[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 11 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                 S. 11

   To provide a comprehensive deficit reduction plan, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 26, 2013

  Mr. Corker (for himself and Mr. Alexander) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To provide a comprehensive deficit reduction plan, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Fiscal 
Sustainability Act of 2013''.
    (b) Table of Contents.--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.
               ``Subpart 2--Medicare Total Health Program

        ``Sec. 1860C-1. Eligibility, enrollment, and information.
        ``Sec. 1860C-2. Total Health plan benefits.
        ``Sec. 1860C-3. Access to a choice of qualified Total Health 
                            benefits plans.
        ``Sec. 1860C-4. Beneficiary protections for Total Health plan 
                            enrollees.
        ``Sec. 1860C-5. Total Health regions; submission of bids; Total 
                            Health plan approval.
        ``Sec. 1860C-6. Requirements for and contracts with Total 
                            Health sponsors.
        ``Sec. 1860C-7. Total Health premiums.
        ``Sec. 1860C-8. Premium and cost-sharing support for Total 
                            Health eligible individuals.
        ``Sec. 1860C-9. Exemption for MSA plans.
        ``Sec. 1860C-10. Special rules for employer-sponsored programs.
        ``Sec. 1860C-11. Coordination with State Medicaid programs.
        ``Sec. 1860C-12. Definitions and miscellaneous provisions.
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 I--MEDICAID

SEC. 1101. COMPREHENSIVE MEDICAID WAIVERS.

    Section 1115 of the Social Security Act (42 U.S.C. 1315) is amended 
by adding at the end the following:
    ``(g) Comprehensive Medicaid Waivers.--
            ``(1) Authority.--
                    ``(A) In general.--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).
                    ``(B) Waiver of state medicaid program 
                requirements.--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.
                    ``(C) Shared savings bonus.--A State conducting a 
                comprehensive Medicaid waiver under this subsection 
                shall be eligible for a shared savings bonus in 
                accordance with paragraph (4).
                    ``(D) Option to include chip-eligible 
                individuals.--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.
            ``(2) Comprehensive medicaid waiver application.--An 
        application for a comprehensive Medicaid waiver under this 
        subsection shall contain the following:
                    ``(A) General description of proposed benefit 
                delivery models, eligibility criteria, and benefits.--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.
                    ``(B) HEDIS measures to evaluate performance.--
                            ``(i) In general.--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.
                            ``(ii) Evaluation.--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.
                    ``(C) Program integrity.--A brief description of 
                the State's program to prevent waste, fraud, and abuse 
                under the waiver.
                    ``(D) Aggregate spending cap.--An assurance that 
                the State agrees--
                            ``(i) 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 `population 
                        category');
                            ``(ii) 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
                            ``(iii) 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.
            ``(3) Determination of aggregate spending cap.--
                    ``(A) Establishment of spending template.--
                            ``(i) In general.--The Secretary, in 
                        coordination with the Director of the Office of 
                        Management and Budget (referred to in this 
                        subsection as the `Director'), 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--
                                    ``(I) publish a proposed template 
                                not later than 60 days after the date 
                                of enactment of this subsection;
                                    ``(II) provide for a period for 
                                public comment on the proposed 
                                template; and
                                    ``(III) promulgate a final template 
                                not later than 120 days after such date 
                                of enactment.
                            ``(ii) Revisions.--
                                    ``(I) In general.--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.
                                    ``(II) Technical changes.--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.
                    ``(B) Determination of aggregate spending cap for 
                each state.--
                            ``(i) In general.--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).
                            ``(ii) Total amount of projected federal 
                        payments.--The amount described in this clause 
                        is equal to the sum of--
                                    ``(I) 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
                                    ``(II) the sum of the amounts 
                                determined under clause (iii) for each 
                                population category.
                            ``(iii) Projected federal payments for 
                        medical assistance provided to population 
                        categories.--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--
                                    ``(I) 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 `population 
                                category per capita baseline');
                                    ``(II) the number of individuals 
                                within such population category that 
                                are projected to be eligible to receive 
                                medical assistance during the waiver 
                                period; and
                                    ``(III) the number of months in the 
                                waiver period.
                            ``(iv) Population categories with no 
                        baseline data.--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.
                            ``(v) Budget neutrality.--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.
                    ``(C) Adjustment of aggregate spending cap for high 
                unemployment.--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).
            ``(4) Shared savings bonuses.--
                    ``(A) In general.--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).
                    ``(B) Dedicated to health care.--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.
                    ``(C) Determination of waiver savings.--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.
                    ``(D) Payment; retrospective adjustment.--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.
            ``(5) Duration.--
                    ``(A) In general.--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.
                    ``(B) State evaluations and target performance 
                goals.--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.
            ``(6) Limited secretarial authority; administrative and 
        judicial review.--
                    ``(A) Certification of waiver applications.--
                            ``(i) In general.--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).
                            ``(ii) Inquiries.--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).
                            ``(iii) Failure to respond by the 
                        secretary.--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.
                            ``(iv) Effective date.--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.
                    ``(B) Denial of waiver applications or renewal 
                requests.--
                            ``(i) In general.--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--
                                    ``(I) the State that submitted the 
                                waiver application or extension 
                                request;
                                    ``(II) the members of Congress 
                                representing such State; and
                                    ``(III) the Committee on Finance of 
                                the Senate and the Committee on Energy 
                                and Commerce of the House of 
                                Representatives.
                            ``(ii) Administrative and judicial 
                        review.--
                                    ``(I) Administrative review.--
                                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.
                                    ``(II) Judicial review.--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.
                    ``(C) Reports.--
                            ``(i) In general.--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 
                        `Comptroller') 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.
                            ``(ii) Reporting of information.--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.
            ``(7) Non-applications.--A comprehensive Medicaid waiver 
        shall not apply to--
                    ``(A) the pediatric vaccine program under section 
                1928; and
                    ``(B) limitations on total payments to territories 
                under section 1108.
            ``(8) Outreach and education.--
                    ``(A) State awareness.--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.
                    ``(B) Public notice and comment.--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.
                    ``(C) Public awareness of approved waiver.--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.
            ``(9) Definitions.--In this subsection:
                    ``(A) Average monthly unemployment rate.--The term 
                `average monthly unemployment rate' 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.
                    ``(B) Eligible individual.--The term `eligible 
                individual' means, for each year during the waiver 
                period--
                            ``(i) any individual who, for such year, 
                        the State would otherwise be required to 
                        provide medical assistance to pursuant to--
                                    ``(I) section 1902(a)(10)(A)(i);
                                    ``(II) paragraphs (1) or (4) of 
                                section 1902(e);
                                    ``(III) section 1925; or
                                    ``(IV) section 1931; and
                            ``(ii) 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
                            ``(iii) 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.
                    ``(C) Medical assistance.--The term `medical 
                assistance' means--
                            ``(i) health care coverage (as determined 
                        by the State); and
                            ``(ii) rehabilitation and other services to 
                        help eligible individuals attain or retain 
                        capability for independence or self-care, such 
                        as home and community-based services.
                    ``(D) State medicaid program.--The term `State 
                Medicaid program' 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.''.

SEC. 1102. PHASED-IN ELIMINATION OF ALLOWABLE PROVIDER TAXES UNDER 
              MEDICAID.

    (a) In General.--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:
            ``(ii) 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--
                    ``(I) for portions of fiscal years beginning on or 
                after January 1, 2008, and before October 1, 2011, `5.5 
                percent' shall be substituted for `6 percent' each 
                place it appears;
                    ``(II) for fiscal years 2012 and 2013, the 
                percentage specified under such paragraph shall apply;
                    ``(III) for fiscal years 2014 through 2022, the 
                percentage determined under clause (iii) for the fiscal 
                year shall be substituted for `6 percent' each place it 
                appears; and
                    ``(IV) for fiscal year 2023 and each fiscal year 
                thereafter, `0 percent' shall be substituted for `6 
                percent' each place it appears.
            ``(iii) 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.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on October 1, 2013.

                           TITLE II--MEDICARE

  Subtitle A--Medicare Total Health Program; Medicare Fee-for-Service 
                        Program Reforms; Reports

SEC. 2000. SHORT TITLE; PURPOSE.

    (a) Short Title.--This subtitle may be cited as the ``Medicare 
Total Health Act of 2013''.
    (b) Purpose.--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.

                 PART I--MEDICARE TOTAL HEALTH PROGRAM

SEC. 2001. ESTABLISHMENT OF MEDICARE TOTAL HEALTH PROGRAM.

    (a) Sunset of Medicare Advantage Plans.--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 ``Subject to'' and inserting 
``For plan years beginning prior to January 1, 2017, and subject to''.
    (b) Establishment.--Part C of title XVIII of the Social Security 
Act (42 U.S.C. 1395w-21 et seq.) is amended--
            (1) in the part heading, by striking ``medicare+choice 
        program'' and inserting ``medicare advantage program; medicare 
        total health program'';
            (2) by inserting before section 1851 the following:

             ``Subpart 1--Medicare Advantage Program''; and

            (3) by adding at the end the following new subpart:

               ``Subpart 2--Medicare Total Health Program

               ``eligibility, enrollment, and information

    ``Sec. 1860C-1.  (a) Eligibility.--
            ``(1) In general.--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--
                    ``(A) 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
                    ``(B) through enrollment in a Total Health plan 
                under this subpart.
            ``(2) Coverage first effective january 1, 2017.--Coverage 
        under the Medicare Total Health program shall first be 
        effective on January 1, 2017.
            ``(3) Total health eligible individual.--For purposes of 
        this subpart, the term `Total Health eligible individual' means 
        an individual who is entitled to benefits under part A and 
        enrolled under part B who resides in a Total Health region.
            ``(4) Types of total health plans that may be available.--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.
    ``(b) Enrollment Process for Total Health Plans.--
            ``(1) Establishment of process.--
                    ``(A) In general.--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).
                    ``(B) Requirements.--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).
            ``(2) Initial enrollment period.--
                    ``(A) Program initiation.--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.
                    ``(B) Continuing periods.--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).
            ``(3) Annual, coordinated election period.--
                    ``(A) In general.--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.
                    ``(B) Annual, coordinated election period.--For 
                purposes of this section, the term `annual, coordinated 
                election period' 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.
            ``(4) Special enrollment periods.--The Secretary shall 
        establish special enrollment periods that are similar to the 
        special enrollment periods established under section 
        1851(e)(4).
            ``(5) Special rule.--
                    ``(A) In general.--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).
                    ``(B) Selection of plan by the secretary.--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.
                    ``(C) Individuals who are not total health eligible 
                individuals.--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.
    ``(c) Providing Information to Beneficiaries.--
            ``(1) In general.--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).
            ``(2) Activities.--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.

                      ``total health plan benefits

    ``Sec. 1860C-2.  (a) Requirements.--
            ``(1) Qualified total health benefits.--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)).
            ``(2) Definition of qualified total health benefits 
        package.--For purposes of this subpart, the term `qualified 
        Total Health benefits package' means either of the following:
                    ``(A) Standard health benefits coverage with access 
                to negotiated prices.--Standard health benefits 
                coverage (as defined in subsection (b)) and access to 
                negotiated prices under subsection (d).
                    ``(B) Alternative total health benefits coverage 
                with at least actuarially equivalent benefits and 
                access to negotiated prices.--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).
            ``(3) Permitting supplemental health benefits coverage.--
                    ``(A) In general.--Subject to subparagraph (B), a 
                qualified Total Health benefits package may include 
                supplemental health benefits coverage consisting of 
                either or both of the following:
                            ``(i) Certain reductions in cost-sharing.--
                                    ``(I) In general.--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.
                                    ``(II) Construction.--Nothing in 
                                this clause shall be construed as 
                                affecting the application of subsection 
                                (c)(3).
                            ``(ii) Additional benefits.--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.
                    ``(B) Requirement for at least one basic benefits 
                plan.--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.
            ``(4) Basic total health benefits package.--For purposes of 
        this subpart, the term `basic Total Health benefits package' 
        means either of the following:
                    ``(A) Coverage that meets the requirements of 
                paragraph (2)(A).
                    ``(B) Coverage that meets the requirements of 
                paragraph (2)(B) but does not have any supplemental 
                health benefits coverage described in paragraph (3)(A).
            ``(5) Application of secondary payer provisions.--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.
            ``(6) Construction.--Nothing in this subsection shall be 
        construed as changing the computation of incurred costs under 
        subsection (b)(3).
    ``(b) Standard Health Benefits Coverage.--For purposes of this 
subpart, the term `standard health benefits coverage' 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:
            ``(1) Deductible.--The coverage has an annual deductible 
        that is equal to the amount of the unified deductible for the 
        year under section 1899C.
            ``(2) 20 percent coinsurance.--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--
                    ``(A) equal to 20 percent; or
                    ``(B) actuarially equivalent (using processes and 
                methods established by the Secretary) to an average 
                expected payment of 20 percent of such costs.
            ``(3) Protection against high out-of-pocket expenditures.--
                    ``(A) In general.--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--
                            ``(i) 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
                            ``(ii) the second threshold annual out-of-
                        pocket limit specified in subparagraph (B)(ii) 
                        for that year, without coinsurance.
                    ``(B) Annual out-of-pocket limits specified.--For 
                purposes of this subpart:
                            ``(i) First threshold annual out-of-pocket 
                        limit specified.--The `first threshold annual 
                        out-of-pocket limit' specified in this clause 
                        is equal to the first threshold annual out-of-
                        pocket limit for the year specified in section 
                        1899B(b)(1).
                            ``(ii) Second threshold annual out-of-
                        pocket limit specified.--The `second threshold 
                        annual out-of-pocket limit' specified in this 
                        clause is equal to the second threshold annual 
                        out-of-pocket limit for the year specified in 
                        section 1899B(b)(2).
                    ``(C) Application.--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.
    ``(c) Alternative Total Health Benefits Coverage Requirements.--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:
            ``(1) Assuring at least actuarially equivalent coverage.--
                    ``(A) Assuring equivalent value of total 
                coverage.--The actuarial value of the total coverage is 
                at least equal to the actuarial value of standard 
                health benefits coverage.
                    ``(B) Assuring equivalent unsubsidized value of 
                coverage.--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.
                    ``(C) Assuring standard payment for costs below 
                first threshold annual out-of-pocket limit.--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--
                            ``(i) the amount by which the costs 
                        incurred exceed the deductible described in 
                        subsection (b)(1) for the year; and
                            ``(ii) 100 percent minus the coinsurance 
                        percentage specified in subsection (b)(2).
            ``(2) Approval of benefit package.--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.
            ``(3) Maximum required deductible.--The deductible under 
        the coverage shall not exceed the deductible amount specified 
        under subsection (b)(1) for the year.
            ``(4) Same protection against high out-of-pocket 
        expenditures.--The coverage provides the coverage required 
        under subsection (b)(3).
    ``(d) Access to Negotiated Prices.--
            ``(1) Access.--
                    ``(A) In general.--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.
                    ``(B) Negotiated prices.--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.
            ``(2) Audits.--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.
            ``(3) Application of general exclusion provisions.--
                    ``(A) In general.--A Total Health plan may exclude 
                from a qualified Total Health benefits package any 
                health care item or service--
                            ``(i) for which payment would not be made 
                        if section 1862(a) applied to this subpart; or
                            ``(ii) which is not prescribed in 
                        accordance with the Total Health plan or this 
                        subpart.
                    ``(B) Reconsideration and appeal.--Any exclusion 
                under subparagraph (A) is a determination subject to 
                reconsideration and appeal under this subpart.
    ``(e) Satisfaction of Requirements.--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).

     ``access to a choice of qualified total health benefits plans

    ``Sec. 1860C-3.  (a) Assuring Access to a Choice of Plans.--
            ``(1) Choice of at least two plans in each area.--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.
            ``(2) Requirement for different plan sponsors.--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.
    ``(b) Flexibility in Risk Assumed.--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.

       ``beneficiary protections for total health plan enrollees

    ``Sec. 1860C-4.  (a) Dissemination of Information.--
            ``(1) General information.--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.
            ``(2) Disclosure upon request of general coverage, 
        utilization, and grievance information.--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.
            ``(3) Provision of specific information.--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.
            ``(4) Claims information.--
                    ``(A) In general.--A Total Health sponsor offering 
                a Total Health plan must furnish to each enrollee in a 
                form easily understandable to such enrollees--
                            ``(i) an explanation of benefits (in 
                        accordance with section 1806(a) or in a 
                        comparable manner); and
                            ``(ii) when Total Health benefits are 
                        provided under this subpart, a notice of the 
                        benefits in relation to--
                                    ``(I) the deductible described in 
                                paragraph (1) of section 1860C-2(b) for 
                                the current year; and
                                    ``(II) the annual out-of-pocket 
                                limits under paragraph (3) of such 
                                section for the current year.
                    ``(B) Timing of notices.--Notices under 
                subparagraph (A)(ii) need not be provided more often 
                than as specified by the Secretary.
    ``(b) Access to Health Care Providers.--
            ``(1) Assuring provider access.--
                    ``(A) Discounts allowed for network providers.--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.
                    ``(B) Convenient access for network providers.--
                            ``(i) In general.--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).
                            ``(ii) Adequate emergency access.--Such 
                        rules shall include adequate emergency access 
                        for enrollees.
                    ``(C) Level playing field.--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.
            ``(2) Use of standardized technology.--
                    ``(A) In general.--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.
                    ``(B) Standards.--
                            ``(i) In general.--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.
                            ``(ii) Consultation.--In developing the 
                        standards under clause (i), the Secretary shall 
                        consult with standard setting organizations 
                        determined appropriate by the Secretary.
                            ``(iii) Implementation.--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.
    ``(c) Cost and Utilization Management; Quality Assurance; Wellness 
Program.--
            ``(1) In general.--The Total Health sponsor shall have in 
        place, directly or through appropriate arrangements, the 
        following:
                    ``(A) A cost-effective health benefits management 
                program, including incentives to reduce costs when 
                medically appropriate.
                    ``(B) Quality assurance measures and systems to 
                reduce errors and improve the use of health benefits.
                    ``(C) A wellness program described in paragraph 
                (2).
                    ``(D) A program to control fraud, abuse, and waste.
        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.
            ``(2) Wellness program.--
                    ``(A) Description.--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.
                    ``(B) Elements.--Such program may include elements 
                that promote--
                            ``(i) 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;
                            ``(ii) increased enrollee adherence with 
                        recommended regimens through compliance 
                        programs and other appropriate means; and
                            ``(iii) detection of adverse events and 
                        patterns of overuse and underuse of health care 
                        items and services.
                    ``(C) Assessment.--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.
                    ``(D) Wellness program enrollment.--The Total 
                Health sponsor shall have in place a process to--
                            ``(i) subject to clause (ii), automatically 
                        enroll plan enrollees in the wellness program 
                        required under this subsection; and
                            ``(ii) permit plan enrolles to opt-out of 
                        enrollment in the wellness program.
                    ``(E) Development of program in cooperation with 
                physicians.--Such program shall be developed in 
                cooperation with physicians.
                    ``(F) Coordination with care management plans.--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 `Total Health eligible individual' for 
                `part D eligible individual') with any care management 
                plan established with respect to such beneficiary under 
                a chronic care improvement program under section 1807.
                    ``(G) Considerations in provider fees.--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.
    ``(d) Consumer Satisfaction Surveys.--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.
    ``(e) Grievance Mechanism.--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).
    ``(f) Coverage Determinations and Reconsiderations.--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.
    ``(g) Appeals.--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.
    ``(h) Privacy, Confidentiality, and Accuracy of Enrollee Records.--
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.
    ``(i) Treatment of Accreditation.--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.
    ``(j) Requirements With Respect to Sales and Marketing 
Activities.--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):
            ``(1) The prohibition under section 1851(h)(4)(C) on 
        conducting activities described in section 1851(j)(1).
            ``(2) 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.
            ``(3) The inclusion of the plan type in the plan name under 
        section 1851(h)(6).
            ``(4) 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).

 ``total health regions; submission of bids; total health plan approval

    ``Sec. 1860C-5.  (a) Establishment of Total Health Regions; Service 
Areas.--
            ``(1) Coverage of entire total health region.--
                    ``(A) In general.--The service area for a Total 
                Health plan shall consist of an entire Total Health 
                region established under paragraph (2).
                    ``(B) No use of segments of service areas.--In no 
                case may a Total Health plan serve only segments of the 
                service area.
            ``(2) Establishment of total health regions.--
                    ``(A) In general.--The Secretary shall establish, 
                and may revise, Total Health regions in accordance with 
                the requirements of this paragraph.
                    ``(B) Regions to be larger than a single county.--
                Total Health regions shall include more than one 
                county.
                    ``(C) Regions within msas.--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.
                    ``(D) Regions outside msas.--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.
                    ``(E) Authority for territories.--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.
            ``(3) National plan.--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).
    ``(b) Submission of Bids, Premiums, and Related Information.--
            ``(1) In general.--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.
            ``(2) Information described.--The information described in 
        this paragraph is information on the following:
                    ``(A) Benefits package provided.--The qualified 
                Total Health benefits package provided under the plan, 
                including the deductible and other cost-sharing.
                    ``(B) Actuarial value.--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).
                    ``(C) Bid.--Information on the bid, including an 
                actuarial certification of--
                            ``(i) the basis for the actuarial value 
                        described in subparagraph (B) assumed in such 
                        bid;
                            ``(ii) 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
                            ``(iii) administrative expenses assumed in 
                        the bid.
                    ``(D) Service area.--The service area for the plan 
                (as described in subsection (a)(1)).
                    ``(E) Level of risk assumed.--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.
                    ``(F) Additional information.--Such other 
                information as the Secretary may require to carry out 
                this subpart.
            ``(3) Paperwork reduction for offering of total health 
        plans nationally or in multi-region areas.--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.
    ``(c) Medicare Fee-for-Service Bid.--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)).
    ``(d) Actuarial Valuation.--
            ``(1) Processes.--For purposes of this subpart, the 
        Secretary shall establish processes and methods for determining 
        the actuarial valuation of a Total Health benefits package, 
        including--
                    ``(A) 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;
                    ``(B) actuarial valuations relating to the 
                qualified Total Health benefits package under section 
                1860C-2(a)(1);
                    ``(C) the use of generally accepted actuarial 
                principles and methodologies; and
                    ``(D) applying the same methodology for 
                determinations of actuarial valuations under 
                subparagraphs (A) and (B).
            ``(2) Accounting for utilization.--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.
            ``(3) Responsibilities.--
                    ``(A) Plan responsibilities.--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.
                    ``(B) Use of outside actuaries.--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.
    ``(e) Review of Information and Negotiation.--
            ``(1) Review of information.--The Secretary shall review 
        the information submitted under subsection (b) for the purpose 
        of conducting negotiations under paragraph (2).
            ``(2) Negotiation regarding terms and conditions.--Subject 
        to subsection (i), in exercising the authority under paragraph 
        (1), the Secretary--
                    ``(A) has the authority to negotiate the terms and 
                conditions of the proposed bid submitted and other 
                terms and conditions of a proposed plan; and
                    ``(B) 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.
            ``(3) Rejection of bids.--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).
    ``(f) Approval of Proposed Plans.--
            ``(1) In general.--After review and negotiation under 
        subsection (e), the Secretary shall approve or disapprove the 
        Total Health plan.
            ``(2) Requirements for approval.--The Secretary may approve 
        a Total Health plan only if the Secretary determines the 
        following requirements are met:
                    ``(A) Compliance with requirements.--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.
                    ``(B) Actuarial determinations.--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).
                    ``(C) Application of fehbp standard.--
                            ``(i) In general.--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.
                            ``(ii) Supplemental coverage.--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.
                    ``(D) Plan design.--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.
    ``(g) Application of Limited Risk Plans.--
            ``(1) Conditions for approval of limited risk plans.--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.
            ``(2) Rules.--The following rules shall apply with respect 
        to the approval of a limited risk plan in a Total Health 
        region:
                    ``(A) Limited exercise of authority.--Only the 
                minimum number of such plans may be approved in order 
                to meet the access requirements under section 1860C-
                3(a).
                    ``(B) Maximizing assumption of risk.--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.
                    ``(C) No full underwriting for limited risk 
                plans.--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.
            ``(3) Acceptance of all full risk contracts.--There shall 
        be no limit on the number of full risk plans that are approved 
        under subsection (e).
            ``(4) Risk-plans defined.--For purposes of this subsection:
                    ``(A) Limited risk plan.--The term `limited risk 
                plan' 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.
                    ``(B) Full risk plan.--The term `full risk plan' 
                means a Total Health plan that is not a limited risk 
                plan.
    ``(h) Annual Report on Use of Limited Risk Plans.--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.
    ``(i) Noninterference.--In order to promote competition under this 
part and in carrying out this part, the Secretary--
            ``(1) may not interfere with the negotiations between 
        physicians or other health professionals, providers, suppliers, 
        drug manufacturers, pharmacies, and Total Health sponsors; and
            ``(2) may not require a particular benefit design or 
        formulary, or institute a price structure for the reimbursement 
        of covered items and services.

      ``requirements for and contracts with total health sponsors

    ``Sec. 1860C-6.  (a) General Requirements.--Each sponsor of a Total 
Health plan shall meet the following requirements:
            ``(1) Licensure.--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.
            ``(2) Assumption of financial risk for unsubsidized 
        coverage.--
                    ``(A) In general.--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.
                    ``(B) Reinsurance permitted.--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.
            ``(3) Solvency for unlicensed sponsors.--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).
    ``(b) Contract Requirements.--
            ``(1) In general.--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.
            ``(2) Incorporation of certain medicare advantage contract 
        requirements.--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):
                    ``(A) Minimum enrollment.--Paragraphs (1) and (3) 
                of section 1857(b), except that--
                            ``(i) the Secretary may increase the 
                        minimum number of enrollees required under such 
                        paragraph (1) as the Secretary determines 
                        appropriate; and
                            ``(ii) the requirement of such paragraph 
                        (1) shall be waived during the first contract 
                        year with respect to an organization in a 
                        region.
                    ``(B) Contract period and effectiveness.--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.
                    ``(C) Protections against fraud and beneficiary 
                protections.--Section 1857(d).
                    ``(D) Additional contract terms.--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--
                            ``(i) 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
                            ``(ii) 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.
                    ``(E) Intermediate sanctions.--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.
                    ``(F) Procedures for termination.--Section 1857(h).
    ``(c) Waiver of Certain Requirements To Expand Choice.--
            ``(1) Authorizing waiver.--
                    ``(A) In general.--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.
                    ``(B) Application of regional plan waiver rule.--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.
            ``(2) Grounds for approval.--
                    ``(A) In general.--The grounds for approval under 
                this paragraph are--
                            ``(i) subject to subparagraph (B), the 
                        grounds for approval described in subparagraphs 
                        (B), (C), and (D) of section 1855(a)(2); and
                            ``(ii) the application by a State of any 
                        grounds other than those required under Federal 
                        law.
                    ``(B) Special rules.--In applying subparagraph 
                (A)(i)--
                            ``(i) 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
                            ``(ii) 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.
            ``(3) Application of waiver procedures.--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.
            ``(4) References to certain provisions.--In applying 
        provisions of section 1855(a)(2) under paragraphs (2) and (3) 
        of this subsection to Total Health plans and Total Health 
        sponsors--
                    ``(A) 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
                    ``(B) any reference to solvency standards shall be 
                treated as a reference to solvency standards 
                established under subsection (d) of this section.
    ``(d) Solvency Standards for Non-Licensed Entities.--
            ``(1) Establishment and publication.--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).
            ``(2) Compliance with standards.--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).
    ``(e) Licensure Does Not Substitute for or Constitute 
Certification.--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.
    ``(f) Periodic Review and Revision of Standards.--
            ``(1) In general.--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.
            ``(2) Prohibition of midyear implementation of significant 
        new regulatory requirements.--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.
    ``(g) Prohibition of State Imposition of Premium Taxes; Relation to 
State Laws.--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.

                        ``total health premiums

    ``Sec. 1860C-7.  (a) Monthly Beneficiary Premium.--
            ``(1) Base beneficiary premium.--The base beneficiary 
        premium under this paragraph for a Total Health plan for a 
        month is equal to the product of--
                    ``(A) 15 percent; and
                    ``(B) 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.
            ``(2) Computation of monthly beneficiary premium.--
                    ``(A) In general.--The monthly beneficiary premium 
                for a Total Health plan is the base beneficiary premium 
                computed under paragraph (1) as adjusted under this 
                paragraph.
                    ``(B) Adjustment to reflect difference between bid 
                and 40th percentile of the monthly standardized bid 
                amount.--
                            ``(i) Above 40th percentile.--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.
                            ``(ii) Below 40th percentile.--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.
                    ``(C) Increase for supplemental benefits.--The base 
                beneficiary premium shall be increased by the portion 
                of the Total Health approved bid that is attributable 
                to supplemental benefits.
                    ``(D) Increase for late enrollment penalty.--The 
                base beneficiary premium shall be increased by the 
                amount of any late enrollment penalty under subsection 
                (e).
                    ``(E) Increase based on income.--The monthly 
                beneficiary premium shall be increased pursuant to 
                subsection (f).
                    ``(F) Uniform premium.--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.
    ``(b) Weighting of Bid Amounts Based on Enrollment.--
            ``(1) In general.--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)).
            ``(2) Special rule for 2017.--For purposes of applying this 
        paragraph for 2017, the Secretary shall establish procedures 
        for determining the weighted average under paragraph (1) for 
        2016.
    ``(c) Standardized Bid Amount Defined.--For purposes of this 
subsection, the term `standardized bid amount' means the following:
            ``(1) Basic coverage only.--In the case of a Total Health 
        plan that provides basic health benefits coverage, the Total 
        Health approved bid (as defined in subsection (d)).
            ``(2) Plans offering supplemental coverage.--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.
    ``(d) Total Health Approved Bid Defined.--For purposes of this 
subpart, the term `Total Health approved bid' means--
            ``(1) with respect to a Total Health plan, the bid amount 
        approved for the plan under section 1860C-5;
            ``(2) with respect to the original medicare fee-for-service 
        program option, the bid described in section 1860C-5(c).
    ``(e) Late Enrollment Penalty.--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).
    ``(f) Increase in Base Beneficiary Premium Based on Income.--
            ``(1) In general.--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).
            ``(2) Modified adjusted gross income.--For purposes of this 
        subsection, the term `modified adjusted gross income' 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.
            ``(3) Determination by commissioner of social security.--
        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.
            ``(4) Procedures to assure correct income-related increase 
        in base beneficiary premium.--
                    ``(A) Disclosure of base beneficiary premium.--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.
                    ``(B) Additional disclosure.--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:
                            ``(i) The modified adjusted gross income 
                        threshold applicable under paragraph (2) of 
                        section 1839(i) (including application of 
                        paragraph (5) of such section).
                            ``(ii) The applicable percentage determined 
                        under paragraph (3)(C) of section 1839(i) 
                        (including application of paragraph (5) of such 
                        section).
                            ``(iii) 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.

     ``premium and cost-sharing support for total health eligible 
                              individuals

    ``Sec. 1860C-8.  (a) Direct Subsidy Payment.--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--
            ``(1) the amount of the plan's standardized bid amount (as 
        defined in section 1860C-7(c)), adjusted under subsection 
        (b)(1), reduced by
            ``(2) the base beneficiary premium (as computed under 
        paragraph (1) of section 1860C-7(a) and as adjusted under 
        paragraph (2)(B) of such section).
    ``(b) Adjustments Relating to Bids.--
            ``(1) Health status risk adjustment.--
                    ``(A) Establishment of risk adjustors.--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).
                    ``(B) Considerations.--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.
                    ``(C) Data collection.--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.
                    ``(D) Publication.--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.
            ``(2) Geographic adjustment.--
                    ``(A) In general.--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.
                    ``(B) De minimis rule.--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.
                    ``(C) Budget neutral adjustment.--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.
    ``(c) Payment Methods.--
            ``(1) In general.--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.
            ``(2) Requirement for provision of information.--
                    ``(A) Requirement.--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.
                    ``(B) Restriction on use of information.--
                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.
            ``(3) Source of payments.--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.
            ``(4) Application of enrollee adjustment.--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).
    ``(d) Plans at Risk for Entire Amount of Benefits.--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.
    ``(e) Disclosure of Information.--
            ``(1) In general.--Each contract under this subpart shall 
        provide that--
                    ``(A) 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
                    ``(B) 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).
            ``(2) Restriction on use of information.--Information 
        disclosed or obtained pursuant to the provisions of this 
        section may be used--
                    ``(A) by officers, employees, and contractors of 
                the Department of Health and Human Services for the 
                purposes of, and to the extent necessary in--
                            ``(i) carrying out this section; and
                            ``(ii) conducting oversight, evaluation, 
                        and enforcement under this title; and
                    ``(B) 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.

                       ``exemption for msa plans

    ``Sec. 1860C-9.  (a) In General.--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.
    ``(b) Continuing Availability.--Notwithstanding any other provision 
of law, the Secretary shall establish procedures under which--
            ``(1) MSA plans may continue to operate on and after 
        January 1, 2017; and
            ``(2) 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.

            ``special rules for employer-sponsored programs

    ``Sec. 1860C-10.  (a) Subsidy Payment.--
            ``(1) In general.--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.
            ``(2) Qualified retiree health benefits plan defined.--For 
        purposes of this subsection, the term `qualified retiree health 
        benefits plan' 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:
                    ``(A) Attestation of actuarial equivalence to 
                standard coverage.--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.
                    ``(B) Audits.--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.
                    ``(C) Provision of disclosure regarding health 
                benefits coverage.--
                            ``(i) In general.--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.
                            ``(ii) Disclosure of non-qualified 
                        coverage.--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.
                            ``(iii) Waiver of requirement.--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.
            ``(3) Employer and union special subsidy amounts.--
                    ``(A) In general.--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.
                    ``(B) Cost threshold and cost limit applicable.--
                            ``(i) In general.--Subject to clause (ii)--
                                    ``(I) the cost threshold under this 
                                subparagraph is equal to $250 for plan 
                                years that end in 2017; and
                                    ``(II) the cost limit under this 
                                subparagraph is equal to $5,000 for 
                                plan years that end in 2017.
                            ``(ii) Indexing.--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.
                    ``(C) Definitions.--For purposes of this paragraph:
                            ``(i) Allowable retiree costs.--The term 
                        `allowable retiree costs' 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.
                            ``(ii) Gross covered retiree plan-related 
                        health benefits costs.--The term `gross covered 
                        retiree plan-related health benefits costs' 
                        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.
                            ``(iii) Coverage year.--The term `coverage 
                        year' has the meaning given such term in 
                        section 1860D-15(b)(4) (as applied by 
                        substituting `covered health benefits' for 
                        `covered part D drugs').
            ``(4) Qualifying covered retiree defined.--For purposes of 
        this subsection, the term `qualifying covered retiree' 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.
            ``(5) Payment methods, including provision of necessary 
        information.--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.
            ``(6) Construction.--Nothing in this subsection shall be 
        construed as--
                    ``(A) precluding a Total Health eligible individual 
                who is covered under employment-based retiree health 
                coverage from enrolling in a Total Health plan;
                    ``(B) 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;
                    ``(C) preventing such employment-based retiree 
                health coverage from providing coverage--
                            ``(i) that is better than standard health 
                        benefits coverage to retirees who are covered 
                        under a qualified retiree health benefits plan; 
                        or
                            ``(ii) 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
                    ``(D) 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.
    ``(b) Application of Medicare Advantage Waiver Authority.--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.
    ``(c) Definitions.--For purposes of this section:
            ``(1) Employment-based retiree health coverage.--The term 
        `employment-based retiree health coverage' 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.
            ``(2) Sponsor.--The term `sponsor' 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.
            ``(3) Group health plan.--The term `group health plan' 
        includes such a plan as defined in section 607(1) of the 
        Employee Retirement Income Security Act of 1974 and also 
        includes the following:
                    ``(A) Federal and state governmental plans.--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.
                    ``(B) Collectively bargained plans.--Such a plan 
                established or maintained under or pursuant to one or 
                more collective bargaining agreements.
                    ``(C) Church plans.--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.

              ``coordination with state medicaid programs

    ``Sec. 1860C-11.  (a) Application.--
            ``(1) In general.--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--
                    ``(A) dually eligible individuals have full access 
                to the services to which they are entitled;
                    ``(B) the development of innovative care 
                coordination and integration models; and
                    ``(C) the elimination of financial misalignments 
                that lead to poor quality and cost-shifting.
            ``(2) Requirements.--Such application shall--
                    ``(A) be filed at such time and in such manner as 
                the Secretary may require;
                    ``(B) contain such information as the Secretary may 
                require, including--
                            ``(i) a comprehensive description of the 
                        proposal and program to implement a plan 
                        meeting the requirements for a waiver under 
                        this section; and
                            ``(ii) an analysis of the proposal 
                        demonstrating that the plan will not increase 
                        Federal Government expenditures; and
                    ``(C) provide an assurance that, if approved, the 
                Total Health sponsor will offer the plan that is the 
                subject of the proposal.
            ``(3) Waiver consideration and transparency.--
                    ``(A) In general.--An application for a waiver 
                under this section shall be considered by the Secretary 
                in accordance with the regulations described in 
                subparagraph (B).
                    ``(B) Regulations.--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--
                            ``(i) a process for public notice and 
                        comment sufficient to ensure a meaningful level 
                        of public input;
                            ``(ii) a process for the submission of an 
                        application for the waiver;
                            ``(iii) a process for the submission to the 
                        Secretary of periodic reports by the State 
                        concerning the implementation of the program 
                        under the waiver; and
                            ``(iv) a process for the periodic 
                        evaluation by the Secretary of the program 
                        under the waiver.
                    ``(C) Report.--The Secretary shall annually report 
                to Congress concerning actions taken by the Secretary 
                with respect to applications for waivers under this 
                section.
            ``(4) State option to be a total health sponsor.--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.
            ``(5) Coordinated waiver process.--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.
    ``(b) Granting of Waivers.--
            ``(1) In general.--The Secretary may grant a request for a 
        waiver under subsection (a)(1) only if the Secretary determines 
        that the proposed Total Health plan--
                    ``(A) 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;
                    ``(B) 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
                    ``(C) will not increase the Federal deficit.
    ``(c) Scope of Waiver.--
            ``(1) In general.--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).
            ``(2) Limitation.--The Secretary may only waive provisions 
        under this title and titles II, XI, XIX, and XXI under a waiver 
        under this section.
    ``(d) Determinations by the Secretary.--
            ``(1) Time for determination.--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.
            ``(2) Effect of determination.--
                    ``(A) Granting of waivers.--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.
                    ``(B) Denial of waiver.--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.
    ``(e) Term of Waiver.--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.

               ``definitions and miscellaneous provisions

    ``Sec. 1860C-12.  (a) Definitions.--For purposes of this subpart:
            ``(1) Basic health benefits coverage.--The term `basic 
        health benefits coverage' means coverage of the health care 
        items and services for which payment may be made under the 
        original medicare fee-for-service program option.
            ``(2) Insurance risk.--The term `insurance risk' 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.
            ``(3) MA plan; medicare advantage plan.--The terms `MA 
        plan' and `Medicare Advantage plan' have the meaning given such 
        terms in section 1859(b)(1).
            ``(4) Original medicare fee-for-service program option.--
        The term `original medicare fee-for-service program option' 
        means the original medicare fee-for-service program under parts 
        A and B, as modified by this subpart.
            ``(5) Standard health benefits coverage.--The term 
        `standard health benefits coverage' has the meaning given such 
        term in section 1860C-2(b).
            ``(6) Total health eligible individual.--The term `Total 
        Health eligible individual' has the meaning given such term in 
        section 1860C-1(a)(3).
            ``(7) Total health plan.--The term `Total Health plan' 
        means health benefits coverage that is offered--
                    ``(A) under a policy, contract, or plan that has 
                been approved under section 1860C-5(f); and
                    ``(B) by a Total Health sponsor pursuant to, and in 
                accordance with, a contract between the Secretary and 
                the sponsor under section 1860C-6(b).
            ``(8) Total health sponsor.--The term `Total Health 
        sponsor' means a nongovernmental entity that is certified under 
        this subpart as meeting the requirements and standards of this 
        subpart for such a sponsor.
    ``(b) Application of Subpart 1 Provisions and Regulations Under 
This Subpart.--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--
            ``(1) any reference to a Medicare Advantage plan or an MA 
        plan included a reference to a Total Health plan;
            ``(2) any reference to an MA organization or a provider-
        sponsored organization included a reference to a Total Health 
        sponsor;
            ``(3) any reference to a contract under section 1857 
        included a reference to a contract under section 1860C-6(b);
            ``(4) any reference to subpart 1 included a reference to 
        this subpart; and
            ``(5) any reference to an election period under section 
        1851 were a reference to an enrollment period under section 
        1860C-1.''.

SEC. 2002. REPLACEMENT OF PART B PREMIUM WITH MEDICARE TOTAL HEALTH 
              PROGRAM PLAN PREMIUM; OTHER TECHNICAL AND CONFORMING 
              AMENDMENTS.

    (a) Replacement of Part B Premium With Medicare Total Health 
Program Plan Premium.--Section 1839 of the Social Security Act (42 
U.S.C. 1395r) is amended--
            (1) in subsection (a)(2), by striking ``The monthly 
        premium'' and inserting ``Subject to subsection (j),''; and
            (2) by adding at the end the following new subsection:
    ``(j) Replacement of Part B Premium With Medicare Total Health 
Program Plan Premium.--
            ``(1) In general.--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.
            ``(2) Individuals enrolled for coverage under part b 
        only.--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.
            ``(3) Crediting of premiums.--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.''.
    (b) Other Technical and Conforming Amendments.--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.

               PART II--MEDICARE FEE-FOR-SERVICE REFORMS

SEC. 2011. MEDICARE PROTECTION AGAINST HIGH OUT-OF-POCKET EXPENDITURES 
              FOR FEE-FOR-SERVICE BENEFITS.

    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:

          ``protection against high out-of-pocket expenditures

    ``Sec. 1899B.  (a) In General.--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--
            ``(1) 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 `5 percent' 
        for `20 percent'; and
            ``(2) 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).
    ``(b) Amount of Annual Out-of-Pocket Limits.--
            ``(1) First threshold annual out-of-pocket limit.--The 
        amount of the first threshold annual out-of-pocket limit under 
        this subsection shall be--
                    ``(A) for 2015, $5,500; or
                    ``(B) 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).
            ``(2) Second threshold annual out-of-pocket limit.--The 
        amount of the second threshold annual out-of-pocket limit under 
        this subsection shall be--
                    ``(A) for 2015, $7,500; or
                    ``(B) 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).
            ``(3) Rounding.--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.
    ``(c) Out-of-Pocket Cost-Sharing Defined.--
            ``(1) In general.--Subject to paragraphs (2) and (3), in 
        this section, the term `out-of-pocket cost-sharing' means, with 
        respect to an individual, the amount of the expenses incurred 
        by the individual that are attributable to--
                    ``(A) deductibles, coinsurance and copayments 
                applicable under part A or B; or
                    ``(B) for items and services that would have 
                otherwise been covered under part A or B but for the 
                exhaustion of those benefits.
            ``(2) Certain costs not included.--
                    ``(A) Non-covered items and services.--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).
                    ``(B) Items and services not furnished on an 
                assignment-related basis.--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).
            ``(3) Source of payment.--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.
    ``(d) Announcement of Annual Out-of-Pocket Limit and Unified 
Deductible.--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.''.

SEC. 2012. UNIFIED MEDICARE DEDUCTIBLE.

    (a) In General.--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:

                   ``unified part a and b deductible

    ``Sec. 1899C.  (a) In General.--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--
            ``(1) 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
            ``(2) the individual shall be responsible for payment of 
        such amount.
    ``(b) Amount of Unified Deductible.--
            ``(1) In general.--The amount of the unified deductible 
        under this section shall be--
                    ``(A) for 2015, $550; or
                    ``(B) 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).
            ``(2) Rounding.--If any amount determined under paragraph 
        (1) is not a multiple of $5, such amount shall be rounded to 
        the nearest multiple of $5.
    ``(c) Application to All Items and Services.--The unified 
deductible under this section for a year shall be applied as follows:
            ``(1) 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.
            ``(2) 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.
            ``(3)(A) 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.
            ``(B) The deductible applicable to blood under sections 
        1813 and 1833 shall apply to blood instead of such unified 
        deductible.
    ``(d) Treatment of Individuals Not Enrolled in Both Parts A and 
B.--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.''.
    (b) Clarification Regarding Application Under Medicare Advantage.--
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: ``For plan years 2015 and 2016, the preceding sentence shall 
be applied to take into account the application of sections 1899B, 
1899C, and 1899D.''.

SEC. 2013. UNIFORM MEDICARE COINSURANCE RATE.

    (a) In General.--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:

                ``uniform part a and b coinsurance rate

    ``Sec. 1899D.  (a) In General.--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.
    ``(b) Application to All Items and Services.--The uniform 
coinsurance under this section for a year shall be applied as follows:
            ``(1) 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.
            ``(2) 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.
            ``(3)(A) 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.
            ``(B) 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.''.
    (b) Conforming Amendments.--
            (1) Section 1813 of the Social Security Act (42 U.S.C. 
        1395e) is amended--
                    (A) in subsection (a), by inserting ``Subject to 
                sections 1899B, 1899C, and 1899D:'' before paragraph 
                (1); and
                    (B) in subsection (b), by inserting ``Subject to 
                sections 1899B, 1899C, and 1899D:'' before paragraph 
                (1).
            (2) Section 1833 of the Social Security Act (42 U.S.C. 
        1395l) is amended--
                    (A) in subsection (a), in the matter preceding 
                paragraph (1), by inserting ``and sections 1899B, 
                1899C, and 1899D'' after ``succeeding provisions of 
                this section'';
                    (B) in subsection (b), in the first sentence, by 
                striking ``Before applying'' and inserting ``Subject to 
                sections 1899B, 1899C, and 1899D, before applying'';
                    (C) in subsection (c)(1), in the matter preceding 
                subparagraph (A), by inserting ``subject to sections 
                1899B, 1899C, and 1899D,'' after ``this part,'';
                    (D) in subsection (f), by striking ``In 
                establishing'' and inserting ``Subject to sections 
                1899B, 1899C, and 1899D, in establishing''; and
                    (E) in subsection (g)(1), by inserting ``and 
                sections 1899B, 1899C, and 1899D'' after ``paragraphs 
                (4) and (5)''.
            (3) Section 1905(p)(3) of the Social Security Act (42 
        U.S.C. 1396d(p)(3)) is amended--
                    (A) in subparagraph (B), by striking ``section 
                1813'' and inserting ``sections 1813 and 1899D''; and
                    (B) in subparagraph (C), by striking ``and section 
                1833(b)'' and inserting ``, 1833(b), and 1899C''.

SEC. 2014. PROHIBITION ON FIRST-DOLLAR COVERAGE UNDER MEDIGAP POLICIES 
              AND DEVELOPMENT OF NEW STANDARDS FOR MEDIGAP POLICIES.

    Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is 
amended by adding at the end the following new subsections:
    ``(z) Prohibition on First-Dollar Coverage and Development of New 
Standards for Medicare Supplemental Policies.--
            ``(1) Development.--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 Fiscal Sustainability Act of 2013 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 `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' deemed a 
        reference to the date of enactment of the Fiscal Sustainability 
        Act of 2013. To the extent practicable, such revision shall 
        provide for the implementation of revised standards for benefit 
        packages as of January 1, 2015.
            ``(2) Cost-sharing requirements.--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--
                    ``(A) any portion of the unified deductible under 
                section 1899C(b) for the year; and
                    ``(B) 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.
            ``(3) Renewability.--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.
    ``(aa) Limitation on Issuing New Medicare Supplemental Policies 
After 2016.--
            ``(1) In general.--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.
            ``(2) Renewals and new policies.--Nothing in this 
        subsection shall be construed as prohibiting--
                    ``(A) the renewal after December 31, 2016, of a 
                medicare supplemental policy that was issued on or 
                before such date; or
                    ``(B) 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.''.

                  PART III--ANNUAL REPORT TO CONGRESS

SEC. 2021. ANNUAL REPORT TO CONGRESS.

    (a) In General.--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.
    (b) Contents.--The report submitted under subsection (a) shall 
contain the following information:
            (1) An evaluation of the financial impact of such 
        provisions and amendments.
            (2) An evaluation of changes in access to physicians and 
        other health care providers as a result of such provisions and 
        amendments.
            (3) An evaluation of changes in beneficiary satisfaction 
        under the Medicare program as a result of such provisions and 
        amendments.
            (4) Such other information as the Secretary determines to 
        be appropriate.

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.

    (a) In General.--Section 7 of the Statutory Pay-As-You-Go Act of 
2010 (2 U.S.C. 936) is amended--
            (1) in subsection (a), by striking paragraph (1); and
            (2) by striking subsection (c).
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date of the enactment of this Act.

  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.

    (a) In General.--Section 1839(i) of the Social Security Act (42 
U.S.C. 1395r(i)) is amended--
            (1) in paragraph (2)(A), by inserting (or, in the case of 
        2013 or a subsequent year, $50,000) after ``$80,000''; and
            (2) in paragraph (3)--
                    (A) in subparagraph (A)(i)--
                            (i) by inserting ``applicable'' before 
                        ``table''; and
                            (ii) by inserting ``and year'' after 
                        ``individual''; and
                    (B) in subparagraph (C)(i)--
                            (i) by striking ``(i) In general.--'' and 
                        inserting ``(i)(I) For 2007 through 2012.--For 
                        each of 2007 through 2012:''; and
                            (ii) by adding at the end the following new 
                        subclause:
                            ``(II) For 2013 and subsequent years.--For 
                        2013 or a subsequent year:


------------------------------------------------------------------------
                                                          The applicable
       ``If the modified adjusted gross income is:        percentage is:
------------------------------------------------------------------------
More than $50,000 but not more than $85,000.............      35 percent
More than $85,000 but not more than $107,000............      40 percent
More than $107,000 but not more than $160,000...........      55 percent
More than $160,000 but not more than $214,000...........      70 percent
More than $214,000 but not more than $250,000...........      85 percent
More than $250,000......................................             100
                                                             percent.''.
------------------------------------------------------------------------

    (b) Extension of Temporary Adjustment to Income Thresholds.--
            (1) In general.--Section 1839(i)(6) of the Social Security 
        Act (42 U.S.C. 1395r(i)(6)) is amended--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``December 31, 2019'' and inserting ``December 
                31, 2021'';
                    (B) in subparagraph (A), by striking ``equal to 
                such amount for 2010; and'' and inserting the 
                following: ``equal to--
                            ``(i) in the case of each of 2011 and 2012, 
                        such amount for 2010; and
                            ``(ii) in the case of each of 2013 through 
                        2021, such amount for 2013; and''; and
                    (C) in subparagraph (B), by striking ``equal to 
                such dollar amounts for 2010.'' and inserting the 
                following: ``equal to--
                            ``(i) in the case of each of 2011 and 2012, 
                        such dollar amounts for 2010; and
                            ``(ii) in the case of each of 2013 through 
                        2021, such dollar amounts for 2013.''.
            (2) Conforming amendment.--Section 1839(i)(5)(A) of the 
        Social Security Act (42 U.S.C. 1395r(i)(5)(A)) is amended by 
        inserting ``for such year'' after ``paragraph (2) or (3)'';

          Subtitle D--Increase in the Medicare Eligibility Age

SEC. 2301. INCREASE IN THE MEDICARE ELIGIBILITY AGE.

    Section 226 of the Social Security Act (42 U.S.C. 426) is amended 
by adding at the end the following new subsection:
    ``(k) Increasing Medicare Qualifying Age.--
            ``(1) In general.--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 `age 65' shall be deemed a 
        reference to the Medicare qualifying age specified in paragraph 
        (2).
            ``(2) Medicare qualifying age specified.--The Medicare 
        qualifying age specified in this paragraph is determined as 
        follows:
                    ``(A) 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.
                    ``(B) 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.
                    ``(C) 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.''.

                      Subtitle E--Other Provisions

SEC. 2401. LIMITATION ON MEDICARE PAYMENTS FOR DIRECT GRADUATE MEDICAL 
              EDUCATION (DGME).

    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:
                            ``(v) Cap on approved fte resident 
                        amount.--
                                    ``(I) In general.--The approved FTE 
                                resident amount for a hospital for a 
                                cost reporting period beginning during 
                                fiscal year 2014 or a subsequent fiscal 
                                year shall not be more than the 
                                applicable amount for the year.
                                    ``(II) Applicable amount.--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.
                                    ``(III) Chained consumer price 
                                index.--In subclause (II), the term 
                                `Chained Consumer Price Index' means 
                                the initial Chained Consumer Price 
                                Index for all-urban consumers published 
                                by the Department of Labor.''.

SEC. 2402. REDUCTION IN MEDICARE INDIRECT GRADUATE MEDICAL EDUCATION 
              (IME) PAYMENTS.

    (a) In General.--Section 1886(d)(5)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended--
            (1) in subclause (XI), by striking ``and'' at the end;
            (2) in subclause (XII)--
                    (A) by inserting ``and before October 1, 2013,'' 
                after ``2007,''; and
                    (B) by striking the period at the end and inserting 
                ``; and''; and
            (3) by adding at the end the following new subclause:
                    ``(XIII) on or after October 1, 2013, `c' is equal 
                to 0.54.''.
    (b) Conforming Amendment Relating to Determination of Standardized 
Amount.--Section 1886(d)(2)(C)(i) of the Social Security Act (42 U.S.C. 
1395ww(d)(2)(C)(i)) is amended by inserting ``or of section 2402(a) of 
the Fiscal Sustainability Act of 2013'' after ``Act of 1997''.

SEC. 2403. ACCELERATION OF APPLICATION OF PRODUCTIVITY ADJUSTMENT TO 
              MEDICARE HOME HEALTH PROSPECTIVE PAYMENT AMOUNTS.

    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 ``2015'' and inserting 
``2014''.

SEC. 2404. ACCELERATION OF REBASING OF MEDICARE HOME HEALTH PROSPECTIVE 
              PAYMENT AMOUNTS.

    Section 1895(b)(3)(A)(iii)(II) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)(A)(iii)(II)) is amended--
            (1) in the first sentence--
                    (A) by striking ``4-year'' and inserting ``2-
                year''; and
                    (B) by striking ``2017'' and inserting ``2015''; 
                and
            (2) by striking the second sentence.

SEC. 2405. REDUCTION OF BAD DEBT TREATED AS AN ALLOWABLE COST.

    (a) Hospitals.--Section 1861(v)(1)(T) of the Social Security Act 
(42 U.S.C. 1395x(v)(1)(T)) is amended--
            (1) in clause (iv), by striking ``and'' at the end;
            (2) in clause (v)--
                    (A) by striking ``or a subsequent fiscal year''; 
                and
                    (B) by striking the period at the end and inserting 
                a comma; and
            (3) by adding at the end the following:
            ``(vi) for cost reporting periods beginning during fiscal 
        year 2014, by 48 percent of such amount otherwise allowable,
            ``(vii) for cost reporting periods beginning during fiscal 
        year 2015, by 61 percent of such amount otherwise allowable,
            ``(viii) for cost reporting periods beginning during fiscal 
        year 2016, by 74 percent of such amount otherwise allowable,
            ``(ix) for cost reporting periods beginning during fiscal 
        year 2017, by 87 percent of such amount otherwise allowable, 
        and
            ``(x) for cost reporting periods beginning during fiscal 
        year 2018 or a subsequent fiscal year, by 100 percent of such 
        amount otherwise allowable.''.
    (b) Skilled Nursing Facilities.--Section 1861(v)(1)(V) of the 
Social Security Act (42 U.S.C. 1395x(v)(1)(V)) is amended--
            (1) by moving subclauses (I) and (II) of clause (i) and 
        subclauses (I) through (IV) of clause (ii) two ems to the 
        right; and
            (2) in clause (i)--
                    (A) in subclause (I), by striking ``and'' at the 
                end;
                    (B) in subclause (II)--
                            (i) by striking ``or a subsequent fiscal 
                        year''; and
                            (ii) by striking the period at the end and 
                        inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(III) for cost reporting periods beginning during 
                fiscal year 2014, by 48 percent of such amount 
                otherwise allowable;
                    ``(IV) for cost reporting periods beginning during 
                fiscal year 2015, by 61 percent of such amount 
                otherwise allowable;
                    ``(V) for cost reporting periods beginning during 
                fiscal year 2016, by 74 percent of such amount 
                otherwise allowable;
                    ``(VI) for cost reporting periods beginning during 
                fiscal year 2017, by 87 percent of such amount 
                otherwise allowable; and
                    ``(VII) for cost reporting periods beginning during 
                fiscal year 2018 or a subsequent fiscal year, by 100 
                percent of such amount otherwise allowable.''.
    (c) Certain Other Providers.--Section 1861(v)(1)(W)(i) of the 
Social Security Act (42 U.S.C. 1395x(v)(1)(W)(i)) is amended--
            (1) in subclause (II), by striking ``and'' at the end;
            (2) in subclause (III)--
                    (A) by striking ``a subsequent fiscal year'' and 
                inserting ``fiscal year 2015''; and
                    (B) by striking the period at the end and inserting 
                a semicolon; and
            (3) by adding at the end the following:
            ``(IV) for cost reporting periods beginning during fiscal 
        year 2016, by 48 percent of such amount otherwise allowable;
            ``(V) for cost reporting periods beginning during fiscal 
        year 2017, by 61 percent of such amount otherwise allowable;
            ``(VI) for cost reporting periods beginning during fiscal 
        year 2018, by 74 percent of such amount otherwise allowable;
            ``(VII) for cost reporting periods beginning during fiscal 
        year 2019, by 87 percent of such amount otherwise allowable; 
        and
            ``(VIII) for cost reporting periods beginning during fiscal 
        year 2020 or a subsequent fiscal year, by 100 percent of such 
        amount otherwise allowable.''.

                       TITLE III--SOCIAL SECURITY

SEC. 3101. ADJUSTMENTS TO BEND POINTS IN DETERMINING PRIMARY INSURANCE 
              AMOUNT.

    Section 215(a)(1) of the Social Security Act (42 U.S.C. 415(a)(1)) 
is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by inserting ``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'' after ``individual'';
            (2) in subparagraph (B)(ii), in the matter preceding 
        subclause (I), by inserting ``and before 2017'' after ``after 
        1979'';
            (3) in subparagraph (C)(i), by inserting ``or (E)'' after 
        ``(A)''; and
            (4) by adding at the end the following:
    ``(E)(i) 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--
            ``(I) 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),
            ``(II) 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),
            ``(III) 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
            ``(IV) 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),
rounded, if not a multiple of $0.10, to the next lower multiple of 
$0.10, and thereafter increased as provided in subsection (i).
    ``(ii) 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.
    ``(iii)(I) 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--
            ``(aa) 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
            ``(bb) 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).
    ``(II) For purposes of--
            ``(aa) 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--
                    ``(AA) the numerator applicable for the preceding 
                year reduced by 1, divided by
                    ``(BB) 34; and
            ``(bb) 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--
                    ``(AA) the numerator applicable for the preceding 
                year increased by 1, divided by
                    ``(BB) 34.''.

SEC. 3102. ADJUSTMENT TO CALCULATION OF BENEFIT COMPUTATION YEARS.

    (a) In General.--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:
            ``(i) 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--
                    ``(I) before January 1, 2014, by 5 years;
                    ``(II) after December 31, 2013, and before January 
                1, 2015, by 4 years;
                    ``(III) after December 31, 2014, and before January 
                1, 2016, by 3 years; and
                    ``(IV) after December 31, 2015, and before January 
                1, 2017, by 2 years; and''.
    (b) Effective Date.--The amendments made by this section shall 
apply to benefits payable for months beginning after December 31, 2013.

SEC. 3103. MINIMUM SOCIAL SECURITY BENEFIT.

    (a) In General.--Section 215 of the Social Security Act (42 U.S.C. 
415) is amended by adding at the end the following:

                  ``Minimum Monthly Insurance Benefit

    ``(j)(1) Notwithstanding the preceding provisions of this section--
            ``(A) 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 `qualified 
        individual'), shall be equal to the greater of--
                    ``(i) the primary insurance amount determined under 
                this section (without regard to this subsection), or
                    ``(ii) the minimum monthly insurance benefit 
                determined under paragraph (2), and
            ``(B) 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.
    ``(2) For purposes of this subsection, the term `minimum monthly 
insurance benefit' means \1/12\ of the applicable percentage of the 
adjusted minimum benefit level (as defined in paragraph (5)).
    ``(3)(A) 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.
    ``(B)(i) 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).
    ``(ii) The number of percentage points under this clause shall be 
determined by--
            ``(I) dividing the number of the qualifying individual's 
        elapsed years (as defined in subsection (b)(2)(B)(iii)) by 40;
            ``(II) multiplying the result under subclause (I) by 20; 
        and
            ``(III) dividing 125 by the result under subclause (II) and 
        rounding to the nearest one hundredth of 1 percentage point.
    ``(iii) 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.
    ``(4) For purposes of this subsection, a year of coverage is a 
calendar year for which an individual is credited with 4 quarters of 
coverage.
    ``(5) For purposes of this subsection--
            ``(A) 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 
        `adjusted minimum benefit level' 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
            ``(B) 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 `adjusted minimum benefit level' means the amount 
        specified in subparagraph (A), multiplied by the quotient 
        described in subsection (b)(3)(A)(ii), except that the 
        reference to `the computation base year for which the 
        determination is made' in such subsection shall be deemed 
        instead to be a reference to `2009'.
    ``(6) 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).''.
    (b) Conforming Amendment.--Section 202(a) of such Act (42 U.S.C. 
402(a)) is amended in the last sentence by striking ``section 215(a)'' 
and inserting ``section 215''.

SEC. 3104. INCREASE IN BENEFITS STARTING 20 YEARS AFTER INITIAL 
              ELIGIBILITY.

    (a) In General.--Section 215 of the Social Security Act (42 U.S.C. 
415), as amended by this Act, is amended by adding at the end the 
following new subsection:

    ``Increased Monthly Insurance Benefit After 20 Years of Initial 
                              Eligibility

    ``(k)(1) 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.
    ``(2) For purposes of this subsection, the term `20-year 
beneficiary' means an individual who has been eligible for old-age 
insurance benefits or disability insurance benefits under this title 
for at least 240 months.
    ``(3) For purposes of paragraph (1), the term `applicable average 
primary insurance amount' 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.
    ``(4) For purposes of paragraph (1), the applicable percentage is--
            ``(A) for each month occurring during the first 12-month 
        period for which an individual is a 20-year beneficiary, 1 
        percent;
            ``(B) for each month occurring during the second 12-month 
        period for which an individual is such a beneficiary, 2 
        percent;
            ``(C) for each month occurring during the third 12-month 
        period for which an individual is such a beneficiary, 3 
        percent;
            ``(D) for each month occurring during the fourth 12-month 
        period for which an individual is such a beneficiary, 4 
        percent; and
            ``(E) for each month occurring thereafter, 5 percent.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to benefits payable for months beginning after December 31, 2013.

SEC. 3105. ADJUSTMENT TO NORMAL AND EARLY RETIREMENT AGES.

    Section 216(l) of the Social Security Act (42 U.S.C. 416(l)) is 
amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (D), by striking ``; and'' and 
                inserting a semicolon; and
                    (B) by striking subparagraph (E) and inserting the 
                following new subparagraphs:
                    ``(E) with respect to an individual who attains 
                early retirement age after December 31, 2021, and 
                before January 1, 2023, 67 years of age;
                    ``(F) with respect to an individual who, during the 
                period after December 31, 2022, and before January 1, 
                2070--
                            ``(i) for purposes of paragraph (2)(A)(ii), 
                        attains 62 years of age, such individual's 
                        early retirement age plus 60 months; or
                            ``(ii) 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
                    ``(G) with respect to an individual who--
                            ``(i) for purposes of paragraph 
                        (2)(A)(iii), attains 62 years of age after 
                        December 31, 2069, 69 years of age; or
                            ``(ii) attains early retirement age 
                        pursuant to paragraph (2)(B) after December 31, 
                        2069, 69 years of age.'';
            (2) by amending paragraph (2) to read as follows:
            ``(2) The term `early retirement age' means--
                    ``(A) in the case of an old-age, wife's, or 
                husband's insurance benefit--
                            ``(i) 62 years of age with respect to an 
                        individual who attains such age before January 
                        1, 2023;
                            ``(ii) 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
                            ``(iii) with respect to an individual who 
                        attains age 62 after December 31, 2069, 64 
                        years of age; or
                    ``(B) in the case of a widow's or widower's 
                insurance benefit, 60 years of age.''; and
            (3) by adding at the end the following new paragraph:
            ``(4) The age increase factor shall be equal to \1/24\ 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--
                    ``(A) for purposes of paragraph (1)(F)(ii), the 
                individual attains 60 years of age; or
                    ``(B) for purposes of paragraph (2)(A)(ii), the 
                individual attains 62 years of age.''.

SEC. 3106. APPLICATION OF ACTUARIAL REDUCTION FOR DISABLED 
              BENEFICIARIES WHO ATTAIN EARLY RETIREMENT AGE.

    (a) In General.--Section 202(k)(4) of the Social Security Act (42 
U.S.C. 402(k)(4)) is amended to read as follows:
    ``(4)(A) 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.
    ``(B) 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).
    ``(C) For purposes of subparagraph (B), the term `transitional 
retirement age' means--
            ``(i) with respect to an individual who attains 62 years of 
        age before January 1, 2014, 66 years of age;
            ``(ii) 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
            ``(iii) with respect to an individual who attains 62 years 
        of age after December 31, 2024, 64 years of age.
    ``(D) 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.''.
    (b) Conforming Amendments.--
            (1) Period of disability.--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 ``retirement age (as 
        defined in subsection (l))'' and inserting ``transitional 
        retirement age (as defined in section 216(k)(4))''.
            (2) Disability insurance benefit payments.--Section 
        223(a)(1) of the Social Security (42 U.S.C. 423(a)(1)) is 
        amended--
                    (A) in subparagraph (B), by striking ``retirement 
                age (as defined in section 216(l))'' and inserting 
                ``transitional retirement age (as defined in section 
                216(k)(4))''; and
                    (B) in the flush matter at the end, by striking 
                ``retirement age (as defined in section 216(l))'' and 
                inserting ``transitional retirement age (as defined in 
                section 216(k)(4))''.
    (c) Effective Date.--The amendments made by this section shall 
apply to benefits payable for months beginning after December 31, 2013.

SEC. 3107. OPTION TO COLLECT UP TO ONE-HALF OF OLD-AGE INSURANCE 
              BENEFIT AT AGE 62.

    (a) In General.--Section 202 of the Social Security Act (42 U.S.C. 
402) is amended by adding at the end the following:

    ``Option to Collect up to One-Half of Old-Age Insurance Benefit 
                          Beginning at Age 62

    ``(z)(1) 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:
            ``(A) 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.
            ``(B) For months beginning with the month in which the 
        individual attains early retirement age, a monthly benefit 
        equal to the sum of--
                    ``(i) the monthly benefit payable to the individual 
                under subparagraph (A); and
                    ``(ii) 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).
            ``(C) For purposes of subparagraph (B)(ii), the applicable 
        percentage shall be equal to the difference between--
                    ``(i) 100 percent; and
                    ``(ii) the percentage elected by the individual 
                under subparagraph (A).
    ``(2) An individual shall elect the option under this subsection in 
accordance with regulations prescribed by the Commissioner of Social 
Security.
    ``(3) The monthly benefit payable to an individual under paragraph 
(1)(A) shall be subject to reduction as provided in subsection (q).''.
    (b) Conforming Amendment.--Section 202(a) of the Social Security 
Act (42 U.S.C. 402(a)) is amended in the last sentence, by striking 
``subsection (q) and subsection (w)'' and inserting ``subsections (q), 
(w), and (z)''.

SEC. 3108. COVERAGE OF NEWLY HIRED STATE AND LOCAL EMPLOYEES.

    (a) Amendments to the Social Security Act.--
            (1) In general.--Paragraph (7) of section 210(a) of the 
        Social Security Act (42 U.S.C. 410(a)(7)) is amended to read as 
        follows:
            ``(7) Excluded State or local government employment (as 
        defined in subsection (s));''.
            (2) Excluded state or local government employment.--
                    (A) In general.--Section 210 of such Act (42 U.S.C. 
                410) is amended by adding at the end the following new 
                subsection:
    ``(s) Excluded State or Local Government Employment.--(1) In 
General.--The term `excluded State or local government employment' 
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--
            ``(A)(i) such service would be excluded from the term 
        `employment' 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
            ``(B) the requirements of paragraph (3) are met with 
        respect to such service.
    ``(2) Exception for Current Employment Which Continues.--
            ``(A) In general.--The requirements of this paragraph are 
        met with respect to service for any employer if--
                    ``(i) such service is performed by an individual--
                            ``(I) who was performing substantial and 
                        regular service for remuneration for that 
                        employer before January 1, 2021,
                            ``(II) who is a bona fide employee of that 
                        employer on December 31, 2020, and
                            ``(III) whose employment relationship with 
                        that employer was not entered into for purposes 
                        of meeting the requirements of this 
                        subparagraph, and
                    ``(ii) the employment relationship with that 
                employer has not been terminated after December 31, 
                2020.
            ``(B) Treatment of multiple agencies and 
        instrumentalities.--For purposes of subparagraph (A), under 
        regulations (consistent with regulations established under 
        section 3121(t)(2)(B) of the Internal Revenue Code of 1986)--
                    ``(i) 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
                    ``(ii) 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).
    ``(3) Exception for Certain Services.--
            ``(A) In general.--The requirements of this paragraph are 
        met with respect to service if such service is performed--
                    ``(i) by an individual who is employed by a State 
                or political subdivision thereof to relieve such 
                individual from unemployment,
                    ``(ii) 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,
                    ``(iii) 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,
                    ``(iv) 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,
                    ``(v) 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
                    ``(vi) 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.
            ``(B) Definitions.--As used in this paragraph, the terms 
        `State' and `political subdivision' have the meanings given 
        those terms in section 218(b).
            ``(C) Adjustments to dollar amount for election officials 
        and election workers.--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--
                    ``(i) for purposes of this subparagraph, 2018 shall 
                be substituted for the calendar year referred to in 
                section 215(a)(1)(B)(ii)(II), and
                    ``(ii) 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.
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.''.
                    (B) Conforming amendments.--
                            (i) Subsection (k) of section 210 of such 
                        Act (42 U.S.C. 410(k)) (relating to covered 
                        transportation service) is repealed.
                            (ii) Section 210(p) of such Act (42 U.S.C. 
                        410(p)) is amended--
                                    (I) in paragraph (2), by striking 
                                ``service is performed'' and all that 
                                follows and inserting ``service is 
                                service described in subsection 
                                (s)(3)(A).''; and
                                    (II) in paragraph (3)(A), by 
                                inserting ``under subsection (a)(7) as 
                                in effect in December 2020'' after 
                                ``section''.
                            (iii) Section 218(c)(6) of such Act (42 
                        U.S.C. 418(c)(6)) is amended--
                                    (I) by striking subparagraph (C);
                                    (II) by redesignating subparagraphs 
                                (D) and (E) as subparagraphs (C) and 
                                (D), respectively; and
                                    (III) by striking subparagraph (F) 
                                and inserting the following:
            ``(E) service which is included as employment under section 
        210(a).''.
    (b) Amendments to the Internal Revenue Code of 1986.--
            (1) In general.--Paragraph (7) of section 3121(b) of the 
        Internal Revenue Code of 1986 (relating to employment) is 
        amended to read as follows:
            ``(7) excluded State or local government employment (as 
        defined in subsection (t));''.
            (2) Excluded state or local government employment.--Section 
        3121 of such Code is amended by inserting after subsection (s) 
        the following new subsection:
    ``(t) Excluded State or Local Government Employment.--
            ``(1) In general.--For purposes of this chapter, the term 
        `excluded State or local government employment' 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--
                    ``(A)(i) such service would be excluded from the 
                term `employment' 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
                    ``(B) the requirements of paragraph (3) are met 
                with respect to such service.
            ``(2) Exception for current employment which continues.--
                    ``(A) In general.--The requirements of this 
                paragraph are met with respect to service for any 
                employer if--
                            ``(i) such service is performed by an 
                        individual--
                                    ``(I) who was performing 
                                substantial and regular service for 
                                remuneration for that employer before 
                                January 1, 2021,
                                    ``(II) who is a bona fide employee 
                                of that employer on December 31, 2020, 
                                and
                                    ``(III) whose employment 
                                relationship with that employer was not 
                                entered into for purposes of meeting 
                                the requirements of this subparagraph, 
                                and
                            ``(ii) the employment relationship with 
                        that employer has not been terminated after 
                        December 31, 2020.
                    ``(B) Treatment of multiple agencies and 
                instrumentalities.--For purposes of subparagraph (A), 
                under regulations--
                            ``(i) all agencies and instrumentalities of 
                        a State (as defined in section 218(b) of the 
                        Social Security Act) or of the District of 
                        Columbia shall be treated as a single employer, 
                        and
                            ``(ii) 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).
            ``(3) Exception for certain services.--
                    ``(A) In general.--The requirements of this 
                paragraph are met with respect to service if such 
                service is performed--
                            ``(i) by an individual who is employed by a 
                        State or political subdivision thereof to 
                        relieve such individual from unemployment,
                            ``(ii) 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,
                            ``(iii) 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,
                            ``(iv) 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,
                            ``(v) 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 Social Security Act 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 Social Security Act, or
                            ``(vi) 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.
                    ``(B) Definitions.--As used in this paragraph, the 
                terms `State' and `political subdivision' have the 
                meanings given those terms in section 218(b) of the 
                Social Security Act.''.
            (3) Conforming amendments.--
                    (A) Subsection (j) of such section 3121 (relating 
                to covered transportation service) is repealed.
                    (B) Paragraph (2) of section 3121(u) of such Code 
                (relating to application of hospital insurance tax to 
                Federal, State, and local employment) is amended--
                            (i) in subparagraph (B), by striking 
                        ``service is performed'' in clause (ii) and all 
                        that follows through the end of such 
                        subparagraph and inserting ``service is service 
                        described in subsection (t)(3)(A).''; and
                            (ii) in subparagraph (C)(i), by inserting 
                        ``under subsection (b)(7) as in effect in 
                        December 2020'' after ``chapter''.
    (c) Effective Date.--Except as otherwise provided in this section, 
the amendments made by this section shall apply with respect to service 
performed after December 31, 2020.

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.

    (a) In General.--Section 1143(a)(2) of the Social Security Act (42 
U.S.C. 1320b-13(a)(2)) is amended--
            (1) in subparagraph (E), by striking ``benefits.'' and 
        inserting ``benefits;''; and
            (2) by adding after subparagraph (E) the following new 
        subparagraphs:
            ``(F) 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--
                    ``(i) 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);
                    ``(ii) the present value of potential lifetime 
                premiums payable (under parts B and D of title XVIII); 
                and
                    ``(iii) 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
            ``(G) 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--
                    ``(i) 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
                    ``(ii) projected lifetime earnings of the eligible 
                individual.''.
    (b) Definitions.--Section 1143(a) of such Act (42 U.S.C. 1320b-
13(a)) is amended--
            (1) by redesignating paragraph (3) as paragraph (4); and
            (2) by inserting after paragraph (2) the following new 
        paragraph:
    ``(3) For purposes of paragraph (2)(G)--
            ``(A) The term `projected deficit-financed benefits' 
        means--
                    ``(i) with respect to an eligible individual in 
                connection with the old-age, survivors, and disability 
                insurance program, the product of--
                            ``(I) the benefits described in 
                        subparagraph (F)(ii) of such individual under 
                        such program, and
                            ``(II) 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
                    ``(ii) with respect to an eligible individual in 
                connection with the Medicare program under title XVIII, 
                the product of--
                            ``(I) the benefits for hospital insurance 
                        (under part A of title XVIII) described in 
                        subparagraph (F)(ii) of such individual under 
                        such program, and
                            ``(II) 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.
            ``(B) The term `projected lifetime earnings' 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.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to annual statements issued after 2013.

SEC. 3110. RETIREMENT INFORMATION CAMPAIGN.

    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.

                  TITLE IV--CONVERSION TO CHAINED CPI

SEC. 4101. CONVERSION TO CHAINED CPI.

    (a) Consumer Price Index Adjustments Applicable to the Internal 
Revenue Code Provisions.--
            (1) In general.--Paragraph (3) of section 1(f) of the 
        Internal Revenue Code of 1986 is amended to read as follows:
            ``(3) Cost-of-living adjustment.--
                    ``(A) In general.--For purposes of paragraph (2), 
                the cost-of-living adjustment for any calendar year 
                is--
                            ``(i) for adjustments first beginning 
                        before 2014, the product of--
                                    ``(I) the CPI fraction for calendar 
                                years before 2014, multiplied by
                                    ``(II) the Chained CPI fraction for 
                                calendar years after 2013,
                        reduced by 1, and
                            ``(ii) for adjustments first beginning 
                        after 2013, the Chained CPI fraction for years 
                        after 2013.
                    ``(B) CPI fraction for calendar years before 
                2014.--The CPI fraction for calendar years before 2014 
                is the fraction--
                            ``(i) the numerator of which is the CPI for 
                        the calendar year 2012; and
                            ``(ii) the denominator of which is the CPI 
                        for the calendar year 1992.
                    ``(C) Chained cpi fraction for calendar years after 
                2013.--The Chained CPI fraction for calendar years 
                after 2013 is the fraction--
                            ``(i) the numerator of which is the Chained 
                        CPI for the preceding calendar year, and
                            ``(ii) the denominator of which is the 
                        Chained CPI for the calendar year 2012.''.
            (2) Conforming amendments.--
                    (A) Paragraph (4) of section 1(f) of such Code is 
                amended to read as follows:
            ``(4) Cpi and chained cpi for any calendar year.--For 
        purposes of paragraph (3)--
                    ``(A) Cpi.--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.
                    ``(B) Chained cpi.--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.''.
                    (B) Paragraph (5) of section 1(f) of such Code is 
                amended to read as follows:
            ``(5) Consumer price index and chained consumer price 
        index.--For purposes of paragraph (4)--
                    ``(A) Consumer price index.--The term `Consumer 
                Price Index' 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.
                    ``(B) Chained consumer price index.--The term 
                `Chained Consumer Price Index' means the most recent 
                estimate of the Chained Consumer Price Index for all 
                urban consumers published by the Department of 
                Labor.''.
                    (C) Subclause (II) of section 36B(b)(3)(A)(ii) of 
                such Code is amended by striking ``consumer price 
                index'' and inserting ``Chained Consumer Price Index 
                (as defined in section 1(f)(5)(B))''.
                    (D) Subclause (II) of section 36B(f)(2)(B)(ii) of 
                such Code is amended by striking ``by substituting 
                `calendar year 2013' for `calendar year 1992' in 
                subparagraph (B) thereof'' and inserting ``by 
                substituting `calendar year 2013' for `calendar year 
                2012' in subparagraph (C) thereof''.
                    (E) Clause (ii) of section 45R(d)(3)(B) of such 
                Code is amended by striking ``determined by 
                substituting `calendar year 2012' for `calendar year 
                1992' in subparagraph (B) thereof''.
                    (F) Subparagraph (B) of section 125(i)(2) of such 
                Code is amended by striking ``determined by 
                substituting `calendar year 2012' for `calendar year 
                1992' in subparagraph (B) thereof''.
                    (G) Subclause (II) of section 4980I(b)(3)(C)(v) of 
                such Code is amended by striking ``for `1992' in 
                subparagraph (B) thereof'' and inserting ``for `2012' 
                in subparagraph (C) thereof''.
                    (H) Clause (ii) of section 5000A(c)(3)(D) of such 
                Code is amended by striking ``by substituting `calendar 
                year 2015' for `calendar year 1992' in subparagraph (B) 
                thereof'' and inserting ``by substituting `calendar 
                year 2015' for `calendar year 2012' in subparagraph (C) 
                thereof''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to taxable years beginning after December 31, 2013.
    (b) Modifications to Cost-of-Living Indexation of Social Security 
Benefits.--
            (1) In general.--Section 215(i)(1)(D) of the Social 
        Security Act (42 U.S.C. 415(i)(1)(D)) is amended to read as 
        follows:
            ``(D) the term `CPI increase percentage', 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--
                    ``(i) 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
                    ``(ii) the most recent cost-of-living computation 
                quarter under subparagraph (B);''.
            (2) Definitions.--Section 215(i)(1)(G) of such Act (42 
        U.S.C. 415(i)(1)(G)) is amended to read as follows:
            ``(G) 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.''.
            (3) Conforming changes for pre-1977 law.--
                    (A) 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--
                            (i) in subparagraph (B), by striking 
                        ``and'' after the semicolon;
                            (ii) in subparagraph (C), by striking ``for 
                        the 3 months in such quarter.'' and inserting 
                        ``for the 12 months in the 12-month period 
                        ending with such quarter; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(D) the term `Consumer Price Index' 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.''.
                    (B) Section 215(i)(4) of the Social Security Act 
                (42 U.S.C. 415(i)(4)) is amended by inserting `` and by 
                section 4101(b) of the Fiscal Sustainability Act of 
                2013'' after ``1986,''.
            (4) Effective date.--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.
    (c) Adjustments of Provisions Utilizing the Consumer Price Index.--
            (1) In general.--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.
            (2) Increases determined from a constant base year.--
                    (A) In general.--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--
                            (i) the CPI fraction prior to 2014; 
                        multiplied by
                            (ii) the Chained CPI fraction after 2013,
                reduced by 1.
                    (B) CPI fraction prior to 2014.--The CPI fraction 
                prior to 2014 is the fraction--
                            (i) the numerator of which is the CPI for 
                        the period, ending with or during 2012, which 
                        corresponds to the base period; and
                            (ii) the denominator of which is the CPI 
                        for the base period.
                    (C) Chained cpi fraction after 2013.--The Chained 
                CPI fraction after 2013 is the fraction--
                            (i) 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
                            (ii) 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.
            (3) Special provisions and exceptions.--
                    (A) Programs tied to social security.--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)).
                    (B) Poverty line.--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.
            (4) Cpi and chained cpi.--For purposes of this subsection--
                    (A) 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
                    (B) 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.
    (d) Change to 12-Month Period for Cost-of-Living Indexation for 
Federal Civil Service and Military Retirement Programs.--
            (1) In general.--
                    (A) Federal civil service.--Sections 8340(a)(2) and 
                8462(a)(2) of title 5, United States Code, are each 
                amended by striking ``3 months comprising such 
                quarter'' and inserting ``12-month period ending with 
                such quarter''.
                    (B) Military.--Section 1401a(h) of title 10, United 
                States Code, is amended by striking ``three months 
                comprising that quarter'' and inserting ``12-month 
                period ending with such quarter''.
            (2) Effective date.--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.
                                 <all>