[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3080 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 3080
To ensure health care fairness and affordability for all Americans
through universal access to equitable health insurance tax credits,
reformed health savings accounts, and strengthened consumer
protections, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 29, 2025
Mr. Sessions introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, and Education and Workforce, 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 ensure health care fairness and affordability for all Americans
through universal access to equitable health insurance tax credits,
reformed health savings accounts, and strengthened consumer
protections, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; PURPOSES; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health Care
Fairness for All Act''.
(b) Purposes.--The purposes of this Act are as follows:
(1) Elimination of individual and employer mandates.--To
eliminate mandates on individuals and employers, and other tax
requirements, imposed under Public Law 111-148.
(2) Providing states with alternative, affordable coverage
options.--To provide greater flexibility in providing States
with options in making affordable health insurance coverage
available by eliminating certain mandates under Public Law 111-
148, while retaining essential consumer protections, by
promoting health savings accounts to pay for such coverage and
long-term care coverage, while permitting States to continue
coverage as provided under such public law.
(c) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; purposes; table of contents.
Sec. 2. Definitions.
TITLE I--REVISION OF FEDERAL HEALTH LAW
Subtitle A--Elimination of Employer and Individual Mandates
Sec. 101. Repeal of individual health insurance mandate.
Sec. 102. Repeal of employer health insurance mandate.
Sec. 103. Clarifying employer's ability to reimburse employee premiums
for purchase of individual health insurance
coverage.
Subtitle B--Limitation on Application of Federal Health Plan
Requirements
Sec. 121. Limiting application of requirements to consumer protections.
Sec. 122. Offering of basic health insurance; protection of assets from
liability or attachment or seizure.
Sec. 123. Ensuring access to short-term limited duration insurance.
Sec. 124. Making telehealth flexibilities permanent.
Subtitle C--Health Insurance Tax Benefit
Sec. 131. Health insurance tax benefit.
Sec. 132. Application of portion of unused tax credits by States for
indigent health care.
Sec. 133. Medicaid option of enrollment under private plan and
contribution to an HSA.
Sec. 134. Repeal of reporting requirements relating to employee health
insurance premiums and health plan
benefits.
Sec. 135. Report.
Subtitle D--Medicare Reforms
Sec. 141. Physician-owned hospitals.
Sec. 142. Prohibiting the use of an inpatient-only list in designating
hospital outpatient services under the
Medicare program.
Sec. 143. Promoting Medicare site-neutral payments.
Sec. 144. Medicare Advantage contributions to Roth HSAs for chronically
ill enrollees.
Sec. 145. Extending acute hospital care at home waiver flexibilities.
TITLE II--IMPROVING HEALTH SAVINGS ACCOUNTS TO PROMOTE ACCOUNTABILITY
Sec. 201. Transition to non-deductible HSAs.
Sec. 202. Elimination of medical expense deduction.
Sec. 203. Treatment of HSA after death of account beneficiary.
Sec. 204. Treatment of direct patient care arrangements.
TITLE III--STATE FLEXIBILITY IN REGULATION OF HEALTH INSURANCE COVERAGE
Sec. 301. State flexibility in regulation of health insurance coverage.
TITLE IV--MEDICAID PAYMENT REFORM
Sec. 401. Medicaid payment reform to ensure equitable access to care.
TITLE V--PRICE TRANSPARENCY
Sec. 501. Promoting transparent hospital prices for consumers.
SEC. 2. DEFINITIONS.
Except as otherwise provided, in this Act:
(1) Basic health insurance.--The term ``basic health
insurance'' is defined in section 122(a).
(2) Default health insurance coverage.--The term ``default
health insurance coverage'' is defined in section 121(b)(4)(B).
(3) Exchange.--The term ``Exchange'' means an Exchange
established under title I of Public Law 111-148.
(4) Health insurance coverage; group health plan, etc.--The
terms defined in section 2791 of the Public Health Service Act,
including ``health insurance coverage'', ``group health plan''
``individual market'', shall apply.
(5) Limited benefit insurance.--The term ``limited benefit
insurance'' is defined in section 122(b).
(6) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(7) State.--The term ``State'' includes the District of
Columbia, Puerto Rico, the United States Virgin Islands,
American Samoa, Guam, and the Northern Mariana Islands.
TITLE I--REVISION OF FEDERAL HEALTH LAW
Subtitle A--Elimination of Employer and Individual Mandates
SEC. 101. REPEAL OF INDIVIDUAL HEALTH INSURANCE MANDATE.
Section 5000A of the Internal Revenue Code of 1986 is amended by
adding at the end the following new subsection:
``(h) Termination.--This section shall not apply to months
beginning after December 31, 2024.''.
SEC. 102. REPEAL OF EMPLOYER HEALTH INSURANCE MANDATE.
(a) In General.--Chapter 43 of the Internal Revenue Code of 1986 is
amended--
(1) by striking section 4980H, and
(2) by striking the item relating to section 4980H from the
table of sections for such chapter.
(b) Repeal of Related Reporting Requirements.--Subpart D of part
III of subchapter A of chapter 61 of such Code is amended by striking
section 6056 and by striking the item relating to section 6056 in the
table of sections for such subpart.
(c) Conforming Amendments.--
(1) Section 6724(d)(1)(B) of such Code is amended by
striking clause (xxv).
(2) Section 6724(d)(2) of such Code is amended by striking
subparagraph (HH).
(3) Section 1513 of Public Law 111-148 is amended by
striking subsection (c).
(d) Effective Dates.--
(1) In general.--Except as otherwise provided in this
subsection, the amendments made by this section shall apply to
months and other periods beginning more than 30 days after the
date of the enactment of this Act.
(2) Repeal of study and report.--The amendment made by
subsection (c)(3) shall take effect on the date of the
enactment of this Act.
SEC. 103. CLARIFYING EMPLOYER'S ABILITY TO REIMBURSE EMPLOYEE PREMIUMS
FOR PURCHASE OF INDIVIDUAL HEALTH INSURANCE COVERAGE.
An employer health care arrangement, such as a health or medical
reimbursement arrangement (HRA) or other employment plans, under which
an employer reimburses an employee for the premiums for the purchase of
individual health insurance coverage does not constitute a group health
plan for any purposes, including for purposes of applying any of the
following:
(1) The Public Health Service Act (including sections 2711
and 2714 of such Act, 42 U.S.C. 300gg-11, 300gg-14).
(2) Public Law 111-148.
(3) The Internal Revenue Code of 1986 (other than for
purposes of section 36B of such Code).
(4) The Employee Retirement Income Security Act of 1974.
(5) The HIPAA privacy regulations (as defined in section
1180(b)(3) of the Social Security Act, 42 U.S.C. 1320d-
9(b)(3)).
(6) The Health Insurance Portability and Accountability Act
of 1996.
(7) COBRA continuation coverage under title XXII of the
Public Health Service Act (42 U.S.C. 300bb-1 et seq.), section
4980B of the Internal Revenue Code of 1986, or title VI of the
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161
et seq.).
Subtitle B--Limitation on Application of Federal Health Plan
Requirements
SEC. 121. LIMITING APPLICATION OF REQUIREMENTS TO CONSUMER PROTECTIONS.
(a) Removal of Public Law 111-148 Plan Requirements, Other Than
Certain Consumer Protections.--
(1) In general.--Notwithstanding any other provision of
law, with respect to group health plans and health insurance
coverage whether or not offered through an Exchange, except as
provided in paragraphs (2) and (3), the provisions of title
XXVII of the Public Health Service Act (42 U.S.C. 300gg et
seq.) as in effect on the day before the date of the enactment
of Public Law 111-148 shall apply instead of the provisions of
such title as in effect after such date.
(2) Public law 111-148 consumer protections continuing to
be applied.--The following sections of the Public Health
Service Act, that were added or amended by subtitles A and C of
title I of Public Law 111-148, shall continue to apply to group
health plans and to health insurance coverage offered in the
individual and group market:
(A) No lifetime or annual limits.--Section 2711 (42
U.S.C. 300gg-11; relating to no lifetime or annual
limits), except in the case of limited benefit
insurance (as defined in section 122(b)).
(B) Dependent coverage through age 26.--Section
2714 (42 U.S.C. 300bb-14; relating to extension of
dependent coverage).
(C) Modified guaranteed availability.--Section 2702
(42 U.S.C. 300gg-1; relating to guaranteed availability
of coverage), subject to paragraph (3) and subsection
(c).
(D) Guaranteed renewability.--Section 2703 (42
U.S.C. 300gg-2; relating to guaranteed renewability of
coverage).
(E) Prohibiting pre-existing condition
exclusions.--Section 2704 (42 U.S.C. 300gg-3; relating
to prohibition on preexisting conditions).
(F) Prohibiting discrimination based on health
status.--Section 2705 (42 U.S.C. 300gg-4; relating to
prohibiting discrimination against individual
participants and beneficiaries based on health status),
subject to subsection (c).
(G) Non-discrimination in health care.--Section
2706 (42 U.S.C. 300gg-5; relating to non-discrimination
in health care).
(3) Application of a late enrollment penalty for those
without continuous coverage.--
(A) In general.--In the case of an individual who
seeks to enroll in health insurance coverage and who,
as of the effective date of such enrollment, does not
have a continuous period of at least 12 months of
creditable coverage, there shall be imposed a late
enrollment penalty in the form of an increase in the
monthly premiums for coverage of under the plan of 20
percent of the monthly premium otherwise determined for
each consecutive full 12-month period (ending before
such effective date) in which the individual was not
enrolled in creditable coverage. Such increase shall
apply during a period, to be specified under
regulations of the Secretary but in no case longer than
3 times the length of the most recent period in which
the individual did not have continuous coverage.
(B) State waiver.--A State may apply to the
Secretary for a waiver of the provisions of
subparagraph (A) and the application of alternative
provisions providing incentives for State residents to
enroll in creditable coverage and maintain continuous
creditable coverage. The Secretary shall approve such
waiver if the Secretary determines that the alternative
provisions provide similar or greater incentives for
such enrollment than the incentives otherwise
applicable.
(4) Coordinating implementation of pre-public law 111-148
phsa provisions with public law 111-148 consumer protections.--
(A) In general.--In applying this subsection, the
provisions described in paragraph (2) shall be treated
as if they were included in title XXVII of the Public
Health Service Act, as in effect before the date of
enactment of Public Law 111-148, and, with respect to
group health plans and health insurance coverage
offered in connection with such plans, in part 7 of
subtitle B of title I of the Employee Retirement and
Income Security Act of 1974 (29 U.S.C. 1181 et seq.),
and, with respect to group health plans, in chapter 100
of the Internal Revenue Code of 1986 as follows:
(i) Lifetime limits; dependent coverage.--
The provisions described in paragraphs (2)(A)
and (2)(B) shall be treated as included--
(I) with respect to group health
plans (and health insurance coverage
offered with respect to such plans),
under subpart 2 of part A of title
XXVII of the Public Health Service Act
(42 U.S.C. 300gg-11 et seq.) and
subpart B of part 7 of subtitle B of
title I of the Employee Retirement and
Income Security Act of 1974 (29 U.S.C.
1181 et seq.);
(II) also with respect to group
health plans, under subchapter B of
chapter 100 of the Internal Revenue
Code of 1986; and
(III) with respect to individual
health insurance coverage, under
subpart 2 of part B of title XXVII of
the Public Health Service Act (42
U.S.C. 300gg-15 et seq.).
(ii) Remaining provisions.--The provision
described in paragraph (2) (other than in
subparagraph (A) or (B) of such paragraph)
shall be treated as included--
(I) with respect to group health
plans (and health insurance coverage
offered with respect to such plans),
under subpart 1 of part A of title
XXVII of the Public Health Service Act
(42 U.S.C. 300gg et seq.) and subpart A
of part 7 of subtitle B of title I of
the Employee Retirement and Income
Security Act of 1974 (29 U.S.C. 1181 et
seq.);
(II) also with respect to group
health plans, under subchapter A of
chapter 100 of the Internal Revenue
Code of 1986; and
(III) with respect to individual
health insurance coverage, under
subpart 1 of part B of title XXVII of
the Public Health Service Act (42
U.S.C. 300gg-41 et seq.).
(B) Conflicting provisions.--In the case described
in paragraph (1) where there is a conflict between a
provision described in paragraph (2) and a provision of
law described in paragraph (1), the provision described
in paragraph (2) shall control and the Secretary, in
consultation with the Secretary of the Treasury and the
Secretary of Labor, shall establish such rules as may
be necessary to carry out this subparagraph.
(5) Conforming amendments.--
(A) ERISA.--Section 715 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1185d) is
amended--
(i) in subsection (a), by striking
``subsection (b)'' and inserting ``subsections
(b) and (c)''; and
(ii) by adding at the end the following new
subsection:
``(c) Additional Exception.--Pursuant to section 121 of the Health
Care Fairness for All Act, the provisions of part A of title XXVII of
the Public Health Service Act referred to in subsection (a), other than
those provisions specified in section 121(a)(2) of the Health Care
Fairness for All Act, shall not apply to plans and coverage described
in subsection (a), whether or not the plans or coverage are offered
through an Exchange established by Public Law 111-148.''.
(B) IRC.--Section 9815 of the Internal Revenue Code
of 1986 is amended--
(i) in subsection (a), by striking
``subsection (b)'' and inserting ``subsections
(b) and (c)''; and
(ii) by adding at the end the following new
subsection:
``(c) Additional Exception.--Pursuant to section 121 of the Health
Care Fairness for All Act, the provisions of part A of title XXVII of
the Public Health Service Act referred to in subsection (a), other than
those provisions specified in section 121(a)(2) of the Health Care
Fairness for All Act, shall not apply to plans described in subsection
(a).''.
(b) State Flexibility in Ensuring Orderly Health Insurance Market
Outside of an Exchange.--
(1) In general.--With respect to health insurance coverage
offered in a State, the State may, in consultation with the
Secretary, take such steps, such as limiting the availability
of general open enrollment periods, imposing delays in the
effectiveness for coverage, permitting differentials in
premiums based on age and other factors, as the State
determines necessary in order to ensure an orderly market for
health insurance coverage in the State that is not offered
through an Exchange. Such steps may include the establishment
of such initial open enrollment period during which qualified
residents may enroll in health insurance coverage without the
imposition of any underwriting as the State determines to be
appropriate in ensuring initial access to such coverage.
(2) Flexibility in imposing additional requirements.--
Subject to paragraph (5), nothing in this section shall be
construed as preventing a State from continuing to apply, to
health insurance coverage issued in the State, requirements
under the provisions of title XXVII of the Public Health
Service Act (as amended by subtitles A and C of title I of
Public Law 111-148) that are not continued under subsection
(a).
(3) State flexibility with respect to exchanges.--A State
may waive such provisions of part II of subtitle D of title I
of Public Law 111-148 (42 U.S.C. 18031 et seq.), in relation to
the establishment of an Exchange in such State, as the State
determines appropriate in order for the State to implement and
administer a market-based system for the availability of health
insurance coverage throughout the State.
(4) State default enrollment option.--
(A) Enrollment, subject to individual opt-out.--
Subject to subparagraph (D), a State may elect to
provide for the enrollment of residents of the State
who are uninsured in default health insurance coverage
(as defined in subparagraph (B)) and establishing a
Roth HSA for such residents who do not have a Roth HSA
unless the resident has affirmatively elected not to be
so enrolled and not to have such an account,
respectively. If a State makes such an election, the
State shall permit eligible residents to enroll in such
coverage on a continuous basis.
(B) Default health insurance coverage defined.--In
this paragraph, the term ``default health insurance
coverage'' means, with respect to a State, health
insurance coverage that--
(i) is a high deductible health plan
(within the meaning of section 223(c)(2) of the
Internal Revenue Code of 1986) with
prescription drug coverage limited to generic
drugs for a limited number of chronic
conditions (commonly referred to as tier I
pharmacy benefit);
(ii) meets such requirements as may apply
to qualify for the payment of plan premiums
from a health savings account under section 223
of such Code (such as age-related premiums and
limitation on imposition of preexisting
condition exclusions);
(iii) has a provider network for covered
benefits that is adequate (as determined
consistent with guidelines issued by the
Secretary) to ensure access to health benefits
under such plan;
(iv) provides for coverage of childhood
immunizations without cost sharing requirements
to the extent such immunizations have in effect
a recommendation from the Advisory Committee on
Immunization Practices of the Centers for
Disease Control and Prevention with respect to
the individual involved; and
(v) meets such other requirements as the
State may specify.
(C) Roth hsa.--In this paragraph, the term ``Roth
HSA'' shall have the meaning given such term by section
530A(c) of the Internal Revenue Code of 1986, as added
by section 201(a) of this Act.
(D) Simple process for individuals to opt out.--As
a condition of a State providing for the enrollment
function described in subparagraph (A), the State must
establish an easy-to-use and transparent means by which
individuals may elect not to be enrolled in default
health insurance coverage or to have a Roth HSA
established on the individual's behalf, or both.
(5) Minimum age variation permitted for premium rates.--
With respect to the premium rate charged by a health insurance
issuer for health insurance coverage offered in the individual
or small group market, a State may not limit the variation by
age in such rate with respect to a particular plan or coverage
involved by less than a factor of 5 to 1 for adults. The
previous sentence shall be treated as if it were included in
subpart I of part A of title XXVII of the Public Health Service
Act (42 U.S.C. 300gg et seq.).
(c) Inapplicability of Required Essential Health Benefits.--
(1) In general.--Notwithstanding any other provision of
law, no health benefits plan shall be required by reason of
Federal law to comply with the requirements of sections
1301(a)(1)(B) and 1302 of Public Law 111-148 (42 U.S.C.
18021(a)(1)(B), 18022).
(2) State flexibility.--Nothing in this subsection shall be
construed as preventing a State from applying, at its option
with respect to health insurance coverage offered through an
Exchange or otherwise in the State, the requirements referred
to in paragraph (1).
(d) Effective Date; Transition.--
(1) In general.--Subsection (a), (b), and (c) shall apply
to plan years beginning after the date of the enactment of this
Act.
(2) Sunsetting required contribution for aca reinsurance
program.--No contribution shall be required under section 1341
of Public Law 111-148 (42 U.S.C. 18061) from any group health
plan or health insurance issuer for portions of plans years
occurring in months beginning more than 30 days after the date
of the enactment of this Act.
(e) Secretarial Guidance.--The Secretary of Health and Human
Services, in coordination with the Secretary of Labor and the Secretary
of the Treasury, shall provide such guidance as may be necessary for
the coordinated implementation of this section on a timely basis.
(f) Transferring Health Plan Records Upon Changing Plans.--
(1) In general.--In the case of an individual who is
covered under health insurance coverage or as a beneficiary or
participant in a group health plan (as such terms are defined
in section 2791 of the Public Health Service Act, 42 U.S.C.
300gg-91), if such coverage is ended and the individual obtains
other health insurance coverage, group health plan coverage, or
other creditable coverage (as defined for purposes of title
XXVII of such Act), the issuer of the prior coverage or
administrator of the prior plan shall forward information
respecting such prior coverage to the issuer of the new
coverage or administrator of the new plan or coverage, as the
case may be, subject to such rules as the Secretary establishes
regarding the right of the beneficiary or participant to object
to such forwarding of information.
(2) Treatment as plan requirement under phsa, erisa, irc.--
The requirement of paragraph (1) shall apply as if it were a
section under part A of title XXVII of the Public Health
Service Act, including for purposes of applying section 715 of
the Employee Retirement Income Security Act of 1976 (29 U.S.C.
1185d) and section 9815 of the Internal Revenue Code of 1986.
(g) Application of Risk Adjustment.--
(1) In general.--Any issuer that offers health insurance
coverage in the individual market in any of the 50 States or
the District of Columbia shall participate in a risk adjustment
mechanism under this subsection with respect to any health
insurance coverage it so offers in such market, whether or not
such coverage is offered through an Exchange.
(2) Form and design of risk adjustment mechanism.--The
Secretary shall, in consultation with the National Association
of Insurance Commissioners and other interested parties,
develop a mechanism to permit the adjustment of risk among
health insurance coverage offered in the individual market
throughout the 50 States and the District of Columbia. Such
mechanism shall be designed to effect the same type of risk
adjustment among such coverage that is applicable to risk
adjustment of payments among Medicare Advantage organizations
under part C of title XVIII of the Social Security Act (42
U.S.C. 1395w-21 et seq.).
(3) Transition for new coverage.--The mechanism developed
under paragraph (2) shall provide for transitional protection,
over a 3-year period, in the case of health insurance coverage
that has not been previously marketed.
(4) Development of further risk adjustment mechanism.--The
Secretary shall request the National Association of Insurance
Commissioners to develop a permanent model for adjustment of
risk among health insurance issuers with respect to health
insurance coverage offered in the individual market, with the
intention that such a model would substitute for the mechanism
developed under paragraph (2).
(5) Treatment as plan requirement under phsa, erisa, irc.--
The requirement of paragraph (1) shall apply as if it were a
section under part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg et seq.), including for purposes
of applying section 715 of the Employee Retirement Income
Security Act of 1976 (29 U.S.C. 1185d) and section 9815 of the
Internal Revenue Code of 1986.
SEC. 122. OFFERING OF BASIC HEALTH INSURANCE; PROTECTION OF ASSETS FROM
LIABILITY OR ATTACHMENT OR SEIZURE.
(a) Requirement for Exchanges.--
(1) In general.--No tax credit shall be allowable under
section 36B or 36C of the Internal Revenue Code of 1986 for
residents of a State unless any Exchange established in the
State provides for the offering of basic health insurance in
all areas of the State.
(2) Basic health insurance defined.--In this subsection,
the term ``basic health insurance'' means, with respect to a
State, such health insurance coverage as the State may specify
and includes limited benefit insurance (as defined in
subsection (b)).
(b) Limited Benefit Insurance Defined.--
(1) In general.--In this title, the term ``limited benefit
insurance'' means individual health insurance coverage that,
with respect to a plan year, imposes (consistent with paragraph
(2)) an annual limit on the amounts that may be payable under
the coverage with respect to expenses incurred for items and
services furnished in that plan year.
(2) Specification of annual limit; variation in limit for
individual and family coverage.--The Secretary shall specify,
from year to year, the annual limit (or range of annual limits)
that may be applied under paragraph (1). Such a limit may
distinguish between coverage that is only provided for an
individual and coverage that is provided also for family
members of the individual.
(c) Protection of Certain Assets in Case of Individuals Covered
Under Limited Benefit Insurance.--
(1) In general.--Notwithstanding any other provision of
law, if an individual is covered under limited benefit
insurance for a plan year and benefits under such insurance
have reached the annual limit under such insurance for items
and services furnished in the plan year, the individual is not
liable for debt incurred and arising from the provision of
subsequently furnished items and services during the plan year,
regardless of whether benefits are otherwise covered for such
items and services under such policy, insofar as the liability
attributable to such items and services exceeds--
(A) the bankruptcy valuation of the individual's
property at the time the debt is incurred; reduced by
(B) such annual limit of benefits under the limited
benefit insurance for the plan year.
Property in the amount so protected from liability shall be
exempt and immune from attachment or seizure with respect to
any judgment related to such debt.
(2) Bankruptcy valuation defined.--In this subsection, the
term ``bankruptcy valuation'' means, with respect to property
of an individual as of a date, the value of the property as of
such date as determined as if the individual were a debtor in a
bankruptcy case that could have been filed under title 11 of
the United States Code and the property could not be exempt
under section 522 of such title.
(3) No requirement for providers to furnish subsequent
services without ensuring payment.--Except as may be explicitly
provided in other law (such as under section 1867 of the Social
Security Act, 42 U.S.C. 1395dd; popularly known as EMTALA), a
health care provider is not required to furnish any items or
services to an individual who has exhausted benefits under
limited benefit insurance for a plan year without the
individual (or another person on the individual's behalf)
providing for such advance or guarantee of payment for such
items and services as may be arranged between the health care
provider and the individual.
SEC. 123. ENSURING ACCESS TO SHORT-TERM LIMITED DURATION INSURANCE.
Section 2791(b)(5) of the Public Health Service Act (42 U.S.C.
300gg-91(b)(5)) is amended by inserting ``(as defined in the rule
entitled `Short-Term, Limited Duration Insurance' (83 Fed. Reg. 38212
(August 3, 2018)))'' after ``short-term limited duration insurance''.
SEC. 124. MAKING TELEHEALTH FLEXIBILITIES PERMANENT.
Notwithstanding any other provision of law, in the case of any
provision of section 1834(m) of the Social Security Act (42 U.S.C.
1395m(m)) that would, absent this section, end on the last day of the
emergency period described in section 1135(g)(1)(B) of the Social
Security Act (42 U.S.C. 1320b-5(a)(1)(B)) or December 1, 2026, such
provision shall be deemed to continue to apply on or after such last
day or such date (as applicable).
Subtitle C--Health Insurance Tax Benefit
SEC. 131. HEALTH INSURANCE TAX BENEFIT.
(a) In General.--Subpart C of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 is amended by inserting after
section 36B the following new section:
``SEC. 36C. HEALTH INSURANCE TAX CREDIT.
``(a) In General.--In the case of an individual who is a qualified
resident, there shall be allowed as a credit against the tax imposed by
this subtitle for any taxable year an amount equal to the health credit
amount of the taxpayer for the taxable year.
``(b) Health Credit Amount.--For purposes of this section--
``(1) In general.--The term `health credit amount' means
the sum of the amounts determined under paragraph (2) with
respect to all months of the taxpayer for the taxable year.
``(2) Monthly credit amount.--
``(A) In general.--Subject to paragraph (4), the
amount determined under this paragraph with respect to
any month shall be an amount equal to the sum of--
``(i) \1/12\ of $4,000 in the case of any
month the first day of which the taxpayer is a
qualified resident and is covered by creditable
coverage (twice such amount in the case of a
joint return if both spouses are so covered by
creditable coverage and are qualified
residents), plus
``(ii) \1/12\ of an amount equal to $2,000
multiplied by the number of qualifying children
(within the meaning of section 152) who are
qualified residents and--
``(I) for whom the taxpayer is
allowed a deduction under section 151
for the taxable year in which such
month ends, and
``(II) who are covered by
creditable coverage on the first day of
such month.
``(B) Carryforward of monthly credit amount in case
credit amount exceeds hsa contributions and premium
payments.--In the case of any month for which the
credit amount determined with respect to the taxpayer
under subparagraph (A) exceeds the limitation amount
determined with respect to the taxpayer for such month
under paragraph (3), such excess may be carried forward
to any subsequent month during the taxable year for
purposes of determining the credit amount for such
month under this paragraph.
``(3) Monthly limitation.--
``(A) In general.--The amount determined under
paragraph (2) for any month of the taxpayer shall not
exceed the sum of--
``(i) the amounts contributed to a health
savings account of the taxpayer for such month,
plus
``(ii) the premiums paid by the taxpayer
for creditable coverage.
``(B) Carryforward of monthly limitation in case
hsa contributions and premium payments exceed monthly
credit amount.--In the case of any month for which the
amount determined with respect to the taxpayer under
subparagraph (A) exceeds the credit amount determined
with respect to the taxpayer for such month under
paragraph (2), such excess may be carried forward to
any subsequent month during the taxable year for
purposes of determining the limitation under
subparagraph (A).
``(4) Adjustment for limited benefit insurance.--In the
case of a taxpayer whose only health insurance coverage for a
month is limited benefit insurance (as defined in section
123(b) of the Health Care Fairness for All Act), the amount
determined under paragraph (2) shall be decreased by such
proportion as the Secretary, in consultation with the Secretary
of Health and Human Services, determines appropriate, taking
into account the ratio of the actuarial value of such limited
benefit insurance to the average actuarial value of health
insurance coverage that is not limited benefit insurance.
``(c) Coordination With Employer-Provided Health Insurance Tax
Subsidy.--
``(1) Credit limited by employer-provided health insurance
tax subsidy.--The credit allowed under this section for any
taxable year shall not exceed an amount equal to the excess (if
any) of--
``(A) the maximum credit which would be allowed for
all months of the taxpayer during the taxable year
(determined under subsection (b)(2) and without regard
to this subsection, the limitation under subsection
(b)(3), and any reduction under subsection (d)(1)),
over
``(B) the taxpayer's employer-provided health
insurance tax subsidy for the taxable year.
``(2) Excess employer-provided health insurance tax subsidy
included in gross income.--In the case of a taxpayer for whom
subparagraph (B) of paragraph (1) exceeds subparagraph (A) of
such paragraph for the taxable year, the tax imposed by this
chapter shall be increased for such taxable year by the amount
of such excess.
``(3) Employer-provided health insurance tax subsidy.--For
purposes of this subsection--
``(A) In general.--The term `employer-provided
health insurance tax subsidy' means, with respect to
any taxpayer for a taxable year, the sum of--
``(i) the Federal income tax subsidy of the
taxpayer for the taxable year, plus
``(ii) the Federal payroll tax subsidy of
the taxpayer for the taxable year.
``(B) Federal income tax subsidy.--The term
`Federal income tax subsidy' means, with respect to any
taxpayer for the taxable year, the excess (if any) of--
``(i) the amount of tax that would have
been imposed by this chapter for the taxable
year had such tax been determined without
regard to this section and by including amounts
otherwise excluded from gross income which were
paid by or on behalf of the taxpayer for
employer-provided insurance that constitutes
medical care, over
``(ii) the amount of tax imposed by this
chapter for the taxable year (determined
without regard to this section).
``(C) Federal payroll tax subsidy.--The term
`Federal payroll tax subsidy' means, with respect to
any taxpayer for the taxable year, the excess (if any)
of--
``(i) the sum of--
``(I) the amount of tax that would
have been imposed by chapter 21 with
respect to any wages of the taxpayer
paid during the taxable year had such
tax been determined by including
amounts otherwise excluded from wages
which were paid by or on behalf of the
taxpayer during the taxable year for
employer-provided insurance that
constitutes medical care, plus
``(II) the amount of tax that would
have been imposed by chapter 2 on any
self-employment income of the taxpayer
for such taxable year had self-
employment income been determined
without regard to any deduction from
gross income for amounts paid for
insurance which constitutes medical
care for the taxpayer, the taxpayer's
spouse, and any qualifying children
(within the meaning of section 152) for
whom the taxpayer is allowed a
deduction under section 151 for the
taxable year, over
``(ii) the amount of tax imposed with
respect to the taxpayer during such taxable
year under chapter 21 and for such taxable year
under chapter 2.
``(d) Reconciliation of Credit and Advance Credit.--
``(1) In general.--The amount of the credit allowed under
this section for any taxable year (after the application of
subsections (b) and (c)) shall be reduced (but not below zero)
by the amount of any advance payment of such credit under
subsection (e)(1).
``(2) Excess advance payments.--
``(A) In general.--If the advance payments to a
taxpayer under subsection (e)(1) for a taxable year
exceed the credit allowed by this section (determined
without regard to paragraph (1)), the tax imposed by
this chapter for the taxable year shall be increased by
the amount of such excess.
``(B) Limitation on increase.--In the case of a
taxpayer whose household income is less than 400
percent of the poverty line for the size of the family
involved for the taxable year, the amount of the
increase under subparagraph (A) shall in no event
exceed an amount equal to the applicable percentage of
the amount of the credit allowed under this section for
the taxable year, determined in accordance with the
following table (one-half of such amount so determined
in the case of a taxpayer whose tax is determined under
section 1(c) for the taxable year):
------------------------------------------------------------------------
``If the household income (expressed as a percent The applicable
of poverty line) is: percentage is:
------------------------------------------------------------------------
Less than 200%.................................... 30%
At least 200% but less than 300%.................. 50%
At least 300% but less than 400%.................. 80%
------------------------------------------------------------------------
``(e) Special Rules.--For purpose of this section--
``(1) Advance payment program.--
``(A) In general.--The Secretary of the Treasury,
in consultation with the Secretary of Health and Human
Services, shall establish a program--
``(i) to make advance determinations with
respect to the eligibility of individuals for
the credit allowed under this section, and
``(ii) to make advance payments of the
credit allowed under this section, at the
election of any such individual so eligible,
directly to the health savings account of any
such individual, or, as a subsidy to the cost
of health insurance coverage provided to any
such individual, to the health insurance issuer
providing such coverage or the person that
administers the plan benefits with respect to
such coverage.
``(B) Program requirements.--Such program shall be
established under rules similar to the rules of section
1412 of Public Law 111-148, as in effect on the day
before the date of the enactment of this section,
except that advance determinations and advance payments
shall be made on request of the individual with respect
to whom the determination is to be made.
``(2) Information requirements.--
``(A) In general.--Each person providing health
insurance coverage which constitutes medical care, and
each trustee of a health savings account, shall provide
the following information to the Secretary and to the
taxpayer with respect to such coverage or such account:
``(i) The total premium for the coverage
without regard to the credit under this
section.
``(ii) The aggregate amount of any advance
payment of such credit made with respect to
such coverage or to such account.
``(iii) The name, address, age, and TIN of
the primary insured or account holder (as the
case may be) and the name, age, and TIN of each
other individual obtaining coverage under such
policy of insurance.
``(iv) Any information provided to such
person necessary to determine eligibility for,
and the amount of, such credit.
``(v) Information necessary to determine
whether a taxpayer has received excess advance
payments.
``(B) Exception.--Subparagraph (A) shall not apply
to any coverage with respect to which reporting under
section 6051 is required.
``(3) Indexing.--
``(A) In general.--In the case of any calendar year
beginning after 2026, each of the dollar amounts in
subsection (b)(2) and in the table contained under
subsection (d)(2)(B) shall be equal to such dollar
amount multiplied by the ratio of--
``(i) the current dollar gross domestic
product (as determined based on the third
estimate of the Bureau of Economic Analysis of
the Department of Commerce for the second
quarter of the previous year), to
``(ii) the current dollar gross domestic
product (as so determined) for the second
quarter of 2025.
``(B) Rounding.--If the amount of any change under
subparagraph (A) is not a multiple of $50, such change
shall be rounded to the next lowest multiple of $50.
``(f) Definitions.--For purposes of this section--
``(1) Creditable coverage.--
``(A) In general.--The term `creditable coverage'
has the meaning given such term for purposes of title
XXVII of the Public Health Service Act. Such term shall
not include coverage under any health plan that
includes coverage for abortions (other than any
abortion described in subparagraph (B)).
``(B) Exception.--The second sentence of
subparagraph (A) shall not apply to an abortion--
``(i) if the pregnancy is the result of an
act of rape or incest, or
``(ii) in the case where a woman suffers
from a physical disorder, physical injury, or
physical illness that would, as certified by a
physician, place the woman in danger of death
unless an abortion is performed, including a
life-endangering physical condition caused by
or arising from the pregnancy itself.
``(C) Separate abortion coverage or plan allowed.--
``(i) Option to purchase separate coverage
or plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any individual from
purchasing separate coverage for abortions
described in such subparagraph, or a health
plan that includes such abortions, so long as
no credit is allowed under this section with
respect to the premiums for such coverage or
plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
non-Federal health insurance issuer offering a
health plan from offering separate coverage for
abortions described in such subparagraph, or a
plan that includes such abortions, so long as
premiums for such separate coverage or plan are
not paid for with any amount attributable to
the credit allowed under this section (or the
amount of any advance payment of the credit).
``(2) Qualified resident.--The term `qualified resident'
means an individual who is a citizen or national of the United
States or otherwise lawfully residing in the United States
under color of law.''.
(b) Disqualification From Exchange Plan Subsidies for Individual
Once They Elect Tax Benefits.--Section 36B(c)(1) of such Code is
amended by adding at the end the following new subparagraph:
``(F) Denial of credit for those electing universal
credit.--In the case of an individual who is allowed a
credit under section 36C for any taxable year, no
credit shall be allowed under this section to such
individual for such taxable year or any subsequent
taxable year.''.
(c) Guidance.--The Secretary of the Treasury shall issue such
guidance as is necessary--
(1) to assist employees and employers in adjusting Federal
income tax withholding to take into account the health
insurance tax credit under section 36C of the Internal Revenue
Code of 1986 (and any advance payment thereof), and
(2) to require employers to report to each employee with
respect to periods not longer than quarterly the employer-
provided health insurance tax subsidy (as defined in section
36C(c)(2) of such Code) with respect to such employee for such
period.
(d) Transfers to Federal Old-Age and Survivors Insurance Trust
Fund.--With respect to each individual for whom tax is increased under
section 36C(c)(2), there are hereby appropriated to the Federal Old Age
and Survivors Trust Fund and the Disability Insurance Trust Fund
established under section 201 of the Social Security Act amounts equal
to the amount which bears the same ratio to the amount of such increase
as--
(1) the Federal payroll tax subsidy (as defined in section
36C(c)(3)) of such individual for the taxable year, bears to
(2) the employer-provided health insurance tax subsidy (as
defined in such section) of the individual for the taxable
year.
(e) Clerical Amendment.--The table of sections for subpart C of
part IV of subchapter A of chapter 1 of the Internal Revenue Code of
1986 is amended by inserting after the item relating to section 36B the
following new item:
``Sec. 36C. Health insurance tax credit.''.
(f) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
SEC. 132. APPLICATION OF PORTION OF UNUSED TAX CREDITS BY STATES FOR
INDIGENT HEALTH CARE.
(a) Computation of Unused Credits.--The Secretary, in consultation
with the Secretary of the Treasury, shall calculate for each State for
each year, beginning with 2026, using the most recent data available--
(1) the maximum aggregate amount of credits under section
36C of the Internal Revenue Code of 1986 that would have been
allowed for the year for qualified residents of the State for
taxable years ending in the year if all eligible qualified
residents had qualified for such credits;
(2) the aggregate amount of credits under such section that
were allowed for taxable years ending in the year by qualified
residents of such State; and
(3) 25 percent of the amount by which--
(A) the amount determined under paragraph (1) with
respect to qualified residents of the State for such
year; exceeds
(B) the amount determined under paragraph (2) for
such State for that year.
(b) Appropriation.--For the purpose of making grants to States
under this section, there is hereby appropriated to the Secretary, out
of any funds in the Treasury not otherwise appropriated, for each year
(beginning with 2025) an amount equivalent to the amount determined
under subsection (a)(3) for all States under subsection (a) for the
year in which such fiscal year ends, subject to adjustment under
subsection (d)(2).
(c) Grants to States for Indigent Assistance.--
(1) Application.--A State may file with the Secretary (in a
form and manner specified by the Secretary) an application to
provide assistance in furnishing health services to indigent
individuals residing in the State. Such application shall
demonstrate the manner in which such assistance is furnished in
an equitable manner to individuals residing in all parts of the
State.
(2) Amount of funds.--From the funds appropriated under
subsection (b) for a year, the amount of funds paid to any
State in any year under this section with an application filed
in accordance with paragraph (1) is equal to an amount
specified in the application, but not to exceed the amount
computed under subsection (a)(3) for the State and the year.
(3) Use of funds.--Funds paid to a State under this
subsection may be used only to assist in the furnishing of
health services to uninsured individuals residing in the State
or for purposes of increasing the payment adjustments made
under sections 1886(d)(5)(F) and 1923 of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(F), 1396r-4) to hospitals that
serve a disproportionate share of such individuals in the
State.
(d) Initial Estimate; Final Calculation and Reconciliation.--
(1) Use of estimates.--The calculations under subsection
(a) for a year shall initially be estimated before the
beginning of the year. Payments under this section to a State
for a year shall be made, subject to reconciliation under
paragraph (2), based on the amount so estimated.
(2) Reconciliation based on final calculation.--The
calculations under subsection (a) for a year shall also be made
after the end of the year. Insofar as the amount calculated
under this paragraph for subsection (a)(3) for a State for a
year exceeds (or is less than) by a material amount from the
amount for subsection (a)(3) estimated and applied for the
State and year under paragraph (1), the amount calculated under
subsection (a)(3) for the State for the 2nd year beginning
after such year, shall be reduced or increased, respectively by
the amount of such excess or deficit.
SEC. 133. MEDICAID OPTION OF ENROLLMENT UNDER PRIVATE PLAN AND
CONTRIBUTION TO AN HSA.
(a) In General.--Notwithstanding any other provision of law, a
State plan under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) may make available to an individual, who is entitled to
medical assistance for a full range of acute care items and services
under such title and at the individual's option, instead of the medical
assistance otherwise provided, medical assistance consisting of
coverage under a health plan that qualifies for a tax credit under
section 36C of the Internal Revenue Code of 1986, but only if the State
provides for the individual medical assistance, in the form of a
deposit into a health savings account for the individual, an amount
equivalent to the amount by which the amount of tax credit for the
individual under such section exceeds the cost of coverage of the
individual under the plan.
(b) FFP Treatment.--The payments by a State described in subsection
(a) for coverage under a health plan and for deposit into a health
savings account shall be treated as medical assistance for purposes of
section 1903 of the Social Security Act (42 U.S.C. 1396b) and subject
to Federal financial participating, including the application of State
matching payments, in the same manner as other medical assistance
furnished under title XIX of such Act, except that such amount shall be
reduced by the amount of any health insurance credits provided under
section 36C of the Internal Revenue Code of 1986 with respect to such
coverage or deposit.
SEC. 134. REPEAL OF REPORTING REQUIREMENTS RELATING TO EMPLOYEE HEALTH
INSURANCE PREMIUMS AND HEALTH PLAN BENEFITS.
(a) Reporting Requirements.--Section 6051(a) of the Internal
Revenue Code of 1986 is amended by striking paragraph (14) and by
redesignating paragraphs (15), (16), and (17) as paragraphs (14), (15),
and (16), respectively.
(b) Effective Dates.--The amendment made by this section shall
apply to calendar years beginning after December 31, 2018.
SEC. 135. REPORT.
For each year beginning on or after the date of the enactment of
this Act, the Secretary of Health and Human Services shall submit to
Congress a report on the extent to which health insurance tax credits
allowed under section 36C of the Internal Revenue Code of 1986, as
added by this Act, are sufficient to cover the cost of health insurance
coverage for individuals electing to purchase such coverage.
Subtitle D--Medicare Reforms
SEC. 141. PHYSICIAN-OWNED HOSPITALS.
The amendments made by section 6001 of Public Law 111-148 are
repealed and the provisions amended by such section are restored as if
such amendments had never occurred.
SEC. 142. PROHIBITING THE USE OF AN INPATIENT-ONLY LIST IN DESIGNATING
HOSPITAL OUTPATIENT SERVICES UNDER THE MEDICARE PROGRAM.
Section 1833(t)(1) of the Social Security Act (42 U.S.C.
1395l(t)(1)) is amended by adding at the end the following new
subparagraph:
``(C) Prohibition on use of an inpatient-only
list.--In designating outpatient hospital services
pursuant to subparagraph (B)(i), the Secretary may not
refuse to so designate such a service based solely on
the Secretary's determination that such service may
only be safely furnished in an inpatient setting.''.
SEC. 143. PROMOTING MEDICARE SITE-NEUTRAL PAYMENTS.
(a) Removing Certain Exceptions to the Definition of an Off-Campus
Outpatient Department of a Provider.--
(1) In general.--Section 1833(t)(21)(B) of the Social
Security Act (42 U.S.C. 1395l(t)(21)(B)) is amended to read as
follows:
``(B) Off-campus outpatient department of a
provider.--For purposes of paragraph (1)(B)(v) and this
paragraph, the term `off-campus outpatient department
of a provider' means a department of a provider (as
defined in section 413.65(a)(2) of title 42 of the Code
of Federal Regulations, as in effect as of the date of
the enactment of the Bipartisan Budget Act of 2015)
that is not located--
``(i) on the campus (as defined in such
section 413.65(a)(2)) of such provider; or
``(ii) within the distance (described in
such definition of campus) from a remote
location of a hospital facility (as defined in
such section 413.65(a)(2)).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply with respect to items and services furnished on or
after January 1, 2026.
(3) Removing site-neutral exception for off-campus
emergency departments.--Section 1833(t)(21)(A) of the Social
Security Act (42 U.S.C. 1395l(t)(21)(A)) is amended by
inserting ``before January 1, 2026'' after ``furnished''.
(4) Clarifying secretarial authority to promote site-
neutral payments.--Section 1833(t)(2)(F) of the Social Security
Act (42 U.S.C. 1395l(t)(2)(F)) is amended by adding at the end
the following new sentence: ``Such method may include actions
determined appropriate by the Secretary to promote site-neutral
payment policies to reduce expenditures attributable to items
and services furnished under this part, such as actions to
prevent hospitals from billing for items and services furnished
at an off-campus outpatient department of a provider as if such
items and services were furnished at such hospital.''.
(b) Ensuring Separate NPIs for Off-Campus Outpatient Departments of
a Provider.--
(1) In general.--Section 1173(b) of the Social Security Act
(42 U.S.C. 1320d-2(b)) is amended by adding at the end the
following new paragraph:
``(3) Ensuring separate npis for off-campus outpatient
departments of a provider.--The standards specified under
paragraph (1) shall ensure that, not later than January 1,
2026, each off-campus outpatient department of a provider (as
defined in section 1833(t)(21)(B)) is assigned a separate
unique health identifier from such provider.''.
(2) Treatment of certain departments as subparts of a
hospital.--Not later than January 1, 2026, the Secretary of
Health and Human Services shall revise sections 162.408 and
162.410 of title 45, Code of Federal Regulations, to ensure
that each off-campus outpatient department of a provider (as
defined in section 1833(t)(21)(B) of the Social Security Act
(42 U.S.C. 1395l(t)(21)(B))) is treated as a subpart (as
described in such sections) of such provider and assigned a
unique health identifier pursuant to section 1173(b)(3) of such
Act (as added by paragraph (1)).
SEC. 144. MEDICARE ADVANTAGE CONTRIBUTIONS TO ROTH HSAS FOR CHRONICALLY
ILL ENROLLEES.
Section 1852(a)(3)(D)(ii)(I) of the Social Security Act (42 U.S.C.
1395w-22(a)(3)(D)(ii)(I)) is amended--
(1) by striking ``are supplemental benefits'' and inserting
the following: ``are
``(aa) supplemental
benefits'';
(2) by striking the period at the end of item (aa), as
inserted by paragraph (1), and inserting ``; and''; and
(3) by adding at the end the following new item:
``(bb) deposits made to a
Roth HSA (as described in
section 530A of the Internal
Revenue Code of 1986) of a
chronically ill enrollee.''.
SEC. 145. EXTENDING ACUTE HOSPITAL CARE AT HOME WAIVER FLEXIBILITIES.
Section 1812 of the Social Security Act (42 U.S.C. 1395d) is
amended--
(1) by redesignating subsection (g) as subsection (h); and
(2) by inserting after subsection (f) the following new
subsection:
``(g)(1) Beginning on the date of the enactment of this subsection,
inpatient hospital services or inpatient critical access hospital
services described in subsection (a)(1) shall include services
(including telehealth services as defined in section 1834(m)) furnished
to an individual by an Acute Hospital Care at Home Program (as defined
by the Secretary).
``(2) With respect to telehealth services furnished by an Acute
Hospital Care at Home Program described in paragraph (1), the
requirements described in section 1834(m)(4)(C)(i) shall not apply and
the sites described in section 1834(m)(4)(C)(ii) shall include the home
or temporary residence of the individual.
``(3) With respect to services furnished in the home or temporary
residence of the individual through an Acute Hospital Care at Home
Program, the requirement for providing 24-hour nursing services and
immediate availability of nursing services as conditions of
participation shall also be satisfied by providing virtual access to
nurses, advanced practice providers, or physicians 24 hours per day.
``(4) With respect to services furnished in the home or temporary
residence of the individual through an Acute Hospital Care at Home
Program, life safety code requirements shall be deemed satisfied for
homes or temporary residences determined to be safe and appropriate for
this care by the Acute Hospital Care at Home Program.
``(5) Not later than 12 months after the date of the enactment of
this subsection, the Secretary shall issue regulations establishing
health and safety requirements for Acute Hospital Care at Home
Programs.''.
TITLE II--IMPROVING HEALTH SAVINGS ACCOUNTS TO PROMOTE ACCOUNTABILITY
SEC. 201. TRANSITION TO NON-DEDUCTIBLE HSAS.
(a) Non-Deductible HSAs.--Subchapter F of chapter 1 of the Internal
Revenue Code of 1986 is amended by adding at the end the following new
part:
``PART IX--ROTH HEALTH SAVINGS ACCOUNTS
``Sec. 530A. Roth HSAs.
``SEC. 530A. ROTH HSAS.
``(a) In General.--A Roth HSA shall be exempt from taxation under
this subtitle. Notwithstanding the preceding sentence, the Roth HSA
shall be subject to the taxes imposed by section 511 (relating to
imposition of tax on unrelated business income of charitable
organizations). No deduction shall be allowed for any contribution to a
Roth HSA.
``(b) Dollar Limitation.--
``(1) In general.--The aggregate amount of contributions
for any taxable year to all Roth HSAs maintained for the
benefit of an individual shall not exceed the sum of the
monthly limitations for any month during such taxable year that
the individual is an eligible individual.
``(2) Monthly limitation.--The monthly limitation for any
month is \1/12\ of--
``(A) in the case of an eligible individual who has
self-only creditable coverage as of the first day of
such month, $5,000, and
``(B) in the case of an eligible individual who has
family creditable coverage as of the first day of such
month, the amount in effect under subparagraph (A) for
the taxable year multiplied by the number of
individuals (including the eligible individual) covered
under such family creditable coverage as of such day.
``(3) Additional contributions for individuals 55 or
older.--In the case of an individual who has attained age 55
before the close of the taxable year, the applicable limitation
under subparagraphs (A) and (B) of paragraph (2) shall be
increased by $1,000.
``(4) Coordination with other contributions.--The
limitation which would (but for this paragraph) apply under
this subsection to an individual for any taxable year shall be
reduced (but not below zero) by the sum of--
``(A) the aggregate amount paid for such taxable
year to Archer MSAs of such individual,
``(B) the aggregate amount contributed to Roth HSAs
of such individual which is excludable from the
taxpayer's gross income for such taxable year under
section 106(d) (and such amount shall not be allowed as
a deduction under subsection (a)), and
``(C) the aggregate amount contributed to Roth HSAs
of such individual for such taxable year under section
408(d)(9) (and such amount shall not be allowed as a
deduction under subsection (a)).
Subparagraph (A) shall not apply with respect to any individual
to whom paragraph (5) applies.
``(5) Special rule for married individuals.--In the case of
individuals who are married to each other, if either spouse has
family coverage--
``(A) both spouses shall be treated as having only
such family coverage (and if such spouses each have
family coverage under different plans, as having the
family coverage with the lowest annual deductible), and
``(B) the limitation under paragraph (1) (after the
application of subparagraph (A) and without regard to
any additional contribution amount under paragraph
(3))--
``(i) shall be reduced by the aggregate
amount paid to Archer MSAs of such spouses for
the taxable year, and
``(ii) after such reduction, shall be
divided equally between them unless they agree
on a different division.
``(6) Denial of deduction to dependents.--No contribution
may be made to a Roth HSA under this section by any individual
with respect to whom a deduction under section 151 is allowable
to another taxpayer for a taxable year beginning in the
calendar year in which such individual's taxable year begins.
``(7) Increase in limit for individuals becoming eligible
individuals after the beginning of the year.--
``(A) In general.--For purposes of computing the
limitation under paragraph (1) for any taxable year, an
individual who is an eligible individual during the
last month of such taxable year shall be treated--
``(i) as having been an eligible individual
during each of the months in such taxable year,
and
``(ii) as having been enrolled, during each
of the months such individual is treated as an
eligible individual solely by reason of clause
(i), in the same high deductible health plan in
which the individual was enrolled for the last
month of such taxable year.
``(B) Failure to maintain creditable coverage.--
``(i) In general.--If, at any time during
the testing period, the individual is not an
eligible individual, then--
``(I) gross income of the
individual for the taxable year in
which occurs the first month in the
testing period for which such
individual is not an eligible
individual is increased by the
aggregate amount of all contributions
to the Roth HSA of the individual which
could not have been made but for
subparagraph (A), and
``(II) the tax imposed by this
chapter for any taxable year on the
individual shall be increased by 10
percent of the amount of such increase.
``(ii) Exception for disability or death.--
Subclauses (I) and (II) of clause (i) shall not
apply if the individual ceased to be an
eligible individual by reason of the death of
the individual or the individual becoming
disabled (within the meaning of section
72(m)(7)).
``(iii) Testing period.--The term `testing
period' means the period beginning with the
last month of the taxable year referred to in
subparagraph (A) and ending on the last day of
the 12th month following such month.
``(c) Roth HSA.--For purposes of this section--
``(1) In general.--The term `Roth HSA' means a trust
created or organized in the United States as a Roth HSA
exclusively for the purpose of paying the qualified medical
expenses of the account beneficiary, but only if the written
governing instrument creating the trust meets the following
requirements:
``(A) Except in the case of a rollover contribution
described in subsection (f)(5) or section 220(f)(5), no
contribution will be accepted--
``(i) unless it is in cash, or
``(ii) to the extent such contribution,
when added to previous contributions to the
trust for the calendar year, exceeds the sum
of--
``(I) the dollar amount in effect
under subsection (b)(2)(B), and
``(II) the dollar amount in effect
under subsection (b)(3).
``(B) The trustee is a bank (as defined in section
408(n)), an insurance company (as defined in section
816), or another person who demonstrates to the
satisfaction of the Secretary that the manner in which
such person will administer the trust will be
consistent with the requirements of this section.
``(C) No part of the trust assets will be invested
in life insurance contracts.
``(D) The assets of the trust will not be
commingled with other property except in a common trust
fund or common investment fund.
``(E) The interest of an individual in the balance
in his account is nonforfeitable.
``(2) Qualified medical expenses.--For purposes of this
section--
``(A) In general.--The term `qualified medical
expenses' means, with respect to an account
beneficiary, amounts paid by such beneficiary for
medical care (as defined in section 213(d)) for such
individual, the spouse of such individual, and any
dependent (as defined in section 152, determined
without regard to subsections (b)(1), (b)(2), and
(d)(1)(B) thereof) of such individual, but only to the
extent such amounts are not compensated for by
insurance or otherwise.
``(B) Limitation on health insurance purchased from
account.--Such term shall not include any payment for
health benefits coverage that is not creditable
coverage (as defined in section 36C).
``(C) Exceptions.--Subparagraph (B) shall not apply
to any expense for coverage under--
``(i) a health plan during any period of
continuation coverage required under any
Federal law,
``(ii) a qualified long-term care insurance
contract (as defined in section 7702B(b)),
``(iii) a health plan during a period in
which the individual is receiving unemployment
compensation under any Federal or State law, or
``(iv) in the case of an account
beneficiary who has attained the age specified
in section 1811 of the Social Security Act, any
health insurance other than a medicare
supplemental policy (as defined in section 1882
of the Social Security Act).
``(3) Account beneficiary.--The term `account beneficiary'
means the individual on whose behalf the Roth HSA was
established.
``(4) Certain rules to apply.--Rules similar to the
following rules shall apply for purposes of this section:
``(A) Section 219(f)(3) (relating to time when
contributions deemed made).
``(B) Except as provided in section 106(d), section
219(f)(5) (relating to employer payments).
``(C) Section 408(g) (relating to community
property laws).
``(D) Section 408(h) (relating to custodial
accounts).
``(d) Eligible Individual; Creditable Coverage.--For purposes of
this section--
``(1) Eligible individual.--
``(A) In general.--The term `eligible individual'
means, with respect to any month, any individual if
such individual is covered under creditable coverage as
of the first day of such month.
``(B) Exception.--An individual shall not be
treated as an eligible individual for any month for
which a credit is determined with respect to the
individual under section 36B.
``(2) Creditable coverage.--The term `creditable coverage'
shall have the meaning given such term in section 36C(f).
``(e) Tax Treatment of Distributions.--
``(1) Amounts used for qualified medical expenses.--Any
amount paid or distributed out of a Roth HSA which is used
exclusively to pay qualified medical expenses of any account
beneficiary shall not be includible in gross income.
``(2) Inclusion of amounts not used for qualified medical
expenses.--Any amount paid or distributed out of a Roth HSA
which is not used exclusively to pay the qualified medical
expenses of the account beneficiary shall be included in the
gross income of such beneficiary.
``(3) Excess contributions returned before due date of
return.--
``(A) In general.--If any excess contribution is
contributed for a taxable year to any Roth HSA of an
individual, paragraph (2) shall not apply to
distributions from the Roth HSAs of such individual (to
the extent such distributions do not exceed the
aggregate excess contributions to all such accounts of
such individual for such year) if--
``(i) such distribution is received by the
individual on or before the last day prescribed
by law (including extensions of time) for
filing such individual's return for such
taxable year, and
``(ii) such distribution is accompanied by
the amount of net income attributable to such
excess contribution.
Any net income described in clause (ii) shall be
included in the gross income of the individual for the
taxable year in which it is received.
``(B) Excess contribution.--For purposes of
subparagraph (A), the term `excess contribution' means
any contribution (other than a rollover contribution
described in paragraph (5) or section 220(f)(5)) which
exceeds the contribution limitation with respect to the
individual for the taxable year.
``(4) Additional tax on distributions not used for
qualified medical expenses.--
``(A) In general.--The tax imposed by this chapter
on the account beneficiary for any taxable year in
which there is a payment or distribution from a Roth
HSA of such beneficiary which is includible in gross
income under paragraph (2) shall be increased by 10
percent of the amount which is so includible.
``(B) Exception for disability or death.--
Subparagraph (A) shall not apply if the payment or
distribution is made after the account beneficiary
becomes disabled within the meaning of section 72(m)(7)
or dies.
``(C) Exception for distributions after medicare
eligibility.--Subparagraph (A) shall not apply to any
payment or distribution after the date on which the
account beneficiary attains the age specified in
section 1811 of the Social Security Act.
``(5) Rollover contribution.--An amount is described in
this paragraph as a rollover contribution if it meets the
requirements of subparagraphs (A) and (B).
``(A) In general.--Paragraph (2) shall not apply to
any amount paid or distributed from a health savings
account (as defined in section 223) or a Roth HSA to
the account beneficiary to the extent the amount
received is paid into a Roth HSA for the benefit of
such beneficiary not later than the 60th day after the
day on which the beneficiary receives the payment or
distribution.
``(B) Limitation.--This paragraph shall not apply
to any amount described in subparagraph (A) received by
an individual from a health savings account or a Roth
HSA if, at any time during the 1-year period ending on
the day of such receipt, such individual received any
other amount described in subparagraph (A) from a
health savings account or Roth HSA which was not
includible in the individual's gross income because of
the application of this paragraph.
``(6) Transfer of account incident to divorce.--The
transfer of an individual's interest in a Roth HSA to an
individual's spouse or former spouse under a divorce or
separation instrument described in subparagraph (A) of section
71(b)(2) shall not be considered a taxable transfer made by
such individual notwithstanding any other provision of this
subtitle, and such interest shall, after such transfer, be
treated as a Roth HSA with respect to which such spouse is the
account beneficiary.
``(7) Treatment after death of account beneficiary.--If an
individual acquires an account beneficiary's interest in a
health savings account by reason of the death of the account
beneficiary, such health savings account shall be treated as if
the individual were the account beneficiary.
``(f) Cost-of-Living Adjustment.--
``(1) In general.--In the case of any calendar year
beginning after 2026, the $5,000 dollar amount in subsection
(b)(2) shall be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year,
determined--
``(i) by substituting `calendar year 2023'
for `calendar year 1992' in subparagraph (B)
thereof, and
``(ii) by substituting `CPI medical care
component' for `CPI'.
``(2) CPI medical care component.--For purposes of this
paragraph, the term `CPI medical care component' means the
medical care component for the Consumer Price Index for All
Urban Consumers published by the Department of Labor.
``(3) Rounding.--If the amount of any increase under the
preceding sentence is not a multiple of $50, such increase
shall be rounded to the next lowest multiple of $50.
``(g) Reports.--The Secretary may require--
``(1) the trustee of a Roth HSA to make such reports
regarding such account to the Secretary and to the account
beneficiary with respect to contributions, distributions, the
return of excess contributions, and such other matters as the
Secretary determines appropriate, and
``(2) any person who provides an individual with creditable
coverage to make such reports to the Secretary and to the
account beneficiary with respect to such plan as the Secretary
determines appropriate.
The reports required by this subsection shall be filed at such time and
in such manner and furnished to such individuals at such time and in
such manner as may be required by the Secretary.
``(h) Cross-Reference.--For contributions from Medicare Advantage
plans of chronically ill enrollees, see section 1852(a)(3)(D)(ii)(I) of
the Social Security Act.''.
(b) Limit on Contributions to Deductible Health Savings Accounts.--
Section 223 of such Code is amended by adding at the end the following
new subsection:
``(i) Limited Contributions After 2025.--
``(1) In general.--No contribution may be accepted by a
health savings account after December 31, 2025.
``(2) Exceptions.--Paragraph (1) shall not apply--
``(A) in the case of a rollover contribution
described in subsection (f)(5) or section 220(f)(5), or
``(B) in the case of a month for which an
individual is covered by insurance that constitutes
medical care and that is provided by an employer with
respect to which an election is in effect for such
month under section 131(b) of the Health Care Fairness
for All Act.''.
(c) Clerical Amendment.--The table of parts for subchapter F of
chapter 1 of such Code is amended by adding at the end the following
new item:
``Part IX. Roth Health Savings Accounts''.
(d) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
SEC. 202. ELIMINATION OF MEDICAL EXPENSE DEDUCTION.
Section 213 of the Internal Revenue Code of 1986 is amended by
adding at the end the following new subsection:
``(f) Termination.--Except in the case of long-term care premiums
(as defined in subsection (d)(10)), subsection (a) shall not apply to
any amounts paid during any taxable year beginning after December 31,
2025.''.
SEC. 203. TREATMENT OF HSA AFTER DEATH OF ACCOUNT BENEFICIARY.
(a) In General.--Section 223(f)(8) of the Internal Revenue Code of
1986 is amended to read as follows:
``(8) Treatment after death of account beneficiary.--If an
individual acquires an account beneficiary's interest in a
health savings account by reason of the death of the account
beneficiary, such health savings account shall be treated as if
the individual were the account beneficiary.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to interests acquired after the date of the enactment of
this Act.
SEC. 204. TREATMENT OF DIRECT PATIENT CARE ARRANGEMENTS.
(a) HSAs.--
(1) Roth hsa.--Section 530A(c)(2)(A) of the Internal
Revenue Code of 1986, as added by section 201 of this Act, is
amended by adding at the end the following: ``Such term shall
include the payment of a monthly or other prepaid amount for
the furnishing (or access to the furnishing) by a physician or
group of physicians of physician professional services (and
ancillary services).''.
(2) HSA.--Section 223(d)(2)(A) of such Code is amended by
adding at the end the following: ``The term `qualified medical
expenses' shall include the payment of a monthly or other
prepaid amount for the furnishing (or access to the furnishing)
by a physician or group of physicians of physician professional
services (and ancillary services).''.
(b) Not Treated as Health Insurance Coverage.--
(1) In general.--For purposes of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg), subtitle B of title I of
the Employee Retirement and Income Security Act of 1974 (29
U.S.C. 1021 et seq.), Public Law 111-148, and this Act, the
offering of direct patient care arrangements shall not be
treated as the offering of health insurance coverage and shall
not be subject to regulations as such coverage under such Acts.
(2) Direct patient care arrangement defined.--In this
subsection, the term ``direct patient care arrangement'' means
the furnishing (or access to the furnishing) by a physician or
group of physicians of physician professional services (and
ancillary services) in return for payment of a monthly or other
prepaid amount.
TITLE III--STATE FLEXIBILITY IN REGULATION OF HEALTH INSURANCE COVERAGE
SEC. 301. STATE FLEXIBILITY IN REGULATION OF HEALTH INSURANCE COVERAGE.
(a) In General.--States are given the flexibility under section
122(b) to revise their regulations of the health insurance marketplace,
without regard to many of the requirements imposed under Public Law
111-148, in order to promote freedom of choice of affordable health
insurance coverage options offered outside of an Exchange.
(b) Construction.--Nothing in the Employee Retirement and Income
Security Act of 1974 (29 U.S.C. 1001 et seq.) or of any amendments made
by the Health Insurance Portability and Accountability Act of 1996
(Public Law 104-191) shall be interpreted as preventing an employer
from offering, or making an employer contribution towards, individual
health insurance coverage for employees and dependent family members.
(c) Association Health Plans.--Nothing in this Act shall be
construed as prohibiting the formation of association health plans (as
defined under State law).
(d) High-Risk Pools.--Nothing in this Act shall be construed as
prohibiting States from establishing pooling arrangements for high-risk
individuals.
TITLE IV--MEDICAID PAYMENT REFORM
SEC. 401. MEDICAID PAYMENT REFORM TO ENSURE EQUITABLE ACCESS TO CARE.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by inserting after section 1903 the following
section:
``SEC. 1903A. REFORMED PAYMENT TO STATES.
``(a) Reformed Payment System.--
``(1) In general.--For quarters beginning on or after the
implementation date (as defined in subsection (k)(1)), in lieu
of amounts otherwise payable to a State under this title
(including any payments attributable to section 1923), except
as otherwise provided in this section, the amount payable to
such State shall be equal to the sum of the following:
``(A) Adjusted aggregate beneficiary-based
amount.--The aggregate beneficiary-based amount
specified in subsection (b) for the quarter and the
State, adjusted under subsection (e).
``(B) Chronic care quality bonus.--The amount (if
any) of the chronic care quality bonus payment
specified in subsection (f) for the quarter for the
State.
``(2) Requirement of state share.--
``(A) In general.--A State shall make, from non-
Federal funds, expenditures in an amount equal to its
State share (as determined under subparagraph (B)) for
a quarter for items, services, and other costs for
which, but for paragraph (1), Federal funds would have
been payable under this title.
``(B) State share.--The State share for a State for
a quarter in a fiscal year is equal to the product of--
``(i) the aggregate beneficiary-based
amount specified in subsection (b) for the
quarter and the State; and
``(ii) the ratio of--
``(I) the State percentage
described in subparagraph (D)(ii) for
such State and fiscal year; to
``(II) the Federal percentage
described in subparagraph (D)(i) for
such State and fiscal year.
``(C) Nonpayment for failure to pay state share.--
``(i) In general.--If a State fails to
expend the amount required under subparagraph
(A) for a quarter in a fiscal year, the amount
payable to the State under paragraph (1) shall
be reduced by the product of the amount by
which the State payment is less than the State
share and the ratio of--
``(I) the Federal percentage
described in subparagraph (D)(i) for
such State and fiscal year; to
``(II) the State percentage
described in subparagraph (D)(ii) for
such State and fiscal year.
``(ii) Grace period.--A State shall not be
considered to have failed to provide payment of
its required State share for a quarter under
subparagraph (A) if the aggregate State payment
towards the State's required State share for
the 4-quarter period beginning with such
quarter exceeds the required State share amount
for such 4-quarter period.
``(D) Federal and state percentages.--In this
paragraph, with respect to a State and a fiscal year:
``(i) Federal percentage.--The Federal
percentage described in this clause is 75
percent or, if higher, the Federal medical
assistance percentage for such State for such
fiscal year.
``(ii) State percentage.--The State
percentage described in this clause is 100
percent minus the Federal percentage described
in clause (i).
``(E) Rules for crediting toward state share.--
``(i) General limitation to matchable
expenditures.--A payment for expenditures shall
not be counted toward the State share under
subparagraph (A) unless Federal payments may be
used for such expenditures consistent with
paragraph (3)(B).
``(ii) Further limitations on allowable
expenditures.--A payment for expenditures shall
not be counted towards the State share under
subparagraph (A) if the expenditure is for any
of the following:
``(I) Abortion.--Expenditures for
an abortion.
``(II) Intergovernmental
transfers.--An expenditure that is
attributable to an intergovernmental
transfer.
``(III) Certified public
expenditures.--An expenditure that is
attributable to certified public
expenditures.
``(iii) Crediting fraud and abuse
recoveries.--Amounts recovered by a State
through the operation of its Medicaid fraud and
abuse control unit described in section 1903(q)
shall be fully counted toward the State share
under subparagraph (A).
``(F) Construction.--Nothing in the paragraph shall
be construed as preventing a State from expending, from
non-Federal funds, an amount under this title in excess
of the amount of the State share.
``(G) Determination based upon submitted claims.--
In applying this paragraph with respect to expenditures
of a State for a quarter, the determination of the
expenditures for such State for such quarter shall be
made after the end of the period (which, as of the date
of the enactment of this section, is 2 years) for which
the Secretary accepts claims for payment under this
title with respect to such quarter.
``(3) Use of federal payments.--
``(A) Application of medicaid limitations.--A State
may only use Federal payments received under subsection
(a) for expenditures for which Federal funds would have
been payable under this title but for this section.
``(B) Limitation for certain eligibles.--
``(i) Application of 100 percent federal
poverty line limit on eligibility.--Subject to
clause (iii), a State may not use such Federal
payments to provide medical assistance for an
individual who has an income (as determined
under clause (ii)) that exceeds 100 percent of
the poverty line (as defined in section
2110(c)(5)) applicable to a family of the size
involved.
``(ii) Determination of income using
modified adjusted gross income without any 5
percent increase.--In determining income for
purposes of clause (i) under section
1902(e)(14) (relating to modified adjusted
gross income), the following rules shall apply:
``(I) Application of spend down.--
The State shall take into account the
costs incurred for medical care or for
any other type of remedial care
recognized under State law in the same
manner and to the same extent that such
State takes such costs into account for
purposes of section 1902(a)(17).
``(II) Disregard of 5 percent
increase.--Subparagraph (I) of section
1902(e)(14) (relating to a 5 percent
reduction) shall not apply.
``(iii) Exception.--Clause (i) shall not
apply to an individual who is--
``(I) a woman described in clause
(i) of section 1903(v)(4)(A);
``(II) a child who is an individual
described in clause (i) of section
1905(a);
``(III) enrolled in a State plan
under this title as of the date of the
enactment of this section for the
period of continuous enrollment; or
``(IV) described in section
1902(e)(14)(D) (relating to modified
adjusted gross income).
``(iv) Clarification related to community
spouse.--Nothing in this subparagraph shall
supersede the application of section 1924
(related to community spouse income and
assets).
``(4) Exceptions for pass-through payments.--
``(A) In general.--Paragraph (1) shall not apply,
and amounts shall continue to be payable under this
title (and not under subsection (a)), in the case of
the following payments (and related administrative
costs and expenditures):
``(i) Payments to territories.--Payments to
a State other than the 50 States and the
District of Columbia.
``(ii) Medicare cost sharing.--Payments
attributable to Medicare cost sharing under
section 1905(p).
``(iii) Pediatric vaccines.--Payments
attributable to section 1928.
``(iv) Emergency services for certain
individuals.--Payments for treatment of
emergency medical conditions attributable to
the application of section 1903(v)(2).
``(v) Indian health care facilities.--
Payments for medical assistance described in
the third sentence of section 1905(b).
``(vi) Employer-sponsored insurance
(esi).--Payments for medical assistance
attributable to payments to employers for
employer-sponsored health benefits coverage.
``(vii) Other populations with limited
benefit coverage.--Other payments that are
determined by the Secretary to be related to a
specified population for which the medical
assistance under this title is limited and does
not include any inpatient, nursing facility, or
long-term care services.
``(B) Certain expenses.--Paragraph (1) shall not
apply, and amounts shall continue to be payable under
this title (and not under subsection (a)), in the case
of the following:
``(i) Administration of medicare
prescription drug benefit.--Expenditures
described in section 1935(b) (relating to
administration of the Medicare prescription
drug benefit).
``(ii) Payments for hit bonuses.--Payments
under section 1903(a)(3)(F) (relating to
payments to encourage the adoption and use of
certified EHR technology).
``(iii) Payments for design, development,
and installation of mmis and eligibility
systems.--Payments under subparagraphs (A)(i)
and (H)(i) of section 1903(a)(3) for
expenditures for design, development, and
installation of the Medicaid management
information systems and mechanized verification
and information retrieval systems (related to
eligibility).
``(5) Payment of amounts.--
``(A) In general.--Except as the Secretary may
otherwise provide, amounts shall be payable to a State
under subsection (a) in the same manner as amounts are
payable under subsection (d) of section 1903 to a State
under subsection (a) of such section.
``(B) Information and forms.--
``(i) Submission.--As a condition of
receiving payment under subsection (a), a State
shall submit such information, in such form,
and manner, as the Secretary shall specify,
including information necessary to make the
computations under subsections (c)(2)(C) and
(e).
``(ii) Uniform reporting.--The Secretary
shall develop such forms as may be needed to
assure a system of uniform reporting of such
information across States.
``(C) Required reporting of information on medical
loss ratios for managed care.--The information required
to be reported under subparagraph (B)(i) shall include
information on the medical loss ratio with respect to
coverage provided under each Medicaid managed care plan
with a contract with the State under section 1903(m) or
1932.
``(b) Aggregate Beneficiary-Based Amount.--
``(1) In general.--The aggregate beneficiary-based amount
specified in this subsection for a State for a quarter is equal
to the sum of the products, for each of the categories of
Medicaid beneficiaries specified in paragraph (2), of the
following:
``(A) Beneficiary-based quarterly amount.--The
beneficiary-based quarterly amount for such category
computed under subsection (c) for such State for such
quarter.
``(B) Number of individuals in category.--Subject
to subsection (d), the average number of Medicaid
beneficiaries enrolled in such category in the State in
such quarter.
``(2) Categories.--The categories specified in this
paragraph are the following:
``(A) Elderly.--A category of Medicaid
beneficiaries who are 65 years of age or older.
``(B) Blind or disabled.--A category of Medicaid
beneficiaries not described in subparagraph (A) who are
described in section 1937(a)(2)(B)(ii).
``(C) Children.--A category of Medicaid
beneficiaries not described in subparagraph (B) who are
under 21 years of age.
``(D) Other adults.--A category of any Medicaid
beneficiaries who are not described in a previous
subparagraph of this paragraph.
``(c) Computation of Per Beneficiary, Per Category Quarterly
Amount.--
``(1) In general.--For a State, for each category of
beneficiary for a quarter--
``(A) First reform year.--For quarters in the first
reform year (as defined in subsection (k)(2)), the
beneficiary-based quarterly amount is equal to \1/4\ of
the base average per beneficiary Federal payments for
such State for such category determined under paragraph
(2), increased by a factor that reflects the sum of the
following:
``(i) Historical medical care component of
cpi through previous reform year.--The
percentage increase in the historical medical
care component of the Consumer Price Index for
all urban consumers (U.S. city average) from
the midpoint of the base fiscal year (as
defined in paragraph (6)) to the midpoint of
the fiscal year preceding the first reform
year.
``(ii) Projected medical care component of
cpi for the first reform year.--The percentage
increase in the projected medical care
component of the Consumer Price Index for all
urban consumers (U.S. city average) from the
midpoint of the previous fiscal year referred
to in clause (i) to the midpoint of the first
reform year.
``(B) Second and third reform years.--The
beneficiary-based quarterly amount for a State for a
category for quarters in the second reform year or the
third reform year is equal to the beneficiary-based
quarterly amount under this paragraph for such State
and category for the previous reform year increased by
the per beneficiary percentage increase (as defined in
subparagraph (E)) for such category and reform year.
``(C) Fourth through tenth reform years.--The
beneficiary-based quarterly amount for a State for a
category for quarters in a reform year beginning with
the fourth reform year and ending with the tenth reform
year is--
``(i) in the case of a State that is a high
per beneficiary State or a low per beneficiary
State (as defined in paragraph (4)(B)(iii)) for
the category, the amount determined under
clause (i) or (ii) of paragraph (4)(B) for such
State, category, and reform year; or
``(ii) in the case of any other State, the
beneficiary-based quarterly amount under this
paragraph for such State and category for the
previous reform year increased by the per
beneficiary percentage increase for such
category and reform year.
``(D) Eleventh reform year and subsequent reform
years.--The beneficiary-based quarterly amount for a
State for a category for quarters in a reform year
beginning with the eleventh reform year is equal to the
beneficiary-based quarterly amount under this paragraph
for such State and category for the previous reform
year increased by the per beneficiary percentage
increase for such category and reform year.
``(E) Annual percentage increase beginning with
second reform year.--For purposes of this subsection,
the term `per beneficiary percentage increase' means,
for a reform year, the sum of--
``(i) the projected percentage change in
nominal gross domestic product from the
midpoint of the previous reform year to the
midpoint of the reform year for which the
percentage increase is being applied; and
``(ii) one percentage point.
``(2) Base per beneficiary, per category amount for each
state.--
``(A) Average per category.--
``(i) In general.--The Secretary shall
determine, consistent with this paragraph and
paragraph (3), a base per beneficiary, per
category amount for each of the 50 States and
the District of Columbia equal to the average
amount, per Medicaid beneficiary, of Federal
payments under this title, including payments
attributable to disproportionate share hospital
payments under section 1923, for each of the
categories of beneficiaries under subsection
(b)(2) for the base fiscal year for each of the
50 States and the District of Columbia.
``(ii) Best available data.--The
determination under clause (i) shall initially
be estimated by the Secretary, based upon the
best available data at the time the
determination is made.
``(iii) Updates.--The determination under
clause (i) shall be updated by the Secretary on
an annual basis based upon improved data. The
Secretary shall adjust the amounts under
subsection (a)(1)(A) to reflect changes in the
amounts so determined based on such updates.
``(B) Exclusion of pass-through payments.--In
computing base per beneficiary, per category amounts
under subparagraph (A)(i) the Secretary shall exclude
payments described in subsection (a)(4).
``(C) Standardization.--
``(i) In general.--In computing each such
amount, the Secretary shall standardize the
amount in order to remove the variation
attributable to the following:
``(I) Risk factors.--Such risk
factors as age, health and disability
status (including high cost medical
conditions), gender, institutional
status, and such other factors as the
Secretary determines to be appropriate,
so as to ensure actuarial equivalence.
``(II) Geographic.--Variations in
costs on a county-by-county basis.
``(ii) Method of standardization.--
``(I) Consultation in development
of risk standardization.--In developing
the methodology for risk
standardization for purposes of clause
(i)(I), the Secretary shall consult
with the Medicaid and CHIP Payment and
Access Commission, the Medicare Payment
Advisory Commission, and the National
Association of Medicaid Directors.
``(II) Method for risk
standardization.--In carrying out
clause (i)(I), the Secretary may apply
the hierarchal condition category
methodology under section
1853(a)(1)(C). If the Secretary uses
such methodology, the Secretary shall
adjust the application of such
methodology to take into account the
differences in services provided under
this title compared to title XVIII,
such as the coverage of long term care,
pregnancy, and pediatric services.
``(III) Method for geographic
standardization.--The Secretary shall
apply the standardization under clause
(i)(II) in a manner similar to that
applied under section
1853(c)(4)(A)(iii).
``(iii) Application on a national, budget
neutral basis.--The standardization under
clause (i) shall be designed and implemented on
a uniform national basis and shall be budget
neutral so as to not result in any aggregate
change in payments under subsection (a).
``(iv) Response to new risk.--Subject to
clause (iii), the Secretary may adjust the
standardization under clause (i) to respond
promptly to new instances of communicable
diseases and other public health hazards.
``(v) Reference to application of risk
adjustment.--For rules related to the
application of risk adjustment to amounts under
subsection (a)(1)(A), see subsection (e).
``(D) Adjustment for temporary fmap increases.--In
computing each base per beneficiary, per category
amounts under subparagraph (A)(i) the Secretary shall
disregard portions of payments that are attributable to
a temporary increase in the Federal matching rates,
including those attributable to the following:
``(i) Public law 111-148 disaster fmap.--
Section 1905(aa).
``(ii) ARRA.--Section 5001 of the American
Recovery and Reinvestment Act of 2009 (42
U.S.C. 1396d note).
``(iii) Extraordinary employer pension
contribution.--Section 614 of the Children's
Health Insurance Program Reauthorization Act of
2009 (42 U.S.C. 1396d note).
``(3) Allocation of nonmedical assistance payments.--The
Secretary shall establish rules for the allocation of payments
under this title (other than those payments described in
paragraph (1) or (5) of section 1903(a) and including such
payments attributable to section 1923)--
``(A) among different categories of beneficiaries;
and
``(B) between payments included under subsection
(a)(1) and payments described in subsection (a)(4).
``(4) Transition to a corridor around the national
average.--
``(A) Determination of national average base per
beneficiary, per category amount.--Subject to
subparagraph (C), the Secretary shall determine a
national average base per beneficiary, per category
amount equal to the average of the base per
beneficiary, per category amounts for each of the 50
States and the District of Columbia determined under
paragraph (2), weighted by the average number of
beneficiaries in each such category and State as
determined by the Secretary consistent with subsection
(d) for the base fiscal year.
``(B) Transition adjustment.--
``(i) High per beneficiary states.--In the
case of a high per beneficiary State (as
defined in clause (iii)(I)) for a category, the
beneficiary-based quarterly amount for such
State and category for a quarter in a reform
year (beginning with the fourth reform year and
ending with the tenth reform year) is equal to
the sum of--
``(I) the product of the State-
specific factor for such reform year
(as defined in clause (iv)) and the
beneficiary-based quarterly amount that
would otherwise be determined under
paragraph (1) for such State and
category if the State were a State
described in clause (ii) of paragraph
(1)(C), instead of a State described in
clause (i) of such paragraph; and
``(II) the product of 1 minus the
State-specific factor for such reform
year and the beneficiary-based
quarterly amount that would otherwise
be determined under paragraph (1) for a
State and category if the base per
beneficiary, per category amount
determined under paragraph (2) for the
State and category were equal to 110
percent of the national average base
per beneficiary, per category amount
determined under subparagraph (A) for
such category.
``(ii) Low per beneficiary states.--In the
case of a low per beneficiary State (as defined
in clause (iii)(II)) for a category, the
beneficiary-based quarterly amount for such
State and category for a quarter in a reform
year (beginning with the fourth reform year and
ending with the tenth reform year) is equal to
the sum of--
``(I) the product of the State-
specific factor for such reform year
and the beneficiary-based quarterly
amount that would otherwise be
determined under paragraph (1) for such
State and category if the State were a
State described in clause (ii) of
paragraph (1)(C), instead of a State
described in clause (i) of such
paragraph; and
``(II) the product of 1 minus the
State-specific factor for such reform
year and the beneficiary-based
quarterly amount that would otherwise
be determined under paragraph (1) for a
State and category if the base per
beneficiary, per category amount
determined under paragraph (2) for the
State and category were equal to 90
percent of the national average base
per beneficiary, per category amount
determined under subparagraph (A) for
such category.
``(iii) High and low per beneficiary states
defined.--In this subparagraph:
``(I) High per beneficiary state.--
The term `high per beneficiary State'
means, with respect to a category, a
State for which the base per
beneficiary, per category amount
determined under paragraph (2) for such
category is greater than 110 percent of
the national average base per
beneficiary, per category amount
determined under subparagraph (A) for
such category.
``(II) Low per beneficiary state.--
The term `low per beneficiary State'
means, with respect to a category, a
State for which the base per
beneficiary, per category amount
determined under paragraph (2) for such
category is less than 90 percent of the
national average base per beneficiary,
per category amount determined under
subparagraph (A) for such category.
``(iv) State-specific factor.--In this
subparagraph, the term `State-specific factor'
means--
``(I) for the fourth reform year,
\7/8\; and
``(II) for a subsequent reform
year, the State-specific factor under
this clause for the previous reform
year minus \1/8.\
``(C) No additional expenditures.--
``(i) Determination of increase in federal
expenditures.--For each category for each
reform year (beginning with the fourth reform
year and ending with the tenth reform year),
the Secretary shall determine whether the
application of this paragraph--
``(I) to the category for the
reform year will result in an aggregate
increase in the aggregate Federal
expenditures under subsection (a); and
``(II) to all the categories for
the reform year will result in a net
aggregate increase in the aggregate
Federal expenditures under subsection
(a).
``(ii) Adjustment.--If the Secretary
determines under clause (i)(II) that the
application of this paragraph to all the
categories for a reform year will result in a
net aggregate increase in the aggregate Federal
expenditures under subsection (a), the
Secretary shall reduce the national average
base per beneficiary, per category amount
computed under subparagraph (A) for each of the
categories determined under clause (i)(I) for
which there will be an aggregate increase in
the aggregate Federal expenditures under
subsection (a) by such uniform percentage as
will ensure that there is no net aggregate
Federal expenditure increase described in
clause (i)(II) for the reform year.
``(5) Reports on per beneficiary rates; appeals.--
``(A) Report to states.--Not later than 8 months
after the date of the enactment of this section, the
Secretary shall submit to each State the Secretary's
initial determination of--
``(i) the base per beneficiary, per
category amounts under paragraph (2) for such
State; and
``(ii) the national average base per
beneficiary, per category amounts under
paragraph (4)(A).
``(B) Opportunity to appeal.--Not later than 3
months after the date a State receives notice of the
Secretary's initial determination of such base per
beneficiary, per category amounts for such State under
subparagraph (A)(i), the State may file with the
Secretary, in a form and manner specified by the
Secretary, an appeal of such determination.
``(C) Determination on appeal.--Not later than 3
months after receiving such an appeal, the Secretary
shall make a final determination on such amounts for
such State. If no such appeal is received for a State,
the Secretary's initial determination under
subparagraph (A)(i) shall become final.
``(6) Base fiscal year defined.--In this section, the term
`base fiscal year' means the latest fiscal year, ending before
the date of the enactment of this section, for which the
Secretary determines that adequate data are available to make
the computations required under this subsection.
``(d) Not Counting Individuals To Account for Excluded Payments.--
Under rules specified by the Secretary, individuals shall not be
counted as Medicaid beneficiaries for purposes of subsection (b)(1)(B)
and subsection (c)(2)(A) in proportion to the extent that such
individuals are receiving medical assistance for which payments
described under subsection (a)(4)(A) are made.
``(e) Risk Adjustment.--
``(1) In general.--The amount under subsection (a)(1)(A)
shall be adjusted under this subsection in an appropriate
manner, specified by the Secretary and consistent with
paragraph (2), to take into account--
``(A) the factors described in subsection
(c)(2)(C)(i)(I) within a category of beneficiaries; and
``(B) variations in costs on a county-by-county
basis for medical assistance and administrative
expenses.
``(2) Method of adjustment.--
``(A) In general.--The adjustments under paragraph
(1) shall be made in a manner similar to the manner in
which similar adjustments are made under subsection
(c)(2)(C) and consistent with the requirements of
clause (iii) of such subsection and subparagraph (B).
``(B) Biannual update of risk adjustment
methodology.--In applying clause (i)(I) of subsection
(c)(2)(C) for purposes of subparagraph (A), the
Secretary shall, in consultation with the entities
described in clause (ii)(I) of such subsection, update
the risk adjustment methodology applied as appropriate
not less often than every 2 years.
``(f) Chronic Care Quality Bonus Payments.--
``(1) Determination of bonus payments.--If the Secretary
determines that, based on the reports under paragraph (5), with
respect to categories of chronic disease for which chronic care
performance targets had been established under paragraph (3)
for each category of Medicaid beneficiaries specified under
subsection (b)(2) such targets have been met by a State for a
reform year, the Secretary shall make an additional payment to
such State in the amount specified in paragraph (6) for each
quarter in the succeeding reform year. Such payments shall be
made in a manner specified by the Secretary and may only be
used consistent with subsection (a)(3).
``(2) Identification of categories of chronic disease.--The
Secretary shall determine the categories of chronic disease for
which bonus payments may be available under this subsection for
each category of Medicaid beneficiaries.
``(3) Adoption of quality measurement system and
identification of performance targets.--
``(A) System and data.--With respect to the
categories of chronic disease under paragraph (2), the
Secretary shall adopt a quality measurement system that
uses data described in paragraph (4) and is similar to
the Five-Star Quality Rating System used to indicate
the performance of Medicare Advantage plans under part
C of title XVIII.
``(B) Targets.--Using such system and data, the
Secretary shall establish for each reform year the
chronic care performance targets for purposes of the
payments under paragraph (1). Such performance targets
shall be established in consultation with States,
associations representing individuals with chronic
illnesses, entities providing treatment to such
individuals for such chronic illnesses, and other
stakeholders, including the National Association of
Medicaid Directors and the National Governors
Association.
``(4) Data to be used.--The data to be used under paragraph
(3) shall include--
``(A) data collected through methods such as--
``(i) the `Healthcare Effectiveness Data
and Information Set' (also known as `HEDIS')
(or an appropriate successor performance
measurement tool);
``(ii) the `Consumer Assessment of
Healthcare Providers and Systems' (also known
as `CAHPS') (or an appropriate successor
performance measurement tool); and
``(iii) the `Health Outcomes Survey' (also
known as `HOS') (or an appropriate successor
performance measurement tool); and
``(B) other data collected by the State.
``(5) Reports.--
``(A) In general.--Each State shall collect,
analyze, and report to the Secretary, at a frequency
and in a manner to be established by the Secretary,
data described in paragraph (4) that permit the
Secretary to monitor the State's performance relative
to the chronic care performance targets established
under paragraph (3).
``(B) Review and verification.--The Secretary may
review the data collected by the State under
subparagraph (A) to verify the State's analysis of such
data with respect to the performance targets under
paragraph (3).
``(6) Amount of bonus payments.--
``(A) In general.--Subject to subparagraphs (B) and
(C), with respect to each category of Medicaid
beneficiaries, in the case of a State that the
Secretary determines, based on the chronic care
performance targets set under paragraph (3) for a
reform year for such category, performs--
``(i) in the top five States in such
category, subject to subparagraph (C)(ii), the
amount of the bonus for each quarter in the
succeeding reform year shall be 10 percent of
the payment amount otherwise paid to the State
under subsection (a) for individuals enrolled
under the plan within such category;
``(ii) in the next five States in such
category, subject to subparagraph (C)(ii), the
amount of the bonus for each such quarter shall
be 5 percent of the payment amount otherwise
paid to the State under subsection (a) for
individuals enrolled under the plan within such
category;
``(iii) in the next five States in such
category, subject to clauses (i) and (iii) of
subparagraph (C), the amount of the bonus for
each such quarter shall be 3 percent of the
payment amount otherwise paid to the State
under subsection (a) for individuals enrolled
under the plan within such category;
``(iv) in the next five States in such
category, subject to clauses (i) and (iii) of
subparagraph (C), the amount of the bonus for
each such quarter shall be 2 percent of the
payment amount otherwise paid to the State
under subsection (a) for individuals enrolled
under the plan within such category; and
``(v) in the next five States in such
category, subject to clauses (i) and (iii) of
subparagraph (C), the amount of the bonus for
each such quarter shall be 1 percent of the
payment amount otherwise paid to the State
under subsection (a) for individuals enrolled
under the plan within such category.
``(B) Aggregate annual limit for each category of
medicaid beneficiaries.--
``(i) In general.--In no case may the
aggregate amount of bonuses under this
subsection for quarters in a reform year for a
category of Medicaid beneficiaries exceed the
limit specified in clause (ii) for the reform
year.
``(ii) Limit.--The limit specified in this
clause--
``(I) for the second reform year is
equal to $250,000,000; or
``(II) for a subsequent reform year
is equal to the limit specified in this
clause for the previous reform year
increased by the per beneficiary
percentage increase determined under
paragraph (1)(E) of subsection (c).
``(C) Limitation and proration of bonuses based on
application of aggregate limit.--
``(i) No bonus for third or subsequent
tiers unless aggregate limit not reached on
first two tiers.--No bonus shall be payable
under clause (iii), (iv), or (v) of
subparagraph (A) for a category of Medicaid
beneficiaries for a quarter in a reform year
unless the aggregate amount of bonuses under
clauses (i) and (ii) of such subparagraph for
such category and reform year is less than the
limit specified in subparagraph (B)(ii) for the
reform year.
``(ii) Proration for first two tiers.--If
the aggregate amount of bonuses under clauses
(i) and (ii) of subparagraph (A) for a category
of Medicaid beneficiaries for quarters in a
reform year exceeds the limit specified in
subparagraph (B)(ii) for the reform year, the
amount of each such bonus shall be prorated in
a manner so the aggregate amount of such
bonuses is equal to such limit.
``(iii) Proration for next three tiers.--If
the aggregate amount of bonuses under clauses
(i) and (ii) of subparagraph (A) for a category
of Medicaid beneficiaries for quarters in a
reform year is less than the limit specified in
subparagraph (B)(ii) for the reform year, but
the aggregate amount of bonuses under clauses
(i) through (v) of subparagraph (A) for the
category and such quarters in the reform year
exceeds the limit specified in subparagraph
(B)(ii) for the reform year, the amount of each
bonus in clauses (iii), (iv), and (v) of
subparagraph (A) shall be prorated in a manner
so the aggregate amount of all the bonuses
under subparagraph (A) is equal to such limit.
``(g) State Option for Receiving Medicare Payments for Full-Benefit
Dual Eligible Individuals.--
``(1) In general.--Under this subsection a State may elect
for quarters beginning on or after the implementation date in a
reform year to receive payment from the Secretary under
paragraph (3). As a condition of receiving such payment, the
State shall agree to provide to full-benefit dual eligible
individuals eligible for medical assistance under the State
plan--
``(A) the medical assistance to which such eligible
individuals would otherwise be entitled under this
title; and
``(B) any items and services which such eligible
individuals would otherwise receive under title XVIII.
``(2) Provider payment requirement.--
``(A) In general.--A State electing the option
under this subsection shall provide payment to health
care providers for the items and services described
under paragraph (1)(B) at a rate that is not less than
the rate at which payments would be made to such
providers for such items and services under title
XVIII.
``(B) Flexibility in payment methods.--Nothing in
subparagraph (A) shall be construed as preventing a
State from using alternative payment methodologies
(such as bundled payments or the use of accountable
care organizations (as such term is used in section
1899)) for purposes of making payments to health care
providers for items and services provided to dual
eligible individuals in the State under the option
under this subsection.
``(3) Payments to states in lieu of medicare payments.--
With respect to a full-benefit dual eligible individual, in the
case of a State that elects the option under paragraph (1) for
quarters in a reform year--
``(A) the Secretary shall not make any payment
under title XVIII for items and services furnished to
such individual for such quarters; and
``(B) the Secretary shall pay to the State, in
addition to the amounts paid to such State under
subsection (a), the amount that the Secretary would,
but for this subsection, otherwise pay under title
XVIII for items and services furnished to such an
individual in such State for such quarters.
``(4) Full-benefit dual eligible individual defined.--In
this subsection, the term `full-benefit dual eligible
individual' means an individual who meets the requirements of
section 1935(c)(6)(A)(ii).
``(h) Audits.--The Secretary shall conduct such audits on the
number and classification of Medicaid beneficiaries under such
subsections and expenditures under this section as may be necessary to
ensure appropriate payments under this section.
``(i) Treatment of Waivers.--
``(1) No impact on current waivers.--In the case of a
waiver of requirements of this title pursuant to section 1115
or other law that is in effect as of the date of the enactment
of this section, nothing in this section shall be construed to
affect such waiver for the period of the waiver as approved as
of such date.
``(2) Application of budget neutrality to subsequent
waivers and renewals taking section into account.--In the case
of a waiver of requirements of this title pursuant to section
1115 or other law that is approved or renewed after the date of
the enactment of this section, to the extent that such approval
or renewal is conditioned upon a demonstration of budget
neutrality, budget neutrality shall be determined taking into
account the application of this section.
``(j) Report to Congress.--Not later than January 1 of the second
reform year, the Secretary shall submit to Congress a report on the
implementation of this section.
``(k) Definitions.--In this section:
``(1) Implementation date.--The term `implementation date'
means--
``(A) July 1, 2022, if this section is enacted on
or before July 1, 2021; or
``(B) July 1, 2022, if this section is enacted
after July 1, 2021.
``(2) Reform years.--
``(A) The term `reform year' means a fiscal year
beginning with the first reform year.
``(B) The term `first reform year' means the fiscal
year in which the implementation date occurs.
``(C) The terms `second', `third', and successive
similar terms mean, with respect to a reform year, the
second, third, or successive reform year, respectively,
succeeding the first reform year.''.
(b) Conforming Amendments.--
(1) Continued application of clawback provisions.--
(A) Continued application.--Subsections (a) and
(c)(1)(C) of section 1935 of such Act (42 U.S.C. 1396u-
5) are each amended by inserting ``or 1903A(a)'' after
``1903(a)''.
(B) Technical amendment.--Section 1935(d)(1) of the
Social Security Act (42 U.S.C. 1396u-5(d)(1)) is
amended by inserting ``except as provided in section
1903A(g)'' after ``any other provision of this title''.
(2) Payment rules under section 1903.--
(A) Section 1903(a) of the Social Security Act (42
U.S.C. 1396b(a)) is amended, in the matter before
paragraph (1), by inserting ``and section 1903A'' after
``except as otherwise provided in this section''.
(B) Section 1903(d) of such Act (42 U.S.C.
1396b(d)) is amended--
(i) in paragraph (1), by inserting ``and
under section 1903A'' after ``subsections (a)
and (b)'';
(ii) in paragraph (2)--
(I) in subparagraph (A), by
inserting ``or section 1903A'' after
``was made under this section''; and
(II) in subparagraph (B), by
inserting ``or section 1903A'' after
``under subsection (a)'';
(iii) in paragraph (4)--
(I) by striking ``under this
subsection'' and inserting ``, with
respect to this section or section
1903A, under this subsection''; and
(II) by striking ``under this
section'' and inserting ``under the
respective section''; and
(iv) in paragraph (5), by inserting ``or
section 1903A'' after ``overpayment under this
section''.
(3) Conforming waiver authority.--Section 1115(a)(2)(A) of
the Social Security Act (42 U.S.C. 1315(a)(2)(A)) is amended by
striking ``or 1903'' and inserting ``1903, or 1903A''.
(4) Report on additional conforming amendments needed.--Not
later than 6 months after the date of the enactment of this
Act, the Secretary of Health and Human Services shall submit to
Congress a report that includes a description of any additional
technical and conforming amendments to law that are required to
properly carry out this Act.
TITLE V--PRICE TRANSPARENCY
SEC. 501. PROMOTING TRANSPARENT HOSPITAL PRICES FOR CONSUMERS.
The provisions of the rule entitled ``Price Transparency
Requirements for Hospitals to Make Standard Charges Public'' published
by the Department of Health and Human Services on November 27, 2019 (85
Fed. Reg. 65524), shall have the force and effect of law.
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