‘‘(ii) EXCEPTION.—Nothing in clause 
(i) shall be construed to prohibit an indi-
vidual who has staff privileges at an insti-
tution where the treatment involved in the 
dispute was provided from serving as a 
member of an expert panel merely on the 
basis of such affiliation, if the affiliation is 
disclosed to the parties and neither party 
objects. 
‘‘(D) PRACTICING HEALTH CARE PROFES-
SIONAL IN SAME FIELD.— 
‘‘(i) IN GENERAL.—In a dispute be-
fore an expert panel that involves treat-
ment, or the provision of items or serv-
ices— 
‘‘(I) by a physician, the medical 
experts on the expert panel shall be 
practicing physicians (allopathic or os-
teopathic) of the same or similar spe-
cialty as a physician who typically 
treats the condition, makes the diag-
nosis, or provides the type of treat-
ment under review; or 
‘‘(II) by a health care profes-
sional other than a physician, at least 
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two medical experts on the expert 
panel shall be practicing physicians 
(allopathic or osteopathic) of the same 
or similar specialty as the health care 
professional who typically treats the 
condition, makes the diagnosis, or 
provides the type of treatment under 
review, and, if determined appropriate 
by the State agency, the third medical 
expert shall be a practicing health 
care professional (other than such a 
physician) of such a same or similar 
specialty. 
‘‘(ii) PRACTICING DEFINED.—In this 
paragraph, the term ‘practicing’ means, 
with respect to an individual who is a phy-
sician or other health care professional, 
that the individual provides health care 
services to individual patients on average 
at least 2 days a week. 
‘‘(E) PEDIATRIC EXPERTISE.—In the case 
of dispute relating to a child, at least 1 medical 
expert on the expert panel shall have expertise 
described in subparagraph (D)(i) in pediatrics. 
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‘‘(3) DETERMINATION.—After a review under 
paragraph (1), an expert panel shall make a deter-
mination as to the liability of the parties involved 
and compensation. 
‘‘(4) ACCEPTANCE.—If the parties to a dispute 
before an expert panel under this subsection accept 
the determination of the expert panel concerning li-
ability and compensation, such compensation shall 
be paid to the claimant and the claimant shall agree 
to forgo any further action against the health care 
providers involved. 
‘‘(5) FAILURE TO ACCEPT.—If any party de-
cides not to accept the expert panel’s determination, 
the matter shall be referred to an administrative 
health care tribunal created pursuant to this section. 
‘‘(e) ADMINISTRATIVE HEALTH CARE TRIBUNALS.— 
‘‘(1) IN GENERAL.—Upon the failure of any 
party to accept the determination of an expert panel 
under subsection (d), the parties shall have the right 
to request a hearing concerning the liability or com-
pensation involved by an administrative health care 
tribunal established by the State involved. 
‘‘(2) REQUIREMENTS.—In establishing an ad-
ministrative health care tribunal under this section, 
a State shall— 
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‘‘(A) ensure that such tribunals are pre-
sided over by special judges with health care ex-
pertise; 
‘‘(B) provide authority to such judges to 
make binding rulings, rendered in written deci-
sions, on standards of care, causation, com-
pensation, and related issues with reliance on 
independent expert witnesses commissioned by 
the tribunal; 
‘‘(C) establish gross negligence as the legal 
standard for the tribunal; 
‘‘(D) allow the admission into evidence of 
the recommendation made by the expert panel 
under subsection (d); and 
‘‘(E) provide for an appeals process to 
allow for review of decisions by State courts. 
‘‘(f) REVIEW BY STATE COURT AFTER EXHAUSTION 
OF ADMINISTRATIVE REMEDIES.— 
‘‘(1) RIGHT TO FILE.—If any party to a dispute 
before a health care tribunal under subsection (e) is 
not satisfied with the determinations of the tribunal, 
the party shall have the right to file their claim in 
a State court of competent jurisdiction. 
‘‘(2) FORFEIT OF AWARDS.—Any party filing 
an action in a State court in accordance with para-
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graph (1) shall forfeit any compensation award 
made under subsection (e). 
‘‘(3) ADMISSIBILITY.—The determinations of 
the expert panel and the administrative health care 
tribunal pursuant to subsections (d) and (e) with re-
spect to a State court proceeding under paragraph 
(1) shall be admissible into evidence in any such 
State court proceeding. 
‘‘(g) DEFINITION.—In this section, the term ‘health 
care provider’ has the meaning given such term for pur-
poses of part A of title VII. 
‘‘(h) FUNDING.— 
‘‘(1) ONE-TIME INCREASE IN MEDICAID PAY-
MENT.—In the case of a State awarded a grant to 
carry out this section, the total amount of Federal 
payments made to the State under section 1903(a) 
of the Social Security Act or section 1939(b)of such 
Act (in the case of fiscal year 2010 or any fiscal 
year thereafter) for the first fiscal year for which 
such grant is awarded shall be increased by an 
amount equal to 1 percent of of the total amount of 
such payments made to the State for the preceding 
fiscal year under such 1903(a) or 1939(b) (as appli-
cable) for purposes of carrying out this section. 
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Amounts paid to a State pursuant to this subsection 
shall remain available until expended. 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated for any fis-
cal year such sums as may be necessary for purposes 
of making payments to States pursuant to para-
graph (1).’’. 
TITLE 
V—TAX 
CREDIT 
FOR 
HEALTH INFORMATION TECH-
NOLOGY 
SEC. 501. PURCHASE OF QUALIFIED HEALTH CARE INFOR-
MATION TECHNOLOGY. 
(a) IN GENERAL.—Section 179 of the Internal Rev-
enue Code of 1986 (relating to election to expense certain 
depreciable assets) is amended by adding at the end the 
following new subsection: 
‘‘(e) HEALTH CARE INFORMATION TECHNOLOGY.— 
‘‘(1) IN
GENERAL.—In the case of qualified 
health care information technology purchased by a 
medical care provider and placed in service during a 
taxable year— 
‘‘(A) subsection (b)(1) shall be applied by 
substituting ‘$300,000’ for ‘$100,000’, 
‘‘(B) subsection (b)(2) shall be applied by 
substituting ‘$600,000’ for ‘$400,000’, and 
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‘‘(C) subsection (b)(5)(A) shall be applied 
by substituting ‘$300,000 and $600,000’ for 
‘$100,000 and $400,000’. 
‘‘(2) DEFINITIONS.—For purposes of this sub-
section— 
‘‘(A) QUALIFIED HEALTH CARE INFORMA-
TION TECHNOLOGY.—The term ‘qualified health 
care information technology’ means section 179 
property which is used primarily for the elec-
tronic creation, maintenance, and exchange of 
medical care information to improve the quality 
or efficiency of medical care. 
‘‘(B) MEDICAL
CARE
PROVIDER.—The 
term ‘medical care provider’ means any person 
engaged in the trade or business of providing 
medical care. 
‘‘(C) MEDICAL CARE.—The term ‘medical 
care’ has the meaning given such term by sec-
tion 213(d).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to property placed in service after 
December 31, 2006. 
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SEC. 502. TELECOMMUNICATIONS CREDIT FOR QUALIFIED 
MEDICAL CARE PROVIDERS. 
(a) IN GENERAL.—Subpart D of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to business related credits) is amended by 
adding at the end the following new section: 
‘‘SEC. 45N. TELECOMMUNICATIONS CREDIT FOR QUALI-
FIED MEDICAL CARE PROVIDERS. 
‘‘(a) GENERAL RULE.—For purposes of section 38, 
in the case of a qualified medical care provider, the tele-
communications credit determined under this section for 
a taxable year is an amount equal to 50 percent of the 
applicable telecommunications charges paid or incurred by 
such provider during the taxable year. 
‘‘(b) DOLLAR LIMITATION.—In the case of a qualified 
medical care provider, the credit determined under sub-
section (a) for a taxable year shall not exceed $12,500. 
‘‘(c) DEFINITIONS.—For purposes of this section— 
‘‘(1) 
APPLICABLE
TELECOMMUNICATIONS 
CHARGES.—The term ‘applicable telecommunications 
charges’ means expenses paid or incurred for the 
purpose of installing or maintaining a communica-
tions network that supports interoperability of elec-
tronic medical record systems. 
‘‘(2) QUALIFIED MEDICAL CARE PROVIDER.— 
The term ‘qualified medical care provider’ means 
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any person engaged in the trade or business of pro-
viding medical care (as defined in section 213(d)) 
who has purchased qualified health care information 
technology (as defined in section 179(e)).’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 38(b) of such Code is amended by 
striking ‘‘plus’’ at the end of paragraph (25), by 
striking the period at the end of paragraph (26) and 
inserting ‘‘, plus’’, and by adding at the end the fol-
lowing new paragraph: 
‘‘(27) the telecommunications credit determined 
under section 45N.’’. 
(2) The table of sections for subpart D of part 
IV of subchapter A of chapter 1 of such Code is 
amended by adding at the end the following new 
item: 
‘‘Sec. 45N. Telecommunications credit for qualified medical care providers.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to expenses paid or incurred after 
December 31, 2006. 
SEC. 503. DEVELOPMENT OF HEALTH CARE INFORMATION 
TECHNOLOGY STANDARDS. 
Not later than 5 years after the date of the enact-
ment of this Act, the Secretary of Health and Human 
Services shall develop standards for health information 
technology, including for qualified health care information 
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technology (as defined in section 179(e)(2)(A) of the In-
ternal Revenue Code of 1986, as added by section 501(a)). 
TITLE VI—MEDICAL LIABILITY 
REFORMS 
SEC. 601. CONSTITUTIONAL AUTHORITY. 
The constitutional authority upon which this title 
rests is the power of the Congress to provide for the gen-
eral welfare, to regulate commerce, and to make all laws 
which shall be necessary and proper for carrying into exe-
cution Federal powers, as enumerated in section 8 of arti-
cle I of the Constitution of the United States. 
SEC. 602. PROTECTION AGAINST LEGAL LIABILITY FOR 
EMERGENCY AND RELATED SERVICES FUR-
NISHED TO ANY INDIVIDUAL. 
Section 224(g) of the Public Health Service Act (42 
U.S.C. 233(g)) is amended— 
(1) in paragraph (4), by striking ‘‘An entity’’ 
and inserting in lieu thereof ‘‘Subject to paragraph 
(6), an entity’’; and 
(2) by adding at the end the following: 
‘‘(6)(A) For purposes of this section— 
‘‘(i) an entity described in subparagraph (B) 
shall be considered to be an entity described in para-
graph (4); and 
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100 
‘‘(ii) the provisions of this section shall apply to 
an entity described in subparagraph (B) in the same 
manner as such provisions apply to an entity de-
scribed in paragraph (4), except that— 
‘‘(I) notwithstanding paragraph (1)(B), the 
deeming of any entity described in subpara-
graph (B), or of an officer, governing board 
member, employee, or contractor of such an en-
tity, to be an employee of the Public Health 
Service for purposes of this section shall apply 
only with respect to items and services that are 
furnished to an individual pursuant to section 
1867 of the Social Security Act and to post-sta-
bilization services (as defined in subparagraph 
(C)) furnished to such an individual; 
‘‘(II) nothing in paragraph (1)(D) shall be 
construed as preventing a physician or physi-
cian group described in subparagraph (B)(ii) 
from making the application referred to in such 
paragraph or as conditioning the deeming of a 
physician or physician group that makes such 
an application upon receipt by the Secretary of 
an application from the hospital or emergency 
department that employs or contracts with the 
physician or group; 
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101 
‘‘(III) notwithstanding paragraph (3), this 
paragraph shall apply only with respect to 
causes of action arising from acts or omissions 
that occur on or after January 1, 2008; 
‘‘(IV) paragraph (5) shall not apply to a 
physician or physician group described in sub-
paragraph (B)(ii); 
‘‘(V) the Attorney General, in consultation 
with the Secretary, shall make separate esti-
mates under subsection (k)(1) with respect to 
entities described in subparagraph (B) and enti-
ties described in paragraph (4) (other than 
those described in subparagraph (B)), and the 
Secretary shall establish separate funds under 
subsection (k)(2) with respect to such groups of 
entities, and any appropriations under this sub-
section for entities described in subparagraph 
(B) shall be separate from the amounts author-
ized by subsection (k)(2); 
‘‘(VI) notwithstanding subsection (k)(2), 
the amount of the fund established by the Sec-
retary under such subsection with respect to en-
tities described in subparagraph (B) may ex-
ceed a total of $10,000,000 for a fiscal year; 
and 
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102 
‘‘(VII) subsection (m) shall not apply to 
entities described in subparagraph (B). 
‘‘(B) An entity described in this subparagraph is— 
‘‘(i) a hospital or an emergency department to 
which section 1867 of the Social Security Act ap-
plies; and 
‘‘(ii) a physician or physician group that is em-
ployed by, or under contract with, such hospital or 
department to furnish items and services to individ-
uals under such section, including so-called ‘on call 
physicians’ . 
‘‘(C) For purposes of this paragraph, the term ‘post- 
stabilization services’ means, with respect to an individual 
who has been treated by an entity described in subpara-
graph (B) for purposes of complying with section 1867 
of the Social Security Act, services that are— 
‘‘(i) related to the condition that was so treated; 
and 
‘‘(ii) provided after the individual is stabilized 
in order to maintain the stabilized condition or to 
improve or resolve the individual’s condition. 
‘‘(D)(i) Nothing in this paragraph (or in any other 
provision of this section as such provision applies to enti-
ties described in subparagraph (B) by operation of sub-
paragraph (A)) shall be construed as authorizing or re-
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103 
quiring the Secretary to make payments to such entities, 
the budget authority for which is not provided in advance 
by appropriation Acts. 
‘‘(ii) The Secretary shall limit the total amount of 
payments under this paragraph for a fiscal year to the 
total amount appropriated in advance by appropriation 
Acts for such purpose for such fiscal year. If the total 
amount of payments that would otherwise be made under 
this paragraph for a fiscal year exceeds such total amount 
appropriated, the Secretary shall take such steps as may 
be necessary to ensure that the total amount of payments 
under this paragraph for such fiscal year does not exceed 
such total amount appropriated.’’. 
TITLE VII—TAX DEDUCTION FOR 
UNCOMPENSATED 
CARE 
IN 
EMERGENCY ROOMS 
SEC. 701. BAD DEBT DEDUCTION FOR DOCTORS TO PAR-
TIALLY OFFSET THE COST OF PROVIDING UN-
COMPENSATED CARE REQUIRED TO BE PRO-
VIDED UNDER AMENDMENTS MADE BY THE 
EMERGENCY 
MEDICAL 
TREATMENT 
AND 
LABOR ACT. 
(a) IN GENERAL.—Section 166 of the Internal Rev-
enue Code of 1986 (relating to bad debts) is amended by 
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104 
redesignating subsection (f) as subsection (g) and by in-
serting after subsection (e) the following new subsection: 
‘‘(f) BAD DEBT TREATMENT FOR DOCTORS TO PAR-
TIALLY OFFSET COST OF PROVIDING UNCOMPENSATED 
CARE REQUIRED TO BE PROVIDED.— 
‘‘(1) AMOUNT OF DEDUCTION.— 
‘‘(A) IN GENERAL.—For purposes of sub-
section (a), the basis for determining the 
amount of any deduction for an eligible 
EMTALA debt shall be treated as being equal 
to the Medicare payment amount. 
‘‘(B) MEDICARE PAYMENT AMOUNT.—For 
purposes of subparagraph (A), the Medicare 
payment amount with respect to an eligible 
EMTALA debt is the fee schedule amount es-
tablished under section 1848 of the Social Secu-
rity Act for the physicians’ service (to which 
such debt relates) as if the service were pro-
vided to an individual enrolled under part B of 
title XVIIII of such Act. 
‘‘(2) ELIGIBLE EMTALA DEBT.—For purposes 
of this section, the term ‘eligible EMTALA debt’ 
means any debt if— 
‘‘(A) such debt arose as a result of physi-
cians’ services— 
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105 
‘‘(i) which were performed in an 
EMTALA hospital by a board-certified 
physician (whether as part of medical 
screening or necessary stabilizing treat-
ment and whether as an emergency depart-
ment physician, as an on-call physician, or 
otherwise), and 
‘‘(ii) which were required to be pro-
vided under section 1867 of the Social Se-
curity Act (42 U.S.C. 1395dd), and 
‘‘(B) such debt is owed— 
‘‘(i) to such physician, or 
‘‘(ii) to an entity if— 
‘‘(I) such entity is a corporation 
and the sole shareholder of such cor-
poration is such physician, or 
‘‘(II) such entity is a partnership 
and any deduction under this sub-
section with respect to such debt is al-
located to such physician or to an en-
tity described in subclause (I). 
‘‘(3) BOARD-CERTIFIED PHYSICIAN.—For pur-
poses of this subsection, the term ‘board-certified 
physician’ means any physician (as defined in sec-
tion 1861(r) of the Social Security Act (42 U.S.C. 
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106 
1395x(r)) who is certified by the American Board of 
Emergency Medicine or other appropriate medical 
specialty board for the specialty in which the physi-
cian practices, or who meets comparable require-
ments, as identified by the Secretary of the Treasury 
in consultation with Secretary of Health and Human 
Services. 
‘‘(4) OTHER
DEFINITIONS.—For purposes of 
this subsection— 
‘‘(A) EMTALA 
HOSPITAL.—The term 
‘EMTALA hospital’ means any hospital having 
a hospital emergency department which is re-
quired to comply with section 1867 of the So-
cial Security Act (42 U.S.C. 1395dd) (relating 
to examination and treatment for emergency 
medical conditions and women in labor). 
‘‘(B) PHYSICIANS’ SERVICES.—The term 
‘physicians’ services’ has the meaning given 
such term in section 1861(q) of the Social Se-
curity Act (42 U.S.C. 1395x(q)).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to debts arising from services per-
formed in taxable years beginning after the date of the 
enactment of this Act. 
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107 
TITLE VIII—ADDITIONAL 
CHANGES 
SEC. 801. APPLICATION OF SECTION 1115 WAIVERS BY 
OTHER STATES. 
Section 1115 of the Social Security Act (42 U.S.C. 
1315) is amended by adding at the end the following new 
subsection: 
‘‘(g) If the Secretary has waived under subsection (a) 
compliance with one or more requirements of title XIX 
in connection with a project of a State and such waiver 
has not been terminated, the Secretary shall also waive 
compliance with such requirements in connection with a 
project conducted by another State that is consistent with 
the terms and conditions for the original project.’’. 
SEC. 802. HIPAA TECHNICAL ADVISORY GROUP. 
(a) ESTABLISHMENT.—The Secretary shall establish 
a Technical Advisory Group (in this section referred to 
as the ‘‘Advisory Group’’) to review issues related to the 
HIPAA regulations and their implementation. In this sec-
tion, the term ‘‘HIPAA regulations’’ refers to the regula-
tions promulgated pursuant to section 264(c) of the 
Health Insurance Portability and Accountability Act of 
1996 (42 U.S.C. 1320d–1 note). 
(b) MEMBERSHIP.—The Advisory Group shall be 
composed of 19 members, including the Administrator of 
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108 
the Centers for Medicare & Medicaid Services and the In-
spector General of the Department of Health and Human 
Services and of which— 
(1) 2 shall be representatives of hospitals, in-
cluding at least one public hospital, that have experi-
ence with the application of HIPAA regulations; 
(2) 9 shall be practicing physicians drawn from 
the fields of emergency medicine, cardiology or 
cardiothoracic surgery, orthopaedic surgery, neuro-
surgery, general surgery with expertise in trauma, 
internal medicine, pediatrics or a pediatric sub-
specialty, obstetrics-gynecology, and psychiatry, with 
not more than one physician from any particular 
field; 
(3) 2 shall be non-physician representatives 
from private medical practices with significant pa-
tient volume; 
(4) 2 shall represent patients; 
(5) 2 shall be staff involved in HIPAA regula-
tions investigations from different regional offices of 
the Centers for Medicare & Medicaid Services; and 
(6) 1 shall be from a State survey office in-
volved in HIPAA regulations investigations and 1 
shall be from a peer review organization, both of 
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109 
whom shall be from areas other than the regions 
represented under paragraph (5). 
In selecting members described in paragraphs (1) through 
(4), the Secretary shall consider qualified individuals nom-
inated by organizations representing providers and pa-
tients. 
(c) GENERAL
RESPONSIBILITIES.—The Advisory 
Group— 
(1) shall review HIPAA regulations; 
(2) may provide advice and recommendations to 
the Secretary with respect to those regulations and 
their application to hospitals, medical practices, out-
patient services and physicians; 
(3) shall solicit comments and recommendations 
from hospitals, physicians, and the public regarding 
the implementation of such regulations; 
(4) may disseminate information on the applica-
tion of such regulations to hospitals, physicians, and 
the public; and 
(5) shall make recommendations to Congress 
regarding any reforms recommended that may ease 
the regulatory burden on those caring for patients. 
(d) ADMINISTRATIVE MATTERS.— 
(1) CHAIRPERSON.—The members of the Advi-
sory Group shall elect a member to serve as chair-
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110 
person of the Advisory Group for the life of the Ad-
visory Group. 
(2) MEETINGS.—The Advisory Group shall first 
meet at the direction of the Secretary. The Advisory 
Group shall then meet twice per year and at such 
other times as the Advisory Group may provide. 
(e) TERMINATION.—The Advisory Group shall termi-
nate 30 months after the date of its first meeting. 
(f) WAIVER OF ADMINISTRATIVE LIMITATION.—The 
Secretary shall establish the Advisory Group notwith-
standing any limitation that may apply to the number of 
advisory committees that may be established (within the 
Department of Health and Human Services or otherwise). 
SEC. 803. MEDICARE PHYSICIAN PAYMENT UPDATE RE-
FORM. 
(a) SUBSTITUTION OF MEI INCREASE FOR SGR AD-
JUSTMENTS.—Section 1848(d) of the Social Security Act 
(42 U.S.C. 1395w–4(d)) is amended— 
(1) in paragraph (1)(A), by inserting ‘‘and be-
fore 2008’’ after ‘‘beginning with 2001’’; 
(2) in paragraph (1)(A), by inserting before the 
period at the end the following: ‘‘, and for years be-
ginning with 2008, multiplied by the update estab-
lished under paragraph (7) applicable to the year in-
volved’’; and 
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111 
(3) in paragraph (4)— 
(A) in the heading by striking ‘‘YEARS BE-
GINNING WITH 2001’’ and inserting ‘‘2001, 2002, 
AND 2003’’; and 
(B) in subparagraph (A), by inserting 
‘‘and ending with 2003’’ after ‘‘beginning with 
2001’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(8) UPDATE BEGINNING WITH 2008.—The up-
date to the single conversion factor established in 
paragraph (1)(C) for 2008 and each succeeding year 
shall be the percentage increase in the MEI (as de-
fined in section 1842(i)(3)) for the year involved.’’. 
(b) 
ENDING
APPLICATION
OF
SUSTAINABLE 
GROWTH RATE (SGR).—Section 1848(f)(1)(B) of such 
Act (42 U.S.C. 1395w–4(f)(1)(B)) is amended by insert-
ing ‘‘(and before 2007)’’ after ‘‘each succeeding year’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to payment for services furnished 
on or after January 1, 2008. 
SEC. 804. 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— 
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112 
(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 in a month to an individual if the 
individual furnishing such services provides the 
advance notice of such non-participation and 
non-acceptance of assignment under paragraph 
(8) and (for services furnished on or after Jan-
uary 1, 2008) submits information in accord-
ance with subsection (k)(4).’’; 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-
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113 
wise furnished in a manner so as to inform the indi-
vidual receiving the item or service that— 
‘‘(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 in a 
month 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 in a month to an individual if the advance 
notice described in section 1848(g)(8) has been pro-
vided and (for services furnished on or after Janu-
ary 1, 2008) the physician furnishing the services 
submits information in accordance with section 
1848(k)(4).’’. 
(c) CONFORMING AMENDMENT TO PARTICIPATION 
PROVISIONS.—Section 1842(h) of such Act (42 U.S.C. 
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114 
1395u) is amended by adding at the end the following new 
paragraph: 
‘‘(8) 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-
nished in a month to an individual if the advance notice 
described in section 1848(g)(8) has been provided and (for 
services furnished on or after January 1, 2008) the physi-
cian furnishing the services submits information in accord-
ance with section 1848(k)(4).’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2008. 
SEC. 805. ELECTION OF TAX CREDIT INSTEAD OF ALTER-
NATIVE GOVERNMENT BENEFITS. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, an individual who is otherwise eligible for ben-
efits under a Federal health program (as defined in sub-
section (c)) may elect, in a form and manner specified by 
the Secretary of Health and Human Services in consulta-
tion with the Secretary of the Treasury, to receive a tax 
credit described in section 36 of the Internal Revenue 
Code of 1986 (which may be used for the purpose of 
health insurance coverage) in lieu of receiving any benefits 
under such program. 
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115 
(b) EFFECTIVE DATE.—An election under subsection 
(a) may first be made for calendar year 2009 and any 
such election shall be effective for such period (not less 
than one calendar year) as the Secretary of Health and 
Human Services shall specify, in consultation with the 
Secretary of the Treasury. 
(c) FEDERAL HEALTH PROGRAM DEFINED.—For 
purposes of this section, the term ‘‘Federal health pro-
gram’’ means any of the following: 
(1) MEDICARE.—The medicare program under 
part A of title XVIII of the Social Security Act, in-
cluding any benefits under any other part of such 
title. 
(2) MEDICAID.—The Medicaid program under 
title XIX of such Act (including such a program op-
erating under a Statewide waiver under section 1115 
of such Act). 
(3) SCHIP.—The State children’s health insur-
ance program under title XXI of such Act. 
(4) 
TRICARE.—The 
TRICARE 
program 
under chapter 55 of title 10, United States Code. 
(5) VETERANS BENEFITS.—Coverage for bene-
fits under chapter 17 of title 38, United States 
Code. 
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116 
SEC. 806. USE OF PRIVATE CONTRACTS BY MEDICARE 
BENEFICIARIES FOR PROFESSIONAL SERV-
ICES. 
(a) IN GENERAL.—Section 1802 of the Social Secu-
rity Act (42 U.S.C. 1395a) is amended by striking sub-
section (b) and inserting the following: 
‘‘(b) CLARIFICATION
OF USE
OF PRIVATE CON-
TRACTS
BY MEDICARE BENEFICIARIES
FOR PROFES-
SIONAL SERVICES.— 
‘‘(1) IN GENERAL.—Nothing in this title shall 
prohibit a medicare beneficiary from entering into a 
private contract with a physician or health care 
practitioner for the provision of medicare covered 
professional services (as defined in paragraph 
(5)(C)) if— 
‘‘(A) the services are covered under a pri-
vate contract that is between the beneficiary 
and the physician or practitioner and meets the 
requirements of paragraph (2); 
‘‘(B) under the private contract no claim 
for payment for services covered under the con-
tract is to be submitted (and no payment made) 
under part A or B under a contract under sec-
tion 1876, or under a Medicare Advantage plan 
(other than an MSA plan); and 
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117 
‘‘(C)(i) the Secretary has been provided 
with the minimum information necessary to 
avoid any payment under part A or B for serv-
ices covered under the contract, or 
‘‘(ii) in the case of an individual enrolled 
under a contract under section 1876 or a Medi-
care Advantage plan (other than an MSA plan) 
under part C, the eligible organization under 
the contract or the Medicare Advantage organi-
zation offering the plan has been provided the 
minimum information necessary to avoid any 
payment under such contract or plan for serv-
ices covered under the contract. 
‘‘(2) 
REQUIREMENTS
FOR
PRIVATE
CON-
TRACTS.—The requirements in this paragraph for a 
private contract between a medicare beneficiary and 
a physician or health care practitioner are as fol-
lows: 
‘‘(A) GENERAL FORM OF CONTRACT.—The 
contract is in writing and is signed by the medi-
care beneficiary. 
‘‘(B) NO CLAIMS TO BE SUBMITTED FOR 
COVERED
SERVICES.—The contract provides 
that no party to the contract (and no entity on 
behalf of any party to the contract) shall sub-
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118 
mit any claim for (or request) payment for 
services covered under the contract under part 
A or B, under a contract under section 1876, 
or under a Medicare Advantage plan (other 
than an MSA plan). 
‘‘(C) SCOPE OF SERVICES.—The contract 
identifies the medicare covered professional 
services and the period (if any) to be covered 
under the contract, but does not cover any serv-
ices furnished— 
‘‘(i) before the contract is entered 
into; or 
‘‘(ii) for the treatment of an emer-
gency medical condition (as defined in sec-
tion 1867(e)(1)(A)), unless the contract 
was entered into before the onset of the 
emergency medical condition. 
‘‘(D) CLEAR DISCLOSURE OF TERMS.—The 
contract clearly indicates that by signing the 
contract the medicare beneficiary— 
‘‘(i) agrees not to submit a claim (or 
to request that anyone submit a claim) 
under part A or B (or under section 1876 
or under a Medicare Advantage plan, other 
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119 
than an MSA plan) for services covered 
under the contract; 
‘‘(ii) agrees to be responsible, whether 
through insurance or otherwise, for pay-
ment for such services and understands 
that no reimbursement will be provided 
under such part, contract, or plan for such 
services; 
‘‘(iii) acknowledges that no limits 
under this title (including limits under 
paragraph (1) and (3) of section 1848(g)) 
will apply to amounts that may be charged 
for such services; 
‘‘(iv) acknowledges that medicare sup-
plemental policies under section 1882 do 
not, and other supplemental health plans 
and policies may elect not to, make pay-
ments for such services because payment is 
not made under this title; and 
‘‘(v) acknowledges that the beneficiary 
has the right to have such services pro-
vided by (or under the supervision of) 
other physicians or health care practi-
tioners for whom payment would be made 
under such part, contract, or plan. 
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120 
Such contract shall also clearly indicate whether 
the physician or practitioner involved is ex-
cluded from participation under this title. 
‘‘(3) MODIFICATIONS.—The parties to a private 
contract may mutually agree at any time to modify 
or terminate the contract on a prospective basis, 
consistent with the provisions of paragraphs (1) and 
(2). 
‘‘(4) NO REQUIREMENTS FOR SERVICES FUR-
NISHED TO MSA PLAN ENROLLEES.—The require-
ments of paragraphs (1) and (2) do not apply to any 
contract or arrangement for the provision of services 
to a medicare beneficiary enrolled in an MSA plan 
under part C. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) HEALTH CARE PRACTITIONER.—The 
term ‘health care practitioner’ means a practi-
tioner described in section 1842(b)(18)(C). 
‘‘(B) MEDICARE BENEFICIARY.—The term 
‘medicare beneficiary’ means an individual who 
is enrolled under part B. 
‘‘(C) MEDICARE COVERED PROFESSIONAL 
SERVICES.—The term ‘medicare covered profes-
sional services’ means— 
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121 
‘‘(i) physicians’ services (as defined in 
section 1861(q), and including services de-
scribed in section 1861(s)(2)(A)), and 
‘‘(ii) professional services of health 
care practitioners, including services de-
scribed in section 1842(b)(18)(D), 
for which payment may be made under part A 
or B, under a contract under section 1876, or 
under a Medicare Advantage plan but for the 
provisions of a private contract that meets the 
requirements of paragraph (2). 
‘‘(D) MEDICARE
ADVANTAGE
PLAN; MSA 
PLAN.—The terms ‘Medicare Advantage plan’ 
and ‘MSA plan’ have the meanings given the 
terms ‘Medicare+Choice plan’ and ‘MSA plan’ 
in section 1859. 
‘‘(E) PHYSICIAN.—The term ‘physician’ 
has the meaning given such term in section 
1861(r).’’. 
(b) CONFORMING AMENDMENTS CLARIFYING EX-
EMPTION FROM LIMITING CHARGE AND FROM REQUIRE-
MENT FOR SUBMISSION OF CLAIMS.—Section 1848(g) of 
the Social Security Act (42 U.S.C. 1395w–4(g)) is amend-
ed— 
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122 
(1) in paragraph (1)(A), by striking ‘‘In’’ and 
inserting ‘‘Subject to paragraph (8), in’’; 
(2) in paragraph (3)(A), by striking ‘‘Payment’’ 
and inserting ‘‘Subject to paragraph (8), payment’’; 
(3) in paragraph (4)(A), by striking ‘‘For’’ and 
inserting ‘‘Subject to paragraph (8), for’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(8) EXEMPTION
FROM
REQUIREMENTS
FOR 
SERVICES
FURNISHED
UNDER
PRIVATE
CON-
TRACTS.— 
‘‘(A) IN
GENERAL.—Pursuant to section 
1802(b)(1), paragraphs (1), (3), and (4) do not 
apply with respect to physicians’ services (and 
services described in section 1861(s)(2)(A)) fur-
nished to an individual by (or under the super-
vision of) a physician if the conditions described 
in section 1802(b)(1) are met with respect to 
the services. 
‘‘(B) NO RESTRICTIONS FOR ENROLLEES 
IN MSA PLANS.—Such paragraphs do not apply 
with respect to services furnished to individuals 
enrolled with MSA plans under part C, without 
regard to whether the conditions described in 
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123 
subparagraphs (A) through (C) of section 
1802(b)(1) are met. 
‘‘(C) APPLICATION
TO
ENROLLEES
IN 
OTHER PLANS.—Subject to subparagraph (B) 
and section 1852(k)(2), the provisions of sub-
paragraph (A) shall apply in the case of an in-
dividual enrolled under a contract under section 
1876 or under a Medicare Advantage plan 
(other than an MSA plan) under part C, in the 
same manner as they apply to individuals not 
enrolled under such a contract or plan.’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1842(b)(18) of the Social Security 
Act (42 U.S.C. 1395u(b)(18)) is amended by adding 
at the end the following: 
‘‘(E) The provisions of section 1848(g)(8) 
shall apply with respect to exemption from limi-
tations on charges and from billing require-
ments for services of health care practitioners 
described in this paragraph in the same manner 
as such provisions apply to exemption from the 
requirements 
referred 
to 
in 
section 
1848(g)(8)(A) for physicians’ services.’’. 
(2) Section 1866(a)(1)(O) of such Act (42 
U.S.C. 1395cc(a)(1)(O)) is amended by inserting 
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