Earned Benefits Equality and Family Reunification Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9054 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9054

    To amend title XVIII of the Social Security Act to establish a
  demonstration program for international coverage under the Medicare
                                program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              May 29, 2026

Mr. Espaillat introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
    and Commerce, 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 XVIII of the Social Security Act to establish a
  demonstration program for international coverage under the Medicare
                                program.

    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 ``Earned Benefits Equality and Family
Reunification Act''.

SEC. 2. ESTABLISHING A DEMONSTRATION PROGRAM FOR INTERNATIONAL COVERAGE
              UNDER THE MEDICARE PROGRAM.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by inserting after section 1866G the following new section:

``SEC. 1866H. DEMONSTRATION PROGRAM FOR INTERNATIONAL COVERAGE.

    ``(a) Implementation of 10-Year Demonstration Program.--Not later
than 1 year after the date of the enactment of this section, the
Secretary shall implement a 10-year demonstration program under this
title (in this section referred to as the Program) to allow Applicable
Beneficiaries to apply Medicare benefits to coverage of items and
services, premiums, and other cost-sharing under the health insurance
systems of other countries. Through the Program, the Secretary shall
make payments under subsection (e) to or on behalf of Applicable
Beneficiaries participating in the Program.
    ``(b) Program Design.--
            ``(1) In general.--The Secretary shall design the Program
        in such a manner to allow for the evaluation of the extent to
        which the Program accomplishes the following purposes:
                    ``(A) Increases the quality of care for Applicable
                Beneficiaries participating in the Program.
                    ``(B) Decreases the cost of care to the government
                for the Applicable Beneficiaries.
                    ``(C) Enables Applicable Beneficiaries to reunify
                with family members.
                    ``(D) Reduced strain on the medical infrastructure
                of the United States.
            ``(2) Consultation.--In designing the Program, the
        Secretary shall use open door forums and other mechanisms to
        seek input from a consortium of stakeholders that may include
        but are not limited to--
                    ``(A) the United States Department of State;
                    ``(B) clinical and analytical experts with relevant
                expertise;
                    ``(C) beneficiaries; and
                    ``(D) foreign health insurance system experts.
            ``(3) Program considerations.--In consultation with
        stakeholders as identified in subsection (b)(2), the Secretary
        shall issue guidance on--
                    ``(A) the guidelines to ensure the usage of
                medications and equipment that are of acceptable
                quality relative to American quality standards;
                    ``(B) ways to ensuring quality of care; and
                    ``(C) ways to target low-income Americans as
                participants in the program.
    ``(c) Selected Countries Initial Selection.--In choosing Selected
Countries for the Program, the Secretary shall initially select at
least 11 distinct nations or political subdivisions thereof, which
shall include Canada, the Federal Republic of Germany, the Republic of
India, the State of Israel, the Republic of Korea, the Republic of the
Philippines, the Republic of Panama, the United Mexican States,
Dominican Republic, and Ghana.
    ``(d) Applicable Beneficiary.--
            ``(1) Voluntary beneficiary participation.--An Applicable
        Beneficiary may participate in the Program on a voluntary basis
        and may terminate participation in the Program at any time. The
        election to participate in the Program or to terminate
        participation shall constitute a Special Election Period under
        section 1852(e)(4) of this title.
            ``(2) Services.--In order to participate in the Program, an
        Applicable Beneficiary shall agree to receive coverage of
        health care items and services in a Selected Country during
        such time as the Applicable Beneficiary is a resident of that
        country.
            ``(3) Beneficiary access to services.--Nothing in this
        section shall be construed as limiting an Applicable
        Beneficiary's access to items and services covered under this
        title when furnished in the United States, and Applicable
        Beneficiaries shall not be required to relinquish access to
        such benefits as a condition of receiving services from a
        participant in the Program.
            ``(4) Number of applicable beneficiaries.--The Secretary
        may cap the number of Applicable Beneficiaries accepted into
        the Program, but at a number no smaller than 150,000.
    ``(e) Physician Certification.--Participating physicians must be in
good standing with accreditation institutions or licensing authorities
in the Selected Countries.
    ``(f) Payments.--
            ``(1) In general.--The Secretary shall make payments to or
        on behalf of Applicable Beneficiaries for the costs of health
        care items and services paid by Applicable Beneficiaries in
        Selected Countries. Such payments may include payments for
        individual items or services paid by Applicable Beneficiaries,
        payments for cost sharing incurred by Applicable Beneficiaries,
        and premiums and equivalent charges for health insurance
        coverage paid by Applicable Beneficiaries. Payments shall not
        include reimbursement for taxes levied on income for the
        purpose of funding health care.
            ``(2) Payment amounts.--The Secretary shall limit the
        amounts of payment to ensure such payments and funds expended
        to design, implement, and evaluate the Program do not exceed in
        the aggregate the amount the Secretary would pay under this
        title for equivalent services delivered in the United States.
            ``(3) No duplicate payment.--The Secretary shall make or
        permit payments under this paragraph only for a calendar month
        in which the Applicable Beneficiary resides in the Selected
        Country and does not incur any costs under this title other
        than the payment hereunder.
    ``(g) Role of Medicare Advantage.--
            ``(1) In carrying out the Program, the Secretary may
        administer the Program, either in part or exclusively, through
        Medicare Advantage Organizations.
            ``(2) To the extent Medicare Advantage Organizations carry
        out functions under the Program, payments made by such
        organizations under subsection (e) shall be considered as if
        they were benefits under the original Medicare fee-for-service
        program option for purposes of sections 1852 and 1854 of this
        title, and a component of standard prescription drug coverage
        and not supplemental prescription drug coverage, under section
        1860D2(a) of this title.
            ``(3) The Secretary may limit the number of Medicare
        Advantage Organizations participating in the Program, in
        accordance with criteria established by the Secretary.
    ``(h) Reporting.--The Secretary shall conduct annual intermediate
and a final evaluation of the Program. Each such evaluation shall
determine the extent to which each of the purposes described in
subsection (b) have been accomplished under the Program. The evaluation
shall contain recommendations to Congress with regards to the expansion
of the Program.
    ``(i) Addressing Waste, Fraud, and Abuse.--
            ``(1) Participating physicians are required to go through
        Fraud, Waste, and Abuse training within 90 days of
        implementation of the demonstration project and at least
        annually thereafter.
            ``(2) The Secretary must create a system to allow patients
        and physicians to report instances or concerns of waste, fraud,
        and abuse.
    ``(j) Definitions.--In this section:
            ``(1) Applicable beneficiary.--The term `Applicable
        Beneficiary' means an individual who--
                    ``(A) is entitled to or enrolled for benefits under
                part A, and enrolled for benefits under part B;
                    ``(B) may be enrolled in a Medicare Advantage plan
                under part C;
                    ``(C) is either--
                            ``(i) a resident of the United States at
                        the time of application to the Program who
                        intends to relocate to a Selected Country on or
                        after the date of such application, or is a
                        former resident of the United States who has
                        relocated to a Selected Country within 180 days
                        of application to the Program; or
                            ``(ii) a resident of a Selected Country for
                        whom the Medicare program is at the time of
                        application the primary payor of their health
                        care costs; and
                    ``(D) meets such other criteria as the Secretary
                determines appropriate.
            ``(2) Selected country.--The term Selected Country means a
        nation or political subdivision thereof identified by the
        Secretary as having a health care system that provides for--
                    ``(A) health care coverage in scope and quality of
                coverage appropriate for Medicare beneficiaries in
                accordance with criteria established by the Secretary;
                and
                    ``(B) cost of coverage, coinsurance, and items and
                services that is equivalent to or less than expected
                costs for such coverage, coinsurance, and items and
                services in the United States under this title.
    ``(k) Funding.--
            ``(1) Administrative funding.--The Secretary shall allocate
        funds made available under section 1115A(f)(1) to design,
        implement, and evaluate the Program.
            ``(2) Benefit funding.--Payments for items and services
        under the Program shall be made in appropriate part from the
        Federal Hospital Insurance Trust Fund established by section
        1817 of this title and the Federal Supplementary Medical
        Insurance Trust Fund established by section 1841 of this title.
    ``(l) Waivers.--The Secretary may waive any provision of this title
as may be necessary to carry out the Program under this section.
    ``(m) Limitations on Review.--There shall be no administrative or
judicial review under section 1869, section 1878, or otherwise of--
            ``(1) the selection of organizations, sites, or
        participants to test the Program; and
            ``(2) the elements, parameters, scope, and duration of the
        Program. The preceding sentence shall not prevent an Applicable
        Beneficiary, having been selected as a participant, from
        exercising a right to appeal under sections 1869, 1155,
        1852(g), 1860D-4, or otherwise.
    ``(n) Administration.--
            ``(1) Chapter 35 of title 44, United States Code, shall not
        apply to the activities under this section.
            ``(2) The Secretary may enter into contracts for the
        administration of the Program without regard to any requirement
        for the use of competitive procedures.''.
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