110 HR 7129 IH: Preexisting Condition Exclusion
U.S. House of Representatives
2008-09-26
text/xml
EN
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.
1.Short title; table of
contents
(a)This Act may be cited
as the Several Approaches to Reduce
the Uninsured Act of 2008
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Promotion under ERISA of State-based expansion of health
care coverage
Sec. 101. Exemption from ERISA preemption for State
comprehensive health care programs.
Sec. 102. State coverage buy-in arrangements and small employer
coverage buy-in arrangements.
Sec. 103. Exemption from preemption to permit pay or play under
State law.
Sec. 104. Exemption from preemption to permit mandates for data
collection under State law relating to group health plans.
Title II—Health Partnership Through Creative
Federalism
Sec. 201. Short title.
Sec. 202. State health reform projects.
Sec. 203. Effective date.
Title III—Demonstration Project for Employer Buy-In
Sec. 301. Demonstration project for employer
buy-in.
Title IV—Access to Health Benefits Through Regional State
Arrangements
Sec. 401. Promoting access through regional State arrangements
under a demonstration project.
Sec. 402. Transparency and accountability for health benefit
plans.
Title V—Amendments Relating to Preexisting Condition
Exclusion
Sec. 501. Short title.
Sec. 502. Amendments relating to preexisting condition
exclusions under group health plans.
Sec. 503. Amendments relating to preexisting condition
exclusions in health insurance coverage in the individual market.
<enum>I</enum><header>Promotion under
ERISA of State-based expansion of health care coverage</header>
<section id="HDE7185ED46144C13A55C42168263D4F" section-type="subsequent-section"><enum>101.</enum><header>Exemption from ERISA
preemption for State comprehensive health care programs</header>
<subsection id="HD2FE8356EFBF46EA8C5C00FE72BA52CF"><enum>(a)</enum><header>Exemption from
preemption</header><text display-inline="yes-display-inline">Section 514(b) of
the Employee Retirement Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1144">29 U.S.C. 1144(b)</external-xref>) is
amended—</text>
<paragraph id="HEDC6FD7BB3A24F5D8BE3001C56BD7768"><enum>(1)</enum><text>by redesignating
paragraph (9) as paragraph (10); and</text>
</paragraph><paragraph id="HF6D53386CB4442DBACD90020025016E3"><enum>(2)</enum><text>by inserting after
paragraph (8) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H7BDE12F566E147F9986B194CFEDDBA38" style="traditional">
<paragraph id="HD1E2532E6E1946F791394E393FF93000" indent="up1"><enum>(9)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H2404290B5B7C4136806F8C07A455B411"><enum>(A)</enum><text>Except as provided in
subparagraph (B), subsection (a) shall not apply to any program established by
or under the laws of any State which is listed pursuant to section 721 as a
State comprehensive health care program (as defined in section 722(a)).</text>
</subparagraph><subparagraph id="H3DA481F8900642FB881B4C8763A5B0F1" indent="up1"><enum>(B)</enum><text>Nothing in subparagraph (A) shall be
construed to exempt from subsection (a) any State tax law relating to employee
benefit plans.</text>
</subparagraph><subparagraph id="H7CDEE82190544EF9BD2285B4E07B469B" indent="up1"><enum>(C)</enum><text>Notwithstanding subparagraph (A),
parts 1 and 4 of this subtitle, and the preceding sections of this part to the
extent they govern matters which are governed by the provisions of such parts 1
and 4, shall supersede any program described in subparagraph (A), but the
Secretary may enter into cooperative arrangements under this paragraph and
section 506 with officials of the State involved to assist them in effectuating
the policies of the provisions of such program which are superseded by such
parts 1 and 4 and the preceding sections of this
part.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H6DC523EC65DC47F0AD48ECD2086C4FF4"><enum>(b)</enum><header>State
comprehensive health care programs</header>
<paragraph id="H8A3CFB3F2EFD4BDEBE779976C92D2F46"><enum>(1)</enum><header>In
general</header><text>Part 7 of subtitle B of title I of such Act (29 U.S.C.
1181 et seq.) is amended—</text>
<subparagraph id="H7A2871966CBA47F08E6E97D3D4D9A18B"><enum>(A)</enum><text>by redesignating
subpart C ad subpart D; and</text>
</subparagraph><subparagraph id="HCEA97889A54F4916BC2CA14800EEF127"><enum>(B)</enum><text>by inserting after
subpart B the following new subpart:</text>
<quoted-block display-inline="no-display-inline" id="H028182974F6849A00040CE808C00E533" style="OLC">
<subpart id="H8BEAF33775CE4BC6863482698E527373"><enum>C</enum><header>State
comprehensive health care programs</header>
<section id="HC0857D2FA4EE4431B3AA7B278C881831"><enum>721.</enum><header>Designation of
State comprehensive health care programs exempt from Federal
preemption</header><text display-inline="no-display-inline">The Secretary
shall, for purposes of the application section 514(b)(9), establish and
maintain a comprehensive list of which programs (if any) established by or
under the laws of each State constitute, as determined by the Secretary, State
comprehensive health care programs. The Secretary shall undertake an ongoing
review of such list so as to ensure such list remains comprehensive and
exclusive of any programs which may have ceased to be State comprehensive
health care programs. Such list shall be periodically published in the Federal
Register and maintained so as to be readily accessible to the general
public.</text>
</section><section id="HC70AF8757B0549D4B2FBEC00996134"><enum>722.</enum><header>Requirements</header>
<subsection display-inline="no-display-inline" id="HFB35333C26F94D67B42BF6625CE75816"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">For purposes of this
subpart and section 514(b)(9), the term <term>State comprehensive health care
program</term> means a program established by or under the laws of any State
under which—</text>
<paragraph commented="no" id="H8781FF62E58C4AF3A912BCF70DB578C"><enum>(1)</enum><text>residents of such
State are required to obtain and maintain health insurance coverage meeting the
Federal threshold of adequate medical care,</text>
</paragraph><paragraph id="HC24AB373A0FC480D00BF2604352F643C"><enum>(2)</enum><text display-inline="yes-display-inline">each employer employing individuals in such
State—</text>
<subparagraph id="HF68933DC2090471283DFB88DC1C0EB97"><enum>(A)</enum><text>that is not a
small employer within the meaning of subsection (c) for a calendar year,</text>
</subparagraph><subparagraph id="H22B06ECD3328470E9BC373BE24AC2FE"><enum>(B)</enum><text>that does not
otherwise provide group health plan coverage for its employees which provides
benefits meeting the criteria for the Federal threshold of adequate medical
care (as described in subsection (d)) for such calendar year, and</text>
</subparagraph><subparagraph id="H6E0C73882BD6440EA82465DDA0166EBE"><enum>(C)</enum><text>in whose case the
Secretary has not waived the requirements of this subsection for such calendar
year pursuant to subsection (e) on the basis of substantial business
hardship,</text>
</subparagraph><continuation-text continuation-text-level="paragraph">is
required to establish and maintain a group health plan for such employees for
such calendar year providing benefits which meet the Federal threshold of
adequate medical care.</continuation-text></paragraph></subsection><subsection id="H9CC9DC5C145F4638A11126D463F4EA5B"><enum>(b)</enum><header>Single program
per State</header><text>A program may be considered a State comprehensive
health care program in connection with any State only if it is the only such
program in effect by or under the laws of such State.</text>
</subsection><subsection id="H5950899FE52C4B768182C3D4E48EBABA"><enum>(c)</enum><header>Federal
threshold of adequate medical care</header><text>For purposes of this section,
the term <term>Federal threshold of adequate medical care</term> means the
package of benefits constituting medical care which the Comprehensive Health
Care Commission currently maintains as the Federal threshold of adequate
medical care as prescribed pursuant to section 723(f)(1).</text>
</subsection><subsection id="HB181A39BBACB4C55831EC2A9626CA15D"><enum>(d)</enum><header>Small
employers</header>
<paragraph id="HDB4E3BA111664E4380CDA1D48E4C1D45"><enum>(1)</enum><header>In
general</header><text>For purposes of subsection (a)(2), the term `small
employer' means, with respect to a calendar year, an employer who employed an
average of at least 2 but not more than 100 employees on business days during
the preceding calendar year and who employs at least 2 employees on the first
day of the current calendar year. For purposes of the preceding sentence, all
persons treated as a single employer under subsection (b), (c), (m), or (o) of
<external-xref legal-doc="usc" parsable-cite="usc/26/414">section 414</external-xref> of the Internal Revenue Code of 1986 shall be treated as 1
employer.</text>
</paragraph><paragraph id="H1B774F45D7FD4F19B351B4EBA1A653E8"><enum>(2)</enum><header>Employers not in
existence in preceding year</header><text>In the case of an employer which was
not in existence throughout the preceding calendar year, the determination of
whether such employer is a small employer shall be based on the average number
of employees that it is reasonably expected such employer will employ on
business days in the current calendar year.</text>
</paragraph><paragraph id="HEDFE9893D5F646AE931EA76657A523A5"><enum>(3)</enum><header>Predecessors</header><text>Any
reference in this subsection to an employer shall include a reference to any
predecessor of such employer.</text>
</paragraph></subsection><subsection id="H507C6BFB62794C949073FE09B2F5AD5B"><enum>(e)</enum><header>Exception
allowed for employers otherwise providing group health plan
coverage</header><text display-inline="yes-display-inline">For purposes of
subsection (a)(2), an employer shall be treated, for any current calendar year,
as otherwise providing coverage of an employee under a group health plan for
its employees which meets the criteria for the Federal threshold of adequate
medical care if, with respect to such calendar year, such employee—</text>
<paragraph id="H0957D518180549FC9D6D88E7B0D546EC"><enum>(1)</enum><text>was eligible under
such a group health plan maintained by the employer for the preceding calendar
year, or</text>
</paragraph><paragraph id="H0ABDB622FB5A49B490D4DA12D382F082"><enum>(2)</enum><text>may be reasonably
expected to be eligible during the current calendar year under a group health
plan referred to in paragraph (1).</text>
</paragraph></subsection><subsection id="H2A726604977142CEA7B65CB33FC523C2"><enum>(f)</enum><header>Waiver in cases
of substantial business hardship</header>
<paragraph id="HE9776E9F75DB4F7B9E30A30085D30062"><enum>(1)</enum><header>In
general</header><text>If an employer is unable to satisfy the requirements of
subsection (a) for any calendar year without substantial business hardship and
application of such requirements for such calendar year would be adverse to the
interests of plan participants in the aggregate, the Secretary may waive the
requirements of subsection (a) for such calendar year. The Secretary shall not
waive such requirements with respect to a plan for more than 3 of any 15
consecutive calendar years.</text>
</paragraph><paragraph id="HD00F2867132940E9BEACC0638966B6E"><enum>(2)</enum><header>Determination of
substantial business hardship</header><text>For purposes of this section, the
factors taken into account in determining substantial business hardship shall
include (but shall not be limited to) whether or not—</text>
<subparagraph id="H04E90A5207224F25A0FA269DB8029DD2"><enum>(A)</enum><text>the employer is
operating at an economic loss,</text>
</subparagraph><subparagraph id="HE20550D7F59E422CA52300D2DADD9E68"><enum>(B)</enum><text>there is
substantial unemployment or under-employment in the trade or business and in
the industry concerned,</text>
</subparagraph><subparagraph id="H7CD7454193624E0BA5166DB4D4FF2893"><enum>(C)</enum><text>the sales and
profits of the industry concerned are depressed or declining, and</text>
</subparagraph><subparagraph id="H4A4D1CB3C59B4796BEAAFD59526A800"><enum>(D)</enum><text>it is reasonable to
expect that the plan will be established or maintained only if the waiver is
granted.</text>
</subparagraph></paragraph></subsection></section><section id="HAB7B8CE88FCE4F7C9CB0F85D64CCD9D7"><enum>723.</enum><header>Comprehensive
Health Care Commission</header>
<subsection display-inline="no-display-inline" id="H6871F1A722C44A4E85F8BBA918DC5B1"><enum>(a)</enum><header>Establishment</header><text>The
Secretary, in consultation with the Secretary of Health and Human Services,
shall establish a commission to be known as the Comprehensive Health Care
Commission (referred to in this section as the
<quote>Commission</quote>).</text>
</subsection><subsection id="H07DC945AD8334FD18FF6EEB73BB671C5"><enum>(b)</enum><header>Membership</header>
<paragraph id="HBB0AAA2E74044A1F9C0491E901A83544"><enum>(1)</enum><header>Number and
appointment</header><text>The Commission shall be composed of 15 members
appointed by the Secretary, in consultation with the Secretary of Health and
Human Services.</text>
</paragraph><paragraph id="H2F94185A7672433C8B77D17242DD7E33"><enum>(2)</enum><header>Qualifications</header>
<subparagraph id="H57739C594B9E4BA0A2331751C248BDB"><enum>(A)</enum><header>In
general</header><text>The membership of the Commission shall include—</text>
<clause id="H4E04F1A4155749DD9850A43628EC38AB"><enum>(i)</enum><text>consumers of
health services that represent those individuals who have not had insurance
within 2 years of appointment, that have had chronic illnesses, including
mental illness, are disabled, and those who receive insurance coverage through
medicare and medicaid; and</text>
</clause><clause id="H6DBFD109AAE44EC3A2E72D11BE411FFF"><enum>(ii)</enum><text>individuals with
expertise in financing and paying for benefits and access to care, business and
labor perspectives, and providers of health care. The membership shall reflect
a broad geographic representation and a balance between urban and rural
representatives.</text>
</clause></subparagraph><subparagraph id="HBCCF64C8D3384F77B5CE7E7BE22456C7"><enum>(B)</enum><header>Prohibited
appointments</header><text>Members of the Commission shall not include Members
of Congress or other elected government officials (Federal, State, or local).
Individuals appointed to the Commission shall not be paid employees or
representatives of associations or advocacy organizations involved in the
health care system.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HD6E5B56EC6EC4D03922FE6FAE1A50156"><enum>(c)</enum><header>Periods of
appointment</header><text>Members of the Commission shall serve for terms of 6
years, except that, of the members first appointed—</text>
<paragraph commented="no" id="H7F369B0517214BDA857977889E00C661"><enum>(1)</enum><text>5 shall serve for
a term of 2 years,</text>
</paragraph><paragraph commented="no" id="HE8666AB9356E4B15ACADBD7F4CA254"><enum>(2)</enum><text>5 shall serve for a
term of 4 years, and</text>
</paragraph><paragraph commented="no" id="H5937B446EC984F378376D52C67B9EE86"><enum>(3)</enum><text>5 shall serve for
a term of 6 years,</text>
</paragraph><continuation-text commented="no" continuation-text-level="subsection">as designated by the Secretary at
the time of appointment. Any vacancies shall not affect the power and duties of
the Commission but shall be filled in the same manner as the original
appointment.</continuation-text></subsection><subsection id="H2295708072C4426800B77E6BE452253F"><enum>(d)</enum><header>Designation of
the chairperson</header><text>The Secretary shall designate the chairperson of
the Commission.</text>
</subsection><subsection id="HD15C8A26759D441A90318D26008272B"><enum>(e)</enum><header>Subcommittees</header><text>The
Commission may establish subcommittees if doing so increases the efficiency of
the Commission in completing its tasks.</text>
</subsection><subsection id="H4D8F4F6E15F84ED492CB0702B03DF2EA"><enum>(f)</enum><header>Duties</header>
<paragraph id="H42456E3BB5D74C7DA0B23D00C3E4B854"><enum>(1)</enum><header>In
general</header><text>The Commission shall prescribe, and from time to time
revise as the Commission deems appropriate, a package of benefits constituting
medical care which it determines to be, for purposes of this part, the Federal
threshold of adequate medical care.</text>
</paragraph><paragraph id="HE1C056A21AF246D3AC0882738F473243"><enum>(2)</enum><header>Hearings</header><text>The
Commission may hold hearings which are determined by the Commission to be
necessary by the Commission in carrying out its duties.</text>
</paragraph><paragraph commented="no" id="H34D748CA8D754C97B15802CB839B8D3B"><enum>(3)</enum><header>Community
meetings</header>
<subparagraph commented="no" id="H8359F93F80294D2A96615E924081156E"><enum>(A)</enum><header>In
general</header><text>Not later than 1 year after the date on which all the
members of the Commission have been appointed under subsection (b)(1) and
appropriations are first made available to carry out this section, the
Commission shall annually provide for health care community meetings throughout
the United States (in this paragraph referred to as <quote>community
meetings</quote>). Such community meetings may be geographically or regionally
based.</text>
</subparagraph><subparagraph commented="no" id="H71B8368A89124625B1D5CF419DB91B83"><enum>(B)</enum><header>Frequency of
meetings</header><text>The Commission shall ensure that community meetings are
held with such frequency as to ensure that the Commission receives information
that reflects, on an ongoing basis—</text>
<clause commented="no" id="H05F50C2B80D542BA8D8276A24D0800A0"><enum>(i)</enum><text>the geographic
differences throughout the United States;</text>
</clause><clause commented="no" id="HB3C434712B9949D4B15CC6001B1471A2"><enum>(ii)</enum><text>diverse
populations; and</text>
</clause><clause commented="no" id="HE014849262104868B264AF3B8B47598D"><enum>(iii)</enum><text>a balance among
urban and rural populations.</text>
</clause></subparagraph><subparagraph commented="no" id="HC3E7EFA9F46342DABF0053641C4531F7"><enum>(C)</enum><header>Meeting
requirements</header>
<clause commented="no" id="H4EB332117F114DC3B8F1CBD1C2F003B"><enum>(i)</enum><header>Facilitator</header><text>A
State health officer may be the facilitator at the community meetings.</text>
</clause><clause commented="no" id="H5B6FB387947E4C35A24C00A0ACA7C4F1"><enum>(ii)</enum><header>Attendance</header><text>At
least 1 member of the Commission shall attend and serve as chair of each
community meeting. Other members may participate through interactive
technology.</text>
</clause><clause commented="no" id="H7CFCE09EA8734BF9A63701895696004F"><enum>(iii)</enum><header>Topics</header><text>The
community meetings shall, at a minimum, address the following questions:</text>
<subclause commented="no" id="H1AA38CF19DBB404F93324123AECB789E"><enum>(I)</enum><text>What health care
benefits and services should be provided?</text>
</subclause><subclause commented="no" id="H325938D53C314B81A8C3282616CABB02"><enum>(II)</enum><text>How does the
American public want health care delivered?</text>
</subclause><subclause commented="no" id="HEC2344F5CEA240C3A2C6001E87002CC2"><enum>(III)</enum><text>How should
health care coverage be financed?</text>
</subclause><subclause commented="no" id="H6FA0FEE78734433BB800D3C18C004B71"><enum>(IV)</enum><text>What trade-offs
are the American public willing to make in either benefits or financing to
ensure access to affordable, high quality health care coverage and
services?</text>
</subclause></clause><clause commented="no" id="H0637EC9FC05E412A9255FDE8E200AD68"><enum>(iv)</enum><header>Interactive
technology</header><text>The Commission may encourage public participation in
community meetings through interactive technology and other means as determined
appropriate by the Commission.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H5B09D31DE6394F119459AC0294F62C39"><enum>(g)</enum><header>Administration</header>
<paragraph id="H50BA9CDA3EE14A9DB49D6B608F4C0001"><enum>(1)</enum><header>Executive
Director</header><text>There shall be an Executive Director of the Commission
who shall be appointed by the chairperson of the Commission in consultation
with the members of the Commission.</text>
</paragraph><paragraph id="H3AB98ABA63F34F1C80F0CCED00792FCF"><enum>(2)</enum><header>Compensation</header><text>While
serving on the business of the Commission (including travel time), a member of
the Commission shall be entitled to compensation at the per diem equivalent of
the rate provided for level IV of the Executive Schedule under section 5315 of
title 5, United States Code, and while so serving away from home and the
member's regular place of business, a member may be allowed travel expenses, as
authorized by the chairperson of the Commission. For purposes of pay and
employment benefits, rights, and privileges, all personnel of the Commission
shall be treated as if they were employees of the Senate.</text>
</paragraph><paragraph id="HE942E519B5D846B18C4700FB7629FCB2"><enum>(3)</enum><header>Information from
Federal agencies</header><text>The Commission may secure directly from any
Federal department or agency such information as the Commission considers
necessary to carry out this section. Upon request of the Commission, the head
of such department or agency shall furnish such information.</text>
</paragraph><paragraph id="H3A7D04F086BF42AEB3E3121B02F67F66"><enum>(4)</enum><header>Postal
services</header><text>The Commission may use the United States mails in the
same manner and under the same conditions as other departments and agencies of
the Federal Government.</text>
</paragraph></subsection><subsection id="H9EBC8FC791D54ED592E3D7C7F97443A5"><enum>(h)</enum><header>Detail</header><text>Not
more than 10 Federal Government employees employed by the Department of Labor
and 10 Federal Government employees employed by the Department of Health and
Human Services may be detailed to the Commission under this section without
further reimbursement. Any detail of an employee shall be without interruption
or loss of civil service status or privilege.</text>
</subsection><subsection id="HDFB777FC634344B4A29309AB715023E7"><enum>(i)</enum><header>Temporary and
intermittent services</header><text>The chairperson of the Commission may
procure temporary and intermittent services under <external-xref legal-doc="usc" parsable-cite="usc/5/3109">section 3109(b)</external-xref> of title 5,
United States Code, at rates for individuals which do not exceed the daily
equivalent of the annual rate of basic pay prescribed for level V of the
Executive Schedule under section 5316 of such title.</text>
</subsection><subsection id="H1DF6D54B1F29473C8D9561BE32CB3E7D"><enum>(j)</enum><header>Annual
report</header><text>Not later than 1 year after the date of enactment of this
Act, and annually thereafter, the Commission shall report to Congress and make
public a detailed description of the expenditures of the Commission used to
carry out its duties under this section.</text>
</subsection><subsection commented="no" id="H5C1D1D053E6E42589035B5A4B7A46DC3"><enum>(k)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated to carry
out this section $3,000,000 for each fiscal year beginning on or after October
1,
2008.</text>
</subsection></section></subpart><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H29E1955317A34DF8B06B0100943648E"><enum>(2)</enum><header>Conforming
amendments</header><text>The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 713 the following new
items:</text>
<quoted-block display-inline="no-display-inline" id="HC7D9ECA4FD5C407692BAF9FA29EEF51" style="OLC">
<toc container-level="quoted-block-container" idref="H028182974F6849A00040CE808C00E533" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="H8BEAF33775CE4BC6863482698E527373" level="subpart">Subpart C—State comprehensive health care programs</toc-entry>
<toc-entry idref="HC0857D2FA4EE4431B3AA7B278C881831" level="section">Sec. 721. Designation of State comprehensive health care
programs exempt from Federal preemption.</toc-entry>
<toc-entry idref="HC70AF8757B0549D4B2FBEC00996134" level="section">Sec. 722. Requirements.</toc-entry>
<toc-entry idref="HAB7B8CE88FCE4F7C9CB0F85D64CCD9D7" level="section">Sec. 723. Comprehensive Health Care
Commission.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HF0F8F2B0B7AE47EE93C16DA5565E32F7" section-type="subsequent-section"><enum>102.</enum><header>State coverage
buy-in arrangements and small employer coverage buy-in arrangements</header>
<subsection id="H4D839E7C49A04C1896CA9D64FD8938F4"><enum>(a)</enum><header>Authorization
for inclusion of individuals as participants in group health plans under State
coverage buy-In arrangements</header><text display-inline="yes-display-inline">Section 404 of the Employee Retirement
Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1104">29 U.S.C. 1104</external-xref>) is amended by adding at the end
the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HD5AA6418594F496D80E6F6558574B7C3" style="traditional">
<subsection id="HBEA4C162DFCF49A381CF3D485888FEE2"><enum>(e)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H2E73FF5BF6C64708B999681DEDD626EA"><enum>(1)</enum><text>Any requirement of the
preceding provisions of this section or any other provision of this title shall
not be treated as violated by reason of the entry of the plan administrator
into a State coverage buy-in arrangement or the treatment as a participant
under the plan, pursuant to such an arrangement, of an individual who is not an
employee, former employee, or member or former member of an employee
organization described in section 3(7)(A) in connection with the plan.</text>
</paragraph><paragraph id="HC8E66317716D4E1282D91EACC3DAC3AC" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1), the
term <term>State coverage buy-in arrangement</term> means an arrangement
entered into between the plan administrator of a group health plan and a State
pursuant to which—</text>
<subparagraph id="H3244589151B946538D885401723D4D71"><enum>(A)</enum><text>individuals who are residents of such
State, are identified under the arrangement, and are not otherwise participants
(within the meaning of section 3(7)(A)) in the plan are treated as participants
in the plan,</text>
</subparagraph><subparagraph id="H42AC3D5CEC8043F4918F7D1C99E1A343"><enum>(B)</enum><text>premiums are payable to the plan, by
such individuals, by the State on behalf of such individuals, or by both, in
total amounts equivalent to the total cost of coverage of the individuals and
their beneficiaries under the plan, and</text>
</subparagraph><subparagraph commented="no" id="HD364AC82D2574FB18739BAABC172344B"><enum>(C)</enum><text>the Secretary determines, under a
procedure providing for determinations prior to the entry into the arrangement,
and annually thereafter during the term of the arrangement, that the
arrangement is—</text>
<clause commented="no" id="H26AAAC08C6D44744906126C074CFFBA5"><enum>(i)</enum><text>administratively feasible,</text>
</clause><clause commented="no" id="HB21AE2EC099D403D8FCFD1B7E856665B"><enum>(ii)</enum><text>in the interests of the plan and
of its participants and beneficiaries, and</text>
</clause><clause commented="no" id="H6FEA0A36A12A4887AE7F971FF1D02ED8"><enum>(iii)</enum><text>protective of the rights of
participants and beneficiaries of the plan.</text>
</clause></subparagraph></paragraph><paragraph id="H365513F8B038496AAA2057A957FE8D5F" indent="up1"><enum>(3)</enum><text>A fiduciary of a group health plan
shall have the same fiduciary duties with respect to participants and their
beneficiaries who are covered under a group health plan solely by reason of a
State coverage buy-in arrangement as are applicable with respect to individuals
who are otherwise participants or beneficiaries under the
plan.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection display-inline="no-display-inline" id="HA4931BC36CD04ADDB0EC00F941ECACD"><enum>(b)</enum><header>Authorization for
inclusion of employees of small employers as participants in group health plans
of large employers under small employer coverage buy-In
arrangements</header><text display-inline="yes-display-inline">Section 404 of
such Act (as amended by subsection (a)) is amended further by adding at the end
the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H0A45158CE845429AA5E6495D8398F222" style="traditional">
<subsection id="H377CDFDE236B4A7CBF05B9A65D00B959"><enum>(f)</enum><paragraph commented="no" display-inline="yes-display-inline" id="HB469F45B760540D9AFCA00587C91BD17"><enum>(1)</enum><text>Any requirement of the
preceding provisions of this section or any other provision of this title shall
not be treated as violated by reason of the entry of a small employer into a
small employer coverage buy-in arrangement with the plan administrator of a
large employer group health plan or the treatment as a participant under the
plan, pursuant to such an arrangement, of an individual who is an employee of
the small employer and who is not an employee or former employee of the plan
sponsor of the plan or a member or former member of an employee organization
referred to in section 3(7)(A) in connection with the plan.</text>
</paragraph><paragraph id="H19CDE1DDE10E4218892959F7E500DBA" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1), the
term <term>small employer coverage buy-in arrangement</term> means an
arrangement entered into between a small employer referred to in paragraph (1)
and a plan administrator of a large employer group health plan referred to in
paragraph (1) pursuant to which—</text>
<subparagraph id="HBE21CF1ACDF141B1BFBBB2A2FF3725B2"><enum>(A)</enum><text>individuals who are employees of the
small employer, are identified under such arrangement, and are not otherwise
participants (within the meaning of section 3(7)(A)) in the plan are treated as
participants in the plan,</text>
</subparagraph><subparagraph id="HEE49D25776654C81ABABF497D5CF1200"><enum>(B)</enum><text>premiums are payable to the plan, by
such individuals, by the small employer, or by both, in total amounts
equivalent to the total cost of coverage of such individuals and their
beneficiaries under the plan, and</text>
</subparagraph><subparagraph commented="no" id="H5402D123E35944A18320D39DC77F106B"><enum>(C)</enum><text>the Secretary determines, under a
procedure providing for determinations prior to the entry into the arrangement,
and annually thereafter during the term of the arrangement, that the
arrangement is—</text>
<clause commented="no" id="H905143F24DDB4473A4C9AD4FA0CF8C9B"><enum>(i)</enum><text>administratively feasible,</text>
</clause><clause commented="no" id="H1A925B6123114AA086C69ED5457E8E54"><enum>(ii)</enum><text>in the interests of the plan and
of its participants and beneficiaries, and</text>
</clause><clause commented="no" id="H5D85B953E15A4769BCB2C629DECCC041"><enum>(iii)</enum><text>protective of the rights of
participants and beneficiaries of the plan.</text>
</clause></subparagraph></paragraph><paragraph id="H4ABA3C586C0B460B9C8B8947FD60438" indent="up1"><enum>(3)</enum><text>A fiduciary of a group health plan
shall have the same fiduciary duties with respect to participants and their
beneficiaries who are covered under a group health plan solely by reason of a
small employer coverage buy-in arrangement as are applicable with respect to
individuals who are otherwise participants or beneficiaries under the
plan.</text>
</paragraph><paragraph id="H35EDEEE80FD1488D9F12084FC04AC02" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">For purposes of this subsection—</text>
<subparagraph display-inline="no-display-inline" id="HBB2208D0473746F39686BF43C1AC6785"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="HFEB473313D6741FC948206FAE0809462"><enum>(i)</enum><text>The term <term>small
employer</term> means, in connection with the calendar year in which the
arrangement referred to in paragraph (1) is entered into, an employer who, on
business days during the period commencing with the preceding calendar year and
ending on the date on which the arrangement referred to in paragraph (1) is
entered into, employed an average of at least 2 but not more than 50
employees.</text>
</clause><clause id="HC6933B87616045BB819FE3C1657B1C8E" indent="up1"><enum>(ii)</enum><text>For purposes of this
subparagraph—</text>
<subclause id="HBB19FA23B9004B3D9638643C4D4BDA10"><enum>(I)</enum><text>rules similar to the rules under
subsections (b), (c), (m), and (o) of section 414 of the Internal Revenue Code
of 1986 shall apply for purposes of treating persons as a single
employer;</text>
</subclause><subclause id="H25B90CCD32C24F83846D71FF895700E8"><enum>(II)</enum><text>in the case of an employer which
was not in existence throughout the period described in subparagraph (A), the
determination of whether the employer is a small employer shall be based on the
average number of employees that it is reasonably expected the employer will
employ on business days in the calendar year during which the arrangement
referred to in paragraph (1) is entered into; and</text>
</subclause><subclause id="H5A06476722AA4714A99D12234F1DC0A8"><enum>(III)</enum><text>any reference in this
subparagraph to an employer shall include a reference to any predecessor of the
employer.</text>
</subclause></clause></subparagraph><subparagraph id="H2403ADE7AB7E41F380606F75F700F79D"><enum>(B)</enum><text>The term <term>large employer group
health plan</term> means a group health plan with respect to which the plan
sponsor is not a small employer in connection with the calendar year in which
the arrangement referred to in paragraph (1) is entered
into.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H4FC3F76A3D774165B7A1A81BBBEA0AD"><enum>(c)</enum><header>Conforming
amendments</header>
<paragraph id="HACC3209AA3614FBEB1D3A51614201402"><enum>(1)</enum><header>Inclusion in
definition of participant</header><text>Section 3(7) of such Act (29 U.S.C.
1002(7)) is amended—</text>
<subparagraph id="HED212771C05C4EABBFBC14832E2287C7"><enum>(A)</enum><text>by inserting
<quote>(A)</quote> after <quote>(7)</quote>; and</text>
</subparagraph><subparagraph id="H1CA4BA967C464BE9B0B815F9379DE47D"><enum>(B)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HE9875637890749D38B168C7B6BD46BB3" style="traditional">
<subparagraph id="H93AAE20AC2F94CA7A354C1ACA0CE3119" indent="up2"><enum>(B)</enum><text>In connection with a group health
plan (as defined in section 733(a)), the term <term>participant</term> includes
any individual not described in subparagraph (A) who is treated as a
participant in connection with a State coverage buy-in arrangement entered into
pursuant to section 404(e) or a small employer coverage buy-in arrangement
entered into pursuant to section
404(f).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H1792B2854DD54ED4B0C5678327AE163F"><enum>(2)</enum><header>Exclusion from
definition of multiple employer welfare arrangement</header><text>Section
3(40)(A) of such Act (29 U.S.C. 1002(40((A)) is amended—</text>
<subparagraph id="H9E0A01029B3547AD88D238188E2310D4"><enum>(A)</enum><text>in clause (ii), by
striking <quote>or</quote>;</text>
</subparagraph><subparagraph id="H0007C2B9732F476B9B435019E3008774"><enum>(B)</enum><text>in clause (iii),
by striking <quote>association.</quote> and inserting <quote>association,
or</quote>; and</text>
</subparagraph><subparagraph id="H963E32730CAC46E9BF76EA449B997E67"><enum>(C)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="HA317DA1B880B4E8FA0F46CE06E31B87F" style="traditional">
<clause id="H7EA10178EF364C7B8EBBDD012B582E95" indent="up1"><enum>(iv)</enum><text>pursuant to subsection (e) or (f)
of section
404.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection display-inline="no-display-inline" id="H9D7EA01854D04B7C8C442ECD23265219"><enum>(d)</enum><header>Credit for
premiums paid under State coverage buy-In arrangements</header>
<paragraph id="HCDD5A3D9FAE3442882A6A0F181D14F71"><enum>(1)</enum><header>In
general</header><text>Subpart D of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to business related credits) is amended
by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HD81BAAFB326C45E6B992D3BD1502679" style="OLC">
<section id="H2E1AD3BCA889469BAC4078E4B89170D5"><enum>45Q.</enum><header>Premiums paid
under qualified coverage buy-in arrangements</header>
<subsection id="HF70B56F954E343AFBCEC0041E47FFE4D"><enum>(a)</enum><header>General
rule</header><text>For purposes of section 38, the qualified coverage buy-in
arrangement credit determined under this section for any taxable year is the
aggregate amount paid in the taxable year as premiums for qualified
participants under a qualified coverage buy-in arrangement.</text>
</subsection><subsection id="H4E1E7972A7B5423482683F22598DFA"><enum>(b)</enum><header>Definitions</header><text>For
purposes of this section—</text>
<paragraph id="HBC5A710D86E44EBDB443A745E900DD47"><enum>(1)</enum><header>Qualified
coverage buy-in arrangement</header><text>The term <term>qualified coverage
buy-in arrangement</term> means—</text>
<subparagraph id="H5F146DE5AB014D8DA464F0D8502BEA47"><enum>(A)</enum><text>a State coverage
buy-in arrangement, and</text>
</subparagraph><subparagraph id="HF21E9C701B954A3CAC4885562F60E7D0"><enum>(B)</enum><text>a small employer
coverage buy-in arrangement.</text>
</subparagraph></paragraph><paragraph id="H020140BDE90F4CF9B747A17A7F5E116"><enum>(2)</enum><header>State coverage
buy-in arrangement; small employer coverage buy-in
arrangement</header><text>The terms <term>State coverage buy-in
arrangement</term> and <term>small employer coverage buy-in arrangement</term>
have the respective meanings given such terms by subsections (e)(2) and (f)(2)
of section 404 of the Employee Retirement Income Security Act of 1974.</text>
</paragraph><paragraph id="HD8679E7C03FF4C94ACC0FB0008CDD43E"><enum>(3)</enum><header>Qualified
participant</header><text>The term <term>qualified participant</term> means a
participant (as defined in section 3(7)(B) of the Employee Retirement Income
Security Act of 1974).</text>
</paragraph><paragraph id="H4813A4881EF3452AB8857DFDF4A06960"><enum>(4)</enum><header>Premium</header><text>The
term <term>premium</term> means the applicable premium (as defined in section
4980B(f)(4)).</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HE174EF014ECD417D81D74700B61D66E4"><enum>(2)</enum><header>Credit allowed
as part of general business credit</header><text>Section 38(b) of such Code
(defining current year business credit) is amended by striking
<quote>plus</quote> at the end of paragraph (32), by striking the period at the
end of paragraph (33) and inserting <quote>, plus</quote>, and by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HD54481730C5B447CB01900F9E227EF5C" style="OLC">
<paragraph id="H4B25416F730645D986B9B078F871A571"><enum>(34)</enum><text display-inline="yes-display-inline">State coverage buy-in arrangement credit
determined under section
45Q(a).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H4333621BB78A4A02BD175B7802C0C36D"><enum>(3)</enum><header>Clerical
amendment</header><text>The table of sections for subpart D of part IV of
subchapter A of chapter 1 of such Code is amended by adding at the end the
following new item:</text>
<quoted-block display-inline="no-display-inline" id="H4470C70BFDD24856A70763BB2630064" style="OLC">
<toc container-level="quoted-block-container" idref="HD81BAAFB326C45E6B992D3BD1502679" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="H2E1AD3BCA889469BAC4078E4B89170D5" level="section">Sec. 45Q. Premiums paid under State coverage buy-in
arrangements.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HACD88B58FA2E49638547755261A047BC"><enum>(e)</enum><header>Effective
dates</header><text>The amendments made by subsections (a), (b), and (c) shall
apply with respect to arrangements entered into after December 31, 2008. The
amendments made by subsection (d) shall apply to costs paid or incurred in
taxable years beginning after December 31, 2008.</text>
</subsection></section><section display-inline="no-display-inline" id="H9220BC9BD0EB4B7C95F25CA5D06BFF87" section-type="subsequent-section"><enum>103.</enum><header>Exemption from
preemption to permit pay or play under State law</header><text display-inline="no-display-inline">Section 514(b) of the Employee Retirement
Income Security Act of 1974 (as amended by section 201) is amended
further—</text>
<paragraph id="HCCF42B5857EA4E53BDCEB7206568B900"><enum>(1)</enum><text>by redesignating
paragraph (10) as paragraph (11); and</text>
</paragraph><paragraph id="H03E725E3B88A4D6A81D203B1C003A2A0"><enum>(2)</enum><text>by inserting after
paragraph (9) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H1308805EDE914C7EAA028F11AF566463" style="traditional">
<paragraph id="H48D8E3C55BB74D47815CEDDE8DFFEFB" indent="up1"><enum>(10)</enum><text display-inline="yes-display-inline">Subsection (a) shall not apply to any
provision of State law to the extent it provides an assessment against an
employer, or a credit against an otherwise applicable assessment against an
employer, based on whether, or the extent to which, such employer makes
contributions to a group health plan established or maintained by such
employer, if such provision does not condition the applicability of the
assessment or credit on the satisfaction of any requirement applicable to such
plan.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section display-inline="no-display-inline" id="HDE3DE9852F36472DAF05EAF04CBB01E4" section-type="subsequent-section"><enum>104.</enum><header>Exemption from
preemption to permit mandates for data collection under State law relating to
group health plans</header><text display-inline="no-display-inline">Section
514(b) of the Employee Retirement Income Security Act of 1974 (as amended by
the preceding provisions of this title) is amended further—</text>
<paragraph id="HF97842BC96A04337B7C8BAAA2ECEAF84"><enum>(1)</enum><text>by redesignating
paragraph (11) as paragraph (12); and</text>
</paragraph><paragraph id="HD25FD182976F4B33A93B96702F108C33"><enum>(2)</enum><text>by inserting after
paragraph (10) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HFE0D564C60124D81A60003722001934F" style="traditional">
<paragraph id="H7FE37E31DC344B368328F5946FEA7076" indent="up1"><enum>(10)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H8DE92E75DC524A0B87F9C41360C3CDC0"><enum>(A)</enum><text>Subsection (a) shall not
apply to any provision of State law to the extent such provision—</text>
<clause id="HF44ADD0443F74013B9A713B10559BB88" indent="up1"><enum>(i)</enum><text>provides for the collection from the
plan sponsor or plan administrator of a group health plan, by the agency or
instrumentality of the State responsible for the administration or enforcement
of any State law regulating insurance or medical care (as defined in section
733(a)(2)), of information relating to the cost and availability of such
medical care through group health insurance coverage or access of individuals
to such coverage, or</text>
</clause><clause id="H11ECBD7CB1144C3C949079264FABD989" indent="up1"><enum>(ii)</enum><text>provides for the enforcement of any
State law described in clause (i).</text>
</clause></subparagraph><subparagraph id="H5DB84602DC1343E1A65B494FEEED5872" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">For purposes of subparagraph (A), any
provision of State law providing for the extent of the information described in
subparagraph (A)(i) to be collected or the timing allowed for compliance with
requests for such information shall be treated as a provision of State law
referred to in subparagraph
(A)(i).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><enum>II</enum><header>Health Partnership
Through Creative Federalism</header>
<section id="HF5E00581F7C945EB8523AF7B28367326"><enum>201.</enum><header>Short
title</header><text display-inline="no-display-inline">This title may be cited
as the <quote><short-title>Health Partnership Through
Creative Federalism Act</short-title></quote>.</text>
</section><section id="H3E8BE400C392499080B25736938D8550"><enum>202.</enum><header>State health
reform projects</header>
<subsection id="HEED5A593D27B4F18BB5353D2071151C0"><enum>(a)</enum><header>Purposes;
Establishment of State Health Care Expansion and Improvement Program</header>
<paragraph id="HCB861496F44D4561A0B22DF843315DD9"><enum>(1)</enum><header>Purposes</header><text>The
purposes of the programs approved under this section shall include—</text>
<subparagraph id="HFF5DD296E59A4E329092C9FB52014B4C"><enum>(A)</enum><text>achieving the
goals of increased health coverage and access; and</text>
</subparagraph><subparagraph id="HE4B37B63A582410400689CDC56FC9031"><enum>(B)</enum><text>testing
alternative reforms, such as building on the public or private health systems,
or creating new systems, to achieve the objectives of this title.</text>
</subparagraph></paragraph><paragraph id="HE659D236348845A0BF83608F40848C2C"><enum>(2)</enum><header>Intent of
congress</header><text>It is the intent of Congress that—</text>
<subparagraph id="HAB2C9AA8ED584CCC83361DFE3ADF929"><enum>(A)</enum><text>the programs
approved under this title each comprise significant coverage expansions;</text>
</subparagraph><subparagraph id="H8866B82C042B44869C55FF753ECA00A0"><enum>(B)</enum><text>taken as a whole,
such programs should be diverse and balanced in their approaches to covering
the uninsured; and</text>
</subparagraph><subparagraph id="H0857F34C0D8946D7B4B366D56EAED969"><enum>(C)</enum><text>each such program
should be rigorously and objectively evaluated, so that the State programs
developed pursuant to this title may guide the development of future State and
national policy.</text>
</subparagraph></paragraph></subsection><subsection id="HB2F1D09BCE584463B762253EADFDFB2E"><enum>(b)</enum><header>Applications by
States and Local Governments</header>
<paragraph id="HE94EE224EC634A19A9A2FB907E1CA19C"><enum>(1)</enum><header>Entities that
may apply</header>
<subparagraph id="H6BD85D8E3B704D64A41BBC02B604C687"><enum>(A)</enum><header>In
general</header><text>A State may apply for a State health care expansion and
improvement program for the entire State (or for regions of the State) under
paragraph (2).</text>
</subparagraph><subparagraph id="H6B8F0E74F34C4E9990964649FEE95EF4"><enum>(B)</enum><header>Regional and
sub-State groups</header><text>A regional entity consisting of more than one
State or one or more local governments within a State may apply for a
multi-State or a sub-State, respectively, health care expansion and improvement
program for the region or area involved.</text>
</subparagraph><subparagraph id="H8AA8939460DF486288F8DB0013A16D38"><enum>(C)</enum><header>State
defined</header><text>In this title, the term <term>State</term> means the 50
States, the District of Columbia, and the Commonwealth of Puerto Rico. Such
term shall include a regional entity described in subparagraph (B).</text>
</subparagraph></paragraph><paragraph id="H40AE23FFF23748D400ADFAD208D7D8E4"><enum>(2)</enum><header>Submission of
application</header><text>In accordance with this section, each State or
regional entity desiring to implement a State health care expansion and
improvement program may submit an application to the State Health Coverage
Innovation Commission under subsection (c) for approval.</text>
</paragraph><paragraph id="H60EE2E252E024F7AB5007232A3EE19EA"><enum>(3)</enum><header>Local government
applications</header><text>Where a State fails to submit an application under
this section, a unit of local government of such State, or a consortium of such
units of local governments, may submit an application directly to the
Commission for programs or projects under this subsection. Such an application
shall be subject to the requirements of this section.</text>
</paragraph></subsection><subsection id="H1F70DC29820240A6A1350151CD004709"><enum>(c)</enum><header>State Health
Coverage Innovation Commission</header>
<paragraph id="H0A5DB75FA0B24761B1286E3BFEEF154"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than 90
days after the date of the enactment of this Act, the Secretary of Health and
Human Services (in this section referred to as the <quote>Secretary</quote>)
shall establish a State Health Coverage Innovation Commission (referred to in
this section as the <quote>Commission</quote>).</text>
</paragraph><paragraph id="H7B50DF582E8E46A9B194A9C6D2512590"><enum>(2)</enum><header>Membership</header><text>The
Commission shall be composed of the following members:</text>
<subparagraph id="HC6595DE922C64E80A99E886B79C159EA"><enum>(A)</enum><text>The
Secretary.</text>
</subparagraph><subparagraph id="HA0A8B35DD64847698C67A20080F71CE2"><enum>(B)</enum><text>Four State
governors to be appointed by the National Governors Association on a bipartisan
basis.</text>
</subparagraph><subparagraph id="HA1A2ED2A81EE4AFAB55D00BA7723208E"><enum>(C)</enum><text>Two members of a
State legislature to be appointed, on a joint and bipartisan basis, by the
National Conference of State Legislators and the American Legislative Exchange
Council.</text>
</subparagraph><subparagraph id="H64F86D511B184BB5A726F3FACA460223"><enum>(D)</enum><text>Two county
officials to be appointed by the National Association of Counties on a
bipartisan basis.</text>
</subparagraph><subparagraph id="HB3A8A38AF6C74499002500C7BEDAB7F"><enum>(E)</enum><text>Two mayors to be
appointed, on a joint and bipartisan basis, by the National League of Cities
and by the United States Conference of Mayors.</text>
</subparagraph><subparagraph id="H58AC9ED9A5E44E42B0FF4E00BEEF7C9"><enum>(F)</enum><text>Two individuals to
be appointed by the Speaker of the House of Representatives.</text>
</subparagraph><subparagraph id="H1BA86C540FEB4A2D003561A7776FA5F9"><enum>(G)</enum><text>Two individuals to
be appointed by the minority leader of the House of Representatives.</text>
</subparagraph><subparagraph id="H1907D3AC0A2C4767B58C68EC41A89CD5"><enum>(H)</enum><text>Two individuals to
be appointed by the majority leader of the Senate.</text>
</subparagraph><subparagraph id="HD51C22C97BE342FBB386BDAD19A42E09"><enum>(I)</enum><text>Two individuals to
be appointed by the minority leader of the Senate.</text>
</subparagraph></paragraph><paragraph id="HD304370C992B4D0F83308184275769DD"><enum>(3)</enum><header>Duties</header><text>The
Commission—</text>
<subparagraph id="HFFC8F09E7E744DAAA2E0C050A63DBF50"><enum>(A)</enum><text>shall request
States to submit proposals, which may include a variety of reform options such
as tax credit approaches, expansions of public programs such as Medicaid and
the State Children’s Health Insurance Program, the creation of purchasing
pooling arrangements similar to the Federal Employees Health Benefits Program,
individual market purchasing options, single risk pool or single payer systems,
health savings accounts, a combination of the options described in this
subparagraph, or other alternatives determined appropriate by the Commission,
including options suggested by States or the public, and nothing in this
subparagraph shall be construed to prevent the Commission from approving a
reform proposal not included in this subparagraph;</text>
</subparagraph><subparagraph id="H70B871FFFE8A49EC88D16B47157387F3"><enum>(B)</enum><text>shall conduct a
thorough review of the grant application from a State and carry on a dialogue
with all State applicants concerning possible modifications and
adjustments;</text>
</subparagraph><subparagraph id="H6185274C5BE147F1A7D7FEBC625935BA"><enum>(C)</enum><text>shall submit the
recommendations and legislative proposal described in subsection
(d)(4)(C);</text>
</subparagraph><subparagraph id="HEF65408FDF3746EE910860FF9015D31F"><enum>(D)</enum><text>shall be
responsible for receiving information to determine the status and progress
achieved under the program or projects granted under this section;</text>
</subparagraph><subparagraph id="HD750EBEB67654C20B465CACCCC9D3F21"><enum>(E)</enum><text>shall report to
the public concerning progress made by States with respect to the performance
measures and goals established under this title, the periodic progress of the
State relative to its State performance measures and goals, and the State
program application procedures, by region and State jurisdiction;</text>
</subparagraph><subparagraph id="H8C901A8E160B4608BDD6301BCE585DD2"><enum>(F)</enum><text>shall promote
information exchange between States and the Federal Government;</text>
</subparagraph><subparagraph id="HE0CFBF828CBA400E003C1817ACB43339"><enum>(G)</enum><text>shall be
responsible for making recommendations to the Secretary and the Congress, using
equivalency or minimum standards, for minimizing the negative effect of State
program on national employer groups, provider organizations, and insurers
because of differing State requirements under the programs; and</text>
</subparagraph><subparagraph id="H2CB70360926E4340B4A0292DFB62B6A3"><enum>(H)</enum><text>may require States
to submit additional information or reports concerning the status and progress
achieved under health care expansion and improvement programs granted under
this section, as needed.</text>
</subparagraph></paragraph><paragraph id="HD5D4CE74469240770054BFB4009E19BB"><enum>(4)</enum><header>Period of
appointment; representation requirements; vacancies</header><text>Members shall
be appointed for a term of 5 years. In appointing such members under paragraph
(2), the designated appointing individuals shall ensure the representation of
urban and rural areas and an appropriate geographic distribution of such
members. Any vacancy in the Commission shall not affect its powers, but shall
be filled in the same manner as the original appointment.</text>
</paragraph><paragraph id="H694F4AF539CF48F6914F94DC68327CA"><enum>(5)</enum><header>Chairperson,
meetings</header>
<subparagraph id="H1B9A5783310B4D40B0222B337FFBAB6"><enum>(A)</enum><header>Chairperson</header><text>The
Commission shall select a Chairperson from among its members.</text>
</subparagraph><subparagraph id="H09DBAA92D18D4246B3796DD71B766987"><enum>(B)</enum><header>Quorum</header><text>Two-thirds
of the members of the Commission shall constitute a quorum, but a lesser number
of members may hold hearings.</text>
</subparagraph><subparagraph id="H0CCE09782A1044748E79C254D6C40009"><enum>(C)</enum><header>Meetings</header><text>Not
later than 30 days after the date on which all members of the Commission have
been appointed, the Commission shall hold its first meeting. The Commission
shall meet at the call of the Chairperson.</text>
</subparagraph></paragraph><paragraph id="H8F6FF901B0504286ABE263775471471F"><enum>(6)</enum><header>Powers of the
commission</header>
<subparagraph id="HF50C0473B09342B6B4AF697FB873DEA5"><enum>(A)</enum><header>Negotiations
with states</header><text>The Commission may conduct detailed discussions and
negotiations with States submitting applications under this section, either
individually or in groups, to facilitate a final set of recommendations for
purposes of subsection (d)(4)(C).</text>
</subparagraph><subparagraph id="H4CE44642FF814568A04ECCF1B5A234D9"><enum>(B)</enum><header>Hearings</header><text>The
Commission may hold such hearings, sit and act at such times and places, take
such testimony, and receive such evidence as the Commission considers advisable
to carry out the purposes of this subsection.</text>
</subparagraph><subparagraph id="H44B3AD8AE1284A5E9664C339DC5C8993"><enum>(C)</enum><header>Meetings</header><text>In
addition to other meetings the Commission may hold, the Commission shall hold
an annual meeting with the participating States under this section for the
purpose of having States report progress toward the purposes in subsection (a)
and for an exchange of information.</text>
</subparagraph><subparagraph id="H0929078679FA407089A397652D833653"><enum>(D)</enum><header>Information</header><text>The
Commission may secure directly from any Federal department or agency such
information as the Commission considers necessary to carry out the provisions
of this subsection. Upon request of the Chairperson of the Commission, the head
of such department or agency shall furnish such information to the Commission
if the head of the department or agency involved determines it
appropriate.</text>
</subparagraph><subparagraph id="HB76D676DDE764862A0537D744DE0AA80"><enum>(E)</enum><header>Postal
services</header><text>The Commission may use the United States mails in the
same manner and under the same conditions as other departments and agencies of
the Federal Government.</text>
</subparagraph></paragraph><paragraph id="H099028D4D09C478AA64D29CECAB44E2F"><enum>(7)</enum><header>Personnel
matters</header>
<subparagraph id="HE329CC56E5534728B97533B1FCA89600"><enum>(A)</enum><header>Compensation</header><text>Each
member of the Commission who is not an officer or employee of the Federal
Government or of a State or local government shall be compensated at a rate
equal to the daily equivalent of the annual rate of basic pay prescribed for
level IV of the Executive Schedule under <external-xref legal-doc="usc" parsable-cite="usc/5/5315">section 5315</external-xref> of title 5, United States
Code, for each day (including travel time) during which such member is engaged
in the performance of the duties of the Commission. All members of the
Commission who are officers or employees of the United States shall serve
without compensation in addition to that received for their services as
officers or employees of the United States.</text>
</subparagraph><subparagraph id="HF0D5F92AAA1E4B32A2F7C1BE7513BFD"><enum>(B)</enum><header>Travel
expenses</header><text>The members of the Commission shall be allowed travel
expenses, including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/57">chapter 57</external-xref> of title 5, United
States Code, while away from their homes or regular places of business in the
performance of services for the Commission.</text>
</subparagraph><subparagraph id="HC1B8CAF858AF4542893023D586DB570"><enum>(C)</enum><header>Staff</header><text>The
Chairperson of the Commission may, without regard to the civil service laws and
regulations, appoint and terminate an executive director and such other
additional personnel as may be necessary to enable the Commission to perform
its duties. The employment of an executive director shall be subject to
confirmation by the Commission.</text>
</subparagraph><subparagraph id="HFC3B6411BCDA43DBBDB20077B978FEEF"><enum>(D)</enum><header>Detail of
government employees</header><text>Any Federal Government employee may be
detailed to the Commission without reimbursement, and such detail shall be
without interruption or loss of civil service status or privilege.</text>
</subparagraph><subparagraph id="H87ECE33F46214AC59BA728ED86C44E12"><enum>(E)</enum><header>Temporary and
intermittent services</header><text>The Chairperson of the Commission may
procure temporary and intermittent services under <external-xref legal-doc="usc" parsable-cite="usc/5/3109">section 3109(b)</external-xref> of title 5,
United States Code, at rates for individuals which do not exceed the daily
equivalent of the annual rate of basic pay prescribed for level V of the
Executive Schedule under section 5316 of such title.</text>
</subparagraph></paragraph><paragraph id="HE2C107C93950407C81ACF082C91C869"><enum>(8)</enum><header>Funding</header><text>For
the purpose of carrying out this subsection, there are authorized to be
appropriated $3,000,000 for fiscal year 2009 and each fiscal year
thereafter.</text>
</paragraph></subsection><subsection id="HBF9F65338FF1406BA165FA35A900A5E6"><enum>(d)</enum><header>Requirements for
Programs</header>
<paragraph id="H6851C0937CD4469B948BE2F0B8FA278D"><enum>(1)</enum><header>State
plan</header><text>A State that seeks to operate a program under this section
shall prepare and submit to the Commission, as part of the application under
subsection (b)(2), a State plan that shall have as its goal increased health
care coverage, and in service of that goal such additional goals as
improvements in health care quality, efficiency, cost-effectiveness, and the
appropriate use of information technology. To achieve such goal, the State plan
shall comply with the following:</text>
<subparagraph id="HBEA150A1F2874E8F954E85EB57B646A2"><enum>(A)</enum><header>Coverage</header>
<clause id="H86F33743DEAE446EB2614FB02D50B16B"><enum>(i)</enum><header>In
general</header><text>With respect to coverage, the State plan shall—</text>
<subclause id="HDADBAE7B4FF94A5892243DCF66D39700"><enum>(I)</enum><text>provide and
describe the manner in which the State will ensure that an increased number of
individuals residing within the State will have expanded access to health care
coverage with a specific 5-year target for reduction in the number or
proportion of uninsured individuals through either private or public program
expansion, or both, in accordance with or in addition to the options
established by the Commission;</text>
</subclause><subclause id="H799EB7C36F0C43CC90A65070CA81F2E7"><enum>(II)</enum><text>describe the
number and percentage of current uninsured individuals who will achieve
coverage under a State health program;</text>
</subclause><subclause id="H4BF59EAF7A9847D6BAE0445ED5C44E"><enum>(III)</enum><text>describe the
coverage that will be provided to beneficiaries under a State health
program;</text>
</subclause><subclause id="H3CCF9B88E0094133B50464D39FCCBDA"><enum>(IV)</enum><text>identify Federal,
State, or local and private programs that currently provide health care
services in the State and describe how such programs could be coordinated with
a State health program, to the extent practicable; and</text>
</subclause><subclause id="H31442EC58AD24E7F808C05DD15D7441C"><enum>(V)</enum><text>provide for
improvements in the availability of appropriate health care coverage that will
increase access to care in urban, suburban, rural, and frontier areas of the
State with medically underserved populations or where there may be an
inadequate supply of health care providers.</text>
</subclause></clause><clause id="H17A31A0A3438434A8C901DCA064D4823"><enum>(ii)</enum><header>Coverage
options</header><text>The coverage under the State plan may be—</text>
<subclause id="H3A7EF3788B5A4687B34B9F6182ABE50"><enum>(I)</enum><text>health insurance
coverage that meets the aggregate actuarial value requirement of section
2103(a)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397cc">42 U.S.C. 1397cc(a)(2)(B)</external-xref>);</text>
</subclause><subclause id="H409690A6B79D4B0A9BEA7589E678EDBB"><enum>(II)</enum><text>a combination of
health insurance coverage and a consumer-directed health care spending account,
if the actuarial value of such coverage plus the amount of annual deposits into
such account from sources other than the beneficiary is not less than the
actuarial value amount described in subclause (I); or</text>
</subclause><subclause id="H1D81156849CE4BC99D00036406BA058B"><enum>(III)</enum><text>health care
access not less on average than that provided through coverage described in
subclause (I).</text>
</subclause></clause><clause id="H47FCDBD854DB4AD49608CC7FE9E40062"><enum>(iii)</enum><header>Construction</header><text>Nothing
in this clause shall be construed to limit in any way the authority of the
Secretary of Health and Human Services to issue waivers under section 1115 of
the Social Security Act.</text>
</clause></subparagraph><subparagraph id="H37CC7A333C8A478DB0A505F37B1230FA"><enum>(B)</enum><header>Quality</header><text>With
respect to quality, the State plan may describe efforts to improve health care
quality in the State, including an explanation of how such efforts would change
(if at all) under the State plan.</text>
</subparagraph><subparagraph id="H4D48AD1E732B4977A21906FA10866083"><enum>(C)</enum><header>Costs</header><text>With
respect to costs, the State plan shall—</text>
<clause id="H64E8BC8F6FE143FBA22145962691A554"><enum>(i)</enum><text>describe such
steps as the State may undertake to improve the efficiency of health
care;</text>
</clause><clause id="HF339DEE2D60C45A6A300D101D229170"><enum>(ii)</enum><text>describe the
public and private sector financing to be provided for the State health
program;</text>
</clause><clause id="HEAF557E3FE3A4E0293BF87C000004E79"><enum>(iii)</enum><text>estimate the
amount of Federal, State, and local expenditures, as well as, the costs to
business and individuals under the State health program; and</text>
</clause><clause id="H5A14C417B9DD4EA58884C893DC87F6BF"><enum>(iv)</enum><text>describe how the
State plan will ensure the financial solvency of the State health
program.</text>
</clause></subparagraph><subparagraph id="H91C849B02EC3468AA16233F93E6981B0"><enum>(D)</enum><header>Health
information technology</header><text>With respect to health information
technology, the State plan may describe efforts to improve the appropriate use
of health information technology, including an explanation of how such efforts
would change (if at all) under the State plan.</text>
</subparagraph><subparagraph id="HAEBEB3FA2CE54602B0C7EF85A78FC368"><enum>(E)</enum><header>Exceptions to
Federal policies</header>
<clause id="HBD88D2F043DA452C9B53C38FD5120256"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), the State plan shall describe the
exceptions to otherwise applicable Federal statutes, regulations, and policies
that would apply within the geographic area and time period governed by the
plan.</text>
</clause><clause id="H884928870F514968BDDB11E9C178D908"><enum>(ii)</enum><header>Recognition of
ERISA requirements</header><text>Except to the extent authorized under
subsection (j)(4), the State plan may not include exceptions to the provisions
of the Employee Retirement Income Security Act of 1974 but may take into
account the amendments made by title I of this Act.</text>
</clause></subparagraph></paragraph><paragraph id="HEFE45C0F919C41FEA533EC027B815F00"><enum>(2)</enum><header>Technical
assistance</header><text>The Secretary shall, if requested, provide technical
assistance to States to assist such States in developing applications and plans
under this section, including technical assistance by private sector entities
if determined appropriate by the Commission.</text>
</paragraph><paragraph id="H20C62F3F3973437F8CC9FB152209376E"><enum>(3)</enum><header>Initial
review</header><text>With respect to a State application under subsection
(b)(2), the Secretary and the Commission shall complete an initial review of
such State application not later than 60 days after the receipt of such
application, analyze the scope of the proposal, and determine whether
additional information is needed from the State. The Commission shall advise
the State within such period of the need to submit additional
information.</text>
</paragraph><paragraph id="H732AF2D9C87E48F9AEAABC5189D1C0F3"><enum>(4)</enum><header>Final
determination</header>
<subparagraph id="H4BAF71C988F14BDFB1492ED2A5A3CC27"><enum>(A)</enum><header>In
general</header><text>In a timely manner consistent with subparagraph (C), the
Commission shall determine whether to submit a State proposal to Congress for
approval.</text>
</subparagraph><subparagraph id="HED985F29F9CD44B39D12C5DD115CAFA5"><enum>(B)</enum><header>Voting</header>
<clause id="H8D2067FD6E8B43C8A441B75DC2E0347"><enum>(i)</enum><header>In
general</header><text>The determination to submit a State proposal to Congress
under subparagraph (A) shall be approved by <fraction>2/3</fraction> of the
members of the Commission who are present and eligible to vote and a majority
of the entire Commission.</text>
</clause><clause id="HC856044A8E4A459F8C7C3707D849CCAE"><enum>(ii)</enum><header>Eligibility</header><text>A
member of the Commission shall not participate in a determination under
subparagraph (A) if—</text>
<subclause id="H066CEA9E4770409E8560B1819B5EB7A1"><enum>(I)</enum><text>in the case of a
member who is a Governor, such determination relates to the State of which the
member is the Governor; or</text>
</subclause><subclause id="H917D09B83F8B46C991CBB1817EB500D7"><enum>(II)</enum><text>in the case of
member not described in subclause (I), such determination relates to the
geographic area of a State of which such member serves as a State or local
official or as a Member of Congress.</text>
</subclause></clause></subparagraph><subparagraph id="H1E693E509D88421A005F62FD1495F95C"><enum>(C)</enum><header>Submission</header><text>Not
later than 90 days before October 1 of each fiscal year, the Commission may
submit to Congress a list, in the form of a legislative proposal, of the State
applications that the Commission recommends for approval under this
section.</text>
</subparagraph></paragraph><paragraph id="H13054A31635E486FB39DCC25A8A6D600"><enum>(5)</enum><header>Program or
project period</header><text>A State program or project may be approved for a
period of 5 years and may be extended for a subsequent period of time upon
approval by the Commission, based upon achievement of targets.</text>
</paragraph></subsection><subsection id="H7E1FEFD6144F40E9B99DF4BD698B41AC"><enum>(e)</enum><header>Expedited
Congressional Consideration</header>
<paragraph id="HA44158B2A7C4427D8BA48E023200E106"><enum>(1)</enum><header>Introduction and
expedited consideration in the House of Representatives</header>
<subparagraph id="H9328DE605A43441F827BC222A0541725"><enum>(A)</enum><header>Introduction in
House of Representatives</header><text>The legislative proposal submitted
pursuant to subsection (d)(4)(C) shall be in the form of a joint resolution (in
this subsection referred to as the <quote>resolution</quote>). Such resolution
shall be introduced in the House of Representatives by the Speaker immediately
upon receipt of the language and shall be referred non-sequentially to the
appropriate committee (or committees) of House of Representatives. If the
resolution is not introduced in accordance with the preceding sentence, the
resolution may be introduced by any member of the House of
Representatives.</text>
</subparagraph><subparagraph id="H45F3E1E894254A9EB6D404D8F45892C5"><enum>(B)</enum><header>Committee
consideration</header><text>Not later than 15 calendar days after the
introduction of the resolution described in subparagraph (A), each committee of
the House of Representatives to which the resolution was referred shall report
the resolution. The report may include, at the committee’s discretion, a
recommendation for action by the House. If a committee has not reported such
resolution (or an identical resolution) at the end of 15 calendar days after
its introduction or at the end of the first day after there has been reported
to the House a resolution, whichever is earlier, such committee shall be deemed
to be discharged from further consideration of such resolution and such
resolution shall be placed on the appropriate calendar of the House of
Representatives.</text>
</subparagraph><subparagraph id="H3524DE0E8A5F4286BFE13FC6D2CD8383"><enum>(C)</enum><header>Expedited
procedure in House</header><text>Not later than 5 legislative days after the
date on which all committees have been discharged from consideration of a
resolution, the Speaker of the House of Representatives, or the Speaker’s
designee, shall move to proceed to the consideration of the resolution. It
shall also be in order for any member of the House of Representatives to move
to proceed to the consideration of the resolution at any time after the
conclusion of such 5-day period. All points of order against the resolution
(and against consideration of the resolution) are waived. A motion to proceed
to the consideration of the resolution is highly privileged in the House of
Representatives and is not debatable. The motion is not subject to amendment,
to a motion to postpone consideration of the resolution, or to a motion to
proceed to the consideration of other business. A motion to reconsider the vote
by which the motion to proceed is agreed to or not agreed to shall not be in
order. If the motion to proceed is agreed to, the House of Representatives
shall immediately proceed to consideration of the resolution without
intervening motion, order, or other business, and the resolution shall remain
the unfinished business of the House of Representatives until disposed of. A
motion to recommit the resolution shall not be in order. Upon its passage in
the House, the clerk of the House shall provide for its immediate transmittal
to the Senate.</text>
</subparagraph></paragraph><paragraph id="HAC701270ECA94A3281C8D07CA73B06F8"><enum>(2)</enum><header>Expedited
consideration in the Senate</header>
<subparagraph id="HC73C35A8C2C24335AB9B3CB0EE184189"><enum>(A)</enum><header>Referral to
committee</header><text>If the resolution is agreed to by the House of
Representatives, upon its receipt in the Senate the majority leader of the
Senate, or the leader’s designee, the resolution shall be referred to the
appropriate committee of Senate.</text>
</subparagraph><subparagraph id="HFDBD956F41484D1BAC214CF31BCAAD1C"><enum>(B)</enum><header>Committee
consideration</header><text>Not later than 15 calendar days after the referral
of the resolution under subparagraph (A), the committee of the Senate to which
the resolution was referred shall report the resolution. The report may
include, at the committee’s discretion, a recommendation for action by the
Senate. If a committee has not reported such resolution (or an identical
resolution) at the end of 15 calendar days after its referral or at the end of
the first day after there has been reported to the Senate a resolution,
whichever is earlier, such committee shall be deemed to be discharged from
further consideration of such resolution and such resolution shall be placed on
the appropriate calendar of the Senate.</text>
</subparagraph><subparagraph id="HE8A0F276F9184EBEA600D8C5CFA744E0"><enum>(C)</enum><header>Expedited floor
consideration</header><text>Not later than 5 legislative days after the date on
which all committees have been discharged from consideration of a resolution,
the majority leader of the Senate, or the majority leader’s designee, shall
move to proceed to the consideration of the resolution. It shall also be in
order for any member of the Senate to move to proceed to the consideration of
the resolution at any time after the conclusion of such 5-day period. All
points of order against the resolution (and against consideration of the
resolution) are waived. A motion to proceed to the consideration of the
resolution in the Senate is privileged and is not debatable. The motion is not
subject to amendment, to a motion to postpone consideration of the resolution,
or to a motion to proceed to the consideration of other business. A motion to
reconsider the vote by which the motion to proceed is agreed to or not agreed
to shall not be in order. If the motion to proceed is agreed to, the Senate
shall immediately proceed to consideration of the resolution without
intervening motion, order, or other business, and the resolution shall remain
the unfinished business of the Senate until disposed of.</text>
</subparagraph></paragraph><paragraph id="HB5350C3BEC4142350073680041CBAA50"><enum>(3)</enum><header>Rules of the
Senate and House of Representatives</header><text>This subsection is enacted by
Congress—</text>
<subparagraph id="H55B15EA4AE8D49B58BC9E29FD54CF600"><enum>(A)</enum><text>as an exercise of
the rulemaking power of the Senate and House of Representatives, respectively,
and is deemed to be part of the rules of each House, respectively, but
applicable only with respect to the procedure to be followed in that House in
the case of a resolution under this subsection, and it supersedes other rules
only to the extent that it is inconsistent with such rules; and</text>
</subparagraph><subparagraph id="HE683CC110E6646588EFC1ECD38AACAE4"><enum>(B)</enum><text>with full
recognition of the constitutional right of either House to change the rules (so
far as they relate to the procedure of that House) at any time, in the same
manner, and to the same extent as in the case of any other rule of that
House.</text>
</subparagraph></paragraph><paragraph id="H120137FA4DC64996B43E504BA0A80830"><enum>(4)</enum><header>Federal budget
neutrality</header><text>Except insofar as it allots appropriations made
pursuant to subsection (k), the legislative proposal submitted pursuant to
subsection (d)(4)(C) may not increase the cumulative, net Federal budget
deficit during the multi-year operation of all the State applications contained
therein, taking into account such applications’ impact on Federal mandatory and
discretionary spending, Federal revenue, and Federal tax expenditures.</text>
</paragraph></subsection><subsection id="H2801A38E09354C56AA2F2FC700536CB7"><enum>(f)</enum><header>Funding</header>
<paragraph id="H07ECCBD4BF084BCCA8C6AFD6F9F34968"><enum>(1)</enum><header>In
general</header><text>The Secretary shall provide a grant to a State that has
an application approved under subsection (e) to enable such State to carry out
an innovative State health program in the State, to the extent that such a
grant is included in the recommendation of the Commission.</text>
</paragraph><paragraph id="H55744180872D41AE99F90401E50BE7F"><enum>(2)</enum><header>Amount of
grant</header><text>The amount of a grant provided to a State under paragraph
(1) shall be determined based upon the recommendations of the Commission,
subject to the amount appropriated under subsection (k).</text>
</paragraph><paragraph id="H62FC2EC9E58E4015836F16C425DE4E4D"><enum>(3)</enum><header>Performance-based
funding allocation</header><text>In awarding grants under paragraph (1), the
Commission shall direct the Secretary to—</text>
<subparagraph id="H49148D8BE6B048620076644DB041A17F"><enum>(A)</enum><text>fund a balanced
diversity of approaches as provided for by the Commission in subsection
(c)(1)(B); and</text>
</subparagraph><subparagraph id="H7BC8CA9FF4C84B248F60DD6928298700"><enum>(B)</enum><text>link allocations
to the State to the meeting of the goals and performance measures relating to
health care coverage and health care costs established under this title through
the State project application process.</text>
</subparagraph></paragraph><paragraph id="HA497F1C7D5DE496E921C28DE8E35B0D9"><enum>(4)</enum><header>Report</header><text>One
year before the end of the 5-year period beginning on the date on which the
first State begins to implement a plan approved under subsection (e), the
Commission shall prepare and submit to the appropriate committees of Congress,
a report on the progress made by States in meeting the goals of expanded
coverage and cost containment through performance measures established during
the 5-year period of the State plan. Such report may contain the recommendation
of the Commission concerning any future action that Congress should take
concerning health care reform, including whether or not to extend the program
established under this subsection.</text>
</paragraph></subsection><subsection id="HC7419E93F95449B9B2CF1CC6425F27C9"><enum>(g)</enum><header>Monitoring and
Evaluation</header>
<paragraph id="H039D16A932364EFB90AE295497EA43AE"><enum>(1)</enum><header>Annual reports
and participation by states</header><text>Each State that has received a
program approval shall—</text>
<subparagraph id="H7EC74EB6500D4C27B570A20935799BF4"><enum>(A)</enum><text>submit to the
Commission an annual report based on the period representing the respective
State’s fiscal year, detailing compliance with the requirements established by
the Commission and the Secretary in the approval and in this section;
and</text>
</subparagraph><subparagraph id="H6E5D62B3C08949549215C1750900ABC5"><enum>(B)</enum><text>participate in the
annual meeting under subsection (c)(4)(C).</text>
</subparagraph></paragraph><paragraph id="H753E040A1B8C44559ED7363B00AD6603"><enum>(2)</enum><header>Evaluations by
Commission</header><text>The Commission shall prepare and submit to Congress
annual reports that shall contain—</text>
<subparagraph id="H755D569A43F24272B0AEF225ED28321"><enum>(A)</enum><text>a description of
the effects of the reforms undertaken in States receiving approvals under this
section;</text>
</subparagraph><subparagraph id="HA8CC324D57B240FEA0CF0983BAAAEB01"><enum>(B)</enum><text>a description of
the recommendations of the Commission and actions taken based on these
recommendations;</text>
</subparagraph><subparagraph id="H635E8AE3174547A4AD221CB08EAA0243"><enum>(C)</enum><text>an independent
evaluation of the effectiveness of such reforms in—</text>
<clause id="H1085B5C96AFE46C188AA8F4820462273"><enum>(i)</enum><text>expanding health
care coverage for State residents; and</text>
</clause><clause id="H18083DB83E95421E9560F6A71637706E"><enum>(ii)</enum><text>reducing or
containing health care costs in the States,</text>
</clause><continuation-text continuation-text-level="subparagraph">as well
as other relevant or significant findings;</continuation-text></subparagraph><subparagraph id="H6A8571D2A06A481BA92397F2982600BD"><enum>(D)</enum><text>recommendations
regarding the advisability of increasing Federal financial assistance for State
ongoing or future health program initiatives, including the amount and source
of such assistance; and</text>
</subparagraph><subparagraph id="H799BB70A205F4894BA6966F781DEE9F3"><enum>(E)</enum><text>as required by the
Commission or the Secretary under this section, a periodic, independent
evaluation of the program.</text>
</subparagraph></paragraph></subsection><subsection id="H5081086C22CA46CF81ED0C34CDF344C"><enum>(h)</enum><header>Noncompliance</header>
<paragraph id="H9AABC8601FB54A3FA34EDAED7EE1E84"><enum>(1)</enum><header>Corrective action
plans</header><text>If a State is not in compliance with a requirement of this
section, the Commission, on recommendation of the Secretary, shall develop a
corrective action plan for such State.</text>
</paragraph><paragraph id="H29878EA82CE340CDA5A1B1B2E00D6A4"><enum>(2)</enum><header>Termination</header><text>The
Commission, on recommendation of the Secretary, may revoke any program granted
under this section. Such decisions shall be subject to a petition for
reconsideration and appeal pursuant to regulations established by the
Secretary.</text>
</paragraph></subsection><subsection id="HF894E1C46BF94DBE9600970074C8BFDA"><enum>(i)</enum><header>Relationship to
Federal Programs</header>
<paragraph id="H083954C3683D45D6B4E097D1F268A391"><enum>(1)</enum><header>In
general</header><text>Nothing in this title, or in section 1115 of the Social
Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315">42 U.S.C. 1315</external-xref>) shall be construed as authorizing the Secretary,
the Commission, a State, or any other person or entity to alter or affect in
any way—</text>
<subparagraph id="H0A0092EBF30140E68FCDF56EE034DD"><enum>(A)</enum><text>the provisions of
title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) or the regulations implementing
such title or,</text>
</subparagraph><subparagraph id="H0127BC4EE7F54EFF9285B3B500BAF685"><enum>(B)</enum><text>except as
authorized in subsection (j)(4), the provisions of the Employee Retirement
Income Security Act of 1974 (as amended by this Act) or the regulations
implementing such Act.</text>
</subparagraph></paragraph><paragraph id="HA8ACBB9280FF429C8E00D7D591203745"><enum>(2)</enum><header>Maintenance of
effort</header><text>No payment may be made under subsection (f)(1) if the
State adopts criteria for benefits or criteria for standards and methodologies
for purposes of determining an individual’s eligibility for medical assistance
under the State plan under title XIX that are more restrictive than those
required under Federal law and applied as of the date of enactment of this
Act.</text>
</paragraph></subsection><subsection id="H0125285FB45441339F327D21BAB79E86"><enum>(j)</enum><header>Miscellaneous
Provisions</header>
<paragraph id="H3B94350A2BF44160A9EA9F6D15170063"><enum>(1)</enum><header>Application of
certain requirements</header>
<subparagraph id="H1611C94DFBE94E5D00F9E3EA0167E5A3"><enum>(A)</enum><header>Restriction on
application of preexisting condition exclusions</header>
<clause id="HD3647E6FC3DC4099845B437BCE2C84E1"><enum>(i)</enum><header>In
general</header><text>Subject to subparagraph (B), a State shall not permit the
imposition of any preexisting condition exclusion for covered benefits under a
program or project under this section.</text>
</clause><clause id="H2ED7F43108354A7E8CC3B76A571AEA7"><enum>(ii)</enum><header>Group health
plans and group health insurance coverage</header><text>If the State program or
project provides for benefits through payment for, or a contract with, a group
health plan or group health insurance coverage, the program or project may
permit the imposition of a preexisting condition exclusion but only insofar and
to the extent that such exclusion is permitted under the applicable provisions
of part 7 of subtitle B of title I of the Employee Retirement Income Security
Act of 1974 and title XXVII of the Public Health Service Act.</text>
</clause></subparagraph><subparagraph id="H65F1896340CA4A5DA1AB82380022EF8"><enum>(B)</enum><header>Compliance with
other requirements</header><text>Coverage offered under the program or project
shall comply with the requirements of subpart 2 of part A of title XXVII of the
Public Health Service Act insofar as such requirements apply with respect to a
health insurance issuer that offers group health insurance coverage.</text>
</subparagraph></paragraph><paragraph id="H4A4544646DA843CC85A1689E17FDF474"><enum>(2)</enum><header>Prevention of
duplicative payments</header>
<subparagraph id="HAF88C2DA58BD497392681CD97FF55CDE"><enum>(A)</enum><header>Other health
plans</header><text>No payment shall be made to a State under subsection (f)(1)
for expenditures for health assistance provided for an individual to the extent
that a private insurer (as defined by the Secretary by regulation and including
a group health plan (as defined in section 607(1) of the Employee Retirement
Income Security Act of 1974), a service benefit plan, and a health maintenance
organization) would have been obligated to provide such assistance but for a
provision of its insurance contract which has the effect of limiting or
excluding such obligation because the individual is eligible for or is provided
health assistance under the plan.</text>
</subparagraph><subparagraph id="HC78B44F4FE2F474997A4CE9EE74FAF4B"><enum>(B)</enum><header>Other Federal
governmental programs</header><text>Except as provided in any other provision
of law, no payment shall be made to a State under subsection (f)(1) for
expenditures for health assistance provided for an individual to the extent
that payment has been made or can reasonably be expected to be made promptly
(as determined in accordance with regulations) under any other federally
operated or financed health care insurance program. For purposes of this
paragraph, rules similar to the rules for overpayments under section 1903(d)(2)
of the Social Security Act shall apply.</text>
</subparagraph></paragraph><paragraph id="HD224198A9D6D4D199F27C4F269005525"><enum>(3)</enum><header>Application of
certain general provisions</header><text>The following provisions of the Social
Security Act shall apply to States under subsection (f)(1) in the same manner
as they apply to a State under such title XIX:</text>
<subparagraph id="H6684EBF56BFF45C0B8F37219D3A1533E"><enum>(A)</enum><header>Title XIX
provisions</header>
<clause id="H7B68E093DD5648D892AAB00341B2CCE"><enum>(i)</enum><text>Section
1902(a)(4)(C) (relating to conflict of interest standards).</text>
</clause><clause id="HD327EDBADC974E70BF008E02BE48E0A2"><enum>(ii)</enum><text>Paragraphs (2),
(16), and (17) of section 1903(i) (relating to limitations on payment).</text>
</clause><clause id="HE6B036FF739C4938A6B6301683629528"><enum>(iii)</enum><text>Section 1903(w)
(relating to limitations on provider taxes and donations).</text>
</clause><clause id="HFCCDCF969E474AD9BDB486F799F6400"><enum>(iv)</enum><text>Section 1920A
(relating to presumptive eligibility for children).</text>
</clause></subparagraph><subparagraph id="HD02C012BC1974805BFBFD1B7C2CF82F"><enum>(B)</enum><header>Title XI
provisions</header>
<clause id="H8721B12FDD5341000022EFD5A427C3B1"><enum>(i)</enum><text>Section 1116
(relating to administrative and judicial review), but only insofar as
consistent with this title.</text>
</clause><clause id="HC253170B83A34EB08BDC5B91C6875B6"><enum>(ii)</enum><text>Section 1124
(relating to disclosure of ownership and related information).</text>
</clause><clause id="H46D50C9A81494D00BD63631CBDD8097"><enum>(iii)</enum><text>Section 1126
(relating to disclosure of information about certain convicted
individuals).</text>
</clause><clause id="H4AF98E29D5AB41D3ADC82121BAFB52D0"><enum>(iv)</enum><text>Section 1128A
(relating to civil monetary penalties).</text>
</clause><clause id="H07DF8E8867924A278C9857FE1EC48BAF"><enum>(v)</enum><text>Section 1128B(d)
(relating to criminal penalties for certain additional charges).</text>
</clause><clause id="HF5661E30BAE949BAAFF0D26D11713902"><enum>(vi)</enum><text>Section 1132
(relating to periods within which claims must be filed).</text>
</clause></subparagraph></paragraph><paragraph id="HFEC137407C04422D99ED045F647BF545"><enum>(4)</enum><header>Relation to
HIPAA</header><text>Health benefits coverage provided under a State program or
project under this section shall be treated as creditable coverage for purposes
of part 7 of subtitle B of title I of the Employee Retirement Income Security
Act of 1974, title XXVII of the Public Health Service Act, and subtitle K of
the Internal Revenue Code of 1986.</text>
</paragraph></subsection><subsection id="H45CC313C82CB4C739CDDF05DB9C36E07"><enum>(k)</enum><header>Authorization of
Appropriations</header><text>There is authorized to be appropriated to carry
out this section (other than subsection (c)), such sums as may be necessary for
each of fiscal years 2009 through 2013. Amounts appropriated for a fiscal year
under this subsection and not expended may be used in subsequent fiscal years
to carry out this section.</text>
</subsection></section><section commented="no" id="H665CB736FC634BD2827F70AEE13D891C"><enum>203.</enum><header>Effective
date</header><text display-inline="no-display-inline">The provisions of this
title shall take effect as of the date of the enactment of this Act.</text>
</section><enum>III</enum><header>Demonstration
Project for Employer Buy-In</header>
<section id="HB3D72B1463494239AA159916C40000A6"><enum>301.</enum><header>Demonstration
project for employer buy-in</header><text display-inline="no-display-inline">Title XXI of the Social Security Act is
amended by adding at the end the following new section:</text>
<quoted-block id="H8759D020C27B468DBE98866E3C93A81F" style="OLC">
<section id="H9A66AF1DF9104D5D9FCEC16338042CC7"><enum>2111.</enum><header>Demonstration
project for employer buy-in</header>
<subsection id="H33DA2288400046B0902EE72D0044A8BD"><enum>(a)</enum><header>Authority</header>
<paragraph id="H497F014D2AC1480086455BB4D33E02A3"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish a demonstration project
under which up to 10 States (each referred to in this section as a
<quote>participating State</quote>) that meet the conditions of paragraph (2)
may provide, under its State child health plan (notwithstanding section
2102(b)(3)(C)) for a period of 5 years, for child health assistance in relation
to family coverage described in subsection (d) for children who would be
targeted low-income children but for coverage as beneficiaries under a group
health plan as the children of participants by virtue of a qualifying
employer’s contribution under subsection (b)(2).</text>
</paragraph><paragraph id="H2C53453344284497A3D12CFD15965400"><enum>(2)</enum><header>Conditions</header><text>The
conditions described in this paragraph for a State are as follows:</text>
<subparagraph id="H3681637441FD47BBA0B833994E343D65"><enum>(A)</enum><header>No waiting
lists</header><text>The State does not impose any waiting list, enrollment cap,
or similar limitation on enrollment of targeted low-income children under the
State child health plan.</text>
</subparagraph><subparagraph id="HCDF1F3098112488BB3E718296F605349"><enum>(B)</enum><header>Eligibility of
all children under 200 percent of poverty line</header><text>The State is
applying an income eligibility level under section 2110(b)(1)(B)(ii)(I) that is
at least 200 percent of the poverty line.</text>
</subparagraph></paragraph><paragraph id="HFE650522CF7748FABE01734C39FB513C"><enum>(3)</enum><header>Qualifying
employer defined</header><text>In this section, the term <term>qualifying
employer</term> means an employer that has a majority of its workforce composed
of full-time workers with family incomes reasonably estimated by the employer
(based on wage information available to the employer) at or below 200 percent
of the poverty line. In applying the previous sentence, two part-time workers
shall be treated as a single full-time worker.</text>
</paragraph></subsection><subsection id="H18C4F0BE7232474CA099D4B8CBF0F38B"><enum>(b)</enum><header>Funding</header><text>A
demonstration project under this section in a participating State shall be
funded, with respect to assistance provided to children described in subsection
(a)(1), consistent with the following:</text>
<paragraph id="H461B1C5BE8744F5BB71D7112B5D52865"><enum>(1)</enum><header>Limited family
contribution</header><text>The family involved shall be responsible for
providing payment towards the premium for such assistance of such amount as the
State may specify, except that the limitations on cost-sharing (including
premiums) under paragraphs (2) and (3) of section 2103(e) shall apply to all
cost-sharing of such family under this section.</text>
</paragraph><paragraph id="H42CB43619AA84BAAAB3273C3A7D92976"><enum>(2)</enum><header>Minimum employer
contribution</header><text>The qualifying employer involved shall be
responsible for providing payment to the State child health plan in the State
of at least 50 percent of the portion of the cost (as determined by the State)
of the family coverage in which the employer is enrolling the family that
exceeds the amount of the family contribution under paragraph (1) applied
towards such coverage.</text>
</paragraph><paragraph id="HD3EEC913F7634DB6AF16E5007028FA87"><enum>(3)</enum><header>Limitation on
Federal financial participation</header><text>In no case shall the Federal
financial participation under section 2105 with respect to a demonstration
project under this section be made for any portion of the costs of family
coverage described in subsection (d) (including the costs of administration of
such coverage) that are not attributable to children described in subsection
(a)(1).</text>
</paragraph></subsection><subsection id="HDC19FEB8B35148328E52DFBA8F5F826E"><enum>(c)</enum><header>Uniform
Eligibility Rules</header><text>In providing assistance under a demonstration
project under this section—</text>
<paragraph id="H90401C0579D14C17A424164471DFCC28"><enum>(1)</enum><text>a State shall
establish uniform rules of eligibility for families to participate; and</text>
</paragraph><paragraph id="HCFED1DDB5D3945549496022FE4007D37"><enum>(2)</enum><text>a State shall not
permit a qualifying employer to select, within those families that meet such
eligibility rules, which families may participate.</text>
</paragraph></subsection><subsection id="H5026BFDFC5FD4CA283AFFDB0417E2EA9"><enum>(d)</enum><header>Terms and
Conditions</header><text>The family coverage offered to families of qualifying
employers under a demonstration project under this section in a State shall be
the same as the coverage and benefits provided under the State child health
plan in the State for targeted low-income children with the highest family
income level
permitted.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>IV</enum><header>Access to Health
Benefits Through Regional State Arrangements</header>
<section commented="no" id="H89CB025815F54AD3BC4DA71E654DA9A5"><enum>401.</enum><header>Promoting
access through regional State arrangements under a demonstration
project</header>
<subsection id="HCAB8C8E96F1F47DA9644D496BEB7BA6B"><enum>(a)</enum><header>In
general</header>
<paragraph id="H5F7FF7923A04411A00A374E896B3179"><enum>(1)</enum><header>Regional State
arrangements</header><text>Under this title the Secretary of Health and Human
Services, in collaboration with the Secretary of Labor, shall facilitate the
establishment of regional State arrangements (each in this title referred to as
a <quote>regional State arrangement</quote>) under which two or more States ban
together in order to increase their purchasing pooling power and offer
affordable health insurance to citizens of those States consistent with
paragraph (2). Such arrangements shall include the following components:</text>
<subparagraph id="HCB32B5C5ADDF4FCC000046191566A369"><enum>(A)</enum><text>The appointment of
a Benefits Administrator under subsection (b)</text>
</subparagraph><subparagraph id="H7B2624868B824C83ABF665B0B91FAD00"><enum>(B)</enum><text>The offering of
standard health benefit plans under subsection (c).</text>
</subparagraph><subparagraph id="HCEB37A164E9D4252BCD686B6E8D80052"><enum>(C)</enum><text>The charging of
premiums using a modified community-rated premiums under subsection (d).</text>
</subparagraph><subparagraph id="H7B8C68E521114FE0909BB252DE3B91E0"><enum>(D)</enum><text>A requirement for
individual health insurance coverage under subsection (e).</text>
</subparagraph><subparagraph id="HD860CCAC1B294ECDAA25BAFE2315A855"><enum>(E)</enum><text>Subsidies for
financially disadvantages persons under subsection (f).</text>
</subparagraph><subparagraph id="H91DD74237F014A94A8EB34AF904053C9"><enum>(F)</enum><text>Employer rule in
funding health benefit plans under subsection (g).</text>
</subparagraph></paragraph><paragraph id="H1539B1BA3F6F42A18C506BE18E2E53E6"><enum>(2)</enum><header>Application on a
demonstration basis</header><text>This title shall be implemented on a
demonstration basis so that—</text>
<subparagraph id="H1504AFA7B30947E592A888BA9875F88D"><enum>(A)</enum><text>the regional State
arrangements cover no more than 20 States; and</text>
</subparagraph><subparagraph id="H9DC7988EAB9846858016B0B50342AD8F"><enum>(B)</enum><text>implementation
occurs only over a 10-year period.</text>
</subparagraph></paragraph><paragraph id="H59D2A0BB87F04109A5FF818BD925131E"><enum>(3)</enum><header>Collaborative
Federal implementation</header>
<subparagraph id="HF2A83E171B0F45FCAE05391282DC17BB"><enum>(A)</enum><header>In
general</header><text>In carrying out this title—</text>
<clause id="H49CDFF85EB7048BAA888E5D967916B1"><enum>(i)</enum><text>the
Secretary of Labor shall be primarily responsible for implementation with
respect to employees and dependents; and</text>
</clause><clause id="HD01374D646104C8EA42C74D0358F95EB"><enum>(ii)</enum><text>the
Secretary of Health and Human Services shall be primarily responsible for
implementation for all other individuals.</text>
</clause></subparagraph><subparagraph id="HB456CD7DA80E472F966B91E31C5B56F6"><enum>(B)</enum><header>Reference to
Secretary</header><text>Except as otherwise provided, in this title, the term
<term>Secretary</term> means the Secretary of Health and Human Services working
in collaboration with the Secretary of Labor.</text>
</subparagraph></paragraph><paragraph id="H982DD447B6F14A20AA572C00009319D1"><enum>(4)</enum><header>Report</header><text>The
Secretary shall jointly submit to Congress a biannual report on the
implementation of this title and shall include in such report recommendations
regarding the expansion and extension of the program under this title.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H8AA1AEF3EAFE476C931429E765E4194"><enum>(b)</enum><header>Benefit
Administrator</header>
<paragraph id="H3F9BC7F683634EE1A8EF978C059CD9A2"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Each regional State
arrangement shall be administered by a Benefit Administrator who shall be
responsible for the administration of this title under the arrangement.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H0F578C261FED4D68939410C29FDEA21"><enum>(2)</enum><header>Disclosure of
performance of Benefit Administrators</header><text display-inline="yes-display-inline">The Secretary shall make available to the
public information on the relative administrative performance of each Benefit
Administrator.</text>
</paragraph></subsection><subsection id="HAB96A30962DE488EA758FFEAB4E75F8E"><enum>(c)</enum><header>Standard health
benefit plans</header>
<paragraph id="H99E69EAA0BAF43B19F7878EBF135686C"><enum>(1)</enum><header>Offering of
standard health benefit plans</header><text display-inline="yes-display-inline">Under each regional State arrangement
State, the Benefit Administrator shall, through a bidding process determined
and administered by the Secretary, offer, directly or indirectly, three to five
standard health benefit plans to all individuals, regardless of employment, who
reside in a State covered by the arrangement.</text>
</paragraph><paragraph id="H3A403074DA4445988DE54280CCC1C99B"><enum>(2)</enum><header>Standard health
benefit plans</header><text>In this title, the term <term>standard health
benefit plan</term> means a health benefits plan that meets standards relating
to benefits recognized by the Secretary. The Secretary shall request the
National Association of Insurance Commissioners or another appropriate entity
to develop such standards for such plans in a manner consistent with the model
for standards development used under section 1881 of the Social Security Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395rr">42 U.S.C. 1395rr</external-xref>) for medicare supplemental policies. Such standards shall be
designed to permit the offering of low-cost benefit options.</text>
</paragraph></subsection><subsection id="HD61D2BD37C644C8CBFF502063FEFC5CF"><enum>(d)</enum><header>Application of
modified community-rated premiums</header>
<paragraph id="H78BE0D0B43064B9BAB5C303DB2DFBDD3"><enum>(1)</enum><header>In
general</header><text>The premiums for the standard health benefit plans
offered under a regional State arrangement within a defined service area (as
identified under paragraph (2)) shall be established consistent with the
following:</text>
<subparagraph id="H792B16D04A3E4458AE6B93D95894EF21"><enum>(A)</enum><text>All such plans in
the area shall uniformly bear the cost of disease and injury.</text>
</subparagraph><subparagraph id="H501B293477684866A00042853F4D0058"><enum>(B)</enum><text>Except as
otherwise provided in this paragraph, the premiums shall be uniform within such
area for family coverage and for individual coverage for each plan in such
area.</text>
</subparagraph><subparagraph id="HB87E433138FF4947AE74BEEE7E82CDCD"><enum>(C)</enum><text>In the case of a
plan purchased by an individual and not in connection with a group health plan,
the regional State arrangement may permit the variation of premiums based upon
the age band in which an individual or family falls in a manner that reasonable
reflects the health cost differences of individuals among such age
bands.</text>
</subparagraph><subparagraph id="HB15B32FE89FB40D499C619965872EEED"><enum>(D)</enum><text>There shall be a
mechanism whereby there would be standardized risk adjustments to premiums of
each plan in the area based on the actual claims under the respective plans
during the previous plan year.</text>
</subparagraph><subparagraph id="HB01AFEC692514AE392464CAAA07C00F3"><enum>(E)</enum><text>Adjustments
related to self-imposed lifestyle risks, such as smoking, alcohol consumption,
and avoidance of personal risk, may be made.</text>
</subparagraph><subparagraph commented="no" id="HD37D5CAFE9FA47C88CFDEBE2EA8202FF"><enum>(F)</enum><text>Premiums may be
varied among standard health benefit plans based on efficiencies generated by
better administrator practices, including efficiencies derived from superior
disease management, utilization management, case management, lifestyle
management, “pay-for-performance” systems, and other innovative initiatives
designed to lower costs, increase quality, and improve accountability.</text>
</subparagraph></paragraph><paragraph commented="no" id="H3243B86904A344CEB51923005EB2457B"><enum>(2)</enum><header>Identification
of defined service areas</header><text display-inline="yes-display-inline">For
purposes of paragraph (1), the Secretary shall divide the area covered by each
regional State arrangement into separate defined service areas based on major
medical markets.</text>
</paragraph></subsection><subsection commented="no" id="H678A7DA220034A82A0BFB085E6E1A28C"><enum>(e)</enum><header>Individual
coverage mandate</header>
<paragraph id="H56E46397BC82457285E8A131275CA7D4"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (3), each regional State arrangement
shall provide that each uninsured individual (as defined in paragraph (4))
shall—</text>
<subparagraph id="HAB705EB34CB34C3998C166E3CEDBD42"><enum>(A)</enum><text>automatically be
enrolled in a standard health benefit plan under this title; and</text>
</subparagraph><subparagraph id="H29FDDF57C71A49F7B7B8D2F972BCEE5B"><enum>(B)</enum><text>be liable, through
payroll deduction or otherwise, for the payment of premiums for such
enrollment, taking into account the amount of any financial subsidy offered
under subsection (f).</text>
</subparagraph></paragraph><paragraph id="HCE5C3A119E9D41F1B8CFA0D741507600"><enum>(2)</enum><header>Certification</header><text display-inline="yes-display-inline">Each Benefit Administrator for a regional
State arrangement shall develop a satisfactory method for certifying compliance
with the provisions of individuals residing in the area covered by the
arrangement with the requirement of paragraph (1).</text>
</paragraph><paragraph id="HEB3C3F4780F640F5B96E77BC5387AAFA"><enum>(3)</enum><header>Exceptions</header><text>The
Secretary may establish exceptions to the requirement of paragraph (1) in
appropriate cases, such as in the case of individuals who are financially
unable to afford to pay the premiums required to enroll in a standard health
benefit plan.</text>
</paragraph><paragraph id="HD0C11B5BF8A8464BB8005E41A0CD89D2"><enum>(4)</enum><header>Uninsured
individual defined</header><text>In this subsection, the term <term>uninsured
individual</term> means, with respect to a regional State arrangement, an
individual who—</text>
<subparagraph id="HB0B2D9FB71124E8FBC0073612200FB3E"><enum>(A)</enum><text display-inline="yes-display-inline">resides in a State included in a regional
State arrangement;</text>
</subparagraph><subparagraph id="HB4509EFEFE754A26B283F3E1E0910EA"><enum>(B)</enum><text>is not enrolled for
benefits under—</text>
<clause id="H085C2BB2843C44158C9F6E9261B164E9"><enum>(i)</enum><text>the
Medicare or Medicaid program or another government-sponsored health program (as
identified by the Secretary of Health and Human Services); or</text>
</clause><clause id="H159C508D7D724155BE364BDE04D4C2FB"><enum>(ii)</enum><text>a
group health plan (as defined in section 607(1) of the Employee Retirement
Income Security Act of 1974); and</text>
</clause></subparagraph><subparagraph id="H6567F6CC30AC451DA0E684A3B84F0468"><enum>(C)</enum><text>does not have
coverage that is otherwise found to be qualifying by the Secretary.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H406FB8F038B543BAB8E22950A013FC8"><enum>(f)</enum><header>Subsidies for
Financially Disadvantaged Persons</header><text display-inline="yes-display-inline">The Secretary shall establish a system of
subsidies to assist in the payment of premiums and cost-sharing for individuals
who are required under subsection (e) (but for paragraph (3)) to be covered
under a standard health benefit plan but who are financially unable to afford
to pay such premiums..</text>
</subsection><subsection commented="no" id="HD94BF32C65D949F8ACFAA48546DBD232"><enum>(g)</enum><header>Employer role in
funding health benefit plans</header>
<paragraph id="H0F0D30AABFC347059C67999B59E8DB"><enum>(1)</enum><header>In
general</header><text>Nothing in this title shall prevent an employer from
providing health benefits coverage to employees and their dependents through
existing arrangements or through a standard health benefit plan offered through
a regional State arrangement under this title.</text>
</paragraph><paragraph id="HE1C9F2E7170C40F59DAAFA09CDAD94F9"><enum>(2)</enum><header>Required
registration with Benefits Administrator</header><text>Each employer with
employees residing in an area covered by a regional State arrangement shall
register with the Benefits Administrator for such arrangement.</text>
</paragraph></subsection></section><section id="HC2B3E58187C04440BF9723A6FC43D46"><enum>402.</enum><header>Transparency and
accountability for health benefit plans</header>
<subsection id="H6D419AB5E0524A6F88B3977F408F00EB"><enum>(a)</enum><header>Plan
comparisons</header><text display-inline="yes-display-inline">The Secretary
shall establish a method for making available, in comparative form, to health
consumers, providers, employers, and health plans, how health benefit plans
offered under this title compare to each other within a regional State
arrangement.</text>
</subsection><subsection id="HA8AE0B47AA964B42A5B2C0DF9EA2001E"><enum>(b)</enum><header>Provider
transparency and accountability</header>
<paragraph id="H69396B78ECFB4080A18901639819A520"><enum>(1)</enum><header>Quality
standards</header><text display-inline="yes-display-inline">Not later than 1
year after the date of the enactment of this Act, the Secretary shall develop
definitions and standards for quality care in collaboration with providers,
public and private-sector representatives, payers, and consumers.</text>
</paragraph><paragraph id="HD4000FF9C4C74E50A77341B3C7D405AF"><enum>(2)</enum><header>Coverage</header><text display-inline="yes-display-inline">The quality standards developed under
paragraph (1) shall cover both process and outcome measures and shall be
applied to health care entities, including individual physicians, groups of
physicians, hospitals, integrated systems, and, to the extent specified by the
Secretary, an entire enterprise. Such standards shall be based on
evidence-based medicine and shall be continuously updated and expanded.</text>
</paragraph><paragraph id="H5342B6AE9F06411EA57BF3F219CA0903"><enum>(3)</enum><header>Measurement</header><text>Once
such standards are developed, performance of health care entities shall be
measured against these standards.</text>
</paragraph></subsection><subsection id="H14A368C4DC53483DA0786791F9CEBFA4"><enum>(c)</enum><header>Health plan
transparency and accountability</header>
<paragraph id="H2AE8C3ABCADB4F4582E9D07686151EB5"><enum>(1)</enum><header>Accountability</header><text display-inline="yes-display-inline">The Secretary shall develop standards to
hold administrators of health benefit plans accountable for their claims
administrative practices, including overhead costs, delayed claims payments,
errors, lost claims, and aggressive denial of claims.</text>
</paragraph><paragraph id="H718BD8D55112480EA4F0683B2143D346"><enum>(2)</enum><header>Development of
standards</header><text display-inline="yes-display-inline">The Secretary shall
develop such standards through a collaborative process between the
public-sector and private-sector stakeholders to measure and make available to
the public information on the performance of health benefit plan administrators
during the period measured. Such information for each health benefit plan
administrator shall include, for each health plan administered for each
measurement period, the following:</text>
<subparagraph id="HFE55A9016B444E6383D80096755461C"><enum>(A)</enum><text display-inline="yes-display-inline">Expense loadings added to the basic premium
amount to cover expenses of the plan, including commissions, premium taxes,
marketing support costs, and other similar expenses.</text>
</subparagraph><subparagraph id="H90D4795B3EB94EA789254CA4CA5D7808"><enum>(B)</enum><text>The total number
and cost of denied claims.</text>
</subparagraph><subparagraph id="H34D1108DAA784FCF9EA7C8FAFC27D7C0"><enum>(C)</enum><text>The total cost of
denied claims that is transferred to providers.</text>
</subparagraph><subparagraph id="H2CB6085AD28A481EA106812D38385C49"><enum>(D)</enum><text display-inline="yes-display-inline">The average out-of-pocket expense incurred
by participants.</text>
</subparagraph><subparagraph id="HA9008E1BF8274FAFA281A8A617BC00C4"><enum>(E)</enum><text>Consumer
assessments regarding plan administration.</text>
</subparagraph><subparagraph id="HAA37D7A1642547E49950D9002D24002E"><enum>(F)</enum><text>The relative
efficiency and quality of claims administration and other administrative
processes.</text>
</subparagraph></paragraph></subsection><subsection id="H36E5880C57E44A49BB32E3559663A312"><enum>(d)</enum><header>Oversight</header><text display-inline="yes-display-inline">The Secretary shall have oversight
responsibility to ensure that health benefit plans are administered
properly.</text>
</subsection></section><enum>V</enum><header>Amendments
Relating to Preexisting Condition Exclusion</header>
<section display-inline="no-display-inline" id="HAD7A8C38CA534F9CBD4509B955FD9C8F" section-type="subsequent-section"><enum>501.</enum><header>Short
title</header><text display-inline="no-display-inline">This Act may be cited as
the <quote><short-title>Preexisting Condition Exclusion
Patient Protection Act of 2008</short-title></quote>.</text>
</section><section id="H16FD1181857A4EADB5FC7F5E99E298E"><enum>502.</enum><header>Amendments
relating to preexisting condition exclusions under group health plans</header>
<subsection id="HB168A14243564FBA82DC068583916D08"><enum>(a)</enum><header>Amendments to
the Employee Retirement Income Security Act of 1974</header>
<paragraph id="H875A2E4B18D643DB9CC851E7FEBC2E87"><enum>(1)</enum><header>Reduction in
look-back period</header><text>Section 701(a)(1) of the Employee Retirement
Income Security Act of 1974 (<external-xref legal-doc="usc" parsable-cite="usc/29/1181">29 U.S.C. 1181(a)(1)</external-xref>) is amended by striking
<quote>6-month period</quote> and inserting <quote>30-day
period</quote>.</text>
</paragraph><paragraph id="HC56AC51C8355438B9666B1FB326D4F3D"><enum>(2)</enum><header>Reduction in
permitted preexisting condition limitation period</header><text>Section
701(a)(2) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1181">29 U.S.C. 1181(a)(2)</external-xref>) is amended by striking <quote>12
months</quote> and inserting <quote>3 months</quote>, and by striking <quote>18
months</quote> and inserting <quote>9 months</quote>.</text>
</paragraph></subsection><subsection id="H054C6810F2CF4F79964B82BFD4580185"><enum>(b)</enum><header>Amendments to
the Public Health Service Act</header>
<paragraph id="HCC60E92683AC402E85D5116C5F80B41"><enum>(1)</enum><header>Reduction in
look-back period</header><text>Section 2701(a)(1) of the Public Health Service
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg(a)(1)</external-xref>) is amended by striking <quote>6-month
period</quote> and inserting <quote>30-day period</quote>.</text>
</paragraph><paragraph id="HDF34C22F767649409F51F7CBE759F204"><enum>(2)</enum><header>Reduction in
permitted preexisting condition limitation period</header><text>Section
2701(a)(2) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg">42 U.S.C. 300gg(a)(2)</external-xref>) is amended by striking <quote>12
months</quote> and inserting <quote>3 months</quote>, and by striking <quote>18
months</quote> and inserting <quote>9 months</quote>.</text>
</paragraph></subsection><subsection id="HA7E30B9FBA61414C823F7DBAEAD146BD"><enum>(c)</enum><header>Amendments to
the Internal Revenue Code of 1986</header>
<paragraph id="HEAD710A8AB0A496700667D41A961C2E4"><enum>(1)</enum><header>Reduction in
look-back period</header><text display-inline="yes-display-inline">Paragraph
(1) of <external-xref legal-doc="usc" parsable-cite="usc/26/9801">section 9801(a)</external-xref> of the Internal Revenue Code of 1986 (relating to
limitation on preexisting condition exclusion period and crediting for periods
of previous coverage) is amended by striking <quote>6-month period</quote> and
inserting <quote>30-day period</quote>.</text>
</paragraph><paragraph id="H48DCCB524ED54544A2E2372934173498"><enum>(2)</enum><header>Reduction in
permitted preexisting condition limitation period</header><text>Paragraph (2)
of section 9801(a) of such Code is amended by striking <quote>12 months</quote>
and inserting <quote>3 months</quote>, and by striking <quote>18 months</quote>
and inserting <quote>9 months</quote>.</text>
</paragraph></subsection><subsection id="H011D85400FB24A29A9BC45FACAD494EB"><enum>(d)</enum><header>Effective
date</header>
<paragraph id="HDB8F4C0AA5DC48BBBFB0D9747EFF2EF4"><enum>(1)</enum><header>In
general</header><text>Except as provided in paragraph (2), the amendments made
by this section shall apply with respect to group health plans for plan years
beginning after the end of the 12th calendar month following the date of the
enactment of this Act.</text>
</paragraph><paragraph id="HD36B389AF1AE49C7BF7FDD5458C60BF"><enum>(2)</enum><header>Special rule for
collective bargaining agreements</header><text>In the case of a group health
plan maintained pursuant to one or more collective bargaining agreements
between employee representatives and one or more employers ratified before the
date of the enactment of this Act, the amendments made by this section shall
not apply to plan years beginning before the earlier of—</text>
<subparagraph id="H3388E6850B744CC5B4D7007DBD7100DE"><enum>(A)</enum><text>the date on which
the last of the collective bargaining agreements relating to the plan
terminates (determined without regard to any extension thereof agreed to after
the date of the enactment of this Act), or</text>
</subparagraph><subparagraph commented="no" id="HDA0A6EF211764D4DBF14AF7E7C0000D8"><enum>(B)</enum><text>3 years after the
date of the enactment of this Act.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">For purposes
of subparagraph (A), any plan amendment made pursuant to a collective
bargaining agreement relating to the plan which amends the plan solely to
conform to any requirement added by the amendments made by this section shall
not be treated as a termination of such collective bargaining agreement.</continuation-text></paragraph></subsection></section><section id="H6AFDC19BEE8E43D2B4C1BB4BAB10ACCC"><enum>503.</enum><header>Amendments
relating to preexisting condition exclusions in health insurance coverage in
the individual market</header>
<subsection id="HE35EE350C0CB4D2DBD1DEA00557701E8"><enum>(a)</enum><header>Applicability of
group health insurance limitations on imposition of preexisting condition
exclusions</header>
<paragraph id="H86B31C91F82B4CB5B8B9FBC16493FB97"><enum>(1)</enum><header>In
general</header><text>Section 2741 of the Public Health Service Act (42 U.S.C.
300gg–41) is amended—</text>
<subparagraph id="H13677C0F086F47F2B089A3980050004E"><enum>(A)</enum><text>by redesignating
the second subsection (e) (relating to market requirements) and subsection (f)
as subsections (f) and (g), respectively; and</text>
</subparagraph><subparagraph id="H43ACDC4F6A474ECD952816BBD200B3F7"><enum>(B)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H74F53392AEA44A4F980098E9E4BA9E75" style="OLC">
<subsection id="H551D2DB5705C4CEEB623D3E107A3859D"><enum>(h)</enum><header>Application of
group health insurance limitations on imposition of preexisting condition
exclusions</header>
<paragraph id="H37A19E8274D8431F82E6B41B1440A068"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), a health insurance issuer that
provides individual health insurance coverage may not impose a preexisting
condition exclusion (as defined in subsection (b)(1)(A) of section 2701) with
respect to such coverage except to the extent that such exclusion could be
imposed consistent with such section if such coverage were group health
insurance coverage.</text>
</paragraph><paragraph id="H09C3B2F305F143D888A78EB3D0082C"><enum>(2)</enum><header>Limitation</header><text>In
the case of an individual who—</text>
<subparagraph id="H2DE3556B59DB4109885C18EE8D4389DE"><enum>(A)</enum><text>is enrolled in
individual health insurance coverage;</text>
</subparagraph><subparagraph id="HD8D67501DF8641EF99CB1EC4FB2700F9"><enum>(B)</enum><text>during the period
of such enrollment has a condition for which no medical advice, diagnosis,
care, or treatment had been recommended or received as of the enrollment date;
and</text>
</subparagraph><subparagraph id="H21135414A9994986B57C4C49A279F8DF"><enum>(C)</enum><text>seeks to enroll
under other individual health insurance coverage which provides benefits
different from those provided under the coverage referred to in subparagraph
(A) with respect to such condition,</text>
</subparagraph><continuation-text continuation-text-level="paragraph">the issuer
of the individual health insurance coverage described in subparagraph (C) may
impose a preexisting condition exclusion with respect to such condition and any
benefits in addition to those provided under the coverage referred to in
subparagraph (A), but such exclusion may not extend for a period of more than 3
months.</continuation-text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H7831FA6C837C4B66BBC61E5E5B70AB00"><enum>(2)</enum><header>Elimination of
COBRA requirement</header><text>Subsection (b) of such section is
amended—</text>
<subparagraph id="H6C2B9F1C476E49708F98C7D7D32C4D5F"><enum>(A)</enum><text>by adding
<quote>and</quote> at the end of paragraph (2);</text>
</subparagraph><subparagraph id="H5F94CD1DF1CD4FADB6A6B695BD343218"><enum>(B)</enum><text>by striking the
semicolon at the end of paragraph (3) and inserting a period; and</text>
</subparagraph><subparagraph id="HD245D1AE6E7642EEB435BC5FD0970100"><enum>(C)</enum><text>by striking
paragraphs (4) and (5).</text>
</subparagraph></paragraph><paragraph id="H59DB4A14CE5B4017BAE39EB0298322CF"><enum>(3)</enum><header>Conforming
amendment</header><text>Section 2744(a)(1) of such Act (42 U.S.C.
300gg–44(a)(1)) is amended by inserting <quote>(other than subsection
(h))</quote> after <quote>section 2741</quote> .</text>
</paragraph></subsection><subsection id="H12031B3F45F349F3B1B213B2BDA64B38"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by this section shall apply with respect
to health insurance coverage offered, sold, issued, renewed, in effect, or
operated in the individual market after the end of the 12th calendar month
following the date of the enactment of this Act.</text>
</subsection></section>