Sec. 1012. Establishment of the Medicare transition plan

1,704 words·~8 min read·/bill/119/s/1506/is/section-1012

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

To carry out the purpose of this section, for plan years beginning with the first plan year that begins after the date of enactment of this Act and ending with the date on which benefits are first available under 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, of a public health plan (in this Act referred to as the Medicare Transition plan ) that provides affordable, high-quality health benefits coverage throughout the United States.

The Administrator shall administer the Medicare Transition plan in accordance with this section. Consistent with this section, the Medicare Transition plan 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).

The Medicare Transition plan 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(f)(2) )) who wish to make such plan available to their employees. Any United States resident may enroll in the Medicare Transition plan. In carrying out this section, the Administrator shall ensure that the Medicare Transition plan provides— coverage for the benefits required to be covered under title II; and coverage of benefits that are actuarially equivalent to 90 percent of the full actuarial value of the benefits provided under the plan.

With respect to the reimbursement provided to health care providers for covered benefits, as described in section 201, provided under the Medicare Transition plan, the Administrator shall reimburse such providers at rates determined for equivalent items and services under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq. ). For items and services covered under the Medicare Transition plan but not covered under such parts A and B, the Administrator shall reimburse providers at rates set by the Administrator in a manner consistent with the manner in which rates for other items and services were set under the original Medicare fee-for-service program.

Any payment rate under this subsection for a prescription drug shall be at a rate negotiated by the Administrator with the manufacturer of the drug. If the Administrator is unable to reach a negotiated agreement on such a reimbursement rate, the Administrator shall establish the rate at an amount equal to the lesser of— the price paid by the Secretary of Veterans Affairs to procure the drug under the laws administered by the Secretary of Veterans Affairs; the price paid to procure the drug under section 8126 of title 38, United States Code; or the best price determined under section 1927(c)(1)(C) of the Social Security Act ( 42 U.S.C. 1396r–8(c)(1)(C) ) for the drug.

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 plan. The Administrator shall establish a process to allow health care providers not described in subparagraph

(A)to become participating providers in the Medicare Transition plan. Such process shall be similar to the process applied to new providers under the Medicare program. The Administrator shall determine the premium amount for enrolling in the Medicare Transition plan, which— 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 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). Variation in premium rates of the Medicare Transition plan 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. The provisions of this section shall cease to have force or effect on the date on which benefits are first available under section 106(a). Paragraph

(1)of section 36B(c) of the Internal Revenue Code of 1986 is amended by redesignating subparagraphs (C), (D), and

(E)as subparagraphs (D), (E), and (F), respectively, and by inserting after subparagraph

(B)the following new subparagraph: 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 plan established under section 1012(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 . The preceding sentence shall not apply to any taxable year to which subparagraph

(E)applies. 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 plan established under section 1012(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. . Subparagraph

(A)of section 36B(b)(3) of such Code is amended— by redesignating clauses

(ii)and

(iii)as clauses

(iii)and (iv), respectively; by striking clause

(ii)in clause

(i)and inserting clauses

(ii)and

(iii); and by inserting after clause

(i)the following new clause: 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 plan established under section 1012(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: In the case of household income (expressed as a percent of poverty line) within the following income tier: The initial premium percentage is— The final premium percentage is— Up to 100 percent 2 2 100 percent up to 138 percent 2.04 2.04 138 percent up to 150 percent 3.06 4.08 150 percent and above 4.08 5. The preceding sentence shall not apply to any taxable year to which clause

(iv)applies. . Subclause

(I)of clause

(iii)of section 36B(b)(3)(A) 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 . Section 36B(b)(3)(A)(iv)(I) of such Code, as redesignated by subparagraph (A)(i), is amended by striking clause

(ii)and inserting clause

(iii). Subsection

(b)of section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071(b) ) is amended— by inserting , or in the Medicare Transition plan established under section 1012(a) of the after Medicare for All Act , coverage in paragraph (1); 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; by striking and inserting “ insured .—In this section insured .— In this section ; by striking the flush language; and by adding at the end the following new paragraph: 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. 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 plan, subparagraph (A), 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. In the case of any individual who enrolls in such Medicare Transition plan, in lieu of the percentages under subsection (c)(1)(B)(i) and (c)(2), the Secretary shall prescribe a method of determining the cost-sharing reduction for any such individual such that the total of the cost-sharing and the premiums paid by the individual under such Medicare Transition plan does not exceed the percentage of the total allowed costs of benefits provided under the plan equal to the final premium percentage applicable to such individual under section 36B(b)(3)(A)(ii) of the Internal Revenue Code of 1986. . Section 1301(a)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18021(a)(2) ) is amended— in the paragraph heading, by inserting before , the Medicare Transition plan, ; and and by inserting the Medicare Transition plan under section 1012 of the before Medicare for All Act , and a multi-State plan . Section 1324(a) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18044(a) ) is amended by inserting the Medicare Transition plan under section 1012 of the before Medicare for All Act , or a multi-State qualified health plan .

Connectionstraces to 8

Traces to 8 documents

U.S. Code