I 
113TH CONGRESS 
2D SESSION 
H. R. 4676 
To amend titles XVIII and XIX of the Social Security Act to apply the 
Medicare restriction on self-referral to State plan requirements under 
Medicaid, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 19, 2014 
Mr. MCDERMOTT 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 jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to apply the Medicare restriction on self-referral to State 
plan requirements under Medicaid, and for other pur-
poses. 
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 ‘‘Medicaid Physician 
Self-Referral Act of 2014’’. 
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SEC. 2. ADJUSTMENTS TO RESTRICTION ON SELF-REFER-
RAL UNDER MEDICAID. 
(a) REPEAL OF RESTRICTION ON RECEIPT OF FED-
ERAL FUNDS IN THE CASE OF SELF-REFERRAL.—Sub-
section (s) of section 1903 of the Social Security Act (42 
U.S.C. 1396b(s)) is repealed. 
(b) REQUIREMENT OF RESTRICTION ON SELF-RE-
FERRAL IN STATE PLAN REQUIREMENTS.—Section 1902 
of such Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) in paragraph (80) by striking ‘‘and’’ at 
the end; 
(B) in paragraph (81) by striking the pe-
riod at the end and inserting ‘‘; and’’; 
(C) by inserting after paragraph (81) the 
following: 
‘‘(82) provide that no payment may be made 
under the State plan for a Medicaid designated 
health service furnished to an individual on the basis 
of a referral by a physician if the physician (or an 
immediate family member of the physician) has an 
ownership or investment interest or a compensation 
arrangement (as defined in section 1877) with the 
entity furnishing the Medicaid designated health 
service that would not comply with section 1877 if 
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the referral were for an item or service otherwise 
payable under title XVIII.’’; and 
(D) by inserting after the matter imme-
diately following paragraph (82) the following: 
‘‘For purposes of paragraph (82), subsections (f) and (g) 
of section 1877 shall apply to a provider of a Medicaid 
designated health service in a similar manner as such sub-
sections apply to a provider of an item or service for which 
payment may be made under title XVIII.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(ll) 
DEFINITION
OF
MEDICAID
DESIGNATED 
HEALTH SERVICE.—For purposes of subsection (a) the 
term ‘Medicaid designated health service’ means an item 
or service listed in subsection (h)(6) of section 1877 as 
covered by a State plan and any other service a State may 
choose to add for purposes of subsection (a)(82).’’. 
(c) APPLICATION OF FALSE CLAIMS ACT TO VIOLA-
TIONS OF SELF-REFERRAL.—Section 1877(g) of such Act 
(42 U.S.C. 1395nn(g)) is amended by adding at the end 
the following: 
‘‘(7) FALSE
CLAIMS
ACT.—A claim that in-
cludes an item or service resulting from a violation 
of this section constitutes a false or fraudulent claim 
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for purposes of sections 3729–3733 of title 31, 
United States Code.’’. 
(d) EXCEPTIONS FOR VIOLATIONS OF SELF-REFER-
RAL LIMITED TO MEDICAID.—Section 1877(h) of such 
Act (42 U.S.C. 1395nn(h)) is amended by adding at the 
end the following: 
‘‘(8) 
MEDICAID
SELF-REFERRAL
LIMITA-
TIONS.—Any authority of the Secretary to issue reg-
ulations under this section shall include the author-
ity to issue regulations limited to the application of 
self-referral limitations to State plan requirements, 
as described under section 1902(a)(82) of this Act 
(42 U.S.C. 1396a(a)(82)).’’. 
(e) MEDICAID SELF-REFERRAL DISCLOSURE PRO-
TOCOL.—The Secretary of Health and Human Services 
shall establish a protocol consistent with the requirements 
of the Medicare self-referral disclosure protocol required 
under section 6409 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 1395nn note) that enables 
health care providers to disclose an actual or potential vio-
lation of section 1877 of the Social Security Act (42 
U.S.C. 1395nn) as applied to title XIX of such Act, pursu-
ant to section 1902(a)(82) of such Act (42 U.S.C. 
1396a(a)(82)). 
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SEC. 3. EFFECTIVE DATE. 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this Act shall apply to 
items and services furnished after the first day of 
the first calendar year that begins after date of en-
actment of this Act. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act that the Secretary of Health and 
Human Services determines requires State legisla-
tion in order for the respective plan to meet any re-
quirement imposed by amendments made by this 
Act, the respective plan shall not be regarded as fail-
ing to comply with the requirements of such title 
solely on the basis of its failure to meet such an ad-
ditional requirement before the first day of the first 
calendar quarter beginning after the close of the 
first regular session of the State legislature that be-
gins after the date of enactment of this Act. For 
purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year 
of the session shall be considered to be a separate 
regular session of the State legislature. 
Æ 
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