113 HR 5113 IH: Protecting Seniors’ Medicare Choices from Obamacare Act of 2014 U.S. House of Representatives 2014-07-15 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.

I 113th CONGRESS 2d Session H. R. 5113 IN THE HOUSE OF REPRESENTATIVES July 15, 2014 Mr. Coffman (for himself, Mrs. Blackburn, Mr. Nugent, Mr. Lamborn, and Mr. Hall) introduced the following bill; which was 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 A BILL To amend title XIX of the Social Security Act to end the increased Federal funding for Medicaid expansion with respect to inmates’ hospital care under the Patient Protection and Affordable Care Act, to apply the savings towards a 2015 Medicare Advantage stabilization program to help protect seniors’ choices, and for other purposes.

1.

Short title

This Act may be cited as the Protecting Seniors’ Medicare Choices from Obamacare Act of 2014.

2.

Eliminating PPACA enhanced Medicaid FMAP for prisoners and applying savings to Medicare Advantage Improvement Fund

(a)

Elimination of PPACA enhanced Medicaid FMAP for prisoners

(1)

In general

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (A)in subsection (y)(2)(A), by adding at the end the following: Such term does not include an individual described in such subparagraph during the period in which the individual is an inmate in a public institution or in which the public institution maintains jurisdiction over the individual.; and (B)in subsection (z)(1)(A), by inserting before the period at the end the following: and who are not inmates of a public institution (or individuals over whom a public institution maintains jurisdiction). (2)

Effective date

The amendments made by paragraph (1) shall apply to items and services furnished on or after January 1, 2015. (b)

Application of savings to 2015 to establishment of 2015 Medicare Advantage stabilization program

Section 1859 of the Social Security Act (42 U.S.C. 1395w–28) is amended by adding at the end the following new subsection: (h)

2015 Medicare Advantage stabilization program

(1)

Establishment

There is established a Medicare Advantage stabilization program (in this subsection referred to as the stabilization program) under which the Secretary shall, subject to paragraph (6), provide a PMPM stabilization funding amount to each eligible Medicare Advantage plan in accordance with this subsection to be used by such plan for plan year 2015 to address the beneficiary plan inadequacies applicable to such plan (as described in paragraph (5)). (2)

Eligible Medicare Advantage plans

For purposes of this subsection, an eligible Medicare Advantage plan is a Medicare Advantage plan to be offered for plan year 2015 that the Secretary determines, based on the bid of such plan submitted under section 1854 for such plan year, satisfies at least one of the following criteria: (A)

Increased beneficiary costs

The total costs (including premiums, cost-sharing responsibilities, and deductibles) projected to be applicable to individuals who enroll in such plan for such plan year are at least 7 percent more than the such total costs that were applicable to individuals enrolled in such plan for plan year 2014. (B)

Decreased supplemental benefits

The supplemental benefits to be offered under such plan for such plan year 2015 are less than the supplemental benefits offered under such plan for plan year 2014. (C)

Decreased provider network

The number of physicians in the plan’s network has been reduced by 3 percent or more from plan year 2014 to plan year 2015. (3)

Distribution of PMPM stabilization funding amounts

(A)

In general

Subject to the availability of funds under paragraph (6), under the stabilization program, the Secretary shall distribute, not later than December 31, 2014, to each eligible Medicare Advantage plan a PMPM stabilization funding amount, as determined by the Secretary in accordance with subparagraph (B). (B)

PMPM stabilization funding amount

A PMPM stabilization funding amount, with respect to an eligible Medicare Advantage plan, shall be determined in accordance with the following: (i)Such amount shall be an amount, with respect to each month of plan year 2015, for each individual projected to be enrolled in such plan for such plan year. (ii)Subject to paragraph (6) and clause (iii), such amount shall be an amount determined by the Secretary to be sufficient for such plan to address for plan year 2015 each beneficiary plan inadequacy specified in paragraph (4) applicable to such plan. (iii)Such amount shall not be more than $85 per member per month. (4)

Timing of determinations

Under the stabilization program, the Secretary shall determine which Medicare Advantage plans are eligible Medicare Advantage plans under paragraph (2), and the PMPM stabilization funding amount to be distributed to each such eligible Medicare Advantage plan under paragraph (3), by not later than October 15, 2014. (5)

Applicable beneficiary plan inadequacies

For purposes of this subsection, a beneficiary plan inadequacy applicable to an eligible Medicare Advantage plan is each of the criteria described in paragraph (2) that the Secretary determined the plan satisfied for qualifying as such an eligible Medicare Advantage plan. (6)

Funding

(A)

In general

There shall be available to the Secretary from amounts in the general fund in the Treasury not otherwise appropriated an amount, not to exceed $3,000,000,000, to carry out this subsection. Such amounts shall remain so available until December 31, 2015. Any amounts made so available but not expended on or before such date shall be transferred to the general fund in the Treasury. (B)

Clarification

Payments under the stabilization program shall not be taken into account for purposes of determining the premium payments applicable under part B..