,i #aafth ,,congress #ast ,session ,h4 ,r4 #ahhd ,,in ,,the ,,house ,,of ,,representatives ,march #bf1 #bjai,mr4 ,pallone 7for himself1 ,mr4 ,neal1 ,mr4 ,scott of ,virginia1 ,mr4 ,hoyer1 ,ms4 ,schrier1 ,mr4 ,cisneros1 ,ms4 ,de,gette1 ,ms4 ,castor of ,florida1 ,mrs4 ,trahan1 ,mrs4 ,craig1 ,ms4 ,kuster of ,new ,hampshire1 ,mr4 ,ruiz1 ,mr4 ,brendan ,f4 ,boyle of ,pennsylvania1 ,mr4 ,allred1 ,mrs4 ,bustos1 ,mrs4 ,mc,bath1 ,mr4 ,lujn1 ,mr4 ,ted ,lieu of ,california1 ,mr4 ,peters1 ,ms4 ,wilson of ,florida1 ,ms4 ,spanberger1 ,mr4 ,rouda1 ,ms4 ,underwood1 ,mr4 ,delgado1 ,mrs4 ,lee of ,nevada1 ,ms4 ,blunt ,rochester1 ,mr4 ,doggett1 ,mr4 ,gomez1 ,mrs4 ,dingell1 ,ms4 ,shalala1 ,ms4 ,frankel1 ,ms4 ,eshoo1 ,mr4 ,sires1 ,mr4 ,soto1 ,ms4 ,jackson ,lee1 ,mr4 ,keating1 ,ms4 ,stevens1 ,ms4 ,sewell of ,alabama1 ,mr4 ,trone1 ,mr4 ,rose of ,new ,york1 ,mrs4 ,kirkpatrick1 ,mr4 ,larson of ,connecticut1 ,mr4 ,lewis1 ,ms4 ,jayapal1 ,ms4 ,garcia of ,texas1 ,mr4 ,courtney1 ,ms4 ,snchez1 ,mrs4 ,demings1 ,mrs4 ,murphy1 ,ms4 ,dean1 ,mr4 ,cohen1 ,mr4 ,thompson of ,california1 ,mr4 ,rush1 ,mr4 ,morelle1 ,ms4 ,hill of ,california1 ,mr4 ,higgins of ,new ,york1 ,mrs4 ,davis of ,california1 ,ms4 ,brownley of ,california1 ,mr4 ,pascrell1 ,ms4 ,slotkin1 ,mr4 ,engel1 ,mr4 ,kim1 ,mr4 ,blumenauer1 ,mrs4 ,hayes1 ,mr4 ,cox of ,california1 ,mr4 ,takano1 ,mr4 ,panetta1 ,mr4 ,kildee1 ,mr4 ,malinowski1 ,mr4 ,levin of ,michigan1 ,mr4 ,golden1 ,mr4 ,van ,drew1 ,ms4 ,mucarsel-,powell1 ,mr4 ,grijalva1 ,mr4 ,espaillat1 ,ms4 ,schakowsky1 ,ms4 ,pingree1 ,ms4 ,norton1 and ,mr4 ,sablan7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and ,education and ,labor1 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 the ,patient ,protection and ,affordable ,care ,act to improve affordability of1 undo sabotage with respect to1 and increase access to health insurance coverage1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,protecting ,pre-,existing ,conditions and ,making ,health ,care ,more ,affordable ,act of #bjai4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,expanding ,affordability ,sec4 #aja4 ,improve affordability and reduce premium costs for consumers4 ,sec4 #ajb4 ,expand affordability for working families4 ,title ,,ii--,undoing ,sabotage ,sec4 #bja4 ,protect comprehensive coverage for small businesses and workers4 ,sec4 #bjb4 ,short-term limited duration insurance rule prohibition4 ,sec4 #bjc4 ,ensure plans provide comprehensive benefits4 ,sec4 #bjd4 ,providing for additional requirements with respect to the navigator program4 ,sec4 #bje4 ,federal ,exchange outreach and educational activities4 ,sec4 #bjf4 ,improve ,health ,insurance ,affordability ,fund4 ,sec4 #bjg4 ,providing that certain guidance related to waivers for ,state innovation under the ,patient ,protection and ,affordable ,care ,act shall have no force or effect4 ,title ,,iii--,state ,innovation and ,transparency ,sec4 #cja4 ,fund ,state health insurance education programs for consumers4 ,sec4 #cjb4 ,fund ,state innovations to expand coverage4 ,sec4 #cjc4 ,preserving ,state option to implement health care marketplaces4 ,sec4 #cjd4 ,promote transparency and accountability in the ,administration's expenditures of ,exchange user fees4 ,i ,expanding ,affordability #aja4 ,improve affordability and reduce premium costs for consumers 7a7 ,in general ,section #cf;,b7b77#c77;,a7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7,a7 ,applicable percentage ,the applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase1 on a sliding scale in a linear manner1 from the initial premium percentage to the final premium percentage specified in such table for such income tier3 ,in the case of household income 7expressed as a percent of poverty line7 within the following income tier3,the initial premiumpercentage is--,the final premium percentage is--,over #ajj4j percent up to #acc4j percent#j4ja4jacc4j percent up to #aej4j percent#a4jb4jaej4j percent up to #bjj4j percent#b4jd4jbjj4j percent up to #bej4j percent#d4jf4jbej4j percent up to #cjj4j percent#f4jg4jcjj4j percent up to #djj4j percent#g4jh4edjj4j percent and higher#h4eh4e 4 7b7 ,conforming amendment ,section #cf;,b7c77#a77;,a7 of the ,internal ,revenue ,code of #aihf is amended by striking but does not exceed #djj percent4 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjbj4 #ajb4 ,expand affordability for working families 7a7 ,in general ,clause 7i7 of section #cf;,b7c77#b77;,c7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7i7 ,coverage must be affordable 7,i7 ,employees ,an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b77 and the employee's required contribution 7within the meaning of section #ejjj;,a7e77#a77;,b77 with respect to the plan exceeds #i4e percent of the employee's household income4 7,,ii7 ,family members ,an individual who is eligible to enroll in an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b77 by reason of a relationship the individual bears to the employee shall not be treated as eligible for minimum essential coverage by reason of such eligibility to enroll if the employee's required contribution 7within the meaning of section #ejjj;,a7e77#a77;,b71 determined by substituting family for self-only7 with respect to the plan exceeds #i4e percent of the employee's household income4 4 7b7 ,conforming amendments 7#a7 ,clause 7ii7 of section #cf;,b7c77#b77;,c7 of the ,internal ,revenue ,code of #aihf is amended by striking ,except as provided in clause 7iii71 an employee and inserting ,an individual4 7#b7 ,clause 7iii7 of section #cf;,b7c77#b77;,c7 of such ,code is amended by striking the last sentence of clause 7i7 and inserting clause 7i77,,ii74 7#c7 ,clause 7iv7 of section #cf;,b7c77#b77;,c7 of such ,code is amended by striking the #i4e percent under clause 7i77,,ii7 and inserting the #i4e percent under clauses 7i77,i7 and 7i77,,ii74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjbj4 ,,ii ,undoing ,sabotage #bja4 ,protect comprehensive coverage for small businesses and workers ,the ,secretary of ,labor may not take any action to implement1 enforce1 or otherwise give effect to the rule entitled ,definition of ,employer ,under ,section #c7e7 of ,,erisa-,association ,health ,plans 7#hc ,fed4 ,reg4 #bhiab 7,june #ba1 #bjah771 and the ,secretary may not promulgate any substantially similar rule4 #bjb4 ,short-term limited duration insurance rule prohibition ,the ,secretary of ,health and ,human ,services1 the ,secretary of the ,treasury1 and the ,secretary of ,labor may not take any action to implement1 enforce1 or otherwise give effect to the rule entitled ,short-,term1 ,limited ,duration ,insurance 7#hc ,fed4 ,reg4 #chbab 7,august #c1 #bjah771 and the ,secretaries may not promulgate any substantially similar rule4 #bjc4 ,ensure plans provide comprehensive benefits 7a7 ,essential health benefits ,section #acjb7;b77#d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#d77 is amended-- 7#a7 in subparagraph 7,a71 by inserting and so that benefits are included within each of such categories before the semicolon2 7#b7 in subparagraph 7,g71 by striking at the end and2 7#c7 in subparagraph 7,h71 by striking the period at the end and inserting 2 and2 and 7#d7 by adding at the end the following new subparagraph3 7,i7 ensure that1 beginning ,january #a1 #bjbj-- 7i7 in the case of health benefits that are established as essential health benefits1 there shall not be substitution of such benefits across benefit categories2 7ii7 a qualified health plan shall not be treated as providing coverage for the essential health benefits unless under such plan-- 7,i7 coverage of prescription drugs provides for access to a wide variety of classes of drugs within the prescription drug formulary of such plan2 and 7,,ii7 in the case that a drug that is medically necessary for an enrollee under such plan is not included within such formulary1 such individual has access to such drug through an exceptions process established by the plan2 and 7iii7 habilitative services are covered at parity with rehabilitative services4 4 7b7 ,standard benefit plans ,section #acjb7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;d77 is amended by adding at the end the following new paragraph3 7#e7 ,standard benefit plans 7,a7 ,in general ,for purposes of providing individuals with the opportunity to make simpler comparisons of health plans offered by different health insurance issuers and simplify the selection process1 the ,secretary shall1 for each plan year beginning with plan year #bjbj1 through rulemaking1 specify a structure described in subparagraph 7,b77i7 for a standard benefit plan for such plan year for each of the bronze1 silver1 and gold levels of coverage and for each actuarial value variation of a silver plan resulting from the application of section #adjb7;c74 ,a standard benefit plan for a plan year for a level of coverage or actuarial value variation of a silver plan shall be modeled on the most commonly purchased plans 7determined by enrollments in such plans7 during the previous #b plan years offered in the federally facilitated ,exchange operated pursuant to section #acba7;c7 in such level or variation and shall include coverage of deductible-exempt services consistent with actual purchasing patterns of consumers in the previous two plan years4 7,b7 ,standard benefit plan ,for purposes of this paragraph1 the term standard benefit plan means a qualified health plan to be offered through an ,exchange on the individual market that has either-- 7i7 a standardized cost-sharing structure specified by the ,secretary pursuant to rulemaking2 or 7ii7 a standardized cost-sharing structure specified by the ,secretary pursuant to rulemaking that is modified by the health insurance issuer of such plan only to the extent necessary to align with high deductible health plan requirements under section #bbc of the ,internal ,revenue ,code of #aihf or the applicable annual limitation on cost sharing under subsection 7c7 and actuarial value requirements specified by the ,secretary4 4 #bjd4 ,providing for additional requirements with respect to the navigator program 7a7 ,in general ,section #acaa7;i7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;i77 is amended-- 7#a7 in paragraph 7#b71 by adding at the end the following new subparagraph3 7,c7 ,selection of recipients ,in the case of an ,exchange established and operated by the ,secretary within a ,state pursuant to section #acba7;c71 in awarding grants under paragraph 7#a71 the ,exchange shall-- 7i7 select entities to receive such grants based solely on an entity's demonstrated capacity to carry out each of the duties specified in paragraph 7#c72 7ii7 not take into account whether or not the entity has demonstrated how the entity will provide information to individuals relating to group health plans offered by a group or association of employers described in section #beaj4c-e7;b7 of title #bi1 ,code of ,federal ,regulations 7or any successor regulation71 or short-term limited duration insurance 7as defined by the ,secretary for purposes of section #bgia7;b77#e7 of the ,public ,health ,service ,act72 and 7iii7 ensure that1 each year1 the ,exchange awards such a grant to-- 7,i7 at least one entity described in this paragraph that is a community and consumer-focused nonprofit group2 and 7,,ii7 at least one entity described in subparagraph 7,b71 which may include another community and consumer-focused nonprofit group in addition to any such group awarded a grant pursuant to subclause 7,i74 2 7#b7 in paragraph 7#c7-- 7,a7 in subparagraph 7,c71 by inserting after qualified health plans the following3 1 ,state ,medicaid plans under title ,,xix of the ,social ,security ,act1 and ,state ,children's ,health ,insurance ,programs under title ,,xxi of such ,act2 and 7,b7 by adding at the end the following flush left sentence3 ,the duties specified in the preceding sentence may be carried out by such a navigator at any time during a year4 2 7#c7 in paragraph 7#d77;,a7-- 7,a7 in the matter preceding clause 7i71 by striking not2 7,b7 in clause 7i7-- 7i7 by inserting not before be2 and 7ii7 by striking 2 or and inserting 22 7,c7 in clause 7ii7-- 7i7 by inserting not before receive2 and 7ii7 by striking the period and inserting 22 and 7,d7 by adding at the end the following new clause3 7iii7 maintain physical presence in the ,state of the ,exchange so as to allow in-person assistance to consumers4 2 and 7#d7 in paragraph 7#f7-- 7,a7 by striking ,funding4--,grants under and inserting ,funding4-- 7,a7 ,state ,exchanges ,grants under 2 and 7,b7 by adding at the end the following new subparagraph3 7,b7 ,federal ,exchanges ,for purposes of carrying out this subsection1 with respect to an ,exchange established and operated by the ,secretary within a ,state pursuant to section #acba7;c71 the ,secretary shall obligate #ajj1jjj1jjj out of amounts collected through the user fees on participating health insurance issuers pursuant to section #aef4ej of title #de1 ,code of ,federal ,regulations 7or any successor regulations7 for fiscal year #bjbj and each subsequent fiscal year4 ,such amount for a fiscal year shall remain available until expended4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply with respect to plan years beginning on or after ,january #a1 #bjbj4 #bje4 ,federal ,exchange outreach and educational activities ,section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 is amended by adding at the end the following new paragraph3 7#c7 ,outreach and educational activities 7,a7 ,in general ,in the case of an ,exchange established or operated by the ,secretary within a ,state pursuant to this subsection1 the ,secretary shall carry out outreach and educational activities for purposes of informing potential enrollees in qualified health plans offered through the ,exchange of the availability of coverage under such plans and financial assistance for coverage under such plans4 ,such outreach and educational activities shall be provided in a manner that is culturally and linguistically appropriate to the needs of the populations being served by the ,exchange 7including hard-to-reach populations1 such as racial and sexual minorities1 limited ,english proficient populations1 and young adults74 7,b7 ,limitation on use of funds ,no funds appropriated under this paragraph shall be used for expenditures for promoting non-,,aca compliant health insurance coverage4 7,c7 ,non-aca compliant health insurance coverage ,for purposes of this subparagraph 7,b73 7i7 ,the term non-,,aca compliant health insurance coverage means health insurance coverage1 or a group health plan1 that is not a qualified health plan4 7ii7 ,such term includes the following3 7,i7 ,an association health plan4 7,,ii7 ,short-term limited duration insurance4 7,d7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are hereby appropriated for fiscal year #bjbj and each subsequent fiscal year1 #ajj1jjj1jjj to carry out this paragraph4 ,funds appropriated under this subparagraph shall remain available until expended4 4 #bjf4 ,improve ,health ,insurance ,affordability ,fund ,subtitle ,d of title ,i of the ,patient ,protection and ,affordable ,care ,act is amended by inserting after part #e 7#db ,u4,s4,c4 #ahjfa et seq47 the following new part3 #f ,improve ,health ,insurance ,affordability ,fund #acea4 ,establishment of program ,there is hereby established the ,improve ,health ,insurance ,affordability ,fund to be administered by the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this section referred to as the ,administrator71 to provide funding1 in accordance with this title1 to the #ej ,states and the ,district of ,columbia 7each referred to in this section as a ,state7 beginning on ,january #a1 #bjbj1 for the purposes described in section #aceb4 #aceb4 ,use of funds 7a7 ,in general ,a ,state shall use the funds allocated to the ,state under this part for one of the following purposes3 7#a7 ,to provide reinsurance payments to health insurance issuers with respect to individuals enrolled under individual health insurance coverage 7other than through a plan described in subsection 7b77 offered by such issuers4 7#b7 ,to provide assistance 7other than through payments described in paragraph 7#a77 to reduce out-of-pocket costs1 such as copayments1 coinsurance1 premiums1 and deductibles1 of individuals enrolled under qualified health plans offered on the individual market through an ,exchange4 7b7 ,exclusion of certain grandfathered and transitional plans ,for purposes of subsection 7a71 a plan described in this subsection is the following3 7#a7 ,a grandfathered health plan 7as defined in section #abea74 7#b7 ,a plan 7commonly referred to as a transitional plan7 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 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 ,february #ac1 #bjag1 and ,april #i1 #bjah1 or under any subsequent extensions thereof4 #acec4 ,state eligibility and approval2 ,default safeguard 7a7 ,encouraging ,state options for allocations 7#a7 ,in general ,to be eligible for an allocation of funds under this part for a year 7beginning with #bjbj71 a ,state shall submit to the ,administrator an application at such time 7but1 in the case of allocations for #bjbj1 not later than #ij days after the date of the enactment of this title and1 in the case of allocations for a subsequent year1 not later than ,march #ca of the previous year7 and in such form and manner as specified by the ,administrator containing-- 7,a7 a description of how the funds will be used2 and 7,b7 such other information as the ,administrator may require4 7#b7 ,automatic approval ,an application so submitted is approved unless the ,administrator notifies the ,state submitting the application1 not later than #fj days after the date of the submission of such application1 that the application has been denied for not being in compliance with any requirement of this part and of the reason for such denial4 7#c7 #e-year application approval ,if an application of a ,state is approved for a purpose described in section #aceb for a year1 such application shall be treated as approved for such purpose for each of the subsequent #d years4 7b7 ,default ,federal safeguard 7#a7 #bjbj ,for allocations made under this part for #bjbj1 in the case of a ,state that does not submit an application under subsection 7a7 by the #ij-;day submission date applicable to such year under subsection 7a77#a7 and in the case of a ,state that does submit such an application by such date that is not approved1 the ,administrator1 in consultation with the ,state insurance commissioner1 shall use1 in accordance with paragraph 7#c71 the allocation that would otherwise be provided to the ,state under this part for such year for such ,state4 7#b7 #bjba and subsequent years ,in the case of a ,state that does not have in effect an approved application under this section for #bjba or a subsequent year1 the ,administrator1 in consultation with the ,state insurance commissioner1 shall use1 in accordance with paragraph 7#c71 the allocation that would otherwise be provided to the ,state under this part for such year for such ,state4 7#c7 ,specified use ,an allocation for a ,state made pursuant to paragraph 7#a7 or 7#b7 for a year shall be used to carry out the purpose described in section #aceb7;a77#a7 in such ,state by providing reinsurance payments to health insurance issuers with respect to attachment range claims 7as defined in section #aced7;b77#b71 using the dollar amounts specified in subparagraph 7,b7 of such section for such year7 in an amount equal to the percentage 7specified for such year by the ,secretary under such subparagraph7 of the amount of such claims4 #aced4 ,allocations 7a7 ,appropriation ,for the purpose of providing allocations for ,states under this part there is appropriated1 out of any money in the ,treasury not otherwise appropriated #aj1jjj1jjj1jjj for #bjbj and each subsequent year4 7b7 ,allocations 7#a7 ,payment 7,a7 ,in general ,from amounts appropriated under subsection 7a7 for a year1 the ,secretary shall1 with respect to a ,state and not later than the date specified under subparagraph 7,b7 for such year1 allocate for such ,state the amount determined for such ,state and year under paragraph 7#b74 7,b7 ,specified date ,for purposes of subparagraph 7,a71 the date specified in this subparagraph is-- 7i7 for #bjbj1 the date that is #de days after the date of the enactment of this title2 and 7ii7 for #bjba or a subsequent year1 ,january #a of the respective year4 7,c7 ,notifications of allocation amounts ,for #bjba and each subsequent year1 the ,secretary shall notify each ,state of the amount determined for such ,state under paragraph 7#b7 for such year by not later than ,january #a of the previous year4 7#b7 ,allocation amount determinations 7,a7 ,in general ,for purposes of paragraph 7#a71 the amount determined under this paragraph for a year for a ,state is the amount that the ,secretary estimates would be expended under this part for such year on attachment range claims of individuals residing in such ,state if all ,states used such funds only for the purpose described in paragraph 7#a7 of section #aceb at the dollar amounts and percentage specified under subparagraph 7,b7 for such year4 ,for purposes of the previous sentence and section #acec7;b77#c71 the term attachment range claims means1 with respect to an individual1 the claims for such individual that exceed a dollar amount specified by the ,secretary for a year1 but do not exceed a ceiling dollar amount specified by the ,secretary for such year1 under subparagraph 7,b74 7,b7 ,specifications ,for purposes of subparagraph 7,a7 and section #acec7;b77#c71 the ,secretary shall determine the dollar amounts and the percentage to be specified under subparagraph 7,a7 for a year in a manner to ensure that the total amount of expenditures under this part for such year is estimated to equal the total amount appropriated for such year under subsection 7a7 if such expenditures were used solely for the purpose described in paragraph 7#a7 of section #aceb7;a7 for attachment range claims at the dollar amounts and percentage so specified for such year4 7#c7 ,availability ,funds allocated to a ,state under this subsection for a year shall remain available through the end of the subsequent year4 7c7 ,annual distribution of previous year's remaining funds 7#a7 ,in general ,in carrying out subsection 7b71 the ,secretary shall1 with respect to a year 7beginning with #bjba71 not later than ,march #ca of such year-- 7,a7 determine the amount of funds1 if any1 from the amounts appropriated under subsection 7a7 for the previous year but not allocated for such previous year2 and 7,b7 if the ,secretary determines that any funds were not so allocated for such previous year1 allocate such remaining funds to ,states for such year1 in accordance with paragraph 7#b74 7#b7 ,allocation methodology ,for purposes of paragraph 7#a71 of the total remaining funds to be allocated for a year pursuant to such paragraph1 the ,secretary shall allocate to each ,state an amount that bears the same ratio to such total remaining funds as the amount allocated pursuant to subsection 7b7 to such ,state for such year bears to the total allocations made under such subsection for such year4 4 #bjg4 ,providing that certain guidance related to waivers for ,state innovation under the ,patient ,protection and ,affordable ,care ,act shall have no force or effect ,beginning ,april #a1 #bjai1 the ,secretary of ,health and ,human ,services and the ,secretary of the ,treasury may not take any action to implement1 enforce1 or otherwise give effect to the guidance entitled ,state ,relief and ,empowerment ,waivers 7#hc ,fed4 ,reg4 #ecege 7,october #bd1 #bjah771 and the ,secretaries may not promulgate any substantially similar guidance or rule4 ,,iii ,state ,innovation and ,transparency #cja4 ,fund ,state health insurance education programs for consumers ,section #bgic7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ic7;e77 is amended by adding at the end the following new paragraph3 7#c7 ,appropriations ,for purposes of carrying out this section1 there is hereby appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 #ajj1jjj1jjj for each of the fiscal years #bjbj through #bjbb4 ,such amount shall remain available until expended4 4 #cjb4 ,fund ,state innovations to expand coverage 7a7 ,in general ,subject to subsection 7d71 the ,secretary of ,health and ,human ,services shall award grants to eligible ,state agencies to enable such ,states to explore innovative solutions to promote greater enrollment in health insurance coverage in the individual and small group markets1 including activities described in subsection 7c74 7b7 ,eligibility ,for purposes of subsection 7a71 eligible ,state agencies are ,exchanges established by a ,state under title ,i of the ,patient ,protection and ,affordable ,care ,act and ,state agencies with primary responsibility over health and human services for the ,state involved4 7c7 ,use of funds ,for purposes of subsection 7a71 the activities described in this subsection are the following3 7#a7 ,state efforts to streamline health insurance enrollment procedures in order to reduce burdens on consumers and facilitate greater enrollment in health insurance coverage in the individual and small group markets1 including automatic enrollment and reenrollment of1 or pre-populated applications for1 individuals without health insurance who are eligible for tax credits under section #cf;,b of the ,internal ,revenue ,code of #aihf1 with the ability to opt out of such enrollment4 7#b7 ,state investment in technology to improve data sharing and collection for the purposes of facilitating greater enrollment in health insurance coverage in such markets4 7#c7 ,implementation of a ,state version of an individual mandate to be enrolled in health insurance coverage4 7#d7 ,feasibility studies to develop comprehensive and coherent ,state plan for increasing enrollment in the individual and small group market4 7d7 ,funding ,for purposes of carrying out this section1 there is hereby appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #bjj1jjj1jjj for each of the fiscal years #bjbj through #bjbb4 ,such amount shall remain available until expended4 #cjc4 ,preserving ,state option to implement health care marketplaces 7a7 ,in general ,section #acaa of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#d77;,b71 by striking under this subsection and inserting under this paragraph or paragraph 7#a72 and 7,b7 by adding at the end the following new paragraph3 7#f7 ,additional planning and establishment grants 7,a7 ,in general ,there shall be appropriated to the ,secretary1 out of any moneys in the ,treasury not otherwise appropriated1 #bjj1jjj1jjj to award grants to eligible ,states for the uses described in paragraph 7#c74 7,b7 ,duration and renewability ,a grant awarded under subparagraph 7,a7 shall be for a period of two years and may not be renewed4 7,c7 ,limitation ,a grant may not be awarded under subparagraph 7,a7 after ,december #ca1 #bjbb4 7,d7 ,eligible ,state defined ,for purposes of this paragraph1 the term eligible ,state means a ,state that1 as of the date of the enactment of this paragraph1 is not operating an ,exchange4 2 and 7#b7 in subsection 7d77#e77;,a7-- 7,a7 by striking ,in establishing an ,exchange under this section and inserting 7i7 ,in general4--,in establishing an ,exchange under this section 7other than in establishing an ,exchange pursuant to subsection 7a77#f772 and 7,b7 by adding at the end the following3 7ii7 ,additional planning and establishment grants ,in establishing an ,exchange pursuant to subsection 7a77#f71 the ,state shall ensure that such ,exchange is self-sustaining beginning on ,january #a1 #bjbd1 including allowing the ,exchange to charge assessments or user fees to participating health insurance issuers1 or to otherwise generate funding1 to support its operations4 4 7b7 ,clarification regarding failure ,to establish ,exchange or implement requirements ,section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c771 as amended by section #bje1 is further amended-- 7#a7 in paragraph 7#a71 by striking ,if and inserting ,subject to paragraph 7#d71 if2 and 7#b7 by adding at the end the following new paragraph3 7#d7 ,clarification ,this subsection shall not apply in the case of a ,state that elects to apply the requirements described in subsection 7a7 and satisfies the requirement described in subsection 7b7 on or after ,january #a1 #bjad4 4 #cjd4 ,promote transparency and accountability in the ,administration's expenditures of ,exchange user fees ,for each of plan years #bjah1 #bjai1 and #bjbj1 not later than the date that is #c months after the end of such plan year1 the ,secretary of ,health and ,human ,services shall submit to the appropriate committees of ,congress and make available to the public an annual report on the expenditure by the ,department of ,health and ,human ,services of user fees collected pursuant to section #aef4ej of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 ,each such report for a plan year shall include a detailed accounting of the amount of such user fees collected during such plan year and of the amount of such expenditures used during such plan year for the federally facilitated ,exchange operated pursuant to section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 on outreach and enrollment activities1 navigators1 maintenance of ,healthcare4gov1 and operation of call centers4