Choice in Healthcare Act - Directs the Secretary of Health and Human Services (HHS) to establish a demonstration program under which Medicare and Medicaid eligible beneficiaries are given: (1) the option of purchasing qualifying health benefits coverage, and (2) access to a debit style card (Medi-Choice card) for purchasing such coverage under the program and for paying certain other out-of-pocket health care expenditures.
Directs the Secretary to contract with a major credit card provider or financial institution for issuing Medi-Choice cards under the program.
Limits the demonstration program to specified counties in California and to a period of ten years.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5994 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 5994
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 21, 2012
Mr. Nunes 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.
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 ``Choice in Healthcare Act''.
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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