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1 II 115 CONGRESS TH ST S ESSION 1 S. 1804 To establish a Medicare-for-all national health insurance program. IN THE SENATE OF THE UNITED STATES EPTEMBER 13, 2017 S Mr. S (for himself, Ms. B ALDWIN , Mr. B ANDERS , Mr. B OOKER , LUMENTHAL Mr. F , Mrs. G ILLIBRAND , Ms. H RANKEN , Mr. H EINRICH , Ms. ARRIS H IRONO , Mr. L EAHY , Mr. M ARKEY , Mr. M ERKLEY , Mr. S CHATZ , Mrs. S HAHEEN DALL , Ms. W ARREN , and Mr. W HITEHOUSE ) introduced , Mr. U the following bill; which was read twice and referred to the Committee on Finance A BILL To establish a Medicare-for-all national health insurance program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) S HORT ITLE .—This Act may be cited as the 4 T ‘‘Medicare for All Act of 2017’’. 5 (b) T ABLE OF C ONTENTS .—The table of contents for 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. TITLE I—ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM; UNIVERSAL ENTITLEMENT; ENROLLMENT VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

2 2 Sec. 101. Establishment of the Universal Medicare Program. Sec. 102. Universal entitlement. Sec. 103. Freedom of choice. Sec. 104. Non-discrimination. Sec. 105. Enrollment. Sec. 106. Effective date of benefits. Sec. 107. Prohibition against duplicating coverage. TITLE II—COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND BENEFITS FOR LONG-TERM CARE Sec. 201. Comprehensive benefits. Sec. 202. No cost-sharing. Sec. 203. Exclusions and limitations. Sec. 204. Coverage of long-term care services under Medicaid. Sec. 205. State standards. TITLE III—PROVIDER PARTICIPATION Sec. 301. Provider participation and standards. Sec. 302. Qualifications for providers. Sec. 303. Use of private contracts. TITLE IV—ADMINISTRATION Subtitle A—General Administration Provisions Sec. 401. Administration. Sec. 402. Consultation. Sec. 403. Regional administration. Sec. 404. Beneficiary ombudsman. Sec. 405. Complementary conduct of related health programs. Subtitle B—Control Over Fraud and Abuse Sec. 411. Application of Federal sanctions to all fraud and abuse under Uni- versal Medicare Program. TITLE V—QUALITY ASSESSMENT Sec. 501. Quality standards. Sec. 502. Addressing health care disparities. TITLE VI—HEALTH BUDGET; PAYMENTS; COST CONTAINMENT MEASURES Subtitle A—Budgeting Sec. 601. National health budget. Subtitle B—Payments to Providers Sec. 611. Payments to institutional and individual providers. Sec. 612. Ensuring accurate valuation of services under the Medicare physician fee schedule. Sec. 613. Office of primary health care. Sec. 614. Payments for prescription drugs and approved devices and equip- ment. S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

3 3 TITLE VII—UNIVERSAL MEDICARE TRUST FUND Sec. 701. Universal Medicare Trust Fund. TITLE VIII—CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 Sec. 801. Prohibition of employee benefits duplicative of benefits under the Universal Medicare Program; coordination in case of workers’ compensation. Sec. 802. Repeal of continuation coverage requirements under ERISA and cer- tain other requirements relating to group health plans. Sec. 803. Effective date of title. TITLE IX—ADDITIONAL CONFORMING AMENDMENTS Sec. 901. Relationship to existing Federal health programs. Sec. 902. Sunset of provisions related to the State Exchanges. TITLE X—TRANSITION Subtitle A—Transitional Medicare Buy-In Option and Transitional Public Option Sec. 1001. Lowering the Medicare age. Sec. 1002. Establishment of the Medicare transition plan. Subtitle B—Transitional Medicare Reforms Sec. 1011. Medicare protection against high out-of-pocket expenditures for fee- for-service benefits and elimination of parts A and B deductibles. Sec. 1012. Reduction in Medicare part D annual out-of-pocket threshold and elimination of cost-sharing above that threshold. Sec. 1013. Coverage of dental and vision services and hearing aids and exami- nations under Medicare part B. Sec. 1014. Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities. TITLE XI—MISCELLANEOUS Sec. 1101. Definitions. • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

4 4 TITLE I—ESTABLISHMENT OF 1 2 THE UNIVERSAL MEDICARE PROGRAM; UNIVERSAL ENTI- 3 4 TLEMENT; ENROLLMENT SEC. 101. ESTABLISHMENT OF THE UNIVERSAL MEDICARE 5 PROGRAM. 6 There is hereby established a national health insur- 7 ance program to provide comprehensive protection against 8 the costs of health care and health-related services, in ac- 9 cordance with the standards specified in, or established 10 under, this Act. 11 SEC. 102. UNIVERSAL ENTITLEMENT. 12 (a) I 13 .—Every individual who is a resident N G ENERAL 14 of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate 15 a rule that provides criteria for determining residency for 16 eligibility purposes under this Act. 17 (b) T NDIVIDUALS REATMENT OF O THER I .—The Sec- 18 retary may make eligible for benefits for health care serv- 19 ices under this Act other individuals not described in sub- 20 section (a), and regulate the nature of eligibility of such 21 individuals, while inhibiting travel and immigration to the 22 United States for the sole purpose of obtaining health care 23 services. 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

5 5 SEC. 103. FREEDOM OF CHOICE. 1 2 Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or in- 3 4 dividual qualified to participate under this Act. SEC. 104. NON-DISCRIMINATION. 5 (a) I N G ENERAL .—No person shall, on the basis of 6 race, color, national origin, age, disability, or sex, includ- 7 ing sex stereotyping, gender identity, sexual orientation, 8 and pregnancy and related medical conditions (including 9 termination of pregnancy), be excluded from participation 10 in, be denied the benefits of, or be subjected to discrimina- 11 tion by any participating provider as defined in section 12 301, or any entity conducting, administering, or funding 13 a health program or activity, including contracts of insur- 14 ance, pursuant to this Act. 15 (b) C D ISCRIMINATION .— 16 LAIMS OF (1) I N GENERAL .—The Secretary shall establish 17 a procedure for adjudication of administrative com- 18 plaints alleging a violation of subsection (a). 19 (2) J URISDICTION .—Any person aggrieved by a 20 violation of subsection (a) by a covered entity may 21 file suit in any district court of the United States 22 having jurisdiction of the parties. 23 (3) D AMAGES .—If the court finds a violation of 24 subsection (a), the court may grant compensatory 25 and punitive damages, declaratory relief, injunctive 26 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

6 6 relief, attorneys’ fees and costs, or other relief as ap- 1 2 propriate. SEC. 105. ENROLLMENT. 3 (a) I N G ENERAL .—The Secretary shall provide a 4 mechanism for the enrollment of individuals eligible for 5 benefits under this Act. The mechanism shall— 6 (1) include a process for the automatic enroll- 7 ment of individuals at the time of birth in the 8 United States and at the time of immigration into 9 the United States or other acquisition of qualified 10 resident status in the United States; 11 (2) provide for the enrollment, as of the date 12 13 described in section 106, of all individuals who are 14 eligible to be enrolled as of such date; and (3) include a process for the enrollment of indi- 15 viduals made eligible for health care services under 16 section 102(b). 17 (b) I C SSUANCE OF U NIVERSAL M EDICARE ARDS .— 18 In conjunction with an individual’s enrollment for benefits 19 under this Act, the Secretary shall provide for the issuance 20 of a Universal Medicare card that shall be used for pur- 21 poses of identification and processing of claims for bene- 22 fits under this program. The card shall not include an in- 23 dividual’s Social Security number. 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

7 7 SEC. 106. EFFECTIVE DATE OF BENEFITS. 1 (a) I N ENERAL .—Except as provided in subsection 2 G (b), benefits shall first be available under this Act for 3 items and services furnished on January 1 of the fourth 4 calendar year that begins after the date of enactment of 5 this Act. 6 (b) C C HILDREN .— 7 OVERAGE FOR (1) I N GENERAL .—For any eligible individual 8 who has not yet attained the age of 19, benefits 9 shall first be available under this Act for items and 10 services furnished on January 1 of the first calendar 11 year that begins after the date of enactment of this 12 Act. 13 (2) O PTION TO CONTINUE IN OTHER COVERAGE 14 DURING TRANSITION PERIOD .—Any person who is 15 eligible to receive benefits as described in paragraph 16 (1) may opt to maintain any coverage described in 17 section 901, private health insurance coverage, or 18 coverage offered pursuant to subtitle A of title X 19 (including the amendments made by such subtitle) 20 until the effective date described in subsection (a). 21 SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. 22 (a) I N G ENERAL .—Beginning on the effective date 23 described in section 106(a), it shall be unlawful for— 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

8 8 (1) a private health insurer to sell health insur- 1 2 ance coverage that duplicates the benefits provided under this Act; or 3 4 (2) an employer to provide benefits for an em- ployee, former employee, or the dependents of an 5 employee or former employee that duplicate the ben- 6 efits provided under this Act. 7 (b) C .—Nothing in this Act shall be 8 ONSTRUCTION construed as prohibiting the sale of health insurance cov- 9 erage for any additional benefits not covered by this Act, 10 including additional benefits that an employer may provide 11 to employees or their dependents, or to former employees 12 13 or their dependents. TITLE II—COMPREHENSIVE BEN- 14 EFITS, INCLUDING PREVEN- 15 TIVE BENEFITS AND BENE- 16 FITS FOR LONG-TERM CARE 17 SEC. 201. COMPREHENSIVE BENEFITS. 18 (a) I ENERAL N G .—Subject to the other provisions of 19 this title and titles IV through IX, individuals enrolled for 20 benefits under this Act are entitled to have payment made 21 by the Secretary to an eligible provider for the following 22 items and services if medically necessary or appropriate 23 for the maintenance of health or for the diagnosis, treat- 24 ment, or rehabilitation of a health condition: 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

9 9 (1) Hospital services, including inpatient and 1 2 outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs. 3 (2) Ambulatory patient services. 4 (3) Primary and preventive services, including 5 chronic disease management. 6 (4) Prescription drugs, medical devices, biologi- 7 cal products, including outpatient prescription drugs, 8 medical devices, and biological products. 9 (5) Mental health and substance abuse treat- 10 ment services, including inpatient care. 11 (6) Laboratory and diagnostic services. 12 13 (7) Comprehensive reproductive, maternity, and newborn care. 14 (8) Pediatrics. 15 (9) Oral health, audiology, and vision services. 16 (10) Short-term rehabilitative and habilitative 17 services and devices. 18 (b) R A EVISION AND DJUSTMENT .—The Secretary 19 shall, on a regular basis, evaluate whether the benefits 20 package should be improved or adjusted to promote the 21 health of beneficiaries, account for changes in medical 22 practice or new information from medical research, or re- 23 spond to other relevant developments in health science, 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

10 10 and shall make recommendations to Congress regarding 1 2 any such improvements or adjustments. (c) C AND I OMPLEMENTARY M EDI - 3 NTEGRATIVE CINE .— 4 (1) I .—In carrying out subsection 5 N GENERAL (b), the Secretary shall consult with the persons de- 6 scribed in paragraph (1) with respect to— 7 (A) identifying specific complementary and 8 integrative medicine practices that, on the basis 9 of research findings or promising clinical inter- 10 ventions, are appropriate to include in the bene- 11 fits package; and 12 (B) identifying barriers to the effective 13 provision and integration of such practices into 14 the delivery of health care, and identifying 15 mechanisms for overcoming such barriers. 16 (2) C ONSULTATION .—In accordance with para- 17 graph (1), the Secretary shall consult with— 18 (A) the Director of the National Center for 19 Complementary and Integrative Health; 20 (B) the Commissioner of Food and Drugs; 21 (C) institutions of higher education, pri- 22 vate research institutes, and individual re- 23 searchers with extensive experience in com- 24 plementary and alternative medicine and the in- 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

11 11 tegration of such practices into the delivery of 1 2 health care; 3 (D) nationally recognized providers of com- plementary and integrative medicine; and 4 5 (E) such other officials, entities, and indi- 6 viduals with expertise on complementary and integrative medicine as the Secretary deter- 7 mines appropriate. 8 (d) S ENE TATES AY P ROVIDE A DDITIONAL B M - 9 FITS .—Individual States may provide additional benefits 10 for the residents of such States at the expense of the 11 12 State. SEC. 202. NO COST-SHARING. 13 (a) I N G ENERAL .—The Secretary shall ensure that 14 no cost-sharing, including deductibles, coinsurance, copay- 15 ments, or similar charges, be imposed on an individual for 16 any benefits provided under this Act, except as described 17 in subsection (b). 18 (b) E XCEPTIONS 19 .—The Secretary may— (1) impose cost-sharing with respect to services 20 provided under section 1946 of the Social Security 21 Act, as added by section 204; and 22 (2) set a cost-sharing schedule for prescription 23 drugs and biological products— 24 (A) provided that— 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

12 12 (i) such schedule is evidence-based 1 2 and encourages the use of generic drugs; 3 (ii) such cost-sharing does not apply to preventive drugs; and 4 5 (iii) such cost-sharing does not exceed 6 $200 annually per individual, adjusted an- nually for inflation; and 7 (B) under which the Secretary may exempt 8 brand-name drugs from consideration in deter- 9 mining whether an individual has reached any 10 out-of-pocket limit if a generic version of such 11 drug is available. 12 (c) N O B ALANCE B ILLING .—Notwithstanding con- 13 tracts in accordance with section 303, no provider may 14 impose a charge to an enrolled individual for covered serv- 15 ices for which benefits are provided under this Act. 16 SEC. 203. EXCLUSIONS AND LIMITATIONS. 17 (a) I N G ENERAL .—Benefits for services are not avail- 18 able under this Act unless the services meet the standards 19 specified in section 201(a), as defined by the Secretary. 20 (b) T E REATMENT OF XPERIMENTAL S ERVICES AND 21 D .— 22 RUGS (1) I N GENERAL .—In applying subsection (a), 23 the Secretary shall make national coverage deter- 24 minations with respect to services that are experi- 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

13 13 1 mental in nature. Such determinations shall be con- sistent with the national coverage determination 2 process as defined in section 1869(f)(1)(B) of the 3 Social Security Act (42 U.S.C. 1395ff(f)(1)(B)). 4 (2) A PPEALS PROCESS .—The Secretary shall 5 establish a process by which individuals can appeal 6 coverage decisions. The process shall, as much as is 7 feasible, follow process for appeals under the Medi- 8 care program described in section 1869 of the Social 9 Security Act (42 U.S.C. 1395ff). 10 (c) A 11 P PPLICATION OF .—In the RACTICE G UIDELINES 12 case of services for which the Department of Health and Human Services has recognized a national practice guide- 13 line, the services are considered to meet the standards 14 specified in section 201(a) if they have been provided in 15 16 accordance with such guideline. For purposes of this sub- section, a service shall be considered to have been provided 17 in accordance with a practice guideline if the health care 18 provider providing the service exercised appropriate pro- 19 fessional discretion to deviate from the guideline in a man- 20 ner authorized or anticipated by the guideline. 21 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

14 14 SEC. 204. COVERAGE OF LONG-TERM CARE SERVICES 1 2 UNDER MEDICAID. 3 Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting the following section after 4 5 section 1946: ‘‘ STATE PLAN FOR PROVIDING LONG - TERM CARE 6 SERVICES 7 ‘‘S 8 . 1947. (a) I N G ENERAL .—For quarters begin- EC ning on or after the effective date of benefits under section 9 106(a) of the Medicare for All Act of 2017, notwith- 10 standing any other provision of this title— 11 ‘‘(1) a State plan for medical assistance shall 12 provide for making medical assistance available for 13 services that are long-term care services (as defined 14 in subsection (b)) in a manner consistent with this 15 section; and 16 ‘‘(2) no payment to a State shall be made 17 under this title with respect to expenditures incurred 18 by the State in providing medical assistance after 19 such date for services that are not long-term care 20 services. 21 ‘‘(b) L D -T ERM C ARE S ERVICES ONG EFINED .—In 22 this section, the term ‘long-term care services’ means the 23 following: 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

15 15 ‘‘(1) Nursing facility services for individuals 21 1 2 years of age or over described in subparagraph (A) of section 1905(a)(4). 3 ‘‘(2) Home health services described in section 4 1905(a)(7). 5 ‘‘(3) Nursing services described in section 6 1905(a)(8). 7 ‘‘(4) Rehabilitative services described in section 8 1905(a)(13). 9 ‘‘(5) Inpatient services for individuals 65 years 10 of age or over provided in an institution for mental 11 disease described in section 1905(a)(14). 12 ‘‘(6) Intermediate care facility services de- 13 scribed in section 1905(a)(15). 14 ‘‘(7) Inpatient psychiatric hospital services for 15 individuals under age 21 described in section 16 1905(a)(16). 17 ‘‘(8) Case management services described in 18 section 1905(a)(19). 19 ‘‘(9) Personal care services described in section 20 1905(a)(24). 21 ‘‘(10) Nursing facility services described in sec- 22 tion 1905(a)(29). 23 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

16 16 ‘‘(11) Home and community-based services pro- 1 2 vided under a State plan amendment under section 3 1915(i). 4 ‘‘(12) Payment for self-directed personal assist- ance services provided under section 1915(j). 5 ‘‘(13) Home and community-based attendant 6 services and supports provided under a State plan 7 amendment under section 1915(k). 8 ‘‘(c) M E FFORT .— 9 AINTENANCE OF ‘‘(1) E LIGIBILITY STANDARDS .— 10 ‘‘(A) I N GENERAL .—Beginning on the date 11 described in subsection (a), no payment may be 12 made under section 1903 with respect to med- 13 ical assistance provided under a State plan for 14 medical assistance if the State adopts income 15 and resource standards and methodologies for 16 purposes of determining an individual’s eligi- 17 bility for medical assistance under the State 18 plan that are more restrictive than those ap- 19 plied as of May 5, 2017. 20 ‘‘(B) I 21 NDEXING OF AMOUNTS OF INCOME AND RESOURCE STANDARDS .—In determining 22 whether a State has adopted income or resource 23 standards that are more restrictive than the 24 standards which applied as of May 5, 2017, the 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

17 17 Secretary shall deem the amount of any such 1 2 standard that was applied as of such date to be increased by the percentage increase in the 3 4 medical care component of the consumer price index for all urban consumers (U.S. city aver- 5 age) from September of 2017 to September of 6 the fiscal year for which the Secretary is mak- 7 ing such determination. 8 ‘‘(2) E XPENDITURES .— 9 ‘‘(A) I N GENERAL .—For each fiscal year 10 or portion of a fiscal year that occurs during 11 the period that begins on the first day of the 12 first fiscal quarter that begins on or after the 13 effective date of benefits under section 106(a) 14 of the Medicare for All Act of 2017, as a condi- 15 tion of receiving payments under section 16 1903(a), a State shall make expenditures for 17 medical assistance for services that are long- 18 term care services in an amount that is not less 19 than the expenditure floor determined for the 20 State and fiscal year (or portion of a fiscal 21 year) under subparagraph (B). 22 ‘‘(B) E XPENDITURE FLOOR .— 23 ‘‘(i) I N GENERAL .—For each fiscal 24 year or portion of a fiscal year described in 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

18 18 subparagraph (A), the Secretary shall de- 1 2 termine for each State an expenditure floor that shall be equal to— 3 ‘‘(I) the amount of the State’s 4 expenditures for fiscal year 2017 on 5 medical assistance for long-term care 6 services; increased by 7 ‘‘(II) the growth factor deter- 8 mined under subclause (ii). 9 ‘‘(ii) G ROWTH FACTOR .—For each fis- 10 cal year or portion of a fiscal year de- 11 12 scribed in subparagraph (A), the Secretary shall, not later than September 1 of the 13 fiscal year preceding such fiscal year or 14 portion of a fiscal year, determine a 15 growth factor for each State that takes 16 into account— 17 ‘‘(I) the percentage increase in 18 health care costs in the State; 19 ‘‘(II) the total amount expended 20 by the State for the previous fiscal 21 year on medical assistance for long- 22 term care services; 23 ‘‘(III) the increase, if any, in the 24 total population of the State from 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

19 19 July of 2017 to July of the fiscal year 1 2 preceding the fiscal year involved; and 3 ‘‘(IV) the increase, if any, in the 4 population of individuals aged 65 and older of the State from July of 2017 5 to July of the fiscal year preceding 6 the fiscal year involved. 7 ‘‘(iii) P RORATION .—Any 8 RULE amount determined under this subpara- 9 graph for a portion of a fiscal year shall be 10 prorated based on the length of such por- 11 tion of a fiscal year relative to a complete 12 fiscal year. 13 ‘‘(d) N C 14 ONAPPLICATION OF - ERTAIN R EQUIRE MENTS 15 .—Beginning on the date described in subsection (a), any provision of this title requiring a State plan for 16 medical assistance to make available medical assistance 17 for services that are not long-term care services or services 18 described in section 901(a)(3)(A)(ii) of the Medicare for 19 All Act of 2017 shall have no effect.’’. 20 SEC. 205. STATE STANDARDS. 21 (a) I G ENERAL .—Nothing in this Act shall prohibit 22 N individual States from setting additional standards, with 23 respect to eligibility, benefits, and minimum provider 24 standards, consistent with the purposes of this Act, pro- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

20 20 vided that such standards do not restrict eligibility or re- 1 2 duce access to benefits or services. (b) R P ROVIDERS .—With respect to ESTRICTIONS ON 3 any individuals or entities certified to provide services cov- 4 ered under section 201(a)(7), a State may not prohibit 5 an individual or entity from participating in the program 6 under this Act, for reasons other than the ability of the 7 individual or entity to provide such services. 8 TITLE III—PROVIDER 9 PARTICIPATION 10 SEC. 301. PROVIDER PARTICIPATION AND STANDARDS. 11 (a) I N G ENERAL .—An individual or other entity fur- 12 nishing any covered service under this Act is not a quali- 13 fied provider unless the individual or entity— 14 (1) is a qualified provider of the services under 15 section 302; 16 (2) has filed with the Secretary a participation 17 agreement described in subsection (b); and 18 (3) meets, as applicable, such other qualifica- 19 tions and conditions with respect to a provider of 20 services under title XVIII of the Social Security Act 21 as described in section 1866 of the Social Security 22 Act (42 U.S.C. 1395cc). 23 (b) R EQUIREMENTS IN P ARTICIPATION A GREE - 24 MENT .— 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

21 21 (1) I .—A participation agreement 1 N GENERAL described in this subsection between the Secretary 2 and a provider shall provide at least for the fol- 3 lowing: 4 (A) Services to eligible persons will be fur- 5 nished by the provider without discrimination, 6 in accordance with section 104(a). Nothing in 7 this subparagraph shall be construed as requir- 8 ing the provision of a type or class of services 9 that are outside the scope of the provider’s nor- 10 mal practice. 11 (B) No charge will be made to any enrolled 12 individual for any covered services other than 13 for payment authorized by this Act. 14 (C) The provider agrees to furnish such in- 15 formation as may be reasonably required by the 16 Secretary, in accordance with uniform reporting 17 standards established under section 401(b)(1), 18 for— 19 (i) quality review by designated enti- 20 ties; 21 (ii) making payments under this Act, 22 including the examination of records as 23 may be necessary for the verification of in- 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

22 22 formation on which such payments are 1 2 based; (iii) statistical or other studies re- 3 4 quired for the implementation of this Act; and 5 (iv) such other purposes as the Sec- 6 retary may specify. 7 (D) In the case of a provider that is not 8 an individual, the provider agrees not to employ 9 or use for the provision of health services any 10 individual or other provider that has had a par- 11 ticipation agreement under this subsection ter- 12 minated for cause. 13 (E) In the case of a provider paid under 14 a fee-for-service basis, the provider agrees to 15 submit bills and any required supporting docu- 16 mentation relating to the provision of covered 17 services within 30 days after the date of pro- 18 viding such services. 19 (2) T - ERMINATION OF PARTICIPATION AGREE 20 MENT 21 .— (A) I N GENERAL .—Participation agree- 22 ments may be terminated, with appropriate no- 23 tice— 24 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

23 23 (i) by the Secretary for failure to meet 1 2 the requirements of this Act; or (ii) by a provider. 3 (B) T ERMINATION PROCESS .—Providers 4 shall be provided notice and a reasonable oppor- 5 tunity to correct deficiencies before the Sec- 6 retary terminates an agreement unless a more 7 immediate termination is required for public 8 safety or similar reasons. 9 (C) P ROVIDER PROTECTIONS .— 10 (i) P 11 .—The Secretary may ROHIBITION not terminate a participation agreement or 12 in any other way discriminate against, or 13 cause to be discriminated against, any cov- 14 ered provider or authorized representative 15 of the provider, on account of such pro- 16 vider or representative— 17 (I) providing, causing to be pro- 18 vided, or being about to provide or 19 cause to be provided to the provider, 20 the Federal Government, or the attor- 21 ney general of a State information re- 22 lating to any violation of, or any act 23 or omission the provider or represent- 24 ative reasonably believes to be a viola- 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

24 24 tion of, any provision of this title (or 1 2 an amendment made by this title); (II) testifying or being about to 3 testify in a proceeding concerning 4 such violation; 5 (III) assisting or participating, or 6 being about to assist or participate, in 7 such a proceeding; or 8 (IV) objecting to, or refusing to 9 participate in, any activity, policy, 10 practice, or assigned task that the 11 provider or representative reasonably 12 believes to be in violation of any provi- 13 sion of this Act (including any amend- 14 ment made by this Act), or any order, 15 rule, regulation, standard, or ban 16 under this Act (including any amend- 17 ment made by this Act). 18 (ii) C OMPLAINT PROCEDURE .—A pro- 19 vider or representative who believes that he 20 or she has been discriminated against in 21 violation of this section may seek relief in 22 accordance with the procedures, notifica- 23 tions, burdens of proof, remedies, and stat- 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

25 25 utes of limitation set forth in section 1 2 2087(b) of title 15, United States Code. SEC. 302. QUALIFICATIONS FOR PROVIDERS. 3 (a) I N G ENERAL .—A health care provider is consid- 4 ered to be qualified to provide covered services if the pro- 5 vider is licensed or certified and meets— 6 (1) all the requirements of State law to provide 7 such services; and 8 (2) applicable requirements of Federal law to 9 provide such services. 10 (b) M .— 11 INIMUM P ROVIDER S TANDARDS (1) I .—The Secretary shall estab- 12 N GENERAL lish, evaluate, and update national minimum stand- 13 ards to ensure the quality of services provided under 14 this Act and to monitor efforts by States to ensure 15 the quality of such services. A State may also estab- 16 lish additional minimum standards which providers 17 shall meet with respect to services provided in such 18 State. 19 (2) N .—The na- 20 ATIONAL MINIMUM STANDARDS tional minimum standards under paragraph (1) shall 21 be established for institutional providers of services 22 and individual health care practitioners. Except as 23 the Secretary may specify in order to carry out this 24 Act, a hospital, skilled nursing facility, or other in- 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

26 26 stitutional provider of services shall meet standards 1 2 for such a provider under the Medicare program under title XVIII of the Social Security Act (42 3 U.S.C. 1395 et seq.). Such standards also may in- 4 clude, where appropriate, elements relating to— 5 (A) adequacy and quality of facilities; 6 (B) training and competence of personnel 7 (including continuing education requirements); 8 (C) comprehensiveness of service; 9 (D) continuity of service; 10 (E) patient satisfaction, including waiting 11 time and access to services; and 12 (F) performance standards, including orga- 13 nization, facilities, structure of services, effi- 14 ciency of operation, and outcome in palliation, 15 improvement of health, stabilization, cure, or 16 rehabilitation. 17 (3) T RANSITION IN APPLICATION .—If the Sec- 18 retary provides for additional requirements for pro- 19 viders under this subsection, any such additional re- 20 quirement shall be implemented in a manner that 21 provides for a reasonable period during which a pre- 22 viously qualified provider is permitted to meet such 23 an additional requirement. 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

27 27 (4) A .—With re- 1 BILITY TO PROVIDE SERVICES 2 spect to any entity or provider certified to provide 3 services described in section 201(a)(7), the Secretary may not prohibit such entity or provider from par- 4 ticipating for reasons other than its ability to pro- 5 vide such services. 6 (c) F P ROVIDERS .—Any provider qualified to 7 EDERAL provide health care services through the Department of 8 Veterans Affairs or Indian Health Service is a qualifying 9 provider under this section with respect to any individual 10 who qualifies for such services under applicable Federal 11 12 law. SEC. 303. USE OF PRIVATE CONTRACTS. 13 (a) I N G ENERAL .—Subject to the provisions of this 14 subsection, nothing in this Act shall prohibit an institu- 15 tional or individual provider from entering into a private 16 contract with an enrolled individual for any item or serv- 17 ice— 18 (1) for which no claim for payment is to be sub- 19 mitted under this Act, and 20 (2) for which the provider receives— 21 (A) no reimbursement under this Act di- 22 rectly or on a capitated basis, and 23 (B) receives no amount for such item or 24 service from an organization which receives re- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

28 28 imbursement for such items or service under 1 2 this Act directly or on a capitated basis. (b) B ENEFICIARY ROTECTIONS .— 3 P (1) I N GENERAL .—Subsection (a) shall not 4 apply to any contract unless— 5 (A) the contract is in writing and is signed 6 by the beneficiary before any item or service is 7 provided pursuant to the contract; 8 (B) the contract contains the items de- 9 scribed in paragraph (2); and 10 (C) the contract is not entered into at a 11 12 time when the beneficiary is facing an emer- gency health care situation. 13 (2) I TEMS REQUIRED TO BE INCLUDED IN CON - 14 TRACT .—Any contract to provide items and services 15 to which subsection (a) applies shall clearly indicate 16 to the beneficiary that by signing such contract the 17 beneficiary— 18 (A) agrees not to submit a claim (or to re- 19 quest that the provider submit a claim) under 20 this Act for such items or services even if such 21 items or services are otherwise covered by this 22 Act; 23 (B) agrees to be responsible, whether 24 through insurance offered under section 107(b) 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

29 29 or otherwise, for payment of such items or serv- 1 2 ices and understands that no reimbursement will be provided under this Act for such items 3 4 or services; (C) acknowledges that no limits under this 5 Act apply to amounts that may be charged for 6 such items or services; 7 (D) if the provider is a non-participating 8 provider, acknowledges that the beneficiary has 9 the right to have such items or services pro- 10 vided by other providers for whom payment 11 would be made under this Act; and 12 (E) acknowledges that the provider is pro- 13 viding services outside the scope of the program 14 under this Act. 15 (c) P R EQUIREMENTS .— 16 ROVIDER (1) I N GENERAL .—Subsection (a) shall not 17 apply to any contract unless an affidavit described 18 in paragraph (2) is in effect during the period any 19 item or service is to be provided pursuant to the 20 contract. 21 (2) A FFIDAVIT .—An affidavit is described in 22 this subparagraph shall— 23 (A) identify the practitioner, and be signed 24 by such practitioner; 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

30 30 (B) provide that the practitioner will not 1 2 submit any claim under this title for any item or service provided to any beneficiary (and will 3 not receive any reimbursement or amount de- 4 scribed in paragraph (1)(B) for any such item 5 or service) during the 1-year period beginning 6 on the date the affidavit is signed; and 7 (C) be filed with the Secretary no later 8 than 10 days after the first contract to which 9 such affidavit applies is entered into. 10 (3) E NFORCEMENT .—If a physician or practi- 11 12 tioner signing an affidavit described in paragraph (2) knowingly and willfully submits a claim under 13 this title for any item or service provided during the 14 1-year period described in paragraph (2)(B) (or re- 15 ceives any reimbursement or amount described in 16 subsection (a)(2) for any such item or service) with 17 respect to such affidavit— 18 (A) this subsection shall not apply with re- 19 spect to any items and services provided by the 20 physician or practitioner pursuant to any con- 21 tract on and after the date of such submission 22 and before the end of such period; and 23 (B) no payment shall be made under this 24 title for any item or service furnished by the 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

31 31 physician or practitioner during the period de- 1 2 scribed in clause (i) (and no reimbursement or payment of any amount described in subsection 3 4 (a)(2) shall be made for any such item or serv- ice). 5 TITLE IV—ADMINISTRATION 6 Subtitle A—General 7 Administration Provisions 8 SEC. 401. ADMINISTRATION. 9 (a) G ENERAL D UTIES OF THE S ECRETARY .— 10 (1) I 11 .—The Secretary shall develop N GENERAL policies, procedures, guidelines, and requirements to 12 carry out this Act, including related to— 13 (A) eligibility for benefits; 14 (B) enrollment; 15 (C) benefits provided; 16 (D) provider participation standards and 17 qualifications, as described in title III; 18 (E) levels of funding; 19 (F) methods for determining amounts of 20 payments to providers of covered services, con- 21 sistent with subtitle B; 22 (G) the determination of medical necessity 23 and appropriateness with respect to coverage of 24 certain services; 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

32 32 (H) planning for capital expenditures and 1 2 service delivery; (I) planning for health professional edu- 3 4 cation funding; (J) encouraging States to develop regional 5 planning mechanisms; and 6 (K) any other regulations necessary to 7 carry out the purpose of this Act. 8 (2) R EGULATIONS .—Regulations authorized by 9 this Act shall be issued by the Secretary in accord- 10 ance with section 553 of title 5, United States Code. 11 (b) U 12 - NIFORM R EPORTING S TANDARDS ; A NNUAL R E PORT TUDIES .— 13 ; S (1) U NIFORM REPORTING STANDARDS .— 14 (A) I N GENERAL .—The Secretary shall es- 15 tablish uniform State reporting requirements 16 and national standards to ensure an adequate 17 national database containing information per- 18 taining to health services practitioners, ap- 19 proved providers, the costs of facilities and 20 practitioners providing such services, the qual- 21 ity of such services, the outcomes of such serv- 22 ices, and the equity of health among population 23 groups. Such standards shall include, to the 24 maximum extent feasible without compromising 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

33 33 1 patient privacy, health outcome measures, and to the maximum extent feasible without exces- 2 sively burdening providers, the measures de- 3 scribed in subparagraphs (D) through (F) of 4 subsection (a)(1). 5 (B) R EPORTS 6 .—The Secretary shall regu- 7 larly analyze information reported to it and shall define rules and procedures to allow re- 8 9 searchers, scholars, health care providers, and others to access and analyze data for purposes 10 consistent with quality and outcomes research, 11 12 without compromising patient privacy. (2) A NNUAL REPORT 13 .—Beginning January 1 of the second year beginning after the effective date of 14 this Act, the Secretary shall annually report to Con- 15 gress on the following: 16 (A) The status of implementation of the 17 Act. 18 (B) Enrollment under this Act. 19 (C) Benefits under this Act. 20 (D) Expenditures and financing under this 21 Act. 22 (E) Cost-containment measures and 23 achievements under this Act. 24 (F) Quality assurance. 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

34 34 (G) Health care utilization patterns, in- 1 2 cluding any changes attributable to the pro- gram. 3 (H) Changes in the per-capita costs of 4 health care. 5 (I) Differences in the health status of the 6 populations of the different States, including in- 7 come and racial characteristics, and other popu- 8 lation health inequities. 9 (J) Progress on quality and outcome meas- 10 ures, and long-range plans and goals for 11 achievements in such areas. 12 (K) Necessary changes in the education of 13 health personnel. 14 (L) Plans for improving service to medi- 15 cally underserved populations. 16 (M) Transition problems as a result of im- 17 plementation of this Act. 18 (N) Opportunities for improvements under 19 this Act. 20 (3) S TATISTICAL ANALYSES AND OTHER STUD - 21 IES .—The Secretary may, either directly or by con- 22 tract— 23 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

35 35 (A) make statistical and other studies, on 1 2 a nationwide, regional, State, or local basis, of any aspect of the operation of this Act; 3 4 (B) develop and test methods of payment or delivery as it may consider necessary or 5 promising for the evaluation, or for the im- 6 provement, of the operation of this Act; and 7 (C) develop methodological standards for 8 evidence-based policymaking. 9 (c) A UDITS .— 10 (1) I N GENERAL .—The Comptroller General of 11 12 the United States shall conduct an audit of the Board every fifth fiscal year following the effective 13 date of this Act to determine the effectiveness of the 14 program in carrying out the duties under subsection 15 (a). 16 (2) R EPORTS .—The Comptroller General of the 17 United States shall submit a report to Congress con- 18 cerning the results of each audit conducted under 19 this subsection. 20 SEC. 402. CONSULTATION. 21 The Secretary shall consult with Federal agencies, 22 Indian tribes and urban Indian health organizations, and 23 private entities, such as professional societies, national as- 24 sociations, nationally recognized associations of experts, 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

36 36 medical schools and academic health centers, consumer 1 2 groups, and labor and business organizations in the for- 3 mulation of guidelines, regulations, policy initiatives, and 4 information gathering to ensure the broadest and most in- formed input in the administration of this Act. Nothing 5 in this Act shall prevent the Secretary from adopting 6 guidelines developed by such a private entity if, in the Sec- 7 retary’s judgment, such guidelines are generally accepted 8 as reasonable and prudent and consistent with this Act. 9 SEC. 403. REGIONAL ADMINISTRATION. 10 (a) C OORDINATION W ITH R EGIONAL O FFICES .—The 11 Secretary shall establish and maintain regional offices to 12 promote adequate access to, and efficient use of, tertiary 13 14 care facilities, equipment, and services. Wherever possible, the Secretary shall incorporate regional offices of the Cen- 15 ters for Medicare & Medicaid Services for this purpose. 16 (b) A - PPOINTMENT OF R EGIONAL AND S TATE D IREC 17 TORS 18 .—In each such regional office there shall be— (1) one regional director appointed by the Sec- 19 retary; 20 (2) for each State in the region, a deputy direc- 21 tor; and 22 (3) one deputy director to represent the Native 23 American and Alaska Native tribes in the region. 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

37 37 (c) R O FFICE D UTIES .—Regional offices EGIONAL 1 shall be responsible for— 2 (1) providing an annual State health care needs 3 assessment report to the Secretary, after a thorough 4 examination of health needs, in consultation with 5 public health officials, clinicians, patients, and pa- 6 tient advocates; 7 (2) recommending changes in provider reim- 8 bursement or payment for delivery of health services 9 in the States within the region; and 10 (3) establishing a quality assurance mechanism 11 in the State in order to minimize both under-utiliza- 12 tion and over-utilization and to ensure that all pro- 13 viders meet high quality standards. 14 SEC. 404. BENEFICIARY OMBUDSMAN. 15 (a) I N G ENERAL .—The Secretary shall appoint a 16 Beneficiary Ombudsman who shall have expertise and ex- 17 perience in the fields of health care and education of, and 18 assistance to, individuals entitled to benefits under this 19 Act. 20 (b) D UTIES .—The Beneficiary Ombudsman shall— 21 (1) receive complaints, grievances, and requests 22 for information submitted by individuals entitled to 23 benefits under this Act with respect to any aspect of 24 the Universal Medicare Program; 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

38 38 (2) provide assistance with respect to com- 1 2 plaints, grievances, and requests referred to in sub- paragraph (a), including— 3 (A) assistance in collecting relevant infor- 4 mation for such individuals, to seek an appeal 5 of a decision or determination made by a re- 6 gional office or the Secretary; and 7 (B) assistance to such individuals in pre- 8 senting information under relating to cost-shar- 9 ing; and 10 (3) submit annual reports to Congress and the 11 Secretary that describe the activities of the Office 12 and that include such recommendations for improve- 13 ment in the administration of this Act as the Om- 14 budsman determines appropriate. The Ombudsman 15 shall not serve as an advocate for any increases in 16 payments or new coverage of services, but may iden- 17 tify issues and problems in payment or coverage 18 policies. 19 SEC. 405. COMPLEMENTARY CONDUCT OF RELATED 20 HEALTH PROGRAMS. 21 In performing functions with respect to health per- 22 sonnel education and training, health research, environ- 23 mental health, disability insurance, vocational rehabilita- 24 tion, the regulation of food and drugs, and all other mat- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

39 39 ters pertaining to health, the Secretary shall direct the ac- 1 2 tivities of the Department of Health and Human Services toward contributions to the health of the people com- 3 4 plementary to this Act. Subtitle B—Control Over Fraud 5 and Abuse 6 SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL 7 FRAUD AND ABUSE UNDER UNIVERSAL MEDI- 8 CARE PROGRAM. 9 The following sections of the Social Security Act shall 10 apply to this Act in the same manner as they apply to 11 State medical assistance plans under title XIX of such 12 Act: 13 (1) Section 1128 (relating to exclusion of indi- 14 viduals and entities). 15 (2) Section 1128A (civil monetary penalties). 16 (3) Section 1128B (criminal penalties). 17 (4) Section 1124 (relating to disclosure of own- 18 ership and related information). 19 (5) Section 1126 (relating to disclosure of cer- 20 tain owners). 21 TITLE V—QUALITY ASSESSMENT 22 SEC. 501. QUALITY STANDARDS. 23 (a) I N G ENERAL .—All standards and quality meas- 24 ures under this Act shall be performed by the Center for 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

40 40 Clinical Standards and Quality of the Centers for Medi- 1 2 care & Medicaid Services (referred to in this title as the ‘‘Center’’), in coordination with the Agency for Healthcare 3 4 Research and Quality and other offices of the Department of Health and Human Services. 5 (b) D UTIES OF THE C ENTER .—The Center shall per- 6 form the following duties: 7 (1) P RACTICE GUIDELINES .—The Center shall 8 review and evaluate each practice guideline devel- 9 oped under part B of title IX of the Public Health 10 Service Act. The Center shall determine whether the 11 guideline should be recognized as a national practice 12 13 guideline. (2) S , PERFORMANCE 14 TANDARDS OF QUALITY MEASURES , AND MEDICAL REVIEW CRITERIA .—The 15 Center shall review and evaluate each standard of 16 quality, performance measure, and medical review 17 criterion developed under part B of title IX of the 18 Public Health Service Act (42 U.S.C. 299 et seq.). 19 The Center shall determine whether the standard, 20 measure, or criterion is appropriate for use in as- 21 sessing or reviewing the quality of services provided 22 by health care institutions or health care profes- 23 sionals. In evaluating such standards, the Center 24 shall consider the evidentiary basis for the standard, 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

41 41 and the validity, reliability, and feasibility of meas- 1 2 uring the standard. (3) P ; 3 ROFILING OF PATTERNS OF PRACTICE .—The Center shall 4 IDENTIFICATION OF OUTLIERS adopt methodologies for profiling the patterns of 5 practice of health care professionals and for identi- 6 fying and notifying outliers. 7 (4) C RITERIA FOR ENTITIES CONDUCTING 8 QUALITY REVIEWS .—The Center shall develop min- 9 imum criteria for competence for entities that can 10 11 qualify to conduct ongoing and continuous external quality reviews in the administrative regions. Such 12 criteria shall require such an entity to be adminis- 13 tratively independent of the individual or board that 14 administers the region and shall ensure that such 15 entities do not provide financial incentives to review- 16 ers to favor one pattern of practice over another. 17 The Center shall ensure coordination and reporting 18 by such entities to ensure national consistency in 19 quality standards. 20 (5) R EPORTING .—The Center shall report to 21 the Secretary annually specifically on findings from 22 outcomes research and development of practice 23 guidelines that may affect the Secretary’s deter- 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

42 42 1 mination of coverage of services under section 401(a)(1)(G). 2 SEC. 502. ADDRESSING HEALTH CARE DISPARITIES. 3 (a) E VALUATING D ATA C OLLECTION A P - 4 PROACHES 5 .—The Center shall evaluate approaches for the collection of data under this Act, to be performed in con- 6 junction with existing quality reporting requirements and 7 programs under this Act, that allow for the ongoing, accu- 8 rate, and timely collection of data on disparities in health 9 care services and performance on the basis of race, eth- 10 nicity, gender, geography, or socioeconomic status. In con- 11 ducting such evaluation, the Secretary shall consider the 12 following objectives: 13 (1) Protecting patient privacy. 14 (2) Minimizing the administrative burdens of 15 data collection and reporting on providers under this 16 Act. 17 (3) Improving Universal Medicare Program 18 data on race, ethnicity, gender, geography, and so- 19 cioeconomic status. 20 (b) R EPORTS TO ONGRESS .— 21 C (1) R EPORT ON EVALUATION .—Not later than 22 18 months after the date on which benefits first be- 23 come available as described in section 106(a), the 24 Center shall submit to Congress and the Secretary 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

43 43 1 a report on the evaluation conducted under sub- section (a). Such report shall, taking into consider- 2 ation the results of such evaluation— 3 (A) identify approaches (including defining 4 methodologies) for identifying and collecting 5 and evaluating data on health care disparities 6 on the basis of race, ethnicity, gender, geog- 7 raphy, or socioeconomic status under the Uni- 8 versal Medicare Program; and 9 (B) include recommendations on the most 10 effective strategies and approaches to reporting 11 quality measures, as appropriate, on the basis 12 of race, ethnicity, gender, geography, or socio- 13 14 economic status. (2) R EPORT ON DATA ANALYSES 15 .—Not later than 4 years after the submission of the report 16 under subsection (b)(1), and 4 years thereafter, the 17 Center shall submit to Congress and the Secretary 18 a report that includes recommendations for improv- 19 ing the identification of health care disparities based 20 on the analyses of data collected under subsection 21 (c). 22 (c) I MPLEMENTING E FFECTIVE A PPROACHES .—Not 23 later than 2 years after the date on which benefits first 24 become available as described in section 106(a), the Sec- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

44 44 1 retary shall implement the approaches identified in the re- port submitted under subsection (b)(1) for the ongoing, 2 accurate, and timely collection and evaluation of data on 3 health care disparities on the basis of race, ethnicity, gen- 4 der, geography, or socioeconomic status. 5 TITLE VI—HEALTH BUDGET; 6 PAYMENTS; COST CONTAIN- 7 8 MENT MEASURES Subtitle A—Budgeting 9 SEC. 601. NATIONAL HEALTH BUDGET. 10 (a) N 11 ATIONAL H EALTH B UDGET .— (1) I N GENERAL 12 .—By not later than September 1 of each year, beginning with the year prior to the 13 date on which benefits first become available as de- 14 scribed in section 106(a), the Secretary shall estab- 15 lish a national health budget, which specifies the 16 total expenditures to be made for covered health 17 care services under this Act. 18 (2) D .— 19 IVISION OF BUDGET INTO COMPONENTS In addition to the cost of covered health services, the 20 national health budget shall consist of at least the 21 following components: 22 (A) Quality assessment activities under 23 title V. 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

45 45 1 (B) Health professional education expendi- tures. 2 (C) Administrative costs. 3 (D) Innovation, including in accordance 4 with section 1115A of the Social Security Act 5 6 (42 U.S.C. 1315a). (E) Operating and other expenditures not 7 described in subparagraphs (A) through (D) 8 (referred to in this Act as the ‘‘operating com- 9 ponent’’), consisting of amounts not included in 10 the other components. 11 (F) Capital expenditures. 12 13 (G) Prevention and public health activities. (3) A LLOCATION AMONG COMPONENTS 14 .—The Secretary shall allocate the budget among the com- 15 ponents in a manner that— 16 (A) ensures a fair allocation for quality as- 17 sessment activities; and 18 (B) ensures that the health professional 19 education expenditure component is sufficient 20 to provide for the amount of health professional 21 education expenditures sufficient to meet the 22 need for covered health care services. 23 (4) T EMPORARY WORKER ASSISTANCE .—For up 24 to 5 years following the date on which benefits first 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

46 46 become available as described in section 106(a), up 1 2 to 1 percent of the budget may be allocated to pro- grams providing assistance to workers who perform 3 4 functions in the administration of the health insur- ance system and who may experience economic dis- 5 location as a result of the implementation of this 6 Act. 7 (5) R .—The Secretary shall es- 8 ESERVE FUND tablish and maintain a reserve fund to respond to 9 the costs of treating an epidemic, pandemic, natural 10 disaster, or other such health emergency. 11 (b) D 12 .—In this section: EFINITIONS (1) C .—The term ‘‘cap- 13 APITAL EXPENDITURES ital expenditures’’ means expenses for the purchase, 14 lease, construction, or renovation of capital facilities 15 and for equipment and includes return on equity 16 capital. 17 (2) H EALTH PROFESSIONAL EDUCATION EX 18 - PENDITURES .—The term ‘‘health professional edu- 19 cation expenditures’’ means expenditures in hospitals 20 and other health care facilities to cover costs associ- 21 ated with teaching and related research activities. 22 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

47 47 1 Subtitle B—Payments to Providers SEC. 611. PAYMENTS TO INSTITUTIONAL AND INDIVIDUAL 2 PROVIDERS. 3 (a) A PPLICATION OF P AYMENT P ROCESSES U NDER 4 T XVIII.—Except as otherwise provided in this sec- 5 ITLE tion, the Secretary shall establish, by regulation, fee 6 schedules that establish payment amounts for benefits 7 under this Act in a manner that is consistent with proc- 8 esses for determining payments for items and services 9 under title XVIII of the Social Security Act (42 U.S.C. 10 1395 et seq.), including the application of the provisions 11 of, and amendments made by, section 612. 12 (b) A AY C URRENT AND P LANNED P PPLICATION OF - 13 MENT R EFORMS .—Any payment reform activities or dem- 14 onstrations planned or implemented with respect to such 15 title XVIII as of the date of the enactment of this Act 16 shall apply to benefits under this Act, including any re- 17 form activities or demonstrations planned or implemented 18 under the provisions of, or amendments made by, the 19 Medicare Access and CHIP Reauthorization Act of 2015 20 (Public Law 114–10) and the Patient Protection and Af- 21 fordable Care Act (Public Law 111–148). 22 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

48 48 SEC. 612. ENSURING ACCURATE VALUATION OF SERVICES 1 2 UNDER THE MEDICARE PHYSICIAN FEE 3 SCHEDULE. (a) S AND D TANDARDIZED R EVIEW 4 OCUMENTED P ROCESS .—Section 1848(c)(2) of the Social Security Act 5 (42 U.S.C. 1395w–4(c)(2)) is amended by adding at the 6 end the following new subparagraph: 7 ‘‘(P) S TANDARDIZED AND DOCUMENTED 8 REVIEW PROCESS .— 9 ‘‘(i) I N GENERAL .—Not later than one 10 year after the date of enactment of this 11 12 subparagraph, the Secretary shall estab- lish, document, and make publicly available 13 a standardized process for reviewing the 14 relative values of physicians’ services under 15 this paragraph. 16 ‘‘(ii) M INIMUM REQUIREMENTS .—The 17 standardized process shall include, at a 18 minimum, methods and criteria for identi- 19 fying services for review, prioritizing the 20 review of services, reviewing stakeholder 21 recommendations, and identifying addi- 22 tional resources to be considered during 23 the review process.’’. 24 (b) P LANNED AND D OCUMENTED U SE OF F UNDS .— 25 Section 1848(c)(2)(M) of the Social Security Act (42 26 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

49 49 U.S.C. 1305w–4(c)(2)(M)) is amended by adding at the 1 2 end the following new clause: ‘‘(x) P AND DOCUMENTED LANNED 3 USE OF FUNDS .—For each fiscal year (be- 4 ginning with the first fiscal year beginning 5 on or after the date of enactment of this 6 clause), the Secretary shall provide to Con- 7 gress a written plan for using the funds 8 provided under clause (ix) to collect and 9 use information on physicians’ services in 10 the determination of relative values under 11 this subparagraph.’’. 12 (c) I RACKING OF 13 NTERNAL T .— R EVIEWS (1) I .—Not later than one year 14 N GENERAL after the date of enactment of this Act, the Sec- 15 retary shall submit to Congress a proposed plan for 16 systematically and internally tracking its review of 17 the relative values of physicians’ services, such as by 18 establishing an internal database, under section 19 1848(c)(2) of the Social Security Act (42 U.S.C. 20 1395w–4(c)(2)), as amended by this section. 21 (2) M INIMUM REQUIREMENTS .—The proposal 22 shall include, at a minimum, plans and a timeline 23 for achieving the ability to systematically and inter- 24 nally track the following: 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

50 50 (A) When, how, and by whom services are 1 2 identified for review. 3 (B) When services are reviewed or re- viewed or when new services are added. 4 5 (C) The resources, evidence, data, and rec- 6 ommendations used in reviews. (D) When relative values are adjusted. 7 (E) The rationale for final relative value 8 decisions. 9 (d) F R EVIEW .—Section 1848(c)(2) of 10 REQUENCY OF the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is 11 amended— 12 (1) in subparagraph (B)(i), by striking ‘‘5’’ and 13 inserting ‘‘4’’; and 14 (2) in subparagraph (K)(i)(I), by striking ‘‘peri- 15 odically’’ and inserting ‘‘annually’’. 16 (e) C P W ITH M EDICARE ONSULTATION AYMENT A D - 17 .— VISORY C OMMISSION 18 (1) I .—Section 1848(c)(2) of the 19 N GENERAL Social Security Act (42 U.S.C. 1395w–4(c)(2)) is 20 amended— 21 (A) in subparagraph (B)(i), by inserting 22 ‘‘in consultation with the Medicare Payment 23 Advisory Commission,’’ after ‘‘The Secretary,’’; 24 and 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

51 51 (B) in subparagraph (K)(i)(I), as amended 1 2 by subsection (d)(2), by inserting ‘‘in coordina- 3 tion with the Medicare Payment Advisory Com- 4 mission,’’ after ‘‘years,’’. (2) C .—Section 1805 5 ONFORMING AMENDMENTS of the Social Security Act (42 U.S.C. 1395b–6) is 6 amended— 7 (A) in subsection (b)(1)(A), by inserting 8 the following before the semicolon at the end: 9 ‘‘and including coordinating with the Secretary 10 in accordance with section 1848(c)(2) to sys- 11 tematically review the relative values established 12 for physicians’ services, identify potentially 13 misvalued services, and propose adjustments to 14 15 the relative values for physicians’ services’’; and (B) in subsection (e)(1), in the second sen- 16 tence, by inserting ‘‘or the Ranking Minority 17 Member’’ after ‘‘the Chairman’’. 18 (f) P ERIODIC 19 UDIT BY THE C OMPTROLLER G EN - A ERAL .—Section 1848(c)(2) of the Social Security Act (42 20 U.S.C. 1395w–4(c)(2)), as amended by subsection (a), is 21 amended by adding at the end the following new subpara- 22 graph: 23 ‘‘(Q) P ERIODIC AUDIT BY THE COMP - 24 TROLLER GENERAL .— 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

52 52 ‘‘(i) I .—The Comptroller 1 N GENERAL 2 General of the United States (in this sub- 3 section referred to as the ‘Comptroller General’) shall periodically audit the review 4 by the Secretary of relative values estab- 5 lished under this paragraph for physicians’ 6 services. 7 ‘‘(ii) A CCESS TO INFORMATION .—The 8 Comptroller General shall have unre- 9 stricted access to all deliberations, records, 10 and nonproprietary data related to the ac- 11 12 tivities carried out under this paragraph, in a timely manner, upon request.’’. 13 SEC. 613. OFFICE OF PRIMARY HEALTH CARE. 14 (a) I N G ENERAL .—There is established within the 15 Agency for Healthcare Research and Quality an Office of 16 Primary Health Care, responsible for coordinating with 17 the Secretary, the Health Resources and Services Admin- 18 istration, and other offices in the Department as nec- 19 essary, in order to— 20 (1) coordinate health professional education 21 policies and goals, in consultation with the Secretary 22 to achieve the national goals specified in subsection 23 (b); 24 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

53 53 (2) develop and maintain a system to monitor 1 2 the number and specialties of individuals through their health professional education, any postgraduate 3 4 training, and professional practice; (3) develop, coordinate, and promote policies 5 that expand the number of primary care practi- 6 tioners, registered nurses, midlevel practitioners, and 7 dentists; and 8 (4) recommend the appropriate training, edu- 9 cation, technical assistance, and patient advocacy en- 10 hancements of primary care health professionals, in- 11 cluding registered nurses, to achieve uniform high 12 quality and patient safety. 13 (b) N .—Not later than 1 year after 14 ATIONAL G OALS the date of enactment of this Act, the Office of Primary 15 Health Care shall set forth national goals to increase ac- 16 cess to high quality primary health care, particularly in 17 underserved areas and for underserved populations. 18 SEC. 614. PAYMENTS FOR PRESCRIPTION DRUGS AND AP- 19 PROVED DEVICES AND EQUIPMENT. 20 (a) N RICES EGOTIATED P .—The prices to be paid for 21 covered pharmaceuticals, medical supplies, and medically 22 necessary assistive equipment shall be negotiated annually 23 by the Secretary. 24 (b) P 25 D RUG F ORMULARY .— RESCRIPTION • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

54 54 (1) I .—The Secretary shall establish 1 N GENERAL 2 a prescription drug formulary system, which shall 3 encourage best-practices in prescribing and discour- 4 age the use of ineffective, dangerous, or excessively 5 costly medications when better alternatives are avail- able. 6 (2) P ROMOTION OF USE OF GENERICS .—The 7 formulary under this subsection shall promote the 8 use of generic medications to the greatest extent 9 possible. 10 (3) F ORMULARY UPDATES AND PETITION 11 .—The formulary under this subsection shall 12 RIGHTS be updated frequently and clinicians and patients 13 may petition the Secretary to add new pharma- 14 ceuticals or to remove ineffective or dangerous medi- 15 cations from the formulary. 16 (4) U SE OF OFF - FORMULARY MEDICATIONS .— 17 The Secretary shall promulgate rules regarding the 18 use of off-formulary medications which allow for pa- 19 tient access but do not compromise the formulary. 20 TITLE VII—UNIVERSAL 21 MEDICARE TRUST FUND 22 SEC. 701. UNIVERSAL MEDICARE TRUST FUND. 23 (a) I N G ENERAL .—There is hereby created on the 24 books of the Treasury of the United States a trust fund 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

55 55 to be known as the Universal Medicare Trust Fund (in 1 2 this section referred to as the ‘‘Trust Fund’’). The Trust Fund shall consist of such gifts and bequests as may be 3 4 made and such amounts as may be deposited in, or appro- priated to, such Trust Fund as provided in this Act. 5 (b) A PPROPRIATIONS I NTO T RUST F UND .— 6 (1) T AXES .—There are hereby appropriated to 7 the Trust Fund for each fiscal year beginning with 8 the fiscal year which includes the date on which ben- 9 10 efits first become available as described in section 106, out of any moneys in the Treasury not other- 11 wise appropriated, amounts equivalent to 100 per- 12 cent of the net increase in revenues to the Treasury 13 which is attributable to the amendments made by 14 sections 801 and 902. The amounts appropriated by 15 the preceding sentence shall be transferred from 16 time to time (but not less frequently than monthly) 17 from the general fund in the Treasury to the Trust 18 Fund, such amounts to be determined on the basis 19 of estimates by the Secretary of the Treasury of the 20 taxes paid to or deposited into the Treasury; and 21 proper adjustments shall be made in amounts subse- 22 quently transferred to the extent prior estimates 23 were in excess of or were less than the amounts that 24 should have been so transferred. 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

56 56 (2) C .—Notwith- 1 URRENT PROGRAM RECEIPTS standing any other provision of law, there are hereby 2 appropriated to the Trust Fund for each fiscal year, 3 beginning with the first fiscal year beginning on or 4 after the effective date of benefits under section 106, 5 the amounts that would otherwise have been appro- 6 priated to carry out the following programs: 7 (A) The Medicare program under title 8 XVIII of the Social Security Act (other than 9 amounts attributable to any premiums under 10 such title). 11 12 (B) The Medicaid program, under State plans approved under title XIX of such Act. 13 (C) The Federal Employees Health Bene- 14 fits program, under chapter 89 of title 5, 15 United States Code. 16 (D) The TRICARE program, under chap- 17 ter 55 of title 10, United States Code. 18 (E) The maternal and child health pro- 19 gram (under title V of the Social Security Act), 20 vocational rehabilitation programs, programs 21 for drug abuse and mental health services 22 under the Public Health Service Act, programs 23 providing general hospital or medical assistance, 24 and any other Federal program identified by 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

57 57 the Secretary, in consultation with the Sec- 1 2 retary of the Treasury, to the extent the pro- grams provide for payment for health services 3 4 the payment of which may be made under this Act. 5 (3) R ESTRICTIONS SHALL NOT APPLY .—Any 6 other provision of law in effect on the date of enact- 7 ment of this Act restricting the use of Federal funds 8 for any reproductive health service shall not apply to 9 monies in the Trust Fund. 10 (c) I NCORPORATION OF P ROVISIONS .—The provisions 11 12 of subsections (b) through (i) of section 1817 of the Social Security Act (42 U.S.C. 1395i) shall apply to the Trust 13 Fund under this section in the same manner as such pro- 14 visions applied to the Federal Hospital Insurance Trust 15 Fund under such section 1817, except that, for purposes 16 of applying such subsections to this section, the ‘‘Board 17 of Trustees of the Trust Fund’’ shall mean the ‘‘Sec- 18 retary’’. 19 (d) T RANSFER OF F UNDS .—Any amounts remaining 20 in the Federal Hospital Insurance Trust Fund under sec- 21 tion 1817 of the Social Security Act (42 U.S.C. 1395i) 22 or the Federal Supplementary Medical Insurance Trust 23 Fund under section 1841 of such Act (42 U.S.C. 1395t) 24 after the payment of claims for items and services fur- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

58 58 nished under title XVIII of such Act have been completed, 1 2 shall be transferred into the Universal Medicare Trust Fund under this section. 3 4 TITLE VIII—CONFORMING AMENDMENTS TO THE EM- 5 PLOYEE RETIREMENT IN- 6 COME SECURITY ACT OF 1974 7 SEC. 801. PROHIBITION OF EMPLOYEE BENEFITS DUPLICA- 8 TIVE OF BENEFITS UNDER THE UNIVERSAL 9 MEDICARE PROGRAM; COORDINATION IN 10 CASE OF WORKERS’ COMPENSATION. 11 (a) I N G ENERAL .—Part 5 of subtitle B of title I of 12 13 the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is amended by adding at the end 14 the following new section: 15 ‘‘SEC. 522. PROHIBITION OF EMPLOYEE BENEFITS DUPLI- 16 CATIVE OF UNIVERSAL MEDICARE PROGRAM 17 BENEFITS; COORDINATION IN CASE OF 18 WORKERS’ COMPENSATION. 19 ‘‘(a) I G N ENERAL .—Subject to subsection (b), no em- 20 ployee benefit plan may provide benefits that duplicate 21 payment for any items or services for which payment may 22 be made under the Medicare for All Act of 2017. 23 ‘‘(b) R EIMBURSEMENT .—Each workers compensation 24 carrier that is liable for payment for workers compensa- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

59 59 tion services furnished in a State shall reimburse the Uni- 1 2 versal Medicare Program for the cost of such services. ‘‘(c) D EFINITIONS 3 .—In this subsection— ‘‘(1) the term ‘workers compensation carrier’ 4 means an insurance company that underwrite work- 5 ers compensation medical benefits with respect to 6 one or more employers and includes an employer or 7 fund that is financially at risk for the provision of 8 workers compensation medical benefits; 9 ‘‘(2) the term ‘workers compensation medical 10 benefits’ means, with respect to an enrollee who is 11 an employee subject to the workers compensation 12 13 laws of a State, the comprehensive medical benefits for work-related injuries and illnesses provided for 14 under such laws with respect to such an employee; 15 and 16 ‘‘(3) the term ‘workers compensation services’ 17 means items and services included in workers com- 18 pensation medical benefits and includes items and 19 services (including rehabilitation services and long- 20 term care services) commonly used for treatment of 21 work-related injuries and illnesses.’’. 22 (b) C ONFORMING A MENDMENT .—Section 4(b) of the 23 Employee Retirement Income Security Act of 1974 (29 24 U.S.C. 1003(b)) is amended by adding at the end the fol- 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

60 60 lowing: ‘‘Paragraph (3) shall apply subject to section 1 2 522(b) (relating to reimbursement of the Universal Medi- care Program by workers compensation carriers).’’. 3 (c) C LERICAL A MENDMENT .—The table of contents 4 in section 1 of such Act is amended by inserting after the 5 item relating to section 521 the following new item: 6 ‘‘Sec 522. Prohibition of employee benefits duplicative of Universal Medicare Program benefits; coordination in case of workers’ compensa- tion.’’. SEC. 802. REPEAL OF CONTINUATION COVERAGE REQUIRE- 7 MENTS UNDER ERISA AND CERTAIN OTHER 8 REQUIREMENTS RELATING TO GROUP 9 HEALTH PLANS. 10 (a) I ENERAL 11 N G .—Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 12 (29 U.S.C. 1161 et seq.) is repealed. 13 (b) C ONFORMING A MENDMENTS .— 14 (1) Section 502(a) of such Act (29 U.S.C. 15 1132(a)) is amended— 16 (A) by striking paragraph (7); and 17 (B) by redesignating paragraphs (8), (9), 18 and (10) as paragraphs (7), (8), and (9), re- 19 spectively. 20 (2) Section 502(c)(1) of such Act (29 U.S.C. 21 1132(c)(1)) is amended by striking ‘‘paragraph (1) 22 or (4) of section 606,’’. 23 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

61 61 (3) Section 514(b) of such Act (29 U.S.C. 1 2 1144(b)) is amended— 3 (A) in paragraph (7), by striking ‘‘section 206(d)(3)(B)(i)).’’; and 4 5 (B) by striking paragraph (8). 6 (4) The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 7 is amended by striking the items relating to part 6 8 of subtitle B of title I of such Act. 9 SEC. 803. EFFECTIVE DATE OF TITLE. 10 The amendments made by this title shall take effect 11 on the effective date of benefits under section 106(a). 12 TITLE IX—ADDITIONAL 13 CONFORMING AMENDMENTS 14 SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH 15 PROGRAMS. 16 (a) M 17 EDICARE , M EDICAID , AND S TATE C HILDREN ’ S H EALTH I NSURANCE P ROGRAM (SCHIP).— 18 (1) I .—Notwithstanding any other N GENERAL 19 provision of law, subject to paragraphs (2) and 20 (3)— 21 (A) no benefits shall be available under 22 title XVIII of the Social Security Act for any 23 item or service furnished beginning on or after 24 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

62 62 the effective date of benefits under section 1 2 106(a); (B) no individual is entitled to medical as- 3 sistance under a State plan approved under 4 title XIX of such Act for any item or service 5 furnished on or after such date; 6 (C) no individual is entitled to medical as- 7 sistance under a State child health plan under 8 title XXI of such Act for any item or service 9 furnished on or after such date; and 10 (D) no payment shall be made to a State 11 under section 1903(a) or 2105(a) of such Act 12 with respect to medical assistance or child 13 health assistance for any item or service fur- 14 nished on or after such date. 15 (2) T RANSITION .—In the case of inpatient hos- 16 pital services and extended care services during a 17 continuous period of stay which began before the ef- 18 fective date of benefits under section 106, and which 19 had not ended as of such date, for which benefits 20 are provided under title XVIII of the Social Security 21 Act, under a State plan under title XIX of such Act, 22 or under a State child health plan under title XXI 23 such Act, the Secretary of Health and Human Serv- 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

63 63 ices shall provide for continuation of benefits under 1 2 such title or plan until the end of the period of stay. (3) S ERVICES UNDER MEDICAID 3 .— (A) I N GENERAL .—This subsection shall 4 not apply to entitlement to medical assistance 5 provided under title XIX of the Social Security 6 Act for— 7 (i) long-term care services (as defined 8 in section 1947(b) of such Act); or 9 (ii) any other service for which bene- 10 fits are not available under this Act and 11 which is furnished under a State plan 12 under title XIX of the Social Security Act 13 which provided for medical assistance for 14 such service on September 1, 2017. 15 (B) C OORDINATION BETWEEN SECRETARY 16 AND STATES .—The Secretary shall coordinate 17 with the directors of State agencies responsible 18 for administering State plans under title XIX 19 of the Social Security Act to— 20 (i) identify services described in sub- 21 paragraph (A)(ii) with respect to each 22 State plan; and 23 (ii) ensure that such services continue 24 to be made available under such plan. 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

64 64 (C) M - 1 AINTENANCE OF EFFORT REQUIRE .—With respect to any service described MENT 2 in subparagraph (A)(ii) that is made available 3 4 under a State plan under title XIX of the So- 5 cial Security Act, the maintenance of effort re- quirements described in section 1947(c) of such 6 Act (related to eligibility standards and re- 7 quired expenditures) shall apply to such service 8 in the same manner that such requirements 9 apply to long-term care services (as defined in 10 section 1947(b) of such Act). 11 (b) F EDERAL E 12 H EALTH B ENEFITS P RO - MPLOYEES 13 .—No benefits shall be made available under chapter GRAM 89 of title 5, United States Code, for any part of a cov- 14 erage period occurring on or after the effective date. 15 (c) T RICARE .—No benefits shall be made available 16 under sections 1079 and 1086 of title 10, United States 17 Code, for items or services furnished on or after the effec- 18 tive date. 19 (d) T V REATMENT OF B ENEFITS FOR ETERANS AND 20 N A MERICANS .— 21 ATIVE (1) I N GENERAL .—Nothing in this Act shall af- 22 fect the eligibility of veterans for the medical bene- 23 fits and services provided under title 38, United 24 States Code, or of Indians for the medical benefits 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

65 65 and services provided by or through the Indian 1 2 Health Service. (2) R .—No reevaluation of the 3 EEVALUATION Indian Health Service shall be undertaken without 4 consultation with tribal leaders and stakeholders. 5 SEC. 902. SUNSET OF PROVISIONS RELATED TO THE STATE 6 EXCHANGES. 7 Effective on the date described in section 106, the 8 Federal and State Exchanges established pursuant to title 9 I of the Patient Protection and Affordable Care Act (Pub- 10 lic Law 111–148) shall terminate, and any other provision 11 of law that relies upon participation in or enrollment 12 through such an Exchange, including such provisions of 13 the Internal Revenue Code of 1986, shall cease to have 14 force or effect. 15 16 TITLE X—TRANSITION Subtitle A—Transitional Medicare 17 Buy-In Option and Transitional 18 Public Option 19 SEC. 1001. LOWERING THE MEDICARE AGE. 20 (a) I N G ENERAL .—Title XVIII of the Social Security 21 Act (42 U.S.C. 1395c et seq.) is amended by adding at 22 the end the following new section: 23 ‘‘ - IN OPTION FOR CERTAIN 24 TRANSITIONAL MEDICARE BUY INDIVIDUALS 25 ‘‘S EC . 1899C. (a) O PTION .— 26 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

66 66 N GENERAL .—Every individual who meets 1 ‘‘(1) I the requirements described in paragraph (3) shall be 2 eligible to enroll under this section. 3 ‘‘(2) P ARTS A , B , AND D BENEFITS .—An indi- 4 vidual enrolled under this section is entitled to the 5 same benefits (and shall receive the same protec- 6 tions) under this title as an individual who is enti- 7 tled to benefits under part A and enrolled under 8 parts B and D, including the ability to enroll in a 9 Medicare Advantage plan that provides qualified pre- 10 scription drug coverage (an MA–PD plan). 11 ‘‘(3) R .—The 12 EQUIREMENTS FOR ELIGIBILITY requirements described in this paragraph are the fol- 13 lowing: 14 ‘‘(A) The individual is a resident of the 15 United States. 16 ‘‘(B) The individual is— 17 ‘‘(i) a citizen or national of the United 18 States; or 19 ‘‘(ii) an alien lawfully admitted for 20 permanent residence. 21 ‘‘(C) The individual is not otherwise enti- 22 tled to benefits under part A or eligible to en- 23 roll under part A or part B. 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

67 67 ‘‘(D) The individual has attained the appli- 1 2 cable years of age but has not attained 65 years of age. 3 ‘‘(4) A PPLICABLE YEARS OF AGE DEFINED .— 4 For purposes of this section, the term ‘applicable 5 years of age’ means— 6 ‘‘(A) effective January 1 of the first year 7 following the date of enactment of the Medicare 8 for All Act of 2017, the age of 55; 9 ‘‘(B) effective January 1 of the second 10 year following such date of enactment, the age 11 of 45; and 12 ‘‘(C) effective January 1 of the third year 13 14 following such date of enactment, the age of 35. ‘‘(b) E ; C OVERAGE .—The Secretary shall 15 NROLLMENT establish enrollment periods and coverage under this sec- 16 tion consistent with the principles for establishment of en- 17 rollment periods and coverage for individuals under other 18 provisions of this title. The Secretary shall establish such 19 periods so that coverage under this section shall first begin 20 on January 1 of the year on which an individual first be- 21 comes eligible to enroll under this section. 22 ‘‘(c) P REMIUM .— 23 ‘‘(1) A MOUNT OF MONTHLY PREMIUMS .—The 24 Secretary shall, during September of each year (be- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

68 68 ginning with the first September following the date 1 2 of enactment of the Medicare for All Act of 2017), 3 determine a monthly premium for all individuals en- 4 rolled under this section. Such monthly premium 1 shall be equal to ⁄ 12 of the annual premium com- 5 puted under paragraph (2)(B), which shall apply 6 with respect to coverage provided under this section 7 for any month in the succeeding year. 8 ‘‘(2) A NNUAL PREMIUM .— 9 ‘‘(A) C OMBINED PER CAPITA AVERAGE FOR 10 ALL MEDICARE BENEFITS .—The Secretary shall 11 12 estimate the average, annual per capita amount for benefits and administrative expenses that 13 will be payable under parts A, B, and D (in- 14 cluding, as applicable, under part C) in the year 15 for all individuals enrolled under this section. 16 ‘‘(B) A NNUAL PREMIUM .—The annual pre- 17 mium under this subsection for months in a 18 year is equal to the average, annual per capita 19 amount estimated under subparagraph (A) for 20 the year. 21 ‘‘(3) I NCREASED PREMIUM FOR CERTAIN PART 22 C AND D PLANS .—Nothing in this section shall pre- 23 clude an individual from choosing a Medicare Advan- 24 tage plan or a prescription drug plan which requires 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

69 69 the individual to pay an additional amount (because 1 2 of supplemental benefits or because it is a more ex- 3 pensive plan). In such case the individual would be responsible for the increased monthly premium. 4 ‘‘(d) P P REMIUMS AYMENT OF 5 .— ‘‘(1) I N GENERAL .—Premiums for enrollment 6 under this section shall be paid to the Secretary at 7 such times, and in such manner, as the Secretary 8 determines appropriate. 9 ‘‘(2) D EPOSIT .—Amounts collected by the Sec- 10 retary under this section shall be deposited in the 11 Federal Hospital Insurance Trust Fund and the 12 Federal Supplementary Medical Insurance Trust 13 Fund (including the Medicare Prescription Drug Ac- 14 count within such Trust Fund) in such proportion 15 as the Secretary determines appropriate. 16 ‘‘(e) N 17 E OT LIGIBLE FOR M EDICARE C OST -S HARING A .—An individual enrolled under this section 18 SSISTANCE shall not be treated as enrolled under any part of this title 19 for purposes of obtaining medical assistance for Medicare 20 cost-sharing or otherwise under title XIX. 21 ‘‘(f) T REATMENT IN R ELATION TO THE A FFORDABLE 22 C A CT .— 23 ARE ‘‘(1) S ATISFACTION OF INDIVIDUAL MAN - 24 DATE .—For purposes of applying section 5000A of 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

70 70 the Internal Revenue Code of 1986, the coverage 1 2 provided under this section constitutes minimum es- sential coverage under subsection (f)(1)(A)(i) of 3 4 such section 5000A. ‘‘(2) E LIGIBILITY FOR PREMIUM ASSISTANCE .— 5 Coverage provided under this section— 6 ‘‘(A) shall be treated as coverage under a 7 qualified health plan in the individual market 8 enrolled in through the Exchange where the in- 9 dividual resides for all purposes of section 36B 10 of the Internal Revenue Code of 1986 other 11 than subsection (c)(2)(B) thereof; and 12 ‘‘(B) shall not be treated as eligibility for 13 14 other minimum essential coverage for purposes of subsection (c)(2)(B) of such section 36B. 15 The Secretary shall determine the applicable second 16 lowest cost silver plan which shall apply to coverage 17 under this section for purposes of section 36B of 18 such Code. 19 ‘‘(3) E - LIGIBILITY FOR COST SHARING SUB - 20 SIDIES 21 .—For purposes of applying section 1402 of the Patient Protection and Affordable Care Act (42 22 U.S.C. 18071)— 23 ‘‘(A) coverage provided under this section 24 shall be treated as coverage under a qualified 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

71 71 health plan in the silver level of coverage in the 1 2 individual market offered through an Exchange; and 3 4 ‘‘(B) the Secretary shall be treated as the issuer of such plan. 5 ‘‘(g) G UARANTEED I SSUE OF M EDIGAP P OLICIES 6 U 7 F IRST E NROLLMENT AND E PON S UBSEQUENT E N - ACH ROLLMENT 8 .—In the case of an individual who enrolls under this section (including an individual who was pre- 9 viously enrolled under this section), paragraphs (2)(A), 10 (2)(D), (3)(B)(ii), and (3)(B)(vi) of section 1882(s)— 11 ‘‘(1) shall be applied by substituting ‘the appli- 12 cable year of age (as defined in section 13 1899C(a)(4))’ for ‘65 years of age’; 14 ‘‘(2) if the individual was enrolled under this 15 section and subsequently disenrolls, shall apply each 16 time the individual subsequently reenrolls under this 17 section as if the individual had attained the applica- 18 ble year of age (as defined in subsection (a)(4)) on 19 the date of such reenrollment (and as if the indi- 20 vidual had never previously enrolled in a Medicare 21 supplemental policy); and 22 ‘‘(3) shall be applied as if this section had not 23 been enacted (and as if the individual had never pre- 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

72 72 viously enrolled in a Medicare supplemental policy) 1 2 when the individual attains 65 years of age. ‘‘(h) N E FFECT ON B O I NDIVIDUALS 3 ENEFITS FOR O THERWISE E LIGIBLE OR ON T RUST F UNDS .—The Sec- 4 retary shall implement the provisions of this section in 5 such a manner to ensure that such provisions— 6 ‘‘(1) have no effect on the benefits under this 7 title for individuals who are entitled to, or enrolled 8 for, such benefits other than through this section; 9 10 and ‘‘(2) have no negative impact on the Federal 11 Hospital Insurance Trust Fund or the Federal Sup- 12 plementary Medical Insurance Trust Fund (includ- 13 ing the Medicare Prescription Drug Account within 14 such Trust Fund). 15 ‘‘(i) C ONSULTATION .—In promulgating regulations 16 to implement this section, the Secretary shall consult with 17 interested parties, including groups representing bene- 18 ficiaries, health care providers, employers, and insurance 19 companies.’’. 20 SEC. 1002. ESTABLISHMENT OF THE MEDICARE TRANSI- 21 TION PLAN. 22 (a) I N G ENERAL .—To carry out the purpose of this 23 section, for plan years beginning with the first plan year 24 that begins after the date of enactment of this Act and 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

73 73 ending with the effective date described in section 106, 1 2 the Secretary, acting through the Administrator of the 3 Centers for Medicare & Medicaid (referred to in this sec- 4 tion as the ‘‘Administrator’’), shall establish, and provide for the offering through the Exchanges, of a public health 5 plan (in this Act referred to as the ‘‘Medicare Transition 6 plan’’) that provides affordable, high-quality health bene- 7 fits coverage throughout the United States. 8 (b) A 9 THE M EDICARE T RANSI - DMINISTRATING TION .— 10 (1) A DMINISTRATOR .—The Administrator shall 11 administer the Medicare Transition plan in accord- 12 ance with this section. 13 (2) A PPLICATION OF ACA REQUIREMENTS .— 14 Consistent with this section, the Medicare Transition 15 plan shall comply with requirements under title I of 16 the Patient Protection and Affordable Care Act (and 17 the amendments made by that title) and title XXVII 18 of the Public Health Service Act (42 U.S.C. 300gg 19 et seq.) that are applicable to qualified health plans 20 offered through the Exchanges, subject to the limita- 21 tion under subsection (e)(2). 22 (3) O FFERING THROUGH EXCHANGES .—The 23 Medicare Transition plan shall be made available 24 only through the Exchanges, and shall be available 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

74 74 to individuals wishing to enroll and to qualified em- 1 2 ployers (as defined in section 1312(f)(2) of the Pa- 3 tient Protection and Affordable Care Act (42 U.S.C. 4 18032)) who wish to make such plan available to their employees. 5 (4) E LIGIBILITY TO PURCHASE .—Any United 6 States resident may enroll in the Medicare Transi- 7 tion plan. 8 (c) B ENEFITS ; A CTUARIAL V ALUE .—In carrying out 9 this section, the Administrator shall ensure that the Medi- 10 care Transition plan provides— 11 (1) coverage for the benefits required to be cov- 12 ered under title II; and 13 (2) coverage of benefits that are actuarially 14 equivalent to 90 percent of the full actuarial value 15 of the benefits provided under the plan. 16 (d) P ROVIDERS AND R EIMBURSEMENT R ATES .— 17 (1) I N GENERAL .—With respect to the reim- 18 bursement provided to health care providers for cov- 19 ered benefits, as described in section 201, provided 20 under the Medicare Transition plan, the Adminis- 21 trator shall reimburse such providers at rates deter- 22 mined for equivalent items and services under the 23 original Medicare fee-for-service program under 24 parts A and B of title XVIII of the Social Security 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

75 75 Act (42 U.S.C. 1395c et seq.). For items and serv- 1 2 ices covered under the Medicare Transition plan but not covered under such parts A and B, the Adminis- 3 trator shall reimburse providers at rates set by the 4 Administrator in a manner consistent with the man- 5 ner in which rates for other items and services were 6 set under the original Medicare fee-for-service pro- 7 gram. 8 (2) P RESCRIPTION DRUGS .—Any payment rate 9 under this subsection for a prescription drug shall be 10 at a rate negotiated by the Administrator with the 11 12 manufacturer of the drug. If the Administrator is unable to reach a negotiated agreement on such a 13 reimbursement rate, the Administrator shall estab- 14 lish the rate at an amount equal to the lesser of— 15 (A) the price paid by the Secretary of Vet- 16 erans Affairs to procure the drug under the 17 laws administered by the Secretary of Veterans 18 Affairs; 19 (B) the price paid to procure the drug 20 under section 8126 of title 38, United States 21 Code; or 22 (C) the best price determined under sec- 23 tion 1927(c)(1)(C) of the Social Security Act 24 (42 U.S.C. 1396r–8(c)(1)(C)) for the drug. 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

76 76 (3) P .— 1 ARTICIPATING PROVIDERS (A) I N GENERAL 2 .—A health care provider that is a participating provider of services or 3 supplier under the Medicare program under 4 title XVIII of the Social Security Act (42 5 U.S.C. 1395 et seq.) or under a State Medicaid 6 plan under title XIX of such Act (42 U.S.C. 7 1396 et seq.) on the date of enactment of this 8 Act shall be a participating provider in the 9 Medicare Transition plan. 10 (B) A DDITIONAL PROVIDERS .—The Ad- 11 ministrator shall establish a process to allow 12 health care providers not described in subpara- 13 graph (A) to become participating providers in 14 the Medicare Transition plan. Such process 15 shall be similar to the process applied to new 16 providers under the Medicare program. 17 (e) P REMIUMS .— 18 (1) D ETERMINATION 19 .—The Administrator shall determine the premium amount for enrolling in the 20 Medicare Transition plan, which— 21 (A) may vary according to family or indi- 22 vidual coverage, age, and tobacco status (con- 23 sistent with clauses (i), (iii), and (iv) of section 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

77 77 2701(a)(1)(A) of the Public Health Service Act 1 2 (42 U.S.C. 300gg(a)(1)(A))); and 3 (B) shall take into account the cost-shar- ing reductions and premium tax credits which 4 will be available with respect to the plan under 5 section 1402 of the Patient Protection and Af- 6 fordable Care Act (42 U.S.C. 18071) and sec- 7 tion 36B of the Internal Revenue Code of 1986, 8 as amended by subsection (g). 9 (2) L IMITATION .—Variation in premium rates 10 of the Medicare Transition plan by rating area, as 11 described in clause (ii) of section 2701(a)(1)(A)(iii) 12 of the Public Health Service Act (42 U.S.C. 13 300gg(a)(1)(A)) is not permitted. 14 (f) T ERMINATION .—This section shall cease to have 15 force or effect on the effective date described in section 16 106. 17 (g) T 18 AX .— C REDITS AND C OST -S HARING S UBSIDIES (1) P .— 19 REMIUM ASSISTANCE TAX CREDITS (A) C REDITS ALLOWED TO MEDICARE 20 TRANSITION PLAN ENROLLEES AT OR ABOVE 44 21 PERCENT OF POVERTY IN NON - EXPANSION 22 STATES .—Paragraph (1) of section 36B(c) of 23 the Internal Revenue Code of 1986 is amended 24 by redesignating subparagraphs (C) and (D) as 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

78 78 subparagraphs (D) and (E), respectively, and 1 2 by inserting after subparagraph (B) the fol- 3 lowing new subparagraph: ‘‘(C) S PECIAL FOR MEDICARE 4 RULES TRANSITION PLAN ENROLLEES .— 5 ‘‘(i) I .—In the case of a 6 N GENERAL taxpayer who is covered, or whose spouse 7 or dependent (as defined in section 152) is 8 covered, by the Medicare Transition plan 9 established under section 1002(a) of the 10 Medicare for All Act of 2017 for all 11 months in the taxable year, subparagraph 12 (A) shall be applied without regard to ‘but 13 does not exceed 400 percent’. 14 ‘‘(ii) E NROLLEES IN MEDICAID NON - 15 EXPANSION STATES .—In the case of a tax- 16 payer residing in a State which (as of the 17 date of the enactment of the Medicare for 18 All Act of 2017) does not provide for eligi- 19 bility under clause (i)(VIII) or (ii)(XX) of 20 section 1902(a)(10)(A) of the Social Secu- 21 rity Act for medical assistance under title 22 XIX of such Act (or a waiver of the State 23 plan approved under section 1115) who is 24 covered, or whose spouse or dependent (as 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

79 79 defined in section 152) is covered, by the 1 2 Medicare Transition plan established under 3 section 1002(a) of the Medicare for All Act 4 of 2017 for all months in the taxable year, subparagraphs (A) and (B) shall be ap- 5 plied by substituting ‘0 percent’ for ‘100 6 percent’ each place it appears.’’. 7 (B) P REMIUM ASSISTANCE AMOUNTS FOR 8 TAXPAYERS ENROLLED IN MEDICARE TRANSI - 9 TION PLAN .— 10 (i) I N GENERAL .—Subparagraph (A) 11 of section 36B(b)(3) of such Code is 12 13 amended— (I) by redesignating clause (ii) as 14 clause (iii), 15 (II) by striking ‘‘clause (ii)’’ in 16 clause (i) and inserting ‘‘clauses (ii) 17 and (iii)’’, and 18 (III) by inserting after clause (i) 19 the following new clause: 20 ‘‘(ii) S PECIAL RULES FOR TAXPAYERS 21 ENROLLED MEDICARE TRANSITION 22 IN PLAN .—In the case of a taxpayer who is 23 covered, or whose spouse or dependent (as 24 defined in section 152) is covered, by the 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

80 80 Medicare Transition plan established under 1 2 section 1002(a) of the Medicare for All Act 3 of 2017 for all months in the taxable year, 4 the applicable percentage for any taxable year shall be determined in the same man- 5 ner as under clause (i), except that the fol- 6 lowing table shall apply in lieu of the table 7 contained in such clause: 8 ‘‘In the case of household income (expressed as a The final premium The initial premium percent of poverty line) percentage is— percentage is— within the following income tier: Up to 100% ... 2% 2% 100% up to 138% ... 2.04% 2.04% 4.08% 3.06% 138% up to 150% ... 150% and above ... 5%.’’. 4.08% (ii) C ONFORMING AMENDMENT .—Sub- 9 clause (I) of clause (iii) of section 10 36B(b)(3) of such Code, as redesignated 11 by subparagraph (A)(i), is amended by in- 12 serting ‘‘, and determined after the appli- 13 cation of clause (ii)’’ after ‘‘after applica- 14 tion of this clause’’. 15 (2) C OST - SHARING SUBSIDIES .—Subsection (b) 16 of section 1402 of the Patient Protection and Af- 17 fordable Care Act (42 U.S.C. 18071(b)) is amend- 18 ed— 19 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

81 81 1 (A) by inserting ‘‘, or in the Medicare Transition plan established under section 2 1002(a) of the Medicare for All Act of 2017,’’ 3 after ‘‘coverage’’ in paragraph (1); 4 (B) by redesignating paragraphs (1) (as so 5 amended) and (2) as subparagraphs (A) and 6 (B), respectively, and by moving such subpara- 7 8 graphs 2 ems to the right; (C) by striking ‘‘I .—In this sec- 9 NSURED tion’’ and inserting ‘‘I NSURED .— 10 ‘‘(1) I N GENERAL .—In this section’’; 11 (D) by striking the flush language; and 12 (E) by adding at the end the following new 13 14 paragraph: ‘‘(2) S PECIAL RULES 15 .— ‘‘(A) I NDIVIDUALS LAWFULLY PRESENT .— 16 In the case of an individual described in section 17 36B(c)(1)(B) of the Internal Revenue Code of 18 1986, the individual shall be treated as having 19 household income equal to 100 percent of the 20 poverty line for a family of the size involved for 21 purposes of applying this section. 22 ‘‘(B) M - 23 EDICARE TRANSITION PLAN EN ROLLEES IN MEDICAID NON - EXPANSION 24 STATES .—In the case of an individual residing 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

82 82 in a State which (as of the date of the enact- 1 2 ment of the Medicare for All Act of 2017) does not provide for eligibility under clause (i)(VIII) 3 4 or (ii)(XX) of section 1902(a)(10)(A) of the So- cial Security Act for medical assistance under 5 title XIX of such Act (or a waiver of the State 6 plan approved under section 1115) who enrolls 7 in such Medicare Transition plan, the preceding 8 sentence, paragraph (1)(B), and paragraphs 9 (1)(A)(i) and (2)(A) of subsection (c) shall each 10 be applied by substituting ‘0 percent’ for ‘100 11 percent’ each place it appears. 12 ‘‘(C) A 13 SHARING FOR MEDI DJUSTED COST - - CARE TRANSITION PLAN ENROLLEES 14 .—In the case of any individual who enrolls in such Medi- 15 care Transition plan, in lieu of the percentages 16 under subsection (c)(1)(B)(i) and (c)(2), the 17 Secretary shall prescribe a method of deter- 18 mining the cost-sharing reduction for any such 19 individual such that the total of the cost-shar- 20 ing and the premiums paid by the individual 21 under such Medicare Transition plan does not 22 exceed the percentage of the total allowed costs 23 of benefits provided under the plan equal to the 24 final premium percentage applicable to such in- 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

83 83 dividual under section 36B(b)(3)(A)(ii) of the 1 2 Internal Revenue Code of 1986.’’. (h) C A MENDMENTS .— 3 ONFORMING (1) T AS A QUALIFIED HEALTH 4 REATMENT PLAN .—Section 1301(a)(2) of the Patient Protection 5 and Affordable Care Act (42 U.S.C. 18021(a)(2)) is 6 amended— 7 (A) in the paragraph heading, by inserting 8 ‘‘, THE MEDICARE TRANSITION PLAN ,’’ before 9 ‘‘ AND ’’; and 10 (B) by inserting ‘‘The Medicare Transition 11 plan,’’ before ‘‘and a multi-State plan’’. 12 (2) L EVEL PLAYING FIELD 13 .—Section 1324(a) of the Patient Protection and Affordable Care Act 14 (42 U.S.C. 18044(a)) is amended by inserting ‘‘the 15 Medicare Transition plan,’’ before ‘‘or a multi-State 16 qualified health plan’’. 17 Subtitle B—Transitional Medicare 18 Reforms 19 SEC. 1011. MEDICARE PROTECTION AGAINST HIGH OUT-OF- 20 POCKET EXPENDITURES FOR FEE-FOR-SERV- 21 ICE BENEFITS AND ELIMINATION OF PARTS A 22 AND B DEDUCTIBLES. 23 (a) P OF A GAINST H IGH O UT - ROTECTION -P OCKET 24 E XPENDITURES .—Title XVIII of the Social Security Act 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

84 84 (42 U.S.C. 1395 et seq.), as amended by section 1001, 1 2 is amended by adding at the end the following new section: ‘‘ - OF - POCKET PROTECTION AGAINST HIGH OUT 3 EXPENDITURES 4 ‘‘S EC . 1899D. (a) I N G ENERAL .—Notwithstanding 5 any other provision of this title, in the case of an indi- 6 vidual entitled to, or enrolled for, benefits under part A 7 or enrolled in part B, if the amount of the out-of-pocket 8 cost-sharing of such individual for a year (effective the 9 year beginning January 1 of the year following the date 10 of enactment of the Medicare for All Act of 2017) equals 11 or exceeds $1,500, the individual shall not be responsible 12 for additional out-of-pocket cost-sharing occurred during 13 that year. 14 ‘‘(b) O D - OF -P OCKET C OST -S HARING UT EFINED .— 15 ‘‘(1) I N GENERAL .—Subject to paragraphs (2) 16 and (3), in this section, the term ‘out-of-pocket cost- 17 sharing’ means, with respect to an individual, the 18 amount of the expenses incurred by the individual 19 that are attributable to— 20 ‘‘(A) coinsurance and copayments applica- 21 ble under part A or B; or 22 ‘‘(B) for items and services that would 23 have otherwise been covered under part A or B 24 but for the exhaustion of those benefits. 25 ‘‘(2) C ERTAIN COSTS NOT INCLUDED .— 26 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

85 85 ‘‘(A) N - COVERED ITEMS AND SERV ON 1 - ICES .—Expenses incurred for items and serv- 2 ices which are not included (or treated as being 3 included) under part A or B shall not be con- 4 sidered incurred expenses for purposes of deter- 5 mining out-of-pocket cost-sharing under para- 6 graph (1). 7 ‘‘(B) I TEMS AND SERVICES NOT FUR - 8 NISHED ON AN ASSIGNMENT - RELATED BASIS .— 9 10 If an item or service is furnished to an indi- vidual under this title and is not furnished on 11 an assignment-related basis, any additional ex- 12 penses the individual incurs above the amount 13 the individual would have incurred if the item 14 or service was furnished on an assignment-re- 15 lated basis shall not be considered incurred ex- 16 penses for purposes of determining out-of-pock- 17 et cost-sharing under paragraph (1). 18 ‘‘(3) S .—For purposes of 19 OURCE OF PAYMENT paragraph (1), the Secretary shall consider expenses 20 to be incurred by the individual without regard to 21 whether the individual or another person, including 22 a State program or other third-party coverage, has 23 paid for such expenses.’’. 24 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

86 86 (b) E OF P ARTS A AND LIMINATION 1 B D EDUCTIBLES .— 2 (1) P ART A .—Section 1813(b) of the Social Se- 3 curity Act (42 U.S.C. 1395e(b)) is amended by add- 4 ing at the end the following new paragraph: 5 ‘‘(4) For each year (beginning January 1 of the year 6 following the date of enactment of the Medicare for All 7 Act of 2017), the inpatient hospital deductible for the year 8 shall be $0.’’. 9 (2) P .—Section 1833(b) of the Social Se- 10 ART B curity Act (42 U.S.C. 1395l(b)) is amended, in the 11 first sentence— 12 (A) by striking ‘‘and for a subsequent 13 year’’ and inserting ‘‘for each of 2006 through 14 the year that includes the date of enactment of 15 the Medicare for All Act of 2017’’; and 16 (B) by inserting ‘‘, and $0 for each year 17 subsequent year’’ after ‘‘$1)’’. 18 SEC. 1012. REDUCTION IN MEDICARE PART D ANNUAL OUT- 19 OF-POCKET THRESHOLD AND ELIMINATION 20 OF COST-SHARING ABOVE THAT THRESHOLD. 21 (a) R EDUCTION .—Section 1860D–2(b)(4)(B) of the 22 Social Security Act (42 U.S.C. 1395w–102(b)(4)(B)) is 23 amended— 24 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

87 87 (1) in clause (i), by striking ‘‘For purposes’’ 1 2 and inserting ‘‘Subject to clause (iii), for purposes’’; 3 and (2) by adding at the end the following new 4 5 clause: ‘‘(iii) R EDUCTION IN THRESHOLD 6 DURING TRANSITION PERIOD .— 7 ‘‘(I) I .—Subject to 8 N GENERAL subclause (II), for plan years begin- 9 ning on or after January 1 following 10 the date of enactment of the Medicare 11 for All Act of 2017 and before Janu- 12 ary 1 of the year that is 4 years fol- 13 14 lowing such date of enactment, not- withstanding clauses (i) and (ii), the 15 ‘annual out-of-pocket threshold’ speci- 16 fied in this subparagraph is equal to 17 $305. 18 ‘‘(II) A UTHORITY TO EXEMPT 19 - BRAND NAME DRUGS IF GENERIC 20 AVAILABLE 21 .—In applying subclause (I), the Secretary may exempt costs 22 incurred for a covered part D drug 23 that is an applicable drug under sec- 24 tion 1860D–14A(g)(2) if the Sec- 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

88 88 retary determines that a generic 1 2 version of that drug is available.’’. (b) E OF C LIMINATION -S HARING .—Section 3 OST 1860D–2(b)(4)(A) of the Social Security Act (42 U.S.C. 4 1395w–102(b)(4)(A)) is amended— 5 (1) in clause (i)— 6 (A) by redesignating subclauses (I) and 7 (II) as items (aa) and (bb), respectively; 8 (B) by striking ‘‘subparagraph (B), with 9 cost-sharing’’ and inserting the following: ‘‘sub- 10 11 paragraph (B)— ‘‘(I) for plan years 2006 through 12 the plan year ending December 31 fol- 13 lowing the date of enactment of the 14 Medicare for All Act of 2017, with 15 cost-sharing’’; 16 (C) in item (bb), as redesignated by sub- 17 paragraph (A), by striking the period at the 18 end and inserting ‘‘; and’’; and 19 (D) by adding at the end the following new 20 subclause: 21 ‘‘(II) for the plan year beginning 22 January 1 following the date of enact- 23 ment of the Medicare for All Act of 24 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

89 89 2017 and the two subsequent plan 1 2 years, without any cost-sharing.’’; and 3 (2) in clause (ii)— (A) by striking ‘‘clause (i)(I)’’ and insert- 4 5 ing ‘‘clause (i)(I)(aa)’’; and 6 (B) by adding at the end the following new sentence: ‘‘The Secretary shall continue to cal- 7 culate the dollar amounts specified in clause 8 (i)(I)(aa), including with the adjustment under 9 this clause, after plan year 2018 for purposes 10 of 1860D–14(a)(1)(D)(iii).’’. 11 (c) C ONFORMING A MENDMENTS TO L OW -I NCOME 12 S 13 .—Section 1860D–14(a) of the Social Security UBSIDY Act (42 U.S.C. 1395w–114(a)) is amended— 14 (1) in paragraph (1)— 15 (A) in subparagraph (D)(iii), by striking 16 ‘‘1860D–2(b)(4)(A)(i)(I)’’ and inserting 17 ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’; and 18 (B) in subparagraph (E)— 19 (i) in the heading, by inserting 20 ‘‘ PRIOR TO THE ELIMINATION OF SUCH 21 COST SHARING FOR ALL INDIVIDUALS ’’ 22 - after ‘‘ THRESHOLD ’’; and 23 (ii) by striking ‘‘The elimination’’ and 24 inserting ‘‘For plan years 2006 through 25 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

90 90 the plan year ending December 31 fol- 1 2 lowing the date of enactment of the Medi- 3 care for All Act of 2017, the elimination’’; 4 and (2) in paragraph (2)(E)— 5 (A) in the heading, by inserting ‘‘ PRIOR TO 6 THE ELIMINATION OF SUCH COST - SHARING FOR 7 ALL INDIVIDUALS THRESHOLD ’’; 8 ’’ after ‘‘ (B) by striking ‘‘Subject to’’ and inserting 9 ‘‘For plan years 2006 through the plan year 10 ending December 31 following the date of en- 11 actment of the Medicare for All Act of 2017, 12 subject to’’; and 13 (C) by striking ‘‘1860D–2(b)(4)(A)(i)(I)’’ 14 and inserting ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’. 15 SEC. 1013. COVERAGE OF DENTAL AND VISION SERVICES 16 AND HEARING AIDS AND EXAMINATIONS 17 UNDER MEDICARE PART B. 18 (a) D ENTAL S ERVICES .— 19 (1) R EMOVAL OF EXCLUSION FROM COV - 20 ERAGE 21 .—Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended by striking para- 22 graph (12). 23 (2) C OVERAGE .— 24 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

91 91 (A) I .—Section 1861(s)(2) of 1 N GENERAL the Social Security Act (42 U.S.C. 1395x(s)(2)) 2 is amended— 3 (i) in subparagraph (FF), by striking 4 ‘‘and’’ at the end; 5 (ii) in subparagraph (GG), by insert- 6 ing ‘‘and’’ at the end; and 7 (iii) by adding at the end the fol- 8 lowing new subparagraph: 9 ‘‘(HH) dental services;’’. 10 (B) P .—Section 1833(a)(1) of the 11 AYMENT Social Security Act (42 U.S.C. 1395l(a)(1)) is 12 amended— 13 (i) by striking ‘‘and’’ before ‘‘(BB)’’; 14 and 15 (ii) by inserting before the semicolon 16 at the end the following: ‘‘, and (CC) with 17 respect to dental services described in sec- 18 tion 1861(s)(2)(HH), the amount paid 19 shall be an amount equal to 80 percent of 20 the lesser of the actual charge for the serv- 21 ices or the amount determined under the 22 fee schedule established under section 23 1848(b).’’. 24 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

92 92 (C) E .—The amendments 1 FFECTIVE DATE 2 made by this subsection shall apply to items 3 and services furnished on or after January 1 following the date of the enactment of this Act. 4 (b) V ISION S ERVICES .— 5 (1) I .—Section 1861(s)(2) of the 6 N GENERAL Social Security Act (42 U.S.C. 1395x(s)(2)), as 7 amended by subsection (a), is amended— 8 (A) in subparagraph (GG), by striking 9 ‘‘and’’ at the end; 10 11 (B) in subparagraph (HH), by inserting ‘‘and’’ at the end; and 12 (C) by adding at the end the following new 13 subparagraph: 14 ‘‘(II) vision services;’’. 15 (2) P AYMENT .—Section 1833(a)(1) of the So- 16 cial Security Act (42 U.S.C. 1395l(a)(1)), as amend- 17 ed by subsection (a), is amended— 18 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 19 (B) by inserting before the semicolon at 20 the end the following: ‘‘, and (DD) with respect 21 to vision services described in section 22 1861(s)(2)(II), the amount paid shall be an 23 amount equal to 80 percent of the lesser of the 24 actual charge for the services or the amount de- 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

93 93 termined under the fee schedule established 1 2 under section 1848(b).’’. (3) E FFECTIVE DATE .—The amendments made 3 by this subsection shall apply to items and services 4 furnished on or after January 1 following the date 5 of the enactment of this Act. 6 (c) H EARING A IDS AND E XAMINATIONS T HERE - 7 FOR .— 8 (1) I N GENERAL .—Section 1862(a)(7) of the 9 Social Security Act (42 U.S.C. 1395y(a)(7)) is 10 amended by striking ‘‘hearing aids or examinations 11 therefor,’’. 12 (2) E FFECTIVE DATE .—The amendment made 13 by this subsection shall apply to items and services 14 furnished on or after January 1 following the date 15 of the enactment of this Act. 16 SEC. 1014. ELIMINATING THE 24-MONTH WAITING PERIOD 17 FOR MEDICARE COVERAGE FOR INDIVID- 18 UALS WITH DISABILITIES. 19 (a) I G ENERAL .—Section 226(b) of the Social Secu- 20 N rity Act (42 U.S.C. 426(b)) is amended— 21 (1) in paragraph (2)(A), by striking ‘‘, and has 22 for 24 calendar months been entitled to,’’; 23 (2) in paragraph (2)(B), by striking ‘‘, and has 24 been for not less than 24 months,’’; 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

94 94 (3) in paragraph (2)(C)(ii), by striking ‘‘, in- 1 2 cluding the requirement that he has been entitled to the specified benefits for 24 months,’’; 3 4 (4) in the first sentence, by striking ‘‘for each month beginning with the later of (I) July 1973 or 5 (II) the twenty-fifth month of his entitlement or sta- 6 tus as a qualified railroad retirement beneficiary de- 7 scribed in paragraph (2), and’’ and inserting ‘‘for 8 each month for which the individual meets the re- 9 quirements of paragraph (2), beginning with the 10 month following the month in which the individual 11 meets the requirements of such paragraph, and’’; 12 and 13 (5) in the second sentence, by striking ‘‘the 14 ‘twenty-fifth month of his entitlement’ ’’ and all that 15 follows through ‘‘paragraph (2)(C) and’’. 16 (b) C ONFORMING A MENDMENTS .— 17 (1) S ECTION 226 .—Section 226 of the Social 18 Security Act (42 U.S.C. 426) is amended by— 19 (A) striking subsections (e)(1)(B), (f), and 20 (h); and 21 (B) redesignating subsections (g) and (i) 22 as subsections (f) and (g), respectively. 23 (2) M EDICARE DESCRIPTION .—Section 1811(2) 24 of the Social Security Act (42 U.S.C. 1395c(2)) is 25 S 1804 IS • VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

95 95 amended by striking ‘‘have been entitled for not less 1 2 than 24 months’’ and inserting ‘‘are entitled’’. (3) M EDICARE COVERAGE 3 .—Section 1837(g)(1) of the Social Security Act (42 U.S.C. 1395p(g)(1)) 4 is amended by striking ‘‘25th month of’’ and insert- 5 ing ‘‘month following the first month of’’. 6 (4) R .—Section 7 AILROAD RETIREMENT SYSTEM 7(d)(2)(ii) of the Railroad Retirement Act of 1974 8 (45 U.S.C. 231f(d)(2)(ii)) is amended— 9 (A) by striking ‘‘has been entitled to an 10 annuity’’ and inserting ‘‘is entitled to an annu- 11 ity’’; 12 13 (B) by striking ‘‘, for not less than 24 months’’; and 14 (C) by striking ‘‘could have been entitled 15 for 24 calendar months, and’’. 16 (c) E .—The amendments made by FFECTIVE D ATE 17 this section shall apply to insurance benefits under title 18 XVIII of the Social Security Act with respect to items and 19 services furnished in months beginning after December 1 20 following the date of enactment of this Act, and before 21 January 1 of the year that is 4 years after such date of 22 enactment. 23 • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

96 96 1 TITLE XI—MISCELLANEOUS SEC. 1101. DEFINITIONS. 2 In this Act— 3 (1) the term ‘‘Secretary’’ means the Secretary 4 of Health and Human Services; 5 6 (2) the term ‘‘State’’ means a State, the Dis- 7 trict of Columbia, or a territory of the United States; and 8 (3) the term ‘‘United States’’ shall include the 9 States, the District of Columbia, and the territories 10 of the United States. 11 Æ • S 1804 IS VerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6301 E:\BILLS\S1804.IS S1804 ethrower on DSK3G9T082PROD with BILLS

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