,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #fege  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #aj1 #bjbe   
,mrs4 ,kiggans ( ,virg9ia 7= h]self1    
,mr4 ,got!im]1 ,mr4 ,lawl]1 ,mr4        
,cuell>1 ,mr4 ,bresnahan1 ,mr4 ,suozzi1 
,mr4 ,mack5zie1 ,ms4 ,lee ( ,nevada1    
,ms4 ,salaz>1 ,mr4 ,l&sman1 ,mr4 ,van   
,drew1 ,mr4 ,case1 ,mr4 ,ciscomani1 ,mr4
 ,co/a1 ,mr4 ,valadao1 ,mr4 ,riley (    
,new ,york1 ,mr4 ,hurd ( ,colorado1 ,ms4
 ,s*olt51 ,mr4 ,bacon1 ,ms4 ,wilson (   
,florida1 ,mr4 ,gim5ez1 ,ms4 ,goodl&]1  
,ms4 ,de ,la ,cruz1 ,mr4 ,soto1 ,mr4    
,la,lota1 ,mr4 ,gray1 ,mr4 ,kiley (     
,cali=nia1 ,mr4 ,vic5te ,gonzalez (     
,texas1 ,mr4 ,kean1 ,mr4 ,figures1 ,mr4 
,fitzpatrick1 ,mr4 ,pappas1 ,mr4        
,licc>do1 ,mr4 ,davis ( ,nor? ,c>ol9a1  
,mr4 ,mosk[itz1 ,mr4 ,panetta1 ,mr4     
,pet]s1 & ,mr4 ,gold5 ( ,ma9e7 introduc$
 ! foll[+ bill2 :i* 0 ref]r$ to !       
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committees on ,ways &    
,means1 & ,rules1 = 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$it1 to am5d !  
,pati5t ,protection & ,af=dable ,c>e    
,act to make c]ta9 adju/m5ts to !       
op]ation ( ! ,ex*anges e/abli%$ "u su*  
,act1 & = o!r purposes4  #a4 ,%ort title
 ,?is ,act may be cit$ z !              
,common,ground = ,af=dable ,heal? ,c>e  
,act4  #b4 ,ext5sion & modification (   
enhanc$ premium tax cr$it  7a7 ,ext5sion
 & modification ( rules to increase     
premium assi/ance am\nts ,section       
#cf;,b7b77#c77;,a77iii7 ( ! ,int]nal    
,rev5ue ,code ( #aihf is am5d$--  7#a7  
by r$esignat+ subclauses 7,i7 & 7,,ii7 z
 items 7aa7 & 7bb71 respectively1 &     
adju/+ ! m>g9s accord+ly1  7#b7 by /rik+
 ,tempor>y p]c5tages = #bjba ?r\gh      
#bjbe4--;,9 ! case ( & ins]t+  ,tempor>y
 p]c5tages = c]ta9 ye>s4-- 7,i7 ,be=e   
#bjbf ,9 ! case (  1 &  7#c7 by add+ at 

! end ! foll[+3  7,,ii7 #bjbf ,9 ! case 
( a taxable ye> beg9n+ aft] ,decemb]    
#ca1 #bjbe1 & be=e ,janu>y #a1 #bjbg--  
7aa7 clause 7ii7 %all n apply = purposes
 ( adju/+ premium p]c5tages "u ?is      
subp>agraph1 &  7bb7 ! 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 premium    
p]c5tage is-,! f9al premium p]c5tage is-
  ,up to #aejj4jj4j #aej up to          
#bjjj4jb4j #bjj up to #bejb4jd4j #bej up
 to #cjjd4jf4j #cjj up to #djjf4jh4e    
#djj up to #fjjh4eh4e #fjj up to        
#ijjh4ei4be #ijj up to #ajjji4beaj4j  4 
7b7 ,ext5sion & modification ( rule to  
all[ cr$it to taxpay]s ^: h\sehold      
income exce$s #djj p]c5t ( pov]ty l9e   
,section #cf;,b7c77#a77;,e7 ( su* ,code 
is am5d$-- 7#a7 by /rik+ ,tempor>y rule 
= #bjba ?r\gh #bjbe4--;,9 ! case ( &    
ins]t+  ,tempor>y rule = c]ta9 ye>s4--  
7i7 ,be=e #bjbf ,9 ! case (  1 &  7#b7  
by add+ at ! end ! foll[+3  7ii7 #bjbf  

,9 ! case ( a taxable ye> beg9n+ aft]   
,decemb] #ca1 #bjbe1 & be=e ,janu>y #a1 
#bjbg1 subp>agraph 7,a7 %all be appli$  
by sub/itut+ b does n exce$ #ajjj p]c5t 
= b does n exce$ #djj p]c5t4  4  7c7    
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ,decemb] #ca1 #bjbe4  #c4   
,gu>drails to prev5t fraud 9 ,ex*anges  
7a7 ,r$uction ( fraudul5t enrollm5t 9   
qualifi$ heal? plans  7#a7 ,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$--  7,a7 9 subp>agraph 7,a7-- 7i7  
by r$esignat+ clause 7ii7 z clause 7iv72
  7ii7 9 clause 7i7-- 7,i7 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 &  7,,ii7 9 !     
second s5t5ce1 by /rik+ ,= purposes &   
ins]t+ ! foll[+3  7iii7 ,def9itions (   
neglig5ce1 disreg>d ,= purposes  2      
7iii7 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$4  2 &    
7iv7 9 clause 7iv7 7z s r$esignat$71 by 
ins]t+ or 7ii7 aft] clause 7i72  7,b7 9 
subp>agraph 7,b7--  7i7 by ins]t+       
includ+ subp>agraph 7,c71 aft] law12    

7ii7 by /rik+ ,any p]son & ins]t+ !     
foll[+3  7i7 ,9 g5]al ,any p]son  2 &   
7iii7 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  7#b7 ,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[+ new p>agraph3  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 #bjbi1 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$-- 7i7
 9 subp>agraph 7,h71 by /rik+ & at !    
end2  7ii7 9 subp>agraph 7,i71 by /rik+ 
! p]iod at ! end & ins]t+ 2 &2 &  7iii7 
by add+ at ! end ! foll[+3  7,j7 report 
to ! ,secret>y ! t]m9ation 7z def9$ 9   
section #acab7;e77#a77;,c77 ( an issu]4 

4  7#c7 ,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    
#bjbi1 ! ,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  7#d7 ,transp>5cy   
,section #acab7;e7 ( ! ,pati5t          

,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjcb7;e771 z am5d$ by       
p>agraph 7#c71 is fur!r am5d$ by add+ at
 ! end ! foll[+ new p>agraphs3  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    
#bjbi1 ! ,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    
7b7 ,removal ( deceas$ individuals f    
,ex*ange plans ,section #acaa7;c7 ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjca7;c771 z am5d$
 by subsection 7a71 is fur!r am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#i7 ,removal ( deceas$ individuals f   
,ex*ange plans  7,a7 ,9 g5]al ,n lat]   
?an #ij days aft] ! date ( ! enactm5t ( 
?is p>agraph1 & on a qu>t]ly basis      
!reaft]1 ! ,secret>y %all conduct a *eck
 ( ! ,dea? ,ma/] ,file 7z su* t]m is    
def9$ 9 section #bjc7;d7 ( ! ,bip>tisan 
,budget ,act ( #bjac7 = purposes (      
id5tify+ individuals enroll$ 9 a        
qualifi$ heal? plan ?r\gh an ,ex*ange :o
 are deceas$4  7,b7 ,process ,!         

,secret>y %all--  7i7 e/abli% a process 
to v]ify t an individual id5tifi$       
pursuant to a *eck describ$ 9           
subp>agraph 7,a7 is deceas$2 &  7ii7    
require an ,ex*ange to t]m9ate su*      
individual's enrollm5t "u a qualifi$    
heal? plan4  4  7c7 ,/&>d ( pro( =      
t]m9at+ ag5ts & brok]s ,section         
#acab7;e7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjcb7;e771 z am5d$ by subsection 7a71 
is fur!r am5d$ by add+ at ! end ! foll[+
 new p>agraph3  7#d7 ,/&>d = t]m9ation =
 c]ta9 ,ex*anges ,9 ! case ( an ag5t or 
brok] ) an agreem5t 9 effect ) an       
,ex*ange op]at$ by ! ,secret>y pursuant 
to section #acba7;c7 to p]=m activities 
describ$ 9 p>agraph 7#a77;,a77i7 )      
respect to su* ,ex*ange1 ! ,secret>y may
 t]m9ate su* agreem5t if ! ,secret>y    
f9ds1 bas$ on a prepond]ance ( !        
evid5ce1 t su* ag5t or brok] has violat$
 su* agreem5t1 o!rwise applicable law1  
or any o!r requirem5t applicable to su* 
ag5t or brok]4  4  7d7 ,requirem5t =    

,ex*ange to notify individuals ( value (
 premium tax cr$its ,section            
#adab7;c77#b7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjhb7;c77#b77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,c7     
,ex*ange responsibilities ,beg9n+       
,janu>y #a1 #bjbg1 if an ,ex*ange is    
notifi$ "u p>agraph 7#a7 ( an advance   
det]m9ation "u section #adaa ) respect  
to ! eligibility ( an individual = a    
premium tax cr$it "u section #cf;,b ( ! 
,int]nal ,rev5ue ,code ( #aihf1 !       
,ex*ange %all1 prior to enroll+ su*     
individual 9 a qualifi$ heal? plan1     
cle>ly notify su* individual ( ! am\nt (
 su* tax cr$it4  4  #d4 ,ext5d+ annual  
op5 enrollm5t p]iod = ,ex*anges = plan  
ye> #bjbf  7a7 ,9 g5]al ,! ,secret>y (  
,heal? & ,human ,s]vices %all revise    
section #aee4daj7;e7 ( title #de1 ,code 
( ,f$]al ,regulations 7or any successor 
regulation7 to provide t ! annual op5   
enrollm5t p]iod det]m9$ = plan ye> #bjbf
 pursuant to section #acaa7;c77#f7 ( !  

,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 %all
 beg9 on ,novemb] #a1 #bjbe1 & end on   
,m>* #ai1 #bjbf4  7b7 ,notification (   
op5 enrollm5t ext5sion ,! ,secret>y (   
,heal? & ,human ,s]vices %all p]=m su*  
outrea* activities z are necess>y to    
in=m qualifi$ individuals 7z def9$ 9    
section #acab7;f77#a7 ( ! ,pati5t       
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjcb7;f77#a777 ( ! ext5d$   
op5 enrollm5t p]iod provid$ = "u        
subsection 7a74  #e4 ,mod]niz+ & ,ensur+
 ,,pbm ,acc\ntability  7a7 ,9 g5]al     
7#a7 ,prescription drug plans ,section  
#ahfj;,d-#ab ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciew-#aab7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7h7 ,requirem5ts relat+ to ph>macy      
b5efit manag]s ,= plan ye>s beg9n+ on or
 aft] ,janu>y #a1 #bjbi3  7#a7          
,agreem5ts ) ph>macy b5efit manag]s ,ea*
 contract ent]$ into ) a ,,pdp sponsor  
"u ?is "p ) respect to a prescription   
drug plan (f]$ by su* sponsor %all      

provide t any ph>macy b5efit manag] act+
 on behalf ( su* sponsor has a writt5   
agreem5t ) ! ,,pdp sponsor "u :i* !     
ph>macy b5efit manag]1 & any affiliates 
( su* ph>macy b5efit manag]1 z          
applicable1 agree to meet ! foll[+      
requirem5ts3 7,a7 ,no income o!r ?an    
bona fide s]vice fees  7i7 ,9 g5]al ,!  
ph>macy b5efit manag] & any affiliate ( 
su* ph>macy b5efit manag] %all n d]ive  
any remun]ation ) respect to any s]vices
 provid$ on behalf ( any entity or      
individual1 9 connection ) ! utilization
 ( cov]$ "p ,d drugs1 f any su* entity  
or individual o!r ?an bona fide s]vice  
fees1 subject to clauses 7ii7 & 7iii74  
7ii7 ,inc5tive paym5ts ,= ! purposes (  
?is subsection1 an inc5tive paym5t 7z   
det]m9$ by ! ,secret>y7 paid by a ,,pdp 
sponsor to a ph>macy b5efit manag] t is 
p]=m+ s]vices on behalf ( su* sponsor   
%all be deem$ a bona fide s]vice fee    
7ev5 if su* paym5t does n o!rwise meet !
 def9ition ( su* t]m "u p>agraph        
7#g77;,b77 if su* paym5t is a flat doll>

 am\nt1 is consi/5t ) fair m>ket value  
7z specifi$ by ! ,secret>y71 is relat$  
to s]vices actually p]=m$ by ! ph>macy  
b5efit manag] or affiliate ( su* ph>macy
 b5efit manag]1 on behalf ( ! ,,pdp     
sponsor mak+ su* paym5t1 9 connection ) 
! utilization ( cov]$ "p ,d drugs1 &    
meets additional requirem5ts1 if any1 z 
det]m9$ appropriate by ! ,secret>y4     
7iii7 ,cl>ification on rebates &        
disc\nts us$ to l[] co/s = cov]$ "p d   
drugs ,rebates1 disc\nts1 & o!r price   
concessions receiv$ by a ph>macy b5efit 
manag] or an affiliate ( a ph>macy      
b5efit manag] f manufactur]s1 ev5 if su*
 price concessions are calculat$ z a    
p]c5tage ( a drug's price1 %all n be    
consid]$ a violation ( ! requirem5ts (  
clause 7i7 if !y are fully pass$ ?r\gh  
to a ,,pdp sponsor & are compliant ) all
 regulatory & subregulatory requirem5ts 
relat$ to direct & indirect remun]ation 
= manufactur] rebates "u ?is "p1 includ+
 9 cases :]e a ,,pdp sponsor is act+ z a
 ph>macy b5efit manag] on behalf ( a    

prescription drug plan (f]$ by su* ,,pdp
 sponsor4  7iv7 ,evaluation (           
remun]ation arrangem5ts ,compon5ts (    
subsets ( remun]ation arrangem5ts 7su* z
 fees or o!r =ms ( comp5sation paid to  
or reta9$ by ! ph>macy b5efit manag] or 
affiliate ( su* ph>macy b5efit manag]71 
z det]m9$ appropriate by ! ,secret>y1   
betwe5 ph>macy b5efit manag]s or        
affiliates ( su* ph>macy b5efit manag]s1
 z applicable1 & o!r entities involv$ 9 
! disp5s+ or utilization ( cov]$ "p ,d  
drugs 7includ+ ,,pdp sponsors1          
manufactur]s1 ph>macies1 & o!r entities 
z det]m9$ appropriate by ! ,secret>y7   
%all be subject to review by !          
,secret>y1 9 consultation ) ! ,(fice ( !
 ,inspector ,g5]al ( ! ,dep>tm5t (      
,heal? & ,human ,s]vices1 z det]m9$     
appropriate by ! ,secret>y4 ,!          
,secret>y1 9 consultation ) ! ,(fice ( !
 ,inspector ,g5]al1 %all review :e!r    
remun]ation "u su* arrangem5ts is       
consi/5t ) fair m>ket value 7z specifi$ 
by ! ,secret>y7 ?r\gh reviews &         

assessm5ts ( su* remun]ation1 z det]m9$ 
appropriate4  7v7 ,disgorgem5t ,!       
ph>macy b5efit manag] %all disgorge any 
remun]ation paid to su* ph>macy b5efit  
manag] or an affiliate ( su* ph>macy    
b5efit manag] 9 violation ( ?is         
subp>agraph to ! ,,pdp sponsor4  7vi7   
,additional requirem5ts ,! ph>macy      
b5efit manag] %all-- 7,i7 ent] into a   
writt5 agreem5t ) any affiliate ( su*   
ph>macy b5efit manag]1 "u :i* !         
affiliate %all id5tify & disgorge any   
remun]ation describ$ 9 clause 7v7 to !  
ph>macy b5efit manag]2 &  7,,ii7 atte/1 
subject to any requirem5ts det]m9$      
appropriate by ! ,secret>y1 t ! ph>macy 
b5efit manag] has ent]$ into a writt5   
agreem5t describ$ 9 subclause 7,i7 ) any
 relevant affiliate ( ! ph>macy b5efit  
manag]4  7,b7 ,transp>5cy reg>d+        
gu>antees & co/ p]=mance evaluations ,! 
ph>macy b5efit manag] %all--  7i7 def9e1
 int]pret1 & apply1 9 a fully transp>5t 
& consi/5t mann] = purposes ( calculat+ 
or o!rwise evaluat+ ph>macy b5efit      

manag] p]=mance aga9/ pric+ gu>antees or
 simil> co/ p]=mance measurem5ts relat$ 
to rebates1 disc\nts1 price concessions1
 or net co/s1 t]ms su* z-- 7,i7 g5]ic   
drug1 9 a mann] consi/5t ) ! def9ition (
 ! t]m "u section #dbc4d ( title #db1   
,code ( ,f$]al ,regulations1 or a       
successor regulation2  7,,ii7 br& "n    
drug1 9 a mann] consi/5t ) ! def9ition (
 ! t]m "u section #dbc4d ( title #db1   
,code ( ,f$]al ,regulations1 or a       
successor regulation2  7,,iii7 specialty
 drug2  7,,iv7 rebate2 &  7,v7 disc\nt2 
7ii7 id5tify any drugs1 claims1 or price
 concessions exclud$ f any pric+        
gu>antee or o!r co/ p]=mance measure 9 a
 cle> & consi/5t mann]2 &  7iii7 :]e a  
pric+ gu>antee or o!r co/ p]=mance      
measure is bas$ on a pric+ b5*m>k o!r   
?an ! :olesale acquisition co/ 7z def9$ 
9 section #ahdg;,a7c77#f77;,b77 ( a     
drug1 calculate & provide a :olesale    
acquisition co/-bas$ equival5t to !     
pric+ gu>antee or o!r co/ p]=mance      
measure4  7,c7 ,provision ( in=mation   

7i7 ,9 g5]al ,n lat] ?an ,july #a ( ea* 
ye>1 beg9n+ 9 #bjbi1 ! ph>macy b5efit   
manag] %all submit to ! ,,pdp sponsor1 &
 to ! ,secret>y1 a report1 9 accordance 
) ?is subp>agraph1 & %all make su*      
report available to su* sponsor at no   
co/ to su* sponsor 9 a =mat specifi$ by 
! ,secret>y "u p>agraph 7#e74 ,ea* su*  
report %all include1 ) respect to su*   
,,pdp sponsor & ea* plan (f]$ by su*    
sponsor1 ! foll[+ in=mation ) respect to
 ! previ\s plan ye>3 7,i7 ,a li/ ( all  
drugs cov]$ by ! plan t 7 disp5s$       
includ+1 ) respect to ea* su* drug--    
7aa7 ! br& "n1 g5]ic or non-propriet>y  
"n1 & ,national ,drug ,code2  7bb7 !    
numb] ( plan enrollees = :om ! drug 0   
disp5s$1 ! total numb] ( prescription   
claims = ! drug 7includ+ orig9al        
prescriptions & refills1 c\nt$ z sep>ate
 claims71 & ! total numb] ( dosage units
 ( ! drug disp5s$2  7cc7 ! numb] (      
prescription claims describ$ 9 item 7bb7
 by ea* type ( disp5s+ *annel ?r\gh :i* 
! drug 0 disp5s$1 includ+ retail1 mail  

ord]1 specialty ph>macy1 long t]m c>e   
ph>macy1 home infusion ph>macy1 or o!r  
types ( ph>macies or provid]s2  7dd7 !  
av]age :olesale acquisition co/1 li/$ z 
co/ p] day's supply1 co/ p] dosage unit1
 & co/ p] typical c\rse ( treatm5t 7z   
applicable72  7ee7 ! av]age :olesale    
price = ! drug1 li/$ z price p] day's   
supply1 price p] dosage unit1 & price p]
 typical c\rse ( treatm5t 7z            
applicable72  7ff7 ! total out-(-pocket 
sp5d+ by plan enrollees on su* drug aft]
 application ( any b5efits "u ! plan1   
includ+ plan enrollee sp5d+ ?r\gh       
copaym5ts1 co9surance1 & d$uctibles2    
7gg7 total rebates paid by ! manufactur]
 on ! drug z report$ "u ! ,detail$ ,,dir
 ,report 7or any successor report7      
submitt$ by su* sponsor to ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices2  7hh7 all   
o!r direct or indirect remun]ation on ! 
drug z report$ "u ! ,detail$ ,,dir      
,report 7or any successor report7       
submitt$ by su* sponsor to ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices2  7ii7 !     

av]age ph>macy reimbursem5t am\nt paid  
by ! plan = ! drug 9 ! aggregate &      
disaggregat$ by disp5s+ *annel id5tifi$ 
9 item 7cc72  7jj7 ! av]age ,national   
,av]age ,drug ,acquisition ,co/         
7,,nadac72 &  7kk7 total                
manufactur]-d]iv$ rev5ue1 inclusive (   
bona fide s]vice fees1 attributable to !
 drug & reta9$ by ! ph>macy b5efit      
manag] & any affiliate ( su* ph>macy    
b5efit manag]4  7,,ii7 ,9 ! case ( a    
ph>macy b5efit manag] t has an affiliate
 t is a retail1 mail ord]1 or specialty 
ph>macy1 ) respect to drugs cov]$ by su*
 plan t 7 disp5s$1 ! foll[+ in=mation3  
7aa7 ,! p]c5tage ( total prescriptions t
 7 disp5s$ by ph>macies t are an        
affiliate ( ! ph>macy b5efit manag] =   
ea* drug4  7bb7 ,! int]qu>tile range ( !
 total comb9$ co/s paid by ! plan & plan
 enrollees1 p] dosage unit1 p] c\rse (  
treatm5t1 p] #cj-;day supply1 & p]      
#ij-;day supply = ea* drug disp5s$ by   
ph>macies t are n an affiliate ( !      
ph>macy b5efit manag] & t are includ$ 9 

! ph>macy network ( su* plan4  7cc7 ,!  
int]qu>tile range ( ! total comb9$ co/s 
paid by ! plan & plan enrollees1 p]     
dosage unit1 p] c\rse ( treatm5t1 p]    
#cj-;day supply1 & p] #ij-;day supply = 
ea* drug disp5s$ by ph>macies t are an  
affiliate ( ! ph>macy b5efit manag] & t 
are includ$ 9 ! ph>macy network ( su*   
plan4  7dd7 ,! l[e/ total comb9$ co/    
paid by ! plan & plan enrollees1 p]     
dosage unit1 p] c\rse ( treatm5t1 p]    
#cj-;day supply1 & p] #ij-;day supply1 =
 ea* drug t is available f any ph>macy  
includ$ 9 ! ph>macy network ( su* plan4 
7ee7 ,! diff]5ce betwe5 ! av]age        
acquisition co/ ( ! affiliate1 su* z a  
ph>macy or o!r entity t acquires        
prescription drugs1 t initially acquires
 ! drug & ! am\nt report$ "u subclause  
7,i77jj7 = ea* drug4  7ff7 ,a li/       
inclusive ( ! br& "n1 g5]ic or          
non-propriet>y "n1 & ,national ,drug    
,code ( cov]$ "p ,d drugs subject to an 
agreem5t ) a cov]$ entity "u section    
#cdj;,b ( ! ,public ,heal? ,s]vice ,act 

= :i* ! ph>macy b5efit manag] or an     
affiliate ( ! ph>macy b5efit manag] _h a
 contract or o!r arrangem5t ) su* a     
cov]$ entity 9 ! s]vice area ( su* plan4
  7,,iii7 ,:]e a drug approv$ "u section
 #eje7;c7 ( ! ,f$]al ,food1 ,drug1 &    
,cosmetic ,act 7ref]r$ to 9 ?is         
subclause z ! li/$ drug7 is cov]$ by !  
plan1 ! foll[+ in=mation3 7aa7 ,a li/ ( 
curr5tly m>ket$ g5]ic drugs approv$ "u  
section #eje7;j7 ( ! ,f$]al ,food1      
,drug1 & ,cosmetic ,act pursuant to an  
application t ref]5ces su* li/$ drug t  
are n cov]$ by ! plan1 are cov]$ on !   
same =mul>y ti] or a =mul>y ti]         
typically associat$ ) high] co/-%>+ ?an 
! li/$ drug1 or are subject to          
utilization managem5t t ! li/$ drug is n
 subject to4  7bb7 ,! e/imat$ av]age    
b5efici>y co/-%>+ "u ! plan = a #cj-;day
 supply ( ! li/$ drug4  7cc7 ,:]e a     
g5]ic drug li/$ "u item 7aa7 is on a    
=mul>y ti] typically associat$ ) high]  
co/-%>+ ?an ! li/$ drug1 ! e/imat$      
av]age co/-%>+ t a b5efici>y w\ld h paid

 = a #cj-;day supply ( ea* ( ! g5]ic    
drugs describ$ 9 item 7aa71 _h ! plan   
provid$ cov]age = su* drugs on ! same   
=mul>y ti] z ! li/$ drug4  7dd7 ,a      
writt5 ju/ification = provid+ m         
favorable cov]age ( ! li/$ drug ?an !   
g5]ic drugs describ$ 9 item 7aa74  7ee7 
,! numb] ( curr5tly m>ket$ g5]ic drugs  
approv$ "u section #eje7;j7 ( ! ,f$]al  
,food1 ,drug1 & ,cosmetic ,act pursuant 
to an application t ref]5ces su* li/$   
drug4  7,,iv7 ,:]e a ref]5ce product 7z 
def9$ 9 section #cea7;i7 ( ! ,public    
,heal? ,s]vice ,act7 is cov]$ by ! plan1
 ! foll[+ in=mation3 7aa7 ,a li/ (      
curr5tly m>ket$ biosimil> biological    
products lic5s$ "u section #cea7k7 ( !  
,public ,heal? ,s]vice ,act pursuant to 
an application t ref]s to su* ref]5ce   
product t are n cov]$ by ! plan1 are    
cov]$ on ! same =mul>y ti] or a =mul>y  
ti] typically associat$ ) high] co/-%>+ 
?an ! ref]5ce product1 or are subject to
 utilization managem5t t ! ref]5ce      
product is n subject to4  7bb7 ,!       

e/imat$ av]age b5efici>y co/-%>+ "u !   
plan = a #cj-;day supply ( ! ref]5ce    
product4  7cc7 ,:]e a biosimil>         
biological product li/$ "u item 7aa7 is 
on a =mul>y ti] typically associat$ )   
high] co/-%>+ ?an ! ref]5ce product1 !  
e/imat$ av]age co/-%>+ t a b5efici>y    
w\ld h paid = a #cj-;day supply ( ea* ( 
! biosimil> biological products describ$
 9 item 7aa71 _h ! plan provid$ cov]age 
= su* products on ! same =mul>y ti] z ! 
ref]5ce product4  7dd7 ,a writt5        
ju/ification = provid+ m favorable      
cov]age ( ! ref]5ce product ?an !       
biosimil> biological product describ$ 9 
item 7aa74  7ee7 ,! numb] ( curr5tly    
m>ket$ biosimil> biological products    
lic5s$ "u section #cea7k7 ( ! ,public   
,heal? ,s]vice ,act1 pursuant to an     
application t ref]s to su* ref]5ce      
product4  7,v7 ,total gross sp5d+ on    
cov]$ "p ,d drugs by ! plan1 n net (    
rebates1 fees1 disc\nts1 or o!r direct  
or indirect remun]ation4  7,,vi7 ,!     
total am\nt reta9$ by ! ph>macy b5efit  

manag] or an affiliate ( su* ph>macy    
b5efit manag] 9 rev5ue relat$ to        
utilization ( cov]$ "p ,d drugs "u t    
plan1 inclusive ( bona fide s]vice fees4
  7,,vii7 ,! total sp5d+ on cov]$ "p ,d 
drugs net ( rebates1 fees1 disc\nts1 or 
o!r direct & indirect remun]ation by !  
plan4  7,,viii7 ,an explanation ( any   
b5efit design p>amet]s "u su* plan t    
enc\rage plan enrollees to fill         
prescriptions at ph>macies t are an     
affiliate ( su* ph>macy b5efit manag]1  
su* z mail & specialty home deliv]y     
programs1 & retail & mail auto-refill   
programs4  7,,ix7 ,! foll[+ in=mation3  
7aa7 ,a li/ ( all brok]s1 consultants1  
advisors1 & auditors t receive          
comp5sation f ! ph>macy b5efit manag] or
 an affiliate ( su* ph>macy b5efit      
manag] = ref]rals1 consult+1 audit+1 or 
o!r s]vices (f]$ to ,,pdp sponsors      
relat$ to ph>macy b5efit managem5t      
s]vices4  7bb7 ,! am\nt ( comp5sation   
provid$ by su* ph>macy b5efit manag] or 
affiliate to ea* su* brok]1 consultant1 

advisor1 & auditor4  7cc7 ,! me?odology 
= calculat+ ! am\nt ( comp5sation       
provid$ by su* ph>macy b5efit manag] or 
affiliate1 = ea* su* brok]1 consultant1 
advisor1 & auditor4  7,x7 ,a li/ ( all  
affiliates ( ! ph>macy b5efit manag]4   
7,,xi7 ,a summ>y docum5t submitt$ 9 a   
/&>diz$ template develop$ by ! ,secret>y
 t includes su* in=mation describ$ 9    
subclauses 7,i7 ?r\gh 7,x74  7ii7       
,writt5 explanation ( contracts or      
agreem5ts ) drug manufactur]s  7,i7 ,9  
g5]al ,! ph>macy b5efit manag] %all1 n  
lat] ?an #cj days aft] ! f9alization (  
any contract or agreem5t betwe5 su*     
ph>macy b5efit manag] or an affiliate ( 
su* ph>macy b5efit manag] & a drug      
manufactur] 7or subsidi>y1 ag5t1 or     
entity affiliat$ ) su* drug manufactur]7
 t makes rebates1 disc\nts1 paym5ts1 or 
o!r f9ancial inc5tives relat$ to "o or m
 cov]$ "p ,d drugs or o!r prescription  
drugs1 z applicable1 ( ! manufactur]    
directly or indirectly cont+5t ^u       
cov]age1 =mul>y placem5t1 or utilization

 managem5t conditions on any o!r cov]$  
"p ,d drugs or o!r prescription drugs1 z
 applicable1 submit to ! ,,pdp sponsor a
 writt5 explanation ( su* contract or   
agreem5t4  7,,ii7 ,requirem5ts ,a writt5
 explanation "u subclause 7,i7 %all--   
7aa7 include ! manufactur] subject to ! 
contract or agreem5t1 all cov]$ "p ,d   
drugs & o!r prescription drugs1 z       
applicable1 subject to ! contract or    
agreem5t & ! manufactur]s ( su* drugs1 &
 a high-level description ( ! t]ms ( su*
 contract or agreem5t & h[ su* t]ms     
apply to su* drugs2 &  7bb7 be c]tifi$  
by ! ,*ief ,executive ,(fic]1 ,*ief     
,f9ancial ,(fic]1 or ,g5]al ,c\nsel (   
su* ph>macy b5efit manag]1 or affiliate 
( su* ph>macy b5efit manag]1 z          
applicable1 or an individual delegat$ ) 
! au?ority to sign on behalf ( "o ( ^!  
(fic]s1 :o reports directly to ! (fic]4 
7,,iii7 ,def9ition ( o!r prescription   
drugs ,= purposes ( ?is clause1 ! t]m   
o!r prescription drugs means            
prescription drugs cov]$ z supplem5tal  

b5efits "u ?is "p or prescription drugs 
paid outside ( ?is "p4  7,d7 ,audit     
rights  7i7 ,9 g5]al ,n less ?an once a 
ye>1 at ! reque/ ( ! ,,pdp sponsor1 !   
ph>macy b5efit manag] %all all[ = an    
audit ( ! ph>macy b5efit manag] to      
ensure compliance ) all t]ms &          
conditions "u ! writt5 agreem5t describ$
 9 ?is p>agraph & ! accuracy ( in=mation
 report$ "u subp>agraph 7,c74  7ii7     
,auditor ,! ,,pdp sponsor %all h ! "r to
 select an auditor4 ,! ph>macy b5efit   
manag] %all n impose any limitations on 
! selection ( su* auditor4  7iii7       
,provision ( in=mation ,! ph>macy b5efit
 manag] %all make available to su*      
auditor all records1 data1 contracts1 & 
o!r in=mation necess>y to confirm !     
accuracy ( in=mation provid$ "u         
subp>agraph 7,c71 subject to reasonable 
re/rictions on h[ su* in=mation mu/ be  
report$ to prev5t r$isclosure ( su*     
in=mation4  7iv7 ,tim+ ,! ph>macy b5efit
 manag] mu/ provide in=mation "u clause 
7iii7 & o!r in=mation1 data1 & records  

relevant to ! audit to su* auditor )9 #f
 mon?s ( ! initiation ( ! audit &       
respond to reque/s = additional         
in=mation f su* auditor )9 #cj days aft]
 ! reque/ = additional in=mation4  7v7  
,in=mation f affiliates ,! ph>macy      
b5efit manag] %all be responsible =     
provid+ to su* auditor in=mation requir$
 to be report$ "u subp>agraph 7,c7 or "u
 clause 7iii7 ( ?is subp>agraph t is    
own$ or held by an affiliate ( su*      
ph>macy b5efit manag]4  7#b7 ,en=cem5t  
7,a7 ,9 g5]al ,ea* ,,pdp sponsor %all-- 
7i7 disgorge to ! ,secret>y any am\nts  
disgorg$ to ! ,,pdp sponsor by a ph>macy
 b5efit manag] "u p>agraph 7#a77;,a77v72
  7ii7 require1 9 a writt5 agreem5t )   
any ph>macy b5efit manag] act+ on behalf
 ( su* sponsor or affiliate ( su*       
ph>macy b5efit manag]1 t su* ph>macy    
b5efit manag] or affiliate reimburse !  
,,pdp sponsor = any civil money p5alty  
impos$ on ! ,,pdp sponsor z a result ( !
 failure ( ! ph>macy b5efit manag] or   
affiliate to meet ! requirem5ts (       

p>agraph 7#a7 t are applicable to !     
ph>macy b5efit manag] or affiliate "u ! 
agreem5t2 &  7iii7 require1 9 a writt5  
agreem5t ) any su* ph>macy b5efit manag]
 act+ on behalf ( su* sponsor or        
affiliate ( su* ph>macy b5efit manag]1 t
 su* ph>macy b5efit manag] or affiliate 
be subject to punitive rem$ies = brea* (
 contract = failure to comply ) !       
requirem5ts applicable "u p>agraph 7#a74
  7,b7 ,report+ ( alleg$ violations ,!  
,secret>y %all make available & ma9ta9 a
 me*anism = manufactur]s1 ,,pdp         
sponsors1 ph>macies1 & o!r entities t h 
contractual relation%ips ) ph>macy      
b5efit manag]s or affiliates ( su*      
ph>macy b5efit manag]s to report1 on a  
confid5tial basis1 alleg$ violations (  
p>agraph 7#a77;,a7 or subp>agraph 7,c74 
7,c7 ,anti-retaliation & anti-co]cion   
,consi/5t ) applicable ,f$]al or ,/ate  
law1 a ,,pdp sponsor %all n--  7i7      
retaliate aga9/ an individual or entity 
= report+ an alleg$ violation "u        
subp>agraph 7,b72 or  7ii7 co]ce1       

intimidate1 ?reat51 or int]f]e ) !      
ability ( an individual or entity to    
report any su* alleg$ violations4  7#c7 
,c]tification ( compliance  7,a7 ,9     
g5]al ,ea* ,,pdp sponsor %all furni% to 
! ,secret>y 7at a "t & 9 a mann]        
specifi$ by ! ,secret>y7 an annual      
c]tification ( compliance ) ?is         
subsection1 z well z su* in=mation z !  
,secret>y det]m9es necess>y to c>ry out 
?is subsection4  7,b7 ,implem5tation    
,not)/&+ any o!r provision ( law1 !     
,secret>y may implem5t ?is p>agraph by  
program in/ruction or o!rwise4  7#d7    
,rule ( con/ruction ,no?+ 9 ?is         
subsection %all be con/ru$ z-- 7,a7     
prohibit+ flat disp5s+ fees or          
reimbursem5t or paym5t = +r$i5t co/s    
7includ+ cu/om>y1 indu/ry-/&>d disc\nts 
directly relat$ to drug acquisition t   
are reta9$ by ph>macies or :olesal]s7 to
 entities t acquire or disp5se          
prescription drugs2 or  7,b7 modify+    
regulatory requirem5ts or sub-regulatory
 program in/ruction or guidance relat$  

to ph>macy paym5t1 reimbursem5t1 or     
disp5s+ fees4  7#e7 ,/&>d =mats  7,a7 ,9
 g5]al ,n lat] ?an ,june #a1 #bjbh1 !   
,secret>y %all specify /&>d1            
ma*9e-readable =mats = ph>macy b5efit   
manag]s to submit annual reports requir$
 "u p>agraph 7#a77;,c77i74  7,b7        
,implem5tation ,not)/&+ any o!r         
provision ( law1 ! ,secret>y may        
implem5t ?is p>agraph by program        
in/ruction or o!rwise4  7#f7            
,confid5tiality  7,a7 ,9 g5]al          
,in=mation disclos$ by a ph>macy b5efit 
manag]1 an affiliate ( a ph>macy b5efit 
manag]1 a ,,pdp sponsor1 or a ph>macy "u
 ?is subsection t is n o!rwise publicly 
available or available = pur*ase %all n 
be disclos$ by ! ,secret>y or a ,,pdp   
sponsor receiv+ ! in=mation1 except t ! 
,secret>y may disclose ! in=mation = !  
foll[+ purposes3  7i7 ,z ! ,secret>y    
det]m9es necess>y to c>ry out ?is "p4   
7ii7 ,to p]mit ! ,comptroll] ,g5]al to  
review ! in=mation provid$4  7iii7 ,to  
p]mit ! ,director ( ! ,congressional    

,budget ,(fice to review ! in=mation    
provid$4  7iv7 ,to p]mit ! ,executive   
,director ( ! ,m$ic>e ,paym5t ,advisory 
,commission to review ! in=mation       
provid$4  7v7 ,to ! ,attorney ,g5]al = !
 purposes ( conduct+ ov]sight & en=cem5t
 "u ?is title4  7vi7 ,to ! ,inspector   
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices 9 accordance ) its au?orities  
"u ! ,inspector ,g5]al ,act ( #aigh     
7section #djf ( title #e1 ,unit$ ,/ates 
,code71 & o!r applicable /atutes4  7,b7 
,re/riction on use ( in=mation ,!       
,secret>y1 ! ,comptroll] ,g5]al1 !      
,director ( ! ,congressional ,budget    
,(fice1 & ! ,executive ,director ( !    
,m$ic>e ,paym5t ,advisory ,commission   
%all n report on or disclose in=mation  
disclos$ pursuant to subp>agraph 7,a7 to
 ! public 9 a mann] t w\ld id5tify-- 7i7
 a specific ph>macy b5efit manag]1      
affiliate1 ph>macy1 manufactur]1        
:olesal]1 ,,pdp sponsor1 or plan2 or    
7ii7 contract prices1 rebates1 disc\nts1
 or o!r remun]ation = specific drugs 9 a

 mann] t may all[ ! id5tification (     
specific contract+ p>ties or ( su*      
specific drugs4  7#g7 ,def9itions ,=    
purposes ( ?is subsection3  7,a7        
,affiliate ,! t]m affiliate means1 )    
respect to any ph>macy b5efit manag] or 
,,pdp sponsor1 any entity t1 directly or
 indirectly-- 7i7 owns or is own$ by1   
controls or is controll$ by1 or is      
o!rwise relat$ 9 any own]%ip /ructure to
 su* ph>macy b5efit manag] or ,,pdp     
sponsor2 or  7ii7 acts z a contractor1  
pr9cipal1 or ag5t to su* ph>macy b5efit 
manag] or ,,pdp sponsor1 ins(> z su*    
contractor1 pr9cipal1 or ag5t p]=ms any 
( ! functions describ$ "u subp>agraph   
7,c74  7,b7 ,bona fide s]vice fee ,! t]m
 bona fide s]vice fee means a fee t is  
reflective ( ! fair m>ket value 7z      
specifi$ by ! ,secret>y1 ?r\gh notice & 
comm5t rulemak+7 = a bona fide1 itemiz$ 
s]vice actually p]=m$ on behalf ( an    
entity1 t ! entity w\ld o!rwise p]=m 7or
 contract =7 9 ! abs5ce ( ! s]vice      
arrangem5t & t is n pass$ on 9 :ole or 9

 "p to a cli5t or cu/om]1 :e!r or n !   
entity takes title to ! drug4 ,su* fee  
mu/ be a flat doll> am\nt & %all n be   
directly or indirectly bas$ on1 or      
cont+5t ^u--  7i7 drug price1 su* z     
:olesale acquisition co/ or drug b5*m>k 
price 7su* z av]age :olesale price72    
7ii7 ! am\nt ( disc\nts1 rebates1 fees1 
or o!r direct or indirect remun]ation ) 
respect to cov]$ "p ,d drugs disp5s$ to 
enrollees 9 a prescription drug plan1   
except z p]mitt$ pursuant to p>agraph   
7#a77;,a77ii72  7iii7 cov]age or =mul>y 
placem5t decisions or ! volume or value 
( any ref]rals or bus9ess g5]at$ betwe5 
! p>ties to ! arrangem5t2 or  7iv7 any  
o!r am\nts or me?odologies prohibit$ by 
! ,secret>y4  7,c7 ,ph>macy b5efit      
manag] ,! t]m ph>macy b5efit manag]     
means any p]son or entity t1 ei!r       
directly or ?r\gh an int]m$i>y1 acts z a
 price negotiator or gr\p pur*as] on    
behalf ( a ,,pdp sponsor or prescription
 drug plan1 or manages ! prescription   
drug b5efits provid$ by su* sponsor or  

plan1 includ+ ! process+ & paym5t (     
claims = prescription drugs1 ! p]=mance 
( drug utilization review1 ! process+ ( 
drug prior au?orization reque/s1 !      
adjudication ( appeals or grievances    
relat$ to ! prescription drug b5efit1   
contract+ ) network ph>macies1 controll+
 ! co/ ( cov]$ "p ,d drugs1 or !        
provision ( relat$ s]vices4 ,su* t]m    
includes any p]son or entity t c>ries   
out "o or m ( ! activities describ$ 9 ! 
prec$+ s5t5ce1 irrespective ( :e!r su*  
p]son or entity calls itself a ph>macy  
b5efit manag]4  4  7#b7 ,,ma-,,pd plans 
,section #aheg7;f77#c7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#bg7;f77#c77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,f7   
,requirem5ts relat+ to ph>macy b5efit   
manag]s ,= plan ye>s beg9n+ on or aft]  
,janu>y #a1 #bjbi1 section              
#ahfj;,d-#ab7;h74  4  7#c7              
,nonapplication ( ,pap]work ,r$uction   
,act ,*apt] #ce ( title #dd1 ,unit$     
,/ates ,code1 %all n apply to !         

implem5tation ( ?is subsection4  7#d7   
,fund+  7,a7 ,secret>y ,9 addition to   
am\nts o!rwise available1 !re is        
appropriat$ to ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt1 out ( any money 9 ! ,treasury n
 o!rwise appropriat$1 #aac1jjj1jjj =    
fiscal ye> #bjbf1 to rema9 available    
until exp5d$1 to c>ry out ?is           
subsection4  7,b7 ,,oig ,9 addition to  
am\nts o!rwise available1 !re is        
appropriat$ to ! ,inspector ,g5]al ( !  
,dep>tm5t ( ,heal? & ,human ,s]vices1   
out ( any money 9 ! ,treasury n o!rwise 
appropriat$1 #bj1jjj1jjj = fiscal ye>   
#bjbf1 to rema9 available until exp5d$1 
to c>ry out ?is subsection4  7b7 ,,gao  
,/udy & ,report on ,price-,relat$       
,comp5sation ,across ! ,supply ,*a9     
7#a7 ,/udy ,! ,comptroll] ,g5]al ( !    
,unit$ ,/ates 79 ?is subsection ref]r$  
to z ! ,comptroll] ,g5]al7 %all conduct 
a /udy describ+ ! use ( comp5sation &   
paym5t /ructures relat$ to a            
prescription drug's price )9 ! retail   

prescription drug supply *a9 9 "p ,d (  
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#aja et seq474   
,su* /udy %all summ>ize in=mation f     
,f$]al ag5cies & indu/ry exp]ts1 to !   
ext5t available1 ) respect to ! foll[+3 
7,a7 ,! type1 magnitude1 o!r features   
7su* z ! pric+ b5*m>ks us$71 & preval5ce
 ( comp5sation & paym5t /ructures relat$
 to a prescription drug's price1 su* z  
calculat+ fee am\nts z a p]c5tage ( a   
prescription drug's price1 betwe5       
int]m$i>ies 9 ! prescription drug supply
 *a91 includ+--  7i7 ph>macy b5efit     
manag]s2  7ii7 ,,pdp sponsors (f]+      
prescription drug plans & ,m$ic>e       
,advantage organizations (f]+ ,,ma-,,pd 
plans2  7iii7 drug :olesal]s2  7iv7     
ph>macies2  7v7 manufactur]s2  7vi7     
ph>macy s]vices adm9i/rative            
organizations2  7vii7 brok]s1 auditors1 
consultants1 & o!r entities t-- 7,i7    
advise ,,pdp sponsors (f]+ prescription 
drug plans & ,m$ic>e ,advantage         
organizations (f]+ ,,ma-,,pd plans      

reg>d+ ph>macy b5efits2 or  7,,ii7      
review ,,pdp sponsor & ,m$ic>e          
,advantage organization contracts )     
ph>macy b5efit manag]s2 &  7viii7 o!r   
s]vice provid]s t contract ) any ( !    
entities describ$ 9 clauses 7i7 ?r\gh   
7vii7 t may use price-relat$ comp5sation
 & paym5t /ructures1 su* z rebate       
aggregators 7or o!r entities t negotiate
 or process price concessions on behalf 
( ph>macy b5efit manag]s1 plan sponsors1
 or ph>macies74  7,b7 ,! prim>y bus9ess 
models & comp5sation /ructures = ea*    
category ( int]m$i>y describ$ 9         
subp>agraph 7,a74  7,c7 ,v>iation 9     
price-relat$ comp5sation /ructures      
betwe5 affiliat$ entities 7su* z        
entities ) common own]%ip1 ei!r full or 
p>tial1 & subsidi>y relation%ips7 &     
unaffiliat$ entities4  7,d7 ,pot5tial   
conflicts ( int]e/ among contract+      
entities relat$ to ! use ( prescription 
drug price-relat$ comp5sation /ructures1
 su* z ! pot5tial = fees or o!r paym5ts 
set z a p]c5tage ( a prescription drug's

 price to advantage =mul>y selection1   
di/ribution1 or pur*as+ ( prescription  
drugs ) high] prices4  7,e7 ,notable    
diff]5ces1 if any1 9 ! use & level (    
price-bas$ comp5sation /ructures ov] "t 
& betwe5 diff]5t m>ket segm5ts1 su* z "u
 "p ,d ( title ,,xviii ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#aja et seq47 & ! ,m$icaid       
program "u title ,,xix ( su* ,act 7#db  
,u4,s4,c4 #acif et seq474  7,f7 ,!      
effects ( drug price-relat$ comp5sation 
/ructures & alt]native comp5sation      
/ructures on ,f$]al heal? c>e programs &
 program b5efici>ies1 includ+ ) respect 
to co/-%>+1 premiums1 ,f$]al outlays1   
biosimil> & g5]ic drug adoption &       
utilization1 drug %ortage risks1 & !    
pot5tial = fees set z a p]c5tage ( a    
drug's price to advantage ! =mul>y      
selection1 di/ribution1 or pur*as+ (    
drugs ) high] prices4  7,g7 ,o!r issues 
det]m9$ to be relevant & appropriate by 
! ,comptroll] ,g5]al4  7#b7 ,report ,n  
lat] ?an #b ye>s aft] ! date ( enactm5t 

( ?is section1 ! ,comptroll] ,g5]al %all
 submit to ,congress a report conta9+ ! 
results ( ! /udy conduct$ "u p>agraph   
7#a71 toge!r ) recomm5dations = su*     
legislation & adm9i/rative action z !   
,comptroll] ,g5]al det]m9es appropriate4
  7c7 ,med,p,a,c reports on agreem5ts ) 
ph>macy b5efit manag]s ) respect to     
prescription drug plans & ,,ma-,,pd     
plans  7#a7 ,9 g5]al ,! ,m$ic>e ,paym5t 
,advisory ,commission %all submit to    
,congress ! foll[+ reports3  7,a7       
,initial report ,n lat] ?an ! fir/ ,m>* 
#ae occurr+ aft] ! date t is #b ye>s    
aft] ! date on :i* ! ,secret>y makes !  
data available to ! ,commission1 a      
report reg>d+ agreem5ts ) ph>macy b5efit
 manag]s ) respect to prescription drug 
plans & ,,ma-,,pd plans4 ,su* report    
%all include1 to ! ext5t practicable--  
7i7 a description ( tr5ds & patt]ns1    
includ+ relevant av]ages1 totals1 & o!r 
figures = ! types ( in=mation submitt$2 
7ii7 an analysis ( any diff]5ces 9      
agreem5ts & _! effects on plan enrollee 

out-(-pocket sp5d+ & av]age ph>macy     
reimbursem5t1 & o!r impacts2 &  7iii7   
any recomm5dations ! ,commission        
det]m9es appropriate4  7,b7 ,f9al report
 ,n lat] ?an #b ye>s aft] ! date on :i* 
! ,commission submits ! initial report  
"u subp>agraph 7,a71 a report describ+  
any *anges ) respect to ! in=mation     
describ$ 9 subp>agraph 7,a7 ov] "t1     
toge!r ) any recomm5dations !           
,commission det]m9es appropriate4  7#b7 
,fund+ ,9 addition to am\nts o!rwise    
available1 !re is appropriat$ to !      
,m$ic>e ,paym5t ,advisory ,commission1  
out ( any money 9 ! ,treasury n o!rwise 
appropriat$1 #a1jjj1jjj = fiscal ye>    
#bjbf1 to rema9 available until exp5d$1 
to c>ry out ?is subsection4  #f4        
,exp$it$ consid]ation ( enhanc$ premium 
tax cr$it re=m bill  7a7 ,qualify+      
legislation  7#a7 ,9 g5]al ,only an     
enhanc$ premium tax cr$it re=m bill %all
 be entitl$ to exp$it$ consid]ation "u  
?is section4  7#b7 ,def9ition ,9 ?is    
section1 ! t]m enhanc$ premium tax cr$it

 re=m bill means a bill or jo9t         
resolution :i* consi/s solely (         
legislative language ) respect to       
cont9u$ heal? insurance premium sav+s1  
includ+ m significant re=ms1 t has      
accumulat$ at lea/ #aj cosponsors f ea* 
( ! majority p>ty & ! m9ority p>ty at ! 
"t x is (f]$4  7b7 ,consid]ation 9 !    
,h\se ( ,repres5tatives  7#a7 ,ref]ral &
 report+ ,any committee ( ! ,h\se (     
,repres5tatives to :i* an enhanc$       
premium tax cr$it re=m bill is ref]r$   
%all report ! enhanc$ premium tax cr$it 
re=m bill to ! ,h\se ( ,repres5tatives  
)\t am5dm5t n lat] ?an #e legislative   
days aft] ! date on :i* ! enhanc$       
premium tax cr$it re=m bill 0 s ref]r$4 
,if a committee ( ! ,h\se (             
,repres5tatives fails to report an      
enhanc$ premium tax cr$it re=m bill )9 t
 p]iod1 t committee %all be             
automatically dis*>g$ f consid]ation ( !
 enhanc$ premium tax cr$it re=m bill1 & 
! enhanc$ premium tax cr$it re=m bill   
%all be plac$ on ! appropriate cal5d>4  

7#b7 ,proce$+ to consid]ation ,aft] !   
la/ committee au?oriz$ to consid] an    
enhanc$ premium tax cr$it re=m bill     
reports x to ! ,h\se ( ,repres5tatives  
or has be5 dis*>g$ f its consid]ation1 x
 %all be 9 ord] to move to proce$ to    
consid] ! enhanc$ premium tax cr$it re=m
 bill 9 ! ,h\se ( ,repres5tatives4 ,su* 
a motion %all n be 9 ord] aft] ! ,h\se (
 ,repres5tatives has dispos$ ( a motion 
to proce$ ) respect to ! enhanc$ premium
 tax cr$it re=m bill4 ,! previ\s "q %all
 be consid]$ z ord]$ on ! motion to its 
adoption )\t int]v5+ motion4 ,! motion  
%all n be debatable4 ,a motion to       
reconsid] ! vote by :i* ! motion is     
dispos$ ( %all n be 9 ord]4  7#c7 ,vote 
on passage ,! vote on passage ( !       
enhanc$ premium tax cr$it re=m bill %all
 occur n lat] ?an #c legislative days   
aft] ! date on :i* ! la/ committee      
au?oriz$ to consid] ! enhanc$ premium   
tax cr$it re=m bill reports x to ! ,h\se
 ( ,repres5tatives or is dis*>g$4  7c7  
,exp$it$ proc$ure 9 ! ,s5ate  7#a7      

,committee consid]ation ,an enhanc$     
premium tax cr$it re=m bill introduc$ 9 
! ,s5ate %all be jo9tly ref]r$ to !     
committee or committees ( jurisdiction1 
:i* committees %all report ! enhanc$    
premium tax cr$it re=m bill )\t any     
revision & ) a favorable recomm5dation1 
an unfavorable recomm5dation1 or )\t    
recomm5dation1 n lat] ?an #e session    
days aft] ! date on :i* ! enhanc$       
premium tax cr$it re=m bill 0 s ref]r$4 
,if any committee to :i* an enhanc$     
premium tax cr$it re=m bill is ref]r$   
fails to report ! enhanc$ premium tax   
cr$it re=m bill )9 t p]iod1 t committee 
%all be automatically dis*>g$ f         
consid]ation ( ! enhanc$ premium tax    
cr$it re=m bill1 & ! enhanc$ premium tax
 cr$it re=m bill %all be plac$ on !     
appropriate cal5d>4  7#b7 ,proce$+      
,not)/&+ rule ,,xxii ( ! ,/&+ ,rules ( !
 ,s5ate1 x is 9 ord]1 n lat] ?an #b days
 ( session aft] ! date on :i* an enhanc$
 premium tax cr$it re=m bill is report$ 
or dis*>g$ f all committees to :i* !    

enhanc$ premium tax cr$it re=m bill 0   
ref]r$1 = ! majority lead] ( ! ,s5ate or
 ! designee ( ! majority lead] to move  
to proce$ to ! consid]ation ( ! enhanc$ 
premium tax cr$it re=m bill4 ,x %all    
also be 9 ord] = any ,memb] ( ! ,s5ate  
to move to proce$ to ! consid]ation ( ! 
enhanc$ premium tax cr$it re=m bill at  
any "t aft] ! conclusion ( su* #b-;day  
p]iod4 ,a motion to proce$ is 9 ord] ev5
 ?\gh a previ\s motion to ! same effect 
has be5 disagre$ to4 ,all po9ts ( ord]  
aga9/ ! motion to proce$ to ! enhanc$   
premium tax cr$it re=m bill are waiv$4  
,! motion to proce$ is n debatable4 ,!  
motion is n subject to a motion to      
po/pone4 ,a motion to reconsid] ! vote  
by :i* ! motion is agre$ to or disagre$ 
to %all n be 9 ord]4 ,if a motion to    
proce$ to ! consid]ation ( ! enhanc$    
premium tax cr$it re=m bill is agre$ to1
 ! enhanc$ premium tax cr$it re=m bill  
%all rema9 ! unf9i%$ bus9ess until      
dispos$ (4 ,all po9ts ( ord] aga9/ an   
enhanc$ premium tax cr$it re=m bill &   

aga9/ consid]ation ( ! enhanc$ premium  
tax cr$it re=m bill are waiv$4  7d7     
,consid]ation by ! o!r ,h\se  7#a7 ,9   
g5]al ,if1 be=e pass+ an enhanc$ premium
 tax cr$it re=m bill1 a ,h\se receives f
 ! o!r ,h\se an enhanc$ premium tax     
cr$it re=m bill ( ! o!r ,h\se--  7,a7 ! 
enhanc$ premium tax cr$it re=m bill ( ! 
o!r ,h\se %all n be ref]r$ to a         
committee2 &  7,b7 ! proc$ure 9 !       
receiv+ ,h\se %all be ! same z if no    
enhanc$ premium tax cr$it re=m bill _h  
be5 receiv$ f ! o!r ,h\se until ! vote  
on passage1 :5 ! enhanc$ premium tax    
cr$it re=m bill receiv$ f ! o!r ,h\se   
%all supplant ! enhanc$ premium tax     
cr$it re=m bill ( ! receiv+ ,h\se4  7#b7
 ,rev5ue measures ,?is subsection %all n
 apply to ! ,h\se ( ,repres5tatives if  
an enhanc$ premium tax cr$it re=m bill  
receiv$ f ! ,s5ate is a rev5ue measure4 
7e7 ,rules to coord9ate action ) o!r    
,h\se  7#a7 ,treatm5t ( enhanc$ premium 
tax cr$it re=m bill ( o!r ,h\se ,if an  
enhanc$ premium tax cr$it re=m bill is n

 introduc$ 9 ! ,s5ate or ! ,s5ate fails 
to consid] an enhanc$ premium tax cr$it 
re=m bill "u ?is section1 ! enhanc$     
premium tax cr$it re=m bill ( ! ,h\se ( 
,repres5tatives %all be entitl$ to      
exp$it$ floor proc$ures "u ?is section4 
7#b7 ,treatm5t ( companion measures 9 ! 
,s5ate ,if1 foll[+ passage ( an enhanc$ 
premium tax cr$it re=m bill 9 ! ,s5ate1 
! ,s5ate !n receives f ! ,h\se (        
,repres5tatives an enhanc$ premium tax  
cr$it re=m bill1 ! ,h\se-pass$ enhanc$  
premium tax cr$it re=m bill %all n be   
debatable4 ,! vote on passage ( !       
enhanc$ premium tax cr$it re=m bill 9 ! 
,s5ate %all be consid]$ to be ! vote on 
passage ( ! enhanc$ premium tax cr$it   
re=m bill receiv$ f ! ,h\se (           
,repres5tatives4  7#c7 ,vetoes ,if !    
,presid5t vetoes an enhanc$ premium tax 
cr$it re=m bill1 consid]ation ( a veto  
message 9 ! ,s5ate "u ?is p>agraph %all 
be #aj h\rs equally divid$ betwe5 !     
majority & m9ority lead]s ( ! ,s5ate or 
! designees ( ! majority & m9ority      

lead]s ( ! ,s5ate4  7f7 ,vote on passage
 ,! vote on f9al passage 9 ! ,h\se (    
,repres5tatives & ! ,s5ate ( ! enhanc$  
premium tax cr$it re=m bill %all occur n
 lat] ?an ,july #a1 #bjbf4  7g7 ,ex]cise
 ( rulemak+ p[] ,?is section is enact$  
by ,congress--  7#a7 z an ex]cise ( !   
rulemak+ p[] ( ! ,s5ate & ,h\se (       
,repres5tatives1 respectively1 & z su* x
 is deem$ a "p ( ! rules ( ea* ,h\se1   
respectively1 b applicable only )       
respect to ! proc$ure to be foll[$ 9 t  
,h\se 9 ! case ( an enhanc$ premium tax 
cr$it re=m bill1 & x sup]s$es o!r rules 
only to ! ext5t t x is inconsi/5t ) su* 
rules2 &  7#b7 ) full recognition ( !   
con/itutional "r ( ei!r ,h\se to *ange !
 rules 7s f> z relat+ to ! proc$ure ( t 
,h\se7 at any "t1 9 ! same mann]1 & to !
 same ext5t z 9 ! case ( any o!r rule ( 
t ,h\se4