[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5299 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5299

    To amend title XVIII of the Social Security Act to establish a 
  demonstration program for international coverage under the Medicare 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            August 29, 2023

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

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to establish a 
  demonstration program for international coverage under the Medicare 
                                program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Earned Benefits Equality and Family 
Reunification Act''.

SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM FOR INTERNATIONAL COVERAGE 
              UNDER THE MEDICARE PROGRAM.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1866F the following new section:

``SEC. 1866G. DEMONSTRATION PROGRAM FOR INTERNATIONAL COVERAGE.

    ``(a) Implementation of 10-Year Demonstration Program.--Not later 
than 1 year after the date of the enactment of this section, the 
Secretary shall implement a 10-year demonstration program under this 
title (in this section referred to as the Program) to allow Applicable 
Beneficiaries to apply Medicare benefits to coverage of items and 
services, premiums, and other cost-sharing under the health insurance 
systems of other countries. Through the Program, the Secretary shall 
make payments under subsection (e) to or on behalf of Applicable 
Beneficiaries participating in the Program.
    ``(b) Program Design.--
            ``(1) In general.--The Secretary shall design the Program 
        in such a manner to allow for the evaluation of the extent to 
        which the Program accomplishes the following purposes:
                    ``(A) Increases the quality of care for Applicable 
                Beneficiaries participating in the Program.
                    ``(B) Decreases the cost of care to the government 
                for the Applicable Beneficiaries.
                    ``(C) Enables Applicable Beneficiaries to reunify 
                with family members.
                    ``(D) Reduced strain on the medical infrastructure 
                of the United States.
            ``(2) Consultation.--In designing the Program, the 
        Secretary shall use open door forums and other mechanisms to 
        seek input from a consortium of stakeholders that may include 
        but are not limited to--
                    ``(A) the United States Department of State;
                    ``(B) clinical and analytical experts with relevant 
                expertise;
                    ``(C) beneficiaries; and
                    ``(D) foreign health insurance system experts.
            ``(3) Program considerations.--In consultation with 
        stakeholders as identified in subsection (b)(2), the Secretary 
        shall issue guidance on--
                    ``(A) the guidelines to ensure the usage of 
                medications and equipment that are of acceptable 
                quality relative to American quality standards;
                    ``(B) ways to ensuring quality of care; and
                    ``(C) ways to target low-income Americans as 
                participants in the program.
    ``(c) Selected Countries Initial Selection.--In choosing Selected 
Countries for the Program, the Secretary shall initially select at 
least 11 distinct nations or political subdivisions thereof, which 
shall include Canada, the Federal Republic of Germany, the Republic of 
India, the State of Israel, the Republic of Korea, the Republic of the 
Philippines, the Republic of Panama, the United Mexican States, 
Dominican Republic, and at least one nation or political subdivision 
thereof in Africa.
    ``(d) Applicable Beneficiary.--
            ``(1) Voluntary beneficiary participation.--An Applicable 
        Beneficiary may participate in the Program on a voluntary basis 
        and may terminate participation in the Program at any time. The 
        election to participate in the Program or to terminate 
        participation shall constitute a Special Election Period under 
        section 1852(e)(4) of this title.
            ``(2) Services.--In order to participate in the Program, an 
        Applicable Beneficiary shall agree to receive coverage of 
        health care items and services in a Selected Country during 
        such time as the Applicable Beneficiary is a resident of that 
        country.
            ``(3) Beneficiary access to services.--Nothing in this 
        section shall be construed as limiting an Applicable 
        Beneficiary's access to items and services covered under this 
        title when furnished in the United States, and Applicable 
        Beneficiaries shall not be required to relinquish access to 
        such benefits as a condition of receiving services from a 
        participant in the Program.
            ``(4) Number of applicable beneficiaries.--The Secretary 
        may cap the number of Applicable Beneficiaries accepted into 
        the Program, but at a number no smaller than 150,000.
    ``(e) Physician Certification.--Participating physicians must be in 
good standing with accreditation institutions or licensing authorities 
in the Selected Countries.
    ``(f) Payments.--
            ``(1) In general.--The Secretary shall make payments to or 
        on behalf of Applicable Beneficiaries for the costs of health 
        care items and services paid by Applicable Beneficiaries in 
        Selected Countries. Such payments may include payments for 
        individual items or services paid by Applicable Beneficiaries, 
        payments for cost sharing incurred by Applicable Beneficiaries, 
        and premiums and equivalent charges for health insurance 
        coverage paid by Applicable Beneficiaries. Payments shall not 
        include reimbursement for taxes levied on income for the 
        purpose of funding health care.
            ``(2) Payment amounts.--The Secretary shall limit the 
        amounts of payment to ensure such payments and funds expended 
        to design, implement, and evaluate the Program do not exceed in 
        the aggregate the amount the Secretary would pay under this 
        title for equivalent services delivered in the United States.
            ``(3) No duplicate payment.--The Secretary shall make or 
        permit payments under this paragraph only for a calendar month 
        in which the Applicable Beneficiary resides in the Selected 
        Country and does not incur any costs under this title other 
        than the payment hereunder.
    ``(g) Role of Medicare Advantage.--
            ``(1) In carrying out the Program, the Secretary may 
        administer the Program, either in part or exclusively, through 
        Medicare Advantage Organizations.
            ``(2) To the extent Medicare Advantage Organizations carry 
        out functions under the Program, payments made by such 
        organizations under subsection (e) shall be considered as if 
        they were benefits under the original Medicare fee-for-service 
        program option for purposes of sections 1852 and 1854 of this 
        title, and a component of standard prescription drug coverage 
        and not supplemental prescription drug coverage, under section 
        1860D2(a) of this title.
            ``(3) The Secretary may limit the number of Medicare 
        Advantage Organizations participating in the Program, in 
        accordance with criteria established by the Secretary.
    ``(h) Reporting.--The Secretary shall conduct annual intermediate 
and a final evaluation of the Program. Each such evaluation shall 
determine the extent to which each of the purposes described in 
subsection (b) have been accomplished under the Program. The evaluation 
shall contain recommendations to Congress with regards to the expansion 
of the Program.
    ``(i) Addressing Waste, Fraud, and Abuse.--
            ``(1) Participating physicians are required to go through 
        Fraud, Waste, and Abuse training within 90 days of 
        implementation of the demonstration project and at least 
        annually thereafter.
            ``(2) The Secretary must create a system to allow patients 
        and physicians to report instances or concerns of waste, fraud, 
        and abuse.
    ``(j) Definitions.--In this section:
            ``(1) Applicable beneficiary.--The term `Applicable 
        Beneficiary' means an individual who--
                    ``(A) is entitled to or enrolled for benefits under 
                part A, and enrolled for benefits under part B;
                    ``(B) may be enrolled in a Medicare Advantage plan 
                under part C;
                    ``(C) is either--
                            ``(i) a resident of the United States at 
                        the time of application to the Program who 
                        intends to relocate to a Selected Country on or 
                        after the date of such application, or is a 
                        former resident of the United States who has 
                        relocated to a Selected Country within 180 days 
                        of application to the Program; or
                            ``(ii) a resident of a Selected Country for 
                        whom the Medicare program is at the time of 
                        application the primary payor of their health 
                        care costs; and
                    ``(D) meets such other criteria as the Secretary 
                determines appropriate.
            ``(2) Selected country.--The term Selected Country means a 
        nation or political subdivision thereof identified by the 
        Secretary as having a health care system that provides for--
                    ``(A) health care coverage in scope and quality of 
                coverage appropriate for Medicare beneficiaries in 
                accordance with criteria established by the Secretary; 
                and
                    ``(B) cost of coverage, coinsurance, and items and 
                services that is equivalent to or less than expected 
                costs for such coverage, coinsurance, and items and 
                services in the United States under this title.
    ``(k) Funding.--
            ``(1) Administrative funding.--The Secretary shall allocate 
        funds made available under section 1115A(f)(1) to design, 
        implement, and evaluate the Program.
            ``(2) Benefit funding.--Payments for items and services 
        under the Program shall be made in appropriate part from the 
        Federal Hospital Insurance Trust Fund established by section 
        1817 of this title and the Federal Supplementary Medical 
        Insurance Trust Fund established by section 1841 of this title.
    ``(l) Waivers.--The Secretary may waive any provision of this title 
as may be necessary to carry out the Program under this section.
    ``(m) Limitations on Review.--There shall be no administrative or 
judicial review under section 1869, section 1878, or otherwise of--
            ``(1) the selection of organizations, sites, or 
        participants to test the Program; and
            ``(2) the elements, parameters, scope, and duration of the 
        Program. The preceding sentence shall not prevent an Applicable 
        Beneficiary, having been selected as a participant, from 
        exercising a right to appeal under sections 1869, 1155, 
        1852(g), 1860D-4, or otherwise.
    ``(n) Administration.--
            ``(1) Chapter 35 of title 44, United States Code, shall not 
        apply to the activities under this section.
            ``(2) The Secretary may enter into contracts for the 
        administration of the Program without regard to any requirement 
        for the use of competitive procedures.''.
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