,,ii #aaf? ,,congress #a/ ,session ,s4 #bjjd ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #bg1 #bjai ,ms4 ,smi? 7= h]self & ,mr4 ,cram]7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d ! ,public ,heal? ,s]vice ,act to e/abli% insul9 assi/ance programs1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,em]g5cy ,access to ,insul9 ,act ( #bjai4 #b4 ,insul9 assi/ance programs 7a7 ,9 g5]al ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq47 is am5d$ by add+ at ! end ! foll[+3 #cbj;,b4 ,insul9 assi/ance programs 7a7 ,e/abli%m5t ( program ( grants to ,/ates1 ,indian tribes1 & tribal organizations 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 make grants to ,/ates1 ,indian tribes1 & tribal organizations = ! purpose ( c>ry+ out programs to assi/ eligible individuals 9 obta9+ insul9 9 accordance ) p>agraph 7#d74 7#b7 ,grant & contract au?ority = ,/ates1 ,indian tribes1 & tribal organizations 7,a7 ,9 g5]al ,a ,/ate1 ,indian tribe1 or tribal organization receiv+ a grant "u p>agraph 7#a7 may1 subject to subp>agraph 7,b71 exp5d ! grant to c>ry out ! purpose describ$ 9 su* p>agraph ?r\gh grants or contracts to public or private entities1 includ+ local gov]nm5ts4 7,b7 ,c]ta9 applications ,if a nonpr(it private entity & a private entity t is n a nonpr(it entity bo? submit applications to a ,/ate1 ,indian tribe1 or tribal organization to receive an aw>d ( a grant or contract "u subp>agraph 7,a71 ! ,/ate1 ,indian tribe1 or tribal organization may give priority to ! application submitt$ by ! nonpr(it private entity 9 any case 9 :i* ! ,/ate1 ,indian tribe1 or tribal organization det]m9es t ! quality ( su* application is equival5t to ! quality ( ! application submitt$ by ! o!r private entity4 7#c7 ,allotm5t ,ea* ,/ate1 ,indian tribe1 or tribal organization t applies = a grant 9 accordance ) subsection 7e7 %all receive a grant "u ?is section 9 an am\nt t is equal to ! sum (-- 7,a7 a m9imum am\nt det]m9$ by ! ,secret>y2 & 7,b7 an additional am\nt bas$ on crit]ia e/abli%$ by ! ,secret>y1 :i* may include ! ability ( ! ,/ate1 ,indian tribe1 or tribal organization to successfully assi/ individuals 9 seek+ eligibility = ,f$]al or ,/ate-fund$ programs z describ$ 9 p>agraph 7#d77;,a77iv74 7#d7 ,program compon5ts 7,a7 ,9 g5]al ,a ,/ate1 ,indian tribe1 or tribal organization c>ry+ out a program support$ by a grant "u ?is subsection %all use ! grant funds to-- 7i7 pur*ase insul92 7ii7 issue insul9 c>ds to eligible individuals 9 accordance ) subp>agraph 7,b72 7iii7 ent] into agreem5ts ) ph>macies-- 7,i7 = su* ph>macies to fill prescriptions = individuals display+ valid insul9 c>ds t are issu$ 9 accordance ) subp>agraph 7,b7 at no co/ to su* individuals2 & 7,,ii7 = ! ,/ate1 ,indian tribe1 or tribal organization to pay su* ph>macies = insul9 fill$ = a prescription describ$ 9 subclause 7,i72 & 7iv7 assi/ individuals 9 seek+ eligibility = ,f$]al or ,/ate-fund$ programs :i* may provide cov]age = insul9 or o!rwise assi/ su* individuals 9 obta9+ insul94 7,b7 ,insul9 c>ds 7i7 ,application ,an eligible individual seek+ an insul9 c>d ?r\gh a program support$ by a grant "u ?is subsection %all submit an application to ! ,/ate1 ,indian tribe1 or tribal organization receiv+ ! grant1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,/ate1 ,indian tribe1 or tribal organization may reasonably require = purposes ( ?is subsection1 includ+-- 7,i7 docum5tation indicat+ pro( (-- 7aa7 9 ! case ( a grant aw>d$ to a ,/ate1 resid5cy 9 ! ,/ate2 7bb7 9 ! case ( a grant aw>d$ to an ,indian tribe1 memb]%ip 9 ! ,indian tribe2 or 7cc7 9 ! case ( a grant aw>d$ to a tribal organization1 memb]%ip 9 ! ,indian tribe or ,indian community s]v$ by ! tribal organization2 7,,ii7 a prescription = insul9 t is prescrib$ to ! individual2 7,,iii7 a /atem5t t1 to ! be/ ( ! individual's k1 ! individual is an un9sur$ individual or an und]9sur$ individual2 & 7,,iv7 if ! individual is an und]9sur$ individual1 ! "n ( ! high-d$uctible heal? plan 9 :i* ! individual is enroll$ & any unique id5tifi] ( ! plan1 su* z a policy numb]4 7ii7 ,initial c>d 7,i7 ,9 g5]al ,a ,/ate1 ,indian tribe1 or tribal organization c>ry+ out a program support$ by a grant "u ?is subsection %all issue an initial insul9 c>d to ea* individual t submits an application to ! ,/ate1 ,indian tribe1 or tribal organization meet+ ! requirem5ts "u clause 7i74 7,,ii7 ,tim+ ,a ,/ate1 ,indian tribe1 or tribal organization t receives an application "u clause 7i7 f an individual %all issue an initial insul9 c>d to su* individual n lat] ?an #e bus9ess days aft] receiv+ su* application4 7,,iii7 ,supply ,an initial insul9 c>d issu$ to an individual "u ?is clause %all be valid = an approximate #g-;day supply ( insul9 t is appropriate = ! individual bas$ on ! prescription = ! individual provid$ 9 ! application "u clause 7i7 & packag+ & process+ practices = insul94 7iii7 #c-mon? c>ds ,n lat] ?an #ab bus9ess days aft] an individual submits an application "u clause 7i7 to a ,/ate1 ,indian tribe1 or tribal organization1 ! ,/ate1 ,indian tribe1 or tribal organization %all-- 7,i7 det]m9e :e!r ! individual is an eligible individual2 & 7,,ii7 if ! individual is an eligible individual1 issue ! individual an insul9 c>d t is valid = an approximate #ij-;day supply ( insul9 t is appropriate = ! individual bas$ on ! prescription provid$ 9 ! application "u clause 7i7 & packag+ & process+ practices = insul94 7iv7 ,r5ewal ( c>ds 7,i7 #c-mon? c>ds ,an eligible individual t is issu$ an insul9 c>d "u clause 7iii7 may apply to r5ew su* c>d 9 accordance ) a process e/abli%$ by ! ,/ate1 ,indian tribe1 or tribal organization4 7,,ii7 ,limitation ,an individual t submits an application "u clause 7i7 & is d5i$ an insul9 c>d "u clause 7ii7 or 7iii7 may n submit ano!r application "u clause 7i7 = ! #a-ye> p]iod beg9n+ on ! date on :i* ! individual is d5i$ su* c>d4 7b7 ,requirem5t ( mat*+ funds 7#a7 ,9 g5]al ,! ,secret>y may n make a grant "u subsection 7a7 unless ! ,/ate1 ,indian tribe1 or tribal organization involv$ agrees1 ) respect to ! co/s to be incurr$ by ! ,/ate1 ,indian tribe1 or tribal organization 9 c>ry+ out ! purpose describ$ 9 subsection 7a77#a71 to make available non-,f$]al contributions 79 ca% or 9 k9d "u p>agraph 7#b77 t[>d su* co/s 9 an am\nt equal to n less ?an #a = ea* #c ( ,f$]al funds provid$ 9 ! grant4 ,su* contributions may be made directly or ?r\gh donations f public or private entities4 7#b7 ,det]m9ation ( am\nt ( non-f$]al contribution 7,a7 ,9 g5]al ,non-,f$]al contributions requir$ 9 p>agraph 7#a7 may be 9 ca% or 9 k9d1 fairly evaluat$1 includ+ equipm5t or s]vices 7& exclud+ indirect or ov]head co/s74 ,am\nts provid$ by ! ,f$]al ,gov]nm5t1 or s]vices assi/$ or subsidiz$ to any significant ext5t by ! ,f$]al ,gov]nm5t1 may n be includ$ 9 det]m9+ ! am\nt ( su* non-,f$]al contributions4 7,b7 ,ma9t5ance ( ef=t ,9 mak+ a det]m9ation ( ! am\nt ( non-,f$]al contributions = purposes ( p>agraph 7#a71 ! ,secret>y may include only non-,f$]al contributions 9 excess ( ! av]age am\nt ( non-,f$]al contributions made by ! ,/ate1 ,indian tribe1 or tribal organization involv$ t[>d ! purpose describ$ 9 subsection 7a77#a7 = ! #b-ye> p]iod prec$+ ! fir/ fiscal ye> = :i* ! ,/ate1 ,indian tribe1 or tribal organization is apply+ to receive a grant "u subsection 7a74 7,c7 ,inclusion ( relevant non-f$]al contributions = m$icaid ,9 mak+ a det]m9ation ( ! am\nt ( non-,f$]al contributions = purposes ( p>agraph 7#a71 ! ,secret>y %all1 subject to subp>agraphs 7,a7 & 7,b7 ( ?is p>agraph1 include any non-,f$]al am\nts exp5d$ pursuant to title ,,xix ( ! ,social ,security ,act by ! ,/ate1 ,indian tribe1 or tribal organization relat$ to insul9 disp5s$ to individuals eligible = m$ical assi/ance "u su* title4 7c7 ,additional requir$ agreem5ts 7#a7 ,/atewide provision ( s]vices 7,a7 ,9 g5]al ,! ,secret>y may n make a grant "u subsection 7a7 unless ! ,/ate1 ,indian tribe1 or tribal organization involv$ agrees t s]vices & activities "u ! grant w be made available ?r\gh\t ! ,/ate 7includ+ availability to memb]s ( any ,indian tribe or tribal organization 9 ! ,/ate71 ,indian tribe1 or tribal organization4 7,b7 ,waiv] 7i7 ,9 g5]al ,! ,secret>y may waive ! requirem5t e/abli%$ 9 subp>agraph 7,a7 = a ,/ate1 ,indian tribe1 or tribal organization if ! ,secret>y det]m9es t compliance by ! ,/ate1 ,indian tribe1 or tribal organization ) ! requirem5t w\ld result 9 an ineffici5t allocation ( res\rces ) respect to c>ry+ out ! purpose describ$ 9 subsection 7a77#a74 7ii7 ,indian tribes & tribal organizations ,if an ,indian tribe or tribal organization is receiv+ a grant "u subsection 7a7 & ! ,/ate 9 :i* ! tribe or organization is locat$ is receiv+ a grant "u subsection 7a71 ! requirem5t "u subp>agraph 7,a7 = ! ,/ate reg>d+ availability to ! tribe or organization is deem$ to h be5 waiv$ "u ?is subp>agraph4 7#b7 ,relation%ip to items & s]vices "u o!r programs 7,a7 ,9 g5]al ,! ,secret>y may n make a grant "u subsection 7a7 unless ! ,/ate1 ,indian tribe1 or tribal organization involv$ agrees t ! grant w n be exp5d$ to make paym5t = any item or s]vice to ! ext5t t paym5t has be5 made1 or c reasonably be expect$ to be made1 ) respect to su* item or s]vice-- 7i7 except z provid$ 9 subp>agraph 7,b71 "u any ,/ate comp5sation program1 "u an insurance policy1 or "u any ,f$]al or ,/ate heal? b5efits program2 or 7ii7 by an entity t provides heal? s]vices on a prepaid basis4 7,b7 ,exception ,! requirem5t "u subp>agraph 7,a77i7 %all n apply ) respect to cov]age "u a high-d$uctible heal? plan4 7#c7 ,limitation on adm9i/rative exp5ses ,! ,secret>y may n make a grant "u subsection 7a7 unless ! ,/ate1 ,indian tribe1 or tribal organization involv$ agrees t n m ?an #aj p]c5t ( ! grant w be exp5d$ = adm9i/rative exp5ses ) respect to ! grant4 7#d7 ,records & audits ,! ,secret>y may n make a grant "u subsection 7a7 unless ! ,/ate1 ,indian tribe1 or tribal organization involv$ agrees t-- 7,a7 ! ,/ate1 ,indian tribe1 or tribal organization w e/abli% su* fiscal control & fund acc\nt+ proc$ures z may be necess>y to ensure ! prop] disbursal (1 & acc\nt+ =1 am\nts receiv$ by ! ,/ate1 ,indian tribe1 or tribal organization "u su* subsection2 7,b7 ^u reque/1 ! ,/ate1 ,indian tribe1 or tribal organization w provide records ma9ta9$ pursuant to subp>agraph 7,a7 to ! ,secret>y or ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates = purposes ( audit+ ! exp5ditures by ! ,/ate1 ,indian tribe1 or tribal organization ( ! grant2 & 7,c7 ! ,/ate1 ,indian tribe1 or tribal organization w keep su* records z ! ,secret>y %all prescribe1 includ+-- 7i7 records t fully disclose-- 7,i7 ! am\nt & disposition by ! ,/ate1 ,indian tribe1 or tribal organization ( ! proce$s ( su* grant2 7,,ii7 ! total co/ ( ! project or und]tak+ int5d$ to be c>ri$ out ?r\gh ! grant2 & 7,,iii7 ! am\nt ( t portion ( ! co/ ( ! project or und]tak+ suppli$ by s\rces o!r ?an ! grant2 & 7ii7 su* o!r records z ! ,secret>y det]m9es appropriate = facilitat+ an effective audit ( grants aw>d$ "u ?is section4 7#e7 ,reports 7,a7 ,reports to ! ,secret>y ,! ,secret>y may n make a grant "u subsection 7a7 unless ! ,/ate1 ,indian tribe1 or tribal organization involv$ agrees to submit to ! ,secret>y su* reports z ! ,secret>y may require ) respect to ! grant1 includ+ a report on-- 7i7 ! types ( problems & inquiries enc\nt]$ by individuals apply+ = or receiv+ insul9 ?r\gh a program support$ by su* grant2 7ii7 ! numb] ( insul9 products disp5s$ & ! unit co/s = ^? products dur+ ! p]iod cov]$ by ! report2 7iii7 ! numb] ( ph>macies p>ticipat+ 9 ! program dur+ ! p]iod cov]$ by ! report2 7iv7 summ>y data on ! individuals apply+ = or receiv+ insul9 ?r\gh ! program2 & 7v7 any o!r in=mation ! ,secret>y %all det]m9e necess>y to provide ov]sight ( ! grants made "u ?is section4 7,b7 ,high-d$uctible heal? plans ,! ,secret>y may n make a grant "u subsection 7a7 unless ! ,/ate1 ,indian tribe1 or tribal organization involv$ agrees to1 z soon z practicable aft] ea* "t ! ,/ate1 ,indian tribe1 or tribal organization provides paym5t to a ph>macy = insul9 = an und]9sur$ individual1 submit to ! high-d$uctible heal? plan 9 :i* ! individual is enroll$ in=mation on ! am\nt ( su* paym5t 9 ord] = su* plan to comply ) ! requirem5ts "u section #bgaj4 7d7 ,description ( int5d$ uses ( grant ,! ,secret>y may n make a grant "u subsection 7a7 unless-- 7#a7 ! ,/ate1 ,indian tribe1 or tribal organization involv$ submits to ! ,secret>y a description ( ! purposes = :i* ! ,/ate1 ,indian tribe1 or tribal organization int5ds to exp5d ! grant2 7#b7 ! description id5tifies ! populations1 areas1 & localities 9 ! ,/ate1 or "u ! jurisdiction ( ! ,indian tribe or tribal organization1 ) a ne$ = a program to assi/ individuals 9 obta9+ insul9 9 accordance ) subsection 7a72 7#c7 ! description provides in=mation relat+ to ! s]vices & activities to be provid$1 includ+ a description ( ! mann] 9 :i* ! s]vices & activities w be coord9at$ ) any simil> s]vices or activities ( public or private entities2 & 7#d7 ! description provides assurances t ! grant funds w be us$ 9 ! mo/ co/-effective mann]4 7e7 ,requirem5t ( submission ( application ,! ,secret>y may n make a grant "u subsection 7a7 unless an application = ! grant is submitt$ to ! ,secret>y1 ! application conta9s ! description ( int5d$ uses requir$ "u subsection 7d71 & ! application is 9 su* =m1 is made 9 su* mann]1 & conta9s su* agreem5ts1 assurances1 & in=mation z ! ,secret>y det]m9es to be necess>y to c>ry out ?is section4 7f7 ,te*nical assi/ance & provision ( supplies & s]vices 9 lieu ( grant funds 7#a7 ,te*nical assi/ance ,! ,secret>y may provide tra9+ & te*nical assi/ance ) respect to ! plann+1 developm5t1 & op]ation ( any program or s]vice c>ri$ out pursuant to subsection 7a74 ,! ,secret>y may provide su* te*nical assi/ance directly or ?r\gh grants to1 or contracts )1 public or private entities4 7#b7 ,provision ( supplies & s]vices 9 lieu ( grant funds 7,a7 ,9 g5]al ,^u ! reque/ ( a ,/ate1 ,indian tribe1 or tribal organization receiv+ a grant "u subsection 7a71 ! ,secret>y may1 subject to subp>agraph 7,b71 provide supplies1 equipm5t1 & s]vices = ! purpose ( aid+ ! ,/ate1 ,indian tribe1 or tribal organization 9 c>ry+ out su* subsection &1 = su* purpose1 may detail to ! ,/ate1 ,indian tribe1 or tribal organization any (fic] or employee ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7,b7 ,correspond+ r$uction 9 paym5ts ,) respect to a reque/ describ$ 9 subp>agraph 7,a71 ! ,secret>y %all r$uce ! am\nt ( paym5ts "u ! grant "u subsection 7a7 to ! ,/ate1 ,indian tribe1 or tribal organization involv$ by an am\nt equal to ! co/s ( detail+ p]sonnel 7includ+ pay1 all[ances1 & travel exp5ses7 & ! fair m>ket value ( any supplies1 equipm5t1 or s]vices provid$ by ! ,secret>y4 ,! ,secret>y %all1 = ! paym5t ( exp5ses incurr$ 9 comply+ ) su* reque/1 exp5d ! am\nts )held4 7g7 ,evaluations & reports 7#a7 ,evaluations ,! ,secret>y %all1 directly or ?r\gh contracts ) public or private entities1 provide = annual evaluations ( programs c>ri$ out pursuant to subsection 7a74 ,su* evaluations %all include evaluations (-- 7,a7 ! ext5t to :i* ,/ates1 ,indian tribes1 & tribal organizations c>ry+ out su* programs are 9 compliance ) subsection 7a7 & ) subsection 7c77#a72 & 7,b7 ! ext5t to :i* ea* ,/ate1 ,indian tribe1 or tribal organization receiv+ a grant "u ?is section is 9 compliance ) subsection 7b71 includ+ id5tification (-- 7i7 ! am\nt ( ! non-,f$]al contributions by ! ,/ate1 ,indian tribe1 or tribal organization = ! prec$+ fiscal ye>1 disaggregat$ accord+ to ! s\rce ( ! contributions2 & 7ii7 ! proportion ( su* am\nt ( non-,f$]al contributions relative to ! am\nt ( ,f$]al funds provid$ ?r\gh ! grant to ! ,/ate1 ,indian tribe1 or tribal organization = ! prec$+ fiscal ye>4 7#b7 ,reports to ,congress ,! ,secret>y %all1 n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ! ,em]g5cy ,access to ,insul9 ,act ( #bjai1 & annually !reaft]1 submit to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report summ>iz+ evaluations c>ri$ out "u p>agraph 7#a7 dur+ ! prec$+ fiscal ye> & mak+ su* recomm5dations = adm9i/rative & legislative initiatives ) respect to ?is section z ! ,secret>y det]m9es to be appropriate1 includ+ recomm5dations reg>d+ compliance by ! ,/ates1 ,indian tribes1 & tribal organizations ) subsection 7a7 & ) subsection 7c77#a74 7h7 ,fund+ = g5]al program 7#a7 ,au?orization ( appropriations ,= ! purpose ( c>ry+ out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y4 7#b7 ,set-aside = te*nical assi/ance & provision ( supplies & s]vices ,( ! am\nts appropriat$ "u p>agraph 7#a7 = a fiscal ye>1 ! ,secret>y %all res]ve n m ?an #bj p]c5t = c>ry+ out subsection 7f74 7i7 ,sunset ,! au?ority to aw>d grants "u subsection 7a7 %all be effective beg9n+ on ! date ( enactm5t ( ! ,em]g5cy ,access to ,insul9 ,act ( #bjai & end+ on ! date t is #e ye>s aft] su* date4 7j7 ,def9itions ,= purposes ( ?is section3 7#a7 ,eligible individual ,! t]m eligible individual1 ) respect to a program support$ by a ,/ate1 ,indian tribe1 or tribal organization receiv+ a grant "u ?is section1 means an un9sur$ individual or an und]9sur$ individual-- 7,a7 7i7 9 ! case ( a grant to a ,/ate1 :o is a resid5t ( ! ,/ate2 7ii7 9 ! case ( a grant to an ,indian tribe1 :o is a memb] ( su* tribe2 or 7iii7 9 ! case ( a grant to a tribal organization1 :o is a memb] ( ! ,indian tribe or ,indian community s]v$ by ! tribal organization2 & 7,b7 :o has a valid prescription = insul9 t is prescrib$ to su* individual4 7#b7 ,gr\p heal? insurance cov]age2 gr\p heal? plan2 heal? insurance issu] ,! t]ms gr\p heal? insurance cov]age1 gr\p heal? plan1 & heal? insurance issu] h ! mean+s giv5 su* t]ms 9 section #bgia4 7#c7 ,high-d$uctible heal? plan ,! t]m high-d$uctible heal? plan means a gr\p heal? plan or gr\p or individual heal? insurance cov]age 7(f]$ by a heal? insurance issu]7 t meets crit]ia e/abli%$ by ! ,secret>y4 7#d7 ,indian tribe ,! t]m ,indian tribe has ! mean+ giv5 su* t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7#e7 ,individual heal? insurance cov]age ,! t]m individual heal? insurance cov]age has ! mean+ giv5 su* t]m 9 section #bgia4 7#f7 ,tribal organization ,! t]m tribal organization has ! mean+ giv5 su* t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7#g7 ,und]9sur$ individual ,! t]m und]9sur$ individual means an individual :o is enroll$ 9 a high-d$uctible heal? plan4 7#h7 ,un9sur$ individual ,! t]m un9sur$ individual means an individual :o does n h m9imum ess5tial cov]age z def9$ 9 section #ejjj;,a7f77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf or cov]age "u a m$ical c>e program ( ! ,indian ,heal? ,s]vice or ( a tribal organization or urban ,indian organization4 7#i7 ,urban ,indian organization ,! t]m urban ,indian organization has ! mean+ giv5 su* t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act4 4 7b7 ,exempt+ prices us$ "u an insul9 assi/ance program f be/ price & av]age manufactur] price "u ! ,m$icaid drug rebate program ,section #aibg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7 is am5d$-- 7#a7 9 subsection 7c77#a77;,c77i77,,iii71 by ins]t+ or "u an insul9 assi/ance program support$ "u section #cbj;,b ( ! ,public ,heal? ,s]vice ,act aft] ,/ate ph>maceutical assi/ance program2 & 7#b7 9 subsection 7k77#a77;,b77i7-- 7,a7 9 subclause 7,,iv71 by /rik+ 2 & & ins]t+ a semicolon2 7,b7 9 subclause 7,v71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subclause3 7,,vi7 any prices us$ "u an insul9 assi/ance program support$ "u section #cbj;,b ( ! ,public ,heal? ,s]vice ,act4 4 7c7 ,d$uctibles = und]9sur$ individuals p>ticipat+ 9 insul9 assi/ance programs ,subp>t ,i ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgaj4 ,d$uctibles = und]9sur$ individuals p>ticipat+ 9 insul9 assi/ance programs 7a7 ,9 g5]al ,a gr\p heal? plan t is a high-d$uctible heal? plan & a heal? insurance issu] (f]+ a high-d$uctible heal? plan %all1 ) respect to any individual :o is enroll$ 9 su* plan & obta9s insul9 dur+ a plan ye> ?r\gh an insul9 c>d issu$ to ! individual by a ,/ate1 ,indian tribe1 or tribal organization c>ry+ out an insul9 assi/ance program "u section #cbj;,b1 c\nt ! am\nt ! ,/ate1 ,indian tribe1 or tribal organization pays a ph>macy = insul9 = su* individual = su* plan ye> t[>ds any d$uctible or o!r out-(-pocket exp5ses requir$ to be paid "u ! plan4 7b7 ,high-,d$uctible heal? plan ,= purposes ( ?is section1 ! t]m high-d$uctible heal? plan has ! mean+ giv5 su* t]m 9 section #cbj;,b7j74 4 #c4 ,annual fees applicable to insul9 manufactur]s 7a7 ,def9itions ,= purposes ( ?is section3 7#a7 ,annual paym5t date ,! t]m annual paym5t date means1 ) respect to a cal5d> ye>1 ! date det]m9$ by ! ,secret>y1 b 9 no ev5t lat] ?an ,septemb] #cj ( su* cal5d> ye>4 7#b7 ,cov]$ entity ,! t]m cov]$ entity1 ) respect to a cal5d> ye>1 means an entity t-- 7,a7 is ! hold] ( an application approv$ "u subsection 7c7 ( section #eje ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cee71 or ( a lic5se issu$ "u subsection 7a7 ( section #cea ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bfb71 = an insul9 product2 & 7,b7 dur+ ! prec$+ cal5d> ye>1 manufactur$ any insul9 product t 0 sold 9 comm]ce & cov]$ by a ,f$]al heal? program at lea/ once dur+ su* prec$+ cal5d> ye>4 7#c7 ,inspector ,g5]al ,! t]m ,inspector ,g5]al means ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#d7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7b7 ,imposition ( fee ,ea* cov]$ entity = a cal5d> ye>1 beg9n+ 9 #bjbj & end+ 9 #bjbd1 %all pay to ! ,secret>y n lat] ?an ! annual paym5t date ( su* cal5d> ye> a fee 9 an am\nt det]m9$ "u subsection 7c74 7c7 ,am\nt ( fees 7#a7 ,total am\nt ,! ,secret>y %all ensure t ! total am\nt 9 fees assess$ "u subsection 7b7-- 7,a7 = cal5d> ye> #bjbj1 equals ! total am\nt ! ,secret>y e/imates z ! total exp5ditures = c>ry+ out section #cbj;,b ( ! ,public ,heal? ,s]vice ,act = su* cal5d> ye>2 & 7,b7 = ea* ( cal5d> ye>s #bjba ?r\gh #bjbd1 equals ! total am\nt ( exp5ditures ! ,secret>y det]m9es = c>ry+ out su* section = ! prec$+ cal5d> ye>4 7#b7 ,det]m9ation ( fees = ea* manufactur] 7,a7 ,=mula ,) respect to ea* cov]$ entity1 ! fee "u ?is section = a cal5d> ye> %all be equal to an am\nt t be>s ! same ratio to ! total am\nt assess$ "u subsection 7b7 = su* ye> z ! cov]$ entity's sales ( insul9 products tak5 into acc\nt dur+ ! prec$+ cal5d> ye>1 be>s to ! aggregate sales ( insul9 products ( all cov]$ entities tak5 into acc\nt dur+ su* prec$+ cal5d> ye>4 7,b7 ,sales ( insul9 products 7i7 ,9 g5]al ,= purposes ( ?is p>agraph1 ! sales ( insul9 products tak5 into acc\nt dur+ any cal5d> ye> ) respect to any cov]$ entity %all be det]m9$ bas$ on ! total numb] ( units ( ! insul9 product :i* 7 sold 9 comm]ce 9 ! prec$+ cal5d> ye> bas$ on-- 7,i7 = a fee assess$ = cal5d> ye> #bjbj1 in=mation obta9$ by ! ,secret>y "u clause 7ii72 & 7,,ii7 = a fee assess$ = ea* ( cal5d> ye>s #bjba ?r\gh #bjbd1 ! in=mation provid$ 9 ! annual reports issu$ by ! ,inspector ,g5]al & made public "u section #d7;e77#a74 7ii7 ,fees assess$ = cal5d> ye> #bjbj ,= purposes ( clause 7i77,i71 ! ,secret>y %all require ea* cov]$ entity to submit to ! ,secret>y in=mation on ! total numb] ( units ( ! insul9 product manufactur$ by ! entity t 7 sold 9 comm]ce 9 cal5d> ye> #bjai4 7d7 ,deposit ,! ,secret>y %all deposit am\nts receiv$ ?r\gh fees assess$ "u subsection 7b7 into ! g5]al fund ( ! ,treasury4 7e7 ,en=cem5t ,! ,secret>y may br+ an action 9 any c\rt ( compet5t jurisdiction to recov] ! am\nt ( any fee t is assess$ "u subsection 7b7 = a cal5d> ye> & n paid by ! annual paym5t date4 #d4 ,id5tification ( insul9 price spikes2 application ( excise tax 7a7 ,def9itions ,9 ?is section3 7#a7 ,applicable entity ,! t]m applicable entity means ! hold] ( an application approv$ "u subsection 7c7 or 7j7 ( section #eje ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cee71 or ( a lic5se issu$ "u subsection 7a7 or 7k7 ( section #cea ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bfb71 = an insul9 product4 7#b7 ,comm]ce ,! t]m comm]ce has ! mean+ giv5 su* t]m 9 section #d ( ! ,f$]al ,trade ,commission ,act 7#ae ,u4,s4,c4 #dd74 7#c7 ,inspector ,g5]al ,! t]m ,inspector ,g5]al means ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#d7 ,price spike 7,a7 ,9 g5]al ,! t]m price spike means an increase 9 ! :olesale acquisition co/ 9 comm]ce ( an insul9 product = :i* ! price spike p]c5tage is equal to or great] ?an ! applicable price increase all[ance4 7,b7 ,price spike p]c5tage ,! price spike p]c5tage is ! p]c5tage 7if any7 by :i*-- 7i7 ! :olesale acquisition co/ ( an insul9 product 9 comm]ce = ! cal5d> ye>2 exce$s 7ii7 ! :olesale acquisition co/ ( su* insul9 product 9 comm]ce = ! cal5d> ye> prec$+ su* ye>4 7,c7 ,applicable price increase all[ance ,! applicable price increase all[ance = any cal5d> ye> is ! p]c5tage 7r\nd$ to ! ne>e/ "o-t5? ( #a p]c5t7 by :i* ! ,c-,,cpi-,u 7z def9$ 9 section #a7;f77#f7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 = t ye> exce$s ! ,c-,,cpi-,u = ! prec$+ cal5d> ye>4 7#e7 ,price spike rev5ue 7,a7 ,9 g5]al ,! price spike rev5ue = any cal5d> ye> is an am\nt equal to-- 7i7 ! gross price spike rev5ue1 m9us 7ii7 ! adju/m5t am\nt4 7,b7 ,gross price spike rev5ue ,! gross price spike rev5ue = any cal5d> ye> is an am\nt equal to ! product (-- 7i7 an am\nt equal to ! diff]5ce betwe5 clause 7i7 ( p>agraph 7#d77;,b7 & clause 7ii7 ( su* p>agraph2 & 7ii7 ! total numb] ( units ( ! insul9 product :i* 7 sold 9 comm]ce 9 su* cal5d> ye>4 7,c7 ,adju/m5t am\nt ,! adju/m5t am\nt is ! am\nt1 if any1 ( ! gross price spike rev5ue :i* ! ,inspector ,g5]al has det]m9$ is due solely to an increase 9 ! co/ ( ! inputs necess>y to manufacture ! insul9 product subject to ! price spike4 7b7 ,submission by ph>maceutical companies ( in=mation to ,inspector ,g5]al 7#a7 ,9 g5]al ,= ea* insul9 product1 ! applicable entity %all submit to ! ,inspector ,g5]al a qu>t]ly report t includes ! foll[+3 7,a7 ,= ea* insul9 product ( ! applicable entity-- 7i7 ! total numb] ( units ( ! insul9 product :i* 7 sold 9 comm]ce 9 ! prec$+ cal5d> qu>t]2 7ii7 ! av]age & m$ian :olesale acquisition co/ p] unit ( su* insul9 product 9 comm]ce 9 ! prec$+ cal5d> qu>t]1 disaggregat$ by mon?2 & 7iii7 ! gross rev5ues f sales ( su* insul9 product 9 comm]ce 9 ! prec$+ cal5d> qu>t]4 7,b7 ,su* in=mation relat$ to increas$ input co/s or public heal? consid]ations z ! applicable entity may wi% ! ,inspector ,g5]al to consid] 9 mak+ a det]m9ation "u clause 7ii7 ( subsection 7c77#b77;,b7 or an assessm5t 9 clause 7iii7 ( su* subsection = ! prec$+ cal5d> qu>t]4 7,c7 ,su* in=mation relat$ to any anticipat$ increas$ input co/s = ! subsequ5t cal5d> qu>t] z ! applicable entity may wi% ! ,inspector ,g5]al to consid] 9 mak+ a det]m9ation "u clause 7ii7 ( subsection 7c77#b77;,b7 or an assessm5t 9 clause 7iii7 ( su* subsection = su* cal5d> qu>t]4 7#b7 ,p5alty = failure to submit 7,a7 ,9 g5]al ,an applicable entity describ$ 9 p>agraph 7#a7 t fails to submit in=mation to ! ,inspector ,g5]al reg>d+ an insul9 product1 z requir$ by su* p>agraph1 be=e ! date specifi$ 9 p>agraph 7#c7 %all be liable = a civil p5alty1 z det]m9$ "u subp>agraph 7,b74 7,b7 ,am\nt ( p5alty ,! am\nt ( ! civil p5alty %all be equal to ! product (-- 7i7 an am\nt1 z det]m9$ appropriate by ! ,inspector ,g5]al1 :i* is-- 7,i7 n less ?an #j4e p]c5t ( ! gross rev5ues f sales ( ! insul9 product describ$ 9 subp>agraph 7,a7 = ! prec$+ cal5d> ye>2 & 7,,ii7 n great] ?an #a p]c5t ( ! gross rev5ues f sales ( su* insul9 product = ! prec$+ cal5d> ye>2 & 7ii7 ! numb] ( days 9 ! p]iod betwe5-- 7,i7 ! applicable date specifi$ 9 p>agraph 7#c72 & 7,,ii7 ! date on :i* ! ,inspector ,g5]al receives ! in=mation describ$ 9 p>agraph 7#a7 f ! applicable entity4 7#c7 ,submission deadl9e ,an applicable entity %all submit ea* qu>t]ly report describ$ 9 p>agraph 7#a7 n lat] ?an ,janu>y #ag1 ,april #ah1 ,june #ae1 & ,septemb] #ae ( ea* cal5d> ye>4 7c7 ,assessm5t by ,inspector ,g5]al 7#a7 ,9 g5]al ,n lat] ?an ! la/ day 9 ,febru>y ( ea* ye>1 ! ,inspector ,g5]al1 9 consultation ) o!r relevant ,f$]al ag5cies 7includ+ ! ,f$]al ,trade ,commission71 %all-- 7,a7 complete an assessm5t ( ! in=mation ! ,inspector ,g5]al receiv$ pursuant to subsection 7b77#a7 ) respect to sales ( insul9 products 9 ! prec$+ cal5d> ye>2 & 7,b7 9 ! case ( any insul9 product :i* satisfies ! conditions describ$ 9 p>agraph 7#a7 or 7#b7 ( subsection 7d71 submit a recomm5dation to ! ,secret>y ( ,heal? & ,human ,s]vices t su* insul9 product be exempt$ f application ( ! tax impos$ "u section #daib ( ! ,int]nal ,rev5ue ,code ( #aihf 7z add$ by subsection 7g77 = su* ye>4 7#b7 ,elem5ts ,! assessm5t requir$ by p>agraph 7#a77;,a7 %all include ! foll[+3 7,a7 ,id5tification ( ea* price spike relat+ to an insul9 product 9 ! prec$+ cal5d> ye>4 7,b7 ,= ea* price spike id5tifi$ "u subp>agraph 7,a7-- 7i7 a det]m9ation ( ! price spike rev5ue2 7ii7 a det]m9ation reg>d+ ! accuracy ( ! in=mation submitt$ by ! applicable entity reg>d+ increas$ input co/s2 & 7iii7 an assessm5t ( ! rationale ( ! applicable entity = ! price spike4 7d7 ,exemption ( c]ta9 insul9 products 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 ^u recomm5dation ( ! ,inspector ,g5]al pursuant to subsection 7c77#a77;,b71 may exempt any insul9 product :i* has be5 subject to a price spike dur+ ! prec$+ cal5d> ye> f application ( ! tax impos$ "u section #daib ( ! ,int]nal ,rev5ue ,code ( #aihf = su* ye>1 if ! ,secret>y det]m9es t1 bas$ on in=mation submitt$ pursuant to subsection 7b77#a77;,b71 a =-cause price increase exemption %\ld apply4 7#b7 ,cl>ification ,9 consid]+1 "u p>agraph 7#a77;,a71 in=mation submitt$ pursuant to subsection 7b77#a77;,b71 ! ,secret>y-- 7,a7 has ! discretion to det]m9e t su* in=mation does n w>rant a =-cause price increase exemption2 & 7,b7 %all exclude f su* consid]ation any in=mation submitt$ by ! applicable entity ?reat5+ to curtail or limit production ( ! insul9 product if ! ,secret>y does n grant an exemption f ! application ( ! tax "u section #daib ( ! ,int]nal ,rev5ue ,code ( #aihf4 7e7 ,reports by ,inspector ,g5]al 7#a7 ,public report 7,a7 ,9 g5]al ,n lat] ?an ! la/ day 9 ,febru>y ( ea* ye>1 subject to subp>agraph 7,c71 ! ,inspector ,g5]al %all issue a report conta9+ ! in=mation describ$ 9 subp>agraph 7,b7 to be made available to ! public1 includ+ on ! ,int]net website ( ! ,inspector ,g5]al4 7,b7 ,cont5ts ,! report issu$ "u subp>agraph 7,a7 %all include ! foll[+3 7i7 ,! in=mation receiv$ "u subsection 7b77#a7 ) respect to ! prec$+ cal5d> ye>4 7ii7 ,! price spikes id5tifi$ "u subp>agraph 7,a7 ( subsection 7c77#b74 7iii7 ,! price spike rev5ue det]m9ations made "u subp>agraph 7,b77i7 ( su* subsection4 7iv7 ,! det]m9ations & assessm5ts made "u clauses 7ii7 & 7iii7 ( subp>agraph 7,b7 ( su* subsection4 7,c7 ,propriet>y in=mation ,! ,inspector ,g5]al %all ensure t any in=mation made public 9 accordance ) subp>agraph 7,a7 excludes trade secrets & confid5tial comm]cial in=mation4 7#b7 ,report to ,int]nal ,rev5ue ,s]vice 7,a7 ,9 g5]al ,subject to subp>agraph 7,c71 n lat] ?an ! la/ day 9 ,febru>y ( ea* ye>1 ! ,inspector ,g5]al %all transmit to ! ,int]nal ,rev5ue ,s]vice a report on ! f9d+s ( ! ,inspector ,g5]al ) respect to ! in=mation ! ,inspector ,g5]al receiv$ "u subsection 7b77#a7 ) respect to ! prec$+ cal5d> ye> & ! assessm5t c>ri$ out by ! ,inspector ,g5]al "u subsection 7c77#a77;,a7 ) respect to su* in=mation4 7,b7 ,cont5ts ,! report transmitt$ "u subp>agraph 7,a7 %all include ! in=mation describ$ 9 p>agraph 7#a77;,b74 7,c7 ,notice & opportunity = he>+ 7i7 ,9 g5]al ,no report %all be transmitt$ to ! ,int]nal ,rev5ue ,s]vice "u subp>agraph 7,a7 ) respect to an insul9 product unless ! ,inspector ,g5]al has provid$ ! applicable entity )-- 7,i7 ! assessm5t ( su* insul9 product "u subsection 7c77#a77;,a72 & 7,,ii7 notice ( _! "r to a he>+ 9 reg>ds to su* assessm5t4 7ii7 ,notice ,! notice requir$ "u clause 7i7 %all be provid$ to ! applicable entity n lat] ?an #cj days aft] completion ( ! assessm5t "u subsection 7c77#a77;,a74 7iii7 ,reque/ = he>+ ,subject to clause 7v71 an applicable entity may reque/ a he>+ be=e ! ,secret>y ( ,heal? & ,human ,s]vices n lat] ?an #cj days aft] ! date on :i* ! notice "u clause 7ii7 is receiv$4 7iv7 ,completion ( he>+ ,9 ! case ( an applicable entity :i* reque/s a he>+ pursuant to clause 7iii71 ! ,secret>y ( ,heal? & ,human ,s]vices %all1 n lat] ?an #ab mon?s aft] ! date on :i* ! assessm5t "u subsection 7c77#a77;,a7 0 complet$ by ! ,inspector ,g5]al-- 7,i7 make a f9al det]m9ation 9 reg>ds to ! accuracy ( su* assessm5t2 & 7,,ii7 provide ! report describ$ 9 subp>agraph 7,b7 to ! ,int]nal ,rev5ue ,s]vice4 7v7 ,limitation ,an applicable entity may reque/ a he>+ "u clause 7iii7 ) respect to a p>ticul> insul9 product only once )9 a #e-ye> p]iod4 7f7 ,notification ,! ,secret>y ( ! ,treasury %all notify1 at su* "t & 9 su* mann] z ! ,secret>y ( ! ,treasury %all provide1 ea* applicable entity 9 reg>d to any insul9 product :i* has be5 det]m9$ to h be5 subject to a price spike dur+ ! prec$+ cal5d> ye> & ! am\nt ( ! tax impos$ on su* applicable entity pursuant to section #daib ( ! ,int]nal ,rev5ue ,code ( #aihf4 7g7 ,excise tax on insul9 products subject to price spikes 7#a7 ,9 g5]al ,sub*apt] ,e ( *apt] #cb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new section3 #daib4 ,insul9 products subject to price spikes 7a7 ,imposition ( tax 7#a7 ,9 g5]al ,subject to p>agraph 7#c71 = ea* taxable insul9 product sold by an applicable entity dur+ ! cal5d> ye>1 !re is h]eby impos$ on su* entity a tax equal to ! great] (-- 7,a7 ! annual price spike tax = su* insul9 product1 or 7,b7 subject to p>agraph 7#b71 ! cumulative price spike tax = su* insul9 product4 7#b7 ,limitation ,9 ! case ( a taxable insul9 product = :i* ! applicable p]iod 7z det]m9$ "u subsection 7c77#b77;,e77i77 is less ?an #b cal5d> ye>s1 ! cumulative price spike tax %all n apply4 7#c7 ,exemption ,= any cal5d> ye> 9 :i* ! ,secret>y ( ,heal? & ,human ,s]vices has provid$ an exemption = a taxable insul9 product pursuant to section #d7;d7 ( ! ,em]g5cy ,access to ,insul9 ,act ( #bjai1 ! am\nt ( ! tax det]m9$ "u p>agraph 7#a7 = su* insul9 product = su* cal5d> ye> %all be r$uc$ to z]o4 7b7 ,annual price spike tax 7#a7 ,9 g5]al ,! am\nt ( ! annual price spike tax %all be equal to ! applicable p]c5tage ( ! price spike rev5ue receiv$ by ! applicable entity on ! sale ( ! taxable insul9 product dur+ ! cal5d> ye>4 7#b7 ,applicable p]c5tage ,= purposes ( p>agraph 7#a71 ! applicable p]c5tage %all be equal to-- 7,a7 9 ! case ( a taxable insul9 product :i* has be5 subject to a price spike p]c5tage great] ?an ! applicable price increase all[ance 7z def9$ 9 section #d7;a77#d77;,c7 ( ! ,em]g5cy ,access to ,insul9 ,act ( #bjai7 b less ?an #ae p]c5t1 #ej p]c5t1 7,b7 9 ! case ( a taxable insul9 product :i* has be5 subject to a price spike p]c5tage equal to or great] ?an #ae p]c5t b less ?an #bj p]c5t1 #ge p]c5t1 & 7,c7 9 ! case ( a taxable insul9 product :i* has be5 subject to a price spike p]c5tage equal to or great] ?an #bj p]c5t1 #ajj p]c5t4 7c7 ,cumulative price spike tax 7#a7 ,9 g5]al ,! am\nt ( ! cumulative price spike tax %all be equal to ! applicable p]c5tage ( ! cumulative price spike rev5ue receiv$ by ! applicable entity on ! sale ( ! taxable insul9 product dur+ ! cal5d> ye>4 7#b7 ,applicable p]c5tage 7,a7 ,9 g5]al ,= purposes ( p>agraph 7#a71 ! applicable p]c5tage %all be equal to-- 7i7 9 ! case ( a taxable insul9 product :i* has be5 subject to a cumulative price spike p]c5tage great] ?an ! cumulative price increase all[ance b less ?an ! fir/ multi-ye> p]c5tage1 #ej p]c5t1 7ii7 9 ! case ( a taxable insul9 product :i* has be5 subject to a cumulative price spike p]c5tage equal to or great] ?an ! fir/ multi-ye> p]c5tage b less ?an ! second multi-ye> p]c5tage1 #ge p]c5t1 & 7iii7 9 ! case ( a taxable insul9 product :i* has be5 subject to a cumulative price spike p]c5tage equal to or great] ?an ! second multi-ye> p]c5tage1 #ajj p]c5t4 7,b7 ,cumulative price spike p]c5tage ,! cumulative price spike p]c5tage is ! p]c5tage 7if any7 by :i*-- 7i7 ! :olesale acquisition co/ ( ! taxable insul9 product 9 comm]ce = ! prec$+ cal5d> ye>1 exce$s 7ii7 ! :olesale acquisition co/ ( su* insul9 product 9 comm]ce = ! base ye>4 7,c7 ,cumulative price increase all[ance ,= purposes ( clause 7i7 ( subp>agraph 7,a71 ! cumulative price increase all[ance = any cal5d> ye> is ! p]c5tage 7r\nd$ to ! ne>e/ "o-t5? ( #a p]c5t7 by :i* ! ,c-,,cpi-,u 7z def9$ 9 section #a7;f77#f77 = t ye> exce$s ! ,c-,,cpi-,u = ! base ye>4 7,d7 ,multi-ye> p]c5tages ,= purposes ( subp>agraph 7,a71 ! fir/ multi-ye> p]c5tage & second multi-ye> p]c5tage %all be det]m9$ 9 accordance ) ! foll[+ table3 ,numb] ( ye>s 9 applicable period,first multi-ye> percentage,second multi-ye> p]c5tage#b ye>s#ag4ebb4ec ye>s#bj4jbe4jd ye>s#bb4ebg4ee ye>s#be4jcj4j4 7,e7 ,applicable p]iod & base ye> 7i7 ,applicable p]iod ,! applicable p]iod %all be ! less] (-- 7,i7 ! #e prec$+ cal5d> ye>s1 7,,ii7 all cal5d> ye>s beg9n+ aft] ! date ( enactm5t ( ?is section1 or 7,,iii7 all cal5d> ye>s 9 :i* ! taxable insul9 product 0 sold 9 comm]ce4 7ii7 ,base ye> ,! base ye> %all be ! cal5d> ye> imm$iately prec$+ ! applicable p]iod4 7#c7 ,cumulative price spike rev5ue ,= purposes ( p>agraph 7#a71 ! cumulative price spike rev5ue = any taxable insul9 product %all be an am\nt equal to-- 7,a7 an am\nt equal to ! product (-- 7i7 an am\nt 7n less ?an z]o7 equal to-- 7,i7 ! :olesale acquisition co/ ( su* insul9 product 9 comm]ce = ! prec$+ cal5d> ye>1 m9us 7,,ii7 ! :olesale acquisition co/ ( su* insul9 product 9 comm]ce = ! base ye>1 & 7ii7 ! total numb] ( units ( su* insul9 product :i* 7 sold 9 comm]ce 9 ! prec$+ cal5d> ye>1 m9us 7,b7 an am\nt equal to ! sum ( ! adju/m5t am\nts1 if any1 det]m9$ "u section #d7;a77#e77;,c7 ( ! ,em]g5cy ,access to ,insul9 ,act ( #bjai = ea* cal5d> ye> dur+ ! applicable p]iod4 7d7 ,def9itions ,= purposes ( ?is section-- 7#a7 ,taxable insul9 product ,! t]m taxable insul9 product means an insul9 product :i* has be5 id5tifi$ by ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 "u section #d7;c77#b77;,a7 ( ! ,em]g5cy ,access to ,insul9 ,act ( #bjai1 z be+ subject to a price spike4 7#b7 ,o!r t]ms ,! t]ms applicable entity1 price spike1 price spike p]c5tage1 & price spike rev5ue h ! same mean+ giv5 su* t]ms "u section #d7;a7 ( ! ,em]g5cy ,access to ,insul9 ,act ( #bjai4 4 7#b7 ,cl]ical am5dm5ts 7,a7 ,! head+ ( sub*apt] ,e ( *apt] #cb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ ,m$ical devices & ins]t+ ,c]ta9 m$ical devices & insul9 products4 7,b7 ,! table ( sub*apt]s = *apt] #cb ( su* ,code is am5d$ by /rik+ ! item relat+ to sub*apt] ,e & ins]t+ ! foll[+ new item3 ,sub*apt] ,e4 ,c]ta9 m$ical devices & insul9 products 4 7,c7 ,! table ( sections = sub*apt] ,e ( *apt] #cb ( su* ,code is am5d$ by add+ at ! end ! foll[+ new item3 ,sec4 #daib4 ,insul9 products subject to price spikes4 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to sales aft] ! date ( ! enactm5t ( ?is ,act4 #e4 ,biological product exclusivity 7a7 ,9 g5]al ,section #cea7k77#g77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bfb7k77#g77;,a77 is am5d$ by /rik+ #ab ye>s & ins]t+ #g ye>s4 7b7 ,con=m+ am5dm5ts ,p>agraphs 7#b77;,a7 & 7#c77;,a7 ( section #cea7m7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bfb7m77 is am5d$ by /rik+ #ab ye>s ea* place x appe>s & ins]t+ #g ye>s4