,,ii #aahth ,,congress #b;d ,session ,s4 #efcc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ai 7legislative day1 ,december #af71 #bjbd,mr4 ,scott of ,florida introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to establish ,medicare flex fund accounts and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,flex ,fund ,accounts and ,flexible ,benefits ,act of #bjbd4 #b4 ,medicare flex fund accounts 7a7 ,in general ,part ,,viii of subchapter ,f of chapter #a of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ecj;,a4 ,medicare flex fund accounts 7a7 ,in general ,a ,medicare flex fund account shall be exempt from taxation under this subtitle4 ,notwithstanding the preceding sentence1 the ,medicare flex fund account shall be subject to the taxes imposed by section #eaa 7relating to imposition of tax on unrelated business income of charitable organizations74 7b7 ,medicare flex fund account ,for purposes of this section3 7#a7 ,in general ,the term ,medicare flex fund account means a trust created or organized in the ,united ,states as a ,medicare flex fund account exclusively for the purpose of paying the qualified medical expenses of the account beneficiary1 but only if the written governing instrument creating the trust meets the following requirements3 7,a7 ,except in the case of a rollover contribution described in subsection 7c77#b71 section #bbj7;f77#e71 or section #bbc7;f77#e7 or a contribution described in section #ach;,a7#a71 no contribution will be accepted-- 7i7 unless it is in cash1 7ii7 unless the account beneficiary is an eligible individual for the taxable year in which the contribution is made1 and 7iii7 to the extent such contribution1 when added to previous contributions to the trust for the calendar year1 exceeds the sum of-- 7,i7 the dollar amount in effect under section #bbc7;b77#b77;,a71 plus 7,,ii7 in the case of an individual who has attained age #ee before the close of the calendar year1 the dollar amount in effect under section #bbc7;b77#c77;,b74 7,b7 ,the trustee is a bank 7as defined in section #djh7n771 an insurance company 7as defined in section #haf71 or another person who demonstrates to the satisfaction of the ,secretary that the manner in which such person will administer the trust will be consistent with the requirements of this section4 7,c7 ,no part of the trust assets will be invested in life insurance contracts4 7,d7 ,the assets of the trust will not be commingled with other property except in a common trust fund or common investment fund4 7,e7 ,the interest of an individual in the balance in his account is nonforfeitable4 7#b7 ,qualified medical expenses 7,a7 ,in general ,except as otherwise provided in this paragraph1 the term qualified medical expenses shall have the meaning given such term under section #bbc7;d77#b7 7determined without regard to subparagraph 7,b7 thereof74 7,b7 ,exception for ,medigap premiums ,such term shall not include any premium for a medicare supplemental policy under section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess74 7#c7 ,eligible individual ,the term eligible individual means1 with respect to any taxable year1 any individual entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled for benefits under part ,b or ,d of such title1 including individuals covered under a ,medicare ,advantage plan1 on the last day of such taxable year4 7#d7 ,certain rules to apply ,rules similar to the following rules shall apply for purposes of this section3 7,a7 ,section #bai7;f77#c7 7relating to time when contributions made74 7,b7 ,section #djh7;g7 7relating to community property laws74 7,c7 ,section #djh7;h7 7relating to custodial accounts74 7,d7 ,paragraphs 7#b7 and 7#d7 of section #djh7;e74 7c7 ,tax treatment of distributions 7#a7 ,in general ,any amount distributed out of a ,medicare flex fund account shall be subject to tax in the same extent and in the same manner as distributions from a health savings account under section #bbc7;f71 except that-- 7,a7 amounts described in paragraph 7#b7 thereof shall be includible in gross income in the manner provided under section #gb 7after taking into account rules similar to the rules of section #djh7;d77#b771 7,b7 for purposes of paragraph 7#c77;,b7 thereof a rollover contribution described in paragraph 7#b7 shall not be considered an excess contribution1 and 7,c7 paragraph 7#d7 thereof shall not apply4 7#b7 ,rollover contribution ,an amount is described in this paragraph as a rollover contribution if it meets the requirements of subparagraphs 7,a7 and 7,b74 7,a7 ,in general ,an amount distributed from a ,medicare flex fund account shall not be includible in gross income if such amount is paid or distributed from a ,medicare flex fund account to the account beneficiary to the extent the amount received is paid into a ,medicare flex fund account for the benefit of such beneficiary not later than the #fjth day after the day on which the beneficiary receives the payment or distribution4 7,b7 ,limitation ,this paragraph shall not apply to any amount described in subparagraph 7,a7 received by an individual from a ,medicare flex fund account if1 at any time during the #a-year period ending on the day of such receipt1 such individual received any other amount described in subparagraph 7,a7 from a ,medicare flex fund account which was not includible in the individual's gross income because of the application of this paragraph4 7d7 ,reports ,the ,secretary may require the trustee of a ,medicare flex fund account to make such reports regarding such account to the ,secretary and to the account beneficiary with respect to contributions1 distributions1 the return of excess contributions1 and such other matters as the ,secretary determines appropriate4 ,the reports required by this subsection shall be filed at such time and in such manner and furnished to such individuals at such time and in such manner as may be required by the ,secretary4 4 7b7 ,government contributions ,part ,,iii of subchapter ,b of chapter #a of the ,internal ,revenue ,code of #aihf is amended by inserting after section #ach the following new section3 #ach;,a4 ,certain contributions to ,medicare flex fund accounts ,gross income shall not include any payment to the ,medicare flex fund account 7as defined in section #ecj;,a7 of an individual by-- 7#a7 the ,secretary of ,health and ,human ,services1 or 7#b7 the administrator of a ,medicare ,advantage plan4 4 7c7 ,contributions from other savings vehicles 7#a7 ,health savings accounts ,section #bbc7;f77#e7 of the ,internal ,revenue ,code of #aihf is amended by inserting or a ,medicare flex fund account 7as defined in section #ecj;,a7 after paid into a health savings account4 7#b7 ,archer ,m,s,as ,section #bbj7;f77#e7 of such ,code is amended by striking or a health savings account 7as defined in section #bbc7;d77 and inserting 1 a health savings account 7as defined in section #bbc7;d771 or a ,medicare flex fund account 7as defined in section #ecj;,a74 7#c7 ,,ira distributions ,section #djh7;d7 of such ,code is amended by adding at the end the following new paragraph3 7#aj7 ,distribution for ,medicare flex fund account funding 7,a7 ,in general ,in the case of an individual who is an eligible individual 7as defined in section #ecj;,a7b77#c77 and who elects the application of this paragraph for a taxable year1 gross income of the individual for the taxable year does not include a qualified ,medicare ,,ffa funding distribution to the extent such distribution is otherwise includible in gross income4 7,b7 ,qualified ,medicare ,,ffa funding distribution ,for purposes of this paragraph1 the term qualified ,medicare ,,ffa funding distribution means a distribution from an individual retirement plan 7other than a plan described in subsection 7k7 or 7p77 of the employee to the extent that such distribution is contributed to the ,medicare flex fund account 7as defined in section #ecj;,a7 of the individual in a direct trustee-to-trustee transfer4 7,c7 ,limitation 7i7 ,in general ,the amount excluded from gross income by subparagraph 7,a7 shall not exceed the annual limitation under section #ecj;,a7b77#a77;,a77iii74 7ii7 ,one-time transfer ,an individual may make an election under subparagraph 7,a7 only for one qualified ,medicare ,,ffa funding distribution during the lifetime of the individual4 ,such an election1 once made1 shall be irrevocable4 7,d7 ,application of section #gb ,rules similar to the rules of paragraph 7#i77;,e7 shall apply for purposes of this paragraph4 4 7d7 ,excess contributions 7#a7 ,in general ,section #digc7;a7 of such ,code is amended by striking or at the end of paragraph 7#e71 by inserting or at the end of paragraph 7#f71 and by inserting after paragraph 7#f7 the following new paragraph3 7#g7 a ,medicare flex fund account 7within the meaning of section #ecj;,a71 4 7#b7 ,excess contributions ,section #digc of such ,code is amended by adding at the end the following new subsection3 7i7 ,excess contributions to ,medicare flex fund accounts 7#a7 ,in general ,in the case of a ,medicare flex fund account1 the term excess contributions means the sum of-- 7,a7 the amount by which the amount contributed for the taxable year to such accounts exceeds the contribution limitation determined under section #ecj;,a7b77#a77;,a77iii71 and 7,b7 the amount determined under this subsection for the preceding taxable year1 reduced by the sum of-- 7i7 the distributions out of the accounts for the taxable year which were not used exclusively to pay the qualified medical expenses 7as determined under section #bbc7;f77#b77 of the account beneficiary1 7ii7 the excess of-- 7,i7 the distributions out of the accounts for such taxable year which were used exclusively to pay the qualified medical expenses 7as determined under section #bbc7;f77#a77 of the account beneficiary1 over 7,,ii7 the amount which would be taxable by reason of section #ecj;,a7c77#a77;,a7 if such amounts were described in section #bbc7;f77#b7 with respect to such distributions1 and 7iii7 the excess 7if any7 of the maximum amount which may be contributed to the accounts for the taxable year over the amount contributed to the accounts for the taxable year4 7#b7 ,special rules ,for purposes of paragraph 7#a71 the following contributions shall not be taken into account3 7,a7 ,any contribution which is distributed out of the ,medicare flex fund account in a distribution if-- 7i7 such distribution is received by the individual on or before the last day prescribed by law 7including extensions of time7 for filing such individual's return for such taxable year1 and 7ii7 such distribution is accompanied by the amount of net income attributable to such excess contribution4 7,b7 ,any rollover contribution described in section #bbj7;f77#e71 #bbc7;f77#e71 or #ecj;,a7c77#b74 4 7e7 ,application of prohibited transaction rules 7#a7 ,in general ,section #dige7;e77#a7 of the ,internal ,revenue ,code of #aihf is amended by striking or at the end of subparagraph 7,f71 by redesignating subparagraph 7,g7 as subparagraph 7,h71 and by inserting after subparagraph 7,f7 the following new subparagraph3 7,g7 a ,medicare flex fund account described in section #ecj;,a1 or 4 7#b7 ,special rule ,section #dige7;c7 of such ,code is amended by adding at the end the following new paragraph3 7#h7 ,special rule for ,medicare flex fund accounts ,an individual for whose benefit a ,medicare flex fund account 7within the meaning of section #ecj;,a7 is established shall be exempt from the tax imposed by this section with respect to any transaction concerning such account 7which would otherwise be taxable under this section7 if1 with respect to such transaction1 the account ceases to be a ,medicare flex fund account by reason of the application of section #ecj;,a7b77#d77;,d7 to such account4 4 7f7 ,other conforming amendments 7#a7 ,section #ce7;g77#c7 of the ,internal ,revenue ,code of #aihf is amended by striking or from a health savings account 7as defined in section #bbc7;d77 and inserting 1 from a health savings account 7as defined in section #bbc7;d771 or from a ,medicare flex fund account 7as defined in section #ecj;,a7b774 7#b7 ,section #hdh7;e77#a77;,b7 of such ,code is amended by striking and at the end of clause 7iv71 by striking the period at the end of clause 7v7 and inserting 1 and1 and by adding at the end the following new clause3 7vi7 any contract which is a ,medicare flex fund account 7as defined in section #ecj;,a7b774 4 7#c7 ,section #hgg;,a7e77#b7 of such ,code is amended by inserting a ,medicare flex fund account 7as defined in section #ecj;,a7b771 after a health savings account 7as defined in section #bbc74 7#d7 ,section #ffic7;a77#b7 of such ,code is amended by striking and at the end of subparagraph 7,e71 by striking the period at the end of subparagraph 7,f7 and inserting 1 and1 and by inserting after subparagraph 7,g7 the following new subparagraph3 7,g7 section #ecj;,a7d7 7relating to ,medicare flex fund accounts74 4 7#e7 ,section #ajbg7;g77#d7 of the ,consumer ,financial ,protection ,act of #bjaj 7#ab ,u4,s4,c4 #eeag7;g77#d77 is amended by striking or #ecj and inserting #ecj1 or #ecj;,a4 7g7 ,clerical amendments 7#a7 ,the table of sections for part ,,viii of subchapter ,f of chapter #a of such ,code is amended by adding at the end the following new item3 ,sec4 #ecj;,a4 ,medicare flex fund accounts4 4 7#b7 ,the table of sections for part ,,iii of subchapter ,b of chapter #a of such ,code is amended by inserting after the item relating to section #ach the following new item3 ,sec4 #ach;,a4 ,certain contributions to ,medicare flex fund accounts4 4 7h7 ,effective date ,the amendments made by this section shall apply to taxable years beginning on or after ,january #a1 #bjbf4 #c4 ,medicare flex fund accounts under ,medicare ,advantage 7a7 ,requirement for ,medicare flex fund accounts 7#a7 ,,ma plan requirement to establish ,medicare flex fund account on behalf of an enrollee ,section #ahea of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7 is amended by adding at the end the following new subsection3 7k7 ,,ma plan requirement to establish ,medicare ,,ffa on behalf of an enrollee 7#a7 ,in general ,notwithstanding any other provision of law and subject to paragraph 7#d71 any ,,ma plan offered under this part 7other than an ,,msa plan7 shall establish a ,medicare flex fund account 7as defined in section #ecj;,a of the ,internal ,revenue ,code of #aihf and referred to in this subsection as a ,medicare ,,ffa7 on behalf of an enrollee in the plan4 7#b7 ,rebates ,in the case of a plan that is required to provide a monthly rebate to an enrollee under section #ahed7;b77#a77;,c71 the ,,ma plan may provide part or all of such rebate through depositing money into the enrollee's ,medicare ,,ffa4 7#c7 ,incentive payments 7,a7 ,in general ,notwithstanding section #ahea7;h77#d77;,a7 or any other provision of this part and subject to subparagraph 7,b71 ,,ma plans may deposit money into an enrollee's ,medicare ,,ffa as a result of the enrollee completing educational or training programs1 programs for chronic disease management1 programs that promote wellness and health1 or other programs as determined by the ,secretary4 7,b7 ,rules ,in making the deposits described in subparagraph 7,a71 the following rules shall apply3 7i7 ,no payment shall be made to an ,,ma organization under this part as a result of such deposits4 7ii7 ,in submitting bid information required under section #ahed1 the ,,ma organization offering the ,,ma plan shall not take into account such deposits4 7iii7 ,the ,,ma plan may not charge a premium or otherwise increase a premium under section #ahed as a result of such deposits4 7#d7 ,initial payment floor 7,a7 ,in general ,subject to subparagraph 7,b71 for the first #c years a ,medicare ,,ffa is established pursuant to paragraph 7#a7 with respect to an enrollee1 each ,,ma plan shall deposit no less than #djj each year into the enrollee's ,medicare ,,ffa4 7,b7 ,rebates and incentive payments ,the rebates described in paragraph 7#b7 and incentive payments described in paragraph 7#c7 shall count towards the required minimum deposit amount described in subparagraph 7,a74 7#e7 ,prohibition on spending ,medicare ,f,f,as on ,medigap premiums ,an enrollee may not spend any amount in a ,medicare ,,ffa on a premium for a medicare supplemental policy under section #ahhb4 7#f7 ,waiver of ,medicare ,,ffa requirement for certain plans 7,a7 ,in general ,the ,secretary may waive the requirement described in paragraph 7#a7 for-- 7i7 a specialized ,,ma plan for special needs individuals2 7ii7 an employer sponsored ,,ma plan described in section #aheg7;i77#b72 and 7iii7 an ,,ma plan in which an enrollee in such plan already has a ,medicare ,,ffa if the study required by section #c7;b7 of the ,medicare ,flex ,fund ,accounts and ,flexible ,benefits ,act of #bjbd concludes that it is feasible to permit ,medicare beneficiaries enrolled in an ,,ma plan to select their preferred ,medicare ,,ffa band under the plan4 7,b7 ,enrollee choice ,notwithstanding subparagraph 7,a71 an ,,ma plan described in such subparagraph shall establish a ,medicare ,,ffa if an enrollee in such plan elects to have a ,medicare ,,ffa established on behalf of the enrollee4 7#g7 ,education ,the ,secretary shall include information regarding ,medicare ,f,f,as in relevant education materials1 including-- 7,a7 the notice required under section #ahjd7;a7 7commonly referred to as the ,medicare ,you handbook72 7,b7 any site-of-service transparency information made available to the public under section #ahcd7t72 7,c7 any information provided to individuals regarding coverage options under section #ahea7;d72 and 7,d7 in consultation with the ,secretary of the ,treasury1 additional general beneficiary educational material regarding this title and this part4 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to plan years beginning on or after ,january #a1 #bjbf4 7b7 ,,hhs study and report on beneficiaries choosing their preferred bank for ,medicare ,f,f,as 7#a7 ,study ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct a study on the feasibility of permitting ,medicare beneficiaries enrolled in a ,medicare ,advantage plan under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 to select their preferred ,medicare flex fund account 7as described in section #ahea7k7 of such ,act 7#db ,u4,s4,c4 #aciew-#ba7k777 bank under the plan4 ,such study shall include an analysis of any administrative actions that the ,secretary may take in order to permit such beneficiaries to make such selection4 7#b7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with-- 7,a7 a description of any administrative actions described in paragraph 7#a7 that the ,secretary has taken1 or plans to take2 and 7,b7 recommendations for such legislation as the ,secretary determines appropriate4 7c7 ,,hhs study and report on beneficiaries choosing their preferred supplemental health benefits 7#a7 ,study ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary71 shall conduct a study on the feasibility of permitting ,medicare beneficiaries enrolled in a ,medicare ,advantage plan under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 to select their preferred supplemental health benefits under such plan and have the savings from unused benefits deposited into the ,medicare flex fund account 7as described in section #ahea7k7 of such ,act 7#db ,u4,s4,c4 #aciew-#ba7k777 of the enrollee4 ,such study shall include an analysis of any administrative actions that the ,secretary may take in order to permit such beneficiaries to make such selection4 7#b7 ,consultation ,in carrying out the study under paragraph 7#a71 the ,secretary shall conduct public meetings and consult with ,medicare ,advantage plans1 actuaries1 and health think tanks4 7#c7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with-- 7,a7 a description of any administrative actions described in paragraph 7#a7 that the ,secretary has taken1 or plans to take2 and 7,b7 recommendations for such legislation as the ,secretary determines appropriate4 #d4 ,medicare flex fund ,accounts under other ,medicare programs 7a7 ,,cmi model ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following new clause3 7xxviii7 ,permitting individuals participating in a model conducted under this section to have a ,medicare flex fund account created by section #ecj;,a of the ,internal ,revenue ,code of #aihf4 4 7b7 ,incentive programs ,the ,secretary of ,health and ,human ,services may include a ,medicare flex fund account created by section #ecj;,a of the ,internal ,revenue ,code of #aihf as a component in any ,medicare shared savings program or other ,medicare incentive based program established after the date of enactment of this section4 #e4 ,site of service price transparency update 7a7 ,price transparency website update ,section #ahcd7t77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7t77#a77 is amended-- 7#a7 in subparagraph 7,a71 by striking and at the end2 7#b7 in subparagraph 7,b71 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following3 7,c7 the hospital outpatient departments and ambulatory surgical centers nearest to a specific zip code entered on the website2 7,d7 whether payments for items and services furnished will be made under the payment system under section #ahcc7t7 or under section #ahcc7;i72 and 7,e7 if available1 the quality rating of each hospital outpatient department and surgical center4 4 7b7 ,price transparency website advisory group 7#a7 ,establishment ,not later than #ij days after the date of enactment of this ,act1 the ,administrator of the ,centers for ,medicare ,medicaid ,services 7referred to in this subsection as the ,administrator7 shall establish a ,medicare ,price ,transparency ,website ,advisory ,group 7referred to in the subsection as the ,advisory ,group74 7#b7 ,members ,the ,advisory ,group shall be composed of the following individuals or the designees of those individuals3 7,a7 ,the ,administrator4 7,b7 ,the ,chair of the ,medicare ,payment ,advisory ,commission4 7,c7 ,two representatives from each of the following sectors to be selected by the ,administrator3 7i7 ,medical4 7ii7 ,technology4 7iii7 ,think tanks with a background in health economics4 7,d7 ,four individuals from non-profit organizations that represent seniors4 7,e7 ,any other individual the ,administrator determines appropriate4 7#c7 ,no compensation for members ,a member of the ,advisory ,group shall serve without compensation in addition to any compensation received for the service of the member as an officer or employee of the ,united ,states1 if applicable4 7#d7 ,duties 7,a7 ,in general ,the ,advisory ,group shall review the website described in section #ahcd7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie7t77 7referred to in this subsection as the website7 and provide recommendations to the ,secretary of ,health and ,human ,services 7referred to in the subsection as the ,secretary7 on ways the website could be changed to increase its usability and allow users of the website to better understand the cost and quality for services offered by hospital outpatient departments and ambulatory surgical centers covered by the ,medicare program under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq47 in order for users of the website to be better informed regarding their medical choices4 7,b7 ,report ,not later than #ahj days after the first meeting of the ,advisory ,group1 the ,advisory ,group shall submit a report to the ,secretary detailing its recommendations4 7#e7 ,website update ,not later than #a year after receiving the report required by paragraph 7#d77;,b71 the ,secretary shall update the website considering the recommendations contained in such report4 #f4 ,voluntary patient driven benefit flexibility 7a7 ,direct primary care payment ,advisory ,group 7#a7 ,establishment ,not later than #ij days after the date of enactment of this ,act1 the ,administrator of the ,centers for ,medicare ,medicaid ,services 7referred to in this subsection as the ,administrator7 shall establish a ,direct ,primary ,care ,payment ,advisory ,group 7referred to in the subsection as the ,advisory ,group74 7#b7 ,members ,the ,advisory ,group shall be composed of the following individuals or the designees of those individuals3 7,a7 ,the ,administrator4 7,b7 ,the ,chair of the ,medicare ,payment ,advisory ,commission4 7,c7 ,two primary care physicians with experience in direct primary care4 7,d7 ,two specialist physicians who provide primary care services to patients with chronic diseases with experience in direct primary care4 7,e7 ,two representatives of ,medicare ,advantage plans4 7,f7 ,two health actuaries4 7,g7 ,two representatives of think tanks with a health policy background4 7,h7 ,any other individual the ,administrator determines appropriate4 7#c7 ,no compensation for members ,a member of the ,advisory ,group shall serve without compensation in addition to any compensation received for the service of the member as an officer or employee of the ,united ,states1 if applicable4 7#d7 ,duties 7,a7 ,in general ,the ,advisory ,group shall determine-- 7i7 a definition of primary care benefits provided under ,medicare ,advantage plans2 and 7ii7 how best to calculate the amount ,medicare ,advantage plans would save if patients1 including patients that have chronic conditions and for whom primary care is provided by a specialist physician1 were to contract with providers of primary care on their own without using health insurance4 7,b7 ,report ,not later than #ahj days after the first meeting of the ,advisory ,group1 the ,advisory ,group shall submit a report to the ,secretary of ,health and ,humans ,services detailing its recommendations4 7b7 ,,ma ,plans ,section #aheb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#a77 is amended-- 7#a7 in subparagraph 7,a71 by inserting and the patient flexibility and bundled payment requirements described in subparagraph 7,c7 after under section #ahed7;f77#a77;,a772 and 7#b7 by adding at the end the following new subparagraph3 7,c7 ,direct primary care and flexibility payments 7i7 ,direct primary care payments 7,i7 ,in general ,beginning with plan years beginning on or after ,january #a1 #bjbg1 each ,medicare ,advantage plan shall allow enrollees to elect to receive a direct primary care benefit payment1 described in subclause 7,,ii71 in lieu of receiving coverage of primary care benefits 7as defined by the ,secretary taking into account the recommendations of the ,direct ,primary ,care ,payment ,advisory ,group established under section #f7;a7 of the ,medicare ,flex ,fund ,accounts and ,flexible ,benefits ,act of #bjbd7 under the ,medicare ,advantage plan4 7,,ii7 ,direct primary care benefit payment ,the direct primary care benefit payment for an enrollee shall be-- 7aa7 equal to the amount of the average per capita savings to the ,medicare ,advantage plan by not providing coverage of primary care benefits under such plan to such enrollee 7as determined by the ,secretary taking into account the recommendations of the ,direct ,primary ,care ,payment ,advisory ,group established under section #f7;a7 of the ,medicare ,flex ,fund ,accounts and ,flexible ,benefits ,act of #bjbd72 and 7bb7 deposited into the ,medicare flex fund account 7as defined in section #ecj;,a of the ,internal ,revenue ,code of #aihf and referred to in this subparagraph as a ,medicare ,,ffa7 of such enrollee4 7,,iii7 ,election 7aa7 ,in general ,subject to item 7bb71 during the period beginning on ,january #a and ending on ,march #ca of each plan year1 an enrollee may elect to receive the direct primary care benefit payment for that year4 7bb7 ,other requirements 7,,aa7 ,frequency of change ,if an enrollee makes the election described in item 7aa71 the enrollee may elect to stop receiving the direct primary care benefit payment and begin to receive primary care benefits under the ,medicare ,advantage plan for the remainder of that calendar year4 7,,bb7 ,carry over of election ,if an enrollee makes the election described in item 7aa71 the enrollee shall continue to receive the direct primary care benefit payment until the enrollee elects to receive primary care benefits under the ,medicare ,advantage plan for the year during the period described in such item1 the enrollee makes the election described in subitem 7,,aa71 or the enrollee changes ,medicare ,advantage plans4 7,,cc7 ,changing of ,medicare ,advantage plans ,if an enrollee changes ,medicare ,advantage plans as described in subitem 7,,bb71 the enrollee may elect to receive the direct primary care benefit payment or to receive primary care benefits under the ,medicare ,advantage plan for the remainder of the year4 7ii7 ,flexibility payments for shoppable services 7,i7 ,in general ,beginning with plan years beginning on or after ,january #a1 #bjbg1 each ,medicare ,advantage plan shall allow enrollees to receive a payment from such plan that meets the requirements of subclause 7,,ii7 and allows enrollees to receive treatment from a pre-approved alternate provider4 7,,ii7 ,payment ,the payment described in subclause 7,i7 shall-- 7aa7 be the same amount that would have been paid to an in-network provider and include any processing costs2 and 7bb7 be deposited in the ,medicare ,,ffa of the enrollee once a contract has been signed by the enrollee1 the ,medicare ,advantage plan1 and the alternative provider to provide treatment to the member4 7,,iii7 ,alternative providers 7aa7 ,menu of options ,each ,medicare ,advantage plan may develop a list of pre-approved alternate providers and information regarding the price1 treatment outcomes1 and customer experience of each pre-approved alternate provider for certain treatments1 procedures1 and episodes of care4 ,if a ,medicare ,advantage plan chooses to develop such list1 the ,medicare ,advantage plan shall provide such list to an enrollee upon the request of such enrollee4 7bb7 ,providing the menu to the enrollee ,each ,medicare ,advantage plan shall provide the list described in item 7aa7 before the enrollee requests such list if it could result in the enrollee receiving treatment for a lesser price4 7cc7 ,no cost for being on alternative treatment location list ,no ,medicare ,advantage plan shall charge a provider for being on a list described in item 7aa74 7,,iv7 ,definition of pre-approved alternate provider ,for the purposes of this clause1 the term pre-approved alternate provider means a provider of services or a supplier-- 7aa7 located in the ,united ,states or a territory of the ,united ,states2 7bb7 licensed by the ,state or territory in which the provider furnishes services2 7cc7 willing to provide services on a cash basis2 and 7dd7 that has received the review described in subclause 7,v74 7,v7 ,review of services ,before an enrollee has received treatment by a pre-approved alternative provider1 the ,medicare ,advantage plan shall review any contracts or documents relating to the treatment provided by such provider to ensure that-- 7aa7 any enrollee who elects to receive treatment by the provider will receive appropriate health quality and the desired treatment outcome2 and 7bb7 to protect the enrollee from hidden fees or surprise bills1 the cost of the service quoted by the pre-approved alternative provider will be the total price paid by the enrollee4 7iii7 ,rule of construction ,nothing in this subparagraph shall be construed to limit any responsibility of a ,medicare ,advantage plan under this part1 to reduce the actuarial value of such a plan1 or to change any network adequacy requirement4 4 7c7 ,prescription ,drug ,coverage ,section #ahfj;,d-#d of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is amended by adding at the end the following new subsection3 7p7 ,pharmaceutical savings 7#a7 ,in general ,in the case of a covered part ,d drug on the formulary of a prescription drug plan or an ,,ma-,,pd plan1 the plan shall1 if requested by an enrollee of such plan1 provide such enrollee with a payment described in paragraph 7#b7 in lieu of the plan paying for such covered part ,d drug under the plan4 7#b7 ,payment ,the payment described in paragraph 7#a7 shall be an amount equal to the amount the prescription drug plan or ,,ma-,,pd plan would reimburse a preferred pharmacy for such covered part ,d drug plus any fees that would be paid to such plan 7or a subsidiary of such plan7 by the manufacturer of such covered part ,d drug4 4 7d7 ,rule for patient driven benefit flexibility spending regarding deductibles and ,out-of-,pocket spending ,section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is amended by adding at the end the following new subsection3 7j7 ,rule for patient driven benefit flexibility spending regarding deductibles and ,out-of-,pocket spending ,any amount spent by an enrollee from payments made by an ,,ma plan under section #aheb7;a77#a77;,c7 or #ahfj;,d-#d7p7 shall not count towards any deductible or maximum limitation on out-of-pocket expenses applicable to such ,,ma plan4 4