,,ii #aafth ,,congress #ast ,session ,s4 #aggc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #aa1 #bjai,mr4 ,sanders 7for himself1 ,mr4 ,merkley1 ,mrs4 ,gillibrand1 ,mr4 ,blumenthal1 ,ms4 ,harris1 ,mr4 ,booker1 ,ms4 ,warren1 and ,mr4 ,markey7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xviii and ,,xix of the ,social ,security ,act to make improvements to the treatment of the ,united ,states territories under the ,medicare and ,medicaid programs1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,territories ,health ,equity ,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--,medicaid ,sec4 #aja4 ,elimination of general ,medicaid funding limitations 7cap7 for territories4 ,sec4 #ajb4 ,elimination of specific ,federal medical assistance percentage 7,,fmap7 limitation for territories2 temporary increase in ,,fmap for ,puerto ,rico and the ,virgin ,islands to #ajj percent4 ,sec4 #ajc4 ,application of ,medicaid waiver authority to all of the territories4 ,sec4 #ajd4 ,permitting ,medicaid ,,dsh allotments for territories4 ,,title ,,ii--,medicare ,subtitle ,a--,part ,a ,sec4 #bja4 ,calculation of ,medicare ,,dsh payments for ,,ipps hospitals in ,puerto ,rico4 ,sec4 #bjb4 ,rebasing target amount for hospitals in territories4 ,sec4 #bjc4 ,medicare ,,dsh target adjustment for hospitals in territories4 ,subtitle ,b--,part ,b ,sec4 #baa4 ,application of part ,b deemed enrollment process to residents of ,puerto ,rico2 special enrollment period and limit on late enrollment penalties4 ,subtitle ,c--,medicare ,advantage 7,part ,c7 ,sec4 #bba4 ,adjustment in benchmark for low-base payment counties in ,puerto ,rico4 ,subtitle ,d--,part ,d ,sec4 #bca4 ,improved use of allocated prescription drug funds by territories4 ,sec4 #bcb4 ,report on treatment of territories under ,medicare part ,d4 ,,title ,,iii--,miscellaneous ,sec4 #cja4 ,modified treatment of territories with respect to application of ,,aca annual health insurance provider fees4 ,sec4 #cjb4 ,medicaid and ,,chip territory transparency and information4 ,sec4 #cjc4 ,report on exclusion of territories from ,exchanges4 ,sec4 #cjd4 ,access to coverage for individuals in certain areas without any available ,exchange plans4 ,sec4 #cje4 ,extension of family-to-family health information centers program to territories4 ,i ,medicaid #aja4 ,elimination of general ,medicaid funding limitations 7cap7 for territories 7a7 ,in general ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is amended-- 7#a7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking subsection 7g7 and inserting subsections 7g7 and 7h72 7#b7 in subsection 7g77#b71 in the matter preceding subparagraph 7,a71 by inserting subsection 7h7 after subject to2 and 7#c7 by adding at the end the following new subsection3 7h7 ,sunset of ,medicaid funding limitations for ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa ,subsections 7f7 and 7g7 shall not apply to ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa beginning with fiscal year #bjbj4 4 7b7 ,conforming amendments 7#a7 ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended by striking 1 the limitation in section #aajh7;f714 7#b7 ,section #aijc7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77 is amended by striking paragraph 7#d74 7c7 ,effective date ,the amendments made by this section shall apply beginning with fiscal year #bjbj4 #ajb4 ,elimination of specific ,federal medical assistance percentage 7,,fmap7 limitation for territories2 temporary increase in ,,fmap for ,puerto ,rico and the ,virgin ,islands to #ajj percent ,section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended-- 7#a7 in clause 7#b71 by inserting for fiscal years before fiscal year #bjbj after ,american ,samoa2 and 7#b7 by adding at the end the following new sentence3 ,notwithstanding the first sentence of this subsection1 for each of fiscal years #bjbj and #bjba1 the ,federal medical assistance percentage for ,puerto ,rico and the ,virgin ,islands shall be #ajj percent44 #ajc4 ,application of ,medicaid waiver authority to all of the territories 7a7 ,in general ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended-- 7#a7 by striking ,american ,samoa and the ,northern ,mariana ,islands and inserting ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa2 7#b7 by striking ,american ,samoa or the ,northern ,mariana ,islands and inserting ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa2 7#c7 by inserting 7#a7 before ,notwithstanding2 7#d7 by inserting except as otherwise provided in this subsection1 after ,notwithstanding any other requirement of this title2 and 7#e7 by adding at the end the following3 7#b7 ,the ,secretary may not waive under this subsection-- 7,a7 the requirement of subsection 7a77#aj77;,a77i77,,ix7 7relating to coverage of adults formerly under foster care7 with respect to any territory2 7,b7 the requirement to provide medical assistance for early and periodic screening1 diagnostic1 and treatment services 7as defined in section #aije7r77 for individuals who are eligible for assistance under the program and who under the age of #ba2 or 7,c7 the requirement to provide for payment for services described in section #aije7;a77#b77;,c7 furnished by a ,federally-qualified health center and services described in section #aije7;a77#b77;,b7 furnished by a rural health clinic in accordance with the provisions of subsection 7bb74 4 7b7 ,effective date ,the amendments made by this section shall apply beginning ,october #a1 #bjai4 #ajd4 ,permitting ,medicaid ,,dsh allotments for territories ,section #aibc7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77 is amended-- 7#a7 in paragraph 7#f71 by adding at the end the following new subparagraph3 7,c7 ,territories 7i7 ,fiscal year #bjbj ,for fiscal year #bjbj1 the ,,dsh allotment for ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa shall bear the same ratio to #cjj1jjj1jjj as the ratio of the number of individuals who are low-income or uninsured and residing in such respective territory 7as estimated from time to time by the ,secretary7 bears to the sums of the number of such individuals residing in all of the territories4 7ii7 ,subsequent fiscal year ,for each subsequent fiscal year1 the ,,dsh allotment for each such territory is subject to an increase in accordance with paragraph 7#c74 2 and 7#b7 in paragraph 7#i71 by inserting before the period at the end the following3 1 and includes1 beginning with fiscal year #bjbj1 ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa4 ,,ii ,medicare ,a ,part ,a #bja4 ,calculation of ,medicare ,,dsh payments for ,,ipps hospitals in ,puerto ,rico ,section #ahhf7;d77#i77;,d77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#i77;,d77iii77 is amended to read as follows3 7iii7 ,subparagraph 7,f7 7relating to disproportionate share payments71 including application of subsection 7r71 except that for this purpose-- 7,i7 the sum described in clause 7ii7 of this subparagraph shall be substituted for the sum referred to in paragraph 7#e77;,f77ii77,i72 and 7,,ii7 for discharges occurring on or after ,october #a1 #bjai1 subclause 7,i7 of paragraph 7#e77;,f77vi7 shall be applied by substituting for the numerator described in such subclause the number of subsection 7d7 ,puerto ,rico hospital's patient days for the cost reporting period involved which were made up of patients who 7for such days7 were entitled to benefits under part ,a of this title and were-- 7aa7 entitled to supplementary security income benefits 7excluding any ,state supplementation7 under title ,,xvi of this ,act2 7bb7 eligible for medical assistance under a ,state plan under title ,,xix2 or 7cc7 receiving aid or assistance under any plan of the ,state approved under title ,i1 ,x1 ,,xiv1 or ,,xvi4 4 #bjb4 ,rebasing target amount for hospitals in territories ,section #ahhf7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77 is amended by adding at the end the following new subparagraph3 7,m7 7i7 ,for each cost reporting period beginning on or after ,october #a1 #bjai1 in the case of a hospital located in a territory of the ,united ,states1 there shall be substituted for the target amount otherwise determined under subparagraph 7,a7 the rebased target amount 7as defined in clause 7ii771 if such substitution results in an amount of payment under this section to the hospital for such period that is greater than the amount of payment that would be made under this section to the hospital for such period if this subparagraph were not to apply4 7ii7 ,for purposes of this subparagraph1 the term rebased target amount has the meaning given the term target amount in subparagraph 7,a71 except that-- 7,i7 there shall be substituted for the preceding #ab-month cost reporting period the #ab-month cost reporting period beginning during fiscal year #bjae 7or1 at the option of the hospital1 beginning during fiscal year #bjag72 7,,ii7 any reference in subparagraph 7,a77i7 to the first such cost reporting period is deemed a reference to the first cost reporting period following the #ab-month cost reporting period beginning during fiscal year #bjae 7or1 at the option of the hospital1 beginning during fiscal year #bjag72 and 7,,iii7 the applicable percentage increase shall only be applied under subparagraph 7,b77ii7 for cost reporting periods beginning on or after ,october #a1 #bjai4 7iii7 ,nothing in this subparagraph shall affect any pending request by a hospital for a new target amount for any cost reporting period beginning during a fiscal year before fiscal year #bjbj4 4 #bjc4 ,medicare ,,dsh target adjustment for hospitals in territories ,section #ahhf7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c771 as amended by section #bjb1 is further amended by adding at the end the following new subparagraph3 7,n7 7i7 ,for each cost reporting period beginning on or after ,october #a1 #bjai1 in the case of a hospital that is located in a territory of the ,united ,states other than ,puerto ,rico and that would be a subsection 7d7 hospital if it were located in one of the #ej ,states1 the target amount shall be increased by-- 7,i7 in the case that such hospital has a disproportionate patient percentage of not less than #ae percent and not greater than #dj percent1 #aj percent2 and 7,,ii7 in the case that such hospital has a disproportionate patient percentage of greater than #dj percent1 #aj percent plus #fj percent of the number of percentage points by which such hospital's disproportionate patient percentage exceeds #dj percent4 7ii7 ,for purposes of this subparagraph1 the term disproportionate patient percentage has the meaning given such term in subsection 7d77#e77;,f77vi71 except that in applying such meaning any reference under such subsection to individuals entitled to supplementary security income under title ,,xvi shall be deemed for purposes of this subparagraph to include individuals-- 7,i7 eligible for medical assistance under a ,state plan under title ,,xix2 or 7,,ii7 receiving aid or assistance under any plan of the territory approved under title ,i1 ,x1 ,,xiv1 or ,,xvi4 4 ,b ,part ,b #baa4 ,application of part ,b deemed enrollment process to residents of ,puerto ,rico2 special enrollment period and limit on late enrollment penalties 7a7 ,application of part ,b deemed enrollment process to residents of ,puerto ,rico ,section #ahcg7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7f77#c77 is amended by striking 1 exclusive of ,puerto ,rico4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to individuals whose initial enrollment period under section #ahcg7;d7 of the ,social ,security ,act begins on or after the first day of the effective month1 specified by the ,secretary of ,health and ,human ,services under section #ahci7;j77#a77;,c7 of such ,act1 as added by subsection 7c77#b74 7c7 ,transition providing special enrollment period and limit on late enrollment penalties for certain ,medicare beneficiaries ,section #ahci of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7 is amended-- 7#a7 in the first sentence of subsection 7b71 by inserting subject to section #ahci7;j77#b71 after subsection 7i77#d7 or 7l7 of section #ahcg12 and 7#b7 by adding at the end the following new subsection3 7j7 ,special rules for certain residents of ,puerto ,rico 7#a7 ,special enrollment period1 coverage period for residents who are eligible but not enrolled 7,a7 ,in general ,in the case of a transition individual 7as defined in paragraph 7#c77 who is not enrolled under this part as of the day before the first day of the effective month 7as defined in subparagraph 7,c771 the ,secretary shall provide for a special enrollment period under section #ahcg of #g months beginning with such effective month during which the individual may be enrolled under this part4 7,b7 ,coverage period ,in the case of such an individual who enrolls during such special enrollment period1 the coverage period under section #ahch shall begin on the first day of the second month after the month in which the individual enrolls4 7,c7 ,effective month defined ,in this section1 the term effective month means a month1 not earlier than ,october #bjbj and not later than ,january #bjba1 specified by the ,secretary4 7#b7 ,reduction in late enrollment penalties for current enrollees and individuals enrolling during transition 7,a7 ,in general ,in the case of a transition individual who is enrolled under this part as of the day before the first day of the effective month or who enrolls under this part on or after the date of the enactment of this subsection but before the end of the special enrollment period under paragraph 7#a77;,a71 the amount of the late enrollment penalty imposed under section #ahci7;b7 shall be recalculated by reducing the penalty to #ae percent of the penalty otherwise established4 7,b7 ,application ,subparagraph 7,a7 shall be applied in the case of a transition individual who-- 7i7 is enrolled under this part as of the month before the effective month1 for premiums for months beginning with such effective month2 or 7ii7 enrolls under this part on or after the date of the enactment of this ,act and before the end of the special enrollment period under paragraph 7#a77;,a71 for premiums for months during the coverage period under this part which occur during or after the effective month4 7,c7 ,loss of reduction if individual terminates enrollment ,subparagraph 7,a7 shall not apply to a transition individual if the individual terminates enrollment under this part after the end of the special enrollment period under paragraph 7#a74 7#c7 ,transition individual defined ,in this section1 the term transition individual means an individual who resides in ,puerto ,rico and who would have been deemed enrolled under this part pursuant to section #ahcg7;f7 before the first day of the effective month but for the fact that the individual was a resident of ,puerto ,rico1 regardless of whether the individual is enrolled under this part as of such first day4 4 ,c ,medicare ,advantage 7,part ,c7 #bba4 ,adjustment in benchmark for low-base payment counties in ,puerto ,rico ,section #ahec7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7n77 is amended-- 7#a7 in paragraph 7#a71 by striking and 7#e7 and inserting 7#e71 and 7#f72 7#b7 in paragraph 7#d71 by striking ,in no case and inserting ,subject to paragraph 7#f71 in no case2 and 7#c7 by adding at the end the following new paragraph3 7#f7 ,special rules for blended benchmark amount for territories 7,a7 ,in general ,subject to subparagraph 7,b71 the blended benchmark amount for an area in a territory for a year 7beginning with #bjbj7 shall not be less than #hj percent of the national average of the base payment amounts specified in subparagraph 7#b77;,e7 for such year for areas within the #ej ,states and the ,district of ,columbia4 7,b7 ,limitation ,in no case shall the blended benchmark amount for an area in a territory for a year under subparagraph 7,a7 exceed the lowest blended benchmark amount for any area within the #ej ,states and the ,district of ,columbia for such year4 4 ,d ,part ,d #bca4 ,improved use of allocated prescription drug funds by territories ,section #aice7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77 is amended by adding at the end the following new paragraph3 7#e7 ,improved use of funds for low-income part d eligible individuals ,this subsection shall be applied beginning with fiscal year #bjbj as follows1 notwithstanding any other provision of this title3 7,a7 ,clarifying state flexibility to cover non-dual-eligible individuals ,in this title1 the term medical assistance includes financial assistance furnished by a ,state under this subsection to part ,d eligible individuals who1 if they were residing in one of the #ej ,states or the ,district of ,columbia1 would qualify as subsidy eligible individuals under section #ahfj;,d-#ad7;a77#c71 and without regard to whether such individuals otherwise qualify for medical assistance under this title4 7,b7 #ajj percent fmap to reflect no state matching required for part d low income subsidies ,the ,federal medical assistance percentage applicable to the assistance furnished under this subsection is #ajj percent4 7,c7 ,limited funding for special rules ,subparagraphs 7,a7 and 7,b71 and the provision of medical assistance for covered part ,d drugs to low-income part ,d eligible individuals for a ,state and period under this subsection1 is limited to the amount specified in paragraph 7#c7 for such ,state and period4 4 #bcb4 ,report on treatment of territories under ,medicare part ,d ,paragraph 7#d7 of section #aice7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77 is amended to read as follows3 7#d7 ,report on application of subsection 7,a7 ,in general ,not later than ,february #a1 #bjba1 the ,secretary shall submit to ,congress a report on the application of this subsection during the period beginning fiscal year #bjjf and ending fiscal year #bjbj4 7,b7 ,information to be included in report ,such report shall include-- 7i7 program guidance issued by the ,secretary to implement this subsection2 7ii7 for each territory1 information on the increased amount under paragraph 7#c7 and how the territory has applied such amount1 including the territory's program design1 expenditures1 and number of individuals 7and dual-eligible individuals7 assisted2 and 7iii7 differences between how such territories are treated under part ,d of title ,,xviii and under this title compared with the treatment of the #ej ,states and the ,district of ,columbia under such part and this title for different fiscal years within the period covered under the report4 7,c7 ,recommendations ,such report shall include recommendations for improving prescription drug coverage for low-income individuals in each territory1 including recommendations regarding each of the following alternative approaches3 7i7 ,adjusting the aggregate amount specified in paragraph 7#c77;,b74 7ii7 ,allowing residents of the territories to be subsidy eligible individuals under section #ahfj;,d-#ad1 notwithstanding subsection 7a77#c77;,f7 of such section1 or providing substantially equivalent low-income prescription drug subsidies to such residents4 4 ,,iii ,miscellaneous #cja4 ,modified treatment of territories with respect to application of ,,aca annual health insurance provider fees ,section #ijaj of the ,patient ,protection and ,affordable ,care ,act 7#bf ,u4,s4,c4 #djja note prec47 is amended-- 7#a7 in subsection 7b77#a71 by inserting subject to subsection 7k77#a71 after ,with respect to each covered entity12 and 7#b7 by adding at the end the following3 7k7 ,special rules for treatment of territories 7#a7 ,in general ,in applying this section with respect to ,united ,states health risks located outside of the #ej ,states or the ,district of ,columbia for years beginning with #bjbj-- 7,a7 the amount of the fee under subsection 7b7 shall be #ej percent of the amount of the fee otherwise determined2 7,b7 the ,secretary shall deposit the amount of such fees collected for each territory into a separate account2 and 7,c7 amounts in such an account for a territory for a year are appropriated and shall be available to the territory in accordance with paragraph 7#b74 7#b7 ,availability of funds ,amounts made available to a territory under paragraph 7#a77;,c7 with respect to a territory for a year shall be made available to the territory1 upon application of the territory to the ,secretary of ,health and ,human ,services1 only for the following purposes1 as elected by the territory in such application3 7,a7 ,increased prescription drug assistance for low-income part ,d eligible individuals ,for increasing the amount of funds made available to the territory under section #aice7;e77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77#c77 for assistance for low-income part ,d eligible individuals in obtaining part ,d covered drugs4 7,b7 ,satisfying ,state ,medicaid matching requirement ,for the territory to meet non-,federal matching requirements imposed with respect to obtaining ,federal financial participation under title ,,xix of the ,social ,security ,act4 4 #cjb4 ,medicaid and ,,chip territory transparency and information 7a7 ,publication of information on ,federal expenditures under ,medicaid and ,,chip in the territories ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall publish1 and periodically update1 on the ,internet site of the ,centers for ,medicare ,medicaid ,services information on ,medicaid and ,,chip carried out in the territories of the ,united ,states4 ,such information shall include1 with respect to each such territory-- 7#a7 the income levels established by the territory for purposes of eligibility of an individual to receive medical assistance under ,medicaid or child health assistance under ,,chip2 7#b7 the number of individuals enrolled in ,medicaid and ,,chip in such territory2 7#c7 any ,state plan amendments in effect to carry out ,medicaid or ,,chip in such territory2 7#d7 any waiver of the requirements of title ,,xix or title ,,xxi issued by the ,secretary to carry out ,medicaid or ,,chip in the territory1 including a waiver under section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae71 any application for such a waiver1 and any documentation related to such application 7including correspondence72 7#e7 the amount of the ,federal and non-,federal share of expenditures under ,medicaid and ,,chip in such territory2 7#f7 the systems in place for the furnishing of health care items and services under ,medicaid and ,,chip in such territory2 7#g7 the design of ,,chip in such territory2 and 7#h7 other information regarding the carrying out of ,medicaid and ,,chip in the territory that is published on such ,internet site with respect to carrying out ,medicaid and ,,chip in each ,state and the ,district of ,columbia4 7b7 ,definitions ,in this section3 7#a7 ,,chip ,the term ,,chip means the ,state ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act4 7#b7 ,medicaid ,the term ,medicaid means the ,medicaid program under title ,,xix of the ,social ,security ,act4 7#c7 ,territory ,the term territory of the ,united ,states includes ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa4 #cjc4 ,report on exclusion of territories from ,exchanges 7a7 ,in general ,not later than ,february #a1 #bjbj1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report that details the adverse impacts in each territory from the practical exclusion of the territories from the provisions of part ,,ii or ,,iii of subtitle ,d of title ,i of the ,patient ,protection and ,affordable ,care ,act insofar as such provisions provide for the establishment of an ,american ,health ,benefit ,exchange or the administration of a federally facilitated ,exchange in each ,state and in the ,district of ,columbia for the purpose of making health insurance more affordable and accessible for individuals and small businesses4 7b7 ,information in report ,the report shall include information on the following3 7#a7 ,an estimate of the total number of individuals residing in each territory with health insurance coverage1 and the total number of individuals in each territory without health insurance coverage4 7#b7 ,the number of health insurance issuers in each territory and the health insurance coverage each such issuer offers4 7#c7 ,an estimate of the number of individuals residing in each territory who are denied premium and cost-sharing assistance that would otherwise be available to them for obtaining health insurance coverage through an ,exchange if they resided in one of the #ej ,states or in the ,district of ,columbia4 7#d7 ,an estimate of the amount of ,federal assistance described in paragraph 7#c7 that is not being made available to residents of each territory4 7#e7 ,an estimate of the number of small employers in each territory that would be eligible to purchase health insurance coverage through a ,small ,business ,health ,options ,program 7,,shop7 ,marketplace that would operate as part of an ,exchange if the employers were in one of the #ej ,states or in the ,district of ,columbia4 #cjd4 ,access to coverage for individuals in certain areas without any available ,exchange plans ,part #b of subtitle ,d of title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca et seq47 is amended by adding at the end the following3 #acad4 ,access to coverage for individuals in certain areas without any available ,exchange plans 7a7 ,in general 7#a7 ,coverage through ,,dc ,exchange ,not later than #c months after the date of enactment of this section1 the ,secretary1 in consultation with the ,secretary of the ,treasury and the ,director of the ,office of ,personnel ,management1 shall establish a mechanism to ensure that1 for any plan year beginning on or after the date described in subsection 7c71 any individual described in paragraph 7#b7 has access to health insurance coverage which is at least as broad as the coverage available to ,members of ,congress and congressional staff 7as defined in section #acab7;d77#c77;,d77 through the ,exchange operating in the ,district of ,columbia4 ,such individuals shall be eligible for any premium tax credit under section #cf;,b of the ,internal ,revenue ,code of #aihf1 reduced cost sharing under section #adjb1 and advance determination and payment of such credits or such reductions under section #adab to be administered by the ,secretary1 in consultation with the ,secretary of the ,treasury and the ,director of the ,office of ,personnel ,management4 ,the ,district of ,columbia1 its residents1 and small businesses shall be held harmless from any increased costs resulting from the enactment of this section4 7#b7 ,individual described ,an individual described in this paragraph is any individual who-- 7,a7 is not eligible to enroll in an employer-sponsored health plan 7excluding such a plan that would not be considered minimum essential coverage due to the application of subparagraph 7,c7 of section #cf;,b7c77#b7 of the ,internal ,revenue ,code of #aihf if such subparagraph applied to such plan72 and 7,b7 is a bona fide resident of any possession of the ,united ,states 7as determined under section #icg7;a7 of such ,code7 in which the ,secretary certifies that no qualified health plan is offered through an ,exchange established under this title4 7#c7 ,possession of the ,united ,states ,for purposes of this section1 the term possession of the ,united ,states shall include such possessions as are specified in section #icg7;a77#a7 of the ,internal ,revenue ,code of #aihf4 7b7 ,treatment of possessions 7#a7 ,payments to possessions 7,a7 ,mirror code possession ,the ,secretary of the ,treasury shall periodically 7but not less frequently than annually7 pay to each possession of the ,united ,states with a mirror code tax system amounts equal to the loss to that possession by reason of the application of this section 7determined without regard to paragraph 7#b77 with respect to taxable years beginning after the date described in subsection 7c74 ,such amounts shall be determined by the ,secretary of the ,treasury based on information provided by the government of the respective possession4 7,b7 ,other possessions ,the ,secretary of the ,treasury shall periodically 7but not less frequently than annually7 pay to each possession of the ,united ,states which does not have a mirror code tax system amounts estimated by the ,secretary of the ,treasury as being equal to the aggregate benefits that would have been provided to residents of such possession by reason of the application of this section for any taxable years beginning after the date described in subsection 7c7 if a mirror code tax system had been in effect in such possession4 ,the preceding sentence shall not apply with respect to any possession of the ,united ,states unless such possession has a plan1 which has been approved by the ,secretary of the ,treasury1 under which such possession will promptly distribute such payments to the residents of such possession4 7#b7 ,coordination with credit allowed against united states income taxes ,no credit shall be allowed against ,united ,states income taxes for any taxable year under section #cf;,b of the ,internal ,revenue ,code of #aihf to any person-- 7,a7 to whom a credit is allowed against taxes imposed by the possession by reason of this section 7determined without regard to this paragraph7 for such taxable year1 or 7,b7 who is eligible for a payment under a plan described in paragraph 7#a77;,b7 with respect to such taxable year4 7#c7 ,mirror code tax system ,for purposes of this subsection1 the term mirror code tax system means1 with respect to any possession of the ,united ,states1 the income tax system of such possession if the income tax liability of the residents of such possession under such system is determined by reference to the income tax laws of the ,united ,states as if such possession were the ,united ,states4 7#d7 ,treatment of payments ,for purposes of section #acbd7;b77#b7 of title #ca1 ,united ,states ,code1 or any similar rule of law1 the payments under this subsection shall be treated in the same manner as a refund due from the credit allowed under section #cf;,b of the ,internal ,revenue ,code of #aihf4 7c7 ,date described ,the date described in this subsection is the date on which the ,secretary establishes the mechanism described in subsection 7a77#a74 4 #cje4 ,extension of family-to-family health information centers program to territories ,section #eja7;c77#c77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gja7;c77 is amended by striking years #bjah and #bjai and inserting year #bjah and each fiscal year thereafter4