[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 4204 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
2d Session
S. 4204
To establish a Medicare-for-all national health insurance program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 12, 2022
Mr. Sanders (for himself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mrs.
Gillibrand, Mr. Heinrich, Ms. Hirono, Mr. Leahy, Mr. Lujan, Mr.
Padilla, Mr. Markey, Mr. Merkley, Mr. Schatz, Ms. Warren, and Mr.
Whitehouse) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To establish a Medicare-for-all national health insurance program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare for All
Act of 2022''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM; UNIVERSAL
ENTITLEMENT TO BENEFITS; ENROLLMENT
Sec. 101. Establishment of the Medicare for All Program.
Sec. 102. Universal entitlement to benefits.
Sec. 103. Freedom of choice.
Sec. 104. Non-discrimination.
Sec. 105. Enrollment.
Sec. 106. Effective date of benefits.
Sec. 107. Prohibition against duplicating coverage.
TITLE II--COMPREHENSIVE BENEFITS, INCLUDING BENEFITS FOR LONG-TERM CARE
Sec. 201. Comprehensive benefits.
Sec. 202. No patient cost-sharing.
Sec. 203. Exclusions and limitations.
Sec. 204. Continued coverage of institutional long-term care and other
services under Medicaid.
Sec. 205. Prohibiting recovery of correctly paid Medicaid benefits.
Sec. 206. Additional State standards.
TITLE III--PROVIDER PARTICIPATION
Sec. 301. Provider participation and standards; whistleblower
protections.
Sec. 302. Qualifications for providers.
Sec. 303. Use of private contracts.
TITLE IV--ADMINISTRATION
Subtitle A--General Administration Provisions
Sec. 401. Administration.
Sec. 402. Consultation.
Sec. 403. Regional administration.
Sec. 404. Beneficiary Ombudsman.
Sec. 405. Conduct of related health programs.
Subtitle B--Control Over Fraud and Abuse
Sec. 411. Application of Federal sanctions to all fraud and abuse under
Medicare for All Program.
TITLE V--QUALITY OF CARE
Sec. 501. Quality standards.
Sec. 502. Addressing health care disparities.
TITLE VI--NATIONAL HEALTH BUDGET; PROVIDER PAYMENTS; COST CONTAINMENT
MEASURES
Subtitle A--Budgeting
Sec. 601. National health budget.
Sec. 602. Temporary worker assistance.
Subtitle B--Payments to Providers
Sec. 611. Payments to institutional providers based on global budgets.
Sec. 612. Payments to individual providers through fee-for-service.
Sec. 613. Accurate valuation of services under the Medicare physician
fee schedule.
Sec. 614. Payments for prescription drugs and approved devices and
equipment.
Sec. 615. Payment prohibitions; capital expenditures; special projects.
Sec. 616. Office of Health Equity.
Sec. 617. Office of Primary Health Care.
TITLE VII--UNIVERSAL MEDICARE TRUST FUND
Sec. 701. Universal Medicare Trust Fund.
TITLE VIII--CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME
SECURITY ACT OF 1974
Sec. 801. Prohibition of employee benefits duplicative of benefits
under the Medicare for All Program;
coordination in case of workers'
compensation.
Sec. 802. Repeal of continuation coverage requirements under ERISA and
certain other requirements relating to
group health plans.
Sec. 803. Effective date of title.
TITLE IX--ADDITIONAL CONFORMING AMENDMENTS
Sec. 901. Relationship to existing Federal health programs.
Sec. 902. Sunset of provisions related to the State Exchanges.
TITLE X--TRANSITION TO MEDICARE FOR ALL
Subtitle A--Improvements to Medicare
Sec. 1001. Protecting Medicare fee-for-service beneficiaries from high
out-of-pocket costs.
Sec. 1002. Reducing Medicare part D annual out-of-pocket threshold and
eliminating cost-sharing above that
threshold.
Sec. 1003. Expanding Medicare to cover dental and vision services and
hearing aids and examinations under part B.
Sec. 1004. Eliminating the 24-month waiting period for Medicare
coverage for individuals with disabilities.
Sec. 1005. Guaranteed issue of Medigap policies.
Subtitle B--Temporary Medicare Buy-In Option and Temporary Public
Option
Sec. 1011. Lowering the Medicare age.
Sec. 1012. Establishment of the Medicare transition plan.
Subtitle C--Patient Protections During Medicare for All Transition
Period
Sec. 1021. Minimizing disruptions to patient care.
Sec. 1022. Public consultation.
Sec. 1023. Definitions.
TITLE XI--MISCELLANEOUS
Sec. 1101. Updating resource limits for Supplemental Security Income
eligibility (SSI).
Sec. 1102. Definitions.
TITLE I--ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM; UNIVERSAL
ENTITLEMENT TO BENEFITS; ENROLLMENT
SEC. 101. ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM.
There is hereby established a national health insurance program to
provide comprehensive protection against the costs of health care and
health-related services, in accordance with the standards specified in,
or established under, this Act.
SEC. 102. UNIVERSAL ENTITLEMENT TO BENEFITS.
(a) In General.--Every individual who is a resident of the United
States is entitled to benefits for health care services under this Act.
The Secretary shall promulgate a rule that provides criteria for
determining residency for eligibility purposes under this Act.
(b) Treatment of Other Individuals.--The Secretary--
(1) may make eligible for benefits for health care services
under this Act other individuals not described in subsection
(a) and regulate their eligibility to ensure that every person
in the United States has access to health care; and
(2) shall promulgate a rule, consistent with Federal
immigration laws, to prevent an individual from traveling to
the United States for the sole purpose of obtaining health care
services provided under this Act.
SEC. 103. FREEDOM OF CHOICE.
Any individual entitled to benefits under this Act may obtain
health services from any institution, agency, or individual qualified
to participate under this Act.
SEC. 104. NON-DISCRIMINATION.
(a) In General.--No person shall, on the basis of race, color,
national origin, age, disability, marital status, citizenship status,
primary language use, genetic conditions, previous or existing medical
conditions, religion, or sex, including sex stereotyping, gender
identity, sexual orientation, and pregnancy and related medical
conditions (including termination of pregnancy), be excluded from
participation in or be denied the benefits of the program established
under this Act (except as expressly authorized by this Act for purposes
of enforcing eligibility standards described in section 102), or be
subject to any reduction of benefits or other discrimination by any
participating provider (as defined in section 301), or any entity
conducting, administering, or funding a health program or activity,
including contracts of insurance, pursuant to this Act.
(b) Claims of Discrimination.--
(1) In general.--The Secretary shall establish a procedure
for adjudication of administrative complaints alleging a
violation of subsection (a).
(2) Jurisdiction.--Any person aggrieved by a violation of
subsection (a) by a covered entity may file suit in any
district court of the United States having jurisdiction of the
parties. A person may bring an action under this paragraph
concurrently with such administrative remedies as established
in paragraph (1).
(3) Damages.--If the court finds a violation of subsection
(a), the court may grant compensatory and punitive damages,
declaratory relief, injunctive relief, attorneys' fees and
costs, or other relief as appropriate.
(c) Continued Application of Laws.--Nothing in this title (or an
amendment made by this title) shall be construed to invalidate or
otherwise limit any of the rights, remedies, procedures, or legal
standards available to individuals aggrieved under section 1557 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18116), title VI
of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title VII of
the Civil Rights Act of 1964 (42 U.S.C. 2000e et seq.), title IX of the
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), section 504 of
the Rehabilitation Act of 1973 (29 U.S.C. 794), or the Age
Discrimination Act of 1975 (42 U.S.C. 611 et seq.). Nothing in this
title (or an amendment to this title) shall be construed to supersede
State laws that provide additional protections against discrimination
on any basis described in subsection (a).
SEC. 105. ENROLLMENT.
(a) In General.--The Secretary shall provide a mechanism for the
enrollment of individuals eligible for benefits under this Act. The
mechanism shall--
(1) include a process for the automatic enrollment of
individuals at the time of birth in the United States (or upon
establishment of residency in the United States);
(2) provide for the enrollment, as of the date described in
section 106, of all individuals who are eligible to be enrolled
as of such date; and
(3) include a process for the enrollment of individuals
made eligible for health care services under section 102(b).
(b) Issuance of Medicare for All Cards.--In conjunction with an
individual's enrollment for benefits under this Act, the Secretary
shall provide for the issuance of a Medicare for All card that shall be
used for purposes of identification and processing of claims for
benefits under this program. The card shall not include an individual's
Social Security number.
SEC. 106. EFFECTIVE DATE OF BENEFITS.
(a) In General.--Except as provided in subsection (b), benefits
shall first be available under this Act for items and services
furnished on January 1 of the fourth calendar year that begins after
the date of enactment of this Act.
(b) Immediate Coverage of Children.--
(1) In general.--For any eligible individual who has not
yet attained the age of 19 as of the date that is 1 year after
the date of enactment of this Act, benefits shall first be
available under this Act for items and services furnished on
January 1 of the first calendar year that begins after the date
of enactment of this Act.
(2) Option to continue in other coverage during transition
period.--Any person who is eligible to receive benefits as
described in paragraph (1) may opt to maintain any coverage
described in section 901, private health insurance coverage, or
coverage offered pursuant to subtitle A of title X (including
the amendments made by such subtitle) until the date on which
benefits are first available under subsection (a).
SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) In General.--Beginning on the date on which benefits are first
available under section 106(a), it shall be unlawful for--
(1) a private health insurer to sell health insurance
coverage that duplicates the benefits provided under this Act;
or
(2) an employer to provide benefits for an employee, former
employee, or the dependents of an employee or former employee
that duplicate the benefits provided under this Act.
(b) Construction.--Nothing in this Act shall be construed as
prohibiting the sale of health insurance coverage for any additional
benefits not covered by this Act, including additional benefits that an
employer may provide to employees or their dependents, or to former
employees or their dependents.
TITLE II--COMPREHENSIVE BENEFITS, INCLUDING BENEFITS FOR LONG-TERM CARE
SEC. 201. COMPREHENSIVE BENEFITS.
(a) In General.--Subject to the other provisions of this title and
titles IV through IX, individuals enrolled for benefits under this Act
are entitled to have payment made by the Secretary to an eligible
provider for the following items and services if medically necessary or
appropriate for the maintenance of health or for the diagnosis,
treatment, or rehabilitation of a health condition:
(1) Hospital services, including inpatient and outpatient
hospital care, including 24-hour-a-day emergency services and
inpatient prescription drugs.
(2) Ambulatory patient services.
(3) Primary and preventive services, including chronic
disease management.
(4) Prescription drugs and medical devices, including
outpatient drugs and devices.
(5) Mental health and substance use treatment services,
including inpatient care and treatment for co-occurring mental
illness and substance use disorders.
(6) Laboratory and diagnostic services.
(7) Comprehensive reproductive, maternity, and newborn
care.
(8) Pediatrics, including early and periodic screening,
diagnostic, and treatment services (as defined in section
1905(r) of the Social Security Act (42 U.S.C. 1396d(r))).
(9) Oral health, audiology, and vision services.
(10) Rehabilitative and habilitative services and devices.
(11) Emergency services and transportation.
(12) Necessary transportation to receive health care
services for persons with disabilities, older individuals with
functional limitations, and low-income individuals (as
determined by the Secretary).
(13) Services provided by a licensed marriage and family
therapist or a licensed mental health counselor.
(14) Home and community-based long-term services and
supports (to be provided in accordance with the requirements
for home and community-based settings under sections 441.530
and 441.710 of title 42, Code of Federal Regulations),
including--
(A) services described in paragraphs (7), (8),
(13), (19), and (24) of section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a));
(B) home and community-based services described in
subsection (c)(4)(B) of section 1915 of the Social
Security Act (including habilitation services defined
in subsection (c)(5) of such section);
(C) self-directed home and community-based services
described in subsection (i) of section 1915 of the
Social Security Act;
(D) self-directed personal assistance services (as
defined in subsection (j)(4)(A) of section 1915 of the
Social Security Act); and
(E) home and community-based attendant services and
supports described in subsection (k) of section 1915 of
the Social Security Act.
(b) Revision.--The Secretary shall, at least on an annual basis,
evaluate whether the benefits package should be improved to promote the
health of beneficiaries, account for changes in medical practice or new
information from medical research, or respond to other relevant
developments in health science, and shall make recommendations to
Congress regarding any such improvements.
(c) Complementary and Alternative Medicine.--
(1) In general.--In carrying out subsection (b), the
Secretary shall consult with the persons described in paragraph
(1) with respect to--
(A) identifying specific complementary and
integrative medicine practices that are appropriate to
include in the benefits package; and
(B) identifying barriers to the effective provision
and integration of such practices into the delivery of
health care, and identifying mechanisms for overcoming
such barriers.
(2) Consultation.--In accordance with paragraph (1), the
Secretary shall consult with--
(A) the Director of the National Center for
Complementary and Integrative Health;
(B) the Commissioner of Food and Drugs;
(C) institutions of higher education, private
research institutes, and individual researchers with
extensive experience in complementary and integrative
medicine and the integration of such practices into the
delivery of health care;
(D) nationally recognized providers of
complementary and alternative medicine; and
(E) such other officials, entities, and individuals
with expertise on complementary and integrative
medicine as the Secretary determines appropriate.
(d) States May Provide Additional Benefits.--Individual States may
provide additional benefits for the residents of such States, as
determined by such State, and may provide benefits to individuals not
eligible for benefits under this Act at the expense of the State.
SEC. 202. NO PATIENT COST-SHARING.
(a) In General.--The Secretary shall ensure that no cost-sharing,
including deductibles, coinsurance, copayments, or similar charges, be
imposed on an individual for any benefits provided under this Act,
except as described in subsection (b).
(b) Exceptions.--The Secretary may set a cost-sharing schedule for
prescription drugs--
(1) provided that--
(A) such schedule is evidence-based, patient-
centered, and encourages the use of generic drugs;
(B) such cost-sharing does not apply to preventive
drugs;
(C) such cost-sharing does not exceed $200 annually
per individual, adjusted annually for inflation; and
(D) such cost-sharing is not imposed on individuals
with a household income equal to or below 250 percent
of the poverty line for a family of the size involved;
and
(2) under which the Secretary may--
(A) exempt brand-name drugs from consideration in
determining whether an individual has reached any out-
of-pocket limit if a safe and appropriate generic
version of such drug is available to such individual;
and
(B) waive cost-sharing in response to a coverage
appeal under section 203(b)(2).
(c) No Balance Billing.--Notwithstanding contracts in accordance
with section 303, no provider may impose a charge to an enrolled
individual for covered services for which benefits are provided under
this Act.
SEC. 203. EXCLUSIONS AND LIMITATIONS.
(a) In General.--Benefits for items and services are not available
under this Act unless the services meet the standards developed by the
Secretary pursuant to section 201(a).
(b) Treatment of Experimental Services and Drugs.--
(1) In general.--In applying subsection (a), the Secretary
shall make national coverage determinations with respect to
services that are experimental in nature. Such determinations
shall be consistent with the national coverage determination
process as defined in section 1869(f)(1)(B) of the Social
Security Act (42 U.S.C. 1395ff(f)(1)(B)).
(2) Appeals process.--The Secretary shall establish a
process by which individuals can appeal coverage decisions. The
process shall, as much as is feasible, follow the process for
appeals under the Medicare program described in section 1869 of
the Social Security Act (42 U.S.C. 1395ff).
(c) Application of Practice Guidelines.--
(1) In general.--In the case of items and services for
which the Department of Health and Human Services has
recognized a national practice guideline, such items and
services are considered to meet the standards specified in
section 201(a) if they have been provided in accordance with
such guideline.
(2) Certain exceptions.--For purposes of this subsection,
an item or service not provided in accordance with a national
practice guideline shall be considered to have been provided in
accordance with such guideline if the health care provider
providing the item or service--
(A) exercised appropriate professional discretion
to deviate from the guideline in a manner authorized or
anticipated by the guideline;
(B) acted in accordance with the laws and
requirements in which such item or service is
furnished;
(C) acted in the best interests of the individual
receiving the item or service; and
(D) acted in a manner consistent with the
individual's wishes.
SEC. 204. CONTINUED COVERAGE OF INSTITUTIONAL LONG-TERM CARE AND OTHER
SERVICES UNDER MEDICAID.
Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is
amended by inserting the following section after section 1947:
``state plan for providing institutional long-term care services
``Sec. 1948. (a) In General.--For quarters beginning on or after
the date on which benefits are first available under section 106(a) of
the Medicare for All Act of 2022, notwithstanding any other provision
of this title--
``(1) a State plan for medical assistance shall provide for
making medical assistance available for services that are
institutional long-term care services in a manner consistent
with this section; and
``(2) no payment to a State shall be made under this title
with respect to expenditures incurred by the State in providing
medical assistance on or after such date for services that are
not--
``(A) institutional long-term care services; or
``(B) other services for which benefits are not
available under the Medicare for All Act of 2022 and
which are furnished under a State plan for medical
assistance which provided for medical assistance for
such services on September 1, 2021.
``(b) Institutional Long-Term Care Services Defined.--In this
section, the term `institutional long-term care services' means the
following:
``(1) Nursing facility services for individuals 21 years of
age or over described in subparagraph (A) of section
1905(a)(4).
``(2) Inpatient services for individuals 65 years of age or
over provided in an institution for mental disease described in
section 1905(a)(14).
``(3) Intermediate care facility services described in
section 1905(a)(15).
``(4) Inpatient psychiatric hospital services for
individuals under age 21 described in section 1905(a)(16).
``(5) Nursing facility services described in section
1905(a)(29).
``(c) State Maintenance of Effort Requirement.--
``(1) Eligibility standards.--
``(A) In general.--Beginning on the date described
in subsection (a), no payment may be made under section
1903 with respect to medical assistance provided under
a State plan for medical assistance if the State adopts
income, resource, or other standards and methodologies
for purposes of determining an individual's eligibility
for medical assistance under the State plan that are
more restrictive than those applied as of January 1,
2022.
``(B) Indexing of amounts of income and resource
standards.--In determining whether a State has adopted
income or resource standards that are more restrictive
than the standards which applied as of January 1, 2022,
the Secretary shall deem the amount of any such
standard that was applied as of such date to be
increased by the percentage increase in the medical
care component of the consumer price index for all
urban consumers (U.S. city average) from September of
2021 to September of the fiscal year for which the
Secretary is making such determination.
``(2) Expenditures.--
``(A) In general.--For each fiscal year or portion
of a fiscal year that occurs during the period that
begins on the first day of the first fiscal quarter
that begins on or after the date on which benefits are
first available under section 106(a) of the Medicare
for All Act of 2022, as a condition of receiving
payments under section 1903(a), a State shall make
expenditures for medical assistance for services that
are institutional long-term care services in an amount
that is not less than the expenditure floor determined
for the State and fiscal year (or portion of a fiscal
year) under subparagraph (B).
``(B) Expenditure floor.--
``(i) In general.--For each fiscal year or
portion of a fiscal year described in
subparagraph (A), the Secretary shall determine
for each State an expenditure floor that shall
be equal to--
``(I) the amount of the State's
expenditures for fiscal year 2021 on
medical assistance for institutional
long-term care services; increased by
``(II) the growth factor determined
under subclause (ii).
``(ii) Growth factor.--For each fiscal year
or portion of a fiscal year described in
subparagraph (A), the Secretary shall, not
later than September 1 of the fiscal year
preceding such fiscal year or portion of a
fiscal year, determine a growth factor for each
State that takes into account--
``(I) the percentage increase in
health care costs in the State;
``(II) the total amount expended by
the State for the previous fiscal year
on medical assistance for institutional
long-term care services;
``(III) the increase, if any, in
the total population of the State from
July of 2021 to July of the fiscal year
preceding the fiscal year involved;
``(IV) the increase, if any, in the
population of individuals aged 65 and
older of the State from July of 2021 to
July of the fiscal year preceding the
fiscal year involved; and
``(V) the decrease, if any, in the
population of the State that requires
medical assistance for institutional
long-term care services that is
attributable to the availability of
coverage for the services described in
section 201(a)(13) of the Medicare for
All Act of 2022.
``(iii) Proration rule.--Any amount
determined under this subparagraph for a
portion of a fiscal year shall be prorated
based on the length of such portion of a fiscal
year relative to a complete fiscal year.
``(d) Nonapplication of Certain Requirements.--Beginning on the
date described in subsection (a), any provision of this title requiring
a State plan for medical assistance to make available medical
assistance for services that are not institutional long-term care
services or services described in section 901(a)(3)(A)(ii) of the
Medicare for All Act of 2022 shall have no effect.''.
SEC. 205. PROHIBITING RECOVERY OF CORRECTLY PAID MEDICAID BENEFITS.
Section 1917 of the Social Security Act (42 U.S.C. 1396p) is
amended--
(1) by amending subsection (a) to read as follows:
``(a) No lien may be imposed against the property of any individual
prior to his death on account of medical assistance paid or to be paid
on his behalf under the State plan, except pursuant to the judgment of
a court on account of benefits incorrectly paid on behalf of such
individual.''; and
(2) by amending subsection (b) to read as follows:
``(b) No adjustment or recovery of any medical assistance correctly
paid on behalf of an individual under the State plan may be made.''.
SEC. 206. ADDITIONAL STATE STANDARDS.
(a) In General.--Nothing in this Act shall prohibit individual
States from setting additional standards, with respect to eligibility,
benefits, and minimum provider standards, consistent with the purposes
of this Act, provided that such standards do not restrict eligibility
or reduce access to benefits for items and services.
(b) Restrictions on Providers.--With respect to any individuals or
entities certified to provide services covered under section 201(a)(7),
a State may not prohibit an individual or entity from participating in
the program under this Act, for reasons other than the ability of the
individual or entity to provide such services.
TITLE III--PROVIDER PARTICIPATION
SEC. 301. PROVIDER PARTICIPATION AND STANDARDS; WHISTLEBLOWER
PROTECTIONS.
(a) In General.--An individual or other entity furnishing any
covered item or service under this Act is not a qualified provider
unless the individual or entity--
(1) is a qualified provider of the items or services under
section 302;
(2) has filed with the Secretary a participation agreement
described in subsection (b); and
(3) meets, as applicable, such other qualifications and
conditions with respect to a provider of services under title
XVIII of the Social Security Act as described in section 1866
of the Social Security Act (42 U.S.C. 1395cc).
(b) Requirements in Participation Agreement.--
(1) In general.--A participation agreement described in
this subsection between the Secretary and a provider shall
provide at least for the following:
(A) Items and services to eligible persons shall be
furnished by the provider without discrimination, in
accordance with section 104(a). Nothing in this
subparagraph shall be construed as requiring the
provision of a type or class of items or services that
are outside the scope of the provider's normal
practice.
(B) No charge will be made to any enrolled
individual for any covered items or services other than
for payment authorized by this Act.
(C) The provider agrees to furnish such information
as may be reasonably required by the Secretary, in
accordance with uniform reporting standards established
under section 401(b)(1), for--
(i) quality review by designated entities;
(ii) making payments under this Act,
including the examination of records as may be
necessary for the verification of information
on which such payments are based;
(iii) statistical or other studies required
for the implementation of this Act; and
(iv) such other purposes as the Secretary
may specify.
(D) In the case of a provider that is not an
individual, the provider agrees not to employ or use
for the provision of health services any individual or
other provider that has had a participation agreement
under this subsection terminated for cause. The
Secretary may authorize such employment or use on a
case-by-case basis.
(E) In the case of a provider paid under a fee-for-
service basis for items and services furnished under
this Act, the provider agrees to submit bills and any
required supporting documentation relating to the
provision of covered items and services within 30 days
after the date of providing such items and services.
(F) In the case of an institutional provider paid
pursuant to section 611, the provider agrees to submit
information and any other required supporting
documentation as may be reasonably required by the
Secretary within 30 days after the date of providing
such items and services and in accordance with the
uniform reporting standards established under section
401(b)(1), including information on a quarterly basis
that--
(i) relates to the provision of covered
items and services; and
(ii) describes items and services furnished
with respect to specific individuals.
(G) In the case of a provider that receives payment
for items and services furnished under this Act based
on diagnosis-related coding, procedure coding, or other
coding system or data, the provider agrees--
(i) to disclose to the Secretary any system
or index of coding or classifying patient
symptoms, diagnoses, clinical interventions,
episodes, or procedures that such provider
utilizes for global budget negotiations under
title VI or for meeting any other payment,
documentation, or data collection requirements
under this Act; and
(ii) not to use any such system or index to
establish financial incentives or disincentives
for health care professionals, or that is
proprietary, interferes with the medical or
nursing process, or is designed to increase the
amount or number of payments.
(H) The provider complies with the duty of provider
ethics and reporting requirements described in
paragraph (2).
(I) In the case of a provider that is not an
individual, the provider agrees that no board member,
executive, or administrator of such provider receives
compensation from, owns stock or has other financial
investments in, or serves as a board member of any
entity that contracts with or provides items or
services, including pharmaceutical products and medical
devices or equipment, to such provider.
(2) Provider duty of ethics.--Each health care provider,
including institutional providers, has a duty to advocate for
and to act in the exclusive interest of each individual under
the care of such provider according to the applicable legal
standard of care, such that no financial interest or
relationship impairs any health care provider's ability to
furnish necessary and appropriate care to such individual. To
implement the duty established in this paragraph, the Secretary
shall--
(A) promulgate reasonable reporting rules to
evaluate participating provider compliance with this
paragraph;
(B) prohibit participating providers, spouses, and
immediate family members of participating providers,
from accepting or entering into any arrangement for any
bonus, incentive payment, profit-sharing, or
compensation based on patient utilization or based on
financial outcomes of any other provider or entity; and
(C) prohibit participating providers or any board
member or representative of such provider from serving
as board members for or receiving any compensation,
stock, or other financial investment in an entity that
contracts with or provides items or services (including
pharmaceutical products and medical devices or
equipment) to such provider.
(3) Termination of participation agreement.--
(A) In general.--Participation agreements may be
terminated, with appropriate notice--
(i) by the Secretary for failure to meet
the requirements of this Act;
(ii) in accordance with the provisions
described in section 411; or
(iii) by a provider.
(B) Termination process.--Providers shall be
provided notice and a reasonable opportunity to correct
deficiencies before the Secretary terminates an
agreement unless a more immediate termination is
required for public safety or similar reasons.
(C) Provider protections.--
(i) Prohibition.--The Secretary may not
terminate a participation agreement or in any
other way discriminate against, or cause to be
discriminated against, any covered provider or
authorized representative of the provider, on
account of such provider or representative--
(I) providing, causing to be
provided, or being about to provide or
cause to be provided to the provider,
the Federal Government, or the attorney
general of a State information relating
to any violation of, or any act or
omission the provider or representative
reasonably believes to be a violation
of, any provision of this title (or an
amendment made by this title);
(II) testifying or being about to
testify in a proceeding concerning such
violation;
(III) assisting or participating,
or being about to assist or
participate, in such a proceeding; or
(IV) objecting to, or refusing to
participate in, any activity, policy,
practice, or assigned task that the
provider or representative reasonably
believes to be in violation of any
provision of this Act (including any
amendment made by this Act), or any
order, rule, regulation, standard, or
ban under this Act (including any
amendment made by this Act).
(ii) Complaint procedure.--A provider or
representative who believes that he or she has
been discriminated against in violation of this
section may seek relief in accordance with the
procedures, notifications, burdens of proof,
remedies, and statutes of limitation set forth
in section 2087(b) of title 15, United States
Code.
(c) Whistleblower Protections.--
(1) Retaliation prohibited.--No person may discharge or
otherwise discriminate against any employee because the
employee or any person acting pursuant to a request of the
employee--
(A) notified the Secretary or the employee's
employer of any alleged violation of this title,
including communications related to carrying out the
employee's job duties;
(B) refused to engage in any practice made unlawful
by this title, if the employee has identified the
alleged illegality to the employer;
(C) testified before or otherwise provided
information relevant for Congress or for any Federal or
State proceeding regarding any provision (or proposed
provision) of this title;
(D) commenced, caused to be commenced, or is about
to commence or cause to be commenced a proceeding under
this title;
(E) testified or is about to testify in any such
proceeding; or
(F) assisted or participated or is about to assist
or participate in any manner in such a proceeding or in
any other manner in such a proceeding or in any other
action to carry out the purposes of this title.
(2) Enforcement action.--Any employee covered by this
section who alleges discrimination by an employer in violation
of paragraph (1) may bring an action, subject to the statute of
limitations in the anti-retaliation provisions of the False
Claims Act and the rules and procedures, legal burdens of
proof, and remedies applicable under the employee protections
provisions of the Surface Transportation Assistance Act.
(3) Application.--
(A) Nothing in this subsection shall be construed
to diminish the rights, privileges, or remedies of any
employee under any Federal or State law or regulation,
including the rights and remedies against retaliatory
action under the False Claims Act (31 U.S.C. 3730(h)),
or under any collective bargaining agreement. The
rights and remedies in this section may not be waived
by any agreement, policy, form, or condition of
employment.
(B) Nothing in this subsection shall be construed
to preempt or diminish any other Federal or State law
or regulation against discrimination, demotion,
discharge, suspension, threats, harassment, reprimand,
retaliation, or any other manner of discrimination,
including the rights and remedies against retaliatory
action under the False Claims Act (31 U.S.C. 3730(h)).
(4) Definitions.--In this subsection:
(A) Employer.--The term ``employer'' means any
person engaged in profit or nonprofit business or
industry, including one or more individuals,
partnerships, associations, corporations, trusts,
professional membership organization including a
certification, disciplinary, or other professional
body, unincorporated organizations, nongovernmental
organizations, or trustees, and subject to liability
for violating the provisions of this Act.
(B) Employee.--The term ``employee'' means any
individual performing activities under this Act on
behalf of an employer.
SEC. 302. QUALIFICATIONS FOR PROVIDERS.
(a) In General.--A health care provider is considered a qualified
provider to furnish covered items and services under this Act if the
provider is licensed or certified to furnish such items and services in
the State in which the individual receiving such items and services is
located and meets--
(1) the requirements of such State's laws to furnish such
items and services; and
(2) applicable requirements of Federal law to furnish such
items and services.
(b) Federal Providers.--Any provider qualified to provide health
care items and services at a facility of the Department of Veterans
Affairs, the Indian Health Service, or the uniformed services (as
defined in section 1072(1) of title 10, United States Code) (with
respect to the direct care component of the TRICARE program) is a
qualified provider under this section with respect to any individual
who qualifies for such items and services under applicable Federal law.
(c) Minimum Provider Standards.--
(1) In general.--The Secretary shall establish, evaluate,
and update national minimum standards to ensure the quality of
items and services provided under this Act and to monitor
efforts by States to ensure the quality of items and such
services. A State may also establish additional minimum
standards which providers shall meet with respect to services
provided in such State.
(2) National minimum standards.--The Secretary shall
establish national minimum standards under paragraph (1) for
institutional providers of services and individual health care
practitioners. Except as the Secretary may specify in order to
carry out this Act, a hospital, skilled nursing facility, or
other institutional provider of services shall meet standards
applicable to such a provider under the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.). Such standards also may include, where appropriate,
elements relating to--
(A) adequacy and quality of facilities;
(B) training and competence of personnel (including
requirements related to the number or type of required
continuing education hours);
(C) comprehensiveness of service;
(D) continuity of service;
(E) patient waiting time, access to service, and
references; and
(F) performance standards, including organization,
facilities, structure of services, efficiency of
operation, and outcome in palliation, improvement of
health, stabilization, cure, or rehabilitation.
(3) Transition in application.--If the Secretary provides
for additional requirements for providers under this
subsection, any such additional requirement shall be
implemented in a manner that provides for a reasonable period
during which a previously qualified provider is permitted to
meet such an additional requirement.
SEC. 303. USE OF PRIVATE CONTRACTS.
(a) In General.--This section shall apply beginning on the date on
which benefits are first available under section 106(a), subject to the
provisions of this subsection, nothing in this Act shall prohibit an
institutional or individual provider from entering into a private
contract with an enrolled individual for any item or service--
(1) for which no claim for payment is to be submitted under
this Act; and
(2) for which the provider receives--
(A) no reimbursement under this Act directly or on
a capitated basis; and
(B) receives no amount for such item or service
from an organization which receives reimbursement for
such items or service under this Act directly or on a
capitated basis.
(b) Contract Requirements.--
(1) In general.--Any contract to provide items and services
under subsection (a) shall--
(A) be in writing and signed by the individual (or
authorized representative of the individual) receiving
the item or service before the item or service is
furnished pursuant to the contract;
(B) be entered into at a time when the individual
is facing an emergency health care situation; and
(C) contain the items described in paragraph (2).
(2) Items required to be included in contract.--Any
contract to provide items and services to which subsection (a)
applies shall clearly indicate to the individual that by
signing such contract the individual--
(A) agrees not to submit a claim (or to request
that the provider submit a claim) under this Act for
such items or services even if such items or services
are otherwise covered by this Act;
(B) agrees to be responsible, whether through
insurance offered under section 107(b) or otherwise,
for payment of such items or services and understands
that no reimbursement will be provided under this Act
for such items or services;
(C) acknowledges that no limits under this Act
apply to amounts that may be charged for such items or
services;
(D) if the provider is a nonparticipating provider,
acknowledges that the beneficiary has the right to have
such items or services provided by other providers for
whom payment would be made under this Act; and
(E) acknowledges that the provider is providing
services outside the scope of the program under this
Act.
(c) Provider Requirements.--
(1) In general.--Subsection (a) shall not apply to any
contract unless an affidavit described in paragraph (2) is in
effect during the period any item or service is to be provided
pursuant to the contract.
(2) Affidavit.--An affidavit as described in this
subparagraph shall--
(A) identify the practitioner, and be signed by
such practitioner;
(B) provide that the practitioner will not submit
any claim under this title for any item or service
provided to any beneficiary (and will not receive any
reimbursement or amount described in paragraph (1)(B)
for any such item or service) during the 1-year period
beginning on the date the affidavit is signed; and
(C) be filed with the Secretary no later than 10
days after the first contract to which such affidavit
applies is entered into.
(3) Enforcement.--If a physician or practitioner signing an
affidavit described in paragraph (2) knowingly and willfully
submits a claim under this title for any item or service
provided during the 1-year period described in paragraph (2)(B)
(or receives any reimbursement or amount described in
subsection (a)(2) for any such item or service) with respect to
such affidavit--
(A) this subsection shall not apply with respect to
any items and services provided by the physician or
practitioner pursuant to any contract on and after the
date of such submission and before the end of such
period; and
(B) no payment shall be made under this title for
any item or service furnished by the physician or
practitioner during the period described in clause (i)
(and no reimbursement or payment of any amount
described in subsection (a)(2) shall be made for any
such item or service).
TITLE IV--ADMINISTRATION
Subtitle A--General Administration Provisions
SEC. 401. ADMINISTRATION.
(a) General Duties of the Secretary.--
(1) In general.--The Secretary shall develop policies,
procedures, guidelines, and requirements to carry out this Act,
including related to--
(A) eligibility for benefits;
(B) enrollment;
(C) benefits provided;
(D) provider participation standards and
qualifications, as described in title III;
(E) levels of funding;
(F) methods for determining amounts of payments to
providers of covered items and services, consistent
with subtitle B;
(G) a process for appealing or petitioning for a
determination of coverage for items and services under
this Act;
(H) planning for capital expenditures and service
delivery;
(I) planning for health professional education
funding;
(J) encouraging States to develop regional planning
mechanisms; and
(K) any other regulations necessary to carry out
the purposes of this Act.
(2) Regulations.--Regulations authorized by this Act shall
be issued by the Secretary in accordance with section 553 of
title 5, United States Code.
(b) Uniform Reporting Standards; Annual Report; Studies.--
(1) Uniform reporting standards.--
(A) In general.--The Secretary shall establish
uniform State reporting requirements, provider
reporting requirements, and national standards to
ensure an adequate national database containing
information pertaining to health services
practitioners, approved providers, the costs of
facilities and practitioners providing such items and
services, the quality of such items and services, the
outcomes of such items and services, and the equity of
health among population groups. Such database shall
include, to the maximum extent feasible without
compromising patient privacy, health outcome measures
used under this Act, and to the maximum extent feasible
without excessively burdening providers, the measures
described in subparagraphs (D) through (F) of
subsection (a)(1).
(B) Reports.--The Secretary shall--
(i) regularly analyze information reported
to the Secretary; and
(ii) define rules and procedures to allow
researchers, scholars, health care providers,
and others to access and analyze data for
purposes consistent with quality and outcomes
research, without compromising patient privacy.
(2) Annual report.--Beginning January 1 of the second year
beginning after the effective date of this Act, the Secretary
shall annually report to Congress on the following:
(A) The status of implementation of the Act.
(B) Enrollment under this Act.
(C) Benefits under this Act.
(D) Expenditures and financing under this Act.
(E) Cost-containment measures and achievements
under this Act.
(F) Quality assurance.
(G) Health care utilization patterns, including any
changes attributable to the program.
(H) Changes in the per capita costs of health care.
(I) Differences in the health status of the
populations of the different States, by demographic
characteristics, including race, ethnicity, gender,
national origin, primary language use, age, disability,
sex (including gender identity and sexual orientation),
geography, or socioeconomic status.
(J) Progress on implementing quality and outcome
measures under this Act, and long-range plans and goals
for achievements in such areas.
(K) Plans for improving service to medically
underserved populations.
(L) Transition problems as a result of
implementation of this Act.
(M) Opportunities for improvements under this Act.
(3) Statistical analyses and other studies.--The Secretary
may, either directly or by contract--
(A) make statistical and other studies, on a
nationwide, regional, State, or local basis, of any
aspect of the operation of this Act;
(B) develop and test methods of delivery of items
and services as the Secretary may consider necessary or
promising for the evaluation, or for the improvement,
of the operation of this Act; and
(C) develop methodological standards for evidence-
based policymaking.
(c) Audits.--
(1) In general.--The Comptroller General of the United
States shall conduct an audit of the Department of Health and
Human Services every fifth fiscal year following the effective
date of this Act to determine the effectiveness of the program
in carrying out the duties under subsection (a).
(2) Reports.--The Comptroller General of the United States
shall submit a report to Congress concerning the results of
each audit conducted under this subsection.
SEC. 402. CONSULTATION.
The Secretary shall consult with Federal agencies, Indian Tribes
and urban Indian health organizations, and private entities, such as
labor organizations representing health care workers, professional
societies, national associations, nationally recognized associations of
health care experts, medical schools and academic health centers,
consumer groups, and labor business organizations in the formulation of
guidelines, regulations, policy initiatives, and information gathering
to ensure the broadest and most informed input in the administration of
this Act. Nothing in this Act shall prevent the Secretary from adopting
guidelines, consistent with section 203(c), developed by such a private
entity if, in the Secretary's judgment, such guidelines are generally
accepted as reasonable and prudent and consistent with this Act.
SEC. 403. REGIONAL ADMINISTRATION.
(a) Regional Medicare for All Offices.--The Secretary shall
establish and maintain regional offices for the purpose of carrying out
the duties specified in subsection (c) and promoting adequate access
to, and efficient use of, tertiary care facilities, equipment, items,
and services by individuals enrolled under this Act.
(b) Coordination.--Wherever possible, the Secretary shall
incorporate the regional offices and the administrative processes of
the Centers for Medicare & Medicaid Services for the purposes of
carrying out subsection (a).
(c) Appointment of Regional Directors.--In each regional office
established under subsection (a) there shall be--
(1) one regional director appointed by the Secretary;
(2) one deputy director appointed by the regional director
to represent the Indian and Alaska Native Tribes in the region,
if any; and
(3) one deputy director appointed by the regional director
to oversee home- and community-based services and supports.
(d) Duties.--Each regional director shall--
(1) submit an annual regional health care needs assessment
report to the Secretary, after a thorough examination of health
needs and consultation with public health officials,
clinicians, patients, and patient advocates;
(2) recommend any changes in provider reimbursement or
payment for delivery of health items and services determined
appropriate by the regional director, subject to the
requirements of title VI; and
(3) establish a quality assurance mechanism in each such
region in order to minimize both under-utilization and over-
utilization of health care items and services and to ensure
that all providers meet the quality and other standards
established pursuant to this Act.
SEC. 404. BENEFICIARY OMBUDSMAN.
(a) In General.--The Secretary shall appoint a Beneficiary
Ombudsman who shall have expertise and experience in the fields of
health care and education of, and assistance to, individuals entitled
to benefits under this Act.
(b) Duties.--The Beneficiary Ombudsman shall--
(1) receive complaints, grievances, and requests for
information submitted by individuals entitled to benefits under
this Act with respect to any aspect of the Medicare for All
Program;
(2) provide assistance with respect to complaints,
grievances, and requests referred to in subparagraph (a),
including--
(A) assistance in collecting relevant information
for such individuals, to seek an appeal of a decision
or determination made by a regional office or the
Secretary; and
(B) assistance to such individuals in presenting
information relating to cost-sharing; and
(3) submit annual reports to Congress and the Secretary
that describe the activities of the Office and that include
such recommendations for improvement in the administration of
this Act as the Ombudsman determines appropriate. The Ombudsman
shall not serve as an advocate for any increases in payments or
new coverage of services, but may identify issues and problems
in payment or coverage policies.
SEC. 405. CONDUCT OF RELATED HEALTH PROGRAMS.
In performing functions with respect to health personnel education
and training, health research, environmental health, disability
insurance, vocational rehabilitation, the regulation of food and drugs,
and all other matters pertaining to health, the Secretary shall direct
the activities of the Department of Health and Human Services toward
contributions to the health of the people complementary to this Act.
Subtitle B--Control Over Fraud and Abuse
SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL FRAUD AND ABUSE UNDER
MEDICARE FOR ALL PROGRAM.
The following sections of the Social Security Act shall apply to
this Act in the same manner as they apply to State medical assistance
plans under title XIX of such Act:
(1) Section 1128 (relating to exclusion of individuals and
entities).
(2) Section 1128A (civil monetary penalties).
(3) Section 1128B (criminal penalties).
(4) Section 1124 (relating to disclosure of ownership and
related information).
(5) Section 1126 (relating to disclosure of certain
owners).
(6) Section 1877 (relating to physician referrals).
TITLE V--QUALITY OF CARE
SEC. 501. QUALITY STANDARDS.
(a) In General.--All standards and quality measures under this Act
shall be implemented and evaluated by the Center for Clinical Standards
and Quality of the Centers for Medicare and Medicaid Services (referred
to in this title as the ``Center'') or such other agencies determined
appropriate by the Secretary, in coordination with the Agency for
Healthcare Research and Quality and other offices of the Department of
Health and Human Services.
(b) Duties of the Center.--The Center shall perform the following
duties:
(1) Review and evaluate each practice guideline developed
under part B of title IX of the Public Health Service Act (42
U.S.C. 299b et seq.). In so reviewing and evaluating, the
Center shall determine whether the guideline should be
recognized as a national practice guideline in accordance with
and subject to section 203(c).
(2) Review and evaluate each standard of quality,
performance measure, and medical review criterion developed
under part B of title IX of the Public Health Service Act (42
U.S.C. 299b et seq.). In so reviewing and evaluating, the
Center shall determine whether the standard, measure, or
criterion is appropriate for use in assessing or reviewing the
quality of items and services provided by health care
institutions or health care professionals. The use of
mechanisms that discriminate against people with disabilities
is prohibited for use in any value or cost-effectiveness
assessments. The Center shall consider the evidentiary basis
for the standard, and the validity, reliability, and
feasibility of measuring the standard.
(3) Adoption of methodologies for profiling the patterns of
practice of health care professionals and for identifying and
notifying outliers.
(4) Development of minimum criteria for competence for
entities that can qualify to conduct ongoing and continuous
external quality reviews in the administrative regions. Such
criteria shall require such an entity to be administratively
independent of the individual or board that administers the
region and shall ensure that such entities do not provide
financial incentives to reviewers to favor one pattern of
practice over another. The Center shall ensure coordination and
reporting by such entities to ensure national consistency in
quality standards.
(5) Submission of a report to the Secretary annually
specifically on findings from outcomes research and development
of practice guidelines that may affect the Secretary's
determination of coverage of services under section
401(a)(1)(G).
SEC. 502. ADDRESSING HEALTH CARE DISPARITIES.
(a) Evaluating Data Collection Approaches.--The Center, in
coordination with the Office of Health Equity established under section
615 and other agencies in the Department of Health and Human Services
deemed relevant by the Secretary, shall evaluate approaches for the
collection of data under this Act, to be performed in conjunction with
existing quality reporting requirements and programs under this Act,
that allow for the ongoing, accurate, and timely collection of data on
disparities in health care services and performance on the basis of
race, ethnicity, gender, national origin, primary language use, age,
disability, sex (including gender identity and sexual orientation),
geography, or socioeconomic status. In conducting such evaluation, the
Center shall consider the following objectives:
(1) Protecting patient privacy.
(2) Minimizing the administrative burdens of data
collection and reporting on providers under this Act.
(3) Improving data on race, ethnicity, national origin,
primary language use, age, disability, sex (including gender
identity and sexual orientation), geography, and socioeconomic
status.
(b) Reports to Congress.--
(1) Report on evaluation.--Not later than 18 months after
the date on which benefits are first available under section
106(a), the Center shall submit to Congress and the Secretary a
report on the evaluation conducted under subsection (a). Such
report shall, taking into consideration the results of such
evaluation--
(A) identify approaches (including defining
methodologies) for identifying and collecting and
evaluating data on health care disparities on the basis
of race, ethnicity, gender national origin, primary
language use, age, disability, sex (including gender
identity and sexual orientation), geography, or
socioeconomic status under the Medicare for All
Program; and
(B) include recommendations on the most effective
strategies and approaches to reporting quality
measures, as appropriate, on the basis of race,
ethnicity, gender national origin, primary language
use, age, disability, sex (including gender identity
and sexual orientation), geography, or socioeconomic
status.
(2) Report on data analyses.--Not later than 4 years after
the submission of the report under subsection (b)(1), and every
4 years thereafter, the Center shall submit to Congress and the
Secretary a report that includes recommendations for improving
the identification of health care disparities based on the
analyses of data collected under subsection (c).
(c) Implementing Effective Approaches.--Not later than 2 years
after the date on which benefits are first available under section
106(a), the Secretary shall implement the approaches identified in the
report submitted under subsection (b)(1) for the ongoing, accurate, and
timely collection and evaluation of data on health care disparities on
the basis of race, ethnicity, gender national origin, primary language
use, age, disability, sex (including gender identity and sexual
orientation), geography, or socioeconomic status.
TITLE VI--NATIONAL HEALTH BUDGET; PROVIDER PAYMENTS; COST CONTAINMENT
MEASURES
Subtitle A--Budgeting
SEC. 601. NATIONAL HEALTH BUDGET.
(a) National Health Budget.--
(1) In general.--By not later than September 1 of each
year, beginning with the year prior to the date on which
benefits are first available under section 106(a), the
Secretary shall establish a national health budget, which
specifies a budget for the total expenditures to be made for
covered health care items and services under this Act.
(2) Division of budget into components.--The national
health budget shall consist of at least the following
components:
(A) An operating budget.
(B) A capital expenditures budget.
(C) A special projects budget.
(D) Quality assessment activities under title V.
(E) Health professional education expenditures.
(F) Administrative costs, including costs related
to the operation of regional offices.
(G) A reserve fund.
(H) Prevention and public health activities.
(3) Allocation among components.--The Secretary shall
allocate the funds received for purposes of carrying out this
Act among the components described in paragraph (2) in a manner
that ensures--
(A) that the operating budget allows for every
participating provider in the Medicare for All Program
to meet the needs of their respective patient
populations;
(B) that the special projects budget is sufficient
to meet the health care needs within areas described in
paragraph (2)(C) through the construction, renovation,
and staffing of health care facilities in a reasonable
timeframe;
(C) a fair allocation for quality assessment
activities; and
(D) that the health professional education
expenditure component is sufficient to provide for the
amount of health professional education expenditures
sufficient to meet the need for covered health care
services.
(4) For regional allocation.--The Secretary shall annually
provide each regional office with an allotment the Secretary
determines appropriate for purposes of carrying out this Act in
such region, including payments to providers in such region,
capital expenditures in such region, special projects in such
region, health professional education in such region,
administrative expenses in such region, and prevention and
public health activities in such region.
(5) Operating budget.--The operating budget described in
paragraph (2)(A) shall be used for--
(A) payments to institutional providers pursuant to
section 611; and
(B) payments to individual providers pursuant to
section 612.
(6) Capital expenditures budget.--The capital expenditures
budget described in paragraph (2)(B) shall be used for--
(A) the construction or renovation of health care
facilities, excluding congregate or segregated
facilities for individuals with disabilities who
receive long-term care services and support; and
(B) major equipment purchases.
(7) Special projects budget.--The special projects budget
described in paragraph (2)(C) shall be used for the purposes of
allocating funds for the construction of new facilities, major
equipment purchases, and staffing in rural or medically
underserved areas (as defined in section 330(b)(3) of the
Public Health Service Act (42 U.S.C. 254b(b)(3))), including
areas designated as health professional shortage areas (as
defined in section 332(a) of the Public Health Service Act (42
U.S.C. 254e(a))), and to address health disparities, including
racial, ethnic, national origin, primary language use, age,
disability, sex (including gender identity and sexual
orientation), geography, or socioeconomic health disparities.
(8) Reserve fund.--The reserve fund described in paragraph
(2)(G) shall be used to respond to the costs of an epidemic,
pandemic, natural disaster, or other such health emergency, or
market-shift adjustments related to patient volume.
(b) Definitions.--In this section:
(1) Capital expenditures.--The term ``capital
expenditures'' means expenses for the purchase, lease,
construction, or renovation of capital facilities and for major
equipment.
(2) Health professional education expenditures.--The term
``health professional education expenditures'' means
expenditures in hospitals and other health care facilities to
cover costs associated with teaching and related research
activities, including the impact of workforce recruitment,
retention, and diversity on patient outcomes.
SEC. 602. TEMPORARY WORKER ASSISTANCE.
(a) In General.--For up to 5 years following the date on which
benefits are first available under section 106(a), at least 1 percent
of the national health budget shall be allocated to programs providing
assistance to workers who perform functions in the administration of
the health insurance system, or related functions within health care
institutions or organizations, who may experience economic dislocation
as a result of the implementation of this Act.
(b) Clarification.--Assistance described in subparagraph (A) shall
include wage replacement, retirement benefits, job training and
placement, preferential hiring, and education benefits.
Subtitle B--Payments to Providers
SEC. 611. PAYMENTS TO INSTITUTIONAL PROVIDERS BASED ON GLOBAL BUDGETS.
(a) In General.--Not later than the beginning of each fiscal
quarter during which an institutional provider of care (including
hospitals, skilled nursing facilities, and independent dialysis
facilities) is to furnish items and services under this Act, the
Secretary shall pay to such institutional provider a lump sum in
accordance with the succeeding provisions of this subsection and
consistent with the following:
(1) Payment in full.--Such payment shall be considered as
payment in full for all operating expenses for items and
services furnished under this Act, whether inpatient or
outpatient, by such provider for such quarter, including
outpatient or any other care provided by the institutional
provider or provided by any health care provider who provided
items and services pursuant to an agreement paid through the
global budget as described in paragraph (3).
(2) Quarterly review.--The regional director, on a
quarterly basis, shall review whether requirements of the
institutional provider's participation agreement and negotiated
global budget have been performed and shall determine whether
adjustments to such institutional provider's payment are
warranted. This review shall include consideration for
additional funding necessary for unanticipated items and
services for individuals with complex medical needs or market-
shift adjustments related to patient volume, and an assessment
of any adjustments made to ensure that accuracy and need for
adjustment was appropriate.
(3) Agreements for salaried payments for certain
providers.--Certain group practices and other health care
providers, as determined by the Secretary, with agreements to
provide items and services at a specified institutional
provider paid a global budget under this subsection may elect
to be paid through such institutional provider's global budget
in lieu of payment under section 612. Any--
(A) individual health care professional of such
group practice or other provider receiving payment
through an institutional provider's global budget shall
be paid on a salaried basis that is equivalent to
salaries or other compensation rates negotiated for
individual health care professionals of such
institutional provider; and
(B) any group practice or other health care
provider that receives payment through an institutional
provider global budget under this paragraph shall be
subject to the same reporting and disclosure
requirements of the institutional provider.
(4) Interim adjustments.--The regional director shall
consider a petition for adjustment of any payment under this
section filed by an institutional provider at any time based on
the following:
(A) Factors that led to increased costs for the
institutional provider that can reasonably be
considered to be unanticipated and out of the control
of the institutional provider, such as--
(i) natural disasters;
(ii) public health emergencies including
outbreaks of epidemics or infectious diseases;
(iii) unexpected facility or equipment
repairs or purchases;
(iv) significant and unexpected increases
in pharmaceutical or medical device prices; and
(v) unanticipated increases in complex or
high-cost patients or care needs.
(B) Changes in Federal or State law that result in
a change in costs.
(C) Reasonable increases in labor costs, including
salaries and benefits, and changes in collective
bargaining agreements, prevailing wage, or local law.
(b) Payment Amount.--
(1) In general.--The amount of each payment to a provider
described in subsection (a) shall be determined before the
start of each calendar year through negotiations between the
provider and the regional director with jurisdiction over such
provider. Such amount shall be based on factors specified in
paragraph (2).
(2) Payment factors.--Payments negotiated pursuant to
paragraph (1) shall take into account, with respect to a
provider--
(A) the historical volume of services provided for
each item and services in the previous 3-year period;
(B) the actual expenditures of such provider in
such provider's most recent cost report under title
XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) for each item and service compared to--
(i) such expenditures for other
institutional providers in the director's
jurisdiction; and
(ii) normative payment rates established
under comparative payment rate systems,
including any adjustments, for such items and
services;
(C) projected changes in the volume and type of
items and services to be furnished;
(D) wages for employees, including any necessary
increases to ensure mandatory minimum safe registered
nurse-to-patient ratios and optimal staffing levels for
physicians and other health care workers;
(E) the provider's maximum capacity to provide
items and services;
(F) education and prevention programs;
(G) permissible adjustment to the provider's
operating budget due to factors such as--
(i) an increase in primary or specialty
care access;
(ii) efforts to decrease health care
disparities in rural or medically underserved
areas;
(iii) a response to emergent epidemic
conditions;
(iv) an increase in complex or high-cost
patients or care needs; or
(v) proposed new and innovative patient
care programs at the institutional level;
(H) whether the provider is located in a high
social vulnerability index community, ZIP Code, or
census track, or is a minority-serving provider; and
(I) any other factor determined appropriate by the
Secretary.
(3) Limitation.--Payment amounts negotiated pursuant to
paragraph (1) may not--
(A) take into account capital expenditures of the
provider or any other expenditure not directly
associated with the provision of items and services by
the provider to an individual;
(B) be used by a provider for capital expenditures
or such other expenditures;
(C) exceed the provider's capacity to provide care
under this Act; or
(D) be used to pay or otherwise compensate any
board member, executive, or administrator of the
institutional provider who has any interest or
relationship prohibited under section 301(b)(2) or
disclosed under section 301.
(4) Limitation on compensation.--Compensation costs for any
employee or any contractor or any subcontractor employee of an
institutional provider receiving global budgets under this
section shall meet the compensation cap established in section
702 of the Bipartisan Budget Act of 2013 (41 U.S.C.
4304(a)(16)) and implementing regulations.
(5) Regional negotiations permitted.--Subject to section
614, a regional director may negotiate changes to an
institutional provider's global budget, including any
adjustments to address unforeseen market shifts related to
patient volume.
(c) Baseline Rates and Adjustments.--
(1) In general.--The Secretary shall use existing
prospective payment systems under title XVIII of the Social
Security Act to serve as the comparative payment rate system in
global budget negotiations described in subsection (b). The
Secretary shall update such comparative payment rate systems
annually.
(2) Specifications.--In developing the comparative payment
rate system, the Secretary shall use only the operating base
payment rates under each such prospective payment systems with
applicable adjustments.
(3) Limitation.--The comparative rate system established
under this subsection shall not include the value-based payment
adjustments and the capital expenses base payment rates that
may be included in such a prospective payment system.
(4) Initial year.--In the first year that global budget
payments under this Act are available to institutional
providers and for purposes of selecting a comparative payment
rate system used during initial global budget negotiations for
each institutional provider, the Secretary shall take into
account the appropriate prospective payment system from the
most recent year under title XVIII of the Social Security Act
to determine what operating base payment the institutional
provider would have been paid for covered items and services
furnished the preceding year with applicable adjustments,
including adjustments due to any public health emergencies in
the preceding year, and excluding value-based payment
adjustments, based on such prospective payment system.
(d) Operating Expenses.--For purposes of this title, ``operating
expenses'' of a provider include the following:
(1) The cost of all items and services associated with the
provision of inpatient care and outpatient care, including the
following:
(A) Wages and salary costs for physicians, nurses,
and other health care practitioners employed by an
institutional provider, including mandatory minimum
safe registered nurse-to-patient staffing ratios and
optimal staffing levels for physicians and other
healthcare workers.
(B) Wages and salary costs for all ancillary staff
and services.
(C) Costs of all pharmaceutical products
administered by health care clinicians at the
institutional provider's facilities or through services
provided in accordance with State licensing laws or
regulations under which the institutional provider
operates.
(D) Costs for infectious disease response
preparedness, including maintenance of a 1-year or 365-
day stockpile of personal protective equipment,
occupational testing and surveillance, medical services
for occupational infectious disease exposure, and
contact tracing.
(E) Purchasing and maintenance of medical devices,
supplies, and other health care technologies, including
diagnostic testing equipment.
(F) Costs of all incidental services necessary for
safe patient care and handling.
(G) Costs of patient care, education, and
prevention programs, including occupational health and
safety programs, public health programs, and necessary
staff to implement such programs, for the continued
education and health and safety of clinicians and other
individuals employed by the institutional provider.
(2) Administrative costs for the institutional provider.
SEC. 612. PAYMENTS TO INDIVIDUAL PROVIDERS THROUGH FEE-FOR-SERVICE.
(a) Medicare for All Fee Schedule.--
(1) Establishment.--Not later than 1 year after the date of
the enactment of this Act, and in consultation with providers
and regional office directors, the Secretary shall establish
and annually update a national fee schedule that establishes
amounts for items and services payable under this Act,
furnished by--
(A) individual providers;
(B) providers in group practices who are not
receiving payments on a salaried basis described in
section 611(a)(3);
(C) providers of home- and community-based
services; and
(D) any other provider not described in section
611.
(2) Amounts.--In establishing the fee schedule under
paragraph (1), the Secretary shall take into account--
(A) the amounts payable for such items and services
under title XVIII of the Social Security Act and other
Federal health programs; and
(B) the expertise of providers and the value of
items and services furnished by such providers.
(b) Leveraging Existing Medicare Payment Processes.--
(1) Application of payment processes under title xviii.--
Except as otherwise provided in this section, the Secretary
shall establish, and shall annually update by regulation, the
fee schedule under subsection (a) in a manner that is
documented, is transparent, allows for public comment, and, to
the greatest extent practicable, is consistent with processes
for determining, revising, and making payments for items and
services under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.), including the application of the
provisions of, and amendments made by, section 613.
(2) Electronic billing.--The Secretary shall establish a
uniform national system for electronic billing for purposes of
making payments under this section.
(c) Application of Current and Planned Payment Reforms.--To the
extent the Secretary determines such application is necessary to ensure
a smooth and fair transition, the Secretary may apply payment reform
activities planned or implemented with respect to such title XVIII as
of the date of the enactment of this Act, including demonstrations,
waivers, or any other provider payment agreements, to benefits under
this Act, provided that the Secretary sets forth a process for
reviewing such applications and making such determinations that is
reasonable, transparent, and documented, and allows for public comment.
(d) Physician Practice Review Board.--Each director of a regional
office, in consultation with representatives of physicians practicing
in that region, shall establish and appoint a physician practice review
board to assure quality, cost effectiveness, and fair reimbursements
for physician-delivered items and services. The use of mechanisms that
discriminate against people with disabilities is prohibited for use in
any value or cost-effectiveness assessments.
SEC. 613. ACCURATE VALUATION OF SERVICES UNDER THE MEDICARE PHYSICIAN
FEE SCHEDULE.
(a) Standardized and Documented Review Process.--Section 1848(c)(2)
of the Social Security Act (42 U.S.C. 1395w-4(c)(2)) is amended by
adding at the end the following new subparagraph:
``(P) Standardized and documented review process.--
``(i) In general.--Not later than one year
after the date of enactment of this
subparagraph, the Secretary shall establish,
document, and make publicly available, in
consultation with the Office of Primary Health
Care, a standardized process for reviewing the
relative values of physicians' services under
this paragraph.
``(ii) Minimum requirements.--The
standardized process shall include, at a
minimum, methods and criteria for identifying
services for review, prioritizing the review of
services, reviewing stakeholder
recommendations, and identifying additional
resources to be considered during the review
process.''.
(b) Planned and Documented Use of Funds.--Section 1848(c)(2)(M) of
the Social Security Act (42 U.S.C. 1305w-4(c)(2)(M)) is amended by
adding at the end the following new clause:
``(x) Planned and documented use of
funds.--For each fiscal year (beginning with
the first fiscal year beginning on or after the
date of enactment of this clause), the
Secretary shall provide to Congress a written
plan for using the funds provided under clause
(ix) to collect and use information on
physicians' services in the determination of
relative values under this subparagraph.''.
(c) Internal Tracking of Reviews.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary shall submit to Congress a
proposed plan for systematically and internally tracking the
Secretary's review of the relative values of physicians'
services, such as by establishing an internal database, under
section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w-
4(c)(2)), as amended by this section.
(2) Minimum requirements.--The proposal shall include, at a
minimum, plans and a timeline for achieving the ability to
systematically and internally track the following:
(A) When, how, and by whom services are identified
for review.
(B) When services are reviewed or when new services
are added.
(C) The resources, evidence, data, and
recommendations used in reviews.
(D) When relative values are adjusted.
(E) The rationale for final relative value
decisions.
(d) Frequency of Review.--Section 1848(c)(2) of the Social Security
Act (42 U.S.C. 1395w-4(c)(2)) is amended--
(1) in subparagraph (B)(i), by striking ``5'' and inserting
``4''; and
(2) in subparagraph (K)(i)(I), by striking ``periodically''
and inserting ``annually''.
(e) Consultation With Medicare Payment Advisory Commission.--
(1) In general.--Section 1848(c)(2) of the Social Security
Act (42 U.S.C. 1395w-4(c)(2)) is amended--
(A) in subparagraph (B)(i), by inserting ``in
consultation with the Medicare Payment Advisory
Commission,'' after ``The Secretary,''; and
(B) in subparagraph (K)(i)(I), as amended by
subsection (d)(2), by inserting ``, in coordination
with the Medicare Payment Advisory Commission,'' after
``annually''.
(2) Conforming amendments.--Section 1805 of the Social
Security Act (42 U.S.C. 1395b-6) is amended--
(A) in subsection (b)(1)(A), by inserting the
following before the semicolon at the end: ``and
including coordinating with the Secretary in accordance
with section 1848(c)(2) to systematically review the
relative values established for physicians' services,
identify potentially misvalued services, and propose
adjustments to the relative values for physicians'
services''; and
(B) in subsection (e)(1), in the second sentence,
by inserting ``or the Ranking Minority Member'' after
``the Chairman''.
(f) Periodic Audit by the Comptroller General.--Section 1848(c)(2)
of the Social Security Act (42 U.S.C. 1395w-4(c)(2)), as amended by
subsection (a), is amended by adding at the end the following new
subparagraph:
``(Q) Periodic audit by the comptroller general.--
``(i) In general.--The Comptroller General
of the United States (in this subparagraph
referred to as the `Comptroller General') shall
periodically audit the review by the Secretary
of relative values established under this
paragraph for physicians' services.
``(ii) Access to information.--The
Comptroller General shall have unrestricted
access to all deliberations, records, and data
related to the activities carried out under
this paragraph, in a timely manner, upon
request.''.
SEC. 614. PAYMENTS FOR PRESCRIPTION DRUGS AND APPROVED DEVICES AND
EQUIPMENT.
(a) Negotiated Prices.--The prices to be paid for covered
pharmaceutical products, medical supplies, and medically necessary
assistive equipment shall be negotiated annually by the Secretary.
(b) Prescription Drug Formulary.--
(1) In general.--The Secretary shall establish a
prescription drug formulary system, pursuant to the
requirements of section 202, which shall encourage best-
practices in prescribing and discourage the use of ineffective,
dangerous, or excessively costly medications when better
alternatives are available.
(2) Promotion of use of generics.--The formulary under this
subsection shall promote the use of generic medications to the
greatest extent possible.
(3) Formulary updates and petition rights.--The formulary
under this subsection shall be updated frequently and
clinicians and patients may petition the Secretary to add new
pharmaceuticals or to remove ineffective or dangerous
medications from the formulary.
(4) Use of off-formulary medications.--The Secretary shall
promulgate rules regarding the use of off-formulary medications
which allow for patient access but do not compromise the
formulary.
SEC. 615. PAYMENT PROHIBITIONS; CAPITAL EXPENDITURES; SPECIAL PROJECTS.
(a) Prohibitions.--Payments to providers under this Act may not
take into account, include any process for the provision of funding
for, or be used by a provider for--
(1) marketing of the provider;
(2) the profit or net revenue of the provider, or
increasing the profit or net revenue of the provider;
(3) any agreement or arrangement described in section
203(a)(4) of the Labor-Management Reporting and Disclosure Act
of 1959 (29 U.S.C. 433(a)(4)); or
(4) political or other contributions prohibited under
section 317 of the Federal Elections Campaign Act of 1971 (52
U.S.C. 30119(a)(1)).
(b) Payments for Capital Expenditures.--
(1) In general.--The Secretary shall pay, from amounts made
available for capital expenditures pursuant to section
601(a)(2)(B), such sums determined appropriate by the Secretary
to providers who have submitted an application to the regional
director of the region or regions in which the provider
operates or seeks to operate in a time and manner specified by
the Secretary for purposes of funding capital expenditures of
such providers.
(2) Priority.--The Secretary shall prioritize allocation of
funding under paragraph (1) to projects that propose to use
such funds to improve service in a medically underserved area
(as defined in section 330(b)(3) of the Public Health Service
Act (42 U.S.C. 254b(b)(3))) or to address health disparities,
including racial, ethnic, national origin, primary language
use, age, disability, sex (including gender identity and sexual
orientation), geography, or socioeconomic health disparities.
(3) Limitation.--The Secretary shall not grant funding for
capital expenditures under this subsection for capital projects
that are financed directly or indirectly through the diversion
of private or other non-Medicare for All Program funding that
results in reductions in care to patients, including reductions
in registered nursing staffing patterns and changes in
emergency room or primary care services or availability.
(4) Capital assets not funded by the medicare for all
program.--Operating expenses and funds shall not be used by an
institutional provider receiving payment for capital
expenditures under this subsection for a capital asset that was
not funded by the Medicare for All Program without the approval
of the regional director or directors of the region or regions
where the capital asset is located.
(c) Prohibition Against Co-Mingling Operating and Capital Funds.--
Providers that receive payment under this title shall be prohibited
from using, with respect to funds made available under this Act--
(1) funds designated for operating expenditures for capital
expenditures or for profit; or
(2) funds designated for capital expenditures for operating
expenditures.
(d) Payments for Special Projects.--
(1) In general.--The Secretary shall allocate to each
regional director, from amounts made available for special
projects pursuant to section 601(a)(2)(C), such sums determined
appropriate by the Secretary for purposes of funding projects
described in such section, including the construction,
renovation, or staffing of health care facilities in rural,
underserved, or health professional or medical shortage areas
within such region and to address health disparities, including
racial, ethnic, national origin, primary language use, age,
disability, sex, including gender identity and sexual
orientation, geography, or socioeconomic health disparities.
Each regional director shall, prior to distributing such funds
in accordance with paragraph (2), present a budget describing
how such funds will be distributed to the Secretary.
(2) Distribution.--A regional director shall distribute
funds to providers operating in the region of such director's
jurisdiction in a manner determined appropriate by the
director.
(e) Prohibition on Financial Incentive Metrics in Payment
Determinations.--The Secretary may not utilize any quality metrics or
standards for the purposes of establishing provider payment
methodologies, programs, modifiers, or adjustments for provider
payments under this title.
SEC. 616. OFFICE OF HEALTH EQUITY.
Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.) is amended by adding at the end the following:
``SEC. 1712. OFFICE OF HEALTH EQUITY.
``(a) In General.--There is established, in the Office of the
Secretary of Health and Human Services, an Office of Health Equity, to
be headed by a Director, to ensure coordination and collaboration
across the programs and activities of the Department of Health and
Human Services with respect to ensuring health equity.
``(b) Monitoring, Tracking, and Availability of Data.--
``(1) In general.--In carrying out subsection (a), the
Director of the Office of Health Equity shall monitor, track,
and make publicly available data on--
``(A) the disproportionate burden of disease and
death among people of color, disaggregated by race,
major ethnic group, Tribal affiliation, national
origin, primary language use, English proficiency
status, immigration status, length of stay in the
United States, age, disability, sex (including gender
identity and sexual orientation), incarceration,
homelessness, geography, and socioeconomic status;
``(B) barriers to health, including such barriers
relating to income, education, housing, food insecurity
(including availability, access, utilization, and
stability), employment status, working conditions, and
conditions related to the physical environment
(including pollutants and population density);
``(C) barriers to health care access, including--
``(i) lack of trust and awareness;
``(ii) lack of transportation;
``(iii) geography;
``(iv) hospital and service closures;
``(v) lack of health care infrastructure
and facilities; and
``(vi) lack of health care professional
staffing and recruitment;
``(D) disparities in quality of care received,
including discrimination in health care settings and
the use of racially biased practice guidelines and
algorithms; and
``(E) disparities in utilization of care.
``(2) Analysis of cross-sectional information.--The
Director of the Office of Health Equity shall ensure that the
data collection and reporting process under paragraph (1)
allows for the analysis of cross-sectional information on
people's identities.
``(c) Policies.--In carrying out subsection (a), the Director of
the Office of Health Equity shall develop, coordinate, and promote
policies that enhance health equity, including by--
``(1) providing recommendations on--
``(A) cultural competence, implicit bias, and
ethics training with respect to health care workers;
``(B) increasing diversity in the health care
workforce; and
``(C) ensuring sufficient health care professionals
and facilities; and
``(2) ensuring adequate public health funding at the local
and State levels to address health disparities.
``(d) Consultation.--In carrying out subsection (a), the Director
of the Office of Health Equity, in coordination with the Director of
the Indian Health Service, shall consult with Indian Tribes and with
Urban Indian organizations on data collection, reporting, and
implementation of policies.
``(e) Annual Report.--In carrying out subsection (a), the Director
of the Office of Health Equity shall develop and publish an annual
report on--
``(1) statistics collected by the Office;
``(2) proposed evidence-based solutions to mitigate health
inequities; and
``(3) health care professional staffing levels and access
to facilities.
``(f) Centralized Electronic Repository.--In carrying out
subsection (a), the Director of the Office of Health Equity shall--
``(1) establish and maintain a centralized electronic
repository to incorporate data collected across Federal
departments and agencies on race, ethnicity, Tribal
affiliation, national origin, primary language use, English
proficiency status, immigration status, length of stay in the
United States, age, disability, sex (including gender identity
and sexual orientation), incarceration, homelessness,
geography, and socioeconomic status; and
``(2) make such data available for public use and analysis.
``(g) Privacy.--Notwithstanding any other Federal or State law, no
Federal or State official or employee or other entity shall disclose,
or use, for any law enforcement or immigration purpose, any personally
identifiable information (including with respect to an individual's
religious beliefs, practices, or affiliation, national origin,
ethnicity, or immigration status) that is collected or maintained
pursuant to this section.''.
SEC. 617. OFFICE OF PRIMARY HEALTH CARE.
Title XVII of the Public Health Service Act (42 U.S.C. 300u et
seq.), as amended by section 616, is further amended by adding at the
end the following:
``SEC. 1713. OFFICE OF PRIMARY HEALTH CARE.
``(a) In General.--There is established, in the Office of Health
Equity established under section 1712, an Office of Primary Health
Care, to be headed by a Director, to ensure coordination and
collaboration across the programs and activities of the Department of
Health and Human Services with respect to increasing access to high-
quality primary health care, particularly in underserved areas and for
underserved populations.
``(b) National Goals.--Not later than 1 year after the date of
enactment of this section, the Director of the Office of Primary Health
Care shall publish national goals--
``(1) to increase access to high-quality primary health
care, particularly in underserved areas and for underserved
populations; and
``(2) to address health disparities, including with respect
to race, ethnicity, national origin (disaggregated by major
ethnic group and Tribal affiliation), primary language use,
English proficiency status, immigration status, length of stay
in the United States, age, disability, sex (including gender
identity and sexual orientation), incarceration, homelessness,
geography, and socioeconomic status.
``(c) Other Responsibilities.--In carrying out subsections (a) and
(b), the Director of the Office of Primary Health Care shall--
``(1) coordinate, in consultation with the Secretary,
health professional education policies and goals to achieve the
national goals published pursuant to subsection (b);
``(2) develop and maintain a system to monitor the number
and specialties of individuals pursuing careers in, or
practicing, primary health care through their health
professional education, any postgraduate training, and
professional practice;
``(3) develop, coordinate, and promote policies that expand
the number of primary health care practitioners including
primary medical, dental, and behavioral health care providers,
registered nurses, and other mid-level practitioners;
``(4) recommend appropriate workforce training, technical
assistance, and patient protection enhancements for primary
health care practitioners, including registered nurses, to
achieve uniform high quality and patient safety;
``(5) provide recommendations on targeted programs and
resources for federally qualified health centers, community
health centers, rural health centers, behavioral health
clinics, and other community-based organizations;
``(6) provide recommendations for broader patient referral
to additional resources, not limited to health care, and
collaboration with other organizations and sectors that
influence health outcomes; and
``(7) consult with the Secretary on the allocation of the
special projects budget under section 601(a)(2)(C) of the
Medicare for All Act of 2022.
``(d) Rule of Construction.--Nothing in this section shall be
construed--
``(1) to preempt any provision of State law establishing
practice standards or guidelines for health care professionals,
including professional licensing or practice laws or
regulations; or
``(2) to require that any State impose additional
educational standards or guidelines for health care
professionals.''.
TITLE VII--UNIVERSAL MEDICARE TRUST FUND
SEC. 701. UNIVERSAL MEDICARE TRUST FUND.
(a) In General.--There is hereby created on the books of the
Treasury of the United States a trust fund to be known as the Universal
Medicare Trust Fund (in this section referred to as the ``Trust
Fund''). The Trust Fund shall consist of such gifts and bequests as may
be made and such amounts as may be deposited in, or appropriated to,
such Trust Fund as provided in this Act.
(b) Appropriations Into Trust Fund.--
(1) Taxes.--There are appropriated to the Trust Fund for
each fiscal year beginning with the fiscal year which includes
the date on which benefits are first available under section
106(a), out of any moneys in the Treasury not otherwise
appropriated, amounts equivalent to 100 percent of the net
increase in revenues to the Treasury which is attributable to
the amendments made by sections 801 and 902. The amounts
appropriated by the preceding sentence shall be transferred
from time to time (but not less frequently than monthly) from
the general fund in the Treasury to the Trust Fund, such
amounts to be determined on the basis of estimates by the
Secretary of the Treasury of the taxes paid to or deposited
into the Treasury, and proper adjustments shall be made in
amounts subsequently transferred to the extent prior estimates
were in excess of or were less than the amounts that should
have been so transferred.
(2) Current program receipts.--
(A) Initial year.--Notwithstanding any other
provision of law, there is hereby appropriated to the
Trust Fund for the first fiscal year beginning at least
one year after the date of the enactment of this Act,
an amount equal to the aggregate amount appropriated
for the preceding fiscal year for the following
(increased by the consumer price index for all urban
consumers for the fiscal year involved):
(i) The Medicare program under title XVIII
of the Social Security Act (other than amounts
attributable to any premiums under such title).
(ii) The Medicaid program under State plans
approved under title XIX of such Act.
(iii) The Federal Employees Health Benefits
program, under chapter 89 of title 5, United
States Code.
(iv) The maternal and child health program
(under title V of the Social Security Act),
vocational rehabilitation programs, programs
for drug abuse and mental health services under
the Public Health Service Act, programs
providing general hospital or medical
assistance, and any other Federal program
identified by the Secretary, in consultation
with the Secretary of the Treasury, to the
extent the programs provide for payment for
health services the payment of which may be
made under this Act.
(B) Subsequent years.--Notwithstanding any other
provision of law, there is appropriated to the Trust
Fund for each fiscal year following the fiscal year in
which the appropriation is made under subparagraph (A),
an amount equal to the amount appropriated to the Trust
Fund for the previous year, adjusted for reductions in
costs resulting from the implementation of this Act,
changes in the consumer price index for all urban
consumers for the fiscal year involved, and other
factors determined appropriate by the Secretary.
(3) Restrictions shall not apply.--Any other provision of
law in effect on the date of enactment of this Act restricting
the use of Federal funds for any reproductive health service
shall not apply to monies in the Trust Fund.
(c) Incorporation of Provisions.--The provisions of subsections (b)
through (i) of section 1817 of the Social Security Act (42 U.S.C.
1395i) shall apply to the Trust Fund under this section in the same
manner as such provisions applied to the Federal Hospital Insurance
Trust Fund under such section 1817, except that, for purposes of
applying such subsections to this section, the ``Board of Trustees of
the Trust Fund'' shall mean the ``Secretary''.
(d) Transfer of Funds.--Any amounts remaining in the Federal
Hospital Insurance Trust Fund under section 1817 of the Social Security
Act (42 U.S.C. 1395i) or the Federal Supplementary Medical Insurance
Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) after the
payment of claims for items and services furnished under title XVIII of
such Act have been completed, shall be transferred into the Universal
Medicare Trust Fund under this section.
TITLE VIII--CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME
SECURITY ACT OF 1974
SEC. 801. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF BENEFITS
UNDER THE MEDICARE FOR ALL PROGRAM; COORDINATION IN CASE
OF WORKERS' COMPENSATION.
(a) In General.--Part 5 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is
amended by adding at the end the following new section:
``SEC. 523. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF MEDICARE
FOR ALL PROGRAM BENEFITS; COORDINATION IN CASE OF
WORKERS' COMPENSATION.
``(a) In General.--Subject to subsection (b), no employee benefit
plan may provide benefits that duplicate payment for any items or
services for which payment may be made under the Medicare for All Act
of 2022.
``(b) Reimbursement.--Each workers compensation carrier that is
liable for payment for workers compensation services furnished in a
State shall reimburse the Medicare for All Program for the cost of such
services.
``(c) Definitions.--In this subsection--
``(1) the term `workers compensation carrier' means an
insurance company that underwrite workers compensation medical
benefits with respect to one or more employers and includes an
employer or fund that is financially at risk for the provision
of workers compensation medical benefits;
``(2) the term `workers compensation medical benefits'
means, with respect to an enrollee who is an employee subject
to the workers compensation laws of a State, the comprehensive
medical benefits for work-related injuries and illnesses
provided for under such laws with respect to such an employee;
and
``(3) the term `workers compensation services' means items
and services included in workers compensation medical benefits
and includes items and services (including rehabilitation
services and long-term care services) commonly used for
treatment of work-related injuries and illnesses.''.
(b) Conforming Amendment.--Section 4(b) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1003(b)) is amended by adding at
the end the following: ``Paragraph (3) shall apply subject to section
523(b) (relating to reimbursement of the Medicare for All Program by
workers compensation carriers).''.
(c) Clerical Amendment.--The table of contents in section 1 of such
Act is amended by inserting after the item relating to section 522 the
following new item:
``Sec. 523. Prohibition of employee benefits duplicative of Medicare
for All Program benefits; coordination in
case of workers' compensation.''.
SEC. 802. REPEAL OF CONTINUATION COVERAGE REQUIREMENTS UNDER ERISA AND
CERTAIN OTHER REQUIREMENTS RELATING TO GROUP HEALTH
PLANS.
(a) In General.--Part 6 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.) is
repealed.
(b) Conforming Amendments.--
(1) Section 502(a) of such Act (29 U.S.C. 1132(a)) is
amended--
(A) by striking paragraph (7); and
(B) by redesignating paragraphs (8), (9), and (10)
as paragraphs (7), (8), and (9), respectively.
(2) Section 502(c)(1) of such Act (29 U.S.C. 1132(c)(1)) is
amended by striking ``paragraph (1) or (4) of section 606,''.
(3) Section 514(b) of such Act (29 U.S.C. 1144(b)) is
amended--
(A) in paragraph (7), by striking ``section
206(d)(3)(B)(i)),''; and
(B) by striking paragraph (8).
(4) The table of contents in section 1 of the Employee
Retirement Income Security Act of 1974 is amended by striking
the items relating to part 6 of subtitle B of title I of such
Act.
SEC. 803. EFFECTIVE DATE OF TITLE.
The provisions of and amendments made by this title shall take
effect on the date on which benefits are first available under section
106(a).
TITLE IX--ADDITIONAL CONFORMING AMENDMENTS
SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS.
(a) Medicare, Medicaid, and State Children's Health Insurance
Program (SCHIP).--
(1) In general.--Notwithstanding any other provision of
law, subject to paragraphs (2) and (3)--
(A) no benefits shall be available under title
XVIII of the Social Security Act for any item or
service furnished beginning on or after the date on
which benefits are first available under section
106(a);
(B) no individual is entitled to medical assistance
under a State plan approved under title XIX of such Act
for any item or service furnished on or after such
date;
(C) no individual is entitled to medical assistance
under a State child health plan under title XXI of such
Act for any item or service furnished on or after such
date; and
(D) no payment shall be made to a State under
section 1903(a) or 2105(a) of such Act with respect to
medical assistance or child health assistance for any
item or service furnished on or after such date.
(2) Transition.--In the case of inpatient hospital services
and extended care services during a continuous period of stay
which began before the date on which benefits are first
available under section 106(a), and which had not ended as of
such date, for which benefits are provided under title XVIII of
the Social Security Act, under a State plan under title XIX of
such Act, or under a State child health plan under title XXI of
such Act, the Secretary shall provide for continuation of
benefits under such title or plan until the end of the period
of stay.
(3) Continued coverage of long-term care and other certain
services under medicaid.--
(A) In general.--This subsection shall not apply to
entitlement to medical assistance provided under title
XIX of the Social Security Act for--
(i) institutional long-term care services
(as defined in section 1948(b) of such Act); or
(ii) any other service for which benefits
are not available under this Act and which is
furnished under a State plan under title XIX of
the Social Security Act which provided for
medical assistance for such service on January
1, 2022.
(B) Coordination between secretary and states.--The
Secretary shall coordinate with the directors of State
agencies responsible for administering State plans
under title XIX of the Social Security Act to--
(i) identify services described in
subparagraph (A)(ii) with respect to each State
plan; and
(ii) ensure that such services continue to
be made available under such plan.
(C) State maintenance of effort requirement.--With
respect to any service described in subparagraph
(A)(ii) that is made available under a State plan under
title XIX of the Social Security Act, the maintenance
of effort requirements described in section 1948(c) of
such Act (related to eligibility standards and required
expenditures) shall apply to such service in the same
manner that such requirements apply to institutional
long-term care services (as defined in section 1948(b)
of such Act).
(b) Federal Employees Health Benefits Program.--No benefits shall
be made available under chapter 89 of title 5, United States Code with
respect to items and services furnished to any individual eligible to
enroll under this Act.
(c) Treatment of Benefits for Veterans and Native Americans.--
(1) In general.--Nothing in this Act shall affect the
eligibility of veterans for the medical benefits and services
provided under title 38, United States Code, the eligibility of
individuals for TRICARE medical benefits and services provided
under sections 1079 and 1086 of title 10, United States Code,
or of Indians for the medical benefits and services provided by
or through the Indian Health Service.
(2) Reevaluation.--No reevaluation of the Indian Health
Service shall be undertaken without consultation with Tribal
leaders and stakeholders.
SEC. 902. SUNSET OF PROVISIONS RELATED TO THE STATE EXCHANGES.
Effective on the date on which benefits are first available under
section 106(a), the Federal and State Exchanges established pursuant to
title I of the Patient Protection and Affordable Care Act (Public Law
111-148) shall terminate, and any other provision of law that relies
upon participation in or enrollment through such an Exchange, including
such provisions of the Internal Revenue Code of 1986, shall cease to
have force or effect.
TITLE X--TRANSITION TO MEDICARE FOR ALL
Subtitle A--Improvements to Medicare
SEC. 1001. PROTECTING MEDICARE FEE-FOR-SERVICE BENEFICIARIES FROM HIGH
OUT-OF-POCKET COSTS.
(a) Protection Against High Out-of-Pocket Expenditures.--Title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by
adding at the end the following new section:
``protection against high out-of-pocket expenditures
``Sec. 1899C. (a) In General.--Notwithstanding any other provision
of this title, in the case of an individual entitled to, or enrolled
for, benefits under part A or enrolled in part B, if the amount of the
out-of-pocket cost-sharing of such individual for a year (effective the
year beginning January 1 of the year following the date of enactment of
the Medicare for All Act of 2022) equals or exceeds $1,500, the
individual shall not be responsible for additional out-of-pocket cost-
sharing that occurred during that year.
``(b) Out-of-Pocket Cost-Sharing Defined.--
``(1) In general.--Subject to paragraphs (2) and (3), in
this section, the term `out-of-pocket cost-sharing' means, with
respect to an individual, the amount of the expenses incurred
by the individual that are attributable to--
``(A) coinsurance and copayments applicable under
part A or B; or
``(B) for items and services that would have
otherwise been covered under part A or B but for the
exhaustion of those benefits.
``(2) Certain costs not included.--
``(A) Non-covered items and services.--Expenses
incurred for items and services which are not included
(or treated as being included) under part A or B shall
not be considered incurred expenses for purposes of
determining out-of-pocket cost-sharing under paragraph
(1).
``(B) Items and services not furnished on an
assignment-related basis.--If an item or service is
furnished to an individual under this title and is not
furnished on an assignment-related basis, any
additional expenses the individual incurs above the
amount the individual would have incurred if the item
or service was furnished on an assignment-related basis
shall not be considered incurred expenses for purposes
of determining out-of-pocket cost-sharing under
paragraph (1).
``(3) Source of payment.--For purposes of paragraph (1),
the Secretary shall consider expenses to be incurred by the
individual without regard to whether the individual or another
person, including a State program or other third-party
coverage, has paid for such expenses.''.
(b) Elimination of Parts A and B Deductibles.--
(1) Part a.--Section 1813(b) of the Social Security Act (42
U.S.C. 1395e(b)) is amended by adding at the end the following
new paragraph:
``(4) For each year (beginning January 1 of the year following the
date of enactment of the Medicare for All Act of 2022), the inpatient
hospital deductible for the year shall be $0.''.
(2) Part b.--Section 1833(b) of the Social Security Act (42
U.S.C. 1395l(b)) is amended, in the first sentence--
(A) by striking ``and for a subsequent year'' and
inserting ``for each of 2006 through the year that
includes the date of enactment of the Medicare for All
Act of 2022''; and
(B) by inserting ``, and $0 for each year
subsequent year'' after ``$1)''.
SEC. 1002. REDUCING MEDICARE PART D ANNUAL OUT-OF-POCKET THRESHOLD AND
ELIMINATING COST-SHARING ABOVE THAT THRESHOLD.
(a) Reduction.--Section 1860D-2(b)(4)(B) of the Social Security Act
(42 U.S.C. 1395w-102(b)(4)(B)) is amended--
(1) in clause (i), by striking ``For purposes'' and
inserting ``Subject to clause (iii), for purposes''; and
(2) by adding at the end the following new clause:
``(iii) Reduction in threshold during
transition period.--
``(I) In general.--Subject to
subclause (II), for plan years
beginning on or after January 1
following the date of enactment of the
Medicare for All Act of 2022 and before
January 1 of the year that is 4 years
following such date of enactment,
notwithstanding clauses (i) and (ii),
the `annual out-of-pocket threshold'
specified in this subparagraph is equal
to $305.
``(II) Authority to exempt brand-
name drugs if generic available.--In
applying subclause (I), the Secretary
may exempt costs incurred for a covered
part D drug that is an applicable drug
under section 1860D-14A(g)(2) if the
Secretary determines that a generic
version of that drug is available.''.
(b) Elimination of Cost-Sharing.--Section 1860D-2(b)(4)(A) of the
Social Security Act (42 U.S.C. 1395w-102(b)(4)(A)) is amended--
(1) in clause (i)--
(A) by redesignating subclauses (I) and (II) as
items (aa) and (bb), respectively;
(B) by striking ``subparagraph (B), with cost-
sharing'' and inserting the following: ``subparagraph
(B)--
``(I) for plan years 2006 through
the plan year ending December 31
following the date of enactment of the
Medicare for All Act of 2022, with
cost-sharing'';
(C) in item (bb), as redesignated by subparagraph
(A), by striking the period at the end and inserting
``; and''; and
(D) by adding at the end the following new
subclause:
``(II) for the plan year beginning
January 1 following the date of
enactment of the Medicare for All Act
of 2022 and the two subsequent plan
years, without any cost-sharing.''; and
(2) in clause (ii)--
(A) by striking ``clause (i)(I)'' and inserting
``clause (i)(I)(aa)''; and
(B) by adding at the end the following new
sentence: ``The Secretary shall continue to calculate
the dollar amounts specified in clause (i)(I)(aa),
including with the adjustment under this clause, after
plan year 2018 for purposes of 1860D-
14(a)(1)(D)(iii).''.
(c) Conforming Amendments to Low-Income Subsidy.--Section 1860D-
14(a) of the Social Security Act (42 U.S.C. 1395w-114(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (D)(iii), by striking ``1860D-
2(b)(4)(A)(i)(I)'' and inserting ``1860D-
2(b)(4)(A)(i)(I)(aa)''; and
(B) in subparagraph (E)--
(i) in the heading, by inserting ``prior to
the elimination of such cost-sharing for all
individuals'' after ``threshold''; and
(ii) by striking ``The elimination'' and
inserting ``For plan years 2006 through the
plan year ending December 31 following the date
of enactment of the Medicare for All Act of
2022, the elimination''; and
(2) in paragraph (2)(E)--
(A) in the heading, by inserting ``prior to the
elimination of such cost-sharing for all individuals''
after ``threshold'';
(B) by striking ``Subject to'' and inserting ``For
plan years 2006 through the plan year ending December
31 following the date of enactment of the Medicare for
All Act of 2022, subject to''; and
(C) by striking ``1860D-2(b)(4)(A)(i)(I)'' and
inserting ``1860D-2(b)(4)(A)(i)(I)(aa)''.
SEC. 1003. EXPANDING MEDICARE TO COVER DENTAL AND VISION SERVICES AND
HEARING AIDS AND EXAMINATIONS UNDER PART B.
(a) Dental Services.--
(1) Removal of exclusion from coverage.--Section 1862(a) of
the Social Security Act (42 U.S.C. 1395y(a)) is amended by
striking paragraph (12).
(2) Coverage.--
(A) In general.--Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended--
(i) in subparagraph (GG), by striking
``and'' at the end;
(ii) in subparagraph (HH), by striking the
period at the end and inserting ``; and''; and
(iii) by adding at the end the following
new subparagraph:
``(II) dental services;''.
(B) Payment.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``and'' before ``(DD)'';
and
(ii) by inserting before the semicolon at
the end the following: ``and (EE) with respect
to dental services described in section
1861(s)(2)(II), the amount paid shall be an
amount equal to 80 percent of the lesser of the
actual charge for the services or the amount
determined under the fee schedule established
under section 1848(b).''.
(C) Effective date.--The amendments made by this
subsection shall apply to items and services furnished
on or after January 1 following the date of the
enactment of this Act.
(b) Vision Services.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)), as amended by subsection (a), is
amended--
(A) in subparagraph (HH), by striking ``and'' at
the end;
(B) in subparagraph (II), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(JJ) vision services;''.
(2) Payment.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)), as amended by subsection (a), is
amended--
(A) by striking ``and'' before ``(EE)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (FF) with respect to vision
services described in section 1861(s)(2)(JJ), the
amount paid shall be an amount equal to 80 percent of
the lesser of the actual charge for the services or the
amount determined under the fee schedule established
under section 1848(b).''.
(3) Effective date.--The amendments made by this subsection
shall apply to items and services furnished on or after January
1 following the date of the enactment of this Act.
(c) Hearing Aids and Examinations Therefor.--
(1) In general.--Section 1862(a)(7) of the Social Security
Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``hearing
aids or examinations therefor,''.
(2) Effective date.--The amendment made by this subsection
shall apply to items and services furnished on or after January
1 following the date of the enactment of this Act.
SEC. 1004. ELIMINATING THE 24-MONTH WAITING PERIOD FOR MEDICARE
COVERAGE FOR INDIVIDUALS WITH DISABILITIES.
(a) In General.--Section 226(b) of the Social Security Act (42
U.S.C. 426(b)) is amended--
(1) in paragraph (2)(A), by striking ``, and has for 24
calendar months been entitled to,'';
(2) in paragraph (2)(B), by striking ``, and has been for
not less than 24 months,'';
(3) in paragraph (2)(C)(ii), by striking ``, including the
requirement that he has been entitled to the specified benefits
for 24 months,'';
(4) in the first sentence, by striking ``for each month
beginning with the later of (I) July 1973 or (II) the twenty-
fifth month of his entitlement or status as a qualified
railroad retirement beneficiary described in paragraph (2),
and'' and inserting ``for each month for which the individual
meets the requirements of paragraph (2), beginning with the
month following the month in which the individual meets the
requirements of such paragraph, and''; and
(5) in the second sentence, by striking ``the `twenty-fifth
month of his entitlement''' and all that follows through
``paragraph (2)(C) and''.
(b) Conforming Amendments.--
(1) Section 226.--Section 226 of the Social Security Act
(42 U.S.C. 426) is amended--
(A) by striking subsections (e)(1)(B), (f), and
(h); and
(B) by redesignating subsections (g) and (i) as
subsections (f) and (g), respectively.
(2) Medicare description.--Section 1811(2) of the Social
Security Act (42 U.S.C. 1395c(2)) is amended by striking ``have
been entitled for not less than 24 months'' and inserting ``are
entitled''.
(3) Medicare coverage.--Section 1837(g)(1) of the Social
Security Act (42 U.S.C. 1395p(g)(1)) is amended by striking
``25th month of'' and inserting ``month following the first
month of''.
(4) Railroad retirement system.--Section 7(d)(2)(ii) of the
Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is
amended--
(A) by striking ``has been entitled to an annuity''
and inserting ``is entitled to an annuity'';
(B) by striking ``, for not less than 24 months'';
and
(C) by striking ``could have been entitled for 24
calendar months, and''.
(c) Effective Date.--The amendments made by this section shall
apply to insurance benefits under title XVIII of the Social Security
Act with respect to items and services furnished in months beginning
after December 1 following the date of enactment of this Act, and
before January 1 of the year that is 4 years after such date of
enactment.
SEC. 1005. GUARANTEED ISSUE OF MEDIGAP POLICIES.
Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is
amended by adding at the end the following new subsection:
``(aa) Guaranteed Issue for All Medigap-Eligible Medicare
Beneficiaries.--Notwithstanding paragraphs (2)(A) and (2)(D) of
subsection (s) or any other provision of this section, on or after the
date of enactment of this subsection, the issuer of a Medicare
supplemental policy may not deny or condition the issuance or
effectiveness of a Medicare supplemental policy, or discriminate in the
pricing of the policy, because of health status, claims experience,
receipt of health care, or medical condition in the case of any
individual entitled to, or enrolled for, benefits under part A and
enrolled for benefits under part B.''.
Subtitle B--Temporary Medicare Buy-In Option and Temporary Public
Option
SEC. 1011. LOWERING THE MEDICARE AGE.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395c et seq.), as amended by section 1001, is amended by adding at the
end the following new section:
``temporary medicare buy-in option for certain individuals
``Sec. 1899E. (a) No Effect on Other Benefits for Individuals
Otherwise Eligible or on Trust Funds.--The Secretary shall implement
the provisions of this section in such a manner to ensure that such
provisions--
``(1) have no effect on the benefits under this title for
individuals who are entitled to, or enrolled for, such benefits
other than through this section; and
``(2) have no negative impact on the Federal Hospital
Insurance Trust Fund or the Federal Supplementary Medical
Insurance Trust Fund (including the Medicare Prescription Drug
Account within such Trust Fund).
``(b) Option.--
``(1) In general.--Every individual who meets the
requirements described in paragraph (3) shall be eligible to
enroll under this section.
``(2) Part a, b, and d benefits.--An individual enrolled
under this section is entitled to the same benefits (and shall
receive the same protections) under this title as an individual
who is entitled to benefits under part A and enrolled under
parts B and D, including the ability to enroll in a private
plan that provides qualified prescription drug coverage.
``(3) Requirements for eligibility.--The requirements
described in this paragraph are the following:
``(A) The individual is a resident of the United
States.
``(B) The individual is--
``(i) a citizen or national of the United
States; or
``(ii) an alien lawfully admitted for
permanent residence.
``(C) The individual is not otherwise entitled to
benefits under part A or eligible to enroll under part
A or part B.
``(D) The individual has attained the applicable
years of age but has not attained 65 years of age.
``(4) Applicable years of age defined.--For purposes of
this section, the term `applicable years of age' means--
``(A) effective January 1 of the first year
following the date of enactment of the Medicare for All
Act of 2022, the age of 55;
``(B) effective January 1 of the second year
following such date of enactment, the age of 45; and
``(C) effective January 1 of the third year
following such date of enactment, the age of 35.
``(c) Enrollment; Coverage.--The Secretary shall establish
enrollment periods and coverage under this section consistent with the
principles for establishment of enrollment periods and coverage for
individuals under other provisions of this title. The Secretary shall
establish such periods so that coverage under this section shall first
begin on January 1 of the year on which an individual first becomes
eligible to enroll under this section.
``(d) Premium.--
``(1) Amount of monthly premiums.--The Secretary shall,
during September of each year (beginning with the first
September following the date of enactment of the Medicare for
All Act of 2022), determine a monthly premium for all
individuals enrolled under this section. Such monthly premium
shall be equal to \1/12\ of the annual premium computed under
paragraph (2)(B), which shall apply with respect to coverage
provided under this section for any month in the succeeding
year.
``(2) Annual premium.--
``(A) Combined per capita average for all medicare
benefits.--The Secretary shall estimate the average,
annual per capita amount for benefits and
administrative expenses that will be payable under
parts A, B, and D in the year for all individuals
enrolled under this section.
``(B) Annual premium.--The annual premium under
this subsection for months in a year is equal to the
average, annual per capita amount estimated under
subparagraph (A) for the year.
``(3) Increased premium for complementary plans.--Nothing
in this section shall preclude an individual from choosing a
prescription drug plan or other complementary plans which
requires the individual to pay an additional amount (because of
supplemental benefits or because it is a more expensive plan).
In such case the individual would be responsible for the
increased monthly premium.
``(e) Payment of Premiums.--
``(1) In general.--Premiums for enrollment under this
section shall be paid to the Secretary at such times, and in
such manner, as the Secretary determines appropriate.
``(2) Deposit.--Amounts collected by the Secretary under
this section shall be deposited in the Federal Hospital
Insurance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund (including the Medicare Prescription Drug
Account within such Trust Fund) in such proportion as the
Secretary determines appropriate.
``(f) Not Eligible for Medicare Cost-Sharing Assistance.--An
individual enrolled under this section shall not be treated as enrolled
under any part of this title for purposes of obtaining medical
assistance for Medicare cost-sharing or otherwise under title XIX.
``(g) Treatment in Relation to the Affordable Care Act.--
``(1) Satisfaction of individual mandate.--For purposes of
applying section 5000A of the Internal Revenue Code of 1986,
the coverage provided under this section constitutes minimum
essential coverage under subsection (f)(1)(A)(i) of such
section 5000A.
``(2) Eligibility for premium assistance.--Coverage
provided under this section--
``(A) shall be treated as coverage under a
qualified health plan in the individual market enrolled
in through the Exchange where the individual resides
for all purposes of section 36B of the Internal Revenue
Code of 1986 other than subsection (c)(2)(B) thereof;
and
``(B) shall not be treated as eligibility for other
minimum essential coverage for purposes of subsection
(c)(2)(B) of such section 36B.
The Secretary shall determine the applicable second lowest cost
silver plan which shall apply to coverage under this section
for purposes of section 36B of such Code.
``(3) Eligibility for cost-sharing subsidies.--For purposes
of applying section 1402 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18071)--
``(A) coverage provided under this section shall be
treated as coverage under a qualified health plan in
the silver level of coverage in the individual market
offered through an Exchange; and
``(B) the Secretary shall be treated as the issuer
of such plan.
``(h) Consultation.--In promulgating regulations to implement this
section, the Secretary shall consult with interested parties, including
groups representing beneficiaries, health care providers, employers,
and insurance companies.''.
SEC. 1012. ESTABLISHMENT OF THE MEDICARE TRANSITION PLAN.
(a) In General.--To carry out the purpose of this section, for plan
years beginning with the first plan year that begins after the date of
enactment of this Act and ending with the date on which benefits are
first available under section 106(a), the Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid (referred to in
this section as the ``Administrator''), shall establish, and provide
for the offering through the Exchanges, of a public health plan (in
this Act referred to as the ``Medicare Transition plan'') that provides
affordable, high-quality health benefits coverage throughout the United
States.
(b) Administrating the Medicare Transition.--
(1) Administrator.--The Administrator shall administer the
Medicare Transition plan in accordance with this section.
(2) Application of aca requirements.--Consistent with this
section, the Medicare Transition plan shall comply with
requirements under title I of the Patient Protection and
Affordable Care Act (and the amendments made by that title) and
title XXVII of the Public Health Service Act (42 U.S.C. 300gg
et seq.) that are applicable to qualified health plans offered
through the Exchanges, subject to the limitation under
subsection (e)(2).
(3) Offering through exchanges.--The Medicare Transition
plan shall be made available only through the Exchanges, and
shall be available to individuals wishing to enroll and to
qualified employers (as defined in section 1312(f)(2) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18032))
who wish to make such plan available to their employees.
(4) Eligibility to purchase.--Any United States resident
may enroll in the Medicare Transition plan.
(c) Benefits; Actuarial Value.--In carrying out this section, the
Administrator shall ensure that the Medicare Transition plan provides--
(1) coverage for the benefits required to be covered under
title II; and
(2) coverage of benefits that are actuarially equivalent to
90 percent of the full actuarial value of the benefits provided
under the plan.
(d) Providers and Reimbursement Rates.--
(1) In general.--With respect to the reimbursement provided
to health care providers for covered benefits, as described in
section 201, provided under the Medicare Transition plan, the
Administrator shall reimburse such providers at rates
determined for equivalent items and services under the original
Medicare fee-for-service program under parts A and B of title
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.). For
items and services covered under the Medicare Transition plan
but not covered under such parts A and B, the Administrator
shall reimburse providers at rates set by the Administrator in
a manner consistent with the manner in which rates for other
items and services were set under the original Medicare fee-
for-service program.
(2) Prescription drugs.--Any payment rate under this
subsection for a prescription drug shall be at a rate
negotiated by the Administrator with the manufacturer of the
drug. If the Administrator is unable to reach a negotiated
agreement on such a reimbursement rate, the Administrator shall
establish the rate at an amount equal to the lesser of--
(A) the price paid by the Secretary of Veterans
Affairs to procure the drug under the laws administered
by the Secretary of Veterans Affairs;
(B) the price paid to procure the drug under
section 8126 of title 38, United States Code; or
(C) the best price determined under section
1927(c)(1)(C) of the Social Security Act (42 U.S.C.
1396r-8(c)(1)(C)) for the drug.
(3) Participating providers.--
(A) In general.--A health care provider that is a
participating provider of services or supplier under
the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) or under a State
Medicaid plan under title XIX of such Act (42 U.S.C.
1396 et seq.) on the date of enactment of this Act
shall be a participating provider in the Medicare
Transition plan.
(B) Additional providers.--The Administrator shall
establish a process to allow health care providers not
described in subparagraph (A) to become participating
providers in the Medicare Transition plan. Such process
shall be similar to the process applied to new
providers under the Medicare program.
(e) Premiums.--
(1) Determination.--The Administrator shall determine the
premium amount for enrolling in the Medicare Transition plan,
which--
(A) may vary according to family or individual
coverage, age, and tobacco status (consistent with
clauses (i), (iii), and (iv) of section 2701(a)(1)(A)
of the Public Health Service Act (42 U.S.C.
300gg(a)(1)(A))); and
(B) shall take into account the cost-sharing
reductions and premium tax credits which will be
available with respect to the plan under section 1402
of the Patient Protection and Affordable Care Act (42
U.S.C. 18071) and section 36B of the Internal Revenue
Code of 1986, as amended by subsection (g).
(2) Limitation.--Variation in premium rates of the Medicare
Transition plan by rating area, as described in clause (ii) of
section 2701(a)(1)(A)(iii) of the Public Health Service Act (42
U.S.C. 300gg(a)(1)(A)) is not permitted.
(f) Termination.--This section shall cease to have force or effect
on the date on which benefits are first available under section 106(a).
(g) Tax Credits and Cost-Sharing Subsidies.--
(1) Premium assistance tax credits.--
(A) Credits allowed to medicare transition plan
enrollees at or above 44 percent of poverty in non-
expansion states.--Paragraph (1) of section 36B(c) of
the Internal Revenue Code of 1986 is amended by
redesignating subparagraphs (C), (D), and (E) as
subparagraphs (D), (E), and (F), respectively, and by
inserting after subparagraph (B) the following new
subparagraph:
``(C) Special rules for medicare transition plan
enrollees.--
``(i) In general.--In the case of a
taxpayer who is covered, or whose spouse or
dependent (as defined in section 152) is
covered, by the Medicare Transition plan
established under section 1002(a) of the
Medicare for All Act of 2022 for all months in
the taxable year, subparagraph (A) shall be
applied without regard to `but does not exceed
400 percent'. The preceding sentence shall not
apply to any taxable year to which subparagraph
(E) applies.
``(ii) Enrollees in medicaid non-expansion
states.--In the case of a taxpayer residing in
a State which (as of the date of the enactment
of the Medicare for All Act of 2022) does not
provide for eligibility under clause (i)(VIII)
or (ii)(XX) of section 1902(a)(10)(A) of the
Social Security Act for medical assistance
under title XIX of such Act (or a waiver of the
State plan approved under section 1115) who is
covered, or whose spouse or dependent (as
defined in section 152) is covered, by the
Medicare Transition plan established under
section 1002(a) of the Medicare for All Act of
2022 for all months in the taxable year,
subparagraphs (A) and (B) shall be applied by
substituting `0 percent' for `100 percent' each
place it appears.''.
(B) Premium assistance amounts for taxpayers
enrolled in medicare transition plan.--
(i) In general.--Subparagraph (A) of
section 36B(b)(3) of such Code is amended--
(I) by redesignating clauses (ii)
and (iii) as clauses (iii) and (iv),
respectively;
(II) by striking ``clause (ii)'' in
clause (i) and inserting ``clauses (ii)
and (iii)''; and
(III) by inserting after clause (i)
the following new clause:
``(ii) Special rules for taxpayers enrolled
in medicare transition plan.--In the case of a
taxpayer who is covered, or whose spouse or
dependent (as defined in section 152) is
covered, by the Medicare Transition plan
established under section 1002(a) of the
Medicare for All Act of 2022 for all months in
the taxable year the applicable percentage for
any taxable year shall be determined in the
same manner as under clause (i), except that
the following table shall apply in lieu of the
table contained in such clause:
------------------------------------------------------------------------
``In the case of household income
(expressed as a percent of poverty The initial The final
line) within the following income premium premium
tier: percentage is-- percentage is--
------------------------------------------------------------------------
Up to 100 percent 2 2
100 percent up to 138 percent 2.04 2.04
138 percent up to 150 percent 3.06 4.08
150 percent and above 4.08 5.
------------------------------------------------------------------------
The preceding sentence shall not apply to any
taxable year to which clause (iv) applies.''.
(ii) Conforming amendment.--Subclause (I)
of clause (iii) of section 36B(b)(3) of such
Code, as redesignated by subparagraph (A)(i),
is amended by inserting ``, and determined
after the application of clause (ii)'' after
``after application of this clause''.
(2) Cost-sharing subsidies.--Subsection (b) of section 1402
of the Patient Protection and Affordable Care Act (42 U.S.C.
18071(b)) is amended--
(A) by inserting ``, or in the Medicare Transition
plan established under section 1002(a) of the Medicare
for All Act of 2022,'' after ``coverage'' in paragraph
(1);
(B) by redesignating paragraphs (1) (as so amended)
and (2) as subparagraphs (A) and (B), respectively, and
by moving such subparagraphs 2 ems to the right;
(C) by striking ``Insured.--In this section'' and
inserting ``Insured.--
``(1) In general.--In this section'';
(D) by striking the flush language; and
(E) by adding at the end the following new
paragraph:
``(2) Special rules.--
``(A) Individuals lawfully present.--In the case of
an individual described in section 36B(c)(1)(B) of the
Internal Revenue Code of 1986, the individual shall be
treated as having household income equal to 100 percent
of the poverty line for a family of the size involved
for purposes of applying this section.
``(B) Medicare transition plan enrollees in
medicaid non-expansion states.--In the case of an
individual residing in a State which (as of the date of
the enactment of the Medicare for All Act of 2022) does
not provide for eligibility under clause (i)(VIII) or
(ii)(XX) of section 1902(a)(10)(A) of the Social
Security Act for medical assistance under title XIX of
such Act (or a waiver of the State plan approved under
section 1115) who enrolls in such Medicare Transition
plan, the preceding sentence, paragraph (1)(B), and
paragraphs (1)(A)(i) and (2)(A) of subsection (c) shall
each be applied by substituting `0 percent' for `100
percent' each place it appears.
``(C) Adjusted cost-sharing for medicare transition
plan enrollees.--In the case of any individual who
enrolls in such Medicare Transition plan, in lieu of
the percentages under subsection (c)(1)(B)(i) and
(c)(2), the Secretary shall prescribe a method of
determining the cost-sharing reduction for any such
individual such that the total of the cost-sharing and
the premiums paid by the individual under such Medicare
Transition plan does not exceed the percentage of the
total allowed costs of benefits provided under the plan
equal to the final premium percentage applicable to
such individual under section 36B(b)(3)(A)(ii) of the
Internal Revenue Code of 1986.''.
(h) Conforming Amendments.--
(1) Treatment as a qualified health plan.--Section
1301(a)(2) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18021(a)(2)) is amended--
(A) in the paragraph heading, by inserting ``, the
medicare transition plan,'' before ``and''; and
(B) by inserting ``The Medicare Transition plan,''
before ``and a multi-State plan''.
(2) Level playing field.--Section 1324(a) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18044(a)) is
amended by inserting ``the Medicare Transition plan,'' before
``or a multi-State qualified health plan''.
Subtitle C--Patient Protections During Medicare for All Transition
Period
SEC. 1021. MINIMIZING DISRUPTIONS TO PATIENT CARE.
The Secretary shall ensure that all individuals enrolled in, or who
seek to enroll in, a group health plan, health insurance coverage
offered by a health insurance issuer, or the plan established under
section 1002 during the transition period of this Act are protected
from disruptions in their care during the transition period.
SEC. 1022. PUBLIC CONSULTATION.
The Secretary shall consult with communities and advocacy
organizations of individuals living with disabilities and other patient
advocacy organizations to ensure the transition described in this
section takes into account the safety and continuity of care for
individuals with disabilities, complex medical needs, or chronic
conditions.
SEC. 1023. DEFINITIONS.
In this subtitle, the terms ``health insurance coverage'', ``health
insurance issuer'', and ``group health plans'' have the meanings given
such terms in section 2791 of the Public Health Service Act (42 U.S.C.
300gg-91).
TITLE XI--MISCELLANEOUS
SEC. 1101. UPDATING RESOURCE LIMITS FOR SUPPLEMENTAL SECURITY INCOME
ELIGIBILITY (SSI).
Section 1611(a)(3) of the Social Security Act (42 U.S.C.
1382(a)(3)) is amended--
(1) in subparagraph (A)--
(A) by striking ``and'' after ``January 1, 1988,'';
and
(B) by inserting ``, and to $6,200 on January 1,
2022'' before the period;
(2) in subparagraph (B)--
(A) by striking ``and'' after ``January 1, 1988,'';
and
(B) by inserting ``, and to $4,100 on January 1,
2022'' before the period; and
(3) by adding at the end the following new subparagraph:
``(C) Beginning with December of 2022, whenever the dollar
amounts in effect under paragraphs (1)(A) and (2)(A) of this
subsection are increased for a month by a percentage under
section 1617(a)(2), each of the dollar amounts in effect under
this paragraph shall be increased, effective with such month,
by the same percentage (and rounded, if not a multiple of $10,
to the closest multiple of $10). Each increase under this
subparagraph shall be based on the unrounded amount for the
prior 12-month period.''.
SEC. 1102. DEFINITIONS.
In this Act--
(1) the term ``Secretary'' means the Secretary of Health
and Human Services;
(2) the term ``State'' means a State, the District of
Columbia, or a territory of the United States; and
(3) the term ``United States'' shall include the States,
the District of Columbia, and the territories of the United
States.
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