1.This Act may be cited as
the Health Care Freedom Act of
2009
.
<enum>I</enum><header>Access to
coverage for every American</header>
<subtitle id="id9C516E6928B34CA28835CA3E304B4147"><enum>A</enum><header>Tax code
equity</header>
<section display-inline="no-display-inline" id="H956D7BC9E9404B008E523D1DAE634440" section-type="subsequent-section"><enum>101.</enum><header>Refundable credit
for health insurance coverage</header>
<subsection id="H93A3A7D713CB46EB928E40E88EF45C7E"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subpart C of part IV
of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by
inserting after section 36A the following new section:</text>
<quoted-block id="H0802A99B153942EC8DBE9B05BAE1CA02">
<section id="H1C542985226C499AB6CE469FB200A0B2"><enum>36B.</enum><header>Qualified
health insurance credit</header>
<subsection id="HFB3DB147AE2441208C7B854C4FEC0066"><enum>(a)</enum><header>Allowance of
credit</header><text>In the case of an individual, there shall be allowed as a
credit against the tax imposed by this chapter for the taxable year so much of
the qualified health insurance costs of the taxpayer as does not exceed the sum
of the monthly limitations determined under subsection (b).</text>
</subsection><subsection display-inline="no-display-inline" id="HABC046941DEF46DA919E41D8A0CA9E89"><enum>(b)</enum><header>Monthly
limitation</header>
<paragraph id="HECF46846E6C64024B8ED578B3425105B"><enum>(1)</enum><header>In
general</header><text>The monthly limitation for each month during the taxable
year is <fraction>1/12</fraction>th of—</text>
<subparagraph id="HE8ED8007D2E14030AEACA812C71376E0"><enum>(A)</enum><text>$2,000, in the
case of an individual purchasing individual coverage for an eligible
individual, and</text>
</subparagraph><subparagraph id="H9772CA7AE0A549148C8CD91C1779545D"><enum>(B)</enum><text>$5,000, in the
case of an individual purchasing family coverage for 2 or more eligible
individuals.</text>
</subparagraph></paragraph><paragraph id="id8D205DC934394243A7847C15590805A9"><enum>(2)</enum><header>Limitation</header><text>In
no case shall the annual sum of the monthly limitations with respect to any
taxpayer exceed $5,000.</text>
</paragraph><paragraph id="H96B32ECEEC9840DAAA31C9DA158D83AD"><enum>(3)</enum><header>No credit for
ineligible months</header><text>With respect to any individual, the monthly
limitation shall be zero for any month for which such individual is not an
eligible individual.</text>
</paragraph></subsection><subsection id="HAE40A83D34424B7D8B55989DCA3088B6"><enum>(c)</enum><header>Eligible
individual</header><text>For purposes of this section—</text>
<paragraph id="HA66FCBBE5434442CA2D5E1744099F969"><enum>(1)</enum><header>In
general</header><text>The term <term>eligible individual</term> means, with
respect to any month, an individual who—</text>
<subparagraph id="HF73E619BA44C4400B1CF7C141821E973"><enum>(A)</enum><text display-inline="yes-display-inline">is the taxpayer, the taxpayer’s spouse, or
the taxpayer’s dependent,</text>
</subparagraph><subparagraph id="HE1BAD31B123A45FDBDB6C3F22B60F300"><enum>(B)</enum><text>is covered under
qualified health insurance as of the 1st day of such month, and</text>
</subparagraph><subparagraph id="id4A24A6F5570945E3A001AA2342B5DB02"><enum>(C)</enum><text>is not covered
under employer-provided health insurance as of the 1st day of such
month.</text>
</subparagraph></paragraph><paragraph id="H4C7C8024FD484510B8DA9CB86FF3F9FD"><enum>(2)</enum><header>Coverage under
Medicare, Medicaid, SCHIP, military coverage</header><text display-inline="yes-display-inline">The term <term>eligible individual</term>
shall not include any individual for a month if, as of the first day of such
month, such individual is—</text>
<subparagraph id="H1D32AE5A14694100896DC900DA05E72F"><enum>(A)</enum><text display-inline="yes-display-inline">entitled to benefits under part A of title
XVIII of the Social Security Act or enrolled under part B of such title, and
the individual is not a participant or beneficiary in a group health plan or
large group health plan that is a primary plan (as defined in section
1862(b)(2)(A) of such Act),</text>
</subparagraph><subparagraph id="HE3706F277D354AFBAFB37390001D31D5"><enum>(B)</enum><text>in the case of a
State that has not made the election described in section 1939(a)(1)(B) of the
Social Security Act, enrolled in the program under title XIX of such Act (other
than under section 1928 of such Act), or</text>
</subparagraph><subparagraph id="H17907DC0745A48CEACB322F0F2439100"><enum>(C)</enum><text>entitled to
benefits under chapter 55 of title 10, United States Code.</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="H742DA7F4E9004AE5A6605EA4E0913CC2"><enum>(3)</enum><header>Identification
requirements</header><text display-inline="yes-display-inline">The term
<term>eligible individual</term> shall not include any individual for any month
unless the policy number associated with the qualified health insurance and the
TIN of each eligible individual covered under such health insurance for such
month are included on the return of tax for the taxable year in which such
month occurs.</text>
</paragraph><paragraph id="H84EFD04C69534DC7856D662B1FEB4213"><enum>(4)</enum><header>Prisoners</header><text display-inline="yes-display-inline">The term <term>eligible individual</term>
shall not include any individual for a month if, as of the first day of such
month, such individual is imprisoned under Federal, State, or local
authority.</text>
</paragraph><paragraph id="H431651994A7C459AB0B3D229FB398305"><enum>(5)</enum><header>Aliens</header><text display-inline="yes-display-inline">The term <term>eligible individual</term>
shall not include any alien individual for a month if, as of the first day of
such month, such individual is not a lawful permanent resident of the United
States.</text>
</paragraph></subsection><subsection id="id0AE4F4BDF5BD40D5BC804A30D50B4685"><enum>(d)</enum><header>Qualified
health insurance costs</header><text>For purposes of this section, the term
<term>qualified health insurance costs</term> means the sum of the amounts paid
during the taxable year to obtain qualified health insurance for 1 or more
eligible individuals.</text>
</subsection><subsection id="HEB6CF88F26234DD8B299A077919537A"><enum>(e)</enum><header>Qualified health
insurance</header><text>For purposes of this section, the term <term>qualified
health insurance</term> includes a high deductible health plan within the
meaning of section 223(c)(2), but shall not include any insurance if a
substantial portion of its benefits are excepted benefits (as defined in
section 9832(c)).</text>
</subsection><subsection id="HFF0D88F186334976004B901FD1C803B9"><enum>(f)</enum><header>Other
definitions</header><text>For purposes of this section—</text>
<paragraph commented="no" id="H9DD8E17FD443460E896607AA817790AF"><enum>(1)</enum><header>Dependent</header><text display-inline="yes-display-inline">The term <term>dependent</term> has the
meaning given such term by section 152 (determined without regard to
subsections (b)(1), (b)(2), and (d)(1)(B) thereof). An individual who is a
child to whom section 152(e) applies shall be treated as a dependent of the
custodial parent for a coverage month unless the custodial and noncustodial
parent agree otherwise.</text>
</paragraph><paragraph id="H567B2E27E33A4160B7BDB1D081CA57"><enum>(2)</enum><header>Child</header><text display-inline="yes-display-inline">The term <term>child</term> means a
qualifying child (as defined in section 152(c)).</text>
</paragraph></subsection><subsection id="H68667668A9C64562AB7C6C04D1D14CE8"><enum>(g)</enum><header>Special
rules</header>
<paragraph id="H088D76CAC54F4DB18FD42FC6CEDC6B01"><enum>(1)</enum><header>Coordination
with medical deduction, etc</header><text>Any amount paid by a taxpayer for
insurance to which subsection (a) applies shall not be taken into account in
computing the amount allowable to the taxpayer as a credit under section 35 or
as a deduction under section 213(a).</text>
</paragraph><paragraph commented="no" id="idF3CF76A5330D496C885498AD7A0861CD"><enum>(2)</enum><header>Medical and
health savings accounts</header><text display-inline="yes-display-inline">The
amounts taken into account as qualified health insurance costs for any taxable
year shall be reduced by the aggregate amounts, if any, distributed from Archer
MSAs (as defined in section 220(d)) and health savings accounts (as defined in
section 223(d)) which are excludable from gross income for such taxable year by
reason of being used to pay premiums for coverage of an individual under
qualified health insurance for any month during such taxable year.</text>
</paragraph><paragraph id="H04EBE1256B9E437FAE4677BA5C987700"><enum>(3)</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="H0B836F25C60E43A0BEE11223BC90B9ED"><enum>(4)</enum><header>Married couples
must file joint return</header>
<subparagraph id="H0A3ED0C419C44F73B43D78EB2F19C8E"><enum>(A)</enum><header>In
general</header><text>If the taxpayer is married at the close of the taxable
year, the credit shall be allowed under subsection (a) only if the taxpayer and
his spouse file a joint return for the taxable year.</text>
</subparagraph><subparagraph id="H6328B2F276754F45A5D646FDEBBA93DE"><enum>(B)</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 paragraph.</text>
</subparagraph></paragraph><paragraph id="H839BDE1611E54B989235189FAFFE4E2E"><enum>(5)</enum><header>Verification of
coverage, etc</header><text>No credit shall be allowed under this section with
respect to any individual unless such individual’s coverage (and such related
information as the Secretary may require) is verified in such manner as the
Secretary may prescribe.</text>
</paragraph><paragraph id="H91A5E727F1304D938EF6BBF67BCFAE08"><enum>(6)</enum><header>Insurance which
covers other individuals; treatment of payments</header><text>Rules similar to
the rules of paragraphs (7) and (8) of section 35(g) shall apply for purposes
of this section.</text>
</paragraph><paragraph id="id06C206C4760F4D6784C85AFF60FFE40B"><enum>(7)</enum><header>Participants in
health care sharing ministries</header>
<subparagraph id="id49ED39DC08F44BB2914FE3574984E43C"><enum>(A)</enum><header>In
general</header><text>In the case of a taxpayer who is a participant or
contributor to a health care sharing ministry during a month in the taxable
year, and who is not covered under qualified health insurance during such
month—</text>
<clause id="id385B010CC672456CB1EEC85593F56388"><enum>(i)</enum><text>such taxpayer
(and such taxpayer's spouse and dependents, if such individuals are covered by
such health care sharing ministry) shall be considered to be eligible
individuals for purposes of subsection (c)(1) for such month,</text>
</clause><clause id="id72B5971E7A2F4098B42FEE51E33D65F2"><enum>(ii)</enum><text>the amount of
such taxpayer's contribution to such health care sharing ministry in such month
shall be considered to be qualified health insurance costs in such
month,</text>
</clause><clause id="idD0A8F94A7F6640E58499081BE3B5FD6C"><enum>(iii)</enum><text>subsection
(c)(3) shall apply to such taxpayer (and such taxpayer's spouse and dependents,
if such individuals are covered by such ministry) without regard to the policy
number requirement, and</text>
</clause><clause id="id279E7C6C2F634025AC23D18BC0726BDB"><enum>(iv)</enum><text>the Secretary
may require such information under paragraph (5) of this subsection as may be
necessary to verify such taxpayer's contribution to such ministry.</text>
</clause></subparagraph><subparagraph id="idEEF743EB3D164F138C0315D497DE2A5D"><enum>(B)</enum><header>Health care
sharing ministry</header><text>For purposes of this paragraph, the term
<term>health care sharing ministry</term> means any health care cost sharing
arrangement among persons of similar beliefs that is not in the trade or
business of providing health insurance.</text>
</subparagraph><subparagraph id="id4D24DCB3689D46ABBF75FCD904F2DFE1"><enum>(C)</enum><header>Credit denied
in the case of charitable contributions</header><text>This paragraph shall not
apply in the case of any contribution for which a deduction is allowable under
section 170.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="idAC48BFDEE69B4E9BB2234BF52CB4B7BD"><enum>(h)</enum><header>Election To
forgo other Federal health benefit programs</header>
<paragraph commented="no" id="idF1EAB0CAEFB74D9498EA07593D536CC4"><enum>(1)</enum><header>In
general</header><text>An individual who is a participant in, or is entitled to
benefits under, any program described in subsection (c)(2) in any month may
elect to forgo such individual's participation in or entitlement to benefits
under such program in such month. If such election is made with respect to any
month, such month shall not fail to be deemed a coverage month with respect to
such individual solely because such individual would, but for such election, be
a participant in or be entitled to benefits under a program described in
subsection (c)(2).</text>
</paragraph><paragraph commented="no" id="idACDE64F420F4432D90CEA2250D6E43FC"><enum>(2)</enum><header>Manner and
reporting of election</header><text>The election described in paragraph (1)
shall be made in a form and manner specified by the Secretary of Health and
Human Services, in consultation with the Secretary of the Treasury, and a
declaration of such election shall be attached to the taxpayer's return of tax
for the taxable year, in a manner specified by the Secretary of the
Treasury.</text>
</paragraph><paragraph commented="no" id="id66D03620449D428CBB59F647DF4130ED"><enum>(3)</enum><header>Prospective and
year-long election</header><text>Each election described in paragraph
(1)—</text>
<subparagraph commented="no" id="id710F863E2F9C4520925ED7D4FD81D102"><enum>(A)</enum><text>shall not be made
with respect to any month beginning before the date of such election,
and</text>
</subparagraph><subparagraph commented="no" id="idC61D6683CF9C446287548D8593DB683D"><enum>(B)</enum><text>shall be
effective for such period (not less than 1 calendar year) as shall be specified
by the Secretary of Health and Human Services, in consultation with the
Secretary of the Treasury.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="id9B504D6FA55B46FA9BB0AE121147F840"><enum>(i)</enum><header>Credit in
excess of allowable credit deposited in tax-favored health care
accounts</header>
<paragraph commented="no" id="idAAD3A505914649FF823DC0E4F56A3C97"><enum>(1)</enum><header>In
general</header><text>The excess, if any, of—</text>
<subparagraph commented="no" id="idACC6F6DB352D40A489F9EE28335BD947"><enum>(A)</enum><text>the monthly
limitation applicable to the individual under subsection (b), multiplied by the
number of coverage months of the individual for the taxable year, over</text>
</subparagraph><subparagraph commented="no" id="idB4BBD8B8727243F8A035B539DA64D22A"><enum>(B)</enum><text>the credit
allowed in such taxable year with respect to such individual under subsection
(a),</text>
</subparagraph><continuation-text continuation-text-level="paragraph">shall be
paid by the Secretary into the designated account of the individual.</continuation-text></paragraph><paragraph id="id384E58DECF9B4C85AA8387E32057948E"><enum>(2)</enum><header>Designated
accounts</header>
<subparagraph id="id77818C624B46452EA8DC88BC872F1F15"><enum>(A)</enum><header>Designated
account</header><text>For purposes of this subsection, the term
<term>designated account</term> means any health savings account under section
223 or any Archer MSA under section 220 established and maintained by the
provider of the individual's qualified health insurance—</text>
<clause id="id901A66C1C88B4F32AFFFB7596456CE77"><enum>(i)</enum><text>which is
designated by the individual (in such form and manner as the Secretary may
provide) on the return of tax for the taxable year, and</text>
</clause><clause id="id48BC8232663B4AADB20CEFCAD4F5D0E7"><enum>(ii)</enum><text>which, under the
terms of the account, accepts the payment described in paragraph (1) on behalf
of the individual.</text>
</clause></subparagraph><subparagraph id="idD60361FD6DEC46B3ABFB4BA46BFFF740"><enum>(B)</enum><header>Treatment of
payment</header><text>Any payment under this subsection to a designated
account—</text>
<clause id="idDBACD2F58E3348D294877BAF314EC330"><enum>(i)</enum><text>shall not be
taken into account with respect to any dollar limitation which applies with
respect to contributions to such account (or to tax benefits with respect to
such contributions),</text>
</clause><clause id="idE865B889A3204E1F88BC556B9B20F64B"><enum>(ii)</enum><text>shall be
included in gross income of the taxpayer for the taxable year in which the
payment is made (except as provided in clause (iii)), and</text>
</clause><clause id="idC7FC2E36A30D428F90A69A6C1E5B804F"><enum>(iii)</enum><text>shall be taken
into account in determining any deduction or exclusion from gross income in the
same manner as if such contribution were made by the taxpayer.</text>
</clause></subparagraph></paragraph></subsection><subsection id="HEBECC6138915440C8D9345F1B29DE596"><enum>(j)</enum><header>Coordination
with advance payments</header>
<paragraph id="H931A66FDE63645D69159D00325CBB855"><enum>(1)</enum><header>Reduction in
credit for advance payments</header><text>With respect to any taxable year, the
amount which would (but for this subsection, and without regard to subsection
(i)) 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="H7FF8B0DB3F4F497EAD9B5B98A2640000"><enum>(2)</enum><header>Recapture of
excess advance payments</header><text display-inline="yes-display-inline">If
the aggregate amount paid on behalf of the taxpayer under section 7527A for
months beginning in the taxable year exceeds the sum of the monthly limitations
under subsection (b) for such taxable year, then the tax imposed by this
chapter for such taxable year shall be increased by the sum of—</text>
<subparagraph id="HFA44606486224A26A410B107C1006217"><enum>(A)</enum><text>such excess,
plus</text>
</subparagraph><subparagraph id="H3B47C346BB704D81BCCBBBAA004749C7"><enum>(B)</enum><text>interest on such
excess determined at the underpayment rate established under section 6621 for
the period from the date of the payment under section 7527A to the date such
excess is paid.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">For
purposes of subparagraph (B), an equal part of the aggregate amount of the
excess shall be deemed to be attributable to payments made under section 7527A
on the first day of each month beginning in such taxable year, unless the
taxpayer establishes the date on which each such payment giving rise to such
excess occurred, in which case subparagraph (B) shall be applied with respect
to each date so established.</continuation-text></paragraph></subsection><subsection id="id03FAD237862D4D8BABE3CB5C263A92FD"><enum>(k)</enum><header>Regulations</header><text>The
Secretary shall prescribe regulations for the administration of this section to
ensure that no portion of the amounts taken into account as qualified health
insurance costs are amounts for which another credit, deduction, or exclusion
is allowed under this subtitle, including through a health flexible spending
arrangement.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HA3E789D3522D4D998F95D1ACB3990595"><enum>(b)</enum><header>Advance payment
of credit</header><text>Chapter 77 of the Internal Revenue Code of 1986 is
amended by inserting after section 7527 the following new section:</text>
<quoted-block id="HEB1FFE0EF00E4FB79460C22E78006C31">
<section id="HE99D6D4261004EFB983C91636CF30073"><enum>7527A.</enum><header>Advance
payment of qualified health insurance credit</header>
<subsection id="H9086B149AEF94204967D5228F2E5AC39"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary shall
establish a program for making payments on behalf of taxpayers who are eligible
individuals within the meaning of section 36B(c) to providers of qualified
health insurance (as defined in section 36B(e)) or to health care sharing
ministries (as defined in section 36B(g)(7)(B)) for such individuals.</text>
</subsection><subsection id="H8D5B4F6FFAE3403EAECD66A020F86CE0"><enum>(b)</enum><header>Limitation</header><text>The
Secretary may make payments under subsection (a) only to the extent that the
Secretary determines that the amount of such payments made on behalf of any
taxpayer for any month does not exceed the monthly limitation in effect under
section 36B(b) for the taxpayer for such
month.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection display-inline="no-display-inline" id="H2CC084D2669C45C785B66506162CD9BA"><enum>(c)</enum><header>Information
reporting</header>
<paragraph id="HF363CD5FD9BD4F0BB21F652C7E2B9CF"><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 is amended by inserting after section 6050W
the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HDFBBA6740CD74BB88FA97758669E91F8" style="OLC">
<section id="HE532EEAD4C034C2C00328D75DA137453"><enum>6050X.</enum><header>Returns
relating to qualified health insurance credit</header>
<subsection id="H7F9FB350D67B4EC7B136E0137EA580B2"><enum>(a)</enum><header>Requirement of
reporting</header><text display-inline="yes-display-inline">Every person who is
entitled to receive payments for any month of any calendar year under section
7527A (relating to advance payment of qualified health insurance credit) with
respect to any individual 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="H9884F668DED24F91A7022F5660141B65"><enum>(b)</enum><header>Form and manner
of returns</header><text>A return is described in this subsection if such
return—</text>
<paragraph id="H8F4DFF4D1DD24B7483831CFCD800CD"><enum>(1)</enum><text>is in such form as
the Secretary may prescribe, and</text>
</paragraph><paragraph id="HECB87C4384E1417DA5AF396278EEC318"><enum>(2)</enum><text>contains, with
respect to each individual referred to in subsection (a)—</text>
<subparagraph id="H5699EB5AA9014AD68E67863846F1502"><enum>(A)</enum><text>the name, address,
and TIN of each such individual,</text>
</subparagraph><subparagraph id="H3751985BC8554336BC168CD0000A4E7"><enum>(B)</enum><text display-inline="yes-display-inline">the months for which amounts payments under
section 7527A were received,</text>
</subparagraph><subparagraph id="HF1046C2D96B64FE39D6D53AAC5189700"><enum>(C)</enum><text>the amount of each
such payment,</text>
</subparagraph><subparagraph id="HB7A51B30765A488099CA1851B4AF69C1"><enum>(D)</enum><text>the type of
insurance coverage provided by such person with respect to such individual and
the policy number associated with such coverage, if applicable,</text>
</subparagraph><subparagraph id="H6C81011FB23747FD8E74BBA48EFBCC"><enum>(E)</enum><text>the name, address,
and TIN of the spouse and each dependent covered under such coverage,
and</text>
</subparagraph><subparagraph id="H54189421CE50431497D7D4916091785"><enum>(F)</enum><text>such other
information as the Secretary may prescribe.</text>
</subparagraph></paragraph></subsection><subsection id="H49A5942F947D47B3AFE0673709A91BB"><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="H9A587C9483304F9DB300A74CB88DB28E"><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="HCEE79A72100E4A729FB852F2F22F5CAE"><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><subsection id="HBE49AEACE3C24E0F919916D33E081E44"><enum>(d)</enum><header>Returns which
would be required To be made by 2 or more persons</header><text>Except to the
extent provided in regulations prescribed by the Secretary, in the case of any
amount received by any person on behalf of another person, only the person
first receiving such amount shall be required to make the return under
subsection
(a).</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H1129CBC7875E4A5B8C85FECC81000038"><enum>(2)</enum><header>Assessable
penalties</header>
<subparagraph id="H07725FAFB67D4CFD8E84F2032131C98"><enum>(A)</enum><text>Subparagraph (B) of
section 6724(d)(1) of such Code 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 inserting after clause (xxiii)
the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H3F614DCF80714615B3BCAE04C5BCD530" style="OLC">
<clause id="H7D8AD845DC67424600DEF208F2E5A4F0"><enum>(xxiv)</enum><text display-inline="yes-display-inline">section 6050X (relating to returns relating
to qualified health insurance credit),
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H7DFDFAB4C55A4683A80059E726F89700"><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 inserting after subparagraph
(FF) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H22053349F832407BBF3B6529747078E2" style="OLC">
<subparagraph id="H4B5A817B76C34721B71330CDE1239E"><enum>(GG)</enum><text display-inline="yes-display-inline">section 6050X (relating to returns relating
to qualified health insurance
credit).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="H08D2FE90556C4CEF93126346B746A086"><enum>(d)</enum><header>Conforming
amendments</header>
<paragraph id="H3FD93D6AAF9B45DE98ACF4B9AAA27666"><enum>(1)</enum><text>Paragraph (2) of
section 1324(b) of title 31, United States Code, is amended by inserting
<quote>36B,</quote> after <quote>36A,</quote>.</text>
</paragraph><paragraph id="H6A456C8BB1A94607BD4FBB26F705F83"><enum>(2)</enum><text display-inline="yes-display-inline">The table of sections for subpart C of part
IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended
by inserting after the item relating to section 36A the following new
item:</text>
<quoted-block id="H518F7C0EA3074A4A8DF1AA963D85BC91" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 36B. Qualified health insurance
credit.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H681A8C6DC20F4E168BD0EAC58C282BE7"><enum>(3)</enum><text>The table of
sections for chapter 77 of such Code is amended by inserting after the item
relating to section 7527 the following new item:</text>
<quoted-block display-inline="no-display-inline" id="HBCCBCC83E5774944AA7FC276E4032798" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec. 7527A. Advance payment of qualified
health insurance
credit.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H36894B2F173440D3B923F109F31E6C41"><enum>(4)</enum><text>The table of
sections for subpart B of part III of subchapter A of chapter 61 of such Code
is amended by adding at the end the following new item:</text>
<quoted-block display-inline="no-display-inline" id="H975735CCFE2D4338BFE6406243FCDC44" style="OLC">
<toc container-level="quoted-block-container" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry level="section">Sec. 6050X. Returns relating to qualified
health insurance
credit.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H0F042D17E0524A519BDA187E2CE634D"><enum>(e)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</subsection></section></subtitle><subtitle id="idC25BEF32F8EA4B4F94164C0D7E204187"><enum>B</enum><header>Improvements to
health savings accounts</header>
<section id="ID81930c7cea454402bbfc78baf748b46d"><enum>111.</enum><header>Purchase of
health insurance from HSA and Archer MSA accounts</header>
<subsection id="ID532eded869b9499a8bca767d92470ad0"><enum>(a)</enum><header>Health savings
accounts</header><text>Paragraph (2) of section 223(d) of the Internal Revenue
Code of 1986 is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="id56537B01A192454587BF7A0740A5B0BA" style="OLC">
<paragraph id="IDdd701a37175f410fa3c0b67e00f9278a"><enum>(2)</enum><header>Qualified
medical expenses</header>
<subparagraph id="ID985137bb759a4141a0a5b64b643ae2f5"><enum>(A)</enum><header>In
general</header><text>The term <term>qualified medical expenses</term> means,
with respect to an account beneficiary, amounts paid by such beneficiary for
medical care (as defined in section 213(d)) for any individual covered by a
high deductible health plan of the account beneficiary, but only to the extent
such amounts are not compensated for by insurance or otherwise.</text>
</subparagraph><subparagraph id="ID6962c733a35647be8c7fb231a4626da6"><enum>(B)</enum><header>Health
insurance may not be purchased from account</header><text>Except as provided in
subparagraph (C), subparagraph (A) shall not apply to any payment for
insurance.</text>
</subparagraph><subparagraph id="IDf3fa0b576cdb425d8b141fdcfae2211b"><enum>(C)</enum><header>Exceptions</header><text>Subparagraph
(B) shall not apply to any expense for coverage under—</text>
<clause id="ID20ca5804913344b08ac1b02ccfc34da8"><enum>(i)</enum><text>a
health plan during any period of continuation coverage required under any
Federal law,</text>
</clause><clause id="idA30C9BC48C0646C89B7822F774F4B0F7"><enum>(ii)</enum><text>a qualified
long-term care insurance contract (as defined in section 7702B(b)),</text>
</clause><clause id="id951F51AA60EA46D9B50991501FAB378C"><enum>(iii)</enum><text>a health plan
during any period in which the individual is receiving unemployment
compensation under any Federal or State law,</text>
</clause><clause id="id9F91BC85F2B84192B45A95D1A2A68850"><enum>(iv)</enum><text>a high
deductible health plan, or</text>
</clause><clause id="ID28867f895ad140408a28adc063eeed45"><enum>(v)</enum><text>any health
insurance under title XVIII of the Social Security Act, other than a Medicare
supplemental policy (as defined in section 1882 of such
Act).</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id82EAF14F9A674E209977E5AD67BE51C4"><enum>(b)</enum><header>Archer
MSAs</header><text>Subparagraph (B) of section 220(d)(2) of the Internal
Revenue Code of 1986 is amended to read as follows:</text>
<quoted-block act-name="" id="id70124564EE7E49E2B3462CEB78D74D7A" style="OLC">
<subparagraph id="idAEAE664CCCFE493F83A59B514F661F83"><enum>(B)</enum><header>Health
insurance may not be purchased from account</header>
<clause id="idC5663379DC2B4539B3F02A65DA083234"><enum>(i)</enum><header>In
general</header><text>Subparagraph (A) shall not apply to any payment for
insurance.</text>
</clause><clause id="id018395F6FD334C0882B0249BA1BB3845"><enum>(ii)</enum><header>Exceptions</header><text>Clause
(i) shall not apply to any expense for coverage under—</text>
<subclause id="idDBF41D8566C8450A9840F30BCDD989C3"><enum>(I)</enum><text>a health plan
during any period of continuation coverage required under any Federal
law,</text>
</subclause><subclause id="idBD9C28EA76664D19BA0E945F74996A47"><enum>(II)</enum><text>a qualified
long-term care insurance contract (as defined in section 7702B(b)),</text>
</subclause><subclause id="id53A8BB05A58544678D9AACD96F29710B"><enum>(III)</enum><text>a health plan
during any period in which the individual is receiving unemployment
compensation under any Federal or State law,</text>
</subclause><subclause id="id20A566D5D058462BB0867FE2692811F6"><enum>(IV)</enum><text>a high
deductible health plan, or</text>
</subclause><subclause id="idF9D9735D58054794A760FFF2AB354A21"><enum>(V)</enum><text>any health
insurance under title XVIII of the Social Security Act, other than a Medicare
supplemental policy (as defined in section 1882 of such
Act).</text>
</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="ID5c43299f781f4f11b87fce50d44e7728"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply with respect
to insurance purchased after the date of the enactment of this Act in taxable
years beginning after such date.</text>
</subsection></section></subtitle><subtitle id="idBA8601BE51214E2F8A2DE0540289FFBB"><enum>C</enum><header>Medical care
access protection</header>
<section id="id0498BA554FB44612A73EC24903ADFE3D"><enum>121.</enum><header>Short
title</header><text display-inline="no-display-inline">This subtitle may be
cited as the <quote><short-title>Medical Care Access
Protection Act of 2009</short-title></quote> or the <quote><short-title>MCAP Act</short-title></quote>.</text>
</section><section id="IDE3173CCF526941E8B14DB790B49036C8"><enum>122.</enum><header>Findings and
purpose</header>
<subsection id="IDB8F039374C1B40E982226376B3ACF6FF"><enum>(a)</enum><header>Findings</header>
<paragraph id="ID263FDE45253B4C08963F28073E65D49F"><enum>(1)</enum><header>Effect on
health care access and costs</header><text>Congress finds that our current
civil justice system is adversely affecting patient access to health care
services, better patient care, and cost-efficient health care, in that the
health care liability system is a costly and ineffective mechanism for
resolving claims of health care liability and compensating injured patients,
and is a deterrent to the sharing of information among health care
professionals which impedes efforts to improve patient safety and quality of
care.</text>
</paragraph><paragraph id="ID5ED89DEB50D1427E83198EECAF5E00D4"><enum>(2)</enum><header>Effect on
interstate commerce</header><text>Congress finds that the health care and
insurance industries are industries affecting interstate commerce and the
health care liability litigation systems existing throughout the United States
are activities that affect interstate commerce by contributing to the high
costs of health care and premiums for health care liability insurance purchased
by health care system providers.</text>
</paragraph><paragraph id="IDA36A20E0B298499493A210209100008B"><enum>(3)</enum><header>Effect on
Federal spending</header><text>Congress finds that the health care liability
litigation systems existing throughout the United States have a significant
effect on the amount, distribution, and use of Federal funds because of—</text>
<subparagraph id="IDF9E3AFA4D5EE457F8D72D3889EA47100"><enum>(A)</enum><text>the large number
of individuals who receive health care benefits under programs operated or
financed by the Federal Government;</text>
</subparagraph><subparagraph id="ID9AE50F9978CF4FF89F001E16752772C0"><enum>(B)</enum><text>the large number
of individuals who benefit because of the exclusion from Federal taxes of the
amounts spent to provide them with health insurance benefits; and</text>
</subparagraph><subparagraph id="ID02F8059996984FCD8523F8703197D240"><enum>(C)</enum><text>the large number
of health care providers who provide items or services for which the Federal
Government makes payments.</text>
</subparagraph></paragraph></subsection><subsection id="ID2FA6190902B340A2B2007CAC5DEEEA85"><enum>(b)</enum><header>Purpose</header><text>It
is the purpose of this subtitle to implement reasonable, comprehensive, and
effective health care liability reforms designed to—</text>
<paragraph id="ID171D0BCDBE424A8FBD8E2887D2A915F8"><enum>(1)</enum><text>improve the
availability of health care services in cases in which health care liability
actions have been shown to be a factor in the decreased availability of
services;</text>
</paragraph><paragraph id="IDB30D8E19D9FA46E09565C3B3FE40E0BC"><enum>(2)</enum><text>reduce the
incidence of <quote>defensive medicine</quote> and lower the cost of health
care liability insurance, all of which contribute to the escalation of health
care costs;</text>
</paragraph><paragraph id="IDF0638CB6FDC94E9298AFC2C67B77C1CB"><enum>(3)</enum><text>ensure that
persons with meritorious health care injury claims receive fair and adequate
compensation, including reasonable noneconomic damages;</text>
</paragraph><paragraph id="IDED8A55F8845640FFB5AA77C05DCE397C"><enum>(4)</enum><text>improve the
fairness and cost-effectiveness of our current health care liability system to
resolve disputes over, and provide compensation for, health care liability by
reducing uncertainty in the amount of compensation provided to injured
individuals; and</text>
</paragraph><paragraph id="IDC6B4220D16564F40A3F23039261F3700"><enum>(5)</enum><text>provide an
increased sharing of information in the health care system which will reduce
unintended injury and improve patient care.</text>
</paragraph></subsection></section><section id="ID27C8C7A90D484E8000D362B393B16400"><enum>123.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle:</text>
<paragraph id="IDC808E49AE65F4246B696704FE8990910"><enum>(1)</enum><header>Alternative
dispute resolution system; ADR</header><text>The term <term>alternative dispute
resolution system</term> or <term>ADR</term> means a system that provides for
the resolution of health care lawsuits in a manner other than through a civil
action brought in a State or Federal court.</text>
</paragraph><paragraph id="IDE404B5EA7B814647BB93BC52DA2FA298"><enum>(2)</enum><header>Claimant</header><text>The
term <term>claimant</term> means any person who brings a health care lawsuit,
including a person who asserts or claims a right to legal or equitable
contribution, indemnity or subrogation, arising out of a health care liability
claim or action, and any person on whose behalf such a claim is asserted or
such an action is brought, whether deceased, incompetent, or a minor.</text>
</paragraph><paragraph id="ID7BC1BC471CB94E4B8BF4DA90185FC015"><enum>(3)</enum><header>Collateral
source benefits</header><text>The term <term>collateral source benefits</term>
means any amount paid or reasonably likely to be paid in the future to or on
behalf of the claimant, or any service, product or other benefit provided or
reasonably likely to be provided in the future to or on behalf of the claimant,
as a result of the injury or wrongful death, pursuant to—</text>
<subparagraph id="IDEFEBA0F5FEF845C6000079E9876810ED"><enum>(A)</enum><text>any State or
Federal health, sickness, income-disability, accident, or workers’ compensation
law;</text>
</subparagraph><subparagraph id="ID6A756DB739B44C01B483CEE9421D2C99"><enum>(B)</enum><text>any health,
sickness, income-disability, or accident insurance that provides health
benefits or income-disability coverage;</text>
</subparagraph><subparagraph id="IDD3220C91037548AAA7DB9465B4042946"><enum>(C)</enum><text>any contract or
agreement of any group, organization, partnership, or corporation to provide,
pay for, or reimburse the cost of medical, hospital, dental, or income
disability benefits; and</text>
</subparagraph><subparagraph id="IDF427C3BFDB5A462E976352AACCB6C0F9"><enum>(D)</enum><text>any other
publicly or privately funded program.</text>
</subparagraph></paragraph><paragraph id="ID0996E20EAD7A4FDC00A893EED0CD90FF"><enum>(4)</enum><header>Compensatory
damages</header><text>The term <term>compensatory damages</term> means
objectively verifiable monetary losses incurred as a result of the provision
of, use of, or payment for (or failure to provide, use, or pay for) health care
services or medical products, such as past and future medical expenses, loss of
past and future earnings, cost of obtaining domestic services, loss of
employment, and loss of business or employment opportunities, damages for
physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature. Such term includes economic damages and noneconomic damages, as
such terms are defined in this section.</text>
</paragraph><paragraph id="ID4AB189ED9B564DF18155B9E86DCF77AA"><enum>(5)</enum><header>Contingent
fee</header><text>The term <term>contingent fee</term> includes all
compensation to any person or persons which is payable only if a recovery is
effected on behalf of one or more claimants.</text>
</paragraph><paragraph id="ID84DFFA8BB07D43C29B057E6C13ADB92D"><enum>(6)</enum><header>Economic
damages</header><text>The term <term>economic damages</term> means objectively
verifiable monetary losses incurred as a result of the provision of, use of, or
payment for (or failure to provide, use, or pay for) health care services or
medical products, such as past and future medical expenses, loss of past and
future earnings, cost of obtaining domestic services, loss of employment, and
loss of business or employment opportunities.</text>
</paragraph><paragraph id="IDB5E4A336FA6F4AB886203C2183FABC3E"><enum>(7)</enum><header>Health care
goods or services</header><text>The term <term>health care goods or
services</term> means any goods or services provided by a health care
institution, provider, or by any individual working under the supervision of a
health care provider, that relates to the diagnosis, prevention, care, or
treatment of any human disease or impairment, or the assessment of the health
of human beings.</text>
</paragraph><paragraph id="ID71293FC36DE244DD80A318342702B19E"><enum>(8)</enum><header>Health care
institution</header><text>The term <term>health care institution</term> means
any entity licensed under Federal or State law to provide health care services
(including but not limited to ambulatory surgical centers, assisted living
facilities, emergency medical services providers, hospices, hospitals and
hospital systems, nursing homes, or other entities licensed to provide such
services).</text>
</paragraph><paragraph id="ID84A1E4863CCC4D90B0A33FB8C9B82551"><enum>(9)</enum><header>Health care
lawsuit</header><text>The term <term>health care lawsuit</term> means any
health care liability claim concerning the provision of health care goods or
services affecting interstate commerce, or any health care liability action
concerning the provision of (or the failure to provide) health care goods or
services affecting interstate commerce, brought in a State or Federal court or
pursuant to an alternative dispute resolution system, against a health care
provider or a health care institution regardless of the theory of liability on
which the claim is based, or the number of claimants, plaintiffs, defendants,
or other parties, or the number of claims or causes of action, in which the
claimant alleges a health care liability claim.</text>
</paragraph><paragraph id="ID89228B4AFF34419FABB17F0008887C87"><enum>(10)</enum><header>Health care
liability action</header><text>The term <term>health care liability
action</term> means a civil action brought in a State or Federal Court or
pursuant to an alternative dispute resolution system, against a health care
provider or a health care institution regardless of the theory of liability on
which the claim is based, or the number of plaintiffs, defendants, or other
parties, or the number of causes of action, in which the claimant alleges a
health care liability claim.</text>
</paragraph><paragraph id="ID5CE677BBEB5D47C4A42D6E2E7E00B2FB"><enum>(11)</enum><header>Health care
liability claim</header><text>The term <term>health care liability claim</term>
means a demand by any person, whether or not pursuant to ADR, against a health
care provider or health care institution, including third-party claims,
cross-claims, counter-claims, or contribution claims, which are based upon the
provision of, use of, or payment for (or the failure to provide, use, or pay
for) health care services, regardless of the theory of liability on which the
claim is based, or the number of plaintiffs, defendants, or other parties, or
the number of causes of action.</text>
</paragraph><paragraph id="IDA2BCA58209EC49F1B15860DBC09BA584"><enum>(12)</enum><header>Health care
provider</header>
<subparagraph id="id926BB6187B064C298EC7F61A2AD14BB8"><enum>(A)</enum><header>In
general</header><text>The term <term>health care provider</term> means any
person (including but not limited to a physician (as defined by section 1861(r)
of the Social Security Act (42 U.S.C. 1395x(r)), registered nurse, dentist,
podiatrist, pharmacist, chiropractor, or optometrist) required by State or
Federal law to be licensed, registered, or certified to provide health care
services, and being either so licensed, registered, or certified, or exempted
from such requirement by other statute or regulation.</text>
</subparagraph><subparagraph id="id33EE54EC519D4AFCA7B9F48C60B167F7"><enum>(B)</enum><header>Treatment of
certain professional associations</header><text>For purposes of this subtitle,
a professional association that is organized under State law by an individual
physician or group of physicians, a partnership or limited liability
partnership formed by a group of physicians, a nonprofit health corporation
certified under State law, or a company formed by a group of physicians under
State law shall be treated as a health care provider under subparagraph
(A).</text>
</subparagraph></paragraph><paragraph id="IDE0A735A2F7FB487CB554BDC459E9E721"><enum>(13)</enum><header>Malicious
intent to injure</header><text>The term <term>malicious intent to injure</term>
means intentionally causing or attempting to cause physical injury other than
providing health care goods or services.</text>
</paragraph><paragraph id="IDB3E6794CD8874E61B3069300FED14794"><enum>(14)</enum><header>Noneconomic
damages</header><text>The term <term>noneconomic damages</term> means damages
for physical and emotional pain, suffering, inconvenience, physical impairment,
mental anguish, disfigurement, loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of domestic service),
hedonic damages, injury to reputation, and all other nonpecuniary losses of any
kind or nature.</text>
</paragraph><paragraph id="ID008193BD17AA40E580CB5456005B8095"><enum>(15)</enum><header>Punitive
damages</header><text>The term <term>punitive damages</term> means damages
awarded, for the purpose of punishment or deterrence, and not solely for
compensatory purposes, against a health care provider or health care
institution. Punitive damages are neither economic nor noneconomic
damages.</text>
</paragraph><paragraph id="ID9A420C24FA2145108BA7304B294CD036"><enum>(16)</enum><header>Recovery</header><text>The
term <term>recovery</term> means the net sum recovered after deducting any
disbursements or costs incurred in connection with prosecution or settlement of
the claim, including all costs paid or advanced by any person. Costs of health
care incurred by the plaintiff and the attorneys’ office overhead costs or
charges for legal services are not deductible disbursements or costs for such
purpose.</text>
</paragraph><paragraph id="ID46ABCF072EF94C17B589AE5B53F29B46"><enum>(17)</enum><header>State</header><text>The
term <term>State</term> means each of the several States, the District of
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American
Samoa, the Northern Mariana Islands, the Trust Territory of the Pacific
Islands, and any other territory or possession of the United States, or any
political subdivision thereof.</text>
</paragraph></section><section id="ID5076125248894FD6A94D987BD3A4E75C"><enum>124.</enum><header>Encouraging
speedy resolution of claims</header>
<subsection id="ID226D95B4DA2342169D34C4632D7F49ED"><enum>(a)</enum><header>In
general</header><text>Except as otherwise provided for in this section, the
time for the commencement of a health care lawsuit shall be 3 years after the
date of manifestation of injury or 1 year after the claimant discovers, or
through the use of reasonable diligence should have discovered, the injury,
whichever occurs first.</text>
</subsection><subsection id="IDB5E5E7ABBE0E458FB8F098C9DA65083F"><enum>(b)</enum><header>General
exception</header><text>The time for the commencement of a health care lawsuit
shall not exceed 3 years after the date of manifestation of injury unless the
tolling of time was delayed as a result of—</text>
<paragraph id="IDC3771A83F3AA4C60AB61DB11BEF498A3"><enum>(1)</enum><text>fraud;</text>
</paragraph><paragraph id="IDE52BCB0F006140559E41038B31E93B4E"><enum>(2)</enum><text>intentional
concealment; or</text>
</paragraph><paragraph id="IDB2FD4420C22747948EEC57CE6D48D644"><enum>(3)</enum><text>the presence of a
foreign body, which has no therapeutic or diagnostic purpose or effect, in the
person of the injured person.</text>
</paragraph></subsection><subsection id="ID0809CDCE6F064F2CB5274DF6E93B00C0"><enum>(c)</enum><header>Minors</header><text>An
action by a minor shall be commenced within 3 years from the date of the
alleged manifestation of injury except that if such minor is under the full age
of 6 years, such action shall be commenced within 3 years of the manifestation
of injury, or prior to the eighth birthday of the minor, whichever provides a
longer period. Such time limitation shall be tolled for minors for any period
during which a parent or guardian and a health care provider or health care
institution have committed fraud or collusion in the failure to bring an action
on behalf of the injured minor.</text>
</subsection><subsection id="id1BA5B1BDB813426FB7889037C6A04230"><enum>(d)</enum><header>Rule 11
sanctions</header><text>Whenever a Federal or State court determines (whether
by motion of the parties or whether on the motion of the court) that there has
been a violation of rule 11 of the Federal Rules of Civil Procedure (or a
similar violation of applicable State court rules) in a health care liability
action to which this subtitle applies, the court shall impose upon the
attorneys, law firms, or pro se litigants that have violated rule 11 or are
responsible for the violation, an appropriate sanction, which shall include an
order to pay the other party or parties for the reasonable expenses incurred as
a direct result of the filing of the pleading, motion, or other paper that is
the subject of the violation, including a reasonable attorneys' fee. Such
sanction shall be sufficient to deter repetition of such conduct or comparable
conduct by others similarly situated, and to compensate the party or parties
injured by such conduct.</text>
</subsection></section><section id="ID4B3AE21E5C63401894B6CD8549D7429D"><enum>125.</enum><header>Compensating
patient injury</header>
<subsection id="ID5C4D895CEED8430D8181348C8F564245"><enum>(a)</enum><header>Unlimited
amount of damages for actual economic losses in health care
lawsuits</header><text>In any health care lawsuit, nothing in this subtitle
shall limit the recovery by a claimant of the full amount of the available
economic damages, notwithstanding the limitation contained in subsection
(b).</text>
</subsection><subsection id="ID37A9D0AAA7414A66BF09C5006D2538D0"><enum>(b)</enum><header>Additional
noneconomic damages</header>
<paragraph id="id5CCCE46C974C4F4BB9587287429DC2F1"><enum>(1)</enum><header>Health care
providers</header><text>In any health care lawsuit where final judgment is
rendered against a health care provider, the amount of noneconomic damages
recovered from the provider, if otherwise available under applicable Federal or
State law, may be as much as $250,000, regardless of the number of parties
other than a health care institution against whom the action is brought or the
number of separate claims or actions brought with respect to the same
occurrence.</text>
</paragraph><paragraph id="idE843C015DC214DA394A5CD19225D52CF"><enum>(2)</enum><header>Health care
institutions</header>
<subparagraph id="id8D32D2A8FF674C39B03B63DDD1208E49"><enum>(A)</enum><header>Single
institution</header><text>In any health care lawsuit where final judgment is
rendered against a single health care institution, the amount of noneconomic
damages recovered from the institution, if otherwise available under applicable
Federal or State law, may be as much as $250,000, regardless of the number of
parties against whom the action is brought or the number of separate claims or
actions brought with respect to the same occurrence.</text>
</subparagraph><subparagraph id="id800CC5C3633248FC9B61F00161D0C864"><enum>(B)</enum><header>Multiple
institutions</header><text>In any health care lawsuit where final judgment is
rendered against more than one health care institution, the amount of
noneconomic damages recovered from each institution, if otherwise available
under applicable Federal or State law, may be as much as $250,000, regardless
of the number of parties against whom the action is brought or the number of
separate claims or actions brought with respect to the same occurrence, except
that the total amount recovered from all such institutions in such lawsuit
shall not exceed $500,000.</text>
</subparagraph></paragraph></subsection><subsection id="IDFBC85C183344400E96FD91EC97E4B8E6"><enum>(c)</enum><header>No discount of
award for noneconomic damages</header><text>In any health care lawsuit—</text>
<paragraph id="IDE7B3B9FBEE124D728F54E6781F637231"><enum>(1)</enum><text>an award for
future noneconomic damages shall not be discounted to present value;</text>
</paragraph><paragraph id="ID9AF9A503FEF44FAFA372567F83B51FDB"><enum>(2)</enum><text>the jury shall
not be informed about the maximum award for noneconomic damages under
subsection (b);</text>
</paragraph><paragraph id="ID16C984C55C0F47D68EDF721D9D8E0574"><enum>(3)</enum><text>an award for
noneconomic damages in excess of the limitations provided for in subsection (b)
shall be reduced either before the entry of judgment, or by amendment of the
judgment after entry of judgment, and such reduction shall be made before
accounting for any other reduction in damages required by law; and</text>
</paragraph><paragraph id="ID99E6DCBF40F44E1696BCA91F73334108"><enum>(4)</enum><text>if separate
awards are rendered for past and future noneconomic damages and the combined
awards exceed the limitations described in subsection (b), the future
noneconomic damages shall be reduced first.</text>
</paragraph></subsection><subsection id="ID51D34B38E99141B8906397C93F520001"><enum>(d)</enum><header>Fair share
rule</header><text>In any health care lawsuit, each party shall be liable for
that party’s several share of any damages only and not for the share of any
other person. Each party shall be liable only for the amount of damages
allocated to such party in direct proportion to such party’s percentage of
responsibility. A separate judgment shall be rendered against each such party
for the amount allocated to such party. For purposes of this section, the trier
of fact shall determine the proportion of responsibility of each party for the
claimant’s harm.</text>
</subsection></section><section id="IDEA06301A666049E9AB9160A003AD517E"><enum>126.</enum><header>Maximizing
patient recovery</header>
<subsection id="ID1C987430706B4140AFC76E68F89446A8"><enum>(a)</enum><header>Court
supervision of share of damages actually paid to claimants</header>
<paragraph id="IDC621C29B130349AC8E25F08CE431A1ED"><enum>(1)</enum><header>In
general</header><text>In any health care lawsuit, the court shall supervise the
arrangements for payment of damages to protect against conflicts of interest
that may have the effect of reducing the amount of damages awarded that are
actually paid to claimants.</text>
</paragraph><paragraph id="ID06482F8EAC584FF783CD081D58C00419"><enum>(2)</enum><header>Contingency
fees</header>
<subparagraph id="ID475929F59A664055A7B639D488D2A356"><enum>(A)</enum><header>In
general</header><text>In any health care lawsuit in which the attorney for a
party claims a financial stake in the outcome by virtue of a contingent fee,
the court shall have the power to restrict the payment of a claimant’s damage
recovery to such attorney, and to redirect such damages to the claimant based
upon the interests of justice and principles of equity.</text>
</subparagraph><subparagraph id="ID5E54F8E911A24163B9ED6B39583B9657"><enum>(B)</enum><header>Limitation</header><text>The
total of all contingent fees for representing all claimants in a health care
lawsuit shall not exceed the following limits:</text>
<clause id="IDD8084C0B29E14F82922DF2197CFBD1B4"><enum>(i)</enum><text>40
percent of the first $50,000 recovered by the claimant(s).</text>
</clause><clause id="ID41970F0025B8448F8612406218E70200"><enum>(ii)</enum><text>33<fraction>1/3</fraction>
percent of the next $50,000 recovered by the claimant(s).</text>
</clause><clause id="IDF350FA26CB10441E91001E6064072907"><enum>(iii)</enum><text>25 percent of
the next $500,000 recovered by the claimant(s).</text>
</clause><clause id="ID064F9D83971647A196A5E31914A4E8A6"><enum>(iv)</enum><text>15
percent of any amount by which the recovery by the claimant(s) is in excess of
$600,000.</text>
</clause></subparagraph></paragraph></subsection><subsection id="ID0E9FB2B895DA4B989C80CD70B822F901"><enum>(b)</enum><header>Applicability</header>
<paragraph id="ID2FDCAF919CE04BB295C0CABA109522F9"><enum>(1)</enum><header>In
general</header><text>The limitations in subsection (a) shall apply whether the
recovery is by judgment, settlement, mediation, arbitration, or any other form
of alternative dispute resolution.</text>
</paragraph><paragraph id="ID0560AEE373AD420EBDB68E93FE373389"><enum>(2)</enum><header>Minors</header><text>In
a health care lawsuit involving a minor or incompetent person, a court retains
the authority to authorize or approve a fee that is less than the maximum
permitted under this section.</text>
</paragraph></subsection><subsection id="ID3B12A925E37A452D00A8B0481C194FEE"><enum>(c)</enum><header>Expert
witnesses</header>
<paragraph id="ID88BA0FE9A1534166B2AEBCD0D63DE514"><enum>(1)</enum><header>Requirement</header><text>No
individual shall be qualified to testify as an expert witness concerning issues
of negligence in any health care lawsuit against a defendant unless such
individual—</text>
<subparagraph id="ID05B7E4211C514CDEA3894532CF67B9D6"><enum>(A)</enum><text>except as
required under paragraph (2), is a health care professional who—</text>
<clause id="ID664D85FD85C549B196C3002B000458D7"><enum>(i)</enum><text>is
appropriately credentialed or licensed in 1 or more States to deliver health
care services; and</text>
</clause><clause id="IDB8FDFC86B28D432FBA5F3900373C95B1"><enum>(ii)</enum><text>typically treats
the diagnosis or condition or provides the type of treatment under review;
and</text>
</clause></subparagraph><subparagraph id="ID59FFE6946F2B49FB9B74636DA1E49984"><enum>(B)</enum><text>can demonstrate
by competent evidence that, as a result of training, education, knowledge, and
experience in the evaluation, diagnosis, and treatment of the disease or injury
which is the subject matter of the lawsuit against the defendant, the
individual was substantially familiar with applicable standards of care and
practice as they relate to the act or omission which is the subject of the
lawsuit on the date of the incident.</text>
</subparagraph></paragraph><paragraph id="ID9AA7E2EBA9314F6100E7D483E57611A5"><enum>(2)</enum><header>Physician
review</header><text>In a health care lawsuit, if the claim of the plaintiff
involved treatment that is recommended or provided by a physician (allopathic
or osteopathic), an individual shall not be qualified to be an expert witness
under this subsection with respect to issues of negligence concerning such
treatment unless such individual is a physician.</text>
</paragraph><paragraph id="ID35107ECC77604E988F5FFA7D69D52D54"><enum>(3)</enum><header>Specialties and
subspecialties</header><text>With respect to a lawsuit described in paragraph
(1), a court shall not permit an expert in one medical specialty or
subspecialty to testify against a defendant in another medical specialty or
subspecialty unless, in addition to a showing of substantial familiarity in
accordance with paragraph (1)(B), there is a showing that the standards of care
and practice in the two specialty or subspecialty fields are similar.</text>
</paragraph><paragraph id="IDB639EB0717AF4E6F8464C2481C4D23E6"><enum>(4)</enum><header>Limitation</header><text>The
limitations in this subsection shall not apply to expert witnesses testifying
as to the degree or permanency of medical or physical impairment.</text>
</paragraph></subsection></section><section id="IDDC7E1D8CA71A4350AEB0CBA9E813634F"><enum>127.</enum><header>Additional
health benefits</header>
<subsection id="IDA2D1A64420F84672BB2CAB93CA7000C0"><enum>(a)</enum><header>In
general</header><text>The amount of any damages received by a claimant in any
health care lawsuit shall be reduced by the court by the amount of any
collateral source benefits to which the claimant is entitled, less any
insurance premiums or other payments made by the claimant (or by the spouse,
parent, child, or legal guardian of the claimant) to obtain or secure such
benefits.</text>
</subsection><subsection id="ID8C93C320A9954A1C904800A8BBE2DE64"><enum>(b)</enum><header>Preservation of
current law</header><text>Where a payor of collateral source benefits has a
right of recovery by reimbursement or subrogation and such right is permitted
under Federal or State law, subsection (a) shall not apply.</text>
</subsection><subsection id="ID60B2D15B8DD64BFF9E3787E3C2CE7CC8"><enum>(c)</enum><header>Application of
provision</header><text>This section shall apply to any health care lawsuit
that is settled or resolved by a fact finder.</text>
</subsection></section><section id="ID3A76354DA69C4C1187356781002B33DF"><enum>128.</enum><header>Punitive
damages</header>
<subsection id="ID9517867D2BB44ED8A4B44D4607D1008B"><enum>(a)</enum><header>Punitive
damages permitted</header>
<paragraph id="ID62E9439F946B4DE791ED2661646E6F61"><enum>(1)</enum><header>In
general</header><text>Punitive damages may, if otherwise available under
applicable State or Federal law, be awarded against any person in a health care
lawsuit only if it is proven by clear and convincing evidence that such person
acted with malicious intent to injure the claimant, or that such person
deliberately failed to avoid unnecessary injury that such person knew the
claimant was substantially certain to suffer.</text>
</paragraph><paragraph id="IDE78D89E491CE4C7084FDCB7296DF45F8"><enum>(2)</enum><header>Filing of
lawsuit</header><text>No demand for punitive damages shall be included in a
health care lawsuit as initially filed. A court may allow a claimant to file an
amended pleading for punitive damages only upon a motion by the claimant and
after a finding by the court, upon review of supporting and opposing affidavits
or after a hearing, after weighing the evidence, that the claimant has
established by a substantial probability that the claimant will prevail on the
claim for punitive damages.</text>
</paragraph><paragraph id="IDD9BE16E239984E08BB043E3CE9F25399"><enum>(3)</enum><header>Separate
proceeding</header><text>At the request of any party in a health care lawsuit,
the trier of fact shall consider in a separate proceeding—</text>
<subparagraph id="ID69B93B42572641CEBF54EB53542B88B9"><enum>(A)</enum><text>whether punitive
damages are to be awarded and the amount of such award; and</text>
</subparagraph><subparagraph id="ID1C2232A52FAE4F358E8B254C331F23CF"><enum>(B)</enum><text>the amount of
punitive damages following a determination of punitive liability.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">If a
separate proceeding is requested, evidence relevant only to the claim for
punitive damages, as determined by applicable State law, shall be inadmissible
in any proceeding to determine whether compensatory damages are to be
awarded.</continuation-text></paragraph><paragraph id="ID2DD43DA402B04DFCA099DE5392ADE4C0"><enum>(4)</enum><header>Limitation
where no compensatory damages are awarded</header><text>In any health care
lawsuit where no judgment for compensatory damages is rendered against a
person, no punitive damages may be awarded with respect to the claim in such
lawsuit against such person.</text>
</paragraph></subsection><subsection id="ID488BB463043F4B8E883EEB1BF372514C"><enum>(b)</enum><header>Determining
amount of punitive damages</header>
<paragraph id="ID5895EBE5D3194492B669F581B3B508DC"><enum>(1)</enum><header>Factors
considered</header><text>In determining the amount of punitive damages under
this section, the trier of fact shall consider only the following:</text>
<subparagraph id="IDABE5EFC84A324DA2AA621C2333F4397B"><enum>(A)</enum><text>the severity of
the harm caused by the conduct of such party;</text>
</subparagraph><subparagraph id="IDFA2B37164DC64E2B9314A19F3D995E6F"><enum>(B)</enum><text>the duration of
the conduct or any concealment of it by such party;</text>
</subparagraph><subparagraph id="ID7EE19261A1E54613A0C433D5714E9052"><enum>(C)</enum><text>the profitability
of the conduct to such party;</text>
</subparagraph><subparagraph id="ID432218A267C8425687D34BC561F64BF7"><enum>(D)</enum><text>the number of
products sold or medical procedures rendered for compensation, as the case may
be, by such party, of the kind causing the harm complained of by the
claimant;</text>
</subparagraph><subparagraph id="ID893BE235960845139F86669095F6EA12"><enum>(E)</enum><text>any criminal
penalties imposed on such party, as a result of the conduct complained of by
the claimant; and</text>
</subparagraph><subparagraph id="IDB9A11D10747847F6989500959B1D7427"><enum>(F)</enum><text>the amount of any
civil fines assessed against such party as a result of the conduct complained
of by the claimant.</text>
</subparagraph></paragraph><paragraph id="ID744CC8EDE1574FA5800307ACC56BA1B7"><enum>(2)</enum><header>Maximum
award</header><text>The amount of punitive damages awarded in a health care
lawsuit may not exceed an amount equal to two times the amount of economic
damages awarded in the lawsuit or $250,000, whichever is greater. The jury
shall not be informed of the limitation under the preceding sentence.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID9C0E86F37D7A4409B1514724C14DDDDD"><enum>(c)</enum><header>Liability of
health care providers</header>
<paragraph commented="no" display-inline="no-display-inline" id="idC737821F74D54CF68144CA162D9D80D5"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">A health care
provider who prescribes, or who dispenses pursuant to a prescription, a drug,
biological product, or medical device approved by the Food and Drug
Administration, for an approved indication of the drug, biological product, or
medical device, shall not be named as a party to a product liability lawsuit
invoking such drug, biological product, or medical device and shall not be
liable to a claimant in a class action lawsuit against the manufacturer,
distributor, or product seller of such drug, biological product, or medical
device.</text>
</paragraph><paragraph id="IDFE70F1EFC69C4BFAADD55EB76B5E3C7C"><enum>(2)</enum><header>Medical
product</header><text>The term <term>medical product</term> means a drug or
device intended for humans. The terms <term>drug</term> and <term>device</term>
have the meanings given such terms in sections 201(g)(1) and 201(h) of the
Federal Food, Drug and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/321">21 U.S.C. 321</external-xref>), respectively,
including any component or raw material used therein, but excluding health care
services.</text>
</paragraph></subsection></section><section id="ID5D208E4A816D4C3BAE79B605D177F206"><enum>129.</enum><header>Authorization
of payment of future damages to claimants in health care lawsuits</header>
<subsection id="ID351F5B4B8D22426886D7496BA03EDEB8"><enum>(a)</enum><header>In
general</header><text>In any health care lawsuit, if an award of future
damages, without reduction to present value, equaling or exceeding $50,000 is
made against a party with sufficient insurance or other assets to fund a
periodic payment of such a judgment, the court shall, at the request of any
party, enter a judgment ordering that the future damages be paid by periodic
payments in accordance with the Uniform Periodic Payment of Judgments Act
promulgated by the National Conference of Commissioners on Uniform State
Laws.</text>
</subsection><subsection id="IDC27FEB2AC6A94FF99C19343F699DD83E"><enum>(b)</enum><header>Applicability</header><text>This
section applies to all actions which have not been first set for trial or
retrial before the effective date of this subtitle.</text>
</subsection></section><section id="IDCD894FC2BBF54A22B79D9C19F5283ED6"><enum>130.</enum><header>Effect on
other laws</header>
<subsection id="IDB95782A750E0467E8B06229D27A1EF64"><enum>(a)</enum><header>General vaccine
injury</header>
<paragraph id="IDA98214C44ED84EE7A62CBC015CAEDBA5"><enum>(1)</enum><header>In
general</header><text>To the extent that title XXI of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> establishes
a Federal rule of law applicable to a civil action brought for a
vaccine-related injury or death—</text>
<subparagraph id="IDA4D009995F354A939159A7C9DB82C199"><enum>(A)</enum><text>this subtitle
shall not affect the application of the rule of law to such an action;
and</text>
</subparagraph><subparagraph id="IDBC1D1F29C7544330884366969ECA1E2F"><enum>(B)</enum><text>any rule of law
prescribed by this subtitle in conflict with a rule of law of such title XXI
shall not apply to such action.</text>
</subparagraph></paragraph><paragraph id="IDCBB0D5E9B56B4EA49BD0A64FD496F2F0"><enum>(2)</enum><header>Exception</header><text>If
there is an aspect of a civil action brought for a vaccine-related injury or
death to which a Federal rule of law under title XXI of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> does not
apply, then this subtitle or otherwise applicable law (as determined under this
subtitle) will apply to such aspect of such action.</text>
</paragraph></subsection><subsection id="ID6479806911144C669A011171995231E0"><enum>(b)</enum><header>Smallpox
vaccine injury</header>
<paragraph id="IDD4D950C25B5F42BEB2C62AEF95CE4AB9"><enum>(1)</enum><header>In
general</header><text>To the extent that part C of title II of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> establishes
a Federal rule of law applicable to a civil action brought for a smallpox
vaccine-related injury or death—</text>
<subparagraph id="IDAAA6B15C7BF34169BD58EFDEA05646D5"><enum>(A)</enum><text>this subtitle
shall not affect the application of the rule of law to such an action;
and</text>
</subparagraph><subparagraph id="IDFD1228E7B6FB423AB24C8740D4A29822"><enum>(B)</enum><text>any rule of law
prescribed by this subtitle in conflict with a rule of law of such part C shall
not apply to such action.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDDD3C82EF3D034FB1A959BEA417705CA1"><enum>(2)</enum><header>Exception</header><text>If
there is an aspect of a civil action brought for a smallpox vaccine-related
injury or death to which a Federal rule of law under part C of title II of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> does not
apply, then this subtitle or otherwise applicable law (as determined under this
subtitle) will apply to such aspect of such action.</text>
</paragraph></subsection><subsection id="ID21AC62A4DC7D468884F71B92B5E9E5A4"><enum>(c)</enum><header>Other Federal
law</header><text>Except as provided in this section, nothing in this subtitle
shall be deemed to affect any defense available, or any limitation on liability
that applies to, a defendant in a health care lawsuit or action under any other
provision of Federal law.</text>
</subsection></section><section id="ID225A415FBC3F40B28F65D8EF24D461E2"><enum>131.</enum><header>State
flexibility and protection of states’ rights</header>
<subsection id="IDFE8D772B35964112897E274948193852"><enum>(a)</enum><header>Health care
lawsuits</header><text>The provisions governing health care lawsuits set forth
in this subtitle shall preempt, subject to subsections (b) and (c), State law
to the extent that State law prevents the application of any provisions of law
established by or under this subtitle. The provisions governing health care
lawsuits set forth in this subtitle supersede chapter 171 of title 28, United
States Code, to the extent that such chapter—</text>
<paragraph id="IDB2F711F9DFBD4056A035265DBF1EAEB9"><enum>(1)</enum><text>provides for a
greater amount of damages or contingent fees, a longer period in which a health
care lawsuit may be commenced, or a reduced applicability or scope of periodic
payment of future damages, than provided in this subtitle; or</text>
</paragraph><paragraph id="IDB3A843AA6D3248469062F19E80F07990"><enum>(2)</enum><text>prohibits the
introduction of evidence regarding collateral source benefits.</text>
</paragraph></subsection><subsection id="ID9FD46538A8DC40B893BC4CCDA1FFC97F"><enum>(b)</enum><header>Preemption of
certain State laws</header><text>No provision of this subtitle shall be
construed to preempt any State law (whether effective before, on, or after the
date of the enactment of this subtitle) that specifies a particular monetary
amount of compensatory or punitive damages (or the total amount of damages)
that may be awarded in a health care lawsuit, regardless of whether such
monetary amount is greater or lesser than is provided for under this subtitle,
notwithstanding section 125(a).</text>
</subsection><subsection id="ID7679463446FA4E62A038B7C469FE4FAF"><enum>(c)</enum><header>Protection of
states’ rights and other laws</header>
<paragraph id="ID4A9168992AD546D4A89C13A3CB5044B6"><enum>(1)</enum><header>In
general</header><text>Any issue that is not governed by a provision of law
established by or under this subtitle (including the State standards of
negligence) shall be governed by otherwise applicable Federal or State
law.</text>
</paragraph><paragraph id="ID3511F33F9B1840A3B9D1886F3DB395AB"><enum>(2)</enum><header>Rule of
construction</header><text>Nothing in this subtitle shall be construed
to—</text>
<subparagraph id="ID843C2F9503A2459FB80060A05DBCD584"><enum>(A)</enum><text>preempt or
supersede any Federal or State law that imposes greater procedural or
substantive protections (such as a shorter statute of limitations) for a health
care provider or health care institution from liability, loss, or damages than
those provided by this subtitle;</text>
</subparagraph><subparagraph id="idF9035E12E7E3421AA9C4B885BD722F4D"><enum>(B)</enum><text>preempt or
supercede any State law that permits and provides for the enforcement of any
arbitration agreement related to a health care liability claim whether enacted
prior to or after the date of enactment of this subtitle;</text>
</subparagraph><subparagraph id="IDBBB9890B263F4E13834102C3A0E210B2"><enum>(C)</enum><text>create a cause of
action that is not otherwise available under Federal or State law; or</text>
</subparagraph><subparagraph id="IDDBBF8A6C3DF44D319D4E4CF7D0AB345C"><enum>(D)</enum><text>affect the scope
of preemption of any other Federal law.</text>
</subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID2CA4306A5A8A4937AC73FF94DAEA618C" section-type="subsequent-section"><enum>132.</enum><header>Applicability;
effective date</header><text display-inline="no-display-inline">This subtitle
shall apply to any health care lawsuit brought in a Federal or State court, or
subject to an alternative dispute resolution system, that is initiated on or
after the date of the enactment of this subtitle, except that any health care
lawsuit arising from an injury occurring prior to the date of enactment of this
subtitle shall be governed by the applicable statute of limitations provisions
in effect at the time the injury occurred.</text>
</section></subtitle><enum>II</enum><header>Enhancement of
insurance markets for all Americans</header>
<subtitle id="idD48D70C5E7E84499A2AFBD4A9E457F1A"><enum>A</enum><header>Elimination of
barriers</header>
<section id="idDFDC593F67DE423CBA9975A527E636BB"><enum>201.</enum><header>Short
title</header><text display-inline="no-display-inline">This title may be cited
as <quote><short-title>Health Care Choice Act of
2009</short-title></quote>.</text>
</section><section id="IDA19287FD768E4AD6900F08D7E20C5C9A"><enum>202.</enum><header>Specification
of constitutional authority for enactment of law</header><text display-inline="no-display-inline">This title is enacted pursuant to the power
granted Congress under article I, section 8, clause 3, of the United States
Constitution.</text>
</section><section id="IDAEBD4EAC67F34FA2BCED998B3C118FC3"><enum>203.</enum><header>Findings</header><text display-inline="no-display-inline">Congress finds the following:</text>
<paragraph id="ID4C98DD76087242F196E49E2122684057"><enum>(1)</enum><text>The application
of numerous and significant variations in State law impacts the ability of
insurers to offer, and individuals to obtain, affordable individual health
insurance coverage, thereby impeding commerce in individual health insurance
coverage.</text>
</paragraph><paragraph id="IDEC7A8A63970A4234B1BCD93DD0F990E0"><enum>(2)</enum><text>Individual health
insurance coverage is increasingly offered through the Internet, other
electronic means, and by mail, all of which are inherently part of interstate
commerce.</text>
</paragraph><paragraph id="IDD318D1A4C1FD41D5B73D45BC2CB99630"><enum>(3)</enum><text>In response to
these issues, it is appropriate to encourage increased efficiency in the
offering of individual health insurance coverage through a collaborative
approach by the States in regulating this coverage.</text>
</paragraph><paragraph id="ID63749C0C1760460C99BA9F3102B8A049"><enum>(4)</enum><text>The establishment
of risk-retention groups has provided a successful model for the sale of
insurance across State lines, as the acts establishing those groups allow
insurance to be sold in multiple States but regulated by a single State.</text>
</paragraph></section><section id="IDB2691E7DAFA5456C82794166B870C1AE"><enum>204.</enum><header>Cooperative
governing of individual health insurance coverage</header>
<subsection id="ID90009E4D020E49BFB4AB1B8A5591E016"><enum>(a)</enum><header>In
general</header><text>Title XXVII of the <act-name parsable-cite="PHSA">Public
Health Service Act</act-name> (42 U.S.C. 300gg et seq.) is amended by adding at
the end the following new part:</text>
<quoted-block display-inline="no-display-inline" id="IDD002A3F5F7BC48628A9321FA0F71A7F1" style="OLC">
<part id="IDC6B334152C6B42B4A6E40ECE4805E487"><enum>D</enum><header>Cooperative
governing of individual health insurance coverage</header>
<section id="ID3C9BE6E05766491DAF4A429BC6EF08D8"><enum>2795.</enum><header>Definitions</header><text display-inline="no-display-inline">In this part:</text>
<paragraph id="IDB467A15B099A4E16BFB65DA89A8C4B94"><enum>(1)</enum><header>Primary
state</header><text>The term <term>primary State</term> means, with respect to
individual health insurance coverage offered by a health insurance issuer, the
State designated by the issuer as the State whose covered laws shall govern the
health insurance issuer in the sale of such coverage under this part. An
issuer, with respect to a particular policy, may only designate one such State
as its primary State with respect to all such coverage it offers. Such an
issuer may not change the designated primary State with respect to individual
health insurance coverage once the policy is issued, except that such a change
may be made upon renewal of the policy. With respect to such designated State,
the issuer is deemed to be doing business in that State.</text>
</paragraph><paragraph id="ID99653C461B564E8985750C050D5C849B"><enum>(2)</enum><header>Secondary
state</header><text>The term <term>secondary State</term> means, with respect
to individual health insurance coverage offered by a health insurance issuer,
any State that is not the primary State. In the case of a health insurance
issuer that is selling a policy in, or to a resident of, a secondary State, the
issuer is deemed to be doing business in that secondary State.</text>
</paragraph><paragraph id="IDA9305C3004E244B5868EB0F13310446C"><enum>(3)</enum><header>Health
insurance issuer</header><text>The term <term>health insurance issuer</term>
has the meaning given such term in section 2791(b)(2), except that such an
issuer must be licensed in the primary State and be qualified to sell
individual health insurance coverage in that State.</text>
</paragraph><paragraph id="IDFD5E5122CF8947D6AD70C00B7D22C58C"><enum>(4)</enum><header>Individual
health insurance coverage</header><text>The term <term>individual health
insurance coverage</term> means health insurance coverage offered in the
individual market, as defined in section 2791(e)(1).</text>
</paragraph><paragraph id="ID06661BB7E3D74EDB8F8F0C34447D974E"><enum>(5)</enum><header>Applicable
state authority</header><text>The term <term>applicable State authority</term>
means, with respect to a health insurance issuer in a State, the State
insurance commissioner or official or officials designated by the State to
enforce the requirements of this title for the State with respect to the
issuer.</text>
</paragraph><paragraph id="ID093C03104053467F9B1EED9DCEE74A2A"><enum>(6)</enum><header>Hazardous
financial condition</header><text>The term <term>hazardous financial
condition</term> means that, based on its present or reasonably anticipated
financial condition, a health insurance issuer is unlikely to be able—</text>
<subparagraph id="ID9D6BD7AF1524438CAA002121D31FEF9E"><enum>(A)</enum><text>to meet
obligations to policyholders with respect to known claims and reasonably
anticipated claims; or</text>
</subparagraph><subparagraph id="IDA52FB6D3C8724D659609218A43339C0B"><enum>(B)</enum><text>to pay other
obligations in the normal course of business.</text>
</subparagraph></paragraph><paragraph id="ID9BB08C1AD9894B50B19BE8184F5268AD"><enum>(7)</enum><header>Covered
laws</header>
<subparagraph id="ID69C0BADF46144F97AFC6E81DC6CE51C9"><enum>(A)</enum><header>In
general</header><text>The term <term>covered laws</term> means the laws, rules,
regulations, agreements, and orders governing the insurance business pertaining
to—</text>
<clause id="ID886FA38438134716ACB79665C822402D"><enum>(i)</enum><text>individual health
insurance coverage issued by a health insurance issuer;</text>
</clause><clause id="ID218A504EDF324E67AD1D531C96D1A5AC"><enum>(ii)</enum><text>the offer, sale,
rating (including medical underwriting), renewal, and issuance of individual
health insurance coverage to an individual;</text>
</clause><clause id="ID24FAD0F93D7E42B982A98A6F65D8EB18"><enum>(iii)</enum><text>the provision
to an individual in relation to individual health insurance coverage of health
care and insurance related services;</text>
</clause><clause id="IDD4A5C70C897C41AFB4C45F068ED5C00D"><enum>(iv)</enum><text>the provision to
an individual in relation to individual health insurance coverage of
management, operations, and investment activities of a health insurance issuer;
and</text>
</clause><clause id="IDA9D367927CC64BD9AB15FD8719BE2003"><enum>(v)</enum><text>the provision to
an individual in relation to individual health insurance coverage of loss
control and claims administration for a health insurance issuer with respect to
liability for which the issuer provides insurance.</text>
</clause></subparagraph><subparagraph id="ID22E051258AF247439BD97786B196B636"><enum>(B)</enum><header>Exception</header><text>Such
term does not include any law, rule, regulation, agreement, or order governing
the use of care or cost management techniques, including any requirement
related to provider contracting, network access or adequacy, health care data
collection, or quality assurance.</text>
</subparagraph></paragraph><paragraph id="ID344AF1B3C79E46BB918A4C60245124A3"><enum>(8)</enum><header>State</header><text>The
term <term>State</term> means the 50 States and includes the District of
Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the
Northern Mariana Islands.</text>
</paragraph><paragraph id="IDD72FCAD342FA448E99EFAAD123C6DDD9"><enum>(9)</enum><header>Unfair claims
settlement practices</header><text>The term <term>unfair claims settlement
practices</term> means only the following practices:</text>
<subparagraph id="IDDC74DA4056B848408E84E43CDF250517"><enum>(A)</enum><text>Knowingly
misrepresenting to claimants and insured individuals relevant facts or policy
provisions relating to coverage at issue.</text>
</subparagraph><subparagraph id="IDE752AAB6A1A6479E82417B4B2205ED84"><enum>(B)</enum><text>Failing to
acknowledge with reasonable promptness pertinent communications with respect to
claims arising under policies.</text>
</subparagraph><subparagraph id="IDC2559A849AFA4077831C564943289074"><enum>(C)</enum><text>Failing to adopt
and implement reasonable standards for the prompt investigation and settlement
of claims arising under policies.</text>
</subparagraph><subparagraph id="ID0C1E9F47F99E462A8B727341A6882B3F"><enum>(D)</enum><text>Failing to
effectuate prompt, fair, and equitable settlement of claims submitted in which
liability has become reasonably clear.</text>
</subparagraph><subparagraph id="ID0127C7D700A9490297171F54598B7887"><enum>(E)</enum><text>Refusing to pay
claims without conducting a reasonable investigation.</text>
</subparagraph><subparagraph id="ID410FB1A287A74E6EB63BFA0B1DC41467"><enum>(F)</enum><text>Failing to affirm
or deny coverage of claims within a reasonable period of time after having
completed an investigation related to those claims.</text>
</subparagraph><subparagraph id="IDF0C3203E31694028B9FC12DDFBF4D9F0"><enum>(G)</enum><text>A pattern or
practice of compelling insured individuals or their beneficiaries to institute
suits to recover amounts due under its policies by offering substantially less
than the amounts ultimately recovered in suits brought by them.</text>
</subparagraph><subparagraph id="IDE0E65E9553984670A6A6D1748266FC71"><enum>(H)</enum><text>A pattern or
practice of attempting to settle or settling claims for less than the amount
that a reasonable person would believe the insured individual or his or her
beneficiary was entitled by reference to written or printed advertising
material accompanying or made part of an application.</text>
</subparagraph><subparagraph id="ID56FA390802AB42FBA4014526052013EF"><enum>(I)</enum><text>Attempting to
settle or settling claims on the basis of an application that was materially
altered without notice to, or knowledge or consent of, the insured.</text>
</subparagraph><subparagraph id="ID9B12298A83374140ACF51B678BD84D56"><enum>(J)</enum><text>Failing to
provide forms necessary to present claims within 15 calendar days of a requests
with reasonable explanations regarding their use.</text>
</subparagraph><subparagraph id="ID1BCFD81430E3404885060D24F16710F9"><enum>(K)</enum><text>Attempting to
cancel a policy in less time than that prescribed in the policy or by the law
of the primary State.</text>
</subparagraph></paragraph><paragraph id="IDFD1D170214B547D79CB5A34F0F919475"><enum>(10)</enum><header>Fraud and
abuse</header><text>The term <term>fraud and abuse</term> means an act or
omission committed by a person who, knowingly and with intent to defraud,
commits, or conceals any material information concerning, one or more of the
following:</text>
<subparagraph id="IDA758B331783343919A5C66D37F35E35F"><enum>(A)</enum><text>Presenting,
causing to be presented or preparing with knowledge or belief that it will be
presented to or by an insurer, a reinsurer, broker or its agent, false
information as part of, in support of or concerning a fact material to one or
more of the following:</text>
<clause id="ID06BB09C4C0B84EA39C89F066C306A329"><enum>(i)</enum><text>An application
for the issuance or renewal of an insurance policy or reinsurance
contract.</text>
</clause><clause id="ID98772A9E3BFB405EA9EEB0B3DF96B5B2"><enum>(ii)</enum><text>The rating of an
insurance policy or reinsurance contract.</text>
</clause><clause id="ID42D2E84814214A28A378B18FC8433FE7"><enum>(iii)</enum><text>A claim for
payment or benefit pursuant to an insurance policy or reinsurance
contract.</text>
</clause><clause id="ID40ADA93BF38D454A849E658C68CDDFD2"><enum>(iv)</enum><text>Premiums paid on
an insurance policy or reinsurance contract.</text>
</clause><clause id="ID77CF590261664828863263B004B05792"><enum>(v)</enum><text>Payments made in
accordance with the terms of an insurance policy or reinsurance
contract.</text>
</clause><clause id="ID9C679914969A4200960BBF99DB6F0AC6"><enum>(vi)</enum><text>A document filed
with the commissioner or the chief insurance regulatory official of another
jurisdiction.</text>
</clause><clause id="ID61EEF1A16DE44DA1A275F9E035693E73"><enum>(vii)</enum><text>The financial
condition of an insurer or reinsurer.</text>
</clause><clause id="ID52C396CBBB3B4389B42F40202AC66FF2"><enum>(viii)</enum><text>The formation,
acquisition, merger, reconsolidation, dissolution or withdrawal from one or
more lines of insurance or reinsurance in all or part of a State by an insurer
or reinsurer.</text>
</clause><clause id="ID461C3EED9C6943779785C7F019DD1706"><enum>(ix)</enum><text>The issuance of
written evidence of insurance.</text>
</clause><clause id="IDA90331AFB56C47589BE0C75C0BE220D9"><enum>(x)</enum><text>The reinstatement
of an insurance policy.</text>
</clause></subparagraph><subparagraph id="ID8478F8395EC3464898885A460D66AA6B"><enum>(B)</enum><text>Solicitation or
acceptance of new or renewal insurance risks on behalf of an insurer reinsurer
or other person engaged in the business of insurance by a person who knows or
should know that the insurer or other person responsible for the risk is
insolvent at the time of the transaction.</text>
</subparagraph><subparagraph id="ID4F4E7B3E3E484EFBA55381E96FCEB0F8"><enum>(C)</enum><text>Transaction of
the business of insurance in violation of laws requiring a license, certificate
of authority, or other legal authority for the transaction of the business of
insurance.</text>
</subparagraph><subparagraph id="ID55DB7798BA744CB9BC058F7E5BD15C02"><enum>(D)</enum><text>Attempt to
commit, aiding or abetting in the commission of, or conspiracy to commit the
acts or omissions specified in this paragraph.</text>
</subparagraph></paragraph></section><section id="ID266F6250E9B148F990D86730A934B6C7"><enum>2796.</enum><header>Application
of law</header>
<subsection id="ID8E60C95E039449F4AEA92BAD1F417D2B"><enum>(a)</enum><header>In
general</header><text>The covered laws of the primary State shall apply to
individual health insurance coverage offered by a health insurance issuer in
the primary State and in any secondary State, but only if the coverage and
issuer comply with the conditions of this section with respect to the offering
of coverage in any secondary State.</text>
</subsection><subsection id="ID52EB1E4BE38D49A699A43647D41B9B99"><enum>(b)</enum><header>Exemptions from
covered laws in a secondary state</header><text>Except as provided in this
section, a health insurance issuer with respect to its offer, sale, rating
(including medical underwriting), renewal, and issuance of individual health
insurance coverage in any secondary State is exempt from any covered laws of
the secondary State (and any rules, regulations, agreements, or orders sought
or issued by such State under or related to such covered laws) to the extent
that such laws would—</text>
<paragraph id="ID0363A7437EAA4C49B3EA6553C4592A2F"><enum>(1)</enum><text>make unlawful, or
regulate, directly or indirectly, the operation of the health insurance issuer
operating in the secondary State, except that any secondary State may require
such an issuer—</text>
<subparagraph id="ID5C3310145506400C9A602DC947AE589C"><enum>(A)</enum><text>to pay, on a
nondiscriminatory basis, applicable premium and other taxes (including high
risk pool assessments) which are levied on insurers and surplus lines insurers,
brokers, or policyholders under the laws of the State;</text>
</subparagraph><subparagraph id="IDAA04AE22C10643B788B5F4BD995464D9"><enum>(B)</enum><text>to register with
and designate the State insurance commissioner as its agent solely for the
purpose of receiving service of legal documents or process;</text>
</subparagraph><subparagraph id="ID34BED7A712BA48BF90049AC4B9411522"><enum>(C)</enum><text>to submit to an
examination of its financial condition by the State insurance commissioner in
any State in which the issuer is doing business to determine the issuer's
financial condition, if—</text>
<clause id="ID3A32AB5301474882AC0F6256D2AA4A45"><enum>(i)</enum><text>the State
insurance commissioner of the primary State has not done an examination within
the period recommended by the National Association of Insurance Commissioners;
and</text>
</clause><clause id="IDCEF750CE581943F0BDCBB7972B3FE700"><enum>(ii)</enum><text>any such
examination is conducted in accordance with the examiners' handbook of the
National Association of Insurance Commissioners and is coordinated to avoid
unjustified duplication and unjustified repetition;</text>
</clause></subparagraph><subparagraph id="IDDD4599F85D1F4FCA8AE0CA16D17F4448"><enum>(D)</enum><text>to comply with a
lawful order issued—</text>
<clause id="ID9BFB883705DF4C00BF64A9911BCE6DB2"><enum>(i)</enum><text>in a delinquency
proceeding commenced by the State insurance commissioner if there has been a
finding of financial impairment under subparagraph (C); or</text>
</clause><clause id="ID116DAEA2FB3C4680843D0792D261E3C7"><enum>(ii)</enum><text>in a voluntary
dissolution proceeding;</text>
</clause></subparagraph><subparagraph id="ID3BD913AE3A7F4162A4BCD1033F334D31"><enum>(E)</enum><text>to comply with an
injunction issued by a court of competent jurisdiction, upon a petition by the
State insurance commissioner alleging that the issuer is in hazardous financial
condition;</text>
</subparagraph><subparagraph id="IDC6C51467B8454857A7573C7127E57AE1"><enum>(F)</enum><text>to participate,
on a nondiscriminatory basis, in any insurance insolvency guaranty association
or similar association to which a health insurance issuer in the State is
required to belong;</text>
</subparagraph><subparagraph id="ID96EB634418834323B146E6B6F7E601AF"><enum>(G)</enum><text>to comply with
any State law regarding fraud and abuse (as defined in section 2795(10)),
except that if the State seeks an injunction regarding the conduct described in
this subparagraph, such injunction must be obtained from a court of competent
jurisdiction;</text>
</subparagraph><subparagraph id="ID78941217CD6548D5800268758BEBF0C4"><enum>(H)</enum><text>to comply with
any State law regarding unfair claims settlement practices (as defined in
section 2795(9)); or</text>
</subparagraph><subparagraph id="ID2B24B50379EA4EA7B0978C33A5CA62E4"><enum>(I)</enum><text>to comply with
the applicable requirements for independent review under section 2798 with
respect to coverage offered in the State;</text>
</subparagraph></paragraph><paragraph id="IDFFD923CD80604B0A9B5C9385CD56A7DC"><enum>(2)</enum><text>require any
individual health insurance coverage issued by the issuer to be countersigned
by an insurance agent or broker residing in that Secondary State; or</text>
</paragraph><paragraph id="ID3A33AB67B9F949AD80361F01B04DBB0B"><enum>(3)</enum><text>otherwise
discriminate against the issuer issuing insurance in both the primary State and
in any secondary State.</text>
</paragraph></subsection><subsection id="ID612A06F7110D4C468DA2E306725DDE76"><enum>(c)</enum><header>Clear and
conspicuous disclosure</header><text>A health insurance issuer shall provide
the following notice, in 12-point bold type, in any insurance coverage offered
in a secondary State under this part by such a health insurance issuer and at
renewal of the policy, with the 5 blank spaces therein being appropriately
filled with the name of the health insurance issuer, the name of primary State,
the name of the secondary State, the name of the secondary State, and the name
of the secondary State, respectively, for the coverage concerned:</text>
<continuation-text continuation-text-level="subsection">“<quote>This policy is issued by
_____ and is governed by the laws and regulations of the State of _____, and it
has met all the laws of that State as determined by that State's Department of
Insurance. This policy may be less expensive than others because it is not
subject to all of the insurance laws and regulations of the State of _____,
including coverage of some services or benefits mandated by the law of the
State of _____. Additionally, this policy is not subject to all of the consumer
protection laws or restrictions on rate changes of the State of _____. As with
all insurance products, before purchasing this policy, you should carefully
review the policy and determine what health care services the policy covers and
what benefits it provides, including any exclusions, limitations, or conditions
for such services or benefits.</quote>
</continuation-text></subsection><subsection id="ID5556273ECD38428B8CE2F268B156FF26"><enum>(d)</enum><header>Prohibition on
certain reclassifications and premium increases</header>
<paragraph id="ID37D0ECD1AF93437081392881BEC9CB7B"><enum>(1)</enum><header>In
general</header><text>For purposes of this section, a health insurance issuer
that provides individual health insurance coverage to an individual under this
part in a primary or secondary State may not upon renewal—</text>
<subparagraph id="IDBB6C0BDD5F664E298521F5B59E873F84"><enum>(A)</enum><text>move or
reclassify the individual insured under the health insurance coverage from the
class such individual is in at the time of issue of the contract based on the
health-status related factors of the individual; or</text>
</subparagraph><subparagraph id="IDD623A3B082D54EFDB19A2DBCDF77B46A"><enum>(B)</enum><text>increase the
premiums assessed the individual for such coverage based on a health
status-related factor or change of a health status-related factor or the past
or prospective claim experience of the insured individual.</text>
</subparagraph></paragraph><paragraph id="ID51D464F6F7704514B4FBBDDFF61BBC07"><enum>(2)</enum><header>Construction</header><text>Nothing
in paragraph (1) shall be construed to prohibit a health insurance
issuer—</text>
<subparagraph id="ID1518BC2F1B804383A184AFA6336C1307"><enum>(A)</enum><text>from terminating
or discontinuing coverage or a class of coverage in accordance with subsections
(b) and (c) of section 2742;</text>
</subparagraph><subparagraph id="IDBFFE08DBB19A430D9DC0B0F402A9A65B"><enum>(B)</enum><text>from raising
premium rates for all policy holders within a class based on claims
experience;</text>
</subparagraph><subparagraph id="ID24F44186234445788C94D5EC7F31D5BA"><enum>(C)</enum><text>from changing
premiums or offering discounted premiums to individuals who engage in wellness
activities at intervals prescribed by the issuer, if such premium changes or
incentives—</text>
<clause id="IDB817E5ED07454CC3B264B473E8C05192"><enum>(i)</enum><text>are disclosed to
the consumer in the insurance contract;</text>
</clause><clause id="IDB501E76DB6BB46C7891A3FA2DD0E3FDF"><enum>(ii)</enum><text>are based on
specific wellness activities that are not applicable to all individuals;
and</text>
</clause><clause id="IDD42336CB9D2E4ED7B890F7CA988D9E13"><enum>(iii)</enum><text>are not
obtainable by all individuals to whom coverage is offered;</text>
</clause></subparagraph><subparagraph id="ID042E6A4840724BB0890F132FF13B3818"><enum>(D)</enum><text>from reinstating
lapsed coverage; or</text>
</subparagraph><subparagraph id="IDD40057874BE544729139EEE5D1B18A00"><enum>(E)</enum><text>from
retroactively adjusting the rates charged an insured individual if the initial
rates were set based on material misrepresentation by the individual at the
time of issue.</text>
</subparagraph></paragraph></subsection><subsection id="ID3AC80047BCE4447394624641D4766C14"><enum>(e)</enum><header>Prior offering
of policy in primary state</header><text>A health insurance issuer may not
offer for sale individual health insurance coverage in a secondary State unless
that coverage is currently offered for sale in the primary State.</text>
</subsection><subsection id="ID5C0AD314FDD84C04B817668CC73748F8"><enum>(f)</enum><header>Licensing of
agents or brokers for health insurance issuers</header><text>Any State may
require that a person acting, or offering to act, as an agent or broker for a
health insurance issuer with respect to the offering of individual health
insurance coverage obtain a license from that State, with commissions or other
compensation subject to the provisions of the laws of that State, except that a
State may not impose any qualification or requirement which discriminates
against a nonresident agent or broker.</text>
</subsection><subsection id="ID5A86ED8A91B649838A8EFE4413519B85"><enum>(g)</enum><header>Documents for
submission to state insurance commissioner</header><text>Each health insurance
issuer issuing individual health insurance coverage in both primary and
secondary States shall submit—</text>
<paragraph id="ID0CE047A4C8264D3E8A3F8B0CB923BF7C"><enum>(1)</enum><text>to the insurance
commissioner of each State in which it intends to offer such coverage, before
it may offer individual health insurance coverage in such State—</text>
<subparagraph id="ID992B52699B3B4B75B33B0917C128806B"><enum>(A)</enum><text>a copy of the
plan of operation or feasibility study or any similar statement of the policy
being offered and its coverage (which shall include the name of its primary
State and its principal place of business);</text>
</subparagraph><subparagraph id="ID4DBA01EE40904C55B00F5C727D43A601"><enum>(B)</enum><text>written notice of
any change in its designation of its primary State; and</text>
</subparagraph><subparagraph id="ID8B0F40DD32294C2189E3A1EABE9B9129"><enum>(C)</enum><text>written notice
from the issuer of the issuer's compliance with all the laws of the primary
State; and</text>
</subparagraph></paragraph><paragraph id="ID01D8EB3EE4604B9F96E08AE8531B723E"><enum>(2)</enum><text>to the insurance
commissioner of each secondary State in which it offers individual health
insurance coverage, a copy of the issuer's quarterly financial statement
submitted to the primary State, which statement shall be certified by an
independent public accountant and contain a statement of opinion on loss and
loss adjustment expense reserves made by—</text>
<subparagraph id="ID156CAEDA00E942CA916E1E12B5540F4A"><enum>(A)</enum><text>a member of the
American Academy of Actuaries; or</text>
</subparagraph><subparagraph id="ID07F26935B7E74CF49D9CAD1D1C75338C"><enum>(B)</enum><text>a qualified loss
reserve specialist.</text>
</subparagraph></paragraph></subsection><subsection id="ID097FA855299146ADAD53E57FD2F48318"><enum>(h)</enum><header>Power of courts
To enjoin conduct</header><text>Nothing in this section shall be construed to
affect the authority of any Federal or State court to enjoin—</text>
<paragraph id="ID03E73CADEB3F49A2B2D10070ECD9BCE3"><enum>(1)</enum><text>the solicitation
or sale of individual health insurance coverage by a health insurance issuer to
any person or group who is not eligible for such insurance; or</text>
</paragraph><paragraph id="ID080DCCD6406247EB94CBFA7E61A56DDD"><enum>(2)</enum><text>the solicitation
or sale of individual health insurance coverage that violates the requirements
of the law of a secondary State which are described in subparagraphs (A)
through (H) of section 2796(b)(1).</text>
</paragraph></subsection><subsection id="ID305D4C02D6784882B557E2E0DF043552"><enum>(i)</enum><header>Power of
secondary states To take administrative action</header><text>Nothing in this
section shall be construed to affect the authority of any State to enjoin
conduct in violation of that State's laws described in section
2796(b)(1).</text>
</subsection><subsection id="ID9E8E390BA5334B25B5DA4864521402B6"><enum>(j)</enum><header>State powers To
enforce state laws</header>
<paragraph id="ID9CA37552207640AC90C429074EE75E64"><enum>(1)</enum><header>In
general</header><text>Subject to the provisions of subsection (b)(1)(G)
(relating to injunctions) and paragraph (2), nothing in this section shall be
construed to affect the authority of any State to make use of any of its powers
to enforce the laws of such State with respect to which a health insurance
issuer is not exempt under subsection (b).</text>
</paragraph><paragraph id="IDA0CF8F4747174BDA8B9A071995A4AD66"><enum>(2)</enum><header>Courts of
competent jurisdiction</header><text>If a State seeks an injunction regarding
the conduct described in paragraphs (1) and (2) of subsection (h), such
injunction must be obtained from a Federal or State court of competent
jurisdiction.</text>
</paragraph></subsection><subsection id="ID8B1B22305F444F24992F1A4AB801CEAB"><enum>(k)</enum><header>States'
authority To sue</header><text>Nothing in this section shall affect the
authority of any State to bring action in any Federal or State court.</text>
</subsection><subsection id="ID1D9F3D5D112646F68741E0792485A000"><enum>(l)</enum><header>Generally
applicable laws</header><text>Nothing in this section shall be construed to
affect the applicability of State laws generally applicable to persons or
corporations.</text>
</subsection><subsection id="IDA6F82FF9C9D64E2B8F7CD2E7B13BC5DD"><enum>(m)</enum><header>Guaranteed
availability of coverage to hIPAA eligible individuals</header><text>To the
extent that a health insurance issuer is offering coverage in a primary State
that does not accommodate residents of secondary States or does not provide a
working mechanism for residents of a secondary State, and the issuer is
offering coverage under this part in such secondary State which has not adopted
a qualified high risk pool as its acceptable alternative mechanism (as defined
in section 2744(c)(2)), the issuer shall, with respect to any individual health
insurance coverage offered in a secondary State under this part, comply with
the guaranteed availability requirements for eligible individuals in section
2741.</text>
</subsection></section><section id="ID90999B5282174B21A7CEF868F9B22714"><enum>2797.</enum><header>Primary state
must meet federal floor before issuer may sell into secondary
states</header><text display-inline="no-display-inline">A health insurance
issuer may not offer, sell, or issue individual health insurance coverage in a
secondary State if the State insurance commissioner does not use a risk-based
capital formula for the determination of capital and surplus requirements for
all health insurance issuers.</text>
</section><section id="ID4208CEFBB4144EE0A70141351C39A7AF"><enum>2798.</enum><header>Independent
external appeals procedures</header>
<subsection id="IDC71665531F83412CAED254F169300798"><enum>(a)</enum><header>Right to
external appeal</header><text>A health insurance issuer may not offer, sell, or
issue individual health insurance coverage in a secondary State under the
provisions of this title unless—</text>
<paragraph id="ID3DBF37B04BBC4D2AAF56B89871D27743"><enum>(1)</enum><text>both the
secondary State and the primary State have legislation or regulations in place
establishing an independent review process for individuals who are covered by
individual health insurance coverage, or</text>
</paragraph><paragraph id="ID341C1D9F21C545B9AD019368B513754A"><enum>(2)</enum><text>in any case in
which the requirements of subparagraph (A) are not met with respect to the
either of such States, the issuer provides an independent review mechanism
substantially identical (as determined by the applicable State authority of
such State) to that prescribed in the <quote>Health Carrier External Review
Model Act</quote> of the National Association of Insurance Commissioners for
all individuals who purchase insurance coverage under the terms of this part,
except that, under such mechanism, the review is conducted by an independent
medical reviewer, or a panel of such reviewers, with respect to whom the
requirements of subsection (b) are met.</text>
</paragraph></subsection><subsection id="IDAD393D4F4B2B466E979C8CA33A4DE94C"><enum>(b)</enum><header>Qualifications
of independent medical reviewers</header><text>In the case of any independent
review mechanism referred to in subsection (a)(2)—</text>
<paragraph id="ID3C3A049F431C4F06A6F51FA77D5CAD98"><enum>(1)</enum><header>In
general</header><text>In referring a denial of a claim to an independent
medical reviewer, or to any panel of such reviewers, to conduct independent
medical review, the issuer shall ensure that—</text>
<subparagraph id="IDF7EC5A84BC6C4F039C794ACDB3AD81E4"><enum>(A)</enum><text>each independent
medical reviewer meets the qualifications described in paragraphs (2) and
(3);</text>
</subparagraph><subparagraph id="ID2BE2B9E4E7D248B6BA28F259E3B8F56B"><enum>(B)</enum><text>with respect to
each review, each reviewer meets the requirements of paragraph (4) and the
reviewer, or at least 1 reviewer on the panel, meets the requirements described
in paragraph (5); and</text>
</subparagraph><subparagraph id="IDE3732EFD7E6B4561BA39ABBEC6B034C5"><enum>(C)</enum><text>compensation
provided by the issuer to each reviewer is consistent with paragraph
(6).</text>
</subparagraph></paragraph><paragraph id="ID6727E3FBD5CE4AB2B03940FAA9C1C644"><enum>(2)</enum><header>Licensure and
expertise</header><text>Each independent medical reviewer shall be a physician
(allopathic or osteopathic) or health care professional who—</text>
<subparagraph id="ID8015C58D61C2451BB71E743B3B61B2CB"><enum>(A)</enum><text>is appropriately
credentialed or licensed in 1 or more States to deliver health care services;
and</text>
</subparagraph><subparagraph id="ID42B230A35E75479BB142AC8064BDDEDE"><enum>(B)</enum><text>typically treats
the condition, makes the diagnosis, or provides the type of treatment under
review.</text>
</subparagraph></paragraph><paragraph id="ID7E653530AA6B48D085BD1B4B20B8B6AA"><enum>(3)</enum><header>Independence</header>
<subparagraph id="IDFC5070337E4945AD898533307B5B2B1A"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), each independent medical
reviewer in a case shall—</text>
<clause id="ID6054A9CA15434D4A877658165009DBC8"><enum>(i)</enum><text>not be a related
party (as defined in paragraph (7));</text>
</clause><clause id="IDA029F1B79986410CA03F124728D1FFA0"><enum>(ii)</enum><text>not have a
material familial, financial, or professional relationship with such a party;
and</text>
</clause><clause id="IDB26E8E15F59B4C648599FBA81666E8DE"><enum>(iii)</enum><text>not otherwise
have a conflict of interest with such a party (as determined under
regulations).</text>
</clause></subparagraph><subparagraph id="ID56C1421E96F44C03912014ABD766E474"><enum>(B)</enum><header>Exception</header><text>Nothing
in subparagraph (A) shall be construed to—</text>
<clause id="IDFF71C37D19C543DDBB40B2ECBD4A8AA0"><enum>(i)</enum><text>prohibit an
individual, solely on the basis of affiliation with the issuer, from serving as
an independent medical reviewer if—</text>
<subclause id="IDCEA18E19435C4F2E9D3EF82DAA21A28D"><enum>(I)</enum><text>a non-affiliated
individual is not reasonably available;</text>
</subclause><subclause id="ID1A76CE8D99064611A84A29DCCA0F42D3"><enum>(II)</enum><text>the affiliated
individual is not involved in the provision of items or services in the case
under review;</text>
</subclause><subclause id="IDAB77C1FD35F64C419A6426F996701AC8"><enum>(III)</enum><text>the fact of
such an affiliation is disclosed to the issuer and the enrollee (or authorized
representative) and neither party objects; and</text>
</subclause><subclause id="ID2321B331070044EDABD6650F58264573"><enum>(IV)</enum><text>the affiliated
individual is not an employee of the issuer and does not provide services
exclusively or primarily to or on behalf of the issuer;</text>
</subclause></clause><clause id="ID1CC4F67174E1499E9D057EE4E3041464"><enum>(ii)</enum><text>prohibit an
individual who has staff privileges at the institution where the treatment
involved takes place from serving as an independent medical reviewer merely on
the basis of such affiliation if the affiliation is disclosed to the issuer and
the enrollee (or authorized representative), and neither party objects;
or</text>
</clause><clause id="IDC2DA4D5C01AF4A76A6828132FE494438"><enum>(iii)</enum><text>prohibit
receipt of compensation by an independent medical reviewer from an entity if
the compensation is provided consistent with paragraph (6).</text>
</clause></subparagraph></paragraph><paragraph id="IDA2F1A99C6C5044239BDEC3BC4244CD81"><enum>(4)</enum><header>Practicing
health care professional in same field</header>
<subparagraph id="IDC9437CE63FF44A58A82D0B1B4AE870C9"><enum>(A)</enum><header>In
general</header><text>In a case involving treatment, or the provision of items
or services—</text>
<clause id="IDFBC2F8048EB444E794499D15311A64D2"><enum>(i)</enum><text>by a physician, a
reviewer shall be a practicing physician (allopathic or osteopathic) of the
same or similar specialty, as a physician who, acting within the appropriate
scope of practice within the State in which the service is provided or
rendered, typically treats the condition, makes the diagnosis, or provides the
type of treatment under review; or</text>
</clause><clause id="ID00423BDF1DC74EA899D96E0066C4D874"><enum>(ii)</enum><text>by a
non-physician health care professional, the reviewer, or at least 1 member of
the review panel, shall be a practicing non-physician health care professional
of the same or similar specialty as the non-physician health care professional
who, acting within the appropriate scope of practice within the State in which
the service is provided or rendered, typically treats the condition, makes the
diagnosis, or provides the type of treatment under review.</text>
</clause></subparagraph><subparagraph id="ID6B422707B21C49E1B2FC45582DAB80EB"><enum>(B)</enum><header>Practicing
defined</header><text>For purposes of this paragraph, the term
<term>practicing</term> means, with respect to an individual who is a physician
or other health care professional, that the individual provides health care
services to individual patients on average at least 2 days per week.</text>
</subparagraph></paragraph><paragraph id="ID17092034CC144D6195A8D9BE7CA75354"><enum>(5)</enum><header>Pediatric
expertise</header><text>In the case of an external review relating to a child,
a reviewer shall have expertise under paragraph (2) in pediatrics.</text>
</paragraph><paragraph id="IDA79FF790708049CBB747EC564D71A153"><enum>(6)</enum><header>Limitations on
reviewer compensation</header><text>Compensation provided by the issuer to an
independent medical reviewer in connection with a review under this section
shall—</text>
<subparagraph id="ID965ECA20DDF0469D885A95839F817F98"><enum>(A)</enum><text>not exceed a
reasonable level; and</text>
</subparagraph><subparagraph id="IDB3891CC3C72E4CEFB6B2C3785FD6E927"><enum>(B)</enum><text>not be contingent
on the decision rendered by the reviewer.</text>
</subparagraph></paragraph><paragraph id="ID8B560887ACA84609A6C8440758900065"><enum>(7)</enum><header>Related party
defined</header><text>For purposes of this section, the term <term>related
party</term> means, with respect to a denial of a claim under a coverage
relating to an enrollee, any of the following:</text>
<subparagraph id="ID17BA4A63FEF24876865DCEFDA4BBBD61"><enum>(A)</enum><text>The issuer
involved, or any fiduciary, officer, director, or employee of the
issuer.</text>
</subparagraph><subparagraph id="ID73FBEBBDE28744608AFBC53437C7B957"><enum>(B)</enum><text>The enrollee (or
authorized representative).</text>
</subparagraph><subparagraph id="ID62D4C732BC8F4303A0D29290A22E5A8C"><enum>(C)</enum><text>The health care
professional that provides the items or services involved in the denial.</text>
</subparagraph><subparagraph id="ID2EF0AF1213AC44CB98B2D9805E0D98F0"><enum>(D)</enum><text>The institution
at which the items or services (or treatment) involved in the denial are
provided.</text>
</subparagraph><subparagraph id="IDCB11C1C5E70146D08A09AAB95B4375BC"><enum>(E)</enum><text>The manufacturer
of any drug or other item that is included in the items or services involved in
the denial.</text>
</subparagraph><subparagraph id="ID093ADDEE71724515BEFA21CF124368C0"><enum>(F)</enum><text>Any other party
determined under any regulations to have a substantial interest in the denial
involved.</text>
</subparagraph></paragraph><paragraph id="ID76C7C29A40C64FA9988A3D281049E242"><enum>(8)</enum><header>Definitions</header><text>For
purposes of this subsection:</text>
<subparagraph id="ID78F057F4863949BF9FA75450A31C0E6D"><enum>(A)</enum><header>Enrollee</header><text>The
term <term>enrollee</term> means, with respect to health insurance coverage
offered by a health insurance issuer, an individual enrolled with the issuer to
receive such coverage.</text>
</subparagraph><subparagraph id="ID6ECA079119344E299C91F32A1E17BFE6"><enum>(B)</enum><header>Health care
professional</header><text>The term <term>health care professional</term> means
an individual who is licensed, accredited, or certified under State law to
provide specified health care services and who is operating within the scope of
such licensure, accreditation, or certification.</text>
</subparagraph></paragraph></subsection></section><section id="IDF8B628225B3D4A5894984C6180BFF3E6"><enum>2799.</enum><header>Enforcement</header>
<subsection id="ID12171A430CBB4C1CA6D4CA79B4061B5B"><enum>(a)</enum><header>In
general</header><text>Subject to subsection (b), with respect to specific
individual health insurance coverage the primary State for such coverage has
sole jurisdiction to enforce the primary State's covered laws in the primary
State and any secondary State.</text>
</subsection><subsection id="ID4A1023862BA44D07B9408ACE119AD7E6"><enum>(b)</enum><header>Secondary
state's authority</header><text>Nothing in subsection (a) shall be construed to
affect the authority of a secondary State to enforce its laws as set forth in
the exception specified in section 2796(b)(1).</text>
</subsection><subsection id="ID47AA9906ACFD4C9A90D96C4EFFE05536"><enum>(c)</enum><header>Court
interpretation</header><text>In reviewing action initiated by the applicable
secondary State authority, the court of competent jurisdiction shall apply the
covered laws of the primary State.</text>
</subsection><subsection id="IDC57A7C8AB1964B959A3895E95DE45E20"><enum>(d)</enum><header>Notice of
compliance failure</header><text>In the case of individual health insurance
coverage offered in a secondary State that fails to comply with the covered
laws of the primary State, the applicable State authority of the secondary
State may notify the applicable State authority of the primary
State.</text>
</subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="ID39A315E2A3674B8EB742838258CCF2F0"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to
individual health insurance coverage offered, issued, or sold after the date
that is one year after the date of the enactment of this Act.</text>
</subsection><subsection id="IDA252277433514B06A403901F2799C26B"><enum>(c)</enum><header>GAO ongoing
study and reports</header>
<paragraph id="IDA1D698F7FCE34644AE643D3C25EAB10B"><enum>(1)</enum><header>Study</header><text>The
Comptroller General of the United States shall conduct an ongoing study
concerning the effect of the amendment made by subsection (a) on—</text>
<subparagraph id="ID64F2C57A52A94A6F9AF86AB5B32B76FA"><enum>(A)</enum><text>the number of
uninsured and under-insured;</text>
</subparagraph><subparagraph id="ID315BE124924B4A47A7DF1F00250B2A1A"><enum>(B)</enum><text>the availability
and cost of health insurance policies for individuals with pre-existing medical
conditions;</text>
</subparagraph><subparagraph id="ID2947C083C2C8439296E9E3766E3F032A"><enum>(C)</enum><text>the availability
and cost of health insurance policies generally;</text>
</subparagraph><subparagraph id="ID8F7DAE33F7F14CFCA7EE5BDACB5AE2A6"><enum>(D)</enum><text>the elimination
or reduction of different types of benefits under health insurance policies
offered in different States; and</text>
</subparagraph><subparagraph id="ID9AB223627C144773A078ECEE266E5CC5"><enum>(E)</enum><text>cases of fraud or
abuse relating to health insurance coverage offered under such amendment and
the resolution of such cases.</text>
</subparagraph></paragraph><paragraph id="ID6872DEC4FF09449385A40E72362288A6"><enum>(2)</enum><header>Annual
reports</header><text>The Comptroller General shall submit to Congress an
annual report, after the end of each of the 5 years following the effective
date of the amendment made by subsection (a), on the ongoing study conducted
under paragraph (1).</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="ID3594184FBCFB41DCB661D89C00D91DA1" section-type="subsequent-section"><enum>205.</enum><header>Severability</header><text display-inline="no-display-inline">If any provision of the Act or the
application of such provision to any person or circumstance is held to be
unconstitutional, the remainder of this Act and the application of the
provisions of such to any other person or circumstance shall not be
affected.</text>
</section></subtitle><subtitle id="id43E5BD20AEC74FE7A6ECC882C05CA619"><enum>B</enum><header>Pre-existing
condition</header>
<section id="id4B52A16B18904F8689CB421C050BC262"><enum>211.</enum><header>Block grants
to States</header>
<subsection id="idD12B850CF2144821AA1D2A260448DD75"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (referred to
in this section as the <quote>Secretary</quote>) shall award block grants to
States to provide for the development of innovative models that ensure
affordable health insurance coverage for Americans with pre-existing health
conditions.</text>
</subsection><subsection id="idF36601BA9E7A4C6BB906D1695976622B"><enum>(b)</enum><header>Application</header><text>To
be eligible to receive a grant under this section a State shall submit to the
Secretary an application, at such time, in such manner, and containing such
information as the Secretary may require.</text>
</subsection><subsection id="idC345393B5D0C4D7ABBA2AE4B8DA6FEBC"><enum>(c)</enum><header>Use of
funds</header><text>A State shall use amounts received under a grant under this
section to develop innovative programs that ensure the provision of affordable
health insurance coverage for eligible individuals with pre-existing health
conditions. Such models may include the development and funding of State
high-risk pools and the enhancement of funding for existing State high risk
pools.</text>
</subsection><subsection id="idC5162526F6BF4BFF8D2D5B0E8E9A2884"><enum>(d)</enum><header>Eligibility</header><text>To
be eligible to participate in a program developed under subsection (c), an
individual shall—</text>
<paragraph id="id4D3D2B6E5BCF4330B5EDC44489DCB070"><enum>(1)</enum><text>be a resident of
the State involved;</text>
</paragraph><paragraph id="idBFA20809C56A46E7B7C30CA64902B67F"><enum>(2)</enum><text>provide
assurances to the Secretary that activities carried out under the grant will
not result in an increase in health insurance premiums for residents of the
State; and</text>
</paragraph><paragraph id="idBF50B9CECB084BE5AB4ACC6048A7C007"><enum>(3)</enum><text>comply with any
other requirements established by the State.</text>
</paragraph></subsection><subsection id="idC5800DAA2887449ABD45FA25FB13BFDA"><enum>(e)</enum><header>Amount of
grant</header><text>The amount of a grant to a State under this section shall
be determined by the Secretary.</text>
</subsection><subsection id="id3E1FE153767A4B9C952CA761D8537487"><enum>(f)</enum><header>Authorization
of appropriations</header><text>There is authorized to be appropriated to carry
out this section, $5,000,000,000 for each of the fiscal years 2010 through
2014.</text>
</subsection><subsection id="id00BE075B8E85436EBBE76CDDFA914426"><enum>(g)</enum><header>Definition</header><text>In
this section, the term <term>pre-existing condition</term> means a medical or
other condition in an individual that exists prior to the date on which such
individuals attempts to enroll in health insurance coverage, whether or not any
medical advice, diagnosis, care, or treatment was recommended or received
before such date.</text>
</subsection></section></subtitle><enum>III</enum><header>Empowering the
health care consumer</header>
<section id="id42C815DC656842CF9E875EE7FD707DD8"><enum>301.</enum><header>Enhancing the
patient-provider relationship</header>
<subsection id="IDa6550d5ad0534452858a85733d8634fc"><enum>(a)</enum><header>Provision of
information</header><text>The Secretary of Health and Human Services shall
promulgate regulations under which a health care provider (including a
hospital) that receives reimbursement under title XVIII or XIX of the Social
Security Act (42 U.S.C. 1395 and 1396 et seq.) shall be required to provide
each patient of such provider (or hospital), upon the request of such patient,
price information with respect to the items or services provided (or that will
be provided) to such patient.</text>
</subsection><subsection id="id049523AF326B4E3F8C86B40435F6BF9F"><enum>(b)</enum><header>Requirement</header><text>The
pricing information required under subsection (a) shall be broken down into the
following categories:</text>
<paragraph id="id77037B31DA5D412ABA4B3378A3078A83"><enum>(1)</enum><text>The usual and
customary price charged for the item or service involved.</text>
</paragraph><paragraph id="id918AE6889BA2449A97BE8C9727D96B83"><enum>(2)</enum><text>The amount that
would be provided as reimbursement under the Medicare and Medicaid Programs
under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 and 1396
et seq.) for the items or services involved.</text>
</paragraph><paragraph id="idB466F0D40D2349B99EBD32D74AF12A34"><enum>(3)</enum><text>The average
amount that would be paid by an insured individual with respect to such item or
service.</text>
</paragraph></subsection></section><section id="ID27864c844583440f83fc7440e7dda658"><enum>302.</enum><header>Health
insurance policy information</header>
<subsection id="IDfb6765edab4741e3b03c0abd992f8732"><enum>(a)</enum><header>In
general</header><text>A group health plan, or health insurance issuer in
connection with group or individual health insurance coverage, shall provide an
enrollee, upon the request of the enrollee, with information concerning their
allowable payment for items or services under the plan or coverage
involved.</text>
</subsection><subsection id="idE949BD7723144CE2B06686912C78F979"><enum>(b)</enum><header>Fee</header><text>A
plan or issuer may assess an enrollee a reasonable fee to cover the costs
incurred by the plan or issuer in providing the enrollee with the information
requested under subsection (a).</text>
</subsection><subsection id="idE332744CC7DF4D61A660A5A280956687"><enum>(c)</enum><header>Definitions</header><text>The
definitions contained in section 2791 of the Public Health Service Act (42
U.S.C. 300gg–91) shall apply for purposes of this section.</text>
</subsection></section><enum>IV</enum><header>Funding</header>
<section id="id8288B25ECE1A422CA52D86F981710175"><enum>401.</enum><header>Funding
provisions</header>
<subsection id="idCDB675A136174F77B4ACE2DD6CD65982"><enum>(a)</enum><header>Termination of
TARP program</header><text display-inline="yes-display-inline">Notwithstanding
any provision of the Emergency Economic Stabilization Act of 2008 (12 U.S.C.
5201 et seq.) or any other provision of law, the Secretary of Treasury may not,
on and after the date of enactment of this Act, make any payment or obligation
under the Emergency Economic Stabilization Act of 2008 (12 U.S.C. 5201 et
seq.). Any funds made available under such Act that have not been obligated
shall be rescinded and made available to carry out this Act.</text>
</subsection><subsection id="id35DE4DA82A65476DBE8E6B9DBCE99CBA"><enum>(b)</enum><header>Collecting
funds</header><text display-inline="yes-display-inline">Notwithstanding any
other provision of the Emergency Economic Stabilization Act of 2008 (12 U.S.C.
5201 et seq.) or any other provision of law, the Secretary of Treasury shall
collect all revenues relating to, and proceeds from the sale of, obligations
purchased and made under the Emergency Economic Stabilization Act of 2008 (12
U.S.C. 5201 et seq.) by not later than September 30, 2014, at a rate of not
less than 20 percent per year of the total obligations purchased and made under
such Act.</text>
</subsection></section>