Medicare-X Choice Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1227 To establish a public health plan. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 23, 2021 Mr. DELGADO (for himself, Mr. HIGGINS of New York, and Mr. LARSON of Connecticut) introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To establish a public health plan. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare-X Choice Act 4 of 2021’’. 5 SEC. 2. ESTABLISHMENT AND ADMINISTRATION OF A PUB- 6 LIC HEALTH PLAN. 7 The Social Security Act is amended by adding at the 8 end the following new title: 9 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 1227 IH ‘‘TITLE XXII—MEDICARE 1 EXCHANGE HEALTH PLAN 2 ‘‘SEC. 2201. ESTABLISHMENT. 3 ‘‘(a) ESTABLISHMENT OF PLAN.— 4 ‘‘(1) IN GENERAL.—The Secretary shall estab- 5 lish a coordinated and low-cost health plan, to be 6 known as the ‘Medicare Exchange health plan’ (re- 7 ferred to in this section as the ‘health plan’) to pro- 8 vide access to quality health care for enrollees. 9 ‘‘(2) TIMEFRAME.— 10 ‘‘(A) INDIVIDUAL MARKET AVAIL- 11 ABILITY.— 12 ‘‘(i) IN GENERAL.—In accordance 13 with clause (ii), the Secretary shall make 14 the health plan available in the individual 15 market, in certain rating areas, for plan 16 year 2022 and each subsequent plan year, 17 and increase the availability such that the 18 plan is available in the individual market 19 to all residents of all rating areas in the 20 United States for plan year 2025 and each 21 subsequent plan year. 22 ‘‘(ii) PRIORITY AREAS.—In deter- 23 mining in which rating areas the Secretary 24 initially will make the health plan avail- 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 1227 IH able, the Secretary shall give priority to 1 rating areas in which— 2 ‘‘(I) not more than 1 health in- 3 surance issuer offers plans on the ap- 4 plicable State or Federal American 5 Health Benefit Exchange (referred to 6 in this title as the ‘Exchange’); or 7 ‘‘(II) there is a shortage of 8 health providers or lack of competition 9 that results in a high cost of health 10 care services, including health profes- 11 sional shortage areas and rural areas. 12 ‘‘(B) SMALL GROUP MARKET.—The Sec- 13 retary shall make the health plan available in 14 the small group market in all rating areas for 15 plan year 2025. 16 ‘‘(b) ESTABLISHMENT OF FUNDS.— 17 ‘‘(1) PLAN RESERVE FUND.— 18 ‘‘(A) IN GENERAL.—There is established in 19 the Treasury of the United States a ‘Plan Re- 20 serve Fund’, to be administered by the Sec- 21 retary of Health and Human Services, for pur- 22 poses of establishing the Medicare Exchange 23 health plan and administering such plan, con- 24 sisting of amounts appropriated to such fund 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 1227 IH during the period of fiscal years 2021 through 1 2030. 2 ‘‘(B) APPROPRIATION.—There is appro- 3 priated $1,000,000,000, out of monies in the 4 Treasury not otherwise obligated, to the Plan 5 Reserve Fund for fiscal year 2021, to remain 6 available until expended. 7 ‘‘(2) DATA AND TECHNOLOGY FUND.— 8 ‘‘(A) IN GENERAL.—There is established in 9 the Treasury of the United States a ‘Data and 10 Technology Fund’, to be administered by the 11 Secretary of Health and Human Services, act- 12 ing through the Chief Actuary of the Centers 13 for Medicare & Medicaid Services, for purposes 14 of updating technology and performing data 15 collection under section 2205 in order to estab- 16 lish appropriate premiums for all geographic re- 17 gions of the United States, consisting of 18 amounts appropriated to such fund during the 19 period of fiscal years 2021 through 2030. 20 ‘‘(B) APPROPRIATION.—There is appro- 21 priated $1,000,000,000, out of amounts in the 22 Treasury not otherwise appropriated, to the 23 Data and Technology Fund for fiscal year 24 2021, to remain available until expended. 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 1227 IH ‘‘(c) RULEMAKING.—Not later than 180 days after 1 the date of enactment of this Act, the Secretary shall pro- 2 mulgate such regulations as may be necessary to carry out 3 this title. Rules promulgated under this subsection shall 4 be finalized not later than 270 days after the date of en- 5 actment of this Act. 6 ‘‘SEC. 2202. AVAILABILITY OF PLAN. 7 ‘‘(a) ELIGIBILITY.—An individual shall be eligible to 8 enroll in the health plan if such individual, for the entire 9 period for which enrollment is sought— 10 ‘‘(1) is a qualified individual within the mean- 11 ing of section 1312 of the Patient Protection and 12 Affordable Care Act (42 U.S.C. 18032); and 13 ‘‘(2) is not eligible for benefits under the Medi- 14 care program under title XVIII. 15 ‘‘(b) EXCHANGES.—In accordance with the time- 16 frame under section 2201(a)(2), the health plan shall be 17 made available through the American Health Benefit Ex- 18 changes described in sections 1311 and 1321 of the Pa- 19 tient Protection and Affordable Care Act (42 U.S.C. 20 18031, 18041), including the Small Business Health Op- 21 tions Program Exchange. 22 ‘‘SEC. 2203. PLAN REQUIREMENTS. 23 ‘‘(a) GENERAL REQUIREMENTS.—The health plan 24 shall comply with all requirements, as applicable, of sub- 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 1227 IH title D of title I of the Patient Protection and Affordable 1 Care Act (42 U.S.C. 18021 et seq.) and title XXVII of 2 the Public Health Service Act (42 U.S.C. 300gg et seq.) 3 applicable to qualified health plans, and such health plan 4 shall be a qualified health plan, including for purposes of 5 the Internal Revenue Code of 1986. 6 ‘‘(b) LEVELS OF COVERAGE.—The Secretary— 7 ‘‘(1) shall make available a silver level and gold 8 level version of the plan, in accordance with section 9 1301(a)(1)(C)(ii); and 10 ‘‘(2) may make available no more than 2 11 versions of the plan for each of the 4 levels of cov- 12 erage described in subparagraphs (A) through (D) of 13 section 1302(d)(1) of the Patient Protection and Af- 14 fordable Care Act (42 U.S.C. 18022(d)(1)). 15 ‘‘(c) PRIMARY CARE SERVICES.—The health plan 16 shall provide coverage for primary care services, and shall 17 not impose any cost-sharing requirements for such serv- 18 ices. 19 ‘‘SEC. 2204. ADMINISTRATIVE CONTRACTING. 20 ‘‘(a) IN GENERAL.—The Secretary may enter into 21 contracts for the purpose of performing administrative 22 functions (including functions described in subsection 23 (a)(4) of section 1874A) with respect to the health plan 24 in the same manner as the Secretary may enter into con- 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 1227 IH tracts under subsection (a)(1) of such section. The Sec- 1 retary shall have the same authority with respect to the 2 public health insurance option as the Secretary has under 3 such subsection (a)(1) and subsection (b) of section 1874A 4 with respect to title XVIII. 5 ‘‘(b) TRANSFER OF INSURANCE RISK.—Any contract 6 under subsection (a) shall not involve the transfer of in- 7 surance risk from the Secretary to the entity entering into 8 such contract with the Secretary, except in the case of an 9 alternative payment model under section 2209(h). 10 ‘‘SEC. 2205. DATA COLLECTION. 11 ‘‘Subject to all applicable privacy requirements, in- 12 cluding the requirements under the regulations promul- 13 gated pursuant to section 264(c) of the Health Insurance 14 Portability and Accountability Act of 1996 (42 U.S.C. 15 1320d–2 note), the Secretary may collect data from State 16 insurance commissioners and other relevant entities to es- 17 tablish rates for premiums and for other purposes includ- 18 ing to improve quality, and reduce racial, ethnic, socio- 19 economic, geographic, gender, sexual identity, and other 20 health disparities, including such disparities experienced 21 by people with disabilities and older adults, with respect 22 to the health plan. 23 ‘‘SEC. 2206. PREMIUMS; RISK POOL. 24 ‘‘(a) SETTING PREMIUMS.— 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 1227 IH ‘‘(1) IN GENERAL.—The Secretary shall estab- 1 lish premiums for the health plan that cover the full 2 actuarial cost of offering such plan, including the 3 administrative costs of offering such plan. Such pre- 4 miums shall vary geographically and between the 5 small group market and the individual market in ac- 6 cordance with differences in the cost of providing 7 such coverage. If, for any plan year, the amount col- 8 lected in premiums exceeds the amount required for 9 health care benefits and administrative costs in that 10 plan year, such excess amounts shall remain avail- 11 able to the Secretary to administer the health plan 12 and finance beneficiary costs in subsequent years. 13 ‘‘(2) INITIAL PLAN YEAR.—For plan year 2022, 14 the Secretary shall set premiums for the health plan 15 for each rating area in which the health plan is 16 available for such plan year, taking into consider- 17 ation the premium rates for plans offered in each 18 such rating area for plan year 2021. 19 ‘‘(b) RISK POOL.—After plan year 2022, all enrollees 20 in the health plan within a State shall be members of a 21 single risk pool, except that the Secretary may establish 22 separate risk pools for the individual market and small 23 group market if the State has not exercised its authority 24 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 1227 IH under section 1312(c)(3) of the Patient Protection and Af- 1 fordable Care Act. 2 ‘‘SEC. 2207. REIMBURSEMENT RATES. 3 ‘‘(a) MEDICARE RATES.— 4 ‘‘(1) IN GENERAL.—Except as provided in para- 5 graph (2) and subsections (b) and (c) and subject to 6 subsection (d), the Secretary shall reimburse health 7 care providers furnishing items and services under 8 the health plan at rates determined for equivalent 9 items and services under the original Medicare fee- 10 for-service program under parts A and B of title 11 XVIII. 12 ‘‘(2) AUTHORITY TO INCREASE PAYMENTS 13 RATES IN RURAL AREAS.—If the Secretary deter- 14 mines appropriate, the Secretary may increase the 15 reimbursements rates described in paragraph (1) by 16 up to 50 percent for items and services furnished in 17 rural areas (as defined in section 1886(d)(2)(D)). 18 ‘‘(b) PRESCRIPTION DRUGS.—Subject to subsection 19 (d), payment rates for prescription drugs shall be at a rate 20 negotiated by the Secretary. Such negotiations may be in 21 conjunction with negotiations for covered part D drugs 22 under part D of title XVIII. 23 ‘‘(c) ADDITIONAL ITEMS AND SERVICES.—Subject to 24 subsection (d), the Secretary shall establish reimburse- 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 1227 IH ment rates for any items and services provided under the 1 health plan that are not items and services provided under 2 the original Medicare fee-for-service program under parts 3 A and B of title XVIII. 4 ‘‘(d) INNOVATIVE PAYMENT METHODS.—The Sec- 5 retary may utilize innovative payment methods, including 6 value-based payment arrangements, in making payments 7 for items and services (including prescription drugs) fur- 8 nished under the health plan. 9 ‘‘(e) COMPREHENSIVE STUDY ON COVERING ADDI- 10 TIONAL SERVICES.— 11 ‘‘(1) IN GENERAL.—The Secretary, acting 12 through the Administrator of the Centers for Medi- 13 care & Medicaid Services, shall conduct a com- 14 prehensive study, in consultation with stakeholders, 15 and develop recommendations for Congress on the 16 need for, and cost of providing coverage for, addi- 17 tional services under the health plan. 18 ‘‘(2) CONTENT.—The study shall under para- 19 graph (1) shall include— 20 ‘‘(A) consideration of providing coverage 21 for long-term services and supports, home and 22 community based services, assistive and ena- 23 bling technologies, and vision, hearing, and den- 24 tal services; 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 1227 IH ‘‘(B) consideration of providing coverage 1 for other services in addition to the services de- 2 scribed in subparagraph (A) that could most 3 benefit the health and financial well-being of 4 beneficiaries, including by reducing health dis- 5 parities, if included for coverage under the plan; 6 ‘‘(C) the costs associated with covering ad- 7 ditional services described in subparagraphs (A) 8 and (B), for beneficiaries through cost-sharing 9 and premiums, and for the Federal Govern- 10 ment; and 11 ‘‘(D) an assessment of the implications of 12 covering such additional services for the risk 13 pool of the health plan and for the individual 14 and small group markets. 15 ‘‘(3) SUBMISSION OF REPORT.—Not later than 16 2 years after the date of enactment of this title, the 17 Secretary shall submit to Congress a report on the 18 findings and recommendations of the study under 19 this subsection and shall make such report publicly 20 available on the website of the Department of 21 Health and Human Services. 22 ‘‘SEC. 2208. PARTICIPATING PROVIDERS. 23 ‘‘(a) REQUIREMENT TO PARTICIPATE IN ORDER TO 24 BE ENROLLED UNDER MEDICARE.—Subject to sub- 25 VerDate Sep 11 2014 20:13 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1227.IH H1227 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 1227 IH section (d), beginning January 1, 2022, a health care pro- 1 vider may not be enrolled under the Medicare program 2 under section 1866(j) unless the provider is also a partici- 3 pating provider under the health plan. 4 ‘‘(b) REQUIREMENT TO PA [Text truncated for display. Full text available on Congress.gov.]