Title: Hospital Competition Act of 2019
Policy area: Health

Summary:
Hospital Competition Act of 2019
This bill establishes a series of programs and requirements relating to hospital costs, payments, and infrastructure.
Among other things, the bill requires hospitals, as a condition of Medicare participation, to (1) in the case of hospitals that meet specified market concentration thresholds, apply Medicare reimbursement rates regardless of whether the individual receiving services is entitled to or enrolled in Medicare; and (2) publish the prices charged for specified services that are highly utilized.
The bill also repeals (1) performance incentives under the Medicare Shared Savings Program for accountable care organizations, and (2) provisions under the Stark law (i.e., the Physician Self-Referral Law) that prohibit physician-owned hospitals from expanding facility capacity.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 506 Introduced in House (IH)]

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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 
                          committee 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 Representatives 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 Federal Trade Commission to hire staff 
to investigate, as consistent 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 Social Security Act 
        (42 U.S.C. 1395cc(a)) is amended--
                    (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 Herfindahl-Hirschman Index (HHI) of greater than 
        5,000, to apply the reimbursement rate with respect to 
        individuals (regardless of whether such an individual is 
        entitled to or eligible for benefits under this title, but 
        excluding individuals eligible for medical assistance under a 
        State plan under title XIX) furnished 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 
        individual 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 referral 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 hospital 
        referral region.''.
            (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 Improvement.--
            (1) In general.--The Secretary of Health and Human Services 
        shall carry out a grant program under which the Secretary shall 
        provide grants to eligible 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 subsection 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 following qualifying 
                criteria:
                            (i) The State does not have in effect any 
                        State certificate of need law that requires 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 
                                providers (such as nurse practitioners, 
                                advanced practice registered nurses, 
                                clinical nurse specialists, and 
                                physician assistants) to evaluate 
                                patients; diagnose, order, and 
                                interpret diagnostic tests; and 
                                initiate and manage treatments; or
                                    (II) provide that the only 
                                justification 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 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 options 
                        through unsolicited recommendations.
            (4) Funding.--There is authorized to be appropriated to 
        carry out this subsection $1,000,000,000 for each of the fiscal 
        years 2019 through 2028. Funds appropriated under this 
        paragraph shall remain available until expended.

SEC. 3. OFF-CAMPUS PROVIDER-BASED DEPARTMENT MEDICARE SITE NEUTRAL 
              PAYMENT.

    (a) In General.--Section 1834 of the Social Security 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 physician 
        office setting.
            ``(2) Off-campus provider-based department.--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 services 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 Security 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 distribute 
                payments for shared savings under subsection (d)(2) to 
                participating providers of services and suppliers''; 
                and
                    (B) in subparagraph (E)--
                            (i) by striking ``the implementation'' and 
                        inserting ``and the implementation''; and
                            (ii) by striking ``, and the determination 
                        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 paragraphs (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;
                    (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 subsection:
    ``(l) Requirement Relating to Publishing Certain Hospital Prices.--
            ``(1) In general.--For purposes of subsection (a)(1)(AA), 
        the requirement described in this subsection is, with respect 
        to a hospital and year (beginning 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 coverage 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 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 system.--Not later 
        than January 1, 2021, the Secretary 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 
              REFERRALS 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 Education 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.
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