,,ii  #aae? ,,congress  #a/ ,session    
,s4 #aia  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,janu>y #bc1 #bjag ,mr4
 ,cassidy 7= himself1 ,ms4 ,coll9s1     
,mrs4 ,capito1 & ,mr4 ,isakson7         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to improve pati5t  
*oice by all[+ ,/ates to adopt          
m>ket-bas$ alt]natives to ! ,af=dable   
,c>e ,act t increase access to af=dable 
heal? insurance & r$uce co/s :ile ensur+
 important consum] protections & improv+
 pati5t c>e4  #a4 ,%ort title2 table (  
cont5ts  7a7 ,%ort title  ,?is ,act may 
be cit$ z ! ,pati5t ,fre$om ,act (      
#bjag4  7b7 ,table ( cont5ts ,! table ( 
cont5ts = ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title2 table ( cont5ts4       
,,title ,i--,heal? re=m ,sec4 #ajj4     
,def9itions4 ,subtitle ,a--,insurance   
m>ket re=m ,sec4 #aja4 ,end+ ! "o size  
fits all ,,aca approa*2 cont9u+ consum] 
protection policies by cov]+ adult      
*ildr51 protect+ individuals ) preexi/+ 

conditions1 & n apply+ lifetime or      
annual limits4 ,sec4 #ajb4 ,/ate heal?  
insurance options4 ,sec4 #ajc4 ,/ate    
alt]native option4 ,sec4 #ajd4          
,computation ( mon?ly ,ro? ,,hsa deposit
 am\nt = deposit qualify+ resid5ts4     
,sec4 #aje4 ,/ate options = improv$     
access to heal? insurance cov]age 9 ea* 
,/ate4 ,sec4 #ajf4 ,/ate flexibility 9  
ensur+ ord]ly heal? insurance m>ket     
outside ( an ,ex*ange4 ,sec4 #ajg4      
,exp&$ access & pati5t protections4     
,sec4 #ajh4 ,application ( heal? sav+s  
acc\nts 9 relation to ,m$icaid4         
,subtitle ,b--,provid] price transp>5cy 
,sec4 #aba4 ,ensur+ access to em]g5cy   
s]vices )\t excessive *>ges =           
out-(-network s]vices4 ,,title          
,,ii--,re=m ( ,tax ,provisions ,relat+  
to ,heal? ,c>e ,subtitle ,a--,heal?     
,sav+s ,acc\nts ,sec4 #bja4 ,transition 
to non-d$uctible ,h,s,as4 ,sec4 #bjb4   
,treatm5t ( direct prim>y c>e4 ,sec4    
#bjc4 ,treatm5t ( ,,hsa aft] dea? (     
acc\nt b5efici>y4 ,subtitle ,b--,heal?  

,c>e ,tax cr$its ,sec4 #baa4 ,limit$    
application ( ,,ppaca heal? premium     
cr$it4 ,sec4 #bab4 ,new ,ro? ,,hsa      
cr$it4  ,i ,heal? re=m  #ajj4           
,def9itions ,9 ?is title3  7#a7         
,pati5t-grant elect+ ,/ate ,! t]m       
pati5t-grant elect+ ,/ate means an      
elect+ ,/ate t specifies "u section     
#ajc7;a77#c77;,b7 t x w c>ry out section
 #ajc7;b7 itself 7& n to h section      
#ajc7;b7 c>ri$ out by means ( ! cr$it "u
 section #cf;,c ( ! ,int]nal ,rev5ue    
,code ( #aihf74  7#b7 ,budget neutral ,!
 t]m budget neutral ) respect to        
exp5ditures provid$ = 9 ?is ,act1 means 
! same am\nt ( exp5ditures z are provid$
 = "u ! ,pati5t ,protection & ,af=dable 
,c>e ,act 7,public ,law #aaa-adh74  7#c7
 ,,*ip ,! t]m ,,*ip means ! ,*ildr5's   
,heal? ,insurance ,program e/abli%$ "u  
title ,,xxi ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acif et seq474  7#d7    
,cr$itable cov]age ,! t]m cr$itable     
cov]age has ! mean+ giv5 su* t]m 9      
section #bgjd7;c77#a7 ( ! ,public ,heal?

 ,s]vice ,act 7#db ,u4,s4,c4            
#cjj;gg-#c7;c77#a771 z 9 effect z ( !   
day be=e ! date ( ! enactm5t ( ?is ,act4
  7#e7 ,default heal? insurance cov]age 
,! t]m default heal? insurance cov]age  
has ! mean+ giv5 su* t]m 9 section      
#ajg7;c77#b74  7#f7 ,deposit qualify+   
resid5t ,! t]m deposit qualify+ resid5t 
has ! mean+ giv5 su* t]m 9 section      
#ajc7;b77#b74  7#g7 ,elect+ /ate ,! t]m 
elect+ ,/ate means a ,/ate t elects "u  
section #ajb7;a77#b7 ! alt]native option
 describ$ 9 section #ajc4  7#h7 ,heal?  
insurance cov]age ,! t]m heal? insurance
 cov]age has ! mean+ giv5 su* t]m 9     
section #bgia7;b77#a7 ( ! ,public ,heal?
 ,s]vice ,act 7#db ,u4,s4,c4            
#cjj;gg-#ia7;b77#a774  7#i7 ,heal? sav+s
 deposit ,! t]m heal? sav+s deposit     
means a deposit made into a ,ro? ,,hsa  
pursuant to section #ajc4  7#aj7        
,m$icaid ,! t]m ,m$icaid means ! program
 "u title ,,xix ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acif et seq474     
7#aa7 ,m$ic>e ,! t]m ,m$ic>e means !    

program "u "p ,a or ,b ( title ,,xviii (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acie et seq474  7#ab7 ,,ppaca ,! t]m  
,,ppaca means ! ,pati5t ,protection &   
,af=dable ,c>e ,act 7,public ,law       
#aaa-adh71 z 9 effect on ! day be=e !   
date ( ! enactm5t ( ?is ,act1 unless    
o!rwise specifi$4  7#ac7 ,qualifi$ heal?
 plan cov]age ,! t]m qualifi$ heal? plan
 cov]age means1 ) respect to resid5ts ( 
a ,/ate1 heal? insurance cov]age t meets
 applicable /&>ds "u ,/ate law1 :i*     
/&>ds ne$ n be ! same z t previ\sly     
requir$ ( qualifi$ heal? plans "u title 
,i ( ,,ppaca1 & includes a high         
d$uctible heal? plan 7z def9$ 9 section 
#bbc7;c77#b7 ( ! ,int]nal ,rev5ue ,code 
( #aihf7 & includes cov]age "u a gr\p   
heal? plan4  7#ad7 ,qualifi$ resid5t ,! 
t]m qualifi$ resid5t means1 ) respect to
 a ,/ate = a mon?1 an individual :o is a
 resid5t ( ! ,/ate z ( ! fir/ day ( !   
mon? & is a citiz5 or national ( !      
,unit$ ,/ates or o!rwise lawfully resid+
 9 ! ,/ate "u color ( law4  7#ae7 ,ro?  

heal? sav+s acc\nt2 ,ro? ,,hsa ,! t]ms  
,ro? heal? sav+s acc\nt & ,ro? ,,hsa    
mean a ,ro? ,,hsa e/abli%$ "u section   
#ecj;,a ( ! ,int]nal ,rev5ue ,code (    
#aihf4  7#af7 ,secret>y ,! t]m ,secret>y
 means ! ,secret>y ( ,heal? & ,human    
,s]vices4  7#ag7 ,/ate ,! t]m ,/ate     
means ! #ej ,/ates & ! ,di/rict (       
,columbia4  7#ah7 ,un9sur$ ,! t]m       
un9sur$ means1 ) respect to an          
individual1 t ! individual does n h     
cr$itable cov]age4  ,a ,insurance m>ket 
re=m  #aja4 ,end+ ! "o size fits all    
,,aca approa*2 cont9u+ consum]          
protection policies by cov]+ adult      
*ildr51 protect+ individuals ) preexi/+ 
conditions1 & n apply+ lifetime or      
annual limits  7a7 ,9 g5]al ,subject to 
subsections 7b7 & 7c71 title ,i ( !     
,pati5t ,protection & ,af=dable ,c>e    
,act 7includ+ ! am5dm5ts made by su*    
title7 %all n apply 7& ! provisions (   
law am5d$ by su* title are re/or$ z if  
su* title _h n be5 enact$7 9 ! case (   
any ,/ate t does n h 9 effect ! election

 describ$ 9 section #ajb7;a77#a74  7b7  
,cont9uation ( policies = ext5sion (    
dep5d5t cov]age = adult *ildr5 &        
prohibition ( lifetime & annual cov]age 
limits2 pres]vation ( black lung b5efits
  7#a7 ,public ,heal? ,s]vice ,act      
provisions ,not)/&+ subsection 7a71 !   
foll[+ sections ( ! ,public ,heal?      
,s]vice ,act1 t 7 add$ or am5d$ by      
subtitles ,a & ,c ( title ,i ( ,,ppaca1 
%all cont9ue to apply to gr\p heal?     
plans & to heal? insurance cov]age (f]$ 
9 ! individual & gr\p m>ket3  7,a7 ,no  
lifetime or annual limits ,section #bgaa
 7relat+ to no lifetime or annual       
limits71 except 9 ! case ( limit$ b5efit
 insurance4  7,b7 ,dep5d5t cov]age ?r\gh
 age #bf ,section #bgad 7relat+ to      
ext5sion ( dep5d5t cov]age74  7,c7      
,prohibit+ pre-exi/+ condition          
exclusions ,section #bgjd 7relat+ to    
prohibition on preexi/+ conditions74    
7,d7 ,prohibit+ discrim9ation bas$ on   
heal? /atus ,section #bgje 7relat+ to   
prohibit+ discrim9ation aga9/ individual

 p>ticipants & b5efici>ies bas$ on heal?
 /atus71 subject to subsection 7c74     
7,e7 ,pres]vation ( prev5tive s]vice    
cov]age ,section #bgac 7relat+ to       
cov]age ( prev5tive heal? s]vices71 if  
employ]s d n contribute to !            
individual's ,ro? ,,hsa4  7#b7          
,pres]vation ( non-discrim9ation 9 heal?
 c>e ,subsection 7a7 %all n apply )     
respect to section #aeeg ( title ,i ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahaaf74  7#c7      
,pres]vation ( cov]age ( m5tal heal?    
s]vices1 & applicability ( m5tal heal?  
p>ity ,= s]i\s m5tal illness1 s]i\s     
emotional di/urbance1 & sub/ance use    
disord]1 subsection 7a7 %all n apply )  
respect to section #acjb7;b77#a77;,e7 ( 
title ,i ( ! ,pati5t ,protection &      
,af=dable ,c>e ,act 7relat+ to cov]age (
 m5tal heal? & sub/ance use treatm5t at 
limit$ co/ %>+7 7#db ,u4,s4,c4          
#ahjbb7;b77#a77;,e774 ,section #bgbf ( !
 ,public ,heal? ,s]vice ,act %all apply 
to qualifi$ heal? plans 9 ! same mann] &

 to ! same ext5t z su* section applies  
to heal? insurance cov]age & gr\p heal? 
plans4  7#d7 ,pres]vation ( black lung  
b5efits = coal m9]s ,subsection 7a7 %all
 n apply ) respect to section #aeef (   
title ,i ( ! ,pati5t ,protection &      
,af=dable ,c>e ,act 7am5d+ ! ,black     
,lung ,b5efits ,act74  7#e7 ,pres]vation
 ( ,/ate innovations ,subsection 7a7    
%all n apply ) respect to section #accb 
( title ,i ( ! ,pati5t ,protection &    
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjeb74  7c7 ,cont9uation ( ,f$]al     
ex*anges ,subsection 7a7 %all n apply ) 
respect to ,f$]al ,ex*anges e/abli%$    
pursuant to section #acba7;c7 ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjda7;c77 & su*   
,ex*anges %all cont9ue to op]ate z      
provid$ = by ! ,secret>y4  #ajb4 ,/ate  
heal? insurance options  7a7 ,9 g5]al   
,ea* ,/ate may elect1 ?r\gh writt5      
notice to ! ,secret>y aft] ! date ( !   
enactm5t ( ?is ,act & 9 accordance ) ?is
 title1 #a ( ! foll[+ #c options 9      

relation to ! implem5tation ( title ,i (
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act aft] ! date ( enactm5t ( ?is ,act3 
7#a7 ,cont9u+ implem5tation ( ,,ppaca ,!
 ,/ate cont9u+-- 7,a7 ! ,f$]al premium &
 co/-%>+ subsidies = cov]age (f]$ "u    
title ,i ( ,,ppaca 7& ! am5dm5ts made   
!reby71 r$uc$ = qualifi$ resid5ts ( su* 
,/ate = any ye> by ! am\nt 7if any7 by  
:i* su* subsidies w\ld exce$ ! am\nt (  
contributions t w\ld h be5 made "u      
section #ajc7;b7 to all su* resid5ts =  
su* ye> if ! ,/ate _h elect$ ! option "u
 p>agraph 7#c72 &  7,b7 all o!r         
requirem5ts "u su* title4  7#b7         
,e/abli%+ new ,/ate & m>ket-bas$        
alt]native1 ) alt]native p] b5efici>y   
,f$]al deposit sy/em ,! ,/ate implem5t+ 
! alt]native option describ$ 9 section  
#ajc1 :i* includes--  7,a7 ! waiv] ( mo/
 requirem5ts impos$ "u su* title ,i2 &  
7,b7 ! provision ( a new1 ,ro? ,,hsa- & 
m>ket-bas$ deposit sy/em = individuals  
:o d n o!rwise qualify = ,f$]al or ,/ate
 subsidies = heal? b5efits cov]age4     

7#c7 ,rejection ( ,,ppaca ,! ,/ate      
reject+ title ,i ( ,,ppaca 7& ! am5dm5ts
 made !reby71 except z o!rwise requir$ 9
 ?is title4  ,if a ,/ate fails to make  
an election describ$ 9 ?is subsection   
dur+ ! #a-ye> p]iod beg9n+ on ! date (  
enactm5t ( ?is ,act1 ! ,/ate %all be    
deem$ to h made ! election describ$ 9   
p>agraph 7#b74 ,a ,/ate may1 ?r\gh      
writt5 notice to ! ,secret>y1 *ange an  
election previ\sly made "u ?is          
subsection4  7b7 ,relation to curr5t    
,m$icaid ,,aca cov]age option ,no?+ 9   
?is section %all be con/ru$ to *ange !  
option ( a ,/ate ) respect to !         
implem5tation ( ,m$icaid ,,aca cov]age  
"u section                              
#aijb7;a77#aj77;,a77i77,,viii7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#aj77;,a77i77,,viii771 except
 t a ,/ate t elects n to provide m$ical 
assi/ance to individuals "u su* section 
may make su* individuals deposit        
qualify+ resid5ts "u ?is title4  #ajc4  
,/ate alt]native option  7a7 ,9 g5]al ,9

 ! case ( a ,/ate t elects "u section   
#ajb7;a77#b7 ! alt]native option "u ?is 
section1 subject to subsection 7d7 &    
section #ajg1 ! foll[+ %all apply3  7#a7
 ,elim9ation ( individual & employ] %>$ 
responsibility = heal? c>e tax          
requirem5ts = resid5ts & employees 9    
,/ate ,! individual & employ] heal? c>e 
responsibilities "u ! am5dm5ts made by  
title ,i ( ,,ppaca 7includ+ "u sections 
#ejjj;,a & #dihj;,h ( ! ,int]nal ,rev5ue
 ,code ( #aihf7 %all no long] apply     
pursuant to section #aja ) respect to   
individuals :o are resid5ts ( su* ,/ate 
& ) respect to individuals :o are       
employ$ 9 su* ,/ate1 respectively4  7#b7
 ,modification ( insurance requirem5ts  
,except z specifically provid$ 9 ?is    
title1 ! requirem5ts "u title ,i (      
,,ppaca 7includ+ am5dm5ts made by su*   
title7 relat+ to heal? insurance cov]age
 (f]$ 9 ! ,/ate %all n apply except to !
 ext5t specifi$ by ! ,/ate4  7#c7 ,new  
deposit sy/em ?r\gh fund+ ,ro? ,h,s,as  
7,a7 ,9 g5]al ,deposit qualify+ resid5ts

 7z def9$ 9 subsection 7b77#b77 :o are  
resid+ 9 ! ,/ate are eligible = a       
deposit to a ,ro? ,,hsa t may be us$ =  
premiums & co/-%>+ = heal? insurance    
cov]age 9 accordance ) subsection 7b74  
7,b7 ,/ate specification ( mann] ( c>ry+
 out ,ro? ,,hsa deposit sy/em           
7pati5t-grant elect+ /ate7 ,9 mak+ !    
election "u ?is subsection1 a ,/ate %all
 specify :e!r ! ,/ate w c>ry out        
subsection 7b7 or if su* subsection %all
 be c>ri$ out by means ( ! cr$it "u     
section #cf;,c ( ! ,int]nal ,rev5ue     
,code ( #aihf4  7#d7 ,additional am\nts 
= population heal? initiatives = ,/ate  
adm9i/]$ ,ro? ,,hsa deposit sy/em ,a    
pati5t-grant elect+ ,/ate 7z def9$ 9    
section #ajj7a77 is entitl$ to receive  
additional fund+ "u subsection 7c7 =    
population heal? initiatives4  7b7      
,deposit ?r\gh paym5t into ,ro? ,,hsa = 
deposit qualify+ resid5ts  7#a7 ,9 g5]al
 ,! subsidies describ$ 9 subsection     
7a77#c7 = an elect+ ,/ate %all be       
furni%$ = ea* deposit qualify+ resid5t  

?r\gh ! deposit ( a contribution into a 
,ro? ,,hsa ( ! individual 9 ! am\nt     
det]m9$ "u section #ajd4 ,= purposes ( !
 ,int]nal ,rev5ue ,code ( #aihf1 ! am\nt
 ( any contribution to a ,ro? ,,hsa made
 "u ?is p>agraph %all be includ$ 9 !    
gross income ( ! individual = ^: b5efit 
! ,ro? ,,hsa 0 e/abli%$4  7#b7 ,deposit 
qualify+ resid5t def9$ ,9 ?is title1 !  
t]m deposit qualify+ resid5t means1 )   
respect to a ,/ate & a mon?1 an         
individual-- 7,a7 :o is a qualifi$      
resid5t 7z def9$ 9 section #ajj7ad77 ( !
 ,/ate z ( ! fir/ day ( ! mon? 7or su*  
o!r day 9 ! mon? z ! ,secret>y may      
specify72  7,b7 ) respect to :om a ,ro? 
,,hsa has be5 e/abli%$1 :i* ,ro? ,,hsa  
may h be5 e/abli%$ by ! ,/ate 9 c>ry+   
out ?is section2  7,c7 :o is enroll$ 9  
qualifi$ heal? plan cov]age 7z def9$ 9  
section #ajj7ac771 :i* enrollm5t may h  
be5 effect$ by ! ,/ate 9 c>ry+ out ?is  
section2 &  7,d7 :o is n eligible =     
cov]age "u ,m$ic>e1 is n enroll$ =      
b5efits "u ,m$icaid or ,,*ip1 & is n    

enroll$ = b5efits "u *apt] #ee ( title  
#aj1 ,unit$ ,/ates ,code 7relat+ to     
,,tric>e71 or title #ci ( su* ,code     
7relat+ to vet]ans' b5efits7 or *apt]   
#hi ( title #e ( su* ,code 7relat+ to ! 
,f$]al ,employees ,heal? ,b5efits       
,program74  7#c7 ,paym5t adm9i/ration   
7,a7 ,/ate ,9 ! case ( an elect+ ,/ate t
 elects to c>ry out ?is subsection ?r\gh
 ! ,/ate1 ! ,secret>y %all provide =    
paym5t to ! ,/ate 9 am\nts & 9 a "t &   
mann] suffici5t to p]mit ! ,/ate to make
 timely mon?ly contributions to ,ro?    
,h,s,as "u ?is subsection4 ,! ,secret>y 
may provide = paym5t to ! ,/ate us+ !   
paym5t me?odology describ$ 9 subsection 
7d7 ( section #aijc ( ! ,social         
,security ,act = paym5ts "u subsection  
7a7 ( su* section 7appli$ )\t reg>d to  
any ,/ate mat*+ requirem5t7 & may       
condition su* paym5ts ^u ! provision (  
su* in=mation z ! ,secret>y may require 
to ensure ! prop] paym5ts "u ?is        
subsection4 ,z a condition ( receiv+    
paym5t "u ?is section1 a ,/ate %all     

submit su* in=mation1 9 su* =m1 & mann]1
 z ! ,secret>y %all specify1 includ+    
in=mation necess>y to make !            
computations ( am\nts "u ?is section4   
7,b7 ,f$]al ,9 ! case ( a ,/ate elect+  
to c>ry out ?is subsection o!r ?an ?r\gh
 ! ,/ate1 subsidies describ$ 9          
subsection 7a77#c7 %all be provid$ ?r\gh
 a refundable tax cr$it "u section      
#cf;,c ( ! ,int]nal ,rev5ue ,code (     
#aihf4  7#d7 ,con/ruction ,no?+ 9 ?is   
subsection %all be con/ru$-- 7,a7 to    
prev5t an individual f affirmatively    
elect+ n to h a ,ro? ,,hsa e/abli%$ on !
 individual's behalf & n to be enroll$ 9
 heal? insurance cov]age2  7,b7 subject 
to subp>agraph 7,a71 to prev5t a ,/ate f
 e/abli%+ a ,ro? ,,hsa = ea* deposit    
qualify+ resid5t :o does n o!rwise h a  
,ro? ,,hsa2  7,c7 subject to subp>agraph
 7,a71 to prev5t a ,/ate f e/abli%+ a   
me*anism :]eby individuals :o w\ld be   
deposit qualify+ resid5ts b = p>agraph  
7#b77;,c7 are enroll$ 9 heal? insurance 
cov]age2 &  7,d7 to prev5t a ,/ate f    

*ang+ its ,/ate ,m$icaid plan to        
elim9ate cov]age "u section             
#aijb7;a77#aj77;,a77i77,,viii7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#aj77;,a77i77,,viii771 9 ord]
 t individuals o!rwise cov]$ "u su*     
section may qualify = subsidies "u ?is  
section4  7c7 ,population heal?         
initiative fund+  7#a7 ,9 g5]al ,9 !    
case ( an elect+ ,/ate = a ye>1 ! ,/ate 
is entitl$ to receive paym5t f !        
,secret>y aft] ! end ( su* ye> 9 an     
am\nt equal to #b p]c5t ( ! actual      
aggregate am\nt deposit$ "u subsection  
7b7 into ,ro? ,h,s,as = resid5ts ( !    
,/ate = ! ye>4  7#b7 ,use ( funds       
,am\nts paid to a ,/ate "u p>agraph 7#a7
 may only be us$ = population heal?     
initiatives 7z def9$ by ! ,secret>y74   
7#c7 ,entitlem5t ,p>agraph 7#a7         
con/itutes budget au?ority 9 advance (  
appropriations ,acts & repres5ts !      
obligation ( ! ,f$]al ,gov]nm5t to      
provide = ! paym5t to ,/ates ( am\nts   
provid$ "u su* p>agraph4  7d7 ,requir+  

rules = comput+ usual1 cu/om>y1 &       
reasonable 7,,ucr7 prices ,z a condition
 = a ,/ate's election ( ! alt]native    
option "u ?is section1 ! ,/ate mu/      
provide1 ?r\gh its dep>tm5t ( insurance 
or equival5t ag5cy1 = e/abli%m5t ( rules
 to c>ry out section                    
#ahfg7;j77#a77;,a77ii7 ( ! ,social      
,security ,act1 z add$ by section       
#aba7;a77#b74  #ajd4 ,computation (     
mon?ly ,ro? ,,hsa deposit am\nt =       
deposit qualify+ resid5ts  7a7          
,computation  7#a7 ,9 g5]al ,! ,secret>y
 %all develop a /&>diz$ me?odology to   
det]m9e consi/5t ) ?is section a mon?ly 
,ro? ,,hsa deposit am\nt = deposit      
qualify+ resid5ts 9 ea* ,/ate = mon?s 9 
ea* ye>4 ,subject to p>agraphs 7#c7 &   
7#d71 su* am\nt %all be equal to #a_/ab 
( ! av]age p] capita annual am\nt       
comput$ "u subsection 7b7 = ! ,/ate = ! 
ye>1 z adju/$ = ! deposit qualify+      
resid5t involv$--  7,a7 = age &         
geographic area "u subsection 7c72 &    
7,b7 = income "u subsection 7d74  7#b7  

,no v>iation bas$ on h[ deposit am\nt   
di/ribut$ ,su* am\nt %all be ! same = a 
deposit qualify+ individual )\t reg>d to
 :e!r ! contribution to ! individual's  
,ro? ,,hsa is made by a ,/ate "u ?is    
section or by ! ,f$]al ,gov]nm5t ?r\gh !
 op]ation ( section #cf;,c ( ! ,int]nal 
,rev5ue ,code ( #aihf4  7#c7            
,pati5t-grant elect+ ,/ate has          
flexibility to ma9ta9 level ( b5efits = 
curr5t ,,aca b5efici>ies ,a pati5t-grant
 elect+ ,/ate may elect to increase !   
am\nt ( ! deposit = all deposit qualify+
 individuals "u ?is section to ! am\nts 
t ! ,secret>y e/imates w\ld h be5 paid )
 respect to su* individuals "u section  
#cf;,b ( ! ,int]nal ,rev5ue ,code (     
#aihf & section #adjb ( ,,ppaca if ^?   
sections _h rema9$ 9 effect 9 ! ,/ate ) 
respect to su* individuals4 ,su*        
election %all be made = a ye> & %all    
cont9ue f ye> to ye> until ! ,/ate      
elects to t]m9ate su* election4 ,!      
,secret>y %all1 9 conjunction ) !       
,actu>y1 ensure su* *anges to ! am\nt ( 

deposit = qualify+ individuals %all     
rema9 budget neutral4  7#d7 ,special    
rule = p>tial deposit = l[-income       
individuals ) employ]-sponsor$ insurance
 7,,esi7 ,9 ! case ( an individual :o is
 cov]$ "u a gr\p heal? plan & ) respect 
to su* cov]age !re is a contribution by 
an employ] :i* is exclud$ f !           
individual's gross income "u ! ,int]nal 
,rev5ue ,code ( #aihf1 ins(> z !        
individual is a deposit qualify+        
resid5t1 ! am\nt ( ! deposit ) respect  
to ! individual %all be r$uc$1 9 a mann]
 specifi$ by ! ,secret>y 9 consultation 
) ! ,secret>y ( ! ,treasury & tak+ into 
acc\nt ! income ( ! individual's        
h\sehold1 by an am\nt t is approximately
 equival5t to ! e/imat$ am\nt ( !       
r$uction 9 ! am\nt ( income tax result+ 
f su* exclusion 7& any r$uction 9 taxes 
impos$ by *apt] #ba or *apt] #b ( su*   
,code by reason ( any exclusion ( su*   
contributions f wages & self employm5t  
income74  7b7 ,computation ( unadju/$   
av]age p] capita annual am\nt  7#a7 ,=  

,/ates t cont9ue ,,ppaca ,m$icaid       
cov]age  7,a7 ,9 g5]al ,9 ! case ( a    
,/ate t provides m$ical assi/ance "u    
section #aijb7;a77#aj77;,a77i77,,viii7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acif;b7a77#aj77;,a77i77,,viii77 dur+ a
 ye>1 subject to p>agraphs 7#c7 & 7#d71 
! ,secret>y %all compute an av]age p]   
capita annual am\nt = ! ,/ate = ! ye>   
equal to--  7i7 ! am\nt specifi$ 9      
subp>agraph 7,b71 divid$ by  7ii7 !     
av]age mon?ly numb] ( deposit qualify+  
resid5ts ( ! ,/ate 9 ! ye>4  7,b7 ,am\nt
 bas$ on ,,ppaca project$ ,f$]al        
exp5ditures ,! am\nt specifi$ 9 ?is     
subp>agraph = a ,/ate = a ye> is #ie    
p]c5t ( ! ,secret>y's e/imate ( ! total 
paym5ts t w\ld h be5 made 7assum+ !     
exi/5ce ( a ,/ate e/abli%$ ,ex*ange 9 ! 
,/ate7 "u section #cf;,b ( ! ,int]nal   
,rev5ue ,code ( #aihf & "u section #adjb
 ( ,,ppaca ) respect to all qualifi$    
resid5ts 9 ! ,/ate 9 ! ye> 7or taxable  
ye> end+ ) su* ye>1 if applicable74 ,!  
,secret>y %all1 9 conjunction ) !       

,actu>y1 ensure su* *anges to ! am\nt ( 
deposit = qualify+ individuals %all     
rema9 budget neutral4  7#b7 ,= ,/ates t 
d n provide ,,ppaca ,m$icaid cov]age    
7,a7 ,9 g5]al ,9 ! case ( a ,/ate n     
describ$ 9 p>agraph 7#a7 = a ye>1       
subject to p>agraphs 7#c7 & 7#d71 !     
,secret>y %all compute an av]age p]     
capita annual am\nt = ! ,/ate = ! ye>   
equal to--  7i7 ! am\nt specifi$ 9      
subp>agraph 7,b7 = ! ,/ate & ye>1 divid$
 by  7ii7 ! av]age mon?ly numb] (       
deposit qualify+ resid5ts ( ! ,/ate 9 ! 
ye>4  7,b7 ,am\nt bas$ on ,,ppaca &     
,m$icaid project$ ,f$]al exp5ditures ,! 
am\nt specifi$ 9 ?is subp>agraph = a    
,/ate = a ye> is equal to ! sum (-- 7i7 
#ie p]c5t ( ! ,secret>y's e/imate ( !   
total paym5ts t w\ld h be5 made 7assum+ 
! exi/5ce ( a ,/ate-e/abli%$ ,ex*ange 9 
! ,/ate7 "u section #cf;,b ( ! ,int]nal 
,rev5ue ,code ( #aihf & "u section #adjb
 ( ,,ppaca ) respect to all qualifi$    
resid5ts 9 ! ye> 7or taxable ye> end+ ) 
su* ye>1 if applicable72 &  7ii7 !      

,secret>y's e/imate ( ! total paym5ts t 
w\ld h be5 made to ! ,/ate "u title     
,,xix ( ! ,social ,security ,act =      
individuals eligible to be cov]$ "u     
section #aijb7;a77#aj77;,a77i77,,viii7 (
 ! ,social ,security ,act assum+ !      
election ( a ,/ate to provide ,m$icaid  
cov]age "u su* section & assum+ !       
applicable ,f$]al m$ical assi/ance      
p]c5tage 7 #ie p]c5t ) respect to su*   
individuals4  7#c7 ,budget neutral      
adju/m5t 9 paym5ts to take into acc\nt  
election ( high] deposits to ma9ta9     
,,aca subsidy levels ,if a ,/ate makes !
 election describ$ 9 subsection 7a77#c7 
) respect to provid+ high] deposit      
am\nts = c]ta9 individuals describ$ 9   
su* subsection1 !n ! ,secret>y %all     
adju/ ! av]age p] capita annual am\nt "u
 p>agraph 7#a7 or 7#b71 z applicable to 
! ,/ate1 by--  7,a7 r$uc+ ! am\nt       
describ$ 9 p>agraph 7#a77;,b7 7or1 if   
applicable1 p>agraph 7#b77;,b77i77 by an
 am\nt equal to #ie p]c5t ( ! aggregate 
increas$ deposit level attributable to  

subsection 7a77#c72 &  7,b7 n c\nt+ su* 
an individual z a qualify+ resid5t =    
purposes ( p>agraph 7#a77;,a77ii7 7or1  
if applicable1 p>agraph 7#b77;,a77ii774 
,! ,secret>y %all1 9 conjunction ) !    
,actu>y1 ensure *anges1 z outl9$ 9 ?is  
subsection1 to ! am\nt ( deposit =      
qualify+ individuals %all rema9 budget  
neutral4  7#d7 ,adju/m5t = co/s ( p>tial
 deposits = l[-income ,,esi individuals 
,! ,secret>y %all adju/ ! av]age p]     
capita annual am\nt "u p>agraph 7#a7 or 
7#b71 z applicable to ! ,/ate1 by--     
7,a7 r$uc+ ! am\nt describ$ 9 p>agraph  
7#a77;,b7 7or1 if applicable1 p>agraph  
7#b77;,b77i77 by an am\nt equal to #ie  
p]c5t ( ! am\nt ( paym5ts "u ?is section
 t are attributable to individuals      
describ$ 9 subsection 7a77#d72 &  7,b7 n
 c\nt+ any individual describ$ 9        
subsection 7a77#d7 z a qualify+ resid5t 
= purposes ( p>agraph 7#a77;,a77ii7 7or1
 if applicable1 p>agraph 7#b77;,a77ii774
  7c7 ,adju/m5t = age1 geographic area1 
& income di/ribution )9 /ate  7#a7 ,9   

g5]al ,! ,secret>y %all apply su*       
adju/m5ts to ! p] capita am\nt comput$  
"u subsection 7b7 z is design$ to take  
into acc\nt1 9 a budget neutral mann] & 
bas$ on ! co/s e/imat$ "u p>agraph 7#b71
 actu>ial diff]5ces 9 heal? c>e co/s    
attributable to individuals 9 diff]5t   
age categories & diff]5t geographic     
locations ( prim>y resid5ces 9 ! ,/ate &
 ! r$uctions bas$ on income "u          
subsection 7d74 ,no su* adju/m5t %all be
 made bas$ on sex4  7#b7 ,data on av]age
 co/s ( s]vices ,n lat] ?an ,decemb] #ae
 be=e ! beg9n+ ( ea* ye>1 ! ,ag5cy =    
,heal?c>e ,rese>* & ,quality %all       
e/imate ! av]age co/ ( heal? c>e = su*  
ye> = individuals "u #fe ye>s ( age &   
may e/imate h[ su* av]age v>ies =       
diff]5t populations ( individuals "u age
 #fe4 ,! adju/m5ts "u p>agraph 7#a7 =   
age categories = a ye> %all be bas$ on  
su* e/imates made4 ,n lat] ?an su* date1
 ! ,secret>y %all prescribe tables =    
purposes ( mak+ adju/m5ts bas$ on age "u
 p>agraph 7#a7 bas$ on su* det]m9ation  

:i* %all apply = taxable ye>s beg9n+ 9 !
 succe$+ cal5d> ye>4  7d7               
,income-,relat$ phase-,out  7#a7 ,9     
g5]al ,! p] capita am\nt z comput$ "u   
subsection 7b7 & adju/$ & appli$ to a   
deposit qualify+ individual "u          
subsection 7c7 %all be multipli$ by a   
phase-out p]c5tage equal to #ajj p]c5t  
r$uc$ by #a p]c5tage po9t = ea* #a1jjj  
7or fraction !re(7 by :i* ! taxpay]'s   
modifi$ adju/$ gross income = ! taxable 
ye> exce$s #ij1jjj 7or1 9 ! case ( a    
jo9t return1 #aej1jjj71 multipli$1 = a  
taxable ye> end+ 9 a ye> beg9n+ aft]    
,decemb] #ca1 #bjae1 by ! co/-(-liv+    
adju/m5t = ! ye> z describ$ 9 section   
#a7;f77#c7 ( ! ,int]nal ,rev5ue ,code ( 
#aihf1 b sub/itut+ #bjae = #aiib 9      
subp>agraph 7,b7 ( su* section4  7#b7   
,z]o p] capita am\nt = m>ri$ fil+       
sep>ately ,! p] capita am\nt "u ?is     
section %all be z]o 9 ! case ( a m>ri$  
c\ple fil+ sep>ately4  #aje4 ,/ate      
options = improv$ access to heal?       
insurance cov]age 9 ea* ,/ate  7a7 ,/ate

 options ,to improve access  7#a7 ,9    
g5]al ,ea* ,/ate may c>ry out any ( !   
functions describ$ 9 ?is section 9 ord] 
to improve ! access ( resid5ts ( ! ,/ate
 to heal? insurance cov]age4  7#b7      
,repurpos+ ,/ate ,ex*anges ,a ,/ate may 
use or adapt an ,ex*ange t ! ,/ate has  
e/abli%$ "u title ,i ( ,,ppaca to c>ry  
out any su* function4  7#c7 ,repurpos+  
,f$]al ,ex*ange ,! ,f$]al ,gov]nm5t %all
 make available to ,/ates curr5t        
capabilities ( ! ,f$]al ,ex*ange1       
includ+ ! ,f$]al ,data ,s]vices ,hub &  
,ag5t ,brok] ,portal1 to ! ext5t reque/$
 by a ,/ate = activities relat$ to      
enrollm5t ( citiz5s ( ! ,/ate into heal?
 insurance cov]age4  7b7 ,transp>5cy    
portal ,ea* ,/ate may e/abli% & op]ate  
an op5 & transp>5t m>ketplace me*anism  
:]eby qualifi$ resid5ts ( ! ,/ate c     
readily comp>e1 ?r\gh ! use ( !         
,int]net1 ! b5efits & prices betwe5     
diff]5t heal? insurance cov]age options 
made available to !m4  7c7 ,enrollm5t1  
subject to individual opt-,out  ,a ,/ate

 may provide = ! enrollm5t ( qualifi$   
resid5ts ( ! ,/ate :o are un9sur$ 9     
default heal? insurance cov]age (f]$ "u 
section #ajg7;c7 & e/abli%+ a ,ro? ,,hsa
 = su* resid5ts :o d n h a ,ro? ,,hsa   
unless ! resid5t has affirmatively      
elect$ n to be s enroll$ & n to h a ,ro?
 ,,hsa1 respectively4 ,any su* enrollm5t
 "u ?is p>agraph %all be coord9at$ ) !  
annual op5 enrollm5t p]iods provid$ "u  
section #ajg7;b74  7d7 ,risk mitigation 
me*anisms & re9surance & risk-,corridor 
programs  7#a7 ,9 g5]al ,not)/&+ any o!r
 provision ( ?is title or section       
#bbc7;c77#b7 ( ! ,int]nal ,rev5ue ,code 
( #aihf1 a ,/ate may e/abli%--  7,a7    
me*anisms = risk mitigation or risk     
adju/m5t 9 ord] to limit volatility 9 ! 
premiums bas$ on heal? exp]i5ce to      
class-av]age premiums2 &  7,b7 a        
re9surance & risk-corridor program t    
involves no ,f$]al funds ) respect to   
cov]age bo? 9 ! individual m>ket & 9 !  
small gr\p m>ket4  7#b7 ,basis = risk   
adju/m5t ,me*anisms & programs "u       

p>agraph 7#a7 may be bas$ on ! heal?    
/atus score ( ea* individual enroll$ 9  
heal? insurance cov]age 9 ! individual  
m>ket & n solely bas$ on ! aggregate    
risk ( ! risk pool ) respect to ea* plan
 ( heal? insurance cov]age4  7e7        
,modifi$ heal? /atus insurance me*anism 
7#a7 ,9 g5]al ,a ,/ate may e/abli% a    
me*anism = provid+ modifi$ heal? /atus  
insurance 9 ! ,/ate to enc\rage heal?   
plans to implem5t adequate b5efit       
designs & s]vices = a *ronically ill    
individual4  7#b7 ,requirem5ts ,a       
me*anism "u p>agraph 7#a7 may implem5t !
 foll[+ requirem5ts3 7,a7 ,dur+ ! fir/  
op5 enrollm5t p]iod aft] ! date (       
enactm5t ( ?is ,act1 an individual heal?
 plan %all provide cov]age = heal?      
b5efits z def9$ 9 ! heal? plan = a p]iod
 ( #ab mon?s4  7,b7 ,if an individual   
enrolls 9 a new heal? plan dur+ ! op5   
enrollm5t p]iod at ! end ( ! fir/ #ab   
mon?s ( cov]age "u subp>agraph 7,a71 !  
plan 9 :i* ! individual 0 enroll$ prior 
to su* p]iod %all be responsible =      

f9anc+ #ge p]c5t ( ! heal? b5efits      
adm9i/]$ to ! individual "u any o!r     
heal? plan 9 :i* ! individual enrolls = 
! initial #c-mon? p]iod ( cov]age "u su*
 o!r plan4  7,c7 ,dur+ ! #c-mon? p]iod  
describ$ 9 subp>agraph 7,b71 ! plan 9   
:i* ! individual 0 enroll$ prior to su* 
p]iod %all receive #ge p]c5t ( !        
premiums paid = ! individual's cov]age  
"u ! o!r heal? plan4  7,d7 ,dur+ ! ?ird 
op5 enrollm5t p]iod aft] ! date (       
enactm5t ( ?is ,act1 & dur+ all         
subsequ5t op5 enrollm5t p]iods1 a heal? 
plan t has enrollees t]m9ate _! cov]age 
9 ord] to enroll 9 o!r heal? plans %all 
be responsible = f9anc+ #ge p]c5t ( !   
heal? b5efits adm9i/]$ to su* enrollees 
"u ! o!r plans & %all receive #ge p]c5t 
( ! premiums paid = su* enrollees'      
cov]age "u su* o!r heal? plans = ! fir/ 
#c mon?s ( cov]age 9 ! new plan ye>4    
#ajf4 ,/ate flexibility 9 ensur+ ord]ly 
heal? insurance m>ket outside ( an      
,ex*ange  7a7 ,9 g5]al ,) respect to    
heal? insurance cov]age (f]$ 9 a ,/ate1 

! ,/ate may1 9 consultation ) !         
,secret>y1 take su* /eps1 su* z limit+ !
 availability ( g5]al op5 enrollm5t     
p]iods1 impos+ delays 9 ! effectiv5ess =
 cov]age1 p]mitt+ diff]5tials 9 premiums
 bas$ on age & o!r factors1 z ! ,/ate   
det]m9es necess>y 9 ord] to ensure an   
ord]ly m>ket = heal? insurance cov]age 9
 ! ,/ate t is n (f]$ ?r\gh an ,ex*ange4 
,su* /eps may include ! e/abli%m5t ( an 
initial op5 enrollm5t p]iod dur+ :i*    
qualifi$ resid5ts may enroll 9 heal?    
insurance cov]age )\t ! imposition ( any
 und]writ+ z ! ,/ate det]m9es to be     
appropriate 9 ensur+ initial access to  
su* cov]age4  7b7 ,flexibility 9 impos+ 
additional requirem5ts ,no?+ 9 ?is      
section %all be con/ru$ z prev5t+ a     
,/ate f cont9u+ to apply1 to heal?      
insurance cov]age issu$ 9 ! ,/ate1      
requirem5ts "u ! provisions ( title     
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
7z am5d$ by subtitles ,a & ,c ( title ,i
 ( ,,ppaca71 t are n cont9u$ "u section 
#aja7;b74  7c7 ,/ate flexibility )      

respect to ,ex*anges ,a ,/ate may waive 
su* provisions ( "p #b ( subtitle ,d (  
title ,i ( ,,ppaca1 9 relation to !     
e/abli%m5t ( an ,ex*ange 9 su* ,/ate1 z 
! ,/ate det]m9es appropriate 9 ord] = ! 
,/ate to implem5t & adm9i/] a m>ket-bas$
 sy/em = ! availability ( heal?         
insurance cov]age ?r\gh\t ! ,/ate4      
#ajg4 ,exp&$ access & pati5t protections
  7a7 ,9 g5]al ,z a condition = !       
election ( ! alt]native option "u       
section #ajc 9 a ,/ate1 ! ,/ate mu/ meet
 ! requirem5ts ( ?is section4  7b7      
,annual & o!r op5 enrollm5t p]iods  7#a7
 ,9 g5]al ,! ,/ate %all require1 9      
connection ) ! (f]+ ( heal? insurance   
cov]age 9 ! individual m>ket 9 ! ,/ate1 
t !re are uni=m annual & o!r op5        
enrollm5t p]iods 7su* z ^? = *anges 9   
life ev5ts1 *anges 9 ,/ate resid5cy1 &  
involunt>y *anges 9 eligibility =       
cov]age "u a gr\p heal? plan7 9 ord] to 
p]mit qualifi$ resid5ts to enroll 9     
qualifi$ heal? plan cov]age 9 a mann] t 
promotes cont9uity ( cov]age4 ,su*      

p]iods %all be consi/5t ) ! op5         
enrollm5t p]iods e/abli%$ "u title ,i ( 
,,ppaca1 z 9 effect on ! day be=e ! date
 ( ! enactm5t ( ?is ,act4  7#b7 ,initial
 op5 enrollm5t p]iod ,9 addition1 !     
,/ate %all e/abli% an initial op5       
enrollm5t p]iod dur+ :i* qualifi$       
resid5ts may enroll 9 qualifi$ heal?    
plan cov]age )\t ! imposition ( any     
und]writ+ describ$ 9 subsection         
7d77#a77;,b74 ,su* p]iod %all be a p]iod
 ( n less ?an #de days & %all provide = 
enrollm5t to become effective on ,janu>y
 #a ( ! ye> specifi$ by ! ,/ate 9 :i*   
su* ,/ate election fir/ becomes         
effective4  7c7 ,(f]+ ( default heal?   
insurance cov]age  7#a7 ,enrollm5t1     
subject to individual opt-,out ,subject 
to p>agraph 7#d71 a ,/ate may elect to  
provide = ! enrollm5t ( resid5ts ( !    
,/ate :o are un9sur$ 9 default heal?    
insurance cov]age 7z def9$ 9 p>agraph   
7#b77 & e/abli%+ a ,ro? ,,hsa = su*     
resid5ts :o d n h a ,ro? ,,hsa unless ! 
resid5t has affirmatively elect$ n to be

 s enroll$ & n to h su* an acc\nt1      
respectively4 ,if a ,/ate makes su* an  
election1 ! ,/ate %all p]mit eligible   
resid5ts to enroll 9 su* cov]age on a   
cont9u\s basis4  7#b7 ,default heal?    
insurance cov]age def9$ ,9 ?is          
subsection1 ! t]m default heal?         
insurance cov]age means1 ) respect to a 
,/ate1 heal? insurance cov]age t-- 7,a7 
is a high d$uctible heal? plan 7)9 !    
mean+ ( section #bbc7;c77#b7 ( !        
,int]nal ,rev5ue ,code ( #aihf7 )       
prescription drug cov]age limit$ to a   
,ti] #a =mul>y b5efit 7z commonly       
und]/ood7 = a limit$ numb] ( *ronic     
conditions 7commonly ref]r$ to z ti] ,i 
ph>macy b5efit72  7,b7 meets su*        
requirem5ts z may apply to qualify = !  
paym5t ( plan premiums f a heal? sav+s  
acc\nt "u section #bbc ( su* ,code 7su* 
z age-relat$ premiums & limitation on   
imposition ( preexi/+ condition         
exclusions72  7,c7 has a provid] network
 = cov]$ b5efits t is adequate 7z       
det]m9$ consi/5t ) ! guidel9es issu$ by 

! ,secret>y relat+ to provid] access    
requirem5ts = ,m$ic>e ,advantage        
organizations "u section #aheb7;d7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bb7;d777 to ensure access to    
heal? b5efits "u su* plan2  7,d7        
provides = cov]age ( *ildhood           
immunizations )\t co/ %>+ requirem5ts to
 ! ext5t su* immunizations h 9 effect a 
recomm5dation f ! ,advisory ,committee  
on ,immunization ,practices ( ! ,c5t]s =
 ,disease ,control & ,prev5tion )       
respect to ! individual involv$2 &  7,e7
 meets su* o!r requirem5ts z ! ,/ate may
 specify4  7#c7 ,ro? ,,hsa ,9 ?is       
subsection1 ! t]m ,ro? ,,hsa %all h !   
mean+ giv5 su* t]m by section #ecj;,a7c7
 ( ! ,int]nal ,rev5ue ,code ( #aihf4    
7#d7 ,simple process = individuals to   
opt-out ,z a condition ( a ,/ate provid+
 = ! enrollm5t function describ$ 9      
p>agraph 7#a71 ! ,/ate %all e/abli% an  
easy-to-use & transp>5t means by :i*    
individuals may elect n to be enroll$ 9 
default heal? insurance cov]age or to h 

a ,ro? ,,hsa e/abli%$ on ! individual's 
behalf1 or bo?4  7d7 ,consequ5ces       
respect+ cont9u\s cov]age  7#a7         
,consequ5ces = n ma9ta9+ cont9u\s       
cov]age  7,a7 ,avoidance ( consequ5ces  
by ma9ta9+ cont9u\s cov]age  7i7 ,9     
g5]al ,all qualifi$ resid5ts ( a ,/ate  
are eligible dur+ ! initial op5         
enrollm5t p]iod provid$ "u subsection   
7b77#b7 to enroll 9 qualifi$ heal? plan 
cov]age &1 !reaft]1 to ma9ta9 cont9u\s  
cov]age 9 ord] to avoid ! adv]se        
consequ5ces describ$ 9 ! succe$+        
provisions ( ?is p>agraph4  7ii7        
,special enrollm5t p]iods ,! ,/ate may  
provide = special enrollm5t p]iods bas$ 
on bir?1 becom+ #bf ye>s ( age1 &       
indep5d5ce f family cov]age1 dur+ :i*   
c]ta9 individuals w be eligible to      
enroll 9 qualifi$ heal? plan cov]age =  
purposes ( ?is subsection4  7,b7        
,und]writ+ p]mitt$ ,9 ! case ( a        
qualifi$ resid5t ( ! ,/ate :o fails to  
ma9ta9 cont9u\s cr$itable cov]age 7n    
includ+ any breaks 9 cov]age ( less ?an 

#fc days71 ! ,/ate %all--  7i7 p]mit    
heal? insurance issu]s = ! p]iod        
specifi$ 9 subp>agraph 7,c7 to m$ically 
und]write 7?r\gh d5ial ( heal? insurance
 cov]age1 application ( preexi/+        
condition limitations1 diff]5tial       
premiums1 or o!rwise7 ! issuance ( heal?
 insurance cov]age1 o!r ?an ) respect to
 ! issuance ( default heal? insurance   
cov]age "u subsection 7c72 &  7ii7      
require heal? insurance issu]s1 dur+ !  
subsequ5t #b-ye> p]iod 9 ! case (       
issuance ( heal? insurance cov]age o!r  
?an su* default heal? insurance cov]age1
 to impose a mon?ly late enrollm5t      
p5alty 9 ! am\nt specifi$ 9 subp>agraph 
7,d77i7 & to remit ! am\nt ( su* p5alty 
collect$ to ! ,f$]al ,treasury 9        
accordance ) subp>agraph 7,d77ii74  7,c7
 ,p]iod = application ( und]writ+ ,=    
purposes ( subp>agraph 7,b77i71 ! p]iod 
specifi$ 9 ?is subp>agraph is1 ) respect
 to an un9sur$ individual z ( a date1 a 
p]iod 7n to exce$ #ah mon?s7 equival5t  
to ! numb] ( mon?s 9 ! previ\s #ah-mon? 

p]iod 9 :i* ! individual did n h        
cont9u\s cr$itable cov]age describ$ 9   
subp>agraph 7,b74  7,d7 ,mon?ly late    
enrollm5t p5alty am\nt  7i7 ,9 g5]al ,! 
mon?ly late enrollm5t p5alty am\nt      
specifi$ 9 ?is clause = a mon? is equal 
to ! less] ( #aj p]c5t or ! product (-- 
7,i7 #a p]c5t ( ! mon?ly premium am\nt =
 default heal? insurance cov]age )      
respect to ! individual & mon?2 &       
7,,ii7 ! numb] ( mon?s dur+ ! #b-ye>    
p]iod 7prec$+ ! #ah-mon? p]iod describ$ 
9 subp>agraph 7,b77i77 9 :i* ! resid5t  
fail$ to ma9ta9 ! cont9u\s cov]age      
describ$ 9 p>agraph 7#a77;,d74  7ii7    
,paym5t ( p5alty am\nt to ,f$]al        
,treasury ,! am\nt ( ! mon?ly late      
enrollm5t p5alty collect$ "u ?is        
subp>agraph %all be paid to ! ,treasury 
( ! ,unit$ ,/ates 9 a =m & mann]        
specifi$ by ! ,secret>y ( ! ,treasury4  
7#b7 ,*anges 9 enrollm5t p]mitt$ )\t    
m$ical und]writ+ dur+ annual op5        
enrollm5t p]iods = ^? ma9ta9+ cont9u\s  
cov]age  7,a7 ,dur+ second op5 enrollm5t

 p]iod ,9 ! case ( a qualifi$ resid5t :o
 ma9ta9s cont9u\s cov]age 7n includ+ any
 breaks 9 cov]age ( less ?an #fc days7  
dur+ ! p]iod aft] ! initial op5         
enrollm5t p]iod "u subsection 7b77#b7 & 
?r\gh ! second annual op5 enrollm5t     
p]iod e/abli%$ by ! ,/ate consi/5t )    
subsection 7b77#a71 ! ,/ate %all require
 heal? insurance issu]s to p]mit su*    
resid5ts dur+ su* second annual op5     
enrollm5t p]iod to *ange ! qualifi$     
heal? plan cov]age 9 :i* ! individual is
 enroll$ )\t m$ical und]writ+4  7,b7    
,dur+ ?ird & subsequ5t op5 enrollm5t    
p]iods ,9 ! case ( a qualifi$ resid5t :o
 ma9ta9s cont9u\s cov]age = a p]iod (   
#ah mon?s or long] 7n includ+ any breaks
 9 cov]age ( less ?an #fc days7 z ( !   
initial date ( a ?ird or subsequ5t      
annual op5 enrollm5t p]iod e/abli%$ by !
 ,/ate "u subsection 7b77#a71 ! ,/ate   
%all require heal? insurance issu]s to  
p]mit su* resid5ts dur+ su* an op5      
enrollm5t p]iod to *ange ! qualifi$     
heal? plan cov]age 9 :i* ! individual is

 enroll$ )\t m$ical und]writ+4  #ajh4   
,application ( heal? sav+s acc\nts 9    
relation to ,m$icaid  7a7 ,9 g5]al      
,title ,,xix ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif et seq47 is am5d$  
by add+ at ! end ! foll[+ new section3  
#aidg4 ,provisions relat+ to heal? sav+s
 acc\nts  7a7 ,disreg>d+ ,ro? ,,hsa 9   
det]m9+ assets & income = ,m$icaid      
eligibility det]m9ations o!r ?an =      
long-,t]m c>e s]vices ,! assets 9 a     
heal? sav+s acc\nt "u section #bbc ( !  
,int]nal ,rev5ue ,code ( #aihf1 & any   
income f su* assets 9 su* acc\nt1 %all  
be disreg>d$ = purposes ( det]m9+       
eligibility = & am\nt ( m$ical assi/ance
 "u ?is title1 o!r ?an = purposes (     
det]m9+ eligibility = & ! am\nt ( m$ical
 assi/ance = long-t]m c>e s]vices       
7describ$ 9 section                     
#aiag7;c77#a77;,c77i774  7b7            
,notifications ( ,treasury ( ,m$icaid   
eligibility ,9 ord] to meet !           
requirem5ts ( ?is subsection 7= purposes
 ( section #aijb7;a77#gh771 a ,/ate %all

 provide su* notice to ! ,secret>y ( !  
,treasury1 9 su* =m & mann] z !         
,secret>y %all specify1 z may be        
necess>y to id5tify individuals :o are  
eligible =1 & receiv+1 m$ical assi/ance 
"u ?is title 9 a mon? 9 ord] to c>ry out
 section #bbc ( ! ,int]nal ,rev5ue ,code
 ( #aihf4  4  7b7 ,implem5tation (      
notification requirem5t ?r\gh ,/ate plan
 ,section #aijb7;a7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77 is am5d$ by ins]t+ aft]     
p>agraph 7#gg7 ! foll[+ new p>agraph3   
7#gh7 provide = notice 9 accordance )   
section #aidg7;b7 to ! ,secret>y ( !    
,treasury ( ! id5tity ( individuals :o  
are eligible = & receiv+ m$ical         
assi/ance "u ?is title2  4  7c7         
,effective date ,! am5dm5ts made by ?is 
section %all apply to eligibility       
det]m9ations ) respect to m$ical        
assi/ance = p]iods beg9n+ on or aft]    
,janu>y #a1 #bjah4  ,b ,provid] price   
transp>5cy  #aba4 ,ensur+ access to     
em]g5cy s]vices )\t excessive *>ges =   

out-(-network s]vices  7a7 ,9 g5]al     
,section #ahfg ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie;dd7 is am5d$--
 7#a7 9 subsection 7d71 by add+ at ! end
 ! foll[+ new p>agraph3  7#e7 ,en=cem5t 
) respect to excessive *>ges ,a         
hospital1 physician1 or o!r entity t    
violates ! requirem5ts ( subsection     
7j77#a7 ) respect to ! furni%+ ( items &
 s]vices is subject to a civil money    
p5alty ( n m ?an #be1jjj = ea* su*      
violation4 ,! provisions ( section      
#aabh;,a 7o!r ?an subsections 7a7 & 7b77
 %all apply to a civil money p5alty "u  
?is p>agraph 9 ! same mann] z su*       
provisions apply ) respect to a p5alty  
or proce$+ "u section #aabh;,a7a74  2 & 
7#b7 by add+ at ! end ! foll[+ new      
subsection3  7j7 ,protections aga9/     
excessive out-(-,network *>ges = em]g5cy
 s]vices  7#a7 ,9 g5]al ,9 ! abs5ce (   
,/ate regulations1 if items or s]vices  
to scre5 or treat an em]g5cy m$ical     
condition are furni%$ "u ?is section 9 a
 p>ticipat+ hospital ) respect to an    

individual & ! individual has n1        
directly or ?r\gh a heal? insurance     
issu]1 gr\p heal? plan1 or o!r ?ird     
p>ty1 negotiat$ a paym5t rate = su*     
items & s]vices1 subject to p>agraph    
7#b71 ! *>ges impos$ = su* items &      
s]vices may n be 9 excess ( ! foll[+3   
7,a7 ,physicians' & o!r pr(essional     
s]vices ,= physicians' s]vices or       
s]vices ( a heal? c>e provid] :i*       
con/itute m$ical c>e 7z def9$ "u section
 #bac7;d7 ( ! ,int]nal ,rev5ue ,code (  
#aihf1 z 9 effect be=e ! date ( !       
enactm5t ( ?is subsection7 7& includ+   
drugs & biologicals furni%$ 9           
conjunction ) & bill$ z "p ( su*        
s]vices71 ! less] (--  7i7 ! ca% price =
 su* s]vices po/$ pursuant to section   
#aba7;b7 ( ! ,pati5t ,fre$om ,act (     
#bjag2 or  7ii7 #he p]c5t ( ! usual1    
cu/om>y1 & reasonable 7,,ucr7 *>ge = su*
 s]vices1 z det]m9$ "u rules e/abli%$ by
 ! dep>tm5t ( insurance = ! ,/ate 9 :i* 
! s]vices are furni%$4  7,b7 ,hospital  
s]vices ,= inpati5t & outpati5t hospital

 s]vices = :i* paym5t rates are e/abli%$
 "u ?is title 7& includ+ drugs &        
biologicals furni%$ 9 conjunction ) &   
bill$ z "p ( su* s]vices71 ! less] (--  
7i7 ! ca% price = su* s]vices po/$      
pursuant to section #aba7;b7 ( ! ,pati5t
 ,fre$om ,act ( #bjag2 or  7ii7 #aaj    
p]c5t ( ! paym5t rate applicable to su* 
s]vices 9 ! case ( an individual entitl$
 to b5efits "u "p ,a & enroll$ "u "p ,b4
  7,c7 ,drugs & biologicals ,= drugs &  
o!r ph>maceuticals furni%$ to :i* a     
previ\s subp>agraph does n apply1 !     
less] (--  7i7 twice ! acquisition co/  
to ! hospital or o!r provid] = ! dose   
involv$2 or  7ii7 ! acquisition co/ to !
 hospital or o!r provid] plus #bej4  ,! 
doll> am\nt 9 clause 7ii7 %all be       
increas$ f ye> to ye> 7beg9n+ ) ! ye>   
aft] ! fir/ ye> 9 :i* ?is subsection    
applies7 by ! same p]c5tage z ! p]c5tage
 increase 9 ! consum] price index = all 
urban consum]s 7all items2 ,u4,s4 city  
av]age7 = ! ye> involv$ 7z det]m9$ by ! 
,secret>y74 ,any su* doll> am\nt z s    

increas$ t is n a multiple ( #e %all be 
r\nd$ to ! ne>e/ multiple ( #e 7or1 if a
 multiple ( #b4ej1 to ! next highe/     
multiple ( #e74  7,d7 ,o!r items &      
s]vices ,= any o!r items or s]vices1 !  
less] (-- 7i7 ! ca% price = su* items & 
s]vices po/$ pursuant to section        
#aba7;b7 ( ! ,pati5t ,fre$om ,act (     
#bjag2 or  7ii7 #aaj p]c5t ( ! paym5t   
basis t w\ld be applicable to paym5t =  
su* items & s]vices "u ?is title 9 !    
case ( an individual entitl$ to b5efits 
"u "p ,a & enroll$ "u "p ,b4  7#b7      
,special rule = items & s]vices furni%$ 
z a bundle ,9 ! case ( items & s]vices =
 :i* !re is a s+le price = a gr\p or    
bundle ( su* items & s]vices1 ! maximum 
*>ge p]mitt$ "u p>agraph 7#a7 may n     
exce$ ! less] (--  7,a7 ! price *>g$ =  
su* bundl$ s]vices2 or  7,b7 ! aggregate
 ( ! maximum *>ges p]mitt$ "u p>agraph  
7#a7 ) respect to items & s]vices       
includ$ 9 su* bundle4  4  7b7 ,ref]5ce  
to price disclosure provision  7#a7 ,9  
g5]al ,p]sons provid+ m$ical c>e 7z     

def9$ 9 section #bac7;d7 ( ! ,int]nal   
,rev5ue ,code ( #aihf1 z 9 effect be=e !
 date ( ! enactm5t ( ?is ,act7 are      
requir$ to po/ prices "u ?is subsection4
  7#b7 ,=m ( disclosure ,! disclosure ( 
prices "u ?is subsection %all be 9 a =m 
& mann] specifi$ by ! ,secret>y1 9      
consultation ) ! ,secret>y ( !          
,treasury1 & %all be design$--  7,a7 to 
e/abli% a s+le price = relat$ items &   
s]vices 9 a mann] simil> to ! mann] 9   
:i* pric+ & paym5t = su* items & s]vices
 is provid$ "u ! ,m$ic>e program "u     
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq472 &  7,b7 
to make x easy = consum]s to comp>e !   
prices = simil> items & s]vices furni%$ 
by diff]5t provid]s4  7c7 ,effective    
date ,! am5dm5ts made by ?is section    
%all apply to *>ges impos$ = items &    
s]vices furni%$ on or aft] ,janu>y #a1  
#bjah4  ,,ii ,re=m ( ,tax ,provisions   
,relat+ to ,heal? ,c>e  ,a ,heal? ,sav+s
 ,acc\nts  #bja4 ,transition to         
non-d$uctible ,h,s,as  7a7              

,non-,d$uctible ,h,s,as ,sub*apt] ,f (  
*apt] #a ( ! ,int]nal ,rev5ue ,code (   
#aihf is am5d$ by add+ at ! end ! foll[+
 new "p3  ,,ix ,heal? sav+s acc\nts     
,sec4 #ecj;,a4 ,ro? ,h,s,as4  #ecj;,a4  
,ro? ,h,s,as  7a7 ,9 g5]al ,) !         
exception ( ! taxes impos$ by section   
#eaa 7relat+ to imposition ( tax on     
unrelat$ bus9ess income ( *>itable      
organizations71 a ,ro? ,,hsa %all be    
exempt f taxation "u ?is subtitle4 ,no  
d$uction %all be all[$ = any            
contribution to a ,ro? ,,hsa4  7b7      
,doll> limitation  7#a7 ,9 g5]al ,!     
aggregate am\nt ( contributions = any   
taxable ye> to all ,ro? ,h,s,as ma9ta9$ 
= ! b5efit ( an individual %all n exce$ 
! sum ( ! mon?ly limitations = any mon? 
dur+ su* taxable ye> t ! individual is  
an eligible individual4  7#b7 ,mon?ly   
limitation ,! mon?ly limitation = any   
mon? is #a_/ab (-- 7,a7 9 ! case ( an   
eligible individual :o has self-only    
cr$itable cov]age z ( ! fir/ day ( su*  
mon?1 #e1jjj1 &  7,b7 9 ! case ( an     

eligible individual :o has family       
cr$itable cov]age z ( ! fir/ day ( su*  
mon?1 ! am\nt 9 effect "u subp>agraph   
7,a7 = ! taxable ye> multipli$ by !     
numb] ( individuals 7includ+ ! eligible 
individual7 cov]$ "u su* family         
cr$itable cov]age z ( su* day4  7#c7    
,additional contributions = individuals 
#ee or old] ,9 ! case ( an individual :o
 has atta9$ age #ee be=e ! close ( !    
taxable ye>1 ! applicable limitation "u 
subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7
 %all be increas$ by #a1jjj4  7#d7      
,coord9ation ) o!r contributions ,!     
limitation :i* w\ld 7b = ?is p>agraph7  
apply "u ?is subsection to an individual
 = any taxable ye> %all be r$uc$ 7b n   
bel[ z]o7 by ! sum (--  7,a7 ! aggregate
 am\nt paid = su* taxable ye> to ,ar*]  
,m,s,as ( su* individual1 &  7,b7 !     
aggregate am\nt contribut$ to ,ro?      
,h,s,as ( su* individual = su* taxable  
ye> "u section #djh7;d77#i74            
,subp>agraph 7,a7 %all n apply ) respect
 to any individual to :om p>agraph 7#e7 

applies4  7#e7 ,special rule = m>ri$    
individuals ,9 ! case ( individuals :o  
are m>ri$ to ea* o!r1 if ei!r sp\se has 
family cov]age-- 7,a7 bo? sp\ses %all be
 treat$ z hav+ only su* family cov]age  
7& if su* sp\ses ea* h family cov]age "u
 diff]5t plans1 z hav+ ! family cov]age 
) ! l[e/ annual d$uctible71 &  7,b7 !   
limitation "u p>agraph 7#a7 7aft] !     
application ( subp>agraph 7,a7 & )\t    
reg>d to any additional contribution    
am\nt "u p>agraph 7#c77--  7i7 %all be  
r$uc$ by ! aggregate am\nt paid to ,ar*]
 ,m,s,as ( su* sp\ses = ! taxable ye>1 &
  7ii7 aft] su* r$uction1 %all be divid$
 equally betwe5 !m unless !y agree on a 
diff]5t division4  7#f7 ,d5ial (        
d$uction to dep5d5ts ,no contribution   
may be made to a ,ro? ,,hsa "u ?is      
section by any individual ) respect to  
:om a d$uction "u section #aea is       
all[able to ano!r taxpay] = a taxable   
ye> beg9n+ 9 ! cal5d> ye> 9 :i* su*     
individual's taxable ye> beg9s4  7#g7   
,m$ic>e eligible individuals ,!         

limitation "u ?is subsection = any mon? 
) respect to an individual %all be z]o =
 ! fir/ mon? su* individual is entitl$  
to b5efits "u title ,,xviii ( ! ,social 
,security ,act & = ea* mon? !reaft]4    
7#h7 ,increase 9 limit = individuals    
becom+ eligible individuals aft] !      
beg9n+ ( ! ye>  7,a7 ,9 g5]al ,=        
purposes ( comput+ ! limitation "u      
p>agraph 7#a7 = any taxable ye>1 an     
individual :o is an eligible individual 
dur+ ! la/ mon? ( su* taxable ye> %all  
be treat$--  7i7 z hav+ be5 an eligible 
individual dur+ ea* ( ! mon?s 9 su*     
taxable ye>1 &  7ii7 z hav+ be5 enroll$1
 dur+ ea* ( ! mon?s su* individual is   
treat$ z an eligible individual solely  
by reason ( clause 7i71 9 ! same heal?  
plan 9 :i* ! individual 0 enroll$ = !   
la/ mon? ( su* taxable ye>4  7,b7       
,failure to ma9ta9 cr$itable cov]age    
7i7 ,9 g5]al ,if1 at any "t dur+ ! te/+ 
p]iod1 ! individual is n an eligible    
individual1 !n-- 7,i7 ! gross income ( !
 individual = ! taxable ye> 9 :i* occurs

 ! fir/ mon? 9 ! te/+ p]iod = :i* su*   
individual is n an eligible individual  
%all be increas$ by ! aggregate am\nt ( 
all contributions to ! ,ro? ,,hsa ( !   
individual :i* c\ld n h be5 made b =    
subp>agraph 7,a71 &  7,,ii7 ! tax impos$
 by ?is *apt] = any taxable ye> on !    
individual %all be increas$ by #aj p]c5t
 ( ! am\nt ( su* increase4  7ii7        
,exception = disability or dea? ,clause 
7i7 %all n apply if ! individual ceas$  
to be an eligible individual by reason (
 ! dea? ( ! individual or ! individual  
becom+ disabl$ 7)9 ! mean+ ( section    
#gb7m77#g774  7iii7 ,te/+ p]iod ,! t]m  
te/+ p]iod means ! p]iod beg9n+ ) ! la/ 
mon? ( ! taxable ye> ref]r$ to 9        
subp>agraph 7,a7 & end+ on ! la/ day ( !
 #ab? mon? foll[+ su* mon?4  7#i7       
,limitation n to apply to c]ta9         
contributions made "u ,pati5t ,fre$om   
,act ,any contributions made "u #ajc7;b7
 ( ! ,pati5t ,fre$om ,act ( #bjag or z  
provid$ 9 section #cf;,c %all n be tak5 
into acc\nt = purposes ( det]m9+ :e!r ! 

limitation "u p>agraph 7#a7 has be5 met4
  7c7 ,ro? ,,hsa ,= purposes ( ?is      
title-- 7#a7 ,9 g5]al ,! t]m ,ro? ,,hsa 
or ,ro? heal? sav+s acc\nt means a tru/ 
creat$ or organiz$ 9 ! ,unit$ ,/ates z a
 ,ro? ,,hsa exclusively = ! purpose (   
pay+ ! qualifi$ m$ical exp5ses ( !      
acc\nt b5efici>y1 b only if ! writt5    
gov]n+ in/rum5t creat+ ! tru/ meets !   
foll[+ requirem5ts3  7,a7 ,except 9 !   
case ( a rollov] contribution describ$ 9
 subsection 7e77#e7 or section          
#bbj7;f77#e7 or #bbc7;f77#e71 no        
contribution w be accept$--  7i7 unless 
x is 9 ca%1 or  7ii7 to ! ext5t su*     
contribution1 :5 add$ to previ\s        
contributions to ! tru/ = ! cal5d> ye>1 
exce$s ! sum (--  7,i7 ! doll> am\nt 9  
effect "u subsection 7b77#b77;,b71 &    
7,,ii7 ! doll> am\nt 9 effect "u        
subsection 7b77#c74  7,b7 ,! tru/ee is a
 bank 7z def9$ 9 section #djh7n771 an   
insurance company 7z def9$ 9 section    
#haf71 or ano!r p]son :o demon/rates to 
! satisfaction ( ! ,secret>y t ! mann] 9

 :i* su* p]son w adm9i/] ! tru/ w be    
consi/5t ) ! requirem5ts ( ?is section4 
7,c7 ,no "p ( ! tru/ assets w be inve/$ 
9 life insurance contracts4  7,d7 ,!    
assets ( ! tru/ w n be comm+l$ ) o!r    
prop]ty except 9 a common tru/ fund or  
common inve/m5t fund4  7,e7 ,! int]e/ ( 
an individual 9 ! balance 9 8 acc\nt is 
non=feitable4  7#b7 ,qualifi$ m$ical    
exp5ses ,= purposes ( ?is section--     
7,a7 ,9 g5]al ,! t]m qualifi$ m$ical    
exp5ses means1 ) respect to an acc\nt   
b5efici>y1 am\nts paid by su* b5efici>y 
= m$ical c>e 7z def9$ 9 section #bac7;d7
 z 9 effect on ! day be=e ! date ( !    
enactm5t ( ! ,pati5t ,fre$om ,act (     
#bjag7 = su* individual1 ! sp\se ( su*  
individual1 & any dep5d5t 7z def9$ 9    
section #aeb1 det]m9$ )\t reg>d to      
subsections 7b77#a71 7b77#b71 &         
7d77#a77;,b7 !re(7 ( su* individual1 b  
only to ! ext5t su* am\nts are n        
comp5sat$ = by insurance or o!rwise4    
7,b7 ,limitation on heal? insurance     
pur*as$ f acc\nt ,su* t]m %all n include

 any paym5t = heal? b5efits cov]age t is
 n cr$itable cov]age 7)9 ! mean+ ( title
 ,,xxvii ( ! ,public ,heal? ,s]vice     
,act74  7,c7 ,exceptions ,subp>agraph   
7,b7 %all n apply to any exp5se =       
cov]age "u-- 7i7 a heal? plan dur+ any  
p]iod ( cont9uation cov]age requir$ "u  
any ,f$]al law1  7ii7 a qualifi$        
long-t]m c>e insurance contract 7z def9$
 9 section #ggjb;,b7b771  7iii7 a heal? 
plan dur+ a p]iod 9 :i* ! individual is 
receiv+ unemploym5t comp5sation "u any  
,f$]al or ,/ate law1 or  7iv7 9 ! case (
 an acc\nt b5efici>y :o has atta9$ ! age
 specifi$ 9 section #ahaa ( ! ,social   
,security ,act1 any heal? insurance o!r 
?an a m$ic>e supplem5tal policy 7z def9$
 9 section #ahhb ( ! ,social ,security  
,act74  7#c7 ,acc\nt b5efici>y ,! t]m   
acc\nt b5efici>y means ! individual on  
^: behalf ! ,ro? ,,hsa 0 e/abli%$4  7#d7
 ,c]ta9 rules to apply ,rules simil> to 
! foll[+ rules %all apply = purposes (  
?is section3  7,a7 ,section #bai7;f77#c7
 7relat+ to "t :5 contributions deem$   

made74  7,b7 ,section #bai7;f77#e7      
7relat+ to employ] paym5ts74  7,c7      
,section #djh7;g7 7relat+ to community  
prop]ty laws74  7,d7 ,section #djh7;h7  
7relat+ to cu/odial acc\nts74  7#e7     
,acc\nt t]m9ations ,rules simil> to !   
rules ( p>agraphs 7#b7 & 7#d7 ( section 
#djh7;e7 %all apply to ,ro? ,h,s,as1 &  
any am\nt treat$ z di/ribut$ "u su*     
rules %all be treat$ z n us$ to pay     
qualifi$ m$ical exp5ses4  7d7 ,eligible 
individual ,= purposes ( ?is section1 ! 
t]m eligible individual means1 ) respect
 to any mon?1 any individual :o is cov]$
 "u cr$itable cov]age 7)9 ! mean+ (     
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act7 z ( ! #a/ day ( su* mon?4  7e7   
,tax treatm5t ( di/ributions  7#a7      
,am\nts us$ = qualifi$ m$ical exp5ses   
,any am\nt paid or di/ribut$ out ( a    
,ro? ,,hsa :i* is us$ exclusively to pay
 qualifi$ m$ical exp5ses ( any acc\nt   
b5efici>y %all n be includible 9 gross  
income 9 ! mann] provid$ 9 section #gb4 
7#b7 ,inclusion ( am\nts n us$ =        

qualifi$ m$ical exp5ses ,any am\nt paid 
or di/ribut$ out ( a ,ro? ,,hsa :i* is n
 us$ exclusively to pay ! qualifi$      
m$ical exp5ses ( ! acc\nt b5efici>y %all
 be includ$ 9 ! gross income ( su*      
b5efici>y4  7#c7 ,excess contributions  
return$ be=e due date ( return  7,a7 ,9 
g5]al ,if any excess contribution is    
contribut$ = a taxable ye> to any ,ro?  
,,hsa ( an individual1 p>agraph 7#b7    
%all n apply to di/ributions f ! ,ro?   
,h,s,as ( su* individual 7to ! ext5t su*
 di/ributions d n exce$ ! aggregate     
excess contributions to all su* acc\nts 
( su* individual = su* ye>7 if--  7i7   
su* di/ribution is receiv$ by !         
individual on or be=e ! la/ day         
prescrib$ by law 7includ+ ext5sions (   
"t7 = fil+ su* individual's return = su*
 taxable ye>1 &  7ii7 su* di/ribution is
 accompani$ by ! am\nt ( net income     
attributable to su* excess contribution4
  ,any net income describ$ 9 clause 7ii7
 %all be includ$ 9 ! gross income ( !   
individual = ! taxable ye> 9 :i* x is   

receiv$4  7,b7 ,excess contribution ,=  
purposes ( subp>agraph 7,a71 ! t]m      
excess contribution means any           
contribution 7o!r ?an a rollov]         
contribution describ$ 9 p>agraph 7#e7 or
 section #bbj7;f77#e7 or #bbc7;f77#e77  
:i* exce$s ! contribution limitation )  
respect to ! individual = ! taxable ye>4
  7#d7 ,additional tax on di/ributions n
 us$ = qualifi$ m$ical exp5ses  7,a7 ,9 
g5]al ,! tax impos$ by ?is *apt] on !   
acc\nt b5efici>y = any taxable ye> 9 :i*
 !re is a paym5t or di/ribution f a ,ro?
 ,,hsa ( su* b5efici>y :i* is includible
 9 gross income "u p>agraph 7#b7 %all be
 increas$ by #aj p]c5t ( ! am\nt :i* is 
s includible4  7,b7 ,exception =        
disability or dea? ,subp>agraph 7,a7    
%all n apply if ! paym5t or di/ribution 
is made aft] ! acc\nt b5efici>y becomes 
disabl$ )9 ! mean+ ( section #gb7m77#g7 
or dies4  7,c7 ,exception = di/ributions
 aft] m$ic>e eligibility ,subp>agraph   
7,a7 %all n apply to any paym5t or      
di/ribution aft] ! date on :i* ! acc\nt 

b5efici>y atta9s ! age specifi$ 9       
section #ahaa ( ! ,social ,security     
,act4  7#e7 ,rollov] contribution ,an   
am\nt is describ$ 9 ?is p>agraph z a    
rollov] contribution if x meets !       
requirem5ts ( subp>agraphs 7,a7 & 7,b74 
7,a7 ,9 g5]al ,p>agraph 7#b7 %all n     
apply to any am\nt paid or di/ribut$ f a
 heal? sav+s acc\nt 7z def9$ 9 section  
#bbc7 or a ,ro? ,,hsa to ! acc\nt       
b5efici>y to ! ext5t ! am\nt receiv$ is 
paid into a ,ro? ,,hsa = ! b5efit ( su* 
b5efici>y n lat] ?an ! #fj? day aft] !  
day on :i* ! b5efici>y receives ! paym5t
 or di/ribution4  7,b7 ,limitation ,?is 
p>agraph %all n apply to any am\nt      
describ$ 9 subp>agraph 7,a7 receiv$ by  
an individual f a heal? sav+s acc\nt or 
a ,ro? ,,hsa if1 at any "t dur+ ! #a-ye>
 p]iod end+ on ! day ( su* receipt1 su* 
individual receiv$ any o!r am\nt        
describ$ 9 subp>agraph 7,a7 f a heal?   
sav+s acc\nt or ,ro? ,,hsa :i* 0 n      
includible 9 ! individual's gross income
 because ( ! application ( ?is p>agraph4

  7#f7 ,transf] ( acc\nt incid5t to     
divorce ,! transf] ( an individual's    
int]e/ 9 a ,ro? ,,hsa to an individual's
 sp\se or =m] sp\se "u a divorce or     
sep>ation in/rum5t describ$ 9           
subp>agraph 7,a7 ( section #ga7;b77#b7  
%all n be consid]$ a taxable transf]    
made by su* individual not)/&+ any o!r  
provision ( ?is subtitle1 & su* int]e/  
%all1 aft] su* transf]1 be treat$ z a   
,ro? ,,hsa ) respect to :i* su* sp\se is
 ! acc\nt b5efici>y4  7#g7 ,treatm5t    
aft] dea? ( acc\nt b5efici>y ,if an     
individual acquires an acc\nt           
b5efici>y's int]e/ 9 a heal? sav+s      
acc\nt by reason ( ! dea? ( ! acc\nt    
b5efici>y1 su* heal? sav+s acc\nt %all  
be treat$ z if ! individual 7 ! acc\nt  
b5efici>y4  7f7 ,co/-(-,liv+ adju/m5t   
7#a7 ,9 g5]al ,9 ! case ( any cal5d> ye>
 beg9n+ aft] #bjag1 ! #e1jjj doll> am\nt
 9 subsection 7b77#b7 %all be increas$  
by an am\nt equal to--  7,a7 su* doll>  
am\nt1 multipli$ by  7,b7 ! co/-(-liv+  
adju/m5t det]m9$ "u section #a7;f77#c7 =

 ! cal5d> ye>1 det]m9$--  7i7 by        
sub/itut+ cal5d> ye> #bjaf = cal5d> ye> 
#aiib 9 subp>agraph 7,b7 !re(1 &  7ii7  
by sub/itut+ ,,cpi m$ical c>e compon5t =
 ,,cpi4  7#b7 ,,cpi m$ical c>e compon5t 
,= purposes ( ?is p>agraph1 ! t]m ,,cpi 
m$ical c>e compon5t means ! m$ical c>e  
compon5t = ! ,consum] ,price ,index =   
,all ,urban ,consum]s publi%$ by !      
,dep>tm5t ( ,labor4  7#c7 ,r\nd+ ,if !  
am\nt ( any increase "u ! prec$+ s5t5ce 
is n a multiple ( #ej1 su* increase %all
 be r\nd$ to ! next l[e/ multiple ( #ej4
  7g7 ,reports ,! ,secret>y may         
require-- 7#a7 ! tru/ee ( a ,ro? ,,hsa  
to make su* reports reg>d+ su* acc\nt to
 ! ,secret>y & to ! acc\nt b5efici>y )  
respect to contributions1 di/ributions1 
! return ( excess contributions1 & su*  
o!r matt]s z ! ,secret>y det]m9es       
appropriate1 &  7#b7 any p]son :o       
provides an individual ) cr$itable      
cov]age to make su* reports to !        
,secret>y & to ! acc\nt b5efici>y )     
respect to su* plan z ! ,secret>y       

det]m9es appropriate4  ,! reports       
requir$ by ?is subsection %all be fil$  
at su* "t & 9 su* mann] & furni%$ to su*
 individuals at su* "t & 9 su* mann] z  
may be requir$ by ! ,secret>y4  4  7b7  
,limit on contributions to d$uctible    
heal? sav+s acc\nts ,section #bbc ( su* 
,code is am5d$ by add+ at ! end ! foll[+
 new subsection3  7i7 ,limit$           
contributions aft] #bjaf  7#a7 ,9 g5]al 
,no contribution may be accept$ by a    
heal? sav+s acc\nt aft] ! date ( !      
enactm5t ( ?is subsection4  7#b7        
,exceptions ,p>agraph 7#a7 %all n apply 
to a rollov] contribution describ$ 9    
subsection 7f77#e74  4  7c7 ,con=m+     
am5dm5ts  7#a7 ,section #bf7;b77#b7 ( ! 
,int]nal ,rev5ue ,code ( #aihf is       
am5d$--  7,a7 9 subp>agraph 7,s71 by    
/rik+ & #djh7;d77#i77;,d77i77,,ii7 &    
ins]t+ #djh7;d77#i77;,d77i77,,ii71 &    
#ecj;,a7b77#h77;,b77i77,,ii71 &  7,b7 9 
subp>agraph 7,u71 by ins]t+ & section   
#ecj;,a7e77#d7 be=e ! comma at ! end4   
7#b7 ,section #ce7;g77#c7 ( su* ,code is

 am5d$-- 7,a7 by /rik+ or f & ins]t+ 1  
f1 &  7,b7 by ins]t+ or f a ,ro? ,,hsa  
7z def9$ 9 section #ecj;,a7c77 aft]     
#bbc7;d774  7#c7 ,section               
#bbj7;f77#e77;,a7 ( su* ,code is am5d$  
by ins]t+ or a ,ro? ,,hsa 7z def9$ 9    
section #ecj;,a7c77 aft] #bbc7;d774     
7#d7 ,section #bbc7;f77#e77;,a7 ( su*   
,code is am5d$ by ins]t+ or a ,ro? ,,hsa
 7z def9$ 9 section #ecj;,a7c77 aft]    
paid into a heal? sav+s acc\nt4  7#e7   
,section #djh7;d77#i7 ( su* ,code is    
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,f7 ,application to ,ro? 
,h,s,as ,rules simil> to ! rules ( !    
prec$+ subp>agraphs ( ?is p>agraph %all 
apply ) respect to eligible individuals 
7z def9$ 9 section #ecj;,a7d77 mak+     
contributions to ,ro? ,h,s,as1 except t 
subp>agraph 7,c7 %all be appli$ by      
sub/itut+ section #ecj;,a7b7 = section  
#bbc7;b74  4  7#f7 ,section             
#hdh7;e77#a77;,b77v7 ( su* ,code is     
am5d$ by ins]t+ or a ,ro? ,,hsa 7z def9$
 9 section #ecj;,a7c77 aft] #bbc7;d774  

7#g7 ,section #hgg;,a7e77#b7 ( su* ,code
 is am5d$ by ins]t+ a ,ro? ,,hsa 7z     
def9$ 9 section #ecj;,a7c71 aft] #bbc714
  7#h7 ,section #digc ( su* ,code is    
am5d$-- 7,a7 9 subsection 7a71 by /rik+ 
or at ! end ( p>agraph 7#e71 by ins]t+  
or at ! end ( p>agraph 7#f71 & by ins]t+
 aft] p>agraph 7#f7 ! foll[+ new        
p>agraph3  7#g7 a ,ro? ,,hsa 7)9 ! mean+
 ( section #ecj;,a71  1 &  7,b7 by add+ 
at ! end ! foll[+ new subsection3  7j7  
,excess contribution to ,ro? ,h,s,as ,= 
purposes ( ?is section1 9 ! case ( ,ro? 
,,hsa 7)9 ! mean+ ( section #ecj;,a7c771
 ! t]m excess contributions means ! sum 
(--  7#a7 ! aggregate am\nt contribut$ =
 ! taxable ye> to ! acc\nts 7o!r ?an a  
rollov] contribution describ$ 9 section 
#bbj7;f77#e71 #bbc7;f77#e71 or          
#ecj;,a7e77#e771 &  7#b7 ! am\nt det]m9$
 "u ?is subsection = ! prec$+ taxable   
ye>1 r$uc$ by ! sum (-- 7,a7 !          
di/ributions out ( ! acc\nts :i* 7      
includ$ 9 gross income "u section       
#ecj;,a7e77#b71 &  7,b7 ! excess 7if    

any7 (-- 7i7 ! maximum am\nt all[able z 
a contribution "u section #ecj;,a7b7 = !
 taxable ye>1 ov]  7ii7 ! am\nt         
contribut$ to ! acc\nts = ! taxable ye>4
  ,= purposes ( ?is subsection1 any     
contribution :i* is di/ribut$ out ( !   
,ro? ,,hsa 9 a di/ribution to :i*       
section #ecj;,a7e77#c7 applies %all be  
treat$ z an am\nt n contribut$4  4  7#i7
 ,section #dige7;c7 ( su* ,code is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#g7 ,special rule = ,ro? ,h,s,as ,an 
individual = ^: b5efit a ,ro? ,,hsa 7)9 
! mean+ ( section #ecj;,a7c77 is        
e/abli%$ %all be exempt f ! tax impos$  
by ?is section ) respect to any         
transaction conc]n+ su* acc\nt 7:i* w\ld
 o!rwise be taxable "u ?is section7 if1 
) respect to su* transaction1 ! acc\nt  
ceases to be a ,ro? ,,hsa by reason ( ! 
application ( section #ecj;,a7c77#e7 to 
su* acc\nt4  4  7#aj7 ,section          
#fjea7;a77#ab7 ( su* ,code is am5d$ by  
ins]t+ & to any ,ro? ,,hsa 7z def9$ 9   
section #ecj;,a7c77 aft] #bbc7;d774     

7#aa7 ,section #ffic7;a77#b7 ( su* ,code
 is am5d$ by /rik+ & at ! end (         
subp>agraph 7,e71 by /rik+ ! p]iod at ! 
end ( subp>agraph 7,f7 & ins]t+ 1 &1 &  
by add+ at ! end ! foll[+ new           
subp>agraph3  7,g7 section #ecj;,a7g7   
7relat+ to ,ro? ,h,s,as74  4  7d7       
,cl]ical am5dm5t ,! table ( p>ts =      
sub*apt] ,f ( *apt] #a ( su* ,code is   
am5d$ by add+ at ! end ! foll[+ new     
item3  ,"p ,,ix4 ,ro? heal? sav+s       
acc\nts  4  7e7 ,effective date ,!      
am5dm5ts made by ?is section %all apply 
to taxable ye>s beg9n+ aft] ,decemb]    
#ca1 #bjaf4  #bjb4 ,treatm5t ( direct   
prim>y c>e  7a7 ,h,s,as  7#a7 ,ro? ,,hsa
 ,section #ecj;,a7c77#b77;,a7 ( !       
,int]nal ,rev5ue ,code ( #aihf1 z add$  
by ?is ,act1 is am5d$ by add+ at ! end !
 foll[+3 ,su* t]m %all include ! paym5t 
( a mon?ly or o!r prepaid am\nt = !     
furni%+ 7or access to ! furni%+7 by a   
physician or gr\p ( physicians (        
physician pr(essional s]vices 7&        
ancill>y s]vices744  7#b7 ,,hsa ,section

 #bbc7;d77#b77;,a7 ( su* ,code is am5d$ 
by add+ at ! end ! foll[+3 ,su* t]m %all
 include ! paym5t ( a mon?ly or o!r     
prepaid am\nt = ! furni%+ 7or access to 
! furni%+7 by a physician or gr\p (     
physicians ( physician pr(essional      
s]vices 7& ancill>y s]vices744  7b7 ,n  
treat$ z heal? insurance cov]age  7#a7  
,9 g5]al ,= purposes ( title ,,xxvii ( !
 ,public ,heal? ,s]vice ,act1 subtitle  
,b ( title ,i ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd1 ,,ppaca1
 & ?is ,act1 ! (f]+ ( direct prim>y c>e 
%all n be treat$ z ! (f]+ ( heal?       
insurance cov]age & %all n be subject to
 regulations z su* cov]age "u su* ,acts4
  7#b7 ,direct prim>y c>e def9$ ,9 ?is  
subsection1 ! t]m direct prim>y c>e     
means ! furni%+ 7or access to ! furni%+7
 by a physician or gr\p ( physicians (  
physician pr(essional s]vices 7&        
ancill>y s]vices7 9 return = paym5t ( a 
mon?ly or o!r prepaid am\nt4  #bjc4     
,treatm5t ( ,,hsa aft] dea? ( acc\nt    
b5efici>y  7a7 ,9 g5]al ,section        

#bbc7;e77#h7 ( ! ,int]nal ,rev5ue ,code 
( #aihf1 z r$esignat$ by section        
#bja7;c77#c7 ( ?is ,act1 is am5d$ to    
read z foll[s3  7#h7 ,treatm5t aft] dea?
 ( acc\nt b5efici>y ,if an individual   
acquires an acc\nt b5efici>y's int]e/ 9 
a heal? sav+s acc\nt by reason ( ! dea? 
( ! acc\nt b5efici>y1 su* heal? sav+s   
acc\nt %all be treat$ z if ! individual 
7 ! acc\nt b5efici>y4  4  7b7 ,effective
 date ,! am5dm5t made by ?is section    
%all apply ) respect to int]e/s acquir$ 
aft] ! date ( ! enactm5t ( ?is ,act4  ,b
 ,heal? ,c>e ,tax cr$its  #baa4 ,limit$ 
application ( ,,ppaca heal? premium     
cr$it  7a7 ,9 g5]al ,section            
#cf;,b7c77#a7 ( ! ,int]nal ,rev5ue ,code
 ( #aihf is am5d$ by add+ at ! end !    
foll[+3  7,e7 ,special rule = resid5ts (
 ,/ates cont9u+ ,,ppaca implem5tation   
,no cr$it %all be all[$ "u ?is section  
to any individual :o is n a qualifi$    
resid5t 7z def9$ 9 section #ajj7ae7 ( ! 
,pati5t ,fre$om ,act ( #bjag7 ( a ,/ate 
t has elect$ ! option "u section        

#ajb7;a77#a7 ( su* ,act 9 relation to ! 
implem5tation ( title ,i ( ! ,pati5t    
,protection & ,af=dable ,c>e ,act4  4   
7b7 ,limitation on am\nt ( cr$it        
,section #cf;,b7b7 ( ! ,int]nal ,rev5ue 
,code ( #aihf is am5d$ by add+ at ! end 
! foll[+ new p>agraph3  7#d7 ,limitation
 on am\nt ( cr$it ,9 ! case ( any       
taxable ye> beg9n+ 9 a cal5d> ye> :i*   
beg9s aft] ! date ( ! enactm5t ( ?is    
p>agraph1 ! ,secret>y %all r$uce ! am\nt
 det]m9$ "u ?is subsection 7det]m9$ be=e
 ! application ( ?is p>agraph7 = ea*    
qualifi$ resid5t 7z def9$ 9 section #ajj
 ( ! ,pati5t ,fre$om ,act ( #bjag7 ( a  
,/ate t makes an election "u section    
#ajb7;a77#a7 ( su* ,act by an am\nt     
equal to--  7,a7 ! am\nt ( ! r$uction   
describ$ 9 section #ajb7;a77#a77;,a7 (  
su* ,act = su* ye> 7calculat$ by only   
tak+ into acc\nt cr$it all[$ "u ?is     
section71 divid$ by  7,b7 ! total numb] 
( su* qualifi$ resid5ts ( su* ,/ate     
e/imat$ by ! ,secret>y to claim ! cr$it 
all[$ "u subsection 7a7 = su* ye>4  4   

7c7 ,effective date ,! am5dm5ts made by 
?is section %all apply to taxable ye>s  
beg9n+ aft] ,janu>y #a1 #bjah4  #bab4   
,new ,ro? ,,hsa cr$it  7a7 ,9 g5]al     
,subp>t ,c ( "p ,,iv ( sub*apt] ,a (    
*apt] #a ( ! ,int]nal ,rev5ue ,code (   
#aihf is am5d$ by ins]t+ aft] section   
#cf;,b ! foll[+ new section3  #cf;,c4   
,ro? ,,hsa cr$it  7a7 ,9 g5]al ,9 ! case
 ( a qualify+ individual1 !re %all be   
all[$ z a cr$it aga9/ ! tax impos$ by   
?is subtitle = any taxable ye>1 an am\nt
 equal to ! ,ro? ,,hsa cr$it am\nt ( !  
individual = ! taxable ye>4  7b7        
,qualify+ individual ,= purposes ( ?is  
section1 ! t]m qualify+ individual      
means1 ) respect to any mon?1 any       
individual :o = su* mon? is a deposit   
qualify+ resid5t 7z def9$ 9 section     
#ajc7;b77#b7 ( ! ,pati5t ,fre$om ,act ( 
#bjag7 ( a ,/ate describ$ 9 section     
#ajb7;a77#b7 ( su* ,act t elects to h   
section #ajc7;b7 ( su* ,act c>ri$ out by
 way ( ! cr$it det]m9$ "u ?is section4  
7c7 ,ro? ,,hsa cr$it am\nt ,= purposes (

 ?is section1 ! t]m ,ro? ,,hsa cr$it    
am\nt means1 ) respect to any taxable   
ye>1 ! sum ( ! ,ro? ,,hsa deposit am\nts
 det]m9$ "u section #ajd ( ! ,pati5t    
,fre$om ,act ( #bjag ) respect to !     
individual = all mon?s end+ dur+ !      
taxable ye>4  7d7 ,special rules ,=     
purposes ( ?is section-- 7#a7           
,reconciliation ( cr$it & advance cr$it 
7,a7 ,excess advance paym5ts ,if !      
advance paym5ts to an individual = a    
taxable ye> "u subsection 7e7 exce$ !   
cr$it all[$ by ?is section ) respect to 
su* individual = su* taxable ye>1 ! tax 
impos$ by ?is *apt] = ! taxable ye> %all
 be increas$ by ! am\nt ( su* excess4   
7,b7 ,advance paym5t %ortfall ,if !     
cr$it all[$ by ?is section 7det]m9$ )\t 
reg>d to ?is subp>agraph7 ) respect to  
an individual = a taxable ye> exce$s !  
advance paym5ts to su* individual = su* 
taxable ye> "u subsection 7e71 !        
,secret>y %all1 9 lieu ( a cr$it all[$  
aga9/ ! tax impos$ by ?is subtitle1 make
 a paym5t on behalf ( su* individual to 

su* individual's heal? sav+s acc\nt 9 an
 am\nt equal to su* excess4  7#b7 ,m>ri$
 c\ples mu/ file jo9t return ,if !      
taxpay] is m>ri$ 7)9 ! mean+ ( section  
#ggjc7 at ! close ( ! taxable ye>1 !    
cr$it %all be all[$ "u ?is section only 
if ! taxpay] & ! taxpay]'s sp\se file a 
jo9t return = ! taxable ye>4  7e7       
,advance paym5t program  7#a7 ,9 g5]al  
,! ,secret>y ( ! ,treasury1 9           
consultation ) ! ,secret>y ( ,heal? &   
,human ,s]vices1 %all e/abli% a         
program--  7,a7 to make advance         
det]m9ations ) respect to ! eligibility 
( individuals = ! cr$it all[$ "u ?is    
section1 &  7,b7 to make advance paym5ts
 ( ! cr$it all[$ "u ?is section directly
 to ! ,ro? ,,hsa ( any su* individual s 
eligible4  7#b7 ,program requirem5ts    
,su* program %all be e/abli%$ "u rules  
simil> to ! rules ( section #adab ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act1 except t advance det]m9ations &   
advance paym5ts %all be made on reque/ (
 ! individual ) respect to :om !        

det]m9ation is to be made & tak+ into   
acc\nt ! enrollm5t process 7includ+ any 
opt-out election "u su* process7        
e/abli%$ "u section #aje7;c7 ( ! ,pati5t
 ,fre$om ,act ( #bjag4  7#c7 ,treatm5t z
 income ,! am\nt ( any cr$it all[$ "u   
?is section %all be includ$ 9 gross     
income4  4  7b7 ,cl]ical am5dm5t ,!     
table ( sections = su* subp>t is am5d$  
by ins]t+ aft] ! item relat+ to section 
#cf;,b ! foll[+ new item3  ,sec4 #cf;,c4
 ,ro? ,,hsa cr$it4  4  7c7 ,effective   
date ,! am5dm5ts made by ?is section    
%all apply to taxable ye>s beg9n+ aft]  
,janu>y #a1 #bjah4