This bill amends the Social Security Act to create a new Medicare payment option, enabling Medicare beneficiaries and eligible professionals to enter into direct contracts for covered fee-for-service items and services. The core purpose is to guarantee freedom of choice and contracting , allowing beneficiaries to utilize their Medicare benefits for these services without penalizing professionals for engaging in such agreements. This framework ensures that professionals are not bound by the usual requirements for participating or non-participating providers when furnishing services under these specific contracts. To protect beneficiaries, contracts must be written, signed, and clearly outline all terms, including payment, before services are rendered, holding the beneficiary harmless from subsequent excess charges. Beneficiaries are responsible for submitting claims to Medicare, though they can negotiate for the professional to handle this and assign payment. Importantly, these contracts cannot be formed during emergency medical conditions or urgent health care situations , and they explicitly exclude individuals who are dually eligible for Medicaid. The bill also specifies that Medicare's usual limits on charges and payment incentives will not apply to amounts charged under these direct agreements. Furthermore, the legislation preempts any state laws that would otherwise limit the amount eligible professionals can charge for services provided under these new contractual arrangements. This ensures a consistent national standard for direct contracting under Medicare, while still allowing professionals to maintain their traditional Medicare participation status for other patients not covered by such contracts.