,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #bfhh  ,,in ,,the ,,house ,,of  
,,representatives  ,july #ae1 #bjac ,mr4
 ,ross introduced the following bill2   
which was referred to the ,committee on 
,ways and ,means1 and in addition to the
 ,committee on ,energy and ,commerce1   
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     
improve healthcare-related1             
tax-preferred savings accounts and to   
provide for cooperative governing of    
individual and group health insurance   
coverage across ,state lines1 and for   
other purposes4  #a4 ,short title2 table
 of contents  7a7 ,short title ,this    
,act may be cited as the ,providing     
,accountability and ,transparency to    
,incentivize ,economically ,necessary   
,transitions in ,health ,care ,act of   
#bjac or the ,,patient's ,health ,care  
,act of #bjac4  7b7 ,table of contents  

,the table of contents for this ,act is 
as follows3  ,sec4 #a4 ,short title2    
table of contents4 ,title               
,i--,healthcare-related savings accounts
 ,sec4 #aja4 ,deduction of premiums for 
high deductible health plans4 ,sec4     
#ajb4 ,repeal of high deductible health 
plan requirement4 ,sec4 #ajc4 ,increase 
in deductible ,,hsa contribution        
limitations4 ,sec4 #ajd4 ,medicare      
eligible individuals eligible to        
contribute to ,,hsa4 ,sec4 #aje4 ,,hsa  
rollover to ,medicare ,advantage ,,msa4 
,sec4 #ajf4 ,one-time transfer of       
flexible spending arrangement balance to
 health savings account in case of      
separation from employment4 ,sec4 #ajg4 
,payment of high deductible health plan 
premiums from ,,hsa4 ,sec4 #ajh4 ,repeal
 of disqualification of expenses for    
over-the-counter drugs under certain    
accounts and arrangements4 ,sec4 #aji4  
,payment of long-term care premiums from
 health flexible spending arrangement4  
,sec4 #aaj4 ,allowing ,,msa and ,,hsa   

rollover to adult child of account      
holder4 ,sec4 #aaa4 ,disposition of     
unused health benefits in cafeteria     
plans and flexible spending             
arrangements4 ,sec4 #aab4 ,permitting   
beneficiary contributions to ,medicare  
,advantage ,,msa4 ,sec4 #aac4 ,child    
health savings account4 ,title          
,,ii--,health insurance provisions ,sec4
 #bja4 ,cooperative governing of        
individual and group health insurance   
coverage4 ,sec4 #bjb4 ,reauthorization  
of the ,preexisting ,condition          
,insurance ,plan 7,,pcip7 ,program4  ,i 
,healthcare-related savings accounts    
#aja4 ,deduction of premiums for high   
deductible health plans  7a7 ,in general
 ,part ,,vii of subchapter ,b of chapter
 #a of the ,internal ,revenue ,code of  
#aihf is amended by redesignating       
section #bbd as section #bbe and by     
inserting after section #bbc the        
following new section3  #bbd4 ,premiums 
for high deductible health plans  7a7   
,deduction allowed ,in the case of an   

individual1 there shall be allowed as a 
deduction for the taxable year the      
aggregate amount paid by such individual
 as premiums under a high deductible    
health plan with respect to months      
during such year for which such         
individual is an eligible individual    
with respect to such health plan4  7b7  
,definitions ,for purposes of this      
section--  7#a7 ,eligible individual    
7,a7 ,in general ,the term eligible     
individual means1 with respect to any   
month1 any individual if--  7i7 such    
individual is covered under a high      
deductible health plan as of the #ast   
day of such month1 and  7ii7 such       
individual is not1 while covered under a
 high deductible health plan1 covered   
under any health plan--  7,i7 which is  
not a high deductible health plan1 and  
7,,ii7 which provides coverage for any  
benefit which is covered under the high 
deductible health plan4  7,b7 ,certain  
coverage disregarded ,subparagraph      
7,a77ii7 shall be applied without regard

 to--  7i7 coverage for any benefit     
provided by permitted insurance1  7ii7  
coverage 7whether through insurance or  
otherwise7 for accidents1 disability1   
dental care1 vision care1 or long-term  
care1 and  7iii7 coverage under a health
 flexible spending arrangement during   
any period immediately following the end
 of a plan year of such arrangement     
during which unused benefits or         
contributions remaining at the end of   
such plan year may be paid or reimbursed
 to plan participants for qualified     
benefit expenses incurred during such   
period if--  7,i7 the balance in such   
arrangement at the end of such plan year
 is zero1 or  7,,ii7 the individual is  
making a qualified ,,hsa distribution   
7as defined in section #ajf7;e77 in an  
amount equal to the remaining balance in
 such arrangement as of the end of such 
plan year1 in accordance with rules     
prescribed by the ,secretary4  7#b7     
,high deductible health plan  7,a7 ,in  
general ,the term high deductible health

 plan means a health plan--  7i7 which  
has an annual deductible which is not   
less than--  7,i7 #a1jjj for self-only  
coverage1 and  7,,ii7 twice the dollar  
amount in subclause 7,i7 for family     
coverage1 and  7ii7 the sum of the      
annual deductible and the other annual  
out-of-pocket expenses required to be   
paid under the plan 7other than for     
premiums7 for covered benefits does not 
exceed--  7,i7 #e1jjj for self-only     
coverage1 and  7,,ii7 twice the dollar  
amount in subclause 7,i7 for family     
coverage4  7,b7 ,exclusion of certain   
plans ,such term does not include a     
health plan if substantially all of its 
coverage is described in paragraph      
7#a77;,b74  7,c7 ,safe harbor for       
absence of preventive care deductible ,a
 plan shall not fail to be treated as a 
high deductible health plan by reason of
 failing to have a deductible for       
preventive care 7within the meaning of  
section #ahga of the ,social ,security  
,act1 except as otherwise provided by   

the ,secretary74  7,d7 ,special rule for
 annual out-of-pocket limitation for    
network plans ,in the case of a plan    
using a network of providers1 such plan 
shall not fail to be treated as a high  
deductible health plan by reason of     
having an out-of-pocket limitation for  
services provided outside of such       
network which exceeds the applicable    
limitation under subparagraph 7,a77ii74 
7#c7 ,permitted insurance ,the term     
permitted insurance means--  7,a7       
insurance if substantially all of the   
coverage provided under such insurance  
relates to--  7i7 liabilities incurred  
under workers' compensation laws1  7ii7 
tort liabilities1  7iii7 liabilities    
relating to ownership or use of         
property1 or  7iv7 such other similar   
liabilities as the ,secretary may       
specify by regulations1  7,b7 insurance 
for a specified disease or illness1 and 
7,c7 insurance paying a fixed amount per
 day 7or other period7 of               
hospitalization4  7#d7 ,family coverage 

,the term family coverage means any     
coverage other than self-only coverage4 
7c7 ,special rules  7#a7 ,deduction     
allowable for only #a plan ,for purposes
 of this section1 in the case of an     
individual covered by more than #a high 
deductible health plan for any month1   
the individual may only take into       
account amounts paid for #a of such     
plans for such month4  7#b7 ,employer   
provided coverage  7,a7 ,in general ,no 
deduction shall be allowed to an        
individual under subsection 7a7 for any 
amount paid for coverage under a high   
deductible health plan for a month if   
that individual participates in any     
coverage for such month that is excluded
 7in whole or in part7 from the gross   
income of the individual or the         
individual's spouse under section #ajf4 
7,b7 ,cafeteria plans1 etc ,employer    
contributions to a cafeteria plan or a  
flexible spending or similar arrangement
 which are excluded from gross income   
under section #ajf shall be treated for 

purposes of this section as paid by the 
employer4  7#c7 ,contributions to health
 savings account required ,a deduction  
shall not be allowed under subsection   
7a7 for a taxable year with respect to  
such individual if such individual is   
not allowed a deduction under section   
#bbc for such taxable year4  7#d7       
,medical and health savings accounts    
,subsection 7a7 shall not apply with    
respect to any amount which is paid or  
distributed out of an ,archer ,,msa or a
 health savings account which is not    
included in gross income under section  
#bbj7;f7 or #bbc7;f71 as the case may   
be4  7#e7 ,coordination with deduction  
for health insurance of self-employed   
individuals ,the amount taken into      
account by the taxpayer in computing the
 deduction under section #afb7l7 shall  
not be taken into account under this    
section4  7#f7 ,coordination with       
medical expense deduction ,the amount   
taken into account by the taxpayer in   
computing the deduction under this      

section shall not be taken into account 
under section #bac4  4  7b7 ,deduction  
allowed whether or not individual       
itemizes other deductions ,subsection   
7a7 of section #fb of such ,code is     
amended by inserting after paragraph    
7#ba7 the following new paragraph3      
7#bb7 ,premiums for high deductible     
health plans ,the deduction allowed by  
section #bbd4  4  7c7 ,clerical         
amendment ,the table of sections for    
part ,,vii of subchapter ,b of chapter  
#a of such ,code is amended by striking 
the last item and inserting the         
following new items3  ,sec4 #bbd4       
,premiums for high deductible health    
plans4 ,sec4 #bbe4 ,cross reference4  4 
7d7 ,effective date ,the amendments made
 by this section shall apply to taxable 
years beginning after ,december #ca1    
#bjac4  #ajb4 ,repeal of high deductible
 health plan requirement  7a7 ,in       
general ,subsection 7a7 of section #bbc 
of such ,code is amended to read as     
follows3  7a7 ,deduction allowed ,in the

 case of an individual1 there shall be  
allowed as a deduction for a taxable    
year an amount equal to the aggregate   
amount paid in cash during such taxable 
year by or on behalf of such individual 
to a health savings account of such     
individual4  4  7b7 ,conforming         
amendments  7#a7 ,section #bbc of such  
,code is amended by striking subsection 
7c7 and redesignating subsections 7d7   
through 7h7 as subsections 7c7 through  
7g71 respectively4  7#b7 ,section       
#bbc7;b7 of such ,code is amended by    
striking paragraph 7#h74  7#c7          
,subparagraph 7,a7 of section           
#bbc7;c77#a7 of such ,code 7as          
redesignated by paragraph 7#a77 is      
amended--  7,a7 by striking subsection  
7f77#e7 and inserting subsection        
7e77#e71 and  7,b7 in clause 7ii7--  7i7
 by striking the sum of-- and all that  
follows and inserting the dollar amount 
in effect under subsection 7b77#a744    
7#d7 ,section #bbc7;f77#a7 of such ,code
 7as redesignated by paragraph 7#a77 is 

amended by striking ,each dollar amount 
in subsections 7b77#b7 and 7c77#b77;,a7 
and inserting ,in the case of a taxable 
year beginning after ,december #ca1     
#bjaj1 each dollar amount in subsection 
7b77#a74  7#e7 ,section #bf7;b77,u7 of  
such ,code is amended by striking       
section #bbc7;f77#d7 and inserting      
section #bbc7;e77#d74  7#f7 ,sections   
#ce7;g77#c71 #bbj7;f77#e77;,a71         
#hdh7;e77#a77v71 #digc7;a77#e71 and     
#fjea7;a77#ab7 of such ,code are each   
amended by striking section #bbc7;d7    
each place it appears and inserting     
section #bbc7;c74  7#g7 ,section        
#ajf7;d77#a7 of such ,code is amended-- 
7,a7 by striking who is an eligible     
individual 7as defined in section       
#bbc7;c77#a771 and  7,b7 by striking    
section #bbc7;d7 and inserting section  
#bbc7;c74  7#h7 ,section #djh7;d77#i7 of
 such ,code is amended--  7,a7 in       
subparagraph 7,a7 by striking who is an 
eligible individual 7as defined in      
section #bbc7;c77 and1 and  7,b7 in     

subparagraph 7,c7 by striking computed  
on the basis of the type of coverage    
under the high deductible health plan   
covering the individual at the time of  
the qualified ,,hsa funding             
distribution4  7#i7 ,section            
#hgg;,a7g77#f7 of such ,code is amended 
by striking #bbc7;f77#d7 and inserting  
#bbc7;e77#d74  7#aj7 ,section #digc7;g7 
of such ,code is amended--  7,a7 by     
striking section #bbc7;d7 and inserting 
section #bbc7;c71  7,b7 in paragraph    
7#b71 by striking section #bbc7;f77#b7  
and inserting section #bbc7;e77#b71 and 
7,c7 by striking section #bbc7;f77#c7   
and inserting section #bbc7;e77#c74     
7#aa7 ,section #dige of such ,code is   
amended--  7,a7 in subsection 7c77#f7-- 
7i7 by striking section #bbc7;d7 and    
inserting section #bbc7;c71 and  7ii7 by
 striking section #bbc7;e77#b7 and      
inserting section #bbc7;d77#b71 and     
7,b7 in subsection 7e77#a77;,e71 by     
striking section #bbc7;d7 and inserting 
section #bbc7;c74  7#ab7 ,section       

#ffic7;a77#b77;,c7 of such ,code is     
amended by striking section #bbc7;h7 and
 inserting section #bbc7;g74  7c7       
,effective date ,the amendments made by 
this section shall apply to taxable     
years beginning after ,december #ca1    
#bjaa4  #ajc4 ,increase in deductible   
,,hsa contribution limitations  7a7 ,in 
general ,paragraph 7#a7 of section      
#bbc7;b7 of the ,internal ,revenue ,code
 of #aihf is amended by striking the sum
 of the monthly and all that follows    
through eligible individual and         
inserting #aj1jjj 7#bj1jjj in the case  
of a joint return74  7b7 ,additional    
contributions ,paragraph 7#c7 of section
 #bbc7;b7 is amended to read as follows3
  7#c7 ,additional contributions for    
individuals between #ee and #fe ,in the 
case of an individual who has attained  
the age of #ee1 but has not attained the
 age of #ff1 before the close of the    
taxable year1 the limitation under      
paragraph 7#a7 shall be increased by    
#aj1jjj4  4  7c7 ,conforming amendments 

7#a7 ,section #bbc7;b7 of such ,code1 as
 amended by this ,act1 is amended by    
striking paragraphs 7#b7 and 7#e7 and by
 redesignating paragraphs 7#c71 7#d71   
7#f71 and 7#g7 as paragraphs 7#b71 7#c71
 7#d71 and 7#e71 respectively4  7#b7    
,section #bbc7;c77#a77;,a77ii7 of such  
,code 7as redesignated by this ,act7 is 
amended by striking the sum of-- and all
 that follows and inserting the dollar  
amount in effect under subsection       
7b77#a744  7#c7 ,section #bbc7;f77#a7 of
 such ,code 7as redesignated by this    
,act7 is amended by striking ,each      
dollar amount in subsections 7b77#b7 and
 7c77#b77;,a7 and inserting ,in the case
 of a taxable year beginning after      
,december #ca1 #bjac1 each dollar amount
 in subsection 7b77#a74  7#d7 ,paragraph
 7#c7 of section #bbc7;b7 of such ,code 
7as redesignated by paragraph 7#a77 is  
amended by striking the last sentence4  
7d7 ,effective date ,the amendments made
 by this section shall apply to taxable 
years beginning after ,december #ca1    

#bjac4  #ajd4 ,medicare eligible        
individuals eligible to contribute to   
,,hsa  7a7 ,subsection 7b7 of section   
#bbc of the ,internal ,revenue ,code of 
#aihf1 as amended by this ,act1 is      
amended by striking paragraph 7#d74  7b7
 ,effective date ,the amendments made by
 this section shall apply to taxable    
years beginning after ,december #ca1    
#bjac4  #aje4 ,,hsa rollover to         
,medicare ,advantage ,,msa  7a7 ,in     
general ,paragraph 7#b7 of section      
#ach7;b7 of the ,internal ,revenue ,code
 of #aihf is amended by striking or at  
the end of subparagraph 7,a71 by adding 
or at the end of subparagraph 7,c71 and 
by adding at the end the following new  
subparagraph3  7,c7 a ,,hsa rollover    
contribution described in subsection    
7c77#e71  4  7b7 ,,hsa rollover         
contribution ,subsection 7c7 of section 
#ach of such ,code is amended by adding 
at the end the following new paragraph3 
7#e7 ,rollover contribution ,an amount  
is described in this paragraph as a     

rollover contribution if it meets the   
requirements of subparagraphs 7,a7 and  
7,b74  7,a7 ,in general ,the            
requirements of this subparagraph are   
met in the case of an amount paid or    
distributed from a health savings       
account to the account beneficiary to   
the extent the amount received is paid  
into a ,medicare ,advantage ,,msa of    
such beneficiary not later than the     
#fjth day after the day on which the    
beneficiary receives the payment or     
distribution4  7,b7 ,limitation ,this   
paragraph shall not apply to any amount 
described in subparagraph 7,a7 received 
by an individual from a health savings  
account if1 at any time during the      
#a-year period ending on the day of such
 receipt1 such individual received any  
other amount described in subparagraph  
7,a7 from a health savings account which
 was not includible in the individual's 
gross income because of the application 
of section #bbc7;e77#e77;,a74  4  7c7   
,conforming amendment ,subparagraph 7,a7

 of section #bbc7;e77#e7 of such ,code1 
as amended by this ,act1 is amended by  
inserting or ,medicare ,advantage ,,msa 
after into a health savings account4    
7d7 ,effective date ,the amendments made
 by this section shall apply to taxable 
years beginning after ,december #ca1    
#bjac4  #ajf4 ,one-,time transfer of    
flexible spending arrangement balance to
 health savings account in case of      
separation from employment  7a7 ,in     
general ,section #abe of the ,internal  
,revenue ,code of #aihf is amended by   
redesignating subsection 7j7 as         
subsection 7k7 and by inserting after   
subsection 7i7 the following new        
subsection3  7j7 ,one-,time transfer of 
remaining balance in health flexible    
spending arrangement after separation   
from employment  7#a7 ,in general ,for  
purposes of this title1 a plan shall not
 fail to be treated as a health flexible
 spending arrangement solely because a  
participant may1 in connection with     
separation from employment with the     

employer1 direct amounts in the         
participant's account under such        
arrangement to be contributed on behalf 
of the participant to a health savings  
account 7as defined in section #bbc7;c77
 maintained for the benefit of the      
participant4  4  7b7 ,conforming        
amendment ,section #bbc7;c77#a77;,a7 of 
such ,code1 as amended by this ,act1 is 
amended by striking or section          
#bbj7;f77#e7 and inserting 1 section    
#abe7;j71 or section #bbj7;f77#e74  7c7 
,effective date ,the amendments made by 
this section shall apply to taxable     
years beginning after ,december #ca1    
#bjac4  #ajg4 ,payment of high          
deductible health plan premiums from    
,,hsa  7a7 ,in general ,subparagraph    
7,b7 of section #bbc7;c77#b7 of such    
,code1 as amended by this ,act1 is      
amended by inserting other than a high  
deductible plan 7as defined in section  
#bbd7;b77#b77 before the period at the  
end4  7b7 ,effective date ,the amendment
 made by this section shall apply to    

taxable years beginning after ,december 
#ca1 #bjac4  #ajh4 ,repeal of           
disqualification of expenses for        
over-the-counter drugs under certain    
accounts and arrangements  7a7 ,h,s,as  
,subparagraph 7,a7 of section           
#bbc7;c77#b7 of the ,internal ,revenue  
,code of #aihf1 as amended by this ,act1
 is amended by striking the last        
sentence4  7b7 ,archer ,m,s,as          
,subparagraph 7,a7 of section           
#bbj7;d77#b7 of such ,code is amended by
 striking the last sentence4  7c7       
,health flexible spending arrangements  
and health reimbursement arrangements   
,section #ajf of such ,code is amended  
by striking subsection 7f74  7d7        
,effective date ,the amendments made by 
this section shall apply to expenses    
incurred after ,december #ca1 #bjac4    
#aji4 ,payment of long-term care        
premiums from health flexible spending  
arrangement  7a7 ,in general ,section   
#abe of the ,internal ,revenue ,code of 
#aihf1 as amended by this ,act1 is      

amended by inserting after subsection   
7h7 the following new subsection3  7i7  
,payment of long-,term care premiums    
from health flexible spending           
arrangement  7#a7 ,in general ,no       
payment for insurance may be made from a
 health flexible spending arrangement4  
7#b7 ,long-term care insurance          
,paragraph 7#a7 shall not apply to any  
expense for coverage under a qualified  
long-term care insurance contract 7as   
defined in section #ggjb;,b7b774  4  7b7
 ,effective date ,the amendments made by
 this section shall apply to taxable    
years beginning after ,december #ca1    
#bjac4  #aaj4 ,allowing ,,msa and ,,hsa 
rollover to adult child of account      
holder  7a7 ,m,s,as  7#a7 ,in general   
,subparagraph 7,a7 of section           
#bbj7;f77#h7 of the ,internal ,revenue  
,code of #aihf 7relating to treatment   
after death of account holder7 is       
amended--  7,a7 by inserting or adult   
child after surviving spouse1  7,b7 by  
inserting or adult child1 as the case   

may be1 after the spouse1 and  7,c7 by  
inserting or adult child after spouse in
 the heading thereof4  7#b7 ,adult child
 defined ,paragraph 7#h7 of section     
#bbj7;f7 of such ,code is amended by    
adding at the end the following new     
subparagraph3  7,c7 ,adult child ,for   
purposes of this paragraph1 the term    
adult child means an individual--  7i7  
who is a child of the deceased          
individual1 and  7ii7 with respect to   
whom a deduction under section #aea     
would not be allowable to another       
taxpayer for a taxable year beginning in
 the calendar year in which such        
individual's taxable year begins4  4    
7b7 ,h,s,as  7#a7 ,in general           
,subparagraph 7,a7 of section           
#bbc7;e77#h7 of such ,code1 as amended  
by this ,act1 is amended--  7,a7 by     
inserting or adult child after surviving
 spouse1  7,b7 by inserting or adult    
child1 as the case may be1 after the    
spouse1 and  7,c7 by inserting or adult 
child after spouse in the heading       

thereof4  7#b7 ,adult child defined     
,paragraph 7#h7 of section #bbc7;e7 of  
such ,code1 as amended by this ,act1 is 
amended by adding at the end the        
following new subparagraph3  7,c7 ,adult
 child ,for purposes of this paragraph1 
the term adult child has the meaning    
given such term by section              
#bbj7;f77#h77;,c74  4  7c7 ,effective   
date ,the amendments made by this       
section shall apply to taxable years    
beginning after ,december #ca1 #bjac4   
#aaa4 ,disposition of unused health     
benefits in cafeteria plans and flexible
 spending arrangements  7a7 ,in general 
,section #abe of the ,internal ,revenue 
,code of #aihf is amended by            
redesignating subsections 7k7 and 7l7 as
 subsections 7l7 and 7m71 respectively1 
and by inserting after subsection 7j7   
the following3  7k7 ,carryforwards or   
payments of certain unused health       
benefits  7#a7 ,in general ,for purposes
 of this title1 a plan or other         
arrangement shall not fail to be treated

 as a cafeteria plan solely because     
qualified benefits under such plan      
include a health flexible spending      
arrangement under which not more than   
#ejj of unused health benefits may be-- 
7,a7 carried forward to the succeeding  
plan year of such health flexible       
spending arrangement1 or  7,b7 paid to  
or on behalf of an employee as          
compensation as of the end of such plan 
year or upon the termination of1 or     
failure to re-enroll in1 such plan or   
arrangement4  7#b7 ,distribution of     
unused health benefits on behalf of     
employee ,for purposes of paragraph     
7#a77;,b71 unused health benefits paid  
as compensation on behalf of an employee
 by the employer shall be--  7,a7       
includible in gross income and wages of 
the employee1 whether or not a deduction
 for such payment is allowable under    
this title to the employee1 and  7,b7   
excludable from--  7i7 gross income to  
the extent provided under section       
#djb7;e71 #deg7;a7 7with respect to     

contributions to an eligible deferred   
compensation plan 7as defined in section
 #deg7;b77 of an eligible employer      
described in section #deg7;e77#a77;,a771
 or #bbj1 and  7ii7 wages to the extent 
otherwise provided for amounts so       
excludable4  7#c7 ,unused health        
benefits ,for purposes of this          
subsection1 the term unused health      
benefits means the excess of--  7,a7 the
 maximum amount of reimbursement        
allowable during a plan year under a    
health flexible spending arrangement1   
over  7,b7 the actual amount of         
reimbursement during such year under    
such arrangement4  4  7b7 ,effective    
date ,the amendment made by subsection  
7a7 shall apply to taxable years        
beginning after ,december #ca1 #bjac4   
#aab4 ,permitting beneficiary           
contributions to ,medicare ,advantage   
,,msa  7a7 ,in general ,subsection 7b7  
of section #ach of such ,code is amended
 by striking paragraph 7#b7 and by      
redesignating paragraphs 7#c7 and 7#d7  

as paragraphs 7#b7 and 7#c71            
respectively4  7b7 ,effective date ,the 
amendments made by this section shall   
apply to taxable years beginning after  
,december #ca1 #bjac4  #aac4 ,child     
health savings account  7a7 ,in general 
,section #bbc of the ,internal ,revenue 
,code of #aihf1 as amended by this ,act1
 is amended by adding at the end the    
following new subsection3  7h7 ,child   
health savings accounts  7#a7 ,in       
general ,in the case of an individual1  
in addition to any deduction allowed    
under subsection 7a7 for any taxable    
year1 there shall be allowed as a       
deduction under this section an amount  
equal to the aggregate amount paid in   
cash by the taxpayer during the taxable 
year to a child health savings account  
of a child of the taxpayer4  7#b7       
,limitation ,the amount taken into      
account under paragraph 7#a7 with       
respect to each child of the taxpayer   
for the taxable year shall not exceed an
 amount equal to #c1jjj4  7#c7 ,child   

health savings account ,for purposes of 
this subsection1 the term child health  
savings account means a health savings  
account designated as a child health    
savings account and established for the 
benefit of a child of a taxpayer1 but   
only if--  7,a7 such account was        
established for the benefit of the child
 before the child attains the age of #e1
 and  7,b7 under the written governing  
instrument creating the trust1 no       
contribution will be accepted to the    
extent such contribution1 when added to 
previous contributions to the trust for 
the calendar year1 exceeds the dollar   
amount in effect under paragraph 7#b74  
7#d7 ,treatment of account before age   
#ah ,for purposes of this section1      
except as otherwise provided in this    
subsection1 a child health savings      
account established for the benefit of  
the child of a taxpayer shall be treated
 as a health savings account of the     
taxpayer until the child attains the age
 of #ah1 after which such account shall 

be treated as a health savings account  
of the child4  7#e7 ,distributions  7,a7
 ,in general ,in the case of a child    
health savings account established under
 this section for the benefit of a child
 of a taxpayer--  7i7 ,before age #ah   
,any amount paid or distributed out of  
such account before the child has       
attained the age of #ah1 shall be       
included in the gross income of the     
taxpayer1 and subparagraph 7,a7 of      
subsection 7f7 shall apply 7relating to 
additional tax on distributions not used
 for qualified medical expenses74  7ii7 
,age #ah and older ,any amount paid or  
distributed out of such account after   
the child has attained the age of #ah   
may only be treated as used to pay      
qualified medical expenses to the extent
 such child is not covered as a         
dependent under insurance 7other than   
permitted insurance7 of a parent4  7,b7 
,exceptions for disability or death of  
child ,if the child becomes disabled    
within the meaning of section #gb7m77#g7

 or dies--  7i7 subparagraph 7,a7 shall 
not apply to any subsequent payment or  
distribution1 and  7ii7 the taxpayer may
 rollover the amount in such account to 
an individual retirement plan of the    
taxpayer1 to any health savings account 
of the taxpayer1 or to any child health 
savings account of any other child of   
the taxpayer4  7,c7 ,health insurance   
may be purchased from account           
,subparagraph 7,b7 of subsection 7d77#b7
 shall not apply to any health savings  
account originally established as a     
child health savings account4  7#f7     
,regulations ,the ,secretary shall      
prescribe such regulations as may be    
necessary to carry out the purposes of  
this subsection1 including rules for    
determining application of this         
subsection in the case of legal         
guardians and in the case of parents of 
a child who file separately1 are        
separated1 or are not married4  4  7b7  
,effective date ,the amendments made by 
this section shall apply to taxable     

years beginning after ,december #ca1    
#bjac4  ,,ii ,health insurance          
provisions  #bja4 ,cooperative governing
 of individual and group health         
insurance coverage  7a7 ,in general     
,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 following new part3  ,d ,cooperative
 ,governing of ,individual and ,group   
,health ,insurance ,coverage  #bgie4    
,definitions ,in this part3  7#a7       
,primary state ,the term primary ,state 
means1 with respect to individual or    
group health insurance coverage offered 
by a health insurance issuer1 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 part4 ,an      
issuer1 with respect to a particular    
policy1 may only designate one such     
,state as its primary ,state with       
respect to all such coverage it offers4 
,such an issuer may not change the      

designated primary ,state with respect  
to individual or group health insurance 
coverage once the policy is issued1     
except that such a change may be made   
upon renewal of the policy4 ,with       
respect to such designated ,state1 the  
issuer is deemed to be doing business in
 that ,state4  7#b7 ,secondary state    
,the term secondary ,state means1 with  
respect to individual or group health   
insurance coverage offered by a health  
insurance issuer1 any ,state that is not
 the primary ,state4 ,in the case of a  
health insurance issuer that is selling 
a policy in1 or to a resident of1 a     
secondary ,state1 the issuer is deemed  
to be doing business in that secondary  
,state4  7#c7 ,health insurance issuer  
,the term health insurance issuer has   
the meaning given such term in section  
#bgia7;b77#b71 except that such an      
issuer must be licensed in the primary  
,state and be qualified to sell         
individual health insurance coverage in 
that ,state4  7#d7 ,individual health   

insurance coverage ,the term individual 
health insurance coverage means health  
insurance coverage offered in the       
individual market1 as defined in section
 #bgia7;e77#a74  7#e7 ,group health     
insurance coverage ,the term group      
health insurance coverage has the       
meaning given such term in              
#bgia7;b77#d74  7#f7 ,applicable state  
authority ,the term applicable ,state   
authority means1 with respect to a      
health insurance issuer in a ,state1 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 issuer4  7#g7 ,hazardous         
financial condition ,the term hazardous 
financial condition means that1 based on
 its present or reasonably anticipated  
financial condition1 a health insurance 
issuer is unlikely to be able--  7,a7 to
 meet obligations to policyholders with 
respect to known claims and reasonably  
anticipated claims2 or  7,b7 to pay     

other obligations in the normal course  
of business4  7#h7 ,covered laws  7,a7  
,in general ,the term covered laws means
 the laws1 rules1 regulations1          
agreements1 and orders governing the    
insurance business pertaining to--  7i7 
individual or group health insurance    
coverage issued by a health insurance   
issuer2  7ii7 the offer1 sale1 rating   
7including medical underwriting71       
renewal1 and issuance of individual or  
group health insurance coverage to an   
individual2  7iii7 the provision to an  
individual in relation to individual or 
group health insurance coverage of      
health care and insurance related       
services2  7iv7 the provision to an     
individual in relation to individual or 
group health insurance coverage of      
management1 operations1 and investment  
activities of a health insurance issuer2
 and  7v7 the provision to an individual
 in relation to individual or group     
health insurance coverage of loss       
control and claims administration for a 

health insurance issuer with respect to 
liability for which the issuer provides 
insurance4  7,b7 ,exception ,such term  
does not include any law1 rule1         
regulation1 agreement1 or order         
governing the use of care or cost       
management techniques1 including any    
requirement related to provider         
contracting1 network access or adequacy1
 health care data collection1 or quality
 assurance4  7#i7 ,state ,the term      
,state means the #ej ,states and        
includes the ,district of ,columbia1    
,puerto ,rico1 the ,virgin ,islands1    
,guam1 ,american ,samoa1 and the        
,northern ,mariana ,islands4  7#aj7     
,unfair claims settlement practices ,the
 term unfair claims settlement practices
 means only the following practices3    
7,a7 ,knowingly misrepresenting to      
claimants and insured individuals       
relevant facts or policy provisions     
relating to coverage at issue4  7,b7    
,failing to acknowledge with reasonable 
promptness pertinent communications with

 respect to claims arising under        
policies4  7,c7 ,failing to adopt and   
implement reasonable standards for the  
prompt investigation and settlement of  
claims arising under policies4  7,d7    
,failing to effectuate prompt1 fair1 and
 equitable settlement of claims         
submitted in which liability has become 
reasonably clear4  7,e7 ,refusing to pay
 claims without conducting a reasonable 
investigation4  7,f7 ,failing to affirm 
or deny coverage of claims within a     
reasonable period of time after having  
completed an investigation related to   
those claims4  7,g7 ,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
 them4  7,h7 ,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        
application4  7,i7 ,attempting to settle
 or settling claims on the basis of an  
application that was materially altered 
without notice to1 or knowledge or      
consent of1 the insured4  7,j7 ,failing 
to provide forms necessary to present   
claims within #ae calendar days of a    
request with reasonable explanations    
regarding their use4  7,k7 ,attempting  
to cancel a policy in less time than    
that prescribed in the policy or by the 
law of the primary ,state4  7#aa7 ,fraud
 and abuse ,the term fraud and abuse    
means an act or omission committed by a 
person who1 knowingly and with intent to
 defraud1 commits1 or conceals any      
material information concerning1 one or 
more of the following3  7,a7            
,presenting1 causing to be presented or 
preparing with knowledge or belief that 
it will be presented to or by an        

insurer1 a reinsurer1 broker or its     
agent1 false information as part of1 in 
support of or concerning a fact material
 to one or more of the following3  7i7  
,an application for the issuance or     
renewal of an insurance policy or       
reinsurance contract4  7ii7 ,the rating 
of an insurance policy or reinsurance   
contract4  7iii7 ,a claim for payment or
 benefit pursuant to an insurance policy
 or reinsurance contract4  7iv7         
,premiums paid on an insurance policy or
 reinsurance contract4  7v7 ,payments   
made in accordance with the terms of an 
insurance policy or reinsurance         
contract4  7vi7 ,a document filed with  
the commissioner or the chief insurance 
regulatory official of another          
jurisdiction4  7vii7 ,the financial     
condition of an insurer or reinsurer4   
7viii7 ,the formation1 acquisition1     
merger1 reconsolidation1 dissolution or 
withdrawal from one or more lines of    
insurance or reinsurance in all or part 
of a ,state by an insurer or reinsurer4 

7ix7 ,the issuance of written evidence  
of insurance4  7x7 ,the reinstatement of
 an insurance policy4  7,b7             
,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 transaction4  7,c7 ,transaction of 
the business of insurance in violation  
of laws requiring a license1 certificate
 of authority or other legal authority  
for the transaction of the business of  
insurance4  7,d7 ,attempt to commit1    
aiding or abetting in the commission of1
 or conspiracy to commit the acts or    
omissions specified in this paragraph4  
#bgif4 ,application of law  7a7 ,in     
general ,the covered laws of the primary
 ,state shall apply to individual and   
group health insurance coverage offered 
by a health insurance issuer in the     
primary ,state and in any secondary     

,state1 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 and only if the covered laws of  
the primary ,state--  7#a7 do not apply 
any age limitations with respect to who 
may purchase such coverage that is a    
high deductible health plan2 and  7#b7  
do not require such coverage that is a  
high deductible health plan to provide  
for any specific type of coverage4  7b7 
,exemptions from covered laws in a      
secondary state ,except as provided in  
this section1 a health insurance issuer 
with respect to its offer1 sale1 rating 
7including medical underwriting71       
renewal1 and issuance of individual or  
group health insurance coverage in any  
secondary ,state is exempt from any     
covered laws of the secondary ,state    
7and any rules1 regulations1 agreements1
 or orders sought or issued by such     
,state under or related to such covered 
laws7 to the extent that such laws      

would--  7#a7 make unlawful1 or         
regulate1 directly or indirectly1 the   
operation of the health insurance issuer
 operating in the secondary ,state1     
except that any secondary ,state may    
require such an issuer--  7,a7 to pay1  
on a nondiscriminatory basis1 applicable
 premium and other taxes 7including high
 risk pool assessments7 which are levied
 on insurers and surplus lines insurers1
 brokers1 or policyholders under the    
laws of the ,state2  7,b7 to register   
with and designate the ,state insurance 
commissioner as its agent solely for the
 purpose of receiving service of legal  
documents or process2  7,c7 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 condition1 if--  
7i7 the ,state insurance commissioner of
 the primary ,state has not done an     
examination within the period           
recommended by the ,national            

,association of ,insurance              
,commissioners2 and  7ii7 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 repetition2  7,d7 to comply 
with a lawful order issued--  7i7 in a  
delinquency proceeding commenced by the 
,state insurance commissioner if there  
has been a finding of financial         
impairment under subparagraph 7,c72 or  
7ii7 in a voluntary dissolution         
proceeding2  7,e7 to comply with an     
injunction issued by a court of         
competent jurisdiction1 upon a petition 
by the ,state insurance commissioner    
alleging that the issuer is in hazardous
 financial condition2  7,f7 to          
participate1 on a nondiscriminatory     
basis1 in any insurance insolvency      
guaranty association or similar         
association to which a health insurance 
issuer in the ,state is required to     

belong2  7,g7 to comply with any ,state 
law regarding fraud and abuse 7as       
defined in section #bgie7aj771 except   
that if the ,state seeks an injunction  
regarding the conduct described in this 
subparagraph1 such injunction must be   
obtained from a court of competent      
jurisdiction2  7,h7 to comply with any  
,state law regarding unfair claims      
settlement practices 7as defined in     
section #bgie7i772 or  7,i7 to comply   
with the applicable requirements for    
independent review under section #bgih  
with respect to coverage offered in the 
,state2  7#b7 require any individual or 
group health insurance coverage issued  
by the issuer to be countersigned by an 
insurance agent or broker residing in   
that secondary ,state2  7#c7 apply any  
age limitations with respect to who may 
purchase such coverage that is a high   
deductible health plan2  7#d7 require   
such coverage that is a high deductible 
health plan to provide for any specific 
type of coverage2 or  7#e7 otherwise    

discriminate against the issuer issuing 
insurance in both the primary ,state and
 in any secondary ,state4  7c7 ,clear   
and conspicuous disclosure ,a health    
insurance issuer shall provide the      
following notice1 in #ab-point bold     
type1 in any insurance coverage offered 
in a secondary ,state under this part by
 such a health insurance issuer and at  
renewal of the policy1 with the #e blank
 spaces therein being appropriately     
filled with the name of the health      
insurance issuer1 the name of primary   
,state1 the name of the secondary       
,state1 the name of the secondary       
,state1 and the name of the secondary   
,state1 respectively1 for the coverage  
concerned3 ,notice3 ,this policy is     
issued by  and is governed by the laws  
and regulations of the ,state of 1 and  
it has met all the laws of that ,state  
as determined by that ,state's          
,department of ,insurance4 ,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 1 including coverage of some  
services or benefits mandated by the law
 of the ,state of 4 ,additionally1 this 
policy is not subject to all of the     
consumer protection laws or restrictions
 on rate changes of the ,state of 4 ,as 
with all insurance products1 before     
purchasing this policy1 you should      
carefully review the policy and         
determine what health care services the 
policy covers and what benefits it      
provides1 including any exclusions1     
limitations1 or conditions for such     
services or benefits44  7d7 ,prohibition
 on certain reclassifications and       
premium increases  7#a7 ,in general ,for
 purposes of this section1 a health     
insurance issuer that provides          
individual or group health insurance    
coverage to an individual under this    
part in a primary or secondary ,state   
may not upon renewal--  7,a7 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    
individual2 or  7,b7 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 individual4  7#b7 ,construction 
,nothing in paragraph 7#a7 shall be     
construed to prohibit a health insurance
 issuer--  7,a7 from terminating or     
discontinuing coverage or a class of    
coverage in accordance with subsections 
7b7 and 7c7 of section #bgdb2  7,b7 from
 raising premium rates for all          
policyholders within a class based on   
claims experience2  7,c7 from changing  
premiums or offering discounted premiums
 to individuals who engage in wellness  
activities at intervals prescribed by   
the issuer1 if such premium changes or  
incentives--  7i7 are disclosed to the  
consumer in the insurance contract2     

7ii7 are based on specific wellness     
activities that are not applicable to   
all individuals2 and  7iii7 are not     
obtainable by all individuals to whom   
coverage is offered2  7,d7 from         
reinstating lapsed coverage2 or  7,e7   
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 issue4  7e7 ,prior offering 
of policy in primary state ,a health    
insurance issuer may not offer for sale 
individual or group health insurance    
coverage in a secondary ,state unless   
that coverage is currently offered for  
sale in the primary ,state4  7f7        
,licensing of agents or brokers for     
health insurance issuers ,any ,state may
 require that a person acting1 or       
offering to act1 as an agent or broker  
for a health insurance issuer with      
respect to the offering of individual or
 group health insurance coverage obtain 
a license from that ,state1 with        

commissions or other compensation       
subject to the provisions of the laws of
 that ,state1 except that a ,state may  
not impose any qualification or         
requirement which discriminates against 
a nonresident agent or broker4  7g7     
,documents for submission to state      
insurance commissioner ,each health     
insurance issuer issuing individual or  
group health insurance coverage in both 
primary and secondary ,states shall     
submit--  7#a7 to the insurance         
commissioner of each ,state in which it 
intends to offer such coverage1 before  
it may offer individual or group health 
insurance coverage in such ,state--     
7,a7 a copy of the plan of operation or 
feasibility study or any similar        
statement of the policy being offered   
and its coverage 7which shall include   
the name of its primary ,state and its  
principal place of business72  7,b7     
written notice of any change in its     
designation of its primary ,state2 and  
7,c7 written notice from the issuer of  

the issuer's compliance with all the    
laws of the primary ,state2 and  7#b7 to
 the insurance commissioner of each     
secondary ,state in which it offers     
individual or group health insurance    
coverage1 a copy of the issuer's        
quarterly financial statement submitted 
to the primary ,state1 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--   
7,a7 a member of the ,american ,academy 
of ,actuaries2 or  7,b7 a qualified loss
 reserve specialist4  7h7 ,power of     
courts ,to enjoin conduct ,nothing in   
this section shall be construed to      
affect the authority of any ,federal or 
,state court to enjoin--  7#a7 the      
solicitation or sale of individual or   
group health insurance coverage by a    
health insurance issuer to any person or
 group who is not eligible for such     
insurance2 or  7#b7 the solicitation or 
sale of individual or group health      

insurance coverage that violates the    
requirements of the law of a secondary  
,state which are described in           
subparagraphs 7,a7 through 7,h7 of      
section #bgif7;b77#a74  7i7 ,power of   
,secondary ,states ,to ,take            
,administrative ,action ,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 #bgif7;b77#a74
  7j7 ,state powers ,to enforce state   
laws  7#a7 ,in general ,subject to the  
provisions of subsection 7b77#a77;,g7   
7relating to injunctions7 and paragraph 
7#b71 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   
7b74  7#b7 ,courts of competent         
jurisdiction ,if a ,state seeks an      
injunction regarding the conduct        
described in paragraphs 7#a7 and 7#b7 of

 subsection 7h71 such injunction must be
 obtained from a ,federal or ,state     
court of competent jurisdiction4  7k7   
,states' authority ,to sue ,nothing in  
this section shall affect the authority 
of any ,state to bring action in any    
,federal or ,state court4  7l7          
,generally applicable laws ,nothing in  
this section shall be construed to      
affect the applicability of ,state laws 
generally applicable to persons or      
corporations4  7m7 ,guaranteed          
,availability of ,coverage to ,,hipaa   
,eligible ,individuals ,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 ,state1 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 7as
 defined in section #bgdd7;c77#b771 the 

issuer shall1 with respect to any       
individual or group health insurance    
coverage offered in a secondary ,state  
under this part1 comply with the        
guaranteed availability requirements for
 eligible individuals in section #bgda4 
7n7 ,no mandated benefit coverage       
requirements ,notwithstanding any other 
provision of law1 a health insurance    
issuer offering individual or group     
health insurance coverage in a primary  
,state and in any secondary ,state in   
accordance with this part 7and any      
coverage so offered7 shall not be       
subject to any ,federal law that would  
otherwise--  7#a7 apply any age         
limitations with respect to who may     
purchase such coverage that is a high   
deductible health plan2 or  7#b7 require
 such coverage that is a high deductible
 health plan to provide for any specific
 type of coverage4  #bgig4 ,primary     
,state must meet ,federal floor before  
issuer may sell into secondary ,states  
,a health insurance issuer may not      

offer1 sell1 or issue individual or     
group 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 issuers4  #bgih4   
,independent external appeals procedures
  7a7 ,right to ,external ,appeal ,a    
health insurance issuer may not offer1  
sell1 or issue individual or group      
health insurance coverage in a secondary
 ,state under the provisions of this    
title unless--  7#a7 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 group health insurance offered by a  
health insurance issuer1 respectively1  
or  7#b7 in any case in which the       
requirements of subparagraph 7,a7 are   
not met with respect to the either of   
such ,states1 the issuer provides an    

independent review mechanism            
substantially identical 7as determined  
by the applicable ,state authority of   
such ,state7 to that prescribed in the  
,health ,carrier ,external ,review      
,model ,act of the ,national            
,association of ,insurance              
,commissioners for all individuals who  
purchase insurance coverage under the   
terms of this part1 except that1 under  
such mechanism1 the review is conducted 
by an independent medical reviewer1 or a
 panel of such reviewers1 with respect  
to whom the requirements of subsection  
7b7 are met4  7b7 ,qualifications of    
,independent ,medical ,reviewers ,in the
 case of any independent review         
mechanism referred to in subsection     
7a77#b73  7#a7 ,in general ,in referring
 a denial of a claim to an independent  
medical reviewer1 or to any panel of    
such reviewers1 to conduct independent  
medical review1 the issuer shall ensure 
that--  7,a7 each independent medical   
reviewer meets the qualifications       

described in paragraphs 7#b7 and 7#c72  
7,b7 with respect to each review1 each  
reviewer meets the requirements of      
paragraph 7#d7 and the reviewer1 or at  
least #a reviewer on the panel1 meets   
the requirements described in paragraph 
7#e72 and  7,c7 compensation provided by
 the issuer to each reviewer is         
consistent with paragraph 7#f74  7#b7   
,licensure and expertise ,each          
independent medical reviewer shall be a 
physician 7allopathic or osteopathic7 or
 health care professional who--  7,a7 is
 appropriately credentialed or licensed 
in #a or more ,states to deliver health 
care services2 and  7,b7 typically      
treats the condition1 makes the         
diagnosis1 or provides the type of      
treatment under review4  7#c7           
,independence  7,a7 ,in general ,subject
 to subparagraph 7,b71 each independent 
medical reviewer in a case shall--  7i7 
not be a related party 7as defined in   
paragraph 7#g772  7ii7 not have a       
material familial1 financial1 or        

professional relationship with such a   
party2 and  7iii7 not otherwise have a  
conflict of interest with such a party  
7as determined under regulations74  7,b7
 ,exception ,nothing in subparagraph    
7,a7 shall be construed to--  7i7       
prohibit an individual1 solely on the   
basis of affiliation with the issuer1   
from serving as an independent medical  
reviewer if--  7,i7 a non-affiliated    
individual is not reasonably available2 
7,,ii7 the affiliated individual is not 
involved in the provision of items or   
services in the case under review2      
7,,iii7 the fact of such an affiliation 
is disclosed to the issuer and the      
enrollee 7or authorized representative7 
and neither party objects2 and  7,,iv7  
the affiliated individual is not an     
employee of the issuer and does not     
provide services exclusively or         
primarily to or on behalf of the issuer2
  7ii7 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
 7or authorized representative71 and    
neither party objects2 or  7iii7        
prohibit receipt of compensation by an  
independent medical reviewer from an    
entity if the compensation is provided  
consistent with paragraph 7#f74  7#d7   
,practicing health care professional in 
same field  7,a7 ,in general ,in a case 
involving treatment1 or the provision of
 items or services--  7i7 by a          
physician1 a reviewer shall be a        
practicing physician 7allopathic or     
osteopathic7 of the same or similar     
specialty1 as a physician who1 acting   
within the appropriate scope of practice
 within the ,state in which the service 
is provided or rendered1 typically      
treats the condition1 makes the         
diagnosis1 or provides the type of      
treatment under review2 or  7ii7 by a   
non-physician health care professional1 

the reviewer1 or at least #a member of  
the review panel1 shall be a practicing 
non-physician health care professional  
of the same or similar specialty as the 
non-physician health care professional  
who1 acting within the appropriate scope
 of practice within the ,state in which 
the service is provided or rendered1    
typically treats the condition1 makes   
the diagnosis1 or provides the type of  
treatment under review4  7,b7           
,practicing defined ,for purposes of    
this paragraph1 the term practicing     
means1 with respect to an individual who
 is a physician or other health care    
professional1 that the individual       
provides health care services to        
individual patients on average at least 
#b days per week4  7#e7 ,pediatric      
expertise ,in the case of an external   
review relating to a child1 a reviewer  
shall have expertise under paragraph    
7#b7 in pediatrics4  7#f7 ,limitations  
on reviewer compensation ,compensation  
provided by the issuer to an independent

 medical reviewer in connection with a  
review under this section shall--  7,a7 
not exceed a reasonable level2 and  7,b7
 not be contingent on the decision      
rendered by the reviewer4  7#g7 ,related
 party defined ,for purposes of this    
section1 the term related party means1  
with respect to a denial of a claim     
under a coverage relating to an         
enrollee1 any of the following3  7,a7   
,the issuer involved1 or any fiduciary1 
officer1 director1 or employee of the   
issuer4  7,b7 ,the enrollee 7or         
authorized representative74  7,c7 ,the  
health care professional that provides  
the items or services involved in the   
denial4  7,d7 ,the institution at which 
the items or services 7or treatment7    
involved in the denial are provided4    
7,e7 ,the manufacturer of any drug or   
other item that is included in the items
 or services involved in the denial4    
7,f7 ,any other party determined under  
any regulations to have a substantial   
interest in the denial involved4  7#h7  

,definitions ,for purposes of this      
subsection3  7,a7 ,enrollee ,the term   
enrollee means1 with respect to health  
insurance coverage offered by a health  
insurance issuer1 an individual enrolled
 with the issuer to receive such        
coverage4  7,b7 ,health care            
professional ,the term health care      
professional means an individual who is 
licensed1 accredited1 or certified under
 ,state law to provide specified health 
care services and who is operating      
within the scope of such licensure1     
accreditation1 or certification4  #bgii4
 ,enforcement  7a7 ,in general ,subject 
to subsection 7b71 with respect to      
specific individual or group 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 ,state4  7b7 ,secondary       
state's authority ,nothing in subsection
 7a7 shall be construed to affect the   
authority of a secondary ,state to      

enforce its laws as set forth in the    
exception specified in section          
#bgif7;b77#a74  7c7 ,court              
interpretation ,in reviewing action     
initiated by the applicable secondary   
,state authority1 the court of competent
 jurisdiction shall apply the covered   
laws of the primary ,state4  7d7 ,notice
 of compliance failure ,in the case of  
individual health insurance coverage    
offered in a secondary ,state1 or group 
health insurance coverage offered by a  
health insurance issuer in a secondary  
,state1 that fails to comply with the   
covered laws of the primary ,state1 the 
applicable ,state authority of the      
secondary ,state may notify the         
applicable ,state authority of the      
primary ,state4  4  7b7 ,effective date 
,the amendment made by subsection 7a7   
shall apply to health insurance coverage
 offered1 issued1 or sold after the date
 that is one year after the date of the 
enactment of this ,act4  7c7 ,,gao      
ongoing study and reports  7#a7 ,study  

,the ,comptroller ,general of the       
,united ,states shall conduct an ongoing
 study concerning the effect of the     
amendment made by subsection 7a7 on--   
7,a7 the number of uninsured and        
under-insured2  7,b7 the availability   
and cost of health insurance policies   
for individuals with pre-existing       
medical conditions2  7,c7 the           
availability and cost of health         
insurance policies generally2  7,d7 the 
elimination or reduction of different   
types of benefits under health insurance
 policies offered in different ,states2 
and  7,e7 cases of fraud or abuse       
relating to health insurance coverage   
offered under such amendment and the    
resolution of such cases4  7#b7 ,annual 
reports ,the ,comptroller ,general shall
 submit to ,congress an annual report1  
after the end of each of the #e years   
following the effective date of the     
amendment made by subsection 7a71 on the
 ongoing study conducted under paragraph
 7#a74  #bjb4 ,reauthorization of the   

,preexisting ,condition ,insurance ,plan
 7,,pcip7 ,program  7a7 ,in general ,the
 ,,pcip program is hereby reauthorized  
through ,december #ca1 #bjaf1 and shall 
continue in effect subject to the       
provisions of this section4  7b7        
,elimination of requirement for         
noncoverage for #f months ,to be        
eligible individual ,the condition under
 paragraph 7#b7 of section #aaja7;d7 of 
the ,patient ,protection and ,affordable
 ,care ,act 7#db ,u4,s4,c4 #ahjja7;d77  
shall not apply to the reauthorized     
,,pcip program4  7c7 ,funding  7#a7     
,initial funding ,initial funding for   
the reauthorized ,,pcip program shall be
 derived from the following3  7,a7      
,funding that was available in the      
,patient-,centered ,outcomes ,research  
,institute ,trust ,fund under section   
#ieaa of the ,internal ,revenue ,code of
 #aihf on the day before the date of the
 enactment of this ,act4  7,b7 ,any     
unobligated funds in the ,prevention and
 ,public ,health ,fund 7under section   

#djjb of ,public ,law #aaa-adh1 #db     
,u4,s4,c4 #cjju-#aa7 attributable to    
fiscal year #bjac as of the day before  
the date of the enactment of this ,act4 
7#b7 ,subsequent funding ,subsequent    
funding for the reauthorized ,,pcip     
program shall be derived from any funds 
that would otherwise be made available  
to such ,prevention and ,public ,health 
,fund for fiscal years #bjad through    
#bjaf4  7#c7 ,transfer ,funding under   
the previous paragraphs shall be        
transferred to an account within the    
,department of ,health and ,human       
,services that provided funding1 as of  
the day before the date of the enactment
 of this ,act1 to carry out the ,,pcip  
program4  7d7 ,definitions ,in this     
section3  7#a7 ,the term ,,pcip program 
means the ,preexisting ,condition       
,insurance ,plan 7,,pcip7 ,program      
established as of the day before the    
date of the enactment of this ,act under
 section #aaja of ,public ,law #aaa-adh 
7#db ,u4,s4,c4 #ahjja74  7#b7 ,the term 

reauthorized ,,pcip program means the   
,,pcip program as reauthorized under    
this section4