,i #aaeth ,,congress #ast ,session ,h4 ,r4 #djid ,,in ,,the ,,house ,,of ,,representatives ,october #bc1 #bjag,mr4 ,higgins of ,new ,york 7for himself1 ,mr4 ,larson of ,connecticut1 ,mr4 ,courtney1 ,mr4 ,scott of ,virginia1 ,mr4 ,o',rourke1 and ,mr4 ,polis7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to establish a public health plan4 #a4 ,short title ,this ,act may be cited as the ,medicare-,x ,choice ,act of #bjag4 #b4 ,establishment and administration of a public health plan ,the ,social ,security ,act is amended by adding at the end the following new title3 ,,xxii ,medicare ,exchange ,health ,plan #bbja4 ,establishment 7a7 ,establishment of plan 7#a7 ,in general ,the ,secretary shall establish a coordinated and low-cost health plan1 to be known as the ,medicare ,exchange health plan 7referred to in this section as the health plan7 to provide access to quality health care for enrollees4 7#b7 ,timeframe 7,a7 ,individual market availability 7i7 ,in general ,in accordance with clause 7ii71 the ,secretary shall make the health plan available in the individual market1 in certain rating areas1 for plan year #bjbj and each subsequent plan year1 and increase the availability such that the plan is available in the individual market to all residents of all rating areas in the ,united ,states for plan year #bjbc and each subsequent plan year4 7ii7 ,priority areas ,in determining in which rating areas the ,secretary initially will make the health plan available1 the ,secretary shall give priority to rating areas in which-- 7,i7 not more than #a health insurance issuer offers plans on the applicable ,state or ,federal ,american ,health ,benefit ,exchange 7referred to in this title as the ,exchange72 or 7,,ii7 there is a shortage of health providers or lack of competition that results in a high cost of health care services1 including health professional shortage areas and rural areas4 7,b7 ,small group market ,the ,secretary shall make the health plan available in the small group market in all rating areas for plan year #bjbd4 7b7 ,establishment of funds 7#a7 ,plan ,reserve ,fund 7,a7 ,in general ,there is established in the ,treasury of the ,united ,states a ,plan ,reserve ,fund1 to be administered by the ,secretary of ,health and ,human ,services1 for purposes of establishing the ,medicare ,exchange health plan and administering such plan1 consisting of amounts appropriated to such fund4 7,b7 ,appropriation ,there is appropriated #a1jjj1jjj1jjj1 out of monies in the ,treasury not otherwise obligated1 to the ,plan ,reserve ,fund for fiscal year #bjah4 7#b7 ,data and ,technology ,fund ,there is established in the ,treasury of the ,united ,states a ,data and ,technology ,fund1 to be administered by the ,secretary of ,health and ,human ,services1 acting through the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services1 for purposes of updating technology and performing data collection under section #bbje in order to establish appropriate premiums for all geographic regions of the ,united ,states4 ,there are authorized to be appropriated to the ,data and ,technology ,fund such sums as may be necessary for fiscal year #bjah4 7c7 ,rulemaking ,the ,secretary may promulgate such regulations as may be necessary to carry out this title4 #bbjb4 ,availability of plan 7a7 ,eligibility ,an individual shall be eligible to enroll in the health plan if such individual1 for the entire period for which enrollment is sought-- 7#a7 is a qualified individual within the meaning of section #acab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb72 and 7#b7 is not eligible for benefits under the ,medicare program under title ,,xviii4 7b7 ,exchanges ,in accordance with the timeframe under section #bbja7;a77#b71 the health plan shall be made available through the ,american ,health ,benefit ,exchanges described in sections #acaa and #acba of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca1 #ahjda71 including the ,small ,business ,health ,options ,program ,exchange4 #bbjc4 ,plan requirements 7a7 ,general requirements ,the health plan shall comply with all requirements of subtitle ,d of title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba et seq47 and title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 applicable to qualified health plans1 and such health plan shall be a qualified health plan1 including for purposes of the ,internal ,revenue ,code of #aihf4 7b7 ,levels of coverage ,the ,secretary-- 7#a7 shall make available a silver level and gold level version of the plan1 in accordance with section #acja7;a77#a77;,c77ii72 and 7#b7 may make available no more than #b versions of the plan for each of the #d levels of coverage described in subparagraphs 7,a7 through 7,d7 of section #acjb7;d77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;d77#a774 #bbjd4 ,administrative contracting 7a7 ,in general ,the ,secretary may enter into contracts for the purpose of performing administrative functions 7including functions described in subsection 7a77#d7 of section #ahgd;,a7 with respect to the health plan in the same manner as the ,secretary may enter into contracts under subsection 7a77#a7 of such section4 ,the ,secretary shall have the same authority with respect to the public health insurance option as the ,secretary has under such subsection 7a77#a7 and subsection 7b7 of section #ahgd;,a with respect to title ,,xviii4 7b7 ,transfer of insurance risk ,any contract under subsection 7a7 shall not involve the transfer of insurance risk from the ,secretary to the entity entering into such contract with the ,secretary1 except in the case of an alternative payment model under section #bbji7;h74 #bbje4 ,data collection ,subject to all applicable privacy requirements1 including the requirements under the regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 the ,secretary may collect data from ,state insurance commissioners and other relevant entities to establish rates for premiums and for other purposes including to improve quality1 and reduce racial1 ethnic1 and other disparities1 with respect to the health plan4 #bbjf4 ,premiums2 risk pools2 reinsurance 7a7 ,premium amounts ,the ,secretary shall establish premiums for the health plan that cover the full actuarial cost of offering such plan1 including the administrative costs of offering such plan4 ,such premiums shall vary geographically and between the small group market and the individual market in accordance with differences in the cost of providing such coverage4 ,if1 for any plan year1 the amount collected in premiums exceeds the amount required for health care benefits and administrative costs in that plan year1 such excess amounts shall remain available to the ,secretary to administer the health plan and finance beneficiary costs in subsequent years4 7b7 ,risk pool ,all enrollees in the health plan within a ,state shall be members of a single risk pool1 except that the ,secretary may establish separate risk pools for the individual market and small group market if the ,state has not exercised its authority under section #acab7;c77#c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;c77#c774 7c7 ,reinsurance ,notwithstanding subsection 7b71 the ,secretary may establish a mechanism to pool the costs of the highest-cost patients on a nationwide basis to the extent such costs are not already pooled pursuant to section #acdc of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfc74 #bbjg4 ,reimbursement rates 7a7 ,medicare rates 7#a7 ,in general ,except as provided in paragraph 7#b7 and subsections 7b7 and 7c7 and subject to subsection 7d71 the ,secretary shall reimburse health care providers furnishing items and services under the health plan at rates determined for equivalent items and services under the original ,medicare fee-for-service program under parts ,a and ,b of title ,,xviii4 7#b7 ,authority to increase payments rates in rural areas ,if the ,secretary determines appropriate1 the ,secretary may increase the reimbursements rates described in paragraph 7#a7 by up to #be percent for items and services furnished in rural areas 7as defined in section #ahhf7;d77#b77;,d774 7b7 ,prescription drugs ,subject to subsection 7d71 payment rates for prescription drugs shall be at a rate negotiated by the ,secretary4 ,such negotiations may be in conjunction with negotiations for covered part ,d drugs under part ,d of title ,,xviii4 7c7 ,additional items and services ,subject to subsection 7d71 the ,secretary shall establish reimbursement rates for any items and services provided under the health plan that are not items and services provided under the original ,medicare fee-for-service program under parts ,a and ,b of title ,,xviii4 7d7 ,innovative payment methods ,the ,secretary may utilize innovative payment methods1 including value-based payment arrangements1 in making payments for items and services 7including prescription drugs7 furnished under the health plan4 #bbjh4 ,participating providers 7a7 ,in general ,a health care provider that is enrolled under the ,medicare program under section #ahff7;j7 or is a participating provider under a ,state ,medicaid plan under title ,,xix on the date of enactment of this ,act shall be a participating provider under the health plan4 7b7 ,additional providers ,the ,secretary shall establish a process to allow health care providers not described in subsection 7a7 to become a participating provider under the health plan4 7c7 ,opt-,out ,the ,secretary shall establish a process by which a health care provider that is a participating provider under the health plan pursuant to subsection 7a7 or 7b7 may opt-out of being such a participating provider4 7d7 ,requirement ,to participate in order ,to be enrolled under ,medicare ,beginning ,january #a1 #bjai1 a health care provider may not be enrolled under the ,medicare program under section #ahff7;j7 unless the provider is also a participating provider under the health plan4 #bbji4 ,delivery system reform for an enhanced health plan 7a7 ,in general ,for plan years beginning with plan year #bjbj1 the ,secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the health plan4 ,the payment mechanisms and policies under this section may include patient-centered medical home and other care management payments1 accountable care organizations1 value-based purchasing1 bundling of services1 differential payment rates1 performance or utilization based payments1 telehealth1 remote patient monitoring1 partial capitation1 and direct contracting with providers4 7b7 ,requirements for innovative payments ,the ,secretary shall design and implement the payment mechanisms and policies under this section in a manner that-- 7#a7 seeks to-- 7,a7 improve health outcomes2 7,b7 reduce health disparities 7including racial1 ethnic1 and other disparities72 7,c7 provide efficient and affordable care2 7,d7 address geographic variation in the provision of health services2 or 7,e7 prevent or manage chronic illness2 and 7#b7 promotes care that is integrated1 patient-centered1 quality1 and efficient4 7c7 ,encouraging the use of high-,value services ,to the extent allowed by the benefit standards applied to all health benefits plans participating in the ,exchanges 7as described in section #bbjb7;b771 the health plan may modify cost-sharing and payment rates to encourage the use of services that promote health and value4 7d7 ,promotion of delivery system reform ,the ,secretary shall monitor and evaluate the progress of payment and delivery system reforms under this section and shall seek to implement such reforms subject to the following3 7#a7 ,to the extent that the ,secretary finds a payment and delivery system reform successful in improving quality and reducing costs1 the ,secretary shall implement such reform on as large a geographic scale as practical and economical4 7#b7 ,the ,secretary may delay the implementation of such a reform in geographic areas in which such implementation would place the public health insurance option at a competitive disadvantage4 7#c7 ,the ,secretary may prioritize implementation of such a reform in high-cost geographic areas or otherwise in order to reduce total program costs or to promote high-value care4 7e7 ,non-,uniformity permitted ,nothing in this section shall prevent the ,secretary from varying payments based on different payment structure models 7such as accountable care organizations and medical homes7 under the health plan for different geographic areas4 7f7 ,integration with ,social ,services ,the ,secretary shall establish processes and1 when appropriate1 collaborate with other agencies to integrate medical care under the health plan with food1 housing1 transportation1 and income assistance if the ,secretary determines that such integration is expected to-- 7#a7 reduce spending without reducing the quality of patient care2 or 7#b7 improve the quality of patient care without increasing spending4 7g7 ,telehealth ,the ,secretary shall ensure the integration of telehealth tools that increase patient access to medical care1 particularly in remote or underserved areas1 if the ,secretary determines that such integration is expected to-- 7#a7 reduce spending without reducing the quality of patient care2 or 7#b7 improve the quality of patient care without increasing spending4 7h7 ,alternative payment model 7#a7 ,in general ,the ,secretary shall evaluate the possibility of providing incentives1 and1 if appropriate1 apply incentives1 for enrollees in the health plan who receive services from providers who are participating in an alternative payment model 7as defined in section #ahcc7z77#c77;,c774 7#b7 ,authority to use apms in use under traditional ,medicare ,nothing in this section shall preclude the ,secretary from using alternative payment models 7as so defined7 under this title that are in use under title ,,xviii4 #bbaj4 ,no effect on ,medicare benefits or ,medicare ,trust ,funds ,nothing in this title shall-- 7#a7 affect the benefits available under title ,,xviii2 or 7#b7 impact the ,federal ,hospital ,insurance ,trust ,fund under section #ahag or the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda 7including the ,medicare ,prescription ,drug ,account within such ,trust ,fund74 4 #c4 ,authority to negotiate fair prices for ,medicare prescription drugs 7a7 ,in general ,section #ahfj;,d-#aa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aaa7 is amended by striking subsection 7i74 7b7 ,effective date ,the amendment made by this section shall take effect on the date of the enactment of this ,act4