II 

117TH CONGRESS 

2D SESSION S. 4204 

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

IN THE SENATE OF THE UNITED STATES 

MAY 12, 2022 

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

Mrs. GILLIBRAND, Mr. HEINRICH, Ms. HIRONO, Mr. LEAHY, Mr. LUJA ́N, 

Mr. PADILLA, Mr. MARKEY, Mr. MERKLEY, Mr. SCHATZ, 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 2022’’. 

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

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

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

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

Sec. 102. Universal entitlement to benefits. 

Sec. 103. Freedom of choice. 

Sec. 104. Non-discrimination. 

Sec. 105. Enrollment. 

Sec. 106. Effective date of benefits. 

Sec. 107. Prohibition against duplicating coverage. 

TITLE II—COMPREHENSIVE BENEFITS, INCLUDING BENEFITS 

FOR LONG-TERM CARE 

Sec. 201. Comprehensive benefits. 

Sec. 202. No patient cost-sharing. 

Sec. 203. Exclusions and limitations. 

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

under Medicaid. 

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

Sec. 206. Additional State standards. 

TITLE III—PROVIDER PARTICIPATION 

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

Sec. 302. Qualifications for providers. 

Sec. 303. Use of private contracts. 

TITLE IV—ADMINISTRATION 

Subtitle A—General Administration Provisions 

Sec. 401. Administration. 

Sec. 402. Consultation. 

Sec. 403. Regional administration. 

Sec. 404. Beneficiary Ombudsman. 

Sec. 405. Conduct of related health programs. 

Subtitle B—Control Over Fraud and Abuse 

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

TITLE V—QUALITY OF CARE 

Sec. 501. Quality standards. 

Sec. 502. Addressing health care disparities. 

TITLE VI—NATIONAL HEALTH BUDGET; PROVIDER PAYMENTS; 

COST CONTAINMENT MEASURES 

Subtitle A—Budgeting 

Sec. 601. National health budget. 

Sec. 602. Temporary worker assistance. 

Subtitle B—Payments to Providers 


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

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

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

schedule. 

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

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

Sec. 616. Office of Health Equity. 

Sec. 617. Office of Primary Health Care. 

TITLE VII—UNIVERSAL MEDICARE TRUST FUND 

Sec. 701. Universal Medicare Trust Fund. 

TITLE VIII—CONFORMING AMENDMENTS TO THE EMPLOYEE 

RETIREMENT INCOME SECURITY ACT OF 1974 

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

Medicare for All Program; coordination in case of workers’ 

compensation. 

Sec. 802. 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 TO MEDICARE FOR ALL 

Subtitle A—Improvements to Medicare 

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

Sec. 1002. Reducing Medicare part D annual out-of-pocket threshold and eliminating cost-sharing above that threshold. 

Sec. 1003. Expanding Medicare to cover dental and vision services and hearing 

aids and examinations under part B. 

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

individuals with disabilities. 

Sec. 1005. Guaranteed issue of Medigap policies. 

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

Option 

Sec. 1011. Lowering the Medicare age. 

Sec. 1012. Establishment of the Medicare transition plan. 

Subtitle C—Patient Protections During Medicare for All Transition Period 

Sec. 1021. Minimizing disruptions to patient care. 

Sec. 1022. Public consultation. 

Sec. 1023. Definitions. 

TITLE XI—MISCELLANEOUS 


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Sec. 1101. Updating resource limits for Supplemental Security Income eligibility (SSI). 

Sec. 1102. Definitions. 

1 TITLE I—ESTABLISHMENT OF 

2 THE MEDICARE FOR ALL PRO3 GRAM; UNIVERSAL ENTITLE4 MENT TO BENEFITS; ENROLL5 MENT 

6 SEC. 101. ESTABLISHMENT OF THE MEDICARE FOR ALL 

7 PROGRAM. 

8 There is hereby established a national health insur9 ance program to provide comprehensive protection against 

10 the costs of health care and health-related services, in ac11 cordance with the standards specified in, or established 

12 under, this Act. 

13 SEC. 102. UNIVERSAL ENTITLEMENT TO BENEFITS. 

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

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

16 services under this Act. The Secretary shall promulgate 

17 a rule that provides criteria for determining residency for 

18 eligibility purposes under this Act. 

19 (b) TREATMENT OF OTHER INDIVIDUALS.—The Sec20 retary— 

21 (1) may make eligible for benefits for health 

22 care services under this Act other individuals not de23 scribed in subsection (a) and regulate their eligibility 


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1 to ensure that every person in the United States has 

2 access to health care; and 

3 (2) shall promulgate a rule, consistent with 

4 Federal immigration laws, to prevent an individual 

5 from traveling to the United States for the sole pur6 pose of obtaining health care services provided under 

7 this Act. 

8 SEC. 103. FREEDOM OF CHOICE. 

9 Any individual entitled to benefits under this Act may 

10 obtain health services from any institution, agency, or in11 dividual qualified to participate under this Act. 

12 SEC. 104. NON-DISCRIMINATION. 

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

14 race, color, national origin, age, disability, marital status, 

15 citizenship status, primary language use, genetic condi16 tions, previous or existing medical conditions, religion, or 

17 sex, including sex stereotyping, gender identity, sexual ori18 entation, and pregnancy and related medical conditions 

19 (including termination of pregnancy), be excluded from 

20 participation in or be denied the benefits of the program 

21 established under this Act (except as expressly authorized 

22 by this Act for purposes of enforcing eligibility standards 

23 described in section 102), or be subject to any reduction 

24 of benefits or other discrimination by any participating 

25 provider (as defined in section 301), or any entity conVerDate Sep 11 2014 18:20 May 24, 2022 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4204.IS S4204

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1 ducting, administering, or funding a health program or 

2 activity, including contracts of insurance, pursuant to this 

3 Act. 

4 (b) CLAIMS OF DISCRIMINATION.— 

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

6 a procedure for adjudication of administrative com7 plaints alleging a violation of subsection (a). 

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

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

10 file suit in any district court of the United States 

11 having jurisdiction of the parties. A person may 

12 bring an action under this paragraph concurrently 

13 with such administrative remedies as established in 

14 paragraph (1). 

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

16 subsection (a), the court may grant compensatory 

17 and punitive damages, declaratory relief, injunctive 

18 relief, attorneys’ fees and costs, or other relief as ap19 propriate. 

20 (c) CONTINUED APPLICATION OF LAWS.—Nothing in 

21 this title (or an amendment made by this title) shall be 

22 construed to invalidate or otherwise limit any of the rights, 

23 remedies, procedures, or legal standards available to indi24 viduals aggrieved under section 1557 of the Patient Pro25 tection and Affordable Care Act (42 U.S.C. 18116), title 


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1 VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et 

2 seq.), title VII of the Civil Rights Act of 1964 (42 U.S.C. 

3 2000e et seq.), title IX of the Education Amendments of 

4 1972 (20 U.S.C. 1681 et seq.), section 504 of the Reha5 bilitation Act of 1973 (29 U.S.C. 794), or the Age Dis6 crimination Act of 1975 (42 U.S.C. 611 et seq.). Nothing 

7 in this title (or an amendment to this title) shall be con8 strued to supersede State laws that provide additional pro9 tections against discrimination on any basis described in 

10 subsection (a). 

11 SEC. 105. ENROLLMENT. 

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

13 mechanism for the enrollment of individuals eligible for 

14 benefits under this Act. The mechanism shall— 

15 (1) include a process for the automatic enroll16 ment of individuals at the time of birth in the 

17 United States (or upon establishment of residency in 

18 the United States); 

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

20 described in section 106, of all individuals who are 

21 eligible to be enrolled as of such date; and 

22 (3) include a process for the enrollment of indi23 viduals made eligible for health care services under 

24 section 102(b). 


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1 (b) ISSUANCE OF MEDICARE FOR ALL CARDS.—In 

2 conjunction with an individual’s enrollment for benefits 

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

4 of a Medicare for All card that shall be used for purposes 

5 of identification and processing of claims for benefits 

6 under this program. The card shall not include an individ7 ual’s Social Security number. 

8 SEC. 106. EFFECTIVE DATE OF BENEFITS. 

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

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

11 items and services furnished on January 1 of the fourth 

12 calendar year that begins after the date of enactment of 

13 this Act. 

14 (b) IMMEDIATE COVERAGE OF CHILDREN.— 

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

16 who has not yet attained the age of 19 as of the 

17 date that is 1 year after the date of enactment of 

18 this Act, benefits shall first be available under this 

19 Act for items and services furnished on January 1 

20 of the first calendar year that begins after the date 

21 of enactment of this Act. 

22 (2) OPTION TO CONTINUE IN OTHER COVERAGE

23 DURING TRANSITION PERIOD.—Any person who is 

24 eligible to receive benefits as described in paragraph 

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


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1 section 901, private health insurance coverage, or 

2 coverage offered pursuant to subtitle A of title X 

3 (including the amendments made by such subtitle) 

4 until the date on which benefits are first available 

5 under subsection (a). 

6 SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. 

7 (a) IN GENERAL.—Beginning on the date on which 

8 benefits are first available under section 106(a), it shall 

9 be unlawful for— 

10 (1) a private health insurer to sell health insur11 ance coverage that duplicates the benefits provided 

12 under this Act; or 

13 (2) an employer to provide benefits for an em14 ployee, former employee, or the dependents of an 

15 employee or former employee that duplicate the ben16 efits provided under this Act. 

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

18 construed as prohibiting the sale of health insurance cov19 erage for any additional benefits not covered by this Act, 

20 including additional benefits that an employer may provide 

21 to employees or their dependents, or to former employees 

22 or their dependents. 


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1 TITLE II—COMPREHENSIVE BEN2 EFITS, INCLUDING BENEFITS 

3 FOR LONG-TERM CARE 

4 SEC. 201. COMPREHENSIVE BENEFITS. 

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

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

7 benefits under this Act are entitled to have payment made 

8 by the Secretary to an eligible provider for the following 

9 items and services if medically necessary or appropriate 

10 for the maintenance of health or for the diagnosis, treat11 ment, or rehabilitation of a health condition: 

12 (1) Hospital services, including inpatient and 

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

14 emergency services and inpatient prescription drugs. 

15 (2) Ambulatory patient services. 

16 (3) Primary and preventive services, including 

17 chronic disease management. 

18 (4) Prescription drugs and medical devices, in19 cluding outpatient drugs and devices. 

20 (5) Mental health and substance use treatment 

21 services, including inpatient care and treatment for 

22 co-occurring mental illness and substance use dis23 orders. 

24 (6) Laboratory and diagnostic services. 


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1 (7) Comprehensive reproductive, maternity, and 

2 newborn care. 

3 (8) Pediatrics, including early and periodic 

4 screening, diagnostic, and treatment services (as de5 fined in section 1905(r) of the Social Security Act 

6 (42 U.S.C. 1396d(r))). 

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

8 (10) Rehabilitative and habilitative services and 

9 devices. 

10 (11) Emergency services and transportation. 

11 (12) Necessary transportation to receive health 

12 care services for persons with disabilities, older indi13 viduals with functional limitations, and low-income 

14 individuals (as determined by the Secretary). 

15 (13) Services provided by a licensed marriage 

16 and family therapist or a licensed mental health 

17 counselor. 

18 (14) Home and community-based long-term 

19 services and supports (to be provided in accordance 

20 with the requirements for home and community21 based settings under sections 441.530 and 441.710 

22 of title 42, Code of Federal Regulations), includ23 ing— 


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1 (A) services described in paragraphs (7), 

2 (8), (13), (19), and (24) of section 1905(a) of 

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

4 (B) home and community-based services 

5 described in subsection (c)(4)(B) of section 

6 1915 of the Social Security Act (including ha7 bilitation services defined in subsection (c)(5) of 

8 such section); 

9 (C) self-directed home and community10 based services described in subsection (i) of sec11 tion 1915 of the Social Security Act; 

12 (D) self-directed personal assistance serv13 ices (as defined in subsection (j)(4)(A) of sec14 tion 1915 of the Social Security Act); and 

15 (E) home and community-based attendant 

16 services and supports described in subsection 

17 (k) of section 1915 of the Social Security Act. 

18 (b) REVISION.—The Secretary shall, at least on an 

19 annual basis, evaluate whether the benefits package should 

20 be improved to promote the health of beneficiaries, ac21 count for changes in medical practice or new information 

22 from medical research, or respond to other relevant devel23 opments in health science, and shall make recommenda24 tions to Congress regarding any such improvements. 


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1 (c) COMPLEMENTARY AND ALTERNATIVE MEDI2 CINE.— 

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

4 (b), the Secretary shall consult with the persons de5 scribed in paragraph (1) with respect to— 

6 (A) identifying specific complementary and 

7 integrative medicine practices that are appro8 priate to include in the benefits package; and 

9 (B) identifying barriers to the effective 

10 provision and integration of such practices into 

11 the delivery of health care, and identifying 

12 mechanisms for overcoming such barriers. 

13 (2) CONSULTATION.—In accordance with para14 graph (1), the Secretary shall consult with— 

15 (A) the Director of the National Center for 

16 Complementary and Integrative Health; 

17 (B) the Commissioner of Food and Drugs; 

18 (C) institutions of higher education, pri19 vate research institutes, and individual re20 searchers with extensive experience in com21 plementary and integrative medicine and the in22 tegration of such practices into the delivery of 

23 health care; 

24 (D) nationally recognized providers of com25 plementary and alternative medicine; and 


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1 (E) such other officials, entities, and indi2 viduals with expertise on complementary and 

3 integrative medicine as the Secretary deter4 mines appropriate. 

5 (d) STATES MAY PROVIDE ADDITIONAL BENE6 FITS.—Individual States may provide additional benefits 

7 for the residents of such States, as determined by such 

8 State, and may provide benefits to individuals not eligible 

9 for benefits under this Act at the expense of the State. 

10 SEC. 202. NO PATIENT COST-SHARING. 

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

12 no cost-sharing, including deductibles, coinsurance, copay13 ments, or similar charges, be imposed on an individual for 

14 any benefits provided under this Act, except as described 

15 in subsection (b). 

16 (b) EXCEPTIONS.—The Secretary may set a cost17 sharing schedule for prescription drugs— 

18 (1) provided that— 

19 (A) such schedule is evidence-based, pa20 tient-centered, and encourages the use of ge21 neric drugs; 

22 (B) such cost-sharing does not apply to 

23 preventive drugs; 


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1 (C) such cost-sharing does not exceed $200 

2 annually per individual, adjusted annually for 

3 inflation; and 

4 (D) such cost-sharing is not imposed on in5 dividuals with a household income equal to or 

6 below 250 percent of the poverty line for a fam7 ily of the size involved; and 

8 (2) under which the Secretary may— 

9 (A) exempt brand-name drugs from consid10 eration in determining whether an individual 

11 has reached any out-of-pocket limit if a safe 

12 and appropriate generic version of such drug is 

13 available to such individual; and 

14 (B) waive cost-sharing in response to a 

15 coverage appeal under section 203(b)(2). 

16 (c) NO BALANCE BILLING.—Notwithstanding con17 tracts in accordance with section 303, no provider may 

18 impose a charge to an enrolled individual for covered serv19 ices for which benefits are provided under this Act. 

20 SEC. 203. EXCLUSIONS AND LIMITATIONS. 

21 (a) IN GENERAL.—Benefits for items and services 

22 are not available under this Act unless the services meet 

23 the standards developed by the Secretary pursuant to sec24 tion 201(a). 


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1 (b) TREATMENT OF EXPERIMENTAL SERVICES AND

2 DRUGS.— 

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

4 the Secretary shall make national coverage deter5 minations with respect to services that are experi6 mental in nature. Such determinations shall be con7 sistent with the national coverage determination 

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

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

10 (2) APPEALS PROCESS.—The Secretary shall 

11 establish a process by which individuals can appeal 

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

13 feasible, follow the process for appeals under the 

14 Medicare program described in section 1869 of the 

15 Social Security Act (42 U.S.C. 1395ff). 

16 (c) APPLICATION OF PRACTICE GUIDELINES.— 

17 (1) IN GENERAL.—In the case of items and 

18 services for which the Department of Health and 

19 Human Services has recognized a national practice 

20 guideline, such items and services are considered to 

21 meet the standards specified in section 201(a) if 

22 they have been provided in accordance with such 

23 guideline. 

24 (2) CERTAIN EXCEPTIONS.—For purposes of 

25 this subsection, an item or service not provided in 


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1 accordance with a national practice guideline shall 

2 be considered to have been provided in accordance 

3 with such guideline if the health care provider pro4 viding the item or service— 

5 (A) exercised appropriate professional dis6 cretion to deviate from the guideline in a man7 ner authorized or anticipated by the guideline; 

8 (B) acted in accordance with the laws and 

9 requirements in which such item or service is 

10 furnished; 

11 (C) acted in the best interests of the indi12 vidual receiving the item or service; and 

13 (D) acted in a manner consistent with the 

14 individual’s wishes. 

15 SEC. 204. CONTINUED COVERAGE OF INSTITUTIONAL 

16 LONG-TERM CARE AND OTHER SERVICES 

17 UNDER MEDICAID. 

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

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

20 section 1947: 

21 ‘‘STATE PLAN FOR PROVIDING INSTITUTIONAL LONG22 TERM CARE SERVICES

23 ‘‘SEC. 1948. (a) IN GENERAL.—For quarters begin24 ning on or after the date on which benefits are first avail25 able under section 106(a) of the Medicare for All Act of 

26 2022, notwithstanding any other provision of this title— 


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

2 provide for making medical assistance available for 

3 services that are institutional long-term care services 

4 in a manner consistent with this section; and 

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

6 under this title with respect to expenditures incurred 

7 by the State in providing medical assistance on or 

8 after such date for services that are not— 

9 ‘‘(A) institutional long-term care services; 

10 or 

11 ‘‘(B) other services for which benefits are 

12 not available under the Medicare for All Act of 

13 2022 and which are furnished under a State 

14 plan for medical assistance which provided for 

15 medical assistance for such services on Sep16 tember 1, 2021. 

17 ‘‘(b) INSTITUTIONAL LONG-TERM CARE SERVICES

18 DEFINED.—In this section, the term ‘institutional long19 term care services’ means the following: 

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

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

22 of section 1905(a)(4). 

23 ‘‘(2) Inpatient services for individuals 65 years 

24 of age or over provided in an institution for mental 

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


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1 ‘‘(3) Intermediate care facility services de2 scribed in section 1905(a)(15). 

3 ‘‘(4) Inpatient psychiatric hospital services for 

4 individuals under age 21 described in section 

5 1905(a)(16). 

6 ‘‘(5) Nursing facility services described in sec7 tion 1905(a)(29). 

8 ‘‘(c) STATE MAINTENANCE OF EFFORT REQUIRE9 MENT.— 

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 resource, or other standards and methodologies 

17 for purposes of determining an individual’s eli18 gibility for medical assistance under the State 

19 plan that are more restrictive than those ap20 plied as of January 1, 2022. 

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 January 1, 2022, 


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1 the Secretary shall deem the amount of any 

2 such standard that was applied as of such date 

3 to be increased by the percentage increase in 

4 the medical care component of the consumer 

5 price index for all urban consumers (U.S. city 

6 average) from September of 2021 to September 

7 of the fiscal year for which the Secretary is 

8 making 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 date on which benefits are first available under 

15 section 106(a) of the Medicare for All Act of 

16 2022, as a condition of receiving payments 

17 under section 1903(a), a State shall make ex18 penditures for medical assistance for services 

19 that are institutional long-term care services in 

20 an amount that is not less than the expenditure 

21 floor determined for the State and fiscal year 

22 (or portion of a fiscal year) under subparagraph 

23 (B). 

24 ‘‘(B) EXPENDITURE FLOOR.— 


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1 ‘‘(i) IN GENERAL.—For each fiscal 

2 year or portion of a fiscal year described in 

3 subparagraph (A), the Secretary shall de4 termine for each State an expenditure floor 

5 that shall be equal to— 

6 ‘‘(I) the amount of the State’s 

7 expenditures for fiscal year 2021 on 

8 medical assistance for institutional 

9 long-term care services; increased by 

10 ‘‘(II) the growth factor deter11 mined under subclause (ii). 

12 ‘‘(ii) GROWTH FACTOR.—For each fis13 cal year or portion of a fiscal year de14 scribed in subparagraph (A), the Secretary 

15 shall, not later than September 1 of the 

16 fiscal year preceding such fiscal year or 

17 portion of a fiscal year, determine a 

18 growth factor for each State that takes 

19 into account— 

20 ‘‘(I) the percentage increase in 

21 health care costs in the State; 

22 ‘‘(II) the total amount expended 

23 by the State for the previous fiscal 

24 year on medical assistance for institu25 tional long-term care services; 


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

2 total population of the State from 

3 July of 2021 to July of the fiscal year 

4 preceding the fiscal year involved; 

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

6 population of individuals aged 65 and 

7 older of the State from July of 2021 

8 to July of the fiscal year preceding 

9 the fiscal year involved; and 

10 ‘‘(V) the decrease, if any, in the 

11 population of the State that requires 

12 medical assistance for institutional 

13 long-term care services that is attrib14 utable to the availability of coverage 

15 for the services described in section 

16 201(a)(13) of the Medicare for All 

17 Act of 2022. 

18 ‘‘(iii) PRORATION RULE.—Any 

19 amount determined under this subpara20 graph for a portion of a fiscal year shall be 

21 prorated based on the length of such por22 tion of a fiscal year relative to a complete 

23 fiscal year. 

24 ‘‘(d) NONAPPLICATION OF CERTAIN REQUIRE25 MENTS.—Beginning on the date described in subsection 


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

2 medical assistance to make available medical assistance 

3 for services that are not institutional long-term care serv4 ices or services described in section 901(a)(3)(A)(ii) of the 

5 Medicare for All Act of 2022 shall have no effect.’’. 

6 SEC. 205. PROHIBITING RECOVERY OF CORRECTLY PAID 

7 MEDICAID BENEFITS. 

8 Section 1917 of the Social Security Act (42 U.S.C. 

9 1396p) is amended— 

10 (1) by amending subsection (a) to read as fol11 lows: 

12 ‘‘(a) No lien may be imposed against the property 

13 of any individual prior to his death on account of medical 

14 assistance paid or to be paid on his behalf under the State 

15 plan, except pursuant to the judgment of a court on ac16 count of benefits incorrectly paid on behalf of such indi17 vidual.’’; and 

18 (2) by amending subsection (b) to read as fol19 lows: 

20 ‘‘(b) No adjustment or recovery of any medical assist21 ance correctly paid on behalf of an individual under the 

22 State plan may be made.’’. 

23 SEC. 206. ADDITIONAL STATE STANDARDS. 

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

25 individual States from setting additional standards, with 


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1 respect to eligibility, benefits, and minimum provider 

2 standards, consistent with the purposes of this Act, pro3 vided that such standards do not restrict eligibility or re4 duce access to benefits for items and services. 

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

6 any individuals or entities certified to provide services cov7 ered under section 201(a)(7), a State may not prohibit 

8 an individual or entity from participating in the program 

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

10 individual or entity to provide such services. 

11 TITLE III—PROVIDER 

12 PARTICIPATION 

13 SEC. 301. PROVIDER PARTICIPATION AND STANDARDS; 

14 WHISTLEBLOWER PROTECTIONS. 

15 (a) IN GENERAL.—An individual or other entity fur16 nishing any covered item or service under this Act is not 

17 a qualified provider unless the individual or entity— 

18 (1) is a qualified provider of the items or serv19 ices under section 302; 

20 (2) has filed with the Secretary a participation 

21 agreement described in subsection (b); and 

22 (3) meets, as applicable, such other qualifica23 tions and conditions with respect to a provider of 

24 services under title XVIII of the Social Security Act 


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1 as described in section 1866 of the Social Security 

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

3 (b) REQUIREMENTS IN PARTICIPATION AGREE4 MENT.— 

5 (1) IN GENERAL.—A participation agreement 

6 described in this subsection between the Secretary 

7 and a provider shall provide at least for the fol8 lowing: 

9 (A) Items and services to eligible persons 

10 shall be furnished by the provider without dis11 crimination, in accordance with section 104(a). 

12 Nothing in this subparagraph shall be con13 strued as requiring the provision of a type or 

14 class of items or services that are outside the 

15 scope of the provider’s normal practice. 

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

17 individual for any covered items or services 

18 other than for payment authorized by this Act. 

19 (C) The provider agrees to furnish such in20 formation as may be reasonably required by the 

21 Secretary, in accordance with uniform reporting 

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

23 for— 

24 (i) quality review by designated enti25 ties; 


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1 (ii) making payments under this Act, 

2 including the examination of records as 

3 may be necessary for the verification of in4 formation on which such payments are 

5 based; 

6 (iii) statistical or other studies re7 quired for the implementation of this Act; 

8 and 

9 (iv) such other purposes as the Sec10 retary may specify. 

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

12 an individual, the provider agrees not to employ 

13 or use for the provision of health services any 

14 individual or other provider that has had a par15 ticipation agreement under this subsection ter16 minated for cause. The Secretary may authorize 

17 such employment or use on a case-by-case 

18 basis. 

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

20 a fee-for-service basis for items and services 

21 furnished under this Act, the provider agrees to 

22 submit bills and any required supporting docu23 mentation relating to the provision of covered 

24 items and services within 30 days after the date 

25 of providing such items and services. 


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1 (F) In the case of an institutional provider 

2 paid pursuant to section 611, the provider 

3 agrees to submit information and any other re4 quired supporting documentation as may be 

5 reasonably required by the Secretary within 30 

6 days after the date of providing such items and 

7 services and in accordance with the uniform re8 porting standards established under section 

9 401(b)(1), including information on a quarterly 

10 basis that— 

11 (i) relates to the provision of covered 

12 items and services; and 

13 (ii) describes items and services fur14 nished with respect to specific individuals. 

15 (G) In the case of a provider that receives 

16 payment for items and services furnished under 

17 this Act based on diagnosis-related coding, pro18 cedure coding, or other coding system or data, 

19 the provider agrees— 

20 (i) to disclose to the Secretary any 

21 system or index of coding or classifying pa22 tient symptoms, diagnoses, clinical inter23 ventions, episodes, or procedures that such 

24 provider utilizes for global budget negotia25 tions under title VI or for meeting any 


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1 other payment, documentation, or data col2 lection requirements under this Act; and 

3 (ii) not to use any such system or 

4 index to establish financial incentives or 

5 disincentives for health care professionals, 

6 or that is proprietary, interferes with the 

7 medical or nursing process, or is designed 

8 to increase the amount or number of pay9 ments. 

10 (H) The provider complies with the duty of 

11 provider ethics and reporting requirements de12 scribed in paragraph (2). 

13 (I) In the case of a provider that is not an 

14 individual, the provider agrees that no board 

15 member, executive, or administrator of such 

16 provider receives compensation from, owns 

17 stock or has other financial investments in, or 

18 serves as a board member of any entity that 

19 contracts with or provides items or services, in20 cluding pharmaceutical products and medical 

21 devices or equipment, to such provider. 

22 (2) PROVIDER DUTY OF ETHICS.—Each health 

23 care provider, including institutional providers, has a 

24 duty to advocate for and to act in the exclusive in25 terest of each individual under the care of such proVerDate Sep 11 2014 18:20 May 24, 2022 Jkt 029200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S4204.IS S4204

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1 vider according to the applicable legal standard of 

2 care, such that no financial interest or relationship 

3 impairs any health care provider’s ability to furnish 

4 necessary and appropriate care to such individual. 

5 To implement the duty established in this para6 graph, the Secretary shall— 

7 (A) promulgate reasonable reporting rules 

8 to evaluate participating provider compliance 

9 with this paragraph; 

10 (B) prohibit participating providers, 

11 spouses, and immediate family members of par12 ticipating providers, from accepting or entering 

13 into any arrangement for any bonus, incentive 

14 payment, profit-sharing, or compensation based 

15 on patient utilization or based on financial out16 comes of any other provider or entity; and 

17 (C) prohibit participating providers or any 

18 board member or representative of such pro19 vider from serving as board members for or re20 ceiving any compensation, stock, or other finan21 cial investment in an entity that contracts with 

22 or provides items or services (including pharma23 ceutical products and medical devices or equip24 ment) to such provider. 


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1 (3) TERMINATION OF PARTICIPATION AGREE2 MENT.— 

3 (A) IN GENERAL.—Participation agree4 ments may be terminated, with appropriate no5 tice— 

6 (i) by the Secretary for failure to meet 

7 the requirements of this Act; 

8 (ii) in accordance with the provisions 

9 described in section 411; or 

10 (iii) by a provider. 

11 (B) TERMINATION PROCESS.—Providers 

12 shall be provided notice and a reasonable oppor13 tunity to correct deficiencies before the Sec14 retary terminates an agreement unless a more 

15 immediate termination is required for public 

16 safety or similar reasons. 

17 (C) PROVIDER PROTECTIONS.— 

18 (i) PROHIBITION.—The Secretary may 

19 not terminate a participation agreement or 

20 in any other way discriminate against, or 

21 cause to be discriminated against, any cov22 ered provider or authorized representative 

23 of the provider, on account of such pro24 vider or representative— 


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1 (I) providing, causing to be pro2 vided, or being about to provide or 

3 cause to be provided to the provider, 

4 the Federal Government, or the attor5 ney general of a State information re6 lating to any violation of, or any act 

7 or omission the provider or represent8 ative reasonably believes to be a viola9 tion of, any provision of this title (or 

10 an amendment made by this title); 

11 (II) testifying or being about to 

12 testify in a proceeding concerning 

13 such violation; 

14 (III) assisting or participating, or 

15 being about to assist or participate, in 

16 such a proceeding; or 

17 (IV) objecting to, or refusing to 

18 participate in, any activity, policy, 

19 practice, or assigned task that the 

20 provider or representative reasonably 

21 believes to be in violation of any provi22 sion of this Act (including any amend23 ment made by this Act), or any order, 

24 rule, regulation, standard, or ban 


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1 under this Act (including any amend2 ment made by this Act). 

3 (ii) COMPLAINT PROCEDURE.—A pro4 vider or representative who believes that he 

5 or she has been discriminated against in 

6 violation of this section may seek relief in 

7 accordance with the procedures, notifica8 tions, burdens of proof, remedies, and stat9 utes of limitation set forth in section 

10 2087(b) of title 15, United States Code. 

11 (c) WHISTLEBLOWER PROTECTIONS.— 

12 (1) RETALIATION PROHIBITED.—No person 

13 may discharge or otherwise discriminate against any 

14 employee because the employee or any person acting 

15 pursuant to a request of the employee— 

16 (A) notified the Secretary or the employ17 ee’s employer of any alleged violation of this 

18 title, including communications related to car19 rying out the employee’s job duties; 

20 (B) refused to engage in any practice made 

21 unlawful by this title, if the employee has iden22 tified the alleged illegality to the employer; 

23 (C) testified before or otherwise provided 

24 information relevant for Congress or for any 


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1 Federal or State proceeding regarding any pro2 vision (or proposed provision) of this title; 

3 (D) commenced, caused to be commenced, 

4 or is about to commence or cause to be com5 menced a proceeding under this title; 

6 (E) testified or is about to testify in any 

7 such proceeding; or 

8 (F) assisted or participated or is about to 

9 assist or participate in any manner in such a 

10 proceeding or in any other manner in such a 

11 proceeding or in any other action to carry out 

12 the purposes of this title. 

13 (2) ENFORCEMENT ACTION.—Any employee 

14 covered by this section who alleges discrimination by 

15 an employer in violation of paragraph (1) may bring 

16 an action, subject to the statute of limitations in the 

17 anti-retaliation provisions of the False Claims Act 

18 and the rules and procedures, legal burdens of proof, 

19 and remedies applicable under the employee protec20 tions provisions of the Surface Transportation As21 sistance Act. 

22 (3) APPLICATION.— 

23 (A) Nothing in this subsection shall be 

24 construed to diminish the rights, privileges, or 

25 remedies of any employee under any Federal or 


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1 State law or regulation, including the rights 

2 and remedies against retaliatory action under 

3 the False Claims Act (31 U.S.C. 3730(h)), or 

4 under any collective bargaining agreement. The 

5 rights and remedies in this section may not be 

6 waived by any agreement, policy, form, or con7 dition of employment. 

8 (B) Nothing in this subsection shall be 

9 construed to preempt or diminish any other 

10 Federal or State law or regulation against dis11 crimination, demotion, discharge, suspension, 

12 threats, harassment, reprimand, retaliation, or 

13 any other manner of discrimination, including 

14 the rights and remedies against retaliatory ac15 tion under the False Claims Act (31 U.S.C. 

16 3730(h)). 

17 (4) DEFINITIONS.—In this subsection: 

18 (A) EMPLOYER.—The term ‘‘employer’’ 

19 means any person engaged in profit or non20 profit business or industry, including one or 

21 more individuals, partnerships, associations, 

22 corporations, trusts, professional membership 

23 organization including a certification, discipli24 nary, or other professional body, unincorporated 

25 organizations, nongovernmental organizations, 


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1 or trustees, and subject to liability for violating 

2 the provisions of this Act. 

3 (B) EMPLOYEE.—The term ‘‘employee’’ 

4 means any individual performing activities 

5 under this Act on behalf of an employer. 

6 SEC. 302. QUALIFICATIONS FOR PROVIDERS. 

7 (a) IN GENERAL.—A health care provider is consid8 ered a qualified provider to furnish covered items and 

9 services under this Act if the provider is licensed or cer10 tified to furnish such items and services in the State in 

11 which the individual receiving such items and services is 

12 located and meets— 

13 (1) the requirements of such State’s laws to 

14 furnish such items and services; and 

15 (2) applicable requirements of Federal law to 

16 furnish such items and services. 

17 (b) FEDERAL PROVIDERS.—Any provider qualified to 

18 provide health care items and services at a facility of the 

19 Department of Veterans Affairs, the Indian Health Serv20 ice, or the uniformed services (as defined in section 

21 1072(1) of title 10, United States Code) (with respect to 

22 the direct care component of the TRICARE program) is 

23 a qualified provider under this section with respect to any 

24 individual who qualifies for such items and services under 

25 applicable Federal law. 


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1 (c) MINIMUM PROVIDER STANDARDS.— 

2 (1) IN GENERAL.—The Secretary shall estab3 lish, evaluate, and update national minimum stand4 ards to ensure the quality of items and services pro5 vided under this Act and to monitor efforts by 

6 States to ensure the quality of items and such serv7 ices. A State may also establish additional minimum 

8 standards which providers shall meet with respect to 

9 services provided in such State. 

10 (2) NATIONAL MINIMUM STANDARDS.—The 

11 Secretary shall establish national minimum stand12 ards under paragraph (1) for institutional providers 

13 of services and individual health care practitioners. 

14 Except as the Secretary may specify in order to 

15 carry out this Act, a hospital, skilled nursing facility, 

16 or other institutional provider of services shall meet 

17 standards applicable to such a provider under the 

18 Medicare program under title XVIII of the Social 

19 Security Act (42 U.S.C. 1395 et seq.). Such stand20 ards also may include, where appropriate, elements 

21 relating to— 

22 (A) adequacy and quality of facilities; 

23 (B) training and competence of personnel 

24 (including requirements related to the number 

25 or type of required continuing education hours); 


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1 (C) comprehensiveness of service; 

2 (D) continuity of service; 

3 (E) patient waiting time, access to service, 

4 and references; and 

5 (F) performance standards, including orga6 nization, facilities, structure of services, effi7 ciency of operation, and outcome in palliation, 

8 improvement of health, stabilization, cure, or 

9 rehabilitation. 

10 (3) TRANSITION IN APPLICATION.—If the Sec11 retary provides for additional requirements for pro12 viders under this subsection, any such additional re13 quirement shall be implemented in a manner that 

14 provides for a reasonable period during which a pre15 viously qualified provider is permitted to meet such 

16 an additional requirement. 

17 SEC. 303. USE OF PRIVATE CONTRACTS. 

18 (a) IN GENERAL.—This section shall apply beginning 

19 on the date on which benefits are first available under sec20 tion 106(a), subject to the provisions of this subsection, 

21 nothing in this Act shall prohibit an institutional or indi22 vidual provider from entering into a private contract with 

23 an enrolled individual for any item or service— 

24 (1) for which no claim for payment is to be sub25 mitted under this Act; and 


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1 (2) for which the provider receives— 

2 (A) no reimbursement under this Act di3 rectly or on a capitated basis; and 

4 (B) receives no amount for such item or 

5 service from an organization which receives re6 imbursement for such items or service under 

7 this Act directly or on a capitated basis. 

8 (b) CONTRACT REQUIREMENTS.— 

9 (1) IN GENERAL.—Any contract to provide 

10 items and services under subsection (a) shall— 

11 (A) be in writing and signed by the indi12 vidual (or authorized representative of the indi13 vidual) receiving the item or service before the 

14 item or service is furnished pursuant to the 

15 contract; 

16 (B) be entered into at a time when the in17 dividual is facing an emergency health care sit18 uation; and 

19 (C) contain the items described in para20 graph (2). 

21 (2) ITEMS REQUIRED TO BE INCLUDED IN CON22 TRACT.—Any contract to provide items and services 

23 to which subsection (a) applies shall clearly indicate 

24 to the individual that by signing such contract the 

25 individual— 


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1 (A) agrees not to submit a claim (or to re2 quest that the provider submit a claim) under 

3 this Act for such items or services even if such 

4 items or services are otherwise covered by this 

5 Act; 

6 (B) agrees to be responsible, whether 

7 through insurance offered under section 107(b) 

8 or otherwise, for payment of such items or serv9 ices and understands that no reimbursement 

10 will be provided under this Act for such items 

11 or services; 

12 (C) acknowledges that no limits under this 

13 Act apply to amounts that may be charged for 

14 such items or services; 

15 (D) if the provider is a nonparticipating 

16 provider, acknowledges that the beneficiary has 

17 the right to have such items or services pro18 vided by other providers for whom payment 

19 would be made under this Act; and 

20 (E) acknowledges that the provider is pro21 viding services outside the scope of the program 

22 under this Act. 

23 (c) PROVIDER REQUIREMENTS.— 

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

25 apply to any contract unless an affidavit described 


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

2 item or service is to be provided pursuant to the 

3 contract. 

4 (2) AFFIDAVIT.—An affidavit as described in 

5 this subparagraph shall— 

6 (A) identify the practitioner, and be signed 

7 by such practitioner; 

8 (B) provide that the practitioner will not 

9 submit any claim under this title for any item 

10 or service provided to any beneficiary (and will 

11 not receive any reimbursement or amount de12 scribed in paragraph (1)(B) for any such item 

13 or service) during the 1-year period beginning 

14 on the date the affidavit is signed; and 

15 (C) be filed with the Secretary no later 

16 than 10 days after the first contract to which 

17 such affidavit applies is entered into. 

18 (3) ENFORCEMENT.—If a physician or practi19 tioner signing an affidavit described in paragraph 

20 (2) knowingly and willfully submits a claim under 

21 this title for any item or service provided during the 

22 1-year period described in paragraph (2)(B) (or re23 ceives any reimbursement or amount described in 

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

25 respect to such affidavit— 


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1 (A) this subsection shall not apply with re2 spect to any items and services provided by the 

3 physician or practitioner pursuant to any con4 tract on and after the date of such submission 

5 and before the end of such period; and 

6 (B) no payment shall be made under this 

7 title for any item or service furnished by the 

8 physician or practitioner during the period de9 scribed in clause (i) (and no reimbursement or 

10 payment of any amount described in subsection 

11 (a)(2) shall be made for any such item or serv12 ice). 

13 TITLE IV—ADMINISTRATION 

14 Subtitle A—General 

15 Administration Provisions 

16 SEC. 401. ADMINISTRATION. 

17 (a) GENERAL DUTIES OF THE SECRETARY.— 

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

19 policies, procedures, guidelines, and requirements to 

20 carry out this Act, including related to— 

21 (A) eligibility for benefits; 

22 (B) enrollment; 

23 (C) benefits provided; 

24 (D) provider participation standards and 

25 qualifications, as described in title III; 


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1 (E) levels of funding; 

2 (F) methods for determining amounts of 

3 payments to providers of covered items and 

4 services, consistent with subtitle B; 

5 (G) a process for appealing or petitioning 

6 for a determination of coverage for items and 

7 services under this Act; 

8 (H) planning for capital expenditures and 

9 service delivery; 

10 (I) planning for health professional edu11 cation funding; 

12 (J) encouraging States to develop regional 

13 planning mechanisms; and 

14 (K) any other regulations necessary to 

15 carry out the purposes of this Act. 

16 (2) REGULATIONS.—Regulations authorized by 

17 this Act shall be issued by the Secretary in accord18 ance with section 553 of title 5, United States Code. 

19 (b) UNIFORM REPORTING STANDARDS; ANNUAL RE20 PORT; STUDIES.— 

21 (1) UNIFORM REPORTING STANDARDS.— 

22 (A) IN GENERAL.—The Secretary shall es23 tablish uniform State reporting requirements, 

24 provider reporting requirements, and national 

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1 base containing information pertaining to 

2 health services practitioners, approved pro3 viders, the costs of facilities and practitioners 

4 providing such items and services, the quality of 

5 such items and services, the outcomes of such 

6 items and services, and the equity of health 

7 among population groups. Such database shall 

8 include, to the maximum extent feasible without 

9 compromising patient privacy, health outcome 

10 measures used under this Act, and to the max11 imum extent feasible without excessively bur12 dening providers, the measures described in 

13 subparagraphs (D) through (F) of subsection 

14 (a)(1). 

15 (B) REPORTS.—The Secretary shall— 

16 (i) regularly analyze information re17 ported to the Secretary; and 

18 (ii) define rules and procedures to 

19 allow researchers, scholars, health care 

20 providers, and others to access and analyze 

21 data for purposes consistent with quality 

22 and outcomes research, without compro23 mising patient privacy. 

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

25 the second year beginning after the effective date of 


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1 this Act, the Secretary shall annually report to Con2 gress on the following: 

3 (A) The status of implementation of the 

4 Act. 

5 (B) Enrollment under this Act. 

6 (C) Benefits under this Act. 

7 (D) Expenditures and financing under this 

8 Act. 

9 (E) Cost-containment measures and 

10 achievements under this Act. 

11 (F) Quality assurance. 

12 (G) Health care utilization patterns, in13 cluding any changes attributable to the pro14 gram. 

15 (H) Changes in the per capita costs of 

16 health care. 

17 (I) Differences in the health status of the 

18 populations of the different States, by demo19 graphic characteristics, including race, eth20 nicity, gender, national origin, primary lan21 guage use, age, disability, sex (including gender 

22 identity and sexual orientation), geography, or 

23 socioeconomic status. 

24 (J) Progress on implementing quality and 

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1 range plans and goals for achievements in such 

2 areas. 

3 (K) Plans for improving service to medi4 cally underserved populations. 

5 (L) Transition problems as a result of im6 plementation of this Act. 

7 (M) Opportunities for improvements under 

8 this Act. 

9 (3) STATISTICAL ANALYSES AND OTHER STUD10 IES.—The Secretary may, either directly or by con11 tract— 

12 (A) make statistical and other studies, on 

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

14 any aspect of the operation of this Act; 

15 (B) develop and test methods of delivery of 

16 items and services as the Secretary may con17 sider necessary or promising for the evaluation, 

18 or for the improvement, of the operation of this 

19 Act; and 

20 (C) develop methodological standards for 

21 evidence-based policymaking. 

22 (c) AUDITS.— 

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

24 the United States shall conduct an audit of the De25 partment of Health and Human Services every fifth 


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1 fiscal year following the effective date of this Act to 

2 determine the effectiveness of the program in car3 rying out the duties under subsection (a). 

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

5 United States shall submit a report to Congress con6 cerning the results of each audit conducted under 

7 this subsection. 

8 SEC. 402. CONSULTATION. 

9 The Secretary shall consult with Federal agencies, 

10 Indian Tribes and urban Indian health organizations, and 

11 private entities, such as labor organizations representing 

12 health care workers, professional societies, national asso13 ciations, nationally recognized associations of health care 

14 experts, medical schools and academic health centers, con15 sumer groups, and labor business organizations in the for16 mulation of guidelines, regulations, policy initiatives, and 

17 information gathering to ensure the broadest and most in18 formed input in the administration of this Act. Nothing 

19 in this Act shall prevent the Secretary from adopting 

20 guidelines, consistent with section 203(c), developed by 

21 such a private entity if, in the Secretary’s judgment, such 

22 guidelines are generally accepted as reasonable and pru23 dent and consistent with this Act. 


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1 SEC. 403. REGIONAL ADMINISTRATION. 

2 (a) REGIONAL MEDICARE FOR ALL OFFICES.—The 

3 Secretary shall establish and maintain regional offices for 

4 the purpose of carrying out the duties specified in sub5 section (c) and promoting adequate access to, and efficient 

6 use of, tertiary care facilities, equipment, items, and serv7 ices by individuals enrolled under this Act. 

8 (b) COORDINATION.—Wherever possible, the Sec9 retary shall incorporate the regional offices and the ad10 ministrative processes of the Centers for Medicare & Med11 icaid Services for the purposes of carrying out subsection 

12 (a). 

13 (c) APPOINTMENT OF REGIONAL DIRECTORS.—In 

14 each regional office established under subsection (a) there 

15 shall be— 

16 (1) one regional director appointed by the Sec17 retary; 

18 (2) one deputy director appointed by the re19 gional director to represent the Indian and Alaska 

20 Native Tribes in the region, if any; and 

21 (3) one deputy director appointed by the re22 gional director to oversee home- and community23 based services and supports. 

24 (d) DUTIES.—Each regional director shall— 

25 (1) submit an annual regional health care needs 

26 assessment report to the Secretary, after a thorough 


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1 examination of health needs and consultation with 

2 public health officials, clinicians, patients, and pa3 tient advocates; 

4 (2) recommend any changes in provider reim5 bursement or payment for delivery of health items 

6 and services determined appropriate by the regional 

7 director, subject to the requirements of title VI; and 

8 (3) establish a quality assurance mechanism in 

9 each such region in order to minimize both under10 utilization and over-utilization of health care items 

11 and services and to ensure that all providers meet 

12 the quality and other standards established pursuant 

13 to this Act. 

14 SEC. 404. BENEFICIARY OMBUDSMAN. 

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

16 Beneficiary Ombudsman who shall have expertise and ex17 perience in the fields of health care and education of, and 

18 assistance to, individuals entitled to benefits under this 

19 Act. 

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

21 (1) receive complaints, grievances, and requests 

22 for information submitted by individuals entitled to 

23 benefits under this Act with respect to any aspect of 

24 the Medicare for All Program; 


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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 relating to cost-sharing; 

10 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. CONDUCT OF RELATED HEALTH PROGRAMS. 

21 In performing functions with respect to health per22 sonnel education and training, health research, environ23 mental health, disability insurance, vocational rehabilita24 tion, the regulation of food and drugs, and all other mat25 ters pertaining to health, the Secretary shall direct the acVerDate Sep 11 2014 18:20 May 24, 2022 Jkt 029200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\S4204.IS S4204

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1 tivities of the Department of Health and Human Services 

2 toward contributions to the health of the people com3 plementary to this Act. 

4 Subtitle B—Control Over Fraud 

5 and Abuse 

6 SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL 

7 FRAUD AND ABUSE UNDER MEDICARE FOR 

8 ALL PROGRAM. 

9 The following sections of the Social Security Act shall 

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

11 State medical assistance plans under title XIX of such 

12 Act: 

13 (1) Section 1128 (relating to exclusion of indi14 viduals and entities). 

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

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

17 (4) Section 1124 (relating to disclosure of own18 ership and related information). 

19 (5) Section 1126 (relating to disclosure of cer20 tain owners). 

21 (6) Section 1877 (relating to physician refer22 rals). 


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1 TITLE V—QUALITY OF CARE 

2 SEC. 501. QUALITY STANDARDS. 

3 (a) IN GENERAL.—All standards and quality meas4 ures under this Act shall be implemented and evaluated 

5 by the Center for Clinical Standards and Quality of the 

6 Centers for Medicare and Medicaid Services (referred to 

7 in this title as the ‘‘Center’’) or such other agencies deter8 mined appropriate by the Secretary, in coordination with 

9 the Agency for Healthcare Research and Quality and other 

10 offices of the Department of Health and Human Services. 

11 (b) DUTIES OF THE CENTER.—The Center shall per12 form the following duties: 

13 (1) Review and evaluate each practice guideline 

14 developed under part B of title IX of the Public 

15 Health Service Act (42 U.S.C. 299b et seq.). In so 

16 reviewing and evaluating, the Center shall determine 

17 whether the guideline should be recognized as a na18 tional practice guideline in accordance with and sub19 ject to section 203(c). 

20 (2) Review and evaluate each standard of qual21 ity, performance measure, and medical review cri22 terion developed under part B of title IX of the Pub23 lic Health Service Act (42 U.S.C. 299b et seq.). In 

24 so reviewing and evaluating, the Center shall deter25 mine whether the standard, measure, or criterion is 


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1 appropriate for use in assessing or reviewing the 

2 quality of items and services provided by health care 

3 institutions or health care professionals. The use of 

4 mechanisms that discriminate against people with 

5 disabilities is prohibited for use in any value or cost6 effectiveness assessments. The Center shall consider 

7 the evidentiary basis for the standard, and the valid8 ity, reliability, and feasibility of measuring the 

9 standard. 

10 (3) Adoption of methodologies for profiling the 

11 patterns of practice of health care professionals and 

12 for identifying and notifying outliers. 

13 (4) Development of minimum criteria for com14 petence for entities that can qualify to conduct ongo15 ing and continuous external quality reviews in the 

16 administrative regions. Such criteria shall require 

17 such an entity to be administratively independent of 

18 the individual or board that administers the region 

19 and shall ensure that such entities do not provide fi20 nancial incentives to reviewers to favor one pattern 

21 of practice over another. The Center shall ensure co22 ordination and reporting by such entities to ensure 

23 national consistency in quality standards. 

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1 search and development of practice guidelines that 

2 may affect the Secretary’s determination of coverage 

3 of services under section 401(a)(1)(G). 

4 SEC. 502. ADDRESSING HEALTH CARE DISPARITIES. 

5 (a) EVALUATING DATA COLLECTION AP6 PROACHES.—The Center, in coordination with the Office 

7 of Health Equity established under section 615 and other 

8 agencies in the Department of Health and Human Serv9 ices deemed relevant by the Secretary, shall evaluate ap10 proaches for the collection of data under this Act, to be 

11 performed in conjunction with existing quality reporting 

12 requirements and programs under this Act, that allow for 

13 the ongoing, accurate, and timely collection of data on dis14 parities in health care services and performance on the 

15 basis of race, ethnicity, gender, national origin, primary 

16 language use, age, disability, sex (including gender iden17 tity and sexual orientation), geography, or socioeconomic 

18 status. In conducting such evaluation, the Center shall 

19 consider the following objectives: 

20 (1) Protecting patient privacy. 

21 (2) Minimizing the administrative burdens of 

22 data collection and reporting on providers under this 

23 Act. 

24 (3) Improving data on race, ethnicity, national 

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1 cluding gender identity and sexual orientation), ge2 ography, and socioeconomic status. 

3 (b) REPORTS TO CONGRESS.— 

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

5 18 months after the date on which benefits are first 

6 available under section 106(a), the Center shall sub7 mit to Congress and the Secretary a report on the 

8 evaluation conducted under subsection (a). Such re9 port shall, taking into consideration the results of 

10 such evaluation— 

11 (A) identify approaches (including defining 

12 methodologies) for identifying and collecting 

13 and evaluating data on health care disparities 

14 on the basis of race, ethnicity, gender national 

15 origin, primary language use, age, disability, 

16 sex (including gender identity and sexual ori17 entation), geography, or socioeconomic status 

18 under the Medicare for All Program; and 

19 (B) include recommendations on the most 

20 effective strategies and approaches to reporting 

21 quality measures, as appropriate, on the basis 

22 of race, ethnicity, gender national origin, pri23 mary language use, age, disability, sex (includ24 ing gender identity and sexual orientation), ge25 ography, or socioeconomic status. 


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

2 than 4 years after the submission of the report 

3 under subsection (b)(1), and every 4 years there4 after, the Center shall submit to Congress and the 

5 Secretary a report that includes recommendations 

6 for improving the identification of health care dis7 parities based on the analyses of data collected 

8 under subsection (c). 

9 (c) IMPLEMENTING EFFECTIVE APPROACHES.—Not 

10 later than 2 years after the date on which benefits are 

11 first available under section 106(a), the Secretary shall 

12 implement the approaches identified in the report sub13 mitted under subsection (b)(1) for the ongoing, accurate, 

14 and timely collection and evaluation of data on health care 

15 disparities on the basis of race, ethnicity, gender national 

16 origin, primary language use, age, disability, sex (includ17 ing gender identity and sexual orientation), geography, or 

18 socioeconomic status. 

19 TITLE VI—NATIONAL HEALTH 

20 BUDGET; PROVIDER PAY21 MENTS; COST CONTAINMENT 

22 MEASURES 

23 Subtitle A—Budgeting 

24 SEC. 601. NATIONAL HEALTH BUDGET. 

25 (a) NATIONAL HEALTH BUDGET.— 


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

2 1 of each year, beginning with the year prior to the 

3 date on which benefits are first available under sec4 tion 106(a), the Secretary shall establish a national 

5 health budget, which specifies a budget for the total 

6 expenditures to be made for covered health care 

7 items and services under this Act. 

8 (2) DIVISION OF BUDGET INTO COMPONENTS.— 

9 The national health budget shall consist of at least 

10 the following components: 

11 (A) An operating budget. 

12 (B) A capital expenditures budget. 

13 (C) A special projects budget. 

14 (D) Quality assessment activities under 

15 title V. 

16 (E) Health professional education expendi17 tures. 

18 (F) Administrative costs, including costs 

19 related to the operation of regional offices. 

20 (G) A reserve fund. 

21 (H) Prevention and public health activities. 

22 (3) ALLOCATION AMONG COMPONENTS.—The 

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1 nents described in paragraph (2) in a manner that 

2 ensures— 

3 (A) that the operating budget allows for 

4 every participating provider in the Medicare for 

5 All Program to meet the needs of their respec6 tive patient populations; 

7 (B) that the special projects budget is suf8 ficient to meet the health care needs within 

9 areas described in paragraph (2)(C) through 

10 the construction, renovation, and staffing of 

11 health care facilities in a reasonable timeframe; 

12 (C) a fair allocation for quality assessment 

13 activities; and 

14 (D) that the health professional education 

15 expenditure component is sufficient to provide 

16 for the amount of health professional education 

17 expenditures sufficient to meet the need for cov18 ered health care services. 

19 (4) FOR REGIONAL ALLOCATION.—The Sec20 retary shall annually provide each regional office 

21 with an allotment the Secretary determines appro22 priate for purposes of carrying out this Act in such 

23 region, including payments to providers in such re24 gion, capital expenditures in such region, special 

25 projects in such region, health professional education 


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1 in such region, administrative expenses in such re2 gion, and prevention and public health activities in 

3 such region. 

4 (5) OPERATING BUDGET.—The operating budg5 et described in paragraph (2)(A) shall be used for— 

6 (A) payments to institutional providers 

7 pursuant to section 611; and 

8 (B) payments to individual providers pur9 suant to section 612. 

10 (6) CAPITAL EXPENDITURES BUDGET.—The 

11 capital expenditures budget described in paragraph 

12 (2)(B) shall be used for— 

13 (A) the construction or renovation of 

14 health care facilities, excluding congregate or 

15 segregated facilities for individuals with disabil16 ities who receive long-term care services and 

17 support; and 

18 (B) major equipment purchases. 

19 (7) SPECIAL PROJECTS BUDGET.—The special 

20 projects budget described in paragraph (2)(C) shall 

21 be used for the purposes of allocating funds for the 

22 construction of new facilities, major equipment pur23 chases, and staffing in rural or medically under24 served areas (as defined in section 330(b)(3) of the 

25 Public Health Service Act (42 U.S.C. 254b(b)(3))), 


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1 including areas designated as health professional 

2 shortage areas (as defined in section 332(a) of the 

3 Public Health Service Act (42 U.S.C. 254e(a))), and 

4 to address health disparities, including racial, ethnic, 

5 national origin, primary language use, age, dis6 ability, sex (including gender identity and sexual ori7 entation), geography, or socioeconomic health dis8 parities. 

9 (8) RESERVE FUND.—The reserve fund de10 scribed in paragraph (2)(G) shall be used to respond 

11 to the costs of an epidemic, pandemic, natural dis12 aster, or other such health emergency, or market13 shift adjustments related to patient volume. 

14 (b) DEFINITIONS.—In this section: 

15 (1) CAPITAL EXPENDITURES.—The term ‘‘cap16 ital expenditures’’ means expenses for the purchase, 

17 lease, construction, or renovation of capital facilities 

18 and for major equipment. 

19 (2) HEALTH PROFESSIONAL EDUCATION EX20 PENDITURES.—The term ‘‘health professional edu21 cation expenditures’’ means expenditures in hospitals 

22 and other health care facilities to cover costs associ23 ated with teaching and related research activities, in24 cluding the impact of workforce recruitment, reten25 tion, and diversity on patient outcomes. 


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1 SEC. 602. TEMPORARY WORKER ASSISTANCE. 

2 (a) IN GENERAL.—For up to 5 years following the 

3 date on which benefits are first available under section 

4 106(a), at least 1 percent of the national health budget 

5 shall be allocated to programs providing assistance to 

6 workers who perform functions in the administration of 

7 the health insurance system, or related functions within 

8 health care institutions or organizations, who may experi9 ence economic dislocation as a result of the implementa10 tion of this Act. 

11 (b) CLARIFICATION.—Assistance described in sub12 paragraph (A) shall include wage replacement, retirement 

13 benefits, job training and placement, preferential hiring, 

14 and education benefits. 

15 Subtitle B—Payments to Providers 

16 SEC. 611. PAYMENTS TO INSTITUTIONAL PROVIDERS 

17 BASED ON GLOBAL BUDGETS. 

18 (a) IN GENERAL.—Not later than the beginning of 

19 each fiscal quarter during which an institutional provider 

20 of care (including hospitals, skilled nursing facilities, and 

21 independent dialysis facilities) is to furnish items and 

22 services under this Act, the Secretary shall pay to such 

23 institutional provider a lump sum in accordance with the 

24 succeeding provisions of this subsection and consistent 

25 with the following: 


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1 (1) PAYMENT IN FULL.—Such payment shall be 

2 considered as payment in full for all operating ex3 penses for items and services furnished under this 

4 Act, whether inpatient or outpatient, by such pro5 vider for such quarter, including outpatient or any 

6 other care provided by the institutional provider or 

7 provided by any health care provider who provided 

8 items and services pursuant to an agreement paid 

9 through the global budget as described in paragraph 

10 (3). 

11 (2) QUARTERLY REVIEW.—The regional direc12 tor, on a quarterly basis, shall review whether re13 quirements of the institutional provider’s participa14 tion agreement and negotiated global budget have 

15 been performed and shall determine whether adjust16 ments to such institutional provider’s payment are 

17 warranted. This review shall include consideration 

18 for additional funding necessary for unanticipated 

19 items and services for individuals with complex med20 ical needs or market-shift adjustments related to pa21 tient volume, and an assessment of any adjustments 

22 made to ensure that accuracy and need for adjust23 ment was appropriate. 

24 (3) AGREEMENTS FOR SALARIED PAYMENTS

25 FOR CERTAIN PROVIDERS.—Certain group practices 


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1 and other health care providers, as determined by 

2 the Secretary, with agreements to provide items and 

3 services at a specified institutional provider paid a 

4 global budget under this subsection may elect to be 

5 paid through such institutional provider’s global 

6 budget in lieu of payment under section 612. Any— 

7 (A) individual health care professional of 

8 such group practice or other provider receiving 

9 payment through an institutional provider’s 

10 global budget shall be paid on a salaried basis 

11 that is equivalent to salaries or other compensa12 tion rates negotiated for individual health care 

13 professionals of such institutional provider; and 

14 (B) any group practice or other health care 

15 provider that receives payment through an in16 stitutional provider global budget under this 

17 paragraph shall be subject to the same report18 ing and disclosure requirements of the institu19 tional provider. 

20 (4) INTERIM ADJUSTMENTS.—The regional di21 rector shall consider a petition for adjustment of any 

22 payment under this section filed by an institutional 

23 provider at any time based on the following: 

24 (A) Factors that led to increased costs for 

25 the institutional provider that can reasonably be 


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1 considered to be unanticipated and out of the 

2 control of the institutional provider, such as— 

3 (i) natural disasters; 

4 (ii) public health emergencies includ5 ing outbreaks of epidemics or infectious 

6 diseases; 

7 (iii) unexpected facility or equipment 

8 repairs or purchases; 

9 (iv) significant and unexpected in10 creases in pharmaceutical or medical device 

11 prices; and 

12 (v) unanticipated increases in complex 

13 or high-cost patients or care needs. 

14 (B) Changes in Federal or State law that 

15 result in a change in costs. 

16 (C) Reasonable increases in labor costs, in17 cluding salaries and benefits, and changes in 

18 collective bargaining agreements, prevailing 

19 wage, or local law. 

20 (b) PAYMENT AMOUNT.— 

21 (1) IN GENERAL.—The amount of each pay22 ment to a provider described in subsection (a) shall 

23 be determined before the start of each calendar year 

24 through negotiations between the provider and the 

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1 vider. Such amount shall be based on factors speci2 fied in paragraph (2). 

3 (2) PAYMENT FACTORS.—Payments negotiated 

4 pursuant to paragraph (1) shall take into account, 

5 with respect to a provider— 

6 (A) the historical volume of services pro7 vided for each item and services in the previous 

8 3-year period; 

9 (B) the actual expenditures of such pro10 vider in such provider’s most recent cost report 

11 under title XVIII of the Social Security Act (42 

12 U.S.C. 1395 et seq.) for each item and service 

13 compared to— 

14 (i) such expenditures for other institu15 tional providers in the director’s jurisdic16 tion; and 

17 (ii) normative payment rates estab18 lished under comparative payment rate 

19 systems, including any adjustments, for 

20 such items and services; 

21 (C) projected changes in the volume and 

22 type of items and services to be furnished; 

23 (D) wages for employees, including any 

24 necessary increases to ensure mandatory min25 imum safe registered nurse-to-patient ratios 


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1 and optimal staffing levels for physicians and 

2 other health care workers; 

3 (E) the provider’s maximum capacity to 

4 provide items and services; 

5 (F) education and prevention programs; 

6 (G) permissible adjustment to the pro7 vider’s operating budget due to factors such 

8 as— 

9 (i) an increase in primary or specialty 

10 care access; 

11 (ii) efforts to decrease health care dis12 parities in rural or medically underserved 

13 areas; 

14 (iii) a response to emergent epidemic 

15 conditions; 

16 (iv) an increase in complex or high17 cost patients or care needs; or 

18 (v) proposed new and innovative pa19 tient care programs at the institutional 

20 level; 

21 (H) whether the provider is located in a 

22 high social vulnerability index community, ZIP 

23 Code, or census track, or is a minority-serving 

24 provider; and 


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1 (I) any other factor determined appro2 priate by the Secretary. 

3 (3) LIMITATION.—Payment amounts negotiated 

4 pursuant to paragraph (1) may not— 

5 (A) take into account capital expenditures 

6 of the provider or any other expenditure not di7 rectly associated with the provision of items and 

8 services by the provider to an individual; 

9 (B) be used by a provider for capital ex10 penditures or such other expenditures; 

11 (C) exceed the provider’s capacity to pro12 vide care under this Act; or 

13 (D) be used to pay or otherwise com14 pensate any board member, executive, or ad15 ministrator of the institutional provider who 

16 has any interest or relationship prohibited 

17 under section 301(b)(2) or disclosed under sec18 tion 301. 

19 (4) LIMITATION ON COMPENSATION.—Com20 pensation costs for any employee or any contractor 

21 or any subcontractor employee of an institutional 

22 provider receiving global budgets under this section 

23 shall meet the compensation cap established in sec24 tion 702 of the Bipartisan Budget Act of 2013 (41 

25 U.S.C. 4304(a)(16)) and implementing regulations. 


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1 (5) REGIONAL NEGOTIATIONS PERMITTED.— 

2 Subject to section 614, a regional director may nego3 tiate changes to an institutional provider’s global 

4 budget, including any adjustments to address un5 foreseen market shifts related to patient volume. 

6 (c) BASELINE RATES AND ADJUSTMENTS.— 

7 (1) IN GENERAL.—The Secretary shall use ex8 isting prospective payment systems under title 

9 XVIII of the Social Security Act to serve as the 

10 comparative payment rate system in global budget 

11 negotiations described in subsection (b). The Sec12 retary shall update such comparative payment rate 

13 systems annually. 

14 (2) SPECIFICATIONS.—In developing the com15 parative payment rate system, the Secretary shall 

16 use only the operating base payment rates under 

17 each such prospective payment systems with applica18 ble adjustments. 

19 (3) LIMITATION.—The comparative rate system 

20 established under this subsection shall not include 

21 the value-based payment adjustments and the cap22 ital expenses base payment rates that may be in23 cluded in such a prospective payment system. 

24 (4) INITIAL YEAR.—In the first year that global 

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1 stitutional providers and for purposes of selecting a 

2 comparative payment rate system used during initial 

3 global budget negotiations for each institutional pro4 vider, the Secretary shall take into account the ap5 propriate prospective payment system from the most 

6 recent year under title XVIII of the Social Security 

7 Act to determine what operating base payment the 

8 institutional provider would have been paid for cov9 ered items and services furnished the preceding year 

10 with applicable adjustments, including adjustments 

11 due to any public health emergencies in the pre12 ceding year, and excluding value-based payment ad13 justments, based on such prospective payment sys14 tem. 

15 (d) OPERATING EXPENSES.—For purposes of this 

16 title, ‘‘operating expenses’’ of a provider include the fol17 lowing: 

18 (1) The cost of all items and services associated 

19 with the provision of inpatient care and outpatient 

20 care, including the following: 

21 (A) Wages and salary costs for physicians, 

22 nurses, and other health care practitioners em23 ployed by an institutional provider, including 

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1 patient staffing ratios and optimal staffing lev2 els for physicians and other healthcare workers. 

3 (B) Wages and salary costs for all ancil4 lary staff and services. 

5 (C) Costs of all pharmaceutical products 

6 administered by health care clinicians at the in7 stitutional provider’s facilities or through serv8 ices provided in accordance with State licensing 

9 laws or regulations under which the institu10 tional provider operates. 

11 (D) Costs for infectious disease response 

12 preparedness, including maintenance of a 1- 

13 year or 365-day stockpile of personal protective 

14 equipment, occupational testing and surveil15 lance, medical services for occupational infec16 tious disease exposure, and contact tracing. 

17 (E) Purchasing and maintenance of med18 ical devices, supplies, and other health care 

19 technologies, including diagnostic testing equip20 ment. 

21 (F) Costs of all incidental services nec22 essary for safe patient care and handling. 

23 (G) Costs of patient care, education, and 

24 prevention programs, including occupational 

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1 grams, and necessary staff to implement such 

2 programs, for the continued education and 

3 health and safety of clinicians and other indi4 viduals employed by the institutional provider. 

5 (2) Administrative costs for the institutional 

6 provider. 

7 SEC. 612. PAYMENTS TO INDIVIDUAL PROVIDERS THROUGH 

8 FEE-FOR-SERVICE. 

9 (a) MEDICARE FOR ALL FEE SCHEDULE.— 

10 (1) ESTABLISHMENT.—Not later than 1 year 

11 after the date of the enactment of this Act, and in 

12 consultation with providers and regional office direc13 tors, the Secretary shall establish and annually up14 date a national fee schedule that establishes 

15 amounts for items and services payable under this 

16 Act, furnished by— 

17 (A) individual providers; 

18 (B) providers in group practices who are 

19 not receiving payments on a salaried basis de20 scribed in section 611(a)(3); 

21 (C) providers of home- and community22 based services; and 

23 (D) any other provider not described in 

24 section 611. 


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1 (2) AMOUNTS.—In establishing the fee schedule 

2 under paragraph (1), the Secretary shall take into 

3 account— 

4 (A) the amounts payable for such items 

5 and services under title XVIII of the Social Se6 curity Act and other Federal health programs; 

7 and 

8 (B) the expertise of providers and the 

9 value of items and services furnished by such 

10 providers. 

11 (b) LEVERAGING EXISTING MEDICARE PAYMENT

12 PROCESSES.— 

13 (1) APPLICATION OF PAYMENT PROCESSES

14 UNDER TITLE XVIII.—Except as otherwise provided 

15 in this section, the Secretary shall establish, and 

16 shall annually update by regulation, the fee schedule 

17 under subsection (a) in a manner that is docu18 mented, is transparent, allows for public comment, 

19 and, to the greatest extent practicable, is consistent 

20 with processes for determining, revising, and making 

21 payments for items and services under title XVIII of 

22 the Social Security Act (42 U.S.C. 1395 et seq.), in23 cluding the application of the provisions of, and 

24 amendments made by, section 613. 


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1 (2) ELECTRONIC BILLING.—The Secretary shall 

2 establish a uniform national system for electronic 

3 billing for purposes of making payments under this 

4 section. 

5 (c) APPLICATION OF CURRENT AND PLANNED PAY6 MENT REFORMS.—To the extent the Secretary determines 

7 such application is necessary to ensure a smooth and fair 

8 transition, the Secretary may apply payment reform ac9 tivities planned or implemented with respect to such title 

10 XVIII as of the date of the enactment of this Act, includ11 ing demonstrations, waivers, or any other provider pay12 ment agreements, to benefits under this Act, provided that 

13 the Secretary sets forth a process for reviewing such appli14 cations and making such determinations that is reason15 able, transparent, and documented, and allows for public 

16 comment. 

17 (d) PHYSICIAN PRACTICE REVIEW BOARD.—Each di18 rector of a regional office, in consultation with representa19 tives of physicians practicing in that region, shall establish 

20 and appoint a physician practice review board to assure 

21 quality, cost effectiveness, and fair reimbursements for 

22 physician-delivered items and services. The use of mecha23 nisms that discriminate against people with disabilities is 

24 prohibited for use in any value or cost-effectiveness assess25 ments. 


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1 SEC. 613. ACCURATE VALUATION OF SERVICES UNDER THE 

2 MEDICARE PHYSICIAN FEE SCHEDULE. 

3 (a) STANDARDIZED AND DOCUMENTED REVIEW

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

5 (42 U.S.C. 1395w–4(c)(2)) is amended by adding at the 

6 end the following new subparagraph: 

7 ‘‘(P) STANDARDIZED AND DOCUMENTED

8 REVIEW PROCESS.— 

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

10 year after the date of enactment of this 

11 subparagraph, the Secretary shall estab12 lish, document, and make publicly avail13 able, in consultation with the Office of Pri14 mary Health Care, a standardized process 

15 for reviewing the relative values of physi16 cians’ services under 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 


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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 the Sec18 retary’s review of the relative values of physicians’ 

19 services, such as by establishing an internal data20 base, under section 1848(c)(2) of the Social Security 

21 Act (42 U.S.C. 1395w–4(c)(2)), as amended by this 

22 section. 

23 (2) MINIMUM REQUIREMENTS.—The proposal 

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


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1 for achieving the ability to systematically and inter2 nally track the following: 

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

4 identified for review. 

5 (B) When services are reviewed or when 

6 new services are added. 

7 (C) The resources, evidence, data, and rec8 ommendations used in reviews. 

9 (D) When relative values are adjusted. 

10 (E) The rationale for final relative value 

11 decisions. 

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

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

14 amended— 

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

16 inserting ‘‘4’’; and 

17 (2) in subparagraph (K)(i)(I), by striking ‘‘peri18 odically’’ and inserting ‘‘annually’’. 

19 (e) CONSULTATION WITH MEDICARE PAYMENT AD20 VISORY COMMISSION.— 

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

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

23 amended— 

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

25 ‘‘in consultation with the Medicare Payment 


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

2 and 

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

4 by subsection (d)(2), by inserting ‘‘, in coordi5 nation with the Medicare Payment Advisory 

6 Commission,’’ after ‘‘annually’’. 

7 (2) CONFORMING AMENDMENTS.—Section 1805 

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

9 amended— 

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

11 the following before the semicolon at the end: 

12 ‘‘and including coordinating with the Secretary 

13 in accordance with section 1848(c)(2) to sys14 tematically review the relative values established 

15 for physicians’ services, identify potentially 

16 misvalued services, and propose adjustments to 

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

18 (B) in subsection (e)(1), in the second sen19 tence, by inserting ‘‘or the Ranking Minority 

20 Member’’ after ‘‘the Chairman’’. 

21 (f) PERIODIC AUDIT BY THE COMPTROLLER GEN22 ERAL.—Section 1848(c)(2) of the Social Security Act (42 

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

24 amended by adding at the end the following new subpara25 graph: 


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1 ‘‘(Q) PERIODIC AUDIT BY THE COMP2 TROLLER GENERAL.— 

3 ‘‘(i) IN GENERAL.—The Comptroller 

4 General of the United States (in this sub5 paragraph referred to as the ‘Comptroller 

6 General’) shall periodically audit the review 

7 by the Secretary of relative values estab8 lished under this paragraph for physicians’ 

9 services. 

10 ‘‘(ii) ACCESS TO INFORMATION.—The 

11 Comptroller General shall have unre12 stricted access to all deliberations, records, 

13 and data related to the activities carried 

14 out under this paragraph, in a timely man15 ner, upon request.’’. 

16 SEC. 614. PAYMENTS FOR PRESCRIPTION DRUGS AND AP17 PROVED DEVICES AND EQUIPMENT. 

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

19 covered pharmaceutical products, medical supplies, and 

20 medically necessary assistive equipment shall be nego21 tiated annually by the Secretary. 

22 (b) PRESCRIPTION DRUG FORMULARY.— 

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

24 a prescription drug formulary system, pursuant to 

25 the requirements of section 202, which shall encourVerDate Sep 11 2014 18:20 May 24, 2022 Jkt 029200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\S4204.IS S4204

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1 age best-practices in prescribing and discourage the 

2 use of ineffective, dangerous, or excessively costly 

3 medications when better alternatives are available. 

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

5 formulary under this subsection shall promote the 

6 use of generic medications to the greatest extent 

7 possible. 

8 (3) FORMULARY UPDATES AND PETITION

9 RIGHTS.—The formulary under this subsection shall 

10 be updated frequently and clinicians and patients 

11 may petition the Secretary to add new pharma12 ceuticals or to remove ineffective or dangerous medi13 cations from the formulary. 

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

15 The Secretary shall promulgate rules regarding the 

16 use of off-formulary medications which allow for pa17 tient access but do not compromise the formulary. 

18 SEC. 615. PAYMENT PROHIBITIONS; CAPITAL EXPENDI19 TURES; SPECIAL PROJECTS. 

20 (a) PROHIBITIONS.—Payments to providers under 

21 this Act may not take into account, include any process 

22 for the provision of funding for, or be used by a provider 

23 for— 

24 (1) marketing of the provider; 


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1 (2) the profit or net revenue of the provider, or 

2 increasing the profit or net revenue of the provider; 

3 (3) any agreement or arrangement described in 

4 section 203(a)(4) of the Labor-Management Report5 ing and Disclosure Act of 1959 (29 U.S.C. 

6 433(a)(4)); or 

7 (4) political or other contributions prohibited 

8 under section 317 of the Federal Elections Cam9 paign Act of 1971 (52 U.S.C. 30119(a)(1)). 

10 (b) PAYMENTS FOR CAPITAL EXPENDITURES.— 

11 (1) IN GENERAL.—The Secretary shall pay, 

12 from amounts made available for capital expendi13 tures pursuant to section 601(a)(2)(B), such sums 

14 determined appropriate by the Secretary to providers 

15 who have submitted an application to the regional 

16 director of the region or regions in which the pro17 vider operates or seeks to operate in a time and 

18 manner specified by the Secretary for purposes of 

19 funding capital expenditures of such providers. 

20 (2) PRIORITY.—The Secretary shall prioritize 

21 allocation of funding under paragraph (1) to 

22 projects that propose to use such funds to improve 

23 service in a medically underserved area (as defined 

24 in section 330(b)(3) of the Public Health Service 

25 Act (42 U.S.C. 254b(b)(3))) or to address health 


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1 disparities, including racial, ethnic, national origin, 

2 primary language use, age, disability, sex (including 

3 gender identity and sexual orientation), geography, 

4 or socioeconomic health disparities. 

5 (3) LIMITATION.—The Secretary shall not 

6 grant funding for capital expenditures under this 

7 subsection for capital projects that are financed di8 rectly or indirectly through the diversion of private 

9 or other non-Medicare for All Program funding that 

10 results in reductions in care to patients, including 

11 reductions in registered nursing staffing patterns 

12 and changes in emergency room or primary care 

13 services or availability. 

14 (4) CAPITAL ASSETS NOT FUNDED BY THE

15 MEDICARE FOR ALL PROGRAM.—Operating expenses 

16 and funds shall not be used by an institutional pro17 vider receiving payment for capital expenditures 

18 under this subsection for a capital asset that was 

19 not funded by the Medicare for All Program without 

20 the approval of the regional director or directors of 

21 the region or regions where the capital asset is lo22 cated. 

23 (c) PROHIBITION AGAINST CO-MINGLING OPER24 ATING AND CAPITAL FUNDS.—Providers that receive payVerDate Sep 11 2014 18:20 May 24, 2022 Jkt 029200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S4204.IS S4204

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1 ment under this title shall be prohibited from using, with 

2 respect to funds made available under this Act— 

3 (1) funds designated for operating expenditures 

4 for capital expenditures or for profit; or 

5 (2) funds designated for capital expenditures 

6 for operating expenditures. 

7 (d) PAYMENTS FOR SPECIAL PROJECTS.— 

8 (1) IN GENERAL.—The Secretary shall allocate 

9 to each regional director, from amounts made avail10 able for special projects pursuant to section 

11 601(a)(2)(C), such sums determined appropriate by 

12 the Secretary for purposes of funding projects de13 scribed in such section, including the construction, 

14 renovation, or staffing of health care facilities in 

15 rural, underserved, or health professional or medical 

16 shortage areas within such region and to address 

17 health disparities, including racial, ethnic, national 

18 origin, primary language use, age, disability, sex, in19 cluding gender identity and sexual orientation, geog20 raphy, or socioeconomic health disparities. Each re21 gional director shall, prior to distributing such funds 

22 in accordance with paragraph (2), present a budget 

23 describing how such funds will be distributed to the 

24 Secretary. 


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1 (2) DISTRIBUTION.—A regional director shall 

2 distribute funds to providers operating in the region 

3 of such director’s jurisdiction in a manner deter4 mined appropriate by the director. 

5 (e) PROHIBITION ON FINANCIAL INCENTIVE

6 METRICS IN PAYMENT DETERMINATIONS.—The Sec7 retary may not utilize any quality metrics or standards 

8 for the purposes of establishing provider payment meth9 odologies, programs, modifiers, or adjustments for pro10 vider payments under this title. 

11 SEC. 616. OFFICE OF HEALTH EQUITY. 

12 Title XVII of the Public Health Service Act (42 

13 U.S.C. 300u et seq.) is amended by adding at the end 

14 the following: 

15 ‘‘SEC. 1712. OFFICE OF HEALTH EQUITY. 

16 ‘‘(a) IN GENERAL.—There is established, in the Of17 fice of the Secretary of Health and Human Services, an 

18 Office of Health Equity, to be headed by a Director, to 

19 ensure coordination and collaboration across the programs 

20 and activities of the Department of Health and Human 

21 Services with respect to ensuring health equity. 

22 ‘‘(b) MONITORING, TRACKING, AND AVAILABILITY OF

23 DATA.— 

24 ‘‘(1) IN GENERAL.—In carrying out subsection 

25 (a), the Director of the Office of Health Equity shall 


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1 monitor, track, and make publicly available data 

2 on— 

3 ‘‘(A) the disproportionate burden of dis4 ease and death among people of color, 

5 disaggregated by race, major ethnic group, 

6 Tribal affiliation, national origin, primary lan7 guage use, English proficiency status, immigra8 tion status, length of stay in the United States, 

9 age, disability, sex (including gender identity 

10 and sexual orientation), incarceration, home11 lessness, geography, and socioeconomic status; 

12 ‘‘(B) barriers to health, including such 

13 barriers relating to income, education, housing, 

14 food insecurity (including availability, access, 

15 utilization, and stability), employment status, 

16 working conditions, and conditions related to 

17 the physical environment (including pollutants 

18 and population density); 

19 ‘‘(C) barriers to health care access, includ20 ing— 

21 ‘‘(i) lack of trust and awareness; 

22 ‘‘(ii) lack of transportation; 

23 ‘‘(iii) geography; 

24 ‘‘(iv) hospital and service closures; 


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1 ‘‘(v) lack of health care infrastructure 

2 and facilities; and 

3 ‘‘(vi) lack of health care professional 

4 staffing and recruitment; 

5 ‘‘(D) disparities in quality of care received, 

6 including discrimination in health care settings 

7 and the use of racially biased practice guide8 lines and algorithms; and 

9 ‘‘(E) disparities in utilization of care. 

10 ‘‘(2) ANALYSIS OF CROSS-SECTIONAL INFORMA11 TION.—The Director of the Office of Health Equity 

12 shall ensure that the data collection and reporting 

13 process under paragraph (1) allows for the analysis 

14 of cross-sectional information on people’s identities. 

15 ‘‘(c) POLICIES.—In carrying out subsection (a), the 

16 Director of the Office of Health Equity shall develop, co17 ordinate, and promote policies that enhance health equity, 

18 including by— 

19 ‘‘(1) providing recommendations on— 

20 ‘‘(A) cultural competence, implicit bias, 

21 and ethics training with respect to health care 

22 workers; 

23 ‘‘(B) increasing diversity in the health care 

24 workforce; and 


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1 ‘‘(C) ensuring sufficient health care profes2 sionals and facilities; and 

3 ‘‘(2) ensuring adequate public health funding at 

4 the local and State levels to address health dispari5 ties. 

6 ‘‘(d) CONSULTATION.—In carrying out subsection 

7 (a), the Director of the Office of Health Equity, in coordi8 nation with the Director of the Indian Health Service, 

9 shall consult with Indian Tribes and with Urban Indian 

10 organizations on data collection, reporting, and implemen11 tation of policies. 

12 ‘‘(e) ANNUAL REPORT.—In carrying out subsection 

13 (a), the Director of the Office of Health Equity shall de14 velop and publish an annual report on— 

15 ‘‘(1) statistics collected by the Office; 

16 ‘‘(2) proposed evidence-based solutions to miti17 gate health inequities; and 

18 ‘‘(3) health care professional staffing levels and 

19 access to facilities. 

20 ‘‘(f) CENTRALIZED ELECTRONIC REPOSITORY.—In 

21 carrying out subsection (a), the Director of the Office of 

22 Health Equity shall— 

23 ‘‘(1) establish and maintain a centralized elec24 tronic repository to incorporate data collected across 

25 Federal departments and agencies on race, ethnicity, 


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1 Tribal affiliation, national origin, primary language 

2 use, English proficiency status, immigration status, 

3 length of stay in the United States, age, disability, 

4 sex (including gender identity and sexual orienta5 tion), incarceration, homelessness, geography, and 

6 socioeconomic status; and 

7 ‘‘(2) make such data available for public use 

8 and analysis. 

9 ‘‘(g) PRIVACY.—Notwithstanding any other Federal 

10 or State law, no Federal or State official or employee or 

11 other entity shall disclose, or use, for any law enforcement 

12 or immigration purpose, any personally identifiable infor13 mation (including with respect to an individual’s religious 

14 beliefs, practices, or affiliation, national origin, ethnicity, 

15 or immigration status) that is collected or maintained pur16 suant to this section.’’. 

17 SEC. 617. OFFICE OF PRIMARY HEALTH CARE. 

18 Title XVII of the Public Health Service Act (42 

19 U.S.C. 300u et seq.), as amended by section 616, is fur20 ther amended by adding at the end the following: 

21 ‘‘SEC. 1713. OFFICE OF PRIMARY HEALTH CARE. 

22 ‘‘(a) IN GENERAL.—There is established, in the Of23 fice of Health Equity established under section 1712, an 

24 Office of Primary Health Care, to be headed by a Direc25 tor, to ensure coordination and collaboration across the 


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1 programs and activities of the Department of Health and 

2 Human Services with respect to increasing access to high3 quality primary health care, particularly in underserved 

4 areas and for underserved populations. 

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

6 the date of enactment of this section, the Director of the 

7 Office of Primary Health Care shall publish national 

8 goals— 

9 ‘‘(1) to increase access to high-quality primary 

10 health care, particularly in underserved areas and 

11 for underserved populations; and 

12 ‘‘(2) to address health disparities, including 

13 with respect to race, ethnicity, national origin 

14 (disaggregated by major ethnic group and Tribal af15 filiation), primary language use, English proficiency 

16 status, immigration status, length of stay in the 

17 United States, age, disability, sex (including gender 

18 identity and sexual orientation), incarceration, home19 lessness, geography, and socioeconomic status. 

20 ‘‘(c) OTHER RESPONSIBILITIES.—In carrying out 

21 subsections (a) and (b), the Director of the Office of Pri22 mary Health Care shall— 

23 ‘‘(1) coordinate, in consultation with the Sec24 retary, health professional education policies and 


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1 goals to achieve the national goals published pursu2 ant to subsection (b); 

3 ‘‘(2) develop and maintain a system to monitor 

4 the number and specialties of individuals pursuing 

5 careers in, or practicing, primary health care 

6 through their health professional education, any 

7 postgraduate training, and professional practice; 

8 ‘‘(3) develop, coordinate, and promote policies 

9 that expand the number of primary health care prac10 titioners including primary medical, dental, and be11 havioral health care providers, registered nurses, and 

12 other mid-level practitioners; 

13 ‘‘(4) recommend appropriate workforce train14 ing, technical assistance, and patient protection en15 hancements for primary health care practitioners, in16 cluding registered nurses, to achieve uniform high 

17 quality and patient safety; 

18 ‘‘(5) provide recommendations on targeted pro19 grams and resources for federally qualified health 

20 centers, community health centers, rural health cen21 ters, behavioral health clinics, and other community22 based organizations; 

23 ‘‘(6) provide recommendations for broader pa24 tient referral to additional resources, not limited to 

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1 tions and sectors that influence health outcomes; 

2 and 

3 ‘‘(7) consult with the Secretary on the alloca4 tion of the special projects budget under section 

5 601(a)(2)(C) of the Medicare for All Act of 2022. 

6 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec7 tion shall be construed— 

8 ‘‘(1) to preempt any provision of State law es9 tablishing practice standards or guidelines for health 

10 care professionals, including professional licensing or 

11 practice laws or regulations; or 

12 ‘‘(2) to require that any State impose additional 

13 educational standards or guidelines for health care 

14 professionals.’’. 

15 TITLE VII—UNIVERSAL 

16 MEDICARE TRUST FUND 

17 SEC. 701. UNIVERSAL MEDICARE TRUST FUND. 

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

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

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

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

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

23 made and such amounts as may be deposited in, or appro24 priated to, such Trust Fund as provided in this Act. 

25 (b) APPROPRIATIONS INTO TRUST FUND.— 


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1 (1) TAXES.—There are appropriated to the 

2 Trust Fund for each fiscal year beginning with the 

3 fiscal year which includes the date on which benefits 

4 are first available under section 106(a), out of any 

5 moneys in the Treasury not otherwise appropriated, 

6 amounts equivalent to 100 percent of the net in7 crease in revenues to the Treasury which is attrib8 utable to the amendments made by sections 801 and 

9 902. The amounts appropriated by the preceding 

10 sentence shall be transferred from time to time (but 

11 not less frequently than monthly) from the general 

12 fund in the Treasury to the Trust Fund, such 

13 amounts to be determined on the basis of estimates 

14 by the Secretary of the Treasury of the taxes paid 

15 to or deposited into the Treasury, and proper adjust16 ments shall be made in amounts subsequently trans17 ferred to the extent prior estimates were in excess 

18 of or were less than the amounts that should have 

19 been so transferred. 

20 (2) CURRENT PROGRAM RECEIPTS.— 

21 (A) INITIAL YEAR.—Notwithstanding any 

22 other provision of law, there is hereby appro23 priated to the Trust Fund for the first fiscal 

24 year beginning at least one year after the date 

25 of the enactment of this Act, an amount equal 


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1 to the aggregate amount appropriated for the 

2 preceding fiscal year for the following (in3 creased by the consumer price index for all 

4 urban consumers for the fiscal year involved): 

5 (i) The Medicare program under title 

6 XVIII of the Social Security Act (other 

7 than amounts attributable to any pre8 miums under such title). 

9 (ii) The Medicaid program under 

10 State plans approved under title XIX of 

11 such Act. 

12 (iii) The Federal Employees Health 

13 Benefits program, under chapter 89 of title 

14 5, United States Code. 

15 (iv) The maternal and child health 

16 program (under title V of the Social Secu17 rity Act), vocational rehabilitation pro18 grams, programs for drug abuse and men19 tal health services under the Public Health 

20 Service Act, programs providing general 

21 hospital or medical assistance, and any 

22 other Federal program identified by the 

23 Secretary, in consultation with the Sec24 retary of the Treasury, to the extent the 

25 programs provide for payment for health 


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1 services the payment of which may be 

2 made under this Act. 

3 (B) SUBSEQUENT YEARS.—Notwith4 standing any other provision of law, there is ap5 propriated to the Trust Fund for each fiscal 

6 year following the fiscal year in which the ap7 propriation is made under subparagraph (A), 

8 an amount equal to the amount appropriated to 

9 the Trust Fund for the previous year, adjusted 

10 for reductions in costs resulting from the imple11 mentation of this Act, changes in the consumer 

12 price index for all urban consumers for the fis13 cal year involved, and other factors determined 

14 appropriate by the Secretary. 

15 (3) RESTRICTIONS SHALL NOT APPLY.—Any 

16 other provision of law in effect on the date of enact17 ment of this Act restricting the use of Federal funds 

18 for any reproductive health service shall not apply to 

19 monies in the Trust Fund. 

20 (c) INCORPORATION OF PROVISIONS.—The provisions 

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

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

23 Fund under this section in the same manner as such pro24 visions applied to the Federal Hospital Insurance Trust 

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


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

2 of Trustees of the Trust Fund’’ shall mean the ‘‘Sec3 retary’’. 

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

5 in the Federal Hospital Insurance Trust Fund under sec6 tion 1817 of the Social Security Act (42 U.S.C. 1395i) 

7 or the Federal Supplementary Medical Insurance Trust 

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

9 after the payment of claims for items and services fur10 nished under title XVIII of such Act have been completed, 

11 shall be transferred into the Universal Medicare Trust 

12 Fund under this section. 

13 TITLE VIII—CONFORMING 

14 AMENDMENTS TO THE EM15 PLOYEE RETIREMENT IN16 COME SECURITY ACT OF 1974 

17 SEC. 801. PROHIBITION OF EMPLOYEE BENEFITS DUPLICA18 TIVE OF BENEFITS UNDER THE MEDICARE 

19 FOR ALL PROGRAM; COORDINATION IN CASE 

20 OF WORKERS’ COMPENSATION. 

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

22 the Employee Retirement Income Security Act of 1974 

23 (29 U.S.C. 1131 et seq.) is amended by adding at the end 

24 the following new section: 


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1 ‘‘SEC. 523. PROHIBITION OF EMPLOYEE BENEFITS DUPLI2 CATIVE OF MEDICARE FOR ALL PROGRAM 

3 BENEFITS; COORDINATION IN CASE OF 

4 WORKERS’ COMPENSATION. 

5 ‘‘(a) IN GENERAL.—Subject to subsection (b), no em6 ployee benefit plan may provide benefits that duplicate 

7 payment for any items or services for which payment may 

8 be made under the Medicare for All Act of 2022. 

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

10 carrier that is liable for payment for workers compensa11 tion services furnished in a State shall reimburse the 

12 Medicare for All Program for the cost of such services. 

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

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

15 means an insurance company that underwrite work16 ers compensation medical benefits with respect to 

17 one or more employers and includes an employer or 

18 fund that is financially at risk for the provision of 

19 workers compensation medical benefits; 

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

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

22 an employee subject to the workers compensation 

23 laws of a State, the comprehensive medical benefits 

24 for work-related injuries and illnesses provided for 

25 under such laws with respect to such an employee; 

26 and 


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

2 means items and services included in workers com3 pensation medical benefits and includes items and 

4 services (including rehabilitation services and long5 term care services) commonly used for treatment of 

6 work-related injuries and illnesses.’’. 

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

8 Employee Retirement Income Security Act of 1974 (29 

9 U.S.C. 1003(b)) is amended by adding at the end the fol10 lowing: ‘‘Paragraph (3) shall apply subject to section 

11 523(b) (relating to reimbursement of the Medicare for All 

12 Program by workers compensation carriers).’’. 

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

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

15 item relating to section 522 the following new item: 

‘‘Sec. 523. Prohibition of employee benefits duplicative of Medicare for All Program benefits; coordination in case of workers’ compensation.’’. 

16 SEC. 802. REPEAL OF CONTINUATION COVERAGE REQUIRE17 MENTS UNDER ERISA AND CERTAIN OTHER 

18 REQUIREMENTS RELATING TO GROUP 

19 HEALTH PLANS. 

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

21 the Employee Retirement Income Security Act of 1974 

22 (29 U.S.C. 1161 et seq.) is repealed. 

23 (b) CONFORMING AMENDMENTS.— 


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

2 1132(a)) is amended— 

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

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

5 and (10) as paragraphs (7), (8), and (9), re6 spectively. 

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

8 1132(c)(1)) is amended by striking ‘‘paragraph (1) 

9 or (4) of section 606,’’. 

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

11 1144(b)) is amended— 

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

13 206(d)(3)(B)(i)),’’; and 

14 (B) by striking paragraph (8). 

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

16 Employee Retirement Income Security Act of 1974 

17 is amended by striking the items relating to part 6 

18 of subtitle B of title I of such Act. 

19 SEC. 803. EFFECTIVE DATE OF TITLE. 

20 The provisions of and amendments made by this title 

21 shall take effect on the date on which benefits are first 

22 available under section 106(a). 


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1 TITLE IX—ADDITIONAL 

2 CONFORMING AMENDMENTS 

3 SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH 

4 PROGRAMS. 

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

6 HEALTH INSURANCE PROGRAM (SCHIP).— 

7 (1) IN GENERAL.—Notwithstanding any other 

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

9 (3)— 

10 (A) no benefits shall be available under 

11 title XVIII of the Social Security Act for any 

12 item or service furnished beginning on or after 

13 the date on which benefits are first available 

14 under section 106(a); 

15 (B) no individual is entitled to medical as16 sistance under a State plan approved under 

17 title XIX of such Act for any item or service 

18 furnished on or after such date; 

19 (C) no individual is entitled to medical as20 sistance under a State child health plan under 

21 title XXI of such Act for any item or service 

22 furnished on or after such date; and 

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

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

25 with respect to medical assistance or child 


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1 health assistance for any item or service fur2 nished on or after such date. 

3 (2) TRANSITION.—In the case of inpatient hos4 pital services and extended care services during a 

5 continuous period of stay which began before the 

6 date on which benefits are first available under sec7 tion 106(a), and which had not ended as of such 

8 date, for which benefits are provided under title 

9 XVIII of the Social Security Act, under a State plan 

10 under title XIX of such Act, or under a State child 

11 health plan under title XXI of such Act, the Sec12 retary shall provide for continuation of benefits 

13 under such title or plan until the end of the period 

14 of stay. 

15 (3) CONTINUED COVERAGE OF LONG-TERM

16 CARE AND OTHER CERTAIN SERVICES UNDER MED17 ICAID.— 

18 (A) IN GENERAL.—This subsection shall 

19 not apply to entitlement to medical assistance 

20 provided under title XIX of the Social Security 

21 Act for— 

22 (i) institutional long-term care serv23 ices (as defined in section 1948(b) of such 

24 Act); or 


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1 (ii) any other service for which bene2 fits are not available under this Act and 

3 which is furnished under a State plan 

4 under title XIX of the Social Security Act 

5 which provided for medical assistance for 

6 such service on January 1, 2022. 

7 (B) COORDINATION BETWEEN SECRETARY

8 AND STATES.—The Secretary shall coordinate 

9 with the directors of State agencies responsible 

10 for administering State plans under title XIX 

11 of the Social Security Act to— 

12 (i) identify services described in sub13 paragraph (A)(ii) with respect to each 

14 State plan; and 

15 (ii) ensure that such services continue 

16 to be made available under such plan. 

17 (C) STATE MAINTENANCE OF EFFORT RE18 QUIREMENT.—With respect to any service de19 scribed in subparagraph (A)(ii) that is made 

20 available under a State plan under title XIX of 

21 the Social Security Act, the maintenance of ef22 fort requirements described in section 1948(c) 

23 of such Act (related to eligibility standards and 

24 required expenditures) shall apply to such serv25 ice in the same manner that such requirements 


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1 apply to institutional long-term care services (as 

2 defined in section 1948(b) of such Act). 

3 (b) FEDERAL EMPLOYEES HEALTH BENEFITS PRO4 GRAM.—No benefits shall be made available under chapter 

5 89 of title 5, United States Code with respect to items 

6 and services furnished to any individual eligible to enroll 

7 under this Act. 

8 (c) TREATMENT OF BENEFITS FOR VETERANS AND

9 NATIVE AMERICANS.— 

10 (1) IN GENERAL.—Nothing in this Act shall af11 fect the eligibility of veterans for the medical bene12 fits and services provided under title 38, United 

13 States Code, the eligibility of individuals for 

14 TRICARE medical benefits and services provided 

15 under sections 1079 and 1086 of title 10, United 

16 States Code, or of Indians for the medical benefits 

17 and services provided by or through the Indian 

18 Health Service. 

19 (2) REEVALUATION.—No reevaluation of the 

20 Indian Health Service shall be undertaken without 

21 consultation with Tribal leaders and stakeholders. 

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

23 EXCHANGES. 

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1 changes established pursuant to title I of the Patient Pro2 tection and Affordable Care Act (Public Law 111–148) 

3 shall terminate, and any other provision of law that relies 

4 upon participation in or enrollment through such an Ex5 change, including such provisions of the Internal Revenue 

6 Code of 1986, shall cease to have force or effect. 

7 TITLE X—TRANSITION TO 

8 MEDICARE FOR ALL 

9 Subtitle A—Improvements to 

10 Medicare 

11 SEC. 1001. PROTECTING MEDICARE FEE-FOR-SERVICE 

12 BENEFICIARIES FROM HIGH OUT-OF-POCKET 

13 COSTS. 

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

15 EXPENDITURES.—Title XVIII of the Social Security Act 

16 (42 U.S.C. 1395 et seq.) is amended by adding at the end 

17 the following new section: 

18 ‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET

19 EXPENDITURES

20 ‘‘SEC. 1899C. (a) IN GENERAL.—Notwithstanding 

21 any other provision of this title, in the case of an indi22 vidual entitled to, or enrolled for, benefits under part A 

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

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

25 year beginning January 1 of the year following the date 

26 of enactment of the Medicare for All Act of 2022) equals 


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

2 for additional out-of-pocket cost-sharing that occurred 

3 during that year. 

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

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

6 and (3), in this section, the term ‘out-of-pocket cost7 sharing’ means, with respect to an individual, the 

8 amount of the expenses incurred by the individual 

9 that are attributable to— 

10 ‘‘(A) coinsurance and copayments applica11 ble under part A or B; or 

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

13 have otherwise been covered under part A or B 

14 but for the exhaustion of those benefits. 

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

16 ‘‘(A) NON-COVERED ITEMS AND SERV17 ICES.—Expenses incurred for items and serv18 ices which are not included (or treated as being 

19 included) under part A or B shall not be con20 sidered incurred expenses for purposes of deter21 mining out-of-pocket cost-sharing under para22 graph (1). 

23 ‘‘(B) ITEMS AND SERVICES NOT FUR24 NISHED ON AN ASSIGNMENT-RELATED BASIS.— 

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1 vidual under this title and is not furnished on 

2 an assignment-related basis, any additional ex3 penses the individual incurs above the amount 

4 the individual would have incurred if the item 

5 or service was furnished on an assignment-re6 lated basis shall not be considered incurred ex7 penses for purposes of determining out-of-pock8 et cost-sharing under paragraph (1). 

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

10 paragraph (1), the Secretary shall consider expenses 

11 to be incurred by the individual without regard to 

12 whether the individual or another person, including 

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

14 paid for such expenses.’’. 

15 (b) ELIMINATION OF PARTS A AND B 

16 DEDUCTIBLES.— 

17 (1) PART A.—Section 1813(b) of the Social Se18 curity Act (42 U.S.C. 1395e(b)) is amended by add19 ing at the end the following new paragraph: 

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

21 following the date of enactment of the Medicare for All 

22 Act of 2022), the inpatient hospital deductible for the year 

23 shall be $0.’’. 


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1 (2) PART B.—Section 1833(b) of the Social Se2 curity Act (42 U.S.C. 1395l(b)) is amended, in the 

3 first sentence— 

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

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

6 the year that includes the date of enactment of 

7 the Medicare for All Act of 2022’’; and 

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

9 subsequent year’’ after ‘‘$1)’’. 

10 SEC. 1002. REDUCING MEDICARE PART D ANNUAL OUT-OF11 POCKET THRESHOLD AND ELIMINATING 

12 COST-SHARING ABOVE THAT THRESHOLD. 

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

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

15 amended— 

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

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

18 and 

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

20 clause: 

21 ‘‘(iii) REDUCTION IN THRESHOLD

22 DURING TRANSITION PERIOD.— 

23 ‘‘(I) IN GENERAL.—Subject to 

24 subclause (II), for plan years begin25 ning on or after January 1 following 


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1 the date of enactment of the Medicare 

2 for All Act of 2022 and before Janu3 ary 1 of the year that is 4 years fol4 lowing such date of enactment, not5 withstanding clauses (i) and (ii), the 

6 ‘annual out-of-pocket threshold’ speci7 fied in this subparagraph is equal to 

8 $305. 

9 ‘‘(II) AUTHORITY TO EXEMPT

10 BRAND-NAME DRUGS IF GENERIC

11 AVAILABLE.—In applying subclause 

12 (I), the Secretary may exempt costs 

13 incurred for a covered part D drug 

14 that is an applicable drug under sec15 tion 1860D–14A(g)(2) if the Sec16 retary determines that a generic 

17 version of that drug is available.’’. 

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

19 1860D–2(b)(4)(A) of the Social Security Act (42 U.S.C. 

20 1395w–102(b)(4)(A)) is amended— 

21 (1) in clause (i)— 

22 (A) by redesignating subclauses (I) and 

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


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

2 cost-sharing’’ and inserting the following: ‘‘sub3 paragraph (B)— 

4 ‘‘(I) for plan years 2006 through 

5 the plan year ending December 31 fol6 lowing the date of enactment of the 

7 Medicare for All Act of 2022, with 

8 cost-sharing’’; 

9 (C) in item (bb), as redesignated by sub10 paragraph (A), by striking the period at the 

11 end and inserting ‘‘; and’’; and 

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

13 subclause: 

14 ‘‘(II) for the plan year beginning 

15 January 1 following the date of enact16 ment of the Medicare for All Act of 

17 2022 and the two subsequent plan 

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

19 (2) in clause (ii)— 

20 (A) by striking ‘‘clause (i)(I)’’ and insert21 ing ‘‘clause (i)(I)(aa)’’; and 

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

23 sentence: ‘‘The Secretary shall continue to cal24 culate the dollar amounts specified in clause 

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


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1 this clause, after plan year 2018 for purposes 

2 of 1860D–14(a)(1)(D)(iii).’’. 

3 (c) CONFORMING AMENDMENTS TO LOW-INCOME

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

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

6 (1) in paragraph (1)— 

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

8 ‘‘1860D–2(b)(4)(A)(i)(I)’’ and inserting 

9 ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’; and 

10 (B) in subparagraph (E)— 

11 (i) in the heading, by inserting 

12 ‘‘PRIOR TO THE ELIMINATION OF SUCH

13 COST-SHARING FOR ALL INDIVIDUALS’’ 

14 after ‘‘THRESHOLD’’; and 

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

16 inserting ‘‘For plan years 2006 through 

17 the plan year ending December 31 fol18 lowing the date of enactment of the Medi19 care for All Act of 2022, the elimination’’; 

20 and 

21 (2) in paragraph (2)(E)— 

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

23 THE ELIMINATION OF SUCH COST-SHARING FOR

24 ALL INDIVIDUALS’’ after ‘‘THRESHOLD’’; 


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

2 ‘‘For plan years 2006 through the plan year 

3 ending December 31 following the date of en4 actment of the Medicare for All Act of 2022, 

5 subject to’’; and 

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

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

8 SEC. 1003. EXPANDING MEDICARE TO COVER DENTAL AND 

9 VISION SERVICES AND HEARING AIDS AND 

10 EXAMINATIONS UNDER PART B. 

11 (a) DENTAL SERVICES.— 

12 (1) REMOVAL OF EXCLUSION FROM COV13 ERAGE.—Section 1862(a) of the Social Security Act 

14 (42 U.S.C. 1395y(a)) is amended by striking para15 graph (12). 

16 (2) COVERAGE.— 

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

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

19 is amended— 

20 (i) in subparagraph (GG), by striking 

21 ‘‘and’’ at the end; 

22 (ii) in subparagraph (HH), by strik23 ing the period at the end and inserting ‘‘; 

24 and’’; and 


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1 (iii) by adding at the end the fol2 lowing new subparagraph: 

3 ‘‘(II) dental services;’’. 

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

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

6 amended— 

7 (i) by striking ‘‘and’’ before ‘‘(DD)’’; 

8 and 

9 (ii) by inserting before the semicolon 

10 at the end the following: ‘‘and (EE) with 

11 respect to dental services described in sec12 tion 1861(s)(2)(II), the amount paid shall 

13 be an amount equal to 80 percent of the 

14 lesser of the actual charge for the services 

15 or the amount determined under the fee 

16 schedule established under section 

17 1848(b).’’. 

18 (C) EFFECTIVE DATE.—The amendments 

19 made by this subsection shall apply to items 

20 and services furnished on or after January 1 

21 following the date of the enactment of this Act. 

22 (b) VISION SERVICES.— 

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

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

25 amended by subsection (a), is amended— 


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1 (A) in subparagraph (HH), by striking 

2 ‘‘and’’ at the end; 

3 (B) in subparagraph (II), by inserting 

4 ‘‘and’’ at the end; and 

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

6 subparagraph: 

7 ‘‘(JJ) vision services;’’. 

8 (2) PAYMENT.—Section 1833(a)(1) of the So9 cial Security Act (42 U.S.C. 1395l(a)(1)), as amend10 ed by subsection (a), is amended— 

11 (A) by striking ‘‘and’’ before ‘‘(EE)’’; and 

12 (B) by inserting before the semicolon at 

13 the end the following: ‘‘, and (FF) with respect 

14 to vision services described in section 

15 1861(s)(2)(JJ), the amount paid shall be an 

16 amount equal to 80 percent of the lesser of the 

17 actual charge for the services or the amount de18 termined under the fee schedule established 

19 under section 1848(b).’’. 

20 (3) EFFECTIVE DATE.—The amendments made 

21 by this subsection shall apply to items and services 

22 furnished on or after January 1 following the date 

23 of the enactment of this Act. 

24 (c) HEARING AIDS AND EXAMINATIONS THERE25 FOR.— 


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

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

3 amended by striking ‘‘hearing aids or examinations 

4 therefor,’’. 

5 (2) EFFECTIVE DATE.—The amendment made 

6 by this subsection shall apply to items and services 

7 furnished on or after January 1 following the date 

8 of the enactment of this Act. 

9 SEC. 1004. ELIMINATING THE 24-MONTH WAITING PERIOD 

10 FOR MEDICARE COVERAGE FOR INDIVID11 UALS WITH DISABILITIES. 

12 (a) IN GENERAL.—Section 226(b) of the Social Secu13 rity Act (42 U.S.C. 426(b)) is amended— 

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

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

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

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

18 (3) in paragraph (2)(C)(ii), by striking ‘‘, in19 cluding the requirement that he has been entitled to 

20 the specified benefits for 24 months,’’; 

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

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

23 (II) the twenty-fifth month of his entitlement or sta24 tus as a qualified railroad retirement beneficiary de25 scribed in paragraph (2), and’’ and inserting ‘‘for 


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1 each month for which the individual meets the re2 quirements of paragraph (2), beginning with the 

3 month following the month in which the individual 

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

5 and 

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

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

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

9 (b) CONFORMING AMENDMENTS.— 

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

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

12 (A) by striking subsections (e)(1)(B), (f), 

13 and (h); and 

14 (B) by redesignating subsections (g) and 

15 (i) as subsections (f) and (g), respectively. 

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

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

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

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

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

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

22 is amended by striking ‘‘25th month of’’ and insert23 ing ‘‘month following the first month of’’. 


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1 (4) RAILROAD RETIREMENT SYSTEM.—Section 

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

3 (45 U.S.C. 231f(d)(2)(ii)) is amended— 

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

5 annuity’’ and inserting ‘‘is entitled to an annu6 ity’’; 

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

8 months’’; and 

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

10 for 24 calendar months, and’’. 

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

12 this section shall apply to insurance benefits under title 

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

14 services furnished in months beginning after December 1 

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

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

17 enactment. 

18 SEC. 1005. GUARANTEED ISSUE OF MEDIGAP POLICIES. 

19 Section 1882 of the Social Security Act (42 U.S.C. 

20 1395ss) is amended by adding at the end the following 

21 new subsection: 

22 ‘‘(aa) GUARANTEED ISSUE FOR ALL MEDIGAP-ELI23 GIBLE MEDICARE BENEFICIARIES.—Notwithstanding 

24 paragraphs (2)(A) and (2)(D) of subsection (s) or any 

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1 actment of this subsection, the issuer of a Medicare sup2 plemental policy may not deny or condition the issuance 

3 or effectiveness of a Medicare supplemental policy, or dis4 criminate in the pricing of the policy, because of health 

5 status, claims experience, receipt of health care, or medical 

6 condition in the case of any individual entitled to, or en7 rolled for, benefits under part A and enrolled for benefits 

8 under part B.’’. 

9 Subtitle B—Temporary Medicare 

10 Buy-In Option and Temporary 

11 Public Option 

12 SEC. 1011. LOWERING THE MEDICARE AGE. 

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

14 Act (42 U.S.C. 1395c et seq.), as amended by section 

15 1001, is amended by adding at the end the following new 

16 section: 

17 ‘‘TEMPORARY MEDICARE BUY-IN OPTION FOR CERTAIN

18 INDIVIDUALS

19 ‘‘SEC. 1899E. (a) NO EFFECT ON OTHER BENEFITS

20 FOR INDIVIDUALS OTHERWISE ELIGIBLE OR ON TRUST

21 FUNDS.—The Secretary shall implement the provisions of 

22 this section in such a manner to ensure that such provi23 sions— 

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

25 title for individuals who are entitled to, or enrolled 


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1 for, such benefits other than through this section; 

2 and 

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

4 Hospital Insurance Trust Fund or the Federal Sup5 plementary Medical Insurance Trust Fund (includ6 ing the Medicare Prescription Drug Account within 

7 such Trust Fund). 

8 ‘‘(b) OPTION.— 

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

10 the requirements described in paragraph (3) shall be 

11 eligible to enroll under this section. 

12 ‘‘(2) PART A, B, AND D BENEFITS.—An indi13 vidual enrolled under this section is entitled to the 

14 same benefits (and shall receive the same protec15 tions) under this title as an individual who is enti16 tled to benefits under part A and enrolled under 

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

18 private plan that provides qualified prescription drug 

19 coverage. 

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

21 requirements described in this paragraph are the fol22 lowing: 

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

24 United States. 

25 ‘‘(B) The individual is— 


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

2 States; or 

3 ‘‘(ii) an alien lawfully admitted for 

4 permanent residence. 

5 ‘‘(C) The individual is not otherwise enti6 tled to benefits under part A or eligible to en7 roll under part A or part B. 

8 ‘‘(D) The individual has attained the appli9 cable years of age but has not attained 65 years 

10 of age. 

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

12 For purposes of this section, the term ‘applicable 

13 years of age’ means— 

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

15 following the date of enactment of the Medicare 

16 for All Act of 2022, the age of 55; 

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

18 year following such date of enactment, the age 

19 of 45; and 

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

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

22 ‘‘(c) ENROLLMENT; COVERAGE.—The Secretary shall 

23 establish enrollment periods and coverage under this sec24 tion consistent with the principles for establishment of en25 rollment periods and coverage for individuals under other 


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1 provisions of this title. The Secretary shall establish such 

2 periods so that coverage under this section shall first begin 

3 on January 1 of the year on which an individual first be4 comes eligible to enroll under this section. 

5 ‘‘(d) PREMIUM.— 

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

7 Secretary shall, during September of each year (be8 ginning with the first September following the date 

9 of enactment of the Medicare for All Act of 2022), 

10 determine a monthly premium for all individuals en11 rolled under this section. Such monthly premium 

shall be equal to 1 12 ⁄12 of the annual premium com13 puted under paragraph (2)(B), which shall apply 

14 with respect to coverage provided under this section 

15 for any month in the succeeding year. 

16 ‘‘(2) ANNUAL PREMIUM.— 

17 ‘‘(A) COMBINED PER CAPITA AVERAGE FOR

18 ALL MEDICARE BENEFITS.—The Secretary shall 

19 estimate the average, annual per capita amount 

20 for benefits and administrative expenses that 

21 will be payable under parts A, B, and D in the 

22 year for all individuals enrolled under this sec23 tion. 

24 ‘‘(B) ANNUAL PREMIUM.—The annual pre25 mium under this subsection for months in a 


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1 year is equal to the average, annual per capita 

2 amount estimated under subparagraph (A) for 

3 the year. 

4 ‘‘(3) INCREASED PREMIUM FOR COMPLEMEN5 TARY PLANS.—Nothing in this section shall preclude 

6 an individual from choosing a prescription drug plan 

7 or other complementary plans which requires the in8 dividual to pay an additional amount (because of 

9 supplemental benefits or because it is a more expen10 sive plan). In such case the individual would be re11 sponsible for the increased monthly premium. 

12 ‘‘(e) PAYMENT OF PREMIUMS.— 

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

14 under this section shall be paid to the Secretary at 

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

16 determines appropriate. 

17 ‘‘(2) DEPOSIT.—Amounts collected by the Sec18 retary under this section shall be deposited in the 

19 Federal Hospital Insurance Trust Fund and the 

20 Federal Supplementary Medical Insurance Trust 

21 Fund (including the Medicare Prescription Drug Ac22 count within such Trust Fund) in such proportion 

23 as the Secretary determines appropriate. 

24 ‘‘(f) NOT ELIGIBLE FOR MEDICARE COST-SHARING

25 ASSISTANCE.—An individual enrolled under this section 


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

2 for purposes of obtaining medical assistance for Medicare 

3 cost-sharing or otherwise under title XIX. 

4 ‘‘(g) TREATMENT IN RELATION TO THE AFFORD5 ABLE CARE ACT.— 

6 ‘‘(1) SATISFACTION OF INDIVIDUAL MAN7 DATE.—For purposes of applying section 5000A of 

8 the Internal Revenue Code of 1986, the coverage 

9 provided under this section constitutes minimum es10 sential coverage under subsection (f)(1)(A)(i) of 

11 such section 5000A. 

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

13 Coverage provided under this section— 

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

15 qualified health plan in the individual market 

16 enrolled in through the Exchange where the in17 dividual resides for all purposes of section 36B 

18 of the Internal Revenue Code of 1986 other 

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

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

21 other minimum essential coverage for purposes 

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

23 The Secretary shall determine the applicable second 

24 lowest cost silver plan which shall apply to coverage 


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1 under this section for purposes of section 36B of 

2 such Code. 

3 ‘‘(3) ELIGIBILITY FOR COST-SHARING SUB4 SIDIES.—For purposes of applying section 1402 of 

5 the Patient Protection and Affordable Care Act (42 

6 U.S.C. 18071)— 

7 ‘‘(A) coverage provided under this section 

8 shall be treated as coverage under a qualified 

9 health plan in the silver level of coverage in the 

10 individual market offered through an Exchange; 

11 and 

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

13 issuer of such plan. 

14 ‘‘(h) CONSULTATION.—In promulgating regulations 

15 to implement this section, the Secretary shall consult with 

16 interested parties, including groups representing bene17 ficiaries, health care providers, employers, and insurance 

18 companies.’’. 

19 SEC. 1012. ESTABLISHMENT OF THE MEDICARE TRANSI20 TION PLAN. 

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

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

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

24 ending with the date on which benefits are first available 

25 under section 106(a), the Secretary, acting through the 


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1 Administrator of the Centers for Medicare & Medicaid (re2 ferred to in this section as the ‘‘Administrator’’), shall es3 tablish, and provide for the offering through the Ex4 changes, of a public health plan (in this Act referred to 

5 as the ‘‘Medicare Transition plan’’) that provides afford6 able, high-quality health benefits coverage throughout the 

7 United States. 

8 (b) ADMINISTRATING THE MEDICARE TRANSI9 TION.— 

10 (1) ADMINISTRATOR.—The Administrator shall 

11 administer the Medicare Transition plan in accord12 ance with this section. 

13 (2) APPLICATION OF ACA REQUIREMENTS.— 

14 Consistent with this section, the Medicare Transition 

15 plan shall comply with requirements under title I of 

16 the Patient Protection and Affordable Care Act (and 

17 the amendments made by that title) and title XXVII 

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

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

20 offered through the Exchanges, subject to the limita21 tion under subsection (e)(2). 

22 (3) OFFERING THROUGH EXCHANGES.—The 

23 Medicare Transition plan shall be made available 

24 only through the Exchanges, and shall be available 

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1 ployers (as defined in section 1312(f)(2) of the Pa2 tient Protection and Affordable Care Act (42 U.S.C. 

3 18032)) who wish to make such plan available to 

4 their employees. 

5 (4) ELIGIBILITY TO PURCHASE.—Any United 

6 States resident may enroll in the Medicare Transi7 tion plan. 

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

9 this section, the Administrator shall ensure that the Medi10 care Transition plan provides— 

11 (1) coverage for the benefits required to be cov12 ered under title II; and 

13 (2) coverage of benefits that are actuarially 

14 equivalent to 90 percent of the full actuarial value 

15 of the benefits provided under the plan. 

16 (d) PROVIDERS AND REIMBURSEMENT RATES.— 

17 (1) IN GENERAL.—With respect to the reim18 bursement provided to health care providers for cov19 ered benefits, as described in section 201, provided 

20 under the Medicare Transition plan, the Adminis21 trator shall reimburse such providers at rates deter22 mined for equivalent items and services under the 

23 original Medicare fee-for-service program under 

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

25 Act (42 U.S.C. 1395c et seq.). For items and servVerDate Sep 11 2014 18:20 May 24, 2022 Jkt 029200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\S4204.IS S4204

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1 ices covered under the Medicare Transition plan but 

2 not covered under such parts A and B, the Adminis3 trator shall reimburse providers at rates set by the 

4 Administrator in a manner consistent with the man5 ner in which rates for other items and services were 

6 set under the original Medicare fee-for-service pro7 gram. 

8 (2) PRESCRIPTION DRUGS.—Any payment rate 

9 under this subsection for a prescription drug shall be 

10 at a rate negotiated by the Administrator with the 

11 manufacturer of the drug. If the Administrator is 

12 unable to reach a negotiated agreement on such a 

13 reimbursement rate, the Administrator shall estab14 lish the rate at an amount equal to the lesser of— 

15 (A) the price paid by the Secretary of Vet16 erans Affairs to procure the drug under the 

17 laws administered by the Secretary of Veterans 

18 Affairs; 

19 (B) the price paid to procure the drug 

20 under section 8126 of title 38, United States 

21 Code; or 

22 (C) the best price determined under sec23 tion 1927(c)(1)(C) of the Social Security Act 

24 (42 U.S.C. 1396r–8(c)(1)(C)) for the drug. 

25 (3) PARTICIPATING PROVIDERS.— 


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

2 that is a participating provider of services or 

3 supplier under the Medicare program under 

4 title XVIII of the Social Security Act (42 

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

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

7 1396 et seq.) on the date of enactment of this 

8 Act shall be a participating provider in the 

9 Medicare Transition plan. 

10 (B) ADDITIONAL PROVIDERS.—The Ad11 ministrator shall establish a process to allow 

12 health care providers not described in subpara13 graph (A) to become participating providers in 

14 the Medicare Transition plan. Such process 

15 shall be similar to the process applied to new 

16 providers under the Medicare program. 

17 (e) PREMIUMS.— 

18 (1) DETERMINATION.—The Administrator shall 

19 determine the premium amount for enrolling in the 

20 Medicare Transition plan, which— 

21 (A) may vary according to family or indi22 vidual coverage, age, and tobacco status (con23 sistent with clauses (i), (iii), and (iv) of section 

24 2701(a)(1)(A) of the Public Health Service Act 

25 (42 U.S.C. 300gg(a)(1)(A))); and 


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1 (B) shall take into account the cost-shar2 ing reductions and premium tax credits which 

3 will be available with respect to the plan under 

4 section 1402 of the Patient Protection and Af5 fordable Care Act (42 U.S.C. 18071) and sec6 tion 36B of the Internal Revenue Code of 1986, 

7 as amended by subsection (g). 

8 (2) LIMITATION.—Variation in premium rates 

9 of the Medicare Transition plan by rating area, as 

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

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

12 300gg(a)(1)(A)) is not permitted. 

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

14 force or effect on the date on which benefits are first avail15 able under section 106(a). 

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

17 (1) PREMIUM ASSISTANCE TAX CREDITS.— 

18 (A) CREDITS ALLOWED TO MEDICARE

19 TRANSITION PLAN ENROLLEES AT OR ABOVE 44

20 PERCENT OF POVERTY IN NON-EXPANSION

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

22 the Internal Revenue Code of 1986 is amended 

23 by redesignating subparagraphs (C), (D), and 

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1 spectively, and by inserting after subparagraph 

2 (B) the following new subparagraph: 

3 ‘‘(C) SPECIAL RULES FOR MEDICARE

4 TRANSITION PLAN ENROLLEES.— 

5 ‘‘(i) IN GENERAL.—In the case of a 

6 taxpayer who is covered, or whose spouse 

7 or dependent (as defined in section 152) is 

8 covered, by the Medicare Transition plan 

9 established under section 1002(a) of the 

10 Medicare for All Act of 2022 for all 

11 months in the taxable year, subparagraph 

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

13 does not exceed 400 percent’. The pre14 ceding sentence shall not apply to any tax15 able year to which subparagraph (E) ap16 plies. 

17 ‘‘(ii) ENROLLEES IN MEDICAID NON18 EXPANSION STATES.—In the case of a tax19 payer residing in a State which (as of the 

20 date of the enactment of the Medicare for 

21 All Act of 2022) does not provide for eligi22 bility under clause (i)(VIII) or (ii)(XX) of 

23 section 1902(a)(10)(A) of the Social Secu24 rity Act for medical assistance under title 

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


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1 plan approved under section 1115) who is 

2 covered, or whose spouse or dependent (as 

3 defined in section 152) is covered, by the 

4 Medicare Transition plan established under 

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

6 of 2022 for all months in the taxable year, 

7 subparagraphs (A) and (B) shall be ap8 plied by substituting ‘0 percent’ for ‘100 

9 percent’ each place it appears.’’. 

10 (B) PREMIUM ASSISTANCE AMOUNTS FOR

11 TAXPAYERS ENROLLED IN MEDICARE TRANSI12 TION PLAN.— 

13 (i) IN GENERAL.—Subparagraph (A) 

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

15 amended— 

16 (I) by redesignating clauses (ii) 

17 and (iii) as clauses (iii) and (iv), re18 spectively; 

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

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

21 and (iii)’’; and 

22 (III) by inserting after clause (i) 

23 the following new clause: 

24 ‘‘(ii) SPECIAL RULES FOR TAXPAYERS

25 ENROLLED IN MEDICARE TRANSITION


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

2 covered, or whose spouse or dependent (as 

3 defined in section 152) is covered, by the 

4 Medicare Transition plan established under 

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

6 of 2022 for all months in the taxable year 

7 the applicable percentage for any taxable 

8 year shall be determined in the same man9 ner as under clause (i), except that the fol10 lowing table shall apply in lieu of the table 

11 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 percent ...................................... 2 2

100 percent up to 138 percent ................... 2.04 2.04

138 percent up to 150 percent ................... 3.06 4.08

150 percent and above ................................ 4.08 5. 

12 The preceding sentence shall not apply to 

13 any taxable year to which clause (iv) ap14 plies.’’. 

15 (ii) CONFORMING AMENDMENT.—Sub16 clause (I) of clause (iii) of section 

17 36B(b)(3) of such Code, as redesignated 

18 by subparagraph (A)(i), is amended by in19 serting ‘‘, and determined after the appli20 cation of clause (ii)’’ after ‘‘after applica21 tion of this clause’’. 


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

2 of section 1402 of the Patient Protection and Af3 fordable Care Act (42 U.S.C. 18071(b)) is amend4 ed— 

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

6 Transition plan established under section 

7 1002(a) of the Medicare for All Act of 2022,’’ 

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

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

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

11 (B), respectively, and by moving such subpara12 graphs 2 ems to the right; 

13 (C) by striking ‘‘INSURED.—In this sec14 tion’’ and inserting ‘‘INSURED.— 

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

16 (D) by striking the flush language; and 

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

18 paragraph: 

19 ‘‘(2) SPECIAL RULES.— 

20 ‘‘(A) INDIVIDUALS LAWFULLY PRESENT.— 

21 In the case of an individual described in section 

22 36B(c)(1)(B) of the Internal Revenue Code of 

23 1986, the individual shall be treated as having 

24 household income equal to 100 percent of the 


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1 poverty line for a family of the size involved for 

2 purposes of applying this section. 

3 ‘‘(B) MEDICARE TRANSITION PLAN EN4 ROLLEES IN MEDICAID NON-EXPANSION

5 STATES.—In the case of an individual residing 

6 in a State which (as of the date of the enact7 ment of the Medicare for All Act of 2022) does 

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

9 or (ii)(XX) of section 1902(a)(10)(A) of the So10 cial Security Act for medical assistance under 

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

12 plan approved under section 1115) who enrolls 

13 in such Medicare Transition plan, the preceding 

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

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

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

17 percent’ each place it appears. 

18 ‘‘(C) ADJUSTED COST-SHARING FOR MEDI19 CARE TRANSITION PLAN ENROLLEES.—In the 

20 case of any individual who enrolls in such Medi21 care Transition plan, in lieu of the percentages 

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

23 Secretary shall prescribe a method of deter24 mining the cost-sharing reduction for any such 

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1 ing and the premiums paid by the individual 

2 under such Medicare Transition plan does not 

3 exceed the percentage of the total allowed costs 

4 of benefits provided under the plan equal to the 

5 final premium percentage applicable to such in6 dividual under section 36B(b)(3)(A)(ii) of the 

7 Internal Revenue Code of 1986.’’. 

8 (h) CONFORMING AMENDMENTS.— 

9 (1) TREATMENT AS A QUALIFIED HEALTH

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

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

12 amended— 

13 (A) in the paragraph heading, by inserting 

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

15 ‘‘AND’’; and 

16 (B) by inserting ‘‘The Medicare Transition 

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

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

19 of the Patient Protection and Affordable Care Act 

20 (42 U.S.C. 18044(a)) is amended by inserting ‘‘the 

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

22 qualified health plan’’. 


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1 Subtitle C—Patient Protections 

2 During Medicare for All Transi3 tion Period 

4 SEC. 1021. MINIMIZING DISRUPTIONS TO PATIENT CARE. 

5 The Secretary shall ensure that all individuals en6 rolled in, or who seek to enroll in, a group health plan, 

7 health insurance coverage offered by a health insurance 

8 issuer, or the plan established under section 1002 during 

9 the transition period of this Act are protected from disrup10 tions in their care during the transition period. 

11 SEC. 1022. PUBLIC CONSULTATION. 

12 The Secretary shall consult with communities and ad13 vocacy organizations of individuals living with disabilities 

14 and other patient advocacy organizations to ensure the 

15 transition described in this section takes into account the 

16 safety and continuity of care for individuals with disabil17 ities, complex medical needs, or chronic conditions. 

18 SEC. 1023. DEFINITIONS. 

19 In this subtitle, the terms ‘‘health insurance cov20 erage’’, ‘‘health insurance issuer’’, and ‘‘group health 

21 plans’’ have the meanings given such terms in section 

22 2791 of the Public Health Service Act (42 U.S.C. 300gg– 

23 91). 


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1 TITLE XI—MISCELLANEOUS 

2 SEC. 1101. UPDATING RESOURCE LIMITS FOR SUPPLE3 MENTAL SECURITY INCOME ELIGIBILITY 

4 (SSI). 

5 Section 1611(a)(3) of the Social Security Act (42 

6 U.S.C. 1382(a)(3)) is amended— 

7 (1) in subparagraph (A)— 

8 (A) by striking ‘‘and’’ after ‘‘January 1, 

9 1988,’’; and 

10 (B) by inserting ‘‘, and to $6,200 on Janu11 ary 1, 2022’’ before the period; 

12 (2) in subparagraph (B)— 

13 (A) by striking ‘‘and’’ after ‘‘January 1, 

14 1988,’’; and 

15 (B) by inserting ‘‘, and to $4,100 on Janu16 ary 1, 2022’’ before the period; and 

17 (3) by adding at the end the following new sub18 paragraph: 

19 ‘‘(C) Beginning with December of 2022, when20 ever the dollar amounts in effect under paragraphs 

21 (1)(A) and (2)(A) of this subsection are increased 

22 for a month by a percentage under section 

23 1617(a)(2), each of the dollar amounts in effect 

24 under this paragraph shall be increased, effective 

25 with such month, by the same percentage (and 


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1 rounded, if not a multiple of $10, to the closest mul2 tiple of $10). Each increase under this subparagraph 

3 shall be based on the unrounded amount for the 

4 prior 12-month period.’’. 

5 SEC. 1102. DEFINITIONS. 

6 In this Act— 

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

8 of Health and Human Services; 

9 (2) the term ‘‘State’’ means a State, the Dis10 trict of Columbia, or a territory of the United 

11 States; and 

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

13 States, the District of Columbia, and the territories 

14 of the United States. 

Æ 


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