[Page S12636]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 2984. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 816, after line 20, insert the following:

     SEC. 3115. USE OF PRIVATE CONTRACTS BY MEDICARE BENEFICIARIES 
                   FOR PROFESSIONAL SERVICES.

       (a) In General.--Section 1802(b) of the Social Security Act 
     (42 U.S.C. 1395a) is amended to read as follows:
       ``(b) Clarification of Use of Private Contracts by Medicare 
     Beneficiaries for Professional Services.--
       ``(1) In general.--Nothing in this title shall prohibit a 
     medicare beneficiary from entering into a private contract 
     with a physician or health care practitioner for the 
     provision of medicare covered professional services (as 
     defined in paragraph (5)(C)) if--
       ``(A) the services are covered under a private contract 
     that is between the beneficiary and the physician or 
     practitioner and meets the requirements of paragraph (2);
       ``(B) under the private contract no claim for payment for 
     services covered under the contract is to be submitted (and 
     no payment made) under part A or B, under a contract under 
     section 1876, or under an MA plan (other than an MSA plan); 
     and
       ``(C)(i) the Secretary has been provided with the minimum 
     information necessary to avoid any payment under part A or B 
     for services covered under the contract, or
       ``(ii) in the case of an individual enrolled under a 
     contract under section 1876 or an MA plan (other than an MSA 
     plan) under part C, the eligible organization under the 
     contract or the MA organization offering the plan has been 
     provided the minimum information necessary to avoid any 
     payment under such contract or plan for services covered 
     under the contract.
       ``(2) Requirements for private contracts.--The requirements 
     in this paragraph for a private contract between a medicare 
     beneficiary and a physician or health care practitioner are 
     as follows:
       ``(A) General form of contract.--The contract is in writing 
     and is signed by the medicare beneficiary.
       ``(B) No claims to be submitted for covered services.--The 
     contract provides that no party to the contract (and no 
     entity on behalf of any party to the contract) shall submit 
     any claim for (or request) payment for services covered under 
     the contract under part A or B, under a contract under 
     section 1876, or under an MA plan (other than an MSA plan).
       ``(C) Scope of services.--The contract identifies the 
     medicare covered professional services and the period (if 
     any) to be covered under the contract, but does not cover any 
     services furnished--
       ``(i) before the contract is entered into; or
       ``(ii) for the treatment of an emergency medical condition 
     (as defined in section 1867(e)(1)(A)), unless the contract 
     was entered into before the onset of the emergency medical 
     condition.
       ``(D) Clear disclosure of terms.--The contract clearly 
     indicates that by signing the contract the medicare 
     beneficiary--
       ``(i) agrees not to submit a claim (or to request that 
     anyone submit a claim) under part A or B (or under section 
     1876 or under an MA plan, other than an MSA plan) for 
     services covered under the contract;
       ``(ii) agrees to be responsible, whether through insurance 
     or otherwise, for payment for such services and understands 
     that no reimbursement will be provided under such part, 
     contract, or plan for such services;
       ``(iii) acknowledges that no limits under this title 
     (including limits under paragraphs (1) and (3) of section 
     1848(g)) will apply to amounts that may be charged for such 
     services;
       ``(iv) acknowledges that medicare supplemental policies 
     under section 1882 do not, and other supplemental health 
     plans and policies may elect not to, make payments for such 
     services because payment is not made under this title; and
       ``(v) acknowledges that the beneficiary has the right to 
     have such services provided by (or under the supervision of) 
     other physicians or health care practitioners for whom 
     payment would be made under such part, contract, or plan.

     Such contract shall also clearly indicate whether the 
     physician or practitioner involved is excluded from 
     participation under this title.
       ``(3) Modifications.--The parties to a private contract may 
     mutually agree at any time to modify or terminate the 
     contract on a prospective basis, consistent with the 
     provisions of paragraphs (1) and (2).
       ``(4) No requirements for services furnished to msa plan 
     enrollees.--The requirements of paragraphs (1) and (2) do not 
     apply to any contract or arrangement for the provision of 
     services to a medicare beneficiary enrolled in an MSA plan 
     under part C.
       ``(5) Definitions.--In this subsection:
       ``(A) Health care practitioner.--The term `health care 
     practitioner' means a practitioner described in section 
     1842(b)(18)(C).
       ``(B) Medicare beneficiary.--The term `medicare 
     beneficiary' means an individual who is enrolled under part 
     B.
       ``(C) Medicare covered professional services.--The term 
     `medicare covered professional services' means--
       ``(i) physicians' services (as defined in section 1861(q), 
     and including services described in section 1861(s)(2)(A)), 
     and
       ``(ii) professional services of health care practitioners, 
     including services described in section 1842(b)(18)(D),

     for which payment may be made under part A or B, under a 
     contract under section 1876, or under a Medicare Advantage 
     plan but for the provisions of a private contract that meets 
     the requirements of paragraph (2).
       ``(D) MA plan; msa plan.--The terms `MA plan' and `MSA 
     plan' have the meanings given such terms in section 1859.
       ``(E) Physician.--The term `physician' has the meaning 
     given such term in section 1861(r).''.
       (b) Conforming Amendments Clarifying Exemption From 
     Limiting Charge and From Requirement for Submission of 
     Claims.--Section 1848(g) of the Social Security Act (42 
     U.S.C. 1395w-4(g)) is amended--
       (1) in paragraph (1)(A), by striking ``In'' and inserting 
     ``Subject to paragraph (8), in'';
       (2) in paragraph (3)(A), by striking ``Payment'' and 
     inserting ``Subject to paragraph (8), payment'';
       (3) in paragraph (4)(A), by striking ``For'' and inserting 
     ``Subject to paragraph (8), for''; and
       (4) by adding at the end the following new paragraph:
       ``(8) Exemption from requirements for services furnished 
     under private contracts.--
       ``(A) In general.--Pursuant to section 1802(b)(1), 
     paragraphs (1), (3), and (4) do not apply with respect to 
     physicians' services (and services described in section 
     1861(s)(2)(A)) furnished to an individual by (or under the 
     supervision of) a physician if the conditions described in 
     section 1802(b)(1) are met with respect to the services.
       ``(B) No restrictions for enrollees in msa plans.--Such 
     paragraphs do not apply with respect to services furnished to 
     individuals enrolled with MSA plans under part C, without 
     regard to whether the conditions described in subparagraphs 
     (A) through (C) of section 1802(b)(1) are met.
       ``(C) Application to enrollees in other plans.--Subject to 
     subparagraph (B) and section 1852(k)(2), the provisions of 
     subparagraph (A) shall apply in the case of an individual 
     enrolled under a contract under section 1876 or under an MA 
     plan (other than an MSA plan) under part C, in the same 
     manner as they apply to individuals not enrolled under such a 
     contract or plan.''.
       (c) Conforming Amendments.--(1) Section 1842(b)(18) of the 
     Social Security Act (42 U.S.C. 1395u(b)(18)) is amended by 
     adding at the end the following:
       ``(E) The provisions of section 1848(g)(8) shall apply with 
     respect to exemption from limitations on charges and from 
     billing requirements for services of health care 
     practitioners described in this paragraph in the same manner 
     as such provisions apply to exemption from the requirements 
     referred to in section 1848(g)(8)(A) for physicians' 
     services.''.
       (2) Section 1866(a)(1)(O) of such Act (42 U.S.C. 
     1395cc(a)(1)(O)) is amended by striking ``enrolled with a 
     Medicare Advantage organization under part C'' and inserting 
     ``enrolled with an MA organization under part C (other than 
     under an MSA plan)''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on the date that is 6 months after the date 
     of the enactment of this Act and apply to contracts entered 
     into on or after that date.
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