,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #ajcc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #d1 #bjai,mr4   
,:iteh\se 7= himself1 ,mr4 ,br[n1 ,ms4  
,baldw91 ,mr4 ,durb91 ,mr4 ,m55dez1 &   
,ms4 ,h>ris7 introduc$ ! foll[+ bill2   
:i* 0 read twice & ref]r$ to !          
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions  ,a ,,bill  ,to am5d 
! ,public ,heal? ,s]vice ,act to e/abli%
 a public heal? insurance option1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,consum] ,heal?        
,options & ,insurance ,competition      
,enhancem5t ,act or ! ,,*oice ,act4  #b4
 ,public heal? insurance option  7a7 ,9 
g5]al ,"p ,c ( title ,,xxvii ( ! ,public
 ,heal? ,s]vice ,act 7#db ,u4,s4,c4     
#cjj;gg-#ia7 is am5d$ by add+ at ! end !
 foll[+3  #bgie4 ,public heal? insurance
 option  7a7 ,e/abli%m5t  7#a7 ,9 g5]al 
,= plan ye>s beg9n+ 9 #bjbj1 ! ,secret>y
 %all e/abli%1 & provide = ! (f]+ ?r\gh 
! ,ex*anges1 ( a qualifi$ heal? plan 79 
?is ,act ref]r$ to z ! public heal?     

insurance option7 t provides value1     
*oice1 competition1 & /ability (        
af=dable1 high-quality cov]age ?r\gh\t !
 ,unit$ ,/ates 9 accordance ) ?is       
section4  7#b7 ,prim>y responsibility ,9
 design+ ! public heal? insurance       
option1 ! prim>y responsibility ( !     
,secret>y %all be to create an af=dable 
heal? plan )\t compromis+ quality or    
access to c>e4  7b7 ,adm9i/rat+ ! public
 heal? insurance option  7#a7 ,(f]$     
?r\gh ,ex*anges  7,a7 ,exclusive to     
,ex*anges ,! public heal? insurance     
option %all be made available ?r\gh !   
,ex*anges4  7,b7 ,ensur+ a level play+  
field ,consi/5t ) ?is section1 ! public 
heal? insurance option %all--  7i7      
comply ) requirem5ts "u title ,i ( !    
,pati5t ,protection & ,af=dable ,c>e    
,act1 & ! am5dm5ts made by t title1 t   
are applicable to heal? plans (f]$ ?r\gh
 ! ,ex*anges1 includ+ provid] networks1 
notices1 consum] protections1 & co/-%>+2
 &  7ii7 provide a b5efit package t is  
compreh5sive & meets ! heal? c>e ne$s ( 

pati5ts1 includ+ b5efits describ$ 9     
section #acjb7;b7 ( ! ,pati5t           
,protection & ,af=dable ,c>e ,act4  7,c7
 ,preemption ,not)/&+ section           
#acjc7;a77#a7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act1 a ,/ate law t      
prohibits ! public heal? insurance      
option f (f]+ ! cov]age describ$ 9      
subp>agraph 7,b7 %all be preempt$4  7,d7
 ,provision ( b5efit levels ,! public   
heal? insurance option %all (f] silv] & 
gold plans & may (f] bronze plans4  7#b7
 ,adm9i/rative contract+  7,a7          
,au?orities ,! ,secret>y may ent] into  
contracts = ! purpose ( p]=m+           
adm9i/rative functions 7includ+         
functions describ$ 9 subsection 7a77#d7 
( section #ahgd;,a ( ! ,social ,security
 ,act7 ) respect to ! public heal?      
insurance option 9 ! same mann] z !     
,secret>y may ent] into contracts "u    
subsection 7a77#a7 ( su* section4 ,!    
,secret>y %all h ! same au?ority )      
respect to ! public heal? insurance     
option z ! ,secret>y has "u su*         

subsection 7a77#a7 & subsection 7b7 (   
section #ahgd;,a ( ! ,social ,security  
,act ) respect to title ,,xviii ( su*   
,act4  7,b7 ,transf] ( insurance risk   
,any contract "u ?is p>agraph %all n    
involve ! transf] ( insurance risk f !  
,secret>y to ! entity ent]+ into su*    
contract ) ! ,secret>y4  7#c7 ,/ate     
,advisory ,c\ncil  7,a7 ,e/abli%m5t ,a  
,/ate may e/abli% a public or nonpr(it  
entity to s]ve z ! ,/ate ,advisory      
,c\ncil to provide recomm5dations to !  
,secret>y on ! op]ations & policies ( ! 
public heal? insurance option (f]$ ?r\gh
 ! ,ex*ange op]at+ 9 ! ,/ate4  7,b7     
,recomm5dations ,a ,/ate ,advisory      
,c\ncil e/abli%$ "u subp>agraph 7,a7    
%all provide recomm5dations on at lea/ !
 foll[+3  7i7 ,policies & proc$ures to  
integrate quality improvem5t & co/      
conta9m5t me*anisms into ! heal? c>e    
deliv]y sy/em4  7ii7 ,me*anisms to      
facilitate public aw>5ess ( !           
availability ( ! public heal? insurance 
option4  7iii7 ,alt]native paym5t models

 & value-bas$ insurance design "u !     
public heal? insurance option t enc\rage
 quality improvem5t & co/ control4  7,c7
 ,memb]s ,! memb]s ( any ,/ate ,advisory
 ,c\ncil %all be repres5tatives ( !     
public & include heal? c>e consum]s &   
heal? c>e provid]s4  7,d7 ,applicability
 ( recomm5dations ,! ,secret>y may apply
 ! recomm5dations ( a ,/ate ,advisory   
,c\ncil to ! public heal? insurance     
option 9 t ,/ate1 9 any o!r ,/ate1 or 9 
all ,/ates4  7#d7 ,data collection ,!   
,secret>y %all collect su* data z may be
 requir$-- 7,a7 to e/abli% rates =      
premiums & heal? c>e provid]            
reimbursem5t "u subsection 7c72 &  7,b7 
= o!r purposes "u ?is section1 includ+  
to improve quality1 & r$uce racial1     
e?nic1 socioeconomic1 & o!r disp>ities1 
9 heal? & heal? c>e4  7c7 ,f9anc+ !     
public heal? insurance option  7#a7     
,premiums  7,a7 ,e/abli%m5t ,! ,secret>y
 %all e/abli% geographically adju/$     
premium rates = ! public heal? insurance
 option--  7i7 9 a mann] t complies ) ! 

requirem5t = premium rates "u           
subp>agraph 7,c7 & consid]s ! data      
collect$ "u subsection 7b77#d72 &  7ii7 
at a level suffici5t to fully f9ance--  
7,i7 ! co/s ( heal? b5efits provid$ by !
 public heal? insurance option2 &       
7,,ii7 adm9i/rative co/s relat$ to      
op]at+ ! public heal? insurance option4 
7,b7 ,cont+5cy m>g9 ,9 e/abli%+ premium 
rates "u subp>agraph 7,a71 ! ,secret>y  
%all include an appropriate am\nt = a   
cont+5cy m>g94  7,c7 ,v>iations 9       
premium rates ,! premium rate *>g$ = !  
public heal? insurance option may n v>y 
except z provid$ "u section #bgja4  7#b7
 ,heal? c>e provid] paym5t rates = items
 & s]vices  7,a7 ,9 g5]al  7i7 ,rates   
negotiat$ by ! ,secret>y ,n lat] ?an    
,janu>y #a1 #bjbj1 & except z provid$ 9 
clause 7ii71 ! ,secret>y %all1 ?r\gh a  
negotiat$ agreem5t ) heal? c>e provid]s1
 e/abli% rates = reimburs+ heal? c>e    
provid]s = provid+ ! b5efits cov]$ by ! 
public heal? insurance option4  7ii7    
,m$ic>e reimbursem5t rates ,if !        

,secret>y & heal? c>e provid]s are      
unable to rea* a negotiat$ agreem5t on a
 reimbursem5t rate1 ! ,secret>y %all    
reimburse provid]s at rates det]m9$ =   
equival5t items & s]vices "u ! orig9al  
,m$ic>e fee-=-s]vice program "u p>ts ,a 
& ,b ( title ,,xviii ( ! ,social        
,security ,act4  7iii7 ,= new s]vices ,!
 ,secret>y %all modify reimbursem5t     
rates describ$ 9 clause 7ii7 9 ord] to  
accommodate paym5ts = s]vices1 su* z    
well-*ild visits1 t are n o!rwise cov]$ 
"u ! orig9al ,m$ic>e fee-=-s]vice       
program4  7,b7 ,prescription drugs ,any 
paym5t rate "u ?is subsection = a       
prescription drug %all be at a rate     
negotiat$ by ! ,secret>y4 ,if !         
,secret>y is unable to rea* a negotiat$ 
agreem5t on su* a reimbursem5t rate1 !  
,secret>y %all use rates det]m9$ =      
equival5t drugs paid = "u ! orig9al     
,m$ic>e fee-=-s]vice program4 ,!        
,secret>y %all modify su* rates 9 ord]  
to accommodate paym5ts = drugs t are n  
o!rwise cov]$ "u ! orig9al ,m$ic>e      

fee-=-s]vice program4  7#c7 ,acc\nt     
7,a7 ,e/abli%m5t ,!re is e/abli%$ 9 !   
,treasury ( ! ,unit$ ,/ates an acc\nt = 
! receipts & disbursem5ts attributable  
to ! op]ation ( ! public heal? insurance
 option1 includ+ ! />tup fund+ "u       
subp>agraph 7,c7 & appropriations       
au?oriz$ "u subp>agraph 7,d74  7,b7     
,prohibition ( ,/ate imposition ( taxes 
,section #ahed7;g7 ( ! ,social ,security
 ,act %all apply to receipts &          
disbursem5ts describ$ 9 subp>agraph 7,a7
 9 ! same mann] z su* section applies to
 paym5ts or premiums describ$ 9 su*     
section4  7,c7 ,/>tup fund+  7i7        
,au?orization ( fund+ ,!re are au?oriz$ 
to be appropriat$ su* sums z may be     
necess>y to e/abli% ! public heal?      
insurance option & cov] #ij days (      
claims res]ves bas$ on project$         
enrollm5t4  7ii7 ,amortization ( />tup  
fund+ ,! ,secret>y %all provide = !     
repaym5t ( ! />tup fund+ provid$ "u     
clause 7i7 to ! ,treasury 9 an amortiz$ 
mann] ov] ! #aj-ye> p]iod beg9n+ on     

,janu>y #a1 #bjbj4  7,d7 ,additional    
au?orization ( appropriations ,to c>ry  
out p>agraph 7#b7 ( subsection 7b71 !re 
are au?oriz$ to be appropriat$ su* sums 
z may be necess>y4  7,e7 ,limitation    
,any provision ( law re/rict+ ! use (   
,f$]al funds ) respect to any           
reproductive heal? s]vice %all n apply  
to funds appropriat$ "u ?is subsection4 
7d7 ,heal? c>e provid] p>ticipation     
7#a7 ,provid] p>ticipation  7,a7 ,9     
g5]al ,! ,secret>y %all e/abli%         
conditions ( p>ticipation = heal? c>e   
provid]s "u ! public heal? insurance    
option4  7,b7 ,lic5sure or c]tification 
,! ,secret>y %all n all[ a heal? c>e    
provid] to p>ticipate 9 ! public heal?  
insurance option unless su* provid] is  
appropriately lic5s$ or c]tifi$ "u ,/ate
 law4  7,c7 ,cl>ification ,not)/&+      
subp>agraph 7,a71 a heal? c>e provid]   
may n be prohibit$ f p>ticipat+ 9 !     
public heal? insurance option = reasons 
o!r ?an ! ability ( su* provid] to      
provide cov]$ s]vices4  7#b7 ,e/abli%m5t

 ( a provid] network  7,a7 ,m$ic>e &    
,m$icaid p>ticipat+ provid]s ,a heal?   
c>e provid] t is a p>ticipat+ provid] ( 
s]vices or suppli] "u ! ,m$ic>e program 
"u title ,,xviii ( ! ,social ,security  
,act or "u a ,/ate ,m$icaid plan "u     
title ,,xix ( su* ,act is a p>ticipat+  
provid] 9 ! public heal? insurance      
option unless ! heal? c>e provid] opts  
out ( p>ticipat+ 9 ! public heal?       
insurance option ?r\gh a process        
e/abli%$ by ! ,secret>y4  7,b7          
,additional provid]s ,! ,secret>y %all  
e/abli% a process to all[ heal? c>e     
provid]s n describ$ 9 subp>agraph 7,a7  
to become p>ticipat+ provid]s 9 ! public
 heal? insurance option4  4  7b7 ,con=m+
 am5dm5ts  7#a7 ,treatm5t z a qualifi$  
heal? plan ,section #acja7;a77#b7 ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjba7;a77#b77 is  
am5d$--  7,a7 9 ! p>agraph head+1 by    
ins]t+ 1 ! public heal? insurance       
option1 be=e &2 &  7,b7 by ins]t+ !     
public heal? insurance option "u section

 #bgie ( ! ,public ,heal? ,s]vice ,act1 
be=e & a multi-,/ate plan4  7#b7 ,level 
play+ field ,section #acbd7;a7 ( !      
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjdd7;a77 is am5d$
 by ins]t+ ! public heal? insurance     
option "u section #bgie ( ! ,public     
,heal? ,s]vice ,act1 be=e or a          
multi-,/ate qualifi$ heal? plan4