,,ii #aafth ,,congress #ast ,session ,s4 #ahfh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #ac1 #bjai,ms4 ,collins 7for herself and ,mr4 ,manchin7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to provide support to ,states to establish invisible high-risk pool or reinsurance programs4 #a4 ,short title ,this ,act may be cited as the ,premium ,reduction ,act of #bjai4 #b4 ,invisible high-risk pool and reinsurance programs 7a7 ,state grants under waivers ,section #accb7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjeb7;a77 is amended-- 7#a7 by redesignating paragraphs 7#d71 7#e71 and 7#f7 as paragraphs 7#f71 7#g71 and 7#h71 respectively2 and 7#b7 by inserting after paragraph 7#c7 the following3 7#d7 ,federal funding for invisible high-risk pool and reinsurance programs 7,a7 ,allocations 7i7 ,methodology ,not later than #de days after the date of enactment of this ,act1 the ,secretary1 in consultation with the ,national ,association of ,insurance ,commissioners1 shall specify an allocation methodology for determining the amount of funds appropriated under section #b7;b7 of the ,premium ,reduction ,act of #bjai for a fiscal year to be allocated for each ,state for purposes of subparagraph 7,b7 and section #b7;c7 of the ,premium ,reduction ,act of #bjai4 7ii7 ,annual determinations ,the ,secretary shall determine the allocations to ,states described in clause 7i7 for each calendar year1 using the methodology determined under clause 7i7 and taking into consideration the experiences of other ,states with respect to participation in an ,exchange and premium tax credits1 cost-sharing reductions1 or small business credits under sections #cf;,b of the ,internal ,revenue ,code of #aihf or under part ,i of subtitle ,e provided to residents of such ,states4 7,b7 ,state grants ,from amounts appropriated under section #b7;b77#a7 of the ,premium ,reduction ,act of #bjai for a fiscal year1 the ,secretary shall award grants to ,states for each of fiscal years #bjbj through #bjbc1 in amounts determined under subparagraph 7,a77ii71 for the following purposes3 7i7 ,for each of fiscal years #bjbj through #bjbd1 out of amounts appropriated under subparagraph 7,a7 of such section #b7;b77#a71 for administrative costs of the ,state associated with preparing and submitting information described in paragraph 7#a77;,b7 that includes an invisible high-risk pool or reinsurance program that meets the requirements of subsection 7f77#b71 or costs associated with the establishment of such invisible high-risk pool or reinsurance program4 7ii7 ,for each of fiscal years #bjba through #bjbc1 out of amounts appropriated under subparagraph 7,b7 of such section #b7;b77#a71 for the establishment or maintenance of invisible high-risk pools and reinsurance programs that meet the requirements of subsection 7f77#b7 and for which the ,state has received a waiver under this section4 7,c7 ,budget neutrality ,funds awarded to a ,state under a grant awarded under subparagraph 7,b7 shall not be taken into account for purposes of determining under paragraph 7#a7 whether the ,state waiver is budget neutral1 or determining under subsection 7b77#a7 whether the ,state waiver increases the ,federal deficit4 7#e7 ,reconciliation of pass through funding and funding for invisible high-risk pool and reinsurance programs ,in allocating amounts under paragraphs 7#c7 and 7#d71 the ,secretary-- 7,a7 not later than ,november #a of each year1 shall estimate the allocation for each ,state under such paragraphs for the upcoming calendar year2 7,b7 not later than ,june #a of each year1 shall revise the estimate of the allocations under subparagraph 7,a7 for each ,state for the current calendar year2 and 7,c7 shall reconcile amounts to be paid to each ,state under such paragraphs for the following calendar year by adjusting each ,state's allocation for the following calendar year to account for the revisions made under subparagraph 7,b74 4 7b7 ,appropriations 7#a7 ,in general ,there are authorized to be appropriated1 and there are appropriated1 to the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 for the purposes described in section #accb7;a77#d77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7as amended by subsection 7a77 and subsection 7c7 of this section1 out of any funds in the ,treasury not otherwise appropriated-- 7,a7 #ejj1jjj1jjj for fiscal year #bjbj2 and 7,b7 #e1jjj1jjj1jjj for each of fiscal years #bjba through #bjbc4 7#b7 ,available until expended ,amounts appropriated under this subsection shall remain available until expended4 7c7 ,default ,federal safeguard 7#a7 ,in general ,for purposes of plan year #bjba1 in the case of a ,state that does not1 by a date specified by the ,secretary for each such year1 in consultation with the ,national ,association of ,insurance ,commissioners1 have in effect a waiver under section #accb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjeb7 that includes an invisible high-risk pool or reinsurance program that meets the requirements of subsection 7f77#b7 of such section #accb1 the ,secretary shall1 from amounts appropriated under subsection 7b71 use the allocation determined for the ,state under subsection 7a77#d77;,a7 of such section #accb for plan year #bjba for the purpose described in paragraph 7#b74 ,such allocation shall be increased by the amount of pass through funding that would be available under section #accb7;a77#c7 of the ,patient ,protection and ,affordable ,care ,act if the ,state obtained a waiver for an invisible high-risk pool or reinsurance program under such section4 7#b7 ,required use for market stabilization payments to issuers ,the ,secretary shall use any allocation for a ,state made pursuant to paragraph 7#a7 to help stabilize premiums for health insurance coverage in the individual market in such ,state by providing payments to health insurance issuers1 using payment parameters and a methodology determined by the ,secretary4 7d7 ,invisible high-,risk pools and reinsurance programs 7#a7 ,in general ,section #accb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjeb7 is amended by adding at the end the following3 7f7 ,invisible high-,risk pools and reinsurance programs 7#a7 ,funding ,with respect to a ,state that has received a waiver under this section to establish an invisible high-risk pool or reinsurance program described in paragraph 7#b71 the ,state may fund such program1 in whole or in part1 using one or both of the following3 7,a7 ,amounts received through a grant described in subsection 7a77#d77;,b74 7,b7 ,all of1 or a portion of1 the payments made to the ,state as described in subsection 7a77#c71 consistent with the information the ,state provides under subsection 7a77#a77;,b74 7#b7 ,program design ,an invisible high-risk pool or reinsurance program described in this paragraph is a program that meets any of the following3 7,a7 ,an invisible high-risk pool1 as defined by the ,state1 under which health insurance issuers1 with respect to designated individuals who experience higher than average health costs as determined by the ,state1 and are enrolled in health insurance coverage offered in the individual market1 cede risk to the pool1 without affecting the premium paid by the designated individuals or their terms of coverage4 ,with respect to such pool1 the ,state1 or an entity operating the pool on behalf of the ,state1 shall establish-- 7i7 the premium amount the ceding issuer shall pay to the reinsurance pool2 7ii7 the applicable attachment points or coinsurance percentages if the ceding issuer retains any portion of the risk under ceded policies2 and 7iii7 the mechanism by which high-risk individuals are designated for cession to the pool1 which may include a list of designated high-cost health conditions4 7,b7 ,a reinsurance program1 as defined by the ,state1 that assumes a portion of the risk for individuals who experience higher than average health costs as determined by the ,state1 in a manner substantially similar to the reinsurance program that operated in the ,state in accordance with section #acda4 7,c7 ,a reinsurance program established by the ,state not otherwise described in this paragraph4 7,d7 ,a program based on another ,state's reinsurance program-- 7i7 described in subparagraph 7,a71 7,b71 or 7,c71 for which an application has been approved under this subsection2 or 7ii7 which was implemented prior to ,september #a1 #bjai1 and which the ,secretary determines meets the requirements of subparagraph 7,a74 7#c7 ,expedited approval 7,a7 ,in general ,the ,secretary shall provide an expedited approval process for an application under subsection 7a77#a7-- 7i7 with respect to an invisible high-risk pool or reinsurance program described in subparagraph 7,a71 7,b71 or 7,d7 of paragraph 7#b72 or 7ii7 that uses a template form designed by the ,administrator of the ,centers for ,medicare ,medicaid ,services1 in consultation with the ,secretary of the ,treasury1 for an application based on a program that is the same or substantially the same as a program implemented in accordance with an application previously approved under this subsection4 7,b7 ,timeframe ,the ,secretary shall make a determination on an application eligible for expedited review under subparagraph 7,a7 not later than #ij days after receipt of such application4 7,c7 ,standard of review ,nothing in this paragraph shall be construed as affecting the requirements under subsection 7a77#a7 with respect to an application approved in accordance with the process under subparagraph 7,a74 4 7#b7 ,application ,section #accb7;a77#a77;,b77i7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjeb7;a77#a77;,b77i77 is amended by inserting 1 including1 as applicable1 a description of the ,state's plan to use any amounts awarded to the ,state under paragraph 7#d7 to support an invisible high-risk pool or reinsurance program consistent with subsection 7f7 and such information about such program as the ,secretary may require before the semicolon4