,,ii #aaf? ,,congress #a/ ,session ,s4 #aggc ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #aa1 #bjai,mr4 ,s&]s 7= himself1 ,mr4 ,m]kley1 ,mrs4 ,gillibr&1 ,mr4 ,blum5?al1 ,ms4 ,h>ris1 ,mr4 ,book]1 ,ms4 ,w>r51 & ,mr4 ,m>key7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d titles ,,xviii & ,,xix ( ! ,social ,security ,act to make improvem5ts to ! treatm5t ( ! ,unit$ ,/ates t]ritories "u ! ,m$ic>e & ,m$icaid programs1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,t]ritories ,heal? ,equity ,act ( #bjai4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,,title ,i--,m$icaid ,sec4 #aja4 ,elim9ation ( g5]al ,m$icaid fund+ limitations 7cap7 = t]ritories4 ,sec4 #ajb4 ,elim9ation ( specific ,f$]al m$ical assi/ance p]c5tage 7,,fmap7 limitation = t]ritories2 tempor>y increase 9 ,,fmap = ,pu]to ,rico & ! ,virg9 ,isl&s to #ajj p]c5t4 ,sec4 #ajc4 ,application ( ,m$icaid waiv] au?ority to all ( ! t]ritories4 ,sec4 #ajd4 ,p]mitt+ ,m$icaid ,,d% allotm5ts = t]ritories4 ,,title ,,ii--,m$ic>e ,subtitle ,a--,"p ,a ,sec4 #bja4 ,calculation ( ,m$ic>e ,,d% paym5ts = ,,ipps hospitals 9 ,pu]to ,rico4 ,sec4 #bjb4 ,rebas+ t>get am\nt = hospitals 9 t]ritories4 ,sec4 #bjc4 ,m$ic>e ,,d% t>get adju/m5t = hospitals 9 t]ritories4 ,subtitle ,b--,"p ,b ,sec4 #baa4 ,application ( "p ,b deem$ enrollm5t process to resid5ts ( ,pu]to ,rico2 special enrollm5t p]iod & limit on late enrollm5t p5alties4 ,subtitle ,c--,m$ic>e ,advantage 7,"p ,c7 ,sec4 #bba4 ,adju/m5t 9 b5*m>k = l[-base paym5t c\nties 9 ,pu]to ,rico4 ,subtitle ,d--,"p ,d ,sec4 #bca4 ,improv$ use ( allocat$ prescription drug funds by t]ritories4 ,sec4 #bcb4 ,report on treatm5t ( t]ritories "u ,m$ic>e "p ,d4 ,,title ,,iii--,miscellane\s ,sec4 #cja4 ,modifi$ treatm5t ( t]ritories ) respect to application ( ,,aca annual heal? insurance provid] fees4 ,sec4 #cjb4 ,m$icaid & ,,*ip t]ritory transp>5cy & in=mation4 ,sec4 #cjc4 ,report on exclusion ( t]ritories f ,ex*anges4 ,sec4 #cjd4 ,access to cov]age = individuals 9 c]ta9 areas )\t any available ,ex*ange plans4 ,sec4 #cje4 ,ext5sion ( family-to-family heal? in=mation c5t]s program to t]ritories4 ,i ,m$icaid #aja4 ,elim9ation ( g5]al ,m$icaid fund+ limitations 7cap7 = t]ritories 7a7 ,9 g5]al ,section #aajh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is am5d$-- 7#a7 9 subsection 7f71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ subsection 7g7 & ins]t+ subsections 7g7 & 7h72 7#b7 9 subsection 7g77#b71 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ subsection 7h7 aft] subject to2 & 7#c7 by add+ at ! end ! foll[+ new subsection3 7h7 ,sunset ( ,m$icaid fund+ limitations = ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa ,subsections 7f7 & 7g7 %all n apply to ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa beg9n+ ) fiscal ye> #bjbj4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,section #aijb7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is am5d$ by /rik+ 1 ! limitation 9 section #aajh7;f714 7#b7 ,section #aijc7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77 is am5d$ by /rik+ p>agraph 7#d74 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply beg9n+ ) fiscal ye> #bjbj4 #ajb4 ,elim9ation ( specific ,f$]al m$ical assi/ance p]c5tage 7,,fmap7 limitation = t]ritories2 tempor>y increase 9 ,,fmap = ,pu]to ,rico & ! ,virg9 ,isl&s to #ajj p]c5t ,section #aije7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is am5d$-- 7#a7 9 clause 7#b71 by ins]t+ = fiscal ye>s be=e fiscal ye> #bjbj aft] ,am]ican ,samoa2 & 7#b7 by add+ at ! end ! foll[+ new s5t5ce3 ,not)/&+ ! fir/ s5t5ce ( ?is subsection1 = ea* ( fiscal ye>s #bjbj & #bjba1 ! ,f$]al m$ical assi/ance p]c5tage = ,pu]to ,rico & ! ,virg9 ,isl&s %all be #ajj p]c5t44 #ajc4 ,application ( ,m$icaid waiv] au?ority to all ( ! t]ritories 7a7 ,9 g5]al ,section #aijb7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is am5d$-- 7#a7 by /rik+ ,am]ican ,samoa & ! ,nor!rn ,m>iana ,isl&s & ins]t+ ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa2 7#b7 by /rik+ ,am]ican ,samoa or ! ,nor!rn ,m>iana ,isl&s & ins]t+ ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa2 7#c7 by ins]t+ 7#a7 be=e ,not)/&+2 7#d7 by ins]t+ except z o!rwise provid$ 9 ?is subsection1 aft] ,not)/&+ any o!r requirem5t ( ?is title2 & 7#e7 by add+ at ! end ! foll[+3 7#b7 ,! ,secret>y may n waive "u ?is subsection-- 7,a7 ! requirem5t ( subsection 7a77#aj77;,a77i77,,ix7 7relat+ to cov]age ( adults =m]ly "u fo/] c>e7 ) respect to any t]ritory2 7,b7 ! requirem5t to provide m$ical assi/ance = e>ly & p]iodic scre5+1 diagno/ic1 & treatm5t s]vices 7z def9$ 9 section #aije7r77 = individuals :o are eligible = assi/ance "u ! program & :o "u ! age ( #ba2 or 7,c7 ! requirem5t to provide = paym5t = s]vices describ$ 9 section #aije7;a77#b77;,c7 furni%$ by a ,f$]ally-qualifi$ heal? c5t] & s]vices describ$ 9 section #aije7;a77#b77;,b7 furni%$ by a rural heal? cl9ic 9 accordance ) ! provisions ( subsection 7bb74 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply beg9n+ ,octob] #a1 #bjai4 #ajd4 ,p]mitt+ ,m$icaid ,,d% allotm5ts = t]ritories ,section #aibc7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77 is am5d$-- 7#a7 9 p>agraph 7#f71 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,t]ritories 7i7 ,fiscal ye> #bjbj ,= fiscal ye> #bjbj1 ! ,,d% allotm5t = ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa %all be> ! same ratio to #cjj1jjj1jjj z ! ratio ( ! numb] ( individuals :o are l[-income or un9sur$ & resid+ 9 su* respective t]ritory 7z e/imat$ f "t to "t by ! ,secret>y7 be>s to ! sums ( ! numb] ( su* individuals resid+ 9 all ( ! t]ritories4 7ii7 ,subsequ5t fiscal ye> ,= ea* subsequ5t fiscal ye>1 ! ,,d% allotm5t = ea* su* t]ritory is subject to an increase 9 accordance ) p>agraph 7#c74 2 & 7#b7 9 p>agraph 7#i71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 & includes1 beg9n+ ) fiscal ye> #bjbj1 ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa4 ,,ii ,m$ic>e ,a ,"p ,a #bja4 ,calculation ( ,m$ic>e ,,d% paym5ts = ,,ipps hospitals 9 ,pu]to ,rico ,section #ahhf7;d77#i77;,d77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#i77;,d77iii77 is am5d$ to read z foll[s3 7iii7 ,subp>agraph 7,f7 7relat+ to disproportionate %>e paym5ts71 includ+ application ( subsection 7r71 except t = ?is purpose-- 7,i7 ! sum describ$ 9 clause 7ii7 ( ?is subp>agraph %all be sub/itut$ = ! sum ref]r$ to 9 p>agraph 7#e77;,f77ii77,i72 & 7,,ii7 = dis*>ges occurr+ on or aft] ,octob] #a1 #bjai1 subclause 7,i7 ( p>agraph 7#e77;,f77vi7 %all be appli$ by sub/itut+ = ! num]ator describ$ 9 su* subclause ! numb] ( subsection 7d7 ,pu]to ,rico hospital's pati5t days = ! co/ report+ p]iod involv$ :i* 7 made up ( pati5ts :o 7= su* days7 7 entitl$ to b5efits "u "p ,a ( ?is title & 7-- 7aa7 entitl$ to supplem5t>y security income b5efits 7exclud+ any ,/ate supplem5tation7 "u title ,,xvi ( ?is ,act2 7bb7 eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix2 or 7cc7 receiv+ aid or assi/ance "u any plan ( ! ,/ate approv$ "u title ,i1 ,x1 ,,xiv1 or ,,xvi4 4 #bjb4 ,rebas+ t>get am\nt = hospitals 9 t]ritories ,section #ahhf7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,m7 7i7 ,= ea* co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #bjai1 9 ! case ( a hospital locat$ 9 a t]ritory ( ! ,unit$ ,/ates1 !re %all be sub/itut$ = ! t>get am\nt o!rwise det]m9$ "u subp>agraph 7,a7 ! rebas$ t>get am\nt 7z def9$ 9 clause 7ii771 if su* sub/itution results 9 an am\nt ( paym5t "u ?is section to ! hospital = su* p]iod t is great] ?an ! am\nt ( paym5t t w\ld be made "u ?is section to ! hospital = su* p]iod if ?is subp>agraph 7 n to apply4 7ii7 ,= purposes ( ?is subp>agraph1 ! t]m rebas$ t>get am\nt has ! mean+ giv5 ! t]m t>get am\nt 9 subp>agraph 7,a71 except t-- 7,i7 !re %all be sub/itut$ = ! prec$+ #ab-mon? co/ report+ p]iod ! #ab-mon? co/ report+ p]iod beg9n+ dur+ fiscal ye> #bjae 7or1 at ! option ( ! hospital1 beg9n+ dur+ fiscal ye> #bjag72 7,,ii7 any ref]5ce 9 subp>agraph 7,a77i7 to ! fir/ su* co/ report+ p]iod is deem$ a ref]5ce to ! fir/ co/ report+ p]iod foll[+ ! #ab-mon? co/ report+ p]iod beg9n+ dur+ fiscal ye> #bjae 7or1 at ! option ( ! hospital1 beg9n+ dur+ fiscal ye> #bjag72 & 7,,iii7 ! applicable p]c5tage increase %all only be appli$ "u subp>agraph 7,b77ii7 = co/ report+ p]iods beg9n+ on or aft] ,octob] #a1 #bjai4 7iii7 ,no?+ 9 ?is subp>agraph %all affect any p5d+ reque/ by a hospital = a new t>get am\nt = any co/ report+ p]iod beg9n+ dur+ a fiscal ye> be=e fiscal ye> #bjbj4 4 #bjc4 ,m$ic>e ,,d% t>get adju/m5t = hospitals 9 t]ritories ,section #ahhf7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c771 z am5d$ by section #bjb1 is fur!r am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,n7 7i7 ,= ea* co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #bjai1 9 ! case ( a hospital t is locat$ 9 a t]ritory ( ! ,unit$ ,/ates o!r ?an ,pu]to ,rico & t w\ld be a subsection 7d7 hospital if x 7 locat$ 9 "o ( ! #ej ,/ates1 ! t>get am\nt %all be increas$ by-- 7,i7 9 ! case t su* hospital has a disproportionate pati5t p]c5tage ( n less ?an #ae p]c5t & n great] ?an #dj p]c5t1 #aj p]c5t2 & 7,,ii7 9 ! case t su* hospital has a disproportionate pati5t p]c5tage ( great] ?an #dj p]c5t1 #aj p]c5t plus #fj p]c5t ( ! numb] ( p]c5tage po9ts by :i* su* hospital's disproportionate pati5t p]c5tage exce$s #dj p]c5t4 7ii7 ,= purposes ( ?is subp>agraph1 ! t]m disproportionate pati5t p]c5tage has ! mean+ giv5 su* t]m 9 subsection 7d77#e77;,f77vi71 except t 9 apply+ su* mean+ any ref]5ce "u su* subsection to individuals entitl$ to supplem5t>y security income "u title ,,xvi %all be deem$ = purposes ( ?is subp>agraph to include individuals-- 7,i7 eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix2 or 7,,ii7 receiv+ aid or assi/ance "u any plan ( ! t]ritory approv$ "u title ,i1 ,x1 ,,xiv1 or ,,xvi4 4 ,b ,"p ,b #baa4 ,application ( "p ,b deem$ enrollm5t process to resid5ts ( ,pu]to ,rico2 special enrollm5t p]iod & limit on late enrollm5t p5alties 7a7 ,application ( "p ,b deem$ enrollm5t process to resid5ts ( ,pu]to ,rico ,section #ahcg7;f77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep7f77#c77 is am5d$ by /rik+ 1 exclusive ( ,pu]to ,rico4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to individuals ^: initial enrollm5t p]iod "u section #ahcg7;d7 ( ! ,social ,security ,act beg9s on or aft] ! fir/ day ( ! effective mon?1 specifi$ by ! ,secret>y ( ,heal? & ,human ,s]vices "u section #ahci7;j77#a77;,c7 ( su* ,act1 z add$ by subsection 7c77#b74 7c7 ,transition provid+ special enrollm5t p]iod & limit on late enrollm5t p5alties = c]ta9 ,m$ic>e b5efici>ies ,section #ahci ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7 is am5d$-- 7#a7 9 ! fir/ s5t5ce ( subsection 7b71 by ins]t+ subject to section #ahci7;j77#b71 aft] subsection 7i77#d7 or 7l7 ( section #ahcg12 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7j7 ,special rules = c]ta9 resid5ts ( ,pu]to ,rico 7#a7 ,special enrollm5t p]iod1 cov]age p]iod = resid5ts :o are eligible b n enroll$ 7,a7 ,9 g5]al ,9 ! case ( a transition individual 7z def9$ 9 p>agraph 7#c77 :o is n enroll$ "u ?is "p z ( ! day be=e ! fir/ day ( ! effective mon? 7z def9$ 9 subp>agraph 7,c771 ! ,secret>y %all provide = a special enrollm5t p]iod "u section #ahcg ( #g mon?s beg9n+ ) su* effective mon? dur+ :i* ! individual may be enroll$ "u ?is "p4 7,b7 ,cov]age p]iod ,9 ! case ( su* an individual :o enrolls dur+ su* special enrollm5t p]iod1 ! cov]age p]iod "u section #ahch %all beg9 on ! fir/ day ( ! second mon? aft] ! mon? 9 :i* ! individual enrolls4 7,c7 ,effective mon? def9$ ,9 ?is section1 ! t]m effective mon? means a mon?1 n e>li] ?an ,octob] #bjbj & n lat] ?an ,janu>y #bjba1 specifi$ by ! ,secret>y4 7#b7 ,r$uction 9 late enrollm5t p5alties = curr5t enrollees & individuals enroll+ dur+ transition 7,a7 ,9 g5]al ,9 ! case ( a transition individual :o is enroll$ "u ?is "p z ( ! day be=e ! fir/ day ( ! effective mon? or :o enrolls "u ?is "p on or aft] ! date ( ! enactm5t ( ?is subsection b be=e ! end ( ! special enrollm5t p]iod "u p>agraph 7#a77;,a71 ! am\nt ( ! late enrollm5t p5alty impos$ "u section #ahci7;b7 %all be recalculat$ by r$uc+ ! p5alty to #ae p]c5t ( ! p5alty o!rwise e/abli%$4 7,b7 ,application ,subp>agraph 7,a7 %all be appli$ 9 ! case ( a transition individual :o-- 7i7 is enroll$ "u ?is "p z ( ! mon? be=e ! effective mon?1 = premiums = mon?s beg9n+ ) su* effective mon?2 or 7ii7 enrolls "u ?is "p on or aft] ! date ( ! enactm5t ( ?is ,act & be=e ! end ( ! special enrollm5t p]iod "u p>agraph 7#a77;,a71 = premiums = mon?s dur+ ! cov]age p]iod "u ?is "p :i* occur dur+ or aft] ! effective mon?4 7,c7 ,loss ( r$uction if individual t]m9ates enrollm5t ,subp>agraph 7,a7 %all n apply to a transition individual if ! individual t]m9ates enrollm5t "u ?is "p aft] ! end ( ! special enrollm5t p]iod "u p>agraph 7#a74 7#c7 ,transition individual def9$ ,9 ?is section1 ! t]m transition individual means an individual :o resides 9 ,pu]to ,rico & :o w\ld h be5 deem$ enroll$ "u ?is "p pursuant to section #ahcg7;f7 be=e ! fir/ day ( ! effective mon? b = ! fact t ! individual 0 a resid5t ( ,pu]to ,rico1 reg>dless ( :e!r ! individual is enroll$ "u ?is "p z ( su* fir/ day4 4 ,c ,m$ic>e ,advantage 7,"p ,c7 #bba4 ,adju/m5t 9 b5*m>k = l[-base paym5t c\nties 9 ,pu]to ,rico ,section #ahec7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7n77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ & 7#e7 & ins]t+ 7#e71 & 7#f72 7#b7 9 p>agraph 7#d71 by /rik+ ,9 no case & ins]t+ ,subject to p>agraph 7#f71 9 no case2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,special rules = bl5d$ b5*m>k am\nt = t]ritories 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! bl5d$ b5*m>k am\nt = an area 9 a t]ritory = a ye> 7beg9n+ ) #bjbj7 %all n be less ?an #hj p]c5t ( ! national av]age ( ! base paym5t am\nts specifi$ 9 subp>agraph 7#b77;,e7 = su* ye> = areas )9 ! #ej ,/ates & ! ,di/rict ( ,columbia4 7,b7 ,limitation ,9 no case %all ! bl5d$ b5*m>k am\nt = an area 9 a t]ritory = a ye> "u subp>agraph 7,a7 exce$ ! l[e/ bl5d$ b5*m>k am\nt = any area )9 ! #ej ,/ates & ! ,di/rict ( ,columbia = su* ye>4 4 ,d ,"p ,d #bca4 ,improv$ use ( allocat$ prescription drug funds by t]ritories ,section #aice7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,improv$ use ( funds = l[-income "p d eligible individuals ,?is subsection %all be appli$ beg9n+ ) fiscal ye> #bjbj z foll[s1 not)/&+ any o!r provision ( ?is title3 7,a7 ,cl>ify+ /ate flexibility to cov] non-dual-eligible individuals ,9 ?is title1 ! t]m m$ical assi/ance includes f9ancial assi/ance furni%$ by a ,/ate "u ?is subsection to "p ,d eligible individuals :o1 if !y 7 resid+ 9 "o ( ! #ej ,/ates or ! ,di/rict ( ,columbia1 w\ld qualify z subsidy eligible individuals "u section #ahfj;,d-#ad7;a77#c71 & )\t reg>d to :e!r su* individuals o!rwise qualify = m$ical assi/ance "u ?is title4 7,b7 #ajj p]c5t fmap to reflect no /ate mat*+ requir$ = "p d l[ income subsidies ,! ,f$]al m$ical assi/ance p]c5tage applicable to ! assi/ance furni%$ "u ?is subsection is #ajj p]c5t4 7,c7 ,limit$ fund+ = special rules ,subp>agraphs 7,a7 & 7,b71 & ! provision ( m$ical assi/ance = cov]$ "p ,d drugs to l[-income "p ,d eligible individuals = a ,/ate & p]iod "u ?is subsection1 is limit$ to ! am\nt specifi$ 9 p>agraph 7#c7 = su* ,/ate & p]iod4 4 #bcb4 ,report on treatm5t ( t]ritories "u ,m$ic>e "p ,d ,p>agraph 7#d7 ( section #aice7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77 is am5d$ to read z foll[s3 7#d7 ,report on application ( subsection 7,a7 ,9 g5]al ,n lat] ?an ,febru>y #a1 #bjba1 ! ,secret>y %all submit to ,congress a report on ! application ( ?is subsection dur+ ! p]iod beg9n+ fiscal ye> #bjjf & end+ fiscal ye> #bjbj4 7,b7 ,in=mation to be includ$ 9 report ,su* report %all include-- 7i7 program guidance issu$ by ! ,secret>y to implem5t ?is subsection2 7ii7 = ea* t]ritory1 in=mation on ! increas$ am\nt "u p>agraph 7#c7 & h[ ! t]ritory has appli$ su* am\nt1 includ+ ! t]ritory's program design1 exp5ditures1 & numb] ( individuals 7& dual-eligible individuals7 assi/$2 & 7iii7 diff]5ces betwe5 h[ su* t]ritories are treat$ "u "p ,d ( title ,,xviii & "u ?is title comp>$ ) ! treatm5t ( ! #ej ,/ates & ! ,di/rict ( ,columbia "u su* "p & ?is title = diff]5t fiscal ye>s )9 ! p]iod cov]$ "u ! report4 7,c7 ,recomm5dations ,su* report %all include recomm5dations = improv+ prescription drug cov]age = l[-income individuals 9 ea* t]ritory1 includ+ recomm5dations reg>d+ ea* ( ! foll[+ alt]native approa*es3 7i7 ,adju/+ ! aggregate am\nt specifi$ 9 p>agraph 7#c77;,b74 7ii7 ,all[+ resid5ts ( ! t]ritories to be subsidy eligible individuals "u section #ahfj;,d-#ad1 not)/&+ subsection 7a77#c77;,f7 ( su* section1 or provid+ sub/antially equival5t l[-income prescription drug subsidies to su* resid5ts4 4 ,,iii ,miscellane\s #cja4 ,modifi$ treatm5t ( t]ritories ) respect to application ( ,,aca annual heal? insurance provid] fees ,section #ijaj ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#bf ,u4,s4,c4 #djja note prec47 is am5d$-- 7#a7 9 subsection 7b77#a71 by ins]t+ subject to subsection 7k77#a71 aft] ,) respect to ea* cov]$ entity12 & 7#b7 by add+ at ! end ! foll[+3 7k7 ,special rules = treatm5t ( t]ritories 7#a7 ,9 g5]al ,9 apply+ ?is section ) respect to ,unit$ ,/ates heal? risks locat$ outside ( ! #ej ,/ates or ! ,di/rict ( ,columbia = ye>s beg9n+ ) #bjbj-- 7,a7 ! am\nt ( ! fee "u subsection 7b7 %all be #ej p]c5t ( ! am\nt ( ! fee o!rwise det]m9$2 7,b7 ! ,secret>y %all deposit ! am\nt ( su* fees collect$ = ea* t]ritory into a sep>ate acc\nt2 & 7,c7 am\nts 9 su* an acc\nt = a t]ritory = a ye> are appropriat$ & %all be available to ! t]ritory 9 accordance ) p>agraph 7#b74 7#b7 ,availability ( funds ,am\nts made available to a t]ritory "u p>agraph 7#a77;,c7 ) respect to a t]ritory = a ye> %all be made available to ! t]ritory1 ^u application ( ! t]ritory to ! ,secret>y ( ,heal? & ,human ,s]vices1 only = ! foll[+ purposes1 z elect$ by ! t]ritory 9 su* application3 7,a7 ,increas$ prescription drug assi/ance = l[-income "p ,d eligible individuals ,= increas+ ! am\nt ( funds made available to ! t]ritory "u section #aice7;e77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7;e77#c77 = assi/ance = l[-income "p ,d eligible individuals 9 obta9+ "p ,d cov]$ drugs4 7,b7 ,satisfy+ ,/ate ,m$icaid mat*+ requirem5t ,= ! t]ritory to meet non-,f$]al mat*+ requirem5ts impos$ ) respect to obta9+ ,f$]al f9ancial p>ticipation "u title ,,xix ( ! ,social ,security ,act4 4 #cjb4 ,m$icaid & ,,*ip t]ritory transp>5cy & in=mation 7a7 ,publication ( in=mation on ,f$]al exp5ditures "u ,m$icaid & ,,*ip 9 ! t]ritories ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all publi%1 & p]iodically update1 on ! ,int]net site ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices in=mation on ,m$icaid & ,,*ip c>ri$ out 9 ! t]ritories ( ! ,unit$ ,/ates4 ,su* in=mation %all include1 ) respect to ea* su* t]ritory-- 7#a7 ! income levels e/abli%$ by ! t]ritory = purposes ( eligibility ( an individual to receive m$ical assi/ance "u ,m$icaid or *ild heal? assi/ance "u ,,*ip2 7#b7 ! numb] ( individuals enroll$ 9 ,m$icaid & ,,*ip 9 su* t]ritory2 7#c7 any ,/ate plan am5dm5ts 9 effect to c>ry out ,m$icaid or ,,*ip 9 su* t]ritory2 7#d7 any waiv] ( ! requirem5ts ( title ,,xix or title ,,xxi issu$ by ! ,secret>y to c>ry out ,m$icaid or ,,*ip 9 ! t]ritory1 includ+ a waiv] "u section #aaae ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae71 any application = su* a waiv]1 & any docum5tation relat$ to su* application 7includ+ correspond5ce72 7#e7 ! am\nt ( ! ,f$]al & non-,f$]al %>e ( exp5ditures "u ,m$icaid & ,,*ip 9 su* t]ritory2 7#f7 ! sy/ems 9 place = ! furni%+ ( heal? c>e items & s]vices "u ,m$icaid & ,,*ip 9 su* t]ritory2 7#g7 ! design ( ,,*ip 9 su* t]ritory2 & 7#h7 o!r in=mation reg>d+ ! c>ry+ out ( ,m$icaid & ,,*ip 9 ! t]ritory t is publi%$ on su* ,int]net site ) respect to c>ry+ out ,m$icaid & ,,*ip 9 ea* ,/ate & ! ,di/rict ( ,columbia4 7b7 ,def9itions ,9 ?is section3 7#a7 ,,*ip ,! t]m ,,*ip means ! ,/ate ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( ! ,social ,security ,act4 7#b7 ,m$icaid ,! t]m ,m$icaid means ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act4 7#c7 ,t]ritory ,! t]m t]ritory ( ! ,unit$ ,/ates includes ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa4 #cjc4 ,report on exclusion ( t]ritories f ,ex*anges 7a7 ,9 g5]al ,n lat] ?an ,febru>y #a1 #bjbj1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ,congress a report t details ! adv]se impacts 9 ea* t]ritory f ! practical exclusion ( ! t]ritories f ! provisions ( "p ,,ii or ,,iii ( subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act ins(> z su* provisions provide = ! e/abli%m5t ( an ,am]ican ,heal? ,b5efit ,ex*ange or ! adm9i/ration ( a f$]ally facilitat$ ,ex*ange 9 ea* ,/ate & 9 ! ,di/rict ( ,columbia = ! purpose ( mak+ heal? insurance m af=dable & accessible = individuals & small bus9esses4 7b7 ,in=mation 9 report ,! report %all include in=mation on ! foll[+3 7#a7 ,an e/imate ( ! total numb] ( individuals resid+ 9 ea* t]ritory ) heal? insurance cov]age1 & ! total numb] ( individuals 9 ea* t]ritory )\t heal? insurance cov]age4 7#b7 ,! numb] ( heal? insurance issu]s 9 ea* t]ritory & ! heal? insurance cov]age ea* su* issu] (f]s4 7#c7 ,an e/imate ( ! numb] ( individuals resid+ 9 ea* t]ritory :o are d5i$ premium & co/-%>+ assi/ance t w\ld o!rwise be available to !m = obta9+ heal? insurance cov]age ?r\gh an ,ex*ange if !y resid$ 9 "o ( ! #ej ,/ates or 9 ! ,di/rict ( ,columbia4 7#d7 ,an e/imate ( ! am\nt ( ,f$]al assi/ance describ$ 9 p>agraph 7#c7 t is n be+ made available to resid5ts ( ea* t]ritory4 7#e7 ,an e/imate ( ! numb] ( small employ]s 9 ea* t]ritory t w\ld be eligible to pur*ase heal? insurance cov]age ?r\gh a ,small ,bus9ess ,heal? ,options ,program 7,,%op7 ,m>ketplace t w\ld op]ate z "p ( an ,ex*ange if ! employ]s 7 9 "o ( ! #ej ,/ates or 9 ! ,di/rict ( ,columbia4 #cjd4 ,access to cov]age = individuals 9 c]ta9 areas )\t any available ,ex*ange plans ,"p #b ( subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca et seq47 is am5d$ by add+ at ! end ! foll[+3 #acad4 ,access to cov]age = individuals 9 c]ta9 areas )\t any available ,ex*ange plans 7a7 ,9 g5]al 7#a7 ,cov]age ?r\gh ,,dc ,ex*ange ,n lat] ?an #c mon?s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) ! ,secret>y ( ! ,treasury & ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t1 %all e/abli% a me*anism to ensure t1 = any plan ye> beg9n+ on or aft] ! date describ$ 9 subsection 7c71 any individual describ$ 9 p>agraph 7#b7 has access to heal? insurance cov]age :i* is at lea/ z broad z ! cov]age available to ,memb]s ( ,congress & congressional /aff 7z def9$ 9 section #acab7;d77#c77;,d77 ?r\gh ! ,ex*ange op]at+ 9 ! ,di/rict ( ,columbia4 ,su* individuals %all be eligible = any premium tax cr$it "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf1 r$uc$ co/ %>+ "u section #adjb1 & advance det]m9ation & paym5t ( su* cr$its or su* r$uctions "u section #adab to be adm9i/]$ by ! ,secret>y1 9 consultation ) ! ,secret>y ( ! ,treasury & ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t4 ,! ,di/rict ( ,columbia1 its resid5ts1 & small bus9esses %all be held h>mless f any increas$ co/s result+ f ! enactm5t ( ?is section4 7#b7 ,individual describ$ ,an individual describ$ 9 ?is p>agraph is any individual :o-- 7,a7 is n eligible to enroll 9 an employ]-sponsor$ heal? plan 7exclud+ su* a plan t w\ld n be consid]$ m9imum ess5tial cov]age due to ! application ( subp>agraph 7,c7 ( section #cf;,b7c77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf if su* subp>agraph appli$ to su* plan72 & 7,b7 is a bona fide resid5t ( any possession ( ! ,unit$ ,/ates 7z det]m9$ "u section #icg7;a7 ( su* ,code7 9 :i* ! ,secret>y c]tifies t no qualifi$ heal? plan is (f]$ ?r\gh an ,ex*ange e/abli%$ "u ?is title4 7#c7 ,possession ( ! ,unit$ ,/ates ,= purposes ( ?is section1 ! t]m possession ( ! ,unit$ ,/ates %all include su* possessions z are specifi$ 9 section #icg7;a77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf4 7b7 ,treatm5t ( possessions 7#a7 ,paym5ts to possessions 7,a7 ,mirror code possession ,! ,secret>y ( ! ,treasury %all p]iodically 7b n less frequ5tly ?an annually7 pay to ea* possession ( ! ,unit$ ,/ates ) a mirror code tax sy/em am\nts equal to ! loss to t possession by reason ( ! application ( ?is section 7det]m9$ )\t reg>d to p>agraph 7#b77 ) respect to taxable ye>s beg9n+ aft] ! date describ$ 9 subsection 7c74 ,su* am\nts %all be det]m9$ by ! ,secret>y ( ! ,treasury bas$ on in=mation provid$ by ! gov]nm5t ( ! respective possession4 7,b7 ,o!r possessions ,! ,secret>y ( ! ,treasury %all p]iodically 7b n less frequ5tly ?an annually7 pay to ea* possession ( ! ,unit$ ,/ates :i* does n h a mirror code tax sy/em am\nts e/imat$ by ! ,secret>y ( ! ,treasury z be+ equal to ! aggregate b5efits t w\ld h be5 provid$ to resid5ts ( su* possession by reason ( ! application ( ?is section = any taxable ye>s beg9n+ aft] ! date describ$ 9 subsection 7c7 if a mirror code tax sy/em _h be5 9 effect 9 su* possession4 ,! prec$+ s5t5ce %all n apply ) respect to any possession ( ! ,unit$ ,/ates unless su* possession has a plan1 :i* has be5 approv$ by ! ,secret>y ( ! ,treasury1 "u :i* su* possession w promptly di/ribute su* paym5ts to ! resid5ts ( su* possession4 7#b7 ,coord9ation ) cr$it all[$ aga9/ unit$ /ates income taxes ,no cr$it %all be all[$ aga9/ ,unit$ ,/ates income taxes = any taxable ye> "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf to any p]son-- 7,a7 to :om a cr$it is all[$ aga9/ taxes impos$ by ! possession by reason ( ?is section 7det]m9$ )\t reg>d to ?is p>agraph7 = su* taxable ye>1 or 7,b7 :o is eligible = a paym5t "u a plan describ$ 9 p>agraph 7#a77;,b7 ) respect to su* taxable ye>4 7#c7 ,mirror code tax sy/em ,= purposes ( ?is subsection1 ! t]m mirror code tax sy/em means1 ) respect to any possession ( ! ,unit$ ,/ates1 ! income tax sy/em ( su* possession if ! income tax liability ( ! resid5ts ( su* possession "u su* sy/em is det]m9$ by ref]5ce to ! income tax laws ( ! ,unit$ ,/ates z if su* possession 7 ! ,unit$ ,/ates4 7#d7 ,treatm5t ( paym5ts ,= purposes ( section #acbd7;b77#b7 ( title #ca1 ,unit$ ,/ates ,code1 or any simil> rule ( law1 ! paym5ts "u ?is subsection %all be treat$ 9 ! same mann] z a refund due f ! cr$it all[$ "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf4 7c7 ,date describ$ ,! date describ$ 9 ?is subsection is ! date on :i* ! ,secret>y e/abli%es ! me*anism describ$ 9 subsection 7a77#a74 4 #cje4 ,ext5sion ( family-to-family heal? in=mation c5t]s program to t]ritories ,section #eja7;c77#c77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gja7;c77 is am5d$ by /rik+ ye>s #bjah & #bjai & ins]t+ ye> #bjah & ea* fiscal ye> !reaft]4