Protecting Seniors' Medicare Choices from Obamacare Act of 2014 - Amends title XIX (Medicaid) of the Social Security Act (SSA) to eliminate the increased Medicaid federal medical assistance percentage (FMAP, or federal matching amount) for prisoners with respect to their hospital care under the Patient Protection and Affordable Care Act.
Amends SSA title XVIII (Medicare) part C (Medicare+Choice) to establish a Medicare Advantage (MA) stabilization program under which the Secretary of Health and Human Services (HHS) shall distribute a stabilization funding amount to each eligible MA plan for plan year 2015 to address any beneficiary plan inadequacies.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5113 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 5113
To amend title XIX of the Social Security Act to end the increased
Federal funding for Medicaid expansion with respect to inmates'
hospital care under the Patient Protection and Affordable Care Act, to
apply the savings towards a 2015 Medicare Advantage stabilization
program to help protect seniors' choices, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 15, 2014
Mr. Coffman (for himself, Mrs. Blackburn, Mr. Nugent, Mr. Lamborn, and
Mr. Hall) 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 amend title XIX of the Social Security Act to end the increased
Federal funding for Medicaid expansion with respect to inmates'
hospital care under the Patient Protection and Affordable Care Act, to
apply the savings towards a 2015 Medicare Advantage stabilization
program to help protect seniors' choices, and for other purposes.
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 ``Protecting Seniors' Medicare Choices
from Obamacare Act of 2014''.
SEC. 2. ELIMINATING PPACA ENHANCED MEDICAID FMAP FOR PRISONERS AND
APPLYING SAVINGS TO MEDICARE ADVANTAGE IMPROVEMENT FUND.
(a) Elimination of PPACA Enhanced Medicaid FMAP for Prisoners.--
(1) In general.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended--
(A) in subsection (y)(2)(A), by adding at the end
the following: ``Such term does not include an
individual described in such subparagraph during the
period in which the individual is an inmate in a public
institution or in which the public institution
maintains jurisdiction over the individual.''; and
(B) in subsection (z)(1)(A), by inserting before
the period at the end the following: ``and who are not
inmates of a public institution (or individuals over
whom a public institution maintains jurisdiction)''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to items and services furnished on or after January
1, 2015.
(b) Application of Savings to 2015 to Establishment of 2015
Medicare Advantage Stabilization Program.--Section 1859 of the Social
Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the
following new subsection:
``(h) 2015 Medicare Advantage Stabilization Program.--
``(1) Establishment.--There is established a Medicare
Advantage stabilization program (in this subsection referred to
as the `stabilization program') under which the Secretary
shall, subject to paragraph (6), provide a PMPM stabilization
funding amount to each eligible Medicare Advantage plan in
accordance with this subsection to be used by such plan for
plan year 2015 to address the beneficiary plan inadequacies
applicable to such plan (as described in paragraph (5)).
``(2) Eligible medicare advantage plans.--For purposes of
this subsection, an eligible Medicare Advantage plan is a
Medicare Advantage plan to be offered for plan year 2015 that
the Secretary determines, based on the bid of such plan
submitted under section 1854 for such plan year, satisfies at
least one of the following criteria:
``(A) Increased beneficiary costs.--The total costs
(including premiums, cost-sharing responsibilities, and
deductibles) projected to be applicable to individuals
who enroll in such plan for such plan year are at least
7 percent more than the such total costs that were
applicable to individuals enrolled in such plan for
plan year 2014.
``(B) Decreased supplemental benefits.--The
supplemental benefits to be offered under such plan for
such plan year 2015 are less than the supplemental
benefits offered under such plan for plan year 2014.
``(C) Decreased provider network.--The number of
physicians in the plan's network has been reduced by 3
percent or more from plan year 2014 to plan year 2015.
``(3) Distribution of pmpm stabilization funding amounts.--
``(A) In general.--Subject to the availability of
funds under paragraph (6), under the stabilization
program, the Secretary shall distribute, not later than
December 31, 2014, to each eligible Medicare Advantage
plan a PMPM stabilization funding amount, as determined
by the Secretary in accordance with subparagraph (B).
``(B) PMPM stabilization funding amount.--A PMPM
stabilization funding amount, with respect to an
eligible Medicare Advantage plan, shall be determined
in accordance with the following:
``(i) Such amount shall be an amount, with
respect to each month of plan year 2015, for
each individual projected to be enrolled in
such plan for such plan year.
``(ii) Subject to paragraph (6) and clause
(iii), such amount shall be an amount
determined by the Secretary to be sufficient
for such plan to address for plan year 2015
each beneficiary plan inadequacy specified in
paragraph (4) applicable to such plan.
``(iii) Such amount shall not be more than
$85 per member per month.
``(4) Timing of determinations.--Under the stabilization
program, the Secretary shall determine which Medicare Advantage
plans are eligible Medicare Advantage plans under paragraph
(2), and the PMPM stabilization funding amount to be
distributed to each such eligible Medicare Advantage plan under
paragraph (3), by not later than October 15, 2014.
``(5) Applicable beneficiary plan inadequacies.--For
purposes of this subsection, a beneficiary plan inadequacy
applicable to an eligible Medicare Advantage plan is each of
the criteria described in paragraph (2) that the Secretary
determined the plan satisfied for qualifying as such an
eligible Medicare Advantage plan.
``(6) Funding.--
``(A) In general.--There shall be available to the
Secretary from amounts in the general fund in the
Treasury not otherwise appropriated an amount, not to
exceed $3,000,000,000, to carry out this subsection.
Such amounts shall remain so available until December
31, 2015. Any amounts made so available but not
expended on or before such date shall be transferred to
the general fund in the Treasury.
``(B) Clarification.--Payments under the
stabilization program shall not be taken into account
for purposes of determining the premium payments
applicable under part B.''.
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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.
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