programs, physicians and other clinicians em-
ployed by such institutions shall be reimbursed 
through a salary included as part of such a 
budget. 
(B) SALARY RANGES.—Salary ranges for 
health care providers shall be determined in the 
same way as fee schedules under paragraph (2). 
(4) SALARIES WITHIN CAPITATED GROUPS.— 
(A) IN GENERAL.—Health maintenance or-
ganizations, group practices, and other institu-
tions may elect to be paid capitation payments 
to cover all outpatient, physician, and medical 
home care provided to individuals enrolled to 
receive benefits through the organization or en-
tity. 
(B) SCOPE.—Such capitation may include 
the costs of services of licensed physicians and 
other licensed, independent practitioners pro-
vided to inpatients. Other costs of inpatient and 
institutional care shall be excluded from capita-
tion payments, and shall be covered under insti-
tutions’ global budgets. 
(C) PROHIBITION OF SELECTIVE ENROLL-
MENT.—Patients shall be permitted to enroll or 
disenroll from such organizations or entities 
VerDate Mar 15 2010 
22:33 Feb 21, 2013
Jkt 029200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
TKELLEY on DSK3SPTVN1PROD with BILLS
without discrimination and with appropriate no-
tice. 
(D) HEALTH
MAINTENANCE
ORGANIZA-
TIONS.—Under this Act— 
(i) health maintenance organizations 
shall be required to reimburse physicians 
based on a salary; and 
(ii) financial incentives between such 
organizations and physicians based on uti-
lization are prohibited. 
SEC. 203. PAYMENT FOR LONG-TERM CARE. 
(a) ALLOTMENT FOR REGIONS.—The Program shall 
provide for each region a single budgetary allotment to 
cover a full array of long-term care services under this 
Act. 
(b) REGIONAL BUDGETS.—Each region shall provide 
a global budget to local long-term care providers for the 
full range of needed services, including in-home, nursing 
home, and community based care. 
(c) BASIS FOR BUDGETS.—Budgets for long-term 
care services under this section shall be based on past ex-
penditures, financial and clinical performance, utilization, 
and projected changes in service, wages, and other related 
factors. 
VerDate Mar 15 2010 
22:33 Feb 21, 2013
Jkt 029200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
TKELLEY on DSK3SPTVN1PROD with BILLS
(d) FAVORING NON-INSTITUTIONAL CARE.—All ef-
forts shall be made under this Act to provide long-term 
care in a home- or community-based setting, as opposed 
to institutional care. 
SEC. 204. MENTAL HEALTH SERVICES. 
(a) IN GENERAL.—The Program shall provide cov-
erage for all medically necessary mental health care on 
the same basis as the coverage for other conditions. Li-
censed mental health clinicians shall be paid in the same 
manner as specified for other health professionals, as pro-
vided for in section 202(b). 
(b) FAVORING
COMMUNITY-BASED
CARE.—The 
Medicare For All Program shall cover supportive resi-
dences, occupational therapy, and ongoing mental health 
and counseling services outside the hospital for patients 
with serious mental illness. In all cases the highest quality 
and most effective care shall be delivered, and, for some 
individuals, this may mean institutional care. 
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, 
MEDICAL SUPPLIES, AND MEDICALLY NEC-
ESSARY ASSISTIVE EQUIPMENT. 
(a) NEGOTIATED PRICES.—The prices to be paid 
each year under this Act for covered pharmaceuticals, 
medical supplies, and medically necessary assistive equip-
ment shall be negotiated annually by the Program. 
VerDate Mar 15 2010 
04:57 Feb 22, 2013
Jkt 029200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
TKELLEY on DSK3SPTVN1PROD with BILLS
(b) PRESCRIPTION DRUG FORMULARY.— 
(1) IN GENERAL.—The Program shall establish 
a prescription drug formulary system, which shall 
encourage best-practices in prescribing and discour-
age the use of ineffective, dangerous, or excessively 
costly medications when better alternatives are avail-
able. 
(2) PROMOTION OF USE OF GENERICS.—The 
formulary shall promote the use of generic medica-
tions but allow the use of brand-name and off-for-
mulary medications. 
(3) FORMULARY
UPDATES
AND
PETITION 
RIGHTS.—The formulary shall be updated frequently 
and clinicians and patients may petition their region 
or the Director to add new pharmaceuticals or to re-
move ineffective or dangerous medications from the 
formulary. 
SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE-
MENT LEVELS. 
Reimbursement levels under this subtitle shall be set 
after close consultation with regional and State Directors 
and after the annual meeting of National Board of Uni-
versal Quality and Access. 
VerDate Mar 15 2010 
22:33 Feb 21, 2013
Jkt 029200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
TKELLEY on DSK3SPTVN1PROD with BILLS
Subtitle B—Funding 
SEC. 211. OVERVIEW: FUNDING THE MEDICARE FOR ALL 
PROGRAM. 
(a) IN GENERAL.—The Medicare For All Program 
is to be funded as provided in subsection (c)(1). 
(b) MEDICARE FOR ALL TRUST FUND.—There shall 
be established a Medicare For All Trust Fund in which 
funds provided under this section are deposited and from 
which expenditures under this Act are made. 
(c) FUNDING.— 
(1) IN GENERAL.—There are appropriated to 
the Medicare For All Trust Fund amounts sufficient 
to carry out this Act from the following sources: 
(A) Existing sources of Federal Govern-
ment revenues for health care. 
(B) Increasing personal income taxes on 
the top 5 percent income earners. 
(C) Instituting a modest and progressive 
excise tax on payroll and self-employment in-
come. 
(D) Instituting a modest tax on unearned 
income. 
(E) Instituting a small tax on stock and 
bond transactions. 
VerDate Mar 15 2010 
22:33 Feb 21, 2013
Jkt 029200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
TKELLEY on DSK3SPTVN1PROD with BILLS