I 
113TH CONGRESS 
2D SESSION 
H. R. 5113 
To amend title XIX of the Social Security Act to end the increased Federal 
funding for Medicaid expansion with respect to inmates’ hospital care 
under the Patient Protection and Affordable Care Act, to apply the 
savings towards a 2015 Medicare Advantage stabilization program to 
help protect seniors’ choices, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 15, 2014 
Mr. COFFMAN (for himself, Mrs. BLACKBURN, Mr. NUGENT, Mr. LAMBORN, 
and Mr. HALL) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend title XIX of the Social Security Act to end the 
increased Federal funding for Medicaid expansion with 
respect to inmates’ hospital care under the Patient Pro-
tection and Affordable Care Act, to apply the savings 
towards a 2015 Medicare Advantage stabilization pro-
gram to help protect seniors’ choices, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Mar 15 2010 
21:11 Jul 18, 2014
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5113.IH
H5113
ebenthall on DSK3TPTVN1PROD with BILLS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting Seniors’ 
Medicare Choices from Obamacare Act of 2014’’. 
SEC. 2. ELIMINATING PPACA ENHANCED MEDICAID FMAP 
FOR PRISONERS AND APPLYING SAVINGS TO 
MEDICARE 
ADVANTAGE 
IMPROVEMENT 
FUND. 
(a) ELIMINATION OF PPACA ENHANCED MEDICAID 
FMAP FOR PRISONERS.— 
(1) IN GENERAL.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (y)(2)(A), by adding at 
the end the following: ‘‘Such term does not in-
clude an individual described in such subpara-
graph during the period in which the individual 
is an inmate in a public institution or in which 
the public institution maintains jurisdiction 
over the individual.’’; and 
(B) in subsection (z)(1)(A), by inserting 
before the period at the end the following: ‘‘and 
who are not inmates of a public institution (or 
individuals over whom a public institution main-
tains jurisdiction)’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to items and services 
furnished on or after January 1, 2015. 
VerDate Mar 15 2010 
21:11 Jul 18, 2014
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5113.IH
H5113
ebenthall on DSK3TPTVN1PROD with BILLS
(b) APPLICATION OF SAVINGS TO 2015 TO ESTAB-
LISHMENT OF 2015 MEDICARE ADVANTAGE STABILIZA-
TION PROGRAM.—Section 1859 of the Social Security Act 
(42 U.S.C. 1395w–28) is amended by adding at the end 
the following new subsection: 
‘‘(h) 2015 MEDICARE ADVANTAGE STABILIZATION 
PROGRAM.— 
‘‘(1) ESTABLISHMENT.—There is established a 
Medicare Advantage stabilization program (in this 
subsection referred to as the ‘stabilization program’) 
under which the Secretary shall, subject to para-
graph (6), provide a PMPM stabilization funding 
amount to each eligible Medicare Advantage plan in 
accordance with this subsection to be used by such 
plan for plan year 2015 to address the beneficiary 
plan inadequacies applicable to such plan (as de-
scribed in paragraph (5)). 
‘‘(2) 
ELIGIBLE
MEDICARE
ADVANTAGE 
PLANS.—For purposes of this subsection, an eligible 
Medicare Advantage plan is a Medicare Advantage 
plan to be offered for plan year 2015 that the Sec-
retary determines, based on the bid of such plan 
submitted under section 1854 for such plan year, 
satisfies at least one of the following criteria: 
VerDate Mar 15 2010 
21:11 Jul 18, 2014
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5113.IH
H5113
ebenthall on DSK3TPTVN1PROD with BILLS
‘‘(A) INCREASED
BENEFICIARY
COSTS.— 
The total costs (including premiums, cost-shar-
ing responsibilities, and deductibles) projected 
to be applicable to individuals who enroll in 
such plan for such plan year are at least 7 per-
cent more than the such total costs that were 
applicable to individuals enrolled in such plan 
for plan year 2014. 
‘‘(B) DECREASED SUPPLEMENTAL BENE-
FITS.—The supplemental benefits to be offered 
under such plan for such plan year 2015 are 
less than the supplemental benefits offered 
under such plan for plan year 2014. 
‘‘(C) DECREASED PROVIDER NETWORK.— 
The number of physicians in the plan’s network 
has been reduced by 3 percent or more from 
plan year 2014 to plan year 2015. 
‘‘(3) DISTRIBUTION
OF
PMPM
STABILIZATION 
FUNDING AMOUNTS.— 
‘‘(A) IN GENERAL.—Subject to the avail-
ability of funds under paragraph (6), under the 
stabilization program, the Secretary shall dis-
tribute, not later than December 31, 2014, to 
each eligible Medicare Advantage plan a PMPM 
stabilization funding amount, as determined by 
VerDate Mar 15 2010 
21:11 Jul 18, 2014
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5113.IH
H5113
ebenthall on DSK3TPTVN1PROD with BILLS
the Secretary in accordance with subparagraph 
(B). 
‘‘(B) PMPM 
STABILIZATION
FUNDING 
AMOUNT.—A 
PMPM 
stabilization 
funding 
amount, with respect to an eligible Medicare 
Advantage plan, shall be determined in accord-
ance with the following: 
‘‘(i) Such amount shall be an amount, 
with respect to each month of plan year 
2015, for each individual projected to be 
enrolled in such plan for such plan year. 
‘‘(ii) Subject to paragraph (6) and 
clause (iii), such amount shall be an 
amount determined by the Secretary to be 
sufficient for such plan to address for plan 
year 2015 each beneficiary plan inad-
equacy specified in paragraph (4) applica-
ble to such plan. 
‘‘(iii) Such amount shall not be more 
than $85 per member per month. 
‘‘(4) TIMING OF DETERMINATIONS.—Under the 
stabilization program, the Secretary shall determine 
which Medicare Advantage plans are eligible Medi-
care Advantage plans under paragraph (2), and the 
PMPM stabilization funding amount to be distrib-
VerDate Mar 15 2010 
21:11 Jul 18, 2014
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5113.IH
H5113
ebenthall on DSK3TPTVN1PROD with BILLS
uted to each such eligible Medicare Advantage plan 
under paragraph (3), by not later than October 15, 
2014. 
‘‘(5) APPLICABLE
BENEFICIARY
PLAN
INAD-
EQUACIES.—For purposes of this subsection, a bene-
ficiary plan inadequacy applicable to an eligible 
Medicare Advantage plan is each of the criteria de-
scribed in paragraph (2) that the Secretary deter-
mined the plan satisfied for qualifying as such an el-
igible Medicare Advantage plan. 
‘‘(6) FUNDING.— 
‘‘(A) IN GENERAL.—There shall be avail-
able to the Secretary from amounts in the gen-
eral fund in the Treasury not otherwise appro-
priated 
an 
amount, 
not 
to 
exceed 
$3,000,000,000, to carry out this subsection. 
Such amounts shall remain so available until 
December 31, 2015. Any amounts made so 
available but not expended on or before such 
date shall be transferred to the general fund in 
the Treasury. 
‘‘(B) CLARIFICATION.—Payments under 
the stabilization program shall not be taken 
VerDate Mar 15 2010 
21:11 Jul 18, 2014
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5113.IH
H5113
ebenthall on DSK3TPTVN1PROD with BILLS
into account for purposes of determining the 
premium payments applicable under part B.’’. 
Æ 
VerDate Mar 15 2010 
21:11 Jul 18, 2014
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6301
E:\BILLS\H5113.IH
H5113
ebenthall on DSK3TPTVN1PROD with BILLS