I 
113TH CONGRESS 
1ST SESSION H. R. 1310 
To amend title XVIII of the Social Security Act to establish a Medicare 
payment option for patients and eligible professionals to freely contract, 
without penalty, for Medicare fee-for-service items and services, while 
allowing Medicare beneficiaries to use their Medicare benefits. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 21, 2013 
Mr. PRICE of Georgia (for himself, Mr. ROE of Tennessee, Mr. TIBERI, Mr. 
HARRIS, Mr. POE of Texas, and Mr. BONNER) 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 sub-
sequently 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 title XVIII of the Social Security Act to establish 
a Medicare payment option for patients and eligible pro-
fessionals to freely contract, without penalty, for Medi-
care fee-for-service items and services, while allowing 
Medicare beneficiaries to use their Medicare benefits. 
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 ‘‘Medicare Patient Em-
powerment Act of 2013’’. 
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SEC. 2. GUARANTEEING FREEDOM OF CHOICE AND CON-
TRACTING FOR PATIENTS. 
(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 for any item or service 
covered under this title. 
‘‘(2) SUBMISSION OF CLAIMS.—Any Medicare 
beneficiary that enters into a contract under this 
section shall be permitted to submit a claim for pay-
ment under this title, and such payment shall be 
made in the amount that would otherwise apply 
under this title if such claim had been filed by a par-
ticipating physician or supplier (as defined in section 
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1842(h)(1)) in the payment area where the eligible 
professional covered by the contract resides. Pay-
ment made under this title for any item or service 
provided under the contract shall not render the eli-
gible professional a participating or non-partici-
pating physician or supplier, and as such, require-
ments of this title that may otherwise apply to a 
participating or non-participating physician or sup-
plier would not apply with respect to any items or 
services furnished 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 a service 
in excess of the amount established under 
the contract during the period the contract 
is in effect; 
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‘‘(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, 
unless otherwise provided in the contract 
under subparagraph (C)(i); and 
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‘‘(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 
covered under this title or under the plan; 
and 
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‘‘(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 to prohibit any eligible profes-
sional from maintaining an election and acting as a 
participating or non-participating physician or sup-
plier with respect to any patient not covered under 
a contract established under this section. 
‘‘(6) DEFINITIONS.—In this subsection: 
‘‘(A) MEDICARE BENEFICIARY.—The term 
‘Medicare beneficiary’ means an individual who 
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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; 
‘‘(ii) serious impairment to bodily 
functions; or 
‘‘(iii) serious dysfunction of any bodily 
organ or part. 
‘‘(D) 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 
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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, for which payment is made under section 
1848 of the Social Security Act (42 U.S.C. 1395w–4), 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 
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