I 
115TH CONGRESS 
2D SESSION 
H. R. 7084 
To amend title XVIII of the Social Security Act to increase hospital 
competition, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 23, 2018 
Mr. BANKS of Indiana introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Ways and Means, and the Judiciary, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to increase 
hospital competition, and for other purposes. 
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 ‘‘Hospital Competition 
Act of 2018’’. 
SEC. 2. HOSPITAL CONSOLIDATION. 
(a) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated $160,000,000 to the Fed-
eral Trade Commission to hire staff to investigate, as con-
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sistent 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)(1) of the 
Social Security Act (42 U.S.C. 1395cc(a)(1)) is 
amended— 
(A) in subparagraph (X), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (Y), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by inserting after subparagraph (Y) 
the following new subparagraph: 
‘‘(Z) 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 re-
imbursement rate with respect to individuals (re-
gardless of whether such an individual is entitled to 
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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.’’. 
(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 IM-
PROVEMENT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall carry out a grant program 
under which the Secretary shall provide grants to el-
igible 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 sub-
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section 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’’ means 
a State that meets any one or more of the fol-
lowing qualifying criteria: 
(i) The State does not have in effect 
any State certificate of need law that re-
quires 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 pro-
viders (such as nurse practitioners, 
advanced practice registered nurses, 
clinical nurse specialists, and physi-
cian assistants) to evaluate patients; 
diagnose, order, and interpret diag-
nostic tests; and initiate and manage 
treatments; or 
(II) provide that the only jus-
tification for limiting the scope of 
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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. 
(4) FUNDING.—There is authorized to be ap-
propriated 
to 
carry 
out 
this 
subsection 
$1,000,000,000 for each of the fiscal years 2019 
through 2028. Funds appropriated under this para-
graph shall remain available until expended. 
SEC. 
3. 
OFF-CAMPUS 
PROVIDER-BASED 
DEPARTMENT 
MEDICARE SITE NEUTRAL PAYMENT. 
(a) IN GENERAL.—Section 1834 of the Social Secu-
rity Act (42 U.S.C. 1395m) is amended by adding at the 
end the following new subsection: 
‘‘(w) 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 
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items and services furnished if furnished in a physi-
cian office setting. 
‘‘(2) OFF-CAMPUS
PROVIDER-BASED
DEPART-
MENT.—For purposes of this subsection, the term 
‘off-campus provider-based department’ has such 
meaning as specified by the Secretary.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to items and serv-
ices furnished on or after January 1, 2021. 
SEC. 4. REPEALING SHARED SAVINGS INCENTIVES FROM 
MEDICARE SHARED SAVINGS PROGRAM. 
(a) IN GENERAL.—Section 1899 of the Social Secu-
rity Act (42 U.S.C. 1395jjj) is amended— 
(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 dis-
tribute payments for shared savings under sub-
section (d)(2) to participating providers of serv-
ices and suppliers’’; and 
(B) in subparagraph (E)— 
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(i) by striking ‘‘the implementation’’ 
and inserting ‘‘and the implementation’’; 
and 
(ii) by striking ‘‘, and the determina-
tion of payments for shared savings under 
subsection (d)(2)’’; 
(3) in subsection (d)— 
(A) in paragraph (1)— 
(i) in subparagraph (A), by striking 
‘‘except’’ and all that follows through the 
period at the end; and 
(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 para-
graphs (4) and (5), respectively. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on January 1, 2021. 
SEC. 5. ADVISORY GROUP ON REDUCING BURDEN OF HOS-
PITAL ADMINISTRATIVE REQUIREMENTS. 
(a) IN GENERAL.—Not later than January 1, 2021, 
the Secretary of Health and Human Services shall convene 
an advisory group to provide, in accordance with this sec-
tion, recommendations on ways the Federal Government 
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could reduce the burden of administrative requirements on 
hospitals. 
(b) RECOMMENDATIONS.—Not later than January 1, 
2022, the advisory board convened under this section 
shall— 
(1) submit to the Secretary of Health and 
Human Services recommendations described under 
subsection (a) for executive action and any rec-
ommendations for State actions for potential consid-
eration in making grants under section 2(c) to 
States; and 
(2) submit to Congress recommendations de-
scribed under subsection (a) for legislative proposals. 
(c) MEMBERSHIP.—The advisory board under this 
section shall consist of the following members: 
(1) Three representatives of companies that 
have— 
(A) geographically distributed workforces; 
(B) at least 10,000 employees; and 
(C) no more than 10 percent of such em-
ployees in any single State. 
(2) Three representatives of health insurance 
issuers and health plans, consisting of— 
(A) one representative of for-profit health 
insurance issuers and health plans with at last 
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20,000,000 enrollees in the employer-sponsored 
market; 
(B) one representative of non-profit health 
insurance issuers and health plans operating in 
at least 5 States; and 
(C) one representative of non-profit health 
insurance issuers and health plans operating in 
a rural State (as defined by the Census Bu-
reau). 
(3) Seven public policy experts in the field of 
hospital consolidation. 
SEC. 6. PRICE TRANSPARENCY. 
Section 1866 of the Social Security Act (42 U.S.C. 
1395cc), as amended by section 2, is further amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (Y), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (Z), by striking the 
period at the end and inserting ‘‘; and’’; 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 sub-
section: 
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‘‘(l) REQUIREMENT RELATING TO PUBLISHING CER-
TAIN HOSPITAL PRICES.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(1)(AA), the requirement described in this sub-
section is, with respect to a hospital and year (begin-
ning 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 cov-
erage 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. 
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‘‘(3) STANDARDIZED DIGITAL REPORTING SYS-
TEM.—Not later than January 1, 2021, the Sec-
retary shall establish a standardized digital system 
for purposes of paragraph (1).’’. 
Æ 
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