Hospital Competition Act of 2019

To amend title XVIII of the Social Security Act to increase hospital competition, and for other purposes. 1. Short title This Act may be cited as the Hospital Competition Act of 2019 2. Hospital consolidation (a) Authorization of appropriations There is authorized to be appropriated $160,000,000 to the Federal Trade Commission to hire staff to investigate, as consistent with the Sherman Antitrust Act and other relevant Federal laws, anti-competitive mergers and practices under such laws to the extent such mergers and practices relate to providers of inpatient and outpatient health care services, as defined by the Secretary of Health and Human Services. (b) Medicare rates applied to certain HHI hospitals (1) In general Section 1866(a) of the Social Security Act ( 42 U.S.C. 1395cc(a) (A) in paragraph (1)— (i) in subparagraph (X), by striking and (ii) in subparagraph (Y), by striking the period at the end and inserting ; and (iii) by inserting after subparagraph (Y) the following new subparagraph: (Z) subject to paragraph (4), in the case of a hospital in an urban area and with respect to which there is a Herfindahl-Hirschman Index (HHI) of greater than 4,000 and in the case of a hospital in a rural area and with respect to which there is Herfindahl-Hirschman Index (HHI) of greater than 5,000, to apply the reimbursement rate with respect to individuals (regardless of whether such an individual is entitled to or eligible for benefits under this title, but excluding individuals eligible for medical assistance under a State plan under title XIX) furnished items and services at such hospital that would be billable under this title for such items and services if furnished by such hospital to an individual entitled to or enrolled for benefits under this title. ; and (B) by adding at the end the following new paragraph: (4) (A) The requirement under paragraph (1)(Z) shall not apply in the case of a hospital in a hospital referral region if the HRR market share of such hospital (as determined under subparagraph (B)) is less than 0.15. (B) For purposes of subparagraph (A), the HRR market share of a hospital in a hospital referral region is equal to— (i) the total revenue of the hospital, divided by (ii) the total revenue of all hospital in the hospital referral region. . (2) Effective date The amendments made by this subsection shall apply with respect to items and services furnished on or after January 1, 2021. (c) Grants for hospital infrastructure improvement (1) In general The Secretary of Health and Human Services shall carry out a grant program under which the Secretary shall provide grants to eligible States, in accordance with this subsection. (2) Uses An eligible State receiving a grant under this subsection may use such grant to improve the State hospital infrastructure and to supplement any other funds provided for a purpose authorized under a State or local hospital grant programs under State law. (3) Eligibility (A) In general An eligible State may receive not more than one grant under this subsection with respect to each qualifying criterion described in subparagraph (B) that is met by the State. (B) Eligible State For purposes of this subsection, the term eligible State (i) The State does not have in effect any State certificate of need law that requires a health care provider to provide to a regulatory body a certification that the community needs the services provided by the health care provider. (ii) The State has in effect State scope of practice laws that— (I) allow advanced practice providers (such as nurse practitioners, advanced practice registered nurses, clinical nurse specialists, and physician assistants) to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments; or (II) provide that the only justification for limiting the scope of practice of a health care provider is safety to the public. (iii) The State does not have in effect any State laws that require managed care plans to accept into the network of such plan any qualified provider who is willing to accept the terms and conditions of the managed care plan. (iv) The State does not have in effect a law that prohibits health insurers from directing policy-holders to lower-cost options through unsolicited recommendations. (4) Funding There is authorized to be appropriated to carry out this subsection $1,000,000,000 for each of the fiscal years 2019 through 2028. Funds appropriated under this paragraph shall remain available until expended. 3. Off-campus provider-based department Medicare site neutral payment (a) In general Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (x) Off-Campus provider-Based department site neutral payment (1) In general With respect to items and services furnished in an off-campus provider-based department, payment under this section for such items and services shall be the amount determined under the fee schedule under section 1848 for such items and services furnished if furnished in a physician office setting. (2) Off-campus provider-based department For purposes of this subsection, the term off-campus provider-based department . (b) Effective date The amendment made by subsection (a) shall apply with respect to items and services furnished on or after January 1, 2021. 4. Repealing shared savings incentives from Medicare shared savings program (a) In general Section 1899 of the Social Security Act ( 42 U.S.C. 1395jjj (1) in subsection (a)(1)— (A) by striking subparagraph (B); and (B) by striking such program— (A) groups of providers and inserting such program, groups of providers ; (2) in subsection (b)(2)— (A) in subparagraph (C), by striking that would allow the organization to receive and distribute payments for shared savings under subsection (d)(2) to participating providers of services and suppliers (B) in subparagraph (E)— (i) by striking the implementation and the implementation (ii) by striking , and the determination of payments for shared savings under subsection (d)(2) (3) in subsection (d)— (A) in paragraph (1)— (i) in subparagraph (A), by striking except (ii) by striking subparagraph (B); and (B) by striking paragraph (2); and (4) in subsection (g), by striking paragraph (4) and redesignating paragraphs (5) and (6) as paragraphs (4) and (5), respectively. (b) Effective date The amendments made by subsection (a) shall take effect on January 1, 2021. 5. Price transparency Section 1866 of the Social Security Act ( 42 U.S.C. 1395cc (1) in subsection (a)(1)— (A) in subparagraph (Y), by striking and (B) in subparagraph (Z), by striking the period at the end and inserting ; and (C) by inserting after subparagraph (Z) the following new subparagraph: (AA) in the case of a hospital, to comply with the requirement under subsection (l). ; and (2) by adding at the end the following new subsection: (l) Requirement relating to publishing certain hospital prices (1) In general For purposes of subsection (a)(1)(AA), the requirement described in this subsection is, with respect to a hospital and year (beginning with 2021), for the hospital to publicly post, through the system established under paragraph (3), for each service included in the list published under paragraph (2) for such year, the volume-weighted average price charged by the hospital to— (A) individuals enrolled during such year in group health plans or health insurance coverage offered in the individual or group market (as such terms are defined in section 2791 of the Public Health Service Act); and (B) individuals who are not enrolled in any health insurance coverage or health benefits plan and individuals who are enrolled in such coverage or plan but such coverage or plan does not provide benefits for the service. (2) Services For purposes of subsection (a)(1)(AA) and this subsection, the Secretary shall, for 2021 and each subsequent year, publish a list of the 100 services that are the most highly utilized in a hospital-based setting. (3) Standardized digital reporting system Not later than January 1, 2021, the Secretary shall establish a standardized digital system for purposes of paragraph (1). . 6. Repeal of health care reform provisions limiting Medicare exception to the prohibition on certain physician referrals for hospitals Sections 6001 and 10601 of the Patient Protection and Affordable Care Act ( Public Law 111–148 Public Law 111–152

Summary: Hospital Competition Act of 2019 This bill establishes a series of programs and requirements relating to hospital costs, payments, and infrastructure. Among other things, the bill requires hospitals, as a condition of Medicare participation, to (1) in the case of hospitals that meet specified market concentration thresholds, apply Medicare reimbursement rates regardless of whether the individual receiving services is entitled to or enrolled in Medicare; and (2) publish the prices charged for specified services that are highly utilized. The bill also repeals (1) performance incentives under the Medicare Shared Savings Program for accountable care organizations, and (2) provisions under the Stark law (i.e., the Physician Self-Referral Law) that prohibit physician-owned hospitals from expanding facility capacity.