Click any annotated section or its icon to see analysis.
Referenced Laws
42 U.S.C. 1395j et seq.
42 U.S.C. 1395x
42 U.S.C. 1395jjj
42 U.S.C. 1395(l)
42 U.S.C. 1395w–4
42 U.S.C. 1315a(b)(4)(A)
Section 1
1. Short title This Act may be cited as the Providers and Payers COMPETE Act.
Section 2
2. Annual report on the impact of certain Medicare regulations on provider and payer consolidation; public comment on provider and payer consolidation for certain proposed rules Not later than December 30, 2026, and annually thereafter, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall submit to Congress a report on the impact in the aggregate on provider and payer consolidation with respect to regulations for parts B, C, and D of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) implemented in the calendar year immediately prior to such report. Such report shall include regulations that— implement a change to an applicable payment system, a rate schedule, or another payment system under part B, C, or D of such title; or result in a significant rule effecting provider or payer consolidation. Beginning for 2025, as part of any notice and comment rulemaking process that will result in a significant rule effecting provider or payer consolidation with respect to a proposed rule for parts B, C, and D of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), the Secretary shall seek public comment on the projected impact of such proposed rule on provider and payer consolidation in the aggregate. In this section: The term provider and payer consolidation includes the vertical or horizontal integration among providers of services (as defined in subsection (u) of section 1861 of the Social Security Act (42 U.S.C. 1395x)), suppliers (as defined in subsection (d) of such section), accountable care organizations under section 1899 of the Social Security Act (42 U.S.C. 1395jjj), Medicare Advantage organizations, PDP sponsors, pharmacy benefit managers, pharmacies, and integrated delivery systems. The term applicable payment system includes— with respect to outpatient hospital services, the prospective payment system for covered OPD services established under section 1833(t) of such Act (42 U.S.C. 1395(l)); and with respect to physicians’ services, the physician fee schedules established under section 1848 of such Act (42 U.S.C. 1395w–4).
Section 3
3. Consideration of effects on provider and payer consolidation with respect to CMI models Section 1115A(b)(4)(A) of the Social Security Act (42 U.S.C. 1315a(b)(4)(A)) is amended— in clause (i), by striking at the end and; in clause (ii), by striking the period at the end and inserting ; and; and by adding at the end the following new clause: the extent to which, and how, the model has effected and could effect provider and payer consolidation, which includes the vertical or horizontal integration among providers of services (as defined in subsection (u) of section 1861), suppliers (as defined in subsection (d) of such section), and accountable care organizations under section 1899. The amendments made by subsection (a) shall apply with respect to models tested on or after January 1, 2025. (iii)the extent to which, and how, the model has effected and could effect provider and payer consolidation, which includes the vertical or horizontal integration among providers of services (as defined in subsection (u) of section 1861), suppliers (as defined in subsection (d) of such section), and accountable care organizations under section 1899. .