[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1804 Introduced in Senate (IS)]
<DOC>
115th CONGRESS
1st Session
S. 1804
To establish a Medicare-for-all national health insurance program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 13, 2017
Mr. Sanders (for himself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mr.
Franken, Mrs. Gillibrand, Ms. Harris, Mr. Heinrich, Ms. Hirono, Mr.
Leahy, Mr. Markey, Mr. Merkley, Mr. Schatz, Mrs. Shaheen, Mr. Udall,
Ms. Warren, and Mr. Whitehouse) introduced the following bill; which
was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To establish a Medicare-for-all national health insurance program.
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 ``Medicare for All
Act of 2017''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM; UNIVERSAL
ENTITLEMENT; ENROLLMENT
Sec. 101. Establishment of the Universal Medicare Program.
Sec. 102. Universal entitlement.
Sec. 103. Freedom of choice.
Sec. 104. Non-discrimination.
Sec. 105. Enrollment.
Sec. 106. Effective date of benefits.
Sec. 107. Prohibition against duplicating coverage.
TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND
BENEFITS FOR LONG-TERM CARE
Sec. 201. Comprehensive benefits.
Sec. 202. No cost-sharing.
Sec. 203. Exclusions and limitations.
Sec. 204. Coverage of long-term care services under Medicaid.
Sec. 205. State standards.
TITLE III--PROVIDER PARTICIPATION
Sec. 301. Provider participation and standards.
Sec. 302. Qualifications for providers.
Sec. 303. Use of private contracts.
TITLE IV--ADMINISTRATION
Subtitle A--General Administration Provisions
Sec. 401. Administration.
Sec. 402. Consultation.
Sec. 403. Regional administration.
Sec. 404. Beneficiary ombudsman.
Sec. 405. Complementary conduct of related health programs.
Subtitle B--Control Over Fraud and Abuse
Sec. 411. Application of Federal sanctions to all fraud and abuse under
Universal Medicare Program.
TITLE V--QUALITY ASSESSMENT
Sec. 501. Quality standards.
Sec. 502. Addressing health care disparities.
TITLE VI--HEALTH BUDGET; PAYMENTS; COST CONTAINMENT MEASURES
Subtitle A--Budgeting
Sec. 601. National health budget.
Subtitle B--Payments to Providers
Sec. 611. Payments to institutional and individual providers.
Sec. 612. Ensuring accurate valuation of services under the Medicare
physician fee schedule.
Sec. 613. Office of primary health care.
Sec. 614. Payments for prescription drugs and approved devices and
equipment.
TITLE VII--UNIVERSAL MEDICARE TRUST FUND
Sec. 701. Universal Medicare Trust Fund.
TITLE VIII--CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME
SECURITY ACT OF 1974
Sec. 801. Prohibition of employee benefits duplicative of benefits
under the Universal Medicare Program;
coordination in case of workers'
compensation.
Sec. 802. Repeal of continuation coverage requirements under ERISA and
certain other requirements relating to
group health plans.
Sec. 803. Effective date of title.
TITLE IX--ADDITIONAL CONFORMING AMENDMENTS
Sec. 901. Relationship to existing Federal health programs.
Sec. 902. Sunset of provisions related to the State Exchanges.
TITLE X--TRANSITION
Subtitle A--Transitional Medicare Buy-In Option and Transitional Public
Option
Sec. 1001. Lowering the Medicare age.
Sec. 1002. Establishment of the Medicare transition plan.
Subtitle B--Transitional Medicare Reforms
Sec. 1011. Medicare protection against high out-of-pocket expenditures
for fee-for-service benefits and
elimination of parts A and B deductibles.
Sec. 1012. Reduction in Medicare part D annual out-of-pocket threshold
and elimination of cost-sharing above that
threshold.
Sec. 1013. Coverage of dental and vision services and hearing aids and
examinations under Medicare part B.
Sec. 1014. Eliminating the 24-month waiting period for Medicare
coverage for individuals with disabilities.
TITLE XI--MISCELLANEOUS
Sec. 1101. Definitions.
TITLE I--ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM; UNIVERSAL
ENTITLEMENT; ENROLLMENT
SEC. 101. ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM.
There is hereby established a national health insurance program to
provide comprehensive protection against the costs of health care and
health-related services, in accordance with the standards specified in,
or established under, this Act.
SEC. 102. UNIVERSAL ENTITLEMENT.
(a) In General.--Every individual who is a resident of the United
States is entitled to benefits for health care services under this Act.
The Secretary shall promulgate a rule that provides criteria for
determining residency for eligibility purposes under this Act.
(b) Treatment of Other Individuals.--The Secretary may make
eligible for benefits for health care services under this Act other
individuals not described in subsection (a), and regulate the nature of
eligibility of such individuals, while inhibiting travel and
immigration to the United States for the sole purpose of obtaining
health care services.
SEC. 103. FREEDOM OF CHOICE.
Any individual entitled to benefits under this Act may obtain
health services from any institution, agency, or individual qualified
to participate under this Act.
SEC. 104. NON-DISCRIMINATION.
(a) In General.--No person shall, on the basis of race, color,
national origin, age, disability, or sex, including sex stereotyping,
gender identity, sexual orientation, and pregnancy and related medical
conditions (including termination of pregnancy), be excluded from
participation in, be denied the benefits of, or be subjected to
discrimination by any participating provider as defined in section 301,
or any entity conducting, administering, or funding a health program or
activity, including contracts of insurance, pursuant to this Act.
(b) Claims of Discrimination.--
(1) In general.--The Secretary shall establish a procedure
for adjudication of administrative complaints alleging a
violation of subsection (a).
(2) Jurisdiction.--Any person aggrieved by a violation of
subsection (a) by a covered entity may file suit in any
district court of the United States having jurisdiction of the
parties.
(3) Damages.--If the court finds a violation of subsection
(a), the court may grant compensatory and punitive damages,
declaratory relief, injunctive relief, attorneys' fees and
costs, or other relief as appropriate.
SEC. 105. ENROLLMENT.
(a) In General.--The Secretary shall provide a mechanism for the
enrollment of individuals eligible for benefits under this Act. The
mechanism shall--
(1) include a process for the automatic enrollment of
individuals at the time of birth in the United States and at
the time of immigration into the United States or other
acquisition of qualified resident status in the United States;
(2) provide for the enrollment, as of the date described in
section 106, of all individuals who are eligible to be enrolled
as of such date; and
(3) include a process for the enrollment of individuals
made eligible for health care services under section 102(b).
(b) Issuance of Universal Medicare Cards.--In conjunction with an
individual's enrollment for benefits under this Act, the Secretary
shall provide for the issuance of a Universal Medicare card that shall
be used for purposes of identification and processing of claims for
benefits under this program. The card shall not include an individual's
Social Security number.
SEC. 106. EFFECTIVE DATE OF BENEFITS.
(a) In General.--Except as provided in subsection (b), benefits
shall first be available under this Act for items and services
furnished on January 1 of the fourth calendar year that begins after
the date of enactment of this Act.
(b) Coverage for Children.--
(1) In general.--For any eligible individual who has not
yet attained the age of 19, benefits shall first be available
under this Act for items and services furnished on January 1 of
the first calendar year that begins after the date of enactment
of this Act.
(2) Option to continue in other coverage during transition
period.--Any person who is eligible to receive benefits as
described in paragraph (1) may opt to maintain any coverage
described in section 901, private health insurance coverage, or
coverage offered pursuant to subtitle A of title X (including
the amendments made by such subtitle) until the effective date
described in subsection (a).
SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) In General.--Beginning on the effective date described in
section 106(a), it shall be unlawful for--
(1) a private health insurer to sell health insurance
coverage that duplicates the benefits provided under this Act;
or
(2) an employer to provide benefits for an employee, former
employee, or the dependents of an employee or former employee
that duplicate the benefits provided under this Act.
(b) Construction.--Nothing in this Act shall be construed as
prohibiting the sale of health insurance coverage for any additional
benefits not covered by this Act, including additional benefits that an
employer may provide to employees or their dependents, or to former
employees or their dependents.
TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND
BENEFITS FOR LONG-TERM CARE
SEC. 201. COMPREHENSIVE BENEFITS.
(a) In General.--Subject to the other provisions of this title and
titles IV through IX, individuals enrolled for benefits under this Act
are entitled to have payment made by the Secretary to an eligible
provider for the following items and services if medically necessary or
appropriate for the maintenance of health or for the diagnosis,
treatment, or rehabilitation of a health condition:
(1) Hospital services, including inpatient and outpatient
hospital care, including 24-hour-a-day emergency services and
inpatient prescription drugs.
(2) Ambulatory patient services.
(3) Primary and preventive services, including chronic
disease management.
(4) Prescription drugs, medical devices, biological
products, including outpatient prescription drugs, medical
devices, and biological products.
(5) Mental health and substance abuse treatment services,
including inpatient care.
(6) Laboratory and diagnostic services.
(7) Comprehensive reproductive, maternity, and newborn
care.
(8) Pediatrics.
(9) Oral health, audiology, and vision services.
(10) Short-term rehabilitative and habilitative services
and devices.
(b) Revision and Adjustment.--The Secretary shall, on a regular
basis, evaluate whether the benefits package should be improved or
adjusted to promote the health of beneficiaries, account for changes in
medical practice or new information from medical research, or respond
to other relevant developments in health science, and shall make
recommendations to Congress regarding any such improvements or
adjustments.
(c) Complementary and Integrative Medicine.--
(1) In general.--In carrying out subsection (b), the
Secretary shall consult with the persons described in paragraph
(1) with respect to--
(A) identifying specific complementary and
integrative medicine practices that, on the basis of
research findings or promising clinical interventions,
are appropriate to include in the benefits package; and
(B) identifying barriers to the effective provision
and integration of such practices into the delivery of
health care, and identifying mechanisms for overcoming
such barriers.
(2) Consultation.--In accordance with paragraph (1), the
Secretary shall consult with--
(A) the Director of the National Center for
Complementary and Integrative Health;
(B) the Commissioner of Food and Drugs;
(C) institutions of higher education, private
research institutes, and individual researchers with
extensive experience in complementary and alternative
medicine and the integration of such practices into the
delivery of health care;
(D) nationally recognized providers of
complementary and integrative medicine; and
(E) such other officials, entities, and individuals
with expertise on complementary and integrative
medicine as the Secretary determines appropriate.
(d) States May Provide Additional Benefits.--Individual States may
provide additional benefits for the residents of such States at the
expense of the State.
SEC. 202. NO COST-SHARING.
(a) In General.--The Secretary shall ensure that no cost-sharing,
including deductibles, coinsurance, copayments, or similar charges, be
imposed on an individual for any benefits provided under this Act,
except as described in subsection (b).
(b) Exceptions.--The Secretary may--
(1) impose cost-sharing with respect to services provided
under section 1946 of the Social Security Act, as added by
section 204; and
(2) set a cost-sharing schedule for prescription drugs and
biological products--
(A) provided that--
(i) such schedule is evidence-based and
encourages the use of generic drugs;
(ii) such cost-sharing does not apply to
preventive drugs; and
(iii) such cost-sharing does not exceed
$200 annually per individual, adjusted annually
for inflation; and
(B) under which the Secretary may exempt brand-name
drugs from consideration in determining whether an
individual has reached any out-of-pocket limit if a
generic version of such drug is available.
(c) No Balance Billing.--Notwithstanding contracts in accordance
with section 303, no provider may impose a charge to an enrolled
individual for covered services for which benefits are provided under
this Act.
SEC. 203. EXCLUSIONS AND LIMITATIONS.
(a) In General.--Benefits for services are not available under this
Act unless the services meet the standards specified in section 201(a),
as defined by the Secretary.
(b) Treatment of Experimental Services and Drugs.--
(1) In general.--In applying subsection (a), the Secretary
shall make national coverage determinations with respect to
services that are experimental in nature. Such determinations
shall be consistent with the national coverage determination
process as defined in section 1869(f)(1)(B) of the Social
Security Act (42 U.S.C. 1395ff(f)(1)(B)).
(2) Appeals process.--The Secretary shall establish a
process by which individuals can appeal coverage decisions. The
process shall, as much as is feasible, follow process for
appeals under the Medicare program described in section 1869 of
the Social Security Act (42 U.S.C. 1395ff).
(c) Application of Practice Guidelines.--In the case of services
for which the Department of Health and Human Services has recognized a
national practice guideline, the services are considered to meet the
standards specified in section 201(a) if they have been provided in
accordance with such guideline. For purposes of this subsection, a
service shall be considered to have been provided in accordance with a
practice guideline if the health care provider providing the service
exercised appropriate professional discretion to deviate from the
guideline in a manner authorized or anticipated by the guideline.
SEC. 204. COVERAGE OF LONG-TERM CARE SERVICES UNDER MEDICAID.
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is
amended by inserting the following section after section 1946:
``state plan for providing long-term care services
``Sec. 1947. (a) In General.--For quarters beginning on or after
the effective date of benefits under section 106(a) of the Medicare for
All Act of 2017, notwithstanding any other provision of this title--
``(1) a State plan for medical assistance shall provide for
making medical assistance available for services that are long-
term care services (as defined in subsection (b)) in a manner
consistent with this section; and
``(2) no payment to a State shall be made under this title
with respect to expenditures incurred by the State in providing
medical assistance after such date for services that are not
long-term care services.
``(b) Long-Term Care Services Defined.--In this section, the term
`long-term care services' means the following:
``(1) Nursing facility services for individuals 21 years of
age or over described in subparagraph (A) of section
1905(a)(4).
``(2) Home health services described in section 1905(a)(7).
``(3) Nursing services described in section 1905(a)(8).
``(4) Rehabilitative services described in section
1905(a)(13).
``(5) Inpatient services for individuals 65 years of age or
over provided in an institution for mental disease described in
section 1905(a)(14).
``(6) Intermediate care facility services described in
section 1905(a)(15).
``(7) Inpatient psychiatric hospital services for
individuals under age 21 described in section 1905(a)(16).
``(8) Case management services described in section
1905(a)(19).
``(9) Personal care services described in section
1905(a)(24).
``(10) Nursing facility services described in section
1905(a)(29).
``(11) Home and community-based services provided under a
State plan amendment under section 1915(i).
``(12) Payment for self-directed personal assistance
services provided under section 1915(j).
``(13) Home and community-based attendant services and
supports provided under a State plan amendment under section
1915(k).
``(c) Maintenance of Effort.--
``(1) Eligibility standards.--
``(A) In general.--Beginning on the date described
in subsection (a), no payment may be made under section
1903 with respect to medical assistance provided under
a State plan for medical assistance if the State adopts
income and resource standards and methodologies for
purposes of determining an individual's eligibility for
medical assistance under the State plan that are more
restrictive than those applied as of May 5, 2017.
``(B) Indexing of amounts of income and resource
standards.--In determining whether a State has adopted
income or resource standards that are more restrictive
than the standards which applied as of May 5, 2017, the
Secretary shall deem the amount of any such standard
that was applied as of such date to be increased by the
percentage increase in the medical care component of
the consumer price index for all urban consumers (U.S.
city average) from September of 2017 to September of
the fiscal year for which the Secretary is making such
determination.
``(2) Expenditures.--
``(A) In general.--For each fiscal year or portion
of a fiscal year that occurs during the period that
begins on the first day of the first fiscal quarter
that begins on or after the effective date of benefits
under section 106(a) of the Medicare for All Act of
2017, as a condition of receiving payments under
section 1903(a), a State shall make expenditures for
medical assistance for services that are long-term care
services in an amount that is not less than the
expenditure floor determined for the State and fiscal
year (or portion of a fiscal year) under subparagraph
(B).
``(B) Expenditure floor.--
``(i) In general.--For each fiscal year or
portion of a fiscal year described in
subparagraph (A), the Secretary shall determine
for each State an expenditure floor that shall
be equal to--
``(I) the amount of the State's
expenditures for fiscal year 2017 on
medical assistance for long-term care
services; increased by
``(II) the growth factor determined
under subclause (ii).
``(ii) Growth factor.--For each fiscal year
or portion of a fiscal year described in
subparagraph (A), the Secretary shall, not
later than September 1 of the fiscal year
preceding such fiscal year or portion of a
fiscal year, determine a growth factor for each
State that takes into account--
``(I) the percentage increase in
health care costs in the State;
``(II) the total amount expended by
the State for the previous fiscal year
on medical assistance for long-term
care services;
``(III) the increase, if any, in
the total population of the State from
July of 2017 to July of the fiscal year
preceding the fiscal year involved; and
``(IV) the increase, if any, in the
population of individuals aged 65 and
older of the State from July of 2017 to
July of the fiscal year preceding the
fiscal year involved.
``(iii) Proration rule.--Any amount
determined under this subparagraph for a
portion of a fiscal year shall be prorated
based on the length of such portion of a fiscal
year relative to a complete fiscal year.
``(d) Nonapplication of Certain Requirements.--Beginning on the
date described in subsection (a), any provision of this title requiring
a State plan for medical assistance to make available medical
assistance for services that are not long-term care services or
services described in section 901(a)(3)(A)(ii) of the Medicare for All
Act of 2017 shall have no effect.''.
SEC. 205. STATE STANDARDS.
(a) In General.--Nothing in this Act shall prohibit individual
States from setting additional standards, with respect to eligibility,
benefits, and minimum provider standards, consistent with the purposes
of this Act, provided that such standards do not restrict eligibility
or reduce access to benefits or services.
(b) Restrictions on Providers.--With respect to any individuals or
entities certified to provide services covered under section 201(a)(7),
a State may not prohibit an individual or entity from participating in
the program under this Act, for reasons other than the ability of the
individual or entity to provide such services.
TITLE III--PROVIDER PARTICIPATION
SEC. 301. PROVIDER PARTICIPATION AND STANDARDS.
(a) In General.--An individual or other entity furnishing any
covered service under this Act is not a qualified provider unless the
individual or entity--
(1) is a qualified provider of the services under section
302;
(2) has filed with the Secretary a participation agreement
described in subsection (b); and
(3) meets, as applicable, such other qualifications and
conditions with respect to a provider of services under title
XVIII of the Social Security Act as described in section 1866
of the Social Security Act (42 U.S.C. 1395cc).
(b) Requirements in Participation Agreement.--
(1) In general.--A participation agreement described in
this subsection between the Secretary and a provider shall
provide at least for the following:
(A) Services to eligible persons will be furnished
by the provider without discrimination, in accordance
with section 104(a). Nothing in this subparagraph shall
be construed as requiring the provision of a type or
class of services that are outside the scope of the
provider's normal practice.
(B) No charge will be made to any enrolled
individual for any covered services other than for
payment authorized by this Act.
(C) The provider agrees to furnish such information
as may be reasonably required by the Secretary, in
accordance with uniform reporting standards established
under section 401(b)(1), for--
(i) quality review by designated entities;
(ii) making payments under this Act,
including the examination of records as may be
necessary for the verification of information
on which such payments are based;
(iii) statistical or other studies required
for the implementation of this Act; and
(iv) such other purposes as the Secretary
may specify.
(D) In the case of a provider that is not an
individual, the provider agrees not to employ or use
for the provision of health services any individual or
other provider that has had a participation agreement
under this subsection terminated for cause.
(E) In the case of a provider paid under a fee-for-
service basis, the provider agrees to submit bills and
any required supporting documentation relating to the
provision of covered services within 30 days after the
date of providing such services.
(2) Termination of participation agreement.--
(A) In general.--Participation agreements may be
terminated, with appropriate notice--
(i) by the Secretary for failure to meet
the requirements of this Act; or
(ii) by a provider.
(B) Termination process.--Providers shall be
provided notice and a reasonable opportunity to correct
deficiencies before the Secretary terminates an
agreement unless a more immediate termination is
required for public safety or similar reasons.
(C) Provider protections.--
(i) Prohibition.--The Secretary may not
terminate a participation agreement or in any
other way discriminate against, or cause to be
discriminated against, any covered provider or
authorized representative of the provider, on
account of such provider or representative--
(I) providing, causing to be
provided, or being about to provide or
cause to be provided to the provider,
the Federal Government, or the attorney
general of a State information relating
to any violation of, or any act or
omission the provider or representative
reasonably believes to be a violation
of, any provision of this title (or an
amendment made by this title);
(II) testifying or being about to
testify in a proceeding concerning such
violation;
(III) assisting or participating,
or being about to assist or
participate, in such a proceeding; or
(IV) objecting to, or refusing to
participate in, any activity, policy,
practice, or assigned task that the
provider or representative reasonably
believes to be in violation of any
provision of this Act (including any
amendment made by this Act), or any
order, rule, regulation, standard, or
ban under this Act (including any
amendment made by this Act).
(ii) Complaint procedure.--A provider or
representative who believes that he or she has
been discriminated against in violation of this
section may seek relief in accordance with the
procedures, notifications, burdens of proof,
remedies, and statutes of limitation set forth
in section 2087(b) of title 15, United States
Code.
SEC. 302. QUALIFICATIONS FOR PROVIDERS.
(a) In General.--A health care provider is considered to be
qualified to provide covered services if the provider is licensed or
certified and meets--
(1) all the requirements of State law to provide such
services; and
(2) applicable requirements of Federal law to provide such
services.
(b) Minimum Provider Standards.--
(1) In general.--The Secretary shall establish, evaluate,
and update national minimum standards to ensure the quality of
services provided under this Act and to monitor efforts by
States to ensure the quality of such services. A State may also
establish additional minimum standards which providers shall
meet with respect to services provided in such State.
(2) National minimum standards.--The national minimum
standards under paragraph (1) shall be established for
institutional providers of services and individual health care
practitioners. Except as the Secretary may specify in order to
carry out this Act, a hospital, skilled nursing facility, or
other institutional provider of services shall meet standards
for such a provider under the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). Such
standards also may include, where appropriate, elements
relating to--
(A) adequacy and quality of facilities;
(B) training and competence of personnel (including
continuing education requirements);
(C) comprehensiveness of service;
(D) continuity of service;
(E) patient satisfaction, including waiting time
and access to services; and
(F) performance standards, including organization,
facilities, structure of services, efficiency of
operation, and outcome in palliation, improvement of
health, stabilization, cure, or rehabilitation.
(3) Transition in application.--If the Secretary provides
for additional requirements for providers under this
subsection, any such additional requirement shall be
implemented in a manner that provides for a reasonable period
during which a previously qualified provider is permitted to
meet such an additional requirement.
(4) Ability to provide services.--With respect to any
entity or provider certified to provide services described in
section 201(a)(7), the Secretary may not prohibit such entity
or provider from participating for reasons other than its
ability to provide such services.
(c) Federal Providers.--Any provider qualified to provide health
care services through the Department of Veterans Affairs or Indian
Health Service is a qualifying provider under this section with respect
to any individual who qualifies for such services under applicable
Federal law.
SEC. 303. USE OF PRIVATE CONTRACTS.
(a) In General.--Subject to the provisions of this subsection,
nothing in this Act shall prohibit an institutional or individual
provider from entering into a private contract with an enrolled
individual for any item or service--
(1) for which no claim for payment is to be submitted under
this Act, and
(2) for which the provider receives--
(A) no reimbursement under this Act directly or on
a capitated basis, and
(B) receives no amount for such item or service
from an organization which receives reimbursement for
such items or service under this Act directly or on a
capitated basis.
(b) Beneficiary Protections.--
(1) In general.--Subsection (a) shall not apply to any
contract unless--
(A) the contract is in writing and is signed by the
beneficiary before any item or service is provided
pursuant to the contract;
(B) the contract contains the items described in
paragraph (2); and
(C) the contract is not entered into at a time when
the beneficiary is facing an emergency health care
situation.
(2) Items required to be included in contract.--Any
contract to provide items and services to which subsection (a)
applies shall clearly indicate to the beneficiary that by
signing such contract the beneficiary--
(A) agrees not to submit a claim (or to request
that the provider submit a claim) under this Act for
such items or services even if such items or services
are otherwise covered by this Act;
(B) agrees to be responsible, whether through
insurance offered under section 107(b) or otherwise,
for payment of such items or services and understands
that no reimbursement will be provided under this Act
for such items or services;
(C) acknowledges that no limits under this Act
apply to amounts that may be charged for such items or
services;
(D) if the provider is a non-participating
provider, acknowledges that the beneficiary has the
right to have such items or services provided by other
providers for whom payment would be made under this
Act; and
(E) acknowledges that the provider is providing
services outside the scope of the program under this
Act.
(c) Provider Requirements.--
(1) In general.--Subsection (a) shall not apply to any
contract unless an affidavit described in paragraph (2) is in
effect during the period any item or service is to be provided
pursuant to the contract.
(2) Affidavit.--An affidavit is described in this
subparagraph shall--
(A) identify the practitioner, and be signed by
such practitioner;
(B) provide that the practitioner will not submit
any claim under this title for any item or service
provided to any beneficiary (and will not receive any
reimbursement or amount described in paragraph (1)(B)
for any such item or service) during the 1-year period
beginning on the date the affidavit is signed; and
(C) be filed with the Secretary no later than 10
days after the first contract to which such affidavit
applies is entered into.
(3) Enforcement.--If a physician or practitioner signing an
affidavit described in paragraph (2) knowingly and willfully
submits a claim under this title for any item or service
provided during the 1-year period described in paragraph (2)(B)
(or receives any reimbursement or amount described in
subsection (a)(2) for any such item or service) with respect to
such affidavit--
(A) this subsection shall not apply with respect to
any items and services provided by the physician or
practitioner pursuant to any contract on and after the
date of such submission and before the end of such
period; and
(B) no payment shall be made under this title for
any item or service furnished by the physician or
practitioner during the period described in clause (i)
(and no reimbursement or payment of any amount
described in subsection (a)(2) shall be made for any
such item or service).
TITLE IV--ADMINISTRATION
Subtitle A--General Administration Provisions
SEC. 401. ADMINISTRATION.
(a) General Duties of the Secretary.--
(1) In general.--The Secretary shall develop policies,
procedures, guidelines, and requirements to carry out this Act,
including related to--
(A) eligibility for benefits;
(B) enrollment;
(C) benefits provided;
(D) provider participation standards and
qualifications, as described in title III;
(E) levels of funding;
(F) methods for determining amounts of payments to
providers of covered services, consistent with subtitle
B;
(G) the determination of medical necessity and
appropriateness with respect to coverage of certain
services;
(H) planning for capital expenditures and service
delivery;
(I) planning for health professional education
funding;
(J) encouraging States to develop regional planning
mechanisms; and
(K) any other regulations necessary to carry out
the purpose of this Act.
(2) Regulations.--Regulations authorized by this Act shall
be issued by the Secretary in accordance with section 553 of
title 5, United States Code.
(b) Uniform Reporting Standards; Annual Report; Studies.--
(1) Uniform reporting standards.--
(A) In general.--The Secretary shall establish
uniform State reporting requirements and national
standards to ensure an adequate national database
containing information pertaining to health services
practitioners, approved providers, the costs of
facilities and practitioners providing such services,
the quality of such services, the outcomes of such
services, and the equity of health among population
groups. Such standards shall include, to the maximum
extent feasible without compromising patient privacy,
health outcome measures, and to the maximum extent
feasible without excessively burdening providers, the
measures described in subparagraphs (D) through (F) of
subsection (a)(1).
(B) Reports.--The Secretary shall regularly analyze
information reported to it and shall define rules and
procedures to allow researchers, scholars, health care
providers, and others to access and analyze data for
purposes consistent with quality and outcomes research,
without compromising patient privacy.
(2) Annual report.--Beginning January 1 of the second year
beginning after the effective date of this Act, the Secretary
shall annually report to Congress on the following:
(A) The status of implementation of the Act.
(B) Enrollment under this Act.
(C) Benefits under this Act.
(D) Expenditures and financing under this Act.
(E) Cost-containment measures and achievements
under this Act.
(F) Quality assurance.
(G) Health care utilization patterns, including any
changes attributable to the program.
(H) Changes in the per-capita costs of health care.
(I) Differences in the health status of the
populations of the different States, including income
and racial characteristics, and other population health
inequities.
(J) Progress on quality and outcome measures, and
long-range plans and goals for achievements in such
areas.
(K) Necessary changes in the education of health
personnel.
(L) Plans for improving service to medically
underserved populations.
(M) Transition problems as a result of
implementation of this Act.
(N) Opportunities for improvements under this Act.
(3) Statistical analyses and other studies.--The Secretary
may, either directly or by contract--
(A) make statistical and other studies, on a
nationwide, regional, State, or local basis, of any
aspect of the operation of this Act;
(B) develop and test methods of payment or delivery
as it may consider necessary or promising for the
evaluation, or for the improvement, of the operation of
this Act; and
(C) develop methodological standards for evidence-
based policymaking.
(c) Audits.--
(1) In general.--The Comptroller General of the United
States shall conduct an audit of the Board every fifth fiscal
year following the effective date of this Act to determine the
effectiveness of the program in carrying out the duties under
subsection (a).
(2) Reports.--The Comptroller General of the United States
shall submit a report to Congress concerning the results of
each audit conducted under this subsection.
SEC. 402. CONSULTATION.
The Secretary shall consult with Federal agencies, Indian tribes
and urban Indian health organizations, and private entities, such as
professional societies, national associations, nationally recognized
associations of experts, medical schools and academic health centers,
consumer groups, and labor and business organizations in the
formulation of guidelines, regulations, policy initiatives, and
information gathering to ensure the broadest and most informed input in
the administration of this Act. Nothing in this Act shall prevent the
Secretary from adopting guidelines developed by such a private entity
if, in the Secretary's judgment, such guidelines are generally accepted
as reasonable and prudent and consistent with this Act.
SEC. 403. REGIONAL ADMINISTRATION.
(a) Coordination With Regional Offices.--The Secretary shall
establish and maintain regional offices to promote adequate access to,
and efficient use of, tertiary care facilities, equipment, and
services. Wherever possible, the Secretary shall incorporate regional
offices of the Centers for Medicare & Medicaid Services for this
purpose.
(b) Appointment of Regional and State Directors.--In each such
regional office there shall be--
(1) one regional director appointed by the Secretary;
(2) for each State in the region, a deputy director; and
(3) one deputy director to represent the Native American
and Alaska Native tribes in the region.
(c) Regional Office Duties.--Regional offices shall be responsible
for--
(1) providing an annual State health care needs assessment
report to the Secretary, after a thorough examination of health
needs, in consultation with public health officials,
clinicians, patients, and patient advocates;
(2) recommending changes in provider reimbursement or
payment for delivery of health services in the States within
the region; and
(3) establishing a quality assurance mechanism in the State
in order to minimize both under-utilization and over-
utilization and to ensure that all providers meet high quality
standards.
SEC. 404. BENEFICIARY OMBUDSMAN.
(a) In General.--The Secretary shall appoint a Beneficiary
Ombudsman who shall have expertise and experience in the fields of
health care and education of, and assistance to, individuals entitled
to benefits under this Act.
(b) Duties.--The Beneficiary Ombudsman shall--
(1) receive complaints, grievances, and requests for
information submitted by individuals entitled to benefits under
this Act with respect to any aspect of the Universal Medicare
Program;
(2) provide assistance with respect to complaints,
grievances, and requests referred to in subparagraph (a),
including--
(A) assistance in collecting relevant information
for such individuals, to seek an appeal of a decision
or determination made by a regional office or the
Secretary; and
(B) assistance to such individuals in presenting
information under relating to cost-sharing; and
(3) submit annual reports to Congress and the Secretary
that describe the activities of the Office and that include
such recommendations for improvement in the administration of
this Act as the Ombudsman determines appropriate. The Ombudsman
shall not serve as an advocate for any increases in payments or
new coverage of services, but may identify issues and problems
in payment or coverage policies.
SEC. 405. COMPLEMENTARY CONDUCT OF RELATED HEALTH PROGRAMS.
In performing functions with respect to health personnel education
and training, health research, environmental health, disability
insurance, vocational rehabilitation, the regulation of food and drugs,
and all other matters pertaining to health, the Secretary shall direct
the activities of the Department of Health and Human Services toward
contributions to the health of the people complementary to this Act.
Subtitle B--Control Over Fraud and Abuse
SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL FRAUD AND ABUSE UNDER
UNIVERSAL MEDICARE PROGRAM.
The following sections of the Social Security Act shall apply to
this Act in the same manner as they apply to State medical assistance
plans under title XIX of such Act:
(1) Section 1128 (relating to exclusion of individuals and
entities).
(2) Section 1128A (civil monetary penalties).
(3) Section 1128B (criminal penalties).
(4) Section 1124 (relating to disclosure of ownership and
related information).
(5) Section 1126 (relating to disclosure of certain
owners).
TITLE V--QUALITY ASSESSMENT
SEC. 501. QUALITY STANDARDS.
(a) In General.--All standards and quality measures under this Act
shall be performed by the Center for Clinical Standards and Quality of
the Centers for Medicare & Medicaid Services (referred to in this title
as the ``Center''), in coordination with the Agency for Healthcare
Research and Quality and other offices of the Department of Health and
Human Services.
(b) Duties of the Center.--The Center shall perform the following
duties:
(1) Practice guidelines.--The Center shall review and
evaluate each practice guideline developed under part B of
title IX of the Public Health Service Act. The Center shall
determine whether the guideline should be recognized as a
national practice guideline.
(2) Standards of quality, performance measures, and medical
review criteria.--The Center shall review and evaluate each
standard of quality, performance measure, and medical review
criterion developed under part B of title IX of the Public
Health Service Act (42 U.S.C. 299 et seq.). The Center shall
determine whether the standard, measure, or criterion is
appropriate for use in assessing or reviewing the quality of
services provided by health care institutions or health care
professionals. In evaluating such standards, the Center shall
consider the evidentiary basis for the standard, and the
validity, reliability, and feasibility of measuring the
standard.
(3) Profiling of patterns of practice; identification of
outliers.--The Center shall adopt methodologies for profiling
the patterns of practice of health care professionals and for
identifying and notifying outliers.
(4) Criteria for entities conducting quality reviews.--The
Center shall develop minimum criteria for competence for
entities that can qualify to conduct ongoing and continuous
external quality reviews in the administrative regions. Such
criteria shall require such an entity to be administratively
independent of the individual or board that administers the
region and shall ensure that such entities do not provide
financial incentives to reviewers to favor one pattern of
practice over another. The Center shall ensure coordination and
reporting by such entities to ensure national consistency in
quality standards.
(5) Reporting.--The Center shall report to the Secretary
annually specifically on findings from outcomes research and
development of practice guidelines that may affect the
Secretary's determination of coverage of services under section
401(a)(1)(G).
SEC. 502. ADDRESSING HEALTH CARE DISPARITIES.
(a) Evaluating Data Collection Approaches.--The Center shall
evaluate approaches for the collection of data under this Act, to be
performed in conjunction with existing quality reporting requirements
and programs under this Act, that allow for the ongoing, accurate, and
timely collection of data on disparities in health care services and
performance on the basis of race, ethnicity, gender, geography, or
socioeconomic status. In conducting such evaluation, the Secretary
shall consider the following objectives:
(1) Protecting patient privacy.
(2) Minimizing the administrative burdens of data
collection and reporting on providers under this Act.
(3) Improving Universal Medicare Program data on race,
ethnicity, gender, geography, and socioeconomic status.
(b) Reports to Congress.--
(1) Report on evaluation.--Not later than 18 months after
the date on which benefits first become available as described
in section 106(a), the Center shall submit to Congress and the
Secretary a report on the evaluation conducted under subsection
(a). Such report shall, taking into consideration the results
of such evaluation--
(A) identify approaches (including defining
methodologies) for identifying and collecting and
evaluating data on health care disparities on the basis
of race, ethnicity, gender, geography, or socioeconomic
status under the Universal Medicare Program; and
(B) include recommendations on the most effective
strategies and approaches to reporting quality
measures, as appropriate, on the basis of race,
ethnicity, gender, geography, or socioeconomic status.
(2) Report on data analyses.--Not later than 4 years after
the submission of the report under subsection (b)(1), and 4
years thereafter, the Center shall submit to Congress and the
Secretary a report that includes recommendations for improving
the identification of health care disparities based on the
analyses of data collected under subsection (c).
(c) Implementing Effective Approaches.--Not later than 2 years
after the date on which benefits first become available as described in
section 106(a), the Secretary shall implement the approaches identified
in the report submitted under subsection (b)(1) for the ongoing,
accurate, and timely collection and evaluation of data on health care
disparities on the basis of race, ethnicity, gender, geography, or
socioeconomic status.
TITLE VI--HEALTH BUDGET; PAYMENTS; COST CONTAINMENT MEASURES
Subtitle A--Budgeting
SEC. 601. NATIONAL HEALTH BUDGET.
(a) National Health Budget.--
(1) In general.--By not later than September 1 of each
year, beginning with the year prior to the date on which
benefits first become available as described in section 106(a),
the Secretary shall establish a national health budget, which
specifies the total expenditures to be made for covered health
care services under this Act.
(2) Division of budget into components.--In addition to the
cost of covered health services, the national health budget
shall consist of at least the following components:
(A) Quality assessment activities under title V.
(B) Health professional education expenditures.
(C) Administrative costs.
(D) Innovation, including in accordance with
section 1115A of the Social Security Act (42 U.S.C.
1315a).
(E) Operating and other expenditures not described
in subparagraphs (A) through (D) (referred to in this
Act as the ``operating component''), consisting of
amounts not included in the other components.
(F) Capital expenditures.
(G) Prevention and public health activities.
(3) Allocation among components.--The Secretary shall
allocate the budget among the components in a manner that--
(A) ensures a fair allocation for quality
assessment activities; and
(B) ensures that the health professional education
expenditure component is sufficient to provide for the
amount of health professional education expenditures
sufficient to meet the need for covered health care
services.
(4) Temporary worker assistance.--For up to 5 years
following the date on which benefits first become available as
described in section 106(a), up to 1 percent of the budget may
be allocated to programs providing assistance to workers who
perform functions in the administration of the health insurance
system and who may experience economic dislocation as a result
of the implementation of this Act.
(5) Reserve fund.--The Secretary shall establish and
maintain a reserve fund to respond to the costs of treating an
epidemic, pandemic, natural disaster, or other such health
emergency.
(b) Definitions.--In this section:
(1) Capital expenditures.--The term ``capital
expenditures'' means expenses for the purchase, lease,
construction, or renovation of capital facilities and for
equipment and includes return on equity capital.
(2) Health professional education expenditures.--The term
``health professional education expenditures'' means
expenditures in hospitals and other health care facilities to
cover costs associated with teaching and related research
activities.
Subtitle B--Payments to Providers
SEC. 611. PAYMENTS TO INSTITUTIONAL AND INDIVIDUAL PROVIDERS.
(a) Application of Payment Processes Under Title XVIII.--Except as
otherwise provided in this section, the Secretary shall establish, by
regulation, fee schedules that establish payment amounts for benefits
under this Act in a manner that is consistent with processes for
determining payments for items and services under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.), including the application
of the provisions of, and amendments made by, section 612.
(b) Application of Current and Planned Payment Reforms.--Any
payment reform activities or demonstrations planned or implemented with
respect to such title XVIII as of the date of the enactment of this Act
shall apply to benefits under this Act, including any reform activities
or demonstrations planned or implemented under the provisions of, or
amendments made by, the Medicare Access and CHIP Reauthorization Act of
2015 (Public Law 114-10) and the Patient Protection and Affordable Care
Act (Public Law 111-148).
SEC. 612. ENSURING ACCURATE VALUATION OF SERVICES UNDER THE MEDICARE
PHYSICIAN FEE SCHEDULE.
(a) Standardized and Documented Review Process.--Section 1848(c)(2)
of the Social Security Act (42 U.S.C. 1395w-4(c)(2)) is amended by
adding at the end the following new subparagraph:
``(P) Standardized and documented review process.--
``(i) In general.--Not later than one year
after the date of enactment of this
subparagraph, the Secretary shall establish,
document, and make publicly available a
standardized process for reviewing the relative
values of physicians' services under this
paragraph.
``(ii) Minimum requirements.--The
standardized process shall include, at a
minimum, methods and criteria for identifying
services for review, prioritizing the review of
services, reviewing stakeholder
recommendations, and identifying additional
resources to be considered during the review
process.''.
(b) Planned and Documented Use of Funds.--Section 1848(c)(2)(M) of
the Social Security Act (42 U.S.C. 1305w-4(c)(2)(M)) is amended by
adding at the end the following new clause:
``(x) Planned and documented use of
funds.--For each fiscal year (beginning with
the first fiscal year beginning on or after the
date of enactment of this clause), the
Secretary shall provide to Congress a written
plan for using the funds provided under clause
(ix) to collect and use information on
physicians' services in the determination of
relative values under this subparagraph.''.
(c) Internal Tracking of Reviews.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary shall submit to Congress a
proposed plan for systematically and internally tracking its
review of the relative values of physicians' services, such as
by establishing an internal database, under section 1848(c)(2)
of the Social Security Act (42 U.S.C. 1395w-4(c)(2)), as
amended by this section.
(2) Minimum requirements.--The proposal shall include, at a
minimum, plans and a timeline for achieving the ability to
systematically and internally track the following:
(A) When, how, and by whom services are identified
for review.
(B) When services are reviewed or reviewed or when
new services are added.
(C) The resources, evidence, data, and
recommendations used in reviews.
(D) When relative values are adjusted.
(E) The rationale for final relative value
decisions.
(d) Frequency of Review.--Section 1848(c)(2) of the Social Security
Act (42 U.S.C. 1395w-4(c)(2)) is amended--
(1) in subparagraph (B)(i), by striking ``5'' and inserting
``4''; and
(2) in subparagraph (K)(i)(I), by striking ``periodically''
and inserting ``annually''.
(e) Consultation With Medicare Payment Advisory Commission.--
(1) In general.--Section 1848(c)(2) of the Social Security
Act (42 U.S.C. 1395w-4(c)(2)) is amended--
(A) in subparagraph (B)(i), by inserting ``in
consultation with the Medicare Payment Advisory
Commission,'' after ``The Secretary,''; and
(B) in subparagraph (K)(i)(I), as amended by
subsection (d)(2), by inserting ``in coordination with
the Medicare Payment Advisory Commission,'' after
``years,''.
(2) Conforming amendments.--Section 1805 of the Social
Security Act (42 U.S.C. 1395b-6) is amended--
(A) in subsection (b)(1)(A), by inserting the
following before the semicolon at the end: ``and
including coordinating with the Secretary in accordance
with section 1848(c)(2) to systematically review the
relative values established for physicians' services,
identify potentially misvalued services, and propose
adjustments to the relative values for physicians'
services''; and
(B) in subsection (e)(1), in the second sentence,
by inserting ``or the Ranking Minority Member'' after
``the Chairman''.
(f) Periodic Audit by the Comptroller General.--Section 1848(c)(2)
of the Social Security Act (42 U.S.C. 1395w-4(c)(2)), as amended by
subsection (a), is amended by adding at the end the following new
subparagraph:
``(Q) Periodic audit by the comptroller general.--
``(i) In general.--The Comptroller General
of the United States (in this subsection
referred to as the `Comptroller General') shall
periodically audit the review by the Secretary
of relative values established under this
paragraph for physicians' services.
``(ii) Access to information.--The
Comptroller General shall have unrestricted
access to all deliberations, records, and
nonproprietary data related to the activities
carried out under this paragraph, in a timely
manner, upon request.''.
SEC. 613. OFFICE OF PRIMARY HEALTH CARE.
(a) In General.--There is established within the Agency for
Healthcare Research and Quality an Office of Primary Health Care,
responsible for coordinating with the Secretary, the Health Resources
and Services Administration, and other offices in the Department as
necessary, in order to--
(1) coordinate health professional education policies and
goals, in consultation with the Secretary to achieve the
national goals specified in subsection (b);
(2) develop and maintain a system to monitor the number and
specialties of individuals through their health professional
education, any postgraduate training, and professional
practice;
(3) develop, coordinate, and promote policies that expand
the number of primary care practitioners, registered nurses,
midlevel practitioners, and dentists; and
(4) recommend the appropriate training, education,
technical assistance, and patient advocacy enhancements of
primary care health professionals, including registered nurses,
to achieve uniform high quality and patient safety.
(b) National Goals.--Not later than 1 year after the date of
enactment of this Act, the Office of Primary Health Care shall set
forth national goals to increase access to high quality primary health
care, particularly in underserved areas and for underserved
populations.
SEC. 614. PAYMENTS FOR PRESCRIPTION DRUGS AND APPROVED DEVICES AND
EQUIPMENT.
(a) Negotiated Prices.--The prices to be paid for covered
pharmaceuticals, medical supplies, and medically necessary assistive
equipment shall be negotiated annually by the Secretary.
(b) Prescription Drug Formulary.--
(1) In general.--The Secretary shall establish a
prescription drug formulary system, which shall encourage best-
practices in prescribing and discourage the use of ineffective,
dangerous, or excessively costly medications when better
alternatives are available.
(2) Promotion of use of generics.--The formulary under this
subsection shall promote the use of generic medications to the
greatest extent possible.
(3) Formulary updates and petition rights.--The formulary
under this subsection shall be updated frequently and
clinicians and patients may petition the Secretary to add new
pharmaceuticals or to remove ineffective or dangerous
medications from the formulary.
(4) Use of off-formulary medications.--The Secretary shall
promulgate rules regarding the use of off-formulary medications
which allow for patient access but do not compromise the
formulary.
TITLE VII--UNIVERSAL MEDICARE TRUST FUND
SEC. 701. UNIVERSAL MEDICARE TRUST FUND.
(a) In General.--There is hereby created on the books of the
Treasury of the United States a trust fund to be known as the Universal
Medicare Trust Fund (in this section referred to as the ``Trust
Fund''). The Trust Fund shall consist of such gifts and bequests as may
be made and such amounts as may be deposited in, or appropriated to,
such Trust Fund as provided in this Act.
(b) Appropriations Into Trust Fund.--
(1) Taxes.--There are hereby appropriated to the Trust Fund
for each fiscal year beginning with the fiscal year which
includes the date on which benefits first become available as
described in section 106, out of any moneys in the Treasury not
otherwise appropriated, amounts equivalent to 100 percent of
the net increase in revenues to the Treasury which is
attributable to the amendments made by sections 801 and 902.
The amounts appropriated by the preceding sentence shall be
transferred from time to time (but not less frequently than
monthly) from the general fund in the Treasury to the Trust
Fund, such amounts to be determined on the basis of estimates
by the Secretary of the Treasury of the taxes paid to or
deposited into the Treasury; and proper adjustments shall be
made in amounts subsequently transferred to the extent prior
estimates were in excess of or were less than the amounts that
should have been so transferred.
(2) Current program receipts.--Notwithstanding any other
provision of law, there are hereby appropriated to the Trust
Fund for each fiscal year, beginning with the first fiscal year
beginning on or after the effective date of benefits under
section 106, the amounts that would otherwise have been
appropriated to carry out the following programs:
(A) The Medicare program under title XVIII of the
Social Security Act (other than amounts attributable to
any premiums under such title).
(B) The Medicaid program, under State plans
approved under title XIX of such Act.
(C) The Federal Employees Health Benefits program,
under chapter 89 of title 5, United States Code.
(D) The TRICARE program, under chapter 55 of title
10, United States Code.
(E) The maternal and child health program (under
title V of the Social Security Act), vocational
rehabilitation programs, programs for drug abuse and
mental health services under the Public Health Service
Act, programs providing general hospital or medical
assistance, and any other Federal program identified by
the Secretary, in consultation with the Secretary of
the Treasury, to the extent the programs provide for
payment for health services the payment of which may be
made under this Act.
(3) Restrictions shall not apply.--Any other provision of
law in effect on the date of enactment of this Act restricting
the use of Federal funds for any reproductive health service
shall not apply to monies in the Trust Fund.
(c) Incorporation of Provisions.--The provisions of subsections (b)
through (i) of section 1817 of the Social Security Act (42 U.S.C.
1395i) shall apply to the Trust Fund under this section in the same
manner as such provisions applied to the Federal Hospital Insurance
Trust Fund under such section 1817, except that, for purposes of
applying such subsections to this section, the ``Board of Trustees of
the Trust Fund'' shall mean the ``Secretary''.
(d) Transfer of Funds.--Any amounts remaining in the Federal
Hospital Insurance Trust Fund under section 1817 of the Social Security
Act (42 U.S.C. 1395i) or the Federal Supplementary Medical Insurance
Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) after the
payment of claims for items and services furnished under title XVIII of
such Act have been completed, shall be transferred into the Universal
Medicare Trust Fund under this section.
TITLE VIII--CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME
SECURITY ACT OF 1974
SEC. 801. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF BENEFITS
UNDER THE UNIVERSAL MEDICARE PROGRAM; COORDINATION IN
CASE OF WORKERS' COMPENSATION.
(a) In General.--Part 5 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is
amended by adding at the end the following new section:
``SEC. 522. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF UNIVERSAL
MEDICARE PROGRAM BENEFITS; COORDINATION IN CASE OF
WORKERS' COMPENSATION.
``(a) In General.--Subject to subsection (b), no employee benefit
plan may provide benefits that duplicate payment for any items or
services for which payment may be made under the Medicare for All Act
of 2017.
``(b) Reimbursement.--Each workers compensation carrier that is
liable for payment for workers compensation services furnished in a
State shall reimburse the Universal Medicare Program for the cost of
such services.
``(c) Definitions.--In this subsection--
``(1) the term `workers compensation carrier' means an
insurance company that underwrite workers compensation medical
benefits with respect to one or more employers and includes an
employer or fund that is financially at risk for the provision
of workers compensation medical benefits;
``(2) the term `workers compensation medical benefits'
means, with respect to an enrollee who is an employee subject
to the workers compensation laws of a State, the comprehensive
medical benefits for work-related injuries and illnesses
provided for under such laws with respect to such an employee;
and
``(3) the term `workers compensation services' means items
and services included in workers compensation medical benefits
and includes items and services (including rehabilitation
services and long-term care services) commonly used for
treatment of work-related injuries and illnesses.''.
(b) Conforming Amendment.--Section 4(b) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1003(b)) is amended by adding at
the end the following: ``Paragraph (3) shall apply subject to section
522(b) (relating to reimbursement of the Universal Medicare Program by
workers compensation carriers).''.
(c) Clerical Amendment.--The table of contents in section 1 of such
Act is amended by inserting after the item relating to section 521 the
following new item:
``Sec 522. Prohibition of employee benefits duplicative of Universal
Medicare Program benefits; coordination in
case of workers' compensation.''.
SEC. 802. REPEAL OF CONTINUATION COVERAGE REQUIREMENTS UNDER ERISA AND
CERTAIN OTHER REQUIREMENTS RELATING TO GROUP HEALTH
PLANS.
(a) In General.--Part 6 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.) is
repealed.
(b) Conforming Amendments.--
(1) Section 502(a) of such Act (29 U.S.C. 1132(a)) is
amended--
(A) by striking paragraph (7); and
(B) by redesignating paragraphs (8), (9), and (10)
as paragraphs (7), (8), and (9), respectively.
(2) Section 502(c)(1) of such Act (29 U.S.C. 1132(c)(1)) is
amended by striking ``paragraph (1) or (4) of section 606,''.
(3) Section 514(b) of such Act (29 U.S.C. 1144(b)) is
amended--
(A) in paragraph (7), by striking ``section
206(d)(3)(B)(i)).''; and
(B) by striking paragraph (8).
(4) The table of contents in section 1 of the Employee
Retirement Income Security Act of 1974 is amended by striking
the items relating to part 6 of subtitle B of title I of such
Act.
SEC. 803. EFFECTIVE DATE OF TITLE.
The amendments made by this title shall take effect on the
effective date of benefits under section 106(a).
TITLE IX--ADDITIONAL CONFORMING AMENDMENTS
SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS.
(a) Medicare, Medicaid, and State Children's Health Insurance
Program (SCHIP).--
(1) In general.--Notwithstanding any other provision of
law, subject to paragraphs (2) and (3)--
(A) no benefits shall be available under title
XVIII of the Social Security Act for any item or
service furnished beginning on or after the effective
date of benefits under section 106(a);
(B) no individual is entitled to medical assistance
under a State plan approved under title XIX of such Act
for any item or service furnished on or after such
date;
(C) no individual is entitled to medical assistance
under a State child health plan under title XXI of such
Act for any item or service furnished on or after such
date; and
(D) no payment shall be made to a State under
section 1903(a) or 2105(a) of such Act with respect to
medical assistance or child health assistance for any
item or service furnished on or after such date.
(2) Transition.--In the case of inpatient hospital services
and extended care services during a continuous period of stay
which began before the effective date of benefits under section
106, and which had not ended as of such date, for which
benefits are provided under title XVIII of the Social Security
Act, under a State plan under title XIX of such Act, or under a
State child health plan under title XXI such Act, the Secretary
of Health and Human Services shall provide for continuation of
benefits under such title or plan until the end of the period
of stay.
(3) Services under medicaid.--
(A) In general.--This subsection shall not apply to
entitlement to medical assistance provided under title
XIX of the Social Security Act for--
(i) long-term care services (as defined in
section 1947(b) of such Act); or
(ii) any other service for which benefits
are not available under this Act and which is
furnished under a State plan under title XIX of
the Social Security Act which provided for
medical assistance for such service on
September 1, 2017.
(B) Coordination between secretary and states.--The
Secretary shall coordinate with the directors of State
agencies responsible for administering State plans
under title XIX of the Social Security Act to--
(i) identify services described in
subparagraph (A)(ii) with respect to each State
plan; and
(ii) ensure that such services continue to
be made available under such plan.
(C) Maintenance of effort requirement.--With
respect to any service described in subparagraph
(A)(ii) that is made available under a State plan under
title XIX of the Social Security Act, the maintenance
of effort requirements described in section 1947(c) of
such Act (related to eligibility standards and required
expenditures) shall apply to such service in the same
manner that such requirements apply to long-term care
services (as defined in section 1947(b) of such Act).
(b) Federal Employees Health Benefits Program.--No benefits shall
be made available under chapter 89 of title 5, United States Code, for
any part of a coverage period occurring on or after the effective date.
(c) Tricare.--No benefits shall be made available under sections
1079 and 1086 of title 10, United States Code, for items or services
furnished on or after the effective date.
(d) Treatment of Benefits for Veterans and Native Americans.--
(1) In general.--Nothing in this Act shall affect the
eligibility of veterans for the medical benefits and services
provided under title 38, United States Code, or of Indians for
the medical benefits and services provided by or through the
Indian Health Service.
(2) Reevaluation.--No reevaluation of the Indian Health
Service shall be undertaken without consultation with tribal
leaders and stakeholders.
SEC. 902. SUNSET OF PROVISIONS RELATED TO THE STATE EXCHANGES.
Effective on the date described in section 106, the Federal and
State Exchanges established pursuant to title I of the Patient
Protection and Affordable Care Act (Public Law 111-148) shall
terminate, and any other provision of law that relies upon
participation in or enrollment through such an Exchange, including such
provisions of the Internal Revenue Code of 1986, shall cease to have
force or effect.
TITLE X--TRANSITION
Subtitle A--Transitional Medicare Buy-In Option and Transitional Public
Option
SEC. 1001. LOWERING THE MEDICARE AGE.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395c et seq.) is amended by adding at the end the following new
section:
``transitional medicare buy-in option for certain individuals
``Sec. 1899C. (a) Option.--
``(1) In general.--Every individual who meets the
requirements described in paragraph (3) shall be eligible to
enroll under this section.
``(2) Parts a, b, and d benefits.--An individual enrolled
under this section is entitled to the same benefits (and shall
receive the same protections) under this title as an individual
who is entitled to benefits under part A and enrolled under
parts B and D, including the ability to enroll in a Medicare
Advantage plan that provides qualified prescription drug
coverage (an MA-PD plan).
``(3) Requirements for eligibility.--The requirements
described in this paragraph are the following:
``(A) The individual is a resident of the United
States.
``(B) The individual is--
``(i) a citizen or national of the United
States; or
``(ii) an alien lawfully admitted for
permanent residence.
``(C) The individual is not otherwise entitled to
benefits under part A or eligible to enroll under part
A or part B.
``(D) The individual has attained the applicable
years of age but has not attained 65 years of age.
``(4) Applicable years of age defined.--For purposes of
this section, the term `applicable years of age' means--
``(A) effective January 1 of the first year
following the date of enactment of the Medicare for All
Act of 2017, the age of 55;
``(B) effective January 1 of the second year
following such date of enactment, the age of 45; and
``(C) effective January 1 of the third year
following such date of enactment, the age of 35.
``(b) Enrollment; Coverage.--The Secretary shall establish
enrollment periods and coverage under this section consistent with the
principles for establishment of enrollment periods and coverage for
individuals under other provisions of this title. The Secretary shall
establish such periods so that coverage under this section shall first
begin on January 1 of the year on which an individual first becomes
eligible to enroll under this section.
``(c) Premium.--
``(1) Amount of monthly premiums.--The Secretary shall,
during September of each year (beginning with the first
September following the date of enactment of the Medicare for
All Act of 2017), determine a monthly premium for all
individuals enrolled under this section. Such monthly premium
shall be equal to \1/12\ of the annual premium computed under
paragraph (2)(B), which shall apply with respect to coverage
provided under this section for any month in the succeeding
year.
``(2) Annual premium.--
``(A) Combined per capita average for all medicare
benefits.--The Secretary shall estimate the average,
annual per capita amount for benefits and
administrative expenses that will be payable under
parts A, B, and D (including, as applicable, under part
C) in the year for all individuals enrolled under this
section.
``(B) Annual premium.--The annual premium under
this subsection for months in a year is equal to the
average, annual per capita amount estimated under
subparagraph (A) for the year.
``(3) Increased premium for certain part c and d plans.--
Nothing in this section shall preclude an individual from
choosing a Medicare Advantage plan or a prescription drug plan
which requires the individual to pay an additional amount
(because of supplemental benefits or because it is a more
expensive plan). In such case the individual would be
responsible for the increased monthly premium.
``(d) Payment of Premiums.--
``(1) In general.--Premiums for enrollment under this
section shall be paid to the Secretary at such times, and in
such manner, as the Secretary determines appropriate.
``(2) Deposit.--Amounts collected by the Secretary under
this section shall be deposited in the Federal Hospital
Insurance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund (including the Medicare Prescription Drug
Account within such Trust Fund) in such proportion as the
Secretary determines appropriate.
``(e) Not Eligible for Medicare Cost-Sharing Assistance.--An
individual enrolled under this section shall not be treated as enrolled
under any part of this title for purposes of obtaining medical
assistance for Medicare cost-sharing or otherwise under title XIX.
``(f) Treatment in Relation to the Affordable Care Act.--
``(1) Satisfaction of individual mandate.--For purposes of
applying section 5000A of the Internal Revenue Code of 1986,
the coverage provided under this section constitutes minimum
essential coverage under subsection (f)(1)(A)(i) of such
section 5000A.
``(2) Eligibility for premium assistance.--Coverage
provided under this section--
``(A) shall be treated as coverage under a
qualified health plan in the individual market enrolled
in through the Exchange where the individual resides
for all purposes of section 36B of the Internal Revenue
Code of 1986 other than subsection (c)(2)(B) thereof;
and
``(B) shall not be treated as eligibility for other
minimum essential coverage for purposes of subsection
(c)(2)(B) of such section 36B.
The Secretary shall determine the applicable second lowest cost
silver plan which shall apply to coverage under this section
for purposes of section 36B of such Code.
``(3) Eligibility for cost-sharing subsidies.--For purposes
of applying section 1402 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18071)--
``(A) coverage provided under this section shall be
treated as coverage under a qualified health plan in
the silver level of coverage in the individual market
offered through an Exchange; and
``(B) the Secretary shall be treated as the issuer
of such plan.
``(g) Guaranteed Issue of Medigap Policies Upon First Enrollment
and Each Subsequent Enrollment.--In the case of an individual who
enrolls under this section (including an individual who was previously
enrolled under this section), paragraphs (2)(A), (2)(D), (3)(B)(ii),
and (3)(B)(vi) of section 1882(s)--
``(1) shall be applied by substituting `the applicable year
of age (as defined in section 1899C(a)(4))' for `65 years of
age';
``(2) if the individual was enrolled under this section and
subsequently disenrolls, shall apply each time the individual
subsequently reenrolls under this section as if the individual
had attained the applicable year of age (as defined in
subsection (a)(4)) on the date of such reenrollment (and as if
the individual had never previously enrolled in a Medicare
supplemental policy); and
``(3) shall be applied as if this section had not been
enacted (and as if the individual had never previously enrolled
in a Medicare supplemental policy) when the individual attains
65 years of age.
``(h) No Effect on Benefits for Individuals Otherwise Eligible or
on Trust Funds.--The Secretary shall implement the provisions of this
section in such a manner to ensure that such provisions--
``(1) have no effect on the benefits under this title for
individuals who are entitled to, or enrolled for, such benefits
other than through this section; and
``(2) have no negative impact on the Federal Hospital
Insurance Trust Fund or the Federal Supplementary Medical
Insurance Trust Fund (including the Medicare Prescription Drug
Account within such Trust Fund).
``(i) Consultation.--In promulgating regulations to implement this
section, the Secretary shall consult with interested parties, including
groups representing beneficiaries, health care providers, employers,
and insurance companies.''.
SEC. 1002. ESTABLISHMENT OF THE MEDICARE TRANSITION PLAN.
(a) In General.--To carry out the purpose of this section, for plan
years beginning with the first plan year that begins after the date of
enactment of this Act and ending with the effective date described in
section 106, the Secretary, acting through the Administrator of the
Centers for Medicare & Medicaid (referred to in this section as the
``Administrator''), shall establish, and provide for the offering
through the Exchanges, of a public health plan (in this Act referred to
as the ``Medicare Transition plan'') that provides affordable, high-
quality health benefits coverage throughout the United States.
(b) Administrating the Medicare Transition.--
(1) Administrator.--The Administrator shall administer the
Medicare Transition plan in accordance with this section.
(2) Application of aca requirements.--Consistent with this
section, the Medicare Transition plan shall comply with
requirements under title I of the Patient Protection and
Affordable Care Act (and the amendments made by that title) and
title XXVII of the Public Health Service Act (42 U.S.C. 300gg
et seq.) that are applicable to qualified health plans offered
through the Exchanges, subject to the limitation under
subsection (e)(2).
(3) Offering through exchanges.--The Medicare Transition
plan shall be made available only through the Exchanges, and
shall be available to individuals wishing to enroll and to
qualified employers (as defined in section 1312(f)(2) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18032))
who wish to make such plan available to their employees.
(4) Eligibility to purchase.--Any United States resident
may enroll in the Medicare Transition plan.
(c) Benefits; Actuarial Value.--In carrying out this section, the
Administrator shall ensure that the Medicare Transition plan provides--
(1) coverage for the benefits required to be covered under
title II; and
(2) coverage of benefits that are actuarially equivalent to
90 percent of the full actuarial value of the benefits provided
under the plan.
(d) Providers and Reimbursement Rates.--
(1) In general.--With respect to the reimbursement provided
to health care providers for covered benefits, as described in
section 201, provided under the Medicare Transition plan, the
Administrator shall reimburse such providers at rates
determined for equivalent items and services under the original
Medicare fee-for-service program under parts A and B of title
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.). For
items and services covered under the Medicare Transition plan
but not covered under such parts A and B, the Administrator
shall reimburse providers at rates set by the Administrator in
a manner consistent with the manner in which rates for other
items and services were set under the original Medicare fee-
for-service program.
(2) Prescription drugs.--Any payment rate under this
subsection for a prescription drug shall be at a rate
negotiated by the Administrator with the manufacturer of the
drug. If the Administrator is unable to reach a negotiated
agreement on such a reimbursement rate, the Administrator shall
establish the rate at an amount equal to the lesser of--
(A) the price paid by the Secretary of Veterans
Affairs to procure the drug under the laws administered
by the Secretary of Veterans Affairs;
(B) the price paid to procure the drug under
section 8126 of title 38, United States Code; or
(C) the best price determined under section
1927(c)(1)(C) of the Social Security Act (42 U.S.C.
1396r-8(c)(1)(C)) for the drug.
(3) Participating providers.--
(A) In general.--A health care provider that is a
participating provider of services or supplier under
the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) or under a State
Medicaid plan under title XIX of such Act (42 U.S.C.
1396 et seq.) on the date of enactment of this Act
shall be a participating provider in the Medicare
Transition plan.
(B) Additional providers.--The Administrator shall
establish a process to allow health care providers not
described in subparagraph (A) to become participating
providers in the Medicare Transition plan. Such process
shall be similar to the process applied to new
providers under the Medicare program.
(e) Premiums.--
(1) Determination.--The Administrator shall determine the
premium amount for enrolling in the Medicare Transition plan,
which--
(A) may vary according to family or individual
coverage, age, and tobacco status (consistent with
clauses (i), (iii), and (iv) of section 2701(a)(1)(A)
of the Public Health Service Act (42 U.S.C.
300gg(a)(1)(A))); and
(B) shall take into account the cost-sharing
reductions and premium tax credits which will be
available with respect to the plan under section 1402
of the Patient Protection and Affordable Care Act (42
U.S.C. 18071) and section 36B of the Internal Revenue
Code of 1986, as amended by subsection (g).
(2) Limitation.--Variation in premium rates of the Medicare
Transition plan by rating area, as described in clause (ii) of
section 2701(a)(1)(A)(iii) of the Public Health Service Act (42
U.S.C. 300gg(a)(1)(A)) is not permitted.
(f) Termination.--This section shall cease to have force or effect
on the effective date described in section 106.
(g) Tax Credits and Cost-Sharing Subsidies.--
(1) Premium assistance tax credits.--
(A) Credits allowed to medicare transition plan
enrollees at or above 44 percent of poverty in non-
expansion states.--Paragraph (1) of section 36B(c) of
the Internal Revenue Code of 1986 is amended by
redesignating subparagraphs (C) and (D) as
subparagraphs (D) and (E), respectively, and by
inserting after subparagraph (B) the following new
subparagraph:
``(C) Special rules for medicare transition plan
enrollees.--
``(i) In general.--In the case of a
taxpayer who is covered, or whose spouse or
dependent (as defined in section 152) is
covered, by the Medicare Transition plan
established under section 1002(a) of the
Medicare for All Act of 2017 for all months in
the taxable year, subparagraph (A) shall be
applied without regard to `but does not exceed
400 percent'.
``(ii) Enrollees in medicaid non-expansion
states.--In the case of a taxpayer residing in
a State which (as of the date of the enactment
of the Medicare for All Act of 2017) does not
provide for eligibility under clause (i)(VIII)
or (ii)(XX) of section 1902(a)(10)(A) of the
Social Security Act for medical assistance
under title XIX of such Act (or a waiver of the
State plan approved under section 1115) who is
covered, or whose spouse or dependent (as
defined in section 152) is covered, by the
Medicare Transition plan established under
section 1002(a) of the Medicare for All Act of
2017 for all months in the taxable year,
subparagraphs (A) and (B) shall be applied by
substituting `0 percent' for `100 percent' each
place it appears.''.
(B) Premium assistance amounts for taxpayers
enrolled in medicare transition plan.--
(i) In general.--Subparagraph (A) of
section 36B(b)(3) of such Code is amended--
(I) by redesignating clause (ii) as
clause (iii),
(II) by striking ``clause (ii)'' in
clause (i) and inserting ``clauses (ii)
and (iii)'', and
(III) by inserting after clause (i)
the following new clause:
``(ii) Special rules for taxpayers enrolled
in medicare transition plan.--In the case of a
taxpayer who is covered, or whose spouse or
dependent (as defined in section 152) is
covered, by the Medicare Transition plan
established under section 1002(a) of the
Medicare for All Act of 2017 for all months in
the taxable year, the applicable percentage for
any taxable year shall be determined in the
same manner as under clause (i), except that
the following table shall apply in lieu of the
table contained in such clause:
----------------------------------------------------------------------------------------------------------------
``In the case of household income
(expressed as a percent of poverty line) The initial premium percentage is-- The final premium
within the following income tier: percentage is--
----------------------------------------------------------------------------------------------------------------
Up to 100%................................. 2% 2%
100% up to 138%............................ 2.04% 2.04%
138% up to 150%............................ 3.06% 4.08%
150% and above............................. 4.08% 5%.''.
----------------------------------------------------------------------------------------------------------------
(ii) Conforming amendment.--Subclause (I)
of clause (iii) of section 36B(b)(3) of such
Code, as redesignated by subparagraph (A)(i),
is amended by inserting ``, and determined
after the application of clause (ii)'' after
``after application of this clause''.
(2) Cost-sharing subsidies.--Subsection (b) of section 1402
of the Patient Protection and Affordable Care Act (42 U.S.C.
18071(b)) is amended--
(A) by inserting ``, or in the Medicare Transition
plan established under section 1002(a) of the Medicare
for All Act of 2017,'' after ``coverage'' in paragraph
(1);
(B) by redesignating paragraphs (1) (as so amended)
and (2) as subparagraphs (A) and (B), respectively, and
by moving such subparagraphs 2 ems to the right;
(C) by striking ``Insured.--In this section'' and
inserting ``Insured.--
``(1) In general.--In this section'';
(D) by striking the flush language; and
(E) by adding at the end the following new
paragraph:
``(2) Special rules.--
``(A) Individuals lawfully present.--In the case of
an individual described in section 36B(c)(1)(B) of the
Internal Revenue Code of 1986, the individual shall be
treated as having household income equal to 100 percent
of the poverty line for a family of the size involved
for purposes of applying this section.
``(B) Medicare transition plan enrollees in
medicaid non-expansion states.--In the case of an
individual residing in a State which (as of the date of
the enactment of the Medicare for All Act of 2017) does
not provide for eligibility under clause (i)(VIII) or
(ii)(XX) of section 1902(a)(10)(A) of the Social
Security Act for medical assistance under title XIX of
such Act (or a waiver of the State plan approved under
section 1115) who enrolls in such Medicare Transition
plan, the preceding sentence, paragraph (1)(B), and
paragraphs (1)(A)(i) and (2)(A) of subsection (c) shall
each be applied by substituting `0 percent' for `100
percent' each place it appears.
``(C) Adjusted cost-sharing for medicare transition
plan enrollees.--In the case of any individual who
enrolls in such Medicare Transition plan, in lieu of
the percentages under subsection (c)(1)(B)(i) and
(c)(2), the Secretary shall prescribe a method of
determining the cost-sharing reduction for any such
individual such that the total of the cost-sharing and
the premiums paid by the individual under such Medicare
Transition plan does not exceed the percentage of the
total allowed costs of benefits provided under the plan
equal to the final premium percentage applicable to
such individual under section 36B(b)(3)(A)(ii) of the
Internal Revenue Code of 1986.''.
(h) Conforming Amendments.--
(1) Treatment as a qualified health plan.--Section
1301(a)(2) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18021(a)(2)) is amended--
(A) in the paragraph heading, by inserting ``, the
medicare transition plan,'' before ``and''; and
(B) by inserting ``The Medicare Transition plan,''
before ``and a multi-State plan''.
(2) Level playing field.--Section 1324(a) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18044(a)) is
amended by inserting ``the Medicare Transition plan,'' before
``or a multi-State qualified health plan''.
Subtitle B--Transitional Medicare Reforms
SEC. 1011. MEDICARE PROTECTION AGAINST HIGH OUT-OF-POCKET EXPENDITURES
FOR FEE-FOR-SERVICE BENEFITS AND ELIMINATION OF PARTS A
AND B DEDUCTIBLES.
(a) Protection Against High Out-of-Pocket Expenditures.--Title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), as amended
by section 1001, is amended by adding at the end the following new
section:
``protection against high out-of-pocket expenditures
``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, if the amount of the
out-of-pocket cost-sharing of such individual for a year (effective the
year beginning January 1 of the year following the date of enactment of
the Medicare for All Act of 2017) equals or exceeds $1,500, the
individual shall not be responsible for additional out-of-pocket cost-
sharing occurred during that year.
``(b) 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) 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.''.
(b) Elimination of Parts A and B Deductibles.--
(1) Part a.--Section 1813(b) of the Social Security Act (42
U.S.C. 1395e(b)) is amended by adding at the end the following
new paragraph:
``(4) For each year (beginning January 1 of the year following the
date of enactment of the Medicare for All Act of 2017), the inpatient
hospital deductible for the year shall be $0.''.
(2) Part b.--Section 1833(b) of the Social Security Act (42
U.S.C. 1395l(b)) is amended, in the first sentence--
(A) by striking ``and for a subsequent year'' and
inserting ``for each of 2006 through the year that
includes the date of enactment of the Medicare for All
Act of 2017''; and
(B) by inserting ``, and $0 for each year
subsequent year'' after ``$1)''.
SEC. 1012. REDUCTION IN MEDICARE PART D ANNUAL OUT-OF-POCKET THRESHOLD
AND ELIMINATION OF COST-SHARING ABOVE THAT THRESHOLD.
(a) Reduction.--Section 1860D-2(b)(4)(B) of the Social Security Act
(42 U.S.C. 1395w-102(b)(4)(B)) is amended--
(1) in clause (i), by striking ``For purposes'' and
inserting ``Subject to clause (iii), for purposes''; and
(2) by adding at the end the following new clause:
``(iii) Reduction in threshold during
transition period.--
``(I) In general.--Subject to
subclause (II), for plan years
beginning on or after January 1
following the date of enactment of the
Medicare for All Act of 2017 and before
January 1 of the year that is 4 years
following such date of enactment,
notwithstanding clauses (i) and (ii),
the `annual out-of-pocket threshold'
specified in this subparagraph is equal
to $305.
``(II) Authority to exempt brand-
name drugs if generic available.--In
applying subclause (I), the Secretary
may exempt costs incurred for a covered
part D drug that is an applicable drug
under section 1860D-14A(g)(2) if the
Secretary determines that a generic
version of that drug is available.''.
(b) Elimination of Cost-Sharing.--Section 1860D-2(b)(4)(A) of the
Social Security Act (42 U.S.C. 1395w-102(b)(4)(A)) is amended--
(1) in clause (i)--
(A) by redesignating subclauses (I) and (II) as
items (aa) and (bb), respectively;
(B) by striking ``subparagraph (B), with cost-
sharing'' and inserting the following: ``subparagraph
(B)--
``(I) for plan years 2006 through
the plan year ending December 31
following the date of enactment of the
Medicare for All Act of 2017, with
cost-sharing'';
(C) in item (bb), as redesignated by subparagraph
(A), by striking the period at the end and inserting
``; and''; and
(D) by adding at the end the following new
subclause:
``(II) for the plan year beginning
January 1 following the date of
enactment of the Medicare for All Act
of 2017 and the two subsequent plan
years, without any cost-sharing.''; and
(2) in clause (ii)--
(A) by striking ``clause (i)(I)'' and inserting
``clause (i)(I)(aa)''; and
(B) by adding at the end the following new
sentence: ``The Secretary shall continue to calculate
the dollar amounts specified in clause (i)(I)(aa),
including with the adjustment under this clause, after
plan year 2018 for purposes of 1860D-
14(a)(1)(D)(iii).''.
(c) Conforming Amendments to Low-Income Subsidy.--Section 1860D-
14(a) of the Social Security Act (42 U.S.C. 1395w-114(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (D)(iii), by striking ``1860D-
2(b)(4)(A)(i)(I)'' and inserting ``1860D-
2(b)(4)(A)(i)(I)(aa)''; and
(B) in subparagraph (E)--
(i) in the heading, by inserting ``prior to
the elimination of such cost-sharing for all
individuals'' after ``threshold''; and
(ii) by striking ``The elimination'' and
inserting ``For plan years 2006 through the
plan year ending December 31 following the date
of enactment of the Medicare for All Act of
2017, the elimination''; and
(2) in paragraph (2)(E)--
(A) in the heading, by inserting ``prior to the
elimination of such cost-sharing for all individuals''
after ``threshold'';
(B) by striking ``Subject to'' and inserting ``For
plan years 2006 through the plan year ending December
31 following the date of enactment of the Medicare for
All Act of 2017, subject to''; and
(C) by striking ``1860D-2(b)(4)(A)(i)(I)'' and
inserting ``1860D-2(b)(4)(A)(i)(I)(aa)''.
SEC. 1013. COVERAGE OF DENTAL AND VISION SERVICES AND HEARING AIDS AND
EXAMINATIONS UNDER MEDICARE PART B.
(a) Dental Services.--
(1) Removal of exclusion from coverage.--Section 1862(a) of
the Social Security Act (42 U.S.C. 1395y(a)) is amended by
striking paragraph (12).
(2) Coverage.--
(A) In general.--Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended--
(i) in subparagraph (FF), by striking
``and'' at the end;
(ii) in subparagraph (GG), by inserting
``and'' at the end; and
(iii) by adding at the end the following
new subparagraph:
``(HH) dental services;''.
(B) Payment.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``and'' before ``(BB)'';
and
(ii) by inserting before the semicolon at
the end the following: ``, and (CC) with
respect to dental services described in section
1861(s)(2)(HH), the amount paid shall be an
amount equal to 80 percent of the lesser of the
actual charge for the services or the amount
determined under the fee schedule established
under section 1848(b).''.
(C) Effective date.--The amendments made by this
subsection shall apply to items and services furnished
on or after January 1 following the date of the
enactment of this Act.
(b) Vision Services.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)), as amended by subsection (a), is
amended--
(A) in subparagraph (GG), by striking ``and'' at
the end;
(B) in subparagraph (HH), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(II) vision services;''.
(2) Payment.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)), as amended by subsection (a), is
amended--
(A) by striking ``and'' before ``(CC)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (DD) with respect to vision
services described in section 1861(s)(2)(II), the
amount paid shall be an amount equal to 80 percent of
the lesser of the actual charge for the services or the
amount determined under the fee schedule established
under section 1848(b).''.
(3) Effective date.--The amendments made by this subsection
shall apply to items and services furnished on or after January
1 following the date of the enactment of this Act.
(c) Hearing Aids and Examinations Therefor.--
(1) In general.--Section 1862(a)(7) of the Social Security
Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``hearing
aids or examinations therefor,''.
(2) Effective date.--The amendment made by this subsection
shall apply to items and services furnished on or after January
1 following the date of the enactment of this Act.
SEC. 1014. ELIMINATING THE 24-MONTH WAITING PERIOD FOR MEDICARE
COVERAGE FOR INDIVIDUALS WITH DISABILITIES.
(a) In General.--Section 226(b) of the Social Security Act (42
U.S.C. 426(b)) is amended--
(1) in paragraph (2)(A), by striking ``, and has for 24
calendar months been entitled to,'';
(2) in paragraph (2)(B), by striking ``, and has been for
not less than 24 months,'';
(3) in paragraph (2)(C)(ii), by striking ``, including the
requirement that he has been entitled to the specified benefits
for 24 months,'';
(4) in the first sentence, by striking ``for each month
beginning with the later of (I) July 1973 or (II) the twenty-
fifth month of his entitlement or status as a qualified
railroad retirement beneficiary described in paragraph (2),
and'' and inserting ``for each month for which the individual
meets the requirements of paragraph (2), beginning with the
month following the month in which the individual meets the
requirements of such paragraph, and''; and
(5) in the second sentence, by striking ``the `twenty-fifth
month of his entitlement''' and all that follows through
``paragraph (2)(C) and''.
(b) Conforming Amendments.--
(1) Section 226.--Section 226 of the Social Security Act
(42 U.S.C. 426) is amended by--
(A) striking subsections (e)(1)(B), (f), and (h);
and
(B) redesignating subsections (g) and (i) as
subsections (f) and (g), respectively.
(2) Medicare description.--Section 1811(2) of the Social
Security Act (42 U.S.C. 1395c(2)) is amended by striking ``have
been entitled for not less than 24 months'' and inserting ``are
entitled''.
(3) Medicare coverage.--Section 1837(g)(1) of the Social
Security Act (42 U.S.C. 1395p(g)(1)) is amended by striking
``25th month of'' and inserting ``month following the first
month of''.
(4) Railroad retirement system.--Section 7(d)(2)(ii) of the
Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is
amended--
(A) by striking ``has been entitled to an annuity''
and inserting ``is entitled to an annuity'';
(B) by striking ``, for not less than 24 months'';
and
(C) by striking ``could have been entitled for 24
calendar months, and''.
(c) Effective Date.--The amendments made by this section shall
apply to insurance benefits under title XVIII of the Social Security
Act with respect to items and services furnished in months beginning
after December 1 following the date of enactment of this Act, and
before January 1 of the year that is 4 years after such date of
enactment.
TITLE XI--MISCELLANEOUS
SEC. 1101. DEFINITIONS.
In this Act--
(1) the term ``Secretary'' means the Secretary of Health
and Human Services;
(2) the term ``State'' means a State, the District of
Columbia, or a territory of the United States; and
(3) the term ``United States'' shall include the States,
the District of Columbia, and the territories of the United
States.
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