[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4519 Enrolled Bill (ENR)]
H.R.4519
One Hundred Ninth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Tuesday,
the third day of January, two thousand and six
An Act
To amend the Public Health Service Act to extend funding for the
operation of State high risk health insurance pools.
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 ``State High Risk Pool Funding
Extension Act of 2006''.
SEC. 2. EXTENSION OF FUNDING FOR OPERATION OF STATE HIGH RISK HEALTH
INSURANCE POOLS.
Section 2745 of the Public Health Service Act (42 U.S.C. 300gg-45)
is amended to read as follows:
``SEC. 2745. RELIEF FOR HIGH RISK POOLS.
``(a) Seed Grants to States.--The Secretary shall provide from the
funds appropriated under subsection (d)(1)(A) a grant of up to
$1,000,000 to each State that has not created a qualified high risk
pool as of the date of enactment of the State High Risk Pool Funding
Extension Act of 2006 for the State's costs of creation and initial
operation of such a pool.
``(b) Grants for Operational Losses.--
``(1) In general.--In the case of a State that has established
a qualified high risk pool that--
``(A) restricts premiums charged under the pool to no more
than 200 percent of the premium for applicable standard risk
rates;
``(B) offers a choice of two or more coverage options
through the pool; and
``(C) has in effect a mechanism reasonably designed to
ensure continued funding of losses incurred by the State in
connection with operation of the pool after the end of the last
fiscal year for which a grant is provided under this paragraph;
the Secretary shall provide, from the funds appropriated under
paragraphs (1)(B)(i) and (2)(A) of subsection (d) and allotted to
the State under paragraph (2), a grant for the losses incurred by
the State in connection with the operation of the pool.
``(2) Allotment.--Subject to paragraph (4), the amounts
appropriated under paragraphs (1)(B)(i) and (2)(A) of subsection
(d) for a fiscal year shall be allotted and made available to the
States (or the entities that operate the high risk pool under
applicable State law) that qualify for a grant under paragraph (1)
as follows:
``(A) An amount equal to 40 percent of such appropriated
amount for the fiscal year shall be allotted in equal amounts
to each qualifying State that is one of the 50 States or the
District of Columbia and that applies for a grant under this
subsection.
``(B) An amount equal to 30 percent of such appropriated
amount for the fiscal year shall be allotted among qualifying
States that apply for such a grant so that the amount allotted
to such a State bears the same ratio to such appropriated
amount as the number of uninsured individuals in the State
bears to the total number of uninsured individuals (as
determined by the Secretary) in all qualifying States that so
apply.
``(C) An amount equal to 30 percent of such appropriated
amount for the fiscal year shall be allotted among qualifying
States that apply for such a grant so that the amount allotted
to a State bears the same ratio to such appropriated amount as
the number of individuals enrolled in health care coverage
through the qualified high risk pool of the State bears to the
total number of individuals so enrolled through qualified high
risk pools (as determined by the Secretary) in all qualifying
States that so apply.
``(3) Special rule for pools charging higher premiums.--In the
case of a qualified high risk pool of a State which charges
premiums that exceed 150 percent of the premium for applicable
standard risks, the State shall use at least 50 percent of the
amount of the grant provided to the State to carry out this
subsection to reduce premiums for enrollees.
``(4) Limitation for territories.--In no case shall the
aggregate amount allotted and made available under paragraph (2)
for a fiscal year to States that are not the 50 States or the
District of Columbia exceed $1,000,000.
``(c) Bonus Grants for Supplemental Consumer Benefits.--
``(1) In general.--In the case of a State that is one of the 50
States or the District of Columbia, that has established a
qualified high risk pool, and that is receiving a grant under
subsection (b)(1), the Secretary shall provide, from the funds
appropriated under paragraphs (1)(B)(ii) and (2)(B) of subsection
(d) and allotted to the State under paragraph (3), a grant to be
used to provide supplemental consumer benefits to enrollees or
potential enrollees (or defined subsets of such enrollees or
potential enrollees) in qualified high risk pools.
``(2) Benefits.--A State shall use amounts received under a
grant under this subsection to provide one or more of the following
benefits:
``(A) Low-income premium subsidies.
``(B) A reduction in premium trends, actual premiums, or
other cost-sharing requirements.
``(C) An expansion or broadening of the pool of individuals
eligible for coverage, such as through eliminating waiting
lists, increasing enrollment caps, or providing flexibility in
enrollment rules.
``(D) Less stringent rules, or additional waiver authority,
with respect to coverage of pre-existing conditions.
``(E) Increased benefits.
``(F) The establishment of disease management programs.
``(3) Allotment; limitation.--The Secretary shall allot funds
appropriated under paragraphs (1)(B)(ii) and (2)(B) of subsection
(d) among States qualifying for a grant under paragraph (1) in a
manner specified by the Secretary, but in no case shall the amount
so allotted to a State for a fiscal year exceed 10 percent of the
funds so appropriated for the fiscal year.
``(4) Rule of construction.--Nothing in this subsection shall
be construed to prohibit a State that, on the date of the enactment
of the State High Risk Pool Funding Extension Act of 2006, is in
the process of implementing a program to provide benefits of the
type described in paragraph (2), from being eligible for a grant
under this subsection.
``(d) Funding.--
``(1) Appropriation for fiscal year 2006.--There are authorized
to be appropriated for fiscal year 2006--
``(A) $15,000,000 to carry out subsection (a); and
``(B) $75,000,000, of which, subject to paragraph (4)--
``(i) two-thirds of the amount appropriated shall be
made available for allotments under subsection (b)(2); and
``(ii) one-third of the amount appropriated shall be
made available for allotments under subsection (c)(3).
``(2) Authorization of appropriations for fiscal years 2007
through 2010.--There are authorized to be appropriated $75,000,000
for each of fiscal years 2007 through 2010, of which, subject to
paragraph (4)--
``(A) two-thirds of the amount appropriated for a fiscal
year shall be made available for allotments under subsection
(b)(2); and
``(B) one-third of the amount appropriated for a fiscal
year shall be made available for allotments under subsection
(c)(3).
``(3) Availability.--Funds appropriated for purposes of
carrying out this section for a fiscal year shall remain available
for obligation through the end of the following fiscal year.
``(4) Reallotment.--If, on June 30 of each fiscal year for
which funds are appropriated under paragraph (1)(B) or (2), the
Secretary determines that all the amounts so appropriated are not
allotted or otherwise made available to States, such remaining
amounts shall be allotted and made available under subsection (b)
among States receiving grants under subsection (b) for the fiscal
year based upon the allotment formula specified in such subsection.
``(5) No entitlement.--Nothing in this section shall be
construed as providing a State with an entitlement to a grant under
this section.
``(e) Applications.--To be eligible for a grant under this section,
a State shall submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary may
require.
``(f) Annual Report.--The Secretary shall submit to Congress an
annual report on grants provided under this section. Each such report
shall include information on the distribution of such grants among
States and the use of grant funds by States.
``(g) Definitions.--In this section:
``(1) Qualified high risk pool.--
``(A) In general.--The term `qualified high risk pool' has
the meaning given such term in section 2744(c)(2), except that
a State may elect to meet the requirement of subparagraph (A)
of such section (insofar as it requires the provision of
coverage to all eligible individuals) through providing for the
enrollment of eligible individuals through an acceptable
alternative mechanism (as defined for purposes of section 2744)
that includes a high risk pool as a component.
``(2) Standard risk rate.--The term `standard risk rate' means
a rate--
``(A) determined under the State high risk pool by
considering the premium rates charged by other health insurers
offering health insurance coverage to individuals in the
insurance market served;
``(B) that is established using reasonable actuarial
techniques; and
``(C) that reflects anticipated claims experience and
expenses for the coverage involved.
``(3) State.--The term `State' means any of the 50 States and
the District of Columbia and includes Puerto Rico, the Virgin
Islands, Guam, American Samoa, and the Northern Mariana Islands.''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.