,i #aafth ,,congress #ast ,session ,h4 ,r4 #dfeb ,,in ,,the ,,house ,,of ,,representatives ,october #aa1 #bjai,mr4 ,langevin 7for himself1 ,ms4 ,judy ,chu of ,california1 and ,mr4 ,ruiz7 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 establish an ,individual ,market ,reinsurance fund to provide funding for ,state individual market stabilization reinsurance programs4 #a4 ,short title ,this ,act may be cited as the ,individual ,health ,insurance ,marketplace ,improvement ,act4 #b4 ,individual ,market ,reinsurance ,fund 7a7 ,establishment of ,fund 7#a7 ,in general ,there is established the ,individual ,market ,reinsurance ,fund 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 ,there is appropriated to the ,fund1 out of any moneys in the ,treasury not otherwise appropriated1 such sums as are necessary to carry out this section 7other than subsection 7c77 for each calendar year beginning with #bjbj4 ,amounts appropriated to the ,fund shall remain available without fiscal or calendar year limitation to carry out this section4 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 payments 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 #bjbj 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 subsection 7a7 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 case of the #bjbj1 #bjba1 or #bjbb 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 #bjbj1 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 #bjbj 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 ,outreach and enrollment 7#a7 ,in general ,during the period that begins on ,january #a1 #bjbj1 and ends on ,december #ca1 #bjbb1 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 encourage enrollment in1 qualified health plans4 7,b7 ,assisting individuals transition to qualified health plans ,to provide assistance to individuals who are enrolled in health insurance coverage that is not a qualified health plan enroll in a qualified health plan4 7,c7 ,assisting enrollment in public health programs ,to facilitate the enrollment of eligible individuals in the ,medicare program or in a ,state ,medicaid program1 as appropriate4 7,d7 ,raising awareness of premium assistance and cost-sharing reductions ,to distribute fair and impartial information concerning enrollment in qualified health plans 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 defined 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 in qualified health plans4 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 qualified individuals or employees of a qualified employer in a qualified health plan4 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 #bjbj through #bjbb1 to carry out this subsection4 7d7 ,reports to ,congress 7#a7 ,annual report ,the ,secretary shall submit a report to ,congress1 not later than ,january #ba1 #bjba1 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 #bjbd1 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 7e7 ,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