,,ii ,cal5d> ,no4 #abj #aae? ,,congress #a/ ,session ,h4 ,r4 #afbh ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #g1 #bjag,receiv$2 read ! fir/ "t ,june #h1 #bjag,read twice & plac$ on ! cal5d> ,,an ,,act ,to provide = reconciliation pursuant to title ,,ii ( ! concurr5t resolution on ! budget = fiscal ye> #bjag4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,am]ican ,heal? ,c>e ,act ( #bjag4 #b4 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title4 ,sec4 #b4 ,table ( cont5ts4 ,title ,i--,en]gy & ,comm]ce ,subtitle ,a--,pati5t ,access to ,public ,heal? ,programs ,sec4 #aja4 ,! ,prev5tion & ,public ,heal? ,fund4 ,sec4 #ajb4 ,community heal? c5t] program4 ,sec4 #ajc4 ,f$]al paym5ts to ,/ates4 ,subtitle ,b--,m$icaid ,program ,enhancem5t ,sec4 #aaa4 ,repeal ( ,m$icaid provisions4 ,sec4 #aab4 ,repeal ( ,m$icaid expansion4 ,sec4 #aac4 ,elim9ation ( ,,d% cuts4 ,sec4 #aad4 ,r$uc+ ,/ate ,m$icaid co/s4 ,sec4 #aae4 ,safety net fund+ = non-expansion ,/ates4 ,sec4 #aaf4 ,provid+ inc5tives = increas$ frequ5cy ( eligibility r$et]m9ations4 ,sec4 #aag4 ,p]mitt+ ,/ates to apply a "w requirem5t = nondisabl$1 noneld]ly1 nonpregnant adults "u ,m$icaid4 ,subtitle ,c--,p] ,capita ,allotm5t = ,m$ical ,assi/ance ,sec4 #aba4 ,p] capita allotm5t = m$ical assi/ance4 ,subtitle ,d--,pati5t ,relief & ,heal? ,insurance ,m>ket ,/ability ,sec4 #aca4 ,repeal ( co/-%>+ subsidy4 ,sec4 #acb4 ,pati5t & ,/ate ,/ability ,fund4 ,sec4 #acc4 ,cont9u\s heal? insurance cov]age inc5tive4 ,sec4 #acd4 ,increas+ cov]age options4 ,sec4 #ace4 ,*ange 9 p]missible age v>iation 9 heal? insurance premium rates4 ,subtitle ,e--,implem5tation ,fund+ ,sec4 #ada4 ,am]ican ,heal? ,c>e ,implem5tation ,fund4 ,title ,,ii--,committee on ,ways & ,means ,subtitle ,a--,repeal & ,replace ( ,heal?-,relat$ ,tax ,policy ,sec4 #bja4 ,recapture excess advance paym5ts ( premium tax cr$its4 ,sec4 #bjb4 ,additional modifications to premium tax cr$it4 ,sec4 #bjc4 ,small bus9ess tax cr$it4 ,sec4 #bjd4 ,individual m&ate4 ,sec4 #bje4 ,employ] m&ate4 ,sec4 #bjf4 ,repeal ( ! tax on employee heal? insurance premiums & heal? plan b5efits4 ,sec4 #bjg4 ,repeal ( tax on ov]-!-c\nt] m$ications4 ,sec4 #bjh4 ,repeal ( increase ( tax on heal? sav+s acc\nts4 ,sec4 #bji4 ,repeal ( limitations on contributions to flexible sp5d+ acc\nts4 ,sec4 #baj4 ,repeal ( m$ical device excise tax4 ,sec4 #baa4 ,repeal ( elim9ation ( d$uction = exp5ses allocable to m$ic>e "p ,d subsidy4 ,sec4 #bab4 ,r$uction ( income ?re%old = det]m9+ m$ical c>e d$uction4 ,sec4 #bac4 ,repeal ( ,m$ic>e tax increase4 ,sec4 #bad4 ,refundable tax cr$it = heal? insurance cov]age4 ,sec4 #bae4 ,maximum contribution limit to heal? sav+s acc\nt increas$ to am\nt ( d$uctible & out-(-pocket limitation4 ,sec4 #baf4 ,all[ bo? sp\ses to make cat*-up contributions to ! same heal? sav+s acc\nt4 ,sec4 #bag4 ,special rule = c]ta9 m$ical exp5ses incurr$ be=e e/abli%m5t ( heal? sav+s acc\nt4 ,subtitle ,b--,repeal ( c]ta9 consum] taxes ,sec4 #bba4 ,repeal ( tax on prescription m$ications4 ,sec4 #bbb4 ,repeal ( heal? insurance tax4 ,subtitle ,c--,repeal ( ,tann+ ,tax ,sec4 #bca4 ,repeal ( tann+ tax4 ,subtitle ,d--,remun]ation f ,c]ta9 ,insur]s ,sec4 #bda4 ,remun]ation f c]ta9 insur]s4 ,subtitle ,e--,repeal ( ,net ,inve/m5t ,income ,tax ,sec4 #bea4 ,repeal ( net inve/m5t income tax4 ,i ,en]gy & ,comm]ce ,a ,pati5t ,access to ,public ,heal? ,programs #aja4 ,! ,prev5tion & ,public ,heal? ,fund 7a7 ,9 g5]al ,subsection 7b7 ( section #djjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #cjju-#aa71 z am5d$ by section #ejji ( ! #ba/ ,c5tury ,cures ,act1 is am5d$-- 7#a7 9 p>agraph 7#b71 by add+ & at ! end2 7#b7 9 p>agraph 7#c7-- 7,a7 by /rik+ ea* ( fiscal ye>s #bjah & #bjai & ins]t+ fiscal ye> #bjah2 & 7,b7 by /rik+ ! semicolon at ! end & ins]t+ a p]iod2 & 7#c7 by /rik+ p>agraphs 7#d7 ?r\gh 7#h74 7b7 ,rescission ( unobligat$ funds ,( ! funds made available by su* section #djjb1 ! unobligat$ balance at ! end ( fiscal ye> #bjah is resc9d$4 #ajb4 ,community heal? c5t] program ,effective z if includ$ 9 ! enactm5t ( ! ,m$ic>e ,access & ,,*ip ,reau?orization ,act ( #bjae 7,public ,law #aad-aj1 #abi ,/at4 #hg71 p>agraph 7#a7 ( section #bba7;a7 ( su* ,act is am5d$ by ins]t+ 1 & an additional #dbb1jjj1jjj = fiscal ye> #bjag aft] #bjag4 #ajc4 ,f$]al paym5ts to ,/ates 7a7 ,9 g5]al ,not)/&+ section #ejd7;a71 #aijb7;a77#bc71 #aijc7;a71 #bjjb1 #bjje7;a77#d71 #bajb7;a77#g71 or #baje7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gjd7;a71 #acif;a7a77#bc71 #acif;b7a71 #acig;a1 #acig;d7a77#d71 #acig;bb7a77#g71 #acig;ee7a77#a771 or ! t]ms ( any ,m$icaid waiv] 9 effect on ! date ( enactm5t ( ?is ,act t is approv$ "u section #aaae or #aiae ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae1 #acifn71 = ! #a-ye> p]iod beg9n+ on ! date ( ! enactm5t ( ?is ,act1 no ,f$]al funds provid$ f a program ref]r$ to 9 ?is subsection t is consid]$ direct sp5d+ = any ye> may be made available to a ,/ate = paym5ts to a prohibit$ entity1 :e!r made directly to ! prohibit$ entity or ?r\gh a manag$ c>e organization "u contract ) ! ,/ate4 7b7 ,def9itions ,9 ?is section3 7#a7 ,prohibit$ entity ,! t]m prohibit$ entity means an entity1 includ+ its affiliates1 subsidi>ies1 successors1 & cl9ics-- 7,a7 t1 z ( ! date ( enactm5t ( ?is ,act-- 7i7 is an organization describ$ 9 section #eja7;c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf & exempt f tax "u section #eja7;a7 ( su* ,code2 7ii7 is an ess5tial community provid] describ$ 9 section #aef4bce ( title #de1 ,code ( ,f$]al ,regulations 7z 9 effect on ! date ( enactm5t ( ?is ,act71 t is prim>ily engag$ 9 family plann+ s]vices1 reproductive heal?1 & relat$ m$ical c>e2 & 7iii7 provides = abortions1 o!r ?an an abortion-- 7,i7 if ! pregnancy is ! result ( an act ( rape or ince/2 or 7,,ii7 9 ! case :]e a woman suff]s f a physical disord]1 physical injury1 or physical illness t w\ld1 z c]tifi$ by a physician1 place ! woman 9 dang] ( dea? unless an abortion is p]=m$1 includ+ a life-endang]+ physical condition caus$ by or aris+ f ! pregnancy itself2 & 7,b7 = :i* ! total am\nt ( ,f$]al & ,/ate exp5ditures "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 9 fiscal ye> #bjad made directly to ! entity & to any affiliates1 subsidi>ies1 successors1 or cl9ics ( ! entity1 or made to ! entity & to any affiliates1 subsidi>ies1 successors1 or cl9ics ( ! entity z "p ( a nationwide heal? c>e provid] network1 exce$$ #cej1jjj1jjj4 7#b7 ,direct sp5d+ ,! t]m direct sp5d+ has ! mean+ giv5 t t]m "u section #bej7;c7 ( ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ijj7;c774 ,b ,m$icaid ,program ,enhancem5t #aaa4 ,repeal ( ,m$icaid provisions ,! ,social ,security ,act is am5d$-- 7#a7 9 section #aijb 7#db ,u4,s4,c4 #acif;a7-- 7,a7 9 subsection 7a77#dg77;,b71 by ins]t+ & provid$ t any su* election %all cease to be effective on ,janu>y #a1 #bjbj1 & no su* election %all be made aft] t date be=e ! semicolon at ! end2 & 7,b7 9 subsection 7l77#b77;,c71 by ins]t+ & end+ ,decemb] #ca1 #bjai1 aft] ,janu>y #a1 #bjad12 7#b7 9 section #aiae7k77#b7 7#db ,u4,s4,c4 #acifn7k77#b771 by /rik+ dur+ ! p]iod describ$ 9 p>agraph 7#a7 & ins]t+ on or aft] ! date ref]r$ to 9 p>agraph 7#a7 & be=e ,janu>y #a1 #bjbj2 & 7#c7 9 section #aibj7;e7 7#db ,u4,s4,c4 #acifr-#a7;e771 by /rik+ "u clause 7i77,,viii71 clause 7i77,,ix71 or clause 7ii77,,xx7 ( subsection 7a77#aj77;,a7 & ins]t+ "u clause 7i77,,viii7 or clause 7ii77,,xx7 ( section #aijb7;a77#aj77;,a7 be=e ,janu>y #a1 #bjbj1 section #aijb7;a77#aj77;,a77i77,,ix714 #aab4 ,repeal ( ,m$icaid expansion 7a7 ,9 g5]al ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$-- 7#a7 9 section #aijb 7#db ,u4,s4,c4 #acif;a7-- 7,a7 9 subsection 7a77#aj77;,a7-- 7i7 9 clause 7i77,,viii71 by ins]t+ & end+ ,decemb] #ca1 #bjai1 aft] #bjad12 7ii7 9 clause 7ii77,,xx71 by ins]t+ & end+ ,decemb] #ca1 #bjag1 aft] #bjad12 & 7iii7 9 clause 7ii71 by add+ at ! end ! foll[+ new subclause3 7,,xxiii7 beg9n+ ,janu>y #a1 #bjbj-- 7aa7 :o are expansion enrollees 7z def9$ 9 subsection 7nn77#a772 or 7bb7 :o are gr&fa!r$ expansion enrollees 7z def9$ 9 subsection 7nn77#b772 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7nn7 ,expansion enrollees ,9 ?is title3 7#a7 ,9 g5]al ,! t]m expansion enrollee means an individual-- 7,a7 :o is "u #fe ye>s ( age2 7,b7 :o is n pregnant2 7,c7 :o is n entitl$ to1 or enroll$ =1 b5efits "u "p ,a ( title ,,xviii1 or enroll$ = b5efits "u "p ,b ( title ,,xviii2 7,d7 :o is n describ$ 9 any ( subclauses 7,i7 ?r\gh 7,,vii7 ( subsection 7a77#aj77;,a77i72 & 7,e7 ^: income 7z det]m9$ "u subsection 7e77#ad77 does n exce$ #acc p]c5t ( ! pov]ty l9e 7z def9$ 9 section #baaj7;c77#e77 applicable to a family ( ! size involv$4 7#b7 ,gr&fa!r$ expansion enrollees ,! t]m gr&fa!r$ expansion enrollee means an expansion enrollee :o-- 7,a7 0 enroll$ "u ! ,/ate plan "u ?is title 7or "u a waiv] ( su* plan7 z ( ,decemb] #ca1 #bjai2 & 7,b7 does n h a break 9 eligibility = m$ical assi/ance "u su* ,/ate plan 7or waiv]7 = m ?an "o mon? aft] su* date4 7#c7 ,application ( relat$ provisions ,any ref]5ce 9 subsection 7a77#aj77;,g71 7k71 or 7gg7 ( ?is section or 9 section #aijc1 #aije7;a71 #aibj7;e71 or #aicg7;a77#a77;,b7 to individuals describ$ 9 subclause 7,,viii7 ( subsection 7a77#aj77;,a77i7 %all be deem$ to include a ref]5ce to expansion enrollees 7includ+ gr&fa!r$ expansion enrollees74 2 & 7#b7 9 section #aije 7#db ,u4,s4,c4 #acif;d7-- 7,a7 9 subsection 7y77#a71 9 ! matt] prec$+ subp>agraph 7,a7-- 7i7 by ins]t+ & t has elect$ to cov] newly eligible individuals be=e ,m>* #a1 #bjag aft] t is "o ( ! #ej ,/ates or ! ,di/rict ( ,columbia2 & 7ii7 by ins]t+ aft] subclause 7,,viii7 ( section #aijb7;a77#aj77;,a77i7 ! foll[+3 :o1 = p]iods aft] ,decemb] #ca1 #bjai1 are gr&fa!r$ expansion enrollees 7z def9$ 9 section #aijb7nn77#b772 & 7,b7 9 subsection 7z77#b7-- 7i7 9 subp>agraph 7,a71 by ins]t+ aft] section #aicg ! foll[+3 &1 = p]iods aft] ,decemb] #ca1 #bjai1 :o are gr&fa!r$ expansion enrollees 7z def9$ 9 section #aijb7nn77#b772 & 7ii7 9 subp>agraph 7,b77ii7-- 7,i7 9 subclause 7,,iii71 by add+ & at ! end2 & 7,,ii7 by /rik+ subclauses 7,,iv71 7,v71 & 7,,vi7 & ins]t+ ! foll[+ new subclause3 7,,iv7 #bjag & ea* subsequ5t ye> is #hj p]c5t4 4 7b7 ,sunset ( ess5tial heal? b5efits requirem5t ,section #aicg7;b77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#e77 is am5d$ by add+ at ! end ! foll[+3 ,?is p>agraph %all n apply aft] ,decemb] #ca1 #bjai44 #aac4 ,elim9ation ( ,,d% cuts ,section #aibc7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77 is am5d$-- 7#a7 9 p>agraph 7#g7-- 7,a7 9 subp>agraph 7,a7-- 7i7 9 clause 7i7-- 7,i7 9 ! matt] prec$+ subclause 7,i71 by /rik+ #bjbe & ins]t+ #bjai2 & 7ii7 9 clause 7ii7-- 7,i7 9 subclause 7,i71 by add+ & at ! end2 7,,ii7 9 subclause 7,,ii71 by /rik+ ! semicolon at ! end & ins]t+ a p]iod2 & 7,,iii7 by /rik+ subclauses 7,,iii7 ?r\gh 7,,viii72 & 7,b7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,exemption f ,r$uction = non-expansion ,/ates 7i7 ,9 g5]al ,9 ! case ( a ,/ate t is a non-expansion ,/ate = a fiscal ye>1 subp>agraph 7,a77i7 %all n apply to ! ,,d% allotm5t = su* ,/ate & fiscal ye>4 7ii7 ,no *ange 9 r$uction = expansion ,/ates ,9 ! case ( a ,/ate t is an expansion ,/ate = a fiscal ye>1 ! ,,d% allotm5t = su* ,/ate & fiscal ye> %all be det]m9$ z if clause 7i7 did n apply4 7iii7 ,non-expansion & expansion ,/ate def9$ 7,i7 ,! t]m expansion ,/ate means ) respect to a fiscal ye>1 a ,/ate t1 z ( ,july #a ( ! prec$+ fiscal ye>1 provides = eligibility "u clause 7i77,,viii7 or 7ii77,,xx7 ( section #aijb7;a77#aj77;,a7 = m$ical assi/ance "u ?is title 7or a waiv] ( ! ,/ate plan approv$ "u section #aaae74 7,,ii7 ,! t]m non-expansion ,/ate means1 ) respect to a fiscal ye>1 a ,/ate t is n an expansion ,/ate4 2 & 7#b7 9 p>agraph 7#h71 by /rik+ fiscal ye> #bjbe & ins]t+ fiscal ye> #bjai4 #aad4 ,r$uc+ ,/ate ,m$icaid co/s 7a7 ,lett+ ,/ates dis5roll high doll> lott]y w9n]s 7#a7 ,9 g5]al ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7,a7 9 subsection 7a77#ag71 by /rik+ 7e77#ad71 7e77#ad7 & ins]t+ 7e77#ad71 7e77#ae72 & 7,b7 9 subsection 7e7-- 7i7 9 p>agraph 7#ad7 7relat+ to modifi$ adju/$ gross income71 by add+ at ! end ! foll[+ new subp>agraph3 7,j7 ,treatm5t ( c]ta9 lott]y w9n+s & income receiv$ z a lump sum 7i7 ,9 g5]al ,9 ! case ( an individual :o is ! recipi5t ( qualifi$ lott]y w9n+s 7pursuant to lott]ies occurr+ on or aft] ,janu>y #a1 #bjbj7 or qualifi$ lump sum income 7receiv$ on or aft] su* date7 & ^: eligibility = m$ical assi/ance is det]m9$ bas$ on ! application ( modifi$ adju/$ gross income "u subp>agraph 7,a71 a ,/ate %all1 9 det]m9+ su* eligibility1 include su* w9n+s or income 7z applicable7 z income receiv$-- 7,i7 9 ! mon? 9 :i* su* w9n+s or income 7z applicable7 is receiv$ if ! am\nt ( su* w9n+s or income is less ?an #hj1jjj2 7,,ii7 ov] a p]iod ( #b mon?s if ! am\nt ( su* w9n+s or income 7z applicable7 is great] ?an or equal to #hj1jjj b less ?an #ij1jjj2 7,,iii7 ov] a p]iod ( #c mon?s if ! am\nt ( su* w9n+s or income 7z applicable7 is great] ?an or equal to #ij1jjj b less ?an #ajj1jjj2 & 7,,iv7 ov] a p]iod ( #c mon?s plus #a additional mon? = ea* increm5t ( #aj1jjj ( su* w9n+s or income 7z applicable7 receiv$1 n to exce$ a p]iod ( #abj mon?s 7= w9n+s or income ( #a1bfj1jjj or m71 if ! am\nt ( su* w9n+s or income is great] ?an or equal to #ajj1jjj4 7ii7 ,c\nt+ 9 equal in/allm5ts ,= purposes ( subclauses 7,,ii71 7,,iii71 & 7,,iv7 ( clause 7i71 w9n+s or income to :i* su* subclause applies %all be c\nt$ 9 equal mon?ly in/allm5ts ov] ! p]iod ( mon?s specifi$ "u su* subclause4 7iii7 ,h>d%ip exemption ,an individual ^: income1 by application ( clause 7i71 exce$s ! applicable eligibility ?re%old e/abli%$ by ! ,/ate1 may cont9ue to be eligible = m$ical assi/ance to ! ext5t t ! ,/ate det]m9es1 "u proc$ures e/abli%$ by ! ,/ate "u ! ,/ate plan 7or 9 ! case ( a waiv] ( ! plan "u section #aaae1 incorporat$ 9 su* waiv]71 or z o!rwise e/abli%$ by su* ,/ate 9 accordance ) su* /&>ds z may be specifi$ by ! ,secret>y1 t ! d5ial ( eligibility ( ! individual w\ld cause an undue m$ical or f9ancial h>d%ip z det]m9$ on ! basis ( crit]ia e/abli%$ by ! ,secret>y4 7iv7 ,notifications & assi/ance requir$ 9 case ( loss ( eligibility ,a ,/ate %all1 ) respect to an individual :o loses eligibility = m$ical assi/ance "u ! ,/ate plan 7or a waiv] ( su* plan7 by reason ( clause 7i71 be=e ! date on :i* ! individual loses su* eligibility1 in=m ! individual ( ! date on :i* ! individual w\ld no long] be consid]$ ineligible by reason ( su* clause to receive m$ical assi/ance "u ! ,/ate plan or "u any waiv] ( su* plan & ! date on :i* ! individual w\ld be eligible to reapply to receive su* m$ical assi/ance4 7v7 ,qualifi$ lott]y w9n+s def9$ ,9 ?is subp>agraph1 ! t]m qualifi$ lott]y w9n+s means w9n+s f a sweep/akes1 lott]y1 or pool describ$ 9 p>agraph 7#c7 ( section #ddjb ( ! ,int]nal ,rev5ue ,code ( #aihf or a lott]y op]at$ by a multi/ate or multijurisdictional lott]y association1 includ+ am\nts aw>d$ z a lump sum paym5t4 7vi7 ,qualifi$ lump sum income def9$ ,9 ?is subp>agraph1 ! t]m qualifi$ lump sum income means income t is receiv$ z a lump sum f "o ( ! foll[+ s\rces3 7,i7 ,monet>y w9n+s f gambl+ 7z def9$ by ! ,secret>y & includ+ monet>y w9n+s f gambl+ activities describ$ 9 section #aiee7;b77#d7 ( title #ah1 ,unit$ ,/ates ,code74 7,,ii7 ,income receiv$ z liquid assets f ! e/ate 7z def9$ 9 section #aiag7;b77#d77 ( a deceas$ individual4 2 & 7ii7 by /rik+ 7#ad7 ,exclusion & ins]t+ 7#ae7 ,exclusion4 7#b7 ,rules ( con/ruction 7,a7 ,int]ception ( lott]y w9n+s all[$ ,no?+ 9 ! am5dm5t made by p>agraph 7#a77;,b77i7 %all be con/ru$ z prev5t+ a ,/ate f int]cept+ ! ,/ate lott]y w9n+s aw>d$ to an individual 9 ! ,/ate to recov] am\nts paid by ! ,/ate "u ! ,/ate ,m$icaid plan "u title ,,xix ( ! ,social ,security ,act = m$ical assi/ance furni%$ to ! individual4 7,b7 ,applicability limit$ to eligibility ( recipi5t ( lott]y w9n+s or lump sum income ,no?+ 9 ! am5dm5t made by p>agraph 7#a77;,b77i7 %all be con/ru$1 ) respect to a det]m9ation ( h\sehold income = purposes ( a det]m9ation ( eligibility = m$ical assi/ance "u ! ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiv] ( su* plan7 made by apply+ modifi$ adju/$ gross income "u subp>agraph 7,a7 ( section #aijb7;e77#ad7 ( su* ,act 7#db ,u4,s4,c4 #acif;a7e77#ad771 z limit+ ! eligibility = su* m$ical assi/ance ( any individual t is a memb] ( ! h\sehold o!r ?an ! individual 7or ! individual's sp\se7 :o receiv$ qualifi$ lott]y w9n+s or qualifi$ lump-sum income 7z def9$ 9 subp>agraph 7,j7 ( su* section #aijb7;e77#ad71 z add$ by p>agraph 7#a77;,b77i7 ( ?is subsection74 7b7 ,repeal ( retroactive eligibility 7#a7 ,9 g5]al 7,a7 ,/ate plan requirem5ts ,section #aijb7;a77#cd7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#cd77 is am5d$ by /rik+ 9 or aft] ! ?ird mon? be=e ! mon? 9 :i* he made application & ins]t+ 9 or aft] ! mon? 9 :i* ! individual made application4 7,b7 ,def9ition ( m$ical assi/ance ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$ by /rik+ 9 or aft] ! ?ird mon? be=e ! mon? 9 :i* ! recipi5t makes application = assi/ance & ins]t+ 9 or aft] ! mon? 9 :i* ! recipi5t makes application = assi/ance4 7#b7 ,effective date ,! am5dm5ts made by p>agraph 7#a7 %all apply to m$ical assi/ance ) respect to individuals ^: eligibility = su* assi/ance is bas$ on an application = su* assi/ance made 7or deem$ to be made7 on or aft] ,octob] #a1 #bjag4 7c7 ,updat+ all[able home equity limits 9 ,m$icaid 7#a7 ,9 g5]al ,section #aiag7;f77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifp7f77#a77 is am5d$-- 7,a7 9 subp>agraph 7,a71 by /rik+ subp>agraphs 7,b7 & 7,c7 & ins]t+ subp>agraph 7,b72 7,b7 by /rik+ subp>agraph 7,b72 7,c7 by r$esignat+ subp>agraph 7,c7 z subp>agraph 7,b72 & 7,d7 9 subp>agraph 7,b71 z s r$esignat$1 by /rik+ doll> am\nts specifi$ 9 ?is p>agraph & ins]t+ doll> am\nt specifi$ 9 subp>agraph 7,a74 7#b7 ,effective date 7,a7 ,9 g5]al ,! am5dm5ts made by p>agraph 7#a7 %all apply ) respect to eligibility det]m9ations made aft] ! date t is #ahj days aft] ! date ( ! enactm5t ( ?is section4 7,b7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 9 ord] = ! respective plan to meet any requirem5t impos$ by am5dm5ts made by ?is subsection1 ! respective plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet su* an additional requirem5t be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( ! enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session %all be consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 #aae4 ,safety net fund+ = non-expansion ,/ates ,title ,,xix ( ! ,social ,security ,act is am5d$ by ins]t+ aft] section #aibc 7#db ,u4,s4,c4 #acifr-#d7 ! foll[+ new section3 #aibc;,a4 ,adju/m5t 9 paym5t = s]vices ( safety net provid]s 9 non-expansion ,/ates 7a7 ,9 g5]al ,subject to ! limitations ( ?is section1 = ea* ye> dur+ ! p]iod beg9n+ ) fiscal ye> #bjah & end+ ) fiscal ye> #bjbb1 ea* ,/ate t is "o ( ! #ej ,/ates or ! ,di/rict ( ,columbia & t1 z ( ,july #a ( ! prec$+ fiscal ye>1 did n provide = eligibility "u clause 7i77,,viii7 or 7ii77,,xx7 ( section #aijb7;a77#aj77;,a7 = m$ical assi/ance "u ?is title 7or a waiv] ( ! ,/ate plan approv$ "u section #aaae7 7ea* su* ,/ate or ,di/rict ref]r$ to 9 ?is section = ! fiscal ye> z a non-expansion ,/ate7 may adju/ ! paym5t am\nts o!rwise provid$ "u ! ,/ate plan "u ?is title 7or a waiv] ( su* plan7 to heal? c>e provid]s t provide heal? c>e s]vices to individuals enroll$ "u ?is title 79 ?is section ref]r$ to z eligible provid]s7 s long z ! paym5t adju/m5t to su* an eligible provid] does n exce$ ! provid]'s co/s 9 furni%+ heal? c>e s]vices 7z det]m9$ by ! ,secret>y & net ( paym5ts "u ?is title1 o!r ?an "u ?is section1 & by un9sur$ pati5ts7 to individuals :o ei!r are eligible = m$ical assi/ance "u ! ,/ate plan 7or "u a waiv] ( su* plan7 or h no heal? insurance or heal? plan cov]age = su* s]vices4 7b7 ,increase 9 applicable ,,fmap ,not)/&+ section #aije7;b71 ! ,f$]al m$ical assi/ance p]c5tage applicable ) respect to exp5ditures attributable to a paym5t adju/m5t "u subsection 7a7 = :i* paym5t is p]mitt$ "u subsection 7c7 %all be equal to-- 7#a7 #ajj p]c5t = cal5d> qu>t]s 9 fiscal ye>s #bjah1 #bjai1 #bjbj1 & #bjba2 & 7#b7 #ie p]c5t = cal5d> qu>t]s 9 fiscal ye> #bjbb4 7c7 ,annual allotm5t limitation ,paym5t "u section #aijc7;a7 %all n be made to a ,/ate ) respect to any paym5t adju/m5t made "u ?is section = all cal5d> qu>t]s 9 a fiscal ye> 9 excess ( ! #b1jjj1jjj1jjj multipli$ by ! ratio (-- 7#a7 ! population ( ! ,/ate ) income bel[ #ach p]c5t ( ! pov]ty l9e 9 #bjae 7z det]m9$ bas$ ! table entitl$ ,heal? ,insurance ,cov]age ,/atus & ,type by ,ratio ( ,income to ,pov]ty ,level 9 ! ,pa/ #ab ,mon?s by ,age = ! univ]se ( ! civilian non9/itutionaliz$ population = :om pov]ty /atus is det]m9$ bas$ on ! #bjae ,am]ican ,community ,survey #a-,ye> ,e/imates1 z publi%$ by ! ,bureau ( ! ,c5sus71 to 7#b7 ! sum ( ! populations "u p>agraph 7#a7 = all non-expansion ,/ates4 7d7 ,disqualification 9 case ( ,/ate cov]age expansion ,if a ,/ate is a non-expansion = a fiscal ye> & provides eligibility = m$ical assi/ance describ$ 9 subsection 7a7 dur+ ! fiscal ye>1 ! ,/ate %all no long] be treat$ z a non-expansion ,/ate "u ?is section = any subsequ5t fiscal ye>s4 4 #aaf4 ,provid+ inc5tives = increas$ frequ5cy ( eligibility r$et]m9ations 7a7 ,9 g5]al ,section #aijb7;e77#ad7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ad77 7relat+ to modifi$ adju/$ gross income71 z am5d$ by section #aad7;a77#a71 is fur!r am5d$ by add+ at ! end ! foll[+3 7,k7 ,frequ5cy ( eligibility r$et]m9ations ,beg9n+ on ,octob] #a1 #bjag1 & not)/&+ subp>agraph 7,h71 9 ! case ( an individual ^: eligibility = m$ical assi/ance "u ! ,/ate plan "u ?is title 7or a waiv] ( su* plan7 is det]m9$ bas$ on ! application ( modifi$ adju/$ gross income "u subp>agraph 7,a7 & :o is s eligible on ! basis ( clause 7i77,,viii7 or clause 7ii77,,xx7 ( subsection 7a77#aj77;,a71 a ,/ate %all r$et]m9e su* individual's eligibility = su* m$ical assi/ance no less frequ5tly ?an once e #f mon?s4 4 7b7 ,increas$ adm9i/rative mat*+ p]c5tage ,= ea* cal5d> qu>t] dur+ ! p]iod beg9n+ on ,octob] #a1 #bjag1 & end+ on ,decemb] #ca1 #bjai1 ! ,f$]al mat*+ p]c5tage o!rwise applicable "u section #aijc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 ) respect to ,/ate exp5ditures dur+ su* qu>t] t are attributable to meet+ ! requirem5t ( section #aijb7;e77#ad7 7relat+ to det]m9ations ( eligibility us+ modifi$ adju/$ gross income7 ( su* ,act %all be increas$ by #e p]c5tage po9ts ) respect to ,/ate exp5ditures attributable to activities c>ri$ out by ! ,/ate 7& approv$ by ! ,secret>y7 to increase ! frequ5cy ( eligibility r$et]m9ations requir$ by subp>agraph 7,k7 ( su* section 7relat+ to eligibility r$et]m9ations made on a #f-mon? basis7 7z add$ by subsection 7a774 #aag4 ,p]mitt+ ,/ates to apply a "w requirem5t = nondisabl$1 noneld]ly1 nonpregnant adults "u ,m$icaid 7a7 ,9 g5]al ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a71 z previ\sly am5d$1 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7oo7 ,"w requirem5t option = nondisabl$1 noneld]ly1 nonpregnant adults 7#a7 ,9 g5]al ,beg9n+ ,octob] #a1 #bjag1 subject to p>agraph 7#c71 a ,/ate may elect to condition m$ical assi/ance to a nondisabl$1 noneld]ly1 nonpregnant individual "u ?is title ^u su* an individual's satisfaction ( a "w requirem5t 7z def9$ 9 p>agraph 7#b774 7#b7 ,"w requirem5t def9$ ,9 ?is section1 ! t]m "w requirem5t means1 ) respect to an individual1 ! individual's p>ticipation 9 "w activities 7z def9$ 9 section #djg7;d77 = su* p]iod ( "t z det]m9$ by ! ,/ate1 & z direct$ & adm9i/]$ by ! ,/ate4 7#c7 ,requir$ exceptions ,/ates adm9i/]+ a "w requirem5t "u ?is subsection may n apply su* requirem5t to-- 7,a7 a woman dur+ pregnancy ?r\gh ! end ( ! mon? 9 :i* ! #fj-;day p]iod 7beg9n+ on ! la/ day ( h] pregnancy7 ends2 7,b7 an individual :o is "u #ai ye>s ( age2 7,c7 an individual :o is ! only p>5t or c>etak] relative 9 ! family ( a *ild :o has n atta9$ #f ye>s ( age or :o is ! only p>5t or c>etak] ( a *ild ) disabilities2 or 7,d7 an individual :o is m>ri$ or a head ( h\sehold & has n atta9$ #bj ye>s ( age & :o-- 7i7 ma9ta9s satisfactory att5dance at second>y s*ool or ! equival5t2 or 7ii7 p>ticipates 9 education directly relat$ to employm5t4 4 7b7 ,increase 9 mat*+ rate = implem5tation ,section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is am5d$ by add+ at ! end ! foll[+3 7aa7 ,! ,f$]al mat*+ p]c5tage o!rwise applicable "u subsection 7a7 ) respect to ,/ate adm9i/rative exp5ditures dur+ a cal5d> qu>t] = :i* ! ,/ate receives paym5t "u su* subsection %all1 9 addition to any o!r increase to su* ,f$]al mat*+ p]c5tage1 be increas$ = su* cal5d> qu>t] by #e p]c5tage po9ts ) respect to ,/ate exp5ditures attributable to activities c>ri$ out by ! ,/ate 7& approv$ by ! ,secret>y7 to implem5t subsection 7oo7 ( section #aijb4 4 ,c ,p] ,capita ,allotm5t = ,m$ical ,assi/ance #aba4 ,p] capita allotm5t = m$ical assi/ance ,title ,,xix ( ! ,social ,security ,act is am5d$-- 7#a7 9 section #aijc 7#db ,u4,s4,c4 #acif;b7-- 7,a7 9 subsection 7a71 9 ! matt] be=e p>agraph 7#a71 by ins]t+ & section #aijc;,a7a7 aft] except z o!rwise provid$ 9 ?is section2 & 7,b7 9 subsection 7d77#a71 by /rik+ to :i* & ins]t+ to :i*1 subject to section #aijc;,a7a712 & 7#b7 by ins]t+ aft] su* section #aijc ! foll[+ new section3 #aijc;,a4 ,p] capita-bas$ cap on paym5ts = m$ical assi/ance 7a7 ,application ( p] capita cap on paym5ts = m$ical assi/ance exp5ditures 7#a7 ,9 g5]al ,if a ,/ate has excess aggregate m$ical assi/ance exp5ditures 7z def9$ 9 p>agraph 7#b77 = a fiscal ye> 7beg9n+ ) fiscal ye> #bjbj71 ! am\nt ( paym5t to ! ,/ate "u section #aijc7;a77#a7 = ea* qu>t] 9 ! foll[+ fiscal ye> %all be r$uc$ by ( ! excess aggregate m$ical assi/ance paym5ts 7z def9$ 9 p>agraph 7#c77 = t previ\s fiscal ye>4 ,9 ?is section1 ! t]m ,/ate means only ! #ej ,/ates & ! ,di/rict ( ,columbia4 7#b7 ,excess aggregate m$ical assi/ance exp5ditures ,9 ?is subsection1 ! t]m excess aggregate m$ical assi/ance exp5ditures means1 = a ,/ate = a fiscal ye>1 ! am\nt 7if any7 by :i*-- 7,a7 ! am\nt ( ! adju/$ total m$ical assi/ance exp5ditures 7z def9$ 9 subsection 7b77#a77 = ! ,/ate & fiscal ye>2 exce$s 7,b7 ! am\nt ( ! t>get total m$ical assi/ance exp5ditures 7z def9$ 9 subsection 7c77 = ! ,/ate & fiscal ye>4 7#c7 ,excess aggregate m$ical assi/ance paym5ts ,9 ?is subsection1 ! t]m excess aggregate m$ical assi/ance paym5ts means1 = a ,/ate = a fiscal ye>1 ! product (-- 7,a7 ! excess aggregate m$ical assi/ance exp5ditures 7z def9$ 9 p>agraph 7#b77 = ! ,/ate = ! fiscal ye>2 & 7,b7 ! ,f$]al av]age m$ical assi/ance mat*+ p]c5tage 7z def9$ 9 p>agraph 7#d77 = ! ,/ate = ! fiscal ye>4 7#d7 ,f$]al av]age m$ical assi/ance mat*+ p]c5tage ,9 ?is subsection1 ! t]m ,f$]al av]age m$ical assi/ance mat*+ p]c5tage means1 = a ,/ate = a fiscal ye>1 ! ratio 7express$ z a p]c5tage7 (-- 7,a7 ! am\nt ( ! ,f$]al paym5ts t w\ld be made to ! ,/ate "u section #aijc7;a77#a7 = m$ical assi/ance exp5ditures = cal5d> qu>t]s 9 ! fiscal ye> if p>agraph 7#a7 did n apply2 to 7,b7 ! am\nt ( ! m$ical assi/ance exp5ditures = ! ,/ate & fiscal ye>4 7b7 ,adju/$ total m$ical assi/ance exp5ditures ,subject to subsection 7g71 ! foll[+ %all apply3 7#a7 ,9 g5]al ,9 ?is section1 ! t]m adju/$ total m$ical assi/ance exp5ditures means1 = a ,/ate-- 7,a7 = fiscal ye> #bjaf1 ! product (-- 7i7 ! am\nt ( ! m$ical assi/ance exp5ditures 7z def9$ 9 p>agraph 7#b77 = ! ,/ate & fiscal ye>1 r$uc$ by ! am\nt ( any exclud$ exp5ditures 7z def9$ 9 p>agraph 7#c77 = ! ,/ate & fiscal ye> o!rwise includ$ 9 su* m$ical assi/ance exp5ditures2 & 7ii7 ! #aijc;,a ,,fy#af population p]c5tage 7z def9$ 9 p>agraph 7#d77 = ! ,/ate2 or 7,b7 = fiscal ye> #bjai or a subsequ5t fiscal ye>1 ! am\nt ( ! m$ical assi/ance exp5ditures 7z def9$ 9 p>agraph 7#b77 = ! ,/ate & fiscal ye> t is attributable to #aijc;,a enrollees1 r$uc$ by ! am\nt ( any exclud$ exp5ditures 7z def9$ 9 p>agraph 7#c77 = ! ,/ate & fiscal ye> o!rwise includ$ 9 su* m$ical assi/ance exp5ditures & includes non-,,d% supplem5tal paym5ts 7z def9$ 9 subsection 7d77#d77;,a77ii77 & paym5ts describ$ 9 subsection 7d77#d77;,a77iii7 b %all n be con/ru$ z includ+ any exp5ditures attributable to ! program "u section #aibh4 ,9 apply+ subp>agraph 7,b71 non-,,d% supplem5tal paym5ts 7z def9$ 9 subsection 7d77#d77;,a77ii77 & paym5ts describ$ 9 subsection 7d77#d77;,a77iii7 %all be treat$ z fully attributable to #aijc;,a enrollees4 7#b7 ,m$ical assi/ance exp5ditures ,9 ?is section1 ! t]m m$ical assi/ance exp5ditures means1 = a ,/ate & fiscal ye>1 ! m$ical assi/ance paym5ts z report$ by m$ical s]vice category on ! ,=m ,,cms-#fd qu>t]ly exp5se report 7or successor to su* a report =m1 & includ+ enrollm5t data & subsequ5t adju/m5ts to any su* report1 9 ?is section ref]r$ to collectively z a ,,cms-#fd report7 = :i* paym5t is 7or may o!rwise be7 made pursuant to section #aijc7;a77#a74 7#c7 ,exclud$ exp5ditures ,9 ?is section1 ! t]m exclud$ exp5ditures means1 = a ,/ate & fiscal ye>1 exp5ditures "u ! ,/ate plan 7or "u a waiv] ( su* plan7 t are attributable to any ( ! foll[+3 7,a7 ,,d% ,paym5t adju/m5ts made = disproportionate %>e hospitals "u section #aibc4 7,b7 ,m$ic>e co/-%>+ ,paym5ts made = m$ic>e co/-%>+ 7z def9$ 9 section #aije7p77#c774 7,c7 ,safety net provid] paym5t adju/m5ts 9 non-expansion ,/ates ,paym5t adju/m5ts "u subsection 7a7 ( section #aibc;,a = :i* paym5t is p]mitt$ "u subsection 7c7 ( su* section4 7#d7 #aijc;,a ,,fy #af population p]c5tage ,9 ?is subsection1 ! t]m #aijc;,a ,,fy#af population p]c5tage means1 = a ,/ate1 ! ,secret>y's calculation ( ! p]c5tage ( ! actual m$ical assi/ance exp5ditures1 z report$ by ! ,/ate on ! ,,cms-#fd reports = cal5d> qu>t]s 9 fiscal ye> #bjaf1 t are attributable to #aijc;,a enrollees 7z def9$ 9 subsection 7e77#a774 7c7 ,t>get total m$ical assi/ance exp5ditures 7#a7 ,calculation ,9 ?is section1 ! t]m t>get total m$ical assi/ance exp5ditures means1 = a ,/ate = a fiscal ye> & subject to p>agraph 7#d71 ! sum ( ! products1 = ea* ( ! #aijc;,a enrollee categories 7z def9$ 9 subsection 7e77#b771 (-- 7,a7 ! t>get p] capita m$ical assi/ance exp5ditures 7z def9$ 9 p>agraph 7#b77 = ! enrollee category1 ,/ate1 & fiscal ye>2 & 7,b7 ! numb] ( #aijc;,a enrollees = su* enrollee category1 ,/ate1 & fiscal ye>1 z det]m9$ "u subsection 7e77#d74 7#b7 ,t>get p] capita m$ical assi/ance exp5ditures ,9 ?is subsection1 ! t]m #8t>get p] capita m$ical assi/ance exp5ditures' means1 = a #aijc;,a enrollee category & ,/ate-- 7,a7 = fiscal ye> #bjbj1 an am\nt equal to-- 7i7 ! provisional ,,fy#ai t>get p] capita am\nt = su* enrollee category 7z calculat$ "u subsection 7d77#e77 = ! ,/ate2 increas$ by 7ii7 ! applicable annual inflation factor 7z def9$ 9 p>agraph 7#c77 = fiscal ye> #bjbj2 & 7,b7 = ea* succe$+ fiscal ye>1 an am\nt equal to-- 7i7 ! t>get p] capita m$ical assi/ance exp5ditures 7"u subp>agraph 7,a7 or ?is subp>agraph7 = ! #aijc;,a enrollee category & ,/ate = ! prec$+ fiscal ye>1 increas$ by 7ii7 ! applicable annual inflation factor = t succe$+ fiscal ye>4 7#c7 ,applicable annual inflation factor ,9 p>agraph 7#b71 ! t]m applicable annual inflation factor means1 = a fiscal ye>-- 7,a7 = ea* ( ! #aijc;,a enrollee categories describ$ 9 subp>agraphs 7,c71 7,d71 & 7,e7 ( subsection 7e77#b71 ! p]c5tage increase 9 ! m$ical c>e compon5t ( ! consum] price index = all urban consum]s 7,u4,s4 city av]age7 f ,septemb] ( ! previ\s fiscal ye> to ,septemb] ( ! fiscal ye> involv$2 & 7,b7 = ea* ( ! #aijc;,a enrollee categories describ$ 9 subp>agraphs 7,a7 & 7,b7 ( subsection 7e77#b71 ! p]c5tage increase describ$ 9 subp>agraph 7,a7 plus #a p]c5tage po9t4 7#d7 ,decrease 9 t>get exp5ditures = requir$ exp5ditures by c]ta9 political subdivisions 7,a7 ,9 g5]al ,9 ! case ( a ,/ate t _h a ,,d% allotm5t "u section #aibc7;f7 = fiscal ye> #bjaf t 0 m ?an #f times ! national av]age ( su* allotm5ts = all ! ,/ates = su* fiscal ye> & t requires political subdivisions )9 ! ,/ate to contribute funds t[>ds m$ical assi/ance or o!r exp5ditures "u ! ,/ate plan "u ?is title 7or "u a waiv] ( su* plan7 = a fiscal ye> 7beg9n+ ) fiscal ye> #bjbj71 ! t>get total m$ical assi/ance exp5ditures = su* ,/ate & fiscal ye> %all be decreas$ by ! am\nt t political subdivisions 9 ! ,/ate are requir$ to contribute "u ! plan 7or waiv]7 )\t reimbursem5t f ! ,/ate = su* fiscal ye>1 o!r ?an contributions describ$ 9 subp>agraph 7,b74 7,b7 ,exceptions ,! contributions describ$ 9 ?is subp>agraph are ! foll[+3 7i7 ,contributions requir$ by a ,/ate f a political subdivision t1 z ( ! fir/ day ( ! cal5d> ye> 9 :i* ! fiscal ye> involv$ beg9s-- 7,i7 has a population ( m ?an #e1jjj1jjj1 z e/imat$ by ! ,bureau ( ! ,c5sus2 & 7,,ii7 imposes a local income tax ^u its resid5ts4 7ii7 ,contributions requir$ by a ,/ate f a political subdivision = adm9i/rative exp5ses if ! ,/ate requir$ su* contributions f su* subdivision )\t reimbursem5t f ! ,/ate z ( ,janu>y #a1 #bjag4 7d7 ,calculation ( ,,fy#ai provisional t>get am\nt = ea* #aijc;,a enrollee category ,subject to subsection 7g71 ! foll[+ %all apply3 7#a7 ,calculation ( base am\nts = fiscal ye> #bjaf ,= ea* ,/ate ! ,secret>y %all calculate 7& provide notice to ! ,/ate n lat] ?an ,april #a1 #bjah1 (7 ! foll[+3 7,a7 ,! am\nt ( ! adju/$ total m$ical assi/ance exp5ditures 7z def9$ 9 subsection 7b77#a77 = ! ,/ate = fiscal ye> #bjaf4 7,b7 ,! numb] ( #aijc;,a enrollees = ! ,/ate 9 fiscal ye> #bjaf 7z det]m9$ "u subsection 7e77#d774 7,c7 ,! av]age p] capita m$ical assi/ance exp5ditures = ! ,/ate = fiscal ye> #bjaf equal to-- 7i7 ! am\nt calculat$ "u subp>agraph 7,a72 divid$ by 7ii7 ! numb] calculat$ "u subp>agraph 7,b74 7#b7 ,fiscal ye> #bjai av]age p] capita am\nt bas$ on inflat+ ! fiscal ye> #bjaf am\nt to fiscal ye> #bjai by ,,cpi-m$ical ,! ,secret>y %all calculate a fiscal ye> #bjai av]age p] capita am\nt = ea* ,/ate equal to-- 7,a7 ! av]age p] capita m$ical assi/ance exp5ditures = ! ,/ate = fiscal ye> #bjaf 7calculat$ "u p>agraph 7#a77;,c772 increas$ by 7,b7 ! p]c5tage increase 9 ! m$ical c>e compon5t ( ! consum] price index = all urban consum]s 7,u4,s4 city av]age7 f ,septemb]1 #bjaf to ,septemb]1 #bjai4 7#c7 ,aggregate & av]age exp5ditures p] capita = fiscal ye> #bjai ,! ,secret>y %all calculate = ea* ,/ate ! foll[+3 7,a7 ,! am\nt ( ! adju/$ total m$ical assi/ance exp5ditures 7z def9$ 9 subsection 7b77#a77 = ! ,/ate = fiscal ye> #bjai4 7,b7 ,! numb] ( #aijc;,a enrollees = ! ,/ate 9 fiscal ye> #bjai 7z det]m9$ "u subsection 7e77#d774 7#d7 ,p] capita exp5ditures = fiscal ye> #bjai = ea* #aijc;,a enrollee category ,! ,secret>y %all calculate 7& provide notice to ea* ,/ate n lat] ?an ,janu>y #a1 #bjbj1 (7 ! foll[+3 7,a7 7i7 ,= ea* #aijc;,a enrollee category1 ! am\nt ( ! adju/$ total m$ical assi/ance exp5ditures 7z def9$ 9 subsection 7b77#a77 = ! ,/ate = fiscal ye> #bjai = individuals 9 ! enrollee category1 calculat$ by exclud+ f m$ical assi/ance exp5ditures ^? exp5ditures attributable to exp5ditures describ$ 9 clause 7iii7 or non-,,d% supplem5tal exp5ditures 7z def9$ 9 clause 7ii774 7ii7 ,9 ?is p>agraph1 ! t]m non-,,d% supplem5tal exp5diture means a paym5t to a provid] "u ! ,/ate plan 7or "u a waiv] ( ! plan7 t-- 7,i7 is n made "u section #aibc2 7,,ii7 is n made ) respect to a specific item or s]vice = an individual2 7,,iii7 is 9 addition to any paym5ts made to ! provid] "u ! plan 7or waiv]7 = any su* item or s]vice2 & 7,,iv7 complies ) ! limits = additional paym5ts to provid]s "u ! plan 7or waiv]7 impos$ pursuant to section #aijb7;a77#cj77;,a71 includ+ ! regulations specify+ upp] paym5t limits "u ! ,/ate plan 9 "p #ddg ( title #db1 ,code ( ,f$]al ,regulations 7or any successor regulations74 7iii7 ,an exp5diture describ$ 9 ?is clause is an exp5diture t meets ! crit]ia specifi$ 9 subclauses 7,i71 7,,ii71 & 7,,iii7 ( clause 7ii7 & is au?oriz$ "u section #aaae = ! purposes ( fund+ a deliv]y sy/em re=m pool1 uncomp5sat$ c>e pool1 a designat$ /ate heal? program1 or any o!r simil> exp5diture 7z def9$ by ! ,secret>y74 7,b7 ,= ea* #aijc;,a enrollee category1 ! numb] ( #aijc;,a enrollees = ! ,/ate 9 fiscal ye> #bjai 9 ! enrollee category 7z det]m9$ "u subsection 7e77#d774 7,c7 ,= fiscal ye> #bjaf1 ! ,/ate's non-,,d% supplem5tal & pool paym5t p]c5tage is equal to ! ratio 7express$ z a p]c5tage7 (-- 7i7 ! total am\nt ( non-,,d% supplem5tal exp5ditures 7z def9$ 9 subp>agraph 7,a77ii77 & paym5ts describ$ 9 subp>agraph 7,a77iii7 = ! ,/ate = fiscal ye> #bjaf2 to 7ii7 ! am\nt describ$ 9 subsection 7b77#a77;,a7 = ! ,/ate = fiscal ye> #bjaf4 7,d7 ,= ea* #aijc;,a enrollee category an av]age m$ical assi/ance exp5ditures p] capita = ! ,/ate = fiscal ye> #bjai = ! enrollee category equal to-- 7i7 ! am\nt calculat$ "u subp>agraph 7,a7 = ! ,/ate1 increas$ by ! non-,,d% supplem5tal & pool paym5t p]c5tage = ! ,/ate 7z calculat$ "u subp>agraph 7,c772 divid$ by 7ii7 ! numb] calculat$ "u subp>agraph 7,b7 = ! ,/ate = ! enrollee category4 7#e7 ,provisional ,,fy#ai p] capita t>get am\nt = ea* #aijc;,a enrollee category ,subject to subsection 7f77#b71 ! ,secret>y %all calculate = ea* ,/ate a provisional ,,fy#ai p] capita t>get am\nt = ea* #aijc;,a enrollee category equal to ! av]age m$ical assi/ance exp5ditures p] capita = ! ,/ate = fiscal ye> #bjai 7z calculat$ "u p>agraph 7#d77;,d77 = su* enrollee category multipli$ by ! ratio (-- 7,a7 ! product (-- 7i7 ! fiscal ye> #bjai av]age p] capita am\nt = ! ,/ate1 z calculat$ "u p>agraph 7#b72 & 7ii7 ! numb] ( #aijc;,a enrollees = ! ,/ate 9 fiscal ye> #bjai1 z calculat$ "u p>agraph 7#c77;,b72 to 7,b7 ! am\nt ( ! adju/$ total m$ical assi/ance exp5ditures = ! ,/ate = fiscal ye> #bjai1 z calculat$ "u p>agraph 7#c77;,a74 7e7 #aijc;,a enrollee2 #aijc;,a enrollee category ,subject to subsection 7g71 = purposes ( ?is section1 ! foll[+ %all apply3 7#a7 #aijc;,a enrollee ,! t]m #aijc;,a enrollee means1 ) respect to a ,/ate & a mon? & subject to subsection 7i77#a77;,b71 any ,m$icaid enrollee 7z def9$ 9 p>agraph 7#c77 = ! mon?1 o!r ?an su* an enrollee :o = su* mon? is 9 any ( ! foll[+ categories ( exclud$ individuals3 7,a7 ,,*ip ,an individual :o is provid$1 "u ?is title 9 ! mann] describ$ 9 section #baja7;a77#b71 *ild heal? assi/ance "u title ,,xxi4 7,b7 ,,ihs ,an individual :o receives any m$ical assi/ance "u ?is title = s]vices = :i* paym5t is made "u ! ?ird s5t5ce ( section #aije7;b74 7,c7 ,brea/ & c]vical canc] s]vices eligible individual ,an individual :o is entitl$ to m$ical assi/ance "u ?is title only pursuant to section #aijb7;a77#aj77;,a77ii77,,xviii74 7,d7 ,p>tial-b5efit enrollees ,an individual :o-- 7i7 is an ali5 :o is entitl$ to m$ical assi/ance "u ?is title only pursuant to section #aijc7v77#b72 7ii7 is entitl$ to m$ical assi/ance "u ?is title only pursuant to subclause 7,,xii7 or 7,,xxi7 ( section #aijb7;a77#aj77;,a77ii7 7or pursuant to a waiv] t provides only comp>able b5efits72 7iii7 is a dual eligible individual 7z def9$ 9 section #aiae7;h77#b77;,b77 & is entitl$ to m$ical assi/ance "u ?is title 7or "u a waiv]7 only = "s or all ( m$ic>e co/-%>+ 7z def9$ 9 section #aije7p77#c772 or 7iv7 is entitl$ to m$ical assi/ance "u ?is title & = :om ! ,/ate is provid+ a paym5t or subsidy to an employ] = cov]age ( ! individual "u a gr\p heal? plan pursuant to section #aijf or section #aijf;,a 7or pursuant to a waiv] t provides only comp>able b5efits74 7#b7 #aijc;,a enrollee category ,! t]m #aijc;,a enrollee category means ea* ( ! foll[+3 7,a7 ,eld]ly ,a category ( #aijc;,a enrollees :o are #fe ye>s ( age or old]4 7,b7 ,bl9d & disabl$ ,a category ( #aijc;,a enrollees 7n describ$ 9 ! previ\s subp>agraph7 :o are eligible = m$ical assi/ance "u ?is title on ! basis ( be+ bl9d or disabl$4 7,c7 ,*ildr5 ,a category ( #aijc;,a enrollees 7n describ$ 9 a previ\s subp>agraph7 :o are *ildr5 "u #ai ye>s ( age4 7,d7 ,expansion enrollees ,a category ( #aijc;,a enrollees 7n describ$ 9 a previ\s subp>agraph7 = :om ! am\nts exp5d$ = m$ical assi/ance are subject to an increase or *ange 9 ! ,f$]al m$ical assi/ance p]c5tage "u subsection 7y7 or 7z77#b71 respectively1 ( section #aije4 7,e7 ,o!r noneld]ly1 nondisabl$1 non-expansion adults ,a category ( #aijc;,a enrollees :o are n describ$ 9 any previ\s subp>agraph4 7#c7 ,m$icaid enrollee ,! t]m ,m$icaid enrollee means1 ) respect to a ,/ate = a mon?1 an individual :o is eligible = m$ical assi/ance = items or s]vices "u ?is title & enroll$ "u ! ,/ate plan 7or a waiv] ( su* plan7 "u ?is title = ! mon?4 7#d7 ,det]m9ation ( numb] ( #aijc;,a enrollees ,! numb] ( #aijc;,a enrollees = a ,/ate & fiscal ye>1 &1 if applicable1 = a #aijc;,a enrollee category1 is ! av]age mon?ly numb] ( ,m$icaid enrollees = su* ,/ate & fiscal ye> 7&1 if applicable1 9 su* category7 t are report$ ?r\gh ! ,,cms-#fd report "u 7& subject to audit "u7 subsection 7h74 7f7 ,special paym5t rules 7#a7 ,application 9 case ( rese>* & demon/ration projects & o!r waiv]s ,9 ! case ( a ,/ate ) a waiv] ( ! ,/ate plan approv$ "u section #aaae1 section #aiae1 or ano!r provision ( ?is title1 ?is section %all apply to m$ical assi/ance exp5ditures & m$ical assi/ance paym5ts "u ! waiv]1 9 ! same mann] z if su* exp5ditures & paym5ts _h be5 made "u a ,/ate plan "u ?is title & ! limitations on exp5ditures "u ?is section %all sup]s$e any o!r paym5t limitations or provisions 7includ+ limitations bas$ on a p] capita limitation7 o!rwise applicable "u su* a waiv]4 7#b7 ,treatm5t ( ,/ates exp&+ cov]age aft] fiscal ye> #bjaf ,9 ! case ( a ,/ate t did n provide = m$ical assi/ance = ! #aijc;,a enrollee category describ$ 9 subsection 7e77#b77;,d7 dur+ fiscal ye> #bjaf b :i* provides = su* assi/ance = su* category 9 a subsequ5t ye>1 ! provisional ,,fy#ai p] capita t>get am\nt = su* enrollee category "u subsection 7d77#e7 %all be equal to ! provisional ,,fy#ai p] capita t>get am\nt = ! #aijc;,a enrollee category describ$ 9 subsection 7e77#b77;,e74 7#c7 ,9 case ( ,/ate failure to report necess>y data ,if a ,/ate = any qu>t] 9 a fiscal ye> 7beg9n+ ) fiscal ye> #bjai7 fails to satisfactorily submit data on exp5ditures & enrollees 9 accordance ) subsection 7h77#a71 = su* fiscal ye> & any succe$+ fiscal ye> = :i* su* data are n satisfactorily submitt$-- 7,a7 ! ,secret>y %all calculate & apply subsections 7a7 ?r\gh 7e7 ) respect to ! ,/ate z if all #aijc;,a enrollee categories = :i* su* exp5diture & enrollee data 7 n satisfactorily submitt$ 7 a s+le #aijc;,a enrollee category2 & 7,b7 ! gr[? factor o!rwise appli$ "u subsection 7c77#b77;,b7 %all be decreas$ by #a p]c5tage po9t4 7g7 ,recalculation ( c]ta9 am\nts = data errors ,! am\nts & p]c5tage calculat$ "u p>agraphs 7#a7 & 7#d77;,c7 ( subsection 7d7 = a ,/ate = fiscal ye> #bjaf1 & ! am\nts ( ! adju/$ total m$ical assi/ance exp5ditures calculat$ "u subsection 7b7 & ! numb] ( ,m$icaid enrollees & #aijc;,a enrollees det]m9$ "u subsection 7e77#d7 = a ,/ate = fiscal ye> #bjaf1 fiscal ye> #bjai1 & any subsequ5t fiscal ye>1 may be adju/$ by ! ,secret>y bas$ ^u an appeal 7fil$ by ! ,/ate 9 su* a =m1 mann]1 & "t1 & conta9+ su* in=mation relat+ to data errors t support su* appeal1 z ! ,secret>y specifies7 t ! ,secret>y det]m9es to be valid1 except t any adju/m5t by ! ,secret>y "u ?is subsection = a ,/ate may n result 9 an increase ( ! t>get total m$ical assi/ance exp5ditures exce$+ #b p]c5t4 7h7 ,requir$ report+ & audit+ ( ,,cms-#fd data2 transitional increase 9 ,f$]al mat*+ p]c5tage = c]ta9 adm9i/rative exp5ses 7#a7 ,report+ ,9 addition to ! data requir$ on =m ,gr\p ,,viii on ! ,,cms-#fd report =m z ( ,janu>y #a1 #bjag1 9 ea* ,,cms-#fd report requir$ to be submitt$ 7= ea* qu>t] beg9n+ on or aft] ,octob] #a1 #bjah71 ! ,/ate %all include data on m$ical assi/ance exp5ditures )9 su* categories ( s]vices & categories ( enrollees 7includ+ ea* #aijc;,a enrollee category & ea* category ( exclud$ individuals "u subsection 7e77#a77 & ! numb]s ( enrollees )9 ea* ( su* enrollee categories1 z ! ,secret>y det]m9es are necess>y 7includ+ timely guidance publi%$ z soon z possible aft] ! date ( ! enactm5t ( ?is section7 9 ord] to implem5t ?is section & to enable ,/ates to comply ) ! requirem5t ( ?is p>agraph on a timely basis4 7#b7 ,audit+ ,! ,secret>y %all conduct = ea* ,/ate an audit ( ! numb] ( individuals & exp5ditures report$ ?r\gh ! ,,cms-#fd report = fiscal ye> #bjaf1 fiscal ye> #bjai1 & ea* subsequ5t fiscal ye>1 :i* audit may be conduct$ on a repres5tative sample 7z det]m9$ by ! ,secret>y74 7#c7 ,tempor>y increase 9 f$]al mat*+ p]c5tage to support improv$ data report+ sy/ems = fiscal ye>s #bjah & #bjai ,= am\nts exp5d$ dur+ cal5d> qu>t]s beg9n+ on or aft] ,octob] #a1 #bjag1 & be=e ,octob] #a1 #bjai-- 7,a7 ! ,f$]al mat*+ p]c5tage appli$ "u section #aijc7;a77#c77;,a77i7 %all be increas$ by #aj p]c5tage po9ts to #ajj p]c5t2 7,b7 ! ,f$]al mat*+ p]c5tage appli$ "u section #aijc7;a77#c77;,b7 %all be increas$ by #be p]c5tage po9ts to #ajj p]c5t2 & 7,c7 ! ,f$]al mat*+ p]c5tage appli$ "u section #aijc7;a77#g7 %all be increas$ by #aj p]c5tage po9ts to #fj p]c5t b only ) respect to am\nts exp5d$ t are attributable to a ,/ate's additional adm9i/rative exp5ditures to implem5t ! data requirem5ts ( p>agraph 7#a74 7i7 ,flexible block grant option = ,/ates 7#a7 ,9 g5]al ,9 ! case ( a ,/ate t elects ! option ( apply+ ?is subsection = a #aj-;fiscal-ye> p]iod 7beg9n+ no e>li] ?an fiscal ye> #bjbj &1 at ! ,/ate option1 = any succe$+ #aj-;fiscal-ye> p]iod7 & t has a plan approv$ by ! ,secret>y "u p>agraph 7#b7 to c>ry out ! option = su* p]iod-- 7,a7 ! ,/ate %all receive1 in/ead ( am\nts o!rwise payable to ! ,/ate "u ?is title = m$ical assi/ance = block grant individuals )9 ! applicable block grant category 7z def9$ 9 p>agraph 7#f77 = ! ,/ate dur+ ! p]iod 9 :i* ! election is 9 effect1 ! am\nt specifi$ 9 p>agraph 7#d72 7,b7 ! previ\s provisions ( ?is section %all be appli$ z if-- 7i7 block grant individuals )9 ! applicable block grant category = ! ,/ate & p]iod 7 n section #aijc;,a enrollees = ea* #aj-;fiscal ye> p]iod = :i* ! ,/ate elects to apply ?is subsection2 & 7ii7 if su* option is n ext5d$ at ! end ( a #aj-;fiscal-ye>-p]iod1 ! p] capita limitations "u su* previ\s provisions %all aga9 apply aft] su* p]iod & su* limitations %all be appli$ z if ! election "u ?is subsection _h nev] tak5 place2 7,c7 ! paym5t "u ?is subsection may only be us$ consi/5t ) ! ,/ate plan "u p>agraph 7#b7 = block grant heal? c>e assi/ance 7z def9$ 9 p>agraph 7#g772 & 7,d7 ) respect to block grant individuals )9 ! applicable block grant category = ! ,/ate = :i* block grant heal? c>e assi/ance is made available "u ?is subsection1 su* assi/ance %all be in/ead ( m$ical assi/ance o!rwise provid$ to ! individual "u ?is title4 7#b7 ,/ate plan = adm9i/]+ block grant option 7,a7 ,9 g5]al ,no paym5t %all be made "u ?is subsection to a ,/ate pursuant to an election = a #aj-;fiscal-ye> p]iod "u p>agraph 7#a7 unless ! ,/ate has a plan1 approv$ "u subp>agraph 7,b71 = su* p]iod t specifies-- 7i7 ! applicable block grant category ) respect to :i* ! ,/ate w apply ! option "u ?is subsection = su* p]iod2 7ii7 ! conditions = eligibility ( block grant individuals )9 su* applicable block grant category = block grant heal? c>e assi/ance "u ! option1 :i* %all be in/ead ( o!r conditions = eligibility "u ?is title1 except t 9 ! case ( a ,/ate t has elect$ ! applicable block grant category describ$ 9-- 7,i7 subp>agraph 7,a7 ( p>agraph 7#f71 ! plan mu/ provide = eligibility = pregnant wom5 & *ildr5 requir$ to be provid$ m$ical assi/ance "u subsections 7a77#aj77;,a77i7 & 7e77#d7 ( section #aijb2 or 7,,ii7 subp>agraph 7,b7 ( p>agraph 7#f71 ! plan mu/ provide = eligibility = pregnant wom5 requir$ to be provid$ m$ical assi/ance "u subsection 7a77#aj77;,a77i72 & 7iii7 ! types ( items & s]vices1 ! am\nt1 duration1 & scope ( su* s]vices1 ! co/-%>+ ) respect to su* s]vices1 & ! me?od = deliv]y ( block grant heal? c>e assi/ance "u ?is subsection1 :i* %all be in/ead ( ! su* types1 am\nt1 duration1 & scope1 co/-%>+1 & me?ods ( deliv]y = m$ical assi/ance o!rwise requir$ "u ?is title1 except t ! plan mu/ provide = assi/ance =-- 7,i7 hospital c>e2 7,,ii7 surgical c>e & treatm5t2 7,,iii7 m$ical c>e & treatm5t2 7,,iv7 ob/etrical & pr5atal c>e & treatm5t2 7,v7 prescrib$ drugs1 m$ic9es1 & pro/hetic devices2 7,,vi7 o!r m$ical supplies & s]vices2 & 7,,vii7 heal? c>e = *ildr5 "u #ah ye>s ( age4 7,b7 ,review & approval ,a plan describ$ 9 subp>agraph 7,a7 %all be deem$ approv$ by ! ,secret>y unless ! ,secret>y det]m9es1 )9 #cj days aft] ! date ( ! ,secret>y's receipt ( ! plan1 t ! plan is incomplete or actu>ially uns\nd &1 ) respect to su* plan & its implem5tation "u ?is subsection1 ! requirem5ts ( p>agraphs 7#a71 7#aj77;,b71 7#ag71 & 7#bc7 ( section #aijb7;a7 %all n apply4 7#c7 ,am\nt ( block grant funds 7,a7 ,= initial fiscal ye> ,! block grant am\nt "u ?is p>agraph = a ,/ate = ! initial fiscal ye> 9 ! fir/ #aj-;fiscal-ye> p]iod is equal to ! sum ( ! products 7= ea* applicable block grant category = su* ,/ate & p]iod7 (-- 7i7 ! t>get p] capita m$ical assi/ance exp5ditures = su* ,/ate = su* fiscal ye> 7"u subsection 7c77#b772 7ii7 ! numb] ( #aijc;,a enrollees = su* category & ,/ate = fiscal ye> #bjai1 z det]m9$ "u subsection 7e77#d72 & 7iii7 ! ,f$]al av]age m$ical assi/ance mat*+ p]c5tage 7z def9$ 9 subsection 7a77#d77 = ! ,/ate = fiscal ye> #bjai4 7,b7 ,= any subsequ5t fiscal ye> ,! block grant am\nt "u ?is p>agraph = a ,/ate = ea* succe$+ fiscal ye> 79 any #aj-;fiscal-ye> p]iod7 is equal to ! block grant am\nt "u subp>agraph 7,a7 7or ?is subp>agraph7 = ! ,/ate = ! previ\s fiscal ye> increas$ by ! annual increase 9 ! consum] price index = all urban consum]s 7all items2 ,u4,s4 city av]age7 = ! fiscal ye> involv$4 7,c7 ,availability ( rollov] funds ,! block grant am\nt "u ?is p>agraph = a ,/ate = a fiscal ye> %all rema9 available to ! ,/ate = exp5ditures "u ?is subsection = ! succe$+ fiscal ye> b only if an election is 9 effect "u ?is subsection = ! ,/ate 9 su* succe$+ fiscal ye>4 7#d7 ,f$]al paym5t & ,/ate responsibility ,! ,secret>y %all pay to ea* ,/ate ) an election 9 effect "u ?is subsection = a fiscal ye>1 f its block grant am\nt "u p>agraph 7#c7 available = su* fiscal ye>1 an am\nt = ea* qu>t] ( su* fiscal ye> equal to ! enhanc$ ,,fmap describ$ 9 ! fir/ s5t5ce ( section #baje7;b7 ( ! total am\nt exp5d$ "u ! ,/ate plan "u ?is subsection dur+ su* qu>t]1 & ! ,/ate is responsible = ! balance ( funds to c>ry out su* plan4 7#e7 ,block grant individual def9$ ,9 ?is subsection1 ! t]m block grant individual means1 ) respect to a ,/ate = a #aj-;fiscal-ye> p]iod1 an individual :o is n disabl$ 7z def9$ = purposes ( ! ,/ate plan7 & :o is )9 an applicable block grant category = ! ,/ate & su* p]iod4 7#f7 ,applicable block grant category def9$ ,9 ?is subsection1 ! t]m applicable block grant category means ) respect to a ,/ate = a #aj-;fiscal-ye> p]iod1 ei!r ( ! foll[+ z specifi$ by ! ,/ate = su* p]iod 9 its plan "u p>agraph 7#b77;,a77i73 7,a7 #b enrollee categories ,bo? ( ! foll[+ #aijc;,a enrollee categories3 7i7 ,*ildr5 ,! #aijc;,a enrollee category specifi$ 9 subp>agraph 7,c7 ( subsection 7e77#b74 7ii7 ,o!r noneld]ly1 nondisabl$1 non-expansion adults ,! #aijc;,a enrollee category specifi$ 9 subp>agraph 7,e7 ( su* subsection4 7,b7 ,o!r noneld]ly1 nondisabl$1 non-expansion adults ,only ! #aijc;,a enrollee category specifi$ 9 subp>agraph 7,e7 ( subsection 7e77#b74 7#g7 ,block grant heal? c>e assi/ance ,9 ?is subsection1 ! t]m block grant heal? c>e assi/ance means assi/ance = heal?-c>e-relat$ items & m$ical s]vices = block grant individuals )9 ! applicable block grant category = ! ,/ate & #aj-;fiscal-ye> p]iod involv$ :o are l[-income individuals 7z def9$ by ! ,/ate74 7#h7 ,audit+ ,z a condition ( receiv+ funds "u ?is subsection1 a ,/ate %all contract ) an indep5d5t entity to conduct audits ( its exp5ditures made ) respect to activities fund$ "u ?is subsection = ea* fiscal ye> = :i* ! ,/ate elects to apply ?is subsection to ensure t su* funds are us$ consi/5t ) ?is subsection & %all make su* audits available to ! ,secret>y ^u ! reque/ ( ! ,secret>y4 4 ,d ,pati5t ,relief & ,heal? ,insurance ,m>ket ,/ability #aca4 ,repeal ( co/-%>+ subsidy 7a7 ,9 g5]al ,section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is repeal$4 7b7 ,effective date ,! repeal made by subsection 7a7 %all apply to co/-%>+ r$uctions 7& paym5ts to issu]s = su* r$uctions7 = plan ye>s beg9n+ aft] ,decemb] #ca1 #bjai4 #acb4 ,pati5t & ,/ate ,/ability ,fund ,! ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq47 is am5d$ by add+ at ! end ! foll[+ new title3 ,,xxii ,pati5t & ,/ate ,/ability ,fund #bbja4 ,e/abli%m5t ( program ,!re is h]eby e/abli%$ ! ,pati5t & ,/ate ,/ability ,fund to be adm9i/]$ by ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 79 ?is section ref]r$ to z ! ,adm9i/rator71 to provide fund+1 9 accordance ) ?is title1 to ! #ej ,/ates & ! ,di/rict ( ,columbia 7ea* ref]r$ to 9 ?is section z a ,/ate7 dur+ ! p]iod1 subject to section #bbjd7;c71 beg9n+ on ,janu>y #a1 #bjah1 & end+ on ,decemb] #ca1 #bjbf1 = ! purposes describ$ 9 section #bbjb4 #bbjb4 ,use ( funds 7a7 ,9 ,g5]al ,subject to subsections 7b7 & 7c71 a ,/ate may use ! funds allocat$ to ! ,/ate "u ?is title = any ( ! foll[+ purposes3 7#a7 ,help+1 ?r\gh ! provision ( f9ancial assi/ance1 high-risk individuals :o d n h access to heal? insurance cov]age (f]$ ?r\gh an employ] enroll 9 heal? insurance cov]age 9 ! individual m>ket 9 ! ,/ate1 z su* m>ket is def9$ by ! ,/ate 7:e!r ?r\gh ! e/abli%m5t ( a new me*anism or ma9t5ance ( an exi/+ me*anism = su* purpose74 7#b7 ,provid+ inc5tives to appropriate entities to ent] into arrangem5ts ) ! ,/ate to help /abilize premiums = heal? insurance cov]age 9 ! individual m>ket1 z su* m>kets are def9$ by ! ,/ate4 7#c7 ,r$uc+ ! co/ = provid+ heal? insurance cov]age 9 ! individual m>ket & small gr\p m>ket1 z su* m>kets are def9$ by ! ,/ate1 to individuals :o h1 or are project$ to h1 a high rate ( utilization ( heal? s]vices 7z measur$ by co/7 & to individuals :o h high co/s ( heal? insurance cov]age due to ! l[ d5sity population ( ! ,/ate 9 :i* !y reside4 7#d7 ,promot+ p>ticipation 9 ! individual m>ket & small gr\p m>ket 9 ! ,/ate & increas+ heal? insurance options available ?r\gh su* m>ket4 7#e7 ,promot+ access to prev5tive s]vices2 d5tal c>e s]vices 7:e!r prev5tive or m$ically necess>y72 vision c>e s]vices 7:e!r prev5tive or m$ically necess>y72 or any comb9ation ( su* s]vices4 7#f7 ,mat]nity cov]age & newborn c>e4 7#g7 ,prev5tion1 treatm5t1 or recov]y support s]vices = individuals ) m5tal or sub/ance use disord]s1 focus$ on ei!r or bo? ( ! foll[+3 7,a7 ,direct inpati5t or outpati5t cl9ical c>e = treatm5t ( addiction & m5tal illness4 7,b7 ,e>ly id5tification & int]v5tion = *ildr5 & "y adults ) s]i\s m5tal illness4 7#h7 ,provid+ paym5ts1 directly or indirectly1 to heal? c>e provid]s = ! provision ( su* heal? c>e s]vices z are specifi$ by ! ,adm9i/rator4 7#i7 ,provid+ assi/ance to r$uce out-(-pocket co/s1 su* z copaym5ts1 co9surance1 premiums1 & d$uctibles1 ( individuals enroll$ 9 heal? insurance cov]age 9 ! ,/ate4 7b7 ,requir$ use ( increase 9 allotm5t ,a ,/ate %all use ! additional allocation provid$ to ! ,/ate f ! funds appropriat$ "u ! second s5t5ce ( section #bbjd7;a7 = ea* ye> only = ! purposes describ$ 9 p>agraphs 7#f7 & 7#g7 ( subsection 7a74 7c7 ,requir$ use ( additional increase to c]ta9 waiv] ,/ates to provide f9ancial h>d%ip assi/ance ,a ,/ate %all use ! additional allocation provid$ to ! ,/ate f ! funds appropriat$ "u ! la/ s5t5ce ( section #bbjd7;a7 only 9 accordance ) su* la/ s5t5ce4 #bbjc4 ,/ate eligibility & approval2 ,default safegu>d 7a7 ,enc\rag+ ,/ate options = allocations 7#a7 ,9 g5]al ,to be eligible = an allocation ( funds "u ?is title = a ye> dur+ ! p]iod describ$ 9 section #bbja = use = "o or m purposes describ$ 9 section #bbjb1 a ,/ate %all submit to ! ,adm9i/rator an application at su* "t 7b1 9 ! case ( allocations = #bjah1 n lat] ?an #de days aft] ! date ( ! enactm5t ( ?is title &1 9 ! case ( allocations = a subsequ5t ye>1 n lat] ?an ,m>* #ca ( ! previ\s ye>7 & 9 su* =m & mann] z specifi$ by ! ,adm9i/rator & conta9+-- 7,a7 a description ( h[ ! funds w be us$ = su* purposes2 7,b7 a c]tification t ! ,/ate w make1 f non-,f$]al funds1 exp5ditures = su* purposes 9 an am\nt t is n less ?an ! ,/ate p]c5tage requir$ = ! ye> "u section #bbjd7;e77#a72 & 7,c7 su* o!r in=mation z ! ,adm9i/rator may require4 7#b7 ,automatic approval ,an application s submitt$ is approv$ unless ! ,adm9i/rator notifies ! ,/ate submitt+ ! application1 n lat] ?an #fj days aft] ! date ( ! submission ( su* application1 t ! application has be5 d5i$ = n be+ 9 compliance ) any requirem5t ( ?is title & ( ! reason = su* d5ial4 7#c7 ,"o-"t application ,if an application ( a ,/ate is approv$ = a ye>1 ) respect to a purpose describ$ 9 section #bbjb1 su* application %all be treat$ z approv$1 ) respect to su* purpose1 = ea* subsequ5t ye> ?r\gh #bjbf4 7#d7 ,treatm5t z a ,/ate ,heal? ,c>e ,program ,any program receiv+ funds f an allocation = a ,/ate "u ?is title1 includ+ pursuant to subsection 7b71 %all be consid]$ to be a ,/ate heal? c>e program = purposes ( sections #aabh1 #aabh;,a1 & #aabh;,b4 7b7 ,default ,f$]al safegu>d 7#a7 ,9 g5]al 7,a7 #bjah ,= allocations made "u ?is title = #bjah1 9 ! case ( a ,/ate t does n submit an application "u subsection 7a7 by ! #de-;day submission date applicable to su* ye> "u subsection 7a77#a7 & 9 ! case ( a ,/ate t does submit su* an application by su* date t is n approv$1 subject to section #bbjd7;e71 ! ,adm9i/rator1 9 consultation ) ! ,/ate insurance commission]1 %all use ! allocation t w\ld o!rwise be provid$ to ! ,/ate "u ?is title = su* ye>1 9 accordance ) p>agraph 7#b71 = su* ,/ate4 7,b7 #bjai ?r\gh #bjbf ,9 ! case ( a ,/ate t does n h 9 effect an approv$ application "u ?is section = #bjai or a subsequ5t ye> beg9n+ dur+ ! p]iod describ$ 9 section #bbja1 subject to section #bbjd7;e71 ! ,adm9i/rator1 9 consultation ) ! ,/ate insurance commission]1 %all use ! allocation t w\ld o!rwise be provid$ to ! ,/ate "u ?is title = su* ye>1 9 accordance ) p>agraph 7#b71 = su* ,/ate4 7#b7 ,requir$ use = m>ket /abilization paym5ts to issu]s ,subject to section #bbjd7;a71 an allocation = a ,/ate made pursuant to p>agraph 7#a7 = a ye> %all be us$ to c>ry out ! purpose describ$ 9 section #bbjb7b7 9 su* ,/ate by provid+ paym5ts to appropriate entities describ$ 9 su* section ) respect to claims t exce$ #ej1jjj 7or1 ) respect to allocations made "u ?is title = #bjbj or a subsequ5t ye> dur+ ! p]iod specifi$ 9 section #bbja1 su* doll> am\nt specifi$ by ! ,adm9i/rator71 b d n exce$ #cej1jjj 7or1 ) respect to allocations made "u ?is title = #bjbj or a subsequ5t ye> dur+ su* p]iod1 su* doll> am\nt specifi$ by ! ,adm9i/rator71 9 an am\nt equal to #ge p]c5t 7or1 ) respect to allocations made "u ?is title = #bjbj or a subsequ5t ye> dur+ su* p]iod1 su* p]c5tage specifi$ by ! ,adm9i/rator7 ( ! am\nt ( su* claims4 #bbjd4 ,allocations 7a7 ,appropriation ,= ! purpose ( provid+ allocations = ,/ates 7includ+ pursuant to section #bbjc7;b77 "u ?is title !re is appropriat$1 out ( any money 9 ! ,treasury n o!rwise appropriat$-- 7#a7 = #bjah1 #ae1jjj1jjj1jjj2 7#b7 = #bjai1 #ae1jjj1jjj1jjj2 7#c7 = #bjbj1 #aj1jjj1jjj1jjj2 7#d7 = #bjba1 #aj1jjj1jjj1jjj2 7#e7 = #bjbb1 #aj1jjj1jjj1jjj2 7#f7 = #bjbc1 #aj1jjj1jjj1jjj2 7#g7 = #bjbd1 #aj1jjj1jjj1jjj2 7#h7 = #bjbe1 #aj1jjj1jjj1jjj2 & 7#i7 = #bjbf1 #aj1jjj1jjj1jjj4 ,! am\nt o!rwise appropriat$ "u ! previ\s s5t5ce = #bjbj %all be increas$ by #ae1jjj1jjj1jjj1 to be us$ & available "u subsection 7d7 only = ! purposes describ$ 9 p>agraphs 7#f7 & 7#g7 ( section #bbjb7;a74 ,! am\nt o!rwise appropriat$ "u ?is subsection %all be increas$ by #h1jjj1jjj1jjj = ! p]iod beg9n+ ) #bjah & end+ ) #bjbc1 to be allocat$ to ,/ates ) a waiv] 9 effect "u section #bgja7;b7 ( ! ,public ,heal? ,s]vice ,act ) respect to ! purpose describ$ 9 p>agraph 7#a77;,c7 ( su* section1 9 accordance ) an allocation me?odology specifi$ by ! ,secret>y t takes into acc\nt ! relative allocation ( o!r am\nts appropriat$ "u ?is subsection among su* ,/ates1 & to be us$ by 7& made available "u subsection 7d71 = any ye> dur+ su* p]iod t su* waiv] is 9 effect1 to7 su* ,/ates = ! purpose ( provid+ assi/ance to r$uce premiums or o!r out-(-pocket co/s ( individuals :o are subject to an increase 9 ! mon?ly premium rate = heal? insurance cov]age z a result ( su* waiv]4 7b7 ,allocations 7#a7 ,paym5t 7,a7 ,9 g5]al ,f am\nts appropriat$ "u subsection 7a7 = a ye>1 ! ,adm9i/rator %all1 ) respect to a ,/ate & n lat] ?an ! date specifi$ "u subp>agraph 7,b7 = su* ye>1 allocate1 subject to subsection 7e71 = su* ,/ate 7includ+ pursuant to section #bbjc7;b77 ! am\nt det]m9$ = su* ,/ate & ye> "u p>agraph 7#b74 7,b7 ,specifi$ date ,= purposes ( subp>agraph 7,a71 ! date specifi$ 9 ?is subp>agraph is-- 7i7 = #bjah1 ! date t is #de days aft] ! date ( ! enactm5t ( ?is title2 & 7ii7 = #bjai & subsequ5t ye>s1 ,janu>y #a ( ! respective ye>4 7#b7 ,allocation am\nt det]m9ations 7,a7 ,= #bjah & #bjai 7i7 ,9 g5]al ,= purposes ( p>agraph 7#a71 ! am\nt det]m9$ "u ?is p>agraph = #bjah & #bjai = a ,/ate is an am\nt equal to ! sum (-- 7,i7 ! relative incurr$ claims am\nt describ$ 9 clause 7ii7 = su* ,/ate & ye>2 & 7,,ii7 ! relative un9sur$ & issu] p>ticipation am\nt describ$ 9 clause 7iv7 = su* ,/ate & ye>4 7ii7 ,relative incurr$ claims am\nt ,= purposes ( clause 7i71 ! relative incurr$ claims am\nt describ$ 9 ?is clause = a ,/ate = #bjah & #bjai is ! product (-- 7,i7 #he p]c5t ( ! am\nt appropriat$ "u subsection 7a7 = ! ye>2 & 7,,ii7 ! relative ,/ate incurr$ claims proportion describ$ 9 clause 7iii7 = su* ,/ate & ye>4 7iii7 ,relative ,/ate incurr$ claims proportion ,! relative ,/ate incurr$ claims proportion describ$ 9 ?is clause = a ,/ate & ye> is ! am\nt equal to ! ratio (-- 7,i7 ! adju/$ incurr$ claims by ! ,/ate1 z report$ ?r\gh ! m$ical loss ratio annual report+ "u section #bgah ( ! ,public ,heal? ,s]vice ,act = ! ?ird previ\s ye>2 to 7,,ii7 ! sum ( su* adju/$ incurr$ claims = all ,/ates1 z s report$1 = su* ?ird previ\s ye>4 7iv7 ,relative un9sur$ & issu] p>ticipation am\nt ,= purposes ( clause 7i71 ! relative un9sur$ & issu] p>ticipation am\nt describ$ 9 ?is clause = a ,/ate = #bjah & #bjai is ! product (-- 7,i7 #ae p]c5t ( ! am\nt appropriat$ "u subsection 7a7 = ! ye>2 & 7,,ii7 ! relative ,/ate un9sur$ & issu] p>ticipation proportion describ$ 9 clause 7v7 = su* ,/ate & ye>4 7v7 ,relative ,/ate un9sur$ & issu] p>ticipation proportion ,! relative ,/ate un9sur$ & issu] p>ticipation proportion describ$ 9 ?is clause = a ,/ate & ye> is-- 7,i7 9 ! case ( a ,/ate n describ$ 9 clause 7vi7 = su* ye>1 #j2 & 7,,ii7 9 ! case ( a ,/ate describ$ 9 clause 7vi7 = su* ye>1 ! am\nt equal to ! ratio (-- 7aa7 ! numb] ( individuals resid+ 9 su* ,/ate :o = ! ?ird prec$+ ye> 7 n enroll$ 9 a heal? plan or o!rwise did n h heal? insurance cov]age 7includ+ ?r\gh a ,f$]al or ,/ate heal? program7 & ^: income is bel[ #ajj p]c5t ( ! pov]ty l9e applicable to a family ( ! size involv$2 to 7bb7 ! sum ( ! numb] ( su* individuals = all ,/ates describ$ 9 clause 7vi7 = ! ?ird prec$+ ye>4 7vi7 ,/ates describ$ ,= purposes ( clause 7v71 a ,/ate is describ$ 9 ?is clause1 ) respect to #bjah & #bjai1 if ! ,/ate satisfies ei!r ( ! foll[+ crit]ion3 7,i7 ,! ratio describ$ 9 subclause 7,,ii7 ( clause 7v7 t w\ld be det]m9$ = su* ,/ate by sub/itut+ #bjae = ea* ref]5ce 9 su* subclause to ! ?ird prec$+ ye> & by sub/itut+ all su* ,/ates = ! ref]5ce 9 item 7bb7 ( su* subclause to all ,/ates describ$ 9 clause 7vi7 is great] ?an ! ratio describ$ 9 su* subclause t w\ld be det]m9$ = su* ,/ate by sub/itut+ #bjac = ea* ref]5ce 9 su* subclause to ! ?ird prec$+ ye> & by sub/itut+ all su* ,/ates = ! ref]5ce 9 item 7bb7 ( su* subclause to all ,/ates describ$ 9 clause 7vi74 7,,ii7 ,! ,/ate has few] ?an ?ree heal? insurance issu]s (f]+ qualifi$ heal? plans ?r\gh ! ,ex*ange = #bjag4 7,b7 ,= #bjbj ?r\gh #bjbf ,= purposes ( p>agraph 7#a71 ! am\nt det]m9$ "u ?is p>agraph = a ye> 7beg9n+ ) #bjbj7 dur+ ! p]iod describ$ 9 section #bbja = a ,/ate is an am\nt det]m9$ 9 accordance ) an allocation me?odology specifi$ by ! ,adm9i/rator :i*-- 7i7 takes into consid]ation ! adju/$ incurr$ claims ( su* ,/ate1 ! numb] ( resid5ts ( su* ,/ate :o = ! previ\s ye> 7 n enroll$ 9 a heal? plan or o!rwise did n h heal? insurance cov]age 7includ+ ?r\gh a ,f$]al or ,/ate heal? program7 & ^: income is bel[ #ajj p]c5t ( ! pov]ty l9e applicable to a family ( ! size involv$1 & ! numb] ( heal? insurance issu]s p>ticipat+ 9 ! insurance m>ket 9 su* ,/ate = su* ye>2 7ii7 is e/abli%$ aft] consultation ) heal? c>e consum]s1 heal? insurance issu]s1 ,/ate insurance commission]s1 & o!r /akehold]s & aft] tak+ into consid]ation additional co/ & risk factors t may inhibit heal? c>e consum] & heal? insurance issu] p>ticipation2 & 7iii7 reflects ! goals ( improv+ ! heal? insurance risk pool1 promot+ a m competitive heal? insurance m>ket1 & increas+ *oice = heal? c>e consum]s4 7c7 ,annual di/ribution ( previ\s ye>'s rema9+ funds ,9 c>ry+ out subsection 7b71 ! ,adm9i/rator %all1 ) respect to a ye> 7beg9n+ ) #bjbj & end+ ) #bjbg71 n lat] ?an ,m>* #ca ( su* ye>-- 7#a7 det]m9e ! am\nt ( funds1 if any1 f ! am\nts appropriat$ "u subsection 7a7 = ! previ\s ye> b n allocat$ = su* previ\s ye>2 & 7#b7 if ! ,adm9i/rator det]m9es t any funds 7 n s allocat$ = su* previ\s ye>1 allocate su* rema9+ funds1 9 accordance ) ! allocation me?odology specifi$ pursuant to subsection 7b77#b77;,b7-- 7,a7 to ,/ates t h submitt$ an application approv$ "u section #bbjc7;a7 = su* previ\s ye> = any purpose = :i* su* an application 0 approv$2 & 7,b7 = ,/ates = :i* allocations 7 made pursuant to section #bbjc7;b7 = su* previ\s ye>1 to be us$ by ! ,adm9i/rator = su* ,/ates1 to c>ry out ! ,f$]al ,invisible ,risk ,%>+ ,program 9 su* ,/ates "u section #bbje2 )1 respect to a ye> be=e #bjbg1 any rema9+ funds be+ made available = allocations to ,/ates = ! subsequ5t ye>4 7d7 ,availability ,am\nts appropriat$ "u subsection 7a7 = a ye> & allocat$ to ,/ates 9 accordance ) ?is section %all rema9 available = exp5diture ?r\gh ,decemb] #ca1 #bjbg4 7e7 ,conditions = & limitations on receipt ( funds ,! ,secret>y may n make an allocation "u ?is title = a ,/ate1 ) respect to a purpose describ$ 9 section #bbjb-- 7#a7 9 ! case ( an allocation t w\ld be made to a ,/ate pursuant to section #bbjc7;a71 if ! ,/ate does n agree t ! ,/ate w make available non-,f$]al contributions t[>ds su* purpose 9 an am\nt equal to-- 7,a7 = #bjbj1 #g p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,b7 = #bjba1 #ad p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,c7 = #bjbb1 #ba p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,d7 = #bjbc1 #bh p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,e7 = #bjbd1 #ce p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,f7 = #bjbe1 #db p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 & 7,g7 = #bjbf1 #ej p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7#b7 9 ! case ( an allocation t w\ld be made = a ,/ate pursuant to section #bbjc7;b71 if ! ,/ate does n agree t ! ,/ate w make available non-,f$]al contributions t[>ds su* purpose 9 an am\nt equal to-- 7,a7 = #bjbj1 #aj p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,b7 = #bjba1 #bj p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 & 7,c7 = #bjbb1 #cj p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,d7 = #bjbc1 #dj p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,e7 = #bjbd1 #ej p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 7,f7 = #bjbe1 #ej p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 & 7,g7 = #bjbf1 #ej p]c5t ( ! am\nt allocat$ "u ?is subsection to su* ,/ate = su* ye> & purpose2 or 7#c7 if su* an allocation = su* purpose w\ld n be p]mitt$ "u subsection 7c77#g7 ( section #baje if su* allocation 7 paym5t made "u su* section4 #bbje4 ,f$]al ,invisible ,risk ,%>+ ,program 7a7 ,9 g5]al ,!re is e/abli%$ )9 ! ,pati5t & ,/ate ,/ability ,fund a ,f$]al ,invisible ,risk ,%>+ ,program 79 ?is section ref]r$ to z ! ,program71 to be adm9i/]$ by ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 79 ?is section ref]r$ to z ! ,adm9i/rator71 to provide paym5ts to heal? insurance issu]s ) respect to claims = eligible individuals = ! purpose ( l[]+ premiums = heal? insurance cov]age (f]$ 9 ! individual m>ket4 7b7 ,fund+ 7#a7 ,appropriation ,= ! purpose ( provid+ fund+ = ! ,program !re is appropriat$1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #ae1jjj1jjj1jjj = ! p]iod beg9n+ on ,janu>y #a1 #bjah1 & end+ on ,decemb] #ca1 #bjbf4 7#b7 ,use ( unallocat$ funds ,funds provid$ "u section #bbjd7;c77#b77;,b7 to c>ry out ?is section are 9 addition to ! am\nt appropriat$ "u p>agraph 7#a74 7c7 ,op]ation ( program 7#a7 ,9 g5]al ,! ,adm9i/rator %all e/abli%1 aft] consultation ) heal? c>e consum]s1 heal? insurance issu]s1 ,/ate insurance commission]s1 & o!r /akehold]s & aft] tak+ into consid]ation high co/ heal? conditions & o!r heal? tr5ds t g5]ate high co/1 p>amet]s = ! op]ation ( ! ,program consi/5t ) ?is section & consi/5t ) ! same limitation on paym5t ) respect to heal? insurance cov]age t applies to paym5t ) respect heal? b5efits cov]age "u section #baje7;c77#g74 7#b7 ,deadl9e = initial op]ation ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is title1 ! ,adm9i/rator %all e/abli% suffici5t p>amet]s to specify h[ ! ,program w op]ate = plan ye> #bjah4 7#c7 ,/ate op]ation ( program ,! ,adm9i/rator %all e/abli% a process = a ,/ate to op]ate ! ,program 9 su* ,/ate beg9n+ ) plan ye> #bjbj4 7d7 ,details ( program ,! p>amet]s = ! ,program %all include ! foll[+3 7#a7 ,eligible individuals ,a def9ition = eligible individuals4 7#b7 ,heal? /atus /atem5ts ,! developm5t & use ( heal? /atus /atem5ts ) respect to su* individuals4 7#c7 ,/&>ds = qualification 7,a7 ,automatic qualification ,! id5tification ( heal? conditions t automatically qualify individuals z eligible individuals at ! "t ( application = heal? insurance cov]age4 7,b7 ,volunt>y qualification ,a process "u :i* heal? insurance issu]s may volunt>ily qualify individuals1 :o d n automatically qualify "u subp>agraph 7,a71 z eligible individuals at ! "t ( application = su* cov]age4 7#d7 ,p]c5tage ( insurance premiums to be appli$ ,! p]c5tage ( ! premiums paid1 to heal? insurance issu]s = heal? insurance cov]age by eligible individuals1 t %all be collect$ & deposit$ to ! cr$it 7& available = ! use7 ( ! ,program4 7#e7 ,atta*m5t doll> am\nt & paym5t proportion ,! doll> am\nt ( claims = eligible individuals aft] :i* ! ,program w provide paym5ts to heal? insurance issu]s & ! proportion ( su* claims above su* doll> am\nt t ! ,program w pay4 4 #acc4 ,cont9u\s heal? insurance cov]age inc5tive ,subp>t ,i ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act is am5d$-- 7#a7 9 section #bgja7;a77#a77;,b71 by /rik+ su* rate & ins]t+ subject to section #bgaj;,a1 su* rate2 7#b7 by r$esignat+ ! second section #bgji z section #bgaj2 & 7#c7 by add+ at ! end ! foll[+ new section3 #bgaj;,a4 ,enc\rag+ cont9u\s heal? insurance cov]age 7a7 ,p5alty appli$ 7#a7 ,9 g5]al ,subject to ! succe$+ provisions ( ?is section1 a heal? insurance issu] (f]+ heal? insurance cov]age 9 ! individual m>ket %all1 9 ! case ( an individual :o is an applicable policyhold] ( su* cov]age ) respect to an en=cem5t p]iod applicable to enrollm5ts = a plan ye> beg9n+ ) plan ye> #bjai 7or1 9 ! case ( enrollm5ts dur+ a special enrollm5t p]iod1 beg9n+ ) plan ye> #bjah71 increase ! mon?ly premium rate o!rwise applicable to su* individual = su* cov]age dur+ ea* mon? ( su* p]iod1 by an am\nt det]m9$ "u p>agraph 7#b74 7#b7 ,am\nt ( p5alty ,! am\nt det]m9$ "u ?is p>agraph = an applicable policyhold] enroll+ 9 heal? insurance cov]age describ$ 9 p>agraph 7#a7 = a plan ye>1 ) respect to ea* mon? dur+ ! en=cem5t p]iod applicable to enrollm5ts = su* plan ye>1 is ! am\nt t is equal to #cj p]c5t ( ! mon?ly premium rate o!rwise applicable to su* applicable policyhold] = su* cov]age dur+ su* mon?4 7b7 ,def9itions ,= purposes ( ?is section3 7#a7 ,applicable policyhold] ,! t]m applicable policyhold] means1 ) respect to mon?s ( an en=cem5t p]iod & heal? insurance cov]age1 an individual :o-- 7,a7 is a policyhold] ( su* cov]age = su* mon?s2 7,b7 _c demon/rate t 7?r\gh pres5tation ( c]tifications describ$ 9 section #bgjd7;e7 or 9 su* o!r mann] z may be specifi$ 9 regulations1 su* z a return or /atem5t made "u section #fjee7;d7 or #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf71 dur+ ! look-back p]iod t is ) respect to su* en=cem5t p]iod1 !re 0 n a p]iod ( at lea/ #fc cont9u\s days dur+ :i* ! individual did n h cr$itable cov]age 7z def9$ 9 p>agraph 7#a7 ( section #bgjd7;c7 & cr$it$ 9 accordance ) p>agraphs 7#b7 & 7#c7 ( su* section72 & 7,c7 9 ! case ( an individual :o _h be5 enroll$ "u dep5d5t cov]age "u a gr\p heal? plan or heal? insurance cov]age by reason ( section #bgad & su* dep5d5t cov]age ( su* individual ceas$ because ( ! age ( su* individual1 is n enroll+ dur+ ! fir/ op5 enrollm5t p]iod foll[+ ! date on :i* su* cov]age s ceas$4 7#b7 ,look-back p]iod ,! t]m look-back p]iod means1 ) respect to an en=cem5t p]iod applicable to an enrollm5t ( an individual = a plan ye> beg9n+ ) plan ye> #bjai 7or1 9 ! case ( an enrollm5t ( an individual dur+ a special enrollm5t p]iod1 beg9n+ ) plan ye> #bjah7 9 heal? insurance cov]age describ$ 9 subsection 7a77#a71 ! #ab-mon? p]iod end+ on ! date ! individual enrolls 9 su* cov]age = su* plan ye>4 7#c7 ,en=cem5t p]iod ,! t]m en=cem5t p]iod means-- 7,a7 ) respect to enrollm5ts dur+ a special enrollm5t p]iod = plan ye> #bjah1 ! p]iod beg9n+ ) ! fir/ mon? t is dur+ su* plan ye> & t beg9s subsequ5t to su* date ( enrollm5t1 & end+ ) ! la/ mon? ( su* plan ye>2 & 7,b7 ) respect to enrollm5ts = plan ye> #bjai or a subsequ5t plan ye>1 ! #ab-mon? p]iod beg9n+ on ! fir/ day ( ! respective plan ye>4 4 #acd4 ,increas+ cov]age options ,section #acjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7 is am5d$-- 7#a7 9 subsection 7a77#c71 by ins]t+ & ) respect to a plan ye> be=e plan ye> #bjbj aft] subsection 7e72 & 7#b7 9 subsection 7d71 by add+ at ! end ! foll[+3 7#e7 ,sunset ,! provisions ( ?is subsection %all n apply aft] ,decemb] #ca1 #bjai1 & aft] su* date any ref]5ce to ?is subsection or level ( cov]age or plan describ$ 9 ?is subsection & any requirem5t "u law apply+ su* a level ( cov]age or plan %all h no =ce or effect 7& su* a requirem5t %all be appli$ z if ?is section _h be5 repeal$74 4 #ace4 ,*ange 9 p]missible age v>iation 9 heal? insurance premium rates ,section #bgja7;a77#a77;,a77iii7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg7a77#a77;,a77iii771 z ins]t$ by section #abja7d7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 is am5d$ by ins]t+ aft] 7consi/5t ) section #bgjg7;c77 ! foll[+3 or1 = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjah1 z ! ,secret>y may implem5t ?r\gh int]im f9al regulation1 #e to #a = adults 7consi/5t ) section #bgjg7;c77 or su* o!r ratio = adults 7consi/5t ) section #bgjg7;c77 z ! ,/ate involv$ may provide 7or1 9 ! case ( a ,/ate ) a waiv] "u subsection 7b7 9 effect = su* a plan ye>1 ! ratio appli$ = su* plan ye> 9 accordance ) su* waiv]74 #acf4 ,p]mitt+ ,/ates to waive c]ta9 ,,aca requirem5ts to enc\rage fair heal? insurance premiums 7a7 ,9 g5]al ,section #bgja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7b7 ,p]missible ,/ate waiv] to enc\rage fair heal? insurance premiums 7#a7 ,9 g5]al ,a ,/ate may submit an application to ! ,secret>y = "o or m ( ! foll[+ purposes3 7,a7 ,9 ! case ( plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjah1 to apply1 subject to p>agraph 7#e71 "u subsection 7a77#a77;,a77iii71 in/ead ( ! ratio specifi$ 9 su* subsection1 a high] ratio specifi$ by ! ,/ate 7consi/5t ) section #bgjg7;c774 7,b7 ,9 ! case ( plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbj1 = heal? insurance cov]age (f]$ 9 ! individual or small gr\p m>ket 9 su* ,/ate1 to apply1 subject to p>agraph 7#e71 in/ead ( ! ess5tial heal? b5efits specifi$ "u subsection 7b7 ( section #acjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 ess5tial heal? b5efits z specifi$ by ! ,/ate4 7,c7 ,9 ! case ( a ,/ate t has 9 place a program t c>ries out ! purpose describ$ 9 p>agraph 7#a7 or 7#b7 ( section #bbjb7;a7 ( ! ,social ,security ,act or p>ticipates 9 ! program e/abli%$ "u section #bbje ( su* ,act1 = heal? insurance (f]$ 9 ! individual m>ket 9 su* ,/ate1 ) respect to an individual :o is an applicable policyhold] ( su* cov]age ) respect to an en=cem5t p]iod 7z def9$ 9 section #bgaj;,a7b77 applicable to enrollm5ts = a plan ye> beg9n+ ) plan ye> #bjai 7or1 9 ! case ( enrollm5ts dur+ a special enrollm5t p]iod1 beg9n+ ) plan ye> #bjah71 to-- 7i7 subject to p>agraph 7#e71 n apply any increase to ! mon?ly premium rate t w\ld o!rwise apply "u section #bgaj;,a to su* individual = su* cov]age2 & 7ii7 in/ead1 subject to p>agraph 7#e7-- 7,i7 apply subsection 7a77#a7 z if heal? /atus 7 includ$ z a factor describ$ 9 subp>agraph 7,a7 ( su* subsection2 & 7,,ii7 n apply section #bgje7;b74 7#b7 ,default approval ,an application submitt$ "u p>agraph 7#a7 is approv$ unless ! ,secret>y notifies ! ,/ate submitt+ ! application1 n lat] ?an #fj days aft] ! date ( ! submission ( su* application1 t ! application has be5 d5i$ = n be+ 9 compliance ) any requirem5t ( p>agraph 7#c7 & ( ! reason = su* d5ial4 7#c7 ,requirem5ts ,! requirem5ts ( ?is p>agraph1 ) respect to an application submitt$ "u p>agraph 7#a71 are ! foll[+3 7,a7 ,! application is submitt$ at su* "t1 & 9 su* mann]1 z ! ,secret>y may require4 7,b7 ,! application specifies h[ ! approval ( su* application w provide = "o or m ( ! foll[+3 7i7 ,r$uc+ av]age premiums = heal? insurance cov]age 9 ! ,/ate4 7ii7 ,increas+ enrollm5t 9 heal? insurance cov]age 9 ! ,/ate4 7iii7 ,/abiliz+ ! m>ket = heal? insurance cov]age 9 ! ,/ate4 7iv7 ,/abiliz+ premiums = individuals ) pre-exi/+ conditions4 7v7 ,increas+ ! *oice ( heal? plans 9 ! ,/ate4 7,c7 ,! application specifies ! p]iod = :i* ! waiv] is to be effective1 consi/5t ) p>agraph 7#d74 7,d7 ,9 ! case ( an application = purposes ( p>agraph 7#a77;,a71 ! application specifies ! high] ratio to be appli$ pursuant to su* p>agraph4 7,e7 ,9 ! case ( an application = purposes ( p>agraph 7#a77;,b71 ! application specifies ! ess5tial heal? b5efits to be appli$ pursuant to su* p>agraph4 7,f7 ,9 ! case ( an application = purposes ( p>agraph 7#a77;,c71 ! application demon/rates t ! ,/ate has 9 place a program t c>ries out ! purpose describ$ 9 p>agraph 7#a7 or 7#b7 ( section #bbjb7;a7 ( ! ,social ,security ,act or p>ticipates 9 ! program e/abli%$ "u section #bbje ( su* ,act4 7#d7 ,t]m ( waiv] 7,a7 ,9 g5]al ,no waiv] = a ,/ate "u ?is subsection may ext5d ov] a p]iod ( long] ?an #aj ye>s unless ! ,/ate reque/s cont9uation ( su* waiv]1 & su* reque/ %all be deem$ grant$ unless ! ,secret>y1 )9 #ij days aft] ! date ( its submission to ! ,secret>y1 ei!r d5ies su* reque/ 9 writ+ or in=ms ! ,/ate 9 writ+ ) respect to any additional in=mation :i* is ne$$ 9 ord] to make a f9al det]m9ation ) respect to ! reque/4 7,b7 ,special rule ,a waiv] appli$ = by a ,/ate "u p>agraph 7#a77;,c7 may only be effective = a p]iod dur+ :i* ! ,/ate-- 7i7 has 9 place a program t c>ries out ! purpose describ$ 9 p>agraph 7#a7 or 7#b7 ( section #bbjb7;a7 ( ! ,social ,security ,act2 or 7ii7 p>ticipates 9 ! program e/abli%$ "u section #bbje ( su* ,act4 7#e7 ,non-application rules 7,a7 ,specifi$ non-application provisions ,9 no case may a waiv] = purposes ( p>agraph 7#a7 apply ) respect to any ( ! foll[+ provisions3 7i7 ,section #acja ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 to ! ext5t t su* section applies to qualifi$ heal? plans (f]$ ?r\gh ! ,,co-,,op program "u section #acbb ( su* ,act or multi-,/ate plans "u section #accd ( su* ,act4 7ii7 ,sections #acab7;d77#c77;,d71 #acca1 #accb1 #accc1 & #accd ( su* ,act4 7,b7 ,hold h>mless ,any /&>d or requirem5t adopt$ by a ,/ate pursuant to ! t]ms ( a waiv] approv$ "u ?is subsection %all be deem$ to comply ) section #abeb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act & subsection 7a7 ( section #acbd ( su* ,act1 ins(> z su* /&>d or requirem5t relates to a ,f$]al or ,/ate law describ$ 9 subsection 7b77#b7 ( su* section 7relat+ to rat+74 4 7b7 ,application to ess5tial heal? b5efits ,section #acjb7;a77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;a77#a77 is am5d$ by ins]t+ 7or1 9 ! case ( heal? insurance cov]age (f]$ 9 ! individual or small gr\p m>ket 9 a ,/ate = :i* !re is an applicable waiv] 9 effect "u section #bgja7;b7 ( ! ,public ,heal? ,s]vice ,act = a plan ye>1 ! ess5tial heal? b5efits applicable "u su* waiv]7 aft] subsection 7b74 #acg4 ,con/ructions 7a7 ,no g5d] rat+ ,no?+ 9 ?is ,act %all be con/ru$ z p]mitt+ heal? insurance issu]s to discrim9ate 9 rates = heal? insurance cov]age by g5d]4 7b7 ,no limit+ access to cov]age = individuals ) preexi/+ conditions ,no?+ 9 ?is ,act %all be con/ru$ z p]mitt+ heal? insurance issu]s to limit access to heal? cov]age = individuals ) preexi/+ conditions4 ,e ,implem5tation ,fund+ #ada4 ,am]ican ,heal? ,c>e ,implem5tation ,fund 7a7 ,9 g5]al ,!re is h]eby e/abli%$ an ,am]ican ,heal? ,c>e ,implem5tation ,fund 7ref]r$ to 9 ?is section z ! ,fund7 )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices to c>ry out sections #aba1 #acb1 #bjb1 & #bad 7includ+ ! am5dm5ts made by su* sections74 7b7 ,fund+ ,!re is appropriat$ to ! ,fund1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 #a1jjj1jjj1jjj = ,f$]al adm9i/rative exp5ses to c>ry out ! sections describ$ 9 subsection 7a7 7includ+ ! am5dm5ts made by su* sections74 ,,ii ,committee on ,ways & ,means ,a ,repeal & ,replace ( ,heal?-,relat$ ,tax ,policy #bja4 ,recapture excess advance paym5ts ( premium tax cr$its ,subp>agraph 7,b7 ( section #cf;,b7f77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new clause3 7iii7 ,nonapplicability ( limitation ,?is subp>agraph %all n apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjag1 & be=e ,janu>y #a1 #bjbj4 4 #bjb4 ,additional modifications to premium tax cr$it 7a7 ,modification ( def9ition ( qualifi$ heal? plan 7#a7 ,9 g5]al ,section #cf;,b7c77#c77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 by ins]t+ 7det]m9$ )\t reg>d to subp>agraphs 7,a71 7,c77ii71 & 7,c77iv7 ( p>agraph 7#a7 !re( & )\t reg>d to :e!r ! plan is (f]$ on an ,ex*ange7 aft] #acja7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 & 7,b7 by /rik+ %all n include & all t foll[s & ins]t+ %all n include any heal? plan t-- 7i7 is a gr&fa!r$ heal? plan or a gr&mo!r$ heal? plan1 or 7ii7 includes cov]age = abortions 7o!r ?an any abortion necess>y to save ! life ( ! "m or any abortion ) respect to a pregnancy t is ! result ( an act ( rape or ince/74 4 7#b7 ,def9ition ( gr&mo!r$ heal? plan ,section #cf;,b7c77#c7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,gr&mo!r$ heal? plan 7i7 ,9 g5]al ,! t]m gr&mo!r$ heal? plan means heal? insurance cov]age :i* is (f]$ 9 ! individual heal? insurance m>ket z ( ,octob] #a1 #bjac1 & is p]mitt$ to be (f]$ 9 su* m>ket aft] ,janu>y #a1 #bjad1 z a result ( ,,cciio guidance4 7ii7 ,,cciio guidance def9$ ,! t]m ,,cciio guidance means ! lett] issu$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices on ,novemb] #ad1 #bjac1 to ! ,/ate ,insurance ,commission]s outl9+ a transitional policy = non-gr&fa!r$ cov]age 9 ! individual heal? insurance m>ket1 z subsequ5tly ext5d$ & modifi$ 7includ+ by a communication entitl$ ,insurance ,/&>ds ,bullet9 ,s]ies--,,in=mation--,ext5sion ( ,transitional ,policy ?r\gh ,cal5d> ,ye> #bjag issu$ on ,febru>y #bi1 #bjaf1 by ! ,director ( ! ,c5t] = ,consum] ,in=mation ,insurance ,ov]sight ( su* ,c5t]s74 7iii7 ,individual heal? insurance m>ket ,! t]m individual heal? insurance m>ket means ! m>ket = heal? insurance cov]age 7z def9$ 9 section #ihcb7;b77 (f]$ to individuals o!r ?an 9 connection ) a gr\p heal? plan 7)9 ! mean+ ( section #ejjj7;b77#a774 4 7#c7 ,con=m+ am5dm5t relat$ to abortion cov]age ,section #cf;,b7c77#c7 ( su* ,code1 z am5d$ by p>agraph 7#b71 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,c]ta9 rules relat$ to abortion 7i7 ,option to pur*ase sep>ate cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all be con/ru$ z prohibit+ any individual f pur*as+ sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a heal? plan t includes su* abortions1 s long z no cr$it is all[$ "u ?is section ) respect to ! premiums = su* cov]age or plan4 7ii7 ,option to (f] cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all re/rict any heal? insurance issu] (f]+ a heal? plan f (f]+ sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a plan t includes su* abortions1 s long z premiums = su* sep>ate cov]age or plan are n paid = ) any am\nt attributable to ! cr$it all[$ "u ?is section 7or ! am\nt ( any advance paym5t ( ! cr$it "u section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act74 7iii7 ,o!r treatm5ts ,! treatm5t ( any infection1 injury1 disease1 or disord] t has be5 caus$ by or exac]bat$ by ! p]=mance ( an abortion %all n be treat$ z an abortion = purposes ( subp>agraph 7,a74 4 7#d7 ,con=m+ am5dm5ts relat$ to (f-,ex*ange cov]age 7,a7 ,advance paym5t n applicable ,section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is am5d$ by add+ at ! end ! foll[+ new subsection3 7f7 ,exclusion ( (f-,ex*ange cov]age ,advance paym5ts "u ?is section1 & advance det]m9ations "u section #adaa1 ) respect to any cr$it all[$ "u section #cf;,b %all n be made ) respect to any heal? plan :i* is n enroll$ 9 ?r\gh an ,ex*ange4 4 7,b7 ,report+ ,section #fjee7;b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,in=mation relat+ to (f-,ex*ange premium cr$it eligible cov]age ,if m9imum ess5tial cov]age provid$ to an individual "u subsection 7a7 consi/s ( a qualifi$ heal? plan 7z def9$ 9 section #cf;,b7c77#c77 :i* is n enroll$ 9 ?r\gh an ,ex*ange e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 a return describ$ 9 ?is subsection %all include-- 7,a7 a /atem5t t su* plan is a qualifi$ heal? plan 7z def9$ 9 section #cf;,b7c77#c771 7,b7 ! premiums paid ) respect to su* cov]age1 7,c7 ! mon?s dur+ :i* su* cov]age is provid$ to ! individual1 7,d7 ! adju/$ mon?ly premium = ! applicable second l[e/ co/ silv] plan 7z def9$ 9 section #cf;,b7b77#c77 = ea* su* mon? ) respect to su* individual1 & 7,e7 su* o!r in=mation z ! ,secret>y may prescribe4 4 7,c7 ,o!r con=m+ am5dm5ts 7i7 ,section #cf;,b7b77#b77;,a7 ( su* ,code is am5d$ by /rik+ & :i* 7 enroll$ & all t foll[s & ins]t+ 1 or4 7ii7 ,section #cf;,b7b77#c77;,b77i7 ( su* ,code is am5d$ by /rik+ ! same ,ex*ange & all t foll[s & ins]t+ ! ,ex*ange ?r\gh :i* su* taxpay] is p]mitt$ to obta9 cov]age1 &4 7iii7 ,section #cf;,b7c77#b77;,a77i7 ( su* ,code is am5d$ by /rik+ t 0 enroll$ 9 ?r\gh an ,ex*ange e/abli%$ by ! ,/ate "u section #acaa ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 7b7 ,modification ( applicable p]c5tage ,section #cf;,b7b77#c77;,a7 ( su* ,code is am5d$ to read z foll[s3 7,a7 ,applicable p]c5tage 7i7 ,9 g5]al ,! applicable p]c5tage = any taxable ye> %all be ! p]c5tage su* t ! applicable p]c5tage = any taxpay] ^: h\sehold income is )9 an income ti] specifi$ 9 ! foll[+ table %all increase1 on a slid+ scale 9 a l9e> mann]1 f ! initial p]c5tage to ! f9al p]c5tage specifi$ 9 su* table = su* income ti] ) respect to a taxpay] ( ! age involv$3 ,9 ! case ( h\sehold income 7express$ z a p]c5t ( ! pov]ty l9e7 )9 ! foll[+ income ti]3,up to ,age #bi;,age #cj-ci;,age #dj-di;,age #ej-ei,ov] ,age #ei ,initial ,f9al ,initial ,f9al ,initial ,f9al ,initial ,f9al ,initial ,f9al ,up to #accbbbbbbbbbb #acc-aejcdcdcdcdcd #aej-bjjdd4cde4cdf4cdg4cdh4c #bjj-bejd4cd4ce4ce4if4ch4jeg4cih4caj #bej-cjjd4cd4ce4ie4ih4jeh4ceiaj4eajaa4e #cjj-djjd4cd4ce4ie4ih4ceh4ceaj4eaj4eaa4e aa4e 7ii7 ,age det]m9ations 7,i7 ,9 g5]al ,= purposes ( clause 7i71 ! age ( ! taxpay] tak5 into acc\nt "u clause 7i7 ) respect to any taxable ye> is ! age atta9$ by su* taxpay] be=e ! close ( su* taxable ye>4 7,,ii7 ,jo9t returns ,9 ! case ( a jo9t return1 ! age ( ! old] sp\se %all be tak5 into acc\nt "u clause 7i74 7iii7 ,index+ ,9 ! case ( any taxable ye> beg9n+ 9 cal5d> ye> #bjai1 ! initial & f9al p]c5tages conta9$ 9 clause 7i7 %all be adju/$ to reflect-- 7,i7 ! excess 7if any7 ( ! rate ( premium gr[? = ! p]iod beg9n+ ) cal5d> ye> #bjac & end+ ) cal5d> ye> #bjah1 ov] ! rate ( income gr[? = su* p]iod1 & 7,,ii7 9 addition to any adju/m5t "u subclause 7,i71 ! excess 7if any7 ( ! rate ( premium gr[? = cal5d> ye> #bjah1 ov] ! rate ( gr[? 9 ! consum] price index = cal5d> ye> #bjah4 7iv7 ,failsafe ,clause 7iii77,,ii7 %all apply only if ! aggregate am\nt ( premium tax cr$its "u ?is section & co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act = cal5d> ye> #bjah exce$s an am\nt equal to #j4ejd p]c5t ( ! gross dome/ic product = su* cal5d> ye>4 4 7c7 ,effective date 7#a7 ,9 g5]al ,except z o!rwise provid$ 9 ?is subsection1 ! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjag4 7#b7 ,advance paym5t n applicable to (f-,ex*ange cov]age ,! am5dm5t made by subsection 7a77#d77;,a7 %all take effect on ,janu>y #a1 #bjah4 7#c7 ,report+ ,! am5dm5t made by subsection 7a77#d77;,b7 %all apply to cov]age provid$ = mon?s beg9n+ aft] ,decemb] #ca1 #bjag4 7#d7 ,modification ( applicable p]c5tage ,! am5dm5t made by subsection 7b7 %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjah4 #bjc4 ,small bus9ess tax cr$it 7a7 ,9 g5]al ,section #de,r ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,%all n apply ,?is section %all n apply ) respect to am\nts paid or incurr$ 9 taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjai4 4 7b7 ,disall[ance ( small employ] heal? insurance exp5se cr$it = plan :i* includes cov]age = abortion ,subsection 7h7 ( section #de,r ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7#a7 by /rik+ ,any t]m & ins]t+ ! foll[+3 7#a7 ,9 g5]al ,any t]m 2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,exclusion ( heal? plans includ+ cov]age = abortion 7,a7 ,9 g5]al ,! t]m qualifi$ heal? plan does n include any heal? plan t includes cov]age = abortions 7o!r ?an any abortion necess>y to save ! life ( ! "m or any abortion ) respect to a pregnancy t is ! result ( an act ( rape or ince/74 7,b7 ,c]ta9 rules relat$ to abortion 7i7 ,option to pur*ase sep>ate cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all be con/ru$ z prohibit+ any employ] f pur*as+ = its employees sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a heal? plan t includes su* abortions1 s long z no cr$it is all[$ "u ?is section ) respect to ! employ] contributions = su* cov]age or plan4 7ii7 ,option to (f] cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all re/rict any heal? insurance issu] (f]+ a heal? plan f (f]+ sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a plan t includes su* abortions1 s long z su* sep>ate cov]age or plan is n paid = ) any employ] contribution eligible = ! cr$it all[$ "u ?is section4 7iii7 ,o!r treatm5ts ,! treatm5t ( any infection1 injury1 disease1 or disord] t has be5 caus$ by or exac]bat$ by ! p]=mance ( an abortion %all n be treat$ z an abortion = purposes ( subp>agraph 7,a74 4 7c7 ,effective dates 7#a7 ,9 g5]al ,! am5dm5t made by subsection 7a7 %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjai4 7#b7 ,disall[ance ( small employ] heal? insurance exp5se cr$it = plan :i* includes cov]age = abortion ,! am5dm5ts made by subsection 7b7 %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjag4 #bjd4 ,individual m&ate 7a7 ,9 g5]al ,section #ejjj;,a7c7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7#a7 9 p>agraph 7#b77;,b77iii71 by /rik+ #b4e p]c5t & ins]t+ ,z]o p]c5t1 & 7#b7 9 p>agraph 7#c7-- 7,a7 by /rik+ #fie 9 subp>agraph 7,a7 & ins]t+ #j1 & 7,b7 by /rik+ subp>agraph 7,d74 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to mon?s beg9n+ aft] ,decemb] #ca1 #bjae4 #bje4 ,employ] m&ate 7a7 ,9 g5]al 7#a7 ,p>agraph 7#a7 ( section #dihj;,h7c7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ 7#j 9 ! case ( mon?s beg9n+ aft] ,decemb] #ca1 #bjae7 aft] #b1jjj4 7#b7 ,p>agraph 7#a7 ( section #dihj;,h7b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ 7#j 9 ! case ( mon?s beg9n+ aft] ,decemb] #ca1 #bjae7 aft] #c1jjj4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to mon?s beg9n+ aft] ,decemb] #ca1 #bjae4 #bjf4 ,repeal ( ! tax on employee heal? insurance premiums & heal? plan b5efits ,section #dihj;,i ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7h7 ,%all n apply ,no tax %all be impos$ "u ?is section ) respect to any taxable p]iod beg9n+ aft] ,decemb] #ca1 #bjai1 & be=e ,janu>y #a1 #bjbf4 4 #bjg4 ,repeal ( tax on ov]-!-c\nt] m$ications 7a7 ,h,s,as ,subp>agraph 7,a7 ( section #bbc7;d77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ ,su* t]m & all t foll[s ?r\gh ! p]iod4 7b7 ,ar*] ,m,s,as ,subp>agraph 7,a7 ( section #bbj7;d77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ ,su* t]m & all t foll[s ?r\gh ! p]iod4 7c7 ,heal? flexible sp5d+ arrangem5ts & heal? reimbursem5t arrangem5ts ,section #ajf ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ subsection 7f7 & by r$esignat+ subsection 7g7 z subsection 7f74 7d7 ,effective dates 7#a7 ,di/ributions f sav+s acc\nts ,! am5dm5ts made by subsections 7a7 & 7b7 %all apply to am\nts paid ) respect to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 7#b7 ,reimbursem5ts ,! am5dm5t made by subsection 7c7 %all apply to exp5ses incurr$ ) respect to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 #bjh4 ,repeal ( increase ( tax on heal? sav+s acc\nts 7a7 ,h,s,as ,section #bbc7;f77#d77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #bj p]c5t & ins]t+ #aj p]c5t4 7b7 ,ar*] ,m,s,as ,section #bbj7;f77#d77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #bj p]c5t & ins]t+ #ae p]c5t4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to di/ributions made aft] ,decemb] #ca1 #bjaf4 #bji4 ,repeal ( limitations on contributions to flexible sp5d+ acc\nts 7a7 ,9 g5]al ,section #abe ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ subsection 7i74 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 #baj4 ,repeal ( m$ical device excise tax ,section #daia ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7d7 ,applicability ,! tax impos$ "u subsection 7a7 %all n apply to sales aft] ,decemb] #ca1 #bjaf4 4 #baa4 ,repeal ( elim9ation ( d$uction = exp5ses allocable to m$ic>e "p ,d subsidy 7a7 ,9 g5]al ,section #aci;,a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new s5t5ce3 ,?is section %all n be tak5 into acc\nt = purposes ( det]m9+ :e!r any d$uction is all[able ) respect to any co/ tak5 into acc\nt 9 det]m9+ su* paym5t44 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 #bab4 ,r$uction ( income ?re%old = det]m9+ m$ical c>e d$uction 7a7 ,9 g5]al ,subsection 7a7 ( section #bac ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #aj p]c5t & ins]t+ #e4h p]c5t4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 #bac4 ,repeal ( ,m$ic>e tax increase 7a7 ,9 g5]al ,subsection 7b7 ( section #caja ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7b7 ,hospital insurance ,9 addition to ! tax impos$ by ! prec$+ subsection1 !re is h]eby impos$ on ! income ( e individual a tax equal to #a4de p]c5t ( ! wages 7z def9$ 9 section #caba7;a77 receiv$ by su* individual ) respect to employm5t 7z def9$ 9 section #caba7;b774 4 7b7 ,,seca ,subsection 7b7 ( section #adja ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7b7 ,hospital insurance ,9 addition to ! tax impos$ by ! prec$+ subsection1 !re %all be impos$ = ea* taxable ye>1 on ! self-employm5t income ( e individual1 a tax equal to #b4i p]c5t ( ! am\nt ( ! self-employm5t income = su* taxable ye>4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to remun]ation receiv$ aft]1 & taxable ye>s beg9n+ aft]1 ,decemb] #ca1 #bjbb4 #bad4 ,refundable tax cr$it = heal? insurance cov]age 7a7 ,9 g5]al ,section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 #cf;,b4 ,refundable cr$it = cov]age "u a qualifi$ heal? plan 7a7 ,all[ance ( premium tax cr$it ,9 ! case ( an individual1 !re %all be all[$ z a cr$it aga9/ ! tax impos$ by ?is subtitle = ! taxable ye> ! sum ( ! mon?ly cr$it am\nts ) respect to su* taxpay] = cal5d> mon?s dur+ su* taxable ye> :i* are eligible cov]age mon?s appropriately tak5 into acc\nt "u subsection 7b77#b7 ) respect to ! taxpay] or any qualify+ family memb] ( ! taxpay]4 7b7 ,mon?ly cr$it am\nts 7#a7 ,9 g5]al ,! mon?ly cr$it am\nt ) respect to any taxpay] = any cal5d> mon? is ! less] (-- 7,a7 ! sum ( ! mon?ly limitation am\nts det]m9$ "u subsection 7c7 ) respect to ! taxpay] & ! taxpay]'s qualify+ family memb]s = su* mon?1 or 7,b7 ! am\nt paid = a qualifi$ heal? plan = ! taxpay] & ! taxpay]'s qualify+ family memb]s = su* mon?4 7#b7 ,eligible cov]age mon? requirem5t ,no am\nt %all be tak5 into acc\nt "u subp>agraph 7,a7 or 7,b7 ( p>agraph 7#a7 ) respect to any individual = any mon? unless su* mon? is an eligible cov]age mon? ) respect to su* individual4 7c7 ,mon?ly limitation am\nts 7#a7 ,9 g5]al ,! mon?ly limitation am\nt ) respect to any individual = any eligible cov]age mon? dur+ any taxable ye> is #a_/ab (-- 7,a7 #b1jjj 9 ! case ( an individual :o has n atta9$ age #cj z ( ! beg9n+ ( su* taxable ye>1 7,b7 #b1ejj 9 ! case ( an individual :o has atta9$ age #cj b :o has n atta9$ age #dj z ( su* "t1 7,c7 #c1jjj 9 ! case ( an individual :o has atta9$ age #dj b :o has n atta9$ age #ej z ( su* "t1 7,d7 #c1ejj 9 ! case ( an individual :o has atta9$ age #ej b :o has n atta9$ age #fj z ( su* "t1 & 7,e7 #d1jjj 9 ! case ( an individual :o has atta9$ age #fj z ( su* "t4 7#b7 ,limitation bas$ on modifi$ adju/$ gross income ,! cr$it all[$ "u subsection 7a7 ) respect to any taxpay] = any taxable ye> %all be r$uc$ 7b n bel[ z]o7 by #aj p]c5t ( ! excess 7if any7 (-- 7,a7 ! taxpay]'s modifi$ adju/$ gross income 7z def9$ 9 section #cf;,b7d77#b77;,b71 z 9 effect = taxable ye>s beg9n+ be=e ,janu>y #a1 #bjbj7 = su* taxable ye>1 ov] 7,b7 #ge1jjj 7twice su* am\nt 9 ! case ( a jo9t return74 7#c7 ,o!r limitations 7,a7 ,aggregate doll> limitation ,! sum ( ! mon?ly limitation am\nts tak5 into acc\nt "u ?is section ) respect to any taxpay] = any taxable ye> %all n exce$ #ad1jjj4 7,b7 ,maximum numb] ( individuals tak5 into acc\nt ,) respect to any taxpay] = any mon?1 mon?ly limitation am\nts %all be tak5 into acc\nt "u ?is section only ) respect to ! #e olde/ individuals ) respect to :om mon?ly limitation am\nts c\ld 7)\t reg>d to ?is subp>agraph7 o!rwise be s tak5 into acc\nt4 7d7 ,eligible cov]age mon? ,= purposes ( ?is section1 ! t]m eligible cov]age mon? means1 ) respect to any individual1 any mon? if1 z ( ! fir/ day ( su* mon?1 ! individual meets ! foll[+ requirem5ts3 7#a7 ,! individual is cov]$ by a heal? insurance cov]age :i* is c]tifi$ by ! ,/ate 9 :i* su* insurance is (f]$ z cov]age t meets ! requirem5ts = qualifi$ heal? plans "u subsection 7f74 7#b7 ,! individual is n eligible =-- 7,a7 cov]age "u a gr\p heal? plan 7)9 ! mean+ ( section #ejjj7;b77#a77 o!r ?an cov]age "u a plan sub/antially all ( ! cov]age ( :i* is ( except$ b5efits describ$ 9 section #ihcb7;c71 or 7,b7 cov]age describ$ 9 section #ejjj;,a7f77#a77;,a74 7#c7 ,! individual is ei!r-- 7,a7 a citiz5 or national ( ! ,unit$ ,/ates1 or 7,b7 a qualifi$ ali5 7)9 ! mean+ ( section #dca ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afda774 7#d7 ,! individual is n inc>c]at$1 o!r ?an inc>c]ation p5d+ ! disposition ( *>ges4 7e7 ,qualify+ family memb] ,= purposes ( ?is section1 ! t]m qualify+ family memb] means-- 7#a7 9 ! case ( a jo9t return1 ! taxpay]'s sp\se1 7#b7 any dep5d5t ( ! taxpay]1 & 7#c7 ) respect to any eligible cov]age mon?1 any *ild 7z def9$ 9 section #aeb7;f77#a77 ( ! taxpay] :o z ( ! end ( ! taxable ye> has n atta9$ age #bg if su* *ild is cov]$ = su* mon? "u a qualifi$ heal? plan :i* also cov]s ! taxpay] 79 ! case ( a jo9t return1 ei!r sp\se74 7f7 ,qualifi$ heal? plan ,= purposes ( ?is section1 ! t]m qualifi$ heal? plan means any heal? insurance cov]age 7z def9$ 9 section #ihcb7;b77 if-- 7#a7 su* cov]age is (f]$ 9 ! individual heal? insurance m>ket )9 a ,/ate 7)9 ! mean+ ( section #ejjj;,a7f77#a77;,c771 7#b7 sub/antially all ( su* cov]age is n ( except$ b5efits describ$ 9 section #ihcb7;c71 7#c7 su* cov]age does n consi/ ( %ort-t]m limit$ duration insurance 7)9 ! mean+ ( section #bgia7;b77#e7 ( ! ,public ,heal? ,s]vice ,act71 7#d7 su* cov]age is n a gr&fa!r$ heal? plan 7z def9$ 9 section #abea ( ! ,pati5t ,protection & ,af=dable ,c>e ,act7 or a gr&mo!r$ heal? plan 7z def9$ 9 section #cf;,b7c77#c77;,c7 z 9 effect = taxable ye>s beg9n+ be=e ,janu>y #a1 #bjbj71 & 7#e7 su* cov]age does n include cov]age = abortions 7o!r ?an any abortion necess>y to save ! life ( ! "m or any abortion ) respect to a pregnancy t is ! result ( an act ( rape or ince/74 7g7 ,special rules 7#a7 ,m>ri$ c\ples mu/ file jo9t return 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 if ! taxpay] is m>ri$ 7)9 ! mean+ ( section #ggjc7 at ! close ( ! taxable ye>1 no cr$it %all be all[$ "u ?is section to su* taxpay] unless su* taxpay] & ! taxpay]'s sp\se file a jo9t return = su* taxable ye>4 7,b7 ,exception = c]ta9 taxpay]s ,subp>agraph 7,a7 %all n apply to any m>ri$ taxpay] :o-- 7i7 is liv+ ap>t f ! taxpay]'s sp\se at ! "t ! taxpay] files ! tax return1 7ii7 is unable to file a jo9t return because su* taxpay] is a victim ( dome/ic abuse or sp\sal ab&onm5t1 7iii7 c]tifies on ! tax return t su* taxpay] meets ! requirem5ts ( clauses 7i7 & 7ii71 & 7iv7 has n met ! requirem5ts ( clauses 7i71 7ii71 & 7iii7 = ea* ( ! #c prec$+ taxable ye>s4 7#b7 ,d5ial ( cr$it to dep5d5ts 7,a7 ,9 g5]al ,no cr$it %all be all[$ "u ?is section to any individual :o is a dep5d5t ) respect to ano!r taxpay] = a taxable ye> beg9n+ 9 ! cal5d> ye> 9 :i* su* individual's taxable ye> beg9s4 7,b7 ,coord9ation ) rule = old] *ildr5 ,9 ! case ( any individual :o is a qualify+ family memb] describ$ 9 subsection 7e77#c7 ) respect to ano!r taxpay] = any mon?1 9 det]m9+ ! am\nt ( any cr$it all[able to su* individual "u ?is section = any taxable ye> ( su* individual :i* includes su* mon?1 ! mon?ly limitation am\nt ) respect to su* individual = su* mon? %all be z]o & no am\nt paid = any qualifi$ heal? plan ) respect to su* individual = su* mon? %all be tak5 into acc\nt4 7#c7 ,coord9ation ) m$ical exp5se d$uction ,am\nts describ$ 9 subsection 7b77#a77;,b7 ) respect to any mon? %all n be tak5 into acc\nt 9 det]m9+ ! d$uction all[$ "u section #bac except to ! ext5t t su* am\nts exce$ ! am\nt describ$ 9 subsection 7b77#a77;,a7 ) respect to su* mon?4 7#d7 ,coord9ation ) advance paym5ts ( cr$it ,) respect to any taxable ye>-- 7,a7 ! am\nt :i* w\ld 7b = ?is subsection7 be all[$ z a cr$it to ! taxpay] "u subsection 7a7 %all be r$uc$ 7b n bel[ z]o7 by ! aggregate am\nt paid on behalf ( su* taxpay] "u section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act = mon?s beg9n+ 9 su* taxable ye>1 & 7,b7 ! tax impos$ by section #a = su* taxable ye> %all be increas$ by ! excess 7if any7 (-- 7i7 ! aggregate am\nt paid on behalf ( su* taxpay] "u su* section #adab = mon?s beg9n+ 9 su* taxable ye>1 ov] 7ii7 ! am\nt :i* w\ld 7b = ?is subsection7 be all[$ z a cr$it to ! taxpay] "u subsection 7a74 7#e7 ,special rules = qualifi$ small employ] heal? reimbursem5t arrangem5ts 7,a7 ,9 g5]al ,if ! taxpay] or any qualify+ family memb] ( ! taxpay] is provid$ a qualifi$ small employ] heal? reimbursem5t arrangem5t = an eligible cov]age mon?1 ! sum det]m9$ "u subsection 7b77#a77;,a7 ) respect to ! taxpay] %all be r$uc$ 7b n bel[ z]o7 by #a_/ab ( ! p]mitt$ b5efit 7z def9$ 9 section #ihca7;d77#c77;,c77 "u su* arrangem5t = ea* su* mon? su* arrangem5t is provid$ to su* taxpay]4 7,b7 ,qualifi$ small employ] heal? reimbursem5t arrangem5t ,= purposes ( ?is p>agraph1 ! t]m qualifi$ small employ] heal? reimbursem5t arrangem5t has ! mean+ giv5 su* t]m by section #ihca7;d77#b74 7,c7 ,cov]age = less ?an entire ye> ,9 ! case ( an employee :o is provid$ a qualifi$ small employ] heal? reimbursem5t arrangem5t = less ?an an entire ye>1 subp>agraph 7,a7 %all be appli$ by sub/itut+ ! numb] ( mon?s dur+ ! ye> = :i* su* arrangem5t 0 provid$ = #ab4 7#f7 ,c]ta9 rules relat$ to nonqualifi$ heal? plans ,! rules ( section #cf;,b7c77#c77;,d71 z 9 effect = taxable ye>s beg9n+ be=e ,janu>y #a1 #bjbj1 %all apply ) respect to subsection 7f77#e74 7#g7 ,inflation adju/m5t 7,a7 ,9 g5]al ,9 ! case ( any taxable ye> beg9n+ 9 a cal5d> ye> aft] #bjbj1 ea* doll> am\nt 9 subsection 7c77#a71 ! #ge1jjj am\nt 9 subsection 7c77#b77;,b71 & ! doll> am\nt 9 subsection 7c77#c77;,a71 %all be increas$ by an am\nt equal to-- 7i7 su* doll> am\nt1 multipli$ by 7ii7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye> 9 :i* ! taxable ye> beg9s1 det]m9$-- 7,i7 by sub/itut+ cal5d> ye> #bjai = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re(1 & 7,,ii7 by sub/itut+ = ! ,,cpi ref]r$ to section #a7;f77#c77;,a7 ! am\nt t su* ,,cpi w\ld h be5 if ! annual p]c5tage increase 9 ,,cpi ) respect to ea* ye> aft] #bjai _h be5 "o p]c5tage po9t great]4 7,b7 ,t]ms relat$ to ,,cpi 7i7 ,annual p]c5tage increase ,= purposes ( subp>agraph 7,a77ii77,,ii71 ! t]m annual p]c5tage increase means ! p]c5tage 7if any7 by :i* ,,cpi = any ye> exce$s ,,cpi = ! prior ye>4 7ii7 ,o!r t]ms ,t]ms us$ 9 ?is p>agraph :i* are also us$ 9 section #a7;f77#c7 %all h ! same mean+s z :5 us$ 9 su* section4 7,c7 ,r\nd+ ,any increase det]m9$ "u subp>agraph 7,a7 %all be r\nd$ to ! ne>e/ multiple ( #ej4 7#h7 ,rules relat$ to ,/ate c]tification ( qualifi$ heal? plans ,a c]tification %all n be tak5 into acc\nt "u subsection 7d77#a7 unless su* c]tification is made available to ! public & meets su* o!r requirem5ts z ! ,secret>y may provide4 7#i7 ,regulations ,! ,secret>y may prescribe su* regulations & o!r guidance z may be necess>y or appropriate to c>ry out ?is section & section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 4 7b7 ,advance paym5t ( cr$it ,section #adab7;f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 z add$ by section #bjb1 is am5d$ to read z foll[s3 7f7 ,application to c]ta9 plans ,! ,secret>y & ! ,secret>y ( ! ,treasury %all prescribe su* regulations z ea* respective ,secret>y may deem necess>y 9 ord] to e/abli% & op]ate ! advance paym5t program e/abli%$ "u ?is section = individuals cov]$ "u qualifi$ heal? plans 7:e!r enroll$ 9 ?r\gh an ,ex*ange or o!rwise7 9 su* a mann] t protects taxpay] in=mation 7includ+ names1 taxpay] id5tification numb]s1 & o!r confid5tial in=mation71 provides robu/ v]ification ( all in=mation necess>y to e/abli% eligibility ( taxpay] = advance paym5ts "u ?is section1 ensures prop] & timely paym5ts to appropriate heal? provid]s1 & protects program integrity to ! maximum ext5t feasible4 4 7c7 ,increas$ p5alty on errone\s claims ( cr$it ,section #ffgf7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ 7#be p]c5t 9 ! case ( a claim = refund or cr$it relat+ to ! heal? insurance cov]age cr$it "u section #cf;,b74 7d7 ,report+ by employ]s ,section #fjea7;a7 ( su* ,code is am5d$ by /rik+ & at ! end ( p>agraph 7#ad71 by /rik+ ! p]iod at ! end ( p>agraph 7#ae7 & ins]t+ 1 &1 & by ins]t+ aft] p>agraph 7#ae7 ! foll[+ new p>agraph3 7#af7 ea* mon? ) respect to :i* ! employee is eligible = cov]age describ$ 9 section #cf;,b7d77#b7 9 connection ) employm5t ) ! employ]4 4 7e7 ,coord9ation ) o!r tax b5efits 7#a7 ,cr$it = heal? insurance co/s ( eligible individuals ,section #ce7;g7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ad7 ,coord9ation ) heal? insurance cov]age cr$it 7,a7 ,9 g5]al ,an eligible cov]age mon? to :i* ! election "u p>agraph 7#aa7 applies %all n be treat$ z an eligible cov]age mon? 7z def9$ 9 section #cf;,b7d77 = purposes ( section #cf;,b ) respect to ! taxpay] or any ( ! taxpay]'s qualify+ family memb]s 7z def9$ 9 section #cf;,b7e774 7,b7 ,coord9ation ) advance paym5ts ( heal? insurance cov]age cr$it ,9 ! case ( a taxpay] :o makes ! election "u p>agraph 7#aa7 ) respect to any eligible cov]age mon? 9 a taxable ye> or on behalf ( :om any advance paym5t is made "u section #gebg ) respect to any mon? 9 su* taxable ye>-- 7i7 ! tax impos$ by ?is *apt] = ! taxable ye> %all be increas$ by ! excess1 if any1 (-- 7,i7 ! sum ( any advance paym5ts made on behalf ( ! taxpay] "u section #gebg & section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 ov] 7,,ii7 ! sum ( ! cr$its all[$ "u ?is section 7det]m9$ )\t reg>d to p>agraph 7#a77 & section #cf;,b 7det]m9$ )\t reg>d to subsection 7g77#d77;,a7 !re(7 = su* taxable ye>1 & 7ii7 section #cf;,b7g77#d77;,b7 %all n apply ) respect to su* taxpay] = su* taxable ye>4 4 7#b7 ,trade or bus9ess d$uction ,section #afb7l7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,coord9ation ) heal? insurance cov]age cr$it ,! d$uction o!rwise all[able to a taxpay] "u p>agraph 7#a7 = any taxable ye> %all be r$uc$ 7b n bel[ z]o7 by ! am\nt ( ! cr$it all[able to su* taxpay] "u section #cf;,b 7det]m9$ )\t reg>d to subsection 7g77#d77;,a7 !re(7 = su* taxable ye>4 4 7f7 ,effective date ,! am5dm5ts made by ?is section %all apply to mon?s beg9n+ aft] ,decemb] #ca1 #bjai1 9 taxable ye>s end+ aft] su* date4 #bae4 ,maximum contribution limit to heal? sav+s acc\nt increas$ to am\nt ( d$uctible & out-(-pocket limitation 7a7 ,self-,only cov]age ,section #bbc7;b77#b77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #b1bej & ins]t+ ! am\nt 9 effect "u subsection 7c77#b77;,a77ii77,i74 7b7 ,family cov]age ,section #bbc7;b77#b77;,b7 ( su* ,code is am5d$ by /rik+ #d1ejj & ins]t+ ! am\nt 9 effect "u subsection 7c77#b77;,a77ii77,,ii74 7c7 ,con=m+ am5dm5ts ,section #bbc7;g77#a7 ( su* ,code is am5d$-- 7#a7 by /rik+ subsections 7b77#b7 & bo? places x appe>s & ins]t+ subsection1 & 7#b7 9 subp>agraph 7,b71 by /rik+ det]m9$ by & all t foll[s ?r\gh cal5d> ye> #bjjc4 & ins]t+ det]m9$ by sub/itut+ cal5d> ye> #bjjc = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re(44 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjag4 #baf4 ,all[ bo? sp\ses to make cat*-up contributions to ! same heal? sav+s acc\nt 7a7 ,9 g5]al ,section #bbc7;b77#e7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7#e7 ,special rule = m>ri$ individuals ) family cov]age 7,a7 ,9 g5]al ,9 ! case ( individuals :o are m>ri$ to ea* o!r1 if bo? sp\ses are eligible individuals & ei!r sp\se has family cov]age "u a high d$uctible heal? plan z ( ! fir/ day ( any mon?-- 7i7 ! limitation "u p>agraph 7#a7 %all be appli$ by n tak+ into acc\nt any o!r high d$uctible heal? plan cov]age ( ei!r sp\se 7& if su* sp\ses bo? h family cov]age "u sep>ate high d$uctible heal? plans1 only "o su* cov]age %all be tak5 into acc\nt71 7ii7 su* limitation 7aft] application ( clause 7i77 %all be r$uc$ by ! aggregate am\nt paid to ,ar*] ,m,s,as ( su* sp\ses = ! taxable ye>1 & 7iii7 su* limitation 7aft] application ( clauses 7i7 & 7ii77 %all be divid$ equally betwe5 su* sp\ses unless !y agree on a diff]5t division4 7,b7 ,treatm5t ( additional contribution am\nts ,if bo? sp\ses ref]r$ to 9 subp>agraph 7,a7 h atta9$ age #ee be=e ! close ( ! taxable ye>1 ! limitation ref]r$ to 9 subp>agraph 7,a77iii7 :i* is subject to division betwe5 ! sp\ses %all include ! additional contribution am\nts det]m9$ "u p>agraph 7#c7 = bo? sp\ses4 ,9 any o!r case1 any additional contribution am\nt det]m9$ "u p>agraph 7#c7 %all n be tak5 into acc\nt "u subp>agraph 7,a77iii7 & %all n be subject to division betwe5 ! sp\ses4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjag4 #bag4 ,special rule = c]ta9 m$ical exp5ses incurr$ be=e e/abli%m5t ( heal? sav+s acc\nt 7a7 ,9 g5]al ,section #bbc7;d77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,treatm5t ( c]ta9 m$ical exp5ses incurr$ be=e e/abli%m5t ( acc\nt ,if a heal? sav+s acc\nt is e/abli%$ dur+ ! #fj-;day p]iod beg9n+ on ! date t cov]age ( ! acc\nt b5efici>y "u a high d$uctible heal? plan beg9s1 !n1 solely = purposes ( det]m9+ :e!r an am\nt paid is us$ = a qualifi$ m$ical exp5se1 su* acc\nt %all be treat$ z hav+ be5 e/abli%$ on ! date t su* cov]age beg9s4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply ) respect to cov]age beg9n+ aft] ,decemb] #ca1 #bjag4 ,b ,repeal ( c]ta9 consum] taxes #bba4 ,repeal ( tax on prescription m$ications ,subsection 7j7 ( section #ijjh ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is am5d$ to read z foll[s3 7j7 ,repeal ,?is section %all apply to cal5d> ye>s beg9n+ aft] ,decemb] #ca1 #bjaj1 & end+ be=e ,janu>y #a1 #bjag4 4 #bbb4 ,repeal ( heal? insurance tax ,subsection 7j7 ( section #ijaj ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is am5d$ to read z foll[s3 7j7 ,repeal ,?is section %all apply to cal5d> ye>s beg9n+ aft] ,decemb] #ca1 #bjac1 & end+ be=e ,janu>y #a1 #bjag4 4 ,c ,repeal ( ,tann+ ,tax #bca4 ,repeal ( tann+ tax 7a7 ,9 g5]al ,! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ *apt] #di4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to s]vices p]=m$ aft] ,june #cj1 #bjag4 ,d ,remun]ation f ,c]ta9 ,insur]s #bda4 ,remun]ation f c]ta9 insur]s ,p>agraph 7#f7 ( section #afb7m7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,i7 ,t]m9ation ,?is p>agraph %all n apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 4 ,e ,repeal ( ,net ,inve/m5t ,income ,tax #bea4 ,repeal ( net inve/m5t income tax 7a7 ,9 g5]al ,subtitle ,a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ *apt] #b;,a4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 ,pass$ ! ,h\se ( ,repres5tatives ,may #d1 #bjag4,k>5 ,l4 ,haas1,cl]k ,june #h1 #bjag,read twice & plac$ on ! cal5d>