,,ii  #aai? ,,congress  #a/ ,session    
,s4 #bhcf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #ag          
7legislative day1 ,septemb] #af71       
#bjbe,mr4 ,m]kley 7= himself1 ,ms4      
,w>r51 & ,mr4 ,m>key7 introduc$ ! foll[+
 bill2 :i* 0 read twice & ref]r$ to !   
,committee on ! ,judici>y  ,a ,,bill    
,to prohibit heal? insurance issu]s &   
c]ta9 heal? c>e provid]s "u ,m$ic>e f   
be+ "u common own]%ip1 & = o!r purposes4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,pati5ts ,ov] ,pr(it ,act or ! ,,pop
 ,act4  #b4 ,prohibition on common      
own]%ip ( heal? insurance issu]s & c]ta9
 heal? c>e provid]s "u ,m$ic>e  7a7 ,9  
g5]al ,x %all be unlawful = any p]son to
 bo?-- 7#a7 directly or indirectly own1 
op]ate1 or control ! :ole or any "p ( an
 applicable provid] or a managem5t      
s]vices organization t has a managem5t  
s]vices agreem5t ) an applicable        
provid]2 &  7#b7 directly or indirectly 
own1 op]ate1 or control ! :ole or any "p
 ( a heal? insurance issu]4  7b7        

,dive/m5t ,any p]son 9 violation (      
subsection 7a7 %all dive/ ei!r !        
applicable provid] 7or1 if applicable1 !
 managem5t s]vices organization7 or !   
heal? insurance issu] ( su* p]son-- 7#a7
 9 ! case ( an applicable provid]1      
managem5t s]vices organization1 or heal?
 insurance issu] acquir$ on or be=e !   
date ( enactm5t ( ?is ,act1 n lat] ?an  
#b ye>s aft] su* date ( enactm5t2 or    
7#b7 9 ! case ( an applicable provid]1  
managem5t s]vices organization1 or heal?
 insurance issu] acquir$ aft] ! date (  
enactm5t ( ?is ,act1 n lat] ?an #a ye>  
aft] ! date ( acquisition4  7c7 ,civil  
actions  7#a7 ,9 g5]al ,:5 ! ,inspector 
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 ! ,assi/ant ,attorney ,g5]al 9
 *>ge ( ! ,antitru/ ,division ( !       
,dep>tm5t ( ,ju/ice1 ! ,f$]al ,trade    
,commission1 or an ,attorney ,g5]al ( a 
,/ate has reason to believe t a p]son is
 9 violation ( subsection 7a7 or 7b71   
su* ,inspector ,g5]al1 ,assi/ant        
,attorney ,g5]al1 ,f$]al ,trade         

,commission1 or ,attorney ,g5]al ( a    
,/ate may br+ a civil action 9 an       
applicable di/rict c\rt ( ! ,unit$      
,/ates = ! relief describ$ 9 p>agraph   
7#b74  7#b7 ,injunctive & equitable     
relief ,9 any action describ$ 9 p>agraph
 7#a71 ! applicable c\rt1 on a f9d+ t a 
p]son is 9 violation ( subsection 7a7 or
 7b71 %all issue an ord] requir+ su*    
p]son-- 7,a7 to cease & desi/ f su*     
violation1 & dive/ ei!r ! applicable    
provid] 7or1 if applicable1 ! managem5t 
s]vices organization7 or ! heal?        
insurance issu] ( su* p]son2 &  7,b7 to 
disgorge any rev5ue receiv$ f !         
provision ( heal? c>e s]vices dur+ !    
p]iod ( su* violation4  7#c7 ,deposit & 
di/ribution ,any rev5ue disgorg$        
pursuant to an action "u ?is subsection 
= a violation ( subsection 7a7 or 7b7   
%all be deposit$ into a fund creat$ by !
 ,f$]al ,trade ,commission & di/ribut$  
by ! ,f$]al ,trade ,commission to be put
 to use 9 ! int]e/ ( s]v+ ! heal? c>e   
ne$s ( ! h>m$ community4 ,receipt ( any 

funds "u ?is p>agraph %all n alt] or    
dim9i% ! rights ( an individual to br+  
an action or recov] any am\nt z o!rwise 
au?oriz$ by law4  7d7 ,,ftc review  7#a7
 ,report+ requir$ ,any dive/m5t ( an    
applicable provid]1 managem5t s]vices   
organization1 or heal? insurance issu]  
requir$ "u subsection 7b7 %all be       
report$ to ! ,f$]al ,trade ,commission &
 ! ,assi/ant ,attorney ,g5]al 9 *>ge ( !
 ,antitru/ ,division ( ! ,dep>tm5t (    
,ju/ice "u section #g;,a ( ! ,clayton   
,act 7#ae ,u4,s4,c4 #ah;a7 )\t respect  
to ! ?re%olds "u subsection 7a77#b7 ( t 
section4  7#b7 ,toll+ ( dive/m5t p]iod  
dur+ review ,! dive/m5t p]iod "u        
subsection 7b7 %all be toll$ dur+ !     
p5d5cy ( any wait+ p]iod requir$ "u     
section #g;,a ( ! ,clayton ,act 7#ae    
,u4,s4,c4 #ah;a74  7#c7 ,review ( effect
 ( dive/iture ,) respect to ea*         
dive/iture und]tak5 pursuant to         
subsection 7b71 9 addition to any       
applicable review "u section #g;,a ( !  
,clayton ,act 7#ae ,u4,s4,c4 #ah;a71 !  

,f$]al ,trade ,commission & ! ,assi/ant 
,attorney ,g5]al 9 *>ge ( ! ,antitru/   
,division ( ! ,dep>tm5t ( ,ju/ice %all  
review ! effect on competition1 f9ancial
 viability1 & ! public int]e/-- 7,a7 ( !
 dive/iture2 &  7,b7 ( ! subsequ5t      
acquisition ( ! applicable provid] 7or1 
if applicable1 ! managem5t s]vices      
organization7 or ! heal? insurance issu]
 ( su* p]son by ! acquir+ p]son4  7e7   
,rulemak+ au?ority ,! ,f$]al ,trade     
,commission %all promulgate rules to    
c>ry out ?is section4 ,su* rules %all n 
dim9i% any obligation "u ?is section4   
7f7 ,rule ( con/ruction ,no?+ 9 ?is     
section %all be con/ru$ to limit !      
au?ority ( ! ,f$]al ,trade ,commission1 
! ,inspector ,g5]al ( ! ,dep>tm5t (     
,ju/ice1 ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 or ! ,attorney ,g5]al ( a     
,/ate "u any o!r provision ( law4  7g7  
,en=cem5t "u ,m$ic>e ,advantage &       
,m$ic>e "p ,d  7#a7 ,m$ic>e ,advantage  
,section #aheg ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciew-#bg7 is am5d$

 by add+ at ! end ! foll[+ new          
subsection3  7j7 ,prohibition on common 
own]%ip ( ,,ma organizations &          
applicable provid]s  7#a7 ,9 g5]al ,=   
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbf1 ! ,secret>y may n contract )1 or 
provide paym5t "u ?is "p to1 a ,m$ic>e  
,advantage organization ) respect to    
(f]+ an ,,ma plan or ,,ma-,,pd plan "u  
?is "p if ! organization-- 7,a7 directly
 or indirectly owns1 op]ates1 or        
controls ! :ole or any "p ( an          
applicable provid] or a managem5t       
s]vices organization t has a managem5t  
s]vices agreem5t ) an applicable        
provid]2 or  7,b7 is directly or        
indirectly own$1 op]at$1 or controll$ 9 
:ole or "p by a p]son :o also directly  
or indirectly owns1 op]ates1 or controls
 ! :ole or any "p ( an applicable       
provid] or a managem5t s]vices          
organization t has a managem5t s]vices  
agreem5t ) an applicable provid]4  7#b7 
,c]tification ,ea* ,m$ic>e ,advantage   
organization %all furni% to ! ,secret>y 

79 a =m & mann]1 & at a "t1 specifi$ by 
! ,secret>y7 a c]tification ( compliance
 ) ?is subsection1 z well z su*         
in=mation z ! ,secret>y det]m9es        
necess>y to c>ry out ?is subsection4    
7#c7 ,false claims submitt$ by entities 
9 violation ( prohibition on common     
own]%ip ,any claim = paym5t f an entity 
9 violation ( p>agraph 7#a7 con/itutes a
 false or fraudul5t claim = purposes (  
sub*apt] ,,iii ( title #ca1 ,unit$      
,/ates ,code4  7#d7 ,def9itions ,9 ?is  
subsection3 7,a7 ,applicable provid]    
7i7 ,9 g5]al ,subject to clause 7ii71 ! 
t]m applicable provid] means any entity 
t receives paym5t = furni%+ s]vices     
cov]$ "u "p ,b or "u a ,m$ic>e          
,advantage plan "u "p ,c4  7ii7         
,exclusions ,su* t]m does n include--   
7,i7 a hospital 7z def9$ 9 section      
#ahfa7;e771 a critical access hospital  
7z def9$ 9 section #ahfa7mm77#a771 or a 
rural em]g5cy hospital 7z def9$ 9       
section #ahfa7kkk77#b772  7,,ii7 a      
suppli] ( durable m$ical equipm5t1      

pro/hetics1 or?otics1 or supplies2 or   
7,,iii7 a ph>macy4  7,b7 ,managem5t     
s]vices agreem5t ,! t]m managem5t       
s]vices agreem5t means a contract betwe5
 a managem5t s]vices organization & an  
applicable provid] = managem5t or       
adm9i/rative s]vices relat+ to1         
support+1 or facilitat+ ! provision (   
heal? c>e s]vices4  7,c7 ,managem5t     
s]vices organization ,! t]m managem5t   
s]vices organization means any          
organization or entity t contracts ) an 
applicable provid] to p]=m managem5t or 
adm9i/rative s]vices relat+ to1         
support+1 or facilitat+ ! provision (   
heal? c>e s]vices4  4  7#b7 ,m$ic>e "p  
,d ,section #ahfj;,d-#ab7;b77#c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aab7;b77#c77 is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,g7  
,prohibition on common own]%ip ,section 
#aheg7;j74  4  7h7 ,def9itions ,9 ?is   
section3 7#a7 ,applicable provid]  7,a7 
,9 g5]al ,subject to subp>agraph 7,b71 !
 t]m applicable provid] means any entity

 t receives paym5t = furni%+ s]vices    
cov]$ "u "p ,b ( title ,,xviii ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;j et seq47 or "u a ,m$ic>e        
,advantage plan "u "p ,c ( su* title    
7#db ,u4,s4,c4 #aciew-#ba et seq474     
7,b7 ,exclusions ,su* t]m does n        
include-- 7i7 a hospital 7z def9$ 9     
section #ahfa7;e7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciex7e7771 a      
critical access hospital 7z def9$ 9     
section #ahfa7mm77#a7 ( su* ,act 7#db   
,u4,s4,c4 #aciex7mm77#a7771 or a rural  
em]g5cy hospital 7z def9$ 9 section     
#ahfa7kkk77#b772  7ii7 a suppli] (      
durable m$ical equipm5t1 pro/hetics1    
or?otics1 & supplies2 or  7iii7 a       
ph>macy4  7#b7 ,heal? insurance issu] ,!
 t]m heal? insurance issu] has ! mean+  
giv5 t t]m 9 section #bgia ( ! ,public  
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#ia74  7#c7 ,managem5t s]vices  
agreem5t ,! t]m managem5t s]vices       
agreem5t means a contract betwe5 a      
managem5t s]vices organization & an     

applicable provid] = managem5t or       
adm9i/rative s]vices relat+ to1         
support+1 or facilitat+ ! provision (   
heal? c>e s]vices4  7#d7 ,managem5t     
s]vices organization ,! t]m managem5t   
s]vices organization means any          
organization or entity t contracts ) an 
applicable provid] to p]=m managem5t or 
adm9i/rative s]vices relat+ to1         
support+1 or facilitat+ ! provision (   
heal? c>e s]vices4  7#e7 ,p]son ,! t]m  
p]son has ! mean+ giv5 ! t]m 9 section  
#h ( ! ,%]man ,act 7#ae ,u4,s4,c4 #g74