119-s1506

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1506 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1506

 To establish a Medicare-for-All national health insurance program.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 April 29, 2025

Mr. Sanders (for himself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mrs. 
 Gillibrand, Mr. Heinrich, Ms. Hirono, Mr. Lujan, Mr. Markey, Mr. 
 Merkley, Mr. Padilla, Mr. Schatz, Mr. Schmitt, Ms. Warren, Mr. Welch, 
and Mr. Whitehouse) introduced the following bill; which was read twice 
 and referred to the Committee on Finance

_______________________________________________________________________

 A BILL

 To establish a 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 for this Act is as 
follows:

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

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

Sec. 102. Universal entitlement to benefits.

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 BENEFITS FOR LONG-TERM CARE

Sec. 201. Comprehensive benefits.

Sec. 202. No patient cost-sharing.

Sec. 203. Exclusions and limitations.

Sec. 204. Continued coverage of institutional long-term care and other 
 services under Medicaid.

Sec. 205. Prohibiting recovery of correctly paid Medicaid benefits.

Sec. 206. Additional State standards.
 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 
 Medicare for All Program.
 TITLE V--QUALITY OF CARE

Sec. 501. Quality standards.

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

 Subtitle A--Budgeting

Sec. 601. National health budget.

Sec. 602. Temporary worker assistance.
 Subtitle B--Payments to Providers

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

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

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

Sec. 614. Payments for prescription drugs and approved devices and 
 equipment.

Sec. 615. Payment prohibitions; capital expenditures; special projects.

Sec. 616. Office of Health Equity.

Sec. 617. Office of Primary Health Care.
 TITLE VII--MEDICARE FOR ALL TRUST FUND

Sec. 701. Medicare for All 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. Repeal 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 Federal and State 
 Exchanges.
 TITLE X--TRANSITION TO MEDICARE FOR ALL

 Subtitle A--Improvements to Medicare

Sec. 1001. Protecting Medicare fee-for-service beneficiaries from high 
 out-of-pocket costs.

Sec. 1002. Reducing Medicare part D annual out-of-pocket threshold.

Sec. 1003. Expanding Medicare to cover dental and vision services and 
 hearing aids and examinations under part B.

Sec. 1004. Eliminating the 24-month waiting period for Medicare 
 coverage for individuals with disabilities.

Sec. 1005. Guaranteed issue of Medigap policies.
 Subtitle B--Temporary Medicare Buy-In Option and Temporary Public 
 Option

Sec. 1011. Lowering the Medicare age.

Sec. 1012. Establishment of the Medicare transition plan.
 Subtitle C--Patient Protections During Medicare for All Transition 
 Period

Sec. 1021. Minimizing disruptions to patient care.

Sec. 1022. Public consultation.

Sec. 1023. Definitions.
 TITLE XI--MISCELLANEOUS

Sec. 1101. Updating resource limits for Supplemental Security Income 
 eligibility

    (SSI) .

Sec. 1102. Definitions.

 TITLE I--ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM; UNIVERSAL 
 ENTITLEMENT TO BENEFITS; ENROLLMENT

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

 There is hereby established a national health insurance program 
(referred to in this Act as the ``Medicare for All Program'') to 
provide comprehensive protection against the costs of health care and 
health-related items and services, in accordance with the standards 
specified in, or established under, this Act.

SEC. 102. UNIVERSAL ENTITLEMENT TO BENEFITS.

    (a) In General.--Every individual who is a resident of the United 
States is entitled to benefits for health care items and 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--

    (1) may make eligible for benefits for health care items 
 and services under this Act other individuals not described in 
 subsection

    (a) and regulate their eligibility to ensure that 
 every person in the United States has access to health care; 
 and

    (2) shall promulgate a rule, consistent with Federal 
 immigration laws, to prevent an individual from traveling to 
 the United States for the sole purpose of obtaining health care 
 items and services provided under this Act.

SEC. 103. FREEDOM OF CHOICE.

 Any individual entitled to benefits under this Act may obtain 
health care items and 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 described in 

section 301

    (a) ), 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) 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 with 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 
 (including damages for emotional harm), declaratory relief, 
 injunctive relief, attorneys' fees and costs, or other relief 
 as appropriate.
            (c) Continued Application of Laws.--Nothing in this title shall be 
construed to invalidate or otherwise limit any of the rights, remedies, 
procedures, or legal standards available to individuals aggrieved under 
other Federal laws, including 

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), title II of the Americans 
with Disabilities Act of 1990 (42 U.S.C. 12131 et seq.), or the Age 
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.). Nothing in 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 the Medicare for 
All Program. 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 date described in 
 subsection

    (a) or

    (b) , as applicable, of 

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

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

section 102

    (b) .

    (b) Issuance of Medicare for All Cards.--In conjunction with an 
individual's enrollment for benefits under this Act, the Secretary 
shall provide for the issuance of a Medicare for All card that shall be 
used for purposes of identification and processing of claims for 
benefits under the Medicare for All 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 the Medicare for All Program for items 
and services furnished on January 1 of the fourth calendar year that 
begins after the date of enactment of this Act.

    (b) Immediate Coverage of Children.--

    (1) In general.--For any eligible individual under 

section 102 who has not yet attained the age of 19 as of the date that 
 is 1 year after the date of enactment of this Act, benefits 
 shall first be available under the Medicare for All Program for 
 items and services furnished on January 1 of the first calendar 
 year that begins after the date of enactment of this Act.

    (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 on which 
 benefits are first available under subsection

    (a) .

SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE.

    (a) In General.--Beginning on the date on which benefits are first 
available under 

section 106

    (a) , it shall be unlawful for--

    (1) a private health insurer to sell health insurance 
 coverage that duplicates the benefits provided under the 
 Medicare for All Program; 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 the Medicare for All 
 Program.

    (b) Construction.--Nothing in this Act shall be construed as 
prohibiting the sale of health insurance coverage for any additional 
benefits not covered by the Medicare for All Program, 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 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 the 
Medicare for All Program are entitled to have payment made by the 
Secretary to a participating 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, biological products, and medical 
 devices, and all contraceptive items approved by the Food and 
 Drug Administration.

    (5) Mental health and substance use treatment services, 
 including inpatient care and treatment for co-occurring mental 
 illness and substance use disorders.

    (6) Laboratory and diagnostic services.

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

    (8) Comprehensive maternity and newborn care.

    (9) Comprehensive gender-affirming health care.

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

    (11) Rehabilitative and habilitative services, including 
 devices.

    (12) Emergency services, including transportation.

    (13) Pediatrics, including early and periodic screening, 
 diagnostic, and treatment services (as defined in 

section 1905

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

    (r) )).

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

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

    (16) Home- and community-based long-term care services and 
 supports (to be provided in accordance with the requirements 
 for home and community-based settings under sections 441.530 
 and 441.710 of title 42, Code of Federal Regulations (as in 
 effect on the date of enactment of this Act), including--
        (A) services described in paragraphs

    (7) ,

    (8) ,

    (13) ,

    (19) , and

    (24) of 

section 1905

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

    (a) );
        (B) home and community-based services described in 
 subsection
            (c) (4)
        (B) of 

section 1915 of the Social 
 Security Act (42 U.S.C. 1396n) (including habilitation 
 services defined in subsection
            (c) (5) of such section);
            (C) self-directed home and community-based services 
 described in subsection
            (i) of 

section 1915 of the 
 Social Security Act;
            (D) self-directed personal assistance services (as 
 defined in subsection

    (j)

    (4)
        (A) of 

section 1915 of the 
 Social Security Act); and
        (E) home and community-based attendant services and 
 supports described in subsection

    (k) of 

section 1915 of 
 the Social Security Act.

    (17) Any item or service described in any of paragraphs

    (1) through

    (16) that is furnished using telehealth, to the extent 
 practicable.

    (b) Revision.--The Secretary shall, at least on an annual 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.
            (c) 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 integrative 
 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.
            (d) 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 the Medicare for All Program at the expense 
of the State.

SEC. 202. NO PATIENT COST-SHARING.

    (a) In General.--The Secretary shall ensure that no cost-sharing, 
including deductibles, coinsurance, copayments, or similar charges, be 
imposed on an individual for any benefits provided under the Medicare 
for All Program, except as described in subsection

    (b) .

    (b) Exceptions.--The Secretary may set a cost-sharing schedule for 
prescription drugs covered under the Medicare for All Program--

    (1) provided that--
        (A) such schedule is evidence-based, patient-
 centered, and encourages the use of generic drugs;
        (B) such cost-sharing does not apply to preventive 
 drugs;
            (C) such cost-sharing does not exceed $200 annually 
 per individual, adjusted annually for inflation; and
            (D) such cost-sharing is not imposed on individuals 
 with a household income equal to or below 250 percent 
 of the poverty line for a family of the size involved; 
 and

    (2) under which the Secretary may--
        (A) exempt brand-name drugs from consideration in 
 determining whether an individual has reached any out-
 of-pocket limit if a safe and appropriate generic 
 version of such drug is available to such individual; 
 and
        (B) waive cost-sharing in response to a coverage 
 appeal under 

section 203

    (b)

    (2) .
            (c) No Balance Billing.--Notwithstanding contracts in accordance 
with 

section 303, no provider may impose a charge to an individual 
enrolled for benefits under the Medicare for All Program for items and 
services for which benefits are provided under such Program.

SEC. 203. EXCLUSIONS AND LIMITATIONS.

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

section 201

    (a) .

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

    (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 are considered to meet the standards specified in 
 

section 201

    (a) if they have been provided in accordance with 
 such guideline.

    (2) Certain exceptions.--For purposes of this subsection, 
 an item or service not provided in accordance with a national 
 practice guideline shall be considered to have been provided in 
 accordance with such guideline if the health care provider 
 providing the item or service--
        (A) exercised appropriate professional discretion 
 to deviate from the guideline in a manner authorized or 
 anticipated by the guideline;
        (B) acted in accordance with the laws and 
 requirements in which such item or service is 
 furnished;
            (C) acted in the best interests of the individual 
 receiving the item or service; and
            (D) acted in a manner consistent with the 
 individual's wishes.

SEC. 204. CONTINUED COVERAGE OF INSTITUTIONAL LONG-TERM CARE AND OTHER 
 SERVICES UNDER MEDICAID.

 Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting the following section after 

section 1948:

``

SEC. 1949. STATE PLAN FOR PROVIDING INSTITUTIONAL LONG-TERM CARE 
 SERVICES.

 ``

    (a) In General.--For quarters beginning on or after the date on 
which benefits are first available under 

section 106

    (a) of the Medicare 
for All Act, notwithstanding any other provision of this title--
 ``

    (1) a State plan for medical assistance shall provide for 
 making medical assistance available for institutional long-term 
 care services in a manner consistent with this section; and
 ``

    (2) no payment to a State shall be made under this title 
 with respect to expenditures incurred by the State in providing 
 medical assistance on or after such date for services that are 
 not--
 ``
        (A) institutional long-term care services; or
 ``
        (B) other services for which benefits are not 
 available under the Medicare for All Act and which are 
 furnished under a State plan for medical assistance 
 which provided for medical assistance for such services 
 on March 1, 2025.
 ``

    (b) Institutional Long-Term Care Services Defined.--In this 
section, the term `institutional long-term care services' means the 
following:
 ``

    (1) Nursing facility services for individuals 21 years of 
 age or over described in subparagraph
        (A) of 

section 1905

    (a)

    (4) .
 ``

    (2) Inpatient services for individuals 65 years of age or 
 over provided in an institution for mental disease described in 
 

section 1905

    (a)

    (14) .
 ``

    (3) Intermediate care facility services described in 
 

section 1905

    (a)

    (15) .
 ``

    (4) Inpatient psychiatric hospital services for 
 individuals under age 21 described in 

section 1905

    (a)

    (16) .
 ``

    (5) Nursing facility services described in 

section 1905

    (a)

    (31) .
 ``
            (c) State Maintenance of Effort Requirement.--
 ``

    (1) Eligibility standards.--
 ``
        (A) In general.--Beginning on the date described 
 in subsection

    (a) , no payment may be made under 

section 1903 with respect to medical assistance provided under 
 a State plan for medical assistance if the State adopts 
 income, resource, or other standards and methodologies 
 for purposes of determining an individual's eligibility 
 for medical assistance under the State plan that are 
 more restrictive than those applied as of January 1, 
 2025.
 ``
        (B) Indexing of amounts of income and resource 
 standards.--In determining whether a State has adopted 
 income or resource standards that are more restrictive 
 than the standards which applied as of January 1, 2025, 
 the Secretary shall deem the amount of any such 
 standard that was applied as of such date to be 
 increased by the percentage increase in the medical 
 care component of the consumer price index for all 
 urban consumers (U.S. city average) from September of 
 2022 to September of the fiscal year for which the 
 Secretary is making such determination.
 ``

    (2) Expenditures.--
 ``
        (A) In general.--For each fiscal year or portion 
 of a fiscal year that occurs during the period that 
 begins on the first day of the first fiscal quarter 
 that begins on or after the date on which benefits are 
 first available under 

section 106

    (a) of the Medicare 
 for All Act, as a condition of receiving payments under 
 

section 1903

    (a) , a State shall make expenditures for 
 medical assistance for institutional long-term care 
 services in an amount that is not less than the 
 expenditure floor determined for the State and fiscal 
 year (or portion of a fiscal year) under subparagraph
        (B) .
 ``
        (B) Expenditure floor.--
 ``
            (i) In general.--For each fiscal year or 
 portion of a fiscal year described in 
 subparagraph
        (A) , the Secretary shall determine 
 for each State an expenditure floor that shall 
 be equal to--
 ``
            (I) the amount of the State's 
 expenditures for fiscal year 2024 on 
 medical assistance for institutional 
 long-term care services; increased by
 ``
            (II) the growth factor determined 
 under subclause
            (ii) .
 ``
            (ii) Growth factor.--For each fiscal year 
 or portion of a fiscal year described in 
 subparagraph
        (A) , the Secretary shall, not 
 later than September 1 of the fiscal year 
 preceding such fiscal year or portion of a 
 fiscal year, determine a growth factor for each 
 State that takes into account--
 ``
            (I) the percentage increase in 
 health care costs in the State;
 ``
            (II) the total amount expended by 
 the State for the previous fiscal year 
 on medical assistance for institutional 
 long-term care services;
 ``
            (III) the increase, if any, in 
 the total population of the State from 
 July of 2024 to July of the fiscal year 
 preceding the fiscal year involved;
 ``
            (IV) the increase, if any, in the 
 population of individuals aged 65 and 
 older of the State from July of 2024 to 
 July of the fiscal year preceding the 
 fiscal year involved; and
 ``
            (V) the decrease, if any, in the 
 population of the State that requires 
 medical assistance for institutional 
 long-term care services that is 
 attributable to the availability of 
 coverage for the services described in 
 

section 201

    (a)

    (16) of the Medicare for 
 All Act.
 ``
            (iii) Proration rule.--Any amount 
 determined under this subparagraph for a 
 portion of a fiscal year shall be prorated 
 based on the length of such portion of a fiscal 
 year relative to a complete fiscal year.
 ``
            (d) Nonapplication of Certain Requirements.--Beginning on the 
date described in subsection

    (a) , any provision of this title requiring 
a State plan for medical assistance to make available medical 
assistance for services that are not institutional long-term care 
services or items and services described in 

section 901

    (a)

    (3)
        (A)
            (ii) of 
the Medicare for All Act shall have no effect.''.

SEC. 205. PROHIBITING RECOVERY OF CORRECTLY PAID MEDICAID BENEFITS.

 

Section 1917 of the Social Security Act (42 U.S.C. 1396p) is 
amended--

    (1) by amending subsection

    (a) to read as follows:
 ``

    (a) No lien may be imposed against the property of any individual 
prior to his death on account of medical assistance paid or to be paid 
on his behalf under the State plan, except pursuant to the judgment of 
a court on account of benefits incorrectly paid on behalf of such 
individual.''; and

    (2) by amending subsection

    (b) to read as follows:
 ``

    (b) No adjustment or recovery of any medical assistance correctly 
paid on behalf of an individual under the State plan may be made.''.

SEC. 206. ADDITIONAL STATE STANDARDS.

    (a) In General.--Nothing in this Act shall prohibit individual 
States from setting additional standards related to eligibility, 
benefits, and minimum provider standards, consistent with the purposes 
of this Act, provided that such standards do not restrict eligibility 
or reduce access to benefits for items and services.

    (b) 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 Medicare for All Program for reasons other than 
the inability of the individual or entity to provide such items and 
services.

 TITLE III--PROVIDER PARTICIPATION

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

    (a) In General.--An individual or entity furnishing any item or 
service covered under the Medicare for All Program is not a 
participating provider under such Program 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 items or services covered under the 
 Medicare for All Program 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;
            (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 care items or 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 
 the Medicare for All Program, the provider agrees to 
 submit bills and any required supporting documentation 
 relating to the provision of items or services covered 
 under such Program 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 
 items and services covered under the Medicare for All 
 Program 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 items and 
 services covered under the Medicare for All 
 Program; and
            (ii) describes such 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 the Medicare for 
 All Program 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 participating 
 provider described in subsection

    (a) 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;
            (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 40

    (b) of the Consumer Product Safety 
 Act (15 U.S.C. 2087

    (b) ).
            (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 described in 

section 3730

    (h)

    (3) of title 31, United 
 States Code, and the rules and procedures, legal burdens of 
 proof, and remedies applicable under 

section 31105 of title 49, 
 United States Code.

    (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 

section 3730

    (h) of title 31, United States 
 Code, 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 

section 3730

    (h) of title 31, United States 
 Code.

    (4) === Definitions. ===
-In this subsection:
        (A) Employer.--The term ``employer'' means any 
 person engaged in profit or a nonprofit business or 
 industry, including one or more individuals, 
 partnerships, associations, corporations, trusts, 
 professional membership organizations 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 a qualified 
provider to furnish items and services under the Medicare for All 
Program if the provider is licensed or certified to furnish such items 
and services in the State in which the individual receiving such items 
and services is located and meets--

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

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

    (b) Federal Providers.--Any provider qualified to provide health 
care items and services at a facility of the Department of Veterans 
Affairs, the Indian Health Service, or the uniformed services (as 
defined in 

section 1072

    (1) of title 10, United States Code) (with 
respect to the direct care component of the TRICARE program) is a 
qualified provider under this section with respect to any individual 
who qualifies for such items and services under applicable Federal law.
            (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 the Medicare for All Program 
 and to monitor efforts by States to ensure the quality of such 
 items and services. A State may also 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 items or 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 items or 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) training and competence of personnel (including 
 requirements related to the number or type of required 
 continuing education hours);
            (C) comprehensiveness of items and services;
            (D) continuity of items and services;
        (E) patient waiting times, access to items and 
 services, and references; and
        (F) performance standards, including organization, 
 facilities, structure of items and 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.

SEC. 303. USE OF PRIVATE CONTRACTS.

    (a) In General.--This section shall apply beginning on the date on 
which benefits are first available under 

section 106

    (a) . Subject to the 
provisions of this section, nothing in this Act shall prohibit an 
institutional or individual provider from entering into a private 
contract with an individual enrolled for benefits under the Medicare 
for All Program for any item or service--

    (1) for which no claim for payment is to be submitted under 
 this Act; and

    (2) for which the provider receives--
        (A) no reimbursement under this Act directly or on 
 a capitated basis; and
        (B) receives no amount from an organization which 
 receives reimbursement for such item or service under 
 this Act directly or on a capitated basis.

    (b) Contract Requirements.--

    (1) In general.--Any contract to provide an item or service 
 under subsection

    (a) 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) be entered into at a time when the individual 
 is facing an emergency health care situation; and
            (C) contain the items described in paragraph

    (2) .

    (2) Items required to be included in contract.--Any 
 contract to provide an item or service to which subsection

    (a) applies shall clearly indicate to the individual that by 
 signing such contract the individual--
        (A) agrees not to submit a claim (or to request 
 that the provider submit a claim) under this Act for 
 such item or service even if such item or service is 
 otherwise covered by the Medicare for All Program;
        (B) agrees to be responsible, whether through 
 insurance offered under 

section 107

    (b) or otherwise, 
 for payment of such item or service and understands 
 that no reimbursement will be provided under this Act 
 for such item or service;
            (C) acknowledges that no limits under this Act 
 apply to amounts that may be charged for such item or 
 service;
            (D) if the provider is a nonparticipating provider, 
 acknowledges that the beneficiary has the right to have 
 such item or service provided by other providers for 
 whom payment would be made under the Medicare for All 
 Program; and
        (E) acknowledges that the provider is providing an 
 item or service outside the scope of the Medicare for 
 All Program.
            (c) Provider Requirements.--

    (1) In general.--Subsection

    (a) shall not apply to any 
 contract unless an affidavit described in paragraph

    (2) is in 
 effect during the period any item or service is to be provided 
 pursuant to the contract.

    (2) Affidavit.--An affidavit as described in this 
 subparagraph shall--
        (A) identify the provider, and be signed by such 
 provider;
        (B) provide that the provider will not submit any 
 claim under this title for any item or service provided 
 to any beneficiary (and will not receive any 
 reimbursement or amount described in subsection

    (a)

    (2) for any such item or service) during the 1-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.

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

    (2) knowingly and willfully submits a 
 claim under this title for any item or service provided during 
 the 1-year period described in paragraph

    (2)
        (B) (or receives 
 any reimbursement or amount described in subsection

    (a)

    (2) for 
 any such item or service) with respect to such affidavit--
        (A) this subsection shall not apply with respect to 
 any item or service provided by the provider pursuant 
 to any contract on and after the date of such 
 submission and before the end of such period; and
        (B) no payment shall be made under this title for 
 any item or service furnished by the provider during 
 the period described in subparagraph
        (A) (and no 
 reimbursement or payment of any amount described in 
 subsection

    (a)

    (2) shall be made for any such item or 
 service).

 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 under the Medicare for 
 All Program;
        (B) enrollment under such Program;
            (C) benefits provided under such Program;
            (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 items and services covered under the 
 Medicare for All Program, consistent with subtitle B;
        (G) a process for appealing or petitioning for a 
 determination of coverage for items and services under 
 the Medicare for All Program;
        (H) planning for capital expenditures and item 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.

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

    (1) Uniform reporting standards.--
        (A) In general.--The Secretary shall establish 
 uniform State reporting requirements, provider 
 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 covered under the Medicare for All Program, 
 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, the measures described in 
 subparagraphs
            (D) through
        (F) of subsection

    (a)

    (1) .
        (B) Reports.--The Secretary shall--
            (i) regularly analyze information reported 
 to the Secretary; and
            (ii) 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 January 1 of the second year 
 beginning after the date on which benefits are first available 
 under 

section 106

    (a) , the Secretary shall annually report to 
 Congress on the following:
        (A) The status of implementation of this Act.
        (B) Enrollment under the Medicare for All Program.
            (C) Benefits under the Medicare for All Program.
            (D) Expenditures and financing under this Act.
        (E) Cost-containment measures and achievements 
 under the Medicare for All Program.
        (F) Quality assurance.
        (G) Health care utilization patterns, including any 
 changes attributable to the Medicare for All Program.
        (H) Changes in the per capita costs of health care.
            (I) Differences in the health status of the 
 populations of the different States, by demographic 
 characteristics, including race, ethnicity, national 
 origin, primary language use, age, disability, sex 
 (including gender identity and sexual orientation), 
 geography, or socioeconomic status.
        (J) Progress on implementing quality and outcome 
 measures under this Act, and long-range plans and goals 
 for achievements in such measures.
        (K) Plans for improving items and services to 
 medically underserved populations (as defined in 
 

section 330

    (b)

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

    (b)

    (3) )).
            (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 evidence-
 based 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 date on 
 which benefits are first available under 

section 106

    (a) to 
 determine the effectiveness of the Medicare for All 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, patient advocate groups, disability rights 
organizations, and labor 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 

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) Regional Medicare for All Offices.--The Secretary shall 
establish and maintain regional offices for the purpose of carrying out 
the duties specified in subsection
            (c) and promoting adequate access 
to, and efficient use of, tertiary care facilities, equipment, items, 
and services by individuals enrolled under the Medicare for All 
Program.

    (b) Coordination.--Wherever possible, the Secretary shall 
incorporate the regional offices and the administrative processes of 
the Centers for Medicare & Medicaid Services for the purposes of 
carrying out subsection

    (a) .
            (c) Appointment of Regional Directors.--In each regional office 
established under subsection

    (a) 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 director appointed by the regional director 
 to oversee home- and community-based services and supports.
            (d) Duties.--Each regional director shall--

    (1) submit an annual regional health care needs assessment 
 report to the Secretary, after a thorough examination of health 
 needs and consultation with public health officials, 
 clinicians, patients, and patient advocates;

    (2) recommend any changes in provider reimbursement or 
 payment for delivery of items and services covered under the 
 Medicare for All Program determined appropriate by the regional 
 director, subject to the requirements 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 covered under 
 the Medicare for All Program and to ensure that all 
 participating providers described in 

section 301

    (a) meet the 
 quality and other 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 and in providing assistance to individuals 
entitled to benefits under the Medicare for All Program.

    (b) Duties.--

    (1) In general.--The Beneficiary Ombudsman shall--
        (A) receive complaints, grievances, and requests 
 for information submitted by individuals entitled to 
 benefits under the Medicare for All Program with 
 respect to any aspect of such Program;
        (B) provide assistance with respect to complaints, 
 grievances, and requests referred to in subparagraph
        (A) , including--
            (i) 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
            (ii) assistance to such individuals in 
 presenting information relating to cost-
 sharing; and
            (C) submit annual reports to Congress and the 
 Secretary that describe the activities of the Office 
 and that include such recommendations for improvement 
 in the administration of this Act as the Ombudsman 
 determines appropriate.

    (2) Authorities.--The Ombudsman shall not serve as an 
 advocate for any increases in payments or new coverage of items 
 or 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 
 MEDICARE FOR ALL PROGRAM.

 The following sections of the Social Security Act shall apply to 
the Medicare for All Program in the same manner as they apply to State 
medical assistance plans under title XIX of such Act (42 U.S.C. 1396 et 
seq.):

    (1) Section 1128 (42 U.S.C. 1320a-7) (relating to exclusion 
 of individuals and entities).

    (2) Section 1128A (42 U.S.C. 1320a-7a) (civil monetary 
 penalties).

    (3) Section 1128B (42 U.S.C. 1320a-7b) (criminal 
 penalties).

    (4) Section 1124 (42 U.S.C. 1320a-3) (relating to 
 disclosure of ownership and related information).

    (5) Section 1126 (42 U.S.C. 1320a-5) (relating to 
 disclosure of certain owners).

    (6) Section 1877 (42 U.S.C. 1395nn) (relating to physician 
 referrals).

 TITLE V--QUALITY OF CARE

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 agencies 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 (42 
 U.S.C. 299b et seq.). 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 

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. 299b 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 items and services under 

section 401

    (a)

    (1)
        (G) .

SEC. 502. ADDRESSING HEALTH CARE DISPARITIES.

    (a) Evaluating Data Collection Approaches.--The Center, in 
coordination with the Office of Health Equity established under 

section 1712 of the Public Health Service Act (as added by 

section 616) and 
other agencies in the Department of Health and Human Services 
determined relevant by the Secretary, 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 items and 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 the Medicare for 
 All Program.

    (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 are first available under 

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 paragraph

    (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 are first available under 

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--NATIONAL HEALTH BUDGET; PROVIDER PAYMENTS; COST CONTAINMENT 
 MEASURES

 Subtitle A--Budgeting

SEC. 601. NATIONAL HEALTH BUDGET.

    (a) National Health Budget.--

    (1) In general.--Not later than September 1 of each year, 
 beginning with the year prior to the date on which benefits are 
 first available under 

section 106

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

    (2) Division of budget into components.--The national 
 health budget shall consist of at least 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

    (7) 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 described in paragraph

    (2)
        (E) is 
 sufficient to provide for the amount of health 
 professional education expenditures sufficient to meet 
 the need for items and services covered under the 
 Medicare for All Program.

    (4) For 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 areas or areas 
 described 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) 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.

    (9) Construction compliance.--Expenditures from each 
 component of the national health budget, including 
 construction, shall expand accessibility for persons with 
 disabilities to achieve full compliance with the Americans with 
 Disabilities Act of 1990 (42 U.S.C. 12101 et seq.). Any project 
 funded through the national budget shall at least meet the new 
 construction standards under such Act.

    (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 recruitment, 
 retention, and diversity on patient outcomes.

SEC. 602. TEMPORARY WORKER ASSISTANCE.

    (a) In General.--For up to 5 years following the date on which 
benefits are first available under 

section 106

    (a) , at least 1 percent 
of the national health 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 experience economic dislocation 
as a result of the implementation of this Act.

    (b) Clarification.--Assistance described in subsection

    (a) shall 
include wage replacement, retirement benefits, job training and 
placement, preferential hiring, and education benefits.

 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, and independent dialysis 
facilities) is to furnish items and services under the Medicare for All 
Program, 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 the Medicare for All Program, 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, and an assessment 
 of any adjustments made to ensure that accuracy and need for 
 adjustment was appropriate.

    (3) Agreements for salaried payments for certain 
 providers.--
        (A) In general.--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.
        (B) Salaries.--Any individual health care 
 professional of such group practice or other provider 
 receiving payment through an institutional provider's 
 global budget under this paragraph 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.
            (C) Reporting and disclosure requirements.--Any 
 group practice or other health care provider that 
 receives payment through an institutional provider's 
 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) public health emergencies including 
 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 wages, 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 calendar 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 items and services 
 provided for each item and service 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 (42 U.S.C. 1395 et 
 seq.) 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 to ensure 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 areas or areas described 
 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) ));
            (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 the Medicare for All Program; 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) .

    (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 not exceed the compensation cap established in 
 

section 4304

    (a)

    (16) of title 41, United States Code, as added 
 by 

section 702 of the Bipartisan Budget Act of 2013, 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 (42 U.S.C. 1395 et seq.) 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 items and services covered 
 under the Medicare for All Program furnished the preceding year 
 with applicable adjustments, including adjustments due to any 
 public health emergencies in the preceding year, and 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 health 
 care 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 items or 
 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 items 
 and 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 items and 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. PAYMENTS TO INDIVIDUAL PROVIDERS THROUGH FEE-FOR-SERVICE.

    (a) Medicare for All 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 
 and annually update a national fee schedule that establishes 
 amounts for items and services payable under the Medicare for 
 All Program, furnished by--
        (A) individual providers;
        (B) providers in group practices who are not 
 receiving payments on a salaried basis described in 
 

section 611

    (a)

    (3) ;
            (C) providers of home- and community-based 
 services; and
            (D) any other provider not described in 

section 611.

    (2) Amounts.--In establishing the fee schedule 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 other 
 Federal health programs; and
        (B) the expertise of providers and the value of 
 items and services furnished by such providers.

    (b) Leveraging Existing Medicare Payment Processes.--

    (1) Application of payment processes under title xviii.--
 Except as otherwise provided in this section, the Secretary 
 shall establish, and shall annually update by regulation, the 
 fee schedule under subsection

    (a) in a manner that is 
 documented, is transparent, allows for public comment, and, to 
 the greatest extent practicable, is consistent with processes 
 for determining, revising, and making payments for items and 
 services under title XVIII of the Social Security Act (42 
 U.S.C. 1395 et seq.), including the application of the 
 provisions of, and amendments made by, 

section 613.

    (2) Electronic billing.--The Secretary shall establish a 
 uniform national system for electronic billing for purposes of 
 making payments under this section.
            (c) Application of Current and Planned Payment Reforms.--To the 
extent the Secretary determines such application is necessary to ensure 
a smooth and fair transition, the Secretary may apply payment reform 
activities planned or implemented with respect to such title XVIII as 
of the date of the enactment of this Act, including demonstrations, 
waivers, or any other provider payment agreements, to benefits under 
the Medicare for All Program, provided that the Secretary sets forth a 
process for reviewing such applications and making such determinations 
that is reasonable, transparent, and documented, and allows for public 
comment.
            (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. 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. 1305w-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 one 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 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 subparagraph 
 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. PAYMENTS FOR PRESCRIPTION DRUGS AND APPROVED DEVICES AND 
 EQUIPMENT.

    (a) Negotiated Prices.--The prices to be paid for pharmaceutical 
products, medical supplies, and medically necessary assistive equipment 
covered under the Medicare for All Program shall be negotiated annually 
by the Secretary.

    (b) Prescription Drug Formulary.--

    (1) In general.--The Secretary shall establish a 
 prescription drug formulary system, pursuant to the 
 requirements of 

section 202, which shall encourage best-
 practices in prescribing and discourage the use of ineffective, 
 dangerous, or excessively costly medications when better 
 alternatives are available.

    (2) Promotion of use of generics.--The formulary under this 
 subsection shall promote the use of generic medications to the 
 greatest extent possible.

    (3) Formulary updates and petition rights.--The formulary 
 under this subsection shall be updated frequently and 
 clinicians and patients may petition the Secretary to add new 
 pharmaceuticals or to remove ineffective or dangerous 
 medications from the formulary.

    (4) Use of off-formulary medications.--The Secretary shall 
 promulgate rules regarding the use of off-formulary medications 
 which allow for patient access but do not compromise the 
 formulary.

SEC. 615. PAYMENT PROHIBITIONS; CAPITAL EXPENDITURES; SPECIAL PROJECTS.

    (a) Prohibitions.--Payments to participating providers described in 

section 301

    (a) 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) 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

    (4) political or other contributions prohibited under 
 

section 317

    (a)

    (1) of the Federal Elections Campaign Act of 1971 
 (52 U.S.C. 30119

    (a)

    (1) ).

    (b) 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 items and services for medically 
 underserved populations and areas described 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.
            (c) 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.
            (d) 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.

    (e) 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. 616. 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, population density, and 
 accessibility);
 ``
            (C) barriers to health care access, including--
 ``
            (i) lack of trust and awareness;
 ``
            (ii) lack of transportation;
 ``
            (iii) lack of accessibility;
 ``
            (iv) geography;
 ``
            (v) hospital and service closures;
 ``
            (vi) lack of health care infrastructure 
 and facilities; and
 ``
            (vii) 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. 617. OFFICE OF PRIMARY HEALTH CARE.

 Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.), as amended by 

section 616, is further amended by adding at the 
end the following:

``

SEC. 1713. OFFICE OF PRIMARY HEALTH 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 including 
 primary medical, dental, and behavioral health care providers, 
 registered nurses, and other advanced practice clinicians;
 ``

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

    (5) provide recommendations on targeted programs and 
 resources for Federally qualified health centers, community 
 health centers, rural health centers, behavioral health 
 clinics, 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.''.

 TITLE VII--MEDICARE FOR ALL TRUST FUND

SEC. 701. MEDICARE FOR ALL 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 Medicare 
for All 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 are first available under 

section 106

    (a) , out of any moneys 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 

section 801 and 

section 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 hereby appropriated to the 
 Trust Fund for the first fiscal year beginning at least 
 one year after 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 (42 U.S.C. 1395 et 
 seq.) (other than amounts attributable to any 
 premiums under such title).
            (ii) The Medicaid program under State plans 
 approved under title XIX of such Act (42 U.S.C. 
 1396 et seq.).
            (iii) The Federal Employees Health Benefits 
 program, under chapter 89 of title 5, United 
 States Code.
            (iv) The maternal and child health program 
 (under title V of the Social Security Act (42 
 U.S.C. 701 et seq.)), 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 care items and 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 each fiscal year following the fiscal year in 
 which the appropriation is made under subparagraph
        (A) , 
 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 item or 
 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'' or the ``Board of Trustees'' 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 Medicare 
for All 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. 524. PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF MEDICARE 
 FOR ALL 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 
Program established under 

section 101 of the Medicare for All Act 
(referred to in this section as the `Medicare for All Program').
 ``

    (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 underwrites 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 items 
 and services and long-term care items and 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 524

    (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 523 the 
following new item:

``

Sec. 524. Prohibition of employee benefits duplicative of Medicare 
 for All Program benefits; coordination in 
 case of workers' compensation.''.

SEC. 802. REPEAL 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.) is 
repealed.

    (b) Conforming Amendments.--

    (1) Section 502

    (a) of such Act (29 U.S.C. 1132

    (a) ) is 
 amended--
        (A) by striking paragraph

    (7) ; and
        (B) by redesignating paragraphs

    (8) ,

    (9) , and

    (10) as paragraphs

    (7) ,

    (8) , and

    (9) , respectively.

    (2) Section 502
            (c) (1) of such Act (29 U.S.C. 1132
            (c) (1) ) is 
 amended by striking ``paragraph

    (1) or

    (4) of 

section 606,''.

    (3) Section 502

    (e) of such Act (29 U.S.C. 1132

    (e) ) is 
 amended by striking ``paragraphs

    (1)
        (B) and

    (7) '' and inserting 
 ``paragraph

    (1)
        (B) ''.

    (4) Section 502
            (l) (3)
        (B) of such Act (29 U.S.C. 
 1132
            (l) (3)
        (B) ) is amended by striking ``subsection

    (a)

    (9) '' and 
 inserting ``subsection

    (a)

    (8) ''.

    (5) Section 514

    (b) of such Act (29 U.S.C. 1144

    (b) ) is 
 amended--
        (A) in paragraph

    (7) , by striking ``

section 206
            (d) (3)
        (B)
            (i) ),''; and
        (B) by striking paragraph

    (8) .

    (6) The table of contents in 

section 1 of the Employee 
 Retirement Income Security Act of 1974 is amended by striking 
 the items relating to part 6 of subtitle B of title I of such 
 Act.

SEC. 803. EFFECTIVE DATE OF TITLE.

 The provisions of and amendments made by this title shall take 
effect on the date on which benefits are first available under 

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, subject to paragraphs

    (2) and

    (3) --
        (A) no benefits shall be available under title 
 XVIII of the Social Security Act (42 U.S.C. 1395 et 
 seq.) for any item or service furnished beginning on or 
 after the date on which benefits are first available 
 under 

section 106

    (a) ;
        (B) no individual is entitled to medical assistance 
 under a State plan approved under title XIX of such Act 
 (42 U.S.C. 1396 et seq.) 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 (42 U.S.C. 1397aa et seq.) 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 (42 U.S.C. 
 1396b

    (a) ; 42 U.S.C. 1397ee) 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 date on which benefits are first 
 available under 

section 106

    (a) , 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) Continued coverage of long-term care and other certain 
 services under medicaid.--
        (A) In general.--This subsection shall not apply to 
 entitlement to medical assistance provided under title 
 XIX of the Social Security Act for--
            (i) institutional long-term care services 
 (as defined in 

section 1948

    (b) of such Act); or
            (ii) any other service for which benefits 
 are not available under the Medicare for All 
 Program and which is furnished under a State 
 plan under title XIX of the Social Security Act 
 which provided for medical assistance for such 
 service on January 1, 2023.
        (B) Coordination between secretary and states.--The 
 Secretary shall coordinate with the directors of State 
 agencies responsible for administering State plans 
 under title XIX of the Social Security Act to--
            (i) identify items and services described 
 in subparagraph
        (A)
            (ii) with respect to each 
 State plan; and
            (ii) ensure that such items and services 
 continue to be made available under such plan.
            (C) State maintenance of effort requirement.--With 
 respect to any service described in subparagraph
        (A)
            (ii) that is made available under a State plan under 
 title XIX of the Social Security Act, the maintenance 
 of effort requirements described in 

section 1948
            (c) of 
 such Act (related to eligibility standards and required 
 expenditures) shall apply to such service in the same 
 manner that such requirements apply to institutional 
 long-term care services (as defined in 

section 1948

    (b) of such Act).

    (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 the Medicare for All Program.
            (c) 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, the eligibility of 
 individuals for TRICARE medical benefits and services provided 
 under sections 1079 and 1086 of title 10, 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 FEDERAL AND STATE 
 EXCHANGES.

 Effective on the date on which benefits are first available under 

section 106

    (a) , 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.

 TITLE X--TRANSITION TO MEDICARE FOR ALL

 Subtitle A--Improvements to Medicare

SEC. 1001. PROTECTING MEDICARE FEE-FOR-SERVICE BENEFICIARIES FROM HIGH 
 OUT-OF-POCKET COSTS.

    (a) Protection Against High Out-of-Pocket Expenditures.--Title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by 
adding at the end the following new section:

 ``protection against high out-of-pocket expenditures

 ``

Sec. 1899C.

    (a) In General.--Notwithstanding any other provision 
of this title, in the case of an individual entitled to, or enrolled 
for, benefits under part A or enrolled in part B, if the amount of the 
out-of-pocket cost-sharing of such individual for a year (effective the 
year beginning January 1 of the year following the date of enactment of 
the Medicare for All Act) equals or exceeds $1,500, the individual 
shall not be responsible for additional out-of-pocket cost-sharing that 
occurred during that year.
 ``

    (b) Out-of-Pocket Cost-Sharing Defined.--
 ``

    (1) In general.--Subject to paragraphs

    (2) and

    (3) , in 
 this section, the term `out-of-pocket cost-sharing' means, with 
 respect to an individual, the amount of the expenses incurred 
 by the individual that are attributable to--
 ``
        (A) coinsurance and copayments applicable under 
 part A or B; or
 ``
        (B) for items and services that would have 
 otherwise been covered under part A or B but for the 
 exhaustion of those benefits.
 ``

    (2) Certain costs not included.--
 ``
        (A) Non-covered items and services.--Expenses 
 incurred for items and services which are not included 
 (or treated as being included) under part A or B shall 
 not be considered incurred expenses for purposes of 
 determining out-of-pocket cost-sharing under paragraph

    (1) .
 ``
        (B) Items and services not furnished on an 
 assignment-related basis.--If an item or service is 
 furnished to an individual under this title and is not 
 furnished on an assignment-related basis, any 
 additional expenses the individual incurs above the 
 amount the individual would have incurred if the item 
 or service was furnished on an assignment-related basis 
 shall not be considered incurred expenses for purposes 
 of determining out-of-pocket cost-sharing under 
 paragraph

    (1) .
 ``

    (3) Source of payment.--For purposes of paragraph

    (1) , 
 the Secretary shall consider expenses to be incurred by the 
 individual without regard to whether the individual or another 
 person, including a State program or other third-party 
 coverage, has paid for such expenses.''.

    (b) Elimination of Parts A and B Deductibles.--

    (1) Part a.--

Section 1813

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

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

    (4) For each year (beginning January 1 of the year following the 
date of enactment of the Medicare for All Act), the inpatient hospital 
deductible for the year shall be $0.''.

    (2) Part b.--

Section 1833

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

    (b) ) is amended, in the first sentence--
        (A) by striking ``and for a subsequent year'' and 
 inserting ``for each of 2006 through the year that 
 includes the date of enactment of the Medicare for All 
 Act''; and
        (B) by inserting ``, and $0 for each year 
 subsequent year'' after ``$1)''.

SEC. 1002. REDUCING MEDICARE PART D ANNUAL OUT-OF-POCKET THRESHOLD.

 

Section 1860D-2

    (b)

    (4)
        (B) of the Social Security Act (42 U.S.C. 
1395w-102

    (b)

    (4)
        (B) ) is amended--

    (1) in clause
            (i) , by striking ``For purposes'' and 
 inserting ``Subject to clause
            (iii) , for purposes''; and

    (2) by adding at the end the following new clause:
 ``
            (iii) Reduction in threshold during 
 transition period.--
 ``
            (I) In general.--Subject to 
 subclause
            (II) , for plan years 
 beginning on or after January 1 
 following the date of enactment of the 
 Medicare for All Act and before January 
 1 of the year that is 4 years following 
 such date of enactment, notwithstanding 
 clauses
            (i) and
            (ii) , the `annual out-
 of-pocket threshold' specified in this 
 subparagraph is equal to $300.
 ``
            (II) Authority to exempt brand-
 name drugs if generic available.--In 
 applying subclause
            (I) , the Secretary 
 may exempt costs incurred for a covered 
 part D drug that is an applicable drug 
 under 

section 1860D-14A

    (g)

    (2) if the 
 Secretary determines that a generic 
 version of that drug is available.''.

SEC. 1003. EXPANDING MEDICARE TO COVER DENTAL AND VISION SERVICES AND 
 HEARING AIDS AND EXAMINATIONS UNDER PART B.

    (a) Dental Services.--

    (1) Removal of exclusion from coverage.--

Section 1862

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

    (a) ) is amended by 
 striking paragraph

    (12) .

    (2) Coverage.--
        (A) In general.--

Section 1861

    (s)

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

    (s)

    (2) ) is amended--
            (i) in subparagraph

    (JJ) , by inserting 
 ``and'' at the end; and
            (ii) by adding at the end the following new 
 subparagraph:
 ``

    (KK) dental services;''.
        (B) Payment.--

Section 1833

    (a)

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

    (a)

    (1) ) is amended--
            (i) by striking ``and'' before ``

    (HH) ''; 
 and
            (ii) by inserting before the semicolon at 
 the end the following: ``and
            (II) with respect 
 to dental services described in 

section 1861

    (s)

    (2) (KK) , the amount paid shall be an 
 amount equal to 80 percent of the lesser of the 
 actual charge for the services or the amount 
 determined under the fee schedule established 
 under 

section 1848

    (b) .''.
            (C) Effective date.--The amendments made by this 
 subsection shall apply to items and services furnished 
 on or after January 1 following the date of the 
 enactment of this Act.

    (b) Vision Services.--

    (1) In general.--

Section 1861

    (s)

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

    (s)

    (2) ), as amended by subsection

    (a) , is 
 amended--
        (A) in subparagraph

    (JJ) , by striking ``and'' at 
 the end;
        (B) in subparagraph

    (KK) , by inserting ``and'' at 
 the end; and
            (C) by adding at the end the following new 
 subparagraph:
 ``
            (LL) vision services;''.

    (2) Payment.--

Section 1833

    (a)

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

    (a)

    (1) ), as amended by subsection

    (a) , is 
 amended--
        (A) by striking ``and'' before ``
            (II) ''; and
        (B) by inserting before the semicolon at the end 
 the following: ``, and

    (JJ) with respect to vision 
 services described in 

section 1861

    (s)

    (2)
            (LL) , the 
 amount paid shall be an amount equal to 80 percent of 
 the lesser of the actual charge for the services or the 
 amount determined under the fee schedule established 
 under 

section 1848

    (b) .''.

    (3) Effective date.--The amendments made by this subsection 
 shall apply to items and services furnished on or after January 
 1 following the date of the enactment of this Act.
            (c) Hearing Aids and Examinations Therefor.--

    (1) In general.--

Section 1862

    (a)

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

    (a)

    (7) ) is amended by striking ``hearing 
 aids or examinations therefor,''.

    (2) Effective date.--The amendment made by this subsection 
 shall apply to items and services furnished on or after January 
 1 following the date of the enactment of this Act.

SEC. 1004. 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--
        (A) by striking subsections

    (e)

    (1)
        (B) ,

    (f) , and

    (h) ; and
        (B) by 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 January 1 of the year that is 4 years after such date of 
enactment.

SEC. 1005. GUARANTEED ISSUE OF MEDIGAP POLICIES.

 

Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is 
amended by adding at the end the following new subsection:
 ``

    (aa) Guaranteed Issue for All Medigap-Eligible Medicare 
Beneficiaries.--Notwithstanding paragraphs

    (2)
        (A) and

    (2)
            (D) of 
subsection

    (s) or any other provision of this section, on or after the 
date of enactment of this subsection, the issuer of a Medicare 
supplemental policy may not deny or condition the issuance or 
effectiveness of a Medicare supplemental policy, or discriminate in the 
pricing of the policy, because of health status, claims experience, 
receipt of health care, or medical condition in the case of any 
individual entitled to, or enrolled for, benefits under part A and 
enrolled for benefits under part B.''.

 Subtitle B--Temporary Medicare Buy-In Option and Temporary Public 
 Option

SEC. 1011. LOWERING THE MEDICARE AGE.

    (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
1395c et seq.), as amended by 

section 1001, is amended by adding at the 
end the following new section:

 ``temporary medicare buy-in option for certain individuals

 ``

Sec. 1899D.

    (a) No Effect on Other Benefits for Individuals 
Otherwise Eligible or on Trust Funds.--The Secretary shall implement 
the provisions of this section in such a manner to ensure that such 
provisions--
 ``

    (1) have no effect on the benefits under this title for 
 individuals who are entitled to, or enrolled for, such benefits 
 other than through this section; and
 ``

    (2) have no negative impact on the Federal Hospital 
 Insurance Trust Fund or the Federal Supplementary Medical 
 Insurance Trust Fund (including the Medicare Prescription Drug 
 Account within such Trust Fund).
 ``

    (b) Option.--
 ``

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

    (3) shall be eligible to 
 enroll under this section.
 ``

    (2) Part a, b, and d benefits.--An individual enrolled 
 under this section is entitled to the same benefits (and shall 
 receive the same protections) under this title as an individual 
 who is entitled to benefits under part A and enrolled under 
 parts B and D, including the ability to enroll in a private 
 plan that provides qualified prescription drug coverage.
 ``

    (3) Requirements for eligibility.--The requirements 
 described in this paragraph are the following:
 ``
        (A) The individual is a resident of the United 
 States.
 ``
        (B) The individual is--
 ``
            (i) a citizen or national of the United 
 States; or
 ``
            (ii) an alien lawfully admitted for 
 permanent residence.
 ``
            (C) The individual is not otherwise entitled to 
 benefits under part A or eligible to enroll under part 
 A or part B.
 ``
            (D) The individual has attained the applicable 
 years of age but has not attained 65 years of age.
 ``

    (4) Applicable years of age defined.--For purposes of 
 this section, the term `applicable years of age' means--
 ``
        (A) effective January 1 of the first year 
 following the date of enactment of the Medicare for All 
 Act, the age of 55;
 ``
        (B) effective January 1 of the second year 
 following such date of enactment, the age of 45; and
 ``
            (C) effective January 1 of the third year 
 following such date of enactment, the age of 35.
 ``
            (c) 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.
 ``
            (d) Premium.--
 ``

    (1) Amount of monthly premiums.--The Secretary shall, 
 during September of each year (beginning with the first 
 September following the date of enactment of the Medicare for 
 All Act), determine a monthly premium for all individuals 
 enrolled under this section. Such monthly premium shall be 
 equal to \1/12\ of the annual premium computed under paragraph

    (2)
        (B) , which shall apply with respect to coverage provided 
 under this section for any month in the succeeding year.
 ``

    (2) Annual premium.--
 ``
        (A) Combined per capita average for all medicare 
 benefits.--The Secretary shall estimate the average, 
 annual per capita amount for benefits and 
 administrative expenses that will be payable under 
 parts A, B, and D in the year for all individuals 
 enrolled under this section.
 ``
        (B) Annual premium.--The annual premium under 
 this subsection for months in a year is equal to the 
 average, annual per capita amount estimated under 
 subparagraph
        (A) for the year.
 ``

    (3) Increased premium for complementary plans.--Nothing 
 in this section shall preclude an individual from choosing a 
 prescription drug plan or other complementary plans which 
 requires the individual to pay an additional amount (because of 
 supplemental benefits or because it is a more expensive plan). 
 In such case the individual would be responsible for the 
 increased monthly premium.
 ``

    (e) Payment of Premiums.--
 ``

    (1) In general.--Premiums for enrollment under this 
 section shall be paid to the Secretary at such times, and in 
 such manner, as the Secretary determines appropriate.
 ``

    (2) Deposit.--Amounts collected by the Secretary under 
 this section shall be deposited in the Federal Hospital 
 Insurance Trust Fund and the Federal Supplementary Medical 
 Insurance Trust Fund (including the Medicare Prescription Drug 
 Account within such Trust Fund) in such proportion as the 
 Secretary determines appropriate.
 ``

    (f) Not Eligible for Medicare Cost-Sharing Assistance.--An 
individual enrolled under this section shall not be treated as enrolled 
under any part of this title for purposes of obtaining medical 
assistance for Medicare cost-sharing or otherwise under title XIX.
 ``

    (g) Treatment in Relation to the Affordable Care Act.--
 ``

    (1) 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.
 ``

    (2) Eligibility for premium assistance.--Coverage 
 provided under this section--
 ``
        (A) shall be treated as coverage under a 
 qualified health plan in the individual market enrolled 
 in through the Exchange where the individual resides 
 for all purposes of 

section 36B of the Internal Revenue 
 Code of 1986 other than subsection
            (c) (2)
        (B) thereof; 
 and
 ``
        (B) shall not be treated as eligibility for other 
 minimum essential coverage for purposes of subsection
            (c) (2)
        (B) of such 

section 36B.
 The Secretary shall determine the applicable second lowest cost 
 silver plan which shall apply to coverage under this section 
 for purposes of 

section 36B of such Code.
 ``

    (3) Eligibility for cost-sharing subsidies.--For purposes 
 of applying 

section 1402 of the Patient Protection and 
 Affordable Care Act (42 U.S.C. 18071)--
 ``
        (A) coverage provided under this section shall be 
 treated as coverage under a qualified health plan in 
 the silver level of coverage in the individual market 
 offered through an Exchange; and
 ``
        (B) the Secretary shall be treated as the issuer 
 of such plan.
 ``

    (h) 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. 1012. ESTABLISHMENT OF THE MEDICARE TRANSITION PLAN.

    (a) In General.--To carry out the purpose of this section, for plan 
years beginning with the first plan year that begins after the date of 
enactment of this Act and ending with the date on which benefits are 
first available under 

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, of a public health plan (in 
this Act referred to as the ``Medicare Transition plan'') that provides 
affordable, high-quality health benefits coverage throughout the United 
States.

    (b) Administrating the Medicare Transition.--

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

    (2) Application of aca requirements.--Consistent with this 
 section, the Medicare Transition plan 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 
 plan 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

    (f)

    (2) )) who wish to make such plan available to their 
 employees.

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

    (1) coverage for the benefits required to be covered under 
 title II; 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 plan, the 
 Administrator shall reimburse such providers at rates 
 determined for equivalent items and services under the original 
 Medicare fee-for-service program under parts A and B of title 
 XVIII of the Social Security Act (42 U.S.C. 1395c et seq.). For 
 items and services covered under the Medicare Transition plan 
 but not covered under such parts A and B, the Administrator 
 shall reimburse providers at rates set by the Administrator in 
 a manner consistent with the manner in which rates for other 
 items and services were set under the original Medicare fee-
 for-service program.

    (2) Prescription drugs.--Any payment rate under this 
 subsection for a prescription drug shall be at a rate 
 negotiated by the Administrator with the manufacturer of the 
 drug. If the Administrator is unable to reach a negotiated 
 agreement on such a reimbursement rate, the Administrator shall 
 establish the rate at an amount equal to the lesser of--
        (A) the price paid by the Secretary of Veterans 
 Affairs to procure the drug under the laws administered 
 by the Secretary of Veterans Affairs;
        (B) the price paid to procure the drug under 
 

section 8126 of title 38, United States Code; or
            (C) the best price determined under 

section 1927
            (c) (1)
            (C) of the Social Security Act (42 U.S.C. 
 1396r-8
            (c) (1)
            (C) ) for the drug.

    (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 plan.
        (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 plan. 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 plan, 
 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 plan 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.--The provisions of this section shall cease to 
have force or effect on the date on which benefits are first available 
under 

section 106

    (a) .

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

    (1) Premium assistance tax credits.--
        (A) Credits allowed to medicare transition plan 
 enrollees at or above 44 percent of poverty in non-
 expansion states.--Paragraph

    (1) of 

section 36B
            (c) of 
 the Internal Revenue Code of 1986 is amended by 
 redesignating subparagraphs
            (C) ,
            (D) , and
        (E) as 
 subparagraphs
            (D) ,
        (E) , and
        (F) , respectively, and by 
 inserting after subparagraph
        (B) the following new 
 subparagraph:
 ``
            (C) Special rules for medicare transition plan 
 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 plan 
 established under 

section 1012

    (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'. The preceding sentence shall not 
 apply to any taxable year to which subparagraph
        (E) applies.
 ``
            (ii) Enrollees in medicaid non-expansion 
 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 plan established under 
 

section 1012

    (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 plan.--
            (i) In general.--Subparagraph
        (A) of 
 

section 36B

    (b)

    (3) of such Code is amended--
            (I) by redesignating clauses
            (ii) and
            (iii) as clauses
            (iii) and
            (iv) , 
 respectively;
            (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 plan.--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 plan 
 established under 

section 1012

    (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 poverty The initial The final
 line) within the following income premium premium
 tier: percentage is-- percentage is--
------------------------------------------------------------------------
 Up to 100 percent 2 2
 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.
------------------------------------------------------------------------

 The preceding sentence shall not apply to any 
 taxable year to which clause
            (iv) applies.''.
            (ii) Conforming amendments.--
            (I) Subclause
            (I) of clause
            (iii) of 

section 36B

    (b)

    (3)
        (A) 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''.
            (II) Section 36B

    (b)

    (3)
        (A)
            (iv) 
            (I) of 
 such Code, as redesignated by 
 subparagraph
        (A)
            (i) , is amended by 
 striking ``clause
            (ii) '' and inserting 
 ``clause
            (iii) ''.

    (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 
 plan established under 

section 1012

    (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 plan 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 
 plan, subparagraph
        (A) , 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.
 ``
            (C) Adjusted cost-sharing for medicare transition 
 plan enrollees.--In the case of any individual who 
 enrolls in such Medicare Transition plan, in lieu of 
 the percentages under subsection
            (c) (1)
        (B)
            (i) and
            (c) (2) , the Secretary shall prescribe a method of 
 determining the cost-sharing reduction for any such 
 individual such that the total of the cost-sharing and 
 the premiums paid by the individual under such Medicare 
 Transition plan does not exceed the percentage of the 
 total allowed costs of benefits provided under the plan 
 equal to the final premium percentage applicable to 
 such individual under 

section 36B

    (b)

    (3)
        (A)
            (ii) of the 
 Internal Revenue Code of 1986.''.

    (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 plan,'' before ``and''; and
        (B) by inserting ``the Medicare Transition plan 
 under 

section 1012 of the Medicare for All Act,'' 
 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 plan under 
 

section 1012 of the Medicare for All Act,'' before ``or a 
 multi-State qualified health plan''.

 Subtitle C--Patient Protections During Medicare for All Transition 
 Period

SEC. 1021. MINIMIZING DISRUPTIONS TO PATIENT CARE.

 The Secretary shall ensure that all individuals enrolled in, or who 
seek to enroll in, a group health plan, health insurance coverage 
offered by a health insurance issuer, or the plan established under 

section 1012 during the transition period of this Act are protected 
from disruptions in their care during the transition period.

SEC. 1022. PUBLIC CONSULTATION.

 The Secretary shall consult with communities and advocacy 
organizations of individuals living with disabilities and other patient 
advocacy organizations to ensure the transition described in 

section 1021 takes into account the safety and continuity of care for 
individuals with disabilities, complex medical needs, or chronic 
conditions.

SEC. 1023. DEFINITIONS.

 In this subtitle, the terms ``health insurance coverage'', ``health 
insurance issuer'', and ``group health plan'' have the meanings given 
such terms in 

section 2791 of the Public Health Service Act (42 U.S.C. 
300gg-91).

 TITLE XI--MISCELLANEOUS

SEC. 1101. UPDATING RESOURCE LIMITS FOR SUPPLEMENTAL SECURITY INCOME 
 ELIGIBILITY

    (SSI) .

 

Section 1611

    (a)

    (3) of the Social Security Act (42 U.S.C. 
1382

    (a)

    (3) ) is amended--

    (1) in subparagraph
        (A) --
        (A) by striking ``and'' after ``January 1, 1988,''; 
 and
        (B) by inserting ``, and to $6,200 on January 1, 
 2025'' before the period;

    (2) in subparagraph
        (B) --
        (A) by striking ``and'' after ``January 1, 1988,''; 
 and
        (B) by inserting ``, and to $4,100 on January 1, 
 2025'' before the period; and

    (3) by adding at the end the following new subparagraph:
 ``
            (C) Beginning with December of 2025, whenever the dollar 
 amounts in effect under paragraphs

    (1)
        (A) and

    (2)
        (A) of this 
 subsection are increased for a month by a percentage under 
 

section 1617

    (a)

    (2) , each of the dollar amounts in effect under 
 this paragraph shall be increased, effective with such month, 
 by the same percentage (and rounded, if not a multiple of $10, 
 to the closest multiple of $10). Each increase under this 
 subparagraph shall be based on the unrounded amount for the 
 prior 12-month period.''.

SEC. 1102. DEFINITIONS.

 In this Act--

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

    (2) the term ``State'' means any of the 50 States, the 
 District of Columbia, or a territory of the United States; and

    (3) the term ``United States'' shall include the 50 States, 
 the District of Columbia, and the territories of the United 
 States.
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