F:\P11\NHI\TRICOMM\AAHCA09_001.

XML

313
1 (C) by adding at the end the following new
2 subparagraph:
3 ‘‘(D) the hospital meets the requirements
4 described in subsection (i)(1).’’;
5 (3) by amending subsection (f) to read as fol-
6 lows:
7 ‘‘(f) REPORTING AND DISCLOSURE REQUIRE-
8 MENTS.—

9 ‘‘(1) IN GENERAL.—Each entity providing cov-

10 ered items or services for which payment may be
11 made under this title shall provide the Secretary
12 with the information concerning the entity’s owner-
13 ship, investment, and compensation arrangements,
14 including—
15 ‘‘(A) the covered items and services pro-
16 vided by the entity, and
17 ‘‘(B) the names and unique physician iden-
18 tification numbers of all physicians with an
19 ownership or investment interest (as described
20 in subsection (a)(2)(A)), or with a compensa-
21 tion arrangement (as described in subsection
22 (a)(2)(B)), in the entity, or whose immediate
23 relatives have such an ownership or investment
24 interest or who have such a compensation rela-
25 tionship with the entity.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

314
1 Such information shall be provided in such form,
2 manner, and at such times as the Secretary shall
3 specify. The requirement of this subsection shall not
4 apply to designated health services provided outside
5 the United States or to entities which the Secretary
6 determines provide services for which payment may
7 be made under this title very infrequently.
8 ‘‘(2) REQUIREMENTS FOR HOSPITALS WITH

9 PHYSICIAN OWNERSHIP OR INVESTMENT.—In the

10 case of a hospital that meets the requirements de-
11 scribed in subsection (i)(1), the hospital shall—
12 ‘‘(A) submit to the Secretary an initial re-
13 port, and periodic updates at a frequency deter-
14 mined by the Secretary, containing a detailed
15 description of the identity of each physician
16 owner and physician investor and any other
17 owners or investors of the hospital;
18 ‘‘(B) require that any referring physician
19 owner or investor discloses to the individual
20 being referred, by a time that permits the indi-
21 vidual to make a meaningful decision regarding
22 the receipt of services, as determined by the
23 Secretary, the ownership or investment interest,
24 as applicable, of such referring physician in the
25 hospital; and

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

315
1 ‘‘(C) disclose the fact that the hospital is
2 partially or wholly owned by one or more physi-
3 cians or has one or more physician investors—
4 ‘‘(i) on any public website for the hos-
5 pital; and
6 ‘‘(ii) in any public advertising for the
7 hospital.
8 The information to be reported or disclosed under
9 this paragraph shall be provided in such form, man-
10 ner, and at such times as the Secretary shall specify.
11 The requirements of this paragraph shall not apply
12 to designated health services furnished outside the
13 United States or to entities which the Secretary de-
14 termines provide services for which payment may be
15 made under this title very infrequently.
16 ‘‘(3) PUBLICATION OF INFORMATION.—The

17 Secretary shall publish, and periodically update, the

18 information submitted by hospitals under paragraph
19 (2)(A) on the public Internet website of the Centers
20 for Medicare & Medicaid Services.’’;
21 (4) by amending subsection (g)(5) to read as
22 follows:
23 ‘‘(5) FAILURE TO REPORT OR DISCLOSE INFOR-

24 MATION.—

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

316
1 ‘‘(A) REPORTING.—Any person who is re-
2 quired, but fails, to meet a reporting require-
3 ment of paragraphs (1) and (2)(A) of sub-
4 section (f) is subject to a civil money penalty of
5 not more than $10,000 for each day for which
6 reporting is required to have been made.
7 ‘‘(B) DISCLOSURE.—Any physician who is
8 required, but fails, to meet a disclosure require-
9 ment of subsection (f)(2)(B) or a hospital that
10 is required, but fails, to meet a disclosure re-
11 quirement of subsection (f)(2)(C) is subject to
12 a civil money penalty of not more than $10,000
13 for each case in which disclosure is required to
14 have been made.
15 ‘‘(C) APPLICATION.—The provisions of
16 section 1128A (other than the first sentence of
17 subsection (a) and other than subsection (b))
18 shall apply to a civil money penalty under sub-
19 paragraphs (A) and (B) in the same manner as
20 such provisions apply to a penalty or proceeding
21 under section 1128A(a).’’; and
22 (5) by adding at the end the following new sub-
23 section:

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

317
1 ‘‘(i) REQUIREMENTS TO QUALIFY FOR RURAL PRO-
2 VIDER AND HOSPITAL OWNERSHIP EXCEPTIONS TO

3 SELF-REFERRAL PROHIBITION.—
4 ‘‘(1) REQUIREMENTS DESCRIBED.—For pur-
5 poses of subsection (d)(3)(D), the requirements de-
6 scribed in this paragraph are as follows:
7 ‘‘(A) PROVIDER AGREEMENT.—The hos-
8 pital had—
9 ‘‘(i) physician ownership or invest-
10 ment on January 1, 2009; and
11 ‘‘(ii) a provider agreement under sec-
12 tion 1866 in effect on such date.
13 ‘‘(B) PROHIBITION ON PHYSICIAN OWNER-

14 SHIP OR INVESTMENT.—The percentage of the

15 total value of the ownership or investment in-
16 terests held in the hospital, or in an entity
17 whose assets include the hospital, by physician
18 owners or investors in the aggregate does not
19 exceed such percentage as of the date of enact-
20 ment of this subsection.
21 ‘‘(C) PROHIBITION ON EXPANSION OF FA-

22 CILITY CAPACITY.—Except as provided in para-

23 graph (2), the number of operating rooms, pro-
24 cedure rooms, or beds of the hospital at any
25 time on or after the date of the enactment of

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

318
1 this subsection are no greater than the number
2 of operating rooms, procedure rooms, or beds,
3 respectively, as of such date.
4 ‘‘(D) ENSURING BONA FIDE OWNERSHIP

5 AND INVESTMENT.—

6 ‘‘(i) Any ownership or investment in-

7 terests that the hospital offers to a physi-
8 cian are not offered on more favorable
9 terms than the terms offered to a person
10 who is not in a position to refer patients
11 or otherwise generate business for the hos-
12 pital.
13 ‘‘(ii) The hospital (or any investors in
14 the hospital) does not directly or indirectly
15 provide loans or financing for any physi-
16 cian owner or investor in the hospital.
17 ‘‘(iii) The hospital (or any investors in
18 the hospital) does not directly or indirectly
19 guarantee a loan, make a payment toward
20 a loan, or otherwise subsidize a loan, for
21 any physician owner or investor or group
22 of physician owners or investors that is re-
23 lated to acquiring any ownership or invest-
24 ment interest in the hospital.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

319
1 ‘‘(iv) Ownership or investment returns
2 are distributed to each owner or investor in
3 the hospital in an amount that is directly
4 proportional to the ownership or invest-
5 ment interest of such owner or investor in
6 the hospital.
7 ‘‘(v) The investment interest of the
8 owner or investor is directly proportional
9 to the owner’s or investor’s capital con-
10 tributions made at the time the ownership
11 or investment interest is obtained.
12 ‘‘(vi) Physician owners and investors
13 do not receive, directly or indirectly, any
14 guaranteed receipt of or right to purchase
15 other business interests related to the hos-
16 pital, including the purchase or lease of
17 any property under the control of other
18 owners or investors in the hospital or lo-
19 cated near the premises of the hospital.
20 ‘‘(vii) The hospital does not offer a
21 physician owner or investor the oppor-
22 tunity to purchase or lease any property
23 under the control of the hospital or any
24 other owner or investor in the hospital on
25 more favorable terms than the terms of-

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

320
1 fered to a person that is not a physician
2 owner or investor.
3 ‘‘(viii) The hospital does not condition
4 any physician ownership or investment in-
5 terests either directly or indirectly on the
6 physician owner or investor making or in-
7 fluencing referrals to the hospital or other-
8 wise generating business for the hospital.
9 ‘‘(E) PATIENT SAFETY.—In the case of a
10 hospital that does not offer emergency services,
11 the hospital has the capacity to—
12 ‘‘(i) provide assessment and initial
13 treatment for medical emergencies; and
14 ‘‘(ii) if the hospital lacks additional
15 capabilities required to treat the emergency
16 involved, refer and transfer the patient
17 with the medical emergency to a hospital
18 with the required capability.
19 ‘‘(F) LIMITATION ON APPLICATION TO

20 CERTAIN CONVERTED FACILITIES.—The hos-

21 pital was not converted from an ambulatory
22 surgical center to a hospital on or after the date
23 of enactment of this subsection.
24 ‘‘(2) EXCEPTION TO PROHIBITION ON EXPAN-

25 SION OF FACILITY CAPACITY.—

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC