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Title X — Transition

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

X Transition

A Medicare for All Transition over 2 Years and Transitional Buy-In Option

Sec. 1001 Medicare for all transition over two years

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:

“1899C. Medicare for all transition over 2 years

“(a) Transition

“(1) In general—Every individual who meets the requirements described in paragraph (3) shall be eligible to enroll in the Medicare for All Program under this section during the transition period starting one year after the date of enactment of the Medicare for All Act.

“(2) Benefits—An individual enrolled under this section is entitled to the benefits established under title II of the Medicare for All Act.

“(3) Requirements for eligibility—The requirements described in this paragraph are the following:

“(A) The individual meets the eligibility requirements established by the Secretary under title I of the Medicare for All Act.

“(B) The individual has attained the applicable year of age, or is currently enrolled in Medicare at the time of the transition to Medicare for All.

“(4) Applicable year of age defined—For purposes of this section, the term applicable year of age means one year after the date of enactment of the Medicare for All Act, the age of 55 or older, the age 18 or younger.

“(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 of the year on which an individual first becomes eligible to enroll under this section.

“(c) 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.

“(d) 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.”

Sec. 1002 Establishment of the Medicare transition buy-in

(a)
In general— To carry out the purpose of this section, for the year beginning one year after the date of enactment of this Act and ending with the effective date described in section 106(a), the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid (referred to in this section as the “Administrator”), shall establish, and provide for the offering through the Exchanges, an option to buy in to the Medicare for All Program (in this Act referred to as the “Medicare Transition buy-in”).
(b)
Administering the medicare transition buy-In—
(1)
Administrator— The Administrator shall administer the Medicare Transition buy-in in accordance with this section.
(2)
Application of ACA requirements— Consistent with this section, the Medicare Transition buy-in shall comply with requirements under title I of the Patient Protection and Affordable Care Act (and the amendments made by that title) and title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) that are applicable to qualified health plans offered through the Exchanges, subject to the limitation under subsection (e)(2).
(3)
Offering through exchanges— The Medicare Transition buy-in shall be made available only through the Exchanges, and shall be available to individuals wishing to enroll and to qualified employers (as defined in section 1312(f)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032)) who wish to make such plan available to their employees.
(4)
Eligibility to purchase— Any United States resident may enroll in the Medicare Transition buy-in.
(c)
Benefits; actuarial value— In carrying out this section, the Administrator shall ensure that the Medicare Transition buy-in provides—
(1)
coverage for the benefits required to be covered under title II of this Act; and
(2)
coverage of benefits that are actuarially equivalent to 90 percent of the full actuarial value of the benefits provided under the plan.
(d)
Providers and reimbursement rates—
(1)
In general— With respect to the reimbursement provided to health care providers for covered benefits, as described in section 201, provided under the Medicare Transition buy-in, the Administrator shall reimburse such providers at rates determined for equivalent items and services under the Medicare for All fee-for-service schedule established in section 612(b) of this Act.
(2)
Prescription drugs— Any payment rate under this subsection for a prescription drug shall be at the prices negotiated under section 616 of this Act.
(3)
Participating providers—
(A)
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 (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.) on the date of enactment of this Act shall be a participating provider in the Medicare Transition buy-in.
(B)
Additional providers— The Administrator shall establish a process to allow health care providers not described in subparagraph (A) to become participating providers in the Medicare Transition buy-in. Such process shall be similar to the process applied to new providers under the Medicare program.
(e)
Premiums—
(1)
Determination— The Administrator shall determine the premium amount for enrolling in the Medicare Transition buy-in, which—
(A)
may vary according to family or individual coverage, age, and tobacco status (consistent with clauses (i), (iii), and (iv) of section 2701(a)(1)(A) of the Public Health Service Act (42 U.S.C. 300gg(a)(1)(A))); and
(B)
shall take into account the cost-sharing reductions and premium tax credits which will be available with respect to the plan under section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) and section 36B of the Internal Revenue Code of 1986, as amended by subsection (g).
(2)
Limitation— Variation in premium rates of the Medicare Transition buy-in by rating area, as described in clause (ii) of section 2701(a)(1)(A)(iii) of the Public Health Service Act (42 U.S.C. 300gg(a)(1)(A)) is not permitted.
(f)
Termination— This section shall cease to have force or effect on the effective date described in section 106(a).
(g)
Tax credits and cost-Sharing subsidies—
(1)
Premium assistance tax credits—
(A)
Credits allowed to medicare transition buy-in enrollees in non-expansion states— Paragraph (1) of section 36B(c) of the Internal Revenue Code of 1986 is amended by redesignating subparagraphs (C) and (D) as subparagraphs (D) and (E), respectively, and by inserting after subparagraph (B) the following new subparagraph:

“(C) Special rules for medicare transition buy-in enrollees

“(i) In general—In the case of a taxpayer who is covered, or whose spouse or dependent (as defined in section 152) is covered, by the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act for all months in the taxable year, subparagraph (A) shall be applied without regard to “but does not exceed 400 percent”.

“(ii) Enrollees in medicaid nonexpansion states—In the case of a taxpayer residing in a State which (as of the date of the enactment of the Medicare for All Act) does not provide for eligibility under clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) of the Social Security Act for medical assistance under title XIX of such Act (or a waiver of the State plan approved under section 1115) who is covered, or whose spouse or dependent (as defined in section 152) is covered, by the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act for all months in the taxable year, subparagraphs (A) and (B) shall be applied by substituting “0 percent” for “100 percent” each place it appears.”

(B)
Premium assistance amounts for taxpayers enrolled in medicare transition buy-in—
(i)
In general— Subparagraph (A) of section 36B(b)(3) of such Code is amended—(I) by redesignating clause (ii) as clause (iii), (II) by striking “clause (ii)” in clause (i) and inserting “clauses (ii) and (iii)”, and (III) by inserting after clause (i) the following new clause:

“(ii) Special rules for taxpayers enrolled in medicare transition buy-in—In the case of a taxpayer who is covered, or whose spouse or dependent (as defined in section 152) is covered, by the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act for all months in the taxable year, the applicable percentage for any taxable year shall be determined in the same manner as under clause (i), except that the following table shall apply in lieu of the table contained in such clause:”

(ii)
Conforming amendment— Subclause (I) of clause (iii) of section 36B(b)(3) of such Code, as redesignated by subparagraph (A)(i), is amended by inserting “, and determined after the application of clause (ii)” after “after application of this clause”.
(2)
Cost-sharing subsidies— Subsection (b) of section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071(b)) is amended—
(A)
by inserting “, or in the Medicare Transition buy-in established under section 1002(a) of the Medicare for All Act,” after “coverage” in paragraph (1);
(B)
by redesignating paragraphs (1) (as so amended) and (2) as subparagraphs (A) and (B), respectively, and by moving such subparagraphs 2 ems to the right;
(C)
by striking “insured.—In this section” and inserting “insured.—

“(1) In general—In this section”

(D)
by striking the flush language; and
(E)
by adding at the end the following new paragraph:

“(2) Special rules

“(A) Individuals lawfully present—In the case of an individual described in section 36B(c)(1)(B) of the Internal Revenue Code of 1986, the individual shall be treated as having household income equal to 100 percent of the poverty line for a family of the size involved for purposes of applying this section.

“(B) Medicare transition buy-in enrollees in medicaid non-expansion states—In the case of an individual residing in a State which (as of the date of the enactment of the Medicare for All Act) does not provide for eligibility under clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) of the Social Security Act for medical assistance under title XIX of such Act (or a waiver of the State plan approved under section 1115) who enrolls in such Medicare Transition buy-in, the preceding sentence, paragraph (1)(B), and paragraphs (1)(A)(i) and (2)(A) of subsection (c) shall each be applied by substituting “0 percent” for “100 percent” each place it appears.”

(h)
Conforming amendments—
(1)
Treatment as a qualified health plan— Section 1301(a)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)(2)) is amended—
(A)
in the paragraph heading, by inserting “The Medicare transition buy-in,” before “and”; and
(B)
by inserting “The Medicare Transition buy-in,” before “and a multi-State plan”.
(2)
Level playing field— Section 1324(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18044(a)) is amended by inserting “the Medicare Transition buy-in,” before “or a multi-State qualified health plan”.

B Transitional Medicare Reforms

Sec. 1011 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 December 1 following the date of enactment of this Act, and before the date that is 2 years after the date of the enactment of such Act.

Sec. 1012 Ensuring continuity of care

(a)
In general— The Secretary shall ensure that all persons enrolled or who seeks to enroll in a health plan during the transition period of the Medicare for All Program are protected from disruptions in their care during the transition period, including continuity of care with such persons current health care provider teams.
(b)
Continuity of coverage and care in general— During the transition period of the Medicare for All Act, group health plans and health insurance issuers offering group or individual health insurance coverage shall not end coverage for an enrollee during the transition period described in the Act until all ages are eligible to enroll in the Medicare for All Program except as expressly agreed upon under the terms of the plan.
(c)
Continuity of coverage and care for persons with complex medical needs—
(1)
The Secretary shall ensure that persons with disabilities, complex medical needs, or chronic conditions are protected from disruptions in their care during the transition period, including continuity of care with such persons current health care provider teams.
(2)
During the transition period of the Medicare for All Act group health plans and health insurance issuers offering group or individual health insurance coverage shall not—
(A)
end coverage for an enrollee who has a disability, complex medical need, or chronic condition during the transition period described in the Act until all ages are eligible to enroll in the Medicare for All Program; or
(B)
impose any exclusion with respect to such plan or coverage on the basis of a person’s disability, complex medical need, or chronic condition during the transition period described under this Act until all ages are eligible to enroll in the Medicare for All Program.
(d)
Public consultation during transition— The Secretary shall consult with communities and advocacy organizations of persons living with disabilities as well as other patient advocacy organizations to ensure that the transition buy-in takes into account the continuity of care for persons with disabilities, complex medical needs, or chronic conditions.