,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #bhab  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #g1 #bjai,mr4 
,paul 7= himself & ,ms4 ,murk[ski7      
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$ic>e paym5t option =       
pati5ts & eligible pr(essionals to      
freely contract1 )\t p5alty1 = ,m$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$ic>e ,pati5t ,emp[]m5t   
,act ( #bjai4  #b4 ,gu>antee+ fre$om (  
*oice & contract+ = pati5ts "u ,m$ic>e  
7a7 ,9 g5]al ,section #ahjb ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acie;a7  
is am5d$ 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$ic>e b5efici>y f ent]+    
into a contract ) an eligible           
pr(essional 7:e!r or n ! pr(essional is 
a p>ticipat+ or non-p>ticipat+ physician
 or practition]7 = any item or s]vice   
cov]$ "u ?is title4  7#b7 ,submission ( 
claims ,any ,m$ic>e b5efici>y t ent]s   
into a contract "u ?is section ) an     
eligible pr(essional %all be p]mitt$ to 
submit a claim = paym5t "u ?is title =  
s]vices furni%$ by su* pr(essional1 &   
su* paym5t %all be made 9 ! am\nt t w\ld
 o!rwise apply to su* pr(essional "u ?is
 title except t :]e su* pr(essional is  
consid]$ to be non-p>ticipat+1 paym5t   
%all be paid z if ! pr(essional 7       
p>ticipat+4 ,paym5t made "u ?is title = 
any item or s]vice provid$ "u ! contract

 %all n r5d] ! pr(essional a p>ticipat+ 
or non-p>ticipat+ physician or          
practition]1 & z su*1 requirem5ts ( ?is 
title t may o!rwise apply to a          
p>ticipat+ or non-p>ticipat+ physician  
or practition] 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$ic>e b5efici>y & ! eligible          
pr(essional1 & e/abli%es all t]ms ( !   
contract 7includ+ specific paym5t =     
items & s]vices cov]$ 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$ = an item or 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$ic>e       
b5efici>y t by sign+ su* contract !     
b5efici>y--  7i7 agrees to be           
responsible = paym5t to su* eligible    
pr(essional = su* items or s]vices "u ! 
t]ms ( & am\nts e/abli%$ "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 ! eligible    
pr(essional 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 ! eligible      
pr(essional %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 ! eligible pr(essional
 = 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$-- 7,a7 to 
prohibit any eligible pr(essional f     
ma9ta9+ an election & act+ z a          
p>ticipat+ or non-p>ticipat+ physician  
or practition] ) respect to any pati5t n
 cov]$ "u a contract e/abli%$ "u ?is    
section2 &  7,b7 z *ang+ ! items &      
s]vices = :i* an eligible pr(essional   
may bill "u ?is title4  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     
,eligible pr(essional ,! t]m eligible   
pr(essional has ! mean+ giv5 su* t]m 9  
section #ahdh7k77#c77;,b74  7,c7        
,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$ical att5tion to result 9--  7i7 s]i\s
 jeop>dy to ! heal? ( ! individual or1 9
 ! case ( a pregnant woman1 ! heal? ( ! 
woman or h] unborn *ild2  7ii7 s]i\s    
impairm5t to bodily functions2 or  7iii7
 s]i\s dysfunction ( any bodily organ or
 "p4  7,d7 ,p>ticipat+2 non-p>ticipat+  
,! t]ms p>ticipat+ & nonp>ticipat+ h !  
mean+s giv5 su* t]ms "u subsection 7h7 (
 section #ahdb = purposes ( su* section4
  7,e7 ,urg5t heal? c>e situation ,! t]m
 urg5t heal? c>e situation means s]vices
 furni%$ to an individual :o requires   
s]vices to be furni%$ )9 #ab h\rs 9 ord]
 to avoid ! likely onset ( an em]g5cy   
m$ical condition4  4  #c4 ,preemption ( 
,/ate laws limit+ *>ges = s]vices by an 
eligible pr(essional  7a7 ,9 g5]al ,no  
,/ate may impose a limit on ! am\nt (   
*>ges = s]vices1 furni%$ by an eligible 
pr(essional 7z def9$ 9 subsection       

7k77#c77;,b7 ( section #ahdh ( ! ,social
 ,security ,act1 #db ,u4,s4,c4          
#aciew-#d71 = :i* paym5t is made "u su* 
section1 & 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