,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #ejf  ,,in ,,the ,,house ,,of   
,,representatives  ,january #aa1 #bjai  
,mr4 ,banks 7for himself and ,mr4       
,westerman7 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  
#bjai4  #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;a7 of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7a77 is amended-- 7,a7 in       
paragraph 7#a7--  7i7 in subparagraph   
7,x71 by striking and at the end2  7ii7 
in subparagraph 7,y71 by striking the   
period at the end and inserting 2 and2  
and  7iii7 by inserting after           
subparagraph 7,y7 the following new     
subparagraph3  7,z7 subject to paragraph
 7#d71 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
  2 and  7,b7 by adding at the end the  
following new paragraph3  7#d7 7,a7 ,the
 requirement under paragraph 7#a77,z7   
shall not apply in the case of a        
hospital in a hospital referral region  
if the ,,hrr market share of such       
hospital 7as determined under           
subparagraph 7,b77 is less than #j4ae4  
7,b7 ,for purposes of subparagraph 7,a71
 the ,,hrr market share of a hospital in
 a hospital referral region is equal    

to-- 7i7 the total revenue of the       
hospital1 divided by  7ii7 the total    
revenue of all hospital in the hospital 
referral region4  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  7iv7 ,the ,state    
does not have in effect a law that      
prohibits health insurers from directing
 policy-holders to lower-cost options   
through unsolicited recommendations4    
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
  7x7 ,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 ,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  #f4 ,repeal of  
health care reform provisions limiting  
,medicare exception to the prohibition  
on certain physician referrals for      
hospitals ,sections #fjja and #ajfja of 
the ,patient ,protection and ,affordable
 ,care ,act 7,public ,law #aaa-adh2 #abd
 ,stat4 #fhd1 #ajje7 and section #aajf  
of the ,health ,care and ,education     
,reconciliation ,act of #bjaj 7,public  
,law #aaa-aeb2 #abd ,stat4 #ajdi7 are   
repealed and the provisions of law      
amended by such sections are restored as
 if such sections had never been        
enacted4