[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5299 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 5299
To amend title XVIII of the Social Security Act to establish a
demonstration program for international coverage under the Medicare
program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 29, 2023
Mr. Espaillat introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a
demonstration program for international coverage under the Medicare
program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Earned Benefits Equality and Family
Reunification Act''.
SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM FOR INTERNATIONAL COVERAGE
UNDER THE MEDICARE PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by inserting after section 1866F the following new section:
``SEC. 1866G. DEMONSTRATION PROGRAM FOR INTERNATIONAL COVERAGE.
``(a) Implementation of 10-Year Demonstration Program.--Not later
than 1 year after the date of the enactment of this section, the
Secretary shall implement a 10-year demonstration program under this
title (in this section referred to as the Program) to allow Applicable
Beneficiaries to apply Medicare benefits to coverage of items and
services, premiums, and other cost-sharing under the health insurance
systems of other countries. Through the Program, the Secretary shall
make payments under subsection (e) to or on behalf of Applicable
Beneficiaries participating in the Program.
``(b) Program Design.--
``(1) In general.--The Secretary shall design the Program
in such a manner to allow for the evaluation of the extent to
which the Program accomplishes the following purposes:
``(A) Increases the quality of care for Applicable
Beneficiaries participating in the Program.
``(B) Decreases the cost of care to the government
for the Applicable Beneficiaries.
``(C) Enables Applicable Beneficiaries to reunify
with family members.
``(D) Reduced strain on the medical infrastructure
of the United States.
``(2) Consultation.--In designing the Program, the
Secretary shall use open door forums and other mechanisms to
seek input from a consortium of stakeholders that may include
but are not limited to--
``(A) the United States Department of State;
``(B) clinical and analytical experts with relevant
expertise;
``(C) beneficiaries; and
``(D) foreign health insurance system experts.
``(3) Program considerations.--In consultation with
stakeholders as identified in subsection (b)(2), the Secretary
shall issue guidance on--
``(A) the guidelines to ensure the usage of
medications and equipment that are of acceptable
quality relative to American quality standards;
``(B) ways to ensuring quality of care; and
``(C) ways to target low-income Americans as
participants in the program.
``(c) Selected Countries Initial Selection.--In choosing Selected
Countries for the Program, the Secretary shall initially select at
least 11 distinct nations or political subdivisions thereof, which
shall include Canada, the Federal Republic of Germany, the Republic of
India, the State of Israel, the Republic of Korea, the Republic of the
Philippines, the Republic of Panama, the United Mexican States,
Dominican Republic, and at least one nation or political subdivision
thereof in Africa.
``(d) Applicable Beneficiary.--
``(1) Voluntary beneficiary participation.--An Applicable
Beneficiary may participate in the Program on a voluntary basis
and may terminate participation in the Program at any time. The
election to participate in the Program or to terminate
participation shall constitute a Special Election Period under
section 1852(e)(4) of this title.
``(2) Services.--In order to participate in the Program, an
Applicable Beneficiary shall agree to receive coverage of
health care items and services in a Selected Country during
such time as the Applicable Beneficiary is a resident of that
country.
``(3) Beneficiary access to services.--Nothing in this
section shall be construed as limiting an Applicable
Beneficiary's access to items and services covered under this
title when furnished in the United States, and Applicable
Beneficiaries shall not be required to relinquish access to
such benefits as a condition of receiving services from a
participant in the Program.
``(4) Number of applicable beneficiaries.--The Secretary
may cap the number of Applicable Beneficiaries accepted into
the Program, but at a number no smaller than 150,000.
``(e) Physician Certification.--Participating physicians must be in
good standing with accreditation institutions or licensing authorities
in the Selected Countries.
``(f) Payments.--
``(1) In general.--The Secretary shall make payments to or
on behalf of Applicable Beneficiaries for the costs of health
care items and services paid by Applicable Beneficiaries in
Selected Countries. Such payments may include payments for
individual items or services paid by Applicable Beneficiaries,
payments for cost sharing incurred by Applicable Beneficiaries,
and premiums and equivalent charges for health insurance
coverage paid by Applicable Beneficiaries. Payments shall not
include reimbursement for taxes levied on income for the
purpose of funding health care.
``(2) Payment amounts.--The Secretary shall limit the
amounts of payment to ensure such payments and funds expended
to design, implement, and evaluate the Program do not exceed in
the aggregate the amount the Secretary would pay under this
title for equivalent services delivered in the United States.
``(3) No duplicate payment.--The Secretary shall make or
permit payments under this paragraph only for a calendar month
in which the Applicable Beneficiary resides in the Selected
Country and does not incur any costs under this title other
than the payment hereunder.
``(g) Role of Medicare Advantage.--
``(1) In carrying out the Program, the Secretary may
administer the Program, either in part or exclusively, through
Medicare Advantage Organizations.
``(2) To the extent Medicare Advantage Organizations carry
out functions under the Program, payments made by such
organizations under subsection (e) shall be considered as if
they were benefits under the original Medicare fee-for-service
program option for purposes of sections 1852 and 1854 of this
title, and a component of standard prescription drug coverage
and not supplemental prescription drug coverage, under section
1860D2(a) of this title.
``(3) The Secretary may limit the number of Medicare
Advantage Organizations participating in the Program, in
accordance with criteria established by the Secretary.
``(h) Reporting.--The Secretary shall conduct annual intermediate
and a final evaluation of the Program. Each such evaluation shall
determine the extent to which each of the purposes described in
subsection (b) have been accomplished under the Program. The evaluation
shall contain recommendations to Congress with regards to the expansion
of the Program.
``(i) Addressing Waste, Fraud, and Abuse.--
``(1) Participating physicians are required to go through
Fraud, Waste, and Abuse training within 90 days of
implementation of the demonstration project and at least
annually thereafter.
``(2) The Secretary must create a system to allow patients
and physicians to report instances or concerns of waste, fraud,
and abuse.
``(j) Definitions.--In this section:
``(1) Applicable beneficiary.--The term `Applicable
Beneficiary' means an individual who--
``(A) is entitled to or enrolled for benefits under
part A, and enrolled for benefits under part B;
``(B) may be enrolled in a Medicare Advantage plan
under part C;
``(C) is either--
``(i) a resident of the United States at
the time of application to the Program who
intends to relocate to a Selected Country on or
after the date of such application, or is a
former resident of the United States who has
relocated to a Selected Country within 180 days
of application to the Program; or
``(ii) a resident of a Selected Country for
whom the Medicare program is at the time of
application the primary payor of their health
care costs; and
``(D) meets such other criteria as the Secretary
determines appropriate.
``(2) Selected country.--The term Selected Country means a
nation or political subdivision thereof identified by the
Secretary as having a health care system that provides for--
``(A) health care coverage in scope and quality of
coverage appropriate for Medicare beneficiaries in
accordance with criteria established by the Secretary;
and
``(B) cost of coverage, coinsurance, and items and
services that is equivalent to or less than expected
costs for such coverage, coinsurance, and items and
services in the United States under this title.
``(k) Funding.--
``(1) Administrative funding.--The Secretary shall allocate
funds made available under section 1115A(f)(1) to design,
implement, and evaluate the Program.
``(2) Benefit funding.--Payments for items and services
under the Program shall be made in appropriate part from the
Federal Hospital Insurance Trust Fund established by section
1817 of this title and the Federal Supplementary Medical
Insurance Trust Fund established by section 1841 of this title.
``(l) Waivers.--The Secretary may waive any provision of this title
as may be necessary to carry out the Program under this section.
``(m) Limitations on Review.--There shall be no administrative or
judicial review under section 1869, section 1878, or otherwise of--
``(1) the selection of organizations, sites, or
participants to test the Program; and
``(2) the elements, parameters, scope, and duration of the
Program. The preceding sentence shall not prevent an Applicable
Beneficiary, having been selected as a participant, from
exercising a right to appeal under sections 1869, 1155,
1852(g), 1860D-4, or otherwise.
``(n) Administration.--
``(1) Chapter 35 of title 44, United States Code, shall not
apply to the activities under this section.
``(2) The Secretary may enter into contracts for the
administration of the Program without regard to any requirement
for the use of competitive procedures.''.
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