113 HR 676 IH: To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.
U.S. House of Representatives
2013-02-13
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited as the Expanded & Improved Medicare For All
Act
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.
Title I—ELIGIBILITY AND BENEFITS
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
Title II—FINANCES
Subtitle A—Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care
clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical
supplies, and medically necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement
levels.
Subtitle B—Funding
Sec. 211. Overview: funding the Medicare For All
Program.
Sec. 212. Appropriations for existing programs.
Title III—ADMINISTRATION
Sec. 301. Public administration; appointment of
Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of
displaced clerical workers.
Sec. 304. Confidential electronic patient record
system.
Sec. 305. National Board of Universal Quality and
Access.
Title IV—ADDITIONAL PROVISIONS
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
Title V—EFFECTIVE DATE
Sec. 501. Effective date.
2.In this Act:
(1)Medicare For All
Program; programThe terms Medicare For All Program
and Program mean the program of benefits provided under this Act
and, unless the context otherwise requires, the Secretary with respect to
functions relating to carrying out such program.
(2)National board
of universal quality and accessThe term National Board of
Universal Quality and Access means such Board established under section
305.
(3)The term regional office means a regional
office established under section 303.
(4)The
term Secretary means the Secretary of Health and Human
Services.
(5)The
term Director means, in relation to the Program, the Director
appointed under section 301.
<enum>I</enum><header>ELIGIBILITY AND
BENEFITS</header>
<section id="HAF41802AF0D04B7CB80212496B76EA16"><enum>101.</enum><header>Eligibility and
registration</header>
<subsection id="HC17D3A2E3C55496C87CD34AD958D2C37"><enum>(a)</enum><header>In
general</header><text>All individuals residing in the United States (including
any territory of the United States) are covered under the Medicare For All
Program entitling them to a universal, best quality standard of care. Each such
individual shall receive a card with a unique number in the mail. An
individual’s Social Security number shall not be used for purposes of
registration under this section.</text>
</subsection><subsection id="H9E1E075F595647E8BFA1F174D4ECE17F"><enum>(b)</enum><header>Registration</header><text>Individuals
and families shall receive a Medicare For All Program Card in the mail, after
filling out a Medicare For All Program application form at a health care
provider. Such application form shall be no more than 2 pages long.</text>
</subsection><subsection id="HD7ECFD9CDC574C3E9DD90E3D91178DE3"><enum>(c)</enum><header>Presumption</header><text>Individuals
who present themselves for covered services from a participating provider shall
be presumed to be eligible for benefits under this Act, but shall complete an
application for benefits in order to receive a Medicare For All Program Card
and have payment made for such benefits.</text>
</subsection><subsection id="H498DE011300D4F5EA949E36AA6B9CC07"><enum>(d)</enum><header>Residency
criteria</header><text>The Secretary shall promulgate a rule that provides
criteria for determining residency for eligibility purposes under the Medicare
For All Program.</text>
</subsection><subsection id="H16B945FB25D7483EABDD21F0DDDEA212"><enum>(e)</enum><header>Coverage for
visitors</header><text display-inline="yes-display-inline">The Secretary shall
promulgate a rule regarding visitors from other countries who seek premeditated
non-emergency surgical procedures. Such a rule should facilitate the
establishment of country-to-country reimbursement arrangements or self pay
arrangements between the visitor and the provider of care.</text>
</subsection></section><section id="H7BDE789263354F4AB817AE0416A5D140"><enum>102.</enum><header>Benefits and
portability</header>
<subsection id="H89827F7045334DE38D1170B0335F6F39"><enum>(a)</enum><header>In
general</header><text>The health care benefits under this Act cover all
medically necessary services, including at least the following:</text>
<paragraph id="H340B6E2076A64EB09E8F4DC146ED7B13"><enum>(1)</enum><text>Primary care and
prevention.</text>
</paragraph><paragraph id="HF9862919006F4306A0CC8544FAD6F773"><enum>(2)</enum><text display-inline="yes-display-inline">Approved dietary and nutritional
therapies.</text>
</paragraph><paragraph id="H2FE49E5552FB4C71AE45C9F7955C81DE"><enum>(3)</enum><text>Inpatient
care.</text>
</paragraph><paragraph id="H138F7AB4F74F4EDBBE4C6F25C8877A79"><enum>(4)</enum><text>Outpatient
care.</text>
</paragraph><paragraph id="H3251A9F29EE64F2B8BD03E1209D81538"><enum>(5)</enum><text>Emergency
care.</text>
</paragraph><paragraph id="HFB36CC3D653C4E64BD855666E5FE207B"><enum>(6)</enum><text>Prescription
drugs.</text>
</paragraph><paragraph id="HF4567BE8C6364ACAB217F75A4E0F5BC2"><enum>(7)</enum><text>Durable medical
equipment.</text>
</paragraph><paragraph id="HAF580A20C1DC44EA965A2112878D0724"><enum>(8)</enum><text>Long-term
care.</text>
</paragraph><paragraph id="H81F73F6C53944981963786E6AC99C2B8"><enum>(9)</enum><text>Palliative
care.</text>
</paragraph><paragraph id="HFC0A80E9C13E4F1E88E3899F6AA31F5E"><enum>(10)</enum><text>Mental health
services.</text>
</paragraph><paragraph id="H0BBAEA8358184649B347317AE46C0E4B"><enum>(11)</enum><text display-inline="yes-display-inline">The full scope of dental services,
services, including periodontics, oral surgery, and endodontics, but not
including cosmetic dentistry.</text>
</paragraph><paragraph id="H6050E3B229F4490B933AABF861B43D59"><enum>(12)</enum><text>Substance abuse
treatment services.</text>
</paragraph><paragraph id="H6422393FF5BC48CCB73FEC75571B9CF2"><enum>(13)</enum><text display-inline="yes-display-inline">Chiropractic services, not including
electrical stimulation.</text>
</paragraph><paragraph id="H8AD88589ED9B47D58493CE9165C31748"><enum>(14)</enum><text>Basic vision care
and vision correction (other than laser vision correction for cosmetic
purposes).</text>
</paragraph><paragraph id="HA176B9CDB3DE4E618721AD7B2926525D"><enum>(15)</enum><text>Hearing services,
including coverage of hearing aids.</text>
</paragraph><paragraph id="H2C9D44D269584840A66CBB4798A4A8B3"><enum>(16)</enum><text>Podiatric
care.</text>
</paragraph></subsection><subsection id="H21957F5F411D4E0C8FDFF65E33654159"><enum>(b)</enum><header>Portability</header><text>Such
benefits are available through any licensed health care clinician anywhere in
the United States that is legally qualified to provide the benefits.</text>
</subsection><subsection id="H61FA926D302D46318C4A074DC88D99CE"><enum>(c)</enum><header>No
cost-Sharing</header><text>No deductibles, copayments, coinsurance, or other
cost-sharing shall be imposed with respect to covered benefits.</text>
</subsection></section><section id="H0374982BE9014D678AB8BA10C25F1CB6"><enum>103.</enum><header>Qualification
of participating providers</header>
<subsection id="H6A92DA2490A84774B84A697769C117CF"><enum>(a)</enum><header>Requirement To
be public or non-Profit</header>
<paragraph id="H9F5DFAE6ABF9452EB9D2E01C7CF2D7B7"><enum>(1)</enum><header>In
general</header><text>No institution may be a participating provider unless it
is a public or not-for-profit institution. Private physicians, private clinics,
and private health care providers shall continue to operate as private
entities, but are prohibited from being investor owned.</text>
</paragraph><paragraph id="H3F5937E26248475CB00AF37094A1FDCC"><enum>(2)</enum><header>Conversion of
investor-owned providers</header><text>For-profit providers of care opting to
participate shall be required to convert to not-for-profit status.</text>
</paragraph><paragraph id="H86D1EFD05BE248369247547BF58B58D3"><enum>(3)</enum><header>Private delivery
of care requirement</header><text>For-profit providers of care that convert to
non-profit status shall remain privately owned and operated entities.</text>
</paragraph><paragraph id="H13050A4A161F408094F63CF2112A6D68"><enum>(4)</enum><header>Compensation for
conversion</header><text>The owners of such for-profit providers shall be
compensated for reasonable financial losses incurred as a result of the
conversion from for-profit to non-profit status.</text>
</paragraph><paragraph id="H45657D9F381E4108B26FF8BCC491214D"><enum>(5)</enum><header>Funding</header><text>There
are authorized to be appropriated from the Treasury such sums as are necessary
to compensate investor-owned providers as provided for under paragraph
(3).</text>
</paragraph><paragraph id="HCE5DFDDAEEB94623A6D09D9D226D562F"><enum>(6)</enum><header>Requirements</header><text>The
payments to owners of converting for-profit providers shall occur during a
15-year period, through the sale of U.S. Treasury Bonds. Payment for
conversions under paragraph (3) shall not be made for loss of business
profits.</text>
</paragraph><paragraph id="H645D066ADEAF439F9B7A190E076570B8"><enum>(7)</enum><header>Mechanism for
conversion process</header><text>The Secretary shall promulgate a rule to
provide a mechanism to further the timely, efficient, and feasible conversion
of for-profit providers of care.</text>
</paragraph></subsection><subsection id="H268D180908DA4C7CBEE897C57A3CB486"><enum>(b)</enum><header>Quality
standards</header>
<paragraph id="H8AA85ECE702B4985AA1D45114016DB59"><enum>(1)</enum><header>In
general</header><text>Health care delivery facilities must meet State quality
and licensing guidelines as a condition of participation under such program,
including guidelines regarding safe staffing and quality of care.</text>
</paragraph><paragraph id="HDF05C72E576649C2AFDC815ECA037A20"><enum>(2)</enum><header>Licensure
requirements</header><text>Participating clinicians must be licensed in their
State of practice and meet the quality standards for their area of care. No
clinician whose license is under suspension or who is under disciplinary action
in any State may be a participating provider.</text>
</paragraph></subsection><subsection id="H3CEB653D85784A80A2D7176402B00509"><enum>(c)</enum><header>Participation of
health maintenance organizations</header>
<paragraph id="HE3F1E9ADBDB143D2AD8808A4EF57D7B7"><enum>(1)</enum><header>In
general</header><text>Non-profit health maintenance organizations that deliver
care in their own facilities and employ clinicians on a salaried basis may
participate in the program and receive global budgets or capitation payments as
specified in section 202.</text>
</paragraph><paragraph id="H781F15BBE7414A23BB491602BD57F822"><enum>(2)</enum><header>Exclusion of
certain health maintenance organizations</header><text>Other health maintenance
organizations which principally contract to pay for services delivered by
non-employees shall be classified as insurance plans. Such organizations shall
not be participating providers, and are subject to the regulations promulgated
by reason of section 104(a) (relating to prohibition against duplicating
coverage).</text>
</paragraph></subsection><subsection id="H1ED24CEA478941C69587BBA0152743CE"><enum>(d)</enum><header>Freedom of
choice</header><text>Patients shall have free choice of participating
physicians and other clinicians, hospitals, and inpatient care
facilities.</text>
</subsection></section><section id="H03A6D53CB7384FA2804B6FEFE8196176"><enum>104.</enum><header>Prohibition
against duplicating coverage</header>
<subsection id="H65C33B4BA1AF4863ABE519C43EB911AA"><enum>(a)</enum><header>In
general</header><text>It is unlawful for a private health insurer to sell
health insurance coverage that duplicates the benefits provided under this
Act.</text>
</subsection><subsection id="H521CA3E0349B4627BF70BC75D6D96707"><enum>(b)</enum><header>Construction</header><text>Nothing
in this Act shall be construed as prohibiting the sale of health insurance
coverage for any additional benefits not covered by this Act, such as for
cosmetic surgery or other services and items that are not medically
necessary.</text>
</subsection></section><enum>II</enum><header>FINANCES</header>
<subtitle id="H1030DE27E72D49B89C5C65E217DE348B"><enum>A</enum><header>Budgeting and
Payments</header>
<section id="HAE6190F7273A43469D59302E919961BD"><enum>201.</enum><header>Budgeting
process</header>
<subsection id="HE9D1FD3F6E5A442090AD76110111D5A2"><enum>(a)</enum><header>Establishment of
operating budget and capital expenditures budget</header>
<paragraph id="HF207BF057F4E4EB1AB53534012275741"><enum>(1)</enum><header>In
general</header><text>To carry out this Act there are established on an annual
basis consistent with this title—</text>
<subparagraph id="H99AEE91E57734E35B0551FB6EBE52B2E"><enum>(A)</enum><text>an operating
budget, including amounts for optimal physician, nurse, and other health care
professional staffing;</text>
</subparagraph><subparagraph id="HD27D02D0AE224658AA27AA41D63B38C4"><enum>(B)</enum><text>a capital
expenditures budget;</text>
</subparagraph><subparagraph id="H40E8958C5C844482A59F2FE2D418E3DD"><enum>(C)</enum><text>reimbursement
levels for providers consistent with subtitle B; and</text>
</subparagraph><subparagraph id="HC972B4E7F5DA41A49048AA1FBAA273F0"><enum>(D)</enum><text>a health
professional education budget, including amounts for the continued funding of
resident physician training programs.</text>
</subparagraph></paragraph><paragraph id="H38C6623502D0427D901D2F86EEDBA299"><enum>(2)</enum><header>Regional
allocation</header><text>After Congress appropriates amounts for the annual
budget for the Medicare For All Program, the Director shall provide the
regional offices with an annual funding allotment to cover the costs of each
region’s expenditures. Such allotment shall cover global budgets,
reimbursements to clinicians, health professional education, and capital
expenditures. Regional offices may receive additional funds from the national
program at the discretion of the Director.</text>
</paragraph></subsection><subsection id="HEAF74FED5A2647D8B052805DE702A92D"><enum>(b)</enum><header>Operating
budget</header><text>The operating budget shall be used for—</text>
<paragraph id="H651B7DBDF3F24D52971C56A93CE499AC"><enum>(1)</enum><text>payment for
services rendered by physicians and other clinicians;</text>
</paragraph><paragraph id="H9AF7A8E73AF54B30B21BAEB7EFE1EEF4"><enum>(2)</enum><text>global budgets for
institutional providers;</text>
</paragraph><paragraph id="H679C67C742FE44F5B8183218922FF899"><enum>(3)</enum><text>capitation
payments for capitated groups; and</text>
</paragraph><paragraph id="HCDD400428BE6441F99F8D83034B1AB12"><enum>(4)</enum><text>administration of
the Program.</text>
</paragraph></subsection><subsection id="HC2BC93E38E4749998DF7293BBF9FDC3F"><enum>(c)</enum><header>Capital
expenditures budget</header><text>The capital expenditures budget shall be used
for funds needed for—</text>
<paragraph id="HD2FB3BE934F84517A31E0B1E8B415B5C"><enum>(1)</enum><text>the construction
or renovation of health facilities; and</text>
</paragraph><paragraph id="HD52A910E513D41B3BE75E5DBBF1A8255"><enum>(2)</enum><text>for major
equipment purchases.</text>
</paragraph></subsection><subsection id="H82DD46AD1F404FDBAB3A233DC979C858"><enum>(d)</enum><header>Prohibition
against co-Mingling operations and capital improvement funds</header><text>It
is prohibited to use funds under this Act that are earmarked—</text>
<paragraph id="H21AC622C61614799AEB19FBDFE2465B0"><enum>(1)</enum><text>for operations for
capital expenditures; or</text>
</paragraph><paragraph id="HB6740A8956AD4CD5B36744686E2D2125"><enum>(2)</enum><text>for capital
expenditures for operations.</text>
</paragraph></subsection></section><section id="H0EB2E05D01024B5BAC6ACD085236D569"><enum>202.</enum><header>Payment of
providers and health care clinicians</header>
<subsection id="HA0256594AC5944D1BC566CA3529A5634"><enum>(a)</enum><header>Establishing
global budgets; monthly lump sum</header>
<paragraph id="HBBF822D57B184604A0DCC08B2C310246"><enum>(1)</enum><header>In
general</header><text>The Medicare For All Program, through its regional
offices, shall pay each institutional provider of care, including hospitals,
nursing homes, community or migrant health centers, home care agencies, or
other institutional providers or pre-paid group practices, a monthly lump sum
to cover all operating expenses under a global budget.</text>
</paragraph><paragraph id="HBFEA4233DC5C431DB2457CB32B98748C"><enum>(2)</enum><header>Establishment of
global budgets</header><text>The global budget of a provider shall be set
through negotiations between providers, State directors, and regional
directors, but are subject to the approval of the Director. The budget shall be
negotiated annually, based on past expenditures, projected changes in levels of
services, wages and input, costs, a provider’s maximum capacity to provide
care, and proposed new and innovative programs.</text>
</paragraph></subsection><subsection id="HA25E977424D4422D85BA400427421983"><enum>(b)</enum><header>Three payment
options for physicians and certain other health professionals</header>
<paragraph id="H04750FE3B87A421EAF594CFC8C4F4B4F"><enum>(1)</enum><header>In
general</header><text>The Program shall pay physicians, dentists, doctors of
osteopathy, pharmacists, psychologists, chiropractors, doctors of optometry,
nurse practitioners, nurse midwives, physicians’ assistants, and other advanced
practice clinicians as licensed and regulated by the States by the following
payment methods:</text>
<subparagraph id="H3DF7A0B72CC44938A60E8D0AAD3C8B86"><enum>(A)</enum><text>Fee for service
payment under paragraph (2).</text>
</subparagraph><subparagraph id="H51F1720286CF4185BA72DD5DF38D7158"><enum>(B)</enum><text>Salaried positions
in institutions receiving global budgets under paragraph (3).</text>
</subparagraph><subparagraph id="HB52BBAC088F04A6388C4E5A14935D963"><enum>(C)</enum><text>Salaried positions
within group practices or non-profit health maintenance organizations receiving
capitation payments under paragraph (4).</text>
</subparagraph></paragraph><paragraph id="H203F2B79A8DB487CB3FE86EF70857055"><enum>(2)</enum><header>Fee for
service</header>
<subparagraph id="HAA3A940A8B2143C08D9C88DF78E11C13"><enum>(A)</enum><header>In
general</header><text>The Program shall negotiate a simplified fee schedule
that is fair and optimal with representatives of physicians and other
clinicians, after close consultation with the National Board of Universal
Quality and Access and regional and State directors. Initially, the current
prevailing fees or reimbursement would be the basis for the fee negotiation for
all professional services covered under this Act.</text>
</subparagraph><subparagraph id="HAB0A02CB56734990A351D81D53E124B6"><enum>(B)</enum><header>Considerations</header><text>In
establishing such schedule, the Director shall take into consideration the
following:</text>
<clause id="H8BDB838B09034BCFB5E1A77343DF28BA"><enum>(i)</enum><text>The
need for a uniform national standard.</text>
</clause><clause id="H13D7C92EEFF2455B82CE5F913F983F53"><enum>(ii)</enum><text>The
goal of ensuring that physicians, clinicians, pharmacists, and other medical
professionals be compensated at a rate which reflects their expertise and the
value of their services, regardless of geographic region and past fee
schedules.</text>
</clause></subparagraph><subparagraph id="H5B8278187F504195ACC7DBABFCCEED39"><enum>(C)</enum><header>State physician
practice review boards</header><text>The State director for each State, in
consultation with representatives of the physician community of that State,
shall establish and appoint a physician practice review board to assure
quality, cost effectiveness, and fair reimbursements for physician delivered
services.</text>
</subparagraph><subparagraph id="H4F0D7800848B42AC9BDC39C3354E55C1"><enum>(D)</enum><header>Final
guidelines</header><text>The Director shall be responsible for promulgating
final guidelines to all providers.</text>
</subparagraph><subparagraph id="HDBF3E00E681E4B2980DD534F377A0B4A"><enum>(E)</enum><header>Billing</header><text>Under
this Act physicians shall submit bills to the regional director on a simple
form, or via computer. Interest shall be paid to providers who are not
reimbursed within 30 days of submission.</text>
</subparagraph><subparagraph id="H287D8D49ED02484CB42F2A154A038E54"><enum>(F)</enum><header>No balance
billing</header><text>Licensed health care clinicians who accept any payment
from the Medicare For All Program may not bill any patient for any covered
service.</text>
</subparagraph><subparagraph id="HBF3EF5EBC63F45CD9E492FA8301A23E3"><enum>(G)</enum><header>Uniform computer
electronic billing system</header><text>The Director shall create a uniform
computerized electronic billing system, including those areas of the United
States where electronic billing is not yet established.</text>
</subparagraph></paragraph><paragraph id="HB2E7C3EF0E5E4770B76F3144AC3F61A1"><enum>(3)</enum><header>Salaries within
institutions receiving global budgets</header>
<subparagraph id="H455B075E4EF041AB8CF10BEB44F34613"><enum>(A)</enum><header>In
general</header><text>In the case of an institution, such as a hospital, health
center, group practice, community and migrant health center, or a home care
agency that elects to be paid a monthly global budget for the delivery of
health care as well as for education and prevention programs, physicians and
other clinicians employed by such institutions shall be reimbursed through a
salary included as part of such a budget.</text>
</subparagraph><subparagraph id="H49951E7BD22E4A99B810F9B0C96E95CE"><enum>(B)</enum><header>Salary
ranges</header><text>Salary ranges for health care providers shall be
determined in the same way as fee schedules under paragraph (2).</text>
</subparagraph></paragraph><paragraph id="H42BB3354EE314326B5D9541E1678865A"><enum>(4)</enum><header>Salaries within
capitated groups</header>
<subparagraph id="H3F2759789D7F4C7A88C9DBDF8A48C146"><enum>(A)</enum><header>In
general</header><text>Health maintenance organizations, group practices, and
other institutions may elect to be paid capitation payments to cover all
outpatient, physician, and medical home care provided to individuals enrolled
to receive benefits through the organization or entity.</text>
</subparagraph><subparagraph id="HB78CE2BFFCEE4066B9FFB0B12904D5B9"><enum>(B)</enum><header>Scope</header><text>Such
capitation may include the costs of services of licensed physicians and other
licensed, independent practitioners provided to inpatients. Other costs of
inpatient and institutional care shall be excluded from capitation payments,
and shall be covered under institutions’ global budgets.</text>
</subparagraph><subparagraph id="H1B0C7B5D8C6E404399D8B631F21253DB"><enum>(C)</enum><header>Prohibition of
selective enrollment</header><text display-inline="yes-display-inline">Patients
shall be permitted to enroll or disenroll from such organizations or entities
without discrimination and with appropriate notice.</text>
</subparagraph><subparagraph id="H875DFF394B784A429947E198594D257C"><enum>(D)</enum><header>Health
maintenance organizations</header><text>Under this Act—</text>
<clause id="H7B0CEECE9CB046F4869CB0F54F3DFBFE"><enum>(i)</enum><text>health maintenance
organizations shall be required to reimburse physicians based on a salary;
and</text>
</clause><clause id="H330E39F0774C477A9132D168E4BD7031"><enum>(ii)</enum><text>financial
incentives between such organizations and physicians based on utilization are
prohibited.</text>
</clause></subparagraph></paragraph></subsection></section><section id="H67ECF142E65143BEA45E42A93957BB59"><enum>203.</enum><header>Payment for
long-term care</header>
<subsection id="HB62ACAC8641341C38894793A142F4610"><enum>(a)</enum><header>Allotment for
regions</header><text>The Program shall provide for each region a single
budgetary allotment to cover a full array of long-term care services under this
Act.</text>
</subsection><subsection id="H80861FC45AAA4931B45A910AD1364B24"><enum>(b)</enum><header>Regional
budgets</header><text>Each region shall provide a global budget to local
long-term care providers for the full range of needed services, including
in-home, nursing home, and community based care.</text>
</subsection><subsection id="H0F1506434E064D198FEAAD0683196D77"><enum>(c)</enum><header>Basis for
budgets</header><text>Budgets for long-term care services under this section
shall be based on past expenditures, financial and clinical performance,
utilization, and projected changes in service, wages, and other related
factors.</text>
</subsection><subsection id="HD5727245079C4D52B74A4137B0C01816"><enum>(d)</enum><header>Favoring
non-Institutional care</header><text>All efforts shall be made under this Act
to provide long-term care in a home- or community-based setting, as opposed to
institutional care.</text>
</subsection></section><section id="H8922ED9385364CE2ADB22CBAA15FDBFB"><enum>204.</enum><header>Mental health
services</header>
<subsection id="HB9A57C7E50194EDCA9A204E6D6648D02"><enum>(a)</enum><header>In
general</header><text>The Program shall provide coverage for all medically
necessary mental health care on the same basis as the coverage for other
conditions. Licensed mental health clinicians shall be paid in the same manner
as specified for other health professionals, as provided for in section
202(b).</text>
</subsection><subsection id="H58C79D5DFA4C4397A038C4CEB777FA18"><enum>(b)</enum><header>Favoring
community-Based care</header><text>The Medicare For All Program shall cover
supportive residences, occupational therapy, and ongoing mental health and
counseling services outside the hospital for patients with serious mental
illness. In all cases the highest quality and most effective care shall be
delivered, and, for some individuals, this may mean institutional care.</text>
</subsection></section><section id="H2411E568C4CB4D1E9FECDBC9F74137A5"><enum>205.</enum><header>Payment for
prescription medications, medical supplies, and medically necessary assistive
equipment</header>
<subsection id="H34F50ED26F494363B02F3FC277A59083"><enum>(a)</enum><header>Negotiated
prices</header><text>The prices to be paid each year under this Act for covered
pharmaceuticals, medical supplies, and medically necessary assistive equipment
shall be negotiated annually by the Program.</text>
</subsection><subsection id="H4E1ADD209CB94E31824F31264E237BB4"><enum>(b)</enum><header>Prescription
drug formulary</header>
<paragraph id="H52DC2B50E1CD47DEB277026719824AD4"><enum>(1)</enum><header>In
general</header><text>The Program shall establish a prescription drug formulary
system, which shall encourage best-practices in prescribing and discourage the
use of ineffective, dangerous, or excessively costly medications when better
alternatives are available.</text>
</paragraph><paragraph id="H01BC7F7D959C47D0AF777CAE58E68B26"><enum>(2)</enum><header>Promotion of use
of generics</header><text>The formulary shall promote the use of generic
medications but allow the use of brand-name and off-formulary
medications.</text>
</paragraph><paragraph id="HF559987BF00E47F4975C09BD51D7C8E3"><enum>(3)</enum><header>Formulary
updates and petition rights</header><text>The formulary shall be updated
frequently and clinicians and patients may petition their region or the
Director to add new pharmaceuticals or to remove ineffective or dangerous
medications from the formulary.</text>
</paragraph></subsection></section><section id="H9D3E15E39F564B2FAB1DDBA454826BEC"><enum>206.</enum><header>Consultation in
establishing reimbursement levels</header><text display-inline="no-display-inline">Reimbursement levels under this subtitle
shall be set after close consultation with regional and State Directors and
after the annual meeting of National Board of Universal Quality and
Access.</text>
</section></subtitle><subtitle id="H5780D4D4E6A74DC18E0DF89CA31114DF"><enum>B</enum><header>Funding</header>
<section id="H22A38DEA75B54CC2B74EA69753A6A07C"><enum>211.</enum><header>Overview:
funding the Medicare For All Program</header>
<subsection id="H0858A164DBD9466F9B1954B38BE6EF68"><enum>(a)</enum><header>In
general</header><text>The Medicare For All Program is to be funded as provided
in subsection (c)(1).</text>
</subsection><subsection id="HD4B10FFEEF944B70A63E3E053E531016"><enum>(b)</enum><header>Medicare For All
Trust Fund</header><text>There shall be established a Medicare For All Trust
Fund in which funds provided under this section are deposited and from which
expenditures under this Act are made.</text>
</subsection><subsection id="H555381C2385C4553A78C0083A405CD4C"><enum>(c)</enum><header>Funding</header>
<paragraph id="HA26F0762F44647D8BA94A879646CAE3A"><enum>(1)</enum><header>In
general</header><text>There are appropriated to the Medicare For All Trust Fund
amounts sufficient to carry out this Act from the following sources:</text>
<subparagraph id="H2C833716C6EF4908A9F9FDA4EA18F6C4"><enum>(A)</enum><text>Existing sources
of Federal Government revenues for health care.</text>
</subparagraph><subparagraph id="H1B94B3E017D6464E8D7DDEFDA3E86266"><enum>(B)</enum><text>Increasing
personal income taxes on the top 5 percent income earners.</text>
</subparagraph><subparagraph id="HE6DE621D9CE643FB88B907557DD31FBD"><enum>(C)</enum><text>Instituting a
modest and progressive excise tax on payroll and self-employment income.</text>
</subparagraph><subparagraph id="H81BA00A8E26C4036A72621E70E08AA4A"><enum>(D)</enum><text display-inline="yes-display-inline">Instituting a modest tax on unearned
income.</text>
</subparagraph><subparagraph id="H6DFEDE38F8C14D2B856D75B39030C355"><enum>(E)</enum><text>Instituting a
small tax on stock and bond transactions.</text>
</subparagraph></paragraph><paragraph id="H82AFB9AC7916490FA04BDE123367BD7D"><enum>(2)</enum><header>System savings
as a source of financing</header><text>Funding otherwise required for the
Program is reduced as a result of—</text>
<subparagraph id="H9AD0B3FF06CC413AB8E42CB23CE79434"><enum>(A)</enum><text>vastly reducing
paperwork;</text>
</subparagraph><subparagraph id="H32E4FA5C314A48ADABE82C5CAD3DC195"><enum>(B)</enum><text>requiring a
rational bulk procurement of medications under section 205(a); and</text>
</subparagraph><subparagraph id="H7AEDC4054A9A4573B163B3CA8FB85FA4"><enum>(C)</enum><text>improved access to
preventive health care.</text>
</subparagraph></paragraph><paragraph id="H1091F5985C0043C8A7001D6BBD51B5A1"><enum>(3)</enum><header>Additional
annual appropriations to Medicare For All Program</header><text>Additional sums
are authorized to be appropriated annually as needed to maintain maximum
quality, efficiency, and access under the Program.</text>
</paragraph></subsection></section><section id="HEA138FA7B3C947699471353E1679DA5C"><enum>212.</enum><header>Appropriations
for existing programs</header><text display-inline="no-display-inline">Notwithstanding any other provision of law,
there are hereby transferred and appropriated to carry out this Act, amounts
from the Treasury equivalent to the amounts the Secretary estimates would have
been appropriated and expended for Federal public health care programs,
including funds that would have been appropriated under the Medicare program
under title XVIII of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, under the Medicaid program under title XIX of such Act, and
under the Children’s Health Insurance Program under title XXI of such
Act.</text>
</section></subtitle><enum>III</enum><header>ADMINISTRATION</header>
<section id="H77B0BF2102584939B9F06D7A4643D211"><enum>301.</enum><header>Public
administration; appointment of Director</header>
<subsection id="HE0E89924FD9547E3BAD0FD8FF1141A77"><enum>(a)</enum><header>In
general</header><text>Except as otherwise specifically provided, this Act shall
be administered by the Secretary through a Director appointed by the
Secretary.</text>
</subsection><subsection id="HA9AE045677774DE78EAC7128CE928718"><enum>(b)</enum><header>Long-Term
care</header><text>The Director shall appoint a director for long-term care who
shall be responsible for administration of this Act and ensuring the
availability and accessibility of high quality long-term care services.</text>
</subsection><subsection id="H27567DC33E5C46FAAA22EA4234F8BAEF"><enum>(c)</enum><header>Mental
health</header><text>The Director shall appoint a director for mental health
who shall be responsible for administration of this Act and ensuring the
availability and accessibility of high quality mental health services.</text>
</subsection></section><section id="H71C811B949EB4EAA9F242BB416FB7536"><enum>302.</enum><header>Office of
Quality Control</header><text display-inline="no-display-inline">The Director
shall appoint a director for an Office of Quality Control. Such director shall,
after consultation with state and regional directors, provide annual
recommendations to Congress, the President, the Secretary, and other Program
officials on how to ensure the highest quality health care service delivery.
The director of the Office of Quality Control shall conduct an annual review on
the adequacy of medically necessary services, and shall make recommendations of
any proposed changes to the Congress, the President, the Secretary, and other
Medicare For All Program officials.</text>
</section><section id="H69F02231210D45F185538232C4A7DAE8"><enum>303.</enum><header>Regional and
State administration; employment of displaced clerical workers</header>
<subsection id="H4AC1908B0169429BAFABF8E31E64028C"><enum>(a)</enum><header>Establishment of
Medicare For All Program regional offices</header><text>The Secretary shall
establish and maintain Medicare For All regional offices for the purpose of
distributing funds to providers of care. Whenever possible, the Secretary
should incorporate pre-existing Medicare infrastructure for this
purpose.</text>
</subsection><subsection id="H3CEC370893784131A7667152DB0C7F77"><enum>(b)</enum><header>Appointment of
Regional and State Directors</header><text>In each such regional office there
shall be—</text>
<paragraph id="HCCBED97158214018A11EAED4568D8823"><enum>(1)</enum><text>one regional
director appointed by the Director; and</text>
</paragraph><paragraph id="H7DD138AC15FC416CAECBEA3AF5CCD1BE"><enum>(2)</enum><text>for each State in
the region, a deputy director (in this Act referred to as a <quote>State
Director</quote>) appointed by the governor of that State.</text>
</paragraph></subsection><subsection id="H2CAC0A003AC94E0096595F1212BD9CFD"><enum>(c)</enum><header>Regional office
duties</header><text display-inline="yes-display-inline">Regional offices of
the Program shall be responsible for—</text>
<paragraph id="H9782E06729FF4C69BF3DC69D7467A5DA"><enum>(1)</enum><text>coordinating
funding to health care providers and physicians; and</text>
</paragraph><paragraph id="H3646AA461AF04057859765F6027CE11E"><enum>(2)</enum><text>coordinating
billing and reimbursements with physicians and health care providers through a
State-based reimbursement system.</text>
</paragraph></subsection><subsection id="H710A09583DC44D06A17ABD65C008F569"><enum>(d)</enum><header>State Director’s
duties</header><text>Each State Director shall be responsible for the following
duties:</text>
<paragraph id="HE52373DEBEA342158084C7762D4DD002"><enum>(1)</enum><text>Providing an
annual state health care needs assessment report to the National Board of
Universal Quality and Access, and the regional board, after a thorough
examination of health needs, in consultation with public health officials,
clinicians, patients, and patient advocates.</text>
</paragraph><paragraph id="HBBA5FD998E2946FA8603519FDB09A8A5"><enum>(2)</enum><text>Health planning,
including oversight of the placement of new hospitals, clinics, and other
health care delivery facilities.</text>
</paragraph><paragraph id="H602ADC4203BB440DB2E0F9B9CF07E92C"><enum>(3)</enum><text>Health planning,
including oversight of the purchase and placement of new health equipment to
ensure timely access to care and to avoid duplication.</text>
</paragraph><paragraph id="H5E41D72C40AC434796A0697EA1702562"><enum>(4)</enum><text>Submitting global
budgets to the regional director.</text>
</paragraph><paragraph id="H25B7696CD2144D1BA8E23BE01044A99B"><enum>(5)</enum><text>Recommending
changes in provider reimbursement or payment for delivery of health services in
the State.</text>
</paragraph><paragraph id="H5F603EEBF5D9448B82369EB242F19C3B"><enum>(6)</enum><text>Establishing a
quality assurance mechanism in the State in order to minimize both under
utilization and over utilization and to assure that all providers meet high
quality standards.</text>
</paragraph><paragraph id="HF6CB70F1965746DC8E5A90D4CC7D5C73"><enum>(7)</enum><text>Reviewing program
disbursements on a quarterly basis and recommending needed adjustments in fee
schedules needed to achieve budgetary targets and assure adequate access to
needed care.</text>
</paragraph></subsection><subsection id="HCB1E95BD4CD647BDA1927FED830A2007"><enum>(e)</enum><header>First priority
in retraining and job placement; 2 years of salary parity
benefits</header><text>The Program shall provide that clerical, administrative,
and billing personnel in insurance companies, doctors offices, hospitals,
nursing facilities, and other facilities whose jobs are eliminated due to
reduced administration—</text>
<paragraph id="H0F6125729D53419AA1FA19FDA304195E"><enum>(1)</enum><text>should have first
priority in retraining and job placement in the new system; and</text>
</paragraph><paragraph id="HE13199BE52924C0B9F18DA30F5F9985B"><enum>(2)</enum><text>shall be eligible
to receive two years of Medicare For All employment transition benefits with
each year’s benefit equal to salary earned during the last 12 months of
employment, but shall not exceed $100,000 per year.</text>
</paragraph></subsection><subsection id="HBFF66E8B42694D2489897E8138849436"><enum>(f)</enum><header>Establishment of
Medicare For All employment transition fund</header><text>The Secretary shall
establish a trust fund from which expenditures shall be made to recipients of
the benefits allocated in subsection (e).</text>
</subsection><subsection id="H7F6DF502C84B446FBB89662641529265"><enum>(g)</enum><header>Annual
appropriations to Medicare For All employment transition
fund</header><text>Sums are authorized to be appropriated annually as needed to
fund the Medicare For All Employment Transition Benefits.</text>
</subsection><subsection id="H6D7DE66707164E23BC75244BAA21D598"><enum>(h)</enum><header>Retention of
right to unemployment benefits</header><text>Nothing in this section shall be
interpreted as a waiver of Medicare For All Employment Transition benefit
recipients’ right to receive Federal and State unemployment benefits.</text>
</subsection></section><section id="HC6BC92E541CE4A04A8AF581512A5436F"><enum>304.</enum><header>Confidential
electronic patient record system</header>
<subsection id="HC63F37B7BAF34D43874842F58CF60AB7"><enum>(a)</enum><header>In
general</header><text>The Secretary shall create a standardized, confidential
electronic patient record system in accordance with laws and regulations to
maintain accurate patient records and to simplify the billing process, thereby
reducing medical errors and bureaucracy.</text>
</subsection><subsection id="HC4BF398ECEFC4BA5A4312D53A25D4D96"><enum>(b)</enum><header>Patient
option</header><text>Notwithstanding that all billing shall be preformed
electronically, patients shall have the option of keeping any portion of their
medical records separate from their electronic medical record.</text>
</subsection></section><section id="H0F872C0AB6A24EBD93E7CB02B60FCA92"><enum>305.</enum><header>National Board
of Universal Quality and Access</header>
<subsection id="H2BA43E04C90746D2A28E6B12B5809DDC"><enum>(a)</enum><header>Establishment</header>
<paragraph id="H7B90015886BA4A5D8AC0EB6E92C13CED"><enum>(1)</enum><header>In
general</header><text>There is established a National Board of Universal
Quality and Access (in this section referred to as the <quote>Board</quote>)
consisting of 15 members appointed by the President, by and with the advice and
consent of the Senate.</text>
</paragraph><paragraph id="H5F62D013C12E46E4BF418FEEE2121E25"><enum>(2)</enum><header>Qualifications</header><text>The
appointed members of the Board shall include at least one of each of the
following:</text>
<subparagraph id="H4E5ED28C45C54A08A19401A7EF62D5B5"><enum>(A)</enum><text>Health care
professionals.</text>
</subparagraph><subparagraph id="H0282BA765105481BA4FD2D2B4626A065"><enum>(B)</enum><text>Representatives of
institutional providers of health care.</text>
</subparagraph><subparagraph id="H32F05658D523472F80EB5E51F943FCA3"><enum>(C)</enum><text>Representatives of
health care advocacy groups.</text>
</subparagraph><subparagraph id="H537CE451D8144ECB9C3F74EC864AB726"><enum>(D)</enum><text>Representatives of
labor unions.</text>
</subparagraph><subparagraph id="HF7973F6331BE4EA995C8C6BEE55B914E"><enum>(E)</enum><text>Citizen patient
advocates.</text>
</subparagraph></paragraph><paragraph id="H5A5462F6E0904E7DB1E7AB1DB16E94CD"><enum>(3)</enum><header>Terms</header><text>Each
member shall be appointed for a term of 6 years, except that the President
shall stagger the terms of members initially appointed so that the term of no
more than 3 members expires in any year.</text>
</paragraph><paragraph id="HF65341903D4F4DB18F45BEC4CA590A77"><enum>(4)</enum><header>Prohibition on
conflicts of interest</header><text>No member of the Board shall have a
financial conflict of interest with the duties before the Board.</text>
</paragraph></subsection><subsection id="HAE3D4DC114CF49B89364644DD053978A"><enum>(b)</enum><header>Duties</header>
<paragraph id="H9551F685DD4E452DB61773265A99642F"><enum>(1)</enum><header>In
general</header><text>The Board shall meet at least twice per year and shall
advise the Secretary and the Director on a regular basis to ensure quality,
access, and affordability.</text>
</paragraph><paragraph id="HEB82EBF968024CF38A7AEF816A145895"><enum>(2)</enum><header>Specific
issues</header><text>The Board shall specifically address the following
issues:</text>
<subparagraph id="HDDE63F2D1AD44B08AAF34EA9727963A5"><enum>(A)</enum><text>Access to
care.</text>
</subparagraph><subparagraph id="HAB58FAA5D780406790817322B5FC8964"><enum>(B)</enum><text>Quality
improvement.</text>
</subparagraph><subparagraph id="H0CF9940C16414B469648991A87840F63"><enum>(C)</enum><text>Efficiency of
administration.</text>
</subparagraph><subparagraph id="H25C6EBCE000144CC9E84A410DFA2E027"><enum>(D)</enum><text>Adequacy of budget
and funding.</text>
</subparagraph><subparagraph id="H08B2698BB18E4CEF8E984E0CFDC00D29"><enum>(E)</enum><text>Appropriateness of
reimbursement levels of physicians and other providers.</text>
</subparagraph><subparagraph id="H2B8554A16EF04789AEEBCB60477D76D5"><enum>(F)</enum><text>Capital
expenditure needs.</text>
</subparagraph><subparagraph id="H703B101C580D4A4990CCB5E48AA76409"><enum>(G)</enum><text>Long-term
care.</text>
</subparagraph><subparagraph id="HE0D358CFCCDC436CA582D96DAB5C7728"><enum>(H)</enum><text>Mental health and
substance abuse services.</text>
</subparagraph><subparagraph id="H8B73327289524F339CD77159D349725C"><enum>(I)</enum><text>Staffing levels
and working conditions in health care delivery facilities.</text>
</subparagraph></paragraph><paragraph id="HF21E9A4BB0B94F3EA87A877BEE26EB4F"><enum>(3)</enum><header>Establishment of
universal, best quality standard of care</header><text>The Board shall
specifically establish a universal, best quality of standard of care with
respect to—</text>
<subparagraph id="H83E29815AD44480AB6CBF01426E9DA72"><enum>(A)</enum><text>appropriate
staffing levels;</text>
</subparagraph><subparagraph id="HC4DF18F0477D44E19F4FE725618B4AAF"><enum>(B)</enum><text>appropriate
medical technology;</text>
</subparagraph><subparagraph id="HBEA19E43660D4395B9D4B7F7D0E26CAE"><enum>(C)</enum><text>design and scope
of work in the health workplace;</text>
</subparagraph><subparagraph id="H7F0AA1034EF84E51BD8CD47790E2AEBF"><enum>(D)</enum><text>best practices;
and</text>
</subparagraph><subparagraph id="H1889FA76A95A408B809DE6D996E3DADC"><enum>(E)</enum><text>salary level and
working conditions of physicians, clinicians, nurses, other medical
professionals, and appropriate support staff.</text>
</subparagraph></paragraph><paragraph id="H42800515B2CB456698A05582B6EFE32E"><enum>(4)</enum><header>Twice-a-year
report</header><text>The Board shall report its recommendations twice each year
to the Secretary, the Director, Congress, and the President.</text>
</paragraph></subsection><subsection id="HE312B1542E0942C0B109985C10969A1C"><enum>(c)</enum><header>Compensation,
etc</header><text>The following provisions of section 1805 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> shall apply to the
Board in the same manner as they apply to the Medicare Payment Assessment
Commission (except that any reference to the Commission or the Comptroller
General shall be treated as references to the Board and the Secretary,
respectively):</text>
<paragraph id="H1D1C058B48DF41F9BED8A05974A54D22"><enum>(1)</enum><text>Subsection (c)(4)
(relating to compensation of Board members).</text>
</paragraph><paragraph id="HE1CFF010C3134AE98585AF43DB0FB496"><enum>(2)</enum><text>Subsection (c)(5)
(relating to chairman and vice chairman).</text>
</paragraph><paragraph id="HDEC528BAECE040FEA2A2965B6B6036D7"><enum>(3)</enum><text>Subsection (c)(6)
(relating to meetings).</text>
</paragraph><paragraph id="HA7FF1EE9FAAB4D60A179732CDF702D8A"><enum>(4)</enum><text>Subsection (d)
(relating to director and staff; experts and consultants).</text>
</paragraph><paragraph id="H66211590C6944C4999FB2AFB6EC3FC90"><enum>(5)</enum><text>Subsection (e)
(relating to powers).</text>
</paragraph></subsection></section><enum>IV</enum><header>ADDITIONAL
PROVISIONS</header>
<section id="H2CCACBC540DB4690AA0C171EA1D98E19"><enum>401.</enum><header>Treatment of VA
and IHS health programs</header>
<subsection id="HF56CB211822D4AF49BB5823CEEA7067B"><enum>(a)</enum><header>VA health
programs</header><text>This Act provides for health programs of the Department
of Veterans’ Affairs to initially remain independent for the 10-year period
that begins on the date of the establishment of the Medicare For All Program.
After such 10-year period, the Congress shall reevaluate whether such programs
shall remain independent or be integrated into the Medicare For All
Program.</text>
</subsection><subsection id="H910161BBF4FC4FC0AFFA7CBCF5BEC0F3"><enum>(b)</enum><header>Indian Health
Service programs</header><text>This Act provides for health programs of the
Indian Health Service to initially remain independent for the 5-year period
that begins on the date of the establishment of the Medicare For All Program,
after which such programs shall be integrated into the Medicare For All
Program.</text>
</subsection></section><section id="HBD19A9BCA32A432DA72C0D6936EDE160"><enum>402.</enum><header>Public health
and prevention</header><text display-inline="no-display-inline">It is the
intent of this Act that the Program at all times stress the importance of good
public health through the prevention of diseases.</text>
</section><section id="H5CC0FC3F2DFF465B89AF92FBAD6E7D27"><enum>403.</enum><header>Reduction in
health disparities</header><text display-inline="no-display-inline">It is the
intent of this Act to reduce health disparities by race, ethnicity, income and
geographic region, and to provide high quality, cost-effective, culturally
appropriate care to all individuals regardless of race, ethnicity, sexual
orientation, or language.</text>
</section><enum>V</enum><header>EFFECTIVE
DATE</header>
<section id="HF321982B81924AABB16E1F4F6F15A656"><enum>501.</enum><header>Effective
date</header><text display-inline="no-display-inline">Except as otherwise
specifically provided, this Act shall take effect on the first day of the first
year that begins more than 1 year after the date of the enactment of this Act,
and shall apply to items and services furnished on or after such date.</text>
</section>