<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="billres.xsl"?>
<!DOCTYPE bill PUBLIC "-//US Congress//DTDs/bill.dtd//EN" "bill.dtd">
<bill bill-stage="Introduced-in-House" dms-id="HAE02F5F4145043049F1F924C34C15738" public-private="public" key="H" bill-type="olc"><metadata xmlns:dc="http://purl.org/dc/elements/1.1/">
<dublinCore>
<dc:title>119 HR 3069 IH: Medicare for All Act</dc:title>
<dc:publisher>U.S. House of Representatives</dc:publisher>
<dc:date>2025-04-29</dc:date>
<dc:format>text/xml</dc:format>
<dc:language>EN</dc:language>
<dc:rights>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.</dc:rights>
</dublinCore>
</metadata>
<form>
<distribution-code display="yes">I</distribution-code><congress display="yes">119th CONGRESS</congress><session display="yes">1st Session</session><legis-num display="yes">H. R. 3069</legis-num><current-chamber>IN THE HOUSE OF REPRESENTATIVES</current-chamber><action display="yes"><action-date date="20250429">April 29, 2025</action-date><action-desc><sponsor name-id="J000298">Ms. Jayapal</sponsor> (for herself, <cosponsor name-id="D000624">Mrs. Dingell</cosponsor>, <cosponsor name-id="A000370">Ms. Adams</cosponsor>, <cosponsor name-id="A000381">Ms. Ansari</cosponsor>, <cosponsor name-id="B001318">Ms. Balint</cosponsor>, <cosponsor name-id="B001300">Ms. Barragán</cosponsor>, <cosponsor name-id="B001324">Mr. Bell</cosponsor>, <cosponsor name-id="B001292">Mr. Beyer</cosponsor>, <cosponsor name-id="B001278">Ms. Bonamici</cosponsor>, <cosponsor name-id="B001296">Mr. Boyle of Pennsylvania</cosponsor>, <cosponsor name-id="B001313">Ms. Brown</cosponsor>, <cosponsor name-id="C001112">Mr. Carbajal</cosponsor>, <cosponsor name-id="C001072">Mr. Carson</cosponsor>, <cosponsor name-id="C001125">Mr. Carter of Louisiana</cosponsor>, <cosponsor name-id="C001131">Mr. Casar</cosponsor>, <cosponsor name-id="C001127">Mrs. Cherfilus-McCormick</cosponsor>, <cosponsor name-id="C001080">Ms. Chu</cosponsor>, <cosponsor name-id="C001067">Ms. Clarke of New York</cosponsor>, <cosponsor name-id="C001061">Mr. Cleaver</cosponsor>, <cosponsor name-id="C001068">Mr. Cohen</cosponsor>, <cosponsor name-id="C001130">Ms. Crockett</cosponsor>, <cosponsor name-id="D000096">Mr. Davis of Illinois</cosponsor>, <cosponsor name-id="D000197">Ms. DeGette</cosponsor>, <cosponsor name-id="D000530">Mr. Deluzio</cosponsor>, <cosponsor name-id="D000623">Mr. DeSaulnier</cosponsor>, <cosponsor name-id="D000635">Ms. Dexter</cosponsor>, <cosponsor name-id="D000399">Mr. Doggett</cosponsor>, <cosponsor name-id="E000299">Ms. Escobar</cosponsor>, <cosponsor name-id="E000297">Mr. Espaillat</cosponsor>, <cosponsor name-id="F000477">Mrs. Foushee</cosponsor>, <cosponsor name-id="F000462">Ms. Lois Frankel of Florida</cosponsor>, <cosponsor name-id="F000483">Ms. Friedman</cosponsor>, <cosponsor name-id="F000476">Mr. Frost</cosponsor>, <cosponsor name-id="G000559">Mr. Garamendi</cosponsor>, <cosponsor name-id="G000598">Mr. Garcia of California</cosponsor>, <cosponsor name-id="G000586">Mr. García of Illinois</cosponsor>, <cosponsor name-id="G000599">Mr. Goldman of New York</cosponsor>, <cosponsor name-id="G000585">Mr. Gomez</cosponsor>, <cosponsor name-id="G000553">Mr. Green of Texas</cosponsor>, <cosponsor name-id="H001081">Mrs. Hayes</cosponsor>, <cosponsor name-id="H001094">Ms. Hoyle of Oregon</cosponsor>, <cosponsor name-id="H001068">Mr. Huffman</cosponsor>, <cosponsor name-id="J000309">Mr. Jackson of Illinois</cosponsor>, <cosponsor name-id="J000305">Ms. Jacobs</cosponsor>, <cosponsor name-id="J000288">Mr. Johnson of Georgia</cosponsor>, <cosponsor name-id="K000400">Ms. Kamlager-Dove</cosponsor>, <cosponsor name-id="K000375">Mr. Keating</cosponsor>, <cosponsor name-id="K000385">Ms. Kelly of Illinois</cosponsor>, <cosponsor name-id="K000402">Mr. Kennedy of New York</cosponsor>, <cosponsor name-id="K000389">Mr. Khanna</cosponsor>, <cosponsor name-id="L000602">Ms. Lee of Pennsylvania</cosponsor>, <cosponsor name-id="L000273">Ms. Leger Fernandez</cosponsor>, <cosponsor name-id="L000593">Mr. Levin</cosponsor>, <cosponsor name-id="L000582">Mr. Lieu</cosponsor>, <cosponsor name-id="L000397">Ms. Lofgren</cosponsor>, <cosponsor name-id="M001143">Ms. McCollum</cosponsor>, <cosponsor name-id="M001220">Mr. McGarvey</cosponsor>, <cosponsor name-id="M000312">Mr. McGovern</cosponsor>, <cosponsor name-id="M001229">Mrs. McIver</cosponsor>, <cosponsor name-id="M001137">Mr. Meeks</cosponsor>, <cosponsor name-id="M001188">Ms. Meng</cosponsor>, <cosponsor name-id="M000687">Mr. Mfume</cosponsor>, <cosponsor name-id="M001241">Mr. Min</cosponsor>, <cosponsor name-id="M001225">Mr. Mullin</cosponsor>, <cosponsor name-id="N000002">Mr. Nadler</cosponsor>, <cosponsor name-id="N000191">Mr. Neguse</cosponsor>, <cosponsor name-id="N000147">Ms. Norton</cosponsor>, <cosponsor name-id="O000172">Ms. Ocasio-Cortez</cosponsor>, <cosponsor name-id="O000173">Ms. Omar</cosponsor>, <cosponsor name-id="P000034">Mr. Pallone</cosponsor>, <cosponsor name-id="P000613">Mr. Panetta</cosponsor>, <cosponsor name-id="P000597">Ms. Pingree</cosponsor>, <cosponsor name-id="P000607">Mr. Pocan</cosponsor>, <cosponsor name-id="P000617">Ms. Pressley</cosponsor>, <cosponsor name-id="Q000023">Mr. Quigley</cosponsor>, <cosponsor name-id="R000617">Mrs. Ramirez</cosponsor>, <cosponsor name-id="R000621">Ms. Randall</cosponsor>, <cosponsor name-id="R000606">Mr. Raskin</cosponsor>, <cosponsor name-id="R000620">Ms. Rivas</cosponsor>, <cosponsor name-id="S001226">Ms. Salinas</cosponsor>, <cosponsor name-id="S001156">Ms. Sánchez</cosponsor>, <cosponsor name-id="S001145">Ms. Schakowsky</cosponsor>, <cosponsor name-id="S000185">Mr. Scott of Virginia</cosponsor>, <cosponsor name-id="S000344">Mr. Sherman</cosponsor>, <cosponsor name-id="S001231">Ms. Simon</cosponsor>, <cosponsor name-id="S000510">Mr. Smith of Washington</cosponsor>, <cosponsor name-id="S001218">Ms. Stansbury</cosponsor>, <cosponsor name-id="S001193">Mr. Swalwell</cosponsor>, <cosponsor name-id="T000472">Mr. Takano</cosponsor>, <cosponsor name-id="T000488">Mr. Thanedar</cosponsor>, <cosponsor name-id="T000193">Mr. Thompson of Mississippi</cosponsor>, <cosponsor name-id="T000460">Mr. Thompson of California</cosponsor>, <cosponsor name-id="T000468">Ms. Titus</cosponsor>, <cosponsor name-id="T000481">Ms. Tlaib</cosponsor>, <cosponsor name-id="T000487">Ms. Tokuda</cosponsor>, <cosponsor name-id="T000469">Mr. Tonko</cosponsor>, <cosponsor name-id="T000482">Mrs. Trahan</cosponsor>, <cosponsor name-id="V000130">Mr. Vargas</cosponsor>, <cosponsor name-id="V000081">Ms. Velázquez</cosponsor>, <cosponsor name-id="W000187">Ms. Waters</cosponsor>, <cosponsor name-id="W000822">Mrs. Watson Coleman</cosponsor>, <cosponsor name-id="W000788">Ms. Williams of Georgia</cosponsor>, <cosponsor name-id="W000808">Ms. Wilson of Florida</cosponsor>, <cosponsor name-id="H001090">Mr. Harder of California</cosponsor>, <cosponsor name-id="I000058">Mr. Ivey</cosponsor>, and <cosponsor name-id="T000486">Mr. Torres of New York</cosponsor>) introduced the following bill; which was referred to the <committee-name committee-id="HIF00">Committee on Energy and Commerce</committee-name>, and in addition to the Committees on <committee-name committee-id="HWM00">Ways and Means</committee-name>, <committee-name committee-id="HED00">Education and Workforce</committee-name>, <committee-name committee-id="HRU00">Rules</committee-name>, <committee-name committee-id="HGO00">Oversight and Government Reform</committee-name>, <committee-name committee-id="HAS00">Armed Services</committee-name>, and <committee-name committee-id="HJU00">the Judiciary</committee-name>, 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</action-desc></action><legis-type>A BILL</legis-type><official-title display="yes">To establish an improved Medicare-for-All national health insurance program.</official-title></form><legis-body id="H48CEF9A3596544A995C72327A135042D" style="OLC"><section id="H58F12632E13A45869BC85AAF9738460D" section-type="section-one"><enum>1.</enum><header>Short title; table of contents</header><subsection id="H3B44F63369F944398899F7E25AD6C146"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This Act may be cited as the <quote><short-title>Medicare for All Act</short-title></quote>.</text></subsection><subsection id="H96EC15B390A341EFA785EE4CB80CBE55"><enum>(b)</enum><header>Table of contents</header><text>The table of contents of this Act is as follows:</text><toc container-level="legis-body-container" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration"><toc-entry idref="H58F12632E13A45869BC85AAF9738460D" level="section">Sec. 1. Short title; table of contents.</toc-entry><toc-entry idref="H6CE0EFC8B7314B9CB9BD7056EA265B9A" level="title">Title I—Establishment of the Medicare for All Program; Universal Coverage; Enrollment</toc-entry><toc-entry idref="H01DEE8630E83499BB53B2C78C91580C6" level="section">Sec. 101. Establishment of the Medicare for All Program.</toc-entry><toc-entry idref="H9E53235CA2C344BAB46C978CA38D2CCE" level="section">Sec. 102. Universal coverage.</toc-entry><toc-entry idref="HA4D982B8855F4F68A5EA2458ECD48EBC" level="section">Sec. 103. Freedom of choice.</toc-entry><toc-entry idref="H391DF3E0730C41AEB78273E27CB8AA16" level="section">Sec. 104. Non-discrimination.</toc-entry><toc-entry idref="HDB8E8FE8FDFC43D78B6B24756918E66F" level="section">Sec. 105. Enrollment.</toc-entry><toc-entry idref="HA9FDD6606BA84B2392B60B2DE0624259" level="section">Sec. 106. Effective date of benefits.</toc-entry><toc-entry idref="H19A78A604B434F22A33B80F35F93F808" level="section">Sec. 107. Prohibition against duplicating coverage.</toc-entry><toc-entry idref="H6D37CD32F12544F6BD9CF5C5104E98F6" level="title">Title II—Comprehensive Benefits, Including Preventive Benefits and Benefits for Long-Term Care</toc-entry><toc-entry idref="H9405D28501574954B2990412506E4947" level="section">Sec. 201. Comprehensive benefits.</toc-entry><toc-entry idref="HBEF5F8AB95E64BDEA310F079224F3E8C" level="section">Sec. 202. No cost-sharing; other limitations.</toc-entry><toc-entry idref="HCDD5D9CFC9934398886B25AA63968A9D" level="section">Sec. 203. Exclusions and limitations.</toc-entry><toc-entry idref="H190A8996EFA744CB84ECAEF5CF50BEE7" level="section">Sec. 204. Coverage of long-term care services.</toc-entry><toc-entry idref="H32CCF76CFCEF45FC9F36A2ACB6C24B31" level="title">Title III—Provider Participation</toc-entry><toc-entry idref="H2520AA18AE7145C9921028C58FB3762F" level="section">Sec. 301. Provider participation and standards; whistleblower protections.</toc-entry><toc-entry idref="H63BE9A5DB0454661A92C9D14D19175DA" level="section">Sec. 302. Qualifications for providers.</toc-entry><toc-entry idref="HB8947A08CBFE41FF963BB422322D47EC" level="section">Sec. 303. Use of private contracts.</toc-entry><toc-entry idref="H51C3ABA791E1432E9C3D7B9D309825F1" level="title">Title IV—Administration</toc-entry><toc-entry idref="H887219E29F174590805A68144B4A7FB8" level="subtitle">Subtitle A—General Administration Provisions</toc-entry><toc-entry idref="HD7B3F5516BB348AB998CBEC1FD1DF80A" level="section">Sec. 401. Administration.</toc-entry><toc-entry idref="H857E0CDF80954704BA3AEA4D44C030AD" level="section">Sec. 402. Consultation.</toc-entry><toc-entry idref="H1EBB18D2BA854AA696EA1EBC901925D7" level="section">Sec. 403. Regional administration.</toc-entry><toc-entry idref="H5F9B37E79F0548DEA10B0DC648B86247" level="section">Sec. 404. Beneficiary ombudsman.</toc-entry><toc-entry idref="H50B995ED81C04D149FC7A3B6AF730D84" level="section">Sec. 405. Conduct of related health programs.</toc-entry><toc-entry idref="H5374A245D9D84F02BAD2FD010771D8CF" level="subtitle">Subtitle B—Control Over Fraud and Abuse</toc-entry><toc-entry idref="HD740DE72E08D436B9090E3033F11B3F2" level="section">Sec. 411. Application of Federal sanctions to all fraud and abuse under the Medicare for All Program.</toc-entry><toc-entry idref="H200D5417BFE5490EB07FA6AB931003A6" level="title">Title V—Quality Assessment</toc-entry><toc-entry idref="H07C969D4EE4F4981A47F5344C262C98B" level="section">Sec. 501. Quality standards.</toc-entry><toc-entry idref="H51CD6E7631B94015BE0C08902045631F" level="section">Sec. 502. Addressing health care disparities.</toc-entry><toc-entry idref="HCAD34F821FB448D4B0E7C49F325B0D17" level="title">Title VI—Health Budget; Payments; Cost Containment Measures</toc-entry><toc-entry idref="H9DE6AED059384373B35D3187F2CDF937" level="subtitle">Subtitle A—Budgeting</toc-entry><toc-entry idref="HA7858BA6F96448E79144AFF02BE91610" level="section">Sec. 601. National health budget.</toc-entry><toc-entry idref="H90AB6890A94B436492DCAEE5F4065797" level="subtitle">Subtitle B—Payments to Providers</toc-entry><toc-entry idref="HA05B00C558D54F2EA590AD6BA5DB2AB9" level="section">Sec. 611. Payments to institutional providers based on global budgets.</toc-entry><toc-entry idref="H9B6AC9B38BD64B10A0C795DAE41F1A74" level="section">Sec. 612. Payment to individual providers through fee-for-service.</toc-entry><toc-entry idref="H514ABB2E2EB54B2B9E9E502F1314D211" level="section">Sec. 613. Ensuring accurate valuation of services under the Medicare physician fee schedule.</toc-entry><toc-entry idref="H74CFC9EB114047EAB0BA4DF54FBF5ACF" level="section">Sec. 614. Payment prohibitions; capital expenditures; special projects.</toc-entry><toc-entry idref="H4A57C55543BE4404BD3A851B1D4393F0" level="section">Sec. 615. Office of Health Equity.</toc-entry><toc-entry idref="HE9F09ACA50E0445B9E76E1BA835EDE4F" level="section">Sec. 616. Office of Primary Care.</toc-entry><toc-entry idref="H81E241D485354A29854818C2D08B5C10" level="section">Sec. 617. Payments for prescription drugs and approved devices and equipment.</toc-entry><toc-entry idref="H8E63B523BA524D10BE20B99913913631" level="title">Title VII—Universal Medicare Trust Fund</toc-entry><toc-entry idref="H8448BB67F4A54E7E9EAF5B50D9DF84D5" level="section">Sec. 701. Universal Medicare Trust Fund.</toc-entry><toc-entry idref="H71364BB1D5804B1A8546BAA18AF32CB8" level="title">Title VIII—Conforming Amendments to the Employee Retirement Income Security Act of 1974</toc-entry><toc-entry idref="H4E1B972D7DE94C24A004CE19BDADBB60" level="section">Sec. 801. Prohibition of employee benefits duplicative of benefits under the Medicare for All Program; coordination in case of workers’ compensation.</toc-entry><toc-entry idref="H777855E5515D4211A351B3470CE185A4" level="section">Sec. 802. Application of continuation coverage requirements under ERISA and certain other requirements relating to group health plans.</toc-entry><toc-entry idref="HBE9CB06604224FBB9A8B50F39EC5BAB6" level="section">Sec. 803. Effective date of title.</toc-entry><toc-entry idref="H006D38FAAA1C467A8A8675832F1F6146" level="title">Title IX—Additional Conforming Amendments</toc-entry><toc-entry idref="H29BD6E7768FD408BAEF7815D8F7A2CA0" level="section">Sec. 901. Relationship to existing Federal health programs.</toc-entry><toc-entry idref="HB0FED97DA88447D2BDCD5E1765216C63" level="section">Sec. 902. Sunset of provisions related to the State Exchanges.</toc-entry><toc-entry idref="H5B41EEB5F2E54DDA80CC896339926FD8" level="section">Sec. 903. Sunset of provisions related to pay for performance programs.</toc-entry><toc-entry idref="H2B2FC479301D4EB8A3E041B0D24BF44E" level="title">Title X—Transition</toc-entry><toc-entry idref="H4998A30A03294564BF7B3210A75B9F1D" level="subtitle">Subtitle A—Medicare for All Transition over 2 Years and Transitional Buy-In Option</toc-entry><toc-entry idref="H0EAD5829AB4140E7A01AD198BB42E903" level="section">Sec. 1001. Medicare for all transition over two years.</toc-entry><toc-entry idref="H9F0F38EB0F8844A69B5F4F2EE309F571" level="section">Sec. 1002. Establishment of the Medicare transition buy-in.</toc-entry><toc-entry idref="HA704B5E0AACF49FBAE35A22B455146B7" level="subtitle">Subtitle B—Transitional Medicare Reforms</toc-entry><toc-entry idref="H0EFBD6D0DC404F5AB8FFB44AB4B97FE0" level="section">Sec. 1011. Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities.</toc-entry><toc-entry idref="H5E7C1ACF641249869B77225C36A294B4" level="section">Sec. 1012. Ensuring continuity of care.</toc-entry><toc-entry idref="H8A46DA6911484092AD0516038ED06031" level="title">Title XI—Miscellaneous</toc-entry><toc-entry idref="HF952FF3F08024480AF9EF59B64EEABE9" level="section">Sec. 1101. Definitions.</toc-entry><toc-entry idref="H530EAAF7504C4DAB970AE8CDF39C382A" level="section">Sec. 1102. Rules of construction.</toc-entry><toc-entry idref="HF5AB7EBA9C7F436497395633886593FF" level="section">Sec. 1103. No use of resources for law enforcement of certain registration requirements.</toc-entry></toc></subsection></section><title id="H6CE0EFC8B7314B9CB9BD7056EA265B9A"><enum>I</enum><header>Establishment of the Medicare for All Program; Universal Coverage; Enrollment</header><section id="H01DEE8630E83499BB53B2C78C91580C6"><enum>101.</enum><header>Establishment of the Medicare for All Program</header><text display-inline="no-display-inline">There is hereby established a national health insurance program to provide comprehensive protection against the costs of health care and health-related services, in accordance with the standards specified in, or established under, this Act.</text></section><section id="H9E53235CA2C344BAB46C978CA38D2CCE"><enum>102.</enum><header>Universal coverage</header><subsection id="HE09399AF1A20409FB12E757073DF2856"><enum>(a)</enum><header>In general</header><text>Every individual who is a resident of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under this Act.</text></subsection><subsection id="HAF0E041FD4D2495A839AB89F5C491831"><enum>(b)</enum><header>Treatment of other individuals</header><text display-inline="yes-display-inline">The Secretary may make eligible for benefits for health care services under this Act other individuals not described in subsection (a), and regulate the eligibility of such individuals, to ensure that every person in the United States has access to health care. In regulating such eligibility, the Secretary shall ensure that individuals are not allowed to travel to the United States for the sole purpose of obtaining health care items and services provided under the program established under this Act.</text></subsection></section><section id="HA4D982B8855F4F68A5EA2458ECD48EBC"><enum>103.</enum><header>Freedom of choice</header><text display-inline="no-display-inline">Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.</text></section><section id="H391DF3E0730C41AEB78273E27CB8AA16"><enum>104.</enum><header>Non-discrimination</header><subsection id="HB07208148A414593AD10D934DC0D8AE2"><enum>(a)</enum><header>In general</header><text>No person shall, on the basis of race, color, national origin, age, disability, marital status, citizenship status, primary language use, genetic conditions, previous or existing medical conditions, religion, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions (including termination of pregnancy), be excluded from participation in or be denied the benefits of the program established under this Act (except as expressly authorized by this Act for purposes of enforcing eligibility standards described in section 102), or be subject to any reduction of benefits or other discrimination by any participating provider (as defined in section 301), or any entity conducting, administering, or funding a health program or activity, including contracts of insurance, pursuant to this Act.</text></subsection><subsection id="H375BD4A5FC474DF181EC9FF1350C1EB8"><enum>(b)</enum><header>Claims of discrimination</header><paragraph id="HB5DF32204D094D10AEFD41A8A3794D8A"><enum>(1)</enum><header>In general</header><text>The Secretary shall establish a procedure for adjudication of administrative complaints alleging a violation of subsection (a).</text></paragraph><paragraph id="H4BD87EC30D6B497B87C8B006A767D6B1"><enum>(2)</enum><header>Jurisdiction</header><text display-inline="yes-display-inline">Any person aggrieved by a violation of subsection (a) by a covered entity may file suit in any district court of the United States having jurisdiction of the parties. A person may bring an action under this paragraph concurrently as such administrative remedies as established in paragraph (1).</text></paragraph><paragraph id="H7CBACD1664BA428DA6EB9B5EE5EA780F"><enum>(3)</enum><header>Damages</header><text>If the court finds a violation of subsection (a), the court may grant compensatory and punitive damages, declaratory relief, injunctive relief, attorneys’ fees and costs, or other relief as appropriate.</text></paragraph></subsection><subsection id="HC188139B44FB44D2A114CFE9600A5457"><enum>(c)</enum><header>Continued application of laws</header><text>Nothing in this title (or an amendment made by this title) shall be construed to invalidate or otherwise limit any of the rights, remedies, procedures, or legal standards available to individuals aggrieved under section 1557 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18116">42 U.S.C. 18116</external-xref>), title VI of the Civil Rights Act of 1964 (<external-xref legal-doc="usc" parsable-cite="usc/42/2000d">42 U.S.C. 2000d et seq.</external-xref>), title VII of the Civil Rights Act of 1964 (<external-xref legal-doc="usc" parsable-cite="usc/42/2000e">42 U.S.C. 2000e et seq.</external-xref>), title IX of the Education Amendments of 1972 (<external-xref legal-doc="usc" parsable-cite="usc/20/1681">20 U.S.C. 1681 et seq.</external-xref>), section 504 of the Rehabilitation Act of 1973 (<external-xref legal-doc="usc" parsable-cite="usc/29/794">29 U.S.C. 794</external-xref>), or the Age Discrimination Act of 1975 (<external-xref legal-doc="usc" parsable-cite="usc/42/611">42 U.S.C. 611 et seq.</external-xref>). Nothing in this title (or an amendment to this title) shall be construed to supersede State laws that provide additional protections against discrimination on any basis described in subsection (a).</text></subsection></section><section id="HDB8E8FE8FDFC43D78B6B24756918E66F"><enum>105.</enum><header>Enrollment</header><subsection id="H4E903C4B46224EDC8C4E3C12430A2171"><enum>(a)</enum><header>In general</header><text>The Secretary shall provide a mechanism for the enrollment of individuals eligible for benefits under this Act. The mechanism shall—</text><paragraph id="HC2578AA4E8914094986C22D4F3CC7F46"><enum>(1)</enum><text>include a process for the automatic enrollment of individuals at the time of birth in the United States (or upon establishment of residency in the United States);</text></paragraph><paragraph id="HE4B1EA8673564484AF35C7837234202F"><enum>(2)</enum><text>provide for the enrollment, as of the dates described in section 106, of all individuals who are eligible to be enrolled as of such dates, as applicable; and</text></paragraph><paragraph id="HE1AB27E8A2634F53B44659B09A77A572"><enum>(3)</enum><text>include a process for the enrollment of individuals made eligible for health care services under section 102(b).</text></paragraph></subsection><subsection id="H8F35E7C5A4254AD5AB6BB834B12538BC"><enum>(b)</enum><header>Issuance of Universal Medicare cards</header><text>In conjunction with an individual’s enrollment for benefits under this Act, the Secretary shall provide for the issuance of a Universal Medicare card that shall be used for purposes of identification and processing of claims for benefits under this program. The card shall not include an individual’s Social Security number.</text></subsection></section><section id="HA9FDD6606BA84B2392B60B2DE0624259"><enum>106.</enum><header>Effective date of benefits</header><subsection id="H232A8919741546FFB97CC5AB1440B5D1"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Except as provided in subsection (b), benefits shall first be available under this Act for items and services furnished 2 years after the date of the enactment of this Act.</text></subsection><subsection id="H82DB4358C9C048E998A0CF96296DB9D3"><enum>(b)</enum><header>Coverage for certain individuals</header><paragraph id="H394C6D38BA774772BEE9F0FC4B7B8566"><enum>(1)</enum><header>In general</header><text>For any eligible individual who—</text><subparagraph id="HF3ABBEAF08D945519DAA4163CAADC9A6"><enum>(A)</enum><text>has not yet attained the age of 19 as of the date that is 1 year after the date of the enactment of this Act; or</text></subparagraph><subparagraph id="H1B26728480D24CCE8463E351EAE1D207"><enum>(B)</enum><text display-inline="yes-display-inline">has attained the age of 55 as of the date that is 1 year after the date of the enactment of this Act,</text></subparagraph><continuation-text continuation-text-level="paragraph">benefits shall first be available under this Act for items and services furnished as of such date.</continuation-text></paragraph><paragraph id="H2BDF23B25BF842F990ADD464E8A3AC4E"><enum>(2)</enum><header>Option to continue in other coverage during transition period</header><text>Any person who is eligible to receive benefits as described in paragraph (1) may opt to maintain any coverage described in section 901, private health insurance coverage, or coverage offered pursuant to subtitle A of title X (including the amendments made by such subtitle) until the date described in subsection (a).</text></paragraph></subsection></section><section id="H19A78A604B434F22A33B80F35F93F808"><enum>107.</enum><header>Prohibition against duplicating coverage</header><subsection id="HC745387E3B2B4E3EAD89DC44675059F0"><enum>(a)</enum><header>In general</header><text>Beginning on the effective date described in section 106(a), it shall be unlawful for—</text><paragraph id="H9C22F423C6E342C5B911B64714E92F96"><enum>(1)</enum><text>a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or</text></paragraph><paragraph id="H7AAE18F08702481A9C8FD74323DCE13E"><enum>(2)</enum><text>an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.</text></paragraph></subsection><subsection id="HF40ED409A0BE412C89548B39B8DF3B98"><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, including additional benefits that an employer may provide to employees or their dependents, or to former employees or their dependents.</text></subsection></section></title><title id="H6D37CD32F12544F6BD9CF5C5104E98F6"><enum>II</enum><header>Comprehensive Benefits, Including Preventive Benefits and Benefits for Long-Term Care</header><section id="H9405D28501574954B2990412506E4947"><enum>201.</enum><header>Comprehensive benefits</header><subsection id="H1A7D240D18FC4DF9BD0A50F5859285BA"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under this Act are entitled to have payment made by the Secretary to an eligible provider for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:</text><paragraph id="HD1170CC95AD4495E968197E52532E1BC"><enum>(1)</enum><text>Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.</text></paragraph><paragraph id="HA5C042183A7B4930A2505EE8E4FDBCFD"><enum>(2)</enum><text>Ambulatory patient services.</text></paragraph><paragraph id="H30BD709C014F42609347492283E1189F"><enum>(3)</enum><text>Primary and preventive services, including chronic disease management.</text></paragraph><paragraph id="HB8A7D2E54F504AE1B87AF17D1617B832"><enum>(4)</enum><text display-inline="yes-display-inline">Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products, and all contraceptive items approved by the Food and Drug Administration.</text></paragraph><paragraph id="HC462632B39594CE29353587DCE4705D8"><enum>(5)</enum><text>Mental health and substance use treatment services, including inpatient care.</text></paragraph><paragraph id="H0BF5DB9DEA2B4EC58E8CF2AB9692846A"><enum>(6)</enum><text>Laboratory and diagnostic services.</text></paragraph><paragraph id="H5283A978698744988640031A36B75C56"><enum>(7)</enum><text display-inline="yes-display-inline">Comprehensive reproductive care, including abortion, contraception, and assistive reproductive technology.</text></paragraph><paragraph id="H2600740DE9A744268328BA6B552F6233"><enum>(8)</enum><text display-inline="yes-display-inline">Maternity and newborn care.</text></paragraph><paragraph id="HBF5C076612D0414EB0D67D1D79938D45"><enum>(9)</enum><text display-inline="yes-display-inline">Comprehensive gender affirming health care.</text></paragraph><paragraph id="HE097B799585B446CBCAA0EFE0849B712"><enum>(10)</enum><text>Oral health, audiology, and vision services.</text></paragraph><paragraph id="H8ED36860EB8C4E8CABC3A2A419CA11A0"><enum>(11)</enum><text>Rehabilitative and habilitative services and devices.</text></paragraph><paragraph id="HB7B3B52F0433448DBC555D59D7B0C365"><enum>(12)</enum><text>Emergency services and transportation.</text></paragraph><paragraph id="H217B8A88ED7A4DA09C536F5417AEE828"><enum>(13)</enum><text display-inline="yes-display-inline">Early and periodic screening, diagnostic, and treatment services, as described in sections 1902(a)(10)(A), 1902(a)(43), 1905(a)(4)(B), and 1905(r) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(10)(A)</external-xref>; 1396a(a)(43); 1396d(a)(4)(B); 1396d(r)).</text></paragraph><paragraph id="HB3C1DCA9CD594530994C45C5893A5E3C"><enum>(14)</enum><text display-inline="yes-display-inline">Necessary transportation to receive health care services for persons with disabilities, older individuals with functional limitations, or low-income individuals (as determined by the Secretary).</text></paragraph><paragraph id="H527CCFAA8C7C4DED9F648D8A8157AC6E"><enum>(15)</enum><text>Long-term care services and support (as described in section 204).</text></paragraph><paragraph id="H1529362D510844F38DB61CD1B3059D5F"><enum>(16)</enum><text>Hospice care.</text></paragraph><paragraph id="H8BBDB3F39A554D4E98BDE1FAE1BAC9A7"><enum>(17)</enum><text>Services provided by a licensed marriage and family therapist or a licensed mental health counselor.</text></paragraph><paragraph id="H71DD04AA48704BDBB9B859D935678FA1"><enum>(18)</enum><text display-inline="yes-display-inline">Any service described in a preceding paragraph that is furnished via telehealth, to the extent practical.</text></paragraph></subsection><subsection id="HA4C59A9A5115469AB42B3161FF17D13A"><enum>(b)</enum><header>Revision</header><text display-inline="yes-display-inline">The Secretary shall, at least annually, and on a regular basis, evaluate whether the benefits package should be improved to promote the health of beneficiaries, account for changes in medical practice or new information from medical research, or respond to other relevant developments in health science, and shall make recommendations to Congress regarding any such improvements. Such recommendations may not include a recommendation to eliminate any benefit.</text></subsection><subsection id="HFF23F64272364C21BE5BA12B4D2A77FF"><enum>(c)</enum><header>Hearings</header><paragraph id="HD1FCA8ECC0E54AB88A43FE8D65F38CB5"><enum>(1)</enum><header>In general</header><text>The Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives shall, not less frequently than annually, hold a hearing on the recommendations submitted by the Secretary under subsection (b).</text></paragraph><paragraph id="H6F1AE34E9CFA48098B876977E3715DE5"><enum>(2)</enum><header>Exercise of rulemaking authority</header><text>Paragraph (1) is enacted—</text><subparagraph id="H9EE0D58037764169BB3D2F148A822CC5"><enum>(A)</enum><text display-inline="yes-display-inline">as an exercise of rulemaking power of the House of Representatives, and, as such, shall be considered as part of the rules of the House, and such rules shall supersede any other rule of the House only to the extent that rule is inconsistent therewith; and</text></subparagraph><subparagraph id="HA34D1A3539EB4BFD8EF5764526E78361"><enum>(B)</enum><text display-inline="yes-display-inline">with full recognition of the constitutional right of either House to change such rules (so far as relating to the procedure in such House) at any time, in the same manner, and to the same extent as in the case of any other rule of the House.</text></subparagraph></paragraph></subsection><subsection id="H7E79EF00CBAD4B2BACBE022176810DD5"><enum>(d)</enum><header>Complementary and Integrative Medicine</header><paragraph id="H662BCB9CFDEB4749ABE1CB361677DD8A"><enum>(1)</enum><header>In general</header><text>In carrying out subsection (b), the Secretary shall consult with the persons described in paragraph (2) with respect to—</text><subparagraph id="H0009D42267B74F17BDF240CD5BBF961E"><enum>(A)</enum><text>identifying specific complementary and integrative medicine practices that are appropriate to include in the benefits package; and</text></subparagraph><subparagraph id="HB46D1EC5985F4B49AADA75F5408CCE45"><enum>(B)</enum><text>identifying barriers to the effective provision and integration of such practices into the delivery of health care, and identifying mechanisms for overcoming such barriers.</text></subparagraph></paragraph><paragraph id="HC6E4C9680BFF46D5AF2BE33068BB90FD"><enum>(2)</enum><header>Consultation</header><text>In accordance with paragraph (1), the Secretary shall consult with—</text><subparagraph id="HBBDB75F7FBB045888457C6B99B0AE28E"><enum>(A)</enum><text>the Director of the National Center for Complementary and Integrative Health;</text></subparagraph><subparagraph id="H482EC726584746C4B295855D2EAF2453"><enum>(B)</enum><text>the Commissioner of Food and Drugs;</text></subparagraph><subparagraph id="H31110167306F40FDB1F78AE88A8CFEC4"><enum>(C)</enum><text>institutions of higher education, private research institutes, and individual researchers with extensive experience in complementary and alternative medicine and the integration of such practices into the delivery of health care;</text></subparagraph><subparagraph id="H54C75CBD56514F1B9ABEE538A1A35567"><enum>(D)</enum><text>nationally recognized providers of complementary and integrative medicine; and</text></subparagraph><subparagraph id="HAC42C60034AA4E609EB0705132B3EF63"><enum>(E)</enum><text>such other officials, entities, and individuals with expertise on complementary and integrative medicine as the Secretary determines appropriate.</text></subparagraph></paragraph></subsection><subsection id="H5159355667664C18B10B49CB1058DA8C"><enum>(e)</enum><header>States may provide additional benefits</header><text display-inline="yes-display-inline">Individual States may provide additional benefits for the residents of such States, as determined by such State, and may provide benefits to individuals not eligible for benefits under this Act, at the expense of the State, subject to the requirements specified in section 1102.</text></subsection></section><section id="HBEF5F8AB95E64BDEA310F079224F3E8C"><enum>202.</enum><header>No cost-sharing; other limitations</header><subsection id="HD7CFFEC58398478BBC38D328EE387011"><enum>(a)</enum><header>In general</header><text>The Secretary shall ensure that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, is imposed on an individual for any benefits provided under this Act.</text></subsection><subsection id="H5C6651906B314509AEF5458EF92250C8"><enum>(b)</enum><header>No balance billing</header><text>No provider may impose a charge to an enrolled individual for covered services for which benefits are provided under this Act.</text></subsection><subsection id="HDE839BAA3473454898CFA0AA66E95BF2"><enum>(c)</enum><header>No prior authorization</header><text display-inline="yes-display-inline">Benefits provided under this Act shall be covered without any need for any prior authorization determination and without any limitation applied through the use of step therapy protocols.</text></subsection></section><section id="HCDD5D9CFC9934398886B25AA63968A9D"><enum>203.</enum><header>Exclusions and limitations</header><subsection id="HA0695DB645504DCFB799F47DFA50F8AF"><enum>(a)</enum><header>In general</header><text>Benefits for items and services are not available under this Act unless the items and services meet the standards developed by the Secretary pursuant to section 201(a).</text></subsection><subsection id="H84F2A540315A4D009392784F576217E9"><enum>(b)</enum><header>Treatment of experimental items and services and drugs</header><paragraph id="H153D7D8585514220A0FE32AB6EBD922E"><enum>(1)</enum><header>In general</header><text>In applying subsection (a), the Secretary shall make national coverage determinations with respect to items and services that are experimental in nature. Such determinations shall be consistent with the national coverage determination process as defined in section 1869(f)(1)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ff">42 U.S.C. 1395ff(f)(1)(B)</external-xref>).</text></paragraph><paragraph id="HF38B0C66DAE04EE49971BE55BDB0C102"><enum>(2)</enum><header>Appeals process</header><text>The Secretary shall establish a process by which individuals can appeal coverage decisions. The process shall, as much as is feasible, follow the process for appeals under the Medicare program described in section 1869 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ff">42 U.S.C. 1395ff</external-xref>).</text></paragraph></subsection><subsection id="H462D3363E2D14E9AA90749B031543D4D"><enum>(c)</enum><header>Application of practice guidelines</header><paragraph id="H660DA6B284B4486CB7FE4BB0B43A7BFC"><enum>(1)</enum><header>In general</header><text>In the case of items and services for which the Department of Health and Human Services has recognized a national practice guideline, such items and services shall be deemed to meet the standards specified in section 201(a) if they have been provided in accordance with such guideline. For purposes of this subsection, an item or service not provided in accordance with a practice guideline shall be deemed to have been provided in accordance with the guideline if the health care provider providing the item or service—</text><subparagraph id="H79B1CB8004C443E3878D1CFD51DDAE5F"><enum>(A)</enum><text>exercised appropriate professional judgment in accordance with the laws and requirements of the State in which such item or service is furnished in deviating from the guideline;</text></subparagraph><subparagraph id="HBFBA54BA6E9C44F899FAF956F31C7093"><enum>(B)</enum><text>acted in the best interest of the individual receiving the item or service; and</text></subparagraph><subparagraph id="H5BCC879995114C5B8CA492E01AEA0127"><enum>(C)</enum><text>acted in a manner consistent with the individual’s wishes.</text></subparagraph></paragraph><paragraph id="H3877CBE937FC4D8DAD8CF4DAF76F1040"><enum>(2)</enum><header>Override of standards</header><subparagraph commented="no" id="H10E84BF1896D4E5DAD0B77493D4D6857"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">An individual’s treating physician or other health care professional authorized to exercise independent professional judgment in implementing a patient’s medical or nursing care plan in accordance with the scope of practice, licensure, and other law of the State where items and services are to be furnished may override practice standards established pursuant to section 201(a) or practice guidelines described in paragraph (1), including such standards and guidelines that are implemented by a provider through the use of health information technology, such as electronic health record technology, clinical decision support technology, and computerized order entry programs.</text></subparagraph><subparagraph id="H0F2D9AA4577E41E48A78E1DE3D862675"><enum>(B)</enum><header>Limitation</header><text>An override described in subparagraph (A) shall, in the professional judgment of such physician, nurse, or health care professional, be—</text><clause id="H1994C6E882BA44878171B6C7C7B9BD80"><enum>(i)</enum><text display-inline="yes-display-inline">consistent with such physician’s, nurse’s, or health care professional’s determination of medical necessity and appropriateness or nursing assessment;</text></clause><clause id="HA622E2A202D64605ABBF84926C31BBD7"><enum>(ii)</enum><text>in the best interests of the individual; and</text></clause><clause id="H0C2B750A79824697BE5CF8B718583A95"><enum>(iii)</enum><text>consistent with the individual’s wishes.</text></clause></subparagraph></paragraph></subsection></section><section id="H190A8996EFA744CB84ECAEF5CF50BEE7"><enum>204.</enum><header>Coverage of long-term care services</header><subsection id="H47C258E938F7431D882708C479A65777"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to the other provisions of this Act, individuals enrolled for benefits under this Act are entitled to the following long-term services and supports and to have payment made by the Secretary to an eligible provider for such services and supports if medically necessary and appropriate and in accordance with the standards established in this Act, for maintenance of health or for care, services, diagnosis, treatment, or rehabilitation that is related to a medically determinable condition, whether physical or mental, of health, injury, or age that—</text><paragraph id="HF86501DF50C840BB932BB9EED8D650B3"><enum>(1)</enum><text>causes a functional limitation in performing one or more activities of daily living; or</text></paragraph><paragraph id="H2A70E4746DD842AAAFF6DE0C2270C289"><enum>(2)</enum><text display-inline="yes-display-inline">requires a similar need of assistance in performing instrumental activities of daily living.</text></paragraph></subsection><subsection id="H6F1C235924D747E58FF4EE992C973A3E"><enum>(b)</enum><header>Eligibility</header><text display-inline="yes-display-inline">An individual shall be eligible for services and supports described in this section if such individual has one or more medically determinable conditions described in subsection (a).</text></subsection><subsection id="HC725E7FE94594B6894DE0BAF72DCB265"><enum>(c)</enum><header>Services and supports</header><text display-inline="yes-display-inline">Long-term services and supports under this section shall be tailored to an individual’s needs, as determined through assessment, and shall be defined by the Secretary to—</text><paragraph id="H9E1245B6B9D14E1DBE75ED274BA97AAA"><enum>(1)</enum><text>include any long-term nursing services for the enrollee, whether provided in an institution or in a home- and community-based setting;</text></paragraph><paragraph id="H9B77BA8BF83D4898BCF77A7919BFD0B2"><enum>(2)</enum><text>provide coverage for a broad spectrum of long-term services and supports, including for home- and community-based services and other care provided through non-institutional settings;</text></paragraph><paragraph id="H7AAA94E682DB418E8A184CED4AE0D06B"><enum>(3)</enum><text>provide coverage that meets the physical, mental, and social needs of recipients while allowing recipients their maximum possible autonomy and their maximum possible civic, social, and economic participation;</text></paragraph><paragraph id="HF284C56D4DA148F7A97FF98EB36EB9B1"><enum>(4)</enum><text>prioritize delivery of long-term services and supports through home- and community-based services over institutionalization;</text></paragraph><paragraph id="H9F1E382FEE1B4F699C38544DE152E4B6"><enum>(5)</enum><text display-inline="yes-display-inline">unless an individual elects otherwise, ensure that recipients will receive home- and community -based long-term services and supports (as defined in subsection (f)(4)), regardless of the individuals’s type or level of disability, service need, or age;</text></paragraph><paragraph id="H15C1E6444A7D483CA171C2C64A4A7756"><enum>(6)</enum><text>be provided with the goal of enabling persons with disabilities to receive services in the least restrictive and most integrated setting appropriate to the individual’s needs;</text></paragraph><paragraph id="H5EEEA65AF43049EDB2B60A2458C94B39"><enum>(7)</enum><text>be provided in such a manner that allows persons with disabilities to maintain their independence, self-determination, and dignity;</text></paragraph><paragraph id="H5ABDB87596CB4593BAEFD080E457E9A5"><enum>(8)</enum><text>provide long-term services and supports that are of equal quality and equally accessible across geographic regions; and</text></paragraph><paragraph id="HBF138AF5A50D4C97B6CEDCB4F023489F"><enum>(9)</enum><text>ensure that long-term services and supports provide recipients the option of self-direction of services from either the recipient or care coordinators of the recipient’s choosing.</text></paragraph></subsection><subsection id="H7545D90E2390475F9133BE4C970953B9"><enum>(d)</enum><header>Public consultation</header><text>In developing regulations to implement this section, the Secretary shall consult with an advisory commission on long-term services and supports that includes—</text><paragraph id="HABBA9F403F864B15B697F137379C3F35"><enum>(1)</enum><text display-inline="yes-display-inline">people with disabilities who use long-term services and supports and older adults who use long-term services and supports;</text></paragraph><paragraph id="HC92D02C3AEA5472388F05B09A3BAA186"><enum>(2)</enum><text display-inline="yes-display-inline">representatives of people with disabilities and representatives of older adults;</text></paragraph><paragraph id="HBBF5C06C8F8441CC8AE2CC720FE962E8"><enum>(3)</enum><text display-inline="yes-display-inline">groups that represent the diversity of the population of people living with disabilities, including racial, ethnic, national origin, primary language use, age, sex, including gender identity and sexual orientation, geographical, and socioeconomic diversity;</text></paragraph><paragraph id="HCEF1CE1BE3864601842089076A96636E"><enum>(4)</enum><text>providers of long-term services and supports, including family attendants and family caregivers, and members of organized labor;</text></paragraph><paragraph id="H2730F985B0FD45C796A28E538043A643"><enum>(5)</enum><text>disability rights organizations; and</text></paragraph><paragraph id="H314051B3E5344AC3917DA7AC1BB3C7F8"><enum>(6)</enum><text>relevant academic institutions and researchers.</text></paragraph></subsection><subsection id="HE44B89600F4A443ABC6B8F4A83ACE88D"><enum>(e)</enum><header>Budgeting and payments</header><text display-inline="yes-display-inline">Budgeting and payments for long-term services and supports provided under this section shall be made in accordance with the provisions under title VI.</text></subsection><subsection id="HEBEE623BBE624044BCD9EFEB79A78E0A"><enum>(f)</enum><header>Definitions</header><text>In this section:</text><paragraph id="H632C1F595B854CFCBE48A96155948F22"><enum>(1)</enum><text>The term <term>long-term services and supports</term> means long-term care, treatment, maintenance, or services needed to support the activities of daily living and instrumental activities of daily living, including home- and community-based services and any additional services and supports identified by the Secretary to support people with disabilities to live, work, and participate in their communities.</text></paragraph><paragraph id="H16D93895476245349B0B3F4D9F354DDD"><enum>(2)</enum><text>The term <term>activities of daily living</term> means basic personal everyday activities, including tasks such as eating, toileting, grooming, dressing, bathing, and transferring.</text></paragraph><paragraph id="H46A293FF89BC4F5089DFB189BE583AC0"><enum>(3)</enum><text>The term <term>instrumental activities of daily living</term> means activities related to living independently in the community, including meal planning and preparation, managing finances, shopping for food, clothing, and other essential items, performing essential household chores, communicating by phone or other media, and traveling around and participating in the community.</text></paragraph><paragraph id="HCD1AB907EDF14401AFA3F2BC75895447"><enum>(4)</enum><text>The term <term>home and community-based services</term> means the home and community-based services that are coverable under subsections (c), (d), (i), and (k) of section 1915 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n</external-xref>), and as defined by the Secretary, including as defined in the home and community-based services settings rule in sections 441.530 and 441.710 of title 42, Code of Federal Regulations (or a successor regulation).</text></paragraph></subsection></section></title><title id="H32CCF76CFCEF45FC9F36A2ACB6C24B31"><enum>III</enum><header>Provider Participation</header><section id="H2520AA18AE7145C9921028C58FB3762F"><enum>301.</enum><header>Provider participation and standards; whistleblower protections</header><subsection id="HFE31678642704D0B94B46168CF6F7388"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">An individual or other entity furnishing any covered item or service under this Act is not a qualified provider unless the individual or entity—</text><paragraph id="HEB38E9AAB72540E9B9FA6A72BD5A2CD3"><enum>(1)</enum><text>is a qualified provider of the items or services under section 302;</text></paragraph><paragraph id="H777131EB912846AF89EB7B3B3B7ED1A7"><enum>(2)</enum><text>has filed with the Secretary a participation agreement described in subsection (b); and</text></paragraph><paragraph id="HEA4E0959E7D544DD9DD472611A6B8EEF"><enum>(3)</enum><text>meets, as applicable, such other qualifications and conditions with respect to a provider of services under title XVIII of the Social Security Act as described in section 1866 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc</external-xref>).</text></paragraph></subsection><subsection id="HFDD37AC4D77B48AEBEF4B95B6435FDA6"><enum>(b)</enum><header>Requirements in participation agreement</header><paragraph id="HF57E11B316E4478781D11FC39CDCDC8D"><enum>(1)</enum><header>In general</header><text>A participation agreement described in this subsection between the Secretary and a provider shall provide at least for the following:</text><subparagraph id="H1E75FAC8FDB243FDA47D27CDE2257885"><enum>(A)</enum><text>Items and services to eligible persons shall be furnished by the provider without discrimination, in accordance with section 104(a). Nothing in this subparagraph shall be construed as requiring the provision of a type or class of items or services that are outside the scope of the provider’s normal practice.</text></subparagraph><subparagraph id="H987A4BD2D75E4CD6904CBB790AF88931"><enum>(B)</enum><text>No charge will be made to any enrolled individual for any covered items or services other than for payment authorized by this Act.</text></subparagraph><subparagraph id="H5E37ABAA2B3E4775A209AA7E30A90725"><enum>(C)</enum><text>The provider agrees to furnish such information as may be reasonably required by the Secretary, in accordance with uniform reporting standards established under section 401(b)(1), for—</text><clause id="HCCC45E755F404853A45FE1217D913BB2"><enum>(i)</enum><text>quality review by designated entities;</text></clause><clause id="H457B06FF09CB4E2687993DDD16B13E12"><enum>(ii)</enum><text>making payments under this Act, including the examination of records as may be necessary for the verification of information on which such payments are based;</text></clause><clause id="HBB9F51BDC7C04A4A993287B9A818D7A8"><enum>(iii)</enum><text>statistical or other studies required for the implementation of this Act; and</text></clause><clause id="H0DA77250883C48D2A9C33573FE764089"><enum>(iv)</enum><text>such other purposes as the Secretary may specify.</text></clause></subparagraph><subparagraph commented="no" id="HDADC472F58BA4115AF6B33B49EA30843"><enum>(D)</enum><text display-inline="yes-display-inline">In the case of a provider that is not an individual, the provider agrees not to employ or use for the provision of health services any individual or other provider that has had a participation agreement under this subsection terminated for cause. The Secretary may authorize such employment or use on a case-by-case basis.</text></subparagraph><subparagraph id="H5F58A162C9D640E198DB035F60CC40E8"><enum>(E)</enum><text>In the case of a provider paid under a fee-for-service basis for items and services furnished under this Act, the provider agrees to submit bills and any required supporting documentation relating to the provision of covered items and services within 30 days after the date of providing such items and services.</text></subparagraph><subparagraph id="H66DBDEC5FB84435698AE893DDE27127B"><enum>(F)</enum><text display-inline="yes-display-inline">In the case of an institutional provider paid pursuant to section 611, the provider agrees to submit information and any other required supporting documentation as may be reasonably required by the Secretary within 30 days after the date of providing such items and services and in accordance with the uniform reporting standards established under section 401(b)(1), including information on a quarterly basis that—</text><clause id="H1893F3F5366B4BA5BFDEF69F1B0DE31A"><enum>(i)</enum><text>relates to the provision of covered items and services; and</text></clause><clause id="H387935BC0EE74E2896061411A2C8F16B"><enum>(ii)</enum><text>describes items and services furnished with respect to specific individuals.</text></clause></subparagraph><subparagraph commented="no" id="HA3E9D92A52A34891AC700717894F2064"><enum>(G)</enum><text display-inline="yes-display-inline">In the case of a provider that receives payment for items and services furnished under this Act based on diagnosis-related coding, procedure coding, or other coding system or data, the provider agrees—</text><clause id="H3B9B6B2FDCBC43D1A01E4D7BD8AF1EEF"><enum>(i)</enum><text display-inline="yes-display-inline">to disclose to the Secretary any system or index of coding or classifying patient symptoms, diagnoses, clinical interventions, episodes, or procedures that such provider utilizes for global budget negotiations under title VI or for meeting any other payment, documentation, or data collection requirements under this Act; and</text></clause><clause id="HED63AFABE8A242BC878CF8C8BC467419"><enum>(ii)</enum><text display-inline="yes-display-inline">not to use any such system or index to establish financial incentives or disincentives for health care professionals, or that is proprietary, interferes with the medical or nursing process, or is designed to increase the amount or number of payments.</text></clause></subparagraph><subparagraph id="H9720796FBF4E4A20BEF2FAC627A8C597"><enum>(H)</enum><text>The provider complies with the duty of provider ethics and reporting requirements described in paragraph (2).</text></subparagraph><subparagraph id="H6FE88CB0B79241E4922A8C74E2212755"><enum>(I)</enum><text display-inline="yes-display-inline">In the case of a provider that is not an individual, the provider agrees that no board member, executive, or administrator of such provider receives compensation from, owns stock or has other financial investments in, or serves as a board member of any entity that contracts with or provides items or services, including pharmaceutical products and medical devices or equipment, to such provider.</text></subparagraph></paragraph><paragraph id="HB46725E7BB134A0FAD2E135CAA59C525"><enum>(2)</enum><header>Provider duty of ethics</header><text display-inline="yes-display-inline">Each health care provider, including institutional providers, has a duty to advocate for and to act in the exclusive interest of each individual under the care of such provider according to the applicable legal standard of care, such that no financial interest or relationship impairs any health care provider’s ability to furnish necessary and appropriate care to such individual. To implement the duty established in this paragraph, the Secretary shall—</text><subparagraph id="HC2D474366C234762A106CFF6A851B901"><enum>(A)</enum><text display-inline="yes-display-inline">promulgate reasonable reporting rules to evaluate participating provider compliance with this paragraph;</text></subparagraph><subparagraph id="HB007B21693E641B5840BC3C09015B32B"><enum>(B)</enum><text display-inline="yes-display-inline">prohibit participating providers, spouses, and immediate family members of participating providers, from accepting or entering into any arrangement for any bonus, incentive payment, profit-sharing, or compensation based on patient utilization or based on financial outcomes of any other provider or entity; and</text></subparagraph><subparagraph id="H6CEC9BF187A94849B81CC91F090F1B60"><enum>(C)</enum><text display-inline="yes-display-inline">prohibit participating providers or any board member or representative of such provider from serving as board members for or receiving any compensation, stock, or other financial investment in an entity that contracts with or provides items or services (including pharmaceutical products and medical devices or equipment) to such provider.</text></subparagraph></paragraph><paragraph id="HD8636EF9A4E148388B759547A016D923"><enum>(3)</enum><header>Termination of participation agreement</header><subparagraph id="H332EA32B8B344743A5BC37D0949FF20A"><enum>(A)</enum><header>In general</header><text>Participation agreements may be terminated, with appropriate notice—</text><clause id="HF80CD959413547B4B909333DCC580567"><enum>(i)</enum><text>by the Secretary for failure to meet the requirements of this Act;</text></clause><clause id="H919636526FB740038A5F94572446B13A"><enum>(ii)</enum><text>in accordance with the provisions described in section 411; or</text></clause><clause id="H455BCCA7B2F94D6A81BB3CBC4B050E18"><enum>(iii)</enum><text>by a provider.</text></clause></subparagraph><subparagraph id="H7AF8E054EAEB4474B0E7EE8F2C91C107"><enum>(B)</enum><header>Termination process</header><text>Providers shall be provided notice and a reasonable opportunity to correct deficiencies before the Secretary terminates an agreement unless a more immediate termination is required for public safety or similar reasons.</text></subparagraph><subparagraph id="HB54BF7579A8C41649047A66D3DE76D1A"><enum>(C)</enum><header>Provider protections</header><clause id="H830427AEBAE14189A33BF22667D0508A"><enum>(i)</enum><header>Prohibition</header><text>The Secretary may not terminate a participation agreement or in any other way discriminate against, or cause to be discriminated against, any covered provider or authorized representative of the provider, on account of such provider or representative—</text><subclause id="HE24538DF29AA4E468A2B45025262FBE3"><enum>(I)</enum><text>providing, causing to be provided, or being about to provide or cause to be provided to the provider, the Federal Government, or the attorney general of a State information relating to any violation of, or any act or omission the provider or representative reasonably believes to be a violation of, any provision of this title (or an amendment made by this title);</text></subclause><subclause id="HEB853B62C00341BA8561A2882E5864B9"><enum>(II)</enum><text>testifying or being about to testify in a proceeding concerning such violation;</text></subclause><subclause id="H8AE8177F767A407FB478A612A28B3425"><enum>(III)</enum><text>assisting or participating, or being about to assist or participate, in such a proceeding; or</text></subclause><subclause id="H887F053612FE49E0981AAC22AB9B1D4D"><enum>(IV)</enum><text>objecting to, or refusing to participate in, any activity, policy, practice, or assigned task that the provider or representative reasonably believes to be in violation of any provision of this Act (including any amendment made by this Act), or any order, rule, regulation, standard, or ban under this Act (including any amendment made by this Act).</text></subclause></clause><clause id="HA374DEE1E32F408799AC22227F71783C"><enum>(ii)</enum><header>Complaint procedure</header><text>A provider or representative who believes that he or she has been discriminated against in violation of this section may seek relief in accordance with the procedures, notifications, burdens of proof, remedies, and statutes of limitation set forth in section 2087(b) of title 15, United States Code.</text></clause></subparagraph></paragraph></subsection><subsection id="H1531E756B5B84ED28178F3E4D2F1FB7F"><enum>(c)</enum><header>Whistleblower protections</header><paragraph id="H88D133368BD54FA9A19A69D90625EBBD"><enum>(1)</enum><header>Retaliation prohibited</header><text>No person may discharge or otherwise discriminate against any employee because the employee or any person acting pursuant to a request of the employee—</text><subparagraph id="HE580F86A33C344598380880792EBDB7D"><enum>(A)</enum><text>notified the Secretary or the employee’s employer of any alleged violation of this title, including communications related to carrying out the employee’s job duties;</text></subparagraph><subparagraph id="H33927C7AF1214FA99A9FED2C303D67EB"><enum>(B)</enum><text>refused to engage in any practice made unlawful by this title, if the employee has identified the alleged illegality to the employer;</text></subparagraph><subparagraph id="HAB82D5B94734478290AD954819EDBA3E"><enum>(C)</enum><text>testified before or otherwise provided information relevant for Congress or for any Federal or State proceeding regarding any provision (or proposed provision) of this title;</text></subparagraph><subparagraph id="HBB12E8FA894E4211892FE35E2AC857F7"><enum>(D)</enum><text>commenced, caused to be commenced, or is about to commence or cause to be commenced a proceeding under this title;</text></subparagraph><subparagraph id="H97338351115F4A70A2A01D8799D2088C"><enum>(E)</enum><text>testified or is about to testify in any such proceeding; or</text></subparagraph><subparagraph id="H0ADFBE68B2AB43E7A387B7583BF34B23"><enum>(F)</enum><text>assisted or participated or is about to assist or participate in any manner in such a proceeding or in any other manner in such a proceeding or in any other action to carry out the purposes of this title.</text></subparagraph></paragraph><paragraph id="H3DF619584BD8469784CEF7E7BAF0671B"><enum>(2)</enum><header>Enforcement action</header><text>Any employee covered by this section who alleges discrimination by an employer in violation of paragraph (1) may bring an action, subject to the statute of limitations in the anti-retaliation provisions of the False Claims Act and the rules and procedures, legal burdens of proof, and remedies applicable under the employee protections provisions of the Surface Transportation Assistance Act.</text></paragraph><paragraph id="H8C1C28E45C5748459642E7563C1C543F"><enum>(3)</enum><header>Application</header><subparagraph id="H17146FC8E297414289AE52C387909C0A"><enum>(A)</enum><text display-inline="yes-display-inline">Nothing in this subsection shall be construed to diminish the rights, privileges, or remedies of any employee under any Federal or State law or regulation, including the rights and remedies against retaliatory action under the False Claims Act (<external-xref legal-doc="usc" parsable-cite="usc/31/3730">31 U.S.C. 3730(h)</external-xref>), or under any collective bargaining agreement. The rights and remedies in this section may not be waived by any agreement, policy, form, or condition of employment.</text></subparagraph><subparagraph id="H4BFE368E7CC4428F975A94B4957B9C7B"><enum>(B)</enum><text display-inline="yes-display-inline">Nothing in this subsection shall be construed to preempt or diminish any other Federal or State law or regulation against discrimination, demotion, discharge, suspension, threats, harassment, reprimand, retaliation, or any other manner of discrimination, including the rights and remedies against retaliatory action under the False Claims Act (<external-xref legal-doc="usc" parsable-cite="usc/31/3730">31 U.S.C. 3730(h)</external-xref>).</text></subparagraph></paragraph><paragraph id="H90C418B621B74AE194C8BC6A8CCCFA4F"><enum>(4)</enum><header>Definitions</header><text>In this subsection:</text><subparagraph id="HD6FACF864E21477A9FE2EAF38F36EC38"><enum>(A)</enum><header>Employer</header><text>The term <term>employer</term> means any person engaged in profit or nonprofit business or industry, including one or more individuals, partnerships, associations, corporations, trusts, professional membership organization including a certification, disciplinary, or other professional body, unincorporated organizations, nongovernmental organizations, or trustees, and subject to liability for violating the provisions of this Act.</text></subparagraph><subparagraph id="H6DBF2B40E7BD4A6E80EE1739C8D9B8F2"><enum>(B)</enum><header>Employee</header><text>The term <term>employee</term> means any individual performing activities under this Act on behalf of an employer.</text></subparagraph></paragraph></subsection></section><section id="H63BE9A5DB0454661A92C9D14D19175DA"><enum>302.</enum><header>Qualifications for providers</header><subsection id="H194DB6AAF8214A15A47444C8A677D64B"><enum>(a)</enum><header>In general</header><text>A health care provider is considered to be qualified to furnish covered items and services under this Act if the provider is licensed or certified to furnish such items and services in the State in which the individual receiving such items or services is located and meets—</text><paragraph id="H2780C29E8B2747BEBDC8448A6F587064"><enum>(1)</enum><text>the requirements of such State’s law to furnish such items and services; and</text></paragraph><paragraph id="HE0F14651DCF64CE782ABDD87901D3917"><enum>(2)</enum><text>applicable requirements of Federal law to furnish such items and services.</text></paragraph></subsection><subsection id="H8793295DA0204074A53132E71C258179"><enum>(b)</enum><header>Limitation</header><text display-inline="yes-display-inline">An entity or provider shall not be qualified to furnish covered items and services under this Act if the entity or provider provides no items and services directly to individuals, including—</text><paragraph id="H684347D832CD43A28CAFA3E365F47B2E"><enum>(1)</enum><text display-inline="yes-display-inline">entities or providers that contract with other entities or providers to provide such items and services; and</text></paragraph><paragraph id="H488BD9C9AF704987B87BFC2EF0B65BFF"><enum>(2)</enum><text display-inline="yes-display-inline">entities that are currently approved to coordinate care plans under the Medicare Advantage program established in part C of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1851">42 U.S.C. 1851 et seq.</external-xref>) but do not directly provide items and services of such care plans.</text></paragraph></subsection><subsection id="HC8FC4623BFC44091808C881F64D61D1E"><enum>(c)</enum><header>Minimum provider standards</header><paragraph id="HF18FEA3086CA4440A307C7D298A96085"><enum>(1)</enum><header>In general</header><text>The Secretary shall establish, evaluate, and update national minimum standards to ensure the quality of items and services provided under this Act and to monitor efforts by States to ensure the quality of such items and services. A State may establish additional minimum standards which providers shall meet with respect to items and services provided in such State.</text></paragraph><paragraph id="HE9F2D39FD0164255A8935345CC8B101E"><enum>(2)</enum><header>National minimum standards</header><text>The Secretary shall establish national minimum standards under paragraph (1) for institutional providers of services and individual health care practitioners. Except as the Secretary may specify in order to carry out this Act, a hospital, skilled nursing facility, or other institutional provider of services shall meet standards applicable to such a provider under the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>). Such standards also may include, where appropriate, elements relating to—</text><subparagraph id="H48A38576304B49F3BBD99AC12ACDB60C"><enum>(A)</enum><text>adequacy and quality of facilities;</text></subparagraph><subparagraph id="HC34526CABEF8428EAE0017EB24296487"><enum>(B)</enum><text display-inline="yes-display-inline">mandatory minimum safe registered nurse-to-patient staffing ratios and optimal staffing levels for physicians and other health care practitioners;</text></subparagraph><subparagraph id="H201312B208644F5CAC6901088D8875DB"><enum>(C)</enum><text>training and competence of personnel (including requirements related to the number of or type of required continuing education hours);</text></subparagraph><subparagraph id="H4706FFEAE14A4E929B85FC4241124719"><enum>(D)</enum><text>comprehensiveness of service;</text></subparagraph><subparagraph id="HCEEE0BEFF06E45C5B638D35451FE5CFC"><enum>(E)</enum><text>continuity of service;</text></subparagraph><subparagraph id="HD38FBD86B68E4BDC94E62635B6B71432"><enum>(F)</enum><text>patient waiting time, access to services, and preferences; and</text></subparagraph><subparagraph id="H62D182C1556343159E6DA721232A92B0"><enum>(G)</enum><text>performance standards, including organization, facilities, structure of services, efficiency of operation, and outcome in palliation, improvement of health, stabilization, cure, or rehabilitation.</text></subparagraph></paragraph><paragraph id="H4825BC091C1D4C8FBEB98D6B649AF0E9"><enum>(3)</enum><header>Transition in application</header><text>If the Secretary provides for additional requirements for providers under this subsection, any such additional requirement shall be implemented in a manner that provides for a reasonable period during which a previously qualified provider is permitted to meet such an additional requirement.</text></paragraph><paragraph id="HB240454E318640DB882F057C72341EF6"><enum>(4)</enum><header>Ability to provide services</header><text>With respect to any entity or provider certified to provide items and services described in section 201(a)(7), the Secretary may not prohibit such entity or provider from participating for reasons other than such entity’s or provider’s ability to provide such items and services.</text></paragraph></subsection><subsection id="HF0DCBEB97088465286735522E023762A" commented="no"><enum>(d)</enum><header>Federal providers</header><text>Any provider qualified to provide health care items and services through the Department of Veterans Affairs, the Indian Health Service, or the uniformed services (with respect to the direct care component of the TRICARE Program) is a qualifying provider under this section with respect to any individual who qualifies for such items and services under applicable Federal law.</text></subsection></section><section id="HB8947A08CBFE41FF963BB422322D47EC"><enum>303.</enum><header>Use of private contracts</header><subsection id="H027BD6B1C6A34A8287F9D3D48FD8BC35"><enum>(a)</enum><header>In general</header><text>This section shall apply beginning 2 years after the date of the enactment of this Act.</text></subsection><subsection id="H540D73527F814F2F988E6847DFAFDB59"><enum>(b)</enum><header>Participating providers</header><paragraph id="H086B7E3254734156ACA8DD9A795DDF60"><enum>(1)</enum><header>Private contracts for covered items and services for eligible individuals</header><text>An institutional or individual provider with an agreement in effect under section 301 may not bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act.</text></paragraph><paragraph id="H5CE05E73C33E4A50B6521AC7758E5856"><enum>(2)</enum><header>Private contracts for noncovered items and services for eligible individuals</header><text>An institutional or individual provider with an agreement in effect under section 301 may bill or enter into a private contract with an individual eligible for benefits under the Act for any item or service that is not a benefit under this Act only if—</text><subparagraph id="H2837DFBFCDFA48FD9F88CB55E1AF41CD"><enum>(A)</enum><text>the contract and provider meet the requirements specified in paragraphs (3) and (4), respectively;</text></subparagraph><subparagraph id="H0F89C8D2440C4479AB03D18E40CD43E4"><enum>(B)</enum><text>such item or service is not payable or available under this Act; and</text></subparagraph><subparagraph id="H35A5FFB55CE04F1CA7D20815AE2A55ED"><enum>(C)</enum><text>the provider receives—</text><clause id="HA99893668D5B48B898596060B2AAA491"><enum>(i)</enum><text>no reimbursement under this Act directly or indirectly for such item or service, and</text></clause><clause id="H368171CFCA484BAB92950C8B075B1780"><enum>(ii)</enum><text>receives no amount for such item or service from an organization which receives reimbursement for such items or service under this Act directly or indirectly.</text></clause></subparagraph></paragraph><paragraph id="H095BE4797E954D3499B3D54FCE4E0E51"><enum>(3)</enum><header>Contract requirements</header><text>Any contract to provide items and services described in paragraph (2) shall—</text><subparagraph id="H1AEC324FFBBC403FB6708B756FAEE366"><enum>(A)</enum><text>be in writing and signed by the individual (or authorized representative of the individual) receiving the item or service before the item or service is furnished pursuant to the contract;</text></subparagraph><subparagraph id="H08E822029D9141B9A8121F10A38F6C4A"><enum>(B)</enum><text>not be entered into at a time when the individual is facing an emergency health care situation; and</text></subparagraph><subparagraph id="H189F00EA45C64C519D5F14F432663E99"><enum>(C)</enum><text>clearly indicate to the individual receiving such items and services that by signing such a contract the individual—</text><clause id="HD23C55A699AC48AF80468908A0C753C6"><enum>(i)</enum><text>agrees not to submit a claim (or to request that the provider submit a claim) under this Act for such items or services;</text></clause><clause id="H0A75DD1240504A098A211794AFB98E10"><enum>(ii)</enum><text>agrees to be responsible for payment of such items or services and understands that no reimbursement will be provided under this Act for such items or services;</text></clause><clause id="H4D867D5E74004ADE84D1641110111A20"><enum>(iii)</enum><text>acknowledges that no limits under this Act apply to amounts that may be charged for such items or services; and</text></clause><clause id="HE23855E9D4B54AF5AC35899E49190954"><enum>(iv)</enum><text>acknowledges that the provider is providing services outside the scope of the program under this Act.</text></clause></subparagraph></paragraph><paragraph id="H65F08D7ED3834612A1A78849CD3CB451"><enum>(4)</enum><header>Affidavit</header><text>A participating provider who enters into a contract described in paragraph (2) shall have in effect during the period any item or service is to be provided pursuant to the contract an affidavit that shall—</text><subparagraph id="H4C138FB9BED54AF7B5768524C8C094BA"><enum>(A)</enum><text>identify the provider who is to furnish such noncovered item or service, and be signed by such provider;</text></subparagraph><subparagraph id="H51DBCC1CFB13498983BFDA5231FB1231"><enum>(B)</enum><text>state that the provider will not submit any claim under this Act for any noncovered item or service provided to any individual enrolled under this Act; and</text></subparagraph><subparagraph id="H61CC46DDEEFE4152B2AA8BBA21BAE860"><enum>(C)</enum><text>be filed with the Secretary no later than 10 days after the first contract to which such affidavit applies is entered into.</text></subparagraph></paragraph><paragraph id="HA677E633DD7048CFAA45CFF80D4208E7"><enum>(5)</enum><header>Enforcement</header><text>If a provider signing an affidavit described in paragraph (4) knowingly and willfully submits a claim under this title for any item or service provided or receives any reimbursement or amount for any such item or service provided pursuant to a private contract described in paragraph (2) with respect to such affidavit—</text><subparagraph id="H4276437BD7DB4B82969BB74A788F65A8"><enum>(A)</enum><text>any contract described in paragraph (2) shall be null and void;</text></subparagraph><subparagraph id="H0768EC18DBB149AB918FAB4670DB005C"><enum>(B)</enum><text>no payment shall be made under this title for any item or service furnished by the provider during the 2-year period beginning on the date the affidavit was signed; and</text></subparagraph><subparagraph id="HCF5D83DD3BB44FDAADB3A79BDC7B6DF3"><enum>(C)</enum><text display-inline="yes-display-inline">any payment received under this title for any item or service furnished during such period shall be remitted.</text></subparagraph></paragraph><paragraph id="HA8EAB7F0655B410784169FEE1237F149"><enum>(6)</enum><header>Private contracts for ineligible individuals</header><text>An institutional or individual provider with an agreement in effect under section 301 may bill or enter into a private contract with any individual ineligible for benefits under the Act for any item or service.</text></paragraph></subsection><subsection id="H80AA4FA290304EB98F17172B41AFF1CE"><enum>(c)</enum><header>Nonparticipating providers</header><paragraph id="H77902DF07F224D0DBC5A89F4320C98AE"><enum>(1)</enum><header>Private contracts for covered items and services for eligible individuals</header><text>An institutional or individual provider with no agreement in effect under section 301 may bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act described in title II only if the contract and provider meet the requirements specified in paragraphs (2) and (3), respectively.</text></paragraph><paragraph id="H3BA07DF1AFD84B8AB597B379A2C1AF8D"><enum>(2)</enum><header>Items required to be included in contract</header><text>Any contract to provide items and services described in paragraph (1) shall—</text><subparagraph id="HD67F165A5CA14A97BAFE88E4E625DB44"><enum>(A)</enum><text>be in writing and signed by the individual (or authorized representative of the individual) receiving the item or service before the item or service is furnished pursuant to the contract;</text></subparagraph><subparagraph id="H29E85103C29145F49E60F74DB7F3BDA8"><enum>(B)</enum><text>not be entered into at a time when the individual is facing an emergency health care situation; and</text></subparagraph><subparagraph id="HCA0A53A789A74750BEB04837EC38CB41"><enum>(C)</enum><text>clearly indicate to the individual receiving such items and services that by signing such a contract the individual—</text><clause id="HEECDD3BFC70447D489365D1500AAEA2A"><enum>(i)</enum><text>acknowledges that the individual has the right to have such items or services provided by other providers for whom payment would be made under this Act;</text></clause><clause id="H78BB64C110F945A7B26C448F4EEE62F2"><enum>(ii)</enum><text>agrees not to submit a claim (or to request that the provider submit a claim) under this Act for such items or services even if such items or services are otherwise covered by this Act;</text></clause><clause id="H1EDF6A8744094E7EA1343EA03EAEEFD5"><enum>(iii)</enum><text>agrees to be responsible for payment of such items or services and understands that no reimbursement will be provided under this Act for such items or services;</text></clause><clause id="H969D382489FF4DBDA5E6DC8CBFC3F927"><enum>(iv)</enum><text>acknowledges that no limits under this Act apply to amounts that may be charged for such items or services; and</text></clause><clause id="H49B576F5341E4331A907890E16E31B35"><enum>(v)</enum><text>acknowledges that the provider is providing services outside the scope of the program under this Act.</text></clause></subparagraph></paragraph><paragraph id="HFC1200F3F1AE472C9040E2E6CED5557A"><enum>(3)</enum><header>Affidavit</header><text>A provider who enters into a contract described in paragraph (1) shall have in effect during the period any item or service is to be provided pursuant to the contract an affidavit that shall—</text><subparagraph id="H069FEE83204840408E8689BF637CEF9B"><enum>(A)</enum><text>identify the provider who is to furnish such covered item or service, and be signed by such provider;</text></subparagraph><subparagraph id="HEC0DA22B73064102988538EFDAB02E7A"><enum>(B)</enum><text>state that the provider will not submit any claim under this Act for any covered item or service provided to any individual enrolled under this Act during the 2-year period beginning on the date the affidavit is signed; and</text></subparagraph><subparagraph id="H79E82FD09190406597D28BA9C37B9330"><enum>(C)</enum><text>be filed with the Secretary no later than 10 days after the first contract to which such affidavit applies is entered into.</text></subparagraph></paragraph><paragraph id="HDADE862AC19F4337B466FD4B6C673DF5"><enum>(4)</enum><header>Enforcement</header><text>If a provider signing an affidavit described in paragraph (3) knowingly and willfully submits a claim under this title for any item or service provided or receives any reimbursement or amount for any such item or service provided pursuant to a private contract described in paragraph (1) with respect to such affidavit—</text><subparagraph id="H32DA6B7957894D9AAD71C6D8F45A4B8D"><enum>(A)</enum><text>any contract described in paragraph (1) shall be null and void; and</text></subparagraph><subparagraph id="HD2243AB3F9EB46BAB770F845E4715E04"><enum>(B)</enum><text>no payment shall be made under this title for any item or service furnished by the provider during the 2-year period beginning on the date the affidavit was signed.</text></subparagraph></paragraph><paragraph id="H363E47BEB5C448F4A9090E0C5A9A1FA7"><enum>(5)</enum><header>Private contracts for noncovered items and services for any individual</header><text>An institutional or individual provider with no agreement in effect under section 301 may bill or enter into a private contract with any individual for a item or service that is not a benefit under this Act.</text><pagebreak></pagebreak></paragraph></subsection></section></title><title id="H51C3ABA791E1432E9C3D7B9D309825F1"><enum>IV</enum><header>Administration</header><subtitle id="H887219E29F174590805A68144B4A7FB8"><enum>A</enum><header>General Administration Provisions</header><section id="HD7B3F5516BB348AB998CBEC1FD1DF80A"><enum>401.</enum><header>Administration</header><subsection id="H68AA126DB77C49B8BD2AFE8C88B74B40"><enum>(a)</enum><header>General duties of the Secretary</header><paragraph id="H6B4E0E92557244B6825957B0872D8915"><enum>(1)</enum><header>In general</header><text>The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including related to—</text><subparagraph id="H2D2A5C711506463B87CA51B1F3BC93F6"><enum>(A)</enum><text>eligibility for benefits;</text></subparagraph><subparagraph id="HED35EFD13B6F454F96B9594320EC16CF"><enum>(B)</enum><text>enrollment;</text></subparagraph><subparagraph id="H283BB70B7DAC43BA936DC13F9B97FF42"><enum>(C)</enum><text>benefits provided;</text></subparagraph><subparagraph id="H1E887C13CA944E169288E84BBCF110DA"><enum>(D)</enum><text>provider participation standards and qualifications, as described in title III;</text></subparagraph><subparagraph id="H7AEEFE4469694845AC7D6BF06A8946B1"><enum>(E)</enum><text>levels of funding;</text></subparagraph><subparagraph id="H7D0FCA9EFB314685A62E89F469E4325C"><enum>(F)</enum><text>methods for determining amounts of payments to providers of covered items and services, consistent with subtitle B;</text></subparagraph><subparagraph commented="no" id="HC2FE21AF84E84F00BA4EE2E814BDA570"><enum>(G)</enum><text>a process for appealing or petitioning for a determination of coverage or noncoverage of items and services under this Act;</text></subparagraph><subparagraph id="HC95BA04FC44747EBAFE48E171E7E124F"><enum>(H)</enum><text>planning for capital expenditures and service delivery;</text></subparagraph><subparagraph id="H09FA47337C344A2281318F696BC0FCF2"><enum>(I)</enum><text>planning for health professional education funding;</text></subparagraph><subparagraph id="H7C6E4338BB284DA986DFBE87E2E2F113"><enum>(J)</enum><text>encouraging States to develop regional planning mechanisms; and</text></subparagraph><subparagraph id="H487F70AA9EBF4FC2A214DCCE8EF26121"><enum>(K)</enum><text>any other regulations necessary to carry out the purposes of this Act.</text></subparagraph></paragraph><paragraph id="HCB99CB296F1B4FFBBDF7FCDDBFC40336"><enum>(2)</enum><header>Regulations</header><text>Regulations authorized by this Act shall be issued by the Secretary in accordance with section 553 of title 5, United States Code.</text></paragraph><paragraph id="H961A679C1D8B4FC181642633D6208739"><enum>(3)</enum><header>Accessibility</header><text>The Secretary shall have the obligation to ensure the timely and accessible provision of items and services that all eligible individuals are entitled to under this Act.</text></paragraph></subsection><subsection id="HD21875668FF64E6FB9E6D815B044D18E"><enum>(b)</enum><header>Uniform reporting standards; annual report; studies</header><paragraph id="HB88F034579BB42219A11F9DE50D820EF"><enum>(1)</enum><header>Uniform reporting standards</header><subparagraph id="H1A2C984DBFD843E0914996CFE5E46E43"><enum>(A)</enum><header>In general</header><text>The Secretary shall establish uniform State reporting requirements and national standards to ensure an adequate national database containing information pertaining to health services practitioners, approved providers, the costs of facilities and practitioners providing items and services, the quality of such items and services, the outcomes of such items and services, and the equity of health among population groups. Such database shall include, to the maximum extent feasible without compromising patient privacy, health outcome measures used under this Act, and to the maximum extent feasible without excessively burdening providers, a description of the standards and qualifications, levels of finding, and methods described in subparagraphs (D) through (F) of subsection (a)(1).</text></subparagraph><subparagraph id="H34C8BD4A83B242639FFEAD3C4F95D543"><enum>(B)</enum><header>Required data disclosures</header><text>In establishing reporting requirements and standards under subparagraph (A), the Secretary shall require a provider with an agreement in effect under section 301 to disclose to the Secretary, in a time and manner specified by the Secretary, the following (as applicable to the type of provider):</text><clause id="HA82B30DD6E7F4E69B7E5D6DBCEAE2D8D"><enum>(i)</enum><text display-inline="yes-display-inline">Any data the provider is required to report or does report to any State or local agency, or, as of January 1, 2019, to the Secretary or any entity that is part of the Department of Health and Human Services, except data that are required under the programs terminated in section 903.</text></clause><clause id="H157AEC5BC8E24F15A2AE7714087A39E5"><enum>(ii)</enum><text display-inline="yes-display-inline">Annual financial data that includes information on employees (including the number of employees, hours worked, and wage information) by job title and by each patient care unit or department within each facility (including outpatient units or departments); the number of registered nurses per staffed bed by each such unit or department; information on the dollar value and annual spending (including purchases, upgrades, and maintenance) for health information technology; and risk-adjusted and raw patient outcome data (including data on medical, surgical, obstetric, and other procedures).</text></clause></subparagraph><subparagraph id="H2AA8B586232641A29CCBE811AABD4833"><enum>(C)</enum><header>Reports</header><text>The Secretary shall regularly analyze information reported to the Secretary and shall define rules and procedures to allow researchers, scholars, health care providers, and others to access and analyze data for purposes consistent with quality and outcomes research, without compromising patient privacy.</text></subparagraph></paragraph><paragraph id="HCE41331C8877493F8673C3AA4C428D91"><enum>(2)</enum><header>Annual report</header><text>Beginning 2 years after the date of the enactment of this Act, the Secretary shall annually report to Congress on the following:</text><subparagraph id="H6A0BF46452144FA68ACADB4C29EE9615"><enum>(A)</enum><text>The status of implementation of the Act.</text></subparagraph><subparagraph id="H9A8511E5A9634841B8BF4FCB6BCD992E"><enum>(B)</enum><text>Enrollment under this Act.</text></subparagraph><subparagraph id="HC654266A7F714F0FA7375591A16A7D06"><enum>(C)</enum><text>Benefits under this Act.</text></subparagraph><subparagraph id="H7658C0E5715E496C9842867CA423A4EB"><enum>(D)</enum><text>Expenditures and financing under this Act.</text></subparagraph><subparagraph id="HF0CF63A49C6747628BC72E8EC9182F02"><enum>(E)</enum><text>Cost-containment measures and achievements under this Act.</text></subparagraph><subparagraph id="H86377BD877AD4BB686459D8B83677966"><enum>(F)</enum><text>Quality assurance.</text></subparagraph><subparagraph id="H157AD4B0404F42EBA41B7364F6C0D079"><enum>(G)</enum><text>Health care utilization patterns, including any changes attributable to the program.</text></subparagraph><subparagraph id="H305C8EAA7FCE4C53ADA7963AD0451CFE"><enum>(H)</enum><text>Changes in the per-capita costs of health care.</text></subparagraph><subparagraph id="HAAD21298FA4845AD881E127BA1F29396"><enum>(I)</enum><text display-inline="yes-display-inline">Differences in the health status of the populations of the different States, including by racial, ethnic, national origin, primary language use, age, disability, sex, including gender identity and sexual orientation, geographical, and income characteristics.</text></subparagraph><subparagraph id="H2373C93C14BF4BA8A63E59ECEF548074"><enum>(J)</enum><text>Progress on quality and outcome measures, and long-range plans and goals for achievements in such areas.</text></subparagraph><subparagraph id="HAD2ADF13F4D74468A2CB0B041A2928C0"><enum>(K)</enum><text>Plans for improving service to medically underserved populations.</text></subparagraph><subparagraph id="H2B84E794E7304F849AC9D0B145A0D636"><enum>(L)</enum><text>Transition problems as a result of implementation of this Act.</text></subparagraph><subparagraph id="H8908DB2F1277440D952867B0BE6199BD"><enum>(M)</enum><text>Opportunities for improvements under this Act.</text></subparagraph></paragraph><paragraph id="H9DE107D83E1D46EDB8925CCB79018D23"><enum>(3)</enum><header>Statistical analyses and other studies</header><text>The Secretary may, either directly or by contract—</text><subparagraph id="H8EAAC550FA734D71BB69D8EA8AE5E331"><enum>(A)</enum><text>make statistical and other studies, on a nationwide, regional, State, or local basis, of any aspect of the operation of this Act;</text></subparagraph><subparagraph id="HC78096CFBEF845D296CCA6D3B80A603E"><enum>(B)</enum><text>develop and test methods of delivery of items and services as the Secretary may consider necessary or promising for the evaluation, or for the improvement, of the operation of this Act; and</text></subparagraph><subparagraph id="H174689D1BDA146F7818CC557B0A8CC37"><enum>(C)</enum><text>develop methodological standards for policymaking.</text></subparagraph></paragraph></subsection><subsection id="H215ABF5B464E49D8A98633CE41D72F81"><enum>(c)</enum><header>Audits</header><paragraph id="HC8BB018FA6E94F5ABEEEF3182FEEBD60"><enum>(1)</enum><header>In general</header><text>The Comptroller General of the United States shall conduct an audit of the Department of Health and Human Services every fifth fiscal year following the effective date of this Act to determine the effectiveness of the program in carrying out the duties under subsection (a).</text></paragraph><paragraph id="HC6796D31F1F24F0A86C5D50A253C4203"><enum>(2)</enum><header>Reports</header><text>The Comptroller General of the United States shall submit a report to Congress concerning the results of each audit conducted under this subsection.</text></paragraph></subsection></section><section id="H857E0CDF80954704BA3AEA4D44C030AD"><enum>402.</enum><header>Consultation</header><text display-inline="no-display-inline">The Secretary shall consult with Federal agencies, Indian tribes and urban Indian health organizations, and private entities, such as labor organizations representing health care workers, professional societies, national associations, nationally recognized associations of health care experts, medical schools and academic health centers, consumer groups, and business organizations in the formulation of guidelines, regulations, policy initiatives, and information gathering to ensure the broadest and most informed input in the administration of this Act. Nothing in this Act shall prevent the Secretary from adopting guidelines, consistent with the provisions of section 203(c), developed by such a private entity if, in the Secretary’s judgment, such guidelines are generally accepted as reasonable and prudent and consistent with this Act.</text></section><section id="H1EBB18D2BA854AA696EA1EBC901925D7"><enum>403.</enum><header>Regional administration</header><subsection id="HBA5D922159BF4232B559B3358911204D"><enum>(a)</enum><header>Coordination with regional offices</header><text>The Secretary shall establish and maintain regional offices for purposes of carrying out the duties specified in subsection (c) and promoting adequate access to, and efficient use of, tertiary care facilities, equipment, and services by individuals enrolled under this Act. Wherever possible, the Secretary shall incorporate regional offices of the Centers for Medicare &amp; Medicaid Services for this purpose.</text></subsection><subsection id="HA6307A06E2E04FA48CC2CEEDE1B5D353"><enum>(b)</enum><header>Appointment of regional directors</header><text>In each such regional office there shall be—</text><paragraph id="HCF7F8B499CAE46649F64C97F53C070E5"><enum>(1)</enum><text>one regional director appointed by the Secretary;</text></paragraph><paragraph id="H2F8C1E481EB04E929BABD9545D499BFE"><enum>(2)</enum><text>one deputy director appointed by the regional director to represent the Indian and Alaska Native tribes in the region, if any; and</text></paragraph><paragraph id="H668C07C52280462EB831F9EF1C374AC6"><enum>(3)</enum><text>one deputy direction appointed by the regional director to oversee long-term services and supports.</text></paragraph></subsection><subsection id="H8CB99413647340329903AACFCCBFD24C"><enum>(c)</enum><header>Regional office duties</header><text>Each regional director shall—</text><paragraph id="H4AF5BAC6B68C4A77A7CD5F545AD8A916"><enum>(1)</enum><text>provide an annual health care needs assessment with respect to the region under the director’s jurisdiction to the Secretary after a thorough examination of health needs and in consultation with public health officials, clinicians, patients, and patient advocates;</text></paragraph><paragraph id="H961031CC51864267A9BFCD6C143C9E5C"><enum>(2)</enum><text>recommend any changes in provider reimbursement or payment for delivery of health services determined appropriate by the regional director, subject to the provisions of title VI; and</text></paragraph><paragraph id="HD964424AA61341EB8EFD3EC5A706EA96"><enum>(3)</enum><text>establish a quality assurance mechanism in each such region in order to minimize both underutilization and overutilization of health care items and services and to ensure that all providers meet quality standards established pursuant to this Act.</text></paragraph></subsection></section><section id="H5F9B37E79F0548DEA10B0DC648B86247"><enum>404.</enum><header>Beneficiary ombudsman</header><subsection id="HE48536D2929F4D3CABF45B78A1D915FA"><enum>(a)</enum><header>In general</header><text>The Secretary shall appoint a Beneficiary Ombudsman who shall have expertise and experience in the fields of health care and education of, and assistance to, individuals enrolled under this Act.</text></subsection><subsection id="HDF7006A524934AC1A71FB7AB976C51F6"><enum>(b)</enum><header>Duties</header><text>The Beneficiary Ombudsman shall—</text><paragraph id="HCF4D9DDC42FB4AC4B18411071BFC0465"><enum>(1)</enum><text>receive complaints, grievances, and requests for information submitted by individuals enrolled under this Act or eligible to enroll under this Act with respect to any aspect of the Medicare for All Program;</text></paragraph><paragraph id="H90D46589786449FC8D9C4DBA4213BEE1"><enum>(2)</enum><text>provide assistance with respect to complaints, grievances, and requests referred to in paragraph (1), including assistance in collecting relevant information for such individuals, to seek an appeal of a decision or determination made by a regional office or the Secretary; and</text></paragraph><paragraph id="H49D6EB1AAA704EECBEE44E79D3051B07"><enum>(3)</enum><text>submit annual reports to Congress and the Secretary that describe the activities of the Ombudsman and that include such recommendations for improvement in the administration of this Act as the Ombudsman determines appropriate. The Ombudsman shall not serve as an advocate for any increases in payments or new coverage of services, but may identify issues and problems in payment or coverage policies.</text></paragraph></subsection></section><section commented="no" id="H50B995ED81C04D149FC7A3B6AF730D84"><enum>405.</enum><header>Conduct of related health programs</header><text display-inline="no-display-inline">In performing functions with respect to health personnel education and training, health research, environmental health, disability insurance, vocational rehabilitation, the regulation of food and drugs, and all other matters pertaining to health, the Secretary shall direct the activities of the Department of Health and Human Services toward contributions to the health of the people complementary to this Act.</text></section></subtitle><subtitle id="H5374A245D9D84F02BAD2FD010771D8CF"><enum>B</enum><header>Control Over Fraud and Abuse</header><section id="HD740DE72E08D436B9090E3033F11B3F2"><enum>411.</enum><header>Application of Federal sanctions to all fraud and abuse under the Medicare for All Program</header><text display-inline="no-display-inline">The following sections of the Social Security Act shall apply to this Act in the same manner as they apply to title XVIII or State plans under title XIX of the Social Security Act:</text><paragraph id="H262DB5F1799C4C67B98552CC02785DEC"><enum>(1)</enum><text>Section 1128 (relating to exclusion of individuals and entities).</text></paragraph><paragraph id="HC649583130F24A64A29B4177D1762AFB"><enum>(2)</enum><text>Section 1128A (civil monetary penalties).</text></paragraph><paragraph id="HF3534B819B4345B398C2FDDAA20609B8"><enum>(3)</enum><text>Section 1128B (criminal penalties).</text></paragraph><paragraph id="HF93C47F0DAFD434F982D54575077D04A"><enum>(4)</enum><text>Section 1124 (relating to disclosure of ownership and related information).</text></paragraph><paragraph id="H8109C09B72B5452D96AE739482AC6B58"><enum>(5)</enum><text>Section 1126 (relating to disclosure of certain owners).</text></paragraph><paragraph id="H9EE1F5EFB10A44BEB6580CDFC073A6CB"><enum>(6)</enum><text>Section 1877 (relating to physician referrals).</text></paragraph></section></subtitle></title><title id="H200D5417BFE5490EB07FA6AB931003A6"><enum>V</enum><header>Quality Assessment</header><section id="H07C969D4EE4F4981A47F5344C262C98B"><enum>501.</enum><header>Quality standards</header><subsection commented="no" id="HB7DE2833C1D3446FACA86C5CF744654C"><enum>(a)</enum><header>In general</header><text>All standards and quality measures under this Act shall be implemented and evaluated by the Center for Clinical Standards and Quality of the Centers for Medicare &amp; Medicaid Services (referred to in this title as the <quote>Center</quote>) or such other agency determined appropriate by the Secretary, in coordination with the Agency for Healthcare Research and Quality and other offices of the Department of Health and Human Services.</text></subsection><subsection id="H33BE7ACA95924E82BF76C3D71C2363A4"><enum>(b)</enum><header>Duties of the center</header><text>The Center shall perform the following duties:</text><paragraph id="H0CFE9C4193874033816D29D5FD439176"><enum>(1)</enum><text>Review and evaluate each practice guideline developed under part B of title IX of the Public Health Service Act. In so reviewing and evaluating, the Center shall determine whether the guideline should be recognized as a national practice guideline in accordance with and subject to the provisions of section 203(c).</text></paragraph><paragraph id="H4B1FF845E647482FB0AA6DCC4E2282E8"><enum>(2)</enum><text display-inline="yes-display-inline">Review and evaluate each standard of quality, performance measure, and medical review criterion developed under part B of title IX of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/299">42 U.S.C. 299 et seq.</external-xref>). In so reviewing and evaluating, the Center shall determine whether the standard, measure, or criterion is appropriate for use in assessing or reviewing the quality of items and services provided by health care institutions or health care professionals. The use of mechanisms that discriminate against people with disabilities is prohibited for use in any value or cost-effectiveness assessments. The Center shall consider the evidentiary basis for the standard, and the validity, reliability, and feasibility of measuring the standard.</text></paragraph><paragraph id="HDA14A2A860BE4013BBB48C12F88E0056"><enum>(3)</enum><text>Adoption of methodologies for profiling the patterns of practice of health care professionals and for identifying and notifying outliers.</text></paragraph><paragraph id="H96517ACBC33E48C795D62A3155AE991C"><enum>(4)</enum><text>Development of minimum criteria for competence for entities that can qualify to conduct ongoing and continuous external quality reviews in the administrative regions. Such criteria shall require such an entity to be administratively independent of the individual or board that administers the region and shall ensure that such entities do not provide financial incentives to reviewers to favor one pattern of practice over another. The Center shall ensure coordination and reporting by such entities to ensure national consistency in quality standards.</text></paragraph><paragraph id="H471866F6E1854C4483554C2A823E6923"><enum>(5)</enum><text>Submission of a report to the Secretary annually specifically on findings from outcomes research and development of practice guidelines that may affect the Secretary’s determination of coverage of services under section 401(a)(1)(G).</text></paragraph></subsection></section><section id="H51CD6E7631B94015BE0C08902045631F"><enum>502.</enum><header>Addressing health care disparities</header><subsection id="HD10E2EE673064C23B9D6E81984FC40C2"><enum>(a)</enum><header>Evaluating data collection approaches</header><text display-inline="yes-display-inline">The Center shall evaluate approaches for the collection of data under this Act, to be performed in conjunction with existing quality reporting requirements and programs under this Act, that allow for the ongoing, accurate, and timely collection of data on disparities in health care services and performance on the basis of race, ethnicity, national origin, primary language use, age, disability, sex (including gender identity and sexual orientation), geography, or socioeconomic status. In conducting such evaluation, the Center shall consider the following objectives:</text><paragraph id="H7F098BDD2E4B471BB372411B025F06F5"><enum>(1)</enum><text>Protecting patient privacy.</text></paragraph><paragraph id="HC44F4B2CA4DF45EFA5DEB4997E519044"><enum>(2)</enum><text>Minimizing the administrative burdens of data collection and reporting on providers under this Act.</text></paragraph><paragraph id="HB6E113027DFB4585A287230E7FC4FACF"><enum>(3)</enum><text display-inline="yes-display-inline">Improving data on race, ethnicity, national origin, primary language use, age, disability, sex (including gender identity and sexual orientation), geography, and socioeconomic status.</text></paragraph></subsection><subsection id="HDC5E70DE89694156B5AE7708A0B98E90"><enum>(b)</enum><header>Reports to congress</header><paragraph id="H1E48460802AF4B2FB0E40AC29E777BE0"><enum>(1)</enum><header>Report on evaluation</header><text>Not later than 18 months after the date on which benefits first become available as described in section 106(a), the Center shall submit to Congress and the Secretary a report on the evaluation conducted under subsection (a). Such report shall, taking into consideration the results of such evaluation—</text><subparagraph id="H2C676AC35947464E9D6F03B64436E28C"><enum>(A)</enum><text display-inline="yes-display-inline">identify approaches (including defining methodologies) for identifying and collecting and evaluating data on health care disparities on the basis of race, ethnicity, national origin, primary language use, age, disability, sex (including gender identity and sexual orientation), geography, or socioeconomic status under the Medicare for All Program; and</text></subparagraph><subparagraph id="H82059EC9C7884E178185E4A9537638D8"><enum>(B)</enum><text display-inline="yes-display-inline">include recommendations on the most effective strategies and approaches to reporting quality measures, as appropriate, on the basis of race, ethnicity, national origin, primary language use, age, disability, sex (including gender identity and sexual orientation), geography, or socioeconomic status.</text></subparagraph></paragraph><paragraph id="H3A35E6F57B46451AB282BDF5BC7B8CA1"><enum>(2)</enum><header>Report on data analyses</header><text>Not later than 4 years after the submission of the report under subsection (b)(1), and every 4 years thereafter, the Center shall submit to Congress and the Secretary a report that includes recommendations for improving the identification of health care disparities based on the analyses of data collected under subsection (c).</text></paragraph></subsection><subsection id="HA463EE4E479B46A3A7465E87DF5D98AF"><enum>(c)</enum><header>Implementing effective approaches</header><text display-inline="yes-display-inline">Not later than 2 years after the date on which benefits first become available as described in section 106(a), the Secretary shall implement the approaches identified in the report submitted under subsection (b)(1) for the ongoing, accurate, and timely collection and evaluation of data on health care disparities on the basis of race, ethnicity, national origin, primary language use, age, disability, sex (including gender identity and sexual orientation), geography, or socioeconomic status.</text></subsection></section></title><title id="HCAD34F821FB448D4B0E7C49F325B0D17"><enum>VI</enum><header>Health Budget; Payments; Cost Containment Measures</header><subtitle id="H9DE6AED059384373B35D3187F2CDF937"><enum>A</enum><header>Budgeting</header><section id="HA7858BA6F96448E79144AFF02BE91610"><enum>601.</enum><header>National health budget</header><subsection id="H241955CF85DA4ADE9A8B7848DAFD3A24"><enum>(a)</enum><header>National health budget</header><paragraph id="HBFADB166947C4196A63B4E66EB4568B7"><enum>(1)</enum><header>In general</header><text>By not later than September 1 of each year, beginning with the year prior to the date on which benefits first become available as described in section 106(a), the Secretary shall establish a national health budget, which specifies a budget for the total expenditures to be made for covered health care items and services under this Act.</text></paragraph><paragraph id="H83164316E2C04DE4A94E44C1CD74A8F6"><enum>(2)</enum><header>Division of budget into components</header><text>The national health budget shall consist of the following components:</text><subparagraph id="HDB223439FF3A468E8FC777020AD7B4D6"><enum>(A)</enum><text>An operating budget.</text></subparagraph><subparagraph id="HE1D5F50FEE2947BDAB73CB0411B08129"><enum>(B)</enum><text>A capital expenditures budget.</text></subparagraph><subparagraph id="H0C4DAB10C8644E97B3D894B3C2A26BAF"><enum>(C)</enum><text>A special projects budget.</text></subparagraph><subparagraph id="HECF74CEB4F42481EB41ED23A18C13A66"><enum>(D)</enum><text>Quality assessment activities under title V.</text></subparagraph><subparagraph id="HBA5ECD601A9843C1A51FF5AFE4D61DA4"><enum>(E)</enum><text>Health professional education expenditures.</text></subparagraph><subparagraph id="HE571CD19D2454677B14C11B58A24D7B1"><enum>(F)</enum><text>Administrative costs, including costs related to the operation of regional offices.</text></subparagraph><subparagraph id="H7054A508837F4DE892DF99465404EB35"><enum>(G)</enum><text display-inline="yes-display-inline">A reserve fund.</text></subparagraph><subparagraph id="HE6D3DD522FFC46C38EDD60A800DFCD3D"><enum>(H)</enum><text>Prevention and public health activities.</text></subparagraph></paragraph><paragraph id="HDCEDC3F46FB444578C52128FB0B2DA1C"><enum>(3)</enum><header>Allocation among components</header><text>The Secretary shall allocate the funds received for purposes of carrying out this Act among the components described in paragraph (2) in a manner that ensures—</text><subparagraph id="H39BED113B275460A915FE34DDC0C4604"><enum>(A)</enum><text display-inline="yes-display-inline">that the operating budget allows for every participating provider in the Medicare for All Program to meet the needs of their respective patient populations;</text></subparagraph><subparagraph id="HAFDA78686B334F5FA8C74D24B63146A6"><enum>(B)</enum><text>that the special projects budget is sufficient to meet the health care needs within areas described in paragraph (2)(C) through the construction, renovation, and staffing of health care facilities in a reasonable timeframe;</text></subparagraph><subparagraph id="HC370F7B724D848EA815AD23D3EF7E6FF"><enum>(C)</enum><text>a fair allocation for quality assessment activities; and</text></subparagraph><subparagraph id="HDB8761E6B59B4DAFAC3838760B733FC6"><enum>(D)</enum><text>that the health professional education expenditure component is sufficient to provide for the amount of health professional education expenditures sufficient to meet the need for covered health care services.</text></subparagraph></paragraph><paragraph id="H930B5D796EA0414A931A6B33B4525372"><enum>(4)</enum><header>Regional allocation</header><text>The Secretary shall annually provide each regional office with an allotment the Secretary determines appropriate for purposes of carrying out this Act in such region, including payments to providers in such region, capital expenditures in such region, special projects in such region, health professional education in such region, administrative expenses in such region, and prevention and public health activities in such region.</text></paragraph><paragraph commented="no" id="HE725AD77FC5C4A24AA7E1BFFC6555DF1"><enum>(5)</enum><header>Operating budget</header><text>The operating budget described in paragraph (2)(A) shall be used for—</text><subparagraph commented="no" id="H7D2CB493FF2B46F1B8441CB8BFD4D5D4"><enum>(A)</enum><text>payments to institutional providers pursuant to section 611; and</text></subparagraph><subparagraph commented="no" id="H666C886B485F40E5921A65581FAF733D"><enum>(B)</enum><text>payments to individual providers pursuant to section 612.</text></subparagraph></paragraph><paragraph id="H0DEB30463C004CFDBAB70A416EEFDD9E"><enum>(6)</enum><header>Capital expenditures budget</header><text>The capital expenditures budget described in paragraph (2)(B) shall be used for—</text><subparagraph id="H151A0590AD094237A83BB8A16F32D8CC"><enum>(A)</enum><text>the construction or renovation of health care facilities, excluding congregate or segregated facilities for individuals with disabilities who receive long-term care services and support; and</text></subparagraph><subparagraph id="H113F1607EF804F268FA1DF38336C4DA9"><enum>(B)</enum><text>major equipment purchases.</text></subparagraph></paragraph><paragraph id="HF88BBED864D84B3FA5A5B794AD180AE6"><enum>(7)</enum><header>Special projects budget</header><text display-inline="yes-display-inline">The special projects budget described in paragraph (2)(C) shall be used for the purposes of allocating funds for the construction of new facilities, major equipment purchases, and staffing in rural or medically underserved areas (as defined in section 330(b)(3) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b">42 U.S.C. 254b(b)(3)</external-xref>)), including areas designated as health professional shortage areas (as defined in section 332(a) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254e">42 U.S.C. 254e(a)</external-xref>)), and to address health disparities, including racial, ethnic, national origin, primary language use, age, disability, sex (including gender identity and sexual orientation), geography, or socioeconomic health disparities.</text></paragraph><paragraph id="H1BEC2A5BACFF4054A1226CB3D7012013"><enum>(8)</enum><header>Temporary worker assistance</header><subparagraph id="H222CD6B10B3E44F2A7AC8D90C9F0790D"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">For up to 5 years following the date on which benefits first become available as described in section 106(a), at least 1 percent of the budget shall be allocated to programs providing assistance to workers who perform functions in the administration of the health insurance system, or related functions within health care institutions or organizations who may be affected by the implementation of this Act and who may experience economic dislocation as a result of the implementation of this Act.</text></subparagraph><subparagraph id="H7FF5E6106D0A438D8B24A513323B9295"><enum>(B)</enum><header>Clarification</header><text display-inline="yes-display-inline">Assistance described in subparagraph (A) shall include wage replacement, retirement benefits, job training and placement, preferential hiring, and education benefits.</text></subparagraph></paragraph><paragraph id="H470C19F1A0394499A1143DC51BB95EFA"><enum>(9)</enum><header>Reserve fund</header><text display-inline="yes-display-inline">The reserve fund described in paragraph (2)(G) shall be used to respond to the costs of an epidemic, pandemic, natural disaster, or other such health emergency, or market-shift adjustments related to patient volume.</text></paragraph><paragraph id="HC6D7FE5CF3E848C3952BE614CD3AF779"><enum>(10)</enum><header>Supplemental Indian Health Service allocation</header><text display-inline="yes-display-inline">The Secretary shall annually determine the need to provide an allotment of supplemental funds to Indian Health Services, including payments to providers, capital expenditures, special projects, health professional education, administrative expenses, and prevention and public health activities.</text></paragraph></subsection><subsection id="H2068C2CDC0494C779C0B6AC6F283631E"><enum>(b)</enum><header>Definitions</header><text>In this section:</text><paragraph id="HD260219FAFC74A26B78F64622BFE878D"><enum>(1)</enum><header>Capital expenditures</header><text>The term <term>capital expenditures</term> means expenses for the purchase, lease, construction, or renovation of capital facilities and for major equipment.</text></paragraph><paragraph id="H48EEFCFC605248718F588A98F209E307"><enum>(2)</enum><header>Health professional education expenditures</header><text display-inline="yes-display-inline">The term <term>health professional education expenditures</term> means expenditures in hospitals and other health care facilities to cover costs associated with teaching and related research activities, including the impact of workforce diversity on patient outcomes.</text></paragraph></subsection></section></subtitle><subtitle id="H90AB6890A94B436492DCAEE5F4065797"><enum>B</enum><header>Payments to Providers</header><section id="HA05B00C558D54F2EA590AD6BA5DB2AB9"><enum>611.</enum><header>Payments to institutional providers based on global budgets</header><subsection id="HF2FBED5B139C43509FF0EA3696553426"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than the beginning of each fiscal quarter during which an institutional provider of care (including hospitals, skilled nursing facilities, Federally qualified health centers, and independent dialysis facilities) is to furnish items and services under this Act, the Secretary shall pay to such institutional provider a lump sum in accordance with the succeeding provisions of this subsection and consistent with the following:</text><paragraph id="H2453F6FA4B644BA3B6959626A9251F10"><enum>(1)</enum><header>Payment in Full</header><text display-inline="yes-display-inline">Such payment shall be considered as payment in full for all operating expenses for items and services furnished under this Act, whether inpatient or outpatient, by such provider for such quarter, including outpatient or any other care provided by the institutional provider or provided by any health care provider who provided items and services pursuant to an agreement paid through the global budget as described in paragraph (3).</text></paragraph><paragraph id="H8B46D1C1E89A48A0A15EB96E215895C5"><enum>(2)</enum><header>Quarterly Review</header><text display-inline="yes-display-inline">The regional director, on a quarterly basis, shall review whether requirements of the institutional provider’s participation agreement and negotiated global budget have been performed and shall determine whether adjustments to such institutional provider’s payment are warranted. This review shall include consideration for additional funding necessary for unanticipated items and services for individuals with complex medical needs or market-shift adjustments related to patient volume. The review shall also include an assessment of any adjustments made to ensure that accuracy and need for adjustment was appropriate.</text></paragraph><paragraph id="H9A14FE9D0F434F39AD2A3EC7E5F3E107"><enum>(3)</enum><header>Agreements for Salaried Payments for Certain Providers</header><text display-inline="yes-display-inline">Certain group practices and other health care providers, as determined by the Secretary, with agreements to provide items and services at a specified institutional provider paid a global budget under this subsection may elect to be paid through such institutional provider’s global budget in lieu of payment under section 612 of this title. Any—</text><subparagraph id="H3017409EF5B74F51A9240B88877D9C00"><enum>(A)</enum><text display-inline="yes-display-inline">individual health care professional of such group practice or other provider receiving payment through an institutional provider’s global budget shall be paid on a salaried basis that is equivalent to salaries or other compensation rates negotiated for individual health care professionals of such institutional provider; and</text></subparagraph><subparagraph id="HCAE9DEA7C9974A60A890D8A0B7E425C7"><enum>(B)</enum><text display-inline="yes-display-inline">any group practice or other health care provider that receives payment through an institutional provider global budget under this paragraph shall be subject to the same reporting and disclosure requirements of the institutional provider.</text></subparagraph></paragraph><paragraph id="HAEDB51BBAC68451184DD7198C2B63379"><enum>(4)</enum><header>Interim adjustments</header><text display-inline="yes-display-inline">The regional director shall consider a petition for adjustment of any payment under this section filed by an institutional provider at any time based on the following:</text><subparagraph id="HE65A81837CB4496196D7F7B1CEA7A872"><enum>(A)</enum><text display-inline="yes-display-inline">Factors that led to increased costs for the institutional provider that can reasonably be considered to be unanticipated and out of the control of the institutional provider, such as—</text><clause id="H7EBE11CAAC49401EA85223D1F551F472"><enum>(i)</enum><text>natural disasters;</text></clause><clause id="H4A12EE098BE64288842DDA5B3707727B"><enum>(ii)</enum><text>outbreaks of epidemics or infectious diseases;</text></clause><clause id="HEFBFFFD3370F4860A9C6CE74FD60B6D3"><enum>(iii)</enum><text>unexpected facility or equipment repairs or purchases;</text></clause><clause id="HA3E3B0B3CD77456E96AA3D6158D0415A"><enum>(iv)</enum><text>significant and unexpected increases in pharmaceutical or medical device prices; and</text></clause><clause id="HB63D09B924A84481B868B69747B277B9"><enum>(v)</enum><text>unanticipated increases in complex or high-cost patients or care needs.</text></clause></subparagraph><subparagraph id="H18965BF59D8348F38491628CF97ECBA2"><enum>(B)</enum><text>Changes in Federal or State law that result in a change in costs.</text></subparagraph><subparagraph id="H708B5B946A6A4368B187E1BEB1AFA1D2"><enum>(C)</enum><text display-inline="yes-display-inline">Reasonable increases in labor costs, including salaries and benefits, and changes in collective bargaining agreements, prevailing wage, or local law.</text></subparagraph></paragraph></subsection><subsection id="H1DB212260D724B0CBB79E1B554AA81F9"><enum>(b)</enum><header>Payment amount</header><paragraph id="H9D17C390BD45479BA26AE5D687E8E242"><enum>(1)</enum><header>In general</header><text>The amount of each payment to a provider described in subsection (a) shall be determined before the start of each fiscal year through negotiations between the provider and the regional director with jurisdiction over such provider. Such amount shall be based on factors specified in paragraph (2).</text></paragraph><paragraph id="HD768181E294643EE8A9D8C17BA8227DE"><enum>(2)</enum><header>Payment factors</header><text>Payments negotiated pursuant to paragraph (1) shall take into account, with respect to a provider—</text><subparagraph id="HD75B4439D75347D5A80A521A5731A386"><enum>(A)</enum><text>the historical volume of services provided for each item and services in the previous 3-year period;</text></subparagraph><subparagraph id="HE4C4E94F7A734CFE9968C12462683CB0"><enum>(B)</enum><text>the actual expenditures of such provider in such provider’s most recent cost report under title XVIII of the Social Security Act for each item and service compared to—</text><clause id="H37C8317C45374BAB9387CCE400D5EB2B"><enum>(i)</enum><text>such expenditures for other institutional providers in the director’s jurisdiction; and</text></clause><clause id="H69F0A9B2DBF040B398D4C02525BD7777"><enum>(ii)</enum><text>normative payment rates established under comparative payment rate systems, including any adjustments, for such items and services;</text></clause></subparagraph><subparagraph id="H5168C4CC44344CF5BB91761697590082"><enum>(C)</enum><text>projected changes in the volume and type of items and services to be furnished;</text></subparagraph><subparagraph id="H35427584337548A992BB44D60105F598"><enum>(D)</enum><text display-inline="yes-display-inline">wages for employees, including any necessary increases for mandatory minimum safe registered nurse-to-patient ratios and optimal staffing levels for physicians and other health care workers;</text></subparagraph><subparagraph id="HA9C47F0E48A44E259A591638B0D8F392"><enum>(E)</enum><text>the provider’s maximum capacity to provide items and services;</text></subparagraph><subparagraph id="HCD699CBE062B4812A7D04A41092560EF"><enum>(F)</enum><text>education and prevention programs;</text></subparagraph><subparagraph id="H4D399657B1474E218C621E9EACED2C19"><enum>(G)</enum><text>permissible adjustment to the provider’s operating budget due to factors such as—</text><clause id="H28D24E22D5AC4620885DFF5940BAF015"><enum>(i)</enum><text>an increase in primary or specialty care access;</text></clause><clause id="HD568FC48F2B24434BC37B11C6FE103F0"><enum>(ii)</enum><text>efforts to decrease health care disparities in rural or medically underserved areas;</text></clause><clause id="H54B4F49A47124CE589CD45A655F333D9"><enum>(iii)</enum><text>a response to emergent epidemic conditions;</text></clause><clause id="H29833D3B56F8460CABAB3E7CFB9DF607"><enum>(iv)</enum><text display-inline="yes-display-inline">an increase in complex or high-cost patients or care needs; or</text></clause><clause id="HB33B8453FC8E44138C4F6B2D0FB2745A"><enum>(v)</enum><text>proposed new and innovative patient care programs at the institutional level;</text></clause></subparagraph><subparagraph id="HFA9ACBA2FFB441A6BF88223B21C7422E"><enum>(H)</enum><text display-inline="yes-display-inline">whether the provider is located in a high social vulnerability index community, ZIP Code, or census track, or is a minority-serving provider; and</text></subparagraph><subparagraph id="H1AC678A899364113914D0742DD77B99B"><enum>(I)</enum><text>any other factor determined appropriate by the Secretary.</text></subparagraph></paragraph><paragraph id="H57A4A18A18F34838A9AC28A15AA197DF"><enum>(3)</enum><header>Limitation</header><text>Payment amounts negotiated pursuant to paragraph (1) may not—</text><subparagraph id="H0F7A7575FBD14697A4E011537AE86BFA"><enum>(A)</enum><text>take into account capital expenditures of the provider or any other expenditure not directly associated with the provision of items and services by the provider to an individual;</text></subparagraph><subparagraph id="HBC5FE94AC3FB498CB63E867B62227CB5"><enum>(B)</enum><text>be used by a provider for capital expenditures or such other expenditures;</text></subparagraph><subparagraph id="HFDFC954B17C14870A7387FD5004431DB"><enum>(C)</enum><text>exceed the provider’s capacity to provide care under this Act; or</text></subparagraph><subparagraph id="H67301E68DF104EA5B8E5B02AA46A5732"><enum>(D)</enum><text display-inline="yes-display-inline">be used to pay or otherwise compensate any board member, executive, or administrator of the institutional provider who has any interest or relationship prohibited under section 301(b)(2) of this Act or disclosed under section 301 of this Act.</text></subparagraph></paragraph><paragraph id="H2D9567E1227D4D619A161DFC5E7EB5FE"><enum>(4)</enum><header>Limitation on Compensation</header><text display-inline="yes-display-inline">Compensation costs for any employee or any contractor or any subcontractor employee of an institutional provider receiving global budgets under this section shall meet the compensation cap established in section 702 of the Bipartisan Budget Act of 2013 (<external-xref legal-doc="usc" parsable-cite="usc/41/4304">41 U.S.C. 4304(a)(16)</external-xref>) and implementing regulations.</text></paragraph><paragraph id="H05F11A3E4D71490FAEEC16BAF1190228"><enum>(5)</enum><header>Regional negotiations permitted</header><text>Subject to section 614, a regional director may negotiate changes to an institutional provider’s global budget, including any adjustments to address unforeseen market-shifts related to patient volume.</text></paragraph></subsection><subsection id="H9C7747250B2C4C76AA75BDE3D6667D31"><enum>(c)</enum><header>Baseline rates and adjustments</header><paragraph id="HF468CD8D71234FF7B84D416AA4405165"><enum>(1)</enum><header>In general</header><text>The Secretary shall use existing prospective payment systems under title XVIII of the Social Security Act to serve as the comparative payment rate system in global budget negotiations described in subsection (b). The Secretary shall update such comparative payment rate systems annually.</text></paragraph><paragraph id="H275BB476F93F4AD9B029BC8C31840D95"><enum>(2)</enum><header>Specifications</header><text>In developing the comparative payment rate system, the Secretary shall use only the operating base payment rates under each such prospective payment systems with applicable adjustments.</text></paragraph><paragraph id="H54D1E6499D824231A18D490EF9877BF5"><enum>(3)</enum><header>Limitation</header><text>The comparative rate system established under this subsection shall not include the value-based payment adjustments and the capital expenses base payment rates that may be included in such a prospective payment system.</text></paragraph><paragraph id="HAC8F03056B024207B91FFA190E61EE26"><enum>(4)</enum><header>Initial year</header><text>In the first year that global budget payments under this Act are available to institutional providers and for purposes of selecting a comparative payment rate system used during initial global budget negotiations for each institutional provider, the Secretary shall take into account the appropriate prospective payment system from the most recent year under title XVIII of the Social Security Act to determine what operating base payment the institutional provider would have been paid for covered items and services furnished the preceding year with applicable adjustments, excluding value-based payment adjustments, based on such prospective payment system.</text></paragraph></subsection><subsection id="HA60B4422726247D9BBC5BE6B7A9AEE65"><enum>(d)</enum><header>Operating expenses</header><text>For purposes of this title, <quote>operating expenses</quote> of a provider include the following:</text><paragraph id="H8CE74995A6E0441FBB0A433CD36F5CCB"><enum>(1)</enum><text>The cost of all items and services associated with the provision of inpatient care and outpatient care, including the following:</text><subparagraph id="H9C486E612B614468B3B6314D29DB1C6A"><enum>(A)</enum><text>Wages and salary costs for physicians, nurses, and other health care practitioners employed by an institutional provider, including mandatory minimum safe registered nurse-to-patient staffing ratios and optimal staffing levels for physicians and other healthcare workers.</text></subparagraph><subparagraph id="H1FD82AB9F88C459184A316EBCC3E0594"><enum>(B)</enum><text>Wages and salary costs for all ancillary staff and services.</text></subparagraph><subparagraph id="H0E424783F43D46C186BD5739A2FA4865"><enum>(C)</enum><text>Costs of all pharmaceutical products administered by health care clinicians at the institutional provider’s facilities or through services provided in accordance with State licensing laws or regulations under which the institutional provider operates.</text></subparagraph><subparagraph id="H937CA4A00EF34F50ABE6A6C02A5D5F55"><enum>(D)</enum><text>Costs for infectious disease response preparedness, including maintenance of a 1-year or 365-day stockpile of personal protective equipment, occupational testing and surveillance, medical services for occupational infectious disease exposure, and contact tracing.</text></subparagraph><subparagraph id="HD33CC23612B547078F7CBD51D5AEF83D"><enum>(E)</enum><text>Purchasing and maintenance of medical devices, supplies, and other health care technologies, including diagnostic testing equipment.</text></subparagraph><subparagraph id="H05C214F5DD78408BB0C1077CD5D02CAD"><enum>(F)</enum><text>Costs of all incidental services necessary for safe patient care and handling.</text></subparagraph><subparagraph id="HAED296BE9363465580EBB251C95A9869"><enum>(G)</enum><text>Costs of patient care, education, and prevention programs, including occupational health and safety programs, public health programs, and necessary staff to implement such programs, for the continued education and health and safety of clinicians and other individuals employed by the institutional provider.</text></subparagraph></paragraph><paragraph id="HFC8853EB96364B54AB012FA05BBB4E1D"><enum>(2)</enum><text>Administrative costs for the institutional provider.</text></paragraph></subsection></section><section id="H9B6AC9B38BD64B10A0C795DAE41F1A74"><enum>612.</enum><header>Payment to individual providers through fee-for-service</header><subsection id="H3153214C3D804947869612ECD0283E55"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">In the case of a provider not described in section 611(a) (including those in group practices who are not receiving payment on a salaried basis described in section 611(a)(3) and providers of home and community-based services), payment for items and services furnished under this Act for which payment is not otherwise made under section 611 shall be made by the Secretary in amounts determined under the fee schedule established pursuant to subsection (b). Such payment shall be considered to be payment in full for such items and services, and a provider receiving such payment may not charge the individual receiving such item or service in any amount.</text></subsection><subsection id="HA9AFA3A0D1524C3B8C67EEF63D94AE0A"><enum>(b)</enum><header>Fee schedule</header><paragraph id="HFE9110DE20AF44EEB0B25421ABC0293B"><enum>(1)</enum><header>Establishment</header><text display-inline="yes-display-inline">Not later than 1 year after the date of the enactment of this Act, and in consultation with providers and regional office directors, the Secretary shall establish a national fee schedule for items and services payable under this Act. The Secretary shall evaluate the effectiveness of the fee-for-service structure and update such fee schedule annually.</text></paragraph><paragraph id="H73FB4AAF03F749E8885C3B2DC076D123"><enum>(2)</enum><header>Amounts</header><text>In establishing payment amounts for items and services under the fee schedule established under paragraph (1), the Secretary shall take into account—</text><subparagraph id="H2D94B5AB3B774B22A95734A1AD610014"><enum>(A)</enum><text>the amounts payable for such items and services under title XVIII of the Social Security Act; and</text></subparagraph><subparagraph id="HB0D387AD1F8D4E4AB8D30C37E4BE6B07"><enum>(B)</enum><text>the expertise of providers and value of items and services furnished by such providers.</text></subparagraph></paragraph></subsection><subsection id="H0439AA22B8334B9DAA5787C8E346035D"><enum>(c)</enum><header>Electronic billing</header><text>The Secretary shall establish a uniform national system for electronic billing for purposes of making payments under this subsection.</text></subsection><subsection id="H62B1DA9513D64E8E99F624C65F7E8928"><enum>(d)</enum><header>Physician practice review board</header><text display-inline="yes-display-inline">Each director of a regional office, in consultation with representatives of physicians practicing in that region, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician-delivered items and services. The use of mechanisms that discriminate against people with disabilities is prohibited for use in any value or cost-effectiveness assessments.</text></subsection></section><section commented="no" id="H514ABB2E2EB54B2B9E9E502F1314D211"><enum>613.</enum><header>Ensuring accurate valuation of services under the Medicare physician fee schedule</header><subsection commented="no" id="H43251FA296B94E3B8E1CCF822EC5BB8F"><enum>(a)</enum><header>Standardized and documented review process</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended by adding at the end the following new subparagraph:</text><quoted-block display-inline="no-display-inline" id="H78B283CE6C4A432382A47EBF64A5E5AE" style="OLC"><subparagraph commented="no" id="H094A797418C7436CA726117FA1DA09B8"><enum>(P)</enum><header>Standardized and documented review process</header><clause commented="no" id="HD51A564DE0A54CEEA280A7B52D7A03C3"><enum>(i)</enum><header>In general</header><text>Not later than one year after the date of enactment of this subparagraph, the Secretary shall establish, document, and make publicly available, in consultation with the Office of Primary Health Care, a standardized process for reviewing the relative values of physicians' services under this paragraph.</text></clause><clause commented="no" id="H0B6F8F6C0F7145A5A8EFE6FDF955600A"><enum>(ii)</enum><header>Minimum requirements</header><text>The standardized process shall include, at a minimum, methods and criteria for identifying services for review, prioritizing the review of services, reviewing stakeholder recommendations, and identifying additional resources to be considered during the review process.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" id="HC6C53215E9E54A6181DE5DC12D3B213D"><enum>(b)</enum><header>Planned and documented use of funds</header><text>Section 1848(c)(2)(M) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(M)</external-xref>) is amended by adding at the end the following new clause:</text><quoted-block display-inline="no-display-inline" id="HFE578C1061AB4096A76E33F0106A208A" style="OLC"><clause commented="no" id="HB481023CA090484BBD27E1EB299B6CC5"><enum>(x)</enum><header>Planned and documented use of funds</header><text>For each fiscal year (beginning with the first fiscal year beginning on or after the date of enactment of this clause), the Secretary shall provide to Congress a written plan for using the funds provided under clause (ix) to collect and use information on physicians’ services in the determination of relative values under this subparagraph.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" id="HE6F44CE082C94BB78498748B1642492A"><enum>(c)</enum><header>Internal tracking of reviews</header><paragraph commented="no" id="H8A37B5FAFFFE41FDAC2B8393EE8ACF5F"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress a proposed plan for systematically and internally tracking the Secretary’s review of the relative values of physicians' services, such as by establishing an internal database, under section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>), as amended by this section.</text></paragraph><paragraph commented="no" id="H6AC68AF1A71842C9AE06A3FD60C757B3"><enum>(2)</enum><header>Minimum requirements</header><text>The proposal shall include, at a minimum, plans and a timeline for achieving the ability to systematically and internally track the following:</text><subparagraph commented="no" id="H0D13AFDF6BED41D5ADADF076F3452037"><enum>(A)</enum><text>When, how, and by whom services are identified for review.</text></subparagraph><subparagraph commented="no" id="HD3D776C5FAD940C48F27AF38078675CC"><enum>(B)</enum><text>When services are reviewed or reviewed or when new services are added.</text></subparagraph><subparagraph commented="no" id="HB34D08042852420FA59E4C6E4BF90EA1"><enum>(C)</enum><text>The resources, evidence, data, and recommendations used in reviews.</text></subparagraph><subparagraph commented="no" id="H1756A4845A8346B3884A3C62FEB17D0A"><enum>(D)</enum><text>When relative values are adjusted.</text></subparagraph><subparagraph commented="no" id="H09F3A4A2C5EC4DA9B647F2AB4D472A43"><enum>(E)</enum><text>The rationale for final relative value decisions.</text></subparagraph></paragraph></subsection><subsection commented="no" id="H4C8C009C8B5A42E2B29DD2B957CCF436"><enum>(d)</enum><header>Frequency of review</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended—</text><paragraph commented="no" id="HCE1046963F0345CA9E0BC73A5EC48AE7"><enum>(1)</enum><text>in subparagraph (B)(i), by striking <quote>5</quote> and inserting <quote>4</quote>; and</text></paragraph><paragraph commented="no" id="H581FF1B93C624C83ABE6D18C3C979B73"><enum>(2)</enum><text>in subparagraph (K)(i)(I), by striking <quote>periodically</quote> and inserting <quote>annually</quote>.</text></paragraph></subsection><subsection commented="no" id="HAC7662C938DE4CAB8B567CA33F00386D"><enum>(e)</enum><header>Consultation with Medicare Payment Advisory Commission</header><paragraph commented="no" id="H8AFB669DBB1A4BE09781E5587CBB7CEB"><enum>(1)</enum><header>In general</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended—</text><subparagraph commented="no" id="H01DA15193C2546DA91F581E8031F34BE"><enum>(A)</enum><text>in subparagraph (B)(i), by inserting <quote>in consultation with the Medicare Payment Advisory Commission,</quote> after <quote>The Secretary,</quote>; and</text></subparagraph><subparagraph commented="no" id="H1BD3082CACCF4AD681147CBE51516519"><enum>(B)</enum><text>in subparagraph (K)(i)(I), as amended by subsection (d)(2), by inserting <quote>, in coordination with the Medicare Payment Advisory Commission,</quote> after <quote>annually</quote>.</text></subparagraph></paragraph><paragraph commented="no" id="H81521E1DC8ED4C06B41049EE160C3AEE"><enum>(2)</enum><header>Conforming amendments</header><text>Section 1805 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-6">42 U.S.C. 1395b–6</external-xref>) is amended—</text><subparagraph commented="no" id="H3B40857649E846B9A9A617E4718BFABC"><enum>(A)</enum><text>in subsection (b)(1)(A), by inserting the following before the semicolon at the end: <quote>and including coordinating with the Secretary in accordance with section 1848(c)(2) to systematically review the relative values established for physicians' services, identify potentially misvalued services, and propose adjustments to the relative values for physicians' services</quote>; and</text></subparagraph><subparagraph commented="no" id="H8C2A4B01DB534FA78F5664CD4F268EDE"><enum>(B)</enum><text>in subsection (e)(1), in the second sentence, by inserting <quote>or the Ranking Minority Member</quote> after <quote>the Chairman</quote>.</text></subparagraph></paragraph></subsection><subsection commented="no" id="H68E5287361B24046A285012D5414B0B3"><enum>(f)</enum><header>Periodic audit by the Comptroller General</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>), as amended by subsection (a), is amended by adding at the end the following new subparagraph:</text><quoted-block display-inline="no-display-inline" id="HD559019850F24FCB97D06A38C37489CC" style="OLC"><subparagraph commented="no" id="H4D154CA141E047ADA8563A93E76D1EC0"><enum>(Q)</enum><header>Periodic audit by the Comptroller General</header><clause commented="no" id="H7A0FA43D72EE4F609AFDAE404713FC3F"><enum>(i)</enum><header>In general</header><text>The Comptroller General of the United States (in this subsection referred to as the <quote>Comptroller General</quote>) shall periodically audit the review by the Secretary of relative values established under this paragraph for physicians' services.</text></clause><clause commented="no" display-inline="no-display-inline" id="H5C8A86CE2FE5465589F4B15F388170F7"><enum>(ii)</enum><header>Access to information</header><text>The Comptroller General shall have unrestricted access to all deliberations, records, and data related to the activities carried out under this paragraph, in a timely manner, upon request.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H74CFC9EB114047EAB0BA4DF54FBF5ACF"><enum>614.</enum><header>Payment prohibitions; capital expenditures; special projects</header><subsection id="H29B5C74A43394384ADDF4A6A34FD7D1C"><enum>(a)</enum><header>Sense of Congress</header><text display-inline="yes-display-inline">It is the sense of Congress that tens of millions of people in the United States do not receive healthcare services while billions of dollars that could be spent on providing health care are diverted to profit. There is a moral imperative to correct the massive deficiencies in our current health system and to eliminate profit from the provision of health care.</text></subsection><subsection id="H0BE923917DFA4172A2F1D6F50CB7D5C7"><enum>(b)</enum><header>Prohibitions</header><text>Payments to providers under this Act may not take into account, include any process for the provision of funding for, or be used by a provider for—</text><paragraph id="HDCE53718E09F44D9B591A0F72151EDCF"><enum>(1)</enum><text>marketing of the provider;</text></paragraph><paragraph id="HDEC53F1C0CE542AFA17264484BF99011"><enum>(2)</enum><text>the profit or net revenue of the provider, or increasing the profit or net revenue of the provider;</text></paragraph><paragraph id="H03E0EBCC1A8A43B592F6A18D067E2B57"><enum>(3)</enum><text>incentive payments, bonuses, or other compensation based on patient utilization of items and services or any financial measure applied with respect to the provider (or any group practice, integrated health care delivery system, or other provider with which the provider contracts or has a pecuniary interest), including any value-based payment or employment-based compensation;</text></paragraph><paragraph id="H3ED3B72C391044288C4215A8EB95A7C9"><enum>(4)</enum><text>any agreement or arrangement described in section 203(a)(4) of the Labor-Management Reporting and Disclosure Act of 1959 (<external-xref legal-doc="usc" parsable-cite="usc/29/433">29 U.S.C. 433(a)(4)</external-xref>); or</text></paragraph><paragraph id="H614359394FF949E7A27BBF1198B3255F"><enum>(5)</enum><text>political or contributions prohibited under section 317 of the Federal Elections Campaign Act of 1971 (<external-xref legal-doc="usc" parsable-cite="usc/52/30119">52 U.S.C. 30119(a)(1)</external-xref>).</text></paragraph></subsection><subsection id="HF42B2109735B469ABE284C7D22CEB892"><enum>(c)</enum><header>Payments for capital expenditures</header><paragraph id="H96E61B96795E4B00B9BBE68D35086EED"><enum>(1)</enum><header>In general</header><text>The Secretary shall pay, from amounts made available for capital expenditures pursuant to section 601(a)(2)(B), such sums determined appropriate by the Secretary to providers who have submitted an application to the regional director of the region or regions in which the provider operates or seeks to operate in a time and manner specified by the Secretary for purposes of funding capital expenditures of such providers.</text></paragraph><paragraph id="HFA76CABBE850428FBD334D52C4A6E181"><enum>(2)</enum><header>Priority</header><text display-inline="yes-display-inline">The Secretary shall prioritize allocation of funding under paragraph (1) to projects that propose to use such funds to improve service in a medically underserved area (as defined in section 330(b)(3) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b">42 U.S.C. 254b(b)(3)</external-xref>)) or to address health disparities, including racial, ethnic, national origin, primary language use, age, disability, sex (including gender identity and sexual orientation), geography, or socioeconomic health disparities.</text></paragraph><paragraph id="H82F0C6D7EE674B3FB16307428AE73036"><enum>(3)</enum><header>Limitation</header><text display-inline="yes-display-inline">The Secretary shall not grant funding for capital expenditures under this subsection for capital projects that are financed directly or indirectly through the diversion of private or other non-Medicare for All Program funding that results in reductions in care to patients, including reductions in registered nursing staffing patterns and changes in emergency room or primary care services or availability.</text></paragraph><paragraph id="H58974345D86645D9BFD07DB3807B7AFB"><enum>(4)</enum><header>Capital assets not funded by the Medicare for All program</header><text>Operating expenses and funds shall not be used by an institutional provider receiving payment for capital expenditures under this subsection for a capital asset that was not funded by the Medicare for All program without the approval of the regional director or directors of the region or regions where the capital asset is located.</text></paragraph></subsection><subsection id="H5A81FD95497F440B98B209361D053D59"><enum>(d)</enum><header>Prohibition against co-Mingling operating and capital funds</header><text>Providers that receive payment under this title shall be prohibited from using, with respect to funds made available under this Act—</text><paragraph id="H459F1FD486A74E5D9F639D67A01F371C"><enum>(1)</enum><text>funds designated for operating expenditures for capital expenditures or for profit; or</text></paragraph><paragraph id="H62021CD82FE14EF4B21BB04D83823ECB"><enum>(2)</enum><text>funds designated for capital expenditures for operating expenditures.</text></paragraph></subsection><subsection id="HBC3D5AC1E0674B27B76084115F9A5291"><enum>(e)</enum><header>Payments for special projects</header><paragraph id="H832A801CD86F40FDBFF2F526D084DA02"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall allocate to each regional director, from amounts made available for special projects pursuant to section 601(a)(2)(C), such sums determined appropriate by the Secretary for purposes of funding projects described in such section, including the construction, renovation, or staffing of health care facilities, in rural, underserved, or health professional or medical shortage areas within such region and to address health disparities, including racial, ethnic, national origin, primary language use, age, disability, sex, including gender identity and sexual orientation, geography, or socioeconomic health disparities. Each regional director shall, prior to distributing such funds in accordance with paragraph (2), present a budget describing how such funds will be distributed to the Secretary.</text></paragraph><paragraph id="H776D522377254A869D3B180715CBA687"><enum>(2)</enum><header>Distribution</header><text>A regional director shall distribute funds to providers operating in the region of such director’s jurisdiction in a manner determined appropriate by the director.</text></paragraph></subsection><subsection id="H817B1CA14A944880888C4975298ECF1C"><enum>(f)</enum><header>Prohibition on financial incentive metrics in payment determinations</header><text>The Secretary may not utilize any quality metrics or standards for the purposes of establishing provider payment methodologies, programs, modifiers, or adjustments for provider payments under this title.</text></subsection></section><section id="H4A57C55543BE4404BD3A851B1D4393F0" section-type="subsequent-section"><enum>615.</enum><header>Office of Health Equity</header><text display-inline="no-display-inline">Title XVII of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300u">42 U.S.C. 300u et seq.</external-xref>) is amended by adding at the end the following:</text><quoted-block style="OLC" id="HA3FEC4F24CDA46FDA5C86DD8D2BB6634" display-inline="no-display-inline"><section id="HBAE480B9FE504830B48883852A9BB19C"><enum>1712.</enum><header>Office of Health Equity</header><subsection id="H8EED6AD045E84362981FB3E8DE690BFF"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">There is established, in the Office of the Secretary of Health and Human Services, an Office of Health Equity, to be headed by a Director, to ensure coordination and collaboration across the programs and activities of the Department of Health and Human Services with respect to ensuring health equity.</text></subsection><subsection id="HF633A009A63041FC8FFB7D551C682DBA"><enum>(b)</enum><header>Monitoring, tracking, and availability of data</header><paragraph id="HD7FEDCC7E7FC44278F7986B5B873DC3E"><enum>(1)</enum><header>In general</header><text>In carrying out subsection (a), the Director of the Office of Health Equity shall monitor, track, and make publicly available data on—</text><subparagraph id="H104B665E610E46AF82AD039CAD2C61A3"><enum>(A)</enum><text display-inline="yes-display-inline">the disproportionate burden of disease and death among people of color, disaggregated by race, major ethnic group, Tribal affiliation, national origin, primary language use, English proficiency status, immigration status, length of stay in the United States age, disability, sex (including gender identity and sexual orientation), incarceration, homelessness, geography, and socioeconomic status;</text></subparagraph><subparagraph id="H07DA3FB2BE6C4417A6D7F0DB6CDAA1ED"><enum>(B)</enum><text display-inline="yes-display-inline">barriers to health, including such barriers relating to income, education, housing, food insecurity (including availability, access, utilization, and stability), employment status, working conditions, and conditions related to the physical environment (including pollutants and population density);</text></subparagraph><subparagraph id="H5A2767055D424C17AE6483A4F46379D2"><enum>(C)</enum><text display-inline="yes-display-inline">barriers to health care access, including—</text><clause id="H2688DEC3D22147E4B1D3672C96AC8BEC"><enum>(i)</enum><text>lack of trust and awareness;</text></clause><clause id="H95775F1B7B924054BE39AB6E254B168E"><enum>(ii)</enum><text>lack of transportation;</text></clause><clause id="HC8B375D3866244D5A7057D95E65CF8CD"><enum>(iii)</enum><text>geography;</text></clause><clause id="HBAE60A01F7A04D5FA0B54F2C1AC52A9F"><enum>(iv)</enum><text>hospital and service closures;</text></clause><clause id="H4F29021075784B91A0B6DB365F93539B"><enum>(v)</enum><text>lack of health care infrastructure and facilities; and</text></clause><clause id="HA856B7A93782463AAAE38DD247F79019"><enum>(vi)</enum><text>lack of health care professional staffing and recruitment;</text></clause></subparagraph><subparagraph id="H4E35552CD59547859F6B3E631A17C3EB"><enum>(D)</enum><text>disparities in quality of care received, including discrimination in health care settings and the use of racially-biased practice guidelines and algorithms; and</text></subparagraph><subparagraph id="H89F16541DB6446899EF2CFA050CDCA1B"><enum>(E)</enum><text>disparities in utilization of care.</text></subparagraph></paragraph><paragraph id="HB34E3775D6224D39AECF43D00FCD8898"><enum>(2)</enum><header>Analysis of cross-sectional information</header><text display-inline="yes-display-inline">The Director of the Office of Health Equity shall ensure that the data collection and reporting process under paragraph (1) allows for the analysis of cross-sectional information on people’s identities.</text></paragraph></subsection><subsection id="H45DD6A081CE74B698977CA32FD09E98E"><enum>(c)</enum><header>Policies</header><text display-inline="yes-display-inline">In carrying out subsection (a), the Director of the Office of Health Equity shall develop, coordinate, and promote policies that enhance health equity, including by—</text><paragraph id="HEE21E41E0E324D8ABC8AE6570A22C1CB"><enum>(1)</enum><text>providing recommendations on—</text><subparagraph id="H4E8031988DB54584BFD73DF3F59D1276"><enum>(A)</enum><text>cultural competence, implicit bias, and ethics training with respect to health care workers;</text></subparagraph><subparagraph id="H81D78FEDA1AF4E3A81976885DF116B13"><enum>(B)</enum><text>increasing diversity in the health care workforce; and</text></subparagraph><subparagraph id="HD70D13B56E6944B49CEA520A68EAD2ED"><enum>(C)</enum><text>ensuring sufficient health care professionals and facilities; and</text></subparagraph></paragraph><paragraph id="H4BA183CBF83748459D370D3FE34F292D"><enum>(2)</enum><text>ensuring adequate public health funding at the local and State levels to address health disparities.</text></paragraph></subsection><subsection id="H9CD0C96D754F40DA870E9C61EDBC9469"><enum>(d)</enum><header>Consultation</header><text display-inline="yes-display-inline">In carrying out subsection (a), the Director of the Office of Health Equity, in coordination with the Director of the Indian Health Service, shall consult with Indian Tribes and with Urban Indian organizations on data collection, reporting, and implementation of policies.</text></subsection><subsection id="H89361C7B0B254C0789F2654F56A5BCAE"><enum>(e)</enum><header>Annual report</header><text display-inline="yes-display-inline">In carrying out subsection (a), the Director of the Office of Health Equity shall develop and publish an annual report on—</text><paragraph id="HA81A20F597D8498CBC8D0BEBADBFE266"><enum>(1)</enum><text>statistics collected by the Office;</text></paragraph><paragraph id="HD4E704AD8F6B4E07BF85B076C4A7447F"><enum>(2)</enum><text>proposed evidence-based solutions to mitigate health inequities; and</text></paragraph><paragraph id="HBDB446DFA0D042F3915D7B2ED0FF6379"><enum>(3)</enum><text>health care professional staffing levels and access to facilities.</text></paragraph></subsection><subsection id="H4BE675CF924241F5BF21B2F815FA0F7E"><enum>(f)</enum><header>Centralized electronic repository</header><text display-inline="yes-display-inline">In carrying out subsection (a), the Director of the Office of Health Equity shall—</text><paragraph id="H4136D35F8832437DB007D06C0BEC5560"><enum>(1)</enum><text display-inline="yes-display-inline">establish and maintain a centralized electronic repository to incorporate data collected across Federal departments and agencies on race, ethnicity, Tribal affiliation, national origin, primary language use, English proficiency status, immigration status, length of stay in the United States age, disability, sex (including gender identity and sexual orientation), incarceration, homelessness, geography, and socioeconomic status; and</text></paragraph><paragraph id="HC11EAF62B56B4DF394001FD71A6EA2C7"><enum>(2)</enum><text>make such data available for public use and analysis.</text></paragraph></subsection><subsection id="H3F466EBDA4DE4BB088DD5BD3ED7AA83A"><enum>(g)</enum><header>Privacy</header><text display-inline="yes-display-inline">Notwithstanding any other Federal or State law, no Federal or State official or employee or other entity shall disclose, or use, for any law enforcement or immigration purpose, any personally identifiable information (including with respect to an individual’s religious beliefs, practices, or affiliation, national origin, ethnicity, or immigration status) that is collected or maintained pursuant to this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="HE9F09ACA50E0445B9E76E1BA835EDE4F"><enum>616.</enum><header>Office of Primary Care</header><text display-inline="no-display-inline">Title XVII of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300u">42 U.S.C. 300u et seq.</external-xref>) is amended by adding at the end the following:</text><quoted-block style="OLC" id="HA8725A9298B24AD580D90F8525B3AB07" display-inline="no-display-inline"><section id="H7201FB78978A4926B2E27F96EF57EA04"><enum>1713.</enum><header>Office of Primary Care</header><subsection id="H24A0C25FD70A43E689FFF00ABBD0ED9F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">There is established, in the Office of Health Equity established under section 1712, an Office of Primary Health Care, to be headed by a Director, to ensure coordination and collaboration across the programs and activities of the Department of Health and Human Services with respect to increasing access to high-quality primary health care, particularly in underserved areas and for underserved populations.</text></subsection><subsection id="HFEB5CD7776D544629B0613A10A192E51"><enum>(b)</enum><header>National Goals</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this section, the Director of the Office of Primary Health Care shall publish national goals—</text><paragraph id="H0613540E80EC49EF85808B4887C122C6"><enum>(1)</enum><text>to increase access to high-quality primary health care, particularly in underserved areas and for underserved populations; and</text></paragraph><paragraph id="HA91553852E874CE7A5552DB653EDFB0A"><enum>(2)</enum><text>to address health disparities, including with respect to race, ethnicity, national origin (disaggregated by major ethnic group and Tribal affiliation), primary language use, English proficiency status, immigration status, length of stay in the United States, age, disability, sex (including gender identity and sexual orientation), incarceration, homelessness, geography, and socioeconomic status.</text></paragraph></subsection><subsection id="H6E0BCAAEEBDE4A1C856C9B873D84E357"><enum>(c)</enum><header>Other responsibilities</header><text display-inline="yes-display-inline">In carrying out subsections (a) and (b), the Director of the Office of Primary Health Care shall—</text><paragraph id="HD979E598480A427FACEFE8969C4CE265"><enum>(1)</enum><text display-inline="yes-display-inline">coordinate, in consultation with the Secretary, health professional education policies and goals to achieve the national goals published pursuant to subsection (b);</text></paragraph><paragraph id="H7C2F5B242F3F44B5A11A743E41E3EBFC"><enum>(2)</enum><text>develop and maintain a system to monitor the number and specialties of individuals pursuing careers in, or practicing, primary health care through their health professional education, any postgraduate training, and professional practice;</text></paragraph><paragraph id="HF2829D55D59A4D2BB469C7B119D0AF36"><enum>(3)</enum><text>develop, coordinate, and promote policies that expand the number of primary health care practitioners, registered nurses, advance practice clinicians, and dentists;</text></paragraph><paragraph id="H4FD5174FD3CD4ECEA26975B3555703B3"><enum>(4)</enum><text>recommend appropriate training, technical assistance, and patient protection enhancements for primary care health professionals, including registered nurses, to achieve uniform high quality and patient safety;</text></paragraph><paragraph id="H51AED68E3AFF468C858EB2AA6BCA9FEC"><enum>(5)</enum><text>provide recommendations on targeted programs and resources for Federally qualified health centers, rural health centers, community health centers, and other community-based organizations;</text></paragraph><paragraph id="HC4486F444B814B5894E8C082AEE04FAC"><enum>(6)</enum><text>provide recommendations for broader patient referral to additional resources, not limited to health care, and collaboration with other organizations and sectors that influence health outcomes; and</text></paragraph><paragraph id="HFB60EFE6C2474B98BD298D2D6009820D"><enum>(7)</enum><text>consult with the Secretary on the allocation of the special projects budget under section 601(a)(2)(C) of the Medicare for All Act.</text></paragraph></subsection><subsection id="H74B2F787ECB442D9883360CFD784D52F"><enum>(d)</enum><header>Rule of construction</header><text>Nothing in this section shall be construed—</text><paragraph id="HED90FA7611174A2897EA29A6FDF8B972"><enum>(1)</enum><text>to preempt any provision of State law establishing practice standards or guidelines for health care professionals, including professional licensing or practice laws or regulations; or</text></paragraph><paragraph id="H2C2998F1507F45929A89D13CA554F32B"><enum>(2)</enum><text>to require that any State impose additional educational standards or guidelines for health care professionals.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="H81E241D485354A29854818C2D08B5C10"><enum>617.</enum><header>Payments for prescription drugs and approved devices and equipment</header><text display-inline="no-display-inline">The prices to be paid for covered pharmaceuticals, medical supplies, medical technologies, and medically necessary equipment covered under this Act shall be negotiated annually by the Secretary.</text><paragraph id="HA7935F59391E436C92C87CE960D30F07"><enum>(1)</enum><header>In general</header><text>Notwithstanding any other provision of law, the Secretary shall, for fiscal years beginning on or after the date of the enactment of this subsection, negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged to the Medicare for All Program during a negotiated price period (as specified by the Secretary) for covered drugs for eligible individuals under the Medicare for All Program. In negotiating such prices under this section, the Secretary shall take into account the following factors:</text><subparagraph id="H6F914606EBC849099075EB76F0BC5987"><enum>(A)</enum><text>The comparative clinical effectiveness and cost effectiveness, when available from an impartial source, of such drug.</text></subparagraph><subparagraph id="H63B94046172D4BC19EC08E98BB6B5CAB"><enum>(B)</enum><text>The budgetary impact of providing coverage of such drug.</text></subparagraph><subparagraph id="H5A19E69E2B4F4F309CE347777E4E624F"><enum>(C)</enum><text>The number of similarly effective drugs or alternative treatment regimens for each approved use of such drug.</text></subparagraph><subparagraph id="HE8BA700670CF4424A3E0CD44B1048D40"><enum>(D)</enum><text>The total revenues from global sales obtained by the manufacturer for such drug and the associated investment in research and development of such drug by the manufacturer.</text></subparagraph></paragraph><paragraph id="H1A3FDB499DF24A28B61E31E7A9FD2786"><enum>(2)</enum><header>Finalization of negotiated price</header><text>The negotiated price of each covered drug for a negotiated price period shall be finalized not later than 30 days before the first fiscal year in such negotiated price period.</text></paragraph><paragraph id="HC601E3CEDA36490AA9D739852F35542C"><enum>(3)</enum><header>Competitive licensing authority</header><subparagraph id="H275AAE1ACCF741B6B4C2DB0B15D9DD44"><enum>(A)</enum><header>In general</header><text>Notwithstanding any exclusivity under clause (iii) or (iv) of section 505(j)(5)(F) of the Federal Food, Drug, and Cosmetic Act, clause (iii) or (iv) of section 505(c)(3)(E) of such Act, section 351(k)(7)(A) of the Public Health Service Act, or section 527(a) of the Federal Food, Drug, and Cosmetic Act, or by an extension of such exclusivity under section 505A of such Act or section 505E of such Act, and any other provision of law that provides for market exclusivity (or extension of market exclusivity) with respect to a drug, in the case that the Secretary is unable to successfully negotiate an appropriate price for a covered drug for a negotiated price period, the Secretary shall authorize the use of any patent, clinical trial data, or other exclusivity granted by the Federal Government with respect to such drug as the Secretary determines appropriate for purposes of manufacturing such drug for sale under Medicare for All Program. Any entity making use of a competitive license to use patent, clinical trial data, or other exclusivity under this section shall provide to the manufacturer holding such exclusivity reasonable compensation, as determined by the Secretary based on the following factors:</text><clause id="H8AA96E00AB074346A53A69AD7F7C55B8"><enum>(i)</enum><text>The risk-adjusted value of any Federal Government subsidies and investments in research and development used to support the development of such drug.</text></clause><clause id="H32F5009F838E4D39937FAB264E72A2C7"><enum>(ii)</enum><text>The risk-adjusted value of any investment made by such manufacturer in the research and development of such drug.</text></clause><clause id="HB914DF090EE7428FBF9E673EC7002997"><enum>(iii)</enum><text>The impact of the price, including license compensation payments, on meeting the medical need of all patients at a reasonable cost.</text></clause><clause id="H325830A2D4CA437DBB5A653B2848AA78"><enum>(iv)</enum><text>The relationship between the price of such drug, including compensation payments, and the health benefits of such drug.</text></clause><clause id="HCE30F8A247C64AE782DAB0A66F1AFF72"><enum>(v)</enum><text>Other relevant factors determined appropriate by the Secretary to provide reasonable compensation.</text></clause></subparagraph><subparagraph id="H42551AFFF2CD409996378AEB41BEFA6B"><enum>(B)</enum><header>Reasonable compensation</header><text>The manufacturer described in subparagraph (A) may seek recovery against the United States in the United States Court of Federal Claims.</text></subparagraph><subparagraph id="H70088CA4AF2C4A2DBF33D51A71F743A0"><enum>(C)</enum><header>Interim period</header><text display-inline="yes-display-inline">Until 1 year after a drug described in subparagraph (A) is approved under section 505(j) of the Federal Food, Drug, and Cosmetic Act or section 351(k) of the Public Health Service Act and is provided under license issued by the Secretary under such subparagraph, the Medicare for All Program shall not pay more for such drug than the average of the prices available, during the most recent 12-month period for which data is available prior to the beginning of such negotiated price period, from the manufacturer to any wholesaler, retailer, provider, health maintenance organization, nonprofit entity, or governmental entity in the ten OECD (Organization for Economic Cooperation and Development) countries that have the largest gross domestic product with a per capita income that is not less than half the per capita income of the United States.</text></subparagraph><subparagraph id="HF517D927DBAA4651846511C6FD342589"><enum>(D)</enum><header>Authorization for Secretary to procure drugs directly</header><text display-inline="yes-display-inline">The Secretary may procure a drug manufactured pursuant to a competitive license under subparagraph (A) for purposes of this Act.</text></subparagraph></paragraph><paragraph id="H7D47C60E94F84C6CBBBD4055C4EB61EB"><enum>(4)</enum><header>FDA review of licensed drug applications</header><text>The Secretary shall prioritize review of applications under section 505(j) of the Federal Food, Drug, and Cosmetic Act for drugs licensed under paragraph (3)(A).</text></paragraph><paragraph id="H5E77AE46EF5B4C6893001F58039B052C"><enum>(5)</enum><header>Prohibition of anticompetitive behavior</header><text>No drug manufacturer may engage in anticompetitive behavior with another manufacturer that may interfere with the issuance and implementation of a competitive license or run contrary to public policy.</text></paragraph><paragraph id="HCB2B7129844347CE9283A450744FC9EB"><enum>(6)</enum><header>Required reporting</header><text>The Secretary may require pharmaceutical manufacturers to disclose to the Secretary such information that the Secretary determines necessary for purposes of carrying out this subsection.</text></paragraph></section></subtitle></title><title id="H8E63B523BA524D10BE20B99913913631"><enum>VII</enum><header>Universal Medicare Trust Fund</header><section id="H8448BB67F4A54E7E9EAF5B50D9DF84D5"><enum>701.</enum><header>Universal Medicare Trust Fund</header><subsection id="H9D109D3857E547FB83390FCB0C89A554"><enum>(a)</enum><header>In general</header><text>There is hereby created on the books of the Treasury of the United States a trust fund to be known as the Universal Medicare Trust Fund (in this section referred to as the <quote>Trust Fund</quote>). The Trust Fund shall consist of such gifts and bequests as may be made and such amounts as may be deposited in, or appropriated to, such Trust Fund as provided in this Act.</text></subsection><subsection id="HA443C56809284BC9AFBFD9E0CEF0A24C"><enum>(b)</enum><header>Appropriations into trust fund</header><paragraph id="H1E5D2B5023754F07825F45B898B1CB2B"><enum>(1)</enum><header>Taxes</header><text>There are appropriated to the Trust Fund for each fiscal year beginning with the fiscal year which includes the date on which benefits first become available as described in section 106, out of any monies in the Treasury not otherwise appropriated, amounts equivalent to 100 percent of the net increase in revenues to the Treasury which is attributable to the amendments made by sections 801 and 902. The amounts appropriated by the preceding sentence shall be transferred from time to time (but not less frequently than monthly) from the general fund in the Treasury to the Trust Fund, such amounts to be determined on the basis of estimates by the Secretary of the Treasury of the taxes paid to or deposited into the Treasury, and proper adjustments shall be made in amounts subsequently transferred to the extent prior estimates were in excess of or were less than the amounts that should have been so transferred.</text></paragraph><paragraph id="H4031E98D5B5449EFB4B95FF3D942A959"><enum>(2)</enum><header>Current program receipts</header><subparagraph id="H3D23CE0905374D348B5A24DAE4906B80"><enum>(A)</enum><header>Initial year</header><text>Notwithstanding any other provision of law, there is appropriated to the Trust Fund for the fiscal year containing January 1 of the first year following the date of the enactment of this Act, an amount equal to the aggregate amount appropriated for the preceding fiscal year for the following (increased by the consumer price index for all urban consumers for the fiscal year involved):</text><clause id="HCE20292397D9494083E6CEEAC9338E07"><enum>(i)</enum><text>The Medicare program under title XVIII of the Social Security Act (other than amounts attributable to any premiums under such title).</text></clause><clause id="HB331FC691233435EBD64B973FA0A2A68"><enum>(ii)</enum><text display-inline="yes-display-inline">The Medicaid program under State plans approved under title XIX of such Act.</text></clause><clause id="HB5C35DCE30434AA9BAC9312850359E53"><enum>(iii)</enum><text>The Federal Employees Health Benefits program, under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter 89</external-xref> of title 5, United States Code.</text></clause><clause id="H6954628070C94ACF972915665C2D23D0"><enum>(iv)</enum><text>The purchased care component of the TRICARE program, under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States Code (other than amounts appropriated for the purchased care component of the TRICARE Overseas Program).</text></clause><clause id="H2239A1D34C5D43D8B82F2C119878A4B2"><enum>(v)</enum><text>The maternal and child health program (under title V of the Social Security Act), vocational rehabilitation programs, programs for drug abuse and mental health services under the Public Health Service Act, programs providing general hospital or medical assistance, and any other Federal program identified by the Secretary, in consultation with the Secretary of the Treasury, to the extent the programs provide for payment for health services the payment of which may be made under this Act.</text></clause></subparagraph><subparagraph id="HA0CCE5E1CFC44A5F8068806A3D9A31EE"><enum>(B)</enum><header>Subsequent years</header><text display-inline="yes-display-inline">Not­with­stand­ing any other provision of law, there is appropriated to the trust fund for the fiscal year containing January 1 of the second year following the date of the enactment of this Act, and for each fiscal year thereafter, an amount equal to the amount appropriated to the Trust Fund for the previous year, adjusted for reductions in costs resulting from the implementation of this Act, changes in the consumer price index for all urban consumers for the fiscal year involved, and other factors determined appropriate by the Secretary.</text></subparagraph></paragraph><paragraph id="H6210F90F9A6C4162A20BD453E273A416"><enum>(3)</enum><header>Restrictions shall not apply</header><text>Any other provision of law in effect on the date of enactment of this Act restricting the use of Federal funds for any reproductive health service shall not apply to monies in the Trust Fund.</text></paragraph></subsection><subsection id="H6B3C6F4AE5EE4C3A86392DB163C943AB"><enum>(c)</enum><header>Incorporation of provisions</header><text>The provisions of subsections (b) through (i) of section 1817 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i</external-xref>) shall apply to the Trust Fund under this section in the same manner as such provisions applied to the Federal Hospital Insurance Trust Fund under such section 1817, except that, for purposes of applying such subsections to this section, the <quote>Board of Trustees of the Trust Fund</quote> shall mean the <quote>Secretary</quote>.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="HBCC7C80001C34F51B468BD64230DD110"><enum>(d)</enum><header>Transfer of funds</header><text>Any amounts remaining in the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i</external-xref>) or the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>) after the payment of claims for items and services furnished under title XVIII of such Act have been completed, shall be transferred into the Universal Medicare Trust Fund under this section.</text></subsection></section></title><title id="H71364BB1D5804B1A8546BAA18AF32CB8"><enum>VIII</enum><header>Conforming Amendments to the Employee Retirement Income Security Act of 1974</header><section id="H4E1B972D7DE94C24A004CE19BDADBB60"><enum>801.</enum><header>Prohibition of employee benefits duplicative of benefits under the Medicare for All Program; coordination in case of workers’ compensation</header><subsection id="H0D851A0F28F04067807FAC62837FE9BC"><enum>(a)</enum><header>In general</header><text>Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1131">29 U.S.C. 1131 et seq.</external-xref>) is amended by adding at the end the following new section:</text><quoted-block display-inline="no-display-inline" id="HB057B820032D449B93B2AC40A1520DDC" style="OLC"><section id="H15B09CABFAF742A898D69C4697261773"><enum>522.</enum><header>Prohibition of employee benefits duplicative of Universal Medicare Program benefits; coordination in case of workers’ compensation</header><subsection id="H33674454A00945D98633D5044C10E8BA"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to subsection (b), no employee benefit plan may provide benefits that duplicate payment for any items or services for which payment may be made under the <short-title>Medicare for All Act</short-title>.</text></subsection><subsection id="H1D8AF086A3A84219BCEC92A167F88338"><enum>(b)</enum><header>Reimbursement</header><text display-inline="yes-display-inline">Each workers compensation carrier that is liable for payment for workers compensation services furnished in a State shall reimburse the Medicare for All Program for the cost of such services.</text></subsection><subsection id="H4C7D1FAD1F434493903B63D722EE8FCC"><enum>(c)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subsection—</text><paragraph id="HCC5EC66840264BE3AAEB819D7DEA7839"><enum>(1)</enum><text display-inline="yes-display-inline">the term <term>workers compensation carrier</term> means an insurance company that underwrite workers compensation medical benefits with respect to one or more employers and includes an employer or fund that is financially at risk for the provision of workers compensation medical benefits;</text></paragraph><paragraph id="H80DE0FED78544ABF879C8C838F8FB9F6"><enum>(2)</enum><text display-inline="yes-display-inline">the term <term>workers compensation medical benefits</term> means, with respect to an enrollee who is an employee subject to the workers compensation laws of a State, the comprehensive medical benefits for work-related injuries and illnesses provided for under such laws with respect to such an employee; and</text></paragraph><paragraph id="H4FCDF753C927447FA05E1E3144744EF9"><enum>(3)</enum><text display-inline="yes-display-inline">the term <term>workers compensation services</term> means items and services included in workers compensation medical benefits and includes items and services (including rehabilitation services and long-term care services) commonly used for treatment of work-related injuries and illnesses.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="HDD1D12BF3C4247D48B002BC075A4671C"><enum>(b)</enum><header>Conforming amendment</header><text>Section 4(b) of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1003">29 U.S.C. 1003(b)</external-xref>) is amended by adding at the end the following: <quote>Paragraph (3) shall apply subject to section 522(b) (relating to reimbursement of the Medicare for All Program by workers compensation carriers).</quote>.</text></subsection><subsection id="H8FC24BCB534B4FDFA489647F5A32F44B"><enum>(c)</enum><header>Clerical amendment</header><text>The table of contents in section 1 of such Act is amended by inserting after the item relating to section 521 the following new item:</text><quoted-block display-inline="no-display-inline" id="HC54728A100F140109A1844293A6DC31E" style="OLC"><toc><toc-entry bold="off" level="section">Sec. 522. Prohibition of employee benefits duplicative of Universal Medicare Program benefits; coordination in case of workers’ compensation.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H777855E5515D4211A351B3470CE185A4"><enum>802.</enum><header>Application of continuation coverage requirements under ERISA and certain other requirements relating to group health plans</header><subsection id="HF0537DC1153D4C559420AD5D908D8AFE"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1161">29 U.S.C. 1161 et seq.</external-xref>) shall apply only with respect to any employee health benefit plan that does not duplicate payments for any items or services for which payment may be made under the this Act.</text></subsection><subsection id="H833B1693CFEA4C8EA3F5522FA38D8468"><enum>(b)</enum><header>Conforming amendment</header><text>Section 601 of part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/19/1161">19 U.S.C. 1161</external-xref>) is amended by adding the following subsection at the end:</text><quoted-block id="H6F3364A9EF93486E8AD41ECA3CDCFDB4" style="OLC"><subsection id="H06C3DB2850DD4163B950ADA0FEFCFDFC"><enum>(c)</enum><text>Subsection (a) shall apply to any group health plan that does not duplicate payments for any items or services for which payment may be made under the Medicare for All Act.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="HBE9CB06604224FBB9A8B50F39EC5BAB6"><enum>803.</enum><header>Effective date of title</header><text display-inline="no-display-inline">The provisions of and amendments made by this title shall take effect on the date described in section 106(a).</text></section></title><title id="H006D38FAAA1C467A8A8675832F1F6146"><enum>IX</enum><header>Additional Conforming Amendments</header><section id="H29BD6E7768FD408BAEF7815D8F7A2CA0"><enum>901.</enum><header>Relationship to existing Federal health programs</header><subsection id="HFDB6DD6EE7AE4A5387D62829D645083C"><enum>(a)</enum><header>Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP)</header><paragraph id="H17DDB74000DE49EF9F62C7BC2CC5CE8F"><enum>(1)</enum><header>In general</header><text>Notwithstanding any other provision of law and with respect to an individual eligible to enroll under this Act, subject to paragraphs (2) and (3)—</text><subparagraph id="H85FD411ADC1E40C78B0251EDD5E3C9DA"><enum>(A)</enum><text>no benefits shall be available under title XVIII of the Social Security Act for any item or service furnished beginning on the date that is 2 years after the date of the enactment of this Act;</text></subparagraph><subparagraph id="H612E73D81EDA4C8ABF1818DB94FAC249"><enum>(B)</enum><text>no individual is entitled to medical assistance under a State plan approved under title XIX of such Act for any item or service furnished on or after such date;</text></subparagraph><subparagraph id="H520712E8B6FA4B0584991617F5C884D2"><enum>(C)</enum><text>no individual is entitled to medical assistance under a State child health plan under title XXI of such Act for any item or service furnished on or after such date; and</text></subparagraph><subparagraph id="H990835B0A3824AE998DF0B3EFA79DA12"><enum>(D)</enum><text>no payment shall be made to a State under section 1903(a) or 2105(a) of such Act with respect to medical assistance or child health assistance for any item or service furnished on or after such date.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HB4885181F62F494A9E605E34A56EC654"><enum>(2)</enum><header>Transition</header><text>In the case of inpatient hospital services and extended care services during a continuous period of stay which began before the effective date of benefits under section 106, and which had not ended as of such date, for which benefits are provided under title XVIII of the Social Security Act, under a State plan under title XIX of such Act, or under a State child health plan under title XXI of such Act, the Secretary shall provide for continuation of benefits under such title or plan until the end of the period of stay.</text></paragraph><paragraph id="H3E1D274282434101ABBA2C4E3504A977"><enum>(3)</enum><header>School programs</header><text>All school related health programs, centers, initiatives, services, or other activities or work provided under title XIX or title XXI of the Social Security Act as of January 1, 2019, shall be continued and covered by the Medicare for All Program.</text></paragraph></subsection><subsection id="HEB0FA5A1C7AD442589EAE0D3AAEEA82A"><enum>(b)</enum><header>Federal employees health benefits program</header><text>No benefits shall be made available under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter 89</external-xref> of title 5, United States Code, with respect to items and services furnished to any individual eligible to enroll under this Act.</text></subsection><subsection id="HBB0704C62E4E4E49BB3CDDEF0B309B45" commented="no"><enum>(c)</enum><header>TRICARE Program</header><paragraph id="H82267CCD6C5F41A2839F66DDDD7820AB"><enum>(1)</enum><header>Direct care component</header><text display-inline="yes-display-inline">Nothing in this Act shall affect the eligibility of beneficiaries under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States Code, who are entitled to receive care furnished at facilities of the uniformed services under the TRICARE program for such care.</text></paragraph><paragraph id="HB75F319E7EE14447BD284CA160906B64" commented="no"><enum>(2)</enum><header>Purchased care component</header><subparagraph id="H612CBEA3673746719DC52348CF6B5E7F"><enum>(A)</enum><header>In general</header><text>Except as provided in subparagraph (B), no benefits shall be made available under the purchased care component of the TRICARE program for items or services furnished to any individual eligible to enroll under this Act.</text></subparagraph><subparagraph id="H50CDF73A66A24778BA35F10891ECC31A"><enum>(B)</enum><header>TRICARE Overseas</header><text>During any period in which an individual is eligible for benefits under the TRICARE Overseas Program and is located in a TRICARE overseas region, the individual may receive benefits for items or services furnished to the individual under the purchased care component of such program during such period.</text></subparagraph></paragraph></subsection><subsection id="HA53D9E78D522459A944A1F0B45F35864"><enum>(d)</enum><header>Treatment of benefits for veterans and Native Americans</header><paragraph commented="no" id="HFD70CC6168E340088791F65BD350880B"><enum>(1)</enum><header>In general</header><text>Nothing in this Act shall affect the eligibility of veterans for the medical benefits and services provided under title 38, United States Code, or of Indians for the medical benefits and services provided by or through the Indian Health Service.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC3AC69DB535B49E191DD9DE3A1B634A5"><enum>(2)</enum><header>Reevaluation</header><text>No reevaluation of the Indian Health Service shall be undertaken without consultation with tribal leaders and stakeholders.</text></paragraph></subsection></section><section id="HB0FED97DA88447D2BDCD5E1765216C63"><enum>902.</enum><header>Sunset of provisions related to the State Exchanges</header><text display-inline="no-display-inline">Effective on the date that is 2 years after the date of the enactment of this Act, the Federal and State Exchanges established pursuant to title I of the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>) shall terminate, and any other provision of law that relies upon participation in or enrollment through such an Exchange, including such provisions of the Internal Revenue Code of 1986, shall cease to have force or effect.</text></section><section id="H5B41EEB5F2E54DDA80CC896339926FD8"><enum>903.</enum><header>Sunset of provisions related to pay for performance programs</header><subsection id="H71AC15C5A22A496BA9FEEC97B03DE047"><enum>(a)</enum><text>Effective on the date described in section 106(a), the Federal programs related to pay for performance programs and value-based purchasing shall terminate, and any other provision of law that relies upon participation in or enrollment in such program shall cease to have force or effect. Programs that shall terminate include—</text><paragraph id="H018F45CCE27A4AD28501FECD053E6A10"><enum>(1)</enum><text>the Merit-based Incentive Payment System established pursuant to subsection (q) of section 1848 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)</external-xref>);</text></paragraph><paragraph id="H50D9BAF905804E278252D532AEF21B72"><enum>(2)</enum><text>the incentives for meaningful use of certified EHR technology established pursuant to subsection (a)(7) of section 1848 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(a)(7)</external-xref>);</text></paragraph><paragraph id="H027E3C8353F24AE18F6A319789DAA4B9"><enum>(3)</enum><text>the incentives for adoption and meaningful use of certified EHR technology established pursuant to subsection (o) of section 1848 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(o)</external-xref>);</text></paragraph><paragraph id="H58FD119C4D0240C89B36FF61A0A5597F"><enum>(4)</enum><text>alternative payment models established under section 1833(z) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395(z)</external-xref>); and</text></paragraph><paragraph id="HAE6475F37EA8471780EE8CFA9F47C339"><enum>(5)</enum><text>the following programs as established pursuant to the following sections of the Patient Protection and Affordable Care Act:</text><subparagraph id="HD58FE0E951A7495FB9FDB5F08AE4934B"><enum>(A)</enum><text>Section 2701 (adult health quality measures).</text></subparagraph><subparagraph id="HB8E2326E17B745DF8CA82D0983EB7995"><enum>(B)</enum><text>Section 2702 (payment adjustments for health care acquired conditions).</text></subparagraph><subparagraph id="HC26F58252B2744A3A12FEA9BE7C1846F"><enum>(C)</enum><text>Section 2706 (Pediatric Accountable Care Organization Demonstration Projects for the purposes of receiving incentive payments).</text></subparagraph><subparagraph id="H0312CF5B3DFF4F8087A97EA70F316E1A"><enum>(D)</enum><text>Section 3002(b) (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(a)(8)</external-xref>) (incentive payments for quality reporting).</text></subparagraph><subparagraph id="H9F496B7FEB084C599E22E6BD5E58F6F2"><enum>(E)</enum><text>Section 3001(a) (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(o)</external-xref>) (Hospital Value-Based Pur­chas­ing).</text></subparagraph><subparagraph id="HEA07D146C20947F9A6F8250916F0828E"><enum>(F)</enum><text>Section 3006 (value-based purchasing program for skilled nursing facilities and home health agencies).</text></subparagraph><subparagraph id="HBCB282B236C047EC9D4DFE8DC2336328"><enum>(G)</enum><text>Section 3007 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(p)</external-xref>) (value based payment modifier under physician fee schedule).</text></subparagraph><subparagraph id="H021564B1AE7C4ACFB97FDCC7B646E606"><enum>(H)</enum><text>Section 3008 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(p)</external-xref>) (payment adjustments for health care-acquired condition).</text></subparagraph><subparagraph id="H1C3BC98973FC4391A7F40CADCED5FF55"><enum>(I)</enum><text>Section 3022 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395jjj">42 U.S.C. 1395jjj</external-xref>) (Medicare shared savings programs).</text></subparagraph><subparagraph id="HF7BA79B736104035AF458C73C767FADD"><enum>(J)</enum><text>Section 3023 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc-4">42 U.S.C. 1395cc–4</external-xref>) (National Pilot Program on Payment Bundling).</text></subparagraph><subparagraph id="HDDE8472FDB784E3C82EAA49D1F6C6D92"><enum>(K)</enum><text>Section 3024 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc-5">42 U.S.C. 1395cc–5</external-xref>) (Independence at home demonstration program).</text></subparagraph><subparagraph id="H37BBD9B3387D4503A52990E10ACB5237"><enum>(L)</enum><text>Section 3025 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(q)</external-xref>) (hospital readmissions reduction program).</text></subparagraph><subparagraph id="HCA9BCA64B0084FE5ACDE86701732A492"><enum>(M)</enum><text>Section 10301 (plans for value-based purchasing program for ambulatory surgical centers).</text></subparagraph></paragraph></subsection></section></title><title id="H2B2FC479301D4EB8A3E041B0D24BF44E" style="OLC"><enum>X</enum><header>Transition</header><subtitle id="H4998A30A03294564BF7B3210A75B9F1D" style="OLC"><enum>A</enum><header>Medicare for All Transition over 2 Years and Transitional Buy-In Option</header><section id="H0EAD5829AB4140E7A01AD198BB42E903"><enum>1001.</enum><header>Medicare for all transition over two years</header><text display-inline="no-display-inline">Title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c et seq.</external-xref>) is amended by adding at the end the following new section:</text><quoted-block id="HB7673880308441538710E0A0BE69D84A" style="OLC"><section id="HB6FC5B343AC64497BEF50D859EE45F4C"><enum>1899C.</enum><header>Medicare for all transition over 2 years</header><subsection id="HAB9C79D533074713AD77DEAE035DAB52"><enum>(a)</enum><header>Transition</header><paragraph id="HDD9D241339134A1FA2BE6124721C9E70"><enum>(1)</enum><header>In general</header><text>Every individual who meets the requirements described in paragraph (3) shall be eligible to enroll in the Medicare for All Program under this section during the transition period starting one year after the date of enactment of the Medicare for All Act.</text></paragraph><paragraph id="HA5867558486647849793181BD70038B0"><enum>(2)</enum><header>Benefits</header><text>An individual enrolled under this section is entitled to the benefits established under title II of the Medicare for All Act.</text></paragraph><paragraph id="HE10E05D64F324803A0776DD601272805"><enum>(3)</enum><header>Requirements for eligibility</header><text>The requirements described in this paragraph are the following:</text><subparagraph id="HEA610C54153D44809DF49EC7988594A4"><enum>(A)</enum><text>The individual meets the eligibility requirements established by the Secretary under title I of the Medicare for All Act.</text></subparagraph><subparagraph id="H1520C32FD4674A439C0E142535D5D674"><enum>(B)</enum><text>The individual has attained the applicable year of age, or is currently enrolled in Medicare at the time of the transition to Medicare for All.</text></subparagraph></paragraph><paragraph id="HA327337C178A4C6DB6F1C737D42B0283"><enum>(4)</enum><header>Applicable year of age defined</header><text>For purposes of this section, the term <term>applicable year of age</term> means one year after the date of enactment of the Medicare for All Act, the age of 55 or older, the age 18 or younger.</text></paragraph></subsection><subsection id="HA1AEE0B2544B4AD48C89A658DDC97417"><enum>(b)</enum><header>Enrollment; coverage</header><text>The Secretary shall establish enrollment periods and coverage under this section consistent with the principles for establishment of enrollment periods and coverage for individuals under other provisions of this title. The Secretary shall establish such periods so that coverage under this section shall first begin on January 1 of the year on which an individual first becomes eligible to enroll under this section.</text></subsection><subsection id="HB73DF247D41F4331815D7B862A95F367"><enum>(c)</enum><header>Satisfaction of individual mandate</header><text>For purposes of applying <external-xref legal-doc="usc" parsable-cite="usc/26/5000A">section 5000A</external-xref> of the Internal Revenue Code of 1986, the coverage provided under this section constitutes minimum essential coverage under subsection (f)(1)(A)(i) of such section 5000A.</text></subsection><subsection id="H8E251EA366BB4EAB86640060366AEE4C"><enum>(d)</enum><header>Consultation</header><text>In promulgating regulations to implement this section, the Secretary shall consult with interested parties, including groups representing beneficiaries, health care providers, employers, and insurance companies.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="H9F0F38EB0F8844A69B5F4F2EE309F571"><enum>1002.</enum><header>Establishment of the Medicare transition buy-in</header><subsection id="HB86ADA9A21D345F2850E46DB343DDE20"><enum>(a)</enum><header>In general</header><text>To carry out the purpose of this section, for the year beginning one year after the date of enactment of this Act and ending with the effective date described in section 106(a), the Secretary, acting through the Administrator of the Centers for Medicare &amp; Medicaid (referred to in this section as the <quote>Administrator</quote>), shall establish, and provide for the offering through the Exchanges, an option to buy in to the Medicare for All Program (in this Act referred to as the <quote>Medicare Transition buy-in</quote>).</text></subsection><subsection id="H8AA6F58C9F384B618E10CDA6E4161A6F"><enum>(b)</enum><header>Administering the medicare transition buy-In</header><paragraph id="H0CF7376AA4EC42C8B8FFC6B8BE837175"><enum>(1)</enum><header>Administrator</header><text>The Administrator shall administer the Medicare Transition buy-in in accordance with this section.</text></paragraph><paragraph id="H03D731863602451581F09CA0643924DE"><enum>(2)</enum><header>Application of ACA requirements</header><text>Consistent with this section, the Medicare Transition buy-in shall comply with requirements under title I of the Patient Protection and Affordable Care Act (and the amendments made by that title) and title XXVII of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg et seq.</external-xref>) that are applicable to qualified health plans offered through the Exchanges, subject to the limitation under subsection (e)(2).</text></paragraph><paragraph id="HCB1D929A37174AF0A171B003B8D23253"><enum>(3)</enum><header>Offering through exchanges</header><text>The Medicare Transition buy-in shall be made available only through the Exchanges, and shall be available to individuals wishing to enroll and to qualified employers (as defined in section 1312(f)(2) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18032">42 U.S.C. 18032</external-xref>)) who wish to make such plan available to their employees.</text></paragraph><paragraph id="H29F11FA160D64013A5A1826C693D0423"><enum>(4)</enum><header>Eligibility to purchase</header><text>Any United States resident may enroll in the Medicare Transition buy-in.</text></paragraph></subsection><subsection id="HD321C030C536415AB140FEAE897C991D"><enum>(c)</enum><header>Benefits; actuarial value</header><text>In carrying out this section, the Administrator shall ensure that the Medicare Transition buy-in provides—</text><paragraph id="H64D1EAD6EA214E53A9D1F47857BD47F5"><enum>(1)</enum><text>coverage for the benefits required to be covered under title II of this Act; and</text></paragraph><paragraph id="HB37280E887D84B4EAD85EBD0D1BDD934"><enum>(2)</enum><text>coverage of benefits that are actuarially equivalent to 90 percent of the full actuarial value of the benefits provided under the plan.</text></paragraph></subsection><subsection id="H37381A201A7C47DCAAB00D181A0DC1B8"><enum>(d)</enum><header>Providers and reimbursement rates</header><paragraph id="H0C61606D91F046C4B3C04F7A7C8F3110"><enum>(1)</enum><header>In general</header><text>With respect to the reimbursement provided to health care providers for covered benefits, as described in section 201, provided under the Medicare Transition buy-in, the Administrator shall reimburse such providers at rates determined for equivalent items and services under the Medicare for All fee-for-service schedule established in section 612(b) of this Act.</text></paragraph><paragraph id="H03DFFF13F5FB40B3B7FEF1388A6052D7"><enum>(2)</enum><header>Prescription drugs</header><text>Any payment rate under this subsection for a prescription drug shall be at the prices negotiated under section 616 of this Act.</text></paragraph><paragraph id="H7DB22209772E4BFA89C7DD9DE23DDF0A"><enum>(3)</enum><header>Participating providers</header><subparagraph id="HC811D6151A8E4B3BB70EF8F582B5925A"><enum>(A)</enum><header>In general</header><text>A health care provider that is a participating provider of services or supplier under the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) or under a State Medicaid plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) on the date of enactment of this Act shall be a participating provider in the Medicare Transition buy-in.</text></subparagraph><subparagraph id="H45C08B97D2004CEB97A39FC2A8BD5021"><enum>(B)</enum><header>Additional providers</header><text>The Administrator shall establish a process to allow health care providers not described in subparagraph (A) to become participating providers in the Medicare Transition buy-in. Such process shall be similar to the process applied to new providers under the Medicare program.</text></subparagraph></paragraph></subsection><subsection id="HA3E401FC42084F09B1C681650F247D67"><enum>(e)</enum><header>Premiums</header><paragraph id="H8E4B4FA3A4B247DE9698179576852960"><enum>(1)</enum><header>Determination</header><text>The Administrator shall determine the premium amount for enrolling in the Medicare Transition buy-in, which—</text><subparagraph id="HED22DF2A89214627863CB89E0D2F7D59"><enum>(A)</enum><text>may vary according to family or individual coverage, age, and tobacco status (consistent with clauses (i), (iii), and (iv) of section 2701(a)(1)(A) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg(a)(1)(A)</external-xref>)); and</text></subparagraph><subparagraph id="HFEA242C56C9346B0B77CB431C42B208F"><enum>(B)</enum><text>shall take into account the cost-sharing reductions and premium tax credits which will be available with respect to the plan under section 1402 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18071">42 U.S.C. 18071</external-xref>) and <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B</external-xref> of the Internal Revenue Code of 1986, as amended by subsection (g).</text></subparagraph></paragraph><paragraph id="H5F1F55B4C95D4D658E5B0CFA61A85EF0"><enum>(2)</enum><header>Limitation</header><text>Variation in premium rates of the Medicare Transition buy-in by rating area, as described in clause (ii) of section 2701(a)(1)(A)(iii) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg(a)(1)(A)</external-xref>) is not permitted.</text></paragraph></subsection><subsection id="HD35B66B57A4C400A953A2A43D845909E"><enum>(f)</enum><header>Termination</header><text>This section shall cease to have force or effect on the effective date described in section 106(a).</text></subsection><subsection id="H4C57B64A032F47CD98B0E7BB6D131AB8"><enum>(g)</enum><header>Tax credits and cost-Sharing subsidies</header><paragraph id="H679EB0858CAB444692F690AFBD6BB682"><enum>(1)</enum><header>Premium assistance tax credits</header><subparagraph id="H1F3F9B9E333E433FB88462381BA75FB1"><enum>(A)</enum><header>Credits allowed to medicare transition buy-in enrollees in non-expansion states</header><text>Paragraph (1) of <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(c)</external-xref> of the Internal Revenue Code of 1986 is amended by redesignating subparagraphs (C) and (D) as subparagraphs (D) and (E), respectively, and by inserting after subparagraph (B) the following new subparagraph:</text><quoted-block id="H1F88F72F114A41228302BD873F69BEBF" style="OLC"><subparagraph id="H08AC507DA4F9429E98D34DDBF539F5DF"><enum>(C)</enum><header>Special rules for medicare transition buy-in enrollees</header><clause id="H5BDE46E9D2B042709D11A7EB721F24E5"><enum>(i)</enum><header>In general</header><text>In the case of a taxpayer who is covered, or whose spouse or dependent (as defined in section 152) is covered, by the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act for all months in the taxable year, subparagraph (A) shall be applied without regard to <quote>but does not exceed 400 percent</quote>.</text></clause><clause id="HB5F0F700D38D4C1095F72C0C5DB699B7"><enum>(ii)</enum><header>Enrollees in medicaid nonexpansion states</header><text>In the case of a taxpayer residing in a State which (as of the date of the enactment of the Medicare for All Act) does not provide for eligibility under clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) of the Social Security Act for medical assistance under title XIX of such Act (or a waiver of the State plan approved under section 1115) who is covered, or whose spouse or dependent (as defined in section 152) is covered, by the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act for all months in the taxable year, subparagraphs (A) and (B) shall be applied by substituting <quote>0 percent</quote> for <quote>100 percent</quote> each place it appears.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph><subparagraph id="H7FD798A743C5485DBC3CBB1AC5E9688B"><enum>(B)</enum><header>Premium assistance amounts for taxpayers enrolled in medicare transition buy-in</header><clause id="H6F5C9B3AEB1D4CF58377CEEE3B918E4C"><enum>(i)</enum><header>In general</header><text>Subparagraph (A) of section 36B(b)(3) of such Code is amended—(I) by redesignating clause (ii) as clause (iii), (II) by striking <quote>clause (ii)</quote> in clause (i) and inserting <quote>clauses (ii) and (iii)</quote>, and (III) by inserting after clause (i) the following new clause:</text><quoted-block id="H1238413A945D4D909F4657FB7F4D678C" style="OLC"><clause id="H816B2461954F4726B1D6F263EE50D746"><enum>(ii)</enum><header>Special rules for taxpayers enrolled in medicare transition buy-in</header><text>In the case of a taxpayer who is covered, or whose spouse or dependent (as defined in section 152) is covered, by the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act for all months in the taxable year, the applicable percentage for any taxable year shall be determined in the same manner as under clause (i), except that the following table shall apply in lieu of the table contained in such clause:</text><table align-to-level="section" blank-lines-before="1" colsep="1" frame="topbot" line-rules="hor-ver" rowsep="0" rule-weights="4.4.4.0.0.0" table-template-name="Generic: 3 text, even cols" table-type=""><tgroup cols="3" grid-typeface="1.1" rowsep="0" thead-tbody-ldg-size="10.10.10"><colspec coldef="txt" colname="column1" colwidth="250.88pt" min-data-value="100" rowsep="0"></colspec><colspec coldef="fig" colname="column2" colwidth="104.13pt" min-data-value="15" rowsep="0"></colspec><colspec coldef="fig" colname="column3" colwidth="113.63pt" min-data-value="15" rowsep="0"></colspec><thead><row><entry align="center" colname="column1" morerows="0" namest="column1" rowsep="1">In the case of household income<linebreak></linebreak> (expressed as a percent of<linebreak></linebreak> poverty line) within the<linebreak></linebreak> following income tier:</entry><entry align="center" colname="column2" morerows="0" namest="column2" rowsep="1">The initial<linebreak></linebreak> premium<linebreak></linebreak> percentage is—</entry><entry align="center" colname="column3" morerows="0" namest="column3" rowsep="1">The final<linebreak></linebreak> premium<linebreak></linebreak> percentage is—</entry></row></thead><tbody><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">Up to 100 percent</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">2.00</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">2.00</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">100 percent up to 138 percent</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">2.04</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">2.04</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">138 percent up to 150 percent</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">3.06</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">4.08</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">150 percent and above</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">4.08</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">5.00.</entry></row></tbody></tgroup></table></clause><after-quoted-block>.</after-quoted-block></quoted-block></clause><clause id="H8571E85DB490416BBCC2F111A9647E47"><enum>(ii)</enum><header>Conforming amendment</header><text>Subclause (I) of clause (iii) of section 36B(b)(3) of such Code, as redesignated by subparagraph (A)(i), is amended by inserting <quote>, and determined after the application of clause (ii)</quote> after <quote>after application of this clause</quote>.</text></clause></subparagraph></paragraph><paragraph id="H0D5A7ACE1C56479CA04953E2A1A5DB91"><enum>(2)</enum><header>Cost-sharing subsidies</header><text>Subsection (b) of section 1402 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18071">42 U.S.C. 18071(b)</external-xref>) is amended—</text><subparagraph id="HB986037900BE4D6AAEA239034F5F36F7"><enum>(A)</enum><text>by inserting <quote>, or in the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act,</quote> after <quote>coverage</quote> in paragraph (1);</text></subparagraph><subparagraph id="H240D6596C9F54AFB8292919392C62D46"><enum>(B)</enum><text>by redesignating paragraphs (1) (as so amended) and (2) as subparagraphs (A) and (B), respectively, and by moving such subparagraphs 2 ems to the right;</text></subparagraph><subparagraph id="H877591A991334F98BFD8116A01A79045"><enum>(C)</enum><text display-inline="yes-display-inline">by striking <quote><header-in-text level="subsection" style="OLC">insured</header-in-text>.—In this section</quote> and inserting “<header-in-text level="subsection" style="OLC">insured</header-in-text>.—</text><quoted-block display-inline="no-display-inline" id="HE837655D65474070911A0E634C1BF0E6" style="OLC"><paragraph id="HA38597721B494951AEE6360AA8CC24E0"><enum>(1)</enum><header>In general</header><text>In this section</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph><subparagraph id="H4F64C60FB75A48F0BA91F4E7CB801227"><enum>(D)</enum><text>by striking the flush language; and</text></subparagraph><subparagraph id="HA1D77F38B9F94EB0B3C2EAED6250A7DE"><enum>(E)</enum><text>by adding at the end the following new paragraph:</text><quoted-block id="H1A8A2E4E3C6A4B6195667B407768F06B" style="OLC"><paragraph id="HD9529A7D48FA4198B790F0558C769456"><enum>(2)</enum><header>Special rules</header><subparagraph id="H173E9D5034A24A13A68D732C6B2DA9C9"><enum>(A)</enum><header>Individuals lawfully present</header><text>In the case of an individual described in <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(c)(1)(B)</external-xref> of the Internal Revenue Code of 1986, the individual shall be treated as having household income equal to 100 percent of the poverty line for a family of the size involved for purposes of applying this section.</text></subparagraph><subparagraph id="H3E8C9D3E02114FF0A3A54A2595CD72F8"><enum>(B)</enum><header>Medicare transition buy-in enrollees in medicaid non-expansion states</header><text>In the case of an individual residing in a State which (as of the date of the enactment of the Medicare for All Act) does not provide for eligibility under clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) of the Social Security Act for medical assistance under title XIX of such Act (or a waiver of the State plan approved under section 1115) who enrolls in such Medicare Transition buy-in, the preceding sentence, paragraph (1)(B), and paragraphs (1)(A)(i) and (2)(A) of subsection (c) shall each be applied by substituting <quote>0 percent</quote> for <quote>100 percent</quote> each place it appears.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection><subsection id="H50523E446D9D4564913F2A78103D11B2"><enum>(h)</enum><header>Conforming amendments</header><paragraph id="H690D0B62428B45239915D2E028B120FC"><enum>(1)</enum><header>Treatment as a qualified health plan</header><text>Section 1301(a)(2) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18021">42 U.S.C. 18021(a)(2)</external-xref>) is amended—</text><subparagraph id="HE8BE396E5B50417D928524DA6E34505E"><enum>(A)</enum><text>in the paragraph heading, by inserting <quote><header-in-text level="paragraph">The Medicare transition buy-in,</header-in-text></quote> before <quote><header-in-text level="paragraph">and</header-in-text></quote>; and</text></subparagraph><subparagraph id="H6EC1BDE28DFF4C13B24DD3297C2F9282"><enum>(B)</enum><text>by inserting <quote>The Medicare Transition buy-in,</quote> before <quote>and a multi-State plan</quote>.</text></subparagraph></paragraph><paragraph id="H182B31D086C54E7A9ED46823C38E36F2"><enum>(2)</enum><header>Level playing field</header><text>Section 1324(a) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18044">42 U.S.C. 18044(a)</external-xref>) is amended by inserting <quote>the Medicare Transition buy-in,</quote> before <quote>or a multi-State qualified health plan</quote>.</text></paragraph></subsection></section></subtitle><subtitle id="HA704B5E0AACF49FBAE35A22B455146B7" style="OLC"><enum>B</enum><header>Transitional Medicare Reforms</header><section id="H0EFBD6D0DC404F5AB8FFB44AB4B97FE0"><enum>1011.</enum><header>Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities</header><subsection id="HAB2B87CB06B24289B756F0676EF00E11"><enum>(a)</enum><header>In general</header><text>Section 226(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/426">42 U.S.C. 426(b)</external-xref>) is amended—</text><paragraph id="HEBEA034331FD49B885EB28593A22C58D"><enum>(1)</enum><text>in paragraph (2)(A), by striking <quote>, and has for 24 calendar months been entitled to,</quote>;</text></paragraph><paragraph id="HF0F25C655C964BC1B8D75ACB90DD1DC5"><enum>(2)</enum><text>in paragraph (2)(B), by striking <quote>, and has been for not less than 24 months,</quote>;</text></paragraph><paragraph id="H3B767B41B5CD4C9BA878E191E97EB405"><enum>(3)</enum><text>in paragraph (2)(C)(ii), by striking <quote>, including the requirement that he has been entitled to the specified benefits for 24 months,</quote>;</text></paragraph><paragraph id="H28733166E1724332BF257ADFE809045A"><enum>(4)</enum><text>in the first sentence, by striking <quote>for each month beginning with the later of (I) July 1973 or (II) the twenty-fifth month of his entitlement or status as a qualified railroad retirement beneficiary described in paragraph (2), and</quote> and inserting <quote>for each month for which the individual meets the requirements of paragraph (2), beginning with the month following the month in which the individual meets the requirements of such paragraph, and</quote>; and</text></paragraph><paragraph id="H2581466905EA495AAC510590E82FB19B"><enum>(5)</enum><text>in the second sentence, by striking <quote>the <quote>twenty-fifth month of his entitlement</quote></quote> and all that follows through <quote>paragraph (2)(C) and</quote>.</text></paragraph></subsection><subsection id="HC9968717D8004F7C924E96BD8AEDD542"><enum>(b)</enum><header>Conforming amendments</header><paragraph id="HD3EA79BD036940EF84BF2BD6948F42E8"><enum>(1)</enum><header>Section 226</header><text>Section 226 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/426">42 U.S.C. 426</external-xref>) is amended by—</text><subparagraph id="H945CF7BA9FDC4ED4A253A9455F0E2B8C"><enum>(A)</enum><text>striking subsections (e)(1)(B), (f), and (h); and</text></subparagraph><subparagraph id="HCB536D833B4B40019BE66592A20E1AD3"><enum>(B)</enum><text>redesignating subsections (g) and (i) as subsections (f) and (g), respectively.</text></subparagraph></paragraph><paragraph id="H45BC840B1638475EBA4A2E35D212B6EF"><enum>(2)</enum><header>Medicare description</header><text>Section 1811(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c(2)</external-xref>) is amended by striking <quote>have been entitled for not less than 24 months</quote> and inserting <quote>are entitled</quote>.</text></paragraph><paragraph id="H347AA6FCB2934057935EB32A90710A98"><enum>(3)</enum><header>Medicare coverage</header><text>Section 1837(g)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395p">42 U.S.C. 1395p(g)(1)</external-xref>) is amended by striking <quote>25th month of</quote> and inserting <quote>month following the first month of</quote>.</text></paragraph><paragraph id="H097841AC77B94772A5D46B97510B10B1"><enum>(4)</enum><header>Railroad retirement system</header><text>Section 7(d)(2)(ii) of the Railroad Retirement Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/45/231f">45 U.S.C. 231f(d)(2)(ii)</external-xref>) is amended—</text><subparagraph id="HA4BF6314F93946488E5F143B9A735C24"><enum>(A)</enum><text>by striking <quote>has been entitled to an annuity</quote> and inserting <quote>is entitled to an annuity</quote>;</text></subparagraph><subparagraph id="HE9481A5234544F2A8856CABD96C81DB0"><enum>(B)</enum><text>by striking <quote>, for not less than 24 months</quote>; and</text></subparagraph><subparagraph id="HD560120720F145B0825C561B9CAFF349"><enum>(C)</enum><text>by striking <quote>could have been entitled for 24 calendar months, and</quote>.</text></subparagraph></paragraph></subsection><subsection id="H4F9106D9D53548A595841368F96D8156"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall apply to insurance benefits under title XVIII of the Social Security Act with respect to items and services furnished in months beginning after December 1 following the date of enactment of this Act, and before the date that is 2 years after the date of the enactment of such Act.</text></subsection></section><section id="H5E7C1ACF641249869B77225C36A294B4"><enum>1012.</enum><header>Ensuring continuity of care</header><subsection id="H927C4747C41446C1A657F953D66A3B95"><enum>(a)</enum><header>In general</header><text>The Secretary shall ensure that all persons enrolled or who seek to enroll in a health plan during the transition period of the Medicare for All Program are protected from disruptions in their care during the transition period, including continuity of care with such persons’ current health care provider teams.</text></subsection><subsection id="HF9F6EDEA30214B57ADC49C0CB39BAC3F"><enum>(b)</enum><header>Continuity of coverage and care in general</header><text>During the transition period of the Medicare for All Act, group health plans and health insurance issuers offering group or individual health insurance coverage shall not end coverage for an enrollee during the transition period described in the Act until all ages are eligible to enroll in the Medicare for All Program except as expressly agreed upon under the terms of the plan.</text></subsection><subsection id="H686289826D0841B8B3CA060ACC7AD7E6"><enum>(c)</enum><header>Continuity of coverage and care for persons with complex medical needs</header><paragraph id="HC69732823BFE4F9780F42FE4628DFCB1"><enum>(1)</enum><text>The Secretary shall ensure that persons’ with disabilities, complex medical needs, or chronic conditions are protected from disruptions in their care during the transition period, including continuity of care with such persons current health care provider teams.</text></paragraph><paragraph id="HC6D5741BA755416284E8EC8EBD0D129E"><enum>(2)</enum><text>During the transition period of the Medicare for All Act group health plans and health insurance issuers offering group or individual health insurance coverage shall not—</text><subparagraph id="H4DA6207AC1B948BFBA9AA2DBA9177781"><enum>(A)</enum><text>end coverage for an enrollee who has a disability, complex medical need, or chronic condition during the transition period described in the Act until all ages are eligible to enroll in the Medicare for All Program; or</text></subparagraph><subparagraph id="H416459A9FA624693AB2335A44D69FF43"><enum>(B)</enum><text>impose any exclusion with respect to such plan or coverage on the basis of a person’s disability, complex medical need, or chronic condition during the transition period described under this Act until all ages are eligible to enroll in the Medicare for All Program.</text></subparagraph></paragraph></subsection><subsection id="H982BBB88BC5549C88B3528E5D1F4504F"><enum>(d)</enum><header>Public consultation during transition</header><text>The Secretary shall consult with communities and advocacy organizations of persons living with disabilities as well as other patient advocacy organizations to ensure that the transition buy-in takes into account the continuity of care for persons with disabilities, complex medical needs, or chronic conditions.</text></subsection></section></subtitle></title><title commented="no" id="H8A46DA6911484092AD0516038ED06031" style="OLC"><enum>XI</enum><header>Miscellaneous</header><section commented="no" id="HF952FF3F08024480AF9EF59B64EEABE9"><enum>1101.</enum><header>Definitions</header><text display-inline="no-display-inline">In this Act—</text><paragraph id="HF2D8BB4138164DA2B84FCFD39066B729"><enum>(1)</enum><text display-inline="yes-display-inline">the term <quote>global budget</quote> means the payment negotiated between an institutional provider and as described in section 611(b);</text></paragraph><paragraph id="HDE8F73F13F5741D98643A05494C05BC5"><enum>(2)</enum><text>the term <term>group practice</term> has the meaning given such term in section 1877(h)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395nn">42 U.S.C. 1395nn(h)(4)</external-xref>);</text></paragraph><paragraph id="HEAF48A180455412BAD07CAC507B1C3CF"><enum>(3)</enum><text display-inline="yes-display-inline">the term <term>individual provider</term> means a supplier (as defined in section 1861(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(d)</external-xref>));</text></paragraph><paragraph id="HB5289E6877A942F29C9818131D3F0565"><enum>(4)</enum><text>the term <term>institutional provider</term> means—</text><subparagraph id="HC9F441A9C502473EA4E7AE3122DCEBF3"><enum>(A)</enum><text>providers of services described in section 1861(u) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(u)</external-xref>);</text></subparagraph><subparagraph id="HB756D26CDB3F402E8D2D2F1EC5D43395"><enum>(B)</enum><text>hospitals as defined in section 1861(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(e)</external-xref>), and any outpatient settings or clinics operating within a hospital license or any setting or clinic that provides outpatient hospital services;</text></subparagraph><subparagraph id="H65249672BFAF4A66B924823EB158D08B"><enum>(C)</enum><text>psychiatric hospitals (as defined in section 1861(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(f)</external-xref>));</text></subparagraph><subparagraph id="HF42195EC825A4D3C8191872FDADC77E3"><enum>(D)</enum><text>rehabilitation hospitals (as defined by the Secretary of Health and Human Services under section 1886(d)(1)(B)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(1)(B)(ii)</external-xref>));</text></subparagraph><subparagraph id="H47F9235101DB46F4A8D9E93A285BD7EB"><enum>(E)</enum><text>long-term care hospitals as defined in section 1861 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(ccc)</external-xref>); and</text></subparagraph><subparagraph id="HD3AB675128CA4238A84426C40017D4CC"><enum>(F)</enum><text>independent dialysis facilities and independent end-stage renal disease facilities as described in 42 CFR 413.174(b);</text></subparagraph></paragraph><paragraph id="HBFE38DE40FDD4642A746FCF236AB5B63"><enum>(5)</enum><text display-inline="yes-display-inline">the term <term>medically necessary or appropriate</term> means the health care items and services or supplies that are needed or appropriate to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms for an individual and are determined to be necessary or appropriate for such individual by the physician or other health care professional treating such individual, after such professional performs an assessment of such individual’s condition, in a manner that meets—</text><subparagraph id="HD3FB8103CA2A4E84A213772F0060A4E3"><enum>(A)</enum><text>the scope of practice, licensing, and other law of the State in which the individual receiving such items and services is located; and</text></subparagraph><subparagraph id="H020B7960BD9A4F31A59030C91776139E"><enum>(B)</enum><text>appropriate standards established by the Secretary for purposes of carrying out this Act;</text></subparagraph></paragraph><paragraph id="H9A1EE708861D4A83BF0840FC4084CEA0"><enum>(6)</enum><text>the term <term>provider</term> means an institutional provider or a supplier (as defined in section 1861(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(d)</external-xref>) if the reference to <quote>this title</quote> were a reference to the Medicare for All Program);</text></paragraph><paragraph commented="no" id="H349DC9D7224F458B8073B91CB230A22C"><enum>(7)</enum><text>the term <term>Secretary</term> means the Secretary of Health and Human Services;</text></paragraph><paragraph commented="no" id="H0A7879000163442BB181A240F6E6ABB9"><enum>(8)</enum><text>the term <term>State</term> means a State, the District of Columbia, or a territory of the United States;</text></paragraph><paragraph id="HA08EA4E69DDC475DAF5F2BB0D5974830"><enum>(9)</enum><text>the term <quote>TRICARE Overseas Program</quote> means the element of the TRICARE program administered by International SOS (or such successor administrator) under which care and health benefits are furnished to TRICARE beneficiaries located in a TRICARE overseas region;</text></paragraph><paragraph id="H362CC795EE724AFCB348E4E268A5957D"><enum>(10)</enum><text>the term <quote>TRICARE program</quote> has the meaning given such term in section 1072 of title 10, United States Code;</text></paragraph><paragraph id="HEF8FD29002FB4FDAAEF6878F9A1C277F"><enum>(11)</enum><text>the term <quote>uniformed services</quote> has the meaning given such term in section 101 of title 10, United States Code; and</text></paragraph><paragraph commented="no" id="H7D43A5E9AAC0428B88065DDDAC944BC5"><enum>(12)</enum><text>the term <term>United States</term> shall include the States, the District of Columbia, and the territories of the United States.</text></paragraph></section><section id="H530EAAF7504C4DAB970AE8CDF39C382A"><enum>1102.</enum><header>Rules of construction</header><subsection id="H4666B42F070D4A218C23781E366ACB80"><enum>(a)</enum><header>In general</header><text>A State or local government may set additional standards or apply other State or local laws with respect to eligibility, benefits, and minimum provider standards, only if such State or local standards—</text><paragraph id="HB2B181F88AF444BB9DFE9B6D351133AD"><enum>(1)</enum><text>provide equal or greater eligibility than is available under this Act;</text></paragraph><paragraph id="HE9A7D3BC92B94CB3B167F2EF5913D821"><enum>(2)</enum><text>provide equal or greater in-person access to benefits under this Act;</text></paragraph><paragraph id="H9C3F4E4F5B3F4746904BF5AEE5FBD832"><enum>(3)</enum><text>do not reduce access to benefits under this Act;</text></paragraph><paragraph id="H4A2206EA30B34145823ACDF81BFA229E"><enum>(4)</enum><text>allow for the effective exercise of the professional judgment of physicians or other health care professionals; and</text></paragraph><paragraph id="H97EF7D73316E44539AE074CA0FBCE959"><enum>(5)</enum><text>are otherwise consistent with this Act.</text></paragraph></subsection><subsection id="H99F80343A2C84FBFA61BF21979932B73"><enum>(b)</enum><header>Relation to state licensing law</header><text>Nothing in this Act shall be construed to preempt State licensing, practice, or educational laws or regulations with respect to health care professionals and health care providers, for such professionals and providers who practice in that State.</text></subsection><subsection id="H5C21F1AC938948C8BEC78F745E594F46"><enum>(c)</enum><header>Application to state and Federal law on workplace rights</header><text>Nothing in this Act shall be construed to diminish or alter the rights, privileges, remedies, or obligations of any employee or employer under any Federal or State law or regulation or under any collective bargaining agreement.</text></subsection><subsection id="H5EFB14DD5B544B17B2F26400E22837EE"><enum>(d)</enum><header>Restrictions on providers</header><text>With respect to any individuals or entities certified to provide items and services covered under section 201(a)(7), a State may not prohibit an individual or entity from participating in the program under this Act for reasons other than the ability of the individual or entity to provide such services.</text></subsection></section><section id="HF5AB7EBA9C7F436497395633886593FF"><enum>1103.</enum><header>No use of resources for law enforcement of certain registration requirements</header><text display-inline="no-display-inline">Notwithstanding any provision of Federal or State law, no Federal or State law enforcement official or employee shall use any funds, facilities, property, equipment, or personnel made available pursuant to this Act (or any amendment made thereby) to investigate, enforce, or assist in the investigation or enforcement of any criminal, civil, or administrative violation or warrant for a violation of any requirement that individuals register with the Federal Government based on religion, national origin, ethnicity, immigration status, or other protected category.</text></section></title></legis-body></bill> 

