,,ii #aah? ,,congress #b;d ,session ,s4 #dbca ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,may #a1 #bjbd ,mr4 ,m]kley 7= himself1 ,mr4 ,murphy1 ,ms4 ,baldw91 ,mr4 ,blum5?al1 ,mr4 ,book]1 ,ms4 ,duckwor?1 ,mr4 ,durb91 ,mrs4 ,gillibr&1 ,mr4 ,re$1 ,mr4 ,s*atz1 ,ms4 ,smi?1 & ,mr4 ,van ,holl57 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to provide = ! e/abli%m5t ( ,m$ic>e "p ,e public heal? plans1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,*oose ,m$ic>e ,act4 #b4 ,public heal? plan 7a7 ,9 g5]al ,! ,social ,security ,act is am5d$ by add+ at ! end ! foll[+3 #bbja4 ,title ,,xxii--,m$ic>e "p ,e public heal? plans ,public heal? plans4-- 7a7 ,e/abli%m5t ,! ,secret>y %all e/abli% public heal? plans 7to be kn[n z ,m$ic>e "p ,e plans7 t are available 9 ! individual m>ket1 small gr\p m>ket1 & l>ge gr\p m>ket4 7b7 ,b5efits 7#a7 ,9 g5]al ,ea* ,m$ic>e "p ,e plan1 reg>dless ( :e!r ! plan is (f]$ 9 ! individual m>ket1 small gr\p m>ket1 or l>ge gr\p m>ket1 %all be a qualifi$ heal? plan )9 ! mean+ ( section #acja7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba7;a77 t-- 7,a7 meets all requirem5ts applicable to qualifi$ heal? plans "u subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba et seq47 7o!r ?an ! requirem5t "u section #acja7;a77#a77;,c77ii7 ( su* ,act7 & title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq472 7,b7 provides cov]age (-- 7i7 ! ess5tial heal? b5efits describ$ 9 section #acjb7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;b772 & 7ii7 all items & s]vices = :i* b5efits are available "u title ,,xviii2 7,c7 provides gold-level cov]age describ$ 9 section #acjb7;d77#a77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;d77#a77;,c772 & 7,d7 provides cov]age ( abortions & all o!r reproductive s]vices4 7#b7 ,preemption ,not)/&+ section #acjc7;a77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbc7;a77#a77-- 7,a7 a ,/ate may n prohibit a ,m$ic>e "p ,e plan f (f]+ ! cov]age describ$ 9 p>agraph 7#a77;,d72 & 7,b7 no provision ( ,/ate law t w\ld prohibit su* a plan f (f]+ su* cov]age %all apply to su* plan4 7c7 ,eligibility2 enrollm5t 7#a7 ,availability on ! ,ex*anges ,! ,m$ic>e "p ,e plans (f]$ 9 ! individual & small gr\p m>kets %all be (f]$ ?r\gh ! ,f$]al & ,/ate ,ex*anges1 includ+ ! ,small ,bus9ess ,heal? ,options ,program ,ex*anges 7commonly ref]r$ to z ! ,,%op ,ex*anges74 7#b7 ,eligibility 7,a7 ,9 g5]al ,any individual :o is a resid5t ( ! ,unit$ ,/ates1 z det]m9$ by ! ,secret>y "u subp>agraph 7,c71 & :o is n an individual describ$ 9 subp>agraph 7,b71 is eligible to enroll 9 a ,m$ic>e "p ,e plan4 7,b7 ,exclusions ,an individual describ$ 9 ?is subp>agraph is any individual :o is-- 7i7 entitl$ to1 or enroll$ =1 b5efits "u title ,,xviii2 7ii7 eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix2 or 7iii7 enroll$ = *ild heal? assi/ance or pregnancy-relat$ assi/ance "u a ,/ate plan "u title ,,xxi4 7,c7 ,regulations ,! ,secret>y %all promulgate a rule = det]m9+ resid5cy = purposes ( subp>agraph 7,a74 7#c7 ,employ]-sponsor$ plans 7,a7 ,employ] enrollm5t ,effective ) respect to ! fir/ plan ye> t beg9s #a ye> aft] ! date ( enactm5t ( ! ,*oose ,m$ic>e ,act & ea* plan ye> !reaft]1 ! ,secret>y %all provide options = ,m$ic>e "p ,e plans 9 ! small gr\p m>ket & l>ge gr\p m>ket t are volunt>y1 & available to all employ]s4 7,b7 ,gr\p heal? plans ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator = ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 at ! reque/ ( a plan sponsor1 %all s]ve z a ?ird p>ty adm9i/rator ( a gr\p heal? plan t is a ,m$ic>e "p ,e plan (f]$ by su* sponsor4 7,c7 ,portability = employ]-sponsor$ plans ,! ,secret>y %all develop a process = all[+ individuals enroll$ 9 a ,m$ic>e "p ,e plan (f]$ 9 ! small gr\p m>ket or l>ge gr\p m>ket to ma9ta9 heal? insurance cov]age ?r\gh a ,m$ic>e "p ,e plan if ! individual subsequ5tly loses eligibility = enrollm5t 9 su* a plan bas$ on t]m9ation ( ! employm5t relation%ip4 ,! ability to ma9ta9 su* cov]age %all exi/ reg>dless ( :e!r ! individual has ! option to enroll 9 o!r heal? insurance cov]age1 includ+ cov]age (f]$ 9 ! individual m>ket or ?r\gh a subsequ5t employ]4 7d7 ,premiums ,! ,secret>y %all e/abli% premium rates = ! ,m$ic>e "p ,e plans t-- 7#a7 are adju/$ bas$ on-- 7,a7 :e!r ! plan is (f]$ 9 ! individual m>ket1 small gr\p m>ket1 or l>ge gr\p m>ket2 & 7,b7 ! applicable rat+ area2 7#b7 are at a level suffici5t to fully f9ance-- 7,a7 ! co/s ( heal? b5efits provid$ by su* plans2 & 7,b7 adm9i/rative co/s relat$ to op]at+ ! plans2 & 7#c7 comply ) ! requirem5ts "u section #bgja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg71 includ+ = su* plans t are (f]$ 9 ! l>ge gr\p m>ket4 7e7 ,provid]s & reimbursem5t rates 7#a7 ,9 g5]al ,! ,secret>y %all e/abli% a rate s*$ule = reimburs+ types ( heal? c>e provid]s furni%+ items & s]vices "u ! ,m$ic>e "p ,e plans at rates t are consi/5t ) ! negotiations describ$ 9 p>agraph 7#b7 & are necess>y to ma9ta9 network adequacy4 7#b7 ,mann] ( negotiation ,! ,secret>y %all negotiate ! rates describ$ 9 p>agraph 7#a7 9 a mann] t results 9 paym5t rates t are n l[]1 9 ! aggregate1 ?an rates "u title ,,xviii1 & n high]1 9 ! aggregate1 ?an ! av]age rates paid by o!r heal? insurance issu]s (f]+ heal? insurance cov]age ?r\gh an ,ex*ange4 7#c7 ,p>ticipat+ provid]s 7,a7 ,9 g5]al ,a heal? c>e provid] t is a p>ticipat+ provid] ( s]vices or suppli] "u ! ,m$ic>e program "u title ,,xviii on ! date ( enactm5t ( ! ,*oose ,m$ic>e ,act %all be a p>ticipat+ provid] = ,m$ic>e "p ,e plans4 7,b7 ,additional provid]s ,! ,secret>y %all e/abli% a process to all[ heal? c>e provid]s n describ$ 9 subp>agraph 7,a7 to become p>ticipat+ provid]s = ,m$ic>e "p ,e plans4 7#d7 ,limitations on balance bill+ ,! limitations on balance bill+ pursuant to ! provisions ( section #ahff7;a77#a77;,a7 %all apply to p>ticipat+ provid]s = ,m$ic>e "p ,e plans 9 ! same mann] z su* provisions apply to p>ticipat+ provid]s "u ! ,m$ic>e program4 7f7 ,enc\rag+ use ( alt]native paym5t models ,! ,secret>y %all1 z applicable1 utilize alt]native paym5t models1 includ+ ^? describ$ 9 section #ahcc7z77#c77;,c71 z add$ by section #aja7;e77#b7 ( ! ,m$ic>e ,access & ,,*ip ,reau?orization ,act ( #bjae 7,public ,law #aad-aj71 9 mak+ paym5ts = items & s]vices 7includ+ prescription drugs7 furni%$ "u ,m$ic>e "p ,e plans4 ,! paym5t rates "u su* alt]native paym5t models %all comply ) ! requirem5t = negotiat$ rates "u subsection 7e77#b74 7g7 ,prescription drugs ,! ,secret>y %all apply ! provisions ( "p ,e ( title ,,xi to prescription drugs "u ,m$ic>e "p ,e plans 9 ! same mann] z su* provisions apply ) respect to select$ drugs "u "p ,e ( title ,,xi4 7h7 ,appropriations 7#a7 ,/>t up fund+ ,= purposes ( e/abli%+ ! ,m$ic>e "p ,e plans1 !re is appropriat$ to ! ,secret>y1 out ( any funds 9 ! ,treasury n o!rwise obligat$1 #b1jjj1jjj1jjj1 = fiscal ye> #bjbe4 7#b7 ,initial res]ves ,!re is appropriat$ to ! ,secret>y1 out ( any funds 9 ! ,treasury n o!rwise obligat$1 su* sums z may be necess>y1 bas$ on project$ enrollm5t 9 ! ,m$ic>e "p ,e plans 9 ! fir/ plan ye> 9 :i* su* plans are (f]$1 to provide res]ves = ! purpose ( pay+ claims fil$ dur+ ! initial #ij-;day p]iod ( su* plan ye>4 7#c7 ,cl>ification ,any provision ( law re/rict+ ! use ( ,f$]al funds ) respect to any reproductive heal? s]vice %all n apply to funds appropriat$ "u p>agraph 7#a7 or 7#b74 7i7 ,heal? insurance issu] ,) respect to any ,m$ic>e "p ,e plan1 ! ,secret>y %all be consid]$ a heal? insurance issu]1 )9 ! mean+ ( section #bgia7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;b774 4 7b7 ,application ( excise tax = noncompliance ) negotiation requirem5ts ,section #ejjj;,d7e77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new s5t5ce3 ,su* t]m %all apply to any drug treat$ 9 ! same mann] z a drug describ$ 9 ! prec$+ s5t5ce by reason ( section #bbja7;g7 ( ! ,social ,security ,act44 #c4 ,notice & navigator ref]ral = employees "u ! ,fair ,labor ,/&>ds ,act ( #aich 7a7 ,9 g5]al ,section #ah;,b ( ! ,fair ,labor ,/&>ds ,act ( #aich 7#bi ,u4,s4,c4 #bah;b7 is am5d$-- 7#a7 9 ! head+1 by /rik+ to & ins]t+ & navigator ref]ral =2 7#b7 by r$esignat+ subsection 7b7 z subsection 7c72 7#c7 by ins]t+ aft] subsection 7a7 ! foll[+3 7b7 ,navigator ref]ral 7#a7 ,9 g5]al ,an employ] describ$ 9 p>agraph 7#c7 %all ref] ea* full-"t employee 7z def9$ 9 section #dihj;,h7c7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 to-- 7,a7 an entity t s]ves z a navigator "u section #acaa7;i7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;i77 = ! ,ex*ange op]at+ 9 ! ,/ate ( ! employ]2 or 7,b7 if ! ,ex*ange op]at+ 9 ! ,/ate ( ! employ] does n h an entity s]v+ z su* a navigator1 ano!r entity t %all c>ry out equival5t activities z su* a navigator4 7#b7 ,ref]ral ,! ref]ral describ$ 9 p>agraph 7#a7 %all occur-- 7,a7 at ! "t ! employ] hires ! employee2 or 7,b7 on ! effective date describ$ 9 subsection 7c77#b7 ) respect to an employee :o is curr5tly employ$ by ! employ] on su* date4 7#c7 ,employ] ,an employ] describ$ 9 ?is p>agraph is any employ] t-- 7,a7 does n provide an eligible employ]-sponsor$ plan z def9$ 9 section #ejjj;,a7f77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf2 or 7,b7 provides su* an eligible employ]-sponsor$ plan1 b ! plan is det]m9$-- 7i7 to be unaf=dable to ! employee "u clause 7i7 ( section #cf;,b7c77#b77;,c7 ( su* ,code2 or 7ii7 to n provide ! requir$ m9imum value "u clause 7ii7 ( su* section4 2 & 7#d7 9 subsection 7c71 z s r$esignat$-- 7,a7 9 ! head+1 by /rik+ ,effective date & ins]t+ ,effective dates2 7,b7 by /rik+ ,subsection 7a7 & ins]t+ ! foll[+3 7#a7 ,notice ,subsection 7a72 2 & 7,c7 by add+ at ! end ! foll[+3 7#b7 ,navigator ref]ral ,subsection 7b7 %all take effect ) respect to employ]s 9 a ,/ate beg9n+ on ! date t is #b ye>s aft] ! date ( enactm5t ( ! ,*oose ,m$ic>e ,act4 4 7b7 ,/udy ,n lat] ?an ,janu>y #a1 #bjbi1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy on ! impact ( ! requirem5ts "u section #ah;,b ( ! ,fair ,labor ,/&>ds ,act ( #aich 7#bi ,u4,s4,c4 #bah;b71 includ+ ! am5dm5ts made by subsection 7a71 on ! rate ( individuals )\t m9imum ess5tial cov]age z def9$ 9 section #ejjj;,a7f7 ( ! ,int]nal ,rev5ue ,code ( #aihf 9 ! ,unit$ ,/ates & 9 ea* ,/ate4 7c7 ,fund+ = navigator program ,section #acaa7;i77#f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;i77#f77 is am5d$-- 7#a7 by /rik+ ,grants & ins]t+ ! foll[+3 7,a7 ,9 g5]al ,grants 2 & 7#b7 by add+ at ! end ! foll[+3 7,b7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ su* sums z may be necess>y to address capacity limitations ( entities s]v+ z navigators ?r\gh a grant "u ?is subsection4 4 #d4 ,protect+ aga9/ high out-(-pocket exp5ditures = ,m$ic>e fee-=-s]vice b5efits ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,c4 ,protection aga9/ high out-(-pocket exp5ditures 7a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 9 ! case ( an individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a or enroll$ 9 "p ,b1 if ! am\nt ( ! out-(-pocket co/-%>+ ( su* individual = a ye> 7beg9n+ ) #bjbf7 equals or exce$s ! annual out-(-pocket limit "u subsection 7b7 = t ye>1 ! individual %all n be responsible = additional out-(-pocket co/-%>+ incurr$ dur+ t ye>4 7b7 ,annual out-(-,pocket limit 7#a7 ,9 g5]al ,! am\nt ( ! annual out-(-pocket limit "u ?is subsection %all be-- 7,a7 = #bjbf1 #f1gjj2 or 7,b7 = a subsequ5t ye>1 ! am\nt specifi$ 9 ?is subsection = ! prec$+ ye> increas$ or decreas$ by ! p]c5tage *ange 9 ! m$ical c>e compon5t ( ! ,consum] ,price ,index = ,all ,urban ,consum]s = ! #ab-mon? p]iod end+ ) ,june ( su* prec$+ ye>4 7#b7 ,r\nd+ ,if any am\nt det]m9$ "u p>agraph 7#a77;,b7 is n a multiple ( #e1 su* am\nt %all be r\nd$ to ! ne>e/ multiple ( #e4 7c7 ,out-(-,pocket co/-,%>+ def9$ 7#a7 ,9 g5]al ,subject to p>agraphs 7#b7 & 7#c71 9 ?is section1 ! t]m out-(-pocket co/-%>+ means1 ) respect to an individual1 ! am\nt ( ! exp5ses incurr$ by ! individual t are attributable to-- 7,a7 d$uctibles1 co9surance1 & copaym5ts applicable "u "p ,a or ,b2 or 7,b7 = items & s]vices t w\ld h o!rwise be5 cov]$ "u "p ,a or ,b b = ! exhau/ion ( ^? b5efits4 7#b7 ,c]ta9 co/s n includ$ 7,a7 ,non-cov]$ items & s]vices ,exp5ses incurr$ = items & s]vices :i* are n cov]$ "u "p ,a or ,b %all n be consid]$ incurr$ exp5ses = purposes ( det]m9+ out-(-pocket co/-%>+ "u p>agraph 7#a74 7,b7 ,items & s]vices n furni%$ on an assignm5t-relat$ basis ,if an item or s]vice is furni%$ to an individual "u ?is title & is n furni%$ on an assignm5t-relat$ basis1 any additional exp5ses ! individual incurs above ! am\nt ! individual w\ld h incurr$ if ! item or s]vice 0 furni%$ on an assignm5t-relat$ basis %all n be consid]$ incurr$ exp5ses = purposes ( det]m9+ out-(-pocket co/-%>+ "u p>agraph 7#a74 7#c7 ,s\rce ( paym5t ,= purposes ( p>agraph 7#a71 ! ,secret>y %all consid] exp5ses to be incurr$ by ! individual )\t reg>d to :e!r ! individual or ano!r p]son1 includ+ a ,/ate program1 an employ]1 a m$ic>e supplem5tal policy1 or o!r ?ird-p>ty cov]age1 has paid = su* exp5ses4 7d7 ,ann\ncem5t ( ! annual out-(-,pocket limit ,! ,secret>y %all 7beg9n+ 9 #bjbe7 ann\nce 79 a mann] int5d$ to provide notice to all int]e/$ p>ties7 ! annual out-(-pocket limit "u ?is section t w be applicable = ! succe$+ ye>4 4 #e4 ,enhancem5t ( premium assi/ance cr$it 7a7 ,use ( gold level plan = b5*m>k 7#a7 ,9 g5]al ,clause 7i7 ( section #cf;,b7b77#b77;,b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ applicable second l[e/ co/ silv] plan & ins]t+ applicable second l[e/ co/ gold plan4 7#b7 ,con=m+ am5dm5t relat$ to af=dability ,section #cf;,b7c77#d77;,c77i77,i7 ( su* ,code is am5d$ by /rik+ second l[e/ co/ silv] plan & ins]t+ second l[e/ co/ gold plan4 7#c7 ,o!r con=m+ am5dm5ts ,subp>agraphs 7,b7 & 7,c7 ( section #cf;,b7b77#c7 ( su* ,code are ea* am5d$ by /rik+ silv] plan ea* place x appe>s 9 ! text & ! head+ & ins]t+ gold plan4 7b7 ,p]man5t ext5sion ( eligibility rules 7#a7 ,9 g5]al ,section #cf;,b7c77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 9 subp>agraph 7,a71 by /rik+ b does n exce$ #djj p]c5t1 & 7,b7 by /rik+ subp>agraph 7,e74 7#b7 ,det]m9ation ( applicable p]c5tage ,subp>agraph 7,a7 ( section #cf;,b7b77#c7 ( su* ,code is am5d$ by /rik+ all t prec$es ! table 9 clause 7iii77,,ii7 & ins]t+ ! foll[+3 7,a7 ,applicable p]c5tage ,= purposes ( p>agraph 7#b71 except z provid$ 9 clause 7ii71 ! applicable p]c5tage = any taxable ye> %all be ! p]c5tage su* t ! applicable p]c5tage = any taxpay] ^: h\sehold income is )9 an income ti] specifi$ 9 ! foll[+ table %all increase1 on a slid+ scale 9 a l9e> mann]1 f ! initial premium p]c5tage to ! f9al premium p]c5tage specifi$ 9 su* table = su* income ti]3 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbc4 #f4 ,enhancem5ts = r$uc$ co/ %>+ 7a7 ,def9ition ( eligible individual ,section #adjb7;b77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjga7;b77#a77 is am5d$ by /rik+ silv] level & ins]t+ gold level4 7b7 ,modification ( am\nt 7#a7 ,9 g5]al ,section #adjb7;c77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is am5d$ to read z foll[s3 7#b7 ,additional r$uction ,! ,secret>y %all e/abli% proc$ures "u :i* ! issu] ( a qualifi$ heal? plan to :i* ?is section applies %all fur!r r$uce co/-%>+ "u ! plan 9 a mann] suffici5t to-- 7,a7 9 ! case ( an eligible insur$ ^: h\sehold income is n less ?an #ajj p]c5t b n m ?an #acc p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #id p]c5t ( su* co/s2 7,b7 9 ! case ( an eligible insur$ ^: h\sehold income is m ?an #acc p]c5t b n m ?an #aej p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #ib p]c5t ( su* co/s2 7,c7 9 ! case ( an eligible insur$ ^: h\sehold income is m ?an #aej p]c5t b n m ?an #bjj p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #ij p]c5t ( su* co/s2 7,d7 9 ! case ( an eligible insur$ ^: h\sehold income is m ?an #bjj p]c5t b n m ?an #cjj p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #he p]c5t ( su* co/s2 & 7,e7 9 ! case ( an eligible insur$ ^: h\sehold income is m ?an #cjj p]c5t b n m ?an #djj p]c5t ( ! pov]ty l9e = a family ( ! size involv$1 increase ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan to #hj p]c5t ( su* co/s4 4 7#b7 ,con=m+ am5dm5t ,clause 7i7 ( section #adjb7;c77#a77;,b7 ( su* ,act is am5d$ to read z foll[s3 7i7 ,9 g5]al ,! ,secret>y %all ensure ! r$uction "u ?is p>agraph %all n result 9 an increase 9 ! plan's %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan above-- 7,i7 #id p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,a72 7,,ii7 #ib p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,b72 7,,iii7 #ij p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,c72 7,,iv7 #he p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,d72 & 7,v7 #hj p]c5t 9 ! case ( an eligible insur$ describ$ 9 p>agraph 7#b77;,e74 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to plan ye>s beg9n+ aft] ,decemb] #ca1 #bjbd4 #g4 ,re9surance & af=dability fund ,"p #e ( subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is am5d$ by ins]t+ aft] section #acda 7#db ,u4,s4,c4 #ahjfa7 ! foll[+3 #acda;,a4 ,re9surance & af=dability fund = ! individual m>ket 9 ea* ,/ate 7a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ! ,national ,association ( ,insurance ,commission]s1 %all e/abli% a program to enable ea* ,/ate1 = any plan ye> beg9n+ 9 ! #c-ye> p]iod beg9n+ ,janu>y #a1 #bjbe1 to-- 7#a7 provide re9surance paym5ts to heal? insurance issu]s ) respect to individuals enroll$ "u individual heal? insurance cov]age (f]$ by su* issu]s2 or 7#b7 provide assi/ance 7o!r ?an ?r\gh paym5ts describ$ 9 p>agraph 7#a77 to r$uce out-(-pocket co/s1 su* z copaym5ts1 co9surance1 premiums1 & d$uctibles1 ( individuals enroll$ "u qualifi$ heal? plans (f]$ 9 ! individual m>ket ?r\gh an ,ex*ange4 7b7 ,appropriations ,!re is appropriat$1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #cj1jjj1jjj1jjj = ! p]iod ( fiscal ye>s #bjbe to #bjbg = purposes ( e/abli%+ & adm9i/]+ ! program e/abli%$ "u ?is section4 ,su* am\nt %all rema9 available until exp5d$4 4 #h4 ,exp&+ rat+ rules to l>ge gr\p m>ket 7a7 ,9 g5]al ,section #bgja7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg7a77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ small2 & 7#b7 by /rik+ p>agraph 7#e74 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all apply to plans (f]$ 9 ! fir/ plan ye> beg9n+ aft] ! date ( enactm5t ( ?is ,act & any plan ye> !reaft]4 #i4 ,protection ( consum]s f excessive1 unju/ifi$1 or unfairly discrim9atory rates 7a7 ,protection f excessive1 unju/ifi$1 or unfairly discrim9atory rates ,section #bgid ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#id7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7e7 ,protection f excessive1 unju/ifi$1 or unfairly discrim9atory rates 7#a7 ,au?ority ( ,/ates ,no?+ 9 ?is section %all be con/ru$ to prohibit a ,/ate f impos+ requirem5ts 7includ+ requirem5ts relat+ to rate review /&>ds & proc$ures & in=mation report+7 on heal? insurance issu]s ) respect to rates t are 9 addition to ! requirem5ts ( ?is section & are m protective ( consum]s ?an su* requirem5ts4 7#b7 ,consultation 9 rate review process ,9 c>ry+ out ?is section1 ! ,secret>y %all consult ) ! ,national ,association ( ,insurance ,commission]s & consum] gr\ps4 7#c7 ,det]m9ation ( :o conducts reviews = ea* ,/ate ,! ,secret>y %all det]m9e1 aft] ! date ( enactm5t ( ?is subsection & p]iodically !reaft]1 ! foll[+3 7,a7 ,9 :i* m>kets 9 ea* ,/ate ! ,/ate insurance commission] or relevant ,/ate regulator %all und]take ! corrective actions "u p>agraph 7#d71 bas$ on ! ,secret>y's det]m9ation t ! ,/ate insurance commission] or relevant ,/ate regulator is adequately und]tak+ & utiliz+ su* actions 9 t m>ket4 7,b7 ,9 :i* m>kets 9 ea* ,/ate ! ,secret>y %all und]take ! corrective actions "u p>agraph 7#d71 9 coop]ation ) ! relevant ,/ate insurance commission] or ,/ate regulator1 bas$ on ! ,secret>y's det]m9ation t ! ,/ate is n adequately und]tak+ & utiliz+ su* actions 9 t m>ket4 7#d7 ,corrective action = excessive1 unju/ifi$1 or unfairly discrim9atory rates ,9 accordance ) ! process e/abli%$ "u ?is section1 ! ,secret>y or ! relevant ,/ate insurance commission] or ,/ate regulator %all take corrective actions to ensure t any excessive1 unju/ifi$1 or unfairly discrim9atory rates are correct$ prior to implem5tation1 or z soon z possible !reaft]1 ?r\gh me*anisms su* z-- 7,a7 d5y+ rates2 7,b7 modify+ rates2 or 7,c7 requir+ rebates to consum]s4 7#e7 ,noncompliance 7,a7 ,9 g5]al ,failure to comply ) any corrective action tak5 by ! ,secret>y "u ?is subsection may result 9 ! application ( civil monet>y p5alties describ$ 9 subp>agraph 7,b7 &1 if ! ,secret>y det]m9es appropriate1 make ! plan involv$ ineligible = classification z a qualifi$ heal? plan4 7,b7 ,civil monet>y p5alties 7i7 ,9 g5]al ,! provisions ( section #aabh;,a ( ! ,social ,security ,act1 o!r ?an subsection 7a7 & 7b7 & ! fir/ s5t5ce ( subsection 7c77#a7 ( su* section1 %all apply to civil monet>y p5alties "u ?is p>agraph 9 ! same mann] z su* provisions apply to a p5alty or proce$+ "u section #aabh;,a ( ! ,social ,security ,act4 7ii7 ,am\nt ,! provisions ( subp>agraph 7,c7 ( section #bgbc7;b77#b7 %all apply to civil monet>y p5alties "u ?is p>agraph 9 ! same mann] z su* provisions apply to a p5alty "u su* section4 4 7b7 ,cl>ification ( ,regulatory ,au?ority ,section #bgid ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#id7 is fur!r am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 ! subsection head+1 by /rik+ premium & ins]t+ rate2 7,b7 9 p>agraph 7#a71 by /rik+ unreasonable increases 9 premiums & ins]t+ pot5tially excessive1 unju/ifi$1 or unfairly discrim9atory rates1 includ+ premiums12 & 7,c7 9 p>agraph 7#b7-- 7i7 by /rik+ an unreasonable premium increase & ins]t+ a pot5tially excessive1 unju/ifi$1 or unfairly discrim9atory rate2 7ii7 by /rik+ ! increase & ins]t+ ! rate2 & 7iii7 by /rik+ su* increases & ins]t+ su* rates2 & 7#b7 9 subsection 7b7-- 7,a7 9 ! subsection head+1 by /rik+ ,premium & ins]t+ ,rate2 7,b7 by /rik+ premium increases ea* place x appe>s & ins]t+ rates2 7,c7 9 p>agraph 7#a7-- 7i7 9 ! p>agraph head+1 by /rik+ ,premium ,increase & ins]t+ ,rate2 & 7ii7 9 subp>agraph 7,b71 by /rik+ excessive or unju/ifi$ & ins]t+ excessive1 unju/ifi$1 or unfairly discrim9atory2 & 7,d7 9 p>agraph 7#b7-- 7i7 9 ! p>agraph head+1 by /rik+ ,premium ,increases & ins]t+ ,rates2 & 7ii7 9 subp>agraph 7,b71 by /rik+ premium & ins]t+ rate4 7c7 ,con=m+ am5dm5t ,section #acaa7;e77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;e77#b77 is am5d$ by /rik+ excessive or unju/ifi$ premium increases & ins]t+ excessive1 unju/ifi$1 or unfairly discrim9atory rates4 7d7 ,applicability to gr&fa!r$ heal? plans ,section #abea7;a77#e7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjaa7;a77#e77 is am5d$-- 7#a7 by /rik+ ,sections #bgii;,a-#a & ins]t+ ! foll[+3 7,a7 ,9 g5]al ,sections #bgii;,a-#a 2 & 7#b7 by add+ at ! end ! foll[+3 7,b7 ,ensur+ t consum]s get value = _! doll>s ,section #bgid ( ! ,public ,heal? ,s]vice ,act %all apply to gr&fa!r$ heal? plans = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbe4 4 7e7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date ( enactm5t ( ?is ,act & %all be implem5t$ ) respect to heal? plans beg9n+ n lat] ?an ,janu>y #a1 #bjbe4 #aj4 ,s5se ( ,congress ,x is ! s5se ( ! ,congress t-- 7#a7 ! ,f$]al ,gov]nm5t1 act+ 9 its capacity z an insur]1 employ]1 or heal? c>e provid]1 %\ld s]ve z a model = ! ,nation to ensure cov]age ( all reproductive s]vices2 & 7#b7 all re/rictions on cov]age ( reproductive s]vices 9 ! private insurance m>ket %\ld end4