SEC. 2. GUARANTEEING FREEDOM OF CHOICE AND CON-
TRACTING FOR PATIENTS UNDER MEDICARE. 
(a) IN GENERAL.—Section 1802 of the Social Secu-
rity Act (42 U.S.C. 1395a) is amended to read as follows: 
‘‘FREEDOM OF CHOICE AND CONTRACTING BY PATIENT 
GUARANTEED 
‘‘SEC. 1802. (a) BASIC FREEDOM OF CHOICE.—Any 
individual entitled to insurance benefits under this title 
may obtain health services from any institution, agency, 
or person qualified to participate under this title if such 
institution, agency, or person undertakes to provide that 
individual such services. 
‘‘(b) FREEDOM TO CONTRACT BY MEDICARE BENE-
FICIARIES.— 
‘‘(1) IN GENERAL.—Subject to the provisions of 
this subsection, nothing in this title shall prohibit a 
Medicare beneficiary from entering into a contract 
with an eligible professional (whether or not the pro-
fessional is a participating or non-participating phy-
sician or practitioner) for any item or service cov-
ered under this title. 
‘‘(2) SUBMISSION OF CLAIMS.—Any Medicare 
beneficiary that enters into a contract under this 
section with an eligible professional shall be per-
mitted to submit a claim for payment under this 
title for services furnished by such professional, and 
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such payment shall be made in the amount that 
would otherwise apply to such professional under 
this title except that where such professional is con-
sidered to be non-participating, payment shall be 
paid as if the professional were participating. Pay-
ment made under this title for any item or service 
provided under the contract shall not render the pro-
fessional a participating or non-participating physi-
cian or practitioner, and as such, requirements of 
this title that may otherwise apply to a participating 
or non-participating physician or practitioner would 
not apply with respect to any items or services fur-
nished under the contract. 
‘‘(3) BENEFICIARY PROTECTIONS.— 
‘‘(A) IN
GENERAL.—Paragraph (1) shall 
not apply to any contract unless— 
‘‘(i) the contract is in writing, is 
signed by the Medicare beneficiary and the 
eligible professional, and establishes all 
terms of the contract (including specific 
payment for items and services covered by 
the contract) before any item or service is 
provided pursuant to the contract, and the 
beneficiary shall be held harmless for any 
subsequent payment charged for an item 
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or service in excess of the amount estab-
lished under the contract during the period 
the contract is in effect; 
‘‘(ii) the contract contains the items 
described in subparagraph (B); and 
‘‘(iii) the contract is not entered into 
at a time when the Medicare beneficiary is 
facing an emergency medical condition or 
urgent health care situation. 
‘‘(B) ITEMS REQUIRED TO BE INCLUDED 
IN CONTRACT.—Any contract to provide items 
and services to which paragraph (1) applies 
shall clearly indicate to the Medicare beneficiary 
that by signing such contract the beneficiary— 
‘‘(i) agrees to be responsible for pay-
ment to such eligible professional for such 
items or services under the terms of and 
amounts established under the contract; 
‘‘(ii) agrees to be responsible for sub-
mitting claims under this title to the Sec-
retary, and to any other supplemental in-
surance plan that may provide supple-
mental insurance, for such items or serv-
ices furnished under the contract if such 
items or services are covered by this title, 
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unless otherwise provided in the contract 
under subparagraph (C)(i); and 
‘‘(iii) acknowledges that no limits or 
other payment incentives that may other-
wise apply under this title (such as the 
limits under subsection (g) of section 1848 
or incentives under subsection (a)(5), (m), 
(q), and (p) of such section) shall apply to 
amounts that may be charged, or paid to 
a beneficiary for, such items or services. 
Such contract shall also clearly indicate whether 
the eligible professional is excluded from par-
ticipation under the Medicare program under 
section 1128. 
‘‘(C) BENEFICIARY
ELECTIONS
UNDER 
THE
CONTRACT.—Any Medicare beneficiary 
that enters into a contract under this section 
may elect to negotiate, as a term of the con-
tract, a provision under which— 
‘‘(i) the eligible professional shall file 
claims on behalf of the beneficiary with the 
Secretary and any supplemental insurance 
plan for items or services furnished under 
the contract if such items or services are 
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covered under this title or under the plan; 
and 
‘‘(ii) the beneficiary assigns payment 
to the eligible professional for any claims 
filed by, or on behalf of, the beneficiary 
with the Secretary and any supplemental 
insurance plan for items or services fur-
nished under the contract. 
‘‘(D) EXCLUSION OF DUAL ELIGIBLE INDI-
VIDUALS.—Paragraph (1) shall not apply to 
any contract if a beneficiary who is eligible for 
medical assistance under title XIX is a party to 
the contract. 
‘‘(4) LIMITATION
ON
ACTUAL
CHARGE
AND 
CLAIM
SUBMISSION
REQUIREMENT
NOT
APPLICA-
BLE.—Section 1848(g) shall not apply with respect 
to any item or service provided to a Medicare bene-
ficiary under a contract described in paragraph (1). 
‘‘(5) CONSTRUCTION.—Nothing in this section 
shall be construed— 
‘‘(A) to prohibit any eligible professional 
from maintaining an election and acting as a 
participating or non-participating physician or 
practitioner with respect to any patient not cov-
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ered under a contract established under this 
section; and 
‘‘(B) as changing the items and services 
for which an eligible professional may bill under 
this title. 
‘‘(6) DEFINITIONS.—In this subsection: 
‘‘(A) MEDICARE BENEFICIARY.—The term 
‘Medicare beneficiary’ means an individual who 
is entitled to benefits under part A or enrolled 
under part B. 
‘‘(B) ELIGIBLE PROFESSIONAL.—The term 
‘eligible professional’ has the meaning given 
such term in section 1848(k)(3)(B). 
‘‘(C) EMERGENCY MEDICAL CONDITION.— 
The term ‘emergency medical condition’ means 
a medical condition manifesting itself by acute 
symptoms of sufficient severity (including se-
vere pain) such that a prudent layperson, with 
an average knowledge of health and medicine, 
could reasonably expect the absence of imme-
diate medical attention to result in— 
‘‘(i) serious jeopardy to the health of 
the individual or, in the case of a pregnant 
woman, the health of the woman or her 
unborn child; 
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‘‘(ii) serious impairment to bodily 
functions; or 
‘‘(iii) serious dysfunction of any bodily 
organ or part. 
‘‘(D) 
PARTICIPATING; 
NON-PARTICI-
PATING.—The terms ‘participating’ and ‘non-
participating’ have the meanings given such 
terms under subsection (h) of section 1842 for 
purposes of such section. 
‘‘(E) 
URGENT
HEALTH
CARE
SITUA-
TION.—The term ‘urgent health care situation’ 
means services furnished to an individual who 
requires services to be furnished within 12 
hours in order to avoid the likely onset of an 
emergency medical condition.’’. 
SEC. 3. PREEMPTION OF STATE LAWS LIMITING CHARGES 
FOR SERVICES BY AN ELIGIBLE PROFES-
SIONAL. 
(a) IN GENERAL.—No State may impose a limit on 
the amount of charges for services, furnished by an eligible 
professional (as defined in subsection (k)(3)(B) of section 
1848 of the Social Security Act, 42 U.S.C. 1395w–4), for 
which payment is made under such section, and any such 
limit is hereby preempted. 
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(b) STATE.—In this section, the term ‘‘State’’ in-
cludes the District of Columbia, Puerto Rico, the Virgin 
Islands, Guam, and American Samoa. 
Æ 
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