL.—The term 

4 ‘eligible professional’ has the meaning given 

5 such term in section 1848(k)(3)(B). 

6 ‘‘(C) EMERGENCY MEDICAL CONDITION.— 

7 The term ‘emergency medical condition’ means 

8 a medical condition manifesting itself by acute 

9 symptoms of sufficient severity (including se10 vere pain) such that a prudent layperson, with 

11 an average knowledge of health and medicine, 

12 could reasonably expect the absence of imme13 diate medical attention to result in— 

14 ‘‘(i) serious jeopardy to the health of 

15 the individual or, in the case of a pregnant 

16 woman, the health of the woman or her 

17 unborn child; 

18 ‘‘(ii) serious impairment to bodily 

19 functions; or 

20 ‘‘(iii) serious dysfunction of any bodily 

21 organ or part. 

22 ‘‘(D) URGENT HEALTH CARE SITUA23 TION.—The term ‘urgent health care situation’ 

24 means services furnished to an individual who 

25 requires services to be furnished within 12 


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1 hours in order to avoid the likely onset of an 

2 emergency medical condition.’’. 

3 SEC. 3. PREEMPTION OF STATE LAWS LIMITING CHARGES 

4 FOR SERVICES BY AN ELIGIBLE PROFES5 SIONAL. 

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

7 the amount of charges for services, furnished by an eligible 

8 professional, for which payment is made under section 

9 1848 of the Social Security Act (42 U.S.C. 1395w–4), and 

10 any such limit is hereby preempted. 

11 (b) STATE.—In this section, the term ‘‘State’’ in12 cludes the District of Columbia, Puerto Rico, the Virgin 

13 Islands, Guam, and American Samoa. 

Æ 


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