I 

113TH CONGRESS 

2D SESSION H. R. 4676 

To amend titles XVIII and XIX of the Social Security Act to apply the 

Medicare restriction on self-referral to State plan requirements under 

Medicaid, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 19, 2014 

Mr. MCDERMOTT 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 titles XVIII and XIX of the Social Security Act 

to apply the Medicare restriction on self-referral to State 

plan requirements under Medicaid, 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 ‘‘Medicaid Physician 

5 Self-Referral Act of 2014’’. 


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1 SEC. 2. ADJUSTMENTS TO RESTRICTION ON SELF-REFER2 RAL UNDER MEDICAID. 

3 (a) REPEAL OF RESTRICTION ON RECEIPT OF FED4 ERAL FUNDS IN THE CASE OF SELF-REFERRAL.—Sub5 section (s) of section 1903 of the Social Security Act (42 

6 U.S.C. 1396b(s)) is repealed. 

7 (b) REQUIREMENT OF RESTRICTION ON SELF-RE8 FERRAL IN STATE PLAN REQUIREMENTS.—Section 1902 

9 of such Act (42 U.S.C. 1396a) is amended— 

10 (1) in subsection (a)— 

11 (A) in paragraph (80) by striking ‘‘and’’ at 

12 the end; 

13 (B) in paragraph (81) by striking the pe14 riod at the end and inserting ‘‘; and’’; 

15 (C) by inserting after paragraph (81) the 

16 following: 

17 ‘‘(82) provide that no payment may be made 

18 under the State plan for a Medicaid designated 

19 health service furnished to an individual on the basis 

20 of a referral by a physician if the physician (or an 

21 immediate family member of the physician) has an 

22 ownership or investment interest or a compensation 

23 arrangement (as defined in section 1877) with the 

24 entity furnishing the Medicaid designated health 

25 service that would not comply with section 1877 if 


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1 the referral were for an item or service otherwise 

2 payable under title XVIII.’’; and 

3 (D) by inserting after the matter imme4 diately following paragraph (82) the following: 

5 ‘‘For purposes of paragraph (82), subsections (f) and (g) 

6 of section 1877 shall apply to a provider of a Medicaid 

7 designated health service in a similar manner as such sub8 sections apply to a provider of an item or service for which 

9 payment may be made under title XVIII.’’; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘(ll) DEFINITION OF MEDICAID DESIGNATED

13 HEALTH SERVICE.—For purposes of subsection (a) the 

14 term ‘Medicaid designated health service’ means an item 

15 or service listed in subsection (h)(6) of section 1877 as 

16 covered by a State plan and any other service a State may 

17 choose to add for purposes of subsection (a)(82).’’. 

18 (c) APPLICATION OF FALSE CLAIMS ACT TO VIOLA19 TIONS OF SELF-REFERRAL.—Section 1877(g) of such Act 

20 (42 U.S.C. 1395nn(g)) is amended by adding at the end 

21 the following: 

22 ‘‘(7) FALSE CLAIMS ACT.—A claim that in23 cludes an item or service resulting from a violation 

24 of this section constitutes a false or fraudulent claim 


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1 for purposes of sections 3729–3733 of title 31, 

2 United States Code.’’. 

3 (d) EXCEPTIONS FOR VIOLATIONS OF SELF-REFER4 RAL LIMITED TO MEDICAID.—Section 1877(h) of such 

5 Act (42 U.S.C. 1395nn(h)) is amended by adding at the 

6 end the following: 

7 ‘‘(8) MEDICAID SELF-REFERRAL LIMITA8 TIONS.—Any authority of the Secretary to issue reg9 ulations under this section shall include the author10 ity to issue regulations limited to the application of 

11 self-referral limitations to State plan requirements, 

12 as described under section 1902(a)(82) of this Act 

13 (42 U.S.C. 1396a(a)(82)).’’. 

14 (e) MEDICAID SELF-REFERRAL DISCLOSURE PRO15 TOCOL.—The Secretary of Health and Human Services 

16 shall establish a protocol consistent with the requirements 

17 of the Medicare self-referral disclosure protocol required 

18 under section 6409 of the Patient Protection and Afford19 able Care Act (42 U.S.C. 1395nn note) that enables 

20 health care providers to disclose an actual or potential vio21 lation of section 1877 of the Social Security Act (42 

22 U.S.C. 1395nn) as applied to title XIX of such Act, pursu23 ant to section 1902(a)(82) of such Act (42 U.S.C. 

24 1396a(a)(82)). 


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1 SEC. 3. EFFECTIVE DATE. 

2 (1) IN GENERAL.—Subject to paragraph (2), 

3 the amendments made by this Act shall apply to 

4 items and services furnished after the first day of 

5 the first calendar year that begins after date of en6 actment of this Act. 

7 (2) EXCEPTION FOR STATE LEGISLATION.—In 

8 the case of a State plan under title XIX of the So9 cial Security Act that the Secretary of Health and 

10 Human Services determines requires State legisla11 tion in order for the respective plan to meet any re12 quirement imposed by amendments made by this 

13 Act, the respective plan shall not be regarded as fail14 ing to comply with the requirements of such title 

15 solely on the basis of its failure to meet such an ad16 ditional requirement before the first day of the first 

17 calendar quarter beginning after the close of the 

18 first regular session of the State legislature that be19 gins after the date of enactment of this Act. For 

20 purposes of the previous sentence, in the case of a 

21 State that has a 2-year legislative session, each year 

22 of the session shall be considered to be a separate 

23 regular session of the State legislature. 

Æ 


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