Medicare-X Choice Act of 2019

II 116TH CONGRESS 1ST SESSION S. 981 To establish a public health plan. IN THE SENATE OF THE UNITED STATES APRIL 2, 2019 Mr. BENNET (for himself, Mr. KAINE, Mr. CARDIN, Ms. KLOBUCHAR, Mr. LEAHY, Ms. SMITH, Ms. STABENOW, Ms. HARRIS, Mr. BOOKER, Mr. PETERS, Mr. DURBIN, and Mrs. SHAHEEN) introduced the following bill; which was read twice and referred to the Committee on Finance 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 2019’’. 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 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 981 IS ‘‘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 2021 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 2024 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 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 981 IS 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 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 981 IS ‘‘(B) APPROPRIATION.—There is appro- 1 priated $1,000,000,000, out of monies in the 2 Treasury not otherwise obligated, to the Plan 3 Reserve Fund for fiscal year 2020. 4 ‘‘(2) DATA AND TECHNOLOGY FUND.—There is 5 established in the Treasury of the United States a 6 ‘Data and Technology Fund’, to be administered by 7 the Secretary of Health and Human Services, acting 8 through the Chief Actuary of the Centers for Medi- 9 care & Medicaid Services, for purposes of updating 10 technology and performing data collection under sec- 11 tion 2205 in order to establish appropriate pre- 12 miums for all geographic regions of the United 13 States. There are authorized to be appropriated to 14 the Data and Technology Fund such sums as may 15 be necessary for fiscal year 2020. 16 ‘‘(c) RULEMAKING.—The Secretary may promulgate 17 such regulations as may be necessary to carry out this 18 title. 19 ‘‘SEC. 2202. AVAILABILITY OF PLAN. 20 ‘‘(a) ELIGIBILITY.—An individual shall be eligible to 21 enroll in the health plan if such individual, for the entire 22 period for which enrollment is sought— 23 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 981 IS ‘‘(1) is a qualified individual within the mean- 1 ing of section 1312 of the Patient Protection and 2 Affordable Care Act (42 U.S.C. 18032); and 3 ‘‘(2) is not eligible for benefits under the Medi- 4 care program under title XVIII. 5 ‘‘(b) EXCHANGES.—In accordance with the time- 6 frame under section 2201(a)(2), the health plan shall be 7 made available through the American Health Benefit Ex- 8 changes described in sections 1311 and 1321 of the Pa- 9 tient Protection and Affordable Care Act (42 U.S.C. 10 18031, 18041), including the Small Business Health Op- 11 tions Program Exchange. 12 ‘‘SEC. 2203. PLAN REQUIREMENTS. 13 ‘‘(a) GENERAL REQUIREMENTS.—The health plan 14 shall comply with all requirements, as applicable, of sub- 15 title D of title I of the Patient Protection and Affordable 16 Care Act (42 U.S.C. 18021 et seq.) and title XXVII of 17 the Public Health Service Act (42 U.S.C. 300gg et seq.) 18 applicable to qualified health plans, and such health plan 19 shall be a qualified health plan, including for purposes of 20 the Internal Revenue Code of 1986. 21 ‘‘(b) LEVELS OF COVERAGE.—The Secretary— 22 ‘‘(1) shall make available a silver level and gold 23 level version of the plan, in accordance with section 24 1301(a)(1)(C)(ii); and 25 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 981 IS ‘‘(2) may make available no more than 2 1 versions of the plan for each of the 4 levels of cov- 2 erage described in subparagraphs (A) through (D) of 3 section 1302(d)(1) of the Patient Protection and Af- 4 fordable Care Act (42 U.S.C. 18022(d)(1)). 5 ‘‘SEC. 2204. ADMINISTRATIVE CONTRACTING. 6 ‘‘(a) IN GENERAL.—The Secretary may enter into 7 contracts for the purpose of performing administrative 8 functions (including functions described in subsection 9 (a)(4) of section 1874A) with respect to the health plan 10 in the same manner as the Secretary may enter into con- 11 tracts under subsection (a)(1) of such section. The Sec- 12 retary shall have the same authority with respect to the 13 public health insurance option as the Secretary has under 14 such subsection (a)(1) and subsection (b) of section 1874A 15 with respect to title XVIII. 16 ‘‘(b) TRANSFER OF INSURANCE RISK.—Any contract 17 under subsection (a) shall not involve the transfer of in- 18 surance risk from the Secretary to the entity entering into 19 such contract with the Secretary, except in the case of an 20 alternative payment model under section 2209(h). 21 ‘‘SEC. 2205. DATA COLLECTION. 22 ‘‘Subject to all applicable privacy requirements, in- 23 cluding the requirements under the regulations promul- 24 gated pursuant to section 264(c) of the Health Insurance 25 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 981 IS Portability and Accountability Act of 1996 (42 U.S.C. 1 1320d–2 note), the Secretary may collect data from State 2 insurance commissioners and other relevant entities to es- 3 tablish rates for premiums and for other purposes includ- 4 ing to improve quality, and reduce racial, ethnic, and other 5 disparities, with respect to the health plan. 6 ‘‘SEC. 2206. PREMIUMS; RISK POOL. 7 ‘‘(a) SETTING PREMIUMS.— 8 ‘‘(1) IN GENERAL.—The Secretary shall estab- 9 lish premiums for the health plan that cover the full 10 actuarial cost of offering such plan, including the 11 administrative costs of offering such plan. Such pre- 12 miums shall vary geographically and between the 13 small group market and the individual market in ac- 14 cordance with differences in the cost of providing 15 such coverage. If, for any plan year, the amount col- 16 lected in premiums exceeds the amount required for 17 health care benefits and administrative costs in that 18 plan year, such excess amounts shall remain avail- 19 able to the Secretary to administer the health plan 20 and finance beneficiary costs in subsequent years. 21 ‘‘(2) INITIAL PLAN YEAR.—For plan year 2021, 22 the Secretary shall set premiums for the health plan 23 for each rating area in which the health plan is 24 available for such plan year, taking into consider- 25 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 981 IS ation the premium rates for plans offered in each 1 such rating area for plan year 2020. 2 ‘‘(b) RISK POOL.—After plan year 2021, all enrollees 3 in the health plan within a State shall be members of a 4 single risk pool, except that the Secretary may establish 5 separate risk pools for the individual market and small 6 group market if the State has not exercised its authority 7 under section 1312(c)(3) of the Patient Protection and Af- 8 fordable Care Act. 9 ‘‘SEC. 2207. REIMBURSEMENT RATES. 10 ‘‘(a) MEDICARE RATES.— 11 ‘‘(1) IN GENERAL.—Except as provided in para- 12 graph (2) and subsections (b) and (c) and subject to 13 subsection (d), the Secretary shall reimburse health 14 care providers furnishing items and services under 15 the health plan at rates determined for equivalent 16 items and services under the original Medicare fee- 17 for-service program under parts A and B of title 18 XVIII. 19 ‘‘(2) AUTHORITY TO INCREASE PAYMENTS 20 RATES IN RURAL AREAS.—If the Secretary deter- 21 mines appropriate, the Secretary may increase the 22 reimbursements rates described in paragraph (1) by 23 up to 25 percent for items and services furnished in 24 rural areas (as defined in section 1886(d)(2)(D)). 25 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 981 IS ‘‘(b) PRESCRIPTION DRUGS.—Subject to subsection 1 (d), payment rates for prescription drugs shall be at a rate 2 negotiated by the Secretary. Such negotiations may be in 3 conjunction with negotiations for covered part D drugs 4 under part D of title XVIII. 5 ‘‘(c) ADDITIONAL ITEMS AND SERVICES.—Subject to 6 subsection (d), the Secretary shall establish reimburse- 7 ment rates for any items and services provided under the 8 health plan that are not items and services provided under 9 the original Medicare fee-for-service program under parts 10 A and B of title XVIII. 11 ‘‘(d) INNOVATIVE PAYMENT METHODS.—The Sec- 12 retary may utilize innovative payment methods, including 13 value-based payment arrangements, in making payments 14 for items and services (including prescription drugs) fur- 15 nished under the health plan. 16 ‘‘SEC. 2208. PARTICIPATING PROVIDERS. 17 ‘‘(a) REQUIREMENT TO PARTICIPATE IN ORDER TO 18 BE ENROLLED UNDER MEDICARE.—Subject to sub- 19 section (d), beginning January 1, 2021, a health care pro- 20 vider may not be enrolled under the Medicare program 21 under section 1866(j) unless the provider is also a partici- 22 pating provider under the health plan. 23 ‘‘(b) REQUIREMENT TO PARTICIPATE IN ORDER TO 24 PARTICIPATE IN MEDICAID.—Subject to subsection (d), 25 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 981 IS beginning January 1, 2021, a health care provider may 1 not be a participating provider under a State Medicaid 2 plan under title XIX unless the provider is also a partici- 3 pating provider under the health plan. 4 ‘‘(c) ADDITIONAL PROVIDERS.—The Secretary shall 5 establish a process to allow health care providers not de- 6 scribed in subsection (a) or (b) to become a participating 7 provider under the health plan. 8 ‘‘(d) OPT-OUT.—The Secretary shall establish a 9 process by which a health care provider described in sub- 10 section (a) or (b) may opt out of being a participating 11 provider under the health plan. 12 ‘‘SEC. 2209. DELIVERY SYSTEM REFORM FOR AN ENHANCED 13 HEALTH PLAN. 14 ‘‘(a) IN GENERAL.—For plan years beginning with 15 plan year 2021, the Secretary may utilize innovative pay- 16 ment mechanisms and policies to determine payments for 17 items and services under the health plan. The payment 18 mechanisms and policies under this section may include 19 patient-centered medical home and other care manage- 20 ment payments, accountable care organizations, account- 21 able communities for health, value-based purchasing, bun- 22 dling of services, differential payment rates, performance 23 or utilization based payments, telehealth, remote patient 24 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 981 IS monitoring, partial capitation, and direct contracting with 1 providers. 2 ‘‘(b) REQUIREMENTS FOR INNOVATIVE PAYMENTS.— 3 The Secretary shall design and implement the payment 4 mechanisms and policies under this section in a manner 5 that— 6 ‘‘(1) seeks to— 7 ‘‘(A) improve health outcomes; 8 ‘‘(B) reduce health disparities (including 9 racial, ethnic, and other disparities); 10 ‘‘(C) provide efficient and affordable care; 11 ‘‘(D) address geographic variation in the 12 provision of health services; or 13 ‘‘(E) prevent or manage chronic illness; 14 and 15 ‘‘(2) promotes care that is integrated, patient- 16 centered, quality, and efficient. 17 ‘‘(c) ENCOURAGING THE USE OF HIGH VALUE SERV- 18 ICES.—To the extent allowed by the benefit standards ap- 19 plied to all health benefits plans participating in the Ex- 20 changes (as described in section 2202(b)), the health plan 21 may modify cost-sharing and payment rates to encourage 22 the use of services that promote health and value. 23 ‘‘(d) PROMOTION OF DELIVERY SYSTEM REFORM.— 24 The Secretary shall monitor and evaluate the progress of 25 VerDate Sep 11 2014 02:10 Apr 09, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S981.IS S981 pamtmann on DSKBFK8HB2PROD with BILLS 12 •S 981 IS payment and delivery system reforms under this section 1 and shall seek to implement such reforms subject to the 2 following: 3 ‘‘(1) To the extent that the Secretary finds a 4 payment and delivery system reform successful in 5 improving quality and reducing costs [Text truncated for display. 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