119-hr3069

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3069 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3069

 To establish an improved Medicare-for-All national health insurance 
 program.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 April 29, 2025

 Ms. Jayapal (for herself, Mrs. Dingell, Ms. Adams, Ms. Ansari, Ms. 
 Balint, Ms. Barragan, Mr. Bell, Mr. Beyer, Ms. Bonamici, Mr. Boyle of 
 Pennsylvania, Ms. Brown, Mr. Carbajal, Mr. Carson, Mr. Carter of 
Louisiana, Mr. Casar, Mrs. Cherfilus-McCormick, Ms. Chu, Ms. Clarke of 
New York, Mr. Cleaver, Mr. Cohen, Ms. Crockett, Mr. Davis of Illinois, 
Ms. DeGette, Mr. Deluzio, Mr. DeSaulnier, Ms. Dexter, Mr. Doggett, Ms. 
Escobar, Mr. Espaillat, Mrs. Foushee, Ms. Lois Frankel of Florida, Ms. 
 Friedman, Mr. Frost, Mr. Garamendi, Mr. Garcia of California, Mr. 
 Garcia of Illinois, Mr. Goldman of New York, Mr. Gomez, Mr. Green of 
 Texas, Mrs. Hayes, Ms. Hoyle of Oregon, Mr. Huffman, Mr. Jackson of 
 Illinois, Ms. Jacobs, Mr. Johnson of Georgia, Ms. Kamlager-Dove, Mr. 
 Keating, Ms. Kelly of Illinois, Mr. Kennedy of New York, Mr. Khanna, 
Ms. Lee of Pennsylvania, Ms. Leger Fernandez, Mr. Levin, Mr. Lieu, Ms. 
 Lofgren, Ms. McCollum, Mr. McGarvey, Mr. McGovern, Mrs. McIver, Mr. 
 Meeks, Ms. Meng, Mr. Mfume, Mr. Min, Mr. Mullin, Mr. Nadler, Mr. 
 Neguse, Ms. Norton, Ms. Ocasio-Cortez, Ms. Omar, Mr. Pallone, Mr. 
 Panetta, Ms. Pingree, Mr. Pocan, Ms. Pressley, Mr. Quigley, Mrs. 
Ramirez, Ms. Randall, Mr. Raskin, Ms. Rivas, Ms. Salinas, Ms. Sanchez, 
 Ms. Schakowsky, Mr. Scott of Virginia, Mr. Sherman, Ms. Simon, Mr. 
 Smith of Washington, Ms. Stansbury, Mr. Swalwell, Mr. Takano, Mr. 
Thanedar, Mr. Thompson of Mississippi, Mr. Thompson of California, Ms. 
 Titus, Ms. Tlaib, Ms. Tokuda, Mr. Tonko, Mrs. Trahan, Mr. Vargas, Ms. 
 Velazquez, Ms. Waters, Mrs. Watson Coleman, Ms. Williams of Georgia, 
 Ms. Wilson of Florida, Mr. Harder of California, Mr. Ivey, and Mr. 
 Torres of New York) introduced the following bill; which was referred 
 to the Committee on Energy and Commerce, and in addition to the 
Committees on Ways and Means, Education and Workforce, Rules, Oversight 
and Government Reform, Armed Services, and the Judiciary, 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 an improved Medicare-for-All national health insurance 
 program.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare for All 
Act''.

    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM; UNIVERSAL 
 COVERAGE; ENROLLMENT

Sec. 101. Establishment of the Medicare for All Program.

Sec. 102. Universal coverage.

Sec. 103. Freedom of choice.

Sec. 104. Non-discrimination.

Sec. 105. Enrollment.

Sec. 106. Effective date of benefits.

Sec. 107. Prohibition against duplicating coverage.
 TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND 
 BENEFITS FOR LONG-TERM CARE

Sec. 201. Comprehensive benefits.

Sec. 202. No cost-sharing; other limitations.

Sec. 203. Exclusions and limitations.

Sec. 204. Coverage of long-term care services.
 TITLE III--PROVIDER PARTICIPATION

Sec. 301. Provider participation and standards; whistleblower 
 protections.

Sec. 302. Qualifications for providers.

Sec. 303. Use of private contracts.
 TITLE IV--ADMINISTRATION

 Subtitle A--General Administration Provisions

Sec. 401. Administration.

Sec. 402. Consultation.

Sec. 403. Regional administration.

Sec. 404. Beneficiary ombudsman.

Sec. 405. Conduct of related health programs.
 Subtitle B--Control Over Fraud and Abuse

Sec. 411. Application of Federal sanctions to all fraud and abuse under 
 the Medicare for All Program.
 TITLE V--QUALITY ASSESSMENT

Sec. 501. Quality standards.

Sec. 502. Addressing health care disparities.
 TITLE VI--HEALTH BUDGET; PAYMENTS; COST CONTAINMENT MEASURES

 Subtitle A--Budgeting

Sec. 601. National health budget.
 Subtitle B--Payments to Providers

Sec. 611. Payments to institutional providers based on global budgets.

Sec. 612. Payment to individual providers through fee-for-service.

Sec. 613. Ensuring accurate valuation of services under the Medicare 
 physician fee schedule.

Sec. 614. Payment prohibitions; capital expenditures; special projects.

Sec. 615. Office of Health Equity.

Sec. 616. Office of Primary Care.

Sec. 617. Payments for prescription drugs and approved devices and 
 equipment.
 TITLE VII--UNIVERSAL MEDICARE TRUST FUND

Sec. 701. Universal Medicare Trust Fund.
 TITLE VIII--CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME 
 SECURITY ACT OF 1974

Sec. 801. Prohibition of employee benefits duplicative of benefits 
 under the Medicare for All Program; 
 coordination in case of workers' 
 compensation.

Sec. 802. Application of continuation coverage requirements under ERISA 
 and certain other requirements relating to 
 group health plans.

Sec. 803. Effective date of title.
 TITLE IX--ADDITIONAL CONFORMING AMENDMENTS

Sec. 901. Relationship to existing Federal health programs.

Sec. 902. Sunset of provisions related to the State Exchanges.

Sec. 903. Sunset of provisions related to pay for performance programs.
 TITLE X--TRANSITION

 Subtitle A--Medicare for All Transition Over 2 Years and Transitional 
 Buy-In Option

Sec. 1001. Medicare for all transition over two years.

Sec. 1002. Establishment of the Medicare transition buy-in.
 Subtitle B--Transitional Medicare Reforms

Sec. 1011. Eliminating the 24-month waiting period for Medicare 
 coverage for individuals with disabilities.

Sec. 1012. Ensuring continuity of care.
 TITLE XI--MISCELLANEOUS

Sec. 1101. Definitions.

Sec. 1102. Rules of construction.

Sec. 1103. No use of resources for law enforcement of certain 
 registration requirements.

 TITLE I--ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM; UNIVERSAL 
 COVERAGE; ENROLLMENT

SEC. 101. ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM.

 There is hereby established a national health insurance program to 
provide comprehensive protection against the costs of health care and 
health-related services, in accordance with the standards specified in, 
or established under, this Act.

SEC. 102. UNIVERSAL COVERAGE.

    (a) In General.--Every individual who is a resident of the United 
States is entitled to benefits for health care services under this Act. 
The Secretary shall promulgate a rule that provides criteria for 
determining residency for eligibility purposes under this Act.

    (b) Treatment of Other Individuals.--The Secretary may make 
eligible for benefits for health care services under this Act other 
individuals not described in subsection

    (a) , and regulate the 
eligibility of such individuals, to ensure that every person in the 
United States has access to health care. In regulating such 
eligibility, the Secretary shall ensure that individuals are not 
allowed to travel to the United States for the sole purpose of 
obtaining health care items and services provided under the program 
established under this Act.

SEC. 103. FREEDOM OF CHOICE.

 Any individual entitled to benefits under this Act may obtain 
health services from any institution, agency, or individual qualified 
to participate under this Act.

SEC. 104. NON-DISCRIMINATION.

    (a) In General.--No person shall, on the basis of race, color, 
national origin, age, disability, marital status, citizenship status, 
primary language use, genetic conditions, previous or existing medical 
conditions, religion, or sex, including sex stereotyping, gender 
identity, sexual orientation, and pregnancy and related medical 
conditions (including termination of pregnancy), be excluded from 
participation in or be denied the benefits of the program established 
under this Act (except as expressly authorized by this Act for purposes 
of enforcing eligibility standards described in 

section 102), or be 
subject to any reduction of benefits or other discrimination by any 
participating provider (as defined in 

section 301), or any entity 
conducting, administering, or funding a health program or activity, 
including contracts of insurance, pursuant to this Act.

    (b) Claims of Discrimination.--

    (1) In general.--The Secretary shall establish a procedure 
 for adjudication of administrative complaints alleging a 
 violation of subsection

    (a) .

    (2) Jurisdiction.--Any person aggrieved by a violation of 
 subsection

    (a) by a covered entity may file suit in any 
 district court of the United States having jurisdiction of the 
 parties. A person may bring an action under this paragraph 
 concurrently as such administrative remedies as established in 
 paragraph

    (1) .

    (3) Damages.--If the court finds a violation of subsection

    (a) , the court may grant compensatory and punitive damages, 
 declaratory relief, injunctive relief, attorneys' fees and 
 costs, or other relief as appropriate.
            (c) Continued Application of Laws.--Nothing in this title (or an 
amendment made by this title) shall be construed to invalidate or 
otherwise limit any of the rights, remedies, procedures, or legal 
standards available to individuals aggrieved under 

section 1557 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18116), title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title VII of 
the Civil Rights Act of 1964 (42 U.S.C. 2000e et seq.), title IX of the 
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 

section 504 of 
the Rehabilitation Act of 1973 (29 U.S.C. 794), or the Age 
Discrimination Act of 1975 (42 U.S.C. 611 et seq.). Nothing in this 
title (or an amendment to this title) shall be construed to supersede 
State laws that provide additional protections against discrimination 
on any basis described in subsection

    (a) .

SEC. 105. ENROLLMENT.

    (a) In General.--The Secretary shall provide a mechanism for the 
enrollment of individuals eligible for benefits under this Act. The 
mechanism shall--

    (1) include a process for the automatic enrollment of 
 individuals at the time of birth in the United States (or upon 
 establishment of residency in the United States);

    (2) provide for the enrollment, as of the dates described 
 in 

section 106, of all individuals who are eligible to be 
 enrolled as of such dates, as applicable; and

    (3) include a process for the enrollment of individuals 
 made eligible for health care services under 

section 102

    (b) .

    (b) Issuance of Universal Medicare Cards.--In conjunction with an 
individual's enrollment for benefits under this Act, the Secretary 
shall provide for the issuance of a Universal Medicare card that shall 
be used for purposes of identification and processing of claims for 
benefits under this program. The card shall not include an individual's 
Social Security number.

SEC. 106. EFFECTIVE DATE OF BENEFITS.

    (a) In General.--Except as provided in subsection

    (b) , benefits 
shall first be available under this Act for items and services 
furnished 2 years after the date of the enactment of this Act.

    (b) Coverage for Certain Individuals.--

    (1) In general.--For any eligible individual who--
        (A) has not yet attained the age of 19 as of the 
 date that is 1 year after the date of the enactment of 
 this Act; or
        (B) has attained the age of 55 as of the date that 
 is 1 year after the date of the enactment of this Act,
 benefits shall first be available under this Act for items and 
 services furnished as of such date.

    (2) Option to continue in other coverage during transition 
 period.--Any person who is eligible to receive benefits as 
 described in paragraph

    (1) may opt to maintain any coverage 
 described in 

section 901, private health insurance coverage, or 
 coverage offered pursuant to subtitle A of title X (including 
 the amendments made by such subtitle) until the date described 
 in subsection

    (a) .

SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE.

    (a) In General.--Beginning on the effective date described in 

section 106

    (a) , it shall be unlawful for--

    (1) a private health insurer to sell health insurance 
 coverage that duplicates the benefits provided under this Act; 
 or

    (2) an employer to provide benefits for an employee, former 
 employee, or the dependents of an employee or former employee 
 that duplicate the benefits provided under this Act.

    (b) Construction.--Nothing in this Act shall be construed as 
prohibiting the sale of health insurance coverage for any additional 
benefits not covered by this Act, including additional benefits that an 
employer may provide to employees or their dependents, or to former 
employees or their dependents.

 TITLE II--COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND 
 BENEFITS FOR LONG-TERM CARE

SEC. 201. COMPREHENSIVE BENEFITS.

    (a) In General.--Subject to the other provisions of this title and 
titles IV through IX, individuals enrolled for benefits under this Act 
are entitled to have payment made by the Secretary to an eligible 
provider for the following items and services if medically necessary or 
appropriate for the maintenance of health or for the diagnosis, 
treatment, or rehabilitation of a health condition:

    (1) Hospital services, including inpatient and outpatient 
 hospital care, including 24-hour-a-day emergency services and 
 inpatient prescription drugs.

    (2) Ambulatory patient services.

    (3) Primary and preventive services, including chronic 
 disease management.

    (4) Prescription drugs and medical devices, including 
 outpatient prescription drugs, medical devices, and biological 
 products, and all contraceptive items approved by the Food and 
 Drug Administration.

    (5) Mental health and substance use treatment services, 
 including inpatient care.

    (6) Laboratory and diagnostic services.

    (7) Comprehensive reproductive care, including abortion, 
 contraception, and assistive reproductive technology.

    (8) Maternity and newborn care.

    (9) Comprehensive gender affirming health care.

    (10) Oral health, audiology, and vision services.

    (11) Rehabilitative and habilitative services and devices.

    (12) Emergency services and transportation.

    (13) Early and periodic screening, diagnostic, and 
 treatment services, as described in sections 1902

    (a)

    (10)
        (A) , 
 1902

    (a)

    (43) , 1905

    (a)

    (4)
        (B) , and 1905

    (r) of the Social Security 
 Act (42 U.S.C. 1396a

    (a)

    (10)
        (A) ; 1396a

    (a)

    (43) ; 1396d

    (a)

    (4)
        (B) ; 
 1396d

    (r) ).

    (14) Necessary transportation to receive health care 
 services for persons with disabilities, older individuals with 
 functional limitations, or low-income individuals (as 
 determined by the Secretary).

    (15) Long-term care services and support (as described in 
 

section 204).

    (16) Hospice care.

    (17) Services provided by a licensed marriage and family 
 therapist or a licensed mental health counselor.

    (18) Any service described in a preceding paragraph that is 
 furnished via telehealth, to the extent practical.

    (b) Revision.--The Secretary shall, at least annually, and on a 
regular basis, evaluate whether the benefits package should be improved 
to promote the health of beneficiaries, account for changes in medical 
practice or new information from medical research, or respond to other 
relevant developments in health science, and shall make recommendations 
to Congress regarding any such improvements. Such recommendations may 
not include a recommendation to eliminate any benefit.
            (c) Hearings.--

    (1) In general.--The Committee on Energy and Commerce and 
 the Committee on Ways and Means of the House of Representatives 
 shall, not less frequently than annually, hold a hearing on the 
 recommendations submitted by the Secretary under subsection

    (b) .

    (2) Exercise of rulemaking authority.--Paragraph

    (1) is 
 enacted--
        (A) as an exercise of rulemaking power of the House 
 of Representatives, and, as such, shall be considered 
 as part of the rules of the House, and such rules shall 
 supersede any other rule of the House only to the 
 extent that rule is inconsistent therewith; and
        (B) with full recognition of the constitutional 
 right of either House to change such rules (so far as 
 relating to the procedure in such House) at any time, 
 in the same manner, and to the same extent as in the 
 case of any other rule of the House.
            (d) Complementary and Integrative Medicine.--

    (1) In general.--In carrying out subsection

    (b) , the 
 Secretary shall consult with the persons described in paragraph

    (2) with respect to--
        (A) identifying specific complementary and 
 integrative medicine practices that are appropriate to 
 include in the benefits package; and
        (B) identifying barriers to the effective provision 
 and integration of such practices into the delivery of 
 health care, and identifying mechanisms for overcoming 
 such barriers.

    (2) Consultation.--In accordance with paragraph

    (1) , the 
 Secretary shall consult with--
        (A) the Director of the National Center for 
 Complementary and Integrative Health;
        (B) the Commissioner of Food and Drugs;
            (C) institutions of higher education, private 
 research institutes, and individual researchers with 
 extensive experience in complementary and alternative 
 medicine and the integration of such practices into the 
 delivery of health care;
            (D) nationally recognized providers of 
 complementary and integrative medicine; and
        (E) such other officials, entities, and individuals 
 with expertise on complementary and integrative 
 medicine as the Secretary determines appropriate.

    (e) States May Provide Additional Benefits.--Individual States may 
provide additional benefits for the residents of such States, as 
determined by such State, and may provide benefits to individuals not 
eligible for benefits under this Act, at the expense of the State, 
subject to the requirements specified in 

section 1102.

SEC. 202. NO COST-SHARING; OTHER LIMITATIONS.

    (a) In General.--The Secretary shall ensure that no cost-sharing, 
including deductibles, coinsurance, copayments, or similar charges, is 
imposed on an individual for any benefits provided under this Act.

    (b) No Balance Billing.--No provider may impose a charge to an 
enrolled individual for covered services for which benefits are 
provided under this Act.
            (c) No Prior Authorization.--Benefits provided under this Act shall 
be covered without any need for any prior authorization determination 
and without any limitation applied through the use of step therapy 
protocols.

SEC. 203. EXCLUSIONS AND LIMITATIONS.

    (a) In General.--Benefits for items and services are not available 
under this Act unless the items and services meet the standards 
developed by the Secretary pursuant to 

section 201

    (a) .

    (b) Treatment of Experimental Items and Services and Drugs.--

    (1) In general.--In applying subsection

    (a) , the Secretary 
 shall make national coverage determinations with respect to 
 items and services that are experimental in nature. Such 
 determinations shall be consistent with the national coverage 
 determination process as defined in 

section 1869

    (f)

    (1)
        (B) of 
 the Social Security Act (42 U.S.C. 1395ff

    (f)

    (1)
        (B) ).

    (2) Appeals process.--The Secretary shall establish a 
 process by which individuals can appeal coverage decisions. The 
 process shall, as much as is feasible, follow the process for 
 appeals under the Medicare program described in 

section 1869 of 
 the Social Security Act (42 U.S.C. 1395ff).
            (c) Application of Practice Guidelines.--

    (1) In general.--In the case of items and services for 
 which the Department of Health and Human Services has 
 recognized a national practice guideline, such items and 
 services shall be deemed to meet the standards specified in 
 

section 201

    (a) if they have been provided in accordance with 
 such guideline. For purposes of this subsection, an item or 
 service not provided in accordance with a practice guideline 
 shall be deemed to have been provided in accordance with the 
 guideline if the health care provider providing the item or 
 service--
        (A) exercised appropriate professional judgment in 
 accordance with the laws and requirements of the State 
 in which such item or service is furnished in deviating 
 from the guideline;
        (B) acted in the best interest of the individual 
 receiving the item or service; and
            (C) acted in a manner consistent with the 
 individual's wishes.

    (2) Override of standards.--
        (A) In general.--An individual's treating physician 
 or other health care professional authorized to 
 exercise independent professional judgment in 
 implementing a patient's medical or nursing care plan 
 in accordance with the scope of practice, licensure, 
 and other law of the State where items and services are 
 to be furnished may override practice standards 
 established pursuant to 

section 201

    (a) or practice 
 guidelines described in paragraph

    (1) , including such 
 standards and guidelines that are implemented by a 
 provider through the use of health information 
 technology, such as electronic health record 
 technology, clinical decision support technology, and 
 computerized order entry programs.
        (B) Limitation.--An override described in 
 subparagraph
        (A) shall, in the professional judgment of 
 such physician, nurse, or health care professional, 
 be--
            (i) consistent with such physician's, 
 nurse's, or health care professional's 
 determination of medical necessity and 
 appropriateness or nursing assessment;
            (ii) in the best interests of the 
 individual; and
            (iii) consistent with the individual's 
 wishes.

SEC. 204. COVERAGE OF LONG-TERM CARE SERVICES.

    (a) In General.--Subject to the other provisions of this Act, 
individuals enrolled for benefits under this Act are entitled to the 
following long-term services and supports and to have payment made by 
the Secretary to an eligible provider for such services and supports if 
medically necessary and appropriate and in accordance with the 
standards established in this Act, for maintenance of health or for 
care, services, diagnosis, treatment, or rehabilitation that is related 
to a medically determinable condition, whether physical or mental, of 
health, injury, or age that--

    (1) causes a functional limitation in performing one or 
 more activities of daily living; or

    (2) requires a similar need of assistance in performing 
 instrumental activities of daily living.

    (b) Eligibility.--An individual shall be eligible for services and 
supports described in this section if such individual has one or more 
medically determinable conditions described in subsection

    (a) .
            (c) Services and Supports.--Long-term services and supports under 
this section shall be tailored to an individual's needs, as determined 
through assessment, and shall be defined by the Secretary to--

    (1) include any long-term nursing services for the 
 enrollee, whether provided in an institution or in a home- and 
 community-based setting;

    (2) provide coverage for a broad spectrum of long-term 
 services and supports, including for home- and community-based 
 services and other care provided through non-institutional 
 settings;

    (3) provide coverage that meets the physical, mental, and 
 social needs of recipients while allowing recipients their 
 maximum possible autonomy and their maximum possible civic, 
 social, and economic participation;

    (4) prioritize delivery of long-term services and supports 
 through home- and community-based services over 
 institutionalization;

    (5) unless an individual elects otherwise, ensure that 
 recipients will receive home- and community -based long-term 
 services and supports (as defined in subsection

    (f)

    (4) ), 
 regardless of the individuals's type or level of disability, 
 service need, or age;

    (6) be provided with the goal of enabling persons with 
 disabilities to receive services in the least restrictive and 
 most integrated setting appropriate to the individual's needs;

    (7) be provided in such a manner that allows persons with 
 disabilities to maintain their independence, self-
 determination, and dignity;

    (8) provide long-term services and supports that are of 
 equal quality and equally accessible across geographic regions; 
 and

    (9) ensure that long-term services and supports provide 
 recipients the option of self-direction of services from either 
 the recipient or care coordinators of the recipient's choosing.
            (d) Public Consultation.--In developing regulations to implement 
this section, the Secretary shall consult with an advisory commission 
on long-term services and supports that includes--

    (1) people with disabilities who use long-term services and 
 supports and older adults who use long-term services and 
 supports;

    (2) representatives of people with disabilities and 
 representatives of older adults;

    (3) groups that represent the diversity of the population 
 of people living with disabilities, including racial, ethnic, 
 national origin, primary language use, age, sex, including 
 gender identity and sexual orientation, geographical, and 
 socioeconomic diversity;

    (4) providers of long-term services and supports, including 
 family attendants and family caregivers, and members of 
 organized labor;

    (5) disability rights organizations; and

    (6) relevant academic institutions and researchers.

    (e) Budgeting and Payments.--Budgeting and payments for long-term 
services and supports provided under this section shall be made in 
accordance with the provisions under title VI.

    (f) 

=== Definitions. ===
-In this section:

    (1) The term ``long-term services and supports'' means 
 long-term care, treatment, maintenance, or services needed to 
 support the activities of daily living and instrumental 
 activities of daily living, including home- and community-based 
 services and any additional services and supports identified by 
 the Secretary to support people with disabilities to live, 
 work, and participate in their communities.

    (2) The term ``activities of daily living'' means basic 
 personal everyday activities, including tasks such as eating, 
 toileting, grooming, dressing, bathing, and transferring.

    (3) The term ``instrumental activities of daily living'' 
 means activities related to living independently in the 
 community, including meal planning and preparation, managing 
 finances, shopping for food, clothing, and other essential 
 items, performing essential household chores, communicating by 
 phone or other media, and traveling around and participating in 
 the community.

    (4) The term ``home and community-based services'' means 
 the home and community-based services that are coverable under 
 subsections
            (c) ,
            (d) ,
            (i) , and

    (k) of 

section 1915 of the 
 Social Security Act (42 U.S.C. 1396n), and as defined by the 
 Secretary, including as defined in the home and community-based 
 services settings rule in sections 441.530 and 441.710 of title 
 42, Code of Federal Regulations (or a successor regulation).

 TITLE III--PROVIDER PARTICIPATION

SEC. 301. PROVIDER PARTICIPATION AND STANDARDS; WHISTLEBLOWER 
 PROTECTIONS.

    (a) In General.--An individual or other entity furnishing any 
covered item or service under this Act is not a qualified provider 
unless the individual or entity--

    (1) is a qualified provider of the items or services under 
 

section 302;

    (2) has filed with the Secretary a participation agreement 
 described in subsection

    (b) ; and

    (3) meets, as applicable, such other qualifications and 
 conditions with respect to a provider of services under title 
 XVIII of the Social Security Act as described in 

section 1866 
 of the Social Security Act (42 U.S.C. 1395cc).

    (b) Requirements in Participation Agreement.--

    (1) In general.--A participation agreement described in 
 this subsection between the Secretary and a provider shall 
 provide at least for the following:
        (A) Items and services to eligible persons shall be 
 furnished by the provider without discrimination, in 
 accordance with 

section 104

    (a) . 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 
 practice.
        (B) No charge will be made to any enrolled 
 individual for any covered items or services other than 
 for payment authorized by this Act.
            (C) The provider agrees to furnish such information 
 as may be reasonably required by the Secretary, in 
 accordance with uniform reporting standards established 
 under 

section 401

    (b)

    (1) , for--
            (i) quality review by designated entities;
            (ii) making payments under this Act, 
 including the examination of records as may be 
 necessary for the verification of information 
 on which such payments are based;
            (iii) statistical or other studies required 
 for the implementation of this Act; and
            (iv) such other purposes as the Secretary 
 may specify.
            (D) In the case of a provider that is not an 
 individual, the provider agrees not to employ or use 
 for the provision of health services any individual or 
 other provider that has had a participation agreement 
 under this subsection terminated for cause. The 
 Secretary may authorize such employment or use on a 
 case-by-case basis.
        (E) In the case of a provider paid under a fee-for-
 service basis for items and services furnished under 
 this Act, the provider agrees to submit bills and any 
 required supporting documentation relating to the 
 provision of covered items and services within 30 days 
 after the date of providing such items and services.
        (F) In the case of an institutional provider paid 
 pursuant to 

section 611, the provider agrees to submit 
 information and any other required supporting 
 documentation as may be reasonably required by the 
 Secretary within 30 days after the date of providing 
 such items and services and in accordance with the 
 uniform reporting standards established under 

section 401

    (b)

    (1) , including information on a quarterly basis 
 that--
            (i) relates to the provision of covered 
 items and services; and
            (ii) describes items and services furnished 
 with respect to specific individuals.
        (G) In the case of a provider that receives payment 
 for items and services furnished under this Act based 
 on diagnosis-related coding, procedure coding, or other 
 coding system or data, the provider agrees--
            (i) to disclose to the Secretary any system 
 or index of coding or classifying patient 
 symptoms, diagnoses, clinical interventions, 
 episodes, or procedures that such provider 
 utilizes for global budget negotiations under 
 title VI or for meeting any other payment, 
 documentation, or data collection requirements 
 under this Act; and
            (ii) not to use any such system or index to 
 establish financial incentives or disincentives 
 for health care professionals, or that is 
 proprietary, interferes with the medical or 
 nursing process, or is designed to increase the 
 amount or number of payments.
        (H) The provider complies with the duty of provider 
 ethics and reporting requirements described in 
 paragraph

    (2) .
            (I) In the case of a provider that is not an 
 individual, the provider agrees that no board member, 
 executive, or administrator of such provider receives 
 compensation from, owns stock or has other financial 
 investments in, or serves as a board member of any 
 entity that contracts with or provides items or 
 services, including pharmaceutical products and medical 
 devices or equipment, to such provider.

    (2) Provider duty of ethics.--Each health care provider, 
 including institutional providers, 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 care, such that no financial interest or 
 relationship impairs any health care provider's ability to 
 furnish necessary and appropriate care to such individual. To 
 implement the duty established in this paragraph, the Secretary 
 shall--
        (A) promulgate reasonable reporting rules to 
 evaluate participating provider compliance with this 
 paragraph;
        (B) prohibit participating providers, spouses, and 
 immediate family members of participating providers, 
 from accepting or entering into any arrangement for any 
 bonus, incentive payment, profit-sharing, or 
 compensation based on patient utilization or based on 
 financial outcomes of any other provider or entity; and
            (C) prohibit participating providers or any board 
 member or representative of such provider from serving 
 as board members for or receiving any compensation, 
 stock, or other financial investment in an entity that 
 contracts with or provides items or services (including 
 pharmaceutical products and medical devices or 
 equipment) to such provider.

    (3) Termination of participation agreement.--
        (A) In general.--Participation agreements may be 
 terminated, with appropriate notice--
            (i) by the Secretary for failure to meet 
 the requirements of this Act;
            (ii) in accordance with the provisions 
 described in 

section 411; or
            (iii) by a provider.
        (B) 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 reasons.
            (C) Provider protections.--
            (i) Prohibition.--The Secretary may not 
 terminate a participation agreement or in any 
 other way discriminate against, or cause to be 
 discriminated against, any covered provider or 
 authorized representative of the provider, on 
 account of such provider or representative--
            (I) providing, causing to be 
 provided, or being about to provide or 
 cause to be provided to the provider, 
 the Federal Government, or the attorney 
 general of a State information relating 
 to any violation of, or any act or 
 omission the provider or representative 
 reasonably believes to be a violation 
 of, any provision of this title (or an 
 amendment made by this title);
            (II) testifying or being about to 
 testify in a proceeding concerning such 
 violation;
            (III) assisting or participating, 
 or being about to assist or 
 participate, in such a proceeding; or
            (IV) objecting to, or refusing to 
 participate in, any activity, policy, 
 practice, or assigned task that the 
 provider or representative reasonably 
 believes to be in violation of any 
 provision of this Act (including any 
 amendment made by this Act), or any 
 order, rule, regulation, standard, or 
 ban under this Act (including any 
 amendment made by this Act).
            (ii) 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 
 procedures, notifications, burdens of proof, 
 remedies, and statutes of limitation set forth 
 in 

section 2087

    (b) of title 15, United States 
 Code.
            (c) Whistleblower Protections.--

    (1) 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--
        (A) notified the Secretary or the employee's 
 employer of any alleged violation of this title, 
 including communications related to carrying out the 
 employee's job duties;
        (B) refused to engage in any practice made unlawful 
 by this title, if the employee has identified the 
 alleged illegality to the employer;
            (C) testified before or otherwise provided 
 information relevant for Congress or for any Federal or 
 State proceeding regarding any provision (or proposed 
 provision) of this title;
            (D) commenced, caused to be commenced, or is about 
 to commence or cause to be commenced a proceeding under 
 this title;
        (E) testified or is about to testify in any such 
 proceeding; or
        (F) 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 title.

    (2) Enforcement action.--Any employee covered by this 
 section who alleges discrimination by an employer in violation 
 of paragraph

    (1) may bring an action, subject to the statute of 
 limitations in the anti-retaliation provisions of the False 
 Claims Act and the rules and procedures, legal burdens of 
 proof, and remedies applicable under the employee protections 
 provisions of the Surface Transportation Assistance Act.

    (3) Application.--
        (A) Nothing in this subsection shall be construed 
 to diminish the rights, privileges, or remedies of any 
 employee under any Federal or State law or regulation, 
 including the rights and remedies against retaliatory 
 action under the False Claims Act (31 U.S.C. 3730

    (h) ), 
 or under any collective bargaining agreement. The 
 rights and remedies in this section may not be waived 
 by any agreement, policy, form, or condition of 
 employment.
        (B) Nothing in this subsection shall be construed 
 to preempt or diminish any other Federal or State law 
 or regulation against discrimination, demotion, 
 discharge, suspension, threats, harassment, reprimand, 
 retaliation, or any other manner of discrimination, 
 including the rights and remedies against retaliatory 
 action under the False Claims Act (31 U.S.C. 3730

    (h) ).

    (4) === Definitions. ===
-In this subsection:
        (A) Employer.--The term ``employer'' means any 
 person engaged in profit or nonprofit business or 
 industry, including one or more individuals, 
 partnerships, associations, corporations, trusts, 
 professional membership organization including a 
 certification, disciplinary, or other professional 
 body, unincorporated organizations, nongovernmental 
 organizations, or trustees, and subject to liability 
 for violating the provisions of this Act.
        (B) Employee.--The term ``employee'' means any 
 individual performing activities under this Act on 
 behalf of an employer.

SEC. 302. QUALIFICATIONS FOR PROVIDERS.

    (a) In General.--A health care provider is considered to be 
qualified to furnish covered items and services under this Act if the 
provider is licensed or certified to furnish such items and services in 
the State in which the individual receiving such items or services is 
located and meets--

    (1) the requirements of such State's law to furnish such 
 items and services; and

    (2) applicable requirements of Federal law to furnish such 
 items and services.

    (b) Limitation.--An entity or provider shall not be qualified to 
furnish covered items and services under this Act if the entity or 
provider provides no items and services directly to individuals, 
including--

    (1) entities or providers that contract with other entities 
 or providers to provide such items and services; and

    (2) entities that are currently approved to coordinate care 
 plans under the Medicare Advantage program established in part 
 C of title XVIII of the Social Security Act (42 U.S.C. 1851 et 
 seq.) but do not directly provide items and services of such 
 care plans.
            (c) Minimum Provider Standards.--

    (1) In general.--The Secretary shall establish, evaluate, 
 and update national minimum standards to ensure the quality of 
 items and services provided under this Act and to monitor 
 efforts by States to ensure the quality of such items and 
 services. A State may establish additional minimum standards 
 which providers shall meet with respect to items and services 
 provided in such State.

    (2) National minimum standards.--The Secretary shall 
 establish national minimum standards under paragraph

    (1) for 
 institutional providers of services and individual health care 
 practitioners. Except as the Secretary may specify in order to 
 carry out this Act, a hospital, skilled nursing facility, or 
 other institutional provider of services shall meet standards 
 applicable to such a provider under the Medicare program under 
 title XVIII of the Social Security Act (42 U.S.C. 1395 et 
 seq.). Such standards also may include, where appropriate, 
 elements relating to--
        (A) adequacy and quality of facilities;
        (B) mandatory minimum safe registered nurse-to-
 patient staffing ratios and optimal staffing levels for 
 physicians and other health care practitioners;
            (C) training and competence of personnel (including 
 requirements related to the number of or type of 
 required continuing education hours);
            (D) comprehensiveness of service;
        (E) continuity of service;
        (F) patient waiting time, access to services, and 
 preferences; and
        (G) performance standards, including organization, 
 facilities, structure of services, efficiency of 
 operation, and outcome in palliation, improvement of 
 health, stabilization, cure, or rehabilitation.

    (3) Transition in application.--If the Secretary provides 
 for additional requirements for providers under this 
 subsection, 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 requirement.

    (4) Ability to provide services.--With respect to any 
 entity or provider certified to provide items and services 
 described in 

section 201

    (a)

    (7) , the Secretary may not prohibit 
 such entity or provider from participating for reasons other 
 than such entity's or provider's ability to provide such items 
 and services.
            (d) Federal Providers.--Any provider qualified to provide health 
care items and services through the Department of Veterans Affairs, the 
Indian Health Service, or the uniformed services (with respect to the 
direct care component of the TRICARE Program) is a qualifying provider 
under this section with respect to any individual who qualifies for 
such items and services under applicable Federal law.

SEC. 303. USE OF PRIVATE CONTRACTS.

    (a) In General.--This section shall apply beginning 2 years after 
the date of the enactment of this Act.

    (b) Participating Providers.--

    (1) Private contracts for covered items and services for 
 eligible individuals.--An institutional or individual provider 
 with an agreement in effect under 

section 301 may not bill or 
 enter into any private contract with any individual eligible 
 for benefits under the Act for any item or service that is a 
 benefit under this Act.

    (2) Private contracts for noncovered items and services for 
 eligible individuals.--An institutional or individual provider 
 with an agreement in effect under 

section 301 may bill or enter 
 into a private contract with an individual eligible for 
 benefits under the Act for any item or service that is not a 
 benefit under this Act only if--
        (A) the contract and provider meet the requirements 
 specified in paragraphs

    (3) and

    (4) , respectively;
        (B) such item or service is not payable or 
 available under this Act; and
            (C) the provider receives--
            (i) no reimbursement under this Act 
 directly or indirectly for such item or 
 service, and
            (ii) receives no amount for such item or 
 service from an organization which receives 
 reimbursement for such items or service under 
 this Act directly or indirectly.

    (3) Contract requirements.--Any contract to provide items 
 and services described in paragraph

    (2) shall--
        (A) be in writing and signed by the individual (or 
 authorized representative of the individual) receiving 
 the item or service before the item or service is 
 furnished pursuant to the contract;
        (B) not be entered into at a time when the 
 individual is facing an emergency health care 
 situation; and
            (C) clearly indicate to the individual receiving 
 such items and services that by signing such a contract 
 the individual--
            (i) agrees not to submit a claim (or to 
 request that the provider submit a claim) under 
 this Act for such items or services;
            (ii) agrees to be responsible for payment 
 of such items or services and understands that 
 no reimbursement will be provided under this 
 Act for such items or services;
            (iii) acknowledges that no limits under 
 this Act apply to amounts that may be charged 
 for such items or services; and
            (iv) acknowledges that the provider is 
 providing services outside the scope of the 
 program under this Act.

    (4) Affidavit.--A participating provider who enters into a 
 contract described in paragraph

    (2) shall have in effect during 
 the period any item or service is to be provided pursuant to 
 the contract an affidavit that shall--
        (A) identify the provider who is to furnish such 
 noncovered item or service, and be signed by such 
 provider;
        (B) state that the provider will not submit any 
 claim under this Act for any noncovered item or service 
 provided to any individual enrolled under this Act; and
            (C) be filed with the Secretary no later than 10 
 days after the first contract to which such affidavit 
 applies is entered into.

    (5) Enforcement.--If a provider signing an affidavit 
 described in paragraph

    (4) knowingly and willfully submits a 
 claim under this title for any item or service provided or 
 receives any reimbursement or amount for any such item or 
 service provided pursuant to a private contract described in 
 paragraph

    (2) with respect to such affidavit--
        (A) any contract described in paragraph

    (2) shall 
 be null and void;
        (B) no payment shall be made under this title for 
 any item or service furnished by the provider during 
 the 2-year period beginning on the date the affidavit 
 was signed; and
            (C) any payment received under this title for any 
 item or service furnished during such period shall be 
 remitted.

    (6) Private contracts for ineligible individuals.--An 
 institutional or individual provider with an agreement in 
 effect under 

section 301 may bill or enter into a private 
 contract with any individual ineligible for benefits under the 
 Act for any item or service.
            (c) Nonparticipating Providers.--

    (1) Private contracts for covered items and services for 
 eligible individuals.--An institutional or individual provider 
 with no agreement in effect under 

section 301 may bill or enter 
 into any private contract with any individual eligible for 
 benefits under the Act for any item or service that is a 
 benefit under this Act described in title II only if the 
 contract and provider meet the requirements specified in 
 paragraphs

    (2) and

    (3) , respectively.

    (2) Items required to be included in contract.--Any 
 contract to provide items and services described in paragraph

    (1) shall--
        (A) be in writing and signed by the individual (or 
 authorized representative of the individual) receiving 
 the item or service before the item or service is 
 furnished pursuant to the contract;
        (B) not be entered into at a time when the 
 individual is facing an emergency health care 
 situation; and
            (C) clearly indicate to the individual receiving 
 such items and services that by signing such a contract 
 the individual--
            (i) acknowledges that the individual has 
 the right to have such items or services 
 provided by other providers for whom payment 
 would be made under this Act;
            (ii) agrees not to submit a claim (or to 
 request that the provider submit a claim) under 
 this Act for such items or services even if 
 such items or services are otherwise covered by 
 this Act;
            (iii) agrees to be responsible for payment 
 of such items or services and understands that 
 no reimbursement will be provided under this 
 Act for such items or services;
            (iv) acknowledges that no limits under this 
 Act apply to amounts that may be charged for 
 such items or services; and
            (v) acknowledges that the provider is 
 providing services outside the scope of the 
 program under this Act.

    (3) Affidavit.--A provider who enters into a contract 
 described in paragraph

    (1) shall have in effect during the 
 period any item or service is to be provided pursuant to the 
 contract an affidavit that shall--
        (A) identify the provider who is to furnish such 
 covered item or service, and be signed by such 
 provider;
        (B) state that the provider will not submit any 
 claim under this Act for any covered item or service 
 provided to any individual enrolled under this Act 
 during the 2-year period beginning on the date the 
 affidavit is signed; and
            (C) be filed with the Secretary no later than 10 
 days after the first contract to which such affidavit 
 applies is entered into.

    (4) Enforcement.--If a provider signing an affidavit 
 described in paragraph

    (3) knowingly and willfully submits a 
 claim under this title for any item or service provided or 
 receives any reimbursement or amount for any such item or 
 service provided pursuant to a private contract described in 
 paragraph

    (1) with respect to such affidavit--
        (A) any contract described in paragraph

    (1) shall 
 be null and void; and
        (B) no payment shall be made under this title for 
 any item or service furnished by the provider during 
 the 2-year period beginning on the date the affidavit 
 was signed.

    (5) Private contracts for noncovered items and services for 
 any individual.--An institutional or individual provider with 
 no agreement in effect under 

section 301 may bill or enter into 
 a private contract with any individual for a item or service 
 that is not a benefit under this Act.

 TITLE IV--ADMINISTRATION

 Subtitle A--General Administration Provisions

SEC. 401. ADMINISTRATION.

    (a) General Duties of the Secretary.--

    (1) In general.--The Secretary shall develop policies, 
 procedures, guidelines, and requirements to carry out this Act, 
 including related to--
        (A) eligibility for benefits;
        (B) enrollment;
            (C) benefits provided;
            (D) provider participation standards and 
 qualifications, as described in title III;
        (E) levels of funding;
        (F) methods for determining amounts of payments to 
 providers of covered items and services, consistent 
 with subtitle B;
        (G) a process for appealing or petitioning for a 
 determination of coverage or noncoverage of items and 
 services under this Act;
        (H) planning for capital expenditures and service 
 delivery;
            (I) planning for health professional education 
 funding;
        (J) encouraging States to develop regional planning 
 mechanisms; and
        (K) any other regulations necessary to carry out 
 the purposes of this Act.

    (2) Regulations.--Regulations authorized by this Act shall 
 be issued by the Secretary in accordance with 

section 553 of 
 title 5, United States Code.

    (3) Accessibility.--The Secretary shall have the obligation 
 to ensure the timely and accessible provision of items and 
 services that all eligible individuals are entitled to under 
 this Act.

    (b) Uniform Reporting Standards; Annual Report; Studies.--

    (1) Uniform reporting standards.--
        (A) In general.--The Secretary shall establish 
 uniform State reporting requirements and national 
 standards to ensure an adequate national database 
 containing information pertaining to health services 
 practitioners, approved providers, the costs of 
 facilities and practitioners providing items and 
 services, the quality of such items and services, the 
 outcomes of such items and services, and the equity of 
 health among population groups. Such database shall 
 include, to the maximum extent feasible without 
 compromising patient privacy, health outcome measures 
 used under this Act, and to the maximum extent feasible 
 without excessively burdening providers, a description 
 of the standards and qualifications, levels of finding, 
 and methods described in subparagraphs
            (D) through
        (F) of subsection

    (a)

    (1) .
        (B) Required data disclosures.--In establishing 
 reporting requirements and standards under subparagraph
        (A) , the Secretary shall require a provider with an 
 agreement in effect under 

section 301 to disclose to 
 the Secretary, in a time and manner specified by the 
 Secretary, the following (as applicable to the type of 
 provider):
            (i) Any data the provider is required to 
 report or does report to any State or local 
 agency, or, as of January 1, 2019, to the 
 Secretary or any entity that is part of the 
 Department of Health and Human Services, except 
 data that are required under the programs 
 terminated in 

section 903.
            (ii) Annual financial data that includes 
 information on employees (including the number 
 of employees, hours worked, and wage 
 information) by job title and by each patient 
 care unit or department within each facility 
 (including outpatient units or departments); 
 the number of registered nurses per staffed bed 
 by each such unit or department; information on 
 the dollar value and annual spending (including 
 purchases, upgrades, and maintenance) for 
 health information technology; and risk-
 adjusted and raw patient outcome data 
 (including data on medical, surgical, 
 obstetric, and other procedures).
            (C) Reports.--The Secretary shall regularly analyze 
 information reported to the Secretary and shall define 
 rules and procedures to allow researchers, scholars, 
 health care providers, and others to access and analyze 
 data for purposes consistent with quality and outcomes 
 research, without compromising patient privacy.

    (2) Annual report.--Beginning 2 years after the date of the 
 enactment of this Act, the Secretary shall annually report to 
 Congress on the following:
        (A) The status of implementation of the Act.
        (B) Enrollment under this Act.
            (C) Benefits under this Act.
            (D) Expenditures and financing under this Act.
        (E) Cost-containment measures and achievements 
 under this Act.
        (F) Quality assurance.
        (G) Health care utilization patterns, including any 
 changes attributable to the program.
        (H) Changes in the per-capita costs of health care.
            (I) Differences in the health status of the 
 populations of the different States, including by 
 racial, ethnic, national origin, primary language use, 
 age, disability, sex, including gender identity and 
 sexual orientation, geographical, and income 
 characteristics.
        (J) Progress on quality and outcome measures, and 
 long-range plans and goals for achievements in such 
 areas.
        (K) Plans for improving service to medically 
 underserved populations.
            (L) Transition problems as a result of 
 implementation of this Act.
            (M) Opportunities for improvements under this Act.

    (3) Statistical analyses and other studies.--The Secretary 
 may, either directly or by contract--
        (A) make statistical and other studies, on a 
 nationwide, regional, State, or local basis, of any 
 aspect of the operation of this Act;
        (B) develop and test methods of delivery of items 
 and services as the Secretary may consider necessary or 
 promising for the evaluation, or for the improvement, 
 of the operation of this Act; and
            (C) develop methodological standards for 
 policymaking.
            (c) Audits.--

    (1) 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 effective 
 date of this Act to determine the effectiveness of the program 
 in carrying out the duties under subsection

    (a) .

    (2) Reports.--The Comptroller General of the United States 
 shall submit a report to Congress concerning the results of 
 each audit conducted under this subsection.

SEC. 402. CONSULTATION.

 The Secretary shall consult with Federal agencies, Indian tribes 
and urban Indian health organizations, and private entities, such as 
labor organizations representing health care workers, professional 
societies, national associations, nationally recognized associations of 
health care experts, medical schools and academic health centers, 
consumer groups, and business organizations in the formulation of 
guidelines, regulations, policy initiatives, and information gathering 
to ensure the broadest and most informed input in the administration of 
this Act. Nothing in this Act shall prevent the Secretary from adopting 
guidelines, consistent with the provisions of 

section 203
            (c) , developed 
by such a private entity if, in the Secretary's judgment, such 
guidelines are generally accepted as reasonable and prudent and 
consistent with this Act.

SEC. 403. REGIONAL ADMINISTRATION.

    (a) Coordination With Regional Offices.--The Secretary shall 
establish and maintain regional offices for purposes of carrying out 
the duties specified in subsection
            (c) and promoting adequate access 
to, and efficient use of, tertiary care facilities, equipment, and 
services by individuals enrolled under this Act. Wherever possible, the 
Secretary shall incorporate regional offices of the Centers for 
Medicare & Medicaid Services for this purpose.

    (b) Appointment of Regional Directors.--In each such regional 
office there shall be--

    (1) one regional director appointed by the Secretary;

    (2) one deputy director appointed by the regional director 
 to represent the Indian and Alaska Native tribes in the region, 
 if any; and

    (3) one deputy direction appointed by the regional director 
 to oversee long-term services and supports.
            (c) Regional Office Duties.--Each regional director shall--

    (1) provide an annual health care needs assessment with 
 respect to the region under the director's jurisdiction to the 
 Secretary after a thorough examination of health needs and in 
 consultation with public health officials, clinicians, 
 patients, and patient advocates;

    (2) recommend any changes in provider reimbursement or 
 payment for delivery of health services determined appropriate 
 by the regional director, subject to the provisions of title 
 VI; and

    (3) establish a quality assurance mechanism in each such 
 region in order to minimize both underutilization and 
 overutilization of health care items and services and to ensure 
 that all providers meet quality standards established pursuant 
 to this Act.

SEC. 404. BENEFICIARY OMBUDSMAN.

    (a) In General.--The Secretary shall appoint a Beneficiary 
Ombudsman who shall have expertise and experience in the fields of 
health care and education of, and assistance to, individuals enrolled 
under this Act.

    (b) Duties.--The Beneficiary Ombudsman shall--

    (1) receive complaints, grievances, and requests for 
 information submitted by individuals enrolled under this Act or 
 eligible to enroll under this Act with respect to any aspect of 
 the Medicare for All Program;

    (2) provide assistance with respect to complaints, 
 grievances, and requests referred to in paragraph

    (1) , 
 including assistance in collecting relevant information for 
 such individuals, to seek an appeal of a decision or 
 determination made by a regional office or the Secretary; and

    (3) submit annual reports to Congress and the Secretary 
 that describe the activities of the Ombudsman and that include 
 such recommendations for improvement in the administration of 
 this Act as the Ombudsman determines appropriate. The Ombudsman 
 shall not serve as an advocate for any increases in payments or 
 new coverage of services, but may identify issues and problems 
 in payment or coverage policies.

SEC. 405. CONDUCT OF RELATED HEALTH PROGRAMS.

 In performing functions with respect to health personnel education 
and training, health research, environmental health, disability 
insurance, vocational rehabilitation, the regulation of food and drugs, 
and all other matters pertaining to health, 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 Act.

 Subtitle B--Control Over Fraud and Abuse

SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL FRAUD AND ABUSE UNDER 
 THE MEDICARE FOR ALL PROGRAM.

 The following sections of the Social Security Act shall apply to 
this Act in the same manner as they apply to title XVIII or State plans 
under title XIX of the Social Security Act:

    (1) Section 1128 (relating to exclusion of individuals and 
 entities).

    (2) Section 1128A (civil monetary penalties).

    (3) Section 1128B (criminal penalties).

    (4) Section 1124 (relating to disclosure of ownership and 
 related information).

    (5) Section 1126 (relating to disclosure of certain 
 owners).

    (6) Section 1877 (relating to physician referrals).

 TITLE V--QUALITY ASSESSMENT

SEC. 501. QUALITY STANDARDS.

    (a) 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 (referred 
to in this title as the ``Center'') or such other agency determined 
appropriate by the Secretary, in coordination with the Agency for 
Healthcare Research and Quality and other offices of the Department of 
Health and Human Services.

    (b) Duties of the Center.--The Center shall perform the following 
duties:

    (1) Review and evaluate each practice guideline developed 
 under part B of title IX of the Public Health Service Act. In 
 so reviewing and evaluating, the Center shall determine whether 
 the guideline should be recognized as a national practice 
 guideline in accordance with and subject to the provisions of 
 

section 203
            (c) .

    (2) Review and evaluate each standard of quality, 
 performance measure, and medical review criterion developed 
 under part B of title IX of the Public Health Service Act (42 
 U.S.C. 299 et seq.). In so reviewing and evaluating, the Center 
 shall determine whether the standard, measure, or criterion is 
 appropriate for use in assessing or reviewing the quality of 
 items and services provided by health care institutions or 
 health care professionals. The use of mechanisms that 
 discriminate against people with disabilities is prohibited for 
 use in any value or cost-effectiveness assessments. The Center 
 shall consider the evidentiary basis for the standard, and the 
 validity, reliability, and feasibility of measuring the 
 standard.

    (3) Adoption of methodologies for profiling the patterns of 
 practice of health care professionals and for identifying and 
 notifying outliers.

    (4) Development of minimum criteria for competence for 
 entities that can qualify to conduct ongoing and continuous 
 external quality reviews in the administrative regions. 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 another. The Center shall ensure coordination and 
 reporting by such entities to ensure national consistency in 
 quality standards.

    (5) 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 services under 

section 401

    (a)

    (1)
        (G) .

SEC. 502. ADDRESSING HEALTH CARE DISPARITIES.

    (a) Evaluating Data Collection Approaches.--The Center shall 
evaluate approaches for the collection of data under this Act, to be 
performed in conjunction with existing quality reporting requirements 
and programs under this Act, that allow for the ongoing, accurate, and 
timely collection of data on disparities in health care services and 
performance on the basis of race, ethnicity, national origin, primary 
language use, age, disability, sex (including gender identity and 
sexual orientation), geography, or socioeconomic status. In conducting 
such evaluation, the Center shall consider the following objectives:

    (1) Protecting patient privacy.

    (2) Minimizing the administrative burdens of data 
 collection and reporting on providers under this Act.

    (3) Improving data on race, ethnicity, national origin, 
 primary language use, age, disability, sex (including gender 
 identity and sexual orientation), geography, and socioeconomic 
 status.

    (b) Reports to Congress.--

    (1) Report on evaluation.--Not later than 18 months after 
 the date on which benefits first become available as described 
 in 

section 106

    (a) , the Center shall submit to Congress and the 
 Secretary a report on the evaluation conducted under subsection

    (a) . Such report shall, taking into consideration the results 
 of such evaluation--
        (A) identify approaches (including defining 
 methodologies) for identifying and collecting and 
 evaluating data on health care disparities on the basis 
 of race, ethnicity, national origin, primary language 
 use, age, disability, sex (including gender identity 
 and sexual orientation), geography, or socioeconomic 
 status under the Medicare for All Program; and
        (B) include recommendations on the most effective 
 strategies and approaches to reporting quality 
 measures, as appropriate, on the basis of race, 
 ethnicity, national origin, primary language use, age, 
 disability, sex (including gender identity and sexual 
 orientation), geography, or socioeconomic status.

    (2) Report on data analyses.--Not later than 4 years after 
 the submission of the report under subsection

    (b)

    (1) , and every 
 4 years thereafter, 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
            (c) .
            (c) Implementing Effective Approaches.--Not later than 2 years 
after the date on which benefits first become available as described in 

section 106

    (a) , the Secretary shall implement the approaches identified 
in the report submitted under subsection

    (b)

    (1) for the ongoing, 
accurate, and timely collection and evaluation of data on health care 
disparities on the basis of race, ethnicity, national origin, primary 
language use, age, disability, sex (including gender identity and 
sexual orientation), geography, or socioeconomic status.

 TITLE VI--HEALTH BUDGET; PAYMENTS; COST CONTAINMENT MEASURES

 Subtitle A--Budgeting

SEC. 601. NATIONAL HEALTH BUDGET.

    (a) National Health Budget.--

    (1) In general.--By not later than September 1 of each 
 year, beginning with the year prior to the date on which 
 benefits first become available as described in 

section 106

    (a) , 
 the Secretary shall establish a national health budget, which 
 specifies a budget for the total expenditures to be made for 
 covered health care items and services under this Act.

    (2) Division of budget into components.--The national 
 health budget shall consist of the following components:
        (A) An operating budget.
        (B) A capital expenditures budget.
            (C) A special projects budget.
            (D) Quality assessment activities under title V.
        (E) Health professional education expenditures.
        (F) Administrative costs, including costs related 
 to the operation of regional offices.
        (G) A reserve fund.
        (H) Prevention and public health activities.

    (3) Allocation among components.--The Secretary shall 
 allocate the funds received for purposes of carrying out this 
 Act among the components described in paragraph

    (2) in a manner 
 that ensures--
        (A) that the operating budget allows for every 
 participating provider in the Medicare for All Program 
 to meet the needs of their respective patient 
 populations;
        (B) that the special projects budget is sufficient 
 to meet the health care needs within areas described in 
 paragraph

    (2)
            (C) through the construction, renovation, 
 and staffing of health care facilities in a reasonable 
 timeframe;
            (C) a fair allocation for quality assessment 
 activities; and
            (D) that the health professional education 
 expenditure component is sufficient to provide for the 
 amount of health professional education expenditures 
 sufficient to meet the need for covered health care 
 services.

    (4) 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 region, including payments to providers in such region, 
 capital expenditures in such region, special projects in such 
 region, health professional education in such region, 
 administrative expenses in such region, and prevention and 
 public health activities in such region.

    (5) Operating budget.--The operating budget described in 
 paragraph

    (2)
        (A) shall be used for--
        (A) payments to institutional providers pursuant to 
 

section 611; and
        (B) payments to individual providers pursuant to 
 

section 612.

    (6) Capital expenditures budget.--The capital expenditures 
 budget described in paragraph

    (2)
        (B) shall be used for--
        (A) the construction or renovation of health care 
 facilities, excluding congregate or segregated 
 facilities for individuals with disabilities who 
 receive long-term care services and support; and
        (B) major equipment purchases.

    (7) Special projects budget.--The special projects budget 
 described in paragraph

    (2)
            (C) shall be used for the purposes of 
 allocating funds for the construction of new facilities, major 
 equipment purchases, and staffing in rural or medically 
 underserved areas (as defined in 

section 330

    (b)

    (3) of the 
 Public Health Service Act (42 U.S.C. 254b

    (b)

    (3) )), including 
 areas designated as health professional shortage areas (as 
 defined in 

section 332

    (a) of the Public Health Service Act (42 
 U.S.C. 254e

    (a) )), and to address health disparities, including 
 racial, ethnic, national origin, primary language use, age, 
 disability, sex (including gender identity and sexual 
 orientation), geography, or socioeconomic health disparities.

    (8) Temporary worker assistance.--
        (A) In general.--For up to 5 years following the 
 date on which benefits first become available as 
 described in 

section 106

    (a) , at least 1 percent of the 
 budget shall be allocated to programs providing 
 assistance to workers who perform functions in the 
 administration of the health insurance system, or 
 related functions within health care institutions or 
 organizations who may be affected by the implementation 
 of this Act and who may experience economic dislocation 
 as a result of the implementation of this Act.
        (B) Clarification.--Assistance described in 
 subparagraph
        (A) shall include wage replacement, 
 retirement benefits, job training and placement, 
 preferential hiring, and education benefits.

    (9) Reserve fund.--The reserve fund described in paragraph

    (2)
        (G) shall be used to respond to the costs of an epidemic, 
 pandemic, natural disaster, or other such health emergency, or 
 market-shift adjustments related to patient volume.

    (10) Supplemental indian health service allocation.--The 
 Secretary shall annually determine the need to provide an 
 allotment of supplemental funds to Indian Health Services, 
 including payments to providers, capital expenditures, special 
 projects, health professional education, administrative 
 expenses, and prevention and public health activities.

    (b) 

=== Definitions. ===
-In this section:

    (1) Capital expenditures.--The term ``capital 
 expenditures'' means expenses for the purchase, lease, 
 construction, or renovation of capital facilities and for major 
 equipment.

    (2) 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 
 activities, including the impact of workforce diversity on 
 patient outcomes.

 Subtitle B--Payments to Providers

SEC. 611. PAYMENTS TO INSTITUTIONAL PROVIDERS BASED ON GLOBAL BUDGETS.

    (a) In General.--Not later than the beginning of each fiscal 
quarter during which an institutional provider of care (including 
hospitals, skilled nursing facilities, Federally qualified health 
centers, and independent dialysis facilities) is to furnish items and 
services under this Act, the Secretary shall pay to such institutional 
provider a lump sum in accordance with the succeeding provisions of 
this subsection and consistent with the following:

    (1) Payment in full.--Such payment shall be considered as 
 payment in full for all operating expenses for items and 
 services furnished under this Act, whether inpatient or 
 outpatient, by such provider for such quarter, 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

    (3) .

    (2) Quarterly review.--The regional director, on a 
 quarterly basis, 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 
 warranted. 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 volume. The review shall 
 also include an assessment of any adjustments made to ensure 
 that accuracy and need for adjustment was appropriate.

    (3) Agreements for salaried payments for certain 
 providers.--Certain group practices and other health care 
 providers, as determined by the Secretary, 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 612 of this title. Any--
        (A) individual health care professional of such 
 group practice or other provider receiving payment 
 through an institutional provider's global budget 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 provider; and
        (B) any group practice or other health care 
 provider that receives payment through an institutional 
 provider global budget under this paragraph shall be 
 subject to the same reporting and disclosure 
 requirements of the institutional provider.

    (4) 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 following:
        (A) 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 provider, such as--
            (i) natural disasters;
            (ii) outbreaks of epidemics or infectious 
 diseases;
            (iii) unexpected facility or equipment 
 repairs or purchases;
            (iv) significant and unexpected increases 
 in pharmaceutical or medical device prices; and
            (v) unanticipated increases in complex or 
 high-cost patients or care needs.
        (B) Changes in Federal or State law that result in 
 a change in costs.
            (C) Reasonable increases in labor costs, including 
 salaries and benefits, and changes in collective 
 bargaining agreements, prevailing wage, or local law.

    (b) Payment Amount.--

    (1) In general.--The amount of each payment to a provider 
 described in subsection

    (a) shall be determined before the 
 start of each fiscal year through negotiations between the 
 provider and the regional director with jurisdiction over such 
 provider. Such amount shall be based on factors specified in 
 paragraph

    (2) .

    (2) Payment factors.--Payments negotiated pursuant to 
 paragraph

    (1) shall take into account, with respect to a 
 provider--
        (A) the historical volume of services provided for 
 each item and services in the previous 3-year period;
        (B) the actual expenditures of such provider in 
 such provider's most recent cost report under title 
 XVIII of the Social Security Act for each item and 
 service compared to--
            (i) such expenditures for other 
 institutional providers in the director's 
 jurisdiction; and
            (ii) normative payment rates established 
 under comparative payment rate systems, 
 including any adjustments, for such items and 
 services;
            (C) projected changes in the volume and type of 
 items and services to be furnished;
            (D) wages for employees, including any necessary 
 increases for mandatory minimum safe registered nurse-
 to-patient ratios and optimal staffing levels for 
 physicians and other health care workers;
        (E) the provider's maximum capacity to provide 
 items and services;
        (F) education and prevention programs;
        (G) permissible adjustment to the provider's 
 operating budget due to factors such as--
            (i) an increase in primary or specialty 
 care access;
            (ii) efforts to decrease health care 
 disparities in rural or medically underserved 
 areas;
            (iii) a response to emergent epidemic 
 conditions;
            (iv) an increase in complex or high-cost 
 patients or care needs; or
            (v) proposed new and innovative patient 
 care programs at the institutional level;
        (H) whether the provider is located in a high 
 social vulnerability index community, ZIP Code, or 
 census track, or is a minority-serving provider; and
            (I) any other factor determined appropriate by the 
 Secretary.

    (3) Limitation.--Payment amounts negotiated pursuant to 
 paragraph

    (1) may not--
        (A) 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 individual;
        (B) be used by a provider for capital expenditures 
 or such other expenditures;
            (C) exceed the provider's capacity to provide care 
 under this Act; or
            (D) be used to pay or otherwise compensate any 
 board member, executive, or administrator of the 
 institutional provider who has any interest or 
 relationship prohibited under 

section 301

    (b)

    (2) of this 
 Act or disclosed under 

section 301 of this Act.

    (4) 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 meet the compensation cap established in 

section 702 of the Bipartisan Budget Act of 2013 (41 U.S.C. 
 4304

    (a)

    (16) ) and implementing regulations.

    (5) Regional negotiations permitted.--Subject to 

section 614, a regional director may negotiate changes to an 
 institutional provider's global budget, including any 
 adjustments to address unforeseen market-shifts related to 
 patient volume.
            (c) Baseline Rates and Adjustments.--

    (1) In general.--The Secretary shall use existing 
 prospective payment systems under title XVIII of the Social 
 Security Act to serve as the comparative payment rate system in 
 global budget negotiations described in subsection

    (b) . The 
 Secretary shall update such comparative payment rate systems 
 annually.

    (2) Specifications.--In developing the comparative payment 
 rate system, the Secretary shall use only the operating base 
 payment rates under each such prospective payment systems with 
 applicable adjustments.

    (3) 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 system.

    (4) 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 provider, 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 covered items and services 
 furnished the preceding year with applicable adjustments, 
 excluding value-based payment adjustments, based on such 
 prospective payment system.
            (d) Operating Expenses.--For purposes of this title, ``operating 
expenses'' of a provider include the following:

    (1) The cost of all items and services associated with the 
 provision of inpatient care and outpatient care, including the 
 following:
        (A) Wages and salary costs for physicians, nurses, 
 and other health care practitioners employed by an 
 institutional provider, including mandatory minimum 
 safe registered nurse-to-patient staffing ratios and 
 optimal staffing levels for physicians and other 
 healthcare workers.
        (B) Wages and salary costs for all ancillary staff 
 and services.
            (C) Costs of all pharmaceutical products 
 administered by health care clinicians at the 
 institutional provider's facilities or through services 
 provided in accordance with State licensing laws or 
 regulations under which the institutional provider 
 operates.
            (D) Costs for infectious disease response 
 preparedness, including maintenance of a 1-year or 365-
 day stockpile of personal protective equipment, 
 occupational testing and surveillance, medical services 
 for occupational infectious disease exposure, and 
 contact tracing.
        (E) Purchasing and maintenance of medical devices, 
 supplies, and other health care technologies, including 
 diagnostic testing equipment.
        (F) Costs of all incidental services necessary for 
 safe patient care and handling.
        (G) Costs of patient care, education, and 
 prevention programs, including occupational health and 
 safety programs, public health programs, and necessary 
 staff to implement such programs, for the continued 
 education and health and safety of clinicians and other 
 individuals employed by the institutional provider.

    (2) Administrative costs for the institutional provider.

SEC. 612. PAYMENT TO INDIVIDUAL PROVIDERS THROUGH FEE-FOR-SERVICE.

    (a) In General.--In the case of a provider not described in 

section 611

    (a) (including those in group practices who are not receiving 
payment on a salaried basis described in 

section 611

    (a)

    (3) and 
providers of home and community-based services), payment for items and 
services furnished under this Act for which payment is not otherwise 
made under 

section 611 shall be made by the Secretary in amounts 
determined under the fee schedule established pursuant to subsection

    (b) . Such payment shall be considered to be payment in full for such 
items and services, and a provider receiving such payment may not 
charge the individual receiving such item or service in any amount.

    (b) Fee Schedule.--

    (1) Establishment.--Not later than 1 year after the date of 
 the enactment of this Act, and in consultation with providers 
 and regional office directors, the Secretary shall establish a 
 national fee schedule for items and services payable under this 
 Act. The Secretary shall evaluate the effectiveness of the fee-
 for-service structure and update such fee schedule annually.

    (2) Amounts.--In establishing payment amounts for items and 
 services under the fee schedule established under paragraph

    (1) , the Secretary shall take into account--
        (A) the amounts payable for such items and services 
 under title XVIII of the Social Security Act; and
        (B) the expertise of providers and value of items 
 and services furnished by such providers.
            (c) Electronic Billing.--The Secretary shall establish a uniform 
national system for electronic billing for purposes of making payments 
under this subsection.
            (d) Physician Practice Review Board.--Each director of a regional 
office, in consultation with representatives of physicians practicing 
in that region, shall establish and appoint a physician practice review 
board to assure quality, cost effectiveness, and fair reimbursements 
for physician-delivered items and services. The use of mechanisms that 
discriminate against people with disabilities is prohibited for use in 
any value or cost-effectiveness assessments.

SEC. 613. ENSURING ACCURATE VALUATION OF SERVICES UNDER THE MEDICARE 
 PHYSICIAN FEE SCHEDULE.

    (a) Standardized and Documented Review Process.--

Section 1848
            (c) (2) of the Social Security Act (42 U.S.C. 1395w-4
            (c) (2) ) is amended by 
adding at the end the following new subparagraph:
 ``
        (P) Standardized and documented review process.--
 ``
            (i) In general.--Not later than one year 
 after the date of enactment of this 
 subparagraph, the Secretary shall establish, 
 document, and make publicly available, in 
 consultation with the Office of Primary Health 
 Care, a standardized process for reviewing the 
 relative values of physicians' services under 
 this paragraph.
 ``
            (ii) Minimum requirements.--The 
 standardized process shall include, at a 
 minimum, methods and criteria for identifying 
 services for review, prioritizing the review of 
 services, reviewing stakeholder 
 recommendations, and identifying additional 
 resources to be considered during the review 
 process.''.

    (b) Planned and Documented Use of Funds.--

Section 1848
            (c) (2)
            (M) of 
the Social Security Act (42 U.S.C. 1395w-4
            (c) (2)
            (M) ) is amended by 
adding at the end the following new clause:
 ``
            (x) Planned and documented use of 
 funds.--For each fiscal year (beginning with 
 the first fiscal year beginning on or after the 
 date of enactment of this clause), the 
 Secretary shall provide to Congress a written 
 plan for using the funds provided under clause
            (ix) to collect and use information on 
 physicians' services in the determination of 
 relative values under this subparagraph.''.
            (c) Internal Tracking of Reviews.--

    (1) In general.--Not later than 1 year after the date of 
 enactment of this Act, the Secretary shall submit to Congress a 
 proposed plan for systematically and internally tracking the 
 Secretary's review of the relative values of physicians' 
 services, such as by establishing an internal database, under 
 

section 1848
            (c) (2) of the Social Security Act (42 U.S.C. 1395w-
 4
            (c) (2) ), as amended by this section.

    (2) Minimum requirements.--The proposal shall include, at a 
 minimum, plans and a timeline for achieving the ability to 
 systematically and internally track the following:
        (A) When, how, and by whom services are identified 
 for review.
        (B) When services are reviewed or reviewed or when 
 new services are added.
            (C) The resources, evidence, data, and 
 recommendations used in reviews.
            (D) When relative values are adjusted.
        (E) The rationale for final relative value 
 decisions.
            (d) Frequency of Review.--

Section 1848
            (c) (2) of the Social Security 
Act (42 U.S.C. 1395w-4
            (c) (2) ) is amended--

    (1) in subparagraph
        (B)
            (i) , by striking ``5'' and inserting 
 ``4''; and

    (2) in subparagraph
        (K)
            (i) 
            (I) , by striking ``periodically'' 
 and inserting ``annually''.

    (e) Consultation With Medicare Payment Advisory Commission.--

    (1) In general.--

Section 1848
            (c) (2) of the Social Security 
 Act (42 U.S.C. 1395w-4
            (c) (2) ) is amended--
        (A) in subparagraph
        (B)
            (i) , by inserting ``in 
 consultation with the Medicare Payment Advisory 
 Commission,'' after ``The Secretary,''; and
        (B) in subparagraph
        (K)
            (i) 
            (I) , as amended by 
 subsection
            (d) (2) , by inserting ``, in coordination 
 with the Medicare Payment Advisory Commission,'' after 
 ``annually''.

    (2) Conforming amendments.--

Section 1805 of the Social 
 Security Act (42 U.S.C. 1395b-6) is amended--
        (A) in subsection

    (b)

    (1)
        (A) , by inserting the 
 following before the semicolon at the end: ``and 
 including coordinating with the Secretary in accordance 
 with 

section 1848
            (c) (2) to systematically review the 
 relative values established for physicians' services, 
 identify potentially misvalued services, and propose 
 adjustments to the relative values for physicians' 
 services''; and
        (B) in subsection

    (e)

    (1) , in the second sentence, 
 by inserting ``or the Ranking Minority Member'' after 
 ``the Chairman''.

    (f) Periodic Audit by the Comptroller General.--

Section 1848
            (c) (2) of the Social Security Act (42 U.S.C. 1395w-4
            (c) (2) ), as amended by 
subsection

    (a) , is amended by adding at the end the following new 
subparagraph:
 ``
        (Q) Periodic audit by the comptroller general.--
 ``
            (i) In general.--The Comptroller General 
 of the United States (in this subsection 
 referred to as the `Comptroller General') shall 
 periodically audit the review by the Secretary 
 of relative values established under this 
 paragraph for physicians' services.
 ``
            (ii) Access to information.--The 
 Comptroller General shall have unrestricted 
 access to all deliberations, records, and data 
 related to the activities carried out under 
 this paragraph, in a timely manner, upon 
 request.''.

SEC. 614. PAYMENT PROHIBITIONS; CAPITAL EXPENDITURES; SPECIAL PROJECTS.

    (a) Sense of Congress.--It is the sense of Congress that tens of 
millions of people in the United States do not receive healthcare 
services while billions of dollars that could be spent on providing 
health care are diverted to profit. There is a moral imperative to 
correct the massive deficiencies in our current health system and to 
eliminate profit from the provision of health care.

    (b) Prohibitions.--Payments to providers under this Act may not 
take into account, include any process for the provision of funding 
for, or be used by a provider for--

    (1) marketing of the provider;

    (2) the profit or net revenue of the provider, or 
 increasing the profit or net revenue of the provider;

    (3) incentive payments, bonuses, or other compensation 
 based on patient utilization of items and services or any 
 financial measure applied with respect to the provider (or any 
 group practice, integrated health care delivery system, or 
 other provider with which the provider contracts or has a 
 pecuniary interest), including any value-based payment or 
 employment-based compensation;

    (4) any agreement or arrangement described in 

section 203

    (a)

    (4) of the Labor-Management Reporting and Disclosure Act 
 of 1959 (29 U.S.C. 433

    (a)

    (4) ); or

    (5) political or contributions prohibited under 

section 317 
 of the Federal Elections Campaign Act of 1971 (52 U.S.C. 
 30119

    (a)

    (1) ).
            (c) Payments for Capital Expenditures.--

    (1) In general.--The Secretary shall pay, from amounts made 
 available for capital expenditures pursuant to 

section 601

    (a)

    (2)
        (B) , 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 providers.

    (2) Priority.--The Secretary shall prioritize allocation of 
 funding under paragraph

    (1) to projects that propose to use 
 such funds to improve service in a medically underserved area 
 (as defined in 

section 330

    (b)

    (3) of the Public Health Service 
 Act (42 U.S.C. 254b

    (b)

    (3) )) or to address health disparities, 
 including racial, ethnic, national origin, primary language 
 use, age, disability, sex (including gender identity and sexual 
 orientation), geography, or socioeconomic health disparities.

    (3) 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 patients, including reductions 
 in registered nursing staffing patterns and changes in 
 emergency room or primary care services or availability.

    (4) 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 located.
            (d) Prohibition Against Co-Mingling Operating and Capital Funds.--
Providers that receive payment under this title shall be prohibited 
from using, with respect to funds made available under this Act--

    (1) funds designated for operating expenditures for capital 
 expenditures or for profit; or

    (2) funds designated for capital expenditures for operating 
 expenditures.

    (e) Payments for Special Projects.--

    (1) In general.--The Secretary shall allocate to each 
 regional director, from amounts made available for special 
 projects pursuant to 

section 601

    (a)

    (2)
            (C) , such sums determined 
 appropriate by the Secretary for purposes of funding projects 
 described in such section, including the construction, 
 renovation, or staffing of health care facilities, in rural, 
 underserved, or health professional or medical shortage areas 
 within such region and to address health disparities, including 
 racial, ethnic, national origin, primary language use, age, 
 disability, sex, including gender identity and sexual 
 orientation, geography, or socioeconomic health disparities. 
 Each regional director shall, prior to distributing such funds 
 in accordance with paragraph

    (2) , present a budget describing 
 how such funds will be distributed to the Secretary.

    (2) 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 
 director.

    (f) 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 
methodologies, programs, modifiers, or adjustments for provider 
payments under this title.

SEC. 615. OFFICE OF HEALTH EQUITY.

 Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.) is amended by adding at the end the following:

``

SEC. 1712. OFFICE OF HEALTH EQUITY.

 ``

    (a) In General.--There is established, in the Office of the 
Secretary of Health and Human Services, an Office of Health Equity, to 
be headed by a Director, to ensure coordination and collaboration 
across the programs and activities of the Department of Health and 
Human Services with respect to ensuring health equity.
 ``

    (b) Monitoring, Tracking, and Availability of Data.--
 ``

    (1) In general.--In carrying out subsection

    (a) , the 
 Director of the Office of Health Equity shall monitor, track, 
 and make publicly available data on--
 ``
        (A) the disproportionate burden of disease and 
 death among people of color, disaggregated by race, 
 major ethnic group, Tribal affiliation, national 
 origin, primary language use, English proficiency 
 status, immigration status, length of stay in the 
 United States age, disability, sex (including gender 
 identity and sexual orientation), incarceration, 
 homelessness, geography, and socioeconomic status;
 ``
        (B) barriers to health, including such barriers 
 relating to income, education, housing, food insecurity 
 (including availability, access, utilization, and 
 stability), employment status, working conditions, and 
 conditions related to the physical environment 
 (including pollutants and population density);
 ``
            (C) barriers to health care access, including--
 ``
            (i) lack of trust and awareness;
 ``
            (ii) lack of transportation;
 ``
            (iii) geography;
 ``
            (iv) hospital and service closures;
 ``
            (v) lack of health care infrastructure 
 and facilities; and
 ``
            (vi) lack of health care professional 
 staffing and recruitment;
 ``
            (D) disparities in quality of care received, 
 including discrimination in health care settings and 
 the use of racially-biased practice guidelines and 
 algorithms; and
 ``
        (E) disparities in utilization of care.
 ``

    (2) Analysis of cross-sectional information.--The 
 Director of the Office of Health Equity shall ensure that the 
 data collection and reporting process under paragraph

    (1) allows for the analysis of cross-sectional information on 
 people's identities.
 ``
            (c) Policies.--In carrying out subsection

    (a) , the Director of 
the Office of Health Equity shall develop, coordinate, and promote 
policies that enhance health equity, including by--
 ``

    (1) providing recommendations on--
 ``
        (A) cultural competence, implicit bias, and 
 ethics training with respect to health care workers;
 ``
        (B) increasing diversity in the health care 
 workforce; and
 ``
            (C) ensuring sufficient health care professionals 
 and facilities; and
 ``

    (2) ensuring adequate public health funding at the local 
 and State levels to address health disparities.
 ``
            (d) Consultation.--In carrying out subsection

    (a) , the Director 
of the Office of Health Equity, in coordination with the Director of 
the Indian Health Service, shall consult with Indian Tribes and with 
Urban Indian organizations on data collection, reporting, and 
implementation of policies.
 ``

    (e) Annual Report.--In carrying out subsection

    (a) , the Director 
of the Office of Health Equity shall develop and publish an annual 
report on--
 ``

    (1) statistics collected by the Office;
 ``

    (2) proposed evidence-based solutions to mitigate health 
 inequities; and
 ``

    (3) health care professional staffing levels and access 
 to facilities.
 ``

    (f) Centralized Electronic Repository.--In carrying out 
subsection

    (a) , the Director of the Office of Health Equity shall--
 ``

    (1) establish and maintain a centralized electronic 
 repository to incorporate data collected across Federal 
 departments and agencies on race, ethnicity, Tribal 
 affiliation, national origin, primary language use, English 
 proficiency status, immigration status, length of stay in the 
 United States age, disability, sex (including gender identity 
 and sexual orientation), incarceration, homelessness, 
 geography, and socioeconomic status; and
 ``

    (2) make such data available for public use and analysis.
 ``

    (g) Privacy.--Notwithstanding any other Federal or State law, no 
Federal or State official or employee or other entity shall disclose, 
or use, for any law enforcement or immigration purpose, any personally 
identifiable information (including with respect to an individual's 
religious beliefs, practices, or affiliation, national origin, 
ethnicity, or immigration status) that is collected or maintained 
pursuant to this section.''.

SEC. 616. OFFICE OF PRIMARY CARE.

 Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.) is amended by adding at the end the following:

``

SEC. 1713. OFFICE OF PRIMARY CARE.

 ``

    (a) In General.--There is established, in the Office of Health 
Equity established under 

section 1712, an Office of Primary Health 
Care, to be headed by a Director, 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 care, particularly in underserved areas and for 
underserved populations.
 ``

    (b) National Goals.--Not later than 1 year after the date of 
enactment of this section, the Director of the Office of Primary Health 
Care shall publish national goals--
 ``

    (1) to increase access to high-quality primary health 
 care, particularly in underserved areas and for underserved 
 populations; and
 ``

    (2) to address health disparities, including with respect 
 to race, ethnicity, national origin (disaggregated by major 
 ethnic group and Tribal affiliation), primary language use, 
 English proficiency status, immigration status, length of stay 
 in the United States, age, disability, sex (including gender 
 identity and sexual orientation), incarceration, homelessness, 
 geography, and socioeconomic status.
 ``
            (c) Other Responsibilities.--In carrying out subsections

    (a) and

    (b) , the Director of the Office of Primary Health Care shall--
 ``

    (1) coordinate, in consultation with the Secretary, 
 health professional education policies and goals to achieve the 
 national goals published pursuant to subsection

    (b) ;
 ``

    (2) develop and maintain a system to monitor the number 
 and specialties of individuals pursuing careers in, or 
 practicing, primary health care through their health 
 professional education, any postgraduate training, and 
 professional practice;
 ``

    (3) develop, coordinate, and promote policies that expand 
 the number of primary health care practitioners, registered 
 nurses, advance practice clinicians, and dentists;
 ``

    (4) recommend appropriate training, technical assistance, 
 and patient protection enhancements for primary care health 
 professionals, including registered nurses, to achieve uniform 
 high quality and patient safety;
 ``

    (5) provide recommendations on targeted programs and 
 resources for Federally qualified health centers, rural health 
 centers, community health centers, and other community-based 
 organizations;
 ``

    (6) provide recommendations for broader patient referral 
 to additional resources, not limited to health care, and 
 collaboration with other organizations and sectors that 
 influence health outcomes; and
 ``

    (7) consult with the Secretary on the allocation of the 
 special projects budget under 

section 601

    (a)

    (2)
            (C) of the 
 Medicare for All Act.
 ``
            (d) Rule of Construction.--Nothing in this section shall be 
construed--
 ``

    (1) to preempt any provision of State law establishing 
 practice standards or guidelines for health care professionals, 
 including professional licensing or practice laws or 
 regulations; or
 ``

    (2) to require that any State impose additional 
 educational standards or guidelines for health care 
 professionals.''.

SEC. 617. PAYMENTS FOR PRESCRIPTION DRUGS AND APPROVED DEVICES AND 
 EQUIPMENT.

 The prices to be paid for covered pharmaceuticals, medical 
supplies, medical technologies, and medically necessary equipment 
covered under this Act shall be negotiated annually by the Secretary.

    (1) In general.--Notwithstanding any other provision of 
 law, the Secretary shall, for fiscal years beginning on or 
 after the date of the enactment of this subsection, negotiate 
 with pharmaceutical manufacturers the prices (including 
 discounts, rebates, and other price concessions) that may be 
 charged to the Medicare for All Program during a negotiated 
 price period (as specified by the Secretary) for covered drugs 
 for eligible individuals under the Medicare for All Program. In 
 negotiating such prices under this section, the Secretary shall 
 take into account the following factors:
        (A) The comparative clinical effectiveness and cost 
 effectiveness, when available from an impartial source, 
 of such drug.
        (B) The budgetary impact of providing coverage of 
 such drug.
            (C) The number of similarly effective drugs or 
 alternative treatment regimens for each approved use of 
 such drug.
            (D) The total revenues from global sales obtained 
 by the manufacturer for such drug and the associated 
 investment in research and development of such drug by 
 the manufacturer.

    (2) Finalization of negotiated price.--The negotiated price 
 of each covered drug for a negotiated price period shall be 
 finalized not later than 30 days before the first fiscal year 
 in such negotiated price period.

    (3) Competitive licensing authority.--
        (A) In general.--Notwithstanding any exclusivity 
 under clause
            (iii) or
            (iv) of 

section 505

    (j)

    (5)
        (F) of 
 the Federal Food, Drug, and Cosmetic Act, clause
            (iii) or
            (iv) of 

section 505
            (c) (3)
        (E) of such Act, 

section 351

    (k)

    (7)
        (A) of the Public Health Service Act, or 
 

section 527

    (a) of the Federal Food, Drug, and Cosmetic 
 Act, or by an extension of such exclusivity under 
 

section 505A of such Act or 

section 505E of such Act, 
 and any other provision of law that provides for market 
 exclusivity (or extension of market exclusivity) with 
 respect to a drug, in the case that the Secretary is 
 unable to successfully negotiate an appropriate price 
 for a covered drug for a negotiated price period, the 
 Secretary shall authorize the use of any patent, 
 clinical trial data, or other exclusivity granted by 
 the Federal Government with respect to such drug as the 
 Secretary determines appropriate for purposes of 
 manufacturing such drug for sale under Medicare for All 
 Program. Any entity making use of a competitive license 
 to use patent, clinical trial data, or other 
 exclusivity under this section shall provide to the 
 manufacturer holding such exclusivity reasonable 
 compensation, as determined by the Secretary based on 
 the following factors:
            (i) The risk-adjusted value of any Federal 
 Government subsidies and investments in 
 research and development used to support the 
 development of such drug.
            (ii) The risk-adjusted value of any 
 investment made by such manufacturer in the 
 research and development of such drug.
            (iii) The impact of the price, including 
 license compensation payments, on meeting the 
 medical need of all patients at a reasonable 
 cost.
            (iv) The relationship between the price of 
 such drug, including compensation payments, and 
 the health benefits of such drug.
            (v) Other relevant factors determined 
 appropriate by the Secretary to provide 
 reasonable compensation.
        (B) Reasonable compensation.--The manufacturer 
 described in subparagraph
        (A) may seek recovery against 
 the United States in the United States Court of Federal 
 Claims.
            (C) Interim period.--Until 1 year after a drug 
 described in subparagraph
        (A) is approved under 

section 505

    (j) of the Federal Food, Drug, and Cosmetic Act or 
 

section 351

    (k) of the Public Health Service Act and is 
 provided under license issued by the Secretary under 
 such subparagraph, the Medicare for All Program shall 
 not pay more for such drug than the average of the 
 prices available, during the most recent 12-month 
 period for which data is available prior to the 
 beginning of such negotiated price period, from the 
 manufacturer to any wholesaler, retailer, provider, 
 health maintenance organization, nonprofit entity, or 
 governmental entity in the ten OECD (Organization for 
 Economic Cooperation and Development) countries that 
 have the largest gross domestic product with a per 
 capita income that is not less than half the per capita 
 income of the United States.
            (D) Authorization for secretary to procure drugs 
 directly.--The Secretary may procure a drug 
 manufactured pursuant to a competitive license under 
 subparagraph
        (A) for purposes of this Act.

    (4) FDA review of licensed drug applications.--The 
 Secretary shall prioritize review of applications under 

section 505

    (j) of the Federal Food, Drug, and Cosmetic Act for drugs 
 licensed under paragraph

    (3)
        (A) .

    (5) Prohibition of anticompetitive behavior.--No drug 
 manufacturer may engage in anticompetitive behavior with 
 another manufacturer that may interfere with the issuance and 
 implementation of a competitive license or run contrary to 
 public policy.

    (6) Required reporting.--The Secretary may require 
 pharmaceutical manufacturers to disclose to the Secretary such 
 information that the Secretary determines necessary for 
 purposes of carrying out this subsection.

 TITLE VII--UNIVERSAL MEDICARE TRUST FUND

SEC. 701. UNIVERSAL MEDICARE TRUST FUND.

    (a) In General.--There is hereby created on the books of the 
Treasury of the United States a trust fund to be known as the Universal 
Medicare Trust Fund (in this section referred to as the ``Trust 
Fund''). The Trust Fund shall consist of such gifts and bequests as may 
be made and such amounts as may be deposited in, or appropriated to, 
such Trust Fund as provided in this Act.

    (b) Appropriations Into Trust Fund.--

    (1) Taxes.--There are appropriated to the Trust Fund for 
 each fiscal year beginning with the fiscal year which includes 
 the date on which benefits first become available as described 
 in 

section 106, out of any monies in the Treasury not otherwise 
 appropriated, amounts equivalent to 100 percent of the net 
 increase in revenues to the Treasury which is attributable to 
 the amendments made by sections 801 and 902. The amounts 
 appropriated by the preceding sentence shall be transferred 
 from time to time (but not less frequently than monthly) from 
 the general fund in the Treasury to the Trust Fund, 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 Treasury, 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 transferred.

    (2) Current program receipts.--
        (A) Initial year.--Notwithstanding any other 
 provision of law, there is appropriated to the Trust 
 Fund for the fiscal year containing January 1 of the 
 first year following the date of the enactment of this 
 Act, an amount equal to the aggregate amount 
 appropriated for the preceding fiscal year for the 
 following (increased by the consumer price index for 
 all urban consumers for the fiscal year involved):
            (i) The Medicare program under title XVIII 
 of the Social Security Act (other than amounts 
 attributable to any premiums under such title).
            (ii) The Medicaid program under State plans 
 approved under title XIX of such Act.
            (iii) The Federal Employees Health Benefits 
 program, under chapter 89 of title 5, United 
 States Code.
            (iv) The purchased care component of the 
 TRICARE program, under chapter 55 of title 10, 
 United States Code (other than amounts 
 appropriated for the purchased care component 
 of the TRICARE Overseas Program).
            (v) The maternal and child health program 
 (under title V of the Social Security Act), 
 vocational rehabilitation programs, programs 
 for drug abuse and mental health services under 
 the Public Health Service Act, programs 
 providing general hospital or medical 
 assistance, and any other Federal program 
 identified by the Secretary, in consultation 
 with the Secretary of the Treasury, to the 
 extent the programs provide for payment for 
 health services the payment of which may be 
 made under this Act.
        (B) Subsequent years.--Notwithstanding any other 
 provision of law, there is appropriated to the trust 
 fund for the fiscal year containing January 1 of the 
 second year following the date of the enactment of this 
 Act, and for each fiscal year thereafter, an amount 
 equal to the amount appropriated to the Trust Fund for 
 the previous year, adjusted for reductions in costs 
 resulting from the implementation of this Act, changes 
 in the consumer price index for all urban consumers for 
 the fiscal year involved, and other factors determined 
 appropriate by the Secretary.

    (3) 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 service 
 shall not apply to monies in the Trust Fund.
            (c) Incorporation of Provisions.--The provisions of subsections

    (b) through
            (i) of 

section 1817 of the Social Security Act (42 U.S.C. 
1395i) 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 1817, except that, for purposes of 
applying such subsections to this section, the ``Board of Trustees of 
the Trust Fund'' shall mean the ``Secretary''.
            (d) Transfer of Funds.--Any amounts remaining in the Federal 
Hospital Insurance Trust Fund under 

section 1817 of the Social Security 
Act (42 U.S.C. 1395i) or the Federal Supplementary Medical Insurance 
Trust Fund under 

section 1841 of such Act (42 U.S.C. 1395t) after the 
payment of claims for items and services furnished under title XVIII of 
such Act have been completed, shall be transferred into the Universal 
Medicare Trust Fund under this section.

 TITLE VIII--CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME 
 SECURITY ACT OF 1974

SEC. 801. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF BENEFITS 
 UNDER THE MEDICARE FOR ALL PROGRAM; COORDINATION IN CASE 
 OF WORKERS' COMPENSATION.

    (a) In General.--Part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is 
amended by adding at the end the following new section:

``

SEC. 522. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF UNIVERSAL 
 MEDICARE PROGRAM BENEFITS; COORDINATION IN CASE OF 
 WORKERS' COMPENSATION.

 ``

    (a) In General.--Subject to subsection

    (b) , 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 Act.
 ``

    (b) 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 
services.
 ``
            (c) === Definitions. ===
-In this subsection--
 ``

    (1) the term `workers compensation carrier' means an 
 insurance company that underwrite 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 benefits;
 ``

    (2) the term `workers compensation medical benefits' 
 means, with respect to an enrollee who is an employee subject 
 to the workers compensation laws of a State, the comprehensive 
 medical benefits for work-related injuries and illnesses 
 provided for under such laws with respect to such an employee; 
 and
 ``

    (3) the term `workers compensation services' means items 
 and services included in workers compensation medical benefits 
 and includes items and services (including rehabilitation 
 services and long-term care services) commonly used for 
 treatment of work-related injuries and illnesses.''.

    (b) Conforming Amendment.--

Section 4

    (b) of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1003

    (b) ) is amended by adding at 
the end the following: ``Paragraph

    (3) shall apply subject to 

section 522

    (b) (relating to reimbursement of the Medicare for All Program by 
workers compensation carriers).''.
            (c) Clerical Amendment.--The table of contents in 

section 1 of such 
Act is amended by inserting after the item relating to 

section 521 the 
following new item:

``

Sec. 522. Prohibition of employee benefits duplicative of Universal 
 Medicare Program benefits; coordination in 
 case of workers' compensation.''.

SEC. 802. APPLICATION OF CONTINUATION COVERAGE REQUIREMENTS UNDER ERISA 
 AND CERTAIN OTHER REQUIREMENTS RELATING TO GROUP HEALTH 
 PLANS.

    (a) In General.--Part 6 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.) shall 
apply only with respect to any employee health benefit plan that does 
not duplicate payments for any items or services for which payment may 
be made under the this Act.

    (b) Conforming Amendment.--

Section 601 of part 6 of subtitle B of 
title I of the Employee Retirement Income Security Act of 1974 (19 
U.S.C. 1161) is amended by adding the following subsection at the end:
 ``
            (c) Subsection

    (a) shall apply to any group health plan that does 
not duplicate payments for any items or services for which payment may 
be made under the Medicare for All Act.''.

SEC. 803. EFFECTIVE DATE OF TITLE.

 The provisions of and amendments made by this title shall take 
effect on the date described in 

section 106

    (a) .

 TITLE IX--ADDITIONAL CONFORMING AMENDMENTS

SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS.

    (a) Medicare, Medicaid, and State Children's Health Insurance 
Program

    (SCHIP) .--

    (1) In general.--Notwithstanding any other provision of law 
 and with respect to an individual eligible to enroll under this 
 Act, subject to paragraphs

    (2) and

    (3) --
        (A) no benefits shall be available under title 
 XVIII of the Social Security Act for any item or 
 service furnished beginning on the date that is 2 years 
 after the date of the enactment of this Act;
        (B) no individual is entitled to medical assistance 
 under a State plan approved under title XIX of such Act 
 for any item or service furnished on or after such 
 date;
            (C) no individual is entitled to medical assistance 
 under a State child health plan under title XXI of such 
 Act for any item or service furnished on or after such 
 date; and
            (D) no payment shall be made to a State under 
 

section 1903

    (a) or 2105

    (a) of such Act with respect to 
 medical assistance or child health assistance for any 
 item or service furnished on or after such date.

    (2) Transition.--In the case of inpatient hospital services 
 and extended care services during a continuous period of stay 
 which began before the effective date of benefits under 

section 106, and which had not ended as of such date, for which 
 benefits are provided under title XVIII of the Social Security 
 Act, under a State plan under title XIX of such Act, or under a 
 State child health plan under title XXI of such Act, the 
 Secretary shall provide for continuation of benefits under such 
 title or plan until the end of the period of stay.

    (3) School programs.--All school related health programs, 
 centers, initiatives, services, or other activities or work 
 provided under title XIX or title XXI of the Social Security 
 Act as of January 1, 2019, shall be continued and covered by 
 the Medicare for All Program.

    (b) Federal Employees Health Benefits Program.--No benefits shall 
be made available under chapter 89 of title 5, United States Code, with 
respect to items and services furnished to any individual eligible to 
enroll under this Act.
            (c) TRICARE Program.--

    (1) Direct care component.--Nothing in this Act shall 
 affect the eligibility of beneficiaries under chapter 55 of 
 title 10, United States Code, who are entitled to receive care 
 furnished at facilities of the uniformed services under the 
 TRICARE program for such care.

    (2) Purchased care component.--
        (A) In general.--Except as provided in subparagraph
        (B) , no benefits shall be made available under the 
 purchased care component of the TRICARE program for 
 items or services furnished to any individual eligible 
 to enroll under this Act.
        (B) TRICARE overseas.--During any period in which 
 an individual is eligible for benefits under the 
 TRICARE Overseas Program and is located in a TRICARE 
 overseas region, the individual may receive benefits 
 for items or services furnished to the individual under 
 the purchased care component of such program during 
 such period.
            (d) Treatment of Benefits for Veterans and Native Americans.--

    (1) In general.--Nothing in this Act shall affect the 
 eligibility of veterans for the medical benefits and services 
 provided under title 38, United States Code, or of Indians for 
 the medical benefits and services provided by or through the 
 Indian Health Service.

    (2) Reevaluation.--No reevaluation of the Indian Health 
 Service shall be undertaken without consultation with tribal 
 leaders and stakeholders.

SEC. 902. SUNSET OF PROVISIONS RELATED TO THE STATE EXCHANGES.

 Effective on the date that is 2 years after the date of the 
enactment of this Act, the Federal and State Exchanges established 
pursuant to title I of the Patient Protection and Affordable Care Act 
(Public Law 111-148) shall terminate, and any other provision of law 
that relies upon participation in or enrollment through such an 
Exchange, including such provisions of the Internal Revenue Code of 
1986, shall cease to have force or effect.

SEC. 903. SUNSET OF PROVISIONS RELATED TO PAY FOR PERFORMANCE PROGRAMS.

    (a) Effective on the date described in 

section 106

    (a) , the Federal 
programs related to pay for performance programs and value-based 
purchasing shall terminate, and any other provision of law that relies 
upon participation in or enrollment in such program shall cease to have 
force or effect. Programs that shall terminate include--

    (1) the Merit-based Incentive Payment System established 
 pursuant to subsection

    (q) of 

section 1848 of the Social 
 Security Act (42 U.S.C. 1395w-4

    (q) );

    (2) the incentives for meaningful use of certified EHR 
 technology established pursuant to subsection

    (a)

    (7) of 

section 1848 of the Social Security Act (42 U.S.C. 1395w-4

    (a)

    (7) );

    (3) the incentives for adoption and meaningful use of 
 certified EHR technology established pursuant to subsection

    (o) of 

section 1848 of the Social Security Act (42 U.S.C. 1395w-
 4

    (o) );

    (4) alternative payment models established under 

section 1833

    (z) of the Social Security Act (42 U.S.C. 1395

    (z) ); and

    (5) the following programs as established pursuant to the 
 following sections of the Patient Protection and Affordable 
 Care Act:
        (A) Section 2701 (adult health quality measures).
        (B) Section 2702 (payment adjustments for health 
 care acquired conditions).
            (C) Section 2706 (Pediatric Accountable Care 
 Organization Demonstration Projects for the purposes of 
 receiving incentive payments).
            (D) Section 3002

    (b) (42 U.S.C. 1395w-4

    (a)

    (8) ) 
 (incentive payments for quality reporting).
        (E) Section 3001

    (a) (42 U.S.C. 1395ww

    (o) ) (Hospital 
 Value-Based Purchasing).
        (F) Section 3006 (value-based purchasing program 
 for skilled nursing facilities and home health 
 agencies).
        (G) Section 3007 (42 U.S.C. 1395w-4

    (p) ) (value 
 based payment modifier under physician fee schedule).
        (H) Section 3008 (42 U.S.C. 1395ww

    (p) ) (payment 
 adjustments for health care-acquired condition).
            (I) Section 3022 (42 U.S.C. 1395jjj) (Medicare 
 shared savings programs).
        (J) Section 3023 (42 U.S.C. 1395cc-4) (National 
 Pilot Program on Payment Bundling).
        (K) Section 3024 (42 U.S.C. 1395cc-5) (Independence 
 at home demonstration program).
            (L) Section 3025 (42 U.S.C. 1395ww

    (q) ) (hospital 
 readmissions reduction program).
            (M) Section 10301 (plans for value-based purchasing 
 program for ambulatory surgical centers).

 TITLE X--TRANSITION

 Subtitle A--Medicare for All Transition Over 2 Years and Transitional 
 Buy-In Option

SEC. 1001. MEDICARE FOR ALL TRANSITION OVER TWO YEARS.

 Title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) is 
amended by adding at the end the following new section:

``

SEC. 1899C. MEDICARE FOR ALL TRANSITION OVER 2 YEARS.

 ``

    (a) Transition.--
 ``

    (1) In general.--Every individual who meets the 
 requirements described in paragraph

    (3) shall be eligible to 
 enroll in the Medicare for All Program under this section 
 during the transition period starting one year after the date 
 of enactment of the Medicare for All Act.
 ``

    (2) Benefits.--An individual enrolled under this section 
 is entitled to the benefits established under title II of the 
 Medicare for All Act.
 ``

    (3) Requirements for eligibility.--The requirements 
 described in this paragraph are the following:
 ``
        (A) The individual meets the eligibility 
 requirements established by the Secretary under title I 
 of the Medicare for All Act.
 ``
        (B) The individual has attained the applicable 
 year of age, or is currently enrolled in Medicare at 
 the time of the transition to Medicare for All.
 ``

    (4) Applicable year of age defined.--For purposes of this 
 section, the term `applicable year of age' means one year after 
 the date of enactment of the Medicare for All Act, the age of 
 55 or older, the age 18 or younger.
 ``

    (b) Enrollment; 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 title. The Secretary shall 
establish such periods so that coverage under this section shall first 
begin on January 1 of the year on which an individual first becomes 
eligible to enroll under this section.
 ``
            (c) Satisfaction of Individual Mandate.--For purposes of applying 

section 5000A of the Internal Revenue Code of 1986, the coverage 
provided under this section constitutes minimum essential coverage 
under subsection

    (f)

    (1)
        (A)
            (i) of such 

section 5000A.
 ``
            (d) Consultation.--In promulgating regulations to implement this 
section, the Secretary shall consult with interested parties, including 
groups representing beneficiaries, health care providers, employers, 
and insurance companies.''.

SEC. 1002. ESTABLISHMENT OF THE MEDICARE TRANSITION BUY-IN.

    (a) In General.--To carry out the purpose of this section, for the 
year beginning one year after the date of enactment of this Act and 
ending with the effective date described in 

section 106

    (a) , the 
Secretary, acting through the Administrator of the Centers for Medicare 
& Medicaid (referred to in this section as the ``Administrator''), 
shall establish, and provide for the offering through the Exchanges, an 
option to buy in to the Medicare for All Program (in this Act referred 
to as the ``Medicare Transition buy-in'').

    (b) Administering the Medicare Transition Buy-In.--

    (1) Administrator.--The Administrator shall administer the 
 Medicare Transition buy-in in accordance with this section.

    (2) Application of aca requirements.--Consistent with this 
 section, the Medicare Transition buy-in shall comply with 
 requirements under title I of the Patient Protection and 
 Affordable Care Act (and the amendments made by that title) and 
 title XXVII of the Public Health Service Act (42 U.S.C. 300gg 
 et seq.) that are applicable to qualified health plans offered 
 through the Exchanges, subject to the limitation under 
 subsection

    (e)

    (2) .

    (3) Offering through exchanges.--The Medicare Transition 
 buy-in shall be made available only through the Exchanges, and 
 shall be available to individuals wishing to enroll and to 
 qualified employers (as defined in 

section 1312

    (f)

    (2) of the 
 Patient Protection and Affordable Care Act (42 U.S.C. 18032)) 
 who wish to make such plan available to their employees.

    (4) Eligibility to purchase.--Any United States resident 
 may enroll in the Medicare Transition buy-in.
            (c) Benefits; Actuarial Value.--In carrying out this section, the 
Administrator shall ensure that the Medicare Transition buy-in 
provides--

    (1) coverage for the benefits required to be covered under 
 title II of this Act; and

    (2) coverage of benefits that are actuarially equivalent to 
 90 percent of the full actuarial value of the benefits provided 
 under the plan.
            (d) Providers and Reimbursement Rates.--

    (1) In general.--With respect to the reimbursement provided 
 to health care providers for covered benefits, as described in 
 

section 201, provided under the Medicare Transition buy-in, the 
 Administrator shall reimburse such providers at rates 
 determined for equivalent items and services under the Medicare 
 for All fee-for-service schedule established in 

section 612

    (b) of this Act.

    (2) Prescription drugs.--Any payment rate under this 
 subsection for a prescription drug shall be at the prices 
 negotiated under 

section 616 of this Act.

    (3) Participating providers.--
        (A) 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 (42 U.S.C. 1395 et seq.) or under a State 
 Medicaid plan under title XIX of such Act (42 U.S.C. 
 1396 et seq.) on the date of enactment of this Act 
 shall be a participating provider in the Medicare 
 Transition buy-in.
        (B) Additional providers.--The Administrator shall 
 establish a process to allow health care providers not 
 described in subparagraph
        (A) to become participating 
 providers in the Medicare Transition buy-in. Such 
 process shall be similar to the process applied to new 
 providers under the Medicare program.

    (e) Premiums.--

    (1) Determination.--The Administrator shall determine the 
 premium amount for enrolling in the Medicare Transition buy-in, 
 which--
        (A) may vary according to family or individual 
 coverage, age, and tobacco status (consistent with 
 clauses
            (i) ,
            (iii) , and
            (iv) of 

section 2701

    (a)

    (1)
        (A) of the Public Health Service Act (42 U.S.C. 
 300gg

    (a)

    (1)
        (A) )); and
        (B) shall take into account the cost-sharing 
 reductions and premium tax credits which will be 
 available with respect to the plan under 

section 1402 
 of the Patient Protection and Affordable Care Act (42 
 U.S.C. 18071) and 

section 36B of the Internal Revenue 
 Code of 1986, as amended by subsection

    (g) .

    (2) Limitation.--Variation in premium rates of the Medicare 
 Transition buy-in by rating area, as described in clause
            (ii) of 

section 2701

    (a)

    (1)
        (A)
            (iii) of the Public Health Service Act 
 (42 U.S.C. 300gg

    (a)

    (1)
        (A) ) is not permitted.

    (f) Termination.--This section shall cease to have force or effect 
on the effective date described in 

section 106

    (a) .

    (g) Tax Credits and Cost-Sharing Subsidies.--

    (1) Premium assistance tax credits.--
        (A) Credits allowed to medicare transition buy-in 
 enrollees in non-expansion states.--Paragraph

    (1) of 
 

section 36B
            (c) of the Internal Revenue Code of 1986 is 
 amended by redesignating subparagraphs
            (C) and
            (D) as 
 subparagraphs
            (D) and
        (E) , respectively, and by 
 inserting after subparagraph
        (B) the following new 
 subparagraph:
 ``
            (C) Special rules for medicare transition buy-in 
 enrollees.--
 ``
            (i) In general.--In the case of a 
 taxpayer who is covered, or whose spouse or 
 dependent (as defined in 

section 152) is 
 covered, by the Medicare Transition buy-in 
 established under 

section 1002

    (a) of the 
 Medicare for All Act for all months in the 
 taxable year, subparagraph
        (A) shall be applied 
 without regard to `but does not exceed 400 
 percent'.
 ``
            (ii) Enrollees in medicaid nonexpansion 
 states.--In the case of a taxpayer residing in 
 a State which (as of the date of the enactment 
 of the Medicare for All Act) does not provide 
 for eligibility under clause
            (i) 
            (VIII) or
            (ii) 
            (XX) of 

section 1902

    (a)

    (10)
        (A) of the 
 Social Security Act for medical assistance 
 under title XIX of such Act (or a waiver of the 
 State plan approved under 

section 1115) who is 
 covered, or whose spouse or dependent (as 
 defined in 

section 152) is covered, by the 
 Medicare Transition buy-in established under 
 

section 1002

    (a) of the Medicare for All Act for 
 all months in the taxable year, subparagraphs
        (A) and
        (B) shall be applied by substituting `0 
 percent' for `100 percent' each place it 
 appears.''.
        (B) Premium assistance amounts for taxpayers 
 enrolled in medicare transition buy-in.--
            (i) In general.--Subparagraph
        (A) of 
 

section 36B

    (b)

    (3) of such Code is amended--
            (I) by redesignating clause
            (ii) as clause
            (iii) ,
            (II) by striking ``clause
            (ii) '' in clause
            (i) and inserting ``clauses
            (ii) and
            (iii) '', and
            (III) by inserting after clause
            (i) the 
 following new clause:
 ``
            (ii) Special rules for taxpayers enrolled 
 in medicare transition buy-in.--In the case of 
 a taxpayer who is covered, or whose spouse or 
 dependent (as defined in 

section 152) is 
 covered, by the Medicare Transition buy-in 
 established under 

section 1002

    (a) 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
            (i) , except that the 
 following table shall apply in lieu of the 
 table contained in such clause:

------------------------------------------------------------------------
 ``In the case of household income
 (expressed as a percent of The initial The final
 poverty line) within the premium premium
 following income tier: percentage is-- percentage is--
------------------------------------------------------------------------
Up to 100 percent................. 2.00 2.00
100 percent up to 138 percent..... 2.04 2.04
138 percent up to 150 percent..... 3.06 4.08
150 percent and above............. 4.08 5.00.''.
------------------------------------------------------------------------
            (ii) Conforming amendment.--Subclause
            (I) of clause
            (iii) of 

section 36B

    (b)

    (3) of such 
 Code, as redesignated by subparagraph
        (A)
            (i) , 
 is amended by inserting ``, and determined 
 after the application of clause
            (ii) '' after 
 ``after application of this clause''.

    (2) Cost-sharing subsidies.--Subsection

    (b) of 

section 1402 
 of the Patient Protection and Affordable Care Act (42 U.S.C. 
 18071

    (b) ) is amended--
        (A) by inserting ``, or in the Medicare Transition 
 buy-in established under 

section 1002

    (a) of the 
 Medicare for All Act,'' after ``coverage'' in paragraph

    (1) ;
        (B) by redesignating paragraphs

    (1) (as so amended) 
 and

    (2) as subparagraphs
        (A) and
        (B) , respectively, and 
 by moving such subparagraphs 2 ems to the right;
            (C) by striking ``Insured.--In this section'' and 
 inserting ``Insured.--
 ``

    (1) In general.--In this section'';
            (D) by striking the flush language; and
        (E) by adding at the end the following new 
 paragraph:
 ``

    (2) Special rules.--
 ``
        (A) Individuals lawfully present.--In the case of 
 an individual described in 

section 36B
            (c) (1)
        (B) of the 
 Internal Revenue Code of 1986, the individual shall be 
 treated as having household income equal to 100 percent 
 of the poverty line for a family of the size involved 
 for purposes of applying this section.
 ``
        (B) Medicare transition buy-in enrollees in 
 medicaid non-expansion states.--In the case of an 
 individual residing in a State which (as of the date of 
 the enactment of the Medicare for All Act) does not 
 provide for eligibility under clause
            (i) 
            (VIII) or
            (ii) 
            (XX) of 

section 1902

    (a)

    (10)
        (A) of the Social 
 Security Act for medical assistance under title XIX of 
 such Act (or a waiver of the State plan approved under 
 

section 1115) who enrolls in such Medicare Transition 
 buy-in, the preceding sentence, paragraph

    (1)
        (B) , and 
 paragraphs

    (1)
        (A)
            (i) and

    (2)
        (A) of subsection
            (c) shall 
 each be applied by substituting `0 percent' for `100 
 percent' each place it appears.''.

    (h) Conforming Amendments.--

    (1) Treatment as a qualified health plan.--

Section 1301

    (a)

    (2) of the Patient Protection and Affordable Care Act 
 (42 U.S.C. 18021

    (a)

    (2) ) is amended--
        (A) in the paragraph heading, by inserting ``The 
 medicare transition buy-in,'' before ``and''; and
        (B) by inserting ``The Medicare Transition buy-
 in,'' before ``and a multi-State plan''.

    (2) Level playing field.--

Section 1324

    (a) of the Patient 
 Protection and Affordable Care Act (42 U.S.C. 18044

    (a) ) is 
 amended by inserting ``the Medicare Transition buy-in,'' before 
 ``or a multi-State qualified health plan''.

 Subtitle B--Transitional Medicare Reforms

SEC. 1011. ELIMINATING THE 24-MONTH WAITING PERIOD FOR MEDICARE 
 COVERAGE FOR INDIVIDUALS WITH DISABILITIES.

    (a) In General.--

Section 226

    (b) of the Social Security Act (42 
U.S.C. 426

    (b) ) is amended--

    (1) in paragraph

    (2)
        (A) , by striking ``, and has for 24 
 calendar months been entitled to,'';

    (2) in paragraph

    (2)
        (B) , by striking ``, and has been for 
 not less than 24 months,'';

    (3) in paragraph

    (2)
            (C) 
            (ii) , by striking ``, including the 
 requirement that he has been entitled to the specified benefits 
 for 24 months,'';

    (4) in the first sentence, by striking ``for each month 
 beginning with the later of
            (I) July 1973 or
            (II) the twenty-
 fifth month of his entitlement or status as a qualified 
 railroad retirement beneficiary described in paragraph

    (2) , 
 and'' and inserting ``for each month for which the individual 
 meets the requirements of paragraph

    (2) , beginning with the 
 month following the month in which the individual meets the 
 requirements of such paragraph, and''; and

    (5) in the second sentence, by striking ``the `twenty-fifth 
 month of his entitlement''' and all that follows through 
 ``paragraph

    (2)
            (C) and''.

    (b) Conforming Amendments.--

    (1) Section 226.--

Section 226 of the Social Security Act 
 (42 U.S.C. 426) is amended by--
        (A) striking subsections

    (e)

    (1)
        (B) ,

    (f) , and

    (h) ; 
 and
        (B) redesignating subsections

    (g) and
            (i) as 
 subsections

    (f) and

    (g) , respectively.

    (2) Medicare description.--

Section 1811

    (2) of the Social 
 Security Act (42 U.S.C. 1395c

    (2) ) is amended by striking ``have 
 been entitled for not less than 24 months'' and inserting ``are 
 entitled''.

    (3) Medicare coverage.--

Section 1837

    (g)

    (1) of the Social 
 Security Act (42 U.S.C. 1395p

    (g)

    (1) ) is amended by striking 
 ``25th month of'' and inserting ``month following the first 
 month of''.

    (4) Railroad retirement system.--

Section 7
            (d) (2)
            (ii) of the 
 Railroad Retirement Act of 1974 (45 U.S.C. 231f
            (d) (2)
            (ii) ) is 
 amended--
        (A) by striking ``has been entitled to an annuity'' 
 and inserting ``is entitled to an annuity'';
        (B) by striking ``, for not less than 24 months''; 
 and
            (C) by striking ``could have been entitled for 24 
 calendar months, and''.
            (c) 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 1 following the date of enactment of this Act, and 
before the date that is 2 years after the date of the enactment of such 
Act.

SEC. 1012. ENSURING CONTINUITY OF CARE.

    (a) In General.--The Secretary shall ensure that all persons 
enrolled or who seek to enroll in a health plan during the transition 
period of the Medicare for All Program are protected from disruptions 
in their care during the transition period, including continuity of 
care with such persons' current health care provider teams.

    (b) Continuity of Coverage and Care in General.--During the 
transition period of the Medicare for All Act, group health plans and 
health insurance issuers offering group or individual health insurance 
coverage shall not end coverage for an enrollee during the transition 
period described in the Act until all ages are eligible to enroll in 
the Medicare for All Program except as expressly agreed upon under the 
terms of the plan.
            (c) Continuity of Coverage and Care for Persons With Complex 
Medical Needs.--

    (1) The Secretary shall ensure that persons' with 
 disabilities, complex medical needs, or chronic conditions are 
 protected from disruptions in their care during the transition 
 period, including continuity of care with such persons current 
 health care provider teams.

    (2) During the transition period of the Medicare for All 
 Act group health plans and health insurance issuers offering 
 group or individual health insurance coverage shall not--
        (A) end coverage for an enrollee who has a 
 disability, complex medical need, or chronic condition 
 during the transition period described in the Act until 
 all ages are eligible to enroll in the Medicare for All 
 Program; or
        (B) impose any exclusion with respect to such plan 
 or coverage on the basis of a person's disability, 
 complex medical need, or chronic condition during the 
 transition period described under this Act until all 
 ages are eligible to enroll in the Medicare for All 
 Program.
            (d) Public Consultation During Transition.--The Secretary shall 
consult with communities and advocacy organizations of persons living 
with disabilities as well as other patient advocacy organizations to 
ensure that the transition buy-in takes into account the continuity of 
care for persons with disabilities, complex medical needs, or chronic 
conditions.

 TITLE XI--MISCELLANEOUS

SEC. 1101. DEFINITIONS.

 In this Act--

    (1) the term ``global budget'' means the payment negotiated 
 between an institutional provider and as described in 

section 611

    (b) ;

    (2) the term ``group practice'' has the meaning given such 
 term in 

section 1877

    (h)

    (4) of the Social Security Act (42 
 U.S.C. 1395nn

    (h)

    (4) );

    (3) the term ``individual provider'' means a supplier (as 
 defined in 

section 1861
            (d) of such Act (42 U.S.C. 1395x
            (d) ));

    (4) the term ``institutional provider'' means--
        (A) providers of services described in 

section 1861

    (u) of such Act (42 U.S.C. 1395x

    (u) );
        (B) hospitals as defined in 

section 1861

    (e) of the 
 Social Security Act (42 U.S.C. 1395x

    (e) ), and any 
 outpatient settings or clinics operating within a 
 hospital license or any setting or clinic that provides 
 outpatient hospital services;
            (C) psychiatric hospitals (as defined in 

section 1861

    (e) of the Social Security Act (42 U.S.C. 
 1395x

    (f) ));
            (D) rehabilitation hospitals (as defined by the 
 Secretary of Health and Human Services under 

section 1886
            (d) (1)
        (B)
            (ii) of the Social Security Act (42 U.S.C. 
 1395ww
            (d) (1)
        (B)
            (ii) ));
        (E) long-term care hospitals as defined in 

section 1861 of the Social Security Act (42 U.S.C. 1395x
            (ccc) ); 
 and
        (F) independent dialysis facilities and independent 
 end-stage renal disease facilities as described in 42 
 CFR 413.174

    (b) ;

    (5) the term ``medically necessary or appropriate'' means 
 the health care items and services or supplies that are needed 
 or appropriate to prevent, diagnose, or treat an illness, 
 injury, condition, disease, or its symptoms for an individual 
 and are determined to be necessary or appropriate for such 
 individual by the physician or other health care professional 
 treating such individual, after such professional performs an 
 assessment of such individual's condition, in a manner that 
 meets--
        (A) the scope of practice, licensing, and other law 
 of the State in which the individual receiving such 
 items and services is located; and
        (B) appropriate standards established by the 
 Secretary for purposes of carrying out this Act;

    (6) the term ``provider'' means an institutional provider 
 or a supplier (as defined in 

section 1861
            (d) of such Act (42 
 U.S.C. 1395x
            (d) ) if the reference to ``this title'' were a 
 reference to the Medicare for All Program);

    (7) the term ``Secretary'' means the Secretary of Health 
 and Human Services;

    (8) the term ``State'' means a State, the District of 
 Columbia, or a territory of the United States;

    (9) the term ``TRICARE Overseas Program'' means the element 
 of the TRICARE program administered by International SOS (or 
 such successor administrator) under which care and health 
 benefits are furnished to TRICARE beneficiaries located in a 
 TRICARE overseas region;

    (10) the term ``TRICARE program'' has the meaning given 
 such term in 

section 1072 of title 10, United States Code;

    (11) the term ``uniformed services'' has the meaning given 
 such term in 

section 101 of title 10, United States Code; and

    (12) the term ``United States'' shall include the States, 
 the District of Columbia, and the territories of the United 
 States.

SEC. 1102. RULES OF CONSTRUCTION.

    (a) In General.--A State or local government may set additional 
standards or apply other State or local laws with respect to 
eligibility, benefits, and minimum provider standards, only if such 
State or local standards--

    (1) provide equal or greater eligibility than is available 
 under this Act;

    (2) provide equal or greater in-person access to benefits 
 under this Act;

    (3) do not reduce access to benefits under this Act;

    (4) allow for the effective exercise of the professional 
 judgment of physicians or other health care professionals; and

    (5) are otherwise consistent with this Act.

    (b) Relation to State Licensing Law.--Nothing in this Act shall be 
construed to preempt State licensing, practice, or educational laws or 
regulations with respect to health care professionals and health care 
providers, for such professionals and providers who practice in that 
State.
            (c) Application to State and Federal Law on Workplace Rights.--
Nothing in this Act shall be construed to diminish or alter the rights, 
privileges, remedies, or obligations of any employee or employer under 
any Federal or State law or regulation or under any collective 
bargaining agreement.
            (d) Restrictions on Providers.--With respect to any individuals or 
entities certified to provide items and services covered under 

section 201

    (a)

    (7) , a State may not prohibit an individual or entity from 
participating in the program under this Act for reasons other than the 
ability of the individual or entity to provide such services.

SEC. 1103. NO USE OF RESOURCES FOR LAW ENFORCEMENT OF CERTAIN 
 REGISTRATION REQUIREMENTS.

 Notwithstanding any provision of Federal or State law, no Federal 
or State law enforcement official or employee shall use any funds, 
facilities, property, equipment, or personnel made available pursuant 
to this Act (or any amendment made thereby) to investigate, enforce, or 
assist in the investigation or enforcement of any criminal, civil, or 
administrative violation or warrant for a violation of any requirement 
that individuals register with the Federal Government based on 
religion, national origin, ethnicity, immigration status, or other 
protected category.
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