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<bill bill-stage="Introduced-in-House" bill-type="olc" dms-id="H504ACA004C8D4F77887D7F81513C7DDF" public-private="public">
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<dublinCore>
<dc:title>110 HR 5955 IH: Increased Access to
</dc:title>
<dc:publisher>U.S. House of Representatives</dc:publisher>
<dc:date>2008-05-01</dc:date>
<dc:format>text/xml</dc:format>
<dc:language>EN</dc:language>
<dc:rights>Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.</dc:rights>
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</metadata>
	<form>
		<distribution-code display="yes">I</distribution-code>
		<congress>110th CONGRESS</congress>
		<session>2d Session</session>
		<legis-num>H. R. 5955</legis-num>
		<current-chamber>IN THE HOUSE OF REPRESENTATIVES</current-chamber>
		<action>
			<action-date date="20080501">May 1, 2008</action-date>
			<action-desc><sponsor name-id="W000798">Mr. Walberg</sponsor> (for
			 himself, <cosponsor name-id="F000448">Mr. Franks of Arizona</cosponsor>,
			 <cosponsor name-id="F000447">Mr. Feeney</cosponsor>,
			 <cosponsor name-id="K000363">Mr. Kline of Minnesota</cosponsor>,
			 <cosponsor name-id="T000260">Mr. Tiahrt</cosponsor>,
			 <cosponsor name-id="C000266">Mr. Chabot</cosponsor>, and
			 <cosponsor name-id="B000208">Mr. Bartlett of Maryland</cosponsor>) introduced
			 the following bill; which was referred to the
			 <committee-name committee-id="HIF00">Committee on Energy and
			 Commerce</committee-name>, and in addition to the Committees on
			 <committee-name committee-id="HED00">Education and Labor</committee-name>,
			 <committee-name committee-id="HJU00">Judiciary</committee-name>, and
			 <committee-name committee-id="HWM00">Ways and Means</committee-name>, 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</action-desc>
		</action>
		<legis-type>A BILL</legis-type>
		<official-title>To provide for comprehensive health
		  reform.</official-title>
	</form>
	<legis-body id="H5584429043CB4AEA95C018FB4482612" style="OLC">
		<section id="H7BF4A20B3D0449E60043FBD18C9087EC" section-type="section-one"><enum>1.</enum><header>Short title; table of
			 contents</header>
			<subsection id="H87876155B8054765A5EF9BF4450684FF"><enum>(a)</enum><header>Short
			 title</header><text display-inline="yes-display-inline">This Act may be cited
			 as the <quote><short-title>Making Health Care More
			 Affordable Act of 2008</short-title></quote>.</text>
			</subsection><subsection id="H51D7B63FCE8F42F3B8C4FABADE74852"><enum>(b)</enum><header>Table of
			 contents</header><text>The table of contents of this Act is as follows:</text>
				<toc container-level="legis-body-container" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
					<toc-entry idref="H7BF4A20B3D0449E60043FBD18C9087EC" level="section">Sec. 1. Short title; table of contents.</toc-entry>
					<toc-entry idref="H0CDFFA48736749759D705FA4F3121DD9" level="title">Title I—HEALTH INSURANCE TAX CREDIT</toc-entry>
					<toc-entry idref="HB5455AE42B2B496DBD81B77995245F6C" level="section">Sec. 101. Refundable credit for health insurance
				coverage.</toc-entry>
					<toc-entry idref="HB8E6FC760A8F4B088C8E1C69A99D02DA" level="section">Sec. 102. Advance payment of credit for purchasers of qualified
				health insurance.</toc-entry>
					<toc-entry idref="HF3E3CB198F7449F587DEBB23331EB454" level="title">Title II—SMALL BUSINESS HEALTH PLANS</toc-entry>
					<toc-entry idref="HF1D5772CD4C849D0B6D1DA954893D22" level="section">Sec. 201. Rules governing association health plans.</toc-entry>
					<toc-entry idref="H3083C1D1DC794015945EF2046BB112D0" level="section">Sec. 202. Clarification of treatment of single employer
				arrangements.</toc-entry>
					<toc-entry idref="H45A7803F92AC4C368E924D34EA52F137" level="section">Sec. 203. Enforcement provisions relating to association health
				plans.</toc-entry>
					<toc-entry idref="H4032AB8046BB4F8FB815D7B6FD10C1E6" level="section">Sec. 204. Cooperation between Federal and State
				authorities.</toc-entry>
					<toc-entry idref="HEA0A74067B5E419FB54CF4A1C00D700" level="section">Sec. 205. Effective date and transitional and other
				rules.</toc-entry>
					<toc-entry idref="HD94AAFA7A4F24083BFC00106A447144E" level="title">Title III—PURCHASE HEALTH INSURANCE ACROSS STATE LINES
				</toc-entry>
					<toc-entry idref="HDF6B8BA339044E4D90EDCAD8206FBACD" level="section">Sec. 301. Cooperative governing of individual health insurance
				coverage.</toc-entry>
					<toc-entry idref="HD3C08F9677A64C01BE6FF8179B68AC09" level="section">Sec. 302. Severability.</toc-entry>
					<toc-entry idref="HD51FB617730641FFA45410AE00EE23F9" level="title">Title IV—EXPANSION OF HEALTH SAVINGS ACCOUNTS</toc-entry>
					<toc-entry idref="H5AE7111A28EA480D8300D33FB667C8E6" level="subtitle">Subtitle A—Promoting Health for Future Generations</toc-entry>
					<toc-entry idref="H67A1604A0E8649D8A67E10D77515C513" level="section">Sec. 401. Short title.</toc-entry>
					<toc-entry idref="HC21FBC3237C8425499F7BA11FE328630" level="section">Sec. 402. Increase in HSA contribution limitation.</toc-entry>
					<toc-entry idref="H258B1CBE10EC4733B1374E27F7F4ADE2" level="section">Sec. 403. Medicare and VA healthcare enrollees eligible to
				contribute to HSA.</toc-entry>
					<toc-entry idref="H1FBC19639D6344AAA9BD8DF1999F0001" level="section">Sec. 404. Expanding additional contributions
				limitation.</toc-entry>
					<toc-entry idref="H7B426D3F78A64571B203EDB9C8B8F9CA" level="section">Sec. 405. Eligibility to contribute to HSA.</toc-entry>
					<toc-entry idref="H93E2C0A30D39491FB5CB99FC9983408D" level="section">Sec. 406. Deduction of premiums for high deductible health
				plans.</toc-entry>
					<toc-entry idref="H8623171A0EA34FEBB8DBA669B514D692" level="section">Sec. 407. MSA plan deductible exception for preventive
				care.</toc-entry>
					<toc-entry idref="HD83E0AC18A5E4D9098CC721172D2B17" level="section">Sec. 408. Permitting individual contributions to Medicare
				Advantage MSA.</toc-entry>
					<toc-entry idref="HBE5E998243A94985BB94827EB287632D" level="section">Sec. 409. Allowing MSA and HSA rollover to adult child of
				account holder.</toc-entry>
					<toc-entry idref="H4EEC2DE887C34AA58DF0B119D4B724FA" level="section">Sec. 410. Permitting Medicare Advantage MSA funds to be used
				for wellness and fitness programs.</toc-entry>
					<toc-entry idref="H18A4B02494F646CFA0FE9F14394029F0" level="section">Sec. 411. Health reimbursement arrangements and spending
				arrangements in combination with health savings accounts.</toc-entry>
					<toc-entry idref="H7EF0FDDBE060465383FA3C956C08B118" level="section">Sec. 412. Special rule for certain medical expenses incurred
				before establishment of account.</toc-entry>
					<toc-entry idref="HA53E136004AE439B979E44748B2B02A9" level="section">Sec. 413. Allow both spouses to make catch-up contributions to
				the same HSA account.</toc-entry>
					<toc-entry idref="HF5456ED0966E44BC813E779BDEAF1B8C" level="section">Sec. 414. FSA and HRA Termination to fund HSAs.</toc-entry>
					<toc-entry idref="H57E127B8A752452BB9EAD6B92B2709DF" level="subtitle">Subtitle B—Increased Access to Health Insurance through
				HSAs</toc-entry>
					<toc-entry idref="H0DC70958747E47B6B7647BF1DC86C699" level="section">Sec. 421. Short title.</toc-entry>
					<toc-entry idref="H190DA4C93C214BFE96E36CC9C7A9D6CA" level="section">Sec. 422. Purchase of health insurance from health savings
				accounts.</toc-entry>
					<toc-entry idref="H4B2CABC5BCE146D28135001190B501D0" level="title">Title V—Health Care Tort Reform</toc-entry>
					<toc-entry idref="HD503AF5C11304959AC005F8502A2F6F3" level="section">Sec. 501. Findings and purpose.</toc-entry>
					<toc-entry idref="H9BE216FA5AB94FD0A3E3072FC9D37961" level="section">Sec. 502. Encouraging speedy resolution of claims.</toc-entry>
					<toc-entry idref="HB16469BED5CA48A8B5E3EB6EFD076369" level="section">Sec. 503. Compensating patient injury.</toc-entry>
					<toc-entry idref="H4DEF9882FC9247F2BC8586B9F3EAD47C" level="section">Sec. 504. Maximizing patient recovery.</toc-entry>
					<toc-entry idref="HC18E5EAB979C4179A7FDA67561DE394" level="section">Sec. 505. Additional health tort reform benefits.</toc-entry>
					<toc-entry idref="HEF7DC557142F400B8E00B9C53E42D576" level="section">Sec. 506. Punitive damages.</toc-entry>
					<toc-entry idref="HF6C8EB041974450EA849BCC3F6FE0020" level="section">Sec. 507. Authorization of payment of future damages to
				claimants in health care lawsuits.</toc-entry>
					<toc-entry idref="H1AE586B4BF27464EA78709DB915C11F8" level="section">Sec. 508. Definitions.</toc-entry>
					<toc-entry idref="HF3EF3AC9C2214A7A9C6FE2862FE15FB8" level="section">Sec. 509. Effect on other laws.</toc-entry>
					<toc-entry idref="H58A1A81D9AB84CBA9CC40774B61E8D41" level="section">Sec. 510. State flexibility and protection of states’
				rights.</toc-entry>
					<toc-entry idref="H57A9D6DD98784D8CAF0600D19BCC85D7" level="section">Sec. 511. Applicability; effective date.</toc-entry>
					<toc-entry idref="H9F55400787DB48039ED59940674300F8" level="section">Sec. 512. Sense of Congress.</toc-entry>
					<toc-entry idref="id7803AE27CDC8458DB8ECB374EAA326F7" level="title">Title VI—Health Information Technology</toc-entry>
					<toc-entry idref="id82B229A8554143FAB9A0D4A2B295CE8E" level="subtitle">Subtitle A—Assisting the Development of Health Information
				Technology</toc-entry>
					<toc-entry idref="idDCCFF8C00AF74671AB51A71B7A54834C" level="section">Sec. 601. Purpose.</toc-entry>
					<toc-entry idref="id00CFE516B46C4BF79C5C3AEA6250CFCF" level="section">Sec. 602. Health record banking.</toc-entry>
					<toc-entry idref="idBC1757FFCA294E62BE36E3AE260B116A" level="section">Sec. 603. Application of Federal and State security and
				confidentiality standards.</toc-entry>
					<toc-entry idref="idA7B909E9AA534E3B90B11646B59D4860" level="subtitle">Subtitle B—Promoting the Use of Health Information Technology
				to Better Coordinate Health Care </toc-entry>
					<toc-entry idref="ID931E5EB242F046C08F60AA9AD74626BB" level="section">Sec. 611. Safe harbors to antikickback civil penalties and
				criminal penalties for provision of health information technology and training
				services.</toc-entry>
					<toc-entry idref="IDA535228AF37E477BB71ED37E38B0A192" level="section">Sec. 612. Exception to limitation on certain physician
				referrals (under stark) for provision of health information technology and
				training services to health care professionals.</toc-entry>
					<toc-entry idref="ID92075C45CF4F4F5ABC71D19D5D99BAC8" level="section">Sec. 613. Rules of construction regarding use of
				consortia.</toc-entry>
				</toc>
			</subsection></section><title id="H0CDFFA48736749759D705FA4F3121DD9"><enum>I</enum><header>HEALTH INSURANCE
			 TAX CREDIT</header>
			<section commented="no" display-inline="no-display-inline" id="HB5455AE42B2B496DBD81B77995245F6C" section-type="subsequent-section"><enum>101.</enum><header display-inline="yes-display-inline">Refundable credit for health insurance
			 coverage</header>
				<subsection commented="no" display-inline="no-display-inline" id="H12655BD84481409A00B78EA6EDCFF26E"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Subpart C of part IV of subchapter A of
			 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/26/1">chapter 1</external-xref> of the Internal Revenue Code of 1986 (relating to refundable credits)
			 is amended by redesignating section 36 as section 37 and by inserting after
			 section 35 the following new section:</text>
					<quoted-block display-inline="no-display-inline" id="H0E6D700A95A043CA8850AC4B209B839C" style="OLC">
						<section commented="no" display-inline="no-display-inline" id="H21784DE308924EFC955C2CB23588B690" section-type="subsequent-section"><enum>36.</enum><header display-inline="yes-display-inline">Qualified health insurance tax
				credit</header>
							<subsection commented="no" display-inline="no-display-inline" id="H2EC7A44816E546589672070234DADB7C"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">In the case of an individual, there shall
				be allowed as a credit against the tax imposed by this subtitle an amount equal
				to the amount paid during the taxable year for qualified health insurance for
				the taxpayer and the taxpayer's spouse or dependent.</text>
							</subsection><subsection commented="no" display-inline="no-display-inline" id="HABCF27ED8B224710917C441DC7C21C78"><enum>(b)</enum><header display-inline="yes-display-inline">Limitations</header>
								<paragraph commented="no" display-inline="no-display-inline" id="HD16EC332F9AC425CACF7208F4E5C9D79"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The amount allowed as a credit under
				subsection (a) to the taxpayer for the taxable year shall not exceed the sum of
				the monthly limitations for coverage months during such taxable year for the
				individual referred to in subsection (a) for whom the taxpayer paid during the
				taxable year any amount for coverage under qualified health insurance.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HEA6603AFDF064565ABF1006D72DD6E47"><enum>(2)</enum><header display-inline="yes-display-inline">Monthly limitation</header>
									<subparagraph commented="no" display-inline="no-display-inline" id="H12FCA78F585040229EB587F354BF72D"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The monthly limitation for an individual
				for each coverage month of such individual during the taxable year is the
				amount equal to <fraction>1/12</fraction> of the qualified health insurance
				amount.</text>
									</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0EC4011CDC864204B4B7478DD3FA52A5"><enum>(B)</enum><header display-inline="yes-display-inline">Qualified health insurance
				amount</header><text display-inline="yes-display-inline">For purposes of this
				paragraph, the qualified health insurance amount is—</text>
										<clause commented="no" display-inline="no-display-inline" id="H59E830C660ED4256A1516EECC63541BA"><enum>(i)</enum><text display-inline="yes-display-inline">$2,500 if such individual is the
				taxpayer,</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="H4C1D055260B54FE2B6DFF65E187C47D6"><enum>(ii)</enum><text display-inline="yes-display-inline">$2,500 if such individual is the spouse of
				the taxpayer, the taxpayer and such spouse are married as of the first day of
				such month, and the taxpayer files a joint return for the taxable year,
				or</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="H0C423F277D954E839012D960BE10C8CD"><enum>(iii)</enum><text display-inline="yes-display-inline">$500 if such individual is an individual
				for whom a deduction under section 151(c) is allowable to the taxpayer for such
				taxable year.</text>
										</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HFB889C05CBD44079BA3953E0C06E9900"><enum>(C)</enum><header display-inline="yes-display-inline">Limitation on dependents</header><text display-inline="yes-display-inline">Not more than 2 individuals may be taken
				into account by the taxpayer under subparagraph (B)(iii).</text>
									</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H9CDB392E517E4F16B5E10019BFC62BC"><enum>(3)</enum><header display-inline="yes-display-inline">Coverage
				month</header><text display-inline="yes-display-inline">For purposes of this
				subsection—</text>
									<subparagraph commented="no" display-inline="no-display-inline" id="H3524F42E4819461E85479628679BBAF1"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The term <term>coverage month</term> means,
				with respect to an individual, any month if—</text>
										<clause commented="no" display-inline="no-display-inline" id="H3C6FB1CB98AB4660B93245F8D1B9E00"><enum>(i)</enum><text display-inline="yes-display-inline">as of the first day of such month such
				individual is covered by qualified health insurance, and</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="H9E0B0FA7E2BE400D9D67727544E4C44F"><enum>(ii)</enum><text display-inline="yes-display-inline">the premium for coverage under such
				insurance for such month is paid by the taxpayer.</text>
										</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H5B1E4A146257483B9B21CAF99F368F33"><enum>(B)</enum><header display-inline="yes-display-inline">Medicare</header><text display-inline="yes-display-inline">Such term shall not include any month with
				respect to an individual if, as of the first day of such month, such individual
				has not made an election to establish and maintain a Medical Retirement Account
				under section 252(a)(2) of the Social Security Act and is entitled to benefits
				under title XVIII of the <act-name parsable-cite="SSA">Social Security
				Act</act-name>.</text>
									</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H6241D2E084EE4CBB9FDA835FEC81EA0"><enum>(C)</enum><header display-inline="yes-display-inline">Certain other coverage</header><text display-inline="yes-display-inline">Such term shall not include any month
				during a taxable year with respect to an individual if, at any time during such
				year, any benefit is provided to such individual under—</text>
										<clause commented="no" display-inline="no-display-inline" id="H0E49C99D8F0F43F8971419DBE4D0B738"><enum>(i)</enum><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States
				Code,</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="HFB6080F6D5994F0AA43E00A44D00DC13"><enum>(ii)</enum><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code,
				or</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="HD6986234262943679E285F7305EDB8CA"><enum>(iii)</enum><text display-inline="yes-display-inline">any medical care program under the
				<act-name parsable-cite="IHCIA">Indian Health Care Improvement
				Act</act-name>.</text>
										</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HAD182F09405C421782AE174D66C02426"><enum>(D)</enum><header display-inline="yes-display-inline">Prisoners</header><text display-inline="yes-display-inline">Such term shall not include any month with
				respect to an individual if, as of the first day of such month, such individual
				is imprisoned under Federal, State, or local authority.</text>
									</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H1C987FA614A04A39A7CA7D4652C918F2"><enum>(E)</enum><header display-inline="yes-display-inline">Insufficient presence in United
				States</header><text display-inline="yes-display-inline">Such term shall not
				include any month during a taxable year with respect to an individual if such
				individual is present in the United States on fewer than 183 days during such
				year (determined in accordance with section 7701(b)(7)).</text>
									</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H3CFEC04AB21049F38D380009AD37007F"><enum>(c)</enum><header display-inline="yes-display-inline">Qualified health insurance</header><text display-inline="yes-display-inline">For purposes of this section—</text>
								<paragraph commented="no" display-inline="no-display-inline" id="H0532AF89E36941C8ABB21D68ACEACCEF"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The term <term>qualified health
				insurance</term> means any health plan (within the meaning of section
				223(c)(2)) determined without regard to any annual deductible
				requirement.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H53E635BF7E2945A3000098DB84A9B68D"><enum>(2)</enum><header display-inline="yes-display-inline">Annual wellness exam</header><text display-inline="yes-display-inline">Such term shall include an annual wellness
				exam fee not to exceed $150 ($100 in the case of an annual child wellness exam)
				if such exam is not covered by the insurance.</text>
								</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H9FBA31A8E0A44E7C96000095D7157FF1"><enum>(d)</enum><header display-inline="yes-display-inline">Archer MSA and health savings account
				contributions</header>
								<paragraph commented="no" display-inline="no-display-inline" id="HABA390FCFFB146339794531671216B06"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">If a deduction would (but for paragraph
				(2)) be allowed under section 220 or 223 to the taxpayer for a payment for the
				taxable year to the Archer MSA or health savings account of an individual,
				subsection (a) shall be applied by treating such payment as a payment for
				qualified health insurance for such individual.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC793FCE271ED416D9ECEBBAE5E5D2BF1"><enum>(2)</enum><header display-inline="yes-display-inline">Denial of double benefit</header><text display-inline="yes-display-inline">No deduction shall be allowed under section
				220 or 223 for that portion of the payments otherwise allowable as a deduction
				under section 220 or 223 for the taxable year which is equal to the amount of
				credit allowed for such taxable year by reason of this subsection.</text>
								</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HD91F25B279204011007F6100F2379B51"><enum>(e)</enum><header display-inline="yes-display-inline">Special rules</header><text display-inline="yes-display-inline">For purposes of this section—</text>
								<paragraph commented="no" display-inline="no-display-inline" id="H972543A5E0824319A9E360311500A05F"><enum>(1)</enum><header display-inline="yes-display-inline">Married couples must file joint
				return</header><text display-inline="yes-display-inline">If the taxpayer is
				married at the close of the taxable year, the credit shall be allowed under
				subsection (a) only if the taxpayer and the taxpayer's spouse file a joint
				return for the taxable year.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBBC59E86A862489BB3870010DEA1044"><enum>(2)</enum><header display-inline="yes-display-inline">Denial of credit to
				dependents</header><text display-inline="yes-display-inline">No credit shall be
				allowed under this section to any individual with respect to whom a deduction
				under section 151 is allowable to another taxpayer for a taxable year beginning
				in the calendar year in which such individual’s taxable year begins.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H89966BE0678049B5A364779B997021E5"><enum>(3)</enum><header display-inline="yes-display-inline">Denial of double benefit</header><text display-inline="yes-display-inline">No credit shall be allowed under subsection
				(a) if the credit under section 35 is allowed and no credit shall be allowed
				under 35 if a credit is allowed under this section.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HDDA8C93E9B0E4865886865B4345B9900"><enum>(4)</enum><header display-inline="yes-display-inline">Coordination with deduction for health
				insurance costs</header><text display-inline="yes-display-inline">In the case
				of a taxpayer who is eligible to deduct any amount under section 162(l) or 213
				for the taxable year, this section shall apply only if the taxpayer elects not
				to claim any amount as a deduction under such section for such year.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H0C3263A2F17F47C2ABD809F219100E7"><enum>(5)</enum><header display-inline="yes-display-inline">Election not to claim credit</header><text display-inline="yes-display-inline">This section shall not apply to a taxpayer
				for any taxable year if such taxpayer elects to have this section not apply for
				such taxable year.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HAF152C1DD80E4490B36DE868975892BB"><enum>(6)</enum><header display-inline="yes-display-inline">Inflation adjustment</header>
									<subparagraph commented="no" display-inline="no-display-inline" id="H1CDB32AF7D174D93A30019E400FDC5A9"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">In the case of any taxable year beginning
				in a calendar year after 2008, each dollar amount contained in subsection
				(b)(2)(B) shall be increased by an amount equal to—</text>
										<clause commented="no" display-inline="no-display-inline" id="H54D56C92FA2E4374B51C883D5329A061"><enum>(i)</enum><text display-inline="yes-display-inline">such dollar amount, multiplied by</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="HF35B01E33EC543DFBE7253F6504EEA8F"><enum>(ii)</enum><text display-inline="yes-display-inline">the cost-of-living adjustment determined
				under subparagraph (B) for the calendar year in which such taxable year
				begins.</text>
										</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H3C47A7B35AB74112AE38E2E686808C7C"><enum>(B)</enum><header display-inline="yes-display-inline">Cost-of-living adjustment</header><text display-inline="yes-display-inline">For purposes of subparagraph (A), the
				cost-of-living adjustment for any calendar year is the percentage (if any) by
				which—</text>
										<clause commented="no" display-inline="no-display-inline" id="HD542129428EB4D7685B01EEBA98EE4BA"><enum>(i)</enum><text display-inline="yes-display-inline">the GDP for the preceding calendar year,
				exceeds</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="H34E4A370B7544544A0BACE34A06E7D3D"><enum>(ii)</enum><text display-inline="yes-display-inline">the GDP for calendar year 2007.</text>
										</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4380D47656474C42AC19E24C66C73F58"><enum>(C)</enum><header display-inline="yes-display-inline">GDP for any calendar year</header><text display-inline="yes-display-inline">For purposes of subparagraph (B), the GDP
				for any calendar year is the average of the chain-weighted price index for the
				gross domestic product as of the close of the 12-month period ending on March
				31 of such calendar year.</text>
									</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0658C1C7818D453D8ED1AE71BE1D3048"><enum>(D)</enum><header display-inline="yes-display-inline">Chain-weighted price index for the gross
				domestic product</header><text display-inline="yes-display-inline">For purposes
				of subparagraph (C), the term <term>chain-weighted price index for the gross
				domestic product</term> means the last chain-weighted price index for the gross
				domestic product published by the Department of Commerce.</text>
									</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF026D3582E984E16A726586158117204"><enum>(E)</enum><header display-inline="yes-display-inline">Rounding</header><text display-inline="yes-display-inline">Any increase determined under subparagraph
				(A) shall be rounded to the nearest multiple of
				$50.</text>
									</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection commented="no" display-inline="no-display-inline" id="H2C0EA1AC03D54FF586961CC6E01D517E"><enum>(b)</enum><header display-inline="yes-display-inline">Information reporting</header>
					<paragraph commented="no" display-inline="no-display-inline" id="H3A8D10887A2D44E6BD18361797CFEA1E"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Subpart B of part III of subchapter A of
			 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/26/61">chapter 61</external-xref> of the Internal Revenue Code of 1986 (relating to information
			 concerning transactions with other persons) is amended by inserting after
			 section 6050V the following new section:</text>
						<quoted-block display-inline="no-display-inline" id="H4B2F8310DC12417AA4758C966583F198" style="OLC">
							<section commented="no" display-inline="no-display-inline" id="HADFBED66949F4543B4A4238D00847304" section-type="subsequent-section"><enum>6050W.</enum><header display-inline="yes-display-inline">Returns relating to payments for qualified
				health insurance</header>
								<subsection commented="no" display-inline="no-display-inline" id="H5C30EFBF3B40422691DA3913EE63979D"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Any person who, in connection with a trade
				or business conducted by such person, receives payments during any calendar
				year from any individual for coverage of such individual or any other
				individual under creditable health insurance, shall make the return described
				in subsection (b) (at such time as the Secretary may by regulations prescribe)
				with respect to each individual from whom such payments were received.</text>
								</subsection><subsection commented="no" display-inline="no-display-inline" id="H616C012DA0C64BC0BD7FD34B9680E5D7"><enum>(b)</enum><header display-inline="yes-display-inline">Form and manner of returns</header><text display-inline="yes-display-inline">A return is described in this subsection if
				such return—</text>
									<paragraph commented="no" display-inline="no-display-inline" id="HDEDC4D4D48834CE283F3EE5B8E5440F7"><enum>(1)</enum><text display-inline="yes-display-inline">is in such form as the Secretary may
				prescribe, and</text>
									</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD99576214EE94CCEAE1089821054C3F4"><enum>(2)</enum><text display-inline="yes-display-inline">contains—</text>
										<subparagraph commented="no" display-inline="no-display-inline" id="H572F8DC336C74E32A468E0D62D002760"><enum>(A)</enum><text display-inline="yes-display-inline">the name, address, and TIN of the
				individual from whom payments described in subsection (a) were received,</text>
										</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H2289E11D994E41649F6760BB1CBD26A5"><enum>(B)</enum><text display-inline="yes-display-inline">the name, address, and TIN of each
				individual who was provided by such person with coverage under creditable
				health insurance by reason of such payments and the period of such coverage,
				and</text>
										</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H17D1FF01A06D4B4D8CCFD617FF310085"><enum>(C)</enum><text display-inline="yes-display-inline">such other information as the Secretary may
				reasonably prescribe.</text>
										</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H30E6BA3CAF7945E2AC97C6DF00B55AB"><enum>(c)</enum><header display-inline="yes-display-inline">Creditable health insurance</header><text display-inline="yes-display-inline">For purposes of this section, the term
				<term>creditable health insurance</term> means qualified health insurance (as
				defined in section 36(c)) other than, to the extent provided in regulations
				prescribed by the Secretary, any insurance covering an individual if no credit
				is allowable under section 36 with respect to such coverage.</text>
								</subsection><subsection commented="no" display-inline="no-display-inline" id="H7A94367029DA4F9BBE043CFAFF1C557C"><enum>(d)</enum><header display-inline="yes-display-inline">Statements To be furnished to individuals
				with respect to whom information is required</header><text display-inline="yes-display-inline">Every person required to make a return
				under subsection (a) shall furnish to each individual whose name is required
				under subsection (b)(2)(A) to be set forth in such return a written statement
				showing—</text>
									<paragraph commented="no" display-inline="no-display-inline" id="H86BFF69004DD40E3BFD98DDA66E9E913"><enum>(1)</enum><text display-inline="yes-display-inline">the name and address of the person required
				to make such return and the phone number of the information contact for such
				person,</text>
									</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HB5BA4271B188447483505E5FD715A1E"><enum>(2)</enum><text display-inline="yes-display-inline">the aggregate amount of payments described
				in subsection (a) received by the person required to make such return from the
				individual to whom the statement is required to be furnished, and</text>
									</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HDF96D4FF333A4C499B1D595DB9FEBCD2"><enum>(3)</enum><text display-inline="yes-display-inline">the information required under subsection
				(b)(2)(B) with respect to such payments.</text>
									</paragraph><continuation-text commented="no" continuation-text-level="subsection">The written statement required under
				the preceding sentence shall be furnished on or before January 31 of the year
				following the calendar year for which the return under subsection (a) is
				required to be made.</continuation-text></subsection><subsection commented="no" display-inline="no-display-inline" id="HA60A1DB80C484C22A100E2F89752ED8"><enum>(e)</enum><header display-inline="yes-display-inline">Returns which would be required To be made
				by 2 or more persons</header><text display-inline="yes-display-inline">Except
				to the extent provided in regulations prescribed by the Secretary, in the case
				of any amount received by any person on behalf of another person, only the
				person first receiving such amount shall be required to make the return under
				subsection
				(a).</text>
								</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HB7D6CFD0901045E189E900DB00AB0789"><enum>(2)</enum><header display-inline="yes-display-inline">Assessable penalties</header>
						<subparagraph commented="no" display-inline="no-display-inline" id="HD6A9A3B34270433E9FB7C0001CE8ABBF"><enum>(A)</enum><text display-inline="yes-display-inline">Subparagraph (B) of section 6724(d)(1) of
			 such Code (relating to definitions) is amended by redesignating clauses (xv)
			 through (xx) as clauses (xvi) through (xxi), respectively, and by inserting
			 after clause (xi) the following new clause:</text>
							<quoted-block display-inline="no-display-inline" id="H82E22A9C64364C07BD09C1B15DA289B6" style="OLC">
								<clause commented="no" display-inline="no-display-inline" id="H3AEA8C66142746C1A2EA3C519921809B"><enum>(xv)</enum><text display-inline="yes-display-inline">section 6050W (relating to returns relating
				to payments for qualified health
				insurance),</text>
								</clause><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF22B2883A3D24A02B242CFEE84268351"><enum>(B)</enum><text display-inline="yes-display-inline">Paragraph (2) of section 6724(d) of such
			 Code is amended by striking the period at the end of subparagraph (CC) and
			 inserting <quote>, or</quote> and by adding at the end the following new
			 subparagraph:</text>
							<quoted-block display-inline="no-display-inline" id="HD345662AD0A845A49D458B0419192B88" style="OLC">
								<subparagraph commented="no" display-inline="no-display-inline" id="HFFD1E41156474B2B94C176BDB5FC8454"><enum>(DD)</enum><text display-inline="yes-display-inline">section 6050W(d) (relating to returns
				relating to payments for qualified health
				insurance).</text>
								</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFE9E0BC69428494984326D9827A6CC65"><enum>(3)</enum><header display-inline="yes-display-inline">Clerical amendment</header><text display-inline="yes-display-inline">The table of sections for subpart B of part
			 III of subchapter A of chapter 61 of such Code is amended by inserting after
			 the item relating to section 6050V the following new item:</text>
						<quoted-block display-inline="no-display-inline" id="H9A71C4B5D271403CA04EA28DAD3093A8" style="USC">
							<toc regeneration="no-regeneration">
								<toc-entry bold="off" level="section">Sec. 6050W. Returns relating to
				payments for qualified health
				insurance.</toc-entry>
							</toc>
							<after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H5C1213F7C38C4AA3B57723BA396C2B46"><enum>(c)</enum><header display-inline="yes-display-inline">Conforming amendments</header>
					<paragraph commented="no" display-inline="no-display-inline" id="HA19077B188244E3CB1B003EC9493E1E3"><enum>(1)</enum><text display-inline="yes-display-inline">Paragraph (2) of section 1324(b) of title
			 31, United States Code, is amended by inserting before the period <quote>, or
			 from section 36 of such Code</quote>.</text>
					</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H420D18B244D34F608100FF8DF467F78"><enum>(2)</enum><text display-inline="yes-display-inline">The table of sections for subpart C of part
			 IV of subchapter A of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/26/1">chapter 1</external-xref> of the Internal Revenue Code of 1986 is amended
			 by striking the last item and inserting the following new items:</text>
						<quoted-block display-inline="no-display-inline" id="H950F754E2255487400AD2E934292298" style="USC">
							<toc regeneration="no-regeneration">
								<toc-entry bold="off" level="section">Sec. 36. Qualified health
				insurance tax credit.</toc-entry>
								<toc-entry bold="off" level="section">Sec. 37. Overpayments of
				tax.</toc-entry>
							</toc>
							<after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HB4750CB98FF849C29628BDACBEF08010"><enum>(d)</enum><header display-inline="yes-display-inline">Effective
			 date</header><text display-inline="yes-display-inline">The amendments made by
			 this section shall apply to taxable years beginning after December 31,
			 2008.</text>
				</subsection></section><section commented="no" display-inline="no-display-inline" id="HB8E6FC760A8F4B088C8E1C69A99D02DA" section-type="subsequent-section"><enum>102.</enum><header display-inline="yes-display-inline">Advance payment of credit for purchasers of
			 qualified health insurance</header>
				<subsection commented="no" display-inline="no-display-inline" id="H6F9D7788FAD44FC296921F06C100C2A5"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Chapter 77 of the Internal Revenue Code of
			 1986 (relating to miscellaneous provisions) is amended by adding at the end the
			 following new section:</text>
					<quoted-block display-inline="no-display-inline" id="H14C045BF5C264F4BB088AE631F733C52" style="OLC">
						<section commented="no" display-inline="no-display-inline" id="H2B06A904AD504A44A400186E39446739" section-type="subsequent-section"><enum>7529.</enum><header display-inline="yes-display-inline">Advance payment of qualified health
				insurance tax credit</header>
							<subsection commented="no" display-inline="no-display-inline" id="HF416E90A84DB4EF291D600113E85BBC0"><enum>(a)</enum><header display-inline="yes-display-inline">General rule</header><text display-inline="yes-display-inline">In the case of an eligible individual, the
				Secretary shall make payments to the provider of such individual’s qualified
				health insurance equal to such individual’s qualified health insurance credit
				advance amount with respect to such provider.</text>
							</subsection><subsection commented="no" display-inline="no-display-inline" id="H0828EEEF625D4807A8243ECBBF8238AC"><enum>(b)</enum><header display-inline="yes-display-inline">Eligible individual</header><text display-inline="yes-display-inline">For purposes of this section, the term
				<term>eligible individual</term> means any individual—</text>
								<paragraph commented="no" display-inline="no-display-inline" id="H4A0BF8BA5C174144938FD46762ABAA24"><enum>(1)</enum><text display-inline="yes-display-inline">who purchases qualified health insurance
				(as defined in section 36(c)), and</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC3421864A3A34587A1C97B5B999819BC"><enum>(2)</enum><text display-inline="yes-display-inline">for whom a qualified health insurance
				credit eligibility certificate is in effect.</text>
								</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H7A44B3D31E844E4800F7B912734DB4C3"><enum>(c)</enum><header display-inline="yes-display-inline">Qualified health insurance credit
				eligibility certificate</header><text display-inline="yes-display-inline">For
				purposes of this section, a qualified health insurance credit eligibility
				certificate is a statement furnished by an individual to the Secretary
				which—</text>
								<paragraph commented="no" display-inline="no-display-inline" id="H0A11E822B6B14C4B92BFC3C013DA3202"><enum>(1)</enum><text display-inline="yes-display-inline">certifies that the individual will be
				eligible to receive the credit provided by section 36 for the taxable
				year,</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7AB1351E7D744052882CF01800C7F7BC"><enum>(2)</enum><text display-inline="yes-display-inline">estimates the amount of such credit for
				such taxable year, and</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBC05C4A5F69D4C12B09109121E6BD146"><enum>(3)</enum><text display-inline="yes-display-inline">provides such other information as the
				Secretary may require for purposes of this section.</text>
								</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H8E7A62A394FA47639EB395140069B43C"><enum>(d)</enum><header display-inline="yes-display-inline">Qualified health insurance credit advance
				amount</header><text display-inline="yes-display-inline">For purposes of this
				section, the term <term>qualified health insurance credit advance amount</term>
				means, with respect to any provider of qualified health insurance, the
				Secretary’s estimate of the amount of credit allowable under section 36 to the
				individual for the taxable year which is attributable to the insurance provided
				to the individual by such provider.</text>
							</subsection><subsection commented="no" display-inline="no-display-inline" id="HCC0E27A2E40A4F0C8B9C573780AA694B"><enum>(e)</enum><header display-inline="yes-display-inline">Regulations</header><text display-inline="yes-display-inline">The Secretary shall prescribe such
				regulations as may be necessary to carry out the purposes of this
				section.</text>
							</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection commented="no" display-inline="no-display-inline" id="H770C7ED14E0844E79969092E4E43888E"><enum>(b)</enum><header display-inline="yes-display-inline">Clerical amendment</header><text display-inline="yes-display-inline">The table of sections for chapter 77 of the
			 Internal Revenue Code of 1986 is amended by adding at the end the following new
			 item:</text>
					<quoted-block display-inline="no-display-inline" id="HFD3F776DA59044E2AF89E5D671007000" style="USC">
						<toc regeneration="no-regeneration">
							<toc-entry bold="off" level="section">Sec. 7529. Advance payment of
				qualified health insurance tax
				credit.</toc-entry>
						</toc>
						<after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection commented="no" display-inline="no-display-inline" id="H72B684BD075849C388D32CFAABF66C9"><enum>(c)</enum><header display-inline="yes-display-inline">Effective
			 date</header><text display-inline="yes-display-inline">The amendments made by
			 this section shall apply to taxable years beginning after December 31,
			 2008.</text>
				</subsection></section></title><title id="HF3E3CB198F7449F587DEBB23331EB454"><enum>II</enum><header>SMALL BUSINESS
			 HEALTH PLANS</header>
			<section id="HF1D5772CD4C849D0B6D1DA954893D22"><enum>201.</enum><header>Rules governing
			 association health plans</header>
				<subsection id="H523E9740F0CA43E293570592C2EB3F2B"><enum>(a)</enum><header>In
			 General</header><text display-inline="yes-display-inline">Subtitle B of title I
			 of the <act-name parsable-cite="ERISA">Employee Retirement Income Security Act
			 of 1974</act-name> is amended by adding after part 7 the following new
			 part:</text>
					<quoted-block act-name="Employee Retirement Income Security Act of 1974" id="H22D0FC90B32B4743927D11C9D791D3C4" style="OLC">
						<part id="H9A755A1DD55C4AD6BC10E97B3413CEF2"><enum>8</enum><header>RULES GOVERNING
				ASSOCIATION HEALTH PLANS</header>
							<section id="H9E044A75ED49492799F8D27CDC3609FD"><enum>801.</enum><header>Association
				health plans</header>
								<subsection id="H73097E1D7BE04C6500372C39779BC6FE"><enum>(a)</enum><header>In
				General</header><text>For purposes of this part, the term <term>association
				health plan</term> means a group health plan whose sponsor is (or is deemed
				under this part to be) described in subsection (b).</text>
								</subsection><subsection id="H8B82E00D91CB47719B005DF17E36832E"><enum>(b)</enum><header>Sponsorship</header><text>The
				sponsor of a group health plan is described in this subsection if such
				sponsor—</text>
									<paragraph id="H90663C21C5E147ACA73B6924CF03A300"><enum>(1)</enum><text>is organized and
				maintained in good faith, with a constitution and bylaws specifically stating
				its purpose and providing for periodic meetings on at least an annual basis, as
				a bona fide trade association, a bona fide industry association (including a
				rural electric cooperative association or a rural telephone cooperative
				association), a bona fide professional association, or a bona fide chamber of
				commerce (or similar bona fide business association, including a corporation or
				similar organization that operates on a cooperative basis (within the meaning
				of <external-xref legal-doc="usc" parsable-cite="usc/26/1381">section 1381</external-xref> of the Internal Revenue Code of 1986)), for substantial
				purposes other than that of obtaining or providing medical care;</text>
									</paragraph><paragraph id="HE31BFD9FF2C2428B9984441029DACB9D"><enum>(2)</enum><text>is established as
				a permanent entity which receives the active support of its members and
				requires for membership payment on a periodic basis of dues or payments
				necessary to maintain eligibility for membership in the sponsor; and</text>
									</paragraph><paragraph id="HA32C812DB34D484F9ECF57EA037882CB"><enum>(3)</enum><text>does not condition
				membership, such dues or payments, or coverage under the plan on the basis of
				health status-related factors with respect to the employees of its members (or
				affiliated members), or the dependents of such employees, and does not
				condition such dues or payments on the basis of group health plan
				participation.</text>
									</paragraph><continuation-text continuation-text-level="subsection">Any
				sponsor consisting of an association of entities which meet the requirements of
				paragraphs (1), (2), and (3) shall be deemed to be a sponsor described in this
				subsection.</continuation-text></subsection></section><section id="H18D5FC7EF674408CBA032043508E0618"><enum>802.</enum><header>Certification
				of association health plans</header>
								<subsection id="HE3267219EE55400A87D18D8FF794AAFB"><enum>(a)</enum><header>In
				General</header><text>The applicable authority shall prescribe by regulation a
				procedure under which, subject to subsection (b), the applicable authority
				shall certify association health plans which apply for certification as meeting
				the requirements of this part.</text>
								</subsection><subsection id="HA981BA46FDC547C1BD8915A2916647B4"><enum>(b)</enum><header>Standards</header><text>Under
				the procedure prescribed pursuant to subsection (a), in the case of an
				association health plan that provides at least one benefit option which does
				not consist of health insurance coverage, the applicable authority shall
				certify such plan as meeting the requirements of this part only if the
				applicable authority is satisfied that the applicable requirements of this part
				are met (or, upon the date on which the plan is to commence operations, will be
				met) with respect to the plan.</text>
								</subsection><subsection id="H41E88AB91387458797E1B54604235687"><enum>(c)</enum><header>Requirements
				Applicable to Certified Plans</header><text>An association health plan with
				respect to which certification under this part is in effect shall meet the
				applicable requirements of this part, effective on the date of certification
				(or, if later, on the date on which the plan is to commence operations).</text>
								</subsection><subsection id="HB2248942369A419ABBA101FD6E16D533"><enum>(d)</enum><header>Requirements for
				Continued Certification</header><text>The applicable authority may provide by
				regulation for continued certification of association health plans under this
				part.</text>
								</subsection><subsection id="HDD8B6844A7444595BF1F4D66A007BC8"><enum>(e)</enum><header>Class
				Certification for Fully Insured Plans</header><text>The applicable authority
				shall establish a class certification procedure for association health plans
				under which all benefits consist of health insurance coverage. Under such
				procedure, the applicable authority shall provide for the granting of
				certification under this part to the plans in each class of such association
				health plans upon appropriate filing under such procedure in connection with
				plans in such class and payment of the prescribed fee under section
				807(a).</text>
								</subsection><subsection id="H5D244FA1A7364869A98CCC9F4565F5B"><enum>(f)</enum><header>Certification of
				Self-Insured Association Health Plans</header><text>An association health plan
				which offers one or more benefit options which do not consist of health
				insurance coverage may be certified under this part only if such plan consists
				of any of the following:</text>
									<paragraph id="HA8A731D6F2374B558E41185CD5312006"><enum>(1)</enum><text>a plan which
				offered such coverage on the date of the enactment of the
				<short-title>Making Health Care More Affordable Act of
				2008</short-title>,</text>
									</paragraph><paragraph id="H98665411623544BC90D47F8FE5569965"><enum>(2)</enum><text>a plan under which
				the sponsor does not restrict membership to one or more trades and businesses
				or industries and whose eligible participating employers represent a broad
				cross-section of trades and businesses or industries, or</text>
									</paragraph><paragraph id="H9F9E461F82E7429798F8F176C3953EEC"><enum>(3)</enum><text>a plan whose
				eligible participating employers represent one or more trades or businesses, or
				one or more industries, consisting of any of the following: agriculture;
				equipment and automobile dealerships; barbering and cosmetology; certified
				public accounting practices; child care; construction; dance, theatrical and
				orchestra productions; disinfecting and pest control; financial services;
				fishing; food service establishments; hospitals; labor organizations; logging;
				manufacturing (metals); mining; medical and dental practices; medical
				laboratories; professional consulting services; sanitary services;
				transportation (local and freight); warehousing; wholesaling/distributing; or
				any other trade or business or industry which has been indicated as having
				average or above-average risk or health claims experience by reason of State
				rate filings, denials of coverage, proposed premium rate levels, or other means
				demonstrated by such plan in accordance with regulations.</text>
									</paragraph></subsection></section><section id="H18FE1DFC88BC4753A5434FC95FDD1F49"><enum>803.</enum><header>Requirements
				relating to sponsors and boards of trustees</header>
								<subsection id="HC09410BB9BEC434B950800890844A2F5"><enum>(a)</enum><header>Sponsor</header><text>The
				requirements of this subsection are met with respect to an association health
				plan if the sponsor has met (or is deemed under this part to have met) the
				requirements of section 801(b) for a continuous period of not less than 3 years
				ending with the date of the application for certification under this
				part.</text>
								</subsection><subsection id="HAB93EE76EAB2421FB9FB52EE0486A6C3"><enum>(b)</enum><header>Board of
				Trustees</header><text>The requirements of this subsection are met with respect
				to an association health plan if the following requirements are met:</text>
									<paragraph id="H4832E5DC5F334C8DA0FA0031337B50E8"><enum>(1)</enum><header>Fiscal
				control</header><text>The plan is operated, pursuant to a trust agreement, by a
				board of trustees which has complete fiscal control over the plan and which is
				responsible for all operations of the plan.</text>
									</paragraph><paragraph id="HB874FB0463614D7BA1E6CB46AE79A299"><enum>(2)</enum><header>Rules of
				operation and financial controls</header><text>The board of trustees has in
				effect rules of operation and financial controls, based on a 3-year plan of
				operation, adequate to carry out the terms of the plan and to meet all
				requirements of this title applicable to the plan.</text>
									</paragraph><paragraph id="HFE65FCF300054044BE55C0CCE2DC2EE"><enum>(3)</enum><header>Rules governing
				relationship to participating employers and to contractors</header>
										<subparagraph id="H5EC46E80268D4D1A9106AD1C22040082"><enum>(A)</enum><header>Board
				membership</header>
											<clause id="HC1CD48313B7244AAB6FDDC99876E4"><enum>(i)</enum><header>In
				general</header><text>Except as provided in clauses (ii) and (iii), the members
				of the board of trustees are individuals selected from individuals who are the
				owners, officers, directors, or employees of the participating employers or who
				are partners in the participating employers and actively participate in the
				business.</text>
											</clause><clause id="HE021C469C3054A0CAE5BBE50144FCFDA"><enum>(ii)</enum><header>Limitation</header>
												<subclause id="H2406B73AFB7A4DD69B400076A34ECB6F"><enum>(I)</enum><header>General
				rule</header><text>Except as provided in subclauses (II) and (III), no such
				member is an owner, officer, director, or employee of, or partner in, a
				contract administrator or other service provider to the plan.</text>
												</subclause><subclause id="HFBBB1C09B40F4AA88300BD055DF877B8"><enum>(II)</enum><header>Limited
				exception for providers of services solely on behalf of the
				sponsor</header><text>Officers or employees of a sponsor which is a service
				provider (other than a contract administrator) to the plan may be members of
				the board if they constitute not more than 25 percent of the membership of the
				board and they do not provide services to the plan other than on behalf of the
				sponsor.</text>
												</subclause><subclause id="H565C8AB9FBE24C51929070AA96E5147E"><enum>(III)</enum><header>Treatment of
				providers of medical care</header><text>In the case of a sponsor which is an
				association whose membership consists primarily of providers of medical care,
				subclause (I) shall not apply in the case of any service provider described in
				subclause (I) who is a provider of medical care under the plan.</text>
												</subclause></clause><clause id="H29F0FF1675D34B78B48E63CA5E06F711"><enum>(iii)</enum><header>Certain plans
				excluded</header><text>Clause (I) shall not apply to an association health plan
				which is in existence on the date of the enactment of the
				<short-title>Making Health Care More Affordable Act of
				2008</short-title>.</text>
											</clause></subparagraph><subparagraph id="H76ABCE2C6FB94F21AE3499BB344900F"><enum>(B)</enum><header>Sole
				authority</header><text>The board has sole authority under the plan to approve
				applications for participation in the plan and to contract with a service
				provider to administer the day-to-day affairs of the plan.</text>
										</subparagraph></paragraph></subsection><subsection id="H50DC59FDFADB427CA231FE3E848CB383"><enum>(c)</enum><header>Treatment of
				Franchise Networks</header><text>In the case of a group health plan which is
				established and maintained by a franchiser for a franchise network consisting
				of its franchisees—</text>
									<paragraph id="HB52D0DE688994E3C83E5DCD86F4E24DC"><enum>(1)</enum><text>the requirements
				of subsection (a) and section 801(a) shall be deemed met if such requirements
				would otherwise be met if the franchiser were deemed to be the sponsor referred
				to in section 801(b), such network were deemed to be an association described
				in section 801(b), and each franchisee were deemed to be a member (of the
				association and the sponsor) referred to in section 801(b); and</text>
									</paragraph><paragraph id="HDDA9ADF93004408F8EA4DEE632A07BB3"><enum>(2)</enum><text>the requirements
				of section 804(a)(1) shall be deemed met.</text>
									</paragraph><continuation-text continuation-text-level="subsection">The
				Secretary may by regulation define for purposes of this subsection the terms
				<term>franchiser</term>, <term>franchise network</term>, and
				<term>franchisee</term>.</continuation-text></subsection></section><section id="HF60740D3C993485FA364D3AEC060D65D"><enum>804.</enum><header>Participation
				and coverage requirements</header>
								<subsection id="H663AE6BB5EA443D19C17B87073FB8D8"><enum>(a)</enum><header>Covered Employers
				and Individuals</header><text>The requirements of this subsection are met with
				respect to an association health plan if, under the terms of the plan—</text>
									<paragraph id="H77A356F78A344745B25DB9FE427CDC82"><enum>(1)</enum><text>each participating
				employer must be—</text>
										<subparagraph id="H36E8117F80B745B485A89EFA2C8EF131"><enum>(A)</enum><text>a member of the
				sponsor,</text>
										</subparagraph><subparagraph id="HC40F23275D154994B759DA971058C7EE"><enum>(B)</enum><text>the sponsor,
				or</text>
										</subparagraph><subparagraph id="H53A39AF15C434B738037B2622F02BFD3"><enum>(C)</enum><text>an affiliated
				member of the sponsor with respect to which the requirements of subsection (b)
				are met,</text>
										</subparagraph><continuation-text continuation-text-level="paragraph">except
				that, in the case of a sponsor which is a professional association or other
				individual-based association, if at least one of the officers, directors, or
				employees of an employer, or at least one of the individuals who are partners
				in an employer and who actively participates in the business, is a member or
				such an affiliated member of the sponsor, participating employers may also
				include such employer; and</continuation-text></paragraph><paragraph id="H46C105B2C8EE422CA06B0700D0392C18"><enum>(2)</enum><text>all individuals
				commencing coverage under the plan after certification under this part must
				be—</text>
										<subparagraph id="H442D96D39B21495EB840D8A0B8998659"><enum>(A)</enum><text>active or retired
				owners (including self-employed individuals), officers, directors, or employees
				of, or partners in, participating employers; or</text>
										</subparagraph><subparagraph id="H272DE4F404594649B87B72BCD7511DF9"><enum>(B)</enum><text>the beneficiaries
				of individuals described in subparagraph (A).</text>
										</subparagraph></paragraph></subsection><subsection id="HFE0379AE0A534A09AB159490F2BE8BAA"><enum>(b)</enum><header>Coverage of
				Previously Uninsured Employees</header><text>In the case of an association
				health plan in existence on the date of the enactment of the
				<short-title>Making Health Care More Affordable Act of
				2008</short-title>, an affiliated member of the sponsor of the plan may be
				offered coverage under the plan as a participating employer only if—</text>
									<paragraph id="HBC453A8A2F2045C0863207713CC501D4"><enum>(1)</enum><text>the affiliated
				member was an affiliated member on the date of certification under this part;
				or</text>
									</paragraph><paragraph id="H05BA87B841AD47829E9BD1A8C6711EFA"><enum>(2)</enum><text>during the
				12-month period preceding the date of the offering of such coverage, the
				affiliated member has not maintained or contributed to a group health plan with
				respect to any of its employees who would otherwise be eligible to participate
				in such association health plan.</text>
									</paragraph></subsection><subsection id="H1C51F67BFE6E44F39989EEC272F1E1D7"><enum>(c)</enum><header>Individual
				Market Unaffected</header><text>The requirements of this subsection are met
				with respect to an association health plan if, under the terms of the plan, no
				participating employer may provide health insurance coverage in the individual
				market for any employee not covered under the plan which is similar to the
				coverage contemporaneously provided to employees of the employer under the
				plan, if such exclusion of the employee from coverage under the plan is based
				on a health status-related factor with respect to the employee and such
				employee would, but for such exclusion on such basis, be eligible for coverage
				under the plan.</text>
								</subsection><subsection id="H14BA38D9BF4E4485A4DFA69DCEC7A4F2"><enum>(d)</enum><header>Prohibition of
				Discrimination Against Employers and Employees Eligible To
				Participate</header><text>The requirements of this subsection are met with
				respect to an association health plan if—</text>
									<paragraph id="H9B97FC82D7E64E589CE2F0AE1CADDECC"><enum>(1)</enum><text>under the terms of
				the plan, all employers meeting the preceding requirements of this section are
				eligible to qualify as participating employers for all geographically available
				coverage options, unless, in the case of any such employer, participation or
				contribution requirements of the type referred to in section 2711 of the
				<act-name parsable-cite="PHSA">Public Health Service Act</act-name> are not
				met;</text>
									</paragraph><paragraph id="H76C68A1ED65040EB9D3915ED3C6DB6C0"><enum>(2)</enum><text>upon request, any
				employer eligible to participate is furnished information regarding all
				coverage options available under the plan; and</text>
									</paragraph><paragraph id="H91B83CDF664745FFA3015968DA41744C"><enum>(3)</enum><text>the applicable
				requirements of sections 701, 702, and 703 are met with respect to the
				plan.</text>
									</paragraph></subsection></section><section id="HDE982BAE1B874F9E9283C18EB3C77BD"><enum>805.</enum><header>Other
				requirements relating to plan documents, contribution rates, and benefit
				options</header>
								<subsection id="H9882CEA8E85F42728773C7FC51BC6EB"><enum>(a)</enum><header>In
				General</header><text>The requirements of this section are met with respect to
				an association health plan if the following requirements are met:</text>
									<paragraph id="H4BEE022833BC4CC59B506FA7E1FF523B"><enum>(1)</enum><header>Contents of
				governing instruments</header><text>The instruments governing the plan include
				a written instrument, meeting the requirements of an instrument required under
				section 402(a)(1), which—</text>
										<subparagraph id="HD1893AACA73C42CD9123B0BEB56DD6D"><enum>(A)</enum><text>provides that the
				board of trustees serves as the named fiduciary required for plans under
				section 402(a)(1) and serves in the capacity of a plan administrator (referred
				to in section 3(16)(A));</text>
										</subparagraph><subparagraph id="HAE7C844F9F734B648B8B3DDD6F067C00"><enum>(B)</enum><text>provides that the
				sponsor of the plan is to serve as plan sponsor (referred to in section
				3(16)(B)); and</text>
										</subparagraph><subparagraph id="HEC55521154504E318CE31E355FB9EB55"><enum>(C)</enum><text>incorporates the
				requirements of section 806.</text>
										</subparagraph></paragraph><paragraph id="H07E6D79BDD9E460C00DAEF5F01D5784"><enum>(2)</enum><header>Contribution
				rates must be nondiscriminatory</header>
										<subparagraph id="HAB7F8BCC43CA4B8CA916FB4447DA35D8"><enum>(A)</enum><text>The contribution
				rates for any participating small employer do not vary on the basis of any
				health status-related factor in relation to employees of such employer or their
				beneficiaries and do not vary on the basis of the type of business or industry
				in which such employer is engaged.</text>
										</subparagraph><subparagraph id="H9C9E606FA1A14EC3ACA87800EE89CFA7"><enum>(B)</enum><text>Nothing in this
				title or any other provision of law shall be construed to preclude an
				association health plan, or a health insurance issuer offering health insurance
				coverage in connection with an association health plan, from—</text>
											<clause id="H83692B66579C4563004FE093002D1FE8"><enum>(i)</enum><text>setting
				contribution rates based on the claims experience of the plan; or</text>
											</clause><clause id="H5B160216EA234ABCBC90E3C921B4EA12"><enum>(ii)</enum><text>varying
				contribution rates for small employers in a State to the extent that such rates
				could vary using the same methodology employed in such State for regulating
				premium rates in the small group market with respect to health insurance
				coverage offered in connection with bona fide associations (within the meaning
				of section 2791(d)(3) of the <act-name parsable-cite="PHSA">Public Health
				Service Act</act-name>),</text>
											</clause><continuation-text continuation-text-level="subparagraph">subject
				to the requirements of section 702(b) relating to contribution rates.</continuation-text></subparagraph></paragraph><paragraph id="H05D2AEF65FFD4154A1570038472300D1"><enum>(3)</enum><header>Floor for number
				of covered individuals with respect to certain plans</header><text>If any
				benefit option under the plan does not consist of health insurance coverage,
				the plan has as of the beginning of the plan year not fewer than 1,000
				participants and beneficiaries.</text>
									</paragraph><paragraph id="H5FE9353378C34916A48853FCB53CC878"><enum>(4)</enum><header>Marketing
				requirements</header>
										<subparagraph id="HE3A1D20C0747406999DB364E256164B4"><enum>(A)</enum><header>In
				general</header><text>If a benefit option which consists of health insurance
				coverage is offered under the plan, State-licensed insurance agents shall be
				used to distribute to small employers coverage which does not consist of health
				insurance coverage in a manner comparable to the manner in which such agents
				are used to distribute health insurance coverage.</text>
										</subparagraph><subparagraph id="H32F5FE3C9C1C41CAB225B4E4B00D1DF"><enum>(B)</enum><header>State-licensed
				insurance agents</header><text>For purposes of subparagraph (A), the term
				<term>State-licensed insurance agents</term> means one or more agents who are
				licensed in a State and are subject to the laws of such State relating to
				licensure, qualification, testing, examination, and continuing education of
				persons authorized to offer, sell, or solicit health insurance coverage in such
				State.</text>
										</subparagraph></paragraph><paragraph id="HAAE65D47F0184CD190A6B8F51CD75897"><enum>(5)</enum><header>Regulatory
				requirements</header><text>Such other requirements as the applicable authority
				determines are necessary to carry out the purposes of this part, which shall be
				prescribed by the applicable authority by regulation.</text>
									</paragraph></subsection><subsection id="H8B08EC8C0BF84E0A8B2CD2F1AF7E5F8D"><enum>(b)</enum><header>Ability of
				Association Health Plans To Design Benefit Options</header><text>Subject to
				section 514(d), nothing in this part or any provision of State law (as defined
				in section 514(c)(1)) shall be construed to preclude an association health
				plan, or a health insurance issuer offering health insurance coverage in
				connection with an association health plan, from exercising its sole discretion
				in selecting the specific items and services consisting of medical care to be
				included as benefits under such plan or coverage, except (subject to section
				514) in the case of (1) any law to the extent that it is not preempted under
				section 731(a)(1) with respect to matters governed by section 711, 712, or 713,
				or (2) any law of the State with which filing and approval of a policy type
				offered by the plan was initially obtained to the extent that such law
				prohibits an exclusion of a specific disease from such coverage.</text>
								</subsection></section><section id="H513D74EBA9764E40B2EE2D344CBD26A9"><enum>806.</enum><header>Maintenance of
				reserves and provisions for solvency for plans providing health benefits in
				addition to health insurance coverage</header>
								<subsection id="HD73196E1A53E4D8FB9FFD1C7104E1848"><enum>(a)</enum><header>In
				General</header><text>The requirements of this section are met with respect to
				an association health plan if—</text>
									<paragraph id="HDA454851608742A9AE8261869F3C3C56"><enum>(1)</enum><text>the benefits under
				the plan consist solely of health insurance coverage; or</text>
									</paragraph><paragraph id="H68085AF2BF4048039BE23DF5492304F"><enum>(2)</enum><text>if the plan
				provides any additional benefit options which do not consist of health
				insurance coverage, the plan—</text>
										<subparagraph id="HAC1A6BCD8EB44ACCA8A22B1E94F8D5D"><enum>(A)</enum><text>establishes and
				maintains reserves with respect to such additional benefit options, in amounts
				recommended by the qualified actuary, consisting of—</text>
											<clause id="HD654030B50F242628CADAED2DBCE263C"><enum>(i)</enum><text>a
				reserve sufficient for unearned contributions;</text>
											</clause><clause id="HBE6A561B05274893AE29CA6219000189"><enum>(ii)</enum><text>a
				reserve sufficient for benefit liabilities which have been incurred, which have
				not been satisfied, and for which risk of loss has not yet been transferred,
				and for expected administrative costs with respect to such benefit
				liabilities;</text>
											</clause><clause id="H07FF7218921C4B2EB5498228941B03AA"><enum>(iii)</enum><text>a reserve
				sufficient for any other obligations of the plan; and</text>
											</clause><clause id="H39B98D2A642849819CBFF21C9E379100"><enum>(iv)</enum><text>a
				reserve sufficient for a margin of error and other fluctuations, taking into
				account the specific circumstances of the plan; and</text>
											</clause></subparagraph><subparagraph id="H3A6F18B09F2043D380F5E3D69950CB58"><enum>(B)</enum><text>establishes and
				maintains aggregate and specific excess/stop loss insurance and solvency
				indemnification, with respect to such additional benefit options for which risk
				of loss has not yet been transferred, as follows:</text>
											<clause id="HADF4247C856949D9BBDD94EBCE7309ED"><enum>(i)</enum><text>The plan shall
				secure aggregate excess/stop loss insurance for the plan with an attachment
				point which is not greater than 125 percent of expected gross annual claims.
				The applicable authority may by regulation provide for upward adjustments in
				the amount of such percentage in specified circumstances in which the plan
				specifically provides for and maintains reserves in excess of the amounts
				required under subparagraph (A).</text>
											</clause><clause id="H7AB6BCC7523344ADAD8C3B09C7999695"><enum>(ii)</enum><text>The plan shall
				secure specific excess/stop loss insurance for the plan with an attachment
				point which is at least equal to an amount recommended by the plan’s qualified
				actuary. The applicable authority may by regulation provide for adjustments in
				the amount of such insurance in specified circumstances in which the plan
				specifically provides for and maintains reserves in excess of the amounts
				required under subparagraph (A).</text>
											</clause><clause id="HCC50C2EE243D4D249CD3CF9B62195CB1"><enum>(iii)</enum><text>The plan shall
				secure indemnification insurance for any claims which the plan is unable to
				satisfy by reason of a plan termination.</text>
											</clause></subparagraph></paragraph><continuation-text continuation-text-level="subsection">Any
				person issuing to a plan insurance described in clause (I), (ii), or (iii) of
				subparagraph (B) shall notify the Secretary of any failure of premium payment
				meriting cancellation of the policy prior to undertaking such a cancellation.
				Any regulations prescribed by the applicable authority pursuant to clause (I)
				or (ii) of subparagraph (B) may allow for such adjustments in the required
				levels of excess/stop loss insurance as the qualified actuary may recommend,
				taking into account the specific circumstances of the plan.</continuation-text></subsection><subsection id="HA8AAF8BDAC394916827F1B46ADE33C"><enum>(b)</enum><header>Minimum Surplus in
				Addition to Claims Reserves</header><text>In the case of any association health
				plan described in subsection (a)(2), the requirements of this subsection are
				met if the plan establishes and maintains surplus in an amount at least equal
				to—</text>
									<paragraph id="H6C7C51CD68794854BC756CDE2490C957"><enum>(1)</enum><text>$500,000,
				or</text>
									</paragraph><paragraph id="H0A485C7D08984E7291B51DBED0FA122"><enum>(2)</enum><text>such greater amount
				(but not greater than $2,000,000) as may be set forth in regulations prescribed
				by the applicable authority, considering the level of aggregate and specific
				excess/stop loss insurance provided with respect to such plan and other factors
				related to solvency risk, such as the plan’s projected levels of participation
				or claims, the nature of the plan’s liabilities, and the types of assets
				available to assure that such liabilities are met.</text>
									</paragraph></subsection><subsection id="H1A2EA4FE4D4A4C6B96103EE6D945462"><enum>(c)</enum><header>Additional
				Requirements</header><text>In the case of any association health plan described
				in subsection (a)(2), the applicable authority may provide such additional
				requirements relating to reserves, excess/stop loss insurance, and
				indemnification insurance as the applicable authority considers appropriate.
				Such requirements may be provided by regulation with respect to any such plan
				or any class of such plans.</text>
								</subsection><subsection id="H85B5122ACD9F49F79FC155C742824BC1"><enum>(d)</enum><header>Adjustments for
				Excess/Stop Loss Insurance</header><text>The applicable authority may provide
				for adjustments to the levels of reserves otherwise required under subsections
				(a) and (b) with respect to any plan or class of plans to take into account
				excess/stop loss insurance provided with respect to such plan or plans.</text>
								</subsection><subsection id="H8DE5FCB866CF4FFDB7345CD64FF00183"><enum>(e)</enum><header>Alternative
				Means of Compliance</header><text>The applicable authority may permit an
				association health plan described in subsection (a)(2) to substitute, for all
				or part of the requirements of this section (except subsection (a)(2)(B)(iii)),
				such security, guarantee, hold-harmless arrangement, or other financial
				arrangement as the applicable authority determines to be adequate to enable the
				plan to fully meet all its financial obligations on a timely basis and is
				otherwise no less protective of the interests of participants and beneficiaries
				than the requirements for which it is substituted. The applicable authority may
				take into account, for purposes of this subsection, evidence provided by the
				plan or sponsor which demonstrates an assumption of liability with respect to
				the plan. Such evidence may be in the form of a contract of indemnification,
				lien, bonding, insurance, letter of credit, recourse under applicable terms of
				the plan in the form of assessments of participating employers, security, or
				other financial arrangement.</text>
								</subsection><subsection id="H996AD0D207C648269EFEDFC9AF70DD95"><enum>(f)</enum><header>Measures To
				Ensure Continued Payment of Benefits by Certain Plans in Distress</header>
									<paragraph id="H68C754A694E8413F85463932322B1F2B"><enum>(1)</enum><header>Payments by
				certain plans to association health plan fund</header>
										<subparagraph id="HB7785901C2F84F1484589BA30800585C"><enum>(A)</enum><header>In
				general</header><text>In the case of an association health plan described in
				subsection (a)(2), the requirements of this subsection are met if the plan
				makes payments into the Association Health Plan Fund under this subparagraph
				when they are due. Such payments shall consist of annual payments in the amount
				of $5,000, and, in addition to such annual payments, such supplemental payments
				as the Secretary may determine to be necessary under paragraph (2). Payments
				under this paragraph are payable to the Fund at the time determined by the
				Secretary. Initial payments are due in advance of certification under this
				part. Payments shall continue to accrue until a plan’s assets are distributed
				pursuant to a termination procedure.</text>
										</subparagraph><subparagraph id="H3D3D5849C1D447129C20752649714991"><enum>(B)</enum><header>Penalties for
				failure to make payments</header><text>If any payment is not made by a plan
				when it is due, a late payment charge of not more than 100 percent of the
				payment which was not timely paid shall be payable by the plan to the
				Fund.</text>
										</subparagraph><subparagraph id="H689ECC6D5D254EE4879F00F0F4ED0187"><enum>(C)</enum><header>Continued duty
				of the secretary</header><text>The Secretary shall not cease to carry out the
				provisions of paragraph (2) on account of the failure of a plan to pay any
				payment when due.</text>
										</subparagraph></paragraph><paragraph id="H4B2E72A3FE964E02A41F92F67603FD25"><enum>(2)</enum><header>Payments by
				secretary to continue excess/stop loss insurance coverage and indemnification
				insurance coverage for certain plans</header><text>In any case in which the
				applicable authority determines that there is, or that there is reason to
				believe that there will be: (A) a failure to take necessary corrective actions
				under section 809(a) with respect to an association health plan described in
				subsection (a)(2); or (B) a termination of such a plan under section 809(b) or
				810(b)(8) (and, if the applicable authority is not the Secretary, certifies
				such determination to the Secretary), the Secretary shall determine the amounts
				necessary to make payments to an insurer (designated by the Secretary) to
				maintain in force excess/stop loss insurance coverage or indemnification
				insurance coverage for such plan, if the Secretary determines that there is a
				reasonable expectation that, without such payments, claims would not be
				satisfied by reason of termination of such coverage. The Secretary shall, to
				the extent provided in advance in appropriation Acts, pay such amounts so
				determined to the insurer designated by the Secretary.</text>
									</paragraph><paragraph id="H909D0A50668B4A64B1C38971C274D71"><enum>(3)</enum><header>Association
				health plan fund</header>
										<subparagraph id="H2EE7C75E47DD40D28234E5D8F8B26B9F"><enum>(A)</enum><header>In
				general</header><text>There is established on the books of the Treasury a fund
				to be known as the <quote>Association Health Plan Fund</quote>. The Fund shall
				be available for making payments pursuant to paragraph (2). The Fund shall be
				credited with payments received pursuant to paragraph (1)(A), penalties
				received pursuant to paragraph (1)(B); and earnings on investments of amounts
				of the Fund under subparagraph (B).</text>
										</subparagraph><subparagraph id="H2ACF93B22EE54CA8A9466CD8356E2CD"><enum>(B)</enum><header>Investment</header><text>Whenever
				the Secretary determines that the moneys of the fund are in excess of current
				needs, the Secretary may request the investment of such amounts as the
				Secretary determines advisable by the Secretary of the Treasury in obligations
				issued or guaranteed by the United States.</text>
										</subparagraph></paragraph></subsection><subsection id="H4FE7616B00624667AB5E1985B7C3DDF"><enum>(g)</enum><header>Excess/Stop Loss
				Insurance</header><text>For purposes of this section—</text>
									<paragraph id="H0D94CC9C8CDD4C0BB5819F9580DF69E"><enum>(1)</enum><header>Aggregate
				excess/stop loss insurance</header><text>The term <term>aggregate excess/stop
				loss insurance</term> means, in connection with an association health plan, a
				contract—</text>
										<subparagraph id="H4F76068EB18D4FA4ACD14D4F668F7547"><enum>(A)</enum><text>under which an
				insurer (meeting such minimum standards as the applicable authority may
				prescribe by regulation) provides for payment to the plan with respect to
				aggregate claims under the plan in excess of an amount or amounts specified in
				such contract;</text>
										</subparagraph><subparagraph id="H71F92D65A7774F79A3798362D5759E08"><enum>(B)</enum><text>which is
				guaranteed renewable; and</text>
										</subparagraph><subparagraph id="H97401DC38CFC46EB980285C0C3568935"><enum>(C)</enum><text>which allows for
				payment of premiums by any third party on behalf of the insured plan.</text>
										</subparagraph></paragraph><paragraph id="H79EB7B4C3A5A459E8F5490A85B64D6AC"><enum>(2)</enum><header>Specific
				excess/stop loss insurance</header><text>The term <term>specific excess/stop
				loss insurance</term> means, in connection with an association health plan, a
				contract—</text>
										<subparagraph id="HDB758ADB4DE54D08A4FA53D46FEFEA99"><enum>(A)</enum><text>under which an
				insurer (meeting such minimum standards as the applicable authority may
				prescribe by regulation) provides for payment to the plan with respect to
				claims under the plan in connection with a covered individual in excess of an
				amount or amounts specified in such contract in connection with such covered
				individual;</text>
										</subparagraph><subparagraph id="H8AFA4B858CBE4A4ABE49C2B0889C4400"><enum>(B)</enum><text>which is
				guaranteed renewable; and</text>
										</subparagraph><subparagraph id="H512A4B498E874C3C8FC710B296A06014"><enum>(C)</enum><text>which allows for
				payment of premiums by any third party on behalf of the insured plan.</text>
										</subparagraph></paragraph></subsection><subsection id="H9E1761E1ABE847FF8CDFC0148E7FEB46"><enum>(h)</enum><header>Indemnification
				Insurance</header><text>For purposes of this section, the term
				<term>indemnification insurance</term> means, in connection with an association
				health plan, a contract—</text>
									<paragraph id="HFB9C05B970D14B49AA5C8F4C8C850135"><enum>(1)</enum><text>under which an
				insurer (meeting such minimum standards as the applicable authority may
				prescribe by regulation) provides for payment to the plan with respect to
				claims under the plan which the plan is unable to satisfy by reason of a
				termination pursuant to section 809(b) (relating to mandatory
				termination);</text>
									</paragraph><paragraph id="H324E9E95A7F449FBB77431C7AF7E3B31"><enum>(2)</enum><text>which is
				guaranteed renewable and noncancellable for any reason (except as the
				applicable authority may prescribe by regulation); and</text>
									</paragraph><paragraph id="H1613E6C43FF54DA5BCEEECCBC037BB"><enum>(3)</enum><text>which allows for
				payment of premiums by any third party on behalf of the insured plan.</text>
									</paragraph></subsection><subsection id="H0F19B51E18714749002CE99F2D6EAED1"><enum>(i)</enum><header>Reserves</header><text>For
				purposes of this section, the term <term>reserves</term> means, in connection
				with an association health plan, plan assets which meet the fiduciary standards
				under part 4 and such additional requirements regarding liquidity as the
				applicable authority may prescribe by regulation.</text>
								</subsection><subsection id="H08AF9702821C45B983EDAC468BC5F46E"><enum>(j)</enum><header>Solvency
				Standards Working Group</header>
									<paragraph id="H056996374B9C42E4A360FD18D9115800"><enum>(1)</enum><header>In
				general</header><text>Within 90 days after the date of the enactment of the
				<short-title>Making Health Care More Affordable Act of
				2008</short-title>, the applicable authority shall establish a Solvency
				Standards Working Group. In prescribing the initial regulations under this
				section, the applicable authority shall take into account the recommendations
				of such Working Group.</text>
									</paragraph><paragraph id="H5E0065FA8560470885CBE3AE037E6D32"><enum>(2)</enum><header>Membership</header><text>The
				Working Group shall consist of not more than 15 members appointed by the
				applicable authority. The applicable authority shall include among persons
				invited to membership on the Working Group at least one of each of the
				following:</text>
										<subparagraph id="H8E12626AD87047B8007E0425000071A8"><enum>(A)</enum><text>a representative
				of the National Association of Insurance Commissioners;</text>
										</subparagraph><subparagraph id="HF809DC81086A4A61AAFF928632304DAA"><enum>(B)</enum><text>a representative
				of the American Academy of Actuaries;</text>
										</subparagraph><subparagraph id="HEB72D36E0B0745B0B55814F830A490B4"><enum>(C)</enum><text>a representative
				of the State governments, or their interests;</text>
										</subparagraph><subparagraph id="H64F9593E936B404091071074C6CF10A1"><enum>(D)</enum><text>a representative
				of existing self-insured arrangements, or their interests;</text>
										</subparagraph><subparagraph id="H7E544C587EAD4BE99B39F2D8925EB2BA"><enum>(E)</enum><text>a representative
				of associations of the type referred to in section 801(b)(1), or their
				interests; and</text>
										</subparagraph><subparagraph id="H633115F2B63B4F3B893C7CAA03498047"><enum>(F)</enum><text>a representative
				of multiemployer plans that are group health plans, or their interests.</text>
										</subparagraph></paragraph></subsection></section><section id="HFF20D30D423C4FE8B5486B2B79D544E5"><enum>807.</enum><header>Requirements
				for application and related requirements</header>
								<subsection id="H485D0E985FE9494CA23F93A83F475497"><enum>(a)</enum><header>Filing
				Fee</header><text>Under the procedure prescribed pursuant to section 802(a), an
				association health plan shall pay to the applicable authority at the time of
				filing an application for certification under this part a filing fee in the
				amount of $5,000, which shall be available in the case of the Secretary, to the
				extent provided in appropriation Acts, for the sole purpose of administering
				the certification procedures applicable with respect to association health
				plans.</text>
								</subsection><subsection id="HA002EBAC1B29452B905500F1B4C1C6A"><enum>(b)</enum><header>Information To Be
				Included in Application for Certification</header><text>An application for
				certification under this part meets the requirements of this section only if it
				includes, in a manner and form which shall be prescribed by the applicable
				authority by regulation, at least the following information:</text>
									<paragraph id="H2C0C8E844682421195EEA8ADB7C172C9"><enum>(1)</enum><header>Identifying
				information</header><text>The names and addresses of—</text>
										<subparagraph id="HD41070F18A554C35B389DFA1DCD3868"><enum>(A)</enum><text>the sponsor;
				and</text>
										</subparagraph><subparagraph id="HF5F70EFF87504FDBA0B9DA2971A2C572"><enum>(B)</enum><text>the members of the
				board of trustees of the plan.</text>
										</subparagraph></paragraph><paragraph id="H68D5BB6A7F3844EBA69515005DF737DC"><enum>(2)</enum><header>States in which
				plan intends to do business</header><text>The States in which participants and
				beneficiaries under the plan are to be located and the number of them expected
				to be located in each such State.</text>
									</paragraph><paragraph id="H3AF53C2A1757424AA2CD236F36A85974"><enum>(3)</enum><header>Bonding
				requirements</header><text>Evidence provided by the board of trustees that the
				bonding requirements of section 412 will be met as of the date of the
				application or (if later) commencement of operations.</text>
									</paragraph><paragraph id="H2B91DA8608294CF3A210D51E836CB95"><enum>(4)</enum><header>Plan
				documents</header><text>A copy of the documents governing the plan (including
				any bylaws and trust agreements), the summary plan description, and other
				material describing the benefits that will be provided to participants and
				beneficiaries under the plan.</text>
									</paragraph><paragraph id="H9F64CCE73F7D45B2B8E043C1CE5571E3"><enum>(5)</enum><header>Agreements with
				service providers</header><text>A copy of any agreements between the plan and
				contract administrators and other service providers.</text>
									</paragraph><paragraph id="H7FA1B5B56D044FDCA7ED8F243B83A8E2"><enum>(6)</enum><header>Funding
				report</header><text>In the case of association health plans providing benefits
				options in addition to health insurance coverage, a report setting forth
				information with respect to such additional benefit options determined as of a
				date within the 120-day period ending with the date of the application,
				including the following:</text>
										<subparagraph id="H53EC879DB8D541B0BBA285ABB00C1C6"><enum>(A)</enum><header>Reserves</header><text>A
				statement, certified by the board of trustees of the plan, and a statement of
				actuarial opinion, signed by a qualified actuary, that all applicable
				requirements of section 806 are or will be met in accordance with regulations
				which the applicable authority shall prescribe.</text>
										</subparagraph><subparagraph id="H90538E6B654C48FBB3E0732C7B5C9DC7"><enum>(B)</enum><header>Adequacy of
				contribution rates</header><text>A statement of actuarial opinion, signed by a
				qualified actuary, which sets forth a description of the extent to which
				contribution rates are adequate to provide for the payment of all obligations
				and the maintenance of required reserves under the plan for the 12-month period
				beginning with such date within such 120-day period, taking into account the
				expected coverage and experience of the plan. If the contribution rates are not
				fully adequate, the statement of actuarial opinion shall indicate the extent to
				which the rates are inadequate and the changes needed to ensure
				adequacy.</text>
										</subparagraph><subparagraph id="H54F7B50CB9CF44C89ED2D57700A4C14"><enum>(C)</enum><header>Current and
				projected value of assets and liabilities</header><text>A statement of
				actuarial opinion signed by a qualified actuary, which sets forth the current
				value of the assets and liabilities accumulated under the plan and a projection
				of the assets, liabilities, income, and expenses of the plan for the 12-month
				period referred to in subparagraph (B). The income statement shall identify
				separately the plan’s administrative expenses and claims.</text>
										</subparagraph><subparagraph id="HC51DB0E2506E44BE9E4E8ECE63436CC8"><enum>(D)</enum><header>Costs of
				coverage to be charged and other expenses</header><text>A statement of the
				costs of coverage to be charged, including an itemization of amounts for
				administration, reserves, and other expenses associated with the operation of
				the plan.</text>
										</subparagraph><subparagraph id="H1A96990BE7F249FD872D2927ACB4F1F4"><enum>(E)</enum><header>Other
				information</header><text>Any other information as may be determined by the
				applicable authority, by regulation, as necessary to carry out the purposes of
				this part.</text>
										</subparagraph></paragraph></subsection><subsection id="H37D421887F9445958CA372256181E6EE"><enum>(c)</enum><header>Filing Notice of
				Certification With States</header><text>A certification granted under this part
				to an association health plan shall not be effective unless written notice of
				such certification is filed with the applicable State authority of each State
				in which at least 25 percent of the participants and beneficiaries under the
				plan are located. For purposes of this subsection, an individual shall be
				considered to be located in the State in which a known address of such
				individual is located or in which such individual is employed.</text>
								</subsection><subsection id="HC9680EF58D034BB499C4AB4810327EB9"><enum>(d)</enum><header>Notice of
				Material Changes</header><text>In the case of any association health plan
				certified under this part, descriptions of material changes in any information
				which was required to be submitted with the application for the certification
				under this part shall be filed in such form and manner as shall be prescribed
				by the applicable authority by regulation. The applicable authority may require
				by regulation prior notice of material changes with respect to specified
				matters which might serve as the basis for suspension or revocation of the
				certification.</text>
								</subsection><subsection id="HF83D2D6751B140C9BA2CE1D368698DE9"><enum>(e)</enum><header>Reporting
				Requirements for Certain Association Health Plans</header><text>An association
				health plan certified under this part which provides benefit options in
				addition to health insurance coverage for such plan year shall meet the
				requirements of section 103 by filing an annual report under such section which
				shall include information described in subsection (b)(6) with respect to the
				plan year and, notwithstanding section 104(a)(1)(A), shall be filed with the
				applicable authority not later than 90 days after the close of the plan year
				(or on such later date as may be prescribed by the applicable authority). The
				applicable authority may require by regulation such interim reports as it
				considers appropriate.</text>
								</subsection><subsection id="H61E3CF441522407A923729A0B7006177"><enum>(f)</enum><header>Engagement of
				Qualified Actuary</header><text>The board of trustees of each association
				health plan which provides benefits options in addition to health insurance
				coverage and which is applying for certification under this part or is
				certified under this part shall engage, on behalf of all participants and
				beneficiaries, a qualified actuary who shall be responsible for the preparation
				of the materials comprising information necessary to be submitted by a
				qualified actuary under this part. The qualified actuary shall utilize such
				assumptions and techniques as are necessary to enable such actuary to form an
				opinion as to whether the contents of the matters reported under this
				part—</text>
									<paragraph id="HE6D0306214FF4BD4ACE04FB2DC71005C"><enum>(1)</enum><text>are in the
				aggregate reasonably related to the experience of the plan and to reasonable
				expectations; and</text>
									</paragraph><paragraph id="HC7AA337F084243E4AA2C6BEA00726762"><enum>(2)</enum><text>represent such
				actuary’s best estimate of anticipated experience under the plan.</text>
									</paragraph><continuation-text continuation-text-level="subsection">The
				opinion by the qualified actuary shall be made with respect to, and shall be
				made a part of, the annual report.</continuation-text></subsection></section><section id="HD940D81D49AD43DE9247C0A3D67CF997"><enum>808.</enum><header>Notice
				requirements for voluntary termination</header><text display-inline="no-display-inline">Except as provided in section 809(b), an
				association health plan which is or has been certified under this part may
				terminate (upon or at any time after cessation of accruals in benefit
				liabilities) only if the board of trustees, not less than 60 days before the
				proposed termination date—</text>
								<paragraph id="HD468388136254F488FC2EFD007B0F800"><enum>(1)</enum><text>provides to the
				participants and beneficiaries a written notice of intent to terminate stating
				that such termination is intended and the proposed termination date;</text>
								</paragraph><paragraph id="HBB190263B36D4CC000A4539B5E40FD34"><enum>(2)</enum><text>develops a plan
				for winding up the affairs of the plan in connection with such termination in a
				manner which will result in timely payment of all benefits for which the plan
				is obligated; and</text>
								</paragraph><paragraph id="HC33DF33FCB94413395C60C83CC6BEF"><enum>(3)</enum><text>submits such plan in
				writing to the applicable authority.</text>
								</paragraph><continuation-text continuation-text-level="section">Actions
				required under this section shall be taken in such form and manner as may be
				prescribed by the applicable authority by regulation.</continuation-text></section><section id="H2664DA0EF02D4E83BFA5D719F0DF79BA"><enum>809.</enum><header>Corrective
				actions and mandatory termination</header>
								<subsection id="HC8807D1E63B34A3C84CA8063C8ED9310"><enum>(a)</enum><header>Actions To Avoid
				Depletion of Reserves</header><text>An association health plan which is
				certified under this part and which provides benefits other than health
				insurance coverage shall continue to meet the requirements of section 806,
				irrespective of whether such certification continues in effect. The board of
				trustees of such plan shall determine quarterly whether the requirements of
				section 806 are met. In any case in which the board determines that there is
				reason to believe that there is or will be a failure to meet such requirements,
				or the applicable authority makes such a determination and so notifies the
				board, the board shall immediately notify the qualified actuary engaged by the
				plan, and such actuary shall, not later than the end of the next following
				month, make such recommendations to the board for corrective action as the
				actuary determines necessary to ensure compliance with section 806. Not later
				than 30 days after receiving from the actuary recommendations for corrective
				actions, the board shall notify the applicable authority (in such form and
				manner as the applicable authority may prescribe by regulation) of such
				recommendations of the actuary for corrective action, together with a
				description of the actions (if any) that the board has taken or plans to take
				in response to such recommendations. The board shall thereafter report to the
				applicable authority, in such form and frequency as the applicable authority
				may specify to the board, regarding corrective action taken by the board until
				the requirements of section 806 are met.</text>
								</subsection><subsection id="H9E92D9E2455949C1A077AD5991DEA990"><enum>(b)</enum><header>Mandatory
				Termination</header><text>In any case in which—</text>
									<paragraph id="H93799C84DF6E46218B003CCBD0B100E7"><enum>(1)</enum><text>the applicable
				authority has been notified under subsection (a) (or by an issuer of
				excess/stop loss insurance or indemnity insurance pursuant to section 806(a))
				of a failure of an association health plan which is or has been certified under
				this part and is described in section 806(a)(2) to meet the requirements of
				section 806 and has not been notified by the board of trustees of the plan that
				corrective action has restored compliance with such requirements; and</text>
									</paragraph><paragraph id="H38CA98618EDF4F43B5E6DBA658B69283"><enum>(2)</enum><text>the applicable
				authority determines that there is a reasonable expectation that the plan will
				continue to fail to meet the requirements of section 806,</text>
									</paragraph><continuation-text continuation-text-level="subsection">the board
				of trustees of the plan shall, at the direction of the applicable authority,
				terminate the plan and, in the course of the termination, take such actions as
				the applicable authority may require, including satisfying any claims referred
				to in section 806(a)(2)(B)(iii) and recovering for the plan any liability under
				subsection (a)(2)(B)(iii) or (e) of section 806, as necessary to ensure that
				the affairs of the plan will be, to the maximum extent possible, wound up in a
				manner which will result in timely provision of all benefits for which the plan
				is obligated.</continuation-text></subsection></section><section id="H7DFC6543A7C1421F90106B8D1707D9DA"><enum>810.</enum><header>Trusteeship by
				the Secretary of insolvent association health plans providing health benefits
				in addition to health insurance coverage</header>
								<subsection id="H918429A0E34943C7AF41CCA5313368E2"><enum>(a)</enum><header>Appointment of
				Secretary as Trustee for Insolvent Plans</header><text>Whenever the Secretary
				determines that an association health plan which is or has been certified under
				this part and which is described in section 806(a)(2) will be unable to provide
				benefits when due or is otherwise in a financially hazardous condition, as
				shall be defined by the Secretary by regulation, the Secretary shall, upon
				notice to the plan, apply to the appropriate United States district court for
				appointment of the Secretary as trustee to administer the plan for the duration
				of the insolvency. The plan may appear as a party and other interested persons
				may intervene in the proceedings at the discretion of the court. The court
				shall appoint such Secretary trustee if the court determines that the
				trusteeship is necessary to protect the interests of the participants and
				beneficiaries or providers of medical care or to avoid any unreasonable
				deterioration of the financial condition of the plan. The trusteeship of such
				Secretary shall continue until the conditions described in the first sentence
				of this subsection are remedied or the plan is terminated.</text>
								</subsection><subsection id="H70B9F2B3E0944D9787FC0034E4E73C8D"><enum>(b)</enum><header>Powers as
				Trustee</header><text>The Secretary, upon appointment as trustee under
				subsection (a), shall have the power—</text>
									<paragraph id="H334CBE14ECDB48DB9CBAE8B78C0375FA"><enum>(1)</enum><text>to do any act
				authorized by the plan, this title, or other applicable provisions of law to be
				done by the plan administrator or any trustee of the plan;</text>
									</paragraph><paragraph id="HB82A7D91910446AF941B489E786E42F4"><enum>(2)</enum><text>to require the
				transfer of all (or any part) of the assets and records of the plan to the
				Secretary as trustee;</text>
									</paragraph><paragraph id="H04752A14F99D4ED38D8700A61E1C2800"><enum>(3)</enum><text>to invest any
				assets of the plan which the Secretary holds in accordance with the provisions
				of the plan, regulations prescribed by the Secretary, and applicable provisions
				of law;</text>
									</paragraph><paragraph id="HE57867FD7D2545EF925758CB3282BD00"><enum>(4)</enum><text>to require the
				sponsor, the plan administrator, any participating employer, and any employee
				organization representing plan participants to furnish any information with
				respect to the plan which the Secretary as trustee may reasonably need in order
				to administer the plan;</text>
									</paragraph><paragraph id="H78B8F68D9BF8482B88342FB9A57E37F4"><enum>(5)</enum><text>to collect for the
				plan any amounts due the plan and to recover reasonable expenses of the
				trusteeship;</text>
									</paragraph><paragraph id="H2A42FF1998C3484991080377C9DF1128"><enum>(6)</enum><text>to commence,
				prosecute, or defend on behalf of the plan any suit or proceeding involving the
				plan;</text>
									</paragraph><paragraph id="HA236784B693549319826C60077693808"><enum>(7)</enum><text>to issue, publish,
				or file such notices, statements, and reports as may be required by the
				Secretary by regulation or required by any order of the court;</text>
									</paragraph><paragraph id="H608A6D28A79A421189A5090FBCEEB9E"><enum>(8)</enum><text>to terminate the
				plan (or provide for its termination in accordance with section 809(b)) and
				liquidate the plan assets, to restore the plan to the responsibility of the
				sponsor, or to continue the trusteeship;</text>
									</paragraph><paragraph id="H519941271DDA465BAEDC4686BDCDC594"><enum>(9)</enum><text>to provide for the
				enrollment of plan participants and beneficiaries under appropriate coverage
				options; and</text>
									</paragraph><paragraph id="HE4934BE379584E87A0D74800B2062FC2"><enum>(10)</enum><text>to do such other
				acts as may be necessary to comply with this title or any order of the court
				and to protect the interests of plan participants and beneficiaries and
				providers of medical care.</text>
									</paragraph></subsection><subsection id="HEDCA47D9BD5E4BC8943371022DEF1FF5"><enum>(c)</enum><header>Notice of
				Appointment</header><text>As soon as practicable after the Secretary’s
				appointment as trustee, the Secretary shall give notice of such appointment
				to—</text>
									<paragraph id="H7F82E65EBB7D4EECA33675C0FCBBAAC"><enum>(1)</enum><text>the sponsor and
				plan administrator;</text>
									</paragraph><paragraph id="H2DA6CA15E54643DD86E9BC25A7F3BEB2"><enum>(2)</enum><text>each
				participant;</text>
									</paragraph><paragraph id="H1DFC38E556B245E3A8ABB1B8A19F3BE0"><enum>(3)</enum><text>each participating
				employer; and</text>
									</paragraph><paragraph id="HAAAE002CE6FE4D45BFDD1842E632B377"><enum>(4)</enum><text>if applicable,
				each employee organization which, for purposes of collective bargaining,
				represents plan participants.</text>
									</paragraph></subsection><subsection id="HB3E1B769A1A34239A3D330F3A9E8C400"><enum>(d)</enum><header>Additional
				Duties</header><text>Except to the extent inconsistent with the provisions of
				this title, or as may be otherwise ordered by the court, the Secretary, upon
				appointment as trustee under this section, shall be subject to the same duties
				as those of a trustee under <external-xref legal-doc="usc" parsable-cite="usc/11/704">section 704</external-xref> of title 11, United States Code, and
				shall have the duties of a fiduciary for purposes of this title.</text>
								</subsection><subsection id="H676BDDBD5A0F4390A41F466B9DF8A09C"><enum>(e)</enum><header>Other
				Proceedings</header><text>An application by the Secretary under this subsection
				may be filed notwithstanding the pendency in the same or any other court of any
				bankruptcy, mortgage foreclosure, or equity receivership proceeding, or any
				proceeding to reorganize, conserve, or liquidate such plan or its property, or
				any proceeding to enforce a lien against property of the plan.</text>
								</subsection><subsection id="HC77C56ECB4244247BD347CE000C5072D"><enum>(f)</enum><header>Jurisdiction of
				Court</header>
									<paragraph id="H06787ED310C24B7CA36C07E600A4A215"><enum>(1)</enum><header>In
				general</header><text>Upon the filing of an application for the appointment as
				trustee or the issuance of a decree under this section, the court to which the
				application is made shall have exclusive jurisdiction of the plan involved and
				its property wherever located with the powers, to the extent consistent with
				the purposes of this section, of a court of the United States having
				jurisdiction over cases under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/11/11">chapter 11</external-xref> of title 11, United States Code.
				Pending an adjudication under this section such court shall stay, and upon
				appointment by it of the Secretary as trustee, such court shall continue the
				stay of, any pending mortgage foreclosure, equity receivership, or other
				proceeding to reorganize, conserve, or liquidate the plan, the sponsor, or
				property of such plan or sponsor, and any other suit against any receiver,
				conservator, or trustee of the plan, the sponsor, or property of the plan or
				sponsor. Pending such adjudication and upon the appointment by it of the
				Secretary as trustee, the court may stay any proceeding to enforce a lien
				against property of the plan or the sponsor or any other suit against the plan
				or the sponsor.</text>
									</paragraph><paragraph id="HF48B826C25C946AA99F75C3FD9906C2C"><enum>(2)</enum><header>Venue</header><text>An
				action under this section may be brought in the judicial district where the
				sponsor or the plan administrator resides or does business or where any asset
				of the plan is situated. A district court in which such action is brought may
				issue process with respect to such action in any other judicial
				district.</text>
									</paragraph></subsection><subsection id="H7AA7CB0CA4B94EB0A112E977CE907E06"><enum>(g)</enum><header>Personnel</header><text>In
				accordance with regulations which shall be prescribed by the Secretary, the
				Secretary shall appoint, retain, and compensate accountants, actuaries, and
				other professional service personnel as may be necessary in connection with the
				Secretary’s service as trustee under this section.</text>
								</subsection></section><section id="H8D0B77E76CBA4982A5B4A4A45478C8F5"><enum>811.</enum><header>State
				assessment authority</header>
								<subsection id="HEA8095456F5B475800A06B18F02F47A8"><enum>(a)</enum><header>In
				General</header><text>Notwithstanding section 514, a State may impose by law a
				contribution tax on an association health plan described in section 806(a)(2),
				if the plan commenced operations in such State after the date of the enactment
				of the <short-title>Making Health Care More Affordable Act
				of 2008</short-title>.</text>
								</subsection><subsection id="HEC961C71214245499E75171B109871C9"><enum>(b)</enum><header>Contribution
				Tax</header><text>For purposes of this section, the term <term>contribution
				tax</term> imposed by a State on an association health plan means any tax
				imposed by such State if—</text>
									<paragraph id="H5A63B3F8E941457C00D4FC0066C19557"><enum>(1)</enum><text>such tax is
				computed by applying a rate to the amount of premiums or contributions, with
				respect to individuals covered under the plan who are residents of such State,
				which are received by the plan from participating employers located in such
				State or from such individuals;</text>
									</paragraph><paragraph id="H07E5A0BFF14741F9954B826977A32709"><enum>(2)</enum><text>the rate of such
				tax does not exceed the rate of any tax imposed by such State on premiums or
				contributions received by insurers or health maintenance organizations for
				health insurance coverage offered in such State in connection with a group
				health plan;</text>
									</paragraph><paragraph id="H33A4BE86C2B14E1AAEE5CD47A9D9A545"><enum>(3)</enum><text>such tax is
				otherwise nondiscriminatory; and</text>
									</paragraph><paragraph id="HA51AA5E8AA1C427100AC17C5449E11D2"><enum>(4)</enum><text>the amount of any
				such tax assessed on the plan is reduced by the amount of any tax or assessment
				otherwise imposed by the State on premiums, contributions, or both received by
				insurers or health maintenance organizations for health insurance coverage,
				aggregate excess/stop loss insurance (as defined in section 806(g)(1)),
				specific excess/stop loss insurance (as defined in section 806(g)(2)), other
				insurance related to the provision of medical care under the plan, or any
				combination thereof provided by such insurers or health maintenance
				organizations in such State in connection with such plan.</text>
									</paragraph></subsection></section><section id="H22456CDFB79145189E889D62779249DF"><enum>812.</enum><header>Definitions and
				rules of construction</header>
								<subsection id="HF923549EFD314207BEA85D5C7BBBFEF"><enum>(a)</enum><header>Definitions</header><text>For
				purposes of this part—</text>
									<paragraph id="H68E52044BF384DEAA100F089717DF28"><enum>(1)</enum><header>Group health
				plan</header><text>The term <term>group health plan</term> has the meaning
				provided in section 733(a)(1) (after applying subsection (b) of this
				section).</text>
									</paragraph><paragraph id="H8136A49DD0D246038B7E72E4B05FFDEF"><enum>(2)</enum><header>Medical
				care</header><text>The term <term>medical care</term> has the meaning provided
				in section 733(a)(2).</text>
									</paragraph><paragraph id="H28E312D0EB3542AE8108EBB27EE1C62F"><enum>(3)</enum><header>Health insurance
				coverage</header><text>The term <term>health insurance coverage</term> has the
				meaning provided in section 733(b)(1).</text>
									</paragraph><paragraph id="HB12643DFA4884E1EB6EDA6A12953FD0"><enum>(4)</enum><header>Health insurance
				issuer</header><text>The term <term>health insurance issuer</term> has the
				meaning provided in section 733(b)(2).</text>
									</paragraph><paragraph id="H73DAC935D69A405DB751E90045788801"><enum>(5)</enum><header>Applicable
				authority</header><text>The term <term>applicable authority</term> means the
				Secretary, except that, in connection with any exercise of the Secretary’s
				authority regarding which the Secretary is required under section 506(d) to
				consult with a State, such term means the Secretary, in consultation with such
				State.</text>
									</paragraph><paragraph id="H543DAEEEE5BE474F9DCF25924C224C17"><enum>(6)</enum><header>Health
				status-related factor</header><text>The term <term>health status-related
				factor</term> has the meaning provided in section 733(d)(2).</text>
									</paragraph><paragraph id="H6B488C4CFC14454CAE318506FDD400DA"><enum>(7)</enum><header>Individual
				market</header>
										<subparagraph id="H30ACA731FAFC4F71921500E4B2E3C600"><enum>(A)</enum><header>In
				general</header><text>The term <term>individual market</term> means the market
				for health insurance coverage offered to individuals other than in connection
				with a group health plan.</text>
										</subparagraph><subparagraph id="HC9C1236EBCD24DF6A4E2A577A276C200"><enum>(B)</enum><header>Treatment of
				very small groups</header>
											<clause id="H5F091694DF9549F8A64639CBFBC27630"><enum>(i)</enum><header>In
				general</header><text>Subject to clause (ii), such term includes coverage
				offered in connection with a group health plan that has fewer than 2
				participants as current employees or participants described in section
				732(d)(3) on the first day of the plan year.</text>
											</clause><clause id="HADCC07E9122B4DF4A195B45706B70072"><enum>(ii)</enum><header>State
				exception</header><text>Clause (I) shall not apply in the case of health
				insurance coverage offered in a State if such State regulates the coverage
				described in such clause in the same manner and to the same extent as coverage
				in the small group market (as defined in section 2791(e)(5) of the
				<act-name parsable-cite="PHSA">Public Health Service Act</act-name>) is
				regulated by such State.</text>
											</clause></subparagraph></paragraph><paragraph id="HC7630C9BCD42448988B0C3AE98F1D252"><enum>(8)</enum><header>Participating
				employer</header><text>The term <term>participating employer</term> means, in
				connection with an association health plan, any employer, if any individual who
				is an employee of such employer, a partner in such employer, or a self-employed
				individual who is such employer (or any dependent, as defined under the terms
				of the plan, of such individual) is or was covered under such plan in
				connection with the status of such individual as such an employee, partner, or
				self-employed individual in relation to the plan.</text>
									</paragraph><paragraph id="H687AB8BF6F2C402C9CDBD5165FE3ECED"><enum>(9)</enum><header>Applicable state
				authority</header><text>The term <term>applicable State authority</term> means,
				with respect to a health insurance issuer in a State, the State insurance
				commissioner or official or officials designated by the State to enforce the
				requirements of title XXVII of the <act-name parsable-cite="PHSA">Public Health
				Service Act</act-name> for the State involved with respect to such
				issuer.</text>
									</paragraph><paragraph id="H8357750AAED04219A3DA343F1F740098"><enum>(10)</enum><header>Qualified
				actuary</header><text>The term <term>qualified actuary</term> means an
				individual who is a member of the American Academy of Actuaries.</text>
									</paragraph><paragraph id="H13597F92BCDF489300F3EFC841C1351B"><enum>(11)</enum><header>Affiliated
				member</header><text>The term <term>affiliated member</term> means, in
				connection with a sponsor—</text>
										<subparagraph id="H947D2267856E4106A631006E49718E55"><enum>(A)</enum><text>a person who is
				otherwise eligible to be a member of the sponsor but who elects an affiliated
				status with the sponsor,</text>
										</subparagraph><subparagraph id="H306532169A24432C9846A56F39008B17"><enum>(B)</enum><text>in the case of a
				sponsor with members which consist of associations, a person who is a member of
				any such association and elects an affiliated status with the sponsor,
				or</text>
										</subparagraph><subparagraph id="HA35875511AAC4FFCA776017100A1445"><enum>(C)</enum><text>in the case of an
				association health plan in existence on the date of the enactment of the
				<short-title>Making Health Care More Affordable Act of
				2008</short-title>, a person eligible to be a member of the sponsor or one of
				its member associations.</text>
										</subparagraph></paragraph><paragraph id="H860878F8B65F46919D05FB289CCE0136"><enum>(12)</enum><header>Large
				employer</header><text>The term <term>large employer</term> means, in
				connection with a group health plan with respect to a plan year, an employer
				who employed an average of at least 51 employees on business days during the
				preceding calendar year and who employs at least 2 employees on the first day
				of the plan year.</text>
									</paragraph><paragraph id="H04443B4C5B054059B277D2D13623F4E"><enum>(13)</enum><header>Small
				employer</header><text>The term <term>small employer</term> means, in
				connection with a group health plan with respect to a plan year, an employer
				who is not a large employer.</text>
									</paragraph></subsection><subsection id="HEC99204608994B538E24F667D000258B"><enum>(b)</enum><header>Rules of
				Construction</header>
									<paragraph id="HCB47C98F83D941A0B3B5322F57562806"><enum>(1)</enum><header>Employers and
				employees</header><text>For purposes of determining whether a plan, fund, or
				program is an employee welfare benefit plan which is an association health
				plan, and for purposes of applying this title in connection with such plan,
				fund, or program so determined to be such an employee welfare benefit
				plan—</text>
										<subparagraph id="H22F88D009ABB43BFAEB0B6FE99A216B4"><enum>(A)</enum><text>in the case of a
				partnership, the term <term>employer</term> (as defined in section 3(5))
				includes the partnership in relation to the partners, and the term
				<term>employee</term> (as defined in section 3(6)) includes any partner in
				relation to the partnership; and</text>
										</subparagraph><subparagraph id="HDCBC1809ED134B6AB5534295F37BCEFB"><enum>(B)</enum><text>in the case of a
				self-employed individual, the term <term>employer</term> (as defined in section
				3(5)) and the term <term>employee</term> (as defined in section 3(6)) shall
				include such individual.</text>
										</subparagraph></paragraph><paragraph id="HD4AF29BDD45449929709CB760066C121"><enum>(2)</enum><header>Plans, funds,
				and programs treated as employee welfare benefit plans</header><text>In the
				case of any plan, fund, or program which was established or is maintained for
				the purpose of providing medical care (through the purchase of insurance or
				otherwise) for employees (or their dependents) covered thereunder and which
				demonstrates to the Secretary that all requirements for certification under
				this part would be met with respect to such plan, fund, or program if such
				plan, fund, or program were a group health plan, such plan, fund, or program
				shall be treated for purposes of this title as an employee welfare benefit plan
				on and after the date of such
				demonstration.</text>
									</paragraph></subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="HA705ABB7A1E044F5A4A022D15675921"><enum>(b)</enum><header>Conforming
			 Amendments to Preemption Rules</header>
					<paragraph id="H4CC912683D534474864EEE05E569CD84"><enum>(1)</enum><text>Section 514(b)(6)
			 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144">29 U.S.C. 1144(b)(6)</external-xref>) is amended by adding at the end the
			 following new subparagraph:</text>
						<quoted-block id="HC32FCC686CF24E6885844DDD4E00C75C" style="OLC">
							<subparagraph id="H64F50788BB1D434A9E209E0049A17F69" indent="up2"><enum>(E)</enum><text>The preceding subparagraphs of this
				paragraph do not apply with respect to any State law in the case of an
				association health plan which is certified under part
				8.</text>
							</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph id="HE34DC43786184B708CBD36B9A1152FC1"><enum>(2)</enum><text>Section 514 of
			 such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144">29 U.S.C. 1144</external-xref>) is amended—</text>
						<subparagraph id="HB61A94BEF4FF4A16ADC985511E5EED00"><enum>(A)</enum><text>in subsection
			 (b)(4), by striking <quote>Subsection (a)</quote> and inserting
			 <quote>Subsections (a) and (d)</quote>;</text>
						</subparagraph><subparagraph id="H7FF54887D8BF4B2B8848215DF0416837"><enum>(B)</enum><text>in subsection
			 (b)(5), by striking <quote>subsection (a)</quote> in subparagraph (A) and
			 inserting <quote>subsection (a) of this section and subsections (a)(2)(B) and
			 (b) of section 805</quote>, and by striking <quote>subsection (a)</quote> in
			 subparagraph (B) and inserting <quote>subsection (a) of this section or
			 subsection (a)(2)(B) or (b) of section 805</quote>;</text>
						</subparagraph><subparagraph id="H67023CC2345E4C07BD6CA4AF66DCADD3"><enum>(C)</enum><text>by redesignating
			 subsection (d) as subsection (e); and</text>
						</subparagraph><subparagraph id="H431C46800C284A228BD100432195D7C1"><enum>(D)</enum><text>by inserting after
			 subsection (c) the following new subsection:</text>
							<quoted-block id="H53914B81B2B0487AB02809DB00E883EC" style="OLC">
								<subsection id="HA3799E5757964461A5127532C7E650E2"><enum>(d)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H67705315E87441858FB0237C42A3D353"><enum>(1)</enum><text>Except as provided in
				subsection (b)(4), the provisions of this title shall supersede any and all
				State laws insofar as they may now or hereafter preclude, or have the effect of
				precluding, a health insurance issuer from offering health insurance coverage
				in connection with an association health plan which is certified under part
				8.</text>
									</paragraph><paragraph id="H087EE67F9F4A48739900110666B98724" indent="up1"><enum>(2)</enum><text>Except as provided in paragraphs (4)
				and (5) of subsection (b) of this section—</text>
										<subparagraph id="H5C4ED36D93FF4042B3A4715860B37E00"><enum>(A)</enum><text>In any case in which health insurance
				coverage of any policy type is offered under an association health plan
				certified under part 8 to a participating employer operating in such State, the
				provisions of this title shall supersede any and all laws of such State insofar
				as they may preclude a health insurance issuer from offering health insurance
				coverage of the same policy type to other employers operating in the State
				which are eligible for coverage under such association health plan, whether or
				not such other employers are participating employers in such plan.</text>
										</subparagraph><subparagraph id="HE193A5D653F84F1AA8898400589F1C41"><enum>(B)</enum><text>In any case in which health insurance
				coverage of any policy type is offered in a State under an association health
				plan certified under part 8 and the filing, with the applicable State authority
				(as defined in section 812(a)(9)), of the policy form in connection with such
				policy type is approved by such State authority, the provisions of this title
				shall supersede any and all laws of any other State in which health insurance
				coverage of such type is offered, insofar as they may preclude, upon the filing
				in the same form and manner of such policy form with the applicable State
				authority in such other State, the approval of the filing in such other
				State.</text>
										</subparagraph></paragraph><paragraph id="H9F500BAC294C4701AEE814EC8F78E8EF" indent="up1"><enum>(3)</enum><text>Nothing in subsection (b)(6)(E) or
				the preceding provisions of this subsection shall be construed, with respect to
				health insurance issuers or health insurance coverage, to supersede or impair
				the law of any State—</text>
										<subparagraph id="H8A3CE762E5E94916B4005EAA00AD4E4"><enum>(A)</enum><text>providing solvency standards or
				similar standards regarding the adequacy of insurer capital, surplus, reserves,
				or contributions, or</text>
										</subparagraph><subparagraph id="HB8435FF012854D9FA1BB9EC2EF3659F5"><enum>(B)</enum><text>relating to prompt payment of
				claims.</text>
										</subparagraph></paragraph><paragraph id="H0B0D05CF73C4409F81C96CD0844800DD" indent="up1"><enum>(4)</enum><text>For additional provisions relating to
				association health plans, see subsections (a)(2)(B) and (b) of section
				805.</text>
									</paragraph><paragraph id="H93089FB6A18B4D6BAAC46EEC76A53C6C" indent="up1"><enum>(5)</enum><text>For purposes of this subsection, the
				term <term>association health plan</term> has the meaning provided in section
				801(a), and the terms <term>health insurance coverage</term>,
				<term>participating employer</term>, and <term>health insurance issuer</term>
				have the meanings provided such terms in section 812,
				respectively.</text>
									</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph id="HDB3CF9B26A5D49D7875D40DA3FF02448"><enum>(3)</enum><text>Section
			 514(b)(6)(A) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144">29 U.S.C. 1144(b)(6)(A)</external-xref>) is amended—</text>
						<subparagraph id="H6821C6493C9F431BB4679D663E04D416"><enum>(A)</enum><text>in clause (I)(II),
			 by striking <quote>and</quote> at the end;</text>
						</subparagraph><subparagraph id="H7514152950434101BC44FB738F55C558"><enum>(B)</enum><text>in clause (ii), by
			 inserting <quote>and which does not provide medical care (within the meaning of
			 section 733(a)(2)),</quote> after <quote>arrangement,</quote>, and by striking
			 <quote>title.</quote> and inserting <quote>title, and</quote>; and</text>
						</subparagraph><subparagraph id="H028BD58F2E314FDAA3C927EAF9FAA37C"><enum>(C)</enum><text>by adding at the
			 end the following new clause:</text>
							<quoted-block id="H8DE36F324E9A4375A2808F51820016A6" style="OLC">
								<clause id="HA06AE23ACD004E03978F5E8E9D7E24D2" indent="up2"><enum>(iii)</enum><text>subject to subparagraph (E), in the
				case of any other employee welfare benefit plan which is a multiple employer
				welfare arrangement and which provides medical care (within the meaning of
				section 733(a)(2)), any law of any State which regulates insurance may
				apply.</text>
								</clause><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph id="H41961ECA2D9C43FD9C8E63A664A503F5"><enum>(4)</enum><text>Section 514(e) of
			 such Act (as redesignated by paragraph (2)(C)) is amended—</text>
						<subparagraph id="H24DE1D6F0B8F4D1C93E093F47D7E094"><enum>(A)</enum><text>by striking
			 <quote>Nothing</quote> and inserting <quote>(1) Except as provided in paragraph
			 (2), nothing</quote>; and</text>
						</subparagraph><subparagraph id="HB5F7CD581F2F48E39455FD4100E797CB"><enum>(B)</enum><text>by adding at the
			 end the following new paragraph:</text>
							<quoted-block id="H1898365C1748417A8D36CA2500A1F072" style="OLC">
								<paragraph id="H29B5814508374639BD14F5CCD2BC789" indent="up1"><enum>(2)</enum><text>Nothing in any other provision of law
				enacted on or after the date of the enactment of the
				<short-title>Making Health Care More Affordable Act of
				2008</short-title> shall be construed to alter, amend, modify, invalidate,
				impair, or supersede any provision of this title, except by specific
				cross-reference to the affected
				section.</text>
								</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph></subsection><subsection id="HF5DCCC67A1984855BB15BA26049FAEC9"><enum>(c)</enum><header>Plan
			 Sponsor</header><text>Section 3(16)(B) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/102">29 U.S.C. 102(16)(B)</external-xref>) is
			 amended by adding at the end the following new sentence: <quote>Such term also
			 includes a person serving as the sponsor of an association health plan under
			 part 8.</quote>.</text>
				</subsection><subsection id="H061F91C8B5134E349C76C179A1974609"><enum>(d)</enum><header>Disclosure of
			 Solvency Protections Related to Self-Insured and Fully Insured Options Under
			 Association Health Plans</header><text>Section 102(b) of such Act (29 U.S.C.
			 102(b)) is amended by adding at the end the following: <quote>An association
			 health plan shall include in its summary plan description, in connection with
			 each benefit option, a description of the form of solvency or guarantee fund
			 protection secured pursuant to this Act or applicable State law, if
			 any.</quote>.</text>
				</subsection><subsection id="H07A81E2738EF48849074B422CF9D93C8"><enum>(e)</enum><header>Savings
			 Clause</header><text>Section 731(c) of such Act is amended by inserting
			 <quote>or part 8</quote> after <quote>this part</quote>.</text>
				</subsection><subsection id="HB98E0ADEC9ED434290078726F4C800C1"><enum>(f)</enum><header>Report to the
			 Congress Regarding Certification of Self-Insured Association Health
			 Plans</header><text>Not later than January 1, 2012, the Secretary of Labor
			 shall report to the Committee on Education and the Workforce of the House of
			 Representatives and the Committee on Health, Education, Labor, and Pensions of
			 the Senate the effect association health plans have had, if any, on reducing
			 the number of uninsured individuals.</text>
				</subsection><subsection id="H0F9E1838D01041CF928036A0DB74005F"><enum>(g)</enum><header>Clerical
			 Amendment</header><text>The table of contents in section 1 of the
			 <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
			 1974</act-name> is amended by inserting after the item relating to section 734
			 the following new items:</text>
					<quoted-block act-name="Employee Retirement Income Security Act of 1974" id="HA2AACA9483CC43098463399F14427EA2" style="OLC">
						<toc regeneration="no-regeneration">
							<toc-entry level="part">Part 8—Rules Governing Association Health
				Plans</toc-entry>
							<toc-entry level="section">801. Association health plans.</toc-entry>
							<toc-entry level="section">802. Certification of association health
				plans.</toc-entry>
							<toc-entry level="section">803. Requirements relating to sponsors and
				boards of trustees.</toc-entry>
							<toc-entry level="section">804. Participation and coverage
				requirements.</toc-entry>
							<toc-entry level="section">805. Other requirements relating to plan
				documents, contribution rates, and benefit options.</toc-entry>
							<toc-entry level="section">806. Maintenance of reserves and
				provisions for solvency for plans providing health benefits in addition to
				health insurance coverage.</toc-entry>
							<toc-entry level="section">807. Requirements for application and
				related requirements.</toc-entry>
							<toc-entry level="section">808. Notice requirements for voluntary
				termination.</toc-entry>
							<toc-entry level="section">809. Corrective actions and mandatory
				termination.</toc-entry>
							<toc-entry level="section">810. Trusteeship by the Secretary of
				insolvent association health plans providing health benefits in addition to
				health insurance coverage.</toc-entry>
							<toc-entry level="section">811. State assessment
				authority.</toc-entry>
							<toc-entry level="section">812. Definitions and rules of
				construction.</toc-entry>
						</toc>
						<after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection></section><section id="H3083C1D1DC794015945EF2046BB112D0"><enum>202.</enum><header>Clarification
			 of treatment of single employer arrangements</header><text display-inline="no-display-inline">Section 3(40)(B) of the
			 <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
			 1974</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/29/1002">29 U.S.C. 1002(40)(B)</external-xref>) is amended—</text>
				<paragraph id="HA097422B8ABD49168E009E5771762E3B"><enum>(1)</enum><text>in clause (I), by
			 inserting after <quote>control group,</quote> the following: <quote>except
			 that, in any case in which the benefit referred to in subparagraph (A) consists
			 of medical care (as defined in section 812(a)(2)), two or more trades or
			 businesses, whether or not incorporated, shall be deemed a single employer for
			 any plan year of such plan, or any fiscal year of such other arrangement, if
			 such trades or businesses are within the same control group during such year or
			 at any time during the preceding 1-year period,</quote>;</text>
				</paragraph><paragraph id="HA4EC110D50F2458C8B28B68BC8D07560"><enum>(2)</enum><text>in clause (iii),
			 by striking <quote>(iii) the determination</quote> and inserting the
			 following:</text>
					<quoted-block id="H2CA3464ABEB841C88558009382CE5DB1" style="OLC">
						<clause id="H7E8346F042FB4A51B94096DD9F0026F6" indent="up2"><enum>(iii)</enum><subclause commented="no" display-inline="yes-display-inline" id="H8AC67F8504F14CDA8242E38F32822E50"><enum>(I)</enum><text>in any case in which the
				benefit referred to in subparagraph (A) consists of medical care (as defined in
				section 812(a)(2)), the determination of whether a trade or business is under
				<quote>common control</quote> with another trade or business shall be
				determined under regulations of the Secretary applying principles consistent
				and coextensive with the principles applied in determining whether employees of
				two or more trades or businesses are treated as employed by a single employer
				under section 4001(b), except that, for purposes of this paragraph, an interest
				of greater than 25 percent may not be required as the minimum interest
				necessary for common control, or</text>
							</subclause><subclause id="H7516A962E97E4FA5AEF4C1D581CD4B7" indent="up1"><enum>(II)</enum><text>in any other case, the
				determination</text>
							</subclause></clause><after-quoted-block>;</after-quoted-block></quoted-block>
				</paragraph><paragraph id="HB9E988AAB1804E0DBACFF6FCA59E6D9C"><enum>(3)</enum><text>by redesignating
			 clauses (iv) and (v) as clauses (v) and (vi), respectively; and</text>
				</paragraph><paragraph id="H5C3CC0F04F5248CE89BDC7E203541C00"><enum>(4)</enum><text>by inserting after
			 clause (iii) the following new clause:</text>
					<quoted-block id="H6A62A10AA9D14FF2B05BC77FAA423EF3" style="OLC">
						<clause id="HB57C7A6B046F4198A2E42F1456893420" indent="up2"><enum>(iv)</enum><text>in any case in which the benefit
				referred to in subparagraph (A) consists of medical care (as defined in section
				812(a)(2)), in determining, after the application of clause (I), whether
				benefits are provided to employees of two or more employers, the arrangement
				shall be treated as having only one participating employer if, after the
				application of clause (I), the number of individuals who are employees and
				former employees of any one participating employer and who are covered under
				the arrangement is greater than 75 percent of the aggregate number of all
				individuals who are employees or former employees of participating employers
				and who are covered under the
				arrangement,</text>
						</clause><after-quoted-block>.</after-quoted-block></quoted-block>
				</paragraph></section><section id="H45A7803F92AC4C368E924D34EA52F137"><enum>203.</enum><header>Enforcement
			 provisions relating to association health plans</header>
				<subsection id="H36DBA0BF2CE5476481833B372626D946"><enum>(a)</enum><header>Criminal
			 Penalties for Certain Willful Misrepresentations</header><text>Section 501 of
			 the <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
			 1974</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/29/1131">29 U.S.C. 1131</external-xref>) is amended—</text>
					<paragraph id="H6FA909F9AA9D4845B95223AC60CFD7B1"><enum>(1)</enum><text>by inserting
			 <quote>(a)</quote> after <quote>Sec. 501.</quote>; and</text>
					</paragraph><paragraph id="H3293C88AD9F347F1ABC38D00DCA499C6"><enum>(2)</enum><text>by adding at the
			 end the following new subsection:</text>
						<quoted-block id="HA16FA93B8B05437897EDBC347EA648BC" style="OLC">
							<subsection id="H9D31B07367354B21B0ACA77DDF6CBDC9"><enum>(b)</enum><text>Any person who
				willfully falsely represents, to any employee, any employee’s beneficiary, any
				employer, the Secretary, or any State, a plan or other arrangement established
				or maintained for the purpose of offering or providing any benefit described in
				section 3(1) to employees or their beneficiaries as—</text>
								<paragraph id="HE0034D55500B42DFB38236120006FBF"><enum>(1)</enum><text>being an
				association health plan which has been certified under part 8;</text>
								</paragraph><paragraph id="H0F8F712AA96A4B0B00EFA24844DAEA24"><enum>(2)</enum><text>having been
				established or maintained under or pursuant to one or more collective
				bargaining agreements which are reached pursuant to collective bargaining
				described in section 8(d) of the National Labor Relations Act (29 U.S.C.
				158(d)) or paragraph Fourth of section 2 of the Railway Labor Act (45 U.S.C.
				152, paragraph Fourth) or which are reached pursuant to labor-management
				negotiations under similar provisions of State public employee relations laws;
				or</text>
								</paragraph><paragraph id="H43B3CF3440144A06806CE1A93825442F"><enum>(3)</enum><text>being a plan or
				arrangement described in section 3(40)(A)(I),</text>
								</paragraph><continuation-text continuation-text-level="subsection">shall,
				upon conviction, be imprisoned not more than 5 years, be fined under title 18,
				United States Code, or
				both.</continuation-text></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection><subsection id="HA91839714F8A4E2DB2C6BDB26095C82"><enum>(b)</enum><header>Cease Activities
			 Orders</header><text>Section 502 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1132">29 U.S.C. 1132</external-xref>) is amended by
			 adding at the end the following new subsection:</text>
					<quoted-block id="H44D9ECC9521B4E4A91E4E6EA7BD7467" style="OLC">
						<subsection id="H3C6B8623EFC547988FDC51AA83FC2BE2"><enum>(n)</enum><header>Association
				Health Plan Cease and Desist Orders</header>
							<paragraph id="H4E6F816BBA9F4FA3A8B158055EF088AE"><enum>(1)</enum><header>In
				general</header><text>Subject to paragraph (2), upon application by the
				Secretary showing the operation, promotion, or marketing of an association
				health plan (or similar arrangement providing benefits consisting of medical
				care (as defined in section 733(a)(2))) that—</text>
								<subparagraph id="H50AF1E55C2E64E3DB2EF0977F27F3410"><enum>(A)</enum><text>is not certified
				under part 8, is subject under section 514(b)(6) to the insurance laws of any
				State in which the plan or arrangement offers or provides benefits, and is not
				licensed, registered, or otherwise approved under the insurance laws of such
				State; or</text>
								</subparagraph><subparagraph id="H334CE6B145B240A98F7D3969CE0529C6"><enum>(B)</enum><text>is an association
				health plan certified under part 8 and is not operating in accordance with the
				requirements under part 8 for such certification,</text>
								</subparagraph><continuation-text continuation-text-level="paragraph">a district
				court of the United States shall enter an order requiring that the plan or
				arrangement cease activities.</continuation-text></paragraph><paragraph id="HCE9223388CDB4CDDB95D65B282D92509"><enum>(2)</enum><header>Exception</header><text>Paragraph
				(1) shall not apply in the case of an association health plan or other
				arrangement if the plan or arrangement shows that—</text>
								<subparagraph id="H22BAAC6D52A14C35BBC85CE97DBDD700"><enum>(A)</enum><text>all benefits under
				it referred to in paragraph (1) consist of health insurance coverage;
				and</text>
								</subparagraph><subparagraph id="H4A792FAE91EC4272A219C900566D10BB"><enum>(B)</enum><text>with respect to
				each State in which the plan or arrangement offers or provides benefits, the
				plan or arrangement is operating in accordance with applicable State laws that
				are not superseded under section 514.</text>
								</subparagraph></paragraph><paragraph id="H1FB2FF9379A44B4DAB42003F45BD5FE3"><enum>(3)</enum><header>Additional
				equitable relief</header><text>The court may grant such additional equitable
				relief, including any relief available under this title, as it deems necessary
				to protect the interests of the public and of persons having claims for
				benefits against the
				plan.</text>
							</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="HFFDAEFDBEA5F416A81E57DA17B06C738"><enum>(c)</enum><header>Responsibility
			 for Claims Procedure</header><text>Section 503 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1133">29 U.S.C. 1133</external-xref>) is
			 amended by inserting <quote>(a) <header-in-text level="subsection" style="OLC">In general</header-in-text>.—</quote> before <quote>In
			 accordance</quote>, and by adding at the end the following new
			 subsection:</text>
					<quoted-block id="H2DA8E42E5FB942D0AB45C03F718900A2" style="OLC">
						<subsection id="H3788EE2E01EB463E8E6082CB9980E6B9"><enum>(b)</enum><header>Association
				Health Plans</header><text>The terms of each association health plan which is
				or has been certified under part 8 shall require the board of trustees or the
				named fiduciary (as applicable) to ensure that the requirements of this section
				are met in connection with claims filed under the
				plan.</text>
						</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection></section><section id="H4032AB8046BB4F8FB815D7B6FD10C1E6"><enum>204.</enum><header>Cooperation
			 between Federal and State authorities</header><text display-inline="no-display-inline">Section 506 of the
			 <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
			 1974</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/29/1136">29 U.S.C. 1136</external-xref>) is amended by adding at the end the following
			 new subsection:</text>
				<quoted-block act-name="Employee Retirement Income Security Act of 1974" id="H46CF6D15A2EF46A5971D00B5646FEA5B" style="OLC">
					<subsection id="H9E47A074B25C453E913096D6FAE87FB"><enum>(d)</enum><header>Consultation With
				States With Respect to Association Health Plans</header>
						<paragraph id="HC782D0F17A904B2E95057096A4FAB83B"><enum>(1)</enum><header>Agreements with
				states</header><text>The Secretary shall consult with the State recognized
				under paragraph (2) with respect to an association health plan regarding the
				exercise of—</text>
							<subparagraph id="HBD110D0247BD4B70ACF5204B3DDAE129"><enum>(A)</enum><text>the Secretary’s
				authority under sections 502 and 504 to enforce the requirements for
				certification under part 8; and</text>
							</subparagraph><subparagraph id="H7EC89379F60445DB8B4EAE6707EC68CE"><enum>(B)</enum><text>the Secretary’s
				authority to certify association health plans under part 8 in accordance with
				regulations of the Secretary applicable to certification under part 8.</text>
							</subparagraph></paragraph><paragraph id="HF556090E6E434A75A593C99005C00E2"><enum>(2)</enum><header>Recognition of
				primary domicile state</header><text>In carrying out paragraph (1), the
				Secretary shall ensure that only one State will be recognized, with respect to
				any particular association health plan, as the State with which consultation is
				required. In carrying out this paragraph—</text>
							<subparagraph id="H2C9999FA05CF4622BE9BC8BF01AAB742"><enum>(A)</enum><text>in the case of a
				plan which provides health insurance coverage (as defined in section
				812(a)(3)), such State shall be the State with which filing and approval of a
				policy type offered by the plan was initially obtained, and</text>
							</subparagraph><subparagraph id="HA272E1D9A092448EAE3E2BA3A4C08F3"><enum>(B)</enum><text>in any other case,
				the Secretary shall take into account the places of residence of the
				participants and beneficiaries under the plan and the State in which the trust
				is
				maintained.</text>
							</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="HEA0A74067B5E419FB54CF4A1C00D700"><enum>205.</enum><header>Effective date
			 and transitional and other rules</header>
				<subsection id="HA1E173F8CABD4395BADB059B2D741237"><enum>(a)</enum><header>Effective
			 Date</header><text>The amendments made by this title shall take effect 1 year
			 after the date of the enactment of this Act. The Secretary of Labor shall first
			 issue all regulations necessary to carry out the amendments made by this title
			 within 1 year after the date of the enactment of this Act.</text>
				</subsection><subsection id="H345783EE2CD44449A0D5B2C400D26759"><enum>(b)</enum><header>Treatment of
			 Certain Existing Health Benefits Programs</header>
					<paragraph id="H34D3495048184997A284200659461B48"><enum>(1)</enum><header>In
			 general</header><text>In any case in which, as of the date of the enactment of
			 this Act, an arrangement is maintained in a State for the purpose of providing
			 benefits consisting of medical care for the employees and beneficiaries of its
			 participating employers, at least 200 participating employers make
			 contributions to such arrangement, such arrangement has been in existence for
			 at least 10 years, and such arrangement is licensed under the laws of one or
			 more States to provide such benefits to its participating employers, upon the
			 filing with the applicable authority (as defined in section 812(a)(5) of the
			 <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
			 1974</act-name> (as amended by this subtitle)) by the arrangement of an
			 application for certification of the arrangement under part 8 of subtitle B of
			 title I of such Act—</text>
						<subparagraph id="HBFC7BC1539C34BDCA2574B1CC921B354"><enum>(A)</enum><text>such arrangement
			 shall be deemed to be a group health plan for purposes of title I of such
			 Act;</text>
						</subparagraph><subparagraph id="H617B78E4C0FF4364A3461EB0747043BE"><enum>(B)</enum><text>the requirements
			 of sections 801(a) and 803(a) of the <act-name parsable-cite="ERISA">Employee
			 Retirement Income Security Act of 1974</act-name> shall be deemed met with
			 respect to such arrangement;</text>
						</subparagraph><subparagraph id="H6DBE0CBFFE3A46D3B443001936E6B472"><enum>(C)</enum><text>the requirements
			 of section 803(b) of such Act shall be deemed met, if the arrangement is
			 operated by a board of directors which—</text>
							<clause id="H94F913BFFC384ADEBFCE736235E364DC"><enum>(i)</enum><text>is
			 elected by the participating employers, with each employer having one vote;
			 and</text>
							</clause><clause id="H0F5F34FCB5674287A637E5D92CF2E59"><enum>(ii)</enum><text>has
			 complete fiscal control over the arrangement and which is responsible for all
			 operations of the arrangement;</text>
							</clause></subparagraph><subparagraph id="H78A4EEED22154EF5A8E946E0009CF912"><enum>(D)</enum><text>the requirements
			 of section 804(a) of such Act shall be deemed met with respect to such
			 arrangement; and</text>
						</subparagraph><subparagraph id="H746294CCBFFC4CC7BF2EFE2C5FCBB823"><enum>(E)</enum><text>the arrangement
			 may be certified by any applicable authority with respect to its operations in
			 any State only if it operates in such State on the date of
			 certification.</text>
						</subparagraph><continuation-text continuation-text-level="paragraph">The
			 provisions of this subsection shall cease to apply with respect to any such
			 arrangement at such time after the date of the enactment of this Act as the
			 applicable requirements of this subsection are not met with respect to such
			 arrangement.</continuation-text></paragraph><paragraph id="H925D042FBCB74EEE9890A0CB9D940300"><enum>(2)</enum><header>Definitions</header><text>For
			 purposes of this subsection, the terms <term>group health plan</term>,
			 <term>medical care</term>, and <term>participating employer</term> shall have
			 the meanings provided in section 812 of the <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
			 1974</act-name>, except that the reference in paragraph (7) of such section to
			 an <quote>association health plan</quote> shall be deemed a reference to an
			 arrangement referred to in this subsection.</text>
					</paragraph></subsection></section></title><title id="HD94AAFA7A4F24083BFC00106A447144E"><enum>III</enum><header>PURCHASE HEALTH
			 INSURANCE ACROSS STATE LINES </header>
			<section id="HDF6B8BA339044E4D90EDCAD8206FBACD"><enum>301.</enum><header>Cooperative
			 governing of individual health insurance coverage</header>
				<subsection id="H440C280F671F4F2F8CFCD10702B661C4"><enum>(a)</enum><header>In
			 general</header><text>Title XXVII of the Public Health Service Act (42 U.S.C.
			 300gg et seq.) is amended by adding at the end the following new part:</text>
					<quoted-block display-inline="no-display-inline" id="HAB078B3709024ECDB47FDED98C8B2B00" style="traditional">
						<part id="H22698E01337F4EBABF226B876BEB2C7C"><enum>D</enum><header>Cooperative
				Governing of Individual Health Insurance Coverage </header>
							<section id="H3AD03012E8FE4C46A9004CEF00A5F793"><enum>2795.</enum><header>Definitions</header><text display-inline="no-display-inline">In this part:</text>
								<paragraph id="HA77F81890F8547CDB32DA35557F2D411"><enum>(1)</enum><header>Primary
				state</header><text>The term <term>primary State</term> means, with respect to
				individual health insurance coverage offered by a health insurance issuer, the
				State designated by the issuer as the State whose covered laws shall govern the
				health insurance issuer in the sale of such coverage under this part. An
				issuer, with respect to a particular policy, may only designate one such State
				as its primary State with respect to all such coverage it offers. Such an
				issuer may not change the designated primary State with respect to individual
				health insurance coverage once the policy is issued, except that such a change
				may be made upon renewal of the policy. With respect to such designated State,
				the issuer is deemed to be doing business in that State.</text>
								</paragraph><paragraph id="H8020B1AF3B4344258600567C5570E18D"><enum>(2)</enum><header>Secondary
				state</header><text>The term <term>secondary State</term> means, with respect
				to individual health insurance coverage offered by a health insurance issuer,
				any State that is not the primary State. In the case of a health insurance
				issuer that is selling a policy in, or to a resident of, a secondary State, the
				issuer is deemed to be doing business in that secondary State.</text>
								</paragraph><paragraph id="H2C79046917E44962ADA29D25249C88C"><enum>(3)</enum><header>Health insurance
				issuer</header><text>The term <term>health insurance issuer</term> has the
				meaning given such term in section 2791(b)(2), except that such an issuer must
				be licensed in the primary State and be qualified to sell individual health
				insurance coverage in that State.</text>
								</paragraph><paragraph id="H287E7B663D46452ABF17ABCBAD958C7"><enum>(4)</enum><header>Individual health
				insurance coverage</header><text>The term <term>individual health insurance
				coverage</term> means health insurance coverage offered in the individual
				market, as defined in section 2791(e)(1).</text>
								</paragraph><paragraph id="HA83559E45B0C411089FC9C8681FED02"><enum>(5)</enum><header>Applicable state
				authority</header><text>The term <term>applicable State authority</term> means,
				with respect to a health insurance issuer in a State, the State insurance
				commissioner or official or officials designated by the State to enforce the
				requirements of this title for the State with respect to the issuer.</text>
								</paragraph><paragraph id="H375708EE852C48DDAE047983024FD85E"><enum>(6)</enum><header>Hazardous
				financial condition</header><text>The term <term>hazardous financial
				condition</term> means that, based on its present or reasonably anticipated
				financial condition, a health insurance issuer is unlikely to be able—</text>
									<subparagraph id="H671A6FDE0B284BACB9000128CAACF26"><enum>(A)</enum><text>to meet obligations
				to policyholders with respect to known claims and reasonably anticipated
				claims; or</text>
									</subparagraph><subparagraph id="H20DB2C7C25B446F3A6A0D43EE1A0FA00"><enum>(B)</enum><text>to pay other
				obligations in the normal course of business.</text>
									</subparagraph></paragraph><paragraph id="HA546EE69034845BAA1C13600B3E2003C"><enum>(7)</enum><header>Covered
				laws</header>
									<subparagraph id="H39B5B11CA3F04F3B9605138F68C227D6"><enum>(A)</enum><header>In
				general</header><text>The term <term>covered laws</term> means the laws, rules,
				regulations, agreements, and orders governing the insurance business pertaining
				to—</text>
										<clause id="H16DFE8F08BAF4050B124DC872CE47549"><enum>(i)</enum><text>individual health
				insurance coverage issued by a health insurance issuer;</text>
										</clause><clause id="HBD8CB1152958486398ACEE077CBBFDBC"><enum>(ii)</enum><text>the offer, sale,
				rating (including medical underwriting), renewal, and issuance of individual
				health insurance coverage to an individual;</text>
										</clause><clause id="HB067C6D5BE174E7AB829D44000A551A9"><enum>(iii)</enum><text>the provision to
				an individual in relation to individual health insurance coverage of health
				care and insurance related services;</text>
										</clause><clause id="H10EC6F90482D455F82914F09F116FE9"><enum>(iv)</enum><text>the provision to
				an individual in relation to individual health insurance coverage of
				management, operations, and investment activities of a health insurance issuer;
				and</text>
										</clause><clause id="HE5F74F9473A44DDDBA6122664E210518"><enum>(v)</enum><text>the provision to
				an individual in relation to individual health insurance coverage of loss
				control and claims administration for a health insurance issuer with respect to
				liability for which the issuer provides insurance.</text>
										</clause></subparagraph><subparagraph id="H71E014AD26E84BF9B4D0C19BC66092CC"><enum>(B)</enum><header>Exception</header><text>Such
				term does not include any law, rule, regulation, agreement, or order governing
				the use of care or cost management techniques, including any requirement
				related to provider contracting, network access or adequacy, health care data
				collection, or quality assurance.</text>
									</subparagraph></paragraph><paragraph id="HF24901C2C8EF4DCAA3BAEEE4E37CDB17"><enum>(8)</enum><header>State</header><text>The
				term <term>State</term> means the 50 States and includes the District of
				Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the
				Northern Mariana Islands.</text>
								</paragraph><paragraph id="H8FC8B0829F544A2184B6EEF5CEEB857"><enum>(9)</enum><header>Unfair claims
				settlement practices</header><text>The term <term>unfair claims settlement
				practices</term> means only the following practices:</text>
									<subparagraph id="H7992C830C825437B8611A410E2258FE"><enum>(A)</enum><text>Knowingly
				misrepresenting to claimants and insured individuals relevant facts or policy
				provisions relating to coverage at issue.</text>
									</subparagraph><subparagraph id="H666A1CD443D3438C8600DDE3BF7DE2C0"><enum>(B)</enum><text>Failing to
				acknowledge with reasonable promptness pertinent communications with respect to
				claims arising under policies.</text>
									</subparagraph><subparagraph id="H94D31B6A44DE4E4DBE66E9EEC938C99C"><enum>(C)</enum><text>Failing to adopt
				and implement reasonable standards for the prompt investigation and settlement
				of claims arising under policies.</text>
									</subparagraph><subparagraph id="HC06DCD92E2AB4BE89C96EDB69BFD60CE"><enum>(D)</enum><text>Failing to
				effectuate prompt, fair, and equitable settlement of claims submitted in which
				liability has become reasonably clear.</text>
									</subparagraph><subparagraph id="H2FAE062E10D84568BBFC68E58F38BE5C"><enum>(E)</enum><text>Refusing to pay
				claims without conducting a reasonable investigation.</text>
									</subparagraph><subparagraph id="H18F0F1E7EF734EB884CEAFF2296EFF1"><enum>(F)</enum><text>Failing to affirm
				or deny coverage of claims within a reasonable period of time after having
				completed an investigation related to those claims.</text>
									</subparagraph><subparagraph id="H26C4E70191374341B88ED718FDE480ED"><enum>(G)</enum><text>A pattern or
				practice of compelling insured individuals or their beneficiaries to institute
				suits to recover amounts due under its policies by offering substantially less
				than the amounts ultimately recovered in suits brought by them.</text>
									</subparagraph><subparagraph id="H2AF7EB56941E46F48DEFD7D28A401A9"><enum>(H)</enum><text>A pattern or
				practice of attempting to settle or settling claims for less than the amount
				that a reasonable person would believe the insured individual or his or her
				beneficiary was entitled by reference to written or printed advertising
				material accompanying or made part of an application.</text>
									</subparagraph><subparagraph id="HB34614D368A84E4988B800B51600BD48"><enum>(I)</enum><text>Attempting to
				settle or settling claims on the basis of an application that was materially
				altered without notice to, or knowledge or consent of, the insured.</text>
									</subparagraph><subparagraph id="HA94F38AAF8F54FC3A0C694E0D5C83F01"><enum>(J)</enum><text>Failing to provide
				forms necessary to present claims within 15 calendar days of a requests with
				reasonable explanations regarding their use.</text>
									</subparagraph><subparagraph id="HA41ABA8A11FF4D92BBE4AA2D6C8F8C2C"><enum>(K)</enum><text>Attempting to
				cancel a policy in less time than that prescribed in the policy or by the law
				of the primary State.</text>
									</subparagraph></paragraph><paragraph id="HF17AD12A54D04A86AFEAFF001D4D257F"><enum>(10)</enum><header>Fraud and
				abuse</header><text>The term <term>fraud and abuse</term> means an act or
				omission committed by a person who, knowingly and with intent to defraud,
				commits, or conceals any material information concerning, one or more of the
				following:</text>
									<subparagraph id="HCBC54A030ABD4CAB8C718200EF32F7ED"><enum>(A)</enum><text>Presenting,
				causing to be presented or preparing with knowledge or belief that it will be
				presented to or by an insurer, a reinsurer, broker or its agent, false
				information as part of, in support of or concerning a fact material to one or
				more of the following:</text>
										<clause id="H7D268024B1F74394AAA0CDDD8F912A3"><enum>(i)</enum><text>An
				application for the issuance or renewal of an insurance policy or reinsurance
				contract.</text>
										</clause><clause id="HE17B5DA92F1842F99BA8F8EA857377F6"><enum>(ii)</enum><text>The rating of an
				insurance policy or reinsurance contract.</text>
										</clause><clause id="H95030A3FBB124439AFE4509E0091616E"><enum>(iii)</enum><text>A claim for
				payment or benefit pursuant to an insurance policy or reinsurance
				contract.</text>
										</clause><clause id="H48B24B1DC2E844FB9800557B31F1A1F9"><enum>(iv)</enum><text>Premiums paid on
				an insurance policy or reinsurance contract.</text>
										</clause><clause id="HDB06D7BEABB746BF885CD138177397FC"><enum>(v)</enum><text>Payments made in
				accordance with the terms of an insurance policy or reinsurance
				contract.</text>
										</clause><clause id="H6A82D200AC3840DF8CA75E40034CBBA5"><enum>(vi)</enum><text>A
				document filed with the commissioner or the chief insurance regulatory official
				of another jurisdiction.</text>
										</clause><clause id="HB20C52CA63F341C6A772EF008626B100"><enum>(vii)</enum><text>The financial
				condition of an insurer or reinsurer.</text>
										</clause><clause id="H6407E3BEDD804DC5BC5CDFBFBAE2239"><enum>(viii)</enum><text>The formation,
				acquisition, merger, reconsolidation, dissolution or withdrawal from one or
				more lines of insurance or reinsurance in all or part of a State by an insurer
				or reinsurer.</text>
										</clause><clause id="H7BFB5BA309EF4A1FAFAD5CBB531EF480"><enum>(ix)</enum><text>The issuance of
				written evidence of insurance.</text>
										</clause><clause id="H1246C16775E9406094DC5D852EF8AA05"><enum>(x)</enum><text>The reinstatement
				of an insurance policy.</text>
										</clause></subparagraph><subparagraph id="HF213B98D75E3487C971B32C099D1D75"><enum>(B)</enum><text>Solicitation or
				acceptance of new or renewal insurance risks on behalf of an insurer reinsurer
				or other person engaged in the business of insurance by a person who knows or
				should know that the insurer or other person responsible for the risk is
				insolvent at the time of the transaction.</text>
									</subparagraph><subparagraph id="HFE1ED4DFFD4C4C03AF75BF3909782598"><enum>(C)</enum><text>Transaction of the
				business of insurance in violation of laws requiring a license, certificate of
				authority or other legal authority for the transaction of the business of
				insurance.</text>
									</subparagraph><subparagraph id="H2E5FBE9DD1AA4AF1BE11C086C324B258"><enum>(D)</enum><text>Attempt to commit,
				aiding or abetting in the commission of, or conspiracy to commit the acts or
				omissions specified in this paragraph.</text>
									</subparagraph></paragraph></section><section id="H6A16289D6B2A4C7B9200B385B74DB2D7"><enum>2796.</enum>
								<header>Application of
		  law</header>
								<subsection id="H7405B641DEF84431A668F7CB3100495C"><enum>(a)</enum><header>In
				general</header><text display-inline="yes-display-inline">The covered laws of
				the primary State shall apply to individual health insurance coverage offered
				by a health insurance issuer in the primary State and in any secondary State,
				but only if the coverage and issuer comply with the conditions of this section
				with respect to the offering of coverage in any secondary State.</text>
								</subsection><subsection id="H720E8FF69F394144858175EE2DE24093"><enum>(b)</enum><header>Exemptions from
				covered laws in a secondary state</header><text>Except as provided in this
				section, a health insurance issuer with respect to its offer, sale, rating
				(including medical underwriting), renewal, and issuance of individual health
				insurance coverage in any secondary State is exempt from any covered laws of
				the secondary State (and any rules, regulations, agreements, or orders sought
				or issued by such State under or related to such covered laws) to the extent
				that such laws would—</text>
									<paragraph id="HA736ACAC27C34FD7B9A8F8DE5E509C54"><enum>(1)</enum><text>make unlawful, or
				regulate, directly or indirectly, the operation of the health insurance issuer
				operating in the secondary State, except that any secondary State may require
				such an issuer—</text>
										<subparagraph id="H1A75451C378B493FB98DF7AAC5CC786C"><enum>(A)</enum><text>to pay, on a
				nondiscriminatory basis, applicable premium and other taxes (including high
				risk pool assessments) which are levied on insurers and surplus lines insurers,
				brokers, or policyholders under the laws of the State;</text>
										</subparagraph><subparagraph id="H62CA8603310746D58636B59025905BF7"><enum>(B)</enum><text>to register with
				and designate the State insurance commissioner as its agent solely for the
				purpose of receiving service of legal documents or process;</text>
										</subparagraph><subparagraph id="HB20E45BA14184C6787189E755F398407"><enum>(C)</enum><text>to submit to an
				examination of its financial condition by the State insurance commissioner in
				any State in which the issuer is doing business to determine the issuer’s
				financial condition, if—</text>
											<clause id="HE66A2DAEB0DB493D861D05DF480230A2"><enum>(i)</enum><text>the State
				insurance commissioner of the primary State has not done an examination within
				the period recommended by the National Association of Insurance Commissioners;
				and</text>
											</clause><clause id="H0337B3AC4F924C48822EEFA43F72CC4"><enum>(ii)</enum><text>any such
				examination is conducted in accordance with the examiners’ handbook of the
				National Association of Insurance Commissioners and is coordinated to avoid
				unjustified duplication and unjustified repetition;</text>
											</clause></subparagraph><subparagraph id="H79955CCB2BDD4B1085F00CCA9BD0EA"><enum>(D)</enum><text>to comply with a
				lawful order issued—</text>
											<clause id="H4D6ACEE577654FAD8E48B7C092F73B90"><enum>(i)</enum><text>in
				a delinquency proceeding commenced by the State insurance commissioner if there
				has been a finding of financial impairment under subparagraph (C); or</text>
											</clause><clause id="H4E3AE1BA7D314A7A882104DBA4DEA0E9"><enum>(ii)</enum><text>in a voluntary
				dissolution proceeding;</text>
											</clause></subparagraph><subparagraph id="H70F3278166D24D878CE071766EA49D61"><enum>(E)</enum><text>to comply with an
				injunction issued by a court of competent jurisdiction, upon a petition by the
				State insurance commissioner alleging that the issuer is in hazardous financial
				condition;</text>
										</subparagraph><subparagraph id="H6A14902ECD924E11A4F497E1DE48F252"><enum>(F)</enum><text>to participate, on
				a nondiscriminatory basis, in any insurance insolvency guaranty association or
				similar association to which a health insurance issuer in the State is required
				to belong;</text>
										</subparagraph><subparagraph id="HCE8BA0D06F69484EAD84868500F0FC15"><enum>(G)</enum><text>to comply with any
				State law regarding fraud and abuse (as defined in section 2795(10)), except
				that if the State seeks an injunction regarding the conduct described in this
				subparagraph, such injunction must be obtained from a court of competent
				jurisdiction;</text>
										</subparagraph><subparagraph id="HBB659C68F9534731AAA2585E498B6997"><enum>(H)</enum><text>to comply with any
				State law regarding unfair claims settlement practices (as defined in section
				2795(9)); or</text>
										</subparagraph><subparagraph id="H460C2515027045F49C6345F03064EDDC"><enum>(I)</enum><text>to comply with the
				applicable requirements for independent review under section 2798 with respect
				to coverage offered in the State;</text>
										</subparagraph></paragraph><paragraph id="H3958C45DCF9040438CA8F4C64F2C481F"><enum>(2)</enum><text>require any
				individual health insurance coverage issued by the issuer to be countersigned
				by an insurance agent or broker residing in that Secondary State; or</text>
									</paragraph><paragraph id="H29539621779C406C800318D3E95E0600"><enum>(3)</enum><text>otherwise
				discriminate against the issuer issuing insurance in both the primary State and
				in any secondary State.</text>
									</paragraph></subsection><subsection id="H223B1A0C52424F418BE9A6C365189829"><enum>(c)</enum><header>Clear and
				conspicuous disclosure</header><text>A health insurance issuer shall provide
				the following notice, in 12-point bold type, in any insurance coverage offered
				in a secondary State under this part by such a health insurance issuer and at
				renewal of the policy, with the 5 blank spaces therein being appropriately
				filled with the name of the health insurance issuer, the name of primary State,
				the name of the secondary State, the name of the secondary State, and the name
				of the secondary State, respectively, for the coverage concerned:
				<quote>Notice: This policy is issued by ____________ and is governed by the
				laws and regulations of the State of ____________, and it has met all the laws
				of that State as determined by that State's Department of Insurance. This
				policy may be less expensive than others because it is not subject to all of
				the insurance laws and regulations of the State of ____________, including
				coverage of some services or benefits mandated by the law of the State of
				____________. Additionally, this policy is not subject to all of the consumer
				protection laws or restrictions on rate changes of the State of ____________.
				As with all insurance products, before purchasing this policy, you should
				carefully review the policy and determine what health care services the policy
				covers and what benefits it provides, including any exclusions, limitations, or
				conditions for such services or benefits.</quote></text>
								</subsection><subsection id="HA7AAD32815184908B75CF809A4708D"><enum>(d)</enum><header>Prohibition on
				certain reclassifications and premium increases</header>
									<paragraph id="HA81B133CAAFA4565927810AA779645EA"><enum>(1)</enum><header>In
				general</header><text>For purposes of this section, a health insurance issuer
				that provides individual health insurance coverage to an individual under this
				part in a primary or secondary State may not upon renewal—</text>
										<subparagraph id="H357B93383A464FFFB2B7D6E1A8B767D"><enum>(A)</enum><text>move or reclassify
				the individual insured under the health insurance coverage from the class such
				individual is in at the time of issue of the contract based on the
				health-status related factors of the individual; or</text>
										</subparagraph><subparagraph id="HDE1A14E2E5EA42599D14EB8C1EAC9705"><enum>(B)</enum><text>increase the
				premiums assessed the individual for such coverage based on a health
				status-related factor or change of a health status-related factor or the past
				or prospective claim experience of the insured individual.</text>
										</subparagraph></paragraph><paragraph id="H134F361D195C41D2AC8400CA7EE21ED7"><enum>(2)</enum><header>Construction</header><text>Nothing
				in paragraph (1) shall be construed to prohibit a health insurance
				issuer—</text>
										<subparagraph id="H082839783AAE4E9E811562D2FC910F3"><enum>(A)</enum><text>from terminating or
				discontinuing coverage or a class of coverage in accordance with subsections
				(b) and (c) of section 2742;</text>
										</subparagraph><subparagraph id="H972BBA3DB9BB4B3A94EA6CD469003221"><enum>(B)</enum><text>from raising
				premium rates for all policy holders within a class based on claims
				experience;</text>
										</subparagraph><subparagraph id="H56B76C9224FB4B328B43CC4446505158"><enum>(C)</enum><text>from changing
				premiums or offering discounted premiums to individuals who engage in wellness
				activities at intervals prescribed by the issuer, if such premium changes or
				incentives—</text>
											<clause id="HD0EDB5DD83DC455182BF96EB95F2E000"><enum>(i)</enum><text>are disclosed to
				the consumer in the insurance contract;</text>
											</clause><clause id="HAE6F4BE9EDF54C7686D71CC3FB21FF9E"><enum>(ii)</enum><text>are based on
				specific wellness activities that are not applicable to all individuals;
				and</text>
											</clause><clause id="H56F0ED6BE2B640F19E724BE092EF19B0"><enum>(iii)</enum><text>are not
				obtainable by all individuals to whom coverage is offered;</text>
											</clause></subparagraph><subparagraph id="H2CB7839178A64D6C97C2F8DDC54D000"><enum>(D)</enum><text>from reinstating
				lapsed coverage; or</text>
										</subparagraph><subparagraph id="HBBF16E85FAD3490994502449A985AAC6"><enum>(E)</enum><text>from retroactively
				adjusting the rates charged an insured individual if the initial rates were set
				based on material misrepresentation by the individual at the time of
				issue.</text>
										</subparagraph></paragraph></subsection><subsection id="HBE0D1FB168AC4113A815FE9E7E8CFE2F"><enum>(e)</enum><header>Prior offering
				of policy in primary state</header><text>A health insurance issuer may not
				offer for sale individual health insurance coverage in a secondary State unless
				that coverage is currently offered for sale in the primary State.</text>
								</subsection><subsection id="H073B6FC696234440A13D8393E45D72C4"><enum>(f)</enum><header>Licensing of
				agents or brokers for health insurance issuers</header><text>Any State may
				require that a person acting, or offering to act, as an agent or broker for a
				health insurance issuer with respect to the offering of individual health
				insurance coverage obtain a license from that State, with commissions or other
				compensation subject to the provisions of the laws of that State, except that a
				State may not impose any qualification or requirement which discriminates
				against a nonresident agent or broker.</text>
								</subsection><subsection id="HE1845C98BC0F405DA36D85DA6FC182CE"><enum>(g)</enum><header>Documents for
				submission to state insurance commissioner</header><text>Each health insurance
				issuer issuing individual health insurance coverage in both primary and
				secondary States shall submit—</text>
									<paragraph id="H91A47006810049EB8658486010764789"><enum>(1)</enum><text>to the insurance
				commissioner of each State in which it intends to offer such coverage, before
				it may offer individual health insurance coverage in such State—</text>
										<subparagraph id="H6DB6C059049348CCAC8BFC09DFE2E235"><enum>(A)</enum><text>a copy of the plan
				of operation or feasibility study or any similar statement of the policy being
				offered and its coverage (which shall include the name of its primary State and
				its principal place of business);</text>
										</subparagraph><subparagraph id="H858A728BC781426CA3FFAC6FC1E2ED00"><enum>(B)</enum><text>written notice of
				any change in its designation of its primary State; and</text>
										</subparagraph><subparagraph id="H5FB193576C2149159D9CF21FA5CB96AE"><enum>(C)</enum><text>written notice
				from the issuer of the issuer’s compliance with all the laws of the primary
				State; and</text>
										</subparagraph></paragraph><paragraph id="HA37A06D6A15E45A694D5DFF000D5499C"><enum>(2)</enum><text>to the insurance
				commissioner of each secondary State in which it offers individual health
				insurance coverage, a copy of the issuer’s quarterly financial statement
				submitted to the primary State, which statement shall be certified by an
				independent public accountant and contain a statement of opinion on loss and
				loss adjustment expense reserves made by—</text>
										<subparagraph id="H993CEB3F54414575B4A293A1B1385CA"><enum>(A)</enum><text>a member of the
				American Academy of Actuaries; or</text>
										</subparagraph><subparagraph id="H0BD87D8A236448C3AA9C0061C88B8B9"><enum>(B)</enum><text>a qualified loss
				reserve specialist.</text>
										</subparagraph></paragraph></subsection><subsection id="HF9858387BD6B461D8FFBD3B6BBA15111"><enum>(h)</enum><header>Power of courts
				To enjoin conduct</header><text>Nothing in this section shall be construed to
				affect the authority of any Federal or State court to enjoin—</text>
									<paragraph id="HA10B949C5FAC407380443B14DA7D1F1E"><enum>(1)</enum><text>the solicitation
				or sale of individual health insurance coverage by a health insurance issuer to
				any person or group who is not eligible for such insurance; or</text>
									</paragraph><paragraph id="HC3ACD4A9059B4FA7BC6962C71900F302"><enum>(2)</enum><text>the solicitation
				or sale of individual health insurance coverage that violates the requirements
				of the law of a secondary State which are described in subparagraphs (A)
				through (H) of section 2796(b)(1).</text>
									</paragraph></subsection><subsection id="H453509196C314D7C84003EC200C700B0"><enum>(i)</enum><header>Power of
				secondary states To take administrative action</header><text>Nothing in this
				section shall be construed to affect the authority of any State to enjoin
				conduct in violation of that State’s laws described in section
				2796(b)(1).</text>
								</subsection><subsection id="HF846927B966B4FB882BFB8A259697B29"><enum>(j)</enum><header>State powers To
				enforce state laws</header>
									<paragraph id="HB7DE6E27A9074BF9BD63BBEC91E81F16"><enum>(1)</enum><header>In
				general</header><text>Subject to the provisions of subsection (b)(1)(G)
				(relating to injunctions) and paragraph (2), nothing in this section shall be
				construed to affect the authority of any State to make use of any of its powers
				to enforce the laws of such State with respect to which a health insurance
				issuer is not exempt under subsection (b).</text>
									</paragraph><paragraph id="HBA9A9576EC924ADF9DE8695918EEBE1B"><enum>(2)</enum><header>Courts of
				competent jurisdiction</header><text>If a State seeks an injunction regarding
				the conduct described in paragraphs (1) and (2) of subsection (h), such
				injunction must be obtained from a Federal or State court of competent
				jurisdiction.</text>
									</paragraph></subsection><subsection id="HE3B3F2D391024A3B98148860692100C9"><enum>(k)</enum><header>States’
				authority To sue</header><text>Nothing in this section shall affect the
				authority of any State to bring action in any Federal or State court.</text>
								</subsection><subsection id="H815991F0C65649BCA2366F81EAE0096"><enum>(l)</enum><header>Generally
				applicable laws</header><text>Nothing in this section shall be construed to
				affect the applicability of State laws generally applicable to persons or
				corporations.</text>
								</subsection><subsection id="HB52B2C631A9C41AFBC7E4FF54F34CADD"><enum>(m)</enum><header>Guaranteed
				Availability of Coverage to HIPAA Eligible Individuals</header><text>To the
				extent that a health insurance issuer is offering coverage in a primary State
				that does not accommodate residents of secondary States or does not provide a
				working mechanism for residents of a secondary State, and the issuer is
				offering coverage under this part in such secondary State which has not adopted
				a qualified high risk pool as its acceptable alternative mechanism (as defined
				in section 2744(c)(2)), the issuer shall, with respect to any individual health
				insurance coverage offered in a secondary State under this part, comply with
				the guaranteed availability requirements for eligible individuals in section
				2741.</text>
								</subsection></section><section id="H530C891994A943ABB58D994059E61843"><enum>2797.</enum><header>Primary State must meet federal floor
		  before issuer may sell into secondary States</header><text display-inline="no-display-inline">A health insurance issuer may not offer,
				sell, or issue individual health insurance coverage in a secondary State if the
				State insurance commissioner does not use a risk-based capital formula for the
				determination of capital and surplus requirements for all health insurance
				issuers.</text>
							</section><section id="H03C59ABFBF7741C085016D93EF3905C9"><enum>2798.</enum>
								<header>Independent external appeals
		  procedures</header>
								<subsection id="H2345D59504414DD09CB54F9780AFFA62"><enum>(a)</enum><header>Right to
				external appeal</header><text>A health insurance issuer may not offer, sell, or
				issue individual health insurance coverage in a secondary State under the
				provisions of this title unless—</text>
									<paragraph id="HA2C2B5AF43D048A5A485F0A06300F347"><enum>(1)</enum><text>both the secondary
				State and the primary State have legislation or regulations in place
				establishing an independent review process for individuals who are covered by
				individual health insurance coverage, or</text>
									</paragraph><paragraph id="HF71CE8FD6559469B93A1C493C5EBC058"><enum>(2)</enum><text>in any case in
				which the requirements of subparagraph (A) are not met with respect to the
				either of such States, the issuer provides an independent review mechanism
				substantially identical (as determined by the applicable State authority of
				such State) to that prescribed in the <quote>Health Carrier External Review
				Model Act</quote> of the National Association of Insurance Commissioners for
				all individuals who purchase insurance coverage under the terms of this part,
				except that, under such mechanism, the review is conducted by an independent
				medical reviewer, or a panel of such reviewers, with respect to whom the
				requirements of subsection (b) are met.</text>
									</paragraph></subsection><subsection id="HE012D6E6958B4F3486D55EA3A6D59674"><enum>(b)</enum><header>Qualifications
				of independent medical reviewers</header><text>In the case of any independent
				review mechanism referred to in subsection (a)(2)—</text>
									<paragraph id="H335CADF15FE4402A954555004BDC9C14"><enum>(1)</enum><header>In
				general</header><text>In referring a denial of a claim to an independent
				medical reviewer, or to any panel of such reviewers, to conduct independent
				medical review, the issuer shall ensure that—</text>
										<subparagraph id="H38D3E0AD333C4BBB977F5CE8ED5FA075"><enum>(A)</enum><text>each independent
				medical reviewer meets the qualifications described in paragraphs (2) and
				(3);</text>
										</subparagraph><subparagraph id="H452D1A8012C54003804EFC1ED1BDC0E1"><enum>(B)</enum><text>with respect to
				each review, each reviewer meets the requirements of paragraph (4) and the
				reviewer, or at least 1 reviewer on the panel, meets the requirements described
				in paragraph (5); and</text>
										</subparagraph><subparagraph id="H90A655507DDD4FFCB94D5EB950780006"><enum>(C)</enum><text>compensation
				provided by the issuer to each reviewer is consistent with paragraph
				(6).</text>
										</subparagraph></paragraph><paragraph id="H2ECD753D5FAD4D01B9ACDBC1B4F5183"><enum>(2)</enum><header>Licensure and
				expertise</header><text>Each independent medical reviewer shall be a physician
				(allopathic or osteopathic) or health care professional who—</text>
										<subparagraph id="H2EEFAD7BBA4244948E92F8E1AA526B02"><enum>(A)</enum><text>is appropriately
				credentialed or licensed in 1 or more States to deliver health care services;
				and</text>
										</subparagraph><subparagraph id="H4F0B23DEA4C94FECA9D42ACBC155C00"><enum>(B)</enum><text>typically treats
				the condition, makes the diagnosis, or provides the type of treatment under
				review.</text>
										</subparagraph></paragraph><paragraph id="H973A9E1017FF4820AA931ED32B92B6F0"><enum>(3)</enum><header>Independence</header>
										<subparagraph id="H9F4A48024E47454682C99CD869724394"><enum>(A)</enum><header>In
				general</header><text>Subject to subparagraph (B), each independent medical
				reviewer in a case shall—</text>
											<clause id="HFC354316BF644CC0863E22CDA2DBD53"><enum>(i)</enum><text>not
				be a related party (as defined in paragraph (7));</text>
											</clause><clause id="HB337CD12D14549E28570F434ABC2733F"><enum>(ii)</enum><text>not have a
				material familial, financial, or professional relationship with such a party;
				and</text>
											</clause><clause id="H7F6EB49521F24F3CA4B700B3AF5D0086"><enum>(iii)</enum><text>not otherwise
				have a conflict of interest with such a party (as determined under
				regulations).</text>
											</clause></subparagraph><subparagraph id="HF9C2CF60C3604278A644E04E8084D6C5"><enum>(B)</enum><header>Exception</header><text>Nothing
				in subparagraph (A) shall be construed to—</text>
											<clause id="HCFCF9982FBB74923B458DD231812C672"><enum>(i)</enum><text>prohibit an
				individual, solely on the basis of affiliation with the issuer, from serving as
				an independent medical reviewer if—</text>
												<subclause id="HB363CE34E2734844B1047086A9262F02"><enum>(I)</enum><text>a non-affiliated
				individual is not reasonably available;</text>
												</subclause><subclause id="H5936608B6C35488CA6B0B3E53ECB641D"><enum>(II)</enum><text>the affiliated
				individual is not involved in the provision of items or services in the case
				under review;</text>
												</subclause><subclause id="H0A66686B0A064483A9EB07C4DD32C0B7"><enum>(III)</enum><text>the fact of such
				an affiliation is disclosed to the issuer and the enrollee (or authorized
				representative) and neither party objects; and</text>
												</subclause><subclause id="HE84026316B5B4F14AF1916139FED9C73"><enum>(IV)</enum><text>the affiliated
				individual is not an employee of the issuer and does not provide services
				exclusively or primarily to or on behalf of the issuer;</text>
												</subclause></clause><clause id="H58DC1D480A7D47A9A91FEAFBE83100C5"><enum>(ii)</enum><text>prohibit an
				individual who has staff privileges at the institution where the treatment
				involved takes place from serving as an independent medical reviewer merely on
				the basis of such affiliation if the affiliation is disclosed to the issuer and
				the enrollee (or authorized representative), and neither party objects;
				or</text>
											</clause><clause id="H4687354C2AE84A639DFBE1E7685690E4"><enum>(iii)</enum><text>prohibit receipt
				of compensation by an independent medical reviewer from an entity if the
				compensation is provided consistent with paragraph (6).</text>
											</clause></subparagraph></paragraph><paragraph id="H55B8CFF4C2FD4C91A18C66B53CA334D"><enum>(4)</enum><header>Practicing health
				care professional in same field</header>
										<subparagraph id="H99F6CE9456D94E3AB860AD005F92E070"><enum>(A)</enum><header>In
				general</header><text>In a case involving treatment, or the provision of items
				or services—</text>
											<clause id="H48EC8B04577C4E0A899D7FE5BE42200"><enum>(i)</enum><text>by
				a physician, a reviewer shall be a practicing physician (allopathic or
				osteopathic) of the same or similar specialty, as a physician who, acting
				within the appropriate scope of practice within the State in which the service
				is provided or rendered, typically treats the condition, makes the diagnosis,
				or provides the type of treatment under review; or</text>
											</clause><clause id="H732AEA94F978436987BBA77F93DBE900"><enum>(ii)</enum><text>by a
				non-physician health care professional, the reviewer, or at least 1 member of
				the review panel, shall be a practicing non-physician health care professional
				of the same or similar specialty as the non-physician health care professional
				who, acting within the appropriate scope of practice within the State in which
				the service is provided or rendered, typically treats the condition, makes the
				diagnosis, or provides the type of treatment under review.</text>
											</clause></subparagraph><subparagraph id="H6EE6735D31DA4481ADE6C0FA30B73160"><enum>(B)</enum><header>Practicing
				defined</header><text>For purposes of this paragraph, the term
				<term>practicing</term> means, with respect to an individual who is a physician
				or other health care professional, that the individual provides health care
				services to individual patients on average at least 2 days per week.</text>
										</subparagraph></paragraph><paragraph id="H7D22F751C1554E3FBB9E5F770013CF02"><enum>(5)</enum><header>Pediatric
				expertise</header><text>In the case of an external review relating to a child,
				a reviewer shall have expertise under paragraph (2) in pediatrics.</text>
									</paragraph><paragraph id="HA6D5B040E63E4DAC82415400788F987E"><enum>(6)</enum><header>Limitations on
				reviewer compensation</header><text>Compensation provided by the issuer to an
				independent medical reviewer in connection with a review under this section
				shall—</text>
										<subparagraph id="H4CD89DE72599413A9512A0887E7DC6BA"><enum>(A)</enum><text>not exceed a
				reasonable level; and</text>
										</subparagraph><subparagraph id="H48A0A37CD915419CA6D7D288D1CEEAFB"><enum>(B)</enum><text>not be contingent
				on the decision rendered by the reviewer.</text>
										</subparagraph></paragraph><paragraph id="H3CBD26D2277E42A49C3F823F00EEA43C"><enum>(7)</enum><header>Related party
				defined</header><text>For purposes of this section, the term <term>related
				party</term> means, with respect to a denial of a claim under a coverage
				relating to an enrollee, any of the following:</text>
										<subparagraph id="HC2AC7E4B468D4CCEBCE5E61900B003A9"><enum>(A)</enum><text>The issuer
				involved, or any fiduciary, officer, director, or employee of the
				issuer.</text>
										</subparagraph><subparagraph id="HC08A6BE4404A4F6A80F7A536E420346E"><enum>(B)</enum><text>The enrollee (or
				authorized representative).</text>
										</subparagraph><subparagraph id="H82BE0BC9B07B4402B3A3408924A3574E"><enum>(C)</enum><text>The health care
				professional that provides the items or services involved in the denial.</text>
										</subparagraph><subparagraph id="H103A23C06767462C003EA5FD19119FC1"><enum>(D)</enum><text>The institution at
				which the items or services (or treatment) involved in the denial are
				provided.</text>
										</subparagraph><subparagraph id="HC890B18C3FCD481D988F5223ED085475"><enum>(E)</enum><text>The manufacturer
				of any drug or other item that is included in the items or services involved in
				the denial.</text>
										</subparagraph><subparagraph id="HC942B35461BF4870B606C138DF726EFB"><enum>(F)</enum><text>Any other party
				determined under any regulations to have a substantial interest in the denial
				involved.</text>
										</subparagraph></paragraph><paragraph id="H7CBDDE25AC3243739ED114D670A98879"><enum>(8)</enum><header>Definitions</header><text>For
				purposes of this subsection:</text>
										<subparagraph id="HAB93C9C4D88846BDB57F8B40BBDB0235"><enum>(A)</enum><header>Enrollee</header><text>The
				term <term>enrollee</term> means, with respect to health insurance coverage
				offered by a health insurance issuer, an individual enrolled with the issuer to
				receive such coverage.</text>
										</subparagraph><subparagraph id="H276D6304FB8E40F5A9723300B9F9ABBC"><enum>(B)</enum><header>Health care
				professional</header><text>The term <term>health care professional</term> means
				an individual who is licensed, accredited, or certified under State law to
				provide specified health care services and who is operating within the scope of
				such licensure, accreditation, or certification.</text>
										</subparagraph></paragraph></subsection></section><section id="H94C6D8245F6F4A8CA51E29F5CAC87450"><enum>2799.</enum>
								<header>Enforcement</header>
								<subsection id="H4BE2856139BA4BF99FD21E532E460000"><enum>(a)</enum><header>In
				general</header><text>Subject to subsection (b), with respect to specific
				individual health insurance coverage the primary State for such coverage has
				sole jurisdiction to enforce the primary State’s covered laws in the primary
				State and any secondary State.</text>
								</subsection><subsection id="HF421DB8AB1B948649B7BA223970412DE"><enum>(b)</enum><header>Secondary
				state’s authority</header><text>Nothing in subsection (a) shall be construed to
				affect the authority of a secondary State to enforce its laws as set forth in
				the exception specified in section 2796(b)(1).</text>
								</subsection><subsection id="HEEE7814E47E04D14A7E4E6027729B628"><enum>(c)</enum><header>Court
				interpretation</header><text>In reviewing action initiated by the applicable
				secondary State authority, the court of competent jurisdiction shall apply the
				covered laws of the primary State.</text>
								</subsection><subsection id="H18A466C812994A5BB41D63FD841E1C"><enum>(d)</enum><header>Notice of
				compliance failure</header><text>In the case of individual health insurance
				coverage offered in a secondary State that fails to comply with the covered
				laws of the primary State, the applicable State authority of the secondary
				State may notify the applicable State authority of the primary
				State.</text>
								</subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H6735C3A73F3D4F1C99F8B1E9ADD3C600"><enum>(b)</enum><header>Effective
			 date</header><text>The amendment made by subsection (a) shall apply to
			 individual health insurance coverage offered, issued, or sold after the date
			 that is one year after the date of the enactment of this Act.</text>
				</subsection><subsection id="HC3EB04FCCC4E499E9097EA6EF39F822E"><enum>(c)</enum><header>GAO Ongoing
			 Study and Reports</header>
					<paragraph id="HCFE226FD44F94B40AEFE6DE33CA0452C"><enum>(1)</enum><header>Study</header><text>The
			 Comptroller General of the United States shall conduct an ongoing study
			 concerning the effect of the amendment made by subsection (a) on—</text>
						<subparagraph id="H70CBE91DA08F427FB0113DB1F604FE32"><enum>(A)</enum><text>the number of
			 uninsured and under-insured;</text>
						</subparagraph><subparagraph id="HA160196705024B88BB20E9003471DCC3"><enum>(B)</enum><text>the availability
			 and cost of health insurance policies for individuals with pre-existing medical
			 conditions;</text>
						</subparagraph><subparagraph id="H54EDC78480DE47BF89005BB5FD00CBC"><enum>(C)</enum><text>the availability
			 and cost of health insurance policies generally;</text>
						</subparagraph><subparagraph id="H194CA9E153874A0EA5F115A33D0419FA"><enum>(D)</enum><text>the elimination or
			 reduction of different types of benefits under health insurance policies
			 offered in different States; and</text>
						</subparagraph><subparagraph id="H68FB890CA716442FA4F5758ECEB300B8"><enum>(E)</enum><text>cases of fraud or
			 abuse relating to health insurance coverage offered under such amendment and
			 the resolution of such cases.</text>
						</subparagraph></paragraph><paragraph id="H26D9DF3A603744D1A7BFA4F7BB097883"><enum>(2)</enum><header>Annual
			 reports</header><text>The Comptroller General shall submit to Congress an
			 annual report, after the end of each of the 5 years following the effective
			 date of the amendment made by subsection (a), on the ongoing study conducted
			 under paragraph (1).</text>
					</paragraph></subsection></section><section id="HD3C08F9677A64C01BE6FF8179B68AC09"><enum>302.</enum><header>Severability</header><text display-inline="no-display-inline">If any provision of the Act or the
			 application of such provision to any person or circumstance is held to be
			 unconstitutional, the remainder of this Act and the application of the
			 provisions of such to any other person or circumstance shall not be
			 affected.</text>
			</section></title><title id="HD51FB617730641FFA45410AE00EE23F9"><enum>IV</enum><header>EXPANSION OF
			 HEALTH SAVINGS ACCOUNTS</header>
			<subtitle id="H5AE7111A28EA480D8300D33FB667C8E6"><enum>A</enum><header>Promoting Health
			 for Future Generations</header>
				<section id="H67A1604A0E8649D8A67E10D77515C513" section-type="subsequent-section"><enum>401.</enum><header>Short
			 title</header><text display-inline="no-display-inline">This subtitle may be
			 cited as the <quote>Promoting Health for Future Generations Act of
			 2008</quote>.</text>
				</section><section display-inline="no-display-inline" id="HC21FBC3237C8425499F7BA11FE328630"><enum>402.</enum><header>Increase in HSA
			 contribution limitation</header>
					<subsection id="H5313F6AA912A4FDFB7BF62F54C1DE000"><enum>(a)</enum><header>In
			 general</header><text>Subsection (b) of section 223 of the Internal Revenue
			 Code of 1986 (relating to monthly limitation) is amended—</text>
						<paragraph id="H47C689AF169240D6837F61FE8B9700F7"><enum>(1)</enum><text>by striking
			 <quote>$2,250</quote> in paragraph (2)(A) and inserting <quote>the amount in
			 effect under subsection (c)(2)(A)(ii)(I)</quote>, and</text>
						</paragraph><paragraph id="H7B608D57409345F992A403391EE4BEA"><enum>(2)</enum><text>by
			 striking <quote>$4,500</quote> in paragraph (2)(B) and inserting <quote>the
			 amount in effect under subsection (c)(2)(A)(ii)(II)</quote>.</text>
						</paragraph></subsection><subsection id="HF8DDF9ACDE1A42EBAE90601E7479D0A"><enum>(b)</enum><header>Conforming
			 amendment</header><text>Paragraph (1) of section 223(g) of such Code is amended
			 by striking <quote>subsections (b)(2)</quote> and inserting
			 <quote>subsection</quote>.</text>
					</subsection><subsection id="H8CC26FCB35F74334BA009EE0DEF68BD"><enum>(c)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to
			 contributions in taxable years beginning after December 31, 2008.</text>
					</subsection></section><section id="H258B1CBE10EC4733B1374E27F7F4ADE2"><enum>403.</enum><header>Medicare and VA
			 healthcare enrollees eligible to contribute to HSA</header>
					<subsection id="H489E66F1C4294ED6876F6CDEA36D071"><enum>(a)</enum><header>In
			 general</header><paragraph commented="no" display-inline="yes-display-inline" id="H62E325EFDF394EB9AEFB4C1B00731FE7"><enum>(1)</enum><text>Subsection (b) of
			 <external-xref legal-doc="usc" parsable-cite="usc/26/223">section 223</external-xref> of the Internal Revenue Code of 1986 is amended by striking
			 paragraph (7).</text>
						</paragraph><paragraph id="HD075132CC32D4FA08BC56D90B5964900" indent="up1"><enum>(2)</enum><text>Subsection (c) of section 223 of such
			 Code (relating to definitions and special rules) is amended by adding at the
			 end to following new paragraph:</text>
							<quoted-block display-inline="no-display-inline" id="HD407D296495C41638F971D21E0E77C9C" style="OLC">
								<paragraph id="H0164B1E3EA684BF680E0F4E644ED3309"><enum>(6)</enum><header>Special rule for
				individuals entitled to benefits under Medicare or enrolled for health benefits
				from VA</header><text>In the case of an individual—</text>
									<subparagraph id="HD0339C419F3348F181DB7748C254528B"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="H3F3805810FA640F6BD1E0519DBFCF2F"><enum>(i)</enum><text>who is entitled to
				benefits under title XVIII of the Social Security Act, and</text>
										</clause><clause id="HB29FDCCA734048799DC76E4F1F2D5913" indent="up1"><enum>(ii)</enum><text>with respect to whom a health
				savings account is established in a month before the first month such
				individual is entitled to such benefits, or</text>
										</clause></subparagraph><subparagraph id="HC6DD4A0102054A5C9064C37121963029"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="H8A2F2837476D4ADFB41466441CA8C992"><enum>(i)</enum><text>who is enrolled in the
				patient enrollment system established by the Secretary of Veterans Affairs
				pursuant to <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705</external-xref> of title 38, United States Code, and</text>
										</clause><clause id="H27CF3BAF24FA4B449743CEA615B7A782" indent="up1"><enum>(ii)</enum><text>with respect to whom a health
				savings account is established in a month before the first month such
				individual is enrolled in such system,</text>
										</clause></subparagraph><continuation-text continuation-text-level="paragraph">such
				individual shall be deemed to be an eligible
				individual.</continuation-text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</paragraph></subsection><subsection id="H4B11130D2DDC4894AD2F38C31229AF19"><enum>(b)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section commented="no" id="H1FBC19639D6344AAA9BD8DF1999F0001"><enum>404.</enum><header>Expanding
			 additional contributions limitation</header>
					<subsection id="H7EB4835F007748F39204961EA82EDF27"><enum>(a)</enum><header>In
			 general</header>
						<paragraph id="H94EAAA73D8514BD7A58346E40375371B"><enum>(1)</enum><header>Age
			 limitation</header><text>Subparagraph (A) of section 223(b)(3) of the Internal
			 Revenue Code of 1986 (relating to additional contributions for individuals 55
			 or older) is amended by striking <quote>age 55</quote> and inserting <quote>age
			 50</quote>.</text>
						</paragraph><paragraph id="H9C6B263BE8F2402E88B4D471335761FB"><enum>(2)</enum><header>Contribution
			 limitation</header><text>The table contained in section 223(b)(3) of such Code
			 is amended by striking <quote>$1,000</quote> and inserting
			 <quote>$2,000</quote>.</text>
						</paragraph><paragraph id="HEAE2C90C4DBF42E5A1495C0592DD555B"><enum>(3)</enum><header>Conforming
			 amendment</header><text>Paragraph (3) of section 223(b) of such Code is amended
			 in the heading by striking <quote><header-in-text level="paragraph" style="OLC">55</header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">50</header-in-text></quote>.</text>
						</paragraph></subsection><subsection commented="no" id="H8A501C5175DF4485BE00AAD7F0016BA4"><enum>(b)</enum><header>Effective
			 date</header><text>The amendment made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section id="H7B426D3F78A64571B203EDB9C8B8F9CA"><enum>405.</enum><header>Eligibility to
			 contribute to HSA</header>
					<subsection id="H0432F6A6F04C41C09F3F9B909DC693F8"><enum>(a)</enum><header>Individuals
			 eligible for reimbursement under spouse’s flexible spending
			 arrangement</header><text display-inline="yes-display-inline">Section 223(c)(1)
			 of the Internal Revenue Code of 1986 (defining eligible individual) is amended
			 by adding at the end the following new subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="H0ACD2232663D424788513E7D7FA4F39C" style="OLC">
							<subparagraph id="H0696B73CC778433E84EE6DF143CA8959"><enum>(C)</enum><header>Special rule for
				certain flexible spending arrangements</header><text display-inline="yes-display-inline">For purposes of subparagraph (A)(ii), an
				individual shall not be treated as covered under a health plan described in
				such subparagraph merely because the individual is covered under a flexible
				spending arrangement (within the meaning of section 106(c)(2)) which is
				maintained by an employer of the spouse of the individual, but only if—</text>
								<clause id="H631C112CD5364A31AE5074ACDEAA2BC7"><enum>(i)</enum><text>the employer is
				not also the employer of the individual, and</text>
								</clause><clause id="H666433D744414C930021BD1A5367270"><enum>(ii)</enum><text>the individual
				certifies to the employer and to the Secretary (in such form and manner as the
				Secretary may prescribe) that the individual and the individual’s spouse will
				not accept reimbursement under the arrangement for any expenses for medical
				care provided to the
				individual.</text>
								</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="H3E0BA1E21B0141D08403B821F49B7CE"><enum>(b)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section id="H93E2C0A30D39491FB5CB99FC9983408D"><enum>406.</enum><header>Deduction of
			 premiums for high deductible health plans</header>
					<subsection id="H1CC27233B65F4E3096687D787984C4E5"><enum>(a)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Part VII of
			 subchapter B of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/26/1">chapter 1</external-xref> of the Internal Revenue Code of 1986 (relating to
			 additional itemized deductions for individuals) is amended by redesignating
			 section 224 as section 225 and by inserting after section 223 the following new
			 section:</text>
						<quoted-block display-inline="no-display-inline" id="H54628D49954F44BB82FFA5F7D16DF54E" style="OLC">
							<section id="HDFCC2E22A8274F688510C5991D545F48"><enum>224.</enum><header>Premiums for
				high deductible health plans</header>
								<subsection id="H482713E2ECDF445DB0C3F26483DC25AD"><enum>(a)</enum><header>Deduction
				allowed</header><text display-inline="yes-display-inline">In the case of an
				individual, there shall be allowed as a deduction for the taxable year the
				aggregate amount paid by the taxpayer as premiums under a high deductible
				health plan with respect to months during such year for which such individual
				is an eligible individual with respect to such health plan.</text>
								</subsection><subsection id="HB3A6044866D94DFBA36EEC5961D548FC"><enum>(b)</enum><header>Definitions</header><text display-inline="yes-display-inline">For purposes of this section—</text>
									<paragraph id="HF760F48C8F254B94B6D21E1D805DBDA3"><enum>(1)</enum><header>Eligible
				individual</header><text>The term <term>eligible individual</term> means an
				individual who—</text>
										<subparagraph id="H9730D11476D34611977BB7008869A23F"><enum>(A)</enum><text>is described in
				section 223(c)(1), and</text>
										</subparagraph><subparagraph id="H9807175A7C0646128B5CE7F4C9F7BC56"><enum>(B)</enum><text>is the taxpayer or
				the taxpayer's spouse and dependents.</text>
										</subparagraph></paragraph><paragraph id="H163743E37B044C5D8164C9B0F033EC61"><enum>(2)</enum><header>High deductible
				health plan</header><text>The term <term>high deductible health plan</term> has
				the meaning given such term by section 223(c)(2).</text>
									</paragraph></subsection><subsection id="H6DACC668BE67497B8515B942F1AD1CC8"><enum>(c)</enum><header>Special
				Rules</header>
									<paragraph id="H6412AFC23D934717BDE27960DDA14D"><enum>(1)</enum><header>Deduction
				limits</header>
										<subparagraph id="HD1FFF32B1F024E0A90DEABFB80672321"><enum>(A)</enum><header>Deduction
				allowable for only 1 plan</header><text>For purposes of this section, in the
				case of an individual covered by more than 1 high deductible health plan for
				any month, the individual may only take into account amounts paid for such
				month for the plan with the lowest premium.</text>
										</subparagraph><subparagraph id="H2E27DCFAC2834A3FAB11223D1060FD45"><enum>(B)</enum><header>Plans covering
				ineligible individuals</header><text>If 2 or more individuals are covered by a
				high deductible health plan for any month but only 1 of such individuals is an
				eligible individual for such month, only 50 percent of the aggregate amount
				paid by such eligible individual as premiums under the plan with respect to
				such month shall be taken into account for purposes of this section.</text>
										</subparagraph></paragraph><paragraph id="HBE9B7A579E8144209E353FACC2E2E31"><enum>(2)</enum><header>Group health plan
				coverage</header>
										<subparagraph id="HA756742373344D3AA0255CEF6F4D1F78"><enum>(A)</enum><header>In
				general</header><text>No deduction shall be allowed for an individual under
				subsection (a) for any amount paid for coverage under a high deductible health
				plan for a month if that individual participates in any coverage under a group
				health plan (within the meaning of section 5000 without regard to section
				5000(d)). For purposes of the preceding sentence, an arrangement which
				constitutes individual health insurance shall not be treated as a group health
				plan if such arrangement is a high deductible health plan (as defined in
				section 223(c)(2)), or is a payment by an employer or employee organization
				with respect to such high deductible health plan, notwithstanding that an
				employer or employee organization negotiates the cost or benefits of such
				arrangement.</text>
										</subparagraph><subparagraph id="HA25AB767FFC344D595946B3CFE8D83B5"><enum>(B)</enum><header>Exception for
				plans only providing contributions to health savings
				accounts</header><text>Subparagraph (A) shall not apply to an individual if the
				individual's only coverage under a group health plan for a month consists of
				contributions by an employer to a health savings account with respect to which
				the individual is the account beneficiary.</text>
										</subparagraph><subparagraph id="HDA69C3B18878474897B2C646CBEB724"><enum>(C)</enum><header>Exception for
				certain permitted coverage</header><text>Subparagraph (A) shall not apply to an
				individual if the individual's only coverage under a group health plan for a
				month is coverage described in clause (i) or (ii) of section
				223(c)(1)(B).</text>
										</subparagraph></paragraph><paragraph id="HC3605687DEF64ED9B7CCE93B7CA2E258"><enum>(3)</enum><header>Medical and
				health savings accounts</header><text>Subsection (a) shall not apply with
				respect to any amount which is paid or distributed out of an Archer MSA or a
				health savings account which is not included in gross income under section
				220(f) or 223(f), as the case may be.</text>
									</paragraph><paragraph id="H0180B7B24D024BDD9935E1CA37D716E2"><enum>(4)</enum><header>Coordination
				with deduction for health insurance of self-employed
				individuals</header><text>Any amount taken into account by the taxpayer in
				computing the deduction under section 162(l) shall not be taken into account
				under this section.</text>
									</paragraph><paragraph id="H470D48B94C53405496A1591F04C8D83F"><enum>(5)</enum><header>Coordination
				with medical expense deduction</header><text>Any amount taken into account by
				the taxpayer in computing the deduction under this section shall not be taken
				into account under section
				213.</text>
									</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="HB7201AB067EE4A4686ED8D5EC7FA918D"><enum>(b)</enum><header>Deduction
			 allowed whether or not individual itemizes other deductions</header><text display-inline="yes-display-inline">Subsection (a) of section 62 of such Code
			 is amended by inserting before the last sentence at the end the following new
			 paragraph:</text>
						<quoted-block display-inline="no-display-inline" id="HA6172AB879474A04A2833BBE1CF5F376" style="OLC">
							<paragraph id="H45D7FF58192C43208F56E76A9926437"><enum>(22)</enum><header>Premiums for
				high deductible health plans</header><text display-inline="yes-display-inline">The deduction allowed by section
				224.</text>
							</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="HAD42EFB258C84F49BA9767F2665D31D4"><enum>(c)</enum><header>Coordination
			 with section 35 health insurance costs credit</header><text display-inline="yes-display-inline">Section 35(g)(2) of such Code (relating to
			 coordination with other deductions) is amended by striking <quote>or
			 213</quote> and inserting <quote>, 213, or 224</quote>.</text>
					</subsection><subsection id="HCF0D7251BC74454FB13B447B22E580BD"><enum>(d)</enum><header>Clerical
			 amendment</header><text display-inline="yes-display-inline">The table of
			 sections for part VII of subchapter B of chapter 1 of such Code is amended by
			 redesignating the item relating to section 224 as an item relating to section
			 225 and by inserting before such item the following new item:</text>
						<quoted-block display-inline="no-display-inline" id="H6C01943F59174339A01370A86FACDD7" style="OLC">
							<toc regeneration="no-regeneration">
								<toc-entry level="section">Sec. 224. Premiums for high deductible
				health
				plans.</toc-entry>
							</toc>
							<after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="HB85D1748DD5D4A58ADB877B6A9A0306"><enum>(e)</enum><header>Effective
			 date</header><text display-inline="yes-display-inline">The amendments made by
			 this section shall apply to taxable years beginning after December 31,
			 2008.</text>
					</subsection></section><section display-inline="no-display-inline" id="H8623171A0EA34FEBB8DBA669B514D692" section-type="subsequent-section"><enum>407.</enum><header>MSA plan deductible
			 exception for preventive care</header>
					<subsection id="H10D66416D9C04273A0D698FCF3C24587"><enum>(a)</enum><header>In
			 general</header><text>Paragraph (3) of section 1859(b) of the Social Security
			 Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1359w-28">42 U.S.C. 1359w–28(b)</external-xref>) is amended by adding at the end the following new
			 subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="HB5624C08EC0042809873A82C0000671E" style="traditional">
							<subparagraph id="HAF0E4AB64F8E4FA3AD0900D4AE2D53E6"><enum>(C)</enum><header>Exception for
				absence of preventive care deductible</header><text>A plan shall not fail to be
				treated as a MSA plan by reason of failing to have a deductible for preventive
				care (within the meaning of such term as applied for purposes of section
				223(c)(2)(C) of the Internal Revenue Code of
				1986).</text>
							</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="H7A25B747282842CDBE4CFB7682A57CC7"><enum>(b)</enum><header>Effective
			 date</header><text>The amendment made by this section shall take effect on
			 January 1, 2009.</text>
					</subsection></section><section id="HD83E0AC18A5E4D9098CC721172D2B17"><enum>408.</enum><header>Permitting
			 individual contributions to Medicare Advantage MSA</header>
					<subsection id="H7921A8CBFD9F4E848DEEF8697E715EA7"><enum>(a)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Paragraph (2) of
			 <external-xref legal-doc="usc" parsable-cite="usc/26/138">section 138(b)</external-xref> of the Internal Revenue Code of 1986 (defining Medicare
			 Advantage MSA) is amended by striking <quote>or</quote> at the end of
			 subparagraph (A), by inserting <quote>or</quote> at the end of subparagraph
			 (B), and by adding at the end the following new subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="HDCF3D559D5AF486A950053571B526322" style="OLC">
							<subparagraph id="H1C9F8BB491CF488486967F02FE041FB9"><enum>(C)</enum><text>any contributions
				by or for the benefit of the account holder (other than a contribution
				described in subparagraph (A)) for the taxable year, the sum of which do not
				exceed the difference of—</text>
								<clause id="H414BB80B4D4E44EABAF2830078927981"><enum>(i)</enum><text display-inline="yes-display-inline">the amount of the annual deductible
				(described in section 1859(b)(3)(B) of the Social Security Act) for the MSA
				plan in which the individual is enrolled, over</text>
								</clause><clause id="HF3C460AE9AED40F7A7CEF060AD240000"><enum>(ii)</enum><text>the amount of
				contributions described in subparagraph (A) for the taxable
				year,</text>
								</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="H5BCEBC9C15CC4945AB67B34589BF8660"><enum>(b)</enum><header>Effective
			 date</header><text>The amendment made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section id="HBE5E998243A94985BB94827EB287632D"><enum>409.</enum><header>Allowing MSA
			 and HSA rollover to adult child of account holder</header>
					<subsection id="H7A277C62723645F4BFFADF59B3E0E1F2"><enum>(a)</enum><header>MSAs</header><paragraph commented="no" display-inline="yes-display-inline" id="H45E52DC2CF78426CA9ECC56900DAAB00"><enum>(1)</enum><text display-inline="yes-display-inline">Subparagraph (A) of section 220(f)(8) of
			 the Internal Revenue Code of 1986 (relating to treatment after death of account
			 holder) is amended—</text>
							<subparagraph id="H90D53EB0EFBF436894706EFBAF4E5E00" indent="up1"><enum>(A)</enum><text>by inserting <quote>or adult
			 child</quote> after <quote>surviving spouse</quote>,</text>
							</subparagraph><subparagraph id="H85DF66126D224E33B700407E65E1A51E" indent="up1"><enum>(B)</enum><text>by inserting <quote>or adult child, as
			 the case may be,</quote> after <quote>the spouse</quote>, and</text>
							</subparagraph><subparagraph id="H4745FF11A9F64325A91DF6DAA7CADAD" indent="up1"><enum>(C)</enum><text>by inserting <quote><header-in-text level="subparagraph" style="OLC">or adult child</header-in-text></quote> after
			 <quote><header-in-text level="subparagraph" style="OLC">spouse</header-in-text></quote> in the heading thereof.</text>
							</subparagraph></paragraph><paragraph id="H0F24BC26A26E41DA83DAAE09239D90B5" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">Paragraph (8) of section 220(f) of such
			 Code is amended by adding at the end the following new subparagraph:</text>
							<quoted-block display-inline="no-display-inline" id="H9FB1676823FF4DEC9C6C35F9DC9D078F" style="OLC">
								<subparagraph id="H5A0AB73CED25475DAE5202751D00511E"><enum>(C)</enum><header>Adult
				child</header><text>For purposes of this paragraph, the term <term>adult
				child</term> means an individual—</text>
									<clause id="H06AE449F1C134F1A81E4F51CBE77C39"><enum>(i)</enum><text>who
				is a child of the deceased individual, and</text>
									</clause><clause id="HD8F445E115B34C07AECA882DEB49833"><enum>(ii)</enum><text>with respect to
				whom a deduction under section 151 would not be allowable to another taxpayer
				for a taxable year beginning in the calendar year in which such individual’s
				taxable year
				begins.</text>
									</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</paragraph></subsection><subsection id="H7169EBD16295420D8222BF9FCA2D8506"><enum>(b)</enum><header>HSAs</header><paragraph commented="no" display-inline="yes-display-inline" id="H863EA28DB7024FAF92161055D112FD1D"><enum>(1)</enum><text display-inline="yes-display-inline">Subparagraph (A) of section 223(f)(8) of
			 such Code (relating to treatment after death of account beneficiary) is
			 amended—</text>
							<subparagraph id="H5131A4C39D534F649273FC8E21EBB88" indent="up1"><enum>(A)</enum><text>by inserting <quote>or adult
			 child</quote> after <quote>surviving spouse</quote>,</text>
							</subparagraph><subparagraph id="HE042BA3E966C45ADA5B8EDC0E2C7CD20" indent="up1"><enum>(B)</enum><text>by inserting <quote>or adult child, as
			 the case may be,</quote> after <quote>the spouse</quote>, and</text>
							</subparagraph><subparagraph id="H4593E47A08274233A01FDC95ECD4D687" indent="up1"><enum>(C)</enum><text>by inserting <quote><header-in-text level="subparagraph" style="OLC">or adult child</header-in-text></quote> after
			 <quote><header-in-text level="subparagraph" style="OLC">spouse</header-in-text></quote> in the heading thereof.</text>
							</subparagraph></paragraph><paragraph id="H67210A92F72D4F39BFA4979B8465FBB9" indent="up1"><enum>(2)</enum><text>Paragraph (8) of section 223(f) of
			 such Code is amended by adding at the end the following new
			 subparagraph:</text>
							<quoted-block display-inline="no-display-inline" id="HF6122633687F4B599089305C8435008E" style="OLC">
								<subparagraph id="HFCA003B752424699AA00DFF100CE8CBE"><enum>(C)</enum><header>Adult
				child</header><text>For purposes of this paragraph, the term <term>adult
				child</term> has the meaning given to such term by section
				220(f)(8)(C).</text>
								</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</paragraph></subsection><subsection id="HA1D2601952A5489D936FD41CA430E5C4"><enum>(c)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section id="H4EEC2DE887C34AA58DF0B119D4B724FA"><enum>410.</enum><header>Permitting
			 Medicare Advantage MSA funds to be used for wellness and fitness
			 programs</header>
					<subsection id="H1C77F957CB0146F089FA4B1939AF8793"><enum>(a)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Paragraph (1) of
			 <external-xref legal-doc="usc" parsable-cite="usc/26/138">section 138(c)</external-xref> of the Internal Revenue Code of 1986 (relating to special rules
			 for distributions) is amended by striking <quote>and</quote> at the end of
			 subparagraph (A), by striking the period at the end of subparagraph (B) and
			 inserting <quote>, and</quote>, and by adding at the end the following new
			 subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="H59A0A3D5FA6B47D7964CD7AA40A56EAD" style="OLC">
							<subparagraph id="H81CDED26636948FDB100AA594900022B"><enum>(C)</enum><text>qualified medical
				expenses shall include amounts paid to a gym for enrollment in a wellness or
				fitness
				program.</text>
							</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="HBFD3D332FD864366999B977BE0B40009"><enum>(b)</enum><header>Effective
			 date</header><text>The amendment made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section display-inline="no-display-inline" id="H18A4B02494F646CFA0FE9F14394029F0" section-type="subsequent-section"><enum>411.</enum><header>Health reimbursement
			 arrangements and spending arrangements in combination with health savings
			 accounts</header>
					<subsection id="HD1F4FFCE08144F9CA020845B92E68922"><enum>(a)</enum><header>In
			 general</header><text>Subparagraph (B) of section 223(c)(1) of the Internal
			 Revenue Code of 1986 (relating to certain coverage disregarded) is amended by
			 striking <quote>and</quote> at the end of clause (ii), by striking the period
			 at the end of clause (iii) and inserting <quote>, and</quote>, and by inserting
			 after clause (iii) the following new clause:</text>
						<quoted-block display-inline="no-display-inline" id="HFFB5A366992F443E94BA001B05BECA31" style="OLC">
							<clause id="H42804D9BB6C54523A3105D3CC4EB41FD"><enum>(iv)</enum><text display-inline="yes-display-inline">coverage under a flexible spending
				arrangement or a health reimbursement arrangement, or both, which meets the
				requirements of paragraph
				(7).</text>
							</clause><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="H863585B2C1DB4858B04B0008615EF403"><enum>(b)</enum><header>Combination
			 health reimbursement, savings, and spending
			 arrangements</header><text>Subsection (c) of section 223 of such Code (relating
			 to definitions and special rules), as amended by this Act, is amended by adding
			 at the end the following new paragraph:</text>
						<quoted-block display-inline="no-display-inline" id="HC05160CCB9934DA6B2AE06DB97C5450" style="OLC">
							<paragraph id="H87E816908C5A4EAC96E182CEE7005506"><enum>(7)</enum><header>Combined limit
				for contributions or credits to health reimbursement, arrangements and spending
				arrangements</header>
								<subparagraph id="HB6FAF25A627842AF00FF85715B6569B"><enum>(A)</enum><header>In
				general</header><text display-inline="yes-display-inline">In the case of
				coverage under a flexible spending arrangement or a health reimbursement
				arrangement, or both, such coverage meets the requirements of this paragraph
				if, with respect to an individual—</text>
									<clause id="H21E152EF098A40A08CD55D1397157C94"><enum>(i)</enum><text>the sum of—</text>
										<subclause id="HD46AC08980524993A1C977863B013709"><enum>(I)</enum><text>the amount
				allowable as a deduction under subsection (a),</text>
										</subclause><subclause id="H86DE8FDF56CD4F16AFBF708BF2745960"><enum>(II)</enum><text>the salary
				reduction amount elected by the individual and, if applicable, the employer
				contribution or credit allocated to the individual for the taxable year under
				the flexible spending arrangement (as defined in section 106(c)(2)),
				plus</text>
										</subclause><subclause id="HDC96F23DB35D4C70BF0007FEA48E6B94"><enum>(III)</enum><text display-inline="yes-display-inline">the amounts that the individual is
				permitted, under the terms of the plan, to receive in reimbursements for the
				taxable year under the health reimbursement arrangement, does not exceed</text>
										</subclause></clause><clause id="HC3F93C59A3054CF8BA2F3F9672CA1E9"><enum>(ii)</enum><text>the sum of the
				annual deductible and the other annual out-of-pocket expenses (other than for
				premiums) required to be paid under the plan by the eligible individual for
				covered benefits.</text>
									</clause></subparagraph><subparagraph id="H571BE3ED90404639982F00CF06B8A7EA"><enum>(B)</enum><header>Exceptions for
				disregarded coverage</header><text display-inline="yes-display-inline">For
				purposes of subparagraph (A)—</text>
									<clause id="HA227963A8D404DF4BBCBF300CBC673BC"><enum>(i)</enum><header>Certain flexible
				spending arrangements</header><text display-inline="yes-display-inline">Any
				flexible spending arrangement salary reduction amounts or employer
				contributions or credits that are restricted by the employer to use for
				coverage described in paragraph (1)(B) shall not be taken into account under
				subparagraph (A)(i)(II).</text>
									</clause><clause id="HCF8100F784F54C4200D438D05CFA39BF"><enum>(ii)</enum><header>Certain health
				reimbursement arrangements</header><text display-inline="yes-display-inline">Any reimbursements from a health
				reimbursement arrangement for coverage described in paragraph (1)(B) shall not
				be taken into account under subparagraph (A)(i)(III).</text>
									</clause><clause id="H2A578E15CBD54118A11F61B56BC570DE"><enum>(iii)</enum><header>Qualified HSA
				distributions from FSA and HRA terminations</header><text>Any qualified HSA
				distribution (as defined in section 106(e)) shall not be taken into account
				under subparagraph (A)(i).</text>
									</clause></subparagraph><subparagraph id="HC2A52420CFDC42D2A8A9CE62E7A53846"><enum>(C)</enum><header>Termination</header><text>Coverage
				shall not be treated as meeting the requirements of this paragraph for any
				taxable year beginning after December 31,
				2012.</text>
								</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection display-inline="no-display-inline" id="H928601910A734AEAA225A09CF5D7972F"><enum>(c)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section display-inline="no-display-inline" id="H7EF0FDDBE060465383FA3C956C08B118" section-type="subsequent-section"><enum>412.</enum><header>Special rule for
			 certain medical expenses incurred before establishment of account</header>
					<subsection id="H1C73F3DC2E8F431FA6A8F7B6B7F2B8E"><enum>(a)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Subsection (d) of
			 <external-xref legal-doc="usc" parsable-cite="usc/26/223">section 223</external-xref> of the Internal Revenue Code of 1986 is amended by redesignating
			 paragraph (4) as paragraph (5) and by inserting after paragraph (3) the
			 following new paragraph:</text>
						<quoted-block display-inline="no-display-inline" id="HD950E77FADEC4466B567A825F7FD985F" style="OLC">
							<paragraph id="H57F127707BC8417E85C61F56C92B62E5"><enum>(4)</enum><header>Certain medical
				expenses incurred before establishment of account treated as qualified</header>
								<subparagraph id="H5BD9A038374E48D1B890F8B8005F3FED"><enum>(A)</enum><header>In
				general</header><text>For purposes of paragraph (2), an expense shall not fail
				to be treated as a qualified medical expense solely because such expense was
				incurred before the establishment of the health savings account if such expense
				was incurred during the 60-day period beginning on the date on which the high
				deductible health plan is first effective.</text>
								</subparagraph><subparagraph id="HA53F08AED53846BA8E15D798732604E"><enum>(B)</enum><header>Special
				rules</header><text>For purposes of subparagraph (A)—</text>
									<clause id="H1D9588ACCBBB4593A19D89791B00161D"><enum>(i)</enum><text>an
				individual shall be treated as an eligible individual for any portion of a
				month for which the individual is described in subsection (c)(1), determined
				without regard to whether the individual is covered under a high deductible
				health plan on the 1st day of such month, and</text>
									</clause><clause id="H8B61A302A58B4C2698807C2592D72547"><enum>(ii)</enum><text display-inline="yes-display-inline">the effective date of the health savings
				account is deemed to be the date on which the high deductible health plan is
				first effective after the date of the enactment of this paragraph.</text>
									</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="HFB43EDCBF2AE4820B7044E546440DE00"><enum>(b)</enum><header>Effective
			 date</header><text>The amendment made by this section shall apply with respect
			 to insurance purchased after December 31, 2008, in taxable years beginning
			 after such date.</text>
					</subsection></section><section display-inline="no-display-inline" id="HA53E136004AE439B979E44748B2B02A9" section-type="subsequent-section"><enum>413.</enum><header>Allow both spouses
			 to make catch-up contributions to the same HSA account</header>
					<subsection id="H14CE72B2B96A418ABD88C465F3295474"><enum>(a)</enum><header>In
			 general</header><text>Paragraph (3) of section 223(b) of the Internal Revenue
			 Code of 1986 is amended by adding at the end the following new
			 subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="HE4C890B138E346339F08A69FF35BBFA4" style="OLC">
							<subparagraph id="H404DA57652164DB2B41D3BFE43B8CC9F"><enum>(C)</enum><header>Special rule
				where both spouses are eligible individuals with 1 account</header><text display-inline="yes-display-inline">If—</text>
								<clause id="H620730DE4C5D4868A48179EF607D1BC"><enum>(i)</enum><text>an
				individual and the individual’s spouse have both attained age 55 before the
				close of the taxable year, and</text>
								</clause><clause id="H563470767D3740AEBF12CE0241F98B94"><enum>(ii)</enum><text>the spouse is not
				an account beneficiary of a health savings account as of the close of such
				year,</text>
								</clause><continuation-text continuation-text-level="subparagraph">the
				additional contribution amount shall be 200 percent of the amount otherwise
				determined under subparagraph
				(B).</continuation-text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="HE093CF0A85DA4566A680D0478942C20"><enum>(b)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to taxable
			 years beginning after December 31, 2008.</text>
					</subsection></section><section display-inline="no-display-inline" id="HF5456ED0966E44BC813E779BDEAF1B8C" section-type="subsequent-section"><enum>414.</enum><header>FSA and HRA
			 Termination to fund HSAs</header>
					<subsection id="H7302D5E5459A464E00C0410097B21E63"><enum>(a)</enum><header>Grace period not
			 required</header><text display-inline="yes-display-inline">Section 106(e)(2) of
			 the Internal Revenue Code of 1986 is amended by adding at the end the following
			 new sentence: <quote>A distribution shall not fail to be treated as a qualified
			 HSA distribution merely because the balance in such arrangement is determined
			 without regard to the requirement that unused amounts remaining at the end of a
			 plan year must be forfeited in the absence of a grace period.</quote>.</text>
					</subsection><subsection id="H3187A5C0D226408B82EFAC003DC3441E"><enum>(b)</enum><header>Deposit in
			 limited FSA or HRA of funds in excess FSA or HRA termination
			 distribution</header><text>Paragraph (1) of section 106(e) of such Code is
			 amended by inserting before the period at the end thereof the following:
			 <quote>and the deposit of funds in excess of a qualified HSA distribution
			 amount into a health flexible spending account or health reimbursement
			 arrangement which is compatible with a health savings account and which, on the
			 date of such distribution, is a part of the employer’s plan</quote>.</text>
					</subsection><subsection id="H7368F71605884EB3A7852024EF6BAD61"><enum>(c)</enum><header>Disclaimer of
			 disqualifying coverage</header><text>Subparagraph (B) of section 223(c)(1) of
			 such Code, as amended by this Act, is amended by striking <quote>and</quote> at
			 the end of clause (iii), by striking the period at the end of clause (iv) and
			 inserting <quote>, and</quote>, and by inserting after clause (iv) the
			 following new clause:</text>
						<quoted-block display-inline="no-display-inline" id="H2A959D08D4BB46F8B618032E922221B8" style="OLC">
							<clause id="H27E2CBD0FDA343D39D3C6CB9A2B2961D"><enum>(v)</enum><text>any coverage
				(whether actual or prospective) otherwise described in subparagraph (A)(ii)
				which is disclaimed at the time of the creation or organization of the health
				savings
				account.</text>
							</clause><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="H661CF361E1AC4D0D8400A0F785BC817E"><enum>(d)</enum><header>Effective
			 date</header><text display-inline="yes-display-inline">The amendments made by
			 this section shall apply to taxable years beginning after December 31,
			 2008.</text>
					</subsection></section></subtitle><subtitle id="H57E127B8A752452BB9EAD6B92B2709DF"><enum>B</enum><header>Increased Access
			 to Health Insurance through HSAs</header>
				<section id="H0DC70958747E47B6B7647BF1DC86C699" section-type="subsequent-section"><enum>421.</enum><header>Short
			 title</header><text display-inline="no-display-inline">This subtitle may be
			 cited as the <quote><short-title>Increased Access to
			 Health Insurance Act of 2008</short-title></quote>.</text>
				</section><section id="H190DA4C93C214BFE96E36CC9C7A9D6CA" section-type="subsequent-section"><enum>422.</enum><header>Purchase of health
			 insurance from health savings accounts</header>
					<subsection id="HA2C1B514C3E147E3AA45123DA296F8B2"><enum>(a)</enum><header>In
			 general</header><text>Paragraph (2) of section 223(d) of the Internal Revenue
			 Code of 1986 (defining qualified medical expenses) is amended to read as
			 follows:</text>
						<quoted-block display-inline="no-display-inline" id="H80963B0B5DC74E64BC5362EC04F0C746" style="OLC">
							<paragraph id="H2237373BF5F54C24B7117600B0CF0D8"><enum>(2)</enum><header>Qualified medical
				expenses</header><text display-inline="yes-display-inline">The term
				<term>qualified medical expenses</term> means, with respect to an account
				beneficiary, amounts paid by such beneficiary for medical care (as defined in
				section 213(d)) for such individual, the spouse of such individual, and any
				dependent (as defined in section 152, determined without regard to subsections
				(b)(1), (b)(2), and (d)(1)(B) thereof) of such individual, but only to the
				extent such amounts are not compensated for by insurance or
				otherwise.</text>
							</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection id="H8EE05A67DD864A61802045001B655111"><enum>(b)</enum><header>Effective
			 date</header><text>The amendment made by this section shall apply with respect
			 to insurance purchased after the date of the enactment of this Act in taxable
			 years beginning after such date.</text>
					</subsection></section></subtitle></title><title id="H4B2CABC5BCE146D28135001190B501D0"><enum>V</enum><header>Health Care Tort
			 Reform</header>
			<section id="HD503AF5C11304959AC005F8502A2F6F3"><enum>501.</enum><header>Findings and
			 purpose</header>
				<subsection id="H113096A431E04E3DA42E94D9819EDB67"><enum>(a)</enum><header>Findings</header>
					<paragraph id="H61D557F32BBD43D1B03400C84F62571B"><enum>(1)</enum><header>Effect on health
			 care access and costs</header><text>Congress finds that our current civil
			 justice system is adversely affecting patient access to health care services,
			 better patient care, and cost-efficient health care, in that the health care
			 liability system is a costly and ineffective mechanism for resolving claims of
			 health care liability and compensating injured patients, and is a deterrent to
			 the sharing of information among health care professionals which impedes
			 efforts to improve patient safety and quality of care.</text>
					</paragraph><paragraph id="H4C86050EDAA847198B9BDAA69937CD2C"><enum>(2)</enum><header>Effect on
			 interstate commerce</header><text>Congress finds that the health care and
			 insurance industries are industries affecting interstate commerce and the
			 health care liability litigation systems existing throughout the United States
			 are activities that affect interstate commerce by contributing to the high
			 costs of health care and premiums for health care liability insurance purchased
			 by health care system providers.</text>
					</paragraph><paragraph id="HB11B48DED57D4B608FBF74C15E1051EF"><enum>(3)</enum><header>Effect on
			 federal spending</header><text>Congress finds that the health care liability
			 litigation systems existing throughout the United States have a significant
			 effect on the amount, distribution, and use of Federal funds because of—</text>
						<subparagraph id="HC82EB04F869B4B2089D13B832585BF5B"><enum>(A)</enum><text>the large number
			 of individuals who receive health care benefits under programs operated or
			 financed by the Federal Government;</text>
						</subparagraph><subparagraph id="H8C47452962C34C9783CBF8F9F23700BD"><enum>(B)</enum><text>the large number
			 of individuals who benefit because of the exclusion from Federal taxes of the
			 amounts spent to provide them with health insurance benefits; and</text>
						</subparagraph><subparagraph id="H9548AC0A7EE0455E86E053FB4F8002F9"><enum>(C)</enum><text>the large number
			 of health care providers who provide items or services for which the Federal
			 Government makes payments.</text>
						</subparagraph></paragraph></subsection><subsection id="H584B897CC0FA4B099BE4E1BBC462EB7"><enum>(b)</enum><header>Purpose</header><text>It
			 is the purpose of this title to implement reasonable, comprehensive, and
			 effective health care liability reforms designed to—</text>
					<paragraph id="H627A0A19B3484E16958CE73455AB3262"><enum>(1)</enum><text>improve the
			 availability of health care services in cases in which health care liability
			 actions have been shown to be a factor in the decreased availability of
			 services;</text>
					</paragraph><paragraph id="H46C38CBB5FB64EDBBDC12F22AFF42E38"><enum>(2)</enum><text>reduce the
			 incidence of <quote>defensive medicine</quote> and lower the cost of health
			 care liability insurance, all of which contribute to the escalation of health
			 care costs;</text>
					</paragraph><paragraph id="H85FEAEE930154D27B6C70088EF097888"><enum>(3)</enum><text>ensure that
			 persons with meritorious health care injury claims receive fair and adequate
			 compensation, including reasonable noneconomic damages;</text>
					</paragraph><paragraph id="H9271823183864C91928F75E01900267B"><enum>(4)</enum><text>improve the
			 fairness and cost-effectiveness of our current health care liability system to
			 resolve disputes over, and provide compensation for, health care liability by
			 reducing uncertainty in the amount of compensation provided to injured
			 individuals; and</text>
					</paragraph><paragraph id="H7EA78EA8A8CE4EE2962DF0BB67BEC16"><enum>(5)</enum><text>provide an
			 increased sharing of information in the health care system which will reduce
			 unintended injury and improve patient care.</text>
					</paragraph></subsection></section><section id="H9BE216FA5AB94FD0A3E3072FC9D37961"><enum>502.</enum><header>Encouraging
			 speedy resolution of claims</header><text display-inline="no-display-inline">The time for the commencement of a health
			 care lawsuit shall be 3 years after the date of manifestation of injury or 1
			 year after the claimant discovers, or through the use of reasonable diligence
			 should have discovered, the injury, whichever occurs first. In no event shall
			 the time for commencement of a health care lawsuit exceed 3 years after the
			 date of manifestation of injury unless tolled for any of the following—</text>
				<paragraph id="HD8B29A6CBE8A4D759260C9F823DC8B2"><enum>(1)</enum><text>upon proof of
			 fraud;</text>
				</paragraph><paragraph id="H19A59F867BB749A48D22FDA1F00C3EA"><enum>(2)</enum><text>intentional
			 concealment; or</text>
				</paragraph><paragraph id="H183D0721B2644B09993E6DD48C5FD389"><enum>(3)</enum><text>the presence of a
			 foreign body, which has no therapeutic or diagnostic purpose or effect, in the
			 person of the injured person.</text>
				</paragraph><continuation-text continuation-text-level="section">Actions by a
			 minor shall be commenced within 3 years from the date of the alleged
			 manifestation of injury except that actions by a minor under the full age of 6
			 years shall be commenced within 3 years of manifestation of injury or prior to
			 the minor’s 8th birthday, whichever provides a longer period. Such time
			 limitation shall be tolled for minors for any period during which a parent or
			 guardian and a health care provider or health care organization have committed
			 fraud or collusion in the failure to bring an action on behalf of the injured
			 minor.</continuation-text></section><section id="HB16469BED5CA48A8B5E3EB6EFD076369"><enum>503.</enum><header>Compensating
			 patient injury</header>
				<subsection id="HE3E1BE25EB1C4243B694CBFE572298DB"><enum>(a)</enum><header>Unlimited Amount
			 of Damages for Actual Economic Losses in Health Care Lawsuits</header><text>In
			 any health care lawsuit, nothing in this title shall limit a claimant’s
			 recovery of the full amount of the available economic damages, notwithstanding
			 the limitation in
			 <internal-xref idref="H4133E01DF3DB4E659B1E769F51D8EBE2" legis-path="4.(b)">subsection (b)</internal-xref>.</text>
				</subsection><subsection id="H4133E01DF3DB4E659B1E769F51D8EBE2"><enum>(b)</enum><header>Additional
			 Noneconomic Damages</header><text>In any health care lawsuit, the amount of
			 noneconomic damages, if available, may be as much as $250,000, regardless of
			 the number of parties against whom the action is brought or the number of
			 separate claims or actions brought with respect to the same injury.</text>
				</subsection><subsection id="H08F34B95189749EE8DA000E01600CFDE"><enum>(c)</enum><header>No Discount of
			 Award for Noneconomic Damages</header><text>For purposes of applying the
			 limitation in
			 <internal-xref idref="H4133E01DF3DB4E659B1E769F51D8EBE2" legis-path="4.(b)">subsection (b)</internal-xref>, future noneconomic damages
			 shall not be discounted to present value. The jury shall not be informed about
			 the maximum award for noneconomic damages. An award for noneconomic damages in
			 excess of $250,000 shall be reduced either before the entry of judgment, or by
			 amendment of the judgment after entry of judgment, and such reduction shall be
			 made before accounting for any other reduction in damages required by law. If
			 separate awards are rendered for past and future noneconomic damages and the
			 combined awards exceed $250,000, the future noneconomic damages shall be
			 reduced first.</text>
				</subsection><subsection id="H29095EF3D4AF44268BB502DD3F721776"><enum>(d)</enum><header>Fair Share
			 Rule</header><text>In any health care lawsuit, each party shall be liable for
			 that party’s several share of any damages only and not for the share of any
			 other person. Each party shall be liable only for the amount of damages
			 allocated to such party in direct proportion to such party’s percentage of
			 responsibility. Whenever a judgment of liability is rendered as to any party, a
			 separate judgment shall be rendered against each such party for the amount
			 allocated to such party. For purposes of this section, the trier of fact shall
			 determine the proportion of responsibility of each party for the claimant’s
			 harm.</text>
				</subsection></section><section id="H4DEF9882FC9247F2BC8586B9F3EAD47C"><enum>504.</enum><header>Maximizing
			 patient recovery</header>
				<subsection id="H372B8AD362154C5FA92472F7DBA270F1"><enum>(a)</enum><header>Court
			 Supervision of Share of Damages Actually Paid to Claimants</header><text>In any
			 health care lawsuit, the court shall supervise the arrangements for payment of
			 damages to protect against conflicts of interest that may have the effect of
			 reducing the amount of damages awarded that are actually paid to claimants. In
			 particular, in any health care lawsuit in which the attorney for a party claims
			 a financial stake in the outcome by virtue of a contingent fee, the court shall
			 have the power to restrict the payment of a claimant’s damage recovery to such
			 attorney, and to redirect such damages to the claimant based upon the interests
			 of justice and principles of equity. In no event shall the total of all
			 contingent fees for representing all claimants in a health care lawsuit exceed
			 the following limits:</text>
					<paragraph id="HFC4F4C0287E541AA94324C3FB9FE633"><enum>(1)</enum><text>40
			 percent of the first $50,000 recovered by the claimant(s).</text>
					</paragraph><paragraph id="HC2D1E2A2499B440893F618430000E8D6"><enum>(2)</enum><text>33<fraction>1/3</fraction>
			 percent of the next $50,000 recovered by the claimant(s).</text>
					</paragraph><paragraph id="H39DC4D690B164A08A9B5B5D8F6D32BF"><enum>(3)</enum><text>25
			 percent of the next $500,000 recovered by the claimant(s).</text>
					</paragraph><paragraph id="H09C932FA47354130A995112400EEAA84"><enum>(4)</enum><text>15 percent of any
			 amount by which the recovery by the claimant(s) is in excess of
			 $600,000.</text>
					</paragraph></subsection><subsection id="H7955F9BC126D4A77BC6CAE95A94BD94B"><enum>(b)</enum><header>Applicability</header><text>The
			 limitations in this section shall apply whether the recovery is by judgment,
			 settlement, mediation, arbitration, or any other form of alternative dispute
			 resolution. In a health care lawsuit involving a minor or incompetent person, a
			 court retains the authority to authorize or approve a fee that is less than the
			 maximum permitted under this section. The requirement for court supervision in
			 the first two sentences of
			 <internal-xref idref="H372B8AD362154C5FA92472F7DBA270F1" legis-path="5.(a)">subsection (a)</internal-xref> applies only in civil
			 actions.</text>
				</subsection></section><section id="HC18E5EAB979C4179A7FDA67561DE394"><enum>505.</enum><header>Additional
			 health tort reform benefits</header><text display-inline="no-display-inline">In
			 any health care lawsuit involving injury or wrongful death, any party may
			 introduce evidence of collateral source benefits. If a party elects to
			 introduce such evidence, any opposing party may introduce evidence of any
			 amount paid or contributed or reasonably likely to be paid or contributed in
			 the future by or on behalf of the opposing party to secure the right to such
			 collateral source benefits. No provider of collateral source benefits shall
			 recover any amount against the claimant or receive any lien or credit against
			 the claimant’s recovery or be equitably or legally subrogated to the right of
			 the claimant in a health care lawsuit involving injury or wrongful death. This
			 section shall apply to any health care lawsuit that is settled as well as a
			 health care lawsuit that is resolved by a fact finder. This section shall not
			 apply to section 1862(b) (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(b)</external-xref>) or section 1902(a)(25) (42 U.S.C.
			 1396a(a)(25)) of the <act-name parsable-cite="SSA">Social Security
			 Act</act-name>.</text>
			</section><section id="HEF7DC557142F400B8E00B9C53E42D576"><enum>506.</enum><header>Punitive
			 damages</header>
				<subsection id="HB7A18F747E62485200BB4C48917F0001"><enum>(a)</enum><header>In
			 General</header><text>Punitive damages may, if otherwise permitted by
			 applicable State or Federal law, be awarded against any person in a health care
			 lawsuit only if it is proven by clear and convincing evidence that such person
			 acted with malicious intent to injure the claimant, or that such person
			 deliberately failed to avoid unnecessary injury that such person knew the
			 claimant was substantially certain to suffer. In any health care lawsuit where
			 no judgment for compensatory damages is rendered against such person, no
			 punitive damages may be awarded with respect to the claim in such lawsuit. No
			 demand for punitive damages shall be included in a health care lawsuit as
			 initially filed. A court may allow a claimant to file an amended pleading for
			 punitive damages only upon a motion by the claimant and after a finding by the
			 court, upon review of supporting and opposing affidavits or after a hearing,
			 after weighing the evidence, that the claimant has established by a substantial
			 probability that the claimant will prevail on the claim for punitive damages.
			 At the request of any party in a health care lawsuit, the trier of fact shall
			 consider in a separate proceeding—</text>
					<paragraph id="HDA1DA22E0D7B4EAF87312C367D762584"><enum>(1)</enum><text>whether punitive
			 damages are to be awarded and the amount of such award; and</text>
					</paragraph><paragraph id="H4689F766E203400FBD37582E5795F629"><enum>(2)</enum><text>the amount of
			 punitive damages following a determination of punitive liability.</text>
					</paragraph><continuation-text continuation-text-level="subsection">If a
			 separate proceeding is requested, evidence relevant only to the claim for
			 punitive damages, as determined by applicable State law, shall be inadmissible
			 in any proceeding to determine whether compensatory damages are to be
			 awarded.</continuation-text></subsection><subsection id="HA4B0E70E576D4D48ABA5BFBB138DA6E0"><enum>(b)</enum><header>Determining
			 Amount of Punitive Damages</header>
					<paragraph id="H83294CA558984BA098675E23BC901C7"><enum>(1)</enum><header>Factors
			 considered</header><text>In determining the amount of punitive damages, if
			 awarded, in a health care lawsuit, the trier of fact shall consider only the
			 following—</text>
						<subparagraph id="HD302F501C1CB4567AF3D126530325584"><enum>(A)</enum><text>the severity of
			 the harm caused by the conduct of such party;</text>
						</subparagraph><subparagraph id="H208189BC7202462AAE702BE50087E6C0"><enum>(B)</enum><text>the duration of
			 the conduct or any concealment of it by such party;</text>
						</subparagraph><subparagraph id="H98761F1CE9F1438BA7AFF7EC9364E9ED"><enum>(C)</enum><text>the profitability
			 of the conduct to such party;</text>
						</subparagraph><subparagraph id="H91B01E1C7B0B4EC18B5C088536141179"><enum>(D)</enum><text>the number of
			 products sold or medical procedures rendered for compensation, as the case may
			 be, by such party, of the kind causing the harm complained of by the
			 claimant;</text>
						</subparagraph><subparagraph id="H8DD91E736C124B338253B69BA6DDBC8D"><enum>(E)</enum><text>any criminal
			 penalties imposed on such party, as a result of the conduct complained of by
			 the claimant; and</text>
						</subparagraph><subparagraph id="H54DC78BA76094752B9AC99C80FDB891"><enum>(F)</enum><text>the amount of any
			 civil fines assessed against such party as a result of the conduct complained
			 of by the claimant.</text>
						</subparagraph></paragraph><paragraph id="H9421B2A5F76B4740A251041DDB137300"><enum>(2)</enum><header>Maximum
			 award</header><text>The amount of punitive damages, if awarded, in a health
			 care lawsuit may be as much as $250,000 or as much as two times the amount of
			 economic damages awarded, whichever is greater. The jury shall not be informed
			 of this limitation.</text>
					</paragraph></subsection><subsection id="HC2168A5C3CE2400F87D78495F2CDF8AE"><enum>(c)</enum><header>No Punitive
			 Damages for Products That Comply With FDA Standards</header>
					<paragraph id="H6B23A1D30E694659AC8EFB27DD78F230"><enum>(1)</enum><header>In
			 general</header>
						<subparagraph id="H90A256BE988040FCBDC1875EA402051B"><enum>(A)</enum><text>No punitive
			 damages may be awarded against the manufacturer or distributor of a medical
			 product, or a supplier of any component or raw material of such medical
			 product, based on a claim that such product caused the claimant’s harm
			 where—</text>
							<clause id="H3FEA67A2977D4DD688472DEA513E7938"><enum>(i)</enum><subclause commented="no" display-inline="yes-display-inline" id="H7CAED2F99890429CACFFEAF5ECC793E9"><enum>(I)</enum><text>such medical product was
			 subject to premarket approval, clearance, or licensure by the Food and Drug
			 Administration with respect to the safety of the formulation or performance of
			 the aspect of such medical product which caused the claimant’s harm or the
			 adequacy of the packaging or labeling of such medical product; and</text>
								</subclause><subclause id="H449EF58BA30C4EC693C97FBBF2DF1EA1" indent="up1"><enum>(II)</enum><text>such medical product was so approved,
			 cleared, or licensed; or</text>
								</subclause></clause><clause id="H583DC1D67B8E455E8206F4DB874D7B1D"><enum>(ii)</enum><text>such medical
			 product is generally recognized among qualified experts as safe and effective
			 pursuant to conditions established by the Food and Drug Administration and
			 applicable Food and Drug Administration regulations, including without
			 limitation those related to packaging and labeling, unless the Food and Drug
			 Administration has determined that such medical product was not manufactured or
			 distributed in substantial compliance with applicable Food and Drug
			 Administration statutes and regulations.</text>
							</clause></subparagraph><subparagraph id="HB44C544CC62E4E56AA5594A87E4DA657"><enum>(B)</enum><header>Rule of
			 construction</header><text><internal-xref idref="H90A256BE988040FCBDC1875EA402051B" legis-path="7.(c)(1)(A)">Subparagraph
			 (A)</internal-xref> may not be construed as establishing the obligation of the
			 Food and Drug Administration to demonstrate affirmatively that a manufacturer,
			 distributor, or supplier referred to in such subparagraph meets any of the
			 conditions described in such subparagraph.</text>
						</subparagraph></paragraph><paragraph id="H67A1CAA0C0EA47AA8BF9F429253F07"><enum>(2)</enum><header>Liability of
			 health care providers</header><text>A health care provider who prescribes, or
			 who dispenses pursuant to a prescription, a medical product approved, licensed,
			 or cleared by the Food and Drug Administration shall not be named as a party to
			 a product liability lawsuit involving such product and shall not be liable to a
			 claimant in a class action lawsuit against the manufacturer, distributor, or
			 seller of such product. Nothing in this paragraph prevents a court from
			 consolidating cases involving health care providers and cases involving
			 products liability claims against the manufacturer, distributor, or product
			 seller of such medical product.</text>
					</paragraph><paragraph id="HA0A913A12E774148A38D756D1158CAD9"><enum>(3)</enum><header>Packaging</header><text>In
			 a health care lawsuit for harm which is alleged to relate to the adequacy of
			 the packaging or labeling of a drug which is required to have tamper-resistant
			 packaging under regulations of the Secretary of Health and Human Services
			 (including labeling regulations related to such packaging), the manufacturer or
			 product seller of the drug shall not be held liable for punitive damages unless
			 such packaging or labeling is found by the trier of fact by clear and
			 convincing evidence to be substantially out of compliance with such
			 regulations.</text>
					</paragraph><paragraph id="HB7D14266FFA5491EA53FD94DFDCF7343"><enum>(4)</enum><header>Exception</header><text><internal-xref idref="H6B23A1D30E694659AC8EFB27DD78F230" legis-path="7.(c)(1)">Paragraph
			 (1)</internal-xref> shall not apply in any health care lawsuit in which—</text>
						<subparagraph id="HF69F8E56D296437E88C6D01FD898B2AE"><enum>(A)</enum><text>a person, before
			 or after premarket approval, clearance, or licensure of such medical product,
			 knowingly misrepresented to or withheld from the Food and Drug Administration
			 information that is required to be submitted under the
			 <act-name parsable-cite="FFDCA">Federal Food, Drug, and Cosmetic Act</act-name>
			 (<external-xref legal-doc="usc" parsable-cite="usc/21/301">21 U.S.C. 301 et seq.</external-xref>) or section 351 of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/262">42 U.S.C. 262</external-xref>) that
			 is material and is causally related to the harm which the claimant allegedly
			 suffered; or</text>
						</subparagraph><subparagraph id="H235FB3AF2C8544BEABC4B3DB7170626B"><enum>(B)</enum><text>a person made an
			 illegal payment to an official of the Food and Drug Administration for the
			 purpose of either securing or maintaining approval, clearance, or licensure of
			 such medical product.</text>
						</subparagraph></paragraph></subsection></section><section id="HF6C8EB041974450EA849BCC3F6FE0020"><enum>507.</enum><header>Authorization
			 of payment of future damages to claimants in health care lawsuits</header>
				<subsection id="H3264EEA8AABB4DCFA573B37FAE98A2FA"><enum>(a)</enum><header>In
			 General</header><text>In any health care lawsuit, if an award of future
			 damages, without reduction to present value, equaling or exceeding $50,000 is
			 made against a party with sufficient insurance or other assets to fund a
			 periodic payment of such a judgment, the court shall, at the request of any
			 party, enter a judgment ordering that the future damages be paid by periodic
			 payments. In any health care lawsuit, the court may be guided by the Uniform
			 Periodic Payment of Judgments Act promulgated by the National Conference of
			 Commissioners on Uniform State Laws.</text>
				</subsection><subsection id="H5AFE56605DB547C784CA7961002B0005"><enum>(b)</enum><header>Applicability</header><text>This
			 section applies to all actions which have not been first set for trial or
			 retrial before the effective date of this title.</text>
				</subsection></section><section id="H1AE586B4BF27464EA78709DB915C11F8"><enum>508.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
				<paragraph id="HAFDCB419DCD947909BDE03DAD9B7DC6"><enum>(1)</enum><header>Alternative
			 dispute resolution system; ADR</header><text>The term <term>alternative dispute
			 resolution system</term> or <term>ADR</term> means a system that provides for
			 the resolution of health care lawsuits in a manner other than through a civil
			 action brought in a State or Federal court.</text>
				</paragraph><paragraph id="H070DE39D967C482EA22448E1FBFBF6B8"><enum>(2)</enum><header>Claimant</header><text>The
			 term <term>claimant</term> means any person who brings a health care lawsuit,
			 including a person who asserts or claims a right to legal or equitable
			 contribution, indemnity, or subrogation, arising out of a health care liability
			 claim or action, and any person on whose behalf such a claim is asserted or
			 such an action is brought, whether deceased, incompetent, or a minor.</text>
				</paragraph><paragraph id="HAAFA624979D64935BC471F5EEAD3CD8"><enum>(3)</enum><header>Collateral source
			 benefits</header><text>The term <term>collateral source benefits</term> means
			 any amount paid or reasonably likely to be paid in the future to or on behalf
			 of the claimant, or any service, product, or other benefit provided or
			 reasonably likely to be provided in the future to or on behalf of the claimant,
			 as a result of the injury or wrongful death, pursuant to—</text>
					<subparagraph id="H7EB0B6572E224D76857DF1586E22D0D3"><enum>(A)</enum><text>any State or
			 Federal health, sickness, income-disability, accident, or workers’ compensation
			 law;</text>
					</subparagraph><subparagraph id="H0FA2BB5E0A1945B6A05D14A1EB8CBFF5"><enum>(B)</enum><text>any health,
			 sickness, income-disability, or accident insurance that provides health
			 benefits or income-disability coverage;</text>
					</subparagraph><subparagraph id="H40CD198A01E3471000203C9696455100"><enum>(C)</enum><text>any contract or
			 agreement of any group, organization, partnership, or corporation to provide,
			 pay for, or reimburse the cost of medical, hospital, dental, or
			 income-disability benefits; and</text>
					</subparagraph><subparagraph id="H0BBD80E32F1047BA9851F5FF709609BE"><enum>(D)</enum><text>any other publicly
			 or privately funded program.</text>
					</subparagraph></paragraph><paragraph id="HCA081897609348A888EC09391EBA8C12"><enum>(4)</enum><header>Compensatory
			 damages</header><text>The term <term>compensatory damages</term> means
			 objectively verifiable monetary losses incurred as a result of the provision
			 of, use of, or payment for (or failure to provide, use, or pay for) health care
			 services or medical products, such as past and future medical expenses, loss of
			 past and future earnings, cost of obtaining domestic services, loss of
			 employment, and loss of business or employment opportunities, damages for
			 physical and emotional pain, suffering, inconvenience, physical impairment,
			 mental anguish, disfigurement, loss of enjoyment of life, loss of society and
			 companionship, loss of consortium (other than loss of domestic service),
			 hedonic damages, injury to reputation, and all other nonpecuniary losses of any
			 kind or nature. The term <term>compensatory damages</term> includes economic
			 damages and noneconomic damages, as such terms are defined in this
			 section.</text>
				</paragraph><paragraph id="H7E092F14F7574DFB98DB5F58C5B2B00"><enum>(5)</enum><header>Contingent
			 fee</header><text>The term <term>contingent fee</term> includes all
			 compensation to any person or persons which is payable only if a recovery is
			 effected on behalf of one or more claimants.</text>
				</paragraph><paragraph id="H2866CC35F4CC4498968047E1A51DD3A6"><enum>(6)</enum><header>Economic
			 damages</header><text>The term <term>economic damages</term> means objectively
			 verifiable monetary losses incurred as a result of the provision of, use of, or
			 payment for (or failure to provide, use, or pay for) health care services or
			 medical products, such as past and future medical expenses, loss of past and
			 future earnings, cost of obtaining domestic services, loss of employment, and
			 loss of business or employment opportunities.</text>
				</paragraph><paragraph id="H802B2E06F10749B6AB9200683B3F77F3"><enum>(7)</enum><header>Health care
			 lawsuit</header><text>The term <term>health care lawsuit</term> means any
			 health care liability claim concerning the provision of health care goods or
			 services or any medical product affecting interstate commerce, or any health
			 care liability action concerning the provision of health care goods or services
			 or any medical product affecting interstate commerce, brought in a State or
			 Federal court or pursuant to an alternative dispute resolution system, against
			 a health care provider, a health care organization, or the manufacturer,
			 distributor, supplier, marketer, promoter, or seller of a medical product,
			 regardless of the theory of liability on which the claim is based, or the
			 number of claimants, plaintiffs, defendants, or other parties, or the number of
			 claims or causes of action, in which the claimant alleges a health care
			 liability claim. Such term does not include a claim or action which is based on
			 criminal liability; which seeks civil fines or penalties paid to Federal,
			 State, or local government; or which is grounded in antitrust.</text>
				</paragraph><paragraph id="HC732BA6CC1C8461AA9CB81F84D712882"><enum>(8)</enum><header>Health care
			 liability action</header><text>The term <term>health care liability
			 action</term> means a civil action brought in a State or Federal court or
			 pursuant to an alternative dispute resolution system, against a health care
			 provider, a health care organization, or the manufacturer, distributor,
			 supplier, marketer, promoter, or seller of a medical product, regardless of the
			 theory of liability on which the claim is based, or the number of plaintiffs,
			 defendants, or other parties, or the number of causes of action, in which the
			 claimant alleges a health care liability claim.</text>
				</paragraph><paragraph id="HC61C63DFC3164C4BA198EDD5A0C2F81E"><enum>(9)</enum><header>Health care
			 liability claim</header><text>The term <term>health care liability claim</term>
			 means a demand by any person, whether or not pursuant to ADR, against a health
			 care provider, health care organization, or the manufacturer, distributor,
			 supplier, marketer, promoter, or seller of a medical product, including, but
			 not limited to, third-party claims, cross-claims, counter-claims, or
			 contribution claims, which are based upon the provision of, use of, or payment
			 for (or the failure to provide, use, or pay for) health care services or
			 medical products, regardless of the theory of liability on which the claim is
			 based, or the number of plaintiffs, defendants, or other parties, or the number
			 of causes of action.</text>
				</paragraph><paragraph id="H6CE80AF6174D440FA4F46FAA412FF2D"><enum>(10)</enum><header>Health care
			 organization</header><text>The term <term>health care organization</term> means
			 any person or entity which is obligated to provide or pay for health benefits
			 under any health plan, including any person or entity acting under a contract
			 or arrangement with a health care organization to provide or administer any
			 health benefit.</text>
				</paragraph><paragraph id="H8636F4C015BA4C03BE0097EE7E983B1F"><enum>(11)</enum><header>Health care
			 provider</header><text>The term <term>health care provider</term> means any
			 person or entity required by State or Federal laws or regulations to be
			 licensed, registered, or certified to provide health care services, and being
			 either so licensed, registered, or certified, or exempted from such requirement
			 by other statute or regulation.</text>
				</paragraph><paragraph id="H0E2CEAD8108E4BDD8380605008B368B7"><enum>(12)</enum><header>Health care
			 goods or services</header><text>The term <term>health care goods or
			 services</term> means any goods or services provided by a health care
			 organization, provider, or by any individual working under the supervision of a
			 health care provider, that relates to the diagnosis, prevention, or treatment
			 of any human disease or impairment, or the assessment or care of the health of
			 human beings.</text>
				</paragraph><paragraph id="HFAE774DDE4F0483C8FE75327B386663F"><enum>(13)</enum><header>Malicious
			 intent to injure</header><text>The term <term>malicious intent to injure</term>
			 means intentionally causing or attempting to cause physical injury other than
			 providing health care goods or services.</text>
				</paragraph><paragraph id="HE5A6B3DCB7E644BF83067EE500A6A90"><enum>(14)</enum><header>Medical
			 product</header><text>The term <term>medical product</term> means a drug,
			 device, or biological product intended for humans, and the terms
			 <term>drug</term>, <term>device</term>, and <term>biological product</term>
			 have the meanings given such terms in sections 201(g)(1) and 201(h) of the
			 Federal Food, Drug and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/321">21 U.S.C. 321(g)(1)</external-xref> and (h)) and section
			 351(a) of the <act-name parsable-cite="PHSA">Public Health Service
			 Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/262">42 U.S.C. 262(a)</external-xref>), respectively, including any component or raw
			 material used therein, but excluding health care services.</text>
				</paragraph><paragraph id="H62788EFC7C2F4290B16625A272273053"><enum>(15)</enum><header>Noneconomic
			 damages</header><text>The term <term>noneconomic damages</term> means damages
			 for physical and emotional pain, suffering, inconvenience, physical impairment,
			 mental anguish, disfigurement, loss of enjoyment of life, loss of society and
			 companionship, loss of consortium (other than loss of domestic service),
			 hedonic damages, injury to reputation, and all other nonpecuniary losses of any
			 kind or nature.</text>
				</paragraph><paragraph id="H170410E339B74724B38166EF06B42786"><enum>(16)</enum><header>Punitive
			 damages</header><text>The term <term>punitive damages</term> means damages
			 awarded, for the purpose of punishment or deterrence, and not solely for
			 compensatory purposes, against a health care provider, health care
			 organization, or a manufacturer, distributor, or supplier of a medical product.
			 Punitive damages are neither economic nor noneconomic damages.</text>
				</paragraph><paragraph id="HA803112D6757492C9BCB85E308DF5943"><enum>(17)</enum><header>Recovery</header><text>The
			 term <term>recovery</term> means the net sum recovered after deducting any
			 disbursements or costs incurred in connection with prosecution or settlement of
			 the claim, including all costs paid or advanced by any person. Costs of health
			 care incurred by the plaintiff and the attorneys’ office overhead costs or
			 charges for legal services are not deductible disbursements or costs for such
			 purpose.</text>
				</paragraph><paragraph id="H3DD0BEA0B641430700CAAE24F8E0D5EF"><enum>(18)</enum><header>State</header><text>The
			 term <term>State</term> means each of the several States, the District of
			 Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American
			 Samoa, the Northern Mariana Islands, the Trust Territory of the Pacific
			 Islands, and any other territory or possession of the United States, or any
			 political subdivision thereof.</text>
				</paragraph></section><section id="HF3EF3AC9C2214A7A9C6FE2862FE15FB8"><enum>509.</enum><header>Effect on other
			 laws</header>
				<subsection id="H3660453B474C4BA0B9ED4028DA068DAE"><enum>(a)</enum><header>Vaccine
			 Injury</header>
					<paragraph id="H27CB21E9EE88452B9446D5EDE7568D5"><enum>(1)</enum><text>To
			 the extent that title XXI of the <act-name parsable-cite="PHSA">Public Health
			 Service Act</act-name> establishes a Federal rule of law applicable to a civil
			 action brought for a vaccine-related injury or death—</text>
						<subparagraph id="H193F54480F5F4B068DDDE400385D1EA4"><enum>(A)</enum><text>this title does
			 not affect the application of the rule of law to such an action; and</text>
						</subparagraph><subparagraph id="H34E8CAACA6F44FA1BCD1EE1213FAB97B"><enum>(B)</enum><text>any rule of law
			 prescribed by this title in conflict with a rule of law of such title XXI shall
			 not apply to such action.</text>
						</subparagraph></paragraph><paragraph id="H81165D082B514B62B87C80634CB6CB73"><enum>(2)</enum><text>If there is an
			 aspect of a civil action brought for a vaccine-related injury or death to which
			 a Federal rule of law under title XXI of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> does not apply, then
			 this title or otherwise applicable law (as determined under this title) will
			 apply to such aspect of such action.</text>
					</paragraph></subsection><subsection id="H1411DFE8A6CC486592BDE0CD00796110"><enum>(b)</enum><header>Other Federal
			 Law</header><text>Except as provided in this section, nothing in this title
			 shall be deemed to affect any defense available to a defendant in a health care
			 lawsuit or action under any other provision of Federal law.</text>
				</subsection></section><section id="H58A1A81D9AB84CBA9CC40774B61E8D41"><enum>510.</enum><header>State
			 flexibility and protection of states’ rights</header>
				<subsection id="HCF6FD75A740D4EA1BA851FF1812D87A4"><enum>(a)</enum><header>Health Care
			 Lawsuits</header><text>The provisions governing health care lawsuits set forth
			 in this title preempt, subject to subsections (b) and (c), State law to the
			 extent that State law prevents the application of any provisions of law
			 established by or under this title. The provisions governing health care
			 lawsuits set forth in this title supersede <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/28/171">chapter 171</external-xref> of title 28, United
			 States Code, to the extent that such chapter—</text>
					<paragraph id="H27282BF86D5141DCAC5395CBD0DBA65E"><enum>(1)</enum><text>provides for a
			 greater amount of damages or contingent fees, a longer period in which a health
			 care lawsuit may be commenced, or a reduced applicability or scope of periodic
			 payment of future damages, than provided in this title; or</text>
					</paragraph><paragraph id="H1802770625CF4924AFA8D1AFCF4FBEFA"><enum>(2)</enum><text>prohibits the
			 introduction of evidence regarding collateral source benefits, or mandates or
			 permits subrogation or a lien on collateral source benefits.</text>
					</paragraph></subsection><subsection id="H7A6A1085CF9D460CA11E4826E0904EFF"><enum>(b)</enum><header>Protection of
			 States’ Rights and Other Laws</header><paragraph commented="no" display-inline="yes-display-inline" id="H15D7961FA0444A04B7BF7EA05E780715"><enum>(1)</enum><text>Any issue that is not
			 governed by any provision of law established by or under this title (including
			 State standards of negligence) shall be governed by otherwise applicable State
			 or Federal law.</text>
					</paragraph><paragraph id="HAB0DF556CA0848ABB667296B7BD1967C" indent="up1"><enum>(2)</enum><text>This title shall not preempt or
			 supersede any State or Federal law that imposes greater procedural or
			 substantive protections for health care providers and health care organizations
			 from liability, loss, or damages than those provided by this title or create a
			 cause of action.</text>
					</paragraph></subsection><subsection id="HF57D889CCF3349FDAF4BCB63F34297CD"><enum>(c)</enum><header>State
			 Flexibility</header><text>No provision of this title shall be construed to
			 preempt—</text>
					<paragraph id="H53785F1B8E624633934FC3F962EC9E0"><enum>(1)</enum><text>any State law
			 (whether effective before, on, or after the date of the enactment of this Act)
			 that specifies a particular monetary amount of compensatory or punitive damages
			 (or the total amount of damages) that may be awarded in a health care lawsuit,
			 regardless of whether such monetary amount is greater or lesser than is
			 provided for under this title, notwithstanding
			 <internal-xref idref="HE3E1BE25EB1C4243B694CBFE572298DB" legis-path="4.(a)">section 4(a)</internal-xref>; or</text>
					</paragraph><paragraph id="H9D31F7FB418D419FB000BDA5873B8394"><enum>(2)</enum><text>any defense
			 available to a party in a health care lawsuit under any other provision of
			 State or Federal law.</text>
					</paragraph></subsection></section><section id="H57A9D6DD98784D8CAF0600D19BCC85D7"><enum>511.</enum><header>Applicability;
			 effective date</header><text display-inline="no-display-inline">This title
			 shall apply to any health care lawsuit brought in a Federal or State court, or
			 subject to an alternative dispute resolution system, that is initiated on or
			 after the date of the enactment of this Act, except that any health care
			 lawsuit arising from an injury occurring prior to the date of the enactment of
			 this Act shall be governed by the applicable statute of limitations provisions
			 in effect at the time the injury occurred.</text>
			</section><section id="H9F55400787DB48039ED59940674300F8"><enum>512.</enum><header>Sense of
			 Congress</header><text display-inline="no-display-inline">It is the sense of
			 Congress that a health insurer should be liable for damages for harm caused
			 when it makes a decision as to what care is medically necessary and
			 appropriate.</text>
			</section></title><title commented="no" id="id7803AE27CDC8458DB8ECB374EAA326F7" level-type="subsequent"><enum>VI</enum><header display-inline="yes-display-inline">Health Information Technology</header>
			<subtitle commented="no" id="id82B229A8554143FAB9A0D4A2B295CE8E" level-type="subsequent" style="OLC"><enum>A</enum><header display-inline="yes-display-inline">Assisting the Development of Health
			 Information Technology</header>
				<section commented="no" display-inline="no-display-inline" id="idDCCFF8C00AF74671AB51A71B7A54834C" section-type="subsequent-section"><enum>601.</enum><header display-inline="yes-display-inline">Purpose</header><text display-inline="no-display-inline">It is the purpose of this subtitle to
			 promote the utilization of health record banking by improving the coordination
			 of health information through an infrastructure for the secure and authorized
			 exchange and use of healthcare information.</text>
				</section><section commented="no" display-inline="no-display-inline" id="id00CFE516B46C4BF79C5C3AEA6250CFCF" section-type="subsequent-section"><enum>602.</enum><header display-inline="yes-display-inline">Health record banking</header>
					<subsection commented="no" display-inline="no-display-inline" id="idA3ED3F8C70DE422884F392BE60CDD7D3"><enum>(a)</enum><header display-inline="yes-display-inline">Establishment</header><text display-inline="yes-display-inline">Not later than 1 year after the date of
			 enactment of this Act, the Secretary of Health and Human Services shall
			 promulgate regulations to provide for the certification and auditing of the
			 banking of electronic medical records.</text>
					</subsection><subsection commented="no" display-inline="no-display-inline" id="id18871B93A820496CB98B5DD054A9BCD6"><enum>(b)</enum><header display-inline="yes-display-inline">General
			 rights</header><text display-inline="yes-display-inline">An individual who has
			 a health record contained in a health record bank shall maintain ownership over
			 the health record and shall have the right to review the contents of the
			 record.</text>
					</subsection></section><section commented="no" display-inline="no-display-inline" id="idBC1757FFCA294E62BE36E3AE260B116A" section-type="subsequent-section"><enum>603.</enum><header display-inline="yes-display-inline">Application of Federal and State security
			 and confidentiality standards</header>
					<subsection commented="no" display-inline="no-display-inline" id="id7E90CD795BD84AF7B08C7A769C6C402B"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Current Federal security and
			 confidentiality standards and State security and confidentiality laws shall
			 apply to this subtitle until such time as Congress acts to amend such
			 standards.</text>
					</subsection><subsection commented="no" display-inline="no-display-inline" id="idA7FC5CF74E6F437297CA876986DFB9A9"><enum>(b)</enum><header display-inline="yes-display-inline">Definitions</header><text display-inline="yes-display-inline">In this section:</text>
						<paragraph commented="no" display-inline="no-display-inline" id="id26FE3F084C1E4F03A7F33C1384C35C6C"><enum>(1)</enum><header display-inline="yes-display-inline">Current Federal security and
			 confidentiality standards</header><text display-inline="yes-display-inline">The
			 term <term>current Federal security and confidentiality standards</term> means
			 the Federal privacy standards established pursuant to section 264(c) of the
			 Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2
			 note) and security standards established under section 1173(d) of the Social
			 Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320d-2">42 U.S.C. 1320d–2(d)</external-xref>).</text>
						</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id561D950A64F546F9AFC51E4F9C192E9F"><enum>(2)</enum><header display-inline="yes-display-inline">State security and confidentiality
			 laws</header><text display-inline="yes-display-inline">The term <term>State
			 security and confidentiality laws</term> means State laws and regulations
			 relating to the privacy and confidentiality of individually identifiable health
			 information or to the security of such information.</text>
						</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id969A94388C694535BE212DEF792969AE"><enum>(3)</enum><header display-inline="yes-display-inline">State</header><text display-inline="yes-display-inline">The term <term>State</term> has the meaning
			 given such term for purposes of title XI of the Social Security Act, as
			 provided under section 1101(a) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301(a)</external-xref>).</text>
						</paragraph></subsection></section></subtitle><subtitle commented="no" id="idA7B909E9AA534E3B90B11646B59D4860" level-type="subsequent" style="OLC"><enum>B</enum><header display-inline="yes-display-inline">Promoting the Use of Health Information
			 Technology to Better Coordinate Health Care </header>
				<section commented="no" display-inline="no-display-inline" id="ID931E5EB242F046C08F60AA9AD74626BB" section-type="subsequent-section"><enum>611.</enum><header display-inline="yes-display-inline">Safe harbors to antikickback civil
			 penalties and criminal penalties for provision of health information technology
			 and training services</header>
					<subsection commented="no" display-inline="no-display-inline" id="ID8324F53458864081B7D9916840BA5657"><enum>(a)</enum><header display-inline="yes-display-inline">For Civil Penalties</header><text display-inline="yes-display-inline">Section 1128A of the
			 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1320a–7a) is amended—</text>
						<paragraph commented="no" display-inline="no-display-inline" id="ID248FBB149457489089A6C73DABA71ADD"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (b), by adding at the end the
			 following new paragraph:</text>
							<quoted-block display-inline="no-display-inline" id="ID35FA746C8DB74B0A8AA9E53497AEAD60" style="OLC">
								<paragraph commented="no" display-inline="no-display-inline" id="ID0FB523E3080E471891AB9A40A8F5918D" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">For purposes of this subsection,
				inducements to reduce or limit services described in paragraph (1) shall not
				include the practical or other advantages resulting from health information
				technology or related installation, maintenance, support, or training
				services.</text>
								</paragraph><after-quoted-block>;
				and</after-quoted-block></quoted-block>
						</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID24931B8FA50045669F8AE5FBDD15BDD8"><enum>(2)</enum><text display-inline="yes-display-inline">in subsection (i), by adding at the end the
			 following new paragraph:</text>
							<quoted-block display-inline="no-display-inline" id="IDECCF1DD48102491D91BF85949C672360" style="OLC">
								<paragraph commented="no" display-inline="no-display-inline" id="IDDACC293A2543466EB569D9056F593234"><enum>(8)</enum><text display-inline="yes-display-inline">The term <term>health information
				technology</term> means hardware, software, license, right, intellectual
				property, equipment, or other information technology (including new versions,
				upgrades, and connectivity) designed or provided primarily for the electronic
				creation, maintenance, or exchange of health information to better coordinate
				care or improve health care quality, efficiency, or
				research.</text>
								</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID3DF05C745EE045E6B8D44C3AD1D4E375"><enum>(b)</enum><header display-inline="yes-display-inline">For Criminal Penalties</header><text display-inline="yes-display-inline">Section 1128B of such Act (42 U.S.C.
			 1320a–7b) is amended—</text>
						<paragraph commented="no" display-inline="no-display-inline" id="ID1795057B103040508198D1290978C143"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (b)(3)—</text>
							<subparagraph commented="no" display-inline="no-display-inline" id="ID514783A789E6482891B012330AB62613"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (G), by striking
			 <quote>and</quote> at the end;</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID0CDADA7F367B42BB892916D7013770DB"><enum>(B)</enum><text display-inline="yes-display-inline">in the subparagraph (H) added by section
			 237(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of
			 2003 (<external-xref legal-doc="public-law" parsable-cite="pl/108/173">Public Law 108–173</external-xref>; 117 Stat. 2213)—</text>
								<clause commented="no" display-inline="no-display-inline" id="IDC65A096BF323487A8D5A12B5A67D4C6F"><enum>(i)</enum><text display-inline="yes-display-inline">by moving such subparagraph 2 ems to the
			 left; and</text>
								</clause><clause commented="no" display-inline="no-display-inline" id="ID075EAF8571EF435BA406D23A714E8D03"><enum>(ii)</enum><text display-inline="yes-display-inline">by striking the period at the end and
			 inserting a semicolon;</text>
								</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDF834EADF2956431A9567E1300AC274F6"><enum>(C)</enum><text display-inline="yes-display-inline">in the subparagraph (H) added by section
			 431(a) of such Act (117 Stat. 2287)—</text>
								<clause commented="no" display-inline="no-display-inline" id="ID3A875253DB02450B929559F650610475"><enum>(i)</enum><text display-inline="yes-display-inline">by redesignating such subparagraph as
			 subparagraph (I);</text>
								</clause><clause commented="no" display-inline="no-display-inline" id="ID30B85D55741A486E8BB4A9734B0352C2"><enum>(ii)</enum><text display-inline="yes-display-inline">by moving such subparagraph 2 ems to the
			 left; and</text>
								</clause><clause commented="no" display-inline="no-display-inline" id="ID892B89FEB1AB4C028DAA1C861C92D4CA"><enum>(iii)</enum><text display-inline="yes-display-inline">by striking the period at the end and
			 inserting <quote>; and</quote>; and</text>
								</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDA15160C188EA4E0CA5A6A3DA8775DC7C"><enum>(D)</enum><text display-inline="yes-display-inline">by adding at the end the following new
			 subparagraph:</text>
								<quoted-block display-inline="no-display-inline" id="IDF615A60D15EE4A9FA624CADF2F1EEBE1" style="OLC">
									<subparagraph commented="no" display-inline="no-display-inline" id="ID3EC1F87656B144A69A0E33E4A02D0032" indent="up1"><enum>(J)</enum><text display-inline="yes-display-inline">any nonmonetary remuneration (in the form
				of health information technology, as defined in section 1128A(i)(8), or related
				installation, maintenance, support or training services) made to a person by a
				specified entity (as defined in subsection (g)) if—</text>
										<clause commented="no" display-inline="no-display-inline" id="IDBF0B4878747F4415A17D600CD9D3A84E"><enum>(i)</enum><text display-inline="yes-display-inline">the provision of such remuneration is
				without an agreement between the parties or legal condition that—</text>
											<subclause commented="no" display-inline="no-display-inline" id="ID5326D2EF13F449068181DADF48E050F5"><enum>(I)</enum><text display-inline="yes-display-inline">limits or restricts the use of the health
				information technology to services provided by the physician to individuals
				receiving services at the specified entity;</text>
											</subclause><subclause commented="no" display-inline="no-display-inline" id="ID84AA94B1FAAB44959085911D1B1AB637"><enum>(II)</enum><text display-inline="yes-display-inline">limits or restricts the use of the health
				information technology in conjunction with other health information technology;
				or</text>
											</subclause><subclause commented="no" display-inline="no-display-inline" id="ID449933F1DF364A2E81CEBE38DDB95653"><enum>(III)</enum><text display-inline="yes-display-inline">conditions the provision of such
				remuneration on the referral of patients or business to the specified
				entity;</text>
											</subclause></clause><clause commented="no" display-inline="no-display-inline" id="IDB748ECA1BA5745899ECA86B28E817E32"><enum>(ii)</enum><text display-inline="yes-display-inline">such remuneration is arranged for in a
				written agreement that is signed by the parties involved (or their
				representatives) and that specifies the remuneration solicited or received (or
				offered or paid) and states that the provision of such remuneration is made for
				the primary purpose of better coordination of care or improvement of health
				quality, efficiency, or research; and</text>
										</clause><clause commented="no" display-inline="no-display-inline" id="IDF695B753D83848F9B1EEECCB2190FBEB"><enum>(iii)</enum><text display-inline="yes-display-inline">the specified entity providing the
				remuneration (or a representative of such entity) has not taken any action to
				disable any basic feature of any hardware or software component of such
				remuneration that would permit
				interoperability.</text>
										</clause></subparagraph><after-quoted-block>;
				and</after-quoted-block></quoted-block>
							</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID91371316D94E4259834645A9BE43A074"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new
			 subsection:</text>
							<quoted-block display-inline="no-display-inline" id="IDEBB557EAE109434CB30B5B2AC615576C" style="OLC">
								<subsection commented="no" display-inline="no-display-inline" id="ID77B8C80603254FDABA72AAD8149B4C44"><enum>(g)</enum><header display-inline="yes-display-inline">Specified Entity Defined</header><text display-inline="yes-display-inline">For purposes of subsection (b)(3)(J), the
				term <term>specified entity</term> means an entity that is a hospital, group
				practice, prescription drug plan sponsor, a Medicare Advantage organization, or
				any other such entity specified by the Secretary, considering the goals and
				objectives of this section, as well as the goals to better coordinate the
				delivery of health care and to promote the adoption and use of health
				information
				technology.</text>
								</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
						</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID4A8B54E68AE6461A9F54D0510783BE15"><enum>(c)</enum><header display-inline="yes-display-inline">Effective Date and Effect on State
			 Laws</header>
						<paragraph commented="no" display-inline="no-display-inline" id="ID141E1D7B1C334347BF6B61AC51239060"><enum>(1)</enum><header display-inline="yes-display-inline">Effective
			 date</header><text display-inline="yes-display-inline">The amendments made by
			 subsections (a) and (b) shall take effect on the date that is 120 days after
			 the date of the enactment of this Act.</text>
						</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID4D7C489765814FDDB47D09D6241278C3"><enum>(2)</enum><header display-inline="yes-display-inline">Preemption of state laws</header><text display-inline="yes-display-inline">No State (as defined in section 1101(a) of
			 the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1301(a)) for purposes of title XI of such Act) shall have in effect a State law
			 that imposes a criminal or civil penalty for a transaction described in section
			 1128A(b)(4) or section 1128B(b)(3)(J) of such Act, as added by subsections
			 (a)(1) and (b), respectively, if the conditions described in the respective
			 provision, with respect to such transaction, are met.</text>
						</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="IDD59B0D5F39364E8ABE4D4B89ED0B7B3C"><enum>(d)</enum><header display-inline="yes-display-inline">Study and Report To Assess Effect of Safe
			 Harbors on Health System</header>
						<paragraph commented="no" display-inline="no-display-inline" id="ID1F4F84EC64B1451281D430C211B09F7E"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services
			 shall conduct a study to determine the impact of each of the safe harbors
			 described in paragraph (3). In particular, the study shall examine the
			 following:</text>
							<subparagraph commented="no" display-inline="no-display-inline" id="IDA2B05FFD27FE44B7AD5BF6E120BBA477"><enum>(A)</enum><text display-inline="yes-display-inline">The effectiveness of each safe harbor in
			 increasing the adoption of health information technology.</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID19751EC85519443489EF342909223E9B"><enum>(B)</enum><text display-inline="yes-display-inline">The types of health information technology
			 provided under each safe harbor.</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID174245C6166542A38C31F51E98071394"><enum>(C)</enum><text display-inline="yes-display-inline">The extent to which the financial or other
			 business relationships between providers under each safe harbor have changed as
			 a result of the safe harbor in a way that adversely affects or benefits the
			 health care system or choices available to consumers.</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDF3F0C9BFA0024977898D805BA103696E"><enum>(D)</enum><text display-inline="yes-display-inline">The impact of the adoption of health
			 information technology on health care quality, cost, and access under each safe
			 harbor.</text>
							</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID834A5CAE1A904E80867381720D043BD0"><enum>(2)</enum><header display-inline="yes-display-inline">Report</header><text display-inline="yes-display-inline">Not later than 3 years after the effective
			 date described in subsection (c)(1), the Secretary of Health and Human Services
			 shall submit to Congress a report on the study under paragraph (1).</text>
						</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID18CC9667FEAA48F99111948630102A1B"><enum>(3)</enum><header display-inline="yes-display-inline">Safe harbors described</header><text display-inline="yes-display-inline">For purposes of paragraphs (1) and (2), the
			 safe harbors described in this paragraph are—</text>
							<subparagraph commented="no" display-inline="no-display-inline" id="ID95B760399FE641B987482D3A4623DF81"><enum>(A)</enum><text display-inline="yes-display-inline">the safe harbor under section 1128A(b)(4)
			 of such Act (42 U.S.C. 1320a–7a(b)(4)), as added by subsection (a)(1);
			 and</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID4860D7948E794E09BC0819EA2B5F1244"><enum>(B)</enum><text display-inline="yes-display-inline">the safe harbor under section
			 1128B(b)(3)(J) of such Act (42 U.S.C. 1320a–7b(b)(3)(J)), as added by
			 subsection (b).</text>
							</subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="IDA535228AF37E477BB71ED37E38B0A192" section-type="subsequent-section"><enum>612.</enum><header display-inline="yes-display-inline">Exception to limitation on certain
			 physician referrals (under stark) for provision of health information
			 technology and training services to health care professionals</header>
					<subsection commented="no" display-inline="no-display-inline" id="IDB86DB4430D1E404F97EEDD97E103FB47"><enum>(a)</enum><header display-inline="yes-display-inline">In General</header><text display-inline="yes-display-inline">Section 1877(b) of the
			 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1395nn(b)) is amended by adding at the end the following new paragraph:</text>
						<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="ID3E3252596A844EBCBC51238D5A5D25E0" style="OLC">
							<paragraph commented="no" display-inline="no-display-inline" id="ID7AFBCAC18CAB4CEA999D0ED935F7EF19"><enum>(6)</enum><header display-inline="yes-display-inline">Information technology and training
				services</header>
								<subparagraph commented="no" display-inline="no-display-inline" id="ID9732193598974622970955B295A2E607"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Any nonmonetary remuneration (in the form
				of health information technology or related installation, maintenance, support
				or training services) made by a specified entity to a physician if—</text>
									<clause commented="no" display-inline="no-display-inline" id="IDF667B4ED24FA48D5BCD066A748221328"><enum>(i)</enum><text display-inline="yes-display-inline">the provision of such remuneration is
				without an agreement between the parties or legal condition that—</text>
										<subclause commented="no" display-inline="no-display-inline" id="ID10B24D12501C488798C4EC8AE2B61445"><enum>(I)</enum><text display-inline="yes-display-inline">limits or restricts the use of the health
				information technology to services provided by the physician to individuals
				receiving services at the specified entity;</text>
										</subclause><subclause commented="no" display-inline="no-display-inline" id="IDF42E04A7514644BC8ABE158C5135A96F"><enum>(II)</enum><text display-inline="yes-display-inline">limits or restricts the use of the health
				information technology in conjunction with other health information technology;
				or</text>
										</subclause><subclause commented="no" display-inline="no-display-inline" id="IDE1944E89C25E440AB310B4F80132877E"><enum>(III)</enum><text display-inline="yes-display-inline">conditions the provision of such
				remuneration on the referral of patients or business to the specified
				entity;</text>
										</subclause></clause><clause commented="no" display-inline="no-display-inline" id="ID95A75BFDCEA241F48E1CBB7BB7A79981"><enum>(ii)</enum><text display-inline="yes-display-inline">such remuneration is arranged for in a
				written agreement that is signed by the parties involved (or their
				representatives) and that specifies the remuneration made and states that the
				provision of such remuneration is made for the primary purpose of better
				coordination of care or improvement of health quality, efficiency, or research;
				and</text>
									</clause><clause commented="no" display-inline="no-display-inline" id="IDE0A804379CA14F3AA5AD280E36B0676C"><enum>(iii)</enum><text display-inline="yes-display-inline">the specified entity (or a representative
				of such entity) has not taken any action to disable any basic feature of any
				hardware or software component of such remuneration that would permit
				interoperability.</text>
									</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID98D80CDCCB5D4A278AFC27C7C5D04C76"><enum>(B)</enum><header display-inline="yes-display-inline">Health information technology
				defined</header><text display-inline="yes-display-inline">For purposes of this
				paragraph, the term <term>health information technology</term> means hardware,
				software, license, right, intellectual property, equipment, or other
				information technology (including new versions, upgrades, and connectivity)
				designed or provided primarily for the electronic creation, maintenance, or
				exchange of health information to better coordinate care or improve health care
				quality, efficiency, or research.</text>
								</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID7640CB4252B54A1F94A2F57A19BC6662"><enum>(C)</enum><header display-inline="yes-display-inline">Specified entity defined</header><text display-inline="yes-display-inline">For purposes of this paragraph, the term
				<term>specified entity</term> means an entity that is a hospital, group
				practice, prescription drug plan sponsor, a Medicare Advantage organization, or
				any other such entity specified by the Secretary, considering the goals and
				objectives of this section, as well as the goals to better coordinate the
				delivery of health care and to promote the adoption and use of health
				information
				technology.</text>
								</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection><subsection commented="no" display-inline="no-display-inline" id="IDCE15623E723D4A7F93CF7191F22B9735"><enum>(b)</enum><header display-inline="yes-display-inline">Effective Date; Effect on State
			 Laws</header>
						<paragraph commented="no" display-inline="no-display-inline" id="ID66E75E2CE8614BB796B7D62B173ACE5E"><enum>(1)</enum><header display-inline="yes-display-inline">Effective
			 date</header><text display-inline="yes-display-inline">The amendment made by
			 subsection (a) shall take effect on the date that is 120 days after the date of
			 the enactment of this Act.</text>
						</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDBEF5BAAB7BEE4CACA3AA272BDC6819AC"><enum>(2)</enum><header display-inline="yes-display-inline">Preemption of state laws</header><text display-inline="yes-display-inline">No State (as defined in section 1101(a) of
			 the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1301(a)) for purposes of title XI of such Act) shall have in effect a State law
			 that imposes a criminal or civil penalty for a transaction described in section
			 1877(b)(6) of such Act, as added by subsection (a), if the conditions described
			 in such section, with respect to such transaction, are met.</text>
						</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID9E462A66545742F983DB9A17EEF59F8F"><enum>(c)</enum><header display-inline="yes-display-inline">Study and Report To Assess Effect of
			 Exception on Health System</header>
						<paragraph commented="no" display-inline="no-display-inline" id="ID73BDF8A4359C420A8DE1FE6B6D7F4B40"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services
			 shall conduct a study to determine the impact of the exception under section
			 1877(b)(6) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395nn">42 U.S.C. 1395nn(b)(6)</external-xref>), as added by subsection (a). In
			 particular, the study shall examine the following:</text>
							<subparagraph commented="no" display-inline="no-display-inline" id="IDEF6830FBCAC54184BC282E8CC2DE058E"><enum>(A)</enum><text display-inline="yes-display-inline">The effectiveness of the exception in
			 increasing the adoption of health information technology.</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID052C996A684D42B3BA20928883A15EFE"><enum>(B)</enum><text display-inline="yes-display-inline">The types of health information technology
			 provided under the exception.</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID6019685720974859ABE2070E2BBB831F"><enum>(C)</enum><text display-inline="yes-display-inline">The extent to which the financial or other
			 business relationships between providers under the exception have changed as a
			 result of the exception in a way that adversely affects or benefits the health
			 care system or choices available to consumers.</text>
							</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID5917A5541F6E4C3B9EC96E782B61A235"><enum>(D)</enum><text display-inline="yes-display-inline">The impact of the adoption of health
			 information technology on health care quality, cost, and access under the
			 exception.</text>
							</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDDF3A465DC4184F4C8B0DCE18D0FE2C62"><enum>(2)</enum><header display-inline="yes-display-inline">Report</header><text display-inline="yes-display-inline">Not later than 3 years after the effective
			 date described in subsection (b)(1), the Secretary of Health and Human Services
			 shall submit to Congress a report on the study under paragraph (1).</text>
						</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID92075C45CF4F4F5ABC71D19D5D99BAC8" section-type="subsequent-section"><enum>613.</enum><header display-inline="yes-display-inline">Rules of construction regarding use of
			 consortia</header>
					<subsection commented="no" display-inline="no-display-inline" id="ID3C84FE7F749B4D57B4446A6DA83FE6DA"><enum>(a)</enum><header display-inline="yes-display-inline">Application to Safe Harbor From Criminal
			 Penalties</header><text display-inline="yes-display-inline">Section 1128B(b)(3)
			 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1320a–7b(b)(3)) is amended by adding after and below subparagraph (J), as added
			 by section 611(b)(1), the following: <quote>For purposes of subparagraph (J),
			 nothing in such subparagraph shall be construed as preventing a specified
			 entity, consistent with the specific requirements of such subparagraph, from
			 forming a consortium composed of health care providers, payers, employers, and
			 other interested entities to collectively purchase and donate health
			 information technology, or from offering health care providers a choice of
			 health information technology products in order to take into account the
			 varying needs of such providers receiving such products.</quote>.</text>
					</subsection><subsection commented="no" display-inline="no-display-inline" id="IDB9CCEC7ED8704F388EE588E9A2323982"><enum>(b)</enum><header display-inline="yes-display-inline">Application to Stark
			 Exception</header><text display-inline="yes-display-inline">Paragraph (6) of
			 section 1877(b) of the <act-name parsable-cite="SSA">Social Security
			 Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395nn">42 U.S.C. 1395nn(b)</external-xref>), as added by section 612(a), is amended by
			 adding at the end the following new subparagraph:</text>
						<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="ID0E5C25ACA1784381BECC667EDEE43D31" style="OLC">
							<subparagraph commented="no" display-inline="no-display-inline" id="ID4CBBB26F555E4448AB2A7CF6DD6AF8C3"><enum>(D)</enum><header display-inline="yes-display-inline">Rule of construction</header><text display-inline="yes-display-inline">For purposes of subparagraph (A), nothing
				in such subparagraph shall be construed as preventing a specified entity,
				consistent with the specific requirements of such subparagraph, from—</text>
								<clause commented="no" display-inline="no-display-inline" id="IDBF5F8658E4F64792A494C328D79F6483"><enum>(i)</enum><text display-inline="yes-display-inline">forming a consortium composed of health
				care providers, payers, employers, and other interested entities to
				collectively purchase and donate health information technology; or</text>
								</clause><clause commented="no" display-inline="no-display-inline" id="IDF096C26C19F64F5B919651122847AB7A"><enum>(ii)</enum><text display-inline="yes-display-inline">offering health care providers a choice of
				health information technology products in order to take into account the
				varying needs of such providers receiving such
				products.</text>
								</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subsection></section></subtitle></title></legis-body>
</bill>


