,i #aacth ,,congress #ast ,session ,h4 ,r4 #bafe ,,in ,,the ,,house ,,of ,,representatives ,may #bc1 #bjac ,mr4 ,heck of ,nevada 7for himself and ,mr4 ,fitzpatrick7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,education and the ,workforce1 ,ways and ,means1 and the ,judiciary1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,public ,health ,service ,act to provide individual and group market reforms to protect health insurance consumers1 to make such reforms and protections contingent on the enactment of legislation repealing the ,patient ,protection and ,affordable ,care ,act1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,ensuring ,quality ,health ,care for ,all ,americans ,act of #bjac4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,effective date contingent on repeal of ,,ppaca4 ,sec4 #c4 ,prohibiting discrimination based on health status4 ,sec4 #d4 ,guaranteed renewability of coverage4 ,sec4 #e4 ,prohibition of preexisting condition exclusions and other discrimination based on health status4 ,sec4 #f4 ,no lifetime or annual limits4 ,sec4 #g4 ,prohibition on rescissions4 ,sec4 #h4 ,extension of dependent coverage4 ,sec4 #i4 ,application of group market reforms to ,,erisa and the ,internal ,revenue ,code of #aihf4 ,sec4 #aj4 ,catastrophic plan4 ,sec4 #aa4 ,grants for health insurance risk adjustment mechanisms4 ,sec4 #ab4 ,liability protections for health care providers4 #b4 ,effective date contingent on repeal of ,,ppaca 7a7 ,in general ,this ,act and the amendments made by this ,act shall take effect upon the enactment of ,,ppaca repeal legislation described in subsection 7b7 and this ,act and the amendments made by this ,act shall have no force or effect if such ,,ppaca repeal legislation is not enacted4 7b7 ,,ppaca repeal legislation described ,for purposes of subsection 7a71 ,,ppaca repeal legislation described in this subsection is legislation that-- 7#a7 repeals ,public ,law #aaa-adh1 and restores or revives the provisions of law amended or repealed1 respectively1 by such ,act as if such ,act had not been enacted and without further amendment to such provisions of law2 and 7#b7 repeals title ,i and subtitle ,b of title ,,ii of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb71 and restores or revives the provisions of law amended or repealed1 respectively1 by such title or subtitle1 respectively1 as if such title and subtitle had not been enacted and without further amendment to such provisions of law4 #c4 ,prohibiting discrimination based on health status 7a7 ,group market ,subpart #c of part ,a of title ,,xxvii of the ,public ,health ,service ,act is amended by striking section #bgaa of such ,act 7#db ,u4,s4,c4 #cjj;gg-#aa7 and inserting the following3 #bgaa4 ,guaranteed availability of coverage 7a7 ,guaranteed issuance of coverage in the group market 7#a7 ,in general ,subject to subsections 7b7 through 7e71 each health insurance issuer that offers health insurance coverage in the group market in a ,state shall accept every employer and every individual in a group in the ,state that applies for such coverage4 7#b7 ,special rule for associations ,an association shall be treated as an employer for purposes of this section if such association seeks to provide group health insurance coverage to not less than #bjj qualified individuals4 7b7 ,enrollment 7#a7 ,restriction ,a health insurance issuer described in subsection 7a7 may restrict enrollment in coverage described in such subsection to open or special enrollment periods4 7#b7 ,establishment ,a health insurance issuer described in subsection 7a7 shall1 in accordance with the regulations promulgated under paragraph 7#c71 establish special enrollment periods for qualifying events 7as such term is defined in section #fjc of the ,employee ,retirement ,income ,security ,act of #aigd74 7#c7 ,special rules for associations 7,a7 ,qualifying events ,for purposes of applying paragraph 7#b7 to an association-- 7i7 the term covered employee in section #fjc of the ,employee ,retirement ,income ,security ,act of #aigd shall include a qualified individual 7as such term is defined in section #bgja7;d77#b77;,d772 7ii7 the term employer shall include an association 7as such term is defined in section #bgja7;d77#b77;,a772 and 7iii7 the term termination 7other than by reason of such employee's gross misconduct71 or reduction of hours1 of the covered employee's employment shall include the termination of membership to the association4 7,b7 ,enrollment ,with respect to health insurance coverage provided to an association under subsection 7a77#b71 a health insurance issuer shall permit a qualified individual who is eligible1 but not enrolled 7or a dependent of such individual if the dependent is eligible1 but not enrolled7 for such coverage to enroll for coverage under the terms of such coverage when any one of the following events occur3 7i7 ,new members and employees ,a qualified individual1 and any dependent of such individual1 may enroll during the #cj-;day period following the end of the period described under section #bgja7;d77#b77;,d7 that applies to such individual4 7ii7 ,annual enrollment ,a qualified individual1 and any dependent of such individual1 may enroll during the annual enrollment period established under the terms of the coverage 7,c7 ,termination of enrollment ,with respect to group health insurance coverage provided by an association1 a qualified individual or dependent who terminates enrollment in such coverage may only re-enroll in such coverage during the annual enrollment period described under subparagraph 7,b77ii74 7,d7 ,definitions ,for purposes of this section1 the terms association and qualified individual have the meaning given such terms in section #bgja7;d77#b74 7#d7 ,regulations ,the ,secretary shall promulgate regulations with respect to enrollment periods under this subsection4 7c7 ,special ,rules for ,network ,plans 7#a7 ,in general ,in the case of a health insurance issuer that offers health insurance coverage in the group market in a ,state through a network plan1 the issuer may-- 7,a7 limit the employers that may apply for such coverage to those with eligible individuals who live1 work1 or reside in the service area for such network plan2 and 7,b7 within the service area of such plan1 deny such coverage to such employers if the issuer has demonstrated1 if required1 to the applicable ,state authority that-- 7i7 it will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees2 and 7ii7 it is applying this paragraph uniformly to all employers without regard to-- 7,i7 the claims experience of those employers and their employees 7and their dependents72 or 7,,ii7 any health-status-related factor relating to such employees and dependents4 7#b7 #ahj-;day suspension upon denial of coverage ,an issuer1 upon denying health insurance coverage in any service area in accordance with paragraph 7#a77;,b71 may not offer coverage in the group market within such service area for a period of #ahj days after the date such coverage is denied4 7d7 ,application of ,financial ,capacity ,limits 7#a7 ,in general ,a health insurance issuer may deny health insurance coverage in the group if the issuer has demonstrated1 if required1 to the applicable ,state authority that-- 7,a7 it does not have the financial reserves necessary to underwrite additional coverage2 and 7,b7 it is applying this paragraph uniformly to all employers and individuals in the group market in the ,state-- 7i7 in a manner that is consistent with applicable ,state law2 and 7ii7 without regard to-- 7,i7 the claims experience of those individuals1 employers1 and their employees 7and their dependents72 or 7,,ii7 any health-status-related factor relating to such individuals1 employees1 and dependents4 7#b7 #ahj-;day suspension upon denial of coverage ,a health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with paragraph 7#a7 in a ,state may not offer coverage in connection with group health plans in the group market in the ,state for a period of #ahj days after the date such coverage is denied or until the issuer has demonstrated to the applicable ,state authority1 if required under applicable ,state law1 that the issuer has sufficient financial reserves to underwrite additional coverage1 whichever is later4 ,an applicable ,state authority may provide for the application of this subsection on a service-area-specific basis4 4 7b7 ,individual market ,subpart #a of part ,b of title ,,xxvii of the ,public ,health ,service ,act is amended by striking section #bgda of such ,act 7#db ,u4,s4,c4 #cjj;gg-#da7 and inserting the following3 #bgda4 ,guaranteed availability of coverage ,the provisions of section #bgaa 7other than subsection 7a77#b7 and subsection 7b77#c77 shall apply to health insurance coverage offered to individuals by a health insurance issuer in the individual market in the same manner as such provisions apply to health insurance coverage offered to employers by a health insurance issuer in connection with health insurance coverage in the group market4 ,for purposes of this section1 the ,secretary shall treat any reference of the word employer in such section as a reference to the term individual4 4 #d4 ,guaranteed renewability of coverage ,section #bgab of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ab7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by inserting 1 including coverage offered before in connection with a group health plan2 and 7,b7 by inserting employer or other before plan sponsor of the plan2 7#b7 in subsection 7b7-- 7,a7 in the matter before paragraph 7#a71 by striking health insurance coverage in connection with a group health plan in the small or large group market and insert such health insurance coverage2 and 7,b7 in paragraph 7#f7 by striking one or more bona fide associations and inserting one or more associations 7as such term is defined in section #bgja7;d77#b77;,a772 7#c7 in subsection 7c77#a77;,b71 by striking to a group health plan2 7#d7 in subsection 7d7-- 7,a7 in matter before paragraph 7#a71 by striking to a group health plan2 and 7,b7 in paragraph 7#b71 by striking bona fide associations and inserting associations 7as such term is defined in section #bgja7;d77#b77;,a772 and 7#e7 in subsection 7e71 by inserting 7as such term is defined in section #bgja7;d77#b77;,a77 after one or more associations4 #e4 ,prohibition of preexisting condition exclusions and other discrimination based on health status 7a7 ,group market ,subpart #a of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by striking section #bgja and inserting the following3 #bgja4 ,prohibition of preexisting condition exclusions and other discrimination based on health status 7a7 ,in ,general ,a group health plan or a health insurance issuer offering group health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage4 7b7 ,definitions ,for purposes of this part3 7#a7 ,preexisting condition exclusion 7,a7 ,in general ,the term preexisting condition exclusion means1 with respect to a group health plan or health insurance coverage1 a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment in such plan or for such coverage1 whether or not any medical advice1 diagnosis1 care1 or treatment was recommended or received before such date4 7,b7 ,treatment of genetic information ,genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to such information4 7#b7 ,date of enrollment ,the term date of enrollment means1 with respect to an individual covered under a group health plan or health insurance coverage1 the date of enrollment of the individual in the plan or coverage or1 if earlier1 the first day of the waiting period for such enrollment4 7#c7 ,waiting period ,the term waiting period means1 with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan1 the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan4 7c7 ,special ,enrollment ,periods 7#a7 ,individuals losing other coverage ,a group health plan1 and a health insurance issuer offering group health insurance coverage in connection with a group health plan1 shall permit an employee who is eligible1 but not enrolled1 for coverage under the terms of the plan 7or a dependent of such an employee if the dependent is eligible1 but not enrolled1 for coverage under such terms7 to enroll for coverage under the terms of the plan if each of the following conditions is met3 7,a7 ,the employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent4 7,b7 ,the employee stated in writing at such time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment1 but only if the plan sponsor or issuer 7if applicable7 required such a statement at such time and provided the employee with notice of such requirement 7and the consequences of such requirement7 at such time4 7,c7 ,the employee's or dependent's coverage described in subparagraph 7,a7-- 7i7 was under a ,,cobra continuation provision and the coverage under such provision was exhausted2 or 7ii7 was not under such a provision and either the coverage was terminated as a result of loss of eligibility for the coverage 7including as a result of legal separation1 divorce1 death1 termination of employment1 or reduction in the number of hours of employment7 or employer contributions toward such coverage were terminated4 7,d7 ,under the terms of the plan1 the employee requests such enrollment not later than #cj days after the date of exhaustion of coverage described in subparagraph 7,c77i7 or termination of coverage or employer contribution described in subparagraph 7,c77ii74 7#b7 ,for dependent beneficiaries 7,a7 ,in general ,if-- 7i7 a group health plan makes coverage available with respect to a dependent of an individual2 7ii7 the individual is a participant under the plan 7or has met any waiting period applicable to becoming a participant under the plan and is eligible to be enrolled under the plan but for a failure to enroll during a previous enrollment period72 and 7iii7 a person becomes such a dependent of the individual through marriage1 birth1 or adoption or placement for adoption1 the group health plan shall provide for a dependent special enrollment period described in subparagraph 7,b7 during which the person 7or1 if not otherwise enrolled1 the individual7 may be enrolled under the plan as a dependent of the individual1 and in the case of the birth or adoption of a child1 the spouse of the individual may be enrolled as a dependent of the individual if such spouse is otherwise eligible for coverage4 7,b7 ,dependent special enrollment period ,a dependent special enrollment period under this subparagraph shall be a period of not less than #cj days and shall begin on the later of-- 7i7 the date dependent coverage is made available2 or 7ii7 the date of the marriage1 birth1 or adoption or placement for adoption 7as the case may be7 described in subparagraph 7,a77iii74 7,c7 ,no waiting period ,if an individual seeks to enroll a dependent during the first #cj days of such a dependent special enrollment period1 the coverage of the dependent shall become effective-- 7i7 in the case of marriage1 not later than the first day of the first month beginning after the date the completed request for enrollment is received2 7ii7 in the case of a dependent's birth1 as of the date of such birth2 or 7iii7 in the case of a dependent's adoption or placement for adoption1 the date of such adoption or placement for adoption4 7#c7 ,special rules for application in case of ,medicaid and chip 7,a7 ,in general ,a group health plan1 and a health insurance issuer offering group health insurance coverage in connection with a group health plan1 shall permit an employee who is eligible1 but not enrolled1 for coverage under the terms of the plan 7or a dependent of such an employee if the dependent is eligible1 but not enrolled1 for coverage under such terms7 to enroll for coverage under the terms of the plan or coverage if either of the following conditions is met3 7i7 ,termination of medicaid or chip coverage ,the employee or dependent is covered under a ,medicaid plan under title ,,xix of the ,social ,security ,act or under a ,state child health plan under title ,,xxi of such ,act and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility for such coverage and the employee requests coverage under the group health plan 7or health insurance coverage7 not later than #fj days after the date of termination of such coverage4 7ii7 ,eligibility for employment assistance under medicaid or chip ,the employee or dependent becomes eligible for assistance1 with respect to coverage under the group health plan or health insurance coverage1 under such ,medicaid plan or ,state child health plan 7including under any waiver or demonstration project conducted under or in relation to such a plan71 if the employee requests coverage under the group health plan or health insurance coverage not later than #fj days after the date the employee or dependent is determined to be eligible for such assistance4 7,b7 ,coordination with medicaid and chip 7i7 ,outreach to employees regarding availability of medicaid and chip coverage 7,i7 ,in general ,each employer that maintains a group health plan in a ,state that provides medical assistance under a ,state ,medicaid plan under title ,,xix of the ,social ,security ,act1 or child health assistance under a ,state child health plan under title ,,xxi of such ,act1 in the form of premium assistance for the purchase of coverage under a group health plan1 shall provide to each employee a written notice informing the employee of potential opportunities then currently available in the ,state in which the employee resides for premium assistance under such plans for health coverage of the employee or the employee's dependents4 ,for purposes of compliance with this subclause1 the employer may use any ,state-specific model notice developed in accordance with section #gja7;f77#c77;,b77i77,,ii7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha7;f77#c77;,b77i77,,ii774 7,,ii7 ,option to provide concurrent with provision of plan materials to employee ,an employer may provide the model notice applicable to the ,state in which an employee resides concurrent with the furnishing of materials notifying the employee of health plan eligibility1 concurrent with materials provided to the employee in connection with an open season or election process conducted under the plan1 or concurrent with the furnishing of the summary plan description as provided in section #ajd7;b7 of the ,employee ,retirement ,income ,security ,act of #aigd4 7ii7 ,disclosure about group health plan benefits to ,states for medicaid- and ,,chip-eligible individuals ,in the case of an enrollee in a group health plan who is covered under a ,medicaid plan of a ,state under title ,,xix of the ,social ,security ,act or under a ,state child health plan under title ,,xxi of such ,act1 the plan administrator of the group health plan shall disclose to the ,state1 upon request1 information about the benefits available under the group health plan in sufficient specificity1 as determined under regulations of the ,secretary of ,health and ,human ,services in consultation with the ,secretary that require use of the model coverage coordination disclosure form developed under section #caa7;b77#a77;,c7 of the ,children's ,health ,insurance ,reauthorization ,act of #bjji1 so as to permit the ,state to establish 7under paragraph 7#b77;,b71 7#c71 or 7#aj7 of section #baje7;c7 of the ,social ,security ,act or otherwise7 the cost effectiveness of the ,state providing medical or child health assistance through premium assistance for the purchase of coverage under such group health plan and in order for the ,state to provide supplemental benefits required under paragraph 7#aj77;,e7 of such section or other authority4 7d7 ,application to association plans 7#a7 ,in general ,a group health plan or health insurance issuer that provides coverage to an association as required under section #bgaa7;a77#b7 shall accept every qualified individual that the association seeks health insurance coverage for1 without regard to the health status of such individual4 7#b7 ,definitions related to associations ,for purposes of this subsection3 7,a7 ,association ,the term association means an association that-- 7i7 has a constitution and bylaws2 7ii7 is determined by the ,secretary to be an association which is operating in good faith for a primary purpose other than that of obtaining insurance2 and 7iii7 has been in existence for a period of at least #e years4 7,b7 ,dependent ,the term dependent1 with respect to a qualified individual1 has the meaning given such term in section #bgad1 with respect to a policy holder4 7,c7 ,qualified actuary ,the term qualified actuary means a member in good standing of the ,american ,academy of ,actuaries1 or a successor organization approved by the ,secretary4 7,d7 ,qualified individuals ,the term qualified individual means1 with respect to an association1 an individual who meets any of the following3 7i7 ,a member of the association who has been such a member for a period of at least #cj days4 7ii7 ,an employee of such member who has been employed by such member for a period of at least #cj days4 7iii7 ,an employee of the association who has been employed by the association for a period of at least #cj days4 4 7b7 ,individual market ,subpart #a of part ,b of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is amended by adding at the end the following3 #bgdf4 ,prohibition of preexisting condition exclusions or other discrimination based on health status ,the provisions of section #bgja 7other than subparagraphs 7,a77ii7 and 7,b7 of subsection 7c77#c77 shall apply to health insurance coverage offered to individuals by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in the group market4 4 #f4 ,no lifetime or annual limits 7a7 ,group market ,subpart #b of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#d et seq47 is amended by adding at the end the following3 #bgjh4 ,no lifetime or annual limits 7a7 ,in general ,a group health plan and a health insurance issuer offering group health insurance coverage may not establish-- 7#a7 lifetime limits on the dollar value of benefits for any participant or beneficiary2 or 7#b7 unreasonable annual limits 7within the meaning of section #bbc of the ,internal ,revenue ,code of #aihf7 on the dollar value of benefits for any participant or beneficiary4 7b7 ,per ,beneficiary ,limits ,a group health plan or health insurance coverage may not place annual or lifetime per beneficiary limits on specific covered benefits unless such limits are otherwise permitted under ,federal or ,state law4 4 7b7 ,individual market ,subpart #b of part ,b of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ea et seq47 is amended by adding at the end the following3 #bged4 ,no lifetime or annual limits ,the provisions of section #bgjh shall apply to health insurance coverage offered to individuals by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in the group market4 4 #g4 ,prohibition on rescissions 7a7 ,group market ,subpart #a of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by adding at the end the following3 #bgjc4 ,prohibition on rescissions ,a group health plan and a health insurance issuer offering group health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved1 except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage4 ,such plan or coverage may not be cancelled except with prior notice to the enrollee1 and only as permitted under section #bgab7;b74 4 7b7 ,individual market ,subpart #a of part ,b of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is amended by adding at the end the following3 #bgdg4 ,prohibition on rescissions ,the provisions of section #bgjc shall apply to health insurance coverage offered to individuals by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in the group market4 4 #h4 ,extension of dependent coverage 7a7 ,group market 7#a7 ,in general ,subpart #a of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by adding at the end3 #bgjc;,a4 ,extension of dependent coverage 7a7 ,in ,general ,a group health plan and a health insurance issuer offering group health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for such a dependent after such dependent turns #ah years of age until the first of the following events occurs3 7#a7 ,the dependent turns #bf years of age4 7#b7 ,the dependent marries4 7#c7 ,subject to subsection 7c71 the dependent no longer resides in the home of-- 7,a7 the policy holder through which such dependent is eligible for dependent coverage2 or 7,b7 in the case that the policy holder through which such dependent is eligible for dependent coverage provides such coverage subject to an order to provide child support1 the dependent's parent or legal guardian4 7b7 ,exception for college students ,paragraph 7#c7 of subsection 7a7 shall not apply to a dependent for any period of time during which such dependent is enrolled as a full-time student at a postsecondary educational institution 7including an institution of higher education as defined in section #ajb of the ,higher ,education ,act of #aife74 7c7 ,limitation ,nothing in this section shall require a plan or an issuer described in subsection 7a7 to make coverage available for a child of an individual receiving dependent coverage pursuant to this section4 7d7 ,rule of ,construction ,nothing in this section shall be construed to modify the definition of dependent as used in the ,internal ,revenue ,code of #aihf with respect to the tax treatment of the cost of coverage4 4 7#b7 ,regulations ,the ,secretary shall promulgate regulations to define the dependents to which coverage shall be made available under section #bgjc;,a of the ,public ,health ,service ,act1 as added by paragraph 7#a74 7b7 ,individual market ,subpart #a of part ,b of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is amended by adding at the end the following3 #bgdh4 ,extension of dependent coverage ,the provisions of section #bgjc;,a shall apply to health insurance coverage offered to individuals by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in the group market4 4 #i4 ,application of group market reforms to ,,erisa and the ,internal ,revenue ,code of #aihf 7a7 ,,erisa 7#a7 ,in general ,subpart ,a of title ,,vii of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha et seq47 is amended-- 7,a7 by striking sections #gja and #gjc2 and 7,b7 by inserting before section #gjb the following3 #gja4 ,application of certain ,,phsa requirements 7a7 ,in general ,sections #bgja1 #bgjc1 #bgjc;,a1 #bgjh1 #bgaa1 and #bgab of the ,public ,health ,service ,act shall apply to group health plans1 and health insurance issuers providing health insurance coverage in connection with group health plans1 as if included in this subpart4 7b7 ,conflict ,to the extent that any provision of this part conflicts with a provision of any section of the ,public ,health ,service ,act listed in subsection 7a7 with respect to group health plans1 or health insurance issuers providing health insurance coverage in connection with group health plans1 the provisions of such sections shall apply4 4 7#b7 ,conforming amendment ,the table of contents in section #a of such ,act 7#bi ,u4,s4,c4 #ajja note7 is amended-- 7,a7 by striking the item related to section #gja and inserting ,sec4 #gja4 ,application of certain ,,phsa requirements42 and 7,b7 by striking the item related to section #gjc4 7b7 ,internal ,revenue ,code of #aihf ,subchapter ,a of chapter #ajj of the ,internal ,revenue ,code of #aihf 7relating to group health plan requirements7 is amended-- 7#a7 by striking sections #ihja and #ihjc2 and 7#b7 by inserting before section #ihjb the following3 #ihja4 ,application of certain ,,phsa requirements 7a7 ,in general ,sections #bgja1 #bgjc1 #bgjc;,a1 #bgjh1 #bgaa1 and #bgab of the ,public ,health ,service ,act shall apply to group health plans1 and health insurance issuers providing health insurance coverage in connection with group health plans1 as if included in this subchapter4 7b7 ,conflict ,to the extent that any provision of this subchapter conflicts with a provision of any section of the ,public ,health ,service ,act listed in subsection 7a7 with respect to group health plans1 or health insurance issuers providing health insurance coverage in connection with group health plans1 the provisions of such sections shall apply4 4 #aj4 ,catastrophic plan ,subpart #a of part ,b of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is amended by adding at the end the following3 #bgdi4 ,catastrophic plan 7a7 ,in general ,each health insurance issuer that offers health insurance coverage in the individual market in a ,state shall offer a catastrophic plan in such ,state in such market4 7b7 ,coverage requirements ,to meet the requirements of this section1 a catastrophic plan must provide for the essential health benefits1 as defined by the ,secretary under subsection 7c74 7c7 ,essential health benefits ,the ,secretary shall define the essential health benefits1 except that such benefits shall include-- 7#a7 coverage for at least three primary care visits during a plan year2 and 7#b7 at least the following general categories and the items and services covered within the categories3 7,a7 ,ambulatory patient services4 7,b7 ,emergency services4 7,c7 ,hospitalization4 7,d7 ,maternity and newborn care4 7,e7 ,mental health and substance use disorder services1 including behavioral health treatment4 7,f7 ,prescription drugs4 7,g7 ,rehabilitative and habilitative services and devices4 7,h7 ,laboratory services4 7,i7 ,preventive and wellness services and chronic disease management4 7,j7 ,pediatric services1 including oral and vision care4 7d7 ,restriction to individual market ,if a health insurance issuer offers a health plan described in this section1 the issuer may only offer the plan in the individual market4 4 #aa4 ,grants for health insurance risk adjustment mechanisms 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall make grants to ,states for planning for the establishment and implementation of health insurance risk adjustment mechanisms4 7b7 ,amount 7#a7 ,in general ,the ,secretary shall determine the amount of a grant made to a ,state under this section pursuant to a formula1 issued by rule not later than one year after the date of the enactment of the ,,ppaca repeal legislation described in section #b7;b71 that takes into account the number of high-risk individuals in such ,state4 7#b7 ,limitation ,the amount of a grant made to a ,state under this section shall not exceed #a1jjj1jjj for any fiscal year4 7c7 ,use of funds ,the grant funds made available to a ,state under this section may only be used by a ,state for the cost associated with planning for the establishment and implementation of health insurance risk adjustment mechanisms4 ,such funds may not be used for costs related to administering such mechanisms4 7d7 ,definitions ,for purposes of this section3 7#a7 ,high-risk individual ,the term high-risk individual means an individual who-- 7,a7 is a citizen or national of the ,united ,states or is lawfully present in the ,united ,states2 7,b7 has not been covered under creditable coverage 7as defined in section #bgja7;c77#a7 of the ,public ,health ,service ,act as in effect on ,march #bb1 #bjaj7 during the previous #f-month period2 and 7,c7 has a preexisting condition1 as determined in a manner consistent with guidance issued by the ,secretary4 7#b7 ,health insurance risk-adjustment mechanisms 7,a7 ,in general ,with respect to a ,state1 the term health insurance risk-adjustment mechanism shall be a mechanism that applies to-- 7i7 all health insurance issuers who offer health insurance coverage in such ,state2 and 7ii7 all covered lives for health insurance coverage offered in such ,state that is subject to the requirements of section #bgaa or section #bgda of the ,public ,health ,service ,act1 as added by section #c of this ,act4 7,b7 ,further definition ,with respect to a ,state1 any further definition of such term shall be determined by the ,state insurance commissioner1 acting in cooperation with health insurance issuers who offer health insurance coverage in such ,state4 7#c7 ,state ,the term ,state means each of the #ej ,states and the ,district of ,columbia4 7e7 ,sunset date ,the ,secretary may not make any grants under this section after the date that is #b years after the date of the enactment of the ,,ppaca repeal legislation described in section #b7;b74 #ab4 ,liability protections for health care providers 7a7 ,health care providers protected ,the liability protections in subsection 7c7 shall apply in any civil action1 including an action before any court of any ,state1 against a health care provider1 arising from health care goods or services that-- 7#a7 were provided by a health care provider in a hospital to which the requirements of section #ahfg of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd7 apply2 and 7#b7 were provided only because they were required under section #ahfg of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd74 7b7 ,burden of proof ,in any proceeding under subsection 7a71 the burden of proof shall be on the defendant to establish the elements in paragraphs 7#a7 and 7#b7 of subsection 7a74 7c7 ,liability protections 7#a7 ,cap on noneconomic damages ,the amount of noneconomic damages1 if available1 shall not exceed #bej1jjj1 regardless of the number of parties against whom the action is brought with respect to the same injury4 ,an award for noneconomic damages in excess of #bej1jjj shall be reduced either before entry of the order granting judgment1 or by amendment of such order4 7#b7 ,installment payments ,if the award for damages exceeds #ej1jjj1 the defendant may pay such damages in installments1 as determined by the court4 7#c7 ,attorney fees ,any contingent fee for a party's attorney shall not exceed-- 7,a7 #dj percent of the portion of the award amount that does not exceed #ej1jjj2 7,b7 #cca_/c percent of the portion of the award amount that exceeds #ej1jjj but does not exceed #ajj1jjj2 7,c7 #be percent of the portion of the award amount that exceeds #ajj1jjj but does not exceed #fjj1jjj2 and 7,d7 #ae percent of the portion of the award amount that exceeds #fjj1jjj4 7#d7 ,disclosure of collateral source benefits ,any person bringing a civil action described in subsection 7a7 shall1 and any party may1 disclose or introduce evidence of collateral source benefits4 7#e7 ,preemption 7,a7 ,in general ,the provisions of this ,act preempt1 subject to subparagraphs 7,b7 and 7,c71 ,state law to the extent that ,state law prevents the application of any provisions of law established by or under this ,act4 ,the provisions governing an action described in subsection 7a7 set forth in this ,act supersede chapter #aga of title #bh1 ,united ,states ,code1 to the extent that such chapter-- 7i7 provides for a greater amount of damages or contingent fees1 a longer period in which a health care lawsuit may be commenced1 or a reduced applicability or scope of periodic payment of future damages1 than provided in this ,act2 or 7ii7 prohibits the introduction of evidence regarding collateral source benefits1 or mandates or permits subrogation or a lien on collateral source benefits4 7,b7 ,greater protections preserved ,this ,act shall not preempt or supersede any ,state or ,federal law that imposes greater procedural or substantive protections for health care providers from liability1 loss1 or damages than those provided by this ,act or create a cause of action4 7,c7 ,rule of construction ,no provision of this ,act shall be construed to preempt-- 7i7 any ,state law 7whether effective before1 on1 or after the date of the enactment of this ,act7 that specifies a particular monetary amount of compensatory or punitive damages 7or the total amount of damages7 that may be awarded in an action described in subsection 7a71 regardless of whether such monetary amount is greater or lesser than is provided for under this ,act2 or 7ii7 any defense available to a party in an action described in subsection 7a7 under any other provision of ,state or ,federal law4 7#f7 ,definitions 7,a7 ,collateral source benefits ,as used in this section1 the term collateral source benefits means any amount paid or reasonably likely to be paid in the future to or on behalf of the claimant1 or any service1 product1 or other benefit provided or reasonably likely to be provided in the future to or on behalf of the claimant1 as a result of the personal harm1 pursuant to-- 7i7 any ,state or ,federal health1 sickness1 income-disability1 accident1 or workers' compensation law2 7ii7 any health1 sickness1 income-disability1 or accident insurance that provides health benefits or income-disability coverage2 7iii7 any contract or agreement of any group1 organization1 partnership1 or corporation to provide1 pay for1 or reimburse the cost of medical1 hospital1 dental1 or income-disability benefits2 and 7iv7 any other publicly or privately funded program4 7,b7 ,noneconomic damages ,as used in this section1 the term noneconomic damages means damages for physical and emotional pain1 suffering1 inconvenience1 physical impairment1 mental anguish1 disfigurement1 loss of enjoyment of life1 loss of society and companionship1 loss of consortium 7other than loss of domestic service71 hedonic damages1 injury to reputation1 and all other nonpecuniary losses of any kind or nature4 7,c7 ,health care provider ,as used in this section1 the term health care provider means any person or entity required by ,state or ,federal laws or regulations to be licensed1 registered1 or certified to provide health care services1 and being either so licensed1 registered1 or certified1 or exempted from such requirement by other statute4 7,d7 ,health care goods or services ,as used in this section1 the term health care goods or services means any goods or services provided by a health care organization1 provider1 or by any individual working under the supervision of a health care provider1 that relates to the diagnosis1 prevention1 or treatment of any human disease or impairment1 or the assessment or care of the health of human beings4