Title: Medicare for America Act of 2018
Policy area: Health

Summary:
Medicare for America Act of 2018
This bill establishes a national health insurance program to be administered by the Department of Health and Human Services. Among other requirements, the program must (1) cover all U.S. residents; (2) cover specified items and services, including hospital services, prescription drugs, and dental services; and (3) be fully implemented in 2022.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7339 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 7339

 To amend the Social Security Act to establish a Medicare for America 
  health program to provide for comprehensive health coverage for all 
                               Americans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 19, 2018

 Ms. DeLauro (for herself and Ms. Schakowsky) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
 addition to the Committees on Energy and Commerce, Education and the 
  Workforce, Natural Resources, and the Judiciary, 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 the Social Security Act to establish a Medicare for America 
  health program to provide for comprehensive health coverage for all 
                               Americans.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare for 
America Act of 2018''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
    TITLE I--TRANSITIONING TO AND ESTABLISHING MEDICARE FOR AMERICA

             Subtitle A--Transitional Public Health Option

Sec. 101. Establishment.
Sec. 102. Eligibility.
Sec. 103. Benefits.
Sec. 104. Premiums.
Sec. 105. Providers and reimbursement rates.
Sec. 106. Account; funding.
                    Subtitle B--Medicare for America

Sec. 111. Establishment and administration of Medicare for America.
Sec. 112. Modifications to and coordination with existing Federal 
                            health programs.
                      Subtitle C--Targeted Reforms

Sec. 121. Limitation on removal of Medicare Advantage providers by MA 
                            organizations.
Sec. 122. Network adequacy.
Sec. 123. Eliminating the 24-month waiting period for Medicare coverage 
                            for individuals with disabilities.
Sec. 124. Employer health plan options.
Sec. 125. Prohibition on step therapy and prior authorization under 
                            group health plans.
Sec. 126. Medicare outpatient observation services.
Sec. 127. Abortion coverage.
                        TITLE II--TAX PROVISIONS

Sec. 201. Sunset of Public Law 115-97.
Sec. 202. Surtax.
Sec. 203. Basis of property acquired from a decedent.
Sec. 204. Medicare payroll tax.
Sec. 205. Net investment income tax.
Sec. 206. Termination of health savings accounts.
Sec. 207. Termination of flexible spending arrangements.
Sec. 208. Increase in excise tax on small cigars and cigarettes and 
                            other tobacco products.
Sec. 209. Excise tax on alcohol.
Sec. 210. Tax on sugared drinks.
                   TITLE III--DRUG-RELATED PROVISIONS

Sec. 301. Establishment of the prescription drug and medical device 
                            review board.
Sec. 302. Membership; staff.
Sec. 303. Reporting requirements.
Sec. 304. Prohibition against excessive price.
Sec. 305. Enforcement provisions.
Sec. 306. Authority.
Sec. 307. Regulations.
Sec. 308. Report to Federal agencies.
Sec. 309. Definitions.
Sec. 310. Moratorium on direct-to-consumer drug advertising.
Sec. 311. Reporting on justification for drug price increases.

    TITLE I--TRANSITIONING TO AND ESTABLISHING MEDICARE FOR AMERICA

             Subtitle A--Transitional Public Health Option

SEC. 101. ESTABLISHMENT.

    The Secretary of Health and Human Services (in this subtitle 
referred to as the ``Secretary'') shall establish a public health plan 
option that is offered in the individual market through the Federal and 
State Exchanges under title I of the Patient Protection and Affordable 
Care Act to eligible individuals for plan years 2020 and 2021 in 
accordance with this subtitle.

SEC. 102. ELIGIBILITY.

    (a) In General.--Subject to subsection (b), an individual is 
eligible to enroll in such public health plan option if the individual 
is otherwise eligible to purchase individual health insurance coverage 
through an Exchange and the individual resides in a rating area in 
which the Secretary makes the public health plan option available.
    (b) Priority.--In determining in which rating areas the Secretary 
initially will make the public health plan option available, the 
Secretary shall give priority to rating areas in which--
            (1) not more than 1 health insurance issuer offers plans on 
        the applicable State or Federal American Health Benefit 
        Exchange; or
            (2) there is a shortage of health providers or lack of 
        competition that results in a high cost of health care 
        services, including health professional shortage areas and 
        rural areas.

SEC. 103. BENEFITS.

    (a) In General.--The public health plan option shall be a qualified 
health plan within the meaning of section 1301(a) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18021(a)) that--
            (1) meets all requirements applicable to qualified health 
        plans under subtitle D of title I of the Patient Protection and 
        Affordable Care Act (other than the requirement under section 
        1301(a)(1)(C)(ii) of such Act (42 U.S.C. 18021(a)(1)(C)(ii))) 
        and title XXVII of the Public Health Service Act;
            (2) provides coverage of the essential health benefits 
        described in section 1302(b) of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18022(b));
            (3) provides silver and gold-level coverage described in 
        section 1302(d)(1)(C) of the Patient Protection and Affordable 
        Care Act (42 U.S.C. 18022(d)(1)(C)); and
            (4) provides coverage of abortions and all other 
        reproductive health services.
    (b) Preemption.--Notwithstanding section 1303(a)(1) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18023(a)(1))--
            (1) a State may not prohibit the public health plan option 
        from offering the coverage described in subsection (a)(4); and
            (2) no State law that would prohibit such a plan from 
        offering such coverage shall apply to such plan.

SEC. 104. PREMIUMS.

    The Secretary shall establish premium rates for the public health 
plan option that--
            (1) are adjusted based on the applicable rating area;
            (2) are at a level sufficient to fully finance--
                    (A) the costs of health benefits provided by such 
                plans; and
                    (B) administrative costs related to operating the 
                plans; and
            (3) comply with the requirements under section 2701 of the 
        Public Health Service Act (42 U.S.C. 300gg).

SEC. 105. PROVIDERS AND REIMBURSEMENT RATES.

    (a) In General.--The Secretary shall establish a rate schedule for 
reimbursing types of health care providers furnishing items and 
services under the public health insurance plan option at rates based 
on rates applied for such items and services under title XVIII of the 
Social Security Act, as of the date of the enactment of this Act, that 
are necessary to maintain network adequacy. The Secretary shall 
establish a rate schedule for items and services not currently covered 
under title XVIII of the Social Security Act at a level to ensure 
adequate access to providers.
    (b) Participating Providers.--
            (1) In general.--A health care provider that is a 
        participating provider of services or supplier under the 
        Medicare program under title XVIII of the Social Security Act 
        or under the Medicaid program under title XIX of such Act on 
        the date of enactment of this title shall be a participating 
        provider for public health insurance plan option.
            (2) Additional providers.--The Secretary shall establish a 
        process to allow health care providers not described in 
        paragraph (1) to become participating providers for the public 
        health insurance plan option.
    (c) Prescription Drugs.--The Secretary shall apply the provisions 
of section 1860D-11(i) of the Social Security Act (42 U.S.C. 1395w-
111(i)) to prescription drugs under the public health plan option in 
the same manner as such provisions apply with respect to applicable 
covered part D drugs under such section.

SEC. 106. ACCOUNT; FUNDING.

    (a) Establishment.--There is established in the Treasury of the 
United States an account for the receipts and disbursements 
attributable to the operation of the public health plan option.
    (b) Appropriation.--There is appropriated to the account 
established under subsection (a), out of any funds in the Treasury not 
otherwise obligated, such sums as may be necessary to be used by the 
Secretary for purposes of carrying out this part.
    (c) Prohibition of State Imposition of Taxes.--Section 1854(g) of 
the Social Security Act (42 U.S.C. 1395w-24(g)) shall apply to receipts 
and disbursements described in subsection (a) in the same manner as 
such section applies to payments or premiums described in such section.
    (d) Clarification.--Any provision of law restricting the use of 
Federal funds with respect to any reproductive health service shall not 
apply to funds appropriated under subsection (b) or with respect to the 
account under subsection (a).

                    Subtitle B--Medicare for America

SEC. 111. ESTABLISHMENT AND ADMINISTRATION OF MEDICARE FOR AMERICA.

    The Social Security Act is amended by adding at the end the 
following new title:

                   ``TITLE XXII--MEDICARE FOR AMERICA

                ``PART A--COMPREHENSIVE HEALTH COVERAGE

``SEC. 2201. ESTABLISHMENT.

    ``The Secretary shall establish a public health insurance program, 
to be known as `Medicare for America', which shall for calendar year 
2022 and each subsequent calendar year provide comprehensive health 
benefits in accordance with this part to individuals enrolled for 
coverage under this title.

``SEC. 2202. ELIGIBILITY; AUTOMATIC ENROLLMENT.

    ``(a) Eligible Individuals.--For purposes of this title, every 
individual who is a resident of the United States is entitled to 
benefits for health care services under this title. The Secretary shall 
promulgate a rule that provides criteria for determining residency for 
eligibility purposes under this title.
    ``(b) Enrollments.--Subject to subsection (c):
            ``(1) In general.--Beginning in 2022, the Secretary shall 
        provide a mechanism for the enrollment of individuals entitled 
        to benefits under this title and, in conjunction with such 
        enrollment, the issuance of a Medicare card which may be used 
        for purposes of identification and processing of claims for 
        benefits under this title. As a condition of participation in 
        the program, participating providers shall facilitate 
        enrollment as specified by the Secretary.
            ``(2) Automatic enrollments.--The mechanism provided under 
        paragraph (1) shall, subject to paragraph (4), provide, for 
        plan years beginning with plan year 2022, for the following 
        automatic enrollments under Medicare for America:
                    ``(A) Enrollment at birth.--For plan years 
                (beginning with plan year 2022), a process, established 
                by the Secretary in consultation with the Commissioner 
                of Social Security, for the automatic enrollment of 
                eligible individuals born during such plan year.
                    ``(B) Current medicare beneficiaries.--
                            ``(i) Current medicare beneficiaries.--For 
                        plan years (beginning with plan year 2022), a 
                        process established by the Secretary for the 
                        automatic enrollment of all individuals who are 
                        enrolled for benefits under part A or B of 
                        title XVIII (other than individuals who are 
                        enrolled for such benefits and receiving 
                        benefits under title XIX).
                            ``(ii) Continuing population.--For plan 
                        years (beginning with plan year 2022), a 
                        process established by the Secretary for the 
                        automatic enrollment of eligible individuals 
                        who attain the age of 65 during such plan year.
                            ``(iii) Duals.--For plan years (beginning 
                        with plan year 2024), a process established by 
                        the Secretary for the automatic enrollment of 
                        eligible individuals who are enrolled for 
                        benefits under part A or B of title XVIII and 
                        receiving benefits under title XIX.
                    ``(C) Other individuals without qualified health 
                coverage.--For plan years (beginning with plan year 
                2022), a process established by the Secretary for the 
                automatic enrollment of eligible individuals who are 
                not enrolled in other qualified health coverage (as 
                defined in paragraph (4)(B)) for such plan year.
            ``(3) Other enrollments.--The mechanism provided under 
        paragraph (1) shall provide for the following:
                    ``(A) In general.--Enrollment periods and processes 
                for each plan year (beginning with plan year 2022) for 
                enrollment under Medicare for America of any eligible 
                individual not otherwise described in paragraph (2).
                    ``(B) Small employers.--For plan years (beginning 
                with plan year 2022), a process and methodology under 
                which a small employer, as defined in section 124(d)(3) 
                of the Medicare for America Act, may provide for the 
                enrollment of the employees of such employer under 
                Medicare for America. For purposes of the previous 
                sentence, the term `small employer' means any employer 
                for any calendar year if the annual payroll of such 
                employer for the preceding calendar year does not 
                exceed $2,000,000 or has fewer than 100 employees.
                    ``(C) Large employers.--For plan years (beginning 
                with plan year 2026), the Secretary shall provide for a 
                process and methodology under which a large employer 
                may provide for the enrollment of the employees of such 
                employer under Medicare for America. For purposes of 
                the preceding sentence, the term `large employer' means 
                an employer with at least 100 employees.
            ``(4) Opt out for individuals enrolled under qualified 
        health coverage.--
                    ``(A) In general.--The mechanism provided under 
                paragraph (1) shall provide, with respect to a plan 
                year, for a process that enables individuals who are 
                enrolled in qualified health coverage for such plan 
                year to opt out of coverage under Medicare for America 
                for such year.
                    ``(B) Qualified health coverage defined.--For 
                purposes of this section, the term `qualified health 
                coverage' means coverage under any of the following:
                            ``(i) For plan years 2022 and 2023:
                                    ``(I) Qualified employer coverage, 
                                as defined in section 124 of the 
                                Medicare for America Act.
                                    ``(II) Medical coverage under 
                                chapter 55 of title 10, United States 
                                Code, including coverage under the 
                                TRICARE program.
                                    ``(III) A health care program under 
                                chapter 17 or 18 of title 38, United 
                                States Code, as determined by the 
                                Secretary of Veterans Affairs, in 
                                coordination with the Secretary of 
                                Health and Human Services and the 
                                Secretary.
                                    ``(IV) The health benefit program 
                                under chapter 89 of title 5, United 
                                States Code.
                                    ``(V) Medical benefits and services 
                                provided by or through the Indian 
                                Health Service.
                                    ``(VI) The Medicaid program under 
                                title XIX of the Social Security Act.
                                    ``(VII) The CHIP program under 
                                title XXI of the Social Security Act.
                            ``(ii) For plan years 2024 and 2025:
                                    ``(I) Coverage described in 
                                subclause (I), (II), (III), (IV), or 
                                (V) of clause (i).
                                    ``(II) Coverage described in 
                                subclause (VI) of clause (i), but only 
                                with respect to coverage that is not 
                                for individuals described in subclause 
                                (VIII) of section 1902(a)(10)(A)(i) or 
                                who are also enrolled for benefits 
                                under title XVIII.
                            ``(iii) For each subsequent plan year, 
                        coverage described in subclause (I), (II), 
                        (III), (IV), or (V) of clause (i).
    ``(c) Waiver.--The Secretary shall establish a process under which 
the Secretary may grant waivers to States for additional time before 
populations described in a previous subsection of this section of such 
State are automatically enrolled under Medicare for America.

``SEC. 2203. BENEFITS.

    ``(a) In General.--Medicare for America shall, in accordance with 
this section, provide coverage for all the benefits, as determined to 
be medically necessary and reasonable, as covered and defined under 
parts A and B of title XVIII and title XIX as of the date of the 
enactment of this title, including the following:
            ``(1) Ambulatory patient services.
            ``(2) Emergency care and urgent care services.
            ``(3) Hospitalization.
            ``(4) Maternity and newborn care.
            ``(5) Behavioral health, mental health and substance use 
        disorder services, including the following:
                    ``(A) Home-based services.
                    ``(B) Acute services for mental health crises, 
                including crisis stabilization services such as mobile 
                crisis services, including emergency mobile psychiatric 
                services.
                    ``(C) 23-hour observation.
                    ``(D) Outpatient services provided by hospitals, 
                freestanding clinics, and behavioral health providers 
                in independent practice.
                    ``(E) Smoking and tobacco cessation.
                    ``(F) Case management.
                    ``(G) Peer support services.
                    ``(H) Counseling.
                    ``(I) Other intensive outpatient community-based 
                services, such as Assertive Community Treatment and 
                supported employment, provided through the LTSS 
                benefit.
                    ``(J) Other intensive community-based services 
                provided through the Early and Periodic Screening, 
                Diagnostic, and Treatment (EPSDT) benefit (as defined 
                in subpart B of part 441 of title 42 of the Code of 
                Federal Regulations).
                    ``(K) Medication assisted treatment and maintenance 
                services.
                    ``(L) Inpatient detoxification.
                    ``(M) Ambulatory detoxification.
                    ``(N) Psychological testing.
                    ``(O) Home health agency services.
            ``(6) Prescription drugs.
            ``(7) Rehabilitative and habilitative services and devices, 
        including the following:
                    ``(A) Physical therapy.
                    ``(B) Speech therapy.
                    ``(C) Occupational therapy.
            ``(8) Laboratory services.
            ``(9) Preventive and wellness services and chronic disease 
        management.
            ``(10) Pediatric services, including oral and vision care 
        and all services that would otherwise be covered under Early 
        and Periodic Screening, Diagnostic, and Treatment under the 
        Medicaid program under title XIX.
            ``(11) Dental.
            ``(12) Hearing health services including aids and exams.
            ``(13) Home and community-based long-term supports and 
        services.
            ``(14) Chiropractic services.
            ``(15) Durable medical equipment, including the following:
                    ``(A) Wheelchairs and accessories.
                    ``(B) Walking aides such as walkers, canes, and 
                crutches.
                    ``(C) Bathroom equipment such as commodes and 
                safety equipment.
                    ``(D) Inhalation therapy equipment such as 
                nebulizers.
                    ``(E) Hospital beds and accessories.
                    ``(F) Other devices such as continuous positive 
                airway pressure (CPAP) machines, apnea monitors, and 
                ventilators.
                    ``(G) Insulin pumps and glucometers.
                    ``(H) Breast pumps.
                    ``(I) Lymphedema compression treatment items.
                    ``(J) Wigs.
                    ``(K) Augmentative and alternative communication 
                devices, including dual-use devices.
            ``(16) Family planning, including the following:
                    ``(A) Reproductive health exams.
                    ``(B) Patient counseling and education related to 
                family planning.
                    ``(C) Abortion.
                    ``(D) Screening, testing, treatment, and pre- and 
                post-test counseling for sexually transmitted diseases 
                and HIV.
                    ``(E) Contraceptives including pill, patch, 
                medication, condom, implant, or other devices used to 
                prevent pregnancy.
                    ``(F) Sterilization for beneficiaries over the age 
                of 21.
                    ``(G) Infertility treatment.
            ``(17) Gender-confirming medical procedures and treatment.
            ``(18) Dietary and nutrition counseling.
            ``(19) Medically necessary food and vitamins for digestive 
        and inherited metabolic disorders.
            ``(20) Nursing facilities.
            ``(21) Orthotic and prosthetics devices.
            ``(22) Oxygen.
            ``(23) Acupuncture.
            ``(24) Telehealth.
            ``(25) Services otherwise included under the maternal, 
        infant, and early childhood home visiting program under section 
        511 of the Social Security Act, as of the date of the enactment 
        of this title.
            ``(26) Any additional benefit or service not included in 
        this section that is covered by any State plan (or waiver of 
        such State plan) under title XIX on the date of the enactment 
        of this title.
    ``(b) Updates.--Benefits covered under Medicare for America shall 
be updated in accordance with the National Coverage Determination 
process that had, as of the date before the date of the enactment of 
this title, applied with respect to benefits covered under title XVIII.
    ``(c) Prohibition Against Duplicating Coverage.--
            ``(1) In general.--It is unlawful for a private health 
        insurer (other than an insurer with respect to a Medicare 
        Advantage for America plan under part C of this title or 
        qualified employer-based coverage) to sell health insurance 
        coverage that duplicates the benefits provided under Medicare 
        for America under this part.
            ``(2) Construction.--Nothing in paragraph (1) shall be 
        construed as prohibiting the sale of health insurance coverage 
        for any additional benefits not covered by this part, insofar 
        as the coverage satisfies the conditions of paragraph (3).
            ``(3) Application of protections.--For purposes of 
        paragraph (2), health insurance coverage for any additional 
        benefits must satisfy the following conditions:
                    ``(A) The provisions of section 2718 of the Public 
                Health Service Act, relating to a medical loss ratio.
                    ``(B) The provisions of section 2702 of the Public 
                Health Service Act, relating to guaranteed issue.
                    ``(C) The provisions of section 2701 of the Public 
                Health Service Act, relating to community rating.
                    ``(D) The provisions of section 2704 of the Public 
                Health Service Act, relating to the ban on pre-existing 
                conditions exclusions.
    ``(d) States May Provide Additional Benefits.--Individual States 
may provide additional benefits for the residents of such States at the 
expense of the State.
    ``(e) Prohibition Against Step Therapy and Prior Authorization.--
Items and services covered under Medicare for America shall be covered 
without any need for any prior authorization determination and without 
any limitation applied through the use of step therapy protocols.

``SEC. 2204. PREMIUMS.

    ``(a) In General.--(1) Subject to paragraph (2), each individual 
enrolled for benefits under this title for a year shall pay monthly 
community-rated premiums for such year in an amount determined by the 
Secretary in accordance with subsection (b).
    ``(2) Grandfathered Medicare Beneficiaries.--In the case of an 
individual enrolled under part B of title XVIII as of the date of the 
enactment of this part, the premium applied under this section for such 
individual for benefits under this title shall be the lesser of--
            ``(A) the premium otherwise applicable to such individual 
        under such title XVIII if this title had not been enacted; or
            ``(B) the premium that would be applied to such individual 
        under this title without the application of this paragraph.
    ``(b) Premium Contribution Based on Income.--The amount of a 
monthly premium, with respect to a plan year (beginning with 2022), 
under this section shall be established by the Secretary in accordance 
with the following:
            ``(1) Such premium shall be determined such that the 
        collective premiums for the plan year are with respect to the 
        costs of health benefits provided under this title for such 
        year and related administrative costs.
            ``(2) Premiums shall vary by family composition only.
            ``(3) Federal subsidies shall be provided to ensure that 
        the premium shall be--
                    ``(A) zero in the case of an individual whose 
                annual household income is below 200 percent of the 
                poverty line;
                    ``(B) determined by a linear sliding scale, in the 
                case of an individual whose household income is at 
                least 200 percent of the poverty line, but not more 
                than 600 percent of the poverty line, with the premiums 
                ranging between the amount determined for individuals 
                described in clause (i) and for individuals described 
                in clause (iii); and
                    ``(C) no individual or household will pay more than 
                9.69 percent of monthly income toward such monthly 
                premium.
            ``(4) For an individual whose employer will be making a 
        firm-wide contribution under this title in lieu of offering 
        employer sponsored insurance (as specified in section 
        124(b)(1)(B) of the Medicare for America Act), such individual 
        shall pay a premium in accordance with this subsection.
            ``(5) For an individual who has opted out of their employer 
        sponsored insurance in order to enroll in Medicare for America 
        as specified in section 124(c) of such Act, the individual 
        shall pay the premium described in this subsection.
    ``(c) Deposits.--Amounts paid under this section for coverage under 
this title shall be deposited in the Treasury to the credit of the 
Trust Fund established under section 2206.
    ``(d) Appeals for Certain Medicare Grandfathered Population.--In 
calculating premiums for purposes of subsection (a)(2):
            ``(1) Any individual that was subject to a late enrollment 
        penalty under part B of title XVIII shall have the right to 
        appeal the assessment of the penalty for good faith enrollment 
        mistakes.
            ``(2) In any case in which the Secretary finds that an 
        individual's enrollment or nonenrollment in the insurance 
        program established by this part or part A of title XVIII 
        pursuant to section 1818 is unintentional, inadvertent, or 
        erroneous, whether the result of the error, misrepresentation, 
        or inaction of an officer, employee, or agent of the Federal 
        Government or its instrumentalities, an employer, a 
        representative of a group health plan, a State, or for any 
        other good faith reason on the part of such individual, the 
        Secretary shall take such action (including the designation for 
        such individual of a special initial or subsequent enrollment 
        period, including retroactive enrollment, with a coverage 
        period determined on the basis thereof and with appropriate 
        adjustments of premiums) as may be necessary to correct or 
        eliminate the effects of such error, misrepresentation, or 
        inaction. The failure of an individual to enroll in the 
        insurance program established by this part or part A pursuant 
        to section 1818 due to enrollment under a group health plan; 
        coverage pursuant to title XXII of the Public Health Service 
        Act, section 4980B of the Internal Revenue Code of 1986, title 
        VI of the Employee Retirement Income Security Act of 1974, or 
        title XIX; or enrollment under a qualified health plan offered 
        through an Exchange established under title I of the Patient 
        Protection and Affordable Care Act shall under this subsection 
        absent exceptional circumstances, as determined by the 
        Secretary.
            ``(3) The Secretary, in consultation with the Commissioner 
        of Social Security, shall develop and publish a formal 
        application for requesting an action of the Secretary under 
        paragraph (1) to correct or eliminate the effects of an error, 
        misrepresentation, or inaction described in such paragraph and 
        determine and publish specific timelines for timely resolution 
        of such a request.
            ``(4) The Secretary shall also require that all such 
        determinations with respect to such requests shall be reached 
        within 15 business days of the submission of such application. 
        All determinations shall be in writing through a standard 
        decision notice which shall include an explanation of the 
        reasons for the determination.
            ``(5) The Commissioner of Social Security shall enter into 
        contracts with independent review organizations in accordance 
        with this subsection for the purpose of reviewing and 
        determining individual appeals of determinations under 
        paragraph (3) with respect to an application submitted pursuant 
        to paragraph (2) relating to enrollment under part A or part B.
            ``(6) An individual who receives an adverse determination 
        under paragraph (3) with respect to an application submitted 
        pursuant to paragraph (2) may appeal to an independent review 
        organization designated by the Commission. Any such appeal must 
        be sent to the independent review organization within 90 days 
        of the date the individual received the determination to be 
        eligible for review. The independent review organization shall 
        review and reach a determination of the review in writing 
        within 45 days of the receipt of any such appeal.
            ``(7) The Secretary of the Treasury may not enter into a 
        contract under paragraph (5) with an independent review 
        organization--
                    ``(A) unless the organization has staff that has 
                the appropriate knowledge of, and experience with, the 
                eligibility and coordination of benefits rules and 
                regulations under this title; and
                    ``(B) to the extent the organization is a fiscal 
                intermediary under section 1816, a carrier under 
                section 1842, or a Medicare administrative contractor 
                under section 1874A.
            ``(8) The Secretary of Health and Human Services shall 
        provide for access by independent review organizations 
        conducting appeal determinations under this subsection, to the 
        database of the Coordination of Benefits Contractor of the 
        Centers for Medicare & Medicaid Services as necessary in order 
        to conduct the duties of such organizations to determine 
        appeals pursuant to this subsection.

``SEC. 2205. PAYMENT OF BENEFITS; COST-SHARING; OUT-OF-POCKET LIMITS.

    ``(a) Payment of Benefits; Cost-Sharing.--There shall be paid, in 
the case of each individual who is enrolled under Medicare for America 
and incurs expenses for items and services with respect to which 
benefits are payable under this part, after application of subsection 
(b) and subject to subsection (c), 80 percent of the reimbursement 
rates established pursuant to section 2206 for such items and services, 
except that with respect to USPTF recommended preventive and chronic 
disease services, and generic drugs, the amounts paid under this 
section shall be equal to 100 percent of the reimbursement rates 
established pursuant to section 2206 for such items and services.
    ``(b) Deductible.--
            ``(1) In general.--There shall be a deductible applied 
        under this part for each plan year that shall be determined on 
        a linear sliding scale for household income that is at least 
        200 percent of the poverty line, but not more than 600 percent 
        of the poverty line, and shall not exceed, subject to 
        paragraphs (2) and (3)--
                    ``(A) $350 for an individual; or
                    ``(B) $500 total for all members of a household.
            ``(2) Indexing.--In the case of plan years beginning after 
        2021, the dollar amounts described in paragraph (1) shall be 
        increased by the percentage increase over the previous year in 
        the medical care expenditure category of the Consumer Price 
        Index for All Urban Consumers (United States city average), 
        published by the Bureau of Labor Statistics.
            ``(3) Exception.--There shall be no deductible applied 
        under this part for months in a plan year for individuals and 
        households with annual income below 200 percent of the federal 
        poverty line.
    ``(c) Maximum Out-of-Pocket Limit.--
            ``(1) In general.--The coverage under Medicare shall 
        provide benefits, after the eligible individual has incurred 
        out-of-pocket expenses for items and services with respect to 
        which benefits are payable under this part in a year equal to 
        the annual out-of-pocket threshold specified in paragraph (2), 
        with cost-sharing that is equal to $0.
            ``(2) Annual out-of-pocket threshold.--
                    ``(A) In general.--For purposes of paragraph (1), 
                subject to subparagraphs (B) and (C), the annual out-
                of-pocket threshold specified in this paragraph is a 
                threshold that shall be determined on a linear sliding 
                scale for household income that is at least 200 percent 
                of the poverty line, but not more than 600 percent of 
                the poverty line, and that shall not exceed--
                            ``(i) with respect to an individual, 
                        $3,500; or
                            ``(ii) with respect to a household, $5,000.
                    ``(B) Indexing.--In the case of plan years 
                beginning after 2021, the threshold described in 
                subparagraph (A) (as in effect for the preceding plan 
                year after application of this subparagraph) shall be 
                increased by the percentage increase over the previous 
                year in the medical care expenditure category of the 
                Consumer Price Index for All Urban Consumers (United 
                States city average), published by the Bureau of Labor 
                Statistics.
                    ``(C) Exception.--For purposes of paragraph (1), 
                the annual out-of-pocket threshold for individuals and 
                households with annual income below 200 percent of the 
                federal poverty line is $0.
    ``(d) No Balance Billing.--No provider may impose a charge to an 
enrolled individual for covered services for which benefits are 
provided under this part in an amount higher than the reimbursement 
rate for such services under section 2206 and may not impose a charge 
to such individual for such service other than with respect to the 
deductible or other cost-sharing described in this section.

``SEC. 2206. PROVIDERS NETWORK AND REIMBURSEMENT RATES.

    ``(a) In General.--The Secretary shall establish a rate schedule 
for reimbursing types of health care providers furnishing items and 
services under Medicare for America at rates that are consistent with 
subsection (b) and are necessary to maintain network adequacy.
    ``(b) Rates.--
            ``(1) In general.--Except as provided in paragraphs (2) and 
        (3), the Secretary shall provide for rates to be provided to 
        health care providers and suppliers furnishing items and 
        services under Medicare for America based on rates that would 
        be applied (including as computed, updated, and adjusted) under 
        title XVIII for such type of health care providers and 
        suppliers and item and service if such title remained in effect 
        and, in the case of a type of provider and supplier or item or 
        service covered under Medicare for America but not otherwise 
        covered under title XVIII, shall provide for rates that ensure 
        adequate access to care.
            ``(2) Exceptions.--For purposes of this section, in 
        applying paragraph (1) the Secretary shall ensure that rates to 
        hospitals for inpatient services or outpatient services 
        furnished under Medicare for America are at least 110 percent 
        of such rates on average or in the aggregate for furnishing 
        such inpatient or outpatient services otherwise applied under 
        title XVIII, except that for hospitals serving underserved 
        areas as specified by the Secretary, such rates are increased 
        as necessary to ensure adequate access to care.
            ``(3) Application.--In applying rates under title XVIII for 
        purposes of this part, the following shall apply:
                    ``(A) The Secretary shall provide for site-neutral 
                payments for items and services furnished in an 
                outpatient hospital and physician office, the rate of 
                payment for such service shall be the same.
                    ``(B) The Secretary shall increase the average 
                relative value of primary care and other mental and 
                behavioral health and cognitive services by not less 
                than 20 percent in order to ensure adequate access to 
                inpatient and outpatient care.
                    ``(C) As a condition of participation in the 
                program, participating providers shall accept Medicare 
                for America rates paid by employer-sponsored insurance 
                plans and Medicare Advantage plans.
    ``(c) Participating Providers.--
            ``(1) In general.--A health care provider that is a 
        participating provider of services or supplier under the 
        Medicare program under title XVIII on the date of enactment of 
        this title shall remain a participating provider for Medicare 
        for America.
            ``(2) Additional providers.--The Secretary shall establish 
        a process to allow health care providers not described in 
        paragraph (1) to become participating providers for Medicare 
        for America.
    ``(d) Prescription Drugs.--
            ``(1) In general.--Any payment rate under this part for a 
        prescription drug shall be at a rate negotiated by the 
        Secretary based on value assessments by one or more independent 
        nonprofit organizations certified by the National Academy of 
        Medicine and MedPAC. If the Secretary is unable to reach a 
        negotiated agreement on such a reimbursement rate, the 
        Secretary shall apply prices paid by the Department of Veterans 
        Affairs for such drugs or the average price of such drugs in 
        nations which are members of the Organization for Economic 
        Cooperation and Development, whichever is lower.
            ``(2) Failure to negotiate.--If a drug manufacturer refuses 
        to negotiate with the Secretary, then Medicare for America will 
        not cover any of the manufacturer's products. There shall be an 
        exceptions process for drugs that are otherwise unavailable for 
        people with chronic conditions. Individuals shall continue to 
        have access to drugs during the appeals process. The Secretary 
        shall modify such rates in order to accommodate payments for 
        drugs that are not otherwise covered under the original 
        Medicare fee-for-service program under title XVIII.
            ``(3) Value or cost-effectiveness assessments.--The use of 
        Quality-Adjusted Life Years, Disability-Adjusted Life Years, or 
        other similar mechanisms is prohibited for use in value or 
        cost-effectiveness assessments for purposes of this subsection.

``SEC. 2207. TRUST FUND; FUNDING.

    ``(a) Trust Fund.--There shall be established a unified Medicare 
Trust Fund in which funds provided under this title are deposited and 
from which expenditures under this title are made. The Trust Fund shall 
consist of such gifts and bequests as may be made and such amounts as 
may be deposited in, or appropriated to, such Trust Fund as provided in 
this Act.
    ``(b) Funding.--
            ``(1) Taxes.--There are hereby appropriated to the Trust 
        Fund for each fiscal year beginning with fiscal year 2022, out 
        of any moneys in the Treasury not otherwise appropriated, 
        amounts equivalent to 100 percent of the net increase in 
        revenues to the Treasury which is attributable to the 
        amendments made by title II of the Medicare for America Act and 
        premiums collected under this title. The amounts appropriated 
        by the preceding sentence shall be transferred from time to 
        time (but not less frequently than monthly) from the general 
        fund in the Treasury to the Trust Fund, such amounts to be 
        determined on the basis of estimates by the Secretary of the 
        Treasury of the taxes paid to or deposited into the Treasury; 
        and proper adjustments shall be made in amounts subsequently 
        transferred to the extent prior estimates were in excess of or 
        were less than the amounts that should have been so 
        transferred.
            ``(2) Current program receipts.--Notwithstanding any other 
        provision of law, there are hereby appropriated to the Trust 
        Fund for each fiscal year, beginning with fiscal year 2022, the 
        amounts that would otherwise have been appropriated to carry 
        out the following programs:
                    ``(A) The Medicare program under title XVIII.
                    ``(B) The Medicaid program under title XIX, 
                beginning as of 2026.
            ``(3) Additional appropriations.--Additional sums are 
        authorized to be appropriated annually as needed to maintain 
        maximum quality, efficiency, and access under this part.
            ``(4) Medicaid maintenance of effort payments.--There shall 
        be transferred to the Trust Fund the maintenance of effort 
        payments made under section 2209.
    ``(c) Restrictions Shall Not Apply.--Any other provision of law in 
effect on the date of enactment of this title restricting the use of 
Federal funds for any reproductive health service, including abortion, 
shall not apply to monies in the Trust Fund.
    ``(d) Incorporation of Provisions.--The provisions of subsections 
(b) through (i) of section 1817 shall apply to the Trust Fund under 
this section in the same manner as such provisions applied to the 
Federal Hospital Insurance Trust Fund under such section 1817, except 
that, for purposes of applying such subsections to this section, the 
`Board of Trustees of the Trust Fund' shall mean the `Secretary'.
    ``(e) Transfer of Funds.--Any amounts remaining in the Federal 
Hospital Insurance Trust Fund under section 1817 or the Federal 
Supplementary Medical Insurance Trust Fund under section 1841 after the 
payment of claims for items and services furnished under title XVIII 
have been completed, shall be transferred into the Trust Fund under 
this section.

``SEC. 2208. ADMINISTRATIVE PROVISIONS.

    ``(a) Center for Medicare.--Beginning 2022, the Centers for 
Medicare & Medicaid Services shall be renamed the Center for Medicare 
and all references in law and regulation to such Centers shall be 
deemed a reference to such Center. All powers, duties, and 
responsibilities of the Centers for Medicare & Medicaid Services shall 
be transferred to the Center for Medicare.
    ``(b) Authority.--The Secretary shall have the authority to issue 
interim final rules with respect to any provision in this part.
    ``(c) Administrative Law Judges.--
            ``(1) In general.--The Center for Medicare is not 
        authorized to appoint administrative law judges, in accordance 
        with pages 11420 through 499 of title 70 of the Federal 
        Register (March 8, 2005).
            ``(2) Timing.--Under this title, administrative law judges 
        must issue a decision within 90 days of receipt of a hearing 
        request, as specified in subsections (a) and (c) of section 
        405.1016 of title 2, Code of Federal Regulations.
    ``(d) Coverage Determinations Appeals.--
            ``(1) Individuals may appeal a coverage determination under 
        this title before the individual obtains the service or item 
        that is the subject of the appeal.
            ``(2) The Secretary shall eliminate the redetermination by 
        a Medicare administrative contractor from the appeals process 
        under the Medicare program for beneficiaries.
    ``(e) Private Right of Action.--
            ``(1) In general.--An applicant or recipient aggrieved by 
        any law, regulation, policy or practice in violation of a 
        provision of this title may bring a civil action seeking any 
        remedy available in law or equity to remedy that violation. In 
        addition to any cause of action that may be available in a 
        State court, the district courts of the United States shall 
        have concurrent jurisdiction in the matters under the 
        provisions of this title.
            ``(2) Reasonable attorney fees.--In any action or 
        proceeding to enforce this title, the court may award 
        reasonable attorneys' fees and litigation costs (including 
        expert fees) reasonably incurred against the defendant or 
        defendants.
            ``(3) Appeal.--Any civil action brought under this section 
        shall be subject to appeal as provided in sections 1291 and 
        1292 of title 28 of the United States Code.

``SEC. 2209. MAINTENANCE OF EFFORT REQUIREMENT.

    ``(a) In General.--A State is not eligible for payment under any 
program specified in subsection (d) for a calendar quarter in a plan 
year beginning after 2026 unless the State makes to the Secretary for 
transfer to the unified Medicare Trust Fund under section 2207 the 
maintenance of effort payment applicable to such State and plan year 
under subsection (b). The Secretary shall extend such a waiver 
(including the availability of Federal financial participation under 
such waiver) for such period as may be required for a State to meet the 
requirement of the previous sentence.
    ``(b) Maintenance of Effort Payments.--For purposes of this 
section, a maintenance of effort payment with respect to a State and 
plan year is--
            ``(1) for plan year 2027 and a State, a payment in an 
        amount equal to the total amount of expenditures of the State 
        for medical assistance under title XIX and child health 
        assistance under title XXI including administrative costs for 
        the plan year before the date of the enactment of this title;
            ``(2) for plan year 2028 and each subsequent plan year 
        before plan year 2032--
                    ``(A) in the case of a State that is a PPACA 
                expansion State, the payment amount applied under this 
                subsection for the previous plan year, increased by 
                growth in GDP per capita plus 0.4 percent; and
                    ``(B) in the case of a State that is not a PPACA 
                expansion State, the payment amount applied under this 
                subsection for the previous plan year, increased by 
                growth in GDP per capita plus 0.7 percent; and
            ``(3) beginning in 2032, for each subsequent plan year, 
        with respect to any State, the payment amount applied under 
        this subsection for the previous year, increased by growth in 
        GDP per capita plus 0.7 percent.
    ``(c) Programs Specified.--For purposes of this section, the 
programs specified in this subsection are each of the following:
            ``(1) Block grants for community mental health services 
        under subpart I of part B of title XIX of the Public Health 
        Service Act.
            ``(2) Block grants and programs for social services and 
        elder justice under title XX of the Social Security Act.
            ``(3) Maternal and child health services block grants under 
        title V of the Social Security Act.
            ``(4) Block grants for prevention and treatment of 
        substance abuse under subpart II of part B of title XIX of the 
        Public Health Service Act.
            ``(5) State Targeted Response to Opioid Crisis Grant 
        Community Services Block Grant.
            ``(6) Grants under section 330 of the Public Health Service 
        Act.
            ``(7) Ryan White HIV/AIDS Program grants under title XXVI 
        of the Public Health Service Act.

``SEC. 2210. APPLICATION OF TITLE XVIII PROVISIONS.

    ``Except as specified otherwise in this title, in implementing 
Medicare for America, the Secretary shall to the greatest extent 
practicable apply the following provisions of title XVIII to the 
program under this title, benefits covered under this title, 
individuals entitled to benefits under this title, and providers of 
services and suppliers participating under the program under this title 
in a similar manner as such provisions applied to the program under 
title XVIII, benefits covered under such title, individuals entitled to 
benefits or enrolled under such title, and providers of services and 
suppliers participating under the program under such title:
            ``(1) Section 1801.
            ``(2) Section 1805.
            ``(3) Section 1806.
            ``(4) Section 1807.
            ``(5) Section 1809.
            ``(6) Section 1812.
            ``(7) Section 1814.
            ``(8) Section 1815.
            ``(9) Section 1816.
            ``(10) Section 1818.
            ``(11) Section 1818A.
            ``(12) Section 1819.
            ``(13) Section 1820.
            ``(14) Section 1832.
            ``(15) Section 1834.
            ``(16) Section 1834A.
            ``(17) Section 1835.
            ``(18) Section 1843.
            ``(19) Section 1846.
            ``(20) Section 1847.
            ``(21) Section 1851.
            ``(22) Section 1852.
            ``(23) Section 1855.
            ``(24) Section 1856.
            ``(25) Section 1857.
            ``(26) Section 1858.
            ``(27) Section 1861.
            ``(28) Section 1863.
            ``(29) Section 1864.
            ``(30) Section 1866B.
            ``(31) Section 1866C.
            ``(32) Section 1866E.
            ``(33) Section 1867.
            ``(34) Section 1868.
            ``(35) Section 1869.
            ``(36) Section 1871.
            ``(37) Section 1874A.
            ``(38) Section 1880.
            ``(39) Section 1881.
            ``(40) Section 1881A.
            ``(41) Section 1891.
            ``(42) Section 1894.
            ``(43) Section 1895.
            ``(44) Section 1896.

               ``PART B--LONG-TERM SERVICES AND SUPPORTS

``SEC. 2221. LONG-TERM SERVICES AND SUPPORTS BENEFIT.

    ``All individuals enrolled under Medicare for America under this 
title shall have coverage for long-term services and supports benefits.

``SEC. 2222. ELIGIBILITY.

    ``(a) Eligible Individuals.--An individual who is eligible for 
long-term care benefits under this part is an individual who satisfies 
each of the following:
            ``(1) The individual is eligible for Medicare for America.
            ``(2) The individual is determined to have a condition, as 
        certified by a licensed health care practitioner, that results 
        in substantially reduced functional capacity in one or more of 
        the following areas:
                    ``(A) Communication.
                    ``(B) Social interaction.
                    ``(C) Learning.
                    ``(D) Mobility.
                    ``(E) Self-care.
                    ``(F) Self-management.
                    ``(G) Impairments that affect the person's capacity 
                for social or economic participation.
    ``(b) Clarification.--Under this part, in the case of an individual 
described in subsection (a) who, due to the nature of the condition of 
the individual, experience periods in which their functional capacity 
changes or improves, such individual shall continue to have access to 
benefits under this part as needed. If such an individual's functional 
capacity improves to a point in which the individual no longer requires 
long term supports and services, or requires fewer services, the 
individual shall be able to immediately and seamlessly resume receiving 
all needed services if and when their functional needs recur. 
Eligibility for services shall be maintained if, without the services, 
the individual would have reduced functional capacity. The presence of 
supports and services or other mitigating measures shall not be taken 
into account when looking at functional impairment.
    ``(c) Benefits.--
            ``(1) Definition.--For purposes of this title, the term 
        `long-term services and supports benefit' means the daily 
        living supports needed by eligible individuals and includes all 
        long-term services and supports covered, as of the date of the 
        enactment of this title, under any State plan under title XIX, 
        including--
                    ``(A) home and community-based services; and
                    ``(B) any additional services and supports 
                developed to help people with disabilities live, work, 
                and participate in their communities, including--
                            ``(i) home health aides and homemakers;
                            ``(ii) direct support professionals and 
                        personal attendant care services;
                            ``(iii) hospice;
                            ``(iv) nursing care;
                            ``(v) medical social services;
                            ``(vi) case management, fiscal 
                        intermediary, and support brokerage services;
                            ``(vii) short-term inpatient care, 
                        including respite care and care for pain 
                        control;
                            ``(viii) behavioral health long-term 
                        services and supports, including assertive 
                        community treatment, peer support services, 
                        intensive case management, supported 
                        employment, and supported housing wraparound; 
                        and
                            ``(ix) all additional services coverable in 
                        Medicaid under state plan services, sections 
                        1115, 1915(c), 1915(k), 1915(i), and 1915(j), 
                        for people with disabilities.
            ``(2) Self-directed model.--All eligible individuals shall 
        be defaulted into a self-directed care option (as defined by 
        the Secretary).
            ``(3) Community first.--The benefit under this part shall 
        be provided with a community-first presumption and eligible 
        individuals should be initially provided home and community-
        based services, as defined for purposes of section 1915(i). 
        Before an eligible individual is admitted into a long term care 
        institution, the State mental health or developmental 
        disability authority or State agency that administers the State 
        plan under title XIX shall conduct a mandatory assessment to 
        determine whether their needs could be met through home and 
        community-based services and if so, the services would have to 
        be arranged for by the State and the coverage would not be 
        provided for the individual with respect to such an admission. 
        This assessment shall be conducted at least annually or upon a 
        change in condition for all individual already admitted to an 
        institution.
    ``(d) Coordination With Other Federal Benefits.--
            ``(1) Rule of construction.--Nothing in this part shall be 
        construed as prohibiting benefits paid under this part from 
        being used to compensate a caregiver who provides community 
        living assistance services and supports to a dependent relative 
        not less than 80 hours a month for providing community living 
        assistance services and supports to an eligible individual 
        under this part.
            ``(2) Dependent relative defined.--The term `dependent 
        relative' means--
                    ``(A) a child, grandchild, niece, or nephew (of 
                such caregiver or such caregiver's spouse or domestic 
                partner);
                    ``(B) a child to which the caregiver or the 
                caregiver's spouse or domestic partner is standing in 
                loco parentis;
                    ``(C) a parent, grandparent, sibling, aunt, or 
                uncle (of such caregiver or his or her spouse or 
                domestic partner); or
                    ``(D) such caregiver's spouse or domestic partner, 
                if such child, grandchild, niece, nephew, parent, 
                grandparent, sibling, aunt, uncle, spouse, or domestic 
                partner is an eligible individual.
            ``(3) Supplement not supplant.--Benefits received under 
        this part by a caregiver shall supplement, but not supplant, 
        other benefits for which the individual is eligible under any 
        other Federally funded program that provides benefits or 
        assistance.
            ``(4) Disregard.--Benefits paid to a caregiver under this 
        part shall be disregarded for purposes of determining or 
        continuing the eligibility of the individual or the spouse of 
        the individual for receipt of benefits under any other Federal, 
        State, or locally funded assistance program, including benefits 
        paid under titles II or XVI under the laws administered by the 
        Secretary of Veterans Affairs, under low-income housing 
        assistance programs, under the supplemental nutrition 
        assistance program established under the Food and Nutrition Act 
        of 2008, or under programs administered by State vocational 
        rehabilitation agencies.

                ``PART C--MEDICARE ADVANTAGE FOR AMERICA

``SEC. 2231. ALL PRIVATE PLANS.

    ``(a) In General.--For plan years beginning with plan year 2026, a 
health insurance issuer may offer health insurance coverage in the 
individual market only if such issuer has entered into a contract with 
the Secretary under subsection (b) to offer such coverage.
    ``(b) Agreements.--The Secretary shall enter into an agreement with 
an MA for America sponsor to offer MA for America plans under this part 
for the coverage of individuals enrolled under Medicare for America who 
elect to receive benefits under part A through such a plan.
    ``(c) MA for America Plan; MA for America Sponsor.--For purposes of 
this part--
            ``(1) MA for america plan.--An MA for America plan is a 
        Medicare Advantage plan under part C of title XVIII, except 
        such plan shall provide coverage for individuals enrolled under 
        Medicare for America under part A of this title, with respect 
        to at least the benefits covered under such part A.
            ``(2) MA for america sponsor.--An MA for America sponsor is 
        a sponsor of an MA for America plan.

``SEC. 2232. APPLICATION OF MEDICARE ADVANTAGE PROVISIONS.

    ``For purposes of applying this part, except as otherwise specified 
under this part, the provisions of part C of title XVIII, as in effect 
as of the date of the enactment of this title shall apply with respect 
to an MA for America sponsor, MA for America plan, individuals eligible 
for coverage under this part, individuals enrolled under such plan, and 
benefits covered under part A in a similar manner and to a similar 
extent as such provisions applied to an MA organization, MA plan, 
individuals eligible for under part C of such title, individuals 
enrolled under an MA plan, and benefits covered under fee-for-service 
Medicare as of such date.

``SEC. 2233. INCREASED PREMIUM FOR MEDICARE ADVANTAGE FOR AMERICA 
              PLANS.

    ``Nothing in this part shall preclude an individual from choosing a 
Medicare Advantage for America plan which requires the individual to 
pay an additional amount because of supplemental benefits or because it 
is a more expensive plan. In such case the individual enrolled under 
such plan would be responsible for the increased monthly premium.

``SEC. 2234. REFERENCES.

    ``Beginning in 2022, all references in law and regulation to 
Medicare Advantage shall be deemed a reference to Medicare Advantage 
for America.''.

SEC. 112. MODIFICATIONS TO AND COORDINATION WITH EXISTING FEDERAL 
              HEALTH PROGRAMS.

    (a) Medicare, Medicaid, and State Children's Health Insurance 
Program (SCHIP).--
            (1) In general.--Notwithstanding any other provision of 
        law, subject to paragraphs (2) and (3) and section 2202(c) of 
        the Social Security Act, as added by section 111--
                    (A) no benefits shall be available under title 
                XVIII of the Social Security Act for any item or 
                service furnished--
                            (i) beginning on or after January 1, 2022 
                        (except in the case of an individual enrolled 
                        under such title and title XIX of such Act); 
                        and
                            (ii) beginning on or after January 1, 2024, 
                        with respect to all individuals, including 
                        individuals enrolled under such title and title 
                        XIX of such Act;
                    (B) no individual is entitled to medical assistance 
                under a State plan approved under title XIX of such 
                Act--
                            (i) for any item or service furnished on or 
                        after January 1, 2024, in the case of an 
                        individual enrolled under such title and title 
                        XVIII of the Social Security Act or an 
                        individual described in subclause (VIII) of 
                        section 1902(a)(10)(A)(i); and
                            (ii) for any item or service furnished on 
                        or after January 1, 2026;
                    (C) no individual is entitled to medical assistance 
                under a State child health plan under title XXI of such 
                Act for any item or service furnished on or after 
                January 1, 2024; and
                    (D) no payment shall be made to a State under 
                section 1903(a) or 2105(a) of such Act with respect to 
                medical assistance or child health assistance--
                            (i) for any item or service furnished on or 
                        after January 1, 2024, in the case of an 
                        individual enrolled under such title and title 
                        XVIII of the Social Security Act or an 
                        individual described in subclause (VIII) of 
                        section 1902(a)(10)(A)(i); and
                            (ii) for any item or service furnished on 
                        or after January 1, 2026.
            (2) Transition.--In the case of inpatient hospital services 
        and extended care services during a continuous period of stay 
        which began before January 1, 2024 for Medicare and 2026 for 
        Medicaid or CHIP, and which had not ended as of such date, for 
        which benefits are provided under title XVIII of the Social 
        Security Act, under a State plan under title XIX of such Act, 
        or under a State child health plan under title XXI such Act, 
        the Secretary of Health and Human Services shall provide for 
        continuation of benefits under such title or plan until the end 
        of the period of stay.
    (b) Other Federal Health Programs.--
            (1) Federal employees health benefits program.--Nothing in 
        this Act, or the amendments made by this Act, shall affect 
        benefits made available under chapter 89 of title 5, United 
        States Code.
            (2) TRICARE.--Nothing in this Act, or the amendments made 
        by this Act, shall affect benefits made available under 
        sections 1079 and 1086 of title 10, United States Code.
            (3) Treatment of benefits for veterans and native 
        americans.--
                    (A) In general.--Nothing in this Act, or the 
                amendments made by this Act, shall affect the 
                eligibility of veterans for the medical benefits and 
                services provided under title 38, United States Code, 
                or of Indians for the medical benefits and services 
                provided by or through the Indian Health Service.
                    (B) Reevaluation.--No reevaluation of the Indian 
                Health Service shall be undertaken without consultation 
                with tribal leaders and stakeholders.
    (c) Sunset of Provisions Related to the State Exchanges.--Effective 
January 1, 2022, the Federal and State Exchanges established pursuant 
to title I of the Patient Protection and Affordable Care Act (Public 
Law 111-148) shall terminate, and any other provision of law that 
relies upon participation in or enrollment through such an Exchange, 
including such provisions of the Internal Revenue Code of 1986, shall 
cease to have force or effect.
    (d) Severability.--Every provision in this Act and every 
application of the provisions in this Act are severable from each other 
as a matter of Federal law. If any application of any provision in this 
Act to any person or group of persons or circumstances is found by a 
court to be invalid, the remainder of this Act and the application of 
the Act's provisions to all other persons and circumstances may not be 
affected.

                      Subtitle C--Targeted Reforms

SEC. 121. LIMITATION ON REMOVAL OF MEDICARE ADVANTAGE PROVIDERS BY MA 
              ORGANIZATIONS.

    (a) Limitation.--Section 1852(d) of the Social Security Act (42 
U.S.C. 1395w-22(d)) is amended by adding at the end the following:
            ``(7) Limitation on removal of providers from ma plans by 
        ma organizations.--
                    ``(A) Removal of providers with cause.--Beginning 
                with plan year 2019, except as provided in subparagraph 
                (C), an MA organization offering an MA plan may only 
                remove a provider of services or a supplier from a 
                network of such plan if the organization has cause to 
                remove such provider or supplier.
                    ``(B) Cause to remove providers.--
                            ``(i) In general.--An MA organization 
                        offering an MA plan has cause to remove a 
                        provider of services or a supplier from a 
                        network of such plan if the Secretary 
                        determines that the provider or supplier is--
                                    ``(I) medically negligent;
                                    ``(II) in violation of any legal or 
                                contractual requirement applicable to 
                                the provider or supplier acting within 
                                the lawful scope of practice, including 
                                any participation or other requirement 
                                applicable to such provider or supplier 
                                under this title or under any 
                                contractual term for such plan; or
                                    ``(III) otherwise unfit to furnish 
                                items and services in accordance with 
                                requirements of this title.
                            ``(ii) Consideration of cost to ma 
                        organizations.--For purposes of subparagraph 
                        (A), cost to an MA organization offering an MA 
                        plan due to the participation of a provider of 
                        services or supplier in a network of such plan 
                        does not constitute cause for the MA 
                        organization to remove such provider or 
                        supplier from the network mid-year, and such 
                        cost may not be considered as a factor in favor 
                        of a determination that such organization has 
                        cause to remove the provider.
                    ``(C) Exception.--With respect to each upcoming 
                plan year, beginning with plan year 2019, an MA 
                organization offering an MA plan may only remove a 
                provider of services or supplier from a network of such 
                plan for reasons not specified in subparagraph (B)(i) 
                before the date that is 60 days before the first day of 
                the annual coordinated election period for such plan 
                year under section 1851(e)(3).
                    ``(D) Notice and appeal process.--
                            ``(i) In general.--Any removal of a 
                        provider of services or supplier from a network 
                        of an MA plan may occur only after the 
                        completion of a fair notice and appeal process 
                        that the Secretary shall establish by 
                        regulation. Such process shall require the MA 
                        organization to provide to such provider or 
                        supplier and to the Secretary an explanation of 
                        the reason or reasons for the removal.
                            ``(ii) Application.--
                                    ``(I) Application of new process.--
                                In the case of a removal of a provider 
                                of services or supplier from a network 
                                of an MA plan occurring on or after the 
                                effective date published in a final 
                                rule for such fair notice and appeal 
                                process, such process shall apply in 
                                lieu of the process for the termination 
                                or suspension of a provider contract 
                                under section 422.202(a) of title 42, 
                                Code of Federal Regulations.
                                    ``(II) Continuation of old 
                                process.--In the case of a removal of a 
                                provider of services or supplier from a 
                                network of an MA plan occurring before 
                                such effective date, the process for 
                                the termination or suspension of a 
                                provider contract under section 
                                422.202(a) of title 42, Code of Federal 
                                Regulations, shall apply.
                    ``(E) Participant notice and protection.--
                            ``(i) Notice to participants of provider 
                        removal.--Not less than 60 days before the date 
                        on which a provider of services or supplier is 
                        removed from a network of an MA plan, the MA 
                        organization offering such plan shall provide 
                        written notification of the removal to each 
                        individual enrolled in such plan receiving 
                        items or services from the provider or supplier 
                        during the plan year in effect on the date of 
                        removal or during the previous plan year. Such 
                        notification shall include at the minimum--
                                    ``(I) the names and telephone 
                                numbers of available in-network 
                                providers of services and suppliers 
                                offering items and services that are 
                                the same or similar to the items and 
                                services offered by the removed 
                                provider or supplier;
                                    ``(II) information regarding the 
                                options available to an individual 
                                enrolled in such plan to request the 
                                continuation of medical treatment or 
                                therapy with the removed provider or 
                                supplier; and
                                    ``(III) one or more customer 
                                service telephone numbers that an 
                                individual enrolled in such plan may 
                                access to obtain information regarding 
                                changes to the network of the plan.
                            ``(ii) Annual notice of change.--In 
                        addition to providing the notification of 
                        removal as required under clause (i), the MA 
                        organization offering such MA plan shall 
                        include such notification in the annual notice 
                        of change for the MA plan for the upcoming plan 
                        year.
                            ``(iii) Continuity of care.--In any case in 
                        which a provider of services or supplier is 
                        removed from a network of an MA plan, such plan 
                        shall ensure that the removal satisfies the 
                        continuity of care requirements under paragraph 
                        (1)(A) with respect to each individual enrolled 
                        in such plan receiving items or services from 
                        the provider or supplier during the plan year 
                        in effect on the date of removal or during the 
                        previous plan year.
                    ``(F) Rule of construction.--Nothing in this 
                paragraph shall be construed as affecting the ability 
                of a provider of services or supplier to decline to 
                participate in a network of an MA plan.
            ``(8) Transparency in measures used by ma organizations to 
        establish or modify provider networks.--
                    ``(A) In general.--Beginning with plan year 2019, 
                an MA organization offering an MA plan shall include 
                the information described in subparagraph (B)--
                            ``(i) in the annual bid information 
                        submitted by the MA organization with respect 
                        to the MA plan under section 1854; and
                            ``(ii) on the Internet Web Site for the MA 
                        plan.
                    ``(B) Information described.--The information 
                described in this subparagraph is the following:
                            ``(i) Information regarding the measures 
                        used by the MA organization to establish or 
                        modify the provider network of the MA plan, 
                        including measures of the quality and 
                        efficiency of providers. Such information shall 
                        include the specifications, methodology, and 
                        sample size of such measures.
                            ``(ii) Other information related to the 
                        establishment or modification of such provider 
                        network that the Secretary determines 
                        appropriate.
                    ``(C) Limitation.--The information described in 
                subparagraph (B) shall not include any individually 
                identifiable information of any provider or supplier of 
                services.''.
    (b) Enforcement.--
            (1) Sanctions for noncompliance.--Section 1857(g)(1) of the 
        Social Security Act (42 U.S.C. 1395w-27(g)(1)) is amended--
                    (A) in subparagraph (J), by striking ``or'';
                    (B) by redesignating subparagraph (K) as 
                subparagraph (L);
                    (C) by inserting after subparagraph (J) the 
                following new subparagraph:
                    ``(K) fails to comply with section 1852(d)(7) or 
                1852(d)(8); or''; and
                    (D) in subparagraph (L) (as so redesignated), by 
                striking ``through (J)'' and inserting ``through (K)''.
            (2) Sanctions not applicable to part d.--Title XVIII of the 
        Social Security Act is amended--
                    (A) in section 1860D-12(b)(3)(E) (42 U.S.C. 1395w-
                112(b)(3)(E)), by striking ``paragraph (1)(F)'' and 
                inserting ``paragraphs (1)(F) and (1)(K)''; and
                    (B) in section 1894(e)(6)(B) (42 U.S.C. 
                1395eee(e)(6)(B)), by inserting ``(other than paragraph 
                (1)(K) of such section)'' after ``1857(g)(1)''.
    (c) Medicare Advantage Plan Compare Tool.--Not later than one year 
after the date of enactment of this Act, the Secretary of Health and 
Human Services shall take such measures as are necessary to ensure that 
the Medicare Advantage Compare Tool takes into account the preferences 
and utilization needs of such individuals.

SEC. 122. NETWORK ADEQUACY.

    (a) In General.--Section 1852(d) of the Social Security Act (42 
U.S.C. 1395w-22(d)) is amended by adding at the end the following:
            ``(9) Network adequacy requirements.--Beginning in plan 
        year 2019, notwithstanding any other provision of law, the 
        following shall apply:
                    ``(A) Provider availability.--When establishing a 
                plan network, a Medicare Advantage organization 
                offering an MA plan shall, among other factors 
                determined by the Secretary, consider the following:
                            ``(i) The anticipated enrollment in the 
                        plan.
                            ``(ii) The expected types of services 
                        provided and utilization of services by 
                        enrollees under the plan.
                            ``(iii) The number and types of providers 
                        needed to provide such services.
                            ``(iv) The number of network providers who 
                        are not accepting new patients.
                            ``(v) The location of providers and 
                        enrollees.
                            ``(vi) The full-time equivalent 
                        availability of a provider to provide such 
                        services.
                    ``(B) Provision of care in a timely manner.--A 
                Medicare Advantage organization offering an MA plan 
                shall ensure that providers are able to provide 
                services in a timely manner, as defined by the 
                Secretary, under the plan.
                    ``(C) Application of network access adequacy 
                standards.--In applying the network access adequacy 
                standards pursuant to paragraph (1), the Secretary 
                shall seek input from patient advocacy groups, 
                providers of services and suppliers, and MA plans under 
                this part.
                    ``(D) Certification.--Each plan year, a Medicare 
                Advantage organization shall certify to the Secretary, 
                with respect to each MA plan offered by the 
                organization, that the providers, including specialists 
                and subspecialists, in the plan network are able to 
                provide the services required under the organization's 
                contract with the Secretary under section 1857 with 
                respect to the offering of such plan and to meet the 
                needs of the enrollees within the plan service area 
                during the year.
                    ``(E) Annual reporting.--Each plan year, a Medicare 
                Advantage organization shall report to the Secretary 
                the following with respect to each MA plan offered by 
                the organization:
                            ``(i) Average wait time.--The average wait 
                        time for primary and specialty care for 
                        enrollees under the plan.
                            ``(ii) Utilization of out-of-network 
                        providers.--The utilization of out-of-network 
                        providers under the plan.
                            ``(iii) Average cost per patient.--The 
                        average annual spending per patient for primary 
                        and specialty care for enrollees under the 
                        plan.
                    ``(F) Certification.--In advance of the annual, 
                coordinated election period under section 1851(e)(3), a 
                Medicare Advantage organization shall certify to the 
                Secretary the accuracy of provider directories for each 
                plan offered by the organization.
                    ``(G) Network review.--The Secretary shall ensure 
                that the network of each MA plan offered by a Medicare 
                Advantage organization meets the network adequacy 
                guidelines established under this paragraph and under 
                section 422.112(a)(4) of title 42, Code of Federal 
                Regulations (or any successor regulation to such 
                section), at least once every 3 years or when a 
                material change in network occurs.''.
    (b) Enforcement.--Section 1857(g)(1)(K) of the Social Security Act 
(42 U.S.C. 1395w-27(g)(1)(K)), as added by section 2(b), is amended by 
striking ``or 1852(d)(8)'' and inserting ``, 1852(d)(8), or 
1852(d)(9)''.

SEC. 123. ELIMINATING THE 24-MONTH WAITING PERIOD FOR MEDICARE COVERAGE 
              FOR INDIVIDUALS WITH DISABILITIES.

    (a) In General.--Section 226(b) of the Social Security Act (42 
U.S.C. 426(b)) is amended--
            (1) in paragraph (2)(A), by striking ``, and has for 24 
        calendar months been entitled to,'';
            (2) in paragraph (2)(B), by striking ``, and has been for 
        not less than 24 months,'';
            (3) in paragraph (2)(C)(ii), by striking ``, including the 
        requirement that he has been entitled to the specified benefits 
        for 24 months,'';
            (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 status as a qualified 
        railroad retirement beneficiary described in paragraph (2), 
        and'' and inserting ``for each month for which the individual 
        meets the requirements 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''.
            (3) Medicare coverage.--Section 1837(g)(1) of the Social 
        Security Act (42 U.S.C. 1395p(g)(1)) is amended by striking 
        ``25th month of'' and inserting ``month following the first 
        month of''.
            (4) Railroad retirement system.--Section 7(d)(2)(ii) of the 
        Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is 
        amended--
                    (A) by striking ``has been entitled to an annuity'' 
                and inserting ``is entitled to an annuity'';
                    (B) by striking ``, for not less than 24 months''; 
                and
                    (C) by striking ``could have been entitled for 24 
                calendar months, and''.
    (c) Effective Date.--The amendments made by this section shall 
apply to insurance benefits under title XVIII of the Social Security 
Act with respect to items and services furnished in months beginning 
after the date of enactment of this Act.

SEC. 124. EMPLOYER HEALTH PLAN OPTIONS.

    (a) Definition.--A qualifying employer sponsored plan is--
            (1) a governmental plan (within the meaning of section 
        2791(d)(8) of the Public Health Service Act); or
            (2) any other plan or coverage that meets the benefits 
        criteria of title XXII of the Social Security Act, as added by 
        section 111, and the criteria under subsection (b),
that provides health coverage that is equivalent to an actuarial value 
of at least 80 percent and makes a premium contribution of at least 70 
percent.
    (b) Obligation.--Large employers shall, with respect to any full-
time employee of such employer--
            (1) offer a qualifying employer sponsored plan to such 
        employee, in accordance with subsection (c); or
            (2) make a contribution of 8 percent of their annual 
        payroll to the Medicare Trust Fund under title XXII of the 
        Social Security Act.
    (c) Employee Choice.--An employee may opt out of a qualifying 
employer sponsored plan as satisfied by subsection (b)(1) in order to 
enroll in Medicare for America. The employer shall be exempt from the 
contribution specified in subsection (b)(2). The Secretary of Health 
and Human Services shall have authority to set standards for 
determining whether employers or insurers are undertaking any actions 
to affect the risk pool within Medicare for America by inducing 
individuals to decline coverage under a qualifying employer sponsored 
plan and instead to enroll in Medicare for America. An employer 
violating such standards shall be treated as not meeting the 
requirements of subsection (a).
    (d) Special Rules.--
            (1) Annual payroll.--For purposes of this paragraph, the 
        term ``annual payroll'' means, with respect to any employer for 
        any calendar year, the aggregate wages paid by the employer 
        during such calendar year.
            (2) Aggregation rules.--Related employers and predecessors 
        shall be treated as a single employer for purposes of this 
        subsection.
            (3) Reduction for part-time employees.--In the case of a 
        part-time employee, the employer contribution requirements of 
        paragraph (1) shall be treated as satisfied if the employer 
        contribution with respect to such employee is not less than the 
        part-time employment ratio of the contribution required under 
        paragraph (1).
            (4) Rules related to part-time employment.--For purposes of 
        this subsection--
                    (A) Part-time employee.--The term ``part-time 
                employee'' means, with respect to any month, an 
                employee who works on average fewer than 30 hours per 
                week.
                    (B) Part-time employment ratio.--The term ``part-
                time employment ratio'' means, with respect to a part-
                time employee of an employer in a month, a fraction--
                            (i) the numerator of which is the number of 
                        hours in the employee's normal work week, and
                            (ii) the denominator of which is 30 hours.
                    (C) Special rules.--Under rules prescribed by the 
                Secretary of Health and Human Services, in consultation 
                with the Secretary of the Treasury, in the case of an 
                employee for an employer whose defined work week for 
                full-time employees is less than 30 hours, any 
                reference in this subsection to 30 hours is deemed a 
                reference to the number of hours in the work week so 
                defined.
                    (D) Conversion to hours of employment.--The 
                Secretary of Health and Human Services, in consultation 
                with the Secretary of the Treasury, shall establish 
                rules for the conversion of compensation to hours of 
                employment, for purposes of this subsection in the case 
                of employees that receive compensation on a salaried 
                basis, or on the basis of a commission, or other 
                contingent or bonus basis, rather than based on an 
                hourly wage.
    (e) Timing and Manner.--Each employer that makes a financial 
contribution under subsection (b)(2) under this section (other than 
with respect to coverage under a group health plan) shall pay such 
contribution in a form and manner, specified by the Secretary of the 
Treasury, based upon the form and manner in which employer excise taxes 
are required to be paid under section 3111 of the Internal Revenue Code 
of 1986.
    (f) Non-Discrimination.--
            (1) In general.--Except as otherwise provided for in this 
        title (or an amendment made by this title), an individual shall 
        not, on the ground prohibited under title VI of the Civil 
        Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 
        Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age 
        Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), or section 
        504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), be 
        excluded from participation in, be denied the benefits of, or 
        be subjected to discrimination under, any health program or 
        activity, any part of which is receiving Federal financial 
        assistance, including credits, subsidies, or contracts of 
        insurance, or under any program or activity that is 
        administered by an Executive Agency or any entity established 
        under this title (or amendments) or any employer-sponsored 
        insurance.
            (2) Continued application of laws.--Nothing in this title 
        (or an amendment made by this title) shall be construed to 
        invalidate or limit the rights, remedies, procedures, or legal 
        standards available to individuals aggrieved under title VI of 
        the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title 
        VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et seq.), 
        title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et 
        seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 
        794), or the Age Discrimination Act of 1975 (42 U.S.C. 611 et 
        seq.), or to supersede State laws that provide additional 
        protections against discrimination on any basis described in 
        paragraph (1).
            (3) Regulations.--The Secretary of Health and Human 
        Services may promulgate regulations to implement this 
        subsection.

SEC. 125. PROHIBITION ON STEP THERAPY AND PRIOR AUTHORIZATION UNDER 
              GROUP HEALTH PLANS.

    Section 2719A of the Public Health Service Act (42 U.S.C. 300gg-
19a) is amended by adding at the end the following new subsection:
    ``(e) Prohibition Against Step Therapy and Prior Authorization.--
Beginning with the first plan year following the date of the enactment 
of this subsection, a group health plan may not require a prior 
authorization determination for coverage of any benefit under such plan 
and may not apply treatment limitations through the use of step therapy 
protocols.''.

SEC. 126. MEDICARE OUTPATIENT OBSERVATION SERVICES.

    Section 1861(i) of the Social Security Act (42 U.S.C. 1395x(i)) is 
amended by adding at the end the following: ``For purposes of this 
subsection, an individual receiving outpatient observation services 
shall be deemed to be an inpatient during such period, and the date 
such individual ceases receiving such services shall be deemed the 
hospital discharge date (unless such individual is admitted as a 
hospital inpatient at the end of such period).''.

SEC. 127. ABORTION COVERAGE.

    Notwithstanding any other provision of law, Federal funds may be 
used to provide for abortion services under any health program under 
any of the following:
            (1) Indian Health Service.
            (2) Benefits provided to women veterans.
            (3) Benefits provided through the United States Immigration 
        and Customs Enforcement to women in detention centers under the 
        jurisdiction of such agency.

                        TITLE II--TAX PROVISIONS

SEC. 201. SUNSET OF PUBLIC LAW 115-97.

    (a) In General.--All provisions of, and amendments made by, Public 
Law 115-97 shall not apply to calendar, taxable, plan, or limitation 
years beginning after December 22, 2017.
    (b) Application of Certain Laws.--The Internal Revenue Code of 1986 
shall be applied and administered to years described in subsection (a) 
as if the provisions and amendments described in subsection (a) had 
never been enacted.

SEC. 202. SURTAX.

    There is hereby imposed a tax of 5 percent on the adjusted gross 
income of each taxpayer to the extent such income exceeds $500,000.

SEC. 203. BASIS OF PROPERTY ACQUIRED FROM A DECEDENT.

    (a) In General.--Section 1014 of the Internal Revenue Code of 1986 
is amended by striking ``person, be'' and all that follows through the 
period at the end and inserting the following: ``person, be the basis 
in the hands of the decedent.''.
    (b) Effective Date.--The amendments made by this section to 
property acquired or passed after the date of enactment of this Act.

SEC. 204. MEDICARE PAYROLL TAX.

    (a) In General.--Section 3101(b)(2) of the Internal Revenue Code of 
1986 is amended by striking ``0.9 percent'' and inserting ``4 
percent''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to taxable years beginning after the date of the 
enactment of this Act.

SEC. 205. NET INVESTMENT INCOME TAX.

    (a) In General.--Section 1411(a) of the Internal Revenue Code of 
1986 is amended by striking ``3.8 percent'' each place such term 
appears and inserting ``6.9 percent''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to taxable years beginning after the date of the 
enactment of this Act.

SEC. 206. TERMINATION OF HEALTH SAVINGS ACCOUNTS.

    Section 223(a) of the Internal Revenue Code of 1986 is amended by 
inserting after ``during such taxable year'' the following: ``and 
before December 31, 2019''.

SEC. 207. TERMINATION OF FLEXIBLE SPENDING ARRANGEMENTS.

    Section 125(i)(1) of the Internal Revenue Code of 1986 is amended 
by striking ``may not elect for any taxable year to have salary 
reduction contributions in excess of $2,500 made to such arrangement'' 
and inserting the following: ``may not elect to have salary reduction 
contributions made to such arrangement--
                    ``(A) for taxable years beginning before January 1, 
                2020, in excess of $2,500, and
                    ``(B) for taxable years beginning after December 
                31, 2019, in excess of $0.''.

SEC. 208. INCREASE IN EXCISE TAX ON SMALL CIGARS AND CIGARETTES AND 
              OTHER TOBACCO PRODUCTS.

    (a) Small Cigars.--Section 5701(a)(1) of the Internal Revenue Code 
of 1986 is amended by striking ``$50.33'' and inserting ``$100.66''.
    (b) Cigarettes.--Section 5701(b) of such Code is amended--
            (1) by striking ``$50.33'' in paragraph (1) and inserting 
        ``$100.66'', and
            (2) by striking ``$105.69'' in paragraph (2) and inserting 
        ``$211.38''.
    (c) Pipe Tobacco.--Section 5701(f) of the Internal Revenue Code of 
1986 is amended by striking ``$2.8311 cents'' and inserting ``$50.00''.
    (d) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is amended 
by striking ``$24.78'' and inserting ``$49.56''.
    (e) Large Cigars.--Paragraph (2) of section 5701(a) of the Internal 
Revenue Code of 1986 is amended by striking ``52.75 percent'' and all 
that follows through the period and inserting ``$24.78 per pound (and a 
proportionate tax at the like rate on all fractional parts of a pound) 
but not less than 5.033 cents per cigar.''.
    (f) Smokeless Tobacco.--
            (1) In general.--Section 5701(e) of the Internal Revenue 
        Code of 1986 is amended--
                    (A) in paragraph (1), by striking ``$1.51'' and 
                inserting ``$28.04'',
                    (B) in paragraph (2), by striking ``50.33 cents'' 
                and inserting ``$12.42'', and
                    (C) by adding at the end the following:
            ``(3) Smokeless tobacco sold in discrete single-use 
        units.--On discrete single-use units, $107.65 per each 1,000 
        single-use units.''.
            (2) Discrete single-use unit.--Section 5702(m) of such Code 
        is amended--
                    (A) in paragraph (1), by striking ``or chewing 
                tobacco'' and inserting ``chewing tobacco, discrete 
                single-use unit'';
                    (B) in paragraphs (2) and (3), by inserting ``that 
                is not a discrete single-use unit'' before the period 
                in each such paragraph; and
                    (C) by adding at the end the following:
            ``(4) Discrete single-use unit.--The term `discrete single-
        use unit' means any product containing tobacco that--
                    ``(A) is not intended to be smoked, and
                    ``(B) is in the form of a lozenge, tablet, pill, 
                pouch, dissolvable strip, or other discrete single-use 
                or single-dose unit.''.

SEC. 209. EXCISE TAX ON ALCOHOL.

    (a) Distilled Spirits.--Section 5001(a)(1) of the Internal Revenue 
Code of 1986 is amended by striking ``$13.50'' and inserting 
``$16.00''.
    (b) Wine.--
            (1) Section 5041(b)(1) of the Internal Revenue Code of 1986 
        is amended by striking ``$1.07 per wine gallon'' and inserting 
        ``$16.00 per proof gallon''.
            (2) Section 5041(b)(2) of the Internal Revenue Code of 1986 
        is amended by striking ``$1.57 per wine gallon'' and inserting 
        ``$16.00 per proof gallon''.
            (3) Section 5041(b)(3) of the Internal Revenue Code of 1986 
        is amended by striking ``$3.15 per wine gallon'' and inserting 
        ``$16.00 per proof gallon''.
            (4) Section 5041(b)(4) of the Internal Revenue Code of 1986 
        is amended by striking ``$3.40 per wine gallon'' and inserting 
        ``$16.00 per proof gallon''.
            (5) Section 5041(b)(5) of the Internal Revenue Code of 1986 
        is amended by striking ``$3.30 per wine gallon'' and inserting 
        ``$16.00 per proof gallon''.
            (6) Section 5041(b)(3) of the Internal Revenue Code of 1986 
        is amended by striking ``$22.6 cents per wine gallon'' and 
        inserting ``$16.00 per proof gallon''.
    (c) Beer.--Section 5051(B) of the Internal Revenue Code of 1986 is 
amended by striking ``$18 for per barrel'' and inserting ``$16 per 
proof gallon''.

SEC. 210. TAX ON SUGARED DRINKS.

    (a) In General.--Subchapter D of chapter 32 of the Internal Revenue 
Code of 1986 is amended by inserting after part I the following new 
part:

                  ``PART II--SUGAR-SWEETENED BEVERAGES

``Sec. 4171. Imposition of tax.
``Sec. 4172. Definitions.
``Sec. 4173. Special rules.

``SEC. 4171. IMPOSITION OF TAX.

    ``(a) In General.--There is hereby imposed a tax on the sale or 
transfer of any specified sugar-sweetened beverage product by the 
manufacturer, producer, or importer thereof.
    ``(b) Rate of Tax.--The rate of tax imposed under subsection (a) 
shall be equal to one cent per 4.2 grams of caloric sweetener contained 
in such specified sugar-sweetened beverage product.
    ``(c) Persons Liable for Tax.--The manufacturer, producer, or 
importer referred to in subsection (a) shall be liable for the tax 
imposed by such subsection.

``SEC. 4172. DEFINITIONS.

    ``(a) Specified Sugar-Sweetened Beverage Product.--For purposes of 
this part--
            ``(1) In general.--For purposes of this part, the term 
        `specified sugar-sweetened beverage product' means--
                    ``(A) any liquid intended for human consumption 
                which contains a caloric sweetener, and
                    ``(B) any liquid, or solid mixture of ingredients, 
                which--
                            ``(i) contains a caloric sweetener, and
                            ``(ii) is intended for use as an ingredient 
                        in a liquid described in subparagraph (A).
            ``(2) Exceptions.--The following shall not be treated as 
        liquids described in paragraph (1)(A):
                    ``(A) Any liquid the primary ingredients of which 
                are milk or soy, rice, or similar plant-based milk 
                substitute.
                    ``(B) Any liquid composed entirely of one or more 
                of the following:
                            ``(i) The original liquid resulting from 
                        the pressing of fruit or vegetables.
                            ``(ii) The liquid resulting from the 
                        reconstitution of fruit or vegetable juice 
                        concentrate.
                            ``(iii) The liquid resulting from the 
                        restoration of water to dehydrated fruit or 
                        vegetable juice.
                    ``(C) Infant formula.
                    ``(D) Any liquid products manufactured for use as--
                            ``(i) an oral nutritional therapy for 
                        persons who cannot absorb or metabolize dietary 
                        nutrients from food or beverages,
                            ``(ii) a source of necessary nutrition used 
                        due to a medical condition, or
                            ``(iii) an oral electrolyte solution for 
                        infants and children formulated to prevent 
                        dehydration due to illness.
                    ``(E) Any liquid with respect to which tax is 
                imposed under chapter 51 (relating to distilled 
                spirits, wines, and beer) or under section 7652 by 
                reason of the tax imposed under chapter 51 being 
                imposed on like articles of domestic manufacture.
    ``(b) Caloric Sweetener.--For purposes of this part, the term 
`caloric sweetener' means monosaccharides, disaccharides, and high-
fructose corn syrup.

``SEC. 4173. SPECIAL RULES.

    ``(a) Sweetener Taxed Only Once.--In the case of any specified 
sugar-sweetened beverage product which is manufactured or produced by 
including one or more other specified sugar-sweetened beverage 
products, no tax shall be imposed under this section on any caloric 
sweetener contained in the resulting specified sugar-sweetened beverage 
product if tax was previously imposed under this section on such 
caloric sweetener when contained in the specified sugar-sweetened 
beverage product so included.
    ``(b) Inflation Adjustment.--In the case of any sale after December 
31, 2015, the one cent amount in section 4171(b) shall be increased by 
an amount equal to--
            ``(1) such amount, multiplied by
            ``(2) the cost-of-living adjustment determined under 
        section 1(f)(3) for the calendar year in which such sale 
        occurs, determined by substituting `calendar year 2014' for 
        `calendar year 1992' in subparagraph (B) thereof.
Any increase determined under this subsection shall be rounded to the 
nearest multiple of one-tenth of a cent.''.
    (b) Conforming Amendments.--
            (1) Section 4221(a) is amended by adding at the end the 
        following: ``Paragraphs (1), (4), (5), and (6) shall not apply 
        to the tax imposed under section 4171.''.
            (2) The table of parts for subchapter D of chapter 32 of 
        such Code is amended by inserting after the item relating to 
        part I the following new item:

                ``Part II--Sugar-Sweetened Beverages''.

    (c) Revenues Used for Prevention, Treatment, and Research of Diet-
Related Health Conditions in Priority Populations.--
            (1) Transfer to prevention and public health fund.--There 
        are hereby appropriated to the Prevention and Public Health 
        Fund created under section 4002 of the Patient Protection and 
        Affordable Care Act (in addition to any other amounts 
        appropriated to such Fund) amounts equivalent to taxes received 
        in the Treasury under part II of subchapter D of chapter 32. 
        Rules similar to the rules of section 9601 of the Internal 
        Revenue Code of 1986 shall apply with respect to amounts 
        appropriated under this paragraph.
            (2) Restriction on use of funds.--Notwithstanding 
        subsections (c) and (d) of section 4002 of the Patient 
        Protection and Affordable Care Act, amounts appropriated to the 
        Prevention and Public Health Fund under paragraph (1) may be 
        transferred to accounts in the Department of Health and Human 
        Services only for the purpose of making expenditures for 
        programs and research designed to reduce the human and economic 
        costs of diabetes, obesity, dental caries, and other diet-
        related health conditions in priority populations (within the 
        meaning of section 901(c) of the Public Health Service Act).
    (d) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall take effect on the date 
        of the enactment of this Act.
            (2) Excise tax.--The amendments made by subsections (a) and 
        (b) shall apply to sales after the date of the enactment of 
        this Act.

                   TITLE III--DRUG-RELATED PROVISIONS

SEC. 301. ESTABLISHMENT OF THE PRESCRIPTION DRUG AND MEDICAL DEVICE 
              REVIEW BOARD.

    There is established in the Department of Health and Human Services 
a board to be known as the Prescription Drug and Medical Device Price 
Review Board (in this Act referred to as the ``Board'').

SEC. 302. MEMBERSHIP; STAFF.

    (a) Members.--The Board shall be composed of the members as 
follows:
            (1) The Assistant Secretary for Planning and Evaluation of 
        the Department of Health and Human Services (or the Assistant 
        Secretary's designee).
            (2) The Administrator of the Centers for Medicare & 
        Medicaid Services or, beginning with 2022, the Administrator of 
        the Center for Medicare (or the Administrator's designee).
            (3) The Assistant Director for the Health Services Division 
        of the Federal Bureau of Prisons (or the Assistant Director's 
        designee).
            (4) The Secretary of Defense (or the Secretary's designee).
            (5) The Secretary of Veterans Affairs (or the Secretary's 
        designee).
            (6) The Commissioner of Food and Drugs (or the 
        Commissioner's designee).
            (7) The Director of the National Institutes of Health.
    (b) Chairperson.--The Board shall designate 1 member of the Board 
to serve as the chairperson.
    (c) Director and Staff.--
            (1) Director.--The Board shall have a director who shall be 
        appointed by the chairperson of the Board, subject to rules 
        prescribed by the Board.
            (2) Staff.--The director may appoint and fix the pay of 
        such additional personnel as the chairperson considers 
        appropriate, subject to rules prescribed by the Board.
            (3) Applicability of certain civil service laws.--The 
        director and staff of the Board shall be appointed subject to 
        the provisions of title 5, United States Code, governing 
        appointments in the competitive service, and shall be paid in 
        accordance with the requirements of chapter 51 and subchapter 
        III of chapter 53 of such title relating to classification and 
        General Schedule pay rates; except that an individual so 
        appointed may not receive pay in excess of the maximum annual 
        rate of basic pay payable for grade GS-15 of the General 
        Schedule.
    (d) Assistance for the Board.--Subject to section 306(g), in 
carrying out this title, the Board--
            (1) may seek assistance from outside experts in the fields 
        of consumer advocacy, medicine, pharmacology, pharmacy, and 
        prescription drug reimbursement; and
            (2) shall establish and maintain an advisory group and a 
        stakeholder group for purposes of seeking such assistance.
    (e) Initial Meeting.--The Board shall hold its initial meeting not 
later than 90 days after the date of the enactment of this Act.

SEC. 303. REPORTING REQUIREMENTS.

    (a) Reporting by Manufacturers.--The Board shall require each 
manufacturer of a prescription drug or medical device that is sold in 
the United States to submit to the Board on a periodic basis, at a 
level of specificity determined by the Board to be necessary to make a 
determination under section 304, the following information with respect 
to the reporting period:
            (1) Each type of prescription drug and medical device that 
        is sold by the manufacturer or an affiliate of the 
        manufacturer--
                    (A) in the United States; or
                    (B) in a country that is a member of the 
                Organization for Economic Co-operation and Development.
            (2) The price charged by the manufacturer and the affiliate 
        for the prescription drug or medical device in the United 
        States and in any such country, as applicable.
            (3) The costs of the manufacturer and the affiliate to 
        produce and market the prescription drug or medical device for 
        sale in the United States and in any such country, as 
        applicable.
    (b) Reporting by CBO.--The Director of the Congressional Budget 
Office shall submit an annual report to the Board on trends in the 
prices charged for prescription drugs and medical devices.

SEC. 304. PROHIBITION AGAINST EXCESSIVE PRICE.

    (a) Prohibition.--Beginning on the effective date of the regulation 
required by subsection (b), the manufacturer of a prescription drug or 
medical device shall not charge an excessive price, as determined 
pursuant to such regulation, for such drug or device.
    (b) Formula.--The Board shall by regulation prescribe a formula for 
determining whether the average manufacturer price of such drug or 
device over an annual quarter is an excessive price.
    (c) Determination of Excessive Price.--If the Board determines, on 
its own initiative or in response to a petition submitted under 
subsection (d), that the manufacturer of a prescription drug or medical 
device charges an excessive price for such drug or device in violation 
of subsection (a)--
            (1) the Board shall give the manufacturer--
                    (A) notice of such violation; and
                    (B) subject to subsection (d), a period to correct 
                such violation; and
            (2) if the manufacturer fails to correct the violation by 
        the end of such period, the manufacturer shall be subject to 
        section 305, section 1927(c)(2)(E) of the Social Security Act 
        (as added by subsection (c) of section 305), and section 4192 
        of the Internal Revenue Code of 1986, as added by subsection 
        (d) of section 305.
    (d) Petitions.--Any person may petition the Board to make a 
determination under subsection (c) regarding the pricing of a 
prescription drug or medical device. Not later than 90 days after the 
date of receipt of such a petition, the Board shall--
            (1) make a determination under subsection (c) regarding 
        such pricing; or
            (2) decline to make such a determination.
    (e) Continuing Violation.--The Board shall not be required to give 
a manufacturer an opportunity to correct a violation, as described in 
subsection (c)(1)(B), before the manufacturer becomes subject to the 
provisions described in subsection (c)(2) for such violation, if--
            (1) the Board has already provided such an opportunity to 
        correct to the manufacturer; and
            (2) the Board finds that the violation of subsection (a) is 
        a continuation of an earlier violation with respect to which 
        such an opportunity was provided.
    (f) Considerations.--The formula required by subsection (a) shall 
at a minimum take into consideration--
            (1) the average manufacturer price of the prescription drug 
        or medical device over the respective annual quarter or 
        quarters;
            (2) the average manufacturer price of other prescription 
        drugs or medical devices in the same therapeutic class over the 
        same quarter or quarters;
            (3) the average price at which the prescription drug or 
        medical device and other prescription drugs and medical devices 
        in the same therapeutic class have been sold by manufacturers 
        in countries other than the United States;
            (4) the costs associated with producing and marketing the 
        prescription drug or medical device, the value of the drug or 
        device to patients where sufficient data is available to 
        determine such value, the total Federal investment in the 
        development of the drug or device, the size of the patient 
        population receiving the drug or device, and other factors 
        determinative as to the true cost of production; and
            (5) whether the price of the prescription drug or medical 
        device increased during any annual quarter by a percentage that 
        is more than 2 percent greater than the CPI increase percentage 
        (as defined in section 215(i) of the Social Security Act (42 
        U.S.C. 415)) for the respective annual quarter.

SEC. 305. ENFORCEMENT PROVISIONS.

    (a) Reduced Patent Term.--If the Board finds that the manufacturer 
of a prescription drug or medical device, who is also an owner of a 
patent for such drug or device, charged an excessive price for such 
drug or device in violation of section 304(a), the Board may--
            (1) reduce the term, by not more than 5 years, of any 
        patent issued under title 35, United States Code, relating to 
        such drug or device; or
            (2) if the term of each patent for such drug or device has 
        expired, reduce the term, by not more than 5 years, of another 
        patent owned by the patent owner relating to a prescription 
        drug or medical device.
    (b) Civil Penalties.--If the Board determines under section 304(c) 
that a manufacturer of a prescription drug or medical device charged an 
excessive price for a prescription drug or medical device in violation 
of section 304(a), the Board may impose a civil penalty on the 
manufacturer of not more than 10 percent of the manufacturer's gross 
sales of the drug or device during the period beginning on the date on 
which an excessive price is first charged and ending on the date on 
which the manufacturer ceases to charge an excessive price.
    (c) Enforcement Through Increased Medicaid Rebates.--
            (1) In general.--Section 1927(c)(2) of the Social Security 
        Act (42 U.S.C. 1396r-8(c)(2)) is amended--
                    (A) in subparagraph (A), by inserting ``, subject 
                to subparagraph (E),'' after ``increased by''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(E) Discouraging excessive prices.--
                            ``(i) In general.--In the case of a 
                        manufacturer of a single source drug or an 
                        innovator multiple source drug with a rebate 
                        agreement under this section, if the 
                        Prescription Drug and Medical Device Price 
                        Review Board established under section 301 of 
                        the Medicare for America Act determines under 
                        section 304(a) of such Act that such 
                        manufacturer charged, with respect to a 30-day 
                        period, an excessive price for such drug, and 
                        the Board determines under clause (ii) to apply 
                        an increased amount described in such clause 
                        with respect to such manufacturer and drug, the 
                        amount of the rebate determined under 
                        subparagraph (A) for such manufacturer and drug 
                        shall be, subject to subparagraph (D), 
                        increased by such amount for the 4 rebate 
                        periods following such 30-day period.
                            ``(ii) Increased amount determination.--For 
                        purposes of clause (i), if the Board described 
                        in such clause makes such a determination under 
                        such section 304(a), with respect to a 
                        manufacturer and drug described in such clause, 
                        the Board may determine an increased amount to 
                        apply with respect to such manufacturer and 
                        drug and rebate period described in such 
                        clause. Such increased amount may not exceed 
                        the rebate amount that would otherwise be 
                        applied to such manufacturer and drug under 
                        this section for such rebate period, without 
                        regard to this subparagraph.''.
            (2) Effective date.--This subsection and the amendments 
        made by this subsection shall apply with respect to rebate 
        agreements entered into after the date that is 60 days after 
        the date of the enactment of this Act.
    (d) Tax on Excess Prescription Drug and Medical Device Profits.--
            (1) Determination of amount.--If the Board determines under 
        section 304(a) that a manufacturer, producer, or importer of a 
        prescription drug or medical device charged an excessive price 
        for such prescription drug or medical device during a taxable 
        year, the Board may determine under this paragraph a reasonable 
        price for such drug or device for such taxable year.
            (2) Imposition of tax.--
                    (A) In general.--The Internal Revenue Code of 1986 
                is amended by inserting after section 4191 the 
                following new section:

``SEC. 4192. EXCESSIVE PRESCRIPTION DRUG AND MEDICAL DEVICE PRICE.

    ``(a) In General.--There is hereby imposed on the sale of any 
prescription drug or medical device by the manufacturer, producer, or 
importer a tax equal to the difference between the price at which such 
drug or device is so sold and the reasonable price determined by the 
Prescription Drug and Medical Device Price Review Board under section 
305(d)(1) of the Medicare for America Act for such drug or device for 
the taxable year for sales after the determination.
    ``(b) Prescription Drug or Medical Device.--For purposes of this 
section, the term `prescription drug or medical device' means any 
prescription drug (as defined in section 9008 of the Patient Protection 
and Affordable Care Act) or device (as defined in section 201(h) of the 
Federal Food, Drug, and Cosmetic Act) intended for humans.''.
                    (B) Clerical amendment.--The table of parts for 
                chapter 32 of such Code is amended--
                            (i) in the item relating to subchapter E, 
                        by striking ``Medical'' and inserting ``Drugs 
                        and medical'', and
                            (ii) by inserting after the item relating 
                        to section 4191 the following new item:

``SEC. 4192. EXCESSIVE PRESCRIPTION DRUG AND MEDICAL DEVICE PRICE.''.

            (3) Effective date.--This subsection and the amendments 
        made by this subsection shall apply with respect to sales after 
        December 31, 2018.

SEC. 306. AUTHORITY.

    (a) Obtaining Official Data.--The chairperson of the Board may 
secure directly from any Federal agency information necessary to enable 
the Board to carry out its duties. Upon request of the chairperson, the 
head of the agency shall furnish such information to the Board to the 
extent such information is not prohibited from disclosure by law.
    (b) Mails.--The Board may use the United States mails in the same 
manner and under the same conditions as other Federal agencies.
    (c) Administrative Support Services.--Upon the request of the 
chairperson of the Board, the Administrator of General Services shall 
provide to the Board, on a reimbursable basis, the administrative 
support services necessary for the Board to carry out its duties.
    (d) Contract Authority.--The Board may contract with and compensate 
government and private agencies or persons for the purpose of 
conducting research, surveys, and other services necessary to enable 
the Board to carry out its duties.
    (e) Investigations.--The Board may make such investigations as it 
considers necessary to determine whether there is or may be a violation 
of any regulation promulgated under this Act and may require or permit 
any person to file with it a statement in writing, under oath or 
otherwise as the Board shall determine, as to all the facts and 
circumstances concerning the matter to be investigated.
    (f) Subpoena Power.--
            (1) In general.--The Board may issue subpoenas requiring 
        the attendance and testimony of witnesses and the production of 
        any evidence relating to any matter under investigation by the 
        Board. The attendance of witnesses and the production of 
        evidence may be required from any place within the United 
        States at any designated place of hearing within the United 
        States.
            (2) Failure to obey a subpoena.--If a person refuses to 
        obey a subpoena issued under paragraph (1), the Board may apply 
        to a United States district court for an order requiring that 
        person to appear before the Board to give testimony, produce 
        evidence, or both, relating to the matter under investigation. 
        The application may be made within the judicial district where 
        the hearing is conducted or where that person is found, 
        resides, or transacts business. Any failure to obey the order 
        of the court may be punished by the court as civil contempt.
            (3) Service of subpoenas.--The subpoenas of the Board shall 
        be served in the manner provided for subpoenas issued by a 
        United States district court under the Federal Rules of Civil 
        Procedure for the United States district courts.
            (4) Service of process.--All process of any court to which 
        application is made under paragraph (2) may be served in the 
        judicial district in which the person required to be served 
        resides or may be found.
            (5) Notice.--Upon issuing any subpoena under this 
        subsection, the Board shall give notice of such issuance to the 
        appropriate committees of Congress, including the Committee on 
        Appropriations of the House of Representatives and the 
        Committee on Appropriations of the Senate.
    (g) Confidentiality.--Nothing in this title shall be construed as 
authorizing the Board to disclose any information that is a trade 
secret or confidential information subject to section 552(b)(4) of 
title 5, United States Code, or section 1905 of title 18, United States 
Code.

SEC. 307. REGULATIONS.

    (a) In General.--Not later than 1 year after the date of the 
initial meeting held under section 302(e), the Board shall issue final 
regulations to carry out this Act.
    (b) Notice and Comment Requirement.--The regulations developed 
under subsection (a) shall be issued in accordance with the notice and 
comment procedures established under section 553 of title 5, United 
States Code.

SEC. 308. REPORT TO FEDERAL AGENCIES.

    Not later than 1 year after the effective date of the regulations 
under section 307 and annually thereafter, the Board shall submit to 
each Federal agency that dispenses or makes payments for the dispensing 
of prescription drugs or medical devices a report containing--
            (1) a list of each prescription drug and medical device for 
        which an excessive price was charged during the preceding 
        calendar year, as determined by the Board under section 304;
            (2) recommendations to the Federal agency against 
        dispensing or making payments for the dispensing of the 
        prescription drug or medical device; and
            (3) recommendations to the Federal agency to substitute, in 
        place of any drug or device listed pursuant to paragraph (1), a 
        similar prescription drug or medical device that is not sold at 
        an excessive price.

SEC. 309. DEFINITIONS.

    In this title:
            (1) The term ``affiliate'' means, with respect to a 
        manufacturer, any entity that controls, is controlled by, or is 
        under common control with such manufacturer.
            (2) The term ``average manufacturer price'' means the 
        average price charged by the manufacturer of a prescription 
        drug or medical device, as applicable, for sales of the drug or 
        device by the manufacturer in the United States over the 
        respective annual quarter.
            (3) The term ``medical device'' means a device (as defined 
        in section 201 of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 321)).
            (4) The term ``prescription drug'' means a drug (as defined 
        in section 201 of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 321)) that is subject to section 503(b)(1) of such Act 
        (21 U.S.C. 353(b)(1)).

SEC. 310. MORATORIUM ON DIRECT-TO-CONSUMER DRUG ADVERTISING.

    The Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) is 
amended--
            (1) in section 301 (21 U.S.C. 331), by adding at the end 
        the following:
    ``(eee) The conduct of direct-to-consumer advertising of a drug in 
violation of section 506J.''; and
            (2) in chapter V, by inserting after section 506I (21 
        U.S.C. 356f) the following:

``SEC. 506J. DIRECT-TO-CONSUMER DRUG ADVERTISING.

    ``(a) Prohibitions.--
            ``(1) First three years.--
                    ``(A) In general.--Subject to subparagraph (B), no 
                person shall conduct direct-to-consumer advertising of 
                a drug for which an application is submitted under 
                section 505(b) before the end of the 3-year period 
                beginning on the date of the approval of such 
                application.
                    ``(B) Waiver.--The Secretary may waive the 
                application of subparagraph (A) to a drug during the 
                third year of the 3-year period described in such 
                subparagraph if--
                            ``(i) the sponsor of the drug submits an 
                        application to the Secretary pursuant to 
                        subparagraph (C); and
                            ``(ii) the Secretary, after considering the 
                        application and any accompanying materials, 
                        determines that direct-to-consumer advertising 
                        of the drug would have an affirmative value to 
                        public health.
                    ``(C) Application for waiver.--To seek a waiver 
                under subparagraph (B), the sponsor of a drug shall 
                submit an application to the Secretary at such time, in 
                such manner, and containing such information as the 
                Secretary may require.
            ``(2) Subsequent years.--The Secretary may prohibit direct-
        to-consumer advertising of a drug during the period beginning 
        at the end of the 3-year period described in paragraph (1)(A) 
        if the Secretary determines that the drug has significant 
        adverse health effects based on post-approval studies, risk-
        benefit analyses, adverse event reports, the scientific 
        literature, any clinical or observational studies, or any other 
        appropriate resource.
    ``(b) Regulations.--Not later than 1 year after the date of the 
enactment of this section, the Secretary shall revise the regulations 
promulgated under this Act governing drug advertisements to the extent 
necessary to implement this section.
    ``(c) Rule of Construction.--This section shall not be construed to 
diminish the authority of the Secretary to prohibit or regulate direct-
to-consumer advertising of drugs under other provisions of law.''.

SEC. 311. REPORTING ON JUSTIFICATION FOR DRUG PRICE INCREASES.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

            ``PART W--DRUG PRICE REPORTING; DRUG VALUE FUND

``SEC. 399OO. REPORTING ON JUSTIFICATION FOR DRUG PRICE INCREASES.

    ``(a) Definitions.--In this section:
            ``(1) Manufacturer.--The term `manufacturer' means the 
        person--
                    ``(A) that holds the application for a drug 
                approved under section 505 of the Federal Food, Drug, 
                and Cosmetic Act or the license issued under section 
                351 of the Public Health Service Act; or
                    ``(B) who is responsible for setting the price for 
                the drug.
            ``(2) Qualifying drug.--The term `qualifying drug' means 
        any drug that is approved under subsection (c) or (j) of 
        section 505 of the Federal Food, Drug, and Cosmetic Act or 
        licensed under subsection (a) or (k) of section 351 of this 
        Act--
                    ``(A) that has a wholesale acquisition cost of $100 
                or more per month supply or per a course of treatment 
                that lasts less than a month and is--
                            ``(i)(I) subject to section 503(b)(1) of 
                        the Federal Food, Drug, and Cosmetic Act; or
                            ``(II) commonly administered by hospitals 
                        (as determined by the Secretary);
                            ``(ii) not designated as a drug for a rare 
                        disease or condition under section 526 of the 
                        Federal Food, Drug, and Cosmetic Act; and
                            ``(iii) not designated by the Secretary as 
                        a vaccine; and
                    ``(B) for which, during the previous calendar year, 
                at least 1 dollar of the total amount of sales were for 
                individuals enrolled under the Medicare program under 
                title XVIII of the Social Security Act (42 U.S.C. 1395 
                et seq.) or under a State Medicaid plan under title XIX 
                of such Act (42 U.S.C. 1396 et seq.) or under a waiver 
                of such plan.
            ``(3) Wholesale acquisition cost.--The term `wholesale 
        acquisition cost' has the meaning given that term in section 
        1847A(c)(6)(B) of the Social Security Act (42 U.S.C. 1395w-
        3a(c)(6)(B)).
    ``(b) Report.--
            ``(1) Report required.--The manufacturer of a qualifying 
        drug shall submit a report to the Secretary for each price 
        increase of a qualifying drug that will result in an increase 
        in the wholesale acquisition cost of that drug that is equal 
        to--
                    ``(A) 10 percent or more over a 12-month period; or
                    ``(B) 25 percent or more over a 36-month period.
            ``(2) Report deadline.--Each report described in paragraph 
        (1) shall be submitted to the Secretary not later than 30 days 
        prior to the planned effective date of such price increase.
    ``(c) Contents.--A report under subsection (b) shall, at a minimum, 
include--
            ``(1) with respect to the qualifying drug--
                    ``(A) the percentage by which the manufacturer will 
                raise the wholesale acquisition cost of the drug on the 
                planned effective date of such price increase;
                    ``(B) a justification for, and description of, each 
                manufacturer's price increase that occurred during the 
                12-month period described in subsection (b)(1)(A) or 
                the 36-month period described in subsection (b)(1)(B), 
                as applicable;
                    ``(C) the identity of the initial developer of the 
                drug;
                    ``(D) a description of the history of the 
                manufacturer's price increases for the drug since the 
                approval of the application for the drug under section 
                505 of the Federal Food, Drug, and Cosmetic Act or the 
                issuance of the license for the drug under section 351, 
                or since the manufacturer acquired such approved 
                application or license;
                    ``(E) the current list price of the drug;
                    ``(F) the total expenditures of the manufacturer 
                on--
                            ``(i) materials and manufacturing for such 
                        drug; and
                            ``(ii) acquiring patents and licensing for 
                        such drug;
                    ``(G) the percentage of total expenditures of the 
                manufacturer on research and development for such drug 
                that was derived from Federal funds;
                    ``(H) the total expenditures of the manufacturer on 
                research and development for such drug that is used 
                for--
                            ``(i) basic and preclinical research;
                            ``(ii) clinical research;
                            ``(iii) new drug development;
                            ``(iv) pursuing new or expanded indications 
                        for such drug through supplemental applications 
                        under section 505 of the Federal Food, Drug, 
                        and Cosmetic Act; and
                            ``(v) carrying out postmarket requirements 
                        related to such drug, including those under 
                        section 505(o)(3) of such Act;
                    ``(I) the total revenue and the net profit 
                generated from the qualifying drug for each calendar 
                year since the approval of the application for the drug 
                under section 505 of the Federal Food, Drug, and 
                Cosmetic Act or the issuance of the license for the 
                drug under section 351, or since the manufacturer 
                acquired such approved application or license; and
                    ``(J) the total costs associated with marketing and 
                advertising for the qualifying drug;
            ``(2) with respect to the manufacturer--
                    ``(A) the total revenue and the net profit of the 
                manufacturer for the 12-month period described in 
                subsection (b)(1)(A) or the 36-month period described 
                in subsection (b)(1)(B), as applicable;
                    ``(B) all stock-based performance metrics used by 
                the manufacturer to determine executive compensation 
                for the 12-month period described in subsection 
                (b)(1)(A) or the 36-month period described in 
                subsection (b)(1)(B), as applicable; and
                    ``(C) any additional information the manufacturer 
                chooses to provide related to drug pricing decisions, 
                such as total expenditures on--
                            ``(i) drug research and development; or
                            ``(ii) clinical trials on drugs that failed 
                        to receive approval by the Food and Drug 
                        Administration; and
            ``(3) such other related information as the Secretary 
        considers appropriate.
    ``(d) Civil Penalty.--Any manufacturer of a qualifying drug that 
fails to submit a report for the drug as required by this section shall 
be subject to a civil penalty of $100,000 for each day on which the 
violation continues.
    ``(e) Public Posting.--
            ``(1) In general.--Subject to paragraph (3), not later than 
        30 days after the submission of a report under subsection (b), 
        the Secretary shall post the report on the public website of 
        the Department of Health and Human Services.
            ``(2) Format.--In developing the format of such report for 
        public posting, the Secretary shall consult stakeholders, 
        including beneficiary groups, and shall seek feedback on the 
        content and format from consumer advocates and readability 
        experts to ensure such public reports are user-friendly to the 
        public and are written in plain language that consumers can 
        readily understand.
            ``(3) Trade secrets and confidential information.--In 
        carrying out this section, the Secretary shall enforce 
        applicable law concerning the protection of confidential 
        commercial information and trade secrets.

``SEC. 399OO-1. USE OF CIVIL PENALTY AMOUNTS.

    ``The Secretary shall collect the civil penalties under section 
399OO, in addition to any other amounts available, and without further 
appropriation, and shall use such funds to carry out activities 
described in this part and to improve consumer and provider information 
about drug value and drug price transparency.

``SEC. 399OO-2. ANNUAL REPORT TO CONGRESS.

    ``(a) In General.--Subject to subsection (b), the Secretary shall 
submit to Congress, and post on the public website of the Department of 
Health and Human Services in a way that is easy to use and understand, 
an annual report--
            ``(1) summarizing the information reported pursuant to 
        section 399OO; and
            ``(2) including copies of the reports and supporting 
        detailed economic analyses submitted pursuant to such section.
    ``(b) Trade Secrets and Confidential Information.--In carrying out 
this section, the Secretary shall enforce applicable law concerning the 
protection of confidential commercial information and trade secrets.''.
                                 <all>