,i #aac? ,,congress #b;d ,session ,h4 ,r4 #ddif ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #bh1 #bjad ,mr4 ,g>dn] introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce ,a ,,bill ,to e/abli% univ]sal access programs to improve high risk pools & re9surance m>kets to ensure cov]age = individuals ) pre-exi/+ conditions1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,cov]+ ,p ,) ,pre-,exi/+ ,conditions ,act ( #bjad4 #b4 ,e/abli%+ univ]sal access programs to improve high risk pools & re9surance m>kets = individuals ) pre-exi/+ conditions 7a7 ,/ate requirem5t 7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjae1 ea* ,/ate %all-- 7,a7 subject to p>agraph 7#c71 op]ate-- 7i7 a qualifi$ ,/ate re9surance program describ$ 9 subsection 7b72 or 7ii7 qualify+ ,/ate high risk pool describ$ 9 subsection 7c77#a72 & 7,b7 subject to p>agraph 7#c71 apply to ! op]ation ( su* a program f ,/ate funds an am\nt equival5t to ! portion ( ,/ate funds d]iv$ f ,/ate premium assessm5ts 7z def9$ by ! ,secret>y7 t are n o!rwise us$ on ,/ate heal? c>e programs4 7#b7 ,relation to curr5t qualifi$ high risk pool program 7,a7 ,/ates n op]at+ a qualifi$ high risk pool ,9 ! case ( a ,/ate t is n op]at+ a curr5t section #bgde qualifi$ high risk pool z ( ! date ( ! enactm5t ( ?is ,act-- 7i7 ! ,/ate may only meet ! requirem5t ( p>agraph 7#a7 ?r\gh ! op]ation ( a qualifi$ ,/ate re9surance program describ$ 9 subsection 7b72 & 7ii7 ! ,/ate's op]ation ( su* a re9surance program %all be treat$1 = purposes ( section #bgde ( ! ,public ,heal? ,s]vice ,act1 z ! op]ation ( a qualifi$ high risk pool describ$ 9 su* section4 7,b7 ,/ate op]at+ a qualifi$ high risk pool ,9 ! case ( a ,/ate t is op]at+ a curr5t section #bgde qualifi$ high risk pool z ( ! date ( ! enactm5t ( ?is ,act-- 7i7 z ( ,janu>y #a1 #bjae1 su* a pool %all n be treat$ z a qualifi$ high risk pool "u section #bgde ( ! ,public ,heal? ,s]vice ,act unless ! pool is a qualify+ ,/ate high risk pool describ$ 9 subsection 7c77#a72 & 7ii7 ! ,/ate may use premium assessm5t funds describ$ 9 p>agraph 7#a77;,b7 to transition f op]ation ( su* a pool to op]ation ( a qualifi$ ,/ate re9surance program describ$ 9 subsection 7b74 7#c7 ,application ( funds ,if ! program or pool op]at$ "u p>agraph 7#a77;,a7 is 9 /rong fiscal heal?1 z det]m9$ 9 accordance ) /&>ds e/abli%$ by ! ,national ,association ( ,insurance ,commission]s & z approv$ by ! ,/ate ,insurance ,commission] involv$1 ! requirem5t ( p>agraph 7#a77;,b7 %all be deem$ to be met4 7b7 ,qualifi$ /ate re9surance program 7#a7 ,9 g5]al ,= purposes ( ?is section1 a qualifi$ ,/ate re9surance program means a program op]at$ by a ,/ate program t provides re9surance = heal? insurance cov]age (f]$ 9 ! small gr\p m>ket 9 accordance ) ! model = su* a program e/abli%$ 7z ( ! date ( ! enactm5t ( ?is ,act74 7#b7 ,=m ( program ,a qualifi$ ,/ate re9surance program may provide re9surance-- 7,a7 on a prospective or retrospective basis2 & 7,b7 on a basis t protects heal? insurance issu]s aga9/ ! annual aggregate sp5d+ ( _! enrollees z well z pur*ase protection aga9/ individual cata/rophic co/s4 7#c7 ,satisfaction ( ,,hipaa requirem5t ,a qualifi$ ,/ate re9surance program %all be deem$1 = purposes ( section #bgde ( ! ,public ,heal? ,s]vice ,act1 to be a qualifi$ high risk pool "u su* section4 7c7 ,qualify+ ,/ate high risk pool 7#a7 ,9 g5]al ,a qualify+ ,/ate high risk pool describ$ 9 ?is subsection means a curr5t section #bgde qualifi$ high risk pool t meets ! foll[+ requirem5ts3 7,a7 ,! pool mu/ provide at lea/ two cov]age options1 "o ( :i* mu/ be a high d$uctible heal? plan c\pl$ ) a heal? sav+s acc\nt4 7,b7 ,! pool mu/ be fund$ ) a /able fund+ s\rce4 7,c7 ,! pool mu/ elim9ate any wait+ li/s s t all eligible resid5ts :o are seek+ cov]age ?r\gh ! pool %\ld be all[$ to receive cov]age ?r\gh ! pool4 7,d7 ,! pool mu/ all[ = cov]age ( individuals :o1 b = ! #bd-mon? disability wait+ p]iod "u section #bbf7;b7 ( ! ,social ,security ,act1 w\ld be eligible = ,m$ic>e dur+ ! p]iod ( su* wait+ p]iod4 7,e7 ,! pool mu/ limit ! pool premiums to no m ?an #aej p]c5t ( ! av]age premium = applicable /&>d risk rates 9 t ,/ate4 7,f7 ,! pool mu/ conduct education & outrea* initiatives s t resid5ts & brok]s und]/& t ! pool is available to eligible resid5ts4 7,g7 ,! pool mu/ provide cov]age = prev5tive s]vices & disease managem5t = *ronic diseases4 7#b7 ,v]ification ( citiz5%ip or ali5 qualification 7,a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 only citiz5s & nationals ( ! ,unit$ ,/ates %all be eligible to p>ticipate 9 a qualify+ ,/ate high risk pool t receives funds "u section #bgde ( ! ,public ,heal? ,s]vice ,act or ?is section4 7,b7 ,condition ( p>ticipation ,z a condition ( a ,/ate receiv+ su* funds1 ! ,secret>y %all require ! ,/ate to c]tify1 to ! satisfaction ( ! ,secret>y1 t su* ,/ate requires all applicants = cov]age 9 ! qualify+ ,/ate high risk pool to provide satisfactory docum5tation ( citiz5%ip or nationality 9 a mann] consi/5t ) section #aijc7x7 ( ! ,social ,security ,act4 7,c7 ,records ,! ,secret>y %all keep suffici5t records su* t a det]m9ation ( citiz5%ip or nationality only has to be made once = any individual "u ?is p>agraph4 7#c7 ,relation to section #bgde ,z ( ,janu>y #a1 #bjae1 a pool %all n qualify z qualifi$ high risk pool "u section #bgde ( ! ,public ,heal? ,s]vice ,act unless ! pool is a qualify+ ,/ate high risk pool describ$ 9 p>agraph 7#a74 7d7 ,waiv]s ,9 ord] to accommodate new & innovative programs1 ! ,secret>y may waive su* requirem5ts ( ?is section = qualifi$ ,/ate re9surance programs & = qualify+ ,/ate high risk pools z ! ,secret>y deems appropriate4 7e7 ,fund+ ,9 addition to any o!r am\nts appropriat$1 !re is appropriat$ to c>ry out section #bgde ( ! ,public ,heal? ,s]vice ,act 7includ+ ?r\gh a program or pool describ$ 9 subsection 7a77#a77-- 7#a7 #ae1jjj1jjj1jjj = ! p]iod ( fiscal ye>s #bjae ?r\gh #bjbd2 & 7#b7 an additional #aj1jjj1jjj1jjj = ! p]iod ( fiscal ye>s #bjbj ?r\gh #bjbd4 7f7 ,def9itions ,9 ?is section3 7#a7 ,heal? insurance cov]age2 heal? insurance issu] ,! t]ms heal? insurance cov]age & heal? insurance issu] h ! mean+s giv5 su* t]ms 9 section #bgia ( ! ,public ,heal? ,s]vice ,act4 7#b7 ,curr5t section #bgde qualifi$ high risk pool ,! t]m curr5t section #bgde qualifi$ high risk pool has ! mean+ giv5 ! t]m qualifi$ high risk pool "u section #bgde7;g7 ( ! ,public ,heal? ,s]vice ,act z 9 effect z ( ! date ( ! enactm5t ( ?is ,act4 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#d7 ,/&>d risk rate ,! t]m /&>d risk rate means a rate t-- 7,a7 is det]m9$ "u ! ,/ate high risk pool by consid]+ ! premium rates *>g$ by o!r heal? insurance issu]s (f]+ heal? insurance cov]age to individuals 9 ! insurance m>ket s]v$2 7,b7 is e/abli%$ us+ reasonable actu>ial te*niques2 & 7,c7 reflects anticipat$ claims exp]i5ce & exp5ses = ! cov]age involv$4 7#e7 ,/ate ,! t]m ,/ate means any ( ! #ej ,/ates or ! ,di/rict ( ,columbia4