,i #aai? ,,congress #a/ ,session ,h4 ,r4 #fjaj ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,novemb] #aj1 #bjbe,mr4 ,licc>do 7= himself1 ,mr4 ,kiley ( ,cali=nia1 ,mr4 ,bacon1 ,ms4 ,goodl&]1 & ,ms4 ,ross7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committee on ,en]gy & ,comm]ce1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d ! ,int]nal ,rev5ue ,code ( #aihf to ext5d & modify ! enhanc$ premium tax cr$it1 & = o!r purposes4 #a4 ,tempor>y premium p]c5tages = #bjbf & #bjbg 7a7 ,9 g5]al ,section #cf;,b7b77#c77;,a77iii7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7iii7 ,tempor>y p]c5tages = #bjbf & #bjbg ,9 ! case ( a taxable ye> beg9n+ aft] ,decemb] #ca1 #bjbe1 & be=e ,janu>y #a1 #bjbh1 ! foll[+ table %all be appli$ 9 lieu ( ! table conta9$ 9 clause 7i73 ,9 ! case ( h\sehold income 7express$ z a p]c5t ( pov]ty l9e7 )9 ! foll[+ income ti]3,! initial premiump]c5tage is--,! f9al premium p]c5tage is-- ,up to #aej p]c5t#j4jj4j #aej p]c5t up to #bjj p]c5t#j4jb4j #bjj p]c5t up to #bej p]c5t#b4jd4j #bej p]c5t up to #cjj p]c5t#d4jf4j #cjj p]c5t up to #djj p]c5t#f4jh4e #djj p]c5t up to #fjj p]c5t#h4eh4e 4 7b7 ,con=m+ am5dm5t ,section #cf;,b7c77#a77;,e7 ( su* ,code is am5d$ to read z foll[s3 7,e7 ,tempor>y rule = #bjbf & #bjbg ,9 ! case ( a taxable ye> beg9n+ aft] ,decemb] #ca1 #bjbe1 & be=e ,janu>y #a1 #bjbh1 subp>agraph 7,a7 %all be appli$ by sub/itut+ #fjj p]c5t = #djj p]c5t4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 #b4 ,improv+ risk adju/m5t "u ,m$ic>e ,advantage 7a7 ,use ( #b ye>s ( diagno/ic data ,section #ahec7;a77#c77;,c77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#c77;,c77iii77 is am5d$-- 7#a7 by /rik+ me?odology4--,su* risk & ins]t+ 8me?odology4-- 7,i7 ,9 g5]al ,subject to subclause 7,,ii71 su* risk 2 & 7#b7 by add+ at ! end ! foll[+ new subclause3 7,,ii7 ,use ( heal? /atus data ,= #bjbf & ea* subsequ5t ye>1 ! ,secret>y %all use #b ye>s ( diagno/ic data 7:5 available7 "u su* risk adju/m5t me?odology4 4 7b7 ,exclusion ( diagnoses collect$ f *>t reviews & heal? risk assessm5ts ,section #ahec7;a77#a77;,c7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#a77;,c77 is am5d$ by add+ at ! end ! foll[+ new clause3 7iv7 ,exclusion ( diagnoses collect$ f *>t reviews & heal? risk assessm5ts 7,i7 ,9 g5]al ,= #bjbf & ea* subsequ5t ye>1 = purposes ( e/abli%+ ! paym5t adju/m5t factors & adju/+ paym5t bas$ on heal? /atus "u clause 7i71 ! ,secret>y %all n take into acc\nt a diagnosis collect$ f a *>t review or a heal? risk assessm5t4 7,,ii7 ,id5tification ( diagnoses collect$ f *>t reviews & heal? risk assessm5ts ,! ,secret>y %all e/abli% proc$ures to provide = ! id5tification & v]ification ( diagnoses collect$ f *>t reviews & heal? risk assessm5ts4 4 7c7 ,application ( cod+ adju/m5t ,section #ahec7;a77#a77;,c77ii7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#a77;,c77ii77 is am5d$-- 7#a7 9 subclause 7,,iii71 by /rik+ ,9 calculat+ & ins]t+ ,subject to subclause 7,v71 9 calculat+2 & 7#b7 by add+ at ! end ! foll[+ new subclause3 7,v7 ,9 calculat+ su* adju/m5t = #bjbf & ea* subsequ5t ye>1 ! ,secret>y %all evaluate ! impact on risk scores = ,m$ic>e ,advantage enrollees ( diff]5ces 9 cod+ patt]ns betwe5 ,m$ic>e ,advantage plans & provid]s "u p>ts ,a & ,b & publicly report ! results ( su* evaluation4 ,! ,secret>y %all ensure t su* adju/m5t1 :i* may include adju/m5t on a plan or contract level1 fully acc\nts = ! impact ( cod+ patt]n diff]5ces n o!rwise acc\nt$ = to ! ext5t t ! ,secret>y id5tifies su* diff]5ces ?r\gh annual evaluation4 4 #c4 ,r$uction ( fraudul5t enrollm5t 9 qualifi$ heal? plans 7a7 ,p5alties = ag5ts & brok]s ,section #adaa7;h77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjha7;h77#a77 is am5d$-- 7#a7 9 subp>agraph 7,a7-- 7,a7 by r$esignat+ clause 7ii7 z clause 7iv72 7,b7 9 clause 7i7-- 7i7 9 ! matt] prec$+ subclause 7,i71 by /rik+ ,if-- & all t foll[s ?r\gh ! su* p]son 9 ! matt] foll[+ subclause 7,,ii7 & ins]t+ ! foll[+3 ,if any p]son 7o!r ?an an ag5t or brok]7 fails to provide correct in=mation "u subsection 7b7 & su* failure is attributable to neglig5ce or disreg>d ( any rules or regulations ( ! ,secret>y1 su* p]son2 & 7ii7 9 ! second s5t5ce1 by /rik+ ,= purposes & ins]t+ ! foll[+3 7iii7 ,def9itions ( neglig5ce1 disreg>d ,= purposes 2 7,c7 by ins]t+ aft] clause 7i7 ! foll[+3 7ii7 ,civil p5alties = c]ta9 violations by ag5ts or brok]s ,if any ag5t or brok] fails to provide correct in=mation "u subsection 7b7 or section #acaa7;c77#h7 or o!r in=mation1 z specifi$ by ! ,secret>y1 & su* failure is attributable to neglig5ce or disreg>d ( any rules or regulations ( ! ,secret>y1 su* ag5t or brok] %all be subject1 9 addition to any o!r p5alties t may be prescrib$ by law1 includ+ subp>agraph 7,c71 to a civil p5alty ( n less ?an #aj1jjj & n m ?an #ej1jjj ) respect to ea* individual :o is ! subject ( an application = :i* su* incorrect in=mation is provid$4 2 & 7,d7 9 clause 7iv7 7z s r$esignat$71 by ins]t+ or 7ii7 aft] clause 7i72 7#b7 9 subp>agraph 7,b7-- 7,a7 by ins]t+ includ+ subp>agraph 7,c71 aft] law12 7,b7 by /rik+ ,any p]son & ins]t+ ! foll[+3 7i7 ,9 g5]al ,any p]son 2 & 7,c7 by add+ at ! end ! foll[+3 7ii7 ,civil p5alties = kn[+ violations by ag5ts or brok]s 7,i7 ,9 g5]al ,any ag5t or brok] :o kn[+ly provides false or fraudul5t in=mation "u subsection 7b7 or section #acaa7;c77#h71 or o!r false or fraudul5t in=mation z "p ( an application = enrollm5t 9 a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange1 z specifi$ by ! ,secret>y1 %all be subject1 9 addition to any o!r p5alties t may be prescrib$ by law1 includ+ subp>agraph 7,c71 to a civil p5alty ( n m ?an #bjj1jjj ) respect to ea* individual :o is ! subject ( an application = :i* su* false or fraudul5t in=mation is provid$4 7,,ii7 ,proc$ure ,! provisions ( section #aabh;,a ( ! ,social ,security ,act 7o!r ?an subsections 7a7 & 7b7 ( su* section7 %all apply to a civil monet>y p5alty "u subclause 7,i7 9 ! same mann] z su* provisions apply to a p5alty or proce$+ "u section #aabh;,a ( ! ,social ,security ,act4 2 & 7#c7 by add+ at ! end ! foll[+3 7,c7 ,crim9al p5alties ,any ag5t or brok] :o kn[+ly & willfully provides false or fraudul5t in=mation "u subsection 7b7 or section #acaa7;c77#h71 or o!r false or fraudul5t in=mation z "p ( an application = enrollm5t 9 a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange1 z specifi$ by ! ,secret>y1 %all be f9$ "u title #ah1 ,unit$ ,/ates ,code1 imprison$ = n m ?an #aj ye>s1 or bo?4 4 7b7 ,consum] protections 7#a7 ,9 g5]al ,section #acaa7;c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77 is am5d$ by add+ at ! end ! foll[+3 7#h7 ,ag5t-or brok]-assi/$ enrollm5t 9 qualifi$ heal? plans 9 c]ta9 ex*anges 7,a7 ,9 g5]al ,= plan ye>s beg9n+ on or aft] su* date specifi$ by ! ,secret>y1 b n lat] ?an ,janu>y #a1 #bjbh1 9 ! case ( an ,ex*ange t ! ,secret>y op]ates pursuant to section #acba7;c77#a71 ! ,secret>y %all e/abli% a v]ification process = new enrollm5ts ( individuals 91 & *anges 9 cov]age = individuals "u1 a qualifi$ heal? plan (f]$ ?r\gh su* ,ex*ange1 :i* are submitt$ by an ag5t or brok] 9 accordance ) section #acab7;e7 & = :i* ! ag5t or brok] is eligible to receive a commission4 7,b7 ,requirem5ts ,! enrollm5t v]ification process "u subp>agraph 7,a7 %all include-- 7i7 a requirem5t t ! ag5t or brok] provide ) ! new enrollm5t or cov]age *ange su* docum5tation or evid5ce 7su* z a /&>diz$ cons5t =m7 or o!r s\rces z ! ,secret>y det]m9es necess>y to e/abli% t ! ag5t or brok] has ! cons5t ( ! individual = ! new enrollm5t or cov]age *ange2 7ii7 a requirem5t t any commissions due to a brok] or ag5t = su* new enrollm5t or cov]age *ange are paid aft] ! enrollee has resolv$ all inconsi/5cies 9 accordance ) p>agraphs 7#c7 & 7#d7 ( section #adaa7;e72 7iii7 a requirem5t t ! in=mation requir$ "u clause 7i7 &1 z applicable1 ! date on :i* inconsi/5cies are resolv$ z describ$ 9 clause 7ii71 is accessible to ! applicable qualifi$ heal? plan ?r\gh a database or o!r res\rce1 z det]m9$ by ! ,secret>y1 s t any commissions due to a brok] or ag5t = su* enrollm5t c be effectuat$ at ! appropriate "t2 7iv7 a requirem5t t individuals are notifi$ ( any *anges to enrollm5t1 cov]age1 ! ag5t ( record1 or premium tax cr$its 9 a timely mann] & t su* notice provides pla9 language in/ructions on h[ individuals c cancel unau?oriz$ activity2 7v7 a requirem5t t individuals be able to access _! acc\nt in=mation on a website or o!r te*nology plat=m1 z def9$ by ! ,secret>y1 :5 us$ to submit an enrollm5t or plan *ange1 9 lieu ( ! ,ex*ange website describ$ 9 subsection 7d77#d77;,c71 includ+ in=mation on ! ag5t ( record1 ! qualifi$ heal? plan1 & :5 any *anges are made to ! ag5t ( record or ! qualifi$ heal? plan1 on a consum]-fac+ website or ?r\gh a toll-free telephone hotl9e2 & 7vi7 a requirem5t t ! ag5t or brok] report to ! ,secret>y any ?ird-p>ty m>ket+ organization or field m>ket+ organization 7z su* t]ms are def9$ 9 section #acab7;e77 involv$ 9 ! *a9 ( enrollm5t 7z s def9$7 ) respect to su* new enrollm5t or cov]age *ange4 7,c7 ,consum] protection ,! ,secret>y %all ensure t ! enrollm5t v]ification process "u subp>agraph 7,a7 prioritizes cont9uity ( cov]age & c>e = individuals1 includ+ by n dis5roll+ individuals f a qualifi$ heal? plan )\t ! cons5t ( ! individual1 reg>dless ( :e!r ! brok]1 ag5t1 or qualifi$ heal? plan is 9 violation ( any requirem5t "u ?is p>agraph4 4 7#b7 ,requir$ report+ ,section #acaa7;c77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77 is am5d$-- 7,a7 9 subp>agraph 7,h71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,i71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7,j7 report to ! ,secret>y ! t]m9ation 7z def9$ 9 section #acab7;e77#d77;,c77 ( an issu]4 4 7c7 ,au?ority ,to regulate field m>ket+ organizations & ?ird-,p>ty m>ket+ organizations ,section #acab7;e7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjcb7;e77 is am5d$-- 7#a7 by r$esignat+ p>agraphs 7#a7 & 7#b7 z subclauses 7,i7 & 7,,ii71 respectively1 & adju/+ ! m>g9s accord+ly2 7#b7 9 subclause 7,,ii7 7z s r$esignat$71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 7#c7 by /rik+ ! subsection designation & head+ & all t foll[s ?r\gh brok]s-- & ins]t+ ! foll[+3 7e7 ,regulation ( ag5ts1 brok]s1 & c]ta9 m>ket+ organizations 7#a7 ,ag5ts1 brok]s1 & c]ta9 m>ket+ organizations 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% proc$ures "u :i* a ,/ate may all[-- 7i7 ag5ts or brok]s-- 2 & 7#d7 by add+ at ! end ! foll[+3 7ii7 field m>ket+ organizations & ?ird-p>ty m>ket+ organizations to p>ticipate 9 ! *a9 ( enrollm5t = an individual ) respect to qualifi$ heal? plans (f]$ ?r\gh an ,ex*ange4 7,b7 ,crit]ia ,= plan ye>s beg9n+ on or aft] su* date specifi$ by ! ,secret>y1 b n lat] ?an ,janu>y #a1 #bjbh1 ! ,secret>y1 by regulation1 %all e/abli% crit]ia = ,/ates to use 9 det]m9+ :e!r to all[ ag5ts & brok]s to enroll individuals & employ]s 9 qualifi$ heal? plans z describ$ 9 subclause 7,i7 ( subp>agraph 7,a77i7 & to assi/ individuals z describ$ 9 subclause 7,,ii7 ( su* subp>agraph & field m>ket+ organizations & ?ird-p>ty m>ket+ organizations to p>ticipate 9 ! *a9 ( enrollm5t z describ$ 9 subp>agraph 7,a77ii74 ,su* crit]ia %all1 at a m9imum1 require t-- 7i7 an ag5t or brok] act 9 accordance ) a /&>d ( conduct t includes a duty ( su* ag5t or brok] to act 9 ! be/ int]e/s ( ! enrollee2 7ii7 a field m>ket+ organization or ?ird-p>ty m>ket+ organization agree to report ! t]m9ation ( an ag5t or brok] to ! applicable ,/ate & ! ,secret>y1 includ+ ! reason = t]m9ation2 & 7iii7 an ag5t1 brok]1 field m>ket+ organization1 or ?ird-p>ty m>ket+ organization-- 7,i7 meet su* m>ket+ requirem5ts z are requir$ by ! ,secret>y2 7,,ii7 meet m>ket+ requirem5ts 9 accordance ) o!r applicable ,f$]al or ,/ate law2 7,,iii7 does n employ practices t are confus+ or mislead+1 z det]m9$ by ! ,secret>y2 7,,iv7 submit all m>ket+ mat]ials to ! ,secret>y =1 z det]m9$ appropriate by ! ,secret>y1 review & approval2 7,v7 is a lic5s$ ag5t or brok] or meets o!r lic5sure requirem5ts1 z requir$ by ! ,/ate2 7,,vi7 regi/] ) ! ,secret>y2 & 7,,vii7 does n comp5sate any individual or organization = ref]rals or any o!r s]vice relat+ to ! sale (1 m>ket+ =1 or enrollm5t 9 qualifi$ heal? plans unless su* individual or organization meets ! crit]ia describ$ 9 subclauses 7,i7 ?r\gh 7,,vi74 7,c7 ,def9itions ,9 ?is p>agraph3 7i7 ,*a9 ( enrollm5t ,! t]m *a9 ( enrollm5t1 ) respect to enrollm5t ( an individual 9 a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange1 means any /eps tak5 f m>ket+ to su* individual1 to su* individual mak+ an enrollm5t decision ) respect to su* a plan4 7ii7 ,field m>ket+ organization ,! t]m field m>ket+ organization means an organization or individual t directly employs or contracts ) ag5ts & brok]s1 or contracts ) c>ri]s1 to provide functions relat+ to enrollm5t ( individuals 9 qualifi$ heal? plans (f]$ ?r\gh an ,ex*ange z "p ( ! *a9 ( enrollm5t4 7iii7 ,m>ket+ ,! t]m m>ket+ means ! use ( m>ket+ mat]ials to provide in=mation to curr5t & prospective enrollees 9 a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange4 7iv7 ,m>ket+ mat]ials ,! t]m m>ket+ mat]ials means mat]ials relat+ to a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange or b5efits (f]$ ?r\gh an ,ex*ange t-- 7,i7 are int5d$-- 7aa7 to draw an individual's att5tion to su* plan or ! premium tax cr$its or co/-%>+ r$uctions = su* plan or plans (f]$ ?r\gh an ,ex*ange2 7bb7 to influ5ce an individual's decision-mak+ process :5 select+ a qualifi$ heal? plan 9 :i* to enroll2 or 7cc7 to influ5ce an enrollee's decision to /ay enroll$ 9 su* plan2 & 7,,ii7 include or address cont5t reg>d+ ! b5efits1 b5efit /ructure1 premiums1 or co/ %>+ ( su* plan4 7v7 ,t]m9ation ,! t]m t]m9ation1 ) respect to a contract or bus9ess arrangem5t betwe5 an ag5t or brok] & a field m>ket+ organization1 ?ird-p>ty m>ket+ organization1 or heal? insurance issu]1 means-- 7,i7 ! end+ ( su* contract or bus9ess arrangem5t1 ei!r unilat]ally by "o ( ! p>ties or on mutual agreem5t2 or 7,,ii7 ! expiration ( su* contract or bus9ess arrangem5t t is n replac$ by a sub/antially simil> agreem5t4 7vi7 ,?ird-p>ty m>ket+ organization ,! t]m ?ird-p>ty m>ket+ organization means an organization or individual t is comp5sat$ to p]=m lead g5]ation1 m>ket+1 or sales relat+ to enrollm5t ( individuals 9 qualifi$ heal? plans (f]$ ?r\gh an ,ex*ange z "p ( ! *a9 ( enrollm5t4 4 7d7 ,transp>5cy ,section #acab7;e7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjcb7;e77 7z am5d$ by subsection 7c77 is am5d$ by add+ at ! end ! foll[+3 7#b7 ,audits 7,a7 ,9 g5]al ,= plan ye>s beg9n+ on or aft] su* date specifi$ by ! ,secret>y1 b n lat] ?an ,janu>y #a1 #bjbh1 ! ,secret>y1 9 coord9ation ) ! ,/ates & 9 consultation ) ! ,national ,association ( ,insurance ,commission]s1 %all implem5t a process = ! ov]sight & en=cem5t ( ag5t & brok] compliance ) ?is section & o!r applicable ,f$]al & ,/ate law 7includ+ regulations7 t %all include-- 7i7 p]iodic audits ( ag5ts & brok]s bas$ on-- 7,i7 compla9ts fil$ ) ! ,secret>y by individuals enroll$ by su* an ag5t or brok] 9 a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange2 7,,ii7 an incid5t or enrollm5t patt]n t sugge/s fraud2 & 7,,iii7 o!r factors det]m9$ by ! ,secret>y2 & 7ii7 a process "u :i* ! ,secret>y %all %>e audit results & ref] pot5tial cases ( fraud to ! relevant ,/ate dep>tm5t ( insurance4 7,b7 ,effect ,no?+ 9 ?is p>agraph limits or re/ricts any ref]rals made "u section #acaa7;i77#c7 or any en=cem5t actions "u section #adaa7;h74 7#c7 ,li/ ,! ,secret>y %all develop a process to regul>ly provide to qualifi$ heal? plans1 ,ex*anges1 & ,/ates a li/ ( susp5d$ & t]m9at$ ag5ts & brok]s4 4