(b) PORTABILITY.—Such benefits are available 
through any licensed health care clinician anywhere in the 
United States that is legally qualified to provide the bene-
fits. 
(c) NO
COST-SHARING.—No deductibles, copay-
ments, coinsurance, or other cost-sharing shall be imposed 
with respect to covered benefits. 
SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS. 
(a) REQUIREMENT TO BE PUBLIC OR NON-PROF-
IT.— 
(1) IN GENERAL.—No institution may be a par-
ticipating provider unless it is a public or not-for- 
profit institution. Private physicians, private clinics, 
and private health care providers shall continue to 
operate as private entities, but are prohibited from 
being investor owned. 
(2) CONVERSION
OF
INVESTOR-OWNED
PRO-
VIDERS.—For-profit providers of care opting to par-
ticipate shall be required to convert to not-for-profit 
status. 
(3) PRIVATE
DELIVERY
OF
CARE
REQUIRE-
MENT.—For-profit providers of care that convert to 
non-profit status shall remain privately owned and 
operated entities. 
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(4) COMPENSATION
FOR
CONVERSION.—The 
owners of such for-profit providers shall be com-
pensated for reasonable financial losses incurred as 
a result of the conversion from for-profit to non- 
profit status. 
(5) FUNDING.—There are authorized to be ap-
propriated from the Treasury such sums as are nec-
essary to compensate investor-owned providers as 
provided for under paragraph (3). 
(6) REQUIREMENTS.—The payments to owners 
of converting for-profit providers shall occur during 
a 15-year period, through the sale of U.S. Treasury 
Bonds. Payment for conversions under paragraph 
(3) shall not be made for loss of business profits. 
(7) MECHANISM FOR CONVERSION PROCESS.— 
The Secretary shall promulgate a rule to provide a 
mechanism to further the timely, efficient, and fea-
sible conversion of for-profit providers of care. 
(b) QUALITY STANDARDS.— 
(1) IN GENERAL.—Health care delivery facili-
ties must meet State quality and licensing guidelines 
as a condition of participation under such program, 
including guidelines regarding safe staffing and 
quality of care. 
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(2) LICENSURE REQUIREMENTS.—Participating 
clinicians must be licensed in their State of practice 
and meet the quality standards for their area of 
care. No clinician whose license is under suspension 
or who is under disciplinary action in any State may 
be a participating provider. 
(c) PARTICIPATION OF HEALTH MAINTENANCE OR-
GANIZATIONS.— 
(1) IN
GENERAL.—Non-profit health mainte-
nance organizations that deliver care in their own 
facilities and employ clinicians on a salaried basis 
may participate in the program and receive global 
budgets or capitation payments as specified in sec-
tion 202. 
(2) EXCLUSION OF CERTAIN HEALTH MAINTE-
NANCE ORGANIZATIONS.—Other health maintenance 
organizations which principally contract to pay for 
services delivered by non-employees shall be classi-
fied as insurance plans. Such organizations shall not 
be participating providers, and are subject to the 
regulations promulgated by reason of section 104(a) 
(relating to prohibition against duplicating cov-
erage). 
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(d) FREEDOM OF CHOICE.—Patients shall have free 
choice of participating physicians and other clinicians, 
hospitals, and inpatient care facilities. 
SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE. 
(a) IN GENERAL.—It is unlawful for a private health 
insurer to sell health insurance coverage that duplicates 
the benefits provided under this Act. 
(b) CONSTRUCTION.—Nothing in this Act shall be 
construed as prohibiting the sale of health insurance cov-
erage for any additional benefits not covered by this Act, 
such as for cosmetic surgery or other services and items 
that are not medically necessary. 
TITLE II—FINANCES 
Subtitle A—Budgeting and 
Payments 
SEC. 201. BUDGETING PROCESS. 
(a) ESTABLISHMENT OF OPERATING BUDGET AND 
CAPITAL EXPENDITURES BUDGET.— 
(1) IN GENERAL.—To carry out this Act there 
are established on an annual basis consistent with 
this title— 
(A) 
an 
operating 
budget, 
including 
amounts for optimal physician, nurse, and other 
health care professional staffing; 
(B) a capital expenditures budget; 
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(C) reimbursement levels for providers con-
sistent with subtitle B; and 
(D) a health professional education budget, 
including amounts for the continued funding of 
resident physician training programs. 
(2) REGIONAL
ALLOCATION.—After Congress 
appropriates amounts for the annual budget for the 
Medicare For All Program, the Director shall pro-
vide the regional offices with an annual funding al-
lotment to cover the costs of each region’s expendi-
tures. Such allotment shall cover global budgets, re-
imbursements to clinicians, health professional edu-
cation, and capital expenditures. Regional offices 
may receive additional funds from the national pro-
gram at the discretion of the Director. 
(b) OPERATING BUDGET.—The operating budget 
shall be used for— 
(1) payment for services rendered by physicians 
and other clinicians; 
(2) global budgets for institutional providers; 
(3) capitation payments for capitated groups; 
and 
(4) administration of the Program. 
(c) CAPITAL EXPENDITURES BUDGET.—The capital 
expenditures budget shall be used for funds needed for— 
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(1) the construction or renovation of health fa-
cilities; and 
(2) for major equipment purchases. 
(d) PROHIBITION AGAINST CO-MINGLING OPER-
ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro-
hibited to use funds under this Act that are earmarked— 
(1) for operations for capital expenditures; or 
(2) for capital expenditures for operations. 
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI-
NICIANS. 
(a) ESTABLISHING GLOBAL BUDGETS; MONTHLY 
LUMP SUM.— 
(1) IN GENERAL.—The Medicare For All Pro-
gram, through its regional offices, shall pay each in-
stitutional provider of care, including hospitals, 
nursing homes, community or migrant health cen-
ters, home care agencies, or other institutional pro-
viders or pre-paid group practices, a monthly lump 
sum to cover all operating expenses under a global 
budget. 
(2) ESTABLISHMENT OF GLOBAL BUDGETS.— 
The global budget of a provider shall be set through 
negotiations between providers, State directors, and 
regional directors, but are subject to the approval of 
the Director. The budget shall be negotiated annu-
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ally, based on past expenditures, projected changes 
in levels of services, wages and input, costs, a pro-
vider’s maximum capacity to provide care, and pro-
posed new and innovative programs. 
(b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND 
CERTAIN OTHER HEALTH PROFESSIONALS.— 
(1) IN GENERAL.—The Program shall pay phy-
sicians, dentists, doctors of osteopathy, pharmacists, 
psychologists, chiropractors, doctors of optometry, 
nurse practitioners, nurse midwives, physicians’ as-
sistants, and other advanced practice clinicians as li-
censed and regulated by the States by the following 
payment methods: 
(A) Fee for service payment under para-
graph (2). 
(B) Salaried positions in institutions re-
ceiving global budgets under paragraph (3). 
(C) Salaried positions within group prac-
tices or non-profit health maintenance organiza-
tions receiving capitation payments under para-
graph (4). 
(2) FEE FOR SERVICE.— 
(A) IN GENERAL.—The Program shall ne-
gotiate a simplified fee schedule that is fair and 
optimal with representatives of physicians and 
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other clinicians, after close consultation with 
the National Board of Universal Quality and 
Access and regional and State directors. Ini-
tially, the current prevailing fees or reimburse-
ment would be the basis for the fee negotiation 
for all professional services covered under this 
Act. 
(B) 
CONSIDERATIONS.—In 
establishing 
such schedule, the Director shall take into con-
sideration the following: 
(i) The need for a uniform national 
standard. 
(ii) The goal of ensuring that physi-
cians, clinicians, pharmacists, and other 
medical professionals be compensated at a 
rate which reflects their expertise and the 
value of their services, regardless of geo-
graphic region and past fee schedules. 
(C) STATE PHYSICIAN PRACTICE REVIEW 
BOARDS.—The State director for each State, in 
consultation with representatives of the physi-
cian community of that State, shall establish 
and appoint a physician practice review board 
to assure quality, cost effectiveness, and fair re-
imbursements for physician delivered services. 
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(D) FINAL
GUIDELINES.—The Director 
shall be responsible for promulgating final 
guidelines to all providers. 
(E) BILLING.—Under this Act physicians 
shall submit bills to the regional director on a 
simple form, or via computer. Interest shall be 
paid to providers who are not reimbursed within 
30 days of submission. 
(F) 
NO
BALANCE
BILLING.—Licensed 
health care clinicians who accept any payment 
from the Medicare For All Program may not 
bill any patient for any covered service. 
(G) UNIFORM
COMPUTER
ELECTRONIC 
BILLING SYSTEM.—The Director shall create a 
uniform computerized electronic billing system, 
including those areas of the United States 
where electronic billing is not yet established. 
(3) SALARIES WITHIN INSTITUTIONS RECEIVING 
GLOBAL BUDGETS.— 
(A) IN GENERAL.—In the case of an insti-
tution, such as a hospital, health center, group 
practice, community and migrant health center, 
or a home care agency that elects to be paid a 
monthly global budget for the delivery of health 
care as well as for education and prevention 
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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 
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TITLE IV—ADDITIONAL 
PROVISIONS 
SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS. 
(a) VA HEALTH PROGRAMS.—This Act provides for 
health programs of the Department of Veterans’ Affairs 
to initially remain independent for the 10-year period that 
begins on the date of the establishment of the Medicare 
For All Program. After such 10-year period, the Congress 
shall reevaluate whether such programs shall remain inde-
pendent or be integrated into the Medicare For All Pro-
gram. 
(b) INDIAN HEALTH SERVICE PROGRAMS.—This Act 
provides for health programs of the Indian Health Service 
to initially remain independent for the 5-year period that 
begins on the date of the establishment of the Medicare 
For All Program, after which such programs shall be inte-
grated into the Medicare For All Program. 
SEC. 402. PUBLIC HEALTH AND PREVENTION. 
It is the intent of this Act that the Program at all 
times stress the importance of good public health through 
the prevention of diseases. 
SEC. 403. REDUCTION IN HEALTH DISPARITIES. 
It is the intent of this Act to reduce health disparities 
by race, ethnicity, income and geographic region, and to 
provide high quality, cost-effective, culturally appropriate 
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