115 HR 676 IH: To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.
U.S. House of Representatives
2017-01-24
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EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)This Act may be cited as the Expanded & Improved Medicare For All Act
. (b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.
Title I—ELIGIBILITY AND BENEFITS
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
Title II—FINANCES
Subtitle A—Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and medically necessary assistive
equipment.
Sec. 206. Consultation in establishing reimbursement levels.
Subtitle B—Funding
Sec. 211. Overview: funding the Medicare For All Program.
Sec. 212. Appropriations for existing programs.
Title III—ADMINISTRATION
Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced clerical workers.
Sec. 304. Confidential electronic patient record system.
Sec. 305. National Board of Universal Quality and Access.
Title IV—ADDITIONAL PROVISIONS
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
Title V—EFFECTIVE DATE
Sec. 501. Effective date.
2.In this Act: (1)Medicare For All Program; programThe terms Medicare For All Program and Program mean the program of benefits provided under this Act and, unless the context otherwise requires, the Secretary with respect to functions relating to carrying out such program.
(2)National board of universal quality and accessThe term National Board of Universal Quality and Access means such Board established under section 305. (3)The term regional office means a regional office established under section 303.
(4)The term Secretary means the Secretary of Health and Human Services. (5)The term Director means, in relation to the Program, the Director appointed under section 301.
<enum>I</enum><header>ELIGIBILITY AND BENEFITS</header>
<section id="H6C8A16D805E84E9BAE0BF1955BF113C4"><enum>101.</enum><header>Eligibility and registration</header>
<subsection id="H47277F48EAAC4E6E93FA90D240D66F17"><enum>(a)</enum><header>In general</header><text>All individuals residing in the United States (including any territory of the United States) are covered under the Medicare For All Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual’s Social Security number shall not be used for purposes of registration under this section.</text>
</subsection><subsection id="H9FE22A06BA394803B4E7B242546B1EA4"><enum>(b)</enum><header>Registration</header><text>Individuals and families shall receive a Medicare For All Program Card in the mail, after filling out a Medicare For All Program application form at a health care provider. Such application form shall be no more than 2 pages long.</text>
</subsection><subsection id="HCA735971BFA443FE99CF01C49B5F78D3"><enum>(c)</enum><header>Presumption</header><text>Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a Medicare For All Program Card and have payment made for such benefits.</text>
</subsection><subsection id="HBE50460628D54466AC15B012D167F059"><enum>(d)</enum><header>Residency criteria</header><text>The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under the Medicare For All Program.</text>
</subsection><subsection id="H56824E4BFDE84F599C65DBE12E0C28D2"><enum>(e)</enum><header>Coverage for visitors</header><text display-inline="yes-display-inline">The Secretary shall promulgate a rule regarding visitors from other countries who seek premeditated non-emergency surgical procedures. Such a rule should facilitate the establishment of country-to-country reimbursement arrangements or self pay arrangements between the visitor and the provider of care.</text>
</subsection></section><section id="HDE87A031B7604A77B77CB32D91D5C25C"><enum>102.</enum><header>Benefits and portability</header>
<subsection id="H9F9DBF8904D3482E84677952BA4ACBF1"><enum>(a)</enum><header>In general</header><text>The health care benefits under this Act cover all medically necessary services, including at least the following:</text>
<paragraph id="H414D210FD8134A99B3A6389C929DA04F"><enum>(1)</enum><text>Primary care and prevention.</text> </paragraph><paragraph id="HCEBAD46E73E14360A810FDAE344022C4"><enum>(2)</enum><text display-inline="yes-display-inline">Approved dietary and nutritional therapies.</text>
</paragraph><paragraph id="H723FB170F8194E6E8AECC9A79C881250"><enum>(3)</enum><text>Inpatient care.</text> </paragraph><paragraph id="H4D14243E0EAA41E6BC6987B51B39D4C7"><enum>(4)</enum><text>Outpatient care.</text>
</paragraph><paragraph id="H1854AC51C4B44C12A96D5CD5D5501389"><enum>(5)</enum><text>Emergency care.</text> </paragraph><paragraph id="H2913A9193C9C4B62B70CA7DE42757A87"><enum>(6)</enum><text>Prescription drugs.</text>
</paragraph><paragraph id="HD39304D922C144EE83A3D1190A325C10"><enum>(7)</enum><text>Durable medical equipment.</text> </paragraph><paragraph id="HF5901B7BD5FC4EAF8AACA11935983760"><enum>(8)</enum><text>Long-term care.</text>
</paragraph><paragraph id="H263A23DB74BC4DE0B69F0EE5E6553D92"><enum>(9)</enum><text>Palliative care.</text> </paragraph><paragraph id="H40D7051BBB8D4FDD88C01248309F3205"><enum>(10)</enum><text>Mental health services.</text>
</paragraph><paragraph id="HD0D37A79B577460A958F2638742E54F0"><enum>(11)</enum><text display-inline="yes-display-inline">The full scope of dental services, services, including periodontics, oral surgery, and endodontics, but not including cosmetic dentistry.</text>
</paragraph><paragraph id="H83D11F533ECE4D48A7D6C2C777E9EA56"><enum>(12)</enum><text>Substance abuse treatment services.</text> </paragraph><paragraph id="H2DEBB87C02E44E6BAE1FCA4827F0513A"><enum>(13)</enum><text display-inline="yes-display-inline">Chiropractic services, not including electrical stimulation.</text>
</paragraph><paragraph id="H3A728A0A8DEB4F0BB5D43362862CCD83"><enum>(14)</enum><text>Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).</text> </paragraph><paragraph id="H5FA699992B3A419FAE64EF3AA4B3830A"><enum>(15)</enum><text>Hearing services, including coverage of hearing aids.</text>
</paragraph><paragraph id="HA979CF5E2F684DA1AD1285C91777CDB0"><enum>(16)</enum><text>Podiatric care.</text> </paragraph></subsection><subsection id="HF2140067BA25489C8D6AB7E26FFCEDF6"><enum>(b)</enum><header>Portability</header><text>Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.</text>
</subsection><subsection id="HA8078F9C94104ACA8B47F52E0550C667"><enum>(c)</enum><header>No cost-Sharing</header><text>No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.</text>
</subsection></section><section id="H47D33ADBB19245B5945D5D0E11B735B1"><enum>103.</enum><header>Qualification of participating providers</header>
<subsection id="HDEA6A53733684F77BE26F259DEA356BD"><enum>(a)</enum><header>Requirement To be public or non-Profit</header>
<paragraph id="H119FF6BACE634C0D9DD130DDDEC4F228"><enum>(1)</enum><header>In general</header><text>No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.</text>
</paragraph><paragraph id="H42E8B01465544C1592BAE8178DA9C0EB"><enum>(2)</enum><header>Conversion of investor-owned providers</header><text>For-profit providers of care opting to participate shall be required to convert to not-for-profit status.</text>
</paragraph><paragraph id="HA63C15FF5E504F6AA605FC5370566A31"><enum>(3)</enum><header>Private delivery of care requirement</header><text>For-profit providers of care that convert to non-profit status shall remain privately owned and operated entities.</text>
</paragraph><paragraph id="HA6A5178B72F7469C9E5C8C9A5A35C90F"><enum>(4)</enum><header>Compensation for conversion</header><text>The owners of such for-profit providers shall be compensated for reasonable financial losses incurred as a result of the conversion from for-profit to non-profit status.</text>
</paragraph><paragraph id="HAF6A401FBC79484BBF56F20659C39C41"><enum>(5)</enum><header>Funding</header><text>There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).</text>
</paragraph><paragraph id="HFC6661CC20224A1D8200187EE982EA1A"><enum>(6)</enum><header>Requirements</header><text>The payments to owners of converting for-profit providers shall occur during a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits.</text>
</paragraph><paragraph id="HEBBF9236CF464E9FAFDCB5D08F8F549D"><enum>(7)</enum><header>Mechanism for conversion process</header><text>The Secretary shall promulgate a rule to provide a mechanism to further the timely, efficient, and feasible conversion of for-profit providers of care.</text>
</paragraph></subsection><subsection id="H4C37F60AD7654BF9BEE8207AA71A1840"><enum>(b)</enum><header>Quality standards</header>
<paragraph id="H7A1E84AF1AFE4B4E85266039580B4BAA"><enum>(1)</enum><header>In general</header><text>Health care delivery facilities must meet State quality and licensing guidelines as a condition of participation under such program, including guidelines regarding safe staffing and quality of care.</text>
</paragraph><paragraph id="H0B6FCE35524D42B7B5327CD3629566B5"><enum>(2)</enum><header>Licensure requirements</header><text>Participating clinicians must be licensed in their State of practice and meet the quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any State may be a participating provider.</text>
</paragraph></subsection><subsection id="H7B69263D5B984FEEAF601D07884B5593"><enum>(c)</enum><header>Participation of health maintenance organizations</header>
<paragraph id="HDB7964C501D94E14B1C1B2F63F635232"><enum>(1)</enum><header>In general</header><text>Non-profit health maintenance organizations that deliver care in their own facilities and employ clinicians on a salaried basis may participate in the program and receive global budgets or capitation payments as specified in section 202.</text>
</paragraph><paragraph id="H3372CC17359443F3A8647508C43EA030"><enum>(2)</enum><header>Exclusion of certain health maintenance organizations</header><text>Other health maintenance organizations which principally contract to pay for services delivered by non-employees shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage).</text>
</paragraph></subsection><subsection id="H1DD0D2064F6E426A8DF4D929C6456DE6"><enum>(d)</enum><header>Freedom of choice</header><text>Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.</text>
</subsection></section><section id="HB05713C4BCDA42BE930F76876025A448"><enum>104.</enum><header>Prohibition against duplicating coverage</header>
<subsection id="H2C4551D7DAEB4C5D867E9D0276777684"><enum>(a)</enum><header>In general</header><text>It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.</text>
</subsection><subsection id="H7F492BE787D640F78A8447D6FD6B2F82"><enum>(b)</enum><header>Construction</header><text>Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.</text>
</subsection></section><enum>II</enum><header>FINANCES</header>
<subtitle id="HFBA9A9540DC649D8B3C3AC4F411E0F2F"><enum>A</enum><header>Budgeting and Payments</header>
<section id="H7B5610D8BFAD42F0BA6DC7BB110F4FD2"><enum>201.</enum><header>Budgeting process</header>
<subsection id="H820E703F31B5430BBFC181613DA1723B"><enum>(a)</enum><header>Establishment of operating budget and capital expenditures budget</header>
<paragraph id="HA2E3AE6DAF9844F288EC5AE2EBCD79A6"><enum>(1)</enum><header>In general</header><text>To carry out this Act there are established on an annual basis consistent with this title—</text> <subparagraph id="HF7AB5350FD164B85AB2B531F6F1B3349"><enum>(A)</enum><text>an operating budget, including amounts for optimal physician, nurse, and other health care professional staffing;</text>
</subparagraph><subparagraph id="H25E8A88F6A454B3B858B48E10CEAA101"><enum>(B)</enum><text>a capital expenditures budget;</text> </subparagraph><subparagraph id="H41A5F13FE5874033BEA6459181CA190A"><enum>(C)</enum><text>reimbursement levels for providers consistent with subtitle B; and</text>
</subparagraph><subparagraph id="H67F8782DAFB747F187014EF60DAAA107"><enum>(D)</enum><text>a health professional education budget, including amounts for the continued funding of resident physician training programs.</text>
</subparagraph></paragraph><paragraph id="HA5A372617AD8481CB9D059A0764DB537"><enum>(2)</enum><header>Regional allocation</header><text>After Congress appropriates amounts for the annual budget for the Medicare For All Program, the Director shall provide the regional offices with an annual funding allotment to cover the costs of each region’s expenditures. Such allotment shall cover global budgets, reimbursements to clinicians, health professional education, and capital expenditures. Regional offices may receive additional funds from the national program at the discretion of the Director.</text>
</paragraph></subsection><subsection id="HE53A030EB8FC4699BFEAD55631A0F62D"><enum>(b)</enum><header>Operating budget</header><text>The operating budget shall be used for—</text> <paragraph id="HD7D05B7279A1437C98EDBFD87D7D680D"><enum>(1)</enum><text>payment for services rendered by physicians and other clinicians;</text>
</paragraph><paragraph id="H42DB03B5847747FAA801EFC2213BC602"><enum>(2)</enum><text>global budgets for institutional providers;</text> </paragraph><paragraph id="HF0A7E20030BB461DB19889CEE2006423"><enum>(3)</enum><text>capitation payments for capitated groups; and</text>
</paragraph><paragraph id="HAB75AD849E7B435DB84288AC1AAB0BE8"><enum>(4)</enum><text>administration of the Program.</text> </paragraph></subsection><subsection id="H23D2C1499DA847BFAD48E765D34B6560"><enum>(c)</enum><header>Capital expenditures budget</header><text>The capital expenditures budget shall be used for funds needed for—</text>
<paragraph id="HBDFB861785EB42FDBD2D996F80708DD4"><enum>(1)</enum><text>the construction or renovation of health facilities; and</text> </paragraph><paragraph id="HAA5BB6D158C348C888BB32DFD8C8E0EA"><enum>(2)</enum><text>for major equipment purchases.</text>
</paragraph></subsection><subsection id="H5DCFE30D38D140938AECED0E20B1020C"><enum>(d)</enum><header>Prohibition against co-Mingling operations and capital improvement funds</header><text>It is prohibited to use funds under this Act that are earmarked—</text> <paragraph id="H6F22B3E4D8B74D1590CBDA0957E144CB"><enum>(1)</enum><text>for operations for capital expenditures; or</text>
</paragraph><paragraph id="HFD440A4E171D4D71980F9DD7530C341E"><enum>(2)</enum><text>for capital expenditures for operations.</text> </paragraph></subsection></section><section id="H5DD5FAEF37C94C58807C9381D6BF0D6D"><enum>202.</enum><header>Payment of providers and health care clinicians</header> <subsection id="H962F8DFAB8B64CBABEC360351D2387A0"><enum>(a)</enum><header>Establishing global budgets; monthly lump sum</header> <paragraph id="HC1597B7E447C4BE49AB17D45EB889D03"><enum>(1)</enum><header>In general</header><text>The Medicare For All Program, through its regional offices, shall pay each institutional provider of care, including hospitals, nursing homes, community or migrant health centers, home care agencies, or other institutional providers or pre-paid group practices, a monthly lump sum to cover all operating expenses under a global budget.</text>
</paragraph><paragraph id="H47D1C6367873413CA887D9F7DC7F7E83"><enum>(2)</enum><header>Establishment of global budgets</header><text>The global budget of a provider shall be set through negotiations between providers, State directors, and regional directors, but are subject to the approval of the Director. The budget shall be negotiated annually, based on past expenditures, projected changes in levels of services, wages and input, costs, a provider’s maximum capacity to provide care, and proposed new and innovative programs.</text>
</paragraph></subsection><subsection id="H827B09B49D154FFA8255E9DA7BA58E9F"><enum>(b)</enum><header>Three payment options for physicians and certain other health professionals</header>
<paragraph id="HAA815FDC26244803890FDF117C62F5B5"><enum>(1)</enum><header>In general</header><text>The Program shall pay physicians, dentists, doctors of osteopathy, pharmacists, psychologists, chiropractors, doctors of optometry, nurse practitioners, nurse midwives, physicians’ assistants, and other advanced practice clinicians as licensed and regulated by the States by the following payment methods:</text>
<subparagraph id="H445B254671504BC7A11AEA7256F054E7"><enum>(A)</enum><text>Fee for service payment under paragraph (2).</text> </subparagraph><subparagraph id="HD19985E3C1234B75813789D2C3A48230"><enum>(B)</enum><text>Salaried positions in institutions receiving global budgets under paragraph (3).</text>
</subparagraph><subparagraph id="H8D729381DF5E411391583BDDF243CC7A"><enum>(C)</enum><text>Salaried positions within group practices or non-profit health maintenance organizations receiving capitation payments under paragraph (4).</text>
</subparagraph></paragraph><paragraph id="H5EB5913B688743BBA043E3998CA1FD40"><enum>(2)</enum><header>Fee for service</header>
<subparagraph id="H45098BD5522C46BCA7103D795BF8296B"><enum>(A)</enum><header>In general</header><text>The Program shall negotiate a simplified fee schedule that is fair and optimal with representatives of physicians and other clinicians, after close consultation with the National Board of Universal Quality and Access and regional and State directors. Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this Act.</text>
</subparagraph><subparagraph id="HC567431101A9462D8B4D04E0EE9C34D8"><enum>(B)</enum><header>Considerations</header><text>In establishing such schedule, the Director shall take into consideration the following:</text> <clause id="H69D7019A283D486E936BFD08492CD9E5"><enum>(i)</enum><text>The need for a uniform national standard.</text>
</clause><clause id="H0DB4F6E39EF04BD3B6AC66C2FF70ECAC"><enum>(ii)</enum><text>The goal of ensuring that physicians, clinicians, pharmacists, and other medical professionals be compensated at a rate which reflects their expertise and the value of their services, regardless of geographic region and past fee schedules.</text>
</clause></subparagraph><subparagraph id="H2659B1547D0A4096AA4FE635192556DD"><enum>(C)</enum><header>State physician practice review boards</header><text>The State director for each State, in consultation with representatives of the physician community of that State, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician delivered services.</text>
</subparagraph><subparagraph id="HE798BA1878B24F7499CC77C24539D394"><enum>(D)</enum><header>Final guidelines</header><text>The Director shall be responsible for promulgating final guidelines to all providers.</text> </subparagraph><subparagraph id="HA7E9D5829B914D21A887F9EBE9A8C423"><enum>(E)</enum><header>Billing</header><text>Under this Act physicians shall submit bills to the regional director on a simple form, or via computer. Interest shall be paid to providers who are not reimbursed within 30 days of submission.</text>
</subparagraph><subparagraph id="H38539DAAD08D4BCC8BD4C557F1F227D3"><enum>(F)</enum><header>No balance billing</header><text>Licensed health care clinicians who accept any payment from the Medicare For All Program may not bill any patient for any covered service.</text>
</subparagraph><subparagraph id="H7B7CF33A6D2A49C5B09DCD8D3DAA5578"><enum>(G)</enum><header>Uniform computer electronic billing system</header><text>The Director shall create a uniform computerized electronic billing system, including those areas of the United States where electronic billing is not yet established.</text>
</subparagraph></paragraph><paragraph id="H106BDDD71C5546D296F211A2E6003E81"><enum>(3)</enum><header>Salaries within institutions receiving global budgets</header>
<subparagraph id="HEF696781E5E045C49A4FFC2F50218A85"><enum>(A)</enum><header>In general</header><text>In the case of an institution, such as a hospital, health center, group practice, community and migrant health center, or a home care agency that elects to be paid a monthly global budget for the delivery of health care as well as for education and prevention programs, physicians and other clinicians employed by such institutions shall be reimbursed through a salary included as part of such a budget.</text>
</subparagraph><subparagraph id="H105EFE16975044C89007A7E98A5CE653"><enum>(B)</enum><header>Salary ranges</header><text>Salary ranges for health care providers shall be determined in the same way as fee schedules under paragraph (2).</text>
</subparagraph></paragraph><paragraph id="HDC9773D8103A47E680536A726EE6E29A"><enum>(4)</enum><header>Salaries within capitated groups</header>
<subparagraph id="HCD461EDE6A3049E3BAA549853DBFD77B"><enum>(A)</enum><header>In general</header><text>Health maintenance organizations, group practices, and other institutions may elect to be paid capitation payments to cover all outpatient, physician, and medical home care provided to individuals enrolled to receive benefits through the organization or entity.</text>
</subparagraph><subparagraph id="H2239FC43EB34462DBA88B328E60854FB"><enum>(B)</enum><header>Scope</header><text>Such capitation may include the costs of services of licensed physicians and other licensed, independent practitioners provided to inpatients. Other costs of inpatient and institutional care shall be excluded from capitation payments, and shall be covered under institutions’ global budgets.</text>
</subparagraph><subparagraph id="H2025D431C4504E598A5FF551F8335F75"><enum>(C)</enum><header>Prohibition of selective enrollment</header><text display-inline="yes-display-inline">Patients shall be permitted to enroll or disenroll from such organizations or entities without discrimination and with appropriate notice.</text>
</subparagraph><subparagraph id="H2BF6CFF9A4D94FB6A8030621CA0C3548"><enum>(D)</enum><header>Health maintenance organizations</header><text>Under this Act—</text> <clause id="HADE59EDFAD5C48758B71C61CDF65E060"><enum>(i)</enum><text>health maintenance organizations shall be required to reimburse physicians based on a salary; and</text>
</clause><clause id="H87E0DAA2B59F49C09A73514FA38F756D"><enum>(ii)</enum><text>financial incentives between such organizations and physicians based on utilization are prohibited.</text> </clause></subparagraph></paragraph></subsection></section><section id="H92E2E4A12EA644008B57F5BED89B477C"><enum>203.</enum><header>Payment for long-term care</header> <subsection id="H49B4EEDE04804EB7AE6BC61EF04F8E6B"><enum>(a)</enum><header>Allotment for regions</header><text>The Program shall provide for each region a single budgetary allotment to cover a full array of long-term care services under this Act.</text>
</subsection><subsection id="H94CA2E95EA0A4E2E8A6443FDB7460154"><enum>(b)</enum><header>Regional budgets</header><text>Each region shall provide a global budget to local long-term care providers for the full range of needed services, including in-home, nursing home, and community based care.</text>
</subsection><subsection id="H61CD4101BB184F098C595562F0302893"><enum>(c)</enum><header>Basis for budgets</header><text>Budgets for long-term care services under this section shall be based on past expenditures, financial and clinical performance, utilization, and projected changes in service, wages, and other related factors.</text>
</subsection><subsection id="HB8A54D6A2E174C70ACE311510C11A81F"><enum>(d)</enum><header>Favoring non-Institutional care</header><text>All efforts shall be made under this Act to provide long-term care in a home- or community-based setting, as opposed to institutional care.</text>
</subsection></section><section id="HB12E833C9F8840ACBFFA2542C8699206"><enum>204.</enum><header>Mental health services</header>
<subsection id="H7CFFDC8AE5BF430DA969FB53C300552E"><enum>(a)</enum><header>In general</header><text>The Program shall provide coverage for all medically necessary mental health care on the same basis as the coverage for other conditions. Licensed mental health clinicians shall be paid in the same manner as specified for other health professionals, as provided for in section 202(b).</text>
</subsection><subsection id="H843F3474F0014665BF79862F7A716E8A"><enum>(b)</enum><header>Favoring community-Based care</header><text>The Medicare For All Program shall cover supportive residences, occupational therapy, and ongoing mental health and counseling services outside the hospital for patients with serious mental illness. In all cases the highest quality and most effective care shall be delivered, and, for some individuals, this may mean institutional care.</text>
</subsection></section><section id="HAE2C176F97804FA292E7FAE85AD19155"><enum>205.</enum><header>Payment for prescription medications, medical supplies, and medically necessary assistive equipment</header>
<subsection id="HC0A776683D864556AE97E955853D203D"><enum>(a)</enum><header>Negotiated prices</header><text>The prices to be paid each year under this Act for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Program.</text>
</subsection><subsection id="H1DF77950D62240DEB43C033174B48A22"><enum>(b)</enum><header>Prescription drug formulary</header>
<paragraph id="HB224DA384BE3481F99995C4E2AC9D397"><enum>(1)</enum><header>In general</header><text>The Program shall establish a prescription drug formulary system, which shall encourage best-practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available.</text>
</paragraph><paragraph id="H5ED9CFBB7042453C8BBD9A7D89D97A5C"><enum>(2)</enum><header>Promotion of use of generics</header><text>The formulary shall promote the use of generic medications but allow the use of brand-name and off-formulary medications.</text>
</paragraph><paragraph id="H4D2A2EB2C71D431CAD7FBF33D2E9FE64"><enum>(3)</enum><header>Formulary updates and petition rights</header><text>The formulary shall be updated frequently and clinicians and patients may petition their region or the Director to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary.</text>
</paragraph></subsection></section><section id="HC3178924B073405B91CAF6E0051666E9"><enum>206.</enum><header>Consultation in establishing reimbursement levels</header><text display-inline="no-display-inline">Reimbursement levels under this subtitle shall be set after close consultation with regional and State Directors and after the annual meeting of National Board of Universal Quality and Access.</text>
</section></subtitle><subtitle id="HDAE3533795664265BF27B6224929757C"><enum>B</enum><header>Funding</header>
<section id="H87F6F4A93DE34DF5B9F91798A4C464A7"><enum>211.</enum><header>Overview: funding the Medicare For All Program</header>
<subsection id="HCAD1DBDB599D42B0B0A71E2A0F0D3DFE"><enum>(a)</enum><header>In general</header><text>The Medicare For All Program is to be funded as provided in subsection (c)(1).</text> </subsection><subsection id="HF758F6153EFB48F1822CAD63DBA1C9C7"><enum>(b)</enum><header>Medicare For All Trust Fund</header><text>There shall be established a Medicare For All Trust Fund in which funds provided under this section are deposited and from which expenditures under this Act are made.</text>
</subsection><subsection id="H5425850F379B4693B5694767321716D9"><enum>(c)</enum><header>Funding</header>
<paragraph id="HB12D8277C7704CC6B471F80385292B77"><enum>(1)</enum><header>In general</header><text>There are appropriated to the Medicare For All Trust Fund amounts sufficient to carry out this Act from the following sources:</text>
<subparagraph id="H89D60A1BE2D04B35A90B0B836CD422E4"><enum>(A)</enum><text>Existing sources of Federal Government revenues for health care.</text> </subparagraph><subparagraph id="H5AB62624C71941A6AD1133ECA13FEEBE"><enum>(B)</enum><text>Increasing personal income taxes on the top 5 percent income earners.</text>
</subparagraph><subparagraph id="H84AF73A74C5B470CA42E8E195D7E285B"><enum>(C)</enum><text>Instituting a modest and progressive excise tax on payroll and self-employment income.</text> </subparagraph><subparagraph id="HBD94C5F13EC643ED9A567EE6C3502D32"><enum>(D)</enum><text display-inline="yes-display-inline">Instituting a modest tax on unearned income.</text>
</subparagraph><subparagraph id="HB54E50271232465FA1E2ADD3F215457B"><enum>(E)</enum><text>Instituting a small tax on stock and bond transactions.</text> </subparagraph></paragraph><paragraph id="HB8F283CCE4A24AA2B395191059626046"><enum>(2)</enum><header>System savings as a source of financing</header><text>Funding otherwise required for the Program is reduced as a result of—</text>
<subparagraph id="H7B7A4437AA0B4674BE875E58750B7FFE"><enum>(A)</enum><text>vastly reducing paperwork;</text> </subparagraph><subparagraph id="H5EFE0503624142E3B35460B06882D999"><enum>(B)</enum><text>requiring a rational bulk procurement of medications under section 205(a); and</text>
</subparagraph><subparagraph id="H81794E3661F54B5AB7E4D46039875172"><enum>(C)</enum><text>improved access to preventive health care.</text> </subparagraph></paragraph><paragraph id="HE405ECEC944C47FC9F4A147D666C4B9D"><enum>(3)</enum><header>Additional annual appropriations to Medicare For All Program</header><text>Additional sums are authorized to be appropriated annually as needed to maintain maximum quality, efficiency, and access under the Program.</text>
</paragraph></subsection></section><section id="HBB6E7C9DBEC046A088E109A2289F79B6"><enum>212.</enum><header>Appropriations for existing programs</header><text display-inline="no-display-inline">Notwithstanding any other provision of law, there are hereby transferred and appropriated to carry out this Act, amounts from the Treasury equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs, including funds that would have been appropriated under the Medicare program under title XVIII of the <act-name parsable-cite="SSA">Social Security Act</act-name>, under the Medicaid program under title XIX of such Act, and under the Children’s Health Insurance Program under title XXI of such Act.</text>
</section></subtitle><enum>III</enum><header>ADMINISTRATION</header>
<section id="H715257B2A85C47D0901796DFF32EAB45"><enum>301.</enum><header>Public administration; appointment of Director</header>
<subsection id="HCD261FC8D5DB4D88AAE5A399ED28A961"><enum>(a)</enum><header>In general</header><text>Except as otherwise specifically provided, this Act shall be administered by the Secretary through a Director appointed by the Secretary.</text>
</subsection><subsection id="H6AA95C6B70744FD3B8DDDAB9AAB81E84"><enum>(b)</enum><header>Long-Term care</header><text>The Director shall appoint a director for long-term care who shall be responsible for administration of this Act and ensuring the availability and accessibility of high quality long-term care services.</text>
</subsection><subsection id="H92B5DB559C7C4FC49F4183D0C9BC73C5"><enum>(c)</enum><header>Mental health</header><text>The Director shall appoint a director for mental health who shall be responsible for administration of this Act and ensuring the availability and accessibility of high quality mental health services.</text>
</subsection></section><section id="H6090C09DED614BD1965F6E30961C6B62"><enum>302.</enum><header>Office of Quality Control</header><text display-inline="no-display-inline">The Director shall appoint a director for an Office of Quality Control. Such director shall, after consultation with State and regional directors, provide annual recommendations to Congress, the President, the Secretary, and other Program officials on how to ensure the highest quality health care service delivery. The director of the Office of Quality Control shall conduct an annual review on the adequacy of medically necessary services, and shall make recommendations of any proposed changes to the Congress, the President, the Secretary, and other Medicare For All Program officials.</text>
</section><section id="HD86A971D20EC439E8203A631A1861CD3"><enum>303.</enum><header>Regional and State administration; employment of displaced clerical workers</header>
<subsection id="H7DE937453C81402282B532B33970D9C9"><enum>(a)</enum><header>Establishment of Medicare For All Program regional offices</header><text>The Secretary shall establish and maintain Medicare For All regional offices for the purpose of distributing funds to providers of care. Whenever possible, the Secretary should incorporate pre-existing Medicare infrastructure for this purpose.</text>
</subsection><subsection id="HD7EB478425F24761A4964FF310089EB9"><enum>(b)</enum><header>Appointment of Regional and State Directors</header><text>In each such regional office there shall be—</text> <paragraph id="H57C20BF20C9D41D0AA0A674F06F5C8C2"><enum>(1)</enum><text>one regional director appointed by the Director; and</text>
</paragraph><paragraph id="H8AFFECCF10AF4904A03DC3A86BA61CFF"><enum>(2)</enum><text>for each State in the region, a deputy director (in this Act referred to as a <quote>State Director</quote>) appointed by the governor of that State.</text> </paragraph></subsection><subsection id="H8685B62C302B40138309ADA4A938BA51"><enum>(c)</enum><header>Regional office duties</header><text display-inline="yes-display-inline">Regional offices of the Program shall be responsible for—</text>
<paragraph id="H65FC5B48A7F4480EB74272FDEED58165"><enum>(1)</enum><text>coordinating funding to health care providers and physicians; and</text> </paragraph><paragraph id="H9AFB95455BB7440692A1F65034F674AA"><enum>(2)</enum><text>coordinating billing and reimbursements with physicians and health care providers through a State-based reimbursement system.</text>
</paragraph></subsection><subsection id="HFB9AC748200E411E85F9B3F1AE8B5BAF"><enum>(d)</enum><header>State Director’s duties</header><text>Each State Director shall be responsible for the following duties:</text> <paragraph id="HCF7A2E511DDE486E8B0F39BAE916CCC0"><enum>(1)</enum><text>Providing an annual State health care needs assessment report to the National Board of Universal Quality and Access, and the regional board, after a thorough examination of health needs, in consultation with public health officials, clinicians, patients, and patient advocates.</text>
</paragraph><paragraph id="HAB3C5F1AC5434303936DAE3D1F60BF8C"><enum>(2)</enum><text>Health planning, including oversight of the placement of new hospitals, clinics, and other health care delivery facilities.</text>
</paragraph><paragraph id="H10D8E4250F444BE98AFBB9605A4B44B2"><enum>(3)</enum><text>Health planning, including oversight of the purchase and placement of new health equipment to ensure timely access to care and to avoid duplication.</text>
</paragraph><paragraph id="HA0535526782F430F93EA913A039F3386"><enum>(4)</enum><text>Submitting global budgets to the regional director.</text> </paragraph><paragraph id="H2651F648778F4BC0A4E17986D2AE80F7"><enum>(5)</enum><text>Recommending changes in provider reimbursement or payment for delivery of health services in the State.</text>
</paragraph><paragraph id="HC4ABBB71CD91456FAED76702E31D6A1C"><enum>(6)</enum><text>Establishing a quality assurance mechanism in the State in order to minimize both under utilization and over utilization and to assure that all providers meet high quality standards.</text>
</paragraph><paragraph id="H43C79DDE02364184BB4A78E0A378EE59"><enum>(7)</enum><text>Reviewing program disbursements on a quarterly basis and recommending needed adjustments in fee schedules needed to achieve budgetary targets and assure adequate access to needed care.</text>
</paragraph></subsection><subsection id="H22E9B605401743F5B4F12612511EABB9"><enum>(e)</enum><header>First priority in retraining and job placement; 2 years of salary parity benefits</header><text>The Program shall provide that clerical, administrative, and billing personnel in insurance companies, doctors offices, hospitals, nursing facilities, and other facilities whose jobs are eliminated due to reduced administration—</text>
<paragraph id="H3CABE6C564B44740BC8226F72CEFDBC8"><enum>(1)</enum><text>should have first priority in retraining and job placement in the new system; and</text> </paragraph><paragraph id="HB62A07A87C2545ED88C553A90850DF45"><enum>(2)</enum><text>shall be eligible to receive two years of Medicare For All employment transition benefits with each year’s benefit equal to salary earned during the last 12 months of employment, but shall not exceed $100,000 per year.</text>
</paragraph></subsection><subsection id="HFAB4E3FFED774511ABD12C7E4C304080"><enum>(f)</enum><header>Establishment of Medicare For All employment transition fund</header><text>The Secretary shall establish a trust fund from which expenditures shall be made to recipients of the benefits allocated in subsection (e).</text>
</subsection><subsection id="H53764BC1918D4C538D5B415ADDA6EB33"><enum>(g)</enum><header>Annual appropriations to Medicare For All employment transition fund</header><text>Sums are authorized to be appropriated annually as needed to fund the Medicare For All Employment Transition Benefits.</text>
</subsection><subsection id="H36B5EC3949EC468683CA16B1D6F432B0"><enum>(h)</enum><header>Retention of right to unemployment benefits</header><text>Nothing in this section shall be interpreted as a waiver of Medicare For All Employment Transition benefit recipients’ right to receive Federal and State unemployment benefits.</text>
</subsection></section><section id="H7C8577ACFAE54377AD41FBB4F2E18F9E"><enum>304.</enum><header>Confidential electronic patient record system</header>
<subsection id="HD727B5FEC4624536AEE2E9020BADE21E"><enum>(a)</enum><header>In general</header><text>The Secretary shall create a standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy.</text>
</subsection><subsection id="H0E4974266AB64AB180FF7F0B3E579DEE"><enum>(b)</enum><header>Patient option</header><text>Notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record.</text>
</subsection></section><section id="H1AA33722963248B39F8F6E56EE74BD70"><enum>305.</enum><header>National Board of Universal Quality and Access</header>
<subsection id="H63C0F239301C4A37B1A82617C4636FEC"><enum>(a)</enum><header>Establishment</header>
<paragraph id="H439EFBD63FA04B98A706B60931559606"><enum>(1)</enum><header>In general</header><text>There is established a National Board of Universal Quality and Access (in this section referred to as the <quote>Board</quote>) consisting of 15 members appointed by the President, by and with the advice and consent of the Senate.</text>
</paragraph><paragraph id="H942B475737824BE39F9C01DE5AB9398A"><enum>(2)</enum><header>Qualifications</header><text>The appointed members of the Board shall include at least one of each of the following:</text> <subparagraph id="HFE16693C1F7D43E392D2CBDC9423672A"><enum>(A)</enum><text>Health care professionals.</text>
</subparagraph><subparagraph id="H6C0DF4AFD3DF4C198B75942EE46D7EF7"><enum>(B)</enum><text>Representatives of institutional providers of health care.</text> </subparagraph><subparagraph id="H13F4A516A22F4446B323CDF3FC13499F"><enum>(C)</enum><text>Representatives of health care advocacy groups.</text>
</subparagraph><subparagraph id="H6F5C53287B484FDA850819710FE85A3A"><enum>(D)</enum><text>Representatives of labor unions.</text> </subparagraph><subparagraph id="HCEF6F5AF802A4A7FAFAE76E289506B7D"><enum>(E)</enum><text>Citizen patient advocates.</text>
</subparagraph></paragraph><paragraph id="H140127E182CB4A69B0639FAC6EDD4C40"><enum>(3)</enum><header>Terms</header><text>Each member shall be appointed for a term of 6 years, except that the President shall stagger the terms of members initially appointed so that the term of no more than 3 members expires in any year.</text>
</paragraph><paragraph id="H408DBA20311E4BFC84E9A2E9761FE4C2"><enum>(4)</enum><header>Prohibition on conflicts of interest</header><text>No member of the Board shall have a financial conflict of interest with the duties before the Board.</text>
</paragraph></subsection><subsection id="H4E1F05F6B793421B9782FA885857EED2"><enum>(b)</enum><header>Duties</header>
<paragraph id="HCF5E858666364DEF91CEB29435D5CC62"><enum>(1)</enum><header>In general</header><text>The Board shall meet at least twice per year and shall advise the Secretary and the Director on a regular basis to ensure quality, access, and affordability.</text>
</paragraph><paragraph id="H597F7D185CB04F8D8B1DE002BBA6BCF6"><enum>(2)</enum><header>Specific issues</header><text>The Board shall specifically address the following issues:</text> <subparagraph id="H0CCE746AEBBA4A12B9F7890BC02C9581"><enum>(A)</enum><text>Access to care.</text>
</subparagraph><subparagraph id="HF5C15980DD934453A92ED334ECA82159"><enum>(B)</enum><text>Quality improvement.</text> </subparagraph><subparagraph id="H840E550BB92940A8A516337013D90470"><enum>(C)</enum><text>Efficiency of administration.</text>
</subparagraph><subparagraph id="HED314840F6624B19AFCA30A3188D5FD8"><enum>(D)</enum><text>Adequacy of budget and funding.</text> </subparagraph><subparagraph id="HCAA2910EA66E4EA39037A3242B6F6BAB"><enum>(E)</enum><text>Appropriateness of reimbursement levels of physicians and other providers.</text>
</subparagraph><subparagraph id="H8529EC886BA34B959BDCD37CB2262CDB"><enum>(F)</enum><text>Capital expenditure needs.</text> </subparagraph><subparagraph id="H07F05A386C104292B5FAD2183565FEEF"><enum>(G)</enum><text>Long-term care.</text>
</subparagraph><subparagraph id="H16DCF32E125B4E5CBF420384D02131D9"><enum>(H)</enum><text>Mental health and substance abuse services.</text> </subparagraph><subparagraph id="H3A1B88FBC983423D888E1B9E6FD208D5"><enum>(I)</enum><text>Staffing levels and working conditions in health care delivery facilities.</text>
</subparagraph></paragraph><paragraph id="H14BCD22540A8410595131E2F832EF4AE"><enum>(3)</enum><header>Establishment of universal, best quality standard of care</header><text>The Board shall specifically establish a universal, best quality of standard of care with respect to—</text>
<subparagraph id="HC805436F7B234C01831B11FE00DDAE22"><enum>(A)</enum><text>appropriate staffing levels;</text> </subparagraph><subparagraph id="H45577CC34C994FE48CDF813C4109BA4C"><enum>(B)</enum><text>appropriate medical technology;</text>
</subparagraph><subparagraph id="HA6D323956B1340F2B167986A705735AF"><enum>(C)</enum><text>design and scope of work in the health workplace;</text> </subparagraph><subparagraph id="HD1298583B2A9477EAEE9EEEBC110EB49"><enum>(D)</enum><text>best practices; and</text>
</subparagraph><subparagraph id="HE015DDB021214EC28EE5906746A3BE65"><enum>(E)</enum><text>salary level and working conditions of physicians, clinicians, nurses, other medical professionals, and appropriate support staff.</text>
</subparagraph></paragraph><paragraph id="H379933B8FDE94B129D6FC53AB82E28D4"><enum>(4)</enum><header>Twice-a-year report</header><text>The Board shall report its recommendations twice each year to the Secretary, the Director, Congress, and the President.</text>
</paragraph></subsection><subsection id="HFCD41FB75CC0428391B8611E4D83E207"><enum>(c)</enum><header>Compensation, etc</header><text>The following provisions of section 1805 of the <act-name parsable-cite="SSA">Social Security Act</act-name> shall apply to the Board in the same manner as they apply to the Medicare Payment Assessment Commission (except that any reference to the Commission or the Comptroller General shall be treated as references to the Board and the Secretary, respectively):</text>
<paragraph id="HCFC01F38BBA94DF9A2785FD63E84B6C1"><enum>(1)</enum><text>Subsection (c)(4) (relating to compensation of Board members).</text> </paragraph><paragraph id="HE85098FB7A4D462A8C43715A0ADF2F4A"><enum>(2)</enum><text>Subsection (c)(5) (relating to chairman and vice chairman).</text>
</paragraph><paragraph id="HB9ECE0E54F5B4F1EBA3692EB5BBB1117"><enum>(3)</enum><text>Subsection (c)(6) (relating to meetings).</text> </paragraph><paragraph id="HD6D5626F7F03476AA037BAE2DA76FEAC"><enum>(4)</enum><text>Subsection (d) (relating to director and staff; experts and consultants).</text>
</paragraph><paragraph id="H81C7255FF1664096AA5CB1F956A4DB44"><enum>(5)</enum><text>Subsection (e) (relating to powers).</text> </paragraph></subsection></section><enum>IV</enum><header>ADDITIONAL PROVISIONS</header> <section id="H0B85BF961BE4437BB2F9B9A0FCB76947"><enum>401.</enum><header>Treatment of VA and IHS health programs</header> <subsection id="H6206989D20994F3D8B010AFBE41B1E3B"><enum>(a)</enum><header>VA health programs</header><text>This Act provides for health programs of the Department of Veterans’ Affairs to initially remain independent for the 10-year period that begins on the date of the establishment of the Medicare For All Program. After such 10-year period, the Congress shall reevaluate whether such programs shall remain independent or be integrated into the Medicare For All Program.</text>
</subsection><subsection id="H2F6F2C9591034DBFB1D758E63F0DB327"><enum>(b)</enum><header>Indian Health Service programs</header><text>This Act provides for health programs of the Indian Health Service to initially remain independent for the 5-year period that begins on the date of the establishment of the Medicare For All Program, after which such programs shall be integrated into the Medicare For All Program.</text>
</subsection></section><section id="HD41C90C263D6498A9D62B7244D7C1168"><enum>402.</enum><header>Public health and prevention</header><text display-inline="no-display-inline">It is the intent of this Act that the Program at all times stress the importance of good public health through the prevention of diseases.</text>
</section><section id="H3A2975A0FE804F00806201355A17BFC2"><enum>403.</enum><header>Reduction in health disparities</header><text display-inline="no-display-inline">It is the intent of this Act to reduce health disparities by race, ethnicity, income and geographic region, and to provide high quality, cost-effective, culturally appropriate care to all individuals regardless of race, ethnicity, sexual orientation, or language.</text>
</section><enum>V</enum><header>EFFECTIVE DATE</header>
<section id="H00D33C1DD832415AA066506CEC889BFE"><enum>501.</enum><header>Effective date</header><text display-inline="no-display-inline">Except as otherwise specifically provided, this Act shall take effect on the first day of the first year that begins more than 1 year after the date of the enactment of this Act, and shall apply to items and services furnished on or after such date.</text>
</section>