H.R. 5994 (112th): Choice in Healthcare Act

112th Congress, 2011–2013. Text as of Jun 21, 2012 (Introduced).

Status & Summary | PDF | Source: GPO

I

112th CONGRESS

2d Session

H. R. 5994

IN THE HOUSE OF REPRESENTATIVES

June 21, 2012

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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

A BILL

To provide a demonstration project under which Medicare and Medicaid beneficiaries are provided the choice of health benefits coverage and access to a debit style card for the purpose of purchasing qualified health benefits coverage and paying for other health care expenses.

1.

Short title

This Act may be cited as the Choice in Healthcare Act.

2.

Medicare and Medicaid Choice

(a)

In general

Notwithstanding any other provision of law, the Secretary of Health and Human Services (referred to in this Act as the Secretary) shall establish a demonstration program (referred to in this Act as the demonstration program) under which Medicare and Medicaid eligible beneficiaries (as defined in section 4) are provided—

(1)

the option of purchasing qualifying health benefits coverage; and

(2)

access to a debit style card (referred to in this Act as a Medi-Choice card) for the purpose of purchasing health benefits coverage in accordance with the demonstration program and for paying certain other out-of-pocket health care expenditures.

(b)

Qualifying health benefits coverage

In this Act, the term qualifying health benefits coverage means health benefits coverage that meets the following requirements:

(1)

Benefits coverage

In the case of—

(A)

a dual eligible beneficiary, the coverage provides benefits that are at least as comprehensive as the benefits provided, as of the date of the enactment of this Act, under parts A, B, and D of title XVIII of the Social Security Act and under the State Medicaid plan under title XIX of such Act in California;

(B)

a Medicare eligible beneficiary who is not a dual eligible beneficiary, the coverage provides benefits that are at least as comprehensive as the benefits provided, as of the date of the enactment of this Act, under parts A, B, and D of title XVIII of the Social Security Act; and

(C)

a Medicaid eligible beneficiary who is not a dual eligible beneficiary, the coverage provides benefits that are at least as comprehensive as the benefits provided, as of the date of the enactment of this Act, under the State Medicaid plan under title XIX of the Social Security Act in California.

(2)

Guarantee issue; no preexisting condition exclusions

The coverage is offered and available under the demonstration program on a guaranteed issue basis without regard to health status and does not apply any preexisting condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act).

(3)

Community rating

Premiums for the coverage are uniform and do not vary by age, health status, geographic area, or other characteristics of the enrolled individual.

3.

Medi-Choice card

(a)

Provision

The Secretary shall enter into a contract with a major credit card provider or financial institution for the purpose of issuing Medi-Choice cards under the demonstration program.

(b)

Use

(1)

Toward purchasing qualifying benefits coverage

Medi-Choice cards shall be used to purchase qualifying health benefits coverage for eligible beneficiaries enrolled in the demonstration program.

(2)

Toward out of pocket costs

Amounts remaining on such a card after the application of paragraph (1) may be used—

(A)

to pay copayments or deductibles and other cost sharing on behalf of enrolled eligible beneficiaries; and

(B)

for other qualified medical expenses (as defined in section 223(d)(2) of the Internal Revenue Code of 1986) of such beneficiaries.

(3)

Unused amount

Amounts on a Medi-Choice card not otherwise used under this paragraph shall remain available under the card until expended by or on behalf of an enrolled eligible beneficiary during the period of participation in the demonstration program.

4.

Eligible beneficiaries

(a)

In general

In this Act, the term eligible beneficiary means an individual—

(1)

who is a legal permanent resident of the United States residing within the area covered by the demonstration program; and

(2)
(A)

who is eligible for medical assistance for full benefits under the State plan under title XIX of the Social Security Act for California as of the date of the enactment of this Act; or

(B)

who is entitled to benefits under part A of title XVIII of the Social Security Act.

(b)

Exclusion

The term eligible beneficiary does not include any individual for a month if the individual, as of the first day of the month is—

(1)

enrolled by reason of disability in the program under title XIX of the Social Security Act;

(2)

entitled to benefits under chapter 55 of title 10, United States Code, including under the TRICARE program (as defined in section 1072(7) of such title);

(3)

imprisoned under Federal, State, or local authority; or

(4)

an alien who is not a lawful permanent resident of the United States.

(c)

References

In this Act:

(1)

Medicare eligible beneficiary

The term Medicare eligible beneficiary means an eligible beneficiary described in subsection (a)(2)(B).

(2)

Medicaid eligible beneficiary

The term Medicaid eligible beneficiary means an eligible beneficiary described in subsection (a)(2)(A).

(3)

Dual eligible beneficiary

The term dual eligible beneficiary means an eligible beneficiary who is both a Medicare eligible beneficiary and a Medicaid eligible beneficiary.

5.

Funding of Medi-choice cards

(a)

Amounts

Under the demonstration program, subject to the succeeding subsections, the Secretary shall make funds available through the Medi-Choice card as follows:

(1)

Dual eligible beneficiaries

For a dual eligible beneficiary the annual amount of the deposit—

(A)

for 2012 is equal to the sum of—

(i)

the United States average nominal dollar value of medical assistance under title XIX of the Social Security Act; and

(ii)

the United States average nominal dollar value of the benefits under parts A, B, and D of title XVIII of such Act;

(B)

for any subsequent year is equal to the annual amount specified in this paragraph for the preceding year increased by the annual inflation adjustment described in subsection (d) for such subsequent year.

(2)

Other Medicaid eligible beneficiaries

For a Medicaid eligible beneficiary who is not a dual eligible beneficiary, the annual amount of the deposit—

(A)

for 2012 is equal to the United States average nominal dollar value of medical assistance under title XIX of the Social Security Act; and

(B)

for any subsequent year is equal to the annual amount specified in this paragraph for the preceding year increased by the annual inflation adjustment described in subsection (d) for such subsequent year.

(3)

Other Medicare eligible beneficiaries

For a Medicare eligible beneficiary who is not a dual eligible beneficiary, the annual amount of the deposit shall—

(A)

for 2012 be equal to the United States average nominal dollar value of the benefits under parts A, B, and D of title XVIII of the Social Security Act; and

(B)

for any subsequent year is equal to the annual amount specified in this paragraph for the preceding year increased by the annual inflation adjustment described in subsection (d) for such subsequent year.

(4)

Rounding

Any amount computed under paragraph (1)(B), (2)(B), or (3)(B) that is not a multiple of $12 shall be rounded to the nearest multiple of $12.

(b)

Risk adjustment

The payment amounts under subsection (a) for an individual shall be adjusted, using a methodology specified by the Secretary, in a manner that takes into account the relative risk factors (such as those described in section 1853(a)(1)(C)(i) of the Social Security Act) associated with such individual. Such adjustment shall be made in such a manner as not to change the total amount of payments made under this section as a result of such adjustment.

(c)

Medi-Choice reductions for higher-Income individuals

In the case of an individual whose modified adjusted gross income (as defined in paragraph (4) of section 1839(i)(4) of the Social Security Act), exceeds the threshold amount specified in paragraph (2) of such section, as adjusted under paragraph (5) of such section, the annual amount under subsection (a)(2) shall be reduced by one percent for each percent of such excess, but not to exceed a reduction of 50 percentage points.

(d)

Annual inflation adjustment

The annual inflation adjustment under paragraphs (1)(B) and (2)(B) for a year is equal to the average of—

(1)

the annual rate of increase in the consumer price index for urban consumers (all items; United States city average) for the year, as projected by the Secretary in consultation with the Bureau of Labor Statistics before the beginning of the year; and

(2)

the annual rate of increase in the medical care component of the consumer price index for all urban consumers (United States city average) for the year, as projected by the Secretary in consultation with the Bureau of Labor Statistics before the beginning of the year.

(e)

Monthly deposits

Deposits of amounts to Medi-Choice cards under this section shall be credited on a monthly basis and prorated for partial months of program enrollment.

6.

Scope of demonstration program

(a)

Area

The demonstration program shall be conducted in the counties of Kern, Tulare, Kings, Fresno, Merced, Madera, Stanislaus, and San Joaquin in California.

(b)

Period of demonstration project

(1)

Duration

The demonstration program shall be conducted for a period of 10 years.

(2)

Initial enrollment

Eligible beneficiaries shall be permitted to enroll in the demonstration program beginning on June 1, 2013.

(c)

Numerical limitation

No more than 100,000 eligible beneficiaries may be enrolled in the demonstration program at any time.

7.

Payment of costs

(a)

In general

The Secretary shall be responsible for the cost of operating the demonstration program, including all amounts deposited onto Medi-Choice cards. The cost of operation of the program insofar as they are attributable (as determined by the Secretary) to—

(1)

Medicare eligible beneficiaries and benefits under part A, part B, or part D of title XVIII of the Social Security Act shall be payable from the respective trust fund or account under the respective part, and the amounts in such trust funds or account shall be available to make such payments; or

(2)

Medicaid eligible beneficiaries and benefits under title XIX of such Act shall be payable from amounts appropriated to carry out such title and the amounts so appropriated shall be available to make such payments.

(b)

No duplicate payments

Except as provided in section 8(d)(2), no amounts shall be payable under title XVIII or XIX of the Social Security Act for benefits or medical assistance for an eligible beneficiary participating in the demonstration program.

8.

Miscellaneous

(a)

Assistance in enrollment

The Secretary shall maintain a toll free phone number to assist eligible beneficiaries with enrollment under the demonstration program and shall make information available to eligible beneficiaries in the demonstration area describing the options available, which shall include a comparison of plan costs and benefits.

(b)

Not treated as income

Amounts paid into a Medi-Choice card shall not be treated as income for purposes of the Internal Revenue Code of 1986 or for purposes of determining eligibility for any Federal program.

(c)

Premium obligations

An individual participating in the demonstration—

(1)

is not responsible for payment of any premium otherwise applicable under part B or D of title XVIII or under title XIX of the Social Security Act; but

(2)

shall use benefits applied to the Medi-Choice card for the purpose of purchasing qualifying health benefits coverage.

(d)

Relation to Medicaid benefits

(1)

In general

In the case of an individual who participates in the demonstration program, the individual is not entitled to any payment under a State plan under title XIX of the Social Security Act with respect to any benefits relating to items and services for which coverage is provided under this title.

(2)

Continuation of medical assistance for noncovered items and services

Nothing in this Act shall affect the continued provision of medical assistance under title XIX of such Act for items and services, such as dental, vision, or long-term care facility services, for which benefits are not provided under this Act regardless of medical necessity.