I 

113TH CONGRESS 

2D SESSION H. R. 5113 

To amend title XIX of the Social Security Act to end the increased Federal 

funding for Medicaid expansion with respect to inmates’ hospital care 

under the Patient Protection and Affordable Care Act, to apply the 

savings towards a 2015 Medicare Advantage stabilization program to 

help protect seniors’ choices, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 15, 2014 

Mr. COFFMAN (for himself, Mrs. BLACKBURN, Mr. NUGENT, Mr. LAMBORN, 

and Mr. HALL) introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committee 

on Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XIX of the Social Security Act to end the 

increased Federal funding for Medicaid expansion with 

respect to inmates’ hospital care under the Patient Protection and Affordable Care Act, to apply the savings 

towards a 2015 Medicare Advantage stabilization program to help protect seniors’ choices, and for other purposes. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Protecting Seniors’ 

3 Medicare Choices from Obamacare Act of 2014’’. 

4 SEC. 2. ELIMINATING PPACA ENHANCED MEDICAID FMAP 

5 FOR PRISONERS AND APPLYING SAVINGS TO 

6 MEDICARE ADVANTAGE IMPROVEMENT 

7 FUND. 

8 (a) ELIMINATION OF PPACA ENHANCED MEDICAID

9 FMAP FOR PRISONERS.— 

10 (1) IN GENERAL.—Section 1905 of the Social 

11 Security Act (42 U.S.C. 1396d) is amended— 

12 (A) in subsection (y)(2)(A), by adding at 

13 the end the following: ‘‘Such term does not in14 clude an individual described in such subpara15 graph during the period in which the individual 

16 is an inmate in a public institution or in which 

17 the public institution maintains jurisdiction 

18 over the individual.’’; and 

19 (B) in subsection (z)(1)(A), by inserting 

20 before the period at the end the following: ‘‘and 

21 who are not inmates of a public institution (or 

22 individuals over whom a public institution main23 tains jurisdiction)’’. 

24 (2) EFFECTIVE DATE.—The amendments made 

25 by paragraph (1) shall apply to items and services 

26 furnished on or after January 1, 2015. 


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1 (b) APPLICATION OF SAVINGS TO 2015 TO ESTAB2 LISHMENT OF 2015 MEDICARE ADVANTAGE STABILIZA3 TION PROGRAM.—Section 1859 of the Social Security Act 

4 (42 U.S.C. 1395w–28) is amended by adding at the end 

5 the following new subsection: 

6 ‘‘(h) 2015 MEDICARE ADVANTAGE STABILIZATION

7 PROGRAM.— 

8 ‘‘(1) ESTABLISHMENT.—There is established a 

9 Medicare Advantage stabilization program (in this 

10 subsection referred to as the ‘stabilization program’) 

11 under which the Secretary shall, subject to para12 graph (6), provide a PMPM stabilization funding 

13 amount to each eligible Medicare Advantage plan in 

14 accordance with this subsection to be used by such 

15 plan for plan year 2015 to address the beneficiary 

16 plan inadequacies applicable to such plan (as de17 scribed in paragraph (5)). 

18 ‘‘(2) ELIGIBLE MEDICARE ADVANTAGE

19 PLANS.—For purposes of this subsection, an eligible 

20 Medicare Advantage plan is a Medicare Advantage 

21 plan to be offered for plan year 2015 that the Sec22 retary determines, based on the bid of such plan 

23 submitted under section 1854 for such plan year, 

24 satisfies at least one of the following criteria: 


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1 ‘‘(A) INCREASED BENEFICIARY COSTS.— 

2 The total costs (including premiums, cost-shar3 ing responsibilities, and deductibles) projected 

4 to be applicable to individuals who enroll in 

5 such plan for such plan year are at least 7 per6 cent more than the such total costs that were 

7 applicable to individuals enrolled in such plan 

8 for plan year 2014. 

9 ‘‘(B) DECREASED SUPPLEMENTAL BENE10 FITS.—The supplemental benefits to be offered 

11 under such plan for such plan year 2015 are 

12 less than the supplemental benefits offered 

13 under such plan for plan year 2014. 

14 ‘‘(C) DECREASED PROVIDER NETWORK.— 

15 The number of physicians in the plan’s network 

16 has been reduced by 3 percent or more from 

17 plan year 2014 to plan year 2015. 

18 ‘‘(3) DISTRIBUTION OF PMPM STABILIZATION

19 FUNDING AMOUNTS.— 

20 ‘‘(A) IN GENERAL.—Subject to the avail21 ability of funds under paragraph (6), under the 

22 stabilization program, the Secretary shall dis23 tribute, not later than December 31, 2014, to 

24 each eligible Medicare Advantage plan a PMPM 

25 stabilization funding amount, as determined by 


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1 the Secretary in accordance with subparagraph 

2 (B). 

3 ‘‘(B) PMPM STABILIZATION FUNDING

4 AMOUNT.—A PMPM stabilization funding 

5 amount, with respect to an eligible Medicare 

6 Advantage plan, shall be determined in accord7 ance with the following: 

8 ‘‘(i) Such amount shall be an amount, 

9 with respect to each month of plan year 

10 2015, for each individual projected to be 

11 enrolled in such plan for such plan year. 

12 ‘‘(ii) Subject to paragraph (6) and 

13 clause (iii), such amount shall be an 

14 amount determined by the Secretary to be 

15 sufficient for such plan to address for plan 

16 year 2015 each beneficiary plan inad17 equacy specified in paragraph (4) applica18 ble to such plan. 

19 ‘‘(iii) Such amount shall not be more 

20 than $85 per member per month. 

21 ‘‘(4) TIMING OF DETERMINATIONS.—Under the 

22 stabilization program, the Secretary shall determine 

23 which Medicare Advantage plans are eligible Medi24 care Advantage plans under paragraph (2), and the 

25 PMPM stabilization funding amount to be distribVerDate Mar 15 2010 21:11 Jul 18, 2014 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5113.IH H5113

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1 uted to each such eligible Medicare Advantage plan 

2 under paragraph (3), by not later than October 15, 

3 2014. 

4 ‘‘(5) APPLICABLE BENEFICIARY PLAN INAD5 EQUACIES.—For purposes of this subsection, a bene6 ficiary plan inadequacy applicable to an eligible 

7 Medicare Advantage plan is each of the criteria de8 scribed in paragraph (2) that the Secretary deter9 mined the plan satisfied for qualifying as such an el10 igible Medicare Advantage plan. 

11 ‘‘(6) FUNDING.— 

12 ‘‘(A) IN GENERAL.—There shall be avail13 able to the Secretary from amounts in the gen14 eral fund in the Treasury not otherwise appro15 priated an amount, not to exceed 

16 $3,000,000,000, to carry out this subsection. 

17 Such amounts shall remain so available until 

18 December 31, 2015. Any amounts made so 

19 available but not expended on or before such 

20 date shall be transferred to the general fund in 

21 the Treasury. 

22 ‘‘(B) CLARIFICATION.—Payments under 

23 the stabilization program shall not be taken 


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1 into account for purposes of determining the 

2 premium payments applicable under part B.’’. 

Æ 


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