[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5113 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5113

  To amend title XIX of the Social Security Act to end the increased 
    Federal funding for Medicaid expansion with respect to inmates' 
hospital care under the Patient Protection and Affordable Care Act, to 
   apply the savings towards a 2015 Medicare Advantage stabilization 
   program to help protect seniors' choices, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 15, 2014

Mr. Coffman (for himself, Mrs. Blackburn, Mr. Nugent, Mr. Lamborn, and 
  Mr. Hall) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to end the increased 
    Federal funding for Medicaid expansion with respect to inmates' 
hospital care under the Patient Protection and Affordable Care Act, to 
   apply the savings towards a 2015 Medicare Advantage stabilization 
   program to help protect seniors' choices, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Seniors' Medicare Choices 
from Obamacare Act of 2014''.

SEC. 2. ELIMINATING PPACA ENHANCED MEDICAID FMAP FOR PRISONERS AND 
              APPLYING SAVINGS TO MEDICARE ADVANTAGE IMPROVEMENT FUND.

    (a) Elimination of PPACA Enhanced Medicaid FMAP for Prisoners.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (y)(2)(A), by adding at the end 
                the following: ``Such term does not include an 
                individual described in such subparagraph during the 
                period in which the individual is an inmate in a public 
                institution or in which the public institution 
                maintains jurisdiction over the individual.''; and
                    (B) in subsection (z)(1)(A), by inserting before 
                the period at the end the following: ``and who are not 
                inmates of a public institution (or individuals over 
                whom a public institution maintains jurisdiction)''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to items and services furnished on or after January 
        1, 2015.
    (b) Application of Savings to 2015 to Establishment of 2015 
Medicare Advantage Stabilization Program.--Section 1859 of the Social 
Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the 
following new subsection:
    ``(h) 2015 Medicare Advantage Stabilization Program.--
            ``(1) Establishment.--There is established a Medicare 
        Advantage stabilization program (in this subsection referred to 
        as the `stabilization program') under which the Secretary 
        shall, subject to paragraph (6), provide a PMPM stabilization 
        funding amount to each eligible Medicare Advantage plan in 
        accordance with this subsection to be used by such plan for 
        plan year 2015 to address the beneficiary plan inadequacies 
        applicable to such plan (as described in paragraph (5)).
            ``(2) Eligible medicare advantage plans.--For purposes of 
        this subsection, an eligible Medicare Advantage plan is a 
        Medicare Advantage plan to be offered for plan year 2015 that 
        the Secretary determines, based on the bid of such plan 
        submitted under section 1854 for such plan year, satisfies at 
        least one of the following criteria:
                    ``(A) Increased beneficiary costs.--The total costs 
                (including premiums, cost-sharing responsibilities, and 
                deductibles) projected to be applicable to individuals 
                who enroll in such plan for such plan year are at least 
                7 percent more than the such total costs that were 
                applicable to individuals enrolled in such plan for 
                plan year 2014.
                    ``(B) Decreased supplemental benefits.--The 
                supplemental benefits to be offered under such plan for 
                such plan year 2015 are less than the supplemental 
                benefits offered under such plan for plan year 2014.
                    ``(C) Decreased provider network.--The number of 
                physicians in the plan's network has been reduced by 3 
                percent or more from plan year 2014 to plan year 2015.
            ``(3) Distribution of pmpm stabilization funding amounts.--
                    ``(A) In general.--Subject to the availability of 
                funds under paragraph (6), under the stabilization 
                program, the Secretary shall distribute, not later than 
                December 31, 2014, to each eligible Medicare Advantage 
                plan a PMPM stabilization funding amount, as determined 
                by the Secretary in accordance with subparagraph (B).
                    ``(B) PMPM stabilization funding amount.--A PMPM 
                stabilization funding amount, with respect to an 
                eligible Medicare Advantage plan, shall be determined 
                in accordance with the following:
                            ``(i) Such amount shall be an amount, with 
                        respect to each month of plan year 2015, for 
                        each individual projected to be enrolled in 
                        such plan for such plan year.
                            ``(ii) Subject to paragraph (6) and clause 
                        (iii), such amount shall be an amount 
                        determined by the Secretary to be sufficient 
                        for such plan to address for plan year 2015 
                        each beneficiary plan inadequacy specified in 
                        paragraph (4) applicable to such plan.
                            ``(iii) Such amount shall not be more than 
                        $85 per member per month.
            ``(4) Timing of determinations.--Under the stabilization 
        program, the Secretary shall determine which Medicare Advantage 
        plans are eligible Medicare Advantage plans under paragraph 
        (2), and the PMPM stabilization funding amount to be 
        distributed to each such eligible Medicare Advantage plan under 
        paragraph (3), by not later than October 15, 2014.
            ``(5) Applicable beneficiary plan inadequacies.--For 
        purposes of this subsection, a beneficiary plan inadequacy 
        applicable to an eligible Medicare Advantage plan is each of 
        the criteria described in paragraph (2) that the Secretary 
        determined the plan satisfied for qualifying as such an 
        eligible Medicare Advantage plan.
            ``(6) Funding.--
                    ``(A) In general.--There shall be available to the 
                Secretary from amounts in the general fund in the 
                Treasury not otherwise appropriated an amount, not to 
                exceed $3,000,000,000, to carry out this subsection. 
                Such amounts shall remain so available until December 
                31, 2015. Any amounts made so available but not 
                expended on or before such date shall be transferred to 
                the general fund in the Treasury.
                    ``(B) Clarification.--Payments under the 
                stabilization program shall not be taken into account 
                for purposes of determining the premium payments 
                applicable under part B.''.
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