1.Short
title; table of contents
(a)This Act may be cited
as the The Dollar for Dollar Act of
2012
.
(b)The table of contents for this Act is as follows:
Sec. 1. Short title; table of
contents.
TITLE I—Medicaid
Sec. 1101. Comprehensive Medicaid Waivers.
Sec. 1102. Phased-in elimination of allowable provider taxes
under Medicaid.
TITLE II—Medicare
Subtitle A—Medicare Total Health program; Medicare
Fee-for-Service program reforms; Reports
Sec. 2000. Short title; purpose.
PART I—Medicare Total Health program
Sec. 2001. Establishment of Medicare Total Health
program.
Sec. 2002. Replacement of part B premium with Medicare Total
Health program plan premium; other technical and conforming
amendments.
PART II—Medicare fee-for-Service reforms
Sec. 2011. Medicare protection against high out-of-pocket
expenditures for fee-for-service benefits.
Sec. 2012. Unified Medicare deductible.
Sec. 2013. Uniform Medicare coinsurance rate.
Sec. 2014. Prohibition on first-dollar coverage under Medigap
policies and development of new standards for Medigap policies.
PART III—Annual report to Congress
Sec. 2021. Annual report to Congress.
Subtitle B—Elimination of exemption of Medicare payments to
physicians under statutory PAYGO
Sec. 2101. Elimination of exemption of Medicare payments to
physicians under statutory PAYGO.
Subtitle C—Adjustments to Medicare part B and D premiums for
high-Income beneficiaries
Sec. 2201. Adjustments to Medicare part B and D premiums for
high-income beneficiaries.
Subtitle D—Increase in the Medicare eligibility
age
Sec. 2301. Increase in the Medicare eligibility
age.
Subtitle E—Other provisions
Sec. 2401. Limitation on Medicare payments for direct graduate
medical education (DGME).
Sec. 2402. Reduction in Medicare indirect graduate medical
education (IME) payments.
Sec. 2403. Acceleration of application of productivity
adjustment to Medicare home health prospective payment amounts.
Sec. 2404. Acceleration of rebasing of Medicare home health
prospective payment amounts.
Sec. 2405. Reduction of bad debt treated as an allowable
cost.
TITLE III—Social Security
Sec. 3101. Adjustments to bend points in determining primary
insurance amount.
Sec. 3102. Adjustment to calculation of benefit computation
years.
Sec. 3103. Minimum social security benefit.
Sec. 3104. Increase in benefits starting 20 years after initial
eligibility.
Sec. 3105. Adjustment to normal and early retirement
ages.
Sec. 3106. Application of actuarial reduction for disabled
beneficiaries who attain early retirement age.
Sec. 3107. Option to collect up to one-half of old-age
insurance benefit at age 62.
Sec. 3108. Coverage of newly hired state and local
employees.
Sec. 3109. Inclusion in annual social security account
statement of estimated present value of taxes and benefits for Social Security
and Medicare and projected deficit as a percent of lifetime
earnings.
Sec. 3110. Retirement information campaign.
TITLE IV—Conversion to chained CPI
Sec. 4101. Conversion to chained CPI.
TITLE V—Public debt limit
Sec. 5101. Increase in public debt limit.
<enum>I</enum><header>Medicaid</header>
<section id="idA4C859D4ABB9499F9AAB93EAFA5C8D4C"><enum>1101.</enum><header>Comprehensive
Medicaid Waivers</header><text display-inline="no-display-inline">Section 1115
of the Social Security Act (42 U.S.C. 1315) is amended by adding at the end the
following:</text>
<quoted-block act-name="" display-inline="no-display-inline" id="idFBBEC16B905941ECB00212AF224A8AF4" style="OLC">
<subsection id="id134CD45F500D4DEAAC991024C2ECD27E"><enum>(g)</enum><header>Comprehensive
Medicaid Waivers</header>
<paragraph id="idB41B229991C048F8A02075E42F61B999"><enum>(1)</enum><header>Authority</header>
<subparagraph id="idE64E7A8AB0FC46C6B7C701611AB5ED25"><enum>(A)</enum><header>In
general</header><text>A State may elect to provide medical assistance under
title XIX, directly or by contract, to eligible individuals pursuant to a
comprehensive Medicaid waiver under this subsection in lieu of providing such
assistance under a State plan approved under title XIX or a waiver approved
under subsection (d) or extended under subsection (e). A State shall make such
an election by submitting a waiver application to the Secretary for
certification that the application satisfies the requirements of paragraph
(2).</text>
</subparagraph><subparagraph id="id4D549B05FE9B4B9FA09071E65C9EE40B"><enum>(B)</enum><header>Waiver of State
Medicaid program requirements</header><text>Any requirements applicable under
this title or title XIX that would prevent a State from carrying out a
comprehensive Medicaid waiver in accordance with the State's certified
application and the requirements of this subsection are deemed waived.</text>
</subparagraph><subparagraph id="id085D5DB65A3C441DB9E40153C7656A84"><enum>(C)</enum><header>Shared savings
bonus</header><text>A State conducting a comprehensive Medicaid waiver under
this subsection shall be eligible for a shared savings bonus in accordance with
paragraph (4).</text>
</subparagraph><subparagraph id="idB4239C072D6B43FD86937ED26F6DEC5B"><enum>(D)</enum><header>Option to
include CHIP-eligible individuals</header><text>A State may elect to treat
individuals eligible for child health assistance under the State child health
plan under title XXI as eligible individuals under a comprehensive Medicaid
waiver. The waiver application and determination of the aggregate spending cap
for the State for the waiver period shall take into account the inclusion of
such individuals in the comprehensive Medicaid waiver. Any requirements
applicable under this title, title XIX, or title XXI that would prevent a State
from including such individuals in the comprehensive Medicaid waiver in
accordance with the State's certified application and the requirements of this
subsection are deemed waived.</text>
</subparagraph></paragraph><paragraph id="idE2534130F4934F33B121D1C031F67B3B"><enum>(2)</enum><header>Comprehensive
Medicaid waiver application</header><text>An application for a comprehensive
Medicaid waiver under this subsection shall contain the following:</text>
<subparagraph id="id49627CA71D274FC9BAAA3610D17B9ABB"><enum>(A)</enum><header>General
description of proposed benefit delivery models, eligibility criteria, and
benefits</header><text>A brief description, which may be in outline form, of
the eligibility criteria and medical assistance to be provided that includes
the methods for delivery of such assistance, the criteria for the determination
of eligibility for such assistance, and the amount, duration, and scope of such
assistance, including a description of the amount (if any) of premiums,
deductibles, coinsurance, or other cost-sharing.</text>
</subparagraph><subparagraph id="idA853DBF9725740919A671787D9AE0A55"><enum>(B)</enum><header>HEDIS measures
to evaluate performance</header>
<clause id="id2766703E0A2042C3BBC677C8C2C5DB8C"><enum>(i)</enum><header>In
general</header><text>A description of not less than 20 of the standard
Medicaid Healthcare Effectiveness Data and Information Set (HEDIS) measures
established by the National Committee for Quality Assurance selected by the
State to annually evaluate the quality and cost-effectiveness of the medical
assistance provided under the waiver, and for each such measure (and, if
applicable, the distinct rates associated with the measure), the baseline data
and the target performance goal applicable for each such measure or rate. The
State shall select HEDIS measures that are closely aligned with the health care
items and services that are provided to eligible individuals as medical
assistance under the waiver.</text>
</clause><clause id="idA240973CEC854361BA925FA0A8F16F88"><enum>(ii)</enum><header>Evaluation</header><text>The
description under this subparagraph shall specify the independent entity that
the State will use to evaluate the waiver. The State shall provide an assurance
that the State will submit a copy of the annual evaluation to the
Secretary.</text>
</clause></subparagraph><subparagraph id="id7553214C0C9B445ABDEA5B090BAEB2C1"><enum>(C)</enum><header>Program
integrity</header><text>A brief description of the State's program to prevent
waste, fraud, and abuse under the waiver.</text>
</subparagraph><subparagraph commented="no" id="id9203AFF256C047FEB4B1F8C955173628"><enum>(D)</enum><header>Aggregate
spending cap</header><text>An assurance that the State agrees—</text>
<clause commented="no" id="id50098063C58D4DEA89DE4126BFBA6E37"><enum>(i)</enum><text>to establish
categories that accurately account for each of the distinct population groups
that will qualify as eligible individuals under the waiver (such as children,
parents, pregnant women, and the blind or disabled) based on such criteria as
are determined appropriate by the State (referred to in this subsection as a
<term>population category</term>);</text>
</clause><clause commented="no" id="id5906EEBB268F4F20AC6E12C193FCB93C"><enum>(ii)</enum><text>to provide the
Secretary with all data relevant to the determination of the aggregate spending
cap for the State for the waiver period, as determined by the Secretary under
paragraph (3)(B); and</text>
</clause><clause commented="no" id="id844DA67A605A40979D0A1D92796D0034"><enum>(iii)</enum><text>with respect to
each period for which the waiver is approved, to not receive any Federal
payments from the Secretary for amounts expended during such period that exceed
the aggregate spending cap.</text>
</clause></subparagraph></paragraph><paragraph id="idAADAB55C687E4ECF97B5EBDAF4B6F78C"><enum>(3)</enum><header>Determination
of aggregate spending cap</header>
<subparagraph id="idE177C06A05D643A09D3DB981B85BE020"><enum>(A)</enum><header>Establishment
of spending template</header>
<clause id="id40A8FE5810D743DEBB87D5D6186EF84B"><enum>(i)</enum><header>In
general</header><text>The Secretary, in coordination with the Director of the
Office of Management and Budget (referred to in this subsection as the
<term>Director</term>), shall establish a template for determining, with
respect to each State, the aggregate spending cap for each period for which the
State conducts a comprehensive Medicaid waiver under this subsection. The
Secretary shall—</text>
<subclause id="id075C985AB896454CA67D76D06C92E8FF"><enum>(I)</enum><text>publish a
proposed template not later than 60 days after the date of enactment of this
subsection;</text>
</subclause><subclause id="id95576AB174C74F90BD1A9272B418E4EC"><enum>(II)</enum><text>provide for a
period for public comment on the proposed template; and</text>
</subclause><subclause id="idE886157A5D19481EB2955D091102A1E6"><enum>(III)</enum><text>promulgate a
final template not later than 120 days after such date of enactment.</text>
</subclause></clause><clause id="id604E9AC691C94853A69A2010065CDD4B"><enum>(ii)</enum><header>Revisions</header>
<subclause id="idFF0AE66CB61F469A859B2F5494B26AE0"><enum>(I)</enum><header>In
general</header><text>Subject to subclause (II), the Secretary, in coordination
with the Director, shall revise the template, as appropriate, not less than
every 5 years pursuant to a process that allows for public comment prior to
publication of the revised template.</text>
</subclause><subclause id="id81B21414090943F592863B3EDAF37C5D"><enum>(II)</enum><header>Technical
changes</header><text>The Secretary or the Director may make any necessary
technical or conforming changes to the template at such times and in such
manner as is determined appropriate.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="id4870A680728448F79D33A2317D533828"><enum>(B)</enum><header>Determination
of aggregate spending cap for each State</header>
<clause commented="no" id="id48F9B49D40DF4BF4BF6AA2BAFD50668C"><enum>(i)</enum><header>In
general</header><text>Subject to subparagraph (C), the aggregate spending cap
applicable to a State for a waiver period shall be equal to 99 percent of the
amount determined under clause (ii).</text>
</clause><clause commented="no" id="id99B394BD13CD4B8B8CBCBB984EF41D41"><enum>(ii)</enum><header>Total amount
of projected Federal payments</header><text>The amount described in this clause
is equal to the sum of—</text>
<subclause commented="no" id="idA8B2871298134BD9830669BCA0B55045"><enum>(I)</enum><text>the total amount
of Federal payments that would otherwise be made to the State during the waiver
period with respect to any disproportionate share payment adjustment made under
section 1923; and</text>
</subclause><subclause commented="no" id="idC97FAE41A439420EBA9C4A64C8F864F6"><enum>(II)</enum><text>the sum of the
amounts determined under clause (iii) for each population category.</text>
</subclause></clause><clause commented="no" id="idCF15E15B87EF4DE4825233D179C0AF66"><enum>(iii)</enum><header>Projected
Federal payments for medical assistance provided to population
categories</header><text>For purposes of clause (ii)(II), the Secretary and the
Director shall calculate the amount of projected expenditures for the provision
of medical assistance to eligible individuals in each population category
during the waiver period (as determined based upon the population categories
established and the data provided by the State pursuant to paragraph (2)(D), as
well as the annual baseline estimates supplied by the Director and such other
data as is determined appropriate by the Secretary), which shall be equal to
the product of—</text>
<subclause commented="no" id="id2ECDCEDC508C4862873640BBE577EAF7"><enum>(I)</enum><text>subject to clause
(iv), the monthly per capita amount of Federal payments that were made to the
State under the State plan under title XIX (or under a waiver approved under
subsection (d) or extended under subsection (e)) for an individual in such
population category during the fiscal year prior to the State application for
the waiver (referred to in this paragraph as the <term>population category per
capita baseline</term>);</text>
</subclause><subclause commented="no" id="id9C8055BEA4384F01931209FE1DC248AF"><enum>(II)</enum><text>the number of
individuals within such population category that are projected to be eligible
to receive medical assistance during the waiver period; and</text>
</subclause><subclause commented="no" id="id05FFA117B2544B5C9AC3FA7C4E473410"><enum>(III)</enum><text>the number of
months in the waiver period.</text>
</subclause></clause><clause commented="no" id="id85322E26AC404CFB9E5062A8DCE15DCE"><enum>(iv)</enum><header>Population
categories with no baseline data</header><text>For purposes of any
determination under clause (iii)(I) for a population category that lacks
sufficient data to calculate the population category per capita baseline and
that consists of individuals for which the State would otherwise be required to
provide medical assistance to pursuant to section 1902(a)(10)(A)(i)(VIII), the
population category per capita baseline shall be equal to the monthly per
capita amount of Federal payments that would otherwise have been made to the
State under the State plan under title XIX (or under a waiver approved under
subsection (d) or extended under subsection (e)) during the preceding fiscal
year for an individual who is under 65 years of age, not pregnant, not entitled
to, or enrolled for, benefits under part A of title XVIII, or enrolled for
benefits under part B of title XVIII.</text>
</clause><clause commented="no" id="id76343F544CAB47089A3C3E9AB66586B6"><enum>(v)</enum><header>Budget
neutrality</header><text>In no event shall the aggregate spending cap
established for a State for a waiver period allow for Federal payments to the
State during the waiver period that exceed the amount of Federal payments to
the State that would have been made during that period if the State had not
elected to conduct a comprehensive Medicaid waiver under this subsection during
the period.</text>
</clause></subparagraph><subparagraph commented="no" id="idDBABE583B64A4D0490F43FBCEFE0D481"><enum>(C)</enum><header>Adjustment of
aggregate spending cap for high unemployment</header><text>For purposes of
subparagraph (B)(i), if the average monthly unemployment rate (as defined in
paragraph (8)(A)) for a State exceeds 10 percent for any consecutive period of
at least 6 months occurring during the waiver period, the aggregate spending
cap applicable to the State for such waiver period shall be equal to 100
percent of the amount determined under subparagraph (B)(ii).</text>
</subparagraph></paragraph><paragraph id="idC2D5B27AFCBF4F5C9941EA66FA91C712"><enum>(4)</enum><header>Shared savings
bonuses</header>
<subparagraph id="id2F317FE1143E4C628E95BBA392C6B7E3"><enum>(A)</enum><header>In
general</header><text>The Secretary shall annually pay each State conducting a
comprehensive Medicaid waiver under this subsection an amount equal to 25
percent of the waiver savings determined with respect to a State and a waiver
period under subparagraph (C).</text>
</subparagraph><subparagraph id="id8E92FD23AF454707B3FF9A84E7C02EC8"><enum>(B)</enum><header>Dedicated to
health care</header><text>A State that receives a payment under this paragraph
shall spend not less than 80 percent of the payment on health care services or
health-related activities for eligible individuals.</text>
</subparagraph><subparagraph id="idA597C198A67243408F886ED3A2ED83FE"><enum>(C)</enum><header>Determination
of waiver savings</header><text>The Secretary and the Director shall establish
a process for determining with respect to a State and a waiver period the
amount of savings achieved by a State for the period. The process shall take
into account the difference between the aggregate spending cap applicable to
the State for the waiver period and the total amount expended by the State
under the waiver for the period.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID939CC789F68B4C53891A778F4B501F39"><enum>(D)</enum><header display-inline="yes-display-inline">Payment; retrospective
adjustment</header><text display-inline="yes-display-inline">The Secretary
shall make annual payments under this paragraph on the basis of claims
submitted by the State for expenses paid by the State for medical assistance
provided under the waiver, and such other investigation as the Secretary or the
Director may find necessary, and may reduce or increase the payments as
necessary to adjust for prior overpayments or under payments under this
paragraph.</text>
</subparagraph></paragraph><paragraph id="id868676AFB76047D1BDD97F8D5C6650F9"><enum>(5)</enum><header>Duration</header>
<subparagraph id="id2E7275DF429A42878540943145074176"><enum>(A)</enum><header>In
general</header><text>A State shall conduct a comprehensive Medicaid waiver
under this subsection for a 5-year period. Subject to subparagraph (B), a
comprehensive Medicaid waiver may be renewed for additional 3-year periods upon
the request of the State, unless within 90 days after receipt of a State
request for a renewal of a waiver, the Secretary and the Director determine,
based on the State evaluations required under paragraph (2)(B), that the waiver
should not be renewed.</text>
</subparagraph><subparagraph commented="no" id="id1E22319DCDF84076BB2EF204556ABF9C"><enum>(B)</enum><header>State
evaluations and target performance goals</header><text>For purposes of
subparagraph (A), the Secretary and the Director may not renew a waiver unless
each of the measures or rates selected by the State pursuant to paragraph
(2)(B) has improved or remained constant during the waiver period.</text>
</subparagraph></paragraph><paragraph id="id639A7050845D4E41B4E4F969F06CACDC"><enum>(6)</enum><header>Limited
Secretarial authority; administrative and judicial review</header>
<subparagraph id="id3269261E4D8146FDBE4F627EA345C66B"><enum>(A)</enum><header>Certification
of waiver applications</header>
<clause id="id308E8F5335DC42B0AE92A53F4DA0BC70"><enum>(i)</enum><header>In
general</header><text>Except as provided under clause (ii), the Secretary and
the Director shall have 90 days from receipt of an application by a State for a
comprehensive Medicaid waiver to certify the application as satisfying the
requirements of paragraph (2).</text>
</clause><clause id="id60B7EA1504244B528476A859E1FC6F3B"><enum>(ii)</enum><header>Inquiries</header><text>The
Secretary and the Director may submit a single set of inquiries for additional
information to the State during the initial 90-day period described under
clause (i). If a State receives a set of inquires, the State shall have up to
60 days to respond. The Secretary and the Director shall have an additional
30-day period, starting on the date the Secretary receives a State response to
a set of inquiries, to make a final determination as to whether the State's
waiver application may be certified as complying with the requirements of
paragraph (2).</text>
</clause><clause id="idB10B427C0D8C4A81A60098282870FCC5"><enum>(iii)</enum><header>Failure to
respond by the Secretary</header><text>An application by a State for a
comprehensive Medicaid waiver shall be deemed certified by the Secretary if the
Secretary does not submit any inquiries during the initial 90-day review
period.</text>
</clause><clause id="id7EDFA29021AD440B81804699E46EFE22"><enum>(iv)</enum><header>Effective
date</header><text>A waiver that has been certified by the Secretary (or deemed
to be certified) may be effective, at the discretion of the State, as of the
first day of the calendar quarter in which the application for the waiver was
submitted by the State.</text>
</clause></subparagraph><subparagraph id="idF91B1D5145A84BEE8291679F9D18E635"><enum>(B)</enum><header>Denial of
waiver applications or renewal requests</header>
<clause id="id8E0C04E09000480F915FF0866743F265"><enum>(i)</enum><header>In
general</header><text>If the Secretary and the Director determine that an
application for a comprehensive Medicaid waiver, or a request for extension of
an existing comprehensive Medicaid waiver, does not satisfy the requirements of
paragraph (2), the Secretary shall notify the State of the disapproval by
written notification, not later than 10 days following the issuance of such
determination and shall provide a detailed description of the reasons for the
denial of the waiver to—</text>
<subclause id="id4A700A932E64482A977E15D12DBE8485"><enum>(I)</enum><text>the State that
submitted the waiver application or extension request;</text>
</subclause><subclause id="idEE265D080533467FA1DD3CB64DAF1B01"><enum>(II)</enum><text>the members of
Congress representing such State; and</text>
</subclause><subclause id="id54E5E4B29B944913A3263DF95C289FD1"><enum>(III)</enum><text>the Committee
on Finance of the Senate and the Committee on Energy and Commerce of the House
of Representatives.</text>
</subclause></clause><clause id="idFD7A4FF1ECCC4AA0A50A980551B92697"><enum>(ii)</enum><header>Administrative
and judicial review</header>
<subclause id="idEF0CAD0D07004C608946A1540C02A927"><enum>(I)</enum><header>Administrative
review</header><text>Within 60 days after the date that a State receives notice
of the denial of a waiver application or extension request, the State may
appeal the determination to the Departmental Appeals Board established in the
Department of Health and Human Services. The Departmental Appeals Board shall
make a final determination with respect to an appeal filed under this
subparagraph not less than 60 days after the date on which the appeal is
filed.</text>
</subclause><subclause id="idBDAF0FE520B842559F5B42287B1101B3"><enum>(II)</enum><header>Judicial
review</header><text>Within 60 days after the date of a final decision by the
Board under subclause (I) that is adverse to a State, the State may obtain
judicial review of the final decision by filing an action in the district court
of the United States for the judicial district in which the principal or
headquarters office of the State agency responsible for administering the State
Medicaid program is located or the United States District Court for the
District of Columbia.</text>
</subclause></clause></subparagraph><subparagraph id="idB79126BD1751442DA9CDE96B93BB4214"><enum>(C)</enum><header>Reports</header>
<clause id="idBCB0625D52524F059F42BB1D109598A1"><enum>(i)</enum><header>In
general</header><text>Not later than 2 years after the date on which the
Secretary and the Director first approve an application for a comprehensive
Medicaid waiver under this subsection and every 3 years thereafter, the
Comptroller General of the United States (referred to in this subparagraph as
the <term>Comptroller</term>) shall submit to the Committee on Finance of the
Senate and the Committee on Energy and Commerce of the House of Representatives
a report on the waivers certified as of the date of such report. Each report
shall include an evaluation of the quality and cost-effectiveness of the
comprehensive Medicaid waivers in effect during the reporting period in
providing medical assistance to eligible individuals, as well as the financial
effort of the waiver on State and Federal budgets.</text>
</clause><clause id="idE0633E9CAFCD4F96909C21AB882D2D06"><enum>(ii)</enum><header>Reporting of
information</header><text>A State with a comprehensive Medicaid waiver under
this subsection shall provide the Comptroller, in such form and manner as the
Comptroller may require, with any relevant information regarding the waiver,
including total expenditures by the State under the waiver, the number of
individuals provided medical assistance under the waiver, and such other
information as the Comptroller may require for purposes of preparing the
reports required under this subparagraph.</text>
</clause></subparagraph></paragraph><paragraph id="id9C7491BC7671454AAF4BCF1E123352A3"><enum>(7)</enum><header>Non-applications</header><text>A
comprehensive Medicaid waiver shall not apply to—</text>
<subparagraph id="id1CB905572A7244CFB5B91AE50DAEC33B"><enum>(A)</enum><text>the pediatric
vaccine program under section 1928; and</text>
</subparagraph><subparagraph id="idB6E2E3CA3E9B4088B9B9E4D6F19E5E7D"><enum>(B)</enum><text>limitations on
total payments to territories under section 1108.</text>
</subparagraph></paragraph><paragraph id="id40D762ECD3FA45E886535FA1D34CF14A"><enum>(8)</enum><header>Outreach and
education</header>
<subparagraph id="idFC3D4DE5C44A479FB6B8D40E0CA86B9C"><enum>(A)</enum><header>State
awareness</header><text>Not later than 30 days after the date of enactment of
this subsection, the Secretary shall conduct an outreach and education campaign
to States regarding the availability of comprehensive Medicaid waivers under
this subsection.</text>
</subparagraph><subparagraph id="id504071EFE67D46DE81B42B24524F0DCE"><enum>(B)</enum><header>Public notice
and comment</header><text>Before submitting an application for a comprehensive
Medicaid waiver, a State shall make the proposed application available to the
public through such means as the State determines appropriate and allow for a
reasonable public comment period of not greater than 30 days.</text>
</subparagraph><subparagraph id="id02EB2A3708CB4655A706EB01C913932C"><enum>(C)</enum><header>Public
awareness of approved waiver</header><text>A State that has been certified for
a comprehensive Medicaid waiver shall conduct an outreach and education
campaign to ensure that health care providers and eligible individuals within
the State are provided with adequate notice regarding the methods and criteria
through which the State intends to provide medical assistance under the
waiver.</text>
</subparagraph></paragraph><paragraph id="id6705C7B532394721A0E1A9E93A7C9C9B"><enum>(9)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph id="idA02CBD880E7E41EAA4547F9E90BD78EB"><enum>(A)</enum><header>Average monthly
unemployment rate</header><text>The term <term>average monthly unemployment
rate</term> means the average of the monthly number unemployed in the State,
divided by the average of the monthly civilian labor force in the State,
seasonally adjusted, as determined based on the most recent monthly
publications of the Bureau of Labor Statistics of the Department of
Labor.</text>
</subparagraph><subparagraph id="id9245EAB665FE4EAD828AEA45C32E7B4F"><enum>(B)</enum><header>Eligible
individual</header><text>The term <term>eligible individual</term> means, for
each year during the waiver period—</text>
<clause id="idC917EC51AA314EB3A26AB712C22861DF"><enum>(i)</enum><text>any individual
who, for such year, the State would otherwise be required to provide medical
assistance to pursuant to—</text>
<subclause id="id54594EA92BF5411E923CD11F67B361E6"><enum>(I)</enum><text>section
1902(a)(10)(A)(i);</text>
</subclause><subclause id="idF159CD9CE20A428E8FC65AEFD9771BF3"><enum>(II)</enum><text>paragraphs (1)
or (4) of section 1902(e);</text>
</subclause><subclause id="idA5D8AB91347C4DD08E55D80F933D5AE0"><enum>(III)</enum><text>section 1925;
or</text>
</subclause><subclause id="idE3B32DEA86A64D84BC6CE597A146889A"><enum>(IV)</enum><text>section
1931;</text>
</subclause></clause><clause id="id1DED7347413C4ACBB56BD0A4B91C2B1A"><enum>(ii)</enum><text>at the option of
the State, any individual who, for such year, the State would otherwise provide
child health assistance to under the State child health plan under title XXI;
and</text>
</clause><clause id="id1B9789EAC846433CA0F837A02FCFC3F3"><enum>(iii)</enum><text>at the option
of the State, any individual who is not described in clause (i) or (ii) and who
satisfies such income, resources, health status, or other criteria as the State
may establish.</text>
</clause></subparagraph><subparagraph id="idFF8B3F6AFC2045988B76FD00807C3B71"><enum>(C)</enum><header>Medical
assistance</header><text>The term <term>medical assistance</term> means—</text>
<clause id="idBED20C22765F478DB257CF0019C1AC14"><enum>(i)</enum><text>health care
coverage (as determined by the State); and</text>
</clause><clause id="id1CDDE6283DF747428337E7411F6C7DBD"><enum>(ii)</enum><text>rehabilitation
and other services to help eligible individuals attain or retain capability for
independence or self-care, such as home and community-based services.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id54C6BD343B38410CA1CDEAE48AC2D858"><enum>(D)</enum><header>State Medicaid
program</header><text>The term <term>State Medicaid program</term> means the
State program for medical assistance provided under a State plan under title
XIX, including any waiver that has been approved with respect to a State plan
prior to an application by the State for a comprehensive Medicaid waiver under
this
subsection.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idEA38DB23369C4D60BB81262BC686D7DD"><enum>1102.</enum><header>Phased-in
elimination of allowable provider taxes under Medicaid</header>
<subsection id="id6FEA0645656E43ED8B956B4539D710AB"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Clause (ii) of
section 1903(w)(4)(C) of the Social Security Act (42 U.S.C. 1396b(w)(4)(C)) is
amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="id6AEA681795ED431CB32DB3AE263A5F03" style="OLC">
<clause id="id8AE5F17A9CA44992A762AF21BB1497E7" indent="up2"><enum>(ii)</enum><text>For purposes of clause (i), a
determination of the existence of an indirect guarantee shall be made under
paragraph (3)(i) of section 433.68(f) of title 42, Code of Federal Regulations,
as in effect on November 1, 2006, except that—</text>
<subclause id="id44B4098269A64E7EB2C70C06FA0CF21E"><enum>(I)</enum><text>for portions of fiscal years
beginning on or after January 1, 2008, and before October 1, 2011, <quote>5.5
percent</quote> shall be substituted for <quote>6 percent</quote> each place it
appears;</text>
</subclause><subclause id="id7EBECC10DB04409C87436CBACA9D3445"><enum>(II)</enum><text>for fiscal years 2012 and 2013,
the percentage specified under such paragraph shall apply;</text>
</subclause><subclause id="idB5ACDE7D528A44348DBA88997EC49E0A"><enum>(III)</enum><text>for fiscal years 2014 through
2022, the percentage determined under clause (iii) for the fiscal year shall be
substituted for <quote>6 percent</quote> each place it appears; and</text>
</subclause><subclause id="idEC20D20981024A08ACED986BF707D275"><enum>(IV)</enum><text>for fiscal year 2023 and each
fiscal year thereafter, <quote>0 percent</quote> shall be substituted for
<quote>6 percent</quote> each place it appears.</text>
</subclause></clause><clause id="id1AC13A2597DB44A2B1864C6D0F9C19DC" indent="up2"><enum>(iii)</enum><text>For purposes of clause (ii)(III),
the percentage determined under this clause shall be equal to the percentage
applicable under subclause (II) or (III) of clause (ii) for the preceding
fiscal year, reduced by 0.6 percentage
points.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id2330F52C4F03499994A3F97FEBFA1670"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall take effect on
October 1, 2013.</text>
</subsection></section><enum>II</enum><header>Medicare</header>
<subtitle id="id5F38CF98B4A646E0AAE4B30B8336FB44"><enum>A</enum><header>Medicare Total
Health program; Medicare Fee-for-Service program reforms; Reports</header>
<section id="id2C5C7AE17F8F4EE3A3B313575A22D030"><enum>2000.</enum><header>Short title;
purpose</header>
<subsection id="id7E71ECB08ED141A6BF6EC31BBD4AF064"><enum>(a)</enum><header>Short
title</header><text>This subtitle may be cited as the <quote>Medicare Total
Health Act of 2012</quote>.</text>
</subsection><subsection id="idD658BAAD2DAE4200B2F0CFE33ACD47A6"><enum>(b)</enum><header>Purpose</header><text>The
purpose of this subtitle is to amend title XVIII of the Social Security Act to
improve the sustainability of the Medicare program by establishing a Total
Health system, reforming the Medicare fee-for-service program, and for other
purposes.</text>
</subsection></section><part id="idF751B8343815488A9C50BE7CB0516DAA"><enum>I</enum><header>Medicare Total
Health program</header>
<section id="id007F39B0410B421783F31344C0650E26"><enum>2001.</enum><header>Establishment
of Medicare Total Health program</header>
<subsection id="idCF5C83E82F86475BBA1B265F35D6F2E8"><enum>(a)</enum><header>Sunset of
Medicare Advantage plans</header><text>Section 1851(a)(1) of the Social
Security Act (42 U.S.C. 1395w–21(a)(1)), in the matter preceding subparagraph
(A), is amended by striking <quote>Subject to</quote> and inserting <quote>For
plan years beginning prior to January 1, 2017, and subject to</quote>.</text>
</subsection><subsection id="id89DFBB3C728D42C5B13B88A2784C8006"><enum>(b)</enum><header>Establishment</header><text>Part
C of title XVIII of the Social Security Act (42 U.S.C. 1395w–21 et seq.) is
amended—</text>
<paragraph id="idCE12AAAE841E418B882DFD56054905DF"><enum>(1)</enum><text>in the part
heading, by striking <quote><header-in-text level="part" style="OLC">Medicare+Choice program</header-in-text></quote> and inserting
<quote><header-in-text level="part" style="OLC">Medicare Advantage program;
Medicare Total Health Program</header-in-text></quote>;</text>
</paragraph><paragraph id="id33DF6147C450402BB8C00B4E06CC4EFF"><enum>(2)</enum><text>by inserting
before section 1851 the following:</text>
<quoted-block display-inline="no-display-inline" id="id5219DB500F514D088D283DF16005360F" other-style="archaic" style="other">
<subpart id="id6EF9154EA88A4CFD9260ED418297FA22"><enum>1</enum><header>Medicare
Advantage program</header>
</subpart><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="id58D15E3A07D242F8B40933E94C1A654C"><enum>(3)</enum><text>by adding at the
end the following new subpart:</text>
<quoted-block display-inline="no-display-inline" id="id7EFA133D75C54B9B90827BCA065D02D2" style="traditional">
<subpart id="idF7A3540FCE5941C994E08915F536C96F"><enum>2</enum><header>Medicare Total
Health program</header>
<section id="id32A015AA93EE4E09AB6B56AF0B3781F7"><enum>1860C–1.</enum><header>Eligibility, enrollment, and
information</header><subsection commented="no" display-inline="yes-display-inline" id="id5CAE35EA81354AF1B58FE1C181B45CA1"><enum>(a)</enum><header>Eligibility</header>
<paragraph id="id486B6CCAF11843A291DB9E5EA28A68E2"><enum>(1)</enum><header>In
general</header><text>Notwithstanding section 1851(a)(1) and subject to the
succeeding provisions of this subpart, each Total Health eligible individual
(as defined in paragraph (3)) may elect to receive benefits under this
title—</text>
<subparagraph id="id7DE613A135314370AEA97C6BF31DD526"><enum>(A)</enum><text>through the
original medicare fee-for-service program under parts A and B, including the
option to elect qualified prescription drug coverage in accordance with section
1860D–1; or</text>
</subparagraph><subparagraph id="id8D09002F7F8E41048F807A82970C1554"><enum>(B)</enum><text>through
enrollment in a Total Health plan under this subpart.</text>
</subparagraph></paragraph><paragraph id="idDE70F5CFE9764D95B9DCB41E49B041F0"><enum>(2)</enum><header>Coverage first
effective January 1, 2017</header><text>Coverage under the Medicare Total
Health program shall first be effective on January 1, 2017.</text>
</paragraph><paragraph id="id16C4D7B21A464D8DBC0DB061DF01ED3F"><enum>(3)</enum><header>Total health
eligible individual</header><text>For purposes of this subpart, the term
<term>Total Health eligible individual</term> means an individual who is
entitled to benefits under part A and enrolled under part B who resides in a
Total Health region.</text>
</paragraph><paragraph id="id2498AF77FAF1471298221E229AE6E91C"><enum>(4)</enum><header>Types of total
health plans that may be available</header><text>A Total Health plan may be any
of the types of plans of health insurance described in section 1851(a)(2)(A),
including a plan for special needs individuals described in clause (ii) of such
section.</text>
</paragraph></subsection><subsection id="id10ECA804CF064F8C94CD72433983184E"><enum>(b)</enum><header>Enrollment
process for Total Health plans</header>
<paragraph id="id74F8F2028D54465EA65FD6EC965387D7"><enum>(1)</enum><header>Establishment
of process</header>
<subparagraph id="idEBDF39E9E9F24B87A6EFD017EBA88843"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish a process for the
enrollment, disenrollment, termination, and change of enrollment of Total
Health eligible individuals in Total Health plans in a manner similar to (and
coordinated with) the process established under section 1860D–1(b)(1).</text>
</subparagraph><subparagraph id="id031EB6545B6D463B9D5458E65A2665C1"><enum>(B)</enum><header>Requirements</header><text>Except
as otherwise provided in this subsection, the process established under
subparagraph (A) shall include a residency requirement similar to the residency
requirement described in section 1851(b)(1) and shall take into account the
process for exercising choice described in section 1851(c).</text>
</subparagraph></paragraph><paragraph id="idFADF958F349246B381FAB5DAEF2F358E"><enum>(2)</enum><header>Initial
enrollment period</header>
<subparagraph id="id4FA21D8C03E54088A8E37BCE119EE012"><enum>(A)</enum><header>Program
initiation</header><text>In the case of an individual who is a Total Health
eligible individual as of November 15, 2016, there shall be an initial
enrollment period beginning on October 15, 2016, and ending on December 7,
2016.</text>
</subparagraph><subparagraph id="idAF983052106647B592D700C9B47B48BD"><enum>(B)</enum><header>Continuing
periods</header><text>In the case of an individual who first becomes a Total
Health eligible individual after November 15, 2016, there shall be an initial
enrollment period which is the same as the period under section
1851(e)(1).</text>
</subparagraph></paragraph><paragraph id="idDC95EB3BF7344D45B3C8EE1E5227C255"><enum>(3)</enum><header>Annual,
coordinated election period</header>
<subparagraph id="id68CE679D7F9247DAB4F07159A6DC24B4"><enum>(A)</enum><header>In
general</header><text>As part of the process established under paragraph (1),
each individual who is eligible to make an election under this section may
change such election during an annual, coordinated election period.</text>
</subparagraph><subparagraph id="idDD4529C057F2407E82C684924D2E3C7D"><enum>(B)</enum><header>Annual,
coordinated election period</header><text>For purposes of this section, the
term <term>annual, coordinated election period</term> means, with respect to
2017 and succeeding years, the period beginning on October 15 and ending on
December 7 of the year before such year.</text>
</subparagraph></paragraph><paragraph id="id921CF0E112934991AB0A5070D1B7EC80"><enum>(4)</enum><header>Special
enrollment periods</header><text>The Secretary shall establish special
enrollment periods that are similar to the special enrollment periods
established under section 1851(e)(4).</text>
</paragraph><paragraph id="idD6C4A6EE57E44398948C8FDA16FCA029"><enum>(5)</enum><header>Special
rule</header>
<subparagraph id="id6A8F36C8B9074C2BA16AEBA767DC6E01"><enum>(A)</enum><header>In
general</header><text>Notwithstanding any other provision of law, the process
established under paragraph (1) shall include, in the case of a Total Health
eligible individual who has failed to enroll in either the original medicare
fee-for-service program option or a Total Health plan prior to the beginning of
a plan year (including a full-benefit dual eligible individual (as defined in
section 1935(c)(6))), for the enrollment in a Total Health plan with a monthly
beneficiary premium under section 1860C–7(a) (taking into account any
adjustment under subparagraph (B) or (C) of section 1860C–7(a)(2) and without
regard to any adjustment under subparagraph (D) or (E) of such section) that
does not exceed the base beneficiary premium computed under section
1860C–7(a)(1).</text>
</subparagraph><subparagraph id="idC46FE5A8157545C9899F519C627F3480"><enum>(B)</enum><header>Selection of
plan by the secretary</header><text>In selecting a plan for the enrollment of a
Total Health eligible individual under subparagraph (A), the Secretary shall
first attempt to identify the Total Health plan in which the cost-sharing and
health benefits are most similar to the coverage the individual had in the
preceding plan year. If there is more than one such plan available, the
Secretary shall enroll such an individual on a random basis among all such
plans in the Total Health region. Nothing in the previous sentence shall
prevent such an individual from declining or changing such enrollment.</text>
</subparagraph><subparagraph id="id7AD2F863D2844A59BD45039A5303BD5A"><enum>(C)</enum><header>Individuals who
are not total health eligible individuals</header><text>The Secretary shall
establish procedures under which individuals who are entitled to, or enrolled
for, coverage under part A or enrolled for coverage under part B (but not
both), may continue to receive benefits with deductible and coinsurance amounts
comparable to the benefits, deductible, and coinsurance amounts they would have
received if this subpart had not been enacted.</text>
</subparagraph></paragraph></subsection><subsection id="id7A0FA2F699F74C9A8D4AB0D52D35EC9F"><enum>(c)</enum><header>Providing
information to beneficiaries</header>
<paragraph id="id7FB5A37A812747E4A0E95FD6B6457F46"><enum>(1)</enum><header>In
general</header><text>The Secretary shall conduct activities that are designed
to broadly disseminate information to Total Health eligible individuals (and
prospective Total Health eligible individuals) regarding the coverage provided
under this subpart. Such activities shall ensure that such information is first
made available at least 30 days prior to the initial enrollment period
described in subsection (b)(2)(A).</text>
</paragraph><paragraph id="id04E2B9C1C5EE473B9342E1448C874579"><enum>(2)</enum><header>Activities</header><text>The
activities conducted under paragraph (1) shall be similar to the activities
described in paragraph (2) of section 1860D–1(c) and contain comparative
information similar to the information described in paragraph (3) of such
section.</text>
</paragraph></subsection></section><section id="idD716C38A39B14AD5A84AB187F210DA4D"><enum>1860C–2.</enum><header>Total Health plan
benefits</header><subsection commented="no" display-inline="yes-display-inline" id="id9654DCEB12F64BA5A365279943229416"><enum>(a)</enum><header>Requirements</header>
<paragraph id="id980EFB64CC074151998C9C501061A103"><enum>(1)</enum><header>Qualified total
health benefits</header><text>Each Total Health plan shall provide to
individuals enrolled under this subpart, through providers and other persons
that meet the applicable requirements of this title and part A of title XI, a
qualified Total Health benefits package and qualified prescription drug
coverage (described in section 1860D–2(a)).</text>
</paragraph><paragraph id="idD19901FCBC484E12B5A09D34F9B1612F"><enum>(2)</enum><header>Definition of
qualified total health benefits package</header><text>For purposes of this
subpart, the term <term>qualified Total Health benefits package</term> means
either of the following:</text>
<subparagraph id="id0C451AE66AFE45B28AE4D5DD73364876"><enum>(A)</enum><header>Standard health
benefits coverage with access to negotiated prices</header><text>Standard
health benefits coverage (as defined in subsection (b)) and access to
negotiated prices under subsection (d).</text>
</subparagraph><subparagraph id="id18B00EB0A9824C00A7B869A0C74C8AB9"><enum>(B)</enum><header>Alternative
total health benefits coverage with at least actuarially equivalent benefits
and access to negotiated prices</header><text>Coverage of health benefits which
meets the alternative health benefits coverage requirements under subsection
(c) and access to negotiated prices under subsection (d), but only if the
benefit design of such coverage is approved by the Secretary, as provided under
subsection (c).</text>
</subparagraph></paragraph><paragraph id="id876BD5D5EF62478CB6BAB09FA5D687EB"><enum>(3)</enum><header>Permitting
supplemental health benefits coverage</header>
<subparagraph id="idFFDDF2829E0D44DD80FDEB433E45A420"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), a qualified Total Health
benefits package may include supplemental health benefits coverage consisting
of either or both of the following:</text>
<clause id="idEDFC02FDA9E44DE88D9511754B3B6D57"><enum>(i)</enum><header>Certain
reductions in cost-sharing</header>
<subclause id="idCF47844BDC014C70809F2477633F7DE8"><enum>(I)</enum><header>In
general</header><text>A reduction in the annual deductible or a reduction in
the coinsurance percentage, or any combination thereof, insofar as such a
reduction or increase increases the actuarial value of benefits above the
actuarial value of a basic Total Health benefits package.</text>
</subclause><subclause id="id4CC0F5C424EE44A9A03386C8199AD77A"><enum>(II)</enum><header>Construction</header><text>Nothing
in this clause shall be construed as affecting the application of subsection
(c)(3).</text>
</subclause></clause><clause id="id9E68F6C7D68B4EA89FD35DDA17B2EDE1"><enum>(ii)</enum><header>Additional
benefits</header><text>Coverage of any health care item or service that is not
covered under the original medicare fee-for-service program option or that is
eligible for coverage under part D, subject to the approval of the
Secretary.</text>
</clause></subparagraph><subparagraph id="id135C2ECFB7D74611AA0B9EFC675B92F9"><enum>(B)</enum><header>Requirement for
at least one basic benefits plan</header><text>A Total Health sponsor may not
offer a Total Health plan that provides supplemental health benefits coverage
pursuant to subparagraph (A) in an area unless the sponsor also offers a Total
Health plan in the area that only provides a basic Total Health benefits
package.</text>
</subparagraph></paragraph><paragraph id="id06FB85A678FA48BA8D7520E7371C1F1F"><enum>(4)</enum><header>Basic total
health benefits package</header><text>For purposes of this subpart, the term
<term>basic Total Health benefits package</term> means either of the
following:</text>
<subparagraph id="id0301B28B0613446ABF21B7F2EA22576B"><enum>(A)</enum><text>Coverage that
meets the requirements of paragraph (2)(A).</text>
</subparagraph><subparagraph id="id2A62CE2464114DCBA1C8499C8206B5BE"><enum>(B)</enum><text>Coverage that
meets the requirements of paragraph (2)(B) but does not have any supplemental
health benefits coverage described in paragraph (3)(A).</text>
</subparagraph></paragraph><paragraph id="id84845866238E4F1E840024999CF808F8"><enum>(5)</enum><header>Application of
secondary payer provisions</header><text>The provisions of section 1852(a)(4)
shall apply under this subpart in the same manner as such provisions applied to
a Medicare Advantage plan.</text>
</paragraph><paragraph id="idEF9FECC223484A619843A540A1E533C2"><enum>(6)</enum><header>Construction</header><text>Nothing
in this subsection shall be construed as changing the computation of incurred
costs under subsection (b)(3).</text>
</paragraph></subsection><subsection id="id0E29BDDFEE1C41F0A1F8EA7468892166"><enum>(b)</enum><header>Standard health
benefits coverage</header><text>For purposes of this subpart, the term
<term>standard health benefits coverage</term> means coverage of benefits under
the original medicare fee-for-service program option (as defined in section
1852(a)(1)(B)), including the following requirements:</text>
<paragraph id="idE4B77F8177FE47BABB042AADED977BD0"><enum>(1)</enum><header>Deductible</header><text>The
coverage has an annual deductible that is equal to the amount of the unified
deductible for the year under section 1899C.</text>
</paragraph><paragraph id="id0D50C280F0DA4654892989FA75A56793"><enum>(2)</enum><header>20 percent
coinsurance</header><text>The coverage has coinsurance (for costs above the
annual deductible specified in paragraph (1) and up to the first threshold
annual out-of-pocket limit specified in paragraph (3)(B)(i)) that is—</text>
<subparagraph id="id23FE49E492FD4880AFCB674A321D3E3A"><enum>(A)</enum><text>equal to 20
percent; or</text>
</subparagraph><subparagraph id="id227054F21D7A47699183DC1F39F0296A"><enum>(B)</enum><text>actuarially
equivalent (using processes and methods established by the Secretary) to an
average expected payment of 20 percent of such costs.</text>
</subparagraph></paragraph><paragraph id="idDEE321C0FCC9463A9C298D39E9019024"><enum>(3)</enum><header>Protection
against high out-of-pocket expenditures</header>
<subparagraph id="idE505FCE1E76849988FA330B538501240"><enum>(A)</enum><header>In
general</header><text>The coverage provides benefits, after the Total Health
eligible individual has incurred costs (as described in subparagraph (C)) for
health benefits in a year equal to—</text>
<clause id="id4400ABE9099543F3979923170B9E7268"><enum>(i)</enum><text display-inline="yes-display-inline">the first threshold annual out-of-pocket
limit specified in subparagraph (B)(i) for that year but less than the second
threshold annual out-of-pocket limit specified in subparagraph (B)(ii) for that
year, with coinsurance that is equal to 5 percent; and</text>
</clause><clause id="idEA31BDC9CCA84AFAA315189E97BCAA22"><enum>(ii)</enum><text display-inline="yes-display-inline">the second threshold annual out-of-pocket
limit specified in subparagraph (B)(ii) for that year, without
coinsurance.</text>
</clause></subparagraph><subparagraph id="idC3C59A5FC01B452FA1CF24329EFE7C10"><enum>(B)</enum><header>Annual
out-of-pocket limits specified</header><text>For purposes of this
subpart:</text>
<clause id="id33B539F837664AB8AFCD8064D1ECC66C"><enum>(i)</enum><header>First threshold
annual out-of-pocket limit specified</header><text>The <quote>first threshold
annual out-of-pocket limit</quote> specified in this clause is equal to the
first threshold annual out-of-pocket limit for the year specified in section
1899B(b)(1).</text>
</clause><clause id="id95B8DB916EE7490493862643DB10FAC5"><enum>(ii)</enum><header>Second
threshold annual out-of-pocket limit specified</header><text>The <quote>second
threshold annual out-of-pocket limit</quote> specified in this clause is equal
to the second threshold annual out-of-pocket limit for the year specified in
section 1899B(b)(2).</text>
</clause></subparagraph><subparagraph id="id5ECA76F3834E4EF2963127849C5C6EF5"><enum>(C)</enum><header>Application</header><text>In
applying subparagraph (A), incurred costs shall only include costs incurred
with respect to health benefits for the annual deductible described in
paragraph (1) and for cost-sharing described in paragraph (2) or paragraph
(3)(A)(i), or for benefits that would have otherwise been covered under the
plan but for the exhaustion of those benefits. Incurred costs do not include
any costs incurred for health benefits which are not included (or treated as
being included) under the plan.</text>
</subparagraph></paragraph></subsection><subsection id="id496FD2AE5F044AA1B7C3C14050DCB330"><enum>(c)</enum><header>Alternative
total health benefits coverage requirements</header><text>A Total Health plan
may provide a different benefit design from standard health benefits coverage
so long as the Secretary determines that the following requirements are met and
the plan applies for, and receives, the approval of the Secretary for such
benefit design:</text>
<paragraph id="id6825B366C8D54BEE93A884C0F271FC21"><enum>(1)</enum><header>Assuring at
least actuarially equivalent coverage</header>
<subparagraph id="id32D3F15CA5AA4A6D86004D0ED821DFF8"><enum>(A)</enum><header>Assuring
equivalent value of total coverage</header><text>The actuarial value of the
total coverage is at least equal to the actuarial value of standard health
benefits coverage.</text>
</subparagraph><subparagraph id="idC685D3AED4A242B6B8F35FEE0C0016E5"><enum>(B)</enum><header>Assuring
equivalent unsubsidized value of coverage</header><text>The unsubsidized value
of the coverage is at least equal to the unsubsidized value of standard health
benefits coverage. For purposes of this subparagraph, the unsubsidized value of
coverage is the amount by which the actuarial value of the coverage exceeds the
subsidy payments with respect to such coverage.</text>
</subparagraph><subparagraph id="id6D43FA465B374141ADEEE2E3E965891E"><enum>(C)</enum><header>Assuring
standard payment for costs below first threshold annual out-of-pocket
limit</header><text>The coverage is designed, based upon an actuarially
representative pattern of utilization, to provide for the payment, with respect
to costs incurred up to the first threshold annual out-of-pocket limit
specified in subsection (b)(3)(B)(i), of an amount equal to at least the
product of—</text>
<clause id="idCA94B9C2309F49838F1DB727FCA3194C"><enum>(i)</enum><text>the amount by
which the costs incurred exceed the deductible described in subsection (b)(1)
for the year; and</text>
</clause><clause id="idC00C5FB8ABFC41EBA44DD815AC0BA965"><enum>(ii)</enum><text>100 percent
minus the coinsurance percentage specified in subsection (b)(2).</text>
</clause></subparagraph></paragraph><paragraph id="idF9D7A56BE3B04D8FAD206B9811B0F54D"><enum>(2)</enum><header>Approval of
benefit package</header><text>The benefit package is approved by the Secretary
as containing a comparable range of benefits to standard health benefits
coverage and meets such other requirements of this subpart as the Secretary may
specify.</text>
</paragraph><paragraph id="id28B102A6CA30432EBE62E6D0164966B8"><enum>(3)</enum><header>Maximum
required deductible</header><text>The deductible under the coverage shall not
exceed the deductible amount specified under subsection (b)(1) for the
year.</text>
</paragraph><paragraph id="idBC2002829EBF44FFB1401314429E58F7"><enum>(4)</enum><header>Same protection
against high out-of-pocket expenditures</header><text>The coverage provides the
coverage required under subsection (b)(3).</text>
</paragraph></subsection><subsection id="idA8652F40F43149B280AB8F573523B1C6"><enum>(d)</enum><header>Access to
negotiated prices</header>
<paragraph id="id29A665FA524C4675A72270C1FA820065"><enum>(1)</enum><header>Access</header>
<subparagraph id="idF016992584A044209117FC580B8880F6"><enum>(A)</enum><header>In
general</header><text>Under a qualified Total Health benefits package offered
by a Total Health sponsor offering a Total Health plan, the sponsor shall
provide enrollees with access to negotiated prices used for payment for covered
health benefits, regardless of the fact that no benefits may be payable under
the coverage with respect to such benefits because of the application of a
deductible or other cost-sharing.</text>
</subparagraph><subparagraph id="id25052B9234F94CDB82961A828F0FEEAD"><enum>(B)</enum><header>Negotiated
prices</header><text>For purposes of this subpart, negotiated prices shall take
into account negotiated price concessions, such as discounts, direct or
indirect subsidies, rebates, and direct or indirect remunerations, for covered
health benefits.</text>
</subparagraph></paragraph><paragraph id="id4267DCCFF4E245BE8B82C50290F7EB9F"><enum>(2)</enum><header>Audits</header><text>To
protect against fraud and abuse and to ensure proper disclosures and accounting
under this part and in accordance with section 1857(d)(2)(B), the Secretary may
conduct periodic audits, directly or through contracts, of the financial
statements and records of Total Health sponsors with respect to Total Health
Plans.</text>
</paragraph><paragraph id="idB882AC0F955548EAB331D8EDF248820E"><enum>(3)</enum><header>Application of
general exclusion provisions</header>
<subparagraph id="id1F0A3178B43F4B999B7B03328C710F77"><enum>(A)</enum><header>In
general</header><text>A Total Health plan may exclude from a qualified Total
Health benefits package any health care item or service—</text>
<clause id="idCA388B604C0D46C28657CEAEA39C571C"><enum>(i)</enum><text>for which payment
would not be made if section 1862(a) applied to this subpart; or</text>
</clause><clause id="idD5747E8E9AB94334B4263233C5497233"><enum>(ii)</enum><text>which is not
prescribed in accordance with the Total Health plan or this subpart.</text>
</clause></subparagraph><subparagraph id="id4F61D6817968407BAB526E089E6A3005"><enum>(B)</enum><header>Reconsideration
and appeal</header><text>Any exclusion under subparagraph (A) is a
determination subject to reconsideration and appeal under this subpart.</text>
</subparagraph></paragraph></subsection><subsection id="idFE3C3725D7234C8E9A3660EBA1CC3CF0"><enum>(e)</enum><header>Satisfaction of
requirements</header><text>A Total Health plan satisfies the requirements of
subsection (a) in the same way a Medicare Advantage plan satisfied the
requirements of section 1852(a)(2).</text>
</subsection></section><section id="id64B9F8109EED467280AEE47D2A511A2A"><enum>1860C–3.</enum><header>Access to a choice of qualified total
health benefits plans</header><subsection commented="no" display-inline="yes-display-inline" id="idEBBEEDDF53F745E4880AF9F7F873218E"><enum>(a)</enum><header>Assuring access to a
choice of plans</header>
<paragraph id="idDD1455908A4E4BC3BC1751AB5E2F9EA2"><enum>(1)</enum><header>Choice of at
least two plans in each area</header><text>The Secretary shall ensure that each
Total Health eligible individual has available, consistent with paragraph (2),
a choice of enrollment in at least 2 Total Health plans in the area in which
the individual resides.</text>
</paragraph><paragraph id="idCA93050FEBD24B9886D462FAD7D5D158"><enum>(2)</enum><header>Requirement for
different plan sponsors</header><text>The requirement in paragraph (1) is not
satisfied with respect to an area if only one entity offers all of the
qualifying plans in the area.</text>
</paragraph></subsection><subsection id="idF74F56A852B74B08A0DBBFE4772530F8"><enum>(b)</enum><header>Flexibility in
risk assumed</header><text>In order to ensure access pursuant to subsection (a)
in an area the Secretary may approve limited risk plans under section
1860C–5(g) for the area.</text>
</subsection></section><section id="idFEC2D3002FEB4F73BDA1A1686D390447"><enum>1860C–4.</enum><header>Beneficiary protections for total
health plan enrollees</header><subsection commented="no" display-inline="yes-display-inline" id="id2EA6EAFB811943F2A9DE954C5CDCBB4C"><enum>(a)</enum><header>Dissemination of
information</header>
<paragraph id="id6205E3E5AD8F4457B01726EC8CDCD4A5"><enum>(1)</enum><header>General
information</header><text>A Total Health sponsor shall disclose, in a clear,
accurate, and standardized form to each enrollee with a Total Health plan
offered by the sponsor under this subpart at the time of enrollment and at
least annually thereafter, the information described in section 1852(c)(1)
relating to such plan, insofar as the Secretary determines appropriate with
respect to benefits provided under this subpart, and including the information
described in section 1860D–4 relating to qualified prescription drug coverage
under the plan.</text>
</paragraph><paragraph id="idF7ED9C16C42747CC9334ADC7859167EF"><enum>(2)</enum><header>Disclosure upon
request of general coverage, utilization, and grievance
information</header><text>Upon request of a Total Health eligible individual
who is eligible to enroll in a Total Health plan, the Total Health sponsor
offering such plan shall provide information similar (as determined by the
Secretary) to the information described in section 1852(c)(2) to such
individual.</text>
</paragraph><paragraph id="id38AA835C755547EF8DBD909FA661AB6E"><enum>(3)</enum><header>Provision of
specific information</header><text>Each Total Health sponsor offering a Total
Health plan shall have a mechanism for providing specific information on a
timely basis to enrollees upon request. Such mechanism shall include access to
information through the use of a toll-free telephone number and, upon request,
the provision of such information in writing.</text>
</paragraph><paragraph id="id131D0A739EC54C6FBDF6B1298863ECB2"><enum>(4)</enum><header>Claims
information</header>
<subparagraph id="id23047D9DA4EF42B8B01DF6A58D5A126A"><enum>(A)</enum><header>In
general</header><text>A Total Health sponsor offering a Total Health plan must
furnish to each enrollee in a form easily understandable to such
enrollees—</text>
<clause id="id1713FE50CB8A41578E9C72444EFFB89E"><enum>(i)</enum><text>an explanation of
benefits (in accordance with section 1806(a) or in a comparable manner);
and</text>
</clause><clause id="idA242A5D1D7D84FAFBDB59F41AEBC7822"><enum>(ii)</enum><text>when Total
Health benefits are provided under this subpart, a notice of the benefits in
relation to—</text>
<subclause id="idAE874A52FEF449DABAE2E7157A63107B"><enum>(I)</enum><text>the deductible
described in paragraph (1) of section 1860C–2(b) for the current year;
and</text>
</subclause><subclause id="id36E5FFB93D5C44C79718CF507C7ECC9E"><enum>(II)</enum><text>the annual
out-of-pocket limits under paragraph (3) of such section for the current
year.</text>
</subclause></clause></subparagraph><subparagraph id="id26E69A28F52D478588A59D2137AF71FB"><enum>(B)</enum><header>Timing of
notices</header><text>Notices under subparagraph (A)(ii) need not be provided
more often than as specified by the Secretary.</text>
</subparagraph></paragraph></subsection><subsection id="id8B56CFEE75394A439587927FD4123D8B"><enum>(b)</enum><header>Access to
health care providers</header>
<paragraph id="idB783E321AAA84E19B8D0DFB5EB17D969"><enum>(1)</enum><header>Assuring
provider access</header>
<subparagraph id="idCDEF439F268F40A78EED76DDF34CA4D2"><enum>(A)</enum><header>Discounts
allowed for network providers</header><text>For health benefits furnished
through in-network providers, a Total Health plan may reduce coinsurance or
copayments for Total Health eligible individuals enrolled in the plan below the
level otherwise required. In no case shall such a reduction result in an
increase in payments made by the Secretary under section 1860C–8 to the Total
Health sponsor of the plan.</text>
</subparagraph><subparagraph id="id437550BDEDD34D3787D825C49657F1BB"><enum>(B)</enum><header>Convenient
access for network providers</header>
<clause id="id79A7C85A3C864B518C9EEAF4BB9AC80D"><enum>(i)</enum><header>In
general</header><text>The Total Health sponsor of the Total Health plan shall
secure the participation in its network of a sufficient number of health care
providers that furnish health care items and services under the plan directly
to patients to ensure convenient access (consistent with rules established by
the Secretary).</text>
</clause><clause id="idF4C1E36A99864E54BA1C2D3779CF8691"><enum>(ii)</enum><header>Adequate
emergency access</header><text>Such rules shall include adequate emergency
access for enrollees.</text>
</clause></subparagraph><subparagraph id="id01290B13A5B14CC1AF5B02F92F2A8DC2"><enum>(C)</enum><header>Level playing
field</header><text>Such a sponsor shall permit enrollees to receive benefits
through any health care provider participating in the program under this title
with any differential in charge paid by such enrollees.</text>
</subparagraph></paragraph><paragraph id="id8D48F29B81B341CEB58A9B2B70D37BC7"><enum>(2)</enum><header>Use of
standardized technology</header>
<subparagraph id="id5700215DFF59414590E1D61BE332A2B3"><enum>(A)</enum><header>In
general</header><text>The Total Health sponsor of a Total Health plan shall
issue (and reissue, as appropriate) such a card (or other technology) that may
be used by an enrollee to assure access to health benefits under this
subpart.</text>
</subparagraph><subparagraph id="idD08BDD50FDD54AE286FE2C98DAA83FFA"><enum>(B)</enum><header>Standards</header>
<clause id="idC69361A52D3F414785D28298D09864B4"><enum>(i)</enum><header>In
general</header><text>The Secretary shall provide for the development,
adoption, or recognition of standards relating to a standardized format for the
card or other technology required under subparagraph (A). Such standards shall
be compatible with part C of title XI and may be based on standards developed
by an appropriate standard setting organization.</text>
</clause><clause id="idFD75527308D643C8916B6D49ABA5A894"><enum>(ii)</enum><header>Consultation</header><text>In
developing the standards under clause (i), the Secretary shall consult with
standard setting organizations determined appropriate by the Secretary.</text>
</clause><clause id="id65DE2CBC3E15406EA9EACE123FF312FA"><enum>(iii)</enum><header>Implementation</header><text>The
Secretary shall develop, adopt, or recognize the standards under clause (i) by
such date as the Secretary determines shall be sufficient to ensure that Total
Health sponsors utilize such standards beginning January 1, 2017.</text>
</clause></subparagraph></paragraph></subsection><subsection id="idC1C2B1F8D18E4C6A866669F70DBB334F"><enum>(c)</enum><header>Cost and
utilization management; quality assurance; wellness program</header>
<paragraph id="id853C982AE6FE4C28A513E476AAE764D2"><enum>(1)</enum><header>In
general</header><text>The Total Health sponsor shall have in place, directly or
through appropriate arrangements, the following:</text>
<subparagraph id="idD0935D1068854B148044F1588F3F38A0"><enum>(A)</enum><text>A cost-effective
health benefits management program, including incentives to reduce costs when
medically appropriate.</text>
</subparagraph><subparagraph id="id4001964ABF44441E93FE7488065FCBDA"><enum>(B)</enum><text>Quality assurance
measures and systems to reduce errors and improve the use of health
benefits.</text>
</subparagraph><subparagraph id="id0EB63D1FA78246A8A31BF2F14955597A"><enum>(C)</enum><text>A wellness
program described in paragraph (2).</text>
</subparagraph><subparagraph id="id9162FA8EA4314600A1D8F5AF5F2B054A"><enum>(D)</enum><text>A program to
control fraud, abuse, and waste.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">Nothing in
this section shall be construed as impairing a Total Health sponsor from
utilizing cost management tools (including differential payments) under all
methods of operation.</continuation-text></paragraph><paragraph id="id90D11E2F48C343988734925DFBDEA3BB"><enum>(2)</enum><header>Wellness
program</header>
<subparagraph id="id7AE5F0C01EC94A878914B840F145EBF5"><enum>(A)</enum><header>Description</header><text>A
wellness program described in this paragraph is a program focused on health
improvement, disease prevention, and management of chronic conditions for Total
Health eligible individuals enrolled in a plan under this part to optimize
health outcomes through improved use of health care items and services and to
reduce the risk of adverse events.</text>
</subparagraph><subparagraph id="id9B95E4CD91E14DA090131827D98CAC10"><enum>(B)</enum><header>Elements</header><text>Such
program may include elements that promote—</text>
<clause id="idA55BB65C65F14C7EB9BC4689AE8CC7BE"><enum>(i)</enum><text>enhanced enrollee
understanding to promote the appropriate use of health care items and services
by enrollees and to reduce the risk of potential adverse events and to improve
health outcomes through beneficiary education, counseling, and other
appropriate means;</text>
</clause><clause id="id8AA92EBEE8C9491EA909481FD594855B"><enum>(ii)</enum><text>increased
enrollee adherence with recommended regimens through compliance programs and
other appropriate means; and</text>
</clause><clause id="id433FE4ACB16742F4A27E61CB851A4F53"><enum>(iii)</enum><text>detection of
adverse events and patterns of overuse and underuse of health care items and
services.</text>
</clause></subparagraph><subparagraph id="idB4DF3A34FF554779958FEFE9DB1E07C4"><enum>(C)</enum><header>Assessment</header><text>The
Total Health sponsor shall have in place a process to assess, at least on a
quarterly basis, the health benefits use of individuals who are not enrolled in
the wellness program.</text>
</subparagraph><subparagraph id="id10A7E395BA9842C3B925823FDFF6BC7C"><enum>(D)</enum><header>Wellness
program enrollment</header><text>The Total Health sponsor shall have in place a
process to—</text>
<clause id="id64DE572466F548A98990378AFCD47636"><enum>(i)</enum><text>subject to clause
(ii), automatically enroll plan enrollees in the wellness program required
under this subsection; and</text>
</clause><clause id="id9CD0F177863C4780A29E5C23464972F5"><enum>(ii)</enum><text>permit plan
enrolles to opt-out of enrollment in the wellness program.</text>
</clause></subparagraph><subparagraph id="idF04B4736986B4054B09565A9A0A8DEC3"><enum>(E)</enum><header>Development of
program in cooperation with physicians</header><text>Such program shall be
developed in cooperation with physicians.</text>
</subparagraph><subparagraph id="id41F7759783AF43D9951C4A7A1CF8A745"><enum>(F)</enum><header>Coordination
with care management plans</header><text>The Secretary shall establish
guidelines for the coordination of any wellness program under this paragraph
with respect to a targeted beneficiary described in section 1860D–4(c)(2)(A)(i)
(applied by substituting <quote>Total Health eligible individual</quote> for
<quote>part D eligible individual</quote>) with any care management plan
established with respect to such beneficiary under a chronic care improvement
program under section 1807.</text>
</subparagraph><subparagraph id="id86D2749C28A24A8AA3FAE3A15B7FD460"><enum>(G)</enum><header>Considerations
in provider fees</header><text>The Total Health sponsor of a Total Health plan
shall take into account, in establishing fees for entities providing services
under such plan, the resources used, and time required to, implement the
wellness program under this paragraph. Each such sponsor shall disclose to the
Secretary upon request the amount of any such fees.</text>
</subparagraph></paragraph></subsection><subsection id="idCF7D68904C974DBA8CAA85DE5F914F45"><enum>(d)</enum><header>Consumer
satisfaction surveys</header><text>In order to provide for comparative
information under section 1860C–1(c), the Secretary shall conduct consumer
satisfaction surveys with respect to Total Health sponsors and Total Health
plans in a manner similar to the manner such surveys were conducted for MA
organizations and MA plans under subpart 1.</text>
</subsection><subsection id="idB82CC6D5BCB24D888F3F706C22C41E1F"><enum>(e)</enum><header>Grievance
mechanism</header><text>Each Total Health sponsor shall provide meaningful
procedures for hearing and resolving grievances between the sponsor (including
any entity or individual through which the sponsor provides covered benefits)
and enrollees with Total Health plans of the sponsor under this part in
accordance with section 1852(f).</text>
</subsection><subsection id="id96DB0B5BB41F42B0A170B04F36B4C9BC"><enum>(f)</enum><header>Coverage
determinations and reconsiderations</header><text>A Total Health sponsor shall
meet the requirements of paragraphs (1) through (3) of section 1852(g) with
respect to covered benefits under the Total Health plan offered by the sponsor
under this subpart in the same manner as such requirements applied to an MA
organization with respect to covered benefits under an MA plan offered by the
organization under subpart 1.</text>
</subsection><subsection id="id72D4466ABFB545C785CD0BF9D97A0D2C"><enum>(g)</enum><header>Appeals</header><text>A
Total Health sponsor shall meet the requirements of paragraphs (4) and (5) of
section 1852(g) with respect to benefits in a manner similar (as determined by
the Secretary) to the manner such requirements applied to an MA organization
with respect to benefits under the original medicare fee-for-service program
option under an MA plan. In applying this subsection, only the Total Health
eligible individual shall be entitled to bring such an appeal.</text>
</subsection><subsection id="idFEF7C91AC57743F3A9CAEE6822EAE9B4"><enum>(h)</enum><header>Privacy,
confidentiality, and accuracy of enrollee records</header><text>The provisions
of section 1852(h) shall apply to a Total Health sponsor and Total Health plan
in the same manner as such provisions applied to an MA organization and an MA
plan.</text>
</subsection><subsection id="id716C41614FBD4CE29B41A8C89A3473FA"><enum>(i)</enum><header>Treatment of
accreditation</header><text>Subparagraph (A) of section 1852(e)(4) (relating to
treatment of accreditation) shall apply to a Total Health sponsor under this
part in the same manner as such subparagraph applied to an MA
organization.</text>
</subsection><subsection id="id2F59689941A746D2AEAD614B41A29BDF"><enum>(j)</enum><header>Requirements
with respect to sales and marketing activities</header><text>The following
provisions shall apply to a Total Health sponsor (and the agents, brokers, and
other third parties representing such sponsor) in the same manner as such
provisions applied to a Medicare Advantage organization (and the agents,
brokers, and other third parties representing such organization):</text>
<paragraph id="id81469DCEFD4A4A1E98DBB22CC3286442"><enum>(1)</enum><text>The prohibition
under section 1851(h)(4)(C) on conducting activities described in section
1851(j)(1).</text>
</paragraph><paragraph id="id82EB01A9B534448BA6055BC84F7B9744"><enum>(2)</enum><text>The requirement
under section 1851(h)(4)(D) to conduct activities described in paragraph (2) of
section 1851(j) in accordance with the limitations established under such
section.</text>
</paragraph><paragraph id="id32CA1F56E6ED4FFFB0B3F03D84F64259"><enum>(3)</enum><text>The inclusion of
the plan type in the plan name under section 1851(h)(6).</text>
</paragraph><paragraph id="id674386321D1449058A826DA69FE4A2A3"><enum>(4)</enum><text>The requirements
regarding the appointment of agents and brokers and compliance with State
information requests under subparagraphs (A) and (B), respectively, of section
1851(h)(7).</text>
</paragraph></subsection></section><section id="idBF16FE8F9FE74F7AB8FA61A0C1BC6F30"><enum>1860C–5.</enum><header>Total Health regions; submission of
bids; total health plan approval</header><subsection commented="no" display-inline="yes-display-inline" id="id92C2A717CB514C8DAFEE6DE64BCFFA52"><enum>(a)</enum><header>Establishment of
total health regions; service areas</header>
<paragraph id="idCEB60D49239647D78D925D74CCD7DBCE"><enum>(1)</enum><header>Coverage of
entire total health region</header>
<subparagraph id="id93C32D8D9C2B4114932FC79BD12E4A64"><enum>(A)</enum><header>In
general</header><text>The service area for a Total Health plan shall consist of
an entire Total Health region established under paragraph (2).</text>
</subparagraph><subparagraph id="idDFEDE7F1369243309C11B18DA8364B3D"><enum>(B)</enum><header>No use of
segments of service areas</header><text>In no case may a Total Health plan
serve only segments of the service area.</text>
</subparagraph></paragraph><paragraph id="idD6A8A1C569E94BF684279856F2DF69BF"><enum>(2)</enum><header>Establishment
of total health regions</header>
<subparagraph id="id67F64F71465F45DCBDC9FFBBD9D6952F"><enum>(A)</enum><header>In
general</header><text>The Secretary shall establish, and may revise, Total
Health regions in accordance with the requirements of this paragraph.</text>
</subparagraph><subparagraph id="idF73E8A7B51D447DD8F517C268547A7EB"><enum>(B)</enum><header>Regions to be
larger than a single county</header><text>Total Health regions shall include
more than one county.</text>
</subparagraph><subparagraph id="idB9C1A78C09644BBA8894721EB17620DC"><enum>(C)</enum><header>Regions within
msas</header><text>Among counties in a metropolitan statistical area, a Total
Health region shall include all of the counties located in the same State in
that metropolitan statistical area.</text>
</subparagraph><subparagraph id="id8AFECACEDD0A4983AC5A91ADFBD17C80"><enum>(D)</enum><header>Regions outside
msas</header><text>Among counties outside a metropolitan statistical area, a
Total Health region shall include all of the counties in the same State that
the Secretary determines are accurate reflections of health care market areas,
such as health service areas.</text>
</subparagraph><subparagraph id="id0DF13D51413B4AF78A82FC6675A07DB5"><enum>(E)</enum><header>Authority for
territories</header><text>The Secretary shall establish, and may revise, Total
Health regions for areas in States that are not within the 50 States or the
District of Columbia.</text>
</subparagraph></paragraph><paragraph id="id278FBB96594843E086A1F3040BC9A28A"><enum>(3)</enum><header>National
plan</header><text>Nothing in this subsection shall be construed as preventing
a Total Health plan from being offered in more than one Total Health region
(including all Total Health regions).</text>
</paragraph></subsection><subsection id="id8A8CEB41F25C473E8E9EF852A2349137"><enum>(b)</enum><header>Submission of
bids, premiums, and related information</header>
<paragraph id="id6688C794D8D7499D932BA1E02CFE0AFB"><enum>(1)</enum><header>In
general</header><text>A Total Health sponsor shall submit to the Secretary
information described in paragraph (2) with respect to each Total Health plan
it offers. Such information shall be submitted at the same time and in a
similar manner to the manner in which information described in paragraph (6) of
section 1854(a) was submitted by an MA organization under paragraph (1) of such
section.</text>
</paragraph><paragraph id="idD0DDACF6614D4975AAEC45AABD4C2849"><enum>(2)</enum><header>Information
described</header><text>The information described in this paragraph is
information on the following:</text>
<subparagraph id="id36A7705407D1485A94AC18523D87D0B0"><enum>(A)</enum><header>Benefits
package provided</header><text>The qualified Total Health benefits package
provided under the plan, including the deductible and other
cost-sharing.</text>
</subparagraph><subparagraph id="id8B8C2AC862D34DB6A5AB487B753849AE"><enum>(B)</enum><header>Actuarial
value</header><text>The actuarial value of the qualified Total Health benefits
package in the Total Health region for a Total Health eligible individual with
a national average risk profile for the factors described in section
1860C–8(b)(1)(A) (as specified by the Secretary).</text>
</subparagraph><subparagraph id="idF597CD9B181647459A17C0B1AB480189"><enum>(C)</enum><header>Bid</header><text>Information
on the bid, including an actuarial certification of—</text>
<clause id="idA797177E150A472B82AB38DF26F00E78"><enum>(i)</enum><text>the basis for the
actuarial value described in subparagraph (B) assumed in such bid;</text>
</clause><clause id="id8075530109C540E39F9A255092ADAA4A"><enum>(ii)</enum><text>the portion of
such bid attributable to a basic Total Health benefits package and, if
applicable, the portion of such bid attributable to supplemental benefits;
and</text>
</clause><clause id="idB2E0F7D018F546959003801105D28AA0"><enum>(iii)</enum><text>administrative
expenses assumed in the bid.</text>
</clause></subparagraph><subparagraph id="idCDD7D30077FF4AFEB86D66CFD1E05E9D"><enum>(D)</enum><header>Service
area</header><text>The service area for the plan (as described in subsection
(a)(1)).</text>
</subparagraph><subparagraph id="id1A77E409F89549B2ABB97647930039D9"><enum>(E)</enum><header>Level of risk
assumed</header><text>Whether the Total Health sponsor requires a modification
of risk level and, if so, the extent of such modification. Any such
modification shall apply with respect to all Total Health plans offered by a
Total Health sponsor in a Total Health region.</text>
</subparagraph><subparagraph id="idF87BE5E9818543AA8EDC982D2838248F"><enum>(F)</enum><header>Additional
information</header><text>Such other information as the Secretary may require
to carry out this subpart.</text>
</subparagraph></paragraph><paragraph id="id9EC70778ED454040B05AD5BA2BDCD2B0"><enum>(3)</enum><header>Paperwork
reduction for offering of total health plans nationally or in multi-region
areas</header><text>The Secretary shall establish requirements for the
submission of information under this subsection in a manner that promotes the
offering of such plans in more than one Total Health region (including all
regions) through the filing of consolidated information.</text>
</paragraph></subsection><subsection id="idBD5C43FC72DA4192907BF1657BB73631"><enum>(c)</enum><header>Medicare
fee-for-Service bid</header><text>For purposes of this subpart, the bid for
benefits under the original medicare fee-for-service program option (as defined
in section 1852(a)(1)(B)) is the dollar amount of the actuarial valuation of
the benefits under that option for each Total Health region (as determined and
submitted by the Chief Actuary of the Centers for Medicare & Medicaid
Services using the same processes used to value Total Health plans under
subsection (d)).</text>
</subsection><subsection id="id1790AE6CE8074D509E2C07571BF06041"><enum>(d)</enum><header>Actuarial
valuation</header>
<paragraph id="id39BE3E92439D46718D67DC7421F66BF5"><enum>(1)</enum><header>Processes</header><text>For
purposes of this subpart, the Secretary shall establish processes and methods
for determining the actuarial valuation of a Total Health benefits package,
including—</text>
<subparagraph id="id50C2E446316445E1800F661ABC9F8B1A"><enum>(A)</enum><text>an actuarial
valuation of the benefits under the original medicare fee-for-service program
option (as defined in section 1852(a)(1)(B)) in each service area;</text>
</subparagraph><subparagraph id="idC83C6C3C6E5040A290E22C3AD6A810F6"><enum>(B)</enum><text>actuarial
valuations relating to the qualified Total Health benefits package under
section 1860C–2(a)(1);</text>
</subparagraph><subparagraph id="id25513A2525384253B8A67E83457AEB0D"><enum>(C)</enum><text>the use of
generally accepted actuarial principles and methodologies; and</text>
</subparagraph><subparagraph id="idDFAD54CBFBAF4F38B2F152460C592129"><enum>(D)</enum><text>applying the same
methodology for determinations of actuarial valuations under subparagraphs (A)
and (B).</text>
</subparagraph></paragraph><paragraph id="idDF820B90085947B2B3791AD78C40EDBA"><enum>(2)</enum><header>Accounting for
utilization</header><text>Such processes and methods for determining actuarial
valuation shall take into account the effect that providing a qualified Total
Health benefits package (rather than benefits under the original medicare
fee-for-service program option) has on the utilization of health care items and
services.</text>
</paragraph><paragraph id="id0E54753516954C30AC37B0E8B1AEB0F0"><enum>(3)</enum><header>Responsibilities</header>
<subparagraph id="id0BBC7F2346F346A5B7D80AD9A6547C61"><enum>(A)</enum><header>Plan
responsibilities</header><text>Total Health sponsors are responsible for the
preparation and submission of actuarial valuations required under this subpart
for the Total Health plans offered by the sponsor.</text>
</subparagraph><subparagraph id="idB233381DAA07450FAEFD0117CB859541"><enum>(B)</enum><header>Use of outside
actuaries</header><text>Under the processes and methods established under
paragraph (1), Total Health sponsors offering a Total Health benefits package
may use actuarial opinions certified by independent, qualified actuaries to
establish actuarial values.</text>
</subparagraph></paragraph></subsection><subsection id="id024D3B738123446C97951E4835FF174D"><enum>(e)</enum><header>Review of
information and negotiation</header>
<paragraph id="id25849F086AE441BAA140BE2E3EA6C659"><enum>(1)</enum><header>Review of
information</header><text>The Secretary shall review the information submitted
under subsection (b) for the purpose of conducting negotiations under paragraph
(2).</text>
</paragraph><paragraph id="id90CBE6693C654C7C8064E060C549C99A"><enum>(2)</enum><header>Negotiation
regarding terms and conditions</header><text>Subject to subsection (i), in
exercising the authority under paragraph (1), the Secretary—</text>
<subparagraph id="id6AE9B99D00374E9BB09E1F74ED814E08"><enum>(A)</enum><text>has the authority
to negotiate the terms and conditions of the proposed bid submitted and other
terms and conditions of a proposed plan; and</text>
</subparagraph><subparagraph id="idADFAF2B58F514B939DC66E84F2A66ADE"><enum>(B)</enum><text>has authority
similar to the authority of the Director of the Office of Personnel Management
with respect to health benefits plans under chapter 89 of title 5, United
States Code.</text>
</subparagraph></paragraph><paragraph id="id3F5DFFDE31BC47748A22A57EF374DED3"><enum>(3)</enum><header>Rejection of
bids</header><text>Paragraph (5)(C) of section 1854(a) shall apply with respect
to bids submitted by a Total Health sponsor under subsection (b) in the same
manner as such paragraph applied to bids submitted by an MA organization under
such section 1854(a).</text>
</paragraph></subsection><subsection id="id15E46B4A705C4F12A8FDAA8906921C66"><enum>(f)</enum><header>Approval of
proposed plans</header>
<paragraph id="idACECB542B5734494ACECDE584B5673A2"><enum>(1)</enum><header>In
general</header><text>After review and negotiation under subsection (e), the
Secretary shall approve or disapprove the Total Health plan.</text>
</paragraph><paragraph id="idB04B0060A2E3473887512932E71CA0F8"><enum>(2)</enum><header>Requirements
for approval</header><text>The Secretary may approve a Total Health plan only
if the Secretary determines the following requirements are met:</text>
<subparagraph id="id71E79220006540D3A19FDC40DEFD52AB"><enum>(A)</enum><header>Compliance with
requirements</header><text>The plan and the Total Health sponsor offering the
plan comply with the requirements under this subpart, including the provision
of a qualified Total Health benefits package.</text>
</subparagraph><subparagraph id="idD521FD3AE9944CD0A81637DD1E1C2E11"><enum>(B)</enum><header>Actuarial
determinations</header><text>The plan and Total Health sponsor offering the
plan meet the requirements under this subpart relating to actuarial
determinations, including such requirements under section 1860C–2(c).</text>
</subparagraph><subparagraph id="idB44B3202F105455FBEC95208AE723557"><enum>(C)</enum><header>Application of
FEHBP standard</header>
<clause id="id20A52D00796D4C6B829F45EA855A4341"><enum>(i)</enum><header>In
general</header><text>The portion of the bid submitted under subsection (b)
that is attributable to basic health benefits coverage is supported by the
actuarial bases provided under such subsection and reasonably and equitably
reflects the revenue requirements (as used for purposes of section 1302(8)(C)
of the Public Health Service Act) for benefits provided under that plan.</text>
</clause><clause id="idA5543F32E9F346A99C5E2D362E9AB7C1"><enum>(ii)</enum><header>Supplemental
coverage</header><text>The portion of the bid submitted under subsection (b)
that is attributable to supplemental health benefits coverage pursuant to
section 1860C–2(a)(3) is supported by the actuarial bases provided under such
subsection and reasonably and equitably reflects the revenue requirements (as
used for purposes of section 1302(8)(C) of the Public Health Service Act) for
such coverage under the plan.</text>
</clause></subparagraph><subparagraph id="idF62F3A3A092646D686B22F1910E553B5"><enum>(D)</enum><header>Plan
design</header><text>The design of the plan and covered benefits under the plan
are not likely to substantially discourage enrollment by certain Total Health
eligible individuals in the plan.</text>
</subparagraph></paragraph></subsection><subsection id="id1A364E240CFF46F794FA6F57B968B417"><enum>(g)</enum><header>Application of
limited risk plans</header>
<paragraph id="id923094F2789543F89A89A268F7947AD9"><enum>(1)</enum><header>Conditions for
approval of limited risk plans</header><text>The Secretary may only approve a
limited risk plan (as defined in paragraph (4)(A)) for a Total Health region if
the access requirements under section 1860C–3(a) would not be met for the
region but for the approval of such a plan.</text>
</paragraph><paragraph id="id85E23EF24A4B4759B9ED1B4EF3A7EF65"><enum>(2)</enum><header>Rules</header><text>The
following rules shall apply with respect to the approval of a limited risk plan
in a Total Health region:</text>
<subparagraph id="idC0B11825BC1149E79C429D283A56EB25"><enum>(A)</enum><header>Limited
exercise of authority</header><text>Only the minimum number of such plans may
be approved in order to meet the access requirements under section
1860C–3(a).</text>
</subparagraph><subparagraph id="idE72E98D70CA942DF9E5FB0219DDBE75B"><enum>(B)</enum><header>Maximizing
assumption of risk</header><text>The Secretary shall provide priority in
approval for those plans bearing the highest level of risk (as computed by the
Secretary), but the Secretary may take into account the level of the bids
submitted by such plans.</text>
</subparagraph><subparagraph id="id01FA8EE4477B478593A8AC3C974CF012"><enum>(C)</enum><header>No full
underwriting for limited risk plans</header><text>In no case may the Secretary
approve a limited risk plan under which the modification of risk level provides
for no (or a de minimis) level of financial risk.</text>
</subparagraph></paragraph><paragraph id="id508010816FE3428F8502DA353115C88E"><enum>(3)</enum><header>Acceptance of
all full risk contracts</header><text>There shall be no limit on the number of
full risk plans that are approved under subsection (e).</text>
</paragraph><paragraph id="id7B379D4D7A754CABA15B96BBDB553B7D"><enum>(4)</enum><header>Risk-plans
defined</header><text>For purposes of this subsection:</text>
<subparagraph id="idC802E24D399A401AAB845134A5151CB6"><enum>(A)</enum><header>Limited risk
plan</header><text>The term <term>limited risk plan</term> means a Total Health
plan that provides a basic Total Health benefits package and for which the
Total Health sponsor includes a modification of risk level described in
subparagraph (E) of subsection (b)(2) in the bid submitted for the plan under
such subsection.</text>
</subparagraph><subparagraph id="id8FBCB5B01AAA4725A4D206A2ED0D6651"><enum>(B)</enum><header>Full risk
plan</header><text>The term <term>full risk plan</term> means a Total Health
plan that is not a limited risk plan.</text>
</subparagraph></paragraph></subsection><subsection id="idFD7A0F719C8145808542BFA7246BBB5C"><enum>(h)</enum><header>Annual report
on use of limited risk plans</header><text>The Secretary shall submit to
Congress an annual report that describes instances in which limited risk plans
were approved under this section. The Secretary shall include in such report
such recommendations as may be appropriate to limit the need for the provision
of such plans and to maximize the assumption of financial risk under such
subsection.</text>
</subsection><subsection id="idA21E103A5B014CE583763E74F9B9CF43"><enum>(i)</enum><header>Noninterference</header><text>In
order to promote competition under this part and in carrying out this part, the
Secretary—</text>
<paragraph id="id26B9281B1A864F8385F66828995C29A4"><enum>(1)</enum><text>may not interfere
with the negotiations between physicians or other health professionals,
providers, suppliers, drug manufacturers, pharmacies, and Total Health
sponsors; and</text>
</paragraph><paragraph id="id554A16AC56784A34864FE6A45D8E7FBA"><enum>(2)</enum><text>may not require a
particular benefit design or formulary, or institute a price structure for the
reimbursement of covered items and services.</text>
</paragraph></subsection></section><section id="id3C768182D1A44483AFAD813252A86927"><enum>1860C–6.</enum><header>Requirements for and contracts with
Total Health sponsors</header><subsection commented="no" display-inline="yes-display-inline" id="idE6D2B9A3FCA64E5A8A6B251A2621373A"><enum>(a)</enum><header>General
requirements</header><text>Each sponsor of a Total Health plan shall meet the
following requirements:</text>
<paragraph id="id69A7FAED45A74D1490618758218A3F2A"><enum>(1)</enum><header>Licensure</header><text>Subject
to subsection (c), the sponsor is organized and licensed under State law as a
risk-bearing entity eligible to offer health insurance or health benefits
coverage in each State in which it offers a Total Health plan.</text>
</paragraph><paragraph id="id01A9623AD7A449028690C59A091DD189"><enum>(2)</enum><header>Assumption of
financial risk for unsubsidized coverage</header>
<subparagraph id="idAD8A26A1F991454EA8E9C7EA89343639"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), to the extent that the
entity is at risk the entity assumes financial risk on a prospective basis for
benefits that it offers under a Total Health plan.</text>
</subparagraph><subparagraph id="id85C4135D02994B7387133E1921F983B7"><enum>(B)</enum><header>Reinsurance
permitted</header><text>The plan sponsor may obtain insurance or make other
arrangements for the cost of coverage provided to any enrollee to the extent
that the sponsor is at risk for providing such coverage.</text>
</subparagraph></paragraph><paragraph id="id408D13D06C62402B864EE2A24B57A83C"><enum>(3)</enum><header>Solvency for
unlicensed sponsors</header><text>In the case of a Total Health sponsor that is
not described in paragraph (1) and for which a waiver has been approved under
subsection (c), such sponsor shall meet solvency standards established by the
Secretary under subsection (d).</text>
</paragraph></subsection><subsection id="idBE1CD4DDC4324CED849DBB77FC9EB6BE"><enum>(b)</enum><header>Contract
requirements</header>
<paragraph id="idF2786F6FCEE54DDDBA4142D6B1F89E1F"><enum>(1)</enum><header>In
general</header><text>The Secretary shall not permit the enrollment under
section 1860C–1 in a Total Health plan offered by a Total Health sponsor under
this subpart, and the sponsor shall not be eligible for payments under section
1860C–8, unless the Secretary has entered into a contract under this subsection
with the sponsor with respect to the offering of such plan. Such a contract
with a sponsor may cover more than one Total Health plan. Such contract shall
provide that the sponsor agrees to comply with the applicable requirements and
standards of this subpart and the terms and conditions of payment as provided
for in this subpart.</text>
</paragraph><paragraph id="id200DA5D977FD49B48844977E6B7EB176"><enum>(2)</enum><header>Incorporation
of certain medicare advantage contract requirements</header><text>Except as
otherwise provided, the following provisions of section 1857 shall apply to
contracts under this section in the same manner as such provisions applied to
contracts under section 1857(a):</text>
<subparagraph id="idDEACBA2C5CF14889A13AA54420D73411"><enum>(A)</enum><header>Minimum
enrollment</header><text>Paragraphs (1) and (3) of section 1857(b), except
that—</text>
<clause id="idCA9DCFCC9EE2491ABA12E414AD30F272"><enum>(i)</enum><text>the Secretary may
increase the minimum number of enrollees required under such paragraph (1) as
the Secretary determines appropriate; and</text>
</clause><clause id="id55F5C223B485446F9BADD8DF5D94DC76"><enum>(ii)</enum><text>the requirement
of such paragraph (1) shall be waived during the first contract year with
respect to an organization in a region.</text>
</clause></subparagraph><subparagraph id="idD8A0A6D0EADD4CC6AD44BDBEEC4EED4C"><enum>(B)</enum><header>Contract period
and effectiveness</header><text>Section 1857(c), except that in applying
paragraph (4)(B) of such section any reference to payment amounts under section
1853 is deemed a reference to payment amounts under section 1860C–8.</text>
</subparagraph><subparagraph id="id4DF3A1FA256B4A2889BA434FE39A9837"><enum>(C)</enum><header>Protections
against fraud and beneficiary protections</header><text>Section 1857(d).</text>
</subparagraph><subparagraph id="id4F342C2B43054403A366D8DD77D6E4E4"><enum>(D)</enum><header>Additional
contract terms</header><text>Section 1857(e); except that section 1857(e)(2)
shall apply as specified to Total Health sponsors and payments to a Total
Health plan under this subpart shall be treated as expenditures made under this
subpart. Notwithstanding any other provision of law, information provided to
the Secretary under the application of section 1857(e)(1) to contracts under
this section under the preceding sentence—</text>
<clause id="id8C25A110B35149DF88BA04125955433A"><enum>(i)</enum><text>may be used for
the purposes of carrying out this subpart, improving public health through
research on the utilization, safety, effectiveness, quality, and efficiency of
health care services (as the Secretary determines appropriate); and</text>
</clause><clause id="id0F8FA4C0D06F4C3B9D3D504BD3E436BB"><enum>(ii)</enum><text>shall be made
available to Congressional support agencies (in accordance with their
obligations to support Congress as set out in their authorizing statutes) for
the purposes of conducting Congressional oversight, monitoring, making
recommendations, and analysis of the program under this title.</text>
</clause></subparagraph><subparagraph id="id585E204792FF4FDCAF78CDCDE6897EA3"><enum>(E)</enum><header>Intermediate
sanctions</header><text>Section 1857(g) (other than paragraph (1)(F) of such
section), except that in applying such section the reference in section
1857(g)(1)(B) to section 1854 is deemed a reference to this subpart.</text>
</subparagraph><subparagraph id="id9A0106C5B56E4E6A94ACC6A668EDE6A4"><enum>(F)</enum><header>Procedures for
termination</header><text>Section 1857(h).</text>
</subparagraph></paragraph></subsection><subsection id="id8DF8F52A4B214421A391ED3B391B03B9"><enum>(c)</enum><header>Waiver of
certain requirements To expand choice</header>
<paragraph id="id8FF35F82F5C347839D5F070681295D52"><enum>(1)</enum><header>Authorizing
waiver</header>
<subparagraph id="id936D36249AA24C5BAA51954E055CD3A4"><enum>(A)</enum><header>In
general</header><text>In the case of an entity that seeks to offer a Total
Health plan in a State, the Secretary shall waive the requirement of subsection
(a)(1) that the entity be licensed in that State if the Secretary determines,
based on the application and other evidence presented to the Secretary, that
any of the grounds for approval of the application described in paragraph (2)
have been met.</text>
</subparagraph><subparagraph id="idFC06C5D7EEE64E15B9F71DD4780E4BA7"><enum>(B)</enum><header>Application of
regional plan waiver rule</header><text>In addition to the waiver available
under subparagraph (A), the provisions of section 1858(d) shall apply to Total
Health sponsors under this part in a manner similar to the manner in which such
provisions applied to MA organizations.</text>
</subparagraph></paragraph><paragraph id="id36A9DC3BE7BC4FEAA58E254FADF1F369"><enum>(2)</enum><header>Grounds for
approval</header>
<subparagraph id="idD259116FE8734E0A977270188E4BA25C"><enum>(A)</enum><header>In
general</header><text>The grounds for approval under this paragraph are—</text>
<clause id="id14D537C2157D4557B72DD7CE80C1701D"><enum>(i)</enum><text>subject to
subparagraph (B), the grounds for approval described in subparagraphs (B), (C),
and (D) of section 1855(a)(2); and</text>
</clause><clause id="id1E063007282745138FEEB4E904E4FBF8"><enum>(ii)</enum><text>the application
by a State of any grounds other than those required under Federal law.</text>
</clause></subparagraph><subparagraph id="idDA9D44ED6CB44D09BE75F761B56993C4"><enum>(B)</enum><header>Special
rules</header><text>In applying subparagraph (A)(i)—</text>
<clause id="id2AA04328279E447F9EAEB5C3632A6074"><enum>(i)</enum><text>the ground of
approval described in section 1855(a)(2)(B) is deemed to have been met if the
State does not have a licensing process in effect with respect to the Total
Health sponsor; and</text>
</clause><clause id="idA96787DB2D31444D971D73061C21CFB8"><enum>(ii)</enum><text>for plan years
beginning before January 1, 2019, if the State does have such a licensing
process in effect, such ground for approval described in such section is deemed
to have been met upon submission of an application described in such
section.</text>
</clause></subparagraph></paragraph><paragraph id="id63901973FE35479186536FF67B3EB579"><enum>(3)</enum><header>Application of
waiver procedures</header><text>With respect to an application for a waiver (or
a waiver granted) under paragraph (1)(A) of this subsection, the provisions of
subparagraphs (E), (F), and (G) of section 1855(a)(2) shall apply, except that
clauses (i) and (ii) of such subparagraph (E) shall not apply in the case of a
State that does not have a licensing process described in paragraph (2)(B)(i)
in effect.</text>
</paragraph><paragraph id="idC7073D015EE645119487BCABDD96721F"><enum>(4)</enum><header>References to
certain provisions</header><text>In applying provisions of section 1855(a)(2)
under paragraphs (2) and (3) of this subsection to Total Health plans and Total
Health sponsors—</text>
<subparagraph id="id5895F5E51830485B9F26822CA02C5DD7"><enum>(A)</enum><text>any reference to
a waiver application under section 1855 shall be treated as a reference to a
waiver application under paragraph (1)(A) of this subsection; and</text>
</subparagraph><subparagraph id="id9A361600FA87436D8B4C5A574256AA23"><enum>(B)</enum><text>any reference to
solvency standards shall be treated as a reference to solvency standards
established under subsection (d) of this section.</text>
</subparagraph></paragraph></subsection><subsection id="id5C4B4E9920B244C980889080BA993EBD"><enum>(d)</enum><header>Solvency
standards for non-Licensed entities</header>
<paragraph id="id4848DBEB55414B09A0AD684B5B7FDB0E"><enum>(1)</enum><header>Establishment
and publication</header><text>The Secretary, in consultation with the National
Association of Insurance Commissioners, shall establish and publish, by not
later than January 1, 2016, financial solvency and capital adequacy standards
for entities described in paragraph (2).</text>
</paragraph><paragraph id="idDB32D02A53DD4730848BC18E81FB386B"><enum>(2)</enum><header>Compliance with
standards</header><text>A Total Health sponsor that is not licensed by a State
under subsection (a)(1) and for which a waiver application has been approved
under subsection (c) shall meet solvency and capital adequacy standards
established under paragraph (1). The Secretary shall establish certification
procedures for such sponsors with respect to such solvency standards in the
manner described in section 1855(c)(2).</text>
</paragraph></subsection><subsection id="id9EED679E0E324BEF94694F79CC8423DF"><enum>(e)</enum><header>Licensure does
not substitute for or constitute certification</header><text>The fact that a
Total Health sponsor is licensed in accordance with subsection (a)(1) or has a
waiver application approved under subsection (c) does not deem the sponsor to
meet other requirements imposed under this subpart for a sponsor.</text>
</subsection><subsection id="id5B9787DE5A5644339FDA964184281B85"><enum>(f)</enum><header>Periodic review
and revision of standards</header>
<paragraph id="id8D31BC25349840A791B250FA5C122292"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), the Secretary may periodically
review the standards established under this section and, based on such review,
may revise such standards if the Secretary determines such revision to be
appropriate.</text>
</paragraph><paragraph id="idFFE3C3DEB5A74DE6883509EBDF282A8F"><enum>(2)</enum><header>Prohibition of
midyear implementation of significant new regulatory
requirements</header><text>The Secretary may not implement, other than at the
beginning of a calendar year, regulations under this section that impose new,
significant regulatory requirements on a Total Health sponsor or a Total Health
plan.</text>
</paragraph></subsection><subsection id="id074C1D3F32A242E48FFE4C4356633B37"><enum>(g)</enum><header>Prohibition of
state imposition of premium taxes; relation to state laws</header><text>The
provisions of sections 1854(g) and 1856(b)(3) shall apply with respect to Total
Health sponsors and Total Health plans under this part in the same manner as
such provisions applied to MA organizations and MA plans.</text>
</subsection></section><section id="id66CDAFA661154E8992798A930C8D48CB"><enum>1860C–7.</enum><header>Total health
premiums</header><subsection commented="no" display-inline="yes-display-inline" id="idD2FB5611A9D748918DB6B72FDE6710D3"><enum>(a)</enum><header>Monthly beneficiary
premium</header>
<paragraph id="idEAEA6B06FC824146BCF6973E35C73027"><enum>(1)</enum><header>Base
beneficiary premium</header><text>The base beneficiary premium under this
paragraph for a Total Health plan for a month is equal to the product
of—</text>
<subparagraph id="id65BB665DCFF64D1CAEC89073C0192DBA"><enum>(A)</enum><text>15 percent;
and</text>
</subparagraph><subparagraph id="idEF4798B8B69347D492A3FE91853AE5C7"><enum>(B)</enum><text>an amount
determined by the Secretary to be equal to the 40th percentile of the monthly
standardized bid amounts (as defined in subsection (c), weighted under
subsection (b), and adjusted under section 1860C–8(b)(2)) for the service area
in which the plan is offered.</text>
</subparagraph></paragraph><paragraph id="id592E748126AA47F29D8A4917D3E1E4FB"><enum>(2)</enum><header>Computation of
monthly beneficiary premium</header>
<subparagraph id="idC9C9156B0BBC47FCA4322372A569BA29"><enum>(A)</enum><header>In
general</header><text>The monthly beneficiary premium for a Total Health plan
is the base beneficiary premium computed under paragraph (1) as adjusted under
this paragraph.</text>
</subparagraph><subparagraph id="idB39C5131306845F598DD7FD76782EF7B"><enum>(B)</enum><header>Adjustment to
reflect difference between bid and 40th percentile of the monthly standardized
bid amount</header>
<clause id="id393AEF3A37C041F5898BB18A65D1B9C4"><enum>(i)</enum><header>Above 40th
percentile</header><text>If the beneficiary enrolls in a plan with a monthly
standardized bid amount that exceeds the 40th percentile (as determined under
paragraph (1)(B)), the base beneficiary premium for the month shall be
increased by the amount of such excess.</text>
</clause><clause id="id785EA4BBB4A8472899291A3C70FBB570"><enum>(ii)</enum><header>Below 40th
percentile</header><text>If the beneficiary enrolls in a plan with a monthly
standardized bid amount that is less than the 40th percentile (as determined
under paragraph (1)(B)), the base beneficiary premium for the month shall be
decreased by the amount of such difference. Any reduction under the preceding
sentence shall not result in a monthly beneficiary premium that is less than
$0.</text>
</clause></subparagraph><subparagraph id="id88C2C72A2C494F75B937FB4A0E6C52D4"><enum>(C)</enum><header>Increase for
supplemental benefits</header><text>The base beneficiary premium shall be
increased by the portion of the Total Health approved bid that is attributable
to supplemental benefits.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id8FC3D33ED5F348FE9A39BE3EE557C770"><enum>(D)</enum><header display-inline="yes-display-inline">Increase for late enrollment
penalty</header><text display-inline="yes-display-inline">The base beneficiary
premium shall be increased by the amount of any late enrollment penalty under
subsection (e).</text>
</subparagraph><subparagraph id="idDDE79D974E7F4F04BAF871E1E66ACD1E"><enum>(E)</enum><header>Increase based
on income</header><text>The monthly beneficiary premium shall be increased
pursuant to subsection (f).</text>
</subparagraph><subparagraph id="id3690A0EF91DA48A3AF08FB61621313CA"><enum>(F)</enum><header>Uniform
premium</header><text>Except as provided in subparagraphs (D) and (E), the
monthly beneficiary premium for a Total Health plan in a Total Health region is
the same for all Total Health eligible individuals enrolled in the plan.</text>
</subparagraph></paragraph></subsection><subsection id="idF9FEE6A3363F449A9C9CAF4029A7589F"><enum>(b)</enum><header>Weighting of
bid amounts based on enrollment</header>
<paragraph id="id39CE3BF3BC7F4BD69F318C44E7ABF17F"><enum>(1)</enum><header>In
general</header><text>For purposes of subsection (a)(1)(B), the weight for each
plan in the service area shall be equal to the average number of Total Health
eligible individuals enrolled in such plan in the reference month (as defined
in section 1858(f)(4)).</text>
</paragraph><paragraph id="id9FEFC75D12794CD9ACC9BD0CF5865DAE"><enum>(2)</enum><header>Special rule
for 2017</header><text>For purposes of applying this paragraph for 2017, the
Secretary shall establish procedures for determining the weighted average under
paragraph (1) for 2016.</text>
</paragraph></subsection><subsection id="id563E053FD8634CA88B194ED5CE3CC015"><enum>(c)</enum><header>Standardized
bid amount defined</header><text>For purposes of this subsection, the term
<term>standardized bid amount</term> means the following:</text>
<paragraph id="id68E49261F7A84BE4A1DEADCE5F83DE65"><enum>(1)</enum><header>Basic coverage
only</header><text>In the case of a Total Health plan that provides basic
health benefits coverage, the Total Health approved bid (as defined in
subsection (d)).</text>
</paragraph><paragraph id="id8483BE7B4FE648E9BF34179329723DD1"><enum>(2)</enum><header>Plans offering
supplemental coverage</header><text>In the case of a Total Health plan that
provides supplemental health benefits coverage, only the portion of the Total
Health approved bid that is attributable to basic health benefits
coverage.</text>
</paragraph></subsection><subsection id="id3FC3ABDE5F3041F5AE570968B24E9868"><enum>(d)</enum><header>Total health
approved bid defined</header><text>For purposes of this subpart, the term
<term>Total Health approved bid</term> means—</text>
<paragraph id="idB5A13E5E913F45D0B3C8681B431F6755"><enum>(1)</enum><text>with respect to a
Total Health plan, the bid amount approved for the plan under section 1860C–5;
and</text>
</paragraph><paragraph id="id7999961CE1DC4DD39EC27C9407B08E1E"><enum>(2)</enum><text>with respect to
the original medicare fee-for-service program option, the bid described in
section 1860C–5(c).</text>
</paragraph></subsection><subsection id="idCEB3315CF0084BF3AD09FB2E1A121BC2"><enum>(e)</enum><header>Late enrollment
penalty</header><text>The monthly beneficiary premium established under
subsection (a) shall be subject to adjustment in the same manner as the part B
monthly beneficiary premium computed under section 1839 is subject to
adjustment under subsection (b) of such section, except that, in applying the
late enrollment penalty under such subsection, the initial enrollment period of
the individual shall be the enrollment period under 1860C–1(b)(2) instead of
the initial enrollment period described in such section 1839(b).</text>
</subsection><subsection id="id4778BB14654D463DA3B2301EE65F8C68"><enum>(f)</enum><header>Increase in
base beneficiary premium based on income</header>
<paragraph id="idFCFC510705874FFDB9D065CB206B87BC"><enum>(1)</enum><header>In
general</header><text>In the case of an individual whose modified adjusted
gross income (as defined in paragraph (2)) exceeds the threshold amount
applicable under paragraph (2) of section 1839(i) (including application of
paragraph (5) of such section), the Secretary shall substitute the applicable
percentage determined under paragraph (3)(C) of section 1839(i) for the
individual for the calendar year for the percentage described in subsection
(a)(1)(A).</text>
</paragraph><paragraph commented="no" id="idBFED33C2B33B47A785AC14EDB9165243"><enum>(2)</enum><header>Modified
adjusted gross income</header><text>For purposes of this subsection, the term
<term>modified adjusted gross income</term> has the meaning given such term in
subparagraph (A) of section 1839(i)(4), determined for the taxable year
applicable under subparagraphs (B) and (C) of such section.</text>
</paragraph><paragraph id="idA4C4FA0865A5403CAD453D8FCE48C316"><enum>(3)</enum><header>Determination
by commissioner of social security</header><text>The Commissioner of Social
Security shall make any determination necessary to carry out the income-related
increase in the base beneficiary premium under this subsection.</text>
</paragraph><paragraph id="id63FDDC728A164151849E380BB6A6D0E5"><enum>(4)</enum><header>Procedures to
assure correct income-related increase in base beneficiary premium</header>
<subparagraph id="id0005D359AA9F4ACCADF5816ED4AE8B2C"><enum>(A)</enum><header>Disclosure of
base beneficiary premium</header><text>Not later than September 15 of each year
beginning with 2016, the Secretary shall disclose to the Commissioner of Social
Security the amount of the base beneficiary premium (as computed under
subsection (a)(1)) for the purpose of carrying out the income-related increase
in the base beneficiary premium under this subsection with respect to the
following year.</text>
</subparagraph><subparagraph id="idC4EB2BD4DB674E159EF3E68AC127C083"><enum>(B)</enum><header>Additional
disclosure</header><text>Not later than October 15 of each year beginning with
2016, the Secretary shall disclose to the Commissioner of Social Security the
following information for the purpose of carrying out the income-related
increase in the base beneficiary premium under this subsection with respect to
the following year:</text>
<clause id="id1EFE727C278E4EE5913A625DDC54A60C"><enum>(i)</enum><text>The modified
adjusted gross income threshold applicable under paragraph (2) of section
1839(i) (including application of paragraph (5) of such section).</text>
</clause><clause id="id87B3B63B6484450380F6EAC1ADA0EF4B"><enum>(ii)</enum><text>The applicable
percentage determined under paragraph (3)(C) of section 1839(i) (including
application of paragraph (5) of such section).</text>
</clause><clause id="id8C95957707A04986A4719C664D1E806D"><enum>(iii)</enum><text>Any other
information the Commissioner of Social Security determines necessary to carry
out the income-related increase in the base beneficiary premium under this
subsection.</text>
</clause></subparagraph></paragraph></subsection></section><section id="idE826DF9BC5A2433A8F1504D5657DF563"><enum>1860C–8.</enum><header>Premium and cost-sharing support for Total
Health eligible individuals</header><subsection commented="no" display-inline="yes-display-inline" id="idC938281428934D1AB885F4ACF533F244"><enum>(a)</enum><header>Direct subsidy
payment</header><text>The Secretary shall provide for payment to a Total Health
sponsor that offers a Total Health plan a direct subsidy for each Total Health
eligible individual enrolled in a Total Health plan for a month equal
to—</text>
<paragraph id="id62F9F1897D5442DFADECEAE861CC52D0"><enum>(1)</enum><text>the amount of the
plan’s standardized bid amount (as defined in section 1860C–7(c)), adjusted
under subsection (b)(1), reduced by</text>
</paragraph><paragraph id="id30C5A326DA174E9AA758711A14EE6817"><enum>(2)</enum><text>the base
beneficiary premium (as computed under paragraph (1) of section 1860C–7(a) and
as adjusted under paragraph (2)(B) of such section).</text>
</paragraph></subsection><subsection id="id8DD056339F9244CAA3419EDCE0E7D073"><enum>(b)</enum><header>Adjustments
relating to bids</header>
<paragraph id="id124AF19820474240A61083EB102B7680"><enum>(1)</enum><header>Health status
risk adjustment</header>
<subparagraph id="id3F79BDC6706646FF9DE10C57635EA439"><enum>(A)</enum><header>Establishment
of risk adjustors</header><text>The Secretary shall establish an appropriate
methodology for adjusting the standardized bid amount under subsection (a)(1)
to take into account variation in costs for health benefits coverage among
Total Health plans based on the differences in actuarial risk of different
enrollees being served. Any such risk adjustment shall be designed in a manner
so as not to result in a change in the aggregate amounts payable to such plans
under subsection (a) and through that portion of the monthly beneficiary Total
Health premiums described in subsection (a)(2).</text>
</subparagraph><subparagraph id="id497765D7C3AB4C47AB3270C5852103D6"><enum>(B)</enum><header>Considerations</header><text>In
establishing the methodology under subparagraph (A), the Secretary may take
into account the similar methodologies used under section 1853(a)(3) to adjust
payments to MA organizations for benefits under the original medicare
fee-for-service program option.</text>
</subparagraph><subparagraph id="id9127A2F3539549C7BCFA74148389FA63"><enum>(C)</enum><header>Data
collection</header><text>In order to carry out this paragraph, the Secretary
shall require Total Health sponsors to submit data regarding claims that can be
linked at the individual level to data under this title and such other
information as the Secretary determines necessary.</text>
</subparagraph><subparagraph id="id577BB32F37C5402DBECDF30F939E4EAB"><enum>(D)</enum><header>Publication</header><text>At
the time of publication of risk adjustment factors under section
1860D–15(c)(1)(D), the Secretary shall publish the risk adjusters established
under this paragraph for the succeeding year.</text>
</subparagraph></paragraph><paragraph id="id5A53590AD4644684AA958A22AA306DA9"><enum>(2)</enum><header>Geographic
adjustment</header>
<subparagraph id="idE3900999F1004601B83BC87D05C3D110"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), for purposes of section
1860C–7(a)(1)(B), the Secretary shall establish an appropriate methodology for
adjusting the amount determined under such section to take into account
differences in prices for covered health benefits among Total Health
regions.</text>
</subparagraph><subparagraph id="idE5076DBE0E1D4F32A73F649C621B4CCF"><enum>(B)</enum><header>De minimis
rule</header><text>If the Secretary determines that the price variations
described in subparagraph (A) among Total Health regions are de minimis, the
Secretary shall not provide for adjustment under this paragraph.</text>
</subparagraph><subparagraph id="id86A9CA23C95D4366BFF6AC6B48646862"><enum>(C)</enum><header>Budget neutral
adjustment</header><text>Any adjustment under this paragraph shall be applied
in a manner so as to not result in a change in the aggregate payments made
under this subpart that would have been made if the Secretary had not applied
such adjustment.</text>
</subparagraph></paragraph></subsection><subsection id="id2073A0C26C1B46CCA0ADEEE9339445DD"><enum>(c)</enum><header>Payment
methods</header>
<paragraph id="id0D6A0E05951A4636960F3ECE44F3B824"><enum>(1)</enum><header>In
general</header><text>Payments under this section shall be based on such a
method as the Secretary determines. The Secretary may establish a payment
method by which interim payments of amounts under this section are made during
a year based on the Secretary’s best estimate of amounts that will be payable
after obtaining all of the information.</text>
</paragraph><paragraph id="id1EE8F2FAA7A243F29ACEF509E786F8BE"><enum>(2)</enum><header>Requirement for
provision of information</header>
<subparagraph id="id13FB8CB5D04A428EACCF37072389D5F6"><enum>(A)</enum><header>Requirement</header><text>Payments
under this section to a Total Health sponsor are conditioned upon the
furnishing to the Secretary, in a form and manner specified by the Secretary,
of such information as may be required to carry out this section.</text>
</subparagraph><subparagraph id="id16AF357D0A9342CC902267FF4C9C6B1A"><enum>(B)</enum><header>Restriction on
use of information</header><text>Information disclosed or obtained pursuant to
subparagraph (A) may be used by officers, employees, and contractors of the
Department of Health and Human Services only for the purposes of, and to the
extent necessary in, carrying out this section.</text>
</subparagraph></paragraph><paragraph id="id972C32D6CB2E4D3A8F8B66FDDD5FA55A"><enum>(3)</enum><header>Source of
payments</header><text>Payments under this section shall be made from the
Federal Hospital Insurance Trust Fund under section 1817 and the Federal
Supplementary Medical Insurance Trust Fund under section 1841, in such
proportion as the Secretary determines appropriate.</text>
</paragraph><paragraph id="id65DBD5CB3D6048E1B736E7922016DFAF"><enum>(4)</enum><header>Application of
enrollee adjustment</header><text>The provisions of section 1853(a)(2) shall
apply to payments to Total Health sponsors under this section in the same
manner as they applied to payments to MA organizations under section
1853(a).</text>
</paragraph></subsection><subsection id="idD01AE545CD784BA2B6E3BAAF68F541C0"><enum>(d)</enum><header>Plans at risk
for entire amount of benefits</header><text>A Total Health sponsor that offers
a plan under this subpart shall be at full financial risk for the provision of
benefits under such plan.</text>
</subsection><subsection id="idFB4E3CF18EDD48B6B92E406342613047"><enum>(e)</enum><header>Disclosure of
information</header>
<paragraph id="idFA38871DC2004D5C83B0DEF845B53AD3"><enum>(1)</enum><header>In
general</header><text>Each contract under this subpart shall provide
that—</text>
<subparagraph id="idA7C3C19B64224691AC99501E6E06868F"><enum>(A)</enum><text>the Total Health
sponsor offering a Total Health plan shall provide the Secretary with such
information as the Secretary determines is necessary to carry out this section;
and</text>
</subparagraph><subparagraph id="idD1DF50AF31D94150AB40D0B5CD3AD1A2"><enum>(B)</enum><text>the Secretary
shall have the right in accordance with section 1857(d)(2)(B) (as applied under
section 1860C–6(b)(2)(C)) to inspect and audit any books and records of a Total
Health sponsor that pertain to the information regarding costs provided to the
Secretary under subparagraph (A).</text>
</subparagraph></paragraph><paragraph id="id9B1CBF8E62424701927E015906DD93E3"><enum>(2)</enum><header>Restriction on
use of information</header><text>Information disclosed or obtained pursuant to
the provisions of this section may be used—</text>
<subparagraph id="id699428DCCA3E4DF69EA268657634F161"><enum>(A)</enum><text>by officers,
employees, and contractors of the Department of Health and Human Services for
the purposes of, and to the extent necessary in—</text>
<clause id="id7D6DFBD45F914CB79CC45BEF55665B43"><enum>(i)</enum><text>carrying out this
section; and</text>
</clause><clause id="id4F53A6444BBF4CE59306FC638C1FF35E"><enum>(ii)</enum><text>conducting
oversight, evaluation, and enforcement under this title; and</text>
</clause></subparagraph><subparagraph id="id893303EC0B8945EA9F6ACDA0D737EA2A"><enum>(B)</enum><text>by the Attorney
General and the Comptroller General of the United States for the purposes of,
and to the extent necessary in, carrying out health oversight
activities.</text>
</subparagraph></paragraph></subsection></section><section id="id6D95B3518A3640989FDF8BB432C9C763"><enum>1860C–9.</enum><header>Exemption for MSA
plans</header><subsection commented="no" display-inline="yes-display-inline" id="id5E4EE0B877394440A1940773B30A4921"><enum>(a)</enum><header>In
general</header><text>None of the provisions in this subpart shall apply to an
MSA plan (as defined in section 1859(b)(3)) and an MSA plan may not be a Total
Health plan.</text>
</subsection><subsection id="idC477A6BF206E4B33A574010FAABF0BF3"><enum>(b)</enum><header>Continuing
availability</header><text>Notwithstanding any other provision of law, the
Secretary shall establish procedures under which—</text>
<paragraph id="id5F4FFA9EE49D4AA79F85CFBE3282FF36"><enum>(1)</enum><text>MSA plans may
continue to operate on and after January 1, 2017; and</text>
</paragraph><paragraph id="idEC73EDD25C1E484E850E619CFD46138B"><enum>(2)</enum><text>individuals who
would have been eligible to enroll in those plans prior to such date continue
to be eligible to enroll in such a plan.</text>
</paragraph></subsection></section><section id="id60869A66A7484038B69EAFF8EDA76957"><enum>1860C–10.</enum><header>Special rules for employer-sponsored
programs</header><subsection commented="no" display-inline="yes-display-inline" id="id8BE3FE2B221348428EA0541651704517"><enum>(a)</enum><header>Subsidy
payment</header>
<paragraph id="id704B278D2A9E4F3BB000CF892CED8010"><enum>(1)</enum><header>In
general</header><text>The Secretary shall provide in accordance with this
subsection for payment to the sponsor of a qualified retiree health benefits
plan (as defined in paragraph (2)) of a special subsidy payment equal to the
amount specified in paragraph (3) for each qualified covered retiree under the
plan (as defined in paragraph (4)). This subsection constitutes budget
authority in advance of appropriations Acts and represents the obligation of
the Secretary to provide for the payment of amounts provided under this
section.</text>
</paragraph><paragraph id="id97DD250CF0CB45E9B6AAE3C0428DE535"><enum>(2)</enum><header>Qualified
retiree health benefits plan defined</header><text>For purposes of this
subsection, the term <term>qualified retiree health benefits plan</term> means
employment-based retiree health coverage (as defined in subsection (c)(1)) if,
with respect to a Total Health eligible individual who is a participant or
beneficiary under such coverage, the following requirements are met:</text>
<subparagraph id="id24046B5656D94A96AEA53D95F4CF283C"><enum>(A)</enum><header>Attestation of
actuarial equivalence to standard coverage</header><text>The sponsor of the
plan provides the Secretary, annually or at such other time as the Secretary
may require, with an attestation that the actuarial value of health benefits
coverage under the plan (as determined using the processes and methods
described in section 1860C–5(d)) is at least equal to the actuarial value of
standard health benefits coverage.</text>
</subparagraph><subparagraph id="idD442262DDE2C4106B2538763D26C8375"><enum>(B)</enum><header>Audits</header><text>The
sponsor of the plan, or an administrator of the plan designated by the sponsor,
shall maintain (and afford the Secretary access to) such records as the
Secretary may require for purposes of audits and other oversight activities
necessary to ensure the adequacy of health benefits coverage and the accuracy
of payments made under this section. The provisions of section 1860C–2(d)(2)
shall apply to such information under this section (including such actuarial
value and attestation) in a manner similar to the manner in which they apply to
financial records of Total Health sponsors.</text>
</subparagraph><subparagraph id="id9652990D87774B5C87D74644296015A4"><enum>(C)</enum><header>Provision of
disclosure regarding health benefits coverage</header>
<clause id="idAA7226CAD4464D1798E2F508544B4F63"><enum>(i)</enum><header>In
general</header><text>Each entity that offers employment-based retiree health
coverage shall provide for disclosure, in a form, manner, and time consistent
with standards established by the Secretary, to the Secretary and Total Health
eligible individuals of whether the coverage meets the requirement of
subparagraph (A) or whether such coverage is changed so it no longer meets such
requirement.</text>
</clause><clause id="id0BC1E86849244F4C90767941BAFD93CA"><enum>(ii)</enum><header>Disclosure of
non-qualified coverage</header><text>In the case of such coverage that does not
meet such requirement, the disclosure to Total Health eligible individuals
under this subparagraph shall include information regarding the fact that
because such coverage does not meet such requirement there are limitations on
the periods in a year in which the individuals may enroll under a Total Health
plan.</text>
</clause><clause id="idAA634912B9FA47BBA4D58C38522B0612"><enum>(iii)</enum><header>Waiver of
requirement</header><text>In the case of a Total Health eligible individual who
was enrolled in employment-based retiree health coverage which does not meet
the requirement of subparagraph (A), the individual may apply to the Secretary
to have such coverage treated as a qualified retiree health benefits plan if
the individual establishes that the individual was not adequately informed that
such coverage did not meet such requirement.</text>
</clause></subparagraph></paragraph><paragraph id="id70A12FB0AD5946EFA8A7A560F60B54CE"><enum>(3)</enum><header>Employer and
union special subsidy amounts</header>
<subparagraph id="id8BE385519D5A4936A859FC03DDEC8EC7"><enum>(A)</enum><header>In
general</header><text>For purposes of this subsection, the special subsidy
payment amount under this paragraph for a qualifying covered retiree for a
coverage year enrolled with the sponsor of a qualified retiree health benefits
plan is, for the portion of the retiree’s gross covered retiree plan-related
health benefits costs (as defined in subparagraph (C)(ii)) for such year that
exceeds the cost threshold amount specified in subparagraph (B) and does not
exceed the cost limit under such subparagraph, an amount equal to 28 percent of
the allowable retiree costs (as defined in subparagraph (C)(i)) attributable to
such gross covered retiree plan-related health benefits costs.</text>
</subparagraph><subparagraph id="idBE3DC61E474F4B87BCC084CDECCFC32C"><enum>(B)</enum><header>Cost threshold
and cost limit applicable</header>
<clause id="id462AD3CAFCCD4BD398D6D7D0057F6860"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii)—</text>
<subclause id="idDB5FDD0D866140679349835C81913293"><enum>(I)</enum><text>the cost
threshold under this subparagraph is equal to $250 for plan years that end in
2017; and</text>
</subclause><subclause id="idFB12BCA4225840C4B9D703866797BC08"><enum>(II)</enum><text>the cost limit
under this subparagraph is equal to $5,000 for plan years that end in
2017.</text>
</subclause></clause><clause id="idE8D023B552044AB6954087A5093A0944"><enum>(ii)</enum><header>Indexing</header><text>The
cost threshold and cost limit amounts specified in subclauses (I) and (II) of
clause (i) for a plan year that ends after 2017 shall be adjusted in the same
manner as the unified deductible and the annual out-of-pocket limits,
respectively, are annually adjusted under sections 1899B and 1899C.</text>
</clause></subparagraph><subparagraph id="id1562242E62EF4582B43E223C096CEA66"><enum>(C)</enum><header>Definitions</header><text>For
purposes of this paragraph:</text>
<clause id="idC712154469C64BE0BD6C1FD54EF44553"><enum>(i)</enum><header>Allowable
retiree costs</header><text>The term <term>allowable retiree costs</term>
means, with respect to gross covered health benefits costs under a qualified
retiree health benefits plan by a plan sponsor, the part of such costs that are
actually paid (net of discounts, chargebacks, and average percentage rebates)
by the sponsor or by or on behalf of a qualifying covered retiree under the
plan.</text>
</clause><clause id="idCD80C2C34ADB4FC1B30F2EC9E2671255"><enum>(ii)</enum><header>Gross covered
retiree plan-related health benefits costs</header><text>The term <term>gross
covered retiree plan-related health benefits costs</term> means, with respect
to a qualifying covered retiree enrolled in a qualified retiree health benefits
plan during a coverage year, the costs incurred under the plan, not including
administrative costs, but including costs directly related to the furnishing of
health benefits items and services during the year. Such costs shall be
determined whether they are paid by the retiree or under the plan.</text>
</clause><clause id="id133B5A6B2C394623967B50CAABE7539C"><enum>(iii)</enum><header>Coverage
year</header><text>The term <term>coverage year</term> has the meaning given
such term in section 1860D–15(b)(4) (as applied by substituting <quote>covered
health benefits</quote> for <quote>covered part D drugs</quote>).</text>
</clause></subparagraph></paragraph><paragraph id="id0DA6149B30F74420B9534603DDB3A576"><enum>(4)</enum><header>Qualifying
covered retiree defined</header><text>For purposes of this subsection, the term
<term>qualifying covered retiree</term> means a Total Health eligible
individual who is not enrolled in a Total Health plan but is covered under a
qualified retiree health benefits plan.</text>
</paragraph><paragraph id="idD6DF9E42E87E40C9A94EB53E4FF7ABD3"><enum>(5)</enum><header>Payment
methods, including provision of necessary information</header><text>The
provisions of section 1860C–8(c) (including paragraph (2) of such section,
relating to requirement for provision of information) shall apply to payments
under this subsection in a manner similar to the manner in which they apply to
payments under section 1860C–8.</text>
</paragraph><paragraph id="id299E66927A864E7388B4482F1A99A81F"><enum>(6)</enum><header>Construction</header><text>Nothing
in this subsection shall be construed as—</text>
<subparagraph id="id518F6544E7314C69B6E9ED45AF97D846"><enum>(A)</enum><text>precluding a
Total Health eligible individual who is covered under employment-based retiree
health coverage from enrolling in a Total Health plan;</text>
</subparagraph><subparagraph id="idFE84E858798A465DA7BE9D355C32651C"><enum>(B)</enum><text>precluding such
employment-based retiree health coverage or an employer or other person from
paying all or any portion of any premium required for coverage under a Total
Health plan on behalf of such an individual;</text>
</subparagraph><subparagraph id="idC2C624F4642C45519601971E049F71FD"><enum>(C)</enum><text>preventing such
employment-based retiree health coverage from providing coverage—</text>
<clause id="id69A0A19767D04452BD2B49A1F7183FDB"><enum>(i)</enum><text>that is better
than standard health benefits coverage to retirees who are covered under a
qualified retiree health benefits plan; or</text>
</clause><clause id="id7A1A97976EF44D3C92CB5BA335A1FA39"><enum>(ii)</enum><text>that is
supplemental to the benefits provided under a Total Health plan, including
benefits to retirees who are not covered under a qualified retiree health
benefits plan but who are enrolled in such a Total Health plan; or</text>
</clause></subparagraph><subparagraph id="idBA71884FFCE440E2878D8FBA27E6042B"><enum>(D)</enum><text>preventing
employers from providing for flexibility in benefit design and provider access
provisions, without regard to the requirements for basic health benefits
coverage, so long as the actuarial equivalence requirement of paragraph (2)(A)
is met.</text>
</subparagraph></paragraph></subsection><subsection id="id4BA6B0385F6D40ACB5E0E9C976E6F47C"><enum>(b)</enum><header>Application of
Medicare Advantage waiver authority</header><text>The provisions of section
1857(i) shall apply with respect to Total Health plans in relation to
employment-based retiree health coverage in a manner similar to the manner in
which they applied to an MA plan in relation to employers, including
authorizing the establishment of separate premium amounts for enrollees in a
Total Health plan by reason of such coverage and limitations on enrollment to
Total Health eligible individuals enrolled under such coverage.</text>
</subsection><subsection id="idD96DA2BD8F274AA6B2C9109F3A9E3D1B"><enum>(c)</enum><header>Definitions</header><text>For
purposes of this section:</text>
<paragraph id="id55DC3A0A8A014B3494A62DA7B8416D47"><enum>(1)</enum><header>Employment-based
retiree health coverage</header><text>The term <term>employment-based retiree
health coverage</term> means health insurance or other coverage of health care
costs (whether provided by voluntary insurance coverage or pursuant to
statutory or contractual obligation) for Total Health eligible individuals (or
for such individuals and their spouses and dependents) under a group health
plan based on their status as retired participants in such plan.</text>
</paragraph><paragraph id="id4D7137F065AE47B48C09786C79B3AB12"><enum>(2)</enum><header>Sponsor</header><text>The
term <term>sponsor</term> means a plan sponsor, as defined in section (16)(B)
of the Employee Retirement Income Security Act of 1974, in relation to a group
health plan, except that, in the case of a plan maintained jointly by one
employer and an employee organization and with respect to which the employer is
the primary source of financing, such term means such employer.</text>
</paragraph><paragraph id="idD7AD0D2F8A4349238FCB6728BE86B8A2"><enum>(3)</enum><header>Group health
plan</header><text>The term <term>group health plan</term> includes such a plan
as defined in section 607(1) of the Employee Retirement Income Security Act of
1974 and also includes the following:</text>
<subparagraph id="id345DA45D4897448E9084D7EA061ABD2E"><enum>(A)</enum><header>Federal and
state governmental plans</header><text>Such a plan established or maintained
for its 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 of the foregoing, including a health benefits plan offered under chapter
89 of title 5, United States Code.</text>
</subparagraph><subparagraph id="idA08ED4ECAA804FA0B61A0664499E8129"><enum>(B)</enum><header>Collectively
bargained plans</header><text>Such a plan established or maintained under or
pursuant to one or more collective bargaining agreements.</text>
</subparagraph><subparagraph id="id2829C825580742FB9FD59CD836BC807B"><enum>(C)</enum><header>Church
plans</header><text>Such a plan established and maintained for its employees
(or their beneficiaries) by a church or by a convention or association of
churches which is exempt from tax under section 501 of the Internal Revenue
Code of 1986.</text>
</subparagraph></paragraph></subsection></section><section id="id7EF23E7A89CF46AC9740FE190A7E83CD"><enum>1860C–11.</enum><header>Coordination with State Medicaid
programs</header><subsection commented="no" display-inline="yes-display-inline" id="idC7842E35B9EB4A8FBEFA8F3898A7C747"><enum>(a)</enum><header>Application</header>
<paragraph id="idF8532614F7E342F1A95F802DB86C91B7"><enum>(1)</enum><header>In
general</header><text>Subject to subsection (c)(2), a State may apply to the
Secretary for the waiver of any or all requirements described in this subpart
for plan years beginning on or after January 1, 2017, with respect to a Total
Health plan offered within the State for the purpose of coordinating that plan
with its State plan under title XIX to ensure—</text>
<subparagraph id="idECB220923DF943F8BCAD2340D8D5B3AD"><enum>(A)</enum><text>dually eligible
individuals have full access to the services to which they are entitled;</text>
</subparagraph><subparagraph id="idFC4B551795DA4A70BEEC93507D264B79"><enum>(B)</enum><text>the development
of innovative care coordination and integration models; and</text>
</subparagraph><subparagraph id="idC498C5ACB1AC46DEB988961499052CB2"><enum>(C)</enum><text>the elimination
of financial misalignments that lead to poor quality and cost-shifting.</text>
</subparagraph></paragraph><paragraph id="idDD5ACD9E103A49028EFF0487E9054167"><enum>(2)</enum><header>Requirements</header><text>Such
application shall—</text>
<subparagraph id="id0A06CB6B3FDA4235803274CC031D18D4"><enum>(A)</enum><text>be filed at such
time and in such manner as the Secretary may require;</text>
</subparagraph><subparagraph id="idF3F95391295B4391A0C64EA8E80FE284"><enum>(B)</enum><text>contain such
information as the Secretary may require, including—</text>
<clause id="idB16F352DA3194AE49D4296854F385D48"><enum>(i)</enum><text>a
comprehensive description of the proposal and program to implement a plan
meeting the requirements for a waiver under this section; and</text>
</clause><clause id="id0DAFB895ECA14655A7A81B0D464D11DA"><enum>(ii)</enum><text>an analysis of
the proposal demonstrating that the plan will not increase Federal Government
expenditures; and</text>
</clause></subparagraph><subparagraph id="idE4189804C9EE407D9216094BFF47C047"><enum>(C)</enum><text>provide an
assurance that, if approved, the Total Health sponsor will offer the plan that
is the subject of the proposal.</text>
</subparagraph></paragraph><paragraph id="id50701300D84E4B62B94A3018146F674D"><enum>(3)</enum><header>Waiver
consideration and transparency</header>
<subparagraph id="id3051A84A5253488FA343EB09A5DFF50A"><enum>(A)</enum><header>In
general</header><text>An application for a waiver under this section shall be
considered by the Secretary in accordance with the regulations described in
subparagraph (B).</text>
</subparagraph><subparagraph id="id09ADAD5C263849B1B1B44FAD306BB9EB"><enum>(B)</enum><header>Regulations</header><text>Not
later than 180 days after the date of enactment of this subpart, the Secretary
shall promulgate regulations relating to waivers under this section that
provide—</text>
<clause id="id7CB7F1CB714C4C098E6A25540BF16E6E"><enum>(i)</enum><text>a
process for public notice and comment sufficient to ensure a meaningful level
of public input;</text>
</clause><clause id="idF7AE99DF6302467B9777B50D43FD1DAE"><enum>(ii)</enum><text>a process for
the submission of an application for the waiver;</text>
</clause><clause id="id79AAB4F93ED64D7A9E22D4794D320F0C"><enum>(iii)</enum><text>a process for
the submission to the Secretary of periodic reports by the State concerning the
implementation of the program under the waiver; and</text>
</clause><clause id="idFD68C45D90DF489DA6F33E0CA2A39E29"><enum>(iv)</enum><text>a process for
the periodic evaluation by the Secretary of the program under the
waiver.</text>
</clause></subparagraph><subparagraph id="id9CC826FE78404058BF2BB0507D64A556"><enum>(C)</enum><header>Report</header><text>The
Secretary shall annually report to Congress concerning actions taken by the
Secretary with respect to applications for waivers under this section.</text>
</subparagraph></paragraph><paragraph id="id2D12F5CCB948472E8516CF9A28712183"><enum>(4)</enum><header>State option to
be a total health sponsor</header><text>For purposes of this section, a State
may elect to be the sponsor of a Total Health plan for residents of the State
who are eligible for benefits under this title and title XIX or to apply on
behalf of a Total Health sponsor offering a Total Health plan in the
State.</text>
</paragraph><paragraph id="id8F49CA930A22453A9B59C652BA5A4048"><enum>(5)</enum><header>Coordinated
waiver process</header><text>The Secretary shall develop a process for
coordinating and consolidating the waiver processes applicable under the
provisions of this section to ensure that individuals eligible to enroll in a
plan offered under the waiver are initially able to do so during an annual,
coordinated election period.</text>
</paragraph></subsection><subsection id="idBDF4B338F7D24900A2CCCE6D51EFEB19"><enum>(b)</enum><header>Granting of
waivers</header>
<paragraph id="id0B99A19861B44E2EBE1D4B8C3783BFE3"><enum>(1)</enum><header>In
general</header><text>The Secretary may grant a request for a waiver under
subsection (a)(1) only if the Secretary determines that the proposed Total
Health plan—</text>
<subparagraph id="id13918A72F0AC4192B3B50FB2C16CAB56"><enum>(A)</enum><text>will provide
coverage that is at least as comprehensive as the coverage described in section
1860C–2(a)(1) as certified by Office of the Actuary of the Centers for Medicare
& Medicaid Services;</text>
</subparagraph><subparagraph id="idAE785719F1F04FBBB7C8FEBD01BB3858"><enum>(B)</enum><text>will provide
coverage and cost-sharing protections against excessive out-of-pocket spending
that are at least as affordable as the provisions of this subtitle would
provide; and</text>
</subparagraph><subparagraph id="id33110ACA813D4F58B39AB61B7DAC9516"><enum>(C)</enum><text>will not increase
the Federal deficit.</text>
</subparagraph></paragraph></subsection><subsection id="id83A30AF11A9D4F25869DBEE8A2B97F4C"><enum>(c)</enum><header>Scope of
waiver</header>
<paragraph id="id50FFEB0646184F91BED8CDCA1CE2FC37"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), the Secretary shall determine
the scope of a waiver granted with respect to a Total Health plan under
subsection (a)(1).</text>
</paragraph><paragraph id="idD32EBD675453423C86057D0707572828"><enum>(2)</enum><header>Limitation</header><text>The
Secretary may only waive provisions under this title and titles II, XI, XIX,
and XXI under a waiver under this section.</text>
</paragraph></subsection><subsection id="idAA40B4EC9F3B400AA258BD1FB5349476"><enum>(d)</enum><header>Determinations
by the secretary</header>
<paragraph id="id6E2F67F496A1491D9CDBC398710B747E"><enum>(1)</enum><header>Time for
determination</header><text>The Secretary shall make a determination under
subsection (a)(1) not later than 180 days after the receipt of an application
from a State under such subsection.</text>
</paragraph><paragraph id="idB2B821A5A7374B0DA90C05C97E5BC1E6"><enum>(2)</enum><header>Effect of
determination</header>
<subparagraph id="idD9CC81863665455980A39903D7DC1AC9"><enum>(A)</enum><header>Granting of
waivers</header><text>If the Secretary determines to grant a waiver under
subsection (a)(1), the Secretary shall notify the Total Health sponsor involved
of such determination and the terms and effectiveness of such waiver.</text>
</subparagraph><subparagraph id="id3C844C83100F40BCA876C5AAE56839CD"><enum>(B)</enum><header>Denial of
waiver</header><text>If the Secretary determines a waiver should not be granted
under subsection (a)(1), the Secretary shall notify the Total Health sponsor
involved, including the reasons therefor.</text>
</subparagraph></paragraph></subsection><subsection id="id11DDFD8F69DE43D58B2643E44D736AD4"><enum>(e)</enum><header>Term of
waiver</header><text>No waiver under this section may extend over a period of
longer than 5 years unless the Total Health sponsor requests continuation of
such waiver, and such request shall be deemed granted unless the Secretary,
within 90 days after the date of the submission of the request to the
Secretary, either denies such request in writing or informs the State in
writing with respect to any additional information that is needed in order to
make a final determination with respect to the request.</text>
</subsection></section><section id="id9F0EB7A3F96341FABF2A5716A0753D5F"><enum>1860C–12.</enum><header>Definitions and miscellaneous
provisions</header><subsection commented="no" display-inline="yes-display-inline" id="idC87C340E5EB5490C95F4DD55606B3E54"><enum>(a)</enum><header>Definitions</header><text>For
purposes of this subpart:</text>
<paragraph id="id15865F29DD894745992A0BF5139D9126"><enum>(1)</enum><header>Basic health
benefits coverage</header><text>The term <term>basic health benefits
coverage</term> means coverage of the health care items and services for which
payment may be made under the original medicare fee-for-service program
option.</text>
</paragraph><paragraph id="idDCE2F1746EC1491D8F3B2466F00C32E6"><enum>(2)</enum><header>Insurance
risk</header><text>The term <term>insurance risk</term> means, with respect to
a participating health care provider, risk of the type commonly assumed only by
insurers licensed by a State and does not include payment variations designed
to reflect performance-based measures of activities within the control of the
health care provider.</text>
</paragraph><paragraph id="idDE7C81039C824B5D832ECBEAE1EAD59A"><enum>(3)</enum><header>MA plan;
Medicare Advantage plan</header><text>The terms <term>MA plan</term> and
<term>Medicare Advantage plan</term> have the meaning given such terms in
section 1859(b)(1).</text>
</paragraph><paragraph id="id8B784FDBD17041869D0CE6E35B88E350"><enum>(4)</enum><header>Original
medicare fee-for-service program option</header><text>The term <term>original
medicare fee-for-service program option</term> means the original medicare
fee-for-service program under parts A and B, as modified by this
subpart.</text>
</paragraph><paragraph id="idD7BBFDB85FD34257ADD80C96253163CF"><enum>(5)</enum><header>Standard health
benefits coverage</header><text>The term <term>standard health benefits
coverage</term> has the meaning given such term in section 1860C–2(b).</text>
</paragraph><paragraph id="id394D7C757C2D41338708ED5ED5D4C5D9"><enum>(6)</enum><header>Total health
eligible individual</header><text>The term <term>Total Health eligible
individual</term> has the meaning given such term in section
1860C–1(a)(3).</text>
</paragraph><paragraph id="idB8527DFDC1B942D09FC473D89C32E73A"><enum>(7)</enum><header>Total health
plan</header><text>The term <term>Total Health plan</term> means health
benefits coverage that is offered—</text>
<subparagraph id="idF248E011A50F4880AC55E8082CD8F48A"><enum>(A)</enum><text>under a policy,
contract, or plan that has been approved under section 1860C–5(f); and</text>
</subparagraph><subparagraph id="id16C4949A1F264550AB4AD2417C0CE913"><enum>(B)</enum><text>by a Total Health
sponsor pursuant to, and in accordance with, a contract between the Secretary
and the sponsor under section 1860C–6(b).</text>
</subparagraph></paragraph><paragraph id="id46F095FEEB1040C9B3F01D5BD18C7879"><enum>(8)</enum><header>Total health
sponsor</header><text>The term <term>Total Health sponsor</term> means a
nongovernmental entity that is certified under this subpart as meeting the
requirements and standards of this subpart for such a sponsor.</text>
</paragraph></subsection><subsection id="id0D519793CA3F4F40A37694B9FC0F24FB"><enum>(b)</enum><header>Application of
subpart 1 provisions and regulations under this subpart</header><text>For
purposes of applying provisions of subpart 1 under this subpart (and
regulations implementing such provisions) with respect to a Total Health plan
and a Total Health sponsor, unless otherwise provided in this subpart, and to
the extent consistent with this subpart, such provisions (and regulations
implementing such provisions) shall be applied as the provisions (and
regulations) applied for plan years beginning prior to January 1, 2017, and as
if—</text>
<paragraph id="idBC5BCBECDF2B47999A015B0762170EB1"><enum>(1)</enum><text>any reference to
a Medicare Advantage plan or an MA plan included a reference to a Total Health
plan;</text>
</paragraph><paragraph id="id5DD8F5A2A97047D6A1B316B177ED721B"><enum>(2)</enum><text>any reference to
an MA organization or a provider-sponsored organization included a reference to
a Total Health sponsor;</text>
</paragraph><paragraph id="idDC5E294AB3CD42679CBDCFA317D3623C"><enum>(3)</enum><text>any reference to
a contract under section 1857 included a reference to a contract under section
1860C–6(b);</text>
</paragraph><paragraph id="id71D4C0CDE6944D5B8BD47ED2E6448416"><enum>(4)</enum><text>any reference to
subpart 1 included a reference to this subpart; and</text>
</paragraph><paragraph id="idD5BE3141077249FBA8D36DA43BE42D58"><enum>(5)</enum><text>any reference to
an election period under section 1851 were a reference to an enrollment period
under section
1860C–1.</text>
</paragraph></subsection></section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="id130D30A428D349D9A3023D7A559A7598"><enum>2002.</enum><header>Replacement
of part B premium with Medicare Total Health program plan premium; other
technical and conforming amendments</header>
<subsection id="id15B484191D0846E8B3BA719FEABE1A6D"><enum>(a)</enum><header>Replacement of
part b premium with Medicare total health program plan
premium</header><text>Section 1839 of the Social Security Act (42 U.S.C. 1395r)
is amended—</text>
<paragraph id="idA573A0EB92EF44098AFBA6403B626FFB"><enum>(1)</enum><text>in subsection
(a)(2), by striking <quote>The monthly premium</quote> and inserting
<quote>Subject to subsection (j),</quote>; and</text>
</paragraph><paragraph id="idED52767A45B449A58B74456B090FBB13"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="idCED20A47CE6D48419E5FECB159A2A020" style="OLC">
<subsection id="idF5A055E92B334724AC01D27258248944"><enum>(j)</enum><header>Replacement of
part b premium with Medicare Total Health program plan premium</header>
<paragraph id="id7CF306A707BD44C1B5C0BBF2C1817759"><enum>(1)</enum><header>In
general</header><text>Notwithstanding the preceding provisions of this section,
except as provided in paragraph (2), on and after January 1, 2017, in lieu of
the premium otherwise applicable under this section, the monthly premium of
each Total Health eligible individual (as defined in section 1860C–1(a)(3))
shall be the monthly beneficiary premium determined under section 1860C–7 for
the Total Health plan or the original medicare fee-for-service program option
and the plan year involved.</text>
</paragraph><paragraph id="id8FCCAB6A1E8A48CB85F351D10C2ACCAC"><enum>(2)</enum><header>Individuals
enrolled for coverage under part b only</header><text>Individuals enrolled
under this part only (and not entitled to, or enrolled for, benefits under part
A) shall pay the premium that would have been calculated under this section but
for the enactment of this subsection.</text>
</paragraph><paragraph id="idFE5A13A97B7342858246BB2F385F417B"><enum>(3)</enum><header>Crediting of
premiums</header><text>Premiums paid by each Total Health eligible individual
enrolled in the original medicare fee-for-service program option (as defined in
section 1860E–13(a)(4)), shall be deposited in the Treasury to the credit of
the Federal Supplementary Medical Insurance Trust Fund under section
1841.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id64245960B08F455BB26D97E78FF9BCCE"><enum>(b)</enum><header>Other technical
and conforming amendments</header><text>Not later than 6 months after the date
of the enactment of this Act, the Secretary of Health and Human Services shall
submit to the appropriate committees of Congress a legislative proposal
providing for such technical and conforming amendments in the law as are
required by the provisions of this part and part II.</text>
</subsection></section></part><part id="id3E4FC090BB574373A17D269F9561CECD"><enum>II</enum><header>Medicare
fee-for-Service reforms </header>
<section id="id61A63357080649C98F0D6DDA3276514E"><enum>2011.</enum><header>Medicare
protection against high out-of-pocket expenditures for fee-for-service
benefits</header><text display-inline="no-display-inline">Title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end
the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id8AE5507A29EC43168A0F67FB1D45B168" style="traditional">
<section id="idCDE4F6459F484272AEFE03671C5B0902"><enum>1899B.</enum><header>Protection against high out-of-pocket
expenditures</header><subsection commented="no" display-inline="yes-display-inline" id="id3D6926614B3947A39D55C956FFC9879C"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Notwithstanding any
other provision of this title, in the case of an individual entitled to, or
enrolled for, benefits under part A or enrolled in part B, if the amount of the
out-of-pocket cost-sharing of such individual for a year (beginning with 2015)
equals or exceeds—</text>
<paragraph id="id35DCE7DD8B96452A96C82EEB22628C6E"><enum>(1)</enum><text display-inline="yes-display-inline">the first threshold annual out-of-pocket
limit under subsection (b)(1) but is less than the second threshold annual
out-of-pocket limit under subsection (b)(2) for that year, section 1899D(a)
shall be applied by substituting <quote>5 percent</quote> for <quote>20
percent</quote>; and</text>
</paragraph><paragraph id="id27243EDCCC1A4CF78FE8734FBB0A534B"><enum>(2)</enum><text display-inline="yes-display-inline">the second threshold annual out-of-pocket
limit under subsection (b)(2) for that year, there shall not be any additional
reduction under section 1899D for the remainder of the year (and the individual
shall not be responsible for additional out-of-pocket cost-sharing incurred
during that year).</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id640A234D435D48ABB87731A65012BB38"><enum>(b)</enum><header>Amount of
annual out-of-Pocket limits</header>
<paragraph commented="no" id="idACFCB044011649F7981C7C88783EC3ED"><enum>(1)</enum><header>First threshold
annual out-of-pocket limit</header><text>The amount of the first threshold
annual out-of-pocket limit under this subsection shall be—</text>
<subparagraph commented="no" id="idDE53C29A28BD4EA9A671686DD86F42A6"><enum>(A)</enum><text>for 2015, $5,500;
or</text>
</subparagraph><subparagraph commented="no" id="id214CC2B09CD94A4888453F7561ABF180"><enum>(B)</enum><text>for a subsequent
year, the amount specified in this subsection for the preceding year increased
or decreased by the percentage change in the Chained Consumer Price Index for
All Urban Consumers for the 12-month period ending with June of such preceding
year (as published in its initial form by the Bureau of Labor Statistics of the
Department of Labor as of the end of such period).</text>
</subparagraph></paragraph><paragraph commented="no" id="id0468120D61E047EAB4907DA7A796F000"><enum>(2)</enum><header>Second
threshold annual out-of-pocket limit</header><text>The amount of the second
threshold annual out-of-pocket limit under this subsection shall be—</text>
<subparagraph commented="no" id="idDFDE3CA620714DBD9C7EDD74B0AE6B85"><enum>(A)</enum><text>for 2015, $7,500;
or</text>
</subparagraph><subparagraph commented="no" id="idFE5F8548D37E465883F5BC6D399BFA3A"><enum>(B)</enum><text>for a subsequent
year, the amount specified in this subsection for the preceding year increased
or decreased by the percentage change in the Chained Consumer Price Index for
All Urban Consumers for the 12-month period ending with June of such preceding
year (as published in its initial form by the Bureau of Labor Statistics of the
Department of Labor as of the end of such period).</text>
</subparagraph></paragraph><paragraph commented="no" id="id1C89442DF0AA40D19E85AD2841D695F5"><enum>(3)</enum><header>Rounding</header><text display-inline="yes-display-inline">If any amount determined under subparagraph
(A) or (B) is not a multiple of $5, such amount shall be rounded to the nearest
multiple of $5.</text>
</paragraph></subsection><subsection id="id7E30D01B6DFF439D8EE9EE5E7134D9B2"><enum>(c)</enum><header>Out-of-Pocket
cost-Sharing defined</header>
<paragraph id="idFA6657F5FD7947569FF31C4FC852DF1A"><enum>(1)</enum><header>In
general</header><text>Subject to paragraphs (2) and (3), in this section, the
term <term>out-of-pocket cost-sharing</term> means, with respect to an
individual, the amount of the expenses incurred by the individual that are
attributable to—</text>
<subparagraph id="idDDF6A287FD9C4F608832CA5697A613F4"><enum>(A)</enum><text>deductibles,
coinsurance and copayments applicable under part A or B; or</text>
</subparagraph><subparagraph id="idB23D9DC9D9CC4EE0A2BB00EAD8960E7C"><enum>(B)</enum><text>for items and
services that would have otherwise been covered under part A or B but for the
exhaustion of those benefits.</text>
</subparagraph></paragraph><paragraph id="id8C270C89F04A438FB0E8F6F7DCFC0CBE"><enum>(2)</enum><header>Certain costs
not included</header>
<subparagraph id="id042B803DF90C44C994705A3E8C9CB5DB"><enum>(A)</enum><header>Non-covered
items and services</header><text>Expenses incurred for items and services which
are not included (or treated as being included) under part A or B shall not be
considered incurred expenses for purposes of determining out-of-pocket
cost-sharing under paragraph (1).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id5BAC29AB79034AA4AEB8D5D3920C1A25"><enum>(B)</enum><header display-inline="yes-display-inline">Items and services not furnished on an
assignment-related basis</header><text display-inline="yes-display-inline">If
an item or service is furnished to an individual under this title and is not
furnished on an assignment-related basis, any additional expenses the
individual incurs above the amount the individual would have incurred if the
item or service was furnished on an assignment-related basis shall not be
considered incurred expenses for purposes of determining out-of-pocket
cost-sharing under paragraph (1).</text>
</subparagraph></paragraph><paragraph id="idD5E44FB5C66247E9AC0798DB263A44BF"><enum>(3)</enum><header>Source of
payment</header><text>For purposes of paragraph (1), the Secretary shall
consider expenses to be incurred by the individual without regard to whether
the individual or another person, including a State program or other
third-party coverage, has paid for such expenses.</text>
</paragraph></subsection><subsection id="id7A0B17DC564E4C16AF070606DF1D152B"><enum>(d)</enum><header>Announcement of
annual out-of-Pocket limit and unified deductible</header><text>The Secretary
shall (beginning in 2014) announce (in a manner intended to provide notice to
all interested parties) the annual out-of-pocket limit under this section and
the unified deductible under section 1899C that will be applicable for the
succeeding
year.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idCA82AD8F294549B09E75FEC84638ABCF"><enum>2012.</enum><header>Unified
Medicare deductible</header>
<subsection id="id22DABA731D66411B86FD1D965A4E77AA"><enum>(a)</enum><header>In
general</header><text>Title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.), as amended by section 2011, is amended by adding at the end the
following new section:</text>
<quoted-block display-inline="no-display-inline" id="id0E7AC7D8692B42DF8D104617D7AC906D" style="traditional">
<section id="id3669C7B33D3A42A8AE2D12CB5804692D"><enum>1899C.</enum><header>Unified part A and B deductible</header><subsection commented="no" display-inline="yes-display-inline" id="id286AF539BB8C4EEABE7E07C0687F6D38"><enum>(a)</enum><header>In
general</header><text>Notwithstanding any other provision of this title,
subject to subsection (d), for a year (beginning with 2015), in the case of an
individual entitled to, or enrolled for, benefits under part A or enrolled in
part B—</text>
<paragraph id="id56ED2619D282428EA202001655409460"><enum>(1)</enum><text>the amount
otherwise payable under part A and the total amount of expenses incurred by the
individual 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 by the amount of the unified deductible under
subsection (b); and</text>
</paragraph><paragraph id="id315E2D50826448C2A6A9733138735116"><enum>(2)</enum><text>the individual
shall be responsible for payment of such amount.</text>
</paragraph></subsection><subsection id="id96AC1CD380984B92B2A706386A88B257"><enum>(b)</enum><header>Amount of
unified deductible</header>
<paragraph id="id123C98E23FA84E23A1175B1CD75CE51A"><enum>(1)</enum><header>In
general</header><text>The amount of the unified deductible under this section
shall be—</text>
<subparagraph id="id9F7EFD5CD3A54F7A8428D812707B7590"><enum>(A)</enum><text>for 2015, $550;
or</text>
</subparagraph><subparagraph id="id9A0A30CE0F4E4AD1B7809E58E76EFC85"><enum>(B)</enum><text>for a subsequent
year, the amount specified in this subsection for the preceding year increased
or decreased by the percentage change in the Chained Consumer Price Index for
All Urban Consumers for the 12-month period ending with June of such preceding
year (as published in its initial form by the Bureau of Labor Statistics of the
Department of Labor as of the end of such period).</text>
</subparagraph></paragraph><paragraph id="id7D6F92FE26644B11B4FD3E3300ECBFA0"><enum>(2)</enum><header>Rounding</header><text>If
any amount determined under paragraph (1) is not a multiple of $5, such amount
shall be rounded to the nearest multiple of $5.</text>
</paragraph></subsection><subsection id="idEE26A83BF23D42F58DF5E38C885F01D6"><enum>(c)</enum><header>Application to
all items and services</header><text>The unified deductible under this section
for a year shall be applied as follows:</text>
<paragraph id="id5F1E4D40574F47F683444FD760BB294C"><enum>(1)</enum><text>With respect to
items and services covered under part A, such unified deductible shall be
applied on the basis of the amount that is payable for such items and services
without regard to any copayments or coinsurance and before the application of
any such copayments or coinsurance.</text>
</paragraph><paragraph id="id2A3E27358F6548D994C8708196862885"><enum>(2)</enum><text>With respect to
items and services covered under part B, such unified deductible shall be
applied on the basis of the total amount of the expenses incurred by the
individual during a year which would, except for the application of the unified
deductible, constitute incurred expenses for which items and services are
payable under part B, without regard to any copayments or coinsurance and
before the application of any such copayments or coinsurance.</text>
</paragraph><paragraph id="id46A56BF96FA4414C83E6AB5AF72DF0B4"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id7D5EEACCD210428BBEB6FAEEB9B8DEB0"><enum>(A)</enum><text>Except as provided in
subparagraph (B), such unified deductible shall be applied with respect to all
items and services covered under parts A and B and in lieu of the deductibles
described in sections 1813(b) and 1833(b) or otherwise.</text>
</subparagraph><subparagraph id="idAA737C86A86644F79F0F5E38E7F99E75" indent="up1"><enum>(B)</enum><text>The deductible applicable to blood
under sections 1813 and 1833 shall apply to blood instead of such unified
deductible.</text>
</subparagraph></paragraph></subsection><subsection id="id3C1D1D6AD98C4CC39A0826AD714421E5"><enum>(d)</enum><header>Treatment of
individuals not enrolled in both parts A and B</header><text>The Secretary
shall establish procedures under which an individual who entitled to, or
enrolled for, benefits under part A or enrolled in part B (but not both) will
continue to be subject to a deductible under this title that is comparable to
the deductible the individual would have been subject to if this section had
not been
enacted.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="idAF9D589E6AA042CBB3A77E5E1CE4DDDD"><enum>(b)</enum><header>Clarification
regarding application under medicare advantage</header><text>Section
1852(a)(1)(B)(iii) of the Social Security Act (42 U.S.C.
1395w–22(a)(1)(B)(iii)) is amended by adding at the end the following new
sentence: <quote>For plan years 2015 and 2016, the preceding sentence shall be
applied to take into account the application of sections 1899B, 1899C, and
1899D.</quote>.</text>
</subsection></section><section id="id60434DD6DCD34AB59EA379949E1104F3"><enum>2013.</enum><header>Uniform
Medicare coinsurance rate</header>
<subsection id="idD5374AA8E93D4B529C37426144500A10"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.), as amended by sections 2011 and
2012, is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id295713455BFB481284684DFEC2EDD1C3" style="traditional">
<section id="id7D25D9080E7B41ACAF98A08981A63B55"><enum>1899D.</enum><header>Uniform part A and B coinsurance rate</header><subsection commented="no" display-inline="yes-display-inline" id="id69B9C645D04A44F9A813E9440B054BAB"><enum>(a)</enum><header>In
general</header><text>Notwithstanding any other provision of this title, in the
case of an individual entitled to, or enrolled for, benefits under part A or
enrolled in part B, after the application of the unified deductible under
section 1899C and subject to the limit on annual out-of-pocket expenses under
section 1899B, the amount otherwise payable under part A and the total amount
of expenses incurred by the individual during a year (beginning in 2015) which
would (except for this section) constitute incurred expenses for which benefits
are payable under part B, shall be reduced by a coinsurance of 20 percent of
such amount.</text>
</subsection><subsection id="id8BC1ACF071AE48C793EA1336010DC5C1"><enum>(b)</enum><header>Application to
all items and services</header><text>The uniform coinsurance under this section
for a year shall be applied as follows:</text>
<paragraph id="id9A3FC4B6ADE741699F2CC7E4B09C1C96"><enum>(1)</enum><text>With respect to
items and services covered under part A, such uniform coinsurance shall be
applied on the basis of the amount that is payable for such items and
services.</text>
</paragraph><paragraph id="id9DA99EFF0B3641AC825F01559A4204D4"><enum>(2)</enum><text>With respect to
items and services covered under part B, such uniform coinsurance shall be
applied on the basis of the total amount of the expenses incurred by the
individual during a year which would, except for the application of the unified
deductible, constitute incurred expenses from which items and services are
payable under part B.</text>
</paragraph><paragraph id="idFA5735386D434E208D9AD81CCFE70BA6"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id6DAF7F44CD20456B8FBC7F914792C8A1"><enum>(A)</enum><text>Except as provided in
subparagraph (B), such uniform coinsurance shall be applied with respect to all
items and services covered under parts A and B and in lieu of any other
copayments or coinsurance under such parts.</text>
</subparagraph><subparagraph id="id7320B9AA1E65411EAC4D0A9FA3BC9BA9" indent="up1"><enum>(B)</enum><text>Coinsurance for blood under this title
shall be determined under the rules that were applicable to blood on December
31, 2014, rather than under this
section.</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="idA20486ACD6364C0C88E8EF2BCB459D30"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="id3C8E38AFEC9748B0B4054FA8285418BE"><enum>(1)</enum><text>Section 1813 of
the Social Security Act (42 U.S.C. 1395e) is amended—</text>
<subparagraph id="idC8449FE8BFFB49C29982634308592243"><enum>(A)</enum><text>in subsection
(a), by inserting <quote>Subject to sections 1899B, 1899C, and 1899D:</quote>
before paragraph (1); and</text>
</subparagraph><subparagraph id="id1FEDE65E4C2145C89BCD4E72C84CD4F6"><enum>(B)</enum><text display-inline="yes-display-inline">in subsection (b), by inserting
<quote>Subject to sections 1899B, 1899C, and 1899D:</quote> before paragraph
(1).</text>
</subparagraph></paragraph><paragraph id="id83ABCFAEF4A64140ACAC7B92805C26CB"><enum>(2)</enum><text>Section 1833 of
the Social Security Act (42 U.S.C. 1395l) is amended—</text>
<subparagraph id="id6D848BFE8126483A9704292791DA3D06"><enum>(A)</enum><text>in subsection
(a), in the matter preceding paragraph (1), by inserting <quote>and sections
1899B, 1899C, and 1899D</quote> after <quote>succeeding provisions of this
section</quote>;</text>
</subparagraph><subparagraph id="idB1535526860F42A9A54E2121117321A1"><enum>(B)</enum><text>in subsection
(b), in the first sentence, by striking <quote>Before applying</quote> and
inserting <quote>Subject to sections 1899B, 1899C, and 1899D, before
applying</quote>;</text>
</subparagraph><subparagraph id="idF710DC9E058F40DFA27A087A7FE602C2"><enum>(C)</enum><text>in subsection
(c)(1), in the matter preceding subparagraph (A), by inserting <quote>subject
to sections 1899B, 1899C, and 1899D,</quote> after <quote>this
part,</quote>;</text>
</subparagraph><subparagraph id="idD86FA3C7606444BAAD816C54302C4A20"><enum>(D)</enum><text>in subsection
(f), by striking <quote>In establishing</quote> and inserting <quote>Subject to
sections 1899B, 1899C, and 1899D, in establishing</quote>; and</text>
</subparagraph><subparagraph id="id8ED63EDBC9D940E3B22C667E92F60ED1"><enum>(E)</enum><text>in subsection
(g)(1), by inserting <quote>and sections 1899B, 1899C, and 1899D</quote> and
<quote>paragraphs (4) and (5)</quote>.</text>
</subparagraph></paragraph><paragraph id="id187052DE0CE441C9ADDC0D6966B109A8"><enum>(3)</enum><text>Section
1905(p)(3) of the Social Security Act (42 U.S.C. 1396d(p)(3)) is
amended—</text>
<subparagraph id="idA2EAB73B5949419987F91174C1E06D54"><enum>(A)</enum><text>in subparagraph
(B), striking <quote>section 1813</quote> and inserting <quote>sections 1813
and 1899C</quote>; and</text>
</subparagraph><subparagraph id="id33EEC5ED31C449E681466D5C30D2C926"><enum>(B)</enum><text>in subparagraph
(C), by striking <quote>and section 1833(b)</quote> and inserting <quote>,
1833(b), and 1899C</quote>.</text>
</subparagraph></paragraph></subsection></section><section id="id8AF0EA81351F4B248DE8C4E34C1AB1CA"><enum>2014.</enum><header>Prohibition
on first-dollar coverage under Medigap policies and development of new
standards for Medigap policies</header><text display-inline="no-display-inline">Section 1882 of the Social Security Act (42
U.S.C. 1395ss) is amended by adding at the end the following new
subsections:</text>
<quoted-block display-inline="no-display-inline" id="idFB540C294560483EB4ED0EF45962D1C0" style="OLC">
<subsection id="id305C424F7196405EAE9743F1B2FC2A67"><enum>(z)</enum><header>Prohibition on
first-Dollar coverage and development of new standards for medicare
supplemental policies</header>
<paragraph id="idD6304D1318F54AA6B19D4695144EE409"><enum>(1)</enum><header>Development</header><text>The
Secretary shall request the National Association of Insurance Commissioners to
review and revise the standards for benefit packages under subsection (p)(1),
taking into account the changes in benefits resulting from the enactment of the
<short-title>The Dollar for Dollar Act of
2012</short-title> and to otherwise update standards to include the
requirements for cost-sharing described in paragraph (2). Such revisions shall
be made consistent with the rules applicable under subsection (p)(1)(E) with
the reference to the <quote>1991 NAIC Model Regulation’ deemed a reference to
the NAIC Model Regulation as published in the Federal Register on December 4,
1998, and as subsequently updated by the National Association of Insurance
Commissioners to reflect previous changes in law and the reference to ‘date of
enactment of this subsection</quote> deemed a reference to the date of
enactment of the <short-title>The Dollar for Dollar Act of
2012</short-title>. To the extent practicable, such revision shall provide for
the implementation of revised standards for benefit packages as of January 1,
2015.</text>
</paragraph><paragraph id="idD6DE20955B5B4B598B7E271081752B6D"><enum>(2)</enum><header>Cost-sharing
requirements</header><text>The cost-sharing requirements described in this
paragraph are that, notwithstanding any other provision of law, no medicare
supplemental policy may provide for coverage of—</text>
<subparagraph id="id3D8B6955FFA1477EB6B8935753518AA1"><enum>(A)</enum><text>any portion of
the unified deductible under section 1899C(b) for the year; and</text>
</subparagraph><subparagraph id="id1122957840A1494FABD011189AF064EC"><enum>(B)</enum><text>more than 50
percent of the cost-sharing (excluding premiums) otherwise applicable under
parts A and B after the individual has met the unified deductible under section
1899C(b) for the year and before the individual has reached the first threshold
annual out-of-pocket limit under section 1899B(b)(1) for the year.</text>
</subparagraph></paragraph><paragraph id="idA8D8D9846B15471892910B526881CC94"><enum>(3)</enum><header>Renewability</header><text>The
renewability requirement under subsection (q)(1) shall be satisfied with the
renewal of the revised package under paragraph (1) that most closely matches
the policy in which the individual was enrolled prior to such revision.</text>
</paragraph></subsection><subsection id="id8E8B20A1384E423C9A8FB29F38D7F42C"><enum>(aa)</enum><header>Limitation on
issuing new medicare supplemental policies after 2016</header>
<paragraph id="idCA6F98C67CAA464AB0EB95CE033C892D"><enum>(1)</enum><header>In
general</header><text>Notwithstanding any other provision of law, a medicare
supplemental policies may not be issued to an individual after December 31,
2016, unless the individual was covered under a medicare supplemental policy as
of such date.</text>
</paragraph><paragraph id="id3408E724B4FC445F8B8CDE9506A3B3D0"><enum>(2)</enum><header>Renewals and
new policies</header><text>Nothing in this subsection shall be construed as
prohibiting—</text>
<subparagraph id="idCFBA1A9B674E4F43BBF46A89FAFD5D93"><enum>(A)</enum><text>the renewal after
December 31, 2016, of a medicare supplemental policy that was issued on or
before such date; or</text>
</subparagraph><subparagraph id="idF522903470D84E2BAE7266E40C039683"><enum>(B)</enum><text>the issuance of a
new medicare supplemental policy after such date as long as the individual was
covered under any medicare supplemental policy as of such
date.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section></part><part id="idC05B3291C3D243F4B42328EE8325D82C"><enum>III</enum><header>Annual report
to Congress</header>
<section id="id4F087FC3A4A749F39CFF6988DA81A6EC"><enum>2021.</enum><header>Annual report
to Congress</header>
<subsection id="id3E9A71CEFEEC4A70A153A2CC50F96081"><enum>(a)</enum><header>In
general</header><text>Not later than July 1, 2016, and annually thereafter, the
Secretary of Health and Human Services shall submit to the Committee on Finance
and the Special Committee on Aging of the Senate and to the Committee on Ways
and Means and the Committee on Energy and Commerce of the House of
Representatives a report on the provisions of, and amendments made by, parts I
and II.</text>
</subsection><subsection id="id157D887F998C40279E78EF6F93E458CF"><enum>(b)</enum><header>Contents</header><text>The
report submitted under subsection (a) shall contain the following
information:</text>
<paragraph id="idC13F8726133E48D0BAA31622F2843426"><enum>(1)</enum><text>An evaluation of
the financial impact of such provisions and amendments.</text>
</paragraph><paragraph id="id959D94C7EA464EEBA24C178F1F186968"><enum>(2)</enum><text>An evaluation of
changes in access to physicians and other health care providers as a result of
such provisions and amendments.</text>
</paragraph><paragraph id="idF918A3E17AEC4C9B99EBC852F46B184C"><enum>(3)</enum><text>An evaluation of
changes in beneficiary satisfaction under the Medicare program as a result of
such provisions and amendments.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idF04E7709E6424EF2B1691CF4760BE5CF"><enum>(4)</enum><text>Such other
information as the Secretary determines to be appropriate.</text>
</paragraph></subsection></section></part></subtitle><subtitle id="idDE26DD9BB37940C18AEBBAADC1FD6F14"><enum>B</enum><header>Elimination of
exemption of Medicare payments to physicians under statutory PAYGO</header>
<section id="id3636FC42706B4C5E8C65A81513C41AC5" section-type="subsequent-section"><enum>2101.</enum><header>Elimination of
exemption of Medicare payments to physicians under statutory PAYGO</header>
<subsection id="idF9C1259C44A84C999D221BF8DD6B685C"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 7 of the
Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 936) is amended—</text>
<paragraph id="idDE1E04BAB42145219EB9D57590083693"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (a), by striking paragraph
(1); and</text>
</paragraph><paragraph id="id3C9E91014DDC4239AF6BCD7C401C1DE7"><enum>(2)</enum><text display-inline="yes-display-inline">by striking subsection (c).</text>
</paragraph></subsection><subsection id="id193E49A852864DEFB1B4B60879B03A27"><enum>(b)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
subsection (a) shall take effect on the date of the enactment of this
Act.</text>
</subsection></section></subtitle><subtitle id="idFADE61BF68B34B15AA971F7CC902D353"><enum>C</enum><header>Adjustments to
Medicare part B and D premiums for high-Income beneficiaries</header>
<section id="id24FBDC9285654AF0A759DC5340E2089E"><enum>2201.</enum><header>Adjustments
to Medicare part B and D premiums for high-income beneficiaries</header>
<subsection commented="no" id="id39CD7C748E7B418388096AD60249D84C"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1839(i) of
the Social Security Act (42 U.S.C. 1395r(i)) is amended—</text>
<paragraph commented="no" id="idF9330E8A36D84617B7B4E0C9BF2A64C4"><enum>(1)</enum><text>in paragraph
(2)(A), by inserting (or, in the case of 2013 or a subsequent year, $50,000)
after <quote>$80,000</quote>; and</text>
</paragraph><paragraph commented="no" id="idF45C56DD41EF42EFAC5C43266CB52420"><enum>(2)</enum><text>in paragraph
(3)—</text>
<subparagraph commented="no" id="id0D55337674AF4E64AF936055B13067FC"><enum>(A)</enum><text>in subparagraph
(A)(i)—</text>
<clause commented="no" id="id35AAE49F7A5D4507B6749D6DE8726B48"><enum>(i)</enum><text>by inserting
<quote>applicable</quote> before <quote>table</quote>; and</text>
</clause><clause commented="no" id="idDCAF2151966C4901B10A4214A385D6A8"><enum>(ii)</enum><text>by inserting
<quote>and year</quote> after <quote>individual</quote>; and</text>
</clause></subparagraph><subparagraph commented="no" id="id4E7FC578966B4698A92BCE41068EED5C"><enum>(B)</enum><text>in subparagraph
(C)(i)—</text>
<clause commented="no" id="id0AD60B77C2E949F8AE4AD413A6E03906"><enum>(i)</enum><text>by striking
<quote>(i) <header-in-text level="clause" style="OLC">In
general</header-in-text>.—</quote> and inserting <quote>(i)(I)
<header-in-text level="subparagraph" style="OLC">For 2007 through
2012</header-in-text>.—For each of 2007 through 2012:</quote>; and</text>
</clause><clause commented="no" id="idB656586E662D4E61B74E78490658E234"><enum>(ii)</enum><text>by adding at the
end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="id93E76BEBE02442C18D4E97AE7B3EB740" style="OLC">
<subclause id="id81B1902D332740B1AAD936B7E5D846F9" indent="up1"><enum>(II)</enum><header>For 2013 and subsequent
years</header><text>For 2013 or a subsequent year:</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" table-type="">
<tgroup cols="2" grid-typeface="1.1" rowsep="0" thead-tbody-ldg-size="10.10.12"><colspec coldef="txt" colname="column1" colwidth="258pts" min-data-value="200" rowsep="0"></colspec><colspec coldef="fig" colname="column2" colwidth="67pts" min-data-value="12" rowsep="0"></colspec>
<thead>
<row><entry align="center" colname="column1" morerows="0" namest="column1" rowsep="1">If the modified adjusted gross income
is:</entry><entry align="center" colname="column2" morerows="0" namest="column2" rowsep="0">The applicable<linebreak></linebreak> percentage is:</entry>
</row>
</thead>
<tbody>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">More than $50,000 but not more
than $85,000</entry><entry align="right" colname="column2" leader-modify="clr-ldr" rowsep="0">35 percent</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">More than $85,000 but not more
than $107,000</entry><entry align="right" colname="column2" leader-modify="clr-ldr" rowsep="0">40 percent</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">More than $107,000 but not more
than $160,000</entry><entry align="right" colname="column2" leader-modify="clr-ldr" rowsep="0">55 percent</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">More than $160,000 but not more
than $214,000</entry><entry align="right" colname="column2" leader-modify="clr-ldr" rowsep="0">70 percent</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">More than $214,000 but not more
than $250,000</entry><entry align="right" colname="column2" leader-modify="clr-ldr" rowsep="0">85 percent</entry>
</row>
<row><entry align="left" colname="column1" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">More than $250,000</entry><entry align="right" colname="column2" leader-modify="clr-ldr" rowsep="0">100
percent.</entry>
</row>
</tbody>
</tgroup></table>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection><subsection commented="no" id="id7032C8104FCC429F858DC49A864012E8"><enum>(b)</enum><header>Extension of
temporary adjustment to income thresholds</header>
<paragraph id="id6ED666ACD73644EEBD25D125870C8F57"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1839(i)(6) of
the Social Security Act (42 U.S.C. 1395r(i)(6)) is amended—</text>
<subparagraph id="id05594EB19900449EAAA7136FBAEAFA6B"><enum>(A)</enum><text display-inline="yes-display-inline">in the matter preceding subparagraph (A),
by striking <quote>December 31, 2019</quote> and inserting <quote>December 31,
2021</quote>;</text>
</subparagraph><subparagraph id="id1742E7F0231B44C49454756EB856A273"><enum>(B)</enum><text>in subparagraph
(A), by striking <quote>equal to such amount for 2010; and</quote> and
inserting the following: “equal to—</text>
<quoted-block display-inline="no-display-inline" id="id4D46E650DA124735872B85FDE580A53B" style="OLC">
<clause id="id7364D28D997E42128EB1F5665CEDF836"><enum>(i)</enum><text>in the case of
each of 2011 and 2012, such amount for 2010; and</text>
</clause><clause id="idBCA1AEE9E4EA41729460A5599FFC527C"><enum>(ii)</enum><text>in the case of
each of 2013 through 2021, such amount for 2013;
and</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id68B6833A5B474CF5B9317493D7A4E5FA"><enum>(C)</enum><text>in subparagraph
(B), by striking <quote>equal to such dollar amounts for 2010.</quote> and
inserting the following: “equal to—</text>
<quoted-block display-inline="no-display-inline" id="id813B31CBA75F4C42B9CCACB41670B688" style="OLC">
<clause id="id8AD84D1A31964194BB404CC212441751"><enum>(i)</enum><text>in the case of
each of 2011 and 2012, such dollar amounts for 2010; and</text>
</clause><clause id="id01C46564EC4943FA8FDE8F21DCD98354"><enum>(ii)</enum><text>in the case of
each of 2013 through 2021, such dollar amounts for
2013.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id38D17B9294B641C9BC4499F0968E7E27"><enum>(2)</enum><header>Conforming
amendment</header><text>Section 1839(i)(5)(A) of the Social Security Act (42
U.S.C. 1395r(i)(5)(A)) is amended by inserting <quote>for such year</quote>
after <quote>paragraph (2) or (3)</quote>.</text>
</paragraph></subsection></section></subtitle><subtitle id="id56B9E82BFBB744B4B07A3A21A1AB89AD"><enum>D</enum><header>Increase in the
Medicare eligibility age</header>
<section id="id256CBCFC1A8F4EBD8255DBC488FF65A8"><enum>2301.</enum><header>Increase in
the Medicare eligibility age</header><text display-inline="no-display-inline">Section 226 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="HAEBDBEC2D1FA4CEC810619313296F979" style="OLC">
<subsection id="HACCD6B6F06F840C28179E18FFFDB8969"><enum>(k)</enum><header>Increasing
Medicare qualifying age</header>
<paragraph id="H26D0B9EE343A4115860AECD5FAF81655"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Notwithstanding any
other provision of law, any reference in this section, title XVIII, or title
XIX (insofar as it relates to the eligibility age for Medicare benefits under
title XVIII) to <quote>age 65</quote> shall be deemed a reference to the
Medicare qualifying age specified in paragraph (2).</text>
</paragraph><paragraph id="HEE8547A2678B4FF38B74E7B7EF9FAFBD"><enum>(2)</enum><header>Medicare
qualifying age specified</header><text>The Medicare qualifying age specified in
this paragraph is determined as follows:</text>
<subparagraph id="H32BEF1F099684C8ABE5908F3C179F832"><enum>(A)</enum><text>In the case of an
individual who attains 65 years of age before January 1, 2014, the Medicare
qualifying age is 65 years of age.</text>
</subparagraph><subparagraph id="H7BB21FC1B8F44D1D86E1A5095649E0DD"><enum>(B)</enum><text>In the case of an
individual who attains 65 years of age in a year after 2013, and before 2025,
the Medicare qualifying age is the Medicare qualifying age specified in this
paragraph for the previous year increased by 2 months.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id5409EEFE847E4B41BF2D3E22A1D55102"><enum>(C)</enum><text display-inline="yes-display-inline">In the case of an individual who attains 65
years of age in a year after 2024, the Medicare qualifying age is 67 years of
age.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section></subtitle><subtitle id="idDD9DC92C08994F9F98441C817D015D05"><enum>E</enum><header>Other
provisions</header>
<section id="idBA50F6FAD5434F45A7A53210B42C7E06"><enum>2401.</enum><header>Limitation on
Medicare payments for direct graduate medical education (DGME)</header><text display-inline="no-display-inline">Section 1886(h)(2)(D) of the Social Security
Act (42 U.S.C. 1395ww(h)(2)(D)) is amended by adding at the end the following
new clause:</text>
<quoted-block display-inline="no-display-inline" id="id5CCEEF46ED8045AB89FA5AB33E6EB282" style="OLC">
<clause id="id827845BB939D4F09B5541A42265F19FA"><enum>(v)</enum><header>Cap on approved
FTE resident amount</header>
<subclause id="id2B399B29AB5B4B289F703FD65BA0D9EC"><enum>(I)</enum><header>In
general</header><text display-inline="yes-display-inline">The approved FTE
resident amount for a hospital for a cost reporting period beginning during
fiscal year 2013 or a subsequent fiscal year shall not be more than the
applicable amount for the year.</text>
</subclause><subclause id="idE6A79D1FD77444A0844C83DA84FFD5A8"><enum>(II)</enum><header>Applicable
amount</header><text display-inline="yes-display-inline">For purposes of
subclause (I), the applicable amount for a year shall be an amount equal to 120
percent of the national average salary paid to residents in 2010, updated
through the year involved by the Chained Consumer Price Index.</text>
</subclause><subclause id="id15E32E0D078E4D61953F7A60523C17E7"><enum>(III)</enum><header>Chained
Consumer Price Index</header><text display-inline="yes-display-inline">In
subclause (II), the term <term>Chained Consumer Price Index</term> means the
initial Chained Consumer Price Index for all-urban consumers published by the
Department of
Labor.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idA786770BCCB5449E968FAC749C76C42E"><enum>2402.</enum><header>Reduction in
Medicare indirect graduate medical education (IME) payments</header>
<subsection id="id536F7B2F00444D7DAF6A96AF9E8DE84A"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section
1886(d)(5)(B)(ii) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is
amended—</text>
<paragraph id="id1046ECAC433B4EF6A1A9B9053DD85D28"><enum>(1)</enum><text display-inline="yes-display-inline">in subclause (XI), by striking
<quote>and</quote> at the end;</text>
</paragraph><paragraph id="id3B11BC977F9143EAA58AF9EFA25EED6A"><enum>(2)</enum><text>in subclause
(XII)—</text>
<subparagraph id="id6EBDA2086C65428F9AA65BCEAE139CC1"><enum>(A)</enum><text>by inserting
<quote>and before October 1, 2012,</quote> after <quote>2007,</quote>;
and</text>
</subparagraph><subparagraph id="idF103263A63FD4E2A81E21645F05DFE03"><enum>(B)</enum><text>by striking the
period at the end and inserting <quote>; and</quote>; and</text>
</subparagraph></paragraph><paragraph id="id0C8F1C32CAA94AC0BE3462C9D1A89F9F"><enum>(3)</enum><text>by adding at the
end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="id9CA18535640E47DCB7AA7FD1D91510EC" style="OLC">
<subclause id="id0595BF0F21DB418F8F029C4F4F66B4E7" indent="up2"><enum>(XIII)</enum><text>on or after October 1, 2012,
<quote>c</quote> is equal to
0.54.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id731F3A5288624673B5403A29EF9C94C6"><enum>(b)</enum><header>Conforming
amendment relating to determination of standardized
amount</header><text>Section 1886(d)(2)(C)(i) of the Social Security Act (42
U.S.C. 1395ww(d)(2)(C)(i)) is amended by inserting <quote>or of section 2402(a)
of the <short-title>The Dollar for Dollar Act of
2012</short-title></quote> after <quote>Act of 1997</quote>.</text>
</subsection></section><section id="idA8C9ACD3E6CD408B8F0731C8FE853A58"><enum>2403.</enum><header>Acceleration
of application of productivity adjustment to Medicare home health prospective
payment amounts</header><text display-inline="no-display-inline">Section
1895(b)(3)(B)(vi)(I) of the Social Security Act (42 U.S.C.
1395fff(b)(3)(B)(vi)(I)) is amended by striking <quote>2015</quote> and
inserting <quote>2013</quote>.</text>
</section><section id="id156ED7A33BA74E3092D6BB2B94C25264"><enum>2404.</enum><header>Acceleration
of rebasing of Medicare home health prospective payment amounts</header><text display-inline="no-display-inline">Section 1895(b)(3)(A)(iii)(II) of the Social
Security Act (42 U.S.C. 1395fff(b)(3)(A)(iii)(II)) is amended—</text>
<paragraph id="idBAF7C99FC6764B9D8C4FD02134EDFC2F"><enum>(1)</enum><text>in the first
sentence—</text>
<subparagraph id="idA4ADA3D928DD454D83AFFA3F9EA8ABC8"><enum>(A)</enum><text>by striking
<quote>4-year</quote> and inserting <quote>2-year</quote>; and</text>
</subparagraph><subparagraph id="id6A96EA307F7545C8883D8415A0B52A70"><enum>(B)</enum><text>by striking
<quote>2017</quote> and inserting <quote>2015</quote>; and</text>
</subparagraph></paragraph><paragraph id="id34078891F41D4223B9E6205AEBF97B3E"><enum>(2)</enum><text>by striking the
second sentence.</text>
</paragraph></section><section display-inline="no-display-inline" id="id142EF9C4AA9E4AC5A9199F3DE2C1836A"><enum>2405.</enum><header>Reduction of
bad debt treated as an allowable cost</header>
<subsection id="id4BE0E3C0D4294149ABC951A6B8CF7FEB"><enum>(a)</enum><header>Hospitals</header><text display-inline="yes-display-inline">Section 1861(v)(1)(T) of the Social
Security Act (42 U.S.C. 1395x(v)(1)(T)) is amended—</text>
<paragraph id="id45D25215E5E248DB9A4C9C8760720F04"><enum>(1)</enum><text>in clause (iv),
by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="id3FB4DABC46274F2492DBD9B7B4A35390"><enum>(2)</enum><text>in clause
(v)—</text>
<subparagraph id="id2A42FE9D258A4EAB94BED48197F886D0"><enum>(A)</enum><text>by striking
<quote>or a subsequent fiscal year</quote>; and</text>
</subparagraph><subparagraph id="id0F975A2268E640048A08C9562802DE1C"><enum>(B)</enum><text>by striking the
period at the end and inserting a comma; and</text>
</subparagraph></paragraph><paragraph id="idC418D4E3ED1A45409C3756FA4A697433"><enum>(3)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="id99EAB03698FD43408CADDBAC1596EE95" style="OLC">
<clause id="idB425F68D35AF4C30920439AEF1F21A04" indent="up2"><enum>(vi)</enum><text display-inline="yes-display-inline">for cost reporting periods beginning during
fiscal year 2014, by 48 percent of such amount otherwise allowable,</text>
</clause><clause id="id1F83462C9B5C4EA3A4E765EFFE4CA4D9" indent="up2"><enum>(vii)</enum><text display-inline="yes-display-inline">for cost reporting periods beginning during
fiscal year 2015, by 61 percent of such amount otherwise allowable,</text>
</clause><clause id="id1BCBF997632D4FF39017268C572C867D" indent="up2"><enum>(viii)</enum><text display-inline="yes-display-inline">for cost reporting periods beginning during
fiscal year 2016, by 74 percent of such amount otherwise allowable,</text>
</clause><clause id="idE34A871A9E884B3EBB769EA23C2FECD3" indent="up2"><enum>(ix)</enum><text display-inline="yes-display-inline">for cost reporting periods beginning during
fiscal year 2017, by 87 percent of such amount otherwise allowable, and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id343425AF6A674C4080A2CB1057751AD7" indent="up2"><enum>(x)</enum><text display-inline="yes-display-inline">for cost reporting periods beginning during
fiscal year 2018 or a subsequent fiscal year, by 100 percent of such amount
otherwise allowable.</text>
</clause><after-quoted-block>.
</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idC4CD2F3963914B998B6ACA705A236E26"><enum>(b)</enum><header>Skilled nursing
facilities</header><text display-inline="yes-display-inline">Section
1861(v)(1)(V) of the Social Security Act (42 U.S.C. 1395x(v)(1)(V)) is
amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="idFCC282F6334A44AC8B992043B89BBDE1"><enum>(1)</enum><text>by moving
subclauses (I) and (II) of clause (i) and subclauses (I) through (IV) of clause
(ii) two ems to the right; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7C28C940A4764EC4B9B8CB2362323DCD"><enum>(2)</enum><text>in clause
(i)—</text>
<subparagraph id="id29A97C681E6B4304AA664D813861E95F"><enum>(A)</enum><text>in subclause (I),
by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="id315B66DF71224DAAAC1746A96754AD6B"><enum>(B)</enum><text>in subclause
(II)—</text>
<clause id="id7E2ED517C7AB45FE8170113390342F99"><enum>(i)</enum><text>by
striking <quote>or a subsequent fiscal year</quote>; and</text>
</clause><clause id="id0C56310C9E044BAA8595ADD60AD7255E"><enum>(ii)</enum><text>by
striking the period at the end and inserting a semicolon; and</text>
</clause></subparagraph><subparagraph id="id47E582D6A6C3474BB570282A16405BEF"><enum>(C)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="id54D2B206AAD54833943ACE5D2A218234" style="OLC">
<subclause id="id6969FBDC63194AC7A62E04D0BD3D0862" indent="up2"><enum>(III)</enum><text>for cost reporting periods
beginning during fiscal year 2014, by 48 percent of such amount otherwise
allowable;</text>
</subclause><subclause id="idF6B19BE196164C23A965EAB892B36A25" indent="up2"><enum>(IV)</enum><text>for cost reporting periods
beginning during fiscal year 2015, by 61 percent of such amount otherwise
allowable;</text>
</subclause><subclause id="id9FB7E187DADE4CB8AE7EC7B4B758DAA7" indent="up2"><enum>(V)</enum><text>for cost reporting periods
beginning during fiscal year 2016, by 74 percent of such amount otherwise
allowable;</text>
</subclause><subclause id="id3EC8306E913A41879922F082E72C38F9" indent="up2"><enum>(VI)</enum><text>for cost reporting periods
beginning during fiscal year 2017, by 87 percent of such amount otherwise
allowable; and</text>
</subclause><subclause id="id787979897B1346BBB7B649E127D86E87" indent="up2"><enum>(VII)</enum><text>for cost reporting periods
beginning during fiscal year 2018 or a subsequent fiscal year, by 100 percent
of such amount otherwise
allowable.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection commented="no" id="id5934810CE28D4D58A57CB3DF2744ED04"><enum>(c)</enum><header>Certain other
providers</header><text display-inline="yes-display-inline">Section
1861(v)(1)(W)(i) of the Social Security Act (42 U.S.C. 1395x(v)(1)(W)(i)) is
amended—</text>
<paragraph id="id6EBE5A12B95E45BCBC63F9B210C170E9"><enum>(1)</enum><text>in subclause
(II), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="id65E30198D56C46F18554C86ACB41E664"><enum>(2)</enum><text>in subclause
(III)—</text>
<subparagraph id="idAE988C57F74A42AF9CE96E4831D663F6"><enum>(A)</enum><text>by striking
<quote>a subsequent fiscal year</quote> and inserting <quote>fiscal year
2015</quote>; and</text>
</subparagraph><subparagraph id="idAC4398A67CCB453496F2295CC101B5E2"><enum>(B)</enum><text>by striking the
period at the end and inserting a semicolon; and</text>
</subparagraph></paragraph><paragraph id="id3AF6DD8CC04E4177827085DA9E1F1C11"><enum>(3)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="id4F588969203B44BFBE4B308AEBAD2709" style="OLC">
<subclause id="id2734DE7AA7F54B0C8079064894F063AA" indent="up3"><enum>(IV)</enum><text>for cost reporting periods beginning
during fiscal year 2016, by 48 percent of such amount otherwise
allowable;</text>
</subclause><subclause id="id1A158B0E27F24E2C98BCD93E649EA408" indent="up3"><enum>(V)</enum><text>for cost reporting periods beginning
during fiscal year 2017, by 61 percent of such amount otherwise
allowable;</text>
</subclause><subclause id="id8EBCF7A4ADCA471293F0261462E85C40" indent="up3"><enum>(VI)</enum><text>for cost reporting periods beginning
during fiscal year 2018, by 74 percent of such amount otherwise
allowable;</text>
</subclause><subclause id="id857A7DB382E941178BEBB70228618E83" indent="up3"><enum>(VII)</enum><text>for cost reporting periods beginning
during fiscal year 2019, by 87 percent of such amount otherwise allowable;
and</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="id57E92BB0F3D94819ABDFBC99AF666D20" indent="up3"><enum>(VIII)</enum><text>for cost reporting periods
beginning during fiscal year 2020 or a subsequent fiscal year, by 100 percent
of such amount otherwise
allowable.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section></subtitle><enum>III</enum><header>Social
Security</header>
<section id="id53DE053DE6C04BEAB765A2050A9A1A2D"><enum>3101.</enum><header>Adjustments
to bend points in determining primary insurance amount</header><text display-inline="no-display-inline">Section 215(a)(1) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
415(a)(1)) is amended—</text>
<paragraph id="id9BB8C9B63F7042029464B927524002CA"><enum>(1)</enum><text>in subparagraph
(A), in the matter preceding clause (i), by inserting <quote>who initially
becomes eligible for old-age or disability insurance benefits, or who dies
(before becoming eligible for such benefits), in any calendar year after 1979
and before 2017</quote> after <quote>individual</quote>;</text>
</paragraph><paragraph id="idFD9C37E8EDBF4E9DB1A1A4BA231334B6"><enum>(2)</enum><text>in subparagraph
(B)(ii), in the matter preceding subclause (I), by inserting <quote>and before
2017</quote> after <quote>after 1979</quote>;</text>
</paragraph><paragraph id="id7F9680EFDB32452D9DC87EB2F97A98FE"><enum>(3)</enum><text>in subparagraph
(C)(i), by inserting <quote>or (E)</quote> after <quote>(A)</quote>; and</text>
</paragraph><paragraph id="id79040E4401274F88964324A59D63448F"><enum>(4)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="id00A55E2D05DC45D1BCBED7A5451BF4CE" style="OLC">
<subparagraph id="idAB75DF8704394961B231B4CC4FBC995C" indent="up2"><enum>(E)</enum><clause commented="no" display-inline="yes-display-inline" id="id876F11AC959B447C8771ACFDA4EC4479"><enum>(i)</enum><text>The primary insurance
amount of an individual who initially becomes eligible for old-age or
disability insurance benefits, or who dies (before becoming eligible for such
benefits), in any calendar year after 2016 shall (except as otherwise provided
in this section) be equal to the sum of—</text>
<subclause id="id335AE5492628411B989536AE1B1DD41F" indent="up1"><enum>(I)</enum><text>90 percent of the individual's average
indexed monthly earnings (determined under subsection (b)) to the extent that
such earnings do not exceed the amount established for purposes of this
subclause by clause (ii),</text>
</subclause></clause></subparagraph><subparagraph id="id55668E4B0473488999114FC81286B106" indent="up1"><enum>(II)</enum><text>30 percent of the individual's
average indexed monthly earnings to the extent that such earnings exceed the
amount established for purposes of subclause (I) but do not exceed the amount
established for purposes of this subclause by clause (ii),</text>
</subparagraph><subparagraph id="id5F1A34ACC5A4485F9570B0DF0212446D" indent="up1"><enum>(III)</enum><text>10 percent of the individual's
average indexed monthly earnings to the extent that such earnings exceed the
amount established for purposes of subclause (II) but do not exceed the amount
established for purposes of this subclause by clause (ii), and</text>
</subparagraph><subparagraph id="id1F60D9B098C74559B6FDCB34ACF3029D" indent="up1"><enum>(IV)</enum><text>5 percent of the individual's average
indexed monthly earnings to the extent that such earnings exceed the amount
established for purposes of subclause (III),</text>
<continuation-text commented="no" continuation-text-level="subparagraph" indent="subsection">rounded, if
not a multiple of $0.10, to the next lower multiple of $0.10, and thereafter
increased as provided in subsection (i).</continuation-text><clause id="id19039F504BD84FA08F450C3910BFAF4E" indent="up2"><enum>(ii)</enum><text>For individuals who initially become
eligible for old-age or disability insurance benefits, or who die (before
becoming eligible for such benefits) in the calendar year 2017 or later, the
amount established for purposes of subclauses (I), (II), and (III) of
subparagraph (E)(i) shall be $180, $736, and $1,085, respectively, as if such
amount was applicable with respect to 1979 and was adjusted for years after
1979 in the same manner as provided under subparagraph (B)(ii), without regard
to the limitation that such adjustment only applies to individuals who
initially become eligible for old-age benefits or disability insurance
benefits, or who die (before becoming eligible for benefits) before
2017.</text>
</clause><clause id="id4C3EE8438C004CEEAC4E0DB791051A39" indent="up2"><enum>(iii)</enum><subclause commented="no" display-inline="yes-display-inline" id="idB8630A7590544AEB9048D48537CB8EEE"><enum>(I)</enum><text>Notwithstanding clauses
(i) and (ii), in the case of any individual who becomes eligible for old-age or
disability insurance benefits, or who dies (before becoming eligible for such
benefits) in any calendar year after 2016 and before 2051, the primary
insurance amount of the individual shall be equal to the sum of—</text>
<item id="id1A14C225BD6B4B2F8954BF580AA51825" indent="up1"><enum>(aa)</enum><text>the primary insurance amount
determined for the individual under subparagraphs (A) and (B) (without regard
to the limitation that such subparagraphs apply only to individuals who
initially become eligible for old-age benefits or disability insurance
benefits, or who die (before becoming eligible for benefits) before 2017)
multiplied by the applicable phase-in factor for the calendar year under
subclause (II); and</text>
</item><item id="id7F8EAE1EDB28400CB34CED981E56E2DA" indent="up1"><enum>(bb)</enum><text>the primary insurance amount
determined for the individual under this subparagraph (other than under this
clause) multiplied by the applicable phase-in factor for the calendar year
under subclause (II).</text>
</item></subclause><subclause id="id520F7E098CB04FA2BF4D2FA894A30C81" indent="up1"><enum>(II)</enum><text>For purposes of—</text>
<item id="id40926521D0984CEE9A2B760DBD9FD085"><enum>(aa)</enum><text>subclause (I)(aa), the applicable
phase-in factor for calendar year 2017, is the quotient of 33 divided by 34,
and for each year thereafter is the quotient of—</text>
<subitem id="idE1D93B1940804E11AC7C50EEEAB72DC2"><enum>(AA)</enum><text>the numerator applicable for the
preceding year reduced by 1, divided by</text>
</subitem><subitem id="idDD685617BB3E4987A90BAD7404EA0F70"><enum>(BB)</enum><text>34; and</text>
</subitem></item><item id="id686CFFE1FD67422C98AB78707F12D44F"><enum>(bb)</enum><text>subclause (I)(bb), the applicable
phase-in factor for calendar year 2017 is the quotient of 1 divided by 34, and
for each year thereafter is the quotient of—</text>
<subitem id="idB46065AE3EC04BCC80B7B4FED7EB05D1"><enum>(AA)</enum><text>the numerator applicable for the
preceding year increased by 1, divided by</text>
</subitem><subitem commented="no" display-inline="no-display-inline" id="idA269B5CB05F740DC9FBC11F5E97B25DD"><enum>(BB)</enum><text>34.</text>
</subitem></item></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="id332CB4F46FF54F4BA354B441DFF8D327"><enum>3102.</enum><header>Adjustment to
calculation of benefit computation years</header>
<subsection id="idE44E1E84C33E4C4F81B836365D524248"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Clause (i) of section
215(b)(2)(A) of the Social Security Act (42 U.S.C. 415(b)(2)(A)) is amended to
read as follows:</text>
<quoted-block display-inline="no-display-inline" id="idCA700B642D044872B073DC67EB3F9FA2" style="OLC">
<clause id="id53C4206BEE5043C78F7787368E3E1B4B" indent="up2"><enum>(i)</enum><text>in the case of an individual who is
entitled to old-age insurance benefits (except as provided in the second
sentence of this subparagraph), or who has died—</text>
<subclause id="idDE79FA06B5754E8FADF64301AF105163"><enum>(I)</enum><text>before January 1, 2014, by 5
years;</text>
</subclause><subclause id="id3B7B4F3C5646404CB529162598FA2A72"><enum>(II)</enum><text>after December 31, 2013, and
before January 1, 2015, by 4 years;</text>
</subclause><subclause id="id6D97EA18527A4E04A79A96E9397D0708"><enum>(III)</enum><text>after December 31, 2014, and
before January 1, 2016, by 3 years; and</text>
</subclause><subclause id="idF3FFF03F774F4C4EBDE241967DCC455A"><enum>(IV)</enum><text>after December 31, 2015, and
before January 1, 2017, by 2 years;
and</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id8B676BAFF80E481F99B6FA33CF3684BD"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to benefits
payable for months beginning after December 31, 2013.</text>
</subsection></section><section commented="no" id="id529911532AE84B13A3FF545026256A4B"><enum>3103.</enum><header>Minimum
social security benefit</header>
<subsection commented="no" id="id8B5E31ACBB0F46AAB865DE7F821F8956"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 215 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/415">42 U.S.C. 415</external-xref>) is
amended by adding at the end the following:</text>
<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="ID97B1DC2F81A04402A1CC00F4B69686BF" other-style="archaic" style="other"><subsection commented="no" id="ID96A6BF81A45B4E23883DBB914F806E96"><enum>(j)</enum><header>Minimum monthly
insurance benefit</header><paragraph commented="no" display-inline="yes-display-inline" id="ID0F84D8249D7F4FC090FC21383DF6791F"><enum>(1)</enum><text>Notwithstanding the
preceding provisions of this section—</text>
<subparagraph commented="no" id="IDCD80A9DCAE00444BA8FB15FFD5E17040" indent="up1"><enum>(A)</enum><text>subject to paragraph (3), the primary
insurance amount of any individual who is credited with at least 10 years of
coverage and who initially becomes eligible for old-age or disability insurance
benefits or dies (before becoming eligible for such benefits) for a month
beginning after December 31, 2016 (in this subsection referred to as a
<quote>qualified individual</quote>), shall be equal to the greater of—</text>
<clause commented="no" id="IDF64828EEA5AD4F1C91D02051FF9F7958"><enum>(i)</enum><text>the primary insurance amount
determined under this section (without regard to this subsection), or</text>
</clause><clause commented="no" id="idC40A25B2DDAE4948A6001EBFE4463066"><enum>(ii)</enum><text>the minimum monthly insurance
benefit determined under paragraph (2), and</text>
</clause></subparagraph><subparagraph commented="no" id="ID834AAB7FB2134B1EB381714E111F1B12" indent="up1"><enum>(B)</enum><text>any recomputation of the primary
insurance amount of a qualified individual shall not result in a primary
insurance amount less than the primary insurance amount as in effect
immediately prior to such recomputation.</text>
</subparagraph></paragraph><paragraph commented="no" id="ID0AF5FC2E7E384D04BC96C5DC00BD3D72" indent="up1"><enum>(2)</enum><text>For purposes of this subsection, the
term <term>minimum monthly insurance benefit</term> means
<fraction>1/12</fraction> of the applicable percentage of the adjusted minimum
benefit level (as defined in paragraph (5)).</text>
</paragraph><paragraph commented="no" id="id143DFD7C57C24FED9B9550B45E678DAA" indent="up1"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idE05970B8E65E4C4785AFBAA0FD7425F6"><enum>(A)</enum><text>For purposes of this
subsection, subject to subparagraph (B), the applicable percentage shall be 125
percent reduced by the number of percentage points determined under
subparagraph (B)(ii) for each year of coverage of the qualified individual less
than 30.</text>
</subparagraph><subparagraph commented="no" id="idF3CC08D2844F4408BDE078A403F69D72" indent="up1"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="id517914D3F3A342D5A99FF26850DC86D4"><enum>(i)</enum><text>In the case of an
individual who initially becomes eligible for disability insurance benefits
under section 223 before attaining age 62, or who dies before attaining age 62,
in a month beginning after December 31, 2016, and who is credited with at least
5 years of coverage, the individual shall be treated as a qualified individual
and the applicable percentage shall be 125 reduced by the number of percentage
points determined under clause (ii) for each year of coverage of the qualified
individual less than the number as determined under clause (iii).</text>
</clause><clause commented="no" id="idC5B84A177B1F4E82A0A8A0D7BF729AAE" indent="up1"><enum>(ii)</enum><text>The number of percentage points
under this clause shall be determined by—</text>
<subclause commented="no" id="idED5343912CA44EAC983954135B5607D1"><enum>(I)</enum><text>dividing the number of the qualifying
individual’s elapsed years (as defined in subsection (b)(2)(B)(iii)) by
40;</text>
</subclause><subclause commented="no" id="id1F6BAD91508147FD83238A606CEB363F"><enum>(II)</enum><text>multiplying the result under
subclause (I) by 20; and</text>
</subclause><subclause commented="no" id="id70695224928E4BC487807665FB23D43D"><enum>(III)</enum><text>dividing 125 by the result under
subclause (II) and rounding to the nearest one hundredth of 1 percentage
point.</text>
</subclause></clause><clause commented="no" id="id92482547E0674A58B3D17EF75B01BA7F" indent="up1"><enum>(iii)</enum><text>The number of years of coverage
under this clause shall be determined by multiplying the ratio determined under
clause (ii)(I) by 30 and rounding to the next lower whole number.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id39BF4142712A4D73ADA7D4B15188BD33" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">For purposes of this subsection, a year of
coverage is a calendar year for which an individual is credited with 4 quarters
of coverage.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id726404E4B21B46978E1059C68ABFAE65" indent="up1"><enum>(5)</enum><text>For purposes of this
subsection—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id585273F4EA9E47C1BB7B29735689DFEB"><enum>(A)</enum><text>for individuals who initially become
eligible for old-age or disability insurance benefits or die (before becoming
eligible for such benefits) in 2017, the term <term>adjusted minimum benefit
level</term> means the weighted average of the Federal poverty threshold
applicable to a family of 1 for 2009 (as determined by the Bureau of the
Census), increased for each year occurring after 2009 and before 2018, by the
percentage increase (rounded to the nearest one-tenth of 1 percent) in the
Chained Consumer Price Index for All Urban Consumers (as published by the
Bureau of Labor Statistics of the Department of Labor) for each such year;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id75ABBE2214F24423B594FC431BEB7913"><enum>(B)</enum><text>for individuals who initially become
eligible for old-age or disability insurance benefits or die (before becoming
eligible for such benefits) in a year after 2017, the term <term>adjusted
minimum benefit level</term> means the amount specified in subparagraph (A),
multiplied by the quotient described in subsection (b)(3)(A)(ii), except that
the reference to <term>the computation base year for which the determination is
made</term> in such subsection shall be deemed instead to be a reference to
<term>2009</term>.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id528A1B2D811D465AA842118A1BD39CE6" indent="up1"><enum>(6)</enum><text>The provisions of this subsection
shall not apply in the case of an individual whose primary insurance amount
would otherwise be computed under subsection
(a)(7).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="id56A1B9A416B94A13A7F18BD580FA0311"><enum>(b)</enum><header>Conforming
amendment</header><text>Section 202(a) of such Act (42 U.S.C. 402(a)) is
amended in the last sentence by striking <quote>section 215(a)</quote> and
inserting <quote>section 215</quote>.</text>
</subsection></section><section id="idE449B68B7161443FA3FA50848F2935BC"><enum>3104.</enum><header>Increase in
benefits starting 20 years after initial eligibility</header>
<subsection id="idD01699E18A234407939D466FCC0D2065"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 215 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/415">42 U.S.C. 415</external-xref>), as
amended by this Act, is amended by adding at the end the following new
subsection:</text>
<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="id37D79C0278AA468C9363765F5D74EDA0" other-style="archaic" style="other"><subsection id="id17675C8D124A41B48791F407C024B4FC"><enum>(k)</enum><header>Increased monthly
insurance benefit after 20 years of initial eligibility</header><paragraph commented="no" display-inline="yes-display-inline" id="id9F8E2DDF5C8E48F4A09D73F2DDC5299E"><enum>(1)</enum><text>Notwithstanding the
preceding provisions of this section, in the case of an individual who is a
20-year beneficiary, the primary insurance amount of the individual (as
determined before the application of this subsection) shall be increased for
months beginning with the first month for which the individual attains such
status by the amount equal to the applicable percentage of the applicable
average primary insurance amount.</text>
</paragraph><paragraph id="idD9E0B4CC1E2E47548D4AD0C53A5EE70E" indent="up1"><enum>(2)</enum><text>For purposes of this subsection, the
term <term>20-year beneficiary</term> means an individual who has been eligible
for old-age insurance benefits or disability insurance benefits under this
title for at least 240 months.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3066226BEDA448F3B3275AE1F34D1A79" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">For purposes of paragraph (1), the term
<term>applicable average primary insurance amount</term> means, with respect to
a 20-year beneficiary, the primary insurance amount determined by the
Commissioner of Social Security that would apply to an individual of the same
age as the age at which the 20-year beneficiary first attains such status, if
the individual had earnings for each calendar year in which the individual
would have attained ages 20 through the year prior to the age of eligibility,
respectively, equal to the national average earnings for all such individuals
for each such year.</text>
</paragraph><paragraph id="id6FCC2DCE81734FCD8D3E9EF6AA782129" indent="up1"><enum>(4)</enum><text>For purposes of paragraph (1), the
applicable percentage is—</text>
<subparagraph id="id7A3D2DAE031B4A86B99E99A521530B55"><enum>(A)</enum><text>for each month occurring during the
first 12-month period for which an individual is a 20-year beneficiary, 1
percent;</text>
</subparagraph><subparagraph id="id8962788D411245849C661322FFE2F300"><enum>(B)</enum><text>for each month occurring during the
second 12-month period for which an individual is such a beneficiary, 2
percent;</text>
</subparagraph><subparagraph id="id4FE34BCEB98A4825A5C4B864594CCDE1"><enum>(C)</enum><text>for each month occurring during the
third 12-month period for which an individual is such a beneficiary, 3
percent;</text>
</subparagraph><subparagraph id="id6298492DFA50411ABEFA681C26CCEB7B"><enum>(D)</enum><text>for each month occurring during the
fourth 12-month period for which an individual is such a beneficiary, 4
percent; and</text>
</subparagraph><subparagraph id="idCCB92EC800494C4EBE593E5978E1891F"><enum>(E)</enum><text>for each month occurring thereafter, 5
percent.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id78AEB4E9E224406DA1C8FB0D3A576BD9"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to benefits
payable for months beginning after December 31, 2013.</text>
</subsection></section><section id="id287E2CFD82854C7897EB59EBA5489857"><enum>3105.</enum><header>Adjustment to
normal and early retirement ages</header><text display-inline="no-display-inline">Section 216(l) of the Social Security Act
(42 U.S.C. 416(l)) is amended—</text>
<paragraph id="idAE8CFB4324494B0FA30F14FBE405AA6A"><enum>(1)</enum><text>in paragraph
(1)—</text>
<subparagraph id="id1FEB6F897552453CADBE071FE6131A3A"><enum>(A)</enum><text>in subparagraph
(D), by striking <quote>; and</quote> and inserting a semicolon; and</text>
</subparagraph><subparagraph id="id3D1373ED60584395B9A604843D4FA0BD"><enum>(B)</enum><text>by striking
subparagraph (E) and inserting the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="id1B2682D0D3FE474D87AE77D7EDC9A2D2" style="OLC">
<subparagraph id="id5103D9117F2647A4BFC24852DACCC871"><enum>(E)</enum><text>with respect to
an individual who attains early retirement age after December 31, 2021, and
before January 1, 2023, 67 years of age;</text>
</subparagraph><subparagraph id="idED404797078343E092FDBB44EBE5FDD4"><enum>(F)</enum><text>with respect to
an individual who, during the period after December 31, 2022, and before
January 1, 2070—</text>
<clause id="idE77ABBEFB9C54C72A513FC58A02650C1"><enum>(i)</enum><text>for purposes of
paragraph (2)(A)(ii), attains 62 years of age, such individual's early
retirement age plus 60 months; or</text>
</clause><clause id="id5B1A063868D14E448659F091247E1406"><enum>(ii)</enum><text>attains early
retirement age pursuant to paragraph (2)(B), 67 years plus the number of months
determined under the age increase factor for the calendar year in which such
individual attains early retirement age; and</text>
</clause></subparagraph><subparagraph id="idC585BE9FBC214CB18AB9F935AFA93E25"><enum>(G)</enum><text>with respect to
an individual who—</text>
<clause id="id2B46776E8D8646B5997F34CAE43EAB90"><enum>(i)</enum><text>for purposes of
paragraph (2)(A)(iii), attains 62 years of age after December 31, 2069, 69
years of age; or</text>
</clause><clause id="id0ED244075E434F6EBF491B5B444E01DB"><enum>(ii)</enum><text>attains early
retirement age pursuant to paragraph (2)(B) after December 31, 2069, 69 years
of
age.</text>
</clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id08FC6488C8474DFEBCE9C5010698C2F6"><enum>(2)</enum><text>by amending
paragraph (2) to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="idD07B5AD3DC8941DBB978EB924AE84C06" style="OLC">
<paragraph id="id1F039ED385474F57B77BD46650AA3749"><enum>(2)</enum><text>The term
<term>early retirement age</term> means—</text>
<subparagraph id="id930FE5C1A6404A179081365F79AA88F7"><enum>(A)</enum><text>in the case of an
old-age, wife's, or husband's insurance benefit—</text>
<clause id="id3CEB1F1A5798410D8B575584AA212CC0"><enum>(i)</enum><text>62 years of age
with respect to an individual who attains such age before January 1,
2023;</text>
</clause><clause id="id7AE2E528C89D4A159CD27546DED68BEC"><enum>(ii)</enum><text>with respect to
an individual who attains 62 years of age after December 31, 2022, and before
January 1, 2070, 62 years of age plus the number of months determined under the
age increase factor for the calendar year in which such individual attains 62
years of age; and</text>
</clause><clause id="idB2B0766206024E71BB30F38A91135CB6"><enum>(iii)</enum><text>with respect to
an individual who attains age 62 after December 31, 2069, 64 years of age;
or</text>
</clause></subparagraph><subparagraph id="idDABE991046AA4891B39B4538DE08F4A3"><enum>(B)</enum><text>in the case of a
widow's or widower's insurance benefit, 60 years of
age.</text>
</subparagraph></paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="id8E38EECD354C455995859BC5409E58E5"><enum>(3)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id5544BACC2A254D10A64BF49179D7C4B1" style="OLC">
<paragraph id="id20DA1FBD2A28494087F9A49EAF8EF1DC"><enum>(4)</enum><text>The age increase
factor shall be equal to <fraction>1/24</fraction> of the number of months
(rounded down to a full month) in the period beginning with January 2023 and
ending with December of the year in which—</text>
<subparagraph id="id01CB624139264F9AB885606997EA81CA"><enum>(A)</enum><text>for purposes of
paragraph (1)(F)(ii), the individual attains 60 years of age; or</text>
</subparagraph><subparagraph id="id6F12A9CF151040DA856437457CD687CA"><enum>(B)</enum><text>for purposes of
paragraph (2)(A)(ii), the individual attains 62 years of
age.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="id4C9006C7A97E49B18A02A4EFAE750363"><enum>3106.</enum><header>Application
of actuarial reduction for disabled beneficiaries who attain early retirement
age</header>
<subsection id="id8D15C166B5F94CAFBC3146603AB4E79F"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 202(k)(4) of
the Social Security Act (42 U.S.C. 402(k)(4)) is amended to read as
follows:</text>
<quoted-block display-inline="no-display-inline" id="idD2CFEB8FBDA74BDF96D333B89A853FF6" style="OLC">
<paragraph id="id87EF0A6D74EB45869DD68B4D2398EF71" indent="up1"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id71EB92F81DEE4A3B9CBD761A59C9A353"><enum>(A)</enum><text display-inline="yes-display-inline">Subject to subparagraph (B), any individual
who, under this section and section 223, is entitled for any month to both an
old-age insurance benefit and a disability insurance benefit under this title
shall be entitled to only the larger of such benefits for such month, except
that, if such individual so elects, he shall instead be entitled to only the
smaller of such benefits for such month.</text>
</subparagraph><subparagraph id="id212A2683F69E40AEA6D1B26C36C9EAFC" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">An individual described in subparagraph (A)
who has attained transitional retirement age (as determined under subparagraph
(C)) shall only be entitled to the old-age insurance benefit for such month, as
reduced for such month pursuant to subsection (q)(1).</text>
</subparagraph><subparagraph id="id6E3F883F75504D5DAF93FB712D03071B" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">For purposes of subparagraph (B), the term
<term>transitional retirement age</term> means—</text>
<clause id="idFCB07835F3C04BECB3DA34E47D12CB5A"><enum>(i)</enum><text display-inline="yes-display-inline">with respect to an individual who attains
62 years of age before January 1, 2014, 66 years of age;</text>
</clause><clause id="idF607EA6A964F43ED8A316994B542F9A5"><enum>(ii)</enum><text display-inline="yes-display-inline">with respect to an individual who attains
62 years of age after December 31, 2013, and before January 1, 2025, 66 years
of age reduced by the number of months determined under the transition factor
(as determined under subparagraph (D)) for the calendar year in which such
individual attains 62 years of age; and</text>
</clause><clause id="id0E1D6290761D4947925E9831AB1EADD0"><enum>(iii)</enum><text display-inline="yes-display-inline">with respect to an individual who attains
62 years of age after December 31, 2024, 64 years of age.</text>
</clause></subparagraph><subparagraph id="idA4B8ADDDCCEC43C1B89762C09CADBAD0" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">For purposes of subparagraph (C)(ii), the
transition factor shall be equal to two-twelfths of the number of months in the
period beginning with January 2014 and ending with December of the year in
which the individual attains 62 years of
age.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id8971A7F0DE9847F8952AEA3B3563C99D"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="idD516AE480E7C41B2B7445EEEE18AC1C7"><enum>(1)</enum><header>Period of
disability</header><text>Clause (i) of section 216(i)(2)(D) of the Social
Security Act (42 U.S.C. 416(i)(2)(D)) is amended by striking <quote>retirement
age (as defined in subsection (l))</quote> and inserting <quote>transitional
retirement age (as defined in section 216(k)(4))</quote>.</text>
</paragraph><paragraph id="id14F30F6DBB924EA28016F4EC1EC7399A"><enum>(2)</enum><header>Disability
insurance benefit payments</header><text>Section 223(a)(1) of the Social
Security (42 U.S.C. 423(a)(1)) is amended—</text>
<subparagraph id="id5C429E536856442ABA03D6A36F337AC6"><enum>(A)</enum><text>in subparagraph
(B), by striking <quote>retirement age (as defined in section 216(l))</quote>
and inserting <quote>transitional retirement age (as defined in section
216(k)(4))</quote>; and</text>
</subparagraph><subparagraph id="id50EAFB7B46694708ACAED45BDC547CF0"><enum>(B)</enum><text>in the flush
matter at the end, by striking <quote>retirement age (as defined in section
216(l))</quote> and inserting <quote>transitional retirement age (as defined in
section 216(k)(4))</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="id272B0ED8B73E49E8A40E21496188E485"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to benefits
payable for months beginning after December 31, 2013.</text>
</subsection></section><section id="idF68B3C1CD6C34F5AA9943AEA1B29898C"><enum>3107.</enum><header>Option to
collect up to one-half of old-age insurance benefit at age 62</header>
<subsection id="idF371A925FE694DD08BE82D355942907C"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 202 of the
Social Security Act (42 U.S.C. 402) is amended by adding at the end the
following:</text>
<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="idBB022AC65C55491DBC8F5EAC35E5E24C" other-style="archaic" style="other"><subsection id="id60FA93114FB24BE5BC15D79743A5407B"><enum>(z)</enum><header>Option To collect up to
one-Half of old-Age insurance benefit beginning at age 62</header><paragraph commented="no" display-inline="yes-display-inline" id="idCD2D2F1971524D678FFA9A0ABB1E73CF"><enum>(1)</enum><text>Not later than January
1, 2014, the Commissioner of Social Security shall establish an option, subject
to such regulations as are prescribed by the Commissioner under paragraph (2),
for a fully insured individual (as defined in section 214) to elect to receive
a reduced monthly benefit after such individual attains 62 years of age,
consisting of the following:</text>
<subparagraph id="id15C93A1A328B4C5E95BE99EBD8DF2EBC" indent="up1"><enum>(A)</enum><text>Subject to paragraph (3), for months
beginning with the month in which the individual attains age 62, a monthly
benefit equal to such percentage as is elected by the individual, but which
shall not be greater than 50 percent, of the primary insurance amount
determined for the individual at age 62.</text>
</subparagraph><subparagraph id="id8411D24F39BF48399A256CF69CAEE54E" indent="up1"><enum>(B)</enum><text>For months beginning with the month in
which the individual attains early retirement age, a monthly benefit equal to
the sum of—</text>
<clause id="id4A243390C8B440D6B7D20F2536B77563"><enum>(i)</enum><text>the monthly benefit payable to the
individual under subparagraph (A); and</text>
</clause><clause id="id7615BE09D7694719849FA600CDDED9F7"><enum>(ii)</enum><text>the amount equal to the applicable
percentage (as determined under subparagraph (C)) of primary insurance amount
determined for the individual under section 215 for such month (determined
without regard to any election under this subsection).</text>
</clause></subparagraph><subparagraph id="id50AD166450D14E5183623A933E6256E0" indent="up1"><enum>(C)</enum><text>For purposes of subparagraph (B)(ii),
the applicable percentage shall be equal to the difference between—</text>
<clause id="id3C2A1E13C05344F1B8C71E539FA246C6"><enum>(i)</enum><text>100 percent; and</text>
</clause><clause id="idF182B2976F1F422A922466F3DF00E4DC"><enum>(ii)</enum><text>the percentage elected by the
individual under subparagraph (A).</text>
</clause></subparagraph></paragraph><paragraph id="id0FC81E72531049B4BCAFB6CA159B2F65" indent="up1"><enum>(2)</enum><text>An individual shall elect the option
under this subsection in accordance with regulations prescribed by the
Commissioner of Social Security.</text>
</paragraph><paragraph id="idFB6DACF8D93B4EB99E9545DB2B58B237" indent="up1"><enum>(3)</enum><text>The monthly benefit payable to an
individual under paragraph (1)(A) shall be subject to reduction as provided in
subsection
(q).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id236303C8B02C4857B84F6FD7C7C84F83"><enum>(b)</enum><header>Conforming
amendment</header><text>Section 202(a) of the Social Security Act (42 U.S.C.
402(a)) is amended in the last sentence, by striking <quote>subsection (q) and
subsection (w)</quote> and inserting <quote>subsections (q), (w), and
(z)</quote>.</text>
</subsection></section><section id="IDCEFD8D1AF677431BA502D8CC73EFE3E6"><enum>3108.</enum><header>Coverage of
newly hired state and local employees</header>
<subsection id="IDE5BE7246BA124E61A51CEE5B96A3011F"><enum>(a)</enum><header>Amendments to
the Social Security Act</header>
<paragraph id="IDCEAE256696664E6B88BB4CBB43339041"><enum>(1)</enum><header>In
general</header><text>Paragraph (7) of section 210(a) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
410(a)(7)) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="ID3CB30C2B077F404098626DD85BBC38C2" style="OLC">
<paragraph id="ID9E6597B6869144F3AF4A00181DFE8713"><enum>(7)</enum><text>Excluded State or
local government employment (as defined in subsection
(s));</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="IDF94AE0701A1A4B9A965AC39D7F775454"><enum>(2)</enum><header>Excluded state
or local government employment</header>
<subparagraph id="ID1A21EED9E73A4468A064209F5C6BDDF3"><enum>(A)</enum><header>In
general</header><text>Section 210 of such Act (42 U.S.C. 410) is amended by
adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="ID28C01C64347A407B8699EF60B21A8860" style="traditional">
<subsection id="ID2D095F545123413D9625C732C500A922"><enum>(s)</enum><header>Excluded state
or local government employment</header><paragraph commented="no" display-inline="yes-display-inline" id="IDEAFCE3E978FA41EBAAD6C70487B9769D"><enum>(1)</enum><header>In
general</header><text>The term <term>excluded State or local government
employment</term> means any service performed in the employ of a State, of any
political subdivision thereof, or of any instrumentality of any one or more of
the foregoing which is wholly owned thereby, if—</text>
<subparagraph id="IDE788D8DA79D5403FBA61235946259025" indent="up1"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="ID58316E0CABE34939A2B8E908C8538CB6"><enum>(i)</enum><text>such service would be
excluded from the term <term>employment</term> for purposes of this title if
the preceding provisions of this section as in effect in December 2020 had
remained in effect, and (ii) the requirements of paragraph (2) are met with
respect to such service, or</text>
</clause></subparagraph><subparagraph id="IDCB513D58C2734704A350C924CE9EB4C7" indent="up1"><enum>(B)</enum><text>the requirements of paragraph (3) are
met with respect to such service.</text>
</subparagraph></paragraph><paragraph id="ID43F955FF9BD24E198FADDDCFCAFDCCAF" indent="up1"><enum>(2)</enum><header>Exception for current employment
which continues</header>
<subparagraph id="ID72EEC100635C450F97A17B3B8E7FCC74"><enum>(A)</enum><header>In general</header><text>The
requirements of this paragraph are met with respect to service for any employer
if—</text>
<clause id="IDA38414D386654CD9A07DD090B12D5FF3"><enum>(i)</enum><text>such service is performed by an
individual—</text>
<subclause id="ID27781B90B7334E4A91E5FA01F3F4E600"><enum>(I)</enum><text>who was performing substantial and
regular service for remuneration for that employer before January 1,
2021,</text>
</subclause><subclause id="IDA19C2A21EA6F43298BF695471CEAB14A"><enum>(II)</enum><text>who is a bona fide employee of that
employer on December 31, 2020, and</text>
</subclause><subclause id="ID636E1563467F4936B7CA229A80716B52"><enum>(III)</enum><text>whose employment relationship with that
employer was not entered into for purposes of meeting the requirements of this
subparagraph, and</text>
</subclause></clause><clause id="ID8E8CA791E70B4F4A8523762402E46B7F"><enum>(ii)</enum><text>the employment relationship with
that employer has not been terminated after December 31, 2020.</text>
</clause></subparagraph><subparagraph id="IDD1155064E2F149879152134E4590D318"><enum>(B)</enum><header>Treatment of multiple agencies and
instrumentalities</header><text>For purposes of subparagraph (A), under
regulations (consistent with regulations established under section
3121(t)(2)(B) of the Internal Revenue Code of 1986)—</text>
<clause id="ID805F5E2A61ED4CCC9011D8BEDAFA53CD"><enum>(i)</enum><text>all agencies and instrumentalities
of a State (as defined in section 218(b)) or of the District of Columbia shall
be treated as a single employer, and</text>
</clause><clause id="IDB83E0078E1874B1EBBB0C2F8B3A6B2FD"><enum>(ii)</enum><text>all agencies and instrumentalities
of a political subdivision of a State (as so defined) shall be treated as a
single employer and shall not be treated as described in clause (i).</text>
</clause></subparagraph></paragraph><paragraph id="IDA51FFFC86B9F4A789B8A7E98E0C7F904" indent="up1"><enum>(3)</enum><header>Exception for certain
services</header>
<subparagraph id="ID7AD6322B4DA044F88751E9D5A534F2C5"><enum>(A)</enum><header>In general</header><text>The
requirements of this paragraph are met with respect to service if such service
is performed—</text>
<clause id="ID06F9F8EB97D04115823B59ACD0852958"><enum>(i)</enum><text>by an individual who is employed by
a State or political subdivision thereof to relieve such individual from
unemployment,</text>
</clause><clause id="IDCD0EA1C19DEB43208F1EF4848C77F7E8"><enum>(ii)</enum><text>in a hospital, home, or other
institution by a patient or inmate thereof as an employee of a State or
political subdivision thereof or of the District of Columbia,</text>
</clause><clause id="IDC03F852E1B3F4252B5950D4E89A31DF2"><enum>(iii)</enum><text>by an individual, as an employee
of a State or political subdivision thereof or of the District of Columbia,
serving on a temporary basis in case of fire, storm, snow, earthquake, flood,
or other similar emergency,</text>
</clause><clause id="ID5A0E41262A934C3A8BA82935DDA55B0E"><enum>(iv)</enum><text>by any individual as an employee
included under section 5351(2) of title 5, United States Code (relating to
certain interns, student nurses, and other student employees of hospitals of
the District of Columbia Government), other than as a medical or dental intern
or a medical or dental resident in training,</text>
</clause><clause id="ID204D3E08CB724040B9EF7436D23275D5"><enum>(v)</enum><text>by an election official or election
worker if the remuneration paid in a calendar year for such service is less
than $1,000 with respect to service performed during 2021, and the adjusted
amount determined under subparagraph (C) for any subsequent year with respect
to service performed during such subsequent year, except to the extent that
service by such election official or election worker is included in employment
under an agreement under section 218, or</text>
</clause><clause id="ID8F42B36D09B74E03ACFC585DE0E737A9"><enum>(vi)</enum><text>by an employee in a position
compensated solely on a fee basis which is treated pursuant to section
211(c)(2)(E) as a trade or business for purposes of inclusion of such fees in
net earnings from self-employment.</text>
</clause></subparagraph><subparagraph id="IDA71BB7F3045640A092C9B58ED2BE6A83"><enum>(B)</enum><header>Definitions</header><text>As used in
this paragraph, the terms <term>State</term> and <term>political
subdivision</term> have the meanings given those terms in section
218(b).</text>
</subparagraph><subparagraph id="ID995E1782D705406DBD13D3C2618D3314"><enum>(C)</enum><header>Adjustments to dollar amount for
election officials and election workers</header><text>For each year after 2021,
the Commissioner of Social Security shall adjust the amount referred to in
subparagraph (A)(v) at the same time and in the same manner as is provided
under section 215(a)(1)(B)(ii) with respect to the amounts referred to in
section 215(a)(1)(B)(i), except that—</text>
<clause id="ID8FD525D88FBE40FEA6791ECFFF55A4A6"><enum>(i)</enum><text>for purposes of this subparagraph,
2018 shall be substituted for the calendar year referred to in section
215(a)(1)(B)(ii)(II), and</text>
</clause><clause id="ID1C49D388A6784C71B8F57DD831FDE949"><enum>(ii)</enum><text>such amount as so adjusted, if not
a multiple of $100, shall be rounded to the next higher multiple of $100 where
such amount is a multiple of $50 and to the nearest multiple of $100 in any
other case.</text>
</clause></subparagraph><continuation-text continuation-text-level="paragraph">The
Commissioner of Social Security shall determine and publish in the Federal
Register each adjusted amount determined under this subparagraph not later than
November 1 preceding the year for which the adjustment is
made.</continuation-text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="ID25DAF8F17A58406F8C0E81459B4BBF54"><enum>(B)</enum><header>Conforming
amendments</header>
<clause id="ID6EA90D7814D84AD285F66B4D3DF72723"><enum>(i)</enum><text>Subsection (k) of
section 210 of such Act (42 U.S.C. 410(k)) (relating to covered transportation
service) is repealed.</text>
</clause><clause id="ID6D926A2B0285495491169F492141E67C"><enum>(ii)</enum><text>Section 210(p)
of such Act (42 U.S.C. 410(p)) is amended—</text>
<subclause id="IDD7FE797A5B654F64841AC3A0D4795A6E"><enum>(I)</enum><text>in paragraph (2),
by striking <quote>service is performed</quote> and all that follows and
inserting <quote>service is service described in subsection (s)(3)(A).</quote>;
and</text>
</subclause><subclause id="ID401C12C306524D5C8C8E091E39D6F650"><enum>(II)</enum><text>in paragraph
(3)(A), by inserting <quote>under subsection (a)(7) as in effect in December
2020</quote> after <quote>section</quote>.</text>
</subclause></clause><clause id="IDE0A6FD0395A14DE4A993F175D6B40399"><enum>(iii)</enum><text>Section
218(c)(6) of such Act (42 U.S.C. 418(c)(6)) is amended—</text>
<subclause id="ID35868ED97BF7469994F1E5E3E675EB61"><enum>(I)</enum><text>by striking
subparagraph (C);</text>
</subclause><subclause id="IDD71CFDEF76604950BA97E0A1929721FF"><enum>(II)</enum><text>by redesignating
subparagraphs (D) and (E) as subparagraphs (C) and (D), respectively;
and</text>
</subclause><subclause id="ID84C26EE06D554E8D984C1FCB0210572A"><enum>(III)</enum><text>by striking
subparagraph (F) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="ID23139C91FF4F488288858B96FD5E9131" style="OLC">
<subparagraph id="ID9146FA4E42BB4FB1B071314C14C02F79" indent="up1"><enum>(E)</enum><text>service which is included as
employment under section
210(a).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subclause></clause></subparagraph></paragraph></subsection><subsection id="IDBDAB450B92FF4B2BA0166D75C116A95C"><enum>(b)</enum><header>Amendments to
the internal revenue code of 1986</header>
<paragraph id="IDF28BCC31615D40BF937F830446D90D72"><enum>(1)</enum><header>In
general</header><text>Paragraph (7) of section 3121(b) of the Internal Revenue
Code of 1986 (relating to employment) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="ID510AE062B7C8475A99A29D2A6AAFBD1F" style="OLC">
<paragraph id="ID2331254276CC488DB7AC954BADEDF430"><enum>(7)</enum><text>excluded State or
local government employment (as defined in subsection
(t));</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="ID39FA5227D77F4AA188745DE97776FAEA"><enum>(2)</enum><header>Excluded state
or local government employment</header><text>Section 3121 of such Code is
amended by inserting after subsection (s) the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="ID06938C3B504C4618B55DA49CD076704F" style="OLC">
<subsection id="IDD3928FAEE8934F7D9AC6A894CE5D5711"><enum>(t)</enum><header>Excluded state
or local government employment</header>
<paragraph id="IDF899BC096648480CAE4382137C47E086"><enum>(1)</enum><header>In
general</header><text>For purposes of this chapter, the term <term>excluded
State or local government employment</term> means any service performed in the
employ of a State, of any political subdivision thereof, or of any
instrumentality of any one or more of the foregoing which is wholly owned
thereby, if—</text>
<subparagraph id="ID81CC4283E47346EFAB6799454FE30CA8"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="IDFA985FC8421D4EAD904A7579E760E2E6"><enum>(i)</enum><text>such service would be
excluded from the term <term>employment</term> for purposes of this chapter if
the provisions of subsection (b)(7) as in effect in December 2020 had remained
in effect, and (ii) the requirements of paragraph (2) are met with respect to
such service, or</text>
</clause></subparagraph><subparagraph id="IDD2E1086C28084D21B21A098DE460A50B"><enum>(B)</enum><text>the requirements
of paragraph (3) are met with respect to such service.</text>
</subparagraph></paragraph><paragraph id="ID8090FE0432DE461B9B28CB2F4B41110D"><enum>(2)</enum><header>Exception for
current employment which continues</header>
<subparagraph id="ID4C5692E70F6E4555BE33F18AEFDB3D2E"><enum>(A)</enum><header>In
general</header><text>The requirements of this paragraph are met with respect
to service for any employer if—</text>
<clause id="ID848D9E6831E34820A6EADFE0FFD79E6F"><enum>(i)</enum><text>such service is
performed by an individual—</text>
<subclause id="ID4B5B90192F314E2989648B772BE009BE"><enum>(I)</enum><text>who was
performing substantial and regular service for remuneration for that employer
before January 1, 2021,</text>
</subclause><subclause id="IDC8C81D86F4E243AF9C742B87EF9D4105"><enum>(II)</enum><text>who is a bona
fide employee of that employer on December 31, 2020, and</text>
</subclause><subclause id="IDD0431CCE8D854F8DB85E95CBB7B189D9"><enum>(III)</enum><text>whose
employment relationship with that employer was not entered into for purposes of
meeting the requirements of this subparagraph, and</text>
</subclause></clause><clause id="ID897F930CA50A447A990AA892BB727C5B"><enum>(ii)</enum><text>the employment
relationship with that employer has not been terminated after December 31,
2020.</text>
</clause></subparagraph><subparagraph id="ID751275681E7F485A9FE174DDEF7527AC"><enum>(B)</enum><header>Treatment of
multiple agencies and instrumentalities</header><text>For purposes of
subparagraph (A), under regulations—</text>
<clause id="IDFD6645234607434E99493B14F6FD2A12"><enum>(i)</enum><text>all agencies and
instrumentalities of a State (as defined in section 218(b) of the
<act-name parsable-cite="SSA">Social Security Act</act-name>) or of the
District of Columbia shall be treated as a single employer, and</text>
</clause><clause id="ID660AD3C1C192458EA672887859242B62"><enum>(ii)</enum><text>all agencies and
instrumentalities of a political subdivision of a State (as so defined) shall
be treated as a single employer and shall not be treated as described in clause
(i).</text>
</clause></subparagraph></paragraph><paragraph id="IDA23CD1BB124B48BE99FE1BC5D04C9D98"><enum>(3)</enum><header>Exception for
certain services</header>
<subparagraph id="ID76380EECE21348C6996D4F31945D5F65"><enum>(A)</enum><header>In
general</header><text>The requirements of this paragraph are met with respect
to service if such service is performed—</text>
<clause id="ID17AAB74ECAC24EDB97716805B496918D"><enum>(i)</enum><text>by an individual
who is employed by a State or political subdivision thereof to relieve such
individual from unemployment,</text>
</clause><clause id="ID3888919AD9E94579BB671F814E48C878"><enum>(ii)</enum><text>in a hospital,
home, or other institution by a patient or inmate thereof as an employee of a
State or political subdivision thereof or of the District of Columbia,</text>
</clause><clause id="ID72BFDA05C6FA4F8D8D0416EA9891795B"><enum>(iii)</enum><text>by an
individual, as an employee of a State or political subdivision thereof or of
the District of Columbia, serving on a temporary basis in case of fire, storm,
snow, earthquake, flood, or other similar emergency,</text>
</clause><clause id="ID93E7AD82DB2E4980BAAFFBAC9F2CFFA6"><enum>(iv)</enum><text>by any
individual as an employee included under section 5351(2) of title 5, United
States Code (relating to certain interns, student nurses, and other student
employees of hospitals of the District of Columbia Government), other than as a
medical or dental intern or a medical or dental resident in training,</text>
</clause><clause id="IDCEE1942ECFEC415882D9535AF1202766"><enum>(v)</enum><text>by an election
official or election worker if the remuneration paid in a calendar year for
such service is less than $1,000 with respect to service performed during 2021,
and the adjusted amount determined under section 210(s)(3)(C) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> for any subsequent
year with respect to service performed during such subsequent year, except to
the extent that service by such election official or election worker is
included in employment under an agreement under section 218 of the
<act-name parsable-cite="SSA">Social Security Act</act-name>, or</text>
</clause><clause id="IDC48DA624AF424BFDA45917E995D7DB5B"><enum>(vi)</enum><text>by an employee
in a position compensated solely on a fee basis which is treated pursuant to
section 1402(c)(2)(E) as a trade or business for purposes of inclusion of such
fees in net earnings from self-employment.</text>
</clause></subparagraph><subparagraph id="ID3A21AC0F5B924FFAB352626A8B36AA80"><enum>(B)</enum><header>Definitions</header><text>As
used in this paragraph, the terms <term>State</term> and <term>political
subdivision</term> have the meanings given those terms in section 218(b) of the
<act-name parsable-cite="SSA">Social Security
Act</act-name>.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="ID4139B281922F45A0A53796D3A6274CA3"><enum>(3)</enum><header>Conforming
amendments</header>
<subparagraph id="IDE6FAAA4CF1ED40E4854DE91448652DA6"><enum>(A)</enum><text>Subsection (j) of
such section 3121 (relating to covered transportation service) is
repealed.</text>
</subparagraph><subparagraph id="IDD5282351F0A14F44BE998F8190A322A0"><enum>(B)</enum><text>Paragraph (2) of
section 3121(u) of such Code (relating to application of hospital insurance tax
to Federal, State, and local employment) is amended—</text>
<clause id="IDF95641CDE7DA414881CA3CB67E936FDE"><enum>(i)</enum><text>in
subparagraph (B), by striking <quote>service is performed</quote> in clause
(ii) and all that follows through the end of such subparagraph and inserting
<quote>service is service described in subsection (t)(3)(A).</quote>;
and</text>
</clause><clause id="ID863F1C54900C4FB09CB4E4C6F39A6855"><enum>(ii)</enum><text>in
subparagraph (C)(i), by inserting <quote>under subsection (b)(7) as in effect
in December 2020</quote> after <quote>chapter</quote>.</text>
</clause></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID36B04F0CFB5F4C06A8D627AC97CC267A"><enum>(c)</enum><header>Effective
date</header><text>Except as otherwise provided in this section, the amendments
made by this section shall apply with respect to service performed after
December 31, 2020.</text>
</subsection></section><section id="H8376C1279B3149CA885530BDF7AB6F51" section-type="subsequent-section"><enum>3109.</enum><header>Inclusion in annual
social security account statement of estimated present value of taxes and
benefits for Social Security and Medicare and projected deficit as a percent of
lifetime earnings</header>
<subsection id="HDE71389863354E59898C57ED81482D25"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1143(a)(2) of
the Social Security Act (42 U.S.C. 1320b–13(a)(2)) is amended—</text>
<paragraph id="H75EE79FF6685493F85254CAA447020B7"><enum>(1)</enum><text>in subparagraph
(E), by striking <quote>benefits.</quote> and inserting
<quote>benefits;</quote>; and</text>
</paragraph><paragraph id="H15200DE8C8704F04BEE6777E8AE966F5"><enum>(2)</enum><text>by adding after
subparagraph (E) the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="HC88CCC08092940ECA891203F3D2F8B5F" style="traditional">
<subparagraph id="H7E1A8B1B7FD44EB6B3A46A569C584CFF" indent="up1"><enum>(F)</enum><text>an estimate, as determined by the
Commissioner, in consultation with the Secretary of Health and Human Services,
on the basis of available records of the Commissioner and projections based on
reasonable assumptions, of—</text>
<clause id="HE64E028AFA794A3DB96BEA7E43228212"><enum>(i)</enum><text display-inline="yes-display-inline">the present value of potential lifetime
aggregate employer, employee, and self-employment contributions of the eligible
individual for old-age, survivors, and disability insurance (under title II)
and for hospital insurance (under part A of title XVIII);</text>
</clause><clause id="H4F74B0C51A2A4ED0A21A4A8FD2280D59"><enum>(ii)</enum><text>the present value of potential
lifetime premiums payable (under parts B and D of title XVIII); and</text>
</clause><clause id="H108745B7C09E4DF88039679D20B220F3"><enum>(iii)</enum><text>the present value of potential
lifetime aggregate retirement, disability, survivor, and auxiliary benefits
payable on the eligible individual’s account under title II and per capita
benefits payable under the Medicare program of title XVIII; and</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="HA1FC166C215E47F3B9AE6F88FA894EF0" indent="up1"><enum>(G)</enum><text display-inline="yes-display-inline">an estimate, as determined by the
Commissioner, in consultation with the Secretary of Health and Human Services,
on the basis of available records of the Commissioner and projections based on
reasonable assumptions, of the ratio (expressed as a percentage) of—</text>
<clause id="H144E926496E0487EBE1B17FB6BCF8A0A"><enum>(i)</enum><text display-inline="yes-display-inline">the sum of the projected deficit-financed
benefits under the old-age, survivors, and disability insurance program with
respect to the eligible individual and the projected deficit-financed benefits
under part A of the Medicare program under title XVIII with respect to the
eligible individual, to</text>
</clause><clause id="H251DE2DF59CF47F69DF288724D8DC205"><enum>(ii)</enum><text>projected lifetime earnings of the
eligible
individual.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H1849044CCA454555B40E26097BBDE5E9"><enum>(b)</enum><header>Definitions</header><text>Section
1143(a) of such Act (42 U.S.C. 1320b–13(a)) is amended—</text>
<paragraph id="H29997A1890CF4B318B94F95740A860B4"><enum>(1)</enum><text>by redesignating
paragraph (3) as paragraph (4); and</text>
</paragraph><paragraph id="HC6BE700284F046219B7D431F8CFFDB8D"><enum>(2)</enum><text>by inserting after
paragraph (2) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H4929322D8E4B45D5BA0CCF0F7893778D" style="traditional">
<paragraph id="H0BEF48EAF949458C8EB2A080E4FB60B1" indent="up1"><enum>(3)</enum><text>For purposes of paragraph
(2)(G)—</text>
<subparagraph id="HA1EEFEE6CC23439AB8A9E30FA7BD3E98"><enum>(A)</enum><text display-inline="yes-display-inline">The term <term>projected deficit-financed
benefits</term> means—</text>
<clause id="HE2F360BE7D6741A094CE7CC5532C1DAE"><enum>(i)</enum><text display-inline="yes-display-inline">with respect to an eligible individual in
connection with the old-age, survivors, and disability insurance program, the
product of—</text>
<subclause id="H6E9CA720E2434A43A85D0C0CFFF68D97"><enum>(I)</enum><text display-inline="yes-display-inline">the
benefits described in subparagraph (F)(ii) of such individual under such
program, and</text>
</subclause><subclause id="H46E07571F9364C59822A0375E9D2EF52"><enum>(II)</enum><text display-inline="yes-display-inline">the
ratio of future annual deficits, excluding interest, of the Federal Old-Age and
Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund
over the eligible individual’s lifetime to future annual outlays from such
Trust Funds over such lifetime; and</text>
</subclause></clause><clause id="HC00C1B8967D24415BE40273DC30662A6"><enum>(ii)</enum><text display-inline="yes-display-inline">with respect to an eligible individual in
connection with the Medicare program under title XVIII, the product of—</text>
<subclause id="HFCB75DD796B84B41835D235C48D72D41"><enum>(I)</enum><text display-inline="yes-display-inline">the
benefits for hospital insurance (under part A of title XVIII) described in
subparagraph (F)(ii) of such individual under such program, and</text>
</subclause><subclause id="H86AE0C23384C49ADBF76CE7B0178AE67"><enum>(II)</enum><text display-inline="yes-display-inline">the
ratio of future annual deficits of the Federal Hospital Insurance Trust Fund
over the eligible individual’s lifetime to future annual outlays from such
Trust Fund over such lifetime.</text>
</subclause></clause></subparagraph><subparagraph id="HD4C7D064111E4587B1C6F70FCC990DA7"><enum>(B)</enum><text display-inline="yes-display-inline">The term <term>projected lifetime
earnings</term> of the eligible individual means the present value of the
potential total wages paid to, and self-employment income derived by, the
eligible individual over the eligible individual’s lifetime, as determined
without regard to the contribution and benefit base under section
230.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H3A35207E4113404E8E09B25782DBD92E"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply with respect
to annual statements issued after 2013.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="id70DA0EE0D62E4A1799D2FEEDA2FF8BC1"><enum>3110.</enum><header>Retirement
information campaign</header><text display-inline="no-display-inline">The
Commissioner of Social Security shall establish a public information campaign
to provide information and education regarding the implications on personal
financial security of early and other retirement decisions and the need for
greater retirement savings. The information campaign should be designed to
encourage individuals to delay retirement so as to build enhanced levels of
social security benefits and personal retirement savings. To the extent the
Commissioner of Social Security determines appropriate, the information
provided through the campaign should utilize behavioral economics approaches,
such as structured choice, and other scientific approaches.</text>
</section><enum>IV</enum><header>Conversion to
chained CPI</header>
<section id="ID3079adaf14514fc69e29482a07194b46"><enum>4101.</enum><header>Conversion to
chained CPI</header>
<subsection id="IDf659eb625d8047e5b114c2f1147670eb"><enum>(a)</enum><header>Consumer price
index adjustments applicable to the Internal Revenue Code provisions</header>
<paragraph id="IDbbb5588994d34e6a83761e60e1d8460a"><enum>(1)</enum><header>In
general</header><text>Paragraph (3) of section 1(f) of the Internal Revenue
Code of 1986 is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="id3438051C01074D50BA12147BA19DD5A1" style="OLC">
<paragraph id="ID80e5af164cc2475da862d98ea2f19d54"><enum>(3)</enum><header>Cost-of-living
adjustment</header>
<subparagraph id="ID7c4918b1047641d3b946100ae7b5cdfb"><enum>(A)</enum><header>In
general</header><text>For purposes of paragraph (2), the cost-of-living
adjustment for any calendar year is—</text>
<clause id="idBEF556E9748D44EA86250D4B1CBD17AE"><enum>(i)</enum><text>for adjustments
first beginning before 2014, the product of—</text>
<subclause id="ID9c447376dbe44ac38e4fe0291c58f6d4"><enum>(I)</enum><text>the CPI fraction
for calendar years before 2014, multiplied by</text>
</subclause><subclause id="IDa75d6fce28fd422ea537608c3d4bc6fd"><enum>(II)</enum><text>the Chained CPI
fraction for calendar years after 2013,</text>
</subclause><continuation-text continuation-text-level="clause">reduced by 1,
and</continuation-text></clause><clause id="id4D08EE35CB054355A301CD4221083D9B"><enum>(ii)</enum><text>for adjustments
first beginning after 2013, the Chained CPI fraction for years after
2013.</text>
</clause></subparagraph><subparagraph id="ID1dec4875f4174af7867797b14316f26f"><enum>(B)</enum><header>CPI fraction
for calendar years before 2014</header><text>The CPI fraction for calendar
years before 2014 is the fraction—</text>
<clause id="ID601d44fd47e9497ca59c86512979cc86"><enum>(i)</enum><text>the numerator of
which is the CPI for the calendar year 2012; and</text>
</clause><clause id="IDb86129a6f8b5465abee70ea0f1531d61"><enum>(ii)</enum><text>the denominator
of which is the CPI for the calendar year 1992.</text>
</clause></subparagraph><subparagraph id="IDc8cc76ff3fde4a9d916ea9e3b1df9c0d"><enum>(C)</enum><header>Chained cpi
fraction for calendar years after 2013</header><text>The Chained CPI fraction
for calendar years after 2013 is the fraction—</text>
<clause id="ID4c644006c1534ed0856021f445ccb79b"><enum>(i)</enum><text>the numerator of
which is the Chained CPI for the preceding calendar year, and</text>
</clause><clause id="ID92f2e1b822a44cc59483159b07f0b849"><enum>(ii)</enum><text>the denominator
of which is the Chained CPI for the calendar year
2012.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="ID3055e11d03f144b5afd524476f3a6f21"><enum>(2)</enum><header>Conforming
amendments</header>
<subparagraph id="ID61ff23f092804ed08b3b196136eca239"><enum>(A)</enum><text>Paragraph (4) of
section 1(f) of such Code is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="id2FC5D58505FA4E399420D76E67A0F083" style="OLC">
<paragraph id="ID15e63cedd3a54ad682ab9c26646c8b9e"><enum>(4)</enum><header>CPI and chained
cpi for any calendar year</header><text>For purposes of paragraph (3)—</text>
<subparagraph id="ID1fa9b5e4fde74542ba4f91fe4caeb4ea"><enum>(A)</enum><header>CPI</header><text>The
CPI for any calendar year is the average of the Consumer Price Index as of the
close of the 12-month period ending on August 31 of such calendar year.</text>
</subparagraph><subparagraph id="ID8de14f560d2246979741a84f1006e044"><enum>(B)</enum><header>Chained
cpi</header><text>The Chained CPI for any calendar year is the average of the
Chained Consumer Price Index as of the close of the 12-month period ending on
August 31 of such calendar
year.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="IDdebb6c8d7a6b407a89f774f9134aa9ff"><enum>(B)</enum><text>Paragraph (5) of
section 1(f) of such Code is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="id37D31644024D4ED1A78E5C2FC39C70FB" style="OLC">
<paragraph id="ID181471826cab44bea81f73bdeeb376c3"><enum>(5)</enum><header>Consumer price
index and chained consumer price index</header><text>For purposes of paragraph
(4)—</text>
<subparagraph id="IDeef31dd4a19c4241a69eb5efc79ec86b"><enum>(A)</enum><header>Consumer price
index</header><text>The term <term>Consumer Price Index</term> means the last
Consumer Price Index for all urban consumers published by the Department of
Labor. For purposes of the preceding sentence, the revision of the Consumer
Price Index which is most consistent with the Consumer Price Index for calendar
year 1986 shall be used.</text>
</subparagraph><subparagraph id="IDe07a862c4e3c4bd1862fb66a94ce47e2"><enum>(B)</enum><header>Chained
consumer price index</header><text>The term <term>Chained Consumer Price
Index</term> means the most recent estimate of the Chained Consumer Price Index
for all urban consumers published by the Department of
Labor.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id3F17C45C58FA46A58D98D261D9980FBB"><enum>(C)</enum><text>Subclause (II) of
section 36B(b)(3)(A)(ii) of such Code is amended by striking <quote>consumer
price index</quote> and inserting <quote>Chained Consumer Price Index (as
defined in section 1(f)(5)(B))</quote>.</text>
</subparagraph><subparagraph id="id9AEC86C1F6F74D849ED1907F57F5B098"><enum>(D)</enum><text>Subclause (II) of
section 36B(f)(2)(B)(ii) of such Code is amended by striking <quote>by
substituting <quote>calendar year 2013</quote> for <quote>calendar year
1992</quote> in subparagraph (B) thereof</quote> and inserting <quote>by
substituting <quote>calendar year 2013</quote> for <quote>calendar year
2012</quote> in subparagraph (C) thereof</quote>.</text>
</subparagraph><subparagraph id="id01A2F33C1F9D4FE39FDEB1CDC6462413"><enum>(E)</enum><text>Clause (ii) of
section 45R(d)(3)(B) of such Code is amended by striking <quote>determined by
substituting <quote>calendar year 2012</quote> for <quote>calendar year
1992</quote> in subparagraph (B) thereof</quote>.</text>
</subparagraph><subparagraph id="idCACD407D546B4E68999FB1B6B2FE8D5E"><enum>(F)</enum><text>Subparagraph (B)
of section 125(i)(2) of such Code is amended by striking <quote>determined by
substituting <quote>calendar year 2012</quote> for <quote>calendar year
1992</quote> in subparagraph (B) thereof</quote>.</text>
</subparagraph><subparagraph id="idD3257D129C8A4471A79BF651CC07F94A"><enum>(G)</enum><text>Subclause (II) of
section 4980I(b)(3)(C)(v) of such Code is amended by striking <quote>for
<quote>1992</quote> in subparagraph (B) thereof</quote> and inserting
<quote>for <quote>2012</quote> in subparagraph (C) thereof</quote>.</text>
</subparagraph><subparagraph id="id339D9671F61D4A0B9FDD1669616C97BF"><enum>(H)</enum><text>Clause (ii) of
section 5000A(c)(3)(D) of such Code is amended by striking <quote>by
substituting <quote>calendar year 2015</quote> for <quote>calendar year
1992</quote> in subparagraph (B) thereof</quote> and inserting <quote>by
substituting <quote>calendar year 2015</quote> for <quote>calendar year
2012</quote> in subparagraph (C) thereof</quote>.</text>
</subparagraph></paragraph><paragraph id="ID6476977161d54856b3e138358d22dab3"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply to
taxable years beginning after December 31, 2013.</text>
</paragraph></subsection><subsection id="IDfc2520f9839440938d943467123e465d"><enum>(b)</enum><header>Modifications
to cost-of-Living indexation of Social Security benefits</header>
<paragraph id="ID7126de50bd824419b206eb84c09e7641"><enum>(1)</enum><header>In
general</header><text>Section 215(i)(1)(D) of the Social Security Act (42
U.S.C. 415(i)(1)(D)) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="id422B121B4A994441B6D319A9CB48BDEA" style="OLC">
<subparagraph id="ID9742c55e358e48b6996f7b35c1ba935d" indent="up1"><enum>(D)</enum><text>the term <term>CPI increase
percentage</term>, with respect to a base quarter or cost-of-living computation
quarter in any calendar year, means the percentage (rounded to the nearest
one-tenth of 1 percent) by which the Chained Consumer Price Index for All Urban
Consumers (as published in its initial form by the Bureau of Labor Statistics
of the Department of Labor) for such base quarter or cost-of-living computation
quarter exceeds such index for the later of—</text>
<clause id="idFD5F91D4B812432684E9E55A843D3B27"><enum>(i)</enum><text>the most recent calendar quarter
(prior to such base quarter or cost-of-living computation quarter) which was a
base quarter under subparagraph (A)(ii); or</text>
</clause><clause id="idFED702382AA147EEB6C784B00477EB87"><enum>(ii)</enum><text>the most recent cost-of-living
computation quarter under subparagraph
(B);</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="IDbc0807d10b504e3d86d52034f789b002"><enum>(2)</enum><header>Definitions</header><text>Section
215(i)(1)(G) of such Act (42 U.S.C. 415(i)(1)(G)) is amended to read as
follows:</text>
<quoted-block display-inline="no-display-inline" id="id3B313C8D64694633B889EF501D721FE0" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="idB8376C21302344FB8EFC20D43F432F6B" indent="up1"><enum>(G)</enum><text display-inline="yes-display-inline">the Chained Consumer Price Index for All
Urban Consumers for a base quarter, a cost-of-living computation quarter, or
any other calendar quarter shall be the arithmetical mean of such index (as
published in its initial form by the Bureau of Labor Statistics of the
Department of Labor as of the end of such quarter) for the 12-month period
ending with such
quarter.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="id340DB4C0F4224314A94BCB81CD2215D6"><enum>(3)</enum><header>Conforming
changes for pre-1977 law</header>
<subparagraph id="id2AC54E04C57841D7A4219CDFE9C065D3"><enum>(A)</enum><text>Section 215(i)(1)
of such Act, as in effect in December 1978, and as applied in certain cases
under the provisions of such Act as in effect after December 1978, is
amended—</text>
<clause id="idB88FEE3DF0104E1B8FFC9D65926D4D74"><enum>(i)</enum><text>in
subparagraph (B), by striking <quote>and</quote> after the semicolon;</text>
</clause><clause id="id707C97F473F04D2796CA932601D7D663"><enum>(ii)</enum><text>in
subparagraph (C), by striking <quote>for the 3 months in such quarter.</quote>
and inserting <quote>for the 12 months in the 12-month period ending with such
quarter; and</quote>; and</text>
</clause><clause id="idFF962D95879E4179A80BAC1627F96DD8"><enum>(iii)</enum><text>by adding at
the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idE837B37DAD2E49AF9636600B5480A780" style="OLC">
<subparagraph id="id15A6D0DE945C4E6182A6DBA38A75E5B1" indent="up1"><enum>(D)</enum><text>the term <term>Consumer Price
Index</term> means the Chained Consumer Price Index for All Urban Consumers
(C–CPI–U), as published in its initial form by the Bureau of Labor Statistics
of the Department of
Labor.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="idDF9F5291C62F43EFB480391B71B0C2B3"><enum>(B)</enum><text>Section 215(i)(4)
of the Social Security Act (42 U.S.C. 415(i)(4)) is amended by inserting
<quote>and by section 4101(b) of the <short-title>The
Dollar for Dollar Act of 2012</short-title></quote> after
<quote>1986,</quote>.</text>
</subparagraph></paragraph><paragraph id="IDdccd7e38957144d796b0f0c906828069"><enum>(4)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply with
respect to increases described in section 215(i) of the Social Security Act,
and to increases under programs dependent on Social Security cost-of-living
adjustments, effective with the month of December for years after 2012.</text>
</paragraph></subsection><subsection id="IDae21fed5a7ea4078afaaeb533c9df64f"><enum>(c)</enum><header>Adjustments of
provisions utilizing the consumer price index</header>
<paragraph id="ID77b3793c8ab94e899be60923fb823bb9"><enum>(1)</enum><header>In
general</header><text>Notwithstanding any other provision of law, and except as
provided in this section, for purposes of determining the amount of any
cost-of-living increase or similar adjustment under a Federal program or law
effective in the month of December 2013 and thereafter, any such increase for
the period for which the percentage change is determined shall be deemed to be,
in lieu of the increase otherwise determined under applicable law, the increase
determined under such applicable law by substituting the Chained CPI for the
CPI.</text>
</paragraph><paragraph id="ID43921979003a4af4923f33fff9358455"><enum>(2)</enum><header>Increases
determined from a constant base year</header>
<subparagraph id="ID4c2c27d581a84ad78b49d62151ad3fe4"><enum>(A)</enum><header>In
general</header><text>In any case in which the amount of a cost-of-living
increase effective in the month of December 2012 and thereafter is determined
under applicable law by reference to a change in the CPI over a period which is
determined by reference to a base period which remains constant from year to
year, any such increase for any period shall be deemed to be, in lieu of the
increase otherwise determined under applicable law, the increase, expressed as
a percentage increase, equal to the product of—</text>
<clause id="ID259f7308942040f7a3a6c8d0734f5bed"><enum>(i)</enum><text>the
CPI fraction prior to 2014; multiplied by</text>
</clause><clause id="ID1541ce673a624223ac1ad8dd4ef456a2"><enum>(ii)</enum><text>the Chained CPI
fraction after 2013,</text>
</clause><continuation-text continuation-text-level="subparagraph">reduced
by 1.</continuation-text></subparagraph><subparagraph id="ID345a1491b2ea4691bd432687c2a19058"><enum>(B)</enum><header>CPI fraction
prior to 2014</header><text>The CPI fraction prior to 2014 is the
fraction—</text>
<clause id="ID7e5585276233409ca0e6160679e31fa6"><enum>(i)</enum><text>the
numerator of which is the CPI for the period, ending with or during 2012, which
corresponds to the base period; and</text>
</clause><clause id="ID3846ea8f646c41fd976b0222fd1a4cad"><enum>(ii)</enum><text>the denominator
of which is the CPI for the base period.</text>
</clause></subparagraph><subparagraph id="ID21a6abc37360483cb0d94ab9750df496"><enum>(C)</enum><header>Chained CPI
fraction after 2013</header><text>The Chained CPI fraction after 2013 is the
fraction—</text>
<clause id="ID15a8179b149048018c3ce3d275885b88"><enum>(i)</enum><text>the
numerator of which is the Chained CPI for the period, ending with or during the
year preceding the year in which the determination takes effect, which
corresponds to the base period; and</text>
</clause><clause id="ID9b59186f7d3a4f758087fc5041ec37bb"><enum>(ii)</enum><text>the denominator
of which is the most recently published estimate of the Chained CPI for the
period, ending with or during 2012, which corresponds to the base
period.</text>
</clause></subparagraph></paragraph><paragraph id="IDacb881aa89364e97b7f84c88fa8ce8e8"><enum>(3)</enum><header>Special
provisions and exceptions</header>
<subparagraph id="ID81338ef1c435436888f9b44da155db6f"><enum>(A)</enum><header>Programs tied
to Social Security</header><text>Subject to subparagraph (B) and the effective
date under subsection (b)(4), this section and the amendments made by this
section shall apply to any cost-of-living increase or other adjustment which is
determined by reference to an adjustment made under section 215(i) of the
Social Security Act (42 U.S.C. 415(i)).</text>
</subparagraph><subparagraph id="ID5f460585bfb24a27b067a22724082ea6"><enum>(B)</enum><header>Poverty
line</header><text>This subsection shall apply to revisions to the poverty line
made pursuant to 42 U.S.C. 9902(2), and any programs for which adjustments or
eligibility thresholds are based upon the poverty line as defined in that
section.</text>
</subparagraph></paragraph><paragraph id="ID0c09a4acd37848fead4ac44d979e2c83"><enum>(4)</enum><header>CPI and chained
cpi</header><text>For purposes of this subsection—</text>
<subparagraph id="IDd4647c3c06904a088aec6266e5a2e942"><enum>(A)</enum><text>the CPI for any
period means the average monthly Consumer Price Index for such period, or a
component thereof, as determined under the applicable law in connection with
any cost-of-living increase or similar adjustment required for such period
(without regard to this subsection); and</text>
</subparagraph><subparagraph id="ID1e05a1e7b01f4ebb965feb85bd1c4c64"><enum>(B)</enum><text>the Chained CPI
for any period means, except as provided in paragraph (2)(C)(ii), the Chained
Consumer Price Index for all urban consumers (as published in its initial form
by the Bureau of Labor Statistics of the Department of Labor) for such period,
or a component thereof, determined under applicable law in the same manner as
the CPI for such period would be determined.</text>
</subparagraph></paragraph></subsection><subsection id="id4A02ECAB53E947478967114ECF755F5B"><enum>(d)</enum><header>Change to
12-Month period for cost-of-Living indexation for Federal civil service and
military retirement programs</header>
<paragraph id="id4ADA388B6087448191CAF206815F3ACB"><enum>(1)</enum><header>In
general</header>
<subparagraph id="id2D2C918A43984C6B8BC0BDB579C901C5"><enum>(A)</enum><header>Federal civil
service</header><text>Sections 8340(a)(2) and 8462(a)(2) of title 5, United
States Code, are each amended by striking <quote>3 months comprising such
quarter</quote> and inserting <quote>12-month period ending with such
quarter</quote>.</text>
</subparagraph><subparagraph id="id55B85D971A534205ACA4BE4DA1B3D070"><enum>(B)</enum><header>Military</header><text>Section
1401a(h) of title 10, United States Code, is amended by striking <quote>three
months comprising that quarter</quote> and inserting <quote>12-month period
ending with such quarter</quote>.</text>
</subparagraph></paragraph><paragraph id="idDADF328F8C7149F39F894AA6EBB71A7A"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply with
respect to cost-of-living increases effective with the month of December of
years after 2012.</text>
</paragraph></subsection></section><enum>V</enum><header>Public debt
limit</header>
<section id="id05095D7F91E745D0970A9898741ACB31"><enum>5101.</enum><header>Increase in
public debt limit</header><text display-inline="no-display-inline">Section 3101
of title 31, United States Code, is amended—</text>
<paragraph id="idD1436ED313A3494EABD0B6943B2FC68D"><enum>(1)</enum><text>in subsection
(b)—</text>
<subparagraph id="id3201DCDAB0664E72A1A03788901233D3"><enum>(A)</enum><text>by inserting
<quote>the sum of</quote> after <quote>shall not be more than</quote>,
and</text>
</subparagraph><subparagraph id="idDEC9C42A564E4020A15A6C7348532CB6"><enum>(B)</enum><text>by inserting
<quote>the amount determined under subsection (d)</quote> before <quote>,
outstanding at one time</quote>, and</text>
</subparagraph></paragraph><paragraph id="id60E44BA70C3D4D9CA4A46DECD4B70217"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="idCC865D2542864116A839644D3BCE8992" style="OLC">
<subsection id="id5B8E223A6EAE406FB597B8CC23CF50CD"><enum>(d)</enum><header>Additional
increase</header><text>The amount determined under this subsection is the
amount of spending reduction attributable to the
<short-title>The Dollar for Dollar Act of
2012</short-title>, as estimated by the Office of Management and
Budget.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section>