,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #fdid  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #e1 #bjbe,ms4
 ,plaskett 7= h]self1 ,mrs4 ,radewag51  
,mr4 ,h]nndez1 ,mr4 ,moylan1 & ,ms4     
,k+-,h9ds7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,en]gy &    
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = 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 titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to make improvem5ts to ! treatm5t (
 ! ,unit$ ,/ates t]ritories "u ! ,m$ic>e
 & ,m$icaid programs1 & = o!r purposes4 
#a4 ,%ort title2 table ( cont5ts  7a7   
,%ort title ,?is ,act may be cit$ z !   
,t]ritories ,heal? ,equity ,act ( #bjbe4
  7b7 ,table ( cont5ts ,! table (       
cont5ts = ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title2 table ( cont5ts4,title 
,i--,m,e,d,i,c,a,i,d,sec4 #aja4         
,elim9ation ( g5]al ,m$icaid fund+      

limitations 7,,cap7 = t]ritories4,sec4  
#ajb4 ,elim9ation ( specific ,f$]al     
m$ical assi/ance p]c5tage 7,,fmap7      
limitation = ,pu]to ,rico4,sec4 #ajc4   
,p]mitt+ ,m$icaid ,,d% allotm5ts =      
t]ritories4,title                       
,,ii--,m,e,d,i,c,a,r,e,subtitle ,a--,"p 
,a,sec4 #bja4 ,calculation ( ,m$ic>e    
,,d% paym5ts = ,,ipps hospitals 9 ,pu]to
 ,rico4,sec4 #bjb4 ,rebas+ t>get am\nt =
 hospitals 9 t]ritories4,sec4 #bjc4     
,m$ic>e ,,d% t>get adju/m5t = hospitals 
9 t]ritories4,subtitle ,b--,"p ,b,sec4  
#baa4 ,elim9at+ late enrollm5t p5alties 
"u ,"p ,b ( ! ,m$ic>e program = c]ta9   
individuals resid+ 9 ,pu]to             
,rico4,subtitle ,c--,m$ic>e ,advantage  
7,"p ,c7,sec4 #bba4 ,adju/m5t 9 b5*m>k =
 l[-base paym5t c\nties 9 ,pu]to        
,rico4,subtitle ,d--,"p ,d,sec4 #bca4   
,automatic eligibility ( c]ta9 l[-income
 t]ritorial resid5ts = premium & co/-%>+
 subsidies "u ! ,m$ic>e program2 sunset 
( enhanc$ allotm5t program4,title       
,,iii--,m,i,s,c,e,l,l,a,n,e,o,u,s,sec4  

#cja4 ,m$icaid & ,,*ip t]ritory         
transp>5cy & in=mation4,sec4 #cjb4      
,report on exclusion ( t]ritories f     
ex*anges4,sec4 #cjc4 ,access to cov]age 
= individuals 9 c]ta9 areas )\t any     
available ex*ange plans4  ,i ,,m$icaid  
#aja4 ,elim9ation ( g5]al ,m$icaid fund+
 limitations 7,,cap7 = t]ritories  7a7  
,9 g5]al ,section #aajh ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acjh7 is 
am5d$-- 7#a7 9 subsection 7f71 9 ! matt]
 prec$+ p>agraph 7#a71 by /rik+         
subsections 7g7 & 7h7 & ins]t+          
subsections 7g71 7h71 & 7j72  7#b7 9    
subsection 7g77#b71 9 ! matt] prec$+    
subp>agraph 7,a71 by ins]t+ subsection  
7j7 & aft] subject to2  7#c7 9          
subsection 7i71 by /rik+ p>agraph 7#d72 
&  7#d7 by add+ at ! end ! foll[+ new   
subsection3  7j7 ,sunset ( m$icaid fund+
 limitations = pu]to rico1 ! virg9      
isl&s1 guam1 ! nor!rn m>iana isl&s1 &   
am]ican samoa ,subsections 7f7 & 7g7    
%all n apply to ,pu]to ,rico1 ! ,virg9  
,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1

 & ,am]ican ,samoa beg9n+ ) fiscal ye>  
#bjbf4  4  7b7 ,con=m+ am5dm5ts  7#a7   
,section #aijb7;j7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;a7j77 is     
am5d$ by /rik+ 1 ! limitation 9 section 
#aajh7;f7114  7#b7 ,section #aijc7u7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;b7u77 is am5d$ by /rik+ p>agraph  
7#d74  7c7 ,effective date ,! am5dm5ts  
made by ?is section %all apply beg9n+ ) 
fiscal ye> #bjbf4  #ajb4 ,elim9ation (  
specific ,f$]al m$ical assi/ance        
p]c5tage 7,,fmap7 limitation = ,pu]to   
,rico ,section #aije ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is am5d$-- 7#a7 9 subsection 7b77#b71 by
 ins]t+ = fiscal ye>s be=e fiscal ye>   
#bjbf aft] ,am]ican ,samoa2 &  7#b7 9   
subsection 7ff77#b71 by /rik+ #bjbg &   
ins]t+ #bjbe4  #ajc4 ,p]mitt+ m$icaid   
,,d% allotm5ts = t]ritories ,section    
#aibc7;f7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acifr-#d7;f77 is am5d$--
 7#a7 9 p>agraph 7#f71 by add+ at ! end 
! foll[+ new subp>agraph3  7,c7         

,t]ritories  7i7 ,fiscal ye> #bjbf ,=   
fiscal ye> #bjbf1 ! ,,d% allotm5t =     
,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! 
,nor!rn ,m>iana ,isl&s1 & ,am]ican      
,samoa %all be> ! same ratio to         
#cjj1jjj1jjj z ! ratio ( ! numb] (      
individuals :o are l[-income or un9sur$ 
& resid+ 9 su* respective t]ritory 7z   
e/imat$ f "t to "t by ! ,secret>y7 be>s 
to ! sums ( ! numb] ( su* individuals   
resid+ 9 all ( ! t]ritories4  7ii7      
,subsequ5t fiscal ye> ,= ea* subsequ5t  
fiscal ye>1 ! ,,d% allotm5t = ea* su*   
t]ritory is subject to an increase 9    
accordance ) p>agraph 7#c74  2 &  7#b7 9
 p>agraph 7#i71 by ins]t+ be=e ! p]iod  
at ! end ! foll[+3 1 & includes1 beg9n+ 
) fiscal ye> #bjbf1 ,pu]to ,rico1 !     
,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana 
,isl&s1 & ,am]ican ,samoa4  ,,ii        
,,m$ic>e  ,a ,"p ,a  #bja4 ,calculation 
( m$ic>e ,,d% paym5ts = ,,ipps hospitals
 9 ,pu]to ,rico ,section                
#ahhf7;d77#i77;,d77iii7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           

#acieww7d77#i77;,d77iii77 is am5d$ to   
read z foll[s3  7iii7 ,subp>agraph 7,f7 
7relat+ to disproportionate %>e         
paym5ts71 includ+ application (         
subsection 7r71 except t = ?is purpose--
 7,i7 ! sum describ$ 9 clause 7ii7 ( ?is
 subp>agraph %all be sub/itut$ = ! sum  
ref]r$ to 9 p>agraph 7#e77;,f77ii77,i72 
&  7,,ii7 = dis*>ges occurr+ on or aft] 
,octob] #a1 #bjbe1 subclause 7,i7 (     
p>agraph 7#e77;,f77vi7 %all be appli$ by
 sub/itut+ = ! num]ator describ$ 9 su*  
subclause ! numb] ( subsection 7d7      
,pu]to ,rico hospital's pati5t days = ! 
co/ report+ p]iod involv$ :i* 7 made up 
( pati5ts :o 7= su* days7 7 entitl$ to  
b5efits "u "p ,a ( ?is title & 7-- 7aa7 
entitl$ to supplem5t>y security income  
b5efits 7exclud+ any ,/ate              
supplem5tation7 "u title ,,xvi2  7bb7   
eligible = m$ical assi/ance "u a ,/ate  
plan "u title ,,xix2 or  7cc7 receiv+   
aid or assi/ance "u any plan ( ! ,/ate  
approv$ "u title ,i1 ,x1 ,,xiv1 or      
,,xvi4  4  #bjb4 ,rebas+ t>get am\nt =  

hospitals 9 t]ritories ,section         
#ahhf7;b77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieww7b77#c77 is am5d$
 by add+ at ! end ! foll[+ new          
subp>agraph3  7,m7 7i7 ,= ea* co/       
report+ p]iod beg9n+ on or aft] ,octob] 
#a1 #bjbe1 9 ! case ( a hospital locat$ 
9 a t]ritory ( ! ,unit$ ,/ates1 !re %all
 be sub/itut$ = ! t>get am\nt o!rwise   
det]m9$ "u subp>agraph 7,a7 ! rebas$    
t>get am\nt 7z def9$ 9 clause 7ii771 if 
su* sub/itution results 9 an am\nt (    
paym5t "u ?is section to ! hospital =   
su* p]iod t is great] ?an ! am\nt (     
paym5t t w\ld be made "u ?is section to 
! hospital = su* p]iod if ?is           
subp>agraph 7 n to apply4  7ii7 ,=      
purposes ( ?is subp>agraph1 ! t]m rebas$
 t>get am\nt has ! mean+ giv5 ! t]m     
t>get am\nt 9 subp>agraph 7,a71 except  
t-- 7,i7 = a co/ report+ p]iod beg9n+ on
 or aft] ,octob] #a1 #bjbe1 & be=e      
,septemb] #cj1 #bjcj1 !re %all be       
sub/itut$ = ! prec$+ #ab-mon? co/       
report+ p]iod ! #ab-mon? co/ report+    

p]iod beg9n+ dur+ fiscal ye> #bjag2     
7,,ii7 = a co/ report+ p]iod beg9n+ on  
or aft] ,octob] #a1 #bjcj1 !re %all be  
sub/itut$ = ! prec$+ #ab-mon? co/       
report+ p]iod ! co/ report+ p]iod = :i* 
! t>get am\nt det]m9$ "u subp>agraph    
7,a7 is ! highe/ among ! #e co/ report+ 
p]iods = :i* ! ,secret>y has ! mo/ rec5t
 settl$ co/ reports2  7,,iii7 any       
ref]5ce 9 subp>agraph 7,a77i7 to ! fir/ 
su* co/ report+ p]iod is deem$ a ref]5ce
 to ! fir/ co/ report+ p]iod foll[+ !   
#ab-mon? co/ report+ p]iod beg9n+ dur+  
fiscal ye> #bjag2 &  7,,iv7 ! applicable
 p]c5tage increase %all only be appli$  
"u subp>agraph 7,b77ii7 = co/ report+   
p]iods beg9n+ on or aft] ,octob] #a1    
#bjbe4  4  #bjc4 ,m$ic>e ,,d% t>get     
adju/m5t = hospitals 9 t]ritories       
,section #ahhf7;b77#c7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acieww7b77#c771 z am5d$ by section     
#bjb1 is fur!r am5d$ by add+ at ! end ! 
foll[+ new subp>agraph3  7,n7 7i7 ,= ea*
 co/ report+ p]iod beg9n+ on or aft]    

,octob] #a1 #bjbe1 9 ! case ( a hospital
 t is locat$ 9 a t]ritory ( ! ,unit$    
,/ates o!r ?an ,pu]to ,rico & t w\ld be 
a subsection 7d7 hospital if x 7 locat$ 
9 "o ( ! #ej ,/ates1 ! t>get am\nt %all 
be increas$ by-- 7,i7 9 ! case t su*    
hospital has a disproportionate pati5t  
p]c5tage ( n less ?an #ae p]c5t & n     
great] ?an #dj p]c5t1 #aj p]c5t2 &      
7,,ii7 9 ! case t su* hospital has a    
disproportionate pati5t p]c5tage (      
great] ?an #dj p]c5t1 #aj p]c5t plus #fj
 p]c5t ( ! numb] ( p]c5tage po9ts by :i*
 su* hospital's disproportionate pati5t 
p]c5tage exce$s #dj p]c5t4  7ii7 ,=     
purposes ( ?is subp>agraph1 ! t]m       
disproportionate pati5t p]c5tage has !  
mean+ giv5 su* t]m 9 subsection         
7d77#e77;,f77vi71 except t 9 apply+ su* 
mean+ any ref]5ce "u su* subsection to  
individuals entitl$ to supplem5t>y      
security income "u title ,,xvi %all be  
deem$ = purposes ( ?is subp>agraph to   
include individuals-- 7,i7 eligible =   
m$ical assi/ance "u a ,/ate plan "u     

title ,,xix2 or  7,,ii7 receiv+ aid or  
assi/ance "u any plan ( ! t]ritory      
approv$ "u title ,i1 ,x1 ,,xiv1 or      
,,xvi4  4  ,b ,"p ,b  #baa4 ,elim9at+   
late enrollm5t p5alties "u ,"p ,b ( !   
m$ic>e program = c]ta9 individuals      
resid+ 9 ,pu]to ,rico  7a7 ,9 g5]al     
,section #ahci7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acier7b77 is am5d$
 9 ! second s5t5ce by ins]t+ or mon?s   
occurr+ 9 ! #e-ye> p]iod beg9n+ on !    
date on :i* ! individual becomes entitl$
 to b5efits "u "p ,a if su* individual 0
 resid+ 9 ,pu]to ,rico z ( su* date &   
su* date is aft] ! date t is #d ye>s    
be=e ! date ( ! enactm5t ( ! ,t]ritories
 ,heal? ,equity ,act ( #bjbe be=e !     
p]iod at ! end ( su* s5t5ce4  7b7       
,application ,! am5dm5t made by         
subsection 7a7 %all apply ) respect to  
premiums paid = mon?s beg9n+ on or aft] 
! date ( ! enactm5t ( ?is ,act4  ,c     
,m$ic>e ,advantage 7,"p ,c7  #bba4      
,adju/m5t 9 b5*m>k = l[-base paym5t     
c\nties 9 ,pu]to ,rico ,section #ahec7n7

 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciew-#bc7n77 is am5d$-- 7#a7
 9 p>agraph 7#a71 by /rik+ & 7#e7 &     
ins]t+ 7#e71 & 7#f72  7#b7 9 p>agraph   
7#d71 by /rik+ ,9 no case & ins]t+      
,subject to p>agraph 7#f71 9 no case2 & 
7#c7 by add+ at ! end ! foll[+ new      
p>agraph3  7#f7 ,special rules = bl5d$  
b5*m>k am\nt = t]ritories  7,a7 ,9 g5]al
 ,subject to p>agraph 7#b71 ! bl5d$     
b5*m>k am\nt = an area 9 a t]ritory = a 
ye> 7beg9n+ ) #bjbf7 %all n be less ?an 
#hj p]c5t ( ! national av]age ( ! base  
paym5t am\nts specifi$ 9 subp>agraph    
7#b77;,e7 = su* ye> = areas )9 ! #ej    
,/ates & ! ,di/rict ( ,columbia4  7,b7  
,limitation ,9 no case %all ! bl5d$     
b5*m>k am\nt = an area 9 a t]ritory = a 
ye> "u subp>agraph 7,a7 exce$ ! l[e/    
bl5d$ b5*m>k am\nt = any area )9 ! #ej  
,/ates & ! ,di/rict ( ,columbia = su*   
ye>4  4  ,d ,"p ,d  #bca4 ,automatic    
eligibility ( c]ta9 l[-income t]ritorial
 resid5ts = premium & co/-%>+ subsidies 
"u ! m$ic>e program2 sunset ( enhanc$   

allotm5t program  7a7 ,automatic        
eligibility ( c]ta9 l[-,income          
t]ritorial resid5ts = premium & co/-,%>+
 subsidies "u ! m$ic>e program  7#a7 ,9 
g5]al ,section #ahfj;,d-#ad7;a77#c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#aad7;a77#c77 is am5d$-- 7,a7 9  
subp>agraph 7,b77v7-- 7i7 9 subclause   
7,i71 by /rik+ & at ! end2  7ii7 9      
subclause 7,,ii71 by /rik+ ! p]iod &    
ins]t+ 2 &2 &  7iii7 by ins]t+ aft]     
subclause 7,,ii7 ! foll[+ new subclause3
  7,,iii7 ) respect to plan ye>s beg9n+ 
on or aft] ,janu>y #a1 #bjbf1 %all      
provide t any "p ,d eligible individual 
:o is enroll$ = m$ical assi/ance "u !   
,/ate ,m$icaid plan ( a t]ritory 7z     
def9$ 9 section #aice7;f77 "u title     
,,xix 7or a waiv] ( su* a plan7 %all be 
treat$ z a subsidy eligible individual  
describ$ 9 p>agraph 7#a74  2 &  7,b7 9  
subp>agraph 7,f71 by add+ at ! end !    
foll[+ new s5t5ce3 ,! previ\s s5t5ce    
%all n apply ) respect to eligibility   
det]m9ations = premium & co/-%>+        

subsidies "u ?is section made on or aft]
 ,janu>y #a1 #bjbf44  7#b7 ,con=m+      
am5dm5t ,section                        
#ahfj;,d-#ca7;j77#b77;,d7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciew-#ada7;j77#b77;,d77 is am5d$ by   
add+ at ! end ! foll[+ new s5t5ce3 ,!   
previ\s s5t5ce %all n apply ) respect to
 am\nts made available to a ,/ate "u ?is
 p>agraph on or aft] ,janu>y #a1 #bjbf44
  7b7 ,sunset ( enhanc$ allotm5t program
  7#a7 ,9 g5]al ,section #aice7;e7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acifu-#e7;e77 is am5d$-- 7,a7 9        
p>agraph 7#a77;,a71 by ins]t+ aft] su*  
,/ate ! foll[+3 be=e ,janu>y #a1 #bjbf2 
&  7,b7 9 p>agraph 7#c7-- 7i7 9         
subp>agraph 7,a71 9 ! matt] prec$+      
clause 7i71 by ins]t+ aft] a ye> !      
foll[+3 7be=e #bjbf72 &  7ii7 9         
subp>agraph 7,b77iii71 by /rik+ a       
subsequ5t ye> & ins]t+ ea* ( fiscal ye>s
 #bjaj ?r\gh #bjbe4  7#b7 ,t]ritory     
def9$ ,section #aice ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acifu-#e7

 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7f7 ,t]ritory def9$ ,9 ?is 
section1 ! t]m t]ritory means ,pu]to    
,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn
 ,m>iana ,isl&s1 & ,am]ican ,samoa4  4  
,,iii ,,miscellane\s  #cja4 ,m$icaid &  
,,*ip t]ritory transp>5cy & in=mation   
7a7 ,publication ( in=mation on f$]al   
exp5ditures "u m$icaid & ,,*ip 9 !      
t]ritories ,n lat] ?an #ahj days aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices    
%all publi%1 & p]iodically update1 on ! 
int]net site ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices in=mation on ,m$icaid 
& ,,*ip c>ri$ out 9 ! t]ritories ( !    
,unit$ ,/ates4 ,su* in=mation %all      
include1 ) respect to ea* su* t]ritory--
 7#a7 ! income levels e/abli%$ by !     
t]ritory = purposes ( eligibility ( an  
individual to receive m$ical assi/ance  
"u ,m$icaid or *ild heal? assi/ance "u  
,,*ip2  7#b7 ! numb] ( individuals      
enroll$ 9 ,m$icaid & ,,*ip 9 su*        
t]ritory2  7#c7 any ,/ate plan am5dm5ts 

9 effect to c>ry out ,m$icaid or ,,*ip 9
 su* t]ritory2  7#d7 any waiv] ( !      
requirem5ts ( title ,,xix or title ,,xxi
 issu$ by ! ,secret>y to c>ry out       
,m$icaid or ,,*ip 9 ! t]ritory1 includ+ 
a waiv] "u section #aaae ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acae71   
any application = su* a waiv]1 & any    
docum5tation relat$ to su* application  
7includ+ correspond5ce72  7#e7 ! am\nt (
 ! ,f$]al & non-,f$]al %>e ( exp5ditures
 "u ,m$icaid & ,,*ip 9 su* t]ritory2    
7#f7 ! sy/ems 9 place = ! furni%+ (     
heal? c>e items & s]vices "u ,m$icaid & 
,,*ip 9 su* t]ritory2  7#g7 ! design (  
,,*ip 9 su* t]ritory2 &  7#h7 o!r       
in=mation reg>d+ ! c>ry+ out ( ,m$icaid 
& ,,*ip 9 ! t]ritory t is publi%$ on su*
 int]net site ) respect to c>ry+ out    
,m$icaid & ,,*ip 9 ea* ,/ate & !        
,di/rict ( ,columbia4  7b7 ,def9itions  
,9 ?is section3 7#a7 ,,*ip ,! t]m ,,*ip 
means ! ,/ate ,*ildr5's ,heal?          
,insurance ,program "u title ,,xxi ( !  
,social ,security ,act4  7#b7 ,m$icaid  

,! t]m ,m$icaid means ! ,m$icaid program
 "u title ,,xix ( ! ,social ,security   
,act4  7#c7 ,t]ritory ,! t]m t]ritory ( 
! ,unit$ ,/ates includes ,pu]to ,rico1 !
 ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1
 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican   
,samoa4  #cjb4 ,report on exclusion (   
t]ritories f ex*anges  7a7 ,9 g5]al ,n  
lat] ?an ,febru>y #a1 #bjbf1 ! ,secret>y
 ( ,heal? & ,human ,s]vices %all submit 
to ,congress a report t details ! adv]se
 impacts 9 ea* t]ritory f ! practical   
exclusion ( ! t]ritories f ! provisions 
( "p ,,ii ( subtitle ,d ( title ,i ( !  
,pati5t ,protection & ,af=dable ,c>e    
,act ins(> z su* provisions provide = ! 
e/abli%m5t ( an ,am]ican ,heal? ,b5efit 
,ex*ange or ! adm9i/ration ( a f$]ally  
facilitat$ ,ex*ange 9 ea* ,/ate & 9 !   
,di/rict ( ,columbia = ! purpose ( mak+ 
heal? insurance m af=dable & accessible 
= individuals & small bus9esses4  7b7   
,in=mation 9 report ,! report %all      
include in=mation on ! foll[+3 7#a7 ,an 
e/imate ( ! total numb] ( un9sur$ &     

und]9sur$ individuals resid+ 9 ea*      
t]ritory ) respect to heal? insurance   
cov]age4  7#b7 ,a description ( ! numb] 
( heal? insurance issu]s 9 ea* t]ritory 
& ! heal? insurance plans ^! issu]s (f]4
  7#c7 ,an e/imate ( ! numb] (          
individuals resid+ 9 ea* t]ritory :o are
 d5i$ premium & co/-%>+ assi/ance t w\ld
 o!rwise be available to !m = obta9+    
heal? insurance cov]age ?r\gh an        
,ex*ange if !y resid$ 9 "o ( ! #ej      
,/ates or 9 ! ,di/rict ( ,columbia4     
7#d7 ,an e/imate ( ! am\nt ( ,f$]al     
assi/ance describ$ 9 p>agraph 7#c7 t is 
n be+ made available to resid5ts ( ea*  
t]ritory4  7#e7 ,an e/imate ( ! numb] ( 
small employ]s 9 ea* t]ritory t w\ld be 
eligible to pur*ase heal? insurance     
cov]age ?r\gh a ,small ,bus9ess ,heal?  
,options ,program 7,,%op7 ,m>ketplace t 
w\ld op]ate z "p ( an ,ex*ange if !     
employ]s 7 9 "o ( ! #ej ,/ates or 9 !   
,di/rict ( ,columbia4  #cjc4 ,access to 
cov]age = individuals 9 c]ta9 areas )\t 
any available ex*ange plans ,"p #b (    

subtitle ,d ( title ,i ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca et seq47 is am5d$ by   
add+ at ! end ! foll[+3  #acad4 ,access 
to cov]age = individuals 9 c]ta9 areas  
)\t any available ex*ange plans  7a7 ,9 
g5]al  7#a7 ,cov]age ?r\gh dc ex*ange ,n
 lat] ?an #c mon?s aft] ! date (        
enactm5t ( ?is section1 ! ,secret>y1 9  
consultation ) ! ,secret>y ( ! ,treasury
 & ! ,director ( ! ,(fice ( ,p]sonnel   
,managem5t1 %all e/abli% a me*anism to  
ensure t1 = any plan ye> beg9n+ on or   
aft] ! date describ$ 9 subsection 7c71  
any individual describ$ 9 p>agraph 7#b7 
has access to heal? insurance cov]age   
:i* is at lea/ z broad z ! cov]age      
available to ,memb]s ( ,congress &      
congressional /aff 7z def9$ 9 section   
#acab7;d77#c77;,d77 ?r\gh ! ,ex*ange    
op]at+ 9 ! ,di/rict ( ,columbia4 ,su*   
individuals %all be eligible = any      
premium tax cr$it "u section #cf;,b ( ! 
,int]nal ,rev5ue ,code ( #aihf1 r$uc$   
co/ %>+ "u section #adjb1 & advance     

det]m9ation & paym5t ( su* cr$its or su*
 r$uctions "u section #adab to be       
adm9i/]$ by ! ,secret>y1 9 consultation 
) ! ,secret>y ( ! ,treasury & !         
,director ( ! ,(fice ( ,p]sonnel        
,managem5t4 ,! ,di/rict ( ,columbia1 its
 resid5ts1 & small bus9esses %all be    
held h>mless f any increas$ co/s result+
 f ! enactm5t ( ?is section4  7#b7      
,individual describ$ ,an individual     
describ$ 9 ?is p>agraph is any          
individual :o-- 7,a7 is n eligible to   
enroll 9 an employ]-sponsor$ heal? plan 
7exclud+ su* a plan t w\ld n be consid]$
 m9imum ess5tial cov]age due to !       
application ( subp>agraph 7,c7 ( section
 #cf;,b7c77#b7 ( ! ,int]nal ,rev5ue     
,code ( #aihf if su* subp>agraph appli$ 
to su* plan72 &  7,b7 is a bona fide    
resid5t ( any possession ( ! ,unit$     
,/ates 7z det]m9$ "u section #icg7;a7 ( 
su* ,code7 9 :i* ! ,secret>y c]tifies t 
no qualifi$ heal? plan is (f]$ ?r\gh an 
,ex*ange e/abli%$ "u ?is title4  7#c7   
,possession ( ! unit$ /ates ,= purposes 

( ?is section1 ! t]m possession ( !     
,unit$ ,/ates %all include su*          
possessions z are specifi$ 9 section    
#icg7;a77#a7 ( ! ,int]nal ,rev5ue ,code 
( #aihf4  7b7 ,treatm5t ( possessions   
7#a7 ,paym5ts to possessions  7,a7      
,mirror code possession ,! ,secret>y ( !
 ,treasury %all p]iodically 7b n less   
frequ5tly ?an annually7 pay to ea*      
possession ( ! ,unit$ ,/ates ) a mirror 
code tax sy/em am\nts equal to ! loss to
 t possession by reason ( ! application 
( ?is section 7det]m9$ )\t reg>d to     
p>agraph 7#b77 ) respect to taxable ye>s
 beg9n+ aft] ! date describ$ 9          
subsection 7c74 ,su* am\nts %all be     
det]m9$ by ! ,secret>y ( ! ,treasury    
bas$ on in=mation provid$ by ! gov]nm5t 
( ! respective possession4  7,b7 ,o!r   
possessions ,! ,secret>y ( ! ,treasury  
%all p]iodically 7b n less frequ5tly ?an
 annually7 pay to ea* possession ( !    
,unit$ ,/ates :i* does n h a mirror code
 tax sy/em am\nts e/imat$ by ! ,secret>y
 ( ! ,treasury z be+ equal to !         

aggregate b5efits t w\ld h be5 provid$  
to resid5ts ( su* possession by reason (
 ! application ( ?is section = any      
taxable ye>s beg9n+ aft] ! date describ$
 9 subsection 7c7 if a mirror code tax  
sy/em _h be5 9 effect 9 su* possession4 
,! prec$+ s5t5ce %all n apply ) respect 
to any possession ( ! ,unit$ ,/ates     
unless su* possession has a plan1 :i*   
has be5 approv$ by ! ,secret>y ( !      
,treasury1 "u :i* su* possession w      
promptly di/ribute su* paym5ts to !     
resid5ts ( su* possession4  7#b7        
,coord9ation ) cr$it all[$ aga9/ unit$  
/ates income taxes ,no cr$it %all be    
all[$ aga9/ ,unit$ ,/ates income taxes =
 any taxable ye> "u section #cf;,b ( !  
,int]nal ,rev5ue ,code ( #aihf to any   
p]son-- 7,a7 to :om a cr$it is all[$    
aga9/ taxes impos$ by ! possession by   
reason ( ?is section 7det]m9$ )\t reg>d 
to ?is p>agraph7 = su* taxable ye>1 or  
7,b7 :o is eligible = a paym5t "u a plan
 describ$ 9 p>agraph 7#a77;,b7 ) respect
 to su* taxable ye>4  7#c7 ,mirror code 

tax sy/em ,= purposes ( ?is subsection1 
! t]m mirror code tax sy/em means1 )    
respect to any possession ( ! ,unit$    
,/ates1 ! income tax sy/em ( su*        
possession if ! income tax liability ( !
 resid5ts ( su* possession "u su* sy/em 
is det]m9$ by ref]5ce to ! income tax   
laws ( ! ,unit$ ,/ates z if su*         
possession 7 ! ,unit$ ,/ates4  7#d7     
,treatm5t ( paym5ts ,= purposes (       
section #acbd7;b77#b7 ( title #ca1      
,unit$ ,/ates ,code1 or any simil> rule 
( law1 ! paym5ts "u ?is subsection %all 
be treat$ 9 ! same mann] z a refund due 
f ! cr$it all[$ "u section #cf;,b ( !   
,int]nal ,rev5ue ,code ( #aihf4  7c7    
,date describ$ ,! date describ$ 9 ?is   
subsection is ! date on :i* ! ,secret>y 
e/abli%es ! me*anism describ$ 9         
subsection 7a77#a74  4