,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #ahfh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #ac1 #bjai,ms4   
,coll9s 7= h]self & ,mr4 ,man*97        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to provide support 
to ,/ates to e/abli% invisible high-risk
 pool or re9surance programs4  #a4 ,%ort
 title ,?is ,act may be cit$ z !        
,premium ,r$uction ,act ( #bjai4  #b4   
,invisible high-risk pool & re9surance  
programs  7a7 ,/ate grants "u waiv]s    
,section #accb7;a7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjeb7;a77 is am5d$--  7#a7  
by r$esignat+ p>agraphs 7#d71 7#e71 &   
7#f7 z p>agraphs 7#f71 7#g71 & 7#h71    
respectively2 &  7#b7 by ins]t+ aft]    
p>agraph 7#c7 ! foll[+3  7#d7 ,f$]al    
fund+ = invisible high-risk pool &      
re9surance programs  7,a7 ,allocations  
7i7 ,me?odology ,n lat] ?an #de days    
aft] ! date ( enactm5t ( ?is ,act1 !    
,secret>y1 9 consultation ) ! ,national 

,association ( ,insurance ,commission]s1
 %all specify an allocation me?odology =
 det]m9+ ! am\nt ( funds appropriat$ "u 
section #b7;b7 ( ! ,premium ,r$uction   
,act ( #bjai = a fiscal ye> to be       
allocat$ = ea* ,/ate = purposes (       
subp>agraph 7,b7 & section #b7;c7 ( !   
,premium ,r$uction ,act ( #bjai4  7ii7  
,annual det]m9ations ,! ,secret>y %all  
det]m9e ! allocations to ,/ates describ$
 9 clause 7i7 = ea* cal5d> ye>1 us+ !   
me?odology det]m9$ "u clause 7i7 & tak+ 
into consid]ation ! exp]i5ces ( o!r     
,/ates ) respect to p>ticipation 9 an   
,ex*ange & premium tax cr$its1 co/-%>+  
r$uctions1 or small bus9ess cr$its "u   
sections #cf;,b ( ! ,int]nal ,rev5ue    
,code ( #aihf or "u "p ,i ( subtitle ,e 
provid$ to resid5ts ( su* ,/ates4  7,b7 
,/ate grants ,f am\nts appropriat$ "u   
section #b7;b77#a7 ( ! ,premium         
,r$uction ,act ( #bjai = a fiscal ye>1 !
 ,secret>y %all aw>d grants to ,/ates = 
ea* ( fiscal ye>s #bjbj ?r\gh #bjbc1 9  
am\nts det]m9$ "u subp>agraph 7,a77ii71 

= ! foll[+ purposes3  7i7 ,= ea* (      
fiscal ye>s #bjbj ?r\gh #bjbd1 out (    
am\nts appropriat$ "u subp>agraph 7,a7 (
 su* section #b7;b77#a71 = adm9i/rative 
co/s ( ! ,/ate associat$ ) prep>+ &     
submitt+ in=mation describ$ 9 p>agraph  
7#a77;,b7 t includes an invisible       
high-risk pool or re9surance program t  
meets ! requirem5ts ( subsection        
7f77#b71 or co/s associat$ ) !          
e/abli%m5t ( su* invisible high-risk    
pool or re9surance program4  7ii7 ,= ea*
 ( fiscal ye>s #bjba ?r\gh #bjbc1 out ( 
am\nts appropriat$ "u subp>agraph 7,b7 (
 su* section #b7;b77#a71 = ! e/abli%m5t 
or ma9t5ance ( invisible high-risk pools
 & re9surance programs t meet !         
requirem5ts ( subsection 7f77#b7 & = :i*
 ! ,/ate has receiv$ a waiv] "u ?is     
section4  7,c7 ,budget neutrality ,funds
 aw>d$ to a ,/ate "u a grant aw>d$ "u   
subp>agraph 7,b7 %all n be tak5 into    
acc\nt = purposes ( det]m9+ "u p>agraph 
7#a7 :e!r ! ,/ate waiv] is budget       
neutral1 or det]m9+ "u subsection       

7b77#a7 :e!r ! ,/ate waiv] increases !  
,f$]al deficit4  7#e7 ,reconciliation ( 
pass ?r\gh fund+ & fund+ = invisible    
high-risk pool & re9surance programs ,9 
allocat+ am\nts "u p>agraphs 7#c7 &     
7#d71 ! ,secret>y-- 7,a7 n lat] ?an     
,novemb] #a ( ea* ye>1 %all e/imate !   
allocation = ea* ,/ate "u su* p>agraphs 
= ! upcom+ cal5d> ye>2  7,b7 n lat] ?an 
,june #a ( ea* ye>1 %all revise !       
e/imate ( ! allocations "u subp>agraph  
7,a7 = ea* ,/ate = ! curr5t cal5d> ye>2 
&  7,c7 %all reconcile am\nts to be paid
 to ea* ,/ate "u su* p>agraphs = !      
foll[+ cal5d> ye> by adju/+ ea* ,/ate's 
allocation = ! foll[+ cal5d> ye> to     
acc\nt = ! revisions made "u subp>agraph
 7,b74  4  7b7 ,appropriations  7#a7 ,9 
g5]al ,!re are au?oriz$ to be           
appropriat$1 & !re are appropriat$1 to !
 ,secret>y ( ,heal? & ,human ,s]vices   
7ref]r$ to 9 ?is section z ! ,secret>y71
 = ! purposes describ$ 9 section        
#accb7;a77#d77;,b7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7z    

am5d$ by subsection 7a77 & subsection   
7c7 ( ?is section1 out ( any funds 9 !  
,treasury n o!rwise appropriat$--  7,a7 
#ejj1jjj1jjj = fiscal ye> #bjbj2 &  7,b7
 #e1jjj1jjj1jjj = ea* ( fiscal ye>s     
#bjba ?r\gh #bjbc4  7#b7 ,available     
until exp5d$ ,am\nts appropriat$ "u ?is 
subsection %all rema9 available until   
exp5d$4  7c7 ,default ,f$]al safegu>d   
7#a7 ,9 g5]al ,= purposes ( plan ye>    
#bjba1 9 ! case ( a ,/ate t does n1 by a
 date specifi$ by ! ,secret>y = ea* su* 
ye>1 9 consultation ) ! ,national       
,association ( ,insurance ,commission]s1
 h 9 effect a waiv] "u section #accb ( !
 ,pati5t ,protection & ,af=dable ,c>e   
,act 7#db ,u4,s4,c4 #ahjeb7 t includes  
an invisible high-risk pool or          
re9surance program t meets ! requirem5ts
 ( subsection 7f77#b7 ( su* section     
#accb1 ! ,secret>y %all1 f am\nts       
appropriat$ "u subsection 7b71 use !    
allocation det]m9$ = ! ,/ate "u         
subsection 7a77#d77;,a7 ( su* section   
#accb = plan ye> #bjba = ! purpose      

describ$ 9 p>agraph 7#b74 ,su*          
allocation %all be increas$ by ! am\nt (
 pass ?r\gh fund+ t w\ld be available "u
 section #accb7;a77#c7 ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act if !  
,/ate obta9$ a waiv] = an invisible     
high-risk pool or re9surance program "u 
su* section4  7#b7 ,requir$ use = m>ket 
/abilization paym5ts to issu]s ,!       
,secret>y %all use any allocation = a   
,/ate made pursuant to p>agraph 7#a7 to 
help /abilize premiums = heal? insurance
 cov]age 9 ! individual m>ket 9 su*     
,/ate by provid+ paym5ts to heal?       
insurance issu]s1 us+ paym5t p>amet]s & 
a me?odology det]m9$ by ! ,secret>y4    
7d7 ,invisible high-,risk pools &       
re9surance programs  7#a7 ,9 g5]al      
,section #accb ( ! ,pati5t ,protection &
 ,af=dable ,c>e ,act 7#db ,u4,s4,c4     
#ahjeb7 is am5d$ by add+ at ! end !     
foll[+3  7f7 ,invisible high-,risk pools
 & re9surance programs  7#a7 ,fund+ ,)  
respect to a ,/ate t has receiv$ a waiv]
 "u ?is section to e/abli% an invisible 

high-risk pool or re9surance program    
describ$ 9 p>agraph 7#b71 ! ,/ate may   
fund su* program1 9 :ole or 9 "p1 us+ "o
 or bo? ( ! foll[+3  7,a7 ,am\nts       
receiv$ ?r\gh a grant describ$ 9        
subsection 7a77#d77;,b74  7,b7 ,all (1  
or a portion (1 ! paym5ts made to !     
,/ate z describ$ 9 subsection 7a77#c71  
consi/5t ) ! in=mation ! ,/ate provides 
"u subsection 7a77#a77;,b74  7#b7       
,program design ,an invisible high-risk 
pool or re9surance program describ$ 9   
?is p>agraph is a program t meets any ( 
! foll[+3  7,a7 ,an invisible high-risk 
pool1 z def9$ by ! ,/ate1 "u :i* heal?  
insurance issu]s1 ) respect to designat$
 individuals :o exp]i5ce high] ?an      
av]age heal? co/s z det]m9$ by ! ,/ate1 
& are enroll$ 9 heal? insurance cov]age 
(f]$ 9 ! individual m>ket1 c$e risk to !
 pool1 )\t affect+ ! premium paid by !  
designat$ individuals or _! t]ms (      
cov]age4 ,) respect to su* pool1 !      
,/ate1 or an entity op]at+ ! pool on    
behalf ( ! ,/ate1 %all e/abli%--  7i7 ! 

premium am\nt ! c$+ issu] %all pay to ! 
re9surance pool2  7ii7 ! applicable     
atta*m5t po9ts or co9surance p]c5tages  
if ! c$+ issu] reta9s any portion ( !   
risk "u c$$ policies2 &  7iii7 !        
me*anism by :i* high-risk individuals   
are designat$ = cession to ! pool1 :i*  
may include a li/ ( designat$ high-co/  
heal? conditions4  7,b7 ,a re9surance   
program1 z def9$ by ! ,/ate1 t assumes a
 portion ( ! risk = individuals :o      
exp]i5ce high] ?an av]age heal? co/s z  
det]m9$ by ! ,/ate1 9 a mann]           
sub/antially simil> to ! re9surance     
program t op]at$ 9 ! ,/ate 9 accordance 
) section #acda4  7,c7 ,a re9surance    
program e/abli%$ by ! ,/ate n o!rwise   
describ$ 9 ?is p>agraph4  7,d7 ,a       
program bas$ on ano!r ,/ate's re9surance
 program--  7i7 describ$ 9 subp>agraph  
7,a71 7,b71 or 7,c71 = :i* an           
application has be5 approv$ "u ?is      
subsection2 or  7ii7 :i* 0 implem5t$    
prior to ,septemb] #a1 #bjai1 & :i* !   
,secret>y det]m9es meets ! requirem5ts (

 subp>agraph 7,a74  7#c7 ,exp$it$       
approval  7,a7 ,9 g5]al ,! ,secret>y    
%all provide an exp$it$ approval process
 = an application "u subsection         
7a77#a7--  7i7 ) respect to an invisible
 high-risk pool or re9surance program   
describ$ 9 subp>agraph 7,a71 7,b71 or   
7,d7 ( p>agraph 7#b72 or  7ii7 t uses a 
template =m design$ by ! ,adm9i/rator ( 
! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1 9
 consultation ) ! ,secret>y ( !         
,treasury1 = an application bas$ on a   
program t is ! same or sub/antially !   
same z a program implem5t$ 9 accordance 
) an application previ\sly approv$ "u   
?is subsection4  7,b7 ,timeframe ,!     
,secret>y %all make a det]m9ation on an 
application eligible = exp$it$ review "u
 subp>agraph 7,a7 n lat] ?an #ij days   
aft] receipt ( su* application4  7,c7   
,/&>d ( review ,no?+ 9 ?is p>agraph %all
 be con/ru$ z affect+ ! requirem5ts "u  
subsection 7a77#a7 ) respect to an      
application approv$ 9 accordance ) !    
process "u subp>agraph 7,a74  4  7#b7   

,application ,section                   
#accb7;a77#a77;,b77i7 ( ! ,pati5t       
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjeb7;a77#a77;,b77i77 is    
am5d$ by ins]t+ 1 includ+1 z applicable1
 a description ( ! ,/ate's plan to use  
any am\nts aw>d$ to ! ,/ate "u p>agraph 
7#d7 to support an invisible high-risk  
pool or re9surance program consi/5t )   
subsection 7f7 & su* in=mation ab\t su* 
program z ! ,secret>y may require be=e !
 semicolon4