,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #fhhe  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,m>* #a1 #bjbb,ms4    
,jayapal introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = 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 ,,xi 
( ! ,social ,security ,act to provide = 
! disclosure & analysis ( c]ta9         
heal?-relat$ own]%ip in=mation4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,heal?c>e ,own]%ip ,transp>5cy ,act4    
#b4 ,disclosure & analysis ( c]ta9      
heal?-relat$ own]%ip in=mation  7a7 ,9  
g5]al ,"p ,a ( title ,,xi ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acja et  
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #aaej;,c4 ,disclosure &  
analysis ( c]ta9 heal?-relat$ own]%ip   
in=mation  7a7 ,requir$ disclosure (    
c]ta9 heal?-,relat$ private equity      

own]%ip in=mation ,! ,secret>y %all     
issue rules to require a cov]$ firm to  
submit to ! ,secret>y1 ?r\gh ! ,provid] 
,enrollm5t1 ,*a91 & ,own]%ip ,sy/em z "p
 ( ! enrollm5t & revalidation (         
enrollm5t processes "u title ,,xviii =  
provid]s ( s]vices & suppli]s-- 7#a7 = a
 cov]$ firm ) respect to :i* !re is a   
private equity fund t is a control p]son
 ( ! cov]$ fund1 ! in=mation describ$ 9 
subsection 7b72 &  7#b7 = a cov]$ firm n
 describ$ "u p>agraph 7#a71 ! in=mation 
describ$ 9 subsection 7c74  7b7         
,in=mation submitt$ by cov]$ firms own$ 
by private equity ,= purposes (         
subsection 7a7 & ) respect to a cov]$   
firm & ea* private equity fund t is a   
control p]son ( ! cov]$ firm1 !         
in=mation describ$ 9 ?is subsection is !
 foll[+ in=mation ) respect to ea* ye> (
 ! previ\s #aj-ye> p]iod3 7#a7 ,!       
p]c5tage ( ! equity ( ! private equity  
fund contribut$ by-- 7,a7 ! g5]al p>tn]s
 ( ! fund2 &  7,b7 ! limit$ p>tn]s ( !  
fund4  7#b7 ,! level ( debt ( ! cov]$   

firm at ! end ( ! applicable ye>4  7#c7 
,in=mation on ! debt held by ! private  
equity fund1 includ+-- 7,a7 ! doll>     
am\nt ( total debt2  7,b7 ! p]c5tage (  
debt = :i* ! cr$itor is a f9ancial      
in/itution 9 ! ,unit$ ,/ates2  7,c7 !   
p]c5tage ( debt = :i* ! cr$itor is a    
f9ancial in/itution outside ( ! ,unit$  
,/ates2  7,d7 ! p]c5tage ( debt = :i* ! 
cr$itor is an entity t is locat$ 9 !    
,unit$ ,/ates & is n a f9ancial         
in/itution2 &  7,e7 ! p]c5tage ( debt = 
:i* ! cr$itor is an entity t is locat$  
outside ( ! ,unit$ ,/ates & is n a      
f9ancial in/itution4  7#d7 ,! total     
am\nt ( debt held by ! cov]$ firm t is  
categoriz$ z-- 7,a7 liabilities2  7,b7  
long-t]m liabilities2 &  7,c7 paym5t 9  
k9d or z]o c\pon debt4  7#e7 ,! av]age  
debt-to-equity ratio (-- 7,a7 ea* cov]$ 
firm ) respect to ! private equity fund2
 &  7,b7 ! private equity fund4  7#f7 ,!
 av]age debt-to-,,ebitda 7,e>n+s ,be=e  
,int]e/1 ,taxes1 ,depreciation1 &       
,amortization7 ( ea* cov]$ firm )       

respect to ! private equity fund4  7#g7 
,! total numb] ( cov]$ firms ) respect  
to ! private equity fund t exp]i5c$ a   
default dur+ ! applicable ye>1 & ! "n ( 
any su* cov]$ firm4  7#h7 ,! total gross
 asset value ( ea* cov]$ firm ) respect 
to ! private equity fund4  7#i7 ,! gross
 p]=mance ( ! private equity fund dur+ !
 applicable ye>4  7#aj7 ,! total doll>  
am\nt ( aggregate fees & exp5ses        
collect$ by ! private equity fund1 !    
manag] ( ! fund1 or relat$ p>ties f     
cov]$ firms ) respect to ! private      
equity fund1 :i* %all-- 7,a7 be         
categoriz$ by ! type ( fee2 &  7,b7     
include a description ( ! purpose ( !   
fees4  7#aa7 ,any transaction1 monitor+1
 managem5t1 p]=mance1 or o!r fees       
collect$ by ! private equity fund f !   
cov]$ firm4  7#ab7 ,9 doll>s1 ! total   
am\nt ( regulatory assets "u managem5t  
by ! private equity fund4  7#ac7 ,9     
doll>s1 ! total am\nt ( net assets "u   
managem5t by ! private equity fund4     
7#ad7 ,) respect to ! applicable ye>1 ! 

diff]5ce obta9$ by subtract+ ! f9ancial 
ga9s ( ! private equity fund by ! fees t
 ! g5]al p>tn]s ( ! fund *>g$ to !      
limit$ p>tn]s ( ! fund 7commonly ref]r$ 
to z ! p]=mance net ( fees74  7#ae7 ,any
 managem5t s]vices agreem5ts betwe5 !   
cov]$ firm & ! private equity fund1     
includ+ a disclosure ( fees paid ?r\gh  
managem5t s]vices agreem5ts4  7#af7 ,any
 o!r s]vices procur$ by ! cov]$ firm f !
 private equity fund or any o!r company 
own$ by ! private equity fund4  7#ag7   
,divid5ds paid by ! cov]$ firm to !     
private equity fund4  7#ah7 ,! names (--
 7,a7 ! limit$ p>tn]s ( ! private equity
 fund2  7,b7 ! bo>d memb]s ( ! private  
equity fund2 &  7,c7 ! lead]%ip ( !     
cov]$ firm4  7#ai7 ,all political sp5d+ 
by ! cov]$ firm1 includ+ contributions1 
lobby+ sp5d+1 & contributions to gr\ps t
 d n %>e _! donor li/4  7#bj7 ,all      
political sp5d+ by ! private equity     
fund1 an affiliate ( ! fund1 or an      
inve/m5t pr(essional at ! fund1 )       
respect to-- 7,a7 heal? c>e-relat$      

issues2 or  7,b7 memb]s ( congressional 
committees ) ov]sight ( heal? c>e4      
7#ba7 ,in=mation on ! ext5t to :i* !    
cov]$ firm ent]$ into any sale lease    
back transactions ) ! private equity    
fund4  7#bb7 ,e asset pur*as$ by ! cov]$
 firm dur+ ! applicable ye>4  7#bc7     
,in=mation t is simil> to ! in=mation ( 
! k9d t w\ld be requir$ to be includ$ 9 
a notification fil$ pursuant to ! rules 
issu$ "u subsection #g;,a7d77#a7 ( !    
,clayton ,act 7#ae ,u4,s4,c4            
#ah;a7d77#a774  7#bd7 ,data relat$ to   
real e/ate1 mortgage1 & lease paym5ts4  
7#be7 ,int]e/ exp5ses & paym5ts made by 
! private equity fund & ea* cov]$ firm )
 respect to ! private equity fund to    
comply ) tax receivable agreem5ts4      
7#bf7 ,av]age int]e/ rate paid on secur$
 & unsecur$ l9es ( cr$it by ! private   
equity fund & ea* cov]$ firm ) respect  
to ! private equity fund4  7#bg7 ,= !   
private equity fund & ea* cov]$ firm )  
respect to ! private equity fund1 a li/ 
(-- 7,a7 all transactions ) ! #aj l>ge/ 

v5dors or s]vice provid]s2 &  7,b7 any  
new v5dors or s]vice provid]s4  7#bh7 ,=
 ! private equity fund & ea* cov]$ firm 
) respect to ! private equity fund1 !   
numb] ( paym5ts to /aff+ firms4  7c7    
,in=mation submitt$ by cov]$ firms n    
own$ by private equity ,= purposes (    
subsection 7a7 & ) respect to a cov]$   
firm1 ! in=mation describ$ 9 ?is        
subsection is ! foll[+ in=mation )      
respect to ea* ye> ( ! previ\s #aj-ye>  
p]iod3 7#a7 ,! level ( debt ( ! cov]$   
firm at ! end ( ! applicable ye>4  7#b7 
,! total am\nt ( debt held by ! cov]$   
firm t is categoriz$ z-- 7,a7           
liabilities2  7,b7 long-t]m liabilities2
 &  7,c7 paym5t 9 k9d or z]o c\pon debt4
  7#c7 ,! av]age debt-to-equity ratio ( 
! cov]$ firm4  7#d7 ,! av]age           
debt-to-,,ebitda 7,e>n+s ,be=e ,int]e/1 
,taxes1 ,depreciation1 & ,amortization7 
( ! cov]$ firm4  7#e7 ,:e!r ! cov]$ firm
 exp]i5c$ a default dur+ ! applicable   
ye>4  7#f7 ,! total gross asset value ( 
! cov]$ firm4  7#g7 ,divid5ds paid by ! 

cov]$ firm4  7#h7 ,! names ( ! lead]%ip 
( ! cov]$ firm4  7#i7 ,all political    
sp5d+ by ! cov]$ firm1 includ+          
contributions1 lobby+ sp5d+1 &          
contributions to gr\ps t d n %>e _!     
donor li/4  7#aj7 ,e asset pur*as$ by ! 
cov]$ firm dur+ ! applicable ye>4  7#aa7
 ,in=mation t is simil> to ! in=mation (
 ! k9d t w\ld be requir$ to be includ$ 9
 a notification fil$ pursuant to ! rules
 issu$ "u subsection #g;,a7d77#a7 ( !   
,clayton ,act 7#ae ,u4,s4,c4            
#ah;a7d77#a774  7#ab7 ,data relat$ to   
real e/ate1 mortgage1 & lease paym5ts4  
7#ac7 ,int]e/ exp5ses & paym5ts made to 
comply ) tax receivable agreem5ts4      
7#ad7 ,av]age int]e/ rate paid on secur$
 & unsecur$ l9es ( cr$it4  7#ae7 ,a li/ 
(-- 7,a7 all transactions ) ! #aj l>ge/ 
v5dors or s]vice provid]s2 &  7,b7 any  
new v5dors or s]vic] provid]s4  7#af7 ,!
 numb] ( paym5ts to /aff+ firms4  7d7   
,requirem5t ,to provide in=mation to a  
cov]$ firm ,a private equity fund t is a
 control p]son ( a cov]$ firm %all      

provide ! cov]$ firm ) any in=mation    
requir$ to complete a disclosure "u ?is 
section4  7e7 ,,gao analysis  7#a7      
,analysis ,n lat] ?an #ab mon?s aft] !  
date ( implem5tation ( ?is section1 & e 
#c ye>s !reaft] dur+ ! #ab-ye> p]iod    
beg9n+ on ! date ( ! enactm5t ( ?is     
section1 ! ,comptroll] ,g5]al ( ! ,unit$
 ,/ates %all conduct a comp>ative       
analysis1 us+ ! in=mation submitt$ "u   
?is section1 to det]m9e to :at ext5t    
heal? c>e consolidation is tak+ place & 
h[ ?is consolidation & private equity's 
involvem5t 9 heal? c>e is contribut+1   
among o!r factors1 to ! foll[+          
indicators3 7,a7 ,rev5ue & co/ to *>ge  
ratio4  7,b7 ,payor mix & case mix      
index4  7,c7 ,9-network v]sus out (     
network ref]rals4  7,d7 ,quality rat+s =
 ! heal? c>e facilities4  7,e7          
,regulation compliance violations1      
includ+ dis*>g]s = pati5ts ) ,m$ic>e or 
,m$icaid cov]age & total dis*>ges p]    
ye>4  7,f7 ,/aff+ levels & ratios4  7,g7
 ,employee wages4  7,h7 ,hospital       

capacity1 includ+ numb] ( b$s4  7#b7    
,report ,aft] ea* analysis requir$ "u   
p>agraph 7#a7 is complet$1 ! ,comptroll]
 ,g5]al %all issue a report on all f9d+s
 & conclusions made 9 c>ry+ out su*     
analysis to ! ,congress1 ! ,secret>y (  
,heal? & ,human ,s]vices1 & ! task =ce  
e/abli%$ "u section #c ( ! ,heal?c>e    
,own]%ip ,transp>5cy ,act4  7f7 ,audits 
,! ,secret>y %all audit a r&om sample   
annually ( applications submitt$ ?r\gh !
 ,provid] ,enrollm5t1 ,*a91 & ,own]%ip  
,sy/em z "p ( ! enrollm5t & revalidation
 ( enrollm5t processes "u title ,,xviii 
to v]ify compliance ) ! requirem5ts (   
?is section & accuracy ( in=mation      
submitt$ pursuant to ?is section4  7g7  
,def9itions ,9 ?is section3 7#a7        
,affiliate ,! t]m affiliate means-- 7,a7
 a p]son t directly or indirectly owns1 
controls1 or holds ) p[] to vote1 #bj   
p]c5t or m ( ! out/&+ vot+ securities ( 
ano!r entity1 o!r ?an a p]son t holds   
su* securities-- 7i7 9 a fiduci>y or    
ag5cy capacity )\t sole discretion>y p[]

 to vote su* securities2 or  7ii7 solely
 to secure a debt1 if su* entity has n 9
 fact ex]cis$ su* p[] to vote2  7,b7 a  
corporation #bj p]c5t or m ( ^: out/&+  
vot+ securities are directly or         
indirectly own$1 controll$1 or held )   
p[] to vote1 by ano!r entity 7ref]r$ to 
9 ?is subp>agraph z a cov]$ entity71 or 
by an entity t directly or indirectly   
owns1 controls1 or holds ) p[] to vote1 
#bj p]c5t or m ( ! out/&+ vot+          
securities ( ! cov]$ entity1 o!r ?an an 
entity t holds su* securities-- 7i7 9 a 
fiduci>y or ag5cy capacity )\t sole     
discretion>y p[] to vote su* securities2
 or  7ii7 solely to secure a debt1 if   
su* entity has n 9 fact ex]cis$ su* p[] 
to vote2  7,c7 a p]son ^: bus9ess is    
op]at$ "u a lease or op]at+ agreem5t by 
ano!r entity1 or p]son sub/antially all 
( ^: prop]ty is op]at$ "u an op]at+     
agreem5t ) t o!r entity2 or  7,d7 an    
entity t op]ates ! bus9ess or           
sub/antially all ( ! prop]ty ( ano!r    
entity "u a lease or op]at+ agreem5t4   

7#b7 ,control p]son ,! t]m control      
p]son-- 7,a7 means a p]son t directly or
 indirectly owns1 controls1 or holds--  
7i7 ! p[] to vote m ?an #bj p]c5t ( any 
class ( vot+ securities ( a cov]$ firm2 
or  7ii7 any less] p]c5tage ( any class 
( vot+ securities ( a cov]$ firm t is   
suffici5t to give ! ability to direct ! 
actions ( ! cov]$ firm2 &  7,b7 does n  
include a p]son t-- 7i7 holds ! vot+    
int]e/s ( a cov]$ firm solely-- 7,i7 9 a
 fiduci>y or ag5cy capacity )\t sole    
discretion>y p[] to vote ! securities2  
or  7,,ii7 to secure a debt1 if ! p]son 
has n ex]cis$ ! p[] to vote2 or  7ii7   
7,i7 is a limit$ p>tn] ) respect to a   
p]son describ$ 9 subp>agraph 7,a7 t is a
 p>tn]%ip2 &  7,,ii7 does n p>ticipate 9
 ! direction ( ! managem5t or policy ( !
 cov]$ firm4  7#c7 ,corporation ,! t]m  
corporation means-- 7,a7 a jo9t-/ock    
company2  7,b7 a company or p>tn]%ip    
association organiz$ "u a law t makes   
only ! capital subscrib$ or callable up 
to a specifi$ am\nt responsible = !     

debts ( ! association1 includ+ a limit$ 
p>tn]%ip & a limit$ liability company2  
7,c7 a tru/2 &  7,d7 an association hav+
 a p[] or privilege t a private         
corporation1 b n an individual or a     
p>tn]%ip1 possesses4  7#d7 ,cov]$ firm  
,! t]m cov]$ firm means a corporation t 
is-- 7,a7 a provid] ( s]vices or suppli]
 t meets all applicable requirem5ts "u  
title ,,xviii = p>ticipat+ 9 ! ,m$ic>e  
program "u su* title2 or  7,b7 any o!r  
p]son or entity :o may receive          
reimbursem5ts1 paym5ts1 or o!r funds f !
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4   
7#e7 ,private equity fund ,! t]m private
 equity fund means-- 7,a7 7i7 a company 
or p>tn]%ip t w\ld be consid]$ an       
inve/m5t company "u section #c ( !      
,inve/m5t ,company ,act ( #aidj 7#ae    
,u4,s4,c4 #hj;a-#c7 b = ! application ( 
p>agraph 7#a7 or 7#g7 ( subsection 7c7 (
 su* section #c2  7ii7 a v5ture capital 
fund1 z def9$ "u section #bge4bjc7l7-#a(
 title #ag1 ,code ( ,f$]al ,regulations2
 or  7iii7 a sov]eign weal? fund2 &     

7,b7 directly1 or ?r\gh an affiliate1   
acts z a control p]son4  4  7b7         
,exclusion f p>ticipation "u ,m$ic>e    
,section #aabh7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acbj;a-#g7;b77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#ah7 ,failure to disclose   
c]ta9 ,,pecos in=mation ,) respect to   
exclusion pursuant to ?is subsection f  
p>ticipation 9 ! ,m$ic>e program "u     
title ,,xviii1 any entity to :i* section
 #aaej;,c applies t did n fully &       
accurately make any disclosure requir$  
by su* section4  4  #c4 ,task ,=ce to   
,analyze & ,provide ,recomm5dations on !
 ,role ( ,private ,equity &             
,consolidation 9 ,heal? ,c>e  7a7       
,e/abli%m5t ,! ,secret>y ( ,heal? &     
,human ,s]vices %all e/abli% & op]ate a 
task =ce to address & limit ! role (    
private equity & consolidation 9        
heal?c>e 7! ,task ,=ce74  7b7           
,composition  7#a7 ,*air ,! ,secret>y ( 
,heal? & ,human ,s]vices %all *air !    
,task ,=ce4  7#b7 ,memb]s ,! ,secret>y  

%all appo9t ! memb]s ( ! ,task ,=ce f   
among ! foll[+3 7,a7 ,academic exp]ts & 
rese>*]s ) exp]tise on-- 7i7 ! role (   
private equity 9 heal?c>e2 &  7ii7 !    
impact ( m]g]s & acquisitions 9 heal?c>e
 on co/s & pati5ts4  7,b7               
,repres5tatives f organizations focus$  
on consum] protection1 antitru/1 pati5t 
advocacy1 & work] advocacy4  7,c7       
,hospital & heal? c>e /aff4  7,d7       
,pati5ts4  7#c7 ,advisory memb]s ,9     
addition to ! memb]s describ$ "u        
p>agraph 7#b71 ! *airman ( ! ,f$]al     
,trade ,commission & ! ,attorney ,g5]al 
%all s]ve z advisory memb]s ( ! ,task   
,=ce4  7#d7 ,memb] appo9tm5t ,n lat] ?an
 #fj days aft] ! receipt ( ! fir/ report
 issu$ by ! ,comptroll] ,g5]al ( !      
,unit$ ,/ates "u section #aaej;,c ( !   
,social ,security ,act1 ! ,secret>y (   
,heal? & ,human ,s]vices %all appo9t !  
memb]s ( ! ,task ,=ce-- 7,a7 9          
accordance ) p>agraph 7#b72 &  7,b7 us+ 
a competitive application process4  7c7 
,recomm5dations ,! ,task ,=ce %all1 bas$

 on ! results ( su* /udy & ! report     
issu$ by ! ,comptroll] ,g5]al ( ! ,unit$
 ,/ates "u section #aaej;,c ( ! ,social 
,security ,act id5tify be/ practices 7& 
= purposes ( subsection 7d7 develop     
recomm5dations7 = limit+ ! role (       
private equity 9 heal? c>e1 tak+ into   
acc\nt ! implications on heal? outcomes 
& /aff work+ conditions4  7d7 ,report ,n
 lat] ?an #f mon?s aft] ! date ( ! fir/ 
report issu$ by ! ,comptroll] ,g5]al ( !
 ,unit$ ,/ates "u section #aaej;,c ( !  
,social ,security ,act1 & e #f mon?s    
!reaft]1 ! ,secret>y ( ,heal? & ,human  
,s]vices %all submit to ,congress a     
report-- 7#a7 on ! recomm5dations       
develop$ subsection 7c72 &  7#b7 t      
includes regulatory & legislative       
recomm5dations to address any adv]se    
effects ( heal? c>e consolidation &     
private equity's involvem5t 9 heal? c>e4
  7e7 ,moratorium  7#a7 ,9 g5]al ,!     
,secret>y ( ,heal? & ,human ,s]vices may
 prohibit a private equity fund f       
pur*as+ vot+ securities ( a cov]$ firm1 

& may prohibit any m]g] or acquisition t
 w\ld result 9 a private equity fund    
ga9+ control ( vot+ securities ( a cov]$
 firm1 until ! date on :i* ! ,secret>y  
det]m9es t ! ,task ,=ce has _h suffici5t
 "t to /udy & id5tify :e!r abuses are   
tak+ place 9 specific heal? c>e sectors 
or by heal? c>e entities relat$ to price
 gaug+1 und]/aff+1 regulation compliance
 violations1 or su* o!r metrics z !     
,secret>y may det]m9ate appropriate4    
7#b7 ,def9itions ,9 ?is subsection3 7,a7
 ,cov]$ firm ,! t]m cov]$ firm has !    
mean+ giv5 t t]m "u section #aaej;,c7g7 
( ! ,social ,security ,act4  7,b7       
,private equity fund ,! t]m private     
equity fund means-- 7i7 a company or    
p>tn]%ip t w\ld be consid]$ an inve/m5t 
company "u section #c ( ! ,inve/m5t     
,company ,act ( #aidj 7#ae ,u4,s4,c4    
#hj;a-#c7 b = ! application ( p>agraph  
7#a7 or 7#g7 ( subsection 7c7 ( su*     
section #c2  7ii7 a v5ture capital fund1
 z def9$ "u section #bge4bjc7l7-#a(     
title #ag1 ,code ( ,f$]al ,regulations2 

&  7iii7 a sov]eign weal? fund4