H.R. 9054

[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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