Amends title XIX (Medicaid) of the Social Security Act (SSAct) with respect to physician self-referral limitations to repeal the prohibition against payment of federal funds to a state for medical assistance expenditures for a designated health service furnished to an individual on the basis of a referral (self-referral) that would result in denial of payment under SSAct title XVIII (Medicare).
Requires a state plan for medical assistance to prohibit payment for a Medicaid designated health service furnished to an individual on the basis of a physician's referral if the physician (or an immediate family member) has an ownership or investment interest or a compensation arrangement with the entity furnishing the service that would not comply with Medicare requirements.
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Requires application of certain reporting requirements and sanctions to a provider of a Medicaid designated health service the same way they apply under Medicare.
Amends SSAct title XVIII to: (1) apply the False Claims Act to violations of the self-referral prohibition, and (2) declare the authority of the Secretary of Health and Human Services to issue regulations under Medicaid limited to the application of self-referral limitations to state plan requirements.
Directs the Secretary to establish a protocol consistent with the Medicare self-referral disclosure protocol required under the Patient Protection and Affordable Care Act that enables health care providers to disclose an actual or potential violation of Medicare self-referral limitations as applied to Medicaid.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsor introductory remarks on measure. (CR E251)
Introduced in House
Introduced in House
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Bill text & related measures
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Source last updated: Aug 12, 2025. Consult Congress.gov for the current record.
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