,i #aae? ,,congress #b;d ,session ,h4 ,r4 #fjig ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,june #ac1 #bjah,ms4 ,jayapal 7= h]self1 ,ms4 ,s*ak[sky1 & ,mr4 ,pocan7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,ways & ,means1 ,ov]sight & ,gov]nm5t ,re=m1 ,arm$ ,s]vices1 & ,education & ! ,work=ce1 = 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 ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act to au?orize ! e/abli%m5t (1 & provide support =1 ,/ate-bas$ univ]sal heal? c>e sy/ems t provide compreh5sive heal? b5efits to ,/ate resid5ts1 & = o!r purposes4 #a4 ,%ort title2 purpose 7a7 ,%ort title ,?is ,act may be cit$ z ! ,/ate-,bas$ ,univ]sal ,heal? ,c>e ,act ( #bjah4 7b7 ,purpose ,! purpose ( ?is ,act is to e/abli% a flexible framework "u :i* ,/ates c provide compreh5sive univ]sal heal? cov]age to all ( _! resid5ts4 #b4 ,waiv] = ,/ate univ]sal heal? c>e 7a7 ,9 g5]al ,title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7 is am5d$ by /rik+ section #accb 7#db ,u4,s4,c4 #ahjeb7 & ins]t+ ! foll[+ new section3 #accb4 ,waiv] = ,/ate univ]sal heal? c>e 7a7 ,application 7#a7 ,9 g5]al ,a ,/ate may apply to ! ,secret>y 7z def9$ 9 subsection 7i77#c77 = ! waiv] ( s mu* ( ! requirem5ts describ$ 9 p>agraph 7#b7 ) respect to heal? b5efits cov]age )9 t ,/ate = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjai1 z is necess>y to implem5t a compreh5sive ,/ate univ]sal heal? c>e plan 9 ! ,/ate "u ?is section4 ,su* application %all-- 7,a7 be fil$ at su* "t & 9 su* mann] z ! ,secret>y may require2 7,b7 conta9 su* in=mation z ! ,secret>y may require1 includ+-- 7i7 a compreh5sive description ( ! ,/ate legislation & program to implem5t a plan meet+ ! requirem5ts = a waiv] "u ?is section2 7ii7 a plan = h[ ! ,/ate w a*ieve 9 #e ye>s heal? cov]age = at lea/ #ie p]c5t ( ! population ( ! ,/ate1 ) five p]c5t ( ! population ( ! ,/ate n sp5d+ m ?an #aj p]c5t ( _! adju/$ gross income on heal?2 & 7iii7 a #aj-;fiscal-ye> budget plan = su* plan t is budget neutral = ! ,f$]al ,gov]nm5t2 & 7,c7 provide an assurance t ! ,/ate has enact$1 or w be enact+ be=e ! curr5t ,/ate legislative session adj\rns1 ! law describ$ 9 subsection 7b77#b74 7#b7 ,requirem5ts ,! requirem5ts describ$ 9 ?is p>agraph ) respect to heal? b5efits cov]age )9 ! ,/ate = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjai1 are z foll[s3 7,a7 ,p>ts ,i1 ,,ii1 & ,,iii ( ?is subtitle4 7,b7 ,section #adjb4 7,c7 ,sections #cf;,b & #dihj;,h ( ! ,int]nal ,rev5ue ,code ( #aihf4 7,d7 ,title ,,xi ( ! ,social ,security ,act4 7,e7 ,title ,,xviii ( ! ,social ,security ,act4 7,f7 ,title ,,xix ( ! ,social ,security ,act4 7,g7 ,title ,,xxi ( ! ,social ,security ,act4 7,h7 ,*apt] #hi ( title #e ( ! ,unit$ ,/ates ,code4 7,i7 ,*apt] #ee ( title #aj1 ,unit$ ,/ates ,code1 includ+ cov]age "u ! ,,tric>e program4 7,j7 ,section #ead ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd4 7#c7 ,pass ?r\gh ( fund+ ,) respect to a ,/ate waiv] "u p>agraph 7#a71 "u :i* ! ,/ate assumes responsibility = heal? cov]age "u a specifi$ ,f$]al heal? program1 includ+ "u ea* ( ! ,f$]al heal? c>e or subsidy programs specifi$ 9 subp>agraphs 7,b71 7,c71 7,e71 7,f71 7,g71 & 7,h7 ( p>agraph 7#b71 ! ,secret>y %all n sp5d ,f$]al heal? funds t w\ld o!rwise h be5 sp5t = su* program & %all provide = an alt]native means by :i* ! aggregate am\nt ( su* funds %all be paid to ! ,/ate = purposes ( implem5t+ ! ,/ate plan "u ! waiv]4 ,su* am\nt %all be det]m9$ annually by ! ,secret>y1 tak+ into acc\nt ! am\nt t w\ld o!rwise h be5 sp5t "u su* ,f$]al heal? program ) respect to resid5ts ( su* ,/ate1 if su* waiv] did n apply4 ,su* am\nt %all include funds equal to ! am\nt ( premium tax cr$its1 co/-%>+ r$uctions1 or small-bus9ess cr$its "u sections #cf;,b & #de,r ( ! ,int]nal ,rev5ue ,code ( #aihf or "u section #adjb t w\ld h be5 available to individuals & bus9esses 9 ! ,/ate if su* waiv] did n apply4 7#d7 ,waiv] consid]ation & transp>5cy 7,a7 ,9 g5]al ,an application = a waiv] "u ?is section %all be consid]$ by ! ,secret>y1 aft] tak+ into acc\nt recomm5dations ( ! ,panel "u subsection 7g71 9 accordance ) ! regulations describ$ 9 subp>agraph 7,b74 7,b7 ,regulations ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ! ,/ate-,bas$ ,univ]sal ,heal? ,c>e ,act ( #bjag1 ! ,secret>y %all promulgate regulations relat+ to waiv]s "u ?is section t provide-- 7i7 a process = public notice & comm5t 9 accordance ) ! public notice & comm5t requirem5ts applicable "u regulations us$ = ,m$icaid waiv]s pursuant to section #aaae ( ! ,social ,security ,act2 7ii7 a process = ! submission ( an application t ensures ! disclosure (-- 7,i7 ! provisions ( law t ! ,/ate involv$ seeks to waive2 & 7,,ii7 ! specific plans ( ! ,/ate to ensure t ! waiv] w be 9 compliance ) subsection 7b72 7iii7 a process = provid+ public notice & comm5t aft] ! application is receiv$ by ! ,secret>y1 t is suffici5t to ensure a mean+ful level ( public input & t does n impose requirem5ts t are 9 addition to1 or duplicative (1 requirem5ts impos$ "u ! ,adm9i/rative ,proc$ure ,act1 or requirem5ts t are unreasonable or unnecess>ily burd5some ) respect to ,/ate compliance2 7iv7 a process = ! ,panel "u subsection 7g7 to consid] ! applications = waiv]s s submitt$ & provide recomm5dations ) respect to su* applications2 7v7 a process = ! submission to ! ,secret>y ( p]iodic reports by ! ,/ate conc]n+ ! implem5tation ( ! program "u ! waiv]2 7vi7 a process = ! p]iodic evaluation by ! ,secret>y ) respect to waiv]s grant$ "u ?is section2 & 7vii7 a process = provid+ te*nical assi/ance on-- 7,i7 h[ to develop an application to any ,/ate seek+ to submit an application = a waiv] relat+ to develop+ a program ( provid+ heal? c>e = all resid5ts = su* ,/ate2 & 7,,ii7 h[ to improve su* a program = purposes ( a ,/ate seek+ assi/ance pursuant to subsection 7e77#b74 7,c7 ,report ,! ,secret>y %all annually report to ,congress conc]n+ actions tak5 by ! ,secret>y ) respect to applications = waiv]s1 & programs conduct$ ?r\gh waiv]s grant$1 "u ?is section4 ,ea* su* report %all include1 ) respect to any action by ! ,secret>y s tak51 ) respect to an application1 t 0 n consi/5t ) ! recomm5dations ( ! ,panel "u subsection 7g71 ) respect to su* application1 ! reasons su* action 0 tak54 7#e7 ,regional waiv] reque/ & plan ,no?+ 9 ?is section %all be con/ru$ to prev5t two or m ,/ates 9 a region f submitt+ a s+le application "u ?is section = a waiv] t e/abli%es a plan t is applicable to all ( ! ,/ates includ$ 9 su* application4 ,9 ! case ( su* an application & plan1 ! requirem5ts ( ?is section %all cont9ue to be applicable ) respect to ea* ,/ate includ$ 9 su* application4 7#f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ su* sums z may be necess>y = provid+ funds to ,/ates ) a waiv] "u ?is section = purposes ( c>ry+ out activities describ$ 9 subsection 7b77#a77;,e74 7b7 ,grant+ ( waiv]s 7#a7 ,9 g5]al ,! ,secret>y may grant a reque/ = a waiv] "u subsection 7a77#a7 only if ! ,secret>y det]m9es t ! ,/ate plan-- 7,a7 w provide1 9 accordance ) subp>agraph 7,b71 heal? b5efits cov]age to ,/ate resid5ts t is at lea/ z compreh5sive z ! heal? b5efits cov]age t su* resid5ts w\ld h receiv$ "u ! specifi$ ,f$]al heal? program 7z def9$ 9 subsection 7i77#d77 = :i* su* resid5ts w\ld h be5 eligible1 abs5t su* waiv]2 7,b7 w provide1 9 ! case ( su* a waiv] "u subsection 7a77#a7 = ! ,/ate to waive any ( ! requirem5ts describ$ 9 subsection 7a77#b77;,f71 heal? b5efits cov]age to ,/ate resid5ts :o w\ld h o!rwise receiv$ heal? b5efits cov]age 9 ! =m ( m$ical assi/ance "u ! ,/ate ,f$]al heal? program describ$ 9 subsection 7i77#d77;,b7 7reg>dless ( :e!r ! ,/ate provides = su* assi/ance ?r\gh a ,/ate plan "u title ,,xix ( ! ,social ,security ,act or a waiv] ( su* plan7 t includes at lea/ ! m&atory b5efits "u title ,,xix ( ! ,social ,security ,act t are requir$ ( a ,/ate )\t a waiv] ( a ,/ate plan "u su* title1 includ+ at lea/ b5efits = e>ly & p]iodic scre5+1 diagno/ic1 & treatm5t2 b5efits = non-em]g5cy transportation2 & retroactive cov]age2 7,c7 w provide cov]age & co/ %>+ protections aga9/ excessive out-(-pocket sp5d+ to ,/ate resid5ts t are at lea/ z af=dable z ! cov]age & co/ %>+ protections "u ! specifi$ ,f$]al heal? program 7z def9$ 9 subsection 7i77#d77 = :i* su* resid5ts w\ld h be5 eligible1 abs5t su* waiv]2 7,d7 w provide cov]age to all resid5ts ( ! ,/ate1 includ+ all ^? o!rwise cov]$ "u ! ,f$]al heal? c>e or subsidy programs specifi$ 9 subp>agraphs 7,b71 7,c71 7,e71 7,f71 7,g71 & 7,h7 ( subsection 7a77#b71 except individuals :o are eligible = b5efits ?r\gh ! ,indian ,heal? ,s]vice or = b5efits & s]vices "u title #ch1 ,unit$ ,/ates ,code2 7,e7 w provide = public education activities to raise aw>5ess ( ! availability ( qualifi$ heal? plans & ! facilitation ( enrollm5t 9 su* cov]age 9 a mann] simil> to an entity t s]ves z a navigator "u a grant "u section #acaa7;i72 7,f7 w be publicly adm9i/]$ by an ag5cy ( ! ,/ate2 7,g7 w n preclude ! pur*ase ( supplem5tal insurance2 7,h7 w provide sy/ems = compla9ts1 appeals1 indep5d5t review1 & o!r proc$ures = access+ & ma9ta9+ b5efits t are at lea/ z accessible to ,/ate resid5ts z ^? ( ! specifi$ ,f$]al heal? programs 7z def9$ 9 subsection 7i77#d77 = :i* su* resid5ts w\ld h o!rwise be5 eligible )\t application ( su* waiv] "u subsection 7a77#a72 & 7,i7 w n increase ! ,f$]al deficit4 ,subp>agraph 7,d7 %all n be con/ru$ z limit+ a ,/ate f contract+ ) "o or m private entities to adm9i/] ! plan4 7#b7 ,requirem5t to enact a law 7,a7 ,9 g5]al ,a law describ$ 9 ?is p>agraph is a ,/ate law t provides = ,/ate actions "u a waiv] "u ?is section1 includ+ ! implem5tation ( ! ,/ate plan "u subsection 7a77#a77;,b74 7,b7 ,t]m9ation ( opt out ,a ,/ate may repeal a law describ$ 9 subp>agraph 7,a7 & t]m9ate ! au?ority provid$ "u ! waiv] ) respect to ! ,/ate4 7c7 ,scope ( waiv] 7#a7 ,9 g5]al ,! ,secret>y %all det]m9e ! scope ( a waiv] ( a requirem5t describ$ 9 subsection 7a77#b7 grant$ to a ,/ate "u subsection 7a77#a74 7#b7 ,limitation ,"u ?is section1 ! ,secret>y may n waive any ,f$]al law or requirem5t t is n li/$ 9 subsection 7a77#b74 7d7 ,det]m9ations by ,secret>y 7#a7 ,"t = det]m9ation ,! ,secret>y %all1 ) respect to an application f a ,/ate "u ?is subsection & aft] tak+ into acc\nt recomm5dations ( ! ,panel "u subsection 7g7 = su* application1 make a det]m9ation "u subsection 7a77#a7 n lat] ?an #ij days aft] ! receipt ( su* recomm5dations4 7#b7 ,effect ( ,det]m9ation 7,a7 ,grant+ ( waiv]s ,if ! ,secret>y det]m9es to grant a waiv] "u subsection 7a77#a71 ! ,secret>y %all notify ! ,/ate involv$ ( su* det]m9ation & ! t]ms & effectiv5ess ( su* waiv]4 7,b7 ,d5ial ( waiv] ,if ! ,secret>y det]m9es a waiv] %\ld n be grant$ "u subsection 7a77#a71 ! ,secret>y %all notify ! ,/ate involv$ & ! appropriate committees ( ,congress ( su* det]m9ation & ! reasons !re=4 7e7 ,requir$ reports2 #e-,ye> review 7#a7 ,9 g5]al ,z a condition ( receipt ( a waiv] "u ?is section1 aft] ea* #e-ye> p]iod ( su* waiv]1 a ,/ate %all submit to ! ,secret>y a report t is c>ri$ out by an indep5d5t1 non-p>tisan entity1 ) respect to su* #e-ye> p]iod & aft] a process = public notice & comm5t at ! ,/ate level1 includ+ public he>+s1 suffici5t to ensure a mean+ful level ( public input1 on ! foll[+3 7,a7 ,h[ waiv] funds h be5 sp5t by ! ,/ate4 7,b7 ,! numb] ( resid5ts ( ! ,/ate )\t heal? insurance & a description ( h[ ! ,/ate plans to provide heal? insurance cov]age )9 ! subsequ5t #e ye>s to resid5ts ( ! ,/ate )\t heal? insurance4 7,c7 ,h[ af=dability 9 ! ,/ate = heal? c>e has *ang$ ov] ! p]iod4 7,d7 ,:e!r ! ,/ate has a*iev$ heal? cov]age = at lea/ #ie p]c5t ( ! population ( ! ,/ate4 7,e7 ,any additional in=mation specifi$ by ! ,secret>y = purposes ( det]m9+ ! successes & *all5ges ( ! waiv]4 7#b7 #e-ye> review ,9 ! case a ,/ate1 bas$ on ! report submitt$ "u p>agraph 7#a7 = a #e-ye> p]iod-- 7,a7 has be5 det]m9$ by ! ,secret>y1 aft] tak+ into acc\nt recomm5dations ( ! ,panel "u subsection 7g71 to h n a*iev$ heal? cov]age = at lea/ #ie p]c5t ( ! population ( ! ,/ate-- 7i7 ! ,/ate %all h access to te*nical assi/ance describ$ 9 subsection 7a77#d77;,b77vii7 to improve ! heal? insurance program ( ! ,/ate implem5t$ ?r\gh ! waiv] "u ?is section2 7ii7 ! ,/ate %all h a grace p]iod ( #f mon?s aft] su* det]m9ation to a*ieve heal? cov]age = at lea/ #ie p]c5t ( su* population2 & 7iii7 if aft] su* #f mon?s1 ! ,/ate has n a*iev$ su* heal? cov]age1 ! waiv] "u ?is section %all be t]m9at$2 & 7,b7 has be5 det]m9$ by ! ,secret>y1 aft] tak+ into acc\nt recomm5dations ( ! ,panel "u subsection 7g71 to h a*iev$ heal? cov]age = at lea/ #ie p]c5t ( ! population ( ! ,/ate1 ! ,/ate1 z a condition ( cont9u+ su* waiv]1 %all submit to ! ,secret>y a plan = a*iev+ heal? cov]age = ! rema9d] ( ! population ( ! ,/ate4 7f7 ,assur+ coord9ation 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! enactm5t ( ! ,/ate-,bas$ ,univ]sal ,heal? ,c>e ,act ( #bjah1 ! ,secret>y ( ,heal? & ,human ,s]vices1 ! ,secret>y ( ! ,treasury1 ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t1 ! ,secret>y ( ,def5se1 & ! ,secret>y ( ,labor %all1 ?r\gh ! execution ( an int]ag5cy memor&um ( und]/&+ among su* ,secret>ies & ! ,director-- 7,a7 develop a process = coord9at+ & consolidat+ ! ,/ate waiv] processes applicable "u ! provisions ( ?is section1 & ! exi/+ waiv] processes applicable "u-- 7i7 titles ,,xi1 ,,xviii1 ,,xix1 & ,,xxi ( ! ,social ,security ,act2 & 7ii7 any o!r ,f$]al law relat+ to ! provision ( heal? c>e items or s]vices2 & 7,b7 ensure t-- 7i7 regulations 7includ+ regulations requir$ "u subsection 7a77#d77;,b771 rul+s1 & int]pretations issu$ by su* ,secret>ies & ! ,director relat+ to ! same matt] ov] :i* two or m su* ,secret>ies or ,director h responsibility "u ?is section are adm9i/]$ s z to h ! same effect at all times2 & 7ii7 coord9ation ( policies relat+ to ! grant+1 implem5tation1 & cont9uation ( waiv]s ?r\gh su* ,secret>ies & ,director 9 ord] to h a coord9at$ /rategy t avoids duplication ( ef=t by ! ,/ates or ,secret>ies & ,director & ensures cl>ity ab\t waiv] application /atus & approval4 7#b7 ,s+le application ,! process "u p>agraph 7#a77;,a7 %all p]mit a ,/ate to submit a s+le application = a waiv] "u all ( ! provisions ( ?is section & ! provisions ( law li/$ "u clauses 7i7 & 7ii7 ( su* p>agraph4 7#c7 ,submission ( con=m+ am5dm5ts ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! o!r ,secret>ies 7includ+ ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t71 %all submit to ,congress su* recomm5dations = su* te*nical & con=m+ am5dm5ts to law z may be appropriate to assi/ 9 ! implem5tation ( ?is section4 7g7 ,indep5d5t ,assessm5t ,panel = ,compreh5sive ,heal? ,c>e 7#a7 ,e/abli%m5t ,!re is e/abli%$ a committee to be kn[n z ! ,indep5d5t ,assessm5t ,panel = ,compreh5sive ,heal? ,c>e 79 ?is section ref]r$ to z ! ,panel74 7#b7 ,consid]ation ( submissions ,! ,secret>y %all =w>d a copy ( ea* waiv] application submitt$ "u ?is section to ! ,panel = consid]ation "u ?is subsection4 7#c7 ,duties ,! ,panel %all-- 7,a7 review any waiv] application by a ,/ate =w>d$ "u p>agraph 7#b7 & any report submitt$ "u p>agraph 7#a7 ( subsection 7e7 = purposes ( ! review "u p>agraph 7#b7 ( su* subsection2 7,b7 n lat] ?an #ij days aft] submission ( su* application 7or report7 by ! ,/ate1 provide to ! ,/ate & to ! ,secret>y ! recomm5dations ( ! ,panel reg>d+ ! approval or disapproval ( su* waiv] application 7or reg>d+ ! /atus ( ! waiv] = cont9uation pursuant to subsection 7e77#b77 &1 if applicable1 possible improvem5ts to su* application 7or = purposes ( subsection 7e77#b772 & 7,c7 submit to ,congress an annual report on waiv] applications 7& waiv] reports "u subsection 7e77 review$ by ! ,panel dur+ ! applicable ye>1 includ+ ! numb] ( applications 7& reports7 receiv$ & ! numb] ( applications recomm5d$ = approval 7& ( reports ) respect to :i* recomm5dations = cont9uation 7 provid$74 7#d7 ,memb]%ip 7,a7 ,numb] & appo9tm5t ,! ,panel %all consi/ ( sev5 memb]s appo9t$ by ! ,secret>y ( ,heal? & ,human ,s]vices1 ( :om-- 7i7 "o %all be appo9t$ on ! recomm5dation ( ! ,speak] ( ! ,h\se ( ,repres5tatives2 7ii7 "o %all be appo9t$ on ! recomm5dation ( ! m9ority lead] ( ! ,h\se ( ,repres5tatives2 7iii7 "o %all be appo9t$ on ! recomm5dation ( ! majority lead] ( ! ,s5ate2 7iv7 "o %all be appo9t$ on ! recomm5dation ( ! m9ority lead] ( ! ,s5ate2 7v7 "o %all be appo9t$ f ! ,republican ,gov]nors ,association2 7vi7 "o %all be appo9t$ f ! ,democratic ,gov]nors ,association2 & 7vii7 "o %all be a repres5tative f ! consum] advocacy community4 7,b7 ,t]m ( s]vice 7i7 ,9 g5]al ,ea* memb] ( ! ,panel %all s]ve a ?ree-ye> t]m4 ,a memb] may s]ve aft] ! expiration ( t memb]'s t]m until a successor has be5 appo9t$ pursuant to subp>agraph 7,a74 7ii7 ,vacancy ,any memb] appo9t$ to fill a vacancy occurr+ be=e ! expiration ( ! t]m = :i* ! memb]'s pr$ecessor 0 appo9t$ %all be appo9t$ only = ! rema9d] ( t t]m4 ,a vacancy 9 ! ,commission %all be fill$ 9 ! mann] 9 :i* ! orig9al appo9tm5t 0 made4 7,c7 ,pay ,memb]s ( ! ,panel %all s]ve )\t pay4 7,d7 ,*airp]son2 ,vice ,*airp]son 7i7 ,*airp]son ,! ,secret>y ( ,heal? & ,human ,s]vices1 or a designee ( ! ,secret>y1 %all s]ve on ! ,panel z ! ,*airp]son ( ! ,panel4 7ii7 ,vice ,*airp]son ,! ,adm9i/rator ( ! ,f$]al ,em]g5cy ,managem5t ,ag5cy1 or a designee ( ! ,adm9i/rator1 %all s]ve on ! ,panel z ! ,vice ,*airp]son ( ! ,panel4 7#e7 ,/aff1 exp]ts1 & consultants ,! ,panel may-- 7,a7 appo9t su* /aff z ! ,panel consid]s to be appropriate1 )\t reg>d to ! provisions ( title #e1 ,unit$ ,/ates ,code1 gov]n+ appo9tm5ts 9 ! competitive s]vice2 7,b7 fix ! pay ( su* /aff1 )\t reg>d to ! provisions ( *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( su* title relat+ to classification & ,g5]al ,s*$ule pay rates2 & 7,c7 procure ! s]vices ( exp]ts & consultants 9 accordance ) ! provisions ( section #caji7;b7 ( su* title4 7#f7 ,detail ( ,f$]al p]sonnel ,^u reque/ ( ! ,panel1 ! head ( any ,f$]al ag5cy may detail1 on a reimbursable basis1 any ( ! p]sonnel ( ! ag5cy to ! ,panel to assi/ x 9 c>ry+ out ! duties "u p>agraph 7#c74 7#g7 ,f$]al ,advisory ,committee ,act ,! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all apply to ! ,panel4 7#h7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ su* sums z may be necess>y to ! ,panel = c>ry+ out ! duties ( ! panel = ea* ( fiscal ye>s #bjah ?r\gh #bjbc4 7h7 ,guidance relat+ to ,am]ican ,indians & ,alaska ,natives 7#a7 ,9 g5]al ,! ,secret>y %all issue guidance ) respect to apply+ ! provisions ( ?is section 9 a mann] consi/5t ) ! foll[+3 7,a7 ,to fur!r ! goal t ,f$]al heal? s]vices to ma9ta9 & improve ! heal? ( ! ,indians are consonant ) & requir$ by ! ,f$]al ,gov]nm5t's hi/orical & unique legal relation%ip )1 & result+ responsibility to1 ! ,am]ican ,indian p4 7,b7 ,no enrollm5t fee1 premium1 or simil> *>ge1 & no d$uction1 copaym5t1 co/ %>+1 or simil> *>ge is to be impos$ aga9/ an ,indian :o is furni%$ an item or s]vice ?r\gh a waiv] "u ?is section4 ,all co/s incurr$ 9 waiv+ su* *>ges %all be borne by ! ,f$]al ,gov]nm5t 9 fulfillm5t ( ! tru/ responsibility4 7,c7 ,a ,/ate may n require ! enrollm5t ( an individual :o is an ,indian 9 heal? insurance (f]$ ?r\gh a waiv] "u ?is section4 7,d7 ,heal? insurance issu]s (f]+ cov]age pursuant to a waiv] "u ?is section mu/ make good fai? ef=ts to contract ) ,indian ,heal? ,c>e ,provid]s op]at+ )9 ! area s]v$ by ! issu]s4 7,e7 ,heal? insurance issu]s (f]+ cov]age pursuant to a waiv] "u ?is section %all pay ,indian ,heal? ,c>e ,provid]s1 :e!r su* provid]s are p>ticipat+ or nonp>ticipat+ provid]s ) respect to ! cov]age1 = cov]$ s]vices provid$ to ^? ,indian enrollees :o are eligible to receive s]vices f su* provid]s at a rate equal to ! rate negotiat$ betwe5 su* entity & ! provid] involv$ or1 if su* a rate has n be5 negotiat$1 at a rate t is n less ?an ! level & am\nt ( paym5t :i* ! entity w\ld make = ! s]vices if ! s]vices 7 furni%$ by a p>ticipat+ provid] :i* is n an ,indian ,heal? ,c>e ,provid]4 7,f7 ,heal? insurance issu]s (f]+ cov]age pursuant to a waiv] "u ?is section w include a /&>d contract add5dum :5 contract+ ) ,indian ,heal? ,c>e ,provid]s4 ,! contract add5dum w be develop$ 9 consultation ) tribes & 9 conf]5ce ) ,urban ,indian ,heal? ,programs op]at+ )9 ! s]vice area ( ! ,/ate4 7,g7 ,! treatm5t ( ,indians "u ?is legislation does n con/itute invidi\s racial discrim9ation 9 violation ( ! ,due ,process ,clause ( ! ,fif? or ,f\rte5? ,am5dm5ts1 b is reasonable & rationally design$ to fur!r ! heal? ( ,indians4 7,h7 ,9 ! case ( any ,/ate 9 :i* #a or m ,indian ,heal? ,c>e ,programs furni%es heal? c>e s]vices1 ! ,/ate w provide = a process "u :i* ! ,/ate seeks advice on a regul>1 ongo+ basis f designees ( su* ,indian ,heal? ,c>e ,programs & ,urban ,indian ,organizations on matt]s relat+ to ! application ( a waiv] "u ?is section t are likely to h a direct effect on su* ,indian ,heal? ,programs & t-- 7i7 %all include solicitation ( advice prior to submission ( any plan am5dm5ts1 waiv] reque/s1 & proposals = demon/ration projects likely to h a direct effect on ,indians or ,indian ,heal? ,c>e ,programs2 & 7ii7 may include appo9tm5t ( an advisory committee & ( a designee ( su* ,indian ,heal? ,c>e ,programs to ! m$ical c>e advisory committee advis+ ! ,/ate on its waiv] "u ?is section4 7#b7 ,def9itions ,= purposes ( ?is subsection3 7,a7 ,! t]m ,indian has ! mean+ giv5 su* t]m 9 section #ddg4ej ( title #db ( ! ,code ( ,f$]al ,regulations 7z 9 effect on ,july #a1 #bjaj74 7,b7 ,! t]m ,indian ,heal? ,c>e ,provid] has ! mean+ giv5 su* t]m 9 section #dch4ad7;a7 ( title #db ( ! ,code ( ,f$]al ,regulations4 7i7 ,def9itions ,9 ?is section3 7#a7 ,heal? b5efits cov]age ,! t]m heal? b5efits cov]age-- 7,a7 means-- 7i7 heal? insurance cov]age1 z su* t]m is def9$ 9 section #bgia7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;b772 & 7ii7 cov]age "u a gr\p heal? plan1 z su* t]m is def9$ 9 section #bgia7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;a772 & 7,b7 includes any m$ical cov]age or heal? b5efits provid$ "u any specifi$ ,f$]al heal? program describ$ 9 subp>agraphs 7,a7 ?r\gh 7,e7 ( p>agraph 7#d74 7#b7 ,resid5t ,) respect to a ,/ate1 ! t]m resid5t means an individual-- 7,a7 :o is-- 7i7 a citiz5 or national ( ! ,unit$ ,/ates2 or 7ii7 an ali5 lawfully resid+ 9 ! ,/ate 7includ+ an ali5 :o is grant$ def]r$ action or :o is o!rwise au?oriz$ to rema9 9 ! ,unit$ ,/ates72 & 7,b7 ^: prim>y resid5ce 7z def9$ by ! ,/ate7 is locat$ 9 ! ,/ate4 7#c7 ,secret>y ,! t]m ,secret>y means-- 7,a7 ! ,secret>y ( ,heal? & ,human ,s]vices ) respect to waiv]s relat+ to ! provisions describ$ 9 subp>agraphs 7,a71 7,b71 & 7,d7 ?r\gh 7,g7 ( p>agraph 7#b7 ( subsection 7a72 7,b7 ! ,secret>y ( ! ,treasury ) respect to waiv]s relat+ to ! provisions describ$ 9 subp>agraph 7,c7 ( su* p>agraph2 7,c7 ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t ) respect to waiv]s relat+ to ! provisions describ$ 9 subp>agraph 7,h7 ( su* p>agraph2 7,d7 ! ,secret>y ( ,def5se ) respect to waiv]s relat+ to ! provisions describ$ 9 subp>agraph 7,i7 ( su* p>agraph2 & 7,e7 ! ,secret>y ( ,labor ) respect to waiv]s relat+ to ! provisions describ$ 9 subp>agraph 7,j7 ( su* p>agraph4 7#d7 ,specifi$ ,f$]al heal? program ,! t]m specifi$ ,f$]al heal? program means all ( ! foll[+ programs3 7,a7 ,! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act4 7,b7 ,! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act4 7,c7 ,! ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( ! ,social ,security ,act4 7,d7 ,! ,f$]al ,employees ,heal? ,b5efits ,plan "u *apt] #hi ( title #e ( ! ,unit$ ,/ates ,code4 7,e7 ,m$ical cov]age "u *apt] #ee ( title #aj1 ,unit$ ,/ates ,code1 includ+ cov]age "u ! ,,tric>e program4 7,f7 ,an ,ex*ange e/abli%$ "u ?is subtitle4 7,g7 ,subsidies "u section #adjb4 7,h7 ,tax cr$its "u sections #cf;,b & #de,r ( ! ,int]nal ,rev5ue ,code ( #aihf4 4 7b7 ,cl]ical am5dm5t ,! item 9 ! table ( cont5ts 9 section #a7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act relat+ to section #accb is am5d$ to read z foll[s3 ,sec4 #accb4 ,waiv] = ,/ate univ]sal heal? c>e4 4 7c7 ,cont9uation ( curr5t law = curr5t waiv]s & waiv] applications 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 9 ! case ( a ,/ate t has appli$ to ! ,secret>y ( ,heal? & ,human ,s]vices = a waiv] "u section #accb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjeb71 z 9 effect be=e ! enactm5t ( ?is ,act1 = plan ye> #bjah1 su* section #accb %all cont9ue to apply to su* application & to any waiv] "u su* application = subsequ5t plan ye>s4 7#b7 ,transition to new waiv] law ,no?+ 9 p>agraph 7#a7 %all be con/ru$ z prev5t+ a ,/ate describ$ 9 su* p>agraph f )draw+ an application describ$ 9 su* p>agraph 7or reque/+ ! ,secret>y to t]m9ate an approv$ waiv] ref]r$ to 9 su* p>agraph7 = plan ye> #bjai or a subsequ5t plan ye> & subsequ5tly apply+ = a waiv] "u section #accb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 z am5d$ by subsection 7a71 = su* a plan ye>4