Providers and Payers COMPETE Act

Subjects: Health, Administrative law and regulatory procedures, Congressional oversight, Health care costs and insurance, Medicare


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3284 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 3284

  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

_______________________________________________________________________

                                 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 30, 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 for parts B, C, and D of title XVIII of the 
Social Security Act (42 U.S.C. 1395j et seq.) implemented in the 
calendar year immediately prior to such report. Such report shall 
include regulations that--
            (1) implement a change to an applicable payment system, a 
        rate schedule, or another payment system under part 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 will result in a significant rule effecting provider or 
payer consolidation with respect to a proposed rule for parts B, C, and 
D of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), 
the Secretary shall seek public comment on the projected 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 effected and could effect 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.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to models tested on or after January 1, 2025.
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