I 
115TH CONGRESS 
1ST SESSION H. R. 4169 
To amend title XVIII of the Social Security Act to remove the enrollment 
restriction on certain physicians and practitioners prescribing covered 
outpatient drugs under the Medicare prescription drug program. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 31, 2017 
Mr. MARCHANT (for himself, Mr. SMITH of Missouri, Mr. SIMPSON, and Mr. 
FERGUSON) introduced the following bill; which was referred to the Com-
mittee 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 remove 
the enrollment restriction on certain physicians and prac-
titioners prescribing covered outpatient drugs under the 
Medicare prescription drug program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting Seniors Ac-
cess to Proper Care Act of 2017’’. 
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SEC. 2. PERMITTING CERTAIN NON-ENROLLED PHYSICIANS 
OR PRACTITIONERS TO PRESCRIBE COVERED 
OUTPATIENT DRUGS UNDER MEDICARE PART 
D. 
(a) IN GENERAL.—Section 1860D–4 of the Social 
Security Act (42 U.S.C. 1395w–103) is amended by add-
ing at the end the following new subsection: 
‘‘(m) REMOVAL OF ENROLLMENT RESTRICTION.— 
‘‘(1) IN GENERAL.—Nothing in this title or sec-
tion 6405(c) of the Patient Protection and Afford-
able Care Act shall be construed as authorizing the 
Secretary to require, as a condition of payment by 
a PDP sponsor for a covered part D drug that is 
prescribed by an applicable physician or practitioner 
who is authorized under State law to prescribe such 
drug, that such applicable physician or practitioner 
be enrolled under section 1866(j). 
‘‘(2) APPLICABLE PHYSICIAN OR PRACTITIONER 
DEFINED.—For purposes of paragraph (1), the term 
‘applicable physician or practitioner’ means an eligi-
ble professional described in section 1848(k)(3)(B) 
(other than a physician described in section 
1861(r)(1))— 
‘‘(A) who— 
‘‘(i) is not excluded under this title or 
title XI; 
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‘‘(ii) is not barred from participating 
in the program under this title for a period 
of time following a revocation under sec-
tion 424.535(c) of title 42, Code of Fed-
eral Regulations (or any successor regula-
tion); or 
‘‘(iii) meets other criteria similar to 
clauses (i) and (ii) that may be specified 
by the Secretary; and 
‘‘(B) who prescribes a low volume (as de-
termined by the Secretary) of such drugs to in-
dividuals enrolled in plans under this part. 
In determining low volume under subparagraph (B), 
the Secretary may determine low volume differently 
based on the specialty of the applicable physician or 
practitioner.’’. 
(b) EFFECTIVE DATE AND ENFORCEMENT DELAY.— 
(1) EFFECTIVE DATE.—The amendment made 
by subsection (a) shall apply to covered part D 
drugs prescribed on or after January 1, 2019. 
(2) DELAY IN ENFORCEMENT OF ENROLLMENT 
REQUIREMENT UNTIL LOW VOLUME EXEMPTION IS 
IMPLEMENTED.—The Secretary shall continue not to 
enforce the enrollment requirement under clauses 
(ii) through (v) of section 423.120(c)(6) of title 42, 
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Code of Federal Regulations, until section 1860D– 
4(m), as added by subsection (a), takes effect. 
Æ 
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