,,ii  #aaeth ,,congress  #ast ,session  
,s4 #ahce  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #ai1
 #bjag ,ms4 ,collins 7for herself and   
,mr4 ,nelson7 introduced the following  
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to provide support to ,states to     
establish invisible high-risk pool or   
reinsurance programs4  #a4 ,short title 
,this ,act may be cited as the ,lower   
,premiums ,through ,reinsurance ,act of 
#bjag4  #b4 ,invisible high-risk pool   
and reinsurance programs ,section #accb 
of the ,patient ,protection and         
,affordable ,care ,act 7#db ,u4,s4,c4   
#ahjeb7 is amended-- 7#a7 by adding at  
the end the following3  7f7 ,high-,risk 
pools and reinsurance programs  7#a7 ,in
 general  7,a7 ,application ,any ,state 
may apply to the ,secretary for approval
 to use the funding described in        
subparagraph 7,b7 to support an         
invisible high-risk pool or reinsurance 
program that is described in paragraph  

7#b74 ,the ,secretary shall approve a   
,state application under this           
subparagraph with respect to any program
 that--  7i7 meets the requirements of  
subparagraph 7,a71 7,b71 7,c71 or 7,d7  
of paragraph 7#b72 and  7ii7 meets the  
requirements of subparagraphs 7,a7      
through 7,d7 of subsection 7b77#a74     
7,b7 ,funding ,if a ,state application  
under subparagraph 7,a7 is approved1 the
 ,state may fund such invisible         
high-risk pool or reinsurance program   
using one or both of the following3  7i7
 ,amounts received through a grant      
described in subparagraph 7,c74  7ii7   
,with respect to a ,state that has      
received a waiver under this section1   
all of1 or a portion of1 the payments   
made to the ,state as described in      
subsection 7a77#c71 consistent with the 
information the ,state provides under   
subsection 7a77#a77;,b77iii74  7,c7     
,federal funding for invisible high-risk
 pool and reinsurance programs ,there   
are authorized to be appropriated1 and  

there are appropriated1 to the          
,secretary1 out of monies in the        
,treasury not otherwise obligated1      
#b1bej1jjj1jjj for each of fiscal years 
#bjah and #bjai1 to remain available    
until expended1 for purposes of awarding
 grants to ,states to support the       
establishment or maintenance of         
invisible high-risk pool and reinsurance
 programs that meet the requirements of 
paragraph 7#b74 ,any funds provided     
under this subparagraph shall not be    
considered in determining under         
subparagraph 7,a77ii7 whether the ,state
 plan increases the ,federal deficit4   
7#b7 ,program design ,an invisible      
high-risk pool or reinsurance program   
described in this paragraph is a program
 that meets one of the following        
requirements3  7,a7 ,an invisible       
high-risk pool under which health       
insurance issuers1 with respect to      
designated high-risk individuals        
enrolled in health insurance coverage   
offered in the individual market1 cede  

risk to the pool1 without affecting the 
premium paid by the designated          
individuals or their terms of coverage4 
,with respect to such pool1 the ,state1 
or an entity operating the pool on      
behalf of the ,state1 shall establish-- 
7i7 the premium amount the ceding       
insurer shall pay to the reinsurance    
pool2  7ii7 the applicable attachment   
points or coinsurance percentages if the
 ceding insurer retains any portion of  
the risk under ceded policies2 and      
7iii7 the mechanism by which high-risk  
individuals are designated for cession  
to the pool1 which may include a risk of
 designated high-cost health conditions4
  7,b7 ,a reinsurance program that      
assumes a portion of the risk for       
high-cost claims within the ,state in a 
manner substantially similar to the     
reinsurance program that operated in the
 ,state in accordance with section      
#acda4  7,c7 ,a new reinsurance program 
established by the ,state4  7,d7 ,a     
program based on another ,state's       

reinsurance program--  7i7 described in 
subparagraph 7,a71 7,b71 or 7,c71 for   
which an application has been approved  
under this subsection2 or  7ii7 which   
was implemented prior to ,september #a1 
#bjag1 and which the ,secretary         
determines meets the requirements of    
subparagraph 7,a74  7#c7 ,expedited     
approval  7,a7 ,in general ,the         
,secretary shall provide an expedited   
approval process for an application     
under paragraph 7#a77;,a7--  7i7 with   
respect to an invisible high-risk pool  
or reinsurance program described in     
subparagraph 7,a71 7,b71 or 7,d7 of     
paragraph 7#b72 or  7ii7 that uses a    
template form designed by the           
,administrator of the ,centers for      
,medicare  ,medicaid ,services1 in      
consultation with the ,secretary of the 
,treasury1 for an application based on a
 program that is the same or            
substantially the same as a program     
implemented in accordance with an       
application previously approved under   

this subsection4  7,b7 ,timeframe ,the  
,secretary shall make a determination on
 an application eligible for expedited  
review under subparagraph 7,a7 not later
 than #ij days after receipt of such    
application4  7,c7 ,standard of review  
,nothing in this paragraph shall be     
construed as affecting the requirements 
under clauses 7i7 and 7ii7 of paragraph 
7#a77;,a7 with respect to an application
 approved in accordance with the process
 under subparagraph 7,a74  7#d7         
,single-risk pool ,an invisible         
high-risk pool or reinsurance program   
established in accordance with this     
subsection shall not be considered a    
separate risk pool for purposes of      
section #acab7;c74  2 and  7#b7 in      
subsection 7a7-- 7,a7 in paragraph      
7#a77;,b7--  7i7 in clause 7i71 by      
striking 2 and and inserting a          
semicolon2 and  7ii7 by adding at the   
end the following3  7iii7 in the case of
 a ,state applying under subsection 7f7 
to use any portion of the payments made 

to the ,state under paragraph 7#c7 to   
support an invisible high-risk pool or  
reinsurance program1 consistent with    
subsection 7f71 such information about  
such program as the ,secretary may      
require1 and the portion of such        
payments under paragraph 7#c7 such      
,state intends to use for such program2 
and  2  7,b7 in paragraph 7#c7-- 7i7 by 
inserting full amount of before premium 
tax credits2 and  7ii7 by inserting     
before the period of the first sentence 
the following3 1 or1 in the case of such
 a ,state whose invisible high-risk pool
 or reinsurance program is approved     
under subsection 7f77#a7 and that has   
submitted the information described in  
paragraph 7#a77;,b77iii71 supporting    
such invisible high-risk pool or        
reinsurance program2 and  7,c7 in       
paragraph 7#f77;,a71 by inserting and   
with respect to applications under      
subsection 7f7 before the semicolon4