able, the Secretary shall give priority to 
rating areas in which— 
‘‘(I) not more than 1 health in-
surance issuer offers plans on the ap-
plicable State or Federal American 
Health Benefit Exchange (referred to 
in this title as the ‘Exchange’); or 
‘‘(II) there is a shortage of 
health providers or lack of competition 
that results in a high cost of health 
care services, including health profes-
sional shortage areas and rural areas. 
‘‘(B) SMALL GROUP MARKET.—The Sec-
retary shall make the health plan available in 
the small group market in all rating areas for 
plan year 2025. 
‘‘(b) ESTABLISHMENT OF FUNDS.— 
‘‘(1) PLAN RESERVE FUND.— 
‘‘(A) IN GENERAL.—There is established in 
the Treasury of the United States a ‘Plan Re-
serve Fund’, to be administered by the Sec-
retary of Health and Human Services, for pur-
poses of establishing the Medicare Exchange 
health plan and administering such plan, con-
sisting of amounts appropriated to such fund 
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during the period of fiscal years 2021 through 
2030. 
‘‘(B) APPROPRIATION.—There is appro-
priated $1,000,000,000, out of monies in the 
Treasury not otherwise obligated, to the Plan 
Reserve Fund for fiscal year 2021, to remain 
available until expended. 
‘‘(2) DATA AND TECHNOLOGY FUND.— 
‘‘(A) IN GENERAL.—There is established in 
the Treasury of the United States a ‘Data and 
Technology Fund’, to be administered by the 
Secretary of Health and Human Services, act-
ing through the Chief Actuary of the Centers 
for Medicare & Medicaid Services, for purposes 
of updating technology and performing data 
collection under section 2205 in order to estab-
lish appropriate premiums for all geographic re-
gions of the United States, consisting of 
amounts appropriated to such fund during the 
period of fiscal years 2021 through 2030. 
‘‘(B) APPROPRIATION.—There is appro-
priated $1,000,000,000, out of amounts in the 
Treasury not otherwise appropriated, to the 
Data and Technology Fund for fiscal year 
2021, to remain available until expended. 
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‘‘(c) RULEMAKING.—Not later than 180 days after 
the date of enactment of this Act, the Secretary shall pro-
mulgate such regulations as may be necessary to carry out 
this title. Rules promulgated under this subsection shall 
be finalized not later than 270 days after the date of en-
actment of this Act. 
‘‘SEC. 2202. AVAILABILITY OF PLAN. 
‘‘(a) ELIGIBILITY.—An individual shall be eligible to 
enroll in the health plan if such individual, for the entire 
period for which enrollment is sought— 
‘‘(1) is a qualified individual within the mean-
ing of section 1312 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18032); and 
‘‘(2) is not eligible for benefits under the Medi-
care program under title XVIII. 
‘‘(b) EXCHANGES.—In accordance with the time-
frame under section 2201(a)(2), the health plan shall be 
made available through the American Health Benefit Ex-
changes described in sections 1311 and 1321 of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18031, 18041), including the Small Business Health Op-
tions Program Exchange. 
‘‘SEC. 2203. PLAN REQUIREMENTS. 
‘‘(a) GENERAL REQUIREMENTS.—The health plan 
shall comply with all requirements, as applicable, of sub-
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title D of title I of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18021 et seq.) and title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg et seq.) 
applicable to qualified health plans, and such health plan 
shall be a qualified health plan, including for purposes of 
the Internal Revenue Code of 1986. 
‘‘(b) LEVELS OF COVERAGE.—The Secretary— 
‘‘(1) shall make available a silver level and gold 
level version of the plan, in accordance with section 
1301(a)(1)(C)(ii); and 
‘‘(2) may make available no more than 2 
versions of the plan for each of the 4 levels of cov-
erage described in subparagraphs (A) through (D) of 
section 1302(d)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18022(d)(1)). 
‘‘(c) PRIMARY CARE SERVICES.—The health plan 
shall provide coverage for primary care services, and shall 
not impose any cost-sharing requirements for such serv-
ices. 
‘‘SEC. 2204. ADMINISTRATIVE CONTRACTING. 
‘‘(a) IN GENERAL.—The Secretary may enter into 
contracts for the purpose of performing administrative 
functions (including functions described in subsection 
(a)(4) of section 1874A) with respect to the health plan 
in the same manner as the Secretary may enter into con-
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tracts under subsection (a)(1) of such section. The Sec-
retary shall have the same authority with respect to the 
public health insurance option as the Secretary has under 
such subsection (a)(1) and subsection (b) of section 1874A 
with respect to title XVIII. 
‘‘(b) TRANSFER OF INSURANCE RISK.—Any contract 
under subsection (a) shall not involve the transfer of in-
surance risk from the Secretary to the entity entering into 
such contract with the Secretary, except in the case of an 
alternative payment model under section 2209(h). 
‘‘SEC. 2205. DATA COLLECTION. 
‘‘Subject to all applicable privacy requirements, in-
cluding the requirements under the regulations promul-
gated pursuant to section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 (42 U.S.C. 
1320d–2 note), the Secretary may collect data from State 
insurance commissioners and other relevant entities to es-
tablish rates for premiums and for other purposes includ-
ing to improve quality, and reduce racial, ethnic, socio-
economic, geographic, gender, sexual identity, and other 
health disparities, including such disparities experienced 
by people with disabilities and older adults, with respect 
to the health plan. 
‘‘SEC. 2206. PREMIUMS; RISK POOL. 
‘‘(a) SETTING PREMIUMS.— 
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‘‘(1) IN GENERAL.—The Secretary shall estab-
lish premiums for the health plan that cover the full 
actuarial cost of offering such plan, including the 
administrative costs of offering such plan. Such pre-
miums shall vary geographically and between the 
small group market and the individual market in ac-
cordance with differences in the cost of providing 
such coverage. If, for any plan year, the amount col-
lected in premiums exceeds the amount required for 
health care benefits and administrative costs in that 
plan year, such excess amounts shall remain avail-
able to the Secretary to administer the health plan 
and finance beneficiary costs in subsequent years. 
‘‘(2) INITIAL PLAN YEAR.—For plan year 2022, 
the Secretary shall set premiums for the health plan 
for each rating area in which the health plan is 
available for such plan year, taking into consider-
ation the premium rates for plans offered in each 
such rating area for plan year 2021. 
‘‘(b) RISK POOL.—After plan year 2022, all enrollees 
in the health plan within a State shall be members of a 
single risk pool, except that the Secretary may establish 
separate risk pools for the individual market and small 
group market if the State has not exercised its authority 
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ment rates for any items and services provided under the 
health plan that are not items and services provided under 
the original Medicare fee-for-service program under parts 
A and B of title XVIII. 
‘‘(d) INNOVATIVE PAYMENT METHODS.—The Sec-
retary may utilize innovative payment methods, including 
value-based payment arrangements, in making payments 
for items and services (including prescription drugs) fur-
nished under the health plan. 
‘‘(e) COMPREHENSIVE STUDY ON COVERING ADDI-
TIONAL SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Centers for Medi-
care & Medicaid Services, shall conduct a com-
prehensive study, in consultation with stakeholders, 
and develop recommendations for Congress on the 
need for, and cost of providing coverage for, addi-
tional services under the health plan. 
‘‘(2) CONTENT.—The study shall under para-
graph (1) shall include— 
‘‘(A) consideration of providing coverage 
for long-term services and supports, home and 
community based services, assistive and ena-
bling technologies, and vision, hearing, and den-
tal services; 
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‘‘(B) consideration of providing coverage 
for other services in addition to the services de-
scribed in subparagraph (A) that could most 
benefit the health and financial well-being of 
beneficiaries, including by reducing health dis-
parities, if included for coverage under the plan; 
‘‘(C) the costs associated with covering ad-
ditional services described in subparagraphs (A) 
and (B), for beneficiaries through cost-sharing 
and premiums, and for the Federal Govern-
ment; and 
‘‘(D) an assessment of the implications of 
covering such additional services for the risk 
pool of the health plan and for the individual 
and small group markets. 
‘‘(3) SUBMISSION OF REPORT.—Not later than 
2 years after the date of enactment of this title, the 
Secretary shall submit to Congress a report on the 
findings and recommendations of the study under 
this subsection and shall make such report publicly 
available on the website of the Department of 
Health and Human Services. 
‘‘SEC. 2208. PARTICIPATING PROVIDERS. 
‘‘(a) REQUIREMENT TO PARTICIPATE IN ORDER TO 
BE ENROLLED UNDER MEDICARE.—Subject to sub-
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section (d), beginning January 1, 2022, a health care pro-
vider may not be enrolled under the Medicare program 
under section 1866(j) unless the provider is also a partici-
pating provider under the health plan. 
‘‘(b) REQUIREMENT TO PARTICIPATE IN ORDER TO 
PARTICIPATE IN MEDICAID.—Subject to subsection (d), 
beginning January 1, 2022, a health care provider may 
not be a participating provider under a State Medicaid 
plan under title XIX unless the provider is also a partici-
pating provider under the health plan. 
‘‘(c) ADDITIONAL PROVIDERS.—The Secretary shall 
establish a process to allow health care providers not de-
scribed in subsection (a) or (b) to become a participating 
provider under the health plan. 
‘‘(d) OPT-OUT.—The Secretary shall establish a 
process by which a health care provider described in sub-
section (a) or (b) may opt out of being a participating 
provider under the health plan, under exceptional cir-
cumstances where participation in the health plan threat-
ens the provider’s ability to operate. 
‘‘SEC. 2209. DELIVERY SYSTEM REFORM FOR AN ENHANCED 
HEALTH PLAN. 
‘‘(a) IN GENERAL.—For plan years beginning with 
plan year 2022, the Secretary may utilize innovative pay-
ment mechanisms and policies to determine payments for 
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items and services under the health plan. The payment 
mechanisms and policies under this section may include 
patient-centered medical home and other care manage-
ment payments, accountable care organizations, account-
able communities for health, value-based purchasing, bun-
dling of services, differential payment rates, performance 
or utilization based payments, telehealth, remote patient 
monitoring, partial capitation, and direct contracting with 
providers. 
‘‘(b) REQUIREMENTS FOR INNOVATIVE PAYMENTS.— 
The Secretary shall design and implement the payment 
mechanisms and policies under this section in a manner 
that— 
‘‘(1) seeks to— 
‘‘(A) improve health outcomes; 
‘‘(B) reduce health disparities (including 
racial, ethnic, socioeconomic, geographic, gen-
der, sexual identity, and other disparities, in-
cluding such disparities experienced by people 
with disabilities and older adults); 
‘‘(C) improve coordination to provide more 
efficient and affordable quality care; 
‘‘(D) address geographic variation in the 
provision of health services; or 
‘‘(E) prevent or manage chronic illness; 
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‘‘(2) promotes care that is integrated, patient- 
centered, quality, and efficient; 
‘‘(3) implements patient feedback mechanisms, 
including culturally- and disability-competent mecha-
nisms; and 
‘‘(4) uses person-reported experiences to im-
prove service delivery. 
‘‘(c) ENCOURAGING THE USE OF HIGH VALUE SERV-
ICES.—To the extent allowed by the benefit standards ap-
plied to all health benefits plans participating in the Ex-
changes (as described in section 2202(b)), the health plan 
may modify cost-sharing and payment rates to encourage 
the use of services that promote health and value. 
‘‘(d) PROMOTION OF DELIVERY SYSTEM REFORM.— 
The Secretary shall monitor and evaluate the progress of 
payment and delivery system reforms under this section 
and shall seek to implement such reforms subject to the 
following: 
‘‘(1) To the extent that the Secretary finds a 
payment and delivery system reform successful in 
improving quality and reducing costs, the Secretary 
shall implement such reform on as large a geo-
graphic scale as practical and economical. 
‘‘(2) The Secretary may delay the implementa-
tion of such a reform in geographic areas in which 
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