Choose Medicare Act

I 116TH CONGRESS 1ST SESSION H. R. 2463 To provide for the establishment of Medicare part E public health plans, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 1, 2019 Mr. RICHMOND (for himself, Mr. HUFFMAN, and Ms. NORTON) introduced the following bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Edu- cation and Labor, 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 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 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 2 •HR 2463 IH ‘‘TITLE XXII—MEDICARE PART E PUBLIC HEALTH PLANS 1 ‘‘SEC. 2201. PUBLIC HEALTH PLANS.— 2 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab- 3 lish public health plans (to be known as ‘Medicare part 4 E plans’) that are available in the individual market, small 5 group market, and large group market. 6 ‘‘(b) BENEFITS.— 7 ‘‘(1) IN GENERAL.—Each Medicare part E 8 plan, regardless of whether the plan is offered in the 9 individual market, small group market, or large 10 group market, shall be a qualified health plan within 11 the meaning of section 1301(a) of the Patient Pro- 12 tection and Affordable Care Act (42 U.S.C. 13 18021(a)) that— 14 ‘‘(A) meets all requirements applicable to 15 qualified health plans under subtitle D of title 16 I of the Patient Protection and Affordable Care 17 Act (42 U.S.C. 18021 et seq.) (other than the 18 requirement under section 1301(a)(1)(C)(ii) of 19 such Act) and title XXVII of the Public Health 20 Service Act (42 U.S.C. 300gg et seq.); 21 ‘‘(B) provides coverage of— 22 ‘‘(i) the essential health benefits de- 23 scribed in section 1302(b) of the Patient 24 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 3 •HR 2463 IH Protection and Affordable Care Act (42 1 U.S.C. 18022(b)); and 2 ‘‘(ii) all items and services for which 3 benefits are available under title XVIII; 4 ‘‘(C) provides gold-level coverage described 5 in section 1302(d)(1)(C) of the Patient Protec- 6 tion and Affordable Care Act (42 U.S.C. 7 18022(d)(1)(C)); and 8 ‘‘(D) provides coverage of abortions and all 9 other reproductive services. 10 ‘‘(2) PREEMPTION.—Notwithstanding section 11 1303(a)(1) of the Patient Protection and Affordable 12 Care Act (42 U.S.C. 18023(a)(1))— 13 ‘‘(A) a State may not prohibit a Medicare 14 part E plan from offering the coverage de- 15 scribed in paragraph (1)(D); and 16 ‘‘(B) no State law that would prohibit such 17 a plan from offering such coverage shall apply 18 to such plan. 19 ‘‘(c) ELIGIBILITY; ENROLLMENT.— 20 ‘‘(1) AVAILABILITY ON THE EXCHANGES.—The 21 Medicare part E plans offered in the individual and 22 small group markets shall be offered through the 23 Federal and State Exchanges, including the Small 24 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 4 •HR 2463 IH Business Health Options Program Exchanges (com- 1 monly referred to as the ‘SHOP Exchanges’). 2 ‘‘(2) ELIGIBILITY.— 3 ‘‘(A) IN GENERAL.—Any individual who is 4 a resident of the United States, as determined 5 by the Secretary under subparagraph (C), and 6 who is not an individual described in subpara- 7 graph (B), is eligible to enroll in a Medicare 8 part E plan. 9 ‘‘(B) EXCLUSIONS.—An individual de- 10 scribed in this subparagraph is any individual 11 who is— 12 ‘‘(i) entitled to, or enrolled for, bene- 13 fits under title XVIII; 14 ‘‘(ii) eligible for medical assistance 15 under a State plan under title XIX; or 16 ‘‘(iii) enrolled for child health assist- 17 ance or pregnancy-related assistance under 18 a State plan under title XXI. 19 ‘‘(C) REGULATIONS.—The Secretary shall 20 promulgate a rule for determining residency for 21 purposes of subparagraph (A). 22 ‘‘(3) EMPLOYER-SPONSORED PLANS.— 23 ‘‘(A) EMPLOYER ENROLLMENT.—Effective 24 with respect to the first plan year that begins 25 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 5 •HR 2463 IH 1 year after the date of enactment of the 1 Choose Medicare Act and each plan year there- 2 after, the Secretary shall provide options for 3 Medicare part E plans in the small group mar- 4 ket and large group market that are voluntary, 5 and available to all employers. 6 ‘‘(B) GROUP HEALTH PLANS.—The Sec- 7 retary, acting through the Administrator for the 8 Centers for Medicare & Medicaid Services, at 9 the request of a plan sponsor, shall serve as a 10 third party administrator of a group health 11 plan that is a Medicare part E plan offered by 12 such sponsor. 13 ‘‘(C) PORTABILITY FOR EMPLOYER-SPON- 14 SORED PLANS.—The Secretary shall develop a 15 process for allowing individuals enrolled in a 16 Medicare part E plan offered in the small group 17 market or large group market to maintain 18 health insurance coverage through a Medicare 19 part E plan if the individual subsequently loses 20 eligibility for enrollment in such a plan based 21 on termination of the employment relationship. 22 The ability to maintain such coverage shall 23 exist regardless of whether the individual has 24 the option to enroll in other health insurance 25 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 6 •HR 2463 IH coverage, including coverage offered in the indi- 1 vidual market or through a subsequent em- 2 ployer. 3 ‘‘(d) PREMIUMS.—The Secretary shall establish pre- 4 mium rates for the Medicare part E plans that— 5 ‘‘(1) are adjusted based on— 6 ‘‘(A) whether the plan is offered in the in- 7 dividual market, small group market, or large 8 group market; and 9 ‘‘(B) the applicable rating area; 10 ‘‘(2) are at a level sufficient to fully finance— 11 ‘‘(A) the costs of health benefits provided 12 by such plans; and 13 ‘‘(B) administrative costs related to oper- 14 ating the plans; and 15 ‘‘(3) comply with the requirements under sec- 16 tion 2701 of the Public Health Service Act, includ- 17 ing for such plans that are offered in the large 18 group market. 19 ‘‘(e) PROVIDERS AND REIMBURSEMENT RATES.— 20 ‘‘(1) IN GENERAL.—The Secretary shall estab- 21 lish a rate schedule for reimbursing types of health 22 care providers furnishing items and services under 23 the Medicare part E plans at rates that are con- 24 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 7 •HR 2463 IH sistent with the negotiations described in paragraph 1 (2) and are necessary to maintain network adequacy. 2 ‘‘(2) MANNER OF NEGOTIATION.—The Sec- 3 retary shall negotiate the rates described in para- 4 graph (1) in a manner that results in payment rates 5 that are not lower, in the aggregate, than rates 6 under title XVIII, and not higher, in the aggregate, 7 than the average rates paid by other health insur- 8 ance issuers offering health insurance coverage 9 through an Exchange. 10 ‘‘(3) PARTICIPATING PROVIDERS.— 11 ‘‘(A) IN GENERAL.—A health care provider 12 that is a participating provider of services or 13 supplier under the Medicare program under 14 title XVIII on the date of enactment of Choose 15 Medicare Act shall be a participating provider 16 for Medicare part E plans. 17 ‘‘(B) ADDITIONAL PROVIDERS.—The Sec- 18 retary shall establish a process to allow health 19 care providers not described in subparagraph 20 (A) to become participating providers for Medi- 21 care part E plans. 22 ‘‘(4) LIMITATIONS ON BALANCE BILLING.—The 23 limitations on balance billing pursuant to the provi- 24 sions of section 1866(a)(1)(A) of the Social Security 25 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 8 •HR 2463 IH Act (42 U.S.C. 1395cc(a)(1)(A)) shall apply to par- 1 ticipating providers for Medicare part E plans in the 2 same manner as such provisions apply to partici- 3 pating providers under the Medicare program. 4 ‘‘(f) ENCOURAGING USE OF ALTERNATIVE PAYMENT 5 MODELS.—The Secretary shall, as applicable, utilize alter- 6 native payment models, including those described in sec- 7 tion 1833(z)(3)(C), as added by section 101(e)(2) of the 8 Medicare Access and CHIP Reauthorization Act of 2015 9 (Public Law 114–10), in making payments for items and 10 services (including prescription drugs) furnished under 11 Medicare part E plans. The payment rates under such al- 12 ternative payment models shall comply with the require- 13 ment for negotiated rates under subsection (e)(2). 14 ‘‘(g) PRESCRIPTION DRUGS.—The Secretary shall 15 apply the provisions of section 1860D–11(i) to prescrip- 16 tion drugs under Medicare part E plans in the same man- 17 ner as such provisions apply with respect to applicable cov- 18 ered part D drugs under such section. 19 ‘‘(h) APPROPRIATIONS.— 20 ‘‘(1) START UP FUNDING.—For purposes of es- 21 tablishing the Medicare part E plans, there is appro- 22 priated to the Secretary, out of any funds in the 23 Treasury not otherwise obligated, $2,000,000,000, 24 for fiscal year 2020. 25 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 9 •HR 2463 IH ‘‘(2) INITIAL RESERVES.—There is appro- 1 priated to the Secretary, out of any funds in the 2 Treasury not otherwise obligated, such sums as may 3 be necessary, based on projected enrollment in the 4 Medicare part E plans in the first plan year in 5 which such plans are offered, to provide reserves for 6 the purpose of paying claims filed during the initial 7 90-day period of such plan year. 8 ‘‘(3) CLARIFICATION.—Any provision of law re- 9 stricting the use of Federal funds with respect to 10 any reproductive health service shall not apply to 11 funds appropriated under paragraph (1) or (2). 12 ‘‘(i) HEALTH INSURANCE ISSUER.—With respect to 13 any Medicare part E plan, the Secretary shall be consid- 14 ered a health insurance issuer, within the meaning of sec- 15 tion 2791(b) of the Public Health Service Act.’’. 16 SEC. 3. NOTICE AND NAVIGATOR REFERRAL FOR EMPLOY- 17 EES UNDER THE FAIR LABOR STANDARDS 18 ACT OF 1938. 19 (a) IN GENERAL.—Section 18B of the Fair Labor 20 Standards Act of 1938 (29 U.S.C. 218b) is amended— 21 (1) in the heading, by striking ‘‘TO’’ and insert- 22 ing ‘‘AND NAVIGATOR REFERRAL FOR’’; 23 (2) by redesignating subsection (b) as sub- 24 section (c); 25 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 10 •HR 2463 IH (3) by inserting after subsection (a) the fol- 1 lowing: 2 ‘‘(b) NAVIGATOR REFERRAL.— 3 ‘‘(1) IN GENERAL.—An employer described in 4 paragraph (3) shall refer each full-time employee (as 5 defined in section 4980H of the Internal Revenue 6 Code of 1986) to— 7 ‘‘(A) an entity that serves as a navigator 8 under section 1311(i) of the Patient Protection 9 and Affordable Care Act (42 U.S.C. 18031(i)) 10 for the Exchange operating in the State of the 11 employer; or 12 ‘‘(B) if the Exchange operating in the 13 State of the employer does not have an entity 14 serving as such a navigator, another entity that 15 shall carry out equivalent activities as such a 16 navigator. 17 ‘‘(2) REFERRAL.—The referral described in 18 paragraph (1) shall occur— 19 ‘‘(A) at the time the employer hires the 20 employee; or 21 ‘‘(B) on the effective date described in sub- 22 section (c)(2) with respect to an employee who 23 is currently employed by the employer on such 24 date. 25 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 11 •HR 2463 IH ‘‘(3) EMPLOYER.—An employer described in 1 this paragraph is any employer that— 2 ‘‘(A) does not provide an eligible employer- 3 sponsored plan as defined in section 4 5000A(f)(2) of the Internal Revenue Code of 5 1986; or 6 ‘‘(B) provides such an eligible employer- 7 sponsored plan, but the plan is determined 8 under section 36B(c)(2)(C) of such Code— 9 ‘‘(i) to be unaffordable to the em- 10 ployee; or 11 ‘‘(ii) to not provide the required min- 12 imum actuarial value.’’; and 13 (4) in subsection (c), as so redesignated— 14 (A) in the heading, by striking ‘‘EFFEC- 15 TIVE DATE’’ and inserting ‘‘EFFECTIVE 16 DATES’’; 17 (B) by striking ‘‘Subsection (a)’’ and in- 18 serting the following: 19 ‘‘(1) NOTICE.—Subsection (a);’’; and 20 (C) by adding at the end the following: 21 ‘‘(2) NAVIGATOR REFERRAL.—Subsection (b) 22 shall take effect with respect to employers in a State 23 beginning on the date that is 2 years after the date 24 of enactment of the Choose Medicare Act.’’. 25 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.IH H2463 kjohnson on DSK79L0C42 with BILLS 12 •HR 2463 IH (b) STUDY.—Not later than January 1, 2024, the 1 Comptroller General of the United States shall conduct 2 a study on the impact of the requirements under section 3 18B of the Fair Labor Standards Act of 1938 (29 U.S.C. 4 218b), including the amendments made by subsection (a), 5 on the rate of individuals without minimum essential cov- 6 erage as defined in section 5000A of the Internal Revenue 7 Code of 1986 in the United States and in each State. 8 (c) FUNDING FOR NAVIGATOR PROGRAM.—Section 9 1311(i)(6) of the Patient Protection and Affordable Care 10 Act (42 U.S.C. 18031(i)(6)) is amended— 11 (1) by striking ‘‘Grants’’ and inserting the fol- 12 lowing: 13 ‘‘(A) IN GENERAL.—Grants’’; and 14 (2) by adding at the end the following: 15 ‘‘(B) AUTHORIZATION OF APPROPRIA- 16 TIONS.—There is authorized to be appropriated 17 such sums as may be necessary to address ca- 18 pacity limitations of entities serving as naviga- 19 tors through a grant under this subsection.’’. 20 VerDate Sep 11 2014 23:53 May 06, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2463.I [Text truncated for display. 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