global budget negotiations for each institutional pro-
vider, the Secretary shall take into account the ap-
propriate prospective payment system from the most 
recent year under title XVIII of the Social Security 
Act to determine what operating base payment the 
institutional provider would have been paid for cov-
ered items and services furnished the preceding year 
with applicable adjustments, excluding value-based 
payment adjustments, based on such prospective 
payment system. 
(d) OPERATING EXPENSES.—For purposes of this 
title, ‘‘operating expenses’’ of a provider include the fol-
lowing: 
(1) The cost of all items and services associated 
with the provision of inpatient care and outpatient 
care, including the following: 
(A) Wages and salary costs for physicians, 
nurses, and other health care practitioners em-
ployed by an institutional provider, including 
mandatory minimum safe registered nurse-to- 
patient staffing ratios and optimal staffing lev-
els for physicians and other healthcare workers. 
(B) Wages and salary costs for all ancil-
lary staff and services. 
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(C) Costs of all pharmaceutical products 
administered by health care clinicians at the in-
stitutional provider’s facilities or through serv-
ices provided in accordance with State licensing 
laws or regulations under which the institu-
tional provider operates. 
(D) Costs for infectious disease response 
preparedness, including maintenance of a 1- 
year or 365-day stockpile of personal protective 
equipment, occupational testing and surveil-
lance, medical services for occupational infec-
tious disease exposure, and contact tracing. 
(E) Purchasing and maintenance of med-
ical devices, supplies, and other health care 
technologies, including diagnostic testing equip-
ment. 
(F) Costs of all incidental services nec-
essary for safe patient care and handling. 
(G) Costs of patient care, education, and 
prevention programs, including occupational 
health and safety programs, public health pro-
grams, and necessary staff to implement such 
programs, for the continued education and 
health and safety of clinicians and other indi-
viduals employed by the institutional provider. 
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(2) Administrative costs for the institutional 
provider. 
SEC. 612. PAYMENT TO INDIVIDUAL PROVIDERS THROUGH 
FEE-FOR-SERVICE. 
(a) IN GENERAL.—In the case of a provider not de-
scribed in section 611(a) (including those in group prac-
tices who are not receiving payment on a salaried basis 
described in section 611(a)(3) and providers of home and 
community-based services), payment for items and serv-
ices furnished under this Act for which payment is not 
otherwise made under section 611 shall be made by the 
Secretary in amounts determined under the fee schedule 
established pursuant to subsection (b). Such payment 
shall be considered to be payment in full for such items 
and services, and a provider receiving such payment may 
not charge the individual receiving such item or service 
in any amount. 
(b) FEE SCHEDULE.— 
(1) ESTABLISHMENT.—Not later than 1 year 
after the date of the enactment of this Act, and in 
consultation with providers and regional office direc-
tors, the Secretary shall establish a national fee 
schedule for items and services payable under this 
Act. The Secretary shall evaluate the effectiveness of 
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the fee-for-service structure and update such fee 
schedule annually. 
(2) 
AMOUNTS.—In 
establishing 
payment 
amounts for items and services under the fee sched-
ule established under paragraph (1), the Secretary 
shall take into account— 
(A) the amounts payable for such items 
and services under title XVIII of the Social Se-
curity Act; and 
(B) the expertise of providers and value of 
items and services furnished by such providers. 
(c) ELECTRONIC BILLING.—The Secretary shall es-
tablish a uniform national system for electronic billing for 
purposes of making payments under this subsection. 
(d) PHYSICIAN PRACTICE REVIEW BOARD.—Each di-
rector of a regional office, in consultation with representa-
tives of physicians practicing in that region, shall establish 
and appoint a physician practice review board to assure 
quality, cost effectiveness, and fair reimbursements for 
physician-delivered items and services. The use of mecha-
nisms that discriminate against people with disabilities is 
prohibited for use in any value or cost-effectiveness assess-
ments. 
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SEC. 613. ENSURING ACCURATE VALUATION OF SERVICES 
UNDER 
THE 
MEDICARE 
PHYSICIAN 
FEE 
SCHEDULE. 
(a) STANDARDIZED
AND
DOCUMENTED
REVIEW 
PROCESS.—Section 1848(c)(2) of the Social Security Act 
(42 U.S.C. 1395w–4(c)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(P) STANDARDIZED
AND
DOCUMENTED 
REVIEW PROCESS.— 
‘‘(i) IN GENERAL.—Not later than one 
year after the date of enactment of this 
subparagraph, the Secretary shall estab-
lish, document, and make publicly avail-
able, in consultation with the Office of Pri-
mary Health Care, a standardized process 
for reviewing the relative values of physi-
cians’ services under this paragraph. 
‘‘(ii) MINIMUM REQUIREMENTS.—The 
standardized process shall include, at a 
minimum, methods and criteria for identi-
fying services for review, prioritizing the 
review of services, reviewing stakeholder 
recommendations, and identifying addi-
tional resources to be considered during 
the review process.’’. 
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(b) PLANNED AND DOCUMENTED USE OF FUNDS.— 
Section 1848(c)(2)(M) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)(M)) is amended by adding at the 
end the following new clause: 
‘‘(x) PLANNED
AND
DOCUMENTED 
USE OF FUNDS.—For each fiscal year (be-
ginning with the first fiscal year beginning 
on or after the date of enactment of this 
clause), the Secretary shall provide to Con-
gress a written plan for using the funds 
provided under clause (ix) to collect and 
use information on physicians’ services in 
the determination of relative values under 
this subparagraph.’’. 
(c) INTERNAL TRACKING OF REVIEWS.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary 
shall submit to Congress a proposed plan for system-
atically and internally tracking the Secretary’s re-
view of the relative values of physicians’ services, 
such as by establishing an internal database, under 
section 1848(c)(2) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)), as amended by this section. 
(2) MINIMUM
REQUIREMENTS.—The proposal 
shall include, at a minimum, plans and a timeline 
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for achieving the ability to systematically and inter-
nally track the following: 
(A) When, how, and by whom services are 
identified for review. 
(B) When services are reviewed or re-
viewed or when new services are added. 
(C) The resources, evidence, data, and rec-
ommendations used in reviews. 
(D) When relative values are adjusted. 
(E) The rationale for final relative value 
decisions. 
(d) FREQUENCY OF REVIEW.—Section 1848(c)(2) of 
the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is 
amended— 
(1) in subparagraph (B)(i), by striking ‘‘5’’ and 
inserting ‘‘4’’; and 
(2) in subparagraph (K)(i)(I), by striking ‘‘peri-
odically’’ and inserting ‘‘annually’’. 
(e) CONSULTATION WITH MEDICARE PAYMENT AD-
VISORY COMMISSION.— 
(1) IN
GENERAL.—Section 1848(c)(2) of the 
Social Security Act (42 U.S.C. 1395w–4(c)(2)) is 
amended— 
(A) in subparagraph (B)(i), by inserting 
‘‘in consultation with the Medicare Payment 
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Advisory Commission,’’ after ‘‘The Secretary,’’; 
and 
(B) in subparagraph (K)(i)(I), as amended 
by subsection (d)(2), by inserting ‘‘, in coordi-
nation with the Medicare Payment Advisory 
Commission,’’ after ‘‘annually’’. 
(2) CONFORMING AMENDMENTS.—Section 1805 
of the Social Security Act (42 U.S.C. 1395b–6) is 
amended— 
(A) in subsection (b)(1)(A), by inserting 
the following before the semicolon at the end: 
‘‘and including coordinating with the Secretary 
in accordance with section 1848(c)(2) to sys-
tematically review the relative values established 
for physicians’ services, identify potentially 
misvalued services, and propose adjustments to 
the relative values for physicians’ services’’; and 
(B) in subsection (e)(1), in the second sen-
tence, by inserting ‘‘or the Ranking Minority 
Member’’ after ‘‘the Chairman’’. 
(f) PERIODIC AUDIT BY THE COMPTROLLER GEN-
ERAL.—Section 1848(c)(2) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)), as amended by subsection (a), is 
amended by adding at the end the following new subpara-
graph: 
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‘‘(Q) PERIODIC
AUDIT
BY
THE
COMP-
TROLLER GENERAL.— 
‘‘(i) IN
GENERAL.—The Comptroller 
General of the United States (in this sub-
section referred to as the ‘Comptroller 
General’) shall periodically audit the review 
by the Secretary of relative values estab-
lished under this paragraph for physicians’ 
services. 
‘‘(ii) ACCESS TO INFORMATION.—The 
Comptroller General shall have unre-
stricted access to all deliberations, records, 
and data related to the activities carried 
out under this paragraph, in a timely man-
ner, upon request.’’. 
SEC. 614. PAYMENT PROHIBITIONS; CAPITAL EXPENDI-
TURES; SPECIAL PROJECTS. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that tens of millions of people in the United States 
do not receive healthcare services while billions of dollars 
that could be spent on providing health care are diverted 
to profit. There is a moral imperative to correct the mas-
sive deficiencies in our current health system and to elimi-
nate profit from the provision of health care. 
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(b) PROHIBITIONS.—Payments to providers under 
this Act may not take into account, include any process 
for the provision of funding for, or be used by a provider 
for— 
(1) marketing of the provider; 
(2) the profit or net revenue of the provider, or 
increasing the profit or net revenue of the provider; 
(3) incentive payments, bonuses, or other com-
pensation based on patient utilization of items and 
services or any financial measure applied with re-
spect to the provider (or any group practice, inte-
grated health care delivery system, or other provider 
with which the provider contracts or has a pecuniary 
interest), including any value-based payment or em-
ployment-based compensation; 
(4) any agreement or arrangement described in 
section 203(a)(4) of the Labor-Management Report-
ing and Disclosure Act of 1959 (29 U.S.C. 
433(a)(4)); or 
(5) political or contributions prohibited under 
section 317 of the Federal Elections Campaign Act 
of 1971 (52 U.S.C. 30119(a)(1)). 
(c) PAYMENTS FOR CAPITAL EXPENDITURES.— 
(1) IN
GENERAL.—The Secretary shall pay, 
from amounts made available for capital expendi-
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tures pursuant to section 601(a)(2)(B), such sums 
determined appropriate by the Secretary to providers 
who have submitted an application to the regional 
director of the region or regions in which the pro-
vider operates or seeks to operate in a time and 
manner specified by the Secretary for purposes of 
funding capital expenditures of such providers. 
(2) PRIORITY.—The Secretary shall prioritize 
allocation of funding under paragraph (1) to 
projects that propose to use such funds to improve 
service in a medically underserved area (as defined 
in section 330(b)(3) of the Public Health Service 
Act (42 U.S.C. 254b(b)(3))) or to address health 
disparities, including racial, ethnic, national origin, 
primary language use, age, disability, sex (including 
gender identity and sexual orientation), geography, 
or socioeconomic health disparities. 
(3) LIMITATION.—The Secretary shall not 
grant funding for capital expenditures under this 
subsection for capital projects that are financed di-
rectly or indirectly through the diversion of private 
or other non-Medicare for All Program funding that 
results in reductions in care to patients, including 
reductions in registered nursing staffing patterns 
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and changes in emergency room or primary care 
services or availability. 
(4) CAPITAL
ASSETS
NOT
FUNDED
BY
THE 
MEDICARE FOR ALL PROGRAM.—Operating expenses 
and funds shall not be used by an institutional pro-
vider receiving payment for capital expenditures 
under this subsection for a capital asset that was 
not funded by the Medicare for All program without 
the approval of the regional director or directors of 
the region or regions where the capital asset is lo-
cated. 
(d) PROHIBITION AGAINST CO-MINGLING OPER-
ATING AND CAPITAL FUNDS.—Providers that receive pay-
ment under this title shall be prohibited from using, with 
respect to funds made available under this Act— 
(1) funds designated for operating expenditures 
for capital expenditures or for profit; or 
(2) funds designated for capital expenditures 
for operating expenditures. 
(e) PAYMENTS FOR SPECIAL PROJECTS.— 
(1) IN GENERAL.—The Secretary shall allocate 
to each regional director, from amounts made avail-
able for special projects pursuant to section 
601(a)(2)(C), such sums determined appropriate by 
the Secretary for purposes of funding projects de-
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scribed in such section, including the construction, 
renovation, or staffing of health care facilities, in 
rural, underserved, or health professional or medical 
shortage areas within such region and to address 
health disparities, including racial, ethnic, national 
origin, primary language use, age, disability, sex, in-
cluding gender identity and sexual orientation, geog-
raphy, or socioeconomic health disparities. Each re-
gional director shall, prior to distributing such funds 
in accordance with paragraph (2), present a budget 
describing how such funds will be distributed to the 
Secretary. 
(2) DISTRIBUTION.—A regional director shall 
distribute funds to providers operating in the region 
of such director’s jurisdiction in a manner deter-
mined appropriate by the director. 
(f) 
PROHIBITION
ON
FINANCIAL
INCENTIVE 
METRICS
IN
PAYMENT
DETERMINATIONS.—The Sec-
retary may not utilize any quality metrics or standards 
for the purposes of establishing provider payment meth-
odologies, programs, modifiers, or adjustments for pro-
vider payments under this title. 
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SEC. 615. OFFICE OF HEALTH EQUITY. 
Title XVII of the Public Health Service Act (42 
U.S.C. 300u et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 1712. OFFICE OF HEALTH EQUITY. 
‘‘(a) IN GENERAL.—There is established, in the Of-
fice of the Secretary of Health and Human Services, an 
Office of Health Equity, to be headed by a Director, to 
ensure coordination and collaboration across the programs 
and activities of the Department of Health and Human 
Services with respect to ensuring health equity. 
‘‘(b) MONITORING, TRACKING, AND AVAILABILITY OF 
DATA.— 
‘‘(1) IN GENERAL.—In carrying out subsection 
(a), the Director of the Office of Health Equity shall 
monitor, track, and make publicly available data 
on— 
‘‘(A) the disproportionate burden of dis-
ease and death among people of color, 
disaggregated by race, major ethnic group, 
Tribal affiliation, national origin, primary lan-
guage use, English proficiency status, immigra-
tion status, length of stay in the United States 
age, disability, sex (including gender identity 
and sexual orientation), incarceration, home-
lessness, geography, and socioeconomic status; 
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‘‘(B) barriers to health, including such 
barriers relating to income, education, housing, 
food insecurity (including availability, access, 
utilization, and stability), employment status, 
working conditions, and conditions related to 
the physical environment (including pollutants 
and population density); 
‘‘(C) barriers to health care access, includ-
ing— 
‘‘(i) lack of trust and awareness; 
‘‘(ii) lack of transportation; 
‘‘(iii) geography; 
‘‘(iv) hospital and service closures; 
‘‘(v) lack of health care infrastructure 
and facilities; and 
‘‘(vi) lack of health care professional 
staffing and recruitment; 
‘‘(D) disparities in quality of care received, 
including discrimination in health care settings 
and the use of racially-biased practice guide-
lines and algorithms; and 
‘‘(E) disparities in utilization of care. 
‘‘(2) ANALYSIS OF CROSS-SECTIONAL INFORMA-
TION.—The Director of the Office of Health Equity 
shall ensure that the data collection and reporting 
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process under paragraph (1) allows for the analysis 
of cross-sectional information on people’s identities. 
‘‘(c) POLICIES.—In carrying out subsection (a), the 
Director of the Office of Health Equity shall develop, co-
ordinate, and promote policies that enhance health equity, 
including by— 
‘‘(1) providing recommendations on— 
‘‘(A) cultural competence, implicit bias, 
and ethics training with respect to health care 
workers; 
‘‘(B) increasing diversity in the health care 
workforce; and 
‘‘(C) ensuring sufficient health care profes-
sionals and facilities; and 
‘‘(2) ensuring adequate public health funding at 
the local and State levels to address health dispari-
ties. 
‘‘(d) CONSULTATION.—In carrying out subsection 
(a), the Director of the Office of Health Equity, in coordi-
nation with the Director of the Indian Health Service, 
shall consult with Indian Tribes and with Urban Indian 
organizations on data collection, reporting, and implemen-
tation of policies. 
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123 
(4) in the first sentence, by striking ‘‘for each 
month beginning with the later of (I) July 1973 or 
(II) the twenty-fifth month of his entitlement or sta-
tus as a qualified railroad retirement beneficiary de-
scribed in paragraph (2), and’’ and inserting ‘‘for 
each month for which the individual meets the re-
quirements of paragraph (2), beginning with the 
month following the month in which the individual 
meets the requirements of such paragraph, and’’; 
and 
(5) in the second sentence, by striking ‘‘the 
‘twenty-fifth month of his entitlement’ ’’ and all that 
follows through ‘‘paragraph (2)(C) and’’. 
(b) CONFORMING AMENDMENTS.— 
(1) SECTION 226.—Section 226 of the Social 
Security Act (42 U.S.C. 426) is amended by— 
(A) striking subsections (e)(1)(B), (f), and 
(h); and 
(B) redesignating subsections (g) and (i) 
as subsections (f) and (g), respectively. 
(2) MEDICARE DESCRIPTION.—Section 1811(2) 
of the Social Security Act (42 U.S.C. 1395c(2)) is 
amended by striking ‘‘have been entitled for not less 
than 24 months’’ and inserting ‘‘are entitled’’. 
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