,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #gjhd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,octob] #bc1 #bjah    
,mr4 ,banks ( ,indiana introduc$ !      
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committees on ,ways &    
,means1 & ! ,judici>y1 = a p]iod to be  
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
increase hospital competition1 & = o!r  
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,hospital ,competition ,act
 ( #bjah4  #b4 ,hospital consolidation  
7a7 ,au?orization ( appropriations ,!re 
is au?oriz$ to be appropriat$           
#afj1jjj1jjj to ! ,f$]al ,trade         
,commission to hire /aff to inve/igate1 
z consi/5t ) ! ,%]man ,antitru/ ,act &  
o!r relevant ,f$]al laws1               
anti-competitive m]g]s & practices "u   
su* laws to ! ext5t su* m]g]s &         

practices relate to provid]s ( inpati5t 
& outpati5t heal? c>e s]vices1 z def9$  
by ! ,secret>y ( ,heal? & ,human        
,s]vices4  7b7 ,m$ic>e rates appli$ to  
c]ta9 ,,hhi hospitals  7#a7 ,9 g5]al    
,section #ahff7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;cc7a77#a77 is am5d$-- 7,a7 9      
subp>agraph 7,x71 by /rik+ & at ! end2  
7,b7 9 subp>agraph 7,y71 by /rik+ !     
p]iod at ! end & ins]t+ 2 &2 &  7,c7 by 
ins]t+ aft] subp>agraph 7,y7 ! foll[+   
new subp>agraph3  7,z7 9 ! case ( a     
hospital 9 an urban area & ) respect to 
:i* !re is a ,h]f9dahl-,hirs*man ,index 
7,,hhi7 ( great] ?an #d1jjj & 9 ! case (
 a hospital 9 a rural area & ) respect  
to :i* !re is ,h]f9dahl-,hirs*man ,index
 7,,hhi7 ( great] ?an #e1jjj1 to apply !
 reimbursem5t rate ) respect to         
individuals 7reg>dless ( :e!r su* an    
individual is entitl$ to or eligible =  
b5efits "u ?is title1 b exclud+         
individuals eligible = m$ical assi/ance 
"u a ,/ate plan "u title ,,xix7 furni%$ 

items & s]vices at su* hospital t w\ld  
be billable "u ?is title = su* items &  
s]vices if furni%$ by su* hospital to an
 individual entitl$ to or enroll$ =     
b5efits "u ?is title4  4  7#b7          
,effective date ,! am5dm5ts made by ?is 
subsection %all apply ) respect to items
 & s]vices furni%$ on or aft] ,janu>y   
#a1 #bjba4  7c7 ,grants = hospital      
infra/ructure improvem5t  7#a7 ,9 g5]al 
,! ,secret>y ( ,heal? & ,human ,s]vices 
%all c>ry out a grant program "u :i* !  
,secret>y %all provide grants to        
eligible ,/ates1 9 accordance ) ?is     
subsection4  7#b7 ,uses ,an eligible    
,/ate receiv+ a grant "u ?is subsection 
may use su* grant to improve ! ,/ate    
hospital infra/ructure & to supplem5t   
any o!r funds provid$ = a purpose       
au?oriz$ "u a ,/ate or local hospital   
grant programs "u ,/ate law4  7#c7      
,eligibility  7,a7 ,9 g5]al ,an eligible
 ,/ate may receive n m ?an "o grant "u  
?is subsection ) respect to ea* qualify+
 crit]ion describ$ 9 subp>agraph 7,b7 t 

is met by ! ,/ate4  7,b7 ,eligible ,/ate
 ,= purposes ( ?is subsection1 ! t]m    
eligible ,/ate means a ,/ate t meets any
 "o or m ( ! foll[+ qualify+ crit]ia3   
7i7 ,! ,/ate does n h 9 effect any ,/ate
 c]tificate ( ne$ law t requires a heal?
 c>e provid] to provide to a regulatory 
body a c]tification t ! community ne$s !
 s]vices provid$ by ! heal? c>e provid]4
  7ii7 ,! ,/ate has 9 effect ,/ate scope
 ( practice laws t--  7,i7 all[ advanc$ 
practice provid]s 7su* z nurse          
practition]s1 advanc$ practice regi/]$  
nurses1 cl9ical nurse speciali/s1 &     
physician assi/ants7 to evaluate        
pati5ts2 diagnose1 ord]1 & int]pret     
diagno/ic te/s2 & initiate & manage     
treatm5ts2 or  7,,ii7 provide t ! only  
ju/ification = limit+ ! scope ( practice
 ( a heal? c>e provid] is safety to !   
public4  7iii7 ,! ,/ate does n h 9      
effect any ,/ate laws t require manag$  
c>e plans to accept into ! network ( su*
 plan any qualifi$ provid] :o is will+  
to accept ! t]ms & conditions ( ! manag$

 c>e plan4  7#d7 ,fund+ ,!re is au?oriz$
 to be appropriat$ to c>ry out ?is      
subsection #a1jjj1jjj1jjj = ea* ( !     
fiscal ye>s #bjai ?r\gh #bjbh4 ,funds   
appropriat$ "u ?is p>agraph %all rema9  
available until exp5d$4  #c4 ,(f-campus 
provid]-bas$ dep>tm5t ,m$ic>e site      
neutral paym5t  7a7 ,9 g5]al ,section   
#ahcd ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciem7 is am5d$ by add+ at ! 
end ! foll[+ new subsection3  7w7       
,(f-,campus provid]-,bas$ dep>tm5t site 
neutral paym5t  7#a7 ,9 g5]al ,) respect
 to items & s]vices furni%$ 9 an        
(f-campus provid]-bas$ dep>tm5t1 paym5t 
"u ?is section = su* items & s]vices    
%all be ! am\nt det]m9$ "u ! fee s*$ule 
"u section #ahdh = su* items & s]vices  
furni%$ if furni%$ 9 a physician (fice  
sett+4  7#b7 ,(f-campus provid]-bas$    
dep>tm5t ,= purposes ( ?is subsection1 !
 t]m (f-campus provid]-bas$ dep>tm5t has
 su* mean+ z specifi$ by ! ,secret>y4  4
  7b7 ,effective date ,! am5dm5t made by
 subsection 7a7 %all apply ) respect to 

items & s]vices furni%$ on or aft]      
,janu>y #a1 #bjba4  #d4 ,repeal+ %>$    
sav+s inc5tives f ,m$ic>e %>$ sav+s     
program  7a7 ,9 g5]al ,section #ahii ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;jjj7 is am5d$-- 7#a7 9 subsection 
7a77#a7--  7,a7 by /rik+ subp>agraph    
7,b72 &  7,b7 by /rik+  su* program--   
7,a7 gr\ps ( provid]s  & ins]t+  su*    
program1 gr\ps ( provid]s 2  7#b7 9     
subsection 7b77#b7--  7,a7 9 subp>agraph
 7,c71 by /rik+ t w\ld all[ !           
organization to receive & di/ribute     
paym5ts = %>$ sav+s "u subsection       
7d77#b7 to p>ticipat+ provid]s ( s]vices
 & suppli]s2 &  7,b7 9 subp>agraph      
7,e7--  7i7 by /rik+ ! implem5tation &  
ins]t+ & ! implem5tation2 &  7ii7 by    
/rik+ 1 & ! det]m9ation ( paym5ts = %>$ 
sav+s "u subsection 7d77#b72  7#c7 9    
subsection 7d7-- 7,a7 9 p>agraph 7#a7-- 
7i7 9 subp>agraph 7,a71 by /rik+ except 
& all t foll[s ?r\gh ! p]iod at ! end2 &
  7ii7 by /rik+ subp>agraph 7,b72 &     
7,b7 by /rik+ p>agraph 7#b72 &  7#d7 9  

subsection 7g71 by /rik+ p>agraph 7#d7 &
 r$esignat+ p>agraphs 7#e7 & 7#f7 z     
p>agraphs 7#d7 & 7#e71 respectively4    
7b7 ,effective date ,! am5dm5ts made by 
subsection 7a7 %all take effect on      
,janu>y #a1 #bjba4  #e4 ,advisory gr\p  
on r$uc+ burd5 ( hospital adm9i/rative  
requirem5ts  7a7 ,9 g5]al ,n lat] ?an   
,janu>y #a1 #bjba1 ! ,secret>y ( ,heal? 
& ,human ,s]vices %all conv5e an        
advisory gr\p to provide1 9 accordance )
 ?is section1 recomm5dations on ways !  
,f$]al ,gov]nm5t c\ld r$uce ! burd5 (   
adm9i/rative requirem5ts on hospitals4  
7b7 ,recomm5dations ,n lat] ?an ,janu>y 
#a1 #bjbb1 ! advisory bo>d conv5$ "u ?is
 section %all-- 7#a7 submit to !        
,secret>y ( ,heal? & ,human ,s]vices    
recomm5dations describ$ "u subsection   
7a7 = executive action & any            
recomm5dations = ,/ate actions =        
pot5tial consid]ation 9 mak+ grants "u  
section #b7;c7 to ,/ates2 &  7#b7 submit
 to ,congress recomm5dations describ$ "u
 subsection 7a7 = legislative proposals4

  7c7 ,memb]%ip ,! advisory bo>d "u ?is 
section %all consi/ ( ! foll[+ memb]s3  
7#a7 ,?ree repres5tatives ( companies t 
h-- 7,a7 geographically di/ribut$       
work=ces2  7,b7 at lea/ #aj1jjj         
employees2 &  7,c7 no m ?an #aj p]c5t ( 
su* employees 9 any s+le ,/ate4  7#b7   
,?ree repres5tatives ( heal? insurance  
issu]s & heal? plans1 consi/+ (-- 7,a7  
"o repres5tative ( =-pr(it heal?        
insurance issu]s & heal? plans ) at la/ 
#bj1jjj1jjj enrollees 9 !               
employ]-sponsor$ m>ket2  7,b7 "o        
repres5tative ( non-pr(it heal?         
insurance issu]s & heal? plans op]at+ 9 
at lea/ #e ,/ates2 &  7,c7 "o           
repres5tative ( non-pr(it heal?         
insurance issu]s & heal? plans op]at+ 9 
a rural ,/ate 7z def9$ by ! ,c5sus      
,bureau74  7#c7 ,sev5 public policy     
exp]ts 9 ! field ( hospital             
consolidation4  #f4 ,price transp>5cy   
,section #ahff ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie;cc71 z am5d$  
by section #b1 is fur!r am5d$--  7#a7 9 

subsection 7a77#a7-- 7,a7 9 subp>agraph 
7,y71 by /rik+ & at ! end2  7,b7 9      
subp>agraph 7,z71 by /rik+ ! p]iod at ! 
end & ins]t+ 2 &2 &  7,c7 by ins]t+ aft]
 subp>agraph 7,z7 ! foll[+ new          
subp>agraph3  7,,aa7 9 ! case ( a       
hospital1 to comply ) ! requirem5t "u   
subsection 7l74  2 &  7#b7 by add+ at ! 
end ! foll[+ new subsection3  7l7       
,requirem5t relat+ to publi%+ c]ta9     
hospital prices  7#a7 ,9 g5]al ,=       
purposes ( subsection 7a77#a77;,,aa71 ! 
requirem5t describ$ 9 ?is subsection is1
 ) respect to a hospital & ye> 7beg9n+ )
 #bjba71 = ! hospital to publicly po/1  
?r\gh ! sy/em e/abli%$ "u p>agraph 7#c71
 = ea* s]vice includ$ 9 ! li/ publi%$ "u
 p>agraph 7#b7 = su* ye>1 !             
volume-weight$ av]age price *>g$ by !   
hospital to-- 7,a7 individuals enroll$  
dur+ su* ye> 9 gr\p heal? plans or heal?
 insurance cov]age (f]$ 9 ! individual  
or gr\p m>ket 7z su* t]ms are def9$ 9   
section #bgia ( ! ,public ,heal? ,s]vice
 ,act72 &  7,b7 individuals :o are n    

enroll$ 9 any heal? insurance cov]age or
 heal? b5efits plan & individuals :o are
 enroll$ 9 su* cov]age or plan b su*    
cov]age or plan does n provide b5efits =
 ! s]vice4  7#b7 ,s]vices ,= purposes ( 
subsection 7a77#a77;,,aa7 & ?is         
subsection1 ! ,secret>y %all1 = #bjba & 
ea* subsequ5t ye>1 publi% a li/ ( ! #ajj
 s]vices t are ! mo/ highly utiliz$ 9 a 
hospital-bas$ sett+4  7#c7 ,/&>diz$     
digital report+ sy/em ,n lat] ?an       
,janu>y #a1 #bjba1 ! ,secret>y %all     
e/abli% a /&>diz$ digital sy/em =       
purposes ( p>agraph 7#a74  4