summary
Introduced
07/23/2015
07/23/2015
In Committee
07/23/2015
07/23/2015
Crossed Over
Passed
Dead
01/03/2017
01/03/2017
Introduced Session
114th Congress
Bill Summary
Medicare Patient Empowerment Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act to allow any Medicare beneficiary to enter into a contract with an eligible professional, regardless of whether the professional is a participating or non-participating physician or practitioner, for any item or service covered by Medicare. Such beneficiaries may submit a claim for Medicare payment in the amount that would otherwise apply, except that, where the professional is considered to be non-participating, payment shall be paid as if the professional were participating. An "eligible professional" is a physician, physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, physical or occupational therapist, qualified speech-language pathologist, or qualified audiologist. A Medicare beneficiary must agree in writing in such a contract to: (1) pay the eligible professional for a Medicare-covered item or service; and (2) submit, in lieu of the eligible professional, a claim for Medicare payment. However, a beneficiary maynegotiate, as a term of the contract, for the eligible professional to file such claims on the beneficiary's behalf. The bill preempts state laws from limiting the amount of charges for physician and practitioner services for which Medicare payment is made.
AI Summary
This bill, the Medicare Patient Empowerment Act of 2015, allows any Medicare beneficiary to directly contract with an "eligible professional" – which includes doctors, physician assistants, nurse practitioners, and various therapists and specialists – for any Medicare-covered service, regardless of whether the professional is a "participating" (agrees to Medicare's payment rates) or "non-participating" physician. Under this contract, the beneficiary agrees in writing to pay the professional directly and to submit the Medicare claim themselves, unless they negotiate for the professional to file the claim on their behalf. Importantly, if the beneficiary submits the claim, Medicare payment will be made as if the professional were participating, even if they are not. The bill also preempts state laws that might limit the charges for these services, meaning states cannot impose their own caps on what eligible professionals can charge for services covered by Medicare under these direct contracts.
Committee Categories
Budget and Finance
Sponsors (7)
Lisa Murkowski (R)*,
John Barrasso (R),
Roy Blunt (R),
Bill Cassidy (R),
James Inhofe (R),
Rand Paul (R),
Roger Wicker (R),
Last Action
Read twice and referred to the Committee on Finance. (on 07/23/2015)
Official Document
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