,,ii #aaith ,,congress #ast ,session ,s4 #aejf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #bi1 #bjbe,mr4 ,sanders 7for himself1 ,ms4 ,baldwin1 ,mr4 ,blumenthal1 ,mr4 ,booker1 ,mrs4 ,gillibrand1 ,mr4 ,heinrich1 ,ms4 ,hirono1 ,mr4 ,lujn1 ,mr4 ,markey1 ,mr4 ,merkley1 ,mr4 ,padilla1 ,mr4 ,schatz1 ,mr4 ,schmitt1 ,ms4 ,warren1 ,mr4 ,welch1 and ,mr4 ,whitehouse7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to establish a ,medicare-for-,all national health insurance program4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,medicare for ,all ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,,title ,i--,establishment of the ,medicare for ,all ,program2 ,universal ,entitlement to ,benefits2 ,enrollment,sec4 #aja4 ,establishment of the ,medicare for ,all ,program4,sec4 #ajb4 ,universal entitlement to benefits4,sec4 #ajc4 ,freedom of choice4,sec4 #ajd4 ,non-discrimination4,sec4 #aje4 ,enrollment4,sec4 #ajf4 ,effective date of benefits4,sec4 #ajg4 ,prohibition against duplicating coverage4,,title ,,ii--,comprehensive ,benefits1 ,including ,benefits for ,long-,term ,care,sec4 #bja4 ,comprehensive benefits4,sec4 #bjb4 ,no patient cost-sharing4,sec4 #bjc4 ,exclusions and limitations4,sec4 #bjd4 ,continued coverage of institutional long-term care and other services under ,medicaid4,sec4 #bje4 ,prohibiting recovery of correctly paid ,medicaid benefits4,sec4 #bjf4 ,additional ,state standards4,,title ,,iii--,provider ,participation,sec4 #cja4 ,provider participation and standards2 whistleblower protections4,sec4 #cjb4 ,qualifications for providers4,sec4 #cjc4 ,use of private contracts4,,title ,,iv--,administration,subtitle ,a--,general ,administration ,provisions,sec4 #dja4 ,administration4,sec4 #djb4 ,consultation4,sec4 #djc4 ,regional administration4,sec4 #djd4 ,beneficiary ,ombudsman4,sec4 #dje4 ,conduct of related health programs4,subtitle ,b--,control ,over ,fraud and ,abuse,sec4 #daa4 ,application of ,federal sanctions to all fraud and abuse under ,medicare for ,all ,program4,,title ,v--,quality of ,care,sec4 #eja4 ,quality standards4,sec4 #ejb4 ,addressing health care disparities4,,title ,,vi--,national ,health ,budget2 ,provider ,payments2 ,cost ,containment ,measures,subtitle ,a--,budgeting,sec4 #fja4 ,national health budget4,sec4 #fjb4 ,temporary worker assistance4,subtitle ,b--,payments to ,providers,sec4 #faa4 ,payments to institutional providers based on global budgets4,sec4 #fab4 ,payments to individual providers through fee-for-service4,sec4 #fac4 ,accurate valuation of services under the ,medicare physician fee schedule4,sec4 #fad4 ,payments for prescription drugs and approved devices and equipment4,sec4 #fae4 ,payment prohibitions2 capital expenditures2 special projects4,sec4 #faf4 ,office of ,health ,equity4,sec4 #fag4 ,office of ,primary ,health ,care4,,title ,,vii--,medicare for ,all ,trust ,fund,sec4 #gja4 ,medicare for ,all ,trust ,fund4,,title ,,viii--,conforming ,amendments to the ,employee ,retirement ,income ,security ,act of #aigd,sec4 #hja4 ,prohibition of employee benefits duplicative of benefits under the ,medicare for ,all ,program2 coordination in case of workers' compensation4,sec4 #hjb4 ,repeal of continuation coverage requirements under ,,erisa and certain other requirements relating to group health plans4,sec4 #hjc4 ,effective date of title4,,title ,,ix--,additional ,conforming ,amendments,sec4 #ija4 ,relationship to existing ,federal health programs4,sec4 #ijb4 ,sunset of provisions related to the ,federal and ,state ,exchanges4,,title ,x--,transition to ,medicare for ,all,subtitle ,a--,improvements to ,medicare,sec4 #ajja4 ,protecting ,medicare fee-for-service beneficiaries from high out-of-pocket costs4,sec4 #ajjb4 ,reducing ,medicare part ,d annual out-of-pocket threshold4,sec4 #ajjc4 ,expanding ,medicare to cover dental and vision services and hearing aids and examinations under part ,b4,sec4 #ajjd4 ,eliminating the #bd-month waiting period for ,medicare coverage for individuals with disabilities4,sec4 #ajje4 ,guaranteed issue of ,medigap policies4,subtitle ,b--,temporary ,medicare ,buy-,in ,option and ,temporary ,public ,option,sec4 #ajaa4 ,lowering the ,medicare age4,sec4 #ajab4 ,establishment of the ,medicare transition plan4,subtitle ,c--,patient ,protections ,during ,medicare for ,all ,transition ,period,sec4 #ajba4 ,minimizing disruptions to patient care4,sec4 #ajbb4 ,public consultation4,sec4 #ajbc4 ,definitions4,,title ,,xi--,miscellaneous,sec4 #aaja4 ,updating resource limits for ,supplemental ,security ,income eligibility 7,,ssi74,sec4 #aajb4 ,definitions4 ,i ,establishment of the ,medicare for ,all ,program2 ,universal ,entitlement to ,benefits2 ,enrollment #aja4 ,establishment of the ,medicare for ,all ,program ,there is hereby established a national health insurance program 7referred to in this ,act as the ,medicare for ,all ,program7 to provide comprehensive protection against the costs of health care and health-related items and services1 in accordance with the standards specified in1 or established under1 this ,act4 #ajb4 ,universal entitlement to benefits 7a7 ,in general ,every individual who is a resident of the ,united ,states is entitled to benefits for health care items and services under this ,act4 ,the ,secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under this ,act4 7b7 ,treatment of other individuals ,the ,secretary-- 7#a7 may make eligible for benefits for health care items and services under this ,act other individuals not described in subsection 7a7 and regulate their eligibility to ensure that every person in the ,united ,states has access to health care2 and 7#b7 shall promulgate a rule1 consistent with ,federal immigration laws1 to prevent an individual from traveling to the ,united ,states for the sole purpose of obtaining health care items and services provided under this ,act4 #ajc4 ,freedom of choice ,any individual entitled to benefits under this ,act may obtain health care items and services from any institution1 agency1 or individual qualified to participate under this ,act4 #ajd4 ,non-discrimination 7a7 ,in general ,no person shall1 on the basis of race1 color1 national origin1 age1 disability1 marital status1 citizenship status1 primary language use1 genetic conditions1 previous or existing medical conditions1 religion1 or sex1 including sex stereotyping1 gender identity1 sexual orientation1 and pregnancy and related medical conditions 7including termination of pregnancy71 be excluded from participation in or be denied the benefits of the program established under this ,act 7except as expressly authorized by this ,act for purposes of enforcing eligibility standards described in section #ajb71 or be subject to any reduction of benefits or other discrimination by any participating provider 7as described in section #cja7;a771 or any entity conducting1 administering1 or funding a health program or activity1 including contracts of insurance1 pursuant to this ,act4 7b7 ,claims of discrimination 7#a7 ,in general ,the ,secretary shall establish a procedure for adjudication of administrative complaints alleging a violation of subsection 7a74 7#b7 ,jurisdiction ,any person aggrieved by a violation of subsection 7a7 may file suit in any district court of the ,united ,states having jurisdiction of the parties4 ,a person may bring an action under this paragraph concurrently with such administrative remedies as established in paragraph 7#a74 7#c7 ,damages ,if the court finds a violation of subsection 7a71 the court may grant compensatory and punitive damages 7including damages for emotional harm71 declaratory relief1 injunctive relief1 attorneys' fees and costs1 or other relief as appropriate4 7c7 ,continued application of laws ,nothing in this title shall be construed to invalidate or otherwise limit any of the rights1 remedies1 procedures1 or legal standards available to individuals aggrieved under other ,federal laws1 including section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf71 title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 title ,,vii of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;e et seq471 title ,,ix of the ,education ,amendments of #aigb 7#bj ,u4,s4,c4 #afha et seq471 section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 title ,,ii of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaca et seq471 or the ,age ,discrimination ,act of #aige 7#db ,u4,s4,c4 #faja et seq474 ,nothing in this title shall be construed to supersede ,state laws that provide additional protections against discrimination on any basis described in subsection 7a74 #aje4 ,enrollment 7a7 ,in general ,the ,secretary shall provide a mechanism for the enrollment of individuals eligible for benefits under the ,medicare for ,all ,program4 ,the mechanism shall-- 7#a7 include a process for the automatic enrollment of individuals at the time of birth in the ,united ,states 7or upon establishment of residency in the ,united ,states72 7#b7 provide for the enrollment1 as of the date described in subsection 7a7 or 7b71 as applicable1 of section #ajf1 of all individuals who are eligible to be enrolled as of such applicable date2 and 7#c7 include a process for the enrollment of individuals made eligible for health care items and services under section #ajb7;b74 7b7 ,issuance of ,medicare for ,all cards ,in conjunction with an individual's enrollment for benefits under this ,act1 the ,secretary shall provide for the issuance of a ,medicare for ,all card that shall be used for purposes of identification and processing of claims for benefits under the ,medicare for ,all ,program4 ,the card shall not include an individual's ,social ,security number4 #ajf4 ,effective date of benefits 7a7 ,in general ,except as provided in subsection 7b71 benefits shall first be available under the ,medicare for ,all ,program for items and services furnished on ,january #a of the fourth calendar year that begins after the date of enactment of this ,act4 7b7 ,immediate coverage of children 7#a7 ,in general ,for any eligible individual under section #ajb who has not yet attained the age of #ai as of the date that is #a year after the date of enactment of this ,act1 benefits shall first be available under the ,medicare for ,all ,program for items and services furnished on ,january #a of the first calendar year that begins after the date of enactment of this ,act4 7#b7 ,option to continue in other coverage during transition period ,any person who is eligible to receive benefits as described in paragraph 7#a7 may opt to maintain any coverage described in section #ija1 private health insurance coverage1 or coverage offered pursuant to subtitle ,a of title ,x 7including the amendments made by such subtitle7 until the date on which benefits are first available under subsection 7a74 #ajg4 ,prohibition against duplicating coverage 7a7 ,in general ,beginning on the date on which benefits are first available under section #ajf7;a71 it shall be unlawful for-- 7#a7 a private health insurer to sell health insurance coverage that duplicates the benefits provided under the ,medicare for ,all ,program2 or 7#b7 an employer to provide benefits for an employee1 former employee1 or the dependents of an employee or former employee that duplicate the benefits provided under the ,medicare for ,all ,program4 7b7 ,construction ,nothing in this ,act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by the ,medicare for ,all ,program1 including additional benefits that an employer may provide to employees or their dependents1 or to former employees or their dependents4 ,,ii ,comprehensive ,benefits1 ,including ,benefits for ,long-,term ,care #bja4 ,comprehensive benefits 7a7 ,in general ,subject to the other provisions of this title and titles ,,iv through ,,ix1 individuals enrolled for benefits under the ,medicare for ,all ,program are entitled to have payment made by the ,secretary to a participating provider for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis1 treatment1 or rehabilitation of a health condition3 7#a7 ,hospital services1 including inpatient and outpatient hospital care1 including #bd-;hour-a-day emergency services and inpatient prescription drugs4 7#b7 ,ambulatory patient services4 7#c7 ,primary and preventive services1 including chronic disease management4 7#d7 ,prescription drugs and medical devices1 including outpatient prescription drugs1 biological products1 and medical devices1 and all contraceptive items approved by the ,food and ,drug ,administration4 7#e7 ,mental health and substance use treatment services1 including inpatient care and treatment for co-occurring mental illness and substance use disorders4 7#f7 ,laboratory and diagnostic services4 7#g7 ,comprehensive reproductive care1 including abortion1 contraception1 and assistive reproductive technology4 7#h7 ,comprehensive maternity and newborn care4 7#i7 ,comprehensive gender-affirming health care4 7#aj7 ,oral health1 audiology1 and vision services4 7#aa7 ,rehabilitative and habilitative services1 including devices4 7#ab7 ,emergency services1 including transportation4 7#ac7 ,pediatrics1 including early and periodic screening1 diagnostic1 and treatment services 7as defined in section #aije7r7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7r7774 7#ad7 ,necessary transportation to receive health care items and services for persons with disabilities1 older individuals with functional limitations1 and low-income individuals 7as determined by the ,secretary74 7#ae7 ,services provided by a licensed marriage and family therapist or a licensed mental health counselor4 7#af7 ,home- and community-based long-term care services and supports 7to be provided in accordance with the requirements for home and community-based settings under sections #dda4ecj and #dda4gaj of title #db1 ,code of ,federal ,regulations 7as in effect on the date of enactment of this ,act71 including-- 7,a7 services described in paragraphs 7#g71 7#h71 7#ac71 7#ai71 and 7#bd7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a772 7,b7 home and community-based services described in subsection 7c77#d77;,b7 of section #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7 7including habilitation services defined in subsection 7c77#e7 of such section72 7,c7 self-directed home and community-based services described in subsection 7i7 of section #aiae of the ,social ,security ,act2 7,d7 self-directed personal assistance services 7as defined in subsection 7j77#d77;,a7 of section #aiae of the ,social ,security ,act72 and 7,e7 home and community-based attendant services and supports described in subsection 7k7 of section #aiae of the ,social ,security ,act4 7#ag7 ,any item or service described in any of paragraphs 7#a7 through 7#af7 that is furnished using telehealth1 to the extent practicable4 7b7 ,revision ,the ,secretary shall1 at least on an annual basis1 evaluate whether the benefits package should be improved to promote the health of beneficiaries1 account for changes in medical practice or new information from medical research1 or respond to other relevant developments in health science1 and shall make recommendations to ,congress regarding any such improvements4 7c7 ,complementary and integrative medicine 7#a7 ,in general ,in carrying out subsection 7b71 the ,secretary shall consult with the persons described in paragraph 7#b7 with respect to-- 7,a7 identifying specific complementary and integrative medicine practices that are appropriate to include in the benefits package2 and 7,b7 identifying barriers to the effective provision and integration of such practices into the delivery of health care1 and identifying mechanisms for overcoming such barriers4 7#b7 ,consultation ,in accordance with paragraph 7#a71 the ,secretary shall consult with-- 7,a7 the ,director of the ,national ,center for ,complementary and ,integrative ,health2 7,b7 the ,commissioner of ,food and ,drugs2 7,c7 institutions of higher education1 private research institutes1 and individual researchers with extensive experience in complementary and integrative medicine and the integration of such practices into the delivery of health care2 7,d7 nationally recognized providers of complementary and integrative medicine2 and 7,e7 such other officials1 entities1 and individuals with expertise on complementary and integrative medicine as the ,secretary determines appropriate4 7d7 ,states may provide additional benefits ,individual ,states may provide additional benefits for the residents of such ,states1 as determined by such ,state1 and may provide benefits to individuals not eligible for benefits under the ,medicare for ,all ,program at the expense of the ,state4 #bjb4 ,no patient cost-sharing 7a7 ,in general ,the ,secretary shall ensure that no cost-sharing1 including deductibles1 coinsurance1 copayments1 or similar charges1 be imposed on an individual for any benefits provided under the ,medicare for ,all ,program1 except as described in subsection 7b74 7b7 ,exceptions ,the ,secretary may set a cost-sharing schedule for prescription drugs covered under the ,medicare for ,all ,program-- 7#a7 provided that-- 7,a7 such schedule is evidence-based1 patient-centered1 and encourages the use of generic drugs2 7,b7 such cost-sharing does not apply to preventive drugs2 7,c7 such cost-sharing does not exceed #bjj annually per individual1 adjusted annually for inflation2 and 7,d7 such cost-sharing is not imposed on individuals with a household income equal to or below #bej percent of the poverty line for a family of the size involved2 and 7#b7 under which the ,secretary may-- 7,a7 exempt brand-name drugs from consideration in determining whether an individual has reached any out-of-pocket limit if a safe and appropriate generic version of such drug is available to such individual2 and 7,b7 waive cost-sharing in response to a coverage appeal under section #bjc7;b77#b74 7c7 ,no balance billing ,notwithstanding contracts in accordance with section #cjc1 no provider may impose a charge to an individual enrolled for benefits under the ,medicare for ,all ,program for items and services for which benefits are provided under such ,program4 #bjc4 ,exclusions and limitations 7a7 ,in general ,benefits for items and services are not available under the ,medicare for ,all ,program unless the items and services meet the standards developed by the ,secretary pursuant to section #bja7;a74 7b7 ,treatment of experimental items and services 7#a7 ,in general ,in applying subsection 7a71 the ,secretary shall make national coverage determinations with respect to items and services that are experimental in nature4 ,such determinations shall be consistent with the national coverage determination process as defined in section #ahfi7;f77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ff7f77#a77;,b774 7#b7 ,appeals process ,the ,secretary shall establish a process by which individuals can appeal coverage decisions4 ,the process shall1 as much as is feasible1 follow the process for appeals under the ,medicare program described in section #ahfi of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ff74 7c7 ,application of practice guidelines 7#a7 ,in general ,in the case of items and services for which the ,department of ,health and ,human ,services has recognized a national practice guideline1 such items and services are considered to meet the standards specified in section #bja7;a7 if they have been provided in accordance with such guideline4 7#b7 ,certain exceptions ,for purposes of this subsection1 an item or service not provided in accordance with a national practice guideline shall be considered to have been provided in accordance with such guideline if the health care provider providing the item or service-- 7,a7 exercised appropriate professional discretion to deviate from the guideline in a manner authorized or anticipated by the guideline2 7,b7 acted in accordance with the laws and requirements in which such item or service is furnished2 7,c7 acted in the best interests of the individual receiving the item or service2 and 7,d7 acted in a manner consistent with the individual's wishes4 #bjd4 ,continued coverage of institutional long-term care and other services under ,medicaid ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting the following section after section #aidh3 #aidi4 ,state ,plan for ,providing ,institutional ,long-,term ,care ,services 7a7 ,in general ,for quarters beginning on or after the date on which benefits are first available under section #ajf7;a7 of the ,medicare for ,all ,act1 notwithstanding any other provision of this title-- 7#a7 a ,state plan for medical assistance shall provide for making medical assistance available for institutional long-term care services in a manner consistent with this section2 and 7#b7 no payment to a ,state shall be made under this title with respect to expenditures incurred by the ,state in providing medical assistance on or after such date for services that are not-- 7,a7 institutional long-term care services2 or 7,b7 other services for which benefits are not available under the ,medicare for ,all ,act and which are furnished under a ,state plan for medical assistance which provided for medical assistance for such services on ,march #a1 #bjbe4 7b7 ,institutional long-,term care services defined ,in this section1 the term institutional long-term care services means the following3 7#a7 ,nursing facility services for individuals #ba years of age or over described in subparagraph 7,a7 of section #aije7;a77#d74 7#b7 ,inpatient services for individuals #fe years of age or over provided in an institution for mental disease described in section #aije7;a77#ad74 7#c7 ,intermediate care facility services described in section #aije7;a77#ae74 7#d7 ,inpatient psychiatric hospital services for individuals under age #ba described in section #aije7;a77#af74 7#e7 ,nursing facility services described in section #aije7;a77#ca74 7c7 ,state maintenance of effort requirement 7#a7 ,eligibility standards 7,a7 ,in general ,beginning on the date described in subsection 7a71 no payment may be made under section #aijc with respect to medical assistance provided under a ,state plan for medical assistance if the ,state adopts income1 resource1 or other standards and methodologies for purposes of determining an individual's eligibility for medical assistance under the ,state plan that are more restrictive than those applied as of ,january #a1 #bjbe4 7,b7 ,indexing of amounts of income and resource standards ,in determining whether a ,state has adopted income or resource standards that are more restrictive than the standards which applied as of ,january #a1 #bjbe1 the ,secretary shall deem the amount of any such standard that was applied as of such date to be increased by the percentage increase in the medical care component of the consumer price index for all urban consumers 7,u4,s4 city average7 from ,september of #bjbb to ,september of the fiscal year for which the ,secretary is making such determination4 7#b7 ,expenditures 7,a7 ,in general ,for each fiscal year or portion of a fiscal year that occurs during the period that begins on the first day of the first fiscal quarter that begins on or after the date on which benefits are first available under section #ajf7;a7 of the ,medicare for ,all ,act1 as a condition of receiving payments under section #aijc7;a71 a ,state shall make expenditures for medical assistance for institutional long-term care services in an amount that is not less than the expenditure floor determined for the ,state and fiscal year 7or portion of a fiscal year7 under subparagraph 7,b74 7,b7 ,expenditure floor 7i7 ,in general ,for each fiscal year or portion of a fiscal year described in subparagraph 7,a71 the ,secretary shall determine for each ,state an expenditure floor that shall be equal to-- 7,i7 the amount of the ,state's expenditures for fiscal year #bjbd on medical assistance for institutional long-term care services2 increased by 7,,ii7 the growth factor determined under subclause 7ii74 7ii7 ,growth factor ,for each fiscal year or portion of a fiscal year described in subparagraph 7,a71 the ,secretary shall1 not later than ,september #a of the fiscal year preceding such fiscal year or portion of a fiscal year1 determine a growth factor for each ,state that takes into account-- 7,i7 the percentage increase in health care costs in the ,state2 7,,ii7 the total amount expended by the ,state for the previous fiscal year on medical assistance for institutional long-term care services2 7,,iii7 the increase1 if any1 in the total population of the ,state from ,july of #bjbd to ,july of the fiscal year preceding the fiscal year involved2 7,,iv7 the increase1 if any1 in the population of individuals aged #fe and older of the ,state from ,july of #bjbd to ,july of the fiscal year preceding the fiscal year involved2 and 7,v7 the decrease1 if any1 in the population of the ,state that requires medical assistance for institutional long-term care services that is attributable to the availability of coverage for the services described in section #bja7;a77#af7 of the ,medicare for ,all ,act4 7iii7 ,proration rule ,any amount determined under this subparagraph for a portion of a fiscal year shall be prorated based on the length of such portion of a fiscal year relative to a complete fiscal year4 7d7 ,nonapplication of certain requirements ,beginning on the date described in subsection 7a71 any provision of this title requiring a ,state plan for medical assistance to make available medical assistance for services that are not institutional long-term care services or items and services described in section #ija7;a77#c77;,a77ii7 of the ,medicare for ,all ,act shall have no effect4 4 #bje4 ,prohibiting recovery of correctly paid ,medicaid benefits ,section #aiag of the ,social ,security ,act 7#db ,u4,s4,c4 #acifp7 is amended-- 7#a7 by amending subsection 7a7 to read as follows3 7a7 ,no lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the ,state plan1 except pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual4 2 and 7#b7 by amending subsection 7b7 to read as follows3 7b7 ,no adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the ,state plan may be made4 4 #bjf4 ,additional ,state standards 7a7 ,in general ,nothing in this ,act shall prohibit individual ,states from setting additional standards related to eligibility1 benefits1 and minimum provider standards1 consistent with the purposes of this ,act1 provided that such standards do not restrict eligibility or reduce access to benefits for items and services4 7b7 ,restrictions on providers ,with respect to any individuals or entities certified to provide items and services covered under section #bja7;a77#g71 a ,state may not prohibit an individual or entity from participating in the ,medicare for ,all ,program for reasons other than the inability of the individual or entity to provide such items and services4 ,,iii ,provider ,participation #cja4 ,provider participation and standards2 whistleblower protections 7a7 ,in general ,an individual or entity furnishing any item or service covered under the ,medicare for ,all ,program is not a participating provider under such ,program unless the individual or entity-- 7#a7 is a qualified provider of the items or services under section #cjb2 7#b7 has filed with the ,secretary a participation agreement described in subsection 7b72 and 7#c7 meets1 as applicable1 such other qualifications and conditions with respect to a provider of services under title ,,xviii of the ,social ,security ,act as described in section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc74 7b7 ,requirements in participation agreement 7#a7 ,in general ,a participation agreement described in this subsection between the ,secretary and a provider shall provide at least for the following3 7,a7 ,items and services to eligible persons shall be furnished by the provider without discrimination1 in accordance with section #ajd7;a74 ,nothing in this subparagraph shall be construed as requiring the provision of a type or class of items or services that are outside the scope of the provider's normal practice4 7,b7 ,no charge will be made to any enrolled individual for any items or services covered under the ,medicare for ,all ,program other than for payment authorized by this ,act4 7,c7 ,the provider agrees to furnish such information as may be reasonably required by the ,secretary1 in accordance with uniform reporting standards established under section #dja7;b77#a71 for-- 7i7 quality review2 7ii7 making payments under this ,act1 including the examination of records as may be necessary for the verification of information on which such payments are based2 7iii7 statistical or other studies required for the implementation of this ,act2 and 7iv7 such other purposes as the ,secretary may specify4 7,d7 ,in the case of a provider that is not an individual1 the provider agrees not to employ or use for the provision of health care items or services any individual or other provider that has had a participation agreement under this subsection terminated for cause4 ,the ,secretary may authorize such employment or use on a case-by-case basis4 7,e7 ,in the case of a provider paid under a fee-for-service basis for items and services furnished under the ,medicare for ,all ,program1 the provider agrees to submit bills and any required supporting documentation relating to the provision of items or services covered under such ,program within #cj days after the date of providing such items and services4 7,f7 ,in the case of an institutional provider paid pursuant to section #faa1 the provider agrees to submit information and any other required supporting documentation as may be reasonably required by the ,secretary within #cj days after the date of providing items and services covered under the ,medicare for ,all ,program and in accordance with the uniform reporting standards established under section #dja7;b77#a71 including information on a quarterly basis that-- 7i7 relates to the provision of items and services covered under the ,medicare for ,all ,program2 and 7ii7 describes such items and services furnished with respect to specific individuals4 7,g7 ,in the case of a provider that receives payment for items and services furnished under the ,medicare for ,all ,program based on diagnosis-related coding1 procedure coding1 or other coding system or data1 the provider agrees-- 7i7 to disclose to the ,secretary any system or index of coding or classifying patient symptoms1 diagnoses1 clinical interventions1 episodes1 or procedures that such provider utilizes for global budget negotiations under title ,,vi or for meeting any other payment1 documentation1 or data collection requirements under this ,act2 and 7ii7 not to use any such system or index to establish financial incentives or disincentives for health care professionals1 or that is proprietary1 interferes with the medical or nursing process1 or is designed to increase the amount or number of payments4 7,h7 ,the provider complies with the duty of provider ethics and reporting requirements described in paragraph 7#b74 7,i7 ,in the case of a provider that is not an individual1 the provider agrees that no board member1 executive1 or administrator of such provider receives compensation from1 owns stock or has other financial investments in1 or serves as a board member of any entity that contracts with or provides items or services1 including pharmaceutical products and medical devices or equipment1 to such provider4 7#b7 ,provider duty of ethics ,each health care provider1 including institutional providers1 has a duty to advocate for and to act in the exclusive interest of each individual under the care of such provider according to the applicable legal standard of care1 such that no financial interest or relationship impairs any health care provider's ability to furnish necessary and appropriate care to such individual4 ,to implement the duty established in this paragraph1 the ,secretary shall-- 7,a7 promulgate reasonable reporting rules to evaluate participating provider compliance with this paragraph2 7,b7 prohibit participating providers1 spouses1 and immediate family members of participating providers1 from accepting or entering into any arrangement for any bonus1 incentive payment1 profit-sharing1 or compensation based on patient utilization or based on financial outcomes of any other provider or entity2 and 7,c7 prohibit participating providers or any board member or representative of such provider from serving as board members for or receiving any compensation1 stock1 or other financial investment in an entity that contracts with or provides items or services 7including pharmaceutical products and medical devices or equipment7 to such provider4 7#c7 ,termination of participation agreement 7,a7 ,in general ,participation agreements may be terminated1 with appropriate notice-- 7i7 by the ,secretary for failure to meet the requirements of this ,act2 7ii7 in accordance with the provisions described in section #daa2 or 7iii7 by a provider4 7,b7 ,termination process ,providers shall be provided notice and a reasonable opportunity to correct deficiencies before the ,secretary terminates an agreement unless a more immediate termination is required for public safety or similar reasons4 7,c7 ,provider protections 7i7 ,prohibition ,the ,secretary may not terminate a participation agreement or in any other way discriminate against1 or cause to be discriminated against1 any participating provider described in subsection 7a7 or authorized representative of the provider1 on account of such provider or representative-- 7,i7 providing1 causing to be provided1 or being about to provide or cause to be provided to the provider1 the ,federal ,government1 or the attorney general of a ,state information relating to any violation of1 or any act or omission the provider or representative reasonably believes to be a violation of1 any provision of this title2 7,,ii7 testifying or being about to testify in a proceeding concerning such violation2 7,,iii7 assisting or participating1 or being about to assist or participate1 in such a proceeding2 or 7,,iv7 objecting to1 or refusing to participate in1 any activity1 policy1 practice1 or assigned task that the provider or representative reasonably believes to be in violation of any provision of this ,act 7including any amendment made by this ,act71 or any order1 rule1 regulation1 standard1 or ban under this ,act 7including any amendment made by this ,act74 7ii7 ,complaint procedure ,a provider or representative who believes that he or she has been discriminated against in violation of this section may seek relief in accordance with the procedures1 notifications1 burdens of proof1 remedies1 and statutes of limitation set forth in section #dj7;b7 of the ,consumer ,product ,safety ,act 7#ae ,u4,s4,c4 #bjhg7;b774 7c7 ,whistleblower protections 7#a7 ,retaliation prohibited ,no person may discharge or otherwise discriminate against any employee because the employee or any person acting pursuant to a request of the employee-- 7,a7 notified the ,secretary or the employee's employer of any alleged violation of this title1 including communications related to carrying out the employee's job duties2 7,b7 refused to engage in any practice made unlawful by this title1 if the employee has identified the alleged illegality to the employer2 7,c7 testified before or otherwise provided information relevant for ,congress or for any ,federal or ,state proceeding regarding any provision 7or proposed provision7 of this title2 7,d7 commenced1 caused to be commenced1 or is about to commence or cause to be commenced a proceeding under this title2 7,e7 testified or is about to testify in any such proceeding2 or 7,f7 assisted or participated or is about to assist or participate in any manner in such a proceeding or in any other manner in such a proceeding or in any other action to carry out the purposes of this title4 7#b7 ,enforcement action ,any employee covered by this section who alleges discrimination by an employer in violation of paragraph 7#a7 may bring an action1 subject to the statute of limitations described in section #cgcj7;h77#c7 of title #ca1 ,united ,states ,code1 and the rules and procedures1 legal burdens of proof1 and remedies applicable under section #caaje of title #di1 ,united ,states ,code4 7#c7 ,application 7,a7 ,nothing in this subsection shall be construed to diminish the rights1 privileges1 or remedies of any employee under any ,federal or ,state law or regulation1 including the rights and remedies against retaliatory action under section #cgcj7;h7 of title #ca1 ,united ,states ,code1 or under any collective bargaining agreement4 ,the rights and remedies in this section may not be waived by any agreement1 policy1 form1 or condition of employment4 7,b7 ,nothing in this subsection shall be construed to preempt or diminish any other ,federal or ,state law or regulation against discrimination1 demotion1 discharge1 suspension1 threats1 harassment1 reprimand1 retaliation1 or any other manner of discrimination1 including the rights and remedies against retaliatory action under section #cgcj7;h7 of title #ca1 ,united ,states ,code4 7#d7 ,definitions ,in this subsection3 7,a7 ,employer ,the term employer means any person engaged in profit or a nonprofit business or industry1 including one or more individuals1 partnerships1 associations1 corporations1 trusts1 professional membership organizations including a certification1 disciplinary1 or other professional body1 unincorporated organizations1 nongovernmental organizations1 or trustees1 and subject to liability for violating the provisions of this ,act4 7,b7 ,employee ,the term employee means any individual performing activities under this ,act on behalf of an employer4 #cjb4 ,qualifications for providers 7a7 ,in general ,a health care provider is considered a qualified provider to furnish items and services under the ,medicare for ,all ,program if the provider is licensed or certified to furnish such items and services in the ,state in which the individual receiving such items and services is located and meets-- 7#a7 the requirements of such ,state's laws to furnish such items and services2 and 7#b7 applicable requirements of ,federal law to furnish such items and services4 7b7 ,federal providers ,any provider qualified to provide health care items and services at a facility of the ,department of ,veterans ,affairs1 the ,indian ,health ,service1 or the uniformed services 7as defined in section #ajgb7a7 of title #aj1 ,united ,states ,code7 7with respect to the direct care component of the ,,tricare program7 is a qualified provider under this section with respect to any individual who qualifies for such items and services under applicable ,federal law4 7c7 ,minimum provider standards 7#a7 ,in general ,the ,secretary shall establish1 evaluate1 and update national minimum standards to ensure the quality of items and services provided under the ,medicare for ,all ,program and to monitor efforts by ,states to ensure the quality of such items and services4 ,a ,state may also establish additional minimum standards which providers shall meet with respect to items and services provided in such ,state4 7#b7 ,national minimum standards ,the ,secretary shall establish national minimum standards under paragraph 7#a7 for institutional providers of items or services and individual health care practitioners4 ,except as the ,secretary may specify in order to carry out this ,act1 a hospital1 skilled nursing facility1 or other institutional provider of items or services shall meet standards applicable to such a provider under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 ,such standards also may include1 where appropriate1 elements relating to-- 7,a7 adequacy and quality of facilities2 7,b7 training and competence of personnel 7including requirements related to the number or type of required continuing education hours72 7,c7 comprehensiveness of items and services2 7,d7 continuity of items and services2 7,e7 patient waiting times1 access to items and services1 and references2 and 7,f7 performance standards1 including organization1 facilities1 structure of items and services1 efficiency of operation1 and outcome in palliation1 improvement of health1 stabilization1 cure1 or rehabilitation4 7#c7 ,transition in application ,if the ,secretary provides for additional requirements for providers under this subsection1 any such additional requirement shall be implemented in a manner that provides for a reasonable period during which a previously qualified provider is permitted to meet such an additional requirement4 #cjc4 ,use of private contracts 7a7 ,in general ,this section shall apply beginning on the date on which benefits are first available under section #ajf7;a74 ,subject to the provisions of this section1 nothing in this ,act shall prohibit an institutional or individual provider from entering into a private contract with an individual enrolled for benefits under the ,medicare for ,all ,program for any item or service-- 7#a7 for which no claim for payment is to be submitted under this ,act2 and 7#b7 for which the provider receives-- 7,a7 no reimbursement under this ,act directly or on a capitated basis2 and 7,b7 receives no amount from an organization which receives reimbursement for such item or service under this ,act directly or on a capitated basis4 7b7 ,contract requirements 7#a7 ,in general ,any contract to provide an item or service under subsection 7a7 shall-- 7,a7 be in writing and signed by the individual 7or authorized representative of the individual7 receiving the item or service before the item or service is furnished pursuant to the contract2 7,b7 be entered into at a time when the individual is facing an emergency health care situation2 and 7,c7 contain the items described in paragraph 7#b74 7#b7 ,items required to be included in contract ,any contract to provide an item or service to which subsection 7a7 applies shall clearly indicate to the individual that by signing such contract the individual-- 7,a7 agrees not to submit a claim 7or to request that the provider submit a claim7 under this ,act for such item or service even if such item or service is otherwise covered by the ,medicare for ,all ,program2 7,b7 agrees to be responsible1 whether through insurance offered under section #ajg7;b7 or otherwise1 for payment of such item or service and understands that no reimbursement will be provided under this ,act for such item or service2 7,c7 acknowledges that no limits under this ,act apply to amounts that may be charged for such item or service2 7,d7 if the provider is a nonparticipating provider1 acknowledges that the beneficiary has the right to have such item or service provided by other providers for whom payment would be made under the ,medicare for ,all ,program2 and 7,e7 acknowledges that the provider is providing an item or service outside the scope of the ,medicare for ,all ,program4 7c7 ,provider requirements 7#a7 ,in general ,subsection 7a7 shall not apply to any contract unless an affidavit described in paragraph 7#b7 is in effect during the period any item or service is to be provided pursuant to the contract4 7#b7 ,affidavit ,an affidavit as described in this subparagraph shall-- 7,a7 identify the provider1 and be signed by such provider2 7,b7 provide that the provider will not submit any claim under this title for any item or service provided to any beneficiary 7and will not receive any reimbursement or amount described in subsection 7a77#b7 for any such item or service7 during the #a-year period beginning on the date the affidavit is signed2 and 7,c7 be filed with the ,secretary no later than #aj days after the first contract to which such affidavit applies is entered into4 7#c7 ,enforcement ,if a provider signing an affidavit described in paragraph 7#b7 knowingly and willfully submits a claim under this title for any item or service provided during the #a-year period described in paragraph 7#b77;,b7 7or receives any reimbursement or amount described in subsection 7a77#b7 for any such item or service7 with respect to such affidavit-- 7,a7 this subsection shall not apply with respect to any item or service provided by the provider pursuant to any contract on and after the date of such submission and before the end of such period2 and 7,b7 no payment shall be made under this title for any item or service furnished by the provider during the period described in subparagraph 7,a7 7and no reimbursement or payment of any amount described in subsection 7a77#b7 shall be made for any such item or service74 ,,iv ,administration ,a ,general ,administration ,provisions #dja4 ,administration 7a7 ,general duties of the ,secretary 7#a7 ,in general ,the ,secretary shall develop policies1 procedures1 guidelines1 and requirements to carry out this ,act1 including related to-- 7,a7 eligibility for benefits under the ,medicare for ,all ,program2 7,b7 enrollment under such ,program2 7,c7 benefits provided under such ,program2 7,d7 provider participation standards and qualifications1 as described in title ,,iii2 7,e7 levels of funding2 7,f7 methods for determining amounts of payments to providers of items and services covered under the ,medicare for ,all ,program1 consistent with subtitle ,b2 7,g7 a process for appealing or petitioning for a determination of coverage for items and services under the ,medicare for ,all ,program2 7,h7 planning for capital expenditures and item and service delivery2 7,i7 planning for health professional education funding2 7,j7 encouraging ,states to develop regional planning mechanisms2 and 7,k7 any other regulations necessary to carry out the purposes of this ,act4 7#b7 ,regulations ,regulations authorized by this ,act shall be issued by the ,secretary in accordance with section #eec of title #e1 ,united ,states ,code4 7b7 ,uniform reporting standards2 annual report2 studies 7#a7 ,uniform reporting standards 7,a7 ,in general ,the ,secretary shall establish uniform ,state reporting requirements1 provider reporting requirements1 and national standards to ensure an adequate national database containing information pertaining to health services practitioners1 approved providers1 the costs of facilities and practitioners providing items and services covered under the ,medicare for ,all ,program1 the quality of such items and services1 the outcomes of such items and services1 and the equity of health among population groups4 ,such database shall include1 to the maximum extent feasible without compromising patient privacy1 health outcome measures used under this ,act1 and to the maximum extent feasible without excessively burdening providers1 the measures described in subparagraphs 7,d7 through 7,f7 of subsection 7a77#a74 7,b7 ,reports ,the ,secretary shall-- 7i7 regularly analyze information reported to the ,secretary2 and 7ii7 define rules and procedures to allow researchers1 scholars1 health care providers1 and others to access and analyze data for purposes consistent with quality and outcomes research1 without compromising patient privacy4 7#b7 ,annual report ,beginning ,january #a of the second year beginning after the date on which benefits are first available under section #ajf7;a71 the ,secretary shall annually report to ,congress on the following3 7,a7 ,the status of implementation of this ,act4 7,b7 ,enrollment under the ,medicare for ,all ,program4 7,c7 ,benefits under the ,medicare for ,all ,program4 7,d7 ,expenditures and financing under this ,act4 7,e7 ,cost-containment measures and achievements under the ,medicare for ,all ,program4 7,f7 ,quality assurance4 7,g7 ,health care utilization patterns1 including any changes attributable to the ,medicare for ,all ,program4 7,h7 ,changes in the per capita costs of health care4 7,i7 ,differences in the health status of the populations of the different ,states1 by demographic characteristics1 including race1 ethnicity1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 or socioeconomic status4 7,j7 ,progress on implementing quality and outcome measures under this ,act1 and long-range plans and goals for achievements in such measures4 7,k7 ,plans for improving items and services to medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c7774 7,l7 ,transition problems as a result of implementation of this ,act4 7,m7 ,opportunities for improvements under this ,act4 7#c7 ,statistical analyses and other studies ,the ,secretary may1 either directly or by contract-- 7,a7 make statistical and other studies1 on a nationwide1 regional1 ,state1 or local basis1 of any aspect of the operation of this ,act2 7,b7 develop and test methods of delivery of items and services as the ,secretary may consider necessary or promising for the evaluation1 or for the improvement1 of the operation of this ,act2 and 7,c7 develop methodological standards for evidence-based policymaking4 7c7 ,audits 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct an audit of the ,department of ,health and ,human ,services every fifth fiscal year following the date on which benefits are first available under section #ajf7;a7 to determine the effectiveness of the ,medicare for ,all ,program in carrying out the duties under subsection 7a74 7#b7 ,reports ,the ,comptroller ,general of the ,united ,states shall submit a report to ,congress concerning the results of each audit conducted under this subsection4 #djb4 ,consultation ,the ,secretary shall consult with ,federal agencies1 ,indian ,tribes and urban ,indian health organizations1 and private entities1 such as labor organizations representing health care workers1 professional societies1 national associations1 nationally recognized associations of health care experts1 medical schools and academic health centers1 consumer groups1 patient advocate groups1 disability rights organizations1 and labor business organizations in the formulation of guidelines1 regulations1 policy initiatives1 and information gathering to ensure the broadest and most informed input in the administration of this ,act4 ,nothing in this ,act shall prevent the ,secretary from adopting guidelines1 consistent with section #bjc7;c71 developed by such a private entity if1 in the ,secretary's judgment1 such guidelines are generally accepted as reasonable and prudent and consistent with this ,act4 #djc4 ,regional administration 7a7 ,regional ,medicare for ,all offices ,the ,secretary shall establish and maintain regional offices for the purpose of carrying out the duties specified in subsection 7c7 and promoting adequate access to1 and efficient use of1 tertiary care facilities1 equipment1 items1 and services by individuals enrolled under the ,medicare for ,all ,program4 7b7 ,coordination ,wherever possible1 the ,secretary shall incorporate the regional offices and the administrative processes of the ,centers for ,medicare ,medicaid ,services for the purposes of carrying out subsection 7a74 7c7 ,appointment of regional directors ,in each regional office established under subsection 7a7 there shall be-- 7#a7 one regional director appointed by the ,secretary2 7#b7 one deputy director appointed by the regional director to represent the ,indian and ,alaska ,native ,tribes in the region1 if any2 and 7#c7 one deputy director appointed by the regional director to oversee home- and community-based services and supports4 7d7 ,duties ,each regional director shall-- 7#a7 submit an annual regional health care needs assessment report to the ,secretary1 after a thorough examination of health needs and consultation with public health officials1 clinicians1 patients1 and patient advocates2 7#b7 recommend any changes in provider reimbursement or payment for delivery of items and services covered under the ,medicare for ,all ,program determined appropriate by the regional director1 subject to the requirements of title ,,vi2 and 7#c7 establish a quality assurance mechanism in each such region in order to minimize both underutilization and overutilization of health care items and services covered under the ,medicare for ,all ,program and to ensure that all participating providers described in section #cja7;a7 meet the quality and other standards established pursuant to this ,act4 #djd4 ,beneficiary ,ombudsman 7a7 ,in general ,the ,secretary shall appoint a ,beneficiary ,ombudsman who shall have expertise and experience in the fields of health care and education and in providing assistance to individuals entitled to benefits under the ,medicare for ,all ,program4 7b7 ,duties 7#a7 ,in general ,the ,beneficiary ,ombudsman shall-- 7,a7 receive complaints1 grievances1 and requests for information submitted by individuals entitled to benefits under the ,medicare for ,all ,program with respect to any aspect of such ,program2 7,b7 provide assistance with respect to complaints1 grievances1 and requests referred to in subparagraph 7,a71 including-- 7i7 assistance in collecting relevant information for such individuals1 to seek an appeal of a decision or determination made by a regional office or the ,secretary2 and 7ii7 assistance to such individuals in presenting information relating to cost-sharing2 and 7,c7 submit annual reports to ,congress and the ,secretary that describe the activities of the ,office and that include such recommendations for improvement in the administration of this ,act as the ,ombudsman determines appropriate4 7#b7 ,authorities ,the ,ombudsman shall not serve as an advocate for any increases in payments or new coverage of items or services1 but may identify issues and problems in payment or coverage policies4 #dje4 ,conduct of related health programs ,in performing functions with respect to health personnel education and training1 health research1 environmental health1 disability insurance1 vocational rehabilitation1 the regulation of food and drugs1 and all other matters pertaining to health1 the ,secretary shall direct the activities of the ,department of ,health and ,human ,services toward contributions to the health of the people complementary to this ,act4 ,b ,control ,over ,fraud and ,abuse #daa4 ,application of ,federal sanctions to all fraud and abuse under ,medicare for ,all ,program ,the following sections of the ,social ,security ,act shall apply to the ,medicare for ,all ,program in the same manner as they apply to ,state medical assistance plans under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq473 7#a7 ,section #aabh 7#db ,u4,s4,c4 #acbj;a-#g7 7relating to exclusion of individuals and entities74 7#b7 ,section #aabh;,a 7#db ,u4,s4,c4 #acbj;a-#g;a7 7civil monetary penalties74 7#c7 ,section #aabh;,b 7#db ,u4,s4,c4 #acbj;a-#g;b7 7criminal penalties74 7#d7 ,section #aabd 7#db ,u4,s4,c4 #acbj;a-#c7 7relating to disclosure of ownership and related information74 7#e7 ,section #aabf 7#db ,u4,s4,c4 #acbj;a-#e7 7relating to disclosure of certain owners74 7#f7 ,section #ahgg 7#db ,u4,s4,c4 #acienn7 7relating to physician referrals74 ,v ,quality of ,care #eja4 ,quality standards 7a7 ,in general ,all standards and quality measures under this ,act shall be implemented and evaluated by the ,center for ,clinical ,standards and ,quality of the ,centers for ,medicare ,medicaid ,services 7referred to in this title as the ,center7 or such other agencies determined appropriate by the ,secretary1 in coordination with the ,agency for ,healthcare ,research and ,quality and other offices of the ,department of ,health and ,human ,services4 7b7 ,duties of the center ,the ,center shall perform the following duties3 7#a7 ,review and evaluate each practice guideline developed under part ,b of title ,,ix of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bii;b et seq474 ,in so reviewing and evaluating1 the ,center shall determine whether the guideline should be recognized as a national practice guideline in accordance with and subject to section #bjc7;c74 7#b7 ,review and evaluate each standard of quality1 performance measure1 and medical review criterion developed under part ,b of title ,,ix of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bii;b et seq474 ,in so reviewing and evaluating1 the ,center shall determine whether the standard1 measure1 or criterion is appropriate for use in assessing or reviewing the quality of items and services provided by health care institutions or health care professionals4 ,the use of mechanisms that discriminate against people with disabilities is prohibited for use in any value or cost-effectiveness assessments4 ,the ,center shall consider the evidentiary basis for the standard1 and the validity1 reliability1 and feasibility of measuring the standard4 7#c7 ,adoption of methodologies for profiling the patterns of practice of health care professionals and for identifying and notifying outliers4 7#d7 ,development of minimum criteria for competence for entities that can qualify to conduct ongoing and continuous external quality reviews in the administrative regions4 ,such criteria shall require such an entity to be administratively independent of the individual or board that administers the region and shall ensure that such entities do not provide financial incentives to reviewers to favor one pattern of practice over another4 ,the ,center shall ensure coordination and reporting by such entities to ensure national consistency in quality standards4 7#e7 ,submission of a report to the ,secretary annually specifically on findings from outcomes research and development of practice guidelines that may affect the ,secretary's determination of coverage of items and services under section #dja7;a77#a77;,g74 #ejb4 ,addressing health care disparities 7a7 ,evaluating data collection approaches ,the ,center1 in coordination with the ,office of ,health ,equity established under section #agab of the ,public ,health ,service ,act 7as added by section #faf7 and other agencies in the ,department of ,health and ,human ,services determined relevant by the ,secretary1 shall evaluate approaches for the collection of data under this ,act1 to be performed in conjunction with existing quality reporting requirements and programs under this ,act1 that allow for the ongoing1 accurate1 and timely collection of data on disparities in health care items and services and performance on the basis of race1 ethnicity1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 or socioeconomic status4 ,in conducting such evaluation1 the ,center shall consider the following objectives3 7#a7 ,protecting patient privacy4 7#b7 ,minimizing the administrative burdens of data collection and reporting on providers under the ,medicare for ,all ,program4 7#c7 ,improving data on race1 ethnicity1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 and socioeconomic status4 7b7 ,reports to ,congress 7#a7 ,report on evaluation ,not later than #ah months after the date on which benefits are first available under section #ajf7;a71 the ,center shall submit to ,congress and the ,secretary a report on the evaluation conducted under subsection 7a74 ,such report shall1 taking into consideration the results of such evaluation-- 7,a7 identify approaches 7including defining methodologies7 for identifying and collecting and evaluating data on health care disparities on the basis of race1 ethnicity1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 or socioeconomic status under the ,medicare for ,all ,program2 and 7,b7 include recommendations on the most effective strategies and approaches to reporting quality measures1 as appropriate1 on the basis of race1 ethnicity1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 or socioeconomic status4 7#b7 ,report on data analyses ,not later than #d years after the submission of the report under paragraph 7#a71 and every #d years thereafter1 the ,center shall submit to ,congress and the ,secretary a report that includes recommendations for improving the identification of health care disparities based on the analyses of data collected under subsection 7c74 7c7 ,implementing effective approaches ,not later than #b years after the date on which benefits are first available under section #ajf7;a71 the ,secretary shall implement the approaches identified in the report submitted under subsection 7b77#a7 for the ongoing1 accurate1 and timely collection and evaluation of data on health care disparities on the basis of race1 ethnicity1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 or socioeconomic status4 ,,vi ,national ,health ,budget2 ,provider ,payments2 ,cost ,containment ,measures ,a ,budgeting #fja4 ,national health budget 7a7 ,national health budget 7#a7 ,in general ,not later than ,september #a of each year1 beginning with the year prior to the date on which benefits are first available under section #ajf7;a71 the ,secretary shall establish a national health budget1 which specifies a budget for the total expenditures to be made for items and services covered under the ,medicare for ,all ,program4 7#b7 ,division of budget into components ,the national health budget shall consist of at least the following components3 7,a7 ,an operating budget4 7,b7 ,a capital expenditures budget4 7,c7 ,a special projects budget4 7,d7 ,quality assessment activities under title ,v4 7,e7 ,health professional education expenditures4 7,f7 ,administrative costs1 including costs related to the operation of regional offices4 7,g7 ,a reserve fund4 7,h7 ,prevention and public health activities4 7#c7 ,allocation among components ,the ,secretary shall allocate the funds received for purposes of carrying out this ,act among the components described in paragraph 7#b7 in a manner that ensures-- 7,a7 that the operating budget allows for every participating provider in the ,medicare for ,all ,program to meet the needs of their respective patient populations2 7,b7 that the special projects budget is sufficient to meet the health care needs within areas described in paragraph 7#g7 through the construction1 renovation1 and staffing of health care facilities in a reasonable timeframe2 7,c7 a fair allocation for quality assessment activities2 and 7,d7 that the health professional education expenditure component described in paragraph 7#b77;,e7 is sufficient to provide for the amount of health professional education expenditures sufficient to meet the need for items and services covered under the ,medicare for ,all ,program4 7#d7 ,for regional allocation ,the ,secretary shall annually provide each regional office with an allotment the ,secretary determines appropriate for purposes of carrying out this ,act in such region1 including payments to providers in such region1 capital expenditures in such region1 special projects in such region1 health professional education in such region1 administrative expenses in such region1 and prevention and public health activities in such region4 7#e7 ,operating budget ,the operating budget described in paragraph 7#b77;,a7 shall be used for-- 7,a7 payments to institutional providers pursuant to section #faa2 and 7,b7 payments to individual providers pursuant to section #fab4 7#f7 ,capital expenditures budget ,the capital expenditures budget described in paragraph 7#b77;,b7 shall be used for-- 7,a7 the construction or renovation of health care facilities1 excluding congregate or segregated facilities for individuals with disabilities who receive long-term care services and support2 and 7,b7 major equipment purchases4 7#g7 ,special projects budget ,the special projects budget described in paragraph 7#b77;,c7 shall be used for the purposes of allocating funds for the construction of new facilities1 major equipment purchases1 and staffing in rural areas or areas described in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c771 including areas designated as health professional shortage areas 7as defined in section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7771 and to address health disparities1 including racial1 ethnic1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 or socioeconomic health disparities4 7#h7 ,reserve fund ,the reserve fund described in paragraph 7#b77;,g7 shall be used to respond to the costs of an epidemic1 pandemic1 natural disaster1 or other such health emergency1 or market-shift adjustments related to patient volume4 7#i7 ,construction compliance ,expenditures from each component of the national health budget1 including construction1 shall expand accessibility for persons with disabilities to achieve full compliance with the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq474 ,any project funded through the national budget shall at least meet the new construction standards under such ,act4 7b7 ,definitions ,in this section3 7#a7 ,capital expenditures ,the term capital expenditures means expenses for the purchase1 lease1 construction1 or renovation of capital facilities and for major equipment4 7#b7 ,health professional education expenditures ,the term health professional education expenditures means expenditures in hospitals and other health care facilities to cover costs associated with teaching and related research activities1 including the impact of workforce recruitment1 retention1 and diversity on patient outcomes4 #fjb4 ,temporary worker assistance 7a7 ,in general ,for up to #e years following the date on which benefits are first available under section #ajf7;a71 at least #a percent of the national health budget shall be allocated to programs providing assistance to workers who perform functions in the administration of the health insurance system1 or related functions within health care institutions or organizations1 who may experience economic dislocation as a result of the implementation of this ,act4 7b7 ,clarification ,assistance described in subsection 7a7 shall include wage replacement1 retirement benefits1 job training and placement1 preferential hiring1 and education benefits4 ,b ,payments to ,providers #faa4 ,payments to institutional providers based on global budgets 7a7 ,in general ,not later than the beginning of each fiscal quarter during which an institutional provider of care 7including hospitals1 skilled nursing facilities1 and independent dialysis facilities7 is to furnish items and services under the ,medicare for ,all ,program1 the ,secretary shall pay to such institutional provider a lump sum in accordance with the succeeding provisions of this subsection and consistent with the following3 7#a7 ,payment in ,full ,such payment shall be considered as payment in full for all operating expenses for items and services furnished under the ,medicare for ,all ,program1 whether inpatient or outpatient1 by such provider for such quarter1 including outpatient or any other care provided by the institutional provider or provided by any health care provider who provided items and services pursuant to an agreement paid through the global budget as described in paragraph 7#c74 7#b7 ,quarterly ,review ,the regional director1 on a quarterly basis1 shall review whether requirements of the institutional provider's participation agreement and negotiated global budget have been performed and shall determine whether adjustments to such institutional provider's payment are warranted4 ,this review shall include consideration for additional funding necessary for unanticipated items and services for individuals with complex medical needs or market-shift adjustments related to patient volume1 and an assessment of any adjustments made to ensure that accuracy and need for adjustment was appropriate4 7#c7 ,agreements for ,salaried ,payments for ,certain ,providers 7,a7 ,in general ,certain group practices and other health care providers1 as determined by the ,secretary1 with agreements to provide items and services at a specified institutional provider paid a global budget under this subsection may elect to be paid through such institutional provider's global budget in lieu of payment under section #fab4 7,b7 ,salaries ,any individual health care professional of such group practice or other provider receiving payment through an institutional provider's global budget under this paragraph shall be paid on a salaried basis that is equivalent to salaries or other compensation rates negotiated for individual health care professionals of such institutional provider4 7,c7 ,reporting and disclosure requirements ,any group practice or other health care provider that receives payment through an institutional provider's global budget under this paragraph shall be subject to the same reporting and disclosure requirements of the institutional provider4 7#d7 ,interim adjustments ,the regional director shall consider a petition for adjustment of any payment under this section filed by an institutional provider at any time based on the following3 7,a7 ,factors that led to increased costs for the institutional provider that can reasonably be considered to be unanticipated and out of the control of the institutional provider1 such as-- 7i7 natural disasters2 7ii7 public health emergencies including outbreaks of epidemics or infectious diseases2 7iii7 unexpected facility or equipment repairs or purchases2 7iv7 significant and unexpected increases in pharmaceutical or medical device prices2 and 7v7 unanticipated increases in complex or high-cost patients or care needs4 7,b7 ,changes in ,federal or ,state law that result in a change in costs4 7,c7 ,reasonable increases in labor costs1 including salaries and benefits1 and changes in collective bargaining agreements1 prevailing wages1 or local law4 7b7 ,payment amount 7#a7 ,in general ,the amount of each payment to a provider described in subsection 7a7 shall be determined before the start of each calendar year through negotiations between the provider and the regional director with jurisdiction over such provider4 ,such amount shall be based on factors specified in paragraph 7#b74 7#b7 ,payment factors ,payments negotiated pursuant to paragraph 7#a7 shall take into account1 with respect to a provider-- 7,a7 the historical volume of items and services provided for each item and service in the previous #c-year period2 7,b7 the actual expenditures of such provider in such provider's most recent cost report under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for each item and service compared to-- 7i7 such expenditures for other institutional providers in the director's jurisdiction2 and 7ii7 normative payment rates established under comparative payment rate systems1 including any adjustments1 for such items and services2 7,c7 projected changes in the volume and type of items and services to be furnished2 7,d7 wages for employees1 including any necessary increases to ensure mandatory minimum safe registered nurse-to-patient ratios and optimal staffing levels for physicians and other health care workers2 7,e7 the provider's maximum capacity to provide items and services2 7,f7 education and prevention programs2 7,g7 permissible adjustment to the provider's operating budget due to factors such as-- 7i7 an increase in primary or specialty care access2 7ii7 efforts to decrease health care disparities in rural areas or areas described in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c771 including areas designated as health professional shortage areas 7as defined in section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a7772 7iii7 a response to emergent epidemic conditions2 7iv7 an increase in complex or high-cost patients or care needs2 or 7v7 proposed new and innovative patient care programs at the institutional level2 7,h7 whether the provider is located in a high social vulnerability index community1 ,,zip ,code1 or census track1 or is a minority-serving provider2 and 7,i7 any other factor determined appropriate by the ,secretary4 7#c7 ,limitation ,payment amounts negotiated pursuant to paragraph 7#a7 may not-- 7,a7 take into account capital expenditures of the provider or any other expenditure not directly associated with the provision of items and services by the provider to an individual2 7,b7 be used by a provider for capital expenditures or such other expenditures2 7,c7 exceed the provider's capacity to provide care under the ,medicare for ,all ,program2 or 7,d7 be used to pay or otherwise compensate any board member1 executive1 or administrator of the institutional provider who has any interest or relationship prohibited under section #cja7;b77#b74 7#d7 ,limitation on ,compensation ,compensation costs for any employee or any contractor or any subcontractor employee of an institutional provider receiving global budgets under this section shall not exceed the compensation cap established in section #dcjd7;a77#af7 of title #da1 ,united ,states ,code1 as added by section #gjb of the ,bipartisan ,budget ,act of #bjac1 and implementing regulations4 7#e7 ,regional negotiations permitted ,subject to section #fad1 a regional director may negotiate changes to an institutional provider's global budget1 including any adjustments to address unforeseen market shifts related to patient volume4 7c7 ,baseline rates and adjustments 7#a7 ,in general ,the ,secretary shall use existing prospective payment systems under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to serve as the comparative payment rate system in global budget negotiations described in subsection 7b74 ,the ,secretary shall update such comparative payment rate systems annually4 7#b7 ,specifications ,in developing the comparative payment rate system1 the ,secretary shall use only the operating base payment rates under each such prospective payment systems with applicable adjustments4 7#c7 ,limitation ,the comparative rate system established under this subsection shall not include the value-based payment adjustments and the capital expenses base payment rates that may be included in such a prospective payment system4 7#d7 ,initial year ,in the first year that global budget payments under this ,act are available to institutional providers and for purposes of selecting a comparative payment rate system used during initial global budget negotiations for each institutional provider1 the ,secretary shall take into account the appropriate prospective payment system from the most recent year under title ,,xviii of the ,social ,security ,act to determine what operating base payment the institutional provider would have been paid for items and services covered under the ,medicare for ,all ,program furnished the preceding year with applicable adjustments1 including adjustments due to any public health emergencies in the preceding year1 and excluding value-based payment adjustments1 based on such prospective payment system4 7d7 ,operating expenses ,for purposes of this title1 operating expenses of a provider include the following3 7#a7 ,the cost of all items and services associated with the provision of inpatient care and outpatient care1 including the following3 7,a7 ,wages and salary costs for physicians1 nurses1 and other health care practitioners employed by an institutional provider1 including mandatory minimum safe registered nurse-to-patient staffing ratios and optimal staffing levels for physicians and other health care workers4 7,b7 ,wages and salary costs for all ancillary staff and services4 7,c7 ,costs of all pharmaceutical products administered by health care clinicians at the institutional provider's facilities or through items or services provided in accordance with ,state licensing laws or regulations under which the institutional provider operates4 7,d7 ,costs for infectious disease response preparedness1 including maintenance of a #a-year or #cfe-;day stockpile of personal protective equipment1 occupational testing and surveillance1 medical items and services for occupational infectious disease exposure1 and contact tracing4 7,e7 ,purchasing and maintenance of medical devices1 supplies1 and other health care technologies1 including diagnostic testing equipment4 7,f7 ,costs of all incidental items and services necessary for safe patient care and handling4 7,g7 ,costs of patient care1 education1 and prevention programs1 including occupational health and safety programs1 public health programs1 and necessary staff to implement such programs1 for the continued education and health and safety of clinicians and other individuals employed by the institutional provider4 7#b7 ,administrative costs for the institutional provider4 #fab4 ,payments to individual providers through fee-for-service 7a7 ,medicare for all fee schedule 7#a7 ,establishment ,not later than #a year after the date of the enactment of this ,act1 and in consultation with providers and regional office directors1 the ,secretary shall establish and annually update a national fee schedule that establishes amounts for items and services payable under the ,medicare for ,all ,program1 furnished by-- 7,a7 individual providers2 7,b7 providers in group practices who are not receiving payments on a salaried basis described in section #faa7;a77#c72 7,c7 providers of home- and community-based services2 and 7,d7 any other provider not described in section #faa4 7#b7 ,amounts ,in establishing the fee schedule under paragraph 7#a71 the ,secretary shall take into account-- 7,a7 the amounts payable for such items and services under title ,,xviii of the ,social ,security ,act and other ,federal health programs2 and 7,b7 the expertise of providers and the value of items and services furnished by such providers4 7b7 ,leveraging existing medicare payment processes 7#a7 ,application of payment processes under title ,,xviii ,except as otherwise provided in this section1 the ,secretary shall establish1 and shall annually update by regulation1 the fee schedule under subsection 7a7 in a manner that is documented1 is transparent1 allows for public comment1 and1 to the greatest extent practicable1 is consistent with processes for determining1 revising1 and making payments for items and services under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including the application of the provisions of1 and amendments made by1 section #fac4 7#b7 ,electronic billing ,the ,secretary shall establish a uniform national system for electronic billing for purposes of making payments under this section4 7c7 ,application of current and planned payment reforms ,to the extent the ,secretary determines such application is necessary to ensure a smooth and fair transition1 the ,secretary may apply payment reform activities planned or implemented with respect to such title ,,xviii as of the date of the enactment of this ,act1 including demonstrations1 waivers1 or any other provider payment agreements1 to benefits under the ,medicare for ,all ,program1 provided that the ,secretary sets forth a process for reviewing such applications and making such determinations that is reasonable1 transparent1 and documented1 and allows for public comment4 7d7 ,physician practice review board ,each director of a regional office1 in consultation with representatives of physicians practicing in that region1 shall establish and appoint a physician practice review board to assure quality1 cost effectiveness1 and fair reimbursements for physician-delivered items and services4 ,the use of mechanisms that discriminate against people with disabilities is prohibited for use in any value or cost-effectiveness assessments4 #fac4 ,accurate valuation of services under the ,medicare physician fee schedule 7a7 ,standardized and documented review process ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is amended by adding at the end the following new subparagraph3 7,p7 ,standardized and documented review process 7i7 ,in general ,not later than one year after the date of enactment of this subparagraph1 the ,secretary shall establish1 document1 and make publicly available1 in consultation with the ,office of ,primary ,health ,care1 a standardized process for reviewing the relative values of physicians' services under this paragraph4 7ii7 ,minimum requirements ,the standardized process shall include1 at a minimum1 methods and criteria for identifying services for review1 prioritizing the review of services1 reviewing stakeholder recommendations1 and identifying additional resources to be considered during the review process4 4 7b7 ,planned and documented use of funds ,section #ahdh7;c77#b77,m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjew-#d7;c77#b77,m77 is amended by adding at the end the following new clause3 7x7 ,planned and documented use of funds ,for each fiscal year 7beginning with the first fiscal year beginning on or after the date of enactment of this clause71 the ,secretary shall provide to ,congress a written plan for using the funds provided under clause 7ix7 to collect and use information on physicians' services in the determination of relative values under this subparagraph4 4 7c7 ,internal tracking of reviews 7#a7 ,in general ,not later than one year after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a proposed plan for systematically and internally tracking the ,secretary's review of the relative values of physicians' services1 such as by establishing an internal database1 under section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b771 as amended by this section4 7#b7 ,minimum requirements ,the proposal shall include1 at a minimum1 plans and a timeline for achieving the ability to systematically and internally track the following3 7,a7 ,when1 how1 and by whom services are identified for review4 7,b7 ,when services are reviewed or when new services are added4 7,c7 ,the resources1 evidence1 data1 and recommendations used in reviews4 7,d7 ,when relative values are adjusted4 7,e7 ,the rationale for final relative value decisions4 7d7 ,frequency of review ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is amended-- 7#a7 in subparagraph 7,b77i71 by striking #e and inserting #d2 and 7#b7 in subparagraph 7,k77i77,i71 by striking periodically and inserting annually4 7e7 ,consultation with ,medicare ,payment ,advisory ,commission 7#a7 ,in general ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is amended-- 7,a7 in subparagraph 7,b77i71 by inserting in consultation with the ,medicare ,payment ,advisory ,commission1 after ,the ,secretary12 and 7,b7 in subparagraph 7,k77i77,i71 as amended by subsection 7d77#b71 by inserting 1 in coordination with the ,medicare ,payment ,advisory ,commission1 after annually4 7#b7 ,conforming amendments ,section #ahje of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#f7 is amended-- 7,a7 in subsection 7b77#a77;,a71 by inserting the following before the semicolon at the end3 and including coordinating with the ,secretary in accordance with section #ahdh7;c77#b7 to systematically review the relative values established for physicians' services1 identify potentially misvalued services1 and propose adjustments to the relative values for physicians' services2 and 7,b7 in subsection 7e77#a71 in the second sentence1 by inserting or the ,ranking ,minority ,member after the ,chairman4 7f7 ,periodic audit by the ,comptroller ,general ,section #ahdh7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b771 as amended by subsection 7a71 is amended by adding at the end the following new subparagraph3 7,q7 ,periodic audit by the ,comptroller ,general 7i7 ,in general ,the ,comptroller ,general of the ,united ,states 7in this subparagraph referred to as the ,comptroller ,general7 shall periodically audit the review by the ,secretary of relative values established under this paragraph for physicians' services4 7ii7 ,access to information ,the ,comptroller ,general shall have unrestricted access to all deliberations1 records1 and data related to the activities carried out under this paragraph1 in a timely manner1 upon request4 4 #fad4 ,payments for prescription drugs and approved devices and equipment 7a7 ,negotiated prices ,the prices to be paid for pharmaceutical products1 medical supplies1 and medically necessary assistive equipment covered under the ,medicare for ,all ,program shall be negotiated annually by the ,secretary4 7b7 ,prescription drug formulary 7#a7 ,in general ,the ,secretary shall establish a prescription drug formulary system1 pursuant to the requirements of section #bjb1 which shall encourage best-practices in prescribing and discourage the use of ineffective1 dangerous1 or excessively costly medications when better alternatives are available4 7#b7 ,promotion of use of generics ,the formulary under this subsection shall promote the use of generic medications to the greatest extent possible4 7#c7 ,formulary updates and petition rights ,the formulary under this subsection shall be updated frequently and clinicians and patients may petition the ,secretary to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary4 7#d7 ,use of off-formulary medications ,the ,secretary shall promulgate rules regarding the use of off-formulary medications which allow for patient access but do not compromise the formulary4 #fae4 ,payment prohibitions2 capital expenditures2 special projects 7a7 ,prohibitions ,payments to participating providers described in section #cja7;a7 may not take into account1 include any process for the provision of funding for1 or be used by a provider for-- 7#a7 marketing of the provider2 7#b7 the profit or net revenue of the provider1 or increasing the profit or net revenue of the provider2 7#c7 any agreement or arrangement described in section #bjc7;a77#d7 of the ,labor-,management ,reporting and ,disclosure ,act of #aiei 7#bi ,u4,s4,c4 #dcc7;a77#d772 or 7#d7 political or other contributions prohibited under section #cag7;a77#a7 of the ,federal ,elections ,campaign ,act of #aiga 7#eb ,u4,s4,c4 #cjaai7;a77#a774 7b7 ,payments for capital expenditures 7#a7 ,in general ,the ,secretary shall pay1 from amounts made available for capital expenditures pursuant to section #fja7;a77#b77;,b71 such sums determined appropriate by the ,secretary to providers who have submitted an application to the regional director of the region or regions in which the provider operates or seeks to operate in a time and manner specified by the ,secretary for purposes of funding capital expenditures of such providers4 7#b7 ,priority ,the ,secretary shall prioritize allocation of funding under paragraph 7#a7 to projects that propose to use such funds to improve items and services for medically underserved populations and areas described in section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c77 or to address health disparities1 including racial1 ethnic1 national origin1 primary language use1 age1 disability1 sex 7including gender identity and sexual orientation71 geography1 or socioeconomic health disparities4 7#c7 ,limitation ,the ,secretary shall not grant funding for capital expenditures under this subsection for capital projects that are financed directly or indirectly through the diversion of private or other non-,medicare for ,all ,program funding that results in reductions in care to patients1 including reductions in registered nursing staffing patterns and changes in emergency room or primary care services or availability4 7#d7 ,capital assets not funded by the ,medicare for ,all ,program ,operating expenses and funds shall not be used by an institutional provider receiving payment for capital expenditures under this subsection for a capital asset that was not funded by the ,medicare for ,all ,program without the approval of the regional director or directors of the region or regions where the capital asset is located4 7c7 ,prohibition against co-,mingling operating and capital funds ,providers that receive payment under this title shall be prohibited from using1 with respect to funds made available under this ,act-- 7#a7 funds designated for operating expenditures for capital expenditures or for profit2 or 7#b7 funds designated for capital expenditures for operating expenditures4 7d7 ,payments for special projects 7#a7 ,in general ,the ,secretary shall allocate to each regional director1 from amounts made available for special projects pursuant to section #fja7;a77#b77;,c71 such sums determined appropriate by the ,secretary for purposes of funding projects described in such section1 including the construction1 renovation1 or staffing of health care facilities in rural1 underserved1 or health professional or medical shortage areas within such region and to address health disparities1 including racial1 ethnic1 national origin1 primary language use1 age1 disability1 sex1 including gender identity and sexual orientation1 geography1 or socioeconomic health disparities4 ,each regional director shall1 prior to distributing such funds in accordance with paragraph 7#b71 present a budget describing how such funds will be distributed to the ,secretary4 7#b7 ,distribution ,a regional director shall distribute funds to providers operating in the region of such director's jurisdiction in a manner determined appropriate by the director4 7e7 ,prohibition on financial incentive metrics in payment determinations ,the ,secretary may not utilize any quality metrics or standards for the purposes of establishing provider payment methodologies1 programs1 modifiers1 or adjustments for provider payments under this title4 #faf4 ,office of ,health ,equity ,title ,,xvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju et seq47 is amended by adding at the end the following3 #agab4 ,office of ,health ,equity 7a7 ,in general ,there is established1 in the ,office of the ,secretary of ,health and ,human ,services1 an ,office of ,health ,equity1 to be headed by a ,director1 to ensure coordination and collaboration across the programs and activities of the ,department of ,health and ,human ,services with respect to ensuring health equity4 7b7 ,monitoring1 tracking1 and availability of data 7#a7 ,in general ,in carrying out subsection 7a71 the ,director of the ,office of ,health ,equity shall monitor1 track1 and make publicly available data on-- 7,a7 the disproportionate burden of disease and death among people of color1 disaggregated by race1 major ethnic group1 ,tribal affiliation1 national origin1 primary language use1 ,english proficiency status1 immigration status1 length of stay in the ,united ,states1 age1 disability1 sex 7including gender identity and sexual orientation71 incarceration1 homelessness1 geography1 and socioeconomic status2 7,b7 barriers to health1 including such barriers relating to income1 education1 housing1 food insecurity 7including availability1 access1 utilization1 and stability71 employment status1 working conditions1 and conditions related to the physical environment 7including pollutants1 population density1 and accessibility72 7,c7 barriers to health care access1 including-- 7i7 lack of trust and awareness2 7ii7 lack of transportation2 7iii7 lack of accessibility2 7iv7 geography2 7v7 hospital and service closures2 7vi7 lack of health care infrastructure and facilities2 and 7vii7 lack of health care professional staffing and recruitment2 7,d7 disparities in quality of care received1 including discrimination in health care settings and the use of racially biased practice guidelines and algorithms2 and 7,e7 disparities in utilization of care4 7#b7 ,analysis of cross-sectional information ,the ,director of the ,office of ,health ,equity shall ensure that the data collection and reporting process under paragraph 7#a7 allows for the analysis of cross-sectional information on people's identities4 7c7 ,policies ,in carrying out subsection 7a71 the ,director of the ,office of ,health ,equity shall develop1 coordinate1 and promote policies that enhance health equity1 including by-- 7#a7 providing recommendations on-- 7,a7 cultural competence1 implicit bias1 and ethics training with respect to health care workers2 7,b7 increasing diversity in the health care workforce2 and 7,c7 ensuring sufficient health care professionals and facilities2 and 7#b7 ensuring adequate public health funding at the local and ,state levels to address health disparities4 7d7 ,consultation ,in carrying out subsection 7a71 the ,director of the ,office of ,health ,equity1 in coordination with the ,director of the ,indian ,health ,service1 shall consult with ,indian ,tribes and with urban ,indian organizations on data collection1 reporting1 and implementation of policies4 7e7 ,annual report ,in carrying out subsection 7a71 the ,director of the ,office of ,health ,equity shall develop and publish an annual report on-- 7#a7 statistics collected by the ,office2 7#b7 proposed evidence-based solutions to mitigate health inequities2 and 7#c7 health care professional staffing levels and access to facilities4 7f7 ,centralized electronic repository ,in carrying out subsection 7a71 the ,director of the ,office of ,health ,equity shall-- 7#a7 establish and maintain a centralized electronic repository to incorporate data collected across ,federal departments and agencies on race1 ethnicity1 ,tribal affiliation1 national origin1 primary language use1 ,english proficiency status1 immigration status1 length of stay in the ,united ,states1 age1 disability1 sex 7including gender identity and sexual orientation71 incarceration1 homelessness1 geography1 and socioeconomic status2 and 7#b7 make such data available for public use and analysis4 7g7 ,privacy ,notwithstanding any other ,federal or ,state law1 no ,federal or ,state official or employee or other entity shall disclose1 or use1 for any law enforcement or immigration purpose1 any personally identifiable information 7including with respect to an individual's religious beliefs1 practices1 or affiliation1 national origin1 ethnicity1 or immigration status7 that is collected or maintained pursuant to this section4 4 #fag4 ,office of ,primary ,health ,care ,title ,,xvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju et seq471 as amended by section #faf1 is further amended by adding at the end the following3 #agac4 ,office of ,primary ,health ,care 7a7 ,in general ,there is established1 in the ,office of ,health ,equity established under section #agab1 an ,office of ,primary ,health ,care1 to be headed by a ,director1 to ensure coordination and collaboration across the programs and activities of the ,department of ,health and ,human ,services with respect to increasing access to high-quality primary health care1 particularly in underserved areas and for underserved populations4 7b7 ,national ,goals ,not later than #a year after the date of enactment of this section1 the ,director of the ,office of ,primary ,health ,care shall publish national goals-- 7#a7 to increase access to high-quality primary health care1 particularly in underserved areas and for underserved populations2 and 7#b7 to address health disparities1 including with respect to race1 ethnicity1 national origin 7disaggregated by major ethnic group and ,tribal affiliation71 primary language use1 ,english proficiency status1 immigration status1 length of stay in the ,united ,states1 age1 disability1 sex 7including gender identity and sexual orientation71 incarceration1 homelessness1 geography1 and socioeconomic status4 7c7 ,other responsibilities ,in carrying out subsections 7a7 and 7b71 the ,director of the ,office of ,primary ,health ,care shall-- 7#a7 coordinate1 in consultation with the ,secretary1 health professional education policies and goals to achieve the national goals published pursuant to subsection 7b72 7#b7 develop and maintain a system to monitor the number and specialties of individuals pursuing careers in1 or practicing1 primary health care through their health professional education1 any postgraduate training1 and professional practice2 7#c7 develop1 coordinate1 and promote policies that expand the number of primary health care practitioners including primary medical1 dental1 and behavioral health care providers1 registered nurses1 and other advanced practice clinicians2 7#d7 recommend appropriate workforce training1 technical assistance1 and patient protection enhancements for primary health care practitioners1 including registered nurses1 to achieve uniform high quality and patient safety2 7#e7 provide recommendations on targeted programs and resources for ,federally qualified health centers1 community health centers1 rural health centers1 behavioral health clinics1 and other community-based organizations2 7#f7 provide recommendations for broader patient referral to additional resources1 not limited to health care1 and collaboration with other organizations and sectors that influence health outcomes2 and 7#g7 consult with the ,secretary on the allocation of the special projects budget under section #fja7;a77#b77;,c7 of the ,medicare for ,all ,act4 7d7 ,rule of construction ,nothing in this section shall be construed-- 7#a7 to preempt any provision of ,state law establishing practice standards or guidelines for health care professionals1 including professional licensing or practice laws or regulations2 or 7#b7 to require that any ,state impose additional educational standards or guidelines for health care professionals4 4 ,,vii ,medicare for ,all ,trust ,fund #gja4 ,medicare for ,all ,trust ,fund 7a7 ,in general ,there is hereby created on the books of the ,treasury of the ,united ,states a trust fund to be known as the ,medicare for ,all ,trust ,fund 7in this section referred to as the ,trust ,fund74 ,the ,trust ,fund shall consist of such gifts and bequests as may be made and such amounts as may be deposited in1 or appropriated to1 such ,trust ,fund as provided in this ,act4 7b7 ,appropriations into trust fund 7#a7 ,taxes ,there are appropriated to the ,trust ,fund for each fiscal year beginning with the fiscal year which includes the date on which benefits are first available under section #ajf7;a71 out of any moneys in the ,treasury not otherwise appropriated1 amounts equivalent to #ajj percent of the net increase in revenues to the ,treasury which is attributable to the amendments made by section #hja and section #ijb4 ,the amounts appropriated by the preceding sentence shall be transferred from time to time 7but not less frequently than monthly7 from the general fund in the ,treasury to the ,trust ,fund1 such amounts to be determined on the basis of estimates by the ,secretary of the ,treasury of the taxes paid to or deposited into the ,treasury1 and proper adjustments shall be made in amounts subsequently transferred to the extent prior estimates were in excess of or were less than the amounts that should have been so transferred4 7#b7 ,current program receipts 7,a7 ,initial year ,notwithstanding any other provision of law1 there is hereby appropriated to the ,trust ,fund for the first fiscal year beginning at least one year after the date of the enactment of this ,act1 an amount equal to the aggregate amount appropriated for the preceding fiscal year for the following 7increased by the consumer price index for all urban consumers for the fiscal year involved73 7i7 ,the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 7other than amounts attributable to any premiums under such title74 7ii7 ,the ,medicaid program under ,state plans approved under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7iii7 ,the ,federal ,employees ,health ,benefits program1 under chapter #hi of title #e1 ,united ,states ,code4 7iv7 ,the maternal and child health program 7under title ,v of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq4771 vocational rehabilitation programs1 programs for drug abuse and mental health services under the ,public ,health ,service ,act1 programs providing general hospital or medical assistance1 and any other ,federal program identified by the ,secretary1 in consultation with the ,secretary of the ,treasury1 to the extent the programs provide for payment for health care items and services the payment of which may be made under this ,act4 7,b7 ,subsequent years ,notwithstanding any other provision of law1 there is appropriated to the ,trust ,fund for each fiscal year following the fiscal year in which the appropriation is made under subparagraph 7,a71 an amount equal to the amount appropriated to the ,trust ,fund for the previous year1 adjusted for reductions in costs resulting from the implementation of this ,act1 changes in the consumer price index for all urban consumers for the fiscal year involved1 and other factors determined appropriate by the ,secretary4 7#c7 ,restrictions shall not apply ,any other provision of law in effect on the date of enactment of this ,act restricting the use of ,federal funds for any reproductive health item or service shall not apply to monies in the ,trust ,fund4 7c7 ,incorporation of provisions ,the provisions of subsections 7b7 through 7i7 of section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 shall apply to the ,trust ,fund under this section in the same manner as such provisions applied to the ,federal ,hospital ,insurance ,trust ,fund under such section #ahag1 except that1 for purposes of applying such subsections to this section1 the ,board of ,trustees of the ,trust ,fund or the ,board of ,trustees shall mean the ,secretary4 7d7 ,transfer of funds ,any amounts remaining in the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 or the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet7 after the payment of claims for items and services furnished under title ,,xviii of such ,act have been completed1 shall be transferred into the ,medicare for ,all ,trust ,fund under this section4 ,,viii ,conforming ,amendments to the ,employee ,retirement ,income ,security ,act of #aigd #hja4 ,prohibition of employee benefits duplicative of benefits under the ,medicare for ,all ,program2 coordination in case of workers' compensation 7a7 ,in general ,part #e of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaca et seq47 is amended by adding at the end the following new section3 #ebd4 ,prohibition of employee benefits duplicative of ,medicare for ,all ,program benefits2 coordination in case of workers' compensation 7a7 ,in general ,subject to subsection 7b71 no employee benefit plan may provide benefits that duplicate payment for any items or services for which payment may be made under the ,medicare for ,all ,program established under section #aja of the ,medicare for ,all ,act 7referred to in this section as the ,medicare for ,all ,program74 7b7 ,reimbursement ,each workers compensation carrier that is liable for payment for workers compensation services furnished in a ,state shall reimburse the ,medicare for ,all ,program for the cost of such services4 7c7 ,definitions ,in this subsection-- 7#a7 the term workers compensation carrier means an insurance company that underwrites workers compensation medical benefits with respect to one or more employers and includes an employer or fund that is financially at risk for the provision of workers compensation medical benefits2 7#b7 the term workers compensation medical benefits means1 with respect to an enrollee who is an employee subject to the workers compensation laws of a ,state1 the comprehensive medical benefits for work-related injuries and illnesses provided for under such laws with respect to such an employee2 and 7#c7 the term workers compensation services means items and services included in workers compensation medical benefits and includes items and services 7including rehabilitation items and services and long-term care items and services7 commonly used for treatment of work-related injuries and illnesses4 4 7b7 ,conforming amendment ,section #d7;b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjc7;b77 is amended by adding at the end the following3 ,paragraph 7#c7 shall apply subject to section #ebd7;b7 7relating to reimbursement of the ,medicare for ,all ,program by workers compensation carriers744 7c7 ,clerical amendment ,the table of contents in section #a of such ,act is amended by inserting after the item relating to section #ebc the following new item3 ,sec4 #ebd4 ,prohibition of employee benefits duplicative of ,medicare for ,all ,program benefits2 coordination in case of workers' compensation4 4 #hjb4 ,repeal of continuation coverage requirements under ,,erisa and certain other requirements relating to group health plans 7a7 ,in general ,part #f of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aafa et seq47 is repealed4 7b7 ,conforming amendments 7#a7 ,section #ejb7;a7 of such ,act 7#bi ,u4,s4,c4 #aacb7;a77 is amended-- 7,a7 by striking paragraph 7#g72 and 7,b7 by redesignating paragraphs 7#h71 7#i71 and 7#aj7 as paragraphs 7#g71 7#h71 and 7#i71 respectively4 7#b7 ,section #ejb7;c77#a7 of such ,act 7#bi ,u4,s4,c4 #aacb7;c77#a77 is amended by striking paragraph 7#a7 or 7#d7 of section #fjf14 7#c7 ,section #ejb7;e7 of such ,act 7#bi ,u4,s4,c4 #aacb7;e77 is amended by striking paragraphs 7#a77;,b7 and 7#g7 and inserting paragraph 7#a77;,b74 7#d7 ,section #ejb7l77#c77;,b7 of such ,act 7#bi ,u4,s4,c4 #aacb7l77#c77;,b77 is amended by striking subsection 7a77#i7 and inserting subsection 7a77#h74 7#e7 ,section #ead7;b7 of such ,act 7#bi ,u4,s4,c4 #aadd7;b77 is amended-- 7,a7 in paragraph 7#g71 by striking section #bjf7;d77#c77;,b77i7712 and 7,b7 by striking paragraph 7#h74 7#f7 ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd is amended by striking the items relating to part #f of subtitle ,b of title ,i of such ,act4 #hjc4 ,effective date of title ,the provisions of and amendments made by this title shall take effect on the date on which benefits are first available under section #ajf7;a74 ,,ix ,additional ,conforming ,amendments #ija4 ,relationship to existing ,federal health programs 7a7 ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance ,program 7,,schip7 7#a7 ,in general ,notwithstanding any other provision of law1 subject to paragraphs 7#b7 and 7#c7-- 7,a7 no benefits shall be available under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for any item or service furnished beginning on or after the date on which benefits are first available under section #ajf7;a72 7,b7 no individual is entitled to medical assistance under a ,state plan approved under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 for any item or service furnished on or after such date2 7,c7 no individual is entitled to medical assistance under a ,state child health plan under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 for any item or service furnished on or after such date2 and 7,d7 no payment shall be made to a ,state under section #aijc7;a7 or #baje7;a7 of such ,act 7#db ,u4,s4,c4 #acif;b7a72 #db ,u4,s4,c4 #acig;ee7 with respect to medical assistance or child health assistance for any item or service furnished on or after such date4 7#b7 ,transition ,in the case of inpatient hospital services and extended care services during a continuous period of stay which began before the date on which benefits are first available under section #ajf7;a71 and which had not ended as of such date1 for which benefits are provided under title ,,xviii of the ,social ,security ,act1 under a ,state plan under title ,,xix of such ,act1 or under a ,state child health plan under title ,,xxi of such ,act1 the ,secretary shall provide for continuation of benefits under such title or plan until the end of the period of stay4 7#c7 ,continued coverage of long-term care and other certain services under ,medicaid 7,a7 ,in general ,this subsection shall not apply to entitlement to medical assistance provided under title ,,xix of the ,social ,security ,act for-- 7i7 institutional long-term care services 7as defined in section #aidh7;b7 of such ,act72 or 7ii7 any other service for which benefits are not available under the ,medicare for ,all ,program and which is furnished under a ,state plan under title ,,xix of the ,social ,security ,act which provided for medical assistance for such service on ,january #a1 #bjbc4 7,b7 ,coordination between ,secretary and ,states ,the ,secretary shall coordinate with the directors of ,state agencies responsible for administering ,state plans under title ,,xix of the ,social ,security ,act to-- 7i7 identify items and services described in subparagraph 7,a77ii7 with respect to each ,state plan2 and 7ii7 ensure that such items and services continue to be made available under such plan4 7,c7 ,state maintenance of effort requirement ,with respect to any service described in subparagraph 7,a77ii7 that is made available under a ,state plan under title ,,xix of the ,social ,security ,act1 the maintenance of effort requirements described in section #aidh7;c7 of such ,act 7related to eligibility standards and required expenditures7 shall apply to such service in the same manner that such requirements apply to institutional long-term care services 7as defined in section #aidh7;b7 of such ,act74 7b7 ,federal employees health benefits program ,no benefits shall be made available under chapter #hi of title #e1 ,united ,states ,code1 with respect to items and services furnished to any individual eligible to enroll under the ,medicare for ,all ,program4 7c7 ,treatment of benefits for veterans and native americans 7#a7 ,in general ,nothing in this ,act shall affect the eligibility of veterans for the medical benefits and services provided under title #ch1 ,united ,states ,code1 the eligibility of individuals for ,,tricare medical benefits and services provided under sections #ajgi and #ajhf of title #aj1 ,united ,states ,code1 or of ,indians for the medical benefits and services provided by or through the ,indian ,health ,service4 7#b7 ,reevaluation ,no reevaluation of the ,indian ,health ,service shall be undertaken without consultation with ,tribal leaders and stakeholders4 #ijb4 ,sunset of provisions related to the ,federal and ,state ,exchanges ,effective on the date on which benefits are first available under section #ajf7;a71 the ,federal and ,state ,exchanges established pursuant to title ,i of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 shall terminate1 and any other provision of law that relies upon participation in or enrollment through such an ,exchange1 including such provisions of the ,internal ,revenue ,code of #aihf1 shall cease to have force or effect4 ,x ,transition to ,medicare for ,all ,a ,improvements to ,medicare #ajja4 ,protecting ,medicare fee-for-service beneficiaries from high out-of-pocket costs 7a7 ,protection against high out-of-,pocket expenditures ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,protection ,against ,high ,out-of-,pocket ,expenditures 7a7 ,in general ,notwithstanding any other provision of this title1 in the case of an individual entitled to1 or enrolled for1 benefits under part ,a or enrolled in part ,b1 if the amount of the out-of-pocket cost-sharing of such individual for a year 7effective the year beginning ,january #a of the year following the date of enactment of the ,medicare for ,all ,act7 equals or exceeds #a1ejj1 the individual shall not be responsible for additional out-of-pocket cost-sharing that occurred during that year4 7b7 ,out-of-,pocket cost-,sharing defined 7#a7 ,in general ,subject to paragraphs 7#b7 and 7#c71 in this section1 the term out-of-pocket cost-sharing means1 with respect to an individual1 the amount of the expenses incurred by the individual that are attributable to-- 7,a7 coinsurance and copayments applicable under part ,a or ,b2 or 7,b7 for items and services that would have otherwise been covered under part ,a or ,b but for the exhaustion of those benefits4 7#b7 ,certain costs not included 7,a7 ,non-covered items and services ,expenses incurred for items and services which are not included 7or treated as being included7 under part ,a or ,b shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph 7#a74 7,b7 ,items and services not furnished on an assignment-related basis ,if an item or service is furnished to an individual under this title and is not furnished on an assignment-related basis1 any additional expenses the individual incurs above the amount the individual would have incurred if the item or service was furnished on an assignment-related basis shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph 7#a74 7#c7 ,source of payment ,for purposes of paragraph 7#a71 the ,secretary shall consider expenses to be incurred by the individual without regard to whether the individual or another person1 including a ,state program or other third-party coverage1 has paid for such expenses4 4 7b7 ,elimination of parts ,a and ,b deductibles 7#a7 ,part ,a ,section #ahac7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;e7b77 is amended by adding at the end the following new paragraph3 7#d7 ,for each year 7beginning ,january #a of the year following the date of enactment of the ,medicare for ,all ,act71 the inpatient hospital deductible for the year shall be #j4 4 7#b7 ,part ,b ,section #ahcc7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b77 is amended1 in the first sentence-- 7,a7 by striking and for a subsequent year and inserting for each of #bjjf through the year that includes the date of enactment of the ,medicare for ,all ,act2 and 7,b7 by inserting 1 and #j for each year subsequent year after #a74 #ajjb4 ,reducing ,medicare part ,d annual out-of-pocket threshold ,section #ahfj;,d-#b7;b77#d77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;b77#d77;,b77 is amended-- 7#a7 in clause 7i71 by striking ,for purposes and inserting ,subject to clause 7iii71 for purposes2 and 7#b7 by adding at the end the following new clause3 7iii7 ,reduction in threshold during transition period 7,i7 ,in general ,subject to subclause 7,,ii71 for plan years beginning on or after ,january #a following the date of enactment of the ,medicare for ,all ,act and before ,january #a of the year that is #d years following such date of enactment1 notwithstanding clauses 7i7 and 7ii71 the annual out-of-pocket threshold specified in this subparagraph is equal to #cjj4 7,,ii7 ,authority to exempt brand-name drugs if generic available ,in applying subclause 7,i71 the ,secretary may exempt costs incurred for a covered part ,d drug that is an applicable drug under section #ahfj;,d-#ad;,a7g77#b7 if the ,secretary determines that a generic version of that drug is available4 4 #ajjc4 ,expanding ,medicare to cover dental and vision services and hearing aids and examinations under part ,b 7a7 ,dental services 7#a7 ,removal of exclusion from coverage ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is amended by striking paragraph 7#ab74 7#b7 ,coverage 7,a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7i7 in subparagraph 7,,jj71 by inserting and at the end2 and 7ii7 by adding at the end the following new subparagraph3 7,,kk7 dental services2 4 7,b7 ,payment ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7i7 by striking and before 7,,hh72 and 7ii7 by inserting before the semicolon at the end the following3 and 7,,ii7 with respect to dental services described in section #ahfa7s77#b77,,kk71 the amount paid shall be an amount equal to #hj percent of the lesser of the actual charge for the services or the amount determined under the fee schedule established under section #ahdh7;b744 7,c7 ,effective date ,the amendments made by this subsection shall apply to items and services furnished on or after ,january #a following the date of the enactment of this ,act4 7b7 ,vision services 7#a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 as amended by subsection 7a71 is amended-- 7,a7 in subparagraph 7,,jj71 by striking and at the end2 7,b7 in subparagraph 7,,kk71 by inserting and at the end2 and 7,c7 by adding at the end the following new subparagraph3 7,,ll7 vision services2 4 7#b7 ,payment ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 as amended by subsection 7a71 is amended-- 7,a7 by striking and before 7,,ii72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,jj7 with respect to vision services described in section #ahfa7s77#b77,,ll71 the amount paid shall be an amount equal to #hj percent of the lesser of the actual charge for the services or the amount determined under the fee schedule established under section #ahdh7;b744 7#c7 ,effective date ,the amendments made by this subsection shall apply to items and services furnished on or after ,january #a following the date of the enactment of this ,act4 7c7 ,hearing aids and examinations therefor 7#a7 ,in general ,section #ahfb7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#g77 is amended by striking hearing aids or examinations therefor14 7#b7 ,effective date ,the amendment made by this subsection shall apply to items and services furnished on or after ,january #a following the date of the enactment of this ,act4 #ajjd4 ,eliminating the #bd-month waiting period for ,medicare coverage for individuals with disabilities 7a7 ,in general ,section #bbf7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7;b77 is amended-- 7#a7 in paragraph 7#b77;,a71 by striking 1 and has for #bd calendar months been entitled to12 7#b7 in paragraph 7#b77;,b71 by striking 1 and has been for not less than #bd months12 7#c7 in paragraph 7#b77;,c77ii71 by striking 1 including the requirement that he has been entitled to the specified benefits for #bd months12 7#d7 in the first sentence1 by striking for each month beginning with the later of 7,i7 ,july #aigc or 7,,ii7 the twenty-fifth month of his entitlement or status as a qualified railroad retirement beneficiary described in paragraph 7#b71 and and inserting for each month for which the individual meets the requirements of paragraph 7#b71 beginning with the month following the month in which the individual meets the requirements of such paragraph1 and2 and 7#e7 in the second sentence1 by striking the twenty-fifth month of his entitlement and all that follows through paragraph 7#b77;,c7 and4 7b7 ,conforming amendments 7#a7 ,section #bbf ,section #bbf of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7 is amended-- 7,a7 by striking subsections 7e77#a77;,b71 7f71 and 7h72 and 7,b7 by redesignating subsections 7g7 and 7i7 as subsections 7f7 and 7g71 respectively4 7#b7 ,medicare description ,section #ahaa7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7#b77 is amended by striking have been entitled for not less than #bd months and inserting are entitled4 7#c7 ,medicare coverage ,section #ahcg7;g77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7g77#a77 is amended by striking #beth month of and inserting month following the first month of4 7#d7 ,railroad retirement system ,section #g7;d77#b77;ii7 of the ,railroad ,retirement ,act of #aigd 7#de ,u4,s4,c4 #bca;f7d77#b77;ii77 is amended-- 7,a7 by striking has been entitled to an annuity and inserting is entitled to an annuity2 7,b7 by striking 1 for not less than #bd months2 and 7,c7 by striking could have been entitled for #bd calendar months1 and4 7c7 ,effective date ,the amendments made by this section shall apply to insurance benefits under title ,,xviii of the ,social ,security ,act with respect to items and services furnished in months beginning after ,december #a following the date of enactment of this ,act1 and before ,january #a of the year that is #d years after such date of enactment4 #ajje4 ,guaranteed issue of ,medigap policies ,section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 is amended by adding at the end the following new subsection3 7aa7 ,guaranteed issue for all ,medigap-,eligible ,medicare beneficiaries ,notwithstanding paragraphs 7#b77;,a7 and 7#b77;,d7 of subsection 7s7 or any other provision of this section1 on or after the date of enactment of this subsection1 the issuer of a ,medicare supplemental policy may not deny or condition the issuance or effectiveness of a ,medicare supplemental policy1 or discriminate in the pricing of the policy1 because of health status1 claims experience1 receipt of health care1 or medical condition in the case of any individual entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b4 4 ,b ,temporary ,medicare ,buy-,in ,option and ,temporary ,public ,option #ajaa4 ,lowering the ,medicare age 7a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq471 as amended by section #ajja1 is amended by adding at the end the following new section3 #ahii;,d4 ,temporary ,medicare ,buy-,in ,option for ,certain ,individuals 7a7 ,no effect on other benefits for individuals otherwise eligible or on ,trust ,funds ,the ,secretary shall implement the provisions of this section in such a manner to ensure that such provisions-- 7#a7 have no effect on the benefits under this title for individuals who are entitled to1 or enrolled for1 such benefits other than through this section2 and 7#b7 have no negative impact on the ,federal ,hospital ,insurance ,trust ,fund or the ,federal ,supplementary ,medical ,insurance ,trust ,fund 7including the ,medicare ,prescription ,drug ,account within such ,trust ,fund74 7b7 ,option 7#a7 ,in general ,every individual who meets the requirements described in paragraph 7#c7 shall be eligible to enroll under this section4 7#b7 ,part ,a1 ,b1 and ,d benefits ,an individual enrolled under this section is entitled to the same benefits 7and shall receive the same protections7 under this title as an individual who is entitled to benefits under part ,a and enrolled under parts ,b and ,d1 including the ability to enroll in a private plan that provides qualified prescription drug coverage4 7#c7 ,requirements for eligibility ,the requirements described in this paragraph are the following3 7,a7 ,the individual is a resident of the ,united ,states4 7,b7 ,the individual is-- 7i7 a citizen or national of the ,united ,states2 or 7ii7 an alien lawfully admitted for permanent residence4 7,c7 ,the individual is not otherwise entitled to benefits under part ,a or eligible to enroll under part ,a or part ,b4 7,d7 ,the individual has attained the applicable years of age but has not attained #fe years of age4 7#d7 ,applicable years of age defined ,for purposes of this section1 the term applicable years of age means-- 7,a7 effective ,january #a of the first year following the date of enactment of the ,medicare for ,all ,act1 the age of #ee2 7,b7 effective ,january #a of the second year following such date of enactment1 the age of #de2 and 7,c7 effective ,january #a of the third year following such date of enactment1 the age of #ce4 7c7 ,enrollment2 coverage ,the ,secretary shall establish enrollment periods and coverage under this section consistent with the principles for establishment of enrollment periods and coverage for individuals under other provisions of this title4 ,the ,secretary shall establish such periods so that coverage under this section shall first begin on ,january #a of the year on which an individual first becomes eligible to enroll under this section4 7d7 ,premium 7#a7 ,amount of monthly premiums ,the ,secretary shall1 during ,september of each year 7beginning with the first ,september following the date of enactment of the ,medicare for ,all ,act71 determine a monthly premium for all individuals enrolled under this section4 ,such monthly premium shall be equal to #a_/ab of the annual premium computed under paragraph 7#b77;,b71 which shall apply with respect to coverage provided under this section for any month in the succeeding year4 7#b7 ,annual premium 7,a7 ,combined per capita average for all ,medicare benefits ,the ,secretary shall estimate the average1 annual per capita amount for benefits and administrative expenses that will be payable under parts ,a1 ,b1 and ,d in the year for all individuals enrolled under this section4 7,b7 ,annual premium ,the annual premium under this subsection for months in a year is equal to the average1 annual per capita amount estimated under subparagraph 7,a7 for the year4 7#c7 ,increased premium for complementary plans ,nothing in this section shall preclude an individual from choosing a prescription drug plan or other complementary plans which requires the individual to pay an additional amount 7because of supplemental benefits or because it is a more expensive plan74 ,in such case the individual would be responsible for the increased monthly premium4 7e7 ,payment of premiums 7#a7 ,in general ,premiums for enrollment under this section shall be paid to the ,secretary at such times1 and in such manner1 as the ,secretary determines appropriate4 7#b7 ,deposit ,amounts collected by the ,secretary under this section shall be deposited in the ,federal ,hospital ,insurance ,trust ,fund and the ,federal ,supplementary ,medical ,insurance ,trust ,fund 7including the ,medicare ,prescription ,drug ,account within such ,trust ,fund7 in such proportion as the ,secretary determines appropriate4 7f7 ,not eligible for ,medicare cost-,sharing assistance ,an individual enrolled under this section shall not be treated as enrolled under any part of this title for purposes of obtaining medical assistance for ,medicare cost-sharing or otherwise under title ,,xix4 7g7 ,treatment in relation to the ,affordable ,care ,act 7#a7 ,satisfaction of individual mandate ,for purposes of applying section #ejjj;,a of the ,internal ,revenue ,code of #aihf1 the coverage provided under this section constitutes minimum essential coverage under subsection 7f77#a77;,a77i7 of such section #ejjj;,a4 7#b7 ,eligibility for premium assistance ,coverage provided under this section-- 7,a7 shall be treated as coverage under a qualified health plan in the individual market enrolled in through the ,exchange where the individual resides for all purposes of section #cf;,b of the ,internal ,revenue ,code of #aihf other than subsection 7c77#b77;,b7 thereof2 and 7,b7 shall not be treated as eligibility for other minimum essential coverage for purposes of subsection 7c77#b77;,b7 of such section #cf;,b4 ,the ,secretary shall determine the applicable second lowest cost silver plan which shall apply to coverage under this section for purposes of section #cf;,b of such ,code4 7#c7 ,eligibility for cost-sharing subsidies ,for purposes of applying section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7-- 7,a7 coverage provided under this section shall be treated as coverage under a qualified health plan in the silver level of coverage in the individual market offered through an ,exchange2 and 7,b7 the ,secretary shall be treated as the issuer of such plan4 7h7 ,consultation ,in promulgating regulations to implement this section1 the ,secretary shall consult with interested parties1 including groups representing beneficiaries1 health care providers1 employers1 and insurance companies4 4 #ajab4 ,establishment of the ,medicare transition plan 7a7 ,in general ,to carry out the purpose of this section1 for plan years beginning with the first plan year that begins after the date of enactment of this ,act and ending with the date on which benefits are first available under section #ajf7;a71 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid 7referred to in this section as the ,administrator71 shall establish1 and provide for the offering through the ,exchanges1 of a public health plan 7in this ,act referred to as the ,medicare ,transition plan7 that provides affordable1 high-quality health benefits coverage throughout the ,united ,states4 7b7 ,administrating the ,medicare transition 7#a7 ,administrator ,the ,administrator shall administer the ,medicare ,transition plan in accordance with this section4 7#b7 ,application of ,,aca requirements ,consistent with this section1 the ,medicare ,transition plan shall comply with requirements under title ,i of the ,patient ,protection and ,affordable ,care ,act 7and the amendments made by that title7 and title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 that are applicable to qualified health plans offered through the ,exchanges1 subject to the limitation under subsection 7e77#b74 7#c7 ,offering through ,exchanges ,the ,medicare ,transition plan shall be made available only through the ,exchanges1 and shall be available to individuals wishing to enroll and to qualified employers 7as defined in section #acab7;f77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;f77#b777 who wish to make such plan available to their employees4 7#d7 ,eligibility to purchase ,any ,united ,states resident may enroll in the ,medicare ,transition plan4 7c7 ,benefits2 actuarial value ,in carrying out this section1 the ,administrator shall ensure that the ,medicare ,transition plan provides-- 7#a7 coverage for the benefits required to be covered under title ,,ii2 and 7#b7 coverage of benefits that are actuarially equivalent to #ij percent of the full actuarial value of the benefits provided under the plan4 7d7 ,providers and reimbursement rates 7#a7 ,in general ,with respect to the reimbursement provided to health care providers for covered benefits1 as described in section #bja1 provided under the ,medicare ,transition plan1 the ,administrator shall reimburse such providers at rates determined for equivalent items and services under the original ,medicare fee-for-service program under parts ,a and ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq474 ,for items and services covered under the ,medicare ,transition plan but not covered under such parts ,a and ,b1 the ,administrator shall reimburse providers at rates set by the ,administrator in a manner consistent with the manner in which rates for other items and services were set under the original ,medicare fee-for-service program4 7#b7 ,prescription drugs ,any payment rate under this subsection for a prescription drug shall be at a rate negotiated by the ,administrator with the manufacturer of the drug4 ,if the ,administrator is unable to reach a negotiated agreement on such a reimbursement rate1 the ,administrator shall establish the rate at an amount equal to the lesser of-- 7,a7 the price paid by the ,secretary of ,veterans ,affairs to procure the drug under the laws administered by the ,secretary of ,veterans ,affairs2 7,b7 the price paid to procure the drug under section #habf of title #ch1 ,united ,states ,code2 or 7,c7 the best price determined under section #aibg7;c77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;c77#a77;,c77 for the drug4 7#c7 ,participating providers 7,a7 ,in general ,a health care provider that is a participating provider of services or supplier under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or under a ,state ,medicaid plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 on the date of enactment of this ,act shall be a participating provider in the ,medicare ,transition plan4 7,b7 ,additional providers ,the ,administrator shall establish a process to allow health care providers not described in subparagraph 7,a7 to become participating providers in the ,medicare ,transition plan4 ,such process shall be similar to the process applied to new providers under the ,medicare program4 7e7 ,premiums 7#a7 ,determination ,the ,administrator shall determine the premium amount for enrolling in the ,medicare ,transition plan1 which-- 7,a7 may vary according to family or individual coverage1 age1 and tobacco status 7consistent with clauses 7i71 7iii71 and 7iv7 of section #bgja7;a77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg7a77#a77;,a7772 and 7,b7 shall take into account the cost-sharing reductions and premium tax credits which will be available with respect to the plan under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 and section #cf;,b of the ,internal ,revenue ,code of #aihf1 as amended by subsection 7g74 7#b7 ,limitation ,variation in premium rates of the ,medicare ,transition plan by rating area1 as described in clause 7ii7 of section #bgja7;a77#a77;,a77iii7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg7a77#a77;,a77 is not permitted4 7f7 ,termination ,the provisions of this section shall cease to have force or effect on the date on which benefits are first available under section #ajf7;a74 7g7 ,tax credits and cost-,sharing subsidies 7#a7 ,premium assistance tax credits 7,a7 ,credits allowed to ,medicare ,transition plan enrollees at or above #dd percent of poverty in non-expansion ,states ,paragraph 7#a7 of section #cf;,b7c7 of the ,internal ,revenue ,code of #aihf is amended by redesignating subparagraphs 7,c71 7,d71 and 7,e7 as subparagraphs 7,d71 7,e71 and 7,f71 respectively1 and by inserting after subparagraph 7,b7 the following new subparagraph3 7,c7 ,special rules for ,medicare ,transition plan enrollees 7i7 ,in general ,in the case of a taxpayer who is covered1 or whose spouse or dependent 7as defined in section #aeb7 is covered1 by the ,medicare ,transition plan established under section #ajab7;a7 of the ,medicare for ,all ,act for all months in the taxable year1 subparagraph 7,a7 shall be applied without regard to but does not exceed #djj percent4 ,the preceding sentence shall not apply to any taxable year to which subparagraph 7,e7 applies4 7ii7 ,enrollees in ,medicaid non-expansion ,states ,in the case of a taxpayer residing in a ,state which 7as of the date of the enactment of the ,medicare for ,all ,act7 does not provide for eligibility under clause 7i77,,viii7 or 7ii77,,xx7 of section #aijb7;a77#aj77;,a7 of the ,social ,security ,act for medical assistance under title ,,xix of such ,act 7or a waiver of the ,state plan approved under section #aaae7 who is covered1 or whose spouse or dependent 7as defined in section #aeb7 is covered1 by the ,medicare ,transition plan established under section #ajab7;a7 of the ,medicare for ,all ,act for all months in the taxable year1 subparagraphs 7,a7 and 7,b7 shall be applied by substituting #j percent for #ajj percent each place it appears4 4 7,b7 ,premium assistance amounts for taxpayers enrolled in ,medicare ,transition plan 7i7 ,in general ,subparagraph 7,a7 of section #cf;,b7b77#c7 of such ,code is amended-- 7,i7 by redesignating clauses 7ii7 and 7iii7 as clauses 7iii7 and 7iv71 respectively2 7,,ii7 by striking clause 7ii7 in clause 7i7 and inserting clauses 7ii7 and 7iii72 and 7,,iii7 by inserting after clause 7i7 the following new clause3 7ii7 ,special rules for taxpayers enrolled in ,medicare ,transition plan ,in the case of a taxpayer who is covered1 or whose spouse or dependent 7as defined in section #aeb7 is covered1 by the ,medicare ,transition plan established under section #ajab7;a7 of the ,medicare for ,all ,act for all months in the taxable year the applicable percentage for any taxable year shall be determined in the same manner as under clause 7i71 except that the following table shall apply in lieu of the table contained in such clause3 ,in the case of household income 7expressed as a percent of poverty line7 within the following income tier3,the initial premium percentage is--,the final premium percentage is-- ,up to #ajj percent#bb #ajj percent up to #ach percent#b4jdb4jd #ach percent up to #aej percent#c4jfd4jh #aej percent and above#d4jhe4 ,the preceding sentence shall not apply to any taxable year to which clause 7iv7 applies4 4 7ii7 ,conforming amendments 7,i7 ,subclause 7,i7 of clause 7iii7 of section #cf;,b7b77#c77;,a7 of such ,code1 as redesignated by subparagraph 7,a77i71 is amended by inserting 1 and determined after the application of clause 7ii7 after after application of this clause4 7,,ii7 ,section #cf;,b7b77#c77;,a77iv77,i7 of such ,code1 as redesignated by subparagraph 7,a77i71 is amended by striking clause 7ii7 and inserting clause 7iii74 7#b7 ,cost-sharing subsidies ,subsection 7b7 of section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7;b77 is amended-- 7,a7 by inserting 1 or in the ,medicare ,transition plan established under section #ajab7;a7 of the ,medicare for ,all ,act1 after coverage in paragraph 7#a72 7,b7 by redesignating paragraphs 7#a7 7as so amended7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively1 and by moving such subparagraphs #b ems to the right2 7,c7 by striking insured4--,in this section and inserting 8insured4-- 7#a7 ,in general ,in this section 2 7,d7 by striking the flush language2 and 7,e7 by adding at the end the following new paragraph3 7#b7 ,special rules 7,a7 ,individuals lawfully present ,in the case of an individual described in section #cf;,b7c77#a77;,b7 of the ,internal ,revenue ,code of #aihf1 the individual shall be treated as having household income equal to #ajj percent of the poverty line for a family of the size involved for purposes of applying this section4 7,b7 ,medicare ,transition plan enrollees in ,medicaid non-expansion ,states ,in the case of an individual residing in a ,state which 7as of the date of the enactment of the ,medicare for ,all ,act7 does not provide for eligibility under clause 7i77,,viii7 or 7ii77,,xx7 of section #aijb7;a77#aj77;,a7 of the ,social ,security ,act for medical assistance under title ,,xix of such ,act 7or a waiver of the ,state plan approved under section #aaae7 who enrolls in such ,medicare ,transition plan1 subparagraph 7,a71 paragraph 7#a77;,b71 and paragraphs 7#a77;,a77i7 and 7#b77;,a7 of subsection 7c7 shall each be applied by substituting #j percent for #ajj percent each place it appears4 7,c7 ,adjusted cost-sharing for ,medicare ,transition plan enrollees ,in the case of any individual who enrolls in such ,medicare ,transition plan1 in lieu of the percentages under subsection 7c77#a77;,b77i7 and 7c77#b71 the ,secretary shall prescribe a method of determining the cost-sharing reduction for any such individual such that the total of the cost-sharing and the premiums paid by the individual under such ,medicare ,transition plan does not exceed the percentage of the total allowed costs of benefits provided under the plan equal to the final premium percentage applicable to such individual under section #cf;,b7b77#c77;,a77ii7 of the ,internal ,revenue ,code of #aihf4 4 7h7 ,conforming amendments 7#a7 ,treatment as a qualified health plan ,section #acja7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba7;a77#b77 is amended-- 7,a7 in the paragraph heading1 by inserting 1 the ,medicare ,transition plan1 before and2 and 7,b7 by inserting the ,medicare ,transition plan under section #ajab of the ,medicare for ,all ,act1 before and a multi-,state plan4 7#b7 ,level playing field ,section #acbd7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjdd7;a77 is amended by inserting the ,medicare ,transition plan under section #ajab of the ,medicare for ,all ,act1 before or a multi-,state qualified health plan4 ,c ,patient ,protections ,during ,medicare for ,all ,transition ,period #ajba4 ,minimizing disruptions to patient care ,the ,secretary shall ensure that all individuals enrolled in1 or who seek to enroll in1 a group health plan1 health insurance coverage offered by a health insurance issuer1 or the plan established under section #ajab during the transition period of this ,act are protected from disruptions in their care during the transition period4 #ajbb4 ,public consultation ,the ,secretary shall consult with communities and advocacy organizations of individuals living with disabilities and other patient advocacy organizations to ensure the transition described in section #ajba takes into account the safety and continuity of care for individuals with disabilities1 complex medical needs1 or chronic conditions4 #ajbc4 ,definitions ,in this subtitle1 the terms health insurance coverage1 health insurance issuer1 and group health plan have the meanings given such terms in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 ,,xi ,miscellaneous #aaja4 ,updating resource limits for ,supplemental ,security ,income eligibility 7,,ssi7 ,section #afaa7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #achb7;a77#c77 is amended-- 7#a7 in subparagraph 7,a7-- 7,a7 by striking and after ,january #a1 #aihh12 and 7,b7 by inserting 1 and to #f1bjj on ,january #a1 #bjbe before the period2 7#b7 in subparagraph 7,b7-- 7,a7 by striking and after ,january #a1 #aihh12 and 7,b7 by inserting 1 and to #d1ajj on ,january #a1 #bjbe before the period2 and 7#c7 by adding at the end the following new subparagraph3 7,c7 ,beginning with ,december of #bjbe1 whenever the dollar amounts in effect under paragraphs 7#a77;,a7 and 7#b77;,a7 of this subsection are increased for a month by a percentage under section #afag7;a77#b71 each of the dollar amounts in effect under this paragraph shall be increased1 effective with such month1 by the same percentage 7and rounded1 if not a multiple of #aj1 to the closest multiple of #aj74 ,each increase under this subparagraph shall be based on the unrounded amount for the prior #ab-month period4 4 #aajb4 ,definitions ,in this ,act-- 7#a7 the term ,secretary means the ,secretary of ,health and ,human ,services2 7#b7 the term ,state means any of the #ej ,states1 the ,district of ,columbia1 or a territory of the ,united ,states2 and 7#c7 the term ,united ,states shall include the #ej ,states1 the ,district of ,columbia1 and the territories of the ,united ,states4