1.Short title; table of
contents
(a)This Act may be cited as the Health Coverage, Affordability, Responsibility, and Equity
Act of 2009
or the HealthCARE Act of 2009
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—State Waivers
Sec. 101. State waivers.
Title II—Improving Quality and Safety Through Preventive
Services, Care Coordination, and the Use of Health Information
Technology
Sec. 201. Additional waiver authority.
Title III—Increasing Health Care Coverage
Subtitle A—Medicaid and SCHIP
Sec. 301. State option to offer medicaid coverage based on
need.
Sec. 302. State option to provide coverage of children under
SCHIP in excess of the State’s allotment.
Subtitle B—Refundable Tax Credit for Health Insurance Costs of
Low-Income Individuals and Families
Sec. 311. Credit for health insurance costs of certain
low-income individuals.
Sec. 312. Advance payment of credit for health insurance costs
of eligible low-income individuals.
Title IV—Improving Access to Health Plans
Sec. 401. Definitions.
Sec. 402. Establishment of health insurance purchasing
pools.
Sec. 403. Purchasing pools.
Sec. 404. Purchasing pool operators.
Sec. 405. Contracts with participating insurers.
Sec. 406. Options for health benefits coverage.
Sec. 407. Enrollment process for eligible
individuals.
Sec. 408. Plan premiums.
Sec. 409. Enrollee premium share.
Sec. 410. Payments to purchasing pool operators and payments to
participating insurers.
Sec. 411. State-based reinsurance programs.
Sec. 412. Coverage under individual health
insurance.
Sec. 413. Use of premium subsidies to unify family coverage
with members enrolled in medicaid and SCHIP.
Sec. 414. Coverage through employer-sponsored health
insurance.
Sec. 415. Participation by small employers.
Sec. 416. Report.
Sec. 417. Authorization of appropriations.
Title V—National Advisory Commission on Expanded Access to Health
Care
Sec. 501. National Advisory Commission on Expanded Access to
Health Care.
Sec. 502. Congressional action.
<enum>I</enum><header>State
Waivers</header>
<section id="H0F68668B56F8439200F5BA9B631398DC"><enum>101.</enum><header>State
waivers</header>
<subsection id="H1CD53F193EE147C2B464E4C8FD139FC"><enum>(a)</enum><header>In
general</header><text>Notwithstanding any other provision of law, a State may
apply to the Secretary of Health and Human Services (in this Act referred to as
the <quote>Secretary</quote>) for waivers of such provisions of law as may be
necessary for the State to implement policies that make comprehensive,
affordable health coverage available for all State residents, including access
to essential benefits with limits on cost-sharing, as provided in the most
recent report under section 501(e)(2).</text>
</subsection><subsection id="H4C39D1E0185B4663ACE4CE003C5E1440"><enum>(b)</enum><header>Requirements</header><text>In
order to ensure that waivers under this section benefit rather than harm health
care consumers, a State shall not be eligible for a waiver under this section
unless—</text>
<paragraph id="H5AE6749F4BBB4FDE00006674ADEB2FC4"><enum>(1)</enum><text>the State
reasonably expects to achieve a level of enrollment in coverage described in
subsection (a) that is at least equal to the level of coverage (taking into
account the number of insured individuals, covered benefits, and premium and
out-of-pocket costs to the consumer for such coverage) that the State would
have achieved if the State had fully implemented the coverage options available
under titles III and IV of this Act;</text>
</paragraph><paragraph id="H07087473777248E2AFDA298118C7B66F"><enum>(2)</enum><text>no individual who
would have qualified for assistance under the State medicaid program under
title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name>
or the State children’s health insurance program under title XXI of such Act,
as of either the date of the waiver request or the date of enactment of this
Act, will be denied eligibility for such program, have a reduction in benefits
under such program, have reduced access to geographically and linguistically
appropriate care or essential community providers, or be subject to increased
premiums or cost-sharing under the waiver program under this section;
and</text>
</paragraph><paragraph id="H82CF070161A04C25B18D850919DF1E5B"><enum>(3)</enum><text>the State agrees
to comply with such standards or guidelines as the Secretary of Health and
Human Services may require to ensure that the requirements of paragraphs (1)
and (2) are satisfied.</text>
</paragraph></subsection><subsection id="HA20C499D91034D4BB08372C5FC755C3C"><enum>(c)</enum><header>Federal
payments</header>
<paragraph id="H4D31CC7AFCB549B3A05C1569BB154D5B"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall pay a
State with a waiver approved under this section an amount each quarter equal to
the sum of—</text>
<subparagraph id="H24E0ABDF83574C1787B238AC1004B05F"><enum>(A)</enum><text>the Federal
payments the State and residents of the State (including, but not limited to,
through the credit allowed under section 36A of the Internal Revenue Code of
1986 for health insurance costs) would have received if the State had exercised
the coverage options under titles III and IV of this Act with respect to
residents of the State who have not attained age 65; and</text>
</subparagraph><subparagraph id="HF9E72E1C2CC54DBDA1ED80EB4770502B"><enum>(B)</enum><text>the amount of any
grants authorized by this Act that the State would have received if the State
had applied for such grants.</text>
</subparagraph></paragraph><paragraph id="HE0029748050B48A89E34540022CB0070"><enum>(2)</enum><header>Additional
payment for medicare beneficiaries under age 65</header>
<subparagraph id="HD957D6875B18460C8FCF2102FD25232D"><enum>(A)</enum><header>In
general</header><text>In the case of a State that elects to enroll an
individual described in subparagraph (B) in coverage described in subsection
(a), the amount described in paragraph (1) with respect to a quarter shall be
increased by the amount described in subparagraph (C).</text>
</subparagraph><subparagraph id="H274CAFEDE2354424A43CDCEC62C9ABF"><enum>(B)</enum><header>Individual
described</header><text>An individual is described in this subparagraph if the
individual—</text>
<clause id="H6F125E31A2D9420EA5AF1577524C7042"><enum>(i)</enum><text>has
not attained age 65;</text>
</clause><clause id="H90ACE035D7C046A3B0647E005BEEB92"><enum>(ii)</enum><text>is
eligible for coverage under title XVIII of the <act-name parsable-cite="SSA">Social Security Act</act-name>; and</text>
</clause><clause id="H2180110444B242549D00C4CA3EA286C4"><enum>(iii)</enum><text>voluntarily
elects to enroll in coverage described in subsection (a).</text>
</clause></subparagraph><subparagraph id="HD35C7002F6B04CD686534C02F86F2000"><enum>(C)</enum><header>Amount
described</header><text>The amount described in this subparagraph is the amount
equal to the amount that the Federal Government would have incurred with
respect to a quarter for providing coverage to an individual described in
subparagraph (B) under title XVIII of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395 et seq.).</text>
</subparagraph></paragraph></subsection><subsection id="HE818D5EE74E74AFEA36C75E358C0B361"><enum>(d)</enum><header>Implementation
date</header><text>No State may submit a request for a waiver under this
section before October 1, 2011.</text>
</subsection></section><enum>II</enum><header>Improving Quality
and Safety Through Preventive Services, Care Coordination, and the Use of
Health Information Technology</header>
<section id="H721A781409064FA700E27D084C008195"><enum>201.</enum><header>Additional
waiver authority</header>
<subsection id="H6D3F89B6D3F84A6FBCAC86A206175BE7"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Notwithstanding the
requirements to submit a state waiver under title I, the Secretary shall
establish a process by which States may apply for a waiver to implement
policies that emphasize the use of preventive services, care coordination by a
personal physician, and health information technology (in this section referred
to as a qualified patient-centered medical home).</text>
</subsection><subsection id="HFC637BC11A1A4D0E89FF2977ABBFA469"><enum>(b)</enum><header>Definitions</header><text>For
purposes of this title:</text>
<paragraph id="H00E5592D81CC46CEA9FB802609CDA88C"><enum>(1)</enum><header>Qualified
patient-centered medical home</header><text display-inline="yes-display-inline">The term <term>qualified patient-centered
medical home</term> or <term>PC–MH</term> means a physician-directed practice
that has voluntarily participated in a qualification process to demonstrate it
has the capabilities to achieve improvements in the management and coordination
of care of eligible beneficiaries, including those with multiple chronic
diseases, by incorporating attributes of the care management model.</text>
</paragraph><paragraph id="H62CD9ACEBAE34031B3BF120758DC0654"><enum>(2)</enum><header>Care management
model</header><text display-inline="yes-display-inline">The term <term>care
management model</term> means a model that uses health information and other
physician practice innovations to improve the management and coordination of
care provided to patients with one or more chronic illnesses. Attributes of the
model include the following:</text>
<subparagraph id="HE1B95132A03848679BB5004237CB5668"><enum>(A)</enum><text display-inline="yes-display-inline">Practices advocate for their patients to
support the attainment of optimal, patient-centered outcomes that are defined
by a care planning process driven by a compassionate, robust partnership
between physicians, patients, and the patient’s family.</text>
</subparagraph><subparagraph id="H92215B3247A14E0494D2EDBD94701583"><enum>(B)</enum><text>Evidence-based
medicine and clinical decision-support tools guide decision making.</text>
</subparagraph><subparagraph id="H1F97E12ADF524315AF2EE5D757993305"><enum>(C)</enum><text>Physicians in the
practice accept accountability for continuous quality improvement through
voluntary engagement in performance measurement and improvement.</text>
</subparagraph><subparagraph id="HA8B763F206B14AF5AE498B2B4410C28E"><enum>(D)</enum><text>Patients actively
participate in decision-making and feedback is sought to ensure patients’
expectations are being met.</text>
</subparagraph><subparagraph id="HB3485A2CA8CE4D8A824D032C21930087"><enum>(E)</enum><text>Information
technology is utilized appropriately to support optimal patient care,
performance measurement, patient education, and enhanced communication.</text>
</subparagraph><subparagraph id="H1706DB33767D475D8CDFF880326922CF"><enum>(F)</enum><text>Practices go
through a voluntary recognition process by an appropriate non-governmental
entity to demonstrate that they have the capabilities to provide patient
centered services consistent with the medical home model.</text>
</subparagraph><subparagraph id="H37B7F7DCC33C419A8D52EAF705EAFDA4"><enum>(G)</enum><text>Patients and
families participate in quality improvement activities at the practice
level.</text>
</subparagraph></paragraph><paragraph id="HBDF7F5F2436B4FB5B4810000D43F76A"><enum>(3)</enum><header>Patient centered
medical home reimbursement methodology</header><text display-inline="yes-display-inline">The patient centered medical home
reimbursement methodology is a methodology to reimburse physicians in qualified
PC–MH practices based on the value of the services provided by such practices.
Such methodology shall include, at a minimum the following:</text>
<subparagraph id="H9841564A19F745B295D772A77CC3697E"><enum>(A)</enum><text display-inline="yes-display-inline">Recognition of the value of physician and
clinical staff work associated with patient care that falls outside the
face-to-face visit, such as the time and effort spent on educating family
caregivers and arranging appropriate follow-up services with other health care
professionals, such as nurse educators.</text>
</subparagraph><subparagraph id="HD3AD832AD67444B39D9053DCDBDEFA4D"><enum>(B)</enum><text>Services
associated with coordination of care both within a given practice and between
consultants, ancillary providers, and community resources.</text>
</subparagraph><subparagraph id="HC692B9F030F3458884C7898B6862008F"><enum>(C)</enum><text>Recognition of
expenses that the PC–MH practices will incur to acquire and utilize health
information technology, such as clinical decision support tools, patient
registries and/or electronic medical records.</text>
</subparagraph><subparagraph id="HFBFACF825467491DAC7ECE7235E16328"><enum>(D)</enum><text>Reimbursement for
separately identifiable email and telephonic consultations, either as
separately billable services or as part of a global management fee.</text>
</subparagraph><subparagraph id="H26F3D42BE2DC4271B0C2E826FD6723D3"><enum>(E)</enum><text>Recognition of the
value of physician work associated with remote monitoring of clinical data
using technology.</text>
</subparagraph><subparagraph id="H41B30502449447D88292DF6B5C4500B4"><enum>(F)</enum><text>Allowance for
separate fee-for-service payments for face-to-face visits.</text>
</subparagraph><subparagraph id="H0DC31D3584ED4C93A793E2BF7C4BE402"><enum>(G)</enum><text>Recognition of
case mix differences in the patient population being treated within the
practice.</text>
</subparagraph><subparagraph id="HDEDB4621D8E543238EC70013D920153"><enum>(H)</enum><text>Recognition and
sharing of savings from reduced hospitalizations associated with
physician-guided care management in the office setting.</text>
</subparagraph><subparagraph id="H55B66F9B3CFE4FAD00F7374FEDF5E9EC"><enum>(I)</enum><text>Allowance for
additional payments for achieving measurable and continuous quality
improvements.</text>
</subparagraph></paragraph><paragraph id="HD65E30D7F10E4B9FAFE5EFFB2D4824E"><enum>(4)</enum><header>Personal
physician</header><text display-inline="yes-display-inline">The term
<term>personal physician</term> means a physician who practices in a qualified
PC–MH and whom the practice has determined has the training to provide first
contact, continuous and comprehensive care for the whole person, not limited to
a specific disease condition or organ system.</text>
</paragraph><paragraph id="H0BB5201E1D814DD0B4058618A29EF57F"><enum>(5)</enum><header>Eligible
beneficiary</header><text display-inline="yes-display-inline">The term
<term>eligible beneficiary</term> means a beneficiary enrolled under the
Medicaid or SCHIP program or other State resident who selects a primary care or
principal care physician in a qualified PC–MH as their personal
physician.</text>
</paragraph><paragraph id="HD4ED7B94E4EC4C3083A79DEBCA1F86AC"><enum>(6)</enum><header>Patient-centered
medical home qualification</header><text display-inline="yes-display-inline">The PC–MH qualification is a process
whereby an interested practice will voluntarily submit information to an
objective external private-sector entity that is recognized and deemed by the
state or by the Secretary to make the determination as to whether the practice
has the attributes of a qualified PC–MH based on standards the Secretary shall
establish.</text>
</paragraph></subsection><subsection id="H83101B2D62194E13BA69A69704E4BD46"><enum>(c)</enum><header>Report and
evaluation</header><text>States shall submit an annual report to the Secretary
that describes initiatives it has taken to encourage the provision of care
through a patient-centered medical home as described in this section.</text>
</subsection></section><enum>III</enum><header>Increasing
Health Care Coverage</header>
<subtitle id="HCDA559921F1A49FC891FD4271CBADAB2"><enum>A</enum><header>Medicaid and
SCHIP</header>
<section id="HCCF03994EC1940C3BDCF36AE95382B78"><enum>301.</enum><header>State option to
offer medicaid coverage based on need</header>
<subsection id="H2EE13EC571CA4C7BB4B7E6EA32706571"><enum>(a)</enum><header>State
option</header><text>Section 1902(a)(10)(A)(ii) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1396a)
is amended—</text>
<paragraph id="H752E550A659244058F478D68DDDDE847"><enum>(1)</enum><text>by striking
<quote>or</quote> at the end of subclause (XVIII);</text>
</paragraph><paragraph id="H0C7E50330DD54AC594DF6DA1140065EE"><enum>(2)</enum><text>by adding
<quote>or</quote> at the end of subclause (XIX); and</text>
</paragraph><paragraph id="HD6AFEFE2A4B247D484C87F726093E87"><enum>(3)</enum><text>by
adding at the end the following:</text>
<quoted-block id="H2A6D06EBBCA840A191323953CBCDB01B">
<subclause id="H26A72B0E198746B29809DA306EE1476D"><enum>(XX)</enum><text>who are not
otherwise eligible for medical assistance under this title and whose income
does not exceed such income level as the State may establish, expressed as a
percentage (not to exceed 100) of the income official poverty line (as defined
by the Office of Management and Budget, and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to
a family of the size
involved;</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H9A7FAC0EDA474B538EC3E5A23B10E5CA"><enum>(b)</enum><header>Increased
FMAP</header><text>Section 1905 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1396d) is amended—</text>
<paragraph id="H69FB6BC3056246D48F492332D34746D3"><enum>(1)</enum><text>in the first
sentence of subsection (b)—</text>
<subparagraph id="HC143D6BC2F63496189002999E584727F"><enum>(A)</enum><text>by striking
<quote>and (4)</quote> and inserting <quote>(4)</quote>; and</text>
</subparagraph><subparagraph id="HE8BA26B063154A26A0ACA5B0DCF0FAED"><enum>(B)</enum><text>by inserting
before the period the following: <quote>, and (5) in the case of a State that
meets the conditions described in paragraph (1) of subsection (y), the Federal
medical assistance percentage shall be equal to the need-based enhanced FMAP
described in paragraph (2) of subsection (y)</quote>; and</text>
</subparagraph></paragraph><paragraph id="H30A30F434A9149E4BDF8F5B8313BD21D"><enum>(2)</enum><text>by adding at the
end the following:</text>
<quoted-block id="HC9273F7A1BD54007999D96B62B23DE33">
<subsection id="H79A698200FFA4FF38C34C7D37BF3F0FF"><enum>(y)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H2C49FD7A8D3F46B7B5C85BF0369466DF"><enum>(1)</enum><text>For purposes of clause
(5) of the first sentence of subsection (b), the conditions described in this
subsection are the following:</text>
<subparagraph id="HAE90756725CB41AD8D7CB348E3ABF264" indent="up1"><enum>(A)</enum><text>The State provides medical assistance
to individuals described in subsection (a)(10)(A)(ii)(XX).</text>
</subparagraph><subparagraph id="H8BFD4209CCB646048DA57502D9B48C5D" indent="up1"><enum>(B)</enum><text>The State uses streamlined enrollment
and outreach measures to all individuals described in subparagraph (A)
including—</text>
<clause id="H2DE9A7C4A2FC410394AB60D2E7E9EFCC"><enum>(i)</enum><text>the same application and retention
procedures (such as 1-page enrollment forms and enrollment by mail) used by the
majority of State programs under title XXI during the preceding year;
and</text>
</clause><clause id="H107DA5509F3F4E60AE23AFDCE4849912"><enum>(ii)</enum><text>outreach efforts proportional in
scope and reasonably expected effectiveness to those employed by the State
during a comparable stage of implementation of the State’s program under title
XXI.</text>
</clause></subparagraph><subparagraph id="H2D7E84BC46194F30BA3D1D12A173D91C" indent="up1"><enum>(C)</enum><text>The State applies eligibility
standards and methodologies under this title with respect to individuals
residing in the State who have not attained age 65 that are not more
restrictive (as determined under section 1902(a)(10)(C)(i)(III)) than the
standards and methodologies that applied under this title with respect to such
individuals as of July 1, 2009.</text>
</subparagraph></paragraph><paragraph id="H4D6121884660470582D4376E419BED8D" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H9230EB0C130E48E8905CA000E7F9E46B"><enum>(A)</enum><text>For purposes of clause
(5) of the first sentence of subsection (b), the need-based enhanced FMAP for a
State for a fiscal year, is equal to the Federal medical assistance percentage
(as defined in the first sentence of subsection (b)) for the State increased,
subject to subparagraph (B), by such percentage increase as would compensate
all States for the additional expenditures that would be incurred by all States
if the States were to provide medical assistance to all individuals whose
income does not exceed 100 percent of the income official poverty line (as
defined by the Office of Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus Budget Reconciliation Act of
1981) applicable to a family of the size involved and who are eligible for such
assistance only on the basis of section 1902(a)(10)(A)(ii)(XX).</text>
</subparagraph><subparagraph id="H5395B181F10A4A49BCDCD682E639474D" indent="up1"><enum>(B)</enum><text>In the case of a State that provides
medical assistance to individuals described in section 1902(a)(10)(A)(ii)(XX)
but limits such assistance to individuals with income at or below a percentage
of the income official poverty line (as defined by the Office of Management and
Budget, and revised annually in accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981) applicable to a family of the size involved
that is less than 100, the Secretary shall reduce the need-based enhanced FMAP
otherwise determined for the State under subparagraph (A) by a proportion based
on the national income distribution of all individuals in all States who are
(regardless of whether such individuals are enrolled under this title) eligible
for medical assistance only on the basis of section
1902(a)(10)(A)(ii)(XX).</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HC682DF13D0E44ADAB4F62E1DCB7DF53F"><enum>(c)</enum><header>Conforming
amendments</header><text>Section 1905(a) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1396d(a)) is
amended in the matter preceding paragraph (1)—</text>
<paragraph id="H16063D3658814A52B1F833F1D5E31132"><enum>(1)</enum><text>by striking
<quote>or</quote> at the end of clause (xii);</text>
</paragraph><paragraph id="H679AA8A958E74174831D028975093600"><enum>(2)</enum><text>by adding
<quote>or</quote> at the end of clause (xiii); and</text>
</paragraph><paragraph id="H1055C8C41E87435D8B26E7C5CDA5DDED"><enum>(3)</enum><text>by inserting after
clause (xiii) the following:</text>
<quoted-block id="HF9905A7163984595BCEF589899FA72A0">
<clause id="H34923A537F5445DBAFB4849E331E5FA" indent="up2"><enum>(xiv)</enum><text>individuals who are eligible for
medical assistance on the basis of section
1902(a)(10)(A)(ii)(XX);</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H1F623540C5B042D3AE66932EDF377E4B"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by this section take effect on October
1, 2010, and apply to medical assistance provided on or after that date,
without regard to whether final regulations to carry out such amendments have
been promulgated by such date.</text>
</subsection></section><section id="H765AF18F686D4986BB52B71100D647E"><enum>302.</enum><header>State option to
provide coverage of children under SCHIP in excess of the State’s
allotment</header>
<subsection id="H66FA205BB2824858ADF5D033F2AD00D3"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Title XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1397aa
et seq.), as amended by sections 111(a) and 112 of the Children's Health
Insurance Program Reauthorization Act of 2009 (Public Law 111–3), is amended by
adding at the end the following:</text>
<quoted-block act-name="Social Security Act" id="HD48E24D9F89D4B43AACBDB80F9EDA775">
<section id="H4A0A170362184540824053295FF01361"><enum>2113.</enum><header>State option
to provide coverage of children in excess of the State’s allotment</header>
<subsection id="H348C5A78A4E14FA992619000075E58DF"><enum>(a)</enum><header>State
option</header><text>In the case of a State that meets the condition described
in subsection (b), the following shall apply:</text>
<paragraph id="H47586824242D46A08EBBF77B4D8EEE4"><enum>(1)</enum><text>Notwithstanding
section 2105 and without regard to the State’s allotment under section 2104,
the Secretary shall pay the State an amount for each quarter equal to the
enhanced FMAP of expenditures incurred in the quarter that are described in
section 2105(a)(1).</text>
</paragraph><paragraph id="HD745D4C71E274D7385F3803300001B8B"><enum>(2)</enum><text>The Secretary
shall reduce the State’s allotment under section 2104, for the first fiscal
year for which the State amendment described in subsection (b) applies, and for
each fiscal year thereafter, by an amount equal to the amount that the
Secretary determines the State would have expended to provide child health
assistance to targeted low-income children during that fiscal year if that
State had not elected the State option to provide such assistance in accordance
with this section.</text>
</paragraph><paragraph id="H3A2107B16C3E4587B85199B53DADE0B4"><enum>(3)</enum><text>Subsections (f)
and (g) of section 2104 shall not apply to the State’s reduced allotment (after
the application of paragraph (2)).</text>
</paragraph></subsection><subsection id="HDFE5484F3CF14C85AF56B55FA39DA2C6"><enum>(b)</enum><header>Condition
described</header><text>For purposes of subsection (a), the condition described
in this subsection is that the State has made an irrevocable election, through
a plan amendment, to provide child health assistance to all targeted low-income
children residing in the State (without regard to date of application for
assistance) and to cover health services listed in the State plan whenever
medically
necessary.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HAD5AB69C4B504F8E8216FB6E4EAEC3E3"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by this section takes effect on October
1, 2010, and applies to child health assistance provided on or after that date,
without regard to whether final regulations to carry out such amendment have
been promulgated by such date.</text>
</subsection></section></subtitle><subtitle id="HA153F079C9D945C090838D478705B5AB"><enum>B</enum><header>Refundable Tax
Credit for Health Insurance Costs of Low-Income Individuals and
Families</header>
<section id="H16E01B46CDBF4D2687CE5F98415E987F"><enum>311.</enum><header>Credit for
health insurance costs of certain low-income individuals</header>
<subsection id="H1803288766214FD1B53855630092E700"><enum>(a)</enum><header>In
general</header><text>Subpart C of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to refundable credits) is amended by
inserting after section 36 the following new section:</text>
<quoted-block id="HDAB00FAE73BD4967B08293F6293BBF4D">
<section id="H5946A030E195426CB8F5ABF953827328"><enum>36A.</enum><header>Health
insurance costs of eligible low-income individuals</header>
<subsection id="H1C133EA458AF44E68616534DB89B50E1"><enum>(a)</enum><header>In
general</header><text>In the case of an individual, there shall be allowed as a
credit against the tax imposed by this subtitle for the taxable year an amount
equal to the applicable percentage of the amount paid by the taxpayer (or on
behalf of the taxpayer) for coverage of the taxpayer or qualifying family
members under qualified health insurance for eligible coverage months beginning
in such taxable year.</text>
</subsection><subsection id="HEDC739AB9348404BA300AC83673FDD6"><enum>(b)</enum><header>Applicable
percentage</header><text>For purposes of this section—</text>
<paragraph id="H0D830A24952B44C38CDC8F0043603306"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), the term <term>applicable
percentage</term> means the standard Government contribution (determined for
full-time Federal employees enrolling in coverage for which such contribution
is not limited by section 8906(b)(1) of title 5, United States Code) for an
employee enrolled in a health benefits plan under chapter 89 of title 5, United
States Code, for the calendar year in which the taxable year begins, expressed
as a percentage of the total premium for such plan.</text>
</paragraph><paragraph id="H6A4A6862E409469BB41B00633BEC643F"><enum>(2)</enum><header>Increased
percentage for certain taxpayers</header>
<subparagraph id="HF377986C404346C59518DD3CB165D708"><enum>(A)</enum><header>In
general</header><text>In the case of a taxpayer whose adjusted gross income for
the preceding taxable year does not exceed 150 percent of the poverty level,
the applicable percentage determined under paragraph (1) shall be increased by
such percentage points as the Secretary determines will fully compensate such
an individual for the individual’s limited purchasing power in comparison to
individuals whose adjusted gross income equals the average adjusted gross
income for all Federal employees, to the extent that the amount of the
resulting increase in the credit amount for all such eligible low-income
individuals for the taxable year is not reasonably expected to exceed the 5
percentage point dollar amount for that year, as determined under subparagraph
(B).</text>
</subparagraph><subparagraph id="H93FA87F71C034B6AA6E5CFB9D9F83F6"><enum>(B)</enum><header>Determination of
5 percentage point dollar amount</header><text>For purposes of subparagraph
(A), the 5 percentage point dollar amount for any taxable year is the product
of—</text>
<clause id="HC98A299AD7E642AE939C668300BE1C6E"><enum>(i)</enum><text>the total number
of individuals receiving credits under this section for such year; and</text>
</clause><clause id="H015EAFE1BDB548A4B576A58600FD8125"><enum>(ii)</enum><text>the amount equal
to 5 percent of the average health insurance premium amount to which such
credits are applied.</text>
</clause></subparagraph><subparagraph id="H59212E6F29AC4972B700BFC8EB2B35BF"><enum>(C)</enum><header>Rule of
construction</header><text>Nothing in this paragraph shall be construed to
prevent the Secretary from establishing more than 1 level of supplemental
assistance that provides greater assistance to individuals with lower income,
determined as a percentage of poverty.</text>
</subparagraph></paragraph><paragraph id="HFDD4E20A5A2144D581EB9ED8377DB177"><enum>(3)</enum><header>Application of
FEHBP coverage categories to determination of credit</header><text>The
percentages described in paragraphs (1) and (2) shall be applied to a taxpayer
consistent with the coverage categories (such as self or family coverage)
applied with respect to a health benefits plan under chapter 89 of title 5,
United States Code.</text>
</paragraph></subsection><subsection id="H4969DCE1EA524368B9A4D65518A80027"><enum>(c)</enum><header>Maximum premium
amount</header><text>The amount paid for qualified health insurance taken into
account under subsection (a) for any taxable year shall not exceed an amount
equal to the capped premium established for the applicable State under section
404(c)(10) of the <short-title>Health Coverage,
Affordability, Responsibility, and Equity Act of 2009</short-title> for the
calendar year in which the such taxable year begins.</text>
</subsection><subsection id="HF2DACD5D97BD4257A8EBD8CC40059B3"><enum>(d)</enum><header>Eligible coverage
month</header><text>For purposes of this section—</text>
<paragraph id="HECE8C90D0C4347F99EC9A49F93B2A106"><enum>(1)</enum><header>In
general</header><text>The term <term>eligible coverage month</term> means any
month if during such month the taxpayer or a qualifying family member—</text>
<subparagraph id="H311E459A0E644EE3B9E0B3404800E450"><enum>(A)</enum><text>is an eligible
low-income individual;</text>
</subparagraph><subparagraph id="H9AFA879455C44FF9887FACE300F6D4F0"><enum>(B)</enum><text>is covered by
qualified health insurance, the premium for which is paid by the taxpayer (or
on behalf of the taxpayer);</text>
</subparagraph><subparagraph id="H9E8554436C454634807C00DEFE67A288"><enum>(C)</enum><text>does not have
other specified coverage; and</text>
</subparagraph><subparagraph id="H4A8FB9BF2BBD4250A89700F8FAD0B200"><enum>(D)</enum><text>is not imprisoned
under Federal, State, or local authority.</text>
</subparagraph></paragraph><paragraph id="HDEABD9C6F1EC469EA024F3CF02A9E406"><enum>(2)</enum><header>Joint
returns</header><text>In the case of a joint return, the requirement of
paragraph (1)(A) shall be treated as met with respect to any month if at least
1 spouse satisfies such requirement.</text>
</paragraph></subsection><subsection id="HA5A2A9BBDF824011B9F4C7E3730E78D"><enum>(e)</enum><header>Eligible
low-income individual</header><text>For purposes of this section—</text>
<paragraph id="HF8566D7CA2644191971651BCDBEAC13D"><enum>(1)</enum><header>In
general</header><text>The term <term>eligible low-income individual</term>
means an individual—</text>
<subparagraph id="HEB025F24CFFF479F85985771C0117061"><enum>(A)</enum><text>who has not
attained age 65;</text>
</subparagraph><subparagraph id="HDE5819CEB76A4D49AB0081328CE4D0B4"><enum>(B)</enum><text>whose adjusted
gross income does not exceed 200 percent of the poverty level;</text>
</subparagraph><subparagraph id="H4B49B468AE7C40A99410836185CF9E69"><enum>(C)</enum><text>who is ineligible
for the medicaid program or the State children’s health insurance program under
title XIX or XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (other than under section 1928 of such Act);</text>
</subparagraph><subparagraph id="H38E6852820974554A6402297C159D4EE"><enum>(D)</enum><text>who has limited
access to health insurance coverage through the employer of the individual or a
member of the individual’s family (either because the employer does not offer
such coverage to the individual or because the employee contribution for such
coverage would exceed an amount equal to 5 percent of the household income of
such individual, as determined in accordance with paragraph (2));</text>
</subparagraph><subparagraph id="HB54F2BCC81704725826800C4AAB7D7BE"><enum>(E)</enum><text>who applies for a
credit under this section not later than 60 days after receiving notice of
potential eligibility for such credit, under procedures established by the
Secretary; and</text>
</subparagraph><subparagraph id="H3EFFCBB0D7FD47329818BDBDF69F3C52"><enum>(F)</enum><text>who resides in a
State where the eligibility standards and methodologies applied under the
medicaid and State children’s health insurance programs with respect to
individuals residing in the State who have not attained age 65 are not more
restrictive (as determined under section 1902(a)(10)(C)(i)(III) of the
<act-name parsable-cite="SSA">Social Security Act</act-name>) than the
standards and methodologies that applied under such programs with respect to
such individuals as of July 1, 2009.</text>
</subparagraph></paragraph><paragraph id="H11161CBA684E4FF39EB43EB2372B00FA"><enum>(2)</enum><header>Determination of
eligibility</header>
<subparagraph id="H2D1C92C3A456469682ED8785BB8F3862"><enum>(A)</enum><header>SCHIP
agency</header>
<clause id="H095E09D868534D9A9813BF1FDD082147"><enum>(i)</enum><header>In
general</header><text>The determination of whether an individual is an eligible
low-income individual for purposes of this section shall be made by the State
agency with responsibility for determining the eligibility of individuals for
assistance under the State children’s health insurance program under title XXI
of the <act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</clause><clause id="HD839A93B9A0047EAA17BB77F60B78DE0"><enum>(ii)</enum><header>Application of
screen and enroll requirements</header>
<subclause id="HE00551B094254CEB8CCE3CBC797188A7"><enum>(I)</enum><header>In
general</header><text>The State agency referred to in clause (i) shall ensure
that individuals applying for a certificate of eligibility are screened for
potential eligibility under the medicaid and State children’s health insurance
programs and that individuals found through screening to be eligible for
assistance under such a program are enrolled for assistance under the
appropriate program. To the maximum extent possible pursuant to State options
under title XIX of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, and notwithstanding any otherwise applicable provision of, or
State plan provision under, such title, screening and enrollment activities
described in the previous sentence shall use the procedures employed by the
State children’s health insurance program operated under title XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name>, if such
procedures differ from those ordinarily employed by the State program operated
under title XIX of such Act.</text>
</subclause><subclause id="H7006D4D6E1B847D09C57B14C697B4D18"><enum>(II)</enum><header>No delay of
issuance of certificate</header><text>The application of the screen and enroll
requirements of clause (i) shall not delay the issuance of a certificate of
eligibility to an individual for purposes of this section. The State agency
referred to in clause (i) shall adopt procedures to ensure that an individual
issued a certificate of eligibility under this paragraph who is subsequently
determined to be eligible for the State medicaid program under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name> or the State
children’s health insurance program under XXI of such Act shall be enrolled in
the appropriate program without an interruption in the individual’s health
insurance coverage.</text>
</subclause></clause></subparagraph><subparagraph id="H48DA3728EC094B21A6B7CEEFDCDF00EF"><enum>(B)</enum><header>Standards</header>
<clause id="HB67C628975184B479D6FF6202B500196"><enum>(i)</enum><header>In
general</header><text>An individual is an eligible low-income individual for
purposes of this section if—</text>
<subclause id="H5AA0162DCD424241885EFCCF2701AB00"><enum>(I)</enum><text>on the basis of
the individual’s tax return for the preceding taxable year, the individual
meets the requirements of paragraph (1)(B), and the individual otherwise
satisfies the requirements of paragraph (1), or</text>
</subclause><subclause id="HE7863DC6875A40D1BAA7CCA42F645700"><enum>(II)</enum><text>the individual is
determined to satisfy the requirements of paragraph (1) after the application
of the same eligibility methodologies as would apply for purposes of
determining the eligibility of an individual for assistance under the State
children’s health insurance program under title XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subclause></clause><clause id="H155B23860CBE4E69BD2E9E1DC0149CFD"><enum>(ii)</enum><header>Application of
schip income determination methodologies</header><text>For purposes of clause
(i)(II), determinations of income levels shall be made using the methodologies
described in that clause, to the extent such methodologies for ascertaining
household income differ from any otherwise applicable method for determining
adjusted gross income or the definition of adjusted gross income.</text>
</clause></subparagraph><subparagraph id="H41B959F1D61B47C7BE62627B4014AA64"><enum>(C)</enum><header>Certificate of
eligibility</header>
<clause id="H9B644F12EA814DD38F975F269B7C2028"><enum>(i)</enum><header>In
general</header><text>An individual who is determined to be an eligible
low-income individual shall be issued a certificate of eligibility by the State
agency referred to in subparagraph (A).</text>
</clause><clause id="HC3FA692D6CB946E89DBE973DC227C1BD"><enum>(ii)</enum><header>Certificate
amount</header><text>Such certificate shall indicate the applicable percentage
of the amount paid for coverage under qualified health insurance that the
individual is eligible for under this section (including any supplemental
assistance which the individual may be eligible for under subsection (b)(2),
unless the individual elects to not receive such supplemental
assistance).</text>
</clause><clause id="H2EF4375F76CB490283B08D21BD06893"><enum>(iii)</enum><header>12-month period
of issue</header><text>The certificate of eligibility shall apply for a
12-month period from the date of issue, notwithstanding any changes in
household circumstances following the individual’s application for a credit
under this section or supplemental assistance.</text>
</clause></subparagraph><subparagraph id="H99DAD3C0C4954099B5B97339F5F0F28C"><enum>(D)</enum><header>Supplemental
assistance</header><text>The State agency described in subparagraph (A) shall
determine an individual’s eligibility for supplemental assistance under
subsection (b)(2) based on the methodologies referred to in subparagraph
(B)(ii).</text>
</subparagraph></paragraph></subsection><subsection id="H50C885AC282C4D689DD9E3C21550B2AD"><enum>(f)</enum><header>Qualifying
family member</header><text>For purposes of this section—</text>
<paragraph id="HC76B7E6A29C042D59CB71EFDB75FACF"><enum>(1)</enum><header>In
general</header><text>The term <term>qualifying family member</term> means the
taxpayer’s spouse and any dependent of the taxpayer. Such term does not include
any individual who is not an eligible low-income individual under subsection
(e)(1).</text>
</paragraph><paragraph id="HA917406B11B240C7BA3309FDFAC65E5"><enum>(2)</enum><header>Special
dependency test in case of divorced parents, etc</header><text>If paragraph (2)
of section 152(e) applies to any child with respect to any calendar year, in
the case of any taxable year beginning in such calendar year, such child shall
be treated as described in paragraph (1)(B) with respect to the custodial
parent (within the meaning of section 152(e)(3)) and not with respect to the
noncustodial parent.</text>
</paragraph></subsection><subsection id="HA1D48B8B6C3E49A58C1333C978C880E4"><enum>(g)</enum><header>Qualified health
insurance</header><text>For purposes of this section—</text>
<paragraph id="H186436E71429482DBA768B00F5DBAD96"><enum>(1)</enum><header>In
general</header><text>The term <term>qualified health insurance</term> means
any of the following:</text>
<subparagraph id="H761A49EDCE684B24A6001CF3C490E600"><enum>(A)</enum><text>Coverage under an
insurance plan participating in a purchasing pool established pursuant to
section 403 of the <short-title>Health Coverage,
Affordability, Responsibility, and Equity Act of 2009</short-title>.</text>
</subparagraph><subparagraph id="H378B7C50CC3B42F4904CA99537B000F4"><enum>(B)</enum><text>Coverage under
individual health insurance pursuant to section 412 of such Act.</text>
</subparagraph><subparagraph id="H65B09876CB7640538FFD42BF3BB8C78E"><enum>(C)</enum><text>Coverage, pursuant
to section 413 of such Act, under the medicaid program or the State children’s
health insurance program if 1 or more family members qualifies for coverage
under such program.</text>
</subparagraph><subparagraph id="H18A34E5478C34EE4B75B175C4C4CD6A3"><enum>(D)</enum><text>Coverage, pursuant
to section 414 of such Act, under an employer-sponsored insurance plan,
including—</text>
<clause id="H87BC360A3B0149FAB3A3CA62E920E722"><enum>(i)</enum><text>coverage under a
COBRA continuation provision (as defined in section 9832(d)(1));</text>
</clause><clause id="HA456B6265BD84F8400E64778473BFC39"><enum>(ii)</enum><text>State-based
continuation coverage provided under a State law that requires such
coverage;</text>
</clause><clause id="H2796B1DC0AF7407694A824659941C1BE"><enum>(iii)</enum><text>coverage
voluntarily offered by a former employer of the individual or family member;
or</text>
</clause><clause id="H43BA5EC31F124D12831E64049B778647"><enum>(iv)</enum><text>coverage under a
group health plan that is available through the employment of the individual or
a family member.</text>
</clause></subparagraph></paragraph><paragraph id="HDEA3584771D84787A400FF3087E8B3CD"><enum>(2)</enum><header>Exception</header><text>The
term <term>qualified health insurance</term> shall not include—</text>
<subparagraph id="H77B4CC6C452C4126ABE606F9ADFD0039"><enum>(A)</enum><text>a flexible
spending or similar arrangement; and</text>
</subparagraph><subparagraph id="HB45E19B781364CB790E3CA48CE4E492E"><enum>(B)</enum><text>any insurance if
substantially all of its coverage is of excepted benefits described in section
9832(c).</text>
</subparagraph></paragraph><paragraph id="HF0298361F07B47DE8C7ED92D1F374574"><enum>(3)</enum><header>Definitions</header><text>For
purposes of this subsection—</text>
<subparagraph id="H3AADBA7BB35640E6A20452EB434CC218"><enum>(A)</enum><header>Employer-sponsored
insurance</header>
<clause id="HF3E764BB9E29425E867E9F54FD2B00E"><enum>(i)</enum><header>In
general</header><text>The term <term>employer-sponsored insurance</term> means
any insurance which covers medical care under any health plan maintained by any
employer (or former employer) of the taxpayer or the taxpayer’s spouse.</text>
</clause><clause id="HA2D617366D03449B84B4FF9FC1B682E8"><enum>(ii)</enum><header>Treatment of
cafeteria plans</header><text>For purposes of clause (i), the cost of coverage
shall be treated as paid or incurred by an employer to the extent the coverage
is in lieu of a right to receive cash or other qualified benefits under a
cafeteria plan (as defined in section 125(d)).</text>
</clause></subparagraph><subparagraph id="HFE218CB52C8D414AB9C606E4B96B3676"><enum>(B)</enum><header>Individual
health insurance</header><text>The term <term>individual health
insurance</term> means any insurance which constitutes medical care offered to
individuals other than in connection with a group health plan and does not
include Federal- or State-based health insurance coverage.</text>
</subparagraph></paragraph></subsection><subsection id="H4D0994A6779D4B67B1E2061CE4A7D3B"><enum>(h)</enum><header>Other specified
coverage</header><text>For purposes of this section, an individual has other
specified coverage for any month if, as of the first day of such month—</text>
<paragraph id="H8FBE1409434140AA956814B4EDC9756"><enum>(1)</enum><header>Coverage under
medicare</header><text>Such individual is entitled to benefits under part A of
title XVIII of the <act-name parsable-cite="SSA">Social Security Act</act-name>
or is enrolled under part B of such title.</text>
</paragraph><paragraph id="HDABA122DFE1E462AB09C78BC02883659"><enum>(2)</enum><header>Certain other
coverage</header><text>Such individual—</text>
<subparagraph id="H255DF3D6B36B426FBC6441DC6C0376C"><enum>(A)</enum><text>is enrolled in a
health benefits plan under chapter 89 of title 5, United States Code; or</text>
</subparagraph><subparagraph id="H83FBE10ECA6343BB95CB271079B05895"><enum>(B)</enum><text>is entitled to
receive benefits under chapter 55 of title 10, United States Code.</text>
</subparagraph></paragraph></subsection><subsection id="H7401A48C8E00492BA8C9F8D7E725D47D"><enum>(i)</enum><header>Federal poverty
level; poverty level; poverty</header><text>For purposes of this section, the
terms <term>Federal poverty level</term>, <term>poverty level</term>, and
<term>poverty</term> mean the income official poverty line (as defined by the
Office of Management and Budget, and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to
a family of the size involved.</text>
</subsection><subsection id="H6D672F502B34459CB6B57580F1FBEBEA"><enum>(j)</enum><header>Special
Rules</header>
<paragraph id="H33080FFCFB6444C595FD28FED7E9DCE8"><enum>(1)</enum><header>Coordination
with advance payments of credit</header><text>With respect to any taxable year,
the amount which would (but for this subsection) be allowed as a credit to the
taxpayer under subsection (a) shall be reduced (but not below zero) by the
aggregate amount paid on behalf of such taxpayer under section 7527A for months
beginning in such taxable year.</text>
</paragraph><paragraph id="H322130596224411A93CB27DF1019891B"><enum>(2)</enum><header>Coordination
with other deductions and credits</header><text>Amounts taken into account
under subsection (a) shall not be taken into account in determining any
deduction allowed under section 162(l) or 213. The amount of any credit
otherwise allowed under this section shall be reduced by the amount of any
credit allowed under section 35.</text>
</paragraph><paragraph id="H8FED367CB73A4197003F3E3F6CAE2FCD"><enum>(3)</enum><header>Health savings
account distributions</header><text>Amounts distributed from a health savings
account (as defined in section 223(d)) or an Archer MSA (as defined in section
220(d)) shall not be taken into account under subsection (a).</text>
</paragraph><paragraph id="H82C22D3CE7B14B5CBB591133F6B0B75C"><enum>(4)</enum><header>Denial of credit
to dependents</header><text>No credit shall be allowed under this section to
any individual with respect to whom a deduction under section 151 is allowable
to another taxpayer for a taxable year beginning in the calendar year in which
such individual’s taxable year begins.</text>
</paragraph><paragraph id="H1A675471C2A34D1FB8E0524FC944232C"><enum>(5)</enum><header>Both spouses
eligible low-income individuals</header><text>The spouse of the taxpayer shall
not be treated as a qualifying family member for purposes of subsection (a),
if—</text>
<subparagraph id="HA071ED0E19744BAE84FA52827B91CA8E"><enum>(A)</enum><text>the taxpayer is
married at the close of the taxable year;</text>
</subparagraph><subparagraph id="HBB4C638E9AE34EA6A140F020939D3BA8"><enum>(B)</enum><text>the taxpayer and
the taxpayer’s spouse are both eligible low-income individuals during the
taxable year; and</text>
</subparagraph><subparagraph id="H32D215DAF4F047BB8FB900BC41C719CA"><enum>(C)</enum><text>the taxpayer files
a separate return for the taxable year.</text>
</subparagraph></paragraph><paragraph id="H0028899A40904A0E85971C13BF86FEBE"><enum>(6)</enum><header>Marital status;
certain married individuals living apart</header><text>Rules similar to the
rules of paragraphs (3) and (4) of section 21(e) shall apply for purposes of
this section.</text>
</paragraph><paragraph id="H15F64F66A02344429C9FFD49B0491273"><enum>(7)</enum><header>Insurance which
covers other individuals</header><text>For purposes of this section, rules
similar to the rules of section 213(d)(6) shall apply with respect to any
contract for qualified health insurance under which amounts are payable for
coverage of an individual other than the taxpayer and qualifying family
members.</text>
</paragraph><paragraph id="HF391969AD7574BDF80FE98FB2830C200"><enum>(8)</enum><header>Treatment of
payments</header><text>For purposes of this section:</text>
<subparagraph id="H88294FEE8E2B487693835E5600ED1796"><enum>(A)</enum><header>Payments by
Secretary</header><text>Any payment made by the Secretary on behalf of any
individual under section 7527A (relating to advance payment of credit for
health insurance costs of eligible low-income individuals) shall be treated as
having been made by the taxpayer (or on behalf of the taxpayer) on the first
day of the month for which such payment was made.</text>
</subparagraph><subparagraph id="HFE60B22E660F4EE49B86BADEFA089D9B"><enum>(B)</enum><header>Payments by
taxpayer</header><text>Any payment made by the taxpayer (or on behalf of the
taxpayer) for eligible coverage months shall be treated as having been so made
on the first day of the month for which such payment was made.</text>
</subparagraph></paragraph><paragraph id="HF9CF390CC86C452CB79E23A86B3F00F"><enum>(9)</enum><header>Regulations</header>
<subparagraph id="H4B6AE27BA16A40CAB6A349C488064400"><enum>(A)</enum><header>In
general</header><text>The Secretary, in consultation with the Secretary of
Health and Human Services, shall administer the credit allowed under this
section and shall prescribe such regulations and other guidance as may be
necessary or appropriate to carry out this section, section 6050W, and section
7527A.</text>
</subparagraph><subparagraph id="H2553B0B63FB2471EAFE4DD73F6FDB6FA"><enum>(B)</enum><header>Eligibility
determinations</header><text>Such regulations shall include such standards as
the Secretary of Health and Human Services may specify with respect to the
requirements for eligibility determinations under subsection (e)(2).</text>
</subparagraph><subparagraph id="H2E47D874FAFC4155971784B3D24F3772"><enum>(C)</enum><header>Measures to
combat fraud and abuse</header><text>Such regulations shall include appropriate
procedures to deter, detect, and penalize fraudulent efforts to obtain a credit
under this section by individuals, providers of qualified health insurance, and
others.</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H3A0C2177BC69409190598DA904002505"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="H0C4DDEB40C544F2A935913AD189D8636"><enum>(1)</enum><text>Paragraph (2) of
section 1324(b) of title 31, United States Code, is amended by inserting
<quote>36A,</quote> after <quote>36,</quote>.</text>
</paragraph><paragraph id="H28EC2C0596A44BA280C7C0E97BF0BB7D"><enum>(2)</enum><text>The table of
sections for subpart C of part IV of chapter 1 of the Internal Revenue Code of
1986 is amended by inserting after the item relating to section 36 the
following new item:</text>
<quoted-block display-inline="no-display-inline" id="HC8E6AB5EBDC04E4596D51043C468D68E" style="OLC">
<toc container-level="quoted-block-container" idref="HDAB00FAE73BD4967B08293F6293BBF4D" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="H5946A030E195426CB8F5ABF953827328" level="section">Sec. 36A. Health insurance costs of eligible low-income
individuals.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H741B0276157C4086BD05A6BD7057B4A9"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2011.</text>
</subsection><subsection id="HA010853F050340F6A9D810E1B045D8B9"><enum>(d)</enum><header>Reimbursement
for administrative costs incurred in determining eligibility for
credit</header>
<paragraph id="H0C83EBDF8DB2420D86EA5D08C5AA4524"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services shall
reimburse States for the reasonable administrative costs incurred in making
eligibility determinations in accordance with section 36A(e) of the Internal
Revenue Code of 1986 (as added by subsection (a)). Such reimbursement shall not
apply to State costs required under the medicaid or State children’s health
insurance programs.</text>
</paragraph><paragraph id="HD93A1A3107BF495CB790D5A5DC536F6"><enum>(2)</enum><header>Application</header><text>A
State desiring reimbursement under this subsection shall submit an application
to the Secretary of Health and Human Services in such manner, at such time, and
containing such information as the Secretary may require.</text>
</paragraph><paragraph id="H350A1EF24B7746958C391BC1FBB52014"><enum>(3)</enum><header>Appropriation</header><text>Out
of any money in the Treasury of the United States not otherwise appropriated,
there are appropriated such sums as may be necessary to carry out this
subsection.</text>
</paragraph></subsection></section><section id="HFF8418A5B22C4364825C67249DC2D539"><enum>312.</enum><header>Advance payment
of credit for health insurance costs of eligible low-income
individuals</header>
<subsection id="H3B2475F42EE34829ACC2784577D329BD"><enum>(a)</enum><header>In
general</header><text>Chapter 77 of the Internal Revenue Code of 1986 (relating
to miscellaneous provisions) is amended by inserting after section 7527 the
following new section:</text>
<quoted-block id="HD120E1665D1A4E2EA7319533AA9FB100">
<section id="HAF1DC7123C854571B99C3D3D011EEA00"><enum>7527A.</enum><header>Advance
payment of credit for health insurance costs of eligible low-income
individuals</header>
<subsection id="HBAE5185A652C44BB9DB531C7751DB747"><enum>(a)</enum><header>General
rule</header><text>Not later than August 1, 2011, the Secretary shall establish
a program for making payments on behalf of certified individuals to providers
of qualified health insurance (as defined in section 36A(g)) for such
individuals.</text>
</subsection><subsection id="H778F46B0E51D4C17A5AE1FA8D0535F31"><enum>(b)</enum><header>Limitation on
advance payments during any taxable year</header><text>The Secretary may make
payments under subsection (a) only to the extent that the total amount of such
payments made on behalf of any individual during the taxable year is not
reasonably expected to exceed the applicable percentage (as defined in section
36A(b)) of the amount paid by the taxpayer (or on behalf of the taxpayer) for
coverage of the taxpayer and qualifying family members under qualified health
insurance for eligible coverage months beginning in the taxable year.</text>
</subsection><subsection id="H2E125341C7114113BFCE46AFDDF10C9"><enum>(c)</enum><header>Certified
individual</header><text>For purposes of this section, the term <term>certified
individual</term> means any individual for whom a health coverage eligibility
certificate is in effect.</text>
</subsection><subsection id="H4394A1D9D58544A5001D2C008CEF9C59"><enum>(d)</enum><header>Health coverage
eligibility certificate</header><text>For purposes of this section, the term
<term>health coverage eligibility certificate</term> means any written
statement that an individual is an eligible low-income individual (as defined
in section 36A(e)) if such statement provides such information as the Secretary
may require for purposes of this section and is issued by the State agency
responsible for administering the State children’s health insurance program
under title XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name>.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HEFAAF1B7A2514A1884F559CA826EA8DC"><enum>(b)</enum><header>Disclosure of
return information for purposes of carrying out a program for advance payment
of credit for health insurance costs of eligible low-income
individuals</header>
<paragraph id="HC0EDECAE27C544F2B4559D31CF008B7B"><enum>(1)</enum><header>In
general</header><text>Subsection (l) of section 6103 of the Internal Revenue
Code of 1986 (relating to disclosure of returns and return information for
purposes other than tax administration) is amended by adding at the end the
following new paragraph:</text>
<quoted-block id="H2DEC6024978B4D3089308F1C469952AA">
<paragraph id="H10CAB5F350414E08AA73E9DB90000EB"><enum>(21)</enum><header>Disclosure of
return information for purposes of carrying out a program for advance payment
of credit for health insurance costs of eligible low-income
individuals</header><text>The Secretary may disclose to providers of health
insurance for any certified individual (as defined in section 7527A(c)) return
information with respect to such certified individual only to the extent
necessary to carry out the program established by section 7527A (relating to
advance payment of credit for health insurance costs of eligible low-income
individuals).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H66687FFA537E4F56A4B55F2C62023822"><enum>(2)</enum><header>Procedures and
recordkeeping related to disclosures</header><text>Paragraph (4) of section
6103(p) of such Code is amended by striking <quote>or (20)</quote> each place
it appears and inserting <quote>(20), or (21)</quote>.</text>
</paragraph><paragraph id="H2B7C51B410A54B4588F03142F8A1DB8C"><enum>(3)</enum><header>Unauthorized
inspection or disclosure of returns or return information</header><text>Section
7213(a)(2) of such Code is amended by striking <quote>or (20)</quote> and
inserting <quote>(20), or (21)</quote>.</text>
</paragraph></subsection><subsection id="H2CABAE8202664585BFF7A7415F1C2745"><enum>(c)</enum><header>Information
reporting</header>
<paragraph id="H7472ADB7C4904B8DB8F0964FF0AFA3B"><enum>(1)</enum><header>In
general</header><text>Subpart B of part III of subchapter A of chapter 61 of
the Internal Revenue Code of 1986 (relating to information concerning
transactions with other persons) is amended by inserting after section 6050W
the following new section:</text>
<quoted-block id="HF4B615C2AC614F8C9BCAAA0884B14594">
<section id="HA621AA08B27C4C4C8F09C1F592E7CDF"><enum>6050X.</enum><header>Returns
relating to credit for health insurance costs of eligible low-income
individuals</header>
<subsection id="HD6CB99BE1F0E46E39DF07E00E9E0D88D"><enum>(a)</enum><header>Requirement of
reporting</header><text>Every person who is entitled to receive payments for
any month of any calendar year under section 7527A (relating to advance payment
of credit for health insurance costs of eligible low-income individuals) with
respect to any certified individual (as defined in section 7527A(c)) shall, at
such time as the Secretary may prescribe, make the return described in
subsection (b) with respect to each such individual.</text>
</subsection><subsection id="H1EC27CC3F493479B8E8F85BF28F551AC"><enum>(b)</enum><header>Form and manner
of returns</header><text>A return is described in this subsection if such
return—</text>
<paragraph id="HAA96CEF8C4944C8EB9A7C7A358E7F641"><enum>(1)</enum><text>is in such form as
the Secretary may prescribe; and</text>
</paragraph><paragraph id="H6C405F4367E54A6F9C2C7F24D9B930EE"><enum>(2)</enum><text>contains—</text>
<subparagraph id="H5BBCF97609C34746829EC50397E4DD73"><enum>(A)</enum><text>the name, address,
and TIN of each individual referred to in subsection (a);</text>
</subparagraph><subparagraph id="HD9E7451D3F4A40F8B5F6C988D72CDE4E"><enum>(B)</enum><text>the number of
months for which amounts were entitled to be received with respect to such
individual under section 7527A (relating to advance payment of credit for
health insurance costs of eligible low-income individuals);</text>
</subparagraph><subparagraph id="H5E8FC81D6E1F48969CBFEB000074CE6F"><enum>(C)</enum><text>the amount
entitled to be received for each such month; and</text>
</subparagraph><subparagraph id="H2D78771941404D15AFFF5D9E00D7F173"><enum>(D)</enum><text>such other
information as the Secretary may prescribe.</text>
</subparagraph></paragraph></subsection><subsection id="H82E3CCDED68149D2B700C00A225A017"><enum>(c)</enum><header>Statements To be
furnished to individuals with respect to whom information is
required</header><text>Every person required to make a return under subsection
(a) shall furnish to each individual whose name is required to be set forth in
such return a written statement showing—</text>
<paragraph id="H8D2A3B781B914B1689F65411C6B00044"><enum>(1)</enum><text>the name and
address of the person required to make such return and the phone number of the
information contact for such person; and</text>
</paragraph><paragraph id="H5AB391C9DFA846738CCFD8C966D90049"><enum>(2)</enum><text>the information
required to be shown on the return with respect to such individual.</text>
</paragraph><continuation-text continuation-text-level="subsection">The
written statement required under the preceding sentence shall be furnished on
or before January 31 of the year following the calendar year for which the
return under subsection (a) is required to be
made.</continuation-text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H9785BC026F264DDBAB711FAB7CF0BFBC"><enum>(2)</enum><header>Assessable
penalties</header>
<subparagraph id="H6AEE43E39FF24193B65E33CFD25FAA3"><enum>(A)</enum><text>Subparagraph (B) of
section 6724(d)(1) of such Code (relating to definitions) is amended by
striking <quote>or</quote> at the end of clause (xxii), by striking <quote>,
and</quote> at the end of clause (xxiii) and inserting <quote>, or</quote>, and
by adding at the end the following new clause:</text>
<quoted-block id="H57025B3957744A958B49F6433D050822">
<clause id="HEEF4B64C30AE46AA877E8B0350BB9572"><enum>(xxiv)</enum><text>section 6050X
(relating to returns relating to credit for health insurance costs of eligible
low-income individuals),
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H9CED6EA5BA0F45B0A89CCE57ABD5B62F"><enum>(B)</enum><text>Paragraph (2) of
section 6724(d) of such Code is amended by striking <quote>or</quote> at the
end of subparagraph (EE), by striking the period at the end of subparagraph
(FF) and inserting <quote>, or</quote>, and by adding after subparagraph (FF)
the following new subparagraph:</text>
<quoted-block id="H4EBF77D5BE204CFABD361DED27F1AD96">
<subclause id="H4460A85B63D846EA99C534E7568D337D" indent="up2"><enum>(GG)</enum><text>section 6050X (relating to returns
relating to credit for health insurance costs of eligible low-income
individuals).</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="HC86AE87211C3470682F06852D3250609"><enum>(d)</enum><header>Clerical
amendments</header>
<paragraph id="H70AAEFBFD7074CFE9D8F1F2158ED724D"><enum>(1)</enum><header>Advance
payment</header><text>The table of sections for chapter 77 of the Internal
Revenue Code of 1986 is amended by inserting after the item relating to section
7527 the following new item:</text>
<quoted-block display-inline="no-display-inline" id="H862455F846994B6AB31D7E875ED0336F" style="OLC">
<toc container-level="quoted-block-container" idref="HD120E1665D1A4E2EA7319533AA9FB100" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="HAF1DC7123C854571B99C3D3D011EEA00" level="section">Sec. 7527A. Advance payment of credit for health insurance
costs of eligible low-income
individuals.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HDBDC5E461B2846DDAA8F5FA595BFED66"><enum>(2)</enum><header>Information
reporting</header><text>The table of sections for subpart B of part III of
subchapter A of chapter 61 of such Code is amended by inserting after the item
relating to section 6050W the following new item:</text>
<quoted-block display-inline="no-display-inline" id="H55D22A0EFA5144968EC9ACC82922C45C" style="OLC">
<toc container-level="quoted-block-container" idref="HF4B615C2AC614F8C9BCAAA0884B14594" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="HA621AA08B27C4C4C8F09C1F592E7CDF" level="section">Sec. 6050X. Returns relating to credit for health insurance
costs of eligible low-income
individuals.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H25E11218089C4A7B9D791C978500F9B7"><enum>(e)</enum><header>Effective
date</header><text>The amendments made by this section shall take effect on
January 1, 2012.</text>
</subsection></section></subtitle><enum>IV</enum><header>Improving Access
to Health Plans</header>
<section id="HD71D1AC67ED848EB87BE3F65C293628C"><enum>401.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph id="HCD4DABEBB2CA4C80AC35899BDC59002C"><enum>(1)</enum><header>Eligible
individual</header><text>The term <term>eligible individual</term> means an
individual with respect to whom a tax credit is allowed under section 36A of
the Internal Revenue Code of 1986 (as added by section 311).</text>
</paragraph><paragraph id="H7A124777671449E89C4EF9CEACFD78"><enum>(2)</enum><header>Employer</header><text>The
term <term>employer</term> includes a not-for-profit employer.</text>
</paragraph><paragraph id="HFA4434AEDA5E4A8FBA811289F91409A3"><enum>(3)</enum><header>Participating
insurer</header><text>The term <term>participating insurer</term> means an
entity with a contract under section 405(a).</text>
</paragraph><paragraph id="HC3CBFF521AD24C01AC7D926CBE668E7D"><enum>(4)</enum><header>Private group
health insurance plan</header><text>The term <term>private group health
insurance plan</term> means a plan offered by a participating insurer that
provides health benefits coverage to eligible individuals and that meets the
requirements of this title.</text>
</paragraph><paragraph id="H8151AD19F0C9427AB0825589F27C0800"><enum>(5)</enum><header>Purchasing pool
operator</header><text>The term <term>purchasing pool operator</term> means the
entity designated by the State under section 404.</text>
</paragraph><paragraph id="H15A047C682AB4F7E8D643C58F5194532"><enum>(6)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph id="H1CF6203FEBF84484B3A166D810CCD03F"><enum>(7)</enum><header>Small
employer</header><text>The term <term>small employer</term> means an employer
with not less than 2 and not more than 100 employees.</text>
</paragraph></section><section id="H19D63B823472455CB4947C64DD0011BB"><enum>402.</enum><header>Establishment
of health insurance purchasing pools</header><text display-inline="no-display-inline">There is established a program under which
the Secretary shall ensure that each eligible individual has the opportunity to
enroll, through a purchasing pool operator, in a private group health insurance
plan offered by a participating insurer under this title.</text>
</section><section id="HAF1EBB210A844105000180CAB61CCDD9"><enum>403.</enum><header>Purchasing
pools</header>
<subsection id="H0F8D5CF60FDC4D44AB1274DB36E0005B"><enum>(a)</enum><header>Establishment of
purchasing pools</header><text>Each State participating in the program under
this title shall establish a purchasing pool that is available to each eligible
individual who resides in the State.</text>
</subsection><subsection id="H151DF8577D63437200C0F315D3DA5854"><enum>(b)</enum><header>Types of
purchasing pools</header>
<paragraph id="H28C40A65ADB84E3E871913BBA421981"><enum>(1)</enum><header>In
general</header><text>A purchasing pool established under subsection (a) shall
be 1 of the following:</text>
<subparagraph id="HB8CD58BB4A354C6D93BC2859CD35471D"><enum>(A)</enum><text>A statewide
purchasing pool operated by the State.</text>
</subparagraph><subparagraph id="HEEB5DC23B52A4FE2953D00D7C28E4D"><enum>(B)</enum><text>A statewide
purchasing pool operated on behalf of the State by the Director of the Office
of Personnel Management, or the designee of such Director.</text>
</subparagraph></paragraph><paragraph id="H3D2DE3281B514D0FB33C4625063810C7"><enum>(2)</enum><header>OPM operated
pool</header><text>In the case of a statewide purchasing pool described in
paragraph (1)(B), the Director of the Office of Personnel Management or the
Director’s designee, may limit participating insurers in such pool to those
described in section 405(e), except that the Director or such designee shall
ensure that additional private group health insurance plans participate in such
a pool to the extent necessary to meet the requirements of section
404(c)(9).</text>
</paragraph></subsection><subsection id="HDF277B3B3A6A473CA18F46BF19E1AA0"><enum>(c)</enum><header>State election
process</header>
<paragraph id="H888620A305F34CB28F2F4C091300791C"><enum>(1)</enum><header>In
general</header><text>Each State participating in the program under this title
shall notify the Secretary, not later than January 4, 2011, of the type of
purchasing pool that applies to residents of the State.</text>
</paragraph><paragraph id="H4A9D15E9503D4A9CB6007C3D003444C6"><enum>(2)</enum><header>Default
choice</header><text>If a State participating in the program under this title
fails to notify the Secretary of the type of purchasing pool elected by the
State by the date described in paragraph (1), the State shall be deemed to have
elected the type of purchasing pool described in subsection (b)(1)(B).</text>
</paragraph><paragraph id="H5E14D174629F49BE99ACF0D83941BEA3"><enum>(3)</enum><header>Change of
election</header><text>The Secretary shall establish procedures under which a
State participating in the program under this title may change the election of
the type of purchasing pool applicable to residents of the State.</text>
</paragraph></subsection></section><section id="H04D5D41C7C944ED9B8A97ED90B95657"><enum>404.</enum><header>Purchasing pool
operators</header>
<subsection id="H811926676C1F4EF990FDC2A1FF8B16D0"><enum>(a)</enum><header>Designation</header><text>Each
State shall designate a purchasing pool operator that shall be responsible for
operating the purchasing pool established under section 403(a). A purchasing
pool operator may be (or, to have 1 or more of its functions performed, may
contract with) a private entity that has entered into a contract with the State
if such entity meets requirements established by the Secretary for purposes of
the program under this title.</text>
</subsection><subsection id="HBC42CDC9DD9C4E3BA1ECC447452100D"><enum>(b)</enum><header>Operation similar
to FEHBP</header><text>Each purchasing pool operator shall operate the
purchasing pool established under section 403(a) in a manner that is similar to
the manner in which the Director of the Office of Personnel Management operates
the Federal employees’ health benefits program under chapter 89 of title 5,
United States Code, including (but not limited to) the performance of the
specific functions described in subsection (c).</text>
</subsection><subsection id="H789BD9BABCA94517BC247275882DCB43"><enum>(c)</enum><header>Specific
functions described</header><text>The specific functions described in this
subsection include the following:</text>
<paragraph id="H720DA28FBCA04416876E449E1C44AB36"><enum>(1)</enum><text>Each purchasing
pool operator shall offer one-stop shopping for eligible individuals to enroll
for health benefits coverage under private, group health insurance plans
offered by participating insurers.</text>
</paragraph><paragraph id="HA4F32AF923F04EDFA748FBCB52A5FD75"><enum>(2)</enum><text>Each purchasing
pool operator shall limit participating insurers to those that meet the
conditions for participation described in this title.</text>
</paragraph><paragraph id="H542B86CB12C0490284A6265D3B1F0080"><enum>(3)</enum><text>Each purchasing
pool operator shall negotiate (or, in the case of a purchasing pool described
in section 403(b)(1)(B), shall negotiate or otherwise determine) bids and terms
of coverage with insurers.</text>
</paragraph><paragraph id="H84804659FC834C2AB5E587B403673987"><enum>(4)</enum><text>Each purchasing
pool operator shall provide eligible individuals with comparative information
on private group health insurance plans offered by participating
insurers.</text>
</paragraph><paragraph id="HCBDD35B299E5421198663D37269323E"><enum>(5)</enum><text>Each purchasing
pool operator shall assist eligible individuals in enrolling with a private
group health insurance plan offered by a participating insurer.</text>
</paragraph><paragraph id="HF7410AC9497D4F769EADEEF05761A8E0"><enum>(6)</enum><text>Each purchasing
pool operator shall collect private group health insurance plan premium
payments for participating insurers and process such premium payments.</text>
</paragraph><paragraph id="H955094E6D17143EE8D63EBB7F03BA81"><enum>(7)</enum><text>Each purchasing
pool operator shall reconcile from year to year aggregate premium payments and
claims costs of private group health insurance plans consistent with practices
under the Federal employees’ health benefits program under chapter 89 of title
5, United States Code.</text>
</paragraph><paragraph id="HA17C97F239E14C188091F663B755DC40"><enum>(8)</enum><text>Each purchasing
pool operator shall offer customer service to eligible individuals enrolled for
health benefits coverage under a private group health insurance plan offered by
a participating insurer.</text>
</paragraph><paragraph id="H69509F2668D54B0383FE92FE71258842"><enum>(9)</enum><text>Each purchasing
pool operator shall ensure that each eligible individual has the option of
enrolling in either of at least 2 benchmark or benchmark-equivalent plans
with—</text>
<subparagraph id="H8077DE213BE44CAEB49EF217D2D609DA"><enum>(A)</enum><text>a premium at or
below a cap established by the pool operator for purposes of this title;
and</text>
</subparagraph><subparagraph id="HAF8C95285A6E478AAB3CDD37D089B29C"><enum>(B)</enum><text>coverage of
essential services included in the report required under section 501(e)(2),
with cost-sharing consistent with such report.</text>
</subparagraph></paragraph><paragraph id="H9FC5A63239BB413AAEA46EA32FDED09"><enum>(10)</enum><text>Each purchasing
pool operator shall establish a premium cap for purposes of determining the
credit limitation under section 36A(c) of the Internal Revenue Code of 1986, as
added by section 311(a). The cap required under this paragraph may not be less
than the premium charged to Federal employees by the most highly enrolled
health plan under the Federal employees’ health benefits program under chapter
89 of title 5, United States Code. If the most highly enrolled plan in that
program differs for Federal enrollees in the State and all Federal enrollees
nationally in such plan, the minimum permitted premium cap shall be the lower
of such premiums.</text>
</paragraph></subsection></section><section id="H82D6AD53BBD044028740DF5722B35B90"><enum>405.</enum><header>Contracts with
participating insurers</header>
<subsection id="HE2D9538AADED4445BCC69B83DD4A7A7"><enum>(a)</enum><header>In
general</header><text>Each purchasing pool operator shall negotiate and enter
into contracts for the provision of health benefits coverage under the program
under this title with entities that meet the conditions of participation
described in subsection (b) and other applicable requirements of this
Act.</text>
</subsection><subsection id="H422FC72204D34162862800DD90E0FC08"><enum>(b)</enum><header>Consumer
information</header><text>In carrying out its duty under section 404(c)(4) to
inform eligible individuals about private group health plans, the purchasing
pool operator shall provide information that meets the requirements of section
412(b)(2).</text>
</subsection><subsection id="H157AADF5035948A29C818494BBCF70AC"><enum>(c)</enum><header>State
licensure</header>
<paragraph id="H2EA6DA793CBF4F25AD4972EBC194300"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), a health plan shall not be a
participating insurer unless the plan has a State license to provide State
residents with the private group coverage health insurance plans that it offers
through the pool.</text>
</paragraph><paragraph id="HB2C9093041C540B5A32CFEE591875C17"><enum>(2)</enum><header>Exception</header><text>A
pool operator may enter into a contract under subsection (a) to cover pool
participants through a health plan without a State license described in
paragraph (1) if such plan is offered to Federal employees nationwide and, with
respect to such employees, is exempt from State health insurance regulation.
Nothing in this paragraph shall be construed to permit coverage of pool
participants through such a plan except with groups, contracts, and premium
rates that are entirely distinct from those used for individuals covered under
the Federal employee’s health benefits program under chapter 89 of title 5,
United States Code.</text>
</paragraph></subsection><subsection id="H4C5B842999FD4E07B7C1D09F5EB5608C"><enum>(d)</enum><header>Additional
stop-loss coverage and reinsurance</header><text>Purchasing pool operators are
authorized to encourage participation in the program under this title, improve
covered benefits, reduce out-of-pocket cost-sharing, limit premiums, or achieve
other objectives of this Act by—</text>
<paragraph id="H984C22AA4BD14242BFE4F02930D6C2EC"><enum>(1)</enum><text>funding stop-loss
coverage above levels otherwise offered in the purchasing pool; or</text>
</paragraph><paragraph id="H1D82A5A1569F4BFC99CD01AE00C33B20"><enum>(2)</enum><text>providing or
subsidizing reinsurance in addition to that provided under section 411.</text>
</paragraph></subsection><subsection id="HF5C9260373AC4B7BB7C20342004346D8"><enum>(e)</enum><header>Participation of
FEHBP plans</header>
<paragraph id="H26AFF91A4FB0426DA1A17FA997249EF8"><enum>(1)</enum><header>In
general</header><text>Each entity with a contract under section 8902 of title
5, United States Code, shall be a participating insurer unless such entity
notifies the Secretary in writing of its intention not to participate in the
program under this title prior to such time as is designated by the Secretary
so as to allow such decisions to be taken into account with respect to eligible
individuals’ choice of a private group health insurance plan under such
program. Such participation in the program under this title shall include at
least the covered benefits and provider networks available through such an
entity and shall not involve greater out-of-pocket cost-sharing than the plan
offered by such entity pursuant to its contract under section 8902 of title 5,
United States Code.</text>
</paragraph><paragraph id="H7A51970B710248B0ACE87C989EDA3D5C"><enum>(2)</enum><header>No effect on
FEHBP coverage</header><text>The Director of Office of Personnel Management
shall take such steps as are necessary to ensure that each individual enrolled
for health benefits coverage under the program under chapter 89 of title 5,
United States Code, is not adversely affected by eligible individuals or others
enrolled for coverage under the program under this title. Such steps shall
include (but need not be limited to) the establishment of separate risk pools,
separate contracts with participating insurers, and separately negotiated
premiums.</text>
</paragraph></subsection></section><section id="H06848CF520F047F4A8751979AB7C29C6"><enum>406.</enum><header>Options for
health benefits coverage</header>
<subsection id="H7A14EBE861D744BAA0983426DCB89C9"><enum>(a)</enum><header>Scope of health
benefits coverage</header><text>The health benefits coverage provided to an
eligible individual under a private group health insurance plan offered by a
participating insurer shall consist of any of the following:</text>
<paragraph id="H047552CDF9E94DF0B9415B695F3E5B15"><enum>(1)</enum><header>Benchmark
coverage</header><text>Health benefits coverage that is equivalent to the
benefits coverage in a benchmark benefit package described in subsection
(b).</text>
</paragraph><paragraph id="H18CE6F64595E4BC7A524C0EF9985D35F"><enum>(2)</enum><header>Benchmark-equivalent
coverage</header><text>Health benefits coverage that meets the following
requirements:</text>
<subparagraph id="H865941124A104DFEA187DB8298BBA76E"><enum>(A)</enum><header>Inclusion of
essential services</header><text>The coverage includes each of the essential
services identified by the National Advisory Commission on Expanded Access to
Health Care and adopted by Congress under title III.</text>
</subparagraph><subparagraph id="HA2F67C5A89F3418CAA188C11942E52BF"><enum>(B)</enum><header>Aggregate
actuarial value equivalent to benchmark package</header><text>The coverage has
an aggregate actuarial value that is equal to or greater than the actuarial
value of one of the benchmark benefit packages.</text>
</subparagraph></paragraph><paragraph id="HD5D274D4E16F464BB3E9C1070015C5F7"><enum>(3)</enum><header>Alternative
coverage</header><text>Any other health benefits coverage that the Secretary
determines, upon application by a State, offers health benefits coverage
equivalent to or greater than a plan described in and offered under section
8903(1) of title 5, United States Code.</text>
</paragraph></subsection><subsection id="H32A747C25BE7457EBC8C357C6666BBC5"><enum>(b)</enum><header>Benchmark
benefit packages</header><text>The benchmark benefit packages are as
follows:</text>
<paragraph id="HB135A2CFDADE4C9284381891277054A0"><enum>(1)</enum><header>FEHBP-equivalent
health benefits coverage</header><text>The plan described in and offered under
chapter 89 of title 5, United States Code with the highest number of enrollees
under such section for the year preceding the year in which the private group
health insurance plan is proposed to be offered.</text>
</paragraph><paragraph id="HA2C3B18F1B2A4A378DBE4FE71C224756"><enum>(2)</enum><header>Public
program-equivalent health benefits coverage</header><text>Coverage provided
under the State plan approved under the medicaid program under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name> or the State
children’s health insurance program under title XXI of such Act (42 U.S.C. 1396
et seq., 1397aa et seq.) (without regard to coverage provided under a waiver of
the requirements of either such program).</text>
</paragraph><paragraph id="H7879E451519A490F8FA10164A700DCE7"><enum>(3)</enum><header>Coverage offered
through hmo</header><text>The health insurance coverage plan that—</text>
<subparagraph id="HDC8D914458EF48B1B6D1753FB3F6D500"><enum>(A)</enum><text>is offered by a
health maintenance organization (as defined in section 2791(b)(3) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
33gg–91(b)(3))); and</text>
</subparagraph><subparagraph id="H68F622319194468C865F3CAB81F05E66"><enum>(B)</enum><text>has the largest
insured commercial, nonmedicaid enrollment of covered lives of such coverage
plans offered by such a health maintenance organization in the State.</text>
</subparagraph></paragraph><paragraph id="H6F8BD44432BF4F61BC3D27E9994F7B7B"><enum>(4)</enum><header>State employee
coverage</header><text>The health insurance plan that is offered to State
employees and has the largest enrollment of covered lives of any such
plan.</text>
</paragraph><paragraph id="H165D41A998834AC7B584D86C42348966"><enum>(5)</enum><header>Application of
benchmark standards</header><text>A private group health plan offers benchmark
benefits if, with respect to a benchmark plan described in paragraph (1), (2),
(3), or (4), the private group health plan covers all items and services
offered by the benchmark plan, with out-of-pocket cost-sharing for such items
and services that is not greater than under the benchmark plan. Nothing in this
title shall be construed to forbid a private group health plan from offering
additional items and services not covered by such a benchmark plan or reducing
out-of-pocket cost-sharing below levels applicable under such plan.</text>
</paragraph></subsection></section><section id="H950FE9364A4D4701927B07F1BFE61318"><enum>407.</enum><header>Enrollment
process for eligible individuals</header>
<subsection id="H8D7CAEF22AC5423300DA00E06FF711AD"><enum>(a)</enum><header>In
general</header><text>The Secretary shall establish a process through which an
eligible individual—</text>
<paragraph id="H2299D516561E421F0032874F1FAB2C80"><enum>(1)</enum><text>may make an annual
election to enroll in any private group health insurance plan offered by a
participating insurer that has been awarded a contract under section 405(a) and
serves the geographic area in which the individual resides, provided that such
insurer’s geographic area of service and guaranteed issuance under this section
is conterminous with, or includes all of, a geographic area served pursuant to
an entity’s contact under section 8902 of title 5, United States Code;
and</text>
</paragraph><paragraph id="H2264A666AF554A820021DF9F62CEB80"><enum>(2)</enum><text>may make an annual
election to change the election under this clause.</text>
</paragraph></subsection><subsection id="H719C8633D6FD45469CFFF4FF62E9285B"><enum>(b)</enum><header>Rules</header><text>In
establishing the process under subsection (a), the Secretary shall use rules
similar to the rules for enrollment, disenrollment, and termination of
enrollment under the Federal employees health benefits program under chapter 89
of title 5, United States Code, including the application of the guaranteed
issuance provision described in subsection (c).</text>
</subsection><subsection id="H8FAD5EE8FDB0429E8709714E75F160E9"><enum>(c)</enum><header>Guaranteed
issuance</header><text>An eligible individual who is eligible to enroll for
health benefits coverage under a private group health insurance plan that has
been awarded a contract under section 405(a) at a time during which elections
are accepted under this title with respect to the plan shall not be denied
enrollment based on any health status-related factor (described in section
2702(a)(1) of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (42 U.S.C. 300gg–1(a)(1))) or any other factor.</text>
</subsection></section><section id="H19244E602CCD479091A5F9268933242B"><enum>408.</enum><header>Plan
premiums</header>
<subsection id="H43D7FE20BD744BD0979935131D5D87C2"><enum>(a)</enum><header>In
general</header><text>Each purchasing pool operator shall negotiate (or, in the
case of a purchasing pool operated pursuant to section 403(b)(1)(B), shall
otherwise determine) a premium for each private group health insurance plan
offered by a participating insurer.</text>
</subsection><subsection id="HE7BD8313ED5E407FA135112E70975297"><enum>(b)</enum><header>Permitted profit
margins</header>
<paragraph id="HC8C20E875368428A8F3753D295E8E8A2"><enum>(1)</enum><header>In
general</header><text>Each premium negotiated under subsection (a) may not
permit a profit margin that exceeds the applicable percentage (as defined in
paragraph (2)).</text>
</paragraph><paragraph id="HABE54A226AEC44AABE93EE81FE9E7090"><enum>(2)</enum><header>Applicable
percentage defined</header><text>In this subsection, the term <term>applicable
percentage</term> means—</text>
<subparagraph id="H70493553D33D4EE49F00781C12D4D1CC"><enum>(A)</enum><text>for the first 3
years that a purchasing pool is operated, 2 percent;</text>
</subparagraph><subparagraph id="HA00A135B571A42BCA708E7578BE048F7"><enum>(B)</enum><text>for any subsequent
year, the percentage determined by the purchasing pool operator, which may not
be—</text>
<clause id="H24AB6EA7F4DE4EBC8FB34D5636E8007B"><enum>(i)</enum><text>less
than the profit margin permitted under the Federal employees health benefits
program under chapter 89 of title 5, United States Code; or</text>
</clause><clause id="H83EE7B3913BC4501A4153EBC00D7DF5B"><enum>(ii)</enum><text>more than a
multiple, established by the Secretary for purposes of this subsection, of
profit margins permitted under such program.</text>
</clause></subparagraph></paragraph></subsection></section><section id="H79B7842F7CC54E239FB09D817C5C81B4"><enum>409.</enum><header>Enrollee
premium share</header>
<subsection id="HA781902068D54DF6A1C05F1075A5A97D"><enum>(a)</enum><header>In
general</header><text>A participating insurer offering a private group health
insurance plan that has been awarded a contract under section 405(a) in which
the eligible individual is enrolled may not deny, limit, or condition the
coverage (including out-of-pocket cost-sharing) or provision of health benefits
coverage or vary or increase the enrollee premium share under the plan based on
any health status-related factor described in section 2702(a)(1) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
300gg–1(a)(1)) or any other factor.</text>
</subsection><subsection id="H0A5FAE4AA67D4F6AA085CCF420C2C394"><enum>(b)</enum><header>Risk-adjusted
plan payments and premiums charged to enrollees</header>
<paragraph id="H199E08AD675A477E83A0C2F0A89C28FB"><enum>(1)</enum><header>In
general</header><text>For each private group health insurance plan operated by
a participating insurer, the pool operator shall adjust premium payments to
compensate for the difference in health risk factors between plan enrollees and
State residents as a whole (including residents who are not eligible
individuals). Such adjustments shall employ risk-adjustment mechanisms
promulgated by the Secretary.</text>
</paragraph><paragraph id="H13CA142071FE4777A3AD783ECB16A781"><enum>(2)</enum><header>Additional
adjustments</header><text>The pool operator shall also provide additional
adjustments to premium payments that compensate participating insurers for the
cost of keeping out-of-pocket cost-sharing amounts consistent with section
404(c)(9)(B).</text>
</paragraph><paragraph id="HCA90B721AD84440300F47CEF4936A48D"><enum>(3)</enum><header>Enrollee premium
costs</header><text>The adjustments described in this subsection shall not
affect enrollee premium shares, which shall be based on the premium that would
be charged for enrollees with health risk factors for State residents as a
whole (as described in paragraph (1)), without taking into account cost-sharing
adjustments under section 404(c)(9)(B).</text>
</paragraph></subsection><subsection id="HAB8F539A01824DC382CFFF408F345990"><enum>(c)</enum><header>Amount of
premium</header><text>The amount of the enrollee premium share shall be equal
to premium amounts (if any) above the applicable cap set pursuant to section
404(c)(10), plus 100 percent of the remainder minus the applicable percentage
(as defined in section 36A(b) of the Internal Revenue Code of 1986, as added by
section 311).</text>
</subsection></section><section id="H6171BD68A9D042918C5F769E0151254E"><enum>410.</enum><header>Payments to
purchasing pool operators and payments to participating insurers</header><text display-inline="no-display-inline">The Secretary shall establish procedures for
making payments to each purchasing pool operator as follows:</text>
<paragraph id="H21D2B4E4AC424B2700FA39750985D0F7"><enum>(1)</enum><header>Risk-adjustment
payment</header><text>The Secretary shall pay each purchasing pool operator for
the net costs of risk-adjusted payments to plans under section 409(b), to the
extent the sum of upward adjustments exceeds the sum of downward adjustments
for the pool operator.</text>
</paragraph><paragraph id="HF5EC4CE0B6DC4D2E875D768C00EDBD70"><enum>(2)</enum><header>Stop-loss and
reinsurance payments</header>
<subparagraph id="H9FAB0B77D7694FCBBE723BDEF6BBEE40"><enum>(A)</enum><header>In
general</header><text>The Secretary shall pay each purchasing pool operator for
the applicable percentage (as defined in subparagraph (B)) of—</text>
<clause id="H31A78339F5FF4C7AB733220096FE2E7"><enum>(i)</enum><text>the
costs of any stop-loss coverage funded by the purchasing pool operator under
section 405(d)(1); and</text>
</clause><clause id="H1D88362ABFD14647B9330072666EC4D7"><enum>(ii)</enum><text>any
reinsurance provided in accordance with section 405(d)(2).</text>
</clause></subparagraph><subparagraph id="H85D51467D4DA4E0A00217E92C00F00"><enum>(B)</enum><header>Applicable
percentage defined</header><text>In this paragraph, the term <term>applicable
percentage</term> means—</text>
<clause id="H40555FB5BC2D4736A0DE57C766A761CE"><enum>(i)</enum><text>for
the first 3 years that a purchasing pool is operated, 100 percent;</text>
</clause><clause id="H49D18A2FD6AA409CBD449B381EAB9357"><enum>(ii)</enum><text>for
the next 2 years that such purchasing pool is operated, 50 percent; and</text>
</clause><clause id="HF43A68BFE0A0485DA8627950CDB01D92"><enum>(iii)</enum><text>for any
subsequent year, 0 percent.</text>
</clause></subparagraph></paragraph><paragraph id="HEE00A4672DFD4E20AD00DABFCCFBA728"><enum>(3)</enum><header>Payments
necessary to keep cost-sharing within applicable limits</header><text>The
Secretary shall make payments to purchasing pool operators to reimburse
purchasing pool operators for the amount paid by such operators to
participating insurers necessary to keep out-of-pocket cost-sharing for
individuals with limited ability to pay within applicable limits.</text>
</paragraph><paragraph id="H1C731527852B49DFA9AC1E4E5D00008D"><enum>(4)</enum><header>Payment for
administrative costs</header><text>The Secretary shall make payments to each
purchasing pool operator for necessary pool administrative expenses.</text>
</paragraph><paragraph id="H3A8C221CA9A040878586FF6E30159744"><enum>(5)</enum><header>Payments to
OPM</header><text>In the case of a purchasing pool described in section
403(b)(1)(B), payments under this section shall be made to the Director of the
Office of Personnel Management.</text>
</paragraph></section><section id="HB41B3ED638F74CF9B67785893BFB6DE9"><enum>411.</enum><header>State-based
reinsurance programs</header>
<subsection id="HDE1F32EA594E4F90ABB542A955F352CE"><enum>(a)</enum><header>Establishment</header><text>The
Secretary shall establish standards for State-based reinsurance programs for
eligible individuals to guard against adverse selection and to improve the
functioning of the individual health insurance market.</text>
</subsection><subsection id="H350DC9B94D8E4C5F9C5467B519025BCD"><enum>(b)</enum><header>Grants for
statewide reinsurance programs</header>
<paragraph id="H190D2E4A22D54220BB118E66BBD9925C"><enum>(1)</enum><header>In
general</header><text>The Secretary may award grants to States for the
reasonable costs incurred in providing reinsurance under this section,
consistent with standards developed by the Secretary, for coverage offered in
the individual health insurance market and through State-based purchasing pools
described in section 403.</text>
</paragraph><paragraph id="H69BF2669F41D4B09947F3C8688FA2677"><enum>(2)</enum><header>Limitation</header><text>Such
grants may not pay for reinsurance extending beyond individuals in the top 3
percent of the national health care spending distribution, as determined by the
Secretary.</text>
</paragraph><paragraph id="H3F3B39A292E54674A8EC0863F3E9767B"><enum>(3)</enum><header>Application</header><text>A
State desiring a grant under this section shall submit an application to the
Secretary in such manner, at such time, and containing such information as the
Secretary may require.</text>
</paragraph><paragraph id="H4C5CA919068747FAA74B73B435FB80FF"><enum>(4)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated to the
Secretary such sums as may be necessary for making grants under this
section.</text>
</paragraph></subsection></section><section id="HD38189B3E13A4564958B9CE8B92D895"><enum>412.</enum><header>Coverage under
individual health insurance</header>
<subsection id="H8B115758307946E700C21E1D612D3674"><enum>(a)</enum><header>In
general</header><text>Eligible individuals may use credits allowed under the
Internal Revenue Code of 1986 (including supplemental assistance provided under
such Code) for the purchase of health insurance coverage to enroll in
State-licensed individual health insurance meeting the conditions of
participation described in subsection (b).</text>
</subsection><subsection id="HF3825A9584FC48FBB62734947C6EF5E"><enum>(b)</enum><header>Conditions of
participation</header><text>The Secretary shall promulgate regulations that
establish the terms and conditions under which an entity may participate in the
program under this section and that include the following:</text>
<paragraph id="H2C397510CFDF45DFB51415F6557582B3"><enum>(1)</enum><header>Plan
marketing</header><text>Conditions of participation for plans in the individual
market (as developed by the Secretary) that—</text>
<subparagraph id="H593478EEA39A41639245993705D2FD98"><enum>(A)</enum><text>ensure that
consumers receive the consumer information described in paragraph (2) before
selecting a plan; and</text>
</subparagraph><subparagraph id="H1BD7EA551F204098BB00789500D4696E"><enum>(B)</enum><text>detect, deter, and
penalize marketing fraud by entities offering or purporting to offer individual
insurance.</text>
</subparagraph></paragraph><paragraph id="HBD752D55A6B646E08D009D215EAD32C6"><enum>(2)</enum><header>Consumer
information</header><text>Requirements for each entity offering individual
insurance to provide eligible individuals with information in a uniform and
easily comprehensible manner that allows for informed comparisons by eligible
individuals and that includes information regarding the health benefits
coverage, costs, provider networks, quality, the amount and proportion of
health insurance premium payments that go directly to patient care, and the
plan’s coverage rules (including amount, duration, and scope limits) and
out-of-pocket cost-sharing (both inside and outside plan networks) for each
essential service recommended by the National Advisory Commission on Expanded
Access to Health Care and adopted by Congress under title III (which shall be
prominently identified as an essential service, including by reference to the
Commission recommendation denoting the service as essential). To the maximum
extent feasible, such requirements shall specify that the content and
presentation of the information shall be provided in the same manner as similar
information is presented to enrollees in the Federal employees health benefits
program under chapter 89 of title 5, United States Code.</text>
</paragraph><paragraph id="HEA5C815497A04F1390BFC3646318B284"><enum>(3)</enum><header>Other
conditions, including the elimination of barriers to affordable
coverage</header>
<subparagraph id="H0EFC304ACF844D0F8DB9C3262780A238"><enum>(A)</enum><header>In
general</header><text>Requirements for each entity offering individual
insurance to abide by conditions of participation that the Secretary believes
are reasonable and appropriate measures to address barriers to affordable
health insurance coverage.</text>
</subparagraph><subparagraph id="H252B6F691C3945E7B00233C8117FB1AC"><enum>(B)</enum><header>Specific
conditions</header><text>The requirements developed by the Secretary under
subparagraph (A) shall include (but need not be limited to)—</text>
<clause id="HBEB29E38FF8B4213A6413200004F0094"><enum>(i)</enum><text>guaranteed
renewability, without premium increases based on changed individual risk;
and</text>
</clause><clause id="H8C55268E6C3245579F9C54142EE9607D"><enum>(ii)</enum><text>limits on risk
rating.</text>
</clause></subparagraph></paragraph><paragraph id="H9030F6D3E72B44C98490E9F2300173EB"><enum>(4)</enum><header>Rule of
construction</header><text>Nothing in this section shall be construed to
authorize the Secretary to impose any requirements on individual insurance,
except with respect to eligible individuals purchasing individual insurance
using advance payment of a tax credit provided under section 36A of the
Internal Revenue Code of 1986.</text>
</paragraph></subsection></section><section id="HB2D5AFD7E68746ABA987CE4D5726CCA8"><enum>413.</enum><header>Use of premium
subsidies to unify family coverage with members enrolled in medicaid and
SCHIP</header><text display-inline="no-display-inline">Notwithstanding any
other provision of law, the Secretary shall establish procedures under which,
in the case of a family with 1 or more members enrolled in with a managed care
entity under the State medicaid program under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name> or the State
children’s health insurance program under title XXI of such Act (42 U.S.C. 1396
et seq., 1397aa et seq.) and 1 or more members who are an eligible individual
under this title, the family shall have the option to enroll all family members
with the managed care entity under either or both such State programs. The
procedures established by the Secretary shall provide that premiums charged to
eligible individuals for enrollment with such an entity shall be based on the
capitated payments established for adults or children, excluding adults and
children who are known to be pregnant, blind, disabled, or (in the case of
adults) elderly, under the applicable State program (except that, in the case
of an eligible individual known to be pregnant, premiums shall reflect
capitated payments established under such State program for individuals known
to be pregnant) plus reasonable administrative costs.</text>
</section><section id="HE8814BF57BCB4C8381D5AC0085C075F0"><enum>414.</enum><header>Coverage
through employer-sponsored health insurance</header>
<subsection id="HDEEBB2B0FDE749488002A32594423E59"><enum>(a)</enum><header>In
general</header><text>Eligible individuals may use credits allowed under the
Internal Revenue Code of 1986 and supplemental assistance to enroll in coverage
offered by eligible employers.</text>
</subsection><subsection id="H0E1FC8DAF1E5418CB44E00EF6DD9FB4B"><enum>(b)</enum><header>Eligible
employers</header><text>For purposes of this section, the term <term>eligible
employers</term> includes the following:</text>
<paragraph id="HB2C83BD83E2A44A800F96CC69F6C653E"><enum>(1)</enum><text>The current
employer of the eligible individual or a member of such individual’s
family.</text>
</paragraph><paragraph id="HD6463448B1C8429CA97613FF7071B54F"><enum>(2)</enum><text>A
former employer required to offer coverage of the eligible individual under a
COBRA continuation provision (as defined in section 9832(d)(1) of the Internal
Revenue Code) or a State law requiring continuation coverage.</text>
</paragraph><paragraph id="H611A4B6858F04EE7A33E002FA8008156"><enum>(3)</enum><text>A
former employer voluntarily offering coverage of the eligible
individual.</text>
</paragraph></subsection><subsection id="HA2A3E8A5EC6A4659B65E07AC536BE017"><enum>(c)</enum><header>Application of
disregard of preexisting conditions exclusions</header><text>Notwithstanding
any other provision of law, in the case of an individual who experiences a
qualifying event (as defined in section 603 of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (29 U.S.C. 1163)) and who, not later than 6 months after such
event, is determined to be an eligible individual under this title, the same
rules with respect to preexisting conditions as apply to a nonelecting
TAA-eligible individual under section 605(b) of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (29 U.S.C. 1165(b)) shall apply with respect to such
individual, regardless of which type of qualified coverage the individual
purchases.</text>
</subsection><subsection id="HB4D773ABA87B43DA89AEE85432359840"><enum>(d)</enum><header>Extension of
COBRA election period</header><text>Notwithstanding any other provision of law,
in the case of an individual who experiences a qualifying event (as defined in
section 603 of the <act-name parsable-cite="ERISA">Employee Retirement Income
Security Act of 1974</act-name> (29 U.S.C. 1163)) and who, not later than 6
months after such event, is determined to be an eligible individual under this
title, the same rules with respect to the temporary extension of a COBRA
election period as apply to a nonelecting TAA-eligible individual under section
605(b) of the <act-name parsable-cite="ERISA">Employee Retirement Income
Security Act of 1974</act-name> (29 U.S.C. 1165(b)) shall apply with respect to
such individual.</text>
</subsection><subsection id="HB70BA59D46824DFABE006DE0A25643BD"><enum>(e)</enum><header>Current employer
coverage</header><text>If an eligible individual uses the credits allowed under
the Internal Revenue Code of 1986 and supplemental assistance to purchase
coverage from an employer described in subsection (b), such credits and
assistance shall apply as a percentage, not of the total premium amount for the
eligible individual, but of the employee’s or former employee’s share of
premium payments.</text>
</subsection></section><section id="H54931460816E475282632CE224A1793"><enum>415.</enum><header>Participation by
small employers</header>
<subsection id="H2F18C81284CF47DFA2B615B8B7244822"><enum>(a)</enum><header>In
general</header><text>Notwithstanding any other provision of this title, the
Secretary shall establish procedures under which, during annual open enrollment
periods, a small employer shall have the option of purchasing group coverage
for employees and dependents of employees, including individuals who are not
otherwise eligible individuals under this title, through a purchasing pool
established under section 403(a).</text>
</subsection><subsection id="H7A10D1778BAB40B18DB053C7F23E9D15"><enum>(b)</enum><header>Conditions of
participation</header>
<paragraph id="H75ED5940D2504433A095AD73343F4C47"><enum>(1)</enum><header>In
general</header><text>Except as otherwise provided in this subsection, the same
requirements that apply with respect to participating insurers covering
eligible low-income individuals under section 403 shall apply with respect to
coverage offered by such insurers through a small employer.</text>
</paragraph><paragraph id="HD5A759DA8FDD413A81CA150483867CE6"><enum>(2)</enum><header>Risk
adjustment</header>
<subparagraph id="H265D9BDE2AA14EA088BB67A0A95D381"><enum>(A)</enum><header>Increased
payments</header><text>If employees of a small employer who are not otherwise
eligible individuals under this title enroll in a private group health
insurance plan under this title and have a collective risk level that exceeds
the statewide average (as determined pursuant to risk adjustment mechanisms
developed by the Secretary consistent with section 409(b)(1)), the Secretary
(through a pool operator) shall provide participating insurers with such small
employer enrollment bonus payments as are necessary to compensate the insurers
for such increased risk. The premium charged to enrollees under this section
shall be the same premium that is the basis of premium charges to enrollees who
are eligible low-income individuals.</text>
</subparagraph><subparagraph id="H32D8D96E80FB4354AF6371627E6FFEC5"><enum>(B)</enum><header>Reduced
payments</header><text>A pool operator shall reduce payments to any plan with a
risk level that falls below the statewide average (as so determined).</text>
</subparagraph></paragraph><paragraph id="H95A4446787114CBC9662AE008BD3E7B"><enum>(3)</enum><header>Administrative
guidelines</header><text>The Secretary shall develop guidelines for pool
operators to use in serving small employers, which shall be modeled after
existing, successful, longstanding small business purchasing cooperatives, and
shall include administratively simple methods for small employers and licensed
insurance brokers to participate in the program established under this
title.</text>
</paragraph></subsection><subsection id="H5B78997C98A94102B795DE008AAF0EF"><enum>(c)</enum><header>Information
campaign</header>
<paragraph id="HD913DAFA8A9C4763BECB2DD0169E6145"><enum>(1)</enum><header>In
general</header><text>The pool operator for a State shall establish and
conduct, directly or through 1 or more public or private entities (which may
include licensed insurance brokers), a health insurance information program to
inform small employers about health coverage for employees.</text>
</paragraph><paragraph id="HBC282080AD3D4F89AE894FCF02D2E12E"><enum>(2)</enum><header>Requirements</header><text>The
program established under paragraph (1) shall educate small employers with
respect to matters that include (but are not limited to) the following:</text>
<subparagraph id="H886A062097FA47EFA85403933400F491"><enum>(A)</enum><text>The benefits of
providing health insurance to employees, including tax benefits to both the
employer and employees, increased productivity, and decreased employee
turnover.</text>
</subparagraph><subparagraph id="H6E0380FE686840AD95AB87426DBD1B46"><enum>(B)</enum><text>The rights of
small employers under Federal and State health insurance reform laws.</text>
</subparagraph><subparagraph id="H2FEB6951789A407C985EF470191BAE44"><enum>(C)</enum><text>Options for
purchasing coverage, including (but not limited to) through the State’s
purchasing pool operated pursuant to section 403.</text>
</subparagraph></paragraph></subsection><subsection id="H0AEF67D911024C1CB868D8ED8FE42513"><enum>(d)</enum><header>Grants To help
State-based pools promote small business coverage</header>
<paragraph id="HAD3EDBDCA4D34ED6A3ADAF7BCE220554"><enum>(1)</enum><header>In
general</header><text>The Secretary may award grants to a pool operator for the
following:</text>
<subparagraph id="HC423EC72AB9A4EDA8823ABA37FF1186C"><enum>(A)</enum><text>The net costs of
risk-adjusted payments under paragraph (b)(2), to the extent the sum of upward
adjustments exceeds the sum of downward adjustments for the pool
operator.</text>
</subparagraph><subparagraph id="H2550A007A10148AA85922145BDC9A2C7"><enum>(B)</enum><text>The reasonable
cost of the information campaign under subsection (c).</text>
</subparagraph><subparagraph id="H57B11104162F43E797E6E39400D3F875"><enum>(C)</enum><text>The pool
operator’s reasonable administrative costs to implement this section.</text>
</subparagraph></paragraph><paragraph id="H61E37B563BD842E6A1C10056F6485046"><enum>(2)</enum><header>Limitation</header><text>This
section shall not apply to a State’s pool unless sufficient grant funds have
been received under this subsection to implement this section on a fiscally
sound basis and such receipt is certified by the pool operator.</text>
</paragraph><paragraph id="HE691165E407543F6B03C9CB4C466052C"><enum>(3)</enum><header>Application</header><text>A
pool operator desiring a grant under this section shall submit an application
to the Secretary in such manner, at such time, and containing such information
as the Secretary may require.</text>
</paragraph><paragraph id="H998970B998F3482B95EA68548E062C53"><enum>(4)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated to the
Secretary such sums as may be necessary for making grants under this
subsection.</text>
</paragraph></subsection></section><section id="H65567B99039548ADB5A2D3956E87BF1"><enum>416.</enum><header>Report</header><text display-inline="no-display-inline">Not later than 1 year after the date of
enactment of this Act, the Secretary shall submit to Congress a report
containing recommendations for such legislative and administrative changes as
the Secretary determines are appropriate to permit affinity groups related for
reasons other than a common employer to participate in purchasing pools
established under section 403.</text>
</section><section id="HA63ECB2D82C94175A4DEEB04508B00E7"><enum>417.</enum><header>Authorization
of appropriations</header>
<subsection id="H68FBB9017C3745F384118ECB5484EE99"><enum>(a)</enum><header>In
general</header><text>There are authorized to be appropriated, such sums as may
be necessary to carry out this title for fiscal year 2012 and each fiscal year
thereafter.</text>
</subsection><subsection id="HA31FF8DD2591466B90CA61C781E889DC"><enum>(b)</enum><header>Rule of
construction</header><text>Amounts appropriated in accordance with subsection
(a) shall be in addition to other amounts appropriated directly under this
title and nothing in subsection (a) shall be construed to relieve the Secretary
of mandatory payment obligations required under this title.</text>
</subsection></section><enum>V</enum><header>National Advisory
Commission on Expanded Access to Health Care</header>
<section id="H510DA9A0667641CF82CFFE075F9D498E"><enum>501.</enum><header>National
Advisory Commission on Expanded Access to Health Care</header>
<subsection id="H2B9ADF8253ED4F0E997384A3F6F069B4"><enum>(a)</enum><header>Establishment</header><text>Not
later than October 1, 2009, the Secretary of Health and Human Services
(referred to in this section as the <quote>Secretary</quote>), shall establish
an entity to be known as the National Advisory Commission on Expanded Access to
Health Care (referred to in this section as the
<quote>Commission</quote>).</text>
</subsection><subsection id="H201986CD5FED414CAC38D2375B086E46"><enum>(b)</enum><header>Appointment of
members</header>
<paragraph id="H9826C817E3474F5790685E828878FF47"><enum>(1)</enum><header>In
general</header><text>Not later than 45 days after the date of enactment of
this Act, the House and Senate majority and minority leaders shall each appoint
4 members of the Commission and the Secretary shall appoint 1 member.</text>
</paragraph><paragraph id="H4DB583CAC9E74022B4FFCE2EF99C8500"><enum>(2)</enum><header>Criteria</header><text>Members
of the Commission shall include representatives of the following:</text>
<subparagraph id="H14FF46AF1FD141A8A6FC00AB50000385"><enum>(A)</enum><text>Consumers of
health insurance.</text>
</subparagraph><subparagraph id="H90FB6E5B90334BB7B8050046A3718DD7"><enum>(B)</enum><text>Health care
professionals.</text>
</subparagraph><subparagraph id="H40D896441C6E4F8187C51562F9B98DD"><enum>(C)</enum><text>State
officials.</text>
</subparagraph><subparagraph id="H4A1EF9C74EAC4374894426A5184FDCDE"><enum>(D)</enum><text>Economists.</text>
</subparagraph><subparagraph id="HF19EEBEE7A9D4D6D91E39C3C22C22B65"><enum>(E)</enum><text>Health care
providers.</text>
</subparagraph><subparagraph id="HC5A7AA5B881341689124B9A94F8D0063"><enum>(F)</enum><text>Experts on health
insurance.</text>
</subparagraph><subparagraph id="H019003785E6146F2B4B67E70FFDBB5B6"><enum>(G)</enum><text>Experts on
expanding health care to individuals who are uninsured.</text>
</subparagraph></paragraph><paragraph id="HF0976488FA234CAD8FF3F32AB385749"><enum>(3)</enum><header>Chairperson</header><text>At
the first meeting of the Commission, the Commission shall select a Chairperson
from among its members.</text>
</paragraph></subsection><subsection id="HD48ACB70FB6F4B03B86456FA00AEB134"><enum>(c)</enum><header>Meetings</header>
<paragraph id="HA4A3EE3A0798443088FC6EC6875FA6FE"><enum>(1)</enum><header>In
general</header><text>After the initial meeting of the Commission which shall
be called by the Secretary, the Commission shall meet at the call of the
Chairperson.</text>
</paragraph><paragraph id="H609B8766080D4751A85EBA2C8B008FC3"><enum>(2)</enum><header>Quorum</header><text>A
majority of the members of the Commission shall constitute a quorum, but a
lesser number of members may hold hearings.</text>
</paragraph><paragraph id="H780262950DE04B240032AAA926DFB6C6"><enum>(3)</enum><header>Supermajority
voting requirement</header><text>To approve a report required under paragraph
(2) or (3) of subsection (e), at least 60 percent of the membership of the
Commission must vote in favor of such a report.</text>
</paragraph></subsection><subsection id="H943408E560534F9AAD4DE7050770DDDF"><enum>(d)</enum><header>Duties</header><text>The
Commission shall—</text>
<paragraph id="H716F26965673454EABA0E3005760236E"><enum>(1)</enum><text>assess the
effectiveness of programs designed to expand health care coverage or make
health care coverage affordable to the otherwise uninsured individuals through
identifying the accomplishments and needed improvements of each program;</text>
</paragraph><paragraph id="H5A0ED5C3BFB44B3CA4F004552FA340D8"><enum>(2)</enum><text>make
recommendations about benefits and cost-sharing to be included in health care
coverage for various groups, taking into account—</text>
<subparagraph id="H14EDFCEA63F5490FBBDCB501232F582E"><enum>(A)</enum><text>the special health
care needs of children and individuals with disabilities;</text>
</subparagraph><subparagraph id="H72114699A9154CC488D0006EA19B0F6"><enum>(B)</enum><text>the different
ability of various populations to pay out-of-pocket costs for services;</text>
</subparagraph><subparagraph id="HCF6B8083D0094F859E0843E251D7A517"><enum>(C)</enum><text>incentives for
efficiency and cost-control; and</text>
</subparagraph><subparagraph id="H24E0AF07597E4E8B927CBBBCF770C779"><enum>(D)</enum><text>preventative care,
disease management services, and other factors;</text>
</subparagraph></paragraph><paragraph id="H732F9B0824E247D987CDDD61F847920"><enum>(3)</enum><text>recommend
mechanisms to discourage individuals and employers from voluntarily opting out
of health insurance coverage;</text>
</paragraph><paragraph id="H25A34BB6CE954EFD9796FEE0969FFA00"><enum>(4)</enum><text>recommend
mechanisms to expand health care coverage to uninsured individuals with incomes
above 200 percent of the official income poverty line (as defined by the Office
of Management and Budget, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family
of the size involved;</text>
</paragraph><paragraph id="H578244CB22D14341B113CE7E27A4C7D6"><enum>(5)</enum><text>recommend
automatic enrollment and retention procedures and other measures to increase
health care coverage among those eligible for assistance;</text>
</paragraph><paragraph id="HC7902B6CE72D47A3862D987E1D4CA410"><enum>(6)</enum><text>review the roles,
responsibilities, and relationship between Federal and State agencies with
respect to health care coverage and recommend improvements; and</text>
</paragraph><paragraph id="H9D8AC03FB1D84B3A00D683CFC360398F"><enum>(7)</enum><text>analyze the size,
effectiveness, and efficiency of current tax and other subsidies for health
care coverage and recommend improvements.</text>
</paragraph></subsection><subsection id="H2119327568204D92B242482FD5965F5D"><enum>(e)</enum><header>Reports</header>
<paragraph id="HC2BA253A659245C8B8FF291FA6CC8048"><enum>(1)</enum><header>Annual
report</header><text>The Commission shall submit annual reports to the
President and Congress addressing the matters identified in subsection
(d).</text>
</paragraph><paragraph id="H07AEC31897B841B08CF6566FAE4800E5"><enum>(2)</enum><header>Biennial
report</header>
<subparagraph id="HC865E5E04D23432896B8BDB8709ED518"><enum>(A)</enum><header>In
general</header><text>The Commission shall submit biennial reports to the
President and Congress, which shall contain—</text>
<clause id="H2F3F03FF732143239856CF6E9548CE8D"><enum>(i)</enum><text>recommendations
concerning essential benefits and maximum out-of-pocket cost-sharing (for the
general population and for individuals with limited ability to pay, which shall
not exceed the out-of-pocket cost-sharing permitted under section 2103(e) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1397cc(e))) for the coverage options described in title IV; and</text>
</clause><clause id="H3EC6A610E3F148BD9C4F3CA56E64EBE"><enum>(ii)</enum><text>proposed
legislative language to implement such recommendations.</text>
</clause></subparagraph><subparagraph id="H7F45558156984F72A812005EE2E44CE6"><enum>(B)</enum><header>Congressional
action</header><text>The legislative language proposed under subparagraph
(A)(ii) shall proceed to immediate consideration on the floor of the House of
Representatives and the Senate and shall be approved or rejected, without
amendment, using procedures employed for recommendations of military base
closing commissions.</text>
</subparagraph></paragraph><paragraph id="H0082708A89D8470EA0586D77A8FCD126"><enum>(3)</enum><header>Commission
report</header><text>No later than January 15, 2013, the Commission shall
submit a report to the President and Congress, which shall include—</text>
<subparagraph id="HA9658C9D5EF84B00993DB89EDB2302D4"><enum>(A)</enum><text>recommendations on
policies to provide health care coverage to uninsured individuals with incomes
above 200 percent of the official income poverty line (as defined by the Office
of Management and Budget, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family
of the size involved;</text>
</subparagraph><subparagraph id="H568C9C2C5D0249A9A3C25BD5074BCC43"><enum>(B)</enum><text>recommendations on
changes to policies enacted under this Act; and</text>
</subparagraph><subparagraph id="H2395BA38C5A84BAAAF92C73FF8E7A700"><enum>(C)</enum><text>proposed
legislative language to implement such recommendations.</text>
</subparagraph></paragraph></subsection><subsection id="H9974B38D0ABE44DA82A642890925E801"><enum>(f)</enum><header>Administration</header>
<paragraph id="HD2A8362EBF314677A0EA1913964706E"><enum>(1)</enum><header>Powers</header>
<subparagraph id="HBCB22A89708C4DEABFBC2DCC0000BC58"><enum>(A)</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 this section.</text>
</subparagraph><subparagraph id="HC4B81F611B20463EB5AF3439E36F88F3"><enum>(B)</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 Chairperson of the
Commission, the head of such department or agency shall furnish such
information to the Commission.</text>
</subparagraph><subparagraph id="HED6E6FCD8D7242B28EB67E4CB7499E10"><enum>(C)</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><subparagraph id="H623F89E61AC94C61B86BB67CEFF63EDE"><enum>(D)</enum><header>Gifts</header><text>The
Commission may accept, use, and dispose of gifts or donations of services or
property.</text>
</subparagraph></paragraph><paragraph id="H7948AC12020446F7BB9FA0011C5844E3"><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. 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>
</paragraph><paragraph id="HCBEBC5748A884A05BCB3E04E168B307C"><enum>(3)</enum><header>Staff</header>
<subparagraph id="H484B9487AE324AE78CA56DF7491F4BE"><enum>(A)</enum><header>In
general</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="H63C128FCF30A490C93D158F474307759"><enum>(B)</enum><header>Staff
compensation</header><text>The Chairperson of the Commission may fix the
compensation of the executive director and other personnel without regard to
chapter 51 and subchapter III of chapter 53 of title 5, United States Code,
relating to classification of positions and General Schedule pay rates, except
that the rate of pay for the executive director and other personnel may not
exceed the rate payable for level V of the Executive Schedule under section
5316 of such title.</text>
</subparagraph><subparagraph id="H719F241CACA743B7912E9DA6B6326983"><enum>(C)</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="H29675DBD93A842ECB4EA08267BD57CCE"><enum>(D)</enum><header>Procurement of
temporary and intermittent services</header><text>The Chairperson of the
Commission may procure temporary and intermittent services under section
3109(b) 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></subsection><subsection id="HFB909B5611874688A33E63D4D0665EC9"><enum>(g)</enum><header>Termination</header><text>Except
with respect to activities in connection with the ongoing biennial report
required under subsection (e)(2), the Commission shall terminate 90 days after
the date on which the Commission submits the report required under subsection
(e)(3).</text>
</subsection><subsection id="HAE251B7650AA485DA5242532981D2BD9"><enum>(h)</enum><header>Authorization of
appropriations</header><text>There are authorized to be appropriated, such sums
as may be necessary to carry out this section for fiscal year 2010 and each
fiscal year thereafter.</text>
</subsection></section><section id="H35CB8A4B12DD44B9942DA0B8C581E2C"><enum>502.</enum><header>Congressional
action</header>
<subsection id="HB4EF6D1A55004E85A921276CD97D1412"><enum>(a)</enum><header>Bill
introduction</header>
<paragraph id="H5539E4ED92914256B1777CE5E5490246"><enum>(1)</enum><header>In
general</header><text>Any legislative language included in the report required
under section 501(e)(3) may be introduced as a bill by request in the following
manner:</text>
<subparagraph id="HB451A31D86E2473DBCFB4DAB86452A3"><enum>(A)</enum><header>House of
Representatives</header><text>In the House of Representatives, by the majority
leader and the minority leader not later than 10 days after receipt of the
legislative language.</text>
</subparagraph><subparagraph id="HFAC86640DAFA49058634924856E25799"><enum>(B)</enum><header>Senate</header><text>In
the Senate, by the majority leader and the minority leader not later than 10
days after receipt of the legislative language.</text>
</subparagraph></paragraph><paragraph id="H346E662CE126401E8BBFB3092636F1C4"><enum>(2)</enum><header>Alternative by
administration</header><text>The President may submit legislative language
based on the recommendations of the Commission and such legislative language
may be introduced in the manner described in paragraph (1).</text>
</paragraph></subsection><subsection id="H43C95BB22E66422BB359DE2EF1818700"><enum>(b)</enum><header>Committee
consideration</header>
<paragraph id="H9A9E1D325F824EBBB4111F805C7827BE"><enum>(1)</enum><header>In
general</header><text>Any legislative language submitted pursuant to paragraph
(1) or (2) of subsection (a) (in this section referred to as
<quote>implementing legislation</quote>) shall be referred to the appropriate
committees of the House of Representatives and the Senate.</text>
</paragraph><paragraph id="H81E14B15925548748D6129D700FA033F"><enum>(2)</enum><header>Reporting</header>
<subparagraph id="H4154DFE7C7EC49B6A7BF03F05C18922E"><enum>(A)</enum><header>Committee
action</header><text>If, not later than 150 days after the date on which the
implementing legislation is referred to a committee under paragraph (1), the
committee has reported the implementing legislation or has reported an original
bill whose subject is related to reforming the health care system, or to
providing access to affordable health care coverage for Americans, the regular
rules of the applicable House of Congress shall apply to such
legislation.</text>
</subparagraph><subparagraph id="H0520E33BF3CA430689FC0098EF8539A6"><enum>(B)</enum><header>Discharge from
committees</header>
<clause id="H4075FB2CE6E547C59FBA552896232BA4"><enum>(i)</enum><header>Senate</header>
<subclause id="H5E4A738B971B46B3BF9DCF25B32CE79C"><enum>(I)</enum><header>In
general</header><text>If the implementing legislation or an original bill
described in subparagraph (A) has not been reported by a committee of the
Senate within 180 days after the date on which such legislation was referred to
committee under paragraph (1), it shall be in order for any Senator to move to
discharge the committee from further consideration of such implementing
legislation.</text>
</subclause><subclause id="H4EF19B4D2EAA499A9C8C02DB7355C03"><enum>(II)</enum><header>Sequential
referrals</header><text>Should a sequential referral of the implementing
legislation be made, the additional committee has 30 days for consideration of
implementing legislation before the discharge motion described in subclause (I)
would be in order.</text>
</subclause><subclause id="HACDF7123085B41DCA8FC0403308F0022"><enum>(III)</enum><header>Procedure</header><text>The
motion described in subclause (I) shall not be in order after the implementing
legislation has been placed on the calendar. While the motion described in
subclause (I) is pending, no other motions related to the motion described in
subclause (I) shall be in order. Debate on a motion to discharge shall be
limited to not more than 10 hours, equally divided and controlled by the
majority leader and the minority leader, or their designees. An amendment to
the motion shall not be in order, nor shall it be in order to move to
reconsider the vote by which the motion is agreed or disagreed to.</text>
</subclause><subclause id="H3723D7BC01074D878300CF00D130D057"><enum>(IV)</enum><header>Exception</header><text>If
implementing language is submitted on a date later than May 1 of the second
session of a Congress, the committee shall have 90 days to consider the
implementing legislation before a motion to discharge under this clause would
be in order.</text>
</subclause></clause><clause id="H5AD974B8ACBA409E8055A7E9D82F908E"><enum>(ii)</enum><header>House of
Representatives</header><text>If the implementing legislation or an original
bill described in subparagraph (A) has not been reported out of a committee of
the House of Representatives within 180 days after the date on which such
legislation was referred to committee under paragraph (1), then on any day on
which the call of the calendar for motions to discharge committees is in order,
any member of the House of Representatives may move that the committee be
discharged from consideration of the implementing legislation, and this motion
shall be considered under the same terms and conditions, and if adopted the
House of Representatives shall follow the procedure described in subsection
(c)(1).</text>
</clause></subparagraph></paragraph></subsection><subsection id="HDC1F4B638E70496E96DFDEDB6E67714"><enum>(c)</enum><header>Floor
consideration</header>
<paragraph id="H11AC866FBD7A43C5872E8692AF78B1A1"><enum>(1)</enum><header>Motion to
proceed</header><text>If a motion to discharge made pursuant to subsection
(b)(2)(B)(i) or (b)(2)(B)(ii) is adopted, then, not earlier than 5 legislative
days after the date on which the motion to discharge is adopted, a motion may
be made to proceed to the bill.</text>
</paragraph><paragraph id="H1453B7F996F64E5B8D83A8EC812C92A9"><enum>(2)</enum><header>Failure of
motion</header><text>If the motion to discharge made pursuant to subsection
(b)(2)(B)(i) or (b)(2)(B)(ii) fails, such motion may be made not more than 2
additional times, but in no case more frequently than within 30 days of the
previous motion. Debate on each of such motions shall be limited to 5 hours,
equally divided.</text>
</paragraph><paragraph id="H5A90053E7D5A4718B7C9FA00800752D9"><enum>(3)</enum><header>Applicable
Rules</header><text>Once the Senate is debating the implementing legislation
the regular rules of the Senate shall apply.</text>
</paragraph></subsection></section>