,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #gjhd ,,in ,,the ,,house ,,of ,,representatives ,october #bc1 #bjah ,mr4 ,banks of ,indiana introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and the ,judiciary1 for a period to be subsequently determined by the ,speaker1 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 competition1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,hospital ,competition ,act of #bjah4 #b4 ,hospital consolidation 7a7 ,authorization of appropriations ,there is authorized to be appropriated #afj1jjj1jjj to the ,federal ,trade ,commission to hire staff to investigate1 as consistent with the ,sherman ,antitrust ,act and other relevant ,federal laws1 anti-competitive mergers and practices under such laws to the extent such mergers and practices relate to providers of inpatient and outpatient health care services1 as defined by the ,secretary of ,health and ,human ,services4 7b7 ,medicare rates applied to certain ,,hhi hospitals 7#a7 ,in general ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7,a7 in subparagraph 7,x71 by striking and at the end2 7,b7 in subparagraph 7,y71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of a hospital in an urban area and with respect to which there is a ,herfindahl-,hirschman ,index 7,,hhi7 of greater than #d1jjj and in the case of a hospital in a rural area and with respect to which there is ,herfindahl-,hirschman ,index 7,,hhi7 of greater than #e1jjj1 to apply the reimbursement rate with respect to individuals 7regardless of whether such an individual is entitled to or eligible for benefits under this title1 but excluding individuals eligible for medical assistance under a ,state plan under title ,,xix7 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 title4 4 7#b7 ,effective date ,the amendments made by this subsection shall apply with respect to items and services furnished on or after ,january #a1 #bjba4 7c7 ,grants for hospital infrastructure improvement 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall carry out a grant program under which the ,secretary shall provide grants to eligible ,states1 in accordance with this subsection4 7#b7 ,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 law4 7#c7 ,eligibility 7,a7 ,in general ,an eligible ,state may receive not more than one grant under this subsection with respect to each qualifying criterion described in subparagraph 7,b7 that is met by the ,state4 7,b7 ,eligible ,state ,for purposes of this subsection1 the term eligible ,state means a ,state that meets any one or more of the following qualifying criteria3 7i7 ,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 provider4 7ii7 ,the ,state has in effect ,state scope of practice laws that-- 7,i7 allow advanced practice providers 7such as nurse practitioners1 advanced practice registered nurses1 clinical nurse specialists1 and physician assistants7 to evaluate patients2 diagnose1 order1 and interpret diagnostic tests2 and initiate and manage treatments2 or 7,,ii7 provide that the only justification for limiting the scope of practice of a health care provider is safety to the public4 7iii7 ,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 plan4 7#d7 ,funding ,there is authorized to be appropriated to carry out this subsection #a1jjj1jjj1jjj for each of the fiscal years #bjai through #bjbh4 ,funds appropriated under this paragraph shall remain available until expended4 #c4 ,off-campus provider-based department ,medicare site neutral payment 7a7 ,in general ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7w7 ,off-,campus provider-,based department site neutral payment 7#a7 ,in general ,with respect to items and services furnished in an off-campus provider-based department1 payment under this section for such items and services shall be the amount determined under the fee schedule under section #ahdh for such items and services furnished if furnished in a physician office setting4 7#b7 ,off-campus provider-based department ,for purposes of this subsection1 the term off-campus provider-based department has such meaning as specified by the ,secretary4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to items and services furnished on or after ,january #a1 #bjba4 #d4 ,repealing shared savings incentives from ,medicare shared savings program 7a7 ,in general ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 by striking subparagraph 7,b72 and 7,b7 by striking such program-- 7,a7 groups of providers and inserting such program1 groups of providers 2 7#b7 in subsection 7b77#b7-- 7,a7 in subparagraph 7,c71 by striking that would allow the organization to receive and distribute payments for shared savings under subsection 7d77#b7 to participating providers of services and suppliers2 and 7,b7 in subparagraph 7,e7-- 7i7 by striking the implementation and inserting and the implementation2 and 7ii7 by striking 1 and the determination of payments for shared savings under subsection 7d77#b72 7#c7 in subsection 7d7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,a71 by striking except and all that follows through the period at the end2 and 7ii7 by striking subparagraph 7,b72 and 7,b7 by striking paragraph 7#b72 and 7#d7 in subsection 7g71 by striking paragraph 7#d7 and redesignating paragraphs 7#e7 and 7#f7 as paragraphs 7#d7 and 7#e71 respectively4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect on ,january #a1 #bjba4 #e4 ,advisory group on reducing burden of hospital administrative requirements 7a7 ,in general ,not later than ,january #a1 #bjba1 the ,secretary of ,health and ,human ,services shall convene an advisory group to provide1 in accordance with this section1 recommendations on ways the ,federal ,government could reduce the burden of administrative requirements on hospitals4 7b7 ,recommendations ,not later than ,january #a1 #bjbb1 the advisory board convened under this section shall-- 7#a7 submit to the ,secretary of ,health and ,human ,services recommendations described under subsection 7a7 for executive action and any recommendations for ,state actions for potential consideration in making grants under section #b7;c7 to ,states2 and 7#b7 submit to ,congress recommendations described under subsection 7a7 for legislative proposals4 7c7 ,membership ,the advisory board under this section shall consist of the following members3 7#a7 ,three representatives of companies that have-- 7,a7 geographically distributed workforces2 7,b7 at least #aj1jjj employees2 and 7,c7 no more than #aj percent of such employees in any single ,state4 7#b7 ,three representatives of health insurance issuers and health plans1 consisting of-- 7,a7 one representative of for-profit health insurance issuers and health plans with at last #bj1jjj1jjj enrollees in the employer-sponsored market2 7,b7 one representative of non-profit health insurance issuers and health plans operating in at least #e ,states2 and 7,c7 one representative of non-profit health insurance issuers and health plans operating in a rural ,state 7as defined by the ,census ,bureau74 7#c7 ,seven public policy experts in the field of hospital consolidation4 #f4 ,price transparency ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc71 as amended by section #b1 is further amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,y71 by striking and at the end2 7,b7 in subparagraph 7,z71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after subparagraph 7,z7 the following new subparagraph3 7,,aa7 in the case of a hospital1 to comply with the requirement under subsection 7l74 2 and 7#b7 by adding at the end the following new subsection3 7l7 ,requirement relating to publishing certain hospital prices 7#a7 ,in general ,for purposes of subsection 7a77#a77;,,aa71 the requirement described in this subsection is1 with respect to a hospital and year 7beginning with #bjba71 for the hospital to publicly post1 through the system established under paragraph 7#c71 for each service included in the list published under paragraph 7#b7 for such year1 the volume-weighted average price charged by the hospital to-- 7,a7 individuals enrolled during such year in group health plans or health insurance coverage offered in the individual or group market 7as such terms are defined in section #bgia of the ,public ,health ,service ,act72 and 7,b7 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 service4 7#b7 ,services ,for purposes of subsection 7a77#a77;,,aa7 and this subsection1 the ,secretary shall1 for #bjba and each subsequent year1 publish a list of the #ajj services that are the most highly utilized in a hospital-based setting4 7#c7 ,standardized digital reporting system ,not later than ,january #a1 #bjba1 the ,secretary shall establish a standardized digital system for purposes of paragraph 7#a74 4