,i #aafth ,,congress #ast ,session ,h4 ,r4 #acdf ,,in ,,the ,,house ,,of ,,representatives ,february #be1 #bjai,mr4 ,higgins of ,new ,york 7for himself1 ,mr4 ,larson of ,connecticut1 ,mr4 ,courtney1 ,mr4 ,welch1 ,mr4 ,aguilar1 ,ms4 ,bonamici1 ,mr4 ,brendan ,f4 ,boyle of ,pennsylvania1 ,mr4 ,clay1 ,mr4 ,deutch1 ,mr4 ,michael ,f4 ,doyle of ,pennsylvania1 ,mr4 ,heck1 ,mr4 ,krishnamoorthi1 ,ms4 ,kuster of ,new ,hampshire1 ,mr4 ,langevin1 ,mr4 ,larsen of ,washington1 ,mr4 ,lowenthal1 ,mr4 ,sean ,patrick ,maloney of ,new ,york1 ,mr4 ,meeks1 ,ms4 ,norton1 ,mr4 ,perlmutter1 ,mr4 ,peterson1 ,mr4 ,schiff1 ,ms4 ,titus1 ,mr4 ,tonko1 ,ms4 ,wasserman ,schultz1 ,ms4 ,wild1 and ,mr4 ,mc,govern7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for an option for individuals who are ages #ej to #fd to buy into ,medicare1 to provide for health insurance market stabilization1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,buy-,in and ,health ,care ,stabilization ,act of #bjai4 #b4 ,findings ,congress finds as follows3 7#a7 ,medicare has coverage gaps and should provide more comprehensive coverage1 including increasing coverage for the medical needs of beneficiaries relating to hearing1 dental1 and vision care4 7#b7 ,special needs populations face financial challenges to secure coverage for ,medicare's out of pocket costs and other hurdles4 7#c7 ,medicare ,buy-,in is a step in the right direction as ,congress considers additional needed legislation to address these and other coverage issues and beneficiary financial challenges in ,medicare and ,medicare ,buy-,in4 #c4 ,medicare buy-in option 7a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,medicare buy-in option 7a7 ,option 7#a7 ,in general ,every individual who meets the requirements described in paragraph 7#b7 shall be eligible to enroll under this section4 7#b7 ,eligibility ,an individual who meets the following requirements is eligible to enroll under this section3 7,a7 ,age ,the individual has attained #ej years of age1 but has not attained #fe years of age4 7,b7 ,medicare eligibility 7but for age7 ,the individual is not otherwise entitled to benefits under part ,a or eligible to enroll under part ,a or part ,b but would be eligible for benefits under part ,a or part ,b if the individual were #fe years of age4 7#c7 ,part ,a1 ,b1 and ,d benefits and protections ,an individual enrolled under this section is entitled to the same benefits 7and shall receive the same protections7 under this title as an individual who is entitled to benefits under part ,a and enrolled under parts ,b and ,d1 including the ability to enroll in a ,medicare ,advantage plan that provides qualified prescription drug coverage 7an ,,ma-,,pd plan7 and including access to the ,medicare ,beneficiary ,ombudsman under section #ahjh7;c74 7b7 ,enrollment and coverage periods ,the ,secretary shall establish enrollment and coverage periods for individuals who enroll under this section4 ,such periods shall be established in coordination with the enrollment and coverage periods for plans offered under an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act4 ,the ,secretary shall establish such periods so that coverage under this section shall first begin on ,january #a of the first year beginning at least one year after the date of the enactment of this section and shall include special enrollment periods1 in accordance with section #aee4dbj of title #de of the ,code of ,federal ,regulations1 that are applicable to qualified health plans offered through an ,exchange4 7c7 ,buy-,in premium 7#a7 ,amount of monthly premiums ,the ,secretary shall 7beginning for the first year that begins more than #a year after the date of the enactment of this section71 during ,september of the preceding year1 determine a monthly premium for individuals enrolled under this section4 ,such monthly premium shall be equal to #a_/ab of the annual premium computed under paragraph 7#b77;,b71 which shall apply with respect to coverage provided under this section for any month in such year4 7#b7 ,annual premium 7,a7 ,combined ,national1 per capita average for parts ,a1 ,b1 and ,d benefits ,the ,secretary shall estimate the average1 annual per capita amount for benefits and administrative expenses that will be payable under parts ,a1 ,b1 and ,d in the year for all individuals enrolled under this section4 7,b7 ,annual premium ,subject to subparagraphs 7,c7 and 7,d71 the annual premium under this subsection for months in a year is equal to the average1 annual per capita amount estimated under subparagraph 7,a7 for the year4 7,c7 ,adjustments ,the ,secretary shall adjust the annual premium under this subsection as necessary-- 7i7 to ensure that expenditures under this title for any year are not increased by reason of this section2 and 7ii7 by a geographic adjustment factor to address regional affordability concerns4 7,d7 ,authority to calculate amounts of monthly premiums separately for different ages ,in determining the annual premium amount under this paragraph for months in a year1 the ,secretary may make separate determinations of such amount for individuals by age1 if the ,secretary determines that making such separate determinations would increase enrollment under this section and reduce the risk of adverse selection4 7#c7 ,additional premium for certain part ,d plans ,nothing in this section shall preclude an individual from choosing a prescription drug plan which requires the individual to pay an additional amount 7because of the inclusion of supplemental prescription drug benefits or because the plan is a more expensive plan1 pursuant to section #ahfj;,d-#ac7;a77#a774 ,in such case1 the monthly premium under paragraph 7#a7 shall be increased with respect to such individual4 7d7 ,payment of premiums 7#a7 ,payment ,premiums for enrollment under this section shall be paid to the ,secretary at such times1 and in such manner1 as the ,secretary determines appropriate4 7#b7 ,deposit ,amounts collected by the ,secretary under this section shall be deposited in the ,medicare ,buy-,in ,trust ,fund established under subsection 7e74 7e7 ,medicare ,buy-,in ,trust ,fund 7#a7 ,in general ,there is hereby created on the books of the ,treasury of the ,united ,states a trust fund to be known as the ,medicare ,buy-,in ,trust ,fund 7in this subsection referred to as the ,trust ,fund74 ,the ,trust ,fund shall consist of such gifts and bequests as may be made as provided in section #bja7;i77#a7 and such amounts as may be deposited in1 or appropriated to1 such fund as provided in this title4 7#b7 ,premiums ,premiums collected under subsection 7d7 shall be transferred to the ,trust ,fund4 7#c7 ,incorporation of ,provisions ,subsections 7b7 through 7i7 of section #ahda shall apply with respect to the ,trust ,fund and this title in the same manner as they apply with respect to the ,federal ,supplementary ,medical ,insurance ,trust ,fund and part ,b1 respectively1 except that in applying such section #ahda1 any reference in such section to this part shall be construed to be a reference to this section and any reference in section #ahda7;h7 to section #ahdj7;d7 and in section #ahda7;i7 to sections #ahdj7;b77#a7 and #ahdb7;g7 are deemed to be references to comparable authority exercised under this section4 7f7 ,clarification ,nothing in this section shall affect the benefits or eligibility under this title of individuals who would otherwise be entitled to or eligible for benefits under this title or title ,,xix1 or both4 7g7 ,eligibility for financial assistance 7#a7 ,in general ,individuals enrolled in coverage under this section shall1 from amounts transferred under paragraph 7#b71 receive financial assistance for such coverage that is substantially similar to the assistance the individual would have received if the individual were enrolled in a qualified health plan through an ,exchange4 7#b7 ,transfer of funds to medicare buy-in trust fund 7,a7 ,in general ,the ,secretary shall transfer to the ,medicare ,buy-,in ,trust ,fund under subsection 7d7 for each plan year the amount determined under paragraph 7,c7 for such year4 7,b7 ,use of funds ,the amounts transferred to the ,medicare ,buy-,in ,trust ,fund under subparagraph 7,a7 shall only be used to reduce the premiums and cost-sharing for coverage under this section of individuals enrolled under such coverage who would be eligible for cost-sharing reductions under section #adjb of the ,patient ,protection and ,affordable ,care ,act and premium assistance under section #cf;,b of the ,internal ,revenue ,code of #aihf if such individual were enrolled in a qualified health plan4 7,c7 ,amount of transfer 7i7 ,in general ,the amount determined under this subparagraph for any plan year is the aggregate amount the ,secretary determines is equal to #ajj percent of the premium tax credits under section #cf;,b of the ,internal ,revenue ,code of #aihf1 and #ajj percent of the cost-sharing reductions under section #adjb of the ,patient ,protection and ,affordable ,care ,act1 that would have been provided for the plan year to eligible individuals who meet specified income criteria and are enrolled for such plan year in coverage provided through enrollment under this section if such individuals were enrolled for such year in a qualified health plan through an ,exchange4 7ii7 ,specific requirements ,the ,secretary shall make the determination under clause 7i7 on a per enrollee basis and shall take into account all relevant factors necessary to determine the value of the premium tax credits and cost-sharing reductions that would have been provided to eligible individuals described in section #acca of the ,patient ,protection and ,affordable ,care ,act1 including the age and income of the enrollee1 geographic differences in average spending for health care across rating areas1 the health status of the enrollee for purposes of determining risk adjustment payments and reinsurance payments that would have been made if the enrollee had enrolled in a qualified health plan through an ,exchange1 and whether any reconciliation of the credit or cost-sharing reductions would have occurred if the enrollee had been so enrolled4 ,this determination shall take into consideration the experience of other ,states with respect to participation in an ,exchange and such credits and reductions provided to residents of the other ,states1 with a special focus on enrollees with income below #bjj percent of poverty4 7,d7 ,certification 7i7 ,in general ,the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services1 in consultation with the ,office of ,tax ,analysis of the ,department of the ,treasury1 shall certify whether the methodology used to make determinations under subparagraph 7,c71 and such determinations1 meet the requirements of this paragraph4 ,such certifications shall be based on sufficient data from the federal exchange and from comparable ,states about their experience with programs created by the ,basic ,health ,plan4 7ii7 ,corrections ,the ,secretary shall adjust the payment to the ,trust ,fund for any plan year to reflect any error in the determinations under subparagraph 7,c7 for any preceding plan year4 7iii7 ,application ,coverage provided through enrollment under this part and parts ,b and ,d pursuant to this section shall be treated as coverage under a qualified health plan in the silver level of coverage in the individual market offered through an ,exchange and the ,secretary shall be treated as the issuer of such plan4 7h7 ,treatment in relation to the ,affordable ,care ,act 7#a7 ,treatment as minimum essential coverage ,for purposes of applying section #ejjj;,a of the ,internal ,revenue ,code of #aihf1 the coverage provided through enrollment under this section constitutes minimum essential coverage under subsection 7f77#a77;,a77i7 of such section4 7#b7 ,use of ,exchanges ,coverage provided through enrollment under this section shall be deemed to be coverage under a qualified health plan for purposes of section #acaa7;d77#d77;,c7 of the ,patient ,protection and ,affordable ,care ,act and shall be made available for enrollment1 information comparison1 and otherwise as such a plan through any internet website maintained by an ,exchange established under title ,i of such ,act 7as described in such section74 7#c7 ,medicaid managed care ,states are prohibited from buying their ,medicaid beneficiaries ages #ej to #fd into ,medicare under this section1 and individuals otherwise eligible for enrollment under a ,state plan under title ,,xix are prohibited from coverage under this title pursuant to enrollment under this section4 ,the preceding sentence shall not apply to ,medicaid beneficiaries whose ,medicaid coverage or eligibility does not meet the definition of minimum essential coverage under a government-sponsored program under section #a4ejjj;,a-#b of title #bf1 ,code of ,federal ,regulations 7or any successor regulation74 7#d7 ,access to ,medigap ,coverage provided through medicare supplemental policies certified under section #ahhb shall be made available to individuals eligible for enrollment pursuant to this section for enrollment1 information1 comparison1 and otherwise as such a policy through any internet website described in paragraph 7#b74 7i7 ,oversight ,there is established an advisory committee to be known as the ,medicare ,buy ,in ,oversight ,board to monitor and oversee the implementation of this section1 including the experience of the individuals enrolling under this section4 ,the ,medicare ,buy ,in ,oversight ,board shall make periodic recommendations for the continual improvement of the implementation of this section as well as the relationship of enrollment under this section to other health care programs4 7j7 ,outreach and enrollment 7#a7 ,in general ,during the period that begins on ,january #a1 #bjai1 and ends on ,december #ca1 #bjba1 the ,secretary shall award grants to eligible entities for the following purposes3 7,a7 ,outreach and enrollment ,to carry out outreach1 public education activities1 and enrollment activities to raise awareness of the availability of1 and encourage1 enrollment under this section4 7,b7 ,assisting individuals transition under this section ,to provide assistance to individuals to enroll under this section4 7,c7 ,raising awareness of premium assistance and cost-sharing reductions ,to distribute fair and impartial information concerning enrollment under this section and the availability of premium assistance tax credits under section #cf;,b of the ,internal ,revenue ,code of #aihf and cost-sharing reductions under section #adjb of the ,patient ,protection and ,affordable ,care ,act1 and to assist eligible individuals in applying for such tax credits and cost-sharing reductions4 7#b7 ,eligible entities 7,a7 ,in general ,in this subsection1 the term eligible entity means-- 7i7 a ,state2 or 7ii7 a nonprofit community-based organization4 7,b7 ,enrollment agents ,such term includes a licensed independent insurance agent or broker that has an arrangement with a ,state or nonprofit community-based organization to enroll eligible individuals under this section4 7,c7 ,exclusions ,such term does not include an entity that-- 7i7 is a health insurance issuer2 or 7ii7 receives any consideration1 either directly or indirectly1 from any health insurance issuer in connection with the enrollment of any individuals under this section4 7#c7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to awarding grants to ,states or eligible entities in ,states that have geographic rating areas at risk of having no qualified health plans in the individual market4 7#d7 ,funding ,out of any moneys in the ,treasury not otherwise appropriated1 #ejj1jjj1jjj is appropriated to the ,secretary for each of calendar years #bjai through #bjba1 to carry out this subsection4 7k7 ,implementation 7#a7 ,consultation ,in carrying out this section1 the ,secretary shall-- 7,a7 consult with other ,federal agencies1 including the ,department of the ,treasury1 the ,department of ,labor1 the ,department of ,veterans ,affairs1 the ,department of ,defense1 and the ,office of ,personnel ,management2 and 7,b7 incorporate significant public consultation and feedback1 through public forums1 notice and comment rulemaking1 and any other appropriate mediums4 7#b7 ,report ,no later than one year after the date of the enactment of this section1 the ,secretary shall submit to ,congress a report establishing the administrative parameters for the implementation of this section4 7l7 ,feasibility study ,the ,secretary shall conduct a study on the feasibility of applying this section with respect to individuals residing in ,states that are not within the #ej ,states or the ,district of ,columbia4 4 7b7 ,medigap ,section #ahhb of the ,social ,security ,act is amended by adding at the end the following new subsection3 7aa7 ,development of ,new ,standards for ,certain ,medicare ,supplemental ,policies relating to buy-,in option ,the ,secretary shall request the ,national ,association of ,insurance ,commissioners to review and revise the standards for benefit packages described in subsection 7p77#a71 to otherwise update standards to include requirements for each medicare supplemental policy that offers such a policy in a ,state1 with respect to each year1 to accept every individual in the ,state who is eligible for enrollment pursuant to section #ahii;,c and who applies for such coverage for such year if the individual applies for enrollment in such policy during the #cj-;day period following the date of enrollment pursuant to section #ahii;,c and to accept every such individual during a period of transition from enrollment pursuant to such section to enrollment under this title pursuant to eligibility other than under such section4 ,such revisions shall be made consistent with the rules applicable under subsection 7p77#a77;,e7 with the reference to the #aiia ,,naic ,model ,regulation deemed a reference to the ,,naic ,model ,regulation as published in the ,federal ,register on ,december #d1 #aiih1 and as subsequently updated by the ,national ,association of ,insurance ,commissioners to reflect previous changes in law and the reference to date of enactment of this subsection deemed a reference to the date of enactment of this subsection 7aa74 4 #d4 ,medicare direct supplemental insurance option 7a7 ,in general ,title ,,xviii of the ,social ,security ,act is amended by inserting after section #ahhb 7#db ,u4,s4,c4 #aciess7 the following new section3 #ahhb;,a4 ,,medicare ,,direct ,,supplemental ,,insurance ,,option 7a7 ,in general ,the ,secretary shall provide for the offering under this section of a voluntary program to supplement the benefits provided to individuals under parts ,a and ,b of this title4 7b7 ,eligibility2 enrollment ,the ,secretary shall provide procedures for the enrollment under the program under this section of individuals who are entitled to benefits under part ,a and enrolled under part ,b1 but who are not enrolled in a ,medicare ,advantage plan 7or in a plan under section #ahgf74 ,such procedures shall be consistent with the following3 7#a7 ,there shall be an initial enrollment period during the last calendar quarter of #bjbj that permits all individuals who are eligible to enroll at that time under this subsection to enroll and obtain benefits effective on ,january #a1 #bjba4 7#b7 ,for individuals who are not eligible to enroll at such time but who subsequently become eligible1 there shall be an individual enrollment period which is the #f-month period described in section #ahhb7s77#b77;,a74 7#c7 ,the ,secretary shall permit eligible individuals to enroll at other times 7and not less frequently than annually7 in a uniform manner1 but such enrollment shall be subject to a late enrollment penalty under subsection 7d77#b77;,b74 7c7 ,benefits 7#a7 ,in general ,the benefits provided under the program under this section shall consist of payment of the cost of deductibles1 copayments1 and other cost-sharing amounts 7including amounts attributable to and permitted as balance billing7 otherwise imposed or permitted under this title1 subject to an annual deductible of #ajj4 7#b7 ,administration ,the ,secretary shall coordinate payment of benefits under this part with those under parts ,a and ,b and may1 for such purpose1 enter into appropriate arrangements with qualified entities 7which may include fiscal intermediaries and carriers74 7#c7 ,no pre-existing condition limitations ,the benefits under this section shall not be subject to any pre-existing condition or similar underwriting limitation4 7d7 ,premiums 7#a7 ,actuarial cost ,the ,secretary shall1 during ,september of each year beginning with #bjbj1 determine a monthly actuarial rate for all enrollees under this section1 which rate shall be applicable for months in the succeeding calendar year4 ,such actuarial rate shall be the amount the ,secretary estimates to be necessary so that the aggregate amount for such calendar year with respect to those enrollees will equal the total amount which the ,secretary estimates will be payable under this section for benefits accrued 7including services performed and related administrative costs incurred7 in such calendar year under the program under this section4 ,in calculating the monthly actuarial rate1 the ,secretary shall make adjustments to take into account errors in estimations under this paragraph for previous years and shall include an appropriate amount for a contingency margin4 7#b7 ,premium 7,a7 ,in general ,the monthly premium of each individual enrolled under this section for a month in a year shall be the monthly actuarial rate determined under paragraph 7#a7 for months in such year4 ,such premium shall be community-rated and shall not vary among enrollees based upon the age1 place of residence1 or any other factors1 except as provided under subparagraph 7,b74 7,b7 ,penalty for late enrollment ,in the case of an individual who does not enroll under this section in a period provided under paragraph 7#a7 or 7#b7 of subsection 7b71 the ,secretary shall increase the monthly premium 7in a manner similar to that applied under part ,b pursuant to section #ahci7;b77 of #aj percent for each full #ab months in which the individual could have been but was not so enrolled4 ,in applying such an increase-- 7i7 the aggregate percentage increase may not exceed #ajj percent2 and 7ii7 periods of time in which an individual is enrolled under an employee welfare benefit plan described in section #ahhb7s77#c77;,b77i71 under a ,medicare ,advantage plan1 with an organization described in section #ahhb7s77#c77;,b77iii71 or under a ,,pace program under section #ahid shall not be taken into account4 7#c7 ,collection ,the ,secretary shall provide for the collection of premiums for enrollees under this part in the same manner as premiums under part ,b are collected under section #ahdj1 except that any reference in such section to the ,federal ,supplementary ,medical ,insurance ,trust ,fund shall be deemed a reference to an account 7to be known as the ,direct ,medicare ,supplemental ,insurance ,account7 to be established in the ,treasury by the ,secretary to carry out the program under this section4 ,amounts in such account may be invested and draw interest in the same manner as such ,trust ,fund under section #ahdj7;c74 7#d7 ,use of funds ,premium amounts deposited into the account established under paragraph 7#c7 shall be available without regard to appropriations to the ,secretary to make payment for benefits and administrative costs incurred in carrying out this section4 7e7 ,nonduplication of coverage ,for purposes of applying section #ahhb7;d77#c77;,a71 coverage under this section shall be treated as coverage under a ,medicare supplemental policy4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of the enactment of this ,act and shall apply to benefits for months beginning with ,january #bjbj4 #e4 ,negotiation of lower covered part ,d drug prices on behalf of medicare beneficiaries 7a7 ,negotiation by secretary ,section #ahfj;,d-#aa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aaa7 is amended by striking subsection 7i7 7relating to noninterference7 and inserting the following3 7i7 ,negotiation of ,lower ,drug ,prices 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary shall negotiate with pharmaceutical manufacturers the prices 7including discounts1 rebates1 and other price concessions7 that may be charged to ,,pdp sponsors and ,,ma organizations for covered part ,d drugs for part ,d eligible individuals who are enrolled under a prescription drug plan or under an ,,ma-,,pd plan4 7#b7 ,no change in rules for formularies 7,a7 ,in general ,nothing in paragraph 7#a7 shall be construed to authorize the ,secretary to establish or require a particular formulary4 7,b7 ,construction ,subparagraph 7,a7 shall not be construed as affecting the ,secretary's authority to ensure appropriate and adequate access to covered part ,d drugs under prescription drug plans and under ,,ma-,,pd plans1 including compliance of such plans with formulary requirements under section #ahfj;,d-#d7;b77#c74 7#c7 ,construction ,nothing in this subsection shall be construed as preventing the sponsor of a prescription drug plan1 or an organization offering an ,,ma-,,pd plan1 from obtaining a discount or reduction of the price for a covered part ,d drug below the price negotiated under paragraph 7#a74 7#d7 ,semi-annual reports to ,congress ,not later than ,june #a1 #bjbb1 and every #f months thereafter1 the ,secretary shall submit to the ,committees on ,ways and ,means1 ,energy and ,commerce1 and ,oversight and ,reform of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on negotiations conducted by the ,secretary to achieve lower prices for ,medicare beneficiaries1 and the prices and price discounts achieved by the ,secretary as a result of such negotiations4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of the enactment of this ,act and shall first apply to negotiations and prices for plan years beginning on ,january #a1 #bjbb4 #f4 ,individual ,market ,reinsurance ,fund 7a7 ,establishment of ,fund 7#a7 ,in general ,there is established the ,individual ,market ,reinsurance ,fund 7in this section referred to as the ,fund7 to be administered by the ,secretary to provide funding for an individual market stabilization reinsurance program in each ,state that complies with the requirements of this section4 7#b7 ,funding ,amounts made available to the ,fund shall consist of the funds deposited into the ,fund under paragraph 7#c7 and shall be used to carry out this section 7other than subsection 7c77 for each calendar year beginning with #bjba4 ,amounts made available to the ,fund shall remain available without fiscal or calendar year limitation to carry out this section4 7#c7 ,cost-sharing in costs of ,program 7,a7 ,in general ,a qualified health plan that participates in the reinsurance program established under subsection 7b7 shall pay the fee established under subparagraph 7,b74 7,b7 ,authorization ,the ,secretary is authorized to charge a fee to each qualified health plan that participates in the reinsurance program established under subsection 7b74 ,any amounts collected pursuant to this paragraph shall be deposited into the ,fund for purposes of payments under subsection 7b74 7,c7 ,requirements ,in establishing the fee under subparagraph 7,b7-- 7i7 the ,secretary shall consult with interested parties2 and 7ii7 shall ensure that the amount of such fee is not excessive so as to unduly discourage qualified health plans from participating in the reinsurance program4 7b7 ,individual ,market reinsurance program 7#a7 ,use of funds ,the ,secretary shall use amounts in the ,fund to establish a reinsurance program under which the ,secretary shall make reinsurance payments1 subject to subsection 7a77#c71 to health insurance issuers with respect to high-cost individuals enrolled in qualified health plans offered by such issuers that are not grandfathered health plans or transitional health plans for any plan year beginning with the #bjah plan year4 ,this subsection constitutes budget authority in advance of appropriations ,acts and represents the obligation of the ,secretary to provide payments from the ,fund in accordance with this subsection4 7#b7 ,amount of payment ,the payment made to a health insurance issuer under paragraph 7#a7 with respect to each high-cost individual enrolled in a qualified health plan issued by the issuer that is not a grandfathered health plan or a transitional health plan shall equal #hj percent of the lesser of-- 7,a7 the amount 7if any7 by which the individual's claims incurred during the plan year exceeds-- 7i7 in the case of the #bjai1 #bjbj1 or #bjba plan year1 #ej1jjj2 and 7ii7 in the case of any other plan year1 #ajj1jjj2 or 7,b7 for plan years described in-- 7i7 subparagraph 7,a77i71 #dej1jjj2 and 7ii7 subparagraph 7,a77ii71 #djj1jjj4 7#c7 ,indexing ,in the case of plan years beginning after #bjai1 the dollar amounts that appear in subparagraphs 7,a7 and 7,b7 of paragraph 7#b7 shall each be increased by an amount equal to-- 7,a7 such amount2 multiplied by 7,b7 the premium adjustment percentage specified under section #acjb7;c77#d7 of the ,affordable ,care ,act1 but determined by substituting #bjai for #bjac4 7#d7 ,payment methods 7,a7 ,in general ,payments under this subsection shall be based on such a method as the ,secretary determines4 ,the ,secretary may establish a payment method by which interim payments of amounts under this subsection are made during a plan year based on the ,secretary's best estimate of amounts that will be payable after obtaining all of the information4 7,b7 ,requirement for provision of information 7i7 ,requirement ,payments under this subsection to a health insurance issuer are conditioned upon the furnishing to the ,secretary1 in a form and manner specified by the ,secretary1 of such information as may be required to carry out this subsection4 7ii7 ,restriction on use of information ,information disclosed or obtained pursuant to clause 7i7 is subject to the ,,hipaa privacy and security law1 as defined in section #cjji7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;a774 7#e7 ,secretary flexibility for budget neutral revisions to reinsurance payment specifications ,if the ,secretary determines appropriate1 the ,secretary may substitute higher dollar amounts for the dollar amounts specified under subparagraphs 7,a7 and 7,b7 of paragraph 7#b7 7and adjusted under paragraph 7#c71 if applicable7 if the ,secretary certifies that such substitutions1 considered together1 neither increase nor decease the total projected payments under this subsection4 7c7 ,reports to ,congress 7#a7 ,annual report ,the ,secretary shall submit a report to ,congress1 not later than ,january #ba1 #bjai1 and each year thereafter1 that contains the following information for the most recently ended year3 7,a7 ,the number and types of plans in each ,state's individual market1 specifying the number that are qualified health plans1 grandfathered health plans1 or health insurance coverage that is not a qualified health plan4 7,b7 ,the impact of the reinsurance payments provided under this section on the availability of coverage1 cost of coverage1 and coverage options in each ,state4 7,c7 ,the amount of premiums paid by individuals in each ,state by age1 family size1 geographic area in the ,state's individual market1 and category of health plan 7as described in subparagraph 7,a774 7,d7 ,the process used to award funds for outreach and enrollment activities awarded to eligible entities under subsection 7c71 the amount of such funds awarded1 and the activities carried out with such funds4 7,e7 ,such other information as the ,secretary deems relevant4 7#b7 ,evaluation report ,not later than ,january #ca1 #bjbb1 the ,secretary shall submit to ,congress a report that-- 7,a7 analyzes the impact of the funds provided under this section on premiums and enrollment in the individual market in all ,states2 and 7,b7 contains a ,state-by-,state comparison of the design of the programs carried out by ,states with funds provided under this section4 7d7 ,definitions ,in this section3 7#a7 ,secretary ,the term ,secretary means the ,secretary of the ,department of ,health and ,human ,services4 7#b7 ,fund ,the term ,fund means the ,individual ,market ,reinsurance ,fund established under subsection 7a74 7#c7 ,grandfathered health plan ,the term grandfathered health plan has the meaning given that term in section #abea7;e7 of the ,patient ,protection and ,affordable ,care ,act4 7#d7 ,high-cost individual ,the term high-cost individual means an individual enrolled in a qualified health plan 7other than a grandfathered health plan or a transitional health plan7 who incurs claims in excess of #ej1jjj during a plan year4 7#e7 ,state ,the term ,state means each of the #ej ,states and the ,district of ,columbia4 7#f7 ,transitional health plan ,the term transitional health plan means a plan continued under the letter issued by the ,centers for ,medicare ,medicaid ,services on ,november #ad1 #bjac1 to the ,state ,insurance ,commissioners outlining a transitional policy for coverage in the individual and small group markets to which section #abea of the ,patient ,protection and ,affordable ,care ,act does not apply1 and under the extension of the transitional policy for such coverage set forth in the ,insurance ,standards ,bulletin ,series guidance issued by the ,centers for ,medicare ,medicaid ,services on ,march #e1 #bjad1 ,february #bi1 #bjaf1 and ,february #ac1 #bjag4 #g4 ,reauthorization of risk corridors ,section #acdb7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfb7;a77 is amended by inserting and calendar years #bjba through #bjbd after #bjaf4 #h4 ,enhancements for reduced cost sharing 7a7 ,modification of amount 7#a7 ,in general ,section #adjb7;c77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7;c77#b77 is amended to read as follows3 7#b7 ,additional reduction ,the ,secretary shall establish procedures under which the issuer of a qualified health plan to which this section applies shall further reduce cost-sharing under the plan in a manner sufficient to-- 7,a7 in the case of an eligible insured whose household income is not less than #ajj percent but not more than #bjj percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #ie percent of such costs2 7,b7 in the case of an eligible insured whose household income is more than #bjj percent but not more than #cjj percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #ij percent of such costs2 and 7,c7 in the case of an eligible insured whose household income is more than #cjj percent but not more than #djj percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #he percent of such costs4 4 7#b7 ,conforming amendment ,clause 7i7 of section #adjb7;c77#a77;,b7 of such ,act 7#db ,u4,s4,c4 #ahjga7;c77#a77;,b77 is amended to read as follows3 7i7 ,in general ,the ,secretary shall ensure the reduction under this paragraph shall not result in an increase in the plan's share of the total allowed costs of benefits provided under the plan above-- 7,i7 #ie percent in the case of an eligible insured described in paragraph 7#b77;,a72 7,,ii7 #ij percent in the case of an eligible insured described in paragraph 7#b77;,b72 and 7,,iii7 #he percent in the case of an eligible insured described in paragraph 7#b77;,c74 4 7#c7 ,effective date ,the amendments made by this subsection shall apply to plan years beginning after ,december #ca1 #bjai4 7b7 ,funding ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 is amended by adding at the end the following new subsection3 7g7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary such sums as may be necessary for payments under this section4 4 #i4 ,integration of individuals aged #ej to #fd into health demonstrations ,the ,center for ,medicare and ,medicaid ,innovation under section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is authorized to include the individuals enrolled under title ,,xviii of the ,social ,security ,act pursuant to section #ahii;,c of such ,act1 as added by section #c1 into existing and future demonstrations conducted by such ,center4