,i #aacth ,,congress #b;d ,session ,h4 ,r4 #ddif ,,in ,,the ,,house ,,of ,,representatives ,april #bh1 #bjad ,mr4 ,gardner introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to establish universal access programs to improve high risk pools and reinsurance markets to ensure coverage for individuals with pre-existing conditions1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,covering ,people ,with ,pre-,existing ,conditions ,act of #bjad4 #b4 ,establishing universal access programs to improve high risk pools and reinsurance markets for individuals with pre-existing conditions 7a7 ,state requirement 7#a7 ,in general ,not later than ,january #a1 #bjae1 each ,state shall-- 7,a7 subject to paragraph 7#c71 operate-- 7i7 a qualified ,state reinsurance program described in subsection 7b72 or 7ii7 qualifying ,state high risk pool described in subsection 7c77#a72 and 7,b7 subject to paragraph 7#c71 apply to the operation of such a program from ,state funds an amount equivalent to the portion of ,state funds derived from ,state premium assessments 7as defined by the ,secretary7 that are not otherwise used on ,state health care programs4 7#b7 ,relation to current qualified high risk pool program 7,a7 ,states not operating a qualified high risk pool ,in the case of a ,state that is not operating a current section #bgde qualified high risk pool as of the date of the enactment of this ,act-- 7i7 the ,state may only meet the requirement of paragraph 7#a7 through the operation of a qualified ,state reinsurance program described in subsection 7b72 and 7ii7 the ,state's operation of such a reinsurance program shall be treated1 for purposes of section #bgde of the ,public ,health ,service ,act1 as the operation of a qualified high risk pool described in such section4 7,b7 ,state operating a qualified high risk pool ,in the case of a ,state that is operating a current section #bgde qualified high risk pool as of the date of the enactment of this ,act-- 7i7 as of ,january #a1 #bjae1 such a pool shall not be treated as a qualified high risk pool under section #bgde of the ,public ,health ,service ,act unless the pool is a qualifying ,state high risk pool described in subsection 7c77#a72 and 7ii7 the ,state may use premium assessment funds described in paragraph 7#a77;,b7 to transition from operation of such a pool to operation of a qualified ,state reinsurance program described in subsection 7b74 7#c7 ,application of funds ,if the program or pool operated under paragraph 7#a77;,a7 is in strong fiscal health1 as determined in accordance with standards established by the ,national ,association of ,insurance ,commissioners and as approved by the ,state ,insurance ,commissioner involved1 the requirement of paragraph 7#a77;,b7 shall be deemed to be met4 7b7 ,qualified state reinsurance program 7#a7 ,in general ,for purposes of this section1 a qualified ,state reinsurance program means a program operated by a ,state program that provides reinsurance for health insurance coverage offered in the small group market in accordance with the model for such a program established 7as of the date of the enactment of this ,act74 7#b7 ,form of program ,a qualified ,state reinsurance program may provide reinsurance-- 7,a7 on a prospective or retrospective basis2 and 7,b7 on a basis that protects health insurance issuers against the annual aggregate spending of their enrollees as well as purchase protection against individual catastrophic costs4 7#c7 ,satisfaction of ,,hipaa requirement ,a qualified ,state reinsurance program shall be deemed1 for purposes of section #bgde of the ,public ,health ,service ,act1 to be a qualified high risk pool under such section4 7c7 ,qualifying ,state high risk pool 7#a7 ,in general ,a qualifying ,state high risk pool described in this subsection means a current section #bgde qualified high risk pool that meets the following requirements3 7,a7 ,the pool must provide at least two coverage options1 one of which must be a high deductible health plan coupled with a health savings account4 7,b7 ,the pool must be funded with a stable funding source4 7,c7 ,the pool must eliminate any waiting lists so that all eligible residents who are seeking coverage through the pool should be allowed to receive coverage through the pool4 7,d7 ,the pool must allow for coverage of individuals who1 but for the #bd-month disability waiting period under section #bbf7;b7 of the ,social ,security ,act1 would be eligible for ,medicare during the period of such waiting period4 7,e7 ,the pool must limit the pool premiums to no more than #aej percent of the average premium for applicable standard risk rates in that ,state4 7,f7 ,the pool must conduct education and outreach initiatives so that residents and brokers understand that the pool is available to eligible residents4 7,g7 ,the pool must provide coverage for preventive services and disease management for chronic diseases4 7#b7 ,verification of citizenship or alien qualification 7,a7 ,in general ,notwithstanding any other provision of law1 only citizens and nationals of the ,united ,states shall be eligible to participate in a qualifying ,state high risk pool that receives funds under section #bgde of the ,public ,health ,service ,act or this section4 7,b7 ,condition of participation ,as a condition of a ,state receiving such funds1 the ,secretary shall require the ,state to certify1 to the satisfaction of the ,secretary1 that such ,state requires all applicants for coverage in the qualifying ,state high risk pool to provide satisfactory documentation of citizenship or nationality in a manner consistent with section #aijc7x7 of the ,social ,security ,act4 7,c7 ,records ,the ,secretary shall keep sufficient records such that a determination of citizenship or nationality only has to be made once for any individual under this paragraph4 7#c7 ,relation to section #bgde ,as of ,january #a1 #bjae1 a pool shall not qualify as qualified high risk pool under section #bgde of the ,public ,health ,service ,act unless the pool is a qualifying ,state high risk pool described in paragraph 7#a74 7d7 ,waivers ,in order to accommodate new and innovative programs1 the ,secretary may waive such requirements of this section for qualified ,state reinsurance programs and for qualifying ,state high risk pools as the ,secretary deems appropriate4 7e7 ,funding ,in addition to any other amounts appropriated1 there is appropriated to carry out section #bgde of the ,public ,health ,service ,act 7including through a program or pool described in subsection 7a77#a77-- 7#a7 #ae1jjj1jjj1jjj for the period of fiscal years #bjae through #bjbd2 and 7#b7 an additional #aj1jjj1jjj1jjj for the period of fiscal years #bjbj through #bjbd4 7f7 ,definitions ,in this section3 7#a7 ,health insurance coverage2 health insurance issuer ,the terms health insurance coverage and health insurance issuer have the meanings given such terms in section #bgia of the ,public ,health ,service ,act4 7#b7 ,current section #bgde qualified high risk pool ,the term current section #bgde qualified high risk pool has the meaning given the term qualified high risk pool under section #bgde7;g7 of the ,public ,health ,service ,act as in effect as of the date of the enactment of this ,act4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#d7 ,standard risk rate ,the term standard risk rate means a rate that-- 7,a7 is determined under the ,state high risk pool by considering the premium rates charged by other health insurance issuers offering health insurance coverage to individuals in the insurance market served2 7,b7 is established using reasonable actuarial techniques2 and 7,c7 reflects anticipated claims experience and expenses for the coverage involved4 7#e7 ,state ,the term ,state means any of the #ej ,states or the ,district of ,columbia4