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IN THE SENATE OF THE UNITED STATES

 

Mr. Storm, Mr.Clay and Mr Baudin(for themselves and for others with special thanks to Ms.Klobuchar,Mr.Stabenow and Ms.Lujan) introduced the following bill

 

A BILL

To Establish A State Public Opton through Medicaid to Provide Americans with the Choice of a high-quality,low-cost health insurance plan

 

Section 1.Short title

This Act may be cited as the "MediChoice Act of 2017".

 

Section 2. Expansion to 175% of the poverty line

1) BEGINNING 2020.—Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396a) is amended— (A) by striking ‘‘or’’ at the end of subclause (VI); (B) by adding ‘‘or’’ at the end of subclause (VII); and (C) by inserting after subclause (VII) the following: ‘‘(VIII) beginning January 1, 2020, who are under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, and are not described in a previous subclause of this clause, and whose income (as determined under subsection (e)(14)) does not exceed 175 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved, subject to subsection (k);’’

 

Section 3.NEGOTIATION OF LOWER COVERED PART D DRUG PRICES ON BEHALF OF MEDICARE BENEFICIARIES.

 

(a) Negotiation By Secretary.—Section 1860D–11 of the Social Security Act (42 U.S.C. 1395w–111) is amended by striking subsection (i) (relating to noninterference) and inserting the following:

 

“(i) Negotiation Of Lower Drug Prices.—

 

“(1) IN GENERAL.—Notwithstanding any other provision of law, the Secretary shall negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged to PDP sponsors and MA organizations for covered part D drugs for part D eligible individuals who are enrolled under a prescription drug plan or under an MA–PD plan.

 

“(2) NO CHANGE IN RULES FOR FORMULARIES.—

 

“(A) IN GENERAL.—Nothing in paragraph (1) shall be construed to authorize the Secretary to establish or require a particular formulary.

 

“(B) CONSTRUCTION.—Subparagraph (A) shall not be construed as affecting the Secretary’s authority to ensure appropriate and adequate access to covered part D drugs under prescription drug plans and under MA–PD plans, including compliance of such plans with formulary requirements under section 1860D–4(b)(3).

 

“(3) CONSTRUCTION.—Nothing in this subsection shall be construed as preventing the sponsor of a prescription drug plan, or an organization offering an MA–PD plan, from obtaining a discount or reduction of the price for a covered part D drug below the price negotiated under paragraph (1).

 

“(4) SEMI-ANNUAL REPORTS TO CONGRESS.—Not later than June 1, 2021, and every 6 months thereafter, the Secretary shall submit to the Committees on Ways and Means, Energy and Commerce, and Oversight and Government Reform of the House of Representatives and the Committee on Finance of the Senate a report on negotiations conducted by the Secretary to achieve lower prices for Medicare beneficiaries, and the prices and price discounts achieved by the Secretary as a result of such negotiations.”.

 

(b) Effective Date.—The amendment made by subsection (a) shall take effect on the date of the enactment of this Act and shall first apply to negotiations and prices for plan years beginning on January 1, 2020.

 

Section 4:Promoting Hospital Competition

SEC. 2. PREMERGER NOTIFICATION FILING FEES.

 

Section 605 of Public Law 101–162 (15 U.S.C. 18a note) is amended—

(1) in subsection (b)—

(A) in paragraph (1)—

(i) by striking “$45,000” and inserting “$30,000”;

(ii) by striking “$100,000,000” and inserting “$161,500,000”;

(iii) by striking “2004” and inserting “2018”; and

(iv) by striking “2003” and inserting “2017”;

(B) in paragraph (2)—

(i) by striking “$125,000” and inserting “$100,000”;

(ii) by striking “$100,000,000” and inserting “$161,500,000”;

(iii) by striking “but less” and inserting “but is less”; and

(iv) by striking “and” at the end;

(C) in paragraph (3)—

(i) by striking “$280,000” and inserting “$250,000”; and

(ii) by striking the period at the end and inserting “but is less than $1,000,000,000 (as so adjusted and published);”; and

(D) by adding at the end the following:

 

“(4) $400,000 if the aggregate total amount determined under section 7A(a)(2) of the Clayton Act (15 U.S.C. 18a(a)(2)) is not less than $1,000,000,000 (as so adjusted and published) but is less than $2,000,000,000 (as so adjusted and published);

 

“(5) $800,000 if the aggregate total amount determined under section 7A(a)(2) of the Clayton Act (15 U.S.C. 18a(a)(2)) is not less than $2,000,000,000 (as so adjusted and published) but is less than $5,000,000,000 (as so adjusted and published); and

 

“(6) $2,250,000 if the aggregate total amount determined under section 7A(a)(2) of the Clayton Act (15 U.S.C. 18a(a)(2)) is not less than $5,000,000,000 (as so adjusted and published).”; and

 

(2) by adding at the end the following:

“(c) (1) For each fiscal year commencing after September 30, 2018, the filing fees in this section shall be increased as of October 1 each year by an amount equal to the percentage increase, if any, in the Producer Price Index, as determined by the Department of Commerce or its successor, for the year then ended over the level so established for the year ending September 30, 2017.

 

“(2) As soon as practicable, but not later than January 31 of each year, the Federal Trade Commission shall publish the adjusted amounts required by this section.

 

“(3) The Federal Trade Commission shall not adjust amounts required by this section if the percentage increase described in paragraph (1) is less than 1 percent.

 

“(4) An amount adjusted under this section shall be rounded to the nearest multiple of $5,000.”.

 

SEC. 3. POST-SETTLEMENT DATA.

Section 7A of the Clayton Act (15 U.S.C. 18a) is amended by adding at the end the following:

“(l) (1) Each person who enters into an agreement with the Federal Trade Commission or the United States to resolve a proceeding brought under the antitrust laws or under the Federal Trade Commission Act (15 U.S.C. 41 et seq.) regarding an acquisition with respect to which notification is required under this section shall, on an annual basis during the 5-year period beginning on the date on which the agreement is entered into, submit to the Federal Trade Commission or the Assistant Attorney General, as applicable, information sufficient for the Federal Trade Commission or the United States, as applicable, to assess the competitive impact of the acquisition, including—

 

“(A) the pricing, availability, and quality of any product or service, or inputs thereto, in any market, that was covered by the agreement;

“(B) the source, and the resulting magnitude and extent, of any cost-saving efficiencies or any consumer benefits that were claimed as a benefit of the acquisition and the extent to which any cost savings were passed on to consumers; and

“(C) the effectiveness of any divestitures or any conditions placed on the acquisition in preventing or mitigating harm to competition.

“(2) The requirement to provide the information described in paragraph (1) shall be included in an agreement described in that paragraph.

 

“(3) The Federal Trade Commission, with the concurrence of the Assistant Attorney General, by rule in accordance with section 553 of title 5, United States Code, and consistent with the purposes of this section—

“(A) shall require that the information described in paragraph (1) be in such form and contain such documentary material and information relevant to a proposed acquisition as is necessary and appropriate to enable the Federal Trade Commission and the Assistant Attorney General to assess the competitive impact of the acquisition under paragraph (1); and

 

“(B) may—

“(i) define the terms used in this subsection;

“(ii) exempt, from the requirements of this section, information not relevant in assessing the competitive impact of the acquisition under paragraph (1); and

“(iii) prescribe such other rules as may be necessary and appropriate to carry out the purposes of this section.”.

 

SEC. 4. FEDERAL TRADE COMMISSION STUDY.

Not later than 2 years after the date of enactment of this Act, the Federal Trade Commission, in consultation with the Securities and Exchange Commission, shall conduct and publish a study, using any compulsory process necessary, relying on public data and information if available and sufficient, and incorporating public comment on—

(1) the extent to which an institutional investor or related institutional investors have ownership or control interests in competitors in moderately concentrated or concentrated markets;

(2) the economic impacts of such overlapping ownership or control; and

(3) the mechanisms by which an institutional investor could affect competition among the companies in which it invests and whether such mechanisms are prevalent.

 

SEC. 5. GAO STUDIES.

(a) In General.—Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall—

(1) conduct a study to assess the success of merger remedies required by the Department of Justice or the Federal Trade Commission in consent decrees entered into since 6 years prior to the date of enactment of this Act, including the impact on maintaining competition, a comparison of structural and conduct remedies, and the viability of divested assets; and

(2) conduct a study on the impact of mergers and acquisitions on wages, employment, innovation, and new business formation.

(b) Update.—The Comptroller General of the United States shall—

(1) update the study under paragraph (1) 3 years and 6 years after the date of enactment of this Act based on the information provided under section 7A(l) of the Clayton Act, as added by section 3 of this Act; and

(2) identify specific remedies or alleged merger benefits that require additional information or research.

 

SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

(a) In General.—There is authorized to be appropriated for fiscal year 2018—

(1) $180,606,000 for the Antitrust Division of the Department of Justice; and

(2) $342,000,000 for the Federal Trade Commission.

 

          Section 5.Empowering Small Businesses to Provide HealthCare

 

(a) In General.—Section 45R of the Internal Revenue Code of 1986 is amended—

(1) in subsection (a), by striking “in the credit period”,

(2) by amending subsection (c) to read as follows:

“(c) Phaseout Of Credit Amount Based On Average Wages.—The amount of the credit determined under subsection (b) without regard to this subsection shall be reduced (but not below zero) by such amount multiplied by a fraction—

“(1) the numerator of which is the average annual wages of the employer in excess of the dollar amount in effect under subsection (d)(3)(B), and

“(2) the denominator which is the amount equal to the difference between—

“(A) the dollar amount in effect under subsection (d)(1)(B), and

“(B) the dollar amount in effect under subsection (d)(3)(B).”,

(3) in subsection (d)—

(A) in paragraph (1)—

(i) in subparagraph (A), by striking “25” and inserting “50”, and

(ii) in subparagraph (B), by striking “an amount equal to twice the dollar amount in effect under paragraph (3)(B) for the taxable year” and inserting “$75,000”, and

(B) in paragraph (3), by amending subparagraph (B) to read as follows:

“(B) DOLLAR AMOUNT.—The dollar amount under this subparagraph shall be $50,000.”,

(4) in subsection (e)—

(A) by striking paragraph (2), and

(B) by redesignating paragraphs (3) through (5) as paragraphs (2) through (4), respectively,

(5) by amending subsection (g) to read as follows:

“(g) Cost-Of-Living Adjustment.—

“(1) IN GENERAL.—In the case of any taxable year beginning in a calendar year after 2017, each dollar amount in paragraphs (1)(B) and (3)(B) of subsection (d) shall be increased by an amount equal to—

“(A) such dollar amount, multiplied by

“(B) the cost-of-living adjustment determined under section 1(f)(3) for such calendar year, determined by substituting ‘calendar year 2016’ for ‘calendar year 1992’ in subparagraph (B) thereof.

“(2) ROUNDING.—If any increase under paragraph (1) is not a multiple of $1,000, such increase shall be rounded to the next lowest multiple of $1,000.”, and

(6) in subsection (i), by striking “2-year limit on the credit period through the use of successor entities and the avoidance of the limitations” and inserting “limitation”.

(b) Effective Date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2018.

 

 

     

 

 

         Section 6.MediChoice

SEC. 6A.

(a) In General.—Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—

(1) in subsection (a)(10)—

(A) in subparagraph (A)(ii)—

(i) in subclause (XXI), by striking “; or” and inserting a semicolon;

(ii) in subclause (XXII), by adding “or” at the end; and

(iii) by adding at the end the following new subclause:

“(XXIII) beginning January 1, 2018, who are residents of the State and are not concurrently enrolled in another health insurance coverage plan, subject, in the case of individuals described in subsection (nn) and notwithstanding section 1916 (except for subsection (k) of such section), to payment of premiums or other cost-sharing charges;”; and

(B) in the matter following subparagraph (G), in clause (XV), by inserting “or subsection (nn)” after “described in subparagraph (A)(i)(VIII)”; and

(2) by adding at the end the following new subsection:

“(nn) Previously Undescribed Individuals.—Individuals described in this subsection are individuals who are—

“(1) described in subclause (XXIII) of subsection (a)(10)(A)(ii); and

“(2) are not described in any other subclause of such subsection or any other provision in this Act which provides for eligibility for medical assistance.”.

(b) Provision Of At Least Minimum Coverage.—

(1) IN GENERAL.—Section 1902(k)(1) of the Social Security Act (42 U.S.C. 1396a(k)(1)) is amended by inserting “or an individual described in subsection (nn)” after “an individual described in subclause (VIII) of subsection (a)(10)(A)(i)” each place it appears.

(2) CONFORMING AMENDMENT.—Section 1903(i)(26) of the Social Security Act (42 U.S.C. 1396b(i)(26)) is amended by striking “individuals described in subclause (VIII) of subsection (a)(10)(A)(i)” and inserting “individuals described in subsection (a)(10)(A)(i)(VIII) or (nn) of section 1902”.

(c) Federal Financial Participation In Buy-In Program.—

(1) ENHANCED MATCH FOR ADMINISTRATIVE EXPENSES.—Section 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) is amended—

(A) by redesignating paragraph (7) as paragraph (8); and

(B) by inserting after paragraph (6) the following new paragraph:

“(7) an amount equal to 90 percent of the sums expended during the quarter which are attributable to reasonable administrative expenses related to the administration of a Medicaid buy-in program for individuals described in section 1902(a)(10)(A)(ii)(XXIII); plus”.

(2) TREATMENT OF PREMIUM AND COST-SHARING REVENUES FROM MEDICAID BUY-IN PROGRAM.—

(A) IN GENERAL.—For purposes of section 1903(a)(1) of the Social Security Act (42 U.S.C. 1396b(a)(1)), for any fiscal quarter during which a State collects premiums, cost-sharing, or similar charges under subsection (k) of section 1916 of such Act (42 U.S.C. 1396o) (as added by this Act), including any advance payments of premium tax credits under section 1412 of the Patient Protection and Affordable Care Act or payments for cost-sharing reductions under section 1402 of such Act that are received by the State, the total amount expended during such quarter as medical assistance for individuals who buy into Medicaid coverage under subclause (XXIII) of section 1902(a)(10)(A)(ii) of the Social Security Act (as added by this Act) shall be reduced by the amount of such premiums or charges.

(B) TREATMENT OF EXCESS PREMIUMS.—Each State that collects premiums or similar charges under subsection (k) of section 1916 of the Social Security Act (42 U.S.C. 1396o) (as added by this Act) in a fiscal year shall pay to the Secretary of Health and Human Services, at such time and in such form and manner as the Secretary shall specify, an amount equal to 50 percent of the amount, if any, by which—

(i) the total amount of such premiums and charges collected by the State for such year; exceeds

(ii) the total amount expended by the State during such year as medical assistance for individuals who buy into Medicaid coverage under subclause (XXIII) of section 1902(a)(10)(A)(ii) of such Act (as added by this Act).

(d) Cost-Sharing Requirement.—Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended by adding at the end the following new subsection:

“(k) Premiums And Cost-Sharing For Individuals Participating In Medicaid Buy-In Program.—

“(1) IN GENERAL.—Subject to paragraph (2), with respect to individuals who are eligible for medical assistance under subsection (a)(10)(A)(ii)(XXIII) of section 1902 and are described in subsection (nn) of such section, a State may—

“(A) impose premiums, deductibles, cost-sharing, or other similar charges that are actuarially fair; and

“(B) vary the premium rate imposed on an individual based only on the factors described in section 2701(a)(1)(A) of the Public Health Service Act and subject to the same limitations on the weight which may be given to such factors under such section.

“(2) LIMITATIONS.—

“(A) PREMIUMS.—The total amount of premiums imposed for a year under this subsection with respect to all individuals described in paragraph (1) in a family shall not exceed an amount equal to 9.5 percent of the family's household income (as defined in section 36B(d)(2) of the Internal Revenue Code of 1986) for the year involved.

“(B) OTHER COST-SHARING.—

“(i) IN GENERAL.—The cost-sharing limitations described in section 1302(c) of the Patient Protection and Affordable Care Act shall apply to cost-sharing (as defined in such section) for medical assistance provided under section 1902(a)(10)(A)(ii)(XXIII) in the same manner as such limitations apply to cost-sharing under qualified health plans under title I of such Act.

“(ii) AVAILABILITY OF COST-SHARING REDUCTIONS.—Individuals provided medical assistance under section 1902(a)(10)(A)(ii)(XXIII) and subject to cost-sharing under this subsection are eligible for cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act (subject to the income eligibility threshold in subsection (b)(2) of such section), and in applying such section—

“(I) enrollment in a State plan under section 1902(a)(10)(A)(ii)(XXIII) shall be treated as coverage under a qualified health plan in the silver level of coverage in the individual market offered through an Exchange established for or by the State under title I of the Patient Protection and Affordable Care Act; and

“(II) the State agency administering such plan shall be treated as the issuer of such plan.

“(3) PREMIUMS AND COST-SHARING FOR CERTAIN OTHER INDIVIDUALS.—If an individual is eligible for medical assistance under subsection (a)(10)(A)(ii)(XXIII) of section 1902 and is not described in subsection (nn) of such section, a State—

“(A) shall not impose premiums and cost-sharing on the individual under this subsection; and

“(B) may impose premiums and cost-sharing on the individual to the extent allowed by another provision of this Act (other than section 1902(a)(10)(A)(ii)(XXIII)) which provides for eligibility for medical assistance, but only if the individual is described in such other provision.

“(4) APPLICATION OF PREMIUM ASSISTANCE TAX CREDITS.—An individual who is required to pay premiums under this subsection for a year for medical assistance shall be eligible for a premium assistance credit under section 36B of the Internal Revenue Code to the same extent that such individual would be eligible for a premium assistance credit under such section if such individual had paid the same amount in premiums for coverage under a qualified health plan for such year.”.

(e) Managed Care.—Section 1932(a)(1)(A)(i) of the Social Security Act (42 U.S.C. 1396u–2(a)(1)(A)(i)) is amended by inserting “, including an individual who is eligible for such assistance after buying into such coverage under section 1902(a)(10)(A)(ii)(XXIII),” after “the State plan under this title”.

(f) Offering Buy-In Program On State Exchange; Enrollment Periods.—

(1) IN GENERAL.—A State that has elected to allow individuals to buy into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)(XXIII)) shall allow individuals to enroll in such coverage through the Federal, Federally-facilitated, or State Exchange established pursuant to title I of the Patient Protection and Affordable Care Act.

(2) ENROLLMENT PERIODS.—A State may limit the enrollment of individuals into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)(XXIII)) to the enrollment periods provided for under section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)).

(g) Application Of Advanced Premium Tax Credits To Medicaid Buy-In Plans.—

(1) IN GENERAL.—Section 36B of the Internal Revenue Code of 1986 is amended—

(A) in subsection (b)(3)(B), by adding at the end the following new sentence:

“If an applicable taxpayer resides in a rating area in which no silver plan is offered on the individual market but the taxpayer buys into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act, such Medicaid coverage shall be deemed to be the applicable second lowest cost silver plan with respect to such taxpayer.”; and

(B) by adding at the end the following new subsection:

“(h) Application To Individuals Purchasing Medicaid Coverage.—In the case of any individual who buys into Medicaid coverage under section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act, this section shall be applied with the following modifications:

“(1) The amount determined under subsection (b)(2)(A) shall be increased by the amount of the monthly premiums paid for such coverage.

“(2) Subsection (c)(2)(A)(i) shall be applied by treating coverage under the Medicaid program under title XIX of the Social Security Act in the same manner as a qualified health plan that was enrolled in through an Exchange.

“(3) In applying subsection (c)(2)(B)—

“(A) an individual shall not be considered to be eligible for minimum essential coverage described in section 5000A(f)(1)(A)(ii) by reason of eligibility for medical assistance under a State Medicaid program under section 1902(a)(10)(A)(ii)(XXIII); and

“(B) an individual who is not covered by minimum essential coverage described in section 5000A(f)(1)(B) shall not be considered to be eligible for such coverage.”.

(2) ADVANCED PAYMENT OF CREDIT.—

(A) IN GENERAL.—The Secretary of Health and Human Services, in consultation with the Secretary of the Treasury, shall establish a program under which—

(i) upon request of a State agency administering a State Medicaid program under title XIX of the Social Security Act, advance determinations are made in a manner similar to advanced determination under section 1411 of the Patient Protection and Affordable Care Act with respect to the income eligibility of individuals enrolling in such program for the premium tax credit allowable under section 36B of the Internal Revenue Code of 1986 and the cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act;

(ii) the Secretary notifies—

(I) the State agency administering the program and the Secretary of the Treasury of the advance determinations; and

(II) the Secretary of the Treasury of the name and employer identification number of each employer with respect to whom 1 or more employee of the employer were determined to be eligible for the premium tax credit under section 36B of the Internal Revenue Code of 1986 and the cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act because—

(aa) the employer did not provide minimum essential coverage; or

(bb) the employer provided such minimum essential coverage but it was determined under section 36B(c)(2)(C) of such Code to either be unaffordable to the employee or not provide the required minimum actuarial value; and

(iii) the Secretary of the Treasury makes advance payments of such credit or reductions to the State agency administering the program in order to reduce the premiums payable by individuals eligible for such credit.

(B) DETERMINATIONS AND PAYMENTS.—Rules similar to subsections (b) and (c) of section 1412 of the Patient Protection and Affordable Care Act shall apply for purposes of this subsection.

(C) COORDINATION WITH CREDIT.—

(i) IN GENERAL.—Section 36B of the Internal Revenue Code of 1986 is amended by inserting “and under section 2(g)(2) of the State PUBLIC OPTION Act” after “section 1412 of the Patient Protection and Affordable Care Act” each place it appears in subsections (f)(1), (f)(2), and (g)(1).

(ii) INFORMATION REPORTING.—Section 36B(f)(3) of such Code is amended by adding at the end the following flush sentence: “In the case of any coverage under the medicaid program under title XIX of the Social Security Act for which a credit under this section is allowable by reason of subsection (h), the State agency administering the Medicaid program shall be treated as an Exchange for purposes of this paragraph and subparagraph (A) shall not apply.”.

(3) CONFORMING AMENDMENT RELATING TO EMPLOYER RESPONSIBILITY.—Paragraph (6) of section 4980H(c) of the Internal Revenue Code of 1986 is amended by inserting “, except that for purposes of subsections (a)(2) and (b)(2), the term ‘qualified health plan’ shall include any plan described in section 36B(h)” after “such Act”.

(h) Conforming Amendments.—

(1) Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)), as amended by subsection (a), is further amended, in the matter following subparagraph (G)—

(A) by striking “and (XVII)” and inserting “, (XVII)”; and

(B) by inserting “, and (XVIII) the medical assistance made available to an individual described in subparagraph (A)(ii)(XXIII) shall be limited to medical assistance described in subsection (k)(1)” before the semicolon.

(2) Section 1903(f)(4) of the Social Security Act (42 U.S.C. 1396b(f)(4)) is amended by inserting “1902(a)(10)(A)(ii)(XXIII),” after “1902(a)(10)(A)(ii)(XXII),”.

(3) Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended in the matter preceding paragraph (1)—

(A) by striking “or” at the end of clause (xvi);

(B) by inserting “or” at the end of clause (xvii); and

(C) by inserting after clause (xvii) the following new clause:

“(xviii) individuals described in section 1902(a)(10)(A)(ii)(XXIII),”.

(4) Section 1916A(a)(1) of the Social Security Act (42 U.S.C. 1396o–1(a)(1)) is amended by striking “or (j)” and inserting “(j), or (k)”.

(5) Section 1937(a)(1)(B) of the Social Security Act (42 U.S.C. 1396u–7(a)(1)(B)) is amended by inserting “, subclause (XXIII) of section 1902(a)(10)(A)(ii),” after “1902(a)(10)(A)(i)”.

SEC. 6a. DEVELOPMENT OF STATE-LEVEL METRICS ON MEDICAID BENEFICIARY ACCESS AND SATISFACTION.

(a) In General.—

(1) DEVELOPMENT OF METRICS.—Not later than 1 year after the date of enactment of this Act, the Director of the Agency for Healthcare Research and Quality, in consultation with the Deputy Administrator for the Center for Medicaid and CHIP Services and State Medicaid Directors, shall develop standardized, State-level metrics of access to, and satisfaction with, providers, including primary care and specialist providers, with respect to individuals who are enrolled in State Medicaid plans under title XIX of the Social Security Act.

(2) PROCESS.—The Director of the Agency for Healthcare Research and Quality shall develop the metrics described in paragraph (1) through a public process, which shall provide opportunities for stakeholders to participate.

(b) Updating Metrics.—The Director of the Agency for Healthcare Research and Quality, in consultation with the Deputy Administrator for the Center for Medicaid and CHIP Services and State Medicaid Directors, shall update the metrics developed under subsection (a) not less than once every 3 years.

(c) State Implementation Funding.—The Director of the Agency for Healthcare Research and Quality may award funds, from the amount appropriated under subsection (d), to States for the purpose of implementing the metrics developed under this section.

(d) Appropriation.—There is appropriated to the Director of the Agency for Healthcare Research and Quality out of any funds in the Treasury not otherwise appropriated, $200,000,000 for fiscal year 2019, to remain available until expended, for the purpose of carrying out this section.

SEC. 6b. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND INCLUSION OF ADDITIONAL PROVIDERS.

(a) Renewal Of Payment Floor; Additional Providers.—

(1) IN GENERAL.—Section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396a(a)(13)) is amended by striking subparagraph (C) and inserting the following:

“(C) payment for primary care services (as defined in subsection (jj)) at a rate that is not less than 100 percent of the payment rate that applies to such services and physician under part B of title XVIII (or, if greater, the payment rate that would be applicable under such part if the conversion factor under section 1848(d) for the year involved were the conversion factor under such section for 2009), and that is not less than the rate that would otherwise apply to such services under this title if the rate were determined without regard to this subparagraph, and that are—

“(i) furnished in 2013 and 2014, by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine; or

“(ii) furnished in the period that begins on the first day of the first month that begins after the date of enactment of the State Public Option Act—

“(I) by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine, but only if the physician self-attests that the physician is Board certified in family medicine, general internal medicine, or pediatric medicine;

“(II) by a physician with a primary specialty designation of obstetrics and gynecology, but only if the physician self-attests that the physician is Board certified in obstetrics and gynecology;

“(III) by an advanced practice clinician, as defined by the Secretary, that works under the supervision of—

“(aa) a physician that satisfies the criteria specified in subclause (I) or (II); or

“(bb) a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife (as defined in section 1861(gg)) who is working in accordance with State law;

“(IV) by a rural health clinic, Federally-qualified health center, or other health clinic that receives reimbursement on a fee schedule applicable to a physician, a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife (as defined in section 1861(gg)) who is working in accordance with State law, for services furnished by a physician, nurse practitioner, physician assistant, or certified nurse-midwife, or services furnished by an advanced practice clinician supervised by a physician described in subclause (I)(aa) or (II)(aa), another advanced practice clinician, or a certified nurse-midwife; or

“(V) by a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law, or a certified nurse-midwife (as defined in section 1861(gg)) who is working in accordance with State law, in accordance with procedures that ensure that the portion of the payment for such services that the nurse practitioner, physician assistant, or certified nurse-midwife is paid is not less than the amount that the nurse practitioner, physician assistant, or certified nurse-midwife would be paid if the services were provided under part B of title XVIII;”.

(2) CONFORMING AMENDMENTS.—Section 1905(dd) of the Social Security Act (42 U.S.C. 1396d(dd)) is amended—

(A) by striking “Notwithstanding” and inserting the following:

“(1) IN GENERAL.—Notwithstanding”;

(B) by inserting “or furnished during an additional period specified in paragraph (2),” after “2015,”; and

(C) by adding at the end the following:

“(2) ADDITIONAL PERIODS.—For purposes of paragraph (1), the following are additional periods:

“(A) The period that begins on the first day of the first month that begins after the date of enactment of the State Public Option Act”..”.

(b) Improved Targeting Of Primary Care.—Section 1902(jj) of the Social Security Act (42 U.S.C. 1396a(jj)) is amended—

(1) by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively and realigning the left margins accordingly;

(2) by striking “For purposes of” and inserting the following:

“(1) IN GENERAL.—For purposes of”; and

(3) by adding at the end the following:

“(2) EXCLUSIONS.—Such term does not include any services described in subparagraph (A) or (B) of paragraph (1) if such services are provided in an emergency department of a hospital.”.

(c) Ensuring Payment By Managed Care Entities.—

(1) IN GENERAL.—Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended—

(A) in clause (xii), by striking “and” after the semicolon;

(B) by realigning the left margin of clause (xiii) so as to align with the left margin of clause (xii) and by striking the period at the end of clause (xiii) and inserting “; and”; and

(C) by inserting after clause (xiii) the following:

“(xiv) such contract provides that (I) payments to providers specified in section 1902(a)(13)(C) for primary care services defined in section 1902(jj) that are furnished during a year or period specified in section 1902(a)(13)(C) and section 1905(dd) are at least equal to the amounts set forth and required by the Secretary by regulation, (II) the entity shall, upon request, provide documentation to the State, sufficient to enable the State and the Secretary to ensure compliance with subclause (I), and (III) the Secretary shall approve payments described in subclause (I) that are furnished through an agreed upon capitation, partial capitation, or other value-based payment arrangement if the capitation, partial capitation, or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the State sufficient to enable the State and the Secretary to ensure compliance with subclause (I).”.

(2) CONFORMING AMENDMENT.—Section 1932(f) of the Social Security Act (42 U.S.C. 1396u–2(f)) is amended by inserting “and clause (xiv) of section 1903(m)(2)(A)” before the period.

SEC. 6c. MEDICAID ACCESS GRANTS.

(a) In General.—Beginning in fiscal year 2019, the Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall award grants to States that submit an application meeting the requirements of subsection (b) for the purpose of improving access to services for individuals enrolled in State Medicaid plans under title XIX of the Social Security Act.

(b) Application Requirements.—To be eligible for a grant under this section, a State shall submit to the Secretary, at such time and in such manner as the Secretary shall require, an application that contains the following:

(1) A description of gaps in access to providers for individuals enrolled in the State Medicaid plan that the State has identified, and how the State proposes to fix such gaps.

(2) A discussion of any changes the State proposes to make to the reimbursement of providers under the State Medicaid plan, including changes to the fee-for-service rates for providers of services under such plans or moving to population-based or episode-based payment models.

(3) A justification establishing that the changes proposed by the State will increase access to providers for individuals enrolled in the State Medicaid plan, and a plan for measuring changes to such access over the grant period.

(c) Use Of Funds.—

(1) IN GENERAL.—If the Secretary determines that a State is using grant funds awarded under this section in a manner that is inconsistent with the purpose described in subsection (a) or paragraph (2), the Secretary may withhold or reduce future grant payments or recover previous grant payments to the State under this section as the Secretary deems appropriate.

(2) USE OF FUNDS TO IMPLEMENT MEDICAID BUY-IN PROGRAM.—A State may use up to 10 percent of the amount of a grant awarded to the State under this section for the purpose of implementing a Medicaid buy-in program under subclause (XXIII) of section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)).

(3) USE OF FUNDS TO INCREASE MEDICAID PROVIDER PAYMENT RATES.—Notwithstanding any other provision of law, a State may use grant funds awarded under this section for the purpose of financing the portion of the non-Federal share of expenditures under the State Medicaid plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) that is attributable to an increase in the payment rate for providers under such plan.

(d) Selection Of States And Maximum Grant Amount.—In awarding grants to States under this section, the Secretary shall—

(1) ensure that geographically diverse areas, including rural and underserved areas, are included; and

(2) award grants both to States that have elected to expand Medicaid eligibility under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) and to States that have not so elected.

(e) Appropriation.—There is appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $100,000,000,000 for fiscal year 2018, to remain available until September 30, 2021, for the purpose of making grants under this section.

SEC. 6d. INCREASED FMAP FOR MEDICAL ASSISTANCE TO NEWLY ELIGIBLE INDIVIDUALS.

(a) In General.—Section 1905(y)(1) of the Social Security Act (42 U.S.C. 1396d(y)(1)) is amended—

(1) in subparagraph (A), by striking “2014, 2015, and 2016” and inserting “each of the first 3 consecutive 12-month periods in which the State provides medical assistance to newly eligible individuals”;

(2) in subparagraph (B), by striking “2017” and inserting “the fourth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals”;

(3) in subparagraph (C), by striking “2018 ” and inserting “the fifth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals”;

(4) in subparagraph (D), by striking “2019” and inserting “the sixth consecutive 12-month period in which the State provides medical assistance to newly eligible individuals”; and

(5) in subparagraph (E), by striking “2020 and each year thereafter” and inserting “the seventh consecutive 12-month period in which the State provides medical assistance to newly eligible individuals and each such period thereafter”.

(b) Effective Date.—The amendments made by subsection (a) shall take effect as if included in the enactment of Public Law 111–148.

 

SEC. 7. MEDICARE BUY-IN OPTION FOR INDIVIDUALS 55 TO 64 YEARS OF AGE.

(a) In General.—Title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) is amended by adding at the end the following new section:

  • “MEDICARE BUY-IN OPTION FOR INDIVIDUALS 55 TO 64 YEARS OF AGE

“Sec. 1899C. (a) Option.—

“(1) IN GENERAL.—Every individual who meets the requirements described in paragraph (3) shall be eligible to enroll under this section.

“(2) PART A, B, AND D BENEFITS.—An individual enrolled under this section is entitled to the same benefits (and shall receive the same protections) under this title as an individual who is entitled to benefits under part A and enrolled under parts B and D, including the ability to enroll in a Medicare Advantage plan that provides qualified prescription drug coverage (an MA–PD plan).

“(3) REQUIREMENTS FOR ELIGIBILITY.—The requirements described in this paragraph are the following:

“(A) The individual is a resident of the United States.

“(B) The individual is—

“(i) a citizen or national of the United States; or

“(ii) an alien lawfully admitted for permanent residence.

“(C) The individual is not otherwise entitled to benefits under part A or eligible to enroll under part A or part B.

“(D) The individual has attained 55 years of age but has not attained 65 years of age.

“(b) Enrollment; Coverage.—The Secretary shall establish enrollment periods and coverage under this section consistent with the principles for establishment of enrollment periods and coverage for individuals under other provisions of this title. The Secretary shall establish such periods so that coverage under this section shall first begin on January 1, 2019.

“(c) Premium.—

“(1) AMOUNT OF MONTHLY PREMIUMS.—The Secretary shall, during September of each year (beginning with 2018), determine a monthly premium for all individuals enrolled under this section. Such monthly premium shall be equal to 1⁄12 of the annual premium computed under paragraph (2)(B), which shall apply with respect to coverage provided under this section for any month in the succeeding year.

“(2) ANNUAL PREMIUM.—

“(A) COMBINED PER CAPITA AVERAGE FOR ALL MEDICARE BENEFITS.—The Secretary shall estimate the average, annual per capita amount for benefits and administrative expenses that will be payable under parts A, B, and D (including, as applicable, under part C) in the year for all individuals enrolled under this section.

“(B) ANNUAL PREMIUM.—The annual premium under this subsection for months in a year is equal to the average, annual per capita amount estimated under subparagraph (A) for the year.

“(3) INCREASED PREMIUM FOR CERTAIN PART C AND D PLANS.—Nothing in this section shall preclude an individual from choosing a Medicare Advantage plan or a prescription drug 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 would be responsible for the increased monthly premium.

“(d) Payment Of Premiums.—

“(1) IN GENERAL.—Premiums for enrollment under this section shall be paid to the Secretary at such times, and in such manner, as the Secretary determines appropriate.

“(2) DEPOSIT.—Amounts collected by the Secretary under this section shall be deposited in the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund (including the Medicare Prescription Drug Account within such Trust Fund) in such proportion as the Secretary determines appropriate.

“(e) Not Eligible For Medicare Cost-Sharing Assistance.—An individual enrolled under this section shall not be treated as enrolled under any part of this title for purposes of obtaining medical assistance for Medicare cost-sharing or otherwise under title XIX.

“(f) Treatment In Relation To The Affordable Care Act.—

“(1) SATISFACTION OF INDIVIDUAL MANDATE.—For purposes of applying section 5000A of the Internal Revenue Code of 1986, the coverage provided under this section constitutes minimum essential coverage under subsection (f)(1)(A)(i) of such section 5000A.

“(2) ELIGIBILITY FOR PREMIUM ASSISTANCE.—Coverage provided under this section—

“(A) shall be treated as coverage under a qualified health plan in the individual market enrolled in through the Exchange where the individual resides for all purposes of section 36B of the Internal Revenue Code of 1986 other than subsection (c)(2)(B) thereof; and

“(B) shall not be treated as eligibility for other minimum essential coverage for purposes of subsection (c)(2)(B) of such section 36B.

The Secretary shall determine the applicable second lowest cost silver plan which shall apply to coverage under this section for purposes of section 36B of such Code.

“(3) ELIGIBILITY FOR COST-SHARING SUBSIDIES.—For purposes of applying section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071)—

“(A) coverage provided under this section shall be treated as coverage under a qualified health plan in the silver level of coverage in the individual market offered through an Exchange; and

“(B) the Secretary shall be treated as the issuer of such plan.

“(g) Guaranteed Issue Of Medigap Policies Upon First Enrollment And Each Subsequent Enrollment.—In the case of an individual who enrolls under this section (including an individual who was previously enrolled under this section), paragraphs (2)(A), (2)(D), (3)(B)(ii), and (3)(B)(vi) of section 1882(s)—

“(1) shall be applied by substituting ‘55’ for ‘65’;

“(2) if the individual was enrolled under this section and subsequently disenrolls, shall apply each time the individual subsequently reenrolls under this section as if the individual had attained 55 years of age on the date of such reenrollment (and as if the individual had never previously enrolled in a Medicare supplemental policy); and

“(3) shall be applied as if this section had not been enacted (and as if the individual had never previously enrolled in a Medicare supplemental policy) when the individual attains 65 years of age.

“(h) No Effect On Benefits For Individuals Otherwise Eligible Or On Trust Funds.—The Secretary shall implement the provisions of this section in such a manner to ensure that such provisions—

“(1) have no effect on the benefits under this title for individuals who are entitled to, or enrolled for, such benefits other than through this section; and

“(2) have no negative impact on the Federal Hospital Insurance Trust Fund or the Federal Supplementary Medical Insurance Trust Fund (including the Medicare Prescription Drug Account within such Trust Fund).

“(i) Consultation.—In promulgating regulations to implement this section, the Secretary shall consult with interested parties, including groups representing beneficiaries, health care providers, employers, and insurance companies.”.


 

Plain English Summary

Medicaid is expanded from 133% to 175%

Medicare Part D is expanded to allow pharmaceuticals to negotiate with any pharmaceutical manufacturer in regards to prescription drugs

Hospital merger reform

Medicaid and Medicare recipients are now able to buy into medicaid and medicare creating a public option.

Medicare recipients can begin buying into Medicare from 54 years of age

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Mr. Chairman,

 

In the interest of transparency and adequately explaining what this bill does to the public, who don't necessarily have the time, staff, or energy to read through all the legalese, I ask that this bill's Plain English Summary be updated to more adequately explain what is going on in this complicated piece of legislation.

 

I also ask that we take a pause in debate and consideration until that PES is updated.

 

I yield.

 

((OOC: Seriously, some better explanation of the bill and its provisions is needed.))

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(The PES does that already and breaks it down by section exactly what is going on)

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Posted (edited)

((I think the problem is the PES is far too generic and doesn't cover what exactly is being done. without delving into the legalese and U.S. Code to try and decipher how exactly, for example, "Hospital merger reform" is accomplished, it is impossible to know what's going on. "Hospital merger reform" is more of a topic that's addressed in the bill, not a description of what the bill does.))

Edited by Recks
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Mr. Chairman,

 

If I may, the sponsor has promised us a new PES, and to the best of my knowledge has yet to provide that for this committee. I ask that you continue to hold off this vote until the bill is in proper form, new PES-included.

 

If you do decide to go forward with the vote immediately, I must vote nay.

 

I yield.

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Plain English Summary

  • Medicaid is expanded from 133% of the poverty line to 175% of the poverty line
  • Medicare Part D is now amended to  allow the secretary of health to begin  negotiating with any pharmaceutical manufacturer in regards to lowering prescription drugs
  • Hospital merger reform: promote merger enforcement and protect competition by adjusting premerger filing fees, increasing antitrust enforcement resources, and improving the information provided to antitrust enforcers. 
  • This bill allows residents not already eligible for Medicaid who is not concurrently enrolled in other health insurance coverage to buy into a state Medicaid plan beginning  the 1st of January of when this bill passes
  • The bill makes such buy-in coverage eligible for premium subsidies and reduced cost sharing under the Patient Protection and Affordable Care Act.

    The Agency for Healthcare Research and Quality shall develop standardized, state-level metrics of access to, and satisfaction with, providers for individuals enrolled in state Medicaid plans.

    Primary care services furnished under Medicaid by certain providers must be paid at a rate that is not less than the rate under Medicare part B.

    Beginning in FY2019, the Department of Health and Human Services may award grants to states for the purpose of improving access to services for individuals enrolled in state Medicaid plans.

  • Residents at the age of 54 are able to begin buying into Medicare

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