115 S1804 IS: Medicare for All Act of 2017
U.S. Senate
2017-09-13
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)This Act may be cited as the Medicare for All Act of 2017
. (b)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.
<enum>I</enum><header>Establishment of the Universal Medicare Program; universal entitlement; enrollment</header>
<section id="id543f8d72ce1c4b05b7d6e4c41b0d31ee"><enum>101.</enum><header>Establishment of the Universal Medicare Program</header><text display-inline="no-display-inline">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.</text>
</section><section id="id7c9f61ac711340cebda48d12fc26fd89"><enum>102.</enum><header>Universal entitlement</header>
<subsection id="idc40f4957badf492fb498c19e016419aa"><enum>(a)</enum><header>In general</header><text>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.</text>
</subsection><subsection id="ide2113863514f4175b24775113dcabe43"><enum>(b)</enum><header>Treatment of other individuals</header><text>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.</text>
</subsection></section><section id="idbd1d01a7be234fa2be16a252c6a2fbb6"><enum>103.</enum><header>Freedom of choice</header><text display-inline="no-display-inline">Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.</text>
</section><section id="id5e75d6f2654741879804ed0f46e368e2"><enum>104.</enum><header>Non-discrimination</header>
<subsection id="idfae75f7785ab44afa3dbcbe5a762f879"><enum>(a)</enum><header>In general</header><text>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.</text>
</subsection><subsection id="id1f686124778e4e569f14c873b2db36e6"><enum>(b)</enum><header>Claims of discrimination</header>
<paragraph id="id063F14C52B714E6FA09E4F349B2BD975"><enum>(1)</enum><header>In general</header><text>The Secretary shall establish a procedure for adjudication of administrative complaints alleging a violation of subsection (a).</text>
</paragraph><paragraph id="id4e5db5e102c644358f5407081d71d06d"><enum>(2)</enum><header>Jurisdiction</header><text>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.</text>
</paragraph><paragraph id="id6af1871b4cb740a088a89d4e19c7547f"><enum>(3)</enum><header>Damages</header><text>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.</text>
</paragraph></subsection></section><section id="idDAB9323B56D9497F8638F85510E78898"><enum>105.</enum><header>Enrollment</header>
<subsection id="id597415fc81ba4e119df14e64d5ea6ed4"><enum>(a)</enum><header>In general</header><text>The Secretary shall provide a mechanism for the enrollment of individuals eligible for benefits under this Act. The mechanism shall—</text>
<paragraph id="id17ca60ae170b40fc86b1ae37724d7db9"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="iddb143e5e83434a23835d4c41058253c4"><enum>(2)</enum><text>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</text>
</paragraph><paragraph id="idbd89c423047a46718cf9c21d3f5826ab"><enum>(3)</enum><text>include a process for the enrollment of individuals made eligible for health care services under section 102(b).</text>
</paragraph></subsection><subsection id="idf626762695fe49d384c7ba22e1324a57"><enum>(b)</enum><header>Issuance of Universal Medicare cards</header><text>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.</text>
</subsection></section><section id="idbc509c718e784652ab51ab7f9602f630"><enum>106.</enum><header>Effective date of benefits</header>
<subsection id="id5DE5461CC66E410F88C35E373DD17842"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="idC3A817DC348D41CE9BD3D4C6121FFDD9"><enum>(b)</enum><header>Coverage for children</header>
<paragraph id="id66EC7E2F1B2D46B7892B33E2DFE14F20"><enum>(1)</enum><header>In general</header><text>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.</text>
</paragraph><paragraph id="id4ae8680de42243e799dc33d340d894c1"><enum>(2)</enum><header>Option to continue in other coverage during transition period</header><text>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).</text>
</paragraph></subsection></section><section id="ide37941c014034d0b92c46663a00be99d"><enum>107.</enum><header>Prohibition against duplicating coverage</header>
<subsection id="id72d3841f588f460aa6636f4d67aeb648"><enum>(a)</enum><header>In general</header><text>Beginning on the effective date described in section 106(a), it shall be unlawful for—</text>
<paragraph id="idAC0B33237AF44E8C8AA2D62C0DA1EFEA"><enum>(1)</enum><text>a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or</text>
</paragraph><paragraph id="id002B2B1DFAED49D3AE0B7118A51EDFDC"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="id417f35d808d34c89abd73395d0b4c311"><enum>(b)</enum><header>Construction</header><text>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.</text>
</subsection></section><enum>II</enum><header>Comprehensive benefits, including preventive benefits and benefits for long-term care</header>
<section id="id25c91cb96228483495ad9de0b47b79f8"><enum>201.</enum><header>Comprehensive benefits</header>
<subsection id="id015da5a863004bb19f7e19cc0cbae591"><enum>(a)</enum><header>In general</header><text>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:</text>
<paragraph id="id80a48e81293d42f98f15830b7f4a14f5"><enum>(1)</enum>
<text>Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.</text>
</paragraph><paragraph id="id5582e97134354d899f573323ab962da7"><enum>(2)</enum><text>Ambulatory patient services.</text> </paragraph><paragraph id="id441f413bb117483485b58e143ca49ed7"><enum>(3)</enum><text>Primary and preventive services, including chronic disease management.</text>
</paragraph><paragraph id="id4a35f492502a403dab4723aa8cc4fa46"><enum>(4)</enum><text>Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products.</text>
</paragraph><paragraph id="idccf804e9c6384261bd1de95b6bbd36d0"><enum>(5)</enum><text>Mental health and substance abuse treatment services, including inpatient care.</text> </paragraph><paragraph id="id8d781a42d2924588bbd7de8dfd28dc10"><enum>(6)</enum><text>Laboratory and diagnostic services.</text>
</paragraph><paragraph id="id36a0a933831344458cf75b88e446d3b1"><enum>(7)</enum><text>Comprehensive reproductive, maternity, and newborn care.</text> </paragraph><paragraph id="id788e8a57221f42709591fbf7ac2e7962"><enum>(8)</enum><text>Pediatrics.</text>
</paragraph><paragraph id="idb46d3d2c0ce84c82837447837bb4b436"><enum>(9)</enum><text>Oral health, audiology, and vision services.</text> </paragraph><paragraph id="id763589B9D38D40998ACB7FEB1B387E11"><enum>(10)</enum><text>Short-term rehabilitative and habilitative services and devices.</text>
</paragraph></subsection><subsection id="id4db570948a0a42caa5934f4d8a36f510"><enum>(b)</enum><header>Revision and adjustment</header><text>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.</text>
</subsection><subsection id="idf4becb0d8c94455aac98c0aaf29a08b7"><enum>(c)</enum><header>Complementary and Integrative Medicine</header>
<paragraph id="id40e57fa3d0214fa88e6a34636dd17471"><enum>(1)</enum><header>In general</header><text>In carrying out subsection (b), the Secretary shall consult with the persons described in paragraph (1) with respect to—</text>
<subparagraph id="idB92B09ACF5E64D6D9048DAD2F5BE3DDD"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="id733b2da582f44e7180c28da97f429efb"><enum>(B)</enum><text>identifying barriers to the effective provision and integration of such practices into the delivery of health care, and identifying mechanisms for overcoming such barriers.</text>
</subparagraph></paragraph><paragraph id="id246F319F24FF4954852CB6E85A560263"><enum>(2)</enum><header>Consultation</header><text>In accordance with paragraph (1), the Secretary shall consult with—</text> <subparagraph id="id6E143584E35D43428B5351F8DA37351C"><enum>(A)</enum><text>the Director of the National Center for Complementary and Integrative Health;</text>
</subparagraph><subparagraph id="id0C11684E1DD945C4BE2775795C96527E"><enum>(B)</enum><text>the Commissioner of Food and Drugs;</text> </subparagraph><subparagraph id="id049883fb660a4143b33c28733a999569"><enum>(C)</enum><text>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;</text>
</subparagraph><subparagraph id="idE1483405D95749A6AA9B253382A76323"><enum>(D)</enum><text>nationally recognized providers of complementary and integrative medicine; and</text> </subparagraph><subparagraph id="idED8BFEF483F14EEEBA90DC6E5F7CBC47"><enum>(E)</enum><text>such other officials, entities, and individuals with expertise on complementary and integrative medicine as the Secretary determines appropriate.</text>
</subparagraph></paragraph></subsection><subsection id="id8A5DD7BEF55247BBAA07182B92467BF0"><enum>(d)</enum><header>States may provide additional benefits</header><text>Individual States may provide additional benefits for the residents of such States at the expense of the State.</text>
</subsection></section><section id="id5a2b7601e7584d96b5b5066ddeed4850"><enum>202.</enum><header>No cost-sharing</header>
<subsection id="id969a8148d0c54821ae4c2256196081ca"><enum>(a)</enum><header>In general</header><text>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).</text>
</subsection><subsection id="id88C5E3E0E9074D61A725980D7BCF1F98"><enum>(b)</enum><header>Exceptions</header><text>The Secretary may—</text> <paragraph id="id973F358CEA8A40C9BA84A172B02B100A"><enum>(1)</enum><text>impose cost-sharing with respect to services provided under section 1946 of the Social Security Act, as added by section 204; and</text>
</paragraph><paragraph id="id7340ffac55aa4cbd89749c98631d2b47"><enum>(2)</enum><text>set a cost-sharing schedule for prescription drugs and biological products—</text> <subparagraph id="idBCEDA9EEBDFB440DA6C222708CEE9530"><enum>(A)</enum><text>provided that—</text>
<clause id="idB275608CA5D74A9994B80A5170CFA458"><enum>(i)</enum><text>such schedule is evidence-based and encourages the use of generic drugs;</text>
</clause><clause id="id7E3238C68CEA408AB334F2B3CFA76C74"><enum>(ii)</enum><text>such cost-sharing does not apply to preventive drugs; and</text>
</clause><clause id="idA4D51D0099634F6B9B5D75CC8E7267C1"><enum>(iii)</enum><text>such cost-sharing does not exceed $200 annually per individual, adjusted annually for inflation; and</text>
</clause></subparagraph><subparagraph id="idD86E41A80B9746BDA9DA316FD5C75E40"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection id="ide80fb401bc3342b9935ba52b7d7e500a"><enum>(c)</enum><header>No balance billing</header><text>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.</text>
</subsection></section><section id="id9F5927123AE44D7CAB459E7FC752BE03"><enum>203.</enum><header>Exclusions and limitations</header>
<subsection id="id5f998780285f429e895b4d4bc1d76310"><enum>(a)</enum><header>In general</header><text>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.</text>
</subsection><subsection id="ide6f5ab2f92c54a73b4f8c140e5dff443"><enum>(b)</enum><header>Treatment of experimental services and drugs</header>
<paragraph id="idc54becb2cf3b42f2be37fd8c13b76037"><enum>(1)</enum><header>In general</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ff">42 U.S.C. 1395ff(f)(1)(B)</external-xref>).</text>
</paragraph><paragraph id="idcf8481c01bc64b9f8f45b8b6a255118d"><enum>(2)</enum><header>Appeals process</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ff">42 U.S.C. 1395ff</external-xref>).</text>
</paragraph></subsection><subsection id="id9a68b304f66f44ce9aa7ef914eb98883"><enum>(c)</enum><header>Application of practice guidelines</header><text>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.</text>
</subsection></section><section id="id1FEE3C9186A045298CEAA837FEA597FF"><enum>204.</enum><header>Coverage of long-term care services under Medicaid</header><text display-inline="no-display-inline">Title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) is amended by inserting the following section after section 1946:</text>
<quoted-block act-name="" display-inline="no-display-inline" id="idA3171FEA044849F78DAF20282E28EC89" style="traditional"><section id="idB414F859F41F47E093869012D509AD15"><enum>1947.</enum><header>State plan for providing long-term care services</header><subsection commented="no" display-inline="yes-display-inline" id="id0EB7C1C674514F1790E915C3B74ACC7F"><enum>(a)</enum><header>In general</header><text>For quarters beginning on or after the effective date of benefits under section 106(a) of the <short-title>Medicare for All Act of 2017</short-title>, notwithstanding any other provision of this title—</text> <paragraph id="idAF3BCE46ED964245A929AA187DC842DE"><enum>(1)</enum><text display-inline="yes-display-inline">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</text>
</paragraph><paragraph id="id0D9E3CB046FB452BA8369473852E046B"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="idDD9483E482094700AB5993E547FD0249"><enum>(b)</enum><header>Long-Term care services defined</header><text display-inline="yes-display-inline">In this section, the term <term>long-term care services</term> means the following:</text> <paragraph id="idE1D061B938DC47159E6D1941DB5539F3"><enum>(1)</enum><text display-inline="yes-display-inline">Nursing facility services for individuals 21 years of age or over described in subparagraph (A) of section 1905(a)(4).</text>
</paragraph><paragraph id="id461FBAB223F64A41BA366B4D267D5138"><enum>(2)</enum><text display-inline="yes-display-inline">Home health services described in section 1905(a)(7).</text> </paragraph><paragraph id="idE2108ADAAC0B423E8BC8384A1F0CADF6"><enum>(3)</enum><text display-inline="yes-display-inline">Nursing services described in section 1905(a)(8).</text>
</paragraph><paragraph id="idE42CAC5D0CEB4526A0F1EDE976C3583E"><enum>(4)</enum><text display-inline="yes-display-inline">Rehabilitative services described in section 1905(a)(13).</text> </paragraph><paragraph id="id98E75F2738BB4804B8B58A0FAD8F0786"><enum>(5)</enum><text>Inpatient services for individuals 65 years of age or over provided in an institution for mental disease described in section 1905(a)(14).</text>
</paragraph><paragraph id="id0F909D741E3D44AA87C88A88070D6635"><enum>(6)</enum><text>Intermediate care facility services described in section 1905(a)(15).</text>
</paragraph><paragraph id="idD782E92DA09749199BC008E069CBC4DC"><enum>(7)</enum><text>Inpatient psychiatric hospital services for individuals under age 21 described in section 1905(a)(16).</text>
</paragraph><paragraph id="id313E39B18E6740BBAD0B9A7E2C8768DF"><enum>(8)</enum><text>Case management services described in section 1905(a)(19).</text> </paragraph><paragraph id="id8742AEF99E924F408E6CAA9D4CD2E8AB"><enum>(9)</enum><text>Personal care services described in section 1905(a)(24).</text>
</paragraph><paragraph id="id99D3A33BE54D4E5697A32B30F023DE9A"><enum>(10)</enum><text display-inline="yes-display-inline">Nursing facility services described in section 1905(a)(29).</text> </paragraph><paragraph id="idF9A8D704B2034D9F8143A6A4B12CE2A0"><enum>(11)</enum><text>Home and community-based services provided under a State plan amendment under section 1915(i).</text>
</paragraph><paragraph id="idCCADC0752E2F403297C5A81F967ED414"><enum>(12)</enum><text>Payment for self-directed personal assistance services provided under section 1915(j).</text> </paragraph><paragraph id="id195521063ACB436B962E143FF6F272D2"><enum>(13)</enum><text>Home and community-based attendant services and supports provided under a State plan amendment under section 1915(k).</text>
</paragraph></subsection><subsection commented="no" id="id879139BFA8414817A7D4E429B1CAB27E"><enum>(c)</enum><header>Maintenance of effort</header>
<paragraph commented="no" id="idAEAAB1E1551E4A6B821988202FDB0CD8"><enum>(1)</enum><header>Eligibility standards</header>
<subparagraph commented="no" id="id95F9ADD7623D4791BFB129619E14AABB"><enum>(A)</enum><header>In general</header><text>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.</text>
</subparagraph><subparagraph commented="no" id="idB83C1DEA328E4E3CA9957D0E524CF4C7"><enum>(B)</enum><header>Indexing of amounts of income and resource standards</header><text>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.</text>
</subparagraph></paragraph><paragraph commented="no" id="id6C32F88F51554C35AC19126BEAEA3CBF"><enum>(2)</enum><header>Expenditures</header>
<subparagraph commented="no" id="id87C6F6AA9D28492DAF613FDB7BDB0F0F"><enum>(A)</enum><header>In general</header><text>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 <short-title>Medicare for All Act of 2017</short-title>, 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).</text>
</subparagraph><subparagraph commented="no" id="idD4158BDE2D3A46C8A6F20E8397379110"><enum>(B)</enum><header>Expenditure floor</header>
<clause commented="no" id="id7102E2E885D4464E8760ADCFFCD7E19C"><enum>(i)</enum><header>In general</header><text>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—</text>
<subclause commented="no" id="id480BD15F5EF8481FA8A114819D3EC50F"><enum>(I)</enum><text>the amount of the State's expenditures for fiscal year 2017 on medical assistance for long-term care services; increased by</text>
</subclause><subclause commented="no" id="idEFA1956966F34032A24A3F9A981C344C"><enum>(II)</enum><text>the growth factor determined under subclause (ii).</text> </subclause></clause><clause commented="no" id="idB90542BD22A0429799552D4636B3D9FB"><enum>(ii)</enum><header>Growth factor</header><text>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—</text>
<subclause commented="no" id="id9CD67E9468DB44ADAD377785E7CF9B06"><enum>(I)</enum><text>the percentage increase in health care costs in the State;</text> </subclause><subclause commented="no" id="id77567A4C503D478F87365949AFC162AB"><enum>(II)</enum><text>the total amount expended by the State for the previous fiscal year on medical assistance for long-term care services;</text>
</subclause><subclause commented="no" id="id0F0A909E38F34410B8DF47B103451441"><enum>(III)</enum><text>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</text>
</subclause><subclause commented="no" id="idE8C5BCD1A42C4044B17E708E6A9BA6BC"><enum>(IV)</enum><text>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.</text>
</subclause></clause><clause commented="no" id="id5427851501E3441D86545241255819F1"><enum>(iii)</enum><header>Proration rule</header><text>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.</text>
</clause></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id771C9A1439BA492F9F75D73AFD8B64C7"><enum>(d)</enum><header>Nonapplication of certain requirements</header><text>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 <short-title>Medicare for All Act of 2017</short-title> shall have no effect.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="id86e76f6e7596484696506d0b3b45377b"><enum>205.</enum><header>State standards</header>
<subsection id="idF915099040654EEAA87FE6AA7777E9ED"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="id84aa8f0f9ecc403e960a5d1e45bd8c44"><enum>(b)</enum><header>Restrictions on providers</header><text>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.</text>
</subsection></section><enum>III</enum><header>Provider participation</header>
<section id="id12e38267beee4b558f45ddd44a53bbe1"><enum>301.</enum><header>Provider participation and standards</header>
<subsection id="idf448f2bfd2e94a828e936fdb2a17dd69"><enum>(a)</enum><header>In general</header><text>An individual or other entity furnishing any covered service under this Act is not a qualified provider unless the individual or entity—</text>
<paragraph id="idd462257895a24dfcabae30c73e478f7a"><enum>(1)</enum><text>is a qualified provider of the services under section 302;</text> </paragraph><paragraph id="id2b7f7ff63c1248119e0916457d296c08"><enum>(2)</enum><text>has filed with the Secretary a participation agreement described in subsection (b); and</text>
</paragraph><paragraph id="id7ab6b53c08f040eaad910d417994e25c"><enum>(3)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc</external-xref>).</text>
</paragraph></subsection><subsection id="id6458254ce23f4bf9b85f95d4bd21fef8"><enum>(b)</enum><header>Requirements in participation agreement</header>
<paragraph id="id3df0fe7f82574db89512a78ec7db5a6d"><enum>(1)</enum><header>In general</header><text>A participation agreement described in this subsection between the Secretary and a provider shall provide at least for the following:</text>
<subparagraph id="idcfc5615234e54c76b2ea77acc710f871"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph id="id8cf1c874602b47c0bc2f08f462692ba2"><enum>(B)</enum><text>No charge will be made to any enrolled individual for any covered services other than for payment authorized by this Act.</text>
</subparagraph><subparagraph id="id6f864e5348374bdeb132a11311574dc1"><enum>(C)</enum><text>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—</text>
<clause id="idd129401faf0847cba39d16fb16fc4afc"><enum>(i)</enum><text>quality review by designated entities;</text> </clause><clause id="id7440e0cbff114066be04e5414fe5148a"><enum>(ii)</enum><text>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;</text>
</clause><clause id="id5f9c9399ff05482cabe86f64a8f910f9"><enum>(iii)</enum><text>statistical or other studies required for the implementation of this Act; and</text> </clause><clause id="idd9d481e09b9148c78b8f715f35124e14"><enum>(iv)</enum><text>such other purposes as the Secretary may specify.</text>
</clause></subparagraph><subparagraph id="idb87ef6c1d73842829cddeb2ce82dc859"><enum>(D)</enum><text>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.</text>
</subparagraph><subparagraph id="id6be8767ef37149159dbf430e385e00e5"><enum>(E)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="id06c779f1d1fd4f69843987457fef4e02"><enum>(2)</enum><header>Termination of participation agreement</header>
<subparagraph id="id542dade5359f46fc9a8d9376e88c6802"><enum>(A)</enum><header>In general</header><text>Participation agreements may be terminated, with appropriate notice—</text> <clause id="idaf4fac823fc44da4aab2aec2e15d8caa"><enum>(i)</enum><text>by the Secretary for failure to meet the requirements of this Act; or</text>
</clause><clause id="id24c0890bc1934ad1bab3c7951c99f048"><enum>(ii)</enum><text>by a provider.</text> </clause></subparagraph><subparagraph id="id8d2109b7ea5d44d0b0b2b4c92ca9d0cf"><enum>(B)</enum><header>Termination process</header><text>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.</text>
</subparagraph><subparagraph id="id28a08b402b654cbf9c7094f878fc6bb1"><enum>(C)</enum><header>Provider protections</header>
<clause id="idddd9bee10e2d46e986e13008f65ec8ac"><enum>(i)</enum><header>Prohibition</header><text>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—</text>
<subclause id="id5d9fe8a788ee4abeb19d95f3b8b420a7"><enum>(I)</enum><text>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);</text>
</subclause><subclause id="id69ce5b634e6541888cd254d5da19d530"><enum>(II)</enum><text>testifying or being about to testify in a proceeding concerning such violation;</text> </subclause><subclause id="id4b5747a197f341288af8c228d2ff17c6"><enum>(III)</enum><text>assisting or participating, or being about to assist or participate, in such a proceeding; or</text>
</subclause><subclause id="id5e297babbdc042ffb3559d1984390bc4"><enum>(IV)</enum><text>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).</text>
</subclause></clause><clause id="id7dc1b588552c4f41a5a4258262a2572b"><enum>(ii)</enum><header>Complaint procedure</header><text>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.</text>
</clause></subparagraph></paragraph></subsection></section><section id="id4e6165a8eb3949baa8ce74a9c9fe551a"><enum>302.</enum><header>Qualifications for providers</header>
<subsection id="id49e1507152cd48848ad5d86cf38000c1"><enum>(a)</enum><header>In general</header><text>A health care provider is considered to be qualified to provide covered services if the provider is licensed or certified and meets—</text>
<paragraph id="id527514317ea244ef86c044a5d3d4f66b"><enum>(1)</enum><text>all the requirements of State law to provide such services; and</text> </paragraph><paragraph id="id047b0f77ed2247f4b1b35b72c0c5e487"><enum>(2)</enum><text>applicable requirements of Federal law to provide such services.</text>
</paragraph></subsection><subsection id="id9afe048985074154a3c045dca67b29f8"><enum>(b)</enum><header>Minimum provider standards</header>
<paragraph id="id1360ea2a4f814462a2726d6538646207"><enum>(1)</enum><header>In general</header><text>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.</text>
</paragraph><paragraph id="idea1d79c2b2f440619efc183077324e14"><enum>(2)</enum><header>National minimum standards</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.). Such standards also may include, where appropriate, elements relating to—</text>
<subparagraph id="idbdd16e75a1b740eb954be5e52bb29232"><enum>(A)</enum><text>adequacy and quality of facilities;</text> </subparagraph><subparagraph id="id888575962446415c9f5267f561900930"><enum>(B)</enum><text>training and competence of personnel (including continuing education requirements);</text>
</subparagraph><subparagraph id="idda1dac1c734b4ae49a0e044dc6f58029"><enum>(C)</enum><text>comprehensiveness of service;</text> </subparagraph><subparagraph id="id253938b1bbe84d748cecd95d3f80d052"><enum>(D)</enum><text>continuity of service;</text>
</subparagraph><subparagraph id="id121aacc12bb34368b34afc07cab6b869"><enum>(E)</enum><text>patient satisfaction, including waiting time and access to services; and</text> </subparagraph><subparagraph id="id045aab35e2214c9fbcc3742be3e4d177"><enum>(F)</enum><text>performance standards, including organization, facilities, structure of services, efficiency of operation, and outcome in palliation, improvement of health, stabilization, cure, or rehabilitation.</text>
</subparagraph></paragraph><paragraph id="idc0a19c33ac0a4ad1ab4bd32671066752"><enum>(3)</enum><header>Transition in application</header><text>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.</text>
</paragraph><paragraph id="id0CF66FA1F03F4C88A3B54A572D4887B9"><enum>(4)</enum><header>Ability to provide services</header><text>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.</text>
</paragraph></subsection><subsection id="id3F4331ED4DA1428992A2831A84309957"><enum>(c)</enum><header>Federal providers</header><text>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.</text>
</subsection></section><section id="id9284868594934585837028a98cfaec3b"><enum>303.</enum><header>Use of private contracts</header>
<subsection commented="no" id="idb2db94ea51ff440cbbb39d44528f50e5"><enum>(a)</enum><header>In general</header><text>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—</text>
<paragraph commented="no" id="id463d83ffcb7c4c3e9a0edead2551d9c4"><enum>(1)</enum><text>for which no claim for payment is to be submitted under this Act, and</text> </paragraph><paragraph commented="no" id="idec4bc08a971a41bbbaf22d40f9a91a66"><enum>(2)</enum><text>for which the provider receives—</text>
<subparagraph commented="no" id="id09424b5d7c54455dad40279af43d5652"><enum>(A)</enum><text>no reimbursement under this Act directly or on a capitated basis, and</text> </subparagraph><subparagraph commented="no" id="id0eff1c0a62d242528326bf6f39944d1b"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection id="ida47840d9d0f24debb860f8885581a32e"><enum>(b)</enum><header>Beneficiary protections</header>
<paragraph id="ida2cc7f984f844f2896033626b77fad8d"><enum>(1)</enum><header>In general</header><text>Subsection (a) shall not apply to any contract unless—</text> <subparagraph id="id39c778645d04450b95e5c80419dc20e0"><enum>(A)</enum><text>the contract is in writing and is signed by the beneficiary before any item or service is provided pursuant to the contract;</text>
</subparagraph><subparagraph id="id697e1e0dfdd94def81f8858839ee754f"><enum>(B)</enum><text>the contract contains the items described in paragraph (2); and</text> </subparagraph><subparagraph id="id7d09a4e96d504fbca6e36d9131a1d5cf"><enum>(C)</enum><text>the contract is not entered into at a time when the beneficiary is facing an emergency health care situation.</text>
</subparagraph></paragraph><paragraph id="id2d3494f0162944d589e0d05fb8cd18d0"><enum>(2)</enum><header>Items required to be included in contract</header><text>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—</text>
<subparagraph id="id4b4433c83c974cf293b8e469dc78063d"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="id46138a0ccb47405d9821d43f98e9abff"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="id80e2298694394e389c45daaf448b24f9"><enum>(C)</enum><text>acknowledges that no limits under this Act apply to amounts that may be charged for such items or services;</text>
</subparagraph><subparagraph id="idc2dcc1dd06c8433084a0bd0656eccfa4"><enum>(D)</enum><text>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</text>
</subparagraph><subparagraph commented="no" id="id98C572342D4A4E9394D9542C56695698"><enum>(E)</enum><text>acknowledges that the provider is providing services outside the scope of the program under this Act.</text>
</subparagraph></paragraph></subsection><subsection id="ide739c8bafcd44794a9a0499e657eb6cf"><enum>(c)</enum><header>Provider requirements</header>
<paragraph id="idfeb06a0f703c4a9cb8592c42dcfdeec2"><enum>(1)</enum><header>In general</header><text>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.</text>
</paragraph><paragraph id="id3ff7a054ea92440897de34d0d1717311"><enum>(2)</enum><header>Affidavit</header><text>An affidavit is described in this subparagraph shall—</text> <subparagraph id="idca41e3f59fe24465915cdaef8e641126"><enum>(A)</enum><text>identify the practitioner, and be signed by such practitioner;</text>
</subparagraph><subparagraph id="id389809094eca46cc8a467401c598fcac"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph id="id53b0911f6cf94a7fb9a68bccafd3ae81"><enum>(C)</enum><text>be filed with the Secretary no later than 10 days after the first contract to which such affidavit applies is entered into.</text>
</subparagraph></paragraph><paragraph id="idcfad098980694ee7bf72c8bcee5592e5"><enum>(3)</enum><header>Enforcement</header><text>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—</text>
<subparagraph id="id88e1636c0d7141de87a87bdb9391cd2b"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="idb3827bb1b6f24d458f5225cc75874380"><enum>(B)</enum><text>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).</text>
</subparagraph></paragraph></subsection></section><enum>IV</enum><header>Administration</header>
<subtitle id="id12a2aee7c7eb47b1877dc52e19d4a951"><enum>A</enum><header>General administration provisions</header>
<section id="id9566d84c94d446278a70f1f132dc1a1f"><enum>401.</enum><header>Administration</header>
<subsection id="idf597f326f23e45c2a5413d11616dee37"><enum>(a)</enum><header>General duties of the Secretary</header>
<paragraph id="ide7bcce059fd74a498f0c17cd8e53382a"><enum>(1)</enum><header>In general</header><text>The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including related to—</text>
<subparagraph id="id51a2d40e73fe486d87f4947cf9d1c86c"><enum>(A)</enum><text>eligibility for benefits;</text> </subparagraph><subparagraph id="idbeb4b031415a47ff9cee73c4f6c52c73"><enum>(B)</enum><text>enrollment;</text>
</subparagraph><subparagraph id="id2208bca60bc5482ba1a2f3126041db95"><enum>(C)</enum><text>benefits provided;</text> </subparagraph><subparagraph id="id9324b5b09ba64055aa4c0a456e34ef2b"><enum>(D)</enum><text>provider participation standards and qualifications, as described in title III;</text>
</subparagraph><subparagraph id="id931c866839c941a3931866190dc4be73"><enum>(E)</enum><text>levels of funding;</text> </subparagraph><subparagraph id="idec6b9d7752264e828272d345ecbb7e33"><enum>(F)</enum><text>methods for determining amounts of payments to providers of covered services, consistent with subtitle B;</text>
</subparagraph><subparagraph id="ide803022fc71941d3852274dcc66422d3"><enum>(G)</enum><text>the determination of medical necessity and appropriateness with respect to coverage of certain services;</text>
</subparagraph><subparagraph id="id96f4a8c609e7436c9178cbb6e6289295"><enum>(H)</enum><text>planning for capital expenditures and service delivery;</text> </subparagraph><subparagraph id="id97150f32bb4a42ea8c7fc8a9afbffada"><enum>(I)</enum><text>planning for health professional education funding;</text>
</subparagraph><subparagraph id="id424f9b95300242b4880dfc9ba595650d"><enum>(J)</enum><text>encouraging States to develop regional planning mechanisms; and</text> </subparagraph><subparagraph id="idb4c229beb4da49c28101dc7ddccf8302"><enum>(K)</enum><text>any other regulations necessary to carry out the purpose of this Act.</text>
</subparagraph></paragraph><paragraph id="idbf81656172eb479d95290048f2fbe0b0"><enum>(2)</enum><header>Regulations</header><text>Regulations authorized by this Act shall be issued by the Secretary in accordance with section 553 of title 5, United States Code.</text>
</paragraph></subsection><subsection id="id23f6e56b5351496a9cf1218899696029"><enum>(b)</enum><header>Uniform reporting standards; annual report; studies</header>
<paragraph id="id0743ddc43eca444f91ec268670aedfce"><enum>(1)</enum><header>Uniform reporting standards</header>
<subparagraph id="id6a012c9890544da5bbf9ef331fdcc5a9"><enum>(A)</enum><header>In general</header><text>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).</text>
</subparagraph><subparagraph id="idf75b6ec0bc8942779561bb5c5506c08b"><enum>(B)</enum><header>Reports</header><text>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.</text>
</subparagraph></paragraph><paragraph id="id675d188be61142939a6a10dc603afd99"><enum>(2)</enum><header>Annual report</header><text>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:</text>
<subparagraph id="id9f6a78f38fed499bafacf46cb932ecd1"><enum>(A)</enum><text>The status of implementation of the Act.</text> </subparagraph><subparagraph id="id9788d59f541f472bb47c698f0bc50f66"><enum>(B)</enum><text>Enrollment under this Act.</text>
</subparagraph><subparagraph id="id6404ec990656449e98ede9071d91891d"><enum>(C)</enum><text>Benefits under this Act.</text> </subparagraph><subparagraph id="id7f00a94e61234e21b9724236ff8b822b"><enum>(D)</enum><text>Expenditures and financing under this Act.</text>
</subparagraph><subparagraph id="id028cd88e28944019b149d01b96926a9f"><enum>(E)</enum><text>Cost-containment measures and achievements under this Act.</text> </subparagraph><subparagraph id="id562a67cb4c264d4a922f80c0185a3047"><enum>(F)</enum><text>Quality assurance.</text>
</subparagraph><subparagraph id="id0ad108aa47694673b5c581dfd08ac298"><enum>(G)</enum><text>Health care utilization patterns, including any changes attributable to the program.</text> </subparagraph><subparagraph id="id5a143d372a90498293ca74ed9bd73b1a"><enum>(H)</enum><text>Changes in the per-capita costs of health care.</text>
</subparagraph><subparagraph id="ida2bb2548efd043439016c84435514b25"><enum>(I)</enum><text>Differences in the health status of the populations of the different States, including income and racial characteristics, and other population health inequities.</text>
</subparagraph><subparagraph id="id8059011B04AB4042A805794E08A25631"><enum>(J)</enum><text>Progress on quality and outcome measures, and long-range plans and goals for achievements in such areas.</text>
</subparagraph><subparagraph id="idbf66f3a621a64484ae894d80b2bc5aae"><enum>(K)</enum><text>Necessary changes in the education of health personnel.</text> </subparagraph><subparagraph id="ida8caca06a4ba48dfaf8be316079a9c3f"><enum>(L)</enum><text>Plans for improving service to medically underserved populations.</text>
</subparagraph><subparagraph id="id4d309bafc032432092f3ca1ea61a78ad"><enum>(M)</enum><text>Transition problems as a result of implementation of this Act.</text> </subparagraph><subparagraph id="idec68d52237044c0790c9780214b3a3cc"><enum>(N)</enum><text>Opportunities for improvements under this Act.</text>
</subparagraph></paragraph><paragraph id="id6dccf3b56db04d7191f78c01e0d3e8b0"><enum>(3)</enum><header>Statistical analyses and other studies</header><text>The Secretary may, either directly or by contract—</text> <subparagraph id="id1d2af516c4fc4d019c76b0856f495ebb"><enum>(A)</enum><text>make statistical and other studies, on a nationwide, regional, State, or local basis, of any aspect of the operation of this Act;</text>
</subparagraph><subparagraph id="id33ed67f9ca9847aabfa5b42c3265eb8c"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph id="id6E0F870112B44FFBB749F9D640093D9B"><enum>(C)</enum><text>develop methodological standards for evidence-based policymaking.</text> </subparagraph></paragraph></subsection><subsection id="id9FC74113E9734C1DB311769420EA0655"><enum>(c)</enum><header>Audits</header> <paragraph id="idf0ab5b523c89444fb4182575d9f4bc80"><enum>(1)</enum><header>In general</header><text>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).</text>
</paragraph><paragraph id="id762bbc97c7f742b7b56be82d20973099"><enum>(2)</enum><header>Reports</header><text>The Comptroller General of the United States shall submit a report to Congress concerning the results of each audit conducted under this subsection.</text>
</paragraph></subsection></section><section id="id6bcbd154ee3e411b81b5540b05be949c"><enum>402.</enum><header>Consultation</header><text display-inline="no-display-inline">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.</text>
</section><section id="id1f82ffb3f60044a985b3555b25ed880a"><enum>403.</enum><header>Regional administration</header>
<subsection id="id28ede1b500824105936c423941d65c4c"><enum>(a)</enum><header>Coordination with regional offices</header><text>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.</text>
</subsection><subsection id="id485636493f9c488d9d3e99aa82deed06"><enum>(b)</enum><header>Appointment of regional and State directors</header><text>In each such regional office there shall be—</text> <paragraph id="idc81ae2c8bcdd4cfdb4ed7944485ba8f3"><enum>(1)</enum><text>one regional director appointed by the Secretary;</text>
</paragraph><paragraph id="ided09e467e345408d8c21262e885bc07d"><enum>(2)</enum><text>for each State in the region, a deputy director; and</text> </paragraph><paragraph id="id7BCC9F966591444E89DA82D164FDD072"><enum>(3)</enum><text>one deputy director to represent the Native American and Alaska Native tribes in the region.</text>
</paragraph></subsection><subsection id="id134965c839da41fea55e4365042fa80b"><enum>(c)</enum><header>Regional office duties</header><text>Regional offices shall be responsible for—</text> <paragraph id="id3052e3360f4b4723b14df5d92d817565"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="ida99f922631ae480bac37f6819d7fa9cd"><enum>(2)</enum><text>recommending changes in provider reimbursement or payment for delivery of health services in the States within the region; and</text>
</paragraph><paragraph id="id29C328491A25422EA4B471E70D504549"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section id="id609368cc74f14ffe8d3a3b50ad657fa8"><enum>404.</enum><header>Beneficiary ombudsman</header>
<subsection id="idb1d9ac2886f14119a23aea34ce5b3f9d"><enum>(a)</enum><header>In general</header><text>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.</text>
</subsection><subsection id="id0671a55d0778420980e8e63783764ecd"><enum>(b)</enum><header>Duties</header><text>The Beneficiary Ombudsman shall—</text> <paragraph id="id707b3b4b5363491583e2ebec77e74681"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="id6ed934e156de4ca393be33a386e81c4d"><enum>(2)</enum><text>provide assistance with respect to complaints, grievances, and requests referred to in subparagraph (a), including—</text>
<subparagraph id="id5c3b5a37cf0c4b64b5ba2db8bcda42dc"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph commented="no" id="id16ccd6520b004ce8aeba4d73ffe75a23"><enum>(B)</enum><text>assistance to such individuals in presenting information under relating to cost-sharing; and</text>
</subparagraph></paragraph><paragraph id="idb6bbc9c9dc314053b3d743df37a23b8d"><enum>(3)</enum><text>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.</text>
</paragraph></subsection></section><section id="idc3c5504d8a794556ac213ef2ad5288d7"><enum>405.</enum><header>Complementary conduct of related health programs</header><text display-inline="no-display-inline">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.</text>
</section></subtitle><subtitle id="id7a2ee307a0a5439a8f7012f4ea9da080"><enum>B</enum><header>Control over fraud and abuse</header>
<section id="id9716a24e6dd74c4293ebcc94c6fccba7"><enum>411.</enum><header>Application of Federal sanctions to all fraud and abuse under Universal Medicare Program</header><text display-inline="no-display-inline">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:</text>
<paragraph id="iddc43c2cb64584a0aa61aaba0325f9d95"><enum>(1)</enum><text>Section 1128 (relating to exclusion of individuals and entities).</text> </paragraph><paragraph id="id799d2a4d34e74299a2a62cc761de8526"><enum>(2)</enum><text>Section 1128A (civil monetary penalties).</text>
</paragraph><paragraph id="id74561bbe6b9d4bdd873e3e0db8fdc77e"><enum>(3)</enum><text>Section 1128B (criminal penalties).</text> </paragraph><paragraph id="id538923b375cb45be91c15e75c74c415c"><enum>(4)</enum><text>Section 1124 (relating to disclosure of ownership and related information).</text>
</paragraph><paragraph id="id4c1563f9efaa4de2a341fd53131870db"><enum>(5)</enum><text>Section 1126 (relating to disclosure of certain owners).</text> </paragraph></section></subtitle><enum>V</enum><header>Quality assessment</header> <section id="id566950cc2a0940208776df06c3d86ded"><enum>501.</enum><header>Quality standards</header> <subsection commented="no" id="iddef4672784c8497c944918180c648a91"><enum>(a)</enum><header>In general</header><text>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 <quote>Center</quote>), in coordination with the Agency for Healthcare Research and Quality and other offices of the Department of Health and Human Services.</text>
</subsection><subsection id="id1f271b7cda9a4f3d9025e5efe6733487"><enum>(b)</enum><header>Duties of the center</header><text>The Center shall perform the following duties:</text> <paragraph id="id94696a31915d49dabd700a05ad94cc3f"><enum>(1)</enum><header>Practice guidelines</header><text>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.</text>
</paragraph><paragraph id="idc3030eb5585943ba87c1a49dd0598f21"><enum>(2)</enum><header>Standards of quality, performance measures, and medical review criteria</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/299">42 U.S.C. 299</external-xref> 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.</text>
</paragraph><paragraph id="id85daa0d6ea3c426fb44e135259faca66"><enum>(3)</enum><header>Profiling of patterns of practice; identification of outliers</header><text>The Center shall adopt methodologies for profiling the patterns of practice of health care professionals and for identifying and notifying outliers.</text>
</paragraph><paragraph id="id5b4273391a394503860d7cf0137f8c0e"><enum>(4)</enum><header>Criteria for entities conducting quality reviews</header><text>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.</text>
</paragraph><paragraph id="id3b4b699cb29347eaae8b7148dc6ea329"><enum>(5)</enum><header>Reporting</header><text>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).</text>
</paragraph></subsection></section><section id="id1dc0384f33844b2292904b2d6d794a15"><enum>502.</enum><header>Addressing health care disparities</header>
<subsection id="idd894933d73eb48caadd7e98a7d61568e"><enum>(a)</enum><header>Evaluating data collection approaches</header><text>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:</text>
<paragraph id="id2579e008a3fa4d808450623de217df2e"><enum>(1)</enum><text>Protecting patient privacy.</text> </paragraph><paragraph id="ide4aa33884167444e81c5b45d0524c0c6"><enum>(2)</enum><text>Minimizing the administrative burdens of data collection and reporting on providers under this Act.</text>
</paragraph><paragraph id="id7888e7271add45c9a962417e58d05e15"><enum>(3)</enum><text>Improving Universal Medicare Program data on race, ethnicity, gender, geography, and socioeconomic status.</text>
</paragraph></subsection><subsection id="id7570b23e4a2444459a47067d63e2329f"><enum>(b)</enum><header>Reports to congress</header>
<paragraph id="id359cea28cedb4d6a86b86b362d35dcf0"><enum>(1)</enum><header>Report on evaluation</header><text>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—</text>
<subparagraph id="id6bd3992cda1e46e9945b24a4943b6939"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="id23f172427964415895f4fd8f6b6ce0ad"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="ide3af066391e54338a5261e93502d54d4"><enum>(2)</enum><header>Report on data analyses</header><text>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).</text>
</paragraph></subsection><subsection id="id7e8e3da068eb4e8da0dc9653525b71fb"><enum>(c)</enum><header>Implementing effective approaches</header><text>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.</text>
</subsection></section><enum>VI</enum><header>Health budget; payments; cost containment measures</header>
<subtitle id="id7a952ee20ca64ea7967afd0785c3e72d"><enum>A</enum><header>Budgeting</header>
<section id="id6a446c63a93e4b7bbbaffa1cb6e6e382"><enum>601.</enum><header>National health budget</header>
<subsection id="id1f398aa1e1cb4906b35e2aa8b15c408b"><enum>(a)</enum><header>National health budget</header>
<paragraph id="id43780a38a4e64de1913b07e01fbec14b"><enum>(1)</enum><header>In general</header><text>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.</text>
</paragraph><paragraph id="id655734adc34c4877ba405709d8bff359"><enum>(2)</enum><header>Division of budget into components</header><text>In addition to the cost of covered health services, the national health budget shall consist of at least the following components:</text>
<subparagraph id="id485a1a0c377b412da556ce37595f2a97"><enum>(A)</enum><text>Quality assessment activities under title V.</text> </subparagraph><subparagraph id="idcbc25e346f5d44b19909d2dcabc9e312"><enum>(B)</enum><text>Health professional education expenditures.</text>
</subparagraph><subparagraph id="id901496f4a96049d687e4614348377f0a"><enum>(C)</enum><text>Administrative costs.</text> </subparagraph><subparagraph id="id590500d0880441de86673758227ba946"><enum>(D)</enum><text>Innovation, including in accordance with section 1115A of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315a">42 U.S.C. 1315a</external-xref>).</text>
</subparagraph><subparagraph id="ida5ed21abb42544e5938d50eeb5dcc10d"><enum>(E)</enum><text>Operating and other expenditures not described in subparagraphs (A) through (D) (referred to in this Act as the <quote>operating component</quote>), consisting of amounts not included in the other components.</text>
</subparagraph><subparagraph id="id928f4faac51a4210b9c3abf00339b115"><enum>(F)</enum><text>Capital expenditures.</text> </subparagraph><subparagraph id="id8412ACF4DFC246C8BE454C3C29306BC7"><enum>(G)</enum><text>Prevention and public health activities.</text>
</subparagraph></paragraph><paragraph id="idd9005ea9810c43699b9780357d98b1ea"><enum>(3)</enum><header>Allocation among components</header><text>The Secretary shall allocate the budget among the components in a manner that—</text> <subparagraph id="id12f8bceddd6b4ad786298e441b5ffe3f"><enum>(A)</enum><text>ensures a fair allocation for quality assessment activities; and</text>
</subparagraph><subparagraph id="idecde327fe7b64f3b99864cb10bff1115"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="id5cd8686073694ce592f52eec55927253"><enum>(4)</enum><header>Temporary worker assistance</header><text>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.</text>
</paragraph><paragraph id="idB0F51E5F6671472AB8589FDC5B2C8F96"><enum>(5)</enum><header>Reserve fund</header><text>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.</text>
</paragraph></subsection><subsection id="idc4a19eee2c0b443e98c4bcad2cdc244f"><enum>(b)</enum><header>Definitions</header><text>In this section:</text> <paragraph id="idcfd575f8e29f4aa8a575cd755957c46e"><enum>(1)</enum><header>Capital expenditures</header><text>The term <term>capital expenditures</term> means expenses for the purchase, lease, construction, or renovation of capital facilities and for equipment and includes return on equity capital.</text>
</paragraph><paragraph id="id0bdf52af735348ae8c3ce73550a58ff4"><enum>(2)</enum><header>Health professional education expenditures</header><text>The term <term>health professional education expenditures</term> means expenditures in hospitals and other health care facilities to cover costs associated with teaching and related research activities.</text>
</paragraph></subsection></section></subtitle><subtitle id="idb1e60341ba8f48ae89babc1f03f3c3e7"><enum>B</enum><header>Payments to providers</header>
<section id="id6cbd889ca09d4bb7937d5e6ecadbcf6f"><enum>611.</enum><header>Payments to institutional and individual providers</header>
<subsection id="id494593af588b420db1cf613c074ad48d"><enum>(a)</enum><header>Application of Payment Processes under Title XVIII</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.), including the application of the provisions of, and amendments made by, section 612.</text>
</subsection><subsection id="id04851daa51c3455f95414351846242b8"><enum>(b)</enum><header>Application of Current and Planned Payment Reforms</header><text>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 (<external-xref legal-doc="public-law" parsable-cite="pl/114/10">Public Law 114–10</external-xref>) and the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>).</text>
</subsection></section><section id="id277b238803bc4edab4ebcb062c010103"><enum>612.</enum><header>Ensuring accurate valuation of services under the Medicare physician fee schedule</header>
<subsection id="idb900a6ce5ff444cb899dbcaae68a7627"><enum>(a)</enum><header>Standardized and Documented Review Process</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idBCBB889880D64ED8A7E5692EC1E02C6C" style="OLC">
<subparagraph id="id4E55A8E40E0A4DDCA656C6E28E9A46B0"><enum>(P)</enum><header>Standardized and documented review process</header>
<clause id="id726C325335A4482FB1E71A8C22357F84"><enum>(i)</enum><header>In general</header><text>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.</text>
</clause><clause id="id9A3C40C2982A4324AF2FCD7138CCAC1C"><enum>(ii)</enum><header>Minimum requirements</header><text>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.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="idaeb23df41a5143c6a931fc1d188bf332"><enum>(b)</enum><header>Planned and Documented Use of Funds</header><text>Section 1848(c)(2)(M) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1305w-4">42 U.S.C. 1305w–4(c)(2)(M)</external-xref>) is amended by adding at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id154C90B2DDDF4713AAA95BE08EB5E4E7" style="OLC">
<clause id="id61EB119574CB4D12B2EF4A9C9696A542"><enum>(x)</enum><header>Planned and documented use of funds</header><text>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.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="ida2f126db21ba4a3c902d575214d36896"><enum>(c)</enum><header>Internal Tracking of Reviews</header>
<paragraph id="id266338473A6A45598183D4B94F0D17A3"><enum>(1)</enum><header>In general</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>), as amended by this section.</text>
</paragraph><paragraph id="idc7422949c9754f34be1c58fe3c3e35fe"><enum>(2)</enum><header>Minimum requirements</header><text>The proposal shall include, at a minimum, plans and a timeline for achieving the ability to systematically and internally track the following:</text>
<subparagraph id="id52514e4a5a464e69ab5914ef938d6d86"><enum>(A)</enum><text>When, how, and by whom services are identified for review.</text> </subparagraph><subparagraph id="idaaa933bb41554c3eb374c1372204ca0c"><enum>(B)</enum><text>When services are reviewed or reviewed or when new services are added.</text>
</subparagraph><subparagraph id="id561623ba2f644ae093a2f164342a3b1c"><enum>(C)</enum><text>The resources, evidence, data, and recommendations used in reviews.</text> </subparagraph><subparagraph id="idcaeeffb8a576422fbabe233bd7de7d79"><enum>(D)</enum><text>When relative values are adjusted.</text>
</subparagraph><subparagraph id="id82b5e08d6fe040ccb91bf9c1ef6f09eb"><enum>(E)</enum><text>The rationale for final relative value decisions.</text> </subparagraph></paragraph></subsection><subsection id="id0c3dff1b745f4fb1b1707aabac83b5f5"><enum>(d)</enum><header>Frequency of Review</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended—</text>
<paragraph id="idd28c31755efe4dabb5582f3ac754cd5f"><enum>(1)</enum><text>in subparagraph (B)(i), by striking <quote>5</quote> and inserting <quote>4</quote>; and</text> </paragraph><paragraph id="id0883db37cb95436da3884f1d46a4f5c2"><enum>(2)</enum><text>in subparagraph (K)(i)(I), by striking <quote>periodically</quote> and inserting <quote>annually</quote>.</text>
</paragraph></subsection><subsection id="id64977587ffce4743a81a5764ade7119c"><enum>(e)</enum><header>Consultation with medicare payment advisory commission</header>
<paragraph id="id887e2cb4ec2f4fe78531353dc8645ecd"><enum>(1)</enum><header>In general</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>) is amended—</text> <subparagraph id="idb9e4178cb70e48a68e9bdb79d877be05"><enum>(A)</enum><text>in subparagraph (B)(i), by inserting <quote>in consultation with the Medicare Payment Advisory Commission,</quote> after <quote>The Secretary,</quote>; and</text>
</subparagraph><subparagraph id="id8129cc21c3da4a008395ffbe5dceb9af"><enum>(B)</enum><text>in subparagraph (K)(i)(I), as amended by subsection (d)(2), by inserting <quote>in coordination with the Medicare Payment Advisory Commission,</quote> after <quote>years,</quote>.</text> </subparagraph></paragraph><paragraph id="id22f1ef2909484b0391e4bb481a003922"><enum>(2)</enum><header>Conforming amendments</header><text>Section 1805 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-6">42 U.S.C. 1395b–6</external-xref>) is amended—</text>
<subparagraph id="idf14cc44a819b41adbb25481df01e20c0"><enum>(A)</enum><text>in subsection (b)(1)(A), by inserting the following before the semicolon at the end: <quote>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</quote>; and</text>
</subparagraph><subparagraph id="idf40fc46a0a154e998cfaea0dd7343216"><enum>(B)</enum><text>in subsection (e)(1), in the second sentence, by inserting <quote>or the Ranking Minority Member</quote> after <quote>the Chairman</quote>.</text> </subparagraph></paragraph></subsection><subsection id="idf9b074936039440e835d8943b1976138"><enum>(f)</enum><header>Periodic Audit by the Comptroller General</header><text>Section 1848(c)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)</external-xref>), as amended by subsection (a), is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="id2502C38438AD4F4FB7D1158982833200" style="OLC">
<subparagraph id="id05f3cbfb87df40fd8b74c09de1269132"><enum>(Q)</enum><header>Periodic audit by the Comptroller General</header>
<clause id="id8961AD4DF1D34285A0CE1B953B1C46A8"><enum>(i)</enum><header>In general</header><text>The Comptroller General of the United States (in this subsection referred to as the <quote>Comptroller General</quote>) shall periodically audit the review by the Secretary of relative values established under this paragraph for physicians' services.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idb83aa76171564b2386f521038eb81751"><enum>(ii)</enum><header>Access to information</header><text>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.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" id="idF9F1E530C9D64593BC1991F2B2677FD8"><enum>613.</enum><header>Office of primary health care</header>
<subsection id="idad739bfbc7eb4f548aabbf057ea4bdb1"><enum>(a)</enum><header>In general</header><text>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—</text>
<paragraph id="id4a434752c3414587b7aa3bc3277527d1"><enum>(1)</enum><text>coordinate health professional education policies and goals, in consultation with the Secretary to achieve the national goals specified in subsection (b);</text>
</paragraph><paragraph id="id525999ff39744e6381199e6b646f9b06"><enum>(2)</enum><text>develop and maintain a system to monitor the number and specialties of individuals through their health professional education, any postgraduate training, and professional practice;</text>
</paragraph><paragraph id="id5c7aa7943dcb4631a6479ac417940300"><enum>(3)</enum><text>develop, coordinate, and promote policies that expand the number of primary care practitioners, registered nurses, midlevel practitioners, and dentists; and</text>
</paragraph><paragraph id="id73e8d3615b8d4efdb8683ac098dc5e75"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><subsection id="idbe29b7c0267f417f86ce61aba6c2a13e"><enum>(b)</enum><header>National goals</header><text>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.</text>
</subsection></section><section id="iddc9275eccb30450894cd33ad24765fb6"><enum>614.</enum><header>Payments for prescription drugs and approved devices and equipment</header>
<subsection id="idc697fd2ce7d84bfd8f57e2d9db544a06"><enum>(a)</enum><header>Negotiated prices</header><text>The prices to be paid for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Secretary.</text>
</subsection><subsection id="id8d26ab3b66b5415d97c9df28372fe41a"><enum>(b)</enum><header>Prescription drug formulary</header>
<paragraph id="id9c82ecde9b3847e38dd072d4972b8aea"><enum>(1)</enum><header>In general</header><text>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.</text>
</paragraph><paragraph id="ida91f0c4310e3416d85eeb8c416969a09"><enum>(2)</enum><header>Promotion of use of generics</header><text>The formulary under this subsection shall promote the use of generic medications to the greatest extent possible.</text>
</paragraph><paragraph id="id3398b9ee4ab44c28bbc9e65770f3c49e"><enum>(3)</enum><header>Formulary updates and petition rights</header><text>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.</text>
</paragraph><paragraph id="id7c67e6d5ded24f74847c7fece7711d1d"><enum>(4)</enum><header>Use of off-formulary medications</header><text>The Secretary shall promulgate rules regarding the use of off-formulary medications which allow for patient access but do not compromise the formulary.</text>
</paragraph></subsection></section></subtitle><enum>VII</enum><header>Universal Medicare Trust Fund</header>
<section id="idf93df9d4a62b40d69223dab0cf0596e1"><enum>701.</enum><header>Universal Medicare Trust Fund</header>
<subsection id="id5c81c23b5dd34a75a85ee1036c599503"><enum>(a)</enum><header>In general</header><text>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 <quote>Trust Fund</quote>). 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.</text>
</subsection><subsection id="ida5870a23e94e42aab559092524a62cc2"><enum>(b)</enum><header>Appropriations into trust fund</header>
<paragraph id="idd55afc0c01e742eb868f3456d2edd257"><enum>(1)</enum><header>Taxes</header>
<text>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.</text>
</paragraph><paragraph id="id7c183bb6f31e4f9e8c26737176945b14"><enum>(2)</enum><header>Current program receipts</header><text>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:</text>
<subparagraph id="id90a76511a2564c06a092f19b9643bc50"><enum>(A)</enum><text>The Medicare program under title XVIII of the Social Security Act (other than amounts attributable to any premiums under such title).</text>
</subparagraph><subparagraph id="id3726c907d83d4e8784a713f74471b08c"><enum>(B)</enum><text>The Medicaid program, under State plans approved under title XIX of such Act.</text> </subparagraph><subparagraph id="id51ec286bef1f49a9b2b87a2adefc4c1b"><enum>(C)</enum><text>The Federal Employees Health Benefits program, under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter 89</external-xref> of title 5, United States Code.</text>
</subparagraph><subparagraph id="id2e8ca2c0b4724ceba8bb903b113c4f77"><enum>(D)</enum><text>The TRICARE program, under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States Code.</text> </subparagraph><subparagraph id="id2d67b64325194fc98243f5b19884391d"><enum>(E)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="id82960257FAD7499AAC1000A681E49385"><enum>(3)</enum><header>Restrictions shall not apply</header><text>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.</text>
</paragraph></subsection><subsection id="id29af0bbf628641c09c9ce85d2e56e5dd"><enum>(c)</enum><header>Incorporation of provisions</header><text>The provisions of subsections (b) through (i) of section 1817 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i</external-xref>) 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 <quote>Board of Trustees of the Trust Fund</quote> shall mean the <quote>Secretary</quote>.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id4524fc8ba10f43eca54c81a1a2d8e9ab"><enum>(d)</enum><header>Transfer of funds</header><text>Any amounts remaining in the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i">42 U.S.C. 1395i</external-xref>) or the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>) 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.</text>
</subsection></section><enum>VIII</enum><header>Conforming amendments to the employee retirement income security act of 1974</header>
<section id="id7a32a7ac8c574e61848ec14990c2bf32"><enum>801.</enum><header>Prohibition of employee benefits duplicative of benefits under the Universal Medicare Program;
coordination in case of workers’ compensation</header>
<subsection id="id57142e44d7a64b859230eb81f085ec5c"><enum>(a)</enum><header>In general</header><text>Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1131">29 U.S.C. 1131</external-xref> et seq.) is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id4AA8AE3FBA734E5D9D1477B47B57915B" style="OLC">
<section id="id777CA93830154D4381085FABC2C3E20B"><enum>522.</enum><header>Prohibition of employee benefits duplicative of Universal Medicare Program benefits;
coordination in case of workers’ compensation</header>
<subsection id="id545337C555B44BE9BA9C4346F6195C65"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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 <short-title>Medicare for All Act of 2017</short-title>.</text>
</subsection><subsection id="id9C415B252ED5407DB185608E0A425126"><enum>(b)</enum><header>Reimbursement</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="id1D6DBB4306374DA983A826868DACE9E5"><enum>(c)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subsection—</text> <paragraph id="idA0EAE984864D4D76B15B7DF38EDD4864"><enum>(1)</enum><text display-inline="yes-display-inline">the term <term>workers compensation carrier</term> 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;</text>
</paragraph><paragraph id="id0632A6D48D564F36B7AACCBAF9F13A5F"><enum>(2)</enum><text display-inline="yes-display-inline">the term <term>workers compensation medical benefits</term> 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</text>
</paragraph><paragraph id="id194D460740D64A648AB881710190A916"><enum>(3)</enum><text display-inline="yes-display-inline">the term <term>workers compensation services</term> 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.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id1af172ab594841e5a42da36ab953f57b"><enum>(b)</enum><header>Conforming amendment</header><text>Section 4(b) of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1003">29 U.S.C. 1003(b)</external-xref>) is amended by adding at the end the following: <quote>Paragraph (3) shall apply subject to section 522(b) (relating to reimbursement of the Universal Medicare Program by workers compensation carriers).</quote>.</text>
</subsection><subsection id="id03d25ca7e192442eaa41ceca0ce56d31"><enum>(c)</enum><header>Clerical amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="id926A70B95CDF446CA3A38FB17B390649" style="OLC"><toc><toc-entry bold="off" level="section">Sec 522. Prohibition of employee benefits duplicative of Universal Medicare Program
benefits; coordination in case of workers’ compensation.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="id571da13ffcae42ab8c4637ce372e7fc5"><enum>802.</enum><header>Repeal of continuation coverage requirements under ERISA and certain other requirements relating to
group health plans</header>
<subsection id="id4530c6935a8444c4b045ec6c113990a1"><enum>(a)</enum><header>In general</header><text>Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1161">29 U.S.C. 1161</external-xref> et seq.) is repealed.</text>
</subsection><subsection id="id4f05205a016c48d59e22bdd8da22b865"><enum>(b)</enum><header>Conforming amendments</header>
<paragraph id="id2cf0a4599e7140bf9b195eae4395632b"><enum>(1)</enum><text>Section 502(a) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1132">29 U.S.C. 1132(a)</external-xref>) is amended—</text> <subparagraph id="id3ecc26e9420f459087589d1fdc9e9308"><enum>(A)</enum><text>by striking paragraph (7); and</text>
</subparagraph><subparagraph id="id40cd3eb6b97e4f568e2691e46273fdd2"><enum>(B)</enum><text>by redesignating paragraphs (8), (9), and (10) as paragraphs (7), (8), and (9), respectively.</text> </subparagraph></paragraph><paragraph id="id6316c80e51a64de9b455a75acbf1004f"><enum>(2)</enum><text>Section 502(c)(1) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1132">29 U.S.C. 1132(c)(1)</external-xref>) is amended by striking <quote>paragraph (1) or (4) of section 606,</quote>.</text>
</paragraph><paragraph id="idef4ce18e76ac455f86f94043ebc09faa"><enum>(3)</enum><text>Section 514(b) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144">29 U.S.C. 1144(b)</external-xref>) is amended—</text> <subparagraph id="idd87e9460ae4d4c44911d772c53608aa9"><enum>(A)</enum><text>in paragraph (7), by striking <quote>section 206(d)(3)(B)(i)).</quote>; and</text>
</subparagraph><subparagraph id="id284c9fe7c949457998247232abcf89e0"><enum>(B)</enum><text>by striking paragraph (8).</text> </subparagraph></paragraph><paragraph id="idc423b181bcc94dff89f8db648e87f028"><enum>(4)</enum><text>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.</text>
</paragraph></subsection></section><section id="id5d176b418d6b4dd9bf18667161eaf624"><enum>803.</enum><header>Effective date of title</header><text display-inline="no-display-inline">The amendments made by this title shall take effect on the effective date of benefits under section 106(a).</text>
</section><enum>IX</enum><header>Additional conforming amendments</header>
<section id="ida557e1ae655449f5a9c34a27625fe9f9"><enum>901.</enum><header>Relationship to existing Federal health programs</header>
<subsection id="id507b210887d846948974f973b6a43541"><enum>(a)</enum><header>Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP)</header>
<paragraph id="id0eea45f1e0564f199061c23677bfbbf0"><enum>(1)</enum><header>In general</header><text>Notwithstanding any other provision of law, subject to paragraphs (2) and (3)—</text> <subparagraph id="id7389fce8362044e2a9988341d9cb9974"><enum>(A)</enum><text>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);</text>
</subparagraph><subparagraph id="id3ed437fc7ee34c96a49e0ded64efed1e"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="ideac96e4fe4044430a2b693f28623f371"><enum>(C)</enum><text>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</text>
</subparagraph><subparagraph id="idb8f7f6e2b1664100a293f4bb1f5abe1d"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3bef89ca41d84b2fb460eb46c2641e2a"><enum>(2)</enum><header>Transition</header><text>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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id4AD85D44F5F8466F8817B600B97090E4"><enum>(3)</enum><header>Services under Medicaid</header>
<subparagraph commented="no" display-inline="no-display-inline" id="idD22ED7A6D9584537954CB2009A8F34D7"><enum>(A)</enum><header>In general</header><text>This subsection shall not apply to entitlement to medical assistance provided under title XIX of the Social Security Act for—</text>
<clause commented="no" display-inline="no-display-inline" id="id7EDA32FF91934007856E6C1798FD72AC"><enum>(i)</enum><text>long-term care services (as defined in section 1947(b) of such Act); or</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id362E280D81F94E35853ED93E25655681"><enum>(ii)</enum><text>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.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idB13B31BFF1F64661A0F55501CC3BBFAC"><enum>(B)</enum><header>Coordination between Secretary and States</header><text>The Secretary shall coordinate with the directors of State agencies responsible for administering State plans under title XIX of the Social Security Act to—</text>
<clause commented="no" display-inline="no-display-inline" id="id9D8622B937664201A6E3A32D23688F2C"><enum>(i)</enum><text>identify services described in subparagraph (A)(ii) with respect to each State plan; and</text> </clause><clause commented="no" display-inline="no-display-inline" id="id048C3DA5890B41F0867257E49E11F700"><enum>(ii)</enum><text>ensure that such services continue to be made available under such plan.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id141AFEDE0CE1453B9F289B684D64D4BB"><enum>(C)</enum><header>Maintenance of effort requirement</header><text>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).</text>
</subparagraph></paragraph></subsection><subsection id="iddf35bfc669d1413a9f87fab997b797bf"><enum>(b)</enum><header>Federal employees health benefits program</header><text>No benefits shall be made available under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter 89</external-xref> of title 5, United States Code, for any part of a coverage period occurring on or after the effective date.</text>
</subsection><subsection id="id4fb759a8c6834b3cbd1652700072458a"><enum>(c)</enum><header>Tricare</header><text>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.</text>
</subsection><subsection id="id308ac60106f146e8b2c6ce3157cc0654"><enum>(d)</enum><header>Treatment of benefits for veterans and native americans</header>
<paragraph id="idbb1694460bc546c7866ee16f9ecc70ad"><enum>(1)</enum><header>In general</header><text>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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id39821868AE5C447AB1F1173E4F9F46CC"><enum>(2)</enum><header>Reevaluation</header><text>No reevaluation of the Indian Health Service shall be undertaken without consultation with tribal leaders and stakeholders.</text>
</paragraph></subsection></section><section id="idf1b0259333a246b39037eac94116b624"><enum>902.</enum><header>Sunset of provisions related to the State Exchanges</header>
<text display-inline="no-display-inline">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 (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>) 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.</text>
</section><enum>X</enum><header>Transition</header>
<subtitle id="id08433796479349C6B467B93D2E90F6CB" style="OLC"><enum>A</enum><header>Transitional Medicare buy-In option and transitional public option</header>
<section id="H36DE0A9229714D36866BFBAD9C533CFA"><enum>1001.</enum><header>Lowering the Medicare age</header>
<subsection display-inline="no-display-inline" id="H124DF366F4694B5F88C508A1AB2F8D79"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c</external-xref> et seq.) is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H66CBE30095004D6F8F51865AE1E53DF2" style="traditional"><section id="HBEED7A2017B04C28B19168668AE7DA4F"><enum>1899C.</enum><header>Transitional Medicare buy-in option for certain individuals</header><subsection commented="no" display-inline="yes-display-inline" id="HF7DF2A34B849473DA380B5CBB2EE71BA"><enum>(a)</enum><header>Option</header>
<paragraph id="id42A13E7EC0824BBC860E1800766748DE"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Every individual who meets the requirements described in paragraph (3) shall be eligible to enroll under this section.</text>
</paragraph><paragraph id="id34AACC8833ED4521A13DD207E9ACDA21"><enum>(2)</enum><header>Parts A, B, and D benefits</header><text>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).</text>
</paragraph><paragraph id="id98FC2C9283C3421380894A9BD45B84E6"><enum>(3)</enum><header>Requirements for eligibility</header><text>The requirements described in this paragraph are the following:</text> <subparagraph id="HB3F5D68C147548D5ABAFD1E98D8AA4A1"><enum>(A)</enum><text>The individual is a resident of the United States.</text>
</subparagraph><subparagraph id="H693844A9E5AA441691092A8BBEDEDE68"><enum>(B)</enum><text>The individual is—</text> <clause id="idD3BF02E1E1774FB68FD290823AC456DE"><enum>(i)</enum><text>a citizen or national of the United States; or</text>
</clause><clause id="idEF5739008E944E21BD878998B07F2DF4"><enum>(ii)</enum><text>an alien lawfully admitted for permanent residence.</text>
</clause></subparagraph><subparagraph id="H8DE1292783A842838255772BBED442CD"><enum>(C)</enum><text>The individual is not otherwise entitled to benefits under part A or eligible to enroll under part A or part B.</text>
</subparagraph><subparagraph id="id516DE65B38454634A34CF7A4861F9851"><enum>(D)</enum><text>The individual has attained the applicable years of age but has not attained 65 years of age.</text> </subparagraph></paragraph><paragraph id="idE5B97D90174A4C4A8B67906CC31870C5"><enum>(4)</enum><header>Applicable years of age defined</header><text>For purposes of this section, the term <term>applicable years of age</term> means—</text>
<subparagraph id="id0F80E85DE6F542E584D1B3916C387B95"><enum>(A)</enum><text>effective January 1 of the first year following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title>, the age of 55;</text> </subparagraph><subparagraph id="id0C3164F806E94A45864A3E9057FCBF19"><enum>(B)</enum><text>effective January 1 of the second year following such date of enactment, the age of 45; and</text>
</subparagraph><subparagraph id="id26AAEB6E655D42768115D0E1E797F6FC"><enum>(C)</enum><text>effective January 1 of the third year following such date of enactment, the age of 35.</text> </subparagraph></paragraph></subsection><subsection id="HCCD3339D605B433482E12064C9B5268D"><enum>(b)</enum><header>Enrollment; coverage</header><text>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.</text>
</subsection><subsection id="id3028BDE9448A477D87CA4DBEE325F6A6"><enum>(c)</enum><header>Premium</header>
<paragraph id="H89831D276DE4492AA7BF53AB28B249ED"><enum>(1)</enum><header>Amount of
monthly premiums</header><text>The Secretary shall, during September of each year (beginning with the first September following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title>), determine a monthly premium for all individuals enrolled under this section. Such monthly premium shall be equal to <fraction>1/12</fraction> 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.</text>
</paragraph><paragraph id="HDD50FF204E7840EB95FBC93BF8EC2E44"><enum>(2)</enum><header>Annual
premium</header>
<subparagraph id="H323EA48A03CF43579578873E6E7CE3FF"><enum>(A)</enum><header>Combined per
capita average for all Medicare benefits</header><text>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.</text>
</subparagraph><subparagraph id="H6F3A14D0D5844612A5D43549AE4D13CF"><enum>(B)</enum><header>Annual
premium</header><text>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.</text>
</subparagraph></paragraph><paragraph id="idB93E1E84968F4E7ABDB908440517A8D4"><enum>(3)</enum><header>Increased premium for certain part C and D plans</header><text>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.</text>
</paragraph></subsection><subsection id="id45BE0B32BC4A40A5BB1A6846026E8915"><enum>(d)</enum><header>Payment of premiums</header>
<paragraph id="id1C2B89834A434464928B181D49160E3C"><enum>(1)</enum><header>In general</header><text>Premiums for enrollment under this section shall be paid to the Secretary at such times, and in such manner, as the Secretary determines appropriate.</text>
</paragraph><paragraph id="idB7FB6644E0CD4B558552C09BFDFA3FAF"><enum>(2)</enum><header>Deposit</header><text>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.</text>
</paragraph></subsection><subsection commented="no" id="H111D717D5AE94721B6A2E8708FACD9FF"><enum>(e)</enum><header>Not eligible for Medicare cost-Sharing assistance</header><text>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.</text>
</subsection><subsection id="idCD0B51193E894C399B03179E96A121C8"><enum>(f)</enum><header>Treatment in relation to the Affordable Care Act</header>
<paragraph id="id1DDA26F324064CAE80ED28D7AF7EE81F"><enum>(1)</enum><header>Satisfaction of individual mandate</header><text display-inline="yes-display-inline">For purposes of applying <external-xref legal-doc="usc" parsable-cite="usc/26/5000A">section 5000A</external-xref> 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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id97F21439D5184C55829456BC0C0C4C59"><enum>(2)</enum><header display-inline="yes-display-inline">Eligibility for premium assistance</header><text display-inline="yes-display-inline">Coverage provided under this section—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idB062317DA7334BDEBE716DCFC9B4BF8B"><enum>(A)</enum><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B</external-xref> of the Internal Revenue Code of 1986 other than subsection (c)(2)(B) thereof; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idFF121C8061CA49A4BA6E80E178815E3A"><enum>(B)</enum><text display-inline="yes-display-inline">shall not be treated as eligibility for other minimum essential coverage for purposes of subsection (c)(2)(B) of such section 36B.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">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.</continuation-text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idB89AADEBC54643A6A1B4101F4860AB5E"><enum>(3)</enum><header>Eligibility for cost-sharing subsidies</header><text display-inline="yes-display-inline">For purposes of applying section 1402 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18071">42 U.S.C. 18071</external-xref>)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id337A4E44B9DB4CDB8D7CEE97F926505E"><enum>(A)</enum><text display-inline="yes-display-inline">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</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idE4E295759572454BBDAB1ED7533B12B1"><enum>(B)</enum><text display-inline="yes-display-inline">the Secretary shall be treated as the issuer of such plan.</text> </subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id8E21A1453A74432D9A2870968C56F8EA"><enum>(g)</enum><header>Guaranteed issue of Medigap policies upon first enrollment and each subsequent enrollment</header><text>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)—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id5A60F20309A840B1A621BE20C1E21EB0"><enum>(1)</enum><text>shall be applied by substituting <quote>the applicable year of age (as defined in section 1899C(a)(4))</quote> for <quote>65 years of age</quote>;</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7F1250E9F2074EF19D9DEC8E981FFF07"><enum>(2)</enum><text>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</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id2701669A6AB248739C2C006A44FF297D"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id00BE8AF7DBE64081909BC24D4FBE4502"><enum>(h)</enum><header>No effect on benefits for individuals otherwise eligible or on Trust funds</header><text>The Secretary shall implement the provisions of this section in such a manner to ensure that such provisions—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id865D767AF2674AF88DD7193E9B918B84"><enum>(1)</enum><text>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</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id54D47E7D767944BAB0D1B94D66C94DBC"><enum>(2)</enum><text>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).</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id56C9FB581E9D481688BEC0EEA2B4F694"><enum>(i)</enum><header>Consultation</header><text>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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="id17555CD0004C496D905BCC992067801A"><enum>1002.</enum><header>Establishment of the Medicare transition plan</header>
<subsection id="id92C9F896B0EB45F59F2B9A3079C254CD"><enum>(a)</enum><header>In general</header><text>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 <quote>Administrator</quote>), shall establish, and provide for the offering through the Exchanges, of a public health plan (in this Act referred to as the <quote>Medicare Transition plan</quote>) that provides affordable, high-quality health benefits coverage throughout the United States.</text>
</subsection><subsection id="id99C451B47583441EA9CE76411D2F0EBB"><enum>(b)</enum><header>Administrating the Medicare transition</header>
<paragraph id="id34C5086FC44C4D40AAE122B8789D4747"><enum>(1)</enum><header>Administrator</header><text>The Administrator shall administer the Medicare Transition plan in accordance with this section.</text> </paragraph><paragraph id="id8d38f109eaf542e4bc81b2840ea2fc55"><enum>(2)</enum><header>Application of ACA requirements</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg</external-xref> et seq.) that are applicable to qualified health plans offered through the Exchanges, subject to the limitation under subsection (e)(2).</text>
</paragraph><paragraph id="iddde64f4b4cee47af991ca35d17e37f86"><enum>(3)</enum><header>Offering through Exchanges</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/18032">42 U.S.C. 18032</external-xref>)) who wish to make such plan available to their employees.</text>
</paragraph><paragraph id="id46D1F44494BB4129A94EB05AE8F2E069"><enum>(4)</enum><header>Eligibility to purchase</header><text>Any United States resident may enroll in the Medicare Transition plan.</text> </paragraph></subsection><subsection id="id7C4C301150534EABA7365338AEA75EE9"><enum>(c)</enum><header>Benefits; actuarial value</header><text>In carrying out this section, the Administrator shall ensure that the Medicare Transition plan provides—</text>
<paragraph id="id387BFD16B76E416594A742A6343AA8E6"><enum>(1)</enum><text>coverage for the benefits required to be covered under title II; and</text> </paragraph><paragraph id="id9A33C4257F204CA99884E8E4C5912F31"><enum>(2)</enum><text>coverage of benefits that are actuarially equivalent to 90 percent of the full actuarial value of the benefits provided under the plan.</text>
</paragraph></subsection><subsection id="id4AE81FDE9903417E97253F0DAC12672F"><enum>(d)</enum><header>Providers and reimbursement rates</header>
<paragraph id="id8899882496874009b80ec90854a86068"><enum>(1)</enum><header>In general</header>
<text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c</external-xref> 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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id4426857AC786439D997BD30F6D474989"><enum>(2)</enum><header display-inline="yes-display-inline">Prescription drugs</header><text display-inline="yes-display-inline">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—</text>
<subparagraph id="id88B30BBE760A4560B406FA4ADF7AD97C"><enum>(A)</enum><text>the price paid by the Secretary of Veterans Affairs to procure the drug under the laws administered by the Secretary of Veterans Affairs;</text>
</subparagraph><subparagraph id="id8AB3D3F2FC884C8293317ECF29971DC1"><enum>(B)</enum><text>the price paid to procure the drug under section 8126 of title 38, United States Code; or</text> </subparagraph><subparagraph id="id96D7756FD0CC4A9DA87F61CDA2C10C66"><enum>(C)</enum><text>the best price determined under section 1927(c)(1)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8(c)(1)(C)</external-xref>) for the drug.</text>
</subparagraph></paragraph><paragraph id="id809520B892824FCD85C759A0F44903D0"><enum>(3)</enum><header>Participating providers</header>
<subparagraph id="id03D4328D9F114FD4832F78CCD007A8C3"><enum>(A)</enum><header>In general</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) or under a State Medicaid plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) on the date of enactment of this Act shall be a participating provider in the Medicare Transition plan.</text>
</subparagraph><subparagraph id="id5E6C7548201442B791B28D34B3EA4E2D"><enum>(B)</enum><header>Additional providers</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection id="id478090A7EDBE437EB0B9FA1EDDDF5BCB"><enum>(e)</enum><header>Premiums</header>
<paragraph id="idFA141268FBDB4EE099592E50619A6F67"><enum>(1)</enum><header>Determination</header><text>The Administrator shall determine the premium amount for enrolling in the Medicare Transition plan, which—</text>
<subparagraph id="id29219C98FB6C4B118469447640C86E39"><enum>(A)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg(a)(1)(A)</external-xref>)); and</text>
</subparagraph><subparagraph id="idD0AF26E814834CC6BD2C935B827631D2"><enum>(B)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/18071">42 U.S.C. 18071</external-xref>) and <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B</external-xref> of the Internal Revenue Code of 1986, as amended by subsection (g).</text>
</subparagraph></paragraph><paragraph id="id5BB8026F4BC44109BEC4985A2AFAE4B0"><enum>(2)</enum><header>Limitation</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg(a)(1)(A)</external-xref>) is not permitted.</text>
</paragraph></subsection><subsection id="id0618E8BF9A494C6CB4DC377392343022"><enum>(f)</enum><header>Termination</header><text>This section shall cease to have force or effect on the effective date described in section 106.</text> </subsection><subsection id="id8E9FAC625F204DD4B86B7EE614F79D0C"><enum>(g)</enum><header>Tax credits and cost-Sharing subsidies</header> <paragraph id="id7748B8389207468B8B5C4BC273B44C63"><enum>(1)</enum><header>Premium assistance tax credits</header> <subparagraph id="id9C531394F46F4DF9BC5C35B762983234"><enum>(A)</enum><header>Credits allowed to Medicare Transition plan enrollees at or above 44 percent of poverty in non-expansion States</header><text>Paragraph (1) of <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(c)</external-xref> 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:</text>
<quoted-block act-name="" id="id12685C1E09034002A02039DF0BBDD5FB" style="OLC">
<subparagraph id="idA0D867B14EA74D64ABA55D9704CF9021"><enum>(C)</enum><header>Special rules for Medicare Transition plan enrollees</header>
<clause id="idBA30FC72849E49A2A38FA5EB5D03C25F"><enum>(i)</enum><header>In general</header><text>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 <short-title>Medicare for All Act of 2017</short-title> for all months in the taxable year, subparagraph (A) shall be applied without regard to <quote>but does not exceed 400 percent</quote>.</text>
</clause><clause id="id207E06B2DD3B4FAC889B70D095293A52"><enum>(ii)</enum><header>Enrollees in Medicaid non-expansion States</header><text>In the case of a taxpayer residing in a State which (as of the date of the enactment of the <short-title>Medicare for All Act of 2017</short-title>) 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 <short-title>Medicare for All Act of 2017</short-title> for all months in the taxable year, subparagraphs (A) and (B) shall be applied by substituting <quote>0 percent</quote> for <quote>100 percent</quote> each place it appears.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id5E620549A7A546978B698C09EF206CFC"><enum>(B)</enum><header>Premium assistance amounts for taxpayers enrolled in Medicare Transition plan</header>
<clause id="idFCEC023A3D5748BCBCC84D1CD100A177"><enum>(i)</enum><header>In general</header><text>Subparagraph (A) of section 36B(b)(3) of such Code is amended—</text> <subclause id="id5B269795627347FEBDE820165AECE4F8"><enum>(I)</enum><text>by redesignating clause (ii) as clause (iii),</text>
</subclause><subclause id="idB95D010065154CE5884BB139AA08F8F4"><enum>(II)</enum><text>by striking <quote>clause (ii)</quote> in clause (i) and inserting <quote>clauses (ii) and (iii)</quote>, and</text> </subclause><subclause id="id5A8CC0A93AD548199BF10E160F02CA2B"><enum>(III)</enum><text>by inserting after clause (i) the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id95C6D6993B4F46B89D0A83C23EF2B8C3" style="OLC">
<clause commented="no" display-inline="no-display-inline" id="id4E322F3EBE5A448A91F7EC7977F3155F"><enum>(ii)</enum><header display-inline="yes-display-inline">Special rules for taxpayers enrolled in Medicare Transition plan</header><text display-inline="yes-display-inline">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 <short-title>Medicare for All Act of 2017</short-title> 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:</text><table align-to-level="section" blank-lines-before="1" colsep="1" frame="topbot" line-rules="hor-ver" rowsep="0" rule-weights="4.4.4.0.0.0" table-template-name="Generic: 3 text, even cols" table-type=""><tgroup cols="3" grid-typeface="1.1" rowsep="0" thead-tbody-ldg-size="10.10.10"><colspec coldef="txt" colname="column1" colwidth="166.50pt" min-data-value="95" rowsep="0"></colspec><colspec align="right" coldef="txt-no-ldr" colname="column2" colwidth="125.31pt" min-data-value="95" rowsep="0"></colspec><colspec coldef="fig" colname="column3" colwidth="155.13pt" min-data-value="17" rowsep="0"></colspec><thead><row><entry align="center" colname="column1" morerows="0" namest="column1" rowsep="1">In the case of household income (expressed as a<linebreak></linebreak> percent of poverty line) within the following<linebreak></linebreak>
income tier:</entry><entry align="center" colname="column2" morerows="0" namest="column2" rowsep="1">The initial premium<linebreak></linebreak> percentage is—</entry><entry align="center" colname="column3" morerows="0" namest="column3" rowsep="1">The final premium<linebreak></linebreak> percentage is—</entry></row></thead><tbody><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">Up to 100%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">2%</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">2%</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">100% up to 138%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">2.04%</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">2.04%</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">138% up to 150%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">3.06%</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">4.08%</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">150% and above</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">4.08%</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">5%.</entry></row></tbody></tgroup></table></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subclause></clause><clause id="id3AB0A2497B0B405C894666A1FA7AFADE"><enum>(ii)</enum><header>Conforming amendment</header><text>Subclause (I) of clause (iii) of section 36B(b)(3) of such Code, as redesignated by subparagraph (A)(i), is amended by inserting <quote>, and determined after the application of clause (ii)</quote> after <quote>after application of this clause</quote>.</text>
</clause></subparagraph></paragraph><paragraph id="idDAF81952911E4836AA285D4A215A4EF3"><enum>(2)</enum><header>Cost-sharing subsidies</header><text>Subsection (b) of section 1402 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18071">42 U.S.C. 18071(b)</external-xref>) is amended—</text>
<subparagraph id="id3D5842E4FCD04543A46983919DFA99B3"><enum>(A)</enum><text>by inserting <quote>, or in the Medicare Transition plan established under section 1002(a) of the <short-title>Medicare for All Act of 2017</short-title>,</quote> after <quote>coverage</quote> in paragraph (1);</text> </subparagraph><subparagraph id="id5E7DAD31C04E4AF3AABD4BD7906EE4BC"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="idA79BBD1CB11D4ECA8CB1AE537E5035E5"><enum>(C)</enum><text>by striking <quote><header-in-text level="subsection" style="OLC">insured</header-in-text>.—In this section</quote> and inserting “<header-in-text level="subsection" style="OLC">insured</header-in-text>.—</text> <quoted-block display-inline="no-display-inline" id="id93B10418F30342979582504863E5C4AE" style="OLC"> <paragraph id="id8E8E921E620743FE8A5C8D5C4596B15B"><enum>(1)</enum><header>In general</header><text>In this section</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="idE76DD8F8C5C640A2BBD9D67812EE0C56"><enum>(D)</enum><text>by striking the flush language; and</text> </subparagraph><subparagraph id="idD25A2C6A7CC84B1992B8E86D04C6CB62"><enum>(E)</enum><text>by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id699C675ACE0B445C80CE375C5E1EF282" style="OLC">
<paragraph id="id4E471F9FAB8F4F6CAFE229295F273B9D"><enum>(2)</enum><header>Special rules</header>
<subparagraph id="idFD862AD58DE54CD5946EE63FD34B56D2"><enum>(A)</enum><header>Individuals lawfully present</header><text>In the case of an individual described in <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(c)(1)(B)</external-xref> 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.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idC5D1846C45304F00AB7AA3C7A2B335A6"><enum>(B)</enum><header>Medicare Transition plan enrollees in Medicaid non-expansion States</header><text>In the case of an individual residing in a State which (as of the date of the enactment of the <short-title>Medicare for All Act of 2017</short-title>) 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 <quote>0 percent</quote> for <quote>100 percent</quote> each place it appears.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id27A07471BE3F4DC1A8212067EA4150D9"><enum>(C)</enum><header>Adjusted cost-sharing for Medicare Transition plan enrollees</header><text>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 <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(b)(3)(A)(ii)</external-xref> of the Internal Revenue Code of 1986.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="id5690EA9C09674A32BB043A6961DA4C8A"><enum>(h)</enum><header>Conforming amendments</header>
<paragraph id="idf08c2f4ce48d4fd5b31a570451af4999"><enum>(1)</enum><header>Treatment as a qualified health plan</header><text>Section 1301(a)(2) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18021">42 U.S.C. 18021(a)(2)</external-xref>) is amended—</text>
<subparagraph id="id570d92c37c6e4d0b946ac27fffbb8d0b"><enum>(A)</enum><text>in the paragraph heading, by inserting <quote><header-in-text level="paragraph" style="OLC">, the Medicare Transition plan,</header-in-text></quote> before <quote><header-in-text level="paragraph" style="OLC">and</header-in-text></quote>; and</text> </subparagraph><subparagraph id="idf061e48c078d4b4393991d68373cd28e"><enum>(B)</enum><text>by inserting <quote>The Medicare Transition plan,</quote> before <quote>and a multi-State plan</quote>.</text>
</subparagraph></paragraph><paragraph id="idc9ff81a3a62e44bd94101767de90e4b0"><enum>(2)</enum><header>Level playing field</header><text>Section 1324(a) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18044">42 U.S.C. 18044(a)</external-xref>) is amended by inserting <quote>the Medicare Transition plan,</quote> before <quote>or a multi-State qualified health plan</quote>.</text>
</paragraph></subsection></section></subtitle><subtitle id="idE5384D6066224491882F77DF57AD40AF" style="OLC"><enum>B</enum><header>Transitional Medicare reforms</header>
<section id="id61A63357080649C98F0D6DDA3276514E"><enum>1011.</enum><header>Medicare
protection against high out-of-pocket expenditures for fee-for-service
benefits and elimination of parts A and B deductibles</header>
<subsection id="id3469E97E409B49D78A3102C604A9CFDD"><enum>(a)</enum><header>Protection against high out-of-Pocket expenditures</header><text display-inline="yes-display-inline">Title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.), as amended by section 1001, is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id8AE5507A29EC43168A0F67FB1D45B168" style="traditional">
<section id="idCDE4F6459F484272AEFE03671C5B0902"><enum>1899D.</enum><header>Protection against high out-of-pocket
expenditures</header><subsection commented="no" display-inline="yes-display-inline" id="id3D6926614B3947A39D55C956FFC9879C"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Notwithstanding any other provision of this title, in the case of an individual entitled to, or enrolled for, benefits under part A or enrolled in part B, if the amount of the out-of-pocket cost-sharing of such individual for a year (effective the year beginning January 1 of the year following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title>) equals or exceeds $1,500, the individual shall not be responsible for additional out-of-pocket cost-sharing occurred during that year.</text>
</subsection><subsection id="id7E30D01B6DFF439D8EE9EE5E7134D9B2"><enum>(b)</enum><header>Out-of-Pocket
cost-Sharing defined</header>
<paragraph id="idFA6657F5FD7947569FF31C4FC852DF1A"><enum>(1)</enum><header>In
general</header><text>Subject to paragraphs (2) and (3), in this section, the term <term>out-of-pocket cost-sharing</term> means, with respect to an individual, the amount of the expenses incurred by the individual that are attributable to—</text>
<subparagraph id="idDDF6A287FD9C4F608832CA5697A613F4"><enum>(A)</enum><text>coinsurance and copayments applicable under part A or B; or</text> </subparagraph><subparagraph id="idB23D9DC9D9CC4EE0A2BB00EAD8960E7C"><enum>(B)</enum><text>for items and services that would have otherwise been covered under part A or B but for the exhaustion of those benefits.</text>
</subparagraph></paragraph><paragraph id="id8C270C89F04A438FB0E8F6F7DCFC0CBE"><enum>(2)</enum><header>Certain costs
not included</header>
<subparagraph id="id042B803DF90C44C994705A3E8C9CB5DB"><enum>(A)</enum><header>Non-covered
items and services</header><text>Expenses incurred for items and services which are not included (or treated as being included) under part A or B shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph (1).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id5BAC29AB79034AA4AEB8D5D3920C1A25"><enum>(B)</enum><header display-inline="yes-display-inline">Items and services not furnished on an
assignment-related basis</header><text display-inline="yes-display-inline">If an item or service is furnished to an individual under this title and is not furnished on an assignment-related basis, any additional expenses the individual incurs above the amount the individual would have incurred if the item or service was furnished on an assignment-related basis shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph (1).</text>
</subparagraph></paragraph><paragraph id="idD5E44FB5C66247E9AC0798DB263A44BF"><enum>(3)</enum><header>Source of
payment</header><text>For purposes of paragraph (1), the Secretary shall consider expenses to be incurred by the individual without regard to whether the individual or another person, including a State program or other third-party coverage, has paid for such expenses.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id16F7E419813F4381A7F773A0CECF6876"><enum>(b)</enum><header>Elimination of parts A and B deductibles</header>
<paragraph id="idCF2C40D5B1044D7592CD7A8F03A99785"><enum>(1)</enum><header>Part A</header><text>Section 1813(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395e">42 U.S.C. 1395e(b)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id6BF1974B8C5A4AA798506DA43931958D" style="OLC">
<paragraph id="id780E5E26C6274D459BD5E3E976A83177" indent="up1"><enum>(4)</enum><text>For each year (beginning January 1 of the year following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title>), the inpatient hospital deductible for the year shall be $0.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="idE11564E075474E37A9A86406B9B25F4B"><enum>(2)</enum><header>Part B</header><text>Section 1833(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(b)</external-xref>) is amended, in the first sentence—</text> <subparagraph id="id53BE2110F3F046888D835FB77F8BD4B7"><enum>(A)</enum><text>by striking <quote>and for a subsequent year</quote> and inserting <quote>for each of 2006 through the year that includes the date of enactment of the <short-title>Medicare for All Act of 2017</short-title></quote>; and</text>
</subparagraph><subparagraph id="idD49D0322C2D9432BAF2316D7672EB9F1"><enum>(B)</enum><text>by inserting <quote>, and $0 for each year subsequent year</quote> after <quote>$1)</quote>.</text> </subparagraph></paragraph></subsection></section><section id="idF778B74069B240BC9F9D0CE73ADBC655"><enum>1012.</enum><header>Reduction in Medicare part D annual out-of-pocket threshold and elimination of cost-sharing above that threshold</header> <subsection id="idEE3AE773265546CDA4276549F1C3BF77"><enum>(a)</enum><header>Reduction</header><text>Section 1860D–2(b)(4)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-102">42 U.S.C. 1395w–102(b)(4)(B)</external-xref>) is amended—</text>
<paragraph id="id72FDE623BED24390811FCD57671229F6"><enum>(1)</enum><text>in clause (i), by striking <quote>For purposes</quote> and inserting <quote>Subject to clause (iii), for purposes</quote>; and</text> </paragraph><paragraph id="id116A81DB7D634F84BD835D0192A1B542"><enum>(2)</enum><text>by adding at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="idB417D12D3AA747FAAB0E3C9F9D535480" style="OLC">
<clause id="id83EA96482D104346845CE3D70EFDF139"><enum>(iii)</enum><header>Reduction in threshold during transition period</header>
<subclause id="idDE5C428E967E468D9A986B8BE2E8ED0E"><enum>(I)</enum><header>In general</header><text>Subject to subclause (II), for plan years beginning on or after January 1 following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title> and before January 1 of the year that is 4 years following such date of enactment, notwithstanding clauses (i) and (ii), the <quote>annual out-of-pocket threshold</quote> specified in this subparagraph is equal to $305.</text>
</subclause><subclause id="idd7a53cd4e2984e4ba2d457b51a696896"><enum>(II)</enum><header>Authority to exempt brand-name drugs if generic available</header><text>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.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id18BE096A80054AF0A2BC66F5CA0B8AF3"><enum>(b)</enum><header>Elimination of cost-Sharing</header><text display-inline="yes-display-inline">Section 1860D–2(b)(4)(A) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-102">42 U.S.C. 1395w–102(b)(4)(A)</external-xref>) is amended—</text>
<paragraph id="idCD76DF8AC06047FEA38B592E4362C87C"><enum>(1)</enum><text>in clause (i)—</text> <subparagraph id="id9EEA97BD7E5B4FD8A4F34AECDA48ACF6"><enum>(A)</enum><text>by redesignating subclauses (I) and (II) as items (aa) and (bb), respectively;</text>
</subparagraph><subparagraph id="id917A6975361D408BA7FCEDE5E70D6514"><enum>(B)</enum><text>by striking <quote>subparagraph (B), with cost-sharing</quote> and inserting the following: “subparagraph (B)—</text> <quoted-block display-inline="no-display-inline" id="id87685C59F204452DB4C87BF423F3A059" style="OLC"> <subclause id="idAF89AF959DF54F17BFDDA6386379079A"><enum>(I)</enum><text>for plan years 2006 through the plan year ending December 31 following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title>, with cost-sharing</text></subclause><after-quoted-block>; </after-quoted-block></quoted-block>
</subparagraph><subparagraph id="id8F088E92725742D6AB5FC57EC9E35B72"><enum>(C)</enum><text>in item (bb), as redesignated by subparagraph (A), by striking the period at the end and inserting <quote>; and</quote>; and</text> </subparagraph><subparagraph id="id2208AAB616F846BBBEB2822518168532"><enum>(D)</enum><text>by adding at the end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="id077085A76F69484B9C13B19BB67D2DDC" style="OLC">
<subclause id="id9767E3675CD34AE1ADDCB911861582E3"><enum>(II)</enum><text>for the plan year beginning January 1 following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title> and the two subsequent plan years, without any cost-sharing.</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="idCF5A277E235E4667AA51BDDFECC4559E"><enum>(2)</enum><text>in clause (ii)—</text> <subparagraph id="id29EB803331D544A795218FD1DF900CF7"><enum>(A)</enum><text>by striking <quote>clause (i)(I)</quote> and inserting <quote>clause (i)(I)(aa)</quote>; and</text>
</subparagraph><subparagraph id="idC09E698C27EA43F58779D9ADF8508D06"><enum>(B)</enum><text>by adding at the end the following new sentence: <quote>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).</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="id89158F82D06B4FF1BDFE508932B23D97"><enum>(c)</enum><header>Conforming
amendments to low-Income subsidy</header><text>Section 1860D–14(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-114">42 U.S.C. 1395w–114(a)</external-xref>) is amended—</text> <paragraph id="id10DD4D34475241BC93B997E6BD2C3697"><enum>(1)</enum><text>in paragraph (1)—</text>
<subparagraph id="id3FB70E2DBD0F45F987E18F862A536697"><enum>(A)</enum><text>in subparagraph (D)(iii), by striking <quote>1860D–2(b)(4)(A)(i)(I)</quote> and inserting <quote>1860D–2(b)(4)(A)(i)(I)(aa)</quote>; and</text> </subparagraph><subparagraph id="idA5D29F3F2937442B85952A544F36EBA7"><enum>(B)</enum><text>in subparagraph (E)—</text>
<clause id="id4402049219354128A6FA6FB23F81F7A9"><enum>(i)</enum><text>in the heading, by inserting <quote><header-in-text level="subparagraph" style="OLC">prior to the elimination of such cost-sharing for all individuals</header-in-text></quote> after <quote><header-in-text level="subparagraph" style="OLC">threshold</header-in-text></quote>; and</text> </clause><clause id="id813AA73D949D47A9A5DE5478B98F06F5"><enum>(ii)</enum><text>by striking <quote>The elimination</quote> and inserting <quote>For plan years 2006 through the plan year ending December 31 following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title>, the elimination</quote>; and</text>
</clause></subparagraph></paragraph><paragraph id="id71EE8CDB90FA4AC299EE033A5841B7AC"><enum>(2)</enum><text>in paragraph (2)(E)—</text> <subparagraph id="id77034856B38649B3B0B0F16DB7317140"><enum>(A)</enum><text>in the heading, by inserting <quote><header-in-text level="subparagraph" style="OLC">prior to the elimination of such cost-sharing for all individuals</header-in-text></quote> after <quote><header-in-text level="subparagraph" style="OLC">threshold</header-in-text></quote>;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id0BD47F23175646078E7A44BD0D4DC954"><enum>(B)</enum><text>by striking <quote>Subject to</quote> and inserting <quote>For plan years 2006 through the plan year ending December 31 following the date of enactment of the <short-title>Medicare for All Act of 2017</short-title>, subject to</quote>; and</text> </subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idC262A1C1A63B439298D3DD3CF85A8CA8"><enum>(C)</enum><text>by striking <quote>1860D–2(b)(4)(A)(i)(I)</quote> and inserting <quote>1860D–2(b)(4)(A)(i)(I)(aa)</quote>.</text>
</subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="idF335B3FF5174480D932838EA6641DB1E"><enum>1013.</enum><header>Coverage of dental and vision services and hearing aids and examinations under Medicare part B</header>
<subsection commented="no" display-inline="no-display-inline" id="id775488E1B46F4C9CB847E7CFF5F8F73C"><enum>(a)</enum><header>Dental services</header>
<paragraph commented="no" display-inline="no-display-inline" id="idF3B23D37302C4F09A54275988B679AEA"><enum>(1)</enum><header>Removal of exclusion from coverage</header><text>Section 1862(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)</external-xref>) is amended by striking paragraph (12).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1DD4C950F32145C78F1EF79E41C829C6"><enum>(2)</enum><header>Coverage</header>
<subparagraph id="HBD9BCBA52BB149D7B9FAAFAA549A5348"><enum>(A)</enum><header>In general</header><text>Section 1861(s)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)</external-xref>) is amended—</text> <clause id="HE1A7A5EC8A5E4A0492F4476E1DF9BF42"><enum>(i)</enum><text>in subparagraph (FF), by striking <quote>and</quote> at the end;</text>
</clause><clause id="HA86AFE40D1A94EB09B1A37F12DA0E5DB"><enum>(ii)</enum><text>in subparagraph (GG), by inserting <quote>and</quote> at the end; and</text> </clause><clause id="H1FD207F55348456DAA2802E4D2E2CA9C"><enum>(iii)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H228C076A217740DC908323C486B33D37" style="OLC">
<subparagraph id="H8F9708B72C614076B4BF2CBE1E8BE7ED" indent="up1"><enum>(HH)</enum><text>dental services;</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </clause></subparagraph><subparagraph id="id8a1936bc9b6d4225bb90c836b621a88b"><enum>(B)</enum><header>Payment</header><text>Section 1833(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)(1)</external-xref>) is amended—</text>
<clause id="id256E870308894641A5BC662D22E058AE"><enum>(i)</enum><text>by striking <quote>and</quote> before <quote>(BB)</quote>; and</text> </clause><clause id="id7E744F47AD70437F85C4831F6190D2B1"><enum>(ii)</enum><text>by inserting before the semicolon at the end the following: <quote>, 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).</quote>.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id049AC97FC7E942F6821A463E25E62FB0"><enum>(C)</enum><header>Effective date</header><text>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.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idDE452E245D824167A0C226CB50AF20C9"><enum>(b)</enum><header>Vision services</header>
<paragraph id="id0A489C4FA6C14D83AB86C2B6AED9B118"><enum>(1)</enum><header>In general</header><text>Section 1861(s)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)</external-xref>), as amended by subsection (a), is amended—</text>
<subparagraph id="id52BC3417A1B84F748C74DF1B1C3F5507"><enum>(A)</enum><text>in subparagraph (GG), by striking <quote>and</quote> at the end;</text> </subparagraph><subparagraph id="id54EDC9DE99D440E09C626609F8C1BA4A"><enum>(B)</enum><text>in subparagraph (HH), by inserting <quote>and</quote> at the end; and</text>
</subparagraph><subparagraph id="id5F8F3717868E4313A5399FD45953FB76"><enum>(C)</enum><text>by adding at the end the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="id9A3DBD7B88B24E8C8DE371AE19D4628D" style="OLC"> <subparagraph id="idDBB79B1CE75E46F9A7F98C447C7B2AD9" indent="up1"><enum>(II)</enum><text>vision services;</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id33BF0CB69B5A48C6B80415CF119A2BF0"><enum>(2)</enum><header>Payment</header><text>Section 1833(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)(1)</external-xref>), as amended by subsection (a), is amended—</text>
<subparagraph id="idC13910AC85564BCDB4C6768A66C838D9"><enum>(A)</enum><text>by striking <quote>and</quote> before <quote>(CC)</quote>; and</text> </subparagraph><subparagraph id="idEFDDA314DDC540AA805813C517323D91"><enum>(B)</enum><text>by inserting before the semicolon at the end the following: <quote>, 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).</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id8DD8D8DCA3D848EEBC57848F2EA6F758"><enum>(3)</enum><header>Effective date</header><text>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.</text>
</paragraph></subsection><subsection id="HE97448097DC8429BAB169E7CCE5F9C10"><enum>(c)</enum><header>Hearing aids and examinations therefor</header>
<paragraph id="H4BBC59745813443E8713C941F90290C3"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1862(a)(7) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)(7)</external-xref>) is amended by striking <quote>hearing aids or examinations therefor,</quote>.</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="H8AB65966496B47C4AAB56363DF1E329E"><enum>(2)</enum><header>Effective date</header><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection></section><section id="id86AC5CEDADF5451DB6917C5A490D346D"><enum>1014.</enum><header>Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities</header>
<subsection id="ID3B806AA6CBCF4D82AF6F7EDAECC9CBC8">
<enum>(a)</enum>
<header>In general</header>
<text>Section 226(b) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/426">42 U.S.C. 426(b)</external-xref>) is amended—</text> <paragraph id="ID4AAEE7502F044A1F8E9470C0EAA85577"> <enum>(1)</enum> <text>in paragraph (2)(A), by striking <quote>, and has for 24 calendar months been entitled to,</quote>;</text>
</paragraph><paragraph id="IDED0BA8CA240F4948BA0186CA5C73CF90">
<enum>(2)</enum>
<text>in paragraph (2)(B), by striking <quote>, and has been for not less than 24 months,</quote>;</text> </paragraph><paragraph id="IDFE796A6D2819437F837B7ECD9312054D"> <enum>(3)</enum> <text>in paragraph (2)(C)(ii), by striking <quote>, including the requirement that he has been entitled to the specified benefits for 24 months,</quote>;</text>
</paragraph><paragraph id="ID6F5EE27AA81A47C2B3679CF275CA00C5">
<enum>(4)</enum>
<text>in the first sentence, by striking <quote>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</quote> and inserting <quote>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</quote>; and</text>
</paragraph><paragraph id="IDDCC3AC2BB6C24D46A105E4BA17EF660E">
<enum>(5)</enum>
<text>in the second sentence, by striking <quote>the <quote>twenty-fifth month of his entitlement</quote> </quote> and all that follows through <quote>paragraph (2)(C) and</quote>.</text>
</paragraph></subsection><subsection id="ID96A4CDEF1D01420CA7D79F5DDB609D09">
<enum>(b)</enum>
<header>Conforming amendments</header>
<paragraph id="IDBE9ABD34762944018490D21753FCDE1A">
<enum>(1)</enum>
<header>Section 226</header>
<text>Section 226 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/426">42 U.S.C. 426</external-xref>) is amended by—</text> <subparagraph id="id0D8CB6E7540E4F9DA4F6222857BF47E6"><enum>(A)</enum><text>striking subsections (e)(1)(B), (f), and (h); and</text>
</subparagraph><subparagraph id="id63E1B28B5AA24B9C8C7AD97F98CE09B5"><enum>(B)</enum><text>redesignating subsections (g) and (i) as subsections (f) and (g), respectively.</text> </subparagraph></paragraph><paragraph id="ID9D988203263F4E7597FE00D6694DE5EA"> <enum>(2)</enum> <header>Medicare description</header> <text>Section 1811(2) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c(2)</external-xref>) is amended by striking <quote>have been entitled for not less than 24 months</quote> and inserting <quote>are entitled</quote>.</text>
</paragraph><paragraph id="IDEA2AFAB9347846889163FCC58EC88EAE">
<enum>(3)</enum>
<header>Medicare coverage</header>
<text>Section 1837(g)(1) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395p">42 U.S.C. 1395p(g)(1)</external-xref>) is amended by striking <quote>25th month of</quote> and inserting <quote>month following the first month of</quote>.</text> </paragraph><paragraph id="IDFE2DF085505844CC898A51F473701002"> <enum>(4)</enum> <header>Railroad retirement system</header> <text>Section 7(d)(2)(ii) of the Railroad Retirement Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/45/231f">45 U.S.C. 231f(d)(2)(ii)</external-xref>) is amended—</text>
<subparagraph id="ID74CD5AE85A3B497DA3332ED127CE0A0F">
<enum>(A)</enum>
<text>by striking <quote>has been entitled to an annuity</quote> and inserting <quote>is entitled to an annuity</quote>;</text> </subparagraph><subparagraph id="IDF5B0E072CDE349A19870B38E86AC3312"> <enum>(B)</enum> <text>by striking <quote>, for not less than 24 months</quote>; and</text>
</subparagraph><subparagraph id="ID6CF67D6828B54AB2A0DAB702075C7E2F">
<enum>(C)</enum>
<text>by striking <quote>could have been entitled for 24 calendar months, and</quote>.</text> </subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID2C53A01D0F2C4B59AA6A1B8C179795FC"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall apply to insurance benefits under title XVIII of the <act-name parsable-cite="SSA">Social Security Act</act-name> 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.</text>
</subsection></section></subtitle><enum>XI</enum><header>Miscellaneous</header>
<section commented="no" id="id52DEA15A0F8B421E9B8E2A4A5A172EED"><enum>1101.</enum><header>Definitions</header><text display-inline="no-display-inline">In this Act—</text> <paragraph commented="no" id="id5E70584A17134D94AB86F8CD1DE9288C"><enum>(1)</enum><text>the term <term>Secretary</term> means the Secretary of Health and Human Services;</text>
</paragraph><paragraph commented="no" id="idE5B6119EC1524F1C97E3F4F615E20EBC"><enum>(2)</enum><text>the term <term>State</term> means a State, the District of Columbia, or a territory of the United States; and</text> </paragraph><paragraph commented="no" id="id21A77D5F87714B549A57F893D1436E43"><enum>(3)</enum><text>the term <term>United States</term> shall include the States, the District of Columbia, and the territories of the United States.</text></paragraph></section>