Choose Medicare Act

II 117TH CONGRESS 1ST SESSION S. 1180 To provide for the establishment of Medicare part E public health plans, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 15, 2021 Mr. MERKLEY (for himself, Mr. MURPHY, Mrs. FEINSTEIN, Mr. BLUMENTHAL, Mr. SCHATZ, Ms. BALDWIN, Ms. SMITH, Mrs. SHAHEEN, Ms. DUCKWORTH, Mr. VAN HOLLEN, Mr. DURBIN, and Mr. REED) intro- duced the following bill; which was read twice and referred to the Com- mittee on Finance A BILL To provide for the establishment of Medicare part E public health plans, and for other purposes. 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 ‘‘Choose Medicare Act’’. 4 SEC. 2. PUBLIC HEALTH PLAN. 5 The Social Security Act is amended by adding at the 6 end the following: 7 ‘‘TITLE XXII—MEDICARE PART E PUBLIC HEALTH PLANS 8 ‘‘SEC. 2201. PUBLIC HEALTH PLANS.— 9 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1180 IS ‘‘(a) ESTABLISHMENT.—The Secretary shall estab- 1 lish public health plans (to be known as ‘Medicare part 2 E plans’) that are available in the individual market, small 3 group market, and large group market. 4 ‘‘(b) BENEFITS.— 5 ‘‘(1) IN GENERAL.—Each Medicare part E 6 plan, regardless of whether the plan is offered in the 7 individual market, small group market, or large 8 group market, shall be a qualified health plan within 9 the meaning of section 1301(a) of the Patient Pro- 10 tection and Affordable Care Act (42 U.S.C. 11 18021(a)) that— 12 ‘‘(A) meets all requirements applicable to 13 qualified health plans under subtitle D of title 14 I of the Patient Protection and Affordable Care 15 Act (42 U.S.C. 18021 et seq.) (other than the 16 requirement under section 1301(a)(1)(C)(ii) of 17 such Act) and title XXVII of the Public Health 18 Service Act (42 U.S.C. 300gg et seq.); 19 ‘‘(B) provides coverage of— 20 ‘‘(i) the essential health benefits de- 21 scribed in section 1302(b) of the Patient 22 Protection and Affordable Care Act (42 23 U.S.C. 18022(b)); and 24 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1180 IS ‘‘(ii) all items and services for which 1 benefits are available under title XVIII; 2 ‘‘(C) provides gold-level coverage described 3 in section 1302(d)(1)(C) of the Patient Protec- 4 tion and Affordable Care Act (42 U.S.C. 5 18022(d)(1)(C)); and 6 ‘‘(D) provides coverage of abortions and all 7 other reproductive services. 8 ‘‘(2) PREEMPTION.—Notwithstanding section 9 1303(a)(1) of the Patient Protection and Affordable 10 Care Act (42 U.S.C. 18023(a)(1))— 11 ‘‘(A) a State may not prohibit a Medicare 12 part E plan from offering the coverage de- 13 scribed in paragraph (1)(D); and 14 ‘‘(B) no State law that would prohibit such 15 a plan from offering such coverage shall apply 16 to such plan. 17 ‘‘(c) ELIGIBILITY; ENROLLMENT.— 18 ‘‘(1) AVAILABILITY ON THE EXCHANGES.—The 19 Medicare part E plans offered in the individual and 20 small group markets shall be offered through the 21 Federal and State Exchanges, including the Small 22 Business Health Options Program Exchanges (com- 23 monly referred to as the ‘SHOP Exchanges’). 24 ‘‘(2) ELIGIBILITY.— 25 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1180 IS ‘‘(A) IN GENERAL.—Any individual who is 1 a resident of the United States, as determined 2 by the Secretary under subparagraph (C), and 3 who is not an individual described in subpara- 4 graph (B), is eligible to enroll in a Medicare 5 part E plan. 6 ‘‘(B) EXCLUSIONS.—An individual de- 7 scribed in this subparagraph is any individual 8 who is— 9 ‘‘(i) entitled to, or enrolled for, bene- 10 fits under title XVIII; 11 ‘‘(ii) eligible for medical assistance 12 under a State plan under title XIX; or 13 ‘‘(iii) enrolled for child health assist- 14 ance or pregnancy-related assistance under 15 a State plan under title XXI. 16 ‘‘(C) REGULATIONS.—The Secretary shall 17 promulgate a rule for determining residency for 18 purposes of subparagraph (A). 19 ‘‘(3) EMPLOYER-SPONSORED PLANS.— 20 ‘‘(A) EMPLOYER ENROLLMENT.—Effective 21 with respect to the first plan year that begins 22 1 year after the date of enactment of the 23 Choose Medicare Act and each plan year there- 24 after, the Secretary shall provide options for 25 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1180 IS Medicare part E plans in the small group mar- 1 ket and large group market that are voluntary, 2 and available to all employers. 3 ‘‘(B) GROUP HEALTH PLANS.—The Sec- 4 retary, acting through the Administrator for the 5 Centers for Medicare & Medicaid Services, at 6 the request of a plan sponsor, shall serve as a 7 third party administrator of a group health 8 plan that is a Medicare part E plan offered by 9 such sponsor. 10 ‘‘(C) PORTABILITY FOR EMPLOYER-SPON- 11 SORED PLANS.—The Secretary shall develop a 12 process for allowing individuals enrolled in a 13 Medicare part E plan offered in the small group 14 market or large group market to maintain 15 health insurance coverage through a Medicare 16 part E plan if the individual subsequently loses 17 eligibility for enrollment in such a plan based 18 on termination of the employment relationship. 19 The ability to maintain such coverage shall 20 exist regardless of whether the individual has 21 the option to enroll in other health insurance 22 coverage, including coverage offered in the indi- 23 vidual market or through a subsequent em- 24 ployer. 25 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1180 IS ‘‘(d) PREMIUMS.—The Secretary shall establish pre- 1 mium rates for the Medicare part E plans that— 2 ‘‘(1) are adjusted based on— 3 ‘‘(A) whether the plan is offered in the in- 4 dividual market, small group market, or large 5 group market; and 6 ‘‘(B) the applicable rating area; 7 ‘‘(2) are at a level sufficient to fully finance— 8 ‘‘(A) the costs of health benefits provided 9 by such plans; and 10 ‘‘(B) administrative costs related to oper- 11 ating the plans; and 12 ‘‘(3) comply with the requirements under sec- 13 tion 2701 of the Public Health Service Act, includ- 14 ing for such plans that are offered in the large 15 group market. 16 ‘‘(e) PROVIDERS AND REIMBURSEMENT RATES.— 17 ‘‘(1) IN GENERAL.—The Secretary shall estab- 18 lish a rate schedule for reimbursing types of health 19 care providers furnishing items and services under 20 the Medicare part E plans at rates that are con- 21 sistent with the negotiations described in paragraph 22 (2) and are necessary to maintain network adequacy. 23 ‘‘(2) MANNER OF NEGOTIATION.—The Sec- 24 retary shall negotiate the rates described in para- 25 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1180 IS graph (1) in a manner that results in payment rates 1 that are not lower, in the aggregate, than rates 2 under title XVIII, and not higher, in the aggregate, 3 than the average rates paid by other health insur- 4 ance issuers offering health insurance coverage 5 through an Exchange. 6 ‘‘(3) PARTICIPATING PROVIDERS.— 7 ‘‘(A) IN GENERAL.—A health care provider 8 that is a participating provider of services or 9 supplier under the Medicare program under 10 title XVIII on the date of enactment of Choose 11 Medicare Act shall be a participating provider 12 for Medicare part E plans. 13 ‘‘(B) ADDITIONAL PROVIDERS.—The Sec- 14 retary shall establish a process to allow health 15 care providers not described in subparagraph 16 (A) to become participating providers for Medi- 17 care part E plans. 18 ‘‘(4) LIMITATIONS ON BALANCE BILLING.—The 19 limitations on balance billing pursuant to the provi- 20 sions of section 1866(a)(1)(A) of the Social Security 21 Act (42 U.S.C. 1395cc(a)(1)(A)) shall apply to par- 22 ticipating providers for Medicare part E plans in the 23 same manner as such provisions apply to partici- 24 pating providers under the Medicare program. 25 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1180 IS ‘‘(f) ENCOURAGING USE OF ALTERNATIVE PAYMENT 1 MODELS.—The Secretary shall, as applicable, utilize alter- 2 native payment models, including those described in sec- 3 tion 1833(z)(3)(C), as added by section 101(e)(2) of the 4 Medicare Access and CHIP Reauthorization Act of 2015 5 (Public Law 114–10), in making payments for items and 6 services (including prescription drugs) furnished under 7 Medicare part E plans. The payment rates under such al- 8 ternative payment models shall comply with the require- 9 ment for negotiated rates under subsection (e)(2). 10 ‘‘(g) PRESCRIPTION DRUGS.—The Secretary shall 11 apply the provisions of section 1860D–11(i) to prescrip- 12 tion drugs under Medicare part E plans in the same man- 13 ner as such provisions apply with respect to applicable cov- 14 ered part D drugs under such section. 15 ‘‘(h) APPROPRIATIONS.— 16 ‘‘(1) START UP FUNDING.—For purposes of es- 17 tablishing the Medicare part E plans, there is appro- 18 priated to the Secretary, out of any funds in the 19 Treasury not otherwise obligated, $2,000,000,000, 20 for fiscal year 2022. 21 ‘‘(2) INITIAL RESERVES.—There is appro- 22 priated to the Secretary, out of any funds in the 23 Treasury not otherwise obligated, such sums as may 24 be necessary, based on projected enrollment in the 25 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1180 IS Medicare part E plans in the first plan year in 1 which such plans are offered, to provide reserves for 2 the purpose of paying claims filed during the initial 3 90-day period of such plan year. 4 ‘‘(3) CLARIFICATION.—Any provision of law re- 5 stricting the use of Federal funds with respect to 6 any reproductive health service shall not apply to 7 funds appropriated under paragraph (1) or (2). 8 ‘‘(i) HEALTH INSURANCE ISSUER.—With respect to 9 any Medicare part E plan, the Secretary shall be consid- 10 ered a health insurance issuer, within the meaning of sec- 11 tion 2791(b) of the Public Health Service Act.’’. 12 SEC. 3. NOTICE AND NAVIGATOR REFERRAL FOR EMPLOY- 13 EES UNDER THE FAIR LABOR STANDARDS 14 ACT OF 1938. 15 (a) IN GENERAL.—Section 18B of the Fair Labor 16 Standards Act of 1938 (29 U.S.C. 218b) is amended— 17 (1) in the heading, by striking ‘‘TO’’ and insert- 18 ing ‘‘AND NAVIGATOR REFERRAL FOR’’; 19 (2) by redesignating subsection (b) as sub- 20 section (c); 21 (3) by inserting after subsection (a) the fol- 22 lowing: 23 ‘‘(b) NAVIGATOR REFERRAL.— 24 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1180 IS ‘‘(1) IN GENERAL.—An employer described in 1 paragraph (3) shall refer each full-time employee (as 2 defined in section 4980H of the Internal Revenue 3 Code of 1986) to— 4 ‘‘(A) an entity that serves as a navigator 5 under section 1311(i) of the Patient Protection 6 and Affordable Care Act (42 U.S.C. 18031(i)) 7 for the Exchange operating in the State of the 8 employer; or 9 ‘‘(B) if the Exchange operating in the 10 State of the employer does not have an entity 11 serving as such a navigator, another entity that 12 shall carry out equivalent activities as such a 13 navigator. 14 ‘‘(2) REFERRAL.—The referral described in 15 paragraph (1) shall occur— 16 ‘‘(A) at the time the employer hires the 17 employee; or 18 ‘‘(B) on the effective date described in sub- 19 section (c)(2) with respect to an employee who 20 is currently employed by the employer on such 21 date. 22 ‘‘(3) EMPLOYER.—An employer described in 23 this paragraph is any employer that— 24 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 11 •S 1180 IS ‘‘(A) does not provide an eligible employer- 1 sponsored plan as defined in section 2 5000A(f)(2) of the Internal Revenue Code of 3 1986; or 4 ‘‘(B) provides such an eligible employer- 5 sponsored plan, but the plan is determined 6 under section 36B(c)(2)(C) of such Code— 7 ‘‘(i) to be unaffordable to the em- 8 ployee; or 9 ‘‘(ii) to not provide the required min- 10 imum actuarial value.’’; and 11 (4) in subsection (c), as so redesignated— 12 (A) in the heading, by striking ‘‘EFFEC- 13 TIVE DATE’’ and inserting ‘‘EFFECTIVE 14 DATES’’; 15 (B) by striking ‘‘Subsection (a)’’ and in- 16 serting the following: 17 ‘‘(1) NOTICE.—Subsection (a);’’; and 18 (C) by adding at the end the following: 19 ‘‘(2) NAVIGATOR REFERRAL.—Subsection (b) 20 shall take effect with respect to employers in a State 21 beginning on the date that is 2 years after the date 22 of enactment of the Choose Medicare Act.’’. 23 (b) STUDY.—Not later than January 1, 2026, the 24 Comptroller General of the United States shall conduct 25 VerDate Sep 11 2014 23:06 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1180.IS S1180 kjohnson on DSK79L0C42PROD with BILLS 12 •S 1180 IS a study on the impact of the requirements under section 1 18B of the Fair Labor Standards Act of 1938 (29 U.S.C. 2 218b), including the amendments made by subsection (a), 3 on the rate of individuals without minimum essential cov- 4 erage as defined in section 5000A of the Internal Revenue 5 Code of 1986 in the United States and in each State. 6 (c) FUNDING FOR NAVIGATOR PROGRAM.—Section 7 1311(i)(6) of the Patient Protection and Affordable Care 8 Act (42 U.S.C. 18031(i)(6)) is amended— 9 (1) by striking ‘‘Grants’’ and inserting the fol- 10 lowing: 11 ‘‘(A) IN GENERAL.—Grants’’; and 12 (2) by adding at the end the following: 13 ‘‘(B) AUTHORIZATION OF APPROPRIA- 14 TIONS.—There is authorized to be appropriated 15 such sums as may be necessary to address ca- 16 pacity limitations of entities serving as naviga- 17 tors through a grant under this subsection.’’. 18 SEC. 4. PROTECTING AGAINST HIGH OUT-OF-POCKET EX- 19 PENDITURES FOR MEDICARE FEE-FOR-SERV- 20 ICE BENEFITS. 21 Title XVIII of the Social Security Act (42 U.S.C. 22 1395 et seq.) is ame [Text truncated for display. Full text available on Congress.gov.]