[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1129 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 1129

   To establish a Medicare-for-all national health insurance program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 10, 2019

Mr. Sanders (for himself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mrs. 
Gillibrand, Ms. Harris, Mr. Leahy, Mr. Markey, Mr. Merkley, Mr. Schatz, 
 Mr. Udall, Ms. Warren, Mr. Whitehouse, Ms. Hirono, and Mr. Heinrich) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To establish a Medicare-for-all national health insurance program.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare for All 
Act of 2019''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
  TITLE I--ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM; UNIVERSAL 
                        ENTITLEMENT; ENROLLMENT

Sec. 101. Establishment of the Universal Medicare Program.
Sec. 102. Universal entitlement.
Sec. 103. Freedom of choice.
Sec. 104. Non-discrimination.
Sec. 105. Enrollment.
Sec. 106. Effective date of benefits.
Sec. 107. Prohibition against duplicating coverage.
  TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND 
                      BENEFITS FOR LONG-TERM CARE

Sec. 201. Comprehensive benefits.
Sec. 202. No cost-sharing.
Sec. 203. Exclusions and limitations.
Sec. 204. Coverage of institutional long-term care services under 
                            Medicaid.
Sec. 205. Prohibiting recovery of correctly paid Medicaid benefits.
Sec. 206. 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.
Sec. 1015. Guaranteed issue of Medigap policies.
 Subtitle C--Private Health Insurance Availability During Transitional 
                                 Period

Sec. 1021. Continuity of care.
                        TITLE XI--MISCELLANEOUS

Sec. 1101. Updating resource limits for Supplemental Security Income 
                            eligibility (SSI).
Sec. 1102. Definitions.

  TITLE I--ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM; UNIVERSAL 
                        ENTITLEMENT; ENROLLMENT

SEC. 101. ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM.

    There is hereby established a national health insurance program to 
provide comprehensive protection against the costs of health care and 
health-related services, in accordance with the standards specified in, 
or established under, this Act.

SEC. 102. UNIVERSAL ENTITLEMENT.

    (a) In General.--Every individual who is a resident of the United 
States is entitled to benefits for health care services under this Act. 
The Secretary shall promulgate a rule that provides criteria for 
determining residency for eligibility purposes under this Act.
    (b) Treatment of Other Individuals.--The Secretary--
            (1) may make eligible for benefits for health care services 
        under this Act other individuals not described in subsection 
        (a) and regulate their eligibility to ensure that every person 
        in the United States has access to health care; and
            (2) shall promulgate a rule, consistent with Federal 
        immigration laws, to prevent an individual from traveling to 
        the United States for the sole purpose of obtaining health care 
        services provided under this Act.

SEC. 103. FREEDOM OF CHOICE.

    Any individual entitled to benefits under this Act may obtain 
health services from any institution, agency, or individual qualified 
to participate under this Act.

SEC. 104. NON-DISCRIMINATION.

    (a) In General.--No person shall, on the basis of race, color, 
national origin, age, disability, or sex, including sex stereotyping, 
gender identity, sexual orientation, and pregnancy and related medical 
conditions (including termination of pregnancy), be excluded from 
participation in, be denied the benefits of, or be subjected to 
discrimination by any participating provider as defined in section 301, 
or any entity conducting, administering, or funding a health program or 
activity, including contracts of insurance, pursuant to this Act.
    (b) Claims of Discrimination.--
            (1) In general.--The Secretary shall establish a procedure 
        for adjudication of administrative complaints alleging a 
        violation of subsection (a).
            (2) Jurisdiction.--Any person aggrieved by a violation of 
        subsection (a) by a covered entity may file suit in any 
        district court of the United States having jurisdiction of the 
        parties.
            (3) Damages.--If the court finds a violation of subsection 
        (a), the court may grant compensatory and punitive damages, 
        declaratory relief, injunctive relief, attorneys' fees and 
        costs, or other relief as appropriate.

SEC. 105. ENROLLMENT.

    (a) In General.--The Secretary shall provide a mechanism for the 
enrollment of individuals eligible for benefits under this Act. The 
mechanism shall--
            (1) include a process for the automatic enrollment of 
        individuals at the time of birth in the United States or upon 
        the establishment of residency in the United States;
            (2) provide for the enrollment, as of the date described in 
        section 106, of all individuals who are eligible to be enrolled 
        as of such date; and
            (3) include a process for the enrollment of individuals 
        made eligible for health care services under section 102(b).
    (b) Issuance of Universal Medicare Cards.--In conjunction with an 
individual's enrollment for benefits under this Act, the Secretary 
shall provide for the issuance of a Universal Medicare card that shall 
be used for purposes of identification and processing of claims for 
benefits under this program. The card shall not include an individual's 
Social Security number.

SEC. 106. EFFECTIVE DATE OF BENEFITS.

    (a) In General.--Except as provided in subsection (b), benefits 
shall first be available under this Act for items and services 
furnished on January 1 of the fourth calendar year that begins after 
the date of enactment of this Act.
    (b) Coverage for Children.--
            (1) In general.--For any eligible individual who has not 
        yet attained the age of 19, benefits shall first be available 
        under this Act for items and services furnished on January 1 of 
        the first calendar year that begins after the date of enactment 
        of this Act.
            (2) Option to continue in other coverage during transition 
        period.--Any person who is eligible to receive benefits as 
        described in paragraph (1) may opt to maintain any coverage 
        described in section 901, private health insurance coverage, or 
        coverage offered pursuant to subtitle A of title X (including 
        the amendments made by such subtitle) until the effective date 
        described in subsection (a).

SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE.

    (a) In General.--Beginning on the effective date described in 
section 106(a), it shall be unlawful for--
            (1) a private health insurer to sell health insurance 
        coverage that duplicates the benefits provided under this Act; 
        or
            (2) an employer to provide benefits for an employee, former 
        employee, or the dependents of an employee or former employee 
        that duplicate the benefits provided under this Act.
    (b) Construction.--Nothing in this Act shall be construed as 
prohibiting the sale of health insurance coverage for any additional 
benefits not covered by this Act, including additional benefits that an 
employer may provide to employees or their dependents, or to former 
employees or their dependents.

  TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND 
                      BENEFITS FOR LONG-TERM CARE

SEC. 201. COMPREHENSIVE BENEFITS.

    (a) In General.--Subject to the other provisions of this title and 
titles IV through IX, individuals enrolled for benefits under this Act 
are entitled to have payment made by the Secretary to an eligible 
provider for the following items and services if medically necessary or 
appropriate for the maintenance of health or for the diagnosis, 
treatment, or rehabilitation of a health condition:
            (1) Hospital services, including inpatient and outpatient 
        hospital care, including 24-hour-a-day emergency services and 
        inpatient prescription drugs.
            (2) Ambulatory patient services.
            (3) Primary and preventive services, including chronic 
        disease management.
            (4) Prescription drugs, medical devices, biological 
        products, including outpatient prescription drugs, medical 
        devices, and biological products.
            (5) Mental health and substance abuse treatment services, 
        including inpatient care.
            (6) Laboratory and diagnostic services.
            (7) Comprehensive reproductive, maternity, and newborn 
        care.
            (8) Pediatrics, including early and periodic screening, 
        diagnostic, and treatment services (as defined in section 
        1905(r) of the Social Security Act (42 U.S.C. 1396d(r))).
            (9) Oral health, audiology, and vision services.
            (10) Short-term rehabilitative and habilitative services 
        and devices.
            (11) Emergency services and transportation.
            (12) Necessary transportation to receive health care 
        services for individuals with disabilities and low-income 
        individuals.
            (13) Home and community-based long-term services and 
        supports (to be provided in accordance with the requirements 
        for home and community-based settings under sections 441.530 
        and 441.710 of title 42, Code of Federal Regulations), 
        including--
                    (A) services described in paragraphs (7), (8), 
                (13), (19), and (24) of section 1905(a) of the Social 
                Security Act (42 U.S.C. 1396d(a));
                    (B) home and community-based services described in 
                subsection (c)(4)(B) of section 1915 of the Social 
                Security Act (including habilitation services defined 
                in subsection (c)(5) of such section);
                    (C) self-directed home and community-based services 
                described in subsection (i) of section 1915 of the 
                Social Security Act;
                    (D) self-directed personal assistance services (as 
                defined in subsection (j)(4)(A) of section 1915 of the 
                Social Security Act); and
                    (E) home and community-based attendant services and 
                supports described in subsection (k) of section 1915 of 
                the Social Security Act.
    (b) Revision and Adjustment.--The Secretary shall, on a regular 
basis, evaluate whether the benefits package should be improved or 
adjusted to promote the health of beneficiaries, account for changes in 
medical practice or new information from medical research, or respond 
to other relevant developments in health science, and shall make 
recommendations to Congress regarding any such improvements or 
adjustments.
    (c) Complementary and Integrative Medicine.--
            (1) In general.--In carrying out subsection (b), the 
        Secretary shall consult with the persons described in paragraph 
        (1) with respect to--
                    (A) identifying specific complementary and 
                integrative medicine practices that, on the basis of 
                research findings or promising clinical interventions, 
                are appropriate to include in the benefits package; and
                    (B) identifying barriers to the effective provision 
                and integration of such practices into the delivery of 
                health care, and identifying mechanisms for overcoming 
                such barriers.
            (2) Consultation.--In accordance with paragraph (1), the 
        Secretary shall consult with--
                    (A) the Director of the National Center for 
                Complementary and Integrative Health;
                    (B) the Commissioner of Food and Drugs;
                    (C) institutions of higher education, private 
                research institutes, and individual researchers with 
                extensive experience in complementary and integrative 
                medicine and the integration of such practices into the 
                delivery of health care;
                    (D) nationally recognized providers of 
                complementary and integrative medicine; and
                    (E) such other officials, entities, and individuals 
                with expertise on complementary and integrative 
                medicine as the Secretary determines appropriate.
    (d) States May Provide Additional Benefits.--Individual States may 
provide additional benefits for the residents of such States at the 
expense of the State.

SEC. 202. NO COST-SHARING.

    (a) In General.--The Secretary shall ensure that no cost-sharing, 
including deductibles, coinsurance, copayments, or similar charges, be 
imposed on an individual for any benefits provided under this Act, 
except as described in subsection (b).
    (b) Exceptions.--The Secretary may set a cost-sharing schedule for 
prescription drugs and biological products--
            (1) provided that--
                    (A) such schedule is evidence-based and encourages 
                the use of generic drugs;
                    (B) such cost-sharing does not apply to preventive 
                drugs;
                    (C) such cost-sharing does not exceed $200 annually 
                per individual, adjusted annually for inflation; and
                    (D) such cost-sharing is not imposed on individuals 
                with a household income equal to or below 200 percent 
                of the poverty line for a family of the size involved; 
                and
            (2) under which the Secretary may exempt brand-name drugs 
        from consideration in determining whether an individual has 
        reached any out-of-pocket limit if a generic version of such 
        drug is available.
    (c) No Balance Billing.--Notwithstanding contracts in accordance 
with section 303, no provider may impose a charge to an enrolled 
individual for covered services for which benefits are provided under 
this Act.

SEC. 203. EXCLUSIONS AND LIMITATIONS.

    (a) In General.--Benefits for services are not available under this 
Act unless the services meet the standards specified in section 201(a), 
as defined by the Secretary.
    (b) Treatment of Experimental Services and Drugs.--
            (1) In general.--In applying subsection (a), the Secretary 
        shall make national coverage determinations with respect to 
        services that are experimental in nature. Such determinations 
        shall be consistent with the national coverage determination 
        process as defined in section 1869(f)(1)(B) of the Social 
        Security Act (42 U.S.C. 1395ff(f)(1)(B)).
            (2) Appeals process.--The Secretary shall establish a 
        process by which individuals can appeal coverage decisions. The 
        process shall, as much as is feasible, follow process for 
        appeals under the Medicare program described in section 1869 of 
        the Social Security Act (42 U.S.C. 1395ff).
    (c) Application of Practice Guidelines.--In the case of services 
for which the Department of Health and Human Services has recognized a 
national practice guideline, the services are considered to meet the 
standards specified in section 201(a) if they have been provided in 
accordance with such guideline. For purposes of this subsection, a 
service shall be considered to have been provided in accordance with a 
practice guideline if the health care provider providing the service 
exercised appropriate professional discretion to deviate from the 
guideline in a manner authorized or anticipated by the guideline.

SEC. 204. COVERAGE OF INSTITUTIONAL LONG-TERM CARE SERVICES UNDER 
              MEDICAID.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting the following section after section 1946:

    ``state plan for providing institutional long-term care services

    ``Sec. 1947.  (a) In General.--For quarters beginning on or after 
date on which benefits are first available under section 106(a) of the 
Medicare for All Act of 2019, notwithstanding any other provision of 
this title--
            ``(1) a State plan for medical assistance shall provide for 
        making medical assistance available for services that are 
        institutional long-term care services in a manner consistent 
        with this section; and
            ``(2) no payment to a State shall be made under this title 
        with respect to expenditures incurred by the State in providing 
        medical assistance on or after such date for services that are 
        not--
                    ``(A) institutional long-term care services; or
                    ``(B) other services for which benefits are not 
                available under the Medicare for All Act of 2019 and 
                which are furnished under a State plan for medical 
                assistance which provided for medical assistance for 
                such services on September 1, 2018.
    ``(b) Institutional Long-Term Care Services Defined.--In this 
section, the term `institutional long-term care services' means the 
following:
            ``(1) Nursing facility services for individuals 21 years of 
        age or over described in subparagraph (A) of section 
        1905(a)(4).
            ``(2) Inpatient services for individuals 65 years of age or 
        over provided in an institution for mental disease described in 
        section 1905(a)(14).
            ``(3) Intermediate care facility services described in 
        section 1905(a)(15).
            ``(4) Inpatient psychiatric hospital services for 
        individuals under age 21 described in section 1905(a)(16).
            ``(5) Nursing facility services described in section 
        1905(a)(29).
    ``(c) Maintenance of Effort.--
            ``(1) Eligibility standards.--
                    ``(A) In general.--Beginning on the date described 
                in subsection (a), no payment may be made under section 
                1903 with respect to medical assistance provided under 
                a State plan for medical assistance if the State adopts 
                income, resource, or other 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 January 1, 
                2019.
                    ``(B) Indexing of amounts of income and resource 
                standards.--In determining whether a State has adopted 
                income or resource standards that are more restrictive 
                than the standards which applied as of January 1, 2019, 
                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 
                2018 to September of the fiscal year for which the 
                Secretary is making such determination.
            ``(2) Expenditures.--
                    ``(A) In general.--For each fiscal year or portion 
                of a fiscal year that occurs during the period that 
                begins on the first day of the first fiscal quarter 
                that begins on or after the date on which benefits are 
                first available under section 106(a) of the Medicare 
                for All Act of 2019, as a condition of receiving 
                payments under section 1903(a), a State shall make 
                expenditures for medical assistance for services that 
                are institutional long-term care services in an amount 
                that is not less than the expenditure floor determined 
                for the State and fiscal year (or portion of a fiscal 
                year) under subparagraph (B).
                    ``(B) Expenditure floor.--
                            ``(i) In general.--For each fiscal year or 
                        portion of a fiscal year described in 
                        subparagraph (A), the Secretary shall determine 
                        for each State an expenditure floor that shall 
                        be equal to--
                                    ``(I) the amount of the State's 
                                expenditures for fiscal year 2018 on 
                                medical assistance for institutional 
                                long-term care services; increased by
                                    ``(II) the growth factor determined 
                                under subclause (ii).
                            ``(ii) Growth factor.--For each fiscal year 
                        or portion of a fiscal year described in 
                        subparagraph (A), the Secretary shall, not 
                        later than September 1 of the fiscal year 
                        preceding such fiscal year or portion of a 
                        fiscal year, determine a growth factor for each 
                        State that takes into account--
                                    ``(I) the percentage increase in 
                                health care costs in the State;
                                    ``(II) the total amount expended by 
                                the State for the previous fiscal year 
                                on medical assistance for institutional 
                                long-term care services;
                                    ``(III) the increase, if any, in 
                                the total population of the State from 
                                July of 2018 to July of the fiscal year 
                                preceding the fiscal year involved;
                                    ``(IV) the increase, if any, in the 
                                population of individuals aged 65 and 
                                older of the State from July of 2018 to 
                                July of the fiscal year preceding the 
                                fiscal year involved; and
                                    ``(V) the decrease, if any, in the 
                                population of the State that requires 
                                medical assistance for institutional 
                                long-term care services that is 
                                attributable to the availability of 
                                coverage for the services described in 
                                section 201(a)(13) of the Medicare for 
                                All Act of 2019.
                            ``(iii) Proration rule.--Any amount 
                        determined under this subparagraph for a 
                        portion of a fiscal year shall be prorated 
                        based on the length of such portion of a fiscal 
                        year relative to a complete fiscal year.
    ``(d) Nonapplication of Certain Requirements.--Beginning on the 
date described in subsection (a), any provision of this title requiring 
a State plan for medical assistance to make available medical 
assistance for services that are not institutional long-term care 
services or services described in section 901(a)(3)(A)(ii) of the 
Medicare for All Act of 2019 shall have no effect.''.

SEC. 205. PROHIBITING RECOVERY OF CORRECTLY PAID MEDICAID BENEFITS.

    Section 1917 of the Social Security Act (42 U.S.C. 1396p) is 
amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) No lien may be imposed against the property of any individual 
prior to his death on account of medical assistance paid or to be paid 
on his behalf under the State plan, except pursuant to the judgment of 
a court on account of benefits incorrectly paid on behalf of such 
individual.''; and
            (2) by amending subsection (b) to read as follows:
    ``(b) No adjustment or recovery of any medical assistance correctly 
paid on behalf of an individual under the State plan may be made.''.

SEC. 206. STATE STANDARDS.

    (a) In General.--Nothing in this Act shall prohibit individual 
States from setting additional standards, with respect to eligibility, 
benefits, and minimum provider standards, consistent with the purposes 
of this Act, provided that such standards do not restrict eligibility 
or reduce access to benefits or services.
    (b) Restrictions on Providers.--With respect to any individuals or 
entities certified to provide services covered under section 201(a)(7), 
a State may not prohibit an individual or entity from participating in 
the program under this Act, for reasons other than the ability of the 
individual or entity to provide such services.

                   TITLE III--PROVIDER PARTICIPATION

SEC. 301. PROVIDER PARTICIPATION AND STANDARDS.

    (a) In General.--An individual or other entity furnishing any 
covered service under this Act is not a qualified provider unless the 
individual or entity--
            (1) is a qualified provider of the services under section 
        302;
            (2) has filed with the Secretary a participation agreement 
        described in subsection (b); and
            (3) meets, as applicable, such other qualifications and 
        conditions with respect to a provider of services under title 
        XVIII of the Social Security Act as described in section 1866 
        of the Social Security Act (42 U.S.C. 1395cc).
    (b) Requirements in Participation Agreement.--
            (1) In general.--A participation agreement described in 
        this subsection between the Secretary and a provider shall 
        provide at least for the following:
                    (A) Services to eligible persons will be furnished 
                by the provider without discrimination, in accordance 
                with section 104(a). Nothing in this subparagraph shall 
                be construed as requiring the provision of a type or 
                class of services that are outside the scope of the 
                provider's normal practice.
                    (B) No charge will be made to any enrolled 
                individual for any covered services other than for 
                payment authorized by this Act.
                    (C) The provider agrees to furnish such information 
                as may be reasonably required by the Secretary, in 
                accordance with uniform reporting standards established 
                under section 401(b)(1), for--
                            (i) quality review by designated entities;
                            (ii) making payments under this Act, 
                        including the examination of records as may be 
                        necessary for the verification of information 
                        on which such payments are based;
                            (iii) statistical or other studies required 
                        for the implementation of this Act; and
                            (iv) such other purposes as the Secretary 
                        may specify.
                    (D) In the case of a provider that is not an 
                individual, the provider agrees not to employ or use 
                for the provision of health services any individual or 
                other provider that has had a participation agreement 
                under this subsection terminated for cause.
                    (E) In the case of a provider paid under a fee-for-
                service basis, the provider agrees to submit bills and 
                any required supporting documentation relating to the 
                provision of covered services within 30 days after the 
                date of providing such services.
            (2) Termination of participation agreement.--
                    (A) In general.--Participation agreements may be 
                terminated, with appropriate notice--
                            (i) by the Secretary for failure to meet 
                        the requirements of this Act; or
                            (ii) by a provider.
                    (B) Termination process.--Providers shall be 
                provided notice and a reasonable opportunity to correct 
                deficiencies before the Secretary terminates an 
                agreement unless a more immediate termination is 
                required for public safety or similar reasons.
                    (C) Provider protections.--
                            (i) Prohibition.--The Secretary may not 
                        terminate a participation agreement or in any 
                        other way discriminate against, or cause to be 
                        discriminated against, any covered provider or 
                        authorized representative of the provider, on 
                        account of such provider or representative--
                                    (I) providing, causing to be 
                                provided, or being about to provide or 
                                cause to be provided to the provider, 
                                the Federal Government, or the attorney 
                                general of a State information relating 
                                to any violation of, or any act or 
                                omission the provider or representative 
                                reasonably believes to be a violation 
                                of, any provision of this title (or an 
                                amendment made by this title);
                                    (II) testifying or being about to 
                                testify in a proceeding concerning such 
                                violation;
                                    (III) assisting or participating, 
                                or being about to assist or 
                                participate, in such a proceeding; or
                                    (IV) objecting to, or refusing to 
                                participate in, any activity, policy, 
                                practice, or assigned task that the 
                                provider or representative reasonably 
                                believes to be in violation of any 
                                provision of this Act (including any 
                                amendment made by this Act), or any 
                                order, rule, regulation, standard, or 
                                ban under this Act (including any 
                                amendment made by this Act).
                            (ii) Complaint procedure.--A provider or 
                        representative who believes that he or she has 
                        been discriminated against in violation of this 
                        section may seek relief in accordance with the 
                        procedures, notifications, burdens of proof, 
                        remedies, and statutes of limitation set forth 
                        in section 2087(b) of title 15, United States 
                        Code.

SEC. 302. QUALIFICATIONS FOR PROVIDERS.

    (a) In General.--A health care provider is considered to be 
qualified to provide covered services if the provider is licensed or 
certified and meets--
            (1) all the requirements of State law to provide such 
        services; and
            (2) applicable requirements of Federal law to provide such 
        services.
    (b) Minimum Provider Standards.--
            (1) In general.--The Secretary shall establish, evaluate, 
        and update national minimum standards to ensure the quality of 
        services provided under this Act and to monitor efforts by 
        States to ensure the quality of such services. A State may also 
        establish additional minimum standards which providers shall 
        meet with respect to services provided in such State.
            (2) National minimum standards.--The national minimum 
        standards under paragraph (1) shall be established for 
        institutional providers of services and individual health care 
        practitioners. Except as the Secretary may specify in order to 
        carry out this Act, a hospital, skilled nursing facility, or 
        other institutional provider of services shall meet standards 
        for such a provider under the Medicare program under title 
        XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). Such 
        standards also may include, where appropriate, elements 
        relating to--
                    (A) adequacy and quality of facilities;
                    (B) training and competence of personnel (including 
                continuing education requirements);
                    (C) comprehensiveness of service;
                    (D) continuity of service;
                    (E) patient satisfaction, including waiting time 
                and access to services; and
                    (F) performance standards, including organization, 
                facilities, structure of services, efficiency of 
                operation, and outcome in palliation, improvement of 
                health, stabilization, cure, or rehabilitation.
            (3) Transition in application.--If the Secretary provides 
        for additional requirements for providers under this 
        subsection, any such additional requirement shall be 
        implemented in a manner that provides for a reasonable period 
        during which a previously qualified provider is permitted to 
        meet such an additional requirement.
            (4) Ability to provide services.--With respect to any 
        entity or provider certified to provide services described in 
        section 201(a)(7), the Secretary may not prohibit such entity 
        or provider from participating for reasons other than its 
        ability to provide such services.
    (c) Federal Providers.--Any provider qualified to provide health 
care services through the Department of Veterans Affairs or Indian 
Health Service is a qualifying provider under this section with respect 
to any individual who qualifies for such services under applicable 
Federal law.

SEC. 303. USE OF PRIVATE CONTRACTS.

    (a) In General.--Subject to the provisions of this subsection, 
nothing in this Act shall prohibit an institutional or individual 
provider from entering into a private contract with an enrolled 
individual for any item or service--
            (1) for which no claim for payment is to be submitted under 
        this Act; and
            (2) for which the provider receives--
                    (A) no reimbursement under this Act directly or on 
                a capitated basis; and
                    (B) receives no amount for such item or service 
                from an organization which receives reimbursement for 
                such items or service under this Act directly or on a 
                capitated basis.
    (b) Beneficiary Protections.--
            (1) In general.--Subsection (a) shall not apply to any 
        contract unless--
                    (A) the contract is in writing and is signed by the 
                beneficiary before any item or service is provided 
                pursuant to the contract;
                    (B) the contract contains the items described in 
                paragraph (2); and
                    (C) the contract is not entered into at a time when 
                the beneficiary is facing an emergency health care 
                situation.
            (2) Items required to be included in contract.--Any 
        contract to provide items and services to which subsection (a) 
        applies shall clearly indicate to the beneficiary that by 
        signing such contract the beneficiary--
                    (A) agrees not to submit a claim (or to request 
                that the provider submit a claim) under this Act for 
                such items or services even if such items or services 
                are otherwise covered by this Act;
                    (B) agrees to be responsible, whether through 
                insurance offered under section 107(b) or otherwise, 
                for payment of such items or services and understands 
                that no reimbursement will be provided under this Act 
                for such items or services;
                    (C) acknowledges that no limits under this Act 
                apply to amounts that may be charged for such items or 
                services;
                    (D) if the provider is a non-participating 
                provider, acknowledges that the beneficiary has the 
                right to have such items or services provided by other 
                providers for whom payment would be made under this 
                Act; and
                    (E) acknowledges that the provider is providing 
                services outside the scope of the program under this 
                Act.
    (c) Provider Requirements.--
            (1) In general.--Subsection (a) shall not apply to any 
        contract unless an affidavit described in paragraph (2) is in 
        effect during the period any item or service is to be provided 
        pursuant to the contract.
            (2) Affidavit.--An affidavit is described in this 
        subparagraph shall--
                    (A) identify the practitioner, and be signed by 
                such practitioner;
                    (B) provide that the practitioner will not submit 
                any claim under this title for any item or service 
                provided to any beneficiary (and will not receive any 
                reimbursement or amount described in paragraph (1)(B) 
                for any such item or service) during the 1-year period 
                beginning on the date the affidavit is signed; and
                    (C) be filed with the Secretary no later than 10 
                days after the first contract to which such affidavit 
                applies is entered into.
            (3) Enforcement.--If a physician or practitioner signing an 
        affidavit described in paragraph (2) knowingly and willfully 
        submits a claim under this title for any item or service 
        provided during the 1-year period described in paragraph (2)(B) 
        (or receives any reimbursement or amount described in 
        subsection (a)(2) for any such item or service) with respect to 
        such affidavit--
                    (A) this subsection shall not apply with respect to 
                any items and services provided by the physician or 
                practitioner pursuant to any contract on and after the 
                date of such submission and before the end of such 
                period; and
                    (B) no payment shall be made under this title for 
                any item or service furnished by the physician or 
                practitioner during the period described in clause (i) 
                (and no reimbursement or payment of any amount 
                described in subsection (a)(2) shall be made for any 
                such item or service).

                        TITLE IV--ADMINISTRATION

             Subtitle A--General Administration Provisions

SEC. 401. ADMINISTRATION.

    (a) General Duties of the Secretary.--
            (1) In general.--The Secretary shall develop policies, 
        procedures, guidelines, and requirements to carry out this Act, 
        including related to--
                    (A) eligibility for benefits;
                    (B) enrollment;
                    (C) benefits provided;
                    (D) provider participation standards and 
                qualifications, as described in title III;
                    (E) levels of funding;
                    (F) methods for determining amounts of payments to 
                providers of covered services, consistent with subtitle 
                B;
                    (G) the determination of medical necessity and 
                appropriateness with respect to coverage of certain 
                services;
                    (H) planning for capital expenditures and service 
                delivery;
                    (I) planning for health professional education 
                funding;
                    (J) encouraging States to develop regional planning 
                mechanisms; and
                    (K) any other regulations necessary to carry out 
                the purpose of this Act.
            (2) Regulations.--Regulations authorized by this Act shall 
        be issued by the Secretary in accordance with section 553 of 
        title 5, United States Code.
    (b) Uniform Reporting Standards; Annual Report; Studies.--
            (1) Uniform reporting standards.--
                    (A) In general.--The Secretary shall establish 
                uniform State reporting requirements and national 
                standards to ensure an adequate national database 
                containing information pertaining to health services 
                practitioners, approved providers, the costs of 
                facilities and practitioners providing such services, 
                the quality of such services, the outcomes of such 
                services, and the equity of health among population 
                groups. Such standards shall include, to the maximum 
                extent feasible without compromising patient privacy, 
                health outcome measures, and to the maximum extent 
                feasible without excessively burdening providers, the 
                measures described in subparagraphs (D) through (F) of 
                subsection (a)(1).
                    (B) Reports.--The Secretary shall regularly analyze 
                information reported to it and shall define rules and 
                procedures to allow researchers, scholars, health care 
                providers, and others to access and analyze data for 
                purposes consistent with quality and outcomes research, 
                without compromising patient privacy.
            (2) Annual report.--Beginning January 1 of the second year 
        beginning after the effective date of this Act, the Secretary 
        shall annually report to Congress on the following:
                    (A) The status of implementation of the Act.
                    (B) Enrollment under this Act.
                    (C) Benefits under this Act.
                    (D) Expenditures and financing under this Act.
                    (E) Cost-containment measures and achievements 
                under this Act.
                    (F) Quality assurance.
                    (G) Health care utilization patterns, including any 
                changes attributable to the program.
                    (H) Changes in the per-capita costs of health care.
                    (I) Differences in the health status of the 
                populations of the different States, including income 
                and racial characteristics, and other population health 
                inequities.
                    (J) Progress on quality and outcome measures, and 
                long-range plans and goals for achievements in such 
                areas.
                    (K) Necessary changes in the education of health 
                personnel.
                    (L) Plans for improving service to medically 
                underserved populations.
                    (M) Transition problems as a result of 
                implementation of this Act.
                    (N) Opportunities for improvements under this Act.
            (3) Statistical analyses and other studies.--The Secretary 
        may, either directly or by contract--
                    (A) make statistical and other studies, on a 
                nationwide, regional, State, or local basis, of any 
                aspect of the operation of this Act;
                    (B) develop and test methods of payment or delivery 
                as it may consider necessary or promising for the 
                evaluation, or for the improvement, of the operation of 
                this Act; and
                    (C) develop methodological standards for evidence-
                based policymaking.
    (c) Audits.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct an audit of the Board every fifth fiscal 
        year following the effective date of this Act to determine the 
        effectiveness of the program in carrying out the duties under 
        subsection (a).
            (2) Reports.--The Comptroller General of the United States 
        shall submit a report to Congress concerning the results of 
        each audit conducted under this subsection.

SEC. 402. CONSULTATION.

    The Secretary shall consult with Federal agencies, Indian tribes 
and urban Indian health organizations, and private entities, such as 
professional societies, national associations, nationally recognized 
associations of experts, medical schools and academic health centers, 
consumer and patient groups, and labor and business organizations in 
the formulation of guidelines, regulations, policy initiatives, and 
information gathering to ensure the broadest and most informed input in 
the administration of this Act. Nothing in this Act shall prevent the 
Secretary from adopting guidelines developed by such a private entity 
if, in the Secretary's judgment, such guidelines are generally accepted 
as reasonable and prudent and consistent with this Act.

SEC. 403. REGIONAL ADMINISTRATION.

    (a) Coordination With Regional Offices.--The Secretary shall 
establish and maintain regional offices to promote adequate access to, 
and efficient use of, tertiary care facilities, equipment, and 
services. Wherever possible, the Secretary shall incorporate regional 
offices of the Centers for Medicare & Medicaid Services for this 
purpose.
    (b) Appointment of Regional and State Directors.--In each such 
regional office there shall be--
            (1) one regional director appointed by the Secretary;
            (2) for each State in the region, a deputy director; and
            (3) one deputy director to represent the Native American 
        and Alaska Native tribes in the region.
    (c) Regional Office Duties.--Regional offices shall be responsible 
for--
            (1) providing an annual State health care needs assessment 
        report to the Secretary, after a thorough examination of health 
        needs, in consultation with public health officials, 
        clinicians, patients, and patient advocates;
            (2) recommending changes in provider reimbursement or 
        payment for delivery of health services in the States within 
        the region; and
            (3) establishing a quality assurance mechanism in the State 
        in order to minimize both under-utilization and over-
        utilization and to ensure that all providers meet high-quality 
        standards.

SEC. 404. BENEFICIARY OMBUDSMAN.

    (a) In General.--The Secretary shall appoint a Beneficiary 
Ombudsman who shall have expertise and experience in the fields of 
health care and education of, and assistance to, individuals entitled 
to benefits under this Act.
    (b) Duties.--The Beneficiary Ombudsman shall--
            (1) receive complaints, grievances, and requests for 
        information submitted by individuals entitled to benefits under 
        this Act with respect to any aspect of the Universal Medicare 
        Program;
            (2) provide assistance with respect to complaints, 
        grievances, and requests referred to in subparagraph (a), 
        including--
                    (A) assistance in collecting relevant information 
                for such individuals, to seek an appeal of a decision 
                or determination made by a regional office or the 
                Secretary; and
                    (B) assistance to such individuals in presenting 
                information under relating to cost-sharing; and
            (3) submit annual reports to Congress and the Secretary 
        that describe the activities of the Office and that include 
        such recommendations for improvement in the administration of 
        this Act as the Ombudsman determines appropriate. The Ombudsman 
        shall not serve as an advocate for any increases in payments or 
        new coverage of services, but may identify issues and problems 
        in payment or coverage policies.

SEC. 405. COMPLEMENTARY CONDUCT OF RELATED HEALTH PROGRAMS.

    In performing functions with respect to health personnel education 
and training, health research, environmental health, disability 
insurance, vocational rehabilitation, the regulation of food and drugs, 
and all other matters pertaining to health, the Secretary shall direct 
the activities of the Department of Health and Human Services toward 
contributions to the health of the people complementary to this Act.

                Subtitle B--Control Over Fraud and Abuse

SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL FRAUD AND ABUSE UNDER 
              UNIVERSAL MEDICARE PROGRAM.

    The following sections of the Social Security Act shall apply to 
this Act in the same manner as they apply to State medical assistance 
plans under title XIX of such Act:
            (1) Section 1128 (relating to exclusion of individuals and 
        entities).
            (2) Section 1128A (civil monetary penalties).
            (3) Section 1128B (criminal penalties).
            (4) Section 1124 (relating to disclosure of ownership and 
        related information).
            (5) Section 1126 (relating to disclosure of certain 
        owners).

                      TITLE V--QUALITY ASSESSMENT

SEC. 501. QUALITY STANDARDS.

    (a) In General.--All standards and quality measures under this Act 
shall be performed by the Center for Clinical Standards and Quality of 
the Centers for Medicare & Medicaid Services (referred to in this title 
as the ``Center''), in coordination with the Agency for Healthcare 
Research and Quality and other offices of the Department of Health and 
Human Services.
    (b) Duties of the Center.--The Center shall perform the following 
duties:
            (1) Practice guidelines.--The Center shall review and 
        evaluate each practice guideline developed under part B of 
        title IX of the Public Health Service Act. The Center shall 
        determine whether the guideline should be recognized as a 
        national practice guideline.
            (2) Standards of quality, performance measures, and medical 
        review criteria.--The Center shall review and evaluate each 
        standard of quality, performance measure, and medical review 
        criterion developed under part B of title IX of the Public 
        Health Service Act (42 U.S.C. 299 et seq.). The Center shall 
        determine whether the standard, measure, or criterion is 
        appropriate for use in assessing or reviewing the quality of 
        services provided by health care institutions or health care 
        professionals. In evaluating such standards, the Center shall 
        consider the evidentiary basis for the standard, and the 
        validity, reliability, and feasibility of measuring the 
        standard.
            (3) Profiling of patterns of practice; identification of 
        outliers.--The Center shall adopt methodologies for profiling 
        the patterns of practice of health care professionals and for 
        identifying and notifying outliers.
            (4) Criteria for entities conducting quality reviews.--The 
        Center shall develop minimum criteria for competence for 
        entities that can qualify to conduct ongoing and continuous 
        external quality reviews in the administrative regions. Such 
        criteria shall require such an entity to be administratively 
        independent of the individual or board that administers the 
        region and shall ensure that such entities do not provide 
        financial incentives to reviewers to favor one pattern of 
        practice over another. The Center shall ensure coordination and 
        reporting by such entities to ensure national consistency in 
        quality standards.
            (5) Reporting.--The Center shall report to the Secretary 
        annually specifically on findings from outcomes research and 
        development of practice guidelines that may affect the 
        Secretary's determination of coverage of services under section 
        401(a)(1)(G).

SEC. 502. ADDRESSING HEALTH CARE DISPARITIES.

    (a) Evaluating Data Collection Approaches.--The Center shall 
evaluate approaches for the collection of data under this Act, to be 
performed in conjunction with existing quality reporting requirements 
and programs under this Act, that allow for the ongoing, accurate, and 
timely collection of data on disparities in health care services and 
performance on the basis of race, ethnicity, gender, geography, or 
socioeconomic status. In conducting such evaluation, the Secretary 
shall consider the following objectives:
            (1) Protecting patient privacy.
            (2) Minimizing the administrative burdens of data 
        collection and reporting on providers under this Act.
            (3) Improving Universal Medicare Program data on race, 
        ethnicity, gender, geography, and socioeconomic status.
    (b) Reports to Congress.--
            (1) Report on evaluation.--Not later than 18 months after 
        the date on which benefits first become available as described 
        in section 106(a), the Center shall submit to Congress and the 
        Secretary a report on the evaluation conducted under subsection 
        (a). Such report shall, taking into consideration the results 
        of such evaluation--
                    (A) identify approaches (including defining 
                methodologies) for identifying and collecting and 
                evaluating data on health care disparities on the basis 
                of race, ethnicity, gender, geography, or socioeconomic 
                status under the Universal Medicare Program; and
                    (B) include recommendations on the most effective 
                strategies and approaches to reporting quality 
                measures, as appropriate, on the basis of race, 
                ethnicity, gender, geography, or socioeconomic status.
            (2) Report on data analyses.--Not later than 4 years after 
        the submission of the report under subsection (b)(1), and 4 
        years thereafter, the Center shall submit to Congress and the 
        Secretary a report that includes recommendations for improving 
        the identification of health care disparities based on the 
        analyses of data collected under subsection (c).
    (c) Implementing Effective Approaches.--Not later than 2 years 
after the date on which benefits first become available as described in 
section 106(a), the Secretary shall implement the approaches identified 
in the report submitted under subsection (b)(1) for the ongoing, 
accurate, and timely collection and evaluation of data on health care 
disparities on the basis of race, ethnicity, gender, geography, or 
socioeconomic status.

      TITLE VI--HEALTH BUDGET; PAYMENTS; COST CONTAINMENT MEASURES

                         Subtitle A--Budgeting

SEC. 601. NATIONAL HEALTH BUDGET.

    (a) National Health Budget.--
            (1) In general.--By not later than September 1 of each 
        year, beginning with the year prior to the date on which 
        benefits first become available as described in section 106(a), 
        the Secretary shall establish a national health budget, which 
        specifies the total expenditures to be made for covered health 
        care services under this Act.
            (2) Division of budget into components.--In addition to the 
        cost of covered health services, the national health budget 
        shall consist of at least the following components:
                    (A) Quality assessment activities under title V.
                    (B) Health professional education expenditures.
                    (C) Administrative costs.
                    (D) Innovation, including in accordance with 
                section 1115A of the Social Security Act (42 U.S.C. 
                1315a).
                    (E) Operating and other expenditures not described 
                in subparagraphs (A) through (D) (referred to in this 
                Act as the ``operating component''), consisting of 
                amounts not included in the other components.
                    (F) Capital expenditures.
                    (G) Prevention and public health activities.
            (3) Allocation among components.--The Secretary shall 
        allocate the budget among the components in a manner that--
                    (A) ensures a fair allocation for quality 
                assessment activities; and
                    (B) ensures that the health professional education 
                expenditure component is sufficient to provide for the 
                amount of health professional education expenditures 
                sufficient to meet the need for covered health care 
                services.
            (4) Temporary worker assistance.--For up to 5 years 
        following the date on which benefits first become available as 
        described in section 106(a), up to 1 percent of the budget may 
        be allocated to programs providing assistance to workers who 
        perform functions in the administration of the health insurance 
        system and who may experience economic dislocation as a result 
        of the implementation of this Act.
            (5) Reserve fund.--The Secretary shall establish and 
        maintain a reserve fund to respond to the costs of treating an 
        epidemic, pandemic, natural disaster, or other such health 
        emergency.
    (b) Definitions.--In this section:
            (1) Capital expenditures.--The term ``capital 
        expenditures'' means expenses for the purchase, lease, 
        construction, or renovation of capital facilities and for 
        equipment and includes return on equity capital.
            (2) Health professional education expenditures.--The term 
        ``health professional education expenditures'' means 
        expenditures in hospitals and other health care facilities to 
        cover costs associated with teaching and related research 
        activities.

                   Subtitle B--Payments to Providers

SEC. 611. PAYMENTS TO INSTITUTIONAL AND INDIVIDUAL PROVIDERS.

    (a) Application of Payment Processes Under Title XVIII.--Except as 
otherwise provided in this section, the Secretary shall establish, by 
regulation, fee schedules that establish payment amounts for benefits 
under this Act in a manner that is consistent with processes for 
determining payments for items and services under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.), including the application 
of the provisions of, and amendments made by, section 612.
    (b) Application of Current and Planned Payment Reforms.--Any 
payment reform activities or demonstrations planned or implemented with 
respect to such title XVIII as of the date of the enactment of this Act 
shall apply to benefits under this Act, including any reform activities 
or demonstrations planned or implemented under the provisions of, or 
amendments made by, the Medicare Access and CHIP Reauthorization Act of 
2015 (Public Law 114-10) and the Patient Protection and Affordable Care 
Act (Public Law 111-148).

SEC. 612. ENSURING ACCURATE VALUATION OF SERVICES UNDER THE MEDICARE 
              PHYSICIAN FEE SCHEDULE.

    (a) Standardized and Documented Review Process.--Section 1848(c)(2) 
of the Social Security Act (42 U.S.C. 1395w-4(c)(2)) is amended by 
adding at the end the following new subparagraph:
                    ``(P) Standardized and documented review process.--
                            ``(i) In general.--Not later than one year 
                        after the date of enactment of this 
                        subparagraph, the Secretary shall establish, 
                        document, and make publicly available a 
                        standardized process for reviewing the relative 
                        values of physicians' services under this 
                        paragraph.
                            ``(ii) Minimum requirements.--The 
                        standardized process shall include, at a 
                        minimum, methods and criteria for identifying 
                        services for review, prioritizing the review of 
                        services, reviewing stakeholder 
                        recommendations, and identifying additional 
                        resources to be considered during the review 
                        process.''.
    (b) Planned and Documented Use of Funds.--Section 1848(c)(2)(M) of 
the Social Security Act (42 U.S.C. 1305w-4(c)(2)(M)) is amended by 
adding at the end the following new clause:
                            ``(x) Planned and documented use of 
                        funds.--For each fiscal year (beginning with 
                        the first fiscal year beginning on or after the 
                        date of enactment of this clause), the 
                        Secretary shall provide to Congress a written 
                        plan for using the funds provided under clause 
                        (ix) to collect and use information on 
                        physicians' services in the determination of 
                        relative values under this subparagraph.''.
    (c) Internal Tracking of Reviews.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        proposed plan for systematically and internally tracking its 
        review of the relative values of physicians' services, such as 
        by establishing an internal database, under section 1848(c)(2) 
        of the Social Security Act (42 U.S.C. 1395w-4(c)(2)), as 
        amended by this section.
            (2) Minimum requirements.--The proposal shall include, at a 
        minimum, plans and a timeline for achieving the ability to 
        systematically and internally track the following:
                    (A) When, how, and by whom services are identified 
                for review.
                    (B) When services are reviewed or when new services 
                are added.
                    (C) The resources, evidence, data, and 
                recommendations used in reviews.
                    (D) When relative values are adjusted.
                    (E) The rationale for final relative value 
                decisions.
    (d) Frequency of Review.--Section 1848(c)(2) of the Social Security 
Act (42 U.S.C. 1395w-4(c)(2)) is amended--
            (1) in subparagraph (B)(i), by striking ``5'' and inserting 
        ``4''; and
            (2) in subparagraph (K)(i)(I), by striking ``periodically'' 
        and inserting ``annually''.
    (e) Consultation With Medicare Payment Advisory Commission.--
            (1) In general.--Section 1848(c)(2) of the Social Security 
        Act (42 U.S.C. 1395w-4(c)(2)) is amended--
                    (A) in subparagraph (B)(i), by inserting ``in 
                consultation with the Medicare Payment Advisory 
                Commission,'' after ``The Secretary,''; and
                    (B) in subparagraph (K)(i)(I), as amended by 
                subsection (d)(2), by inserting ``, in coordination 
                with the Medicare Payment Advisory Commission,'' after 
                ``annually''.
            (2) Conforming amendments.--Section 1805 of the Social 
        Security Act (42 U.S.C. 1395b-6) is amended--
                    (A) in subsection (b)(1)(A), by inserting the 
                following before the semicolon at the end: ``and 
                including coordinating with the Secretary in accordance 
                with section 1848(c)(2) to systematically review the 
                relative values established for physicians' services, 
                identify potentially misvalued services, and propose 
                adjustments to the relative values for physicians' 
                services''; and
                    (B) in subsection (e)(1), in the second sentence, 
                by inserting ``or the Ranking Minority Member'' after 
                ``the Chairman''.
    (f) Periodic Audit by the Comptroller General.--Section 1848(c)(2) 
of the Social Security Act (42 U.S.C. 1395w-4(c)(2)), as amended by 
subsection (a), is amended by adding at the end the following new 
subparagraph:
                    ``(Q) Periodic audit by the comptroller general.--
                            ``(i) In general.--The Comptroller General 
                        of the United States (in this subparagraph 
                        referred to as the `Comptroller General') shall 
                        periodically audit the review by the Secretary 
                        of relative values established under this 
                        paragraph for physicians' services.
                            ``(ii) Access to information.--The 
                        Comptroller General shall have unrestricted 
                        access to all deliberations, records, and 
                        nonproprietary data related to the activities 
                        carried out under this paragraph, in a timely 
                        manner, upon request.''.

SEC. 613. OFFICE OF PRIMARY HEALTH CARE.

    (a) In General.--There is established within the Agency for 
Healthcare Research and Quality an Office of Primary Health Care, 
responsible for coordinating with the Secretary, the Health Resources 
and Services Administration, and other offices in the Department as 
necessary, in order to--
            (1) coordinate health professional education policies and 
        goals, in consultation with the Secretary to achieve the 
        national goals specified in subsection (b);
            (2) develop and maintain a system to monitor the number and 
        specialties of individuals through their health professional 
        education, any postgraduate training, and professional 
        practice;
            (3) develop, coordinate, and promote policies that expand 
        the number of primary care practitioners, registered nurses, 
        midlevel practitioners, and dentists; and
            (4) recommend the appropriate training, education, 
        technical assistance, and patient advocacy enhancements of 
        primary care health professionals, including registered nurses, 
        to achieve uniform high-quality and patient safety.
    (b) National Goals.--Not later than 1 year after the date of 
enactment of this Act, the Office of Primary Health Care shall set 
forth national goals to increase access to high-quality primary health 
care, particularly in underserved areas and for underserved 
populations.

SEC. 614. PAYMENTS FOR PRESCRIPTION DRUGS AND APPROVED DEVICES AND 
              EQUIPMENT.

    (a) Negotiated Prices.--The prices to be paid for covered 
pharmaceuticals, medical supplies, and medically necessary assistive 
equipment shall be negotiated annually by the Secretary.
    (b) Prescription Drug Formulary.--
            (1) In general.--The Secretary shall establish a 
        prescription drug formulary system, which shall encourage best-
        practices in prescribing and discourage the use of ineffective, 
        dangerous, or excessively costly medications when better 
        alternatives are available.
            (2) Promotion of use of generics.--The formulary under this 
        subsection shall promote the use of generic medications to the 
        greatest extent possible.
            (3) Formulary updates and petition rights.--The formulary 
        under this subsection shall be updated frequently and 
        clinicians and patients may petition the Secretary to add new 
        pharmaceuticals or to remove ineffective or dangerous 
        medications from the formulary.
            (4) Use of off-formulary medications.--The Secretary shall 
        promulgate rules regarding the use of off-formulary medications 
        which allow for patient access but do not compromise the 
        formulary.

                TITLE VII--UNIVERSAL MEDICARE TRUST FUND

SEC. 701. UNIVERSAL MEDICARE TRUST FUND.

    (a) In General.--There is hereby created on the books of the 
Treasury of the United States a trust fund to be known as the Universal 
Medicare Trust Fund (in this section referred to as the ``Trust 
Fund''). The Trust Fund shall consist of such gifts and bequests as may 
be made and such amounts as may be deposited in, or appropriated to, 
such Trust Fund as provided in this Act.
    (b) Appropriations Into Trust Fund.--
            (1) Taxes.--There are hereby appropriated to the Trust Fund 
        for each fiscal year beginning with the fiscal year which 
        includes the date on which benefits first become available as 
        described in section 106, out of any moneys in the Treasury not 
        otherwise appropriated, amounts equivalent to 100 percent of 
        the net increase in revenues to the Treasury which is 
        attributable to the amendments made by sections 801 and 902. 
        The amounts appropriated by the preceding sentence shall be 
        transferred from time to time (but not less frequently than 
        monthly) from the general fund in the Treasury to the Trust 
        Fund, such amounts to be determined on the basis of estimates 
        by the Secretary of the Treasury of the taxes paid to or 
        deposited into the Treasury; and proper adjustments shall be 
        made in amounts subsequently transferred to the extent prior 
        estimates were in excess of or were less than the amounts that 
        should have been so transferred.
            (2) Current program receipts.--Notwithstanding any other 
        provision of law, there are hereby appropriated to the Trust 
        Fund for each fiscal year, beginning with the first fiscal year 
        beginning on or after the effective date of benefits under 
        section 106, the amounts that would otherwise have been 
        appropriated to carry out the following programs:
                    (A) The Medicare program under title XVIII of the 
                Social Security Act (other than amounts attributable to 
                any premiums under such title).
                    (B) The Medicaid program, under State plans 
                approved under title XIX of such Act.
                    (C) The Federal employees health benefit program, 
                under chapter 89 of title 5, United States Code.
                    (D) The TRICARE program, under chapter 55 of title 
                10, United States Code.
                    (E) The maternal and child health program (under 
                title V of the Social Security Act), vocational 
                rehabilitation programs, programs for drug abuse and 
                mental health services under the Public Health Service 
                Act, programs providing general hospital or medical 
                assistance, and any other Federal program identified by 
                the Secretary, in consultation with the Secretary of 
                the Treasury, to the extent the programs provide for 
                payment for health services the payment of which may be 
                made under this Act.
            (3) Restrictions shall not apply.--Any other provision of 
        law in effect on the date of enactment of this Act restricting 
        the use of Federal funds for any reproductive health service 
        shall not apply to monies in the Trust Fund.
    (c) Incorporation of Provisions.--The provisions of subsections (b) 
through (i) of section 1817 of the Social Security Act (42 U.S.C. 
1395i) shall apply to the Trust Fund under this section in the same 
manner as such provisions applied to the Federal Hospital Insurance 
Trust Fund under such section 1817, except that, for purposes of 
applying such subsections to this section, the ``Board of Trustees of 
the Trust Fund'' shall mean the ``Secretary''.
    (d) Transfer of Funds.--Any amounts remaining in the Federal 
Hospital Insurance Trust Fund under section 1817 of the Social Security 
Act (42 U.S.C. 1395i) or the Federal Supplementary Medical Insurance 
Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) after the 
payment of claims for items and services furnished under title XVIII of 
such Act have been completed, shall be transferred into the Universal 
Medicare Trust Fund under this section.

  TITLE VIII--CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME 
                          SECURITY ACT OF 1974

SEC. 801. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF BENEFITS 
              UNDER THE UNIVERSAL MEDICARE PROGRAM; COORDINATION IN 
              CASE OF WORKERS' COMPENSATION.

    (a) In General.--Part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is 
amended by adding at the end the following new section:

``SEC. 522. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF UNIVERSAL 
              MEDICARE PROGRAM BENEFITS; COORDINATION IN CASE OF 
              WORKERS' COMPENSATION.

    ``(a) In General.--Subject to subsection (b), no employee benefit 
plan may provide benefits that duplicate payment for any items or 
services for which payment may be made under the Medicare for All Act 
of 2019.
    ``(b) Reimbursement.--Each workers compensation carrier that is 
liable for payment for workers compensation services furnished in a 
State shall reimburse the Universal Medicare Program for the cost of 
such services.
    ``(c) Definitions.--In this subsection--
            ``(1) the term `workers compensation carrier' means an 
        insurance company that underwrite workers compensation medical 
        benefits with respect to one or more employers and includes an 
        employer or fund that is financially at risk for the provision 
        of workers compensation medical benefits;
            ``(2) the term `workers compensation medical benefits' 
        means, with respect to an enrollee who is an employee subject 
        to the workers compensation laws of a State, the comprehensive 
        medical benefits for work-related injuries and illnesses 
        provided for under such laws with respect to such an employee; 
        and
            ``(3) the term `workers compensation services' means items 
        and services included in workers compensation medical benefits 
        and includes items and services (including rehabilitation 
        services and long-term-care services) commonly used for 
        treatment of work-related injuries and illnesses.''.
    (b) Conforming Amendment.--Section 4(b) of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1003(b)) is amended by adding at 
the end the following: ``Paragraph (3) shall apply subject to section 
522(b) (relating to reimbursement of the Universal Medicare Program by 
workers compensation carriers).''.
    (c) Clerical Amendment.--The table of contents in section 1 of such 
Act is amended by inserting after the item relating to section 521 the 
following new item:

``Sec 522. Prohibition of employee benefits duplicative of Universal 
                            Medicare Program benefits; coordination in 
                            case of workers' compensation.''.

SEC. 802. REPEAL OF CONTINUATION COVERAGE REQUIREMENTS UNDER ERISA AND 
              CERTAIN OTHER REQUIREMENTS RELATING TO GROUP HEALTH 
              PLANS.

    (a) In General.--Part 6 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.) is 
repealed.
    (b) Conforming Amendments.--
            (1) Section 502(a) of such Act (29 U.S.C. 1132(a)) is 
        amended--
                    (A) by striking paragraph (7); and
                    (B) by redesignating paragraphs (8), (9), and (10) 
                as paragraphs (7), (8), and (9), respectively.
            (2) Section 502(c)(1) of such Act (29 U.S.C. 1132(c)(1)) is 
        amended by striking ``paragraph (1) or (4) of section 606,''.
            (3) Section 514(b) of such Act (29 U.S.C. 1144(b)) is 
        amended--
                    (A) in paragraph (7), by striking ``section 
                206(d)(3)(B)(i)).''; and
                    (B) by striking paragraph (8).
            (4) The table of contents in section 1 of the Employee 
        Retirement Income Security Act of 1974 is amended by striking 
        the items relating to part 6 of subtitle B of title I of such 
        Act.

SEC. 803. EFFECTIVE DATE OF TITLE.

    The amendments made by this title shall take effect on effective 
date of benefits under section 106(a).

               TITLE IX--ADDITIONAL CONFORMING AMENDMENTS

SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS.

    (a) Medicare, Medicaid, and State Children's Health Insurance 
Program (SCHIP).--
            (1) In general.--Notwithstanding any other provision of 
        law, subject to paragraphs (2) and (3)--
                    (A) no benefits shall be available under title 
                XVIII of the Social Security Act for any item or 
                service furnished beginning on or after the effective 
                date of benefits under section 106(a);
                    (B) no individual is entitled to medical assistance 
                under a State plan approved under title XIX of such Act 
                for any item or service furnished on or after such 
                date;
                    (C) no individual is entitled to medical assistance 
                under a State child health plan under title XXI of such 
                Act for any item or service furnished on or after such 
                date; and
                    (D) no payment shall be made to a State under 
                section 1903(a) or 2105(a) of such Act with respect to 
                medical assistance or child health assistance for any 
                item or service furnished on or after such date.
            (2) Transition.--In the case of inpatient hospital services 
        and extended care services during a continuous period of stay 
        which began before the effective date of benefits under section 
        106, and which had not ended as of such date, for which 
        benefits are provided under title XVIII of the Social Security 
        Act, under a State plan under title XIX of such Act, or under a 
        State child health plan under title XXI such Act, the Secretary 
        of Health and Human Services shall provide for continuation of 
        benefits under such title or plan until the end of the period 
        of stay.
            (3) Services under medicaid.--
                    (A) In general.--This subsection shall not apply to 
                entitlement to medical assistance provided under title 
                XIX of the Social Security Act for--
                            (i) institutional long-term care services 
                        (as defined in section 1947(b) of such Act); or
                            (ii) any other service for which benefits 
                        are not available under this Act and which is 
                        furnished under a State plan under title XIX of 
                        the Social Security Act which provided for 
                        medical assistance for such service on January 
                        1, 2019.
                    (B) Coordination between secretary and states.--The 
                Secretary shall coordinate with the directors of State 
                agencies responsible for administering State plans 
                under title XIX of the Social Security Act to--
                            (i) identify services described in 
                        subparagraph (A)(ii) with respect to each State 
                        plan; and
                            (ii) ensure that such services continue to 
                        be made available under such plan.
                    (C) Maintenance of effort requirement.--With 
                respect to any service described in subparagraph 
                (A)(ii) that is made available under a State plan under 
                title XIX of the Social Security Act, the maintenance 
                of effort requirements described in section 1947(c) of 
                such Act (related to eligibility standards and required 
                expenditures) shall apply to such service in the same 
                manner that such requirements apply to institutional 
                long-term care services (as defined in section 1947(b) 
                of such Act).
    (b) Federal Employees Health Benefits Program.--No benefits shall 
be made available under chapter 89 of title 5, United States Code, for 
any part of a coverage period occurring on or after the effective date.
    (c) TRICARE.--No benefits shall be made available under sections 
1079 and 1086 of title 10, United States Code, for items or services 
furnished on or after the effective date.
    (d) Treatment of Benefits for Veterans and Native Americans.--
            (1) In general.--Nothing in this Act shall affect the 
        eligibility of veterans for the medical benefits and services 
        provided under title 38, United States Code, or of Indians for 
        the medical benefits and services provided by or through the 
        Indian Health Service.
            (2) Reevaluation.--No reevaluation of the Indian Health 
        Service shall be undertaken without consultation with tribal 
        leaders and stakeholders.

SEC. 902. SUNSET OF PROVISIONS RELATED TO THE STATE EXCHANGES.

    Effective on the date described in section 106, the Federal and 
State Exchanges established pursuant to title I of the Patient 
Protection and Affordable Care Act (Public Law 111-148) shall 
terminate, and any other provision of law that relies upon 
participation in or enrollment through such an Exchange, including such 
provisions of the Internal Revenue Code of 1986, shall cease to have 
force or effect.

                          TITLE X--TRANSITION

Subtitle A--Transitional Medicare Buy-In Option and Transitional Public 
                                 Option

SEC. 1001. LOWERING THE MEDICARE AGE.

    (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
1395c et seq.) is amended by adding at the end the following new 
section:

     ``transitional medicare buy-in option for certain individuals

    ``Sec. 1899C.  (a) Option.--
            ``(1) In general.--Every individual who meets the 
        requirements described in paragraph (3) shall be eligible to 
        enroll under this section.
            ``(2) Part a, b, and d benefits.--An individual enrolled 
        under this section is entitled to the same benefits (and shall 
        receive the same protections) under this title as an individual 
        who is entitled to benefits under part A and enrolled under 
        parts B and D, including the ability to enroll in a Medicare 
        Advantage plan that provides qualified prescription drug 
        coverage (an MA-PD plan).
            ``(3) Requirements for eligibility.--The requirements 
        described in this paragraph are the following:
                    ``(A) The individual is a resident of the United 
                States.
                    ``(B) The individual is--
                            ``(i) a citizen or national of the United 
                        States; or
                            ``(ii) an alien lawfully admitted for 
                        permanent residence.
                    ``(C) The individual is not otherwise entitled to 
                benefits under part A or eligible to enroll under part 
                A or part B.
                    ``(D) The individual has attained the applicable 
                years of age but has not attained 65 years of age.
            ``(4) Applicable years of age defined.--For purposes of 
        this section, the term `applicable years of age' means--
                    ``(A) effective January 1 of the first year 
                following the date of enactment of the Medicare for All 
                Act of 2019, the age of 55;
                    ``(B) effective January 1 of the second year 
                following such date of enactment, the age of 45; and
                    ``(C) effective January 1 of the third year 
                following such date of enactment, the age of 35.
    ``(b) Enrollment; Coverage.--The Secretary shall establish 
enrollment periods and coverage under this section consistent with the 
principles for establishment of enrollment periods and coverage for 
individuals under other provisions of this title. The Secretary shall 
establish such periods so that coverage under this section shall first 
begin on January 1 of the year on which an individual first becomes 
eligible to enroll under this section.
    ``(c) Premium.--
            ``(1) Amount of monthly premiums.--The Secretary shall, 
        during September of each year (beginning with the first 
        September following the date of enactment of the Medicare for 
        All Act of 2019), determine a monthly premium for all 
        individuals enrolled under this section. Such monthly premium 
        shall be equal to \1/12\ of the annual premium computed under 
        paragraph (2)(B), which shall apply with respect to coverage 
        provided under this section for any month in the succeeding 
        year.
            ``(2) Annual premium.--
                    ``(A) Combined per capita average for all medicare 
                benefits.--The Secretary shall estimate the average, 
                annual per capita amount for benefits and 
                administrative expenses that will be payable under 
                parts A, B, and D (including, as applicable, under part 
                C) in the year for all individuals enrolled under this 
                section.
                    ``(B) Annual premium.--The annual premium under 
                this subsection for months in a year is equal to the 
                average, annual per capita amount estimated under 
                subparagraph (A) for the year.
            ``(3) Increased premium for certain part c and d plans.--
        Nothing in this section shall preclude an individual from 
        choosing a Medicare Advantage plan or a prescription drug plan 
        which requires the individual to pay an additional amount 
        (because of supplemental benefits or because it is a more 
        expensive plan). In such case the individual would be 
        responsible for the increased monthly premium.
    ``(d) Payment of Premiums.--
            ``(1) In general.--Premiums for enrollment under this 
        section shall be paid to the Secretary at such times, and in 
        such manner, as the Secretary determines appropriate.
            ``(2) Deposit.--Amounts collected by the Secretary under 
        this section shall be deposited in the Federal Hospital 
        Insurance Trust Fund and the Federal Supplementary Medical 
        Insurance Trust Fund (including the Medicare Prescription Drug 
        Account within such Trust Fund) in such proportion as the 
        Secretary determines appropriate.
    ``(e) Not Eligible for Medicare Cost-Sharing Assistance.--An 
individual enrolled under this section shall not be treated as enrolled 
under any part of this title for purposes of obtaining medical 
assistance for Medicare cost-sharing or otherwise under title XIX.
    ``(f) Treatment in Relation to the Affordable Care Act.--
            ``(1) Satisfaction of individual mandate.--For purposes of 
        applying section 5000A of the Internal Revenue Code of 1986, 
        the coverage provided under this section constitutes minimum 
        essential coverage under subsection (f)(1)(A)(i) of such 
        section 5000A.
            ``(2) Eligibility for premium assistance.--Coverage 
        provided under this section--
                    ``(A) shall be treated as coverage under a 
                qualified health plan in the individual market enrolled 
                in through the Exchange where the individual resides 
                for all purposes of section 36B of the Internal Revenue 
                Code of 1986 other than subsection (c)(2)(B) thereof; 
                and
                    ``(B) shall not be treated as eligibility for other 
                minimum essential coverage for purposes of subsection 
                (c)(2)(B) of such section 36B.
        The Secretary shall determine the applicable second lowest cost 
        silver plan which shall apply to coverage under this section 
        for purposes of section 36B of such Code.
            ``(3) Eligibility for cost-sharing subsidies.--For purposes 
        of applying section 1402 of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18071)--
                    ``(A) coverage provided under this section shall be 
                treated as coverage under a qualified health plan in 
                the silver level of coverage in the individual market 
                offered through an Exchange; and
                    ``(B) the Secretary shall be treated as the issuer 
                of such plan.
    ``(g) No Effect on Benefits for Individuals Otherwise Eligible or 
on Trust Funds.--The Secretary shall implement the provisions of this 
section in such a manner to ensure that such provisions--
            ``(1) have no effect on the benefits under this title for 
        individuals who are entitled to, or enrolled for, such benefits 
        other than through this section; and
            ``(2) have no negative impact on the Federal Hospital 
        Insurance Trust Fund or the Federal Supplementary Medical 
        Insurance Trust Fund (including the Medicare Prescription Drug 
        Account within such Trust Fund).
    ``(h) Consultation.--In promulgating regulations to implement this 
section, the Secretary shall consult with interested parties, including 
groups representing beneficiaries, health care providers, employers, 
and insurance companies.''.

SEC. 1002. ESTABLISHMENT OF THE MEDICARE TRANSITION PLAN.

    (a) In General.--To carry out the purpose of this section, for plan 
years beginning with the first plan year that begins after the date of 
enactment of this Act and ending with the effective date described in 
section 106, the Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid (referred to in this section as the 
``Administrator''), shall establish, and provide for the offering 
through the Exchanges, of a public health plan (in this Act referred to 
as the ``Medicare Transition plan'') that provides affordable, high-
quality health benefits coverage throughout the United States.
    (b) Administrating the Medicare Transition.--
            (1) Administrator.--The Administrator shall administer the 
        Medicare Transition plan in accordance with this section.
            (2) Application of aca requirements.--Consistent with this 
        section, the Medicare Transition plan shall comply with 
        requirements under title I of the Patient Protection and 
        Affordable Care Act (and the amendments made by that title) and 
        title XXVII of the Public Health Service Act (42 U.S.C. 300gg 
        et seq.) that are applicable to qualified health plans offered 
        through the Exchanges, subject to the limitation under 
        subsection (e)(2).
            (3) Offering through exchanges.--The Medicare Transition 
        plan shall be made available only through the Exchanges, and 
        shall be available to individuals wishing to enroll and to 
        qualified employers (as defined in section 1312(f)(2) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18032)) 
        who wish to make such plan available to their employees.
            (4) Eligibility to purchase.--Any United States resident 
        may enroll in the Medicare Transition plan.
    (c) Benefits; Actuarial Value.--In carrying out this section, the 
Administrator shall ensure that the Medicare Transition plan provides--
            (1) coverage for the benefits required to be covered under 
        title II; and
            (2) coverage of benefits that are actuarially equivalent to 
        90 percent of the full actuarial value of the benefits provided 
        under the plan.
    (d) Providers and Reimbursement Rates.--
            (1) In general.--With respect to the reimbursement provided 
        to health care providers for covered benefits, as described in 
        section 201, provided under the Medicare Transition plan, the 
        Administrator shall reimburse such providers at rates 
        determined for equivalent items and services under the original 
        Medicare fee-for-service program under parts A and B of title 
        XVIII of the Social Security Act (42 U.S.C. 1395c et seq.). For 
        items and services covered under the Medicare Transition plan 
        but not covered under such parts A and B, the Administrator 
        shall reimburse providers at rates set by the Administrator in 
        a manner consistent with the manner in which rates for other 
        items and services were set under the original Medicare fee-
        for-service program.
            (2) Prescription drugs.--Any payment rate under this 
        subsection for a prescription drug shall be at a rate 
        negotiated by the Administrator with the manufacturer of the 
        drug. If the Administrator is unable to reach a negotiated 
        agreement on such a reimbursement rate, the Administrator shall 
        establish the rate at an amount equal to the lesser of--
                    (A) the price paid by the Secretary of Veterans 
                Affairs to procure the drug under the laws administered 
                by the Secretary of Veterans Affairs;
                    (B) the price paid to procure the drug under 
                section 8126 of title 38, United States Code; or
                    (C) the best price determined under section 
                1927(c)(1)(C) of the Social Security Act (42 U.S.C. 
                1396r-8(c)(1)(C)) for the drug.
            (3) Participating providers.--
                    (A) In general.--A health care provider that is a 
                participating provider of services or supplier under 
                the Medicare program under title XVIII of the Social 
                Security Act (42 U.S.C. 1395 et seq.) or under a State 
                Medicaid plan under title XIX of such Act (42 U.S.C. 
                1396 et seq.) on the date of enactment of this Act 
                shall be a participating provider in the Medicare 
                Transition plan.
                    (B) Additional providers.--The Administrator shall 
                establish a process to allow health care providers not 
                described in subparagraph (A) to become participating 
                providers in the Medicare Transition plan. Such process 
                shall be similar to the process applied to new 
                providers under the Medicare program.
    (e) Premiums.--
            (1) Determination.--The Administrator shall determine the 
        premium amount for enrolling in the Medicare Transition plan, 
        which--
                    (A) may vary according to family or individual 
                coverage, age, and tobacco status (consistent with 
                clauses (i), (iii), and (iv) of section 2701(a)(1)(A) 
                of the Public Health Service Act (42 U.S.C. 
                300gg(a)(1)(A))); and
                    (B) shall take into account the cost-sharing 
                reductions and premium tax credits which will be 
                available with respect to the plan under section 1402 
                of the Patient Protection and Affordable Care Act (42 
                U.S.C. 18071) and section 36B of the Internal Revenue 
                Code of 1986, as amended by subsection (g).
            (2) Limitation.--Variation in premium rates of the Medicare 
        Transition plan by rating area, as described in clause (ii) of 
        section 2701(a)(1)(A)(iii) of the Public Health Service Act (42 
        U.S.C. 300gg(a)(1)(A)) is not permitted.
    (f) Termination.--This section shall cease to have force or effect 
on the effective date described in section 106.
    (g) Tax Credits and Cost-Sharing Subsidies.--
            (1) Premium assistance tax credits.--
                    (A) Credits allowed to medicare transition plan 
                enrollees at or above 44 percent of poverty in non-
                expansion states.--Paragraph (1) of section 36B(c) of 
                the Internal Revenue Code of 1986 is amended by 
                redesignating subparagraphs (C) and (D) as 
                subparagraphs (D) and (E), respectively, and by 
                inserting after subparagraph (B) the following new 
                subparagraph:
                    ``(C) Special rules for medicare transition plan 
                enrollees.--
                            ``(i) In general.--In the case of a 
                        taxpayer who is covered, or whose spouse or 
                        dependent (as defined in section 152) is 
                        covered, by the Medicare Transition plan 
                        established under section 1002(a) of the 
                        Medicare for All Act of 2019 for all months in 
                        the taxable year, subparagraph (A) shall be 
                        applied without regard to `but does not exceed 
                        400 percent'.
                            ``(ii) Enrollees in medicaid non-expansion 
                        states.--In the case of a taxpayer residing in 
                        a State which (as of the date of the enactment 
                        of the Medicare for All Act of 2019) does not 
                        provide for eligibility under clause (i)(VIII) 
                        or (ii)(XX) of section 1902(a)(10)(A) of the 
                        Social Security Act for medical assistance 
                        under title XIX of such Act (or a waiver of the 
                        State plan approved under section 1115) who is 
                        covered, or whose spouse or dependent (as 
                        defined in section 152) is covered, by the 
                        Medicare Transition plan established under 
                        section 1002(a) of the Medicare for All Act of 
                        2019 for all months in the taxable year, 
                        subparagraphs (A) and (B) shall be applied by 
                        substituting `0 percent' for `100 percent' each 
                        place it appears.''.
                    (B) Premium assistance amounts for taxpayers 
                enrolled in medicare transition plan.--
                            (i) In general.--Subparagraph (A) of 
                        section 36B(b)(3) of such Code is amended--
                                    (I) by redesignating clause (ii) as 
                                clause (iii);
                                    (II) by striking ``clause (ii)'' in 
                                clause (i) and inserting ``clauses (ii) 
                                and (iii)''; and
                                    (III) by inserting after clause (i) 
                                the following new clause:
                            ``(ii) Special rules for taxpayers enrolled 
                        in medicare transition plan.--In the case of a 
                        taxpayer who is covered, or whose spouse or 
                        dependent (as defined in section 152) is 
                        covered, by the Medicare Transition plan 
                        established under section 1002(a) of the 
                        Medicare for All Act of 2019 for all months in 
                        the taxable year, the applicable percentage for 
                        any taxable year shall be determined in the 
                        same manner as under clause (i), except that 
                        the following table shall apply in lieu of the 
                        table contained in such clause:


------------------------------------------------------------------------
   ``In the case of household income
  (expressed as a percent of poverty      The initial       The final
  line)  within the following income        premium          premium
                 tier:                  percentage is--  percentage is--
------------------------------------------------------------------------
  Up to 100 percent                                   2                2
  100 percent up to 138 percent                    2.04             2.04
  138 percent up to 150 percent                    3.06             4.08
  150 percent and above                            4.08             5''.
------------------------------------------------------------------------

                            (ii) Conforming amendment.--Subclause (I) 
                        of clause (iii) of section 36B(b)(3) of such 
                        Code, as redesignated by subparagraph (A)(i), 
                        is amended by inserting ``, and determined 
                        after the application of clause (ii)'' after 
                        ``after application of this clause''.
            (2) Cost-sharing subsidies.--Subsection (b) of section 1402 
        of the Patient Protection and Affordable Care Act (42 U.S.C. 
        18071(b)) is amended--
                    (A) by inserting ``, or in the Medicare Transition 
                plan established under section 1002(a) of the Medicare 
                for All Act of 2019,'' after ``coverage'' in paragraph 
                (1);
                    (B) by redesignating paragraphs (1) (as so amended) 
                and (2) as subparagraphs (A) and (B), respectively, and 
                by moving such subparagraphs 2 ems to the right;
                    (C) by striking ``Insured.--In this section'' and 
                inserting ``Insured.--
            ``(1) In general.--In this section'';
                    (D) by striking the flush language; and
                    (E) by adding at the end the following new 
                paragraph:
            ``(2) Special rules.--
                    ``(A) Individuals lawfully present.--In the case of 
                an individual described in section 36B(c)(1)(B) of the 
                Internal Revenue Code of 1986, the individual shall be 
                treated as having household income equal to 100 percent 
                of the poverty line for a family of the size involved 
                for purposes of applying this section.
                    ``(B) Medicare transition plan enrollees in 
                medicaid non-expansion states.--In the case of an 
                individual residing in a State which (as of the date of 
                the enactment of the Medicare for All Act of 2019) does 
                not provide for eligibility under clause (i)(VIII) or 
                (ii)(XX) of section 1902(a)(10)(A) of the Social 
                Security Act for medical assistance under title XIX of 
                such Act (or a waiver of the State plan approved under 
                section 1115) who enrolls in such Medicare Transition 
                plan, the preceding sentence, paragraph (1)(B), and 
                paragraphs (1)(A)(i) and (2)(A) of subsection (c) shall 
                each be applied by substituting `0 percent' for `100 
                percent' each place it appears.
                    ``(C) Adjusted cost-sharing for medicare transition 
                plan enrollees.--In the case of any individual who 
                enrolls in such Medicare Transition plan, in lieu of 
                the percentages under subsection (c)(1)(B)(i) and 
                (c)(2), the Secretary shall prescribe a method of 
                determining the cost-sharing reduction for any such 
                individual such that the total of the cost-sharing and 
                the premiums paid by the individual under such Medicare 
                Transition plan does not exceed the percentage of the 
                total allowed costs of benefits provided under the plan 
                equal to the final premium percentage applicable to 
                such individual under section 36B(b)(3)(A)(ii) of the 
                Internal Revenue Code of 1986.''.
    (h) Conforming Amendments.--
            (1) Treatment as a qualified health plan.--Section 
        1301(a)(2) of the Patient Protection and Affordable Care Act 
        (42 U.S.C. 18021(a)(2)) is amended--
                    (A) in the paragraph heading, by inserting ``, the 
                medicare transition plan,'' before ``and''; and
                    (B) by inserting ``The Medicare Transition plan,'' 
                before ``and a multi-State plan''.
            (2) Level playing field.--Section 1324(a) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18044(a)) is 
        amended by inserting ``the Medicare Transition plan,'' before 
        ``or a multi-State qualified health plan''.

               Subtitle B--Transitional Medicare Reforms

SEC. 1011. MEDICARE PROTECTION AGAINST HIGH OUT-OF-POCKET EXPENDITURES 
              FOR FEE-FOR-SERVICE BENEFITS AND ELIMINATION OF PARTS A 
              AND B DEDUCTIBLES.

    (a) Protection Against High Out-of-Pocket Expenditures.--Title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), as amended 
by section 1001, is amended by adding at the end the following new 
section:

          ``protection against high out-of-pocket expenditures

    ``Sec. 1899D.  (a) In General.--Notwithstanding any other provision 
of this title, in the case of an individual entitled to, or enrolled 
for, benefits under part A or enrolled in part B, if the amount of the 
out-of-pocket cost-sharing of such individual for a year (effective the 
year beginning January 1 of the year following the date of enactment of 
the Medicare for All Act of 2019) equals or exceeds $1,500, the 
individual shall not be responsible for additional out-of-pocket cost-
sharing occurred during that year.
    ``(b) Out-of-Pocket Cost-Sharing Defined.--
            ``(1) In general.--Subject to paragraphs (2) and (3), in 
        this section, the term `out-of-pocket cost-sharing' means, with 
        respect to an individual, the amount of the expenses incurred 
        by the individual that are attributable to--
                    ``(A) coinsurance and copayments applicable under 
                part A or B; or
                    ``(B) for items and services that would have 
                otherwise been covered under part A or B but for the 
                exhaustion of those benefits.
            ``(2) Certain costs not included.--
                    ``(A) Non-covered items and services.--Expenses 
                incurred for items and services which are not included 
                (or treated as being included) under part A or B shall 
                not be considered incurred expenses for purposes of 
                determining out-of-pocket cost-sharing under paragraph 
                (1).
                    ``(B) Items and services not furnished on an 
                assignment-related basis.--If an item or service is 
                furnished to an individual under this title and is not 
                furnished on an assignment-related basis, any 
                additional expenses the individual incurs above the 
                amount the individual would have incurred if the item 
                or service was furnished on an assignment-related basis 
                shall not be considered incurred expenses for purposes 
                of determining out-of-pocket cost-sharing under 
                paragraph (1).
            ``(3) Source of payment.--For purposes of paragraph (1), 
        the Secretary shall consider expenses to be incurred by the 
        individual without regard to whether the individual or another 
        person, including a State program or other third-party 
        coverage, has paid for such expenses.''.
    (b) Elimination of Parts A and B Deductibles.--
            (1) Part a.--Section 1813(b) of the Social Security Act (42 
        U.S.C. 1395e(b)) is amended by adding at the end the following 
        new paragraph:
    ``(4) For each year (beginning January 1 of the year following the 
date of enactment of the Medicare for All Act of 2019), the inpatient 
hospital deductible for the year shall be $0.''.
            (2) Part b.--Section 1833(b) of the Social Security Act (42 
        U.S.C. 1395l(b)) is amended, in the first sentence--
                    (A) by striking ``and for a subsequent year'' and 
                inserting ``for each of 2006 through the year that 
                includes the date of enactment of the Medicare for All 
                Act of 2019''; and
                    (B) by inserting ``, and $0 for each year 
                subsequent year'' after ``$1)''.

SEC. 1012. REDUCTION IN MEDICARE PART D ANNUAL OUT-OF-POCKET THRESHOLD 
              AND ELIMINATION OF COST-SHARING ABOVE THAT THRESHOLD.

    (a) Reduction.--Section 1860D-2(b)(4)(B) of the Social Security Act 
(42 U.S.C. 1395w-102(b)(4)(B)) is amended--
            (1) in clause (i), by striking ``For purposes'' and 
        inserting ``Subject to clause (iii), for purposes''; and
            (2) by adding at the end the following new clause:
                            ``(iii) Reduction in threshold during 
                        transition period.--
                                    ``(I) In general.--Subject to 
                                subclause (II), for plan years 
                                beginning on or after January 1 
                                following the date of enactment of the 
                                Medicare for All Act of 2019 and before 
                                January 1 of the year that is 4 years 
                                following such date of enactment, 
                                notwithstanding clauses (i) and (ii), 
                                the `annual out-of-pocket threshold' 
                                specified in this subparagraph is equal 
                                to $305.
                                    ``(II) Authority to exempt brand-
                                name drugs if generic available.--In 
                                applying subclause (I), the Secretary 
                                may exempt costs incurred for a covered 
                                part D drug that is an applicable drug 
                                under section 1860D-14A(g)(2) if the 
                                Secretary determines that a generic 
                                version of that drug is available.''.
    (b) Elimination of Cost-Sharing.--Section 1860D-2(b)(4)(A) of the 
Social Security Act (42 U.S.C. 1395w-102(b)(4)(A)) is amended--
            (1) in clause (i)--
                    (A) by redesignating subclauses (I) and (II) as 
                items (aa) and (bb), respectively;
                    (B) by striking ``subparagraph (B), with cost-
                sharing'' and inserting the following: ``subparagraph 
                (B)--
                                    ``(I) for plan years 2006 through 
                                the plan year ending December 31 
                                following the date of enactment of the 
                                Medicare for All Act of 2019, with 
                                cost-sharing'';
                    (C) in item (bb), as redesignated by subparagraph 
                (A), by striking the period at the end and inserting 
                ``; and''; and
                    (D) by adding at the end the following new 
                subclause:
                                    ``(II) for the plan year beginning 
                                January 1 following the date of 
                                enactment of the Medicare for All Act 
                                of 2019 and the two subsequent plan 
                                years, without any cost-sharing.''; and
            (2) in clause (ii)--
                    (A) by striking ``clause (i)(I)'' and inserting 
                ``clause (i)(I)(aa)''; and
                    (B) by adding at the end the following new 
                sentence: ``The Secretary shall continue to calculate 
                the dollar amounts specified in clause (i)(I)(aa), 
                including with the adjustment under this clause, after 
                plan year 2018 for purposes of 1860D-
                14(a)(1)(D)(iii).''.
    (c) Conforming Amendments to Low-Income Subsidy.--Section 1860D-
14(a) of the Social Security Act (42 U.S.C. 1395w-114(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (D)(iii), by striking ``1860D-
                2(b)(4)(A)(i)(I)'' and inserting ``1860D-
                2(b)(4)(A)(i)(I)(aa)''; and
                    (B) in subparagraph (E)--
                            (i) in the heading, by inserting ``prior to 
                        the elimination of such cost-sharing for all 
                        individuals'' after ``threshold''; and
                            (ii) by striking ``The elimination'' and 
                        inserting ``For plan years 2006 through the 
                        plan year ending December 31 following the date 
                        of enactment of the Medicare for All Act of 
                        2019, the elimination''; and
            (2) in paragraph (2)(E)--
                    (A) in the heading, by inserting ``prior to the 
                elimination of such cost-sharing for all individuals'' 
                after ``threshold'';
                    (B) by striking ``Subject to'' and inserting ``For 
                plan years 2006 through the plan year ending December 
                31 following the date of enactment of the Medicare for 
                All Act of 2019, subject to''; and
                    (C) by striking ``1860D-2(b)(4)(A)(i)(I)'' and 
                inserting ``1860D-2(b)(4)(A)(i)(I)(aa)''.

SEC. 1013. COVERAGE OF DENTAL AND VISION SERVICES AND HEARING AIDS AND 
              EXAMINATIONS UNDER MEDICARE PART B.

    (a) Dental Services.--
            (1) Removal of exclusion from coverage.--Section 1862(a) of 
        the Social Security Act (42 U.S.C. 1395y(a)) is amended by 
        striking paragraph (12).
            (2) Coverage.--
                    (A) In general.--Section 1861(s)(2) of the Social 
                Security Act (42 U.S.C. 1395x(s)(2)) is amended--
                            (i) in subparagraph (GG), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (HH), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(II) dental services;''.
                    (B) Payment.--Section 1833(a)(1) of the Social 
                Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                            (i) by striking ``and'' before ``(CC)''; 
                        and
                            (ii) by inserting before the semicolon at 
                        the end the following: ``, and (DD) with 
                        respect to dental 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).''.
                    (C) Effective date.--The amendments made by this 
                subsection shall apply to items and services furnished 
                on or after January 1 following the date of the 
                enactment of this Act.
    (b) Vision Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)), as amended by subsection (a), is 
        amended--
                    (A) in subparagraph (HH), by striking ``and'' at 
                the end;
                    (B) in subparagraph (II), by inserting ``and'' at 
                the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(JJ) vision services;''.
            (2) Payment.--Section 1833(a)(1) of the Social Security Act 
        (42 U.S.C. 1395l(a)(1)), as amended by subsection (a), is 
        amended--
                    (A) by striking ``and'' before ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (EE) with respect to vision 
                services described in section 1861(s)(2)(JJ), the 
                amount paid shall be an amount equal to 80 percent of 
                the lesser of the actual charge for the services or the 
                amount determined under the fee schedule established 
                under section 1848(b).''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to items and services furnished on or after January 
        1 following the date of the enactment of this Act.
    (c) Hearing Aids and Examinations Therefor.--
            (1) In general.--Section 1862(a)(7) of the Social Security 
        Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``hearing 
        aids or examinations therefor,''.
            (2) Effective date.--The amendment made by this subsection 
        shall apply to items and services furnished on or after January 
        1 following the date of the enactment of this Act.

SEC. 1014. ELIMINATING THE 24-MONTH WAITING PERIOD FOR MEDICARE 
              COVERAGE FOR INDIVIDUALS WITH DISABILITIES.

    (a) In General.--Section 226(b) of the Social Security Act (42 
U.S.C. 426(b)) is amended--
            (1) in paragraph (2)(A), by striking ``, and has for 24 
        calendar months been entitled to,'';
            (2) in paragraph (2)(B), by striking ``, and has been for 
        not less than 24 months,'';
            (3) in paragraph (2)(C)(ii), by striking ``, including the 
        requirement that he has been entitled to the specified benefits 
        for 24 months,'';
            (4) in the first sentence, by striking ``for each month 
        beginning with the later of (I) July 1973 or (II) the twenty-
        fifth month of his entitlement or status as a qualified 
        railroad retirement beneficiary described in paragraph (2), 
        and'' and inserting ``for each month for which the individual 
        meets the requirements of paragraph (2), beginning with the 
        month following the month in which the individual meets the 
        requirements of such paragraph, and''; and
            (5) in the second sentence, by striking ``the `twenty-fifth 
        month of his entitlement''' and all that follows through 
        ``paragraph (2)(C) and''.
    (b) Conforming Amendments.--
            (1) Section 226.--Section 226 of the Social Security Act 
        (42 U.S.C. 426) is amended by--
                    (A) striking subsections (e)(1)(B), (f), and (h); 
                and
                    (B) redesignating subsections (g) and (i) as 
                subsections (f) and (g), respectively.
            (2) Medicare description.--Section 1811(2) of the Social 
        Security Act (42 U.S.C. 1395c(2)) is amended by striking ``have 
        been entitled for not less than 24 months'' and inserting ``are 
        entitled''.
            (3) Medicare coverage.--Section 1837(g)(1) of the Social 
        Security Act (42 U.S.C. 1395p(g)(1)) is amended by striking 
        ``25th month of'' and inserting ``month following the first 
        month of''.
            (4) Railroad retirement system.--Section 7(d)(2)(ii) of the 
        Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is 
        amended--
                    (A) by striking ``has been entitled to an annuity'' 
                and inserting ``is entitled to an annuity'';
                    (B) by striking ``, for not less than 24 months''; 
                and
                    (C) by striking ``could have been entitled for 24 
                calendar months, and''.
    (c) Effective Date.--The amendments made by this section shall 
apply to insurance benefits under title XVIII of the Social Security 
Act with respect to items and services furnished in months beginning 
after December 1 following the date of enactment of this Act, and 
before January 1 of the year that is 4 years after such date of 
enactment.

SEC. 1015. GUARANTEED ISSUE OF MEDIGAP POLICIES.

    Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is 
amended by adding at the end the following new subsection:
    ``(aa) Guaranteed Issue for All Medigap-Eligible Medicare 
Beneficiaries.--Notwithstanding paragraphs (2)(A) and (2)(D) of 
subsection (s) or any other provision of this section, on or after the 
date of enactment of this subsection, the issuer of a medicare 
supplemental policy may not deny or condition the issuance or 
effectiveness of a medicare supplemental policy, or discriminate in the 
pricing of the policy, because of health status, claims experience, 
receipt of health care, or medical condition in the case of any 
individual entitled to, or enrolled for, benefits under part A and 
enrolled for benefits under part B.''.

 Subtitle C--Private Health Insurance Availability During Transitional 
                                 Period

SEC. 1021. CONTINUITY OF CARE.

    (a) In General.--The Secretary shall ensure that all individuals 
enrolled in, or who seek to enroll in, a group health plan, health 
insurance coverage offered by a health insurance issuer, or the plan 
established under section 1002 during the transition period of this Act 
are protected from disruptions in their care during the transition 
period.
    (b) Public Consultation During Transition.--The Secretary shall 
consult with communities and advocacy organizations of individuals 
living with disabilities and other patient advocacy organizations to 
ensure the transition described in this section takes into account the 
continuity of care for individuals with disabilities, complex medical 
needs, or chronic conditions.
    (c) Definitions.--In this section, the terms ``health insurance 
coverage'', ``health insurance issuer'', and ``group health plans'' 
have the meanings given such terms in section 2791 of the Public Health 
Service Act (42 U.S.C. 300gg-91).

                        TITLE XI--MISCELLANEOUS

SEC. 1101. UPDATING RESOURCE LIMITS FOR SUPPLEMENTAL SECURITY INCOME 
              ELIGIBILITY (SSI).

    Section 1611(a)(3) of the Social Security Act (42 U.S.C. 
1382(a)(3)) is amended--
            (1) in subparagraph (A)--
                    (A) by striking ``and'' after ``January 1, 1988,''; 
                and
                    (B) by inserting ``, and to $6,200 on January 1, 
                2019'' before the period;
            (2) in subparagraph (B)--
                    (A) by striking ``and'' after ``January 1, 1988,''; 
                and
                    (B) by inserting ``, and to $4,100 on January 1, 
                2019'' before the period; and
            (3) by adding at the end the following new subparagraph:
            ``(C) Beginning with December of 2019, whenever the dollar 
        amounts in effect under paragraphs (1)(A) and (2)(A) of this 
        subsection are increased for a month by a percentage under 
        section 1617(a)(2), each of the dollar amounts in effect under 
        this paragraph shall be increased, effective with such month, 
        by the same percentage (and rounded, if not a multiple of $10, 
        to the closest multiple of $10). Each increase under this 
        subparagraph shall be based on the unrounded amount for the 
        prior 12-month period.''.

SEC. 1102. DEFINITIONS.

    In this Act--
            (1) the term ``Secretary'' means the Secretary of Health 
        and Human Services;
            (2) the term ``State'' means a State, the District of 
        Columbia, or a territory of the United States; and
            (3) the term ``United States'' shall include the States, 
        the District of Columbia, and the territories of the United 
        States.
                                 <all>