,,ii #aae? ,,congress #a/ ,session ,s4 #bjbf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,octob] #bf1 #bjag,mr4 ,nelson 7= himself1 ,mrs4 ,gillibr&1 ,mr4 ,blum5?al1 ,mr4 ,m55dez1 & ,mr4 ,book]7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d titles ,,xviii & ,,xix ( ! ,social ,security ,act to make improvem5ts to ! treatm5t ( ! ,unit$ ,/ates t]ritories "u ! ,m$ic>e & ,m$icaid programs1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,improv+ ! ,treatm5t ( ! ,u4,s4 ,t]ritories ,"u ,f$]al ,heal? ,programs ,act ( #bjag4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,,title ,i--,m$icaid ,sec4 #aja4 ,elim9ation ( g5]al ,m$icaid fund+ limitations 7cap7 = t]ritories4 ,sec4 #ajb4 ,elim9ation ( specific ,f$]al m$ical assi/ance p]c5tage 7,,fmap7 limitation = t]ritories4 ,sec4 #ajc4 ,application ( ,m$icaid waiv] au?ority to all ( ! t]ritories4 ,sec4 #ajd4 ,p]mitt+ ,m$icaid ,,d% allotm5ts = t]ritories4 ,,title ,,ii--,m$ic>e ,subtitle ,a--,"p ,a ,sec4 #bja4 ,calculation ( ,m$ic>e ,,d% paym5ts = ,,ipps hospitals 9 ,pu]to ,rico4 ,sec4 #bjb4 ,rebas+ ,t>get ,am\nt = ,hospitals 9 ,t]ritories4 ,sec4 #bjc4 ,m$ic>e ,,d% ,t>get ,adju/m5t = ,hospitals 9 ,t]ritories4 ,subtitle ,b--,"p ,b ,sec4 #baa4 ,application ( "p ,b deem$ enrollm5t process to resid5ts ( ,pu]to ,rico2 special enrollm5t p]iod & limit on late enrollm5t p5alties4 ,subtitle ,c--,m$ic>e ,advantage 7,"p ,c7 ,sec4 #bba4 ,adju/m5t 9 b5*m>k = l[ base paym5t c\nties 9 ,pu]to ,rico4 ,subtitle ,d--,"p ,d ,sec4 #bca4 ,elim9at+ exclusion ( "p ,d eligible individuals resid+ 9 t]ritories f eligibility = premium & co/-%>+ subsidies4 ,sec4 #bcb4 ,report on treatm5t ( t]ritories "u ,m$ic>e "p ,d4 ,,title ,,iii--,miscellane\s ,sec4 #cja4 ,report on exclusion ( t]ritories f ,ex*anges4 ,sec4 #cjb4 ,m$icaid & ,,*ip t]ritory transp>5cy & in=mation4 ,i ,m$icaid #aja4 ,elim9ation ( g5]al ,m$icaid fund+ limitations 7cap7 = t]ritories 7a7 ,9 g5]al ,section #aajh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is am5d$-- 7#a7 9 subsection 7f71 9 ! matt] be=e p>agraph 7#a71 by /rik+ subsection 7g7 & ins]t+ subsections 7g7 & 7h72 7#b7 9 subsection 7g77#b71 9 ! matt] be=e subp>agraph 7,a71 by ins]t+ & subsection 7h7 aft] p>agraphs 7#c7 & 7#e72 & 7#c7 by add+ at ! end ! foll[+ new subsection3 7h7 ,sunset ( ,m$icaid fund+ limitations = ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa ,subsections 7f7 & 7g7 %all n apply to ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa beg9n+ ) fiscal ye> #bjah4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,section #aijb7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is am5d$ by /rik+ 1 ! limitation 9 section #aajh7;f714 7#b7 ,section #aijc7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77 is am5d$ by /rik+ p>agraph 7#d74 7#c7 ,section #acbc7;c77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjdc7;c77#a77 is am5d$ by /rik+ #bjai & ins]t+ #bjah4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply beg9n+ ) fiscal ye> #bjah4 #ajb4 ,elim9ation ( specific ,f$]al m$ical assi/ance p]c5tage 7,,fmap7 limitation = t]ritories ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9 subsection 7b77#b71 by ins]t+ = fiscal ye>s be=e fiscal ye> #bjah aft] ,am]ican ,samoa2 & 7#b7 9 subsection 7y77#a71 9 ! matt] prec$+ subp>agraph 7,a7-- 7,a7 by ins]t+ 1 = fiscal ye>s be=e fiscal ye> #bjah1 be=e is "o ( !2 & 7,b7 by ins]t+ &1 = fiscal ye> #bjah & subsequ5t fiscal ye>s1 is "o ( ! #ej ,/ates1 ! ,di/rict ( ,columbia1 ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa1 aft] ! ,di/rict ( ,columbia4 #ajc4 ,application ( ,m$icaid waiv] au?ority to all ( ! t]ritories 7a7 ,9 g5]al ,section #aijb7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is am5d$-- 7#a7 by /rik+ ,am]ican ,samoa & ! ,nor!rn ,m>iana ,isl&s & ins]t+ ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa2 7#b7 by /rik+ ,am]ican ,samoa or ! ,nor!rn ,m>iana ,isl&s & ins]t+ ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa2 7#c7 by /rik+ 1 ! limitation 9 section #aajh7;f712 7#d7 by ins]t+ 7#a7 aft] 7j72 7#e7 by ins]t+ except z o!rwise provid$ 9 ?is subsection1 aft] ,not)/&+ any o!r requirem5t ( ?is title2 & 7#f7 by add+ at ! end ! foll[+3 7#b7 ,! ,secret>y may n waive "u ?is subsection ! requirem5t ( subsection 7a77#aj77;,a77i77,,ix7 7relat+ to cov]age ( adults =m]ly "u fo/] c>e7 ) respect to any t]ritory4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply beg9n+ ,octob] #a1 #bjag4 #ajd4 ,p]mitt+ ,m$icaid ,,d% allotm5ts = t]ritories ,section #aibc7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif7 is am5d$-- 7#a7 9 p>agraph 7#f71 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,t]ritories 7i7 ,fiscal ye> #bjah ,= fiscal ye> #bjah1 ) respect to ! t]ritories ( ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa1 ! ,,d% allotm5t det]m9$ = ea* su* t]ritory %all be> ! same ratio to #aej1jjj1jjj z ! ratio ( ! numb] ( individuals :o are l[-income or un9sur$ & resid+ 9 ea* su* respective t]ritory 7z e/imat$ f "t to "t by ! ,secret>y7 be>s to ! sums ( ! numb] ( su* individuals resid+ 9 all ( ! t]ritories4 7ii7 ,subsequ5t fiscal ye> ,= ea* subsequ5t fiscal ye>1 ! ,,d% allotm5t = ea* su* t]ritory is subject to an increase or r$uction 9 accordance ) p>agraphs 7#c7 & 7#g74 2 7#b7 9 p>agraph 7#g77;,a71 by /rik+ clause 7iv7 & r$esignat+ clause 7v7 z clause 7iv72 & 7#c7 9 p>agraph 7#i71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 & includes1 beg9n+ ) fiscal ye> #bjah1 ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa4 ,,ii ,m$ic>e ,a ,"p ,a #bja4 ,calculation ( ,m$ic>e ,,d% paym5ts = ,,ipps hospitals 9 ,pu]to ,rico ,section #ahhf7;d77#i77;,d77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#i77;,d77iii77 is am5d$ to read z foll[s3 7iii7 ,subp>agraph 7,f7 7relat+ to disproportionate %>e paym5ts71 includ+ application ( subsection 7r71 except t = ?is purpose-- 7,i7 ! sum describ$ 9 clause 7ii7 ( ?is subp>agraph %all be sub/itut$ = ! sum ref]r$ to 9 p>agraph 7#e77;,f77ii77,i72 & 7,,ii7 = dis*>ges occurr+ on or aft] ,octob] #a1 #bjag1 subclause 7,i7 ( p>agraph 7#e77;,f77vi7 %all be appli$ by sub/itut+ = ! num]ator describ$ 9 su* subclause ! numb] ( subsection 7d7 ,pu]to ,rico hospital's pati5t days = ! co/ report+ p]iod involv$ :i* 7 made up ( pati5ts :o 7= su* days7 7 entitl$ to b5efits "u "p ,a ( ?is title & 7-- 7aa7 entitl$ to supplem5t>y security income b5efits 7exclud+ any ,/ate supplem5tation7 "u title ,,xvi ( ?is ,act2 7bb7 eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix2 or 7cc7 receiv+ aid or assi/ance "u any plan ( ! ,/ate approv$ "u title ,i1 ,x1 ,,xiv1 or ,,xvi4 4 #bjb4 ,rebas+ ,t>get ,am\nt = ,hospitals 9 ,t]ritories ,section #ahhf7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,m7 7i7 ,= ea* co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #bjag1 9 ! case ( a hospital locat$ 9 a t]ritory ( ! ,unit$ ,/ates1 !re %all be sub/itut$ = ! t>get am\nt o!rwise det]m9$ "u subp>agraph 7,a7 ! rebas$ t>get am\nt 7z def9$ 9 clause 7ii771 if su* sub/itution results 9 an am\nt ( paym5t "u ?is section to ! hospital = su* p]iod t is great] ?an ! am\nt ( paym5t t w\ld be made "u ?is section to ! hospital = su* p]iod if ?is subp>agraph 7 n to apply4 7ii7 ,= purposes ( ?is subp>agraph1 ! t]m rebas$ t>get am\nt has ! mean+ giv5 ! t]m t>get am\nt 9 subp>agraph 7,a71 except t-- 7,i7 !re %all be sub/itut$ = ! base co/ report+ p]iod ! #ab-mon? co/ report+ p]iod beg9n+ dur+ fiscal ye> #bjae2 7,,ii7 any ref]5ce 9 subp>agraph 7,a77i7 to ! fir/ su* co/ report+ p]iod is deem$ a ref]5ce to ! fir/ co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #bjag2 & 7,,iii7 ! applicable p]c5tage increase %all only be appli$ "u subp>agraph 7,b77ii7 = co/ report+ p]iods beg9n+ on or aft] ,octob] #a1 #bjag4 7iii7 ,no?+ 9 ?is subp>agraph %all affect any rebas+ reque/ by a hospital = any co/ report+ p]iod beg9n+ dur+ a fiscal ye> be=e fiscal ye> #bjae4 4 #bjc4 ,m$ic>e ,,d% ,t>get ,adju/m5t = ,hospitals 9 ,t]ritories ,section #ahhf7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c771 z am5d$ by section #bjb1 is fur!r am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,n7 7i7 ,= ea* co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #bjag1 9 ! case ( a hospital t is locat$ 9 a t]ritory ( ! ,unit$ ,/ates o!r ?an ,pu]to ,rico & t w\ld be a subsection 7d7 hospital if x 7 locat$ 9 "o ( ! #ej ,/ates1 ! t>get am\nt %all be increas$ by-- 7,i7 9 ! case t su* hospital has a disproportionate pati5t p]c5tage ( n less ?an #ae p]c5t & n great] ?an #dj p]c5t1 #aj p]c5t2 & 7,,ii7 9 ! case t su* hospital has a disproportionate pati5t p]c5tage ( great] ?an #dj p]c5t1 #aj p]c5t plus #fj p]c5t ( ! numb] ( p]c5tage po9ts by :i* su* hospital's disproportionate pati5t p]c5tage exce$s #dj p]c5t4 7ii7 ,= purposes ( ?is subp>agraph1 ! t]m disproportionate pati5t p]c5tage has ! mean+ giv5 su* t]m 9 subsection 7d77#e77;,f77vi71 except t 9 apply+ su* mean+ any ref]5ce "u su* subsection to individuals entitl$ to supplem5t>y security income "u title ,,xvi %all be deem$ = purposes ( ?is subp>agraph to include individuals-- 7,i7 eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix2 or 7,,ii7 receiv+ aid or assi/ance "u any plan ( ! t]ritory approv$ "u title ,i1 ,x1 ,,xiv1 or ,,xvi4 4 ,b ,"p ,b #baa4 ,application ( "p ,b deem$ enrollm5t process to resid5ts ( ,pu]to ,rico2 special enrollm5t p]iod & limit on late enrollm5t p5alties 7a7 ,application ( "p ,b deem$ enrollm5t process to resid5ts ( ,pu]to ,rico ,section #ahcg7;f77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep7f77#c77 is am5d$ by /rik+ 1 exclusive ( ,pu]to ,rico4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to individuals ^: initial enrollm5t p]iod "u section #ahcg7;d7 ( ! ,social ,security ,act beg9s on or aft] ! fir/ day ( ! effective mon?1 specifi$ by ! ,secret>y ( ,heal? & ,human ,s]vices "u section #ahci7;j77#a77;,c7 ( su* ,act1 z add$ by subsection 7c77#b74 7c7 ,transition provid+ special enrollm5t p]iod & limit on late enrollm5t p5alties = c]ta9 ,m$ic>e b5efici>ies ,section #ahci ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7 is am5d$-- 7#a7 9 ! fir/ s5t5ce ( subsection 7b71 by ins]t+ subject to section #ahci7;j77#b71 aft] subsection 7i77#d7 or 7l7 ( section #ahcg12 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7j7 ,special rules = c]ta9 resid5ts ( ,pu]to ,rico 7#a7 ,special enrollm5t p]iod1 cov]age p]iod = resid5ts :o are eligible b n enroll$ 7,a7 ,9 g5]al ,9 ! case ( a transition individual 7z def9$ 9 p>agraph 7#c77 :o is n enroll$ "u ?is "p z ( ! day be=e ! fir/ day ( ! effective mon? 7z def9$ 9 subp>agraph 7,c771 ! ,secret>y %all provide = a special enrollm5t p]iod "u section #ahcg ( #g mon?s beg9n+ ) su* effective mon? dur+ :i* ! individual may be enroll$ "u ?is "p4 7,b7 ,cov]age p]iod ,9 ! case ( su* an individual :o enrolls dur+ su* special enrollm5t p]iod1 ! cov]age p]iod "u section #ahch %all beg9 on ! fir/ day ( ! second mon? aft] ! mon? 9 :i* ! individual enrolls4 7,c7 ,effective mon? def9$ ,9 ?is section1 ! t]m effective mon? means a mon?1 n e>li] ?an ,octob] #bjag & n lat] ?an ,janu>y #bjah1 specifi$ by ! ,secret>y4 7#b7 ,r$uction 9 late enrollm5t p5alties = curr5t enrollees & individuals enroll+ dur+ transition 7,a7 ,9 g5]al ,9 ! case ( a transition individual :o is enroll$ "u ?is "p z ( ! day be=e ! fir/ day ( ! effective mon? or :o enrolls "u ?is "p on or aft] ! date ( ! enactm5t ( ?is subsection b be=e ! end ( ! special enrollm5t p]iod "u p>agraph 7#a77;,a71 ! am\nt ( ! late enrollm5t p5alty impos$ "u section #ahci7;b7 %all be recalculat$ by r$uc+ ! p5alty to #ae p]c5t ( ! p5alty o!rwise e/abli%$4 7,b7 ,application ,subp>agraph 7,a7 %all be appli$ 9 ! case ( a transition individual :o-- 7i7 is enroll$ "u ?is "p z ( ! mon? be=e ! effective mon?1 = premiums = mon?s beg9n+ ) su* effective mon?2 or 7ii7 enrolls "u ?is "p on or aft] ! date ( ! enactm5t ( ?is ,act & be=e ! end ( ! special enrollm5t p]iod "u p>agraph 7#a77;,a71 = premiums = mon?s dur+ ! cov]age p]iod "u ?is "p :i* occur dur+ or aft] ! effective mon?4 7,c7 ,loss ( r$uction if individual t]m9ates enrollm5t ,subp>agraph 7,a7 %all n apply to a transition individual if ! individual t]m9ates enrollm5t "u ?is "p aft] ! end ( ! special enrollm5t p]iod "u p>agraph 7#a74 7#c7 ,transition individual def9$ ,9 ?is section1 ! t]m transition individual means an individual :o resides 9 ,pu]to ,rico & :o w\ld h be5 deem$ enroll$ "u ?is "p pursuant to section #ahcg7;f7 be=e ! fir/ day ( ! effective mon? b = ! fact t ! individual 0 a resid5t ( ,pu]to ,rico1 reg>dless ( :e!r ! individual is enroll$ "u ?is "p z ( su* fir/ day4 4 ,c ,m$ic>e ,advantage 7,"p ,c7 #bba4 ,adju/m5t 9 b5*m>k = l[ base paym5t c\nties 9 ,pu]to ,rico ,section #ahec7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7n77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ & 7#e7 & ins]t+ 1 7#e71 & 7#f72 7#b7 9 p>agraph 7#d71 by /rik+ ,9 no case & ins]t+ ,subject to p>agraph 7#f71 9 no case2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,special rules = bl5d$ b5*m>k am\nt = t]ritories 7,a7 ,9 g5]al ,subject to p>agraph 7#b71 ! bl5d$ b5*m>k am\nt = an area 9 a t]ritory = a ye> 7beg9n+ ) #bjah7 %all n be less ?an #hj p]c5t ( ! national av]age ( ! base paym5t am\nts specifi$ 9 subp>agraph 7#b77;,e7 = su* ye> = areas )9 ! #ej ,/ates & ! ,di/rict ( ,columbia4 7,b7 ,limitation ,9 no case %all ! bl5d$ b5*m>k am\nt = an area 9 a t]ritory = a ye> "u subp>agraph 7,a7 exce$ ! l[e/ bl5d$ b5*m>k am\nt = any area )9 ! #ej ,/ates & ! ,di/rict ( ,columbia = su* ye>4 4 ,d ,"p ,d #bca4 ,elim9at+ exclusion ( "p ,d eligible individuals resid+ 9 t]ritories f eligibility = premium & co/-%>+ subsidies 7a7 ,9 g5]al ,section #ahfj;,d-#ad7;a77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77 is am5d$-- 7#a7 9 subp>agraph 7,a71 9 ! matt] prec$+ clause 7i71 by /rik+ subject to subp>agraph 7,f712 7#b7 9 subp>agraph 7,b77v71 9 ! matt] prec$+ subclause 7,i71 by /rik+ ,subject to subp>agraph 7,f71 ! ,secret>y & ins]t+ ,! ,secret>y2 7#c7 9 subp>agraph 7,c71 by add+ at ! end ! foll[+ new s5t5ce3 ,9 ! case ( an individual :o is n a resid5t ( ! #ej ,/ates or ! ,di/rict ( ,columbia1 ! pov]ty l9e 7z su* t]m is def9$ 9 clause 7ii77 t %all apply to su* individual %all be ! pov]ty l9e = ! #dh contigu\s ,/ates & ! ,di/rict ( ,columbia42 & 7#d7 by /rik+ subp>agraph 7,f74 7b7 ,application ( ,m$icaid provisions ,section #aice ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7 is am5d$-- 7#a7 9 subsection 7a71 by /rik+ subject to subsection 7e7 9 ! matt] prec$+ p>agraph 7#a72 & 7#b7 by /rik+ subsection 7e74 7c7 ,con=m+ am5dm5t ,section #aajh7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;f77 is am5d$ by /rik+ & section #aice7;e77#a77;,b7 9 ! matt] prec$+ clause 7i74 7d7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ,janu>y #a1 #bjah4 #bcb4 ,report on treatm5t ( t]ritories "u ,m$ic>e "p ,d ,p>agraph 7#d7 ( section #aice7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77 is am5d$ to read z foll[s3 7#d7 ,report on application ( subsection 7,a7 ,9 g5]al ,n lat] ?an ,may #a1 #bjah1 ! ,secret>y %all submit to ,congress a report on ! application ( ?is subsection dur+ ! p]iod beg9n+ ) fiscal ye> #bjjf & end+ ) ,decemb] #ca1 #bjag4 7,b7 ,in=mation to be includ$ 9 report ,su* report %all include-- 7i7 program guidance issu$ by ! ,secret>y to implem5t ?is subsection2 7ii7 = ea* ( ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa1 in=mation on ! increas$ am\nt "u p>agraph 7#c7 & h[ ! t]ritory has appli$ su* am\nt1 includ+ ! t]ritory's program design1 exp5ditures1 & numb] ( individuals 7& dual-eligible individuals7 assi/$2 & 7iii7 a description ( ! diff]5ces betwe5 h[ su* t]ritories are treat$ "u "p ,d ( title ,,xviii & "u ?is title comp>$ ) ! treatm5t ( ! #ej ,/ates & ! ,di/rict ( ,columbia "u su* "p & ?is title = diff]5t fiscal ye>s )9 ! p]iod cov]$ "u ! report4 7,c7 ,recomm5dations ,su* report %all include recomm5dations = improv+ prescription drug cov]age = l[-income individuals 9 ea* t]ritory id5tifi$ 9 subp>agraph 7,b77ii71 includ+ recomm5dations reg>d+ ea* ( ! foll[+ alt]native approa*es3 7i7 ,adju/+ ! aggregate am\nt specifi$ 9 p>agraph 7#c77;,b74 7ii7 ,all[+ resid5ts ( ! t]ritories to be subsidy eligible individuals "u section #ahfj;,d-#ad1 not)/&+ subsection 7a77#c77;,f7 ( su* section1 or provid+ sub/antially equival5t l[-income prescription drug subsidies to su* resid5ts4 4 ,,iii ,miscellane\s #cja4 ,report on exclusion ( t]ritories f ,ex*anges 7a7 ,9 g5]al ,n lat] ?an ,febru>y #a1 #bjai1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ,congress a report t details ! adv]se impacts 9 ea* t]ritory f ! practical exclusion ( ! t]ritories f ! provisions ( "p ,,ii ( subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act ins(> z su* provisions provide = ! e/abli%m5t ( an ,am]ican ,heal? ,b5efit ,ex*ange or ! adm9i/ration ( a f$]ally facilitat$ ,ex*ange 9 ea* ,/ate & 9 ! ,di/rict ( ,columbia = ! purpose ( mak+ heal? insurance m af=dable & accessible = individuals & small bus9esses4 7b7 ,in=mation 9 report ,! report %all include in=mation on ! foll[+3 7#a7 ,an e/imate ( ! total numb] ( un9sur$ & und]9sur$ individuals resid+ 9 ea* t]ritory ) respect to heal? insurance cov]age4 7#b7 ,a description ( ! numb] ( heal? insurance issu]s 9 ea* t]ritory & ! heal? insurance plans ^! issu]s (f]4 7#c7 ,an e/imate ( ! numb] ( individuals resid+ 9 ea* t]ritory :o are d5i$ premium & co/-%>+ assi/ance t w\ld o!rwise be available to !m = obta9+ heal? insurance cov]age ?r\gh an ,ex*ange if !y resid$ 9 "o ( ! #ej ,/ates or 9 ! ,di/rict ( ,columbia4 7#d7 ,an e/imate ( ! am\nt ( ,f$]al assi/ance describ$ 9 p>agraph 7#c7 t is n be+ made available to resid5ts ( ea* t]ritory4 7#e7 ,an e/imate ( ! numb] ( small employ]s 9 ea* t]ritory t w\ld be eligible to pur*ase heal? insurance cov]age ?r\gh a ,small ,bus9ess ,heal? ,options ,program 7,,%op7 ,m>ketplace t w\ld op]ate z "p ( an ,ex*ange if ! employ]s 7 9 "o ( ! #ej ,/ates or 9 ! ,di/rict ( ,columbia4 #cjb4 ,m$icaid & ,,*ip t]ritory transp>5cy & in=mation 7a7 ,publication ( ,in=mation on ,f$]al ,exp5ditures ,"u ,m$icaid & ,,*ip 9 ! ,t]ritories ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all publi%1 & p]iodically update1 on ! ,int]net site ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices in=mation on ,m$icaid & ,,*ip c>ri$ out 9 ! t]ritories ( ! ,unit$ ,/ates4 ,su* in=mation %all include1 ) respect to ea* su* t]ritory-- 7#a7 ! income levels e/abli%$ by ! t]ritory = purposes ( eligibility ( an individual to receive m$ical assi/ance "u ,m$icaid or *ild heal? assi/ance "u ,,*ip2 7#b7 ! numb] ( individuals enroll$ 9 ,m$icaid & ,,*ip 9 su* t]ritory2 7#c7 any ,/ate plan am5dm5ts 9 effect to c>ry out ,m$icaid or ,,*ip 9 su* t]ritory2 7#d7 any waiv] ( ! requirem5ts ( title ,,xix or ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq41 #acig;aa et seq47 issu$ by ! ,secret>y to c>ry out ,m$icaid or ,,*ip 9 ! t]ritory1 includ+ a waiv] "u section #aaae ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae71 any application = su* a waiv]1 & any docum5tation relat$ to su* application 7includ+ correspond5ce72 7#e7 ! am\nt ( ! ,f$]al & non-,f$]al %>e ( exp5ditures "u ,m$icaid & ,,*ip 9 su* t]ritory2 7#f7 ! sy/ems 9 place = ! furni%+ ( heal? c>e items & s]vices "u ,m$icaid & ,,*ip 9 su* t]ritory2 7#g7 ! design ( ,,*ip 9 su* t]ritory2 & 7#h7 o!r in=mation reg>d+ ! c>ry+ out ( ,m$icaid & ,,*ip 9 ! t]ritory t is publi%$ on su* ,int]net site ) respect to c>ry+ out ,m$icaid & ,,*ip 9 ea* ( ! #ej ,/ates & ! ,di/rict ( ,columbia4 7b7 ,def9itions ,9 ?is section3 7#a7 ,,*ip ,! t]m ,,*ip means ! ,/ate ,*ildr5's ,heal? ,insurance ,program e/abli%$ "u title ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq474 7#b7 ,m$icaid ,! t]m ,m$icaid means ! ,m$icaid program e/abli%$ "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,t]ritory ( ! ,unit$ ,/ates ,! t]m t]ritory ( ! ,unit$ ,/ates means ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa4