Title IV — Administration

H.R. 3421 · 118th Congress · May 17, 2023 · Lineage

IV Administration

A General Administration Provisions

Sec. 401 Administration

(a)

General duties of the Secretary—

(1)

In general— The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including related to—

(A)

eligibility for benefits;

(B)

enrollment;

(C)

benefits provided;

(D)

provider participation standards and qualifications, as described in title III;

(E)

levels of funding;

(F)

methods for determining amounts of payments to providers of covered items and services, consistent with subtitle B;

(G)

a process for appealing or petitioning for a determination of coverage or noncoverage of items and services under this Act;

(H)

planning for capital expenditures and service delivery;

(I)

planning for health professional education funding;

(J)

encouraging States to develop regional planning mechanisms; and

(K)

any other regulations necessary to carry out the purposes of this Act.

(2)

Regulations— Regulations authorized by this Act shall be issued by the Secretary in accordance with section 553 of title 5, United States Code.

(3)

Accessibility— The Secretary shall have the obligation to ensure the timely and accessible provision of items and services that all eligible individuals are entitled to under this Act.

(b)

Uniform reporting standards; annual report; studies—

(1)

Uniform reporting standards—

(A)

In general— The Secretary shall establish uniform State reporting requirements and national standards to ensure an adequate national database containing information pertaining to health services practitioners, approved providers, the costs of facilities and practitioners providing items and services, the quality of such items and services, the outcomes of such items and services, and the equity of health among population groups. Such database shall include, to the maximum extent feasible without compromising patient privacy, health outcome measures used under this Act, and to the maximum extent feasible without excessively burdening providers, a description of the standards and qualifications, levels of finding, and methods described in subparagraphs (D) through (F) of subsection (a)(1).

(B)

Required data disclosures— In establishing reporting requirements and standards under subparagraph (A), the Secretary shall require a provider with an agreement in effect under section 301 to disclose to the Secretary, in a time and manner specified by the Secretary, the following (as applicable to the type of provider):

(i)

Any data the provider is required to report or does report to any State or local agency, or, as of January 1, 2019, to the Secretary or any entity that is part of the Department of Health and Human Services, except data that are required under the programs terminated in section 903.

(ii)

Annual financial data that includes information on employees (including the number of employees, hours worked, and wage information) by job title and by each patient care unit or department within each facility (including outpatient units or departments); the number of registered nurses per staffed bed by each such unit or department; information on the dollar value and annual spending (including purchases, upgrades, and maintenance) for health information technology; and risk-adjusted and raw patient outcome data (including data on medical, surgical, obstetric, and other procedures).

(C)

Reports— The Secretary shall regularly analyze information reported to the Secretary and shall define rules and procedures to allow researchers, scholars, health care providers, and others to access and analyze data for purposes consistent with quality and outcomes research, without compromising patient privacy.

(2)

Annual report— Beginning 2 years after the date of the enactment of this Act, the Secretary shall annually report to Congress on the following:

(A)

The status of implementation of the Act.

(B)

Enrollment under this Act.

(C)

Benefits under this Act.

(D)

Expenditures and financing under this Act.

(E)

Cost-containment measures and achievements under this Act.

(F)

Quality assurance.

(G)

Health care utilization patterns, including any changes attributable to the program.

(H)

Changes in the per-capita costs of health care.

(I)

Differences in the health status of the populations of the different States, including by racial, ethnic, national origin, primary language use, age, disability, sex, including gender identity and sexual orientation, geographical, and income characteristics;

(J)

Progress on quality and outcome measures, and long-range plans and goals for achievements in such areas.

(K)

Plans for improving service to medically underserved populations.

(L)

Transition problems as a result of implementation of this Act.

(M)

Opportunities for improvements under this Act.

(3)

Statistical analyses and other studies— The Secretary may, either directly or by contract—

(A)

make statistical and other studies, on a nationwide, regional, State, or local basis, of any aspect of the operation of this Act;

(B)

develop and test methods of delivery of items and services as the Secretary may consider necessary or promising for the evaluation, or for the improvement, of the operation of this Act; and

(C)

develop methodological standards for policymaking.

(c)

Audits—

(1)

In general— The Comptroller General of the United States shall conduct an audit of the Department of Health and Human Services every fifth fiscal year following the effective date of this Act to determine the effectiveness of the program in carrying out the duties under subsection (a).

(2)

Reports— The Comptroller General of the United States shall submit a report to Congress concerning the results of each audit conducted under this subsection.

Sec. 402 Consultation

The Secretary shall consult with Federal agencies, Indian tribes and urban Indian health organizations, and private entities, such as labor organizations representing health care workers, professional societies, national associations, nationally recognized associations of health care experts, medical schools and academic health centers, consumer groups, and business organizations in the formulation of guidelines, regulations, policy initiatives, and information gathering to ensure the broadest and most informed input in the administration of this Act. Nothing in this Act shall prevent the Secretary from adopting guidelines, consistent with the provisions of section 203(c), developed by such a private entity if, in the Secretary’s judgment, such guidelines are generally accepted as reasonable and prudent and consistent with this Act.

Sec. 403 Regional administration

(a)

Coordination with regional offices— The Secretary shall establish and maintain regional offices for purposes of carrying out the duties specified in subsection (c) and promoting adequate access to, and efficient use of, tertiary care facilities, equipment, and services by individuals enrolled under this Act. Wherever possible, the Secretary shall incorporate regional offices of the Centers for Medicare & Medicaid Services for this purpose.

(b)

Appointment of regional directors— In each such regional office there shall be—

(1)

one regional director appointed by the Secretary;

(2)

one deputy director appointed by the regional director to represent the Indian and Alaska Native tribes in the region, if any; and

(3)

one deputy direction appointed by the regional director to oversee long-term services and supports.

(c)

Regional office duties— Each regional director shall—

(1)

provide an annual health care needs assessment with respect to the region under the director’s jurisdiction to the Secretary after a thorough examination of health needs and in consultation with public health officials, clinicians, patients, and patient advocates;

(2)

recommend any changes in provider reimbursement or payment for delivery of health services determined appropriate by the regional director, subject to the provisions of title VI; and

(3)

establish a quality assurance mechanism in each such region in order to minimize both underutilization and overutilization of health care items and services and to ensure that all providers meet quality standards established pursuant to this Act.

Sec. 404 Beneficiary ombudsman

(a)

In general— The Secretary shall appoint a Beneficiary Ombudsman who shall have expertise and experience in the fields of health care and education of, and assistance to, individuals enrolled under this Act.

(b)

Duties— The Beneficiary Ombudsman shall—

(1)

receive complaints, grievances, and requests for information submitted by individuals enrolled under this Act or eligible to enroll under this Act with respect to any aspect of the Medicare for All Program;

(2)

provide assistance with respect to complaints, grievances, and requests referred to in paragraph (1), including assistance in collecting relevant information for such individuals, to seek an appeal of a decision or determination made by a regional office or the Secretary; and

(3)

submit annual reports to Congress and the Secretary that describe the activities of the Ombudsman and that include such recommendations for improvement in the administration of this Act as the Ombudsman determines appropriate. The Ombudsman shall not serve as an advocate for any increases in payments or new coverage of services, but may identify issues and problems in payment or coverage policies.

Sec. 405 Conduct of related health programs

In performing functions with respect to health personnel education and training, health research, environmental health, disability insurance, vocational rehabilitation, the regulation of food and drugs, and all other matters pertaining to health, the Secretary shall direct the activities of the Department of Health and Human Services toward contributions to the health of the people complementary to this Act.

B Control Over Fraud and Abuse

Sec. 411 Application of Federal sanctions to all fraud and abuse under the Medicare for All Program

The following sections of the Social Security Act shall apply to this Act in the same manner as they apply to title XVIII or State plans under title XIX of the Social Security Act:

(1)

Section 1128 (relating to exclusion of individuals and entities).

(2)

Section 1128A (civil monetary penalties).

(3)

Section 1128B (criminal penalties).

(4)

Section 1124 (relating to disclosure of ownership and related information).

(5)

Section 1126 (relating to disclosure of certain owners).

(6)

Section 1877 (relating to physician referrals).

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May 17, 2023viewing Introduced in House Ms. Jayapal (for herself, Mrs. Dingell, Ms. Adams, Ms. Balint, Ms. Barragán, Mr. Beyer, Mr. Blumenauer, Ms. Bonamici, Mr. Bowman, Mr. Boyle of Pennsylvania, Ms. Brown, Ms. Bush, Mr. Carbajal, Mr. Cárdenas, Mr. Carson, Mr. Carter of Louisiana, Mr. Cartwright, Mr. Casar, Mrs. Cherfilus-McCormick, Ms. Chu, Mr. Cicilline, Ms. Clarke of New York, Mr. Cleaver, Mr. Cohen, Ms. Crockett, Mr. Davis of Illinois, Ms. DeGette, Mr. Deluzio, Mr. DeSaulnier, Mr. Doggett, Ms. Escobar, Mr. Espaillat, Mrs. Foushee, Ms. Lois Frankel of Florida, Mr. Frost, Mr. Garamendi, Mr. Robert Garcia of California, Mr. García of Illinois, Mr. Goldman of New York, Mr. Gomez, Mr. Green of Texas, Mr. Grijalva, Mr. Harder of California, Mrs. Hayes, Mr. Higgins of New York, Ms. Hoyle of Oregon, Mr. Huffman, Mr. Ivey, Mr. Jackson of Illinois, Ms. Jackson Lee, Ms. Jacobs, Mr. Johnson of Georgia, Ms. Kamlager-Dove, Mr. Keating, Ms. Kelly of Illinois, Mr. Khanna, Ms. Lee of California, Ms. Lee of Pennsylvania, Ms. Leger Fernandez, Mr. Levin, Mr. Lieu, Ms. McCollum, Mr. McGarvey, Mr. McGovern, Mr. Meeks, Ms. Meng, Mr. Mfume, Mr. Mullin, Mr. Nadler, Mrs. Napolitano, Mr. Neguse, Ms. Norton, Ms. Ocasio-Cortez, Ms. Omar, Mr. Pallone, Mr. Panetta, Mr. Payne, Ms. Pingree, Mr. Pocan, Ms. Porter, Ms. Pressley, Mr. Quigley, Mrs. Ramirez, Mr. Raskin, Mr. Sablan, Ms. Salinas, Ms. Sánchez, Mr. Sarbanes, Ms. Schakowsky, Mr. Schiff, Mr. Scott of Virginia, Mr. Sherman, Mr. Smith of Washington, Ms. Stansbury, Mr. Swalwell, Mr. Takano, Mr. Thanedar, Mr. Thompson of California, Mr. Thompson of Mississippi, Ms. Titus, Ms. Tlaib, Ms. Tokuda, Mr. Tonko, Mr. Torres of New York, Mrs. Trahan, Mr. Vargas, Ms. Velázquez, Ms. Waters, Mrs. Watson Coleman, Ms. Wild, Ms. Williams of Georgia, Ms. Wilson of Florida, and Ms. Lofgren) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, Rules, Oversight and Accountability, Armed Services, 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