[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6645 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 6645
To amend title XVIII of the Social Security Act to save and strengthen
the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 11, 2012
Mr. Herger introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committees on
Energy and Commerce and Rules, 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 save and strengthen
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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Save and
Strengthen Medicare Act of 2012''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--IMPROVED AND UNIFIED MEDICARE PROGRAM THROUGH CHOICE AND
COMPETITION
Sec. 101. New unified eligibility and enrollment rules.
``Part E--Unified Medicare With Choice and Competition
``subpart 1--eligibility; enrollment
``Sec. 1860E-11. Unified eligibility and enrollment under parts
A and B.
``Sec. 1860E-12. Coordination with part D.
``Sec. 1944. Maintenance of effort options for full-benefit
dual eligible individuals.
Sec. 102. Incentivized Medicare eligibility at increased age.
Sec. 103. New benefit structure under unified Medicare.
``subpart 2--benefits
``Sec. 1860E-21. Unified part A and B deductible.
``Sec. 1860E-22. Uniform coinsurance.
``Sec. 1860E-23. Out-of-pocket limit.
``Sec. 1860E-24. Offering of tiered cost-sharing coverage
levels instead of medigap.
``Sec. 1860E-25. Contributions into health individual
retirement accounts.
``Sec. 1860E-26. Requiring MA plans to offer prescription drug
coverage.
Sec. 104. Late enrollment penalty not to apply for months of any health
coverage.
Sec. 105. Competitive bidding and premiums under unified Medicare.
``subpart 3--competitive bidding and premiums
``Sec. 1860E-31. Application of competitive bidding and changes
in premiums.
``Sec. 1860E-32. Application of competitive bidding to Medicare
fee-for-service.
``Sec. 1860E-33. Ensuring a level playing field.
Sec. 106. Separate Medicare FFS accounts and other financing under
unified Medicare.
``subpart 4--subsidies
``Sec. 1860E-41. Changes in subsidies.
Sec. 107. Medicare Choices Commission; general provisions; effective
date.
``subpart 5--medicare choices commission
``Sec. 1860E-51. Medicare Choices Commission.
``Sec. 1860E-52. Duties of the Commission.
``Sec. 1860E-53. Powers of Commission.
``Sec. 1860E-54. Commission personnel matters.
``Sec. 1860E-55. Reports; communications with Congress.
``Sec. 1860E-56. Funding of the Commission.
``subpart 6--general provisions
``Sec. 1860E-61. Applicability; definitions.
``Sec. 1860E-62. General effective date.
TITLE II--HEALTH INDIVIDUAL RETIREMENT ACCOUNTS
Subtitle A--Establishment of Accounts
Sec. 201. Definitions.
Sec. 202. Health Individual Retirement Account Fund.
Sec. 203. Establishment of health individual retirement accounts.
Sec. 204. Transfer of HIRA contributions to HIRA Fund.
Sec. 205. Operation of HIRA Fund.
Sec. 206. Health individual retirement account distributions.
Subtitle B--Tax Treatment
Sec. 211. Tax treatment of accounts.
``Part IX--Health Individual Retirement Account Program
``Sec. 530A. Health Individual Retirement Account Program.
Sec. 212. HIRA contributions.
Sec. 213. Contributions eligible for saver's credit.
Sec. 214. Exclusion of certain HIRA transfers.
``Sec. 139F. Government HIRA subsidies.
Subtitle C--Other Tax Provisions
Sec. 221. Health Savings Accounts available to individuals eligible for
Medicare.
Sec. 222. Reduction in Medicare portion of payroll tax to incentivize
late retirement.
Sec. 223. 15-percent excise tax on employer-sponsored Medicare
supplemental coverage.
``Sec. 4980J. Employer-sponsored Medicare supplemental
coverage.
TITLE III--OTHER HEALTH PROVISIONS
Subtitle A--Transparency, Outreach, and Education
Sec. 301. Public outreach and education initiatives.
Sec. 302. Annual Medicare beneficiary contributions and benefits
statements.
``Sec. 1143A. Annual Medicare beneficiary contributions and
benefits statements.
Subtitle B--Miscellaneous
Sec. 311. Repeal of IPAB.
Sec. 312. Repeal of Medicare payment productivity adjustments after
2020.
Sec. 313. Graduate medical education grant program.
``Sec. 1899B. Graduate medical education grant program.
``Sec. 9512. Graduate Medical Education Trust Fund.
Sec. 314. Report on transitioning payments under Medicare for
disproportionate share hospitals into a
grant program.
Sec. 315. One-year freeze for physician payment update; Sense of
Congress relating to the sustainable growth
rate (SGR).
Sec. 316. Improvements to MSA plans; permitting offering of
catastrophic plan with high deductible and
contribution to MSA, HSA, or HIRA.
Sec. 317. Extension for specialized MA plans for special needs
individuals.
Sec. 318. Conscience protections.
``Sec. 1899C. Conscience protections; Prohibition against
discrimination on assisted suicide and
abortion services.
``Sec. 1899D. Prohibition against discrimination on assisted
suicide and abortions.
TITLE I--IMPROVED AND UNIFIED MEDICARE PROGRAM THROUGH CHOICE AND
COMPETITION
SEC. 101. NEW UNIFIED ELIGIBILITY AND ENROLLMENT RULES.
(a) In General.--Title XVIII of the Social Security Act is
amended--
(1) by redesignating part E as part F; and
(2) by inserting after part D the following new part:
``PART E--UNIFIED MEDICARE WITH CHOICE AND COMPETITION
``Subpart 1--Eligibility; Enrollment
``SEC. 1860E-11. UNIFIED ELIGIBILITY AND ENROLLMENT UNDER PARTS A AND
B.
``(a) Requiring Coverage Under Both Parts A and B.--
``(1) In general.--Effective as of the general effective
date (as specified in section 1860E-62), except as provided
under paragraph (3), no benefits shall be covered under part A
or part B for an individual unless the individual is both--
``(A) entitled (or enrolled) for benefits under
part A; and
``(B) enrolled under part B.
``(2) Clarification of part a enrollment required to obtain
part b benefits.--Effective as of the general effective date,
except as provided under paragraph (3), an individual who is
enrolled under part B and is not entitled to hospital insurance
benefits under part A shall be entitled to benefits under part
B only if the individual enrolls under part A pursuant to
section 1818 or 1818A.
``(3) Exceptions.--
``(A) Continuation of treatment of working
beneficiaries.--Paragraphs (1) and (2) shall not apply
to an individual with respect to whom the provisions of
section 1862(b) apply because of enrollment in a
primary plan (as defined for purposes of such section).
``(B) Grandfathered for current part b only
enrollees.--
``(i) In general.--Paragraphs (1) and (2)
shall not apply to an individual who as of the
general effective date is enrolled under part B
but is not entitled to benefits (or otherwise
enrolled) under part A, so long as the
individual does not terminate enrollment under
part B or enroll under part A.
``(ii) New cost-sharing applies.--
``(I) In general.--Nothing in
clause (i) shall be construed to exempt
an individual described in such clause
from the application of the provisions
of subpart 2 (relating to cost-
sharing), except that the total amount
of expenses incurred by the individual
during a year which would constitute
incurred expenses for which benefits
payable under section 1833(a) are
determinable shall be reduced by the
deductible described in subclause (II)
for such year instead of the deductible
described in section 1860E-21.
``(II) Applicable deductible.--The
deductible described in this subclause
for 2016, is the deductible that would
be applied under section 1833(b) (but
for the application of this section and
subpart 2) for such year, adjusted by
the Secretary to take into account any
change in the monthly actuarial rate
under section 1839(a)(1) because of the
application of the out-of-pocket limit
under section 1860E-23, and for a
subsequent year the amount of such
deductible for the previous year
increased by the annual percentage
increase in the monthly actuarial rate
under section 1839(a)(1) (taking into
account the application of the out-of-
pocket limit under section 1860E-23)
ending with such subsequent year
(rounded to the nearest $1).
``(iii) Premium.--In the case of an
individual described in clause (i), for 2016 or
a subsequent year, instead of the combined
monthly premium under section 1860E-32(c),
there shall be applied to such individual the
monthly premium that would be determined under
section 1839 for such year.
``(b) Permitting Individuals To Opt Out of Part A Coverage Without
Losing Social Security Benefits.--
``(1) In general.--The Medicare Choices Commission shall
establish--
``(A) a process by which an individual otherwise
entitled to benefits under part A may elect (at a time
and in a manner specified under the process) to waive
such entitlement; and
``(B) a process by which an individual who elects
to waive such entitlement may revoke (at a time and in
a manner specified under the process) such waiver.
The process under subparagraph (B) shall be coordinated with
the enrollment process under section 1837 for part B.
``(2) Application of late enrollment penalty.--An
individual who revokes a waiver under paragraph (1)(B) shall be
subject to a late enrollment penalty as applied under section
1860E-32(c)(2)(C).
``(3) No impact on title ii benefits.--Notwithstanding any
other provision of law, an election of an individual to waive
entitlement to benefits under part A under paragraph (1)(A)
shall not result in any loss of benefits under title II.
``(4) Deemed opt out.--
``(A) An election of an individual to waive
entitlement to benefits under part A under paragraph
(1)(A) is also deemed the filing of a notice of
termination of benefits under part B pursuant to
section 1838(b)(1).
``(B) The termination of benefits under part B
pursuant to section 1838(b) is also deemed to be a
waiver of any entitlement to benefits under part A.
``(c) Special Open Enrollment Period Without Late Enrollment
Penalty for Current Part A Only or Part B Only Enrollees.--
Notwithstanding any other provision of law, in the case of an
individual who as of the general effective date, is entitled to
benefits under part A but not enrolled under part B, or who is enrolled
under part B but not entitled to benefits (or enrolled) under part A,
beginning as of such date, such individual shall be deemed to be
enrolled under part B or part A, respectively, unless such individual
elects to be enrolled (or entitled to benefits) under neither of such
parts during a special open enrollment period specified by the Medicare
Choices Commission. No increase in the monthly premium of an individual
pursuant to section 1839(b) or section 1818(c) shall be effected in the
case of any such individual who is deemed enrolled under part B or part
A pursuant to the previous sentence with respect to any period prior to
the date of such enrollment.
``(d) Auto Enrollment of Dual Eligible Individuals Under Medicare
Advantage Plans.--
``(1) In general.--Except in the case of a State that has
elected the maintenance of effort option described in section
1944(b)(2), in the case of an individual described in
subparagraph (A)(ii) of section 1935(c)(6) (taking into account
the application of subparagraph (B) of such section), the
Medicare Choices Commission shall establish a process for the
enrollment in an MA-PD plan that is a managed care plan under
part C that has a monthly beneficiary premium that does not
exceed the premium assistance available under section 1860E-
41(b)(1)(A). If there is more than one such plan available, the
Medicare Choices Commission shall enroll such an individual on
a random basis among all such plans in the PDP region.
``(2) Right to disenroll.--Nothing in paragraph (1) shall
prevent such an individual from declining enrollment in any
such plan (and thereby obtaining coverage under Medicare fee-
for-service) or from changing enrollment in such a plan to
another MA-PD plan.
``SEC. 1860E-12. COORDINATION WITH PART D.
``(a) Deemed Enrollment Under Part D.--
``(1) In general.--The Medicare Choices Commission shall
establish a process that, beginning as of the general effective
date, provides for the enrollment in a prescription drug plan
that has a monthly base beneficiary premium that does not
exceed the weighted average of premiums for such plans that
provide standard prescription drug coverage (as defined in
section 1860D-2(b)) with respect to the area involved (on a
random basis among all such plans in the applicable PDP region)
of each Medicare enrollee (as defined in section 1860E-51)
who--
``(A) failed to enroll in such a prescription drug
plan during the applicable enrollment or coverage
election period under section 1860D-1(b); and
``(B) failed to elect not to enroll in such a
prescription drug plan during an applicable opt out
period described in paragraph (2).
Nothing in the previous sentence shall prevent such an
individual from declining or changing such enrollment. Such
process shall be carried out in the same manner as the process
described in section 1860D-1(b)(1)(C).
``(2) Opt out periods.--The process under paragraph (1)
shall provide for the opportunity to make an election described
in subparagraph (B) of such paragraph during an opt out period
that is coordinated with the relevant enrollment or coverage
election period under section 1860D-1.
``(3) Late enrollment penalties.--In the case of an
individual who makes an election described in paragraph (1)(B)
and then enrolls in a prescription drug plan, the late
enrollment penalty under section 1860D-13(b) shall apply to the
monthly beneficiary premium of such individual, except that in
applying such section, any reference to the initial enrollment
period of such individual shall be deemed to be a reference to
the opt out period under paragraph (2) during which the
individual elected not to enroll in a prescription drug plan.
``(4) No late enrollment penalty for current fee-for-
service beneficiaries without drug coverage.--In the case of an
individual who is a Medicare enrollee before the date of
enactment of this section and who was not enrolled under a
prescription drug plan before being enrolled under such a plan
pursuant to paragraph (1), there shall be no increase in the
base beneficiary premium of an individual under section 1860D-
13 by a late enrollment penalty under subsection (b) of such
section with respect to any period prior to the date of such
enrollment.
``(b) Reference to Required Prescription Drug Coverage Under Part
C.--For provision requiring coverage under MA plans to include
prescription drug coverage, see section 1860E-26.''.
(b) Limitation on Medicaid Benefits for Full-Benefit Dual Eligible
Individuals.--Section 1902 of the Social Security Act (42 U.S.C. 1396a)
is amended by adding at the end the following new subsection:
``(ll) Limitation on Benefits for Full-Benefit Dual Eligible
Individuals.--Effective as of the general effective date (as specified
in section 1860E-62), except in the case of a State which has elected
the option described in section 1944(b)(2), in the case of an
individual described in subparagraph (A)(ii) of section 1935(c)(6)
(taking into account the application of subparagraph (B) of such
section), notwithstanding any other provision of law, medical
assistance shall not be available under this title for any items and
services for which payment may be made under title XVIII.''.
(c) Medicaid Maintenance of Effort and Alternatives.--Title XIX of
the Social Security Act is amended by inserting after section 1943 the
following new section:
``maintenance of effort options for full-benefit dual eligible
individuals
``Sec. 1944. (a) In General.--Effective as of the general
effective date (as specified in section 1860E-62), a State shall elect,
in a form and manner specified by the Secretary, a maintenance of
effort option described in subsection (b). In the case of a State that
fails to make such an election, the State shall be deemed to have
elected the option described in subsection (b)(3).
``(b) Maintenance of Effort Options Described.--The following are
maintenance of effort options described in this subsection for a State,
which shall apply to all individuals described in subparagraph (A)(ii)
of section 1935(c)(6) (taking into account the application of
subparagraph (B) of such section) for such State:
``(1) Contribution towards out-of-pocket expenses under a
tier 3 medicare plan.--The State establishes a program under
which the State makes a contribution to a health investment
retirement account established under section 503(b) of the Save
and Strengthen Medicare Act of 2012 for each such individual in
an amount which--
``(A) is calculated, on an average actuarial basis,
to cover at least the remaining expenses under a plan
with a tier 3 benefit level under section 1860E-24(b);
and
``(B) is risk-adjusted based upon the actuarial
characteristics of the individual involved.
``(2) Enrollment of dual eligibles in comprehensive
medicaid managed care plan.--
``(A) In general.--The State enrolls all such
individuals in a comprehensive Medicaid managed care
plan offered by a managed care entity under section
1932.
``(B) Payment of subsidy amount to state.--In the
case of a State that elects the option under this
paragraph with respect to an individual, the Medicare
Choices Commission established under section 1860E-51
shall pay to the State the same amount that the
individual would be entitled to have paid as an income-
related premium subsidy under section 1860E-41(b)(1)(A)
plus the amount that the Medicare Choices Commission
estimates would have been paid with respect to the
individual under part D (including the actuarial value
of subsidy payments under sections 1860D-13 and 1860D-
14). Such payment shall be made in appropriate part
from the Federal Hospital Insurance Trust Fund under
section 1817 and the Federal Supplementary Medical
Insurance Trust Fund under section 1841.
``(C) Relation to part d rules.--In the case of a
State that has elected the option under this paragraph,
notwithstanding any other provision of law--
``(i) the coverage provided under this
option shall be in lieu of any coverage that
may otherwise be provided under part D; and
``(ii) the payment to the State under
subparagraph (B) shall be in lieu of any
payments otherwise made with respect to such
individual under such part.
``(3) State contribution amount and federal contributions
to hiras.--
``(A) In general.--The State provides for payment
to the Secretary for each month in an amount determined
under subparagraph (B)(i) and the Secretary makes a
contribution to a health investment retirement account
established under section 503(b) of the Save and
Strengthen Medicare Act of 2012 for each such
individual in an amount described in subparagraph (C).
``(B) State contribution amount.--
``(i) In general.--Subject to clause (iii),
the amount determined under this clause for a
State for a month in a year is equal to the
product described in subparagraph (A) of
section 1935(c)(1) for the State for the month.
``(ii) Form and manner of payment.--The
provisions of subparagraphs (B) through (D) of
section 1935(c)(1) shall apply to payment by a
State to the Secretary under this paragraph in
the same manner as such subparagraphs apply to
payment under section 1935(c)(1)(A).
``(iii) Application of different factors.--
In applying clause (i), the following shall be
substituted under paragraphs (2) and (3) of
section 1935(c):
``(I) The base year State Medicaid
per capita expenditures for covered
part D drugs described in subparagraph
(A)(i)(I) of such paragraph (2) shall
be deemed to be the per capita
expenditures for Medicare cost-sharing
that would apply, with respect to an
individual described in subparagraph
(A)(ii) of section 1935(c)(6) (taking
into account the application of
subparagraph (B) of such section) and
the State involved, if such an
individual received benefits only under
title XVIII (and not the State plan
under this title).
``(II) Any reference to
expenditures for covered part D drugs
or for prescription drug benefits shall
be deemed a reference to the
expenditures for Medicare cost-sharing
described in subclause (I).
``(III) Any reference to 2003 or
2004 shall be deemed a reference to
2014 or 2015, respectively.
``(IV) Any reference to a full-
benefit-dual-eligible individual shall
be deemed a reference to an individual
described in subparagraph (A)(ii) of
section 1935(c)(6) (taking into account
the application of subparagraph (B) of
such section).
``(V) The applicable growth factor
under section 1935(c)(4) for a year,
with respect to a State, shall be the
average annual percentage change (to
that year from the previous year) of
the expenditures of the State under the
State plan under title XIX.
``(VI) The factor described in
section 1935(c)(5) is deemed to be 90
percent.
``(C) Federal contributions to hiras.--For purposes
of subparagraph (A), the amount described in this
subparagraph, with respect to each such individual
described in subparagraph (A), is an amount which--
``(i) is calculated, on an average
actuarial basis, to cover the remaining
expenses under a plan with a tier 3 benefit
level under section 1860E-24(b); and
``(ii) is risk-adjusted based upon the
actuarial characteristics of the individual.
``(4) Other innovative alternatives.--
``(A) In general.--The State submits to the
Secretary, and has approved by the Secretary, an
innovative alternative proposal relating to
coordinating coverage of such individuals under
Medicare and the State plan under title XIX.
``(B) Process for review.--With respect to
proposals submitted to the Secretary under subparagraph
(A), the Secretary shall approve such a proposal if the
State demonstrates with respect to the proposal that--
``(i) there would be no increased cost to
the Federal Government if it were approved; and
``(ii) there would be no reduction in the
quality of care provided to such individuals if
the proposal were approved.''.
(d) Conforming Amendments.--
(1) Section 226.--Section 226 of the Social Security Act
(42 U.S.C. 426) is amended--
(A) in subsection (a), in the matter preceding
paragraph (1), by inserting ``, subject to section
1860E-11(b)'' after ``individual who'';
(B) in subsection (b), in the matter preceding
paragraph (1), by inserting ``, subject to section
1860E-11(b)'' after ``individual who''; and
(C) in subsection (c), in the matter preceding
paragraph (1), by inserting ``, subject to section
1860E-11(a)'' after ``subsection (a)''.
(2) Section 226A.--Section 226A(a) of such Act (42 U.S.C.
426-1(a)) is amended, in the matter preceding paragraph (1), by
inserting ``and subject to section 1860E-11(b)'' after ``or
title XVIII''.
(3) Section 1818A.--Section 1818A(a) of such Act (42 U.S.C.
1395i-2a(a)) is amended, in the matter preceding paragraph (1),
by inserting ``, subject to section 1860E-11(a)'' after
``individual who''.
(4) Section 1836.--Section 1836 of such Act is amended, in
the matter preceding paragraph (1), by inserting ``, subject to
section 1860E-11(a)'' after ``individual who''.
(5) Section 1932.--Section 1932(a)(2)(B) of the Social
Security Act (42 U.S.C. 1396u-2(a)(2)(B)) is amended by
striking ``A State'' and inserting ``Except in the case of a
State that has elected the maintenance of effort option
described in section 1944(b)(2), a State''.
SEC. 102. INCENTIVIZED MEDICARE ELIGIBILITY AT INCREASED AGE.
(a) In General.--Section 216 of the Social Security Act (42 U.S.C.
426) is amended by adding at the end the following new subsection:
``(m) Medicare Eligibility Age Defined.--
``(1) In general.--In this Act, the term `Medicare
eligibility age' means, in accordance with paragraph (2), 65
years of age, the preferred Medicare age, or any age between 65
years of age and the preferred Medicare age.
``(2) Choice.--
``(A) In general.--Unless an individual elects
otherwise (in a manner specified by the Medicare
Choices Commission) the Medicare eligibility age shall
be the preferred Medicare age described in subparagraph
(B) applicable to such individual.
``(B) Preferred medicare age.--
``(i) In general.--The preferred Medicare
age with respect to an individual--
``(I) who attains the age of 65
before January 1, 2016, is 65 years of
age;
``(II) who attains the age of 65
after December 31, 2015, and before
January 1, 2026, is 65 years of age
plus the number of months specified by
the Medicare Choices Commission for the
preferred age phase-in factor under
clause (ii) for the calendar year in
which the individual attains the age of
65; and
``(III) who attains the age of 65
during a 10-year period (with the first
such period beginning on January 1,
2026), 67 years of age increased by the
life expectancy increase factor
described in clause (iii) for such 10-
year period.
``(ii) Preferred age phase-in factor.--For
each year during the 10-year period beginning
with 2016, the Medicare Choices Commission
shall specify the preferred age phase-in factor
as either 2 or 3 months to be applied under
clause (i)(II) for individuals attaining 65
years of age during such year in a manner that
results in the preferred Medicare age being
increased over such 10-year period in as
equivalent increments as possible such that for
individuals attaining the age of 65 as of
December 31, 2025, such preferred Medicare age
will be 67 years of age.
``(iii) Life expectancy increase factor.--
The life expectancy increase factor under this
clause for a 10-year period is the age, rounded
to the nearest month, at which (as estimated by
the Medicare Choices Commission based on the
most recent information available from the
National Center for Health Statistics for the
3rd year beginning before such 10-year period)
the average life expectancy of an individual
who is eligible to enroll under this title and
who has attained 67 years of age is 18 years,
except that the application of this clause may
not result in a year-to-year increase of more
than 2 months or in the preferred Medicare age
being less than 67 years of age.
``(C) Enrollment options.--The Medicare Choices
Commission shall specify a manner and process in which
an individual may make an election described in
subparagraph (A) to have the Medicare eligibility age
applicable to such individual be an age described in
paragraph (1) other than the preferred Medicare age so
that such election takes effect in the month in which
the individuals attains such age. Such process shall
provide for an initial election period and subsequent
annual election periods for each age that may be
elected for the Medicare eligibility age.
``(D) Notification.--The Medicare Choices
Commission shall provide for notification of each
individual who will be eligible for benefits under
title XVIII that the Medicare eligibility age of such
individual will be the preferred Medicare age unless
the individual elects under subparagraph (C) an earlier
age described in paragraph (1).
``(3) Premium.--For provisions relating to premium
incentives for deferred Medicare eligibility until the
preferred Medicare age see section 1860E-32(c).''.
(b) Conforming Amendments.--
(1) Social security act.--
(A) Entitlement to hospital insurance benefits.--
Section 226 of such Act (42 U.S.C. 426) is amended by
striking ``age 65'' each place such term appears and
inserting ``medicare eligibility age (as such term is
defined in section 216(m))''.
(B) Hospital insurance benefits for the aged.--
Section 1811 of such Act (42 U.S.C. 1395c) is amended
by striking ``age 65'' each place such term appears and
inserting ``medicare eligibility age (as such term is
defined in section 216(m))''.
(C) Hospital insurance benefits for uninsured
elderly individuals not otherwise eligible.--Section
1818 of such Act (42 U.S.C. 1395i-2) is amended--
(i) in subsection (a)(1), by striking ``age
of 65'' and inserting ``medicare eligibility
age (as such term is defined in section
216(m))'';
(ii) in subsection (d)(1), by striking
``age 65'' and inserting ``medicare eligibility
age (as such term is defined in section
216(m))''; and
(iii) in subsection (d)(3), by striking
``65'' and inserting ``medicare eligibility age
(as such term is defined in section 216(m))''.
(D) Hospital insurance benefits for disabled
individuals who have exhausted other entitlement.--
Section 1818A(a)(1) of such Act (42 U.S.C. 1395i-
2a(a)(1)) is amended by striking ``the age of 65'' and
inserting ``medicare eligibility age (as such term is
defined in section 216(m))''.
(E) Eligibility for part b benefits.--
(i) In general.--Section 1836 of such Act
(42 U.S.C. 1395o) is amended by striking ``age
65'' each place such term appears and inserting
``medicare eligibility age (as such term is
defined in section 216(m))''.
(ii) Enrollment periods.--Section 1837 of
such Act (42 U.S.C. 1395p) is amended by
striking ``age 65'' and ``the age of 65'' each
place such terms appear and inserting
``medicare eligibility age (as such term is
defined in section 216(m))''.
(iii) Coverage period.--Section 1838 of
such Act (42 U.S.C. 1395q) is amended--
(I) in subsection (a), by striking
``age 65'' and inserting ``medicare
eligibility age (as such term is
defined in section 216(m))''.
(II) in subsection (c), by striking
``the age of 65'' and inserting
``medicare eligibility age (as such
term is defined in section 216(m))''.
(iv) Amounts of premiums.--Section 1839 of
such Act (42 U.S.C. 1395r) is amended by
striking ``age 65'' and ``the age of 65'' each
place such terms appear and inserting
``medicare eligibility age (as such term is
defined in section 216(m))''.
(F) Appropriations to cover government
contributions and contingency reserve.--Section
1844(a)(1) of such Act (42 U.S.C. 1395w) is amended by
striking ``age 65'' each place such term appears and
inserting ``medicare eligibility age (as such term is
defined in section 216(m))''.
(G) Eligibility, election, and enrollment.--The
matter following subparagraph (D) of section 1851(e)(4)
of such Act (42 U.S.C. 1395w-21(e)(4)) is amended by
striking ``age 65'' and inserting ``medicare
eligibility age (as such term is defined in section
216(m))''.
(H) Payments to medicare+choice organizations.--
Section 1853(c)(4)(C)(v) of such Act (42 U.S.C. 1395w-
23(c)(4)(C)(v)) is amended by striking ``65 years of
age'' and inserting ``medicare eligibility age (as such
term is defined in section 216(m))''.
(I) Part d premiums and late enrollment penalty.--
Section 1860D-13(b)(7)(B)(i) of such Act (42 U.S.C.
1395w-113(b)(7)(B)(i)) is amended by striking ``age
65'' and inserting ``the medicare eligibility age (as
such term is defined in section 216(m))''.
(J) Medicare secondary payer.--Section 1862(b) of
such Act (42 U.S.C. 1395y(b)) is amended by striking
``age 65'' each place such term appears and inserting
``medicare eligibility age (as such term is defined in
section 216(m))''.
(K) Certification of medicare supplemental health
insurance policies.--Section 1882(s) of such Act (42
U.S.C. 1395ss(s)) is amended--
(i) in paragraph (2)(A) by striking ``65
years of age'' and inserting ``medicare
eligibility age (as such term is defined in
section 216(m))'';
(ii) in paragraph (2)(D) by striking ``65
years of age'' and inserting ``medicare
eligibility age (as such term is defined in
section 216(m))''; and
(iii) in paragraph (3)(B)(vi) by striking
``age 65'' and inserting ``medicare eligibility
age (as such term is defined in section
216(m))''.
(L) Medicare subvention demonstration project for
military retirees.--Section 1896(a)(5)(D) of such Act
(42 U.S.C. 1395ggg(a)(5)(D)) is amended by striking
``age 65'' and inserting ``medicare eligibility age (as
such term is defined in section 216(m))''.
(M) Medicaid state plan provisions.--Section 1902
of the Social Security Act (42 U.S.C. 1396a) is
amended--
(i) in subsection (a)(10)(A)--
(I) in clause (i)(VIII), by
striking ``65 years of age'' and
inserting ``the medicare eligibility
age (as such term is defined in section
216(m))'';
(II) in clause (ii)(XV), by
striking ``at least 16, but less than
65, years of age'' and inserting ``at
least 16 years of age but less than the
medicare eligibility age (as such term
is defined in section 216(m))''; and
(III) in clause (ii)(XX), by
striking ``65 years of age'' and
inserting ``the medicare eligibility
age (as such term is defined in section
216(m))'';
(ii) in subsection (e)(14)(D)(i)(II), by
striking ``age 65'' and inserting ``the
medicare eligibility age (as such term is
defined in section 216(m))'';
(iii) in subsection (m)(1), by striking
``65 years of age'' and inserting ``the
medicare eligibility age (as such term is
defined in section 216(m))''; and
(iv) in subsection (aa)(2), by striking
``age 65'' and inserting ``the medicare
eligibility age (as such term is defined in
section 216(m))''.
(N) Medicaid medical assistance definition.--
Section 1905(a) of the Social Security Act (42 U.S.C.
1396d(a)) is amended--
(i) in clause (iii), by striking ``65 years
of age'' and inserting ``the medicare
eligibility age (as such term is defined in
section 216(m))''; and
(ii) in the matter following paragraph
(29)(B), by striking ``65 years of age'' and
inserting ``of medicare eligibility age (as
such term is defined in section 216(m))''.
(O) Qualified medicare beneficiary definition.--
Section 1905(p)(2)(C) of the Social Security Act (42
U.S.C. 1396d(p)(2)(C)) is amended by striking ``age
65'' and inserting ``who are the medicare eligibility
age (as such term is defined in section 216(m))''.
(P) Medicaid definition for qualified severely
impaired individual.--Section 1905(q) of the Social
Security Act (42 U.S.C. 1396d(q)) is amended by
striking ``age 65'' and inserting ``the medicare
eligibility age (as such term is defined in section
216(m))''.
(Q) Medicaid definition for employed individual
with a medically improved disability.--Section
1905(v)(1)(A) of the Social Security Act (42 U.S.C.
1396d(v)(1)(A)) is amended by striking ``16, but less
than 65, years of age'' and inserting ``16 years of
age, but less than the medicare eligibility age (as
such term is defined in section 216(m))''.
(R) Liens, adjustments and recoveries, and
transfers of assets under medicaid.--Section 1917(c) of
the Social Security Act (42 U.S.C. 1396p(c)) is
amended--
(i) in paragraph (2)(B)(iv), by striking
``65 years of age'' and inserting ``the
medicare eligibility age (as such term is
defined in section 216(m))''; and
(ii) in paragraph (4)(A), by striking ``age
65'' and inserting ``the medicare eligibility
age (as such term is defined in section
216(m))''.
(2) Other provisions of law.--
(A) Contracts for health benefits for certain
members of uniformed services, former members, and
dependents.--Section 1086(d)(2)(B) of title 10, United
States Code, is amended by striking ``under 65 years of
age'' and inserting ``under the medicare eligibility
age (as such term is defined in section 216(m) of the
Social Security Act)''.
(B) Eligible individual definition for earned
income.--Section 32(c)(1)(A)(ii)(II) of the Internal
Revenue Code is amended by striking ``age 65'' and
inserting ``the preferred Medicare age (as such term is
described in section 216(m) of the Social Security
Act)''.
(C) Tax treatment of blue cross and blue shield
organizations.--Section 833(c)(3)(A)(iv) of the
Internal Revenue Code is amended by striking ``age 65''
and inserting ``the medicare eligibility age (as such
term is defined in section 216(m) of the Social
Security Act)''.
(D) Community-based prevention and wellness
programs.--Section 4202 of the Patient Protection and
Affordable Care Act (42 U.S.C. 300u-14) is amended--
(i) in subsection (a)--
(I) in paragraph (1), by striking
``who are between 55 and 64 years of
age'' and inserting ``who are at least
55 years of age but less than the
medicare eligibility age (as such term
is defined in section 216(m) of the
Social Security Act)'';
(II) in paragraph (2)(C), by
striking ``the 55-to-64 year-old
population'' and inserting ``the
population of individuals who are at
least 55 years of age but less than the
medicare eligibility age (as such term
is defined in section 216(m) of the
Social Security Act)'';
(III) in paragraph (3)(A), by
striking ``who are between 55 and 64
years of age'' and inserting ``who are
at least 55 years of age but less than
the medicare eligibility age (as such
term is so defined)'';
(IV) in paragraph (3)(C)(i), by
striking ``who are between 55 and 64
years of age'' and inserting ``who are
at least 55 years of age but less than
the medicare eligibility age (as such
term is so defined)''; and
(V) in paragraph (3)(D), by
striking ``between 55 and 64 years of
age'' and inserting ``at least 55 years
of age but less than the medicare
eligibility age (as such term is so
defined)''; and
(ii) in subsection (b)(2)(A), by striking
``65 years of age'' and inserting ``the
medicare eligibility age (as such term is
defined in section 216(m) of the Social
Security Act)''.
SEC. 103. NEW BENEFIT STRUCTURE UNDER UNIFIED MEDICARE.
(a) In General.--Part E of title XVIII of the Social Security Act,
as added by section 101, is amended by adding at the end the following:
``Subpart 2--Benefits
``SEC. 1860E-21. UNIFIED PART A AND B DEDUCTIBLE.
``(a) In General.--Effective as of the general effective date, in
the case of a Medicare enrollee--
``(1) the amount otherwise payable under part A and the
total amount of expenses incurred by the enrollee during a year
which would (except for this section) constitute incurred
expenses for which benefits payable under section 1833(a) are
determinable, shall be reduced under sections 1813(b) and
1833(b) by the amount of the unified deductible under
subsection (b); and
``(2) the enrollee shall be responsible for payment of such
amount.
``(b) Amount of Unified Deductible.--
``(1) In general.--The amount of the unified deductible
under this subsection shall be--
``(A) for 2016, $550; or
``(B) for a subsequent year, the amount specified
in this subsection for the preceding year increased by
the percentage increase in the per capita actuarial
value of benefits under parts A and B for such
subsequent year.
``(2) Rounding.--If any amount determined under paragraph
(1) is not a multiple of $10, such amount shall be rounded to
the nearest multiple of $10.
``(c) Application.--The unified deductible under this section for a
year shall be applied, with respect to a Medicare enrollee--
``(1) with respect to benefits under part A, on the basis
of the amount that is payable for such benefits without regard
to any other copayments or coinsurance and before the
application of any such copayments or coinsurance;
``(2) with respect to benefits under part B, on the basis
of the total amount of the expenses incurred by the enrollee
during a year which would, except for the application of the
deductible, constitute incurred expenses from which benefits
payable under section 1833(a) are determinable, without regard
to any other copayments or coinsurance and before the
application of any such copayments or coinsurance;
``(3) instead of the deductibles described in sections
1813(b) and 1833(b); and
``(4) with respect to all items and services under parts A
and B.
``SEC. 1860E-22. UNIFORM COINSURANCE.
``(a) In General.--Subject to subsection (c) and section 1860E-23,
with respect to a year (beginning with 2016), in the case of a Medicare
enrollee (as defined in section 1860E-61(b))--
``(1) the amount otherwise payable under part A and the
total amount of expenses incurred by the enrollee during the
year which would (except for this section) constitute incurred
expenses for which benefits payable under section 1833(a) are
determinable, shall be reduced by a uniform coinsurance of 20
percent of such amount; and
``(2) the individual shall be responsible for payment of
the amount of such uniform coinsurance.
``(b) Application to All Items and Services.--The uniform
coinsurance under this subsection for a year shall, subject to
subsection (d)--
``(1) be applied with respect to items and services under
part A on the basis of the amount that is payable for such
items and services and in lieu of any other copayments or
coinsurance under such part;
``(2) be applied with respect to items and services under
part B on the basis of the total amount of the expenses
incurred by the individual during the year which would, except
for the application of the deductible, constitute incurred
expenses from which items and services payable under section
1833(a) are determinable, and in lieu of any other copayments
or coinsurance.
``(c) Application of Deductible.--Before applying subsection (a),
with respect to payment under part A or B for items and services
furnished to an individual, such individual shall be required to meet
the unified deductible under section 1860E-21.
``(d) Authority To Apply Actuarially Equivalent Copayment.--
``(1) In general.--Subject to paragraph (2), the Secretary
may provide for the application of a copayment amount instead
of the coinsurance under this section in cases for which the
coinsurance cannot be readily computed at the time of provision
of the items or services involved or the imposition of a
copayment amount would simplify the administration of this
title.
``(2) Actuarial equivalence.--In applying paragraph (1),
the amount of any copayment established under such paragraph
with respect to a type of item or service shall be calculated
to provide, in the aggregate and taking into account the
application of this section, for cost-sharing that is
actuarially equivalent to the cost-sharing that would be
imposed under this section if this subsection did not apply.
``SEC. 1860E-23. OUT-OF-POCKET LIMIT.
``(a) In General.--Beginning with 2016, in the case of a Medicare
enrollee, if the amount of the out-of-pocket cost-sharing of such
enrollee for a calendar year equals or exceeds the catastrophic limit
under subsection (b) for that year--
``(1) the enrollee shall not be responsible for additional
out-of-pocket cost-sharing incurred during that year; and
``(2) the Secretary shall establish procedures under which
the Secretary shall, in appropriate part from the Part A
Medicare FFS Account under section 1817 and the Part B Medicare
FFS Account under section 1841--
``(A) pay on behalf of the enrollee the amount of
the additional out-of-pocket cost-sharing described in
paragraph (1) attributable to deductibles and
coinsurance described in subsection (c)(1); and
``(B) reimburse the enrollee the amount of the
additional out-of-pocket cost-sharing described in
paragraph (1) attributable to deductibles and
coinsurance described in subsection (c)(2).
``(b) Catastrophic Limit.--The amount of the catastrophic limit
under this subsection for a year shall be the dollar amount in effect
under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986 for
self-only coverage for taxable years beginning in such year.
``(c) Out-of-Pocket Cost-Sharing Defined.--In this section, the
term `out-of-pocket cost-sharing' means, with respect to an individual,
the amount of costs incurred by the individual that are attributable
to--
``(1) deductibles and coinsurance imposed under sections
1860E-21 and 1860E-22; and
``(2) deductibles and coinsurance imposed under standard
prescription drug coverage pursuant to section 1860D-2(b) or
alternative prescription drug coverage pursuant to section
1860D-2(c) offered by a prescription drug plan.
``SEC. 1860E-24. OFFERING OF TIERED COST-SHARING COVERAGE LEVELS
INSTEAD OF MEDIGAP.
``(a) Recognition of 3 Tiers of Cost-Sharing Coverage.--For plans
years beginning on or after the general effective date, MA plans shall
be classified based upon the following 3 tiers of cost-sharing coverage
(each in this part referred to as a `tier of cost-sharing coverage'):
``(1) Tier 1.--A tier 1 level (in this part referred to as
`tier 1') for Medicare Advantage plans with cost-sharing
designed to provide benefits that are actuarially equivalent to
that provided under Medicare fee-for-service.
``(2) Tier 2.--A tier 2 level (in this part referred to as
`tier 2') for Medicare Advantage plans with cost-sharing
designed to provide benefits that would provide a level of
coverage of at least 85 percent of the expenses under Medicare
fee-for-service for the average Medicare enrollee.
``(3) Tier 3.--A tier 3 level (in this part referred to as
`tier 3') for Medicare Advantage plans with cost-sharing
designed to provide benefits that would provide a level of
coverage of at least 95 percent of the expenses under Medicare
fee-for-service for the average Medicare enrollee.
For purposes of this Act, Medicare fee-for-service shall be included in
tier 1.
``(b) Assuring Access to a Choice of Coverage.--
``(1) Choice of at least two plans in each area and tier.--
``(A) In general.--The Medicare Choices Commission
shall ensure that there is available, consistent with
subparagraph (B), a choice of enrollment in at least 2
qualifying plans (as defined in paragraph (3)) for each
tier of cost-sharing coverage and each MA region.
``(B) Requirement for different plan sponsors.--The
requirement in subparagraph (A) is not satisfied with
respect to a region if only one entity offers all the
qualifying plans in the region.
``(C) Qualifying plan defined.--For purposes of
this section, the term `qualifying plan' means--
``(i) with respect to tier 1, Medicare fee-
for-service or any MA-PD plan that is not
classified under tier 2 or tier 3; or
``(ii) with respect to any other tier, an
MA-PD plan that is classified under the
respective tier.
``(2) Fallback plan.--In order to ensure access pursuant to
paragraph (1) in an MA region, with respect to the offering of
plans in a tier, if such access is not provided in such region,
the Medicare Choices Commission shall direct the Secretary to
provide for the offering of a fallback plan in such tier for
that region in a similar manner that the Secretary provides for
the offering of a fallback prescription drug plan under section
1860D-11(g) in an area that does not provide access described
in section 1860D-3(a).
``(c) Medigap.--
``(1) Limitation on new enrollment.--Subject to paragraph
(2), a health insurance issuer that offers a Medicare
supplemental health insurance policy (as defined in section
1882(g)(1)) may not enroll an individual under such policy on
or after the general effective date.
``(2) Treatment of current medigap enrollees.--
``(A) Permitted to continue under medigap.--In the
case of an individual who, as of the day before the
general effective date is entitled to benefits under
part A or enrolled under part B and is enrolled under a
Medicare supplemental health insurance policy certified
under section 1882, such individual may choose to
remain enrolled under such policy or disenroll and
change enrollment to a different policy so certified
during a period and in accordance with a process
specified by the Secretary.
``(B) Treatment of medigap policies.--
``(i) In general.--With respect to plan
years beginning on or after January 1, 2016, a
Medicare supplemental health insurance policy
shall be certified under section 1882 only with
respect to individuals described in
subparagraph (A) and only if such policy is
modified to be in accordance with standards
revised pursuant to clause (ii).
``(ii) New standards.--The Secretary shall
request the National Association of Insurance
Commissioners to revise the standards for all
benefit packages for Medicare supplemental
health insurance policies under section 1882(p)
to be in accordance with the cost-sharing
provisions established by this subpart.
``(C) Availability of substitute policies with
guaranteed issue.--
``(i) In general.--The issuer of a medicare
supplemental policy--
``(I) may not deny or condition the
issuance or effectiveness of a medicare
supplemental policy that is offered and
is available for issuance to new
enrollees by such issuer;
``(II) may not discriminate in the
pricing of such policy, because of
health status, claims experience,
receipt of health care, or medical
condition; and
``(III) may not impose an exclusion
of benefits based on a pre-existing
condition under such policy, in the
case of an individual described in
clause (ii) who seeks to enroll under
the policy during a period described in
subparagraph (A).
``(ii) Individual covered.--An individual
described in this subparagraph with respect to
the issuer of a medicare supplemental policy is
an individual who--
``(I) is described in subparagraph
(A) and, as of the date described in
such subparagraph, is enrolled under a
medicare supplemental policy; and
``(II) terminates enrollment in
such policy and submits evidence of
such termination along with the
application for the policy under
subparagraph (A) during the period
described in such subparagraph.
``(iii) Limitation.--Subclause (i) shall
apply to an issuer of a medicare supplemental
policy, with respect to an individual, only in
the case the actuarial value of the benefits
under such policy does not substantially exceed
the actuarial value of the policy described in
clause (ii)(II) with respect to which the
individual terminated enrollment.
``SEC. 1860E-25. CONTRIBUTIONS INTO HEALTH INDIVIDUAL RETIREMENT
ACCOUNTS.
``(a) Contributions.--The Secretary shall establish procedures to
ensure that, for each year (beginning with 2016), the Secretary shall
deposit in the health individual retirement account (as defined in
section 201(1) of the Save and Strengthen Medicare Act of 2012) of an
account holder (as defined in section 201(2) of such Act) who is a
Medicare fee-for-service enrollee the per capita Medicare preventive
benefit amount under subsection (b) for such year. In no case shall a
deposit be made under the previous sentence in the case of an
individual described in subparagraph (A)(ii) of section 1935(c)(6)
(taking into account the application of subparagraph (B) of such
section) in a State that has elected the maintenance of effort option
described in section 1944(b)(2).
``(b) Per Capita Medicare Preventive Benefit Amount.--
``(1) In general.--For purposes of subsection (b), the per
capita Medicare preventive benefit amount is equal to--
``(A) with respect to 2016, the amount by which--
``(i) the average per capita amount
estimated to have been expended under Medicare
fee-for-service for preventive services during
the previous year; exceeds
``(ii) the average per capita amount that
would have been expended under Medicare fee-
for-service for such services during such
previous year if payment under Medicare fee-
for-service for such services had been subject
to the deductible and cost-sharing provisions
of section 1833;
``(B) with respect to 2017, the amount by which--
``(i) the actual average per capita amount
expended under Medicare fee-for-service for
preventive services during 2015; exceeds
``(ii) the average per capita amount that
would have been expended under Medicare fee-
for-service for such services during such year
if payment under Medicare fee-for-service for
such services had been subject to the
deductible and cost-sharing provisions of
section 1833;
increased by the annual percentage increase in the
consumer price index (all items; U.S. city average) as
of September of such previous year; and
``(C) with respect to a subsequent year, the amount
determined under this paragraph for the previous year,
increased by the annual percentage increase in the
consumer price index (all items; U.S. city average) as
of September of such previous year.
``(2) Preventive services.--For purposes of this section,
the term `preventive services' means preventive services that
are exempt from coinsurance under section 1833(a)(1)(Y) for
2015.
``(c) Payment.--
``(1) From cms operating account.--Payment of each per
capita Medicare preventive benefit amount shall be made in
appropriate part from the Part A Medicare FFS Account under
section 1817 and the Part B Medicare FFS Account under section
1841.
``(2) Availability.--Payment of a per capita Medicare
preventive benefit amount for a year to the health individual
retirement account of an individual shall be made available to
such account only for such year. If, by December 31 of such
year, the amount of the per capita Medicare preventive benefit
amount deposited for such year exceeds the amount distributed
from the account of the individual (in accordance with section
206(a) of the Save and Strengthen Medicare Act of 2012) during
such year, such excess shall be returned to the Medicare FFS
Account in accordance with procedures established under
subsection (e).
``SEC. 1860E-26. REQUIRING MA PLANS TO OFFER PRESCRIPTION DRUG
COVERAGE.
``Beginning for plan years beginning on or after the general
effective date, the only MA plans that may be offered under part C are
MA-PD plans.''.
(b) Application of Out-of-Pocket Limit to MA-PD Plans.--
(1) In general.--Section 1852(a)(1)(B) of the Social
Security Act (42 U.S.C. 1395w-22(a)(1)(B)) is amended--
(A) in clause (i), by striking ``clause (iii)'' and
inserting ``clauses (iii) and (vi)''; and
(B) by adding at the end the following new clause:
``(vi) Out-of-pocket limit.--The provisions
of section 1860E-23--
``(I) shall apply to individuals
enrolled under an MA-PD plan in the
same manner as such provisions apply to
Medicare enrollees under such section,
except that in lieu of the application
of subsection (a)(2) of such section
the MA-PD plan shall establish
procedures to provide for payment of
any additional out-of-pocket cost-
sharing described in subsection (a)(1)
of such section incurred by individuals
enrolled under the MA-PD plan; and
``(II) as applied under subclause
(I), may not be waived by application
of this subparagraph.
In applying subsection (b) of section 1860E-23
pursuant to the previous sentence, an MA-PD
plan may substitute a dollar amount that is
less than the dollar amount specified under
such subsection.''.
(2) Exempting ma-pd plans offering alternative prescription
drug coverage from part d deductible and out-of-pocket limit
requirements.--Section 1860D-2(c) of the Social Security Act
(42 U.S.C. 1395w-102(c)) is amended--
(A) in paragraph (2), by striking ``The
deductible'' and inserting ``In the case of a
prescription drug plan, the deductible''; and
(B) in paragraph (3), by striking ``The coverage
provides'' and inserting ``In the case of a
prescription drug plan, the coverage provides''.
(c) Prescription Drug Plans Required To Report Enrollees' Out-of-
Pocket Cost-Sharing.--Section 1860D-12(b) of the Social Security Act
(42 U.S.C. 1395w-112(b)) is amended by adding at the end the following
new paragraph:
``(7) Out-of-pocket cost-sharing reports.--Each contract
entered into with a PDP sponsor under this part with respect to
a prescription drug plan offered by such sponsor shall require
that, with respect to each claim submitted for items or
services furnished to an individual enrolled under the plan
pursuant to the contract, the sponsor submits to the Secretary
information on the amount of out-of-pocket cost-sharing (as
defined in section 1860E-23(c)) applicable to such enrollee for
such items or services.''.
(d) Conforming Amendments.--
(1) Section 1813 of the Social Security Act (42 U.S.C.
1395e) is amended--
(A) in subsection (a), by inserting ``Subject to
subpart 2 of part E:'' before paragraph (1); and
(B) in subsection (b), by inserting ``Subject to
subpart 2 of part E:'' before paragraph (1).
(2) Section 1833 of such Act (42 U.S.C. 1395l) is amended--
(A) in subsection (a), in the matter preceding
paragraph (1), by inserting ``and subpart 2 of part E''
after ``succeeding provisions of this section'';
(B) in subsection (b), in the first sentence, by
striking ``Before applying'' and inserting ``Subject to
subpart 2 of part E, before applying'';
(C) in subsection (c)(1), in the matter preceding
subparagraph (A), by inserting ``subject to subpart 2
of part E,'' after ``this part,'';
(D) in subsection (f), by striking ``In
establishing'' and inserting ``Subject to subpart 2 of
part E, in establishing''; and
(E) in subsection (g)(1), by inserting ``and
subpart 2 of part E'' and ``paragraphs (4) and (5)''.
(3) Section 1882(a)(2) of such Act is amended by striking
``No medicare'' and inserting ``Subject to section 1860E-24(c),
no medicare''.
SEC. 104. LATE ENROLLMENT PENALTY NOT TO APPLY FOR MONTHS OF ANY HEALTH
COVERAGE.
(a) In General.--Section 1839(b) of the Social Security Act (42
U.S.C. 1395r) is amended in the second sentence, by inserting before
the period at the end the following: ``or months during which the
individual has any other health coverage''.
(b) Effective Date.--The amendment made by paragraph (1) shall
apply for months of coverage beginning after the date of the enactment
of this Act.
SEC. 105. COMPETITIVE BIDDING AND PREMIUMS UNDER UNIFIED MEDICARE.
(a) In General.--Part E of title XVIII of the Social Security Act,
as added by section 101 and amended by section 103, is further amended
by adding at the end the following:
``Subpart 3--Competitive Bidding and Premiums
``SEC. 1860E-31. APPLICATION OF COMPETITIVE BIDDING AND CHANGES IN
PREMIUMS.
``(a) Competitive Bidding Based on Levels of Coverage and MA
Regions.--In applying section 1854 for plan years beginning on or after
the general effective date the following rules shall apply:
``(1) Separate bids for each tier of cost-sharing
coverage.--A Medicare Advantage organization shall submit a
separate bid for each tier of cost-sharing coverage for each
MA-PD plan offered by such organization.
``(2) Bids.--Any bid submitted by a Medicare Advantage
organization under such section--
``(A) with respect to an MA region, shall provide
for the offering of an MA-PD plan in each county within
such region; and
``(B) with respect to an MA local area, shall
provide for the offering of an MA-PD plan in each
county within such area.
``(3) Uniform bids for all areas within an ma region.--Any
bid submitted by a Medicare Advantage organization under such
section shall, as specified by the organization, be uniform
for--
``(A) all plans offered in any MA local area within
an MA region; or
``(B) subject to paragraph (4), all plans offered
within a county; and
section 1854(h) shall apply.
``(4) Authority of medicare choices commission to reject
bids.--In the case that the Medicare Choices Commission
determines that a Medicare Advantage organization is submitting
bids in accordance with paragraph (3)(B) in a manner that
demonstrates a disproportionate change in the amounts of the
bids for such areas compared to the actual costs for providing
benefits in such areas, the Commission may reject such bids.
``(5) Acceptance of bid.--
``(A) In general.--A Medicare Advantage
organization shall not be eligible to submit a bid
under such section unless the organization provides
assurances satisfactory to the Medicare Choices
Commission that the organization will accept an award
of a contract under this part pursuant to such bid.
``(B) Certain modifications permitted.--Nothing in
subparagraph (A) shall be construed as preventing a
Medicare Advantage organization that submits a bid
under such section from withdrawing or modifying the
bid before the date on which the risk-adjusted
benchmark amount under paragraph (3)(B)(i) or
(4)(B)(i), as appropriate, of section 1854(b) is
calculated for the area and year involved.
``(b) Adjustment in Payment to MA Plans.--
``(1) In general.--In applying section 1853 for plans years
beginning on or after the general effective date, the amount
specified in subparagraph (B) of section 1853(a)(1) shall be
\1/12\ of 88 percent of the revised benchmark for the region
and year involved.
``(2) Revised benchmark.--
``(A) In general.--The Medicare Choices Commission
shall compute a revised benchmark for each plan year
and each MA region.
``(B) Revised benchmark.--Subject to the succeeding
provisions of this paragraph, the revised benchmark for
a plan year and MA region is equal to the sum of--
``(i) the phase-out percentage (as
specified in subparagraph (C)) of the average
of the lowest and third lowest bid amount
submitted for such year and region for the tier
1 level of cost-sharing coverage under section
1860E-24(b), taking into account section 1860E-
32(b); and
``(ii) the phase-in percentage (as
specified in subparagraph (C)) of the lowest
bid amount so submitted.
``(C) Phase out and phase-in percentages.--In
subparagraph (B), with respect--
``(i) to the first plan year in which this
section applies, the phase-out percentage shall
be 100 percent and the phase-in percentage
shall be 0 percent; and
``(ii) each succeeding plan year the phase-
out percentage shall be the phase-out
percentage for the previous year decreased by
20 percentage points (but not below 0 percent)
and the phase-in percentage shall be 100
percent minus the phase-out percentage for the
year.
``(D) Limitation.--In no case shall the revised
benchmark for a plan year and MA region be lower than
the lowest bid amount submitted for such year and
region that when combined with all bids below such bid
amount would result in the capacity to provide coverage
to all Medicare enrollees in such region.
``(3) Review and revisions of risk adjustment.--
``(A) In general.--The Medicare Choices Commission
shall review and, as the Commission determines
appropriate, revise the risk adjustments payment
mechanism under section 1853(a)(1)(C) for purposes of
applying such mechanism under this section and under
section 1860E-32, including pursuant to section 1860E-
33(a).
``(B) Requirements for revisions.--In making the
revisions under subparagraph (A) to the risk
adjustments payment mechanism described in such
subparagraph, the following shall apply:
``(i) Incorporating private health
insurance data.--The Medicare Choices
Commission shall incorporate data on the cost
and utilization of services by individuals
receiving benefits under a group health plan or
health insurance coverage offered in the
individual or group market who have the same
case characteristics (such as conditions or
combinations of conditions) as such
characteristics that are to be used under such
mechanism for risk adjusting payment amounts to
Medicare Advantage organizations under part C
and Medicare fee-for-service under section
1860E-32, including pursuant to section 1860E-
33(a).
``(ii) Inclusion of number of conditions.--
The Medicare Choices Commission shall provide
that a risk score under such mechanism, with
respect to an individual, includes an indicator
for the number of chronic conditions with which
the individual has been diagnosed.
``(iii) Use of 2 years of diagnosis data.--
The Medicare Choices Commission shall ensure
that a risk score under such mechanism, with
respect to an individual, shall reflect two
years of diagnosis data, to the extent
available.
``(C) Evaluating addition of retrospective risk
transfer pool.--In conducting the review under
subparagraph (A) of the risk adjustments payment
mechanism described in such subparagraph, the Medicare
Choices Commission shall evaluate the extent to which
it would be appropriate to establish, in addition to
such risk adjustments payment mechanism, a
retrospective risk transfer pool--
``(i) that would enable MA organizations,
with respect to MA-PD plans offered by such
organization, and the Secretary, with respect
to Medicare fee-for-service, to collectively
devise and administer procedures for adjusting
for enrollee selection effects that are not, in
the judgment of the organizations, with respect
to such plans, and the Secretary, with respect
to Medicare fee-for-service, adequately
addressed by the risk adjustments payment
mechanism;
``(ii) under which each MA-PD plan and
Medicare fee-for-service must participate;
``(iii) which shall be operated by the MA
organizations offering such MA-PD plans and the
Secretary under the supervision of the Medicare
Choices Commission; and
``(iv) which would be funded entirely out
of premiums and assessments on such plans and
Medicare fee-for-service.
``(4) Application on a regional basis.--In applying
sections 1853 and 1854, the revised benchmark under this
subsection for each MA local area within an MA region shall be
the revised benchmark for such region.
``(c) Premiums Under MA Plans.--
``(1) In general.--For plans years beginning on or after
the general effective date, sections 1853 and 1854 shall be
applied--
``(A) by substituting the modified monthly basic
beneficiary premium described in paragraph (2)(A) for
the MA monthly basic beneficiary premium defined in
section 1854(b)(2)(A); and
``(B) by substituting the revised benchmark under
subsection (b) for the unadjusted MA area specific non-
drug monthly benchmark amount (as defined in section
1853(j)).
``(2) Modified monthly basic beneficiary premium.--
``(A) In general.--The modified monthly basic
beneficiary premium described in this paragraph, with
respect to a month in a year and an MA plan offered in
a tier of cost-sharing coverage in an MA region, is the
amount (if any) by which the MA non-drug bid described
in subparagraph (B) for such plan exceeds \1/12\ of the
revised benchmark described in subsection (b) for the
year and region.
``(B) MA non-drug bid.--The MA non-drug bid
described in this subparagraph is, with respect to a
month and an MA plan offered in a tier of cost-sharing
coverage, the portion of the bid amount submitted under
clause (i) of section 1854(a)(6)(A) for the tier
benefit level, MA region, and year involved that is
attributable under clause (ii)(I) of such section to
the provision of benefits under Medicare fee-for-
service.
``(3) Application on a regional basis.--In applying
sections 1853 and 1854, the average per capita monthly savings
under section 1854(b)(3) shall be computed by substituting each
region for a State and all plans within the region for MA local
plans within a State.
``(4) Treatment of beneficiary rebate rule.--Section
1854(b)(1)(C) shall not apply to the modified monthly basic
beneficiary premium applied under this subsection.
``(5) Treatment of individuals electing earlier benefit
coverage.--Section 1860E-32(c)(3) shall apply to an MA
organization and the premium charged under section 1854(b)(1)
to an individual enrolled in an MA plan offered by such
organization who makes an election described in such section
1860E-32(c)(3) in the same manner as such section applies to
the Secretary and an individual enrolled under Medicare fee-
for-service who makes such an election.
``(d) Annual Report.--Beginning for 2016, the Medicare Choices
Commission shall submit to Congress an annual report on any
questionable activities or irregularities that have arisen in the
bidding process under part C, as modified by this section, during such
year.
``SEC. 1860E-32. APPLICATION OF COMPETITIVE BIDDING TO MEDICARE FEE-
FOR-SERVICE.
``(a) Submission of Bid.--
``(1) In general.--The Secretary shall submit a bid for
Medicare fee-for-service (in this part referred to as a
`Medicare FFS bid') offered for each MA region in the same
manner as a bid submitted by a Medicare Advantage organization
under section 1854 for offering an MA plan under such tier.
``(2) Basis for bid.--In applying paragraph (1) in
computing the average revenue requirements under section
1854(a)(6)(A)(i) for a plan year, the Secretary shall base such
requirements on--
``(A) adjusted average per capita costs payable
during the previous plan year under parts A and B
attributable to all individuals enrolled under Medicare
fee-for-service in such region, including
administrative costs attributable to such individuals
and costs attributable to such individuals with respect
to per capita Medicare preventive benefit amounts
contributed under section 1860E-25 into health
individual retirement accounts, (as estimated by the
Secretary), increased by
``(B) the Secretary's estimate of the percentage
increase in the per capita actuarial value of benefits
under such parts for the plan year involved.
``(3) Modification.--In applying this subsection, clause
(iii) of section 1854(a)(6)(B) shall not be construed as
applying to Medicare fee-for-service.
``(b) Treatment of Bid as a Tier 1 Bid Under Part C.--Any bid under
subsection (a) for a region shall be considered as a bid for an MA plan
offered in the region with tier 1 cost-sharing coverage for purposes of
this part and sections 1853 and 1854.
``(c) Premiums Adjustment.--
``(1) In general.--Beginning for months beginning on or
after the general effective date--
``(A) there shall be a combined monthly premium
amount described in paragraph (2) charged to a Medicare
enrollee, with respect to coverage under Medicare fee-
for-service;
``(B) such premium amount under subparagraph (A)
shall be instead of the part B monthly premium under
section 1839; and
``(C) such premium shall be separate from (and in
addition to) any monthly beneficiary premium that may
apply to the individual with respect to a prescription
drug plan under part D.
``(2) Combined monthly premium.--
``(A) In general.--The combined monthly premium
amount under this paragraph for a Medicare enrollee in
an MA region shall be, subject to subparagraph (D) and
section 1860E-41(b), equal to the combined monthly base
amount under subparagraph (B), adjusted in accordance
with subparagraphs (C) and (D).
``(B) Combined monthly base amount.--The combined
monthly base amount shall be an amount calculated in a
manner similar to the manner in which the part B
monthly premium is calculated under subsections (a) and
(c) of section 1839, in effect as of December 31, 2015,
except that in applying such section--
``(i) the actuarial rate determined under
the second sentence of subsection (a)(1) of
such section shall be an amount the Secretary
estimates to be necessary so that the aggregate
amount for the calendar year involved with
respect to all Medicare enrollees will equal
the total of the benefits and administrative
costs which the Secretary estimates will be
payable from the Federal Hospital Insurance
Trust Fund under section 1817 and the Federal
Supplementary Medical Insurance Trust Fund
under section 1841 for services performed and
related administrative costs incurred in such
calendar year with respect to such enrollees
under parts A and B; and
``(ii) by substituting `24 percent' for `50
percent' in subsection (a)(3) of such section.
``(C) Application of other provisions.--The
combined monthly base amount shall be subject to
adjustment in the same manner as the part B monthly
premium calculated under section 1839(a) is subject to
adjustment under subsections (b) and (i) of such
section, except that--
``(i) in applying the late enrollment
penalty under subsection (b) of such section,
the initial enrollment period of the individual
shall be the enrollment period specified by the
Secretary pursuant to subpart 1 instead of the
initial enrollment period described in such
section 1839(b); and
``(ii) the income reduction under
subsection (i) of such section shall be applied
in accordance with section 1860E-41(a).
Adjustments under this subparagraph shall be made
without regard to any adjustment under subparagraph
(D).
``(D) Amount of adjustment for non-ma enrollees.--
Under this subparagraph, with respect to a Medicare
fee-for-service enrollee for a month who resides in an
MA region, if the Medicare FFS bid under subsection (a)
for the region and month exceeds such revised
benchmark, the amount of the combined monthly base
amount for the enrollee for the month (without regard
to any adjustment under subparagraph (C)) shall be
increased, subject to subparagraph (E), by the amount
by which such bid exceeds such benchmark.
``(E) Transition for current traditional ffs
medicare beneficiaries.--In the case of an individual
who, as of December 31, 2015, is entitled to (or
enrolled for) benefits under part A or enrolled under
part B but is not enrolled in an MA plan--
``(i) with respect to months in 2016, the
adjustment under subparagraph (D) for such
individual for such months may in no case
exceed 20 percent of the part B monthly premium
amount under section 1839 that was applicable
to such individual for months in the previous
year; and
``(ii) with respect to months in a
subsequent year (before 2026), such adjustment
for such months may in no case exceed 20
percent of the combined monthly premium amount
applicable to such individual (not taking into
account subparagraph (C)) for months in the
previous year.
``(3) Treatment of individuals electing earlier benefit
coverage.--In the case of an individual who elects under
section 216(m) a Medicare eligibility age of at least 65 but
less than the preferred Medicare age applicable to such
individual under paragraph (2)(B) of such section, the
Secretary shall adjust the premium otherwise computed for
individuals with a Medicare eligibility age of the preferred
Medicare age in a manner so that, on an actuarial basis over
the lifetime of individuals making such an election (taking
into account the relevant risk characteristics of individuals
who as a class have selected the respective age compared to
those who have not made the election), the actuarial value of
the benefits (net of premiums) is equal among such groups.
``(4) Payment of premiums.--The provisions of section
1854(d)(2) shall apply to the payment and collection of
combined monthly premium amounts under this subsection in a
similar manner as such provisions apply to the payment to and
collection by an MA organization of monthly premiums under part
C.
``SEC. 1860E-33. ENSURING A LEVEL PLAYING FIELD.
``(a) In General.--Except as specified otherwise in this part, the
Secretary and Medicare fee-for-service shall be subject to requirements
that are applicable under this title to an MA organization and Medicare
Advantage plan, and payments shall be made to the Secretary, with
respect to coverage of an individual under Medicare fee-for-service in
the same manner as payments are made under section 1853(a)(1) to an MA
organization, with respect to coverage of an individual under a
Medicare Advantage plan offered by such organization.
``(b) Ensuring Collection of Quality and Risk Data.--The Medicare
Choices Commission shall establish procedures to ensure that quality
data and data on risk factors of Medicare enrollees are collected and
reported with respect to Medicare fee-for-service in the same manner as
such data are collected and reported with respect to Medicare Advantage
plans.
``(c) Noninterference Rules.--
``(1) Negotiations between ma plans and providers.--In
order to promote competition under this title and in carrying
out this title, neither the Secretary nor the Medicare Choices
Commission may interfere with the negotiations between any MA
organization and a hospital, physician, or other provider of
services or supplier.
``(2) Bidding process.--The Medicare Choices Commission may
not reject a bid submitted by an MA organization for the
offering of an MA-PD plan based on the amount of such bid.
Nothing in the previous sentence shall be construed as
affecting the regulatory authority of the Commission or as
affecting the authority of the Commission to reject a bid
pursuant to section 1860E-31(a)(3).
``(3) Treatment of regulatory functions.--
``(A) In general.--The Secretary, through the
Centers of Medicare & Medicaid Services, shall maintain
regulatory functions associated with conditions of
participation applicable to participation of providers
of services and suppliers in Medicare fee-for-service.
``(B) No application to providers with respect to
ma plans.--Beginning on the general effective date, the
Secretary shall not have the authority to apply any
conditions of participation or similar requirements on
providers of services and suppliers insofar as they are
not related to Medicare fee-for-service.
``(C) GAO report.--By not later than January 31,
2015, the Comptroller General of the United States
shall submit to Congress a report containing
recommendations on the extent to which any condition of
participation or requirement described in paragraph (2)
should be applied to providers of services and
suppliers furnishing items and services under this
title under arrangements with Medicare Advantage plans.
``(d) Report.--
``(1) Initial report.--Not later than September 30, 2014,
the Medicare Choices Commission shall submit to Congress a
report that--
``(A) identifies all the requirements that are
applicable to MA organizations and Medicare Advantage
plans and the extent to which such requirements are
also applicable to the Secretary and Medicare fee-for-
service; and
``(B) includes a plan for achieving the requirement
described in subsection (a).
``(2) GAO reports.--Not later than January 1, 2016, and
every 3 years thereafter, the Comptroller General of the United
States shall submit to Congress a report on the extent to which
the Secretary and Medicare fee-for-service are in compliance
with subsection (a) and the plan described in paragraph
(1)(B).''.
(b) Conforming Amendments.--
(1) Section 1839(a) of the Social Security Act is amended
by inserting after the subsection enumerator the following:
``Subject to section 1860E-32:''.
(2) Section 1839(i)(1) of the Social Security Act is
amended by striking ``In the case'' and inserting ``Subject to
sections 1860E-32 and 1860E-41, in the case''.
(3) Section 1853(a)(1)(A) of the Social Security Act is
amended by striking ``and section 1859(e)(4)'' and inserting
``, section 1859(e)(4), and subpart 3 of part E''.
(4) Section 1853(j) of such Act is amended by inserting
``and subpart 3 of part E'' after ``subsection (o)''.
(5) Section 1854 of such Act is amended--
(A) in subsection (a), after the heading, by
inserting ``Subject to subpart 3 of part E:'';
(B) in subsection (b), after the heading, by
inserting ``Subject to subpart 3 of part E:'';
(C) in subsection (d), after the heading, by
inserting ``Subject to subpart 3 of part E:''; and
(D) in subsection (e), after the heading, by
inserting ``Subject to subpart 3 of part E:''.
SEC. 106. SEPARATE MEDICARE FFS ACCOUNTS AND OTHER FINANCING UNDER
UNIFIED MEDICARE.
(a) Separate Medicare FFS Accounts.--
(1) Under federal hospital insurance trust fund.--Section
1817 of the Social Security Act (42 U.S.C. 1395i) is amended by
adding at the end the following new subsection:
``(l) Part A Medicare FFS Account.--
``(1) Establishment.--There is hereby established within
the Trust Fund an account to be known as the `Part A Medicare
FFS account' for the receipts and disbursements attributable to
the operation of Medicare fee-for-service (as defined in
section 1860E-61(b)) insofar as it relates to the program under
this part, as modified under part E, including the transition
funding under paragraph (2)(B). Section 1854(g) shall apply to
receipts described in the previous sentence in the same manner
as such section applies to payments or premiums described in
such section.
``(2) Funding.--
``(A) In general.--The Part A Medicare FFS Account
shall consist of such gifts and bequests as may be made
as provided in section 201(i)(1), as applied under this
section, accrued interest on balances in the Part A
Medicare FFS Account, and such amounts as may be
deposited in, or appropriated to, such Part A Medicare
FFS Account as provided in this subsection.
``(B) Transition funding.--
``(i) In general.--In order to provide for
funding relating to transitional costs for
carrying out Medicare fee-for-service insofar
as it relates to the program under this part,
as modified under part E, as of the general
effective date (as defined in section 1860E-
62), there shall be transferred from the Trust
Fund to the Part A Medicare FFS Account such
sums as specified necessary by the Medicare
Choices Commission. In order to provide for
initial claims reserves before the collection
of premiums, there shall be transferred from
the Trust Fund to the Part A Medicare FFS
Account such sums as necessary to cover 90 days
worth of claims reserves based on projected
enrollment.
``(ii) Amortization of transition
funding.--The Secretary shall provide for the
repayment to the Trust Fund of the funding
transferred under clause (i) in an amortized
manner over the 10-year period beginning with
the first plan year beginning on or after the
general effective date (as defined in section
1860E-62).
``(iii) Limitation on funding.--Nothing in
this paragraph shall be construed as
authorizing any additional transfers to the
Part A Medicare FFS Account, other than such
amounts as are otherwise provided with respect
to Medicare Advantage plans.
``(3) Separate from rest of trust fund.--Funds provided
under this subsection to the Part A Medicare FFS Account
shall--
``(A) be kept separate from all other funds within
the Trust Fund, but shall be invested, and such
investments redeemed, in the same manner as all other
funds and investments within the Trust Fund; and
``(B) notwithstanding the previous subsections of
this section, be managed and administered by the
Administrator of the Centers for Medicare & Medicaid
Services.''.
(2) Under supplementary medical insurance trust fund.--
Section 1841 of the Social Security Act (42 U.S.C. 1395t) is
amended by adding at the end the following new subsection:
``(j) Part B Medicare FFS Account.--
``(1) Establishment.--There is hereby established within
the Trust Fund an account to be known as the `Part B Medicare
FFS account' for the receipts and disbursements attributable to
the operation of Medicare fee-for-service (as defined in
section 1860E-61(b)) insofar as it relates to the program under
this part, as modified under part E, including the transition
funding under paragraph (2)(B). Section 1854(g) shall apply to
receipts described in the previous sentence in the same manner
as such section applies to payments or premiums described in
such section.
``(2) Funding.--
``(A) In general.--The Part B Medicare FFS Account
shall consist of such gifts and bequests as may be made
as provided in section 201(i)(1), as applied pursuant
to this section, accrued interest on balances in the
Part B Medicare FFS Account, and such amounts as may be
deposited in, or appropriated to, the Part B Medicare
FFS Account as provided in this subsection.
``(B) Transition funding.--
``(i) In general.--In order to provide for
funding relating to transitional costs for
carrying out Medicare fee-for-service insofar
as it relates to the program under this part,
as modified under part E, as of the general
effective date (as defined in section 1860E-
62), there shall be transferred from the Trust
Fund to the Part B Medicare FFS Account such
sums as specified necessary by the Medicare
Choices Commission. In order to provide for
initial claims reserves before the collection
of premiums, there shall be transferred from
the Trust Fund to the Part B Medicare FFS
Account such sums as necessary to cover 90 days
worth of claims reserves based on projected
enrollment.
``(ii) Amortization of transition
funding.--The Secretary shall provide for the
repayment to the Trust Fund of the funding
transferred under clause (i) in an amortized
manner over the 10-year period beginning with
the first plan year beginning on or after the
general effective date (as defined in section
1860E-62).
``(iii) Limitation on funding.--Nothing in
this paragraph shall be construed as
authorizing any additional transfers to the
Part B Medicare FFS Account, other than such
amounts as are otherwise provided with respect
to Medicare Advantage plans.
``(3) Separate from rest of trust fund.--Funds provided
under this subsection to the Part B Medicare FFS Account
shall--
``(A) be kept separate from all other funds within
the Trust Fund, but shall be invested, and such
investments redeemed, in the same manner as all other
funds and investments within the Trust Fund; and
``(B) notwithstanding the previous subsections of
this section, be managed and administered by the the
Administrator of the Centers for Medicare & Medicaid
Services.''.
(b) Chairperson of Medicare Choices Commission To Replace
Administrator of CMS on as Secretary of Board of Trustees of HI and SMI
Trust Funds.--
(1) HI trust fund.--Section 1817(b) of the Social Security
Act (42 U.S.C. 1395i(b)) is amended by striking ``The
Administrator of the Centers for Medicare & Medicaid Services
shall serve as the Secretary of the Board of Trustees.'' and
inserting ``Before the general effective date defined under
section 1860E-62, the Administrator of the Centers for Medicare
& Medicaid Services shall serve as the Secretary of the Board
of Trustees. On and after such general effective date such
Administrator shall not serve as the Secretary of such Board
and instead the Chairperson of the Medicare Choices Commission
established under section 1860E-51 shall serve as the Secretary
of such Board.''.
(2) SMI trust fund.--Section 1841(b) of the Social Security
Act (42 U.S.C. 1395t(b)) is amended by striking ``The
Administrator of the Centers for Medicare & Medicaid Services
shall serve as the Secretary of the Board of Trustees.'' and
inserting ``Before the general effective date defined under
section 1860E-62, the Administrator of the Centers for Medicare
& Medicaid Services shall serve as the Secretary of the Board
of Trustees. On and after such general effective date such
Administrator shall not serve as the Secretary of such Board
and instead the Chairperson of the Medicare Choices Commission
established under section 1860E-51 shall serve as the Secretary
of such Board.''.
(c) Subsidies.--Part E of title XVIII of the Social Security Act,
as added by section 101 and amended by sections 103 and 105, is further
amended by adding at the end the following:
``Subpart 4--Subsidies
``SEC. 1860E-41. CHANGES IN SUBSIDIES.
``(a) Reduced Government Contribution for High-Income Seniors.--
``(1) In general.--For purposes of determining the combined
monthly base amount under section 1860E-32(c)(2)(B) for an
individual, in applying section 1839(i) under such section, the
following shall apply:
``(A) 2016.--For 2016, notwithstanding paragraph
(6) of such section 1839(i), subject to paragraph (3)--
``(i) the threshold amount otherwise
applicable under paragraph (2)(A) of such
section for individuals shall be equal to
$50,000 (or couples, $100,000); and
``(ii) instead of the sliding scale
percentage specified in paragraph (3)(A)(i) of
such section (and instead of the amount which
would be applied in the case of a joint return
described in paragraph (3)(C)(ii) of such
section), the sliding scale percentage shall be
determined so that for individuals (or couples)
whose modified adjusted gross income is within
an income tier specified in the table described
in paragraph (2) the sliding scale percentage
shall increase, on a sliding scale in a linear
manner, from the initial premium percentage to
the final premium percentage as specified in
such table for such income tier for such
individuals (or couples, respectively).
``(B) Subsequent years.--For each subsequent year,
such section 1839(i) shall be applied, as modified by
subparagraph (A) and subject to paragraphs (3) and (4),
without taking into account paragraph (5) or (6) of
such section.
``(2) Table.--The table specified in this paragraph is as
follows:
------------------------------------------------------------------------
``Initial Income Final Income Level
Level within Tier within Tier for Initial Final
for Individual (or Individual (or Premium Premium
Couple) Couple) Percentage Percentage
------------------------------------------------------------------------
$50,000 ($100,000) $85,000 ($150,000) 12 percent 20 percent
$85,001 ($150,001) $130,000 ($214,000) 20 percent 32 percent
$130,001 ($214,001) $190,000 ($300,000) 32 percent 50 percent
$190,001 ($300,001) No Limi50 percent 50 percent.
------------------------------------------------------------------------
``(3) Transition for certain seniors.--
``(A) In general.--In the case of individuals and
couples with an income level that is below the minimum
level for which section 1839(i) would otherwise apply
(as in effect as of the date of enactment of this
section), the premium to be applied shall be the sum
of--
``(i) the premium otherwise applicable to
individuals whose income is $1 below the
applicable threshold amount under subsection
(a)(1); and
``(ii) the transition percentage of the
amount by which the premium that would
otherwise apply (but for this paragraph) under
this subsection exceeds the premium described
in clause (i).
``(B) Transition percentage.--The transition
percentage specified in this subparagraph--
``(i) for fiscal year 2016, is 20 percent;
``(ii) for fiscal year 2017, is 40 percent;
``(iii) for fiscal year 2018, is 60
percent;
``(iv) for fiscal year 2019, is 80 percent;
and
``(v) for any succeeding fiscal year, is
100 percent.
``(4) Inflation adjustment.--
``(A) In general.--In the case of any calendar year
beginning after such date that the minimum income level
for which section 1839(i) applies pursuant to paragraph
(1)(A)(i) is not greater than 150 percent of the
poverty line, each dollar amount in paragraph (1)(A) or
(2) shall be increased by an amount equal to--
``(i) such dollar amount, multiplied by
``(ii) the percentage (if any) by which the
average of the Consumer Price Index for all
urban consumers (United States city average)
for the 12-month period ending with August of
the preceding calendar year exceeds such
average for the 12-month period ending with
August of the calendar year preceding the first
calendar year beginning after such date.
``(B) Rounding.--If any dollar amount after being
increased under subparagraph (A) is not a multiple of
$1,000, such dollar amount shall be rounded to the
nearest multiple of $1,000.
``(b) Enhanced Subsidies to Low-Income Seniors.--
``(1) In general.--Beginning with 2016, in lieu of any
medical assistance available for medicare cost sharing
described in section 1905(p)(3), the following shall apply:
``(A) Individuals with income below 100 percent of
poverty line (qualified medicare beneficiaries) and
full-benefit dual eligible individuals.--In the case of
an individual described in section 1902(a)(10)(E)(i) or
subparagraph (A)(ii) of section 1935(c)(6) (taking into
account the application of subparagraph (B) of such
section), the individual is entitled under this section
to an income-related premium subsidy equal to 100
percent of the modified monthly basic beneficiary
premium under section 1860E-31(c)(2) for the MA-PD plan
with the lowest bid under the tier 3 benefit level
under section 1860E-24(a)(3).
``(B) Individuals with income between 100 percent
and 120 percent of poverty line (specified low-income
beneficiaries).--In the case of an individual described
in section 1902(a)(10)(E)(iii), the individual is
entitled under this section to an income-related
premium subsidy equal to 100 percent of the modified
monthly basic beneficiary premium under section 1860E-
31(c)(2) for the MA-PD plan with the lowest bid under
the tier 2 benefit level under section 1860E-24(b).
``(C) Other individuals with income below 135
percent of poverty line (qualifying individuals).--In
the case of an individual described in section
1902(a)(10)(E)(iv), the individual is entitled under
this section to an income-related premium subsidy equal
to 100 percent of the modified monthly basic
beneficiary premium under section 1860E-31(c)(2) for
the MA-PD plan with the lowest bid under the tier 1
benefit level under section 1860E-24(b). In no case
shall an individual described in this subparagraph be
subject to a late enrollment penalty, which would
otherwise be applied under section 1860E-32(c).
``(2) Flexibility in use of subsidies.--An individual
entitled to an amount of an income-related premium subsidy
under paragraph (1) may use the amount of such subsidy toward
the premium applied under Medicare fee-for-service or any MA-PD
plan offered under any tier benefit level.
``(3) Deposit of excess into health iras.--In the case of
such an individual who is an account holder (as defined in
section 201(2) of the Save and Strengthen Medicare Act of 2012)
and for whom the subsidy amount under this subsection exceeds
the premium amount which is applicable to the individual, the
Medicare Choices Commission shall provide for the deposit of
such excess amount into the health individual retirement
account (as defined in section 201(1) of such Act) of such
account holder.''.
(d) Application of Revised Income Thresholds to Part D.--Section
1860D-13(a)(7) of the Social Security Act (42 U.S.C. 1395w-113(a)(7))
is amended--
(1) in subparagraph (A), by inserting ``(or, for a calendar
year after 2015, the threshold amount applicable under
paragraph (1) of section 1860E-41(a) (including application of
paragraph (4) of such section) for the calendar year)'' after
``for the calendar year'';
(2) in subparagraph (B)--
(A) in the matter preceding clause (i), by striking
``The monthly'' and inserting ``Subject to subparagraph
(H), the monthly''; and
(B) in clause (i)(I), by inserting ``(or, for a
calendar year after 2015, the applicable percentage
that would be determined under paragraph (2) of section
1860E-41(a) (including application of paragraph (4) of
such section) for the individual for the calendar year
if the table specified in subparagraph (G) were
substituted for the table specified in the table under
such paragraph (2))'' after ``for the calendar year'';
(3) in subparagraph (E)(ii)--
(A) in subclause (I), by inserting ``or, for a year
after 2015, the modified adjusted gross income
threshold amount applicable under paragraph (1) of
section 1860E-41(a) (including application of paragraph
(4) of such section)'' before the period at the end;
and
(B) in subclause (II), by inserting ``or, for a
year after 2015, the applicable percentage that would
be determined under paragraph (2) of section 1860E-
41(a) (including application of paragraph (4) of such
section) if the table specified in subparagraph (G)
were substituted for the table specified in the table
under such paragraph (2))'' before the period at the
end; and
(4) by adding at the end the following new subparagraphs:
``(G) Table.--For purposes of subparagraph
(B)(i)(I), the table specified in this subparagraph is
as follows:
------------------------------------------------------------------------
``Initial Income Final Income Level
Level within Tier within Tier for Initial Final
for Individual (or Individual (or Premium Premium
Couple) Couple) Percentage Percentage
------------------------------------------------------------------------
$50,000 ($100,000) $85,000 ($150,000) 25 percent 35 percent
$85,001 ($150,001) $130,000 ($214,000) 35 percent 50 percent
$130,001 ($214,001) $190,000 ($300,000) 50 percent 80 percent
$190,001 ($300,001) No Limi80 percent 80 percent.
------------------------------------------------------------------------
``(H) Transition for certain seniors.--In the case
of individuals and couples with an income level that is
below the minimum level for which section 1839(i) (as
in effect as of the date of enactment of this
subparagraph) would otherwise apply before application
of the amendments made by section 106(b) of the Save
and Strengthen Medicare Act of 2012, the monthly
adjustment amount to be applied under subparagraph (B)
for such an individual for a month in a fiscal year
shall be the transition percentage specified in section
1860E-41(a)(3)(B) for such fiscal year of the monthly
adjustment amount otherwise specified under such
subparagraph.''.
SEC. 107. MEDICARE CHOICES COMMISSION; GENERAL PROVISIONS; EFFECTIVE
DATE.
Part E of title XVIII of the Social Security Act, as inserted by
section 101(a)(2) and as previously amended, is further amended by
adding at the end the following new subpart:
``Subpart 5--Medicare Choices Commission
``SEC. 1860E-51. MEDICARE CHOICES COMMISSION.
``(a) Establishment.--Subject to subsection (d), there is
established as an independent agency of the United States a Medicare
Commission (in this part referred to as the `Medicare Choices
Commission').
``(b) Membership.--
``(1) Number and appointment.--The Medicare Choices
Commission shall be composed of 7 members appointed by the
President, by and with the advice and consent of the Senate.
``(2) Deadline for initial appointment.--The initial
members of the Commission shall be nominated for appointment by
not later than 6 months after the date of enactment of this
title.
``(3) Terms.--
``(A) In general.--The terms of members of the
Commission shall be for 7 years, except that of the
members first appointed--
``(i) 3 shall be appointed for terms of 3
years;
``(ii) 2 shall be appointed for terms of 5
years; and
``(iii) 2 shall be appointed for terms of 7
years.
``(B) Vacancies.--Any member appointed to fill a
vacancy occurring before the expiration of the term for
which the member's predecessor was appointed shall be
appointed only for the remainder of that term. A member
may serve after the expiration of that member's term
until a successor has taken office.
``(C) Limitation on number of terms.--Any person
appointed as a member of the Commission shall not be
eligible for reappointment to the Commission after
having served 2 terms.
``(4) Chairperson and other officers.--The Commission shall
elect a chairperson and such officers as the Commission
determines appropriate.
``(c) Operation of the Board.--
``(1) Meetings.--The Commission shall meet at the call of
its chairperson or a majority of its members.
``(2) Quorum.--A quorum shall consist of 4 members of the
Commission, except that the Commission may establish a lesser
quorum to conduct a hearing under section 2243(a).
``(d) Assuring Timely Implementation of Commission.--If, by not
later than one year after the date of the enactment of this subpart,
the Senate has not consented to a quorum of initial members of the
Commission under subsection (b), the duties and powers of the
Commission under this part shall be carried out by the Office of the
Actuary of the Centers for Medicare & Medicaid Services.
``SEC. 1860E-52. DUTIES OF THE COMMISSION.
``(a) In General.--Except as otherwise provided in this title and
effective with respect to benefits furnished on or after January 1,
2015, the Medicare Choices Commission shall--
``(1) coordinate determinations of beneficiary eligibility
and enrollment under title XVIII with the Administrator of
Social Security;
``(2) oversee and administer the competitive bidding under
subpart 3;
``(3) oversee and administer the provisions of part C;
``(4) oversee and administer the provisions of part D;
``(5) distribute funds in appropriate part from the Federal
Hospital Insurance Trust Fund under section 1817 and the
Federal Supplementary Medical Insurance Trust Fund under
section 1841;
``(6) oversee and enforce the provisions of section 1851(g)
(relating to guaranteed issue and renewal), as applied through
this part, including to ensure a Medicare Advantage
organization offering an MA-PD plan does not impose under such
plan an exclusion of benefits based on a pre-existing
condition;
``(7) disseminate to Medicare enrollees information with
respect to benefits and limitations on payment under Medicare
fee-for-service and Medicare Advantage plans, including a
comparative analysis of Medicare plans and the quality of such
plans in the area in which the Medicare beneficiary resides;
``(8) establish a Medicare enrollee education program to
provide timely, readable, accurate, and understandable
information to Medicare enrollees regarding Medicare fee-for-
service and Medicare Advantage plan options;
``(9) coordinate and maintain the Medicare.gov Internet Web
site; and
``(10) conduct public outreach and education efforts in
accordance with section 301 of the Save and Strengthen Medicare
Act of 2012.
``(b) Relation to Medicare Fee-for-Service.--The Commission shall
not be responsible for the operation of Medicare fee-for-service, but
shall have oversight authority over Medicare fee-for-service in a
similar manner to that provided with respect to Medicare Advantage
plans.
``(c) Transition Provisions.--The Secretary and the Commission
shall cooperate to establish an appropriate transition of
responsibility for the administration of title XVIII and other related
laws, from the Secretary to the Commission as is appropriate to carry
out the purposes of this part and as is consistent with the duties of
the Commission described in subsection (a). Insofar as a responsibility
is transferred to the Commission under this subsection, any reference
to the Secretary or the Centers of Medicare & Medicaid Services in
title XVIII or other provision of law with respect to such
responsibility is deemed to be a reference to the Commission.
``SEC. 1860E-53. POWERS OF COMMISSION.
``(a) In General.--The Medicare Choices Commission may, for the
purpose of carrying out its duties, promulgate regulations, hold
hearings, sit and act at times and places, take testimony, and receive
evidence as the Commission considers appropriate.
``(b) Contract Authority.--The Commission may contract with, and
compensate, government and private agencies or persons for items and
services, without regard to section 3709 of the Revised Statutes (41
U.S.C. 5).
``(c) Commission Authority To Permit Flexibility in Requirements.--
In promulgating regulations under subsection (a) to carry out the
requirements of part C of title XVIII, the Commission may modify the
regulations previously promulgated by the Secretary to carry out such
requirements (other than those relating to benefits or beneficiary
protections) as may be appropriate to better meet the needs of Medicare
enrollees and promote fair and open competition among Medicare fee-for-
service and Medicare Advantage plans.
``(d) Overseeing Solvency of Medicare Fee-for-Service.--The
Commission shall monitor and oversee the financial solvency of Medicare
fee-for-service in a manner similar to the manner in which State
insurance commissioners monitor and oversee the solvency of health
insurance issuers in the States. The Commission shall include in its
periodic reports to Congress an analysis of the solvency of Medicare
fee-for-service.
``SEC. 1860E-54. COMMISSION PERSONNEL MATTERS.
``(a) Members.--
``(1) Compensation.--Members of the Medicare Choices
Commission shall devote their entire time to the business of
the Commission, and each member shall be compensated at a rate
equal to the per diem equivalent of the rate provided for level
II of the Executive Schedule under section 5315 of title 5,
United States Code.
``(2) Travel expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of service for the Commission.
``(3) Removal.--The President may remove a member of the
Commission only for neglect of duty or malfeasance in office.
``(b) Staff and Support Services.--
``(1) Executive director.--The chairperson shall appoint an
executive director of the Commission who shall be paid at a
rate specified by the Commission.
``(2) Staff.--With the approval of the Commission, the
executive director may appoint such personnel as the executive
director considers appropriate.
``(3) Inapplicability of civil service laws.--The staff of
the Commission shall be appointed without regard to the
provisions of title 5, United States Code, governing
appointments in the competitive service, and shall be paid
without regard to the provisions of chapter 51 and subchapter
III of chapter 53 of such title (relating to classification and
General Schedule pay rates).
``(4) Experts and consultants.--With the approval of the
Commission, the executive director may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code.
``(c) Transfer of Personnel, Assets, etc.--For purposes of the
Commission carrying out its duties, the Secretary and the Commission
may provide for the transfer to the Commission of such civil service
personnel employed by the Department of Health and Human Services, and
such resources and assets of the Department used in carrying out title
XVIII, as the Commission requires.
``SEC. 1860E-55. REPORTS; COMMUNICATIONS WITH CONGRESS.
``(a) Report on Medicare Program.--Not less frequently than
annually, the Medicare Choices Commission shall submit to Congress such
reports describing the Medicare program under title XVIII as the
Commission determines appropriate.
``(b) Maintaining Independence of Commission in Communications With
Congress.--The Commission may directly submit to Congress reports,
legislative recommendations, testimony, or comments on legislation. No
officer or agency of the United States may require the Commission to
submit to any officer or agency of the United States for approval,
comments, or review, prior to the submission to Congress of such
reports, recommendations, testimony, or comments.
``SEC. 1860E-56. FUNDING OF THE COMMISSION.
``There is authorized to be appropriated to the Medicare Choices
Commission (in appropriate part from the Federal Hospital Insurance
Trust Fund under section 1817 and the Federal Supplementary Medical
Insurance Trust Fund under section 1841) such sums as are necessary for
the Commission to carry out its duties for each fiscal year beginning
with fiscal year 2014.
``Subpart 6--General Provisions
``SEC. 1860E-61. APPLICABILITY; DEFINITIONS.
``(a) In General.--The provisions of this Act are superseded to the
extent inconsistent with the provisions of this part.
``(b) Terminology.--For purposes of this part:
``(1) Medicare enrollee.--
``(A) In general.--The term `Medicare enrollee'
means--
``(i) an individual entitled to (or
enrolled for benefits) under part A and
enrolled under part B; and
``(ii) except as otherwise specified, an
individual described in section 1860E-11(a)(3).
``(B) Treatment.--Any reference in this Act (or any
other Act) in effect before the date of the enactment
of this part, to an individual entitled to benefits
under part A or enrolled under part B shall be deemed a
reference to a Medicare enrollee.
``(2) Medicare fee-for-service.--The term `Medicare fee-
for-service' means the original Medicare fee-for-service
program under parts A and B, as modified by this part, and does
not include part C or part D.
``(3) Medicare fee-for-service enrollee.--The term
`Medicare fee-for-service enrollee' means a Medicare enrollee
who is not enrolled under a Medicare Advantage plan under part
C.
``SEC. 1860E-62. GENERAL EFFECTIVE DATE.
``Except as otherwise specified, the provisions of this part shall
apply to items and services furnished on or after January 1, 2016, and
to plan years beginning on or after such date (referred to in this
title as the `general effective date').''.
TITLE II--HEALTH INDIVIDUAL RETIREMENT ACCOUNTS
Subtitle A--Establishment of Accounts
SEC. 201. DEFINITIONS.
For purposes of this subtitle--
(1) Health individual retirement account.--The term
``health individual retirement account'' means an account
established under section 203.
(2) Account holder.--The term ``account holder'' means any
individual for whom an account is established under section
203.
(3) HIRA fund.--The term ``HIRA Fund'' means the Health
Individual Retirement Account Fund established under section
202.
SEC. 202. HEALTH INDIVIDUAL RETIREMENT ACCOUNT FUND.
(a) Establishment of Fund.--
(1) Establishment.--There is established in the Treasury of
the United States a trust fund to be known as the Health
Individual Retirement Account Fund.
(2) Amounts in fund.--The HIRA Fund shall consist of all
amounts contributed to the HIRA Fund under section 204,
increased by the total net earnings from investments of sums in
the HIRA Fund attributable to such contributed amounts, and
reduced by the total net losses from investments of such sums.
(3) Trustees.--The Commissioner of Social Security shall
serve as trustee of the HIRA Fund.
(4) Budget authority; appropriation.--This subtitle
constitutes budget authority in advance of appropriations Acts
and represents the obligation of the Commissioner to provide
for the payment of amounts provided under this subtitle. The
amounts held in the HIRA Fund are appropriated and shall remain
available without fiscal year limitation.
(b) Availability.--The sums in the HIRA Fund are appropriated and
shall remain available without fiscal year limitation--
(1) to invest funds in the HIRA Fund under section 205;
(2) to make distributions in accordance with section 206;
and
(3) to pay the administrative expenses of the Board in
accordance with subsection (d).
(c) Limitations on Use of Funds.--
(1) In general.--Sums in the HIRA Fund credited to a
account holder's health individual retirement account under
section 205(a)(1)(2) may not be used for, or diverted to,
purposes other than for the exclusive benefit of the account
holder or the account holder's beneficiaries under this
subtitle.
(2) Assignments.--Sums in the HIRA Fund may not be assigned
or alienated and are not subject to execution, levy,
attachment, garnishment, or other legal process.
(d) Payment of Administrative Expenses.--Administrative expenses
incurred to carry out this subtitle shall be paid out of net earnings
in the HIRA Fund in conjunction with the allocation of investment
earnings and losses under section 203(d).
(e) Limitation.--The sums in the HIRA Fund shall not be
appropriated for any purpose other than the purposes specified in this
part and may not be used for any other purpose.
SEC. 203. ESTABLISHMENT OF HEALTH INDIVIDUAL RETIREMENT ACCOUNTS.
(a) Establishment of Publicly Administered System of Health
Individual Retirement Accounts.--The Commissioner shall establish a
health individual account for each individual who--
(1) receives wages in any calendar year after December 31,
2015, subject to the contribution requirement of section
3101(a) of the Internal Revenue Code of 1986;
(2) derives self-employment income for a taxable year
beginning after December 31, 2015, subject to the contribution
requirement of section 1401(a) of such Code; or
(3) is a Medicare enrollee (as defined in section 1860E-
61(b) of the Social Security Act).
(b) Management of Accounts.--Such account shall be the means by
which amounts contributed to, and held in, the HIRA Fund under section
204 are credited to the account holder, under procedures which shall be
established by the Commissioner by regulation. Each account shall be
identified to the account holder by means of the account holder's
social security account number. The Commissioner shall take such steps
as are necessary to protect account holders' social security numbers,
including not using complete social security numbers on any statements
or identification or payment cards.
(c) Account Balance.--The balance in an account holder's account at
any time is the excess of--
(1) all deposits in the HIRA Fund credited to such account
holder's health individual retirement account, subject to such
increases and reductions as may result from allocations made to
and reductions made in the account pursuant to subsection (d);
over
(2) amounts paid out of the HIRA Fund in connection with
amounts credited to such account holder's account.
(d) Allocation of Earnings and Losses.--Pursuant to regulations
which shall be prescribed by the Commissioner, the Commissioner shall
allocate to each health individual retirement account an amount equal
to the net earnings and net losses from each investment of sums in the
HIRA Fund which are attributable to sums credited to such account
reduced by an appropriate share of the administrative expenses paid out
of the net earnings, as determined by the Commissioner.
SEC. 204. TRANSFER OF HIRA CONTRIBUTIONS TO HIRA FUND.
(a) In General.--There is hereby appropriated to the HIRA Fund, out
of moneys in the Treasury not otherwise appropriated, amounts
equivalent to 100 percent of amounts contributed under sections 3101(d)
and 1401(d) of the Internal Revenue Code of 1986. The Secretary of the
Treasury shall from time to time transfer such amounts from the general
fund in the Treasury to the HIRA Fund.
(b) Contributions From HHS.--The Commissioner shall accept any
contributions with respect to an account holder's account, including
contributions from the Secretary of Health and Human Services under
sections 1860E-25 and 1860E-41(b)(3) of the Social Security Act and any
contribution from a State under section 1944(b) of such Act.
(c) Coordination With Social Security Trust Funds.--The amounts
contributed under sections 3101(d) and 1401(d) of such Code shall not
be taken into account in determining the amounts appropriated and
transferred under section 201 of the Social Security Act.
SEC. 205. OPERATION OF HIRA FUND.
(a) Separate Crediting to Health Individual Retirement Accounts.--
(1) In general.--Subject to this subsection, the
Commissioner shall provide for prompt, separate crediting of
the amounts deposited in the HIRA Fund to each account holder's
health individual savings account to the extent such amount
consists of contributions made to the HIRA Fund under section
204 with respect to such account holder, together with any
increases or decreases therein so as to reflect the net returns
and losses from investment thereof while held in the Fund.
(2) Use of funds.--The amounts held in the Fund are
appropriated and shall remain available without fiscal year
limitation--
(A) to be held for investment under subsection (b),
and
(B) to pay the administrative expenses related to
the HIRA Fund.
(b) Investment Guidelines.--
(1) In general.--For purposes of investment of amounts
credited to each health individual retirement account, the
Commissioner shall provide by regulation for investment options
similar to investment options available under the Thrift
Savings Fund under section 8438 of title 5, United States Code.
(2) Elections among investment options.--Pursuant to any
individual's election filed in accordance with regulations of
the Commissioner, the Commissioner shall, in accordance with
such regulations, provide for disinvestment and reinvestment of
amounts credited to the account holder's health individual
retirement account and held in the HIRA Fund under any of the
investment options described in paragraph (1).
(3) Special rule for investing certain amounts contributed
from hhs.--Amounts contributed to any account by the Secretary
of Health and Human Services under section 1860E-25 of the
Social Security Act may be invested only in the investment
option established under paragraph (1) that is the equivalent
to the Government Securities Investment Fund (as defined under
section 8438(a)(4) of title 5, United States Code).
(c) Annual Description of Investment Options and Disclosure of
Administrative Costs.--The Commissioner shall provide annually to each
account holder--
(1) a description of the investment options available with
respect to amounts held in the HIRA Fund and the procedures for
selecting such options; and
(2) a disclosure of the rate of administrative costs
chargeable with respect to each investment option.
Descriptions and disclosures required under this subsection shall be
written in a manner calculated to be understood by the average account
holder.
(d) Account Information.--The Commissioner shall create an online
portal that enables account holders to view their account information,
modify investment allocations, and request quarterly paper account
statements.
(e) Treatment of Amounts Held in HIRA Fund.--Subject to this
subtitle and to the extent provided in section 1860E-25(c)(2) of the
Social Security Act with respect to amounts contributed under such
section, amounts deposited into, and held and accounted for in, the
HIRA Fund with respect to any account holder shall be treated as
property of such account holder, held in trust for such account holder
in the Fund.
SEC. 206. HEALTH INDIVIDUAL RETIREMENT ACCOUNT DISTRIBUTIONS.
(a) In General.--The Commissioner may distribute amounts from an
account holder's health individual retirement account only--
(1) for qualified medical expenses (as defined in section
530A(d)(1) of the Internal Revenue Code of 1986);
(2) to an individual's spouse or former spouse under a
divorce or separation instrument described in subparagraph (A)
of section 71(b)(2) of such Code;
(3) by a transfer at the death of the account holder as
provided under subsection (b); or
(4) as provided in section 1860E-25(c)(2) of the Social
Security Act.
(b) Special Accounting Rule for Certain Amounts.--Each calendar
year, any distributions from an account shall be treated as--
(1) first from any amounts contributed to the account for
such calendar year by the Secretary of Health and Human
Services under section 1860E-25 of the Social Security Act, and
(2) then from all other amounts credited to the account.
(c) Treatment at Death.--If the account holder dies before all
amounts which are held in the HIRA Fund which are credited to the
health individual retirement account of the individual are otherwise
distributed in accordance with this section, such amounts shall be
distributed, under regulations which shall be prescribed by the
Commissioner--
(1) in any case in which one or more beneficiaries have
been designated in advance, to such beneficiaries in accordance
with such designation as provided in such regulations; and
(2) in the case of any amount not distributed as described
in paragraph (1), to such individual's estate.
Subtitle B--Tax Treatment
SEC. 211. TAX TREATMENT OF ACCOUNTS.
(a) In General.--Subchapter F of chapter 1 of the Internal Revenue
Code of 1986 (relating to exempt organizations) is amended by adding at
the end the following new part:
``PART IX--HEALTH INDIVIDUAL RETIREMENT ACCOUNT PROGRAM
``Sec. 530A. Health Individual Retirement Account Program.
``SEC. 530A. HEALTH INDIVIDUAL RETIREMENT ACCOUNT PROGRAM.
``(a) Tax Treatment of Accounts.--The Health Individual Retirement
Account Fund is exempt from taxation under this subtitle.
``(b) Treatment of Distributions.--
``(1) Exclusion of amounts used for qualified medical
expenses.--Any amount paid or distributed out of a health
individual retirement account which is used exclusively to pay
qualified medical expenses of the account beneficiary shall not
be includible in gross income.
``(2) Inclusion of amounts not used for qualified medical
expenses.--Any amount paid or distributed out of a health
individual retirement account which is used other than as
described in paragraph (1) shall be included in the gross
income of the account beneficiary.
``(3) Additional tax on distributions not used for
qualified medical expenses.--The tax imposed by this chapter on
the account beneficiary for any taxable year in which there is
a payment or distribution from a health savings account of such
beneficiary which is includible in gross income under paragraph
(2) shall be increased by 10 percent of the amount which is so
includible.
``(4) Coordination with medical expense deduction.--For
purposes of determining the amount of the deduction under
section 213, any payment or distribution out of a health
individual retirement account for qualified medical expenses
shall not be treated as an expense paid for medical care.
``(5) Transfer of account incident to divorce.--The
transfer of an individual's interest in a health individual
retirement account to an individual's spouse or former spouse
under a divorce or separation instrument described in
subparagraph (A) of section 71(b)(2) shall not be considered a
taxable transfer made by such individual notwithstanding any
other provision of this subtitle, and such interest shall,
after such transfer, be treated as a health individual
retirement account with respect to which such spouse is the
account beneficiary.
``(6) Treatment after death of account beneficiary.--
``(A) In general.--The transfer of an account
beneficiary's interest in a health individual
retirement account to another individual by reason of
being the designated beneficiary of such account at the
death of the account beneficiary shall not be
considered a taxable transfer made by such individual
notwithstanding any other provision of this title.
``(B) Other cases.--In the case of any other
transfer or acquisition of account beneficiary's
interest at the death of the account beneficiary, an
amount equal to the fair market value of the assets in
such account as of the date of death shall be
includible in such beneficiary's gross income for the
last taxable year of such beneficiary.
``(c) Estate Tax Treatment.--No amount shall be includible in the
gross estate of any individual for purposes of chapter 11 by reason of
an interest in a health individual retirement account of the
individual.
``(d) Definitions.--For purposes of this section--
``(1) Qualified medical expenses.--The term `qualified
medical expenses' means, with respect to an account
beneficiary, amounts paid for medical care (as defined in
section 213(d)) for such individual, the individual's spouse,
and any dependent (as defined in section 152, determined
without regard to subsections (b)(1), (b)(2), and (d)(1)(B)
thereof) of the individual, but only to the extent such amounts
are not compensated for by insurance or otherwise and only if
the individual, spouse, or dependent with respect to whom the
amount is paid is entitled, at the time the amount is paid, to
a monthly benefit under title II of the Social Security Act or
a tier 1 railroad retirement benefit.
``(2) Abortion and euthanasia excluded.--
``(A) In general.--Such term shall not include any
amount paid for an abortion or for the purposeful
causing of, or the purposeful assisting in causing, the
death of any individual, such as by assisted suicide,
euthanasia, or mercy killing.
``(B) Exceptions.--Subparagraph (A) shall not apply
to--
``(i) an abortion--
``(I) in the case of a pregnancy
that is the result of an act of rape or
incest, or
``(II) in the case where a woman
suffers from a physical disorder,
physical injury, or physical illness
that would, as certified by a
physician, place the woman in danger of
death unless an abortion is performed,
including a life-endangering physical
condition caused by or arising from the
pregnancy, and
``(ii) the treatment of any infection,
injury, disease, or disorder that has been
caused by or exacerbated by the performance of
an abortion.
``(3) Account beneficiary.--The term `account beneficiary'
means the account holder (as defined in section 201 of the Save
and Strengthen Medicare Act of 2012) on whose behalf the health
individual retirement account is held.
``(4) Health individual retirement account.--The term
`health individual retirement account' means an account
established under section 203(b) of the Save and Strengthen
Medicare Act of 2012.
``(5) Health individual retirement account fund.--The term
`Health Individual Retirement Account Fund' means the Fund
established under section 202 of the Save and Strengthen
Medicare Act of 2012.''.
(b) Clerical Amendment.--The table of parts for subchapter F of
chapter 1 of such Code is amended by adding at the end the following
new item:
``Part IX. Health Individual Retirement Account Program''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2015.
SEC. 212. HIRA CONTRIBUTIONS.
(a) Employment.--
(1) In general.--Section 3101 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(d) Health Individual Retirement Accounts.--
``(1) In general.--In addition to the taxes imposed by
subsections (a) and (b), there shall be deducted and withheld
from the income of every individual an amount equal to the
applicable percentage of wages (as defined in section 3121(a))
received by him with respect to employment during any taxable
year.
``(2) Limitation.--The amount deducted and withheld under
paragraph (1) shall not exceed $2,500 ($5,000 in the case of a
married couple filing jointly) for any taxable year.
``(3) Applicable percentage.--For purposes of this
subsection, the applicable percentage shall be 2 percent, or
such other percentage (including zero) as the individual elects
in such form and manner as the Secretary shall prescribe.
``(4) Inflation adjustment.--
``(A) In general.--In the case of any taxable year
beginning after 2016, the dollar amounts under the
third sentence of subsection (a) shall be increased by
an amount equal to--
``(i) such dollar amount, multiplied by
``(ii) the cost-of-living adjustment
determined under section 1(f)(3) for the
calendar year in which the taxable year begins,
determined by substituting `2015' for `1992' in
subparagraph (B) thereof.
``(B) Rounding.--If any amount as adjusted under
subparagraph (A) is not a multiple of $100, such amount
shall be rounded to the nearest multiple of $100.''.
(2) Contributions pre-tax.--Subsection (a) of section 3401
of such Code is amended by adding at the end the following new
sentence: ``Such term shall not include so much of any amounts
deducted and withheld from such remuneration under section
3101(d) for any taxable year as does not exceed $2,500 ($5,000
in the case of a married couple filing jointly).''.
(b) Self-Employment.--
(1) In general.--Section 1401 of such Code is amended by
adding at the end the following new subsection:
``(d) Health Individual Retirement Accounts.--
``(1) In general.--In addition to the taxes imposed by the
preceding subsections, in the case of an individual with self-
employment income for the taxable year, such individual shall
contribute for such taxable year an amount equal to the
applicable percentage of such self employment income.
``(2) Applicable percentage.--For purposes of this
subsection, the applicable percentage shall be 2 percent, or
such other percentage (including zero) as the individual
elects, in such form and manner as the Secretary shall
prescribe.
``(3) Inflation adjustment.--
``(A) In general.--In the case of any taxable year
beginning after 2016, the dollar amounts under
subsection (a)(18) shall be increased by an amount
equal to--
``(i) such dollar amount, multiplied by
``(ii) the cost-of-living adjustment
determined under section 1(f)(3) for the
calendar year in which the taxable year begins,
determined by substituting `2015' for `1992' in
subparagraph (B) thereof.
``(B) Rounding.--If any amount as adjusted under
subparagraph (A) is not a multiple of $100, such amount
shall be rounded to the nearest multiple of $100.''.
(2) Deduction for self-employment amounts contributed to
hira.--Subsection (a) of section 1401 of such Code is amended
by striking ``and'' at the end of paragraph (16), but striking
the period at the end of paragraph (17) and inserting ``;
and'', and by inserting after paragraph (17) the following new
paragraph:
``(18) there shall be excluded so much of any amounts
contributed by the individual for such taxable year under
1401(d) as does not exceed $2,500 ($5,000 in the case of a
married couple filing jointly) reduced (but not below zero) by
the amount of contributions for the taxable year with respect
to the individual under section 3101.''.
(c) Procedure for Reconciliation.--The Secretary of the Treasury
shall, in consultation with the Commission of Social Security,
prescribe such regulations and guidance as are necessary to--
(1) allow the taxpayer to make additional contributions in
any case in which contributions for the taxable year are less
than the applicable limitations for the taxable year under
sections 3101(d) and 1401(d) with respect to the taxpayer, and
(2) provide for adding to gross income of the taxpayer for
the taxable year amounts equal to any contributions in excess
of such applicable limitations.
(d) Election Coordination.--The Secretary of the Treasury and the
Commissioner of Social Security shall consult and cooperate in
prescribing the time, form, and manner of elections under sections
3101(d) and 1401(d) of the Internal Revenue Code of 1986 and section
203(a) this Act so as to reduce unnecessary paperwork and duplication.
SEC. 213. CONTRIBUTIONS ELIGIBLE FOR SAVER'S CREDIT.
(a) In General.--Paragraph (1) of section 25B(d) of the Internal
Revenue Code of 1986 is amended by striking ``and'' at the end of
subparagraph (B), by striking the period at the end of subparagraph (C)
and inserting ``, and'', and by adding at the end the following new
subparagraph:
``(D) the amount of contributions with respect to
the individual pursuant to sections 3101(d) and 1401(d)
(reduced or increased, as the case may be, to account
for any reconciliation under section 212(d) of the Save
and Strengthen Medicare Act of 2012).''.
(b) Portion of Credit Made Refundable.--Section 25B of such Code is
amended by adding at the end the following new subsection:
``(h) Portion of Credit Refundable.--
``(1) In general.--The aggregate credits allowed to a
taxpayer under subpart C shall be increased by the lesser of--
``(A) the credit which would be allowed under this
section without regard to this subsection and the
limitation under section 26(a)(2) or subsection (g), as
the case may be, or
``(B) the amount by which the aggregate amount of
credits allowed by this subpart (determined without
regard to this subsection) would be increased if the
limitation imposed by section 26(a)(2) or subsection
(g), as the case may be, were increased by an amount
equal to the taxpayer's hospital insurance taxes for
the taxable year.
The amount of the credit allowed under this subsection shall
not be treated as a credit allowed under this subpart and shall
reduce the amount of credit otherwise allowable under
subsection (a) without regard to section 26(a)(2) or subsection
(g), as the case may be.
``(2) Hospital insurance tax.--
``(A) In general.--The term `hospital insurance
taxes' means, with respect to any taxpayer for any
taxable year--
``(i) the amount of the taxes imposed by
sections 3101(b) and 3201(a) (to the extent
attributable to the rate in effect under
section 3101(b)) on amounts received by the
taxpayer during the calendar year in which the
taxable year begins,
``(ii) the amount of the taxes imposed by
sections 3111(b) and 3221(a) (to the extent
attributable to the rate in effect under
section 3111(b)) on amounts paid by the
employer to the taxpayer with respect to
employment during the calendar year in which
the taxable year begins,
``(iii) the amount of the taxes imposed by
section 1401(b) on the self-employment income
of the taxpayer for the taxable year, and
``(iv) the amount of the taxes imposed by
section 3211(a) (to the extent attributable to
the rate in effect under sections 3101(b) and
3111(b)) on amounts received by the taxpayer
during the calendar year in which the taxable
year begins.
``(B) Coordination with special refund of tax.--The
term `hospital insurance taxes' shall not include any
taxes to the extent the taxpayer is entitled to a
special refund of such taxes under section 6413(c).
``(C) Special rule.--Any amounts paid pursuant to
an agreement under section 3121(l) (relating to
agreements entered into by American employers with
respect to foreign affiliates) which are equivalent to
the taxes referred to in subparagraph (A)(i) shall be
treated as taxes referred to in such subparagraph.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2015.
SEC. 214. EXCLUSION OF CERTAIN HIRA TRANSFERS.
(a) In General.--Part II of subchapter B of chapter 1 of the
Internal Revenue Code of 1986 is amended by inserting before section
140 the following new section:
``SEC. 139F. GOVERNMENT HIRA SUBSIDIES.
``Gross income shall not include any payment to the health
individual retirement account (as defined in section 530A(d)(3)) of an
individual by the Secretary of Health and Human Services under part E
of title XVIII of the Social Security Act.''.
Subtitle C--Other Tax Provisions
SEC. 221. HEALTH SAVINGS ACCOUNTS AVAILABLE TO INDIVIDUALS ELIGIBLE FOR
MEDICARE.
(a) In General.--Subsection (b) of section 223 of the Internal
Revenue Code of 1986 is amended by striking paragraph (7) and by
redesignating paragraph (8) as paragraph (7).
(b) Elimination of Medicare Eligibility Exception to Nonqualified
Withdrawal Penalty.--Paragraph (4) of section 223(f) of such Code is
amended by striking subparagraph (C).
(c) Conforming Amendment.--Subparagraph (S) of section 26(b)(2) of
such Code is amended by striking ``223(b)(8)(B)(i)(II)'' and inserting
``223(b)(7)(B)(i)(II)''.
(d) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2015.
SEC. 222. REDUCTION IN MEDICARE PORTION OF PAYROLL TAX TO INCENTIVIZE
LATE RETIREMENT.
(a) Employees.--Section 3101 of the Internal Revenue Code of 1986,
as amended by this Act, is amended by adding at the end the following
new subsection:
``(e) Exception for Individuals 65 and Older.--
``(1) In general.--In the case of an individual who has
attained the age of 65, the rate of tax otherwise in effect
under subsection (b)--
``(A) shall be \1/2\ such rate, if such individual
has not attained the applicable age, and
``(B) shall be zero, if such individual has
attainted the applicable age.
``(2) Applicable age.--For purposes of this subsection--
``(A) In general.--Except as provided in
subparagraph (B), the applicable age shall be 67.
``(B) Preferred medicare age.--In the case of wages
received after December 31, 2025, the applicable age
shall be the preferred Medicare age (within the meaning
of section 216(m)(2)(B) of the Social Security Act).''.
(b) Employers.--Section 3111 of such Code is amended by adding at
the end the following new subsection:
``(d) Exception for Individuals 65 and Older.--In the case of an
individual who has attained the age of 65, the rate of tax otherwise in
effect under subsection (b)--
``(1) shall be \1/2\ such rate, if such individual has not
attained the applicable age (within the meaning of section
3101(e)(2)), and
``(2) shall be zero, if such individual has attained such
age.''.
(c) Self-Employment.--Section 1401 of such Code, as amended by this
Act, is amended by adding at the end the following new subsection:
``(e) Exception for Individuals 65 and Older.--
``(1) In general.--In the case of an individual who has
attained the age of 65, the rate of tax otherwise in effect
under subsection (b) for the taxable year--
``(A) shall be \1/2\ such rate, if such individual
has not attained the applicable age before the end of
such taxable year, and
``(B) shall be zero, if such individual has
attained such age before the end of such taxable year.
``(2) Applicable age.--For purposes of this subsection--
``(A) In general.--Except as provided in
subparagraph (B), the applicable age shall be 67.
``(B) Preferred medicare age.--In the case of
taxable years beginning after December 31, 2025, the
applicable age shall be the preferred Medicare age
(within the meaning of section 216(m)(2)(B) of the
Social Security Act).''.
(d) Effective Dates.--
(1) Subsections (a) and (b).--The amendments made by
subsections (a) and (b) shall apply to wages paid after
December 31, 2015.
(2) Subsection (c).--The amendments made by subsection (c)
shall apply to remuneration paid in taxable years ending after
December 31, 2015.
SEC. 223. 15-PERCENT EXCISE TAX ON EMPLOYER-SPONSORED MEDICARE
SUPPLEMENTAL COVERAGE.
(a) In General.--Chapter 43 of the Internal Revenue Code of 1986 is
amended by adding at the end the following new section:
``SEC. 4980J. EMPLOYER-SPONSORED MEDICARE SUPPLEMENTAL COVERAGE.
``(a) Imposition of Tax.--In the case of any employee who--
``(1) becomes a Medicare enrollee (as defined in section
1860E-61(b) of the Social Security Act) after December 31,
2015, and
``(2) is covered for any period during a calendar year
beginning after such date under applicable employer-sponsored
supplemental coverage,
there is hereby imposed a tax equal to 15 percent of the aggregate cost
(determined under rules similar to the rules of section 4980B(f)(4)) of
such coverage of the employee for such period.
``(b) Liability To Pay Tax.--The coverage provider (as defined in
section 4980I(c)(1)) shall pay the tax imposed by subsection (a).
``(c) Applicable Employer-Sponsored Supplemental Coverage.--For
purposes of this section--
``(1) In general.--The term `applicable employer-sponsored
supplemental coverage' means, with respect to any employee, any
first-dollar coverage made available by an employer to an
employee during the calendar year.
``(2) First-dollar insurance coverage.--The term `first-
dollar insurance coverage' means coverage for--
``(A) the amount of the unified deductible for the
calendar year under section 1860E-21(b) of the Social
Security Act, and
``(B) the first $500 of coinsurance for the
calendar year under section 1860E-22 of such Act.
``(3) Coverage includes employee paid portion.--Coverage
shall be treated as applicable employer-sponsored supplemental
coverage without regard to whether the employer or employee
pays for the coverage.
``(4) Self-employed individual.--In the case of an
individual who is an employee within the meaning of section
401(c)(1), coverage under any group health plan providing
health insurance coverage shall be treated as applicable
employer-sponsored coverage if a deduction is allowable under
section 162(l) with respect to all or any portion of the cost
of the coverage.
``(5) Employee.--The term `employee' includes any former
employee, surviving spouse, or other primary insured adult.
``(6) Governmental plans included.--Applicable employer-
sponsored coverage shall include coverage under any group
health plan established and maintained primarily for its
civilian employees by the Government of the United States, by
the government of any State or political subdivision thereof,
or by any agency or instrumentality of any such government.
``(7) Not applicable to certain accounts.--The term `first-
dollar coverage' does not include coverage under a flexible
spending arrangement (as defined in section 106(c)(2)),
coverage under an arrangement under which the employer makes
contributions described in subsection (b) or (d) of section
106, a health reimbursement arrangement treated as employer
coverage under an accident or health plan for purposes of
section 106, or coverage under a health individual retirement
account (as defined in section 530A(d)(3)).
``(8) Denial of deduction.--For denial of deduction for the
tax imposed by this section, see section 275(a)(6).
``(d) Regulations.--The Secretary shall prescribe such regulations
as may be necessary to carry out this section.''.
(b) Clerical Amendment.--The table of sections for chapter 43 of
such Code is amended by adding at the end the following new item:
``Sec. 4980J. Employer-sponsored Medicare supplemental coverage.''.
(c) Effective Date.--The amendments made by this section shall
apply to periods after December 31, 2015.
TITLE III--OTHER HEALTH PROVISIONS
Subtitle A--Transparency, Outreach, and Education
SEC. 301. PUBLIC OUTREACH AND EDUCATION INITIATIVES.
Beginning not later than January 1, 2015, the Medicare Choices
Commission shall conduct public outreach and education efforts, through
a variety of media and forums, to provide information to Medicare
enrollees (as defined in section 1860E-51 of the Social Security Act),
providers of services and suppliers (as such terms are defined in
section 1861 of such Act), health insurance plans, and other
appropriate individuals and entities on the modifications made by the
provisions of, including amendments made by, this Act to Medicare under
title XVIII of the Social Security Act. Such efforts shall include at
least the following:
(1) Interactive Web sites for Medicare enrollees.
(2) Opportunities for Medicare enrollees to sign up for
informational emails from the Centers of Medicare & Medicaid
Services.
(3) Social media pages to provide basic facts to Medicare
enrollees and family members of such enrollees.
(4) National town hall meetings.
(5) Educational materials for hospitals, medical schools,
and other providers of services and suppliers.
(6) Resources for physicians, home nurses, and other
medical professionals to provide to patients.
(7) Coordination with a broad range of community partners,
including community centers, retirement centers, assisted
living communities, and faith-based organizations.
(8) Coordination with health plans.
SEC. 302. ANNUAL MEDICARE BENEFICIARY CONTRIBUTIONS AND BENEFITS
STATEMENTS.
(a) In General.--Part A of title XI of the Social Security Act is
amended by inserting after section 1143 (42 U.S.C. 1320b-13) the
following new section:
``SEC. 1143A. ANNUAL MEDICARE BENEFICIARY CONTRIBUTIONS AND BENEFITS
STATEMENTS.
``(a) Provision.--
``(1) In general.--Beginning not later than 2 years after
the date of the enactment of this section, the Medicare Choices
Commission established under section 1860E-51, in coordination
with the Commissioner of Social Security, shall provide a
statement described in subsection (b) (in this section referred
to as an `annual Medicare information statement') on an annual
basis to each eligible individual (as defined in subsection
(d)) for whom a current mailing address can be determined
through such methods as the Medicare Choices Commission
determines to be appropriate.
``(2) Coordination in single mailing with social security
account statements.--In order to avoid sending separate
statements under this section and section 1143 in the case of
an individual for whom a social security account statement is
provided under section 1143 and a separate annual Medicare
information statement would otherwise be provided under this
section, the Medicare Choices Commission shall coordinate with
the Commissioner of Social Security, whether through
transmittal of data or otherwise, in a manner so that the
annual Medicare information statement is included and sent with
such social security account statement.
``(3) Methodology.--
``(A) In general.--The Medicare Choices Commission,
in consultation with the Commissioner of Social
Security and the Secretary of the Treasury, shall
specify the methodology to be used in estimating
lifetime contributions and lifetime benefits with
respect to annual Medicare information statements. Such
methodology for computing the lifespan of an individual
shall be the same methodology used for purposes of the
social security account statement under section 1143.
``(B) Inclusion of description in statement.--The
Medicare Choices Commission shall include a brief
description of the key assumptions used in such
methodology in the annual Medicare information
statements.
``(4) Summary of medicare program.--Each annual Medicare
information statement shall include a summary of the Medicare
programs under title XVIII, including a summary description of
the status of the Federal Hospital Insurance Trust Fund under
section 1817 and the Federal Supplementary Medical Insurance
Trust Fund under section 1841, using information from the most
recent report of the Board of Trustees of such Fund. Such
summary shall also include a summary description of benefits
and enrollment options under parts C and D of such title, but
shall indicate that the information described in subsection (b)
does not include information related to contributions and
benefits under those parts.
``(b) Medicare Information Statement Described.--In addition to the
information described in paragraphs (3)(B) and (4) of subsection (a),
each annual Medicare information statement for an eligible individual
shall contain the following:
``(1) HI employee contributions.--The total contributions
described in section 1143(a)(2)(C) for the individual--
``(A) for the most recent year for which data are
available;
``(B) to the extent feasible, for previous periods
through the end of such year; and
``(C) as projected for the individual during the
individual's lifetime.
To the extent feasible, of such total contributions the portion
that is attributable to employer, employee, and self-employment
contributions.
``(2) Medicare benefits.--In the case of an eligible
individual--
``(A) an estimate of the actuarial value of the
expected benefits under such parts for the individual
during the individual's lifetime, including (but stated
separately) any benefits described in subparagraph (A);
and
``(B) if, for such most recent year, such
individual was a Medicare enrollee (as defined in
section 1860E-61(b)), the total value of such benefits
provided to the individual under such parts as of the
end of such year and, to the extent feasible, the total
value of such benefits for such individual for previous
periods through the end of such year.
``(3) Comparison.--An appropriate comparison of such
contributions with such benefits.
``(c) Records Retention.--The Medicare Choices Commission shall
provide for the indefinite retention of information that--
``(1) is described in subsection (b), including benefits
described in subsection (b)(2); and
``(2) the Medicare Choices Commission has not discarded as
of the date of the enactment of this section.
``(d) Eligible Individual Defined.--In this section, the term
`eligible individual' means an individual--
``(1) who has a social security account number;
``(2) who has attained age 25 or over; and
``(3) who is a Medicare enrollee (as defined in section
1860E-61(b)) or who, as of the end of the most recent year
referred to in subsection (b)(1)(A), has had any contributions
described in subsection (b)(1) made with respect to the
individual during such year or a previous year.''.
(b) Inclusion of Social Security Account Statement for Those
Receiving Annual Medicare Information Statement.--Section 1143(a)(3) of
such Act (42 U.S.C. 1320b-13(a)(3)) is amended by adding at the end the
following:
``Such term includes an individual not described in the previous
sentence who is an eligible individual (as defined in subsection (d) of
section 1143A) for whom an annual Medicare information statement is
provided under such section.''.
Subtitle B--Miscellaneous
SEC. 311. REPEAL OF IPAB.
Effective as if included in the enactment of the Patient Protection
and Affordable Care Act (Public Law 111-148), the provisions of, and
amendments made by, sections 3403 and 10320 of such Act (other than
subsection (d) of section 1899A of the Social Security Act, as added
and amended by such sections) are repealed.
SEC. 312. REPEAL OF MEDICARE PAYMENT PRODUCTIVITY ADJUSTMENTS AFTER
2020.
The provisions of, and amendments made by, section 3401 of the
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by title X of such Act and section 1105 of the Health Care and
Education Reconciliation Act of 2010, insofar as such provisions (and
amendments) relate to a productivity adjustment, shall not apply with
respect to payments for items or services furnished during any year
after fiscal year 2020 or calendar year 2020, as applicable.
SEC. 313. GRADUATE MEDICAL EDUCATION GRANT PROGRAM.
(a) In General.--Title XVIII of the Social Security Act is amended
by adding at the end the following new section:
``SEC. 1899B. GRADUATE MEDICAL EDUCATION GRANT PROGRAM.
``(a) Establishment.--For cost reporting periods occurring during
fiscal year 2015 or a subsequent fiscal year, the Secretary shall carry
out a grant program under which the Secretary shall provide to each
hospital with an approved medical residency training program a grant in
accordance with the subsequent provisions of this section for costs of
such hospital for indirect and direct graduate medical education. Such
grants are instead of any payment under subsection (d)(5)(B) or (h) of
section 1886, payments for direct or indirect medical education costs
under title XIX, or section 340E of the Public Health Service Act for
such costs during such fiscal year.
``(b) Grant Amount.--Subject to subsections (c) and (d), the amount
of a grant to a hospital under subsection (a) for a cost reporting
period occurring during a fiscal year shall be equal to--
``(1) in the case of a subsection (d) hospital, the sum
of--
``(A) the payment amount the hospital would have
received under section 1886(h)(3), without application
of this section or the last sentence of section
1886(h)(1), for such cost reporting period; and
``(B) 72 percent of the additional payment amount
the hospital would have received under section
1886(d)(5)(B), without application of this section or
clause (xii) of such section 1886(d)(5)(B), for such
cost reporting period;
``(2) in the case of a hospital in a State, an amount
determined in accordance with a methodology specified by the
Secretary, which shall be in lieu of any amount that the
hospital otherwise would, without application of this section
or section 1903(i)(27), have received under the State plan
under title XIX for expenses of such hospital attributable to
the costs of direct and indirect graduate medical education;
and
``(3) in the case of a children's hospital (as defined in
subsection (g) of section 340E of the Public Health Service
Act), the sum of--
``(A) the amount that would be determined under
subsection (c) of such section for such hospital for
direct expenses associated with operating approved
graduate medical residency training programs for such
period, without application of this section or
subsection (h) of such section 340E; and
``(B) the amount that would be determined under
subsection (d) of such section for such hospital for
indirect expenses associated with the treatment of more
severely ill patients and the additional costs relating
to teaching residents in such programs for such period,
without application of this section or subsection (h)
of such section 340E.
``(c) Modification.--Subject to subsection (d)(1), the Secretary
may modify the grant amounts under subsection (b), including after
application of subsection (d)(2), based on factors such as the number
of residents of approved medical residency training programs, the
extent to which such programs provide for primary care training, the
curriculum of such programs, and the quality of care provided through
such programs.
``(d) Limitation.--
``(1) In general.--In no case may the aggregate amount of
grants awarded under subsection (a) for a fiscal year exceed
the amount made available under subsection (e)(1) for such
fiscal year for carrying out this section.
``(2) Pro-ration.--In the case of a fiscal year for which
the aggregate amount of grants under this section is projected
to exceed the amount made available under subsection (e)(1) for
such fiscal year for carrying out this section, the Secretary
shall reduce the amount of each grant awarded under this
section for such fiscal year by a prorated amount. Subject to
paragraph (1), the Secretary may modify such a prorated amount
in accordance with subsection (c).
``(e) Funding.--
``(1) In general.--For fiscal year 2015 and each subsequent
fiscal year, amounts in the Graduate Medical Education Trust
Fund under section 9512 of the Internal Revenue Code of 1986
shall be available, without further appropriation, to the
Secretary to carry out this section.
``(2) Transfers to gme trust fund.--There shall be provided
for the transfer to the Graduate Medical Education Trust Fund
by the Medicare Choices Commission in appropriate part from the
Federal Hospital Insurance Trust Fund under section 1817 and
the Federal Supplementary Medical Insurance Trust Fund under
section 1841 of the following:
``(A) For fiscal year 2015, an amount equal to the
aggregate amount that would have been calculated under
subsection (b)(1) for such fiscal year for all
hospitals with approved medical residency training
programs if the percentage described in paragraph
(1)(B) of such subsection were 82 percent.
``(B) For fiscal year 2016 and each subsequent
fiscal year, the amount transferred under this
paragraph for the previous fiscal year increased by the
annual percentage increase in the medical component of
the Consumer Price Index for All Urban Consumers (all
items; United States city average) as of June of the
previous fiscal year.
``(f) Definitions.--The terms `approved medical residency training
program' and `direct graduate medical education costs' have the
meanings given such terms under section 1886(h)(5).''.
(b) GME Trust Fund.--
(1) In general.--Subchapter A of chapter 98 of the Internal
Revenue Code of 1986 is amended by adding at the end the
following new section:
``SEC. 9512. GRADUATE MEDICAL EDUCATION TRUST FUND.
``(a) In General.--There is established in the Treasury of the
United States a trust fund to be known as the `Graduate Medical
Education Trust Fund' (hereafter in this section referred to as the
`GME Trust Fund'), consisting of such amounts as may be appropriated or
credited to such Trust Fund as provided in this section and section
9602(b).
``(b) Transfers to Fund.--
``(1) Trust fund transfers.--There shall be credited to the
GME Trust Fund for fiscal year 2015 and each subsequent fiscal
year--
``(A) the amounts transferred under section 1899B
of the Social Security Act; and
``(B) the amounts transferred from the Patient-
Centered Outcomes Research Trust Fund under section
9511(g).
``(2) Appropriation.--There are hereby appropriated to the
GME Trust Fund for fiscal year 2015 and each subsequent fiscal
year an amount equal to the aggregate payment amounts
determined for such fiscal year under section 1899B(b)(2) of
the Social Security Act.
``(3) Authorization of appropriations.--In addition to
amounts credited to the GME Trust Fund under paragraph (1) for
a fiscal year, there are authorized to be appropriated to the
Trust Fund--
``(A) for each of fiscal years 2015 and 2016,
$200,000,000; and
``(B) for each of fiscal years 2017 and 2018,
$100,000,000.
``(c) Expenditures From Fund.--Amounts in the GME Trust Fund are
available, without further appropriation, to the Secretary for carrying
out section 1899B of the Social Security Act.''.
(2) Clerical amendment.--The table of sections for
subchapter A of chapter 98 of such Code is amended by adding at
the end the following new item:
``Sec. 9512. Graduate Medical Education Trust Fund.''.
(c) Conforming Amendments.--
(1) Sunset medicare gme.--Section 1886 of the Social
Security Act (42 U.S.C. 1395ww) is amended--
(A) in subsection (d)(5)(B)--
(i) by redesignating the second clause (x)
as clause (xi); and
(ii) by adding at the end the following new
clause:
``(xii) For cost reporting periods beginning on or
after October 1, 2014, no additional payment amount for
subsection (d) hospitals with indirect costs of medical
education shall be made under this subparagraph and
instead payments for such costs shall be made in
accordance with section 1899B.''; and
(B) in subsection (h)(1), by adding at the end the
following new sentence: ``For cost reporting periods
beginning on or after October 1, 2014, no payments for
direct graduate medical education costs shall be made
under this subsection and instead payments for such
costs shall be made in accordance with section
1899B.''.
(2) Sunset medicaid gme.--Section 1903(i) of the Social
Security Act (42 U.S.C. 1396b(i)) is amended--
(A) in paragraph (25), by striking ``or'' at the
end;
(B) in paragraph (26), by striking the period at
the end and inserting ``; or''; and
(C) by inserting after paragraph (26) the following
new paragraph:
``(27) with respect to any amounts expended on or after
October 1, 2014, for payments to hospitals for direct or
indirect costs of graduate medical education.''.
(3) Sunset phsa children's hospital gme.--Section 340E of
the Public Health Service Act (42 U.S.C. 256e) is amended--
(A) in the first sentence of subsection (a), by
striking ``The Secretary'' and inserting ``Subject to
subsection (h), the Secretary''; and
(B) by adding at the end the following new
subsection:
``(h) Sunset.--For fiscal year 2015 and each subsequent fiscal
year, no payments shall be made under this section to a children's
hospital for the direct expenses and the indirect expenses associated
with operating approved graduate medical residency training programs
and instead payments for such expenses shall be made to such hospital
in accordance with section 1899B of the Social Security Act.''.
(4) Transfer of pcori funds.--
(A) Medicare transfer.--Section 1183 of the Social
Security Act is amended--
(i) in the heading, by striking ``patient-
centered outcomes research trust fund'' and
inserting ``graduate medical education trust
fund''; and
(ii) in subsection (a), by striking ``to
the Patient-Centered Outcomes Research Trust
Fund (referred to in this section as the
`PCORTF') under section 9511 of the Internal
Revenue Code of 1986'' and inserting ``to the
Graduate Medical Education Trust Fund under
section 9512 of the Internal Revenue Code of
1986''.
(B) PCORI trust fund.--Section 9511 of the Internal
Revenue Code of 1986 is amended--
(i) in subsection (d)(1), by inserting
``and subsection (g)'' after ``paragraph (2)'';
and
(ii) by adding at the end the following new
subsection:
``(g) Transfer to Graduate Medical Education Trust Fund.--The
Secretary of the Treasury shall transfer to the Graduate Medical
Education Trust Fund under section 9512 all funds made available,
appropriated, or transferred to the trust fund under this section on or
after October 1, 2014.''.
SEC. 314. REPORT ON TRANSITIONING PAYMENTS UNDER MEDICARE FOR
DISPROPORTIONATE SHARE HOSPITALS INTO A GRANT PROGRAM.
Not later than December 31, 2017, the Secretary of Health and Human
Services shall submit to Congress a report containing recommendations
on the extent to which--
(1) adjustments in payments under section 1886(d)(5)(F) of
the Social Security Act for inpatient hospital services
furnished by disproportionate share hospitals should be
terminated; and
(2) instead of such adjustments described in paragraph (1)
there should be established a grant program (separate from the
Medicare programs under title XVIII of the Social Security Act)
to provide disproportionate care hospitals funding for
providing such services.
SEC. 315. ONE-YEAR FREEZE FOR PHYSICIAN PAYMENT UPDATE; SENSE OF
CONGRESS RELATING TO THE SUSTAINABLE GROWTH RATE (SGR).
(a) One-Year Freeze for Physician Payment Update.--Section 1848(d)
of the Social Security Act (42 U.S.C. 1395w-4(d)) is amended by adding
at the end the following new paragraph:
``(14) Update for 2013.--
``(A) In general.--Subject to paragraphs (7)(B),
(8)(B), (9)(B), (10)(B), (11)(B), (12)(B), and (13)(B),
in lieu of the update to the single conversion factor
established in paragraph (1)(C) that would otherwise
apply for 2013, the update to the single conversion
factor shall be zero percent.
``(B) No effect on computation of conversion factor
for 2014 and subsequent years.--The conversion factor
under this subsection shall be computed under paragraph
(1)(A) for 2014 and subsequent years as if subparagraph
(A) had never applied.''.
(b) Sense of Congress Relating to the Sustainable Growth Rate
(SGR).--It is the Sense of Congress that the sustainable growth rate
(SGR) formula under the Medicare physician fee schedule under section
1848 of the Social Security Act (42 U.S.C. 1395w-4(d) is fundamentally
flawed and that replacing such formula with a payment system that
protects the access of seniors to high-quality physician care should be
an urgent priority.
SEC. 316. IMPROVEMENTS TO MSA PLANS; PERMITTING OFFERING OF
CATASTROPHIC PLAN WITH HIGH DEDUCTIBLE AND CONTRIBUTION
TO MSA, HSA, OR HIRA.
(a) MSA Plan May Choose To Not Apply Deductible to Preventive
Services.--Section 1859(b)(3) of the Social Security Act is amended--
(1) in subparagraph (A), by inserting ``, subject to
subparagraph (C)'' after ``plan that''; and
(2) by adding at the end the following new subparagraph:
``(C) Deductible not applicable to preventive
services.--With respect to expenses incurred during the
first plan year beginning on or after the date of the
enactment of this subparagraph or a subsequent plan
year, a Medicare Advantage organization offering an MSA
plan may waive application of the deductible under this
paragraph with respect to preventive care (within the
meaning of section 1871) under such plan and such
waiver shall not affect the plan satisfying the
definition under subparagraph (A).''.
(b) MA and MSA Plans Allowed To Make Medicare Advantage MSA
Contributions.--Section 138(b)(2) of the Internal Revenue Code of 1986
is amended--
(1) in subparagraph (A), by striking at the end ``or'';
(2) in subparagraph (B), by adding at the end ``or''; and
(3) by adding at the end the following new subparagraph:
``(C) a contribution made by a Medicare Advantage
plan or MSA plan under part C of title XVIII of the
Social Security Act pursuant to subparagraph (B) or (D)
of section 1851(a)(2) of such Act,''.
(c) MA Plans Offered May Include Catastrophic Plan With High
Deductible and MSA, HSA, or HIRA Contribution.--Section 1851(a)(2) of
the Social Security Act (42 U.S.C. 1395w-21(a)(2)) is amended by adding
at the end the following new subparagraph:
``(D) Combination catastrophic high deductible plan
with msa, hsa, or hira contribution.--A plan offering
catastrophic coverage with a high deductible feature
(as described in section 1882(p)(11)(B)), and a
contribution by such plan into a Medicare Advantage
medical savings account (MSA) (as defined in section
138(b)(2) of the Internal Revenue Code of 1986), a
health savings account (as defined in section 223(d) of
the Internal Revenue Code of 1986), or a health
individual retirement account established under section
503(b) of the Save and Strengthen Medicare Act of
2012.''.
SEC. 317. EXTENSION FOR SPECIALIZED MA PLANS FOR SPECIAL NEEDS
INDIVIDUALS.
(a) No Period Limitation Applied for Restricted Enrollments.--
Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-
28(f)(1)) is amended by striking ``and for periods before January 1,
2014''.
(b) Period for Meeting Applicable Requirements Extended.--Section
1859(b)(6)(A) of the Social Security Act (42 U.S.C. 1395w-28(b)(6)(A))
is amended by striking ``, as of January 1, 2010,''.
(c) Extension of Authority To Operate but No Service Area Expansion
for Dual Special Needs Plans That Do Not Meet Certain Requirements.--
Section 164(c)(2) of the Medicare Improvements for Patients and
Providers Act of 2008 (Public Law 110-275), as amended by section
3205(d) of the Patient Protection and Affordable Care Act (Public Law
111-148), is amended by striking ``December 31, 2012'' and inserting
``December 31, 2015''.
SEC. 318. CONSCIENCE PROTECTIONS.
Part F of title XVIII of the Social Security Act, as redesignated
by section 101(a)(1) and amended by section 313, is further amended by
adding at the end the following new sections:
``SEC. 1899C. CONSCIENCE PROTECTIONS; PROHIBITION AGAINST
DISCRIMINATION ON ASSISTED SUICIDE AND ABORTION SERVICES.
``(a) Prohibition on Funding for Abortions.--No payment may be made
under this title for any expenses incurred for any abortion.
``(b) Prohibition on Funding for Health Benefits Plans That Cover
Abortion.--No payment may be made under this title for any expenses for
coverage under an MA plan or prescription drug plan that includes
coverage of any abortion.
``(c) Treatment of Abortions Related to Rape, Incest, or Preserving
the Life of the Mother.--The limitations established in the previous
subsections shall not apply to an abortion--
``(1) if the pregnancy is the result of an act of rape or
incest; or
``(2) in the case where a woman suffers from a physical
disorder, physical injury, or physical illness that would, as
certified by a physician, place the woman in danger of death
unless an abortion is performed, including a life-endangering
physical condition caused by or arising from the pregnancy
itself.
``SEC. 1899D. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE
AND ABORTIONS.
``(a) In General.--The Federal Government, any MA plan or
prescription drug plan that receives payment under this title, and any
provider of services or supplier that receives payment under this title
with respect to Medicare fee-for-service (as defined in section 1860E-
61(b)) may not subject an individual or institutional health care
entity to discrimination on the basis that the entity does not
provide--
``(1) any health care item or service furnished for the
purpose of causing, or for the purpose of assisting in causing,
the death of any individual, such as by assisted suicide,
euthanasia, or mercy killing; or
``(2) abortions.
``(b) Definition.--In this section, the term `health care entity'
includes an individual physician or other health care professional, a
hospital, a provider-sponsored organization, a health maintenance
organization, a health insurance plan, or any other kind of health care
facility, organization, or plan.
``(c) Construction and Treatment of Certain Services in the Case of
Assisted Suicide.--Nothing in subsection (a)(1) shall be construed to
apply to, or to affect, any limitation relating to--
``(1) the withholding or withdrawing of medical treatment
or medical care;
``(2) the withholding or withdrawing of nutrition or
hydration; or
``(3) the use of an item, good, benefit, or service
furnished for the purpose of alleviating pain or discomfort,
even if such use may increase the risk of death, so long as
such item, good, benefit, or service is not also furnished for
the purpose of causing, or the purpose of assisting in causing,
death, for any reason.
``(d) Administration.--The Office for Civil Rights of the
Department of Health and Human Services is designated to receive
complaints of discrimination based on this section. Any such complaint
shall, by not later than 180 days after receipt by the Office of such
complaint, be reviewed by the Office and, as appropriate, referred to
the Medicare Choices Commission or Centers for Medicare & Medicaid
Services for purposes of subsection (e).
``(e) Enforcement.--
``(1) MA plans and prescription drug plans.--In the case of
an MA plan or prescription drug plan that is in violation of
subsection (a), the Medicare Choices Commission may, as
determined appropriate by the Commission--
``(A) apply against the MA organization offering
the MA plan or the PDP sponsor offering the
prescription drug plan a civil monetary penalty or
assessment in the same manner as such a penalty or
assessment is authorized under section 1128A(a);
``(B) exclude the plan from participation under
this title, in accordance with the procedures of
subsections (c), (f), and (g) of section 1128; or
``(C) apply both subparagraphs (A) and (B) with
respect to the plan.
``(2) Medicare fee-for-service providers of services and
suppliers.--In the case of a provider of services or supplier
described in subsection (a) that is in violation of such
subsection, the Secretary, through the Administrator of the
Centers for Medicare & Medicaid Services, may, as determined
appropriate by the Secretary--
``(A) apply against the provider of services or
supplier a civil monetary penalty or assessment in the
same manner as such a penalty or assessment is
authorized under section 1128A(a);
``(B) exclude the provider of services or supplier
from participation under this title, in accordance with
the procedures of subsections (c), (f), and (g) of
section 1128; or
``(C) apply both subparagraphs (A) and (B) with
respect to the provider of services or supplier.
``(3) Administration.--The provisions of section 1128A
(other than the first 2 sentences of subsection (a) and other
than subsection (b)) shall apply to a civil money penalty and
assessment under paragraph (1) or (2) in the same manner as
such provisions apply to a penalty, assessment, or proceeding
under section 1128A(a), except to the extent such provisions
are inconsistent with paragraph (1)(B) or (2)(B),
respectively.''.
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