II 

113TH CONGRESS 

1ST SESSION S. 1469 

To provide higher-quality, lower-cost health care to seniors. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 1, 2013 

Mr. PAUL introduced the following bill; which was read twice and referred to 

the Committee on Finance 

A BILL 

To provide higher-quality, lower-cost health care to seniors. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Congressional Health 

5 Care for Seniors Act of 2013’’. 

6 SEC. 2. ENROLLING SENIORS IN THE SAME HEALTH CARE 

7 PLANS AS MEMBERS OF CONGRESS. 

8 (a) IN GENERAL.—Chapter 89 of title 5, United 

9 States Code, is amended— 

10 (1) in section 8901— 

11 (A) in paragraph (10), by striking ‘‘and’’ 

12 at the end; 


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1 (B) in paragraph (11), by striking the pe2 riod at the end and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following: 

4 ‘‘(12) the term ‘covered individual’ means an 

5 individual who, taking into account section 226(k) of 

6 the Social Security Act, would have been entitled to, 

7 or could have enrolled for, benefits under part A of 

8 title XVIII of such Act or could have enrolled under 

9 part B of such title if section 1899B had not been 

10 enacted.’’; 

11 (2) by inserting after section 8901 the fol12 lowing: 

13 ‘‘SUBCHAPTER I—FEDERAL EMPLOYEES’’; 

14 (3) in section 8902— 

15 (A) in subsection (a)— 

16 (i) by inserting ‘‘(1)’’ after ‘‘(a)’’; and 

17 (ii) by adding at the end the fol18 lowing: 

19 ‘‘(2)(A) In this paragraph, the term ‘equivalent 

20 health benefits plan’ means a health benefits plan pro21 posed to be provided that offers benefits that the Director 

22 of the Office of Personnel Management determines are 

23 substantially equivalent or superior to benefits offered 

24 under, and does not impose requirements that are sub25 stantially different than requirements under, a health benVerDate Mar 15 2010 02:32 Aug 09, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1469.IS S1469

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1 efits plan in which an employee could enroll on the date 

2 of enactment of the Congressional Health Care for Seniors 

3 Act of 2013 if the employee resided— 

4 ‘‘(i) anywhere in the United States; or 

5 ‘‘(ii) in the same region of the United States as 

6 the health benefits plan proposed to be provided. 

7 ‘‘(B) For contract years beginning on or after Janu8 ary 1, 2015, if a carrier offers to provide an equivalent 

9 health benefits plan, the Director shall enter into a con10 tract with the carrier to provide the equivalent health ben11 efits plan.’’; 

12 (B) in subsection (e), by striking ‘‘The Of13 fice may prescribe’’ and inserting ‘‘Subject to 

14 subsection (a)(2), the Office may prescribe’’; 

15 and 

16 (C) by adding at the end the following: 

17 ‘‘(p) A contract under this chapter for a contract year 

18 beginning on or after January 1, 2015, shall offer benefits 

19 for employees, annuitants, members of their families, 

20 former spouses, persons having continued coverage under 

21 section 8905a of this title, and covered individuals. In ad22 ministering this subchapter and subchapter II, employees, 

23 annuitants, members of their families, former spouses, 

24 persons having continued coverage under section 8905a of 


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1 this title, and covered individuals shall be in the same risk 

2 pool.’’; 

3 (4) in section 8904— 

4 (A) by striking ‘‘(a) The benefits’’ and in5 serting ‘‘The benefits’’; 

6 (B) by striking ‘‘this subsection’’ each 

7 place it appears and inserting ‘‘this section’’; 

8 and 

9 (C) by striking subsection (b); 

10 (5) in section 8909(a)(1), by inserting ‘‘and for 

11 all payments under section 8921(d)’’ before the 

12 semicolon; 

13 (6) in section 8910, by striking subsection (d); 

14 and 

15 (7) by adding at the end the following: 

16 ‘‘SUBCHAPTER II—COVERED INDIVIDUALS 

17 ‘‘§ 8921. Health insurance for covered individuals 

18 ‘‘(a) For contract years beginning on or after Janu19 ary 1, 2015, and except as otherwise provided in this sub20 chapter, the Director of the Office of Personnel Manage21 ment shall ensure that to the greatest extent possible 

22 health benefits plans provide benefits for covered individ23 uals to the same extent and in the same manner as pro24 vided under subchapter I for employees, annuitants, memVerDate Mar 15 2010 02:32 Aug 09, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1469.IS S1469

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1 bers of their families, former spouses, and persons having 

2 continued coverage under section 8905a of this title. 

3 ‘‘(b)(1) The Director shall establish the deadline by 

4 which a covered individual shall elect to— 

5 ‘‘(A) enroll in a health benefits plan under this 

6 chapter based on the status of the individual as a 

7 covered individual; 

8 ‘‘(B) with the concurrence of the employer or 

9 former employer of the covered individual, receive 

10 payments under subsection (d) to assist in paying 

11 for health insurance provided through the employer 

12 or former employer of the covered individual; or 

13 ‘‘(C) not enroll in a health benefits plan or re14 ceive payments under this chapter. 

15 ‘‘(2) Failure to make a timely election under this sub16 section shall be deemed as an election to not enroll in a 

17 health benefits plan or receive payment under this chapter. 

18 ‘‘(3) A covered individual— 

19 ‘‘(A) may elect to enroll in a health benefits 

20 plan as an individual; and 

21 ‘‘(B) may not enroll in a health benefits plan 

22 for self and family. 

23 ‘‘(4)(A) A covered individual who elects not to enroll, 

24 or who elects not to continue enrollment, in a health bene25 fits plan under this chapter (including a covered individual 


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1 who elects to receive payments under subsection (d)) may 

2 subsequently enroll in a health benefits plan under this 

3 chapter based on the status of the covered individual as 

4 a covered individual in accordance with such procedures, 

5 and after paying such fees, as the Director of the Office 

6 of Personnel Management may establish. 

7 ‘‘(B) The fact that a covered individual elects not to 

8 enroll, or elects not to continue enrollment, in a health 

9 benefits plan under this chapter shall not affect the eligi10 bility of the covered individual for benefits under title II 

11 of the Social Security Act (42 U.S.C. 401 et seq.). 

12 ‘‘(c)(1)(A) A covered individual who elects to enroll 

13 in a health benefits plan under this chapter based on the 

14 status of the covered individual as a covered individual 

15 shall pay a monthly individual premium payment deter16 mined in accordance with subparagraph (B). 

17 ‘‘(B) The individual premium payment under sub18 paragraph (A) shall be determined based on income, as 

19 follows: 

20 ‘‘(i) For an individual with an adjusted gross 

21 income (as defined under section 62 of the Internal 

22 Revenue Code of 1986) of not more than $85,000, 

23 the individual premium payment shall be in an 

24 amount equal to the employee contribution for the 


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1 health benefits plan, as determined under section 

2 8906. 

3 ‘‘(ii) For an individual with an adjusted gross 

4 income of more than $85,000 and not more than 

5 $107,000, the individual premium payment shall be 

6 in an amount equal to the sum of— 

7 ‘‘(I) the employee contribution for the 

8 health benefits plan, as determined under sec9 tion 8906; and 

10 ‘‘(II) the product obtained by multi11 plying— 

12 ‘‘(aa) the Government contribution 

13 (as determined under section 8906(b)); by 

14 ‘‘(bb) 0.05. 

15 ‘‘(iii) For an individual with an adjusted gross 

16 income of more than $107,000 and not more than 

17 $160,000, the individual premium payment shall be 

18 in an amount equal to the sum of— 

19 ‘‘(I) the employee contribution for the 

20 health benefits plan, as determined under sec21 tion 8906; and 

22 ‘‘(II) the product obtained by multi23 plying— 

24 ‘‘(aa) the Government contribution 

25 (as determined under section 8906(b)); by 


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1 ‘‘(bb) 0.1. 

2 ‘‘(iv) For an individual with an adjusted gross 

3 income of more than $160,000 and not more than 

4 $250,000, the individual premium payment shall be 

5 in an amount equal to the sum of— 

6 ‘‘(I) the employee contribution for the 

7 health benefits plan, as determined under sec8 tion 8906; and 

9 ‘‘(II) the product obtained by multi10 plying— 

11 ‘‘(aa) the Government contribution 

12 (as determined under section 8906(b)); by 

13 ‘‘(bb) 0.15. 

14 ‘‘(v) For an individual with an adjusted gross 

15 income of more than $250,000 and not more than 

16 $1,000,000, the individual premium payment shall 

17 be in an amount equal to the sum of— 

18 ‘‘(I) the employee contribution for the 

19 health benefits plan, as determined under sec20 tion 8906; and 

21 ‘‘(II) the product obtained by multi22 plying— 

23 ‘‘(aa) the Government contribution 

24 (as determined under section 8906(b)); by 

25 ‘‘(bb) 0.5. 


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1 ‘‘(vi) For an individual with an adjusted gross 

2 income of more than $1,000,000, the individual pre3 mium payment shall be in an amount equal to the 

4 sum of— 

5 ‘‘(I) the employee contribution for the 

6 health benefits plan, as determined under sec7 tion 8906; and 

8 ‘‘(II) the Government contribution (as de9 termined under section 8906(b)). 

10 ‘‘(C) The Director of the Office of Personnel Manage11 ment shall adjust the income amounts under subpara12 graph (B) annually to reflect changes in the Consumer 

13 Price Index for all Urban Consumers published by the De14 partment of Labor. 

15 ‘‘(2)(A) For a covered individual who is entitled to 

16 monthly benefits under section 202 or 223 of the Social 

17 Security Act (42 U.S.C. 402 and 423), the monthly pre18 miums of the covered individual under this subchapter 

19 shall (except as provided in subparagraph (B) or (C)) be 

20 collected by deducting the amount of the premium from 

21 the amount of such monthly benefits. 

22 ‘‘(B) For a covered individual who is entitled to re23 ceive for a month an annuity under the Railroad Retire24 ment Act of 1974 (whether or not the covered individual 

25 is also entitled for such month to a monthly insurance benVerDate Mar 15 2010 02:32 Aug 09, 2013 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1469.IS S1469

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1 efit under section 202 of the Social Security Act (42 

2 U.S.C. 402)), the monthly premiums of the covered indi3 vidual under this subchapter shall (except as provided in 

4 subparagraph (C)) be collected by deducting the amount 

5 thereof from such annuity or pension. 

6 ‘‘(C) If a covered individual to whom subparagraph 

7 (A) or (B) applies estimates that the amount which will 

8 be available for deduction under such subparagraph for 

9 any premium payment period will be less than the amount 

10 of the monthly premiums for such period, the covered indi11 vidual may pay to the Director of the Office of Personnel 

12 Management such portion of the monthly premiums for 

13 such period as the covered individual desires. 

14 ‘‘(D) For a covered individual who is not described 

15 in subparagraph (A) or (B) and who elects to enroll in 

16 a health benefits plan under this chapter, or with respect 

17 to whom subparagraph (C) applies, the covered individual 

18 shall pay monthly premiums to the Director of the Office 

19 of Personnel Management at such times, and in such man20 ner, as the Director shall by regulations prescribe. 

21 ‘‘(E) Amounts deducted or paid under this paragraph 

22 shall be deposited in the Treasury to the credit of the Em23 ployees Health Benefits Fund established under section 

24 8909. 


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1 ‘‘(F) After consultation with the Director of the Of2 fice of Personnel Management, the Secretary of Health 

3 and Human Services shall establish procedures for making 

4 and depositing deductions under this paragraph. 

5 ‘‘(3) The Director of the Office of Personnel Manage6 ment shall establish procedures for terminating the enroll7 ment of a covered individual in a health benefits plan if 

8 the covered individual fails to make timely payment of pre9 miums, which shall allow such a covered individual to re10 enroll in a health benefits plan under such terms and con11 ditions as the Director may prescribe. 

12 ‘‘(d) The Director of the Office of Personnel Manage13 ment shall make periodic payments to the employer or 

14 former employer providing health insurance to a covered 

15 individual who makes an election under subsection 

16 (b)(1)(B) in a total amount not to exceed the lesser of— 

17 ‘‘(1) the cost to the employer or former em18 ployer of providing health insurance to the covered 

19 individual; and 

20 ‘‘(2) the average Government contribution for 

21 an individual enrolled in a health benefits plan under 

22 this chapter that is available to individuals residing 

23 anywhere in the United States. 

24 ‘‘(e) For fiscal year 2015 and each fiscal year there25 after, there are appropriated to the Employees Health 


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1 Benefits Fund established under section 8909, out of any 

2 funds in the Treasury not otherwise appropriated— 

3 ‘‘(1) an amount equal to— 

4 ‘‘(A) the taxes imposed by sections 

5 3101(b) and 3111(b) of the Internal Revenue 

6 Code of 1986 with respect to wages reported to 

7 the Secretary of the Treasury pursuant to sub8 title F of such Code after December 31, 2014, 

9 as determined by the Secretary of the Treasury 

10 by applying the applicable rates of tax under 

11 such sections to such wages, which wages shall 

12 be certified by the Commissioner of Social Se13 curity on the basis of records of wages estab14 lished and maintained by the Commissioner of 

15 Social Security in accordance with such reports; 

16 ‘‘(B) the taxes imposed by section 1401(b) 

17 of the Internal Revenue Code of 1986 with re18 spect to self-employment income reported to the 

19 Secretary of the Treasury on tax returns under 

20 subtitle F of such Code, as determined by the 

21 Secretary of the Treasury by applying the ap22 plicable rate of tax under such section to such 

23 self-employment income, which self-employment 

24 income shall be certified by the Commissioner 

25 of Social Security on the basis of records of 


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1 self-employment established and maintained by 

2 the Commissioner of Social Security in accord3 ance with such returns; and 

4 ‘‘(C) any amounts that, on or after Janu5 ary 1, 2015, are to be deposited in the Federal 

6 Hospital Insurance Trust Fund established 

7 under section 1817 of the Social Security Act 

8 (42 U.S.C. 1395i) under any other provision of 

9 law; and 

10 ‘‘(2) a Government contribution equal to the 

11 difference obtained by subtracting— 

12 ‘‘(A) the sum of— 

13 ‘‘(i) the total amount of premiums 

14 paid by covered individuals under sub15 section (c)(2) for the fiscal year; and 

16 ‘‘(ii) the amount appropriated under 

17 paragraph (1); from 

18 ‘‘(B) the sum of— 

19 ‘‘(i) the total cost for the fiscal year 

20 of subscription charges for health benefits 

21 plans for covered individuals enrolled in a 

22 health benefits plan based on the status of 

23 the covered individuals as covered individ24 uals; and 


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1 ‘‘(ii) the total amount of payments for 

2 the fiscal year under subsection (d). 

3 ‘‘(f) The Director of the Office of Personnel Manage4 ment shall establish, in consultation with the Secretary of 

5 Health and Human Services acting through the Adminis6 trator of the Centers for Medicare & Medicaid Services, 

7 procedures to ensure that health benefits plans coordinate 

8 with State Medicaid programs with respect to the provi9 sion of cost-sharing and other medical assistance for cov10 ered individuals enrolled in health benefit plans who are 

11 also eligible for medical assistance and enrolled in a State 

12 Medicaid program. 

13 ‘‘SUBCHAPTER III—COVERAGE OF HIGH RISK 

14 INDIVIDUALS 

15 ‘‘§ 8941. Reimbursement of costs for high risk individ16 uals 

17 ‘‘(a) In this section, the term ‘high risk individual’ 

18 means an individual identified under subsection (b)(1). 

19 ‘‘(b) After the end of each contract year beginning 

20 on or after January 1, 2015, the Director of the Office 

21 of Personnel Management shall— 

22 ‘‘(1) identify, for the contract year, individuals 

23 who— 

24 ‘‘(A) enrolled in a health benefits plan 

25 under this chapter for a contract year; and 


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1 ‘‘(B) who, of all individuals enrolled in a 

2 health benefits plan under this chapter for the 

3 contract year, are in the highest 5 percent in 

4 terms of benefits paid by a carrier under a 

5 health benefits plan relating to the contract 

6 year; and 

7 ‘‘(2) pay to a carrier contracting to provide a 

8 health benefits plan to a high risk individual for the 

9 contract year 90 percent of the benefits paid by the 

10 carrier relating to the high risk individual. 

11 ‘‘(c)(1) For fiscal year 2015 and each fiscal year 

12 thereafter, there are appropriated to the Director of the 

13 Office of Personnel Management from the Federal Hos14 pital Insurance Trust Fund established under section 

15 1817 of the Social Security Act (42 U.S.C. 1395i) such 

16 sums as are necessary to carry out this section. 

17 ‘‘(2) If the amounts appropriated under paragraph 

18 (1) are insufficient to carry out this section, for fiscal year 

19 2015 and each fiscal year thereafter, there are appro20 priated to the Director of the Office of Personnel Manage21 ment, out of any funds in the Treasury not otherwise ap22 propriated, such sums as are necessary to carry out this 

23 section.’’. 

24 (b) EXEMPTION FROM INSURANCE REQUIRE25 MENTS.— 


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1 (1) AMENDMENT TO TITLE 5.—Chapter 89 of 

2 title 5, United States Code, is amended by inserting 

3 after section 8901 the following: 

4 ‘‘§ 8901A. Exemption from insurance requirements 

5 ‘‘Title I of the Patient Protection and Affordable 

6 Care Act, subtitle A of title X of such Act, and the amend7 ments made by such title I and subtitle A shall not apply 

8 to health benefits plans.’’. 

9 (2) CONFORMING AMENDMENT.—Section 2709 

10 of the Public Health Service Act (42 U.S.C. 300gg– 

11 8) (as added by section 10103 of the Patient Protec12 tion and Affordable Care Act) is amended— 

13 (A) by striking subsection (g); and 

14 (B) by redesignating subsection (h) as sub15 section (g). 

16 (c) TECHNICAL AND CONFORMING AMENDMENTS.— 

17 Chapter 89 of title 5, United States Code, is amended— 

18 (1) in the table of sections— 

19 (A) by inserting after the item relating to 

20 section 8901 the following: 

‘‘8901A. Exemption from insurance requirements. 

‘‘SUBCHAPTER I—FEDERAL EMPLOYEES’’; 

21 and 

22 (B) by adding at the end the following: 

‘‘SUBCHAPTER II—COVERED INDIVIDUALS

‘‘8921. Health insurance for covered individuals. 


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‘‘SUBCHAPTER III—COVERAGE OF HIGH RISK INDIVIDUALS

‘‘8941. Reimbursement of costs for high risk individuals.’’; 

1 (2) in section 8902a(d)(1)— 

2 (A) in subparagraph (A), by adding ‘‘or’’ 

3 at the end; 

4 (B) by striking subparagraph (B); and 

5 (C) by redesignating subparagraph (C) as 

6 subparagraph (B); and 

7 (3) by striking section 8910(d). 

8 (d) EFFECTIVE DATE; APPLICABILITY.—The amend9 ments made by this section shall take effect on the date 

10 of enactment of this Act and apply on and after January 

11 1, 2015. 

12 SEC. 3. TRANSITIONING MEDICARE PATIENTS TO COV13 ERAGE UNDER THE FEDERAL EMPLOYEES 

14 HEALTH BENEFITS PROGRAM. 

15 (a) INCREASE IN MEDICARE ELIGIBILITY AGE.—Sec16 tion 226 of the Social Security Act (42 U.S.C. 426) is 

17 amended by adding at the end the following new sub18 section: 

19 ‘‘(k) INCREASING MEDICARE QUALIFYING AGE.— 

20 ‘‘(1) IN GENERAL.—Notwithstanding any other 

21 provision of law, any reference in this section, title 

22 XVIII, or title XIX (insofar as it relates to the eligi23 bility age for Medicare benefits under title XVIII) to 


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1 ‘age 65’ shall be deemed a reference to the Medicare 

2 qualifying age specified in paragraph (2). 

3 ‘‘(2) MEDICARE QUALIFYING AGE SPECIFIED.— 

4 The Medicare qualifying age specified in this para5 graph is determined as follows: 

6 ‘‘(A) In the case of an individual who at7 tains 65 years of age before January 1, 2015, 

8 the Medicare qualifying age is 65 years of age. 

9 ‘‘(B) In the case of an individual who at10 tains 65 years of age in a year after 2014, and 

11 before 2035, the Medicare qualifying age is the 

12 Medicare qualifying age specified in this para13 graph for the previous year increased by 3 

14 months. 

15 ‘‘(C) In the case of an individual who at16 tains 65 years of age in a year after 2034, the 

17 Medicare qualifying age is 70 years of age plus 

18 the number of months in the age increase factor 

19 (as determined under paragraph (3)). 

20 ‘‘(3) AGE INCREASE FACTOR.—The Commis21 sioner of Social Security shall determine (using rea22 sonable actuarial assumptions) and publish on or be23 fore November 1 of each calendar year after 2033 

24 the number of months (rounded, if not a multiple of 

25 one month, to the next lower multiple of one month) 


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1 by which life expectancy as of October 1 of such cal2 endar year of an individual attaining age 65 on such 

3 October 1 exceeds the life expectancy as of October 

4 1, 2034, of an individual attaining age 65 on Octo5 ber 1, 2034. With respect to an individual who at6 tains age 65 in the calendar year following any cal7 endar year in which a determination is made under 

8 this paragraph, the age increase factor shall be the 

9 number of months determined under this paragraph 

10 as of October 1 of such calendar year in which such 

11 determination is made.’’. 

12 (b) SUNSET.—Title XVIII of the Social Security Act 

13 (42 U.S.C. 1395 et seq.) is amended by adding at the end 

14 the following new section: 

15 ‘‘SUNSET OF MEDICARE PROGRAM WITH TRANSITION TO

16 COVERAGE UNDER THE FEDERAL EMPLOYEES

17 HEALTH BENEFITS PROGRAM

18 ‘‘SEC. 1899B. Notwithstanding any other provision 

19 of law, on and after January 1, 2015, the following rules 

20 shall apply: 

21 ‘‘(1) The preceding provisions of this title shall 

22 not apply. 

23 ‘‘(2) No payments for items and services fur24 nished under this title after such date shall be made. 

25 No additional, bonus, or incentive payments under 


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1 this title, such as graduate medical education pay2 ments, may be made. 

3 ‘‘(3) Payments for items and services furnished 

4 under this title prior to such date shall be made in 

5 the same manner as if this section had not been en6 acted. 

7 ‘‘(4) All Medicare supplemental policies under 

8 section 1882 are terminated. 

9 ‘‘(5) All demonstration projects conducted 

10 under this title are terminated. 

11 ‘‘(6) Entitlement to health benefits for individ12 uals who, but for this section (and taking into ac13 count section 226(k)), would have been entitled to, 

14 or could have enrolled for, benefits under part A or 

15 could have enrolled under part B shall be through 

16 enrollment in a health benefits plan under chapter 

17 89 of title 5, United States Code. 

18 ‘‘(7) At a date determined appropriate by the 

19 Secretary (after payments described in paragraph 

20 (3) have been made), amounts in the Federal Hos21 pital Insurance Trust Fund and the Federal Supple22 mentary Medical Insurance Trust Fund (including 

23 the Medicare Prescription Drug Account within such 

24 Trust Fund) shall be transferred to the Employees 


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1 Health Benefits Fund established under section 

2 8909 of chapter 5, United States Code. 

3 ‘‘(8) Any determination under Federal law 

4 (other than this title and title II) relating to Medi5 care eligibility shall be made based on whether an 

6 individual is a covered individual, as defined in sec7 tion 8901 of title 5, United States Code.’’. 

8 (c) CONFORMING AMENDMENT.—(1) Section 226 of 

9 the Social Security Act (42 U.S.C. 426), as amended by 

10 subsection (a), is amended by adding at the end the fol11 lowing new subsection: 

12 ‘‘(l) Notwithstanding the preceding provisions of this 

13 section, on and after January 1, 2015, entitlement to 

14 health benefits to individuals who, but for this subsection 

15 and section 1899B, would have been entitled to benefits 

16 under part A and eligible to enroll under part B of title 

17 XVIII pursuant to this section shall be through enrollment 

18 in a health benefits plan under chapter 89 of title 5, 

19 United States Code, rather than under title XVIII of this 

20 Act.’’. 

21 (2) Section 226A of the Social Security Act (42 

22 U.S.C. 426) is amended by adding at the end the following 

23 new subsection: 

24 ‘‘(d) Notwithstanding the preceding provisions of this 

25 section, on and after January 1, 2015, entitlement to 


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1 health benefits to individuals who, but for this subsection 

2 and section 1899B, would have been entitled to benefits 

3 under part A and eligible to enroll under part B of title 

4 XVIII pursuant to this section shall be through enrollment 

5 in a health benefits plan under chapter 89 of title 5, 

6 United States Code, rather than under title XVIII of this 

7 Act.’’. 

8 (d) RECOMMENDATIONS TO STATES.—Not later than 

9 1 year after the date of the enactment of this Act, the 

10 Secretary of Health and Human Services shall make avail11 able to States recommendations with respect to require12 ments for health care entities and individuals under the 

13 Medicare program that, by reason of section 1899B of the 

14 Social Security Act, as added by subsection (b), will no 

15 longer apply but that should be considered on the State 

16 level. 

Æ 


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