Providers and Payers COMPETE Act

Bill: 118-hr-3284
Sponsor: full_name: Rep. Burgess, Michael C. [R-TX-26]
Introduced: 2023-05-15
Policy area: Health
Subjects: Administrative law and regulatory procedures

Congressional oversight

Health care costs and insurance

Medicare
Latest action: action_date: 2024-12-05
text: Placed on the Union Calendar, Calendar No. 672.

Summaries:
action_date: 2023-05-15
action_desc: Introduced in House
text: <p><b>Providers and Payers COMPETE Act</b></p> <p>This bill requires the Centers for Medicare &amp; Medicaid Services (CMS) to report annually on the impact of Medicare regulatory changes on provider and payer consolidation (e.g., vertical or horizontal integration among providers, suppliers, and other health care entities). The CMS must also solicit public comment on the projected impact of a proposed rule with respect to provider and payer consolidation.</p> <p>The bill also requires the Center for Medicare and Medicaid Innovation to evaluate the impact of tested models on provider and payer consolidation.</p>

tv_txt: IB Union Calendar No. 672 118th CONGRESS 2d Session H. R. 3284 [Report No. 118–765, Parts I and II] IN THE HOUSE OF REPRESENTATIVES May 15, 2023 Mr. Burgess (for himself, Mrs. Dingell , Mr. Ferguson , and Mr. Bilirakis ) 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 jurisdiction of the committee concerned November 22, 2024 Reported from the Committee on Energy and Commerce with an amendment Strike out all after the enacting clause and insert the part printed in italic November 22, 2024 Referral to the Committee on Ways and Means extended for a period ending not later than December 19, 2024 December 5, 2024 Additional sponsor: Ms. Lee of Nevada December 5, 2024 Reported from the Committee on Ways and Means with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed Strike out all after the enacting clause and insert the part printed in boldface roman For text of introduced bill, see copy of bill as introduced on May 15, 2023 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 consolidation.

1. Short title This Act may be cited as the Providers and Payers COMPETE Act . 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 31, 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 impact in the aggregate on provider and payer consolidation with respect to regulations and rules for parts A, B, C, and D of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq. ) implemented in the calendar year immediately prior to such report. Such report shall include regulations and rules that— (1) implement a change to an applicable payment system, a rate schedule, or another payment system under parts A, 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 could result in a significant rule affecting provider or payer consolidation with respect to a proposed rule for parts A, B, C, and D of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq. ), the Secretary shall seek public comment on the potential 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 includes 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 ). 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 amended— (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 affected and could affect provider and payer consolidation, which includes 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 section), and accountable care organizations under section 1899, or pursuant to models under this section. . (b) Effective date The amendments made by subsection (a) shall apply with respect to models tested on or after January 1, 2025.

1. Short title This Act may be cited as the Providers and Payers COMPETE Act . 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 31, 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 impact in the aggregate on provider and payer consolidation with respect to regulations and rules for parts A, B, C, and D of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq. ) implemented in the calendar year immediately prior to such report. Such report shall include regulations and rules that— (1) implement a change to an applicable payment system, a rate schedule, or another payment system under parts A, 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 could result in a significant rule affecting provider or payer consolidation with respect to a proposed rule for parts A, B, C, and D of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq. ), the Secretary shall seek public comment on the potential 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 includes 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 ). 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 amended— (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 affected and could affect provider and payer consolidation, which includes 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 section), and accountable care organizations under section 1899, or pursuant to models under this section. . (b) Effective date The amendments made by subsection (a) shall apply with respect to models tested on or after January 1, 2025.

December 5, 2024 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

tv_txt: I 118th CONGRESS 1st Session H. R. 3284 IN THE HOUSE OF REPRESENTATIVES May 15, 2023 Mr. Burgess (for himself, Mrs. Dingell , Mr. Ferguson , and Mr. Bilirakis ) 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 jurisdiction 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 consolidation.

1. Short title This Act may be cited as the Providers and Payers COMPETE Act . 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 impact 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 payment 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 result in a significant rule effecting provider or payer consolidation 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 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 includes 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 ). 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 amended— (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 includes 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 section), 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.