,i #aafth ,,congress #b;d ,session ,h4 ,r4 #hdgc ,,in ,,the ,,house ,,of ,,representatives ,october #a1 #bjbj,mr4 ,gonzalez of ,ohio 7for himself and ,mr4 ,westerman7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 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 ,internal ,revenue ,code of #aihf to consolidate health accounts into ,medisave ,accounts1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,family ,first ,medisave ,empowerment ,act4 #b4 ,medisave ,accounts 7a7 ,in general ,part ,,viii of subchapter ,f of chapter #a of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ecj;,a4 ,medisave ,accounts 7a7 ,medisave account ,for purposes of this section-- 7#a7 ,in general ,the term ,medisave account means a trust created or organized in the ,united ,states as a ,medisave account exclusively for the purpose of paying the qualified medical expenses of the account beneficiary1 but only if the written governing instrument creating the trust meets the following requirements3 7,a7 ,except in the case of a rollover contribution described in subparagraph 7,a7 or 7,b7 of subsection 7e77#e71 no contribution will be accepted-- 7i7 unless it is in cash1 7ii7 to the extent such contribution1 when added to previous contributions to the trust for the calendar year1 exceeds the limitation amount specified in subsection 7b77#a71 or 7iii7 to the extent such contribution1 when added to the balance of the account1 exceeds the limitation amount specified in subsection 7b77#b74 7,b7 ,the trustee is a bank 7as defined in section #djh7n771 an insurance company 7as defined in section #haf71 or another person who demonstrates to the satisfaction of the ,secretary that the manner in which such person will administer the trust will be consistent with the requirements of this section4 7,c7 ,no part of the trust assets will be invested in life insurance contracts4 7,d7 ,the assets of the trust will not be commingled with other property except in a common trust fund or common investment fund4 7,e7 ,the interest of an individual in the balance in his account is nonforfeitable4 7#b7 ,qualified medical expenses 7,a7 ,in general ,the term qualified medical expenses means1 with respect to an account beneficiary1 amounts paid by such beneficiary for medical care1 but only to the extent such amounts are not compensated for by insurance or otherwise-- 7i7 for-- 7,i7 such individual1 7,,ii7 the spouse of such individual1 7,,iii7 any dependent 7as defined in section #aeb1 determined without regard to subsections 7b77#a71 7b77#b71 and 7d77#a77;,b7 thereof7 of such individual1 and 7,,iv7 any individual who bears a relationship to the account beneficiary that is described in subparagraph 7,c7 or 7,d7 of section #aeb7;d7 if the account beneficiary is or was a dependent of such individual for any taxable year ending before or with the taxable year in which the individual attained #ah years of age1 and 7ii7 if1 on the date such medical care was provided1 such individual1 spouse or dependent to whom such care was provided was covered under the qualified health insurance of the account beneficiary4 7,b7 ,modified definition of medical care ,for purposes of subparagraph 7,a71 the term medical care has the meaning given such term by section #bac7;d71 except that such term includes-- 7i7 direct pay arrangements with primary physicians1 and 7ii7 predetermined level of access to care from an integrated health plan4 7#c7 ,account beneficiary ,the term account beneficiary means the individual on whose behalf the ,medisave account was established4 7#d7 ,certain rules to apply ,rules similar to the following rules shall apply for purposes of this section3 7,a7 ,section #bai7;d77#b7 7relating to no deduction for rollovers74 7,b7 ,section #bai7;f77#c7 7relating to time when contributions deemed made74 7,c7 ,except as provided in section #ajf7;d71 section #bai7;f77#e7 7relating to employer payments74 7,d7 ,section #djh7;g7 7relating to community property laws74 7,e7 ,section #djh7;h7 7relating to custodial accounts74 7b7 ,limitations 7#a7 ,annual limitation 7,a7 ,in general ,the limitation amount specified in this paragraph is-- 7i7 #aj1jjj in the case of a qualified health plan with an actuarial value of less than #ee percent1 7ii7 #h1fjj in the case of a qualified health plan with an actuarial value that is #ee percent or more and less than #fe percent1 and 7iii7 #g1bjj in the case of a qualified health plan with an actuarial value that is #fe percent or more4 7,b7 ,actuarial value of qualified health plan ,for purposes of subparagraph 7,a71 the actuarial value of a qualified health plan is the percentage of the total average costs of covered benefits under the health plan4 7#b7 ,account accumulation limitation ,the limitation amount specified in this paragraph is #ej1jjj4 7#c7 ,indexing 7,a7 ,in general ,in the case of any taxable year beginning in a calendar year after #bjbj1 each dollar amount contained in paragraph 7#a77;,a7 shall be increased by the medical care cost adjustment of such amount for such calendar year4 7,b7 ,medical care cost adjustment ,for purposes of subparagraph 7,a71 the medical care cost adjustment for any calendar year is the percentage 7if any7 by which-- 7i7 the medical care component of the ,c-,,cpi-,u 7as defined in section #a7;f77#f77 for ,august of the preceding calendar year1 exceeds 7ii7 such component of the ,c-,,cpi-,u 7as so defined7 for ,august of #bjai4 7,c7 ,rounding 7i7 ,annual limitation ,if any increase in a dollar amount contained in paragraph 7#a77;,a7 determined under subparagraph 7,a7 is not a multiple of #ajj1 such increase shall be rounded to the nearest multiple of #ajj4 7ii7 ,account limitation ,if any increase in the dollar amount contained in paragraph 7#b7 determined under subparagraph 7,a7 is not a multiple of #a1jjj1 such increase shall be rounded to the nearest multiple of #a1jjj4 7#d7 ,coordination with other contributions ,the limitation which would 7but for this paragraph7 apply under paragraphs 7#a7 and 7#b7 to an individual for any taxable year shall be reduced 7but not below zero7 by the sum of-- 7,a7 the aggregate amount contributed to ,medisave accounts of such individual which is excludable from the taxpayer's gross income for such taxable year under section #ajf7;d71 and 7,b7 the aggregate amount contributed to ,medisave accounts of such individual for such taxable year under section #djh7;d77#i74 7#e7 ,deposit of advance premium tax credit ,an account beneficiary who is eligible for an advance payment of the premium tax credit may elect to have the ,secretary deposit the advance payment into the ,medisave account of the account beneficiary4 7c7 ,definitions and special rules ,for purposes of this section-- 7#a7 ,eligible individual 7,a7 ,in general ,the term eligible individual means1 with respect to any month1 any individual if such individual is covered under a qualified health plan as of the #ast day of such month4 7,b7 ,certain coverage disregarded ,subparagraph 7,a7 shall be applied without regard to-- 7i7 coverage for any benefit provided by permitted insurance1 and 7ii7 coverage 7whether through insurance or otherwise7 for accidents1 disability1 dental care1 vision care1 or long-term care4 7,c7 ,special rule for individuals eligible for certain veterans benefits ,an individual shall not fail to be treated as an eligible individual for any period merely because the individual receives hospital care or medical services under any law administered by the ,secretary of ,veterans ,affairs for a service-connected disability 7within the meaning of section #aja7af7 of title #ch1 ,united ,states ,code74 7#b7 ,qualified health plan 7,a7 ,in general ,the term qualified health plan means a health plan that offers health insurance coverage4 ,such term includes entitlement to benefits under title ,,xviii or title ,,xix of the ,social ,security ,act4 7,b7 ,exclusion of certain plans ,such term does not include a health plan if substantially all of its coverage is disregarded under paragraph 7#a77;,b74 7,c7 ,health insurance coverage ,the term health insurance coverage means benefits consisting of medical care 7provided directly1 through insurance or reimbursement1 or otherwise and including items and services paid for as medical care7 under any hospital or medical service policy or certificate1 hospital or medical service plan contract1 or health maintenance organization contract offered by a health insurance issuer4 7,d7 ,health insurance issuer ,the term health insurance issuer means an insurance company1 insurance service1 or insurance organization 7including a health maintenance organization7 which is licensed to engage in the business of insurance in a ,state and which is subject to ,state law which regulates insurance 7within the meaning of section #ead7;b77#b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aadd7;b77#b774 7,e7 ,health maintenance organization ,the term health maintenance organization means-- 7i7 a ,federally qualified health maintenance organization 7as defined in section #acja7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;e7a771 7ii7 an organization recognized under ,state law as a health maintenance organization1 or 7iii7 a similar organization regulated under ,state law for solvency in the same manner and to the same extent as such a health maintenance organization4 7#c7 ,permitted insurance ,the term permitted insurance means-- 7,a7 insurance if substantially all of the coverage provided under such insurance relates to-- 7i7 liabilities incurred under workers' compensation laws1 7ii7 tort liabilities1 7iii7 liabilities relating to ownership or use of property1 or 7iv7 such other similar liabilities as the ,secretary may specify by regulations1 7,b7 insurance for a specified disease or illness1 and 7,c7 insurance paying a fixed amount per day 7or other period7 of hospitalization4 7#d7 ,family coverage ,the term family coverage means any coverage other than self-only coverage4 7d7 ,tax treatment of accounts 7#a7 ,in general ,a ,medisave account is exempt from taxation under this subtitle unless such account has ceased to be a ,medisave account4 ,notwithstanding the preceding sentence1 any ,medisave account is subject to the taxes imposed by section #eaa 7relating to imposition of tax on unrelated business income of charitable1 etc4 organizations74 7#b7 ,account terminations ,rules similar to the rules of paragraphs 7#b7 and 7#d7 of section #djh7;e7 shall apply to ,medisave accounts1 and any amount treated as distributed under such rules shall be treated as not used to pay qualified medical expenses4 7e7 ,tax treatment of distributions 7#a7 ,amounts used for qualified medical expenses ,any amount paid or distributed out of a ,medisave account which is used exclusively to pay qualified medical expenses of any account beneficiary shall not be includible in gross income4 7#b7 ,inclusion of amounts not used for qualified medical expenses ,any amount paid or distributed out of a ,medisave account which is not used exclusively to pay the qualified medical expenses of the account beneficiary shall be included in the gross income of such beneficiary4 7#c7 ,excess contributions returned before due date of return 7,a7 ,in general ,if any excess contribution is contributed for a taxable year to any ,medisave account of an individual1 paragraph 7#b7 shall not apply to distributions from the ,medisave accounts of such individual 7to the extent such distributions do not exceed the aggregate excess contributions to all such accounts of such individual for such year7 if-- 7i7 such distribution is received by the individual on or before the last day prescribed by law 7including extensions of time7 for filing such individual's return for such taxable year1 and 7ii7 such distribution is accompanied by the amount of net income attributable to such excess contribution4 ,any net income described in clause 7ii7 shall be included in the gross income of the individual for the taxable year in which it is received4 7,b7 ,excess contribution ,for purposes of subparagraph 7,a71 the term excess contribution means any contribution 7other than a rollover contribution described in paragraph 7#e77 which exceeds the limitations specified in subsection 7b74 7#d7 ,additional tax on distributions not used for qualified medical expenses 7,a7 ,in general ,the tax imposed by this chapter on the account beneficiary for any taxable year in which there is a payment or distribution from a ,medisave account of such beneficiary which is includible in gross income under paragraph 7#b7 shall be increased by #bj percent of the amount which is so includible4 7,b7 ,exception for disability or death ,subparagraph 7,a7 shall not apply if the payment or distribution is made after the account beneficiary becomes disabled within the meaning of section #gb7m77#g7 or dies4 7#e7 ,rollover contribution 7,a7 ,in general ,an amount is described in this subparagraph as a rollover contribution if it meets the requirements of clauses 7i7 and 7ii74 7i7 ,in general ,paragraph 7#b7 shall not apply to any amount paid or distributed from a ,medisave account to the account beneficiary to the extent the amount received is paid into a ,medisave account for the benefit of such beneficiary not later than the #fjth day after the day on which the beneficiary receives the payment or distribution4 7ii7 ,limitation ,this paragraph shall not apply to any amount described in clause 7i7 received by an individual from a ,medisave account if1 at any time during the #a-year period ending on the day of such receipt1 such individual received any other amount described in clause 7i7 from a ,medisave account which was not includible in the individual's gross income because of the application of this paragraph4 7,b7 ,rollover from ,,fsa1 ,archer ,,msa1 and ,,hsa ,an amount is described in this subparagraph for a calendar year as a rollover contribution if the amount is the remaining balance in a flexible spending account1 ,archer ,,msa1 or health savings account that is contributed to the ,medisave account for a taxable year ending on or before one year after the date of the enactment of the ,family ,first ,medisave ,empowerment ,act4 7#f7 ,coordination with medical expense deduction ,for purposes of determining the amount of the deduction under section #bac1 any payment or distribution out of a ,medisave account for qualified medical expenses shall not be treated as an expense paid for medical care4 7#g7 ,transfer of account incident to divorce ,the transfer of an individual's interest in a ,medisave account to an individual's spouse or former spouse under a divorce or separation instrument described in clause 7i7 of section #aba7;d77#c77;,c7 shall not be considered a taxable transfer made by such individual notwithstanding any other provision of this subtitle1 and such interest shall1 after such transfer1 be treated as a ,medisave account with respect to which such spouse is the account beneficiary4 7#h7 ,treatment after death of account beneficiary 7,a7 ,treatment if designated beneficiary is spouse ,if the account beneficiary's surviving spouse acquires such beneficiary's interest in a ,medisave account by reason of being the designated beneficiary of such account at the death of the account beneficiary1 such ,medisave account shall be treated as if the spouse were the account beneficiary4 7,b7 ,other cases 7i7 ,in general ,if1 by reason of the death of the account beneficiary1 any person acquires the account beneficiary's interest in a ,medisave account in a case to which subparagraph 7,a7 does not apply-- 7,i7 such account shall cease to be a ,medisave account as of the date of death1 and 7,,ii7 an amount equal to the fair market value of the assets in such account on such date shall be includible if such person is not the estate of such beneficiary1 in such person's gross income for the taxable year which includes such date1 or if such person is the estate of such beneficiary1 in such beneficiary's gross income for the last taxable year of such beneficiary4 7ii7 ,special rules 7,i7 ,reduction of inclusion for predeath expenses ,the amount includible in gross income under clause 7i7 by any person 7other than the estate7 shall be reduced by the amount of qualified medical expenses which were incurred by the decedent before the date of the decedent's death and paid by such person within #a year after such date4 7,,ii7 ,deduction for estate taxes ,an appropriate deduction shall be allowed under section #fia7;c7 to any person 7other than the decedent or the decedent's spouse7 with respect to amounts included in gross income under clause 7i7 by such person4 7f7 ,reports ,the ,secretary may require-- 7#a7 the trustee of a ,medisave account to make such reports regarding such account to the ,secretary and to the account beneficiary with respect to contributions1 distributions1 the return of excess contributions1 and such other matters as the ,secretary determines appropriate1 and 7#b7 any person who provides an individual with a qualified health plan to make such reports to the ,secretary and to the account beneficiary with respect to such plan as the ,secretary determines appropriate4 ,the reports required by this subsection shall be filed at such time and in such manner and furnished to such individuals at such time and in such manner as may be required by the ,secretary4 7g7 ,regulations and guidance ,for purposes of this section1 the ,secretary shall prescribe such regulations or other guidance as the ,secretary determines necessary or appropriate to carry out this section1 including regulations or guidance on the methods acceptable to the ,secretary for determining qualified health plan actuarial value4 4 7b7 ,treatment of employer payments 7#a7 ,exclusion limited to self-funded major medical plan of employers ,section #aje7;b7 of such ,code is amended by striking paid1 and inserting paid under a self-funded major medical plan of the employer4 7#b7 ,exclusion not applicable to health reimbursement arrangements ,subsection 7h7 of such ,code is amended to read as follows3 7h7 ,exclusion not applicable to health reimbursement arrangements ,subsection 7b7 shall not apply to health reimbursement arrangements4 4 7#c7 ,repeal of exclusions from income for ,archer ,m,s,as1 ,f,s,as1 and ,h,s,as 7,a7 ,in general ,section #ajf of such ,code is amended-- 7i7 by striking subsections 7b71 7d71 and 7e71 and 7ii7 by redesignating subsections 7f7 and 7g7 as subsections 7d7 and 7e71 respectively4 7,b7 ,exclusion from income for ,medisave accounts ,section #ajf of such ,code1 as amended by subparagraph 7,a71 is amended by inserting after subsection 7a7 the following3 7b7 ,contributions to ,medisave accounts 7#a7 ,in general ,in the case of an employee who is an eligible individual 7as defined in section #ecj;,a7c77#a771 amounts contributed by such employee's employer to any ,medisave account 7as defined in section #ecj;,a7a77 of such employee shall be treated as employer-provided coverage for medical expenses under an accident or health plan to the extent such amounts do not exceed the limitations specified in clauses 7ii7 and 7iii7 of section #ecj;,a7a77#a77;,a7 7determined without regard to this subsection7 which is applicable to such employee for such taxable year4 7#b7 ,no constructive receipt ,no amount shall be included in the gross income of any employee solely because the employee may choose between the contributions referred to in paragraph 7#a7 and employer contributions to another health plan of the employer4 7#c7 ,special rule for deduction of employer contributions ,any employer contribution to a ,medisave account1 if otherwise allowable as a deduction under this chapter1 shall be allowed only for the taxable year in which paid4 7#d7 ,employer ,medisave account contributions required to be shown on return ,every individual required to file a return under section #fjab for the taxable year shall include on such return the aggregate amount contributed by employers to the ,medisave accounts of such individual or such individual's spouse for such taxable year4 7#e7 ,medisave account contributions not part of ,,cobra coverage ,paragraph 7#a7 shall not apply for purposes of section #dihj;,b4 7#f7 ,cross reference ,for penalty on failure by employer to make comparable contributions to the ,medisave accounts of comparable employees1 see section #dihj;,g4 4 7#d7 ,distribution from certain retirement accounts for ,medisave account funding ,section #djh7;d77#i7 of such ,code is amended to read as follows3 7#i7 ,distribution for ,medisave account funding 7,a7 ,in general ,in the case of an individual who is an eligible individual 7as defined in section #ecj;,a7c77#a77 and who elects the application of this paragraph for a taxable year1 gross income of the individual for the taxable year does not include a qualified ,medisave account funding distribution to the extent such distribution is otherwise includible in gross income4 7,b7 ,qualified ,medisave account funding distribution ,for purposes of this paragraph1 the term qualified ,medisave account funding distribution means a distribution from an individual retirement plan 7other than a plan described in subsection 7k7 or 7p77 of the employee to the extent that-- 7i7 such distribution is contributed to the ,medisave account of the individual in a direct trustee-to-trustee transfer1 and 7ii7 such distribution-- 7,i7 when added to previous contributions to the ,medisave account for the calendar year does not exceed the limitation amount specified in section #ecj;,a7b77#a71 and 7,,ii7 when added to the balance of the ,medisave account1 exceeds the limitation amount specified in section #ecj;,a7b77#b74 7,c7 ,one-time transfer ,an individual may make an election under subparagraph 7,a7 only for one qualified ,medisave account funding distribution during the lifetime of the individual4 ,such an election1 once made1 shall be irrevocable4 7,d7 ,application of section #gb ,notwithstanding section #gb1 in determining the extent to which an amount is treated as otherwise includible in gross income for purposes of subparagraph 7,a71 the aggregate amount distributed from an individual retirement plan shall be treated as includible in gross income to the extent that such amount does not exceed the aggregate amount which would have been so includible if all amounts from all individual retirement plans were distributed4 ,proper adjustments shall be made in applying section #gb to other distributions in such taxable year and subsequent taxable years4 4 7#e7 ,failure of employer to make comparable contributions 7,a7 ,section #dihj;,g7a7 of such ,code is amended by striking health savings account and inserting ,medisave account4 7,b7 ,section #dihj;,g7c7 of such ,code is amended by striking ,archer ,m,s,as and health savings accounts and inserting ,medisave accounts4 7#f7 ,w-#b statements ,section #fjea7;a7 of such ,code is amended-- 7,a7 by striking paragraph 7#aa7 and redesignating paragraphs 7#ab7 through 7#ag7 as paragraphs 7#aa7 through 7#af71 respectively1 and 7,b7 by amending paragraph 7#aa71 as so redesignated1 to read as follows3 7#aa7 the amount contributed to any ,medisave account 7as defined in section #ecj;,a7 of such employee or such employee's spouse1 4 7c7 ,other conforming amendments 7#a7 ,archer ,m,s,as ,section #bbj7;a7 of such ,code is amended by adding at the end the following3 ,no amount is allowed as a deduction under the preceding sentence for any taxable year beginning after one year after the date of the enactment of ,family ,first ,medisave ,empowerment ,act44 7#b7 ,health savings accounts ,section #bbc7;a7 of such ,code is amended by adding at the end the following3 ,no amount is allowed as a deduction under the preceding sentence for any taxable year beginning after one year after the date of the enactment of the ,family ,first ,medisave ,empowerment ,act44 7d7 ,rollover of ,,fsa1 ,archer ,,msa1 ,,hsa to ,medisave account ,notwithstanding any other provision of law1 if the remaining balance in a health flexible spending arrangement1 ,archer ,,msa1 or ,health ,savings ,account is transferred to a ,medisave account before the end of any taxable year ending on or before one year after the date of the enactment of the ,family ,first ,medisave ,empowerment ,act1 such transfer shall be treated as a rollover to the ,medisave account under section #ecj;,a7e77#e77;,b7 of the ,internal ,revenue ,code of #aihf and the distribution from the health flexible spending arrangement1 ,archer ,,msa1 or ,health ,savings ,account shall not be includible in gross income4 7e7 ,clerical amendments ,the table of sections for part ,,viii of subchapter ,f of chapter #a of such ,code is amended by adding at the end the following new item3 ,sec4 #ecj;,a4 ,medisave ,accounts4 4 7f7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after one year after the date of the enactment of this ,act4 #c4 ,tax credit for contributions to ,medisave account during first year 7a7 ,in general ,in the case of an individual who makes a contribution to a ,medisave account before the end of the #a-year period beginning on the date of the enactment of this ,act1 there shall be allowed as a credit against the tax imposed by subtitle ,a of the ,internal ,revenue ,code of #aihf for the taxable year in which the contribution is made an amount equal to the aggregate of #a for every #c contributed to the account 7other than a rollover contribution under section #ecj;,a7e77#e7 of such ,code7 for such taxable year4 7b7 ,limitation ,the aggregate amount allowed to an individual as a credit under subsection 7a7 for all taxable years shall not exceed #a1jjj4 7c7 ,portion of credit refundable ,for purposes of this section-- 7#a7 ,in general ,for purposes of the ,internal ,revenue ,code of #aihf1 in the case of an eligible individual-- 7,a7 ,increase in credit rate ,subsection 7a7 shall be applied by substituting #a for every #a contributed for #a for every #c contributed4 7,b7 ,credit refundable ,the credit allowed under this section shall be treated in the same manner as a credit allowed under subpart ,c of part ,,iv of subchapter ,a of chapter #a of such ,code4 7#b7 ,eligible individual 7,a7 ,in general ,the term eligible individual means1 with respect to any taxable year1 a taxpayer whose household income for the taxable year does not exceeds #djj percent of an amount equal to the poverty line for a family of the size involved4 7,b7 ,married couples must file joint return ,if the taxpayer is married 7within the meaning of section #ggjc of such ,code7 at the close of the taxable year-- 7i7 the taxpayer shall be treated as an eligible individual only if the taxpayer and the taxpayer's spouse file a joint return for the taxable year1 and 7ii7 paragraph 7#a7 shall be applied separately to each spouse4 7#c7 ,family size1 household income1 modified adjusted gross income1 poverty line ,the terms family size1 household income1 modified adjusted gross income1 and poverty line have the meaning given such terms by section #cf;,b7d7 of such ,code4 7d7 ,denial of credit to dependents ,no credit shall be allowed under this section to any individual with respect to whom a deduction under section #aea is allowable to another taxpayer for a taxable year beginning in the calendar year in which such individual's taxable year begins4 #d4 ,alternative waiver for ,state innovation2 cost-sharing reduction payments 7a7 ,alternative waiver for ,state innovation ,section #accb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjeb7 is amended by adding at the end the following new subsection3 7f7 ,alternative waiver for ,state innovation 7#a7 ,in general ,notwithstanding any preceding provision of this section1 a ,state may apply to the ,secretary for the waiver of any requirement of subsection 7a77#b7 with respect to health insurance coverage within that ,state for plan years beginning on or after ,january #a1 #bjbb1 if instead of complying with section #adjb the ,state provides for the distribution of funding received under paragraph 7#b7 to ,medisave accounts of qualifying individuals with respect to such ,state4 ,such application shall be filed at such time and in such manner as the ,secretary may require1 and shall include such information as the ,secretary may require 7including a #aj-year budget plan for such plan that is budget neutral for the ,federal ,government74 7#b7 ,pass-through funding ,with respect to a ,state waiver under paragraph 7#a71 under which1 due to the structure of such waiver1 individuals in the ,state would not qualify for cost-sharing reductions under section #adjb for which they would otherwise be eligible1 the ,secretary shall provide for an alternative means by which an amount is transferred to the ,state equal to the aggregate amount of such reductions that would have been paid on behalf of the participants in the ,exchanges established under this title-- 7,a7 had the ,state not received such waiver2 7,b7 had references to eligible insureds under section #adjb referred to qualifying insureds 7as defined in section #accb7;f772 and 7,c7 had1 after application of clause 7ii71 in the case of a qualifying insured enrolled in the bronze level of coverage-- 7i7 the percentages specified in subclauses 7,i71 7,,ii71 and 7,,iii7 of section #adjb7;c77#a77;,b7 were references to #hd percent1 #gg percent1 and #fc percent1 respectively2 and 7ii7 the references in subparagraphs 7,a71 7,b71 and 7,c7 of section #adjb7;c77#b7 to #id percent1 #hg percent1 and #gc percent1 respectively1 were references to #hd percent1 #gg percent1 and #fc percent1 respectively4 ,the amount transferred pursuant to the previous sentence shall be determined annually by the ,secretary1 taking into consideration the experience of other ,states with respect to participation in an ,exchange and reductions provided under such provisions to residents of the other ,states1 and shall be paid to the ,state for purposes of implementing such waiver4 7#c7 ,waiver consideration and transparency ,the provisions of paragraph 7#d7 of subsection 7a7 shall apply to an application for a waiver under paragraph 7#a7 in the same manner as such provisions apply with respect to an application for a waiver under subsection 7a77#a71 except that1 for purposes of this paragraph1 the provisions of subsection 7a77#d77;,b77ii7 shall not apply4 7#d7 ,determinations2 term of waiver ,the provisions of subsections 7d7 and 7e7 shall apply with respect to a determination with respect to an application under paragraph 7#a71 and with respect to the term of a waiver under such paragraph1 in the same manner as such provisions apply with respect to a determination with respect to an application under subsection 7a77#a71 and with respect to the term of a waiver under such subsection4 7#e7 ,definitions ,for purposes of this subsection3 7,a7 ,medisave account ,the term ,medisave account has the meaning given such term in section #ecj;,a7a7 of the ,internal ,revenue ,code of #aihf4 7,b7 ,qualifying insured ,the term qualifying insured means1 with respect to a ,state and a year1 an individual-- 7i7 who is enrolled in a ,medisave account2 7ii7 who is enrolled for such year in a silver level or bronze level coverage offered through an ,exchange2 and 7iii7 whose household income is not less than #ajj percent but not more than #bej percent of the ,federal poverty line for a family of the size involved4 4 7b7 ,conforming amendments ,section #accb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjeb71 as amended by subsection 7a71 is further amended in subsection 7a77#d7-- 7#a7 in subparagraph 7,a7 by striking the period and inserting 1 except in the case of a waiver described in subsection 7f742 and 7#b7 in subparagraph 7,b77ii7 by inserting after an application the following3 7except in the case of a waiver described in subsection 7f774 7c7 ,appropriation for cost-,sharing payments ,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 7#a7 ,appropriations ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated such sums as may be necessary to1 subject to paragraph 7#b71 provide health benefits coverage through payment to issuers 7under this section or through advance payment by the ,secretary of the ,treasury under section #adab7;c77#c77 of the amounts computed under this section for each of plan years #bjbb through #bjbf4 7#b7 ,adjustments ,notwithstanding any other provision of law1 payments and other actions for adjustments to obligations incurred prior to ,december #ca1 #bjbb1 may be made through ,december #ca1 #bjbb4 7#c7 ,limitation ,amounts appropriated under paragraph 7#a7 for each of plan years #bjbb through #bjbf are subject to the requirements and limitations under sections #ejf and #ejg of division ,h of ,public ,law #aae-ca in the same manner and to the same extent as if such amounts for each such year were appropriated under such division4 4 #e4 ,grants for ,medisave assistance and outreach 7a7 ,in general ,the ,administrator shall establish a grant program to provide assistance to eligible entities to carry out the activities described in subsection 7c74 7b7 ,application ,an eligible entity shall submit an application to the ,administrator in such time and in such manner as the ,administrator may require1 providing that such application requires a demonstration of the existence of a relationship with1 or the ability to establish a relationship with1 an employer1 employee1 self-employed individual1 or consumer eligible to enroll in a ,medisave account4 7c7 ,use of funds ,an eligible entity receiving a grant under this section shall use such funds to-- 7#a7 distribute fair and impartial information to consumers about ,medisave accounts1 including the availability of such accounts and how such accounts may be utilized2 7#b7 conduct activities to raise public awareness of ,medisave accounts2 7#c7 facilitate enrollment in ,medisave accounts2 and 7#d7 refer individuals enrolled in a ,medisave account to the appropriate official1 organization1 or ,state agency for the purpose of addressing a complaint1 grievance1 or other question with respect to such ,medisave account4 7d7 ,amount ,the ,administrator may distribute up to #e1jjj1jjj annually to be divided among grant recipients under this section4 7e7 ,report ,not later than one year after the date on which the last of the grant periods awarded under this section ends1 the ,administrator shall submit a report to the ,congress on the effectiveness of the grants provided under this section4 7f7 ,definitions ,in this section3 7#a7 ,administrator ,the term ,administrator means the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7#b7 ,consumer ,the term consumer means an individual enrolled in1 or seeking to enroll in1 a ,medisave account4 7#c7 ,eligible entity ,the term eligible entity includes the following3 7,a7 ,a ,state4 7,b7 ,trade4 7,c7 ,industry4 7,d7 ,professional associations4 7,e7 ,commercial fishing industry organizations4 7,f7 ,ranching and farming organizations4 7,g7 ,community and consumer-focused nonprofit groups4 7,h7 ,chambers of commerce4 7,i7 ,unions4 7,j7 ,small business development centers 7as defined in section #ba of the ,small ,business ,act 7#ae ,u4,s4,c4 #fdh774 7,k7 ,other entities capable of carrying out the activities described under subsection 7b74 7#d7 ,medisave account ,the term ,medisave account has the meaning given such term in section #ecj;,a7a7 of the ,internal ,revenue ,code of #aihf 7as added by section #b7;a774 7#e7 ,state ,the term ,state means each of the several ,states1 the ,district of ,columbia1 each territory and possession of the ,united ,states1 and each federally recognized ,indian ,tribe4