I 111th CONGRESS 1st Session H. R. 2520 IN THE HOUSE OF REPRESENTATIVES May 20, 2009 Mr. Ryan of Wisconsin (for himself and Mr. Nunes) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide comprehensive solutions for the health care system of the United States, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Patients' Choice Act. (b)

Table of contents

The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—Investing in prevention Sec. 101. Strategic approach to outcome-based prevention. Sec. 102. State grants for outcome-based prevention effort. Sec. 103. Focusing the food stamp program on nutrition. Sec. 104. Immunizations. TITLE II—State-based health care exchanges Sec. 201. State-based health care exchanges. Sec. 202. Requirements. Sec. 203. State Exchange incentives. TITLE III—Fair tax treatment for all Americans to afford health care Sec. 300. Reference. Subtitle A—Refundable and advanceable credit for certain health insurance coverage Sec. 301. Refundable and advanceable credit for certain health insurance coverage. Sec. 302. Requiring employer transparency about employee benefits. Sec. 303. Changes to existing tax preferences for medical coverage, etc., for individuals eligible for qualified health insurance credit. Subtitle B—Health Savings Accounts Sec. 311. Improvements to health savings accounts. Sec. 312. Exception to requirement for employers to make comparable health savings account contributions. TITLE IV—Fairness for every American patient Subtitle A—Medicaid modernization Sec. 401. Medicaid modernization. Sec. 402. Outreach. Sec. 403. Transition rules; miscellaneous provisions. Subtitle B—Supplemental Health Care Assistance for Low-Income Families Sec. 411. Supplemental Health Care Assistance for Low-Income Families. TITLE V—Fixing Medicare for American seniors Subtitle A—Increasing programmatic efficiency, economy, and accountability Sec. 501. Eliminating inefficiencies and increasing choice in Medicare Advantage. Sec. 502. Medicare Accountable Care Organization demonstration program. Sec. 503. Reducing government handouts to wealthier seniors. Sec. 504. Rewarding prevention. Sec. 505. Promoting healthcare provider transparency. Sec. 506. Availability of Medicare and Medicaid claims and patient encounter data. Subtitle B—Reducing fraud and abuse Sec. 511. Requiring the Secretary of Health and Human Services to change the Medicare beneficiary identifier used to identify Medicare beneficiaries under the Medicare program. Sec. 512. Use of technology for real-time data review. Sec. 513. Detection of medicare fraud and abuse. Sec. 514. Edits on 855S Medicare enrollment application and exemption of pharmacists from surety bond requirement. Sec. 515. GAO study and report on effectiveness of surety bond requirements for suppliers of durable medical equipment in combating fraud. TITLE VI—Ending lawsuit abuse Sec. 601. State grants to create health court solutions. TITLE VII—Promoting health information technology Subtitle A—Assisting the development of health information technology Sec. 701. Purpose. Sec. 702. Health record banking. Sec. 703. Application of Federal and State security and confidentiality standards. Subtitle B—Removing barriers to the use of health information technology to better coordinate health care Sec. 711. Safe harbors to antikickback civil penalties and criminal penalties for provision of health information technology and training services. Sec. 712. Exception to limitation on certain physician referrals (under Stark) for provision of health information technology and training services to health care professionals. Sec. 713. Rules of construction regarding use of consortia. TITLE VIII—Health Care Services Commission Subtitle A—Establishment and general duties Sec. 801. Establishment. Sec. 802. General authorities and duties. Sec. 803. Dissemination. Subtitle B—Forum for quality and effectiveness in health care Sec. 811. Establishment of office. Sec. 812. Membership. Sec. 813. Duties. Sec. 814. Adoption and enforcement of guidelines and standards. Sec. 815. Additional requirements. Subtitle C—General provisions Sec. 821. Certain administrative authorities. Sec. 822. Funding. Sec. 823. Definitions. Subtitle D—Terminations and transition Sec. 831. Termination of Agency for Healthcare Research and Quality. Sec. 832. Transition. Subtitle E—Independent Health Record Trust Sec. 841. Short title. Sec. 842. Purpose. Sec. 843. Definitions. Sec. 844. Establishment, certification, and membership of Independent Health Record Trusts. Sec. 845. Duties of IHRT to IHRT participants. Sec. 846. Availability and use of information from records in IHRT consistent with privacy protections and agreements. Sec. 847. Voluntary nature of trust participation and information sharing. Sec. 848. Financing of activities. Sec. 849. Regulatory oversight. TITLE IX—Miscellaneous Sec. 901. Health care choice for veterans. Sec. 902. Health care choice for Indians. Sec. 903. Termination of Federal Coordinating Council for Comparative Effectiveness Research. Sec. 904. HHS and GAO joint study and report on costs of the 5 medical conditions that have the greatest impact.

. (b)

Repeal of Title XXI

Effective January 1, 2011, title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) is repealed.

402.

Outreach

(a)

Authorization of appropriations

The following amounts are authorized to be appropriated to the Secretary of Health and Human Services: (1)For fiscal year 2009, $100,000,000 for the design and implementation of a public outreach campaign to inform the public about the changes to the programs under such titles that take effect on January 1, 2011, as a result of the amendment made by section 401. (2)For each of fiscal years 2010 and 2011, $200,000,000 to carry out such public outreach campaign. (3)For fiscal year 2012, $50,000,000 to carry out such public outreach campaign. (b)

Availability

Funds appropriated under subsection (a) shall remain available for expenditure through September 30, 2012. (c)

Authority for use of funds

The Secretary may use funds made available under paragraphs (2) and (3) of subsection (a) to award grants to, or enter into contracts with, public or private entities, including States, local governments, schools, churches, and community groups.

403.

Transition rules; miscellaneous provisions

(a)

In general

(1)Not later than June 30, 2010, a State that is one of the 50 States or the District of Columbia shall inform all individuals enrolled in a State plan under title XIX or XXI of the Social Security Act on such date (and any new enrollees after such date) of the changes to the programs under such titles that take effect on January 1, 2011, as a result of the amendment made by section 401. (2)No State that is one of the 50 States or the District of Columbia shall approve any applications for medical assistance or child health assistance under a State plan under title XIX or XXI (as in effect for fiscal year 2010) after December 31, 2010. (b)

Submission of legislative proposal for technical and conforming amendments

Not later than 6 months after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a legislative proposal for such technical and conforming amendments as are necessary to carry out the amendments made by this Act.

B

Supplemental Health Care Assistance for Low-Income Families

411.

Supplemental Health Care Assistance for Low-Income Families

Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by adding at the end the following: XI

Health care assistance to low-income families

340A–1.

Financial assistance to low-income families

(a)

In general

The Secretary shall supplement the costs of private health insurance for eligible low-income families through the distribution of supplemental debit cards to eligible families, which may be used to pay for costs associated with health care for the members of such eligible families and provide direct support to such families in accessing health care. (b)

Eligibility

(1)

Eligible families

To be eligible for financial assistance under this section— (A)a family shall— (i)consist of 2 or more individuals living together who are related by marriage, birth, adoption, or guardianship; (ii)have a gross income that does not exceed 200 percent of the poverty line, as applicable to a family of the size involved; and (iii)include at least 1 individual who is a dependent under the age of 19; and (B)no member of the family shall be covered by private health insurance. (2)

Determination of gross income

The gross income of a family shall be determined by taking the sum of the income of each family member who is at least age 21 but not older than age 65, except that the income of any member of the family who qualifies for coverage under Medicaid Part A or B shall not be counted. (3)

Limitation on individual eligibility; assistance

(A)

In general

No individual who is a member of an eligible family under paragraph (1) is eligible to qualify separately for financial assistance under this section. (B)

Aliens

The Secretary shall ensure that financial assistance under this section is not provided for costs associated with health care for any member of an eligible family who is an alien individual who is not a lawful permanent resident of the United States. (c)

Supplemental debit card for health care expenditures

(1)

In general

The Secretary shall issue to each eligible family that enrolls in the program in accordance with subsection (f) a supplemental debit card with a dollar-amount value, in accordance with subsection (d), that may be used to pay for qualifying health care expenses. (2)

Use of the debit card

(A)

Qualifying health care expenses

A supplemental debit card issued under this section may be used by members of the eligible family to pay for— (i)the purchase of health care insurance for any member of the family; (ii)cost sharing expenses related to health care, including deductibles, copayments, and coinsurance, for any member of the family; and (iii)the direct purchase of health care services and supplies for any member of the family. (B)

Geographic range

Each supplemental debit card may be used to pay for qualifying health care expenses incurred anywhere in the 50 States or the District of Columbia. (C)

Limitations

No supplemental debit card shall be used to make a payment for any cost— (i)incurred prior to the determination of the family's eligibility for assistance under this section; or (ii)that is not a health-related expense. (3)

Rollover of unused amounts

Not more than one-quarter of the annual dollar amount of a supplemental debit card that is unexpended at the end of each 12-month period may rollover— (A)to the family's supplemental debit card for expenditure during the subsequent 12-month period, provided that the family to which the supplemental debit card was issued in the previous 12-month period is eligible to receive a supplemental debit card in the subsequent 12-month period; or (B)to the family's health savings account (as defined in section 223(g)(2) of the Internal Revenue Code of 1986). (4)

Monthly statements

The Secretary shall issue a monthly statement to each family to which a supplemental debit card has been issued under this section, which shall state each payment made with the family's supplemental debit card during the month covered by the statement, the dollar amount of each such payment, and the provider to which each such payment was made. (d)

Amount of financial assistance

(1)

Amounts for calendar year 2011

Subject to paragraph (5), the amount of financial assistance available to each eligible family during the calendar year 2011 shall be determined as follows: (A)Each family whose annual income does not exceed 100 percent of the poverty level, as applicable to a family of the size involved, shall receive $5,000. (B)Each family whose annual income exceeds 100 percent, but does not exceed 200 percent, of the poverty level, as applicable to a family of the size involved, shall receive an amount as follows: (i)For families whose annual income exceeds 100 percent but does not exceed 120 percent, of the poverty level, $4,000. (ii)For families whose annual income exceeds 120 percent but does not exceed 140 percent, of the poverty level, $3,500. (iii)For families whose annual income exceeds 140 percent but does not exceed 160 percent, of the poverty level, $3,000. (iv)For families whose annual income exceeds 160 percent but does not exceed 180 percent, of the poverty level, $2,500. (v)For families whose annual income exceeds 180 percent but does not exceed 200 percent, of the poverty level, $2,000. (2)

Additional amounts

In addition to the amounts under paragraph (1), subject to paragraph (5), the following amounts shall be added to the supplemental debit cards of qualifying families: (A)For each pregnancy during which a pregnant woman's family is eligible for assistance under this section, an additional amount of $1,000 shall be added to the family's supplemental debit card, except that no family shall receive such additional $1,000 for any pregnancy for which the family received such amount in the previous 12-month period. (B)For each member of an eligible family who is less than 1 year old on any day within the calendar year in which the family is eligible for assistance, an additional amount of $500 shall be added to the family's supplemental debit card. (3)

Cost of living adjustments

In the case of any taxable year beginning in a calendar year after 2011, each dollar amount contained in paragraphs (1) and (2) shall be increased in the same manner as the dollar amounts specified in section 25E(b)(3) of the Internal Revenue Code of 1986 are increased by the blended cost-of-living adjustment determined under subsection (k)(2) of section 25E of the Internal Revenue Code for the taxable year involved. (4)

State option to increase amounts

At the option of each State, amounts in excess of the annual dollar amounts under paragraphs (1) and (2) may be provided through the supplemental debit card to eligible families in that State, but no Federal funds shall be paid to any State for any amount provided in excess of such annual dollar amount. (5)

Risk adjustment

The Secretary may adjust the amount of financial assistance available to an eligible family for a calendar year under this section based on age, health indicators, and other factors that represent distinct patterns of health care services utilization and costs. (e)

Contributions of States

(1)

In general

As a condition for receiving Federal funds under Part A or Part B of Medicaid, each State shall contribute 50 percent of the total amount expended under the supplemental debit card program by the participating families that reside within the State during the time that the family resides in that State. For purposes of this section, the residency of a family is determined by the residency the legally responsible head of the household. (2)

Payments from States

(A)

Billing notification

(i)

Timing

On June 30th and December 31st of each year, the Secretary shall send written notification to each State of that State's 50 percent share of expenses, as described in paragraph (1), for the 6-month period ending on the last day of the month previous to such notification. (ii)

Contents

Each such notification to a State shall clearly state— (I)the payment amount due from the State; (II)the name of each individual for whom payment was made through the supplemental debit card program; (III)the health care provider to whom each payment was made; (IV)the amount of each payment; and (V)any other information, as the Secretary requires. (B)

Payments

Each State shall make a payment to the Secretary, in the amount billed, not later than 30 days after the billing notification date, in accordance with subparagraph (A)(i). (C)

Penalties

If a State fails to pay to the Secretary an amount required under subparagraph (B), interest shall accrue on such amount at the rate provided under old section 1903(d)(5) of the Social Security Act. The amount so owed and applicable interest shall be immediately offset against amounts otherwise payable to the State under this section, in accordance with the Federal Claims Collection Act of 1996 and applicable regulations. (f)

Enrollment

(1)

In general

The Secretary shall establish procedures and times for enrollment in the supplemental debit card program. Open enrollment shall be available not less than 4 times per calendar year. (2)

Transition of individuals enrolled in Medicaid or the State Children's Health Insurance Program

(A)

Information from the States

Each State shall— (i)not later than June 30, 2010, inform all individuals then enrolled in Medicaid or the State Children's Health Insurance Program (SCHIP), of the changes in effect beginning on January 1, 2011; and (ii)not later than October 31, 2010, redetermine the eligibility of each individual enrolled in Medicaid or SCHIP, other than those individuals who qualify for Medicaid or SCHIP as disabled, elderly, or a special population, for the supplemental debit card program, according to the eligibility criteria under subsection (b). (B)

Automatic enrollment

The Secretary shall provide for the automatic enrollment in the supplemental debit card program of all individuals who are enrolled in Medicaid or SCHIP and who have been redetermined by a State under subparagraph (A) to be eligible for Medicaid or SCHIP. Any individual who is determined by a State not to qualify for the supplemental debit card program may retain coverage under Medicaid or SCHIP until June 30, 2011. (3)

Assistance with qualified health insurance credit

Each State shall, to the extent practicable, provide individuals residing within the State with information regarding the qualified health insurance credit described in section 25E of the Internal Revenue Code of 1986, including information regarding eligibility for, and how to claim, such credit. (g)

Administration

(1)

National system

The Secretary may enter into contracts or agreements with a State, a consortium of States, or a private entity, including a bank, enrollment broker, or similar entity, to establish and maintain a unified national system to support the processes and transactions necessary to administer this section. (2)

Automated system

The Secretary shall establish an automated means, such as an electronic benefit transfer system, by which the benefits under this section shall be transferred to eligible families. (3)

Verification of applicant information

The Secretary may verify information provided by applicants with the appropriate Federal, State, and local agencies, including the Internal Revenue Service, the Social Security Administration, the Department of Labor, and child support enforcement agencies. (4)

Choice counseling

The Secretary may enter into contracts or agreements with a State, a consortium of a State, or a private entity, including an enrollment broker or community organization or other organization, to educate eligible families about their options and to assist in their enrollment in the supplemental debit card plan. (5)

Appeals

The Secretary shall establish an independent appeals process, to be administered by an entity separate from the entity that makes initial eligibility determinations, which shall be available to individuals who are denied benefits under the supplemental debit card program. (6)

Resolution of errors

The Secretary shall provide for a reconciliation process with the States to resolve any errors and adjudicate disputes due to incomplete or false information in a family's application or in the billing process described in subsection (e). (7)

Penalties for false information

Any person who provides false information to qualify for the supplemental debit card program shall pay a penalty in the amount of 110 percent of the amount of assistance paid on behalf of such person and all members of such person's family. (h)

Implementation plan

Not later than 6 months after the date of enactment of this section, the Secretary shall submit to Congress a plan for implementing this program during fiscal years 2009–2012. (i)

Authorization of appropriations

(1)

Administration of the supplemental debit card program

To administer the program under this section, there are authorized to be appropriated— (A)for fiscal year 2009, $300,000,000, for the design of a unified, national system of conducting the supplemental debit card program; (B)for fiscal year 2010, $1,000,000,000 for start-up costs, including, contracting, hiring and training employees, and testing the program; and (C)for fiscal year 2011 and each subsequent fiscal year, $3,000,000,000. (2)

Authorization of benefits under the supplemental debit card program

To provide the supplemental debit card benefits described in this section, there are authorized to be appropriated— (A)for fiscal year 2011, $24,020,000,000; (B)for fiscal year 2012, $25,220,000,000; (C)for fiscal year 2013, $26,480,000,000; (D)for fiscal year 2014, $27,810,000,000; and (E)for fiscal year 2015, $29,200,000,000.

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