S.Amdt. 2984

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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