IB 
Union Calendar No. 672 
118TH CONGRESS 
2D SESSION 
H. R. 3284 
[Report No. 118–765, Parts I and II] 
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. BILI-
RAKIS) 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 juris-
diction of the committee concerned 
NOVEMBER 22, 2024 
Reported from the Committee on Energy and Commerce with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
NOVEMBER 22, 2024 
Referral to the Committee on Ways and Means extended for a period ending 
not later than December 19, 2024 
DECEMBER 5, 2024 
Additional sponsor: Ms. LEE of Nevada 
DECEMBER 5, 2024 
Reported from the Committee on Ways and Means with an amendment, com-
mitted to the Committee of the Whole House on the State of the Union, 
and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in boldface roman] 
[For text of introduced bill, see copy of bill as introduced on May 15, 2023] 
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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 ‘‘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 31, 
2026, and annually thereafter, the Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall submit to Congress a report on the impact 
in the aggregate on provider and payer consolidation with 
respect to regulations and rules for parts A, B, C, and D 
of title XVIII of the Social Security Act (42 U.S.C. 1395c 
et seq.) implemented in the calendar year immediately 
prior to such report. Such report shall include regulations 
and rules that— 
(1) implement a change to an applicable pay-
ment system, a rate schedule, or another payment sys-
tem under parts A, B, C, or D of such title; or 
(2) result in a significant rule effecting provider 
or payer consolidation. 
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(b) PUBLIC COMMENT ON IMPACT TO PROVIDER AND 
PAYER CONSOLIDATION.—Beginning for 2025, as part of 
any notice and comment rulemaking process that could re-
sult in a significant rule affecting provider or payer con-
solidation with respect to a proposed rule for parts A, B, 
C, and D of title XVIII of the Social Security Act (42 
U.S.C. 1395c et seq.), the Secretary shall seek public com-
ment on the potential impact of such proposed rule on pro-
vider 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)), sup-
pliers (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 serv-
ices, the prospective payment system for covered 
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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 So-
cial 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 affected and could affect provider 
and payer consolidation, which includes the 
vertical or horizontal integration among 
providers of services (as defined in sub-
section (u) of section 1861), suppliers (as 
defined in subsection (d) of such section), 
and accountable care organizations under 
section 1899, or pursuant to models under 
this section.’’. 
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(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply with respect to models tested on or 
after January 1, 2025. 
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 De-
cember 31, 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 im-
pact in the aggregate on provider and payer 
consolidation with respect to regulations and 
rules for parts A, B, C, and D of title XVIII of 
the Social Security Act (42 U.S.C. 1395c et 
seq.) implemented in the calendar year imme-
diately prior to such report. Such report shall 
include regulations and rules that— 
(1) implement a change to an applica-
ble payment system, a rate schedule, or 
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another payment system under parts A, 
B, C, or D of such title; or 
(2) result in a significant rule effect-
ing provider or payer consolidation. 
(b) PUBLIC COMMENT ON IMPACT TO PRO-
VIDER AND PAYER CONSOLIDATION.—Beginning 
for 2025, as part of any notice and comment 
rulemaking process that could result in a sig-
nificant rule affecting provider or payer con-
solidation with respect to a proposed rule for 
parts A, B, C, and D of title XVIII of the Social 
Security Act (42 U.S.C. 1395c et seq.), the Sec-
retary shall seek public comment on the po-
tential impact of such proposed rule on pro-
vider and payer consolidation in the aggre-
gate. 
(c) DEFINITIONS.—In this section: 
(1) PROVIDER
AND
PAYER
CONSOLIDA-
TION.—The term ‘‘provider and payer con-
solidation’’ includes the vertical or hori-
zontal 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), account-
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