,,ii  #aai? ,,congress  #b;d ,session   
,s4 #edai  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #af1         
#bjbf,ms4 ,w>r5 7= h]self1 ,mr4 ,wyd51 &
 ,mr4 ,m]kley7 introduc$ ! foll[+ bill2 
:i* 0 read twice & ref]r$ to !          
,committee on ,comm]ce1 ,sci5ce1 &      
,transportation  ,a ,,bill  ,to e/abli% 
c]ta9 protections = physicians & o!r    
lic5s$ heal? pr(essionals1 place c]ta9  
requirem5ts on m$ical practices &       
managem5t s]vices organizations1 & = o!r
 purposes4  #a4 ,%ort title ,?is ,act   
may be cit$ z ! ,/op ,corporate         
,takeov]s ( ,physicians ,act ( #bjbf4   
#b4 ,prohibition on ! corporate practice
 ( m$ic9e1 protections = employ$        
lic5sees1 & re/rictions reg>d+ managem5t
 s]vices organizations  7a7 ,prohibition
 on ! corporate practice ( m$ic9e  7#a7 
,9 g5]al ,except z provid$ 9 p>agraph   
7#c71 x %all be unlawful = any p>tn]%ip 
or corporate entity1 su* z a pr(essional
 corporation1 limit$ liability company1 
or limit$ liability p>tn]%ip1 t is n    

majority-own$ & controll$ by #a or m    
lic5sees to-- 7,a7 own or control1 9    
:ole or 9 "p1 a m$ical practice2  7,b7  
employ1 or ent] into a contract = !     
pr(essional s]vices (1 a lic5see2 or    
7,c7 engage 9 ! practice ( m$ic9e 7z    
describ$ 9 subsection 7d77#d77;,b774    
7#b7 ,majority-own$ & controll$ by      
lic5sees describ$ ,= purposes ( ?is     
subsection1 a p>tn]%ip or corporate     
entity %all be consid]$ majority-own$ & 
controll$ by #a or m lic5sees if su*    
lic5sees-- 7,a7 hold n less ?an a       
majority ( ! own]%ip or memb]%ip int]e/ 
9 ! p>tn]%ip or corporate entity2 &     
7,b7 con/itute a majority ( ! gov]n+    
body ( su* p>tn]%ip or corporate entity4
  7#c7 ,exception ,?is subsection %all n
 apply to ! foll[+3 7,a7 ,any non-pr(it 
or public heal? c>e provid]4  7,b7 ,a   
hospital 7z def9$ 9 subsection 7e7 (    
section #ahfa ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciex771 a             
hospital-affiliat$ cl9ic1 a critical    
access hospital 7z def9$ 9 subsection   

7mm77#a7 ( su* section71 or a rural     
em]g5cy hospital 7z def9$ 9 subsection  
7kkk77#a7 ( su* section74  7b7          
,protections ( lic5sees & requirem5ts   
reg>d+ m$ical practices & managem5t     
s]vices organizations  7#a7 ,protections
 ( lic5sees  7,a7 ,agreem5ts  7i7 ,9    
g5]al ,except z provid$ 9 clause 7iii71 
x %all be unlawful = any lic5see1 heal? 
c>e provid]1 or managem5t s]vices       
organization to ent] into ! foll[+      
agreem5ts3 7,i7 ,a non-compete clause4  
7,,ii7 ,a non-disclosure or             
non-disp>agem5t agreem5t4  7ii7         
,agreem5ts void ,any agreem5t describ$ 9
 clause 7i7 %all be void & un5=ceable4  
7iii7 ,exception ,a non-compete clause  
betwe5 a lic5see ( a m$ical practice & !
 m$ical practice is only valid &        
en=ceable if ! lic5see is a %>ehold] or 
memb] ( ! m$ical practice or o!rwise    
owns or controls an own]%ip or memb]%ip 
int]e/ t is equival5t to #be p]c5t or m 
( ! entire own]%ip or memb]%ip int]e/ t 
exi/s 9 ! m$ical practice4  7iv7        

,cl>ification ,clause 7i77,,ii7 does n  
limit or o!rwise affect any cause (     
action t-- 7,i7 a p>ty to1 or ?ird-p>ty 
b5efici>y (1 an agreem5t describ$ 9 su* 
clause may h ) respect to a /atem5t ( a 
lic5see t con/itutes libel1 sl&]1 a     
torti\s int]f]5ce ) contractual         
relations1 or ano!r tort = :i* a p>ty   
has a cause ( action aga9/ ! lic5see2 or
  7,,ii7 does n dep5d ^u or d]ive f a   
brea* or violation ( an agreem5t        
describ$ 9 su* clause4  7,b7            
,re/rictions on heal? c>e provid]s ,a   
heal? c>e provid] may n1 ei!r directly  
or indirectly1 ?r\gh discipl9e1         
puni%m5t1 ?reats1 adv]se employm5t      
actions1 co]cion1 retaliation1 or       
excessive pressure1 int]f]e )1 control1 
or o!rwise direct ! pr(essional judgm5t 
or cl9ical decisions ( a lic5see1       
includ+ by-- 7i7 specify+ ! p]iod ( "t a
 lic5see may sp5d ) a pati5t1 includ+ ! 
"t p]mitt$ = a lic5see to beg9 or       
complete evaluat+ pati5ts 9 an em]g5cy  
dep>tm5t or evaluate admitt$ pati5ts2   

7ii7 det]m9+ ! cl9ical /atus ( a pati5t1
 includ+ :e!r ! pati5t %\ld-- 7,i7 be   
admitt$ to inpati5t /atus2  7,,ii7 be   
kept 9 obs]vation /atus2  7,,iii7       
receive palliative c>e2 or  7,,iv7 be   
ref]r$ to an alt]native treatm5t c5t]   
su* z a skill$ nurs+ facility2  7iii7   
specify+ h[ quickly a treatm5t %\ld be  
initiat$2  7iv7 controll+ :]e a pati5t  
is ref]r$ to ^u dis*>ge2  7v7 hav+ f9al 
decision-mak+ au?ority ov] diagnoses1   
diagno/ic t]m9ology1 or diagnosis codes 
t are ent]$ into ! m$ical record by !   
lic5see2  7vi7 controll+ or limit+ !    
range ( cl9ical ord]s available to      
lic5sees1 includ+ by configur+ or       
controll+ ! m$ical record 9 a mann] t   
influ5ces ! cl9ical decision mak+ ( a   
lic5see2 or  7vii7 any o!r action t !   
,commission det]m9es1 9 consultation ) !
 ,secret>y ( ,heal? & ,human ,s]vices1  
int]f]es or controls ! cl9ical judgm5t  
or decision mak+ ( a lic5see4  7#b7     
,re/rictions reg>d+ managem5t s]vices   
organizations  7,a7 ,9 g5]al ,a         

managem5t s]vices organization or a     
%>ehold]1 director1 memb]1 manag]1      
(fic]1 employee1 or contractor ( su* an 
organization may n-- 7i7 control or ent]
 into an agreem5t to control or re/rict 
! sale or transf] ( a m$ical practice's 
%>es1 int]e/s1 or assets1 or o!rwise    
p]mit a p]son o!r ?an a lic5see to      
control or re/rict ! sale or transf] (  
su* %>es1 int]e/s1 or assets2  7ii7     
issue %>es ( /ock or o!r own]%ip int]e/ 
9 a m$ical practice or cause a m$ical   
practice to issue %>es ( /ock or o!r    
own]%ip int]e/ 9 su* practice1 9 a      
subsidi>y ( su* practice1 or 9 an       
affiliate ( su* practice1 includ+ by    
e/abli%+ or caus+ ! e/abli%m5t ( a      
m$ical practice ) :i* ! managem5t       
s]vices organization or affiliate ( su* 
organization int5ds to contract2  7iii7 
pay divid5ds f %>es or an own]%ip int]e/
 9 a m$ical practice2  7iv7 own or      
control %>es or o!r own]%ip int]e/ 91   
s]ve z a director1 manag]1 or (fic] (1  
be an employee (1 be a contractor )1 or 

o!rwise p>ticipate 9 manag+ a m$ical    
practice2  7v7 acquire1 cause !         
acquisition (1 or f9ance ! acquisition (
 %>es or o!r own]%ip int]e/ 9 a m$ical  
practice2  7vi7 contract )1 or am5d1    
r5ew1 or t]m9ate a contract ) a m$ical  
practice = managem5t s]vices unless--   
7,i7 ! m$ical practice negotiat$ !      
contract at arm's l5g? ?r\gh legal      
c\nsel1 negotiators1 & f9ancial advisors
 select$ by su* practice )\t !          
involvem5t ( ! managem5t s]vices        
organization & free f any f9ancial      
conflict ( int]e/ ) ! managem5t s]vices 
organization2 &  7,,ii7 any comp5sation 
"u ! contract reflects fair m>ket value1
 z det]m9$ by ! ,commission2  7vii7     
adv]tise ! s]vices ( a m$ical practice  
"u ! "n ( an entity t is n ! m$ical     
practice2 or  7viii7 control or ex]cise 
de facto control ov] ! adm9i/rative1    
bus9ess1 or cl9ical op]ations ( a m$ical
 practice 9 a mann] t affects ! nature  
or quality ( m$ical c>e t ! m$ical      
practice furni%es1 includ+ ?r\gh ex]cis+

 ultimate decision-mak+ au?ority ov]--  
7,i7 ! hir+ or t]m9ation ( employees ( !
 m$ical practice2  7,,ii7 ! "w s*$ules1 
comp5sation1 or o!r t]ms ( employm5t =  
lic5sees ( ! m$ical practice2  7,,iii7  
/aff+ levels ( ! m$ical practice2       
7,,iv7 ! p]iod ( "t a lic5see ( ! m$ical
 practice may see a pati5t2  7,v7 !     
disbursem5t ( rev5ue g5]at$ f lic5see   
fees & o!r rev5ue g5]at$ by s]vices     
furni%$ by lic5sees ( ! m$ical practice2
  7,,vi7 requir$ degrees or cr$5tials = 
a lic5see ( ! m$ical practice to see a  
pati5t2  7,,vii7 ! e/abli%m5t ( rev5ue  
t>gets = lic5sees or o!r inc5tives =    
lic5sees ( ! m$ical practice2  7,,viii7 
decisions reg>d+ ! diagno/ic cod+ us$ by
 ! m$ical practice2  7,,ix7 cl9ical     
/&>ds or policies ( ! m$ical practice2  
7,x7 policies reg>d+ bill+ = s]vices    
furni%$ by ! m$ical practice2  7,,xi7 ! 
price1 rates1 or am\nts *>g$ = s]vices  
furni%$ by lic5sees ( ! m$ical practice2
 or  7,,xii7 ! negotiation1 execution1  
p]=mance1 en=cem5t1 or t]m9ation (      

contracts ) ?ird-p>ty payors or         
individuals t are n employees ( ! m$ical
 practice4  7,b7 ,agreem5ts void ,any   
agreem5t betwe5 a managem5t s]vices     
organization & a m$ical practice t all[s
 a managem5t s]vices organization or    
%>ehold]1 director1 memb]1 manag]1      
(fic]1 employee1 or contractor ( su* an 
organization to take any action t is 9  
violation ( ?is p>agraph %all be        
consid]$ void1 un5=ceable1 & aga9/      
public policy4  7c7 ,requirem5t (       
lic5see own]s ( a m$ical practice       
,lic5see own]s ( a m$ical practice %all 
be-- 7#a7 lic5s$ & pres5t 9 a ,/ate :]e 
s]vices to pati5ts are furni%$ by !     
m$ical practice2 &  7#b7 sub/antially   
engag$ 9 deliv]+ m$ical c>e4  7d7       
,def9itions ,= purposes ( ?is section3  
7#a7 ,commission ,! t]m ,commission     
means ! ,f$]al ,trade ,commission4  7#b7
 ,heal? c>e provid] ,! t]m heal? c>e    
provid]-- 7,a7 means any entity t       
deliv]s heal? c>e s]vices2 &  7,b7      
includes a m$ical practice4  7#c7       

,lic5see ,! t]m lic5see means a         
physician 7z def9$ 9 section            
#ahfa7r77#a7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7r77#a777 or o!r   
advanc$ practice provid] su* z a        
physician assi/ant or nurse practition] 
7z ^? t]ms are def9$ 9 section          
#ahfa7;aa77#e7 ( su* ,act 7#db ,u4,s4,c4
 #aciex7aa77#e777 :o is au?oriz$ "u     
,/ate law to diagnose & treat pati5ts 9 
a cl9ical sett+4  7#d7 ,managem5t       
s]vices organization  7,a7 ,9 g5]al ,!  
t]m managem5t s]vices organization means
 an entity t has ent]$ into an agreem5t 
) a m$ical practice to provide s]vices  
to su* practice 9 return = comp5sation1 
includ+ s]vices reg>d+ payroll1 human   
res\rces1 employm5t scre5+1 pay]        
contract+1 bill+ & collection1 cod+1    
in=mation te*nology s]vices1 pati5t     
s*$ul+1 prop]ty or equipm5t leas+1 &    
adm9i/rative or bus9ess s]vices t d n   
con/itute ! practice ( m$ic9e4  7,b7    
,practice ( m$ic9e ,= purposes ( ?is    
section1 an entity %all be deem$ to be  

provid+ s]vices t con/itute ! practice (
 m$ic9e if ! provision ( su* s]vices    
affects ! pati5t-lic5see relation%ip1   
includ+ by-- 7i7 p]=m+ an evaluation ( a
 pati5t t results 9 ! =mulation ( a     
diff]5tial diagnosis1 diagno/ic plan1   
!rapeutic plan & disposition ( ! pati5t2
 &  7ii7 impos+ an adm9i/rative or      
facility-bas$ measurem5t or re/riction  
on any portion ( ! pati5t-lic5see       
relation%ip4  7#e7 ,m$ical practice ,!  
t]m m$ical practice means a p>tn]%ip or 
corporate entity1 su* z a pr(essional   
corporation1 limit$ liability company1  
or limit$ liability p>tn]%ip t is       
organiz$ = ! purpose ( practic+ m$ic9e4 
7#f7 ,non-compete clause  7,a7 ,9 g5]al 
,! t]m non-compete clause means a t]m or
 condition ( employm5t t prohibits a    
work] f1 p5alizes a work] =1 or         
functions to prev5t a work] f-- 7i7     
seek+ or accept+ "w 9 ! ,unit$ ,/ates ) 
a diff]5t p]son :]e su* "w w\ld beg9    
aft] ! conclusion ( ! employm5t t       
includes ! t]m or condition2 or  7ii7   

op]at+ a bus9ess 9 ! ,unit$ ,/ates aft] 
! conclusion ( ! employm5t t includes ! 
t]m or condition4  7,b7 ,t]m or         
condition ( employm5t ,= ! purposes (   
subp>agraph 7,a71 a t]m or condition (  
employm5t includes1 b is n limit$ to1 a 
contractual t]m or workplace policy1    
:e!r writt5 or oral4  7e7 ,en=cem5t     
7#a7 ,en=cem5t by ! ,commission  7,a7   
,unfair or deceptive acts or practices  
,a violation ( ?is section or a         
regulation promulgat$ "u ?is section    
%all be treat$ z a violation ( a rule   
def9+ an unfair or deceptive act or     
practice "u section #ah7;a77#a77;,b7 ( !
 ,f$]al ,trade ,commission ,act 7#ae    
,u4,s4,c4 #eg;a7a77#a77;,b774  7,b7     
,p[]s ( ! ,commission  7i7 ,9 g5]al     
,except z provid$ 9 clause 7iii71 !     
,commission %all en=ce ?is section 9 !  
same mann]1 by ! same means1 & ) ! same 
jurisdiction1 p[]s1 & duties z ?\gh all 
applicable t]ms & provisions ( ! ,f$]al 
,trade ,commission ,act 7#ae ,u4,s4,c4  
#da et seq47 7 incorporat$ into & made a

 "p ( ?is section4  7ii7 ,privileges &  
immunities ,except z provid$ 9 clause   
7iii71 any p]son :o violates ?is section
 %all be subject to ! p5alties & entitl$
 to ! privileges & immunities provid$ 9 
! ,f$]al ,trade ,commission ,act 7#ae   
,u4,s4,c4 #da et seq474  7iii7 ,nonpr(it
 organizations ,not)/&+ section #d1     
#e7;a77#b71 or #f ( ! ,f$]al ,trade     
,commission ,act 7#ae ,u4,s4,c4 #dd1    
#de7;a77#b71 #df7 or any jurisdictional 
limitation ( ! ,commission1 !           
,commission %all also en=ce ?is section1
 9 ! same mann] provid$ 9 clauses 7i7 & 
7ii71 ) respect to organizations n      
organiz$ to c>ry on bus9ess = _! own    
pr(it or t ( _! memb]s4  7iv7 ,au?ority 
pres]v$ ,no?+ 9 ?is section may be      
con/ru$ to limit ! au?ority ( !         
,commission "u any o!r provision ( law4 
7v7 ,rulemak+ ,! ,commission %all       
promulgate 9 accordance ) section #eec (
 title #e1 ,unit$ ,/ates ,code1 su*     
rules z may be necess>y to c>ry out ?is 
section4  7#b7 ,private "r ( action     

7,a7 ,9 g5]al ,any p]son :o has be5     
injur$ by a p]son 9 violation ( ?is     
section1 or a regulation promulgat$     
!reund]1 may br+ a civil action aga9/   
su* p]son 9 a c\rt ( compet5t           
jurisdiction4  7,b7 ,relief ,9 a civil  
action br\ght "u subp>agraph 7,a7 9 :i* 
! pla9tiff prevails1 ! c\rt may aw>d--  
7i7 treble damages2  7ii7 reasonable    
attorney's fees & litigation co/s2 &    
7iii7 any o!r relief1 includ+ equitable 
or decl>atory relief1 t ! c\rt det]m9es 
appropriate4  7#c7 ,actions by ,/ate    
attorneys g5]al ,9 any case 9 :i* !     
attorney g5]al ( a ,/ate has reason to  
believe t an int]e/ ( ! resid5ts ( su*  
,/ate has be5 or is ?reat5$ or adv]sely 
affect$ by ! engagem5t ( any p]son 9 an 
act or practice 9 violation ( ?is       
section1 or a regulation promulgat$     
!reund]1 ! attorney g5]al ( ! ,/ate1 may
 z p>5s patriae1 br+ a civil action on  
behalf ( ! resid5ts ( ! ,/ate 9 an      
appropriate ,/ate c\rt or an appropriate
 di/rict c\rt ( ! ,unit$ ,/ates to obta9

 appropriate relief1 includ+ equitable  
relief & monet>y damages4  7#d7         
,injunctive & equitable relief ,9 any   
action describ$ 9 p>agraph 7#a71 7#b7 or
 7#c71 ! applicable c\rt1 on a f9d+ t a 
p]son is 9 violation ( ?is section1 %all
 issue an ord] requir+ su* p]son-- 7,a7 
to cease & desi/ f su* violation1 &1 if 
applicable1 dive/ an entity ( su* p]son2
 &  7,b7 to disgorge any rev5ue receiv$ 
f an entity subject to dive/m5t = !     
p]iod ( su* violation4  7#e7 ,"r to jury
 trial ,9 any action br\ght "u p>agraph 
7#a71 7#b71 or 7#c71 ei!r p>ty1 ^u      
reque/1 %all h ! "r to a jury trial4    
7f7 ,effective date ,! requirem5ts ( ?is
 section %all take effect on ! date t is
 #a ye> aft] ! date ( enactm5t ( ?is    
,act4  #c4 ,f$]al heal? programs        
,section #aabh7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acbj;a-#g7;b77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#ah7 ,violations (          
re/rictions reg>d+ managem5t s]vices    
organization ,any entity t violates !   

requirem5ts describ$ 9 section #b ( !   
,/op ,corporate ,takeov]s ( ,physicians 
,act ( #bjbf4  4  #d4 ,preemption ,no?+ 
9 ?is ,act %all be con/ru$ to preempt1  
displace1 or sup]s$e any ,/ate law t--  
7#a7 imposes equal or m /r+5t own]%ip & 
control requirem5ts on m$ical practices 
?an ! requirem5ts impos$ "u ?is ,act1   
includ+ a ,/ate law t applies su*       
requirem5ts to any entity exempt f !    
requirem5ts impos$ "u ?is ,act2  7#b7   
af=ds equal or great] protection to     
lic5sees ?an ! protections provid$ "u   
?is ,act2 or  7#c7 imposes equal or m   
/r+5t re/rictions on managem5t s]vices  
organizations ?an ! re/rictions impos$  
"u ?is ,act4