,i #aaf? ,,congress #a/ ,session ,h4 ,r4 #dibe ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,octob] #cj1 #bjai,mr4 ,huiz5ga introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,education & ,labor1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to require ! ,secret>y ( ,heal? & ,human ,s]vices to aw>d grants to support community-bas$ cov]age entities to c>ry out a cov]age program t provides to qualify+ individuals heal? cov]age & educational & occupational tra9+1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,community ,multi-%>e ,cov]age ,program ,act4 #b4 ,grants to community-bas$ cov]age entities to c>ry out a cov]age program t provides heal? cov]age & educational & occupational tra9+ 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ! ,community ,multi-%>e ,cov]age ,program ,act1 ! ,secret>y %all aw>d at lea/ #c & n m ?an #e grants to support community-bas$ cov]age entities to c>ry out qualify+ cov]age b5efit pilot programs4 ,su* programs %all-- 7#a7 r$uce ! numb] ( un9sur$ individuals ?r\gh hospital-community p>tn]%ip initiatives t provide an af=dable heal? cov]age option = su* individuals & provide a cov]age transition = ^? limit$ to cov]age ?r\gh gov]nm5t-sponsor$ programs2 & 7#b7 te/ ! feasibility ( mov+ individuals eligible = m$ical assi/ance "u a ,/ate plan "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 ) full-"t employm5t into su* programs4 7b7 ,qualify+ cov]age b5efit program requirem5ts ,= purposes ( ?is section1 ! t]m qualify+ cov]age b5efit program means a program t satisfies ea* ( ! foll[+ program requirem5ts3 7#a7 ,heal? cov]age ,"u ! program1 a community-bas$ cov]age entity %all provide to qualify+ individuals heal? cov]age (f]$ 9 connection ) a qualify+ cov]age b5efit program t satisfies ! foll[+3 7,a7 ,fir/-doll> cov]age 7:]e su* cov]age is furni%$ by network provid]s & community res\rces7 =-- 7i7 diagno/ic laboratory te/s & x-rays2 7ii7 em]g5cy ambulance s]vices t are provid$ by gr\nd transportation2 7iii7 em]g5cy s]vices 7z def9$ 9 section #bgai;,a7b77#b77;,b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7b77#b77;,b7772 7iv7 inpati5t & outpati5t hospital s]vices2 7v7 m5tal heal? s]vices2 7vi7 physician s]vices2 7vii7 population heal? improvem5t s]vices2 7viii7 prev5tatives s]vices2 7ix7 prescription drugs2 & 7x7 sub/ance abuse s]vices4 7,b7 ,cov]age =-- 7i7 community & individual assessm5t tools to id5tify any negative influ5ces ( heal? & economic self-suffici5cy to assi/ physicians 9 und]/&+ ! social det]m9ants ( heal? impact+ an individual2 7ii7 a plann+ process to resolve any negative influ5ces id5tifi$ pursuant to clause 7i7 & promote well-be+ ?r\gh community p>tn]%ips betwe5 ! community-bas$ cov]age entity &-- 7,i7 bus9esses2 7,,ii7 educational in/itutions2 7,,iii7 inve/ors2 7,,iv7 local1 ,/ate1 & ,f$]al gov]nm5tal ag5cies2 & 7,v7 organizations describ$ 9 section #eja7;c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf t focuses on human s]vice ne$s relat+ to behavioral heal?1 pov]ty1 education1 & access & safety2 7iii7 ! monitor+ ( & support 7includ+ heal? coa*+ s]vices & coord9ation ( s]vices )9 a community to address ! ne$s ( an individual7 ) respect to f9ancial1 emotional1 & physical heal?2 & 7iv7 any o!r b5efit ! community-bas$ cov]age entity det]m9es appropriate4 7#b7 ,educational & occupational tra9+ ,"u ! program1 a community-bas$ cov]age entity %all-- 7,a7 connect & fo/] ongo+ relation%ips betwe5 qualify+ individuals & educational & occupational tra9+ 7includ+ classes1 work%ops1 m5tor%ips1 & appr5tice%ips7 design$ to enhance prep>ation = "w & support economic self-suffici5cy 9 a mann] t reflects ! ne$s ( su* individuals & opportunities 9 ! community2 7,b7 ) respect to ! compreh5sive heal? improvem5t process describ$ 9 subsection 7e77#a77;,c77vi71 id5tify & address b>ri]s to employm5t & increas+ income = qualify+ individuals2 & 7,c7 measure & assess ! effectiv5ess ( ! program 9 increas+ employm5t & increas+ income = qualify+ individuals4 7#c7 ,bo>d ( directors ,= ! purpose ( c>ry+ out ! program1 ! community-bas$ cov]age entity %all =m a bo>d ( directors1 or utilize an exi/+ bo>d ( directors1 9 accordance ) subsection 7e74 7c7 ,community-,bas$ cov]age entity ,= ! purposes ( ?is section1 ! t]m community-bas$ cov]age entity means an entity t ma9ta9s a physical pres5ce )9 close geographic proximity to ! individuals x is s]v+1 ) a focus on mitigat+ b>ri]s to engagem5t by enabl+ face-to-face int]actions betwe5 ! entity /aff1 ! individuals s]v$1 & community organizations4 7d7 ,qualify+ individual ,= ! purposes ( ?is section1 ! t]m qualify+ individual means an individual :o meets ! foll[+ requirem5ts3 7#a7 ,subject to any modification made by su* program pursuant to subsection 7e77#b77;,c77vii71 an income t exce$s #ajj p]c5t b does n exce$ #djj p]c5t ( ! pov]ty l9e applicable to a family ( ! size involv$4 7#b7 ,n enroll$ "u a qualifi$ heal? plan dur+ ! #ahj-;day p]iod prec$+ ! date on :i* su* qualify+ individual seeks to enroll "u ! cov]age program "u ?is section4 7#c7 ,ineligibility = enrollm5t 9 a ,f$]al heal? c>e program 7includ+ ineligibility to receive heal? s]vices ?r\gh ! ,indian ,heal? ,s]vice74 7#d7 ,resides or works )9 ! cat*m5t area ( a hospital describ$ 9 subsection 7g77#b77;,c74 7#e7 ,works = a small employ] t does n make enrollm5t 9 qualifi$ heal? plans 9 ! small gr\p m>ket su* t ! comb9$ premium plus d$uctible co/ to cov] ! employee's h\sehold is less ?an sev5 p]c5t ( ! employee's h\sehold income available to its employees ?r\gh-- 7,a7 9 ! case t a ,/ate elects to provide "o ex*ange 9 ! ,/ate = bo? qualify+ individuals & qualifi$ small employ]s pursuant to p>agraph 7#b7 ( section #acaa7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;b771 ! ,am]ican ,heal? ,b5efit ,ex*ange 7z su* t]m is us$ 9 p>agraph 7#a7 ( su* section7 = ! plan ye> 9 :i* su* qualify+ individual seeks heal? insurance cov]age describ$ 9 subsection 7b77#a7 f a qualify+ cov]age b5efit program2 & 7,b7 9 ! case t a ,/ate reta9s sep>ate ex*anges = qualify+ individuals & qualifi$ small employ]s1 ! ,small ,bus9ess ,heal? ,options ,program 7z su* t]m is us$ 9 section #acaa7;b77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;b77#b777 = ! plan ye> 9 :i* su* qualify+ individual seeks heal? insurance cov]age describ$ 9 subsection 7b77#a7 f a qualify+ cov]age b5efit program4 7#f7 ,any o!r requirem5t ! ,secret>y det]m9es appropriate4 7e7 ,bo>d ( directors 7#a7 ,composition ,a bo>d ( directors =m$ pursuant to subsection 7b77#c7 %all be compos$ ( at lea/ #i memb]s & n m ?an #ae memb]s ) repres5tation f-- 7,a7 local heal? c>e provid]s1 ( :i* n m ?an two individuals may be f ! sponsor+ heal? c>e organization2 7,b7 qualify+ individuals2 7,c7 contribut+ employ]s2 7,d7 gov]nm5t repres5tatives2 7,e7 ! local heal? au?ority2 7,f7 local education sy/ems2 & 7,g7 o!r repres5tatives z necess>y to reflect ! community composition4 7#b7 ,duties 7,a7 ,enactm5t ( bylaws ,a bo>d ( directors %all enact bylaws relat+ to-- 7i7 public engagem5t ) ! bo>d ( directors2 7ii7 a %>$ goal ( improv+ heal? access & increas+ af=dability2 7iii7 outcome-bas$ goals = ! program t consid]s ! ne$s ( ! community2 7iv7 program co/s2 & 7v7 an int5t to receive comm5ts reg>d+ ! heal? improvem5t goals = ! community4 7,b7 ,meet+s ,a bo>d ( directors %all meet at lea/ bimon?ly4 7,c7 ,qualify+ cov]age b5efits program ,a bo>d ( directors %all-- 7i7 c>ry out ! qualify+ cov]age b5efit program describ$ 9 subsection 7b72 7ii7 det]m9e ! %>e ( paym5ts = b5efits "u ! heal? cov]age describ$ 9 subsection 7b77#a7 t are attributable to-- 7,i7 ! am\nt aw>d$ to a community-bas$ cov]age entity2 7,,ii7 a sponsor+ heal? c>e organization2 7,,iii7 a qualify+ individual2 & 7,,iv7 an employ] ( a qualify+ individual or a skill$ trade organization ( a qualify+ individual2 7iii7 det]m9e ! premiums & limitations on paym5ts 7includ+ d$uctibles & co9surance am\nts7 = ! heal? cov]age describ$ 9 subsection 7b77#a7 = a qualify+ individual enroll$ "u su* cov]age & ! ext5t1 if any1 to :i* su* premiums & limitations = a qualify+ individual %all increase z ! income ( su* qualify+ individual increases relative to ! pov]ty l9e applicable to a family ( ! size involv$2 7iv7 e/abli% a proc$ure to-- 7,i7 assi/ qualify+ individuals 9 enroll+ "u ! heal? cov]age describ$ 9 subsection 7b77#a72 7,,ii7 assi/ a qualify+ individual t does n meet ! requirem5ts ( a qualifi$ individual specifi$ "u subsection 7d71 is eligible = m$ical assi/ance "u a ,/ate plan "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 & resides 9 ! cat*m5t area ( ! hospital describ$ 9 subsection 7g77#b77;,c7 9 enroll+ "u ! appropriate ,/ate plan "u su* program2 7,,iii7 bill & collect ! %>e ( paym5ts = b5efits describ$ 9 clause 7ii72 7,,iv7 bill & collect ! premiums & limitations on paym5t describ$ 9 clause 7iii72 7,v7 = ! purposes ( integrat+ community res\rces1 =m p>tn]%ips ) community population heal? initiatives2 7,,vi7 remove a qualify+ individual f ! heal? insurance cov]age describ$ 9 subsection 7b77#a7 9 ! case ! qualify+ individual-- 7aa7 has be5 enroll$ "u ! qualify+ cov]$ b5efits program = a #d-ye> p]iod2 & 7bb7 fails to meet ! mile/ones id5tifi$ pursuant to clause 7vi72 & 7,,vii7 det]m9e a maximum enrollm5t p]iod = individual p>ticipation1 includ+ requir$ mile/ones = address+ social det]m9ants ( heal? :ile enroll$2 7v7 = ! purpose ( enc\rag+ a qualify+ individual to seek a prim>y c>e physician1 e/abli% inc5tives = a qualify+ individual to initially seek su* physician = c>e 7includ+ ! r$uction ( b5efits until a prim>y c>e physician is engag$ 9 ! c>e ( su* qualify+ individual72 7vi7 = ! purpose ( mak+ progress t[>d heal? & economic self-suffici5cy1 e/abli% r\t9e mile/ones & supportive s]vices 7to be kn[n z ! compreh5sive heal? improvem5t process7 t a qualify+ individual enroll$ "u heal? cov]age describ$ 9 subsection 7b77#a7 %all meet to ma9ta9 enrollm5t & su* mile/ones %all include-- 7,i7 an assessm5t relat+ to social det]m9ants ( heal?1 heal? risks1 & any o!r assessm5t t is appropriate z det]m9$ by ! circum/ances ( ! qualify+ individual2 7,,ii7 meet+s ) a heal? coa* to address social influ5ces ( heal? & to support ! physical1 emotional1 & f9ancial heal? ( ! qualify+ individual2 7,,iii7 connections ) local community l9kage p>tn]s to (f] heal?-relat$ programs & s]vices2 & 7,,iv7 enrollm5t 9 gr\p classes t address b>ri]s to physical1 emotional1 & f9ancial heal?2 7vii7 = ! purpose ( tailor+ a qualify+ cov]age b5efits program to ! ne$s & res\rces ( ! cat*m5t area ( ! hospital describ$ 9 subsection 7g77#b77;,c71 det]m9e ! ext5t1 if any1 to n>r[ ! income range specifi$ 9 subsection 7d77#a7 ) respect to fir/-"t enrollees & cont9u+ enrollees2 7viii7 incorporate population heal? improvem5t /rategies into ! b5efits ( heal? cov]age describ$ 9 subsection 7b77#a71 includ+ /rategies t align ) ! objectives ( ! program ( ! ,secret>y reg>d+ heal?-/atus goals = #bjbj1 commonly ref]r$ to z ,heal?y ,p #bjbj2 7ix7 select a plan adm9i/rator pursuant to subsection 7g77#b77;,e7 to c>ry out adm9i/rative & acc\nt+ responsibilities ( ! heal? cov]age describ$ 9 subsection 7b77#a72 & 7x7 conduct a community asset assessm5t to det]m9e ! s]vices to be made available 9 ! community to address social det]m9ants ( heal? & ! eligibility requirem5ts = su* s]vices4 7#c7 ,advisory committee ,a bo>d ( directors %all e/abli% a f9ance advisory committee & a cl9ical & population heal? improvem5t advisory committee4 7f7 ,grant t]ms 7#a7 ,duration ,a grant aw>d$ "u ?is section %all be made = a p]iod ( #d ye>s4 7#b7 ,am\nt ,! ,secret>y %all det]m9e ! maximum am\nt ( ea* grant aw>d$ "u subsection 7a74 7#c7 ,numb] ,! ,secret>y may n aw>d m ?an #d grants "u subsection 7a74 7g7 ,applications 7#a7 ,9 g5]al ,to be eligible to be aw>d$ a grant "u subsection 7a71 a community-bas$ cov]age entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ ! c]tification describ$ 9 p>agraph 7#b7 & su* o!r in=mation z ! ,secret>y may require4 7#b7 ,c]tification ,an application describ$ 9 p>agraph 7#a7 %all include a c]tification by ! community-bas$ cov]age entity t ! entity w-- 7,a7 n impose any preexi/+ condition exclusion 7z su* t]m is def9$ 9 section #bgjd7;b77#a77;,a77 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#c7;b77#a77;,a77 ) respect to ! heal? cov]age describ$ 9 subsection 7b77#a72 7,b7 n lat] ?an #b ye>s aft] ! date on :i* a grant is aw>d$ "u subsection 7a71 e/abli% a plan to measure quality & effici5cy ( c>e provid$ "u ! cov]age program2 7,c7 p>tn] ) a hospital t w e/abli% a network ( heal? c>e provid]s suffici5t to provide s]vices to qualify+ individuals enroll$ "u ! heal? insurance cov]age describ$ 9 subsection 7b77#a72 7,d7 seek to provide to #g p]c5t ( individuals ^: h\sehold income is m ?an #cjj p]c5t ( ! pov]ty l9e = a family ( ! size involv$ & less ?an ! basic co/ ( liv+ 7z det]m9$ 9 a mann] consi/5t ! ,asset ,limit$1 ,income ,con/ra9$1 ,employ$ or ,,alice me?odology t det]m9es ! co/ ( a basic h\sehold budget 9 ! c\nty ( a ,/ate 9 :i* ! cat*m5t area ( ! hospital describ$ 9 subp>agraph 7,c7 heal? cov]age describ$ 9 subsection 7b77#a7 is locat$7 = ! size ( ! family involv$ liv+ 9 su* cat*m5t area2 & 7,e7 select an entity to c>ry out adm9i/rative & acc\nt+ responsibilities 7includ+ mon?ly bill+1 v]ification ( eligibility ( qualify+ individuals1 enrollm5t ( qualify+ individuals1 ma9t5ance ( a li/ ( active enrollees1 & op]ation ( a b5efit utilization managem5t program7 necess>y ) respect to ! heal? insurance cov]age describ$ 9 subsection 7b77#a74 7h7 ,report+ ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is section & annually = ea* ( ! #c succe$+ ye>s1 ! bo>d ( directors =m$ pursuant to subsection 7b77#c7 %all submit to ! ,secret>y a report t-- 7#a7 evaluates ! progress ( ! qualify+ cov]age b5efits program2 & 7#b7 evaluates measurem5ts relat+ to quality & effici5cy ( c>e describ$ 9 subsection 7g77#b77;,b7 collect$ by ! community-bas$ cov]age entity4 7i7 ,def9itions ,9 ?is section3 7#a7 ,ag5cy ,! t]m ag5cy means a local1 ,/ate1 or ,f$]al ag5cy4 7#b7 ,f$]al heal? c>e program ,! t]m ,f$]al heal? c>e program has ! mean+ giv5 su* t]m 9 section #aabh;,b7f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f774 7#c7 ,fir/ doll> cov]age ,! t]m fir/ doll> cov]age means cov]age ( a b5efit by heal? cov]age describ$ 9 subsection 7b77#a7 )\t requir+ any paym5t by ! qualify+ individual4 7#d7 ,heal? coa* ,! t]m heal? coa* means an individual :o is a memb] ( ! /aff ( ! community-bas$ cov]age entity t has receiv$ tra9+ to provide heal? coa*+ s]vices 7includ+ heal? improvem5t program s]vices74 7#e7 ,hospital ,! t]m hospital means an in/itution t-- 7,a7 meets ! requirem5ts ( section #ahfa7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7e772 & 7,b7 is an organization describ$ 9 p>agraphs 7c77#c7 & 7r77#c7 ( section #eja ( ! ,int]nal ,rev5ue ,code ( #aihf & is exempt f taxation "u section #eja7;a7 ( su* ,code4 7#f7 ,population heal? improvem5t s]vice 7,a7 ,9 g5]al ,! t]m population heal? improvem5t s]vice means a s]vice t supports ! physical1 emotional1 & f9ancial heal? ( a qualify+ individual ?r\gh-- 7i7 heal? coa*+ t-- 7,i7 id5tifies any social det]m9ant ( heal? t prev5ts a qualify+ individual f obta9+ physical1 emotional1 & f9ancial heal?2 7,,ii7 develops a p]sonaliz$ plan to improve ! physical1 emotional1 & f9ancial heal? ( a qualify+ individual bas$ on ! circum/ances & heal? doma9 score ( su* qualify+ individual2 & 7,,iii7 measures & evaluates ! heal? doma9 score ( an individual2 7ii7 heal? education c\rses2 & 7iii7 integrat$ community l9kage p>tn]%ips ) organizations s]v+ ! cat*m5t area ( a hospital describ$ 9 subsection 7g77#b77;,c7 t provide heal? programs & s]vices to qualify+ individuals t-- 7,i7 support a qualify+ individual ) respect to any appropriate social det]m9ant ( heal?2 & 7,,ii7 support a qualify+ individual 9 job ret5tion1 includ+ jobs 9 *ildc>e & transportation4 7,b7 ,heal? doma9 score def9$ ,9 ?is p>agraph1 ! t]m heal? doma9 score means a measurem5t ( specific influ5ces ( physical1 emotional1 & f9ancial heal? ) respect to a qualify+ individual4 7#g7 ,qualifi$ heal? plan ,! t]m qualifi$ heal? plan has ! mean+ giv5 su* t]m 9 section #acja7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba7;a774 7#h7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#i7 ,small ,bus9ess ,heal? ,options ,program ,! t]m ,small ,bus9ess ,heal? ,options ,program has ! mean+ giv5 su* t]m 9 section #acaa7;b77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;b77#b774 7#aj7 ,small employ] ,! t]m small employ] has ! mean+ giv5 su* t]m 9 section #acjd7;b77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbd7;b77#b774 7#aa7 ,social det]m9ants ( heal? ,! t]m social det]m9ants ( heal? has ! mean+ giv5 su* t]m by ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7j7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section-- 7#a7 #d1hjj1jjj = fiscal ye> #bjbj2 7#b7 #g1bjj1jjj = fiscal ye> #bjba2 & 7#c7 #ab1jjj1jjj = ea* ( fiscal ye>s #bjbb & #bjbc4