,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #bijj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,augu/ #a1 #bjac ,mr4 
,br\n ( ,georgia introduc$ ! foll[+     
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committees on ,ways & ,means1          
,education & ! ,work=ce1 ,natural       
,res\rces1 ! ,judici>y1 ,h\se           
,adm9i/ration1 ,appropriations1 &       
,rules1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to repeal ! ,pati5t           
,protection & ,af=dable ,c>e ,act & !   
,heal? ,c>e & ,education ,reconciliation
 ,act ( #bjaj2 to am5d ! ,int]nal       
,rev5ue ,code ( #aihf to repeal !       
p]c5tage floor on m$ical exp5se         
d$uctions1 exp& ! use ( tax-pref]r$     
heal? c>e acc\nts1 & e/abli% a *>ity c>e
 cr$it2 to am5d ! ,social ,security ,act
 to create a ,m$ic>e ,premium ,assi/ance
 ,program1 re=m ,,emtala requirem5ts1 & 

to replace ! ,m$icaid program & !       
,*ildr5's ,heal? ,insurance program ) a 
block grant to ! ,/ates2 to am5d !      
,public ,heal? ,s]vice ,act to provide =
 coop]ative gov]n+ ( individual & gr\p  
heal? insurance cov]age (f]$ 9 int]/ate 
comm]ce2 & = o!r purposes4  #a4 ,%ort   
title2 table ( cont5ts2 con/ruction  7a7
 ,%ort title ,?is ,act may be cit$ z !  
,(f]+ ,pati5ts ,true ,individualiz$     
,options ,n[ ,act ( #bjac or ! ,,option 
,act ( #bjac4  7b7 ,table ( cont5ts ,!  
table ( cont5ts ( ?is ,act is z foll[s3 
,sec4 #a4 ,%ort title2 table ( cont5ts2 
con/ruction4 ,title ,i--,repeal (       
,,ppaca & ,,hc]a ,sec4 #aja4 ,repeal (  
,,ppaca & ,,hc]a4 ,title ,,ii--,heal?   
,c>e ,tax ,re=m ,subtitle ,a--,,hsa     
,re=m ,sec4 #bja4 ,repeal ( high        
d$uctible heal? plan requirem5t4 ,sec4  
#bjb4 ,increase 9 d$uctible ,,hsa       
contribution limitations4 ,sec4 #bjc4   
,m$ic>e eligible individuals eligible to
 contribute to ,,hsa4 ,sec4 #bjd4 ,,hsa 
,rollov] to ,m$ic>e ,advantage ,,msa4   

,sec4 #bje4 ,repeal ( additional tax on 
di/ributions n us$ = qualifi$ m$ical    
exp5ses4 ,subtitle ,b--,o!r ,heal? ,c>e 
,tax ,re=m ,sec4 #bjf4 ,elim9ation (    
#aj-p]c5t floor on m$ical exp5se        
d$uctions4 ,sec4 #bjg4 ,repeal (        
prescrib$ drug limitation on c]ta9 tax  
b5efits = m$ical exp5ses4 ,sec4 #bjh4   
,repeal ( #b-p]c5t miscellane\s itemiz$ 
d$uction floor = m$ical exp5se          
d$uctions4 ,sec4 #bji4 ,*>ity c>e cr$it4
 ,sec4 #baj4 ,cr$it = contributions made
 = purpose ( provid+ m$ical c>e to !    
indig5t4 ,sec4 #baa4 ,,cobra cont9uation
 cov]age ext5d$4 ,sec4 #bab4 ,,hsa      
*>itable contributions4 ,title          
,,iii--,m$ic>e ,premium ,assi/ance      
,program ,sec4 #cja4 ,replacem5t (      
,m$ic>e "p ,a entitlem5t ) ,m$ic>e ,re=m
 ,premium ,assi/ance ,program4 ,sec4    
#cjb4 ,gradual phas+ out ( ,,cms &      
transf] ( functions to ,dep>tm5t ( !    
,treasury4 ,title ,,iv--,,emtala ,re=ms 
,sec4 #dja4 ,,emtala re=ms4 ,title      
,v--,coop]ative ,gov]n+ ( ,individual & 

,gr\p ,heal? ,insurance ,cov]age ,sec4  
#eja4 ,coop]ative gov]n+ ( individual & 
gr\p heal? insurance cov]age4 ,sec4     
#ejb4 ,cont9u+ ,/ate au?ority4 ,title   
,,vi--,/ate ,heal? ,flexibility ,sec4   
#fja4 ,%ort title4 ,sec4 #fjb4 ,heal?   
grants to ! ,/ates = heal? c>e s]vices  
to indig5t individuals4 ,sec4 #fjc4     
,repeal ( ,f$]al requirem5ts ( ,m$icaid 
& ,,*ip4 ,sec4 #fjd4 ,sev]ability4 ,sec4
 #fje4 ,effective date4  7c7            
,con/ruction ,no?+ 9 ?is ,act %all be   
con/ru$ to preclude or prohibit a heal? 
c>e provid] or heal? insurance issu] f  
publicly disclos+ any pric+ ( s]vices   
provid$ or cov]$4  ,i ,repeal ( ,,ppaca 
& ,,hc]a  #aja4 ,repeal ( ,,ppaca &     
,,hc]a ,! ,pati5t ,protection &         
,af=dable ,c>e ,act & ! ,heal? ,c>e &   
,education ,reconciliation ,act ( #bjaj 
are ea* repeal$1 effective z ( !        
respective date ( enactm5t ( ea* su*    
,act1 & ! provisions ( law am5d$ or     
repeal$ by su* ,acts are re/or$ or      
reviv$ z if su* ,acts _h n be5 enact$4  

,,ii ,heal? ,c>e ,tax ,re=m  ,a ,,hsa   
,re=m  #bja4 ,repeal ( high d$uctible   
heal? plan requirem5t  7a7 ,9 g5]al     
,section #bbc ( ! ,int]nal ,rev5ue ,code
 ( #aihf is am5d$ by /rik+ subsection   
7c7 & r$esignat+ subsections 7d7 ?r\gh  
7h7 z subsections 7c7 ?r\gh 7g71        
respectively4  7b7 ,con=m+ am5dm5ts     
7#a7 ,subsection 7a7 ( section #bbc (   
su* ,code is am5d$ to read z foll[s3    
7a7 ,d$uction all[$ ,9 ! case ( an      
individual1 !re %all be all[$ z a       
d$uction = a taxable ye> an am\nt equal 
to ! aggregate am\nt paid 9 ca% dur+ su*
 taxable ye> by or on behalf ( su*      
individual to a heal? sav+s acc\nt ( su*
 individual4  4  7#b7 ,subsection 7b7 ( 
section #bbc ( su* ,code is am5d$ by    
/rik+ p>agraph 7#h74  7#c7 ,subp>agraph 
7,a7 ( section #bbc7;c77#a7 ( ! ,int]nal
 ,rev5ue ,code ( #aihf 7z r$esignat$ by 
subsection 7b77#a77 is am5d$--  7,a7 by 
/rik+ subsection 7f77#e7 & ins]t+       
subsection 7e77#e71 &  7,b7 9 clause    
7ii7--  7i7 by /rik+ ! sum (-- & all t  

foll[s & ins]t+ ! doll> am\nt 9 effect  
"u subsection 7b77#a744  7#d7 ,section  
#bbc7;f77#a7 ( su* ,code 7z r$esignat$  
by subsection 7b77#a77 is am5d$ by /rik+
 ,ea* doll> am\nt 9 subsections 7b77#b7 
& 7c77#b77;,a7 & ins]t+ ,9 ! case ( a   
taxable ye> beg9n+ aft] ,decemb] #ca1   
#bjaj1 ea* doll> am\nt 9 subsection     
7b77#a74  7#e7 ,section #bf7;b77,u7 (   
su* ,code is am5d$ by /rik+ section     
#bbc7;f77#d7 & ins]t+ section           
#bbc7;e77#d74  7#f7 ,sections           
#ce7;g77#c71 #bbj7;f77#e77;,a71         
#hdh7;e77#a77v71 #digc7;a77#e71 &       
#fjea7;a77#ab7 ( su* ,code are ea* am5d$
 by /rik+ section #bbc7;d7 ea* place x  
appe>s & ins]t+ section #bbc7;c74  7#g7 
,section #ajf7;d77#a7 ( su* ,code is    
am5d$--  7,a7 by /rik+ :o is an eligible
 individual 7z def9$ 9 section          
#bbc7;c77#a771 &  7,b7 by /rik+ section 
#bbc7;d7 & ins]t+ section #bbc7;c74     
7#h7 ,section #djh7;d77#i7 ( su* ,code  
is am5d$--  7,a7 9 subp>agraph 7,a7 by  
/rik+ :o is an eligible individual 7z   

def9$ 9 section #bbc7;c77 &1 &  7,b7 9  
subp>agraph 7,c7 by /rik+ comput$ on !  
basis ( ! type ( cov]age "u ! high      
d$uctible heal? plan cov]+ ! individual 
at ! "t ( ! qualifi$ ,,hsa fund+        
di/ribution4  7#i7 ,section             
#hgg;,a7g77#f7 ( su* ,code is am5d$ by  
/rik+ #bbc7;f77#d7 & ins]t+             
#bbc7;e77#d74  7#aj7 ,section #digc7;g7 
( su* ,code is am5d$--  7,a7 by /rik+   
section #bbc7;d7 & ins]t+ section       
#bbc7;c71  7,b7 9 p>agraph 7#b71 by     
/rik+ section #bbc7;f77#b7 & ins]t+     
section #bbc7;e77#b71 &  7,c7 by /rik+  
section #bbc7;f77#c7 & ins]t+ section   
#bbc7;e77#c74  7#aa7 ,section #dige (   
su* ,code is am5d$--  7,a7 9 subsection 
7c77#f7--  7i7 by /rik+ section #bbc7;d7
 & ins]t+ section #bbc7;c71 &  7ii7 by  
/rik+ section #bbc7;e77#b7 & ins]t+     
section #bbc7;d77#b71 &  7,b7 9         
subsection 7e77#a77;,e71 by /rik+       
section #bbc7;d7 & ins]t+ section       
#bbc7;c74  7#ab7 ,section               
#ffic7;a77#b77;,c7 ( su* ,code is am5d$ 

by /rik+ section #bbc7;h7 & ins]t+      
section #bbc7;g74  7c7 ,effective date  
,! am5dm5ts made by ?is section %all    
apply to taxable ye>s beg9n+ aft]       
,decemb] #ca1 #bjab4  #bjb4 ,increase 9 
d$uctible ,,hsa contribution limitations
  7a7 ,9 g5]al ,p>agraph 7#a7 ( section 
#bbc7;b7 ( ! ,int]nal ,rev5ue ,code (   
#aihf is am5d$ by /rik+ ! sum ( ! mon?ly
 & all t foll[s ?r\gh eligible          
individual & ins]t+ #aj1jjj 7#bj1jjj 9 !
 case ( a jo9t return74  7b7 ,con=m+    
am5dm5ts  7#a7 ,subsection 7b7 ( su*    
,code is am5d$ by /rik+ p>agraphs 7#b71 
7#c71 & 7#e7 & by r$esignat+ p>agraphs  
7#d71 7#f71 & 7#g7 z p>agraphs 7#b71    
7#c71 & 7#d71 respectively4  7#b7       
,p>agraph 7#b7 ( section #bbc7;b7 ( su* 
,code 7z r$esignat$ by p>agraph 7#a77 is
 am5d$ by /rik+ ! la/ s5t5ce4  7c7      
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ,decemb] #ca1 #bjab4  #bjc4 
,m$ic>e eligible individuals eligible to
 contribute to ,,hsa  7a7 ,subsection   

7b7 ( section #bbc ( ! ,int]nal ,rev5ue 
,code ( #aihf is am5d$ by /rik+ p>agraph
 7#g74  7b7 ,p>agraph 7#a7 ( section    
#bbc7;c7 ( su* ,code is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,c7  
,special rule = individuals entitl$ to  
b5efits "u m$ic>e ,9 ! case ( an        
individual--  7i7 :o is entitl$ to      
b5efits "u title ,,xviii ( ! ,social    
,security ,act1 &  7ii7 ) respect to :om
 a heal? sav+s acc\nt is e/abli%$ 9 a   
mon? be=e ! fir/ mon? su* individual is 
entitl$ to su* b5efits1  su* individual 
%all be deem$ to be an eligible         
individual4  4  7c7 ,effective date ,!  
am5dm5ts made by ?is section %all apply 
to taxable ye>s beg9n+ aft] ,decemb]    
#ca1 #bjab4  #bjd4 ,,hsa ,rollov] to    
,m$ic>e ,advantage ,,msa  7a7 ,9 g5]al  
,p>agraph 7#b7 ( section #ach7;b7 ( !   
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by /rik+ or at ! end ( subp>agraph 7,a71
 by add+ or at ! end ( subp>agraph 7,c71
 & by add+ at ! end ! foll[+ new        
subp>agraph3  7,c7 a ,,hsa rollov]      

contribution describ$ 9 subsection      
7d77#e71  4  7b7 ,,hsa rollov]          
contribution ,subsection 7c7 ( section  
#ach ( su* ,code is am5d$ by add+ at !  
end ! foll[+ new p>agraph3  7#e7        
,rollov] contribution ,an am\nt is      
describ$ 9 ?is p>agraph z a rollov]     
contribution if x meets ! requirem5t (  
subp>agraphs 7,a7 & 7,b74  7,a7 ,9 g5]al
 ,! requirem5ts ( ?is subp>agraph are   
met 9 ! case ( an am\nt paid or         
di/ribut$ f a heal? sav+s to ! acc\nt   
b5efici>y to ! ext5t ! am\nt is receiv$ 
is paid into a ,m$ic>e ,advantage ,,msa 
( su* b5efici>y n lat] ?an ! #fj? day   
aft] ! day on :i* ! b5efici>y receives !
 paym5t or di/ribution4  7,b7           
,limitation ,?is p>agraph %all n apply  
to any am\nt describ$ 9 subp>agraph 7,a7
 receiv$ by an individual f a heal?     
sav+s acc\nt if1 at any "t dur+ ! #a-ye>
 p]iod end+ on ! day ( su* receipt1 su* 
individual receiv$ any o!r am\nt        
describ$ 9 subp>agraph 7,a7 f a heal?   
sav+s acc\nt :i* 0 n includible 9 !     

individual's gross income because ( !   
application ( section #bbc7;f77#e77;,a74
  4  7c7 ,con=m+ am5dm5t ,subp>agraph   
7,a7 ( section #bbc7;f77#e7 ( su* ,code 
is am5d$ by ins]t+ or ,m$ic>e ,advantage
 ,,msa aft] into a heal? sav+s acc\nt4  
7d7 ,effective date ,! am5dm5ts made by 
?is section %all apply to taxable ye>s  
beg9n+ aft] ,decemb] #ca1 #bjab4  #bje4 
,repeal ( additional tax on di/ributions
 n us$ = qualifi$ m$ical exp5ses  7a7 ,9
 g5]al ,subsection 7f7 ( section #bbc ( 
! ,int]nal ,rev5ue ,code ( #aihf is     
am5d$ by /rik+ p>agraph 7#d7 &          
r$esignat+ p>agraphs 7#e71 7#f71 & 7#g7 
& p>agraphs 7#d71 7#e71 & 7#f71         
respectively4  7b7 ,con=m+ am5dm5ts     
7#a7 ,p>agraph 7#b7 ( section #be7;b7 ( 
su* ,code is am5d$ by /rik+ subp>agraph 
7,u7 & by r$esignat+ subp>agraphs 7,v71 
7,w71 & 7,x7 z subp>agraphs 7,u71 7,v71 
& 7,w74  7#b7 ,subp>agraph 7,c7 (       
section #ajf7;e77#d7 ( su* ,code is     
am5d$ by /rik+ #bbc7;f77#e7 & ins]t+    
#bbc7;f77#d74  7#c7 ,p>agraph 7#f7 (    

section #hgg;,a7g7 ( su* ,code is am5d$ 
by /rik+ #bbc7;f77#d714  7#d7 ,p>agraph 
7#a7 ( section #digc7;g7 ( su* ,code is 
am5d$ by /rik+ #bbc7;f77#e7 & ins]t+    
#bbc7;f77#d74  7c7 ,effective date ,!   
am5dm5ts made by ?is section %all apply 
to taxable ye>s beg9n+ aft] ,decemb]    
#ca1 #bjab4  ,b ,o!r ,heal? ,c>e ,tax   
,re=m  #bjf4 ,elim9ation ( #aj-p]c5t    
floor on m$ical exp5se d$uctions  7a7 ,9
 g5]al ,subsection 7a7 ( section #bac ( 
! ,int]nal ,rev5ue ,code ( #aihf is     
am5d$ by /rik+ 1 to ! ext5t t su*       
exp5ses exce$ #aj p]c5t ( adju/$ gross  
income4  7b7 ,con=m+ am5dm5t ,p>agraph  
7#a7 ( section #ef7;b7 ( su* ,code is   
am5d$ by /rik+ subp>agraph 7,b74  7c7   
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ,decemb] #ca1 #bjab4  #bjg4 
,repeal ( prescrib$ drug limitation on  
c]ta9 tax b5efits = m$ical exp5ses  7a7 
,d$uction = m$ical exp5ses  7#a7 ,9     
g5]al ,section #bac ( ! ,int]nal ,rev5ue
 ,code ( #aihf is am5d$ by /rik+        

subsection 7b74  7#b7 ,con=m+ am5dm5t   
,subsection 7d7 ( section #bac ( su*    
,code is am5d$ by /rik+ p>agraph 7#c74  
7b7 ,treatm5t ( reimbursem5ts "u accid5t
 or heal? plans ,section #ajf ( su*     
,code is am5d$ by /rik+ subsection 7f74 
7c7 ,heal? sav+s acc\nts ,subp>agraph   
7,a7 ( section #bbc7;d77#b7 ( su* ,code 
is am5d$ by /rik+ ! la/ s5t5ce !re(4    
7d7 ,ar*] ,m,s,as ,subp>agraph 7,a7 (   
section #bbj7;d77#b7 ( su* ,code is     
am5d$ by /rik+ ! la/ s5t5ce !re(4  7e7  
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ,decemb] #ca1 #bjab4  #bjh4 
,repeal ( #b-p]c5t miscellane\s itemiz$ 
d$uction floor = m$ical exp5se d$uctions
  7a7 ,9 g5]al ,subsection 7b7 ( section
 #fg ( ! ,int]nal ,rev5ue ,code ( #aihf 
is am5d$ by /rik+ p>agraph 7#e74  7b7   
,effective date ,! am5dm5t made by ?is  
section %all apply to taxable ye>s      
beg9n+ aft] ! ,decemb] #ca1 #bjab4      
#bji4 ,*>ity c>e cr$it  7a7 ,9 g5]al    
,subp>t ,a ( "p ,,iv ( sub*apt] ,a (    

*apt] #a ( ! ,int]nal ,rev5ue ,code (   
#aihf 7relat+ to nonrefundable p]sonal  
cr$its7 is am5d$ by ins]t+ aft] section 
#be;,d ! foll[+ new section3  #be;,e4   
,*>ity c>e cr$it  7a7 ,all[ance ( cr$it 
,9 ! case ( a physician1 !re %all be    
all[$ z a cr$it aga9/ ! tax impos$ by   
?is *apt] = a taxable ye> ! am\nt       
det]m9$ 9 accordance ) ! foll[+ table3  
,if ! physician has provid$ dur+ su*    
taxable ye>3,! am\nt ( ! cr$it is3  ,at 
lea/ #be b less ?an #cj qualifi$ h\rs ( 
*>ity c>e#b1jjj4  ,at lea/ #cj b less   
?an #ce qualifi$ h\rs ( *>ity c>e#b1djj4
  ,at lea/ #ce b less ?an #dj qualifi$  
h\rs ( *>ity c>e#b1hjj4  ,at lea/ #dj b 
less ?an #de qualifi$ h\rs ( *>ity      
c>e#c1bjj4  ,at lea/ #de b less ?an #ej 
qualifi$ h\rs ( *>ity c>e#c1fjj4  ,at   
lea/ #ej b less ?an #ee qualifi$ h\rs ( 
*>ity c>e#d1jjj4  ,at lea/ #ee b less   
?an #fj qualifi$ h\rs ( *>ity c>e#d1djj4
  ,at lea/ #fj b less ?an #fe qualifi$  
h\rs ( *>ity c>e#d1hjj4  ,at lea/ #fe b 
less ?an #gj qualifi$ h\rs ( *>ity      

c>e#e1bjj4  ,at lea/ #gj b less ?an #ge 
qualifi$ h\rs ( *>ity c>e#e1fjj4  ,at   
lea/ #ge b less ?an #hj qualifi$ h\rs ( 
*>ity c>e#f1jjj4  ,at lea/ #hj b less   
?an #he qualifi$ h\rs ( *>ity c>e#f1djj4
  ,at lea/ #he b less ?an #ij qualifi$  
h\rs ( *>ity c>e#f1hjj4  ,at lea/ #ij b 
less ?an #ie qualifi$ h\rs ( *>ity      
c>e#g1bjj4  ,at lea/ #ie b less ?an #ajj
 qualifi$ h\rs ( *>ity c>e#g1fjj4  ,at  
lea/ #ajj h\rs ( *>ity c>e#h1jjj4  7b7  
,qualifi$ h\rs ( *>ity c>e ,= purposes (
 ?is section--  7#a7 ,qualifi$ h\rs (   
*>ity c>e ,! t]m qualifi$ h\rs ( *>ity  
c>e means ! h\rs t a physician provides 
m$ical c>e 7z def9$ 9 section           
#bac7;d77#a77;,a77 on a volunte] or pro 
bono basis4  7#b7 ,physician ,! t]m     
physician has ! mean+ giv5 to su* t]m 9 
section #ahfa7r7 ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #aciex7r774  4  7b7 
,con=m+ am5dm5t ,! table ( sections =   
subp>t ,a ( "p ,,iv ( sub*apt] ,a (     
*apt] #a ( su* ,code is am5d$ by ins]t+ 
aft] ! item relat+ to section #be;,d !  

foll[+ new item3  ,sec4 #be;,e4 ,*>ity  
c>e cr$it4  4  7c7 ,effective date ,!   
am5dm5ts made by ?is section %all apply 
to taxable ye>s beg9n+ aft] ,decemb]    
#ca1 #bjab4  #baj4 ,cr$it =             
contributions made = purpose ( provid+  
m$ical c>e to ! indig5t  7a7 ,9 g5]al   
,subp>t ,b ( "p ,,iv ( sub*apt] ,a (    
*apt] #a ( ! ,int]nal ,rev5ue ,code (   
#aihf is am5d$ by add+ at ! end ! foll[+
 new section3  #cj;,e4 ,contributions = 
provid+ m$ical c>e to ! indig5t  7a7 ,9 
g5]al ,!re %all be all[$ z a cr$it aga9/
 ! tax impos$ by ?is *apt] = ! taxable  
ye> an am\nt equal to ! indig5t c>e     
contributions made by ! taxpay] dur+ !  
taxable ye>4  7b7 ,indig5t c>e          
contribution ,= purposes ( ?is section1 
! t]m indig5t c>e contribution means any
 contribution or gift ( money or o!r    
prop]ty to or = ! use ( any p]son if su*
 contribution or gift is us$ 7or !      
proce$s f :i* are us$7 by su* p]son = ! 
purpose ( provid+ m$ical c>e to indig5t 
individuals 9 ! ,unit$ ,/ates4  7c7     

,valuation & sub/antiation (            
contributions1 etc ,rules simil> to !   
rules ( subsections 7e7 & 7f7 ( section 
#agj %all apply = purposes ( ?is        
section4  7d7 ,application ) o!r cr$its 
7#a7 ,bus9ess cr$it treat$ z "p ( g5]al 
bus9ess cr$it ,s mu* ( ! cr$it :i* w\ld 
be all[$ "u subsection 7a7 = any taxable
 ye> 7det]m9$ )\t reg>d to ?is          
subsection7 t is attributable to indig5t
 c>e contributions made by--  7,a7 any  
corporation or p>tn]%ip1 or  7,b7 any   
o!r p]son if su* contribution 0 made 9  
connection ) a trade or bus9ess c>ri$ on
 by su* p]son1  %all be treat$ z a cr$it
 li/$ 9 section #ch7;b7 = su* taxable   
ye> 7& n all[$ "u subsection 7a774  7#b7
 ,p]sonal cr$it ,= purposes ( ?is title1
 ! cr$it all[$ "u subsection 7a7 = any  
taxable ye> 7det]m9$ aft] application ( 
p>agraph 7#a77 %all be treat$ z a cr$it 
all[able "u subp>t ,a = su* taxable ye>4
  7e7 ,d5ial ( d\ble b5efit ,! am\nt (  
any d$uction or o!r cr$it all[able "u   
?is *apt] = any indig5t c>e contribution

 %all be r$uc$ by ! am\nt ( cr$it       
all[able "u ?is section = su*           
contribution4  4  7b7 ,con=m+ am5dm5ts  
7#a7 ,section #ch7;b7 ( su* ,code is    
am5d$ by /rik+ plus at ! end ( p>agraph 
7#ce71 by /rik+ ! p]iod at ! end (      
p>agraph 7#cf7 & ins]t+ 1 plus1 & by    
add+ at ! end ! foll[+ new p>agraph3    
7#cg7 ! portion ( ! cr$it describ$ 9    
section #cj;,e7d77#a7 7relat+ to cr$it =
 contributions = provid+ m$ical c>e to !
 indig5t74  4  7#b7 ,section            
#ch7;c77#d77;,b7 ( su* ,code is am5d$ by
 /rik+ & at ! end ( clause 7viii71 by   
/rik+ ! p]iod at ! end ( clause 7ix7 &  
ins]t+ 1 &1 & by add+ at ! end ! foll[+ 
new clause3  7x7 ! portion ( ! cr$it    
describ$ 9 section #cj;,e7d77#a7 7relat+
 to cr$it = contributions = provid+     
m$ical c>e to ! indig5t74  4  7#c7 ,!   
table ( sections = subp>t ,b ( "p ,,iv (
 sub*apt] ,a ( *apt] #a ( su* ,code is  
am5d$ by add+ at ! end ! foll[+ new     
item3  ,sec4 #cj;,e4 ,contributions =   
provid+ m$ical c>e to ! indig5t4  4  7c7

 ,effective date ,! am5dm5ts made by ?is
 section %all apply to contributions    
made aft] ! date ( ! enactm5t ( ?is     
,act4  #baa4 ,,cobra cont9uation cov]age
 ext5d$  7a7 ,"u ,,irc ,subp>agraph 7,b7
 ( section #dihj;,b7f77#b7 ( ! ,int]nal 
,rev5ue ,code ( #aihf is am5d$ by /rik+ 
clauses 7i7 & 7v7 & by r$esignat+       
clauses 7ii71 7iii71 & 7iv7 z clauses   
7i71 7ii71 & 7iii71 respectively4  7b7  
,"u ,,erisa ,p>agraph 7#b7 ( section    
#fjb ( ! ,employee ,retirem5t ,income   
,security ,act ( #bjji 7#bi ,u4,s4,c4   
#aafb7 is am5d$ by /rik+ subp>agraphs   
7,a7 & 7,e7 & by r$esignat+ subp>agraphs
 7,b71 7,c71 & 7,d7 z subp>agraphs 7,a71
 7,b71 & 7,c71 respectively4  7c7 ,"u   
,,phsa ,p>agraph 7#b7 ( section #bbjb7b7
 ( ! ,public ,heal? ,s]vice ,act 7#db   
,u4,s4,c4 #cjj;bb-#b7b77 is am5d$ by    
/rik+ subp>agraphs 7,a7 & 7,e7 & by     
r$esignat+ subp>agraphs 7,b71 7,c71 &   
7,d7 z subp>agraphs 7,a71 7,b71 & 7,c71 
respectively4  7d7 ,effective date ,!   
am5dm5ts made by ?is section %all apply 

) respect to gr\p heal? plans1 & heal?  
insurance cov]age (f]$ 9 connection )   
gr\p heal? plans1 = plan ye>s beg9n+    
aft] ! date ( ! enactm5t ( ?is ,act4    
#bab4 ,,hsa *>itable contributions  7a7 
,9 g5]al ,subsection 7f7 ( section #bbc 
( ! ,int]nal ,rev5ue ,code ( #aihf is   
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#i7 ,di/ributions = *>itable
 purposes ,= purposes ( ?is subsection--
  7,a7 ,9 g5]al ,p>agraph 7#b7 %all n   
apply to any qualifi$ *>itable          
di/ributions ) respect to a taxpay] made
 dur+ any taxable ye>4  7,b7 ,qualifi$  
*>itable di/ribution ,= purposes ( ?is  
p>agraph1 ! t]m qualifi$ *>itable       
di/ribution means any di/ribution f a   
heal? sav+s acc\nt :i* is made directly 
by ! tru/ee to an organization describ$ 
9 section #agj7;b77#a77;,a7 7o!r ?an any
 organization describ$ 9 section        
#eji7;a77#c7 or any fund or acc\nt      
describ$ 9 section #diff7;d77#b774 ,a   
di/ribution %all be treat$ z a qualifi$ 
*>itable di/ribution only to ! ext5t t !

 di/ribution w\ld be includible 9 gross 
income )\t reg>d to subp>agraph 7,a74   
7,c7 ,contributions mu/ be o!rwise      
d$uctible ,= purposes ( ?is p>agraph1 a 
di/ribution to an organization describ$ 
9 subp>agraph 7,b7 %all be treat$ z a   
qualifi$ *>itable di/ribution only if a 
d$uction = ! entire di/ribution w\ld be 
all[able "u section #agj 7det]m9$ )\t   
reg>d to subsection 7b7 !re( & ?is      
p>agraph74  7,d7 ,d5ial ( d$uction      
,qualifi$ *>itable di/ributions :i* are 
n includible 9 gross income pursuant to 
subp>agraph 7,a7 %all n be tak5 into    
acc\nt 9 det]m9+ ! d$uction "u section  
#agj4  4  7b7 ,effective date ,! am5dm5t
 made by ?is section %all apply to      
taxable ye>s beg9n+ aft] ,decemb] #ca1  
#bjab4  ,,iii ,m$ic>e ,premium          
,assi/ance ,program  #cja4 ,replacem5t (
 ,m$ic>e "p ,a entitlem5t ) ,m$ic>e     
,re=m ,premium ,assi/ance ,program  7a7 
,9 g5]al ,section #bbf ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #dbf7 is  
am5d$ by add+ at ! end ! foll[+ new     

subsections3  7k7 ,replacem5t (         
entitlem5t ) premium assi/ance program  
7#a7 ,9 g5]al ,not)/&+ ! previ\s        
provisions ( ?is section1 beg9n+ ! fir/ 
,janu>y #a aft] ! date ( ! enactm5t ( ! 
,(f]+ ,pati5ts ,true ,individualiz$     
,options ,n[ ,act ( #bjac1 ! ,secret>y  
%all e/abli% proc$ures "u :i*--  7,a7 9 
! case ( an individual :o1 b = !        
application ( ?is p>agraph1 w\ld o!rwise
 become entitl$ "u subsection 7a7 on or 
aft] su* ,janu>y #a to b5efits "u "p ,a 
( title ,,xviii1 subject to p>agraph    
7#d71 ! individual %all 9 lieu ( su*    
entitlem5t be automatically enroll$ 9 ! 
,m$ic>e ,re=m ,premium ,assi/ance       
,program e/abli%$ "u subsection 7l72 &  
7,b7 9 ! case ( an individual :o be=e   
su* ,janu>y #a is entitl$ "u subsection 
7a7 to b5efits "u "p ,a ( title ,,xviii1
 ! individual may 9 lieu ( su*          
entitlem5t elect on or aft] su* ,janu>y 
#a to enroll 9 ! ,m$ic>e ,re=m ,premium 
,assi/ance ,program e/abli%$ "u         
subsection 7l74  7#b7 ,treatm5t "u !    

,int]nal ,rev5ue ,code ( #aihf ,an      
individual :o is enroll$ "u ! ,m$ic>e   
,re=m ,premium ,assi/ance ,program "u   
p>agraph 7#a7 %all n be treat$ z entitl$
 to b5efits "u title ,,xviii = purposes 
( section #bbc7;b77#g7 ( ! ,int]nal     
,rev5ue ,code ( #aihf4  7#c7            
,ineligibility = "p ,b or ,d b5efits ,an
 individual %all n be eligible = b5efits
 "u "p ,b or ,d ( title ,,xviii once !  
individual is enroll$ 9 ! ,m$ic>e ,re=m 
,premium ,assi/ance ,program "u p>agraph
 7#a74  7#d7 ,opt out  7,a7 ,9 g5]al    
,any individual :o is o!rwise eligible =
 automatic enrollm5t 9 ! ,m$ic>e ,re=m  
,premium ,assi/ance ,program "u p>agraph
 7#a77;,a7 may elect 79 su* =m & mann] z
 may be specifi$ by ! ,secret>y ( ,heal?
 & ,human ,s]vices7 to n be s enroll$4  
7,b7 ,individuals elect+ to opt out n   
treat$ z entitl$ to ,m$ic>e b5efits ,9 !
 case ( an individual :o makes an       
election "u subp>agraph 7,a7--  7i7 su* 
individual %all n be eligible = b5efits 
"u "p ,a ( title ,,xviii2 &  7ii7 !     

provisions ( p>agraphs 7#b7 & 7#c7 %all 
apply to su* individual 9 ! same mann] z
 su* p>agraphs apply to an individual   
enroll$ "u ! ,m$ic>e ,re=m ,premium     
,assi/ance ,program "u p>agraph 7#a74   
7l7 ,m$ic>e ,re=m ,premium ,assi/ance   
7#a7 ,e/abli%m5t ( premium assi/ance    
program ,! ,secret>y %all e/abli% a     
program to be kn[n z ! ,m$ic>e ,re=m    
,premium ,assi/ance ,program 79 ?is     
subsection ref]r$ to z ! premium        
assi/ance program7 consi/5t ) ?is       
subsection4  7#b7 ,automatic enrollm5t  
,an individual o!rwise entitl$ "u       
subsection 7a7 to b5efits "u "p ,a (    
title ,,xviii %all1 subject to          
subsection 7k77#d71 be enroll$ 9 !      
premium assi/ance program = ! p]iod dur+
 :i* su* individual w\ld o!rwise be s   
entitl$ to b5efits4  7#c7 ,am\nt (      
premium assi/ance  7,a7 ,9 g5]al        
,subject to clause 7ii71 = ea* ye> t an 
individual is enroll$ 9 ! premium       
assi/ance program1 ! ,secret>y %all     
provide premium assi/ance to su*        

individual 9 an am\nt det]m9$ by !      
,secret>y t is bas$ on ! geographic     
location ( ! individual & ! co/ (       
applicable heal? insurance cov]age &    
b5efits 9 su* area4  7,b7 ,computation (
 premium assi/ance am\nts ,! am\nt (    
premium assi/ance provid$ to an         
individual locat$ 9 a geographic area = 
a ye> %all be comput$ at #ajj p]c5t ( ! 
sum ( ! m$ian premium & m$ian d$uctible 
paym5t = su* ye> = all heal? insurance  
cov]age (f]$ by heal? insurance issu]s 9
 ! individual m>ket s]v+ su* area4  7#d7
 ,p]missible use ( premium assi/ance    
,premium assi/ance "u p>agraph 7#c7 may 
be us$ only = ! foll[+ purposes3  7,a7  
,= paym5t ( premiums1 d$uctibles1       
copaym5ts1 or o!r co/-%>+ = enrollm5t ( 
su* individual = heal? insurance cov]age
 (f]$ by heal? insurance issu]s 9 !     
individual m>ket4  7,b7 ,z a            
contribution into a ,,msa plan e/abli%$ 
by su* individual1 z def9$ 9 section    
#ach7;b77#b7 ( ! ,int]nal ,rev5ue ,code 
( #aihf4  7#e7 ,,msa deposits ,! am\nt (

 ! premium assi/ance receiv$ by an      
individual "u ?is subsection %all be    
deposit$1 on behalf ( su* individual1   
into ! ,,msa plan ( su* individual4  4  
7b7 ,effective date ,! am5dm5t made by  
?is section %all take effect on ! fir/  
,janu>y #a aft] ! date ( ! enactm5t (   
?is ,act4  #cjb4 ,gradual phas+ out (   
,,cms & transf] ( functions to ,dep>tm5t
 ( ! ,treasury  7a7 ,9 g5]al ,beg9n+ on 
,janu>y #a ( ! fir/ ye> beg9n+ aft] !   
date ( ! enactm5t ( ?is ,act1 !         
,secret>y %all provide = ! gradual phas+
 out ov] a p]iod 7n to exce$ #aj ye>s7 (
 ! ,(fice ( ! ,adm9i/rator ( ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices & su* ,c5t]s 
& ! transf] ( ! duties &                
responsibilities ( su* ,adm9i/rator &   
,c5t]s to su* an (fice & (ficial )9 !   
,dep>tm5t ( ! ,treasury z ! ,secret>y ( 
! ,treasury %all specify4  7b7 ,ref]5ces
 ,any ref]5ce 9 law to ! ,adm9i/rator ( 
! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1  
or to su* ,c5t]s1 is deem$ to include a 
ref]5ce to su* (ficial & (fice1         

respectively1 )9 ! ,dep>tm5t ( !        
,treasury z is specifi$ "u subsection   
7a74  ,,iv ,,emtala ,re=ms  #dja4       
,,emtala re=ms  7a7 ,use ( qualifi$     
em]g5cy dep>tm5t p]sonnel 9 p]=m+       
initial scre5+ ,subsection 7a7 ( section
 #ahfg ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acie;dd7 is am5d$--  7#a7 by 
designat+ ! s5t5ce beg9n+ ) ,9 ! case ( 
z p>agraph 7#a71 ) ! head+ ,9 g5]al4-- &
 appropriate ind5tation2 &  7#b7 by add+
 at ! end ! foll[+ new p>agraph3  7#b7  
,p]mitt+ application ( ,,er triage  7,a7
 ,9 g5]al ,! requirem5t ( p>agraph 7#a7 
t a hospital conduct an appropriate     
m$ical scre5+ exam9ation ( an individual
 is deem$ to be satisfi$ if a qualifi$  
em]g5cy scre5] 7z def9$ 9 subp>agraph   
7,b77 p]=ms a prelim9>y triage-type     
scre5+ 9 :i* ! p]sonnel--  7i7 assesses 
! nature & ext5t ( ! individual's       
illness or injury2 &  7ii7 det]m9es1    
bas$ on su* assessm5t1 t an em]g5cy     
m$ical condition does n exi/4  7,b7     
,qualifi$ em]g5cy scre5] def9$ ,9 ?is   

p>agraph1 ! t]m qualifi$ em]g5cy scre5] 
means a physician1 lic5s$ practical     
nurse or regi/]$ nurse1 qualifi$ em]g5cy
 m$ical te*nician1 or o!r individual )  
basic1 heal? c>e education t meets /&>ds
 specifi$ by ! ,secret>y z be+ suffici5t
 to p]=m ! scre5+ describ$ 9 subp>agraph
 7,a74  4  7b7 ,revision ( em]g5cy      
m$ical condition def9ition ,subsection  
7e77#a77;,a7 ( su* section is am5d$ to  
read z foll[s3  7,a7 a m$ical condition 
manife/+ itself by symptoms ( suffici5t 
sev]ity 7includ+ sev]e pa97 & ) an onset
 or ( a c\rse su* t ! abs5ce ( imm$iate 
m$ical att5tion c\ld reasonably be      
expect$ to pose an imm$iate risk to life
 or long-t]m heal? ( ! individual 7or1 )
 respect to a pregnant woman1 ! life or 
long-t]m heal? ( ! woman or h] unborn   
*ild72 or  4  7c7 ,effective date ,!    
am5dm5ts made by ?is section %all take  
effect on ! date ( ! enactm5t ( ?is ,act
 & %all apply to individuals :o come to 
an em]g5cy room on or aft] ! date t is  
#cj days aft] ! date ( ! enactm5t ( ?is 

,act4  ,v ,coop]ative ,gov]n+ (         
,individual & ,gr\p ,heal? ,insurance   
,cov]age  #eja4 ,coop]ative gov]n+ (    
individual & gr\p heal? insurance       
cov]age  7a7 ,9 g5]al ,title ,,xxvii ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #cjj;gg et seq47 is am5d$ by  
add+ at ! end ! foll[+ new "p3  ,d      
,coop]ative ,gov]n+ ( ,individual &     
,gr\p ,heal? ,insurance ,cov]age  #bgie4
 ,def9itions ,9 ?is "p3  7#a7 ,prim>y   
/ate ,! t]m prim>y ,/ate means1 )       
respect to individual or gr\p heal?     
insurance cov]age (f]$ by a heal?       
insurance issu]1 ! ,/ate designat$ by ! 
issu] z ! ,/ate ^: cov]$ laws %all gov]n
 ! heal? insurance issu] 9 ! sale ( su* 
cov]age "u ?is "p4 ,an issu]1 ) respect 
to a p>ticul> policy1 may only designate
 "o su* ,/ate z its prim>y ,/ate )      
respect to all su* cov]age x (f]s4 ,su* 
an issu] may n *ange ! designat$ prim>y 
,/ate ) respect to individual or gr\p   
heal? insurance cov]age once ! policy is
 issu$1 except t su* a *ange may be made

 ^u r5ewal ( ! policy4 ,) respect to su*
 designat$ ,/ate1 ! issu] is deem$ to be
 do+ bus9ess 9 t ,/ate4  7#b7 ,second>y 
/ate ,! t]m second>y ,/ate means1 )     
respect to individual or gr\p heal?     
insurance cov]age (f]$ by a heal?       
insurance issu]1 any ,/ate t is n !     
prim>y ,/ate4 ,9 ! case ( a heal?       
insurance issu] t is sell+ a policy 91  
or to a resid5t (1 a second>y ,/ate1 !  
issu] is deem$ to be do+ bus9ess 9 t    
second>y ,/ate4  7#c7 ,heal? insurance  
issu] ,! t]m heal? insurance issu] has !
 mean+ giv5 su* t]m 9 section           
#bgia7;b77#b71 except t su* an issu] mu/
 be lic5s$ 9 ! prim>y ,/ate & be        
qualifi$ to sell individual heal?       
insurance cov]age 9 t ,/ate4  7#d7      
,individual heal? insurance cov]age ,!  
t]m individual heal? insurance cov]age  
means heal? insurance cov]age (f]$ 9 !  
individual m>ket1 z def9$ 9 section     
#bgia7;e77#a74  7#e7 ,gr\p heal?        
insurance cov]age ,! t]m gr\p heal?     
insurance cov]age has ! mean+ giv5 su*  

t]m 9 #bgia7;b77#d74  7#f7 ,applicable  
/ate au?ority ,! t]m applicable ,/ate   
au?ority means1 ) respect to a heal?    
insurance issu] 9 a ,/ate1 ! ,/ate      
insurance commission] or (ficial or     
(ficials designat$ by ! ,/ate to en=ce !
 requirem5ts ( ?is title = ! ,/ate )    
respect to ! issu]4  7#g7 ,haz>d\s      
f9ancial condition ,! t]m haz>d\s       
f9ancial condition means t1 bas$ on its 
pres5t or reasonably anticipat$ f9ancial
 condition1 a heal? insurance issu] is  
unlikely to be able--  7,a7 to meet     
obligations to policyhold]s ) respect to
 kn[n claims & reasonably anticipat$    
claims2 or  7,b7 to pay o!r obligations 
9 ! normal c\rse ( bus9ess4  7#h7 ,cov]$
 laws  7,a7 ,9 g5]al ,! t]m cov]$ laws  
means ! laws1 rules1 regulations1       
agreem5ts1 & ord]s gov]n+ ! insurance   
bus9ess p]ta9+ to--  7i7 individual or  
gr\p heal? insurance cov]age issu$ by a 
heal? insurance issu]2  7ii7 ! (f]1     
sale1 rat+ 7includ+ m$ical und]writ+71  
r5ewal1 & issuance ( individual or gr\p 

heal? insurance cov]age to an           
individual2  7iii7 ! provision to an    
individual 9 relation to individual or  
gr\p heal? insurance cov]age ( heal? c>e
 & insurance relat$ s]vices2  7iv7 !    
provision to an individual 9 relation to
 individual or gr\p heal? insurance     
cov]age ( managem5t1 op]ations1 &       
inve/m5t activities ( a heal? insurance 
issu]2 &  7v7 ! provision to an         
individual 9 relation to individual or  
gr\p heal? insurance cov]age ( loss     
control & claims adm9i/ration = a heal? 
insurance issu] ) respect to liability =
 :i* ! issu] provides insurance4  7,b7  
,exception ,su* t]m does n include any  
law1 rule1 regulation1 agreem5t1 or ord]
 gov]n+ ! use ( c>e or co/ managem5t    
te*niques1 includ+ any requirem5t relat$
 to provid] contract+1 network access or
 adequacy1 heal? c>e data collection1 or
 quality assurance4  7#i7 ,/ate ,! t]m  
,/ate means ! #ej ,/ates & includes !   
,di/rict ( ,columbia1 ,pu]to ,rico1 !   
,virg9 ,isl&s1 ,guam1 ,am]ican ,samoa1 &

 ! ,nor!rn ,m>iana ,isl&s4  7#aj7       
,unfair claims settlem5t practices ,!   
t]m unfair claims settlem5t practices   
means only ! foll[+ practices3  7,a7    
,kn[+ly misrepres5t+ to claimants &     
insur$ individuals relevant facts or    
policy provisions relat+ to cov]age at  
issue4  7,b7 ,fail+ to ackn[l$ge )      
reasonable promptness p]t95t            
communications ) respect to claims aris+
 "u policies4  7,c7 ,fail+ to adopt &   
implem5t reasonable /&>ds = ! prompt    
inve/igation & settlem5t ( claims aris+ 
"u policies4  7,d7 ,fail+ to effectuate 
prompt1 fair1 & equitable settlem5t (   
claims submitt$ 9 :i* liability has     
become reasonably cle>4  7,e7 ,refus+ to
 pay claims )\t conduct+ a reasonable   
inve/igation4  7,f7 ,fail+ to affirm or 
d5y cov]age ( claims )9 a reasonable    
p]iod ( "t aft] hav+ complet$ an        
inve/igation relat$ to ^? claims4  7,g7 
,a patt]n or practice ( compell+ insur$ 
individuals or _! b5efici>ies to        
in/itute suits to recov] am\nts due "u  

its policies by (f]+ sub/antially less  
?an ! am\nts ultimately recov]$ 9 suits 
br\ght by !m4  7,h7 ,a patt]n or        
practice ( attempt+ to settle or settl+ 
claims = less ?an ! am\nt t a reasonable
 p]son w\ld believe ! insur$ individual 
or 8 or h] b5efici>y 0 entitl$ by       
ref]5ce to writt5 or pr9t$ adv]tis+     
mat]ial accompany+ or made "p ( an      
application4  7,i7 ,attempt+ to settle  
or settl+ claims on ! basis ( an        
application t 0 mat]ially alt]$ )\t     
notice to1 or k or cons5t (1 ! insur$4  
7,j7 ,fail+ to provide =ms necess>y to  
pres5t claims )9 #ae cal5d> days ( a    
reque/s ) reasonable explanations reg>d+
 _! use4  7,k7 ,attempt+ to cancel a    
policy 9 less "t ?an t prescrib$ 9 !    
policy or by ! law ( ! prim>y ,/ate4    
7#aa7 ,fraud & abuse ,! t]m fraud &     
abuse means an act or omission committ$ 
by a p]son :o1 kn[+ly & ) int5t to      
defraud1 commits1 or conceals any       
mat]ial in=mation conc]n+1 "o or m ( !  
foll[+3  7,a7 ,pres5t+1 caus+ to be     

pres5t$ or prep>+ ) k or belief t x w be
 pres5t$ to or by an insur]1 a re9sur]1 
brok] or its ag5t1 false in=mation z "p 
(1 9 support ( or conc]n+ a fact mat]ial
 to "o or m ( ! foll[+3  7i7 ,an        
application = ! issuance or r5ewal ( an 
insurance policy or re9surance contract4
  7ii7 ,! rat+ ( an insurance policy or 
re9surance contract4  7iii7 ,a claim =  
paym5t or b5efit pursuant to an         
insurance policy or re9surance contract4
  7iv7 ,premiums paid on an insurance   
policy or re9surance contract4  7v7     
,paym5ts made 9 accordance ) ! t]ms ( an
 insurance policy or re9surance         
contract4  7vi7 ,a docum5t fil$ ) !     
commission] or ! *ief insurance         
regulatory (ficial ( ano!r jurisdiction4
  7vii7 ,! f9ancial condition ( an      
insur] or re9sur]4  7viii7 ,! =mation1  
acquisition1 m]g]1 reconsolidation1     
dissolution or )drawal f "o or m l9es ( 
insurance or re9surance 9 all or "p ( a 
,/ate by an insur] or re9sur]4  7ix7 ,! 
issuance ( writt5 evid5ce ( insurance4  

7x7 ,! re9/atem5t ( an insurance policy4
  7,b7 ,solicitation or acceptance ( new
 or r5ewal insurance risks on behalf (  
an insur] re9sur] or o!r p]son engag$ 9 
! bus9ess ( insurance by a p]son :o kn[s
 or %\ld "k t ! insur] or o!r p]son     
responsible = ! risk is insolv5t at ! "t
 ( ! transaction4  7,c7 ,transaction ( !
 bus9ess ( insurance 9 violation ( laws 
requir+ a lic5se1 c]tificate ( au?ority 
or o!r legal au?ority = ! transaction ( 
! bus9ess ( insurance4  7,d7 ,attempt to
 commit1 aid+ or abett+ 9 ! commission  
(1 or conspiracy to commit ! acts or    
omissions specifi$ 9 ?is p>agraph4      
#bgif4 ,application ( law  7a7 ,9 g5]al 
,! cov]$ laws ( ! prim>y ,/ate %all     
apply to individual & gr\p heal?        
insurance cov]age (f]$ by a heal?       
insurance issu] 9 ! prim>y ,/ate & 9 any
 second>y ,/ate1 b only if ! cov]age &  
issu] comply ) ! conditions ( ?is       
section ) respect to ! (f]+ ( cov]age 9 
any second>y ,/ate4  7b7 ,exemptions f  
cov]$ laws 9 a second>y /ate ,except z  

provid$ 9 ?is section1 a heal? insurance
 issu] ) respect to its (f]1 sale1 rat+ 
7includ+ m$ical und]writ+71 r5ewal1 &   
issuance ( individual or gr\p heal?     
insurance cov]age 9 any second>y ,/ate  
is exempt f any cov]$ laws ( ! second>y 
,/ate 7& any rules1 regulations1        
agreem5ts1 or ord]s s\ght or issu$ by   
su* ,/ate "u or relat$ to su* cov]$     
laws7 to ! ext5t t su* laws w\ld--  7#a7
 make unlawful1 or regulate1 directly or
 indirectly1 ! op]ation ( ! heal?       
insurance issu] op]at+ 9 ! second>y     
,/ate1 except t any second>y ,/ate may  
require su* an issu]--  7,a7 to pay1 on 
a nondiscrim9atory basis1 applicable    
premium & o!r taxes 7includ+ high risk  
pool assessm5ts7 :i* are levi$ on       
insur]s & surplus l9es insur]s1 brok]s1 
or policyhold]s "u ! laws ( ! ,/ate2    
7,b7 to regi/] ) & designate ! ,/ate    
insurance commission] z its ag5t solely 
= ! purpose ( receiv+ s]vice ( legal    
docum5ts or process2  7,c7 to submit to 
an exam9ation ( its f9ancial condition  

by ! ,/ate insurance commission] 9 any  
,/ate 9 :i* ! issu] is do+ bus9ess to   
det]m9e ! issu]'s f9ancial condition1   
if--  7i7 ! ,/ate insurance commission] 
( ! prim>y ,/ate has n done an          
exam9ation )9 ! p]iod recomm5d$ by !    
,national ,association ( ,insurance     
,commission]s2 &  7ii7 any su*          
exam9ation is conduct$ 9 accordance ) ! 
exam9]s' h&book ( ! ,national           
,association ( ,insurance ,commission]s 
& is coord9at$ to avoid unju/ifi$       
duplication & unju/ifi$ repetition2     
7,d7 to comply ) a lawful ord] issu$--  
7i7 9 a del9qu5cy proce$+ comm5c$ by !  
,/ate insurance commission] if !re has  
be5 a f9d+ ( f9ancial impairm5t "u      
subp>agraph 7,c72 or  7ii7 9 a volunt>y 
dissolution proce$+2  7,e7 to comply )  
an injunction issu$ by a c\rt ( compet5t
 jurisdiction1 ^u a petition by ! ,/ate 
insurance commission] alleg+ t ! issu]  
is 9 haz>d\s f9ancial condition2  7,f7  
to p>ticipate1 on a nondiscrim9atory    
basis1 9 any insurance insolv5cy gu>anty

 association or simil> association to   
:i* a heal? insurance issu] 9 ! ,/ate is
 requir$ to belong2  7,g7 to comply )   
any ,/ate law reg>d+ fraud & abuse 7z   
def9$ 9 section #bgie7aj771 except t if 
! ,/ate seeks an injunction reg>d+ !    
conduct describ$ 9 ?is subp>agraph1 su* 
injunction mu/ be obta9$ f a c\rt (     
compet5t jurisdiction2  7,h7 to comply )
 any ,/ate law reg>d+ unfair claims     
settlem5t practices 7z def9$ 9 section  
#bgie7i772 or  7,i7 to comply ) !       
applicable requirem5ts = indep5d5t      
review "u section #bgih ) respect to    
cov]age (f]$ 9 ! ,/ate2  7#b7 require   
any individual or gr\p heal? insurance  
cov]age issu$ by ! issu] to be          
c\nt]sign$ by an insurance ag5t or brok]
 resid+ 9 t ,second>y ,/ate2 or  7#c7   
o!rwise discrim9ate aga9/ ! issu] issu+ 
insurance 9 bo? ! prim>y ,/ate & 9 any  
second>y ,/ate4  7c7 ,cle> & conspicu\s 
disclosure ,a heal? insurance issu] %all
 provide ! foll[+ notice1 9 #ab-po9t    
bold type1 9 any insurance cov]age (f]$ 

9 a second>y ,/ate "u ?is "p by su* a   
heal? insurance issu] & at r5ewal ( !   
policy1 ) ! #e blank spaces !re9 be+    
appropriately fill$ ) ! "n ( ! heal?    
insurance issu]1 ! "n ( prim>y ,/ate1 ! 
"n ( ! second>y ,/ate1 ! "n ( ! second>y
 ,/ate1 & ! "n ( ! second>y ,/ate1      
respectively1 = ! cov]age conc]n$3      
,notice3 ,?is policy is issu$ by  & is  
gov]n$ by ! laws & regulations ( ! ,/ate
 ( 1 & x has met all ! laws ( t ,/ate z 
det]m9$ by t ,/ate's ,dep>tm5t (        
,insurance4 ,?is policy may be less     
exp5sive ?an o!rs because x is n subject
 to all ( ! insurance laws & regulations
 ( ! ,/ate ( 1 includ+ cov]age ( "s     
s]vices or b5efits m&at$ by ! law ( !   
,/ate ( 4 ,additionally1 ?is policy is n
 subject to all ( ! consum] protection  
laws or re/rictions on rate *anges ( !  
,/ate ( 4 ,z ) all insurance products1  
be=e pur*as+ ?is policy1 y %\ld c>efully
 review ! policy & det]m9e :at heal? c>e
 s]vices ! policy cov]s & :at b5efits x 
provides1 includ+ any exclusions1       

limitations1 or conditions = su* s]vices
 or b5efits44  7d7 ,prohibition on c]ta9
 reclassifications & premium increases  
7#a7 ,9 g5]al ,= purposes ( ?is section1
 a heal? insurance issu] t provides     
individual or gr\p heal? insurance      
cov]age to an individual "u ?is "p 9 a  
prim>y or second>y ,/ate may n ^u       
r5ewal--  7,a7 move or reclassify !     
individual insur$ "u ! heal? insurance  
cov]age f ! class su* individual is 9 at
 ! "t ( issue ( ! contract bas$ on !    
heal? /atus-relat$ factors ( !          
individual2 or  7,b7 increase ! premiums
 assess$ ! individual = su* cov]age bas$
 on a heal? /atus-relat$ factor or *ange
 ( a heal? /atus-relat$ factor or ! pa/ 
or prospective claim exp]i5ce ( ! insur$
 individual4  7#b7 ,con/ruction ,no?+ 9 
p>agraph 7#a7 %all be con/ru$ to        
prohibit a heal? insurance issu]--  7,a7
 f t]m9at+ or discont9u+ cov]age or a   
class ( cov]age 9 accordance )          
subsections 7b7 & 7c7 ( section #bgdb2  
7,b7 f rais+ premium rates = all policy 

hold]s )9 a class bas$ on claims        
exp]i5ce2  7,c7 f *ang+ premiums or (f]+
 disc\nt$ premiums to individuals :o    
engage 9 wellness activities at int]vals
 prescrib$ by ! issu]1 if su* premium   
*anges or inc5tives--  7i7 are disclos$ 
to ! consum] 9 ! insurance contract2    
7ii7 are bas$ on specific wellness      
activities t are n applicable to all    
individuals2 &  7iii7 are n obta9able by
 all individuals to :om cov]age is (f]$2
  7,d7 f re9/at+ laps$ cov]age2 or  7,e7
 f retroactively adju/+ ! rates *>g$ an 
insur$ individual if ! initial rates 7  
set bas$ on mat]ial misrepres5tation by 
! individual at ! "t ( issue4  7e7      
,prior (f]+ ( policy 9 prim>y /ate ,a   
heal? insurance issu] may n (f] = sale  
individual or gr\p heal? insurance      
cov]age 9 a second>y ,/ate unless t     
cov]age is curr5tly (f]$ = sale 9 !     
prim>y ,/ate4  7f7 ,lic5s+ ( ag5ts or   
brok]s = heal? insurance issu]s ,any    
,/ate may require t a p]son act+1 or    
(f]+ to act1 z an ag5t or brok] = a     

heal? insurance issu] ) respect to !    
(f]+ ( individual or gr\p heal?         
insurance cov]age obta9 a lic5se f t    
,/ate1 ) commissions or o!r comp5sation 
subject to ! provisions ( ! laws ( t    
,/ate1 except t a ,/ate may n impose any
 qualification or requirem5t :i*        
discrim9ates aga9/ a nonresid5t ag5t or 
brok]4  7g7 ,docum5ts = submission to   
/ate insurance commission] ,ea* heal?   
insurance issu] issu+ individual or gr\p
 heal? insurance cov]age 9 bo? prim>y & 
second>y ,/ates %all submit--  7#a7 to !
 insurance commission] ( ea* ,/ate 9 :i*
 x int5ds to (f] su* cov]age1 be=e x may
 (f] individual or gr\p heal? insurance 
cov]age 9 su* ,/ate--  7,a7 a copy ( !  
plan ( op]ation or feasibility /udy or  
any simil> /atem5t ( ! policy be+ (f]$ &
 its cov]age 7:i* %all include ! "n (   
its prim>y ,/ate & its pr9cipal place ( 
bus9ess72  7,b7 writt5 notice ( any     
*ange 9 its designation ( its prim>y    
,/ate2 &  7,c7 writt5 notice f ! issu] (
 ! issu]'s compliance ) all ! laws ( !  

prim>y ,/ate2 &  7#b7 to ! insurance    
commission] ( ea* second>y ,/ate 9 :i* x
 (f]s individual or gr\p heal? insurance
 cov]age1 a copy ( ! issu]'s qu>t]ly    
f9ancial /atem5t submitt$ to ! prim>y   
,/ate1 :i* /atem5t %all be c]tifi$ by an
 indep5d5t public acc\ntant & conta9 a  
/atem5t ( op9ion on loss & loss adju/m5t
 exp5se res]ves made by--  7,a7 a memb] 
( ! ,am]ican ,academy ( ,actu>ies2 or   
7,b7 a qualifi$ loss res]ve speciali/4  
7h7 ,p[] ( c\rts ,to enjo9 conduct ,no?+
 9 ?is section %all be con/ru$ to affect
 ! au?ority ( any ,f$]al or ,/ate c\rt  
to enjo9--  7#a7 ! solicitation or sale 
( individual or gr\p heal? insurance    
cov]age by a heal? insurance issu] to   
any p]son or gr\p :o is n eligible = su*
 insurance2 or  7#b7 ! solicitation or  
sale ( individual or gr\p heal?         
insurance cov]age t violates !          
requirem5ts ( ! law ( a second>y ,/ate  
:i* are describ$ 9 subp>agraphs 7,a7    
?r\gh 7,h7 ( section #bgif7;b77#a74  7i7
 ,p[] ( ,second>y ,/ates ,to ,take      

,adm9i/rative ,action ,no?+ 9 ?is       
section %all be con/ru$ to affect !     
au?ority ( any ,/ate to enjo9 conduct 9 
violation ( t ,/ate's laws describ$ 9   
section #bgif7;b77#a74  7j7 ,/ate p[]s  
,to en=ce /ate laws  7#a7 ,9 g5]al      
,subject to ! provisions ( subsection   
7b77#a77;,g7 7relat+ to injunctions7 &  
p>agraph 7#b71 no?+ 9 ?is section %all  
be con/ru$ to affect ! au?ority ( any   
,/ate to make use ( any ( its p[]s to   
en=ce ! laws ( su* ,/ate ) respect to   
:i* a heal? insurance issu] is n exempt 
"u subsection 7b74  7#b7 ,c\rts (       
compet5t jurisdiction ,if a ,/ate seeks 
an injunction reg>d+ ! conduct describ$ 
9 p>agraphs 7#a7 & 7#b7 ( subsection    
7h71 su* injunction mu/ be obta9$ f a   
,f$]al or ,/ate c\rt ( compet5t         
jurisdiction4  7k7 ,/ates' au?ority ,to 
sue ,no?+ 9 ?is section %all affect !   
au?ority ( any ,/ate to br+ action 9 any
 ,f$]al or ,/ate c\rt4  7l7 ,g5]ally    
applicable laws ,no?+ 9 ?is section %all
 be con/ru$ to affect ! applicability ( 

,/ate laws g5]ally applicable to p]sons 
or corporations4  7m7 ,gu>ante$         
,availability ( ,cov]age to ,,hipaa     
,eligible ,individuals ,to ! ext5t t a  
heal? insurance issu] is (f]+ cov]age 9 
a prim>y ,/ate t does n accommodate     
resid5ts ( second>y ,/ates or does n    
provide a work+ me*anism = resid5ts ( a 
second>y ,/ate1 & ! issu] is (f]+       
cov]age "u ?is "p 9 su* second>y ,/ate  
:i* has n adopt$ a qualifi$ high risk   
pool z its acceptable alt]native        
me*anism 7z def9$ 9 section             
#bgdd7;c77#b771 ! issu] %all1 ) respect 
to any individual or gr\p heal?         
insurance cov]age (f]$ 9 a second>y     
,/ate "u ?is "p1 comply ) ! gu>ante$    
availability requirem5ts = eligible     
individuals 9 section #bgda4  #bgig4    
,prim>y ,/ate mu/ meet ,f$]al floor be=e
 issu] may sell into second>y ,/ates ,a 
heal? insurance issu] may n (f]1 sell1  
or issue individual or gr\p heal?       
insurance cov]age 9 a second>y ,/ate if 
! ,/ate insurance commission] does n use

 a risk-bas$ capital =mula = !          
det]m9ation ( capital & surplus         
requirem5ts = all heal? insurance       
issu]s4  #bgih4 ,indep5d5t ext]nal      
appeals proc$ures  7a7 ,"r to ,ext]nal  
,appeal ,a heal? insurance issu] may n  
(f]1 sell1 or issue individual or gr\p  
heal? insurance cov]age 9 a second>y    
,/ate "u ! provisions ( ?is title       
unless--  7#a7 bo? ! second>y ,/ate & ! 
prim>y ,/ate h legislation or           
regulations 9 place e/abli%+ an         
indep5d5t review process = individuals  
:o are cov]$ by individual heal?        
insurance cov]age or gr\p heal?         
insurance (f]$ by a heal? insurance     
issu]1 respectively1 or  7#b7 9 any case
 9 :i* ! requirem5ts ( subp>agraph 7,a7 
are n met ) respect to ! ei!r ( su*     
,/ates1 ! issu] provides an indep5d5t   
review me*anism sub/antially id5tical 7z
 det]m9$ by ! applicable ,/ate au?ority 
( su* ,/ate7 to t prescrib$ 9 ! ,heal?  
,c>ri] ,ext]nal ,review ,model ,act ( ! 
,national ,association ( ,insurance     

,commission]s = all individuals :o      
pur*ase insurance cov]age "u ! t]ms (   
?is "p1 except t1 "u su* me*anism1 !    
review is conduct$ by an indep5d5t      
m$ical review]1 or a panel ( su*        
review]s1 ) respect to :om ! requirem5ts
 ( subsection 7b7 are met4  7b7         
,qualifications ( ,indep5d5t ,m$ical    
,review]s ,9 ! case ( any indep5d5t     
review me*anism ref]r$ to 9 subsection  
7a77#b73  7#a7 ,9 g5]al ,9 ref]r+ a     
d5ial ( a claim to an indep5d5t m$ical  
review]1 or to any panel ( su* review]s1
 to conduct indep5d5t m$ical review1 !  
issu] %all ensure t--  7,a7 ea*         
indep5d5t m$ical review] meets !        
qualifications describ$ 9 p>agraphs 7#b7
 & 7#c72  7,b7 ) respect to ea* review1 
ea* review] meets ! requirem5ts (       
p>agraph 7#d7 & ! review]1 or at lea/ #a
 review] on ! panel1 meets ! requirem5ts
 describ$ 9 p>agraph 7#e72 &  7,c7      
comp5sation provid$ by ! issu] to ea*   
review] is consi/5t ) p>agraph 7#f74    
7#b7 ,lic5sure & exp]tise ,ea* indep5d5t

 m$ical review] %all be a physician     
7allopa?ic or o/eopa?ic7 or heal? c>e   
pr(essional :o--  7,a7 is appropriately 
cr$5tial$ or lic5s$ 9 #a or m ,/ates to 
deliv] heal? c>e s]vices2 &  7,b7       
typically treats ! condition1 makes !   
diagnosis1 or provides ! type ( treatm5t
 "u review4  7#c7 ,indep5d5ce  7,a7 ,9  
g5]al ,subject to subp>agraph 7,b71 ea* 
indep5d5t m$ical review] 9 a case %all--
  7i7 n be a relat$ p>ty 7z def9$ 9     
p>agraph 7#g772  7ii7 n h a mat]ial     
familial1 f9ancial1 or pr(essional      
relation%ip ) su* a p>ty2 &  7iii7 n    
o!rwise h a conflict ( int]e/ ) su* a   
p>ty 7z det]m9$ "u regulations74  7,b7  
,exception ,no?+ 9 subp>agraph 7,a7 %all
 be con/ru$ to--  7i7 prohibit an       
individual1 solely on ! basis (         
affiliation ) ! issu]1 f s]v+ z an      
indep5d5t m$ical review] if--  7,i7 a   
non-affiliat$ individual is n reasonably
 available2  7,,ii7 ! affiliat$         
individual is n involv$ 9 ! provision ( 
items or s]vices 9 ! case "u review2    

7,,iii7 ! fact ( su* an affiliation is  
disclos$ to ! issu] & ! enrollee 7or    
au?oriz$ repres5tative7 & nei!r p>ty    
objects2 &  7,,iv7 ! affiliat$          
individual is n an employee ( ! issu] & 
does n provide s]vices exclusively or   
prim>ily to or on behalf ( ! issu]2     
7ii7 prohibit an individual :o has /aff 
privileges at ! in/itution :]e !        
treatm5t involv$ takes place f s]v+ z an
 indep5d5t m$ical review] m]ely on !    
basis ( su* affiliation if ! affiliation
 is disclos$ to ! issu] & ! enrollee 7or
 au?oriz$ repres5tative71 & nei!r p>ty  
objects2 or  7iii7 prohibit receipt (   
comp5sation by an indep5d5t m$ical      
review] f an entity if ! comp5sation is 
provid$ consi/5t ) p>agraph 7#f74  7#d7 
,practic+ heal? c>e pr(essional 9 same  
field  7,a7 ,9 g5]al ,9 a case involv+  
treatm5t1 or ! provision ( items or     
s]vices--  7i7 by a physician1 a review]
 %all be a practic+ physician 7allopa?ic
 or o/eopa?ic7 ( ! same or simil>       
specialty1 z a physician :o1 act+ )9 !  

appropriate scope ( practice )9 ! ,/ate 
9 :i* ! s]vice is provid$ or r5d]$1     
typically treats ! condition1 makes !   
diagnosis1 or provides ! type ( treatm5t
 "u review2 or  7ii7 by a non-physician 
heal? c>e pr(essional1 ! review]1 or at 
lea/ #a memb] ( ! review panel1 %all be 
a practic+ non-physician heal? c>e      
pr(essional ( ! same or simil> specialty
 z ! non-physician heal? c>e pr(essional
 :o1 act+ )9 ! appropriate scope (      
practice )9 ! ,/ate 9 :i* ! s]vice is   
provid$ or r5d]$1 typically treats !    
condition1 makes ! diagnosis1 or        
provides ! type ( treatm5t "u review4   
7,b7 ,practic+ def9$ ,= purposes ( ?is  
p>agraph1 ! t]m practic+ means1 )       
respect to an individual :o is a        
physician or o!r heal? c>e pr(essional1 
t ! individual provides heal? c>e       
s]vices to individual pati5ts on av]age 
at lea/ #b days p] week4  7#e7 ,p$iatric
 exp]tise ,9 ! case ( an ext]nal review 
relat+ to a *ild1 a review] %all h      
exp]tise "u p>agraph 7#b7 9 p$iatrics4  

7#f7 ,limitations on review] comp5sation
 ,comp5sation provid$ by ! issu] to an  
indep5d5t m$ical review] 9 connection ) 
a review "u ?is section %all--  7,a7 n  
exce$ a reasonable level2 &  7,b7 n be  
cont+5t on ! decision r5d]$ by !        
review]4  7#g7 ,relat$ p>ty def9$ ,=    
purposes ( ?is section1 ! t]m relat$    
p>ty means1 ) respect to a d5ial ( a    
claim "u a cov]age relat+ to an         
enrollee1 any ( ! foll[+3  7,a7 ,! issu]
 involv$1 or any fiduci>y1 (fic]1       
director1 or employee ( ! issu]4  7,b7  
,! enrollee 7or au?oriz$ repres5tative74
  7,c7 ,! heal? c>e pr(essional t       
provides ! items or s]vices involv$ 9 ! 
d5ial4  7,d7 ,! in/itution at :i* !     
items or s]vices 7or treatm5t7 involv$ 9
 ! d5ial are provid$4  7,e7 ,!          
manufactur] ( any drug or o!r item t is 
includ$ 9 ! items or s]vices involv$ 9 !
 d5ial4  7,f7 ,any o!r p>ty det]m9$ "u  
any regulations to h a sub/antial int]e/
 9 ! d5ial involv$4  7#h7 ,def9itions ,=
 purposes ( ?is subsection3  7,a7       

,enrollee ,! t]m enrollee means1 )      
respect to heal? insurance cov]age (f]$ 
by a heal? insurance issu]1 an          
individual enroll$ ) ! issu] to receive 
su* cov]age4  7,b7 ,heal? c>e           
pr(essional ,! t]m heal? c>e pr(essional
 means an individual :o is lic5s$1      
accr$it$1 or c]tifi$ "u ,/ate law to    
provide specifi$ heal? c>e s]vices & :o 
is op]at+ )9 ! scope ( su* lic5sure1    
accr$itation1 or c]tification4  #bgii4  
,en=cem5t  7a7 ,9 g5]al ,subject to     
subsection 7b71 ) respect to specific   
individual or gr\p heal? insurance      
cov]age ! prim>y ,/ate = su* cov]age has
 sole jurisdiction to en=ce ! prim>y    
,/ate's cov]$ laws 9 ! prim>y ,/ate &   
any second>y ,/ate4  7b7 ,second>y      
/ate's au?ority ,no?+ 9 subsection 7a7  
%all be con/ru$ to affect ! au?ority ( a
 second>y ,/ate to en=ce its laws z set 
=? 9 ! exception specifi$ 9 section     
#bgif7;b77#a74  7c7 ,c\rt int]pretation 
,9 review+ action initiat$ by !         
applicable second>y ,/ate au?ority1 !   

c\rt ( compet5t jurisdiction %all apply 
! cov]$ laws ( ! prim>y ,/ate4  7d7     
,notice ( compliance failure ,9 ! case (
 individual heal? insurance cov]age (f]$
 9 a second>y ,/ate1 or gr\p heal?      
insurance cov]ag$ (f]$ by a heal?       
insurance issu] 9 a second>y ,/ate1 t   
fails to comply ) ! cov]$ laws ( !      
prim>y ,/ate1 ! applicable ,/ate        
au?ority ( ! second>y ,/ate may notify !
 applicable ,/ate au?ority ( ! prim>y   
,/ate4  4  7b7 ,effective date ,!       
am5dm5t made by subsection 7a7 %all     
apply to heal? insurance cov]age (f]$1  
issu$1 or sold aft] ! date t is "o ye>  
aft] ! date ( ! enactm5t ( ?is ,act4    
7c7 ,,gao ongo+ /udy & reports  7#a7    
,/udy ,! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all conduct an ongo+ /udy       
conc]n+ ! effect ( ! am5dm5t made by    
subsection 7a7 on--  7,a7 ! numb] (     
un9sur$ & "u-insur$2  7,b7 !            
availability & co/ ( heal? insurance    
policies = individuals ) pre-exi/+      
m$ical conditions2  7,c7 ! availability 

& co/ ( heal? insurance policies        
g5]ally2  7,d7 ! elim9ation or r$uction 
( diff]5t types ( b5efits "u heal?      
insurance policies (f]$ 9 diff]5t       
,/ates2 &  7,e7 cases ( fraud or abuse  
relat+ to heal? insurance cov]age (f]$  
"u su* am5dm5t & ! resolution ( su*     
cases4  7#b7 ,annual reports ,!         
,comptroll] ,g5]al %all submit to       
,congress an annual report1 aft] ! end (
 ea* ( ! #e ye>s foll[+ ! effective date
 ( ! am5dm5t made by subsection 7a71 on 
! ongo+ /udy conduct$ "u p>agraph 7#a74 
#ejb4 ,cont9u+ ,/ate au?ority ,no?+ 9   
?is title1 or ! am5dm5ts made by ?is    
title1 %all be con/ru$ z prev5t+ a      
,/ate--  7#a7 f p]mitt+ resid5ts ( !    
,/ate to pur*ase ( heal? insurance (f]$ 
by a heal? insurance issu] locat$       
outside ! ,/ate2 or  7#b7 f p]mitt+     
gr\ps to directly obta91 ?r\gh an       
association heal? plan or o!rwise1 heal?
 insurance cov]age = _! memb]s4  ,,vi   
,/ate ,heal? ,flexibility  #fja4 ,%ort  
title ,?is title may be cit$ z ! ,/ate  

,heal? ,flexibility ,act ( #bjac4  #fjb4
 ,heal? grants to ! ,/ates = heal? c>e  
s]vices to indig5t individuals  7a7     
,heal? c>e block grant to ,/ates ,!     
,social ,security ,act is am5d$ by add+ 
at ! end ! foll[+ new title3  ,,xxii    
,,block ,,grants ,,to ,,/ates ,,=       
,,heal? ,,c>e ,,s]vices ,,to ,,indig5t  
,,individuals  #bbja4 ,purpose ,!       
purpose ( ?is title is to provide ,f$]al
 f9ancial assi/ance to ! ,/ates1 9 ! =m 
( a s+le grant1 to all[ ! ,/ates maximum
 flexibility 9 provid+1 & f9anc+ !      
provision (1 heal?-c>e-relat$ items &   
s]vices to indig5t individuals4  #bbjb4 
,grants to ,/ates  7a7 ,9 g5]al ,subject
 to ! requirem5ts ( ?is title1 ea* ,/ate
 is entitl$ to receive f ! ,secret>y ( !
 ,treasury a grant = ea* qu>t] ( fiscal 
ye>s #bjad1 #bjae1 #bjaf1 #bjag1 #bjah1 
#bjai1 #bjbj1 #bjba1 #bjbb1 & #bjbc1 9  
an am\nt t is equal to #be p]c5t ( !    
total am\nt receiv$ by a ,/ate "u title 
,,xix & title ,,xxi = fiscal ye> #bjab4 
7b7 ,appropriation ,out ( any money 9 ! 

,treasury ( ! ,unit$ ,/ates n o!rwise   
appropriat$1 !re are appropriat$ =      
fiscal ye>s #bjad1 #bjae1 #bjaf1 #bjag1 
#bjah1 #bjai1 #bjbj1 #bjba1 #bjbb1 &    
#bjbc su* sums z are necess>y = grants  
"u ?is section4  7c7 ,requirem5ts relat+
 to int]gov]nm5tal f9anc+ ,! ,secret>y (
 ! ,treasury %all make ! transf] ( funds
 "u grants "u subsection 7a7 directly to
 ea* ,/ate 9 accordance ) ! requirem5ts 
( section #fejc ( title #ca1 ,unit$     
,/ates ,code4  7d7 ,exp5diture ( funds  
7#a7 ,9 g5]al ,except z provid$ 9       
p>agraph 7#b71 am\nts receiv$ by a ,/ate
 "u ?is title = any fiscal ye> %all be  
exp5d$ by ! ,/ate 9 su* fiscal ye> or 9 
! succe$+ fiscal ye>4  7#b7 ,use ( ra9y 
day fund p]mitt$ ,( ! am\nts receiv$ by 
a ,/ate "u ?is title1 ! ,/ate may set   
aside1 9 a sep>ate acc\nt1 su* am\nts z 
! ,/ate deems necess>y to provide1 )\t  
fiscal limitation1 heal?-c>e-relat$     
items & s]vices = indig5t individuals   
dur+--  7,a7 p]iods ( unexpect$ly high  
rates ( unemploym5t2 or  7,b7 p]iods    

relat$ to circum/ances t are n describ$ 
9 subp>agraph 7,a7 & t cause unexpect$  
increases 9 ! ne$ = su* items & s]vices 
= su* individuals4  7#c7 ,funds rema9+  
aft] fiscal ye> #bjbb ,if1 aft] fiscal  
ye> #bjbc1 a ,/ate has funds 9 ! acc\nt 
"u p>agraph 7#b71 ! ,/ate may only exp5d
 su* funds if su* funds are us$ 9 a     
mann] t is p]mitt$ "u subsection 7e71 z 
su* subsection is 9 effect on ,septemb] 
#cj1 #bjbc4  7e7 ,use ( funds ,a ,/ate  
may only use ! am\nts receiv$ "u        
subsection 7a7 z foll[s3  7#a7 ,g5]al   
purpose ,= ! purpose "u section #bbja1  
includ+ ! provision ( heal?-c>e-relat$  
items & s]vices z requir$ "u section    
#bbje4 ,no?+ 9 ?is title %all be con/ru$
 z limit+ ! flexibility ( a ,/ate to    
det]m9e :i* provid]s ( su* items &      
s]vices qualify to receive paym5t f a   
grant made to ! ,/ate "u ?is title4     
7#b7 ,fund+ = risk adju/m5t me*anisms   
,to fund qualifi$ high risk pools1      
re9surance pools1 or o!r risk-adju/m5t  
me*anisms us$ = ! purpose ( subsidiz+ ! 

pur*ase ( private heal? insurance = !   
high-risk population4  7#c7 ,au?ority to
 use portion ( ,f$]al assi/ance = o!r   
welf>e-relat$ programs  7,a7 ,9 g5]al   
,subject to ! limit "u subp>agraph 7,b71
 to c>ry out a ,/ate program pursuant to
 any or all ( ! foll[+ provisions ( law3
  7i7 ,"p ,a ( title ,,iv ( ?is ,act4   
7ii7 ,section #afaf ( ?is ,act4  7iii7  
,! ,food & ,nutrition ,act ( #bjjh4     
7,b7 ,limitation ,a ,/ate may n use m   
?an #cj p]c5t ( ! am\nt receiv$ "u      
subsection 7a7 = a fiscal ye> to c>ry   
out a ,/ate program1 or programs1 "u    
subp>agraph 7,a74  7,c7 ,requirem5ts on 
funds ,any am\nts t are us$ "u          
subp>agraph 7,a7--  7i7 %all n be       
subject to any ( ! requirem5ts (        
subsection 7d71 subsection 7f71 section 
#bbjd1 or section #bbje2 &  7ii7 %all be
 subject to--  7,i7 ! audit requirem5ts 
"u section #bbjc2 &  7,,ii7 any         
requirem5ts t apply to ,f$]al funds     
provid$ directly = su* ,/ate program4   
7f7 ,ma9t5ance ( curr5t law re/rictions 

on use ( f$]al funds  7#a7 ,9 g5]al     
7,a7 ,no fund+ = abortions ,none ( !    
funds appropriat$ 9 ?is title %all be   
exp5d$ = any abortion4  7,b7 ,no funds =
 cov]age ( abortion ,none ( ! funds     
appropriat$ 9 ?is title %all be exp5d$ =
 heal? b5efits cov]age t includes       
cov]age ( abortion4  7,c7 ,heal? b5efits
 cov]age def9$ ,= purposes ( ?is        
subsection1 ! t]m heal? b5efits cov]age 
means ! package ( s]vices cov]$ by a    
manag$ c>e provid] or organization      
pursuant to a contract or o!r           
arrangem5t4  7#b7 ,exceptions ,!        
limitations e/abli%$ 9 p>agraph 7#a7    
%all n apply to an abortion 9 ! case :]e
 a woman suff]s f a physical disord]1   
physical injury1 or physical illness t  
w\ld1 z c]tifi$ by a physician1 place ! 
woman 9 dang] ( dea? unless an abortion 
is p]=m$1 includ+ a life-endang]+       
physical condition caus$ by or aris+ f !
 pregnancy itself4  7#c7 ,/ate funds us$
 9 conjunction ) ,f$]al funds ,!        
limitations e/abli%$ 9 p>agraph 7#a7    

%all apply to any ,/ate funds us$ 9     
conjunction ) ,f$]al funds appropriat$  
"u ?is title to provide1 or f9ance !    
provision (1 heal?-c>e-relat$ items &   
s]vices to indig5t individuals pursuant 
to section #bbja or subsections 7d77#b71
 7e77#a71 or 7e77#b7 ( ?is section4     
7#d7 ,option to pur*ase sep>ate cov]age 
or plan ,no?+ 9 ?is subsection %all be  
con/ru$ z prohibit+ a ,/ate f pur*as+   
sep>ate cov]age = abortions = :i* fund+ 
is prohibit$ "u ?is subsection1 or a    
heal? plan t includes su* abortions1 s  
long z su* cov]age or plan is paid =    
entirely us+ funds n provid$ by ?is     
title4  7#e7 ,option to (f] cov]age or  
plan ,no?+ 9 ?is subsection %all re/rict
 any heal? insurance issu] f (f]+       
sep>ate cov]age = abortions = :i* fund+ 
is prohibit$ "u ?is subsection1 or a    
heal? plan t includes su* abortions1 s  
long z--  7,a7 premiums = su* sep>ate   
cov]age or plan are paid entirely )     
funds n provid$ by ?is title2 &  7,b7   
adm9i/rative co/s & all s]vices (f]$    

?r\gh su* sep>ate cov]age or plan are   
paid = us+ only premiums collect$ = su* 
cov]age or plan4  7#f7 ,consci5ce       
protections  7,a7 ,none ( ! funds       
appropriat$ 9 ?is ,act may be made      
available to a ,f$]al ag5cy or program1 
or to a ,/ate or local gov]nm5t1 if su* 
ag5cy1 program1 or gov]nm5t subjects any
 in/itutional or individual heal? c>e   
entity to discrim9ation on ! basis t !  
heal? c>e entity does n provide1 pay =1 
provide cov]age (1 or ref] = abortions4 
7,b7 ,9 ?is p>agraph1 ! t]m heal? c>e   
entity includes an individual physician1
 ph>maci/1 or o!r heal? c>e pr(essional1
 a hospital1 a provid]-sponsor$         
organization1 a heal? ma9t5ance         
organization1 a heal? insurance plan1 or
 any o!r k9d ( heal? c>e facility1      
organization1 or plan4  7g7 ,no fund+ = 
illegal ali5s ,except z provid$ "u ?is  
section & section #bbje1 no funds       
appropriat$ 9 ?is title may be us$ to   
provide heal?-c>e-relat$ items & s]vices
 to an ali5 :o is n lawfully admitt$ =  

p]man5t resid5ce or o!rwise p]man5tly   
resid+ 9 ! ,unit$ ,/ates "u color ( law4
  7h7 ,non5titlem5t ,no?+ 9 ?is title   
%all be con/ru$ z provid+ an individual 
) an entitlem5t to heal?-c>e-relat$     
items & s]vices "u ?is title4  #bbjc4   
,adm9i/rative & fiscal acc\ntability    
7a7 ,audits  7#a7 ,contract ) approv$   
audit+ entity ,n lat] ?an ,octob] #a1   
#bjad1 & annually !reaft]1 a ,/ate %all 
contract ) an approv$ audit+ entity 7z  
def9$ "u p>agraph 7#c77;,b77 = purposes 
( conduct+ an audit "u p>agraph 7#b7 7) 
respect to ! fiscal ye> end+ ,septemb]  
#cj ( su* ye>74  7#b7 ,audit requirem5t 
,"u a contract "u p>agraph 7#a71 an     
approv$ audit+ entity %all conduct an   
audit ( ! exp5ditures or transf]s made  
by a ,/ate f am\nts receiv$ "u a grant  
"u ?is title1 or f ,/ate funds describ$ 
9 section #bbjb7;f77#c71 ) respect to ! 
fiscal ye> :i* su* audit cov]s1 to      
det]m9e ! ext5t to :i* su* exp5ditures &
 transf]s 7 exp5d$ 9 accordance ) ?is   
title4  7#c7 ,entity conduct+ audit     

7,a7 ,9 g5]al ,) respect to a ,/ate1 !  
audit "u p>agraph 7#b7 %all be conduct$ 
by an approv$ audit+ entity 9 accordance
 ) g5]ally accept$ audit+ pr9ciples4    
7,b7 ,approv$ audit+ entity ,= purposes 
( ?is section1 ! t]m approv$ audit+     
entity means1 ) respect to a ,/ate1 an  
entity t is--  7i7 approv$ by !         
,secret>y ( ! ,treasury2  7ii7 approv$  
by ! *ief executive (fic] ( ! ,/ate2 &  
7iii7 indep5d5t ( any ,f$]al1 ,/ate1 or 
local ag5cy4  7#d7 ,submission ( audit  
,n lat] ?an ,decemb] #ca1 #bjad1 &      
annually !reaft]1 a ,/ate %all submit ! 
results ( ! audit "u p>agraph 7#b7 7)   
respect to ! fiscal ye> end+ on         
,septemb] #cj ( su* ye>7 to ! ,/ate     
legislature & to ! ,secret>y ( !        
,treasury4  7#e7 ,additional acc\nt+    
requirem5ts ,! provisions ( *apt] #ge ( 
title #ca1 ,unit$ ,/ates ,code1 %all    
apply to ! audit requirem5ts ( ?is      
section4  7b7 ,reimbursem5t & p5alty    
7#a7 ,9 g5]al ,if1 ?r\gh an audit       
conduct$ "u subsection 7a71 an approv$  

audit+ entity f9ds t any am\nts paid to 
a ,/ate "u a grant "u ?is title 7 n     
exp5d$ 9 accordance ) ?is title--  7,a7 
! ,/ate %all pay to ! ,treasury ( !     
,unit$ ,/ates any su* am\nt1 plus #aj   
p]c5t ( su* am\nt z a p5alty2 or  7,b7 !
 ,secret>y ( ! ,treasury %all (fset su* 
am\nt plus ! #aj p]c5t p5alty aga9/ any 
o!r am\nt 9 any o!r fiscal ye> t ! ,/ate
 may be entitl$ to receive "u a grant "u
 ?is title4  7#b7 ,misuse ( ,/ate funds 
,if1 ?r\gh an audit conduct$ "u         
subsection 7a71 an approv$ audit+ entity
 f9ds t a ,/ate violat$ ! requirem5ts ( 
section #bbjb7;f77#c71 ! ,/ate %all pay 
to ! ,treasury ( ! ,unit$ ,/ates #ajj   
p]c5t ( ! am\nt ( ,/ate funds t 7 us$ 9 
violation ( section #bbjb7;f77#c7 z a   
p5alty4 ,ins(> z a ,/ate fails to pay   
any su* p5alty1 ! ,secret>y ( !         
,treasury %all (fset ! am\nt n s paid   
aga9/ ! am\nt ( any grant o!rwise       
payable to ! ,/ate "u ?is title4  7c7   
,annual report+ requirem5ts  7#a7 ,9    
g5]al ,n lat] ?an ,janu>y #ca1 #bjae1 & 

annually !reaft]1 ea* ,/ate %all submit 
to ! ,secret>y ( ! ,treasury & ! ,/ate  
legislature a report on ! activities    
c>ri$ out by ! ,/ate dur+ ! mo/ rec5tly 
complet$ fiscal ye> ) funds receiv$ by !
 ,/ate "u a grant "u ?is title = su*    
fiscal ye>4  7#b7 ,cont5t ,a report "u  
p>agraph 7#a7 %all1 ) respect to a      
fiscal ye>--  7,a7 conta9 ! results ( ! 
audit conduct$ by an approv$ audit+     
entity = a ,/ate = su* fiscal ye>1 9    
accordance ) ! requirem5ts ( subsection 
7a7 ( ?is section2  7,b7 specify ! am\nt
 ( ! grant made to ! ,/ate "u ?is title 
t is us$ to c>ry out a program "u       
section #bbjb7;e77#c72 &  7,c7 be 9 su* 
=m & conta9 su* o!r in=mation z ! ,/ate 
det]m9es is necess>y to provide--  7i7  
an accurate description ( ! activities  
conduct$ by ! ,/ate = ! purpose describ$
 "u section #bbja & any o!r use ( funds 
p]mitt$ "u subsections 7d7 & 7e7 (      
section #bbjb2 &  7ii7 a complete record
 ( ! purposes = :i* am\nts 7 exp5d$ 9   
accordance ) ?is title4  7#c7 ,con=mity 

) acc\nt+ pr9cipals ,any f9ancial       
in=mation 9 ! report "u p>agraph 7#a7   
%all be prep>$ & report$ 9 accordance ) 
g5]ally accept$ acc\nt+ pr9ciples1      
includ+ ! provisions ( *apt] #ge ( title
 #ca1 ,unit$ ,/ates ,code4  7#d7 ,public
 availability ,a ,/ate %all make copies 
( ! reports requir$ "u ?is section      
available on a public ,web site & %all  
make copies available 9 o!r =mats ^u    
reque/4  7d7 ,failure ,to comply )      
requirem5ts ,! ,secret>y ( ! ,treasury  
%all n make any paym5t to a ,/ate "u a  
grant au?oriz$ by section #bbjb7;a7--   
7#a7 if an audit = a ,/ate is n submitt$
 z requir$ "u subsection 7a71 dur+ !    
p]iod betwe5 ! date su* audit is due & !
 date on :i* su* audit is submitt$2     
7#b7 if a ,/ate fails to submit a report
 z requir$ "u subsection 7c71 dur+ !    
p]iod betwe5 ! date su* report is due & 
! date on :i* su* report is submitt$2 or
  7#c7 if a ,/ate violates a requirem5t 
( section #bbjb7;f71 dur+ ! p]iod beg9n+
 on ! date ! ,secret>y becomes aw>e (   

su* violation & ! date on :i* su*       
violation is correct$ by ! ,/ate4  7e7  
,adm9i/rative sup]vision & ov]sight     
7#a7 ,limit$ role = ,secret>y (         
,treasury & ! ,attorney g5]al  7,a7     
,treasury ,! au?ority ( ! ,secret>y ( ! 
,treasury "u ?is title is limit$ to--   
7i7 promulgat+ regulations1 issu+ rules1
 or publi%+ guidance docum5ts to ! ext5t
 necess>y = purposes ( implem5t+        
subsection 7a77#c77;,b71 subsection 7b71
 & subsection 7d72  7ii7 mak+ qu>t]ly   
paym5ts to ! ,/ates "u grants "u ?is    
title 9 accordance ) section #bbjb7;a72 
7iii7 approv+ entities "u subsection    
7a77#c77;,b7 = purposes ( ! audits      
requir$ "u subsection 7a72  7iv7 )hold+ 
paym5t to a ,/ate ( a grant "u          
subsection 7d7 or (fsett+ a paym5t ( su*
 a grant to a ,/ate "u subsection 7b72 &
  7v7 ex]cis+ ! au?ority relat+ to      
nondiscrim9ation t is specifi$ 9 section
 #bbjd7;b74  7,b7 ,attorney g5]al ,!    
au?ority ( ! ,attorney ,g5]al to        
sup]vise ! am\nts receiv$ by a ,/ate "u 

?is title is limit$ to ! au?ority "u    
section #bbjd7;c74  7#b7 ,f$]al         
sup]vision  7,a7 ,9 g5]al ,except z     
provid$ "u p>agraph 7#a71 an            
adm9i/rative (fic]1 employee1 dep>tm5t1 
or ag5cy ( ! ,unit$ ,/ates 7includ+ !   
,secret>y ( ,heal? & ,human ,s]vices7   
may n--  7i7 sup]vise--  7,i7 ! am\nts  
receiv$ by ! ,/ates "u ?is title2 or    
7,,ii7 ! use ( su* am\nts by ! ,/ates2  
or  7ii7 promulgate regulations or issue
 rules 9 accordance ) ?is title4  7,b7  
,limitation on ,secret>y ( ,heal? &     
,human ,s]vices ,! ,secret>y ( ,heal? & 
,human ,s]vices %all h no au?ority ov]  
any provision ( ?is title4  7f7         
,res]vation ( ,/ate p[]s ,no?+ 9 ?is    
section %all be con/ru$ to limit ! p[] (
 a ,/ate1 includ+ ! p[] ( a ,/ate to    
pursue civil & crim9al p5alties "u ,/ate
 law aga9/ any individual or entity t   
misuses1 or engages 9 fraud or abuse    
relat$ to1 ! funds provid$ to a ,/ate "u
 ?is title4  #bbjd4 ,nondiscrim9ation   
provisions  7a7 ,no discrim9ation aga9/ 

individuals ,no individual %all be      
exclud$ f p>ticipation 91 d5i$ ! b5efits
 (1 or subject$ to discrim9ation "u1 any
 program or activity fund$ 9 :ole or 9  
"p ) am\nts paid to a ,/ate "u ?is title
 on ! basis ( su* individual's--  7#a7  
disability "u section #ejd ( !          
,rehabilitation ,act ( #aigc 7#bi       
,u4,s4,c4 #gid72  7#b7 sex "u title ,,ix
 ( ! ,education ,am5dm5ts ( #aigb 7#bj  
,u4,s4,c4 #afha et seq472 or  7#c7 race1
 color1 or national orig9 "u title ,,vi 
( ! ,civil ,rights ,act ( #aifd 7#db    
,u4,s4,c4 #bjjj;d et seq474  7b7        
,compliance  7#a7 ,if ! ,secret>y ( !   
,treasury det]m9es t a ,/ate or an      
entity t has receiv$ funds f am\nts paid
 to a ,/ate "u a grant "u ?is title has 
fail$ to comply ) a provision ( law     
ref]r$ to 9 subsection 7a71 ! ,secret>y 
( ! ,treasury %all notify ! *ief        
executive (fic] ( ! ,/ate ( su* failure 
to comply & %all reque/ t su* *ief      
executive (fic] secure su* compliance4  
7#b7 ,if1 n lat] ?an #fj days aft]      

receiv+ notification "u p>agraph 7#a71 !
 *ief executive (fic] ( a ,/ate fails or
 refuses to secure compliance ) !       
provision ( law ref]r$ to 9 su*         
notification1 ! ,secret>y ( ! ,treasury 
may--  7,a7 ref] ! matt] to ! ,attorney 
,g5]al ) a recomm5dation t an           
appropriate civil action be in/itut$2 or
  7,b7 ex]cise ! p[]s & functions       
provid$ "u section #eje ( !             
,rehabilitation ,act ( #aigc 7#bi       
,u4,s4,c4 #gid;a71 title ,,ix ( !       
,education ,am5dm5ts ( #aigb 7#bj       
,u4,s4,c4 #afha et seq471 or title ,,vi 
( ! ,civil ,rights ,act ( #aifd 7#db    
,u4,s4,c4 #bjjj;d et seq47 7z           
applicable74  7c7 ,civil actions ,if a  
matt] is ref]r$ to ! ,attorney ,g5]al "u
 subsection 7b77#b77;,a71 or ! ,attorney
 ,g5]al has reason to believe t a ,/ate 
or entity has fail$ to comply ) a       
provision ( law ref]r$ to 9 subsection  
7a71 ! ,attorney ,g5]al may br+ a civil 
action 9 an appropriate di/rict c\rt ( !
 ,unit$ ,/ates = su* relief z may be    

appropriate1 includ+ injunctive relief4 
#bbje4 ,em]g5cy assi/ance  7a7 ,9 g5]al 
,a ,/ate t receives a grant "u ?is title
 = a fiscal ye> %all provide paym5t =   
heal?-c>e-relat$ items & s]vices provid$
 to a citiz51 legal resid5t1 or an ali5 
:o is n lawfully admitt$ = p]man5t      
resid5ce or o!rwise p]man5tly resid+ 9 !
 ,unit$ ,/ates "u color ( law1 consi/5t 
) ! requirem5ts ( section #ahfg1 if--   
7#a7 su* heal?-c>e-relat$ items &       
s]vices are--  7,a7 necess>y = !        
treatm5t ( an em]g5cy m$ical condition2 
&  7,b7 heal?-c>e-relat$ items & s]vices
 t su* ,/ate w\ld provide paym5t = "u   
?is title1 if provid$ to an indig5t     
individual2  7#b7 ! individual meets all
 necess>y eligibility requirem5ts =     
heal?-c>e-relat$ items & s]vices "u !   
,/ate program fund$ "u ?is title1 except
 = any requirem5t relat$ to immigration 
/atus2 &  7#c7 su* items & s]vices are n
 relat$ to an organ transplant proc$ure4
  7b7 ,em]g5cy m$ical condition ,=      
purposes ( ?is section1 ! t]m em]g5cy   

m$ical condition means a m$ical         
condition 7includ+ em]g5cy labor &      
deliv]y7 manife/+ itself by acute       
symptoms ( suffici5t sev]ity 7includ+   
sev]e pa97 su* t ! abs5ce ( imm$iate    
m$ical att5tion c\ld reasonably be      
expect$ to result 9--  7#a7 plac+ !     
pati5t's heal? 9 s]i\s jeop>dy2  7#b7   
s]i\s impairm5t to bodily functions2 or 
7#c7 s]i\s dysfunction ( any bodily     
organ or "p4  #bbjf4 ,def9itions ,=     
purposes ( ?is title3  7#a7             
,heal?-c>e-relat$ items & s]vices ,! t]m
 heal?-c>e-relat$ items & s]vices %all  
be def9$ by a ,/ate ) respect to use (  
su* t]m = purposes ( ! application ( ?is
 title to ! ,/ate4  7#b7 ,high-,risk    
,population ,! t]m high-risk population 
means individuals :o are describ$ 9 "o (
 ! foll[+ subp>agraphs3  7,a7           
,individuals :o1 by reason ( ! exi/5ce  
or hi/ory ( a m$ical condition1 are able
 to acquire heal? cov]age only at rates 
:i* are at lea/ #aej p]c5t ( ! /&>d risk
 rates = su* cov]age4  7,b7 ,individuals

 :o are provid$ heal? cov]age by a      
qualifi$ high risk pool4  7#c7 ,indig5t 
individual ,! t]m indig5t individual    
%all be def9$ by a ,/ate ) respect to   
use ( su* t]m = purposes ( ! application
 ( ?is title to ! ,/ate4  7#d7 ,qualifi$
 high risk pool ,! t]m qualifi$ high    
risk pool has ! mean+ giv5 su* t]m 9    
section #bgde7;g77#a77;,a7 ( ! ,public  
,heal? ,s]vice ,act4  7#e7              
,risk-,adju/m5t ,me*anism ,def9$ ,=     
purposes ( ?is section1 ! t]m           
risk-adju/m5t me*anism means any        
risk-spread+ me*anism to subsidize !    
pur*ase ( private heal? insurance = !   
high-risk population1 includ+ a qualifi$
 high risk pool4  4  7b7 ,report on     
r$uction ( ,f$]al adm9i/rative          
exp5ditures ,beg9n+ n lat] ?an ,octob]  
#ca1 #bjad1 & annually !reaft] until    
,octob] #ca1 #bjbc1 ! ,secret>y ( ,heal?
 & ,human ,s]vices1 9 consultation ) !  
,secret>y ( ! ,treasury1 %all submit a  
report to ! ,committee on ,en]gy &      
,comm]ce 9 ! ,h\se ( ,repres5tatives & !

 ,f9ance ,committee 9 ! ,s5ate conta9+ a
 description ( ! total r$uction 9 ,f$]al
 exp5ditures requir$ to adm9i/] &       
provide ov]sight = ! programs to provide
 heal?-c>e-relat$ items & s]vices to    
indig5t individuals "u ?is ,act1 comp>$ 
to ! exp5ditures requir$ to adm9i/] &   
provide ov]sight = ! programs "u titles 
,,xix & ,,xxi ( ! ,social ,security     
,act1 z 9 effect on ,septemb] #cj1      
#bjab4  7c7 ,/ate def9$ ,section        
#aaja7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acja7;a77#a77 is       
am5d$--  7#a7 9 ! fir/ s5t5ce1 by /rik+ 
& ,,xxi & ins]t+ ,,xxi1 & ,,xxii2 &     
7#b7 9 ! f\r? s5t5ce1 by /rik+ & ,,xxi &
 ins]t+ 1 ,,xxi1 & ,,xxii4  #fjc4       
,repeal ( ,f$]al requirem5ts ( ,m$icaid 
& ,,*ip ,titles ,,xix & ,,xxi ( !       
,social ,security ,act are repeal$4     
#fjd4 ,sev]ability ,if any provision (  
?is title1 or ! application ( su*       
provision to any p]son or circum/ance1  
is f\nd to be uncon/itutional1 ! rema9d]
 ( ?is title1 or ! application ( t      

provision to o!r p]sons or circum/ances1
 %all n be affect$4  #fje4 ,effective   
date ,?is title & ! am5dm5ts made by ?is
 title %all take effect ) respect to    
items & s]vices furni%$ on or aft]      
,octob] #a1 #bjac4