,i #aaeth ,,congress #ast ,session ,h4 ,r4 #dfff ,,in ,,the ,,house ,,of ,,representatives ,december #ah1 #bjag,mr4 ,costello of ,pennsylvania introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend the ,public ,health ,service ,act to provide for a ,patient and ,state ,stability ,fund4 #a4 ,short title ,this ,act may be cited as the ,premium ,relief ,act of #bjag4 #b4 ,patient and ,state ,stability 7a7 ,patient and ,state ,stability ,fund ,the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bja et seq47 is amended by adding at the end the following new title3 ,,xxxiv ,patient and ,state ,stability ,fund #cdja4 ,establishment of program ,there is hereby established the ,patient and ,state ,stability ,fund to be administered by the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this title referred to as the ,administrator71 to provide health benefits coverage funding1 in accordance with this title1 to the #ej ,states and the ,district of ,columbia 7each referred to in this section as a ,state7 during the period1 subject to section #cdjd7;c71 beginning on ,january #a1 #bjai1 and ending on ,december #ca1 #bjba1 for the purposes described in section #cdjb4 #cdjb4 ,use of funds ,a ,state may use the funds allocated to the ,state under this title for any of the following purposes3 7#a7 ,helping1 through the provision of financial assistance1 high-risk individuals who do not have access to health insurance coverage offered through an employer enroll in health insurance coverage in the individual market in the ,state1 as such market is defined by the ,state 7whether through the establishment of a new mechanism or maintenance of an existing mechanism for such purpose74 7#b7 ,providing incentives to appropriate entities to enter into arrangements with the ,state to help stabilize premiums for health insurance coverage in the individual market1 as such markets are defined by the ,state4 7#c7 ,reducing the cost for providing health insurance coverage in the individual market and small group market1 as such markets are defined by the ,state1 to individuals who have1 or are projected to have1 a high rate of utilization of health services 7as measured by cost7 and to individuals who have high costs of health insurance coverage due to the low density population of the ,state in which they reside4 7#d7 ,promoting participation in the individual market and small group market in the ,state and increasing health insurance options available through such market4 7#e7 ,promoting access to preventive services2 dental care services 7whether preventive or medically necessary72 vision care services 7whether preventive or medically necessary72 or any combination of such services4 7#f7 ,maternity coverage and newborn care4 7#g7 ,prevention1 treatment1 or recovery support services for individuals with mental or substance use disorders1 focused on either or both of the following3 7,a7 ,direct inpatient or outpatient clinical care for treatment of addiction and mental illness4 7,b7 ,early identification and intervention for children and young adults with serious mental illness4 7#h7 ,providing payments1 directly or indirectly1 to health care providers for the provision of such health care services as are specified by the ,administrator4 7#i7 ,providing assistance to reduce out-of-pocket costs1 such as copayments1 coinsurance1 premiums1 and deductibles1 of individuals enrolled in health insurance coverage in the ,state4 #cdjc4 ,state eligibility and approval2 ,default safeguard 7a7 ,encouraging ,state options for allocations 7#a7 ,in general ,to be eligible for an allocation of funds under this title for a year during the period described in section #cdja for use for one or more purposes described in section #cdjb1 a ,state shall submit to the ,administrator an application at such time 7but not later than ,march #ca of the previous year7 and in such form and manner as specified by the ,administrator and containing-- 7,a7 a description of how the funds will be used for such purposes2 and 7,b7 such other information as the ,administrator may require4 7#b7 ,automatic approval ,an application so submitted is approved unless the ,administrator notifies the ,state submitting the application1 not later than #fj days after the date of the submission of such application1 that the application has been denied for not being in compliance with any requirement of this title and of the reason for such denial4 7#c7 ,one-time application ,if an application of a ,state is approved for a year1 with respect to a purpose described in section #cdjb1 such application shall be treated as approved1 with respect to such purpose1 for each subsequent year through #bjba4 7b7 ,default ,federal safeguard 7#a7 ,in general ,in the case of a ,state that does not have in effect an approved application under this section for #bjai1 #bjbj1 or #bjba1 the ,administrator1 in consultation with the ,state insurance commissioner1 shall use the allocation that would otherwise be provided to the ,state under this title for such year1 in accordance with paragraph 7#b71 for such ,state4 7#b7 ,required use for market stabilization payments to issuers ,subject to section #cdjd7;a71 an allocation for a ,state made pursuant to paragraph 7#a7 for a year shall be used to carry out the purpose described in section #cdjb7b7 in such ,state by providing payments to appropriate entities described in such section with respect to claims that exceed #ej1jjj 7or1 with respect to allocations made under this title for #bjbj or a subsequent year during the period specified in section #cdja1 such dollar amount specified by the ,administrator71 but do not exceed #cej1jjj 7or1 with respect to allocations made under this title for #bjbj or a subsequent year during such period1 such dollar amount specified by the ,administrator71 in an amount equal to #ge percent 7or1 with respect to allocations made under this title for #bjbj or a subsequent year during such period1 such percentage specified by the ,administrator7 of the amount of such claims4 #cdjd4 ,allocations 7a7 ,appropriation ,for the purpose of providing allocations for ,states 7including pursuant to section #cdjc7;b77 under this title there is appropriated1 out of any money in the ,treasury not otherwise appropriated-- 7#a7 for #bjai1 #aj1jjj1jjj1jjj2 7#b7 for #bjbj1 #aj1jjj1jjj1jjj2 and 7#c7 for #bjba1 #aj1jjj1jjj1jjj4 7b7 ,allocations 7#a7 ,payment ,from amounts appropriated under subsection 7a7 for a year 7beginning with #bjai and ending with #bjba71 the ,administrator shall1 with respect to a ,state and not later than ,january #a of such year1 allocate for such ,state 7including pursuant to section #cdjc7;b77 the amount determined for such ,state and year under paragraph 7#b74 7#b7 ,allocation amount determinations ,for purposes of paragraph 7#a71 the amount determined under this paragraph for a year for a ,state is an amount determined in accordance with an allocation methodology specified by the ,administrator4 7c7 ,annual distribution of previous year's remaining funds ,in carrying out subsection 7b71 the ,administrator shall1 with respect to a year 7beginning with #bjbj and ending with #bjbb71 not later than ,march #ca of such year-- 7#a7 determine the amount of funds1 if any1 from the amounts appropriated under subsection 7a7 for the previous year but not allocated for such previous year2 and 7#b7 if the ,administrator determines that any funds were not so allocated for such previous year1 allocate such remaining funds1 in accordance with the allocation methodology specified pursuant to subsection 7b77#b7-- 7,a7 to ,states that have submitted an application approved under section #cdjc7;a7 for such previous year for any purpose for which such an application was approved2 and 7,b7 for ,states for which allocations were made pursuant to section #cdjc7;b7 for such previous year1 to be used by the ,administrator for such ,states1 to carry out the purpose described in section #cdjb7b7 in such ,state by providing payments to appropriate entities described in such section #cdjb7b7 with respect to claims that exceed #a1jjj1jjj1 with1 respect to a year before #bjbb1 any remaining funds being made available for allocations to ,states for the subsequent year4 7d7 ,availability ,amounts appropriated under subsection 7a7 for a year and allocated to ,states in accordance with this section shall remain available for expenditure through ,december #ca1 #bjbb4 7e7 ,limitation ,amounts appropriated under subsection 7a7 for a year 7beginning with #bjai and ending with #bjba7 are subject to the requirements and limitations under sections #ejf and #ejg of division ,h of ,public ,law #aae-ca in the same manner and to the same extent as if such amounts for such year were appropriated under such division4 4 7b7 ,cost-,sharing reduction payments ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 is amended by adding at the end the following new subsection3 7g7 ,funding 7#a7 ,appropriations ,there is appropriated1 from any money in the ,treasury not otherwise appropriated1 such sums as may be necessary to1 subject to paragraph 7#b71 provide health benefits coverage through payment to issuers 7under this section or through advance payment by the ,secretary of the ,treasury under section #adab7;c77#c77 of the amounts computed under this section for the last quarter of plan year #bjag and each of plan years #bjai and #bjbj4 7#b7 ,adjustments ,notwithstanding any other provision of law1 payments and other actions for adjustments to obligations incurred prior to ,december #ca1 #bjbj1 may be made through ,december #ca1 #bjba4 7#c7 ,limitation ,amounts appropriated under paragraph 7#a7 for the last quarter of plan year #bjag and each of plan years #bjai and #bjbj are subject to the requirements and limitations under sections #ejf and #ejg of division ,h of ,public ,law #aae-ca in the same manner and to the same extent as if such amounts for such quarter and each such year were appropriated under such division4 4