I 
113TH CONGRESS 
1ST SESSION H. R. 3567 
To amend title XVIII of the Social Security Act to provide for additional 
coverage options for beneficiaries under the original Medicare fee-for- 
service program through a Medicare Link program. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 20, 2013 
Mr. SCHRADER (for himself and Mr. RIBBLE) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 XVIII of the Social Security Act to provide 
for additional coverage options for beneficiaries under 
the original Medicare fee-for-service program through a 
Medicare Link program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Link Act 
of 2013’’. 
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SEC. 2. ESTABLISHMENT OF MEDICARE LINK PROGRAM. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act is amended by adding after section 1899A (42 U.S.C. 
1395kkk) the following new section: 
‘‘MEDICARE LINK PROGRAM OPTION 
‘‘SEC. 1899B. (a) IN GENERAL.—The Secretary shall 
establish under this section a program (to be known as 
the ‘Medicare Link Program’ and in this section referred 
to as the ‘Program’) through which individuals who are 
entitled to enroll in a Medicare Advantage plan under part 
C but who are not enrolled in such a plan under such part 
are eligible to enroll with a Medicare Link contractor 
under this section. 
‘‘(b) ENROLLMENT; DISENROLLMENT.—The Sec-
retary shall establish a process for the enrollment (and 
disenrollment) of eligible individuals with Medicare Link 
contractors under the Program which process shall be, to 
the maximum extent practicable, the same as (and coordi-
nated with) the process for enrollment (and disenrollment) 
of individuals in Medicare Advantage plans under part C. 
‘‘(c) QUALIFICATION OF CONTRACTORS; AWARDING 
OF CONTRACTS.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘Medicare Link contractor’ means a nongovern-
mental entity, that may be a Medicare Advantage 
organization, health plan, health insurance issuer, 
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medicare administrative contractor, or other quali-
fied third-party entity, that has entered into a con-
tract with the Secretary with respect to one or more 
Medicare Link regions (as specified by the Secretary 
under paragraph (3)) for the offering of Medicare 
Link services (described in subsection (d)) to indi-
viduals residing in the region who enroll with the 
contractor under the Program. 
‘‘(2) LIMITATION; REQUIREMENTS.—For each 
such Medicare Link region, the Secretary shall select 
(and contract with) at least 1, and not more than 
3, Medicare Link contractors for the offering of 
plans (in this section referred to as ‘Medicare Link 
plans’) under this section. The Secretary shall seek 
to contract with at least 2 Medicare Link contrac-
tors within each Medicare Link region. A contract 
with a Medicare Link contractor may cover a multi- 
year period. 
‘‘(3) SPECIFICATION OF MEDICARE LINK RE-
GIONS.—The Secretary shall define and specify 
Medicare Link regions (each in this section referred 
to as a ‘Medicare Link region’) that, across all such 
regions, encompass all 50 States, the District of Co-
lumbia, and the territories. 
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‘‘(4) QUALIFICATION
OF
CONTRACTORS.—The 
Secretary shall establish uniform qualifications for 
Medicare Link contractors based on their experience 
and qualifications to offer Medicare Link plans 
under this section and to provide additional services 
to individuals enrolled under such plans under this 
section and to provide for reduced expenditures 
under parts A and B. Contracts with Medicare Link 
contractors under this section shall be for periods 
similar to the contracts with MA organizations 
under part C and shall contain such terms and con-
ditions as the Secretary shall specify. 
‘‘(5) CONTRACTING
AUTHORITY.—Nothing in 
this section shall be construed as preventing a Medi-
care Link contractor from contracting with other en-
tities in carrying out activities under this section, in-
cluding the offering of Medicare Link plans under 
this section. 
‘‘(6) BIDDING PROCESS.—In selecting Medicare 
Link contractors, the Secretary shall establish a bid-
ding process similar to the process of bidding by 
medicare administrative contractors under section 
1874A. 
‘‘(7) CONTRACTOR PAYMENTS.—Medicare Link 
contractors with contracts under this section shall be 
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paid, on a monthly basis, a per enrollee monthly 
service fee for the provision of services under the 
contract consistent with the provisions of paragraph 
(8). A portion of such fee (not to exceed 5 percent) 
may be subject to adjustment based on a contrac-
tor’s performance on financial and quality bench-
marks based upon pre-established measures specified 
by the Secretary. 
‘‘(8) REQUIREMENT
FOR
FEDERAL
SAVINGS 
UNDER CONTRACT.— 
‘‘(A) IN GENERAL.—Before entering into 
or renewing a contract with a Medicare Link 
contractor, the Secretary must determine (and 
the Chief Actuary of the Centers for Medicare 
& Medicaid Services must certify) that the 
terms of the contract are expected to yield aver-
age, net savings to the Medicare program under 
this title of not less than 5 percent per program 
enrollee in the Medicare Link region covered 
under the contract. 
‘‘(B) COMPUTATION.—Such savings shall 
be computed taking into account all effects on 
spending under this title, including any reduc-
tions in premiums and cost sharing or other in-
centives for enrollees under subsection (d), pay-
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ments to Medicare Link contractors under the 
contract, and reductions in payments to medi-
care administrative contractors that would oth-
erwise have been made under section 1874A. 
‘‘(C) PAYMENTS BASED ON SHARED SAV-
INGS, ADJUSTED FOR QUALITY.—The contract 
shall be structured in a manner so that— 
‘‘(i) subject to clause (ii), the pay-
ments to the contractor under paragraph 
(7) are computed to represent a proportion 
(as specified in the contract) of the net 
savings in excess of the minimum savings 
required under subparagraph (A); and 
‘‘(ii) such proportion may be increased 
under the contract based on a contractor’s 
performance on quality benchmarks, based 
upon pre-established measures specified by 
the Secretary. 
‘‘(D) GUARANTEED FEDERAL SAVINGS.—If 
the Secretary determines that a Medicare Link 
contractor, after a period of three consecutive 
years, does not maintain an average net savings 
to the Medicare program of at least 5 percent 
per program enrollee as required under sub-
paragraph (A), the Medicare Link contractor 
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shall remit to the Secretary a sum specified by 
the Secretary and related to the amount of the 
shortfall. 
‘‘(9) SAVINGS
VALIDATION
AUDIT.—The Sec-
retary shall provide for the annual auditing of the fi-
nancial records (including data relating to Medicare 
utilization and costs) of organizations offering Medi-
care Link plans under this section 
‘‘(10) GAO AUDIT.—Every 3 years the Comp-
troller General of the United States shall conduct an 
audit of the Medicare Link program costs and pro-
gram savings. Such report shall be submitted to the 
committees of the House of Representatives and of 
the Senate with jurisdiction over Medicare. 
‘‘(d) SERVICES UNDER A MEDICARE LINK PLAN.— 
‘‘(1) IN GENERAL.—Each Medicare Link plan 
offered under this section— 
‘‘(A) shall provide for care management 
services (described in paragraph (2)) and pre-
dictive modeling and risk prioritization (de-
scribed in paragraph (3)) for individuals en-
rolled under the plan consistent with this sub-
section; 
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‘‘(B) shall carry out the functions of medi-
care administrative contractors described in 
paragraph 1874A(a)(4); 
‘‘(C) shall provide a reduction or rebate in 
the premium otherwise applicable under part B 
(as determined without regard to section 
1839(i)) to individuals so enrolled; and 
‘‘(D) may provide for a reduction in cost- 
sharing otherwise applicable to such individuals 
who use providers within a plan network. 
‘‘(2) CARE MANAGEMENT SERVICES.— 
‘‘(A) REQUIRED.—The required care man-
agement services shall include clinical interven-
tions to help coordinate care. 
‘‘(B) OPTIONAL.—Optional care manage-
ment services may include interventions such as 
the following: 
‘‘(i) Prevention and wellness. 
‘‘(ii) Transitional and case manage-
ment and other clinical programs. 
‘‘(iii) Chronic disease management. 
‘‘(iv) Advanced illness care initiatives. 
‘‘(v) Diabetes prevention programs. 
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‘‘(vi) Transitional case management, 
for individuals discharged from a hospital 
or other health care institution. 
‘‘(vii) Nurse practitioner-led interven-
tions (consistent with restrictions under 
applicable State law). 
‘‘(viii) Post-acute transition programs. 
‘‘(ix) High-risk case management. 
‘‘(x) Home-based primary care. 
‘‘(xi) Advanced illness transitional 
care. 
‘‘(xii) Operation of clinical manage-
ment programs. 
‘‘(xiii) Management and development 
of provider networks. 
‘‘(xiv) Consumer engagement with de-
cision support. 
‘‘(3) 
PREDICTIVE
MODELING
AND
RISK 
PRIORITIZATION.—The predictive modeling and risk 
prioritization services described in this paragraph 
shall include the following: 
‘‘(A) PREDICTIVE
MODELING
AND
HIGH 
RISK IDENTIFICATION.—The use of claims data 
and trend data to predict which enrollees could 
benefit from the application of a clinical inter-
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vention or which might be high risk and in need 
of a care plan. 
‘‘(B) 
PRIORITIZATION
OF
INTERVEN-
TIONS.—Programs to identify, prioritize, and 
personalize care opportunities through a com-
prehensive profile of each enrollee. 
‘‘(4) OPTIONAL
INCENTIVES
AND
ENROLLEE 
EMPOWERMENT.— 
‘‘(A) IN GENERAL.—A Medicare Link con-
tractor may use appropriate incentives to man-
age overall care for enrollees. The Secretary 
shall establish terms and conditions under 
which a Medicare Link contractor may elect to 
use optional incentives for its members. 
‘‘(B) TYPES OF INCENTIVES.—The types 
of incentives that may be used include the fol-
lowing: 
‘‘(i) HEALTHY
REWARDS.—Premium 
rebates and other incentives approved by 
the Secretary for enrollees to make 
healthier choices and actively engage in 
their health care. 
‘‘(ii) MEMBER
INCENTIVES
TO
USE 
QUALITY
NETWORK
PROVIDERS.—Reduc-
tions in beneficiary cost-sharing (and other 
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incentives approved by the Secretary) for 
enrollees who use providers (which may be 
accountable care organizations) within a 
plan network in order to reward quality, 
efficient care. 
‘‘(iii) COST ESTIMATOR TOOLS.—Pro-
viding beneficiaries with tools designed to 
help them simplify the evaluation of health 
care costs through cost estimates for dif-
ferent treatment options. 
‘‘(5) APPLICATION OF MA GRIEVANCE AND AP-
PEALS
PROCEDURES.—In accordance with regula-
tions, the provisions of part C insofar as they apply 
to grievances and appeals, shall apply to Medicare 
Link plans and enrollees under this section in a 
manner similar to how such provisions apply to MA 
plans under such part. 
‘‘(e) MAINTENANCE OF CURRENT BENEFITS; CON-
TRACTOR NOT AT FINANCIAL RISK FOR ORIGINAL FEE- 
FOR-SERVICE BENEFITS.— 
‘‘(1) NO CHANGE IN MEDICARE COVERED ITEMS 
AND SERVICES OR LIMITATION ON SUPPLEMENTAL 
PLANS.—Medicare Link plans shall provide for cov-
erage of the same items and services that are cov-
ered under parts A and B. Nothing in this section 
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shall be construed as preventing an individual en-
rolled under a Medicare Link plan from purchasing 
a medicare supplemental policy (described in section 
1881) or other supplemental coverage outside of a 
Medicare Link plan. 
‘‘(2) NO
CHANGE
IN
PAYMENTS
TO
PRO-
VIDERS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), nothing in this section shall be con-
strued as authorizing a payment level to a pro-
vider of services or supplier for Medicare cov-
ered services that is other than the payment 
level otherwise applicable under part A or B for 
such services. 
‘‘(B) 
NEGOTIATION
OF
RATES
PER-
MITTED.—A Medicare Link contractor may ne-
gotiate with providers of services and suppliers 
payment rates that are less or greater than the 
payment rates referred to in subparagraph (A). 
‘‘(3) CONTRACTOR NOT AT FINANCIAL RISK.— 
A Medicare Link contractor shall not be at financial 
risk with respect to the coverage or payment for 
Medicare services covered under parts A and B. But 
the Secretary may provide financial incentives for 
contractors that are able to reduce Medicare expend-
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itures for such services below benchmark levels 
(specified by the Secretary) that reasonably rep-
resent the levels of payments that would be made 
(with respect to individuals enrolled under a Medi-
care Link plan) if such individuals were not so en-
rolled.’’. 
Æ 
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