1.Short title; table of
contents
(a)This Act may be cited
as the Save and Strengthen Medicare
Act of 2012
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—IMPROVED AND UNIFIED MEDICARE PROGRAM THROUGH CHOICE AND
COMPETITION
Sec. 101. New unified eligibility and enrollment
rules.
Part E—Unified Medicare with Choice and Competition
Subpart 1—Eligibility; Enrollment
Sec. 1860E–11. Unified eligibility and enrollment under parts A
and B.
Sec. 1860E–12. Coordination with part D.
Sec. 1944. Maintenance of effort options for full-benefit dual
eligible individuals.
Sec. 102. Incentivized Medicare eligibility at increased
age.
Sec. 103. New benefit structure under unified
Medicare.
Subpart 2—Benefits
Sec. 1860E–21. Unified part A and B deductible.
Sec. 1860E–22. Uniform coinsurance.
Sec. 1860E–23. Out-of-pocket limit.
Sec. 1860E–24. Offering of tiered cost-sharing coverage levels
instead of medigap.
Sec. 1860E–25. Contributions into health individual retirement
accounts.
Sec. 1860E–26. Requiring MA plans to offer prescription drug
coverage.
Sec. 104. Late enrollment penalty not to apply for months of
any health coverage.
Sec. 105. Competitive bidding and premiums under unified
Medicare.
Subpart 3—Competitive Bidding and Premiums
Sec. 1860E–31. Application of competitive bidding and changes
in premiums.
Sec. 1860E–32. Application of competitive bidding to Medicare
fee-for-service.
Sec. 1860E–33. Ensuring a level playing
field.
Sec. 106. Separate Medicare FFS accounts and other financing
under unified Medicare.
Subpart 4—Subsidies
Sec. 1860E–41. Changes in
subsidies.
Sec. 107. Medicare Choices Commission; general provisions;
effective date.
Subpart 5—Medicare Choices Commission
Sec. 1860E–51. Medicare Choices Commission.
Sec. 1860E–52. Duties of the Commission.
Sec. 1860E–53. Powers of Commission.
Sec. 1860E–54. Commission personnel matters.
Sec. 1860E–55. Reports; communications with
Congress.
Sec. 1860E–56. Funding of the Commission.
Subpart 6—General Provisions
Sec. 1860E–61. Applicability; definitions.
Sec. 1860E–62. General effective
date.
TITLE II—HEALTH INDIVIDUAL RETIREMENT ACCOUNTS
Subtitle A—Establishment of Accounts
Sec. 201. Definitions.
Sec. 202. Health Individual Retirement Account
Fund.
Sec. 203. Establishment of health individual retirement
accounts.
Sec. 204. Transfer of HIRA contributions to HIRA
Fund.
Sec. 205. Operation of HIRA Fund.
Sec. 206. Health individual retirement account
distributions.
Subtitle B—Tax Treatment
Sec. 211. Tax treatment of
accounts.
Part IX—Health Individual Retirement Account Program
Sec. 530A. Health Individual Retirement Account
Program.
Sec. 212. HIRA contributions.
Sec. 213. Contributions eligible for saver’s
credit.
Sec. 214. Exclusion of certain HIRA
transfers.
Sec. 139F. Government HIRA
subsidies.
Subtitle C—Other Tax Provisions
Sec. 221. Health Savings Accounts available to individuals
eligible for Medicare.
Sec. 222. Reduction in Medicare portion of payroll tax to
incentivize late retirement.
Sec. 223. 15-percent excise tax on employer-sponsored Medicare
supplemental coverage.
Sec. 4980J. Employer-sponsored Medicare supplemental
coverage.
TITLE III—OTHER HEALTH PROVISIONS
Subtitle A—Transparency, Outreach, and Education
Sec. 301. Public outreach and education
initiatives.
Sec. 302. Annual Medicare beneficiary contributions and
benefits statements.
Sec. 1143A. Annual Medicare beneficiary contributions and
benefits statements.
Subtitle B—Miscellaneous
Sec. 311. Repeal of IPAB.
Sec. 312. Repeal of Medicare payment productivity adjustments
after 2020.
Sec. 313. Graduate medical education grant
program.
Sec. 1899B. Graduate medical education grant
program.
Sec. 9512. Graduate Medical Education Trust
Fund.
Sec. 314. Report on transitioning payments under Medicare for
disproportionate share hospitals into a grant program.
Sec. 315. One-year freeze for physician payment update; Sense
of Congress relating to the sustainable growth rate (SGR).
Sec. 316. Improvements to MSA plans; permitting offering of
catastrophic plan with high deductible and contribution to MSA, HSA, or
HIRA.
Sec. 317. Extension for specialized MA plans for special needs
individuals.
Sec. 318. Conscience protections.
Sec. 1899C. Conscience protections; Prohibition against
discrimination on assisted suicide and abortion services.
Sec. 1899D. Prohibition against discrimination on assisted
suicide and abortions.
<enum>I</enum><header>Improved and
Unified Medicare Program Through Choice and Competition</header>
<section id="H467A8A95AF67458AA9F14DC0A243B1EB"><enum>101.</enum><header>New unified
eligibility and enrollment rules</header>
<subsection id="H00242AB9936143B0A3CE64C274C9D587"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Title XVIII of the
Social Security Act is amended—</text>
<paragraph id="HC361A3C4C517497CB5099B43E86C4B2C"><enum>(1)</enum><text>by redesignating
part E as part F; and</text>
</paragraph><paragraph id="H390597B69B724E00AF0F8B29835D3F54"><enum>(2)</enum><text>by inserting after
part D the following new part:</text>
<quoted-block display-inline="no-display-inline" id="H1598DA67D0CD4804B0D2C74553C6408A" style="OLC">
<part id="H38D00B7DBF3F4E2694E8D42273054286"><enum>E</enum><header>Unified Medicare
with Choice and Competition</header>
<subpart id="H3D9392D4AF17450D862ADB74ACC03CBF"><enum>1</enum><header>Eligibility;
enrollment </header>
<section id="H71917E150D9D42B7B052E4540E420041"><enum>1860E–11.</enum><header>Unified
eligibility and enrollment under parts A and B</header>
<subsection id="HFE721E206ADA486FA3AED0BF24067658"><enum>(a)</enum><header>Requiring
coverage under both parts A and B</header>
<paragraph id="H1FA49DA3DE624827983DF419CECC92CE"><enum>(1)</enum><header>In
general</header><text>Effective as of the general effective date (as specified
in section 1860E–62), except as provided under paragraph (3), no benefits shall
be covered under part A or part B for an individual unless the individual is
both—</text>
<subparagraph id="H7F7120212C894396B80810C51D64442E"><enum>(A)</enum><text>entitled (or
enrolled) for benefits under part A; and</text>
</subparagraph><subparagraph id="H48524676BDE14B439834E2DEF4E50B8A"><enum>(B)</enum><text>enrolled under
part B.</text>
</subparagraph></paragraph><paragraph id="H2B10316CB6E6404F9DCD30101CD5BCF3"><enum>(2)</enum><header>Clarification of
part A enrollment required to obtain part B benefits</header><text display-inline="yes-display-inline">Effective as of the general effective date,
except as provided under paragraph (3), an individual who is enrolled under
part B and is not entitled to hospital insurance benefits under part A shall be
entitled to benefits under part B only if the individual enrolls under part A
pursuant to section 1818 or 1818A.</text>
</paragraph><paragraph id="H822AF1C672BE4487ABD5692856D25AC3"><enum>(3)</enum><header>Exceptions</header>
<subparagraph commented="no" id="HFCA64E966B874F7B8EB2D0669269A4E0"><enum>(A)</enum><header>Continuation of
Treatment of working beneficiaries</header><text>Paragraphs (1) and (2) shall
not apply to an individual with respect to whom the provisions of section
1862(b) apply because of enrollment in a primary plan (as defined for purposes
of such section).</text>
</subparagraph><subparagraph id="H0FA124563D394EAA988FEB5403CA5CD8"><enum>(B)</enum><header>Grandfathered
for current part B only enrollees</header>
<clause id="H9003842E7974458799F411D4B4DC9FBA"><enum>(i)</enum><header>In
general</header><text>Paragraphs (1) and (2) shall not apply to an individual
who as of the general effective date is enrolled under part B but is not
entitled to benefits (or otherwise enrolled) under part A, so long as the
individual does not terminate enrollment under part B or enroll under part
A.</text>
</clause><clause id="H9AFD196A0D2144DBAA9D37D8F8E99D1D"><enum>(ii)</enum><header>New
cost-sharing applies</header>
<subclause id="HE9EFB54995614E61AAC9F94042A47E48"><enum>(I)</enum><header>In
general</header><text>Nothing in clause (i) shall be construed to exempt an
individual described in such clause from the application of the provisions of
subpart 2 (relating to cost-sharing), except that the total amount of expenses
incurred by the individual during a year which would constitute incurred
expenses for which benefits payable under section 1833(a) are determinable
shall be reduced by the deductible described in subclause (II) for such year
instead of the deductible described in section 1860E–21.</text>
</subclause><subclause id="H35906302EAC04DCEA6D53D6109AF8D59"><enum>(II)</enum><header>Applicable
deductible</header><text>The deductible described in this subclause for 2016,
is the deductible that would be applied under section 1833(b) (but for the
application of this section and subpart 2) for such year, adjusted by the
Secretary to take into account any change in the monthly actuarial rate under
section 1839(a)(1) because of the application of the out-of-pocket limit under
section 1860E–23, and for a subsequent year the amount of such deductible for
the previous year increased by the annual percentage increase in the monthly
actuarial rate under section 1839(a)(1) (taking into account the application of
the out-of-pocket limit under section 1860E–23) ending with such subsequent
year (rounded to the nearest $1).</text>
</subclause></clause><clause id="H44E1DF6A4DAA468092265797A5631BE1"><enum>(iii)</enum><header>Premium</header><text display-inline="yes-display-inline">In the case of an individual described in
clause (i), for 2016 or a subsequent year, instead of the combined monthly
premium under section 1860E–32(c), there shall be applied to such individual
the monthly premium that would be determined under section 1839 for such
year.</text>
</clause></subparagraph></paragraph></subsection><subsection id="HEA4DE9D264DC4DE29132D743681AE7AC"><enum>(b)</enum><header>Permitting
individuals To opt out of part A coverage without losing social security
benefits</header>
<paragraph id="H3201A6F5D03341F59F13951687BA39E7"><enum>(1)</enum><header>In
general</header><text>The Medicare Choices Commission shall establish—</text>
<subparagraph id="H1A0013AE2B3E43BDB6446AAFCF61C94B"><enum>(A)</enum><text>a process by which
an individual otherwise entitled to benefits under part A may elect (at a time
and in a manner specified under the process) to waive such entitlement;
and</text>
</subparagraph><subparagraph id="HBC2E1170D8A849159535B1484C1AAA47"><enum>(B)</enum><text display-inline="yes-display-inline">a process by which an individual who elects
to waive such entitlement may revoke (at a time and in a manner specified under
the process) such waiver.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The
process under subparagraph (B) shall be coordinated with the enrollment process
under section 1837 for part B.</continuation-text></paragraph><paragraph id="HCBAC0889E5444B7CA720EAFDF51378D7"><enum>(2)</enum><header>Application of
late enrollment penalty</header><text display-inline="yes-display-inline">An
individual who revokes a waiver under paragraph (1)(B) shall be subject to a
late enrollment penalty as applied under section 1860E–32(c)(2)(C).</text>
</paragraph><paragraph id="H57B7BA22EE614DF38028E49E99F7118F"><enum>(3)</enum><header>No impact on
title II benefits</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law,
an election of an individual to waive entitlement to benefits under part A
under paragraph (1)(A) shall not result in any loss of benefits under title
II.</text>
</paragraph><paragraph id="H3492BDECCE854CD58736912AF9A7E4D5"><enum>(4)</enum><header>Deemed opt
out</header>
<subparagraph id="H67F9AEBC63D544E9A8A013615CC40204"><enum>(A)</enum><text>An election of an
individual to waive entitlement to benefits under part A under paragraph (1)(A)
is also deemed the filing of a notice of termination of benefits under part B
pursuant to section 1838(b)(1).</text>
</subparagraph><subparagraph id="H76A4A05077764FEA84B8F76A891DEF2A"><enum>(B)</enum><text>The termination of
benefits under part B pursuant to section 1838(b) is also deemed to be a waiver
of any entitlement to benefits under part A.</text>
</subparagraph></paragraph></subsection><subsection id="H77862319F386425ABB7752B4F108C46D"><enum>(c)</enum><header>Special open
enrollment period without late enrollment penalty for current part A only or
part B only enrollees</header><text>Notwithstanding any other provision of law,
in the case of an individual who as of the general effective date, is entitled
to benefits under part A but not enrolled under part B, or who is enrolled
under part B but not entitled to benefits (or enrolled) under part A, beginning
as of such date, such individual shall be deemed to be enrolled under part B or
part A, respectively, unless such individual elects to be enrolled (or entitled
to benefits) under neither of such parts during a special open enrollment
period specified by the Medicare Choices Commission. No increase in the monthly
premium of an individual pursuant to section 1839(b) or section 1818(c) shall
be effected in the case of any such individual who is deemed enrolled under
part B or part A pursuant to the previous sentence with respect to any period
prior to the date of such enrollment.</text>
</subsection><subsection id="H8D0E720A853A48989B192F00E8998AD8"><enum>(d)</enum><header>Auto enrollment
of dual eligible individuals under Medicare Advantage plans</header>
<paragraph id="H4A3C1083A8D84C678E42102AA25334C5"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Except in the case of
a State that has elected the maintenance of effort option described in section
1944(b)(2), in the case of an individual described in subparagraph (A)(ii) of
section 1935(c)(6) (taking into account the application of subparagraph (B) of
such section), the Medicare Choices Commission shall establish a process for
the enrollment in an MA–PD plan that is a managed care plan under part C that
has a monthly beneficiary premium that does not exceed the premium assistance
available under section 1860E–41(b)(1)(A). If there is more than one such plan
available, the Medicare Choices Commission shall enroll such an individual on a
random basis among all such plans in the PDP region.</text>
</paragraph><paragraph id="H83634D99F8EA4CFDBCB4A78F9F2C4C7D"><enum>(2)</enum><header>Right to
disenroll</header><text>Nothing in paragraph (1) shall prevent such an
individual from declining enrollment in any such plan (and thereby obtaining
coverage under Medicare fee-for-service) or from changing enrollment in such a
plan to another MA–PD plan.</text>
</paragraph></subsection></section><section id="H5E045A672DCF4CE8AF73E6581E199E75"><enum>1860E–12.</enum><header>Coordination
with part D</header>
<subsection id="H6DBDA5A997E64684A7C2165C228BD50E"><enum>(a)</enum><header>Deemed
enrollment under part D</header>
<paragraph id="HDAC2854817EB4898A31D31F492F69FFE"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The Medicare Choices
Commission shall establish a process that, beginning as of the general
effective date, provides for the enrollment in a prescription drug plan that
has a monthly base beneficiary premium that does not exceed the weighted
average of premiums for such plans that provide standard prescription drug
coverage (as defined in section 1860D–2(b)) with respect to the area involved
(on a random basis among all such plans in the applicable PDP region) of each
Medicare enrollee (as defined in section 1860E–51) who—</text>
<subparagraph id="H825B081F878A48A198C3BB458E8C2AF0"><enum>(A)</enum><text>failed to enroll
in such a prescription drug plan during the applicable enrollment or coverage
election period under section 1860D–1(b); and</text>
</subparagraph><subparagraph id="H534AE4D6BE7B457D978E0D32B2B92DA6"><enum>(B)</enum><text>failed to elect
not to enroll in such a prescription drug plan during an applicable opt out
period described in paragraph (2).</text>
</subparagraph><continuation-text continuation-text-level="paragraph">Nothing in
the previous sentence shall prevent such an individual from declining or
changing such enrollment. Such process shall be carried out in the same manner
as the process described in section 1860D–1(b)(1)(C).</continuation-text></paragraph><paragraph id="H8C9C3B967154435BABD51F1E84A60439"><enum>(2)</enum><header>Opt out
periods</header><text display-inline="yes-display-inline">The process under
paragraph (1) shall provide for the opportunity to make an election described
in subparagraph (B) of such paragraph during an opt out period that is
coordinated with the relevant enrollment or coverage election period under
section 1860D–1.</text>
</paragraph><paragraph id="H5CA9F863032847098D359DCB68647D9C"><enum>(3)</enum><header>Late enrollment
penalties</header><text>In the case of an individual who makes an election
described in paragraph (1)(B) and then enrolls in a prescription drug plan, the
late enrollment penalty under section 1860D–13(b) shall apply to the monthly
beneficiary premium of such individual, except that in applying such section,
any reference to the initial enrollment period of such individual shall be
deemed to be a reference to the opt out period under paragraph (2) during which
the individual elected not to enroll in a prescription drug plan.</text>
</paragraph><paragraph id="H497B230695044782AC5284DDDB369F3B"><enum>(4)</enum><header>No late
enrollment penalty for current fee-for-service beneficiaries without drug
coverage</header><text display-inline="yes-display-inline">In the case of an
individual who is a Medicare enrollee before the date of enactment of this
section and who was not enrolled under a prescription drug plan before being
enrolled under such a plan pursuant to paragraph (1), there shall be no
increase in the base beneficiary premium of an individual under section
1860D–13 by a late enrollment penalty under subsection (b) of such section with
respect to any period prior to the date of such enrollment.</text>
</paragraph></subsection><subsection id="H4B47D1BC9BE94CF694BB976E78719049"><enum>(b)</enum><header>Reference to
required prescription drug coverage under part C</header><text>For provision
requiring coverage under MA plans to include prescription drug coverage, see
section
1860E–26.</text>
</subsection></section></subpart></part><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H60315CC8F1CE4F059D397EBF5808B131"><enum>(b)</enum><header>Limitation on
Medicaid benefits for full-Benefit dual eligible
individuals</header><text>Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HB106B060B57B432F9C634226ECEF5278" style="OLC">
<subsection id="H66135FD3C6924B798CA1D8BA2E7C57AF"><enum>(ll)</enum><header>Limitation on
benefits for full-Benefit dual eligible individuals</header><text display-inline="yes-display-inline">Effective as of the general effective date
(as specified in section 1860E–62), except in the case of a State which has
elected the option described in section 1944(b)(2), in the case of an
individual described in subparagraph (A)(ii) of section 1935(c)(6) (taking into
account the application of subparagraph (B) of such section), notwithstanding
any other provision of law, medical assistance shall not be available under
this title for any items and services for which payment may be made under title
XVIII.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HD42AB9559D3E4B68B6C444A0E933624D"><enum>(c)</enum><header>Medicaid
maintenance of effort and alternatives</header><text>Title XIX of the Social
Security Act is amended by inserting after section 1943 the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="H369E6C121C33488892C722CE52FACE35" style="traditional">
<section id="H0C49B37296F24CB0BAB3567A76E801C3"><enum>1944.</enum><header>Maintenance of effort options for full-benefit dual eligible
individuals</header><subsection commented="no" display-inline="yes-display-inline" id="H12EDBD7072034E5C8AF7D6173F1DC783"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Effective as of the
general effective date (as specified in section 1860E–62), a State shall elect,
in a form and manner specified by the Secretary, a maintenance of effort option
described in subsection (b). In the case of a State that fails to make such an
election, the State shall be deemed to have elected the option described in
subsection (b)(3).</text>
</subsection><subsection id="HE79A6FF15232413FA70F43CC5FF7598F"><enum>(b)</enum><header>Maintenance of
effort options described</header><text display-inline="yes-display-inline">The
following are maintenance of effort options described in this subsection for a
State, which shall apply to all individuals described in subparagraph (A)(ii)
of section 1935(c)(6) (taking into account the application of subparagraph (B)
of such section) for such State:</text>
<paragraph id="H60C8D4115B694B388B58EEFC5ED7CD83"><enum>(1)</enum><header>Contribution
towards out-of-pocket expenses under a tier 3 Medicare plan</header><text display-inline="yes-display-inline">The State establishes a program under which
the State makes a contribution to a health investment retirement account
established under section 503(b) of the <short-title>Save
and Strengthen Medicare Act of 2012</short-title> for each such individual in
an amount which—</text>
<subparagraph id="HF61893EDF570440E92367992B7AD2CE6"><enum>(A)</enum><text display-inline="yes-display-inline">is calculated, on an average actuarial
basis, to cover at least the remaining expenses under a plan with a tier 3
benefit level under section 1860E–24(b); and</text>
</subparagraph><subparagraph id="H0DA466A077BB45F1ABEB21202B5EED53"><enum>(B)</enum><text>is risk-adjusted
based upon the actuarial characteristics of the individual involved.</text>
</subparagraph></paragraph><paragraph id="H9A546085734B40D180718C52563219BE"><enum>(2)</enum><header>Enrollment of
dual eligibles in comprehensive Medicaid managed care plan</header>
<subparagraph id="HC930EAF66AAB40989117D6A2B983CEAD"><enum>(A)</enum><header>In
general</header><text>The State enrolls all such individuals in a comprehensive
Medicaid managed care plan offered by a managed care entity under section
1932.</text>
</subparagraph><subparagraph id="H72F87B49766F409A89155C5BE606C897"><enum>(B)</enum><header>Payment of
subsidy amount to State</header><text display-inline="yes-display-inline">In
the case of a State that elects the option under this paragraph with respect to
an individual, the Medicare Choices Commission established under section
1860E–51 shall pay to the State the same amount that the individual would be
entitled to have paid as an income-related premium subsidy under section
1860E–41(b)(1)(A) plus the amount that the Medicare Choices Commission
estimates would have been paid with respect to the individual under part D
(including the actuarial value of subsidy payments under sections 1860D–13 and
1860D–14). Such payment shall be made in appropriate part from the Federal
Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary
Medical Insurance Trust Fund under section 1841.</text>
</subparagraph><subparagraph id="H9435BE5838D6421FA9146D528B8524A7"><enum>(C)</enum><header>Relation to part
D rules</header><text display-inline="yes-display-inline">In the case of a
State that has elected the option under this paragraph, notwithstanding any
other provision of law—</text>
<clause id="H4BADC6897F3A4C848EA67AE3EF49B869"><enum>(i)</enum><text>the coverage
provided under this option shall be in lieu of any coverage that may otherwise
be provided under part D; and</text>
</clause><clause id="H8C885DBAFCC14501B91D40B0959C8A98"><enum>(ii)</enum><text>the payment to
the State under subparagraph (B) shall be in lieu of any payments otherwise
made with respect to such individual under such part.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="HBF6A27826DAF4505B0F700C5A2008792"><enum>(3)</enum><header>State
contribution amount and Federal contributions to HIRAs</header>
<subparagraph commented="no" id="H53A555314FE249ABB96B73AF2361625E"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The State provides
for payment to the Secretary for each month in an amount determined under
subparagraph (B)(i) and the Secretary makes a contribution to a health
investment retirement account established under section 503(b) of the
<short-title>Save and Strengthen Medicare Act of
2012</short-title> for each such individual in an amount described in
subparagraph (C).</text>
</subparagraph><subparagraph commented="no" id="HA1556960D3644563BD07F3E3BA2FE0C2"><enum>(B)</enum><header>State
contribution amount</header>
<clause id="H915AD29B23FC4F8389603901466F2262"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to clause
(iii), the amount determined under this clause for a State for a month in a
year is equal to the product described in subparagraph (A) of section
1935(c)(1) for the State for the month.</text>
</clause><clause commented="no" id="H001D02E68E0E4290AE06F60B86EF3F9E"><enum>(ii)</enum><header>Form and manner
of payment</header><text>The provisions of subparagraphs (B) through (D) of
section 1935(c)(1) shall apply to payment by a State to the Secretary under
this paragraph in the same manner as such subparagraphs apply to payment under
section 1935(c)(1)(A).</text>
</clause><clause commented="no" id="H088CB021291C4213AD8131208C040367"><enum>(iii)</enum><header>Application of
different factors</header><text>In applying clause (i), the following shall be
substituted under paragraphs (2) and (3) of section 1935(c):</text>
<subclause commented="no" id="H6F1F117B55594C22ACF58CD9779209FC"><enum>(I)</enum><text display-inline="yes-display-inline">The base year State Medicaid per capita
expenditures for covered part D drugs described in subparagraph (A)(i)(I) of
such paragraph (2) shall be deemed to be the per capita expenditures for
Medicare cost-sharing that would apply, with respect to an individual described
in subparagraph (A)(ii) of section 1935(c)(6) (taking into account the
application of subparagraph (B) of such section) and the State involved, if
such an individual received benefits only under title XVIII (and not the State
plan under this title).</text>
</subclause><subclause commented="no" id="HFE2171ADBE5841EC9358257984563B33"><enum>(II)</enum><text>Any reference to
expenditures for covered part D drugs or for prescription drug benefits shall
be deemed a reference to the expenditures for Medicare cost-sharing described
in subclause (I).</text>
</subclause><subclause commented="no" id="H3AA1D559494A4186BDDB76E56F35D10B"><enum>(III)</enum><text>Any reference to
2003 or 2004 shall be deemed a reference to 2014 or 2015, respectively.</text>
</subclause><subclause commented="no" id="HEA8355195A2040338E9EE132C4501C07"><enum>(IV)</enum><text display-inline="yes-display-inline">Any reference to a
full-benefit-dual-eligible individual shall be deemed a reference to an
individual described in subparagraph (A)(ii) of section 1935(c)(6) (taking into
account the application of subparagraph (B) of such section).</text>
</subclause><subclause commented="no" id="H464BF48B29CB4A22BEE7BFF08EFE05A0"><enum>(V)</enum><text>The applicable
growth factor under section 1935(c)(4) for a year, with respect to a State,
shall be the average annual percentage change (to that year from the previous
year) of the expenditures of the State under the State plan under title
XIX.</text>
</subclause><subclause commented="no" id="H033D7EEA179A44DB9598AC49119E0747"><enum>(VI)</enum><text>The factor
described in section 1935(c)(5) is deemed to be 90 percent.</text>
</subclause></clause></subparagraph><subparagraph id="H9408D6B3AB204F9885A8C18D292D546A"><enum>(C)</enum><header>Federal
contributions to HIRAs</header><text>For purposes of subparagraph (A), the
amount described in this subparagraph, with respect to each such individual
described in subparagraph (A), is an amount which—</text>
<clause id="HC894F1BF3AA745C4ACB50FC697955230"><enum>(i)</enum><text display-inline="yes-display-inline">is calculated, on an average actuarial
basis, to cover the remaining expenses under a plan with a tier 3 benefit level
under section 1860E–24(b); and</text>
</clause><clause id="HE7791BE5A59D46BA8BCB6B44C6DC676F"><enum>(ii)</enum><text>is risk-adjusted
based upon the actuarial characteristics of the individual.</text>
</clause></subparagraph></paragraph><paragraph id="HC12AEF24374E4E6AAE19F37DF8D57381"><enum>(4)</enum><header>Other innovative
alternatives</header>
<subparagraph id="H912D846A629E4233B286BF51B31371FA"><enum>(A)</enum><header>In
general</header><text>The State submits to the Secretary, and has approved by
the Secretary, an innovative alternative proposal relating to coordinating
coverage of such individuals under Medicare and the State plan under title
XIX.</text>
</subparagraph><subparagraph id="H174B8A32B98D443A93E32A9A22FC230B"><enum>(B)</enum><header>Process for
review</header><text>With respect to proposals submitted to the Secretary under
subparagraph (A), the Secretary shall approve such a proposal if the State
demonstrates with respect to the proposal that—</text>
<clause id="HCD57A44D35664D9BA3DDE7E419CFCEA5"><enum>(i)</enum><text>there would be no
increased cost to the Federal Government if it were approved; and</text>
</clause><clause id="H613CA51F0ABE4983A03610BE71FE6AAB"><enum>(ii)</enum><text>there would be no
reduction in the quality of care provided to such individuals if the proposal
were
approved.</text>
</clause></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H6EAFC70D468D429F83218C49785B5A7C"><enum>(d)</enum><header>Conforming
amendments</header>
<paragraph id="H5D62E63D213148C78C7C1F307F4AD775"><enum>(1)</enum><header>Section
<enum-in-header>226</enum-in-header></header><text display-inline="yes-display-inline">Section 226 of the Social Security Act (42
U.S.C. 426) is amended—</text>
<subparagraph id="H4B79DEA4EA51479F982086B1ECD500E5"><enum>(A)</enum><text>in subsection (a),
in the matter preceding paragraph (1), by inserting <quote>, subject to section
1860E–11(b)</quote> after <quote>individual who</quote>;</text>
</subparagraph><subparagraph id="H49E5D469C76F405A8EB775893A0B4D94"><enum>(B)</enum><text>in subsection (b),
in the matter preceding paragraph (1), by inserting <quote>, subject to section
1860E–11(b)</quote> after <quote>individual who</quote>; and</text>
</subparagraph><subparagraph id="H7B02C21BDCD043E1B1FCE56B421FD196"><enum>(C)</enum><text>in subsection (c),
in the matter preceding paragraph (1), by inserting <quote>, subject to section
1860E–11(a)</quote> after <quote>subsection (a)</quote>.</text>
</subparagraph></paragraph><paragraph id="H7A6E2516D5304F1FAA168A959948532A"><enum>(2)</enum><header>Section
<enum-in-header>226A</enum-in-header></header><text display-inline="yes-display-inline">Section 226A(a) of such Act (42 U.S.C.
426–1(a)) is amended, in the matter preceding paragraph (1), by inserting
<quote>and subject to section 1860E–11(b)</quote> after <quote>or title
XVIII</quote>.</text>
</paragraph><paragraph id="HCD987543F58845BCAA7D7582E84BAFEE"><enum>(3)</enum><header>Section
<enum-in-header>1818A</enum-in-header></header><text display-inline="yes-display-inline">Section 1818A(a) of such Act (42 U.S.C.
1395i–2a(a)) is amended, in the matter preceding paragraph (1), by inserting
<quote>, subject to section 1860E–11(a)</quote> after <quote>individual
who</quote>.</text>
</paragraph><paragraph id="HF482F18B609741BCB648428860D19594"><enum>(4)</enum><header>Section
<enum-in-header>1836</enum-in-header></header><text display-inline="yes-display-inline">Section 1836 of such Act is amended, in the
matter preceding paragraph (1), by inserting <quote>, subject to section
1860E–11(a)</quote> after <quote>individual who</quote>.</text>
</paragraph><paragraph id="HB1C49EB294D546198B416BF49DC3C437"><enum>(5)</enum><header>Section
<enum-in-header>1932</enum-in-header></header><text>Section 1932(a)(2)(B) of
the Social Security Act (42 U.S.C. 1396u–2(a)(2)(B)) is amended by striking
<quote>A State</quote> and inserting <quote>Except in the case of a State that
has elected the maintenance of effort option described in section 1944(b)(2), a
State</quote>.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="H14E145647F4849E59AB23D399D5A682C"><enum>102.</enum><header>Incentivized
Medicare eligibility at increased age</header>
<subsection commented="no" id="H4351000CE8E24BE992749B06EEEA626D"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 216 of the
Social Security Act (42 U.S.C. 426) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H38F2F40996F543D08CA83FE710837959" style="OLC">
<subsection commented="no" id="H5FF4669FE05C40849A7D8DFEBDF7ED2C"><enum>(m)</enum><header>Medicare
eligibility age defined</header>
<paragraph commented="no" id="HBF49633FAEF9419BBA1493A82DCC8AA8"><enum>(1)</enum><header>In
general</header><text>In this Act, the term <term>Medicare eligibility
age</term> means, in accordance with paragraph (2), 65 years of age, the
preferred Medicare age, or any age between 65 years of age and the preferred
Medicare age.</text>
</paragraph><paragraph commented="no" id="H4BEF27CFF2C243C5A8B28EB909F6F960"><enum>(2)</enum><header>Choice</header>
<subparagraph commented="no" id="H120EF1C6D9BA42619C55CA31F57668C0"><enum>(A)</enum><header>In
general</header><text>Unless an individual elects otherwise (in a manner
specified by the Medicare Choices Commission) the Medicare eligibility age
shall be the preferred Medicare age described in subparagraph (B) applicable to
such individual.</text>
</subparagraph><subparagraph commented="no" id="H22959ED3042143ECB035E43CEFEC8E2B"><enum>(B)</enum><header>Preferred
Medicare age</header>
<clause commented="no" id="HD96ADA9DAE94446E8B748E36122CD71B"><enum>(i)</enum><header>In
general</header><text>The preferred Medicare age with respect to an
individual—</text>
<subclause commented="no" id="H64AD379FEFEA474E8B45C50F632A6D74"><enum>(I)</enum><text>who attains the
age of 65 before January 1, 2016, is 65 years of age;</text>
</subclause><subclause commented="no" id="H310DD4E4D7524B219CB162C0DCC952CB"><enum>(II)</enum><text>who attains the
age of 65 after December 31, 2015, and before January 1, 2026, is 65 years of
age plus the number of months specified by the Medicare Choices Commission for
the preferred age phase-in factor under clause (ii) for the calendar year in
which the individual attains the age of 65; and</text>
</subclause><subclause commented="no" id="HB74DAA1BEC354BBFB46E161C19EE4775"><enum>(III)</enum><text display-inline="yes-display-inline">who attains the age of 65 during a 10-year
period (with the first such period beginning on January 1, 2026), 67 years of
age increased by the life expectancy increase factor described in clause (iii)
for such 10-year period.</text>
</subclause></clause><clause id="HE41363A8B2BB46CC9EADBE44446563A9"><enum>(ii)</enum><header>Preferred age
phase-in factor</header><text>For each year during the 10-year period beginning
with 2016, the Medicare Choices Commission shall specify the preferred age
phase-in factor as either 2 or 3 months to be applied under clause (i)(II) for
individuals attaining 65 years of age during such year in a manner that results
in the preferred Medicare age being increased over such 10-year period in as
equivalent increments as possible such that for individuals attaining the age
of 65 as of December 31, 2025, such preferred Medicare age will be 67 years of
age.</text>
</clause><clause commented="no" id="H98E7ECC16B234F9AAC35E9FF30008333"><enum>(iii)</enum><header>Life
expectancy increase factor</header><text display-inline="yes-display-inline">The life expectancy increase factor under
this clause for a 10-year period is the age, rounded to the nearest month, at
which (as estimated by the Medicare Choices Commission based on the most recent
information available from the National Center for Health Statistics for the
3rd year beginning before such 10-year period) the average life expectancy of
an individual who is eligible to enroll under this title and who has attained
67 years of age is 18 years, except that the application of this clause may not
result in a year-to-year increase of more than 2 months or in the preferred
Medicare age being less than 67 years of age.</text>
</clause></subparagraph><subparagraph commented="no" id="HAA211CF534724668A04991C7C0C69FD6"><enum>(C)</enum><header>Enrollment
options</header><text>The Medicare Choices Commission shall specify a manner
and process in which an individual may make an election described in
subparagraph (A) to have the Medicare eligibility age applicable to such
individual be an age described in paragraph (1) other than the preferred
Medicare age so that such election takes effect in the month in which the
individuals attains such age. Such process shall provide for an initial
election period and subsequent annual election periods for each age that may be
elected for the Medicare eligibility age.</text>
</subparagraph><subparagraph commented="no" id="HA182B7C9691D461287AF567CDF4677D7"><enum>(D)</enum><header>Notification</header><text display-inline="yes-display-inline">The Medicare Choices Commission shall
provide for notification of each individual who will be eligible for benefits
under title XVIII that the Medicare eligibility age of such individual will be
the preferred Medicare age unless the individual elects under subparagraph (C)
an earlier age described in paragraph (1).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFE17C64BA3874369A525F5F710F44CB3"><enum>(3)</enum><header>Premium</header><text display-inline="yes-display-inline">For provisions relating to premium
incentives for deferred Medicare eligibility until the preferred Medicare age
see section
1860E–32(c).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="HB17D8CCAC8A94B258A4FA57F445BD752"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph commented="no" id="HDBCE672D9EBC4CDB99CE6C4F6A5672A7"><enum>(1)</enum><header>Social Security
Act</header>
<subparagraph id="H5B7599680531430EB8E72146CAFD9A05"><enum>(A)</enum><header>Entitlement to
hospital insurance benefits</header><text>Section 226 of such Act (42 U.S.C.
426) is amended by striking <quote>age 65</quote> each place such term appears
and inserting <quote>medicare eligibility age (as such term is defined in
section 216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="HC320D1601EAD46B4A0E9BE4B2296DB56"><enum>(B)</enum><header>Hospital
insurance benefits for the aged</header><text display-inline="yes-display-inline">Section 1811 of such Act (42 U.S.C. 1395c)
is amended by striking <quote>age 65</quote> each place such term appears and
inserting <quote>medicare eligibility age (as such term is defined in section
216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="H2C39094E07D34B37BE59CF80C5E01AA2"><enum>(C)</enum><header>Hospital
insurance benefits for uninsured elderly individuals not otherwise
eligible</header><text>Section 1818 of such Act (42 U.S.C. 1395i–2) is
amended—</text>
<clause commented="no" id="HCD576CBEE4D24A368CAD111AA266C706"><enum>(i)</enum><text>in subsection
(a)(1), by striking <quote>age of 65</quote> and inserting <quote>medicare
eligibility age (as such term is defined in section 216(m))</quote>;</text>
</clause><clause commented="no" id="H6A4D63F20A804D92914A2F5EA3E5D5D7"><enum>(ii)</enum><text>in subsection
(d)(1), by striking <quote>age 65</quote> and inserting <quote>medicare
eligibility age (as such term is defined in section 216(m))</quote>; and</text>
</clause><clause commented="no" id="H072DFCAAD2F543B292D844D5AB637FED"><enum>(iii)</enum><text>in subsection
(d)(3), by striking <quote>65</quote> and inserting <quote>medicare eligibility
age (as such term is defined in section 216(m))</quote>.</text>
</clause></subparagraph><subparagraph commented="no" id="H86DEF8B12E424992B7066EFE7D57CF74"><enum>(D)</enum><header>Hospital
insurance benefits for disabled individuals who have exhausted other
entitlement</header><text>Section 1818A(a)(1) of such Act (42 U.S.C.
1395i–2a(a)(1)) is amended by striking <quote>the age of 65</quote> and
inserting <quote>medicare eligibility age (as such term is defined in section
216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="H3AE155D77F674CDB969F347AB47A0272"><enum>(E)</enum><header>Eligibility for
part B benefits</header>
<clause commented="no" id="H58F620FE94964021A10059E851E8A17E"><enum>(i)</enum><header>In
general</header><text>Section 1836 of such Act (42 U.S.C. 1395o) is amended by
striking <quote>age 65</quote> each place such term appears and inserting
<quote>medicare eligibility age (as such term is defined in section
216(m))</quote>.</text>
</clause><clause commented="no" id="H9827A72DF844439895F906316248A6FC"><enum>(ii)</enum><header>Enrollment
periods</header><text>Section 1837 of such Act (42 U.S.C. 1395p) is amended by
striking <quote>age 65</quote> and <quote>the age of 65</quote> each place such
terms appear and inserting <quote>medicare eligibility age (as such term is
defined in section 216(m))</quote>.</text>
</clause><clause commented="no" id="H34D1DB187EC14B9E82612FA19A753245"><enum>(iii)</enum><header>Coverage
period</header><text>Section 1838 of such Act (42 U.S.C. 1395q) is
amended—</text>
<subclause commented="no" id="HDD5BB6E584A645FB88E87F44AA42603A"><enum>(I)</enum><text>in subsection (a),
by striking <quote>age 65</quote> and inserting <quote>medicare eligibility age
(as such term is defined in section 216(m))</quote>.</text>
</subclause><subclause commented="no" id="H0EB332F07A2F41C58E95B616013A74B9"><enum>(II)</enum><text>in subsection
(c), by striking <quote>the age of 65</quote> and inserting <quote>medicare
eligibility age (as such term is defined in section 216(m))</quote>.</text>
</subclause></clause><clause commented="no" id="H711728A76553481F98C73F967B20F2DE"><enum>(iv)</enum><header>Amounts of
premiums</header><text>Section 1839 of such Act (42 U.S.C. 1395r) is amended by
striking <quote>age 65</quote> and <quote>the age of 65</quote> each place such
terms appear and inserting <quote>medicare eligibility age (as such term is
defined in section 216(m))</quote>.</text>
</clause></subparagraph><subparagraph commented="no" id="H9D8046933FC8495882091CBE54537387"><enum>(F)</enum><header>Appropriations
to cover Government contributions and contingency reserve</header><text>Section
1844(a)(1) of such Act (42 U.S.C. 1395w) is amended by striking <quote>age
65</quote> each place such term appears and inserting <quote>medicare
eligibility age (as such term is defined in section 216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="H47DD57664D77459BACF041C119951A23"><enum>(G)</enum><header>Eligibility,
election, and enrollment</header><text>The matter following subparagraph (D) of
section 1851(e)(4) of such Act (42 U.S.C. 1395w–21(e)(4)) is amended by
striking <quote>age 65</quote> and inserting <quote>medicare eligibility age
(as such term is defined in section 216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="H859192F612574ADB907925202B918DCD"><enum>(H)</enum><header>Payments to
Medicare+choice organizations</header><text>Section 1853(c)(4)(C)(v) of such
Act (42 U.S.C. 1395w–23(c)(4)(C)(v)) is amended by striking <quote>65 years of
age</quote> and inserting <quote>medicare eligibility age (as such term is
defined in section 216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="HFD7453EE1D0446BA89896BC4462FA0B9"><enum>(I)</enum><header>Part D premiums
and late enrollment penalty</header><text display-inline="yes-display-inline">Section 1860D–13(b)(7)(B)(i) of such Act
(42 U.S.C. 1395w–113(b)(7)(B)(i)) is amended by striking <quote>age 65</quote>
and inserting <quote>the medicare eligibility age (as such term is defined in
section 216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="HE7C5A28E01B74C6F893037279FB1CD69"><enum>(J)</enum><header>Medicare
secondary payer</header><text>Section 1862(b) of such Act (42 U.S.C. 1395y(b))
is amended by striking <quote>age 65</quote> each place such term appears and
inserting <quote>medicare eligibility age (as such term is defined in section
216(m))</quote>.</text>
</subparagraph><subparagraph commented="no" id="HF323550C5EA143C0BF28B6AF0F913CE1"><enum>(K)</enum><header>Certification of
medicare supplemental health insurance policies</header><text>Section 1882(s)
of such Act (42 U.S.C. 1395ss(s)) is amended—</text>
<clause commented="no" id="H52AA36F60C7D4712AC81E648E55289DA"><enum>(i)</enum><text>in paragraph
(2)(A) by striking <quote>65 years of age</quote> and inserting <quote>medicare
eligibility age (as such term is defined in section 216(m))</quote>;</text>
</clause><clause commented="no" id="H8968582AA8EF43ECAB855EF2895EA2AF"><enum>(ii)</enum><text>in paragraph
(2)(D) by striking <quote>65 years of age</quote> and inserting <quote>medicare
eligibility age (as such term is defined in section 216(m))</quote>; and</text>
</clause><clause commented="no" id="HCA2AD8A6B16B4CB184AE68A6A391AF8F"><enum>(iii)</enum><text>in paragraph
(3)(B)(vi) by striking <quote>age 65</quote> and inserting <quote>medicare
eligibility age (as such term is defined in section 216(m))</quote>.</text>
</clause></subparagraph><subparagraph commented="no" id="H702BA365DF5742989E4A56EDC9CE2FC2"><enum>(L)</enum><header>Medicare
subvention demonstration project for military retirees</header><text>Section
1896(a)(5)(D) of such Act (42 U.S.C. 1395ggg(a)(5)(D)) is amended by striking
<quote>age 65</quote> and inserting <quote>medicare eligibility age (as such
term is defined in section 216(m))</quote>.</text>
</subparagraph><subparagraph id="H16B6AA91FE764B69BD8F28EF9D3EB954"><enum>(M)</enum><header>Medicaid State
plan provisions</header><text>Section 1902 of the Social Security Act (42
U.S.C. 1396a) is amended—</text>
<clause id="HA06AF4931A26483DB5BC37E3391253CD"><enum>(i)</enum><text>in
subsection (a)(10)(A)—</text>
<subclause id="HCFEE97F1309C46B69447780647ECB8D7"><enum>(I)</enum><text>in clause
(i)(VIII), by striking <quote>65 years of age</quote> and inserting <quote>the
medicare eligibility age (as such term is defined in section
216(m))</quote>;</text>
</subclause><subclause id="HD6E6FD392A1C4F7492A5953912769F18"><enum>(II)</enum><text>in clause
(ii)(XV), by striking <quote>at least 16, but less than 65, years of
age</quote> and inserting <quote>at least 16 years of age but less than the
medicare eligibility age (as such term is defined in section 216(m))</quote>;
and</text>
</subclause><subclause id="H742486EB420B40F0ACF793083DFA74ED"><enum>(III)</enum><text display-inline="yes-display-inline">in clause (ii)(XX), by striking <quote>65
years of age</quote> and inserting <quote>the medicare eligibility age (as such
term is defined in section 216(m))</quote>;</text>
</subclause></clause><clause id="H2A82243C4AA847FC9ABC433C29BA0ADA"><enum>(ii)</enum><text display-inline="yes-display-inline">in subsection (e)(14)(D)(i)(II), by
striking <quote>age 65</quote> and inserting <quote>the medicare eligibility
age (as such term is defined in section 216(m))</quote>;</text>
</clause><clause id="HC70D195CA69C4A22B20D9361BDAFFE60"><enum>(iii)</enum><text display-inline="yes-display-inline">in subsection (m)(1), by striking <quote>65
years of age</quote> and inserting <quote>the medicare eligibility age (as such
term is defined in section 216(m))</quote>; and</text>
</clause><clause id="HB42313198EEF4B15B4FA82B6AE9625B3"><enum>(iv)</enum><text display-inline="yes-display-inline">in subsection (aa)(2), by striking
<quote>age 65</quote> and inserting <quote>the medicare eligibility age (as
such term is defined in section 216(m))</quote>.</text>
</clause></subparagraph><subparagraph id="HA50B6CFEE4EA4A6C86262A8552289FFF"><enum>(N)</enum><header>Medicaid medical
assistance definition</header><text>Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended—</text>
<clause id="HCC4C17B2BC4947DB9BAD9D7E5558C877"><enum>(i)</enum><text>in
clause (iii), by striking <quote>65 years of age</quote> and inserting
<quote>the medicare eligibility age (as such term is defined in section
216(m))</quote>; and</text>
</clause><clause id="H3C62C1FD6B71485FAFE243E67DED367B"><enum>(ii)</enum><text>in
the matter following paragraph (29)(B), by striking <quote>65 years of
age</quote> and inserting <quote>of medicare eligibility age (as such term is
defined in section 216(m))</quote>.</text>
</clause></subparagraph><subparagraph id="H6D19084046F540C7B7CC7434C653EB47"><enum>(O)</enum><header>Qualified
medicare beneficiary definition</header><text>Section 1905(p)(2)(C) of the
Social Security Act (42 U.S.C. 1396d(p)(2)(C)) is amended by striking
<quote>age 65</quote> and inserting <quote>who are the medicare eligibility age
(as such term is defined in section 216(m))</quote>.</text>
</subparagraph><subparagraph id="HE5207A965B4D4BCEBEF4C3A56BED131D"><enum>(P)</enum><header>Medicaid
definition for qualified severely impaired individual</header><text>Section
1905(q) of the Social Security Act (42 U.S.C. 1396d(q)) is amended by striking
<quote>age 65</quote> and inserting <quote>the medicare eligibility age (as
such term is defined in section 216(m))</quote>.</text>
</subparagraph><subparagraph id="H56C14971AB32490E921150CAC361ED64"><enum>(Q)</enum><header>Medicaid
definition for employed individual with a medically improved
disability</header><text>Section 1905(v)(1)(A) of the Social Security Act (42
U.S.C. 1396d(v)(1)(A)) is amended by striking <quote>16, but less than 65,
years of age</quote> and inserting <quote>16 years of age, but less than the
medicare eligibility age (as such term is defined in section
216(m))</quote>.</text>
</subparagraph><subparagraph id="HD80D07BA7C3B4F868A98FF1AC600C7CB"><enum>(R)</enum><header>Liens,
adjustments and recoveries, and transfers of assets under
Medicaid</header><text>Section 1917(c) of the Social Security Act (42 U.S.C.
1396p(c)) is amended—</text>
<clause id="HB4536998A2BD4E708797E81BA63E0F1D"><enum>(i)</enum><text>in
paragraph (2)(B)(iv), by striking <quote>65 years of age</quote> and inserting
<quote>the medicare eligibility age (as such term is defined in section
216(m))</quote>; and</text>
</clause><clause id="H8F68EDF59B2443CF9964520CC58F1C09"><enum>(ii)</enum><text>in
paragraph (4)(A), by striking <quote>age 65</quote> and inserting <quote>the
medicare eligibility age (as such term is defined in section
216(m))</quote>.</text>
</clause></subparagraph></paragraph><paragraph id="H2D6BC9B152DD46C1B644C64FBD97475D"><enum>(2)</enum><header>Other provisions
of law</header>
<subparagraph commented="no" id="HEB2747C8790A47E59E327CCE56352A03"><enum>(A)</enum><header>Contracts for
health benefits for certain members of uniformed services, former members, and
dependents</header><text>Section 1086(d)(2)(B) of title 10, United States Code,
is amended by striking <quote>under 65 years of age</quote> and inserting
<quote>under the medicare eligibility age (as such term is defined in section
216(m) of the Social Security Act)</quote>.</text>
</subparagraph><subparagraph commented="no" id="H615A9276547248C2950287E607A2A222"><enum>(B)</enum><header>Eligible
individual definition for earned income</header><text>Section
32(c)(1)(A)(ii)(II) of the Internal Revenue Code is amended by striking
<quote>age 65</quote> and inserting <quote>the preferred Medicare age (as such
term is described in section 216(m) of the Social Security Act)</quote>.</text>
</subparagraph><subparagraph commented="no" id="H1FB9D3E3697E47A4BAC5474364696D2C"><enum>(C)</enum><header>Tax treatment of
Blue Cross and Blue Shield organizations</header><text>Section 833(c)(3)(A)(iv)
of the Internal Revenue Code is amended by striking <quote>age 65</quote> and
inserting <quote>the medicare eligibility age (as such term is defined in
section 216(m) of the Social Security Act)</quote>.</text>
</subparagraph><subparagraph id="H7EFC56D56C5242C0B74C11ACB12FE04B"><enum>(D)</enum><header>Community-based
prevention and wellness programs</header><text>Section 4202 of the Patient
Protection and Affordable Care Act (42 U.S.C. 300u–14) is amended—</text>
<clause id="H53B4A0F424CF44FA843A2C759837089B"><enum>(i)</enum><text>in
subsection (a)—</text>
<subclause id="H09ECDF9E5C0341D4A2DCFEB55C6569B8"><enum>(I)</enum><text>in paragraph (1),
by striking <quote>who are between 55 and 64 years of age</quote> and inserting
<quote>who are at least 55 years of age but less than the medicare eligibility
age (as such term is defined in section 216(m) of the Social Security
Act)</quote>;</text>
</subclause><subclause id="H1FB12F63468B46BCB8450CE759F4A0F5"><enum>(II)</enum><text>in paragraph
(2)(C), by striking <quote>the 55-to-64 year-old population</quote> and
inserting <quote>the population of individuals who are at least 55 years of age
but less than the medicare eligibility age (as such term is defined in section
216(m) of the Social Security Act)</quote>;</text>
</subclause><subclause id="H5BA30594267A40259625285F8E4F15D5"><enum>(III)</enum><text display-inline="yes-display-inline">in paragraph (3)(A), by striking <quote>who
are between 55 and 64 years of age</quote> and inserting <quote>who are at
least 55 years of age but less than the medicare eligibility age (as such term
is so defined)</quote>;</text>
</subclause><subclause id="H1776187A1B384FD794D3C39E6D6354FD"><enum>(IV)</enum><text display-inline="yes-display-inline">in paragraph (3)(C)(i), by striking
<quote>who are between 55 and 64 years of age</quote> and inserting <quote>who
are at least 55 years of age but less than the medicare eligibility age (as
such term is so defined)</quote>; and</text>
</subclause><subclause id="H6DAD611256AA4A4689541BB1DEE1FE15"><enum>(V)</enum><text>in paragraph
(3)(D), by striking <quote>between 55 and 64 years of age</quote> and inserting
<quote>at least 55 years of age but less than the medicare eligibility age (as
such term is so defined)</quote>; and</text>
</subclause></clause><clause id="H0C668DD8FEA9480E9011BB2AD4C7CDFF"><enum>(ii)</enum><text>in
subsection (b)(2)(A), by striking <quote>65 years of age</quote> and inserting
<quote>the medicare eligibility age (as such term is defined in section 216(m)
of the Social Security Act)</quote>.</text>
</clause></subparagraph></paragraph></subsection></section><section id="HF63ECE03B0CE4AEC8EBA129CA7C2DA1F"><enum>103.</enum><header>New benefit
structure under unified Medicare</header>
<subsection id="HE9CD6062F3884754A77718ECB7DB7822"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Part E of title XVIII
of the Social Security Act, as added by section 101, is amended by adding at
the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H6E76692EFC264335845D89490C5D2D42" style="OLC">
<subpart id="HA294B4E63C174582AC82BED4E92AC004"><enum>2</enum><header>Benefits</header>
<section display-inline="no-display-inline" id="H6825D50155E84DD8B27BCA025E85321B" section-type="subsequent-section"><enum>1860E–21.</enum><header>Unified part A
and B deductible</header>
<subsection commented="no" display-inline="no-display-inline" id="H8158A3132ADB40F0BDD0D2CAED77AEE8"><enum>(a)</enum><header>In
general</header><text>Effective as of the general effective date, in the case
of a Medicare enrollee—</text>
<paragraph id="H0D52882AFCE44843805C81B40AD6F261"><enum>(1)</enum><text>the amount
otherwise payable under part A and the total amount of expenses incurred by the
enrollee during a year which would (except for this section) constitute
incurred expenses for which benefits payable under section 1833(a) are
determinable, shall be reduced under sections 1813(b) and 1833(b) by the amount
of the unified deductible under subsection (b); and</text>
</paragraph><paragraph id="H4CD59147BF184FA7800A98B500CCD598"><enum>(2)</enum><text>the enrollee shall
be responsible for payment of such amount.</text>
</paragraph></subsection><subsection id="H6B336D878ACD48F8947A06E142D0DB1E"><enum>(b)</enum><header>Amount of
unified deductible</header>
<paragraph id="HD07E226A59864374840C7168D14D7C0C"><enum>(1)</enum><header>In
general</header><text>The amount of the unified deductible under this
subsection shall be—</text>
<subparagraph id="H10A0790F8E674B0FA9CD644AEF27EAC8"><enum>(A)</enum><text>for 2016, $550;
or</text>
</subparagraph><subparagraph id="H375AC0DE5083473CA03704B444787B83"><enum>(B)</enum><text>for a subsequent
year, the amount specified in this subsection for the preceding year increased
by the percentage increase in the per capita actuarial value of benefits under
parts A and B for such subsequent year.</text>
</subparagraph></paragraph><paragraph id="H9701C2E77DDD41C0B276284B03C95BBF"><enum>(2)</enum><header>Rounding</header><text>If
any amount determined under paragraph (1) is not a multiple of $10, such amount
shall be rounded to the nearest multiple of $10.</text>
</paragraph></subsection><subsection id="H0EBCB99727104DDB8334F6DFAEF60867"><enum>(c)</enum><header>Application</header><text>The
unified deductible under this section for a year shall be applied, with respect
to a Medicare enrollee—</text>
<paragraph id="HC36C08234E7E43908F302DB3A1900CA5"><enum>(1)</enum><text>with respect to
benefits under part A, on the basis of the amount that is payable for such
benefits without regard to any other copayments or coinsurance and before the
application of any such copayments or coinsurance;</text>
</paragraph><paragraph id="HBB2E35C77593499CA78A842CCD2E8D3E"><enum>(2)</enum><text>with respect to
benefits under part B, on the basis of the total amount of the expenses
incurred by the enrollee during a year which would, except for the application
of the deductible, constitute incurred expenses from which benefits payable
under section 1833(a) are determinable, without regard to any other copayments
or coinsurance and before the application of any such copayments or
coinsurance;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H438235C9E4C842328185B9C0A268E65E"><enum>(3)</enum><text>instead of the
deductibles described in sections 1813(b) and 1833(b); and</text>
</paragraph><paragraph id="H692B947B026742FC95AF4D016AD7D82D"><enum>(4)</enum><text>with respect to
all items and services under parts A and B.</text>
</paragraph></subsection></section><section id="HCC2AD521356F40FDBD269D48C488374C"><enum>1860E–22.</enum><header>Uniform
coinsurance</header>
<subsection id="H503FEABCE3C84A95B4C99274C4253869"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to subsection
(c) and section 1860E–23, with respect to a year (beginning with 2016), in the
case of a Medicare enrollee (as defined in section 1860E–61(b))—</text>
<paragraph id="H72464B75A1E641768A54D6718D73ADF8"><enum>(1)</enum><text>the amount
otherwise payable under part A and the total amount of expenses incurred by the
enrollee during the year which would (except for this section) constitute
incurred expenses for which benefits payable under section 1833(a) are
determinable, shall be reduced by a uniform coinsurance of 20 percent of such
amount; and</text>
</paragraph><paragraph commented="no" id="H32F00E118623464BAAEEB91746A9A627"><enum>(2)</enum><text>the individual
shall be responsible for payment of the amount of such uniform
coinsurance.</text>
</paragraph></subsection><subsection id="H60873D1F57864E6AB6F6B1E776B884FE"><enum>(b)</enum><header>Application to
all items and services</header><text>The uniform coinsurance under this
subsection for a year shall, subject to subsection (d)—</text>
<paragraph id="H46B87EC0B289447CB3360CC72E2FBFD5"><enum>(1)</enum><text>be applied with
respect to items and services under part A on the basis of the amount that is
payable for such items and services and in lieu of any other copayments or
coinsurance under such part;</text>
</paragraph><paragraph id="H01B5643F1363468A9C53CE430E483888"><enum>(2)</enum><text>be applied with
respect to items and services under part B on the basis of the total amount of
the expenses incurred by the individual during the year which would, except for
the application of the deductible, constitute incurred expenses from which
items and services payable under section 1833(a) are determinable, and in lieu
of any other copayments or coinsurance.</text>
</paragraph></subsection><subsection id="H91175BF535E043CABB91CCFF23035B6C"><enum>(c)</enum><header>Application of
deductible</header><text>Before applying subsection (a), with respect to
payment under part A or B for items and services furnished to an individual,
such individual shall be required to meet the unified deductible under section
1860E–21.</text>
</subsection><subsection commented="no" id="H2E073DFE2DF748EE8D93B821CA7F730D"><enum>(d)</enum><header>Authority To
apply actuarially equivalent copayment</header>
<paragraph commented="no" id="H79319306275D4F19B95DBA43D4DF66BA"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), the Secretary may provide for
the application of a copayment amount instead of the coinsurance under this
section in cases for which the coinsurance cannot be readily computed at the
time of provision of the items or services involved or the imposition of a
copayment amount would simplify the administration of this title.</text>
</paragraph><paragraph commented="no" id="H2A99A4E6AF1647B38D4979F4E8C7AF40"><enum>(2)</enum><header>Actuarial
equivalence</header><text>In applying paragraph (1), the amount of any
copayment established under such paragraph with respect to a type of item or
service shall be calculated to provide, in the aggregate and taking into
account the application of this section, for cost-sharing that is actuarially
equivalent to the cost-sharing that would be imposed under this section if this
subsection did not apply.</text>
</paragraph></subsection></section><section id="H179F5593773E493AB02F50263F648699"><enum>1860E–23.</enum><header>Out-of-pocket
limit</header>
<subsection commented="no" display-inline="no-display-inline" id="H9047F0E710DF4DF190D5FE152206C4DE"><enum>(a)</enum><header>In
general</header><text>Beginning with 2016, in the case of a Medicare enrollee,
if the amount of the out-of-pocket cost-sharing of such enrollee for a calendar
year equals or exceeds the catastrophic limit under subsection (b) for that
year—</text>
<paragraph id="H63A27FCDA06B4A8C85E10D245DF262E6"><enum>(1)</enum><text>the enrollee shall
not be responsible for additional out-of-pocket cost-sharing incurred during
that year; and</text>
</paragraph><paragraph id="HCFFDA94FA694460DB085B60D283FDCEA"><enum>(2)</enum><text display-inline="yes-display-inline">the Secretary shall establish procedures
under which the Secretary shall, in appropriate part from the Part A Medicare
FFS Account under section 1817 and the Part B Medicare FFS Account under
section 1841—</text>
<subparagraph id="HCBA724662DE54951B7B946BEFA9A8448"><enum>(A)</enum><text>pay on behalf of
the enrollee the amount of the additional out-of-pocket cost-sharing described
in paragraph (1) attributable to deductibles and coinsurance described in
subsection (c)(1); and</text>
</subparagraph><subparagraph id="H220D598BDD124500A6158D5F13836561"><enum>(B)</enum><text display-inline="yes-display-inline">reimburse the enrollee the amount of the
additional out-of-pocket cost-sharing described in paragraph (1) attributable
to deductibles and coinsurance described in subsection (c)(2).</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H50C45A656FEF41388F5B156C477FD8E1"><enum>(b)</enum><header>Catastrophic
limit</header><text display-inline="yes-display-inline">The amount of the
catastrophic limit under this subsection for a year shall be the dollar amount
in effect under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986
for self-only coverage for taxable years beginning in such year.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H5B42E5B88E9C464498DD5959770424AE"><enum>(c)</enum><header>Out-of-Pocket
cost-Sharing defined</header><text display-inline="yes-display-inline">In this
section, the term <term>out-of-pocket cost-sharing</term> means, with respect
to an individual, the amount of costs incurred by the individual that are
attributable to—</text>
<paragraph id="H39F103660D7B4398A567F88DA2017640"><enum>(1)</enum><text>deductibles and
coinsurance imposed under sections 1860E–21 and 1860E–22; and</text>
</paragraph><paragraph id="HE19BBA08296B4541894B0DED025D6705"><enum>(2)</enum><text display-inline="yes-display-inline">deductibles and coinsurance imposed under
standard prescription drug coverage pursuant to section 1860D–2(b) or
alternative prescription drug coverage pursuant to section 1860D–2(c) offered
by a prescription drug plan.</text>
</paragraph></subsection></section><section id="HCFB89E16088A430584D483E368E3051C"><enum>1860E–24.</enum><header>Offering
of tiered cost-sharing coverage levels instead of medigap</header>
<subsection id="H66396D177B794389B7851764AE2000D8"><enum>(a)</enum><header>Recognition of 3
tiers of cost-Sharing coverage</header><text>For plans years beginning on or
after the general effective date, MA plans shall be classified based upon the
following 3 tiers of cost-sharing coverage (each in this part referred to as a
<quote>tier of cost-sharing coverage</quote>):</text>
<paragraph id="HA3B32356F8BD4A8B82017461395DEB41"><enum>(1)</enum><header>Tier
<enum-in-header>1</enum-in-header></header><text display-inline="yes-display-inline">A tier 1 level (in this part referred to as
<term>tier 1</term>) for Medicare Advantage plans with cost-sharing designed to
provide benefits that are actuarially equivalent to that provided under
Medicare fee-for-service.</text>
</paragraph><paragraph id="H82BD097C942A4B62ADC97316F5580BA7"><enum>(2)</enum><header>Tier
<enum-in-header>2</enum-in-header></header><text display-inline="yes-display-inline">A tier 2 level (in this part referred to as
<term>tier 2</term>) for Medicare Advantage plans with cost-sharing designed to
provide benefits that would provide a level of coverage of at least 85 percent
of the expenses under Medicare fee-for-service for the average Medicare
enrollee.</text>
</paragraph><paragraph id="HCA7EA788F86F4AAB927D028D8502E114"><enum>(3)</enum><header>Tier
<enum-in-header>3</enum-in-header></header><text display-inline="yes-display-inline">A tier 3 level (in this part referred to as
<term>tier 3</term>) for Medicare Advantage plans with cost-sharing designed to
provide benefits that would provide a level of coverage of at least 95 percent
of the expenses under Medicare fee-for-service for the average Medicare
enrollee.</text>
</paragraph><continuation-text continuation-text-level="subsection">For
purposes of this Act, Medicare fee-for-service shall be included in tier
1.</continuation-text></subsection><subsection id="H2AC132C25F6D45EDA57B19169162C225"><enum>(b)</enum><header>Assuring access
to a choice of coverage</header>
<paragraph id="HFDC699EC0BD240D9A38A16C6A1792822"><enum>(1)</enum><header>Choice of at
least two plans in each area and tier</header>
<subparagraph id="H6F37C89D6BA34CAF81CB5131E5BE7B57"><enum>(A)</enum><header>In
general</header><text>The Medicare Choices Commission shall ensure that there
is available, consistent with subparagraph (B), a choice of enrollment in at
least 2 qualifying plans (as defined in paragraph (3)) for each tier of
cost-sharing coverage and each MA region.</text>
</subparagraph><subparagraph id="H622359B0B03A4FF1B627BB6F52EDDD56"><enum>(B)</enum><header>Requirement for
different plan sponsors</header><text display-inline="yes-display-inline">The
requirement in subparagraph (A) is not satisfied with respect to a region if
only one entity offers all the qualifying plans in the region.</text>
</subparagraph><subparagraph id="H7C0751BDEC4448EC8DCD9FB9F4BEA120"><enum>(C)</enum><header>Qualifying plan
defined</header><text>For purposes of this section, the term <term>qualifying
plan</term> means—</text>
<clause id="H5EBEBAB98DA2400CA174FC41FC9AAB66"><enum>(i)</enum><text>with respect to
tier 1, Medicare fee-for-service or any MA–PD plan that is not classified under
tier 2 or tier 3; or</text>
</clause><clause id="H2F550DF8C74D41F8A60A168D66849E4B"><enum>(ii)</enum><text>with respect to
any other tier, an MA–PD plan that is classified under the respective
tier.</text>
</clause></subparagraph></paragraph><paragraph id="H1E1953563E654CA2BA0D6F8C8412DCBD"><enum>(2)</enum><header>Fallback
plan</header><text display-inline="yes-display-inline">In order to ensure
access pursuant to paragraph (1) in an MA region, with respect to the offering
of plans in a tier, if such access is not provided in such region, the Medicare
Choices Commission shall direct the Secretary to provide for the offering of a
fallback plan in such tier for that region in a similar manner that the
Secretary provides for the offering of a fallback prescription drug plan under
section 1860D–11(g) in an area that does not provide access described in
section 1860D–3(a).</text>
</paragraph></subsection><subsection id="H422A1EA2707B40EF80F0CC9B0A151907"><enum>(c)</enum><header>Medigap</header>
<paragraph id="H9BB7A63A1EB14510883CE600465E4F35"><enum>(1)</enum><header>Limitation on
new enrollment</header><text>Subject to paragraph (2), a health insurance
issuer that offers a Medicare supplemental health insurance policy (as defined
in section 1882(g)(1)) may not enroll an individual under such policy on or
after the general effective date.</text>
</paragraph><paragraph id="HD59E118B14A948708E52D78C340F8C0F"><enum>(2)</enum><header>Treatment of
current Medigap enrollees</header>
<subparagraph id="HD8B5E87AEF994415B8173980A6E0A425"><enum>(A)</enum><header>Permitted to
continue under medigap</header><text>In the case of an individual who, as of
the day before the general effective date is entitled to benefits under part A
or enrolled under part B and is enrolled under a Medicare supplemental health
insurance policy certified under section 1882, such individual may choose to
remain enrolled under such policy or disenroll and change enrollment to a
different policy so certified during a period and in accordance with a process
specified by the Secretary.</text>
</subparagraph><subparagraph id="H53A51E07ECE84796A7A63CE9FF24EE59"><enum>(B)</enum><header>Treatment of
Medigap policies</header>
<clause id="H077A9771829147FF88F22EC193F797C4"><enum>(i)</enum><header>In
general</header><text>With respect to plan years beginning on or after January
1, 2016, a Medicare supplemental health insurance policy shall be certified
under section 1882 only with respect to individuals described in subparagraph
(A) and only if such policy is modified to be in accordance with standards
revised pursuant to clause (ii).</text>
</clause><clause commented="no" id="HF49B07B5A8B845629A0DF025E735EC81"><enum>(ii)</enum><header>New
standards</header><text display-inline="yes-display-inline">The Secretary shall
request the National Association of Insurance Commissioners to revise the
standards for all benefit packages for Medicare supplemental health insurance
policies under section 1882(p) to be in accordance with the cost-sharing
provisions established by this subpart.</text>
</clause></subparagraph><subparagraph id="H472FEC2A3BBE4C359DF4E1FFA53298D1"><enum>(C)</enum><header>Availability of
substitute policies with guaranteed issue</header>
<clause id="HB828F9FCDC1E467AAA79EEE220F3245B"><enum>(i)</enum><header>In
general</header><text>The issuer of a medicare supplemental policy—</text>
<subclause id="H13DA3B72455746D49121ED335A6C4518"><enum>(I)</enum><text>may not deny or
condition the issuance or effectiveness of a medicare supplemental policy that
is offered and is available for issuance to new enrollees by such
issuer;</text>
</subclause><subclause id="H4627A603D42B450FA5467F05A9570FB6"><enum>(II)</enum><text>may not
discriminate in the pricing of such policy, because of health status, claims
experience, receipt of health care, or medical condition; and</text>
</subclause><subclause id="H3FD5CF72534D4F4691FF0BE3C42D87A9"><enum>(III)</enum><text>may not impose
an exclusion of benefits based on a pre-existing condition under such policy,
in the case of an individual described in clause (ii) who seeks to enroll under
the policy during a period described in subparagraph (A).</text>
</subclause></clause><clause id="H6A5CD0243B8340E08C69E3AB175133FA"><enum>(ii)</enum><header>Individual
covered</header><text>An individual described in this subparagraph with respect
to the issuer of a medicare supplemental policy is an individual who—</text>
<subclause id="H617AF05266264402AADA5459C397F6F7"><enum>(I)</enum><text>is described in
subparagraph (A) and, as of the date described in such subparagraph, is
enrolled under a medicare supplemental policy; and</text>
</subclause><subclause id="H022EFD6C52594F3387BD543338DA6B4F"><enum>(II)</enum><text>terminates
enrollment in such policy and submits evidence of such termination along with
the application for the policy under subparagraph (A) during the period
described in such subparagraph.</text>
</subclause></clause><clause id="H40AB7A2239654AF3A29FAA7ADE8FE907"><enum>(iii)</enum><header>Limitation</header><text display-inline="yes-display-inline">Subclause (i) shall apply to an issuer of a
medicare supplemental policy, with respect to an individual, only in the case
the actuarial value of the benefits under such policy does not substantially
exceed the actuarial value of the policy described in clause (ii)(II) with
respect to which the individual terminated enrollment.</text>
</clause></subparagraph></paragraph></subsection></section><section id="H6EC9E17809FC400E8CEA222B7A55D2F9"><enum>1860E–25.</enum><header>Contributions
into health individual retirement accounts</header>
<subsection id="H72A5C28FA918481085C36D2EC75ECEA2"><enum>(a)</enum><header>Contributions</header><text>The
Secretary shall establish procedures to ensure that, for each year (beginning
with 2016), the Secretary shall deposit in the health individual retirement
account (as defined in section 201(1) of the Save and Strengthen Medicare Act
of 2012) of an account holder (as defined in section 201(2) of such Act) who is
a Medicare fee-for-service enrollee the per capita Medicare preventive benefit
amount under subsection (b) for such year. In no case shall a deposit be made
under the previous sentence in the case of an individual described in
subparagraph (A)(ii) of section 1935(c)(6) (taking into account the application
of subparagraph (B) of such section) in a State that has elected the
maintenance of effort option described in section 1944(b)(2).</text>
</subsection><subsection id="HAB148B4B8F004C3B8DE8325FADC01E13"><enum>(b)</enum><header>Per capita
Medicare preventive benefit amount</header>
<paragraph id="HB2A058F63DEA4875BED42B14622809D8"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">For purposes of
subsection (b), the per capita Medicare preventive benefit amount is equal
to—</text>
<subparagraph id="H2C6AA8B4FE25449B98936D45ADCCE8A3"><enum>(A)</enum><text>with respect to
2016, the amount by which—</text>
<clause id="H1B1EC0B3F01C499D8C9D54A3BF7EB4F9"><enum>(i)</enum><text display-inline="yes-display-inline">the average per capita amount estimated to
have been expended under Medicare fee-for-service for preventive services
during the previous year; exceeds</text>
</clause><clause id="H957670F2E05C471FACD4AFAAE1D955C5"><enum>(ii)</enum><text display-inline="yes-display-inline">the average per capita amount that would
have been expended under Medicare fee-for-service for such services during such
previous year if payment under Medicare fee-for-service for such services had
been subject to the deductible and cost-sharing provisions of section
1833;</text>
</clause></subparagraph><subparagraph id="H5820DF222D5A44719E83D298D6F1D1D2"><enum>(B)</enum><text>with respect to
2017, the amount by which—</text>
<clause id="H967F29F93B2245BB8E29FD71651CB4B6"><enum>(i)</enum><text>the actual average
per capita amount expended under Medicare fee-for-service for preventive
services during 2015; exceeds</text>
</clause><clause id="H26CCF543608341768317CF0BF952462F"><enum>(ii)</enum><text display-inline="yes-display-inline">the average per capita amount that would
have been expended under Medicare fee-for-service for such services during such
year if payment under Medicare fee-for-service for such services had been
subject to the deductible and cost-sharing provisions of section 1833;</text>
</clause><continuation-text continuation-text-level="subparagraph">increased by the annual percentage
increase in the consumer price index (all items; U.S. city average) as of
September of such previous year; and</continuation-text></subparagraph><subparagraph id="H65A31554ACD44D2DA783315CB29F7A02"><enum>(C)</enum><text display-inline="yes-display-inline">with respect to a subsequent year, the
amount determined under this paragraph for the previous year, increased by the
annual percentage increase in the consumer price index (all items; U.S. city
average) as of September of such previous year.</text>
</subparagraph></paragraph><paragraph id="HC02A6E5FF4D147F2B859D633F9A00711"><enum>(2)</enum><header>Preventive
services</header><text display-inline="yes-display-inline">For purposes of this
section, the term <term>preventive services</term> means preventive services
that are exempt from coinsurance under section 1833(a)(1)(Y) for 2015.</text>
</paragraph></subsection><subsection id="H8551B8E3818A4673B1C8B82ED3BEC5C7"><enum>(c)</enum><header>Payment</header>
<paragraph id="H0EDD9D2A08DA4376B182640DA0503CB8"><enum>(1)</enum><header>From CMS
operating account</header><text display-inline="yes-display-inline">Payment of
each per capita Medicare preventive benefit amount shall be made in appropriate
part from the Part A Medicare FFS Account under section 1817 and the Part B
Medicare FFS Account under section 1841.</text>
</paragraph><paragraph id="H727546294F454E1C949BB6102227AB58"><enum>(2)</enum><header>Availability</header><text display-inline="yes-display-inline">Payment of a per capita Medicare preventive
benefit amount for a year to the health individual retirement account of an
individual shall be made available to such account only for such year. If, by
December 31 of such year, the amount of the per capita Medicare preventive
benefit amount deposited for such year exceeds the amount distributed from the
account of the individual (in accordance with section 206(a) of the Save and
Strengthen Medicare Act of 2012) during such year, such excess shall be
returned to the Medicare FFS Account in accordance with procedures established
under subsection (e).</text>
</paragraph></subsection></section><section id="H082070DD47BD48208FD1242A723738D8"><enum>1860E–26.</enum><header>Requiring
MA plans to offer prescription drug coverage</header><text display-inline="no-display-inline">Beginning for plan years beginning on or
after the general effective date, the only MA plans that may be offered under
part C are MA–PD
plans.</text>
</section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H32DAB38D50BA4C44AF8E78113D1C0078"><enum>(b)</enum><header>Application of
out-of-Pocket limit to MA–PD plans</header>
<paragraph id="HDE7E9A02D9ED4B8EABAEE33B0FC77EF1"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1852(a)(1)(B)
of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended—</text>
<subparagraph id="H8B63E12893E64CCA9F36A89C93C0A0A3"><enum>(A)</enum><text>in clause (i), by
striking <quote>clause (iii)</quote> and inserting <quote>clauses (iii) and
(vi)</quote>; and</text>
</subparagraph><subparagraph id="H0261FB64FEC74ECB85BA160A7C1C9B61"><enum>(B)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H63782FCCDC4444B8A27F00DC315C7FD0" style="OLC">
<clause id="HABE613C2B7BA42B2AB1BCF7F5A6295C3"><enum>(vi)</enum><header>Out-of-pocket
limit</header><text display-inline="yes-display-inline">The provisions of
section 1860E–23—</text>
<subclause id="HA7226E94DD4F4A0D9B69DD7BD062EABD"><enum>(I)</enum><text>shall apply to
individuals enrolled under an MA–PD plan in the same manner as such provisions
apply to Medicare enrollees under such section, except that in lieu of the
application of subsection (a)(2) of such section the MA–PD plan shall establish
procedures to provide for payment of any additional out-of-pocket cost-sharing
described in subsection (a)(1) of such section incurred by individuals enrolled
under the MA–PD plan; and</text>
</subclause><subclause id="HDF703CFFDF1041359BBCC32773803EDE"><enum>(II)</enum><text>as applied under
subclause (I), may not be waived by application of this subparagraph.</text>
</subclause><continuation-text continuation-text-level="clause">In applying
subsection (b) of section 1860E–23 pursuant to the previous sentence, an MA–PD
plan may substitute a dollar amount that is less than the dollar amount
specified under such
subsection.</continuation-text></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H0BC9662B315E4109BB58EDEAD39F9D88"><enum>(2)</enum><header>Exempting MA–PD
plans offering alternative prescription drug coverage from part D deductible
and out-of-pocket limit requirements</header><text>Section 1860D–2(c) of the
Social Security Act (42 U.S.C. 1395w–102(c)) is amended—</text>
<subparagraph id="H46970EF109954C34BCD4B74848F5C06B"><enum>(A)</enum><text>in paragraph (2),
by striking <quote>The deductible</quote> and inserting <quote>In the case of a
prescription drug plan, the deductible</quote>; and</text>
</subparagraph><subparagraph id="H9F2275886CF7407B8861A3A215FE604F"><enum>(B)</enum><text>in paragraph (3),
by striking <quote>The coverage provides</quote> and inserting <quote>In the
case of a prescription drug plan, the coverage provides</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="HDB67D8391ED04658AF514274D0A58E6E"><enum>(c)</enum><header>Prescription
drug plans required To report enrollees’ out-of-Pocket
cost-Sharing</header><text>Section 1860D–12(b) of the Social Security Act (42
U.S.C. 1395w–112(b)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HD522DD5BA1124F85A8FA419B6D5BE445" style="OLC">
<paragraph id="H5A7C53DA8BAB4E8BA0E3792678CE6997"><enum>(7)</enum><header>Out-of-pocket
cost-sharing reports</header><text display-inline="yes-display-inline">Each
contract entered into with a PDP sponsor under this part with respect to a
prescription drug plan offered by such sponsor shall require that, with respect
to each claim submitted for items or services furnished to an individual
enrolled under the plan pursuant to the contract, the sponsor submits to the
Secretary information on the amount of out-of-pocket cost-sharing (as defined
in section 1860E–23(c)) applicable to such enrollee for such items or
services.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H8A97A3A349D14082BCF8BC20360CE801"><enum>(d)</enum><header>Conforming
amendments</header>
<paragraph id="H259C30A131E94A73A1C378E986CCDF61"><enum>(1)</enum><text>Section 1813 of
the Social Security Act (42 U.S.C. 1395e) is amended—</text>
<subparagraph id="HD1EE5259EEB445FBB8CD410C991F7533"><enum>(A)</enum><text>in subsection (a),
by inserting <quote>Subject to subpart 2 of part E:</quote> before paragraph
(1); and</text>
</subparagraph><subparagraph id="H3D09E3ED63F243AEBCDE962CA390B2B8"><enum>(B)</enum><text display-inline="yes-display-inline">in subsection (b), by inserting
<quote>Subject to subpart 2 of part E:</quote> before paragraph (1).</text>
</subparagraph></paragraph><paragraph id="HB8DF1C5EA622433697A52BB8F9728B09"><enum>(2)</enum><text>Section 1833 of
such Act (42 U.S.C. 1395l) is amended—</text>
<subparagraph id="H20977F29E7774E7883EB0C5A4F44F4F9"><enum>(A)</enum><text>in subsection (a),
in the matter preceding paragraph (1), by inserting <quote>and subpart 2 of
part E</quote> after <quote>succeeding provisions of this
section</quote>;</text>
</subparagraph><subparagraph id="HD68193F023334DBCA4128193B230669E"><enum>(B)</enum><text>in subsection (b),
in the first sentence, by striking <quote>Before applying</quote> and inserting
<quote>Subject to subpart 2 of part E, before applying</quote>;</text>
</subparagraph><subparagraph id="HEDEC0C1873494017851CA54566471ECF"><enum>(C)</enum><text>in subsection
(c)(1), in the matter preceding subparagraph (A), by inserting <quote>subject
to subpart 2 of part E,</quote> after <quote>this part,</quote>;</text>
</subparagraph><subparagraph id="H3FBBBC1AC33544659B6B41B1E84C0568"><enum>(D)</enum><text>in subsection (f),
by striking <quote>In establishing</quote> and inserting <quote>Subject to
subpart 2 of part E, in establishing</quote>; and</text>
</subparagraph><subparagraph id="H6AD4518AF137464595DA380ECCB2BD7B"><enum>(E)</enum><text>in subsection
(g)(1), by inserting <quote>and subpart 2 of part E</quote> and
<quote>paragraphs (4) and (5)</quote>.</text>
</subparagraph></paragraph><paragraph id="H8AAB7EDF27FF4B31A23B1C439CA96E72"><enum>(3)</enum><text>Section 1882(a)(2)
of such Act is amended by striking <quote>No medicare</quote> and inserting
<quote>Subject to section 1860E–24(c), no medicare</quote>.</text>
</paragraph></subsection></section><section id="H6E640586178749E29241B19FDAAE50DA"><enum>104.</enum><header>Late enrollment
penalty not to apply for months of any health coverage</header>
<subsection id="H85C06C81D7774CB28F55F85CF1FE9392"><enum>(a)</enum><header>In
general</header><text>Section 1839(b) of the Social Security Act (42 U.S.C.
1395r) is amended in the second sentence, by inserting before the period at the
end the following: <quote>or months during which the individual has any other
health coverage</quote>.</text>
</subsection><subsection id="HC139E4142A844804BA4F701A1403353B"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by paragraph (1) shall apply for months
of coverage beginning after the date of the enactment of this Act.</text>
</subsection></section><section id="HBC0FF83FD5874F66A2B3BAB9B121DF0E"><enum>105.</enum><header>Competitive
bidding and premiums under unified Medicare</header>
<subsection id="H282666D394954B479C8A098832BB41CE"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Part E of title XVIII
of the Social Security Act, as added by section 101 and amended by section 103,
is further amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H6F44D9158080492DB3746495D805A6AA" style="OLC">
<subpart id="H890FB7CC96C941D8BCBEA273396B98AC"><enum>3</enum><header>Competitive
bidding and premiums</header>
<section id="HF858EE7E24FA44BEBABD26211DC0BA26"><enum>1860E–31.</enum><header>Application
of competitive bidding and changes in premiums</header>
<subsection id="H489C1290D73644B8B37943C39029F5B3"><enum>(a)</enum><header>Competitive
bidding based on levels of coverage and MA regions</header><text>In applying
section 1854 for plan years beginning on or after the general effective date
the following rules shall apply:</text>
<paragraph id="HA54BEF2E85744166A130496867AF4BC5"><enum>(1)</enum><header>Separate bids
for each tier of cost-sharing coverage</header><text>A Medicare Advantage
organization shall submit a separate bid for each tier of cost-sharing coverage
for each MA–PD plan offered by such organization.</text>
</paragraph><paragraph id="H14349473DC64437E924AE1D0737C520F"><enum>(2)</enum><header>Bids</header><text display-inline="yes-display-inline">Any bid submitted by a Medicare Advantage
organization under such section—</text>
<subparagraph id="HCD12B2CF89724B78B72176ACADC08723"><enum>(A)</enum><text>with respect to an
MA region, shall provide for the offering of an MA–PD plan in each county
within such region; and</text>
</subparagraph><subparagraph id="HB0C6A59CFF8D4682BDEDEC07516F6F2E"><enum>(B)</enum><text>with respect to an
MA local area, shall provide for the offering of an MA–PD plan in each county
within such area.</text>
</subparagraph></paragraph><paragraph id="H3683AF2EB4024AA0A9F2D8B77DF80AE7"><enum>(3)</enum><header>Uniform bids for
all areas within an MA region</header><text display-inline="yes-display-inline">Any bid submitted by a Medicare Advantage
organization under such section shall, as specified by the organization, be
uniform for—</text>
<subparagraph id="H6BCC265C8C6F41D198F2D3D806F381B4"><enum>(A)</enum><text>all plans offered
in any MA local area within an MA region; or</text>
</subparagraph><subparagraph id="HF6ADE10C8F044269BDF7E42FFFE19A05"><enum>(B)</enum><text>subject to
paragraph (4), all plans offered within a county; and</text>
</subparagraph><continuation-text continuation-text-level="paragraph">section
1854(h) shall apply.</continuation-text></paragraph><paragraph commented="no" id="H87CB19474CCE4CA7BD3615D5C3619302"><enum>(4)</enum><header>Authority of
Medicare Choices Commission to reject bids</header><text display-inline="yes-display-inline">In the case that the Medicare Choices
Commission determines that a Medicare Advantage organization is submitting bids
in accordance with paragraph (3)(B) in a manner that demonstrates a
disproportionate change in the amounts of the bids for such areas compared to
the actual costs for providing benefits in such areas, the Commission may
reject such bids.</text>
</paragraph><paragraph id="HCEB4372D536F457385CE0F0EA9E5ED96"><enum>(5)</enum><header>Acceptance of
bid</header>
<subparagraph id="H81A95FA586194CB6AB5677B1B1BAD83C"><enum>(A)</enum><header>In
general</header><text>A Medicare Advantage organization shall not be eligible
to submit a bid under such section unless the organization provides assurances
satisfactory to the Medicare Choices Commission that the organization will
accept an award of a contract under this part pursuant to such bid.</text>
</subparagraph><subparagraph id="HFAE00F14FF0D4F7585EE16CDC3FB7ED7"><enum>(B)</enum><header>Certain
modifications permitted</header><text>Nothing in subparagraph (A) shall be
construed as preventing a Medicare Advantage organization that submits a bid
under such section from withdrawing or modifying the bid before the date on
which the risk-adjusted benchmark amount under paragraph (3)(B)(i) or
(4)(B)(i), as appropriate, of section 1854(b) is calculated for the area and
year involved.</text>
</subparagraph></paragraph></subsection><subsection id="H3A0C747D2BD7448B86D0FAA6591B5D6E"><enum>(b)</enum><header>Adjustment in
payment to MA plans</header>
<paragraph id="H3A143270E5034577B40BBB45B0C9D14F"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">In applying section
1853 for plans years beginning on or after the general effective date, the
amount specified in subparagraph (B) of section 1853(a)(1) shall be
<fraction>1/12</fraction> of 88 percent of the revised benchmark for the region
and year involved.</text>
</paragraph><paragraph id="H1E82334C7B0F412581F35AEFACC6F0E7"><enum>(2)</enum><header>Revised
benchmark</header>
<subparagraph id="H4921DB01AC2B427F8356980EE501650E"><enum>(A)</enum><header>In
general</header><text>The Medicare Choices Commission shall compute a revised
benchmark for each plan year and each MA region.</text>
</subparagraph><subparagraph id="HED7D97AE90264F678FBAF1DA1E6A940E"><enum>(B)</enum><header>Revised
benchmark</header><text>Subject to the succeeding provisions of this paragraph,
the revised benchmark for a plan year and MA region is equal to the sum
of—</text>
<clause id="H915CA875B67C46D9B9ED6FEAA8D33399"><enum>(i)</enum><text>the phase-out
percentage (as specified in subparagraph (C)) of the average of the lowest and
third lowest bid amount submitted for such year and region for the tier 1 level
of cost-sharing coverage under section 1860E–24(b), taking into account section
1860E–32(b); and</text>
</clause><clause id="H6E88FC5E2DCD41A490C4EB7FB55DCA46"><enum>(ii)</enum><text>the phase-in
percentage (as specified in subparagraph (C)) of the lowest bid amount so
submitted.</text>
</clause></subparagraph><subparagraph id="HEE85D06A155843B8B5637CAE2742BDFE"><enum>(C)</enum><header>Phase out and
phase-in percentages</header><text display-inline="yes-display-inline">In
subparagraph (B), with respect—</text>
<clause id="H46E2A3E22EDC42D38CB20304D0180105"><enum>(i)</enum><text>to
the first plan year in which this section applies, the phase-out percentage
shall be 100 percent and the phase-in percentage shall be 0 percent; and</text>
</clause><clause id="H06F654AED6E64627AC4B15FBC2607DD4"><enum>(ii)</enum><text>each succeeding
plan year the phase-out percentage shall be the phase-out percentage for the
previous year decreased by 20 percentage points (but not below 0 percent) and
the phase-in percentage shall be 100 percent minus the phase-out percentage for
the year.</text>
</clause></subparagraph><subparagraph id="H97F19A24FAB04B54BCB46B72B639C6AB"><enum>(D)</enum><header>Limitation</header><text>In
no case shall the revised benchmark for a plan year and MA region be lower than
the lowest bid amount submitted for such year and region that when combined
with all bids below such bid amount would result in the capacity to provide
coverage to all Medicare enrollees in such region.</text>
</subparagraph></paragraph><paragraph id="H0C026EB2ECC54231A473744D5C4219C6"><enum>(3)</enum><header>Review and
revisions of risk adjustment</header>
<subparagraph id="HFC1BFD0E81C74D1DB03AED239FA2DC26"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The Medicare Choices
Commission shall review and, as the Commission determines appropriate, revise
the risk adjustments payment mechanism under section 1853(a)(1)(C) for purposes
of applying such mechanism under this section and under section 1860E–32,
including pursuant to section 1860E–33(a).</text>
</subparagraph><subparagraph id="H114F7DD90F8F4FB6936935CD9916E153"><enum>(B)</enum><header>Requirements for
revisions</header><text display-inline="yes-display-inline">In making the
revisions under subparagraph (A) to the risk adjustments payment mechanism
described in such subparagraph, the following shall apply:</text>
<clause id="H207B962954E942AD86ABDCE9230F40F4"><enum>(i)</enum><header>Incorporating
private health insurance data</header><text>The Medicare Choices Commission
shall incorporate data on the cost and utilization of services by individuals
receiving benefits under a group health plan or health insurance coverage
offered in the individual or group market who have the same case
characteristics (such as conditions or combinations of conditions) as such
characteristics that are to be used under such mechanism for risk adjusting
payment amounts to Medicare Advantage organizations under part C and Medicare
fee-for-service under section 1860E–32, including pursuant to section
1860E–33(a).</text>
</clause><clause id="H18965E9D6C5241B4901D3C1CCA2AC1F1"><enum>(ii)</enum><header>Inclusion of
number of conditions</header><text>The Medicare Choices Commission shall
provide that a risk score under such mechanism, with respect to an individual,
includes an indicator for the number of chronic conditions with which the
individual has been diagnosed.</text>
</clause><clause id="HC63874D64FDE4D75A94C94073F80838D"><enum>(iii)</enum><header>Use of 2 years
of diagnosis data</header><text>The Medicare Choices Commission shall ensure
that a risk score under such mechanism, with respect to an individual, shall
reflect two years of diagnosis data, to the extent available.</text>
</clause></subparagraph><subparagraph id="H2947B8916F694BF9B0C59F401D417829"><enum>(C)</enum><header>Evaluating
addition of retrospective risk transfer pool</header><text display-inline="yes-display-inline">In conducting the review under subparagraph
(A) of the risk adjustments payment mechanism described in such subparagraph,
the Medicare Choices Commission shall evaluate the extent to which it would be
appropriate to establish, in addition to such risk adjustments payment
mechanism, a retrospective risk transfer pool—</text>
<clause id="H42A84104B0E9484FB88E033EB63C3FD2"><enum>(i)</enum><text display-inline="yes-display-inline">that would enable MA organizations, with
respect to MA–PD plans offered by such organization, and the Secretary, with
respect to Medicare fee-for-service, to collectively devise and administer
procedures for adjusting for enrollee selection effects that are not, in the
judgment of the organizations, with respect to such plans, and the Secretary,
with respect to Medicare fee-for-service, adequately addressed by the risk
adjustments payment mechanism;</text>
</clause><clause id="H270997E2152E436BB5D673E843F88DD0"><enum>(ii)</enum><text display-inline="yes-display-inline">under which each MA–PD plan and Medicare
fee-for-service must participate;</text>
</clause><clause id="H0E3AEF46DA1C42DF994390AEE81AE7F0"><enum>(iii)</enum><text display-inline="yes-display-inline">which shall be operated by the MA
organizations offering such MA–PD plans and the Secretary under the supervision
of the Medicare Choices Commission; and</text>
</clause><clause id="H2152757B44FD4E99AA4EB71143E9740F"><enum>(iv)</enum><text display-inline="yes-display-inline">which would be funded entirely out of
premiums and assessments on such plans and Medicare fee-for-service.</text>
</clause></subparagraph></paragraph><paragraph id="H29406C96A64540D2A4D02C3927B04080"><enum>(4)</enum><header>Application on a
regional basis</header><text>In applying sections 1853 and 1854, the revised
benchmark under this subsection for each MA local area within an MA region
shall be the revised benchmark for such region.</text>
</paragraph></subsection><subsection display-inline="no-display-inline" id="H7BCF6B61F3184430843C74E3B5A08ABA"><enum>(c)</enum><header>Premiums under
MA plans</header>
<paragraph id="HECE1D962B3B04CBEB83551ADA4E92B22"><enum>(1)</enum><header>In
general</header><text>For plans years beginning on or after the general
effective date, sections 1853 and 1854 shall be applied—</text>
<subparagraph id="HC97D6EE7205C4C60A443A74368EA8CD3"><enum>(A)</enum><text>by substituting
the modified monthly basic beneficiary premium described in paragraph (2)(A)
for the MA monthly basic beneficiary premium defined in section 1854(b)(2)(A);
and</text>
</subparagraph><subparagraph id="H3F2D129D9F2B43E9A8BE91F7864F4D8C"><enum>(B)</enum><text display-inline="yes-display-inline">by substituting the revised benchmark under
subsection (b) for the unadjusted MA area specific non-drug monthly benchmark
amount (as defined in section 1853(j)).</text>
</subparagraph></paragraph><paragraph id="H7817BA84662D4F7CBC02061331DD4486"><enum>(2)</enum><header>Modified monthly
basic beneficiary premium</header>
<subparagraph id="H7E38F43F98D541BAA64701D811829D18"><enum>(A)</enum><header>In
general</header><text>The modified monthly basic beneficiary premium described
in this paragraph, with respect to a month in a year and an MA plan offered in
a tier of cost-sharing coverage in an MA region, is the amount (if any) by
which the MA non-drug bid described in subparagraph (B) for such plan exceeds
<fraction>1/12</fraction> of the revised benchmark described in subsection (b)
for the year and region.</text>
</subparagraph><subparagraph id="H929E3025A5674321A271EE2410F3EE82"><enum>(B)</enum><header>MA non-drug
bid</header><text display-inline="yes-display-inline">The MA non-drug bid
described in this subparagraph is, with respect to a month and an MA plan
offered in a tier of cost-sharing coverage, the portion of the bid amount
submitted under clause (i) of section 1854(a)(6)(A) for the tier benefit level,
MA region, and year involved that is attributable under clause (ii)(I) of such
section to the provision of benefits under Medicare fee-for-service.</text>
</subparagraph></paragraph><paragraph id="H57F12EBE4CEE4D448BDF4EE9456DC2C1"><enum>(3)</enum><header>Application on a
regional basis</header><text>In applying sections 1853 and 1854, the average
per capita monthly savings under section 1854(b)(3) shall be computed by
substituting each region for a State and all plans within the region for MA
local plans within a State.</text>
</paragraph><paragraph commented="no" id="HBB4663D71D074B39ABAFF84A3A75610D"><enum>(4)</enum><header>Treatment of
beneficiary rebate rule</header><text>Section 1854(b)(1)(C) shall not apply to
the modified monthly basic beneficiary premium applied under this
subsection.</text>
</paragraph><paragraph id="H0CDE24FA071E49FD831C89A85D742A25"><enum>(5)</enum><header>Treatment of
individuals electing earlier benefit coverage</header><text display-inline="yes-display-inline">Section 1860E–32(c)(3) shall apply to an MA
organization and the premium charged under section 1854(b)(1) to an individual
enrolled in an MA plan offered by such organization who makes an election
described in such section 1860E–32(c)(3) in the same manner as such section
applies to the Secretary and an individual enrolled under Medicare
fee-for-service who makes such an election.</text>
</paragraph></subsection><subsection id="HA3086418E3D44F03B3270B7F560C74D9"><enum>(d)</enum><header>Annual
report</header><text>Beginning for 2016, the Medicare Choices Commission shall
submit to Congress an annual report on any questionable activities or
irregularities that have arisen in the bidding process under part C, as
modified by this section, during such year.</text>
</subsection></section><section id="H0F8492EFD8E5434DB50EE51CCFB7041D"><enum>1860E–32.</enum><header>Application
of competitive bidding to Medicare fee-for-service</header>
<subsection id="HFAA8E17F543A413C8808B6830915500D"><enum>(a)</enum><header>Submission of
bid</header>
<paragraph id="HB6305ECB796242BAAA9E8B8ECBADE71F"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary shall
submit a bid for Medicare fee-for-service (in this part referred to as a
<term>Medicare FFS bid</term>) offered for each MA region in the same manner as
a bid submitted by a Medicare Advantage organization under section 1854 for
offering an MA plan under such tier.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H84660735CC414DD88B7ECA9C169DA683"><enum>(2)</enum><header>Basis for
bid</header><text>In applying paragraph (1) in computing the average revenue
requirements under section 1854(a)(6)(A)(i) for a plan year, the Secretary
shall base such requirements on—</text>
<subparagraph id="H919B6705B04B4911AA8C94E76B234410"><enum>(A)</enum><text display-inline="yes-display-inline">adjusted average per capita costs payable
during the previous plan year under parts A and B attributable to all
individuals enrolled under Medicare fee-for-service in such region, including
administrative costs attributable to such individuals and costs attributable to
such individuals with respect to per capita Medicare preventive benefit amounts
contributed under section 1860E–25 into health individual retirement accounts,
(as estimated by the Secretary), increased by</text>
</subparagraph><subparagraph id="H8E60A4A2260841FCA08952AFFAABA76D"><enum>(B)</enum><text>the Secretary’s
estimate of the percentage increase in the per capita actuarial value of
benefits under such parts for the plan year involved.</text>
</subparagraph></paragraph><paragraph id="HDBA03622FCD844E3840A68C966A7C747"><enum>(3)</enum><header>Modification</header><text>In
applying this subsection, clause (iii) of section 1854(a)(6)(B) shall not be
construed as applying to Medicare fee-for-service.</text>
</paragraph></subsection><subsection id="H6A6425702683476B8484CF3325F96FCC"><enum>(b)</enum><header>Treatment of bid
as a tier 1 bid under part C</header><text display-inline="yes-display-inline">Any bid under subsection (a) for a region
shall be considered as a bid for an MA plan offered in the region with tier 1
cost-sharing coverage for purposes of this part and sections 1853 and
1854.</text>
</subsection><subsection id="H917DC22546B446D29A36C9D6413F6A8B"><enum>(c)</enum><header>Premiums
adjustment</header>
<paragraph id="H259ACBF898804C44A9EC9688309F5E7B"><enum>(1)</enum><header>In
general</header><text>Beginning for months beginning on or after the general
effective date—</text>
<subparagraph id="HD8E83E1B222E4BBA85BA17C6BC6996DB"><enum>(A)</enum><text display-inline="yes-display-inline">there shall be a combined monthly premium
amount described in paragraph (2) charged to a Medicare enrollee, with respect
to coverage under Medicare fee-for-service;</text>
</subparagraph><subparagraph id="HF12BDCC3FF96472D8C1E0597A0E99DF4"><enum>(B)</enum><text>such premium
amount under subparagraph (A) shall be instead of the part B monthly premium
under section 1839; and</text>
</subparagraph><subparagraph id="HCF7A467CAA3541D5A3B522FE9EBF4B51"><enum>(C)</enum><text>such premium shall
be separate from (and in addition to) any monthly beneficiary premium that may
apply to the individual with respect to a prescription drug plan under part
D.</text>
</subparagraph></paragraph><paragraph id="HF144D530B65D4B848AA6F2A3C0FBB223"><enum>(2)</enum><header>Combined monthly
premium</header>
<subparagraph id="HF8754973B737444AA829771F14C7726F"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The combined monthly
premium amount under this paragraph for a Medicare enrollee in an MA region
shall be, subject to subparagraph (D) and section 1860E–41(b), equal to the
combined monthly base amount under subparagraph (B), adjusted in accordance
with subparagraphs (C) and (D).</text>
</subparagraph><subparagraph id="H542AC4173DB04C2185EBB39A2BA6A83E"><enum>(B)</enum><header>Combined monthly
base amount</header><text>The combined monthly base amount shall be an amount
calculated in a manner similar to the manner in which the part B monthly
premium is calculated under subsections (a) and (c) of section 1839, in effect
as of December 31, 2015, except that in applying such section—</text>
<clause id="HF2543E62504B4F7CA161ACCEBAA51F89"><enum>(i)</enum><text display-inline="yes-display-inline">the actuarial rate determined under the
second sentence of subsection (a)(1) of such section shall be an amount the
Secretary estimates to be necessary so that the aggregate amount for the
calendar year involved with respect to all Medicare enrollees will equal the
total of the benefits and administrative costs which the Secretary estimates
will be payable from the Federal Hospital Insurance Trust Fund under section
1817 and the Federal Supplementary Medical Insurance Trust Fund under section
1841 for services performed and related administrative costs incurred in such
calendar year with respect to such enrollees under parts A and B; and</text>
</clause><clause id="H548573B6601540B9B1A438891DCC07E3"><enum>(ii)</enum><text>by substituting
<quote>24 percent</quote> for <quote>50 percent</quote> in subsection (a)(3) of
such section.</text>
</clause></subparagraph><subparagraph id="H4C09BE97C7E34A89B0512FCB464C32EE"><enum>(C)</enum><header>Application of
other provisions</header><text>The combined monthly base amount shall be
subject to adjustment in the same manner as the part B monthly premium
calculated under section 1839(a) is subject to adjustment under subsections (b)
and (i) of such section, except that—</text>
<clause id="HEC6D0DE5D6114993A6BEB671B3BD4583"><enum>(i)</enum><text>in
applying the late enrollment penalty under subsection (b) of such section, the
initial enrollment period of the individual shall be the enrollment period
specified by the Secretary pursuant to subpart 1 instead of the initial
enrollment period described in such section 1839(b); and</text>
</clause><clause id="H3BDF9BEDDC1048E59BF918E717E7219D"><enum>(ii)</enum><text>the income
reduction under subsection (i) of such section shall be applied in accordance
with section 1860E–41(a).</text>
</clause><continuation-text continuation-text-level="subparagraph">Adjustments under this
subparagraph shall be made without regard to any adjustment under subparagraph
(D).</continuation-text></subparagraph><subparagraph id="H3A4FE26DB7EB40E9AA53F01FD0EDC15C"><enum>(D)</enum><header>Amount of
adjustment for non-MA enrollees</header><text>Under this subparagraph, with
respect to a Medicare fee-for-service enrollee for a month who resides in an MA
region, if the Medicare FFS bid under subsection (a) for the region and month
exceeds such revised benchmark, the amount of the combined monthly base amount
for the enrollee for the month (without regard to any adjustment under
subparagraph (C)) shall be increased, subject to subparagraph (E), by the
amount by which such bid exceeds such benchmark.</text>
</subparagraph><subparagraph id="HFF1709F5DC7A459281E5B3614B950B62"><enum>(E)</enum><header>Transition for
current traditional FFS Medicare beneficiaries</header><text display-inline="yes-display-inline">In the case of an individual who, as of
December 31, 2015, is entitled to (or enrolled for) benefits under part A or
enrolled under part B but is not enrolled in an MA plan—</text>
<clause id="H25227C72AA9E48B2BFDEFA8332007121"><enum>(i)</enum><text>with respect to
months in 2016, the adjustment under subparagraph (D) for such individual for
such months may in no case exceed 20 percent of the part B monthly premium
amount under section 1839 that was applicable to such individual for months in
the previous year; and</text>
</clause><clause id="H267996A96A3A4567986E5ACCBAB7B9A1"><enum>(ii)</enum><text>with respect to
months in a subsequent year (before 2026), such adjustment for such months may
in no case exceed 20 percent of the combined monthly premium amount applicable
to such individual (not taking into account subparagraph (C)) for months in the
previous year.</text>
</clause></subparagraph></paragraph><paragraph id="H850D9CDE5F59473D87B9B0343E092545"><enum>(3)</enum><header>Treatment of
individuals electing earlier benefit coverage</header><text display-inline="yes-display-inline">In the case of an individual who elects
under section 216(m) a Medicare eligibility age of at least 65 but less than
the preferred Medicare age applicable to such individual under paragraph (2)(B)
of such section, the Secretary shall adjust the premium otherwise computed for
individuals with a Medicare eligibility age of the preferred Medicare age in a
manner so that, on an actuarial basis over the lifetime of individuals making
such an election (taking into account the relevant risk characteristics of
individuals who as a class have selected the respective age compared to those
who have not made the election), the actuarial value of the benefits (net of
premiums) is equal among such groups.</text>
</paragraph><paragraph id="H0212DC062C834F149D85E5B0743CA22F"><enum>(4)</enum><header>Payment of
premiums</header><text>The provisions of section 1854(d)(2) shall apply to the
payment and collection of combined monthly premium amounts under this
subsection in a similar manner as such provisions apply to the payment to and
collection by an MA organization of monthly premiums under part C.</text>
</paragraph></subsection></section><section commented="no" id="H27FC7FCDF49A4E058CC320C90F2ACBFA"><enum>1860E–33.</enum><header>Ensuring a
level playing field</header>
<subsection commented="no" id="HC715CF57FFA649ADB0EF11144E061A2A"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Except as specified
otherwise in this part, the Secretary and Medicare fee-for-service shall be
subject to requirements that are applicable under this title to an MA
organization and Medicare Advantage plan, and payments shall be made to the
Secretary, with respect to coverage of an individual under Medicare
fee-for-service in the same manner as payments are made under section
1853(a)(1) to an MA organization, with respect to coverage of an individual
under a Medicare Advantage plan offered by such organization.</text>
</subsection><subsection commented="no" id="HEE32C4D3985A472E89B94C1A031B7402"><enum>(b)</enum><header>Ensuring
collection of quality and risk data</header><text>The Medicare Choices
Commission shall establish procedures to ensure that quality data and data on
risk factors of Medicare enrollees are collected and reported with respect to
Medicare fee-for-service in the same manner as such data are collected and
reported with respect to Medicare Advantage plans.</text>
</subsection><subsection id="H2FB059F7C7284610ABB8F5829E72F6C6"><enum>(c)</enum><header>Noninterference
rules</header>
<paragraph id="H17039F08C342464AA8D4700083DEDF2A"><enum>(1)</enum><header>Negotiations
between MA plans and providers</header><text display-inline="yes-display-inline">In order to promote competition under this
title and in carrying out this title, neither the Secretary nor the Medicare
Choices Commission may interfere with the negotiations between any MA
organization and a hospital, physician, or other provider of services or
supplier.</text>
</paragraph><paragraph commented="no" id="H2F4B4E65447D4D56A9EBD7C866477792"><enum>(2)</enum><header>Bidding
process</header><text display-inline="yes-display-inline">The Medicare Choices
Commission may not reject a bid submitted by an MA organization for the
offering of an MA–PD plan based on the amount of such bid. Nothing in the
previous sentence shall be construed as affecting the regulatory authority of
the Commission or as affecting the authority of the Commission to reject a bid
pursuant to section 1860E–31(a)(3).</text>
</paragraph><paragraph display-inline="no-display-inline" id="HEC45FE89193C441B957266A43E261909"><enum>(3)</enum><header>Treatment of
regulatory functions</header>
<subparagraph id="H2D084D9195B34547BEA4680E7378CCEE"><enum>(A)</enum><header>In
general</header><text>The Secretary, through the Centers of Medicare &
Medicaid Services, shall maintain regulatory functions associated with
conditions of participation applicable to participation of providers of
services and suppliers in Medicare fee-for-service.</text>
</subparagraph><subparagraph id="HC9FC1604FCE64D03AA5157F3BEA7C775"><enum>(B)</enum><header>No application
to providers with respect to MA plans</header><text>Beginning on the general
effective date, the Secretary shall not have the authority to apply any
conditions of participation or similar requirements on providers of services
and suppliers insofar as they are not related to Medicare
fee-for-service.</text>
</subparagraph><subparagraph id="H7B502210FAE24CABA17499AAD165A909"><enum>(C)</enum><header>GAO
report</header><text>By not later than January 31, 2015, the Comptroller
General of the United States shall submit to Congress a report containing
recommendations on the extent to which any condition of participation or
requirement described in paragraph (2) should be applied to providers of
services and suppliers furnishing items and services under this title under
arrangements with Medicare Advantage plans.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H4921A5ACF9FC4BA28086AC5F159396A9"><enum>(d)</enum><header>Report</header>
<paragraph commented="no" id="H8FBABDEBD9C4408E8553D754133E9835"><enum>(1)</enum><header>Initial
report</header><text display-inline="yes-display-inline">Not later than
September 30, 2014, the Medicare Choices Commission shall submit to Congress a
report that—</text>
<subparagraph commented="no" id="H0F628F11A39E423F970CE178E0311CB9"><enum>(A)</enum><text>identifies all the
requirements that are applicable to MA organizations and Medicare Advantage
plans and the extent to which such requirements are also applicable to the
Secretary and Medicare fee-for-service; and</text>
</subparagraph><subparagraph commented="no" id="H19C346937D89466B804A125F14C405E4"><enum>(B)</enum><text>includes a plan
for achieving the requirement described in subsection (a).</text>
</subparagraph></paragraph><paragraph commented="no" id="H959F400857E94F748C104F45F8D2047A"><enum>(2)</enum><header>GAO
reports</header><text>Not later than January 1, 2016, and every 3 years
thereafter, the Comptroller General of the United States shall submit to
Congress a report on the extent to which the Secretary and Medicare
fee-for-service are in compliance with subsection (a) and the plan described in
paragraph
(1)(B).</text>
</paragraph></subsection></section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H159CFEF6EE6041A8A9D9F06BAA62886E"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="H5938AFB4689C40FB8E0EDBF5220FBE24"><enum>(1)</enum><text display-inline="yes-display-inline">Section 1839(a) of the Social Security Act
is amended by inserting after the subsection enumerator the following:
<quote>Subject to section 1860E–32:</quote>.</text>
</paragraph><paragraph id="H3343C5D723B849C1BB56532725B4DBEE"><enum>(2)</enum><text>Section 1839(i)(1)
of the Social Security Act is amended by striking <quote>In the case</quote>
and inserting <quote>Subject to sections 1860E–32 and 1860E–41, in the
case</quote>.</text>
</paragraph><paragraph id="H9107644CF28649378A368250E3EC8955"><enum>(3)</enum><text>Section
1853(a)(1)(A) of the Social Security Act is amended by striking <quote>and
section 1859(e)(4)</quote> and inserting <quote>, section 1859(e)(4), and
subpart 3 of part E</quote>.</text>
</paragraph><paragraph id="H930D7BB219334FB98A997BB7D4851F00"><enum>(4)</enum><text>Section 1853(j) of
such Act is amended by inserting <quote>and subpart 3 of part E</quote> after
<quote>subsection (o)</quote>.</text>
</paragraph><paragraph id="H16E15184B97B442EAF2187EA07B53A02"><enum>(5)</enum><text>Section 1854 of
such Act is amended—</text>
<subparagraph id="H297D567F597F48EA8E7C321AD3A89E86"><enum>(A)</enum><text>in subsection (a),
after the heading, by inserting <quote>Subject to subpart 3 of part
E:</quote>;</text>
</subparagraph><subparagraph id="H974EFF92D8244A649357768DD19C24D9"><enum>(B)</enum><text>in subsection (b),
after the heading, by inserting <quote>Subject to subpart 3 of part
E:</quote>;</text>
</subparagraph><subparagraph id="H32CF6829075C42B7BA90C67B931FF249"><enum>(C)</enum><text>in subsection (d),
after the heading, by inserting <quote>Subject to subpart 3 of part E:</quote>;
and</text>
</subparagraph><subparagraph id="H6C0471D0E85C478E9B765B9BF617DC8B"><enum>(D)</enum><text>in subsection (e),
after the heading, by inserting <quote>Subject to subpart 3 of part
E:</quote>.</text>
</subparagraph></paragraph></subsection></section><section id="H386905ADDB334FA3AA97F8FDDF60DC5C"><enum>106.</enum><header>Separate
Medicare FFS accounts and other financing under unified Medicare</header>
<subsection id="H8E093D2A58464BA8AD22C273D2C33B88"><enum>(a)</enum><header>Separate
Medicare FFS accounts</header>
<paragraph id="HBB60B36F8BA8415D8D5C90309B5AB6BF"><enum>(1)</enum><header>Under Federal
Hospital Insurance Trust Fund</header><text display-inline="yes-display-inline">Section 1817 of the Social Security Act (42
U.S.C. 1395i) is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="HBB78CE76BE304B75B16825482A75671C" style="OLC">
<subsection commented="no" id="HB332CFA6B9B44D1692FBFA8FF1CDB177"><enum>(l)</enum><header>Part A Medicare
FFS account</header>
<paragraph commented="no" id="H8DFDFF4DD873415AB4FFE952234ED479"><enum>(1)</enum><header>Establishment</header><text>There
is hereby established within the Trust Fund an account to be known as the
<term>Part A Medicare FFS account</term> for the receipts and disbursements
attributable to the operation of Medicare fee-for-service (as defined in
section 1860E–61(b)) insofar as it relates to the program under this part, as
modified under part E, including the transition funding under paragraph (2)(B).
Section 1854(g) shall apply to receipts described in the previous sentence in
the same manner as such section applies to payments or premiums described in
such section.</text>
</paragraph><paragraph commented="no" id="H76914E1F0CCC4EB3B02A1815E08A196C"><enum>(2)</enum><header>Funding</header>
<subparagraph id="HF3F82105C3784D3F99B72142D1C7F58A"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The Part A Medicare
FFS Account shall consist of such gifts and bequests as may be made as provided
in section 201(i)(1), as applied under this section, accrued interest on
balances in the Part A Medicare FFS Account, and such amounts as may be
deposited in, or appropriated to, such Part A Medicare FFS Account as provided
in this subsection.</text>
</subparagraph><subparagraph id="H966C0C60679249D8B036B0740510F1A6"><enum>(B)</enum><header>Transition
funding</header>
<clause id="H97D16B70FFBC488C92C122690F4DC213"><enum>(i)</enum><header>In
general</header><text>In order to provide for funding relating to transitional
costs for carrying out Medicare fee-for-service insofar as it relates to the
program under this part, as modified under part E, as of the general effective
date (as defined in section 1860E–62), there shall be transferred from the
Trust Fund to the Part A Medicare FFS Account such sums as specified necessary
by the Medicare Choices Commission. In order to provide for initial claims
reserves before the collection of premiums, there shall be transferred from the
Trust Fund to the Part A Medicare FFS Account such sums as necessary to cover
90 days worth of claims reserves based on projected enrollment.</text>
</clause><clause id="HC9ACDCDC83C6436DA124CB8D9E85666A"><enum>(ii)</enum><header>Amortization of
transition funding</header><text>The Secretary shall provide for the repayment
to the Trust Fund of the funding transferred under clause (i) in an amortized
manner over the 10-year period beginning with the first plan year beginning on
or after the general effective date (as defined in section 1860E–62).</text>
</clause><clause id="HDCBD8B3CDCFB4157B4214F26F3BE014C"><enum>(iii)</enum><header>Limitation on
funding</header><text>Nothing in this paragraph shall be construed as
authorizing any additional transfers to the Part A Medicare FFS Account, other
than such amounts as are otherwise provided with respect to Medicare Advantage
plans.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H3A9886B8A6EE4CBEB3244C302BE1B3D2"><enum>(3)</enum><header>Separate from
rest of trust fund</header><text>Funds provided under this subsection to the
Part A Medicare FFS Account shall—</text>
<subparagraph id="H9498C99CEB03406B8456EE646EB79A4A"><enum>(A)</enum><text>be kept separate
from all other funds within the Trust Fund, but shall be invested, and such
investments redeemed, in the same manner as all other funds and investments
within the Trust Fund; and</text>
</subparagraph><subparagraph commented="no" id="HF48D53E912FF4B71A426DE23A43006B6"><enum>(B)</enum><text>notwithstanding
the previous subsections of this section, be managed and administered by the
Administrator of the Centers for Medicare & Medicaid
Services.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HBAFF1992E5784684A89683CE94031D4A"><enum>(2)</enum><header>Under
Supplementary Medical Insurance Trust Fund</header><text>Section 1841 of the
Social Security Act (42 U.S.C. 1395t) is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HC0873B437FE6490E84C78F21F2154567" style="OLC">
<subsection commented="no" id="H71522AED88EB45C9A7B9A374D76EBDDB"><enum>(j)</enum><header>Part B Medicare
FFS account</header>
<paragraph commented="no" id="HDB4992A4E87C453F92A28BB747E9DD4C"><enum>(1)</enum><header>Establishment</header><text display-inline="yes-display-inline">There is hereby established within the
Trust Fund an account to be known as the <term>Part B Medicare FFS
account</term> for the receipts and disbursements attributable to the operation
of Medicare fee-for-service (as defined in section 1860E–61(b)) insofar as it
relates to the program under this part, as modified under part E, including the
transition funding under paragraph (2)(B). Section 1854(g) shall apply to
receipts described in the previous sentence in the same manner as such section
applies to payments or premiums described in such section.</text>
</paragraph><paragraph commented="no" id="H5820661769A145F9B041F51D4CE8929F"><enum>(2)</enum><header>Funding</header>
<subparagraph id="HC565317976814F6B97C0A0DD27F34326"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The Part B Medicare
FFS Account shall consist of such gifts and bequests as may be made as provided
in section 201(i)(1), as applied pursuant to this section, accrued interest on
balances in the Part B Medicare FFS Account, and such amounts as may be
deposited in, or appropriated to, the Part B Medicare FFS Account as provided
in this subsection.</text>
</subparagraph><subparagraph id="H7D0F399E7A18491FBAA5CE77FA40FA57"><enum>(B)</enum><header>Transition
funding</header>
<clause id="H4CD2284531D1484BA8CE7C0D119BEA59"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">In order to provide
for funding relating to transitional costs for carrying out Medicare
fee-for-service insofar as it relates to the program under this part, as
modified under part E, as of the general effective date (as defined in section
1860E–62), there shall be transferred from the Trust Fund to the Part B
Medicare FFS Account such sums as specified necessary by the Medicare Choices
Commission. In order to provide for initial claims reserves before the
collection of premiums, there shall be transferred from the Trust Fund to the
Part B Medicare FFS Account such sums as necessary to cover 90 days worth of
claims reserves based on projected enrollment.</text>
</clause><clause id="H3FDF16E970C64727B64D283C61698134"><enum>(ii)</enum><header>Amortization of
transition funding</header><text>The Secretary shall provide for the repayment
to the Trust Fund of the funding transferred under clause (i) in an amortized
manner over the 10-year period beginning with the first plan year beginning on
or after the general effective date (as defined in section 1860E–62).</text>
</clause><clause id="HB68EF92A1FD8430A9F29C69531F6C853"><enum>(iii)</enum><header>Limitation on
funding</header><text>Nothing in this paragraph shall be construed as
authorizing any additional transfers to the Part B Medicare FFS Account, other
than such amounts as are otherwise provided with respect to Medicare Advantage
plans.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H7CBDB26054874CEA93E9F5756D0A9402"><enum>(3)</enum><header>Separate from
rest of trust fund</header><text>Funds provided under this subsection to the
Part B Medicare FFS Account shall—</text>
<subparagraph id="H352BD6416EF34198AFF13C1AAA5BAFE1"><enum>(A)</enum><text>be kept separate
from all other funds within the Trust Fund, but shall be invested, and such
investments redeemed, in the same manner as all other funds and investments
within the Trust Fund; and</text>
</subparagraph><subparagraph commented="no" id="H4D9EB338556349D690204A0BABA5F005"><enum>(B)</enum><text display-inline="yes-display-inline">notwithstanding the previous subsections of
this section, be managed and administered by the the Administrator of the
Centers for Medicare & Medicaid
Services.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" id="H6263204290C0484DBE09D5CECC1294D6"><enum>(b)</enum><header>Chairperson of
Medicare Choices Commission To replace Administrator of CMS on as Secretary of
Board of Trustees of HI and SMI Trust Funds</header>
<paragraph commented="no" id="H17723B2003E64C86AFE4F99A2FE74E40"><enum>(1)</enum><header>HI Trust
Fund</header><text display-inline="yes-display-inline">Section 1817(b) of the
Social Security Act (42 U.S.C. 1395i(b)) is amended by striking <quote>The
Administrator of the Centers for Medicare & Medicaid Services shall serve
as the Secretary of the Board of Trustees.</quote> and inserting <quote>Before
the general effective date defined under section 1860E–62, the Administrator of
the Centers for Medicare & Medicaid Services shall serve as the Secretary
of the Board of Trustees. On and after such general effective date such
Administrator shall not serve as the Secretary of such Board and instead the
Chairperson of the Medicare Choices Commission established under section
1860E–51 shall serve as the Secretary of such Board.</quote>.</text>
</paragraph><paragraph commented="no" id="HA9F02E0F44CF40FBBC590F0076DEFF38"><enum>(2)</enum><header>SMI Trust
Fund</header><text display-inline="yes-display-inline">Section 1841(b) of the
Social Security Act (42 U.S.C. 1395t(b)) is amended by striking <quote>The
Administrator of the Centers for Medicare & Medicaid Services shall serve
as the Secretary of the Board of Trustees.</quote> and inserting <quote>Before
the general effective date defined under section 1860E–62, the Administrator of
the Centers for Medicare & Medicaid Services shall serve as the Secretary
of the Board of Trustees. On and after such general effective date such
Administrator shall not serve as the Secretary of such Board and instead the
Chairperson of the Medicare Choices Commission established under section
1860E–51 shall serve as the Secretary of such Board.</quote>.</text>
</paragraph></subsection><subsection id="HB918F37023114D72B952A021EC98DB19"><enum>(c)</enum><header>Subsidies</header><text display-inline="yes-display-inline">Part E of title XVIII of the Social
Security Act, as added by section 101 and amended by sections 103 and 105, is
further amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H34BC16AB203442F2B02656F749958B06" style="OLC">
<subpart id="H491FD00688D443BFBBAFAC14DA404476"><enum>4</enum><header>Subsidies</header>
<section display-inline="no-display-inline" id="H9175C2B3CA1E4A699FC4B8E7F2487202" section-type="subsequent-section"><enum>1860E–41.</enum><header>Changes in
subsidies</header>
<subsection id="H72CD2B1C5DAE45E3A0F29753B1E8CABC"><enum>(a)</enum><header>Reduced
Government contribution for high-Income seniors</header>
<paragraph id="HAB0DA4A1808647FDBCBF28242A538652"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">For purposes of
determining the combined monthly base amount under section 1860E–32(c)(2)(B)
for an individual, in applying section 1839(i) under such section, the
following shall apply:</text>
<subparagraph id="H4F73E4EACE1C4A1DA9854F9C544CDBC9"><enum>(A)</enum><header>2016</header><text>For
2016, notwithstanding paragraph (6) of such section 1839(i), subject to
paragraph (3)—</text>
<clause id="H649E98D07F9F4CA5AFF8C4C3627A42AE"><enum>(i)</enum><text>the threshold
amount otherwise applicable under paragraph (2)(A) of such section for
individuals shall be equal to $50,000 (or couples, $100,000); and</text>
</clause><clause id="H7FA2B84669244C61A36B058ACE8A226F"><enum>(ii)</enum><text display-inline="yes-display-inline">instead of the sliding scale percentage
specified in paragraph (3)(A)(i) of such section (and instead of the amount
which would be applied in the case of a joint return described in paragraph
(3)(C)(ii) of such section), the sliding scale percentage shall be determined
so that for individuals (or couples) whose modified adjusted gross income is
within an income tier specified in the table described in paragraph (2) the
sliding scale percentage shall increase, on a sliding scale in a linear manner,
from the initial premium percentage to the final premium percentage as
specified in such table for such income tier for such individuals (or couples,
respectively).</text>
</clause></subparagraph><subparagraph id="H1A501F38412F441FBA61F2A8C78D0D1C"><enum>(B)</enum><header>Subsequent
years</header><text>For each subsequent year, such section 1839(i) shall be
applied, as modified by subparagraph (A) and subject to paragraphs (3) and (4),
without taking into account paragraph (5) or (6) of such section.</text>
</subparagraph></paragraph><paragraph id="H48EB545FA90446D7A0C2EA0266776F12"><enum>(2)</enum><header>Table</header><text display-inline="yes-display-inline">The table specified in this paragraph is as
follows: <pagebreak></pagebreak></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: 1 text, 1 num, 1 text" table-type="">
<tgroup cols="4" grid-typeface="1.1" rowsep="0" thead-tbody-ldg-size="10.10.10"><colspec align="left" coldef="fig" colname="column1" colnum="0" colwidth="144.00pt" min-data-value="15" rowsep="0"></colspec><colspec align="left" coldef="fig" colname="column2" colnum="1" colwidth="139.50pt" min-data-value="15"></colspec><colspec align="center" coldef="fig" colname="column3" colnum="2" colsep="0" colwidth="102.75pt" min-data-value="10" rowsep="0"></colspec><colspec align="center" coldef="fig" colname="column4" colnum="3" colsep="0" colwidth="103.50pt" min-data-value="10" rowsep="0"></colspec>
<thead>
<row><entry align="center" colname="column1" morerows="0" namest="column1">Initial Income Level within<linebreak></linebreak> Tier for
Individual<linebreak></linebreak> (or Couple)</entry><entry align="center" colname="column2" morerows="0" namest="column2">Final Income Level
within<linebreak></linebreak> Tier for Individual<linebreak></linebreak> (or Couple)</entry><entry align="center" colname="column3" morerows="0" namest="column3">Initial<linebreak></linebreak> Premium<linebreak></linebreak>
Percentage</entry><entry align="center" colname="column4" morerows="0" namest="column4">Final<linebreak></linebreak> Premium<linebreak></linebreak> Percentage</entry>
</row>
</thead>
<tbody>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$50,000 ($100,000)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">$85,000
($150,000)</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">12 percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">20 percent</entry>
</row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$85,001 ($150,001)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">$130,000
($214,000)</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">20 percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">32 percent</entry>
</row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$130,001 ($214,001)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">$190,000
($300,000)</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">32 percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">50 percent</entry>
</row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$190,001 ($300,001)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">No Limit</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">50
percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">50 percent.</entry>
</row>
</tbody>
</tgroup>
</table>
</paragraph><paragraph commented="no" id="H498A6829C6F547199119621E1BC15AEC"><enum>(3)</enum><header>Transition for
certain seniors</header>
<subparagraph commented="no" id="HAA6D6BABFC284B2A8156201567D3A5E2"><enum>(A)</enum><header>In
general</header><text>In the case of individuals and couples with an income
level that is below the minimum level for which section 1839(i) would otherwise
apply (as in effect as of the date of enactment of this section), the premium
to be applied shall be the sum of—</text>
<clause commented="no" id="H678583B13D6A4791922688564EFFE10F"><enum>(i)</enum><text>the premium
otherwise applicable to individuals whose income is $1 below the applicable
threshold amount under subsection (a)(1); and</text>
</clause><clause commented="no" id="H2336D297EADA429CAFAAD5FB466776F7"><enum>(ii)</enum><text>the transition
percentage of the amount by which the premium that would otherwise apply (but
for this paragraph) under this subsection exceeds the premium described in
clause (i).</text>
</clause></subparagraph><subparagraph commented="no" id="H32835D5DF2CE4E4199DD39424DC9A8A0"><enum>(B)</enum><header>Transition
percentage</header><text>The transition percentage specified in this
subparagraph—</text>
<clause commented="no" id="H0461E2A9A192474AA27FD2BBF59FA3B2"><enum>(i)</enum><text>for fiscal year
2016, is 20 percent;</text>
</clause><clause commented="no" id="H09834268ED5F458797856C51B6F2936F"><enum>(ii)</enum><text display-inline="yes-display-inline">for fiscal year 2017, is 40 percent;</text>
</clause><clause commented="no" id="H0B46B50EDCCB495F8E32C8954046829C"><enum>(iii)</enum><text display-inline="yes-display-inline">for fiscal year 2018, is 60 percent;</text>
</clause><clause commented="no" id="H3C2C16D7DCFE47FA9C10506E8C02A6D7"><enum>(iv)</enum><text display-inline="yes-display-inline">for fiscal year 2019, is 80 percent;
and</text>
</clause><clause commented="no" id="HA3BCB4373B89485A930ADCA01D5421AC"><enum>(v)</enum><text display-inline="yes-display-inline">for any succeeding fiscal year, is 100
percent.</text>
</clause></subparagraph></paragraph><paragraph id="H66C17F83997D42FFBE1A1BC526769958"><enum>(4)</enum><header>Inflation
adjustment</header>
<subparagraph id="H752312A735C0448CA1EC9D23CF9499A7"><enum>(A)</enum><header>In
general</header><text>In the case of any calendar year beginning after such
date that the minimum income level for which section 1839(i) applies pursuant
to paragraph (1)(A)(i) is not greater than 150 percent of the poverty line,
each dollar amount in paragraph (1)(A) or (2) shall be increased by an amount
equal to—</text>
<clause id="HBD8295A592F7400FA1DFD2FA1EC9584F"><enum>(i)</enum><text>such dollar
amount, multiplied by</text>
</clause><clause id="HAA6BDF0850E44AFBAA543DA1E3681FBB"><enum>(ii)</enum><text>the percentage
(if any) by which the average of the Consumer Price Index for all urban
consumers (United States city average) for the 12-month period ending with
August of the preceding calendar year exceeds such average for the 12-month
period ending with August of the calendar year preceding the first calendar
year beginning after such date.</text>
</clause></subparagraph><subparagraph id="H20B89518CC4B419880D506D52FA8EC76"><enum>(B)</enum><header>Rounding</header><text>If
any dollar amount after being increased under subparagraph (A) is not a
multiple of $1,000, such dollar amount shall be rounded to the nearest multiple
of $1,000.</text>
</subparagraph></paragraph></subsection><subsection id="H68849EC09BA44ECC8DB8F21B2D1FA4A5"><enum>(b)</enum><header>Enhanced
subsidies to low-Income seniors</header>
<paragraph id="H3F0D3C5890AC4856BF17F2CEF47346AB"><enum>(1)</enum><header>In
general</header><text>Beginning with 2016, in lieu of any medical assistance
available for medicare cost sharing described in section 1905(p)(3), the
following shall apply:</text>
<subparagraph id="HA34FDC61C1074903A192D9561DAA91B1"><enum>(A)</enum><header>Individuals with
income below 100 percent of poverty line (qualified Medicare beneficiaries) and
full-benefit dual eligible individuals</header><text display-inline="yes-display-inline">In the case of an individual described in
section 1902(a)(10)(E)(i) or subparagraph (A)(ii) of section 1935(c)(6) (taking
into account the application of subparagraph (B) of such section), the
individual is entitled under this section to an income-related premium subsidy
equal to 100 percent of the modified monthly basic beneficiary premium under
section 1860E–31(c)(2) for the MA–PD plan with the lowest bid under the tier 3
benefit level under section 1860E–24(a)(3).</text>
</subparagraph><subparagraph id="H00118F498CD64C43A96DF6731A4043BE"><enum>(B)</enum><header>Individuals with
income between 100 percent and 120 percent of poverty line (specified
low-income beneficiaries)</header><text display-inline="yes-display-inline">In
the case of an individual described in section 1902(a)(10)(E)(iii), the
individual is entitled under this section to an income-related premium subsidy
equal to 100 percent of the modified monthly basic beneficiary premium under
section 1860E–31(c)(2) for the MA–PD plan with the lowest bid under the tier 2
benefit level under section 1860E–24(b).</text>
</subparagraph><subparagraph id="H6B9F6A7883594B1C8ABE90B37F8F2FE4"><enum>(C)</enum><header>Other
individuals with income below 135 percent of poverty line (qualifying
individuals)</header><text display-inline="yes-display-inline">In the case of
an individual described in section 1902(a)(10)(E)(iv), the individual is
entitled under this section to an income-related premium subsidy equal to 100
percent of the modified monthly basic beneficiary premium under section
1860E–31(c)(2) for the MA–PD plan with the lowest bid under the tier 1 benefit
level under section 1860E–24(b). In no case shall an individual described in
this subparagraph be subject to a late enrollment penalty, which would
otherwise be applied under section 1860E–32(c).</text>
</subparagraph></paragraph><paragraph id="H318DC444DF514C39BA6A00F4C347CD73"><enum>(2)</enum><header>Flexibility in
use of subsidies</header><text>An individual entitled to an amount of an
income-related premium subsidy under paragraph (1) may use the amount of such
subsidy toward the premium applied under Medicare fee-for-service or any MA–PD
plan offered under any tier benefit level.</text>
</paragraph><paragraph commented="no" id="H49FDF94A227C4019AC66FA276C25A5C5"><enum>(3)</enum><header>Deposit of
excess into health IRAs</header><text>In the case of such an individual who is
an account holder (as defined in section 201(2) of the
<short-title>Save and Strengthen Medicare Act of
2012</short-title>) and for whom the subsidy amount under this subsection
exceeds the premium amount which is applicable to the individual, the Medicare
Choices Commission shall provide for the deposit of such excess amount into the
health individual retirement account (as defined in section 201(1) of such Act)
of such account
holder.</text>
</paragraph></subsection></section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H10563B37024E453C994F2DDE1DD5E0F6"><enum>(d)</enum><header>Application of
revised income thresholds to part D</header><text display-inline="yes-display-inline">Section 1860D–13(a)(7) of the Social
Security Act (42 U.S.C. 1395w–113(a)(7)) is amended—</text>
<paragraph id="H229F10D1203A49A1939E7287A9C37F66"><enum>(1)</enum><text>in subparagraph
(A), by inserting <quote>(or, for a calendar year after 2015, the threshold
amount applicable under paragraph (1) of section 1860E–41(a) (including
application of paragraph (4) of such section) for the calendar year)</quote>
after <quote>for the calendar year</quote>;</text>
</paragraph><paragraph id="H6EA49C77CDC24EF195A3FC260649C572"><enum>(2)</enum><text>in subparagraph
(B)—</text>
<subparagraph id="HE9A9076BA98B4F63BDCBC416143A16D1"><enum>(A)</enum><text>in the matter
preceding clause (i), by striking <quote>The monthly</quote> and inserting
<quote>Subject to subparagraph (H), the monthly</quote>; and</text>
</subparagraph><subparagraph id="HEB0CBEF4EB864CCA964741A130CFDDE7"><enum>(B)</enum><text>in clause (i)(I),
by inserting <quote>(or, for a calendar year after 2015, the applicable
percentage that would be determined under paragraph (2) of section 1860E–41(a)
(including application of paragraph (4) of such section) for the individual for
the calendar year if the table specified in subparagraph (G) were substituted
for the table specified in the table under such paragraph (2))</quote> after
<quote>for the calendar year</quote>;</text>
</subparagraph></paragraph><paragraph id="H488DA22DB2A24D64AB8E2B16B08AC5B7"><enum>(3)</enum><text>in subparagraph
(E)(ii)—</text>
<subparagraph id="HC75762DD73914D6EB2BD457E178DD5C5"><enum>(A)</enum><text>in subclause (I),
by inserting <quote>or, for a year after 2015, the modified adjusted gross
income threshold amount applicable under paragraph (1) of section 1860E–41(a)
(including application of paragraph (4) of such section)</quote> before the
period at the end; and</text>
</subparagraph><subparagraph id="HC7FF94A465974FC1AAA6E2B4DF59F6AD"><enum>(B)</enum><text>in subclause (II),
by inserting <quote>or, for a year after 2015, the applicable percentage that
would be determined under paragraph (2) of section 1860E–41(a) (including
application of paragraph (4) of such section) if the table specified in
subparagraph (G) were substituted for the table specified in the table under
such paragraph (2))</quote> before the period at the end; and</text>
</subparagraph></paragraph><paragraph id="H27B3F8007074405898A1D51055218AB7"><enum>(4)</enum><text>by adding at the
end the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="HCF1A83A05345492B9AAF69D39CE2EC28" style="OLC">
<subparagraph id="HD6A72F4201B7456BB21225215F4074BE"><enum>(G)</enum><header>Table</header><text display-inline="yes-display-inline">For purposes of subparagraph (B)(i)(I), the
table specified in this subparagraph is as follows:</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: 1 text, 1 num, 1 text" table-type="">
<tgroup cols="4" grid-typeface="1.1" rowsep="0" thead-tbody-ldg-size="10.10.10"><colspec align="left" coldef="fig" colname="column1" colnum="0" colwidth="129.75pt" min-data-value="15" rowsep="0"></colspec><colspec align="left" coldef="fig" colname="column2" colnum="1" colwidth="132.75pt" min-data-value="15"></colspec><colspec align="center" coldef="fig" colname="column3" colnum="2" colsep="0" colwidth="108.75pt" min-data-value="10" rowsep="0"></colspec><colspec align="center" coldef="fig" colname="column4" colnum="3" colsep="0" colwidth="112.50pt" min-data-value="10" rowsep="0"></colspec>
<thead>
<row><entry align="center" colname="column1" morerows="0" namest="column1">Initial Income Level within<linebreak></linebreak> Tier for
Individual<linebreak></linebreak> (or Couple)</entry><entry align="center" colname="column2" morerows="0" namest="column2">Final Income Level
within<linebreak></linebreak> Tier for Individual<linebreak></linebreak> (or Couple)</entry><entry align="center" colname="column3" morerows="0" namest="column3">Initial<linebreak></linebreak> Premium<linebreak></linebreak>
Percentage</entry><entry align="center" colname="column4" morerows="0" namest="column4">Final<linebreak></linebreak> Premium<linebreak></linebreak> Percentage</entry>
</row>
</thead>
<tbody>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$50,000 ($100,000)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">$85,000
($150,000)</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">25 percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">35 percent</entry>
</row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$85,001 ($150,001)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">$130,000
($214,000)</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">35 percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">50 percent</entry>
</row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$130,001 ($214,001)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">$190,000
($300,000)</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">50 percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">80 percent</entry>
</row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">$190,001 ($300,001)</entry><entry align="left" colname="column2" leader-modify="force-ldr" rowsep="0">No Limit</entry><entry align="center" colname="column3" leader-modify="clr-ldr" rowsep="0">80
percent</entry><entry align="center" colname="column4" leader-modify="clr-ldr">80 percent.</entry>
</row>
</tbody>
</tgroup>
</table>
</subparagraph><subparagraph id="H2D5D6D78482544378E609430DA080EC2"><enum>(H)</enum><header>Transition for
certain seniors</header><text display-inline="yes-display-inline">In the case
of individuals and couples with an income level that is below the minimum level
for which section 1839(i) (as in effect as of the date of enactment of this
subparagraph) would otherwise apply before application of the amendments made
by section 106(b) of the <short-title>Save and Strengthen
Medicare Act of 2012</short-title>, the monthly adjustment amount to be applied
under subparagraph (B) for such an individual for a month in a fiscal year
shall be the transition percentage specified in section 1860E–41(a)(3)(B) for
such fiscal year of the monthly adjustment amount otherwise specified under
such
subparagraph.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="H300B42BC8EA34F8AABE13521D8C29502"><enum>107.</enum><header>Medicare
Choices Commission; general provisions; effective date</header><text display-inline="no-display-inline">Part E of title XVIII of the Social Security
Act, as inserted by section 101(a)(2) and as previously amended, is further
amended by adding at the end the following new subpart:</text>
<quoted-block display-inline="no-display-inline" id="H4F18EC22C9054C3DB69D5288E2F48684" style="OLC">
<subpart id="HB13051911B9B45779FC862EFA1360F6B"><enum>5</enum><header>Medicare Choices
Commission</header>
<section id="HC63143AFB74949D0A14A08F8DE938DC5"><enum>1860E–51.</enum><header>Medicare
Choices Commission</header>
<subsection id="H787EA52A4F1A4BDD92ADE50468DC7C19"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">Subject to subsection (d), there is
established as an independent agency of the United States a Medicare Commission
(in this part referred to as the <term>Medicare Choices
Commission</term>).</text>
</subsection><subsection id="H0ED9AB364A4D408183BA248487B6B60E"><enum>(b)</enum><header>Membership</header>
<paragraph id="HFE83D34123DA4CC59DF0FBBFD107DDD9"><enum>(1)</enum><header>Number and
appointment</header><text display-inline="yes-display-inline">The Medicare
Choices Commission shall be composed of 7 members appointed by the President,
by and with the advice and consent of the Senate.</text>
</paragraph><paragraph id="HF91CE559B6C14DF485D17A07C519A436"><enum>(2)</enum><header>Deadline for
initial appointment</header><text display-inline="yes-display-inline">The
initial members of the Commission shall be nominated for appointment by not
later than 6 months after the date of enactment of this title.</text>
</paragraph><paragraph id="HFFC5FBCC152F459086B578300EE6071C"><enum>(3)</enum><header>Terms</header>
<subparagraph id="HAC92CB4491244FA28DB651EAEA550CAD"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The terms of members
of the Commission shall be for 7 years, except that of the members first
appointed—</text>
<clause id="H4C61077CFDB940EFA867B4B766BF4423"><enum>(i)</enum><text>3
shall be appointed for terms of 3 years;</text>
</clause><clause id="H59AC3D68C6C049FBBAAFAF5AA5E2D26E"><enum>(ii)</enum><text>2
shall be appointed for terms of 5 years; and</text>
</clause><clause id="HBDBDB2EB77484E80A52037DA458C3DC6"><enum>(iii)</enum><text>2 shall be
appointed for terms of 7 years.</text>
</clause></subparagraph><subparagraph id="H4EF1F1432DD64298A4EF6E22D095E954"><enum>(B)</enum><header>Vacancies</header><text>Any
member appointed to fill a vacancy occurring before the expiration of the term
for which the member’s predecessor was appointed shall be appointed only for
the remainder of that term. A member may serve after the expiration of that
member’s term until a successor has taken office.</text>
</subparagraph><subparagraph id="HD5A0E8B51E3640389F98959A23D43458"><enum>(C)</enum><header>Limitation on
number of terms</header><text display-inline="yes-display-inline">Any person
appointed as a member of the Commission shall not be eligible for reappointment
to the Commission after having served 2 terms.</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="H6B3A360F31E54A0F8E1792E4EA01EBF3"><enum>(4)</enum><header>Chairperson and
other officers</header><text display-inline="yes-display-inline">The Commission
shall elect a chairperson and such officers as the Commission determines
appropriate.</text>
</paragraph></subsection><subsection display-inline="no-display-inline" id="H600C24039FF644CE970B71FB5FE31E13"><enum>(c)</enum><header>Operation of the
board</header>
<paragraph id="H050C22B7A9CA4BC2A0C27DA2DE4DFEDC"><enum>(1)</enum><header>Meetings</header><text display-inline="yes-display-inline">The Commission shall meet at the call of
its chairperson or a majority of its members.</text>
</paragraph><paragraph id="HD147115FC8E5444A941F92FF8AC62D21"><enum>(2)</enum><header>Quorum</header><text display-inline="yes-display-inline">A quorum shall consist of 4 members of the
Commission, except that the Commission may establish a lesser quorum to conduct
a hearing under section 2243(a).</text>
</paragraph></subsection><subsection id="H57268FD588A14A689B6BA8F90BC62FC8"><enum>(d)</enum><header>Assuring timely
implementation of Commission</header><text>If, by not later than one year after
the date of the enactment of this subpart, the Senate has not consented to a
quorum of initial members of the Commission under subsection (b), the duties
and powers of the Commission under this part shall be carried out by the Office
of the Actuary of the Centers for Medicare & Medicaid Services.</text>
</subsection></section><section display-inline="no-display-inline" id="H9B2922C4EFE141769E25AF4E07B802AD" section-type="subsequent-section"><enum>1860E–52.</enum><header>Duties of the
Commission</header>
<subsection id="H03DA4C534D6E4030B25230F0BE8A8BF9"><enum>(a)</enum><header>In
general</header><text>Except as otherwise provided in this title and effective
with respect to benefits furnished on or after January 1, 2015, the Medicare
Choices Commission shall—</text>
<paragraph id="H93B6F3CDABCF4290866AC7F6D1F9163F"><enum>(1)</enum><text>coordinate
determinations of beneficiary eligibility and enrollment under title XVIII with
the Administrator of Social Security;</text>
</paragraph><paragraph id="H16FE38955CCC4CB08BA794A056506AB3"><enum>(2)</enum><text>oversee and
administer the competitive bidding under subpart 3;</text>
</paragraph><paragraph id="H9D2FC978669E43C6BDE84D434020FB35"><enum>(3)</enum><text>oversee and
administer the provisions of part C;</text>
</paragraph><paragraph id="H895B39CD9CCC4B9C92C85F3EF765E835"><enum>(4)</enum><text>oversee and
administer the provisions of part D;</text>
</paragraph><paragraph id="HDF807EE367EE428E968D5AC7ADD0FB26"><enum>(5)</enum><text display-inline="yes-display-inline">distribute funds in appropriate part from
the Federal Hospital Insurance Trust Fund under section 1817 and the Federal
Supplementary Medical Insurance Trust Fund under section 1841;</text>
</paragraph><paragraph id="H94D6E132C3CF4703AD019B9DB708FBFE"><enum>(6)</enum><text>oversee and
enforce the provisions of section 1851(g) (relating to guaranteed issue and
renewal), as applied through this part, including to ensure a Medicare
Advantage organization offering an MA–PD plan does not impose under such plan
an exclusion of benefits based on a pre-existing condition;</text>
</paragraph><paragraph id="H424A9978DC324F7190177538F8F10310"><enum>(7)</enum><text>disseminate to
Medicare enrollees information with respect to benefits and limitations on
payment under Medicare fee-for-service and Medicare Advantage plans, including
a comparative analysis of Medicare plans and the quality of such plans in the
area in which the Medicare beneficiary resides;</text>
</paragraph><paragraph id="HAE1C28D6C67643CE8C6C388BE354C0A1"><enum>(8)</enum><text>establish a
Medicare enrollee education program to provide timely, readable, accurate, and
understandable information to Medicare enrollees regarding Medicare
fee-for-service and Medicare Advantage plan options;</text>
</paragraph><paragraph id="H9DE3A6827C2F4153ADBA1B5FC6A17FD9"><enum>(9)</enum><text display-inline="yes-display-inline">coordinate and maintain the Medicare.gov
Internet Web site; and</text>
</paragraph><paragraph id="H59BF3FD63BC7414F8C9A69B2DA799908"><enum>(10)</enum><text display-inline="yes-display-inline">conduct public outreach and education
efforts in accordance with section 301 of the <short-title>Save and Strengthen Medicare Act of
2012</short-title>.</text>
</paragraph></subsection><subsection id="H8BDA8EF584694B1D9908043668F52BF4"><enum>(b)</enum><header>Relation to
Medicare fee-for-Service</header><text>The Commission shall not be responsible
for the operation of Medicare fee-for-service, but shall have oversight
authority over Medicare fee-for-service in a similar manner to that provided
with respect to Medicare Advantage plans.</text>
</subsection><subsection id="HD0D794449F48467289BE67C650C22984"><enum>(c)</enum><header>Transition
provisions</header><text>The Secretary and the Commission shall cooperate to
establish an appropriate transition of responsibility for the administration of
title XVIII and other related laws, from the Secretary to the Commission as is
appropriate to carry out the purposes of this part and as is consistent with
the duties of the Commission described in subsection (a). Insofar as a
responsibility is transferred to the Commission under this subsection, any
reference to the Secretary or the Centers of Medicare & Medicaid Services
in title XVIII or other provision of law with respect to such responsibility is
deemed to be a reference to the Commission.</text>
</subsection></section><section id="H235D76D306FD4DB78B1773D75754BDD8"><enum>1860E–53.</enum><header>Powers of
Commission</header>
<subsection id="H51B003B1FCEB4EDB91744039532E8F18"><enum>(a)</enum><header>In
general</header><text>The Medicare Choices Commission may, for the purpose of
carrying out its duties, promulgate regulations, hold hearings, sit and act at
times and places, take testimony, and receive evidence as the Commission
considers appropriate.</text>
</subsection><subsection id="HA4DC864370984AF39153F26EFD9E5304"><enum>(b)</enum><header>Contract
authority</header><text>The Commission may contract with, and compensate,
government and private agencies or persons for items and services, without
regard to section 3709 of the Revised Statutes (41 U.S.C. 5).</text>
</subsection><subsection id="H2F9106C6C6B14171B6180D4DF901BFC8"><enum>(c)</enum><header>Commission
authority To permit flexibility in requirements</header><text>In promulgating
regulations under subsection (a) to carry out the requirements of part C of
title XVIII, the Commission may modify the regulations previously promulgated
by the Secretary to carry out such requirements (other than those relating to
benefits or beneficiary protections) as may be appropriate to better meet the
needs of Medicare enrollees and promote fair and open competition among
Medicare fee-for-service and Medicare Advantage plans.</text>
</subsection><subsection id="H4D72006D771F40F699ED69057117EB85"><enum>(d)</enum><header>Overseeing
solvency of Medicare fee-for-Service</header><text>The Commission shall monitor
and oversee the financial solvency of Medicare fee-for-service in a manner
similar to the manner in which State insurance commissioners monitor and
oversee the solvency of health insurance issuers in the States. The Commission
shall include in its periodic reports to Congress an analysis of the solvency
of Medicare fee-for-service.</text>
</subsection></section><section display-inline="no-display-inline" id="H8672E5325B834751A6F6F4FBBFE07A3E" section-type="subsequent-section"><enum>1860E–54.</enum><header>Commission
personnel matters</header>
<subsection id="H4F051ABFF02F458B9DD70C3D3F07ACE6"><enum>(a)</enum><header>Members</header>
<paragraph id="HDDC3D35D3AE64003868DB130D2470D7F"><enum>(1)</enum><header>Compensation</header><text>Members
of the Medicare Choices Commission shall devote their entire time to the
business of the Commission, and each member shall be compensated at a rate
equal to the per diem equivalent of the rate provided for level II of the
Executive Schedule under section 5315 of title 5, United States Code.</text>
</paragraph><paragraph id="H9D05D5C1F59D4824919350A6549D84AE"><enum>(2)</enum><header>Travel
expenses</header><text>The members of the Commission shall be allowed travel
expenses, including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of chapter 57 of title 5, United
States Code, while away from their homes or regular places of business in the
performance of service for the Commission.</text>
</paragraph><paragraph id="H90CCD0D5F9944637BB4300518467D759"><enum>(3)</enum><header>Removal</header><text>The
President may remove a member of the Commission only for neglect of duty or
malfeasance in office.</text>
</paragraph></subsection><subsection id="H49F30000893141568A480C63A598BE7E"><enum>(b)</enum><header>Staff and
support services</header>
<paragraph id="H270EB09C77264884B6551711C4C6D6C8"><enum>(1)</enum><header>Executive
director</header><text>The chairperson shall appoint an executive director of
the Commission who shall be paid at a rate specified by the Commission.</text>
</paragraph><paragraph id="H6A2626E4E6DA4DE4A8C56053CB33C509"><enum>(2)</enum><header>Staff</header><text>With
the approval of the Commission, the executive director may appoint such
personnel as the executive director considers appropriate.</text>
</paragraph><paragraph id="HA2C70FABB0B94D7E9F67939F9B811EE7"><enum>(3)</enum><header>Inapplicability
of civil service laws</header><text>The staff of the Commission shall be
appointed without regard to the provisions of title 5, United States Code,
governing appointments in the competitive service, and shall be paid without
regard to the provisions of chapter 51 and subchapter III of chapter 53 of such
title (relating to classification and General Schedule pay rates).</text>
</paragraph><paragraph id="H2DA84E6ED66C4CFB83AD733FCF7FCA8A"><enum>(4)</enum><header>Experts and
consultants</header><text>With the approval of the Commission, the executive
director may procure temporary and intermittent services under section 3109(b)
of title 5, United States Code.</text>
</paragraph></subsection><subsection id="H97126568241F43DA9E25578125961BDE"><enum>(c)</enum><header>Transfer of
personnel, assets, etc</header><text>For purposes of the Commission carrying
out its duties, the Secretary and the Commission may provide for the transfer
to the Commission of such civil service personnel employed by the Department of
Health and Human Services, and such resources and assets of the Department used
in carrying out title XVIII, as the Commission requires.</text>
</subsection></section><section display-inline="no-display-inline" id="H744ED2F6848D4597A20D388F8416AE8F" section-type="subsequent-section"><enum>1860E–55.</enum><header>Reports;
communications with Congress</header>
<subsection id="H1D8632F8E14042429ED498E50245B368"><enum>(a)</enum><header>Report on
medicare program</header><text>Not less frequently than annually, the Medicare
Choices Commission shall submit to Congress such reports describing the
Medicare program under title XVIII as the Commission determines
appropriate.</text>
</subsection><subsection id="H621F2E690EBB41DA9F76A9520145AF7C"><enum>(b)</enum><header>Maintaining
independence of commission in communications with congress</header><text>The
Commission may directly submit to Congress reports, legislative
recommendations, testimony, or comments on legislation. No officer or agency of
the United States may require the Commission to submit to any officer or agency
of the United States for approval, comments, or review, prior to the submission
to Congress of such reports, recommendations, testimony, or comments.</text>
</subsection></section><section display-inline="no-display-inline" id="H6F775A38945A4948AE79D356D0BBEEC1" section-type="subsequent-section"><enum>1860E–56.</enum><header>Funding of the
Commission</header><text display-inline="no-display-inline">There is authorized
to be appropriated to the Medicare Choices Commission (in appropriate part from
the Federal Hospital Insurance Trust Fund under section 1817 and the Federal
Supplementary Medical Insurance Trust Fund under section 1841) such sums as are
necessary for the Commission to carry out its duties for each fiscal year
beginning with fiscal year 2014.</text>
</section></subpart><subpart id="H8747EFA4C3F1454D891AF9083D997062"><enum>6</enum><header>General
provisions</header>
<section id="HAE28CE02BE794642AA24FBFF70DD1874"><enum>1860E–61.</enum><header>Applicability;
definitions</header>
<subsection display-inline="no-display-inline" id="HDA871E9E8B674508AB87D4734045A0A0"><enum>(a)</enum><header>In
general</header><text>The provisions of this Act are superseded to the extent
inconsistent with the provisions of this part.</text>
</subsection><subsection id="H7D99211E3B65446EACCF386B51B2A230"><enum>(b)</enum><header>Terminology</header><text display-inline="yes-display-inline">For purposes of this part:</text>
<paragraph id="H3885E6A4E5FE44669EFBC41042E75FE2"><enum>(1)</enum><header>Medicare
enrollee</header>
<subparagraph id="H1F1827AD4BEE4876BD92D0E00C41454D"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The term
<term>Medicare enrollee</term> means—</text>
<clause id="H6CF080250AD94CE3B51074B3A36DFA70"><enum>(i)</enum><text>an
individual entitled to (or enrolled for benefits) under part A and enrolled
under part B; and</text>
</clause><clause commented="no" id="HAFD950B1094E469C97611D1EFE4A2F1D"><enum>(ii)</enum><text>except as
otherwise specified, an individual described in section 1860E–11(a)(3).</text>
</clause></subparagraph><subparagraph id="H9EF03B348AEC431DA4C1FFDEE32A7359"><enum>(B)</enum><header>Treatment</header><text>Any
reference in this Act (or any other Act) in effect before the date of the
enactment of this part, to an individual entitled to benefits under part A or
enrolled under part B shall be deemed a reference to a Medicare
enrollee.</text>
</subparagraph></paragraph><paragraph id="HCB7A873164E040B8AEC9385AB2F6CB5A"><enum>(2)</enum><header>Medicare
fee-for-service</header><text display-inline="yes-display-inline">The term
<term>Medicare fee-for-service</term> means the original Medicare
fee-for-service program under parts A and B, as modified by this part, and does
not include part C or part D.</text>
</paragraph><paragraph id="HE34EC07B8FF54E5D92AB33A1620145F3"><enum>(3)</enum><header>Medicare
fee-for-service enrollee</header><text display-inline="yes-display-inline">The
term <term>Medicare fee-for-service enrollee</term> means a Medicare enrollee
who is not enrolled under a Medicare Advantage plan under part C.</text>
</paragraph></subsection></section><section id="H4641DDDBE6C44DA9A99BF501A39D723A"><enum>1860E–62.</enum><header>General
effective date</header><text display-inline="no-display-inline">Except as
otherwise specified, the provisions of this part shall apply to items and
services furnished on or after January 1, 2016, and to plan years beginning on
or after such date (referred to in this title as the <quote>general effective
date</quote>).</text>
</section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>II</enum><header>Health Individual
Retirement Accounts</header>
<subtitle id="H3B98AF8740FC4D59AEF4418A704437DD"><enum>A</enum><header>Establishment of
Accounts</header>
<section id="H183222E787A44FA5A8ADE1A4E25FF8EB"><enum>201.</enum><header>Definitions</header><text display-inline="no-display-inline">For purposes of this subtitle—</text>
<paragraph id="HED0D91C6572B43DB965082573CCC87E4"><enum>(1)</enum><header>Health
individual retirement account</header><text display-inline="yes-display-inline">The term <term>health individual retirement
account</term> means an account established under section 203.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H3D295C4036E74F7E8BE5669B57BF97FC"><enum>(2)</enum><header>Account
holder</header><text>The term <term>account holder</term> means any individual
for whom an account is established under section 203.</text>
</paragraph><paragraph id="H0F5B3D69D54040C8AE47B722CBB29607"><enum>(3)</enum><header>HIRA
Fund</header><text>The term <term>HIRA Fund</term> means the Health Individual
Retirement Account Fund established under section 202.</text>
</paragraph></section><section id="H5BA9367429504B958EB6A4C03815001F"><enum>202.</enum><header>Health
Individual Retirement Account Fund</header>
<subsection id="H4C5B5B142E994333AB8D1EF9F03440CE"><enum>(a)</enum><header>Establishment of
Fund</header>
<paragraph id="H5F44446980404BAC97F3430FEE79DDED"><enum>(1)</enum><header>Establishment</header><text display-inline="yes-display-inline">There is established in the Treasury of the
United States a trust fund to be known as the Health Individual Retirement
Account Fund.</text>
</paragraph><paragraph id="H7C56D5809C464387834FB9BDDF739855"><enum>(2)</enum><header>Amounts in
Fund</header><text display-inline="yes-display-inline">The HIRA Fund shall
consist of all amounts contributed to the HIRA Fund under section 204,
increased by the total net earnings from investments of sums in the HIRA Fund
attributable to such contributed amounts, and reduced by the total net losses
from investments of such sums.</text>
</paragraph><paragraph id="HCA872B7DFF3F4636BD4E14B7A9CA9ADC"><enum>(3)</enum><header>Trustees</header><text>The
Commissioner of Social Security shall serve as trustee of the HIRA Fund.</text>
</paragraph><paragraph id="H27123351FCDA44C5A53D9ACE2A1E2B7A"><enum>(4)</enum><header>Budget
authority; appropriation</header><text display-inline="yes-display-inline">This
subtitle constitutes budget authority in advance of appropriations Acts and
represents the obligation of the Commissioner to provide for the payment of
amounts provided under this subtitle. The amounts held in the HIRA Fund are
appropriated and shall remain available without fiscal year limitation.</text>
</paragraph></subsection><subsection id="H9C2A0D4999DE420B957485923861C905"><enum>(b)</enum><header>Availability</header><text display-inline="yes-display-inline">The sums in the HIRA Fund are appropriated
and shall remain available without fiscal year limitation—</text>
<paragraph id="H8EF330E14E8B4D3684EFCCFEB17B9553"><enum>(1)</enum><text display-inline="yes-display-inline">to invest funds in the HIRA Fund under
section 205;</text>
</paragraph><paragraph id="HD6B559A427994A1296BD49A630CD4FFC"><enum>(2)</enum><text display-inline="yes-display-inline">to make distributions in accordance with
section 206; and</text>
</paragraph><paragraph commented="no" id="H999530E6558748CD989A490A15D1A1CD"><enum>(3)</enum><text display-inline="yes-display-inline">to pay the administrative expenses of the
Board in accordance with subsection (d).</text>
</paragraph></subsection><subsection id="H07BD46C580C64B7C8C4F49ABD4BF8527"><enum>(c)</enum><header>Limitations on
use of funds</header>
<paragraph commented="no" id="H9CE91D9AF6DA4DE0BA03D2A98452EEDF"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Sums in the HIRA Fund
credited to a account holder’s health individual retirement account under
section 205(a)(1)(2) may not be used for, or diverted to, purposes other than
for the exclusive benefit of the account holder or the account holder’s
beneficiaries under this subtitle.</text>
</paragraph><paragraph id="H534A30FDE96E437DA2FF908C151C8B23"><enum>(2)</enum><header>Assignments</header><text display-inline="yes-display-inline">Sums in the HIRA Fund may not be assigned
or alienated and are not subject to execution, levy, attachment, garnishment,
or other legal process.</text>
</paragraph></subsection><subsection commented="no" id="HEC0213252F47442688CC1602531676F5"><enum>(d)</enum><header>Payment of
administrative expenses</header><text display-inline="yes-display-inline">Administrative expenses incurred to carry
out this subtitle shall be paid out of net earnings in the HIRA Fund in
conjunction with the allocation of investment earnings and losses under section
203(d).</text>
</subsection><subsection id="HB0D5654AAA1C49F1A078CA23AB62EF1C"><enum>(e)</enum><header>Limitation</header><text display-inline="yes-display-inline">The sums in the HIRA Fund shall not be
appropriated for any purpose other than the purposes specified in this part and
may not be used for any other purpose.</text>
</subsection></section><section id="HFD0E380099D444ACBFD8BAEBD45C1331"><enum>203.</enum><header>Establishment
of health individual retirement accounts</header>
<subsection id="HAD6CFDED5050487892889ED7183F8ED0"><enum>(a)</enum><header>Establishment of
publicly administered system of health individual retirement
accounts</header><text display-inline="yes-display-inline">The Commissioner
shall establish a health individual account for each individual who—</text>
<paragraph id="H813BB63F89374968BACEF5D4C7CB8E32"><enum>(1)</enum><text display-inline="yes-display-inline">receives wages in any calendar year after
December 31, 2015, subject to the contribution requirement of section 3101(a)
of the Internal Revenue Code of 1986;</text>
</paragraph><paragraph id="H4EE61DC2D581421DA42A7002A5959661"><enum>(2)</enum><text>derives
self-employment income for a taxable year beginning after December 31, 2015,
subject to the contribution requirement of section 1401(a) of such Code;
or</text>
</paragraph><paragraph id="H9C70DB9A3B6049AEB7B8B4B328CDCA2A"><enum>(3)</enum><text>is a Medicare
enrollee (as defined in section 1860E–61(b) of the Social Security Act).</text>
</paragraph></subsection><subsection id="H8F815228D3514754A2B36E57B6BF44D4"><enum>(b)</enum><header>Management of
accounts</header><text>Such account shall be the means by which amounts
contributed to, and held in, the HIRA Fund under section 204 are credited to
the account holder, under procedures which shall be established by the
Commissioner by regulation. Each account shall be identified to the account
holder by means of the account holder’s social security account number. The
Commissioner shall take such steps as are necessary to protect account holders’
social security numbers, including not using complete social security numbers
on any statements or identification or payment cards.</text>
</subsection><subsection id="H75693078763942C88A7910BBF882B61B"><enum>(c)</enum><header>Account
balance</header><text display-inline="yes-display-inline">The balance in an
account holder’s account at any time is the excess of—</text>
<paragraph display-inline="no-display-inline" id="H34C1D662629149A2AA03A328855A6C6F"><enum>(1)</enum><text display-inline="yes-display-inline">all deposits in the HIRA Fund credited to
such account holder’s health individual retirement account, subject to such
increases and reductions as may result from allocations made to and reductions
made in the account pursuant to subsection (d); over</text>
</paragraph><paragraph id="HD67FC1A2654D44E6A95B6FA755653DC9"><enum>(2)</enum><text display-inline="yes-display-inline">amounts paid out of the HIRA Fund in
connection with amounts credited to such account holder’s account.</text>
</paragraph></subsection><subsection id="HDE167F580FD34DF1B28CE6E4C111D3DB"><enum>(d)</enum><header>Allocation of
earnings and losses</header><text display-inline="yes-display-inline">Pursuant
to regulations which shall be prescribed by the Commissioner, the Commissioner
shall allocate to each health individual retirement account an amount equal to
the net earnings and net losses from each investment of sums in the HIRA Fund
which are attributable to sums credited to such account reduced by an
appropriate share of the administrative expenses paid out of the net earnings,
as determined by the Commissioner.</text>
</subsection></section><section commented="no" id="H07AAB907DC814E069DD21F7F947EF3D8"><enum>204.</enum><header>Transfer of
HIRA contributions to HIRA Fund</header>
<subsection commented="no" id="HC3050D88EF644770BA3908B907D03848"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">There is hereby
appropriated to the HIRA Fund, out of moneys in the Treasury not otherwise
appropriated, amounts equivalent to 100 percent of amounts contributed under
sections 3101(d) and 1401(d) of the Internal Revenue Code of 1986. The
Secretary of the Treasury shall from time to time transfer such amounts from
the general fund in the Treasury to the HIRA Fund.</text>
</subsection><subsection id="HC607505EC49D4001905A1681B238174E"><enum>(b)</enum><header>Contributions
from HHS</header><text>The Commissioner shall accept any contributions with
respect to an account holder’s account, including contributions from the
Secretary of Health and Human Services under sections 1860E–25 and
1860E–41(b)(3) of the Social Security Act and any contribution from a State
under section 1944(b) of such Act.</text>
</subsection><subsection commented="no" id="HFEA33E1CC21B4D4FA13B0A4D1FA5F577"><enum>(c)</enum><header>Coordination
with Social Security Trust Funds</header><text>The amounts contributed under
sections 3101(d) and 1401(d) of such Code shall not be taken into account in
determining the amounts appropriated and transferred under section 201 of the
Social Security Act.</text>
</subsection></section><section id="H0ACAB6CF248B45C0A00FD3F921753BCD"><enum>205.</enum><header>Operation of
HIRA Fund</header>
<subsection id="H60444838AD62474AA65500928F170C59"><enum>(a)</enum><header>Separate
crediting to health individual retirement accounts</header>
<paragraph id="H539ABB422C124078A461A4120BA5B0B4"><enum>(1)</enum><header>In
general</header><text>Subject to this subsection, the Commissioner shall
provide for prompt, separate crediting of the amounts deposited in the HIRA
Fund to each account holder’s health individual savings account to the extent
such amount consists of contributions made to the HIRA Fund under section 204
with respect to such account holder, together with any increases or decreases
therein so as to reflect the net returns and losses from investment thereof
while held in the Fund.</text>
</paragraph><paragraph id="H5E601FDB6DC44640886C579B786769D6"><enum>(2)</enum><header>Use of
funds</header><text>The amounts held in the Fund are appropriated and shall
remain available without fiscal year limitation—</text>
<subparagraph id="HC8D02E08358C49F6AC18DBA9F8130F37"><enum>(A)</enum><text>to be held for
investment under subsection (b), and</text>
</subparagraph><subparagraph id="H46D1BF6526DD41448C6850534810C150"><enum>(B)</enum><text>to pay the
administrative expenses related to the HIRA Fund.</text>
</subparagraph></paragraph></subsection><subsection display-inline="no-display-inline" id="HC693723E5E1641CE8C964F0DB5A711FF"><enum>(b)</enum><header>Investment
guidelines</header>
<paragraph id="H16881CA409974C1BACDF132400FD3AF4"><enum>(1)</enum><header>In
general</header><text>For purposes of investment of amounts credited to each
health individual retirement account, the Commissioner shall provide by
regulation for investment options similar to investment options available under
the Thrift Savings Fund under section 8438 of title 5, United States
Code.</text>
</paragraph><paragraph id="HD8004CE7F9784BF3A880380CAA54C9B9"><enum>(2)</enum><header>Elections among
investment options</header><text display-inline="yes-display-inline">Pursuant
to any individual’s election filed in accordance with regulations of the
Commissioner, the Commissioner shall, in accordance with such regulations,
provide for disinvestment and reinvestment of amounts credited to the account
holder’s health individual retirement account and held in the HIRA Fund under
any of the investment options described in paragraph (1).</text>
</paragraph><paragraph id="HBBC3F8B679C348B3BAA6B56D270339C6"><enum>(3)</enum><header>Special rule for
investing certain amounts contributed from HHS</header><text>Amounts
contributed to any account by the Secretary of Health and Human Services under
section 1860E–25 of the Social Security Act may be invested only in the
investment option established under paragraph (1) that is the equivalent to the
Government Securities Investment Fund (as defined under section 8438(a)(4) of
title 5, United States Code).</text>
</paragraph></subsection><subsection id="HDBD07A6E3B114C97ADE99DBA6784ED98"><enum>(c)</enum><header>Annual
description of investment options and disclosure of administrative
costs</header><text>The Commissioner shall provide annually to each account
holder—</text>
<paragraph id="H0899B1A001D245ECA812BA73C409C715"><enum>(1)</enum><text>a
description of the investment options available with respect to amounts held in
the HIRA Fund and the procedures for selecting such options; and</text>
</paragraph><paragraph id="H2F60AAD3370F4C2D999643284CE89D1E"><enum>(2)</enum><text>a
disclosure of the rate of administrative costs chargeable with respect to each
investment option.</text>
</paragraph><continuation-text continuation-text-level="subsection">Descriptions and disclosures
required under this subsection shall be written in a manner calculated to be
understood by the average account holder.</continuation-text></subsection><subsection id="HBD10806A9C304C1F850BA7888993F483"><enum>(d)</enum><header>Account
information</header><text>The Commissioner shall create an online portal that
enables account holders to view their account information, modify investment
allocations, and request quarterly paper account statements.</text>
</subsection><subsection id="HA134342968FB4D0685EE0633DDACC264"><enum>(e)</enum><header>Treatment of
amounts held in HIRA Fund</header><text>Subject to this subtitle and to the
extent provided in section 1860E–25(c)(2) of the Social Security Act with
respect to amounts contributed under such section, amounts deposited into, and
held and accounted for in, the HIRA Fund with respect to any account holder
shall be treated as property of such account holder, held in trust for such
account holder in the Fund.</text>
</subsection></section><section id="HF2C214F69C6B4720A140B25A3B38A46E"><enum>206.</enum><header>Health
individual retirement account distributions</header>
<subsection id="H92FF89722ECC4ECE97C7828682535F38"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Commissioner may
distribute amounts from an account holder’s health individual retirement
account only—</text>
<paragraph id="HBD7C97DBC2834A168618E7BF48E1E7F3"><enum>(1)</enum><text>for qualified
medical expenses (as defined in section 530A(d)(1) of the Internal Revenue Code
of 1986);</text>
</paragraph><paragraph id="H2D25D846AE9547129781908C1DD86C8E"><enum>(2)</enum><text display-inline="yes-display-inline">to an individual’s spouse or former spouse
under a divorce or separation instrument described in subparagraph (A) of
section 71(b)(2) of such Code;</text>
</paragraph><paragraph id="HD9BD125C4A344032AB4AAF359A47C6BA"><enum>(3)</enum><text>by a transfer at
the death of the account holder as provided under subsection (b); or</text>
</paragraph><paragraph id="H44F836B668AD4A5CBC4568BFB402128F"><enum>(4)</enum><text>as provided in
section 1860E–25(c)(2) of the Social Security Act.</text>
</paragraph></subsection><subsection id="HA02D332B7FEC41B6B41C5CA574A7E95B"><enum>(b)</enum><header>Special
accounting rule for certain amounts</header><text>Each calendar year, any
distributions from an account shall be treated as—</text>
<paragraph id="H294E28666FAE49339D192BB7795788DD"><enum>(1)</enum><text>first from any
amounts contributed to the account for such calendar year by the Secretary of
Health and Human Services under section 1860E–25 of the Social Security Act,
and</text>
</paragraph><paragraph id="H58EB44E0F7444560839A6271C44836A2"><enum>(2)</enum><text>then from all
other amounts credited to the account.</text>
</paragraph></subsection><subsection id="H13EC8A7628584B20946C82EDD67A2236"><enum>(c)</enum><header>Treatment at
death</header><text display-inline="yes-display-inline">If the account holder
dies before all amounts which are held in the HIRA Fund which are credited to
the health individual retirement account of the individual are otherwise
distributed in accordance with this section, such amounts shall be distributed,
under regulations which shall be prescribed by the Commissioner—</text>
<paragraph id="H874945D2DB19456889A6281B7EB700A2"><enum>(1)</enum><text display-inline="yes-display-inline">in any case in which one or more
beneficiaries have been designated in advance, to such beneficiaries in
accordance with such designation as provided in such regulations; and</text>
</paragraph><paragraph id="H1F87A90AA4EA4A55A079B51CFFD690C2"><enum>(2)</enum><text>in the case of any
amount not distributed as described in paragraph (1), to such individual’s
estate.</text>
</paragraph></subsection></section></subtitle><subtitle id="H1579C79EF4914C34BD345135CA30581C"><enum>B</enum><header>Tax
Treatment</header>
<section display-inline="no-display-inline" id="H6100444F6DED44D890749841003AA86B"><enum>211.</enum><header>Tax treatment
of accounts</header>
<subsection id="H1D5435E5A23F41CB9292089D817D1591"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subchapter F of
chapter 1 of the Internal Revenue Code of 1986 (relating to exempt
organizations) is amended by adding at the end the following new part:</text>
<quoted-block id="H6C6674EDCF5F4628B09F2EB42E9EB13E">
<part id="H22C1A928942A4A92BBDD700960BEAC61"><enum>IX</enum><header>Health Individual
Retirement Account Program</header>
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 530A. Health Individual Retirement
Account Program.</toc-entry>
</toc>
<section id="H47FA7293B3D6492E9874CF9BBD13726A"><enum>530A.</enum><header>Health
Individual Retirement Account Program</header>
<subsection id="H826C7CFD543D43A188B7C79AA03D8585"><enum>(a)</enum><header>Tax treatment of
accounts</header><text display-inline="yes-display-inline">The Health
Individual Retirement Account Fund is exempt from taxation under this
subtitle.</text>
</subsection><subsection display-inline="no-display-inline" id="H40230D0CF992439199567421AD4839D4"><enum>(b)</enum><header>Treatment of
distributions</header>
<paragraph id="HA3F9938F2C4A461E96A6EFF3375A48DA"><enum>(1)</enum><header>Exclusion of
amounts used for qualified medical expenses</header><text>Any amount paid or
distributed out of a health individual retirement account which is used
exclusively to pay qualified medical expenses of the account beneficiary shall
not be includible in gross income.</text>
</paragraph><paragraph id="H0FF5370AE31C430B92A501077A7F1754"><enum>(2)</enum><header>Inclusion of
amounts not used for qualified medical expenses</header><text>Any amount paid
or distributed out of a health individual retirement account which is used
other than as described in paragraph (1) shall be included in the gross income
of the account beneficiary.</text>
</paragraph><paragraph id="H30FDB04CD32B483A8C9FD6433784001B"><enum>(3)</enum><header>Additional tax
on distributions not used for qualified medical expenses</header><text display-inline="yes-display-inline">The tax imposed by this chapter on the
account beneficiary for any taxable year in which there is a payment or
distribution from a health savings account of such beneficiary which is
includible in gross income under paragraph (2) shall be increased by 10 percent
of the amount which is so includible.</text>
</paragraph><paragraph id="H00C9C8AD1CAB4CFA8B42D9F25DEFF0B6"><enum>(4)</enum><header>Coordination
with medical expense deduction</header><text>For purposes of determining the
amount of the deduction under section 213, any payment or distribution out of a
health individual retirement account for qualified medical expenses shall not
be treated as an expense paid for medical care.</text>
</paragraph><paragraph id="H23A7F8F7AD45409CA86B0C48A1609CEB"><enum>(5)</enum><header>Transfer of
account incident to divorce</header><text display-inline="yes-display-inline">The transfer of an individual’s interest in
a health individual retirement account to an individual’s spouse or former
spouse under a divorce or separation instrument described in subparagraph (A)
of section 71(b)(2) shall not be considered a taxable transfer made by such
individual notwithstanding any other provision of this subtitle, and such
interest shall, after such transfer, be treated as a health individual
retirement account with respect to which such spouse is the account
beneficiary.</text>
</paragraph><paragraph id="H8D3B21E46AC84C0B99DFBC64AC0BD75E"><enum>(6)</enum><header>Treatment after
death of account beneficiary</header>
<subparagraph id="H0DE93862D3A8467DBE46828DF56C4E4E"><enum>(A)</enum><header>In
general</header><text>The transfer of an account beneficiary’s interest in a
health individual retirement account to another individual by reason of being
the designated beneficiary of such account at the death of the account
beneficiary shall not be considered a taxable transfer made by such individual
notwithstanding any other provision of this title.</text>
</subparagraph><subparagraph commented="no" id="H8A8B08E43AD749DC8C5804DA6327E508"><enum>(B)</enum><header>Other
cases</header><text>In the case of any other transfer or acquisition of account
beneficiary’s interest at the death of the account beneficiary, an amount equal
to the fair market value of the assets in such account as of the date of death
shall be includible in such beneficiary’s gross income for the last taxable
year of such beneficiary.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HF71CBCDFB32546CB98F4B77F0CBFCCF5"><enum>(c)</enum><header>Estate tax
treatment</header><text display-inline="yes-display-inline">No amount shall be
includible in the gross estate of any individual for purposes of chapter 11 by
reason of an interest in a health individual retirement account of the
individual.</text>
</subsection><subsection id="HDCE0D3355D4F40AA9A5AAD6AFC22457D"><enum>(d)</enum><header>Definitions</header><text>For
purposes of this section—</text>
<paragraph id="H55DAA361F1FC4787A773901880BFEA00"><enum>(1)</enum><header>Qualified
medical expenses</header><text display-inline="yes-display-inline">The term
<term>qualified medical expenses</term> means, with respect to an account
beneficiary, amounts paid for medical care (as defined in section 213(d)) for
such individual, the individual’s spouse, and any dependent (as defined in
section 152, determined without regard to subsections (b)(1), (b)(2), and
(d)(1)(B) thereof) of the individual, but only to the extent such amounts are
not compensated for by insurance or otherwise and only if the individual,
spouse, or dependent with respect to whom the amount is paid is entitled, at
the time the amount is paid, to a monthly benefit under title II of the Social
Security Act or a tier 1 railroad retirement benefit.</text>
</paragraph><paragraph id="HA8DBAE6B8B3948B2BD6275F7B37B056F"><enum>(2)</enum><header>Abortion and
euthanasia excluded</header>
<subparagraph id="HE46C71E2E0C24F51AB22B6F876FA84AA"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Such term shall not
include any amount paid for an abortion or for the purposeful causing of, or
the purposeful assisting in causing, the death of any individual, such as by
assisted suicide, euthanasia, or mercy killing.</text>
</subparagraph><subparagraph id="HBB8C95D53D44423E960615F0773A8C6C"><enum>(B)</enum><header>Exceptions</header><text>Subparagraph
(A) shall not apply to—</text>
<clause id="H937CAB40027A4AC5A3561DD581F44B8B"><enum>(i)</enum><text>an
abortion—</text>
<subclause id="HD51EDE1CF4884DDFA91D80EC9D84C9FD"><enum>(I)</enum><text>in the case of a
pregnancy that is the result of an act of rape or incest, or</text>
</subclause><subclause id="H627F800DBAAD4C66A276F4AD3845D612"><enum>(II)</enum><text>in the case where
a woman suffers from a physical disorder, physical injury, or physical illness
that would, as certified by a physician, place the woman in danger of death
unless an abortion is performed, including a life-endangering physical
condition caused by or arising from the pregnancy, and</text>
</subclause></clause><clause id="H14FF3E04CB0340BBAAF81C44E8A8B75D"><enum>(ii)</enum><text>the treatment of
any infection, injury, disease, or disorder that has been caused by or
exacerbated by the performance of an abortion.</text>
</clause></subparagraph></paragraph><paragraph id="H95D3316B84294A62AAEF272981AB6486"><enum>(3)</enum><header>Account
beneficiary</header><text>The term <term>account beneficiary</term> means the
account holder (as defined in section 201 of the Save and Strengthen Medicare
Act of 2012) on whose behalf the health individual retirement account is
held.</text>
</paragraph><paragraph display-inline="no-display-inline" id="HCF1C6657CF174911B3CAA2C3A8FC26D2"><enum>(4)</enum><header>Health
individual retirement account</header><text>The term <term>health individual
retirement account</term> means an account established under section 203(b) of
the Save and Strengthen Medicare Act of 2012.</text>
</paragraph><paragraph id="HAA627B62E0B64F02A4D2BD87ECB3E1D5"><enum>(5)</enum><header>Health
Individual Retirement Account Fund</header><text display-inline="yes-display-inline">The term <term>Health Individual Retirement
Account Fund</term> means the Fund established under section 202 of the Save
and Strengthen Medicare Act of
2012.</text>
</paragraph></subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HBB6D4EC18F5A46E2824582D21F905C2E"><enum>(b)</enum><header>Clerical
amendment</header><text>The table of parts for subchapter F of chapter 1 of
such Code is amended by adding at the end the following new item:</text>
<quoted-block display-inline="no-display-inline" id="H001F1F258920461EA601A383E76B6D82" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="part">Part IX. Health Individual Retirement Account
Program</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H22157AE6344A4585AD28DF05CE4A6A00"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2015.</text>
</subsection></section><section id="HE75F3368972340B6B40CF67D460F6E37"><enum>212.</enum><header>HIRA
contributions</header>
<subsection id="HAB4C6F49511648BFB0C4A71204228450"><enum>(a)</enum><header>Employment</header>
<paragraph id="H1A43DF7FD00F4285AA9E3D45BCE14831"><enum>(1)</enum><header>In
general</header><text>Section 3101 of the Internal Revenue Code of 1986 is
amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H997225E33AEC4E1589989666C1058C9C" style="OLC">
<subsection id="H54DB16703E444636966AAC525174E3E4"><enum>(d)</enum><header>Health
Individual Retirement Accounts</header>
<paragraph id="H697F2083121949E181582B30D5A9D5BE"><enum>(1)</enum><header>In
general</header><text>In addition to the taxes imposed by subsections (a) and
(b), there shall be deducted and withheld from the income of every individual
an amount equal to the applicable percentage of wages (as defined in section
3121(a)) received by him with respect to employment during any taxable
year.</text>
</paragraph><paragraph id="HC6F2A413364845D4B59EC837B184CA47"><enum>(2)</enum><header>Limitation</header><text>The
amount deducted and withheld under paragraph (1) shall not exceed $2,500
($5,000 in the case of a married couple filing jointly) for any taxable
year.</text>
</paragraph><paragraph id="H8EA0AA0356B744FA8A8F5E7776D6CCDC"><enum>(3)</enum><header>Applicable
percentage</header><text display-inline="yes-display-inline">For purposes of
this subsection, the applicable percentage shall be 2 percent, or such other
percentage (including zero) as the individual elects in such form and manner as
the Secretary shall prescribe.</text>
</paragraph><paragraph id="H5A96D0AA28224D6E85132147919E29D3"><enum>(4)</enum><header>Inflation
adjustment</header>
<subparagraph id="H2F668506A8D3449E995F6041E275DBBD"><enum>(A)</enum><header>In
general</header><text>In the case of any taxable year beginning after 2016, the
dollar amounts under the third sentence of subsection (a) shall be increased by
an amount equal to—</text>
<clause id="H7DB96DEC152B4D27AF726E4223F71D96"><enum>(i)</enum><text>such dollar
amount, multiplied by</text>
</clause><clause id="HE1CAE4732D0E476B88806D31DBEE13D3"><enum>(ii)</enum><text>the
cost-of-living adjustment determined under section 1(f)(3) for the calendar
year in which the taxable year begins, determined by substituting
<quote>2015</quote> for <quote>1992</quote> in subparagraph (B) thereof.</text>
</clause></subparagraph><subparagraph id="H5E9DC58A67F2449682FA3EF2948DE1F5"><enum>(B)</enum><header>Rounding</header><text>If
any amount as adjusted under subparagraph (A) is not a multiple of $100, such
amount shall be rounded to the nearest multiple of
$100.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H427661754E2F48FF86E7889754699A7A"><enum>(2)</enum><header>Contributions
pre-tax</header><text>Subsection (a) of section 3401 of such Code is amended by
adding at the end the following new sentence: <quote>Such term shall not
include so much of any amounts deducted and withheld from such remuneration
under section 3101(d) for any taxable year as does not exceed $2,500 ($5,000 in
the case of a married couple filing jointly).</quote>.</text>
</paragraph></subsection><subsection id="HE73EE99FEC2342F094EB57428D9DAFEC"><enum>(b)</enum><header>Self-Employment</header>
<paragraph id="H9A134925391146E0BB2BCC23212CA68E"><enum>(1)</enum><header>In
general</header><text>Section 1401 of such Code is amended by adding at the end
the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HD1F25C62A06048418DAFAD7C3504617E" style="OLC">
<subsection id="HD03B94AC13D2482CBD82088D82B81113"><enum>(d)</enum><header>Health
Individual Retirement Accounts</header>
<paragraph id="H405541EC3DEE4DA586165B9E535401B1"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">In addition to the
taxes imposed by the preceding subsections, in the case of an individual with
self-employment income for the taxable year, such individual shall contribute
for such taxable year an amount equal to the applicable percentage of such self
employment income.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H01CEA501FC3F450B85BF71B4E2E2F7A9"><enum>(2)</enum><header>Applicable
percentage</header><text display-inline="yes-display-inline">For purposes of
this subsection, the applicable percentage shall be 2 percent, or such other
percentage (including zero) as the individual elects, in such form and manner
as the Secretary shall prescribe.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H0AA40D89AC154B5AB53DAC8A8315994B"><enum>(3)</enum><header>Inflation
adjustment</header>
<subparagraph id="H1BE1430E264F43ACB1E0743C6E1E81AB"><enum>(A)</enum><header>In
general</header><text>In the case of any taxable year beginning after 2016, the
dollar amounts under subsection (a)(18) shall be increased by an amount equal
to—</text>
<clause id="HD464806FC0C94DBA9B68CEE2DA5E729A"><enum>(i)</enum><text>such dollar
amount, multiplied by</text>
</clause><clause id="HEEABEEF0D8944381813EED05594C0110"><enum>(ii)</enum><text>the
cost-of-living adjustment determined under section 1(f)(3) for the calendar
year in which the taxable year begins, determined by substituting
<quote>2015</quote> for <quote>1992</quote> in subparagraph (B) thereof.</text>
</clause></subparagraph><subparagraph id="H3CD4079605BD48738E103E1792D60490"><enum>(B)</enum><header>Rounding</header><text>If
any amount as adjusted under subparagraph (A) is not a multiple of $100, such
amount shall be rounded to the nearest multiple of
$100.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H0A0AA34CDF5345A0971D91354529ED75"><enum>(2)</enum><header>Deduction for
self-employment amounts contributed to HIRA</header><text>Subsection (a) of
section 1401 of such Code is amended by striking <quote>and</quote> at the end
of paragraph (16), but striking the period at the end of paragraph (17) and
inserting <quote>; and</quote>, and by inserting after paragraph (17) the
following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HD56D796D94B0427E869D5320F35C4F94" style="OLC">
<paragraph id="HD9C56CB8D52648D9AD7B4CDA435A6969"><enum>(18)</enum><text display-inline="yes-display-inline">there shall be excluded so much of any
amounts contributed by the individual for such taxable year under 1401(d) as
does not exceed $2,500 ($5,000 in the case of a married couple filing jointly)
reduced (but not below zero) by the amount of contributions for the taxable
year with respect to the individual under section
3101.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H721E88B2F1AD4C47967AD7E068FD6610"><enum>(c)</enum><header>Procedure for
reconciliation</header><text>The Secretary of the Treasury shall, in
consultation with the Commission of Social Security, prescribe such regulations
and guidance as are necessary to—</text>
<paragraph id="HFA202BD0136E4099A810DF9E30541CA6"><enum>(1)</enum><text>allow the taxpayer
to make additional contributions in any case in which contributions for the
taxable year are less than the applicable limitations for the taxable year
under sections 3101(d) and 1401(d) with respect to the taxpayer, and</text>
</paragraph><paragraph id="H5C439A3E5EE041EEAA8F4E4E13FEA4A0"><enum>(2)</enum><text>provide for adding
to gross income of the taxpayer for the taxable year amounts equal to any
contributions in excess of such applicable limitations.</text>
</paragraph></subsection><subsection id="H629E358B8BC34090AF7346365E7B60DB"><enum>(d)</enum><header>Election
coordination</header><text display-inline="yes-display-inline">The Secretary of
the Treasury and the Commissioner of Social Security shall consult and
cooperate in prescribing the time, form, and manner of elections under sections
3101(d) and 1401(d) of the Internal Revenue Code of 1986 and section 203(a)
this Act so as to reduce unnecessary paperwork and duplication.</text>
</subsection></section><section id="H3F9FE879FCFC4973B15FDCF5C17C4766"><enum>213.</enum><header>Contributions
eligible for saver’s credit</header>
<subsection id="H6EBF2BC1E12E4C3BAF49D38356B12119"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Paragraph (1) of
section 25B(d) of the Internal Revenue Code of 1986 is amended by striking
<quote>and</quote> at the end of subparagraph (B), by striking the period at
the end of subparagraph (C) and inserting <quote>, and</quote>, and by adding
at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H2612F41010AC4653B6AB133519DB803D" style="OLC">
<subparagraph id="H0A3D7B64F4F64652853B4E86399E61D6"><enum>(D)</enum><text display-inline="yes-display-inline">the amount of contributions with respect to
the individual pursuant to sections 3101(d) and 1401(d) (reduced or increased,
as the case may be, to account for any reconciliation under section 212(d) of
the Save and Strengthen Medicare Act of
2012).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HC62AAC61A63D47148B3C881BEF5C29EE"><enum>(b)</enum><header>Portion of
credit made refundable</header><text>Section 25B of such Code is amended by
adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HD321A08D80CC4B1B9ADA6F24BD281E91" style="OLC">
<subsection id="H21F7F2EF83664528BB5EFD23E16BF372"><enum>(h)</enum><header>Portion of
credit refundable</header>
<paragraph id="H7161CB920ABA4605A26CDDF744FD4493"><enum>(1)</enum><header>In
general</header><text>The aggregate credits allowed to a taxpayer under subpart
C shall be increased by the lesser of—</text>
<subparagraph id="H6E23E3DD525C46849C269024CA72F7A1"><enum>(A)</enum><text display-inline="yes-display-inline">the credit which would be allowed under
this section without regard to this subsection and the limitation under section
26(a)(2) or subsection (g), as the case may be, or</text>
</subparagraph><subparagraph id="H2B74D591BF9F499B8DE2C4DF9AE13A31"><enum>(B)</enum><text>the amount by
which the aggregate amount of credits allowed by this subpart (determined
without regard to this subsection) would be increased if the limitation imposed
by section 26(a)(2) or subsection (g), as the case may be, were increased by an
amount equal to the taxpayer’s hospital insurance taxes for the taxable
year.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The amount
of the credit allowed under this subsection shall not be treated as a credit
allowed under this subpart and shall reduce the amount of credit otherwise
allowable under subsection (a) without regard to section 26(a)(2) or subsection
(g), as the case may be.</continuation-text></paragraph><paragraph id="H5C45E2DC9C05405ABC28C86B403661D2"><enum>(2)</enum><header>Hospital
insurance tax</header>
<subparagraph id="H790D96877F844FA5BB73E8239A4EEECC"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">The term
<term>hospital insurance taxes</term> means, with respect to any taxpayer for
any taxable year—</text>
<clause id="H13E63586485142D5ABE17B3A8F5D46BA"><enum>(i)</enum><text>the amount of the
taxes imposed by sections 3101(b) and 3201(a) (to the extent attributable to
the rate in effect under section 3101(b)) on amounts received by the taxpayer
during the calendar year in which the taxable year begins,</text>
</clause><clause id="H22B5BD99F7DF4B1B823312C840E27956"><enum>(ii)</enum><text>the amount of the
taxes imposed by sections 3111(b) and 3221(a) (to the extent attributable to
the rate in effect under section 3111(b)) on amounts paid by the employer to
the taxpayer with respect to employment during the calendar year in which the
taxable year begins,</text>
</clause><clause id="H28B523A66149448FB2DBC3B1A6317D48"><enum>(iii)</enum><text>the amount of
the taxes imposed by section 1401(b) on the self-employment income of the
taxpayer for the taxable year, and</text>
</clause><clause id="H6759057F273740EA9C75B684280C469D"><enum>(iv)</enum><text>the amount of the
taxes imposed by section 3211(a) (to the extent attributable to the rate in
effect under sections 3101(b) and 3111(b)) on amounts received by the taxpayer
during the calendar year in which the taxable year begins.</text>
</clause></subparagraph><subparagraph id="HBC5A0E4C72744A22B1ECCA1341C0EA56"><enum>(B)</enum><header>Coordination
with special refund of tax</header><text>The term <term>hospital insurance
taxes</term> shall not include any taxes to the extent the taxpayer is entitled
to a special refund of such taxes under section 6413(c).</text>
</subparagraph><subparagraph id="H93FA6A478E9C4169B144EBB80441599E"><enum>(C)</enum><header>Special
rule</header><text>Any amounts paid pursuant to an agreement under section
3121(l) (relating to agreements entered into by American employers with respect
to foreign affiliates) which are equivalent to the taxes referred to in
subparagraph (A)(i) shall be treated as taxes referred to in such
subparagraph.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HD0DD9CD42E0A40AE927D781CBBA501AC"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2015.</text>
</subsection></section><section id="HBCAD37411ABD4A5F8BE1BAADDF07689B"><enum>214.</enum><header>Exclusion of
certain HIRA transfers</header>
<subsection id="H279EB1F69A214F37B83EE32E989EE5C0"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Part II of subchapter
B of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting
before section 140 the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H7D96A8A0084842978A83FCA8EF855756" style="OLC">
<section id="HA3DF73D9D2B646B7AE07D07F69FB7F4F"><enum>139F.</enum><header>Government
HIRA subsidies</header><text display-inline="no-display-inline">Gross income
shall not include any payment to the health individual retirement account (as
defined in section 530A(d)(3)) of an individual by the Secretary of Health and
Human Services under part E of title XVIII of the Social Security
Act.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section></subtitle><subtitle id="H5DBDCDBBEB5B49A288209483E715F306"><enum>C</enum><header>Other tax
provisions</header>
<section id="HCFA1570EB3C24E849E8FDA8F87B34322"><enum>221.</enum><header>Health Savings
Accounts available to individuals eligible for Medicare</header>
<subsection id="HA75ECD2269D54AFE8064E1ADC809FECE"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subsection (b) of
section 223 of the Internal Revenue Code of 1986 is amended by striking
paragraph (7) and by redesignating paragraph (8) as paragraph (7).</text>
</subsection><subsection id="H38BEFF276AE3497DB3EE7FF7FD6CC0AE"><enum>(b)</enum><header>Elimination of
Medicare eligibility exception to nonqualified withdrawal
penalty</header><text>Paragraph (4) of section 223(f) of such Code is amended
by striking subparagraph (C).</text>
</subsection><subsection id="H25D6654E27754E06BFF6ED87843C3A0B"><enum>(c)</enum><header>Conforming
amendment</header><text display-inline="yes-display-inline">Subparagraph (S) of
section 26(b)(2) of such Code is amended by striking
<quote>223(b)(8)(B)(i)(II)</quote> and inserting
<quote>223(b)(7)(B)(i)(II)</quote>.</text>
</subsection><subsection id="HE2B95F5EF4BE4F64BBA9D377CB29B8E2"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2015.</text>
</subsection></section><section id="H8EE73ED339204B28A3C2DB7EAA3F6093"><enum>222.</enum><header>Reduction in
Medicare portion of payroll tax to incentivize late retirement</header>
<subsection id="H4ECC62A9438242A6A319ABD083711B45"><enum>(a)</enum><header>Employees</header><text display-inline="yes-display-inline">Section 3101 of the Internal Revenue Code
of 1986, as amended by this Act, is amended by adding at the end the following
new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H3574B07D4DDE4303AF517E46DD3C6DD2" style="OLC">
<subsection id="H7F12A4CA04AC4EA183726406A1E15EFF"><enum>(e)</enum><header>Exception for
individuals 65 and older</header>
<paragraph id="H35BFE363A6BE4375B37B0D30F3EA0D7E"><enum>(1)</enum><header>In
general</header><text>In the case of an individual who has attained the age of
65, the rate of tax otherwise in effect under subsection (b)—</text>
<subparagraph id="HB37B5E6A240A406DA73AD0B22D002E74"><enum>(A)</enum><text display-inline="yes-display-inline">shall be <fraction>½</fraction> such rate,
if such individual has not attained the applicable age, and</text>
</subparagraph><subparagraph id="HC78C86E3205E4FBBA69E76B3676C2F20"><enum>(B)</enum><text>shall be zero, if
such individual has attainted the applicable age.</text>
</subparagraph></paragraph><paragraph id="H326E454EB2BB487F90E8324F36D8CE20"><enum>(2)</enum><header>Applicable
age</header><text>For purposes of this subsection—</text>
<subparagraph id="H1F943035837547A0B70D45C3E71C1698"><enum>(A)</enum><header>In
general</header><text>Except as provided in subparagraph (B), the applicable
age shall be 67.</text>
</subparagraph><subparagraph id="H569E9F844DF74B6F88F8E140712E6A58"><enum>(B)</enum><header>Preferred
Medicare age</header><text>In the case of wages received after December 31,
2025, the applicable age shall be the preferred Medicare age (within the
meaning of section 216(m)(2)(B) of the Social Security
Act).</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H167D032188D54D99B9A3C48D1568A31D"><enum>(b)</enum><header>Employers</header><text>Section
3111 of such Code is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="HA1CE386ABBD747FEAACC7ED34C624B56" style="OLC">
<subsection id="H8C1E1EB32DEA4317A8DA1F53C21C2914"><enum>(d)</enum><header>Exception for
individuals 65 and older</header><text display-inline="yes-display-inline">In
the case of an individual who has attained the age of 65, the rate of tax
otherwise in effect under subsection (b)—</text>
<paragraph id="H10730079936A4A0FA6BC68A8B19F0ECA"><enum>(1)</enum><text>shall be
<fraction>½</fraction> such rate, if such individual has not attained the
applicable age (within the meaning of section 3101(e)(2)), and</text>
</paragraph><paragraph id="HD9CB4729DDC8407E93E9BC0788CA83E6"><enum>(2)</enum><text>shall be zero, if
such individual has attained such
age.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HA712BE26DE9145E784C75D2B45BCDC58"><enum>(c)</enum><header>Self-Employment</header><text>Section
1401 of such Code, as amended by this Act, is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HE03E0E3B21C34F5C887F7A0EF4638154" style="OLC">
<subsection id="H9EB8E9FD12A84C20AD0A17CD7065CB22"><enum>(e)</enum><header>Exception for
individuals 65 and older</header>
<paragraph id="HBFBCA27766994E0599A587E6CE6D4A77"><enum>(1)</enum><header>In
general</header><text>In the case of an individual who has attained the age of
65, the rate of tax otherwise in effect under subsection (b) for the taxable
year—</text>
<subparagraph id="H8C802EBABE77476890B7C5043B9CA31A"><enum>(A)</enum><text>shall be
<fraction>½</fraction> such rate, if such individual has not attained the
applicable age before the end of such taxable year, and</text>
</subparagraph><subparagraph id="H291A383CE9C54BC186A6CAD1E8524838"><enum>(B)</enum><text>shall be zero, if
such individual has attained such age before the end of such taxable
year.</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="H3AECD8E537CB4A2D84FDAA4353744D26"><enum>(2)</enum><header>Applicable
age</header><text>For purposes of this subsection—</text>
<subparagraph id="HCF3F4D9C4541469FAE50230642A6472D"><enum>(A)</enum><header>In
general</header><text>Except as provided in subparagraph (B), the applicable
age shall be 67.</text>
</subparagraph><subparagraph id="H8D608B63EBB140689DAC249B6BB24D68"><enum>(B)</enum><header>Preferred
Medicare age</header><text>In the case of taxable years beginning after
December 31, 2025, the applicable age shall be the preferred Medicare age
(within the meaning of section 216(m)(2)(B) of the Social Security
Act).</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="HEFA83DDA55A449C59C9CE31B2FA637B0"><enum>(d)</enum><header>Effective
dates</header>
<paragraph commented="no" display-inline="no-display-inline" id="H8274A448186C43A9ADD6A8896042DC83"><enum>(1)</enum><header>Subsections
<enum-in-header>(a)</enum-in-header> and
<enum-in-header>(b)</enum-in-header></header><text display-inline="yes-display-inline">The amendments made by subsections (a) and
(b) shall apply to wages paid after December 31, 2015.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFE69131A89D343FBAEA3D4F091DB2F39"><enum>(2)</enum><header>Subsection
<enum-in-header>(c)</enum-in-header></header><text>The amendments made by
subsection (c) shall apply to remuneration paid in taxable years ending after
December 31, 2015.</text>
</paragraph></subsection></section><section id="H36E1CD9A503F4C60A0ECE23DC8FB610B"><enum>223.</enum><header>15-percent
excise tax on employer-sponsored Medicare supplemental coverage</header>
<subsection id="HB0EEA1EE4E6E4B3CADB5554DC64FC261"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Chapter 43 of the
Internal Revenue Code of 1986 is amended by adding at the end the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="HCABD79FA99464B488196043848864071" style="OLC">
<section id="H27635D9D43AF4DFEB3975D1D13EDECA5"><enum>4980J.</enum><header>Employer-sponsored
Medicare supplemental coverage</header>
<subsection id="HEFE9CA8AB31A46A6AB9CAFA20D92AC66"><enum>(a)</enum><header>Imposition of
tax</header><text display-inline="yes-display-inline">In the case of any
employee who—</text>
<paragraph id="H0F066F7185ED4CE5A8B5ACE1E6B90E8C"><enum>(1)</enum><text>becomes a Medicare
enrollee (as defined in section 1860E–61(b) of the Social Security Act) after
December 31, 2015, and</text>
</paragraph><paragraph id="H5B7EF2D276E5415C9CEA9B5D62F33F22"><enum>(2)</enum><text>is covered for any
period during a calendar year beginning after such date under applicable
employer-sponsored supplemental coverage,</text>
</paragraph><continuation-text continuation-text-level="subsection">there is
hereby imposed a tax equal to 15 percent of the aggregate cost (determined
under rules similar to the rules of section 4980B(f)(4)) of such coverage of
the employee for such period.</continuation-text></subsection><subsection id="H81A2BF0A171E43CA8C7B146C920284A0"><enum>(b)</enum><header>Liability To pay
tax</header><text>The coverage provider (as defined in section 4980I(c)(1))
shall pay the tax imposed by subsection (a).</text>
</subsection><subsection id="H2A1EC7E6EC704DD698F23E7A26EBAFBF"><enum>(c)</enum><header>Applicable
employer-Sponsored supplemental coverage</header><text display-inline="yes-display-inline">For purposes of this section—</text>
<paragraph id="HDAFA3D2DF8094B7BA2386FF762CCE93E"><enum>(1)</enum><header>In
general</header><text>The term <term>applicable employer-sponsored supplemental
coverage</term> means, with respect to any employee, any first-dollar coverage
made available by an employer to an employee during the calendar year.</text>
</paragraph><paragraph id="H40924BEF6725486F881D2589C764F39A"><enum>(2)</enum><header>First-dollar
insurance coverage</header><text>The term <term>first-dollar insurance
coverage</term> means coverage for—</text>
<subparagraph id="H7D2341DB4C904F409A8AACF99CA85F63"><enum>(A)</enum><text>the amount of the
unified deductible for the calendar year under section 1860E–21(b) of the
Social Security Act, and</text>
</subparagraph><subparagraph id="HC8B6628EF500495D80A79E9122E9A64F"><enum>(B)</enum><text>the first $500 of
coinsurance for the calendar year under section 1860E–22 of such Act.</text>
</subparagraph></paragraph><paragraph id="H07BC7607E43040F79171D6648233D7C0"><enum>(3)</enum><header>Coverage
includes employee paid portion</header><text>Coverage shall be treated as
applicable employer-sponsored supplemental coverage without regard to whether
the employer or employee pays for the coverage.</text>
</paragraph><paragraph id="HF4660388D7184913AE62B2AF7CF1D021"><enum>(4)</enum><header>Self-employed
individual</header><text>In the case of an individual who is an employee within
the meaning of section 401(c)(1), coverage under any group health plan
providing health insurance coverage shall be treated as applicable
employer-sponsored coverage if a deduction is allowable under section 162(l)
with respect to all or any portion of the cost of the coverage.</text>
</paragraph><paragraph id="H524745B9A060454BB830028E4A46039E"><enum>(5)</enum><header>Employee</header><text>The
term <term>employee</term> includes any former employee, surviving spouse, or
other primary insured adult.</text>
</paragraph><paragraph id="HCEC2B1CE403C4AFEB84434F185BBEEC1"><enum>(6)</enum><header>Governmental
plans included</header><text>Applicable employer-sponsored coverage shall
include coverage under any group health plan established and maintained
primarily for its civilian employees by the Government of the United States, by
the government of any State or political subdivision thereof, or by any agency
or instrumentality of any such government.</text>
</paragraph><paragraph id="H44D2A82CA69E40E2836C70213E223BFE"><enum>(7)</enum><header>Not applicable
to certain accounts</header><text>The term <term>first-dollar coverage</term>
does not include coverage under a flexible spending arrangement (as defined in
section 106(c)(2)), coverage under an arrangement under which the employer
makes contributions described in subsection (b) or (d) of section 106, a health
reimbursement arrangement treated as employer coverage under an accident or
health plan for purposes of section 106, or coverage under a health individual
retirement account (as defined in section 530A(d)(3)).</text>
</paragraph><paragraph id="H2C2EC5891820456882583F0CCFB00C7D"><enum>(8)</enum><header>Denial of
deduction</header><text>For denial of deduction for the tax imposed by this
section, see section 275(a)(6).</text>
</paragraph></subsection><subsection id="H52BE3D22F3474F5D9B0DC092F96A4400"><enum>(d)</enum><header>Regulations</header><text>The
Secretary shall prescribe such regulations as may be necessary to carry out
this
section.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HB0ACFA9F21F34383A07472909335394E"><enum>(b)</enum><header>Clerical
amendment</header><text display-inline="yes-display-inline">The table of
sections for chapter 43 of such Code is amended by adding at the end the
following new item:</text>
<quoted-block display-inline="no-display-inline" id="H3388B193B1BF47A4A19B20B840DFF220" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 4980J. Employer-sponsored Medicare
supplemental
coverage.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H646586D039C34B27B9C499F7067871D2"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to periods
after December 31, 2015.</text>
</subsection></section></subtitle><enum>III</enum><header>Other Health
Provisions</header>
<subtitle id="H8CC6F061A23B4B7E928A1F815FA5E28F"><enum>A</enum><header>Transparency,
Outreach, and Education </header>
<section display-inline="no-display-inline" id="H50379B68A0BB4B0BA6F5CDAAC458F55E"><enum>301.</enum><header>Public outreach
and education initiatives</header><text display-inline="no-display-inline">Beginning not later than January 1, 2015,
the Medicare Choices Commission shall conduct public outreach and education
efforts, through a variety of media and forums, to provide information to
Medicare enrollees (as defined in section 1860E–51 of the Social Security Act),
providers of services and suppliers (as such terms are defined in section 1861
of such Act), health insurance plans, and other appropriate individuals and
entities on the modifications made by the provisions of, including amendments
made by, this Act to Medicare under title XVIII of the Social Security Act.
Such efforts shall include at least the following:</text>
<paragraph id="H28AAB8E6D8174EAB8E74A4E9BF37A943"><enum>(1)</enum><text>Interactive Web
sites for Medicare enrollees.</text>
</paragraph><paragraph id="H34FDAB44447543C7901498F0D81A65F4"><enum>(2)</enum><text>Opportunities for
Medicare enrollees to sign up for informational emails from the Centers of
Medicare & Medicaid Services.</text>
</paragraph><paragraph id="H0569A35EA2864F8A81E6975165F5CA0A"><enum>(3)</enum><text>Social media pages
to provide basic facts to Medicare enrollees and family members of such
enrollees.</text>
</paragraph><paragraph id="H83AC98258D5547F988C336A15C43B6C7"><enum>(4)</enum><text>National town hall
meetings.</text>
</paragraph><paragraph id="H0EE6DFC50AC94672911624A00C6D63CF"><enum>(5)</enum><text>Educational
materials for hospitals, medical schools, and other providers of services and
suppliers.</text>
</paragraph><paragraph id="H464A3A3645154AD4A422D9AE421B1D60"><enum>(6)</enum><text>Resources for
physicians, home nurses, and other medical professionals to provide to
patients.</text>
</paragraph><paragraph id="HD80EA67949F94FD39713668F296A2D6C"><enum>(7)</enum><text>Coordination with
a broad range of community partners, including community centers, retirement
centers, assisted living communities, and faith-based organizations.</text>
</paragraph><paragraph id="HB01EA0CB346B41D4BFC1A4EEE7065A6E"><enum>(8)</enum><text>Coordination with
health plans.</text>
</paragraph></section><section id="HB64BA480BF7249B7AAE53F22ECE8E5AB"><enum>302.</enum><header>Annual Medicare
beneficiary contributions and benefits statements</header>
<subsection id="H3C92B27D55D0415AAB7CE2B8505E61CA"><enum>(a)</enum><header>In
general</header><text>Part A of title XI of the Social Security Act is amended
by inserting after section 1143 (42 U.S.C. 1320b–13) the following new
section:</text>
<quoted-block id="H5400DA5078234EA78D0A3C656416BAE9" style="OLC">
<section id="H30DB431EFB2A49D5A099C10D5AF45664"><enum>1143A.</enum><header>Annual
Medicare beneficiary contributions and benefits statements</header>
<subsection id="H293385FB3F6F4C0EB09FBBDFBA1B6AEE"><enum>(a)</enum><header>Provision</header>
<paragraph id="H3417E79C8D944E439EE93AF3C9DBCCC3"><enum>(1)</enum><header>In
general</header><text>Beginning not later than 2 years after the date of the
enactment of this section, the Medicare Choices Commission established under
section 1860E–51, in coordination with the Commissioner of Social Security,
shall provide a statement described in subsection (b) (in this section referred
to as an <term>annual Medicare information statement</term>) on an annual basis
to each eligible individual (as defined in subsection (d)) for whom a current
mailing address can be determined through such methods as the Medicare Choices
Commission determines to be appropriate.</text>
</paragraph><paragraph id="H55CC15B6876543F5AED4472AD1DDE890"><enum>(2)</enum><header>Coordination in
single mailing with social security account statements</header><text>In order
to avoid sending separate statements under this section and section 1143 in the
case of an individual for whom a social security account statement is provided
under section 1143 and a separate annual Medicare information statement would
otherwise be provided under this section, the Medicare Choices Commission shall
coordinate with the Commissioner of Social Security, whether through
transmittal of data or otherwise, in a manner so that the annual Medicare
information statement is included and sent with such social security account
statement.</text>
</paragraph><paragraph id="H2D6F05AD056442E9A365243EA44573C0"><enum>(3)</enum><header>Methodology</header>
<subparagraph id="H73BD88BDE74B4D14A4964F782C0B6593"><enum>(A)</enum><header>In
general</header><text>The Medicare Choices Commission, in consultation with the
Commissioner of Social Security and the Secretary of the Treasury, shall
specify the methodology to be used in estimating lifetime contributions and
lifetime benefits with respect to annual Medicare information statements. Such
methodology for computing the lifespan of an individual shall be the same
methodology used for purposes of the social security account statement under
section 1143.</text>
</subparagraph><subparagraph id="H22455E425D384F7880221992B2B5844A"><enum>(B)</enum><header>Inclusion of
description in statement</header><text display-inline="yes-display-inline">The
Medicare Choices Commission shall include a brief description of the key
assumptions used in such methodology in the annual Medicare information
statements.</text>
</subparagraph></paragraph><paragraph id="H196BD3325C5643C7A1B352E3B66E17C1"><enum>(4)</enum><header>Summary of
medicare program</header><text display-inline="yes-display-inline">Each annual
Medicare information statement shall include a summary of the Medicare programs
under title XVIII, including a summary description of the status of the Federal
Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary
Medical Insurance Trust Fund under section 1841, using information from the
most recent report of the Board of Trustees of such Fund. Such summary shall
also include a summary description of benefits and enrollment options under
parts C and D of such title, but shall indicate that the information described
in subsection (b) does not include information related to contributions and
benefits under those parts.</text>
</paragraph></subsection><subsection id="HA8333BFE22514A629BBA3CBEAFFFF67C"><enum>(b)</enum><header>Medicare
information statement described</header><text>In addition to the information
described in paragraphs (3)(B) and (4) of subsection (a), each annual Medicare
information statement for an eligible individual shall contain the
following:</text>
<paragraph id="HB295218977404AE3AA1C82058E87D571"><enum>(1)</enum><header>HI Employee
contributions</header><text>The total contributions described in section
1143(a)(2)(C) for the individual—</text>
<subparagraph id="HF8EC2198202A4301AB2EE6994AACA7A8"><enum>(A)</enum><text>for the most
recent year for which data are available;</text>
</subparagraph><subparagraph id="H9D6316CC883040A781E7BD060A8AE446"><enum>(B)</enum><text>to the extent
feasible, for previous periods through the end of such year; and</text>
</subparagraph><subparagraph id="H030C5F9FE2B54D73BC317DA924BE018A"><enum>(C)</enum><text>as projected for
the individual during the individual’s lifetime.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">To the
extent feasible, of such total contributions the portion that is attributable
to employer, employee, and self-employment contributions.</continuation-text></paragraph><paragraph id="HA0E662500A314A43BF0D413477CA91B3"><enum>(2)</enum><header>Medicare
benefits</header><text>In the case of an eligible individual—</text>
<subparagraph id="H89DD6EF377F34856935DA077BCAA7BC6"><enum>(A)</enum><text>an estimate of the
actuarial value of the expected benefits under such parts for the individual
during the individual’s lifetime, including (but stated separately) any
benefits described in subparagraph (A); and</text>
</subparagraph><subparagraph id="HBECE82506FEB484DA56E404EDCA9EDE0"><enum>(B)</enum><text>if, for such most
recent year, such individual was a Medicare enrollee (as defined in section
1860E–61(b)), the total value of such benefits provided to the individual under
such parts as of the end of such year and, to the extent feasible, the total
value of such benefits for such individual for previous periods through the end
of such year.</text>
</subparagraph></paragraph><paragraph id="H6310042A752647C3ACE19E1AA54F72D2"><enum>(3)</enum><header>Comparison</header><text display-inline="yes-display-inline">An appropriate comparison of such
contributions with such benefits.</text>
</paragraph></subsection><subsection id="HF3F39830A6084163BC4BB66618BE8116"><enum>(c)</enum><header>Records
retention</header><text display-inline="yes-display-inline">The Medicare
Choices Commission shall provide for the indefinite retention of information
that—</text>
<paragraph id="H05CA080CB7F140A1A2AADFD894518E9C"><enum>(1)</enum><text>is described in
subsection (b), including benefits described in subsection (b)(2); and</text>
</paragraph><paragraph id="H42B62380B73544F2A7A96EED9818DDBF"><enum>(2)</enum><text display-inline="yes-display-inline">the Medicare Choices Commission has not
discarded as of the date of the enactment of this section.</text>
</paragraph></subsection><subsection id="H0B451E30AE324955A7BA87305E7B62BE"><enum>(d)</enum><header>Eligible
individual defined</header><text>In this section, the term <term>eligible
individual</term> means an individual—</text>
<paragraph id="H660525EAB48748548DF100C54E5B7F50"><enum>(1)</enum><text>who has a social
security account number;</text>
</paragraph><paragraph id="HF0274008E432412F829A9DC113219888"><enum>(2)</enum><text>who has attained
age 25 or over; and</text>
</paragraph><paragraph id="H11BE1935F46649999794D697FA368CF2"><enum>(3)</enum><text>who is a Medicare
enrollee (as defined in section 1860E–61(b)) or who, as of the end of the most
recent year referred to in subsection (b)(1)(A), has had any contributions
described in subsection (b)(1) made with respect to the individual during such
year or a previous
year.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H1E681A776ACE437D86028754B1B82E51"><enum>(b)</enum><header>Inclusion of
social security account statement for those receiving annual medicare
information statement</header><text>Section 1143(a)(3) of such Act (42 U.S.C.
1320b–13(a)(3)) is amended by adding at the end the following:</text>
<quoted-block id="H383A13B8EE8F4A809B8E4F6323D5E090" style="OLC">
<text display-inline="no-display-inline">Such term includes an individual not
described in the previous sentence who is an eligible individual (as defined in
subsection (d) of section 1143A) for whom an annual Medicare information
statement is provided under such
section.</text>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section></subtitle><subtitle id="H512D0ABD616A4A048AC35F7F662040FB"><enum>B</enum><header>Miscellaneous</header>
<section id="H6E51376CA2F443D68C57087CDA00C4B6"><enum>311.</enum><header>Repeal of
IPAB</header><text display-inline="no-display-inline">Effective as if included
in the enactment of the Patient Protection and Affordable Care Act (Public Law
111–148), the provisions of, and amendments made by, sections 3403 and 10320 of
such Act (other than subsection (d) of section 1899A of the Social Security
Act, as added and amended by such sections) are repealed.</text>
</section><section id="H51914B861D274257BA7CD7894ECED008"><enum>312.</enum><header>Repeal of
Medicare payment productivity adjustments after 2020</header><text display-inline="no-display-inline">The provisions of, and amendments made by,
section 3401 of the Patient Protection and Affordable Care Act (Public Law
111–148), as amended by title X of such Act and section 1105 of the Health Care
and Education Reconciliation Act of 2010, insofar as such provisions (and
amendments) relate to a productivity adjustment, shall not apply with respect
to payments for items or services furnished during any year after fiscal year
2020 or calendar year 2020, as applicable.</text>
</section><section id="H74C8E001B82D48DEA50AB851667467EB"><enum>313.</enum><header>Graduate
medical education grant program</header>
<subsection id="HDA61A040A3114067A57DADD2E40BC3B7"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Title XVIII of the
Social Security Act is amended by adding at the end the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="H82261535CBF243C5887379D9EE91B9EF" style="OLC">
<section id="HB7B457632DE94E7FAB86610F9FFE4DF3"><enum>1899B.</enum><header>Graduate
medical education grant program</header>
<subsection id="HEC01D44C8C5F445CB92E369C58E5A8CD"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">For cost reporting periods occurring during
fiscal year 2015 or a subsequent fiscal year, the Secretary shall carry out a
grant program under which the Secretary shall provide to each hospital with an
approved medical residency training program a grant in accordance with the
subsequent provisions of this section for costs of such hospital for indirect
and direct graduate medical education. Such grants are instead of any payment
under subsection (d)(5)(B) or (h) of section 1886, payments for direct or
indirect medical education costs under title XIX, or section 340E of the Public
Health Service Act for such costs during such fiscal year.</text>
</subsection><subsection id="H744E2C85B752419B8FEAB28972F9BF53"><enum>(b)</enum><header>Grant
amount</header><text>Subject to subsections (c) and (d), the amount of a grant
to a hospital under subsection (a) for a cost reporting period occurring during
a fiscal year shall be equal to—</text>
<paragraph id="H142067BBEC4D420C89D3AA5A0C5A6444"><enum>(1)</enum><text>in the case of a
subsection (d) hospital, the sum of—</text>
<subparagraph id="H305882F3F1FB40BB82DAA10A7A03ACD3"><enum>(A)</enum><text>the payment amount
the hospital would have received under section 1886(h)(3), without application
of this section or the last sentence of section 1886(h)(1), for such cost
reporting period; and</text>
</subparagraph><subparagraph id="HE50B2F81993343FC9FAA54224E3392BF"><enum>(B)</enum><text>72 percent of the
additional payment amount the hospital would have received under section
1886(d)(5)(B), without application of this section or clause (xii) of such
section 1886(d)(5)(B), for such cost reporting period;</text>
</subparagraph></paragraph><paragraph id="H4CD1D104DF76483E8B83F3DDE51AB421"><enum>(2)</enum><text>in the case of a
hospital in a State, an amount determined in accordance with a methodology
specified by the Secretary, which shall be in lieu of any amount that the
hospital otherwise would, without application of this section or section
1903(i)(27), have received under the State plan under title XIX for expenses of
such hospital attributable to the costs of direct and indirect graduate medical
education; and</text>
</paragraph><paragraph id="H31D24E89537B4B90BE14D7A7AFD71D71"><enum>(3)</enum><text>in the case of a
children’s hospital (as defined in subsection (g) of section 340E of the Public
Health Service Act), the sum of—</text>
<subparagraph id="H14924B9C92BA49F290DFA7B7F6586A20"><enum>(A)</enum><text>the amount that
would be determined under subsection (c) of such section for such hospital for
direct expenses associated with operating approved graduate medical residency
training programs for such period, without application of this section or
subsection (h) of such section 340E; and</text>
</subparagraph><subparagraph id="HED17F9A6081E47E6A6B65B7C24840BA8"><enum>(B)</enum><text>the amount that
would be determined under subsection (d) of such section for such hospital for
indirect expenses associated with the treatment of more severely ill patients
and the additional costs relating to teaching residents in such programs for
such period, without application of this section or subsection (h) of such
section 340E.</text>
</subparagraph></paragraph></subsection><subsection id="HBD8A692365464E168BE2AF69590ABB1D"><enum>(c)</enum><header>Modification</header><text display-inline="yes-display-inline">Subject to subsection (d)(1), the Secretary
may modify the grant amounts under subsection (b), including after application
of subsection (d)(2), based on factors such as the number of residents of
approved medical residency training programs, the extent to which such programs
provide for primary care training, the curriculum of such programs, and the
quality of care provided through such programs.</text>
</subsection><subsection id="H39052A32BEAB436B9CA6C0D21AF6AD68"><enum>(d)</enum><header>Limitation</header>
<paragraph id="H9837245D51E545AA84CB092E9661A9E9"><enum>(1)</enum><header>In
general</header><text>In no case may the aggregate amount of grants awarded
under subsection (a) for a fiscal year exceed the amount made available under
subsection (e)(1) for such fiscal year for carrying out this section.</text>
</paragraph><paragraph id="HF6CBBB64FD5447A4972E400B383C28A3"><enum>(2)</enum><header>Pro-ration</header><text display-inline="yes-display-inline">In the case of a fiscal year for which the
aggregate amount of grants under this section is projected to exceed the amount
made available under subsection (e)(1) for such fiscal year for carrying out
this section, the Secretary shall reduce the amount of each grant awarded under
this section for such fiscal year by a prorated amount. Subject to paragraph
(1), the Secretary may modify such a prorated amount in accordance with
subsection (c).</text>
</paragraph></subsection><subsection id="H01E724D05BF44879921FC14A192DC59D"><enum>(e)</enum><header>Funding</header>
<paragraph id="H33B6680B179D487892CC3BA8D2805670"><enum>(1)</enum><header>In
general</header><text>For fiscal year 2015 and each subsequent fiscal year,
amounts in the Graduate Medical Education Trust Fund under section 9512 of the
Internal Revenue Code of 1986 shall be available, without further
appropriation, to the Secretary to carry out this section.</text>
</paragraph><paragraph id="HFE719C2B2B89492E960C9CA01505A902"><enum>(2)</enum><header>Transfers to GME
Trust Fund</header><text display-inline="yes-display-inline">There shall be
provided for the transfer to the Graduate Medical Education Trust Fund by the
Medicare Choices Commission in appropriate part from the Federal Hospital
Insurance Trust Fund under section 1817 and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of the following:</text>
<subparagraph id="HBCC57B6900F0488BBAF0D893C634879D"><enum>(A)</enum><text>For fiscal year
2015, an amount equal to the aggregate amount that would have been calculated
under subsection (b)(1) for such fiscal year for all hospitals with approved
medical residency training programs if the percentage described in paragraph
(1)(B) of such subsection were 82 percent.</text>
</subparagraph><subparagraph id="H3EB3455D70404CBF96ED06D9F2566706"><enum>(B)</enum><text display-inline="yes-display-inline">For fiscal year 2016 and each subsequent
fiscal year, the amount transferred under this paragraph for the previous
fiscal year increased by the annual percentage increase in the medical
component of the Consumer Price Index for All Urban Consumers (all items;
United States city average) as of June of the previous fiscal year.</text>
</subparagraph></paragraph></subsection><subsection id="HAC7245B6370E4887989D21C89913C116"><enum>(f)</enum><header>Definitions</header><text>The
terms <term>approved medical residency training program</term> and <term>direct
graduate medical education costs</term> have the meanings given such terms
under section
1886(h)(5).</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H65D10B4A84E14D268E6C217ABE6DA1B7"><enum>(b)</enum><header>GME Trust
Fund</header>
<paragraph id="H127334704BBB4A8085E5DE5512EF536B"><enum>(1)</enum><header>In
general</header><text>Subchapter A of chapter 98 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H4FBE159F1A58482594255FFBF9ADE8B7" style="OLC">
<section id="HB460941726A44A64A74F3E8637C38411"><enum>9512.</enum><header>Graduate
Medical Education Trust Fund</header>
<subsection id="HF3DF95F93DBD4DAF8A9BE62F60C2D28B"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">There is established
in the Treasury of the United States a trust fund to be known as the
<term>Graduate Medical Education Trust Fund</term> (hereafter in this section
referred to as the <term>GME Trust Fund</term>), consisting of such amounts as
may be appropriated or credited to such Trust Fund as provided in this section
and section 9602(b).</text>
</subsection><subsection id="HC125D523A0064CD79E008A6D357E12B5"><enum>(b)</enum><header>Transfers to
fund</header>
<paragraph id="H749EEB3B46664FE896D208958E2A53FE"><enum>(1)</enum><header>Trust fund
transfers</header><text>There shall be credited to the GME Trust Fund for
fiscal year 2015 and each subsequent fiscal year—</text>
<subparagraph id="H20791A75319B465281CD8E53F2A7874B"><enum>(A)</enum><text>the amounts
transferred under section 1899B of the Social Security Act; and</text>
</subparagraph><subparagraph id="H74AE22DA3AB34E6DBA5542F9DCA43100"><enum>(B)</enum><text>the amounts
transferred from the Patient-Centered Outcomes Research Trust Fund under
section 9511(g).</text>
</subparagraph></paragraph><paragraph id="HA640A28B704840F0B553A7D091F3ECAD"><enum>(2)</enum><header>Appropriation</header><text display-inline="yes-display-inline">There are hereby appropriated to the GME
Trust Fund for fiscal year 2015 and each subsequent fiscal year an amount equal
to the aggregate payment amounts determined for such fiscal year under section
1899B(b)(2) of the Social Security Act.</text>
</paragraph><paragraph id="H34B0F6DE55AE4DAAA5811F52BFE6C4BC"><enum>(3)</enum><header>Authorization of
Appropriations</header><text>In addition to amounts credited to the GME Trust
Fund under paragraph (1) for a fiscal year, there are authorized to be
appropriated to the Trust Fund—</text>
<subparagraph id="HF96C2C291A1B42F4B84FD934A10B22A2"><enum>(A)</enum><text>for each of fiscal
years 2015 and 2016, $200,000,000; and</text>
</subparagraph><subparagraph id="HB351A82232C74410BAAE90962EEFA596"><enum>(B)</enum><text>for each of fiscal
years 2017 and 2018, $100,000,000.</text>
</subparagraph></paragraph></subsection><subsection id="H0781557D716B45DF910688F9E11CEB3B"><enum>(c)</enum><header>Expenditures
from fund</header><text display-inline="yes-display-inline">Amounts in the GME
Trust Fund are available, without further appropriation, to the Secretary for
carrying out section 1899B of the Social Security
Act.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H868DB6579E50405C862F6E9863746E4B"><enum>(2)</enum><header>Clerical
amendment</header><text display-inline="yes-display-inline">The table of
sections for subchapter A of chapter 98 of such Code is amended by adding at
the end the following new item:</text>
<quoted-block display-inline="no-display-inline" id="HE68ABF286FA7423C8C6DB62B8D16946B" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 9512. Graduate Medical Education
Trust
Fund.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H9AE0CA7F8D6843CFBC5833CA58858CB0"><enum>(c)</enum><header>Conforming
amendments</header>
<paragraph id="HC3C3F42BB4274D10BE3717BDA1828B97"><enum>(1)</enum><header>Sunset Medicare
GME</header><text display-inline="yes-display-inline">Section 1886 of the
Social Security Act (42 U.S.C. 1395ww) is amended—</text>
<subparagraph id="HAD28FA24EF3E420AB65E4DDBA08BB5B1"><enum>(A)</enum><text>in subsection
(d)(5)(B)—</text>
<clause id="HC86701701BEE44899F9009D34B7F462C"><enum>(i)</enum><text>by
redesignating the second clause (x) as clause (xi); and</text>
</clause><clause id="H5412573661BF47FE97D8527D396E0A33"><enum>(ii)</enum><text>by
adding at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H1F9763F5B792434590AD10985BC74C0D" style="OLC">
<clause id="HCF18A90B178C4DE6AD569F79C575CBBA" indent="up1"><enum>(xii)</enum><text display-inline="yes-display-inline">For cost reporting periods beginning on or
after October 1, 2014, no additional payment amount for subsection (d)
hospitals with indirect costs of medical education shall be made under this
subparagraph and instead payments for such costs shall be made in accordance
with section 1899B.</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H6083E6E842594EAAA01E3696DF9AD0B9"><enum>(B)</enum><text>in subsection
(h)(1), by adding at the end the following new sentence: <quote>For cost
reporting periods beginning on or after October 1, 2014, no payments for direct
graduate medical education costs shall be made under this subsection and
instead payments for such costs shall be made in accordance with section
1899B.</quote>.</text>
</subparagraph></paragraph><paragraph id="HDAEF3316C0BE45ECBEA0B0BF951FFFAA"><enum>(2)</enum><header>Sunset Medicaid
GME</header><text display-inline="yes-display-inline">Section 1903(i) of the
Social Security Act (42 U.S.C. 1396b(i)) is amended—</text>
<subparagraph id="H20BE2B2FF0604DDD8128C0F7D36F6D77"><enum>(A)</enum><text>in paragraph (25),
by striking <quote>or</quote> at the end;</text>
</subparagraph><subparagraph id="HC78305977A454C9DA4F1E3658E39201C"><enum>(B)</enum><text>in paragraph (26),
by striking the period at the end and inserting <quote>; or</quote>; and</text>
</subparagraph><subparagraph id="H58148885D6444B3699694233C729BC70"><enum>(C)</enum><text>by inserting after
paragraph (26) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H685EDC71CBDD41DCAB6E8EB65EDA4B73" style="OLC">
<paragraph id="H86DCD10B9B6144F0A50AF594CD4C8340"><enum>(27)</enum><text display-inline="yes-display-inline">with respect to any amounts expended on or
after October 1, 2014, for payments to hospitals for direct or indirect costs
of graduate medical
education.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H2C6CFC7192B74689BEAF506E92BC4950"><enum>(3)</enum><header>Sunset PHSA
children’s hospital GME</header><text display-inline="yes-display-inline">Section 340E of the Public Health Service
Act (42 U.S.C. 256e) is amended—</text>
<subparagraph id="H87A3144AE845476E88B84412095F3C5C"><enum>(A)</enum><text>in the first
sentence of subsection (a), by striking <quote>The Secretary</quote> and
inserting <quote>Subject to subsection (h), the Secretary</quote>; and</text>
</subparagraph><subparagraph id="HC524BD3F27B1464DBB04B32C9C282465"><enum>(B)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H03AD12F66F5949CFB701550960904C7B" style="OLC">
<subsection id="H10812B7EF24D41F6B3973F983BC96CB1"><enum>(h)</enum><header>Sunset</header><text display-inline="yes-display-inline">For fiscal year 2015 and each subsequent
fiscal year, no payments shall be made under this section to a children’s
hospital for the direct expenses and the indirect expenses associated with
operating approved graduate medical residency training programs and instead
payments for such expenses shall be made to such hospital in accordance with
section 1899B of the Social Security
Act.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HB225AC7FF8D6460A87BD914194893D34"><enum>(4)</enum><header>Transfer of
PCORI funds</header>
<subparagraph id="H917485E08D0A4124BEBB4120D61699F9"><enum>(A)</enum><header>Medicare
transfer</header><text>Section 1183 of the Social Security Act is
amended—</text>
<clause id="H6B38C6906D754498AFED9B18EDFCDE47"><enum>(i)</enum><text>in
the heading, by striking <quote><header-in-text level="section" style="OLC">patient-centered outcomes research trust
fund</header-in-text></quote> and inserting <quote><header-in-text level="section" style="OLC">graduate medical education trust
fund</header-in-text></quote>; and</text>
</clause><clause id="H36CE5B1D0D0E4B6980EDAD3A8AE87F09"><enum>(ii)</enum><text>in
subsection (a), by striking <quote>to the Patient-Centered Outcomes Research
Trust Fund (referred to in this section as the <term>PCORTF</term>) under
section 9511 of the Internal Revenue Code of 1986</quote> and inserting
<quote>to the Graduate Medical Education Trust Fund under section 9512 of the
Internal Revenue Code of 1986</quote>.</text>
</clause></subparagraph><subparagraph id="HB737B69947C6480EA088E4B38D6C910A"><enum>(B)</enum><header>PCORI trust
fund</header><text>Section 9511 of the Internal Revenue Code of 1986 is
amended—</text>
<clause id="HD77AFC10C4B1453B94539B86A25DBA82"><enum>(i)</enum><text>in
subsection (d)(1), by inserting <quote>and subsection (g)</quote> after
<quote>paragraph (2)</quote>; and</text>
</clause><clause id="HBBB4C47D054640A9B7FD89B2D5A865BD"><enum>(ii)</enum><text>by
adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H9E5A7660F395467685253378C9876C19" style="OLC">
<subsection id="H5D85ADFE0F194634806EC18623779969"><enum>(g)</enum><header>Transfer to
Graduate Medical Education Trust Fund</header><text display-inline="yes-display-inline">The Secretary of the Treasury shall
transfer to the Graduate Medical Education Trust Fund under section 9512 all
funds made available, appropriated, or transferred to the trust fund under this
section on or after October 1,
2014.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection></section><section id="H98F4BB594396460397788415485355FE"><enum>314.</enum><header>Report on
transitioning payments under Medicare for disproportionate share hospitals into
a grant program</header><text display-inline="no-display-inline">Not later than
December 31, 2017, the Secretary of Health and Human Services shall submit to
Congress a report containing recommendations on the extent to which—</text>
<paragraph id="H9F032490D6EC4BF8B4E9C85348223C91"><enum>(1)</enum><text>adjustments in
payments under section 1886(d)(5)(F) of the Social Security Act for inpatient
hospital services furnished by disproportionate share hospitals should be
terminated; and</text>
</paragraph><paragraph id="H0B244671874E4A879A7FA1BC1F1C14C9"><enum>(2)</enum><text>instead of such
adjustments described in paragraph (1) there should be established a grant
program (separate from the Medicare programs under title XVIII of the Social
Security Act) to provide disproportionate care hospitals funding for providing
such services.</text>
</paragraph></section><section display-inline="no-display-inline" id="HCBEF568DEA7142FF9A079C3FF75D6F45" section-type="subsequent-section"><enum>315.</enum><header>One-year freeze for
physician payment update; Sense of Congress relating to the sustainable growth
rate (SGR)</header>
<subsection id="H62985547633344109DE53A956AE3D9E1"><enum>(a)</enum><header>One-Year freeze
for physician payment update</header><text display-inline="yes-display-inline">Section 1848(d) of the Social Security Act
(42 U.S.C. 1395w–4(d)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H0DAEB9EA2D3247699141622DE613C5EE" style="OLC">
<paragraph id="H8C71D5953D41476F908FF89087AC10A0"><enum>(14)</enum><header>Update for
2013</header>
<subparagraph id="HC7AFFB6F02FE42F3A213A5CFEF366859"><enum>(A)</enum><header>In
general</header><text>Subject to paragraphs (7)(B), (8)(B), (9)(B), (10)(B),
(11)(B), (12)(B), and (13)(B), in lieu of the update to the single conversion
factor established in paragraph (1)(C) that would otherwise apply for 2013, the
update to the single conversion factor shall be zero percent.</text>
</subparagraph><subparagraph id="H983A42A5976A4834973FD5EE54025F27"><enum>(B)</enum><header>No effect on
computation of conversion factor for 2014 and subsequent
years</header><text>The conversion factor under this subsection shall be
computed under paragraph (1)(A) for 2014 and subsequent years as if
subparagraph (A) had never
applied.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HD8207E66BCDD4C5695008262473A2C27"><enum>(b)</enum><header>Sense of
Congress relating to the sustainable growth rate (SGR)</header><text display-inline="yes-display-inline">It is the Sense of Congress that the
sustainable growth rate (SGR) formula under the Medicare physician fee schedule
under section 1848 of the Social Security Act (42 U.S.C. 1395w–4(d) is
fundamentally flawed and that replacing such formula with a payment system that
protects the access of seniors to high-quality physician care should be an
urgent priority.</text>
</subsection></section><section id="H5D977A9FE7D0449199B73D6F110AB56B"><enum>316.</enum><header>Improvements to
MSA plans; permitting offering of catastrophic plan with high deductible and
contribution to MSA, HSA, or HIRA</header>
<subsection id="H1AE3AE89ACFD4C42AD10466B90380EF7"><enum>(a)</enum><header>MSA plan may
choose To not apply deductible to preventive services</header><text display-inline="yes-display-inline">Section 1859(b)(3) of the Social Security
Act is amended—</text>
<paragraph id="H52B227B5641946C5BA87774D82D1F3A9"><enum>(1)</enum><text>in subparagraph
(A), by inserting <quote>, subject to subparagraph (C)</quote> after
<quote>plan that</quote>; and</text>
</paragraph><paragraph id="H3CC9DF73243047F89931F957BB2E069B"><enum>(2)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HC8256980E81047B0B020C9AFDD389571" style="OLC">
<subparagraph id="H2454990F9F24431C8D8C7FCF01B44B86"><enum>(C)</enum><header>Deductible not
applicable to preventive services</header><text display-inline="yes-display-inline">With respect to expenses incurred during
the first plan year beginning on or after the date of the enactment of this
subparagraph or a subsequent plan year, a Medicare Advantage organization
offering an MSA plan may waive application of the deductible under this
paragraph with respect to preventive care (within the meaning of section 1871)
under such plan and such waiver shall not affect the plan satisfying the
definition under subparagraph
(A).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H74C012D5FD0749FF8BB929015E70F7FB"><enum>(b)</enum><header>MA and MSA plans
allowed To make Medicare Advantage MSA contributions</header><text>Section
138(b)(2) of the Internal Revenue Code of 1986 is amended—</text>
<paragraph id="H24AD1D34E5DD4556BA8629408E84289F"><enum>(1)</enum><text>in subparagraph
(A), by striking at the end <quote>or</quote>;</text>
</paragraph><paragraph id="H49F130465CB24C45A1B50368E34D4A56"><enum>(2)</enum><text>in subparagraph
(B), by adding at the end <quote>or</quote>; and</text>
</paragraph><paragraph id="HF2A1BB0EE6354A25A966928F0D6175CD"><enum>(3)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H8726B7E14E334724A23E2F51F6CC9EE7" style="OLC">
<subparagraph id="HE9788EF97B95405E98F1D27E484D3331"><enum>(C)</enum><text display-inline="yes-display-inline">a contribution made by a Medicare Advantage
plan or MSA plan under part C of title XVIII of the Social Security Act
pursuant to subparagraph (B) or (D) of section 1851(a)(2) of such
Act,</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HA52FAD99E3604F6D97397FE8E0AC70C6"><enum>(c)</enum><header>MA plans offered
may include catastrophic plan with high deductible and MSA, HSA, or HIRA
contribution</header><text>Section 1851(a)(2) of the Social Security Act (42
U.S.C. 1395w–21(a)(2)) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H74BE7581689848E3B509335ABAD1206B" style="OLC">
<subparagraph id="H7BA8EA057AC64C04A35CD16FFF3151F8"><enum>(D)</enum><header>Combination
catastrophic high deductible plan with MSA, HSA, or HIRA
contribution</header><text display-inline="yes-display-inline">A plan offering
catastrophic coverage with a high deductible feature (as described in section
1882(p)(11)(B)), and a contribution by such plan into a Medicare Advantage
medical savings account (MSA) (as defined in section 138(b)(2) of the Internal
Revenue Code of 1986), a health savings account (as defined in section 223(d)
of the Internal Revenue Code of 1986), or a health individual retirement
account established under section 503(b) of the
<short-title>Save and Strengthen Medicare Act of
2012</short-title>.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" id="H1D1EC970BDE243FC8A44CAFD6EEF0012"><enum>317.</enum><header>Extension for
specialized MA plans for special needs individuals</header>
<subsection commented="no" id="HBBB63C93302E4095BB1795F9503A56DA"><enum>(a)</enum><header>No period
limitation applied for restricted enrollments</header><text display-inline="yes-display-inline">Section 1859(f)(1) of the Social Security
Act (42 U.S.C. 1395w–28(f)(1)) is amended by striking <quote>and for periods
before January 1, 2014</quote>.</text>
</subsection><subsection commented="no" id="H994D7E0726F34925AE2BF0169AB1DE86"><enum>(b)</enum><header>Period for
meeting applicable requirements extended</header><text display-inline="yes-display-inline">Section 1859(b)(6)(A) of the Social
Security Act (42 U.S.C. 1395w–28(b)(6)(A)) is amended by striking <quote>, as
of January 1, 2010,</quote>.</text>
</subsection><subsection commented="no" id="H1F61AF3407BE44328BF4C28A448EF066"><enum>(c)</enum><header>Extension of
Authority To Operate but No Service Area Expansion for Dual Special Needs Plans
That Do Not Meet Certain Requirements</header><text display-inline="yes-display-inline">Section 164(c)(2) of the Medicare
Improvements for Patients and Providers Act of 2008 (Public Law 110–275), as
amended by section 3205(d) of the Patient Protection and Affordable Care Act
(Public Law 111–148), is amended by striking <quote>December 31, 2012</quote>
and inserting <quote>December 31, 2015</quote>.</text>
</subsection></section><section id="H514332FEE2604270902EECAA07DCEC0F"><enum>318.</enum><header>Conscience
protections</header><text display-inline="no-display-inline">Part F of title
XVIII of the Social Security Act, as redesignated by section 101(a)(1) and
amended by section 313, is further amended by adding at the end the following
new sections:</text>
<quoted-block display-inline="no-display-inline" id="HB06C1EF273E44E6B9E54707C6671F0E4" style="OLC">
<section id="H6C329A3E27B5409993C235CBF535BF02"><enum>1899C.</enum><header>Conscience
protections; Prohibition against discrimination on assisted suicide and
abortion services</header>
<subsection id="H414A6F3B622641C19B3966EA7735B346"><enum>(a)</enum><header>Prohibition on
funding for abortions</header><text>No payment may be made under this title for
any expenses incurred for any abortion.</text>
</subsection><subsection id="HAC5150C03FA949FEB5AEC32FB4D11278"><enum>(b)</enum><header>Prohibition on
funding for health benefits plans that cover abortion</header><text>No payment
may be made under this title for any expenses for coverage under an MA plan or
prescription drug plan that includes coverage of any abortion.</text>
</subsection><subsection id="H375452BE9FDB4610B99E7ACA785F8275"><enum>(c)</enum><header>Treatment of
abortions related to rape, incest, or preserving the life of the
mother</header><text display-inline="yes-display-inline">The limitations
established in the previous subsections shall not apply to an abortion—</text>
<paragraph id="H70215CCDB6DA4C08B334F30BA66365C0"><enum>(1)</enum><text>if the pregnancy
is the result of an act of rape or incest; or</text>
</paragraph><paragraph id="HF31B683CC9574A2683EDAB66DE074909"><enum>(2)</enum><text>in the case where
a woman suffers from a physical disorder, physical injury, or physical illness
that would, as certified by a physician, place the woman in danger of death
unless an abortion is performed, including a life-endangering physical
condition caused by or arising from the pregnancy itself.</text>
</paragraph></subsection></section><section id="HDF82B9439C33478EA2C159D9564ED8DB"><enum>1899D.</enum><header>Prohibition
against discrimination on assisted suicide and abortions</header>
<subsection commented="no" id="H57D75C42974942AA8B5EA8319A906694"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Federal
Government, any MA plan or prescription drug plan that receives payment under
this title, and any provider of services or supplier that receives payment
under this title with respect to Medicare fee-for-service (as defined in
section 1860E–61(b)) may not subject an individual or institutional health care
entity to discrimination on the basis that the entity does not provide—</text>
<paragraph commented="no" id="H40D83E8AAC9A47EDADDA7D37E8ABBA41"><enum>(1)</enum><text>any health care
item or service furnished for the purpose of causing, or for the purpose of
assisting in causing, the death of any individual, such as by assisted suicide,
euthanasia, or mercy killing; or</text>
</paragraph><paragraph commented="no" id="HDA50872727BF4619971749049F27F911"><enum>(2)</enum><text>abortions.</text>
</paragraph></subsection><subsection id="HC429F561DA544A61A6F23B5C9CE90FE6"><enum>(b)</enum><header>Definition</header><text>In
this section, the term <term>health care entity</term> includes an individual
physician or other health care professional, a hospital, a provider-sponsored
organization, a health maintenance organization, a health insurance plan, or
any other kind of health care facility, organization, or plan.</text>
</subsection><subsection id="HD14ADB81352047549BC007B18741678B"><enum>(c)</enum><header>Construction and
treatment of certain services in the case of assisted
suicide</header><text>Nothing in subsection (a)(1) shall be construed to apply
to, or to affect, any limitation relating to—</text>
<paragraph id="H6AE91876D7FA46EDAB63D2C1D778B29B"><enum>(1)</enum><text>the withholding or
withdrawing of medical treatment or medical care;</text>
</paragraph><paragraph id="H38C8E661D10F41E78BDA1D48C44DFC09"><enum>(2)</enum><text>the withholding or
withdrawing of nutrition or hydration; or</text>
</paragraph><paragraph id="H462FA72D504043CE9B89493629BDE881"><enum>(3)</enum><text>the use of an
item, good, benefit, or service furnished for the purpose of alleviating pain
or discomfort, even if such use may increase the risk of death, so long as such
item, good, benefit, or service is not also furnished for the purpose of
causing, or the purpose of assisting in causing, death, for any reason.</text>
</paragraph></subsection><subsection commented="no" id="H279C54F51DBD4318985B5EC4BA72EC25"><enum>(d)</enum><header>Administration</header><text display-inline="yes-display-inline">The Office for Civil Rights of the
Department of Health and Human Services is designated to receive complaints of
discrimination based on this section. Any such complaint shall, by not later
than 180 days after receipt by the Office of such complaint, be reviewed by the
Office and, as appropriate, referred to the Medicare Choices Commission or
Centers for Medicare & Medicaid Services for purposes of subsection
(e).</text>
</subsection><subsection id="HEBFB168464884BFEB4DD030F5287CC05"><enum>(e)</enum><header>Enforcement</header>
<paragraph id="HCA7623A7856C43C68A8B1461A1831A08"><enum>(1)</enum><header>MA plans and
prescription drug plans</header><text display-inline="yes-display-inline">In
the case of an MA plan or prescription drug plan that is in violation of
subsection (a), the Medicare Choices Commission may, as determined appropriate
by the Commission—</text>
<subparagraph id="HA40BD4DEBCB74F09963D5D57F176D684"><enum>(A)</enum><text>apply against the
MA organization offering the MA plan or the PDP sponsor offering the
prescription drug plan a civil monetary penalty or assessment in the same
manner as such a penalty or assessment is authorized under section
1128A(a);</text>
</subparagraph><subparagraph id="H56EBD7F464CF419E8B5DABF017A7B85B"><enum>(B)</enum><text>exclude the plan
from participation under this title, in accordance with the procedures of
subsections (c), (f), and (g) of section 1128; or</text>
</subparagraph><subparagraph id="H2008362D8BC040FC9392133C1534087C"><enum>(C)</enum><text>apply both
subparagraphs (A) and (B) with respect to the plan.</text>
</subparagraph></paragraph><paragraph id="H1E4932533B6A48C0A7E3B7FFB56F8075"><enum>(2)</enum><header>Medicare
fee-for-service providers of services and suppliers</header><text>In the case
of a provider of services or supplier described in subsection (a) that is in
violation of such subsection, the Secretary, through the Administrator of the
Centers for Medicare & Medicaid Services, may, as determined appropriate by
the Secretary—</text>
<subparagraph id="H33F95D3D2F1F40428CF280443F58BFBF"><enum>(A)</enum><text>apply against the
provider of services or supplier a civil monetary penalty or assessment in the
same manner as such a penalty or assessment is authorized under section
1128A(a);</text>
</subparagraph><subparagraph id="HDF138F3496F4461E8433028BE510FEEB"><enum>(B)</enum><text>exclude the
provider of services or supplier from participation under this title, in
accordance with the procedures of subsections (c), (f), and (g) of section
1128; or</text>
</subparagraph><subparagraph id="HC982D8C9B91847EA914B53B35824CD85"><enum>(C)</enum><text>apply both
subparagraphs (A) and (B) with respect to the provider of services or
supplier.</text>
</subparagraph></paragraph><paragraph id="HD072E373EF274805836CB9089A390EDF"><enum>(3)</enum><header>Administration</header><text>The
provisions of section 1128A (other than the first 2 sentences of subsection (a)
and other than subsection (b)) shall apply to a civil money penalty and
assessment under paragraph (1) or (2) in the same manner as such provisions
apply to a penalty, assessment, or proceeding under section 1128A(a), except to
the extent such provisions are inconsistent with paragraph (1)(B) or (2)(B),
respectively.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section></subtitle>