I 
111TH CONGRESS 
1ST SESSION H. R. 1384 
To amend part B of title XVIII of the Social Security Act to remove 
limiting charges under the Medicare Program for non-participating physi-
cians with beneficiary notice and to preempt State laws that prohibit 
balance billing. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 9, 2009 
Mr. PRICE of Georgia 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 part B of title XVIII of the Social Security 
Act to remove limiting charges under the Medicare Pro-
gram for non-participating physicians with beneficiary 
notice and to preempt State laws that prohibit balance 
billing. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. REMOVING LIMITATIONS ON BALANCE BILLING 
WITH BENEFICIARY NOTICE. 
(a) IN GENERAL.—Section 1848(g) of the Social Se-
curity Act (42 U.S.C. 1395w–4(g)) is amended— 
VerDate Nov 24 2008 
21:04 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1384.IH
H1384
hsrobinson on PROD1PC76 with BILLS
(1) in paragraph (1)(A), in the matter before 
clause (i), by inserting ‘‘, subject to subparagraph 
(D),’’ after ‘‘enrolled under this part’’; 
(2) in paragraph (1), by adding at the end the 
following new subparagraph: 
‘‘(D) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply with respect to physicians’ serv-
ices furnished to an individual if the individual 
furnishing such services provides the advance 
notice of such non-participation and non-accept-
ance of assignment under paragraph (8).’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(8) NOTICE OF NON-PARTICIPATION AND NON- 
ACCEPTANCE
OF
ASSIGNMENT.—For purposes of 
paragraph (1)(D), the advance notice of non-partici-
pation and non-acceptance of assignment shall be, 
with respect to an item or service furnished under 
this part by (or under the supervision of) a physi-
cian, a notice (that may be in the form of a posting 
in a conspicuous place in a physician’s office or on 
patient information forms) that is posted or other-
wise furnished in a manner so as to inform the indi-
vidual receiving the item or service that— 
VerDate Nov 24 2008 
21:04 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1384.IH
H1384
hsrobinson on PROD1PC76 with BILLS
‘‘(A) the physician furnishing (or super-
vising the furnishing of) the items or service is 
not a participating physician and does not ac-
cept assignment with respect to the service; and 
‘‘(B) because of such non-acceptance, in 
the case of physicians’ services furnished to an 
individual, the charge imposed is not limited 
and may exceed the limiting charge described in 
paragraph (2).’’. 
(b) CONFORMING AMENDMENT TO PRIVATE CON-
TRACT PROVISIONS.—Section 1802 of such Act (42 
U.S.C. 1395a) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(6) EXCEPTION.—The previous provisions of 
this subsection shall not apply to physicians’ services 
furnished to an individual if the advance notice de-
scribed in section 1848(g)(8) has been provided.’’. 
(c) CONFORMING AMENDMENT TO PARTICIPATION 
PROVISIONS.—Section 1842(h) of such Act (42 U.S.C. 
1395u) is amended by adding at the end the following new 
paragraph: 
‘‘(9) The previous provisions of this subsection, inso-
far as they limit the charges that a participating physician 
may impose, shall not apply to physicians’ services fur-
VerDate Nov 24 2008 
21:04 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1384.IH
H1384
hsrobinson on PROD1PC76 with BILLS
nished to an individual if the advance notice described in 
section 1848(g)(8) has been provided.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
the date of the enactment of this Act. 
SEC. 2. PREEMPTION OF STATE LAWS LIMITING CHARGES 
FOR PHYSICIANS’ SERVICES. 
(a) IN GENERAL.—No State may impose a limit on 
the amount of charges, in relation to recognized payment 
amounts under any health plan or otherwise, a physician 
(as defined in section 1861(r)(1) of the Social Security 
Act) may impose for services furnished by the physician 
and any such limit is hereby preempted. 
(b) STATE.—In this section, the term ‘‘State’’ in-
cludes the District of Columbia, Puerto Rico, the Virgin 
Islands, Guam, and American Samoa. 
Æ 
VerDate Nov 24 2008 
21:04 Mar 10, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H1384.IH
H1384
hsrobinson on PROD1PC76 with BILLS