II 

115TH CONGRESS 

1ST SESSION S. 1804 

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

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 13, 2017 

Mr. SANDERS (for himself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, 

Mr. FRANKEN, Mrs. GILLIBRAND, Ms. HARRIS, Mr. HEINRICH, Ms. 

HIRONO, Mr. LEAHY, Mr. MARKEY, Mr. MERKLEY, Mr. SCHATZ, Mrs. 

SHAHEEN, Mr. UDALL, Ms. WARREN, 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. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare for All Act of 2017’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—ESTABLISHMENT OF THE UNIVERSAL MEDICARE 

PROGRAM; UNIVERSAL ENTITLEMENT; ENROLLMENT 


ethrower on DSK3G9T082PROD with BILLS
2 

•S 1804 IS

Sec. 101. Establishment of the Universal Medicare Program. 

Sec. 102. Universal entitlement. 

Sec. 103. Freedom of choice. 

Sec. 104. Non-discrimination. 

Sec. 105. Enrollment. 

Sec. 106. Effective date of benefits. 

Sec. 107. Prohibition against duplicating coverage. 

TITLE II—COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE 

BENEFITS AND BENEFITS FOR LONG-TERM CARE 

Sec. 201. Comprehensive benefits. 

Sec. 202. No cost-sharing. 

Sec. 203. Exclusions and limitations. 

Sec. 204. Coverage of long-term care services under Medicaid. 

Sec. 205. State standards. 

TITLE III—PROVIDER PARTICIPATION 

Sec. 301. Provider participation and standards. 

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. Complementary conduct of related health programs. 

Subtitle B—Control Over Fraud and Abuse 

Sec. 411. Application of Federal sanctions to all fraud and abuse under Universal Medicare Program. 

TITLE V—QUALITY ASSESSMENT 

Sec. 501. Quality standards. 

Sec. 502. Addressing health care disparities. 

TITLE VI—HEALTH BUDGET; PAYMENTS; COST CONTAINMENT 

MEASURES 

Subtitle A—Budgeting 

Sec. 601. National health budget. 

Subtitle B—Payments to Providers 

Sec. 611. Payments to institutional and individual providers. 

Sec. 612. Ensuring accurate valuation of services under the Medicare physician 

fee schedule. 

Sec. 613. Office of primary health care. 

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


ethrower on DSK3G9T082PROD with BILLS
3 

•S 1804 IS

TITLE VII—UNIVERSAL MEDICARE TRUST FUND 

Sec. 701. Universal Medicare Trust Fund. 

TITLE VIII—CONFORMING AMENDMENTS TO THE EMPLOYEE 

RETIREMENT INCOME SECURITY ACT OF 1974 

Sec. 801. Prohibition of employee benefits duplicative of benefits under the 

Universal Medicare 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 State Exchanges. 

TITLE X—TRANSITION 

Subtitle A—Transitional Medicare Buy-In Option and Transitional Public 

Option 

Sec. 1001. Lowering the Medicare age. 

Sec. 1002. Establishment of the Medicare transition plan. 

Subtitle B—Transitional Medicare Reforms 

Sec. 1011. Medicare protection against high out-of-pocket expenditures for feefor-service benefits and elimination of parts A and B 

deductibles. 

Sec. 1012. Reduction in Medicare part D annual out-of-pocket threshold and 

elimination of cost-sharing above that threshold. 

Sec. 1013. Coverage of dental and vision services and hearing aids and examinations under Medicare part B. 

Sec. 1014. Eliminating the 24-month waiting period for Medicare coverage for 

individuals with disabilities. 

TITLE XI—MISCELLANEOUS 

Sec. 1101. Definitions. 


ethrower on DSK3G9T082PROD with BILLS
4 

•S 1804 IS

1 TITLE I—ESTABLISHMENT OF 

2 THE UNIVERSAL MEDICARE 

3 PROGRAM; UNIVERSAL ENTI4 TLEMENT; ENROLLMENT 

5 SEC. 101. ESTABLISHMENT OF THE UNIVERSAL MEDICARE 

6 PROGRAM. 

7 There is hereby established a national health insur8 ance program to provide comprehensive protection against 

9 the costs of health care and health-related services, in ac10 cordance with the standards specified in, or established 

11 under, this Act. 

12 SEC. 102. UNIVERSAL ENTITLEMENT. 

13 (a) IN GENERAL.—Every individual who is a resident 

14 of the United States is entitled to benefits for health care 

15 services under this Act. The Secretary shall promulgate 

16 a rule that provides criteria for determining residency for 

17 eligibility purposes under this Act. 

18 (b) TREATMENT OF OTHER INDIVIDUALS.—The Sec19 retary may make eligible for benefits for health care serv20 ices under this Act other individuals not described in sub21 section (a), and regulate the nature of eligibility of such 

22 individuals, while inhibiting travel and immigration to the 

23 United States for the sole purpose of obtaining health care 

24 services. 


ethrower on DSK3G9T082PROD with BILLS
5 

•S 1804 IS

1 SEC. 103. FREEDOM OF CHOICE. 

2 Any individual entitled to benefits under this Act may 

3 obtain health services from any institution, agency, or in4 dividual qualified to participate under this Act. 

5 SEC. 104. NON-DISCRIMINATION. 

6 (a) IN GENERAL.—No person shall, on the basis of 

7 race, color, national origin, age, disability, or sex, includ8 ing sex stereotyping, gender identity, sexual orientation, 

9 and pregnancy and related medical conditions (including 

10 termination of pregnancy), be excluded from participation 

11 in, be denied the benefits of, or be subjected to discrimina12 tion by any participating provider as defined in section 

13 301, or any entity conducting, administering, or funding 

14 a health program or activity, including contracts of insur15 ance, pursuant to this Act. 

16 (b) CLAIMS OF DISCRIMINATION.— 

17 (1) IN GENERAL.—The Secretary shall establish 

18 a procedure for adjudication of administrative com19 plaints alleging a violation of subsection (a). 

20 (2) JURISDICTION.—Any person aggrieved by a 

21 violation of subsection (a) by a covered entity may 

22 file suit in any district court of the United States 

23 having jurisdiction of the parties. 

24 (3) DAMAGES.—If the court finds a violation of 

25 subsection (a), the court may grant compensatory 

26 and punitive damages, declaratory relief, injunctive 


ethrower on DSK3G9T082PROD with BILLS
6 

•S 1804 IS

1 relief, attorneys’ fees and costs, or other relief as ap2 propriate. 

3 SEC. 105. ENROLLMENT. 

4 (a) IN GENERAL.—The Secretary shall provide a 

5 mechanism for the enrollment of individuals eligible for 

6 benefits under this Act. The mechanism shall— 

7 (1) include a process for the automatic enroll8 ment of individuals at the time of birth in the 

9 United States and at the time of immigration into 

10 the United States or other acquisition of qualified 

11 resident status in the United States; 

12 (2) provide for the enrollment, as of the date 

13 described in section 106, of all individuals who are 

14 eligible to be enrolled as of such date; and 

15 (3) include a process for the enrollment of indi16 viduals made eligible for health care services under 

17 section 102(b). 

18 (b) ISSUANCE OF UNIVERSAL MEDICARE CARDS.— 

19 In conjunction with an individual’s enrollment for benefits 

20 under this Act, the Secretary shall provide for the issuance 

21 of a Universal Medicare card that shall be used for pur22 poses of identification and processing of claims for bene23 fits under this program. The card shall not include an in24 dividual’s Social Security number. 


ethrower on DSK3G9T082PROD with BILLS
7 

•S 1804 IS

1 SEC. 106. EFFECTIVE DATE OF BENEFITS. 

2 (a) IN GENERAL.—Except as provided in subsection 

3 (b), benefits shall first be available under this Act for 

4 items and services furnished on January 1 of the fourth 

5 calendar year that begins after the date of enactment of 

6 this Act. 

7 (b) COVERAGE FOR CHILDREN.— 

8 (1) IN GENERAL.—For any eligible individual 

9 who has not yet attained the age of 19, benefits 

10 shall first be available under this Act for items and 

11 services furnished on January 1 of the first calendar 

12 year that begins after the date of enactment of this 

13 Act. 

14 (2) OPTION TO CONTINUE IN OTHER COVERAGE

15 DURING TRANSITION PERIOD.—Any person who is 

16 eligible to receive benefits as described in paragraph 

17 (1) may opt to maintain any coverage described in 

18 section 901, private health insurance coverage, or 

19 coverage offered pursuant to subtitle A of title X 

20 (including the amendments made by such subtitle) 

21 until the effective date described in subsection (a). 

22 SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. 

23 (a) IN GENERAL.—Beginning on the effective date 

24 described in section 106(a), it shall be unlawful for— 


ethrower on DSK3G9T082PROD with BILLS
8 

•S 1804 IS

1 (1) a private health insurer to sell health insur2 ance coverage that duplicates the benefits provided 

3 under this Act; or 

4 (2) an employer to provide benefits for an em5 ployee, former employee, or the dependents of an 

6 employee or former employee that duplicate the ben7 efits provided under this Act. 

8 (b) CONSTRUCTION.—Nothing in this Act shall be 

9 construed as prohibiting the sale of health insurance cov10 erage for any additional benefits not covered by this Act, 

11 including additional benefits that an employer may provide 

12 to employees or their dependents, or to former employees 

13 or their dependents. 

14 TITLE II—COMPREHENSIVE BEN15 EFITS, INCLUDING PREVEN16 TIVE BENEFITS AND BENE17 FITS FOR LONG-TERM CARE 

18 SEC. 201. COMPREHENSIVE BENEFITS. 

19 (a) IN GENERAL.—Subject to the other provisions of 

20 this title and titles IV through IX, individuals enrolled for 

21 benefits under this Act are entitled to have payment made 

22 by the Secretary to an eligible provider for the following 

23 items and services if medically necessary or appropriate 

24 for the maintenance of health or for the diagnosis, treat25 ment, or rehabilitation of a health condition: 


ethrower on DSK3G9T082PROD with BILLS
9 

•S 1804 IS

1 (1) Hospital services, including inpatient and 

2 outpatient hospital care, including 24-hour-a-day 

3 emergency services and inpatient prescription drugs. 

4 (2) Ambulatory patient services. 

5 (3) Primary and preventive services, including 

6 chronic disease management. 

7 (4) Prescription drugs, medical devices, biologi8 cal products, including outpatient prescription drugs, 

9 medical devices, and biological products. 

10 (5) Mental health and substance abuse treat11 ment services, including inpatient care. 

12 (6) Laboratory and diagnostic services. 

13 (7) Comprehensive reproductive, maternity, and 

14 newborn care. 

15 (8) Pediatrics. 

16 (9) Oral health, audiology, and vision services. 

17 (10) Short-term rehabilitative and habilitative 

18 services and devices. 

19 (b) REVISION AND ADJUSTMENT.—The Secretary 

20 shall, on a regular basis, evaluate whether the benefits 

21 package should be improved or adjusted to promote the 

22 health of beneficiaries, account for changes in medical 

23 practice or new information from medical research, or re24 spond to other relevant developments in health science, 


ethrower on DSK3G9T082PROD with BILLS
10 

•S 1804 IS

1 and shall make recommendations to Congress regarding 

2 any such improvements or adjustments. 

3 (c) COMPLEMENTARY AND INTEGRATIVE MEDI4 CINE.— 

5 (1) IN GENERAL.—In carrying out subsection 

6 (b), the Secretary shall consult with the persons de7 scribed in paragraph (1) with respect to— 

8 (A) identifying specific complementary and 

9 integrative medicine practices that, on the basis 

10 of research findings or promising clinical inter11 ventions, are appropriate to include in the bene12 fits package; and 

13 (B) identifying barriers to the effective 

14 provision and integration of such practices into 

15 the delivery of health care, and identifying 

16 mechanisms for overcoming such barriers. 

17 (2) CONSULTATION.—In accordance with para18 graph (1), the Secretary shall consult with— 

19 (A) the Director of the National Center for 

20 Complementary and Integrative Health; 

21 (B) the Commissioner of Food and Drugs; 

22 (C) institutions of higher education, pri23 vate research institutes, and individual re24 searchers with extensive experience in com25 plementary and alternative medicine and the inVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
11 

•S 1804 IS

1 tegration of such practices into the delivery of 

2 health care; 

3 (D) nationally recognized providers of com4 plementary and integrative medicine; and 

5 (E) such other officials, entities, and indi6 viduals with expertise on complementary and 

7 integrative medicine as the Secretary deter8 mines appropriate. 

9 (d) STATES MAY PROVIDE ADDITIONAL BENE10 FITS.—Individual States may provide additional benefits 

11 for the residents of such States at the expense of the 

12 State. 

13 SEC. 202. NO COST-SHARING. 

14 (a) IN GENERAL.—The Secretary shall ensure that 

15 no cost-sharing, including deductibles, coinsurance, copay16 ments, or similar charges, be imposed on an individual for 

17 any benefits provided under this Act, except as described 

18 in subsection (b). 

19 (b) EXCEPTIONS.—The Secretary may— 

20 (1) impose cost-sharing with respect to services 

21 provided under section 1946 of the Social Security 

22 Act, as added by section 204; and 

23 (2) set a cost-sharing schedule for prescription 

24 drugs and biological products— 

25 (A) provided that— 


ethrower on DSK3G9T082PROD with BILLS
12 

•S 1804 IS

1 (i) such schedule is evidence-based 

2 and encourages the use of generic drugs; 

3 (ii) such cost-sharing does not apply 

4 to preventive drugs; and 

5 (iii) such cost-sharing does not exceed 

6 $200 annually per individual, adjusted an7 nually for inflation; and 

8 (B) under which the Secretary may exempt 

9 brand-name drugs from consideration in deter10 mining whether an individual has reached any 

11 out-of-pocket limit if a generic version of such 

12 drug is available. 

13 (c) NO BALANCE BILLING.—Notwithstanding con14 tracts in accordance with section 303, no provider may 

15 impose a charge to an enrolled individual for covered serv16 ices for which benefits are provided under this Act. 

17 SEC. 203. EXCLUSIONS AND LIMITATIONS. 

18 (a) IN GENERAL.—Benefits for services are not avail19 able under this Act unless the services meet the standards 

20 specified in section 201(a), as defined by the Secretary. 

21 (b) TREATMENT OF EXPERIMENTAL SERVICES AND

22 DRUGS.— 

23 (1) IN GENERAL.—In applying subsection (a), 

24 the Secretary shall make national coverage deter25 minations with respect to services that are experiVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
13 

•S 1804 IS

1 mental in nature. Such determinations shall be con2 sistent with the national coverage determination 

3 process as defined in section 1869(f)(1)(B) of the 

4 Social Security Act (42 U.S.C. 1395ff(f)(1)(B)). 

5 (2) APPEALS PROCESS.—The Secretary shall 

6 establish a process by which individuals can appeal 

7 coverage decisions. The process shall, as much as is 

8 feasible, follow process for appeals under the Medi9 care program described in section 1869 of the Social 

10 Security Act (42 U.S.C. 1395ff). 

11 (c) APPLICATION OF PRACTICE GUIDELINES.—In the 

12 case of services for which the Department of Health and 

13 Human Services has recognized a national practice guide14 line, the services are considered to meet the standards 

15 specified in section 201(a) if they have been provided in 

16 accordance with such guideline. For purposes of this sub17 section, a service shall be considered to have been provided 

18 in accordance with a practice guideline if the health care 

19 provider providing the service exercised appropriate pro20 fessional discretion to deviate from the guideline in a man21 ner authorized or anticipated by the guideline. 


ethrower on DSK3G9T082PROD with BILLS
14 

•S 1804 IS

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

2 UNDER MEDICAID. 

3 Title XIX of the Social Security Act (42 U.S.C. 1396 

4 et seq.) is amended by inserting the following section after 

5 section 1946: 

6 ‘‘STATE PLAN FOR PROVIDING LONG-TERM CARE

7 SERVICES

8 ‘‘SEC. 1947. (a) IN GENERAL.—For quarters begin9 ning on or after the effective date of benefits under section 

10 106(a) of the Medicare for All Act of 2017, notwith11 standing any other provision of this title— 

12 ‘‘(1) a State plan for medical assistance shall 

13 provide for making medical assistance available for 

14 services that are long-term care services (as defined 

15 in subsection (b)) in a manner consistent with this 

16 section; and 

17 ‘‘(2) no payment to a State shall be made 

18 under this title with respect to expenditures incurred 

19 by the State in providing medical assistance after 

20 such date for services that are not long-term care 

21 services. 

22 ‘‘(b) LONG-TERM CARE SERVICES DEFINED.—In 

23 this section, the term ‘long-term care services’ means the 

24 following: 


ethrower on DSK3G9T082PROD with BILLS
15 

•S 1804 IS

1 ‘‘(1) Nursing facility services for individuals 21 

2 years of age or over described in subparagraph (A) 

3 of section 1905(a)(4). 

4 ‘‘(2) Home health services described in section 

5 1905(a)(7). 

6 ‘‘(3) Nursing services described in section 

7 1905(a)(8). 

8 ‘‘(4) Rehabilitative services described in section 

9 1905(a)(13). 

10 ‘‘(5) Inpatient services for individuals 65 years 

11 of age or over provided in an institution for mental 

12 disease described in section 1905(a)(14). 

13 ‘‘(6) Intermediate care facility services de14 scribed in section 1905(a)(15). 

15 ‘‘(7) Inpatient psychiatric hospital services for 

16 individuals under age 21 described in section 

17 1905(a)(16). 

18 ‘‘(8) Case management services described in 

19 section 1905(a)(19). 

20 ‘‘(9) Personal care services described in section 

21 1905(a)(24). 

22 ‘‘(10) Nursing facility services described in sec23 tion 1905(a)(29). 


ethrower on DSK3G9T082PROD with BILLS
16 

•S 1804 IS

1 ‘‘(11) Home and community-based services pro2 vided under a State plan amendment under section 

3 1915(i). 

4 ‘‘(12) Payment for self-directed personal assist5 ance services provided under section 1915(j). 

6 ‘‘(13) Home and community-based attendant 

7 services and supports provided under a State plan 

8 amendment under section 1915(k). 

9 ‘‘(c) MAINTENANCE OF EFFORT.— 

10 ‘‘(1) ELIGIBILITY STANDARDS.— 

11 ‘‘(A) IN GENERAL.—Beginning on the date 

12 described in subsection (a), no payment may be 

13 made under section 1903 with respect to med14 ical assistance provided under a State plan for 

15 medical assistance if the State adopts income 

16 and resource standards and methodologies for 

17 purposes of determining an individual’s eligi18 bility for medical assistance under the State 

19 plan that are more restrictive than those ap20 plied as of May 5, 2017. 

21 ‘‘(B) INDEXING OF AMOUNTS OF INCOME

22 AND RESOURCE STANDARDS.—In determining 

23 whether a State has adopted income or resource 

24 standards that are more restrictive than the 

25 standards which applied as of May 5, 2017, the 


ethrower on DSK3G9T082PROD with BILLS
17 

•S 1804 IS

1 Secretary shall deem the amount of any such 

2 standard that was applied as of such date to be 

3 increased by the percentage increase in the 

4 medical care component of the consumer price 

5 index for all urban consumers (U.S. city aver6 age) from September of 2017 to September of 

7 the fiscal year for which the Secretary is mak8 ing such determination. 

9 ‘‘(2) EXPENDITURES.— 

10 ‘‘(A) IN GENERAL.—For each fiscal year 

11 or portion of a fiscal year that occurs during 

12 the period that begins on the first day of the 

13 first fiscal quarter that begins on or after the 

14 effective date of benefits under section 106(a) 

15 of the Medicare for All Act of 2017, as a condi16 tion of receiving payments under section 

17 1903(a), a State shall make expenditures for 

18 medical assistance for services that are long19 term care services in an amount that is not less 

20 than the expenditure floor determined for the 

21 State and fiscal year (or portion of a fiscal 

22 year) under subparagraph (B). 

23 ‘‘(B) EXPENDITURE FLOOR.— 

24 ‘‘(i) IN GENERAL.—For each fiscal 

25 year or portion of a fiscal year described in 


ethrower on DSK3G9T082PROD with BILLS
18 

•S 1804 IS

1 subparagraph (A), the Secretary shall de2 termine for each State an expenditure floor 

3 that shall be equal to— 

4 ‘‘(I) the amount of the State’s 

5 expenditures for fiscal year 2017 on 

6 medical assistance for long-term care 

7 services; increased by 

8 ‘‘(II) the growth factor deter9 mined under subclause (ii). 

10 ‘‘(ii) GROWTH FACTOR.—For each fis11 cal year or portion of a fiscal year de12 scribed in subparagraph (A), the Secretary 

13 shall, not later than September 1 of the 

14 fiscal year preceding such fiscal year or 

15 portion of a fiscal year, determine a 

16 growth factor for each State that takes 

17 into account— 

18 ‘‘(I) the percentage increase in 

19 health care costs in the State; 

20 ‘‘(II) the total amount expended 

21 by the State for the previous fiscal 

22 year on medical assistance for long23 term care services; 

24 ‘‘(III) the increase, if any, in the 

25 total population of the State from 


ethrower on DSK3G9T082PROD with BILLS
19 

•S 1804 IS

1 July of 2017 to July of the fiscal year 

2 preceding the fiscal year involved; and 

3 ‘‘(IV) the increase, if any, in the 

4 population of individuals aged 65 and 

5 older of the State from July of 2017 

6 to July of the fiscal year preceding 

7 the fiscal year involved. 

8 ‘‘(iii) PRORATION RULE.—Any 

9 amount determined under this subpara10 graph for a portion of a fiscal year shall be 

11 prorated based on the length of such por12 tion of a fiscal year relative to a complete 

13 fiscal year. 

14 ‘‘(d) NONAPPLICATION OF CERTAIN REQUIRE15 MENTS.—Beginning on the date described in subsection 

16 (a), any provision of this title requiring a State plan for 

17 medical assistance to make available medical assistance 

18 for services that are not long-term care services or services 

19 described in section 901(a)(3)(A)(ii) of the Medicare for 

20 All Act of 2017 shall have no effect.’’. 

21 SEC. 205. STATE STANDARDS. 

22 (a) IN GENERAL.—Nothing in this Act shall prohibit 

23 individual States from setting additional standards, with 

24 respect to eligibility, benefits, and minimum provider 

25 standards, consistent with the purposes of this Act, proVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
20 

•S 1804 IS

1 vided that such standards do not restrict eligibility or re2 duce access to benefits or services. 

3 (b) RESTRICTIONS ON PROVIDERS.—With respect to 

4 any individuals or entities certified to provide services cov5 ered under section 201(a)(7), a State may not prohibit 

6 an individual or entity from participating in the program 

7 under this Act, for reasons other than the ability of the 

8 individual or entity to provide such services. 

9 TITLE III—PROVIDER 

10 PARTICIPATION 

11 SEC. 301. PROVIDER PARTICIPATION AND STANDARDS. 

12 (a) IN GENERAL.—An individual or other entity fur13 nishing any covered service under this Act is not a quali14 fied provider unless the individual or entity— 

15 (1) is a qualified provider of the services under 

16 section 302; 

17 (2) has filed with the Secretary a participation 

18 agreement described in subsection (b); and 

19 (3) meets, as applicable, such other qualifica20 tions and conditions with respect to a provider of 

21 services under title XVIII of the Social Security Act 

22 as described in section 1866 of the Social Security 

23 Act (42 U.S.C. 1395cc). 

24 (b) REQUIREMENTS IN PARTICIPATION AGREE25 MENT.— 


ethrower on DSK3G9T082PROD with BILLS
21 

•S 1804 IS

1 (1) IN GENERAL.—A participation agreement 

2 described in this subsection between the Secretary 

3 and a provider shall provide at least for the fol4 lowing: 

5 (A) Services to eligible persons will be fur6 nished by the provider without discrimination, 

7 in accordance with section 104(a). Nothing in 

8 this subparagraph shall be construed as requir9 ing the provision of a type or class of services 

10 that are outside the scope of the provider’s nor11 mal practice. 

12 (B) No charge will be made to any enrolled 

13 individual for any covered services other than 

14 for payment authorized by this Act. 

15 (C) The provider agrees to furnish such in16 formation as may be reasonably required by the 

17 Secretary, in accordance with uniform reporting 

18 standards established under section 401(b)(1), 

19 for— 

20 (i) quality review by designated enti21 ties; 

22 (ii) making payments under this Act, 

23 including the examination of records as 

24 may be necessary for the verification of inVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
22 

•S 1804 IS

1 formation on which such payments are 

2 based; 

3 (iii) statistical or other studies re4 quired for the implementation of this Act; 

5 and 

6 (iv) such other purposes as the Sec7 retary may specify. 

8 (D) In the case of a provider that is not 

9 an individual, the provider agrees not to employ 

10 or use for the provision of health services any 

11 individual or other provider that has had a par12 ticipation agreement under this subsection ter13 minated for cause. 

14 (E) In the case of a provider paid under 

15 a fee-for-service basis, the provider agrees to 

16 submit bills and any required supporting docu17 mentation relating to the provision of covered 

18 services within 30 days after the date of pro19 viding such services. 

20 (2) TERMINATION OF PARTICIPATION AGREE21 MENT.— 

22 (A) IN GENERAL.—Participation agree23 ments may be terminated, with appropriate no24 tice— 


ethrower on DSK3G9T082PROD with BILLS
23 

•S 1804 IS

1 (i) by the Secretary for failure to meet 

2 the requirements of this Act; or 

3 (ii) by a provider. 

4 (B) TERMINATION PROCESS.—Providers 

5 shall be provided notice and a reasonable oppor6 tunity to correct deficiencies before the Sec7 retary terminates an agreement unless a more 

8 immediate termination is required for public 

9 safety or similar reasons. 

10 (C) PROVIDER PROTECTIONS.— 

11 (i) PROHIBITION.—The Secretary may 

12 not terminate a participation agreement or 

13 in any other way discriminate against, or 

14 cause to be discriminated against, any cov15 ered provider or authorized representative 

16 of the provider, on account of such pro17 vider or representative— 

18 (I) providing, causing to be pro19 vided, or being about to provide or 

20 cause to be provided to the provider, 

21 the Federal Government, or the attor22 ney general of a State information re23 lating to any violation of, or any act 

24 or omission the provider or represent25 ative reasonably believes to be a violaVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
24 

•S 1804 IS

1 tion of, any provision of this title (or 

2 an amendment made by this title); 

3 (II) testifying or being about to 

4 testify in a proceeding concerning 

5 such violation; 

6 (III) assisting or participating, or 

7 being about to assist or participate, in 

8 such a proceeding; or 

9 (IV) objecting to, or refusing to 

10 participate in, any activity, policy, 

11 practice, or assigned task that the 

12 provider or representative reasonably 

13 believes to be in violation of any provi14 sion of this Act (including any amend15 ment made by this Act), or any order, 

16 rule, regulation, standard, or ban 

17 under this Act (including any amend18 ment made by this Act). 

19 (ii) COMPLAINT PROCEDURE.—A pro20 vider or representative who believes that he 

21 or she has been discriminated against in 

22 violation of this section may seek relief in 

23 accordance with the procedures, notifica24 tions, burdens of proof, remedies, and statVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
25 

•S 1804 IS

1 utes of limitation set forth in section 

2 2087(b) of title 15, United States Code. 

3 SEC. 302. QUALIFICATIONS FOR PROVIDERS. 

4 (a) IN GENERAL.—A health care provider is consid5 ered to be qualified to provide covered services if the pro6 vider is licensed or certified and meets— 

7 (1) all the requirements of State law to provide 

8 such services; and 

9 (2) applicable requirements of Federal law to 

10 provide such services. 

11 (b) MINIMUM PROVIDER STANDARDS.— 

12 (1) IN GENERAL.—The Secretary shall estab13 lish, evaluate, and update national minimum stand14 ards to ensure the quality of services provided under 

15 this Act and to monitor efforts by States to ensure 

16 the quality of such services. A State may also estab17 lish additional minimum standards which providers 

18 shall meet with respect to services provided in such 

19 State. 

20 (2) NATIONAL MINIMUM STANDARDS.—The na21 tional minimum standards under paragraph (1) shall 

22 be established for institutional providers of services 

23 and individual health care practitioners. Except as 

24 the Secretary may specify in order to carry out this 

25 Act, a hospital, skilled nursing facility, or other inVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
26 

•S 1804 IS

1 stitutional provider of services shall meet standards 

2 for such a provider under the Medicare program 

3 under title XVIII of the Social Security Act (42 

4 U.S.C. 1395 et seq.). Such standards also may in5 clude, where appropriate, elements relating to— 

6 (A) adequacy and quality of facilities; 

7 (B) training and competence of personnel 

8 (including continuing education requirements); 

9 (C) comprehensiveness of service; 

10 (D) continuity of service; 

11 (E) patient satisfaction, including waiting 

12 time and access to services; and 

13 (F) performance standards, including orga14 nization, facilities, structure of services, effi15 ciency of operation, and outcome in palliation, 

16 improvement of health, stabilization, cure, or 

17 rehabilitation. 

18 (3) TRANSITION IN APPLICATION.—If the Sec19 retary provides for additional requirements for pro20 viders under this subsection, any such additional re21 quirement shall be implemented in a manner that 

22 provides for a reasonable period during which a pre23 viously qualified provider is permitted to meet such 

24 an additional requirement. 


ethrower on DSK3G9T082PROD with BILLS
27 

•S 1804 IS

1 (4) ABILITY TO PROVIDE SERVICES.—With re2 spect to any entity or provider certified to provide 

3 services described in section 201(a)(7), the Secretary 

4 may not prohibit such entity or provider from par5 ticipating for reasons other than its ability to pro6 vide such services. 

7 (c) FEDERAL PROVIDERS.—Any provider qualified to 

8 provide health care services through the Department of 

9 Veterans Affairs or Indian Health Service is a qualifying 

10 provider under this section with respect to any individual 

11 who qualifies for such services under applicable Federal 

12 law. 

13 SEC. 303. USE OF PRIVATE CONTRACTS. 

14 (a) IN GENERAL.—Subject to the provisions of this 

15 subsection, nothing in this Act shall prohibit an institu16 tional or individual provider from entering into a private 

17 contract with an enrolled individual for any item or serv18 ice— 

19 (1) for which no claim for payment is to be sub20 mitted under this Act, and 

21 (2) for which the provider receives— 

22 (A) no reimbursement under this Act di23 rectly or on a capitated basis, and 

24 (B) receives no amount for such item or 

25 service from an organization which receives reVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
28 

•S 1804 IS

1 imbursement for such items or service under 

2 this Act directly or on a capitated basis. 

3 (b) BENEFICIARY PROTECTIONS.— 

4 (1) IN GENERAL.—Subsection (a) shall not 

5 apply to any contract unless— 

6 (A) the contract is in writing and is signed 

7 by the beneficiary before any item or service is 

8 provided pursuant to the contract; 

9 (B) the contract contains the items de10 scribed in paragraph (2); and 

11 (C) the contract is not entered into at a 

12 time when the beneficiary is facing an emer13 gency health care situation. 

14 (2) ITEMS REQUIRED TO BE INCLUDED IN CON15 TRACT.—Any contract to provide items and services 

16 to which subsection (a) applies shall clearly indicate 

17 to the beneficiary that by signing such contract the 

18 beneficiary— 

19 (A) agrees not to submit a claim (or to re20 quest that the provider submit a claim) under 

21 this Act for such items or services even if such 

22 items or services are otherwise covered by this 

23 Act; 

24 (B) agrees to be responsible, whether 

25 through insurance offered under section 107(b) 


ethrower on DSK3G9T082PROD with BILLS
29 

•S 1804 IS

1 or otherwise, for payment of such items or serv2 ices and understands that no reimbursement 

3 will be provided under this Act for such items 

4 or services; 

5 (C) acknowledges that no limits under this 

6 Act apply to amounts that may be charged for 

7 such items or services; 

8 (D) if the provider is a non-participating 

9 provider, acknowledges that the beneficiary has 

10 the right to have such items or services pro11 vided by other providers for whom payment 

12 would be made under this Act; and 

13 (E) acknowledges that the provider is pro14 viding services outside the scope of the program 

15 under this Act. 

16 (c) PROVIDER REQUIREMENTS.— 

17 (1) IN GENERAL.—Subsection (a) shall not 

18 apply to any contract unless an affidavit described 

19 in paragraph (2) is in effect during the period any 

20 item or service is to be provided pursuant to the 

21 contract. 

22 (2) AFFIDAVIT.—An affidavit is described in 

23 this subparagraph shall— 

24 (A) identify the practitioner, and be signed 

25 by such practitioner; 


ethrower on DSK3G9T082PROD with BILLS
30 

•S 1804 IS

1 (B) provide that the practitioner will not 

2 submit any claim under this title for any item 

3 or service provided to any beneficiary (and will 

4 not receive any reimbursement or amount de5 scribed in paragraph (1)(B) for any such item 

6 or service) during the 1-year period beginning 

7 on the date the affidavit is signed; and 

8 (C) be filed with the Secretary no later 

9 than 10 days after the first contract to which 

10 such affidavit applies is entered into. 

11 (3) ENFORCEMENT.—If a physician or practi12 tioner signing an affidavit described in paragraph 

13 (2) knowingly and willfully submits a claim under 

14 this title for any item or service provided during the 

15 1-year period described in paragraph (2)(B) (or re16 ceives any reimbursement or amount described in 

17 subsection (a)(2) for any such item or service) with 

18 respect to such affidavit— 

19 (A) this subsection shall not apply with re20 spect to any items and services provided by the 

21 physician or practitioner pursuant to any con22 tract on and after the date of such submission 

23 and before the end of such period; and 

24 (B) no payment shall be made under this 

25 title for any item or service furnished by the 


ethrower on DSK3G9T082PROD with BILLS
31 

•S 1804 IS

1 physician or practitioner during the period de2 scribed in clause (i) (and no reimbursement or 

3 payment of any amount described in subsection 

4 (a)(2) shall be made for any such item or serv5 ice). 

6 TITLE IV—ADMINISTRATION 

7 Subtitle A—General 

8 Administration Provisions 

9 SEC. 401. ADMINISTRATION. 

10 (a) GENERAL DUTIES OF THE SECRETARY.— 

11 (1) IN GENERAL.—The Secretary shall develop 

12 policies, procedures, guidelines, and requirements to 

13 carry out this Act, including related to— 

14 (A) eligibility for benefits; 

15 (B) enrollment; 

16 (C) benefits provided; 

17 (D) provider participation standards and 

18 qualifications, as described in title III; 

19 (E) levels of funding; 

20 (F) methods for determining amounts of 

21 payments to providers of covered services, con22 sistent with subtitle B; 

23 (G) the determination of medical necessity 

24 and appropriateness with respect to coverage of 

25 certain services; 


ethrower on DSK3G9T082PROD with BILLS
32 

•S 1804 IS

1 (H) planning for capital expenditures and 

2 service delivery; 

3 (I) planning for health professional edu4 cation funding; 

5 (J) encouraging States to develop regional 

6 planning mechanisms; and 

7 (K) any other regulations necessary to 

8 carry out the purpose of this Act. 

9 (2) REGULATIONS.—Regulations authorized by 

10 this Act shall be issued by the Secretary in accord11 ance with section 553 of title 5, United States Code. 

12 (b) UNIFORM REPORTING STANDARDS; ANNUAL RE13 PORT; STUDIES.— 

14 (1) UNIFORM REPORTING STANDARDS.— 

15 (A) IN GENERAL.—The Secretary shall es16 tablish uniform State reporting requirements 

17 and national standards to ensure an adequate 

18 national database containing information per19 taining to health services practitioners, ap20 proved providers, the costs of facilities and 

21 practitioners providing such services, the qual22 ity of such services, the outcomes of such serv23 ices, and the equity of health among population 

24 groups. Such standards shall include, to the 

25 maximum extent feasible without compromising 


ethrower on DSK3G9T082PROD with BILLS
33 

•S 1804 IS

1 patient privacy, health outcome measures, and 

2 to the maximum extent feasible without exces3 sively burdening providers, the measures de4 scribed in subparagraphs (D) through (F) of 

5 subsection (a)(1). 

6 (B) REPORTS.—The Secretary shall regu7 larly analyze information reported to it and 

8 shall define rules and procedures to allow re9 searchers, scholars, health care providers, and 

10 others to access and analyze data for purposes 

11 consistent with quality and outcomes research, 

12 without compromising patient privacy. 

13 (2) ANNUAL REPORT.—Beginning January 1 of 

14 the second year beginning after the effective date of 

15 this Act, the Secretary shall annually report to Con16 gress on the following: 

17 (A) The status of implementation of the 

18 Act. 

19 (B) Enrollment under this Act. 

20 (C) Benefits under this Act. 

21 (D) Expenditures and financing under this 

22 Act. 

23 (E) Cost-containment measures and 

24 achievements under this Act. 

25 (F) Quality assurance. 


ethrower on DSK3G9T082PROD with BILLS
34 

•S 1804 IS

1 (G) Health care utilization patterns, in2 cluding any changes attributable to the pro3 gram. 

4 (H) Changes in the per-capita costs of 

5 health care. 

6 (I) Differences in the health status of the 

7 populations of the different States, including in8 come and racial characteristics, and other popu9 lation health inequities. 

10 (J) Progress on quality and outcome meas11 ures, and long-range plans and goals for 

12 achievements in such areas. 

13 (K) Necessary changes in the education of 

14 health personnel. 

15 (L) Plans for improving service to medi16 cally underserved populations. 

17 (M) Transition problems as a result of im18 plementation of this Act. 

19 (N) Opportunities for improvements under 

20 this Act. 

21 (3) STATISTICAL ANALYSES AND OTHER STUD22 IES.—The Secretary may, either directly or by con23 tract— 


ethrower on DSK3G9T082PROD with BILLS
35 

•S 1804 IS

1 (A) make statistical and other studies, on 

2 a nationwide, regional, State, or local basis, of 

3 any aspect of the operation of this Act; 

4 (B) develop and test methods of payment 

5 or delivery as it may consider necessary or 

6 promising for the evaluation, or for the im7 provement, of the operation of this Act; and 

8 (C) develop methodological standards for 

9 evidence-based policymaking. 

10 (c) AUDITS.— 

11 (1) IN GENERAL.—The Comptroller General of 

12 the United States shall conduct an audit of the 

13 Board every fifth fiscal year following the effective 

14 date of this Act to determine the effectiveness of the 

15 program in carrying out the duties under subsection 

16 (a). 

17 (2) REPORTS.—The Comptroller General of the 

18 United States shall submit a report to Congress con19 cerning the results of each audit conducted under 

20 this subsection. 

21 SEC. 402. CONSULTATION. 

22 The Secretary shall consult with Federal agencies, 

23 Indian tribes and urban Indian health organizations, and 

24 private entities, such as professional societies, national as25 sociations, nationally recognized associations of experts, 


ethrower on DSK3G9T082PROD with BILLS
36 

•S 1804 IS

1 medical schools and academic health centers, consumer 

2 groups, and labor and business organizations in the for3 mulation of guidelines, regulations, policy initiatives, and 

4 information gathering to ensure the broadest and most in5 formed input in the administration of this Act. Nothing 

6 in this Act shall prevent the Secretary from adopting 

7 guidelines developed by such a private entity if, in the Sec8 retary’s judgment, such guidelines are generally accepted 

9 as reasonable and prudent and consistent with this Act. 

10 SEC. 403. REGIONAL ADMINISTRATION. 

11 (a) COORDINATION WITH REGIONAL OFFICES.—The 

12 Secretary shall establish and maintain regional offices to 

13 promote adequate access to, and efficient use of, tertiary 

14 care facilities, equipment, and services. Wherever possible, 

15 the Secretary shall incorporate regional offices of the Cen16 ters for Medicare & Medicaid Services for this purpose. 

17 (b) APPOINTMENT OF REGIONAL AND STATE DIREC18 TORS.—In each such regional office there shall be— 

19 (1) one regional director appointed by the Sec20 retary; 

21 (2) for each State in the region, a deputy direc22 tor; and 

23 (3) one deputy director to represent the Native 

24 American and Alaska Native tribes in the region. 


ethrower on DSK3G9T082PROD with BILLS
37 

•S 1804 IS

1 (c) REGIONAL OFFICE DUTIES.—Regional offices 

2 shall be responsible for— 

3 (1) providing an annual State health care needs 

4 assessment report to the Secretary, after a thorough 

5 examination of health needs, in consultation with 

6 public health officials, clinicians, patients, and pa7 tient advocates; 

8 (2) recommending changes in provider reim9 bursement or payment for delivery of health services 

10 in the States within the region; and 

11 (3) establishing a quality assurance mechanism 

12 in the State in order to minimize both under-utiliza13 tion and over-utilization and to ensure that all pro14 viders meet high quality standards. 

15 SEC. 404. BENEFICIARY OMBUDSMAN. 

16 (a) IN GENERAL.—The Secretary shall appoint a 

17 Beneficiary Ombudsman who shall have expertise and ex18 perience in the fields of health care and education of, and 

19 assistance to, individuals entitled to benefits under this 

20 Act. 

21 (b) DUTIES.—The Beneficiary Ombudsman shall— 

22 (1) receive complaints, grievances, and requests 

23 for information submitted by individuals entitled to 

24 benefits under this Act with respect to any aspect of 

25 the Universal Medicare Program; 


ethrower on DSK3G9T082PROD with BILLS
38 

•S 1804 IS

1 (2) provide assistance with respect to com2 plaints, grievances, and requests referred to in sub3 paragraph (a), including— 

4 (A) assistance in collecting relevant infor5 mation for such individuals, to seek an appeal 

6 of a decision or determination made by a re7 gional office or the Secretary; and 

8 (B) assistance to such individuals in pre9 senting information under relating to cost-shar10 ing; and 

11 (3) submit annual reports to Congress and the 

12 Secretary that describe the activities of the Office 

13 and that include such recommendations for improve14 ment in the administration of this Act as the Om15 budsman determines appropriate. The Ombudsman 

16 shall not serve as an advocate for any increases in 

17 payments or new coverage of services, but may iden18 tify issues and problems in payment or coverage 

19 policies. 

20 SEC. 405. COMPLEMENTARY CONDUCT OF RELATED 

21 HEALTH PROGRAMS. 

22 In performing functions with respect to health per23 sonnel education and training, health research, environ24 mental health, disability insurance, vocational rehabilita25 tion, the regulation of food and drugs, and all other matVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
39 

•S 1804 IS

1 ters pertaining to health, the Secretary shall direct the ac2 tivities of the Department of Health and Human Services 

3 toward contributions to the health of the people com4 plementary to this Act. 

5 Subtitle B—Control Over Fraud 

6 and Abuse 

7 SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL 

8 FRAUD AND ABUSE UNDER UNIVERSAL MEDI9 CARE PROGRAM. 

10 The following sections of the Social Security Act shall 

11 apply to this Act in the same manner as they apply to 

12 State medical assistance plans under title XIX of such 

13 Act: 

14 (1) Section 1128 (relating to exclusion of indi15 viduals and entities). 

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

17 (3) Section 1128B (criminal penalties). 

18 (4) Section 1124 (relating to disclosure of own19 ership and related information). 

20 (5) Section 1126 (relating to disclosure of cer21 tain owners). 

22 TITLE V—QUALITY ASSESSMENT 

23 SEC. 501. QUALITY STANDARDS. 

24 (a) IN GENERAL.—All standards and quality meas25 ures under this Act shall be performed by the Center for 


ethrower on DSK3G9T082PROD with BILLS
40 

•S 1804 IS

1 Clinical Standards and Quality of the Centers for Medi2 care & Medicaid Services (referred to in this title as the 

3 ‘‘Center’’), in coordination with the Agency for Healthcare 

4 Research and Quality and other offices of the Department 

5 of Health and Human Services. 

6 (b) DUTIES OF THE CENTER.—The Center shall per7 form the following duties: 

8 (1) PRACTICE GUIDELINES.—The Center shall 

9 review and evaluate each practice guideline devel10 oped under part B of title IX of the Public Health 

11 Service Act. The Center shall determine whether the 

12 guideline should be recognized as a national practice 

13 guideline. 

14 (2) STANDARDS OF QUALITY, PERFORMANCE

15 MEASURES, AND MEDICAL REVIEW CRITERIA.—The 

16 Center shall review and evaluate each standard of 

17 quality, performance measure, and medical review 

18 criterion developed under part B of title IX of the 

19 Public Health Service Act (42 U.S.C. 299 et seq.). 

20 The Center shall determine whether the standard, 

21 measure, or criterion is appropriate for use in as22 sessing or reviewing the quality of services provided 

23 by health care institutions or health care profes24 sionals. In evaluating such standards, the Center 

25 shall consider the evidentiary basis for the standard, 


ethrower on DSK3G9T082PROD with BILLS
41 

•S 1804 IS

1 and the validity, reliability, and feasibility of meas2 uring the standard. 

3 (3) PROFILING OF PATTERNS OF PRACTICE; 

4 IDENTIFICATION OF OUTLIERS.—The Center shall 

5 adopt methodologies for profiling the patterns of 

6 practice of health care professionals and for identi7 fying and notifying outliers. 

8 (4) CRITERIA FOR ENTITIES CONDUCTING

9 QUALITY REVIEWS.—The Center shall develop min10 imum criteria for competence for entities that can 

11 qualify to conduct ongoing and continuous external 

12 quality reviews in the administrative regions. Such 

13 criteria shall require such an entity to be adminis14 tratively independent of the individual or board that 

15 administers the region and shall ensure that such 

16 entities do not provide financial incentives to review17 ers to favor one pattern of practice over another. 

18 The Center shall ensure coordination and reporting 

19 by such entities to ensure national consistency in 

20 quality standards. 

21 (5) REPORTING.—The Center shall report to 

22 the Secretary annually specifically on findings from 

23 outcomes research and development of practice 

24 guidelines that may affect the Secretary’s deterVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
42 

•S 1804 IS

1 mination of coverage of services under section 

2 401(a)(1)(G). 

3 SEC. 502. ADDRESSING HEALTH CARE DISPARITIES. 

4 (a) EVALUATING DATA COLLECTION AP5 PROACHES.—The Center shall evaluate approaches for the 

6 collection of data under this Act, to be performed in con7 junction with existing quality reporting requirements and 

8 programs under this Act, that allow for the ongoing, accu9 rate, and timely collection of data on disparities in health 

10 care services and performance on the basis of race, eth11 nicity, gender, geography, or socioeconomic status. In con12 ducting such evaluation, the Secretary shall consider the 

13 following objectives: 

14 (1) Protecting patient privacy. 

15 (2) Minimizing the administrative burdens of 

16 data collection and reporting on providers under this 

17 Act. 

18 (3) Improving Universal Medicare Program 

19 data on race, ethnicity, gender, geography, and so20 cioeconomic status. 

21 (b) REPORTS TO CONGRESS.— 

22 (1) REPORT ON EVALUATION.—Not later than 

23 18 months after the date on which benefits first be24 come available as described in section 106(a), the 

25 Center shall submit to Congress and the Secretary 


ethrower on DSK3G9T082PROD with BILLS
43 

•S 1804 IS

1 a report on the evaluation conducted under sub2 section (a). Such report shall, taking into consider3 ation the results of such evaluation— 

4 (A) identify approaches (including defining 

5 methodologies) for identifying and collecting 

6 and evaluating data on health care disparities 

7 on the basis of race, ethnicity, gender, geog8 raphy, or socioeconomic status under the Uni9 versal Medicare Program; and 

10 (B) include recommendations on the most 

11 effective strategies and approaches to reporting 

12 quality measures, as appropriate, on the basis 

13 of race, ethnicity, gender, geography, or socio14 economic status. 

15 (2) REPORT ON DATA ANALYSES.—Not later 

16 than 4 years after the submission of the report 

17 under subsection (b)(1), and 4 years thereafter, the 

18 Center shall submit to Congress and the Secretary 

19 a report that includes recommendations for improv20 ing the identification of health care disparities based 

21 on the analyses of data collected under subsection 

22 (c). 

23 (c) IMPLEMENTING EFFECTIVE APPROACHES.—Not 

24 later than 2 years after the date on which benefits first 

25 become available as described in section 106(a), the SecVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
44 

•S 1804 IS

1 retary shall implement the approaches identified in the re2 port submitted under subsection (b)(1) for the ongoing, 

3 accurate, and timely collection and evaluation of data on 

4 health care disparities on the basis of race, ethnicity, gen5 der, geography, or socioeconomic status. 

6 TITLE VI—HEALTH BUDGET; 

7 PAYMENTS; COST CONTAIN8 MENT MEASURES 

9 Subtitle A—Budgeting 

10 SEC. 601. NATIONAL HEALTH BUDGET. 

11 (a) NATIONAL HEALTH BUDGET.— 

12 (1) IN GENERAL.—By not later than September 

13 1 of each year, beginning with the year prior to the 

14 date on which benefits first become available as de15 scribed in section 106(a), the Secretary shall estab16 lish a national health budget, which specifies the 

17 total expenditures to be made for covered health 

18 care services under this Act. 

19 (2) DIVISION OF BUDGET INTO COMPONENTS.— 

20 In addition to the cost of covered health services, the 

21 national health budget shall consist of at least the 

22 following components: 

23 (A) Quality assessment activities under 

24 title V. 


ethrower on DSK3G9T082PROD with BILLS
45 

•S 1804 IS

1 (B) Health professional education expendi2 tures. 

3 (C) Administrative costs. 

4 (D) Innovation, including in accordance 

5 with section 1115A of the Social Security Act 

6 (42 U.S.C. 1315a). 

7 (E) Operating and other expenditures not 

8 described in subparagraphs (A) through (D) 

9 (referred to in this Act as the ‘‘operating com10 ponent’’), consisting of amounts not included in 

11 the other components. 

12 (F) Capital expenditures. 

13 (G) Prevention and public health activities. 

14 (3) ALLOCATION AMONG COMPONENTS.—The 

15 Secretary shall allocate the budget among the com16 ponents in a manner that— 

17 (A) ensures a fair allocation for quality as18 sessment activities; and 

19 (B) ensures that the health professional 

20 education expenditure component is sufficient 

21 to provide for the amount of health professional 

22 education expenditures sufficient to meet the 

23 need for covered health care services. 

24 (4) TEMPORARY WORKER ASSISTANCE.—For up 

25 to 5 years following the date on which benefits first 


ethrower on DSK3G9T082PROD with BILLS
46 

•S 1804 IS

1 become available as described in section 106(a), up 

2 to 1 percent of the budget may be allocated to pro3 grams providing assistance to workers who perform 

4 functions in the administration of the health insur5 ance system and who may experience economic dis6 location as a result of the implementation of this 

7 Act. 

8 (5) RESERVE FUND.—The Secretary shall es9 tablish and maintain a reserve fund to respond to 

10 the costs of treating an epidemic, pandemic, natural 

11 disaster, or other such health emergency. 

12 (b) DEFINITIONS.—In this section: 

13 (1) CAPITAL EXPENDITURES.—The term ‘‘cap14 ital expenditures’’ means expenses for the purchase, 

15 lease, construction, or renovation of capital facilities 

16 and for equipment and includes return on equity 

17 capital. 

18 (2) HEALTH PROFESSIONAL EDUCATION EX19 PENDITURES.—The term ‘‘health professional edu20 cation expenditures’’ means expenditures in hospitals 

21 and other health care facilities to cover costs associ22 ated with teaching and related research activities. 


ethrower on DSK3G9T082PROD with BILLS
47 

•S 1804 IS

1 Subtitle B—Payments to Providers 

2 SEC. 611. PAYMENTS TO INSTITUTIONAL AND INDIVIDUAL 

3 PROVIDERS. 

4 (a) APPLICATION OF PAYMENT PROCESSES UNDER

5 TITLE XVIII.—Except as otherwise provided in this sec6 tion, the Secretary shall establish, by regulation, fee 

7 schedules that establish payment amounts for benefits 

8 under this Act in a manner that is consistent with proc9 esses for determining payments for items and services 

10 under title XVIII of the Social Security Act (42 U.S.C. 

11 1395 et seq.), including the application of the provisions 

12 of, and amendments made by, section 612. 

13 (b) APPLICATION OF CURRENT AND PLANNED PAY14 MENT REFORMS.—Any payment reform activities or dem15 onstrations planned or implemented with respect to such 

16 title XVIII as of the date of the enactment of this Act 

17 shall apply to benefits under this Act, including any re18 form activities or demonstrations planned or implemented 

19 under the provisions of, or amendments made by, the 

20 Medicare Access and CHIP Reauthorization Act of 2015 

21 (Public Law 114–10) and the Patient Protection and Af22 fordable Care Act (Public Law 111–148). 


ethrower on DSK3G9T082PROD with BILLS
48 

•S 1804 IS

1 SEC. 612. ENSURING ACCURATE VALUATION OF SERVICES 

2 UNDER THE MEDICARE PHYSICIAN FEE 

3 SCHEDULE. 

4 (a) STANDARDIZED AND DOCUMENTED REVIEW

5 PROCESS.—Section 1848(c)(2) of the Social Security Act 

6 (42 U.S.C. 1395w–4(c)(2)) is amended by adding at the 

7 end the following new subparagraph: 

8 ‘‘(P) STANDARDIZED AND DOCUMENTED

9 REVIEW PROCESS.— 

10 ‘‘(i) IN GENERAL.—Not later than one 

11 year after the date of enactment of this 

12 subparagraph, the Secretary shall estab13 lish, document, and make publicly available 

14 a standardized process for reviewing the 

15 relative values of physicians’ services under 

16 this paragraph. 

17 ‘‘(ii) MINIMUM REQUIREMENTS.—The 

18 standardized process shall include, at a 

19 minimum, methods and criteria for identi20 fying services for review, prioritizing the 

21 review of services, reviewing stakeholder 

22 recommendations, and identifying addi23 tional resources to be considered during 

24 the review process.’’. 

25 (b) PLANNED AND DOCUMENTED USE OF FUNDS.— 

26 Section 1848(c)(2)(M) of the Social Security Act (42 


ethrower on DSK3G9T082PROD with BILLS
49 

•S 1804 IS

1 U.S.C. 1305w–4(c)(2)(M)) is amended by adding at the 

2 end the following new clause: 

3 ‘‘(x) PLANNED AND DOCUMENTED

4 USE OF FUNDS.—For each fiscal year (be5 ginning with the first fiscal year beginning 

6 on or after the date of enactment of this 

7 clause), the Secretary shall provide to Con8 gress a written plan for using the funds 

9 provided under clause (ix) to collect and 

10 use information on physicians’ services in 

11 the determination of relative values under 

12 this subparagraph.’’. 

13 (c) INTERNAL TRACKING OF REVIEWS.— 

14 (1) IN GENERAL.—Not later than one year 

15 after the date of enactment of this Act, the Sec16 retary shall submit to Congress a proposed plan for 

17 systematically and internally tracking its review of 

18 the relative values of physicians’ services, such as by 

19 establishing an internal database, under section 

20 1848(c)(2) of the Social Security Act (42 U.S.C. 

21 1395w–4(c)(2)), as amended by this section. 

22 (2) MINIMUM REQUIREMENTS.—The proposal 

23 shall include, at a minimum, plans and a timeline 

24 for achieving the ability to systematically and inter25 nally track the following: 


ethrower on DSK3G9T082PROD with BILLS
50 

•S 1804 IS

1 (A) When, how, and by whom services are 

2 identified for review. 

3 (B) When services are reviewed or re4 viewed or when new services are added. 

5 (C) The resources, evidence, data, and rec6 ommendations used in reviews. 

7 (D) When relative values are adjusted. 

8 (E) The rationale for final relative value 

9 decisions. 

10 (d) FREQUENCY OF REVIEW.—Section 1848(c)(2) of 

11 the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is 

12 amended— 

13 (1) in subparagraph (B)(i), by striking ‘‘5’’ and 

14 inserting ‘‘4’’; and 

15 (2) in subparagraph (K)(i)(I), by striking ‘‘peri16 odically’’ and inserting ‘‘annually’’. 

17 (e) CONSULTATION WITH MEDICARE PAYMENT AD18 VISORY COMMISSION.— 

19 (1) IN GENERAL.—Section 1848(c)(2) of the 

20 Social Security Act (42 U.S.C. 1395w–4(c)(2)) is 

21 amended— 

22 (A) in subparagraph (B)(i), by inserting 

23 ‘‘in consultation with the Medicare Payment 

24 Advisory Commission,’’ after ‘‘The Secretary,’’; 

25 and 


ethrower on DSK3G9T082PROD with BILLS
51 

•S 1804 IS

1 (B) in subparagraph (K)(i)(I), as amended 

2 by subsection (d)(2), by inserting ‘‘in coordina3 tion with the Medicare Payment Advisory Com4 mission,’’ after ‘‘years,’’. 

5 (2) CONFORMING AMENDMENTS.—Section 1805 

6 of the Social Security Act (42 U.S.C. 1395b–6) is 

7 amended— 

8 (A) in subsection (b)(1)(A), by inserting 

9 the following before the semicolon at the end: 

10 ‘‘and including coordinating with the Secretary 

11 in accordance with section 1848(c)(2) to sys12 tematically review the relative values established 

13 for physicians’ services, identify potentially 

14 misvalued services, and propose adjustments to 

15 the relative values for physicians’ services’’; and 

16 (B) in subsection (e)(1), in the second sen17 tence, by inserting ‘‘or the Ranking Minority 

18 Member’’ after ‘‘the Chairman’’. 

19 (f) PERIODIC AUDIT BY THE COMPTROLLER GEN20 ERAL.—Section 1848(c)(2) of the Social Security Act (42 

21 U.S.C. 1395w–4(c)(2)), as amended by subsection (a), is 

22 amended by adding at the end the following new subpara23 graph: 

24 ‘‘(Q) PERIODIC AUDIT BY THE COMP25 TROLLER GENERAL.— 


ethrower on DSK3G9T082PROD with BILLS
52 

•S 1804 IS

1 ‘‘(i) IN GENERAL.—The Comptroller 

2 General of the United States (in this sub3 section referred to as the ‘Comptroller 

4 General’) shall periodically audit the review 

5 by the Secretary of relative values estab6 lished under this paragraph for physicians’ 

7 services. 

8 ‘‘(ii) ACCESS TO INFORMATION.—The 

9 Comptroller General shall have unre10 stricted access to all deliberations, records, 

11 and nonproprietary data related to the ac12 tivities carried out under this paragraph, 

13 in a timely manner, upon request.’’. 

14 SEC. 613. OFFICE OF PRIMARY HEALTH CARE. 

15 (a) IN GENERAL.—There is established within the 

16 Agency for Healthcare Research and Quality an Office of 

17 Primary Health Care, responsible for coordinating with 

18 the Secretary, the Health Resources and Services Admin19 istration, and other offices in the Department as nec20 essary, in order to— 

21 (1) coordinate health professional education 

22 policies and goals, in consultation with the Secretary 

23 to achieve the national goals specified in subsection 

24 (b); 


ethrower on DSK3G9T082PROD with BILLS
53 

•S 1804 IS

1 (2) develop and maintain a system to monitor 

2 the number and specialties of individuals through 

3 their health professional education, any postgraduate 

4 training, and professional practice; 

5 (3) develop, coordinate, and promote policies 

6 that expand the number of primary care practi7 tioners, registered nurses, midlevel practitioners, and 

8 dentists; and 

9 (4) recommend the appropriate training, edu10 cation, technical assistance, and patient advocacy en11 hancements of primary care health professionals, in12 cluding registered nurses, to achieve uniform high 

13 quality and patient safety. 

14 (b) NATIONAL GOALS.—Not later than 1 year after 

15 the date of enactment of this Act, the Office of Primary 

16 Health Care shall set forth national goals to increase ac17 cess to high quality primary health care, particularly in 

18 underserved areas and for underserved populations. 

19 SEC. 614. PAYMENTS FOR PRESCRIPTION DRUGS AND AP20 PROVED DEVICES AND EQUIPMENT. 

21 (a) NEGOTIATED PRICES.—The prices to be paid for 

22 covered pharmaceuticals, medical supplies, and medically 

23 necessary assistive equipment shall be negotiated annually 

24 by the Secretary. 

25 (b) PRESCRIPTION DRUG FORMULARY.— 


ethrower on DSK3G9T082PROD with BILLS
54 

•S 1804 IS

1 (1) IN GENERAL.—The Secretary shall establish 

2 a prescription drug formulary system, which shall 

3 encourage best-practices in prescribing and discour4 age the use of ineffective, dangerous, or excessively 

5 costly medications when better alternatives are avail6 able. 

7 (2) PROMOTION OF USE OF GENERICS.—The 

8 formulary under this subsection shall promote the 

9 use of generic medications to the greatest extent 

10 possible. 

11 (3) FORMULARY UPDATES AND PETITION

12 RIGHTS.—The formulary under this subsection shall 

13 be updated frequently and clinicians and patients 

14 may petition the Secretary to add new pharma15 ceuticals or to remove ineffective or dangerous medi16 cations from the formulary. 

17 (4) USE OF OFF-FORMULARY MEDICATIONS.— 

18 The Secretary shall promulgate rules regarding the 

19 use of off-formulary medications which allow for pa20 tient access but do not compromise the formulary. 

21 TITLE VII—UNIVERSAL 

22 MEDICARE TRUST FUND 

23 SEC. 701. UNIVERSAL MEDICARE TRUST FUND. 

24 (a) IN GENERAL.—There is hereby created on the 

25 books of the Treasury of the United States a trust fund 


ethrower on DSK3G9T082PROD with BILLS
55 

•S 1804 IS

1 to be known as the Universal Medicare Trust Fund (in 

2 this section referred to as the ‘‘Trust Fund’’). The Trust 

3 Fund shall consist of such gifts and bequests as may be 

4 made and such amounts as may be deposited in, or appro5 priated to, such Trust Fund as provided in this Act. 

6 (b) APPROPRIATIONS INTO TRUST FUND.— 

7 (1) TAXES.—There are hereby appropriated to 

8 the Trust Fund for each fiscal year beginning with 

9 the fiscal year which includes the date on which ben10 efits first become available as described in section 

11 106, out of any moneys in the Treasury not other12 wise appropriated, amounts equivalent to 100 per13 cent of the net increase in revenues to the Treasury 

14 which is attributable to the amendments made by 

15 sections 801 and 902. The amounts appropriated by 

16 the preceding sentence shall be transferred from 

17 time to time (but not less frequently than monthly) 

18 from the general fund in the Treasury to the Trust 

19 Fund, such amounts to be determined on the basis 

20 of estimates by the Secretary of the Treasury of the 

21 taxes paid to or deposited into the Treasury; and 

22 proper adjustments shall be made in amounts subse23 quently transferred to the extent prior estimates 

24 were in excess of or were less than the amounts that 

25 should have been so transferred. 


ethrower on DSK3G9T082PROD with BILLS
56 

•S 1804 IS

1 (2) CURRENT PROGRAM RECEIPTS.—Notwith2 standing any other provision of law, there are hereby 

3 appropriated to the Trust Fund for each fiscal year, 

4 beginning with the first fiscal year beginning on or 

5 after the effective date of benefits under section 106, 

6 the amounts that would otherwise have been appro7 priated to carry out the following programs: 

8 (A) The Medicare program under title 

9 XVIII of the Social Security Act (other than 

10 amounts attributable to any premiums under 

11 such title). 

12 (B) The Medicaid program, under State 

13 plans approved under title XIX of such Act. 

14 (C) The Federal Employees Health Bene15 fits program, under chapter 89 of title 5, 

16 United States Code. 

17 (D) The TRICARE program, under chap18 ter 55 of title 10, United States Code. 

19 (E) The maternal and child health pro20 gram (under title V of the Social Security Act), 

21 vocational rehabilitation programs, programs 

22 for drug abuse and mental health services 

23 under the Public Health Service Act, programs 

24 providing general hospital or medical assistance, 

25 and any other Federal program identified by 


ethrower on DSK3G9T082PROD with BILLS
57 

•S 1804 IS

1 the Secretary, in consultation with the Sec2 retary of the Treasury, to the extent the pro3 grams provide for payment for health services 

4 the payment of which may be made under this 

5 Act. 

6 (3) RESTRICTIONS SHALL NOT APPLY.—Any 

7 other provision of law in effect on the date of enact8 ment of this Act restricting the use of Federal funds 

9 for any reproductive health service shall not apply to 

10 monies in the Trust Fund. 

11 (c) INCORPORATION OF PROVISIONS.—The provisions 

12 of subsections (b) through (i) of section 1817 of the Social 

13 Security Act (42 U.S.C. 1395i) shall apply to the Trust 

14 Fund under this section in the same manner as such pro15 visions applied to the Federal Hospital Insurance Trust 

16 Fund under such section 1817, except that, for purposes 

17 of applying such subsections to this section, the ‘‘Board 

18 of Trustees of the Trust Fund’’ shall mean the ‘‘Sec19 retary’’. 

20 (d) TRANSFER OF FUNDS.—Any amounts remaining 

21 in the Federal Hospital Insurance Trust Fund under sec22 tion 1817 of the Social Security Act (42 U.S.C. 1395i) 

23 or the Federal Supplementary Medical Insurance Trust 

24 Fund under section 1841 of such Act (42 U.S.C. 1395t) 

25 after the payment of claims for items and services furVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
58 

•S 1804 IS

1 nished under title XVIII of such Act have been completed, 

2 shall be transferred into the Universal Medicare Trust 

3 Fund under this section. 

4 TITLE VIII—CONFORMING 

5 AMENDMENTS TO THE EM6 PLOYEE RETIREMENT IN7 COME SECURITY ACT OF 1974 

8 SEC. 801. PROHIBITION OF EMPLOYEE BENEFITS DUPLICA9 TIVE OF BENEFITS UNDER THE UNIVERSAL 

10 MEDICARE PROGRAM; COORDINATION IN 

11 CASE OF WORKERS’ COMPENSATION. 

12 (a) IN GENERAL.—Part 5 of subtitle B of title I of 

13 the Employee Retirement Income Security Act of 1974 

14 (29 U.S.C. 1131 et seq.) is amended by adding at the end 

15 the following new section: 

16 ‘‘SEC. 522. PROHIBITION OF EMPLOYEE BENEFITS DUPLI17 CATIVE OF UNIVERSAL MEDICARE PROGRAM 

18 BENEFITS; COORDINATION IN CASE OF 

19 WORKERS’ COMPENSATION. 

20 ‘‘(a) IN GENERAL.—Subject to subsection (b), no em21 ployee benefit plan may provide benefits that duplicate 

22 payment for any items or services for which payment may 

23 be made under the Medicare for All Act of 2017. 

24 ‘‘(b) REIMBURSEMENT.—Each workers compensation 

25 carrier that is liable for payment for workers compensaVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
59 

•S 1804 IS

1 tion services furnished in a State shall reimburse the Uni2 versal Medicare Program for the cost of such services. 

3 ‘‘(c) DEFINITIONS.—In this subsection— 

4 ‘‘(1) the term ‘workers compensation carrier’ 

5 means an insurance company that underwrite work6 ers compensation medical benefits with respect to 

7 one or more employers and includes an employer or 

8 fund that is financially at risk for the provision of 

9 workers compensation medical benefits; 

10 ‘‘(2) the term ‘workers compensation medical 

11 benefits’ means, with respect to an enrollee who is 

12 an employee subject to the workers compensation 

13 laws of a State, the comprehensive medical benefits 

14 for work-related injuries and illnesses provided for 

15 under such laws with respect to such an employee; 

16 and 

17 ‘‘(3) the term ‘workers compensation services’ 

18 means items and services included in workers com19 pensation medical benefits and includes items and 

20 services (including rehabilitation services and long21 term care services) commonly used for treatment of 

22 work-related injuries and illnesses.’’. 

23 (b) CONFORMING AMENDMENT.—Section 4(b) of the 

24 Employee Retirement Income Security Act of 1974 (29 

25 U.S.C. 1003(b)) is amended by adding at the end the folVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
60 

•S 1804 IS

1 lowing: ‘‘Paragraph (3) shall apply subject to section 

2 522(b) (relating to reimbursement of the Universal Medi3 care Program by workers compensation carriers).’’. 

4 (c) CLERICAL AMENDMENT.—The table of contents 

5 in section 1 of such Act is amended by inserting after the 

6 item relating to section 521 the following new item: 

‘‘Sec 522. Prohibition of employee benefits duplicative of Universal Medicare 

Program benefits; coordination in case of workers’ compensation.’’. 

7 SEC. 802. REPEAL OF CONTINUATION COVERAGE REQUIRE8 MENTS UNDER ERISA AND CERTAIN OTHER 

9 REQUIREMENTS RELATING TO GROUP 

10 HEALTH PLANS. 

11 (a) IN GENERAL.—Part 6 of subtitle B of title I of 

12 the Employee Retirement Income Security Act of 1974 

13 (29 U.S.C. 1161 et seq.) is repealed. 

14 (b) CONFORMING AMENDMENTS.— 

15 (1) Section 502(a) of such Act (29 U.S.C. 

16 1132(a)) is amended— 

17 (A) by striking paragraph (7); and 

18 (B) by redesignating paragraphs (8), (9), 

19 and (10) as paragraphs (7), (8), and (9), re20 spectively. 

21 (2) Section 502(c)(1) of such Act (29 U.S.C. 

22 1132(c)(1)) is amended by striking ‘‘paragraph (1) 

23 or (4) of section 606,’’. 


ethrower on DSK3G9T082PROD with BILLS
61 

•S 1804 IS

1 (3) Section 514(b) of such Act (29 U.S.C. 

2 1144(b)) is amended— 

3 (A) in paragraph (7), by striking ‘‘section 

4 206(d)(3)(B)(i)).’’; and 

5 (B) by striking paragraph (8). 

6 (4) The table of contents in section 1 of the 

7 Employee Retirement Income Security Act of 1974 

8 is amended by striking the items relating to part 6 

9 of subtitle B of title I of such Act. 

10 SEC. 803. EFFECTIVE DATE OF TITLE. 

11 The amendments made by this title shall take effect 

12 on the effective date of benefits under section 106(a). 

13 TITLE IX—ADDITIONAL 

14 CONFORMING AMENDMENTS 

15 SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH 

16 PROGRAMS. 

17 (a) MEDICARE, MEDICAID, AND STATE CHILDREN’S

18 HEALTH INSURANCE PROGRAM (SCHIP).— 

19 (1) IN GENERAL.—Notwithstanding any other 

20 provision of law, subject to paragraphs (2) and 

21 (3)— 

22 (A) no benefits shall be available under 

23 title XVIII of the Social Security Act for any 

24 item or service furnished beginning on or after 


ethrower on DSK3G9T082PROD with BILLS
62 

•S 1804 IS

1 the effective date of benefits under section 

2 106(a); 

3 (B) no individual is entitled to medical as4 sistance under a State plan approved under 

5 title XIX of such Act for any item or service 

6 furnished on or after such date; 

7 (C) no individual is entitled to medical as8 sistance under a State child health plan under 

9 title XXI of such Act for any item or service 

10 furnished on or after such date; and 

11 (D) no payment shall be made to a State 

12 under section 1903(a) or 2105(a) of such Act 

13 with respect to medical assistance or child 

14 health assistance for any item or service fur15 nished on or after such date. 

16 (2) TRANSITION.—In the case of inpatient hos17 pital services and extended care services during a 

18 continuous period of stay which began before the ef19 fective date of benefits under section 106, and which 

20 had not ended as of such date, for which benefits 

21 are provided under title XVIII of the Social Security 

22 Act, under a State plan under title XIX of such Act, 

23 or under a State child health plan under title XXI 

24 such Act, the Secretary of Health and Human ServVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
63 

•S 1804 IS

1 ices shall provide for continuation of benefits under 

2 such title or plan until the end of the period of stay. 

3 (3) SERVICES UNDER MEDICAID.— 

4 (A) IN GENERAL.—This subsection shall 

5 not apply to entitlement to medical assistance 

6 provided under title XIX of the Social Security 

7 Act for— 

8 (i) long-term care services (as defined 

9 in section 1947(b) of such Act); or 

10 (ii) any other service for which bene11 fits are not available under this Act and 

12 which is furnished under a State plan 

13 under title XIX of the Social Security Act 

14 which provided for medical assistance for 

15 such service on September 1, 2017. 

16 (B) COORDINATION BETWEEN SECRETARY

17 AND STATES.—The Secretary shall coordinate 

18 with the directors of State agencies responsible 

19 for administering State plans under title XIX 

20 of the Social Security Act to— 

21 (i) identify services described in sub22 paragraph (A)(ii) with respect to each 

23 State plan; and 

24 (ii) ensure that such services continue 

25 to be made available under such plan. 


ethrower on DSK3G9T082PROD with BILLS
64 

•S 1804 IS

1 (C) MAINTENANCE OF EFFORT REQUIRE2 MENT.—With respect to any service described 

3 in subparagraph (A)(ii) that is made available 

4 under a State plan under title XIX of the So5 cial Security Act, the maintenance of effort re6 quirements described in section 1947(c) of such 

7 Act (related to eligibility standards and re8 quired expenditures) shall apply to such service 

9 in the same manner that such requirements 

10 apply to long-term care services (as defined in 

11 section 1947(b) of such Act). 

12 (b) FEDERAL EMPLOYEES HEALTH BENEFITS PRO13 GRAM.—No benefits shall be made available under chapter 

14 89 of title 5, United States Code, for any part of a cov15 erage period occurring on or after the effective date. 

16 (c) TRICARE.—No benefits shall be made available 

17 under sections 1079 and 1086 of title 10, United States 

18 Code, for items or services furnished on or after the effec19 tive date. 

20 (d) TREATMENT OF BENEFITS FOR VETERANS AND

21 NATIVE AMERICANS.— 

22 (1) IN GENERAL.—Nothing in this Act shall af23 fect the eligibility of veterans for the medical bene24 fits and services provided under title 38, United 

25 States Code, or of Indians for the medical benefits 


ethrower on DSK3G9T082PROD with BILLS
65 

•S 1804 IS

1 and services provided by or through the Indian 

2 Health Service. 

3 (2) REEVALUATION.—No reevaluation of the 

4 Indian Health Service shall be undertaken without 

5 consultation with tribal leaders and stakeholders. 

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

7 EXCHANGES. 

8 Effective on the date described in section 106, the 

9 Federal and State Exchanges established pursuant to title 

10 I of the Patient Protection and Affordable Care Act (Pub11 lic Law 111–148) shall terminate, and any other provision 

12 of law that relies upon participation in or enrollment 

13 through such an Exchange, including such provisions of 

14 the Internal Revenue Code of 1986, shall cease to have 

15 force or effect. 

16 TITLE X—TRANSITION 

17 Subtitle A—Transitional Medicare 

18 Buy-In Option and Transitional 

19 Public Option 

20 SEC. 1001. LOWERING THE MEDICARE AGE. 

21 (a) IN GENERAL.—Title XVIII of the Social Security 

22 Act (42 U.S.C. 1395c et seq.) is amended by adding at 

23 the end the following new section: 

24 ‘‘TRANSITIONAL MEDICARE BUY-IN OPTION FOR CERTAIN

25 INDIVIDUALS

26 ‘‘SEC. 1899C. (a) OPTION.— 


ethrower on DSK3G9T082PROD with BILLS
66 

•S 1804 IS

1 ‘‘(1) IN GENERAL.—Every individual who meets 

2 the requirements described in paragraph (3) shall be 

3 eligible to enroll under this section. 

4 ‘‘(2) PARTS A, B, AND D BENEFITS.—An indi5 vidual enrolled under this section is entitled to the 

6 same benefits (and shall receive the same protec7 tions) under this title as an individual who is enti8 tled to benefits under part A and enrolled under 

9 parts B and D, including the ability to enroll in a 

10 Medicare Advantage plan that provides qualified pre11 scription drug coverage (an MA–PD plan). 

12 ‘‘(3) REQUIREMENTS FOR ELIGIBILITY.—The 

13 requirements described in this paragraph are the fol14 lowing: 

15 ‘‘(A) The individual is a resident of the 

16 United States. 

17 ‘‘(B) The individual is— 

18 ‘‘(i) a citizen or national of the United 

19 States; or 

20 ‘‘(ii) an alien lawfully admitted for 

21 permanent residence. 

22 ‘‘(C) The individual is not otherwise enti23 tled to benefits under part A or eligible to en24 roll under part A or part B. 


ethrower on DSK3G9T082PROD with BILLS
67 

•S 1804 IS

1 ‘‘(D) The individual has attained the appli2 cable years of age but has not attained 65 years 

3 of age. 

4 ‘‘(4) APPLICABLE YEARS OF AGE DEFINED.— 

5 For purposes of this section, the term ‘applicable 

6 years of age’ means— 

7 ‘‘(A) effective January 1 of the first year 

8 following the date of enactment of the Medicare 

9 for All Act of 2017, the age of 55; 

10 ‘‘(B) effective January 1 of the second 

11 year following such date of enactment, the age 

12 of 45; and 

13 ‘‘(C) effective January 1 of the third year 

14 following such date of enactment, the age of 35. 

15 ‘‘(b) ENROLLMENT; COVERAGE.—The Secretary shall 

16 establish enrollment periods and coverage under this sec17 tion consistent with the principles for establishment of en18 rollment periods and coverage for individuals under other 

19 provisions of this title. The Secretary shall establish such 

20 periods so that coverage under this section shall first begin 

21 on January 1 of the year on which an individual first be22 comes eligible to enroll under this section. 

23 ‘‘(c) PREMIUM.— 

24 ‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 

25 Secretary shall, during September of each year (beVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
68 

•S 1804 IS

1 ginning with the first September following the date 

2 of enactment of the Medicare for All Act of 2017), 

3 determine a monthly premium for all individuals en4 rolled under this section. Such monthly premium 

shall be equal to 1 5 ⁄12 of the annual premium com6 puted under paragraph (2)(B), which shall apply 

7 with respect to coverage provided under this section 

8 for any month in the succeeding year. 

9 ‘‘(2) ANNUAL PREMIUM.— 

10 ‘‘(A) COMBINED PER CAPITA AVERAGE FOR

11 ALL MEDICARE BENEFITS.—The Secretary shall 

12 estimate the average, annual per capita amount 

13 for benefits and administrative expenses that 

14 will be payable under parts A, B, and D (in15 cluding, as applicable, under part C) in the year 

16 for all individuals enrolled under this section. 

17 ‘‘(B) ANNUAL PREMIUM.—The annual pre18 mium under this subsection for months in a 

19 year is equal to the average, annual per capita 

20 amount estimated under subparagraph (A) for 

21 the year. 

22 ‘‘(3) INCREASED PREMIUM FOR CERTAIN PART

23 C AND D PLANS.—Nothing in this section shall pre24 clude an individual from choosing a Medicare Advan25 tage plan or a prescription drug plan which requires 


ethrower on DSK3G9T082PROD with BILLS
69 

•S 1804 IS

1 the individual to pay an additional amount (because 

2 of supplemental benefits or because it is a more ex3 pensive plan). In such case the individual would be 

4 responsible for the increased monthly premium. 

5 ‘‘(d) PAYMENT OF PREMIUMS.— 

6 ‘‘(1) IN GENERAL.—Premiums for enrollment 

7 under this section shall be paid to the Secretary at 

8 such times, and in such manner, as the Secretary 

9 determines appropriate. 

10 ‘‘(2) DEPOSIT.—Amounts collected by the Sec11 retary under this section shall be deposited in the 

12 Federal Hospital Insurance Trust Fund and the 

13 Federal Supplementary Medical Insurance Trust 

14 Fund (including the Medicare Prescription Drug Ac15 count within such Trust Fund) in such proportion 

16 as the Secretary determines appropriate. 

17 ‘‘(e) NOT ELIGIBLE FOR MEDICARE COST-SHARING

18 ASSISTANCE.—An individual enrolled under this section 

19 shall not be treated as enrolled under any part of this title 

20 for purposes of obtaining medical assistance for Medicare 

21 cost-sharing or otherwise under title XIX. 

22 ‘‘(f) TREATMENT IN RELATION TO THE AFFORDABLE

23 CARE ACT.— 

24 ‘‘(1) SATISFACTION OF INDIVIDUAL MAN25 DATE.—For purposes of applying section 5000A of 


ethrower on DSK3G9T082PROD with BILLS
70 

•S 1804 IS

1 the Internal Revenue Code of 1986, the coverage 

2 provided under this section constitutes minimum es3 sential coverage under subsection (f)(1)(A)(i) of 

4 such section 5000A. 

5 ‘‘(2) ELIGIBILITY FOR PREMIUM ASSISTANCE.— 

6 Coverage provided under this section— 

7 ‘‘(A) shall be treated as coverage under a 

8 qualified health plan in the individual market 

9 enrolled in through the Exchange where the in10 dividual resides for all purposes of section 36B 

11 of the Internal Revenue Code of 1986 other 

12 than subsection (c)(2)(B) thereof; and 

13 ‘‘(B) shall not be treated as eligibility for 

14 other minimum essential coverage for purposes 

15 of subsection (c)(2)(B) of such section 36B. 

16 The Secretary shall determine the applicable second 

17 lowest cost silver plan which shall apply to coverage 

18 under this section for purposes of section 36B of 

19 such Code. 

20 ‘‘(3) ELIGIBILITY FOR COST-SHARING SUB21 SIDIES.—For purposes of applying section 1402 of 

22 the Patient Protection and Affordable Care Act (42 

23 U.S.C. 18071)— 

24 ‘‘(A) coverage provided under this section 

25 shall be treated as coverage under a qualified 


ethrower on DSK3G9T082PROD with BILLS
71 

•S 1804 IS

1 health plan in the silver level of coverage in the 

2 individual market offered through an Exchange; 

3 and 

4 ‘‘(B) the Secretary shall be treated as the 

5 issuer of such plan. 

6 ‘‘(g) GUARANTEED ISSUE OF MEDIGAP POLICIES

7 UPON FIRST ENROLLMENT AND EACH SUBSEQUENT EN8 ROLLMENT.—In the case of an individual who enrolls 

9 under this section (including an individual who was pre10 viously enrolled under this section), paragraphs (2)(A), 

11 (2)(D), (3)(B)(ii), and (3)(B)(vi) of section 1882(s)— 

12 ‘‘(1) shall be applied by substituting ‘the appli13 cable year of age (as defined in section 

14 1899C(a)(4))’ for ‘65 years of age’; 

15 ‘‘(2) if the individual was enrolled under this 

16 section and subsequently disenrolls, shall apply each 

17 time the individual subsequently reenrolls under this 

18 section as if the individual had attained the applica19 ble year of age (as defined in subsection (a)(4)) on 

20 the date of such reenrollment (and as if the indi21 vidual had never previously enrolled in a Medicare 

22 supplemental policy); and 

23 ‘‘(3) shall be applied as if this section had not 

24 been enacted (and as if the individual had never preVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
72 

•S 1804 IS

1 viously enrolled in a Medicare supplemental policy) 

2 when the individual attains 65 years of age. 

3 ‘‘(h) NO EFFECT ON BENEFITS FOR INDIVIDUALS

4 OTHERWISE ELIGIBLE OR ON TRUST FUNDS.—The Sec5 retary shall implement the provisions of this section in 

6 such a manner to ensure that such provisions— 

7 ‘‘(1) have no effect on the benefits under this 

8 title for individuals who are entitled to, or enrolled 

9 for, such benefits other than through this section; 

10 and 

11 ‘‘(2) have no negative impact on the Federal 

12 Hospital Insurance Trust Fund or the Federal Sup13 plementary Medical Insurance Trust Fund (includ14 ing the Medicare Prescription Drug Account within 

15 such Trust Fund). 

16 ‘‘(i) CONSULTATION.—In promulgating regulations 

17 to implement this section, the Secretary shall consult with 

18 interested parties, including groups representing bene19 ficiaries, health care providers, employers, and insurance 

20 companies.’’. 

21 SEC. 1002. ESTABLISHMENT OF THE MEDICARE TRANSI22 TION PLAN. 

23 (a) IN GENERAL.—To carry out the purpose of this 

24 section, for plan years beginning with the first plan year 

25 that begins after the date of enactment of this Act and 


ethrower on DSK3G9T082PROD with BILLS
73 

•S 1804 IS

1 ending with the effective date described in section 106, 

2 the Secretary, acting through the Administrator of the 

3 Centers for Medicare & Medicaid (referred to in this sec4 tion as the ‘‘Administrator’’), shall establish, and provide 

5 for the offering through the Exchanges, of a public health 

6 plan (in this Act referred to as the ‘‘Medicare Transition 

7 plan’’) that provides affordable, high-quality health bene8 fits coverage throughout the United States. 

9 (b) ADMINISTRATING THE MEDICARE TRANSI10 TION.— 

11 (1) ADMINISTRATOR.—The Administrator shall 

12 administer the Medicare Transition plan in accord13 ance with this section. 

14 (2) APPLICATION OF ACA REQUIREMENTS.— 

15 Consistent with this section, the Medicare Transition 

16 plan shall comply with requirements under title I of 

17 the Patient Protection and Affordable Care Act (and 

18 the amendments made by that title) and title XXVII 

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

20 et seq.) that are applicable to qualified health plans 

21 offered through the Exchanges, subject to the limita22 tion under subsection (e)(2). 

23 (3) OFFERING THROUGH EXCHANGES.—The 

24 Medicare Transition plan shall be made available 

25 only through the Exchanges, and shall be available 


ethrower on DSK3G9T082PROD with BILLS
74 

•S 1804 IS

1 to individuals wishing to enroll and to qualified em2 ployers (as defined in section 1312(f)(2) of the Pa3 tient Protection and Affordable Care Act (42 U.S.C. 

4 18032)) who wish to make such plan available to 

5 their employees. 

6 (4) ELIGIBILITY TO PURCHASE.—Any United 

7 States resident may enroll in the Medicare Transi8 tion plan. 

9 (c) BENEFITS; ACTUARIAL VALUE.—In carrying out 

10 this section, the Administrator shall ensure that the Medi11 care Transition plan provides— 

12 (1) coverage for the benefits required to be cov13 ered under title II; and 

14 (2) coverage of benefits that are actuarially 

15 equivalent to 90 percent of the full actuarial value 

16 of the benefits provided under the plan. 

17 (d) PROVIDERS AND REIMBURSEMENT RATES.— 

18 (1) IN GENERAL.—With respect to the reim19 bursement provided to health care providers for cov20 ered benefits, as described in section 201, provided 

21 under the Medicare Transition plan, the Adminis22 trator shall reimburse such providers at rates deter23 mined for equivalent items and services under the 

24 original Medicare fee-for-service program under 

25 parts A and B of title XVIII of the Social Security 


ethrower on DSK3G9T082PROD with BILLS
75 

•S 1804 IS

1 Act (42 U.S.C. 1395c et seq.). For items and serv2 ices covered under the Medicare Transition plan but 

3 not covered under such parts A and B, the Adminis4 trator shall reimburse providers at rates set by the 

5 Administrator in a manner consistent with the man6 ner in which rates for other items and services were 

7 set under the original Medicare fee-for-service pro8 gram. 

9 (2) PRESCRIPTION DRUGS.—Any payment rate 

10 under this subsection for a prescription drug shall be 

11 at a rate negotiated by the Administrator with the 

12 manufacturer of the drug. If the Administrator is 

13 unable to reach a negotiated agreement on such a 

14 reimbursement rate, the Administrator shall estab15 lish the rate at an amount equal to the lesser of— 

16 (A) the price paid by the Secretary of Vet17 erans Affairs to procure the drug under the 

18 laws administered by the Secretary of Veterans 

19 Affairs; 

20 (B) the price paid to procure the drug 

21 under section 8126 of title 38, United States 

22 Code; or 

23 (C) the best price determined under sec24 tion 1927(c)(1)(C) of the Social Security Act 

25 (42 U.S.C. 1396r–8(c)(1)(C)) for the drug. 


ethrower on DSK3G9T082PROD with BILLS
76 

•S 1804 IS

1 (3) PARTICIPATING PROVIDERS.— 

2 (A) IN GENERAL.—A health care provider 

3 that is a participating provider of services or 

4 supplier under the Medicare program under 

5 title XVIII of the Social Security Act (42 

6 U.S.C. 1395 et seq.) or under a State Medicaid 

7 plan under title XIX of such Act (42 U.S.C. 

8 1396 et seq.) on the date of enactment of this 

9 Act shall be a participating provider in the 

10 Medicare Transition plan. 

11 (B) ADDITIONAL PROVIDERS.—The Ad12 ministrator shall establish a process to allow 

13 health care providers not described in subpara14 graph (A) to become participating providers in 

15 the Medicare Transition plan. Such process 

16 shall be similar to the process applied to new 

17 providers under the Medicare program. 

18 (e) PREMIUMS.— 

19 (1) DETERMINATION.—The Administrator shall 

20 determine the premium amount for enrolling in the 

21 Medicare Transition plan, which— 

22 (A) may vary according to family or indi23 vidual coverage, age, and tobacco status (con24 sistent with clauses (i), (iii), and (iv) of section 


ethrower on DSK3G9T082PROD with BILLS
77 

•S 1804 IS

1 2701(a)(1)(A) of the Public Health Service Act 

2 (42 U.S.C. 300gg(a)(1)(A))); and 

3 (B) shall take into account the cost-shar4 ing reductions and premium tax credits which 

5 will be available with respect to the plan under 

6 section 1402 of the Patient Protection and Af7 fordable Care Act (42 U.S.C. 18071) and sec8 tion 36B of the Internal Revenue Code of 1986, 

9 as amended by subsection (g). 

10 (2) LIMITATION.—Variation in premium rates 

11 of the Medicare Transition plan by rating area, as 

12 described in clause (ii) of section 2701(a)(1)(A)(iii) 

13 of the Public Health Service Act (42 U.S.C. 

14 300gg(a)(1)(A)) is not permitted. 

15 (f) TERMINATION.—This section shall cease to have 

16 force or effect on the effective date described in section 

17 106. 

18 (g) TAX CREDITS AND COST-SHARING SUBSIDIES.— 

19 (1) PREMIUM ASSISTANCE TAX CREDITS.— 

20 (A) CREDITS ALLOWED TO MEDICARE

21 TRANSITION PLAN ENROLLEES AT OR ABOVE 44

22 PERCENT OF POVERTY IN NON-EXPANSION

23 STATES.—Paragraph (1) of section 36B(c) of 

24 the Internal Revenue Code of 1986 is amended 

25 by redesignating subparagraphs (C) and (D) as 


ethrower on DSK3G9T082PROD with BILLS
78 

•S 1804 IS

1 subparagraphs (D) and (E), respectively, and 

2 by inserting after subparagraph (B) the fol3 lowing new subparagraph: 

4 ‘‘(C) SPECIAL RULES FOR MEDICARE

5 TRANSITION PLAN ENROLLEES.— 

6 ‘‘(i) IN GENERAL.—In the case of a 

7 taxpayer who is covered, or whose spouse 

8 or dependent (as defined in section 152) is 

9 covered, by the Medicare Transition plan 

10 established under section 1002(a) of the 

11 Medicare for All Act of 2017 for all 

12 months in the taxable year, subparagraph 

13 (A) shall be applied without regard to ‘but 

14 does not exceed 400 percent’. 

15 ‘‘(ii) ENROLLEES IN MEDICAID NON16 EXPANSION STATES.—In the case of a tax17 payer residing in a State which (as of the 

18 date of the enactment of the Medicare for 

19 All Act of 2017) does not provide for eligi20 bility under clause (i)(VIII) or (ii)(XX) of 

21 section 1902(a)(10)(A) of the Social Secu22 rity Act for medical assistance under title 

23 XIX of such Act (or a waiver of the State 

24 plan approved under section 1115) who is 

25 covered, or whose spouse or dependent (as 


ethrower on DSK3G9T082PROD with BILLS
79 

•S 1804 IS

1 defined in section 152) is covered, by the 

2 Medicare Transition plan established under 

3 section 1002(a) of the Medicare for All Act 

4 of 2017 for all months in the taxable year, 

5 subparagraphs (A) and (B) shall be ap6 plied by substituting ‘0 percent’ for ‘100 

7 percent’ each place it appears.’’. 

8 (B) PREMIUM ASSISTANCE AMOUNTS FOR

9 TAXPAYERS ENROLLED IN MEDICARE TRANSI10 TION PLAN.— 

11 (i) IN GENERAL.—Subparagraph (A) 

12 of section 36B(b)(3) of such Code is 

13 amended— 

14 (I) by redesignating clause (ii) as 

15 clause (iii), 

16 (II) by striking ‘‘clause (ii)’’ in 

17 clause (i) and inserting ‘‘clauses (ii) 

18 and (iii)’’, and 

19 (III) by inserting after clause (i) 

20 the following new clause: 

21 ‘‘(ii) SPECIAL RULES FOR TAXPAYERS

22 ENROLLED IN MEDICARE TRANSITION

23 PLAN.—In the case of a taxpayer who is 

24 covered, or whose spouse or dependent (as 

25 defined in section 152) is covered, by the 


ethrower on DSK3G9T082PROD with BILLS
80 

•S 1804 IS

1 Medicare Transition plan established under 

2 section 1002(a) of the Medicare for All Act 

3 of 2017 for all months in the taxable year, 

4 the applicable percentage for any taxable 

5 year shall be determined in the same man6 ner as under clause (i), except that the fol7 lowing table shall apply in lieu of the table 

8 contained in such clause: 

‘‘In the case of household 

income (expressed as a 

percent of poverty line) 

within the following 

income tier: 

The initial premium 

percentage is— 

The final premium 

percentage is— 

Up to 100% ....................... 2% 2%

100% up to 138% ............. 2.04% 2.04%

138% up to 150% ............. 3.06% 4.08%

150% and above ................ 4.08% 5%.’’. 

9 (ii) CONFORMING AMENDMENT.—Sub10 clause (I) of clause (iii) of section 

11 36B(b)(3) of such Code, as redesignated 

12 by subparagraph (A)(i), is amended by in13 serting ‘‘, and determined after the appli14 cation of clause (ii)’’ after ‘‘after applica15 tion of this clause’’. 

16 (2) COST-SHARING SUBSIDIES.—Subsection (b) 

17 of section 1402 of the Patient Protection and Af18 fordable Care Act (42 U.S.C. 18071(b)) is amend19 ed— 


ethrower on DSK3G9T082PROD with BILLS
81 

•S 1804 IS

1 (A) by inserting ‘‘, or in the Medicare 

2 Transition plan established under section 

3 1002(a) of the Medicare for All Act of 2017,’’ 

4 after ‘‘coverage’’ in paragraph (1); 

5 (B) by redesignating paragraphs (1) (as so 

6 amended) and (2) as subparagraphs (A) and 

7 (B), respectively, and by moving such subpara8 graphs 2 ems to the right; 

9 (C) by striking ‘‘INSURED.—In this sec10 tion’’ and inserting ‘‘INSURED.— 

11 ‘‘(1) IN GENERAL.—In this section’’; 

12 (D) by striking the flush language; and 

13 (E) by adding at the end the following new 

14 paragraph: 

15 ‘‘(2) SPECIAL RULES.— 

16 ‘‘(A) INDIVIDUALS LAWFULLY PRESENT.— 

17 In the case of an individual described in section 

18 36B(c)(1)(B) of the Internal Revenue Code of 

19 1986, the individual shall be treated as having 

20 household income equal to 100 percent of the 

21 poverty line for a family of the size involved for 

22 purposes of applying this section. 

23 ‘‘(B) MEDICARE TRANSITION PLAN EN24 ROLLEES IN MEDICAID NON-EXPANSION

25 STATES.—In the case of an individual residing 


ethrower on DSK3G9T082PROD with BILLS
82 

•S 1804 IS

1 in a State which (as of the date of the enact2 ment of the Medicare for All Act of 2017) does 

3 not provide for eligibility under clause (i)(VIII) 

4 or (ii)(XX) of section 1902(a)(10)(A) of the So5 cial Security Act for medical assistance under 

6 title XIX of such Act (or a waiver of the State 

7 plan approved under section 1115) who enrolls 

8 in such Medicare Transition plan, the preceding 

9 sentence, paragraph (1)(B), and paragraphs 

10 (1)(A)(i) and (2)(A) of subsection (c) shall each 

11 be applied by substituting ‘0 percent’ for ‘100 

12 percent’ each place it appears. 

13 ‘‘(C) ADJUSTED COST-SHARING FOR MEDI14 CARE TRANSITION PLAN ENROLLEES.—In the 

15 case of any individual who enrolls in such Medi16 care Transition plan, in lieu of the percentages 

17 under subsection (c)(1)(B)(i) and (c)(2), the 

18 Secretary shall prescribe a method of deter19 mining the cost-sharing reduction for any such 

20 individual such that the total of the cost-shar21 ing and the premiums paid by the individual 

22 under such Medicare Transition plan does not 

23 exceed the percentage of the total allowed costs 

24 of benefits provided under the plan equal to the 

25 final premium percentage applicable to such inVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
83 

•S 1804 IS

1 dividual under section 36B(b)(3)(A)(ii) of the 

2 Internal Revenue Code of 1986.’’. 

3 (h) CONFORMING AMENDMENTS.— 

4 (1) TREATMENT AS A QUALIFIED HEALTH

5 PLAN.—Section 1301(a)(2) of the Patient Protection 

6 and Affordable Care Act (42 U.S.C. 18021(a)(2)) is 

7 amended— 

8 (A) in the paragraph heading, by inserting 

9 ‘‘, THE MEDICARE TRANSITION PLAN,’’ before 

10 ‘‘AND’’; and 

11 (B) by inserting ‘‘The Medicare Transition 

12 plan,’’ before ‘‘and a multi-State plan’’. 

13 (2) LEVEL PLAYING FIELD.—Section 1324(a) 

14 of the Patient Protection and Affordable Care Act 

15 (42 U.S.C. 18044(a)) is amended by inserting ‘‘the 

16 Medicare Transition plan,’’ before ‘‘or a multi-State 

17 qualified health plan’’. 

18 Subtitle B—Transitional Medicare 

19 Reforms 

20 SEC. 1011. MEDICARE PROTECTION AGAINST HIGH OUT-OF21 POCKET EXPENDITURES FOR FEE-FOR-SERV22 ICE BENEFITS AND ELIMINATION OF PARTS A 

23 AND B DEDUCTIBLES. 

24 (a) PROTECTION AGAINST HIGH OUT-OF-POCKET

25 EXPENDITURES.—Title XVIII of the Social Security Act 


ethrower on DSK3G9T082PROD with BILLS
84 

•S 1804 IS

1 (42 U.S.C. 1395 et seq.), as amended by section 1001, 

2 is amended by adding at the end the following new section: 

3 ‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET

4 EXPENDITURES

5 ‘‘SEC. 1899D. (a) IN GENERAL.—Notwithstanding 

6 any other provision of this title, in the case of an indi7 vidual entitled to, or enrolled for, benefits under part A 

8 or enrolled in part B, if the amount of the out-of-pocket 

9 cost-sharing of such individual for a year (effective the 

10 year beginning January 1 of the year following the date 

11 of enactment of the Medicare for All Act of 2017) equals 

12 or exceeds $1,500, the individual shall not be responsible 

13 for additional out-of-pocket cost-sharing occurred during 

14 that year. 

15 ‘‘(b) OUT-OF-POCKET COST-SHARING DEFINED.— 

16 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

17 and (3), in this section, the term ‘out-of-pocket cost18 sharing’ means, with respect to an individual, the 

19 amount of the expenses incurred by the individual 

20 that are attributable to— 

21 ‘‘(A) coinsurance and copayments applica22 ble under part A or B; or 

23 ‘‘(B) for items and services that would 

24 have otherwise been covered under part A or B 

25 but for the exhaustion of those benefits. 

26 ‘‘(2) CERTAIN COSTS NOT INCLUDED.— 


ethrower on DSK3G9T082PROD with BILLS
85 

•S 1804 IS

1 ‘‘(A) NON-COVERED ITEMS AND SERV2 ICES.—Expenses incurred for items and serv3 ices which are not included (or treated as being 

4 included) under part A or B shall not be con5 sidered incurred expenses for purposes of deter6 mining out-of-pocket cost-sharing under para7 graph (1). 

8 ‘‘(B) ITEMS AND SERVICES NOT FUR9 NISHED ON AN ASSIGNMENT-RELATED BASIS.— 

10 If an item or service is furnished to an indi11 vidual under this title and is not furnished on 

12 an assignment-related basis, any additional ex13 penses the individual incurs above the amount 

14 the individual would have incurred if the item 

15 or service was furnished on an assignment-re16 lated basis shall not be considered incurred ex17 penses for purposes of determining out-of-pock18 et cost-sharing under paragraph (1). 

19 ‘‘(3) SOURCE OF PAYMENT.—For purposes of 

20 paragraph (1), the Secretary shall consider expenses 

21 to be incurred by the individual without regard to 

22 whether the individual or another person, including 

23 a State program or other third-party coverage, has 

24 paid for such expenses.’’. 


ethrower on DSK3G9T082PROD with BILLS
86 

•S 1804 IS

1 (b) ELIMINATION OF PARTS A AND B 

2 DEDUCTIBLES.— 

3 (1) PART A.—Section 1813(b) of the Social Se4 curity Act (42 U.S.C. 1395e(b)) is amended by add5 ing at the end the following new paragraph: 

6 ‘‘(4) For each year (beginning January 1 of the year 

7 following the date of enactment of the Medicare for All 

8 Act of 2017), the inpatient hospital deductible for the year 

9 shall be $0.’’. 

10 (2) PART B.—Section 1833(b) of the Social Se11 curity Act (42 U.S.C. 1395l(b)) is amended, in the 

12 first sentence— 

13 (A) by striking ‘‘and for a subsequent 

14 year’’ and inserting ‘‘for each of 2006 through 

15 the year that includes the date of enactment of 

16 the Medicare for All Act of 2017’’; and 

17 (B) by inserting ‘‘, and $0 for each year 

18 subsequent year’’ after ‘‘$1)’’. 

19 SEC. 1012. REDUCTION IN MEDICARE PART D ANNUAL OUT20 OF-POCKET THRESHOLD AND ELIMINATION 

21 OF COST-SHARING ABOVE THAT THRESHOLD. 

22 (a) REDUCTION.—Section 1860D–2(b)(4)(B) of the 

23 Social Security Act (42 U.S.C. 1395w–102(b)(4)(B)) is 

24 amended— 


ethrower on DSK3G9T082PROD with BILLS
87 

•S 1804 IS

1 (1) in clause (i), by striking ‘‘For purposes’’ 

2 and inserting ‘‘Subject to clause (iii), for purposes’’; 

3 and 

4 (2) by adding at the end the following new 

5 clause: 

6 ‘‘(iii) REDUCTION IN THRESHOLD

7 DURING TRANSITION PERIOD.— 

8 ‘‘(I) IN GENERAL.—Subject to 

9 subclause (II), for plan years begin10 ning on or after January 1 following 

11 the date of enactment of the Medicare 

12 for All Act of 2017 and before Janu13 ary 1 of the year that is 4 years fol14 lowing such date of enactment, not15 withstanding clauses (i) and (ii), the 

16 ‘annual out-of-pocket threshold’ speci17 fied in this subparagraph is equal to 

18 $305. 

19 ‘‘(II) AUTHORITY TO EXEMPT

20 BRAND-NAME DRUGS IF GENERIC

21 AVAILABLE.—In applying subclause 

22 (I), the Secretary may exempt costs 

23 incurred for a covered part D drug 

24 that is an applicable drug under sec25 tion 1860D–14A(g)(2) if the SecVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
88 

•S 1804 IS

1 retary determines that a generic 

2 version of that drug is available.’’. 

3 (b) ELIMINATION OF COST-SHARING.—Section 

4 1860D–2(b)(4)(A) of the Social Security Act (42 U.S.C. 

5 1395w–102(b)(4)(A)) is amended— 

6 (1) in clause (i)— 

7 (A) by redesignating subclauses (I) and 

8 (II) as items (aa) and (bb), respectively; 

9 (B) by striking ‘‘subparagraph (B), with 

10 cost-sharing’’ and inserting the following: ‘‘sub11 paragraph (B)— 

12 ‘‘(I) for plan years 2006 through 

13 the plan year ending December 31 fol14 lowing the date of enactment of the 

15 Medicare for All Act of 2017, with 

16 cost-sharing’’; 

17 (C) in item (bb), as redesignated by sub18 paragraph (A), by striking the period at the 

19 end and inserting ‘‘; and’’; and 

20 (D) by adding at the end the following new 

21 subclause: 

22 ‘‘(II) for the plan year beginning 

23 January 1 following the date of enact24 ment of the Medicare for All Act of 


ethrower on DSK3G9T082PROD with BILLS
89 

•S 1804 IS

1 2017 and the two subsequent plan 

2 years, without any cost-sharing.’’; and 

3 (2) in clause (ii)— 

4 (A) by striking ‘‘clause (i)(I)’’ and insert5 ing ‘‘clause (i)(I)(aa)’’; and 

6 (B) by adding at the end the following new 

7 sentence: ‘‘The Secretary shall continue to cal8 culate the dollar amounts specified in clause 

9 (i)(I)(aa), including with the adjustment under 

10 this clause, after plan year 2018 for purposes 

11 of 1860D–14(a)(1)(D)(iii).’’. 

12 (c) CONFORMING AMENDMENTS TO LOW-INCOME

13 SUBSIDY.—Section 1860D–14(a) of the Social Security 

14 Act (42 U.S.C. 1395w–114(a)) is amended— 

15 (1) in paragraph (1)— 

16 (A) in subparagraph (D)(iii), by striking 

17 ‘‘1860D–2(b)(4)(A)(i)(I)’’ and inserting 

18 ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’; and 

19 (B) in subparagraph (E)— 

20 (i) in the heading, by inserting 

21 ‘‘PRIOR TO THE ELIMINATION OF SUCH

22 COST-SHARING FOR ALL INDIVIDUALS’’ 

23 after ‘‘THRESHOLD’’; and 

24 (ii) by striking ‘‘The elimination’’ and 

25 inserting ‘‘For plan years 2006 through 


ethrower on DSK3G9T082PROD with BILLS
90 

•S 1804 IS

1 the plan year ending December 31 fol2 lowing the date of enactment of the Medi3 care for All Act of 2017, the elimination’’; 

4 and 

5 (2) in paragraph (2)(E)— 

6 (A) in the heading, by inserting ‘‘PRIOR TO

7 THE ELIMINATION OF SUCH COST-SHARING FOR

8 ALL INDIVIDUALS’’ after ‘‘THRESHOLD’’; 

9 (B) by striking ‘‘Subject to’’ and inserting 

10 ‘‘For plan years 2006 through the plan year 

11 ending December 31 following the date of en12 actment of the Medicare for All Act of 2017, 

13 subject to’’; and 

14 (C) by striking ‘‘1860D–2(b)(4)(A)(i)(I)’’ 

15 and inserting ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’. 

16 SEC. 1013. COVERAGE OF DENTAL AND VISION SERVICES 

17 AND HEARING AIDS AND EXAMINATIONS 

18 UNDER MEDICARE PART B. 

19 (a) DENTAL SERVICES.— 

20 (1) REMOVAL OF EXCLUSION FROM COV21 ERAGE.—Section 1862(a) of the Social Security Act 

22 (42 U.S.C. 1395y(a)) is amended by striking para23 graph (12). 

24 (2) COVERAGE.— 


ethrower on DSK3G9T082PROD with BILLS
91 

•S 1804 IS

1 (A) IN GENERAL.—Section 1861(s)(2) of 

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

3 is amended— 

4 (i) in subparagraph (FF), by striking 

5 ‘‘and’’ at the end; 

6 (ii) in subparagraph (GG), by insert7 ing ‘‘and’’ at the end; and 

8 (iii) by adding at the end the fol9 lowing new subparagraph: 

10 ‘‘(HH) dental services;’’. 

11 (B) PAYMENT.—Section 1833(a)(1) of the 

12 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

13 amended— 

14 (i) by striking ‘‘and’’ before ‘‘(BB)’’; 

15 and 

16 (ii) by inserting before the semicolon 

17 at the end the following: ‘‘, and (CC) with 

18 respect to dental services described in sec19 tion 1861(s)(2)(HH), the amount paid 

20 shall be an amount equal to 80 percent of 

21 the lesser of the actual charge for the serv22 ices or the amount determined under the 

23 fee schedule established under section 

24 1848(b).’’. 


ethrower on DSK3G9T082PROD with BILLS
92 

•S 1804 IS

1 (C) EFFECTIVE DATE.—The amendments 

2 made by this subsection shall apply to items 

3 and services furnished on or after January 1 

4 following the date of the enactment of this Act. 

5 (b) VISION SERVICES.— 

6 (1) IN GENERAL.—Section 1861(s)(2) of the 

7 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

8 amended by subsection (a), is amended— 

9 (A) in subparagraph (GG), by striking 

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (HH), by inserting 

12 ‘‘and’’ at the end; and 

13 (C) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(II) vision services;’’. 

16 (2) PAYMENT.—Section 1833(a)(1) of the So17 cial Security Act (42 U.S.C. 1395l(a)(1)), as amend18 ed by subsection (a), is amended— 

19 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 

20 (B) by inserting before the semicolon at 

21 the end the following: ‘‘, and (DD) with respect 

22 to vision services described in section 

23 1861(s)(2)(II), the amount paid shall be an 

24 amount equal to 80 percent of the lesser of the 

25 actual charge for the services or the amount deVerDate Sep 11 2014 22:32 Sep 19, 2017 Jkt 069200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S1804.IS S1804

ethrower on DSK3G9T082PROD with BILLS
93 

•S 1804 IS

1 termined under the fee schedule established 

2 under section 1848(b).’’. 

3 (3) EFFECTIVE DATE.—The amendments made 

4 by this subsection shall apply to items and services 

5 furnished on or after January 1 following the date 

6 of the enactment of this Act. 

7 (c) HEARING AIDS AND EXAMINATIONS THERE8 FOR.— 

9 (1) IN GENERAL.—Section 1862(a)(7) of the 

10 Social Security Act (42 U.S.C. 1395y(a)(7)) is 

11 amended by striking ‘‘hearing aids or examinations 

12 therefor,’’. 

13 (2) EFFECTIVE DATE.—The amendment made 

14 by this subsection shall apply to items and services 

15 furnished on or after January 1 following the date 

16 of the enactment of this Act. 

17 SEC. 1014. ELIMINATING THE 24-MONTH WAITING PERIOD 

18 FOR MEDICARE COVERAGE FOR INDIVID19 UALS WITH DISABILITIES. 

20 (a) IN GENERAL.—Section 226(b) of the Social Secu21 rity Act (42 U.S.C. 426(b)) is amended— 

22 (1) in paragraph (2)(A), by striking ‘‘, and has 

23 for 24 calendar months been entitled to,’’; 

24 (2) in paragraph (2)(B), by striking ‘‘, and has 

25 been for not less than 24 months,’’; 


ethrower on DSK3G9T082PROD with BILLS
94 

•S 1804 IS

1 (3) in paragraph (2)(C)(ii), by striking ‘‘, in2 cluding the requirement that he has been entitled to 

3 the specified benefits for 24 months,’’; 

4 (4) in the first sentence, by striking ‘‘for each 

5 month beginning with the later of (I) July 1973 or 

6 (II) the twenty-fifth month of his entitlement or sta7 tus as a qualified railroad retirement beneficiary de8 scribed in paragraph (2), and’’ and inserting ‘‘for 

9 each month for which the individual meets the re10 quirements of paragraph (2), beginning with the 

11 month following the month in which the individual 

12 meets the requirements of such paragraph, and’’; 

13 and 

14 (5) in the second sentence, by striking ‘‘the 

15 ‘twenty-fifth month of his entitlement’ ’’ and all that 

16 follows through ‘‘paragraph (2)(C) and’’. 

17 (b) CONFORMING AMENDMENTS.— 

18 (1) SECTION 226.—Section 226 of the Social 

19 Security Act (42 U.S.C. 426) is amended by— 

20 (A) striking subsections (e)(1)(B), (f), and 

21 (h); and 

22 (B) redesignating subsections (g) and (i) 

23 as subsections (f) and (g), respectively. 

24 (2) MEDICARE DESCRIPTION.—Section 1811(2) 

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


ethrower on DSK3G9T082PROD with BILLS
95 

•S 1804 IS

1 amended by striking ‘‘have been entitled for not less 

2 than 24 months’’ and inserting ‘‘are entitled’’. 

3 (3) MEDICARE COVERAGE.—Section 1837(g)(1) 

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

5 is amended by striking ‘‘25th month of’’ and insert6 ing ‘‘month following the first month of’’. 

7 (4) RAILROAD RETIREMENT SYSTEM.—Section 

8 7(d)(2)(ii) of the Railroad Retirement Act of 1974 

9 (45 U.S.C. 231f(d)(2)(ii)) is amended— 

10 (A) by striking ‘‘has been entitled to an 

11 annuity’’ and inserting ‘‘is entitled to an annu12 ity’’; 

13 (B) by striking ‘‘, for not less than 24 

14 months’’; and 

15 (C) by striking ‘‘could have been entitled 

16 for 24 calendar months, and’’. 

17 (c) EFFECTIVE DATE.—The amendments made by 

18 this section shall apply to insurance benefits under title 

19 XVIII of the Social Security Act with respect to items and 

20 services furnished in months beginning after December 1 

21 following the date of enactment of this Act, and before 

22 January 1 of the year that is 4 years after such date of 

23 enactment. 


ethrower on DSK3G9T082PROD with BILLS
96 

•S 1804 IS

1 TITLE XI—MISCELLANEOUS 

2 SEC. 1101. DEFINITIONS. 

3 In this Act— 

4 (1) the term ‘‘Secretary’’ means the Secretary 

5 of Health and Human Services; 

6 (2) the term ‘‘State’’ means a State, the Dis7 trict of Columbia, or a territory of the United 

8 States; and 

9 (3) the term ‘‘United States’’ shall include the 

10 States, the District of Columbia, and the territories 

11 of the United States. 

Æ 


ethrower on DSK3G9T082PROD with BILLS