I 
118TH CONGRESS 
1ST SESSION H. R. 3284 
To require the Secretary of Health and Human Services to submit an annual 
report on the impact of certain Medicare regulations on provider and 
payer consolidation. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2023 
Mr. BURGESS (for himself, Mrs. DINGELL, Mr. FERGUSON, and Mr. BILI-
RAKIS) 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 juris-
diction of the committee concerned 
A BILL 
To require the Secretary of Health and Human Services 
to submit an annual report on the impact of certain 
Medicare regulations on provider and payer consolida-
tion. 
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 ‘‘Providers and Payers 
COMPETE Act’’. 
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SEC. 2. ANNUAL REPORT ON THE IMPACT OF CERTAIN 
MEDICARE REGULATIONS ON PROVIDER AND 
PAYER CONSOLIDATION; PUBLIC COMMENT 
ON PROVIDER AND PAYER CONSOLIDATION 
FOR CERTAIN PROPOSED RULES. 
(a) ANNUAL REPORT.—Not later than December 30, 
2026, and annually thereafter, the Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’) shall submit to Congress a report on the im-
pact in the aggregate on provider and payer consolidation 
with respect to regulations for parts B, C, and D of title 
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) 
implemented in the calendar year immediately prior to 
such report. Such report shall include regulations that— 
(1) implement a change to an applicable pay-
ment system, a rate schedule, or another payment 
system under part B, C, or D of such title; or 
(2) result in a significant rule effecting provider 
or payer consolidation. 
(b) PUBLIC COMMENT ON IMPACT TO PROVIDER AND 
PAYER CONSOLIDATION.—Beginning for 2025, as part of 
any notice and comment rulemaking process that will re-
sult in a significant rule effecting provider or payer con-
solidation with respect to a proposed rule for parts B, C, 
and D of title XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.), the Secretary shall seek public comment 
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on the projected impact of such proposed rule on provider 
and payer consolidation in the aggregate. 
(c) DEFINITIONS.—In this section: 
(1) PROVIDER AND PAYER CONSOLIDATION.— 
The term ‘‘provider and payer consolidation’’ in-
cludes the vertical or horizontal integration among 
providers of services (as defined in subsection (u) of 
section 1861 of the Social Security Act (42 U.S.C. 
1395x)), suppliers (as defined in subsection (d) of 
such section), accountable care organizations under 
section 1899 of the Social Security Act (42 U.S.C. 
1395jjj), Medicare Advantage organizations, PDP 
sponsors, pharmacy benefit managers, pharmacies, 
and integrated delivery systems. 
(2) APPLICABLE PAYMENT SYSTEM.—The term 
‘‘applicable payment system’’ includes— 
(A) with respect to outpatient hospital 
services, the prospective payment system for 
covered OPD services established under section 
1833(t) of such Act (42 U.S.C. 1395(l)); and 
(B) with respect to physicians’ services, 
the physician fee schedules established under 
section 1848 of such Act (42 U.S.C. 1395w–4). 
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SEC. 3. CONSIDERATION OF EFFECTS ON PROVIDER AND 
PAYER CONSOLIDATION WITH RESPECT TO 
CMI MODELS. 
(a) IN GENERAL.—Section 1115A(b)(4)(A) of the 
Social Security Act (42 U.S.C. 1315a(b)(4)(A)) is amend-
ed— 
(1) in clause (i), by striking at the end ‘‘and’’; 
(2) in clause (ii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) the extent to which, and how, 
the model has effected and could effect 
provider and payer consolidation, which in-
cludes the vertical or horizontal integration 
among providers of services (as defined in 
subsection (u) of section 1861), suppliers 
(as defined in subsection (d) of such sec-
tion), and accountable care organizations 
under section 1899.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to models tested 
on or after January 1, 2025. 
Æ 
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