I 
116TH CONGRESS 
1ST SESSION 
H. R. 506 
To amend title XVIII of the Social Security Act to increase hospital 
competition, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 11, 2019 
Mr. BANKS (for himself and Mr. WESTERMAN) 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 provisions as fall within the jurisdiction of the com-
mittee 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 2019’’. 
SEC. 2. HOSPITAL CONSOLIDATION. 
(a) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated $160,000,000 to the Fed-
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
eral Trade Commission to hire staff to investigate, as con-
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) of the So-
cial Security Act (42 U.S.C. 1395cc(a)) is amend-
ed— 
(A) in paragraph (1)— 
(i) in subparagraph (X), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (Y), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(Y) the following new subparagraph: 
‘‘(Z) subject to paragraph (4), 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 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
Herfindahl-Hirschman Index (HHI) of greater than 
5,000, to apply the reimbursement rate with respect 
to individuals (regardless of whether such an indi-
vidual is entitled to or eligible for benefits under this 
title, but excluding individuals eligible for medical 
assistance under a State plan under title XIX) fur-
nished 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 indi-
vidual entitled to or enrolled for benefits under this 
title.’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4)(A) The requirement under paragraph (1)(Z) 
shall not apply in the case of a hospital in a hospital refer-
ral region if the HRR market share of such hospital (as 
determined under subparagraph (B)) is less than 0.15. 
‘‘(B) For purposes of subparagraph (A), the HRR 
market share of a hospital in a hospital referral region 
is equal to— 
‘‘(i) the total revenue of the hospital, divided by 
‘‘(ii) the total revenue of all hospital in the hos-
pital referral region.’’. 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
(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-
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: 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
(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 
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 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
to accept the terms and conditions of the 
managed care plan. 
(iv) The State does not have in effect 
a law that prohibits health insurers from 
directing policy-holders to lower-cost op-
tions through unsolicited recommendations. 
(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: 
‘‘(x) 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 
items and services furnished if furnished in a physi-
cian office setting. 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
‘‘(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)— 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
(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. 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; 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
(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: 
‘‘(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 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS
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. 
‘‘(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).’’. 
SEC. 6. REPEAL OF HEALTH CARE REFORM PROVISIONS 
LIMITING MEDICARE EXCEPTION TO THE 
PROHIBITION ON CERTAIN PHYSICIAN RE-
FERRALS FOR HOSPITALS. 
Sections 6001 and 10601 of the Patient Protection 
and Affordable Care Act (Public Law 111–148; 124 Stat. 
684, 1005) and section 1106 of the Health Care and Edu-
cation Reconciliation Act of 2010 (Public Law 111–152; 
124 Stat. 1049) are repealed and the provisions of law 
amended by such sections are restored as if such sections 
had never been enacted. 
Æ 
VerDate Sep 11 2014 
22:25 Jan 25, 2019
Jkt 089200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6301
E:\BILLS\H506.IH
H506
pamtmann on DSKBFK8HB2PROD with BILLS