II 

116TH CONGRESS 

1ST SESSION S. 1129 

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

IN THE SENATE OF THE UNITED STATES 

APRIL 10, 2019 

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

Mrs. GILLIBRAND, Ms. HARRIS, Mr. LEAHY, Mr. MARKEY, Mr. 

MERKLEY, Mr. SCHATZ, Mr. UDALL, Ms. WARREN, Mr. WHITEHOUSE, 

Ms. HIRONO, and Mr. HEINRICH) 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 2019’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—ESTABLISHMENT OF THE UNIVERSAL MEDICARE 

PROGRAM; UNIVERSAL ENTITLEMENT; ENROLLMENT 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

•S 1129 IS

Sec. 101. Establishment of the Universal Medicare Program. 

Sec. 102. Universal entitlement. 

Sec. 103. Freedom of choice. 

Sec. 104. Non-discrimination. 

Sec. 105. Enrollment. 

Sec. 106. Effective date of benefits. 

Sec. 107. Prohibition against duplicating coverage. 

TITLE II—COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE 

BENEFITS AND BENEFITS FOR LONG-TERM CARE 

Sec. 201. Comprehensive benefits. 

Sec. 202. No cost-sharing. 

Sec. 203. Exclusions and limitations. 

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

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

Sec. 206. State standards. 

TITLE III—PROVIDER PARTICIPATION 

Sec. 301. Provider participation and standards. 

Sec. 302. Qualifications for providers. 

Sec. 303. Use of private contracts. 

TITLE IV—ADMINISTRATION 

Subtitle A—General Administration Provisions 

Sec. 401. Administration. 

Sec. 402. Consultation. 

Sec. 403. Regional administration. 

Sec. 404. Beneficiary ombudsman. 

Sec. 405. Complementary conduct of related health programs. 

Subtitle B—Control Over Fraud and Abuse 

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

TITLE V—QUALITY ASSESSMENT 

Sec. 501. Quality standards. 

Sec. 502. Addressing health care disparities. 

TITLE VI—HEALTH BUDGET; PAYMENTS; COST CONTAINMENT 

MEASURES 

Subtitle A—Budgeting 

Sec. 601. National health budget. 

Subtitle B—Payments to Providers 

Sec. 611. Payments to institutional and individual providers. 

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

fee schedule. 

Sec. 613. Office of primary health care. 

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


pamtmann on DSKBFK8HB2PROD with BILLS
3 

•S 1129 IS

TITLE VII—UNIVERSAL MEDICARE TRUST FUND 

Sec. 701. Universal Medicare Trust Fund. 

TITLE VIII—CONFORMING AMENDMENTS TO THE EMPLOYEE 

RETIREMENT INCOME SECURITY ACT OF 1974 

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

Universal Medicare Program; coordination in case of workers’ 

compensation. 

Sec. 802. Repeal of continuation coverage requirements under ERISA and certain other requirements relating to group health plans. 

Sec. 803. Effective date of title. 

TITLE IX—ADDITIONAL CONFORMING AMENDMENTS 

Sec. 901. Relationship to existing Federal health programs. 

Sec. 902. Sunset of provisions related to the State Exchanges. 

TITLE X—TRANSITION 

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

Option 

Sec. 1001. Lowering the Medicare age. 

Sec. 1002. Establishment of the Medicare transition plan. 

Subtitle B—Transitional Medicare Reforms 

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

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

elimination of cost-sharing above that threshold. 

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

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

individuals with disabilities. 

Sec. 1015. Guaranteed issue of Medigap policies. 

Subtitle C—Private Health Insurance Availability During Transitional Period 

Sec. 1021. Continuity of care. 

TITLE XI—MISCELLANEOUS 

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

Sec. 1102. Definitions. 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•S 1129 IS

1 TITLE I—ESTABLISHMENT OF 

2 THE UNIVERSAL MEDICARE 

3 PROGRAM; UNIVERSAL ENTI4 TLEMENT; ENROLLMENT 

5 SEC. 101. ESTABLISHMENT OF THE UNIVERSAL MEDICARE 

6 PROGRAM. 

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

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

11 under, this Act. 

12 SEC. 102. UNIVERSAL ENTITLEMENT. 

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

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

15 services under this Act. The Secretary shall promulgate 

16 a rule that provides criteria for determining residency for 

17 eligibility purposes under this Act. 

18 (b) TREATMENT OF OTHER INDIVIDUALS.—The Sec19 retary— 

20 (1) may make eligible for benefits for health 

21 care services under this Act other individuals not de22 scribed in subsection (a) and regulate their eligibility 

23 to ensure that every person in the United States has 

24 access to health care; and 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

•S 1129 IS

1 (2) shall promulgate a rule, consistent with 

2 Federal immigration laws, to prevent an individual 

3 from traveling to the United States for the sole pur4 pose of obtaining health care services provided under 

5 this Act. 

6 SEC. 103. FREEDOM OF CHOICE. 

7 Any individual entitled to benefits under this Act may 

8 obtain health services from any institution, agency, or in9 dividual qualified to participate under this Act. 

10 SEC. 104. NON-DISCRIMINATION. 

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

12 race, color, national origin, age, disability, or sex, includ13 ing sex stereotyping, gender identity, sexual orientation, 

14 and pregnancy and related medical conditions (including 

15 termination of pregnancy), be excluded from participation 

16 in, be denied the benefits of, or be subjected to discrimina17 tion by any participating provider as defined in section 

18 301, or any entity conducting, administering, or funding 

19 a health program or activity, including contracts of insur20 ance, pursuant to this Act. 

21 (b) CLAIMS OF DISCRIMINATION.— 

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

23 a procedure for adjudication of administrative com24 plaints alleging a violation of subsection (a). 


pamtmann on DSKBFK8HB2PROD with BILLS
6 

•S 1129 IS

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

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

3 file suit in any district court of the United States 

4 having jurisdiction of the parties. 

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

6 subsection (a), the court may grant compensatory 

7 and punitive damages, declaratory relief, injunctive 

8 relief, attorneys’ fees and costs, or other relief as ap9 propriate. 

10 SEC. 105. ENROLLMENT. 

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

12 mechanism for the enrollment of individuals eligible for 

13 benefits under this Act. The mechanism shall— 

14 (1) include a process for the automatic enroll15 ment of individuals at the time of birth in the 

16 United States or upon the establishment of resi17 dency in the United States; 

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

19 described in section 106, of all individuals who are 

20 eligible to be enrolled as of such date; and 

21 (3) include a process for the enrollment of indi22 viduals made eligible for health care services under 

23 section 102(b). 

24 (b) ISSUANCE OF UNIVERSAL MEDICARE CARDS.— 

25 In conjunction with an individual’s enrollment for benefits 


pamtmann on DSKBFK8HB2PROD with BILLS
7 

•S 1129 IS

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

2 of a Universal Medicare card that shall be used for pur3 poses of identification and processing of claims for bene4 fits under this program. The card shall not include an in5 dividual’s Social Security number. 

6 SEC. 106. EFFECTIVE DATE OF BENEFITS. 

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

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

9 items and services furnished on January 1 of the fourth 

10 calendar year that begins after the date of enactment of 

11 this Act. 

12 (b) COVERAGE FOR CHILDREN.— 

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

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

15 shall first be available under this Act for items and 

16 services furnished on January 1 of the first calendar 

17 year that begins after the date of enactment of this 

18 Act. 

19 (2) OPTION TO CONTINUE IN OTHER COVERAGE

20 DURING TRANSITION PERIOD.—Any person who is 

21 eligible to receive benefits as described in paragraph 

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

23 section 901, private health insurance coverage, or 

24 coverage offered pursuant to subtitle A of title X 


pamtmann on DSKBFK8HB2PROD with BILLS
8 

•S 1129 IS

1 (including the amendments made by such subtitle) 

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

3 SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. 

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

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

6 (1) a private health insurer to sell health insur7 ance coverage that duplicates the benefits provided 

8 under this Act; or 

9 (2) an employer to provide benefits for an em10 ployee, former employee, or the dependents of an 

11 employee or former employee that duplicate the ben12 efits provided under this Act. 

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

14 construed as prohibiting the sale of health insurance cov15 erage for any additional benefits not covered by this Act, 

16 including additional benefits that an employer may provide 

17 to employees or their dependents, or to former employees 

18 or their dependents. 

19 TITLE II—COMPREHENSIVE BEN20 EFITS, INCLUDING PREVEN21 TIVE BENEFITS AND BENE22 FITS FOR LONG-TERM CARE 

23 SEC. 201. COMPREHENSIVE BENEFITS. 

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

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


pamtmann on DSKBFK8HB2PROD with BILLS
9 

•S 1129 IS

1 benefits under this Act are entitled to have payment made 

2 by the Secretary to an eligible provider for the following 

3 items and services if medically necessary or appropriate 

4 for the maintenance of health or for the diagnosis, treat5 ment, or rehabilitation of a health condition: 

6 (1) Hospital services, including inpatient and 

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

8 emergency services and inpatient prescription drugs. 

9 (2) Ambulatory patient services. 

10 (3) Primary and preventive services, including 

11 chronic disease management. 

12 (4) Prescription drugs, medical devices, biologi13 cal products, including outpatient prescription drugs, 

14 medical devices, and biological products. 

15 (5) Mental health and substance abuse treat16 ment services, including inpatient care. 

17 (6) Laboratory and diagnostic services. 

18 (7) Comprehensive reproductive, maternity, and 

19 newborn care. 

20 (8) Pediatrics, including early and periodic 

21 screening, diagnostic, and treatment services (as de22 fined in section 1905(r) of the Social Security Act 

23 (42 U.S.C. 1396d(r))). 

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


pamtmann on DSKBFK8HB2PROD with BILLS
10 

•S 1129 IS

1 (10) Short-term rehabilitative and habilitative 

2 services and devices. 

3 (11) Emergency services and transportation. 

4 (12) Necessary transportation to receive health 

5 care services for individuals with disabilities and low6 income individuals. 

7 (13) Home and community-based long-term 

8 services and supports (to be provided in accordance 

9 with the requirements for home and community10 based settings under sections 441.530 and 441.710 

11 of title 42, Code of Federal Regulations), includ12 ing— 

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

14 (8), (13), (19), and (24) of section 1905(a) of 

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

16 (B) home and community-based services 

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

18 1915 of the Social Security Act (including ha19 bilitation services defined in subsection (c)(5) of 

20 such section); 

21 (C) self-directed home and community22 based services described in subsection (i) of sec23 tion 1915 of the Social Security Act; 


pamtmann on DSKBFK8HB2PROD with BILLS
11 

•S 1129 IS

1 (D) self-directed personal assistance serv2 ices (as defined in subsection (j)(4)(A) of sec3 tion 1915 of the Social Security Act); and 

4 (E) home and community-based attendant 

5 services and supports described in subsection 

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

7 (b) REVISION AND ADJUSTMENT.—The Secretary 

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

9 package should be improved or adjusted to promote the 

10 health of beneficiaries, account for changes in medical 

11 practice or new information from medical research, or re12 spond to other relevant developments in health science, 

13 and shall make recommendations to Congress regarding 

14 any such improvements or adjustments. 

15 (c) COMPLEMENTARY AND INTEGRATIVE MEDI16 CINE.— 

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

18 (b), the Secretary shall consult with the persons de19 scribed in paragraph (1) with respect to— 

20 (A) identifying specific complementary and 

21 integrative medicine practices that, on the basis 

22 of research findings or promising clinical inter23 ventions, are appropriate to include in the bene24 fits package; and 


pamtmann on DSKBFK8HB2PROD with BILLS
12 

•S 1129 IS

1 (B) identifying barriers to the effective 

2 provision and integration of such practices into 

3 the delivery of health care, and identifying 

4 mechanisms for overcoming such barriers. 

5 (2) CONSULTATION.—In accordance with para6 graph (1), the Secretary shall consult with— 

7 (A) the Director of the National Center for 

8 Complementary and Integrative Health; 

9 (B) the Commissioner of Food and Drugs; 

10 (C) institutions of higher education, pri11 vate research institutes, and individual re12 searchers with extensive experience in com13 plementary and integrative medicine and the in14 tegration of such practices into the delivery of 

15 health care; 

16 (D) nationally recognized providers of com17 plementary and integrative medicine; and 

18 (E) such other officials, entities, and indi19 viduals with expertise on complementary and 

20 integrative medicine as the Secretary deter21 mines appropriate. 

22 (d) STATES MAY PROVIDE ADDITIONAL BENE23 FITS.—Individual States may provide additional benefits 

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

25 State. 


pamtmann on DSKBFK8HB2PROD with BILLS
13 

•S 1129 IS

1 SEC. 202. NO COST-SHARING. 

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

3 no cost-sharing, including deductibles, coinsurance, copay4 ments, or similar charges, be imposed on an individual for 

5 any benefits provided under this Act, except as described 

6 in subsection (b). 

7 (b) EXCEPTIONS.—The Secretary may set a cost8 sharing schedule for prescription drugs and biological 

9 products— 

10 (1) provided that— 

11 (A) such schedule is evidence-based and 

12 encourages the use of generic drugs; 

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

14 preventive drugs; 

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

16 annually per individual, adjusted annually for 

17 inflation; and 

18 (D) such cost-sharing is not imposed on in19 dividuals with a household income equal to or 

20 below 200 percent of the poverty line for a fam21 ily of the size involved; and 

22 (2) under which the Secretary may exempt 

23 brand-name drugs from consideration in determining 

24 whether an individual has reached any out-of-pocket 

25 limit if a generic version of such drug is available. 


pamtmann on DSKBFK8HB2PROD with BILLS
14 

•S 1129 IS

1 (c) NO BALANCE BILLING.—Notwithstanding con2 tracts in accordance with section 303, no provider may 

3 impose a charge to an enrolled individual for covered serv4 ices for which benefits are provided under this Act. 

5 SEC. 203. EXCLUSIONS AND LIMITATIONS. 

6 (a) IN GENERAL.—Benefits for services are not avail7 able under this Act unless the services meet the standards 

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

9 (b) TREATMENT OF EXPERIMENTAL SERVICES AND

10 DRUGS.— 

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

12 the Secretary shall make national coverage deter13 minations with respect to services that are experi14 mental in nature. Such determinations shall be con15 sistent with the national coverage determination 

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

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

18 (2) APPEALS PROCESS.—The Secretary shall 

19 establish a process by which individuals can appeal 

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

21 feasible, follow process for appeals under the Medi22 care program described in section 1869 of the Social 

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

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

25 case of services for which the Department of Health and 


pamtmann on DSKBFK8HB2PROD with BILLS
15 

•S 1129 IS

1 Human Services has recognized a national practice guide2 line, the services are considered to meet the standards 

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

4 accordance with such guideline. For purposes of this sub5 section, a service shall be considered to have been provided 

6 in accordance with a practice guideline if the health care 

7 provider providing the service exercised appropriate pro8 fessional discretion to deviate from the guideline in a man9 ner authorized or anticipated by the guideline. 

10 SEC. 204. COVERAGE OF INSTITUTIONAL LONG-TERM CARE 

11 SERVICES UNDER MEDICAID. 

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

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

14 section 1946: 

15 ‘‘STATE PLAN FOR PROVIDING INSTITUTIONAL LONG16 TERM CARE SERVICES

17 ‘‘SEC. 1947. (a) IN GENERAL.—For quarters begin18 ning on or after date on which benefits are first available 

19 under section 106(a) of the Medicare for All Act of 2019, 

20 notwithstanding any other provision of this title— 

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

22 provide for making medical assistance available for 

23 services that are institutional long-term care services 

24 in a manner consistent with this section; and 

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

26 under this title with respect to expenditures incurred 


pamtmann on DSKBFK8HB2PROD with BILLS
16 

•S 1129 IS

1 by the State in providing medical assistance on or 

2 after such date for services that are not— 

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

4 or 

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

6 not available under the Medicare for All Act of 

7 2019 and which are furnished under a State 

8 plan for medical assistance which provided for 

9 medical assistance for such services on Sep10 tember 1, 2018. 

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

12 DEFINED.—In this section, the term ‘institutional long13 term care services’ means the following: 

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

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

16 of section 1905(a)(4). 

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

18 of age or over provided in an institution for mental 

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

20 ‘‘(3) Intermediate care facility services de21 scribed in section 1905(a)(15). 

22 ‘‘(4) Inpatient psychiatric hospital services for 

23 individuals under age 21 described in section 

24 1905(a)(16). 


pamtmann on DSKBFK8HB2PROD with BILLS
17 

•S 1129 IS

1 ‘‘(5) Nursing facility services described in sec2 tion 1905(a)(29). 

3 ‘‘(c) MAINTENANCE OF EFFORT.— 

4 ‘‘(1) ELIGIBILITY STANDARDS.— 

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

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

7 made under section 1903 with respect to med8 ical assistance provided under a State plan for 

9 medical assistance if the State adopts income, 

10 resource, or other standards and methodologies 

11 for purposes of determining an individual’s eli12 gibility for medical assistance under the State 

13 plan that are more restrictive than those ap14 plied as of January 1, 2019. 

15 ‘‘(B) INDEXING OF AMOUNTS OF INCOME

16 AND RESOURCE STANDARDS.—In determining 

17 whether a State has adopted income or resource 

18 standards that are more restrictive than the 

19 standards which applied as of January 1, 2019, 

20 the Secretary shall deem the amount of any 

21 such standard that was applied as of such date 

22 to be increased by the percentage increase in 

23 the medical care component of the consumer 

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

25 average) from September of 2018 to September 


pamtmann on DSKBFK8HB2PROD with BILLS
18 

•S 1129 IS

1 of the fiscal year for which the Secretary is 

2 making such determination. 

3 ‘‘(2) EXPENDITURES.— 

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

5 or portion of a fiscal year that occurs during 

6 the period that begins on the first day of the 

7 first fiscal quarter that begins on or after the 

8 date on which benefits are first available under 

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

10 2019, as a condition of receiving payments 

11 under section 1903(a), a State shall make ex12 penditures for medical assistance for services 

13 that are institutional long-term care services in 

14 an amount that is not less than the expenditure 

15 floor determined for the State and fiscal year 

16 (or portion of a fiscal year) under subparagraph 

17 (B). 

18 ‘‘(B) EXPENDITURE FLOOR.— 

19 ‘‘(i) IN GENERAL.—For each fiscal 

20 year or portion of a fiscal year described in 

21 subparagraph (A), the Secretary shall de22 termine for each State an expenditure floor 

23 that shall be equal to— 

24 ‘‘(I) the amount of the State’s 

25 expenditures for fiscal year 2018 on 


pamtmann on DSKBFK8HB2PROD with BILLS
19 

•S 1129 IS

1 medical assistance for institutional 

2 long-term care services; increased by 

3 ‘‘(II) the growth factor deter4 mined under subclause (ii). 

5 ‘‘(ii) GROWTH FACTOR.—For each fis6 cal year or portion of a fiscal year de7 scribed in subparagraph (A), the Secretary 

8 shall, not later than September 1 of the 

9 fiscal year preceding such fiscal year or 

10 portion of a fiscal year, determine a 

11 growth factor for each State that takes 

12 into account— 

13 ‘‘(I) the percentage increase in 

14 health care costs in the State; 

15 ‘‘(II) the total amount expended 

16 by the State for the previous fiscal 

17 year on medical assistance for institu18 tional long-term care services; 

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

20 total population of the State from 

21 July of 2018 to July of the fiscal year 

22 preceding the fiscal year involved; 

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

24 population of individuals aged 65 and 

25 older of the State from July of 2018 


pamtmann on DSKBFK8HB2PROD with BILLS
20 

•S 1129 IS

1 to July of the fiscal year preceding 

2 the fiscal year involved; and 

3 ‘‘(V) the decrease, if any, in the 

4 population of the State that requires 

5 medical assistance for institutional 

6 long-term care services that is attrib7 utable to the availability of coverage 

8 for the services described in section 

9 201(a)(13) of the Medicare for All 

10 Act of 2019. 

11 ‘‘(iii) PRORATION RULE.—Any 

12 amount determined under this subpara13 graph for a portion of a fiscal year shall be 

14 prorated based on the length of such por15 tion of a fiscal year relative to a complete 

16 fiscal year. 

17 ‘‘(d) NONAPPLICATION OF CERTAIN REQUIRE18 MENTS.—Beginning on the date described in subsection 

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

20 medical assistance to make available medical assistance 

21 for services that are not institutional long-term care serv22 ices or services described in section 901(a)(3)(A)(ii) of the 

23 Medicare for All Act of 2019 shall have no effect.’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
21 

•S 1129 IS

1 SEC. 205. PROHIBITING RECOVERY OF CORRECTLY PAID 

2 MEDICAID BENEFITS. 

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

4 1396p) is amended— 

5 (1) by amending subsection (a) to read as fol6 lows: 

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

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

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

10 plan, except pursuant to the judgment of a court on ac11 count of benefits incorrectly paid on behalf of such indi12 vidual.’’; and 

13 (2) by amending subsection (b) to read as fol14 lows: 

15 ‘‘(b) No adjustment or recovery of any medical assist16 ance correctly paid on behalf of an individual under the 

17 State plan may be made.’’. 

18 SEC. 206. STATE STANDARDS. 

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

20 individual States from setting additional standards, with 

21 respect to eligibility, benefits, and minimum provider 

22 standards, consistent with the purposes of this Act, pro23 vided that such standards do not restrict eligibility or re24 duce access to benefits or services. 

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

26 any individuals or entities certified to provide services covVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
22 

•S 1129 IS

1 ered under section 201(a)(7), a State may not prohibit 

2 an individual or entity from participating in the program 

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

4 individual or entity to provide such services. 

5 TITLE III—PROVIDER 

6 PARTICIPATION 

7 SEC. 301. PROVIDER PARTICIPATION AND STANDARDS. 

8 (a) IN GENERAL.—An individual or other entity fur9 nishing any covered service under this Act is not a quali10 fied provider unless the individual or entity— 

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

12 section 302; 

13 (2) has filed with the Secretary a participation 

14 agreement described in subsection (b); and 

15 (3) meets, as applicable, such other qualifica16 tions and conditions with respect to a provider of 

17 services under title XVIII of the Social Security Act 

18 as described in section 1866 of the Social Security 

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

20 (b) REQUIREMENTS IN PARTICIPATION AGREE21 MENT.— 

22 (1) IN GENERAL.—A participation agreement 

23 described in this subsection between the Secretary 

24 and a provider shall provide at least for the fol25 lowing: 


pamtmann on DSKBFK8HB2PROD with BILLS
23 

•S 1129 IS

1 (A) Services to eligible persons will be fur2 nished by the provider without discrimination, 

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

4 this subparagraph shall be construed as requir5 ing the provision of a type or class of services 

6 that are outside the scope of the provider’s nor7 mal practice. 

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

9 individual for any covered services other than 

10 for payment authorized by this Act. 

11 (C) The provider agrees to furnish such in12 formation as may be reasonably required by the 

13 Secretary, in accordance with uniform reporting 

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

15 for— 

16 (i) quality review by designated enti17 ties; 

18 (ii) making payments under this Act, 

19 including the examination of records as 

20 may be necessary for the verification of in21 formation on which such payments are 

22 based; 

23 (iii) statistical or other studies re24 quired for the implementation of this Act; 

25 and 


pamtmann on DSKBFK8HB2PROD with BILLS
24 

•S 1129 IS

1 (iv) such other purposes as the Sec2 retary may specify. 

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

4 an individual, the provider agrees not to employ 

5 or use for the provision of health services any 

6 individual or other provider that has had a par7 ticipation agreement under this subsection ter8 minated for cause. 

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

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

11 submit bills and any required supporting docu12 mentation relating to the provision of covered 

13 services within 30 days after the date of pro14 viding such services. 

15 (2) TERMINATION OF PARTICIPATION AGREE16 MENT.— 

17 (A) IN GENERAL.—Participation agree18 ments may be terminated, with appropriate no19 tice— 

20 (i) by the Secretary for failure to meet 

21 the requirements of this Act; or 

22 (ii) by a provider. 

23 (B) TERMINATION PROCESS.—Providers 

24 shall be provided notice and a reasonable oppor25 tunity to correct deficiencies before the SecVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
25 

•S 1129 IS

1 retary terminates an agreement unless a more 

2 immediate termination is required for public 

3 safety or similar reasons. 

4 (C) PROVIDER PROTECTIONS.— 

5 (i) PROHIBITION.—The Secretary may 

6 not terminate a participation agreement or 

7 in any other way discriminate against, or 

8 cause to be discriminated against, any cov9 ered provider or authorized representative 

10 of the provider, on account of such pro11 vider or representative— 

12 (I) providing, causing to be pro13 vided, or being about to provide or 

14 cause to be provided to the provider, 

15 the Federal Government, or the attor16 ney general of a State information re17 lating to any violation of, or any act 

18 or omission the provider or represent19 ative reasonably believes to be a viola20 tion of, any provision of this title (or 

21 an amendment made by this title); 

22 (II) testifying or being about to 

23 testify in a proceeding concerning 

24 such violation; 


pamtmann on DSKBFK8HB2PROD with BILLS
26 

•S 1129 IS

1 (III) assisting or participating, or 

2 being about to assist or participate, in 

3 such a proceeding; or 

4 (IV) objecting to, or refusing to 

5 participate in, any activity, policy, 

6 practice, or assigned task that the 

7 provider or representative reasonably 

8 believes to be in violation of any provi9 sion of this Act (including any amend10 ment made by this Act), or any order, 

11 rule, regulation, standard, or ban 

12 under this Act (including any amend13 ment made by this Act). 

14 (ii) COMPLAINT PROCEDURE.—A pro15 vider or representative who believes that he 

16 or she has been discriminated against in 

17 violation of this section may seek relief in 

18 accordance with the procedures, notifica19 tions, burdens of proof, remedies, and stat20 utes of limitation set forth in section 

21 2087(b) of title 15, United States Code. 

22 SEC. 302. QUALIFICATIONS FOR PROVIDERS. 

23 (a) IN GENERAL.—A health care provider is consid24 ered to be qualified to provide covered services if the pro25 vider is licensed or certified and meets— 


pamtmann on DSKBFK8HB2PROD with BILLS
27 

•S 1129 IS

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

2 such services; and 

3 (2) applicable requirements of Federal law to 

4 provide such services. 

5 (b) MINIMUM PROVIDER STANDARDS.— 

6 (1) IN GENERAL.—The Secretary shall estab7 lish, evaluate, and update national minimum stand8 ards to ensure the quality of services provided under 

9 this Act and to monitor efforts by States to ensure 

10 the quality of such services. A State may also estab11 lish additional minimum standards which providers 

12 shall meet with respect to services provided in such 

13 State. 

14 (2) NATIONAL MINIMUM STANDARDS.—The na15 tional minimum standards under paragraph (1) shall 

16 be established for institutional providers of services 

17 and individual health care practitioners. Except as 

18 the Secretary may specify in order to carry out this 

19 Act, a hospital, skilled nursing facility, or other in20 stitutional provider of services shall meet standards 

21 for such a provider under the Medicare program 

22 under title XVIII of the Social Security Act (42 

23 U.S.C. 1395 et seq.). Such standards also may in24 clude, where appropriate, elements relating to— 

25 (A) adequacy and quality of facilities; 


pamtmann on DSKBFK8HB2PROD with BILLS
28 

•S 1129 IS

1 (B) training and competence of personnel 

2 (including continuing education requirements); 

3 (C) comprehensiveness of service; 

4 (D) continuity of service; 

5 (E) patient satisfaction, including waiting 

6 time and access to services; and 

7 (F) performance standards, including orga8 nization, facilities, structure of services, effi9 ciency of operation, and outcome in palliation, 

10 improvement of health, stabilization, cure, or 

11 rehabilitation. 

12 (3) TRANSITION IN APPLICATION.—If the Sec13 retary provides for additional requirements for pro14 viders under this subsection, any such additional re15 quirement shall be implemented in a manner that 

16 provides for a reasonable period during which a pre17 viously qualified provider is permitted to meet such 

18 an additional requirement. 

19 (4) ABILITY TO PROVIDE SERVICES.—With re20 spect to any entity or provider certified to provide 

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

22 may not prohibit such entity or provider from par23 ticipating for reasons other than its ability to pro24 vide such services. 


pamtmann on DSKBFK8HB2PROD with BILLS
29 

•S 1129 IS

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

2 provide health care services through the Department of 

3 Veterans Affairs or Indian Health Service is a qualifying 

4 provider under this section with respect to any individual 

5 who qualifies for such services under applicable Federal 

6 law. 

7 SEC. 303. USE OF PRIVATE CONTRACTS. 

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

9 subsection, nothing in this Act shall prohibit an institu10 tional or individual provider from entering into a private 

11 contract with an enrolled individual for any item or serv12 ice— 

13 (1) for which no claim for payment is to be sub14 mitted under this Act; and 

15 (2) for which the provider receives— 

16 (A) no reimbursement under this Act di17 rectly or on a capitated basis; and 

18 (B) receives no amount for such item or 

19 service from an organization which receives re20 imbursement for such items or service under 

21 this Act directly or on a capitated basis. 

22 (b) BENEFICIARY PROTECTIONS.— 

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

24 apply to any contract unless— 


pamtmann on DSKBFK8HB2PROD with BILLS
30 

•S 1129 IS

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

2 by the beneficiary before any item or service is 

3 provided pursuant to the contract; 

4 (B) the contract contains the items de5 scribed in paragraph (2); and 

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

7 time when the beneficiary is facing an emer8 gency health care situation. 

9 (2) ITEMS REQUIRED TO BE INCLUDED IN CON10 TRACT.—Any contract to provide items and services 

11 to which subsection (a) applies shall clearly indicate 

12 to the beneficiary that by signing such contract the 

13 beneficiary— 

14 (A) agrees not to submit a claim (or to re15 quest that the provider submit a claim) under 

16 this Act for such items or services even if such 

17 items or services are otherwise covered by this 

18 Act; 

19 (B) agrees to be responsible, whether 

20 through insurance offered under section 107(b) 

21 or otherwise, for payment of such items or serv22 ices and understands that no reimbursement 

23 will be provided under this Act for such items 

24 or services; 


pamtmann on DSKBFK8HB2PROD with BILLS
31 

•S 1129 IS

1 (C) acknowledges that no limits under this 

2 Act apply to amounts that may be charged for 

3 such items or services; 

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

5 provider, acknowledges that the beneficiary has 

6 the right to have such items or services pro7 vided by other providers for whom payment 

8 would be made under this Act; and 

9 (E) acknowledges that the provider is pro10 viding services outside the scope of the program 

11 under this Act. 

12 (c) PROVIDER REQUIREMENTS.— 

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

14 apply to any contract unless an affidavit described 

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

16 item or service is to be provided pursuant to the 

17 contract. 

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

19 this subparagraph shall— 

20 (A) identify the practitioner, and be signed 

21 by such practitioner; 

22 (B) provide that the practitioner will not 

23 submit any claim under this title for any item 

24 or service provided to any beneficiary (and will 

25 not receive any reimbursement or amount deVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
32 

•S 1129 IS

1 scribed in paragraph (1)(B) for any such item 

2 or service) during the 1-year period beginning 

3 on the date the affidavit is signed; and 

4 (C) be filed with the Secretary no later 

5 than 10 days after the first contract to which 

6 such affidavit applies is entered into. 

7 (3) ENFORCEMENT.—If a physician or practi8 tioner signing an affidavit described in paragraph 

9 (2) knowingly and willfully submits a claim under 

10 this title for any item or service provided during the 

11 1-year period described in paragraph (2)(B) (or re12 ceives any reimbursement or amount described in 

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

14 respect to such affidavit— 

15 (A) this subsection shall not apply with re16 spect to any items and services provided by the 

17 physician or practitioner pursuant to any con18 tract on and after the date of such submission 

19 and before the end of such period; and 

20 (B) no payment shall be made under this 

21 title for any item or service furnished by the 

22 physician or practitioner during the period de23 scribed in clause (i) (and no reimbursement or 

24 payment of any amount described in subsection 


pamtmann on DSKBFK8HB2PROD with BILLS
33 

•S 1129 IS

1 (a)(2) shall be made for any such item or serv2 ice). 

3 TITLE IV—ADMINISTRATION 

4 Subtitle A—General 

5 Administration Provisions 

6 SEC. 401. ADMINISTRATION. 

7 (a) GENERAL DUTIES OF THE SECRETARY.— 

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

9 policies, procedures, guidelines, and requirements to 

10 carry out this Act, including related to— 

11 (A) eligibility for benefits; 

12 (B) enrollment; 

13 (C) benefits provided; 

14 (D) provider participation standards and 

15 qualifications, as described in title III; 

16 (E) levels of funding; 

17 (F) methods for determining amounts of 

18 payments to providers of covered services, con19 sistent with subtitle B; 

20 (G) the determination of medical necessity 

21 and appropriateness with respect to coverage of 

22 certain services; 

23 (H) planning for capital expenditures and 

24 service delivery; 


pamtmann on DSKBFK8HB2PROD with BILLS
34 

•S 1129 IS

1 (I) planning for health professional edu2 cation funding; 

3 (J) encouraging States to develop regional 

4 planning mechanisms; and 

5 (K) any other regulations necessary to 

6 carry out the purpose of this Act. 

7 (2) REGULATIONS.—Regulations authorized by 

8 this Act shall be issued by the Secretary in accord9 ance with section 553 of title 5, United States Code. 

10 (b) UNIFORM REPORTING STANDARDS; ANNUAL RE11 PORT; STUDIES.— 

12 (1) UNIFORM REPORTING STANDARDS.— 

13 (A) IN GENERAL.—The Secretary shall es14 tablish uniform State reporting requirements 

15 and national standards to ensure an adequate 

16 national database containing information per17 taining to health services practitioners, ap18 proved providers, the costs of facilities and 

19 practitioners providing such services, the qual20 ity of such services, the outcomes of such serv21 ices, and the equity of health among population 

22 groups. Such standards shall include, to the 

23 maximum extent feasible without compromising 

24 patient privacy, health outcome measures, and 

25 to the maximum extent feasible without excesVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
35 

•S 1129 IS

1 sively burdening providers, the measures de2 scribed in subparagraphs (D) through (F) of 

3 subsection (a)(1). 

4 (B) REPORTS.—The Secretary shall regu5 larly analyze information reported to it and 

6 shall define rules and procedures to allow re7 searchers, scholars, health care providers, and 

8 others to access and analyze data for purposes 

9 consistent with quality and outcomes research, 

10 without compromising patient privacy. 

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

12 the second year beginning after the effective date of 

13 this Act, the Secretary shall annually report to Con14 gress on the following: 

15 (A) The status of implementation of the 

16 Act. 

17 (B) Enrollment under this Act. 

18 (C) Benefits under this Act. 

19 (D) Expenditures and financing under this 

20 Act. 

21 (E) Cost-containment measures and 

22 achievements under this Act. 

23 (F) Quality assurance. 


pamtmann on DSKBFK8HB2PROD with BILLS
36 

•S 1129 IS

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

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

5 health care. 

6 (I) Differences in the health status of the 

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

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

12 achievements in such areas. 

13 (K) Necessary changes in the education of 

14 health personnel. 

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

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

19 (N) Opportunities for improvements under 

20 this Act. 

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


pamtmann on DSKBFK8HB2PROD with BILLS
37 

•S 1129 IS

1 (A) make statistical and other studies, on 

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

3 any aspect of the operation of this Act; 

4 (B) develop and test methods of payment 

5 or delivery as it may consider necessary or 

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

8 (C) develop methodological standards for 

9 evidence-based policymaking. 

10 (c) AUDITS.— 

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

12 the United States shall conduct an audit of the 

13 Board every fifth fiscal year following the effective 

14 date of this Act to determine the effectiveness of the 

15 program in carrying out the duties under subsection 

16 (a). 

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

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

20 this subsection. 

21 SEC. 402. CONSULTATION. 

22 The Secretary shall consult with Federal agencies, 

23 Indian tribes and urban Indian health organizations, and 

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


pamtmann on DSKBFK8HB2PROD with BILLS
38 

•S 1129 IS

1 medical schools and academic health centers, consumer 

2 and patient groups, and labor and business organizations 

3 in the formulation of guidelines, regulations, policy initia4 tives, and information gathering to ensure the broadest 

5 and most informed input in the administration of this Act. 

6 Nothing in this Act shall prevent the Secretary from 

7 adopting guidelines developed by such a private entity if, 

8 in the Secretary’s judgment, such guidelines are generally 

9 accepted as reasonable and prudent and consistent with 

10 this Act. 

11 SEC. 403. REGIONAL ADMINISTRATION. 

12 (a) COORDINATION WITH REGIONAL OFFICES.—The 

13 Secretary shall establish and maintain regional offices to 

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

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

16 the Secretary shall incorporate regional offices of the Cen17 ters for Medicare & Medicaid Services for this purpose. 

18 (b) APPOINTMENT OF REGIONAL AND STATE DIREC19 TORS.—In each such regional office there shall be— 

20 (1) one regional director appointed by the Sec21 retary; 

22 (2) for each State in the region, a deputy direc23 tor; and 

24 (3) one deputy director to represent the Native 

25 American and Alaska Native tribes in the region. 


pamtmann on DSKBFK8HB2PROD with BILLS
39 

•S 1129 IS

1 (c) REGIONAL OFFICE DUTIES.—Regional offices 

2 shall be responsible for— 

3 (1) providing an annual State health care needs 

4 assessment report to the Secretary, after a thorough 

5 examination of health needs, in consultation with 

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

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

10 in the States within the region; and 

11 (3) establishing a quality assurance mechanism 

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

15 SEC. 404. BENEFICIARY OMBUDSMAN. 

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

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

19 assistance to, individuals entitled to benefits under this 

20 Act. 

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

22 (1) receive complaints, grievances, and requests 

23 for information submitted by individuals entitled to 

24 benefits under this Act with respect to any aspect of 

25 the Universal Medicare Program; 


pamtmann on DSKBFK8HB2PROD with BILLS
40 

•S 1129 IS

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

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

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

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

11 (3) submit annual reports to Congress and the 

12 Secretary that describe the activities of the Office 

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

16 shall not serve as an advocate for any increases in 

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

19 policies. 

20 SEC. 405. COMPLEMENTARY CONDUCT OF RELATED 

21 HEALTH PROGRAMS. 

22 In performing functions with respect to health per23 sonnel education and training, health research, environ24 mental health, disability insurance, vocational rehabilita25 tion, the regulation of food and drugs, and all other matVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
41 

•S 1129 IS

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

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

5 Subtitle B—Control Over Fraud 

6 and Abuse 

7 SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL 

8 FRAUD AND ABUSE UNDER UNIVERSAL MEDI9 CARE PROGRAM. 

10 The following sections of the Social Security Act shall 

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

12 State medical assistance plans under title XIX of such 

13 Act: 

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

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

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

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

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

22 TITLE V—QUALITY ASSESSMENT 

23 SEC. 501. QUALITY STANDARDS. 

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


pamtmann on DSKBFK8HB2PROD with BILLS
42 

•S 1129 IS

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

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

4 Research and Quality and other offices of the Department 

5 of Health and Human Services. 

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

8 (1) PRACTICE GUIDELINES.—The Center shall 

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

11 Service Act. The Center shall determine whether the 

12 guideline should be recognized as a national practice 

13 guideline. 

14 (2) STANDARDS OF QUALITY, PERFORMANCE

15 MEASURES, AND MEDICAL REVIEW CRITERIA.—The 

16 Center shall review and evaluate each standard of 

17 quality, performance measure, and medical review 

18 criterion developed under part B of title IX of the 

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

20 The Center shall determine whether the standard, 

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

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

25 shall consider the evidentiary basis for the standard, 


pamtmann on DSKBFK8HB2PROD with BILLS
43 

•S 1129 IS

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

3 (3) PROFILING OF PATTERNS OF PRACTICE; 

4 IDENTIFICATION OF OUTLIERS.—The Center shall 

5 adopt methodologies for profiling the patterns of 

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

8 (4) CRITERIA FOR ENTITIES CONDUCTING

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

11 qualify to conduct ongoing and continuous external 

12 quality reviews in the administrative regions. Such 

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

15 administers the region and shall ensure that such 

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

18 The Center shall ensure coordination and reporting 

19 by such entities to ensure national consistency in 

20 quality standards. 

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

22 the Secretary annually specifically on findings from 

23 outcomes research and development of practice 

24 guidelines that may affect the Secretary’s deterVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
44 

•S 1129 IS

1 mination of coverage of services under section 

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

3 SEC. 502. ADDRESSING HEALTH CARE DISPARITIES. 

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

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

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

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

13 following objectives: 

14 (1) Protecting patient privacy. 

15 (2) Minimizing the administrative burdens of 

16 data collection and reporting on providers under this 

17 Act. 

18 (3) Improving Universal Medicare Program 

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

21 (b) REPORTS TO CONGRESS.— 

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

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

25 Center shall submit to Congress and the Secretary 


pamtmann on DSKBFK8HB2PROD with BILLS
45 

•S 1129 IS

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

4 (A) identify approaches (including defining 

5 methodologies) for identifying and collecting 

6 and evaluating data on health care disparities 

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

10 (B) include recommendations on the most 

11 effective strategies and approaches to reporting 

12 quality measures, as appropriate, on the basis 

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

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

16 than 4 years after the submission of the report 

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

18 Center shall submit to Congress and the Secretary 

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

21 on the analyses of data collected under subsection 

22 (c). 

23 (c) IMPLEMENTING EFFECTIVE APPROACHES.—Not 

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

25 become available as described in section 106(a), the SecVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
46 

•S 1129 IS

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

3 accurate, and timely collection and evaluation of data on 

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

6 TITLE VI—HEALTH BUDGET; 

7 PAYMENTS; COST CONTAIN8 MENT MEASURES 

9 Subtitle A—Budgeting 

10 SEC. 601. NATIONAL HEALTH BUDGET. 

11 (a) NATIONAL HEALTH BUDGET.— 

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

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

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

17 total expenditures to be made for covered health 

18 care services under this Act. 

19 (2) DIVISION OF BUDGET INTO COMPONENTS.— 

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

21 national health budget shall consist of at least the 

22 following components: 

23 (A) Quality assessment activities under 

24 title V. 


pamtmann on DSKBFK8HB2PROD with BILLS
47 

•S 1129 IS

1 (B) Health professional education expendi2 tures. 

3 (C) Administrative costs. 

4 (D) Innovation, including in accordance 

5 with section 1115A of the Social Security Act 

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

7 (E) Operating and other expenditures not 

8 described in subparagraphs (A) through (D) 

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

11 the other components. 

12 (F) Capital expenditures. 

13 (G) Prevention and public health activities. 

14 (3) ALLOCATION AMONG COMPONENTS.—The 

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

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

19 (B) ensures that the health professional 

20 education expenditure component is sufficient 

21 to provide for the amount of health professional 

22 education expenditures sufficient to meet the 

23 need for covered health care services. 

24 (4) TEMPORARY WORKER ASSISTANCE.—For up 

25 to 5 years following the date on which benefits first 


pamtmann on DSKBFK8HB2PROD with BILLS
48 

•S 1129 IS

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

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

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

7 Act. 

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

10 the costs of treating an epidemic, pandemic, natural 

11 disaster, or other such health emergency. 

12 (b) DEFINITIONS.—In this section: 

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

15 lease, construction, or renovation of capital facilities 

16 and for equipment and includes return on equity 

17 capital. 

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

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


pamtmann on DSKBFK8HB2PROD with BILLS
49 

•S 1129 IS

1 Subtitle B—Payments to Providers 

2 SEC. 611. PAYMENTS TO INSTITUTIONAL AND INDIVIDUAL 

3 PROVIDERS. 

4 (a) APPLICATION OF PAYMENT PROCESSES UNDER

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

7 schedules that establish payment amounts for benefits 

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

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

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

12 of, and amendments made by, section 612. 

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

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

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

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

20 Medicare Access and CHIP Reauthorization Act of 2015 

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


pamtmann on DSKBFK8HB2PROD with BILLS
50 

•S 1129 IS

1 SEC. 612. ENSURING ACCURATE VALUATION OF SERVICES 

2 UNDER THE MEDICARE PHYSICIAN FEE 

3 SCHEDULE. 

4 (a) STANDARDIZED AND DOCUMENTED REVIEW

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

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

7 end the following new subparagraph: 

8 ‘‘(P) STANDARDIZED AND DOCUMENTED

9 REVIEW PROCESS.— 

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

11 year after the date of enactment of this 

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

14 a standardized process for reviewing the 

15 relative values of physicians’ services under 

16 this paragraph. 

17 ‘‘(ii) MINIMUM REQUIREMENTS.—The 

18 standardized process shall include, at a 

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

21 review of services, reviewing stakeholder 

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

24 the review process.’’. 

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

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


pamtmann on DSKBFK8HB2PROD with BILLS
51 

•S 1129 IS

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

2 end the following new clause: 

3 ‘‘(x) PLANNED AND DOCUMENTED

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

6 on or after the date of enactment of this 

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

9 provided under clause (ix) to collect and 

10 use information on physicians’ services in 

11 the determination of relative values under 

12 this subparagraph.’’. 

13 (c) INTERNAL TRACKING OF REVIEWS.— 

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

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

17 systematically and internally tracking its review of 

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

19 establishing an internal database, under section 

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

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

22 (2) MINIMUM REQUIREMENTS.—The proposal 

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

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


pamtmann on DSKBFK8HB2PROD with BILLS
52 

•S 1129 IS

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

2 identified for review. 

3 (B) When services are reviewed or when 

4 new services are added. 

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

7 (D) When relative values are adjusted. 

8 (E) The rationale for final relative value 

9 decisions. 

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

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

12 amended— 

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

14 inserting ‘‘4’’; and 

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

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

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

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

21 amended— 

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

23 ‘‘in consultation with the Medicare Payment 

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

25 and 


pamtmann on DSKBFK8HB2PROD with BILLS
53 

•S 1129 IS

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

2 by subsection (d)(2), by inserting ‘‘, in coordi3 nation with the Medicare Payment Advisory 

4 Commission,’’ after ‘‘annually’’. 

5 (2) CONFORMING AMENDMENTS.—Section 1805 

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

7 amended— 

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

9 the following before the semicolon at the end: 

10 ‘‘and including coordinating with the Secretary 

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

13 for physicians’ services, identify potentially 

14 misvalued services, and propose adjustments to 

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

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

18 Member’’ after ‘‘the Chairman’’. 

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

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

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

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


pamtmann on DSKBFK8HB2PROD with BILLS
54 

•S 1129 IS

1 ‘‘(i) IN GENERAL.—The Comptroller 

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

4 General’) shall periodically audit the review 

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

7 services. 

8 ‘‘(ii) ACCESS TO INFORMATION.—The 

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

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

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

14 SEC. 613. OFFICE OF PRIMARY HEALTH CARE. 

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

16 Agency for Healthcare Research and Quality an Office of 

17 Primary Health Care, responsible for coordinating with 

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

21 (1) coordinate health professional education 

22 policies and goals, in consultation with the Secretary 

23 to achieve the national goals specified in subsection 

24 (b); 


pamtmann on DSKBFK8HB2PROD with BILLS
55 

•S 1129 IS

1 (2) develop and maintain a system to monitor 

2 the number and specialties of individuals through 

3 their health professional education, any postgraduate 

4 training, and professional practice; 

5 (3) develop, coordinate, and promote policies 

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

8 dentists; and 

9 (4) recommend the appropriate training, edu10 cation, technical assistance, and patient advocacy en11 hancements of primary care health professionals, in12 cluding registered nurses, to achieve uniform high13 quality and patient safety. 

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

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

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

18 underserved areas and for underserved populations. 

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

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

22 covered pharmaceuticals, medical supplies, and medically 

23 necessary assistive equipment shall be negotiated annually 

24 by the Secretary. 

25 (b) PRESCRIPTION DRUG FORMULARY.— 


pamtmann on DSKBFK8HB2PROD with BILLS
56 

•S 1129 IS

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

2 a prescription drug formulary system, which shall 

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

5 costly medications when better alternatives are avail6 able. 

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

8 formulary under this subsection shall promote the 

9 use of generic medications to the greatest extent 

10 possible. 

11 (3) FORMULARY UPDATES AND PETITION

12 RIGHTS.—The formulary under this subsection shall 

13 be updated frequently and clinicians and patients 

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

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

18 The Secretary shall promulgate rules regarding the 

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

21 TITLE VII—UNIVERSAL 

22 MEDICARE TRUST FUND 

23 SEC. 701. UNIVERSAL MEDICARE TRUST FUND. 

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

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


pamtmann on DSKBFK8HB2PROD with BILLS
57 

•S 1129 IS

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

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

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

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

6 (b) APPROPRIATIONS INTO TRUST FUND.— 

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

8 the Trust Fund for each fiscal year beginning with 

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

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

14 which is attributable to the amendments made by 

15 sections 801 and 902. The amounts appropriated by 

16 the preceding sentence shall be transferred from 

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

18 from the general fund in the Treasury to the Trust 

19 Fund, such amounts to be determined on the basis 

20 of estimates by the Secretary of the Treasury of the 

21 taxes paid to or deposited into the Treasury; and 

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

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

25 should have been so transferred. 


pamtmann on DSKBFK8HB2PROD with BILLS
58 

•S 1129 IS

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

3 appropriated to the Trust Fund for each fiscal year, 

4 beginning with the first fiscal year beginning on or 

5 after the effective date of benefits under section 106, 

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

8 (A) The Medicare program under title 

9 XVIII of the Social Security Act (other than 

10 amounts attributable to any premiums under 

11 such title). 

12 (B) The Medicaid program, under State 

13 plans approved under title XIX of such Act. 

14 (C) The Federal employees health benefit 

15 program, under chapter 89 of title 5, United 

16 States Code. 

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

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

21 vocational rehabilitation programs, programs 

22 for drug abuse and mental health services 

23 under the Public Health Service Act, programs 

24 providing general hospital or medical assistance, 

25 and any other Federal program identified by 


pamtmann on DSKBFK8HB2PROD with BILLS
59 

•S 1129 IS

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

4 the payment of which may be made under this 

5 Act. 

6 (3) RESTRICTIONS SHALL NOT APPLY.—Any 

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

9 for any reproductive health service shall not apply to 

10 monies in the Trust Fund. 

11 (c) INCORPORATION OF PROVISIONS.—The provisions 

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

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

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

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

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

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

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

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

23 or the Federal Supplementary Medical Insurance Trust 

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

25 after the payment of claims for items and services furVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
60 

•S 1129 IS

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

2 shall be transferred into the Universal Medicare Trust 

3 Fund under this section. 

4 TITLE VIII—CONFORMING 

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

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

10 MEDICARE PROGRAM; COORDINATION IN 

11 CASE OF WORKERS’ COMPENSATION. 

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

13 the Employee Retirement Income Security Act of 1974 

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

15 the following new section: 

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

18 BENEFITS; COORDINATION IN CASE OF 

19 WORKERS’ COMPENSATION. 

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

22 payment for any items or services for which payment may 

23 be made under the Medicare for All Act of 2019. 

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

25 carrier that is liable for payment for workers compensaVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
61 

•S 1129 IS

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

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

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

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

7 one or more employers and includes an employer or 

8 fund that is financially at risk for the provision of 

9 workers compensation medical benefits; 

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

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

12 an employee subject to the workers compensation 

13 laws of a State, the comprehensive medical benefits 

14 for work-related injuries and illnesses provided for 

15 under such laws with respect to such an employee; 

16 and 

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

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

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

22 work-related injuries and illnesses.’’. 

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

24 Employee Retirement Income Security Act of 1974 (29 

25 U.S.C. 1003(b)) is amended by adding at the end the folVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
62 

•S 1129 IS

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

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

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

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

6 item relating to section 521 the following new item: 

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

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

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

9 REQUIREMENTS RELATING TO GROUP 

10 HEALTH PLANS. 

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

12 the Employee Retirement Income Security Act of 1974 

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

14 (b) CONFORMING AMENDMENTS.— 

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

16 1132(a)) is amended— 

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

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

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

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

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

23 or (4) of section 606,’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
63 

•S 1129 IS

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

2 1144(b)) is amended— 

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

4 206(d)(3)(B)(i)).’’; and 

5 (B) by striking paragraph (8). 

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

7 Employee Retirement Income Security Act of 1974 

8 is amended by striking the items relating to part 6 

9 of subtitle B of title I of such Act. 

10 SEC. 803. EFFECTIVE DATE OF TITLE. 

11 The amendments made by this title shall take effect 

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

13 TITLE IX—ADDITIONAL 

14 CONFORMING AMENDMENTS 

15 SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH 

16 PROGRAMS. 

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

18 HEALTH INSURANCE PROGRAM (SCHIP).— 

19 (1) IN GENERAL.—Notwithstanding any other 

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

21 (3)— 

22 (A) no benefits shall be available under 

23 title XVIII of the Social Security Act for any 

24 item or service furnished beginning on or after 


pamtmann on DSKBFK8HB2PROD with BILLS
64 

•S 1129 IS

1 the effective date of benefits under section 

2 106(a); 

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

5 title XIX of such Act for any item or service 

6 furnished on or after such date; 

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

9 title XXI of such Act for any item or service 

10 furnished on or after such date; and 

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

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

13 with respect to medical assistance or child 

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

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

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

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

21 are provided under title XVIII of the Social Security 

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

23 or under a State child health plan under title XXI 

24 such Act, the Secretary of Health and Human ServVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
65 

•S 1129 IS

1 ices shall provide for continuation of benefits under 

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

3 (3) SERVICES UNDER MEDICAID.— 

4 (A) IN GENERAL.—This subsection shall 

5 not apply to entitlement to medical assistance 

6 provided under title XIX of the Social Security 

7 Act for— 

8 (i) institutional long-term care serv9 ices (as defined in section 1947(b) of such 

10 Act); or 

11 (ii) any other service for which bene12 fits are not available under this Act and 

13 which is furnished under a State plan 

14 under title XIX of the Social Security Act 

15 which provided for medical assistance for 

16 such service on January 1, 2019. 

17 (B) COORDINATION BETWEEN SECRETARY

18 AND STATES.—The Secretary shall coordinate 

19 with the directors of State agencies responsible 

20 for administering State plans under title XIX 

21 of the Social Security Act to— 

22 (i) identify services described in sub23 paragraph (A)(ii) with respect to each 

24 State plan; and 


pamtmann on DSKBFK8HB2PROD with BILLS
66 

•S 1129 IS

1 (ii) ensure that such services continue 

2 to be made available under such plan. 

3 (C) MAINTENANCE OF EFFORT REQUIRE4 MENT.—With respect to any service described 

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

6 under a State plan under title XIX of the So7 cial Security Act, the maintenance of effort re8 quirements described in section 1947(c) of such 

9 Act (related to eligibility standards and re10 quired expenditures) shall apply to such service 

11 in the same manner that such requirements 

12 apply to institutional long-term care services (as 

13 defined in section 1947(b) of such Act). 

14 (b) FEDERAL EMPLOYEES HEALTH BENEFITS PRO15 GRAM.—No benefits shall be made available under chapter 

16 89 of title 5, United States Code, for any part of a cov17 erage period occurring on or after the effective date. 

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

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

20 Code, for items or services furnished on or after the effec21 tive date. 

22 (d) TREATMENT OF BENEFITS FOR VETERANS AND

23 NATIVE AMERICANS.— 

24 (1) IN GENERAL.—Nothing in this Act shall af25 fect the eligibility of veterans for the medical beneVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
67 

•S 1129 IS

1 fits and services provided under title 38, United 

2 States Code, or of Indians for the medical benefits 

3 and services provided by or through the Indian 

4 Health Service. 

5 (2) REEVALUATION.—No reevaluation of the 

6 Indian Health Service shall be undertaken without 

7 consultation with tribal leaders and stakeholders. 

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

9 EXCHANGES. 

10 Effective on the date described in section 106, the 

11 Federal and State Exchanges established pursuant to title 

12 I of the Patient Protection and Affordable Care Act (Pub13 lic Law 111–148) shall terminate, and any other provision 

14 of law that relies upon participation in or enrollment 

15 through such an Exchange, including such provisions of 

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

17 force or effect. 

18 TITLE X—TRANSITION 

19 Subtitle A—Transitional Medicare 

20 Buy-In Option and Transitional 

21 Public Option 

22 SEC. 1001. LOWERING THE MEDICARE AGE. 

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

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

25 the end the following new section: 


pamtmann on DSKBFK8HB2PROD with BILLS
68 

•S 1129 IS

1 ‘‘TRANSITIONAL MEDICARE BUY-IN OPTION FOR CERTAIN

2 INDIVIDUALS

3 ‘‘SEC. 1899C. (a) OPTION.— 

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

5 the requirements described in paragraph (3) shall be 

6 eligible to enroll under this section. 

7 ‘‘(2) PART A, B, AND D BENEFITS.—An indi8 vidual enrolled under this section is entitled to the 

9 same benefits (and shall receive the same protec10 tions) under this title as an individual who is enti11 tled to benefits under part A and enrolled under 

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

13 Medicare Advantage plan that provides qualified pre14 scription drug coverage (an MA–PD plan). 

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

16 requirements described in this paragraph are the fol17 lowing: 

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

19 United States. 

20 ‘‘(B) The individual is— 

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

22 States; or 

23 ‘‘(ii) an alien lawfully admitted for 

24 permanent residence. 


pamtmann on DSKBFK8HB2PROD with BILLS
69 

•S 1129 IS

1 ‘‘(C) The individual is not otherwise enti2 tled to benefits under part A or eligible to en3 roll under part A or part B. 

4 ‘‘(D) The individual has attained the appli5 cable years of age but has not attained 65 years 

6 of age. 

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

8 For purposes of this section, the term ‘applicable 

9 years of age’ means— 

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

11 following the date of enactment of the Medicare 

12 for All Act of 2019, the age of 55; 

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

14 year following such date of enactment, the age 

15 of 45; and 

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

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

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

19 establish enrollment periods and coverage under this sec20 tion consistent with the principles for establishment of en21 rollment periods and coverage for individuals under other 

22 provisions of this title. The Secretary shall establish such 

23 periods so that coverage under this section shall first begin 

24 on January 1 of the year on which an individual first be25 comes eligible to enroll under this section. 


pamtmann on DSKBFK8HB2PROD with BILLS
70 

•S 1129 IS

1 ‘‘(c) PREMIUM.— 

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

3 Secretary shall, during September of each year (be4 ginning with the first September following the date 

5 of enactment of the Medicare for All Act of 2019), 

6 determine a monthly premium for all individuals en7 rolled under this section. Such monthly premium 

shall be equal to 1 8 ⁄12 of the annual premium com9 puted under paragraph (2)(B), which shall apply 

10 with respect to coverage provided under this section 

11 for any month in the succeeding year. 

12 ‘‘(2) ANNUAL PREMIUM.— 

13 ‘‘(A) COMBINED PER CAPITA AVERAGE FOR

14 ALL MEDICARE BENEFITS.—The Secretary shall 

15 estimate the average, annual per capita amount 

16 for benefits and administrative expenses that 

17 will be payable under parts A, B, and D (in18 cluding, as applicable, under part C) in the year 

19 for all individuals enrolled under this section. 

20 ‘‘(B) ANNUAL PREMIUM.—The annual pre21 mium under this subsection for months in a 

22 year is equal to the average, annual per capita 

23 amount estimated under subparagraph (A) for 

24 the year. 


pamtmann on DSKBFK8HB2PROD with BILLS
71 

•S 1129 IS

1 ‘‘(3) INCREASED PREMIUM FOR CERTAIN PART

2 C AND D PLANS.—Nothing in this section shall pre3 clude an individual from choosing a Medicare Advan4 tage plan or a prescription drug plan which requires 

5 the individual to pay an additional amount (because 

6 of supplemental benefits or because it is a more ex7 pensive plan). In such case the individual would be 

8 responsible for the increased monthly premium. 

9 ‘‘(d) PAYMENT OF PREMIUMS.— 

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

11 under this section shall be paid to the Secretary at 

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

13 determines appropriate. 

14 ‘‘(2) DEPOSIT.—Amounts collected by the Sec15 retary under this section shall be deposited in the 

16 Federal Hospital Insurance Trust Fund and the 

17 Federal Supplementary Medical Insurance Trust 

18 Fund (including the Medicare Prescription Drug Ac19 count within such Trust Fund) in such proportion 

20 as the Secretary determines appropriate. 

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

22 ASSISTANCE.—An individual enrolled under this section 

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

24 for purposes of obtaining medical assistance for Medicare 

25 cost-sharing or otherwise under title XIX. 


pamtmann on DSKBFK8HB2PROD with BILLS
72 

•S 1129 IS

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

2 CARE ACT.— 

3 ‘‘(1) SATISFACTION OF INDIVIDUAL MAN4 DATE.—For purposes of applying section 5000A of 

5 the Internal Revenue Code of 1986, the coverage 

6 provided under this section constitutes minimum es7 sential coverage under subsection (f)(1)(A)(i) of 

8 such section 5000A. 

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

10 Coverage provided under this section— 

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

12 qualified health plan in the individual market 

13 enrolled in through the Exchange where the in14 dividual resides for all purposes of section 36B 

15 of the Internal Revenue Code of 1986 other 

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

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

18 other minimum essential coverage for purposes 

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

20 The Secretary shall determine the applicable second 

21 lowest cost silver plan which shall apply to coverage 

22 under this section for purposes of section 36B of 

23 such Code. 

24 ‘‘(3) ELIGIBILITY FOR COST-SHARING SUB25 SIDIES.—For purposes of applying section 1402 of 


pamtmann on DSKBFK8HB2PROD with BILLS
73 

•S 1129 IS

1 the Patient Protection and Affordable Care Act (42 

2 U.S.C. 18071)— 

3 ‘‘(A) coverage provided under this section 

4 shall be treated as coverage under a qualified 

5 health plan in the silver level of coverage in the 

6 individual market offered through an Exchange; 

7 and 

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

9 issuer of such plan. 

10 ‘‘(g) NO EFFECT ON BENEFITS FOR INDIVIDUALS

11 OTHERWISE ELIGIBLE OR ON TRUST FUNDS.—The Sec12 retary shall implement the provisions of this section in 

13 such a manner to ensure that such provisions— 

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

15 title for individuals who are entitled to, or enrolled 

16 for, such benefits other than through this section; 

17 and 

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

19 Hospital Insurance Trust Fund or the Federal Sup20 plementary Medical Insurance Trust Fund (includ21 ing the Medicare Prescription Drug Account within 

22 such Trust Fund). 

23 ‘‘(h) CONSULTATION.—In promulgating regulations 

24 to implement this section, the Secretary shall consult with 

25 interested parties, including groups representing beneVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
74 

•S 1129 IS

1 ficiaries, health care providers, employers, and insurance 

2 companies.’’. 

3 SEC. 1002. ESTABLISHMENT OF THE MEDICARE TRANSI4 TION PLAN. 

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

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

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

8 ending with the effective date described in section 106, 

9 the Secretary, acting through the Administrator of the 

10 Centers for Medicare & Medicaid (referred to in this sec11 tion as the ‘‘Administrator’’), shall establish, and provide 

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

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

14 plan’’) that provides affordable, high-quality health bene15 fits coverage throughout the United States. 

16 (b) ADMINISTRATING THE MEDICARE TRANSI17 TION.— 

18 (1) ADMINISTRATOR.—The Administrator shall 

19 administer the Medicare Transition plan in accord20 ance with this section. 

21 (2) APPLICATION OF ACA REQUIREMENTS.— 

22 Consistent with this section, the Medicare Transition 

23 plan shall comply with requirements under title I of 

24 the Patient Protection and Affordable Care Act (and 

25 the amendments made by that title) and title XXVII 


pamtmann on DSKBFK8HB2PROD with BILLS
75 

•S 1129 IS

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

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

3 offered through the Exchanges, subject to the limita4 tion under subsection (e)(2). 

5 (3) OFFERING THROUGH EXCHANGES.—The 

6 Medicare Transition plan shall be made available 

7 only through the Exchanges, and shall be available 

8 to individuals wishing to enroll and to qualified em9 ployers (as defined in section 1312(f)(2) of the Pa10 tient Protection and Affordable Care Act (42 U.S.C. 

11 18032)) who wish to make such plan available to 

12 their employees. 

13 (4) ELIGIBILITY TO PURCHASE.—Any United 

14 States resident may enroll in the Medicare Transi15 tion plan. 

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

17 this section, the Administrator shall ensure that the Medi18 care Transition plan provides— 

19 (1) coverage for the benefits required to be cov20 ered under title II; and 

21 (2) coverage of benefits that are actuarially 

22 equivalent to 90 percent of the full actuarial value 

23 of the benefits provided under the plan. 

24 (d) PROVIDERS AND REIMBURSEMENT RATES.— 


pamtmann on DSKBFK8HB2PROD with BILLS
76 

•S 1129 IS

1 (1) IN GENERAL.—With respect to the reim2 bursement provided to health care providers for cov3 ered benefits, as described in section 201, provided 

4 under the Medicare Transition plan, the Adminis5 trator shall reimburse such providers at rates deter6 mined for equivalent items and services under the 

7 original Medicare fee-for-service program under 

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

9 Act (42 U.S.C. 1395c et seq.). For items and serv10 ices covered under the Medicare Transition plan but 

11 not covered under such parts A and B, the Adminis12 trator shall reimburse providers at rates set by the 

13 Administrator in a manner consistent with the man14 ner in which rates for other items and services were 

15 set under the original Medicare fee-for-service pro16 gram. 

17 (2) PRESCRIPTION DRUGS.—Any payment rate 

18 under this subsection for a prescription drug shall be 

19 at a rate negotiated by the Administrator with the 

20 manufacturer of the drug. If the Administrator is 

21 unable to reach a negotiated agreement on such a 

22 reimbursement rate, the Administrator shall estab23 lish the rate at an amount equal to the lesser of— 

24 (A) the price paid by the Secretary of Vet25 erans Affairs to procure the drug under the 


pamtmann on DSKBFK8HB2PROD with BILLS
77 

•S 1129 IS

1 laws administered by the Secretary of Veterans 

2 Affairs; 

3 (B) the price paid to procure the drug 

4 under section 8126 of title 38, United States 

5 Code; or 

6 (C) the best price determined under sec7 tion 1927(c)(1)(C) of the Social Security Act 

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

9 (3) PARTICIPATING PROVIDERS.— 

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

11 that is a participating provider of services or 

12 supplier under the Medicare program under 

13 title XVIII of the Social Security Act (42 

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

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

16 1396 et seq.) on the date of enactment of this 

17 Act shall be a participating provider in the 

18 Medicare Transition plan. 

19 (B) ADDITIONAL PROVIDERS.—The Ad20 ministrator shall establish a process to allow 

21 health care providers not described in subpara22 graph (A) to become participating providers in 

23 the Medicare Transition plan. Such process 

24 shall be similar to the process applied to new 

25 providers under the Medicare program. 


pamtmann on DSKBFK8HB2PROD with BILLS
78 

•S 1129 IS

1 (e) PREMIUMS.— 

2 (1) DETERMINATION.—The Administrator shall 

3 determine the premium amount for enrolling in the 

4 Medicare Transition plan, which— 

5 (A) may vary according to family or indi6 vidual coverage, age, and tobacco status (con7 sistent with clauses (i), (iii), and (iv) of section 

8 2701(a)(1)(A) of the Public Health Service Act 

9 (42 U.S.C. 300gg(a)(1)(A))); and 

10 (B) shall take into account the cost-shar11 ing reductions and premium tax credits which 

12 will be available with respect to the plan under 

13 section 1402 of the Patient Protection and Af14 fordable Care Act (42 U.S.C. 18071) and sec15 tion 36B of the Internal Revenue Code of 1986, 

16 as amended by subsection (g). 

17 (2) LIMITATION.—Variation in premium rates 

18 of the Medicare Transition plan by rating area, as 

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

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

21 300gg(a)(1)(A)) is not permitted. 

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

23 force or effect on the effective date described in section 

24 106. 

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


pamtmann on DSKBFK8HB2PROD with BILLS
79 

•S 1129 IS

1 (1) PREMIUM ASSISTANCE TAX CREDITS.— 

2 (A) CREDITS ALLOWED TO MEDICARE

3 TRANSITION PLAN ENROLLEES AT OR ABOVE 44

4 PERCENT OF POVERTY IN NON-EXPANSION

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

6 the Internal Revenue Code of 1986 is amended 

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

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

9 by inserting after subparagraph (B) the fol10 lowing new subparagraph: 

11 ‘‘(C) SPECIAL RULES FOR MEDICARE

12 TRANSITION PLAN ENROLLEES.— 

13 ‘‘(i) IN GENERAL.—In the case of a 

14 taxpayer who is covered, or whose spouse 

15 or dependent (as defined in section 152) is 

16 covered, by the Medicare Transition plan 

17 established under section 1002(a) of the 

18 Medicare for All Act of 2019 for all 

19 months in the taxable year, subparagraph 

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

21 does not exceed 400 percent’. 

22 ‘‘(ii) ENROLLEES IN MEDICAID NON23 EXPANSION STATES.—In the case of a tax24 payer residing in a State which (as of the 

25 date of the enactment of the Medicare for 


pamtmann on DSKBFK8HB2PROD with BILLS
80 

•S 1129 IS

1 All Act of 2019) does not provide for eligi2 bility under clause (i)(VIII) or (ii)(XX) of 

3 section 1902(a)(10)(A) of the Social Secu4 rity Act for medical assistance under title 

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

6 plan approved under section 1115) who is 

7 covered, or whose spouse or dependent (as 

8 defined in section 152) is covered, by the 

9 Medicare Transition plan established under 

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

11 of 2019 for all months in the taxable year, 

12 subparagraphs (A) and (B) shall be ap13 plied by substituting ‘0 percent’ for ‘100 

14 percent’ each place it appears.’’. 

15 (B) PREMIUM ASSISTANCE AMOUNTS FOR

16 TAXPAYERS ENROLLED IN MEDICARE TRANSI17 TION PLAN.— 

18 (i) IN GENERAL.—Subparagraph (A) 

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

20 amended— 

21 (I) by redesignating clause (ii) as 

22 clause (iii); 

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

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

25 and (iii)’’; and 


pamtmann on DSKBFK8HB2PROD with BILLS
81 

•S 1129 IS

1 (III) by inserting after clause (i) 

2 the following new clause: 

3 ‘‘(ii) SPECIAL RULES FOR TAXPAYERS

4 ENROLLED IN MEDICARE TRANSITION

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

6 covered, or whose spouse or dependent (as 

7 defined in section 152) is covered, by the 

8 Medicare Transition plan established under 

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

10 of 2019 for all months in the taxable year, 

11 the applicable percentage for any taxable 

12 year shall be determined in the same man13 ner as under clause (i), except that the fol14 lowing table shall apply in lieu of the table 

15 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’’. 

16 (ii) CONFORMING AMENDMENT.—Sub17 clause (I) of clause (iii) of section 

18 36B(b)(3) of such Code, as redesignated 

19 by subparagraph (A)(i), is amended by in20 serting ‘‘, and determined after the appliVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
82 

•S 1129 IS

1 cation of clause (ii)’’ after ‘‘after applica2 tion of this clause’’. 

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

4 of section 1402 of the Patient Protection and Af5 fordable Care Act (42 U.S.C. 18071(b)) is amend6 ed— 

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

8 Transition plan established under section 

9 1002(a) of the Medicare for All Act of 2019,’’ 

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

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

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

13 (B), respectively, and by moving such subpara14 graphs 2 ems to the right; 

15 (C) by striking ‘‘INSURED.—In this sec16 tion’’ and inserting ‘‘INSURED.— 

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

18 (D) by striking the flush language; and 

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

20 paragraph: 

21 ‘‘(2) SPECIAL RULES.— 

22 ‘‘(A) INDIVIDUALS LAWFULLY PRESENT.— 

23 In the case of an individual described in section 

24 36B(c)(1)(B) of the Internal Revenue Code of 

25 1986, the individual shall be treated as having 


pamtmann on DSKBFK8HB2PROD with BILLS
83 

•S 1129 IS

1 household income equal to 100 percent of the 

2 poverty line for a family of the size involved for 

3 purposes of applying this section. 

4 ‘‘(B) MEDICARE TRANSITION PLAN EN5 ROLLEES IN MEDICAID NON-EXPANSION

6 STATES.—In the case of an individual residing 

7 in a State which (as of the date of the enact8 ment of the Medicare for All Act of 2019) does 

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

10 or (ii)(XX) of section 1902(a)(10)(A) of the So11 cial Security Act for medical assistance under 

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

13 plan approved under section 1115) who enrolls 

14 in such Medicare Transition plan, the preceding 

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

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

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

18 percent’ each place it appears. 

19 ‘‘(C) ADJUSTED COST-SHARING FOR MEDI20 CARE TRANSITION PLAN ENROLLEES.—In the 

21 case of any individual who enrolls in such Medi22 care Transition plan, in lieu of the percentages 

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

24 Secretary shall prescribe a method of deter25 mining the cost-sharing reduction for any such 


pamtmann on DSKBFK8HB2PROD with BILLS
84 

•S 1129 IS

1 individual such that the total of the cost-shar2 ing and the premiums paid by the individual 

3 under such Medicare Transition plan does not 

4 exceed the percentage of the total allowed costs 

5 of benefits provided under the plan equal to the 

6 final premium percentage applicable to such in7 dividual under section 36B(b)(3)(A)(ii) of the 

8 Internal Revenue Code of 1986.’’. 

9 (h) CONFORMING AMENDMENTS.— 

10 (1) TREATMENT AS A QUALIFIED HEALTH

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

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

13 amended— 

14 (A) in the paragraph heading, by inserting 

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

16 ‘‘AND’’; and 

17 (B) by inserting ‘‘The Medicare Transition 

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

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

20 of the Patient Protection and Affordable Care Act 

21 (42 U.S.C. 18044(a)) is amended by inserting ‘‘the 

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

23 qualified health plan’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
85 

•S 1129 IS

1 Subtitle B—Transitional Medicare 

2 Reforms 

3 SEC. 1011. MEDICARE PROTECTION AGAINST HIGH OUT-OF4 POCKET EXPENDITURES FOR FEE-FOR-SERV5 ICE BENEFITS AND ELIMINATION OF PARTS A 

6 AND B DEDUCTIBLES. 

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

8 EXPENDITURES.—Title XVIII of the Social Security Act 

9 (42 U.S.C. 1395 et seq.), as amended by section 1001, 

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

11 ‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET

12 EXPENDITURES

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

14 any other provision of this title, in the case of an indi15 vidual entitled to, or enrolled for, benefits under part A 

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

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

18 year beginning January 1 of the year following the date 

19 of enactment of the Medicare for All Act of 2019) equals 

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

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

22 that year. 

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

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

25 and (3), in this section, the term ‘out-of-pocket costVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
86 

•S 1129 IS

1 sharing’ means, with respect to an individual, the 

2 amount of the expenses incurred by the individual 

3 that are attributable to— 

4 ‘‘(A) coinsurance and copayments applica5 ble under part A or B; or 

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

7 have otherwise been covered under part A or B 

8 but for the exhaustion of those benefits. 

9 ‘‘(2) CERTAIN COSTS NOT INCLUDED.— 

10 ‘‘(A) NON-COVERED ITEMS AND SERV11 ICES.—Expenses incurred for items and serv12 ices which are not included (or treated as being 

13 included) under part A or B shall not be con14 sidered incurred expenses for purposes of deter15 mining out-of-pocket cost-sharing under para16 graph (1). 

17 ‘‘(B) ITEMS AND SERVICES NOT FUR18 NISHED ON AN ASSIGNMENT-RELATED BASIS.— 

19 If an item or service is furnished to an indi20 vidual under this title and is not furnished on 

21 an assignment-related basis, any additional ex22 penses the individual incurs above the amount 

23 the individual would have incurred if the item 

24 or service was furnished on an assignment-re25 lated basis shall not be considered incurred exVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
87 

•S 1129 IS

1 penses for purposes of determining out-of-pock2 et cost-sharing under paragraph (1). 

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

4 paragraph (1), the Secretary shall consider expenses 

5 to be incurred by the individual without regard to 

6 whether the individual or another person, including 

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

8 paid for such expenses.’’. 

9 (b) ELIMINATION OF PARTS A AND B 

10 DEDUCTIBLES.— 

11 (1) PART A.—Section 1813(b) of the Social Se12 curity Act (42 U.S.C. 1395e(b)) is amended by add13 ing at the end the following new paragraph: 

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

15 following the date of enactment of the Medicare for All 

16 Act of 2019), the inpatient hospital deductible for the year 

17 shall be $0.’’. 

18 (2) PART B.—Section 1833(b) of the Social Se19 curity Act (42 U.S.C. 1395l(b)) is amended, in the 

20 first sentence— 

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

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

23 the year that includes the date of enactment of 

24 the Medicare for All Act of 2019’’; and 


pamtmann on DSKBFK8HB2PROD with BILLS
88 

•S 1129 IS

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

2 subsequent year’’ after ‘‘$1)’’. 

3 SEC. 1012. REDUCTION IN MEDICARE PART D ANNUAL OUT4 OF-POCKET THRESHOLD AND ELIMINATION 

5 OF COST-SHARING ABOVE THAT THRESHOLD. 

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

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

8 amended— 

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

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

11 and 

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

13 clause: 

14 ‘‘(iii) REDUCTION IN THRESHOLD

15 DURING TRANSITION PERIOD.— 

16 ‘‘(I) IN GENERAL.—Subject to 

17 subclause (II), for plan years begin18 ning on or after January 1 following 

19 the date of enactment of the Medicare 

20 for All Act of 2019 and before Janu21 ary 1 of the year that is 4 years fol22 lowing such date of enactment, not23 withstanding clauses (i) and (ii), the 

24 ‘annual out-of-pocket threshold’ speciVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
89 

•S 1129 IS

1 fied in this subparagraph is equal to 

2 $305. 

3 ‘‘(II) AUTHORITY TO EXEMPT

4 BRAND-NAME DRUGS IF GENERIC

5 AVAILABLE.—In applying subclause 

6 (I), the Secretary may exempt costs 

7 incurred for a covered part D drug 

8 that is an applicable drug under sec9 tion 1860D–14A(g)(2) if the Sec10 retary determines that a generic 

11 version of that drug is available.’’. 

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

13 1860D–2(b)(4)(A) of the Social Security Act (42 U.S.C. 

14 1395w–102(b)(4)(A)) is amended— 

15 (1) in clause (i)— 

16 (A) by redesignating subclauses (I) and 

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

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

19 cost-sharing’’ and inserting the following: ‘‘sub20 paragraph (B)— 

21 ‘‘(I) for plan years 2006 through 

22 the plan year ending December 31 fol23 lowing the date of enactment of the 

24 Medicare for All Act of 2019, with 

25 cost-sharing’’; 


pamtmann on DSKBFK8HB2PROD with BILLS
90 

•S 1129 IS

1 (C) in item (bb), as redesignated by sub2 paragraph (A), by striking the period at the 

3 end and inserting ‘‘; and’’; and 

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

5 subclause: 

6 ‘‘(II) for the plan year beginning 

7 January 1 following the date of enact8 ment of the Medicare for All Act of 

9 2019 and the two subsequent plan 

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

11 (2) in clause (ii)— 

12 (A) by striking ‘‘clause (i)(I)’’ and insert13 ing ‘‘clause (i)(I)(aa)’’; and 

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

15 sentence: ‘‘The Secretary shall continue to cal16 culate the dollar amounts specified in clause 

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

18 this clause, after plan year 2018 for purposes 

19 of 1860D–14(a)(1)(D)(iii).’’. 

20 (c) CONFORMING AMENDMENTS TO LOW-INCOME

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

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

23 (1) in paragraph (1)— 


pamtmann on DSKBFK8HB2PROD with BILLS
91 

•S 1129 IS

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

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

3 ‘‘1860D–2(b)(4)(A)(i)(I)(aa)’’; and 

4 (B) in subparagraph (E)— 

5 (i) in the heading, by inserting 

6 ‘‘PRIOR TO THE ELIMINATION OF SUCH

7 COST-SHARING FOR ALL INDIVIDUALS’’ 

8 after ‘‘THRESHOLD’’; and 

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

10 inserting ‘‘For plan years 2006 through 

11 the plan year ending December 31 fol12 lowing the date of enactment of the Medi13 care for All Act of 2019, the elimination’’; 

14 and 

15 (2) in paragraph (2)(E)— 

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

17 THE ELIMINATION OF SUCH COST-SHARING FOR

18 ALL INDIVIDUALS’’ after ‘‘THRESHOLD’’; 

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

20 ‘‘For plan years 2006 through the plan year 

21 ending December 31 following the date of en22 actment of the Medicare for All Act of 2019, 

23 subject to’’; and 

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

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


pamtmann on DSKBFK8HB2PROD with BILLS
92 

•S 1129 IS

1 SEC. 1013. COVERAGE OF DENTAL AND VISION SERVICES 

2 AND HEARING AIDS AND EXAMINATIONS 

3 UNDER MEDICARE PART B. 

4 (a) DENTAL SERVICES.— 

5 (1) REMOVAL OF EXCLUSION FROM COV6 ERAGE.—Section 1862(a) of the Social Security Act 

7 (42 U.S.C. 1395y(a)) is amended by striking para8 graph (12). 

9 (2) COVERAGE.— 

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

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

12 is amended— 

13 (i) in subparagraph (GG), by striking 

14 ‘‘and’’ at the end; 

15 (ii) in subparagraph (HH), by strik16 ing the period at the end and inserting ‘‘; 

17 and’’; and 

18 (iii) by adding at the end the fol19 lowing new subparagraph: 

20 ‘‘(II) dental services;’’. 

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

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

23 amended— 

24 (i) by striking ‘‘and’’ before ‘‘(CC)’’; 

25 and 


pamtmann on DSKBFK8HB2PROD with BILLS
93 

•S 1129 IS

1 (ii) by inserting before the semicolon 

2 at the end the following: ‘‘, and (DD) with 

3 respect to dental services described in sec4 tion 1861(s)(2)(II), the amount paid shall 

5 be an amount equal to 80 percent of the 

6 lesser of the actual charge for the services 

7 or the amount determined under the fee 

8 schedule established under section 

9 1848(b).’’. 

10 (C) EFFECTIVE DATE.—The amendments 

11 made by this subsection shall apply to items 

12 and services furnished on or after January 1 

13 following the date of the enactment of this Act. 

14 (b) VISION SERVICES.— 

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

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

17 amended by subsection (a), is amended— 

18 (A) in subparagraph (HH), by striking 

19 ‘‘and’’ at the end; 

20 (B) in subparagraph (II), by inserting 

21 ‘‘and’’ at the end; and 

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

23 subparagraph: 

24 ‘‘(JJ) vision services;’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
94 

•S 1129 IS

1 (2) PAYMENT.—Section 1833(a)(1) of the So2 cial Security Act (42 U.S.C. 1395l(a)(1)), as amend3 ed by subsection (a), is amended— 

4 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 

5 (B) by inserting before the semicolon at 

6 the end the following: ‘‘, and (EE) with respect 

7 to vision services described in section 

8 1861(s)(2)(JJ), the amount paid shall be an 

9 amount equal to 80 percent of the lesser of the 

10 actual charge for the services or the amount de11 termined under the fee schedule established 

12 under section 1848(b).’’. 

13 (3) EFFECTIVE DATE.—The amendments made 

14 by this subsection shall apply to items and services 

15 furnished on or after January 1 following the date 

16 of the enactment of this Act. 

17 (c) HEARING AIDS AND EXAMINATIONS THERE18 FOR.— 

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

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

21 amended by striking ‘‘hearing aids or examinations 

22 therefor,’’. 

23 (2) EFFECTIVE DATE.—The amendment made 

24 by this subsection shall apply to items and services 


pamtmann on DSKBFK8HB2PROD with BILLS
95 

•S 1129 IS

1 furnished on or after January 1 following the date 

2 of the enactment of this Act. 

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

4 FOR MEDICARE COVERAGE FOR INDIVID5 UALS WITH DISABILITIES. 

6 (a) IN GENERAL.—Section 226(b) of the Social Secu7 rity Act (42 U.S.C. 426(b)) is amended— 

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

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

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

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

12 (3) in paragraph (2)(C)(ii), by striking ‘‘, in13 cluding the requirement that he has been entitled to 

14 the specified benefits for 24 months,’’; 

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

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

17 (II) the twenty-fifth month of his entitlement or sta18 tus as a qualified railroad retirement beneficiary de19 scribed in paragraph (2), and’’ and inserting ‘‘for 

20 each month for which the individual meets the re21 quirements of paragraph (2), beginning with the 

22 month following the month in which the individual 

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

24 and 


pamtmann on DSKBFK8HB2PROD with BILLS
96 

•S 1129 IS

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

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

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

4 (b) CONFORMING AMENDMENTS.— 

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

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

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

8 (h); and 

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

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

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

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

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

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

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

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

17 is amended by striking ‘‘25th month of’’ and insert18 ing ‘‘month following the first month of’’. 

19 (4) RAILROAD RETIREMENT SYSTEM.—Section 

20 7(d)(2)(ii) of the Railroad Retirement Act of 1974 

21 (45 U.S.C. 231f(d)(2)(ii)) is amended— 

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

23 annuity’’ and inserting ‘‘is entitled to an annu24 ity’’; 


pamtmann on DSKBFK8HB2PROD with BILLS
97 

•S 1129 IS

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

2 months’’; and 

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

4 for 24 calendar months, and’’. 

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

6 this section shall apply to insurance benefits under title 

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

8 services furnished in months beginning after December 1 

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

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

11 enactment. 

12 SEC. 1015. GUARANTEED ISSUE OF MEDIGAP POLICIES. 

13 Section 1882 of the Social Security Act (42 U.S.C. 

14 1395ss) is amended by adding at the end the following 

15 new subsection: 

16 ‘‘(aa) GUARANTEED ISSUE FOR ALL MEDIGAP-ELI17 GIBLE MEDICARE BENEFICIARIES.—Notwithstanding 

18 paragraphs (2)(A) and (2)(D) of subsection (s) or any 

19 other provision of this section, on or after the date of en20 actment of this subsection, the issuer of a medicare sup21 plemental policy may not deny or condition the issuance 

22 or effectiveness of a medicare supplemental policy, or dis23 criminate in the pricing of the policy, because of health 

24 status, claims experience, receipt of health care, or medical 

25 condition in the case of any individual entitled to, or enVerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129

pamtmann on DSKBFK8HB2PROD with BILLS
98 

•S 1129 IS

1 rolled for, benefits under part A and enrolled for benefits 

2 under part B.’’. 

3 Subtitle C—Private Health Insur4 ance Availability During Transi5 tional Period 

6 SEC. 1021. CONTINUITY OF CARE. 

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

8 all individuals enrolled in, or who seek to enroll in, a group 

9 health plan, health insurance coverage offered by a health 

10 insurance issuer, or the plan established under section 

11 1002 during the transition period of this Act are protected 

12 from disruptions in their care during the transition period. 

13 (b) PUBLIC CONSULTATION DURING TRANSITION.— 

14 The Secretary shall consult with communities and advo15 cacy organizations of individuals living with disabilities 

16 and other patient advocacy organizations to ensure the 

17 transition described in this section takes into account the 

18 continuity of care for individuals with disabilities, complex 

19 medical needs, or chronic conditions. 

20 (c) DEFINITIONS.—In this section, the terms ‘‘health 

21 insurance coverage’’, ‘‘health insurance issuer’’, and 

22 ‘‘group health plans’’ have the meanings given such terms 

23 in section 2791 of the Public Health Service Act (42 

24 U.S.C. 300gg–91). 


pamtmann on DSKBFK8HB2PROD with BILLS
99 

•S 1129 IS

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, 2019’’ 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, 2019’’ before the period; and 

17 (3) by adding at the end the following new sub18 paragraph: 

19 ‘‘(C) Beginning with December of 2019, 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 


pamtmann on DSKBFK8HB2PROD with BILLS
100 

•S 1129 IS

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 


pamtmann on DSKBFK8HB2PROD with BILLS