,,ii  #aac? ,,congress  #b;d ,session   
,s4 #bagc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #bg1 #bjad ,ms4   
,l&rieu 7= h]self1 ,mr4 ,man*91 ,mr4    
,w>n]1 ,ms4 ,heitkamp1 & ,mr4 ,begi*7   
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to am5d ! ,pati5t           
,protection & ,af=dable ,c>e ,act to    
provide a p]man5t pa? = ! direct        
enrollm5t ( individuals 9 qualifi$ heal?
 plans4  #a4 ,%ort title  ,?is ,act may 
be cit$ z ! ,consum]s ,hav+ ,options 9  
,*oos+ ,enrollm5t ,act or ! ,,*oice     
,act4  #b4 ,p]man5t ,pa?way = ,direct   
,enrollm5t  7a7 ,f9d+s ,congress f9ds ! 
foll[+3 7#a7 ,successful implem5tation (
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act 7ref]r$ to 9 ?is section z ! ,,aca7
 is critical to ensur+ t m ,am]icans are
 able to access heal? c>e cov]age4  7#b7
 ,! ,,aca provid$ = ! e/abli%m5t ( new  
,/ate-bas$ or1 9 ! abs5ce ( ,/ate       
action1 f$]ally facilitat$ m>ketplaces  

to help connect consum]s ) heal?        
insurance options & cov]age4  7#c7 ,z "p
 ( ! regulatory guidance relat$ to !    
m>ketplaces1 ! ,dep>tm5t ( ,heal? &     
,human ,s]vices provid$ consum]s ) an   
option to enroll 9 heal? insurance      
cov]age directly1 kn[n z direct         
enrollm5t4  7#d7 ,! ,dep>tm5t ( ,heal? &
 ,human ,s]vices also p]mits enrollm5t  
?r\gh an ,ex*ange ) ! assi/ance ( an    
ag5t or brok]1 includ+ p]mitt+ consum]s 
to select a product on ! ,int]net       
website ( an ag5t or brok]4  7#e7       
,consum]s %\ld be p]mitt$ a p]man5t     
option to enroll directly ) a qualifi$  
heal? plan issu]1 or ,int]net website ( 
an ag5t or brok]1 9 a mann] consi/5t ) !
 m>ketplaces & z long z c]ta9 consum]   
protections are foll[$4  7#f7 ,consum]s 
%\ld cont9ue to be in=m$ t o!r heal?    
insurance products are available & (f]$4
  7#g7 ,consum]s %\ld be notifi$ ( _!   
eligibility det]m9ation = cov]age ?r\gh 
! ,ex*ange ,int]net website = premium   
tax cr$its & co/ %>+ r$uctions4  7#h7   

,direct enrollm5t is n a new idea & has 
prov5 to "w successfully 9 gett+ s5iors 
cov]age ?r\gh ! ,m$ic>e ,advantage      
program & ! ,m$ic>e ,"p ,d program4     
7#i7 ,provid+ a p]man5t pa?way =        
consum]s to directly enroll ) a qualifi$
 heal? plan issu] or ! c]tifi$ ,int]net 
website ( an ag5t or brok] gives su*    
consum]s ano!r option to sign up = heal?
 insurance cov]age & takes ! ,unit$     
,/ates "o /ep clos] to a*iev+ ! goals ( 
! ,,aca4  7b7 ,direct enrollm5t ,section
 #acab ( ! ,pati5t ,protection &        
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjcb7 is am5d$ by add+ at ! end !     
foll[+3  7g7 ,direct enrollm5t  7#a7 ,9 
g5]al ,n lat] ?an #cj days aft] ! date (
 enactm5t ( ?is subsection1 ! ,secret>y 
%all issue guidel9es & necess>y         
op]ational specifications to provide = !
 e/abli%m5t ( a p]man5t pa?way to enable
 individuals to enroll 9 qualifi$ heal? 
plans ?r\gh-- 7,a7 9 ! case ( a ,/ate ) 
a ,/ate-bas$ ,ex*ange1 ! ,ex*ange1 or if
 det]m9$ appropriate by ! ,/ate1 a heal?

 insurance issu]1 a c]tifi$ ag5t or     
brok]1 or a ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices c]tifi$ ,int]net web-bas$ brok]
 or entity2 or  7,b7 9 ! case ( a ,/ate 
) no ,/ate ,ex*ange1 ! ,f$]al ,ex*ange1 
a heal? insurance issu]1 an ag5t or     
brok] c]tifi$ by ! ,f$]al ,ex*ange1 or a
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices    
c]tifi$ ,int]net web-bas$ brok] or      
entity4  7#b7 ,availability ,guidel9es &
 op]ational capabilities issu$ "u       
p>agraph 7#a7 %all be available to      
consum]s & applicable heal? insurance   
issu]s & entities = any enrollm5t p]iod 
requir$ "u section #acaa7;c77#f74  4