,i #aaeth ,,congress #ast ,session ,h4 ,r4 #bgg ,,in ,,the ,,house ,,of ,,representatives ,january #d1 #bjag,mr4 ,roe of ,tennessee 7for himself1 ,mr4 ,walker1 ,mr4 ,rokita1 ,mr4 ,gosar1 ,mr4 ,flores1 ,mr4 ,barr1 ,mr4 ,carter of ,georgia1 ,mr4 ,austin ,scott of ,georgia1 ,mr4 ,duncan of ,tennessee1 ,mr4 ,hill1 ,mr4 ,chabot1 ,mrs4 ,blackburn1 ,mr4 ,rouzer1 ,mr4 ,culberson1 ,mrs4 ,hartzler1 ,mr4 ,babin1 ,mr4 ,bucshon1 and ,mr4 ,scalise7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on the ,budget1 ,ways and ,means1 ,education and the ,workforce1 the ,judiciary1 ,natural ,resources1 ,house ,administration1 ,rules1 ,appropriations1 and ,veterans' ,affairs1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to repeal the ,patient ,protection and ,affordable ,care ,act and related reconciliation provisions1 to promote patient-centered health care1 to provide for the creation of a safe harbor for defendants in medical malpractice actions who demonstrate adherence to clinical practice guidelines1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,american ,health ,care ,reform ,act of #bjag4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,repeal of ,obamacare ,sec4 #aja4 ,repeal of ,,ppaca and health care-related provisions in the ,health ,care and ,education ,reconciliation ,act of #bjaj4 ,sec4 #ajb4 ,budgetary effects4 ,title ,,ii--,increasing ,access to ,portable1 ,affordable ,health ,insurance ,sec4 #bjj4 ,amendment of #aihf ,code4 ,subtitle ,a--,standard ,deduction for ,health ,insurance ,sec4 #bja4 ,standard deduction for health insurance4 ,sec4 #bjb4 ,changes to existing tax preferences for medical coverage and costs for individuals eligible for standard deduction for health insurance4 ,sec4 #bjc4 ,exclusion of standard deduction for health insurance from employment taxes4 ,sec4 #bjd4 ,information reporting4 ,sec4 #bje4 ,election to disregard inclusion of contributions by employer to accident or health plan4 ,subtitle ,b--,enhancement of health savings accounts ,sec4 #bba4 ,allow both spouses to make catch-up contributions to the same ,,hsa account4 ,sec4 #bbb4 ,provisions relating to ,medicare4 ,sec4 #bbc4 ,individuals eligible for veterans benefits for a service-connected disability4 ,sec4 #bbd4 ,individuals eligible for ,indian ,health ,service assistance4 ,sec4 #bbe4 ,individuals eligible for ,,tricare coverage4 ,sec4 #bbf4 ,,fsa and ,,hra interaction with ,h,s,as4 ,sec4 #bbg4 ,purchase of health insurance from ,,hsa account4 ,sec4 #bbh4 ,special rule for certain medical expenses incurred before establishment of account4 ,sec4 #bbi4 ,preventive care prescription drug clarification4 ,sec4 #bcj4 ,equivalent bankruptcy protections for health savings accounts as retirement funds4 ,sec4 #bca4 ,administrative error correction before due date of return4 ,sec4 #bcb4 ,reauthorization of ,medicaid health opportunity accounts4 ,sec4 #bcc4 ,members of health care sharing ministries eligible to establish health savings accounts4 ,sec4 #bcd4 ,high deductible health plans renamed ,,hsa qualified plans4 ,sec4 #bce4 ,treatment of direct primary care service arrangements4 ,sec4 #bcf4 ,certain exercise equipment and physical fitness programs treated as medical care4 ,sec4 #bcg4 ,certain nutritional and dietary supplements to be treated as medical care4 ,sec4 #bch4 ,certain provider fees to be treated as medical care4 ,sec4 #bci4 ,increase the maximum contribution limit to an ,,hsa to match deductible and out-of-pocket expense limitation4 ,sec4 #bdj4 ,child health savings account4 ,sec4 #bda4 ,allowing minimum distributions from tax-deferred retirement accounts to be deposited into ,h,s,as4 ,sec4 #bdb4 ,distributions for abortion expenses from health savings accounts included in gross income4 ,subtitle ,c--,enhanced wellness incentives ,sec4 #bea4 ,providing financial incentives for treatment compliance4 ,title ,,iii--,improving ,access to ,insurance for ,vulnerable ,americans ,subtitle ,a--,eliminating barriers to insurance coverage ,sec4 #cja4 ,elimination of certain requirements for guaranteed availability in individual market4 ,subtitle ,b--,ensuring coverage for individuals with preexisting conditions and multiple health care needs through high-,risk pools ,sec4 #caa4 ,improvement of high-risk pools4 ,title ,,iv--,encouraging a ,more ,competitive ,health ,care ,market ,subtitle ,a--,expanding patient choice ,sec4 #dja4 ,cooperative governing of individual health insurance coverage4 ,subtitle ,b--,mc,carran-,ferguson reform ,sec4 #daa4 ,restoring the application of antitrust laws to health sector insurers4 ,subtitle ,c--,medicare ,price ,transparency ,sec4 #dba4 ,public availability of ,medicare claims data4 ,subtitle ,d--,state transparency portals ,sec4 #dca4 ,providing information on health coverage options and health care providers4 ,subtitle ,e--,protecting the ,doctor-,patient ,relationship ,sec4 #dda4 ,rule of construction4 ,sec4 #ddb4 ,repeal of ,federal ,coordinating ,council for ,comparative ,effectiveness ,research4 ,subtitle ,f--,establishing ,association ,health ,plans ,sec4 #dea4 ,rules governing association health plans4 ,sec4 #deb4 ,clarification of treatment of single employer arrangements4 ,sec4 #dec4 ,enforcement provisions relating to association health plans4 ,sec4 #ded4 ,cooperation between ,federal and ,state authorities4 ,sec4 #dee4 ,effective date and transitional and other rules4 ,subtitle ,g--,greater ,choice for ,veterans ,sec4 #dfa4 ,removing barriers to health care choice for ,category #a veterans and medal of honor recipients4 ,title ,v--,reforming ,medical ,liability ,law ,sec4 #eja4 ,requirements for selection of clinical practice guidelines4 ,sec4 #ejb4 ,development4 ,sec4 #ejc4 ,no liability for guideline producers4 ,sec4 #ejd4 ,internet publication of guidelines4 ,sec4 #eje4 ,state flexibility and protection of ,states' rights4 ,sec4 #ejf4 ,federal cause of action4 ,sec4 #ejg4 ,right of removal4 ,sec4 #ejh4 ,mandatory review by independent medical panel4 ,sec4 #eji4 ,definitions4 ,title ,,vi--,other provisions ,sec4 #fja4 ,respecting human life4 ,sec4 #fjb4 ,offsets4 ,i ,repeal of ,obamacare #aja4 ,repeal of ,,ppaca and health care-related provisions in the ,health ,care and ,education ,reconciliation ,act of #bjaj 7a7 ,,ppaca ,effective on ,january #a1 #bjah1 the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 is repealed1 and the provisions of law amended or repealed by such ,act are restored or revived as if such ,act had not been enacted4 7b7 ,health care-,related provisions in the health care and education reconciliation act of #bjaj ,effective on ,january #a1 #bjah1 title ,i and subtitle ,b of title ,,ii of the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb7 are repealed1 and the provisions of law amended or repealed by such title or subtitle1 respectively1 are restored or revived as if such title and subtitle had not been enacted4 #ajb4 ,budgetary effects ,the budgetary effects of this ,act shall not be entered on either ,,paygo scorecard maintained pursuant to section #d7;d7 of the ,statutory ,pay-,as-,you-,go ,act of #bjaj4 ,,ii ,increasing ,access to ,portable1 ,affordable ,health ,insurance #bjj4 ,amendment of #aihf ,code ,except as otherwise expressly provided1 whenever in this title an amendment or repeal is expressed in terms of an amendment to1 or repeal of1 a section or other provision1 the reference shall be considered to be made to a section or other provision of the ,internal ,revenue ,code of #aihf4 ,a ,standard ,deduction for ,health ,insurance #bja4 ,standard deduction for health insurance 7a7 ,in general ,part ,,vii of subchapter ,b of chapter #a is amended by redesignating section #bbd as section #bbe and by inserting after section #bbc the following new section3 #bbd4 ,standard deduction for health insurance 7a7 ,deduction allowed ,in the case of an individual1 there shall be allowed as a deduction to the taxpayer for the taxable year the standard deduction for health insurance4 7b7 ,standard deduction for health insurance ,for purposes of this section-- 7#a7 ,in general ,the term standard deduction for health insurance means the sum of the monthly limitations for months during the taxable year4 7#b7 ,monthly limitation 7,a7 ,in general ,the monthly limitation for any month is #a_/ab of-- 7i7 #bj1ejj1 in the case of a taxpayer who is allowed a deduction under section #aea for more than one individual who for such month is an eligible individual1 and 7ii7 #g1ejj1 in the case of a taxpayer who is allowed a deduction under section #aea for only one individual who for such month is an eligible individual4 7,b7 ,cost-of-living adjustment 7i7 ,in general ,in the case of taxable years beginning in calendar years after the first calendar year to which this section applies1 the dollar amounts under subparagraph 7,a7 shall be increased by an amount equal to-- 7,i7 such dollar amount1 multiplied by 7,,ii7 the cost-of-living adjustment determined under section #a7;f77#c7 for the calendar year in which such taxable year begins1 determined by substituting the calendar year preceding the first calendar year to which section #bbd applies for calendar year #aiib in subparagraph 7,b7 thereof4 7ii7 ,rounding ,if any increase under clause 7i7 is not a multiple of #ej1 such increase shall be rounded to the nearest multiple of #ej4 7#c7 ,yearly limitation ,the amount allowed as a deduction under subsection 7a7 for any taxable year shall not exceed the taxpayer's earned income 7as defined in section #cb7;c77#b77 for such taxable year4 7c7 ,limitations and special rules relating to standard deduction ,for purposes of this section-- 7#a7 ,special rule for married individuals filing separately ,in the case of a married individual who files a separate return for the taxable year1 the deduction allowed under subsection 7a7 shall be equal to one-half of the amount which would otherwise be determined under subsection 7a7 if such individual filed a joint return for the taxable year4 7#b7 ,denial of deduction to dependents ,no deduction shall be allowed under this section to any individual with respect to whom a deduction under section #aea is allowable to another taxpayer for a taxable year beginning in the calendar year in which such individual's taxable year begins4 7#c7 ,coordination with other health tax incentives 7,a7 ,denial of deduction if health insurance costs credit allowed ,no deduction shall be allowed under this section to any taxpayer if a credit is allowed to the taxpayer under section #ce for the taxable year4 7,b7 ,reduction for insurance purchased with msa or hsa funds ,the amount allowed as a deduction under subsection 7a7 for the taxable year shall be reduced by the aggregate amount-- 7i7 paid during the taxable year from an ,archer ,,msa to which section #bbj7;d77#b77;,b77ii7 7other than subclause 7,,ii7 thereof7 applies1 and 7ii7 paid during the taxable year from a health savings account to which section #bbc7;d77#b77;,c7 7other than clause 7ii7 thereof7 applies4 7#d7 ,special rule for divorced parents1 etc ,notwithstanding subsection 7b77#a71 an individual who is a child may be taken into account on the return of the parent other than the parent for whom a deduction with respect to the child is allowed under section #aea for a taxable year beginning in a calendar year if-- 7,a7 the parent for whom the deduction under section #aea is allowed for a taxable year beginning in such calendar year signs a written declaration 7in such manner and form as the ,secretary may by regulations prescribe7 that such parent will not claim the deduction allowable under this section with respect to the child for taxable years beginning in such calendar year1 and 7,b7 the parent for whom the deduction under section #aea is not allowed attaches such written declaration to the parent's return for the taxable year beginning in such calendar year4 7d7 ,other definitions ,for purposes of this section-- 7#a7 ,eligible individual 7,a7 ,in general ,the term eligible individual means1 with respect to any month1 an individual who is covered under a qualified health plan as of the #ast day of such month4 7,b7 ,coverage under ,medicare1 ,medicaid1 ,,schip1 ,,tricare1 and grandfathered employer coverage ,the term eligible individual shall not include any individual who for any month is-- 7i7 entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled under part ,b of such title1 7ii7 enrolled in the program under title ,,xix or ,,xxi of such ,act 7other than under section #aibh of such ,act71 7iii7 receiving benefits 7other than under continuation coverage under section #dihj;,b7 which constitute medical care from an employer-- 7,i7 from whom such individual is separated from service at the time of receipt of such benefits1 and 7,,ii7 after such separation1 if such benefits began before ,january #a1 #bjah1 unless such individual is also covered by a qualified health plan as of the #ast day of such month1 or 7iv7 entitled to receive benefits under chapter #ee of title #aj1 ,united ,states ,code4 7,c7 ,identification requirements ,the term eligible individual shall not include any individual for any month unless the policy number associated with coverage under the qualified health plan and the ,,tin of each eligible individual covered under such coverage for such month is included on the return for the taxable year in which such month occurs4 7#b7 ,qualified health plan 7,a7 ,in general ,the term qualified health plan means a health plan 7within the meaning of section #bbc7;c77#b71 without regard to subparagraph 7,a77i7 thereof7 which1 under regulations prescribed by the ,secretary1 meets the following requirements3 7i7 ,the plan has coverage for inpatient and outpatient care1 emergency benefits1 and physician care4 7ii7 ,the plan has coverage which meaningfully limits individual economic exposure to extraordinary medical expenses 7,b7 ,exclusion of certain plans ,the term qualified health plan does not include-- 7i7 a health plan if substantially all of its coverage is coverage described in section #bbc7;c77#a77;,b71 7ii7 any program or benefits referred to in clause 7i71 7ii71 or 7iii7 of paragraph 7#a77;,b71 and 7iii7 a ,medicare supplemental policy 7as defined in section #ahhb of the ,social ,security ,act74 7e7 ,regulations ,the ,secretary may prescribe such regulations as may be necessary to carry out this section4 4 7b7 ,deduction allowed whether or not individual itemizes other deductions ,subsection 7a7 of section #fb is amended by inserting before the last sentence at the end the following new paragraph3 7#bb7 ,standard deduction for health insurance ,the deduction allowed by section #bbd4 4 7c7 ,election ,to take health insurance costs credit ,section #ce7;g7 is amended by redesignating paragraphs 7#i71 7#aj71 and 7#aa7 as paragraphs 7#aj71 7#aa71 and 7#ab71 respectively1 and by inserting after paragraph 7#h7 the following new paragraph3 7#i7 ,election not to claim credit ,this section shall not apply to a taxpayer for any taxable year if such taxpayer elects to have this section not apply for such taxable year4 4 7d7 ,clerical amendment ,the table of sections for part ,,vii of subchapter ,b of chapter #a is amended by striking the item relating to section #bbd and adding at the end the following new items3 ,sec4 #bbd4 ,standard deduction for health insurance4 ,sec4 #bbe4 ,cross reference4 4 7e7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bjb4 ,changes to existing tax preferences for medical coverage and costs for individuals eligible for standard deduction for health insurance 7a7 ,exclusion for contributions by employer to accident and health plans 7#a7 ,in general ,section #ajf is amended by adding at the end the following new subsection3 7g7 ,subsections 7a7 and 7c7 apply only to individuals covered by ,medicare1 ,medicaid1 ,,schip1 ,,tricare1 or grandfathered employer plans 7#a7 ,in general ,except as provided in paragraph 7#b71 subsections 7a7 and 7c7 shall not apply for any taxable year with respect to which a deduction under section #bbd is allowable4 7#b7 ,exception for individuals covered by ,medicare1 ,medicaid1 ,,schip1 or grandfathered employer plans ,paragraph 7#a7 shall not apply to an individual for any taxable year if such individual is not an eligible individual 7as defined in section #bbd7;d77#a77 for any month during such taxable year by reason of coverage described in section #bbd7;d77#a77;,b74 4 7#b7 ,conforming amendments 7,a7 ,section #ajf7;b77#a7 is amended-- 7i7 by inserting gross income does not include before amounts contributed1 and 7ii7 by striking shall be treated as employer-provided coverage for medical expenses under an accident or health plan4 7,b7 ,section #ajf7;d77#a7 is amended-- 7i7 by inserting gross income does not include before amounts contributed1 and 7ii7 by striking shall be treated as employer-provided coverage for medical expenses under an accident or health plan4 7b7 ,termination of deduction for health insurance costs of self-,employed individuals ,subsection 7l7 of section #afb is amended by adding at the end the following new paragraph3 7#f7 ,termination ,this subsection shall not apply to taxable years with respect to which a deduction under section #bbd is allowable4 4 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bjc4 ,exclusion of standard deduction for health insurance from employment taxes 7a7 ,in general ,chapter #be is amended by adding at the end the following new section3 #ceab4 ,exclusion of standard deduction from employment taxes 7a7 ,in general ,for purposes of chapters #ba1 #bb1 and #bc1 each of the following amounts for any period 7determined without regard to this section7 shall be reduced by the portion of the standard deduction for health insurance 7as defined in section #bbd7 allocable to the period3 7#a7 ,the amount of wages determined under section #caba7;a74 7#b7 ,the amount of compensation determined under section #cbca7;e74 7#c7 ,the amount of wages determined under section #ccjf7;b74 7b7 ,determination of standard deduction allocable to a period ,for purposes of subsection 7a7-- 7#a7 ,in general ,the determination of the portion of the standard deduction for health insurance allocable to a period shall be made on the basis of a qualified certificate of eligible coverage furnished by the employee to the employer4 7#b7 ,qualified certificate of eligible coverage ,the term qualified certificate of eligible coverage means a statement of eligibility for the deduction allowable under section #bbd which contains such information1 is in such form1 and is provided at such times1 as the ,secretary may prescribe4 7#c7 ,only #a certificate in effect at a time ,except as provided by the ,secretary1 an employee may have only #a qualified certificate of eligible coverage in effect for any period4 7#d7 ,election ,an employee may elect not to have this section apply for any period for purposes of chapter #ba or #bb4 7c7 ,reconciliation of erroneous payments ,to be made at employee level 7#a7 ,in general ,if the application of this subsection results in an incorrect amount being treated as wages or compensation for purposes of chapter #ba1 #bb1 or #bc1 whichever is applicable1 with respect to any employee for one or more periods ending within a taxable year of the employee-- 7,a7 in the case of an aggregate overpayment of the taxes imposed by any such chapter for all such periods1 there shall be allowed as a credit against the tax imposed by chapter #a for such taxable year on such employee an amount equal to the amount of such overpayment1 and 7,b7 in the case of an aggregate underpayment of the taxes imposed by any such chapter for all such periods1 the employee shall be liable for payment of the entire amount of such underpayment4 7#b7 ,credits treated as refundable ,for purposes of this title1 any credit determined under paragraph 7#a77;,a7 or subsection 7d77#b7 shall be treated as if it were a credit allowed under subpart ,c of part ,,iv of subchapter ,a of chapter #a4 7#c7 ,rules for reporting and collection of tax ,any tax required to be paid by an employee under paragraph 7#a77;,b7 shall be included with the employee's return of ,federal income tax for the taxable year4 7#d7 ,secretarial authority ,the ,secretary shall prescribe such rules as may be necessary to carry out the provisions of this subsection4 4 7b7 ,self-,employment income ,section #adjb is amended by adding at the end the following3 7m7 ,standard deduction for health insurance ,for purposes of this chapter-- 7#a7 ,in general ,the self-employment income of a taxpayer for any period 7determined without regard to this subsection7 shall be reduced by the excess 7if any7 of-- 7,a7 the portion of the standard deduction for health insurance 7as defined in section #bbd7 allocable to the period1 over 7,b7 the amount of any reduction in wages or compensation for such period under section #ceab4 7#b7 ,determination of standard deduction allocable to a period ,for purposes of paragraph 7#a71 the portion of the standard deduction allocable to any period shall be determined in a manner similar to the manner under section #ceab4 4 7c7 ,conforming amendments 7#a7 ,section #caba7;a77#b7 is amended by inserting which is excludable from gross income under section #aje or #ajf after such payment74 7#b7 ,subsection 7a7 of section #bji of the ,social ,security ,act 7#db ,u4,s4,c4 #dji7 is amended by striking or at the end of paragraph 7#ai71 by striking the period at the end of paragraph 7#bj7 and inserting 2 or1 and by inserting after paragraph 7#bj7 the following new paragraph3 7#ba7 any amount excluded from wages under section #ceab7;a7 of the ,internal ,revenue ,code of #aihf 7relating to exclusion of standard deduction from employment taxes74 4 7#c7 ,section #acbd7;b77#b7 of title #ca1 ,united ,states ,code1 is amended by inserting 1 or the credit under section #ceab7;c77#b7 of such ,code before the period at the end4 7#d7 ,section #bji7k77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dji7k77#b77 is amended by redesignating subparagraphs 7,c7 and 7,d7 as subparagraphs 7,d7 and 7,e71 respectively1 and by inserting after subparagraph 7,b7 the following new subparagraph3 7,c7 by disregarding the exclusion from wages in subsection 7a77#ba71 4 7#e7 ,the table of sections for chapter #be is amended by adding at the end the following new item3 ,sec4 #ceab4 ,exclusion of standard deduction from employment taxes4 4 7d7 ,effective dates 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall apply to remuneration paid or accrued for periods on or after ,december #ca1 #bjag4 7#b7 ,reconciliation and self-employed ,sections #ceab7;c7 and 7d77#b7 of the ,internal ,revenue ,code of #aihf 7as added by subsection 7a771 and the amendments made by subsection 7b71 shall apply to taxable years beginning after ,december #ca1 #bjag4 #bjd4 ,information reporting 7a7 ,health plan providers ,subpart ,b of part ,,iii of subchapter ,a of chapter #fa is amended by adding at the end the following new section3 #fjej,x4 ,coverage under qualified health plan 7a7 ,in general ,every person providing coverage under a qualified health plan 7as defined in section #bbd7;d77#b77 during a calendar year shall1 on or before ,january #ca of the succeeding year1 make a return described in subsection 7b7 with respect to each individual who is covered by such person under a qualified health plan for any month during the calendar year4 7b7 ,return ,a return is described in this subsection if such return-- 7#a7 is in such form as the ,secretary prescribes1 and 7#b7 contains-- 7,a7 the name of the person providing coverage under the qualified health plan1 7,b7 the name1 address1 and ,,tin of the individual covered by the plan1 7,c7 if such individual is the owner of the policy under which such plan is provided1 the name1 address1 and ,,tin of each other individual covered by such policy and the relationship of each such individual to such owner1 and 7,d7 the specific months of the year for which each individual referred to in subparagraph 7,b7 is1 as of the first day of each such month1 covered by such plan4 7c7 ,statement ,to be furnished with respect to whom information is required ,every person required to make a return under subsection 7a7 shall furnish to each individual whose name is required to be set forth in such return under subsection 7b77#b77;,a7 a written statement showing-- 7#a7 the name1 address1 and phone number of the information contact of the person required to make such return1 and 7#b7 the information described in subsection 7b77#b74 ,the written statement required under the preceding sentence shall be furnished on or before ,january #ca of the year following the calendar year for which the return under subsection 7a7 was required to be made4 4 7b7 ,employers ,subsection 7a7 of section #fjea is amended by striking and at the end of paragraph 7#ac71 by striking the period at the end of paragraph 7#ad7 and inserting 1 and1 and by inserting after paragraph 7#ad7 the following new paragraph3 7#ae7 the value 7determined under section #dihj;,b7f77#d77 of employer-provided coverage for each month under an accident or health plan and the category of such coverage for purposes of section #faaf4 4 7c7 ,application to retirees ,subsection 7a7 of section #fjea is amended by adding at the end the following3 ,in the case of a retiree1 this section shall 7to the extent established by the ,secretary by regulation7 apply only with respect to paragraph 7#ae744 7d7 ,assessable penalties 7#a7 ,subparagraph 7,b7 of section #fgbd7;d77#a7 is amended by striking or at the end of clause 7xxiv71 by striking and at the end of clause 7xxv7 and inserting or1 and by adding at the end the following new clause3 7xxvi7 section #fjej,x 7relating to returns relating to payments for qualified health insurance71 and 4 7#b7 ,paragraph 7#b7 of section #fgbd7;d7 is amended by striking or at the end of subparagraph 7,,gg71 by striking the period at the end of subparagraph 7,,hh7 and inserting 1 or and by adding at the end the following new subparagraph3 7,,ii7 section #fjej,x7d7 7relating to returns relating to payments for qualified health insurance74 4 7e7 ,clerical amendment ,the table of sections for such subpart ,b is amended by adding at the end the following new item3 ,sec4 #fjej,x4 ,coverage under qualified health plan4 4 7f7 ,effective date ,the amendments made by this section shall apply to years beginning after ,december #ca1 #bjag4 #bje4 ,election to disregard inclusion of contributions by employer to accident or health plan 7a7 ,in general ,subparagraph 7,b7 of section #cb7;c77#b7 is amended by striking and at the end of clause 7v71 by striking the period at the end of clause 7vi7 and inserting 1 and1 and by adding at the end the following new clause3 7vii7 a taxpayer may elect to exclude from earned income amounts that would have been excluded from gross income under section #ajf but for subsection 7g7 thereof4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to taxable years beginning after ,december #ca1 #bjag4 ,b ,enhancement of health savings accounts #bba4 ,allow both spouses to make catch-up contributions to the same ,,hsa account 7a7 ,in general ,paragraph 7#c7 of section #bbc7;b7 is amended by adding at the end the following new subparagraph3 7,c7 ,special rule where both spouses are eligible individuals with #a account ,if-- 7i7 an individual and the individual's spouse have both attained age #ee before the close of the taxable year1 and 7ii7 the spouse is not an account beneficiary of a health savings account as of the close of such year1 the additional contribution amount shall be #bjj percent of the amount otherwise determined under subparagraph 7,b74 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bbb4 ,provisions relating to ,medicare 7a7 ,individuals over age #fe only enrolled in ,medicare ,part ,a ,paragraph 7#g7 of section #bbc7;b7 is amended by adding at the end the following3 ,this paragraph shall not apply to any individual during any period for which the individual's only entitlement to such benefits is an entitlement to hospital insurance benefits under part ,a of title ,,xviii of such ,act pursuant to an enrollment for such hospital insurance benefits under section #bbf7;a77#a7 of such ,act44 7b7 ,medicare beneficiaries participating in ,medicare advantage ,,msa may contribute their own money to their ,,msa 7#a7 ,in general ,subsection 7b7 of section #ach is amended by striking paragraph 7#b7 and by redesignating paragraphs 7#c7 and 7#d7 as paragraphs 7#b7 and 7#c71 respectively4 7#b7 ,conforming amendment ,paragraph 7#d7 of section #ach7;c7 is amended by striking and paragraph 7#b74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bbc4 ,individuals eligible for veterans benefits for a service-connected disability 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c7 is amended by adding at the end the following new subparagraph3 7,c7 ,special rule for individuals eligible for certain veterans benefits ,for purposes of subparagraph 7,a77ii71 an individual shall not be treated as covered under a health plan described in such subparagraph merely because the individual receives periodic hospital care or medical services for a service-connected disability under any law administered by the ,secretary of ,veterans ,affairs but only if the individual is not eligible to receive such care or services for any condition other than a service-connected disability4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bbd4 ,individuals eligible for ,indian ,health ,service assistance 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c71 as amended by this ,act1 is amended by adding at the end the following new subparagraph3 7,d7 ,special rule for individuals eligible for assistance under ,indian ,health ,service programs ,for purposes of subparagraph 7,a77ii71 an individual shall not be treated as covered under a health plan described in such subparagraph merely because the individual receives hospital care or medical services under a medical care program of the ,indian ,health ,service or of a tribal organization4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bbe4 ,individuals eligible for ,,tricare coverage 7a7 ,in general ,paragraph 7#a7 of section #bbc7;c71 as amended by this ,act1 is amended by adding at the end the following new subparagraph3 7,e7 ,special rule for individuals eligible for assistance under ,,tricare ,for purposes of subparagraph 7,a77ii71 an individual shall not be treated as covered under a health plan described in such subparagraph merely because the individual is eligible to receive hospital care1 medical services1 or prescription drugs under chapter #ee of title #aj1 ,united ,states ,code1 under ,,tricare ,extra or ,,tricare ,standard and such individual is not enrolled in ,,tricare ,prime4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bbf4 ,,fsa and ,,hra interaction with ,h,s,as 7a7 ,eligible individuals include ,,fsa and ,,hra participants ,subparagraph 7,b7 of section #bbc7;c77#a7 is amended-- 7#a7 by striking and at the end of clause 7ii71 7#b7 by striking the period at the end of clause 7iii7 and inserting 1 and1 and 7#c7 by inserting after clause 7iii7 the following new clause3 7iv7 coverage under a health flexible spending arrangement or a health reimbursement arrangement in the plan year a qualified ,,hsa distribution as described in section #ajf7;e7 is made on behalf of the individual if after the qualified ,,hsa distribution is made and for the remaining duration of the plan year1 the coverage provided under the health flexible spending arrangement or health reimbursement arrangement is converted to-- 7,i7 coverage that does not pay or reimburse any medical expense incurred before the minimum annual deductible under paragraph 7#b77;,a77i7 7prorated for the period occurring after the qualified ,,hsa distribution is made7 is satisfied1 7,,ii7 coverage that1 after the qualified ,,hsa distribution is made1 does not pay or reimburse any medical expense incurred after the qualified ,,hsa distribution is made other than preventive care as defined in paragraph 7#b77;,c71 7,,iii7 coverage that1 after the qualified ,,hsa distribution is made1 pays or reimburses benefits for coverage described in clause 7ii7 7but not through insurance or for long-term care services71 7,,iv7 coverage that1 after the qualified ,,hsa distribution is made1 pays or reimburses benefits for permitted insurance or coverage described in clause 7ii7 7but not for long-term care services71 7,v7 coverage that1 after the qualified ,,hsa distribution is made1 pays or reimburses only those medical expenses incurred after an individual's retirement 7and no expenses incurred before retirement71 or 7,,vi7 coverage that1 after the qualified ,,hsa distribution is made1 is suspended1 pursuant to an election made on or before the date the individual elects a qualified ,,hsa distribution or1 if later1 on the date of the individual enrolls in a high deductible health plan1 that does not pay or reimburse1 at any time1 any medical expense incurred during the suspension period except as defined in the preceding subclauses of this clause4 4 7b7 ,qualified ,,hsa distribution shall not affect flexible spending arrangement ,paragraph 7#a7 of section #ajf7;e7 is amended to read as follows3 7#a7 ,in general ,a plan shall not fail to be treated as a health flexible spending arrangement under this section1 section #aje1 or section #abe1 or as a health reimbursement arrangement under this section or section #aje1 merely because such plan provides for a qualified ,,hsa distribution4 4 7c7 ,,fsa balances at year end shall not forfeit ,paragraph 7#b7 of section #abe7;d7 is amended by adding at the end the following new subparagraph3 7,e7 ,exception for qualified ,,hsa distributions ,subparagraph 7,a7 shall not apply to the extent that there is an amount remaining in a health flexible spending account at the end of a plan year that an individual elects to contribute to a health savings account pursuant to a qualified ,,hsa distribution 7as defined in section #ajf7;e77#b774 4 7d7 ,simplification of limitations on ,,fsa and ,,hra rollovers ,paragraph 7#b7 of section #ajf7;e7 is amended to read as follows3 7#b7 ,qualified ,,hsa distribution 7,a7 ,in general ,the term qualified ,,hsa distribution means a distribution from a health flexible spending arrangement or health reimbursement arrangement to the extent that such distribution does not exceed the lesser of-- 7i7 the balance in such arrangement as of the date of such distribution1 or 7ii7 the amount determined under subparagraph 7,b74 ,such term shall not include more than #a distribution with respect to any arrangement4 7,b7 ,dollar limitations 7i7 ,distributions from a health flexible spending arrangement ,a qualified ,,hsa distribution from a health flexible spending arrangement shall not exceed the applicable amount4 7ii7 ,distributions from a health reimbursement arrangement ,a qualified ,,hsa distribution from a health reimbursement arrangement shall not exceed-- 7,i7 the applicable amount divided by #ab1 multiplied by 7,,ii7 the number of months during which the individual is a participant in the health reimbursement arrangement4 7iii7 ,applicable amount ,for purposes of this subparagraph1 the applicable amount is-- 7,i7 #b1bej in the case of an eligible individual who has self-only coverage under a high deductible health plan at the time of such distribution1 and 7,,ii7 #d1ejj in the case of an eligible individual who has family coverage under a high deductible health plan at the time of such distribution4 4 7e7 ,elimination of additional tax for failure ,to maintain high deductible health plan coverage ,subsection 7e7 of section #ajf is amended-- 7#a7 by striking paragraph 7#c7 and redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#c7 and 7#d71 respectively1 and 7#b7 by striking subparagraph 7,a7 of paragraph 7#c71 as so redesignated1 and redesignating subparagraphs 7,b7 and 7,c7 of such paragraph as subparagraphs 7,a7 and 7,b7 thereof1 respectively4 7f7 ,limited purpose ,f,s,as and ,h,r,as ,subsection 7e7 of section #ajf1 as amended by this section1 is amended by adding at the end the following new paragraph3 7#e7 ,limited purpose ,f,s,as and ,h,r,as ,a plan shall not fail to be a health flexible spending arrangement or health reimbursement arrangement under this section or section #aje merely because the plan converts coverage for individuals who enroll in a high deductible health plan described in section #bbc7;c77#b7 to coverage described in section #bbc7;c77#a77;,b77iv74 ,coverage for such individuals may be converted as of the date of enrollment in the high deductible health plan1 without regard to the period of coverage under the health flexible spending arrangement or health reimbursement arrangement1 and without requiring any change in coverage to individuals who do not enroll in a high deductible health plan4 4 7g7 ,distribution amounts adjusted for cost-of-,living ,subsection 7e7 of section #ajf1 as amended by this section1 is amended by adding at the end the following new paragraph3 7#f7 ,cost-of-living adjustment 7,a7 ,in general ,in the case of any taxable year beginning in a calendar year after #bjag1 each of the dollar amounts in paragraph 7#b77;,b77iii7 shall be increased by an amount equal to such dollar amount1 multiplied by the cost-of-living adjustment determined under section #a7;f77#c7 for the calendar year in which such taxable year begins by substituting calendar year #bjaf for calendar year #aiib in subparagraph 7,b7 thereof4 7,b7 ,rounding ,if any increase under paragraph 7#a7 is not a multiple of #ej1 such increase shall be rounded to the nearest multiple of #ej4 4 7h7 ,disclaimer of disqualifying coverage ,subparagraph 7,b7 of section #bbc7;c77#a71 as amended by this section1 is amended-- 7#a7 by striking and at the end of clause 7iii71 7#b7 by striking the period at the end of clause 7iv7 and inserting 1 and1 and 7#c7 by inserting after clause 7iv7 the following new clause3 7v7 any coverage 7including prospective coverage7 under a health plan that is not a high deductible health plan which is disclaimed in writing1 at the time of the creation or organization of the health savings account1 including by execution of a trust described in subsection 7d77#a7 through a governing instrument that includes such a disclaimer1 or by acceptance of an amendment to such a trust that includes such a disclaimer4 4 7i7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bbg4 ,purchase of health insurance from ,,hsa account 7a7 ,in general ,paragraph 7#b7 of section #bbc7;d7 is amended to read as follows3 7#b7 ,qualified medical expenses 7,a7 ,in general ,the term qualified medical expenses means1 with respect to an account beneficiary1 amounts paid by such beneficiary for medical care 7as defined in section #bac7;d77 for any individual covered by a high deductible health plan of the account beneficiary1 but only to the extent such amounts are not compensated for by insurance or otherwise4 7,b7 ,health insurance may not be purchased from account ,except as provided in subparagraph 7,c71 subparagraph 7,a7 shall not apply to any payment for insurance4 7,c7 ,exceptions ,subparagraph 7,b7 shall not apply to any expense for coverage under-- 7i7 a health plan during any period of continuation coverage required under any ,federal law1 7ii7 a qualified long-term care insurance contract 7as defined in section #ggjb;,b7b771 7iii7 a health plan during any period in which the individual is receiving unemployment compensation under any ,federal or ,state law1 7iv7 a high deductible health plan1 or 7v7 any health insurance under title ,,xviii of the ,social ,security ,act1 other than a ,medicare supplemental policy 7as defined in section #ahhb of such ,act74 4 7b7 ,effective date ,the amendment made by this section shall apply with respect to insurance purchased after the date of the enactment of this ,act in taxable years beginning after ,december #ca1 #bjag4 #bbh4 ,special rule for certain medical expenses incurred before establishment of account 7a7 ,in general ,paragraph 7#b7 of section #bbc7;d71 as amended by this ,act1 is amended by adding at the end the following new subparagraph3 7,d7 ,certain medical expenses incurred before establishment of account treated as qualified ,an expense shall not fail to be treated as a qualified medical expense solely because such expense was incurred before the establishment of the health savings account if such expense was incurred-- 7i7 during either-- 7,i7 the taxable year in which the health savings account was established1 or 7,,ii7 the preceding taxable year in the case of a health savings account established after the taxable year in which such expense was incurred but before the time prescribed by law for filing the return for such taxable year 7not including extensions thereof71 and 7ii7 for medical care of an individual during a period that such individual was covered by a high deductible health plan and met the requirements of subsection 7c77#a77;,a77ii7 7after application of subsection 7c77#a77;,b774 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bbi4 ,preventive care prescription drug clarification 7a7 ,clarify use of drugs in preventive care ,subparagraph 7,c7 of section #bbc7;c77#b7 is amended by adding at the end the following3 ,preventive care shall include prescription and over-the-counter drugs and medicines which have the primary purpose of preventing the onset of1 further deterioration from1 or complications associated with chronic conditions1 illnesses1 or diseases44 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after ,december #ca1 #bjjc4 #bcj4 ,equivalent bankruptcy protections for health savings accounts as retirement funds 7a7 ,in general ,section #ebb of title #aa1 ,united ,states ,code1 is amended by adding at the end the following new subsection3 7r7 ,treatment of health savings accounts ,for purposes of this section1 any health savings account 7as described in section #bbc of the ,internal ,revenue ,code of #aihf7 shall be treated in the same manner as an individual retirement account described in section #djh of such ,code4 4 7b7 ,effective date ,the amendment made by this section shall apply to cases commencing under title #aa1 ,united ,states ,code1 after the date of the enactment of this ,act4 #bca4 ,administrative error correction before due date of return 7a7 ,in general ,paragraph 7#d7 of section #bbc7;f7 is amended by adding at the end the following new subparagraph3 7,d7 ,exception for administrative errors corrected before due date of return ,subparagraph 7,a7 shall not apply if any payment or distribution is made to correct an administrative1 clerical or payroll contribution error and if-- 7i7 such distribution is received by the individual on or before the last day prescribed by law 7including extensions of time7 for filing such individual's return for such taxable year1 and 7ii7 such distribution is accompanied by the amount of net income attributable to such contribution4 ,any net income described in clause 7ii7 shall be included in the gross income of the individual for the taxable year in which it is received4 4 7b7 ,effective date ,the amendment made by this section shall take effect on the date of the enactment of this ,act4 #bcb4 ,reauthorization of ,medicaid health opportunity accounts 7a7 ,in general ,section #aich of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#h7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,initial demonstration ,the demonstration program under this section shall begin again on ,january #a1 #bjaf4 ,the ,secretary shall approve ,states to conduct demonstration programs under this section for a #e-year period1 with each ,state demonstration program covering one or more geographic areas specified by the ,state4 ,with respect to a ,state1 after the initial #e-year period of any demonstration program conducted under this section by the ,state1 unless the ,secretary finds1 taking into account cost-effectiveness and quality of care1 that the ,state demonstration program has been unsuccessful1 the demonstration program may be extended or made permanent in the ,state4 2 and 7,b7 in paragraph 7#c71 in the matter preceding subparagraph 7,a7-- 7i7 by striking not2 and 7ii7 by striking unless and inserting if 2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#c71 by inserting clause 7i7 through 7vii71 7viii7 7without regard to the amendment made by section #bjjd7;c77#b7 of ,public ,law #aaa-adh71 7x71 or 7xi7 of after described in 2 and 7,b7 by striking paragraphs 7#d71 7#e71 and 7#f72 7#c7 in subsection 7c7-- 7,a7 in paragraph 7#f71 by striking ,subject to subparagraphs 7,d7 and 7,e7 and inserting ,subject to subparagraph 7,d72 7,b7 by striking paragraphs 7#c7 and 7#d72 and 7,c7 by redesignating paragraphs 7#e7 through 7#h7 as paragraphs 7#c7 through 7#f71 respectively2 and 7#d7 in subsection 7d7-- 7,a7 in paragraph 7#b71 by striking subparagraph 7,e72 and 7,b7 in paragraph 7#c7-- 7i7 in subparagraph 7,a77ii71 by striking ,subject to subparagraph 7,b77ii71 in and inserting ,in2 and 7ii7 by striking subparagraph 7,b7 and inserting the following3 7,b7 ,maintenance of health opportunity account after becoming ineligible for public benefit ,notwithstanding any other provision of law1 if an account holder of a health opportunity account becomes ineligible for benefits under this title because of an increase in income or assets-- 7i7 no additional contribution shall be made into the account under paragraph 7#b77;,a77i72 and 7ii7 the account shall remain available to the account holder for #c years after the date on which the individual becomes ineligible for such benefits for withdrawals under the same terms and conditions as if the account holder remained eligible for such benefits1 and such withdrawals shall be treated as medical assistance in accordance with subsection 7c77#d74 4 7b7 ,conforming amendment ,section #fac of the ,children's ,health ,insurance ,program ,reauthorization ,act of #bjji 7,public ,law #aaa-c2 #db ,u4,s4,c4 #acifu-#h note7 is repealed4 #bcc4 ,members of health care sharing ministries eligible to establish health savings accounts 7a7 ,in general ,section #bbc is amended by adding at the end the following new subsection3 7i7 ,application to health care sharing ministries ,for purposes of this section1 membership in a health care sharing ministry 7as defined in section #ejjj;,a7d77#b77;,b77ii77 shall be treated as coverage under a high deductible health plan4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bcd4 ,high deductible health plans renamed ,,hsa qualified plans 7a7 ,in general ,section #bbc1 as amended by this subtitle1 is amended by striking high deductible health plan each place it appears and inserting ,,hsa qualified health plan4 7b7 ,conforming amendments 7#a7 ,section #ajf7;e71 as amended by this subtitle1 is amended by striking high deductible health plan each place it appears and inserting ,,hsa qualified health plan4 7#b7 ,the heading for paragraph 7#b7 of section #bbc7;c7 is amended by striking ,high deductible health plan and inserting ,,hsa qualified health plan4 7#c7 ,section #djh7;d77#i7 is amended-- 7,a7 by striking high deductible health plan each place it appears in subparagraph 7,c7 and inserting ,,hsa qualified health plan1 and 7,b7 by striking ,high deductible health plan in the heading of subparagraph 7,d7 and inserting ,,hsa qualified health plan4 #bce4 ,treatment of direct primary care service arrangements 7a7 ,in general ,section #bbc7;c7 is amended by adding at the end the following new paragraph3 7#f7 ,treatment of direct primary care service arrangements ,an arrangement under which an individual is provided coverage restricted to primary care services in exchange for a fixed periodic fee-- 7,a7 shall not be treated as a health plan for purposes of paragraph 7#a77;,a77ii71 and 7,b7 shall not be treated as insurance for purposes of subsection 7d77#b77;,b74 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bcf4 ,certain exercise equipment and physical fitness programs treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac is amended by adding at the end the following new paragraph3 7#ab7 ,exercise equipment and physical fitness programs 7,a7 ,in general ,the term medical care shall include amounts paid-- 7i7 to purchase or use equipment used in a program 7including a self-directed program7 of physical exercise1 7ii7 to participate1 or receive instruction1 in a program of physical exercise1 and 7iii7 for membership dues in a fitness club the primary purpose of which is to provide access to equipment and facilities for physical exercise4 7,b7 ,limitation ,amounts treated as medical care under subparagraph 7,a7 shall not exceed #a1jjj with respect to any individual for any taxable year4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bcg4 ,certain nutritional and dietary supplements to be treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac1 as amended by this ,act1 is amended by adding at the end the following new paragraph3 7#ac7 ,nutritional and dietary supplements 7,a7 ,in general ,the term medical care shall include amounts paid to purchase herbs1 vitamins1 minerals1 homeopathic remedies1 meal replacement products1 and other dietary and nutritional supplements4 7,b7 ,limitation ,amounts treated as medical care under subparagraph 7,a7 shall not exceed #a1jjj with respect to any individual for any taxable year4 7,c7 ,meal replacement product ,for purposes of this paragraph1 the term meal replacement product means any product that-- 7i7 is permitted to bear labeling making a claim described in section #djc7r77#c7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and 7ii7 is permitted to claim under such section that such product is low in fat and is a good source of protein1 fiber1 and multiple essential vitamins and minerals4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bch4 ,certain provider fees to be treated as medical care 7a7 ,in general ,subsection 7d7 of section #bac1 as amended by this ,act1 is amended by adding at the end the following new paragraph3 7#ad7 ,periodic provider fees ,the term medical care shall include periodic fees paid to a primary care physician for the right to receive medical services on an as-needed basis4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bci4 ,increase the maximum contribution limit to an ,,hsa to match deductible and out-of-pocket expense limitation 7a7 ,self-,only coverage ,subparagraph 7,a7 of section #bbc7;b77#b7 is amended by striking #b1bej and inserting the amount in effect under subsection 7c77#b77;,a77ii77,i74 7b7 ,family coverage ,subparagraph 7,b7 of section #bbc7;b77#b7 is amended by striking #d1ejj and inserting the amount in effect under subsection 7c77#b77;,a77ii77,,ii74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 #bdj4 ,child health savings account 7a7 ,in general ,section #bbc1 as amended by this ,act1 is amended by adding at the end the following new subsection3 7j7 ,child health savings accounts 7#a7 ,in general ,in the case of an individual1 in addition to any deduction allowed under subsection 7a7 for any taxable year1 there shall be allowed as a deduction under this section an amount equal to the aggregate amount paid in cash by the taxpayer during the taxable year to a child health savings account of a child of the taxpayer4 7#b7 ,limitation ,the amount taken into account under paragraph 7#a7 with respect to each child of the taxpayer for the taxable year shall not exceed an amount equal to #c1jjj4 7#c7 ,child health savings account ,for purposes of this subsection1 the term child health savings account means a health savings account designated as a child health savings account and established for the benefit of a child of a taxpayer1 but only if-- 7,a7 such account was established for the benefit of the child before the child attains the age of #e1 and 7,b7 under the written governing instrument creating the trust1 no contribution will be accepted to the extent such contribution1 when added to previous contributions to the trust for the calendar year1 exceeds the dollar amount in effect under paragraph 7#b74 7#d7 ,treatment of account before age #ah ,for purposes of this section1 except as otherwise provided in this subsection1 a child health savings account established for the benefit of the child of a taxpayer shall be treated as a health savings account of the taxpayer until the child attains the age of #ah1 after which such account shall be treated as a health savings account of the child4 7#e7 ,distributions 7,a7 ,in general ,in the case of a child health savings account established under this section for the benefit of a child of a taxpayer-- 7i7 ,before age #ah ,any amount paid or distributed out of such account before the child has attained the age of #ah1 shall be included in the gross income of the taxpayer1 and subparagraph 7,a7 of subsection 7f7 shall apply 7relating to additional tax on distributions not used for qualified medical expenses74 7ii7 ,age #ah and older ,any amount paid or distributed out of such account after the child has attained the age of #ah may only be treated as used to pay qualified medical expenses to the extent such child is not covered as a dependent under insurance 7other than permitted insurance7 of a parent4 7,b7 ,exceptions for disability or death of child ,if the child becomes disabled within the meaning of section #gb7m77#g7 or dies-- 7i7 subparagraph 7,a7 shall not apply to any subsequent payment or distribution1 and 7ii7 the taxpayer may rollover the amount in such account to an individual retirement plan of the taxpayer1 to any health savings account of the taxpayer1 or to any child health savings account of any other child of the taxpayer4 7,c7 ,health insurance may be purchased from account ,subparagraph 7,b7 of subsection 7d77#b7 shall not apply to any health savings account originally established as a child health savings account4 7#f7 ,regulations ,the ,secretary shall prescribe such regulations as may be necessary to carry out the purposes of this subsection1 including rules for determining application of this subsection in the case of legal guardians and in the case of parents of a child who file separately1 are separated1 or are not married4 4 7b7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjag4 #bda4 ,allowing minimum distributions from tax-deferred retirement accounts to be deposited into ,h,s,as 7a7 ,transfer from retirement plan 7#a7 ,individual retirement accounts ,section #djh7;d7 is amended by adding at the end the following new paragraph3 7#aj7 ,required minimum distribution transferred to health savings account 7,a7 ,in general ,in the case of an individual who has attained the age of #gj and who elects the application of this paragraph for a taxable year1 gross income of the individual for the taxable year does not include a qualified ,,hsa transfer to the extent such transfer is otherwise includible in gross income4 7,b7 ,qualified ,,hsa transfer ,for purposes of this paragraph1 the term qualified ,,hsa transfer means any distribution from an individual retirement plan-- 7i7 to a health savings account of the individual in a direct trustee-to-trustee transfer1 and 7ii7 to the extent such distribution does not exceed the required minimum distribution determined under section #dja7;a77#i7 for the distribution calendar year ending during the taxable year4 7,c7 ,application of section #gb ,notwithstanding section #gb1 in determining the extent to which an amount is treated as a distribution for purposes of paragraph 7#a71 the entire amount of the distribution shall be treated as includible in gross income without regard to paragraph 7#a7 to the extent that such amount does not exceed the aggregate amount which would have been so includible if all amounts in all individual retirement plans of the individual were distributed during such taxable year and all such plans were treated as #a contract for purposes of determining under section #gb the aggregate amount which would have been so includible4 ,proper adjustments shall be made in applying section #gb to other distributions in such taxable year and subsequent taxable years4 7,d7 ,coordination ,an election may not be made under subparagraph 7,a7 for a taxable year for which an election is in effect under paragraph 7#i74 4 7#b7 ,other retirement plans ,section #djb of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new subsection3 7m7 ,required minimum distribution transferred to health savings account 7#a7 ,in general ,in the case of an individual who has attained the age of #gj and who elects the application of this subsection for a taxable year1 gross income of the individual for the taxable year does not include a qualified ,,hsa transfer to the extent such transfer is otherwise includible in gross income4 7#b7 ,qualified ,,hsa transfer ,for purposes of this subsection1 the term qualified ,,hsa transfer means any distribution from an individual retirement plan-- 7,a7 to a health savings account of the individual in a direct trustee-to-trustee transfer1 and 7,b7 to the extent such distribution does not exceed the required minimum distribution determined under section #dja7;a77#i7 for the distribution calendar year ending during the taxable year4 7#c7 ,application of section #gb ,notwithstanding section #gb1 in determining the extent to which an amount is treated as a distribution for purposes of paragraph 7#a71 the entire amount of the distribution shall be treated as includible in gross income without regard to paragraph 7#a7 to the extent that such amount does not exceed the aggregate amount which would have been so includible if all amounts in all eligible retirement plans of the individual were distributed during such taxable year and all such plans were treated as #a contract for purposes of determining under section #gb the aggregate amount which would have been so includible4 ,proper adjustments shall be made in applying section #gb to other distributions in such taxable year and subsequent taxable years4 7#d7 ,eligible retirement plan ,for purposes of this subsection1 the term eligible retirement plan has the meaning given such term by subsection 7c77#h77;,b7 7determined without regard to clauses 7i7 and 7ii7 thereof74 4 7b7 ,transfer to health savings account 7#a7 ,in general ,subparagraph 7,a7 of section #bbc7;d77#a7 is amended by striking or at the end of clause 7i71 by striking the period at the end of clause 7ii77,,ii7 and inserting 1 or1 and by adding at the end the following new clause3 7iii7 unless it is in a qualified ,,hsa transfer described in section #djh7;d77#aj7 or #djb7m74 4 7#b7 ,excise tax inapplicable to qualified ,,hsa transfer ,paragraph 7#a7 of section #digc7;g7 is amended by inserting or in a qualified ,,hsa transfer described in section #djh7;d77#aj7 or #djb7m7 after or #bbc7;f77#e74 7c7 ,effective date ,the amendments made by this section shall apply to distributions made after the date of the enactment of this ,act1 in taxable years ending after such date4 #bdb4 ,distributions for abortion expenses from health savings accounts included in gross income 7a7 ,in general ,subsection 7f7 of section #bbc is amended by adding at the end the following new paragraph3 7#i7 ,exception for certain abortion expenses 7,a7 ,in general ,notwithstanding paragraph 7#a71 any amount used to pay for an abortion 7other than an abortion described in subparagraph 7,b77 shall be included in the gross income of such beneficiary4 7,b7 ,exceptions ,subparagraph 7,a7 shall not apply to-- 7i7 an abortion-- 7,i7 in the case of a pregnancy that is the result of an act of rape or incest1 or 7,,ii7 in the case where a woman suffers from a physical disorder1 physical injury1 or physical illness that would1 as certified by a physician1 place the woman in danger of death unless an abortion is performed1 including a life-endangering physical condition caused by or arising from the pregnancy1 and 7ii7 the treatment of any infection1 injury1 disease1 or disorder that has been caused by or exacerbated by the performance of an abortion4 4 7b7 ,effective date ,the amendment made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 ,c ,enhanced wellness incentives #bea4 ,providing financial incentives for treatment compliance 7a7 ,limitation on exception for wellness programs under ,,hipaa discrimination rules 7#a7 ,employee ,retirement ,income ,security ,act of #aigd amendment ,section #gjb7;b77#b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahb7;b77#b77 is amended by adding at the end the following flush sentence3 ,in applying subparagraph 7,b71 a group health plan 7or a health insurance issuer with respect to health insurance coverage7 may vary premiums and cost-sharing by up to #ej percent of the value of the benefits under the plan 7or coverage7 based on participation 7or lack of participation7 in a standards-based wellness program4 4 7#b7 ,,phsa amendment ,section #bgje7;b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#d7;b77#b77 is amended by adding at the end the following flush sentence3 ,in applying subparagraph 7,b71 a group health plan 7or a health insurance issuer with respect to health insurance coverage7 may vary premiums and cost-sharing by up to #ej percent of the value of the benefits under the plan 7or coverage7 based on participation 7or lack of participation7 in a standards-based wellness program4 4 7#c7 ,,irc amendment ,section #ihjb7;b77#b7 of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following flush sentence3 ,in applying subparagraph 7,b71 a group health plan may vary premiums and cost-sharing by up to #ej percent of the value of the benefits under the plan based on participation 7or lack of participation7 in a standards-based wellness program4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to plan years beginning more than #a year after the date of the enactment of this ,act4 ,,iii ,improving ,access to ,insurance for ,vulnerable ,americans ,a ,eliminating barriers to insurance coverage #cja4 ,elimination of certain requirements for guaranteed availability in individual market 7a7 ,in general ,section #bgda7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#da7;b77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking 7#a77;,a7 and inserting 7#a72 and 7,b7 by striking and 7,b7 and all that follows up to the semicolon at the end2 7#b7 by adding and at the end of paragraph 7#b72 7#c7 in paragraph 7#c7-- 7,a7 by striking 7#a77;,a7 and inserting 7#a72 and 7,b7 by striking the semicolon at the end and inserting a period2 and 7#d7 by striking paragraphs 7#d7 and 7#e74 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect #b years after the date of the enactment of this ,act4 ,b ,ensuring coverage for individuals with preexisting conditions and multiple health care needs through high-,risk pools #caa4 ,improvement of high-risk pools ,section #bgde of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#de7 is amended-- 7#a7 in subsection 7a71 by adding at the end the following3 ,the ,secretary shall provide from the funds appropriated under subsection 7d77#c77;,a7 a grant of up to #e1jjj1jjj to each ,state that has not created a qualified high-risk pool as of ,september #a1 #bjag1 for the ,state's costs of creation and initial operation of such a pool42 7#b7 in paragraphs 7#a7 and 7#b7 of subsection 7b71 by striking and 7#b77;,a7 and inserting 7#b77;,a71 7#c77;,b71 and 7#d7 each place it appears2 7#c7 in subsection 7b77#c71 by inserting with respect to funds made available for fiscal years before fiscal year #bjaf1;after applicable standard risks12 7#d7 by adding at the end of subsection 7b7 the following new paragraph3 7#e7 ,verification of citizenship or alien qualification 7,a7 ,in general ,notwithstanding any other provision of law1 effective upon the date of the enactment of this paragraph1 only citizens and nationals of the ,united ,states shall be eligible to participate in a qualified high-risk pool that receives funds under this section4 7,b7 ,condition of participation ,as a condition of a ,state receiving such funds under this subsection for a fiscal year beginning with fiscal year #bjah1 the ,secretary shall require the ,state to certify1 to the satisfaction of the ,secretary1 that such ,state requires all applicants for coverage in the qualified high-risk pool to provide satisfactory documentation of citizenship or nationality in a manner consistent with section #aijc7x7 of the ,social ,security ,act4 7,c7 ,records ,the ,secretary shall keep sufficient records such that a determination of citizenship or nationality only has to be made once for any individual under this paragraph4 2 and 7#e7 in subsection 7d7-- 7,a7 in paragraphs 7#a77;,b7 and 7#b7 by striking paragraph 7#d7 and inserting paragraph 7#f72 7,b7 in paragraph 7#d71 by striking or 7#b7 and inserting 7#b71 7#c77;,b71 or 7#d72 7,c7 by redesignating paragraphs 7#c7 through 7#e7 as paragraphs 7#e7 through 7#g71 respectively2 and 7,d7 by inserting after paragraph 7#b7 the following3 7#c7 ,authorization of appropriations for fiscal year #bjah ,there are authorized to be appropriated for fiscal year #bjah-- 7,a7 #ej1jjj1jjj to carry out the second sentence of subsection 7a72 and 7,b7 #b1dej1jjj1jjj which1 subject to paragraph 7#f71 shall be made available for allotments under subsection 7b77#b74 7#d7 ,authorization of appropriations for fiscal years #bjai through #bjbg ,there are authorized to be appropriated #b1ejj1jjj1jjj for each of fiscal years #bjai through #bjbg which1 subject to paragraph 7#f71 shall be made available for allotments under subsection 7b77#b74 4 ,,iv ,encouraging a ,more ,competitive ,health ,care ,market ,a ,expanding patient choice #dja4 ,cooperative governing of individual health insurance coverage 7a7 ,in ,general ,title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by adding at the end the following new part3 ,d ,cooperative ,governing of ,individual ,health ,insurance ,coverage #bgie4 ,definitions ,in this part3 7#a7 ,primary state ,the term primary ,state means1 with respect to individual health insurance coverage offered by a health insurance issuer1 the ,state designated by the issuer as the ,state whose covered laws shall govern the health insurance issuer in the sale of such coverage under this part4 ,an issuer1 with respect to a particular policy1 may only designate one such ,state as its primary ,state with respect to all such coverage it offers4 ,such an issuer may not change the designated primary ,state with respect to individual health insurance coverage once the policy is issued1 except that such a change may be made upon renewal of the policy4 ,with respect to such designated ,state1 the issuer is deemed to be doing business in that ,state4 7#b7 ,secondary state ,the term secondary ,state means1 with respect to individual health insurance coverage offered by a health insurance issuer1 any ,state that is not the primary ,state4 ,in the case of a health insurance issuer that is selling a policy in1 or to a resident of1 a secondary ,state1 the issuer is deemed to be doing business in that secondary ,state4 7#c7 ,health insurance issuer ,the term health insurance issuer has the meaning given such term in section #bgia7;b77#b71 except that such an issuer must be licensed in the primary ,state and be qualified to sell individual health insurance coverage in that ,state4 7#d7 ,individual health insurance coverage ,the term individual health insurance coverage means health insurance coverage offered in the individual market1 as defined in section #bgia7;e77#a74 7#e7 ,applicable state authority ,the term applicable ,state authority means1 with respect to a health insurance issuer in a ,state1 the ,state insurance commissioner or official or officials designated by the ,state to enforce the requirements of this title for the ,state with respect to the issuer4 7#f7 ,hazardous financial condition ,the term hazardous financial condition means that1 based on its present or reasonably anticipated financial condition1 a health insurance issuer is unlikely to be able-- 7,a7 to meet obligations to policyholders with respect to known claims and reasonably anticipated claims2 or 7,b7 to pay other obligations in the normal course of business4 7#g7 ,covered laws 7,a7 ,in general ,the term covered laws means the laws1 rules1 regulations1 agreements1 and orders governing the insurance business pertaining to-- 7i7 individual health insurance coverage issued by a health insurance issuer2 7ii7 the offer1 sale1 rating 7including medical underwriting71 renewal1 and issuance of individual health insurance coverage to an individual2 7iii7 the provision to an individual in relation to individual health insurance coverage of health care and insurance related services2 7iv7 the provision to an individual in relation to individual health insurance coverage of management1 operations1 and investment activities of a health insurance issuer2 and 7v7 the provision to an individual in relation to individual health insurance coverage of loss control and claims administration for a health insurance issuer with respect to liability for which the issuer provides insurance4 7,b7 ,exception ,such term does not include any law1 rule1 regulation1 agreement1 or order governing the use of care or cost management techniques1 including any requirement related to provider contracting1 network access or adequacy1 health care data collection1 or quality assurance4 7#h7 ,state ,the term ,state means the #ej ,states and includes the ,district of ,columbia1 ,puerto ,rico1 the ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,northern ,mariana ,islands4 7#i7 ,unfair claims settlement practices ,the term unfair claims settlement practices means only the following practices3 7,a7 ,knowingly misrepresenting to claimants and insured individuals relevant facts or policy provisions relating to coverage at issue4 7,b7 ,failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under policies4 7,c7 ,failing to adopt and implement reasonable standards for the prompt investigation and settlement of claims arising under policies4 7,d7 ,failing to effectuate prompt1 fair1 and equitable settlement of claims submitted in which liability has become reasonably clear4 7,e7 ,refusing to pay claims without conducting a reasonable investigation4 7,f7 ,failing to affirm or deny coverage of claims within a reasonable period of time after having completed an investigation related to those claims4 7,g7 ,a pattern or practice of compelling insured individuals or their beneficiaries to institute suits to recover amounts due under its policies by offering substantially less than the amounts ultimately recovered in suits brought by them4 7,h7 ,a pattern or practice of attempting to settle or settling claims for less than the amount that a reasonable person would believe the insured individual or his or her beneficiary was entitled by reference to written or printed advertising material accompanying or made part of an application4 7,i7 ,attempting to settle or settling claims on the basis of an application that was materially altered without notice to1 or knowledge or consent of1 the insured4 7,j7 ,failing to provide forms necessary to present claims within #ae calendar days of a request with reasonable explanations regarding their use4 7,k7 ,attempting to cancel a policy in less time than that prescribed in the policy or by the law of the primary ,state4 7#aj7 ,fraud and abuse ,the term fraud and abuse means an act or omission committed by a person who1 knowingly and with intent to defraud1 commits1 or conceals any material information concerning1 one or more of the following3 7,a7 ,presenting1 causing to be presented or preparing with knowledge or belief that it will be presented to or by an insurer1 a reinsurer1 broker or its agent1 false information as part of1 in support of or concerning a fact material to one or more of the following3 7i7 ,an application for the issuance or renewal of an insurance policy or reinsurance contract4 7ii7 ,the rating of an insurance policy or reinsurance contract4 7iii7 ,a claim for payment or benefit pursuant to an insurance policy or reinsurance contract4 7iv7 ,premiums paid on an insurance policy or reinsurance contract4 7v7 ,payments made in accordance with the terms of an insurance policy or reinsurance contract4 7vi7 ,a document filed with the commissioner or the chief insurance regulatory official of another jurisdiction4 7vii7 ,the financial condition of an insurer or reinsurer4 7viii7 ,the formation1 acquisition1 merger1 reconsolidation1 dissolution or withdrawal from one or more lines of insurance or reinsurance in all or part of a ,state by an insurer or reinsurer4 7ix7 ,the issuance of written evidence of insurance4 7x7 ,the reinstatement of an insurance policy4 7,b7 ,solicitation or acceptance of new or renewal insurance risks on behalf of an insurer reinsurer or other person engaged in the business of insurance by a person who knows or should know that the insurer or other person responsible for the risk is insolvent at the time of the transaction4 7,c7 ,transaction of the business of insurance in violation of laws requiring a license1 certificate of authority or other legal authority for the transaction of the business of insurance4 7,d7 ,attempt to commit1 aiding or abetting in the commission of1 or conspiracy to commit the acts or omissions specified in this paragraph4 #bgif4 ,application of law 7a7 ,in ,general ,subject to section #fja7;d7 of the ,american ,health ,care ,reform ,act of #bjag1 the covered laws of the primary ,state shall apply to individual health insurance coverage offered by a health insurance issuer in the primary ,state and in any secondary ,state1 but only if the coverage and issuer comply with the conditions of this section with respect to the offering of coverage in any secondary ,state4 7b7 ,exemptions ,from ,covered ,laws in a ,secondary ,state ,except as provided in this section1 a health insurance issuer with respect to its offer1 sale1 rating 7including medical underwriting71 renewal1 and issuance of individual health insurance coverage in any secondary ,state is exempt from any covered laws of the secondary ,state 7and any rules1 regulations1 agreements1 or orders sought or issued by such ,state under or related to such covered laws7 to the extent that such laws would-- 7#a7 make unlawful1 or regulate1 directly or indirectly1 the operation of the health insurance issuer operating in the secondary ,state1 except that any secondary ,state may require such an issuer-- 7,a7 to pay1 on a nondiscriminatory basis1 applicable premium and other taxes 7including high-risk pool assessments7 which are levied on insurers and surplus lines insurers1 brokers1 or policyholders under the laws of the ,state2 7,b7 to register with and designate the ,state insurance commissioner as its agent solely for the purpose of receiving service of legal documents or process2 7,c7 to submit to an examination of its financial condition by the ,state insurance commissioner in any ,state in which the issuer is doing business to determine the issuer's financial condition1 if-- 7i7 the ,state insurance commissioner of the primary ,state has not done an examination within the period recommended by the ,national ,association of ,insurance ,commissioners2 and 7ii7 any such examination is conducted in accordance with the examiners' handbook of the ,national ,association of ,insurance ,commissioners and is coordinated to avoid unjustified duplication and unjustified repetition2 7,d7 to comply with a lawful order issued-- 7i7 in a delinquency proceeding commenced by the ,state insurance commissioner if there has been a finding of financial impairment under subparagraph 7,c72 or 7ii7 in a voluntary dissolution proceeding2 7,e7 to comply with an injunction issued by a court of competent jurisdiction1 upon a petition by the ,state insurance commissioner alleging that the issuer is in hazardous financial condition2 7,f7 to participate1 on a nondiscriminatory basis1 in any insurance insolvency guaranty association or similar association to which a health insurance issuer in the ,state is required to belong2 7,g7 to comply with any ,state law regarding fraud and abuse 7as defined in section #bgie7aj771 except that if the ,state seeks an injunction regarding the conduct described in this subparagraph1 such injunction must be obtained from a court of competent jurisdiction2 7,h7 to comply with any ,state law regarding unfair claims settlement practices 7as defined in section #bgie7i772 or 7,i7 to comply with the applicable requirements for independent review under section #bgih with respect to coverage offered in the ,state2 7#b7 require any individual health insurance coverage issued by the issuer to be countersigned by an insurance agent or broker residing in that ,secondary ,state2 or 7#c7 otherwise discriminate against the issuer issuing insurance in both the primary ,state and in any secondary ,state4 7c7 ,clear and ,conspicuous ,disclosure ,a health insurance issuer shall provide the following notice1 in #ab-point bold type1 in any insurance coverage offered in a secondary ,state under this part by such a health insurance issuer and at renewal of the policy1 with the #e blank spaces therein being appropriately filled with the name of the health insurance issuer1 the name of primary ,state1 the name of the secondary ,state1 the name of the secondary ,state1 and the name of the secondary ,state1 respectively1 for the coverage concerned3 ,notice ,this policy is issued by and is governed by the laws and regulations of the ,state of 1 and it has met all the laws of that ,state as determined by that ,state's ,department of ,insurance4 ,this policy may be less expensive than others because it is not subject to all of the insurance laws and regulations of the ,state of 1 including coverage of some services or benefits mandated by the law of the ,state of 4 ,additionally1 this policy is not subject to all of the consumer protection laws or restrictions on rate changes of the ,state of 4 ,as with all insurance products1 before purchasing this policy1 you should carefully review the policy and determine what health care services the policy covers and what benefits it provides1 including any exclusions1 limitations1 or conditions for such services or benefits4 4 7d7 ,prohibition on ,certain ,reclassifications and ,premium ,increases 7#a7 ,in general ,for purposes of this section1 a health insurance issuer that provides individual health insurance coverage to an individual under this part in a primary or secondary ,state may not upon renewal-- 7,a7 move or reclassify the individual insured under the health insurance coverage from the class such individual is in at the time of issue of the contract based on the health-status related factors of the individual2 or 7,b7 increase the premiums assessed the individual for such coverage based on a health status-related factor or change of a health status-related factor or the past or prospective claim experience of the insured individual4 7#b7 ,construction ,nothing in paragraph 7#a7 shall be construed to prohibit a health insurance issuer-- 7,a7 from terminating or discontinuing coverage or a class of coverage in accordance with subsections 7b7 and 7c7 of section #bgdb2 7,b7 from raising premium rates for all policy holders within a class based on claims experience2 7,c7 from changing premiums or offering discounted premiums to individuals who engage in wellness activities at intervals prescribed by the issuer1 if such premium changes or incentives-- 7i7 are disclosed to the consumer in the insurance contract2 7ii7 are based on specific wellness activities that are not applicable to all individuals2 and 7iii7 are not obtainable by all individuals to whom coverage is offered2 7,d7 from reinstating lapsed coverage2 or 7,e7 from retroactively adjusting the rates charged an insured individual if the initial rates were set based on material misrepresentation by the individual at the time of issue4 7e7 ,prior ,offering of ,policy in ,primary ,state ,a health insurance issuer may not offer for sale individual health insurance coverage in a secondary ,state unless that coverage is currently offered for sale in the primary ,state4 7f7 ,licensing of ,agents or ,brokers for ,health ,insurance ,issuers ,any ,state may require that a person acting1 or offering to act1 as an agent or broker for a health insurance issuer with respect to the offering of individual health insurance coverage obtain a license from that ,state1 with commissions or other compensation subject to the provisions of the laws of that ,state1 except that a ,state may not impose any qualification or requirement which discriminates against a nonresident agent or broker4 7g7 ,documents for ,submission to ,state ,insurance ,commissioner ,each health insurance issuer issuing individual health insurance coverage in both primary and secondary ,states shall submit-- 7#a7 to the insurance commissioner of each ,state in which it intends to offer such coverage1 before it may offer individual health insurance coverage in such ,state-- 7,a7 a copy of the plan of operation or feasibility study or any similar statement of the policy being offered and its coverage 7which shall include the name of its primary ,state and its principal place of business72 7,b7 written notice of any change in its designation of its primary ,state2 and 7,c7 written notice from the issuer of the issuer's compliance with all the laws of the primary ,state2 and 7#b7 to the insurance commissioner of each secondary ,state in which it offers individual health insurance coverage1 a copy of the issuer's quarterly financial statement submitted to the primary ,state1 which statement shall be certified by an independent public accountant and contain a statement of opinion on loss and loss adjustment expense reserves made by-- 7,a7 a member of the ,american ,academy of ,actuaries2 or 7,b7 a qualified loss reserve specialist4 7h7 ,power of ,courts ,to ,enjoin ,conduct ,nothing in this section shall be construed to affect the authority of any ,federal or ,state court to enjoin-- 7#a7 the solicitation or sale of individual health insurance coverage by a health insurance issuer to any person or group who is not eligible for such insurance2 or 7#b7 the solicitation or sale of individual health insurance coverage that violates the requirements of the law of a secondary ,state which are described in subparagraphs 7,a7 through 7,h7 of section #bgif7;b77#a74 7i7 ,power of ,secondary ,states ,to ,take ,administrative ,action ,nothing in this section shall be construed to affect the authority of any ,state to enjoin conduct in violation of that ,state's laws described in section #bgif7;b77#a74 7j7 ,state ,powers ,to ,enforce ,state ,laws 7#a7 ,in general ,subject to the provisions of subsection 7b77#a77;,g7 7relating to injunctions7 and paragraph 7#b71 nothing in this section shall be construed to affect the authority of any ,state to make use of any of its powers to enforce the laws of such ,state with respect to which a health insurance issuer is not exempt under subsection 7b74 7#b7 ,courts of competent jurisdiction ,if a ,state seeks an injunction regarding the conduct described in paragraphs 7#a7 and 7#b7 of subsection 7h71 such injunction must be obtained from a ,federal or ,state court of competent jurisdiction4 7k7 ,states' ,authority ,to ,sue ,nothing in this section shall affect the authority of any ,state to bring action in any ,federal or ,state court4 7l7 ,generally ,applicable ,laws ,nothing in this section shall be construed to affect the applicability of ,state laws generally applicable to persons or corporations4 7m7 ,guaranteed ,availability of ,coverage to ,,hipaa ,eligible ,individuals ,to the extent that a health insurance issuer is offering coverage in a primary ,state that does not accommodate residents of secondary ,states or does not provide a working mechanism for residents of a secondary ,state1 and the issuer is offering coverage under this part in such secondary ,state which has not adopted a qualified high-risk pool as its acceptable alternative mechanism 7as defined in section #bgdd7;c77#b771 the issuer shall1 with respect to any individual health insurance coverage offered in a secondary ,state under this part1 comply with the guaranteed availability requirements for eligible individuals in section #bgda4 #bgig4 ,primary ,state must meet ,federal floor before issuer may sell into secondary ,states ,a health insurance issuer may not offer1 sell1 or issue individual health insurance coverage in a secondary ,state if the ,state insurance commissioner does not use a risk-based capital formula for the determination of capital and surplus requirements for all health insurance issuers4 #bgih4 ,independent external appeals procedures 7a7 ,right to ,external ,appeal ,a health insurance issuer may not offer1 sell1 or issue individual health insurance coverage in a secondary ,state under the provisions of this title unless-- 7#a7 both the secondary ,state and the primary ,state have legislation or regulations in place establishing an independent review process for individuals who are covered by individual health insurance coverage1 or 7#b7 in any case in which the requirements of subparagraph 7,a7 are not met with respect to the either of such ,states1 the issuer provides an independent review mechanism substantially identical 7as determined by the applicable ,state authority of such ,state7 to that prescribed in the ,health ,carrier ,external ,review ,model ,act of the ,national ,association of ,insurance ,commissioners for all individuals who purchase insurance coverage under the terms of this part1 except that1 under such mechanism1 the review is conducted by an independent medical reviewer1 or a panel of such reviewers1 with respect to whom the requirements of subsection 7b7 are met4 7b7 ,qualifications of ,independent ,medical ,reviewers ,in the case of any independent review mechanism referred to in subsection 7a77#b7-- 7#a7 ,in general ,in referring a denial of a claim to an independent medical reviewer1 or to any panel of such reviewers1 to conduct independent medical review1 the issuer shall ensure that-- 7,a7 each independent medical reviewer meets the qualifications described in paragraphs 7#b7 and 7#c72 7,b7 with respect to each review1 each reviewer meets the requirements of paragraph 7#d7 and the reviewer1 or at least #a reviewer on the panel1 meets the requirements described in paragraph 7#e72 and 7,c7 compensation provided by the issuer to each reviewer is consistent with paragraph 7#f74 7#b7 ,licensure and expertise ,each independent medical reviewer shall be a physician 7allopathic or osteopathic7 or health care professional who-- 7,a7 is appropriately credentialed or licensed in one or more ,states to deliver health care services2 and 7,b7 typically treats the condition1 makes the diagnosis1 or provides the type of treatment under review4 7#c7 ,independence 7,a7 ,in general ,subject to subparagraph 7,b71 each independent medical reviewer in a case shall-- 7i7 not be a related party 7as defined in paragraph 7#g772 7ii7 not have a material familial1 financial1 or professional relationship with such a party2 and 7iii7 not otherwise have a conflict of interest with such a party 7as determined under regulations74 7,b7 ,exception ,nothing in subparagraph 7,a7 shall be construed to-- 7i7 prohibit an individual1 solely on the basis of affiliation with the issuer1 from serving as an independent medical reviewer if-- 7,i7 a non-affiliated individual is not reasonably available2 7,,ii7 the affiliated individual is not involved in the provision of items or services in the case under review2 7,,iii7 the fact of such an affiliation is disclosed to the issuer and the enrollee 7or authorized representative7 and neither party objects2 and 7,,iv7 the affiliated individual is not an employee of the issuer and does not provide services exclusively or primarily to or on behalf of the issuer2 7ii7 prohibit an individual who has staff privileges at the institution where the treatment involved takes place from serving as an independent medical reviewer merely on the basis of such affiliation if the affiliation is disclosed to the issuer and the enrollee 7or authorized representative71 and neither party objects2 or 7iii7 prohibit receipt of compensation by an independent medical reviewer from an entity if the compensation is provided consistent with paragraph 7#f74 7#d7 ,practicing health care professional in same field 7,a7 ,in general ,in a case involving treatment1 or the provision of items or services-- 7i7 by a physician1 a reviewer shall be a practicing physician 7allopathic or osteopathic7 of the same or similar specialty1 as a physician who1 acting within the appropriate scope of practice within the ,state in which the service is provided or rendered1 typically treats the condition1 makes the diagnosis1 or provides the type of treatment under review2 or 7ii7 by a non-physician health care professional1 the reviewer1 or at least #a member of the review panel1 shall be a practicing non-physician health care professional of the same or similar specialty as the non-physician health care professional who1 acting within the appropriate scope of practice within the ,state in which the service is provided or rendered1 typically treats the condition1 makes the diagnosis1 or provides the type of treatment under review4 7,b7 ,practicing defined ,for purposes of this paragraph1 the term practicing means1 with respect to an individual who is a physician or other health care professional1 that the individual provides health care services to individual patients on average at least #b days per week4 7#e7 ,pediatric expertise ,in the case of an external review relating to a child1 a reviewer shall have expertise under paragraph 7#b7 in pediatrics4 7#f7 ,limitations on reviewer compensation ,compensation provided by the issuer to an independent medical reviewer in connection with a review under this section shall-- 7,a7 not exceed a reasonable level2 and 7,b7 not be contingent on the decision rendered by the reviewer4 7#g7 ,related party defined ,for purposes of this section1 the term related party means1 with respect to a denial of a claim under a coverage relating to an enrollee1 any of the following3 7,a7 ,the issuer involved1 or any fiduciary1 officer1 director1 or employee of the issuer4 7,b7 ,the enrollee 7or authorized representative74 7,c7 ,the health care professional that provides the items or services involved in the denial4 7,d7 ,the institution at which the items or services 7or treatment7 involved in the denial are provided4 7,e7 ,the manufacturer of any drug or other item that is included in the items or services involved in the denial4 7,f7 ,any other party determined under any regulations to have a substantial interest in the denial involved4 7#h7 ,definitions ,for purposes of this subsection3 7,a7 ,enrollee ,the term enrollee means1 with respect to health insurance coverage offered by a health insurance issuer1 an individual enrolled with the issuer to receive such coverage4 7,b7 ,health care professional ,the term health care professional means an individual who is licensed1 accredited1 or certified under ,state law to provide specified health care services and who is operating within the scope of such licensure1 accreditation1 or certification4 #bgii4 ,enforcement 7a7 ,in ,general ,subject to subsection 7b7 and section #fja7;d7 of the ,american ,health ,care ,reform ,act of #bjag1 with respect to specific individual health insurance coverage the primary ,state for such coverage has sole jurisdiction to enforce the primary ,state's covered laws in the primary ,state and any secondary ,state4 7b7 ,secondary ,state's ,authority ,nothing in subsection 7a7 shall be construed to affect the authority of a secondary ,state to enforce its laws as set forth in the exception specified in section #bgif7;b77#a74 7c7 ,court ,interpretation ,in reviewing action initiated by the applicable secondary ,state authority1 the court of competent jurisdiction shall apply the covered laws of the primary ,state4 7d7 ,notice of ,compliance ,failure ,in the case of individual health insurance coverage offered in a secondary ,state that fails to comply with the covered laws of the primary ,state1 the applicable ,state authority of the secondary ,state may notify the applicable ,state authority of the primary ,state4 4 7b7 ,effective ,date ,the amendment made by subsection 7a7 shall apply to individual health insurance coverage offered1 issued1 or sold after the date that is one year after the date of the enactment of this ,act4 7c7 ,,gao ,ongoing ,study and ,reports 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct an ongoing study concerning the effect of the amendment made by subsection 7a7 on-- 7,a7 the number of uninsured and under-insured2 7,b7 the availability and cost of health insurance policies for individuals with pre-existing medical conditions2 7,c7 the availability and cost of health insurance policies generally2 7,d7 the elimination or reduction of different types of benefits under health insurance policies offered in different ,states2 and 7,e7 cases of fraud or abuse relating to health insurance coverage offered under such amendment and the resolution of such cases4 7#b7 ,annual reports ,the ,comptroller ,general shall submit to ,congress an annual report1 after the end of each of the #e years following the effective date of the amendment made by subsection 7a71 on the ongoing study conducted under paragraph 7#a74 ,b ,mc,carran-,ferguson reform #daa4 ,restoring the application of antitrust laws to health sector insurers 7a7 ,amendment to ,mc,carran-,ferguson ,act ,section #c of the ,act of ,march #i1 #aide 7#ae ,u4,s4,c4 #ajac71 commonly known as the ,mc,carran-,ferguson ,act1 is amended by adding at the end the following3 7c7 7#a7 ,nothing contained in this ,act shall modify1 impair1 or supersede the operation of any of the antitrust laws with respect to the business of health insurance 7including the business of dental insurance74 ,for purposes of the preceding sentence1 the term antitrust laws has the meaning given it in subsection 7a7 of the first section of the ,clayton ,act1 except that such term includes section #e of the ,federal ,trade ,commission ,act to the extent that such section #e applies to unfair methods of competition4 7#b7 ,for purposes of paragraph 7#a71 the term business of health insurance 7including the business of dental insurance7 does not include-- 7,a7 the business of life insurance 7including annuities72 or 7,b7 the business of property or casualty insurance1 including but not limited to1 any insurance or benefits defined as #8excepted benefits' under paragraph 7#a71 subparagraphs 7,b7 or 7,c7 of paragraph 7#b71 or paragraph 7#c7 of section #ihcb7;c7 of the ,internal ,revenue ,code of #aihf 7#bf ,u4,s4,c4 #ihcb7;c77 whether offered separately or in combination with insurance or benefits described in paragraph 7#b77;,a7 of such section4 4 7b7 ,related ,provision ,for purposes of section #e of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #de7 to the extent such section applies to unfair methods of competition1 section #c7;c7 of the ,mc,carran-,ferguson ,act shall apply with respect to the business of health insurance without regard to whether such business is carried on for profit1 notwithstanding the definition of ,corporation contained in section #d of the ,federal ,trade ,commission ,act4 ,c ,medicare ,price ,transparency #dba4 ,public availability of ,medicare claims data 7a7 ,in general ,section #aabh;,j of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#gk7 is amended by adding at the end the following new subsection3 7f7 ,public availability of medicare claims data 7#a7 ,in general ,the ,secretary shall1 to the extent consistent with applicable information1 privacy1 security1 and disclosure laws1 including the regulations promulgated under the ,health ,insurance ,portability and ,accountability ,act of #aiif and section #eeb;a of title #e1 ,united ,states ,code1 make available to the public claims and payment data of the ,department of ,health and ,human ,services related to title ,,xviii1 including data on payments made to any provider of services or supplier under such title4 7#b7 ,implementation 7,a7 ,in general ,not later than ,december #ca1 #bjag1 the ,secretary shall promulgate regulations to carry out this subsection4 7,b7 ,requirements ,the regulations promulgated under subparagraph 7,a7 shall ensure that-- 7i7 the data described in paragraph 7#a7 is made available to the public through a searchable database that the public can access at no cost2 7ii7 such database-- 7,i7 includes the amount paid to each provider of services or supplier under title ,,xviii1 the items or services for which such payment was made1 and the location of the provider of services or supplier2 7,,ii7 is organized based on the specialty or the type of provider of services or supplier involved2 7,,iii7 is searchable based on the type of items or services furnished2 and 7,,iv7 includes a disclaimer that the aggregate data in the database does not reflect on the quality of the items or services furnished or of the provider of services or supplier who furnished the items or services2 and 7iii7 each provider of services or supplier in the database is identified by a unique identifier that is available to the public 7such as the ,national ,provider ,identifier of the provider of services or supplier74 7,c7 ,scope of data ,the database shall include data for fiscal year #bjah1 and each year fiscal year thereafter4 4 7b7 ,information not exempt under the ,freedom of ,information ,act ,the term personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy1 as used in section #eeb7;b77#f7 of title #e1 ,united ,states ,code1 does not include the information required to be made available to the public under section #aabh;,j7f7 of the ,social ,security ,act1 as added by subsection 7a74 ,d ,state transparency portals #dca4 ,providing information on health coverage options and health care providers 7a7 ,state-,based portal ,a ,state 7by itself or jointly with other ,states7 may contract with a private entity to establish a ,health ,plan and ,provider ,portal ,web site 7referred to in this section as a plan portal7 for the purposes of providing standardized information-- 7#a7 on health insurance plans that have been certified to be available for purchase in that ,state2 and 7#b7 on price and quality information on health care providers 7including physicians1 hospitals1 and other health care institutions74 7b7 ,prohibitions 7#a7 ,direct ,enrollment ,a plan portal may not directly enroll individuals in health insurance plans or under a ,state ,medicaid plan or a ,state children's health insurance plan4 7#b7 ,conflicts of interest 7,a7 ,companies ,a health insurance issuer offering a health insurance plan through a plan portal may not-- 7i7 be the private entity developing and maintaining a plan portal under this section2 or 7ii7 have an ownership interest in such private entity or in the plan portal4 7,b7 ,individuals ,an individual employed by a health insurance issuer offering a health insurance plan through a plan portal may not serve as a director or officer for-- 7i7 the private entity developing and maintaining a plan portal under this section2 or 7ii7 the plan portal4 7c7 ,construction ,nothing in this section shall be construed to prohibit health insurance brokers and agents from-- 7#a7 utilizing the plan portal for any purpose2 or 7#b7 marketing or offering health insurance products4 7d7 ,state defined ,in this section1 the term ,state has the meaning given such term for purposes of title ,,xix of the ,social ,security ,act4 7e7 ,health insurance plans ,for purposes of this section1 the term health insurance plan does not include coverage of excepted benefits1 as defined in section #bgia7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;c774 7f7 ,authorization of appropriations ,there are authorized to be appropriated #ej1jjj1jjj for fiscal year #bjah to provide funding for the ,secretary of ,health and ,human ,services to award grants to ,states to enter into contracts to establish a portal plan under this section1 to remain available until expended4 ,e ,protecting the ,doctor-,patient ,relationship #dda4 ,rule of construction ,nothing in this ,act shall be construed to interfere with the doctor-patient relationship or the practice of medicine4 #ddb4 ,repeal of ,federal ,coordinating ,council for ,comparative ,effectiveness ,research ,effective on the date of the enactment of this ,act1 section #hjd of the ,american ,recovery and ,reinvestment ,act of #bjji 7#db ,u4,s4,c4 #bii;b-#h7 is repealed4 ,f ,establishing ,association ,health ,plans #dea4 ,rules governing association health plans 7a7 ,in ,general ,subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd is amended by adding after part #g the following new part3 #h ,,rules ,,governing ,,association ,,health ,,plans #hja4 ,association health plans 7a7 ,in ,general ,for purposes of this part1 the term association health plan means a group health plan whose sponsor is 7or is deemed under this part to be7 described in subsection 7b74 7b7 ,sponsorship ,the sponsor of a group health plan is described in this subsection if such sponsor-- 7#a7 is organized and maintained in good faith1 with a constitution and bylaws specifically stating its purpose and providing for periodic meetings on at least an annual basis1 as a bona fide trade association1 a bona fide industry association 7including a rural electric cooperative association or a rural telephone cooperative association71 a bona fide professional association1 or a bona fide chamber of commerce 7or similar bona fide business association1 including a corporation or similar organization that operates on a cooperative basis 7within the meaning of section #acha of the ,internal ,revenue ,code of #aihf771 for substantial purposes other than that of obtaining or providing medical care2 7#b7 is established as a permanent entity which receives the active support of its members and requires for membership payment on a periodic basis of dues or payments necessary to maintain eligibility for membership in the sponsor2 and 7#c7 does not condition membership1 such dues or payments1 or coverage under the plan on the basis of health status-related factors with respect to the employees of its members 7or affiliated members71 or the dependents of such employees1 and does not condition such dues or payments on the basis of group health plan participation4 ,any sponsor consisting of an association of entities which meet the requirements of paragraphs 7#a71 7#b71 and 7#c7 shall be deemed to be a sponsor described in this subsection4 #hjb4 ,certification of association health plans 7a7 ,in ,general ,the applicable authority shall prescribe by regulation a procedure under which1 subject to subsection 7b71 the applicable authority shall certify association health plans which apply for certification as meeting the requirements of this part4 7b7 ,standards ,under the procedure prescribed pursuant to subsection 7a71 in the case of an association health plan that provides at least one benefit option which does not consist of health insurance coverage1 the applicable authority shall certify such plan as meeting the requirements of this part only if the applicable authority is satisfied that the applicable requirements of this part are met 7or1 upon the date on which the plan is to commence operations1 will be met7 with respect to the plan4 7c7 ,requirements ,applicable to ,certified ,plans ,an association health plan with respect to which certification under this part is in effect shall meet the applicable requirements of this part1 effective on the date of certification 7or1 if later1 on the date on which the plan is to commence operations74 7d7 ,requirements for ,continued ,certification ,the applicable authority may provide by regulation for continued certification of association health plans under this part4 7e7 ,class ,certification for ,fully ,insured ,plans ,the applicable authority shall establish a class certification procedure for association health plans under which all benefits consist of health insurance coverage4 ,under such procedure1 the applicable authority shall provide for the granting of certification under this part to the plans in each class of such association health plans upon appropriate filing under such procedure in connection with plans in such class and payment of the prescribed fee under section #hjg7;a74 7f7 ,certification of ,self-,insured ,association ,health ,plans ,an association health plan which offers one or more benefit options which do not consist of health insurance coverage may be certified under this part only if such plan consists of any of the following3 7#a7 a plan which offered such coverage on the date of the enactment of this part1 7#b7 a plan under which the sponsor does not restrict membership to one or more trades and businesses or industries and whose eligible participating employers represent a broad cross-section of trades and businesses or industries1 or 7#c7 a plan whose eligible participating employers represent one or more trades or businesses1 or one or more industries1 consisting of any of the following3 ,agriculture2 equipment and automobile dealerships2 barbering and cosmetology2 certified public accounting practices2 child care2 construction2 dance1 theatrical and orchestra productions2 disinfecting and pest control2 financial services2 fishing2 food service establishments2 hospitals2 labor organizations2 logging2 manufacturing 7metals72 mining2 medical and dental practices2 medical laboratories2 professional consulting services2 sanitary services2 transportation 7local and freight72 warehousing2 wholesaling_/distributing2 or any other trade or business or industry which has been indicated as having average or above-average risk or health claims experience by reason of ,state rate filings1 denials of coverage1 proposed premium rate levels1 or other means demonstrated by such plan in accordance with regulations4 #hjc4 ,requirements relating to sponsors and boards of trustees 7a7 ,sponsor ,the requirements of this subsection are met with respect to an association health plan if the sponsor has met 7or is deemed under this part to have met7 the requirements of section #hja7;b7 for a continuous period of not less than #c years ending with the date of the application for certification under this part4 7b7 ,board of ,trustees ,the requirements of this subsection are met with respect to an association health plan if the following requirements are met3 7#a7 ,fiscal control ,the plan is operated1 pursuant to a trust agreement1 by a board of trustees which has complete fiscal control over the plan and which is responsible for all operations of the plan4 7#b7 ,rules of operation and financial controls ,the board of trustees has in effect rules of operation and financial controls1 based on a #c-year plan of operation1 adequate to carry out the terms of the plan and to meet all requirements of this title applicable to the plan4 7#c7 ,rules governing relationship to participating employers and to contractors 7,a7 ,board membership 7i7 ,in general ,except as provided in clauses 7ii7 and 7iii71 the members of the board of trustees are individuals selected from individuals who are the owners1 officers1 directors1 or employees of the participating employers or who are partners in the participating employers and actively participate in the business4 7ii7 ,limitation 7,i7 ,general rule ,except as provided in subclauses 7,,ii7 and 7,,iii71 no such member is an owner1 officer1 director1 or employee of1 or partner in1 a contract administrator or other service provider to the plan4 7,,ii7 ,limited exception for providers of services solely on behalf of the sponsor ,officers or employees of a sponsor which is a service provider 7other than a contract administrator7 to the plan may be members of the board if they constitute not more than #be percent of the membership of the board and they do not provide services to the plan other than on behalf of the sponsor4 7,,iii7 ,treatment of providers of medical care ,in the case of a sponsor which is an association whose membership consists primarily of providers of medical care1 subclause 7,i7 shall not apply in the case of any service provider described in subclause 7,i7 who is a provider of medical care under the plan4 7iii7 ,certain plans excluded ,clause 7i7 shall not apply to an association health plan which is in existence on the date of the enactment of this part4 7,b7 ,sole authority ,the board has sole authority under the plan to approve applications for participation in the plan and to contract with a service provider to administer the day-to-day affairs of the plan4 7c7 ,treatment of ,franchise ,networks ,in the case of a group health plan which is established and maintained by a franchiser for a franchise network consisting of its franchisees-- 7#a7 the requirements of subsection 7a7 and section #hja7;a7 shall be deemed met if such requirements would otherwise be met if the franchiser were deemed to be the sponsor referred to in section #hja7;b71 such network were deemed to be an association described in section #hja7;b71 and each franchisee were deemed to be a member 7of the association and the sponsor7 referred to in section #hja7;b72 and 7#b7 the requirements of section #hjd7;a77#a7 shall be deemed met4 ,the ,secretary may by regulation define for purposes of this subsection the terms franchiser1 franchise network1 and franchisee4 #hjd4 ,participation and coverage requirements 7a7 ,covered ,employers and ,individuals ,the requirements of this subsection are met with respect to an association health plan if1 under the terms of the plan-- 7#a7 each participating employer must be-- 7,a7 a member of the sponsor1 7,b7 the sponsor1 or 7,c7 an affiliated member of the sponsor with respect to which the requirements of subsection 7b7 are met1 except that1 in the case of a sponsor which is a professional association or other individual-based association1 if at least one of the officers1 directors1 or employees of an employer1 or at least one of the individuals who are partners in an employer and who actively participates in the business1 is a member or such an affiliated member of the sponsor1 participating employers may also include such employer1 and 7#b7 all individuals commencing coverage under the plan after certification under this part must be-- 7,a7 active or retired owners 7including self-employed individuals71 officers1 directors1 or employees of1 or partners in1 participating employers1 or 7,b7 the beneficiaries of individuals described in subparagraph 7,a74 7b7 ,coverage of ,previously ,uninsured ,employees ,in the case of an association health plan in existence on the date of the enactment of this part1 an affiliated member of the sponsor of the plan may be offered coverage under the plan as a participating employer only if-- 7#a7 the affiliated member was an affiliated member on the date of certification under this part1 or 7#b7 during the #ab-month period preceding the date of the offering of such coverage1 the affiliated member has not maintained or contributed to a group health plan with respect to any of its employees who would otherwise be eligible to participate in such association health plan4 7c7 ,individual ,market ,unaffected ,the requirements of this subsection are met with respect to an association health plan if1 under the terms of the plan1 no participating employer may provide health insurance coverage in the individual market for any employee not covered under the plan which is similar to the coverage contemporaneously provided to employees of the employer under the plan1 if such exclusion of the employee from coverage under the plan is based on a health status-related factor with respect to the employee and such employee would1 but for such exclusion on such basis1 be eligible for coverage under the plan4 7d7 ,prohibition of ,discrimination ,against ,employers and ,employees ,eligible ,to ,participate ,the requirements of this subsection are met with respect to an association health plan if-- 7#a7 under the terms of the plan1 all employers meeting the preceding requirements of this section are eligible to qualify as participating employers for all geographically available coverage options1 unless1 in the case of any such employer1 participation or contribution requirements of the type referred to in section #bgaa of the ,public ,health ,service ,act are not met1 7#b7 upon request1 any employer eligible to participate is furnished information regarding all coverage options available under the plan1 and 7#c7 the applicable requirements of sections #gja1 #gjb1 and #gjc are met with respect to the plan4 #hje4 ,other requirements relating to plan documents1 contribution rates1 and benefit options 7a7 ,in ,general ,the requirements of this section are met with respect to an association health plan if the following requirements are met3 7#a7 ,contents of governing instruments ,the instruments governing the plan include a written instrument1 meeting the requirements of an instrument required under section #djb7;a77#a71 which-- 7,a7 provides that the board of trustees serves as the named fiduciary required for plans under section #djb7;a77#a7 and serves in the capacity of a plan administrator 7referred to in section #c7af77;,a771 7,b7 provides that the sponsor of the plan is to serve as plan sponsor 7referred to in section #c7af77;,b771 and 7,c7 incorporates the requirements of section #hjf4 7#b7 ,contribution rates must be nondiscriminatory 7,a7 ,the contribution rates for any participating small employer do not vary on the basis of any health status-related factor in relation to employees of such employer or their beneficiaries and do not vary on the basis of the type of business or industry in which such employer is engaged4 7,b7 ,nothing in this title or any other provision of law shall be construed to preclude an association health plan1 or a health insurance issuer offering health insurance coverage in connection with an association health plan1 from-- 7i7 setting contribution rates based on the claims experience of the plan1 or 7ii7 varying contribution rates for small employers in a ,state to the extent that such rates could vary using the same methodology employed in such ,state for regulating premium rates in the small group market with respect to health insurance coverage offered in connection with bona fide associations 7within the meaning of section #bgia7;d77#c7 of the ,public ,health ,service ,act71 subject to the requirements of section #gjb7;b7 relating to contribution rates4 7#c7 ,floor for number of covered individuals with respect to certain plans ,if any benefit option under the plan does not consist of health insurance coverage1 the plan has as of the beginning of the plan year not fewer than #a1jjj participants and beneficiaries4 7#d7 ,marketing requirements 7,a7 ,in general ,if a benefit option which consists of health insurance coverage is offered under the plan1 ,state-licensed insurance agents shall be used to distribute to small employers coverage which does not consist of health insurance coverage in a manner comparable to the manner in which such agents are used to distribute health insurance coverage4 7,b7 ,state-licensed insurance agents ,for purposes of subparagraph 7,a71 the term ,state-licensed insurance agents means one or more agents who are licensed in a ,state and are subject to the laws of such ,state relating to licensure1 qualification1 testing1 examination1 and continuing education of persons authorized to offer1 sell1 or solicit health insurance coverage in such ,state4 7#e7 ,regulatory requirements ,such other requirements as the applicable authority determines are necessary to carry out the purposes of this part1 which shall be prescribed by the applicable authority by regulation4 7b7 ,ability of ,association ,health ,plans ,to ,design ,benefit ,options ,subject to section #ead7;d71 nothing in this part or any provision of ,state law 7as defined in section #ead7;c77#a77 shall be construed to preclude an association health plan1 or a health insurance issuer offering health insurance coverage in connection with an association health plan1 from exercising its sole discretion in selecting the specific items and services consisting of medical care to be included as benefits under such plan or coverage1 except 7subject to section #ead7 in the case of 7#a7 any law to the extent that it is not preempted under section #gca7;a77#a7 with respect to matters governed by section #gaa1 #gab1 or #gac1 7#b7 any law of the ,state with which filing and approval of a policy type offered by the plan was initially obtained to the extent that such law prohibits an exclusion of a specific disease from such coverage1 or 7#c7 any law described in section #fja7;d7 of the ,american ,health ,care ,reform ,act of #bjag4 #hjf4 ,maintenance of reserves and provisions for solvency for plans providing health benefits in addition to health insurance coverage 7a7 ,in ,general ,the requirements of this section are met with respect to an association health plan if-- 7#a7 the benefits under the plan consist solely of health insurance coverage1 or 7#b7 if the plan provides any additional benefit options which do not consist of health insurance coverage1 the plan-- 7,a7 establishes and maintains reserves with respect to such additional benefit options1 in amounts recommended by the qualified actuary1 consisting of-- 7i7 a reserve sufficient for unearned contributions1 7ii7 a reserve sufficient for benefit liabilities which have been incurred1 which have not been satisfied1 and for which risk of loss has not yet been transferred1 and for expected administrative costs with respect to such benefit liabilities1 7iii7 a reserve sufficient for any other obligations of the plan1 and 7iv7 a reserve sufficient for a margin of error and other fluctuations1 taking into account the specific circumstances of the plan1 and 7,b7 establishes and maintains aggregate and specific excess_/stop loss insurance and solvency indemnification1 with respect to such additional benefit options for which risk of loss has not yet been transferred1 as follows3 7i7 ,the plan shall secure aggregate excess_/stop loss insurance for the plan with an attachment point which is not greater than #abe percent of expected gross annual claims4 ,the applicable authority may by regulation provide for upward adjustments in the amount of such percentage in specified circumstances in which the plan specifically provides for and maintains reserves in excess of the amounts required under subparagraph 7,a74 7ii7 ,the plan shall secure specific excess_/stop loss insurance for the plan with an attachment point which is at least equal to an amount recommended by the plan's qualified actuary4 ,the applicable authority may by regulation provide for adjustments in the amount of such insurance in specified circumstances in which the plan specifically provides for and maintains reserves in excess of the amounts required under subparagraph 7,a74 7iii7 ,the plan shall secure indemnification insurance for any claims which the plan is unable to satisfy by reason of a plan termination4 ,any person issuing to a plan insurance described in clause 7i71 7ii71 or 7iii7 of subparagraph 7,b7 shall notify the ,secretary of any failure of premium payment meriting cancellation of the policy prior to undertaking such a cancellation4 ,any regulations prescribed by the applicable authority pursuant to clause 7i7 or 7ii7 of subparagraph 7,b7 may allow for such adjustments in the required levels of excess_/stop loss insurance as the qualified actuary may recommend1 taking into account the specific circumstances of the plan4 7b7 ,minimum ,surplus in ,addition to ,claims ,reserves ,in the case of any association health plan described in subsection 7a77#b71 the requirements of this subsection are met if the plan establishes and maintains surplus in an amount at least equal to-- 7#a7 #ejj1jjj1 or 7#b7 such greater amount 7but not greater than #b1jjj1jjj7 as may be set forth in regulations prescribed by the applicable authority1 considering the level of aggregate and specific excess_/stop loss insurance provided with respect to such plan and other factors related to solvency risk1 such as the plan's projected levels of participation or claims1 the nature of the plan's liabilities1 and the types of assets available to assure that such liabilities are met4 7c7 ,additional ,requirements ,in the case of any association health plan described in subsection 7a77#b71 the applicable authority may provide such additional requirements relating to reserves1 excess_/stop loss insurance1 and indemnification insurance as the applicable authority considers appropriate4 ,such requirements may be provided by regulation with respect to any such plan or any class of such plans4 7d7 ,adjustments for ,excess_/,stop ,loss ,insurance ,the applicable authority may provide for adjustments to the levels of reserves otherwise required under subsections 7a7 and 7b7 with respect to any plan or class of plans to take into account excess_/stop loss insurance provided with respect to such plan or plans4 7e7 ,alternative ,means of ,compliance ,the applicable authority may permit an association health plan described in subsection 7a77#b7 to substitute1 for all or part of the requirements of this section 7except subsection 7a77#b77;,b77iii771 such security1 guarantee1 hold-harmless arrangement1 or other financial arrangement as the applicable authority determines to be adequate to enable the plan to fully meet all its financial obligations on a timely basis and is otherwise no less protective of the interests of participants and beneficiaries than the requirements for which it is substituted4 ,the applicable authority may take into account1 for purposes of this subsection1 evidence provided by the plan or sponsor which demonstrates an assumption of liability with respect to the plan4 ,such evidence may be in the form of a contract of indemnification1 lien1 bonding1 insurance1 letter of credit1 recourse under applicable terms of the plan in the form of assessments of participating employers1 security1 or other financial arrangement4 7f7 ,measures ,to ,ensure ,continued ,payment of ,benefits by ,certain ,plans in ,distress 7#a7 ,payments by certain plans to association health plan fund 7,a7 ,in general ,in the case of an association health plan described in subsection 7a77#b71 the requirements of this subsection are met if the plan makes payments into the ,association ,health ,plan ,fund under this subparagraph when they are due4 ,such payments shall consist of annual payments in the amount of #e1jjj1 and1 in addition to such annual payments1 such supplemental payments as the ,secretary may determine to be necessary under paragraph 7#b74 ,payments under this paragraph are payable to the ,fund at the time determined by the ,secretary4 ,initial payments are due in advance of certification under this part4 ,payments shall continue to accrue until a plan's assets are distributed pursuant to a termination procedure4 7,b7 ,penalties for failure to make payments ,if any payment is not made by a plan when it is due1 a late payment charge of not more than #ajj percent of the payment which was not timely paid shall be payable by the plan to the ,fund4 7,c7 ,continued duty of the secretary ,the ,secretary shall not cease to carry out the provisions of paragraph 7#b7 on account of the failure of a plan to pay any payment when due4 7#b7 ,payments by secretary to continue excess_/stop loss insurance coverage and indemnification insurance coverage for certain plans ,in any case in which the applicable authority determines that there is1 or that there is reason to believe that there will be3 7,a7 ,a failure to take necessary corrective actions under section #hji7;a7 with respect to an association health plan described in subsection 7a77#b72 or 7,b7 a termination of such a plan under section #hji7;b7 or #haj7;b77#h7 7and1 if the applicable authority is not the ,secretary1 certifies such determination to the ,secretary71 the ,secretary shall determine the amounts necessary to make payments to an insurer 7designated by the ,secretary7 to maintain in force excess_/stop loss insurance coverage or indemnification insurance coverage for such plan1 if the ,secretary determines that there is a reasonable expectation that1 without such payments1 claims would not be satisfied by reason of termination of such coverage4 ,the ,secretary shall1 to the extent provided in advance in appropriation ,acts1 pay such amounts so determined to the insurer designated by the ,secretary4 7#c7 ,association health plan fund 7,a7 ,in general ,there is established on the books of the ,treasury a fund to be known as the ,association ,health ,plan ,fund4 ,the ,fund shall be available for making payments pursuant to paragraph 7#b74 ,the ,fund shall be credited with payments received pursuant to paragraph 7#a77;,a71 penalties received pursuant to paragraph 7#a77;,b72 and earnings on investments of amounts of the ,fund under subparagraph 7,b74 7,b7 ,investment ,whenever the ,secretary determines that the moneys of the fund are in excess of current needs1 the ,secretary may request the investment of such amounts as the ,secretary determines advisable by the ,secretary of the ,treasury in obligations issued or guaranteed by the ,united ,states4 7g7 ,excess_/,stop ,loss ,insurance ,for purposes of this section-- 7#a7 ,aggregate excess_/stop loss insurance ,the term aggregate excess_/stop loss insurance means1 in connection with an association health plan1 a contract-- 7,a7 under which an insurer 7meeting such minimum standards as the applicable authority may prescribe by regulation7 provides for payment to the plan with respect to aggregate claims under the plan in excess of an amount or amounts specified in such contract1 7,b7 which is guaranteed renewable1 and 7,c7 which allows for payment of premiums by any third party on behalf of the insured plan4 7#b7 ,specific excess_/stop loss insurance ,the term specific excess_/stop loss insurance means1 in connection with an association health plan1 a contract-- 7,a7 under which an insurer 7meeting such minimum standards as the applicable authority may prescribe by regulation7 provides for payment to the plan with respect to claims under the plan in connection with a covered individual in excess of an amount or amounts specified in such contract in connection with such covered individual1 7,b7 which is guaranteed renewable1 and 7,c7 which allows for payment of premiums by any third party on behalf of the insured plan4 7h7 ,indemnification ,insurance ,for purposes of this section1 the term indemnification insurance means1 in connection with an association health plan1 a contract-- 7#a7 under which an insurer 7meeting such minimum standards as the applicable authority may prescribe by regulation7 provides for payment to the plan with respect to claims under the plan which the plan is unable to satisfy by reason of a termination pursuant to section #hji7;b7 7relating to mandatory termination71 7#b7 which is guaranteed renewable and noncancellable for any reason 7except as the applicable authority may prescribe by regulation71 and 7#c7 which allows for payment of premiums by any third party on behalf of the insured plan4 7i7 ,reserves ,for purposes of this section1 the term reserves means1 in connection with an association health plan1 plan assets which meet the fiduciary standards under part #d and such additional requirements regarding liquidity as the applicable authority may prescribe by regulation4 7j7 ,solvency ,standards ,working ,group 7#a7 ,in general ,within #ij days after the date of the enactment of this part1 the applicable authority shall establish a ,solvency ,standards ,working ,group4 ,in prescribing the initial regulations under this section1 the applicable authority shall take into account the recommendations of such ,working ,group4 7#b7 ,membership ,the ,working ,group shall consist of not more than #ae members appointed by the applicable authority4 ,the applicable authority shall include among persons invited to membership on the ,working ,group at least one of each of the following3 7,a7 ,a representative of the ,national ,association of ,insurance ,commissioners4 7,b7 ,a representative of the ,american ,academy of ,actuaries4 7,c7 ,a representative of the ,state governments1 or their interests4 7,d7 ,a representative of existing self-insured arrangements1 or their interests4 7,e7 ,a representative of associations of the type referred to in section #hja7;b77#a71 or their interests4 7,f7 ,a representative of multiemployer plans that are group health plans1 or their interests4 #hjg4 ,requirements for application and related requirements 7a7 ,filing ,fee ,under the procedure prescribed pursuant to section #hjb7;a71 an association health plan shall pay to the applicable authority at the time of filing an application for certification under this part a filing fee in the amount of #e1jjj1 which shall be available in the case of the ,secretary1 to the extent provided in appropriation ,acts1 for the sole purpose of administering the certification procedures applicable with respect to association health plans4 7b7 ,information ,to ,be ,included in ,application for ,certification ,an application for certification under this part meets the requirements of this section only if it includes1 in a manner and form which shall be prescribed by the applicable authority by regulation1 at least the following information3 7#a7 ,identifying information ,the names and addresses of-- 7,a7 the sponsor1 and 7,b7 the members of the board of trustees of the plan4 7#b7 ,states in which plan intends to do business ,the ,states in which participants and beneficiaries under the plan are to be located and the number of them expected to be located in each such ,state4 7#c7 ,bonding requirements ,evidence provided by the board of trustees that the bonding requirements of section #dab will be met as of the date of the application or 7if later7 commencement of operations4 7#d7 ,plan documents ,a copy of the documents governing the plan 7including any bylaws and trust agreements71 the summary plan description1 and other material describing the benefits that will be provided to participants and beneficiaries under the plan4 7#e7 ,agreements with service providers ,a copy of any agreements between the plan and contract administrators and other service providers4 7#f7 ,funding report ,in the case of association health plans providing benefits options in addition to health insurance coverage1 a report setting forth information with respect to such additional benefit options determined as of a date within the #abj-;day period ending with the date of the application1 including the following3 7,a7 ,reserves ,a statement1 certified by the board of trustees of the plan1 and a statement of actuarial opinion1 signed by a qualified actuary1 that all applicable requirements of section #hjf are or will be met in accordance with regulations which the applicable authority shall prescribe4 7,b7 ,adequacy of contribution rates ,a statement of actuarial opinion1 signed by a qualified actuary1 which sets forth a description of the extent to which contribution rates are adequate to provide for the payment of all obligations and the maintenance of required reserves under the plan for the #ab-month period beginning with such date within such #abj-;day period1 taking into account the expected coverage and experience of the plan4 ,if the contribution rates are not fully adequate1 the statement of actuarial opinion shall indicate the extent to which the rates are inadequate and the changes needed to ensure adequacy4 7,c7 ,current and projected value of assets and liabilities ,a statement of actuarial opinion signed by a qualified actuary1 which sets forth the current value of the assets and liabilities accumulated under the plan and a projection of the assets1 liabilities1 income1 and expenses of the plan for the #ab-month period referred to in subparagraph 7,b74 ,the income statement shall identify separately the plan's administrative expenses and claims4 7,d7 ,costs of coverage to be charged and other expenses ,a statement of the costs of coverage to be charged1 including an itemization of amounts for administration1 reserves1 and other expenses associated with the operation of the plan4 7,e7 ,other information ,any other information as may be determined by the applicable authority1 by regulation1 as necessary to carry out the purposes of this part4 7c7 ,filing ,notice of ,certification ,with ,states ,a certification granted under this part to an association health plan shall not be effective unless written notice of such certification is filed with the applicable ,state authority of each ,state in which at least #be percent of the participants and beneficiaries under the plan are located4 ,for purposes of this subsection1 an individual shall be considered to be located in the ,state in which a known address of such individual is located or in which such individual is employed4 7d7 ,notice of ,material ,changes ,in the case of any association health plan certified under this part1 descriptions of material changes in any information which was required to be submitted with the application for the certification under this part shall be filed in such form and manner as shall be prescribed by the applicable authority by regulation4 ,the applicable authority may require by regulation prior notice of material changes with respect to specified matters which might serve as the basis for suspension or revocation of the certification4 7e7 ,reporting ,requirements for ,certain ,association ,health ,plans ,an association health plan certified under this part which provides benefit options in addition to health insurance coverage for such plan year shall meet the requirements of section #ajc by filing an annual report under such section which shall include information described in subsection 7b77#f7 with respect to the plan year and1 notwithstanding section #ajd7;a77#a77;,a71 shall be filed with the applicable authority not later than #ij days after the close of the plan year 7or on such later date as may be prescribed by the applicable authority74 ,the applicable authority may require by regulation such interim reports as it considers appropriate4 7f7 ,engagement of ,qualified ,actuary ,the board of trustees of each association health plan which provides benefits options in addition to health insurance coverage and which is applying for certification under this part or is certified under this part shall engage1 on behalf of all participants and beneficiaries1 a qualified actuary who shall be responsible for the preparation of the materials comprising information necessary to be submitted by a qualified actuary under this part4 ,the qualified actuary shall utilize such assumptions and techniques as are necessary to enable such actuary to form an opinion as to whether the contents of the matters reported under this part-- 7#a7 are in the aggregate reasonably related to the experience of the plan and to reasonable expectations1 and 7#b7 represent such actuary's best estimate of anticipated experience under the plan4 ,the opinion by the qualified actuary shall be made with respect to1 and shall be made a part of1 the annual report4 #hjh4 ,notice requirements for voluntary termination ,except as provided in section #hji7;b71 an association health plan which is or has been certified under this part may terminate 7upon or at any time after cessation of accruals in benefit liabilities7 only if the board of trustees1 not less than #fj days before the proposed termination date-- 7#a7 provides to the participants and beneficiaries a written notice of intent to terminate stating that such termination is intended and the proposed termination date1 7#b7 develops a plan for winding up the affairs of the plan in connection with such termination in a manner which will result in timely payment of all benefits for which the plan is obligated1 and 7#c7 submits such plan in writing to the applicable authority4 ,actions required under this section shall be taken in such form and manner as may be prescribed by the applicable authority by regulation4 #hji4 ,corrective actions and mandatory termination 7a7 ,actions ,to ,avoid ,depletion of ,reserves ,an association health plan which is certified under this part and which provides benefits other than health insurance coverage shall continue to meet the requirements of section #hjf1 irrespective of whether such certification continues in effect4 ,the board of trustees of such plan shall determine quarterly whether the requirements of section #hjf are met4 ,in any case in which the board determines that there is reason to believe that there is or will be a failure to meet such requirements1 or the applicable authority makes such a determination and so notifies the board1 the board shall immediately notify the qualified actuary engaged by the plan1 and such actuary shall1 not later than the end of the next following month1 make such recommendations to the board for corrective action as the actuary determines necessary to ensure compliance with section #hjf4 ,not later than #cj days after receiving from the actuary recommendations for corrective actions1 the board shall notify the applicable authority 7in such form and manner as the applicable authority may prescribe by regulation7 of such recommendations of the actuary for corrective action1 together with a description of the actions 7if any7 that the board has taken or plans to take in response to such recommendations4 ,the board shall thereafter report to the applicable authority1 in such form and frequency as the applicable authority may specify to the board1 regarding corrective action taken by the board until the requirements of section #hjf are met4 7b7 ,mandatory ,termination ,in any case in which-- 7#a7 the applicable authority has been notified under subsection 7a7 7or by an issuer of excess_/stop loss insurance or indemnity insurance pursuant to section #hjf7;a77 of a failure of an association health plan which is or has been certified under this part and is described in section #hjf7;a77#b7 to meet the requirements of section #hjf and has not been notified by the board of trustees of the plan that corrective action has restored compliance with such requirements1 and 7#b7 the applicable authority determines that there is a reasonable expectation that the plan will continue to fail to meet the requirements of section #hjf1 the board of trustees of the plan shall1 at the direction of the applicable authority1 terminate the plan and1 in the course of the termination1 take such actions as the applicable authority may require1 including satisfying any claims referred to in section #hjf7;a77#b77;,b77iii7 and recovering for the plan any liability under subsection 7a77#b77;,b77iii7 or 7e7 of section #hjf1 as necessary to ensure that the affairs of the plan will be1 to the maximum extent possible1 wound up in a manner which will result in timely provision of all benefits for which the plan is obligated4 #haj4 ,trusteeship by the ,secretary of insolvent association health plans providing health benefits in addition to health insurance coverage 7a7 ,appointment of ,secretary as ,trustee for ,insolvent ,plans ,whenever the ,secretary determines that an association health plan which is or has been certified under this part and which is described in section #hjf7;a77#b7 will be unable to provide benefits when due or is otherwise in a financially hazardous condition1 as shall be defined by the ,secretary by regulation1 the ,secretary shall1 upon notice to the plan1 apply to the appropriate ,united ,states district court for appointment of the ,secretary as trustee to administer the plan for the duration of the insolvency4 ,the plan may appear as a party and other interested persons may intervene in the proceedings at the discretion of the court4 ,the court shall appoint such ,secretary trustee if the court determines that the trusteeship is necessary to protect the interests of the participants and beneficiaries or providers of medical care or to avoid any unreasonable deterioration of the financial condition of the plan4 ,the trusteeship of such ,secretary shall continue until the conditions described in the first sentence of this subsection are remedied or the plan is terminated4 7b7 ,powers as ,trustee ,the ,secretary1 upon appointment as trustee under subsection 7a71 shall have the power-- 7#a7 to do any act authorized by the plan1 this title1 or other applicable provisions of law to be done by the plan administrator or any trustee of the plan1 7#b7 to require the transfer of all 7or any part7 of the assets and records of the plan to the ,secretary as trustee1 7#c7 to invest any assets of the plan which the ,secretary holds in accordance with the provisions of the plan1 regulations prescribed by the ,secretary1 and applicable provisions of law1 7#d7 to require the sponsor1 the plan administrator1 any participating employer1 and any employee organization representing plan participants to furnish any information with respect to the plan which the ,secretary as trustee may reasonably need in order to administer the plan1 7#e7 to collect for the plan any amounts due the plan and to recover reasonable expenses of the trusteeship1 7#f7 to commence1 prosecute1 or defend on behalf of the plan any suit or proceeding involving the plan1 7#g7 to issue1 publish1 or file such notices1 statements1 and reports as may be required by the ,secretary by regulation or required by any order of the court1 7#h7 to terminate the plan 7or provide for its termination in accordance with section #hji7;b77 and liquidate the plan assets1 to restore the plan to the responsibility of the sponsor1 or to continue the trusteeship1 7#i7 to provide for the enrollment of plan participants and beneficiaries under appropriate coverage options1 and 7#aj7 to do such other acts as may be necessary to comply with this title or any order of the court and to protect the interests of plan participants and beneficiaries and providers of medical care4 7c7 ,notice of ,appointment ,as soon as practicable after the ,secretary's appointment as trustee1 the ,secretary shall give notice of such appointment to-- 7#a7 the sponsor and plan administrator1 7#b7 each participant1 7#c7 each participating employer1 and 7#d7 if applicable1 each employee organization which1 for purposes of collective bargaining1 represents plan participants4 7d7 ,additional ,duties ,except to the extent inconsistent with the provisions of this title1 or as may be otherwise ordered by the court1 the ,secretary1 upon appointment as trustee under this section1 shall be subject to the same duties as those of a trustee under section #gjd of title #aa1 ,united ,states ,code1 and shall have the duties of a fiduciary for purposes of this title4 7e7 ,other ,proceedings ,an application by the ,secretary under this subsection may be filed notwithstanding the pendency in the same or any other court of any bankruptcy1 mortgage foreclosure1 or equity receivership proceeding1 or any proceeding to reorganize1 conserve1 or liquidate such plan or its property1 or any proceeding to enforce a lien against property of the plan4 7f7 ,jurisdiction of ,court 7#a7 ,in general ,upon the filing of an application for the appointment as trustee or the issuance of a decree under this section1 the court to which the application is made shall have exclusive jurisdiction of the plan involved and its property wherever located with the powers1 to the extent consistent with the purposes of this section1 of a court of the ,united ,states having jurisdiction over cases under chapter #aa of title #aa1 ,united ,states ,code4 ,pending an adjudication under this section such court shall stay1 and upon appointment by it of the ,secretary as trustee1 such court shall continue the stay of1 any pending mortgage foreclosure1 equity receivership1 or other proceeding to reorganize1 conserve1 or liquidate the plan1 the sponsor1 or property of such plan or sponsor1 and any other suit against any receiver1 conservator1 or trustee of the plan1 the sponsor1 or property of the plan or sponsor4 ,pending such adjudication and upon the appointment by it of the ,secretary as trustee1 the court may stay any proceeding to enforce a lien against property of the plan or the sponsor or any other suit against the plan or the sponsor4 7#b7 ,venue ,an action under this section may be brought in the judicial district where the sponsor or the plan administrator resides or does business or where any asset of the plan is situated4 ,a district court in which such action is brought may issue process with respect to such action in any other judicial district4 7g7 ,personnel ,in accordance with regulations which shall be prescribed by the ,secretary1 the ,secretary shall appoint1 retain1 and compensate accountants1 actuaries1 and other professional service personnel as may be necessary in connection with the ,secretary's service as trustee under this section4 #haa4 ,state assessment authority 7a7 ,in ,general ,notwithstanding section #ead1 a ,state may impose by law a contribution tax on an association health plan described in section #hjf7;a77#b71 if the plan commenced operations in such ,state after the date of the enactment of this part4 7b7 ,contribution ,tax ,for purposes of this section1 the term contribution tax imposed by a ,state on an association health plan means any tax imposed by such ,state if-- 7#a7 such tax is computed by applying a rate to the amount of premiums or contributions1 with respect to individuals covered under the plan who are residents of such ,state1 which are received by the plan from participating employers located in such ,state or from such individuals1 7#b7 the rate of such tax does not exceed the rate of any tax imposed by such ,state on premiums or contributions received by insurers or health maintenance organizations for health insurance coverage offered in such ,state in connection with a group health plan1 7#c7 such tax is otherwise nondiscriminatory1 and 7#d7 the amount of any such tax assessed on the plan is reduced by the amount of any tax or assessment otherwise imposed by the ,state on premiums1 contributions1 or both received by insurers or health maintenance organizations for health insurance coverage1 aggregate excess_/stop loss insurance 7as defined in section #hjf7;g77#a771 specific excess_/stop loss insurance 7as defined in section #hjf7;g77#b771 other insurance related to the provision of medical care under the plan1 or any combination thereof provided by such insurers or health maintenance organizations in such ,state in connection with such plan4 #hab4 ,definitions and rules of construction 7a7 ,definitions ,for purposes of this part-- 7#a7 ,group health plan ,the term group health plan has the meaning provided in section #gcc7;a77#a7 7after applying subsection 7b7 of this section74 7#b7 ,medical care ,the term medical care has the meaning provided in section #gcc7;a77#b74 7#c7 ,health insurance coverage ,the term health insurance coverage has the meaning provided in section #gcc7;b77#a74 7#d7 ,health insurance issuer ,the term health insurance issuer has the meaning provided in section #gcc7;b77#b74 7#e7 ,applicable authority ,the term applicable authority means the ,secretary1 except that1 in connection with any exercise of the ,secretary's authority regarding which the ,secretary is required under section #ejf7;d7 to consult with a ,state1 such term means the ,secretary1 in consultation with such ,state4 7#f7 ,health status-related factor ,the term health status-related factor has the meaning provided in section #gcc7;d77#b74 7#g7 ,individual market 7,a7 ,in general ,the term individual market means the market for health insurance coverage offered to individuals other than in connection with a group health plan4 7,b7 ,treatment of very small groups 7i7 ,in general ,subject to clause 7ii71 such term includes coverage offered in connection with a group health plan that has fewer than #b participants as current employees or participants described in section #gcb7;d77#c7 on the first day of the plan year4 7ii7 ,state exception ,clause 7i7 shall not apply in the case of health insurance coverage offered in a ,state if such ,state regulates the coverage described in such clause in the same manner and to the same extent as coverage in the small group market 7as defined in section #bgia7;e77#e7 of the ,public ,health ,service ,act7 is regulated by such ,state4 7#h7 ,participating employer ,the term participating employer means1 in connection with an association health plan1 any employer1 if any individual who is an employee of such employer1 a partner in such employer1 or a self-employed individual who is such employer 7or any dependent1 as defined under the terms of the plan1 of such individual7 is or was covered under such plan in connection with the status of such individual as such an employee1 partner1 or self-employed individual in relation to the plan4 7#i7 ,applicable state authority ,the term applicable ,state authority means1 with respect to a health insurance issuer in a ,state1 the ,state insurance commissioner or official or officials designated by the ,state to enforce the requirements of title ,,xxvii of the ,public ,health ,service ,act for the ,state involved with respect to such issuer4 7#aj7 ,qualified actuary ,the term qualified actuary means an individual who is a member of the ,american ,academy of ,actuaries4 7#aa7 ,affiliated member ,the term affiliated member means1 in connection with a sponsor-- 7,a7 a person who is otherwise eligible to be a member of the sponsor but who elects an affiliated status with the sponsor1 7,b7 in the case of a sponsor with members which consist of associations1 a person who is a member of any such association and elects an affiliated status with the sponsor1 or 7,c7 in the case of an association health plan in existence on the date of the enactment of this part1 a person eligible to be a member of the sponsor or one of its member associations4 7#ab7 ,large employer ,the term large employer means1 in connection with a group health plan with respect to a plan year1 an employer who employed an average of at least #ea employees on business days during the preceding calendar year and who employs at least #b employees on the first day of the plan year4 7#ac7 ,small employer ,the term small employer means1 in connection with a group health plan with respect to a plan year1 an employer who is not a large employer4 7b7 ,rules of ,construction 7#a7 ,employers and employees ,for purposes of determining whether a plan1 fund1 or program is an employee welfare benefit plan which is an association health plan1 and for purposes of applying this title in connection with such plan1 fund1 or program so determined to be such an employee welfare benefit plan-- 7,a7 in the case of a partnership1 the term employer 7as defined in section #c7e77 includes the partnership in relation to the partners1 and the term employee 7as defined in section #c7f77 includes any partner in relation to the partnership1 and 7,b7 in the case of a self-employed individual1 the term employer 7as defined in section #c7e77 and the term employee 7as defined in section #c7f77 shall include such individual4 7#b7 ,plans1 funds1 and programs treated as employee welfare benefit plans ,in the case of any plan1 fund1 or program which was established or is maintained for the purpose of providing medical care 7through the purchase of insurance or otherwise7 for employees 7or their dependents7 covered thereunder and which demonstrates to the ,secretary that all requirements for certification under this part would be met with respect to such plan1 fund1 or program if such plan1 fund1 or program were a group health plan1 such plan1 fund1 or program shall be treated for purposes of this title as an employee welfare benefit plan on and after the date of such demonstration4 4 7b7 ,conforming ,amendments to ,preemption ,rules 7#a7 ,section #ead7;b77#f7 of such ,act 7#bi ,u4,s4,c4 #aadd7;b77#f77 is amended by adding at the end the following new subparagraph3 7,e7 ,the preceding subparagraphs of this paragraph do not apply with respect to any ,state law in the case of an association health plan which is certified under part #h4 4 7#b7 ,section #ead of such ,act 7#bi ,u4,s4,c4 #aadd7 is amended-- 7,a7 in subsection 7b77#d71 by striking ,subsection 7a7 and inserting ,subsections 7a7 and 7f72 7,b7 in subsection 7b77#e71 by striking subsection 7a7 in subparagraph 7,a7 and inserting subsection 7a7 of this section and subsections 7a77#b77;,b7 and 7b7 of section #hje1 and by striking subsection 7a7 in subparagraph 7,b7 and inserting subsection 7a7 of this section or subsection 7a77#b77;,b7 or 7b7 of section #hje2 and 7,c7 by adding at the end the following new subsection3 7f7 7#a7 ,except as provided in subsection 7b77#d71 the provisions of this title shall supersede any and all ,state laws insofar as they may now or hereafter preclude1 or have the effect of precluding1 a health insurance issuer from offering health insurance coverage in connection with an association health plan which is certified under part #h4 7#b7 ,except as provided in paragraphs 7#d7 and 7#e7 of subsection 7b7 of this section-- 7,a7 ,in any case in which health insurance coverage of any policy type is offered under an association health plan certified under part #h to a participating employer operating in such ,state1 the provisions of this title shall supersede any and all laws of such ,state insofar as they may preclude a health insurance issuer from offering health insurance coverage of the same policy type to other employers operating in the ,state which are eligible for coverage under such association health plan1 whether or not such other employers are participating employers in such plan4 7,b7 ,in any case in which health insurance coverage of any policy type is offered in a ,state under an association health plan certified under part #h and the filing1 with the applicable ,state authority 7as defined in section #hab7;a77#i771 of the policy form in connection with such policy type is approved by such ,state authority1 the provisions of this title shall supersede any and all laws of any other ,state in which health insurance coverage of such type is offered1 insofar as they may preclude1 upon the filing in the same form and manner of such policy form with the applicable ,state authority in such other ,state1 the approval of the filing in such other ,state4 7#c7 ,nothing in subsection 7b77#f77;,e7 or the preceding provisions of this subsection shall be construed1 with respect to health insurance issuers or health insurance coverage1 to supersede or impair the law of any ,state-- 7,a7 providing solvency standards or similar standards regarding the adequacy of insurer capital1 surplus1 reserves1 or contributions1 or 7,b7 relating to prompt payment of claims4 7#d7 ,for additional provisions relating to association health plans1 see subsections 7a77#b77;,b7 and 7b7 of section #hje4 7#e7 ,for purposes of this subsection1 the term association health plan has the meaning provided in section #hja7;a71 and the terms health insurance coverage1 participating employer1 and health insurance issuer have the meanings provided such terms in section #hab1 respectively4 4 7#c7 ,section #ead7;b77#f77;,a7 of such ,act 7#bi ,u4,s4,c4 #aadd7;b77#f77;,a77 is amended-- 7,a7 in clause 7i77,,ii71 by striking and at the end2 7,b7 in clause 7ii71 by inserting and which does not provide medical care 7within the meaning of section #gcc7;a77#b771 after arrangement11 and by striking title4 and inserting title1 and2 and 7,c7 by adding at the end the following new clause3 7iii7 subject to subparagraph 7,e71 in the case of any other employee welfare benefit plan which is a multiple employer welfare arrangement and which provides medical care 7within the meaning of section #gcc7;a77#b771 any law of any ,state which regulates insurance may apply4 4 7#d7 ,section #ead7;d7 of such ,act 7#bi ,u4,s4,c4 #aadd7;d77 is amended-- 7,a7 by striking ,nothing and inserting 7#a7 ,except as provided in paragraph 7#b71 nothing2 and 7,b7 by adding at the end the following new paragraph3 7#b7 ,nothing in any other provision of law enacted on or after the date of the enactment of this paragraph shall be construed to alter1 amend1 modify1 invalidate1 impair1 or supersede any provision of this title1 except by specific cross-reference to the affected section4 4 7c7 ,plan ,sponsor ,section #c7af77;,b7 of such ,act 7#bi ,u4,s4,c4 #ajb7af77;,b77 is amended by adding at the end the following new sentence3 ,such term also includes a person serving as the sponsor of an association health plan under part #h44 7d7 ,disclosure of ,solvency ,protections ,related to ,self-,insured and ,fully ,insured ,options ,under ,association ,health ,plans ,section #ajb7;b7 of such ,act 7#bi ,u4,s4,c4 #ajb7;b77 is amended by adding at the end the following3 ,an association health plan shall include in its summary plan description1 in connection with each benefit option1 a description of the form of solvency or guarantee fund protection secured pursuant to this ,act or applicable ,state law1 if any44 7e7 ,savings ,clause ,section #gca7;c7 of such ,act is amended by inserting or part #h after this part4 7f7 ,report to the ,congress ,regarding ,certification of ,self-,insured ,association ,health ,plans ,not later than ,january #a1 #bjai1 the ,secretary of ,labor shall report to the ,committee on ,education and the ,workforce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate the effect association health plans have had1 if any1 on reducing the number of uninsured individuals4 7g7 ,clerical ,amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd is amended by inserting after the item relating to section #gcd the following new items3 ,part #h--,rules ,governing ,association ,health ,plans #hja4 ,association health plans4 #hjb4 ,certification of association health plans4 #hjc4 ,requirements relating to sponsors and boards of trustees4 #hjd4 ,participation and coverage requirements4 #hje4 ,other requirements relating to plan documents1 contribution rates1 and benefit options4 #hjf4 ,maintenance of reserves and provisions for solvency for plans providing health benefits in addition to health insurance coverage4 #hjg4 ,requirements for application and related requirements4 #hjh4 ,notice requirements for voluntary termination4 #hji4 ,corrective actions and mandatory termination4 #haj4 ,trusteeship by the ,secretary of insolvent association health plans providing health benefits in addition to health insurance coverage4 #haa4 ,state assessment authority4 #hab4 ,definitions and rules of construction4 4 #deb4 ,clarification of treatment of single employer arrangements ,section #c7dj77;,b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb7dj77;,b77 is amended-- 7#a7 in clause 7i71 by inserting after control group1 the following3 except that1 in any case in which the benefit referred to in subparagraph 7,a7 consists of medical care 7as defined in section #hab7;a77#b771 two or more trades or businesses1 whether or not incorporated1 shall be deemed a single employer for any plan year of such plan1 or any fiscal year of such other arrangement1 if such trades or businesses are within the same control group during such year or at any time during the preceding #a-year period12 7#b7 in clause 7iii71 by striking 7iii7 the determination and inserting the following3 7iii7 7,i7 in any case in which the benefit referred to in subparagraph 7,a7 consists of medical care 7as defined in section #hab7;a77#b771 the determination of whether a trade or business is under common control with another trade or business shall be determined under regulations of the ,secretary applying principles consistent and coextensive with the principles applied in determining whether employees of two or more trades or businesses are treated as employed by a single employer under section #djja7;b71 except that1 for purposes of this paragraph1 an interest of greater than #be percent may not be required as the minimum interest necessary for common control1 or 7,,ii7 in any other case1 the determination 2 7#c7 by redesignating clauses 7iv7 and 7v7 as clauses 7v7 and 7vi71 respectively2 and 7#d7 by inserting after clause 7iii7 the following new clause3 7iv7 in any case in which the benefit referred to in subparagraph 7,a7 consists of medical care 7as defined in section #hab7;a77#b771 in determining1 after the application of clause 7i71 whether benefits are provided to employees of two or more employers1 the arrangement shall be treated as having only one participating employer if1 after the application of clause 7i71 the number of individuals who are employees and former employees of any one participating employer and who are covered under the arrangement is greater than #ge percent of the aggregate number of all individuals who are employees or former employees of participating employers and who are covered under the arrangement1 4 #dec4 ,enforcement provisions relating to association health plans 7a7 ,criminal ,penalties for ,certain ,willful ,misrepresentations ,section #eja of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaca7 is amended by adding at the end the following new subsection3 7c7 ,any person who willfully falsely represents1 to any employee1 any employee's beneficiary1 any employer1 the ,secretary1 or any ,state1 a plan or other arrangement established or maintained for the purpose of offering or providing any benefit described in section #c7a7 to employees or their beneficiaries as-- 7#a7 being an association health plan which has been certified under part #h1 7#b7 having been established or maintained under or pursuant to one or more collective bargaining agreements which are reached pursuant to collective bargaining described in section #h7;d7 of the ,national ,labor ,relations ,act 7#bi ,u4,s4,c4 #aeh7;d77 or paragraph ,fourth of section #b of the ,railway ,labor ,act 7#de ,u4,s4,c4 #aeb1 paragraph ,fourth7 or which are reached pursuant to labor-management negotiations under similar provisions of ,state public employee relations laws1 or 7#c7 being a plan or arrangement described in section #c7dj77;,a77i71 shall1 upon conviction1 be imprisoned not more than #e years1 be fined under title #ah1 ,united ,states ,code1 or both4 4 7b7 ,cease ,activities ,orders ,section #ejb of such ,act 7#bi ,u4,s4,c4 #aacb7 is amended by adding at the end the following new subsection3 7n7 ,association ,health ,plan ,cease and ,desist ,orders 7#a7 ,in general ,subject to paragraph 7#b71 upon application by the ,secretary showing the operation1 promotion1 or marketing of an association health plan 7or similar arrangement providing benefits consisting of medical care 7as defined in section #gcc7;a77#b777 that-- 7,a7 is not certified under part #h1 is subject under section #ead7;b77#f7 to the insurance laws of any ,state in which the plan or arrangement offers or provides benefits1 and is not licensed1 registered1 or otherwise approved under the insurance laws of such ,state1 or 7,b7 is an association health plan certified under part #h and is not operating in accordance with the requirements under part #h for such certification1 a district court of the ,united ,states shall enter an order requiring that the plan or arrangement cease activities4 7#b7 ,exception ,paragraph 7#a7 shall not apply in the case of an association health plan or other arrangement if the plan or arrangement shows that-- 7,a7 all benefits under it referred to in paragraph 7#a7 consist of health insurance coverage1 and 7,b7 with respect to each ,state in which the plan or arrangement offers or provides benefits1 the plan or arrangement is operating in accordance with applicable ,state laws that are not superseded under section #ead4 7#c7 ,additional equitable relief ,the court may grant such additional equitable relief1 including any relief available under this title1 as it deems necessary to protect the interests of the public and of persons having claims for benefits against the plan4 4 7c7 ,responsibility for ,claims ,procedure ,section #ejc of such ,act 7#bi ,u4,s4,c4 #aacc7 is amended by inserting 7a7 ,in general4-- before ,in accordance1 and by adding at the end the following new subsection3 7b7 ,association ,health ,plans ,the terms of each association health plan which is or has been certified under part #h shall require the board of trustees or the named fiduciary 7as applicable7 to ensure that the requirements of this section are met in connection with claims filed under the plan4 4 #ded4 ,cooperation between ,federal and ,state authorities ,section #ejf of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aacf7 is amended by adding at the end the following new subsection3 7d7 ,consultation ,with ,states ,with ,respect to ,association ,health ,plans 7#a7 ,agreements with states ,the ,secretary shall consult with the ,state recognized under paragraph 7#b7 with respect to an association health plan regarding the exercise of-- 7,a7 the ,secretary's authority under sections #ejb and #ejd to enforce the requirements for certification under part #h1 and 7,b7 the ,secretary's authority to certify association health plans under part #h in accordance with regulations of the ,secretary applicable to certification under part #h4 7#b7 ,recognition of primary domicile state ,in carrying out paragraph 7#a71 the ,secretary shall ensure that only one ,state will be recognized1 with respect to any particular association health plan1 as the ,state with which consultation is required4 ,in carrying out this paragraph-- 7,a7 in the case of a plan which provides health insurance coverage 7as defined in section #hab7;a77#c771 such ,state shall be the ,state with which filing and approval of a policy type offered by the plan was initially obtained1 and 7,b7 in any other case1 the ,secretary shall take into account the places of residence of the participants and beneficiaries under the plan and the ,state in which the trust is maintained4 4 #dee4 ,effective date and transitional and other rules 7a7 ,effective ,date ,the amendments made by this subtitle shall take effect #a year after the date of the enactment of this ,act4 ,the ,secretary of ,labor shall first issue all regulations necessary to carry out the amendments made by this subtitle within #a year after the date of the enactment of this ,act4 7b7 ,treatment of ,certain ,existing ,health ,benefits ,programs 7#a7 ,in general ,in any case in which1 as of the date of the enactment of this ,act1 an arrangement is maintained in a ,state for the purpose of providing benefits consisting of medical care for the employees and beneficiaries of its participating employers1 at least #bjj participating employers make contributions to such arrangement1 such arrangement has been in existence for at least #aj years1 and such arrangement is licensed under the laws of one or more ,states to provide such benefits to its participating employers1 upon the filing with the applicable authority 7as defined in section #hab7;a77#e7 of the ,employee ,retirement ,income ,security ,act of #aigd 7as amended by this subtitle77 by the arrangement of an application for certification of the arrangement under part #h of subtitle ,b of title ,i of such ,act-- 7,a7 such arrangement shall be deemed to be a group health plan for purposes of title ,i of such ,act2 7,b7 the requirements of sections #hja7;a7 and #hjc7;a7 of the ,employee ,retirement ,income ,security ,act of #aigd shall be deemed met with respect to such arrangement2 7,c7 the requirements of section #hjc7;b7 of such ,act shall be deemed met1 if the arrangement is operated by a board of directors which-- 7i7 is elected by the participating employers1 with each employer having one vote2 and 7ii7 has complete fiscal control over the arrangement and which is responsible for all operations of the arrangement2 7,d7 the requirements of section #hjd7;a7 of such ,act shall be deemed met with respect to such arrangement2 and 7,e7 the arrangement may be certified by any applicable authority with respect to its operations in any ,state only if it operates in such ,state on the date of certification4 ,the provisions of this subsection shall cease to apply with respect to any such arrangement at such time after the date of the enactment of this ,act as the applicable requirements of this subsection are not met with respect to such arrangement4 7#b7 ,definitions ,for purposes of this subsection1 the terms group health plan1 medical care1 and participating employer shall have the meanings provided in section #hab of the ,employee ,retirement ,income ,security ,act of #aigd1 except that the reference in paragraph 7#g7 of such section to an association health plan shall be deemed a reference to an arrangement referred to in this subsection4 ,g ,greater ,choice for ,veterans #dfa4 ,removing barriers to health care choice for ,category #a veterans and medal of honor recipients ,section #aja7;b77#b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended-- 7#a7 in subparagraph 7,c77ii71 by striking the or at the end2 7#b7 in subparagraph 7,d77ii77,,ii71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new subparagraph3 7,e7 is a veteran described in section #agje7;a77#a7 of title #ch1 ,united ,states ,code1 or a veteran who was awarded the medal of honor under section #cgda1 #fbda1 or #hgda of title #aj or section #dia of title #ad4 4 ,v ,reforming ,medical ,liability ,law #eja4 ,requirements for selection of clinical practice guidelines 7a7 ,selection ,not later than #f months after the date of enactment of this ,act1 eligible professional organizations that have established1 published1 maintained1 and updated on a regular basis1 clinical practice guidelines1 including when applicable1 appropriate use criteria1 that incorporate best practices1 may submit such guidelines to the ,secretary4 ,not later than #f months after the last day for submitting such guidelines1 the ,secretary shall select and designate one or more eligible professional organizations to provide and maintain such clinical practice guidelines on behalf of the ,secretary4 ,not later than #f months after designating each such eligible professional organization1 the ,secretary shall enter into an agreement with each such eligible professional organization for maintenance1 publication1 and updating of such clinical practice guidelines4 7b7 ,maintenance 7#a7 ,periodic review ,not later than #e years the ,secretary enters into an agreement with each eligible professional organization under subsection 7a71 and every #e years thereafter1 the ,secretary shall review the clinical practice guidelines of such organization and shall1 as necessary1 enter into agreements with additional eligible professional organizations1 as appropriate1 in accordance with subsection 7a74 7#b7 ,update by eligible professional organization ,an eligible professional organization that collaborated in the establishment of a clinical practice guidelines may submit amendments to that clinical practice guideline at any time to the ,secretary for review by the ,secretary4 7#c7 ,notification required for certain updates ,an amendment under paragraph 7#b7 may not add1 materially change1 or remove a guideline from a set of guidelines1 unless notification of such update is made available to applicable eligible professionals4 #ejb4 ,development 7a7 ,guideline standards ,the ,secretary shall ensure that1 to the extent practicable1 the development of clinical practice guidelines are guided by the ,standards for ,developing ,trustworthy ,clinical ,practice ,guidelines of the ,institute of ,medicine and-- 7#a7 are developed through a transparent process that minimizes conflicts of interest2 7#b7 are developed by a knowledgeable1 multidisciplinary panel of experts and representatives from key affected groups2 7#c7 take into consideration important patient subgroups and patient preferences1 as appropriate2 7#d7 are based on a systematic review of the existing evidence2 7#e7 provide a clear explanation of the relationship between care options and health outcomes2 7#f7 provide ratings of both the quality of evidence and strength of recommendation2 7#g7 are reconsidered and revised when new evidence emerges2 and 7#h7 clearly identify any exceptions to the application of the clinical practice guideline4 7b7 ,required disclosures from eligible professional organizations ,any person who is affiliated with an eligible professional organization and who directly participated in the creation of a clinical practice guideline shall disclose any conflicts of interest pertaining to the development of the clinical practice guideline1 including any conflict of interest pertaining to any instrument1 medicine1 drug1 or any other substance1 device1 or means included in the clinical practice guideline4 ,disclosures to the ,secretary by eligible professional organizations shall be made promptly1 upon submission of the guidelines1 and during every review of the guidelines4 ,disclosures shall include the following3 7#a7 ,scientific methodology and evidence that supports clinical practice guidelines4 7#b7 ,outside collaborators4 7#c7 ,endorsements4 #ejc4 ,no liability for guideline producers ,neither an eligible professional organization nor the participants in its guideline development and approval process1 may be held liable for any injury alleged to be caused by adhering to a clinical practice guideline to which they contributed4 #ejd4 ,internet publication of guidelines ,the ,secretary shall publish on the ,internet through the ,national ,guideline ,clearinghouse or other appropriate sites or sources1 all clinical practice guidelines1 including all data and methodology used in the development and selection of the guidelines in compliance with data disclosure standards in the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia74 #eje4 ,state flexibility and protection of ,states' rights 7a7 ,limitation ,this ,act shall not preempt or supersede any ,state or ,federal law that-- 7#a7 imposes procedural or substantive protections for health care providers and health care organizations from liability1 loss1 or damages greater than such protections provided by this title2 or 7#b7 creates a cause of action related to the provision of health care goods or services4 7b7 ,state ,flexibility ,no provision of this ,act shall be construed to preempt any defense available to a party in a health care liability action under any other provision of ,state or ,federal law4 #ejf4 ,federal cause of action 7a7 ,in general ,chapter #he of title #bh1 ,united ,states ,code1 is amended by adding at the end the following3 #acgj4 ,health care liability claims 7a7 ,definitions ,in this section1 the terms applicable eligible professional1 health care goods or services1 health care liability action1 health care liability claim1 health care organization1 and health care provider have the meaning given such terms in section #aj of the ,saving ,lives1 ,saving ,costs ,act4 7b7 ,jurisdiction of claims ,the district courts shall have original jurisdiction of a health care liability action against an applicable eligible professional1 health care provider1 or health care organization4 7c7 ,substantive law ,the substantive law for decision in a health care liability action brought under subsection 7b7 shall be derived from the law1 including choice of law principles1 of the ,state in which the provision of1 use of1 or payment for 7or the failure to provide1 use1 or pay for7 health care goods or services giving rise to the health care liability claim occurred unless such law is inconsistent with or preempted by ,federal law4 4 7b7 ,technical and conforming amendment ,the table of sections for chapter #he of title #bh1 ,united ,states ,code1 is amended by adding at the end the following3 #acgj4 ,health care liability claims4 4 #ejg4 ,right of removal ,section #adda of title #bh1 ,united ,states ,code1 is amended by adding at the end the following3 7g7 ,certain actions against medical professionals 7#a7 ,a health care liability action brought in a ,state court against an applicable eligible professional1 health care provider1 or health care organization may be removed by any defendant or the defendants to the district court of the ,united ,states for the district and division embracing the place where such action is pending4 7#b7 ,in this subsection1 the terms applicable eligible professional1 health care liability action1 health care organization1 and health care provider have the meaning given such terms in section #aj of the ,saving ,lives1 ,saving ,costs ,act4 4 #ejh4 ,mandatory review by independent medical panel 7a7 ,in general ,if1 in any health care liability action removed to ,federal court pursuant to section #adda7;g7 of title #bh1 ,united ,states ,code1 against an applicable eligible professional1 health care provider1 or health care organization1 the applicable eligible professional1 health care provider1 or health care organization alleges1 in response to a filing of the claimant1 that the applicable eligible professional1 health care provider1 or health care organization adhered to an applicable clinical practice guideline in the provision of health care goods or services to the claimant1 then the court shall suspend further proceedings on the health care liability action prior to discovery proceedings1 until the completion of a review of the action by an independent medical review panel4 7b7 ,independent medical review panel 7#a7 ,composition ,an independent medical review panel under this section shall be composed of #c members who are experts in the relevant field of clinical practice1 appointed in accordance with paragraph 7#e74 7#b7 ,requirements for member eligibility 7,a7 ,in general ,to be eligible to serve on an independent medical review panel1 a member shall-- 7i7 be an experienced physician certified by a board recognized by the ,american ,board of ,medical ,specialties2 7ii7 not earlier than #b years prior to the date of selection to the board1 have been in active medical practice or devoted a substantial portion of his or her time to teaching at an accredited medical school1 or have been engaged in university-based research in relation to the medical care and type of treatment at issue2 and 7iii7 be approved by his or her specialty society4 7,b7 ,regional preference ,when possible1 members should be from the region where the case in question originates to account for geographical practice variation4 7#c7 ,no civil liability for members ,no civil action shall be brought in any court against any member for any act1 failure to act1 or statement or opinion made1 within the scope of his or her duties as a member of the independent medical review panel4 7#d7 ,considerations in making determinations ,the members of the independent medical review panel shall acknowledge that1 under certain circumstances1 it may be appropriate for a physician to depart from the recommendations in clinical practice guidelines in the care of individual patients4 7#e7 ,selection of members ,each member of the independent medical review panel shall be jointly selected by the parties4 ,a member whose selection one party does not concur in may not serve on the panel1 except that1 if1 not later than #cj days after a response to the health care liability action is filed1 #c members have not been selected by the parties1 the court shall appoint any remaining members4 7#f7 ,compensation of members ,the costs of compensation to the members of the independent medical review panel shall be shared between the parties equally1 unless otherwise agreed to by the parties4 7c7 ,terms of review ,a review by an independent medical review panel under this section shall comply with the following3 7#a7 ,standard of conduct ,the mandatory independent medical review panel that is charged with the responsibility of making a preliminary finding as to liability of the defendant applicable eligible professional shall deem the prescribed clinical practice guidelines as the standard of conduct1 care1 and skill expected of members of the medical profession engaged in the defendant's field of practice under the same or similar circumstances1 subject to the provisions of subsection 7b77#d74 7#b7 ,record for review ,the independent medical review panel shall make a preliminary finding based solely upon the pre-discovery evidence submitted to it pursuant to ,rule #bf of the ,federal ,rules of ,civil ,procedure1 any medical records that would be discoverable if the lawsuit advances to trial1 and the applicable prescribed clinical practice guidelines4 7#c7 ,limitation ,the independent medical review panel shall not make a finding of negligence from the mere fact that a treatment or procedure was unsuccessful or failed to bring the best result1 or that the patient died4 7#d7 ,use at trial of work product of review panel ,no preliminary finding by the independent medical review panel that the defendant applicable eligible professional breached the standard of care as set forth under the prescribed clinical practice guidelines shall constitute negligence per se or conclusive evidence of liability1 but findings1 opinions1 and conclusions of the review panel shall be admissible as evidence in any and all subsequent proceedings before the court1 including for purposes of motions for summary judgment and at trial4 7d7 ,results of review 7#a7 ,in general ,not later than #fj days after all members of the independent medical review panel have been selected1 the panel shall complete a review of the record of the liability action and shall make a finding under this subsection4 7#b7 ,finding described ,a finding under this subsection shall include the following3 7,a7 ,a determination of whether there are any applicable clinical practice guidelines to the health care liability action that substantively pertains to the injury suffered by the claimant4 7,b7 ,whether the applicable eligible professional has alleged adherence to any such guideline4 7,c7 ,whether the applicable eligible professional adhered to any such guideline4 7,d7 ,whether there is a reasonable probability that-- 7i7 the applicable eligible professional violated the applicable clinical practice guideline2 7ii7 that violation proximately caused the claimant's alleged injury2 and 7iii7 the claimant suffered damages as a result of the injury4 7#c7 ,use at trial ,the finding under this subsection may be received into evidence by the court4 ,if the independent medical review panel made any finding under paragraph 7#b77;,d7 that there was no reasonable probability of the matters described in clauses 7i7 through 7iii71 the court may issue a summary judgment in favor of the applicable eligible professional unless the claimant is able to show otherwise by clear and convincing evidence4 ,if the panel made a finding under subparagraphs 7,a7 through 7,c7 of paragraph 7#b7 that there was an applicable clinical practice guideline that the defendant adhered to1 the court shall issue summary judgment in favor of the applicable eligible professional unless the claimant is able to show otherwise by clear and convincing evidence4 ,any preliminary finding that the defendant applicable eligible professional did not breach the standard of care as set forth under the prescribed medical practice guidelines or that the defendant applicable eligible professional's nonadherence to the applicable standard was neither the cause in fact nor the proximate cause of the plaintiff's injury or that the plaintiff did not incur any damages as a result shall be given deference by the court and shall entitle the defendant applicable eligible professional to summary judgment unless the plaintiff is able to show by clear and convincing evidence that the independent medical review panel was in error and that there is a genuine issue as to a material fact in the case4 #eji4 ,definitions ,in this ,act3 7#a7 ,applicable eligible professional ,the term applicable eligible professional means a physician practicing within clinical practice guidelines submitted by an eligible professional organization and includes employees and agents of a physician4 7#b7 ,appropriate use criteria ,the term appropriate use criteria means established evidence-based guidelines developed or endorsed by an eligible professional organization that specify when the health benefits of a procedure or service exceed the expected health risks by a significantly wide margin4 7#c7 ,clinical practice guideline ,the term clinical practice guideline means systematically developed statements based on the review of clinical evidence for assisting a health care provider to determine the appropriate health care in specific clinical circumstances4 7#d7 ,eligible professional organization ,the term eligible professional organization means a national or ,state medical society or medical specialty society4 7#e7 ,federal payor ,the term ,federal payor includes reimbursements made under the ,medicare program under title ,,xviii of the ,social ,security ,act or the ,medicaid program under title ,,xix of the ,social ,security ,act1 or medical screenings1 treatments1 or transfer services provided pursuant to section #ahfg of the ,social ,security ,act is not made by the individual or any non-,federal third party on behalf of the individual4 7#f7 ,health care goods or services ,the term health care goods or services means any goods or services provided by a health care organization1 provider1 or by any individual working under the supervision of a health care provider1 that relates to the diagnosis1 prevention1 or treatment of any human disease or impairment1 or the assessment or care of the health of human beings4 7#g7 ,health care liability action ,the term health care liability action means a civil action against an applicable eligible professional1 a health care provider1 or a health care organization1 regardless of the theory of liability on which the claim is based1 or the number of plaintiffs1 defendants1 or other parties1 or the number of causes of action1 in which the claimant alleges a health care liability claim4 7#h7 ,health care liability claim ,the term health care liability claim means a claim by any person against an applicable eligible professional1 a health care provider1 or a health care organization which is based upon the provision of1 use of1 or payment for 7or the failure to provide1 use1 or pay for7 health care goods or services for which at least partial payment was made by a ,federal payor or which was mandated by ,federal law1 regardless of the theory of liability on which the claim is based4 7#i7 ,health care organization ,the term health care organization means any person or entity which is obligated to provide or pay for health benefits under any health plan1 including any person or entity acting under a contract or arrangement with a health care organization to provide or administer any health benefit4 7#aj7 ,health care provider ,the term health care provider means any person or entity required by ,state or ,federal laws or regulations to be licensed1 registered1 or certified to provide health care services1 and being either so licensed1 registered1 or certified1 or exempted from such requirement by other statute or regulation4 7#aa7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 ,,vi ,other provisions #fja4 ,respecting human life 7a7 ,prohibition on abortion mandates ,nothing in this ,act 7or any amendment made by this ,act7 shall be construed to require any health plan 7including any high-risk pool7 to provide coverage of1 or access to1 abortion services or to allow the ,secretary of the ,treasury1 the ,secretary of ,labor1 the ,secretary of ,health and ,human ,services1 or any other ,federal or non-,federal person or entity in implementing this ,act 7or an amendment made by this ,act7 to require coverage of1 or access to1 abortion services4 7b7 ,prohibition on certain research funding 7#a7 ,in general ,no funds authorized or appropriated by this ,act 7or an amendment made by this ,act7 may be used to conduct or support research that includes embryo-destructive stem cell research and human cloning4 7#b7 ,human cloning defined ,in this subsection1 the term human cloning means human asexual reproduction accomplished by introducing the nuclear material from a human diploid cell into an oocyte to produce a living organism at any stage of development with a human or predominantly human genetic constitution4 7#c7 ,construction ,nothing in this subsection may be construed to prohibit conducting or supporting research that does not include embryo-destructive stem cell research or human cloning1 including research involving nuclear transfer or other cloning techniques to produce molecules1 ,,dna1 cells other than human embryos1 tissues1 or animals other than humans4 7c7 ,limitation on abortion funding 7#a7 ,in general ,no funds authorized or appropriated by this ,act 7or an amendment made by this ,act7 may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion 7including a high-risk pool described in section #bgde of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#de71 as amended by section #caa of this ,act71 except-- 7,a7 if the pregnancy is the result of an act of rape or incest2 or 7,b7 in the case where a pregnant female suffers from a physical disorder1 physical injury1 or physical illness that would1 as certified by a physician1 place the female in danger of death unless an abortion is performed1 including a life-endangering physical condition caused by or arising from the pregnancy itself4 7#b7 ,option to purchase separate coverage or plan ,nothing in this subsection shall be construed as prohibiting any non-,federal entity 7including an individual or a ,state or local government7 from purchasing separate coverage for abortions for which funding is prohibited under this subsection1 or a health plan that includes such abortions1 so long as such coverage or plan is paid for entirely using only funds not authorized or appropriated by this ,act4 7#c7 ,option to offer coverage or plan ,nothing in this subsection shall restrict any non-,federal health insurance issuer offering a health plan from offering separate coverage for abortions for which funding is prohibited under this subsection1 or a health plan that includes such abortions1 so long as-- 7,a7 premiums for such separate coverage or plan are paid for entirely with funds not authorized or appropriated by this ,act2 and 7,b7 administrative costs and all services offered through such coverage or plan are paid for using only premiums collected for such coverage or plan4 7#d7 ,administrative expenses ,no funds authorized or appropriated by this ,act shall be available to pay for administrative expenses in connection with any health plan 7including an association health plan that has entered into trusteeship7 which provides any benefits or coverage for abortions except where the life of the mother would be endangered if the fetus were carried to term1 or the pregnancy is the result of an act of rape or incest4 7d7 ,no preemption of ,state laws ,nothing in this ,act 7or an amendment made by this ,act7 shall be construed to preempt or otherwise have any effect on ,state laws-- 7#a7 protecting conscience rights or restricting or prohibiting abortion or coverage or funding of abortion1 as in effect on the date of the enactment of this ,act2 or 7#b7 establishing procedural requirements on abortions1 including parental notification or consent for the performance of an abortion on a minor4 7e7 ,definitions ,in this section3 7#a7 ,the term association health plan has the meaning given to such term in section #hja of the ,employee ,retirement ,income ,security ,act of #aigd1 as added by section #dea of this ,act4 7#b7 ,the term high-risk pool means a high-risk pool described in section #bgde of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#de71 as amended by section #caa of this ,act4 #fjb4 ,offsets ,section #bea7;c7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe 7#b ,u4,s4,c4 #ija7 is amended as follows3 7#a7 ,in paragraph 7#e77;,b71 by striking the dollar amount and inserting #ejg1cjj1jjj1jjj4 7#b7 ,in paragraph 7#f77;,b71 by striking the dollar amount and inserting #ebc1gjj1jjj1jjj4 7#c7 ,in paragraph 7#g77;,b71 by striking the dollar amount and inserting #ecd1ijj1jjj1jjj4 7#d7 ,in paragraph 7#h77;,b71 by striking the dollar amount and inserting #edf1gjj1jjj1jjj4