[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4616 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 4616
To establish a public health plan.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 20, 2024
Mr. Bennet (for himself, Mr. Kaine, Mr. Booker, Ms. Duckworth, Mr.
Hickenlooper, Ms. Klobuchar, Mrs. Shaheen, Ms. Smith, and Ms. Stabenow)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To establish a public health plan.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare-X Choice Act of 2024''.
SEC. 2. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH PLAN.
The Social Security Act is amended by adding at the end the
following new title:
``TITLE XXII--MEDICARE EXCHANGE HEALTH PLAN
``SEC. 2201. ESTABLISHMENT.
``(a) Establishment of Plan.--
``(1) In general.--The Secretary shall establish a
coordinated and low-cost health plan, to be known as the
`Medicare Exchange health plan' (referred to in this section as
the `health plan') to provide access to quality health care for
enrollees.
``(2) Timeframe.--
``(A) Individual market availability.--
``(i) In general.--In accordance with
clause (ii), the Secretary shall make the
health plan available in the individual market,
in certain rating areas, for plan year 2026 and
each subsequent plan year, and increase the
availability such that the plan is available in
the individual market to all residents of all
rating areas in the United States for plan year
2029 and each subsequent plan year.
``(ii) Priority areas.--In determining in
which rating areas the Secretary initially will
make the health plan available, the Secretary
shall give priority to rating areas in which--
``(I) not more than 1 health
insurance issuer offers plans on the
applicable State or Federal American
Health Benefit Exchange (referred to in
this title as the `Exchange'); or
``(II) 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.
``(B) Small group market.--The Secretary shall make
the health plan available in the small group market in
all rating areas for plan year 2029.
``(b) Establishment of Funds.--
``(1) Plan reserve fund.--
``(A) In general.--There is established in the
Treasury of the United States a `Plan Reserve Fund', to
be administered by the Secretary of Health and Human
Services, for purposes of establishing the Medicare
Exchange health plan and administering such plan,
consisting of amounts appropriated to such fund during
the period of fiscal years 2025 through 2034.
``(B) Appropriation.--There is appropriated
$1,000,000,000, out of monies in the Treasury not
otherwise obligated, to the Plan Reserve Fund for
fiscal year 2025, to remain available until expended.
``(2) Data and technology fund.--
``(A) In general.--There is established in the
Treasury of the United States a `Data and Technology
Fund', to be administered by the Secretary of Health
and Human Services, acting through the Chief Actuary of
the Centers for Medicare & Medicaid Services, for
purposes of updating technology and performing data
collection under section 2205 in order to establish
appropriate premiums for all geographic regions of the
United States, consisting of amounts appropriated to
such fund during the period of fiscal years 2025
through 2034.
``(B) Appropriation.--There is appropriated
$1,000,000,000, out of amounts in the Treasury not
otherwise appropriated, to the Data and Technology Fund
for fiscal year 2025, to remain available until
expended.
``(c) Rulemaking.--Not later than 180 days after the date of
enactment of the Medicare-X Choice Act of 2024, the Secretary shall
promulgate such regulations as may be necessary to carry out this
title. Rules promulgated under this subsection shall be finalized not
later than 270 days after the date of enactment of the Medicare-X
Choice Act of 2024.
``SEC. 2202. AVAILABILITY OF PLAN.
``(a) Eligibility.--An individual shall be eligible to enroll in
the health plan if such individual, for the entire period for which
enrollment is sought--
``(1) is a qualified individual within the meaning of
section 1312 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18032); and
``(2) is not eligible for benefits under the Medicare
program under title XVIII.
``(b) Exchanges.--In accordance with the timeframe under section
2201(a)(2), the health plan shall be made available through the
American Health Benefit Exchanges described in sections 1311 and 1321
of the Patient Protection and Affordable Care Act (42 U.S.C. 18031,
18041), including the Small Business Health Options Program Exchange.
``SEC. 2203. PLAN REQUIREMENTS.
``(a) General Requirements.--The health plan shall comply with all
requirements, as applicable, of subtitle D of title I of the Patient
Protection and Affordable Care Act (42 U.S.C. 18021 et seq.) and title
XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.)
applicable to qualified health plans, and such health plan shall be a
qualified health plan, including for purposes of the Internal Revenue
Code of 1986.
``(b) Levels of Coverage.--The Secretary--
``(1) shall make available a silver level and gold level
version of the plan, in accordance with section
1301(a)(1)(C)(ii); and
``(2) may make available no more than 2 versions of the
plan for each of the 4 levels of coverage described in
subparagraphs (A) through (D) of section 1302(d)(1) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18022(d)(1)).
``(c) Primary Care Services.--The health plan shall provide
coverage for primary care services, and shall not impose any cost-
sharing requirements for such services.
``SEC. 2204. ADMINISTRATIVE CONTRACTING.
``(a) In General.--The Secretary may enter into contracts for the
purpose of performing administrative functions (including functions
described in subsection (a)(4) of section 1874A) with respect to the
health plan in the same manner as the Secretary may enter into
contracts under subsection (a)(1) of such section. The Secretary shall
have the same authority with respect to the public health insurance
option as the Secretary has under such subsection (a)(1) and subsection
(b) of section 1874A with respect to title XVIII.
``(b) Transfer of Insurance Risk.--Any contract under subsection
(a) shall not involve the transfer of insurance risk from the Secretary
to the entity entering into such contract with the Secretary, except in
the case of an alternative payment model under section 2209(h).
``SEC. 2205. DATA COLLECTION.
``Subject to all applicable privacy requirements, including the
requirements under the regulations promulgated pursuant to section
264(c) of the Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d-2 note), the Secretary may collect data from
State insurance commissioners and other relevant entities to establish
rates for premiums and for other purposes, including to improve
quality, and reduce racial, ethnic, socioeconomic, geographic, gender,
sexual identity, and other health disparities, including such
disparities experienced by people with disabilities and older adults,
with respect to the health plan.
``SEC. 2206. PREMIUMS; RISK POOL.
``(a) Setting Premiums.--
``(1) In general.--The Secretary shall establish premiums
for the health plan that cover the full actuarial cost of
offering such plan, including the administrative costs of
offering such plan. Such premiums shall vary geographically and
between the small group market and the individual market in
accordance with differences in the cost of providing such
coverage. If, for any plan year, the amount collected in
premiums exceeds the amount required for health care benefits
and administrative costs in that plan year, such excess amounts
shall remain available to the Secretary to administer the
health plan and finance beneficiary costs in subsequent years.
``(2) Initial plan year.--For plan year 2026, the Secretary
shall set premiums for the health plan for each rating area in
which the health plan is available for such plan year, taking
into consideration the premium rates for plans offered in each
such rating area for plan year 2025.
``(b) Risk Pool.--After plan year 2026, all enrollees in the health
plan within a State shall be members of a single risk pool, except that
the Secretary may establish separate risk pools for the individual
market and small group market if the State has not exercised its
authority under section 1312(c)(3) of the Patient Protection and
Affordable Care Act.
``SEC. 2207. REIMBURSEMENT RATES.
``(a) Medicare Rates.--
``(1) In general.--Except as provided in paragraph (2) and
subsections (b) and (c) and subject to subsection (d), the
Secretary shall reimburse health care providers furnishing
items and services under the health plan at rates determined
for equivalent items and services under the original Medicare
fee-for-service program under parts A and B of title XVIII.
``(2) Authority to increase payments rates in rural
areas.--If the Secretary determines appropriate, the Secretary
may increase the reimbursements rates described in paragraph
(1) by up to 50 percent for items and services furnished in
rural areas (as defined in section 1886(d)(2)(D)).
``(b) Prescription Drugs.--Subject to subsection (d), payment rates
for prescription drugs shall be at a rate negotiated by the Secretary.
Such negotiations may be in conjunction with negotiations for selected
drugs under part E of title XI.
``(c) Additional Items and Services.--Subject to subsection (d),
the Secretary shall establish reimbursement rates for any items and
services provided under the health plan that are not items and services
provided under the original Medicare fee-for-service program under
parts A and B of title XVIII.
``(d) Innovative Payment Methods.--The Secretary may utilize
innovative payment methods, including value-based payment arrangements,
in making payments for items and services (including prescription
drugs) furnished under the health plan.
``(e) Comprehensive Study on Covering Additional Services.--
``(1) In general.--The Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid Services,
shall conduct a comprehensive study, in consultation with
stakeholders, and develop recommendations for Congress on the
need for, and cost of providing coverage for, additional
services under the health plan.
``(2) Content.--The study shall under paragraph (1) shall
include--
``(A) consideration of providing coverage for long-
term services and supports, home and community based
services, assistive and enabling technologies, and
vision, hearing, and dental services;
``(B) consideration of providing coverage for other
services in addition to the services described in
subparagraph (A) that could most benefit the health and
financial well-being of beneficiaries, including by
reducing health disparities, if included for coverage
under the plan;
``(C) the costs associated with covering additional
services described in subparagraphs (A) and (B), for
beneficiaries through cost-sharing and premiums, and
for the Federal Government; and
``(D) an assessment of the implications of covering
such additional services for the risk pool of the
health plan and for the individual and small group
markets.
``(3) Submission of report.--Not later than 2 years after
the date of enactment of this title, the Secretary shall submit
to Congress a report on the findings and recommendations of the
study under this subsection and shall make such report publicly
available on the website of the Department of Health and Human
Services.
``SEC. 2208. PARTICIPATING PROVIDERS.
``(a) Requirement To Participate in Order To Be Enrolled Under
Medicare.--Subject to subsection (d), beginning January 1, 2026, a
health care provider may not be enrolled under the Medicare program
under section 1866(j) unless the provider is also a participating
provider under the health plan.
``(b) Requirement To Participate in Order To Participate in
Medicaid.--Subject to subsection (d), beginning January 1, 2026, a
health care provider may not be a participating provider under a State
Medicaid plan under title XIX unless the provider is also a
participating provider under the health plan.
``(c) Additional Providers.--The Secretary shall establish a
process to allow health care providers not described in subsection (a)
or (b) to become a participating provider under the health plan.
``(d) Opt-Out.--The Secretary shall establish a process by which a
health care provider described in subsection (a) or (b) may opt out of
being a participating provider under the health plan, under exceptional
circumstances where participation in the health plan threatens the
provider's ability to operate.
``SEC. 2209. DELIVERY SYSTEM REFORM FOR AN ENHANCED HEALTH PLAN.
``(a) In General.--For plan years beginning with plan year 2026,
the Secretary may utilize innovative payment mechanisms and policies to
determine payments for items and services under the health plan. The
payment mechanisms and policies under this section may include patient-
centered medical home and other care management payments, accountable
care organizations, accountable communities for health, value-based
purchasing, bundling of services, differential payment rates,
performance or utilization based payments, telehealth, remote patient
monitoring, partial capitation, and direct contracting with providers.
``(b) Requirements for Innovative Payments.--The Secretary shall
design and implement the payment mechanisms and policies under this
section in a manner that--
``(1) seeks to--
``(A) improve health outcomes;
``(B) reduce health disparities (including racial,
ethnic, socioeconomic, geographic, gender, sexual
identity, and other disparities, including such
disparities experienced by people with disabilities and
older adults);
``(C) improve coordination to provide more
efficient and affordable quality care;
``(D) address geographic variation in the provision
of health services; or
``(E) prevent or manage chronic illness;
``(2) promotes care that is integrated, patient-centered,
quality, and efficient;
``(3) implements patient feedback mechanisms, including
culturally- and disability-competent mechanisms; and
``(4) uses person-reported experiences to improve service
delivery.
``(c) Encouraging the Use of High-Value Services.--To the extent
allowed by the benefit standards applied to all health benefits plans
participating in the Exchanges (as described in section 2202(b)), the
health plan may modify cost-sharing and payment rates to encourage the
use of services that promote health and value.
``(d) Promotion of Delivery System Reform.--The Secretary shall
monitor and evaluate the progress of payment and delivery system
reforms under this section and shall seek to implement such reforms
subject to the following:
``(1) To the extent that the Secretary finds a payment and
delivery system reform successful in improving quality and
reducing costs, the Secretary shall implement such reform on as
large a geographic scale as practical and economical.
``(2) The Secretary may delay the implementation of such a
reform in geographic areas in which such implementation would
place the public health insurance option at a competitive
disadvantage.
``(3) The Secretary may prioritize implementation of such a
reform in high-cost geographic areas or otherwise in order to
reduce total program costs or to promote high-value care.
``(4) The Secretary may prioritize implementation of such a
reform to reduce racial, ethnic, socioeconomic, geographic,
gender, sexual identity, or other health disparities, including
such disparities experienced by people with disabilities or
older adults.
``(e) Non-Uniformity Permitted.--Nothing in this section shall
prevent the Secretary from varying payments based on different payment
structure models (such as accountable care organizations and medical
homes) under the health plan for different geographic areas.
``(f) Integration With Social Services.--
``(1) In general.--The Secretary shall establish processes
and, when appropriate, collaborate with other agencies to
integrate medical care under the health plan with food,
housing, transportation, and income assistance if the Secretary
determines that such integration is expected to--
``(A) reduce spending without reducing the quality
of patient care;
``(B) improve the quality of patie