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Legislation from United States of America Senate

Medicare Patient Empowerment Act of 2019


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Medicare Patient Empowerment Act of 2019

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Introduced in Senate

Date: November 7, 2019

1.Short titleThis Act may be cited as the Medicare Patient Empowerment Act of 2019.
2.Guaranteeing freedom of choice and contracting for patients under Medicare
  • (a)In generalSection 1802 of the Social Security Act (42 U.S.C. 1395a) is amended to read as follows:
    • 1802.Freedom of Choice and Contracting by Patient Guaranteed
      • (a)Basic freedom of choiceAny individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide that individual such services.
      • (b)Freedom To contract by Medicare beneficiaries
        • (1)In generalSubject to the provisions of this subsection, nothing in this title shall prohibit a Medicare beneficiary from entering into a contract with an eligible professional (whether or not the professional is a participating or non-participating physician or practitioner) for any item or service covered under this title.
        • (2)Submission of claimsAny Medicare beneficiary that enters into a contract under this section with an eligible professional shall be permitted to submit a claim for payment under this title for services furnished by such professional, and such payment shall be made in the amount that would otherwise apply to such professional under this title except that where such professional is considered to be non-participating, payment shall be paid as if the professional were participating. Payment made under this title for any item or service provided under the contract shall not render the professional a participating or non-participating physician or practitioner, and as such, requirements of this title that may otherwise apply to a participating or non-participating physician or practitioner would not apply with respect to any items or services furnished under the contract.
        • (3)Beneficiary protections
          • (A)In generalParagraph (1) shall not apply to any contract unless
            • (i)the contract is in writing, is signed by the Medicare beneficiary and the eligible professional, and establishes all terms of the contract (including specific payment for items and services covered by the contract) before any item or service is provided pursuant to the contract, and the beneficiary shall be held harmless for any subsequent payment charged for an item or service in excess of the amount established under the contract during the period the contract is in effect;
            • (ii)the contract contains the items described in subparagraph (B); and
            • (iii)the contract is not entered into at a time when the Medicare beneficiary is facing an emergency medical condition or urgent health care situation.
          • (B)Items required to be included in contractAny contract to provide items and services to which paragraph (1) applies shall clearly indicate to the Medicare beneficiary that by signing such contract the beneficiary
            • (i)agrees to be responsible for payment to such eligible professional for such items or services under the terms of and amounts established under the contract;
            • (ii)agrees to be responsible for submitting claims under this title to the Secretary, and to any other supplemental insurance plan that may provide supplemental insurance, for such items or services furnished under the contract if such items or services are covered by this title, unless otherwise provided in the contract under subparagraph (C)(i); and
            • (iii)acknowledges that no limits or other payment incentives that may otherwise apply under this title (such as the limits under subsection (g) of section 1848 or incentives under subsection (a)(5), (m), (q), and (p) of such section) shall apply to amounts that may be charged, or paid to a beneficiary for, such items or services.
          • Such contract shall also clearly indicate whether the eligible professional is excluded from participation under the Medicare program under section 1128.