1.This Act may be cited as the
Choice in Healthcare
Act
.
2.Medicare and
Medicaid Choice
(a)Notwithstanding any other provision of law, the Secretary
of Health and Human Services (referred to in this Act as the
Secretary) shall establish a demonstration program (referred to in
this Act as the demonstration program) under which Medicare and
Medicaid eligible beneficiaries (as defined in section 4) are provided—
(1)the option of
purchasing qualifying health benefits coverage; and
(2)access to a debit
style card (referred to in this Act as a Medi-Choice card) for the
purpose of purchasing health benefits coverage in accordance with the
demonstration program and for paying certain other out-of-pocket health care
expenditures.
(b)Qualifying
health benefits coverageIn this Act, the term qualifying
health benefits coverage means health benefits coverage that meets the
following requirements:
(1)In the case
of—
(A)a dual eligible
beneficiary, the coverage provides benefits that are at least as comprehensive
as the benefits provided, as of the date of the enactment of this Act, under
parts A, B, and D of title XVIII of the Social Security Act and under the State
Medicaid plan under title XIX of such Act in California;
(B)a Medicare eligible beneficiary who is not
a dual eligible beneficiary, the coverage provides benefits that are at least
as comprehensive as the benefits provided, as of the date of the enactment of
this Act, under parts A, B, and D of title XVIII of the Social Security Act;
and
(C)a Medicaid eligible beneficiary who is not
a dual eligible beneficiary, the coverage provides benefits that are at least
as comprehensive as the benefits provided, as of the date of the enactment of
this Act, under the State Medicaid plan under title XIX of the Social Security
Act in California.
(2)Guarantee issue;
no preexisting condition exclusionsThe coverage is offered and
available under the demonstration program on a guaranteed issue basis without
regard to health status and does not apply any preexisting condition exclusion
(as defined in section 2701(b)(1)(A) of the Public Health Service Act).
(3)Premiums for the coverage are uniform and do not vary by
age, health status, geographic area, or other characteristics of the enrolled
individual.
3.
(a)The
Secretary shall enter into a contract with a major credit card provider or
financial institution for the purpose of issuing Medi-Choice cards under the
demonstration program.
(b)
(1)Toward
purchasing qualifying benefits coverageMedi-Choice cards shall
be used to purchase qualifying health benefits coverage for eligible
beneficiaries enrolled in the demonstration program.
(2)Toward out of
pocket costsAmounts remaining on such a card after the
application of paragraph (1) may be used—
(A)to pay copayments
or deductibles and other cost sharing on behalf of enrolled eligible
beneficiaries; and
(B)for other
qualified medical expenses (as defined in section 223(d)(2) of the Internal
Revenue Code of 1986) of such beneficiaries.
(3)Amounts on a Medi-Choice card not otherwise used under
this paragraph shall remain available under the card until expended by or on
behalf of an enrolled eligible beneficiary during the period of participation
in the demonstration program.
4.
(a)In this Act, the term eligible beneficiary
means an individual—
(1)who is a legal
permanent resident of the United States residing within the area covered by the
demonstration program; and
(2)(A)who is eligible for
medical assistance for full benefits under the State plan under title XIX of
the Social Security Act for California as of the date of the enactment of this
Act; or
(B)who is entitled to benefits under part
A of title XVIII of the Social Security Act.
(b)The
term eligible beneficiary does not include any individual for a
month if the individual, as of the first day of the month is—
(1)enrolled by reason
of disability in the program under title XIX of the Social Security Act;
(2)entitled to
benefits under chapter 55 of title 10, United States Code, including under the
TRICARE program (as defined in section 1072(7) of such title);
(3)imprisoned under
Federal, State, or local authority; or
(4)an alien who is
not a lawful permanent resident of the United States.
(c)In
this Act:
(1)Medicare
eligible beneficiaryThe term Medicare eligible
beneficiary means an eligible beneficiary described in subsection
(a)(2)(B).
(2)Medicaid
eligible beneficiaryThe term Medicaid eligible
beneficiary means an eligible beneficiary described in subsection
(a)(2)(A).
(3)Dual eligible
beneficiaryThe term dual eligible beneficiary means
an eligible beneficiary who is both a Medicare eligible beneficiary and a
Medicaid eligible beneficiary.
5.Funding of
Medi-choice cards
(a)Under the demonstration program, subject to
the succeeding subsections, the Secretary shall make funds available through
the Medi-Choice card as follows:
(1)Dual eligible
beneficiariesFor a dual eligible beneficiary the annual amount
of the deposit—
(A)for 2012 is equal
to the sum of—
(i)the
United States average nominal dollar value of medical assistance under title
XIX of the Social Security Act; and
(ii)the United States average nominal dollar
value of the benefits under parts A, B, and D of title XVIII of such
Act;
(B)for any subsequent
year is equal to the annual amount specified in this paragraph for the
preceding year increased by the annual inflation adjustment described in
subsection (d) for such subsequent year.
(2)Other Medicaid
eligible beneficiariesFor a Medicaid eligible beneficiary who is
not a dual eligible beneficiary, the annual amount of the deposit—
(A)for 2012 is equal
to the United States average nominal dollar value of medical assistance under
title XIX of the Social Security Act; and
(B)for any subsequent
year is equal to the annual amount specified in this paragraph for the
preceding year increased by the annual inflation adjustment described in
subsection (d) for such subsequent year.
(3)Other Medicare
eligible beneficiariesFor a
Medicare eligible beneficiary who is not a dual eligible beneficiary, the
annual amount of the deposit shall—
(A)for 2012 be equal
to the United States average nominal dollar value of the benefits under parts
A, B, and D of title XVIII of the Social Security Act; and
(B)for any subsequent
year is equal to the annual amount specified in this paragraph for the
preceding year increased by the annual inflation adjustment described in
subsection (d) for such subsequent year.
(4)Any
amount computed under paragraph (1)(B), (2)(B), or (3)(B) that is not a
multiple of $12 shall be rounded to the nearest multiple of $12.
(b)The payment amounts under subsection (a) for an
individual shall be adjusted, using a methodology specified by the Secretary,
in a manner that takes into account the relative risk factors (such as those
described in section 1853(a)(1)(C)(i) of the Social Security Act) associated
with such individual. Such adjustment shall be made in such a manner as not to
change the total amount of payments made under this section as a result of such
adjustment.
(c)Medi-Choice
reductions for higher-Income individualsIn the case of an
individual whose modified adjusted gross income (as defined in paragraph (4) of
section 1839(i)(4) of the Social Security Act), exceeds the threshold amount
specified in paragraph (2) of such section, as adjusted under paragraph (5) of
such section, the annual amount under subsection (a)(2) shall be reduced by one
percent for each percent of such excess, but not to exceed a reduction of 50
percentage points.
(d)Annual inflation
adjustmentThe annual inflation adjustment under paragraphs
(1)(B) and (2)(B) for a year is equal to the average of—
(1)the annual rate of
increase in the consumer price index for urban consumers (all items; United
States city average) for the year, as projected by the Secretary in
consultation with the Bureau of Labor Statistics before the beginning of the
year; and
(2)the annual rate of
increase in the medical care component of the consumer price index for all
urban consumers (United States city average) for the year, as projected by the
Secretary in consultation with the Bureau of Labor Statistics before the
beginning of the year.
(e)Deposits of amounts to Medi-Choice cards under this
section shall be credited on a monthly basis and prorated for partial months of
program enrollment.
6.Scope of
demonstration program
(a)The
demonstration program shall be conducted in the counties of Kern, Tulare,
Kings, Fresno, Merced, Madera, Stanislaus, and San Joaquin in
California.
(b)Period of
demonstration project
(1)The
demonstration program shall be conducted for a period of 10 years.
(2)Eligible beneficiaries shall be permitted to enroll in
the demonstration program beginning on June 1, 2013.
(c)No more than 100,000 eligible beneficiaries may be
enrolled in the demonstration program at any time.
7.
(a)The Secretary shall
be responsible for the cost of operating the demonstration program, including
all amounts deposited onto Medi-Choice cards. The cost of operation of the
program insofar as they are attributable (as determined by the Secretary)
to—
(1)Medicare eligible
beneficiaries and benefits under part A, part B, or part D of title XVIII of
the Social Security Act shall be payable from the respective trust fund or
account under the respective part, and the amounts in such trust funds or
account shall be available to make such payments; or
(2)Medicaid eligible
beneficiaries and benefits under title XIX of such Act shall be payable from
amounts appropriated to carry out such title and the amounts so appropriated
shall be available to make such payments.
(b)Except as provided in section 8(d)(2), no amounts shall
be payable under title XVIII or XIX of the Social Security Act for benefits or
medical assistance for an eligible beneficiary participating in the
demonstration program.
8.
(a)The Secretary shall maintain a toll free phone number
to assist eligible beneficiaries with enrollment under the demonstration
program and shall make information available to eligible beneficiaries in the
demonstration area describing the options available, which shall include a
comparison of plan costs and benefits.
(b)Amounts paid into a Medi-Choice card shall not be treated
as income for purposes of the Internal Revenue Code of 1986 or for purposes of
determining eligibility for any Federal program.
(c)An individual participating in the
demonstration—
(1)is not responsible
for payment of any premium otherwise applicable under part B or D of title
XVIII or under title XIX of the Social Security Act; but
(2)shall use benefits
applied to the Medi-Choice card for the purpose of purchasing qualifying health
benefits coverage.
(d)Relation to
Medicaid benefits
(1)In the case of an individual who participates in the
demonstration program, the individual is not entitled to any payment under a
State plan under title XIX of the Social Security Act with respect to any
benefits relating to items and services for which coverage is provided under
this title.
(2)Continuation of
medical assistance for noncovered items and servicesNothing in
this Act shall affect the continued provision of medical assistance under title
XIX of such Act for items and services, such as dental, vision, or long-term
care facility services, for which benefits are not provided under this Act
regardless of medical necessity.