,,ii #aacth ,,congress #ast ,session ,s4 #bcf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #g1 #bjac ,ms4 ,murkowski 7for herself1 ,mr4 ,coburn1 ,mr4 ,paul1 and ,mr4 ,barrasso7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish a ,medicare payment option for patients and physicians or practitioners to freely contract1 without penalty1 for ,medicare fee-for-service items and services1 while allowing ,medicare beneficiaries to use their ,medicare benefits4 #a4 ,short title ,this ,act may be cited as the ,medicare ,patient ,empowerment ,act4 #b4 ,guaranteeing freedom of choice and contracting for patients 7a7 ,in general ,section #ahjb of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;a7 is amended to read as follows3 #ahjb4 ,freedom of choice and contracting by patient guaranteed 7a7 ,basic freedom of choice ,any individual entitled to insurance benefits under this title may obtain health services from any institution1 agency1 or person qualified to participate under this title if such institution1 agency1 or person undertakes to provide that individual such services4 7b7 ,freedom ,to contract by ,medicare beneficiaries 7#a7 ,in general ,subject to the provisions of this subsection1 nothing in this title shall prohibit a ,medicare beneficiary from entering into a contract with a participating or non-participating physician or practitioner for any item or service covered under this title4 7#b7 ,submission of claims ,any ,medicare beneficiary that enters into a contract under this section shall be permitted to submit a claim for payment under this title1 and such payment shall be made in the amount that would otherwise apply under this title if such claim had been filed by a participating physician or practitioner 7as defined in section #ahdb7;i77#b77 in the payment area where the physician or practitioner covered by the contract resides4 ,payment made under this title for any item or service provided under the contract shall not render the physician a participating or non-participating physician1 and as such1 requirements of this title that may otherwise apply to a participating or non-participating physician would not apply with respect to any items or services furnished under the contract4 7#c7 ,beneficiary protections 7,a7 ,in general ,paragraph 7#a7 shall not apply to any contract unless-- 7i7 the contract is in writing1 is signed by the ,medicare beneficiary and the physician or practitioner1 and establishes all terms of the contract 7including specific payment for physicians' services covered by the contract7 before any item or service is provided pursuant to the contract1 and the beneficiary shall be held harmless for any subsequent payment charged for a service in excess of the amount established under the contract during the period the contract is in effect2 7ii7 the contract contains the items described in subparagraph 7,b72 and 7iii7 the contract is not entered into at a time when the ,medicare beneficiary is facing an emergency medical condition or urgent health care situation4 7,b7 ,items required to be included in contract ,any contract to provide items and services to which paragraph 7#a7 applies shall clearly indicate to the ,medicare beneficiary that by signing such contract the beneficiary-- 7i7 agrees to be responsible for payment to such physician or practitioner for such items or services under the terms of and amounts established under the contract2 7ii7 agrees to be responsible for submitting claims under this title to the ,secretary1 and to any other supplemental insurance plan that may provide supplemental insurance1 for such items or services furnished under the contract if such items or services are covered by this title1 unless otherwise provided in the contract under subparagraph 7,c77i72 and 7iii7 acknowledges that no limits or other payment incentives that may otherwise apply under this title 7such as the limits under subsection 7g7 of section #ahdh or incentives under subsection 7a77#e71 7m71 7q71 and 7p7 of such section7 shall apply to amounts that may be charged1 or paid to a beneficiary for1 such items or services4 ,such contract shall also clearly indicate whether the physician or practitioner is excluded from participation under the ,medicare program under section #aabh4 7,c7 ,beneficiary elections under the contract ,any ,medicare beneficiary that enters into a contract under this section may elect to negotiate1 as a term of the contract1 a provision under which-- 7i7 the physician or practitioner shall file claims on behalf of the beneficiary with the ,secretary and any supplemental insurance plan for items or services furnished under the contract if such items or services are covered under this title or under the plan2 and 7ii7 the beneficiary assigns payment to the physician for any claims filed by1 or on behalf of1 the beneficiary with the ,secretary and any supplemental insurance plan for items or services furnished under the contract4 7,d7 ,exclusion of dual eligible individuals ,paragraph 7#a7 shall not apply to any contract if a beneficiary who is eligible for medical assistance under title ,,xix is a party to the contract4 7#d7 ,limitation on actual charge and claim submission requirement not applicable ,section #ahdh7;g7 shall not apply with respect to any item or service provided to a ,medicare beneficiary under a contract described in paragraph 7#a74 7#e7 ,construction ,nothing in this section shall be construed to prohibit any physician or practitioner from maintaining an election and acting as a participating or non-participating physician or practitioner with respect to any patient not covered under a contract established under this section4 7#f7 ,definitions ,in this subsection3 7,a7 ,medicare beneficiary ,the term ,medicare beneficiary means an individual who is entitled to benefits under part ,a or enrolled under part ,b4 7,b7 ,physician ,the term physician has the meaning given such term by paragraphs 7#a71 7#b71 7#c71 and 7#d7 of section #ahfa7r74 7,c7 ,practitioner ,the term practitioner means a practitioner described in section #ahdb7;b77#ah77;,c74 7,d7 ,emergency medical condition ,the term emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity 7including severe pain7 such that a prudent layperson1 with an average knowledge of health and medicine1 could reasonably expect the absence of immediate medical attention to result in-- 7i7 serious jeopardy to the health of the individual or1 in the case of a pregnant woman1 the health of the woman or her unborn child2 7ii7 serious impairment to bodily functions2 or 7iii7 serious dysfunction of any bodily organ or part4 7,e7 ,urgent health care situation ,the term urgent health care situation means services furnished to an individual who requires services to be furnished within #ab hours in order to avoid the likely onset of an emergency medical condition4 4 #c4 ,preemption of ,state laws limiting charges for physician and practitioner services 7a7 ,in general ,no ,state may impose a limit on the amount of charges for services1 furnished by a physician or practitioner1 for which payment is made under section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d71 and any such limit is hereby preempted4 7b7 ,state ,in this section1 the term ,state includes the ,district of ,columbia1 ,puerto ,rico1 the ,virgin ,islands1 ,guam1 and ,american ,samoa4