Public health plan

(a) In general The Social Security Act is amended by adding at the end the following: 2201. Title XXII—Medicare part E public health plans Public health plans.— (a) Establishment The Secretary shall establish public health plans (to be known as Medicare part E plans) that are available in the individual market, small group market, and large group market. (b) Benefits (1) In general Each Medicare part E plan, regardless of whether the plan is offered in the individual market, small group market, or large group market, shall be a qualified health plan within the meaning of section 1301(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)) that— (A) meets all requirements applicable to qualified health plans under subtitle D of title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18021 et seq.) (other than the requirement under section 1301(a)(1)(C)(ii) of such Act) and title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.); (B) provides coverage of— (i) the essential health benefits described in section 1302(b) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)); and (ii) all items and services for which benefits are available under title XVIII; (C) provides gold-level coverage described in section 1302(d)(1)(C) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(d)(1)(C)); and (D) provides coverage of abortions and all other reproductive services. (2) Preemption Notwithstanding section 1303(a)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18023(a)(1))— (A) a State may not prohibit a Medicare part E plan from offering the coverage described in paragraph (1)(D); and (B) no provision of State law that would prohibit such a plan from offering such coverage shall apply to such plan. (c) Eligibility; enrollment (1) Availability on the Exchanges The Medicare part E plans offered in the individual and small group markets shall be offered through the Federal and State Exchanges, including the Small Business Health Options Program Exchanges (commonly referred to as the SHOP Exchanges). (2) Eligibility (A) In general Any individual who is a resident of the United States, as determined by the Secretary under subparagraph (C), and who is not an individual described in subparagraph (B), is eligible to enroll in a Medicare part E plan. (B) Exclusions An individual described in this subparagraph is any individual who is— (i) entitled to, or enrolled for, benefits under title XVIII; (ii) eligible for medical assistance under a State plan under title XIX; or (iii) enrolled for child health assistance or pregnancy-related assistance under a State plan under title XXI. (C) Regulations The Secretary shall promulgate a rule for determining residency for purposes of subparagraph (A). (3) Employer-sponsored plans (A) Employer enrollment Effective with respect to the first plan year that begins 1 year after the date of enactment of the Choose Medicare Act and each plan year thereafter, the Secretary shall provide options for Medicare part E plans in the small group market and large group market that are voluntary, and available to all employers. (B) Group health plans The Secretary, acting through the Administrator for the Centers for Medicare & Medicaid Services, at the request of a plan sponsor, shall serve as a third party administrator of a group health plan that is a Medicare part E plan offered by such sponsor. (C) Portability for employer-sponsored plans The Secretary shall develop a process for allowing individuals enrolled in a Medicare part E plan offered in the small group market or large group market to maintain health insurance coverage through a Medicare part E plan if the individual subsequently loses eligibility for enrollment in such a plan based on termination of the employment relationship. The ability to maintain such coverage shall exist regardless of whether the individual has the option to enroll in other health insurance coverage, including coverage offered in the individual market or through a subsequent employer. (d) Premiums The Secretary shall establish premium rates for the Medicare part E plans that— (1) are adjusted based on— (A) whether the plan is offered in the individual market, small group market, or large group market; and (B) the applicable rating area; (2) are at a level sufficient to fully finance— (A) the costs of health benefits provided by such plans; and (B) administrative costs related to operating the plans; and (3) comply with the requirements under section 2701 of the Public Health Service Act (42 U.S.C. 300gg), including for such plans that are offered in the large group market. (e) Providers and reimbursement rates (1) In general The Secretary shall establish a rate schedule for reimbursing types of health care providers furnishing items and services under the Medicare part E plans at rates that are consistent with the negotiations described in paragraph (2) and are necessary to maintain network adequacy. (2) Manner of negotiation The Secretary shall negotiate the rates described in paragraph (1) in a manner that results in payment rates that are not lower, in the aggregate, than rates under title XVIII, and not higher, in the aggregate, than the average rates paid by other health insurance issuers offering health insurance coverage through an Exchange. (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 on the date of enactment of the Choose Medicare Act shall be a participating provider for Medicare part E plans. (B) Additional providers The Secretary shall establish a process to allow health care providers not described in subparagraph (A) to become participating providers for Medicare part E plans. (4) Limitations on balance billing The limitations on balance billing pursuant to the provisions of section 1866(a)(1)(A) shall apply to participating providers for Medicare part E plans in the same manner as such provisions apply to participating providers under the Medicare program. (f) Encouraging use of alternative payment models The Secretary shall, as applicable, utilize alternative payment models, including those described in section 1833(z)(3)(C), in making payments for items and services (including prescription drugs) furnished under Medicare part E plans. The payment rates under such alternative payment models shall comply with the requirement for negotiated rates under subsection (e)(2). (g) Prescription drugs The Secretary shall apply the provisions of part E of title XI to prescription drugs under Medicare part E plans in the same manner as such provisions apply with respect to selected drugs under part E of title XI. (h) Appropriations (1) Start up funding For purposes of establishing the Medicare part E plans, there is appropriated to the Secretary, out of any funds in the Treasury not otherwise obligated, $2,000,000,000, for fiscal year 2026. (2) Initial reserves There is appropriated to the Secretary, out of any funds in the Treasury not otherwise obligated, such sums as may be necessary, based on projected enrollment in the Medicare part E plans in the first plan year in which such plans are offered, to provide reserves for the purpose of paying claims filed during the initial 90-day period of such plan year. (3) Clarification Any provision of law restricting the use of Federal funds with respect to any reproductive health service shall not apply to funds appropriated under paragraph (1) or (2). (i) Health insurance issuer With respect to any Medicare part E plan, the Secretary shall be considered a health insurance issuer, within the meaning of section 2791(b) of the Public Health Service Act (42 U.S.C. 300gg–91(b)).. (b) Application of excise tax for noncompliance with negotiation requirements Section 5000D(e)(1) of the Internal Revenue Code of 1986 is amended by adding at the end the following new sentence: Such term shall apply to any drug treated in the same manner as a drug described in the preceding sentence by reason of section 2201(g) of the Social Security Act..