,i  #aagth ,,congress  #b;d ,session    
,h4 ,r4 #fhhe  ,,in ,,the ,,house ,,of  
,,representatives  ,march #a1 #bjbb,ms4 
,jayapal introduced the following bill2 
which was referred to the ,committee on 
,energy and ,commerce1 and in addition  
to the ,committee on ,ways and ,means1  
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 ,,xi of the ,social         
,security ,act to provide for the       
disclosure and analysis of certain      
health-related ownership information4   
#a4 ,short title ,this ,act may be cited
 as the ,healthcare ,ownership          
,transparency ,act4  #b4 ,disclosure and
 analysis of certain health-related     
ownership information  7a7 ,in general  
,part ,a of title ,,xi of the ,social   
,security ,act 7#db ,u4,s4,c4 #acja et  
seq47 is amended by adding at the end   
the following new section3  #aaej;,c4   

,disclosure and analysis of certain     
health-related ownership information    
7a7 ,required disclosure of certain     
health-,related private equity ownership
 information ,the ,secretary shall issue
 rules to require a covered firm to     
submit to the ,secretary1 through the   
,provider ,enrollment1 ,chain1 and      
,ownership ,system as part of the       
enrollment and revalidation of          
enrollment processes under title ,,xviii
 for providers of services and          
suppliers-- 7#a7 for a covered firm with
 respect to which there is a private    
equity fund that is a control person of 
the covered fund1 the information       
described in subsection 7b72 and  7#b7  
for a covered firm not described under  
paragraph 7#a71 the information         
described in subsection 7c74  7b7       
,information submitted by covered firms 
owned by private equity ,for purposes of
 subsection 7a7 and with respect to a   
covered firm and each private equity    
fund that is a control person of the    

covered firm1 the information described 
in this subsection is the following     
information with respect to each year of
 the previous #aj-year period3 7#a7 ,the
 percentage of the equity of the private
 equity fund contributed by-- 7,a7 the  
general partners of the fund2 and  7,b7 
the limited partners of the fund4  7#b7 
,the level of debt of the covered firm  
at the end of the applicable year4  7#c7
 ,information on the debt held by the   
private equity fund1 including-- 7,a7   
the dollar amount of total debt2  7,b7  
the percentage of debt for which the    
creditor is a financial institution in  
the ,united ,states2  7,c7 the          
percentage of debt for which the        
creditor is a financial institution     
outside of the ,united ,states2  7,d7   
the percentage of debt for which the    
creditor is an entity that is located in
 the ,united ,states and is not a       
financial institution2 and  7,e7 the    
percentage of debt for which the        
creditor is an entity that is located   

outside of the ,united ,states and is   
not a financial institution4  7#d7 ,the 
total amount of debt held by the covered
 firm that is categorized as-- 7,a7     
liabilities2  7,b7 long-term            
liabilities2 and  7,c7 payment in kind  
or zero coupon debt4  7#e7 ,the average 
debt-to-equity ratio of-- 7,a7 each     
covered firm with respect to the private
 equity fund2 and  7,b7 the private     
equity fund4  7#f7 ,the average         
debt-to-,,ebitda 7,earnings ,before     
,interest1 ,taxes1 ,depreciation1 and   
,amortization7 of each covered firm with
 respect to the private equity fund4    
7#g7 ,the total number of covered firms 
with respect to the private equity fund 
that experienced a default during the   
applicable year1 and the name of any    
such covered firm4  7#h7 ,the total     
gross asset value of each covered firm  
with respect to the private equity fund4
  7#i7 ,the gross performance of the    
private equity fund during the          
applicable year4  7#aj7 ,the total      

dollar amount of aggregate fees and     
expenses collected by the private equity
 fund1 the manager of the fund1 or      
related parties from covered firms with 
respect to the private equity fund1     
which shall-- 7,a7 be categorized by the
 type of fee2 and  7,b7 include a       
description of the purpose of the fees4 
7#aa7 ,any transaction1 monitoring1     
management1 performance1 or other fees  
collected by the private equity fund    
from the covered firm4  7#ab7 ,in       
dollars1 the total amount of regulatory 
assets under management by the private  
equity fund4  7#ac7 ,in dollars1 the    
total amount of net assets under        
management by the private equity fund4  
7#ad7 ,with respect to the applicable   
year1 the difference obtained by        
subtracting the financial gains of the  
private equity fund by the fees that the
 general partners of the fund charged to
 the limited partners of the fund       
7commonly referred to as the performance
 net of fees74  7#ae7 ,any management   

services agreements between the covered 
firm and the private equity fund1       
including a disclosure of fees paid     
through management services agreements4 
7#af7 ,any other services procured by   
the covered firm from the private equity
 fund or any other company owned by the 
private equity fund4  7#ag7 ,dividends  
paid by the covered firm to the private 
equity fund4  7#ah7 ,the names of-- 7,a7
 the limited partners of the private    
equity fund2  7,b7 the board members of 
the private equity fund2 and  7,c7 the  
leadership of the covered firm4  7#ai7  
,all political spending by the covered  
firm1 including contributions1 lobbying 
spending1 and contributions to groups   
that do not share their donor list4     
7#bj7 ,all political spending by the    
private equity fund1 an affiliate of the
 fund1 or an investment professional at 
the fund1 with respect to-- 7,a7 health 
care-related issues2 or  7,b7 members of
 congressional committees with oversight
 of health care4  7#ba7 ,information on 

the extent to which the covered firm    
entered into any sale lease back        
transactions with the private equity    
fund4  7#bb7 ,every asset purchased by  
the covered firm during the applicable  
year4  7#bc7 ,information that is       
similar to the information of the kind  
that would be required to be included in
 a notification filed pursuant to the   
rules issued under subsection           
#g;,a7d77#a7 of the ,clayton ,act 7#ae  
,u4,s4,c4 #ah;a7d77#a774  7#bd7 ,data   
related to real estate1 mortgage1 and   
lease payments4  7#be7 ,interest        
expenses and payments made by the       
private equity fund and each covered    
firm with respect to the private equity 
fund to comply with tax receivable      
agreements4  7#bf7 ,average interest    
rate paid on secured and unsecured lines
 of credit by the private equity fund   
and each covered firm with respect to   
the private equity fund4  7#bg7 ,for the
 private equity fund and each covered   
firm with respect to the private equity 

fund1 a list of-- 7,a7 all transactions 
with the #aj largest vendors or service 
providers2 and  7,b7 any new vendors or 
service providers4  7#bh7 ,for the      
private equity fund and each covered    
firm with respect to the private equity 
fund1 the number of payments to staffing
 firms4  7c7 ,information submitted by  
covered firms not owned by private      
equity ,for purposes of subsection 7a7  
and with respect to a covered firm1 the 
information described in this subsection
 is the following information with      
respect to each year of the previous    
#aj-year period3 7#a7 ,the level of debt
 of the covered firm at the end of the  
applicable year4  7#b7 ,the total amount
 of debt held by the covered firm that  
is categorized as-- 7,a7 liabilities2   
7,b7 long-term liabilities2 and  7,c7   
payment in kind or zero coupon debt4    
7#c7 ,the average debt-to-equity ratio  
of the covered firm4  7#d7 ,the average 
debt-to-,,ebitda 7,earnings ,before     
,interest1 ,taxes1 ,depreciation1 and   

,amortization7 of the covered firm4     
7#e7 ,whether the covered firm          
experienced a default during the        
applicable year4  7#f7 ,the total gross 
asset value of the covered firm4  7#g7  
,dividends paid by the covered firm4    
7#h7 ,the names of the leadership of the
 covered firm4  7#i7 ,all political     
spending by the covered firm1 including 
contributions1 lobbying spending1 and   
contributions to groups that do not     
share their donor list4  7#aj7 ,every   
asset purchased by the covered firm     
during the applicable year4  7#aa7      
,information that is similar to the     
information of the kind that would be   
required to be included in a            
notification filed pursuant to the rules
 issued under subsection #g;,a7d77#a7 of
 the ,clayton ,act 7#ae ,u4,s4,c4       
#ah;a7d77#a774  7#ab7 ,data related to  
real estate1 mortgage1 and lease        
payments4  7#ac7 ,interest expenses and 
payments made to comply with tax        
receivable agreements4  7#ad7 ,average  

interest rate paid on secured and       
unsecured lines of credit4  7#ae7 ,a    
list of-- 7,a7 all transactions with the
 #aj largest vendors or service         
providers2 and  7,b7 any new vendors or 
servicer providers4  7#af7 ,the number  
of payments to staffing firms4  7d7     
,requirement ,to provide information to 
a covered firm ,a private equity fund   
that is a control person of a covered   
firm shall provide the covered firm with
 any information required to complete a 
disclosure under this section4  7e7     
,,gao analysis  7#a7 ,analysis ,not     
later than #ab months after the date of 
implementation of this section1 and     
every #c years thereafter during the    
#ab-year period beginning on the date of
 the enactment of this section1 the     
,comptroller ,general of the ,united    
,states shall conduct a comparative     
analysis1 using the information         
submitted under this section1 to        
determine to what extent health care    
consolidation is taking place and how   

this consolidation and private equity's 
involvement in health care is           
contributing1 among other factors1 to   
the following indicators3 7,a7 ,revenue 
and cost to charge ratio4  7,b7 ,payor  
mix and case mix index4  7,c7           
,in-network versus out of network       
referrals4  7,d7 ,quality ratings for   
the health care facilities4  7,e7       
,regulation compliance violations1      
including dischargers for patients with 
,medicare or ,medicaid coverage and     
total discharges per year4  7,f7        
,staffing levels and ratios4  7,g7      
,employee wages4  7,h7 ,hospital        
capacity1 including number of beds4     
7#b7 ,report ,after each analysis       
required under paragraph 7#a7 is        
completed1 the ,comptroller ,general    
shall issue a report on all findings and
 conclusions made in carrying out such  
analysis to the ,congress1 the          
,secretary of ,health and ,human        
,services1 and the task force           
established under section #c of the     

,healthcare ,ownership ,transparency    
,act4  7f7 ,audits ,the ,secretary shall
 audit a random sample annually of      
applications submitted through the      
,provider ,enrollment1 ,chain1 and      
,ownership ,system as part of the       
enrollment and revalidation of          
enrollment processes under title ,,xviii
 to verify compliance with the          
requirements of this section and        
accuracy of information submitted       
pursuant to this section4  7g7          
,definitions ,in this section3 7#a7     
,affiliate ,the term affiliate means--  
7,a7 a person that directly or          
indirectly owns1 controls1 or holds with
 power to vote1 #bj percent or more of  
the outstanding voting securities of    
another entity1 other than a person that
 holds such securities-- 7i7 in a       
fiduciary or agency capacity without    
sole discretionary power to vote such   
securities2 or  7ii7 solely to secure a 
debt1 if such entity has not in fact    
exercised such power to vote2  7,b7 a   

corporation #bj percent or more of whose
 outstanding voting securities are      
directly or indirectly owned1           
controlled1 or held with power to vote1 
by another entity 7referred to in this  
subparagraph as a covered entity71 or by
 an entity that directly or indirectly  
owns1 controls1 or holds with power to  
vote1 #bj percent or more of the        
outstanding voting securities of the    
covered entity1 other than an entity    
that holds such securities-- 7i7 in a   
fiduciary or agency capacity without    
sole discretionary power to vote such   
securities2 or  7ii7 solely to secure a 
debt1 if such entity has not in fact    
exercised such power to vote2  7,c7 a   
person whose business is operated under 
a lease or operating agreement by       
another entity1 or person substantially 
all of whose property is operated under 
an operating agreement with that other  
entity2 or  7,d7 an entity that operates
 the business or substantially all of   
the property of another entity under a  

lease or operating agreement4  7#b7     
,control person ,the term control       
person-- 7,a7 means a person that       
directly or indirectly owns1 controls1  
or holds-- 7i7 the power to vote more   
than #bj percent of any class of voting 
securities of a covered firm2 or  7ii7  
any lesser percentage of any class of   
voting securities of a covered firm that
 is sufficient to give the ability to   
direct the actions of the covered firm2 
and  7,b7 does not include a person     
that-- 7i7 holds the voting interests of
 a covered firm solely-- 7,i7 in a      
fiduciary or agency capacity without    
sole discretionary power to vote the    
securities2 or  7,,ii7 to secure a debt1
 if the person has not exercised the    
power to vote2 or  7ii7 7,i7 is a       
limited partner with respect to a person
 described in subparagraph 7,a7 that is 
a partnership2 and  7,,ii7 does not     
participate in the direction of the     
management or policy of the covered     
firm4  7#c7 ,corporation ,the term      

corporation means-- 7,a7 a joint-stock  
company2  7,b7 a company or partnership 
association organized under a law that  
makes only the capital subscribed or    
callable up to a specified amount       
responsible for the debts of the        
association1 including a limited        
partnership and a limited liability     
company2  7,c7 a trust2 and  7,d7 an    
association having a power or privilege 
that a private corporation1 but not an  
individual or a partnership1 possesses4 
7#d7 ,covered firm ,the term covered    
firm means a corporation that is-- 7,a7 
a provider of services or supplier that 
meets all applicable requirements under 
title ,,xviii for participating in the  
,medicare program under such title2 or  
7,b7 any other person or entity who may 
receive reimbursements1 payments1 or    
other funds from the ,centers for       
,medicare  ,medicaid ,services4  7#e7   
,private equity fund ,the term private  
equity fund means-- 7,a7 7i7 a company  
or partnership that would be considered 

an investment company under section #c  
of the ,investment ,company ,act of     
#aidj 7#ae ,u4,s4,c4 #hj;a-#c7 but for  
the application of paragraph 7#a7 or    
7#g7 of subsection 7c7 of such section  
#c2  7ii7 a venture capital fund1 as    
defined under section #bge4bjc7l7-#aof  
title #ag1 ,code of ,federal            
,regulations2 or  7iii7 a sovereign     
wealth fund2 and  7,b7 directly1 or     
through an affiliate1 acts as a control 
person4  4  7b7 ,exclusion from         
participation under ,medicare ,section  
#aabh7;b7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acbj;a-#g7;b77 is       
amended by adding at the end the        
following new paragraph3  7#ah7 ,failure
 to disclose certain ,,pecos information
 ,with respect to exclusion pursuant to 
this subsection from participation in   
the ,medicare program under title       
,,xviii1 any entity to which section    
#aaej;,c applies that did not fully and 
accurately make any disclosure required 
by such section4  4  #c4 ,task ,force to

 ,analyze and ,provide ,recommendations 
on the ,role of ,private ,equity and    
,consolidation in ,health ,care  7a7    
,establishment ,the ,secretary of       
,health and ,human ,services shall      
establish and operate a task force to   
address and limit the role of private   
equity and consolidation in healthcare  
7the ,task ,force74  7b7 ,composition   
7#a7 ,chair ,the ,secretary of ,health  
and ,human ,services shall chair the    
,task ,force4  7#b7 ,members ,the       
,secretary shall appoint the members of 
the ,task ,force from among the         
following3 7,a7 ,academic experts and   
researchers with expertise on-- 7i7 the 
role of private equity in healthcare2   
and  7ii7 the impact of mergers and     
acquisitions in healthcare on costs and 
patients4  7,b7 ,representatives from   
organizations focused on consumer       
protection1 antitrust1 patient advocacy1
 and worker advocacy4  7,c7 ,hospital   
and health care staff4  7,d7 ,patients4 
7#c7 ,advisory members ,in addition to  

the members described under paragraph   
7#b71 the chairman of the ,federal      
,trade ,commission and the ,attorney    
,general shall serve as advisory members
 of the ,task ,force4  7#d7 ,member     
appointment ,not later than #fj days    
after the receipt of the first report   
issued by the ,comptroller ,general of  
the ,united ,states under section       
#aaej;,c of the ,social ,security ,act1 
the ,secretary of ,health and ,human    
,services shall appoint the members of  
the ,task ,force-- 7,a7 in accordance   
with paragraph 7#b72 and  7,b7 using a  
competitive application process4  7c7   
,recommendations ,the ,task ,force      
shall1 based on the results of such     
study and the report issued by the      
,comptroller ,general of the ,united    
,states under section #aaej;,c of the   
,social ,security ,act identify best    
practices 7and for purposes of          
subsection 7d7 develop recommendations7 
for limiting the role of private equity 
in health care1 taking into account the 

implications on health outcomes and     
staff working conditions4  7d7 ,report  
,not later than #f months after the date
 of the first report issued by the      
,comptroller ,general of the ,united    
,states under section #aaej;,c of the   
,social ,security ,act1 and every #f    
months thereafter1 the ,secretary of    
,health and ,human ,services shall      
submit to ,congress a report-- 7#a7 on  
the recommendations developed subsection
 7c72 and  7#b7 that includes regulatory
 and legislative recommendations to     
address any adverse effects of health   
care consolidation and private equity's 
involvement in health care4  7e7        
,moratorium  7#a7 ,in general ,the      
,secretary of ,health and ,human        
,services may prohibit a private equity 
fund from purchasing voting securities  
of a covered firm1 and may prohibit any 
merger or acquisition that would result 
in a private equity fund gaining control
 of voting securities of a covered firm1
 until the date on which the ,secretary 

determines that the ,task ,force has had
 sufficient time to study and identify  
whether abuses are taking place in      
specific health care sectors or by      
health care entities related to price   
gauging1 understaffing1 regulation      
compliance violations1 or such other    
metrics as the ,secretary may           
determinate appropriate4  7#b7          
,definitions ,in this subsection3 7,a7  
,covered firm ,the term covered firm has
 the meaning given that term under      
section #aaej;,c7g7 of the ,social      
,security ,act4  7,b7 ,private equity   
fund ,the term private equity fund      
means-- 7i7 a company or partnership    
that would be considered an investment  
company under section #c of the         
,investment ,company ,act of #aidj 7#ae 
,u4,s4,c4 #hj;a-#c7 but for the         
application of paragraph 7#a7 or 7#g7 of
 subsection 7c7 of such section #c2     
7ii7 a venture capital fund1 as defined 
under section #bge4bjc7l7-#aof title    
#ag1 ,code of ,federal ,regulations2 and

  7iii7 a sovereign wealth fund4