Physician Wellness Program Act of 2022

To amend title XVIII of the Social Security Act to establish exceptions for certain physician wellness programs, and for other purposes. 1. Short title This Act may be cited as the Physician Wellness Program Act of 2022 2. Exception for physician wellness programs (a) Exception for physician wellness programs (1) In general Section 1877(e) of the Social Security Act ( 42 U.S.C. 1395nn(e) (9) Physician wellness programs A bona fide mental health or behavioral health improvement or maintenance program offered to a physician by an entity, if— (A) such program— (i) consists of counseling, mental health services, a suicide prevention program, or a substance use disorder prevention and treatment program; (ii) is made available to a physician for the primary purpose of preventing suicide, improving mental health and resiliency, or providing training in appropriate strategies to promote the mental health and resiliency of such physician; (iii) is set out in a written policy, approved in advance of the operation of the program by the governing body of the entity providing such program, that includes— (I) a description of the content and duration of the program; (II) a description of the evidence-based support for the design of the program; (III) the estimated cost of the program; (IV) the personnel (including the qualifications of such personnel) implementing the program; and (V) the method by which such entity will evaluate the use and success of the program; (iv) is offered by an entity with a formal medical staff to all physicians who practice in the geographic area served by such entity, including physicians who hold bona fide appointments to the medical staff of such entity or otherwise have clinical privileges at such entity; (v) is offered to all such physicians on the same terms and conditions and without regard to the volume or value of referrals or other business generated by a physician for such entity; (vi) is evidence-based and conducted by a qualified health professional; and (vii) meets such other requirements the Secretary may impose by regulation as needed to protect against program or patient abuse; (B) such entity is— (i) a hospital; (ii) an ambulatory surgical center; (iii) a community health center; (iv) a rural emergency hospital; (v) a rural health clinic; (vi) a skilled nursing facility; or (vii) a similar entity, as determined by the Secretary; and (C) neither the provision of such program, nor the value of such program, are contingent upon the number or value of referrals made by a physician to such entity. . (2) Regulation Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall promulgate such regulations as are necessary to carry out the amendment made by paragraph (1). (b) Exception under the anti-Kickback statute Section 1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a–7b(b)(3)) is amended— (1) in subparagraph (J), by striking and (2) in subparagraph (K), by striking the period at the end and inserting ; and (3) by adding at the end the following: (L) a bona fide mental health or behavioral health improvement or maintenance program, if— (i) such program— (I) consists of counseling, mental health services, a suicide prevention program, or a substance use disorder prevention and treatment program; (II) is made available to a physician and other clinicians for the primary purpose of preventing suicide, improving mental health and resiliency, or providing training in appropriate strategies to promote the mental health and resiliency of such physician; (III) is set out in a written policy, approved in advance of the operation of the program by the governing body of the entity providing such program, that includes— (aa) a description of the content and duration of the program; (bb) a description of the evidence-based support for the design of the program; (cc) the estimated cost of the program; (dd) the personnel (including the qualifications of such personnel) implementing the program; and (ee) the method by which such entity will evaluate the use and success of the program; (IV) is offered by an entity with a formal medical staff to all physicians and other clinicians who practice in the geographic area served by such entity, including physicians who hold bona fide appointments to the medical staff of such entity or otherwise have clinical privileges at such entity; (V) is offered to all such physicians and clinicians on the same terms and conditions and without regard to the volume or value of referrals or other business generated by a physician or clinician for such entity; (VI) is evidence-based and conducted by a qualified health professional; and (VII) meets such other requirements the Secretary may impose by regulation as needed to protect against program or patient abuse; (ii) such entity is— (I) a hospital; (II) an ambulatory surgical center; (III) a community health center; (IV) a rural emergency hospital; (V) a skilled nursing facility; or (VI) any similar entity, as determined by the Secretary; and (iii) neither the provision of such program, nor the value of such program, are contingent upon the number or value of referrals made by a physician or other clinician to such entity. .

Summary: Physician Wellness Program Act of 2022 This bill exempts wellness programs that provide certain mental or behavioral health services for physicians from restrictions under the Stark law (i.e., the Physician Self-Referral Law) and federal anti-kickback laws.