,i #aae? ,,congress #a/ ,session ,h4 ,r4 #cgdh ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,septemb] #ab1 #bjag,mr4 ,higg9s ( ,new ,york 7= himself1 ,mr4 ,l>son ( ,connecticut1 ,mr4 ,c\rtney1 ,mr4 ,c>son ( ,indiana1 ,mr4 ,cicill9e1 ,mr4 ,coh51 ,ms4 ,de,lauro1 ,mr4 ,deut*1 ,mr4 ,huffman1 ,ms4 ,kaptur1 ,mr4 ,keat+1 ,mr4 ,khanna1 ,mr4 ,kri%namoor?i1 ,ms4 ,mc,collum1 ,mr4 ,mc,eachin1 ,mr4 ,mc,govern1 ,mr4 ,p]lmutt]1 ,mr4 ,price ( ,nor? ,c>ol9a1 ,mr4 ,quigley1 ,mr4 ,ryan ( ,ohio1 ,ms4 ,titus1 ,mr4 ,tonko1 ,mr4 ,wel*1 ,mr4 ,delaney1 ,ms4 ,p+ree1 ,ms4 ,e/y ( ,connecticut1 ,mr4 ,l[5?al1 ,mr4 ,kihu51 ,mrs4 ,napolitano1 ,mr4 ,sean ,patrick ,maloney ( ,new ,york1 ,mr4 ,g>am5di1 ,ms4 ,%ea-,port]1 ,mr4 ,pet]son1 ,mr4 ,polis1 & ,mr4 ,heck7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = an option = individuals :o are ages #ej to #fd to buy into ,m$ic>e1 to provide = heal? insurance m>ket /abilization1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,buy-,9 & ,heal? ,c>e ,/abilization ,act ( #bjag4 #b4 ,m$ic>e buy-9 option 7a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,c4 ,m$ic>e buy-9 option 7a7 ,option 7#a7 ,eligibility ,e individual :o meets ! requirem5ts describ$ 9 p>agraph 7#c7 %all be eligible to enroll "u ?is section4 7#b7 ,9 g5]al ,an individual :o meets ! foll[+ requirem5ts is eligible to enroll "u ?is section3 7,a7 ,age ,! individual has atta9$ #ej ye>s ( age1 b has n atta9$ #fe ye>s ( age4 7,b7 ,m$ic>e eligibility 7b = age7 ,! individual is n o!rwise entitl$ to b5efits "u "p ,a or eligible to enroll "u "p ,a or "p ,b b w\ld be eligible = b5efits "u "p ,a or "p ,b if ! individual 7 #fe ye>s ( age4 7#c7 ,b5efits ,an individual enroll$ "u ?is section is entitl$ to ! same b5efits "u ?is title z an individual :o is entitl$ to b5efits "u "p ,a & enroll$ "u p>ts ,b & ,d4 7b7 ,enrollm5t & cov]age p]iods ,! ,secret>y %all e/abli% enrollm5t & cov]age p]iods = individuals :o enroll "u ?is section4 ,su* p]iods %all be e/abli%$ 9 coord9ation ) ! enrollm5t & cov]age p]iods = plans (f]$ "u an ,ex*ange e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 ,! ,secret>y %all e/abli% su* p]iods s t cov]age "u ?is section %all fir/ beg9 on ,janu>y #a ( ! fir/ ye> beg9n+ at lea/ "o ye> aft] ! date ( ! enactm5t ( ?is section4 7c7 ,buy-,9 premium 7#a7 ,am\nt ( mon?ly premiums ,! ,secret>y %all 7beg9n+ = ! fir/ ye> t beg9s m ?an #a ye> aft] ! date ( ! enactm5t ( ?is section71 dur+ ,septemb] ( ! prec$+ ye>1 det]m9e a mon?ly premium = individuals enroll$ "u ?is section4 ,su* mon?ly premium %all be equal to #a_/ab ( ! annual premium comput$ "u p>agraph 7#b77;,b71 :i* %all apply ) respect to cov]age provid$ "u ?is section = any mon? 9 su* ye>4 7#b7 ,annual premium 7,a7 ,comb9$ ,national1 p] capita av]age = p>ts ,a1 ,b1 & ,d b5efits ,! ,secret>y %all e/imate ! av]age1 annual p] capita am\nt = b5efits & adm9i/rative exp5ses t w be payable "u p>ts ,a1 ,b1 & ,d 9 ! ye> = all individuals enroll$ "u ?is section4 7,b7 ,annual premium ,! annual premium "u ?is subsection = mon?s 9 a ye> is equal to ! av]age1 annual p] capita am\nt e/imat$ "u subp>agraph 7,a7 = ! ye>4 7,c7 ,adju/m5ts ,! ,secret>y %all adju/ ! annual premium "u ?is subsection z necess>y-- 7i7 to ensure t exp5ditures "u ?is title = any ye> are n increas$ by reason ( ?is section2 & 7ii7 by a geographic adju/m5t factor to address regional af=dability conc]ns4 7#c7 ,additional premium = c]ta9 ,d plans ,no?+ 9 ?is section %all preclude an individual f *oos+ a prescription drug plan :i* requires ! individual to pay an additional am\nt 7because ( ! inclusion ( supplem5tal prescription drug b5efits or because ! plan is a m exp5sive plan1 pursuant to section #ahfj;,d-#ac7;a77#a774 ,9 su* case1 ! mon?ly premium "u p>agraph 7#a7 %all be increas$ ) respect to su* individual4 7d7 ,paym5t ( premiums 7#a7 ,paym5t 7,a7 ,9 g5]al ,premiums = enrollm5t "u ?is section %all be paid to ! ,secret>y at su* times1 & 9 su* mann]1 z ! ,secret>y det]m9es appropriate4 7,b7 ,paym5t ( premiums by employ]s on behalf ( employees ,an employ] ( an individual :o enrolls "u ?is section may make paym5ts = ! premiums = su* enrollm5t on behalf ( su* individual pursuant to a process e/abli%$ by ! ,secret>y4 ,su* process %all ensure t enrollm5t "u ?is section is ! *oice ( ! individual & n ! employ]4 7#b7 ,deposit ,am\nts collect$ by ! ,secret>y "u ?is section %all be deposit$ 9 ! ,m$ic>e ,buy-,9 ,tru/ ,fund e/abli%$ "u subsection 7e74 7e7 ,m$ic>e ,buy-,9 ,tru/ ,fund 7#a7 ,9 g5]al ,!re is h]eby creat$ on ! books ( ! ,treasury ( ! ,unit$ ,/ates a tru/ fund to be kn[n z ! ,m$ic>e ,buy-,9 ,tru/ ,fund 79 ?is subsection ref]r$ to z ! ,tru/ ,fund74 ,! ,tru/ ,fund %all consi/ ( su* gifts & beque/s z may be made z provid$ 9 section #bja7;i77#a7 & su* am\nts z may be deposit$ 91 or appropriat$ to1 su* fund z provid$ 9 ?is title4 7#b7 ,premiums ,premiums collect$ "u subsection 7d7 %all be transf]r$ to ! ,tru/ ,fund4 7#c7 ,incorporation ( ,provisions ,subsections 7b7 ?r\gh 7i7 ( section #ahda %all apply ) respect to ! ,tru/ ,fund & ?is title 9 ! same mann] z !y apply ) respect to ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund & "p ,b1 respectively1 except t 9 apply+ su* section #ahda1 any ref]5ce 9 su* section to ?is "p %all be con/ru$ to be a ref]5ce to ?is section & any ref]5ce 9 section #ahda7;h7 to section #ahdj7;d7 & 9 section #ahda7;i7 to sections #ahdj7;b77#a7 & #ahdb7;g7 are deem$ to be ref]5ces to comp>able au?ority ex]cis$ "u ?is section4 7f7 ,cl>ification ,no?+ 9 ?is section %all affect ! b5efits or eligibility "u ?is title ( individuals :o w\ld o!rwise be entitl$ to or eligible = b5efits "u ?is title or title ,,xix1 or bo?4 7g7 ,treatm5t 9 relation to ! ,af=dable ,c>e ,act 7#a7 ,satisfaction ( individual m&ate ,= purposes ( apply+ section #ejjj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf1 ! cov]age provid$ ?r\gh enrollm5t "u ?is section con/itutes m9imum ess5tial cov]age "u subsection 7f77#a77;,a77i7 ( su* section4 7#b7 ,eligibility = premium assi/ance ,cov]age provid$ ?r\gh enrollm5t "u ?is section-- 7,a7 %all be treat$ z cov]age "u a qualifi$ heal? plan 9 ! individual m>ket enroll$ 9 ?r\gh ! ,ex*ange :]e ! individual resides = all purposes ( section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf o!r ?an subsection 7c77#b77;,b7 !re(2 & 7,b7 %all n be treat$ z eligibility = o!r m9imum ess5tial cov]age = purposes ( subsection 7c77#b77;,b7 ( su* section #cf;,b4 ,! ,secret>y %all det]m9e ! applicable second l[e/ co/ silv] plan :i* %all apply to cov]age provid$ ?r\gh enrollm5t "u ?is section = purposes ( section #cf;,b ( su* ,code4 7#c7 ,eligibility = co/-%>+ subsidies ,= purposes ( apply+ section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act-- 7,a7 cov]age provid$ ?r\gh enrollm5t "u ?is "p & p>ts ,b & ,d pursuant to ?is section %all be treat$ z cov]age "u a qualifi$ heal? plan 9 ! silv] level ( cov]age 9 ! individual m>ket (f]$ ?r\gh an ,ex*ange2 & 7,b7 ! ,secret>y %all be treat$ z ! issu] ( su* plan4 7#d7 ,use ( ,ex*anges ,cov]age provid$ ?r\gh enrollm5t "u ?is section %all be deem$ to be cov]age "u a qualifi$ heal? plan = purposes ( section #acaa7;d77#d77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act & %all be made available = enrollm5t1 in=mation comp>ison1 & o!rwise z su* a plan ?r\gh any ,int]net website ma9ta9$ by an ,ex*ange e/abli%$ "u title ,i ( su* ,act 7z describ$ 9 su* section74 7#e7 ,access to ,m$igap ,cov]age provid$ ?r\gh m$ic>e supplem5tal policies c]tifi$ "u section #ahhb %all be made available to individuals eligible = enrollm5t pursuant to ?is section = enrollm5t1 in=mation1 comp>ison1 & o!rwise z su* a policy ?r\gh any ,int]net website describ$ 9 p>agraph 7#d74 7h7 ,ov]sight ,!re is e/abli%$ an advisory committee to be kn[n z ! ,m$ic>e ,buy ,9 ,ov]sight ,bo>d to monitor & ov]see ! implem5tation ( ?is section1 includ+ ! exp]i5ce ( ! individuals enroll+ "u ?is section4 ,! ,m$ic>e ,buy ,9 ,ov]sight ,bo>d %all make p]iodic recomm5dations = ! cont9ual improvem5t ( ! implem5tation ( ?is section z well z ! relation%ip ( enrollm5t "u ?is section to o!r heal? c>e programs4 7i7 ,outrea* & enrollm5t 7#a7 ,9 g5]al ,dur+ ! p]iod t beg9s on ,janu>y #a1 #bjah1 & ends on ,decemb] #ca1 #bjbj1 ! ,secret>y %all aw>d grants to eligible entities = ! foll[+ purposes3 7,a7 ,outrea* & enrollm5t ,to c>ry out outrea*1 public education activities1 & enrollm5t activities to raise aw>5ess ( ! availability (1 & enc\rage1 enrollm5t "u ?is section4 7,b7 ,assi/+ individuals transition "u ?is section ,to provide assi/ance to individuals to enroll "u ?is section4 7,c7 ,rais+ aw>5ess ( premium assi/ance & co/-%>+ r$uctions ,to di/ribute fair & imp>tial in=mation conc]n+ enrollm5t "u ?is section & ! availability ( premium assi/ance tax cr$its "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf & co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 & to assi/ eligible individuals 9 apply+ = su* tax cr$its & co/-%>+ r$uctions4 7#b7 ,eligible entities 7,a7 ,9 g5]al ,9 ?is subsection1 ! t]m eligible entity means-- 7i7 a ,/ate2 or 7ii7 a nonpr(it community-bas$ organization4 7,b7 ,enrollm5t ag5ts ,su* t]m includes a lic5s$ indep5d5t insurance ag5t or brok] t has an arrangem5t ) a ,/ate or nonpr(it community-bas$ organization to enroll eligible individuals "u ?is section4 7,c7 ,exclusions ,su* t]m does n include an entity t-- 7i7 is a heal? insurance issu]2 or 7ii7 receives any consid]ation1 ei!r directly or indirectly1 f any heal? insurance issu] 9 connection ) ! enrollm5t ( any individuals "u ?is section4 7#c7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to aw>d+ grants to ,/ates or eligible entities 9 ,/ates t h geographic rat+ areas at risk ( hav+ no qualifi$ heal? plans 9 ! individual m>ket4 7#d7 ,fund+ ,out ( any moneys 9 ! ,treasury n o!rwise appropriat$1 #ejj1jjj1jjj is appropriat$ to ! ,secret>y = ea* ( cal5d> ye>s #bjah ?r\gh #bjbj1 to c>ry out ?is subsection4 7j7 ,implem5tation 7#a7 ,consultation ,9 c>ry+ out ?is section1 ! ,secret>y %all-- 7,a7 consult ) o!r ,f$]al ag5cies1 includ+ ! ,dep>tm5t ( ! ,treasury1 ! ,dep>tm5t ( ,labor1 ! ,dep>tm5t ( ,vet]ans ,affairs1 ! ,dep>tm5t ( ,def5se1 & ! ,(fice ( ,p]sonnel ,managem5t2 & 7,b7 incorporate significant public consultation & fe$back1 ?r\gh public =ums1 notice & comm5t rulemak+1 & any o!r appropriate m$iums4 7#b7 ,report ,no lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all submit to ,congress a report e/abli%+ ! adm9i/rative p>amet]s = ! implem5tation ( ?is section4 7k7 ,feasibility /udy ,! ,secret>y %all conduct a /udy on ! feasibility ( apply+ ?is section ) respect to individuals resid+ 9 ,/ates t are n )9 ! #ej ,/ates or ! ,di/rict ( ,columbia4 4 7b7 ,m$igap ,section #ahhb ( ! ,social ,security ,act is am5d$ by add+ at ! end ! foll[+ new subsection3 7aa7 ,developm5t ( ,new ,/&>ds = ,c]ta9 ,m$ic>e ,supplem5tal ,policies relat+ to buy-,9 option ,! ,secret>y %all reque/ ! ,national ,association ( ,insurance ,commission]s to review & revise ! /&>ds = b5efit packages describ$ 9 subsection 7p77#a71 to o!rwise update /&>ds to include requirem5ts = ea* m$ic>e supplem5tal policy t (f]s su* a policy 9 a ,/ate1 ) respect to ea* ye>1 to accept e individual 9 ! ,/ate :o is eligible = enrollm5t pursuant to section #ahii;,c & :o applies = su* cov]age = su* ye> if ! individual applies = enrollm5t 9 su* policy dur+ ! #cj-;day p]iod foll[+ ! date ( enrollm5t pursuant to section #ahii;,c & to accept e su* individual dur+ a p]iod ( transition f enrollm5t pursuant to su* section to enrollm5t "u ?is title pursuant to eligibility o!r ?an "u su* section4 ,su* revisions %all be made consi/5t ) ! rules applicable "u subsection 7p77#a77;,e7 ) ! ref]5ce to ! #aiia ,,naic ,model ,regulation deem$ a ref]5ce to ! ,,naic ,model ,regulation z publi%$ 9 ! ,f$]al ,regi/] on ,decemb] #d1 #aiih1 & z subsequ5tly updat$ by ! ,national ,association ( ,insurance ,commission]s to reflect previ\s *anges 9 law & ! ref]5ce to date ( enactm5t ( ?is subsection deem$ a ref]5ce to ! date ( enactm5t ( ?is subsection 7aa74 4 #c4 ,negotiation ( l[] cov]$ "p ,d drug prices on behalf ( m$ic>e b5efici>ies 7a7 ,negotiation by secret>y ,section #ahfj;,d-#aa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aaa7 is am5d$ by /rik+ subsection 7i7 7relat+ to non9t]f]5ce7 & ins]t+ ! foll[+3 7i7 ,negotiation ( ,l[] ,drug ,prices 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y %all negotiate ) ph>maceutical manufactur]s ! prices 7includ+ disc\nts1 rebates1 & o!r price concessions7 t may be *>g$ to ,,pdp sponsors & ,,ma organizations = cov]$ "p ,d drugs = "p ,d eligible individuals :o are enroll$ "u a prescription drug plan or "u an ,,ma-,,pd plan4 7#b7 ,no *ange 9 rules = =mul>ies 7,a7 ,9 g5]al ,no?+ 9 p>agraph 7#a7 %all be con/ru$ to au?orize ! ,secret>y to e/abli% or require a p>ticul> =mul>y4 7,b7 ,con/ruction ,subp>agraph 7,a7 %all n be con/ru$ z affect+ ! ,secret>y's au?ority to ensure appropriate & adequate access to cov]$ "p ,d drugs "u prescription drug plans & "u ,,ma-,,pd plans1 includ+ compliance ( su* plans ) =mul>y requirem5ts "u section #ahfj;,d-#d7;b77#c74 7#c7 ,con/ruction ,no?+ 9 ?is subsection %all be con/ru$ z prev5t+ ! sponsor ( a prescription drug plan1 or an organization (f]+ an ,,ma-,,pd plan1 f obta9+ a disc\nt or r$uction ( ! price = a cov]$ "p ,d drug bel[ ! price negotiat$ "u p>agraph 7#a74 7#d7 ,semi-annual reports to ,congress ,n lat] ?an ,june #a1 #bjah1 & e #f mon?s !reaft]1 ! ,secret>y %all submit to ! ,committees on ,ways & ,means1 ,en]gy & ,comm]ce1 & ,ov]sight & ,gov]nm5t ,re=m ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report on negotiations conduct$ by ! ,secret>y to a*ieve l[] prices = ,m$ic>e b5efici>ies1 & ! prices & price disc\nts a*iev$ by ! ,secret>y z a result ( su* negotiations4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ! date ( ! enactm5t ( ?is ,act & %all fir/ apply to negotiations & prices = plan ye>s beg9n+ on ,janu>y #a1 #bjah4 #d4 ,individual ,m>ket ,re9surance ,fund 7a7 ,e/abli%m5t ( ,fund 7#a7 ,9 g5]al ,!re is e/abli%$ ! ,individual ,m>ket ,re9surance ,fund 79 ?is section ref]r$ to z ! ,fund7 to be adm9i/]$ by ! ,secret>y to provide fund+ = an individual m>ket /abilization re9surance program 9 ea* ,/ate t complies ) ! requirem5ts ( ?is section4 7#b7 ,fund+ ,am\nts made available to ! ,fund %all consi/ ( ! funds deposit$ into ! ,fund "u p>agraph 7#c7 & %all be us$ to c>ry out ?is section 7o!r ?an subsection 7c77 = ea* cal5d> ye> beg9n+ ) #bjah4 ,am\nts made available to ! ,fund %all rema9 available )\t fiscal or cal5d> ye> limitation to c>ry out ?is section4 7#c7 ,co/-%>+ 9 co/s ( ,program 7,a7 ,9 g5]al ,a qualifi$ heal? plan t p>ticipates 9 ! re9surance program e/abli%$ "u subsection 7b7 %all pay ! fee e/abli%$ "u subp>agraph 7,b74 7,b7 ,au?orization ,! ,secret>y is au?oriz$ to *>ge a fee to ea* qualifi$ heal? plan t p>ticipates 9 ! re9surance program e/abli%$ "u subsection 7b74 ,any am\nts collect$ pursuant to ?is p>agraph %all be deposit$ into ! ,fund = purposes ( paym5ts "u subsection 7b74 7,c7 ,requirem5ts ,9 e/abli%+ ! fee "u subp>agraph 7,b7-- 7i7 ! ,secret>y %all consult ) int]e/$ p>ties2 & 7ii7 %all ensure t ! am\nt ( su* fee is n excessive s z to unduly disc\rage qualifi$ heal? plans f p>ticipat+ 9 ! re9surance program4 7b7 ,individual ,m>ket re9surance program 7#a7 ,use ( funds ,! ,secret>y %all use am\nts 9 ! ,fund to e/abli% a re9surance program "u :i* ! ,secret>y %all make re9surance paym5ts1 subject to subsection 7a77#c71 to heal? insurance issu]s ) respect to high-co/ individuals enroll$ 9 qualifi$ heal? plans (f]$ by su* issu]s t are n gr&fa!r$ heal? plans or transitional heal? plans = any plan ye> beg9n+ ) ! #bjah plan ye>4 ,?is subsection con/itutes budget au?ority 9 advance ( appropriations ,acts & repres5ts ! obligation ( ! ,secret>y to provide paym5ts f ! ,fund 9 accordance ) ?is subsection4 7#b7 ,am\nt ( paym5t ,! paym5t made to a heal? insurance issu] "u p>agraph 7#a7 ) respect to ea* high-co/ individual enroll$ 9 a qualifi$ heal? plan issu$ by ! issu] t is n a gr&fa!r$ heal? plan or a transitional heal? plan %all equal #hj p]c5t ( ! less] (-- 7,a7 ! am\nt 7if any7 by :i* ! individual's claims incurr$ dur+ ! plan ye> exce$s-- 7i7 9 ! case ( ! #bjah1 #bjai1 or #bjbj plan ye>1 #ej1jjj2 & 7ii7 9 ! case ( any o!r plan ye>1 #ajj1jjj2 or 7,b7 = plan ye>s describ$ 9-- 7i7 subp>agraph 7,a77i71 #dej1jjj2 & 7ii7 subp>agraph 7,a77ii71 #djj1jjj4 7#c7 ,index+ ,9 ! case ( plan ye>s beg9n+ aft] #bjah1 ! doll> am\nts t appe> 9 subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7 %all ea* be increas$ by an am\nt equal to-- 7,a7 su* am\nt2 multipli$ by 7,b7 ! premium adju/m5t p]c5tage specifi$ "u section #acjb7;c77#d7 ( ! ,af=dable ,c>e ,act1 b det]m9$ by sub/itut+ #bjah = #bjac4 7#d7 ,paym5t me?ods 7,a7 ,9 g5]al ,paym5ts "u ?is subsection %all be bas$ on su* a me?od z ! ,secret>y det]m9es4 ,! ,secret>y may e/abli% a paym5t me?od by :i* int]im paym5ts ( am\nts "u ?is subsection are made dur+ a plan ye> bas$ on ! ,secret>y's be/ e/imate ( am\nts t w be payable aft] obta9+ all ( ! in=mation4 7,b7 ,requirem5t = provision ( in=mation 7i7 ,requirem5t ,paym5ts "u ?is subsection to a heal? insurance issu] are condition$ ^u ! furni%+ to ! ,secret>y1 9 a =m & mann] specifi$ by ! ,secret>y1 ( su* in=mation z may be requir$ to c>ry out ?is subsection4 7ii7 ,re/riction on use ( in=mation ,in=mation disclos$ or obta9$ pursuant to clause 7i7 is subject to ! ,,hipaa privacy & security law1 z def9$ 9 section #cjji7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;a774 7#e7 ,secret>y flexibility = budget neutral revisions to re9surance paym5t specifications ,if ! ,secret>y det]m9es appropriate1 ! ,secret>y may sub/itute high] doll> am\nts = ! doll> am\nts specifi$ "u subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7 7& adju/$ "u p>agraph 7#c71 if applicable7 if ! ,secret>y c]tifies t su* sub/itutions1 consid]$ toge!r1 nei!r increase nor decease ! total project$ paym5ts "u ?is subsection4 7c7 ,reports to ,congress 7#a7 ,annual report ,! ,secret>y %all submit a report to ,congress1 n lat] ?an ,janu>y #ba1 #bjai1 & ea* ye> !reaft]1 t conta9s ! foll[+ in=mation = ! mo/ rec5tly end$ ye>3 7,a7 ,! numb] & types ( plans 9 ea* ,/ate's individual m>ket1 specify+ ! numb] t are qualifi$ heal? plans1 gr&fa!r$ heal? plans1 or heal? insurance cov]age t is n a qualifi$ heal? plan4 7,b7 ,! impact ( ! re9surance paym5ts provid$ "u ?is section on ! availability ( cov]age1 co/ ( cov]age1 & cov]age options 9 ea* ,/ate4 7,c7 ,! am\nt ( premiums paid by individuals 9 ea* ,/ate by age1 family size1 geographic area 9 ! ,/ate's individual m>ket1 & category ( heal? plan 7z describ$ 9 subp>agraph 7,a774 7,d7 ,! process us$ to aw>d funds = outrea* & enrollm5t activities aw>d$ to eligible entities "u subsection 7c71 ! am\nt ( su* funds aw>d$1 & ! activities c>ri$ out ) su* funds4 7,e7 ,su* o!r in=mation z ! ,secret>y deems relevant4 7#b7 ,evaluation report ,n lat] ?an ,janu>y #ca1 #bjbb1 ! ,secret>y %all submit to ,congress a report t-- 7,a7 analyzes ! impact ( ! funds provid$ "u ?is section on premiums & enrollm5t 9 ! individual m>ket 9 all ,/ates2 & 7,b7 conta9s a ,/ate-by-,/ate comp>ison ( ! design ( ! programs c>ri$ out by ,/ates ) funds provid$ "u ?is section4 7d7 ,def9itions ,9 ?is section3 7#a7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#b7 ,fund ,! t]m ,fund means ! ,individual ,m>ket ,re9surance ,fund e/abli%$ "u subsection 7a74 7#c7 ,gr&fa!r$ heal? plan ,! t]m gr&fa!r$ heal? plan has ! mean+ giv5 t t]m 9 section #abea7;e7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 7#d7 ,high-co/ individual ,! t]m high-co/ individual means an individual enroll$ 9 a qualifi$ heal? plan 7o!r ?an a gr&fa!r$ heal? plan or a transitional heal? plan7 :o incurs claims 9 excess ( #ej1jjj dur+ a plan ye>4 7#e7 ,/ate ,! t]m ,/ate means ea* ( ! #ej ,/ates & ! ,di/rict ( ,columbia4 7#f7 ,transitional heal? plan ,! t]m transitional heal? plan means a plan cont9u$ "u ! lett] issu$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices on ,novemb] #ad1 #bjac1 to ! ,/ate ,insurance ,commission]s outl9+ a transitional policy = cov]age 9 ! individual & small gr\p m>kets to :i* section #abea ( ! ,pati5t ,protection & ,af=dable ,c>e ,act does n apply1 & "u ! ext5sion ( ! transitional policy = su* cov]age set =? 9 ! ,insurance ,/&>ds ,bullet9 ,s]ies guidance issu$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices on ,m>* #e1 #bjad1 ,febru>y #bi1 #bjaf1 & ,febru>y #ac1 #bjag4 #e4 ,reau?orization ( risk corridors ,section #acdb7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjfb7;a77 is am5d$ by ins]t+ & cal5d> ye>s #bjah ?r\gh #bjbj aft] #bjaf4 #f4 ,enhancem5ts = r$uc$ co/ %>+ 7a7 ,modification ( am\nt 7#a7 ,9 g5]al ,section #adjb7;c77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjga7;c77#b77 is am5d$ to read z foll[s3 7#b7 ,additional r$uction ,! ,secret>y %all e/abli% proc$ures "u :i* ! issu] ( a qualifi$ heal? plan to :i* ?is section applies %all fur!r r$uce co/-%>+ "u ! plan 9 a mann] suffici5t to-- 7,a7 9 ! case ( an eligible insur$ ^: h\sehold income is n less ?an #ajj p]c5t b n m ?an #bjj p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #ie p]c5t ( su* co/s2 7,b7 9 ! case ( an eligible insur$ ^: h\sehold income is m ?an #bjj p]c5t b n m ?an #cjj p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #ij p]c5t ( su* co/s2 & 7,c7 9 ! case ( an eligible insur$ ^: h\sehold income is m ?an #cjj p]c5t b n m ?an #djj p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #he p]c5t ( su* co/s4 4 7#b7 ,con=m+ am5dm5t ,clause 7i7 ( section #adjb7;c77#a77;,b7 ( su* ,act 7#db ,u4,s4,c4 #ahjga7;c77#a77;,b77 is am5d$ to read z foll[s3 7i7 ,9 g5]al ,! ,secret>y %all ensure ! r$uction "u ?is p>agraph %all n result 9 an increase 9 ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan above-- 7,i7 #ie p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,a72 7,,ii7 #ij p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,b72 & 7,,iii7 #he p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,c74 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to plan ye>s beg9n+ aft] ,decemb] #ca1 #bjag4 7b7 ,fund+ ,section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjga7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7g7 ,fund+ ,out ( any funds 9 ! ,treasury n o!rwise appropriat$1 !re are appropriat$ to ! ,secret>y su* sums z may be necess>y = paym5ts "u ?is section4 4 #g4 ,te*nical ,advisory ,committee on ,heal? ,c>e ,deliv]y ,sy/em ,re=m & ,program ,integrity 7a7 ,e/abli%m5t ,!re is e/abli%$ a committee to be kn[n z ! ,committee on ,deliv]y ,sy/em ,re=m & ,program ,integrity4 7b7 ,memb]%ip ,! ,committee %all be compos$ ( #aa memb]s appo9t$ by ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates4 ,su* memb]s %all include individuals ) national recognition = _! exp]tise 9 heal? c>e deliv]y sy/em re=m & ! relat$ deliv]y ( heal? c>e4 ,heal? c>e provid]s & pati5t advocates %all h adequate repres5tation on ! ,committee4 7c7 ,duties ,! ,committee %all p]iodically submit to ! ,secret>y ( ,heal? & ,human ,s]vices & ! ,congress writt5 recomm5dations1 provid$ 9 a compreh5sive report =mat1 to fur!r ! goals ( heal? c>e deliv]y sy/em re=m t g5]ally aim to improve ! quality ( pati5t c>e1 improve ! heal? ( populations1 & r$uce ! co/ ( c>e4 ,! orig9 ( ^! proposals c be d]iv$ f any initiative und]way betwe5 ! ,dep>tm5t ( ,heal? & ,human ,s]vices & any p>ty1 or o!r initiatives1 national or regional 9 scope1 t (f] promise to accel]ate ! goals ( deliv]y sy/em re=m or improve program integrity t[>d ! goal ( provid+ fur!r /ability to ! appropriate ,tru/ ,funds "u title ,,xviii ( ! ,social ,security ,act4