,,ii #aad? ,,congress #b;d ,session ,s4 #bihe ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,may #be1 #bjaf,mr4 ,cassidy introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to elim9ate ! individual & employ] heal? cov]age m&ates "u ! ,pati5t ,protection & ,af=dable ,c>e ,act1 to exp& beyond t ,act ! *oices 9 obta9+ & f9anc+ af=dable heal? insurance cov]age1 & = o!r purposes4 #a4 ,%ort title2 purposes2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf4 7b7 ,purposes ,! purposes ( ?is ,act are z foll[s3 7#a7 ,elim9ation ( individual & employ] m&ates "u ,,aca ,to elim9ate m&ates on individuals & employ]s1 & o!r tax requirem5ts1 impos$ "u ,pati5t ,protection & ,af=dable ,c>e ,act4 7#b7 ,provid+ ,/ates ) alt]native1 af=dable cov]age options ,to provide great] flexibility 9 provid+ ,/ates ) options 9 mak+ af=dable heal? insurance cov]age available by elim9at+ c]ta9 m&ates "u ,,ppaca1 :ile reta9+ ess5tial consum] protections1 by promot+ heal? sav+s acc\nts to pay = su* cov]age & long-t]m c>e cov]age1 :ile p]mitt+ ,/ates to cont9ue cov]age z provid$ "u ,,ppaca4 7c7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 purposes2 table ( cont5ts4 ,sec4 #b4 ,def9itions4 ,,title ,i--,revisions ( ,,ppaca ,subtitle ,a--,elim9ation ( ,individual & ,employ] ,m&ates ,sec4 #aja4 ,repeal ( individual heal? insurance m&ate4 ,sec4 #ajb4 ,repeal ( employ] heal? insurance m&ate4 ,sec4 #ajc4 ,cl>ify+ employ]'s ability to reimburse employee premiums = pur*ase ( individual heal? insurance cov]age4 ,subtitle ,b--,limitation on ,application ( ,,ppaca ,plan ,requirem5ts ,sec4 #aba4 ,limit+ application ( requirem5ts to consum] protections4 ,sec4 #abb4 ,(f]+ ( basic heal? insurance2 protection ( assets f liability or atta*m5t or seizure4 ,subtitle ,c--,univ]sal ,heal? ,insurance ,tax ,b5efit ,sec4 #aca4 ,univ]sal heal? insurance tax b5efit4 ,sec4 #acb4 ,application ( portion ( unus$ tax cr$its by ,/ates = indig5t heal? c>e4 ,sec4 #acc4 ,m$icaid option ( enrollm5t "u private plan & contribution to an ,,hsa4 ,,title ,,ii--,improv+ ,heal? ,sav+s ,acc\nts to ,promote ,acc\ntability ,sec4 #bja4 ,transition to non-d$uctible ,h,s,as4 ,sec4 #bjb4 ,elim9ation ( m$ical exp5se d$uction4 ,sec4 #bjc4 ,treatm5t ( ,,hsa aft] dea? ( acc\nt b5efici>y4 ,sec4 #bjd4 ,treatm5t ( direct prim>y c>e4 ,,title ,,iii--,/ate flexibility 9 regulation ( heal? insurance cov]age ,sec4 #cja4 ,/ate flexibility 9 regulation ( heal? insurance cov]age4 ,,title ,,iv--,m$icaid ,paym5t ,re=m ,sec4 #dja4 ,m$icaid paym5t re=m4 ,,title ,v--,increas+ ,price ,transp>5cy & ,fre$om ( ,practice ,sec4 #eja4 ,ensur+ access to em]g5cy s]vices )\t excessive *>ges = out-(-network s]vices4 ,sec4 #ejb4 ,publi%+ ( ca% price = c>e paid ?r\gh heal? sav+s acc\nts4 ,sec4 #ejc4 ,lib]at+ ! local practice ( heal? c>e4 #b4 ,def9itions ,except z o!rwise provid$1 9 ?is ,act3 7#a7 ,basic heal? insurance ,! t]m basic heal? insurance has ! mean+ giv5 su* t]m 9 section #abb7;a74 7#b7 ,default heal? insurance cov]age ,! t]m default heal? insurance cov]age has ! mean+ giv5 su* t]m 9 section #aba7;b77#d77;,b74 7#c7 ,ex*ange ,! t]m ,ex*ange means an ,ex*ange e/abli%$ "u title ,i ( ,,ppaca4 7#d7 ,heal? insurance cov]age2 gr\p heal? plan1 etc ,! t]ms def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act1 includ+ heal? insurance cov]age1 gr\p heal? plan9dividual m>ket1 %all apply4 7#e7 ,limit$ b5efit insurance ,! t]m limit$ b5efit insurance has ! mean+ giv5 su* t]m 9 section #abb7;b74 7#f7 ,,ppaca ,! t]m ,,ppaca means ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh74 7#g7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#h7 ,/ate ,! t]m ,/ate includes ! ,di/rict ( ,columbia1 ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,am]ican ,samoa1 ,guam1 & ! ,nor!rn ,m>iana ,isl&s4 ,i ,revisions ( ,,ppaca ,a ,elim9ation ( ,individual & ,employ] ,m&ates #aja4 ,repeal ( individual heal? insurance m&ate ,section #ejjj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7h7 ,t]m9ation ,?is section %all n apply ) respect to any mon? beg9n+ m ?an #cj days aft] ! date ( ! enactm5t ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf4 4 #ajb4 ,repeal ( employ] heal? insurance m&ate 7a7 ,9 g5]al ,*apt] #dc ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7#a7 by /rik+ section #dihj;,h2 & 7#b7 by /rik+ ! item relat+ to section #dihj;,h f ! table ( sections = su* *apt]4 7b7 ,repeal ( relat$ report+ requirem5ts ,subp>t ,d ( "p ,,iii ( sub*apt] ,a ( *apt] #fa ( su* ,code is am5d$ by /rik+ section #fjef & by /rik+ ! item relat+ to section #fjef 9 ! table ( sections = su* subp>t4 7c7 ,con=m+ am5dm5ts 7#a7 ,section #fgbd7;d77#a77;,b7 ( su* ,code is am5d$-- 7,a7 by ins]t+ or at ! end ( clause 7xxiii72 7,b7 by /rik+ 1 or at ! end ( clause 7xxiv7 & ins]t+ a p]iod2 & 7,c7 by /rik+ clause 7xxv74 7#b7 ,section #fgbd7;d77#b7 ( su* ,code is am5d$ by ins]t+ or at ! end ( subp>agraph 7,,gg71 by /rik+ subp>agraph 7,,hh71 & by r$esignat+ subp>agraph 7,,ii7 z subp>agraph 7,,hh74 7#c7 ,section #aeac ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is am5d$ by /rik+ subsection 7c74 7d7 ,effective dates 7#a7 ,9 g5]al ,except z o!rwise provid$ 9 ?is subsection1 ! am5dm5ts made by ?is section %all apply to mon?s & o!r p]iods beg9n+ m ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,repeal ( /udy & report ,! am5dm5t made by subsection 7c77#c7 %all take effect on ! date ( ! enactm5t ( ?is ,act4 #ajc4 ,cl>ify+ employ]'s ability to reimburse employee premiums = pur*ase ( individual heal? insurance cov]age ,an employ] heal? c>e arrangem5t1 su* z a heal? or m$ical reimbursem5t arrangem5t or o!r employm5t plans1 "u :i* an employ] reimburses an employee = ! premiums = ! pur*ase ( individual heal? insurance cov]age does n con/itute a gr\p heal? plan = any purposes1 includ+ = purposes ( apply+ any ( ! foll[+3 7#a7 ,! ,public ,heal? ,s]vice ,act 7includ+ sections #bgaa & #bgad ( su* ,act 7#db ,u4,s4,c4 #cjj;gg-#aa1 #cjj;gg-#ad774 7#b7 ,! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh74 7#c7 ,! ,int]nal ,rev5ue ,code ( #aihf4 7#d7 ,! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #ajja et seq474 7#e7 ,! ,,hipaa privacy regulations 7z def9$ 9 section #aahj7;b77#c7 ( ! ,social ,security ,act1 #db ,u4,s4,c4 #acbj;d-#i7;b77#c774 7#f7 ,! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7,public ,law #ajd-aia74 7#g7 ,,cobra cont9uation cov]age "u title ,,xxii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;bb-#a et seq471 section #dihj;,b ( ! ,int]nal ,rev5ue ,code ( #aihf1 or "p #f ( subtitle ,b ( title ,i ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aafa et seq474 ,b ,limitation on ,application ( ,,ppaca ,plan ,requirem5ts #aba4 ,limit+ application ( requirem5ts to consum] protections 7a7 ,removal ( ,,ppaca plan requirem5ts1 o!r ?an c]ta9 consum] protections 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ) respect to gr\p heal? plans & heal? insurance cov]age :e!r or n (f]$ ?r\gh an ,ex*ange1 except z provid$ 9 p>agraphs 7#b7 & 7#c71 ! provisions ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 z 9 effect be=e ! date ( ! enactm5t ( ,,ppaca %all apply in/ead ( ! provisions ( su* title z 9 effect aft] su* date4 7#b7 ,,ppaca consum] protections cont9u+ to be appli$ ,! foll[+ sections ( ! ,public ,heal? ,s]vice ,act1 t 7 add$ or am5d$ by subtitles ,a & ,c ( title ,i ( ,,ppaca1 %all cont9ue to apply to gr\p heal? plans & to heal? insurance cov]age (f]$ 9 ! individual & gr\p m>ket3 7,a7 ,no lifetime or annual limits ,section #bgaa 7relat+ to no lifetime or annual limits71 except 9 ! case ( limit$ b5efit insurance 7z def9$ 9 section #abb7;b774 7,b7 ,dep5d5t cov]age ?r\gh age #bf ,section #bgad 7relat+ to ext5sion ( dep5d5t cov]age74 7,c7 ,modifi$ gu>ante$ availability ,section #bgjb 7relat+ to gu>ante$ availability ( cov]age71 subject to p>agraph 7#c7 & subsection 7c74 7,d7 ,gu>ante$ r5ewability ,section #bgjc 7relat+ to gu>ante$ r5ewability ( cov]age74 7,e7 ,prohibit+ pre-exi/+ condition exclusions ,section #bgjd 7relat+ to prohibition on preexi/+ conditions74 7,f7 ,prohibit+ discrim9ation bas$ on heal? /atus ,section #bgje 7relat+ to prohibit+ discrim9ation aga9/ individual p>ticipants & b5efici>ies bas$ on heal? /atus71 subject to subsection 7c74 7,g7 ,non-discrim9ation 9 heal? c>e ,section #bgjf 7relat+ to non-discrim9ation 9 heal? c>e74 7#c7 ,application ( a late enrollm5t p5alty = ^? )\t cont9u\s cov]age 7,a7 ,9 g5]al ,9 ! case ( an individual :o seeks to enroll 9 heal? insurance cov]age & :o1 z ( ! effective date ( su* enrollm5t1 does n h a cont9u\s p]iod ( at lea/ #ab-mon?s ( cr$itable cov]age1 !re %all be impos$ a late enrollm5t p5alty 9 ! =m ( an increase 9 ! mon?ly premiums = cov]age ( "u ! plan ( #bj p]c5t ( ! mon?ly premium o!rwise det]m9$ = ea* consecutive full #ab-mon? p]iod 7end+ be=e su* effective date7 9 :i* ! individual 0 n enroll$ 9 cr$itable cov]age4 ,su* increase %all apply dur+ a p]iod1 to be specifi$ "u regulations ( ! ,secret>y b 9 no case long] ?an #c times ! l5g? ( ! mo/ rec5t p]iod 9 :i* ! individual did n h cont9u\s cov]age4 7,b7 ,/ate waiv] ,a ,/ate may apply to ! ,secret>y = a waiv] ( ! provisions ( subp>agraph 7,a7 & ! application ( alt]native provisions provid+ inc5tives = ,/ate resid5ts to enroll 9 cr$itable cov]age & ma9ta9 cont9u\s cr$itable cov]age4 ,! ,secret>y %all approve su* waiv] if ! ,secret>y det]m9es t ! alt]native provisions provide simil> or great] inc5tives = su* enrollm5t ?an ! inc5tives o!rwise applicable4 7#d7 ,coord9at+ implem5tation ( pre-,,ppaca ,,phsa provisions ) ,,ppaca consum] protections 7,a7 ,9 g5]al ,9 apply+ ?is subsection1 ! provisions describ$ 9 p>agraph 7#b7 %all be treat$ z if !y 7 includ$ 9 title ,,xxvii ( ! ,public ,heal? ,s]vice ,act1 z 9 effect on ! day be=e ! date ( enactm5t ( ,,ppaca1 &1 ) respect to gr\p heal? plans & heal? insurance cov]age (f]$ 9 connection ) su* plans1 9 "p #g ( subtitle ,b ( title ,i ( ! ,employee ,retirem5t & ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aha et seq471 &1 ) respect to gr\p heal? plans1 9 *apt] #ajj ( ! ,int]nal ,rev5ue ,code ( #aihf z foll[s3 7i7 ,lifetime limits2 dep5d5t cov]age ,! provisions describ$ 9 p>agraphs 7#b77;,a7 & 7#b77;,b7 %all be treat$ z includ$-- 7,i7 ) respect to gr\p heal? plans 7& heal? insurance cov]age (f]$ ) respect to su* plans71 "u subp>t #b ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act & subp>t ,b ( "p #g ( subtitle ,b ( title ,i ( ! ,employee ,retirem5t & ,income ,security ,act ( #aigd2 7,,ii7 ) respect to gr\p heal? plans1 "u sub*apt] ,b ( *apt] #ajj ( ! ,int]nal ,rev5ue ,code ( #aihf2 & 7,,iii7 ) respect to individual heal? insurance cov]age1 "u subp>t #b ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act4 7ii7 ,rema9+ provisions ,! provision describ$ 9 p>agraph 7#b7 7o!r ?an 9 subp>agraph 7,a7 or 7,b7 ( su* p>agraph7 %all be treat$ z includ$-- 7,i7 ) respect to gr\p heal? plans 7& heal? insurance cov]age (f]$ ) respect to su* plans71 "u subp>t #a ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act & subp>t ,a ( "p #g ( subtitle ,b ( title ,i ( ! ,employee ,retirem5t & ,income ,security ,act ( #aigd2 7,,ii7 also ) respect to gr\p heal? plans1 "u sub*apt] ,a ( *apt] #ajj ( ! ,int]nal ,rev5ue ,code ( #aihf2 & 7,,iii7 ) respect to individual heal? insurance cov]age1 "u subp>t #a ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act4 7,b7 ,conflict+ provisions ,9 ! case describ$ 9 p>agraph 7#a7 :]e !re is a conflict betwe5 a provision describ$ 9 p>agraph 7#b7 & a provision ( law describ$ 9 p>agraph 7#a71 ! provision describ$ 9 p>agraph 7#b7 %all control & ! ,secret>y1 9 consultation ) ! ,secret>y ( ! ,treasury & ! ,secret>y ( ,labor1 %all e/abli% su* rules z may be necess>y to c>ry out ?is subp>agraph4 7#e7 ,con=m+ am5dm5ts 7,a7 ,,erisa ,section #gae ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aahe;d7 is am5d$-- 7i7 9 subsection 7a71 by /rik+ subsection 7b7 & ins]t+ subsections 7b7 & 7c72 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7c7 ,additional exception ,pursuant to section #aba ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf1 ! provisions ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act ref]r$ to 9 subsection 7a71 o!r ?an ^? provisions specifi$ 9 section #aba7;a77#b7 ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf1 %all n apply to plans & cov]age describ$ 9 subsection 7a71 :e!r or n ! plans or cov]age are (f]$ ?r\gh an ,ex*ange e/abli%$ "u ! ,pati5t ,protection & ,af=dable ,c>e ,act4 4 7,b7 ,,irc ,section #ihae ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7i7 9 subsection 7a71 by /rik+ subsection 7b7 & ins]t+ subsections 7b7 & 7c72 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7c7 ,additional exception ,pursuant to section #aba ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf1 ! provisions ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act ref]r$ to 9 subsection 7a71 o!r ?an ^? provisions specifi$ 9 section #aba7;a77#b7 ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf1 %all n apply to plans describ$ 9 subsection 7a74 4 7b7 ,/ate flexibility 9 ensur+ ord]ly heal? insurance m>ket outside ( an ,ex*ange 7#a7 ,9 g5]al ,) respect to heal? insurance cov]age (f]$ 9 a ,/ate1 ! ,/ate may1 9 consultation ) ! ,secret>y1 take su* /eps1 su* z limit+ ! availability ( g5]al op5 enrollm5t p]iods1 impos+ delays 9 ! effectiv5ess = cov]age1 p]mitt+ diff]5tials 9 premiums bas$ on age & o!r factors1 z ! ,/ate det]m9es necess>y 9 ord] to ensure an ord]ly m>ket = heal? insurance cov]age 9 ! ,/ate t is n (f]$ ?r\gh an ,ex*ange4 ,su* /eps may include ! e/abli%m5t ( su* initial op5 enrollm5t p]iod dur+ :i* qualifi$ resid5ts may enroll 9 heal? insurance cov]age )\t ! imposition ( any und]writ+ z ! ,/ate det]m9es to be appropriate 9 ensur+ initial access to su* cov]age4 7#b7 ,flexibility 9 impos+ additional requirem5ts ,no?+ 9 ?is section %all be con/ru$ z prev5t+ a ,/ate f cont9u+ to apply1 to heal? insurance cov]age issu$ 9 ! ,/ate1 requirem5ts "u ! provisions ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7z am5d$ by subtitles ,a & ,c ( title ,i ( ,,ppaca7 t are n cont9u$ "u subsection 7a74 7#c7 ,/ate flexibility ) respect to ,ex*anges ,a ,/ate may waive su* provisions ( "p #b ( subtitle ,d ( title ,i ( ,,ppaca1 9 relation to ! e/abli%m5t ( an ,ex*ange 9 su* ,/ate1 z ! ,/ate det]m9es appropriate 9 ord] = ! ,/ate to implem5t & adm9i/] a m>ket-bas$ sy/em = ! availability ( heal? insurance cov]age ?r\gh\t ! ,/ate4 7#d7 ,/ate default enrollm5t option 7,a7 ,enrollm5t1 subject to individual opt-,out ,subject to subp>agraph 7,d71 a ,/ate may elect to provide = ! enrollm5t ( resid5ts ( ! ,/ate :o are un9sur$ 9 default heal? insurance cov]age 7z def9$ 9 subp>agraph 7,b77 & e/abli%+ a ,ro? ,,hsa = su* resid5ts :o d n h a ,ro? ,,hsa unless ! resid5t has affirmatively elect$ n to be s enroll$ & n to h su* an acc\nt4 respectively4 ,if a ,/ate makes su* an election1 ! ,/ate %all p]mit eligible resid5ts to enroll 9 su* cov]age on a cont9u\s basis4 7,b7 ,default heal? insurance cov]age def9$ ,9 ?is p>agraph1 ! t]m default heal? insurance cov]age means1 ) respect to a ,/ate1 heal? insurance cov]age t-- 7i7 is a high d$uctible heal? plan 7)9 ! mean+ ( section #bbc7;c77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 ) prescription drug cov]age limit$ to g5]ic drugs = a limit$ numb] ( *ronic conditions 7commonly ref]r$ to z ti] ,i ph>macy b5efit72 7ii7 meets su* requirem5ts z may apply to qualify = ! paym5t ( plan premiums f a heal? sav+s acc\nt "u section #bbc ( su* ,code 7su* z age-relat$ premiums & limitation on imposition ( preexi/+ condition exclusions72 7iii7 has a provid] network = cov]$ b5efits t is adequate 7z det]m9$ consi/5t ) guidel9es issu$ by ! ,secret>y7 to ensure access to heal? b5efits "u su* plan2 7iv7 provides = cov]age ( *ildhood immunizations )\t co/ %>+ requirem5ts to ! ext5t su* immunizations h 9 effect a recomm5dation f ! ,advisory ,committee on ,immunization ,practices ( ! ,c5t]s = ,disease ,control & ,prev5tion ) respect to ! individual involv$2 & 7v7 meets su* o!r requirem5ts z ! ,/ate may specify4 7,c7 ,ro? ,,hsa ,9 ?is p>agraph1 ! t]m ,ro? ,,hsa %all h ! mean+ giv5 su* t]m by section #ecj;,a7c7 ( ! ,int]nal ,rev5ue ,code ( #aihf4 7,d7 ,simple process = individuals to opt-out ,z a condition ( a ,/ate provid+ = ! enrollm5t function describ$ 9 subp>agraph 7,a71 ! ,/ate %all e/abli% an easy-to-use & transp>5t means by :i* individuals may elect n to be enroll$ 9 default heal? insurance cov]age or to h a ,ro? ,,hsa e/abli%$ on ! individual's behalf1 or bo?4 7c7 ,inapplicability ( requir$ ess5tial heal? b5efits 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 no heal? b5efits plan %all be requir$ by reason ( ,f$]al law to comply ) ! requirem5ts ( sections #acja7;a77#a77;,b7 & #acjb ( ,,ppaca 7#db ,u4,s4,c4 #ahjba7;a77#a77;,b71 #ahjbb74 7#b7 ,/ate flexibility ,no?+ 9 ?is subsection %all be con/ru$ z prev5t+ a ,/ate f apply+1 at its option ) respect to heal? insurance cov]age (f]$ ?r\gh an ,ex*ange or o!rwise 9 ! ,/ate1 ! requirem5ts ref]r$ to 9 p>agraph 7#a74 7d7 ,effective date2 transition 7#a7 ,9 g5]al ,subsections 7a71 7b71 & 7c7 %all apply to plan ye>s beg9n+ aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,sunsett+ requir$ contribution = ,,aca re9surance program ,no contribution %all be requir$ "u section #acda ( ,,ppaca 7#db ,u4,s4,c4 #ahjfa7 f any gr\p heal? plan or heal? insurance issu] = portions ( plans ye>s occurr+ 9 mon?s beg9n+ m ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act4 7e7 ,secret>ial guidance ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! ,secret>y ( ,labor & ! ,secret>y ( ! ,treasury1 %all provide su* guidance z may be necess>y = ! coord9at$ implem5tation ( ?is section on a timely basis4 7f7 ,transf]r+ heal? plan records ^u *ang+ plans 7#a7 ,9 g5]al ,9 ! case ( an individual :o is cov]$ "u heal? insurance cov]age or z a b5efici>y or p>ticipant 9 a gr\p heal? plan 7z su* t]ms are def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act71 if su* cov]age is end$ & ! individual obta9s o!r heal? insurance cov]age1 gr\p heal? plan cov]age1 or o!r cr$itable cov]age 7z def9$ = purposes ( title ,,xxvii ( su* ,act71 ! issu] ( ! prior cov]age or adm9i/rator ( ! prior plan %all =w>d in=mation respect+ su* prior cov]age to ! issu] ( ! new cov]age or adm9i/rator ( ! new plan or cov]age1 z ! case may be1 subject to su* rules z ! ,secret>y e/abli%es reg>d+ ! "r ( ! b5efici>y or p>ticipant to object to su* =w>d+ ( in=mation4 7#b7 ,treatm5t z plan requirem5t "u ,,phsa1 ,,erisa1 ,,irc ,! requirem5t ( p>agraph 7#a7 %all apply z if x 7 includ$ 9 "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act1 includ+ = purposes ( apply+ section #gae ( ! ,employee ,retirem5t ,income ,security ,act ( #aigf 7#bi ,u4,s4,c4 #aahe;d7 & section #ihae ( ! ,int]nal ,rev5ue ,code ( #aihf4 7g7 ,application ( risk adju/m5t 7#a7 ,9 g5]al ,any issu] t (f]s heal? insurance cov]age 9 ! individual m>ket 9 any ( ! #ej ,/ates or ! ,di/rict ( ,columbia %all p>ticipate 9 a risk adju/m5t me*anism "u ?is subsection ) respect to any heal? insurance cov]age x s (f]s 9 su* m>ket1 :e!r or n su* cov]age is (f]$ ?r\gh an ,ex*ange4 7#b7 ,=m & design ( risk adju/m5t me*anism ,! ,secret>y %all1 9 consultation ) ! ,national ,association ( ,insurance ,commission]s & o!r int]e/$ p>ties1 develop a me*anism to p]mit ! adju/m5t ( risk among heal? insurance cov]age (f]$ 9 ! individual m>ket ?r\gh\t ! #ej ,/ates & ! ,di/rict ( ,columbia4 ,su* me*anism %all be design$ to effect ! same type ( risk adju/m5t among su* cov]age t is applicable to risk adju/m5t ( paym5ts among ,m$ic>e ,advantage organizations "u "p ,c ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq474 7#c7 ,transition = new cov]age ,! me*anism develop$ "u p>agraph 7#b7 %all provide = transitional protection1 ov] a #c-ye> p]iod1 9 ! case ( heal? insurance cov]age t has n be5 previ\sly m>ket$4 7#d7 ,developm5t ( fur!r risk adju/m5t me*anism ,! ,secret>y %all reque/ ! ,national ,association ( ,insurance ,commission]s to develop a p]man5t model = adju/m5t ( risk among heal? insurance issu]s ) respect to heal? insurance cov]age (f]$ 9 ! individual m>ket1 ) ! int5tion t su* a model w\ld sub/itute = ! me*anism develop$ "u p>agraph 7#b74 7#e7 ,treatm5t z plan requirem5t "u ,,phsa1 ,,erisa1 ,,irc ,! requirem5t ( p>agraph 7#a7 %all apply z if x 7 includ$ 9 "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act1 includ+ = purposes ( apply+ section #gae ( ! ,employee ,retirem5t ,income ,security ,act ( #aigf 7#bi ,u4,s4,c4 #aahe;d7 & section #ihae ( ! ,int]nal ,rev5ue ,code ( #aihf4 #abb4 ,(f]+ ( basic heal? insurance2 protection ( assets f liability or atta*m5t or seizure 7a7 ,requirem5t = ,ex*anges 7#a7 ,9 g5]al ,no tax cr$it %all be all[able "u section #cf;,b or #cf;,c ( ! ,int]nal ,rev5ue ,code ( #aihf = resid5ts ( a ,/ate unless any ,ex*ange e/abli%$ 9 ! ,/ate provides = ! (f]+ ( basic heal? insurance 9 all areas ( ! ,/ate4 7#b7 ,basic heal? insurance def9$ ,9 ?is subsection1 ! t]m basic heal? insurance means1 ) respect to a ,/ate1 su* heal? insurance cov]age z ! ,/ate may specify & includes limit$ b5efit insurance 7z def9$ 9 subsection 7b774 7b7 ,limit$ b5efit insurance def9$ 7#a7 ,9 g5]al ,9 ?is section1 ! t]m limit$ b5efit insurance means individual heal? insurance cov]age t1 ) respect to a plan ye>1 imposes 7consi/5t ) p>agraph 7#b77 an annual limit on ! am\nts t may be payable "u ! cov]age ) respect to exp5ses incurr$ = items & s]vices furni%$ 9 t plan ye>4 7#b7 ,specification ( annual limit2 v>iation 9 limit = individual & family cov]age ,! ,secret>y %all specify1 f ye> to ye>1 ! annual limit 7or range ( annual limits7 t may be appli$ "u p>agraph 7#a74 ,su* a limit may di/+ui% betwe5 cov]age t is only provid$ = an individual & cov]age t is provid$ also = family memb]s ( ! individual4 7c7 ,protection ( c]ta9 assets 9 case ( individuals cov]$ "u limit$ b5efit insurance 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 if an individual is cov]$ "u limit$ b5efit insurance = a plan ye> & b5efits "u su* insurance h rea*$ ! annual limit "u su* insurance = items & s]vices furni%$ 9 ! plan ye>1 ! individual is n liable = debt incurr$ & aris+ f ! provision ( subsequ5tly furni%$ items & s]vices dur+ ! plan ye>1 reg>dless ( :e!r b5efits are o!rwise cov]$ = su* items & s]vices "u su* policy1 ins(> z ! liability attributable to su* items & s]vices exce$s-- 7,a7 ! bankruptcy valuation ( ! individual's prop]ty at ! "t ! debt is incurr$2 r$uc$ by 7,b7 su* annual limit ( b5efits "u ! limit$ b5efit insurance = ! plan ye>4 ,prop]ty 9 ! am\nt s protect$ f liability %all be exempt & immune f atta*m5t or seizure ) respect to any judgm5t relat$ to su* debt4 7#b7 ,bankruptcy valuation def9$ ,9 ?is subsection1 ! t]m bankruptcy valuation means1 ) respect to prop]ty ( an individual z ( a date1 ! value ( ! prop]ty z ( su* date z det]m9$ z if ! individual 7 a debtor 9 a bankruptcy case t c\ld h be5 fil$ "u title #aa ( ! ,unit$ ,/ates ,code & ! prop]ty c\ld n be exempt "u section #ebb ( su* title4 7#c7 ,no requirem5t = provid]s to furni% subsequ5t s]vices )\t ensur+ paym5t ,except z may be explicitly provid$ 9 o!r law 7su* z "u section #ahfg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd71 popul>ly kn[n z ,,emtala71 a heal? c>e provid] is n requir$ to furni% any items or s]vices to an individual :o has exhau/$ b5efits "u limit$ b5efit insurance = a plan ye> )\t ! individual 7or ano!r p]son on ! individual's behalf7 provid+ = su* advance or gu>antee ( paym5t = su* items & s]vices z may be arrang$ betwe5 ! heal? c>e provid] & ! individual4 ,c ,univ]sal ,heal? ,insurance ,tax ,b5efit #aca4 ,univ]sal heal? insurance tax b5efit 7a7 ,9 g5]al ,subp>t ,c ( "p ,,iv ( sub*apt] ,a ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] section #cf;,b ! foll[+ new section3 #cf;,c4 ,univ]sal heal? insurance tax cr$it 7a7 ,9 g5]al ,9 ! case ( a taxpay] :o is a qualifi$ resid5t1 !re %all be all[$ z a cr$it aga9/ ! tax impos$ by ?is subtitle = any taxable ye> an am\nt equal to ! univ]sal heal? cr$it am\nt ( ! taxpay] = ! taxable ye>4 7b7 ,univ]sal heal? cr$it am\nt ,= purposes ( ?is section-- 7#a7 ,9 g5]al ,! t]m univ]sal heal? cr$it am\nt means ! sum ( ! am\nts det]m9$ "u p>agraph 7#b7 ) respect to all mon?s ( ! taxpay] = ! taxable ye>4 7#b7 ,mon?ly cr$it am\nt 7,a7 ,9 g5]al ,subject to p>agraph 7#c71 ! am\nt det]m9$ "u ?is p>agraph ) respect to any mon? %all be an am\nt equal to ! sum (-- 7i7 #a_/ab ( #b1ejj 9 ! case ( any mon? ! fir/ day ( :i* ! taxpay] is a qualifi$ resid5t & is cov]$ by cr$itable cov]age 7twice su* am\nt 9 ! case ( a jo9t return if bo? sp\ses are s cov]$ by cr$itable cov]age & are qualifi$ resid5ts71 plus 7ii7 #a_/ab ( an am\nt equal to #a1ejj multipli$ by ! numb] ( qualify+ *ildr5 7)9 ! mean+ ( section #aeb7;c77 :o are qualifi$ resid5ts &-- 7,i7 = :om ! taxpay] is all[$ a d$uction "u section #aea = ! taxable ye> 9 :i* su* mon? ends1 & 7,,ii7 :o are cov]$ by cr$itable cov]age on ! fir/ day ( su* mon?4 7,b7 ,c>ry=w>d ( mon?ly cr$it am\nt 9 case cr$it am\nt exce$s ,,hsa contributions & premium paym5ts ,9 ! case ( any mon? = :i* ! cr$it am\nt det]m9$ ) respect to ! taxpay] "u subp>agraph 7,a7 exce$s ! limitation am\nt det]m9$ ) respect to ! taxpay] = su* mon? "u p>agraph 7#c71 su* excess may be c>ri$ =w>d to any subsequ5t mon? dur+ ! taxable ye> = purposes ( det]m9+ ! cr$it am\nt = su* mon? "u ?is p>agraph4 7#c7 ,mon?ly limitation 7,a7 ,9 g5]al ,! am\nt det]m9$ "u p>agraph 7#b7 = any mon? ( ! taxpay] %all n exce$ ! sum (-- 7i7 ! am\nts contribut$ to a heal? sav+s acc\nt ( ! taxpay] = su* mon?1 plus 7ii7 ! premiums paid by ! taxpay] = cr$itable cov]age4 7,b7 ,c>ry=w>d ( mon?ly limitation 9 case ,,hsa contributions & premium paym5ts exce$ mon?ly cr$it am\nt ,9 ! case ( any mon? = :i* ! am\nt det]m9$ ) respect to ! taxpay] "u subp>agraph 7,a7 exce$s ! cr$it am\nt det]m9$ ) respect to ! taxpay] = su* mon? "u p>agraph 7#b71 su* excess may be c>ri$ =w>d to any subsequ5t mon? dur+ ! taxable ye> = purposes ( det]m9+ ! limitation "u subp>agraph 7,a74 7#d7 ,adju/m5t = limit$ b5efit insurance ,9 ! case ( a taxpay] ^: only heal? insurance cov]age = a mon? is limit$ b5efit insurance 7z def9$ 9 section #abb7;b7 ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf71 ! am\nt det]m9$ "u p>agraph 7#b7 %all be decreas$ by su* proportion z ! ,secret>y1 9 consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 det]m9es appropriate1 tak+ into acc\nt ! ratio ( ! actu>ial value ( su* limit$ b5efit insurance to ! av]age actu>ial value ( heal? insurance cov]age t is n limit$ b5efit insurance4 7#e7 ,adju/m5t = geographic area & age ( cov]$ individual ,! am\nt det]m9$ "u p>agraph 7#b7 %all be adju/$1 9 a mann] specifi$ by ! ,secret>y1 9 consultation ) & bas$ on data collect$ by ! ,secret>y ( ,heal? & ,human ,s]vices1 to take into acc\nt ! age & area ( resid5ce ( a taxpay] or o!r cov]$ individual bas$ on ! ratio ( ! av]age co/ ( typical individual heal? insurance cov]age = an individual ( su* age & resid+ 9 su* area to ! national av]age co/ ( su* typical heal? insurance cov]age4 ,su* adju/m5t %all be made 9 a mann] s t ! application ( ?is p>agraph is e/imat$ n to *ange ! aggregate am\nt ( ! cr$its all[able "u ?is section = taxable ye>s end+ 9 a ye>4 7c7 ,coord9ation ) employ]-,provid$ heal? insurance tax subsidy 7#a7 ,cr$it limit$ by employ]-provid$ heal? insurance tax subsidy ,! cr$it all[$ "u ?is section = any taxable ye> %all n exce$ an am\nt equal to ! excess 7if any7 (-- 7,a7 ! maximum cr$it :i* w\ld be all[$ = all mon?s ( ! taxpay] dur+ ! taxable ye> 7det]m9$ "u subsection 7b77#b7 & )\t reg>d to ?is subsection1 ! limitation "u subsection 7b77#c71 & any r$uction "u subsection 7d77#a771 ov] 7,b7 ! taxpay]'s employ]-provid$ heal? insurance tax subsidy = ! taxable ye>4 7#b7 ,recapture ( excess employ]-provid$ heal? insurance tax subsidy ,9 ! case ( a taxpay] = :om ! am\nt describ$ 9 subp>agraph 7,b7 ( p>agraph 7#a7 exce$s ! am\nt describ$ 9 subp>agraph 7,a7 ( su* p>agraph = any taxable ye>1 ! cr$it all[$ "u ?is section %all be treat$ z z]o & ! tax impos$ by ?is *apt] = ! taxable ye> %all be increas$ by ! am\nt ( su* excess4 7#c7 ,employ]-provid$ heal? insurance tax subsidy ,= purposes ( ?is subsection-- 7,a7 ,9 g5]al ,! t]m employ]-provid$ heal? insurance tax subsidy means1 ) respect to any taxpay] = a taxable ye>1 ! sum (-- 7i7 ! ,f$]al income tax subsidy ( ! taxpay] = ! taxable ye>1 plus 7ii7 ! ,f$]al payroll tax subsidy ( ! taxpay] = ! taxable ye>4 7,b7 ,f$]al income tax subsidy ,! t]m ,f$]al income tax subsidy means1 ) respect to any taxpay] = ! taxable ye>1 ! excess 7if any7 (-- 7i7 ! am\nt ( tax t w\ld h be5 impos$ by ?is *apt] = ! taxable ye> _h su* tax be5 det]m9$ )\t reg>d to ?is section & by includ+ am\nts o!rwise exclud$ f gross income :i* 7 paid by or on behalf ( ! taxpay] = employ]-provid$ insurance t con/itutes m$ical c>e1 ov] 7ii7 ! am\nt ( tax impos$ by ?is *apt] = ! taxable ye> 7det]m9$ )\t reg>d to ?is section74 7,c7 ,f$]al payroll tax subsidy ,! t]m ,f$]al payroll tax subsidy means1 ) respect to any taxpay] = ! taxable ye>1 ! excess 7if any7 (-- 7i7 ! sum (-- 7,i7 ! am\nt ( tax t w\ld h be5 impos$ by *apt] #ba ) respect to any wages ( ! taxpay] paid dur+ ! taxable ye> _h su* tax be5 det]m9$ by includ+ am\nts o!rwise exclud$ f wages :i* 7 paid by or on behalf ( ! taxpay] dur+ ! taxable ye> = employ]-provid$ insurance t con/itutes m$ical c>e1 plus 7,,ii7 ! am\nt ( tax t w\ld h be5 impos$ by *apt] #b on any self-employm5t income ( ! taxpay] = su* taxable ye> _h self-employm5t income be5 det]m9$ )\t reg>d to any d$uction f gross income = am\nts paid = insurance :i* con/itutes m$ical c>e = ! taxpay]1 ! taxpay]'s sp\se1 & any qualify+ *ildr5 7)9 ! mean+ ( section #aeb7 = :om ! taxpay] is all[$ a d$uction "u section #aea = ! taxable ye>1 ov] 7ii7 ! am\nt ( tax impos$ ) respect to ! taxpay] dur+ su* taxable ye> "u *apt] #ba & = su* taxable ye> "u *apt] #b4 7#d7 ,no cr$it or recapture = insurance provid$ by employ] elect+ exclusion regime ,9 ! case ( an individual :o = any mon? is cov]$ by insurance t con/itutes m$ical c>e & t is provid$ by an employ] ) respect to :i* an election is 9 effect = su* mon? "u section #aca7;b7 ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf-- 7,a7 ! mon?ly cr$it am\nt det]m9$ "u subsection 7b77#b7 = su* mon? ) respect to su* individual %all be z]o1 & 7,b7 su* mon? %all n be tak5 into acc\nt = purposes ( det]m9+ any recapture "u p>agraph 7#b7 ) respect to su* individual4 7d7 ,reconciliation ( cr$it & advance cr$it 7#a7 ,9 g5]al ,! am\nt ( ! cr$it all[$ "u ?is section = any taxable ye> 7aft] ! application ( subsections 7b7 & 7c77 %all be r$uc$ 7b n bel[ z]o7 by ! am\nt ( any advance paym5t ( su* cr$it "u subsection 7e77#a74 7#b7 ,excess advance paym5ts 7,a7 ,9 g5]al ,if ! advance paym5ts to a taxpay] "u subsection 7e77#a7 = a taxable ye> exce$ ! cr$it all[$ by ?is section 7det]m9$ )\t reg>d to p>agraph 7#a771 ! tax impos$ by ?is *apt] = ! taxable ye> %all be increas$ by ! am\nt ( su* excess4 7,b7 ,limitation on increase ,9 ! case ( a taxpay] ^: h\sehold income is less ?an #djj p]c5t ( ! pov]ty l9e = ! size ( ! family involv$ = ! taxable ye>1 ! am\nt ( ! increase "u subp>agraph 7,a7 %all n exce$ ! applicable doll> am\nt det]m9$ 9 accordance ) ! foll[+ table 7"o-half ( su* am\nt 9 ! case ( a taxpay] ^: tax is det]m9$ "u section #a7;c7 = ! taxable ye>73 ,if ! h\sehold income 7express$ z a p]c5t ( pov]ty l9e7 is3,! applicable doll> am\nt is3,less ?an #bjjfjj;,at lea/ #bjj b less ?an #cjja1ejj;,at lea/ #cjj b less ?an #djjb1ejj 7e7 ,special rules ,= purpose ( ?is section-- 7#a7 ,advance paym5t program 7,a7 ,9 g5]al ,! ,secret>y ( ! ,treasury1 9 consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 %all e/abli% a program-- 7i7 to make advance det]m9ations ) respect to ! eligibility ( individuals = ! cr$it all[$ "u ?is section1 & 7ii7 to make advance paym5ts ( ! cr$it all[$ "u ?is section1 at ! election ( any su* individual s eligible1 directly to ! heal? sav+s acc\nt ( any su* individual1 or1 z a subsidy to ! co/ ( heal? insurance cov]age provid$ to any su* individual1 to ! heal? insurance issu] provid+ su* cov]age or ! p]son t adm9i/]s ! plan b5efits ) respect to su* cov]age4 7,b7 ,program requirem5ts ,su* program %all be e/abli%$ "u rules simil> to ! rules ( section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 z 9 effect on ! day be=e ! date ( ! enactm5t ( ?is section1 except t advance det]m9ations & advance paym5ts %all be made on reque/ ( ! individual ) respect to :om ! det]m9ation is to be made4 7#b7 ,in=mation requirem5ts 7,a7 ,9 g5]al ,ea* p]son provid+ insurance cov]age :i* con/itutes m$ical c>e1 & ea* tru/ee ( a heal? sav+s acc\nt1 %all provide ! foll[+ in=mation to ! ,secret>y & to ! taxpay] ) respect to su* cov]age or su* acc\nt3 7i7 ,! total premium = ! cov]age )\t reg>d to ! cr$it "u ?is section4 7ii7 ,! aggregate am\nt ( any advance paym5t ( su* cr$it made ) respect to su* cov]age or to su* acc\nt4 7iii7 ,! "n1 address1 age1 & ,,t9 ( ! prim>y insur$ or acc\nt hold] 7z ! case may be7 & ! "n1 age1 & ,,t9 ( ea* o!r individual obta9+ cov]age "u su* policy ( insurance4 7iv7 ,any in=mation provid$ to su* p]son necess>y to det]m9e eligibility =1 & ! am\nt (1 su* cr$it4 7v7 ,in=mation necess>y to det]m9e :e!r a taxpay] has receiv$ excess advance paym5ts4 7,b7 ,exception ,subp>agraph 7,a7 %all n apply to any cov]age ) respect to :i* report+ "u section #fjea is requir$4 7#c7 ,index+ 7,a7 ,9 g5]al ,9 ! case ( any cal5d> ye> beg9n+ aft] #bjaf1 ea* ( ! doll> am\nts 9 subsection 7b77#b7 & 9 ! table conta9$ "u subsection 7d77#b77;,b7 %all be equal to su* doll> am\nt multipli$ by ! ratio (-- 7i7 ! curr5t doll> gross dome/ic product 7z det]m9$ bas$ on ! ?ird e/imate ( ! ,bureau ( ,economic ,analysis ( ! ,dep>tm5t ( ,comm]ce = ! second qu>t] ( ! previ\s ye>71 to 7ii7 ! curr5t doll> gross dome/ic product 7z s det]m9$7 = ! second qu>t] ( #bjae4 7,b7 ,r\nd+ ,if any doll> am\nt adju/$ "u subp>agraph 7,a7 is n a multiple ( #ej1 su* am\nt %all be r\nd$ to ! next l[e/ multiple ( #ej4 7f7 ,def9itions ,= purposes ( ?is section-- 7#a7 ,cr$itable cov]age ,! t]m cr$itable cov]age has ! mean+ giv5 su* t]m = purposes ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act4 7#b7 ,qualifi$ resid5t ,! t]m qualifi$ resid5t means an individual :o is a citiz5 or national ( ! ,unit$ ,/ates or o!rwise lawfully resid+ 9 ! ,unit$ ,/ates "u color ( law4 4 7b7 ,election by employ] ,to make excise tax applicable & ,to be gov]n$ solely by exclusion regime 7#a7 ,9 g5]al ,if an eligible employ] makes ! election "u ?is subsection 7at su* "t & 9 su* =m & mann] z ! ,secret>y %all prescribe7 ! tax impos$ by section #dihj;,i ( ! ,int]nal ,rev5ue ,code ( #aihf %all apply to any excess b5efit ) respect to employ]-sponsor$ heal? cov]age provid$ by su* employ] & ! cr$it & recapture "u section #cf;,c ( su* ,code %all n apply ) respect to individuals cov]$ by su* cov]age4 ,su* election1 once made1 may be revok$ only ) ! cons5t ( ! ,secret>y4 7#b7 ,eligible employ] ,= purposes ( ?is subsection1 ! t]m eligible employ] means an employ] 9 exi/5ce be=e ! date ( ! enactm5t ( ?is ,act4 7#c7 ,controll$ gr\ps ,= purposes ( ?is subsection1 all p]sons treat$ z a s+le employ] "u subsection 7a7 or 7b7 ( section #eb ( ! ,int]nal ,rev5ue ,code ( #aihf or subsection 7m7 or 7o7 ( section #dad ( su* ,code %all be treat$ z a s+le eligible employ]4 7#d7 ,regulations ,! ,secret>y ( ! ,treasury %all prescribe su* regulations z may be necess>y to prev5t ! avoidance ( ! purposes ( ?is subsection4 7c7 ,excise tax on high co/ employ]-,sponsor$ heal? insurance only ,to apply to employ]s mak+ election ,section #dihj;,i7d77#a77;,b7 ( su* ,code 7relat+ to exceptions7 is am5d$ by /rik+ or at ! end ( clauses 7i7 & 7ii71 by /rik+ ! p]iod at ! end ( clause 7iii7 & ins]t+ 1 or1 & by add+ at ! end ! foll[+ new clause3 7iv7 any gr\p heal? plan made available by an employ] :i* does n h 9 effect an election "u section #aca7;b7 ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf4 4 7d7 ,disqualification f ,ex*ange plan subsidies = individual once !y elect tax b5efits ,section #cf;,b7c77#a7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,d5ial ( cr$it = ^? elect+ univ]sal cr$it ,9 ! case ( an individual :o is all[$ a cr$it "u section #cf;,c = any taxable ye>1 no cr$it %all be all[$ "u ?is section to su* individual = su* taxable ye> or any subsequ5t taxable ye>4 4 7e7 ,guidance ,! ,secret>y ( ! ,treasury %all issue su* guidance z is necess>y-- 7#a7 to assi/ employees & employ]s 9 adju/+ ,f$]al income tax )hold+ to take into acc\nt ! univ]sal heal? insurance tax cr$it "u section #cf;,c ( ! ,int]nal ,rev5ue ,code ( #aihf 7& any advance paym5t !re(71 & 7#b7 to require employ]s to report to ea* employee ) respect to p]iods n long] ?an qu>t]ly ! employ]-provid$ heal? insurance tax subsidy 7z def9$ 9 section #cf;,c7c77#c7 ( su* ,code7 ) respect to su* employee = su* p]iod4 7f7 ,cl]ical am5dm5t ,! table ( sections = subp>t ,c ( "p ,,iv ( sub*apt] ,a ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] ! item relat+ to section #cf;,b ! foll[+ new item3 ,sec4 #cf;,c4 ,univ]sal heal? insurance tax cr$it4 4 7g7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjae4 #acb4 ,application ( portion ( unus$ tax cr$its by ,/ates = indig5t heal? c>e 7a7 ,computation ( unus$ cr$its ,! ,secret>y1 9 consultation ) ! ,secret>y ( ! ,treasury1 %all calculate = ea* ,/ate = ea* ye>1 beg9n+ ) #bjag1 us+ ! mo/ rec5t data available -- 7#a7 ! maximum aggregate am\nt ( cr$its "u section #cf;,c ( ! ,int]nal ,rev5ue ,code ( #aihf t w\ld h be5 all[$ = ! ye> = qualifi$ resid5ts ( ! ,/ate = taxable ye>s end+ 9 ! ye> if all eligible qualifi$ resid5ts _h qualifi$ = su* cr$its2 7#b7 ! aggregate am\nt ( cr$its "u su* section t 7 all[$ = taxable ye>s end+ 9 t ye> by qualifi$ resid5ts ( su* ,/ate2 & 7#c7 #be p]c5t ( ! am\nt by :i*-- 7,a7 ! am\nt det]m9$ "u p>agraph 7#a7 ) respect to qualifi$ resid5ts ( ! ,/ate = su* ye>2 exce$s 7,b7 ! am\nt det]m9$ "u p>agraph 7#b7 = su* ,/ate = t ye>4 7b7 ,appropriation ,= ! purpose ( mak+ grants to ,/ates "u ?is section1 !re is h]eby appropriat$ to ! ,secret>y1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 = ea* ye> 7beg9n+ ) #bjag7 an am\nt equival5t to ! am\nt det]m9$ "u subsection 7a77#c7 = all ,/ates = ! ye> 9 :i* su* fiscal ye> ends1 subject to adju/m5t "u subsection 7d77#b74 7c7 ,grants to ,/ates = indig5t assi/ance 7#a7 ,application ,a ,/ate may file ) ! ,secret>y 79 a =m & mann] specifi$ by ! ,secret>y7 an application to provide assi/ance 9 furni%+ heal? s]vices to indig5t individuals resid+ 9 ! ,/ate4 ,su* application %all demon/rate ! mann] 9 :i* su* assi/ance is furni%$ 9 an equitable mann] to individuals resid+ 9 all p>ts ( ! ,/ate4 7#b7 ,am\nt ( funds ,f ! funds appropriat$ "u subsection 7b7 = a ye>1 ! am\nt ( funds paid to any ,/ate 9 any ye> "u ?is section ) an application fil$ 9 accordance ) p>agraph 7#a7 is equal to an am\nt specifi$ 9 ! application1 b n to exce$ ! am\nt comput$ "u subsection 7a77#c7 = ! ,/ate & ! ye>4 7#c7 ,use ( funds ,funds paid to a ,/ate "u ?is subsection may be us$ only to assi/ 9 ! furni%+ ( heal? s]vices to un9sur$ individuals resid+ 9 ! ,/ate or = purposes ( increas+ ! paym5t adju/m5ts made "u sections #ahhf7;d77#e77;,f7 & #aibc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f71 #acifr-#d7 to hospitals t s]ve a disproportionate %>e ( su* individuals 9 ! ,/ate4 7d7 ,initial e/imate2 f9al calculation & reconciliation 7#a7 ,use ( e/imates ,! calculations "u subsection 7a7 = a ye> %all initially be e/imat$ be=e ! beg9n+ ( ! ye>4 ,paym5ts "u ?is section to a ,/ate = a ye> %all be made1 subject to reconciliation "u p>agraph 7#b71 bas$ on ! am\nt s e/imat$4 7#b7 ,reconciliation bas$ on f9al calculation ,! calculations "u subsection 7a7 = a ye> %all also be made aft] ! end ( ! ye>4 ,ins(> z ! am\nt calculat$ "u ?is p>agraph = subsection 7a77#c7 = a ,/ate = a ye> exce$s 7or is less ?an7 by a mat]ial am\nt f ! am\nt = subsection 7a77#c7 e/imat$ & appli$ = ! ,/ate & ye> "u p>agraph 7#a71 ! am\nt calculat$ "u subsection 7a77#c7 = ! ,/ate = ! #bnd ye> beg9n+ aft] su* ye>1 %all be r$uc$ or increas$1 respectively by ! am\nt ( su* excess or deficit4 #acc4 ,m$icaid option ( enrollm5t "u private plan & contribution to an ,,hsa 7a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 may make available to an individual1 :o is entitl$ to m$ical assi/ance = a full range ( acute c>e items & s]vices "u su* title & at ! individual's option1 in/ead ( ! m$ical assi/ance o!rwise provid$1 m$ical assi/ance consi/+ ( cov]age "u a heal? plan t qualifies = a tax cr$it "u section #cf;,c ( ! ,int]nal ,rev5ue ,code ( #aihf1 b only if1 = ea* ye> ! individual receives m$ical assi/ance 9 ! =m ( su* cov]age1 ! ,/ate also deposits into a heal? sav+s acc\nt = ! individual an am\nt equal to ! am\nt 7if any7 by :i* ! am\nt ( ! tax cr$it = ! individual "u su* section exce$s ! co/ ( cov]age ( ! individual "u ! plan4 7b7 ,,ffp treatm5t ,! paym5ts by a ,/ate describ$ 9 subsection 7a7 = cov]age "u a heal? plan & = deposit into a heal? sav+s acc\nt %all be treat$ z m$ical assi/ance = purposes ( section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 & section #aijc;,a ( su* ,act 7z add$ by section #dja7 & subject to ,f$]al f9ancial p>ticipation1 includ+ ! application ( ,/ate mat*+ paym5ts1 9 ! same mann] z o!r m$ical assi/ance furni%$ "u title ,,xix ( su* ,act1 except t su* am\nt %all be r$uc$ by ! am\nt ( any heal? insurance cr$its provid$ "u section #cf;,c ( ! ,int]nal ,rev5ue ,code ( #aihf ) respect to su* cov]age or deposit4 ,,ii ,improv+ ,heal? ,sav+s ,acc\nts to ,promote ,acc\ntability #bja4 ,transition to non-d$uctible ,h,s,as 7a7 ,non-,d$uctible ,h,s,as ,sub*apt] ,f ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new "p3 ,,ix ,heal? sav+s acc\nts ,sec4 #ecj;,a4 ,ro? ,h,s,as4 #ecj;,a4 ,ro? ,h,s,as 7a7 ,9 g5]al ,) ! exception ( ! taxes impos$ by section #eaa 7relat+ to imposition ( tax on unrelat$ bus9ess income ( *>itable organizations71 a ,ro? ,,hsa %all be exempt f taxation "u ?is subtitle4 ,no d$uction %all be all[$ = any contribution to a ,ro? ,,hsa4 7b7 ,doll> limitation 7#a7 ,9 g5]al ,! aggregate am\nt ( contributions = any taxable ye> to all ,ro? ,h,s,as ma9ta9$ = ! b5efit ( an individual %all n exce$ ! sum ( ! mon?ly limitations = any mon? dur+ su* taxable ye> t ! individual is an eligible individual4 7#b7 ,mon?ly limitation ,! mon?ly limitation = any mon? is #a_/ab (-- 7,a7 9 ! case ( an eligible individual :o has self-only cr$itable cov]age z ( ! fir/ day ( su* mon?1 #e1jjj1 & 7,b7 9 ! case ( an eligible individual :o has family cr$itable cov]age z ( ! fir/ day ( su* mon?1 ! am\nt 9 effect "u subp>agraph 7,a7 = ! taxable ye> multipli$ by ! numb] ( individuals 7includ+ ! eligible individual7 cov]$ "u su* family cr$itable cov]age z ( su* day4 7#c7 ,additional contributions = individuals #ee or old] ,9 ! case ( an individual :o has atta9$ age #ee be=e ! close ( ! taxable ye>1 ! applicable limitation "u subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7 %all be increas$ by #a1jjj4 7#d7 ,coord9ation ) o!r contributions ,! limitation :i* w\ld 7b = ?is p>agraph7 apply "u ?is subsection to an individual = any taxable ye> %all be r$uc$ 7b n bel[ z]o7 by ! sum (-- 7,a7 ! aggregate am\nt paid = su* taxable ye> to ,ar*] ,m,s,as ( su* individual1 7,b7 ! aggregate am\nt contribut$ to ,ro? ,h,s,as ( su* individual :i* is excludable f ! taxpay]'s gross income = su* taxable ye> "u section #ajf7;d7 7& su* am\nt %all n be all[$ z a d$uction "u subsection 7a771 & 7,c7 ! aggregate am\nt contribut$ to ,ro? ,h,s,as ( su* individual = su* taxable ye> "u section #djh7;d77#i7 7& su* am\nt %all n be all[$ z a d$uction "u subsection 7a774 ,subp>agraph 7,a7 %all n apply ) respect to any individual to :om p>agraph 7#e7 applies4 7#e7 ,special rule = m>ri$ individuals ,9 ! case ( individuals :o are m>ri$ to ea* o!r1 if ei!r sp\se has family cov]age-- 7,a7 bo? sp\ses %all be treat$ z hav+ only su* family cov]age 7& if su* sp\ses ea* h family cov]age "u diff]5t plans1 z hav+ ! family cov]age ) ! l[e/ annual d$uctible71 & 7,b7 ! limitation "u p>agraph 7#a7 7aft] ! application ( subp>agraph 7,a7 & )\t reg>d to any additional contribution am\nt "u p>agraph 7#c77-- 7i7 %all be r$uc$ by ! aggregate am\nt paid to ,ar*] ,m,s,as ( su* sp\ses = ! taxable ye>1 & 7ii7 aft] su* r$uction1 %all be divid$ equally betwe5 !m unless !y agree on a diff]5t division4 7#f7 ,d5ial ( d$uction to dep5d5ts ,no contribution may be made to a ,ro? ,,hsa "u ?is section by any individual ) respect to :om a d$uction "u section #aea is all[able to ano!r taxpay] = a taxable ye> beg9n+ 9 ! cal5d> ye> 9 :i* su* individual's taxable ye> beg9s4 7#g7 ,m$ic>e eligible individuals ,! limitation "u ?is subsection = any mon? ) respect to an individual %all be z]o = ! fir/ mon? su* individual is entitl$ to b5efits "u title ,,xviii ( ! ,social ,security ,act & = ea* mon? !reaft]4 7#h7 ,increase 9 limit = individuals becom+ eligible individuals aft] ! beg9n+ ( ! ye> 7,a7 ,9 g5]al ,= purposes ( comput+ ! limitation "u p>agraph 7#a7 = any taxable ye>1 an individual :o is an eligible individual dur+ ! la/ mon? ( su* taxable ye> %all be treat$-- 7i7 z hav+ be5 an eligible individual dur+ ea* ( ! mon?s 9 su* taxable ye>1 & 7ii7 z hav+ be5 enroll$1 dur+ ea* ( ! mon?s su* individual is treat$ z an eligible individual solely by reason ( clause 7i71 9 ! same high d$uctible heal? plan 9 :i* ! individual 0 enroll$ = ! la/ mon? ( su* taxable ye>4 7,b7 ,failure to ma9ta9 cr$itable cov]age 7i7 ,9 g5]al ,if1 at any "t dur+ ! te/+ p]iod1 ! individual is n an eligible individual1 !n-- 7,i7 ! gross income ( ! individual = ! taxable ye> 9 :i* occurs ! fir/ mon? 9 ! te/+ p]iod = :i* su* individual is n an eligible individual %all be increas$ by ! aggregate am\nt ( all contributions to ! ,ro? ,,hsa ( ! individual :i* c\ld n h be5 made b = subp>agraph 7,a71 & 7,,ii7 ! tax impos$ by ?is *apt] = any taxable ye> on ! individual %all be increas$ by #aj p]c5t ( ! am\nt ( su* increase4 7ii7 ,exception = disability or dea? ,clause 7i7 %all n apply if ! individual ceas$ to be an eligible individual by reason ( ! dea? ( ! individual or ! individual becom+ disabl$ 7)9 ! mean+ ( section #gb7m77#g774 7iii7 ,te/+ p]iod ,! t]m te/+ p]iod means ! p]iod beg9n+ ) ! la/ mon? ( ! taxable ye> ref]r$ to 9 subp>agraph 7,a7 & end+ on ! la/ day ( ! #ab? mon? foll[+ su* mon?4 7c7 ,ro? ,,hsa ,= purposes ( ?is section-- 7#a7 ,9 g5]al ,! t]m ,ro? ,,hsa means a tru/ creat$ or organiz$ 9 ! ,unit$ ,/ates z a ,ro? ,,hsa exclusively = ! purpose ( pay+ ! qualifi$ m$ical exp5ses ( ! acc\nt b5efici>y1 b only if ! writt5 gov]n+ in/rum5t creat+ ! tru/ meets ! foll[+ requirem5ts3 7,a7 ,except 9 ! case ( a rollov] contribution describ$ 9 subsection 7f77#e7 or section #bbj7;f77#e71 no contribution w be accept$-- 7i7 unless x is 9 ca%1 or 7ii7 to ! ext5t su* contribution1 :5 add$ to previ\s contributions to ! tru/ = ! cal5d> ye>1 exce$s ! sum (-- 7,i7 ! doll> am\nt 9 effect "u subsection 7b77#b77;,b71 & 7,,ii7 ! doll> am\nt 9 effect "u subsection 7b77#c74 7,b7 ,! tru/ee is a bank 7z def9$ 9 section #djh7n771 an insurance company 7z def9$ 9 section #haf71 or ano!r p]son :o demon/rates to ! satisfaction ( ! ,secret>y t ! mann] 9 :i* su* p]son w adm9i/] ! tru/ w be consi/5t ) ! requirem5ts ( ?is section4 7,c7 ,no "p ( ! tru/ assets w be inve/$ 9 life insurance contracts4 7,d7 ,! assets ( ! tru/ w n be comm+l$ ) o!r prop]ty except 9 a common tru/ fund or common inve/m5t fund4 7,e7 ,! int]e/ ( an individual 9 ! balance 9 8 acc\nt is non=feitable4 7#b7 ,qualifi$ m$ical exp5ses ,= purposes ( ?is section-- 7,a7 ,9 g5]al ,! t]m qualifi$ m$ical exp5ses means1 ) respect to an acc\nt b5efici>y1 am\nts paid by su* b5efici>y = m$ical c>e 7z def9$ 9 section #bac7;d7 z 9 effect on ! day be=e ! date ( ! enactm5t ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf7 = su* individual1 ! sp\se ( su* individual1 & any dep5d5t 7z def9$ 9 section #aeb1 det]m9$ )\t reg>d to subsections 7b77#a71 7b77#b71 & 7d77#a77;,b7 !re(7 ( su* individual1 b only to ! ext5t su* am\nts are n comp5sat$ = by insurance or o!rwise4 7,b7 ,limitation on heal? insurance pur*as$ f acc\nt ,su* t]m %all n include any paym5t = heal? b5efits cov]age t is n cr$itable cov]age 7z def9$ 9 section #cf;,c74 7,c7 ,exceptions ,subp>agraph 7,b7 %all n apply to any exp5se = cov]age "u-- 7i7 a heal? plan dur+ any p]iod ( cont9uation cov]age requir$ "u any ,f$]al law1 7ii7 a qualifi$ long-t]m c>e insurance contract 7z def9$ 9 section #ggjb;,b7b771 7iii7 a heal? plan dur+ a p]iod 9 :i* ! individual is receiv+ unemploym5t comp5sation "u any ,f$]al or ,/ate law1 or 7iv7 9 ! case ( an acc\nt b5efici>y :o has atta9$ ! age specifi$ 9 section #ahaa ( ! ,social ,security ,act1 any heal? insurance o!r ?an a m$ic>e supplem5tal policy 7z def9$ 9 section #ahhb ( ! ,social ,security ,act74 7#c7 ,acc\nt b5efici>y ,! t]m acc\nt b5efici>y means ! individual on ^: behalf ! ,ro? ,,hsa 0 e/abli%$4 7#d7 ,c]ta9 rules to apply ,rules simil> to ! foll[+ rules %all apply = purposes ( ?is section3 7,a7 ,section #bai7;f77#c7 7relat+ to "t :5 contributions deem$ made74 7,b7 ,except z provid$ 9 section #ajf7;d71 section #bai7;f77#e7 7relat+ to employ] paym5ts74 7,c7 ,section #djh7;g7 7relat+ to community prop]ty laws74 7,d7 ,section #djh7;h7 7relat+ to cu/odial acc\nts74 7d7 ,eligible individual2 cr$itable cov]age ,= purposes ( ?is section-- 7#a7 ,eligible individual ,! t]m eligible individual means1 ) respect to any mon?1 any individual :o is cov]$ "u cr$itable cov]age z ( ! #a/ day ( su* mon?4 7#b7 ,cr$itable cov]age ,! t]m cr$itable cov]age %all h ! mean+ giv5 su* t]m 9 section #cf;,c7f77#a74 7e7 ,tax treatm5t ( di/ributions 7#a7 ,am\nts us$ = qualifi$ m$ical exp5ses ,any am\nt paid or di/ribut$ out ( a ,ro? ,,hsa :i* is us$ exclusively to pay qualifi$ m$ical exp5ses ( any acc\nt b5efici>y %all n be includible 9 gross income4 7#b7 ,inclusion ( am\nts n us$ = qualifi$ m$ical exp5ses ,any am\nt paid or di/ribut$ out ( a ,ro? ,,hsa :i* is n us$ exclusively to pay ! qualifi$ m$ical exp5ses ( ! acc\nt b5efici>y %all be includ$ 9 ! gross income ( su* b5efici>y4 7#c7 ,excess contributions return$ be=e due date ( return 7,a7 ,9 g5]al ,if any excess contribution is contribut$ = a taxable ye> to any ,ro? ,,hsa ( an individual1 p>agraph 7#b7 %all n apply to di/ributions f ! ,ro? ,h,s,as ( su* individual 7to ! ext5t su* di/ributions d n exce$ ! aggregate excess contributions to all su* acc\nts ( su* individual = su* ye>7 if-- 7i7 su* di/ribution is receiv$ by ! individual on or be=e ! la/ day prescrib$ by law 7includ+ ext5sions ( "t7 = fil+ su* individual's return = su* taxable ye>1 & 7ii7 su* di/ribution is accompani$ by ! am\nt ( net income attributable to su* excess contribution4 ,any net income describ$ 9 clause 7ii7 %all be includ$ 9 ! gross income ( ! individual = ! taxable ye> 9 :i* x is receiv$4 7,b7 ,excess contribution ,= purposes ( subp>agraph 7,a71 ! t]m excess contribution means any contribution 7o!r ?an a rollov] contribution describ$ 9 p>agraph 7#e7 or section #bbj7;f77#e77 :i* exce$s ! contribution limitation ) respect to ! individual = ! taxable ye>4 7#d7 ,additional tax on di/ributions n us$ = qualifi$ m$ical exp5ses 7,a7 ,9 g5]al ,! tax impos$ by ?is *apt] on ! acc\nt b5efici>y = any taxable ye> 9 :i* !re is a paym5t or di/ribution f a ,ro? ,,hsa ( su* b5efici>y :i* is includible 9 gross income "u p>agraph 7#b7 %all be increas$ by #aj p]c5t ( ! am\nt :i* is s includible4 7,b7 ,exception = disability or dea? ,subp>agraph 7,a7 %all n apply if ! paym5t or di/ribution is made aft] ! acc\nt b5efici>y becomes disabl$ )9 ! mean+ ( section #gb7m77#g7 or dies4 7,c7 ,exception = di/ributions aft] m$ic>e eligibility ,subp>agraph 7,a7 %all n apply to any paym5t or di/ribution aft] ! date on :i* ! acc\nt b5efici>y atta9s ! age specifi$ 9 section #ahaa ( ! ,social ,security ,act4 7#e7 ,rollov] contribution ,an am\nt is describ$ 9 ?is p>agraph z a rollov] contribution if x meets ! requirem5ts ( subp>agraphs 7,a7 & 7,b74 7,a7 ,9 g5]al ,p>agraph 7#b7 %all n apply to any am\nt paid or di/ribut$ f a heal? sav+s acc\nt 7z def9$ 9 section #bbc7 or a ,ro? ,,hsa to ! acc\nt b5efici>y to ! ext5t ! am\nt receiv$ is paid into a ,ro? ,,hsa = ! b5efit ( 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 or a ,ro? ,,hsa 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 or ,ro? ,,hsa :i* 0 n includible 9 ! individual's gross income because ( ! application ( ?is p>agraph4 7#f7 ,transf] ( acc\nt incid5t to divorce ,! transf] ( an individual's int]e/ 9 a ,ro? ,,hsa to an individual's sp\se or =m] sp\se "u a divorce or sep>ation in/rum5t describ$ 9 subp>agraph 7,a7 ( section #ga7;b77#b7 %all n be consid]$ a taxable transf] made by su* individual not)/&+ any o!r provision ( ?is subtitle1 & su* int]e/ %all1 aft] su* transf]1 be treat$ z a ,ro? ,,hsa ) respect to :i* su* sp\se is ! acc\nt b5efici>y4 7#g7 ,treatm5t aft] dea? ( acc\nt b5efici>y ,if an individual acquires an acc\nt b5efici>y's int]e/ 9 a heal? sav+s acc\nt by reason ( ! dea? ( ! acc\nt b5efici>y1 su* heal? sav+s acc\nt %all be treat$ z if ! individual 7 ! acc\nt b5efici>y4 7f7 ,co/-(-,liv+ adju/m5t 7#a7 ,9 g5]al ,9 ! case ( any cal5d> ye> beg9n+ aft] #bjaf1 ! #e1jjj doll> am\nt 9 subsection 7b77#b7 %all be increas$ by an am\nt equal to-- 7,a7 su* doll> am\nt1 multipli$ by 7,b7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye>1 det]m9$-- 7i7 by sub/itut+ cal5d> ye> #bjae = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re(1 & 7ii7 by sub/itut+ ,,cpi m$ical c>e compon5t = ,,cpi4 7#b7 ,,cpi m$ical c>e compon5t ,= purposes ( ?is p>agraph1 ! t]m ,,cpi m$ical c>e compon5t means ! m$ical c>e compon5t = ! ,consum] ,price ,index = ,all ,urban ,consum]s publi%$ by ! ,dep>tm5t ( ,labor4 7#c7 ,r\nd+ ,if ! am\nt ( any increase "u ! prec$+ s5t5ce is n a multiple ( #ej1 su* increase %all be r\nd$ to ! next l[e/ multiple ( #ej4 7g7 ,reports ,! ,secret>y may require-- 7#a7 ! tru/ee ( a ,ro? ,,hsa to make su* reports reg>d+ su* acc\nt to ! ,secret>y & to ! acc\nt b5efici>y ) respect to contributions1 di/ributions1 ! return ( excess contributions1 & su* o!r matt]s z ! ,secret>y det]m9es appropriate1 & 7#b7 any p]son :o provides an individual ) cr$itable cov]age to make su* reports to ! ,secret>y & to ! acc\nt b5efici>y ) respect to su* plan z ! ,secret>y det]m9es appropriate4 ,! reports requir$ by ?is subsection %all be fil$ at su* "t & 9 su* mann] & furni%$ to su* individuals at su* "t & 9 su* mann] z may be requir$ by ! ,secret>y4 4 7b7 ,limit on contributions to d$uctible heal? sav+s acc\nts ,section #bbc ( su* ,code is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,limit$ contributions aft] #bjaf 7#a7 ,9 g5]al ,no contribution may be accept$ by a heal? sav+s acc\nt aft] ,decemb] #ca1 #bjaf4 7#b7 ,exceptions ,p>agraph 7#a7 %all n apply-- 7,a7 9 ! case ( a rollov] contribution describ$ 9 subsection 7f77#e7 or section #bbj7;f77#e71 or 7,b7 9 ! case ( a mon? = :i* an individual is cov]$ by insurance t con/itutes m$ical c>e & t is provid$ by an employ] ) respect to :i* an election is 9 effect = su* mon? "u section #aca7;b7 ( ! ,_w's ,greate/ ,heal?c>e ,plan ,act ( #bjaf4 4 7c7 ,cl]ical am5dm5t ,! table ( p>ts = sub*apt] ,f ( *apt] #a ( su* ,code is am5d$ by add+ a ! end ! foll[+ new item3 ,"p ,,ix4 ,ro? heal? sav+s acc\nts4 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 #bjb4 ,elim9ation ( m$ical exp5se d$uction ,section #bac ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7g7 ,t]m9ation ,except 9 ! case ( long-t]m c>e premiums 7z def9$ 9 subsection 7d77#aj771 subsection 7a7 %all n apply to any am\nts paid dur+ any taxable ye> beg9n+ aft] ,decemb] #ca1 #bjae4 4 #bjc4 ,treatm5t ( ,,hsa aft] dea? ( acc\nt b5efici>y 7a7 ,9 g5]al ,section #bbc7;f77#h7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7#h7 ,treatm5t aft] dea? ( acc\nt b5efici>y ,if an individual acquires an acc\nt b5efici>y's int]e/ 9 a heal? sav+s acc\nt by reason ( ! dea? ( ! acc\nt b5efici>y1 su* heal? sav+s acc\nt %all be treat$ z if ! individual 7 ! acc\nt b5efici>y4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply ) respect to int]e/s acquir$ aft] ! date ( ! enactm5t ( ?is ,act4 #bjd4 ,treatm5t ( direct prim>y c>e 7a7 ,h,s,as 7#a7 ,ro? ,,hsa ,section #ecj;,a7c77#b77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z add$ by ?is ,act1 is am5d$ by add+ at ! end ! foll[+3 ,su* t]m %all include ! paym5t ( a mon?ly or o!r prepaid am\nt = ! furni%+ 7or access to ! furni%+7 by a physician or gr\p ( physicians ( physician pr(essional s]vices 7& ancill>y s]vices744 7#b7 ,,hsa ,section #bbc7;d77#b77;,a7 ( su* ,code is am5d$ by add+ at ! end ! foll[+3 ,su* t]m %all include ! paym5t ( a mon?ly or o!r prepaid am\nt = ! furni%+ 7or access to ! furni%+7 by a physician or gr\p ( physicians ( physician pr(essional s]vices 7& ancill>y s]vices744 7b7 ,n treat$ z heal? insurance cov]age 7#a7 ,9 g5]al ,= purposes ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act1 subtitle ,b ( title ,i ( ! ,employee ,retirem5t & ,income ,security ,act ( #aigd1 ,,ppaca1 & ?is ,act1 ! (f]+ ( direct prim>y c>e %all n be treat$ z ! (f]+ ( heal? insurance cov]age & %all n be subject to regulations z su* cov]age "u su* ,acts4 7#b7 ,direct prim>y c>e def9$ ,9 ?is subsection1 ! t]m direct prim>y c>e means ! furni%+ 7or access to ! furni%+7 by a physician or gr\p ( physicians ( physician pr(essional s]vices 7& ancill>y s]vices7 9 return = paym5t ( a mon?ly or o!r prepaid am\nt4 ,,iii ,/ate flexibility 9 regulation ( heal? insurance cov]age #cja4 ,/ate flexibility 9 regulation ( heal? insurance cov]age 7a7 ,9 g5]al ,/ates are giv5 ! flexibility "u section #abb7;b7 to revise _! regulations ( ! heal? insurance m>ketplace1 )\t reg>d to _m ( ! requirem5ts impos$ "u ,,ppaca1 9 ord] to promote fre$om ( *oice ( af=dable heal? insurance cov]age options (f]$ outside ( an ,ex*ange4 7b7 ,con/ruction ,no?+ 9 ! ,employee ,retirem5t & ,income ,security ,act ( #aigd or ( any am5dm5ts made by ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif %all be int]pret$ z prev5t+ an employ] f (f]+1 or mak+ an employ] contribution t[>ds1 individual heal? insurance cov]age = employees & dep5d5t family memb]s4 ,,iv ,m$icaid ,paym5t ,re=m #dja4 ,m$icaid paym5t re=m 7a7 ,9 g5]al ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$ by ins]t+ aft] section #aijc ! foll[+ section3 #aijc;,a4 ,re=m$ paym5t to ,/ates 7a7 ,re=m$ paym5t sy/em 7#a7 ,9 g5]al ,= qu>t]s beg9n+ on or aft] ! implem5tation date 7z def9$ 9 subsection 7k77#a771 9 lieu ( am\nts o!rwise payable to a ,/ate "u ?is title 7includ+ any paym5ts attributable to section #aibc71 except z o!rwise provid$ 9 ?is section1 ! am\nt payable to su* ,/ate %all be equal to ! sum ( ! foll[+3 7,a7 ,adju/$ aggregate b5efici>y-bas$ am\nt ,! aggregate b5efici>y-bas$ am\nt specifi$ 9 subsection 7b7 = ! qu>t] & ! ,/ate1 adju/$ "u subsection 7e74 7,b7 ,*ronic c>e quality bonus ,! am\nt 7if any7 ( ! *ronic c>e quality bonus paym5t specifi$ 9 subsection 7f7 = ! qu>t] = ! ,/ate4 7#b7 ,requirem5t ( ,/ate %>e 7,a7 ,9 g5]al ,a ,/ate %all make1 f non-,f$]al funds1 exp5ditures 9 an am\nt equal to its ,/ate %>e 7z det]m9$ "u subp>agraph 7,b77 = a qu>t] = items1 s]vices1 & o!r co/s = :i*1 b = p>agraph 7#a71 ,f$]al funds w\ld h be5 payable "u ?is title4 7,b7 ,/ate %>e ,! ,/ate %>e = a ,/ate = a qu>t] 9 a fiscal ye> is equal to ! product (-- 7i7 ! aggregate b5efici>y-bas$ am\nt specifi$ 9 subsection 7b7 = ! qu>t] & ! ,/ate2 & 7ii7 ! ratio (-- 7,i7 ! ,/ate p]c5tage describ$ 9 subp>agraph 7,d77ii7 = su* ,/ate & fiscal ye>2 to 7,,ii7 ! ,f$]al p]c5tage describ$ 9 subp>agraph 7,d77i7 = su* ,/ate & fiscal ye>4 7,c7 ,nonpaym5t = failure to pay /ate %>e 7i7 ,9 g5]al ,if a ,/ate fails to exp5d ! am\nt requir$ "u subp>agraph 7,a7 = a qu>t] 9 a fiscal ye>1 ! am\nt payable to ! ,/ate "u p>agraph 7#a7 %all be r$uc$ by ! product ( ! am\nt by :i* ! ,/ate paym5t is less ?an ! ,/ate %>e & ! ratio (-- 7,i7 ! ,f$]al p]c5tage describ$ 9 subp>agraph 7,d77i7 = su* ,/ate & fiscal ye>2 to 7,,ii7 ! ,/ate p]c5tage describ$ 9 subp>agraph 7,d77ii7 = su* ,/ate & fiscal ye>4 7ii7 ,grace p]iod ,a ,/ate %all n be consid]$ to h fail$ to provide paym5t ( its requir$ ,/ate %>e = a qu>t] "u subp>agraph 7,a7 if ! aggregate ,/ate paym5t t[>ds ! ,/ate's requir$ ,/ate %>e = ! #d-qu>t] p]iod beg9n+ ) su* qu>t] exce$s ! requir$ ,/ate %>e am\nt = su* #d-qu>t] p]iod4 7,d7 ,f$]al & ,/ate p]c5tages ,9 ?is p>agraph1 ) respect to a ,/ate & a fiscal ye>3 7i7 ,f$]al p]c5tage ,! ,f$]al p]c5tage describ$ 9 ?is clause is #ge p]c5t or1 if high]1 ! ,f$]al m$ical assi/ance p]c5tage = su* ,/ate = su* fiscal ye>4 7ii7 ,/ate p]c5tage ,! ,/ate p]c5tage describ$ 9 ?is clause is #ajj p]c5t m9us ! ,f$]al p]c5tage describ$ 9 clause 7i74 7,e7 ,rules = cr$it+ t[>d ,/ate %>e 7i7 ,g5]al limitation to mat*able exp5ditures ,a paym5t = exp5ditures %all n be c\nt$ t[>d ! ,/ate %>e "u subp>agraph 7,a7 unless ,f$]al paym5ts may be us$ = su* exp5ditures consi/5t ) p>agraph 7#c77;,b74 7ii7 ,fur!r limitations on all[able exp5ditures ,a paym5t = exp5ditures %all n be c\nt$ t[>ds ! ,/ate %>e "u subp>agraph 7,a7 if ! exp5diture is = any ( ! foll[+3 7,i7 ,abortion ,exp5ditures = an abortion4 7,,ii7 ,int]gov]nm5tal transf]s ,an exp5diture t is attributable to an int]gov]nm5tal transf]4 7,,iii7 ,c]tifi$ public exp5ditures ,an exp5diture t is attributable to c]tifi$ public exp5ditures4 7iii7 ,cr$it+ fraud & abuse recov]ies ,am\nts recov]$ by a ,/ate ?r\gh ! op]ation ( its ,m$icaid fraud & abuse control unit describ$ 9 section #aijc7q7 %all be fully c\nt$ t[>d ! ,/ate %>e "u subp>agraph 7,a74 7,f7 ,con/ruction ,no?+ 9 ! p>agraph %all be con/ru$ z prev5t+ a ,/ate f exp5d+1 f non-,f$]al funds1 an am\nt "u ?is title 9 excess ( ! am\nt ( ! ,/ate %>e4 7,g7 ,det]m9ation bas$ ^u submitt$ claims ,9 apply+ ?is p>agraph ) respect to exp5ditures ( a ,/ate = a qu>t]1 ! det]m9ation ( ! exp5ditures = su* ,/ate = su* qu>t] %all be made aft] ! end ( ! p]iod 7:i*1 z ( ! date ( ! enactm5t ( ?is section1 is #b ye>s7 = :i* ! ,secret>y accepts claims = paym5t "u ?is title ) respect to su* qu>t]4 7#c7 ,use ( ,f$]al paym5ts 7,a7 ,application ( ,m$icaid limitations ,a ,/ate may only use ,f$]al paym5ts receiv$ "u subsection 7a7 = exp5ditures = :i* ,f$]al funds w\ld h be5 payable "u ?is title b = ?is section4 7,b7 ,limitation = c]ta9 eligibles 7i7 ,application ( #ajj p]c5t f$]al pov]ty l9e limit on eligibility ,subject to clause 7iii71 a ,/ate may n use su* ,f$]al paym5ts to provide m$ical assi/ance = an individual :o has an income 7z det]m9$ "u clause 7ii77 t exce$s #ajj p]c5t ( ! pov]ty l9e 7z def9$ 9 section #baaj7;c77#e77 applicable to a family ( ! size involv$4 7ii7 ,det]m9ation ( income us+ modifi$ adju/$ gross income )\t any #e p]c5t increase ,9 det]m9+ income = purposes ( clause 7i7 "u section #aijb7;e77#ad7 7relat+ to modifi$ adju/$ gross income71 ! foll[+ rules %all apply3 7,i7 ,application ( sp5d d[n ,! ,/ate %all take into acc\nt ! co/s incurr$ = m$ical c>e or = any o!r type ( rem$ial c>e recogniz$ "u ,/ate law 9 ! same mann] & to ! same ext5t t su* ,/ate takes su* co/s into acc\nt = purposes ( section #aijb7;a77#ag74 7,,ii7 ,disreg>d ( #e p]c5t increase ,subp>agraph 7,i7 ( section #aijb7;e77#ad7 7relat+ to a #e p]c5t r$uction7 %all n apply4 7iii7 ,exception ,clause 7i7 %all n apply to an individual :o is-- 7,i7 a woman describ$ 9 clause 7i7 ( section #aijc7v77#d77;,a72 7,,ii7 a *ild :o is an individual describ$ 9 clause 7i7 ( section #aije7;a72 7,,iii7 enroll$ 9 a ,/ate plan "u ?is title z ( ! date ( ! enactm5t ( ?is section = ! p]iod ( cont9u\s enrollm5t2 or 7,,iv7 describ$ 9 section #aijb7;e77#ad77;,d7 7relat+ to modifi$ adju/$ gross income74 7iv7 ,cl>ification relat$ to community sp\se ,no?+ 9 ?is subp>agraph %all sup]s$e ! application ( section #aibd 7relat$ to community sp\se income & assets74 7#d7 ,exceptions = pass-?r\gh paym5ts 7,a7 ,9 g5]al ,p>agraph 7#a7 %all n apply1 & am\nts %all cont9ue to be payable "u ?is title 7& n "u ?is subsection71 9 ! case ( ! foll[+ paym5ts 7& relat$ adm9i/rative co/s & exp5ditures73 7i7 ,paym5ts to t]ritories ,paym5ts to a ,/ate o!r ?an ! #ej ,/ates & ! ,di/rict ( ,columbia4 7ii7 ,m$ic>e co/ %>+ ,paym5ts attributable to ,m$ic>e co/ %>+ "u section #aije7p74 7iii7 ,p$iatric vacc9es ,paym5ts attributable to section #aibh4 7iv7 ,em]g5cy s]vices = c]ta9 individuals ,paym5ts = treatm5t ( em]g5cy m$ical conditions attributable to ! application ( section #aijc7v77#b74 7v7 ,indian heal? c>e facilities ,paym5ts = m$ical assi/ance describ$ 9 ! ?ird s5t5ce ( section #aije7;b74 7vi7 ,employ]-sponsor$ insurance 7,,esi7 ,paym5ts = m$ical assi/ance attributable to paym5ts to employ]s = employ]-sponsor$ heal? b5efits cov]age4 7vii7 ,o!r populations ) limit$ b5efit cov]age ,o!r paym5ts t are det]m9$ by ! ,secret>y to be relat$ to a specifi$ population = :i* ! m$ical assi/ance "u ?is title is limit$ & does n include any inpati5t1 nurs+ facility1 or long-t]m c>e s]vices4 7,b7 ,c]ta9 exp5ses ,p>agraph 7#a7 %all n apply1 & am\nts %all cont9ue to be payable "u ?is title 7& n "u ?is subsection71 9 ! case ( ! foll[+3 7i7 ,adm9i/ration ( m$ic>e prescription drug b5efit ,exp5ditures describ$ 9 section #aice7;b7 7relat+ to adm9i/ration ( ! ,m$ic>e prescription drug b5efit74 7ii7 ,paym5ts = ,,hit bonuses ,paym5ts "u section #aijc7;a77#c77;,f7 7relat+ to paym5ts to enc\rage ! adoption & use ( c]tifi$ ,,ehr te*nology74 7iii7 ,paym5ts = design1 developm5t1 & in/allation ( ,,mmis & eligibility sy/ems ,paym5ts "u subp>agraphs 7,a77i7 & 7,h77i7 ( section #aijc7;a77#c7 = exp5ditures = design1 developm5t1 & in/allation ( ! ,m$icaid managem5t in=mation sy/ems & me*aniz$ v]ification & in=mation retrieval sy/ems 7relat$ to eligibility74 7#e7 ,paym5t ( am\nts 7,a7 ,9 g5]al ,except z ! ,secret>y may o!rwise provide1 am\nts %all be payable to a ,/ate "u ?is subsection 9 ! same mann] z am\nts are payable "u subsection 7d7 ( section #aijc to a ,/ate "u subsection 7a7 ( su* section4 7,b7 ,in=mation & =ms 7i7 ,submission ,z a condition ( receiv+ paym5t "u ?is subsection1 a ,/ate %all submit su* in=mation1 9 su* =m1 & mann]1 z ! ,secret>y %all specify1 includ+ in=mation necess>y to make ! computations "u subsections 7c77#b77;,c7 & 7e74 7ii7 ,uni=m report+ ,! ,secret>y %all develop su* =ms z may be ne$$ to assure a sy/em ( uni=m report+ ( su* in=mation across ,/ates4 7,c7 ,requir$ report+ ( in=mation on m$ical loss ratios = manag$ c>e ,! in=mation requir$ to be report$ "u subp>agraph 7,b77i7 %all include in=mation on ! m$ical loss ratio ) respect to cov]age provid$ "u ea* ,m$icaid manag$ c>e plan ) a contract ) ! ,/ate "u section #aijc7m7 or #aicb4 7b7 ,aggregate b5efici>y-,bas$ am\nt 7#a7 ,9 g5]al ,! aggregate b5efici>y-bas$ am\nt specifi$ 9 ?is subsection = a ,/ate = a qu>t] is equal to ! sum ( ! products1 = ea* ( ! categories ( ,m$icaid b5efici>ies specifi$ 9 p>agraph 7#b71 ( ! foll[+3 7,a7 ,b5efici>y-bas$ qu>t]ly am\nt ,! b5efici>y-bas$ qu>t]ly am\nt = su* category comput$ "u subsection 7c7 = su* ,/ate = su* qu>t]4 7,b7 ,numb] ( individuals 9 category ,subject to subsection 7d71 ! av]age numb] ( ,m$icaid b5efici>ies enroll$ 9 su* category 9 ! ,/ate 9 su* qu>t]4 7#b7 ,categories ,! categories specifi$ 9 ?is p>agraph are ! foll[+3 7,a7 ,eld]ly ,a category ( ,m$icaid b5efici>ies :o are #fe ye>s ( age or old]4 7,b7 ,bl9d or disabl$ ,a category ( ,m$icaid b5efici>ies n describ$ 9 subp>agraph 7,a7 :o are describ$ 9 section #aicg7;a77#b77;,b77ii74 7,c7 ,*ildr5 ,a category ( ,m$icaid b5efici>ies n describ$ 9 subp>agraph 7,b7 :o are "u #ba ye>s ( age4 7,d7 ,o!r adults ,a category ( any ,m$icaid b5efici>ies :o are n describ$ 9 a previ\s subp>agraph ( ?is p>agraph4 7c7 ,computation ( p] b5efici>y1 p] category qu>t]ly am\nt 7#a7 ,9 g5]al ,= a ,/ate1 = ea* category ( b5efici>y = a qu>t]-- 7,a7 ,fir/ re=m ye> ,= qu>t]s 9 ! fir/ re=m ye> 7z def9$ 9 subsection 7k77#b771 ! b5efici>y-bas$ qu>t]ly am\nt is equal to #a_/d ( ! base av]age p] b5efici>y ,f$]al paym5ts = su* ,/ate = su* category det]m9$ "u p>agraph 7#b71 increas$ by a factor t reflects ! sum ( ! foll[+3 7i7 ,hi/orical m$ical c>e compon5t ( ,,cpi ?r\gh previ\s re=m ye> ,! p]c5tage increase 9 ! hi/orical m$ical c>e compon5t ( ! ,consum] ,price ,index = all urban consum]s 7,u4,s4 city av]age7 f ! midpo9t ( ! base fiscal ye> 7z def9$ 9 p>agraph 7#f77 to ! midpo9t ( ! fiscal ye> prec$+ ! fir/ re=m ye>4 7ii7 ,project$ m$ical c>e compon5t ( ,,cpi = ! fir/ re=m ye> ,! p]c5tage increase 9 ! project$ m$ical c>e compon5t ( ! ,consum] ,price ,index = all urban consum]s 7,u4,s4 city av]age7 f ! midpo9t ( ! previ\s fiscal ye> ref]r$ to 9 clause 7i7 to ! midpo9t ( ! fir/ re=m ye>4 7,b7 ,second & ?ird re=m ye>s ,! b5efici>y-bas$ qu>t]ly am\nt = a ,/ate = a category = qu>t]s 9 ! second re=m ye> or ! ?ird re=m ye> is equal to ! b5efici>y-bas$ qu>t]ly am\nt "u ?is p>agraph = su* ,/ate & category = ! previ\s re=m ye> increas$ by ! p] b5efici>y p]c5tage increase 7z def9$ 9 subp>agraph 7,e77 = su* category & re=m ye>4 7,c7 ,f\r? ?r\gh t5? re=m ye>s ,! b5efici>y-bas$ qu>t]ly am\nt = a ,/ate = a category = qu>t]s 9 a re=m ye> beg9n+ ) ! f\r? re=m ye> & end+ ) ! t5? re=m ye> is-- 7i7 9 ! case ( a ,/ate t is a high p] b5efici>y ,/ate or a l[ p] b5efici>y ,/ate 7z def9$ 9 p>agraph 7#d77;,b77iii77 = ! category1 ! am\nt det]m9$ "u clause 7i7 or 7ii7 ( p>agraph 7#d77;,b7 = su* ,/ate1 category1 & re=m ye>2 or 7ii7 9 ! case ( any o!r ,/ate1 ! b5efici>y-bas$ qu>t]ly am\nt "u ?is p>agraph = su* ,/ate & category = ! previ\s re=m ye> increas$ by ! p] b5efici>y p]c5tage increase = su* category & re=m ye>4 7,d7 ,elev5? re=m ye> & subsequ5t re=m ye>s ,! b5efici>y-bas$ qu>t]ly am\nt = a ,/ate = a category = qu>t]s 9 a re=m ye> beg9n+ ) ! elev5? re=m ye> is equal to ! b5efici>y-bas$ qu>t]ly am\nt "u ?is p>agraph = su* ,/ate & category = ! previ\s re=m ye> increas$ by ! p] b5efici>y p]c5tage increase = su* category & re=m ye>4 7,e7 ,annual p]c5tage increase beg9n+ ) second re=m ye> ,= purposes ( ?is subsection1 ! t]m p] b5efici>y p]c5tage increase means1 = a re=m ye>1 ! sum (-- 7i7 ! project$ p]c5tage *ange_/increase1 if any1 9 nom9al gross dome/ic product f ! midpo9t ( ! previ\s re=m ye> to ! midpo9t ( ! re=m ye> = :i* ! p]c5tage increase is be+ appli$2 & 7ii7 "o p]c5tage po9t4 7#b7 ,base p] b5efici>y1 p] category am\nt = ea* ,/ate 7,a7 ,av]age p] category 7i7 ,9 g5]al ,! ,secret>y %all det]m9e1 consi/5t ) ?is p>agraph & p>agraph 7#c71 a base p] b5efici>y1 p] category am\nt = ea* ( ! #ej ,/ates & ! ,di/rict ( ,columbia equal to ! av]age am\nt1 p] ,m$icaid b5efici>y1 ( ,f$]al paym5ts "u ?is title1 includ+ paym5ts attributable to disproportionate %>e hospital paym5ts "u section #aibc1 = ea* ( ! categories ( b5efici>ies "u subsection 7b77#b7 = ! base fiscal ye> = ea* ( ! #ej ,/ates & ! ,di/rict ( ,columbia4 7ii7 ,be/ available data ,! det]m9ation "u clause 7i7 %all initially be e/imat$ by ! ,secret>y1 bas$ ^u ! be/ available data at ! "t ! det]m9ation is made4 7iii7 ,updates ,! det]m9ation "u clause 7i7 %all be updat$ by ! ,secret>y on an annual basis bas$ ^u improv$ data4 ,! ,secret>y %all adju/ ! am\nts "u subsection 7a77#a77;,a7 to reflect *anges 9 ! am\nts s det]m9$ bas$ on su* updates4 7,b7 ,exclusion ( pass-?r\gh paym5ts ,9 comput+ base p] b5efici>y1 p] category am\nts "u subp>agraph 7,a77i7 ! ,secret>y %all exclude paym5ts describ$ 9 subsection 7a77#d74 7,c7 ,/&>dization 7i7 ,9 g5]al ,9 comput+ ea* su* am\nt1 ! ,secret>y %all /&>dize ! am\nt 9 ord] to remove ! v>iation attributable to ! foll[+3 7,i7 ,risk factors ,su* risk factors z age1 heal? & disability /atus 7includ+ high co/ m$ical conditions71 g5d]1 in/itutional /atus1 & su* o!r factors z ! ,secret>y det]m9es to be appropriate1 s z to ensure actu>ial equival5ce4 7,,ii7 ,geographic ,v>iations 9 co/s on a c\nty-by-c\nty basis4 7ii7 ,me?od ( /&>dization 7,i7 ,consultation 9 developm5t ( risk /&>dization ,9 develop+ ! me?odology = risk /&>dization = purposes ( clause 7i77,i71 ! ,secret>y %all consult ) ! ,m$icaid & ,,*ip ,paym5t & ,access ,commission1 ! ,m$ic>e ,paym5t ,advisory ,commission1 & ! ,national ,association ( ,m$icaid ,directors4 7,,ii7 ,me?od = risk /&>dization ,9 c>ry+ out clause 7i77,i71 ! ,secret>y may apply ! hi]>*al condition category me?odology "u section #ahec7;a77#a77;,c74 ,if ! ,secret>y uses su* me?odology1 ! ,secret>y %all adju/ ! application ( su* me?odology to take into acc\nt ! diff]5ces 9 s]vices provid$ "u ?is title comp>$ to title ,,xviii1 su* z ! cov]age ( long-t]m c>e1 pregnancy1 & p$iatric s]vices4 7,,iii7 ,me?od = geographic /&>dization ,! ,secret>y %all apply ! /&>dization "u clause 7i77,,ii7 9 a mann] simil> to t appli$ "u section #ahec7;c77#d77;,a77iii74 7iii7 ,application on a national1 budget neutral basis ,! /&>dization "u clause 7i7 %all be design$ & implem5t$ on a uni=m national basis & %all be budget neutral s z to n result 9 any aggregate *ange 9 paym5ts "u subsection 7a74 7iv7 ,response to new risk ,subject to clause 7iii71 ! ,secret>y may adju/ ! /&>dization "u clause 7i7 to respond promptly to new in/ances ( communicable diseases & o!r public heal? haz>ds4 7v7 ,ref]5ce to application ( risk adju/m5t ,= rules relat$ to ! application ( risk adju/m5t to am\nts "u subsection 7a77#a77;,a71 see subsection 7e74 7,d7 ,adju/m5t = tempor>y ,,fmap increases ,9 comput+ ea* base p] b5efici>y1 p] category am\nts "u subp>agraph 7,a77i7 ! ,secret>y %all disreg>d portions ( paym5ts t are attributable to a tempor>y increase 9 ! ,f$]al mat*+ rates1 includ+ ^? attributable to ! foll[+3 7i7 ,,ppaca disa/] ,,fmap ,section #aije7;aa74 7ii7 ,,arra ,section #ejja ( ! ,am]ican ,recov]y & ,re9ve/m5t ,act ( #bjji 7#db ,u4,s4,c4 #acif;d note74 7iii7 ,extraord9>y employ] p5sion contribution ,section #fad ( ! ,*ildr5's ,heal? ,insurance ,program ,reau?orization ,act ( #bjji 7#db ,u4,s4,c4 #acif;d note74 7#c7 ,allocation ( nonm$ical assi/ance paym5ts ,! ,secret>y %all e/abli% rules = ! allocation ( paym5ts "u ?is title 7o!r ?an ^? paym5ts describ$ 9 p>agraph 7#a7 or 7#e7 ( section #aijc7;a7 & includ+ su* paym5ts attributable to section #aibc7-- 7,a7 among diff]5t categories ( b5efici>ies2 & 7,b7 betwe5 paym5ts includ$ "u subsection 7a77#a7 & paym5ts describ$ 9 subsection 7a77#d74 7#d7 ,transition to a corridor ar\nd ! national av]age 7,a7 ,det]m9ation ( national av]age base p] b5efici>y1 p] category am\nt ,subject to subp>agraph 7,c71 ! ,secret>y %all det]m9e a national av]age base p] b5efici>y1 p] category am\nt equal to ! av]age ( ! base p] b5efici>y1 p] category am\nts = ea* ( ! #ej ,/ates & ! ,di/rict ( ,columbia det]m9$ "u p>agraph 7#b71 weight$ by ! av]age numb] ( b5efici>ies 9 ea* su* category & ,/ate z det]m9$ by ! ,secret>y consi/5t ) subsection 7d7 = ! base fiscal ye>4 7,b7 ,transition adju/m5t 7i7 ,high p] b5efici>y /ates ,9 ! case ( a high p] b5efici>y ,/ate 7z def9$ 9 clause 7iii77,i77 = a category1 ! b5efici>y-bas$ qu>t]ly am\nt = su* ,/ate & category = a qu>t] 9 a re=m ye> 7beg9n+ ) ! f\r? re=m ye> & end+ ) ! t5? re=m ye>7 is equal to ! sum (-- 7,i7 ! product ( ! ,/ate-specific factor = su* re=m ye> 7z def9$ 9 clause 7iv77 & ! b5efici>y-bas$ qu>t]ly am\nt t w\ld o!rwise be det]m9$ "u p>agraph 7#a7 = su* ,/ate & category if ! ,/ate 7 a ,/ate describ$ 9 clause 7ii7 ( p>agraph 7#a77;,c71 in/ead ( a ,/ate describ$ 9 clause 7i7 ( su* p>agraph2 & 7,,ii7 ! product ( #a m9us ! ,/ate-specific factor = su* re=m ye> & ! b5efici>y-bas$ qu>t]ly am\nt t w\ld o!rwise be det]m9$ "u p>agraph 7#a7 = a ,/ate & category if ! base p] b5efici>y1 p] category am\nt det]m9$ "u p>agraph 7#b7 = ! ,/ate & category 7 equal to #aaj p]c5t ( ! national av]age base p] b5efici>y1 p] category am\nt det]m9$ "u subp>agraph 7,a7 = su* category4 7ii7 ,l[ p] b5efici>y /ates ,9 ! case ( a l[ p] b5efici>y ,/ate 7z def9$ 9 clause 7iii77,,ii77 = a category1 ! b5efici>y-bas$ qu>t]ly am\nt = su* ,/ate & category = a qu>t] 9 a re=m ye> 7beg9n+ ) ! f\r? re=m ye> & end+ ) ! t5? re=m ye>7 is equal to ! sum (-- 7,i7 ! product ( ! ,/ate-specific factor = su* re=m ye> & ! b5efici>y-bas$ qu>t]ly am\nt t w\ld o!rwise be det]m9$ "u p>agraph 7#a7 = su* ,/ate & category if ! ,/ate 7 a ,/ate describ$ 9 clause 7ii7 ( p>agraph 7#a77;,c71 in/ead ( a ,/ate describ$ 9 clause 7i7 ( su* p>agraph2 & 7,,ii7 ! product ( #a m9us ! ,/ate-specific factor = su* re=m ye> & ! b5efici>y-bas$ qu>t]ly am\nt t w\ld o!rwise be det]m9$ "u p>agraph 7#a7 = a ,/ate & category if ! base p] b5efici>y1 p] category am\nt det]m9$ "u p>agraph 7#b7 = ! ,/ate & category 7 equal to #ij p]c5t ( ! national av]age base p] b5efici>y1 p] category am\nt det]m9$ "u subp>agraph 7,a7 = su* category4 7iii7 ,high & l[ p] b5efici>y ,/ates def9$ ,9 ?is subp>agraph3 7,i7 ,high p] b5efici>y ,/ate ,! t]m high p] b5efici>y ,/ate means1 ) respect to a category1 a ,/ate = :i* ! base p] b5efici>y1 p] category am\nt det]m9$ "u p>agraph 7#b7 = su* category is great] ?an #aaj p]c5t ( ! national av]age base p] b5efici>y1 p] category am\nt det]m9$ "u subp>agraph 7,a7 = su* category4 7,,ii7 ,l[ p] b5efici>y ,/ate ,! t]m l[ p] b5efici>y ,/ate means1 ) respect to a category1 a ,/ate = :i* ! base p] b5efici>y1 p] category am\nt det]m9$ "u p>agraph 7#b7 = su* category is less ?an #ij p]c5t ( ! national av]age base p] b5efici>y1 p] category am\nt det]m9$ "u subp>agraph 7,a7 = su* category4 7iv7 ,/ate-specific factor ,9 ?is subp>agraph1 ! t]m ,/ate-specific factor means-- 7,i7 = ! f\r? re=m ye>1 #g_/h2 & 7,,ii7 = a subsequ5t re=m ye>1 ! ,/ate-specific factor "u ?is clause = ! previ\s re=m ye> m9us #a_/h4 7,c7 ,no additional exp5ditures 7i7 ,det]m9ation ( increase 9 ,f$]al exp5ditures ,= ea* category = ea* re=m ye> 7beg9n+ ) ! f\r? re=m ye> & end+ ) ! t5? re=m ye>71 ! ,secret>y %all det]m9e :e!r ! application ( ?is p>agraph-- 7,i7 to ! category = ! re=m ye> w result 9 an aggregate increase 9 ! aggregate ,f$]al exp5ditures "u subsection 7a72 & 7,,ii7 to all ! categories = ! re=m ye> w result 9 a net aggregate increase 9 ! aggregate ,f$]al exp5ditures "u subsection 7a74 7ii7 ,adju/m5t ,if ! ,secret>y det]m9es "u clause 7i77,,ii7 t ! application ( ?is p>agraph to all ! categories = a re=m ye> w result 9 a net aggregate increase 9 ! aggregate ,f$]al exp5ditures "u subsection 7a71 ! ,secret>y %all r$uce ! national av]age base p] b5efici>y1 p] category am\nt comput$ "u subp>agraph 7,a7 = ea* ( ! categories det]m9$ "u clause 7i77,i7 = :i* !re w be an aggregate increase 9 ! aggregate ,f$]al exp5ditures "u subsection 7a7 by su* uni=m p]c5tage z w ensure t !re is no net aggregate ,f$]al exp5diture increase describ$ 9 clause 7i77,,ii7 = ! re=m ye>4 7#e7 ,reports on p] b5efici>y rates2 appeals 7,a7 ,report to /ates ,n lat] ?an #h mon?s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all submit to ea* ,/ate ! ,secret>y's initial det]m9ation (-- 7i7 ! base p] b5efici>y1 p] category am\nts "u p>agraph 7#b7 = su* ,/ate2 & 7ii7 ! national av]age base p] b5efici>y1 p] category am\nts "u p>agraph 7#d77;,a74 7,b7 ,opportunity to appeal ,n lat] ?an #c mon?s aft] ! date a ,/ate receives notice ( ! ,secret>y's initial det]m9ation ( su* base p] b5efici>y1 p] category am\nts = su* ,/ate "u subp>agraph 7,a77i71 ! ,/ate may file ) ! ,secret>y1 9 a =m & mann] specifi$ by ! ,secret>y1 an appeal ( su* det]m9ation4 7,c7 ,det]m9ation on appeal ,n lat] ?an #c mon?s aft] receiv+ su* an appeal1 ! ,secret>y %all make a f9al det]m9ation on su* am\nts = su* ,/ate4 ,if no su* appeal is receiv$ = a ,/ate1 ! ,secret>y's initial det]m9ation "u subp>agraph 7,a77i7 %all become f9al4 7#f7 ,base fiscal ye> def9$ ,9 ?is section1 ! t]m base fiscal ye> means ! late/ fiscal ye>1 end+ be=e ! date ( ! enactm5t ( ?is section1 = :i* ! ,secret>y det]m9es t adequate data are available to make ! computations requir$ "u ?is subsection4 7d7 ,n c\nt+ individuals ,to acc\nt = exclud$ paym5ts ,"u rules specifi$ by ! ,secret>y1 individuals %all n be c\nt$ z ,m$icaid b5efici>ies = purposes ( subsection 7b77#a77;,b7 & subsection 7c77#b77;,a7 9 proportion to ! ext5t t su* individuals are receiv+ m$ical assi/ance = :i* paym5ts describ$ "u subsection 7a77#d77;,a7 are made4 7e7 ,risk ,adju/m5t 7#a7 ,9 g5]al ,! am\nt "u subsection 7a77#a77;,a7 %all be adju/$ "u ?is subsection 9 an appropriate mann]1 specifi$ by ! ,secret>y & consi/5t ) p>agraph 7#b71 to take into acc\nt-- 7,a7 ! factors describ$ 9 subsection 7c77#b77;,c77i77,i7 )9 a category ( b5efici>ies2 & 7,b7 v>iations 9 co/s on a c\nty-by-c\nty basis = m$ical assi/ance & adm9i/rative exp5ses4 7#b7 ,me?od ( adju/m5t 7,a7 ,9 g5]al ,! adju/m5ts "u p>agraph 7#a7 %all be made 9 a mann] simil> to ! mann] 9 :i* simil> adju/m5ts are made "u subsection 7c77#b77;,c7 & consi/5t ) ! requirem5ts ( clause 7iii7 ( su* subsection & subp>agraph 7,b74 7,b7 ,biannual update ( risk adju/m5t me?odology ,9 apply+ clause 7i77,i7 ( subsection 7c77#b77;,c7 = purposes ( subp>agraph 7,a71 ! ,secret>y %all1 9 consultation ) ! entities describ$ 9 clause 7ii77,i7 ( su* subsection1 update ! risk adju/m5t me?odology appli$ z appropriate n less (t5 ?an e #b ye>s4 7f7 ,*ronic c>e quality bonus paym5ts 7#a7 ,det]m9ation ( bonus paym5ts ,if ! ,secret>y det]m9es t1 bas$ on ! reports "u p>agraph 7#e71 ) respect to categories ( *ronic disease = :i* *ronic c>e p]=mance t>gets _h be5 e/abli%$ "u p>agraph 7#c7 = ea* category ( ,m$icaid b5efici>ies specifi$ "u subsection 7b77#b7 su* t>gets h be5 met by a ,/ate = a re=m ye>1 ! ,secret>y %all make an additional paym5t to su* ,/ate 9 ! am\nt specifi$ 9 p>agraph 7#f7 = ea* qu>t] 9 ! succe$+ re=m ye>4 ,su* paym5ts %all be made 9 a mann] specifi$ by ! ,secret>y & may only be us$ consi/5t ) subsection 7a77#c74 7#b7 ,id5tification ( categories ( *ronic disease ,! ,secret>y %all det]m9e ! categories ( *ronic disease = :i* bonus paym5ts may be available "u ?is subsection = ea* category ( ,m$icaid b5efici>ies4 7#c7 ,adoption ( quality measurem5t sy/em & id5tification ( p]=mance t>gets 7,a7 ,sy/em & data ,) respect to ! categories ( *ronic disease "u p>agraph 7#b71 ! ,secret>y %all adopt a quality measurem5t sy/em t uses data describ$ 9 p>agraph 7#d7 & is simil> to ! ,five-,/> ,quality ,rat+ ,sy/em us$ to indicate ! p]=mance ( ,m$ic>e ,advantage plans "u "p ,c ( title ,,xviii4 7,b7 ,t>gets ,us+ su* sy/em & data1 ! ,secret>y %all e/abli% = ea* re=m ye> ! *ronic c>e p]=mance t>gets = purposes ( ! paym5ts "u p>agraph 7#a74 ,su* p]=mance t>gets %all be e/abli%$ 9 consultation ) ,/ates1 associations repres5t+ individuals ) *ronic illnesses1 entities provid+ treatm5t to su* individuals = su* *ronic illnesses1 & o!r /akehold]s1 includ+ ! ,national ,association ( ,m$icaid ,directors & ! ,national ,gov]nors ,association4 7#d7 ,data to be us$ ,! data to be us$ "u p>agraph 7#c7 %all include-- 7,a7 data collect$ ?r\gh me?ods su* z-- 7i7 ! ,heal?c>e ,effectiv5ess ,data & ,in=mation ,set 7also kn[n z ,,h$is7 7or an appropriate successor p]=mance measurem5t tool72 7ii7 ! ,consum] ,assessm5t ( ,heal?c>e ,provid]s & ,sy/ems 7also kn[n z ,,cahps7 7or an appropriate successor p]=mance measurem5t tool72 & 7iii7 ! ,heal? ,outcomes ,survey 7also kn[n z ,,hos7 7or an appropriate successor p]=mance measurem5t tool72 & 7,b7 o!r data collect$ by ! ,/ate4 7#e7 ,reports 7,a7 ,9 g5]al ,ea* ,/ate %all collect1 analyze1 & report to ! ,secret>y1 at a frequ5cy & 9 a mann] to be e/abli%$ by ! ,secret>y1 data describ$ 9 p>agraph 7#d7 t p]mit ! ,secret>y to monitor ! ,/ate's p]=mance relative to ! *ronic c>e p]=mance t>gets e/abli%$ "u p>agraph 7#c74 7,b7 ,review & v]ification ,! ,secret>y may review ! data collect$ by ! ,/ate "u subp>agraph 7,a7 to v]ify ! ,/ate's analysis ( su* data ) respect to ! p]=mance t>gets "u p>agraph 7#c74 7#f7 ,am\nt ( bonus paym5ts 7,a7 ,9 g5]al ,subject to subp>agraphs 7,b7 & 7,c71 ) respect to ea* category ( ,m$icaid b5efici>ies1 9 ! case ( a ,/ate t ! ,secret>y det]m9es1 bas$ on ! *ronic c>e p]=mance t>gets set "u p>agraph 7#c7 = a re=m ye> = su* category1 p]=ms-- 7i7 9 ! top five ,/ates 9 su* category1 subject to subp>agraph 7,c77ii71 ! am\nt ( ! bonus = ea* qu>t] 9 ! succe$+ re=m ye> %all be #aj p]c5t ( ! paym5t am\nt o!rwise paid to ! ,/ate "u subsection 7a7 = individuals enroll$ "u ! plan )9 su* category2 7ii7 9 ! next five ,/ates 9 su* category1 subject to subp>agraph 7,c77ii71 ! am\nt ( ! bonus = ea* su* qu>t] %all be #e p]c5t ( ! paym5t am\nt o!rwise paid to ! ,/ate "u subsection 7a7 = individuals enroll$ "u ! plan )9 su* category2 7iii7 9 ! next five ,/ates 9 su* category1 subject to clauses 7i7 & 7iii7 ( subp>agraph 7,c71 ! am\nt ( ! bonus = ea* su* qu>t] %all be #c p]c5t ( ! paym5t am\nt o!rwise paid to ! ,/ate "u subsection 7a7 = individuals enroll$ "u ! plan )9 su* category2 7iv7 9 ! next five ,/ates 9 su* category1 subject to clauses 7i7 & 7iii7 ( subp>agraph 7,c71 ! am\nt ( ! bonus = ea* su* qu>t] %all be #b p]c5t ( ! paym5t am\nt o!rwise paid to ! ,/ate "u subsection 7a7 = individuals enroll$ "u ! plan )9 su* category2 & 7v7 9 ! next five ,/ates 9 su* category1 subject to clauses 7i7 & 7iii7 ( subp>agraph 7,c71 ! am\nt ( ! bonus = ea* su* qu>t] %all be #a p]c5t ( ! paym5t am\nt o!rwise paid to ! ,/ate "u subsection 7a7 = individuals enroll$ "u ! plan )9 su* category4 7,b7 ,aggregate annual limit = ea* category ( ,m$icaid b5efici>ies 7i7 ,9 g5]al ,9 no case may ! aggregate am\nt ( bonuses "u ?is subsection = qu>t]s 9 a re=m ye> = a category ( ,m$icaid b5efici>ies exce$ ! limit specifi$ 9 clause 7ii7 = ! re=m ye>4 7ii7 ,limit ,! limit specifi$ 9 ?is clause-- 7,i7 = ! second re=m ye> is equal to #bej1jjj1jjj2 or 7,,ii7 = a subsequ5t re=m ye> is equal to ! limit specifi$ 9 ?is clause = ! previ\s re=m ye> increas$ by ! p] b5efici>y p]c5tage increase det]m9$ "u p>agraph 7#a77;,e7 ( subsection 7c74 7,c7 ,limitation & proration ( bonuses bas$ on application ( aggregate limit 7i7 ,no bonus = ?ird or subsequ5t ti]s unless aggregate limit n rea*$ on fir/ two ti]s ,no bonus %all be payable "u clause 7iii71 7iv71 or 7v7 ( subp>agraph 7,a7 = a category ( ,m$icaid b5efici>ies = a qu>t] 9 a re=m ye> unless ! aggregate am\nt ( bonuses "u clauses 7i7 & 7ii7 ( su* subp>agraph = su* category & re=m ye> is less ?an ! limit specifi$ 9 subp>agraph 7,b77ii7 = ! re=m ye>4 7ii7 ,proration = fir/ two ti]s ,if ! aggregate am\nt ( bonuses "u clauses 7i7 & 7ii7 ( subp>agraph 7,a7 = a category ( ,m$icaid b5efici>ies = qu>t]s 9 a re=m ye> exce$s ! limit specifi$ 9 subp>agraph 7,b77ii7 = ! re=m ye>1 ! am\nt ( ea* su* bonus %all be prorat$ 9 a mann] s ! aggregate am\nt ( su* bonuses is equal to su* limit4 7iii7 ,proration = next ?ree ti]s ,if ! aggregate am\nt ( bonuses "u clauses 7i7 & 7ii7 ( subp>agraph 7,a7 = a category ( ,m$icaid b5efici>ies = qu>t]s 9 a re=m ye> is less ?an ! limit specifi$ 9 subp>agraph 7,b77ii7 = ! re=m ye>1 b ! aggregate am\nt ( bonuses "u clauses 7i7 ?r\gh 7v7 ( subp>agraph 7,a7 = ! category & su* qu>t]s 9 ! re=m ye> exce$s ! limit specifi$ 9 subp>agraph 7,b77ii7 = ! re=m ye>1 ! am\nt ( ea* bonus 9 clauses 7iii71 7iv71 & 7v7 ( subp>agraph 7,a7 %all be prorat$ 9 a mann] s ! aggregate am\nt ( all ! bonuses "u subp>agraph 7,a7 is equal to su* limit4 7g7 ,/ate option = receiv+ ,m$ic>e paym5ts = full-,b5efit dual eligible individuals 7#a7 ,9 g5]al ,"u ?is subsection a ,/ate may elect = qu>t]s beg9n+ on or aft] ! implem5tation date 9 a re=m ye> to receive paym5t f ! ,secret>y "u p>agraph 7#c74 ,z a condition ( receiv+ su* paym5t1 ! ,/ate %all agree to provide to full-b5efit dual eligible individuals eligible = m$ical assi/ance "u ! ,/ate plan-- 7,a7 ! m$ical assi/ance to :i* su* eligible individuals w\ld o!rwise be entitl$ "u ?is title2 & 7,b7 any items & s]vices :i* su* eligible individuals w\ld o!rwise receive "u title ,,xviii4 7#b7 ,provid] paym5t requirem5t 7,a7 ,9 g5]al ,a ,/ate elect+ ! option "u ?is subsection %all provide paym5t to heal? c>e provid]s = ! items & s]vices describ$ "u p>agraph 7#a77;,b7 at a rate t is n less ?an ! rate at :i* paym5ts w\ld be made to su* provid]s = su* items & s]vices "u title ,,xviii4 7,b7 ,flexibility 9 paym5t me?ods ,no?+ 9 subp>agraph 7,a7 %all be con/ru$ z prev5t+ a ,/ate f us+ alt]native paym5t me?odologies 7su* z bundl$ paym5ts or ! use ( acc\ntable c>e organizations 7z su* t]m is us$ 9 section #ahii77 = purposes ( mak+ paym5ts to heal? c>e provid]s = items & s]vices provid$ to dual eligible individuals 9 ! ,/ate "u ! option "u ?is subsection4 7#c7 ,paym5ts to ,/ates 9 lieu ( ,m$ic>e paym5ts ,) respect to a full-b5efit dual eligible individual1 9 ! case ( a ,/ate t elects ! option "u p>agraph 7#a7 = qu>t]s 9 a re=m ye>-- 7,a7 ! ,secret>y %all n make any paym5t "u title ,,xviii = items & s]vices furni%$ to su* individual = su* qu>t]s2 & 7,b7 ! ,secret>y %all pay to ! ,/ate1 9 addition to ! am\nts paid to su* ,/ate "u subsection 7a71 ! am\nt t ! ,secret>y w\ld1 b = ?is subsection1 o!rwise pay "u title ,,xviii = items & s]vices furni%$ to su* an individual 9 su* ,/ate = su* qu>t]s4 7#d7 ,full-b5efit dual eligible individual def9$ ,9 ?is subsection1 ! t]m full-b5efit dual eligible individual means an individual :o meets ! requirem5ts ( section #aice7;c77#f77;,a77ii74 7h7 ,audits ,! ,secret>y %all conduct su* audits on ! numb] & classification ( ,m$icaid b5efici>ies "u su* subsections & exp5ditures "u ?is section z may be necess>y to ensure appropriate paym5ts "u ?is section4 7i7 ,treatm5t ( waiv]s 7#a7 ,no impact on curr5t waiv]s ,9 ! case ( a waiv] ( requirem5ts ( ?is title pursuant to section #aaae or o!r law t is 9 effect z ( ! date ( ! enactm5t ( ?is section1 no?+ 9 ?is section %all be con/ru$ to affect su* waiv] = ! p]iod ( ! waiv] z approv$ z ( su* date4 7#b7 ,application ( budget neutrality to subsequ5t waiv]s & r5ewals tak+ section into acc\nt ,9 ! case ( a waiv] ( requirem5ts ( ?is title pursuant to section #aaae or o!r law t is approv$ or r5ew$ aft] ! date ( ! enactm5t ( ?is section1 to ! ext5t t su* approval or r5ewal is condition$ ^u a demon/ration ( budget neutrality1 budget neutrality %all be det]m9$ tak+ into acc\nt ! application ( ?is section4 7j7 ,report to ,congress ,n lat] ?an ,janu>y #a ( ! second re=m ye>1 ! ,secret>y %all submit to ,congress a report on ! implem5tation ( ?is section4 7k7 ,def9itions ,9 ?is section3 7#a7 ,implem5tation date ,! t]m implem5tation date means-- 7,a7 ,july #a1 #bjag1 if ?is section is enact$ on or be=e ,july #a1 #bjaf2 or 7,b7 ,july #a1 #bjah1 if ?is section is enact$ aft] ,july #a1 #bjaf4 7#b7 ,re=m ye>s 7,a7 ,! t]m re=m ye> means a fiscal ye> beg9n+ ) ! fir/ re=m ye>4 7,b7 ,! t]m fir/ re=m ye> means ! fiscal ye> 9 :i* ! implem5tation date occurs4 7,c7 ,! t]ms second1 ?ird1 & successive simil> t]ms mean1 ) respect to a re=m ye>1 ! second1 ?ird1 or successive re=m ye>1 respectively1 succe$+ ! fir/ re=m ye>4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,cont9u$ application ( clawback provisions 7,a7 ,cont9u$ application ,subsections 7a7 & 7c77#a77;,c7 ( section #aice ( su* ,act 7#db ,u4,s4,c4 #acifu-#e7 are ea* am5d$ by ins]t+ or #aijc;,a7a7 aft] #aijc7;a74 7,b7 ,te*nical am5dm5t ,section #aice7;d77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;d77#a77 is am5d$ by ins]t+ except z provid$ 9 section #aijc;,a7g7 aft] any o!r provision ( ?is title4 7#b7 ,paym5t rules "u section #aijc 7,a7 ,section #aijc7;a7 ( su* ,act 7#db ,u4,s4,c4 #acif;b7a77 is am5d$1 9 ! matt] be=e p>agraph 7#a71 by ins]t+ & section #aijc;,a aft] except z o!rwise provid$ 9 ?is section4 7,b7 ,section #aijc7;d7 ( su* ,act 7#db ,u4,s4,c4 #acif;b7d77 is am5d$-- 7i7 9 p>agraph 7#a71 by ins]t+ & "u section #aijc;,a aft] subsections 7a7 & 7b72 7ii7 9 p>agraph 7#b7-- 7,i7 9 subp>agraph 7,a71 by ins]t+ or section #aijc;,a aft] 0 made "u ?is section2 & 7,,ii7 9 subp>agraph 7,b71 by ins]t+ or section #aijc;,a aft] "u subsection 7a72 7iii7 9 p>agraph 7#d7-- 7,i7 by /rik+ "u ?is subsection & ins]t+ 1 ) respect to ?is section or section #aijc;,a1 "u ?is subsection2 & 7,,ii7 by /rik+ "u ?is section & ins]t+ "u ! respective section2 & 7iv7 9 p>agraph 7#e71 by ins]t+ or section #aijc;,a aft] ov]paym5t "u ?is section4 7#c7 ,con=m+ waiv] au?ority ,section #aaae7;a77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae7;a77#b77;,a77 is am5d$ by /rik+ or #aijc & ins]t+ #aijc1 or #aijc;,a4 7#d7 ,report on additional con=m+ am5dm5ts ne$$ ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ,congress a report t includes a description ( any additional te*nical & con=m+ am5dm5ts to law t are requir$ to prop]ly c>ry out ?is ,act4 ,v ,increas+ ,price ,transp>5cy & ,fre$om ( ,practice #eja4 ,ensur+ access to em]g5cy s]vices )\t excessive *>ges = out-(-network s]vices 7a7 ,9 g5]al ,section #ahfg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd7 is am5d$-- 7#a7 9 subsection 7d71 by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,en=cem5t ) respect to excessive *>ges ,a hospital1 physician1 or o!r entity t violates ! requirem5ts ( subsection 7j77#a7 ) respect to ! furni%+ ( items & s]vices is subject to a civil money p5alty ( n m ?an #be1jjj = ea* su* violation4 ,! provisions ( section #aabh;,a 7o!r ?an subsections 7a7 & 7b77 %all apply to a civil money p5alty "u ?is p>agraph 9 ! same mann] z su* provisions apply ) respect to a p5alty or proce$+ "u section #aabh;,a7a74 2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7j7 ,protections aga9/ excessive out-(-,network *>ges = em]g5cy s]vices 7#a7 ,9 g5]al ,if items or s]vices to scre5 or treat an em]g5cy m$ical condition are furni%$ "u ?is section 9 a p>ticipat+ hospital ) respect to an individual & ! individual has n1 directly or ?r\gh a heal? insurance issu]1 gr\p heal? plan1 or o!r ?ird p>ty1 negotiat$ a paym5t rate = su* items & s]vices1 subject to p>agraph 7#b71 ! *>ges impos$ = su* items & s]vices may n be 9 excess ( ! foll[+3 7,a7 ,physicians' & o!r pr(essional s]vices ,= physicians' s]vices or s]vices ( a heal? c>e provid] to :i* section #bbc7;f77#i7 ( ! ,int]nal ,rev5ue ,code ( #aihf applies 7& includ+ drugs & biologicals furni%$ 9 conjunction ) & bill$ z "p ( su* s]vices71 ! less] (-- 7i7 ! ca% price = su* s]vices po/$ pursuant to su* section2 or 7ii7 #he p]c5t ( ! usual1 cu/om>y1 & reasonable 7,,ucr7 *>ge = su* s]vices1 z det]m9$ "u rules e/abli%$ by ! dep>tm5t ( insurance = ! ,/ate 9 :i* ! s]vices are furni%$4 7,b7 ,hospital s]vices ,= inpati5t & outpati5t hospital s]vices = :i* paym5t rates are e/abli%$ "u ?is title 7& includ+ drugs & biologicals furni%$ 9 conjunction ) & bill$ z "p ( su* s]vices71 ! less] (-- 7i7 ! ca% price = su* s]vices po/$ pursuant to section #bbc7;f77#i7 ( ! ,int]nal ,rev5ue ,code ( #aihf2 or 7ii7 #aaj p]c5t ( ! paym5t rate applicable to su* s]vices 9 ! case ( an individual entitl$ to b5efits "u "p ,a & enroll$ "u "p ,b4 7,c7 ,drugs & biologicals ,= drugs & o!r ph>maceuticals furni%$ to :i* a previ\s subp>agraph does n apply1 ! less] (-- 7i7 twice ! acquisition co/ to ! hospital or o!r provid] = ! dose involv$2 or 7ii7 ! acquisition co/ to ! hospital or o!r provid] plus #bej4 ,! doll> am\nt 9 clause 7ii7 %all be increas$ f ye> to ye> 7beg9n+ ) ! ye> aft] ! fir/ ye> 9 :i* ?is subsection applies7 by ! same p]c5tage z ! p]c5tage increase 9 ! consum] price index = all urban consum]s 7all items2 ,u4,s4 city av]age7 = ! ye> involv$ 7z det]m9$ by ! ,secret>y74 ,any su* doll> am\nt z s increas$ t is n a multiple ( #e %all be r\nd$ to ! ne>e/ multiple ( #e 7or1 if a multiple ( #b4ej1 to ! next highe/ multiple ( #e74 7,d7 ,o!r items & s]vices ,= any o!r items or s]vices1 ! less] (-- 7i7 ! ca% price = su* items & s]vices po/$ pursuant to section #bbc7;f77#i7 ( ! ,int]nal ,rev5ue ,code ( #aihf2 or 7ii7 #aaj p]c5t ( ! paym5t basis t w\ld be applicable to paym5t = su* items & s]vices "u ?is title 9 ! case ( an individual entitl$ to b5efits "u "p ,a & enroll$ "u "p ,b4 7#b7 ,special rule = items & s]vices furni%$ z a bundle ,9 ! case ( items & s]vices = :i* !re is a s+le price = a gr\p or bundle ( su* items & s]vices1 ! maximum *>ge p]mitt$ "u p>agraph 7#a7 may n exce$ ! less] (-- 7,a7 ! price *>g$ = su* bundl$ s]vices2 or 7,b7 ! aggregate ( ! maximum *>ges p]mitt$ "u p>agraph 7#a7 ) respect to items & s]vices includ$ 9 su* bundle4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to *>ges impos$ = items & s]vices furni%$ on or aft] ,janu>y #a1 #bjag4 #ejb4 ,publi%+ ( ca% price = c>e paid ?r\gh heal? sav+s acc\nts 7a7 ,heal? ,sav+s ,acc\nts ,section #bbc7;f7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,ca% price transp>5cy requir$ = paym5ts to heal? c>e provid]s 7,a7 ,9 g5]al ,a paym5t to a heal? c>e provid] ) respect to ! furni%+ ( heal? c>e items & s]vices by su* provid] %all n be treat$ z a qualifi$ m$ical exp5se unless heal? c>e provid] provides = cont9u+ disclosure 7su* z ?r\gh po/+ on a publicly accessible website7 ( ! ca% price ! heal? c>e provid] *>ges = ! furni%+ ( su* items & s]vices4 7,b7 ,=m ( disclosure ,! disclosure ( prices "u ?is subsection %all be 9 a =m & mann] specifi$ by ! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,secret>y1 & %all be design$-- 7i7 to e/abli% a s+le price = relat$ items & s]vices 9 a mann] simil> to ! mann] 9 :i* pric+ & paym5t = su* items & s]vices is provid$ "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act1 & 7ii7 to make x easy = consum]s to comp>e ! prices = simil> items & s]vices furni%$ by diff]5t provid]s4 7,c7 ,failure to furni% s]vices or *>ge 9 excess ( /at$ price ,a heal? c>e provid] %all be treat$ z n meet+ ! requirem5t ( subp>agraph 7,a71 9 ! case ( items & s]vices = :i* ! provid] is disclos+ a ca% price1 if ! provid]-- 7i7 refuses to furni% su* items or s]vices at ! price li/$1 or 7ii7 *>ges m ?an ! price li/$ = ! furni%+ ( ! items & s]vices4 4 7b7 ,ro? ,,hsa ,section #ecj;,a7c77#d7 ( su* ,code1 z add$ by ?is ,act1 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,section #bbc7;f77#i7 7relat+ to ca% price transp>5cy requir$ = paym5ts to heal? c>e provid]s74 4 7c7 ,en=cem5t ,if ! ,secret>y det]m9es t a heal? c>e provid] has n provid$ = cont9u+ disclosure ( ! ca% price ( heal? c>e provid] *>ges "u section #bbc7;f77#i7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 ! ,secret>y may in/ruct ! ,secret>y ( ! ,treasury t paym5ts made to su* provid] %all be n treat$1 = purposes ( section #bbc ( ! ,int]nal ,rev5ue ,code ( #aihf1 z an am\nt us$ = a qualifi$ m$ical exp5se = a p]iod ( n to exce$ #a ye>4 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 #ejc4 ,lib]at+ ! local practice ( heal? c>e 7a7 ,waiv+ national re/rictions on physician-,own$ facilities ,section #ahgg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,waiv] au?ority ,a physician or o!r entity may apply to ! ,secret>y to waive any provision ( ?is section & ! ,secret>y may waive su* provision ) respect to su* physician or entity if ! ,secret>y det]m9es t su* waiv] w\ld-- 7#a7 increase competition )9 ! heal? c>e m>ket2 7#b7 r$uce ! co/s ( heal? c>e2 & 7#c7 increase ! quality ( heal? c>e4 4 7b7 ,remov+ c]ta9 ,/ate & local lic5sure or c]tification re/rictions 7#a7 ,application = waiv] ( re/rictions ,an individual :o is requir$ to be lic5s$ or c]tifi$ by a ,/ate z a condition ( furni%+ items or s]vices z a heal? c>e pr(essional 7z def9$ by ! ,secret>y ( ,heal? & ,human ,s]vices7 may submit to ! ,secret>y an application to waive any condition ( su* lic5sure or c]tification4 7#b7 ,/&>d ,! ,secret>y may grant a waiv] submitt$ "u p>agraph 7#a7 if ! ,secret>y det]m9es su* waiv] w\ld-- 7,a7 increase competition )9 ! heal? c>e m>ket2 7,b7 r$uce ! co/s ( heal? c>e2 & 7,c7 increase ! quality ( heal? c>e4 7#c7 ,preemption ,9 ! case ( a heal? c>e pr(essional grant$ a waiv] "u p>agraph 7#b71 any requirem5t ) respect to :i* su* waiv] is grant$ is preempt$ to ! ext5t specifi$ 9 su* waiv]4