,,ii  #aac? ,,congress  #a/ ,session    
,s4 #bcf  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #g1 #bjac ,ms4
 ,murk[ski 7= h]self1 ,mr4 ,coburn1 ,mr4
 ,paul1 & ,mr4 ,b>rasso7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xviii ( ! ,social      
,security ,act to e/abli% a ,m$ic>e     
paym5t option = pati5ts & physicians or 
practition]s to freely contract1 )\t    
p5alty1 = ,m$ic>e fee-=-s]vice items &  
s]vices1 :ile all[+ ,m$ic>e b5efici>ies 
to use _! ,m$ic>e b5efits4  #a4 ,%ort   
title ,?is ,act may be cit$ z ! ,m$ic>e 
,pati5t ,emp[]m5t ,act4  #b4 ,gu>antee+ 
fre$om ( *oice & contract+ = pati5ts    
7a7 ,9 g5]al ,section #ahjb ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acie;a7  
is am5d$ to read z foll[s3  #ahjb4      
,fre$om ( *oice & contract+ by pati5t   
gu>ante$  7a7 ,basic fre$om ( *oice ,any
 individual entitl$ to insurance b5efits
 "u ?is title may obta9 heal? s]vices f 
any in/itution1 ag5cy1 or p]son qualifi$

 to p>ticipate "u ?is title if su*      
in/itution1 ag5cy1 or p]son und]takes to
 provide t individual su* s]vices4  7b7 
,fre$om ,to contract by ,m$ic>e         
b5efici>ies  7#a7 ,9 g5]al ,subject to !
 provisions ( ?is subsection1 no?+ 9 ?is
 title %all prohibit a ,m$ic>e b5efici>y
 f ent]+ into a contract ) a p>ticipat+ 
or non-p>ticipat+ physician or          
practition] = any item or s]vice cov]$  
"u ?is title4  7#b7 ,submission ( claims
 ,any ,m$ic>e b5efici>y t ent]s into a  
contract "u ?is section %all be p]mitt$ 
to submit a claim = paym5t "u ?is title1
 & su* paym5t %all be made 9 ! am\nt t  
w\ld o!rwise apply "u ?is title if su*  
claim _h be5 fil$ by a p>ticipat+       
physician or practition] 7z def9$ 9     
section #ahdb7;i77#b77 9 ! paym5t area  
:]e ! physician or practition] cov]$ by 
! contract resides4 ,paym5t made "u ?is 
title = any item or s]vice provid$ "u ! 
contract %all n r5d] ! physician a      
p>ticipat+ or non-p>ticipat+ physician1 
& z su*1 requirem5ts ( ?is title t may  

o!rwise apply to a p>ticipat+ or        
non-p>ticipat+ physician w\ld n apply ) 
respect to any items or s]vices furni%$ 
"u ! contract4  7#c7 ,b5efici>y         
protections  7,a7 ,9 g5]al ,p>agraph    
7#a7 %all n apply to any contract       
unless--  7i7 ! contract is 9 writ+1 is 
sign$ by ! ,m$ic>e b5efici>y & !        
physician or practition]1 & e/abli%es   
all t]ms ( ! contract 7includ+ specific 
paym5t = physicians' s]vices cov]$ by ! 
contract7 be=e any item or s]vice is    
provid$ pursuant to ! contract1 & !     
b5efici>y %all be held h>mless = any    
subsequ5t paym5t *>g$ = a s]vice 9      
excess ( ! am\nt e/abli%$ "u ! contract 
dur+ ! p]iod ! contract is 9 effect2    
7ii7 ! contract conta9s ! items describ$
 9 subp>agraph 7,b72 &  7iii7 ! contract
 is n ent]$ into at a "t :5 ! ,m$ic>e   
b5efici>y is fac+ an em]g5cy m$ical     
condition or urg5t heal? c>e situation4 
7,b7 ,items requir$ to be includ$ 9     
contract ,any contract to provide items 
& s]vices to :i* p>agraph 7#a7 applies  

%all cle>ly indicate to ! ,m$ic>e       
b5efici>y t by sign+ su* contract !     
b5efici>y--  7i7 agrees to be           
responsible = paym5t to su* physician or
 practition] = su* items or s]vices "u !
 t]ms ( & am\nts e/abli%$ "u ! contract2
  7ii7 agrees to be responsible =       
submitt+ claims "u ?is title to !       
,secret>y1 & to any o!r supplem5tal     
insurance plan t may provide supplem5tal
 insurance1 = su* items or s]vices      
furni%$ "u ! contract if su* items or   
s]vices are cov]$ by ?is title1 unless  
o!rwise provid$ 9 ! contract "u         
subp>agraph 7,c77i72 &  7iii7 ackn[l$ges
 t no limits or o!r paym5t inc5tives t  
may o!rwise apply "u ?is title 7su* z ! 
limits "u subsection 7g7 ( section #ahdh
 or inc5tives "u subsection 7a77#e71    
7m71 7q71 & 7p7 ( su* section7 %all     
apply to am\nts t may be *>g$1 or paid  
to a b5efici>y =1 su* items or s]vices4 
,su* contract %all also cle>ly indicate 
:e!r ! physician or practition] is      
exclud$ f p>ticipation "u ! ,m$ic>e     

program "u section #aabh4  7,c7         
,b5efici>y elections "u ! contract ,any 
,m$ic>e b5efici>y t ent]s into a        
contract "u ?is section may elect to    
negotiate1 z a t]m ( ! contract1 a      
provision "u :i*--  7i7 ! physician or  
practition] %all file claims on behalf (
 ! b5efici>y ) ! ,secret>y & any        
supplem5tal insurance plan = items or   
s]vices furni%$ "u ! contract if su*    
items or s]vices are cov]$ "u ?is title 
or "u ! plan2 &  7ii7 ! b5efici>y       
assigns paym5t to ! physician = any     
claims fil$ by1 or on behalf (1 !       
b5efici>y ) ! ,secret>y & any           
supplem5tal insurance plan = items or   
s]vices furni%$ "u ! contract4  7,d7    
,exclusion ( dual eligible individuals  
,p>agraph 7#a7 %all n apply to any      
contract if a b5efici>y :o is eligible =
 m$ical assi/ance "u title ,,xix is a   
p>ty to ! contract4  7#d7 ,limitation on
 actual *>ge & claim submission         
requirem5t n applicable ,section        
#ahdh7;g7 %all n apply ) respect to any 

item or s]vice provid$ to a ,m$ic>e     
b5efici>y "u a contract describ$ 9      
p>agraph 7#a74  7#e7 ,con/ruction ,no?+ 
9 ?is section %all be con/ru$ to        
prohibit any physician or practition] f 
ma9ta9+ an election & act+ z a          
p>ticipat+ or non-p>ticipat+ physician  
or practition] ) respect to any pati5t n
 cov]$ "u a contract e/abli%$ "u ?is    
section4  7#f7 ,def9itions ,9 ?is       
subsection3  7,a7 ,m$ic>e b5efici>y ,!  
t]m ,m$ic>e b5efici>y means an          
individual :o is entitl$ to b5efits "u  
"p ,a or enroll$ "u "p ,b4  7,b7        
,physician ,! t]m physician has ! mean+ 
giv5 su* t]m by p>agraphs 7#a71 7#b71   
7#c71 & 7#d7 ( section #ahfa7r74  7,c7  
,practition] ,! t]m practition] means a 
practition] describ$ 9 section          
#ahdb7;b77#ah77;,c74  7,d7 ,em]g5cy     
m$ical condition ,! t]m em]g5cy m$ical  
condition means a m$ical condition      
manife/+ itself by acute symptoms (     
suffici5t sev]ity 7includ+ sev]e pa97   
su* t a prud5t layp]son1 ) an av]age k (

 heal? & m$ic9e1 c\ld reasonably expect 
! abs5ce ( imm$iate m$ical att5tion to  
result 9--  7i7 s]i\s jeop>dy to ! heal?
 ( ! individual or1 9 ! case ( a        
pregnant woman1 ! heal? ( ! woman or h] 
unborn *ild2  7ii7 s]i\s impairm5t to   
bodily functions2 or  7iii7 s]i\s       
dysfunction ( any bodily organ or "p4   
7,e7 ,urg5t heal? c>e situation ,! t]m  
urg5t heal? c>e situation means s]vices 
furni%$ to an individual :o requires    
s]vices to be furni%$ )9 #ab h\rs 9 ord]
 to avoid ! likely onset ( an em]g5cy   
m$ical condition4  4  #c4 ,preemption ( 
,/ate laws limit+ *>ges = physician &   
practition] s]vices  7a7 ,9 g5]al ,no   
,/ate may impose a limit on ! am\nt (   
*>ges = s]vices1 furni%$ by a physician 
or practition]1 = :i* paym5t is made "u 
section #ahdh ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#d71 & any su*   
limit is h]eby preempt$4  7b7 ,/ate ,9  
?is section1 ! t]m ,/ate includes !     
,di/rict ( ,columbia1 ,pu]to ,rico1 !   
,virg9 ,isl&s1 ,guam1 & ,am]ican ,samoa4