,i #aai? ,,congress #b;d ,session ,h4 ,r4 #giji ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,m>* #ab1 #bjbf,mr4 ,kri%namoor?i 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 title ,,xviii ( ! ,social ,security ,act to provide = an option = individuals :o are ages #ej to #fd to buy into ,m$ic>e1 to provide = heal? insurance m>ket /abilization1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,expansion & ,l[]+ ,co/s ,n[ ,act4 #b4 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,m$ic>e has cov]age gaps & %\ld provide m compreh5sive cov]age1 includ+ increas+ cov]age = ! m$ical ne$s ( b5efici>ies relat+ to he>+1 d5tal1 & vision c>e4 7#b7 ,special ne$s populations face f9ancial *all5ges to secure cov]age = ,m$ic>e's out-(-pocket co/s & o!r hurdles4 7#c7 ,m$ic>e ,buy-,9 is a /ep 9 ! "r direction z ,congress consid]s additional ne$$ legislation to address ^! & o!r cov]age issues & b5efici>y f9ancial *all5ges 9 ,m$ic>e & ,m$ic>e ,buy-,94 #c4 ,m$ic>e buy-9 option 7a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,d4 ,m$ic>e buy-9 option 7a7 ,option 7#a7 ,9 g5]al ,e individual :o meets ! requirem5ts describ$ 9 p>agraph 7#b7 %all be eligible to enroll "u ?is section4 7#b7 ,eligibility ,an individual :o meets ! foll[+ requirem5ts is eligible to enroll "u ?is section3 7,a7 ,age ,! individual has atta9$ #ej ye>s ( age1 b has n atta9$ #fe ye>s ( age4 7,b7 ,m$ic>e eligibility 7b = age7 ,! individual is n o!rwise entitl$ to b5efits "u "p ,a or eligible to enroll "u "p ,a or "p ,b b w\ld be eligible = b5efits "u "p ,a or "p ,b if ! individual 7 #fe ye>s ( age4 7#c7 ,"p ,a1 ,b1 & ,d b5efits & protections ,an individual enroll$ "u ?is section is entitl$ to ! same b5efits 7& %all receive ! same protections7 "u ?is title z an individual :o is entitl$ to b5efits "u "p ,a & enroll$ "u p>ts ,b & ,d1 includ+ ! ability to enroll 9 a ,m$ic>e ,advantage plan t provides qualifi$ prescription drug cov]age 7an ,,ma-,,pd plan7 & includ+ access to ! ,m$ic>e ,b5efici>y ,ombudsman "u section #ahjh7;c74 7b7 ,enrollm5t & cov]age p]iods ,! ,secret>y %all e/abli% enrollm5t & cov]age p]iods = individuals :o enroll "u ?is section4 ,su* p]iods %all be e/abli%$ 9 coord9ation ) ! enrollm5t & cov]age p]iods = plans (f]$ "u an ,ex*ange e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 ,! ,secret>y %all e/abli% su* p]iods s t cov]age "u ?is section %all fir/ beg9 on ,janu>y #a ( ! fir/ ye> beg9n+ at lea/ "o ye> aft] ! date ( ! enactm5t ( ?is section & %all include special enrollm5t p]iods1 9 accordance ) section #aee4dbj ( title #de ( ! ,code ( ,f$]al ,regulations1 t are applicable to qualifi$ heal? plans (f]$ ?r\gh an ,ex*ange4 7c7 ,buy-,9 premium 7#a7 ,am\nt ( mon?ly premiums ,! ,secret>y %all 7beg9n+ = ! fir/ ye> t beg9s m ?an #a ye> aft] ! date ( ! enactm5t ( ?is section71 dur+ ,septemb] ( ! prec$+ ye>1 det]m9e a mon?ly premium = individuals enroll$ "u ?is section4 ,su* mon?ly premium %all be equal to #a_/ab ( ! annual premium comput$ "u p>agraph 7#b77;,b71 :i* %all apply ) respect to cov]age provid$ "u ?is section = any mon? 9 su* ye>4 7#b7 ,annual premium 7,a7 ,comb9$ ,national1 p] capita av]age = p>ts ,a1 ,b1 & ,d b5efits ,! ,secret>y %all e/imate ! av]age1 annual p] capita am\nt = b5efits & adm9i/rative exp5ses t w be payable "u p>ts ,a1 ,b1 & ,d 9 ! ye> = all individuals enroll$ "u ?is section4 7,b7 ,annual premium ,subject to subp>agraphs 7,c7 & 7,d71 ! annual premium "u ?is subsection = mon?s 9 a ye> is equal to ! av]age1 annual p] capita am\nt e/imat$ "u subp>agraph 7,a7 = ! ye>4 7,c7 ,adju/m5ts ,! ,secret>y %all adju/ ! annual premium "u ?is subsection z necess>y-- 7i7 to ensure t exp5ditures "u ?is title = any ye> are n increas$ by reason ( ?is section2 & 7ii7 by a geographic adju/m5t factor to address regional af=dability conc]ns4 7,d7 ,au?ority to calculate am\nts ( mon?ly premiums sep>ately = diff]5t ages ,9 det]m9+ ! annual premium am\nt "u ?is p>agraph = mon?s 9 a ye>1 ! ,secret>y may make sep>ate det]m9ations ( su* am\nt = individuals by age1 if ! ,secret>y det]m9es t mak+ su* sep>ate det]m9ations w\ld increase enrollm5t "u ?is section & r$uce ! risk ( adv]se selection4 7#c7 ,additional premium = c]ta9 "p ,d plans ,no?+ 9 ?is section %all preclude an individual f *oos+ a prescription drug plan :i* requires ! individual to pay an additional am\nt 7because ( ! inclusion ( supplem5tal prescription drug b5efits or because ! plan is a m exp5sive plan1 pursuant to section #ahfj;,d-#ac7;a77#a774 ,9 su* case1 ! mon?ly premium "u p>agraph 7#a7 %all be increas$ ) respect to su* individual4 7d7 ,paym5t ( premiums 7#a7 ,paym5t ,premiums = enrollm5t "u ?is section %all be paid to ! ,secret>y at su* times1 & 9 su* mann]1 z ! ,secret>y det]m9es appropriate4 7#b7 ,deposit ,am\nts collect$ by ! ,secret>y "u ?is section %all be deposit$ 9 ! ,m$ic>e ,buy-,9 ,tru/ ,fund e/abli%$ "u subsection 7e74 7e7 ,m$ic>e ,buy-,9 ,tru/ ,fund 7#a7 ,9 g5]al ,!re is h]eby creat$ on ! books ( ! ,treasury ( ! ,unit$ ,/ates a tru/ fund to be kn[n z ! ,m$ic>e ,buy-,9 ,tru/ ,fund 79 ?is subsection ref]r$ to z ! ,tru/ ,fund74 ,! ,tru/ ,fund %all consi/ ( su* gifts & beque/s z may be made z provid$ 9 section #bja7;i77#a7 & su* am\nts z may be deposit$ 91 or appropriat$ to1 su* fund z provid$ 9 ?is title4 7#b7 ,premiums ,premiums collect$ "u subsection 7d7 %all be transf]r$ to ! ,tru/ ,fund4 7#c7 ,incorporation ( ,provisions ,subsections 7b7 ?r\gh 7i7 ( section #ahda %all apply ) respect to ! ,tru/ ,fund & ?is title 9 ! same mann] z !y apply ) respect to ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund & "p ,b1 respectively1 except t 9 apply+ su* section #ahda1 any ref]5ce 9 su* section to ?is "p %all be con/ru$ to be a ref]5ce to ?is section & any ref]5ce 9 section #ahda7;h7 to section #ahdj7;d7 & 9 section #ahda7;i7 to sections #ahdj7;b77#a7 & #ahdb7;g7 are deem$ to be ref]5ces to comp>able au?ority ex]cis$ "u ?is section4 7f7 ,cl>ification ,no?+ 9 ?is section %all affect ! b5efits or eligibility "u ?is title ( individuals :o w\ld o!rwise be entitl$ to or eligible = b5efits "u ?is title or title ,,xix1 or bo?4 7g7 ,eligibility = f9ancial assi/ance 7#a7 ,9 g5]al ,individuals enroll$ 9 cov]age "u ?is section %all1 f am\nts transf]r$ "u p>agraph 7#b71 receive f9ancial assi/ance = su* cov]age t is sub/antially simil> to ! assi/ance ! individual w\ld h receiv$ if ! individual 7 enroll$ 9 a qualifi$ heal? plan ?r\gh an ,ex*ange4 7#b7 ,transf] ( funds to m$ic>e buy-9 tru/ fund 7,a7 ,9 g5]al ,! ,secret>y %all transf] to ! ,m$ic>e ,buy-,9 ,tru/ ,fund "u subsection 7d7 = ea* plan ye> ! am\nt det]m9$ "u p>agraph 7,c7 = su* ye>4 7,b7 ,use ( funds ,! am\nts transf]r$ to ! ,m$ic>e ,buy-,9 ,tru/ ,fund "u subp>agraph 7,a7 %all only be us$ to r$uce ! premiums & co/-%>+ = cov]age "u ?is section ( individuals enroll$ "u su* cov]age :o w\ld be eligible = co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act & premium assi/ance "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf if su* individual 7 enroll$ 9 a qualifi$ heal? plan4 7,c7 ,am\nt ( transf] 7i7 ,9 g5]al ,! am\nt det]m9$ "u ?is subp>agraph = any plan ye> is ! aggregate am\nt ! ,secret>y det]m9es is equal to #ajj p]c5t ( ! premium tax cr$its "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf1 & #ajj p]c5t ( ! co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 t w\ld h be5 provid$ = ! plan ye> to eligible individuals :o meet specifi$ income crit]ia & are enroll$ = su* plan ye> 9 cov]age provid$ ?r\gh enrollm5t "u ?is section if su* individuals 7 enroll$ = su* ye> 9 a qualifi$ heal? plan ?r\gh an ,ex*ange4 7ii7 ,specific requirem5ts ,! ,secret>y %all make ! det]m9ation "u clause 7i7 on a p] enrollee basis & %all take into acc\nt all relevant factors necess>y to det]m9e ! value ( ! premium tax cr$its & co/-%>+ r$uctions t w\ld h be5 provid$ to eligible individuals describ$ 9 section #acca ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 includ+ ! age & income ( ! enrollee1 geographic diff]5ces 9 av]age sp5d+ = heal? c>e across rat+ areas1 ! heal? /atus ( ! enrollee = purposes ( det]m9+ risk adju/m5t paym5ts & re9surance paym5ts t w\ld h be5 made if ! enrollee _h enroll$ 9 a qualifi$ heal? plan ?r\gh an ,ex*ange1 & :e!r any reconciliation ( ! cr$it or co/-%>+ r$uctions w\ld h occurr$ if ! enrollee _h be5 s enroll$4 ,?is det]m9ation %all take into consid]ation ! exp]i5ce ( o!r ,/ates ) respect to p>ticipation 9 an ,ex*ange & su* cr$its & r$uctions provid$ to resid5ts ( ! o!r ,/ates1 ) a special focus on enrollees ) income bel[ #bjj p]c5t ( pov]ty4 7,d7 ,c]tification 7i7 ,9 g5]al ,! ,*ief ,actu>y ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 9 consultation ) ! ,(fice ( ,tax ,analysis ( ! ,dep>tm5t ( ! ,treasury1 %all c]tify :e!r ! me?odology us$ to make det]m9ations "u subp>agraph 7,c71 & su* det]m9ations1 meet ! requirem5ts ( ?is p>agraph4 ,su* c]tifications %all be bas$ on suffici5t data f ! ,f$]al ex*ange & f comp>able ,/ates ab\t _! exp]i5ce ) programs creat$ by ! ,basic ,heal? ,plan4 7ii7 ,corrections ,! ,secret>y %all adju/ ! paym5t to ! ,tru/ ,fund = any plan ye> to reflect any error 9 ! det]m9ations "u subp>agraph 7,c7 = any prec$+ plan ye>4 7iii7 ,application ,cov]age provid$ ?r\gh enrollm5t "u ?is "p & p>ts ,b & ,d pursuant to ?is section %all be treat$ z cov]age "u a qualifi$ heal? plan 9 ! silv] level ( cov]age 9 ! individual m>ket (f]$ ?r\gh an ,ex*ange & ! ,secret>y %all be treat$ z ! issu] ( su* plan4 7h7 ,treatm5t 9 relation to ! ,af=dable ,c>e ,act 7#a7 ,treatm5t z m9imum ess5tial cov]age ,= purposes ( apply+ section #ejjj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf1 ! cov]age provid$ ?r\gh enrollm5t "u ?is section con/itutes m9imum ess5tial cov]age "u subsection 7f77#a77;,a77i7 ( su* section4 7#b7 ,use ( ,ex*anges ,cov]age provid$ ?r\gh enrollm5t "u ?is section %all be deem$ to be cov]age "u a qualifi$ heal? plan = purposes ( section #acaa7;d77#d77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act & %all be made available = enrollm5t1 in=mation comp>ison1 & o!rwise z su* a plan ?r\gh any int]net website ma9ta9$ by an ,ex*ange e/abli%$ "u title ,i ( su* ,act 7z describ$ 9 su* section74 7#c7 ,m$icaid manag$ c>e ,/ates are prohibit$ f buy+ _! ,m$icaid b5efici>ies ages #ej to #fd into ,m$ic>e "u ?is section1 & individuals o!rwise eligible = enrollm5t "u a ,/ate plan "u title ,,xix are prohibit$ f cov]age "u ?is title pursuant to enrollm5t "u ?is section4 ,! prec$+ s5t5ce %all n apply to ,m$icaid b5efici>ies ^: ,m$icaid cov]age or eligibility does n meet ! def9ition ( m9imum ess5tial cov]age "u a gov]nm5t-sponsor$ program "u section #a4ejjj;,a-#b ( title #bf1 ,code ( ,f$]al ,regulations 7or any successor regulation74 7#d7 ,access to ,m$igap ,cov]age provid$ ?r\gh m$ic>e supplem5tal policies c]tifi$ "u section #ahhb %all be made available to individuals eligible = enrollm5t pursuant to ?is section = enrollm5t1 in=mation1 comp>ison1 & o!rwise z su* a policy ?r\gh any int]net website describ$ 9 p>agraph 7#b74 7i7 ,ov]sight ,!re is e/abli%$ an advisory committee to be kn[n z ! ,m$ic>e ,buy-,9 ,ov]sight ,bo>d to monitor & ov]see ! implem5tation ( ?is section1 includ+ ! exp]i5ce ( ! individuals enroll+ "u ?is section4 ,! ,m$ic>e ,buy-,9 ,ov]sight ,bo>d %all make p]iodic recomm5dations = ! cont9ual improvem5t ( ! implem5tation ( ?is section z well z ! relation%ip ( enrollm5t "u ?is section to o!r heal? c>e programs4 7j7 ,outrea* & enrollm5t 7#a7 ,9 g5]al ,dur+ ! p]iod t beg9s on ,janu>y #a1 #bjbf1 & ends on ,decemb] #ca1 #bjbh1 ! ,secret>y %all aw>d grants to eligible entities = ! foll[+ purposes3 7,a7 ,outrea* & enrollm5t ,to c>ry out outrea*1 public education activities1 & enrollm5t activities to raise aw>5ess ( ! availability (1 & enc\rage1 enrollm5t "u ?is section4 7,b7 ,assi/+ individuals transition "u ?is section ,to provide assi/ance to individuals to enroll "u ?is section4 7,c7 ,rais+ aw>5ess ( premium assi/ance & co/-%>+ r$uctions ,to di/ribute fair & imp>tial in=mation conc]n+ enrollm5t "u ?is section & ! availability ( premium assi/ance tax cr$its "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf & co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 & to assi/ eligible individuals 9 apply+ = su* tax cr$its & co/-%>+ r$uctions4 7#b7 ,eligible entities 7,a7 ,9 g5]al ,9 ?is subsection1 ! t]m eligible entity means-- 7i7 a ,/ate2 or 7ii7 a nonpr(it community-bas$ organization4 7,b7 ,enrollm5t ag5ts ,su* t]m includes a lic5s$ indep5d5t insurance ag5t or brok] t has an arrangem5t ) a ,/ate or nonpr(it community-bas$ organization to enroll eligible individuals "u ?is section4 7,c7 ,exclusions ,su* t]m does n include an entity t-- 7i7 is a heal? insurance issu]2 or 7ii7 receives any consid]ation1 ei!r directly or indirectly1 f any heal? insurance issu] 9 connection ) ! enrollm5t ( any individuals "u ?is section4 7#c7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to aw>d+ grants to ,/ates or eligible entities 9 ,/ates t h geographic rat+ areas at risk ( hav+ no qualifi$ heal? plans 9 ! individual m>ket4 7#d7 ,fund+ ,out ( any moneys 9 ! ,treasury n o!rwise appropriat$1 #ejj1jjj1jjj is appropriat$ to ! ,secret>y = ea* ( cal5d> ye>s #bjbf ?r\gh #bjbh1 to c>ry out ?is subsection4 7k7 ,implem5tation 7#a7 ,consultation ,9 c>ry+ out ?is section1 ! ,secret>y %all-- 7,a7 consult ) o!r ,f$]al ag5cies1 includ+ ! ,dep>tm5t ( ! ,treasury1 ! ,dep>tm5t ( ,labor1 ! ,dep>tm5t ( ,vet]ans ,affairs1 ! ,dep>tm5t ( ,def5se1 & ! ,(fice ( ,p]sonnel ,managem5t2 & 7,b7 incorporate significant public consultation & fe$back1 ?r\gh public =ums1 notice & comm5t rulemak+1 & any o!r appropriate m$iums4 7#b7 ,report ,no lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all submit to ,congress a report e/abli%+ ! adm9i/rative p>amet]s = ! implem5tation ( ?is section4 7l7 ,feasibility /udy ,! ,secret>y %all conduct a /udy on ! feasibility ( apply+ ?is section ) respect to individuals resid+ 9 ,/ates t are n )9 ! #ej ,/ates or ! ,di/rict ( ,columbia4 4 7b7 ,m$igap ,section #ahhb ( ! ,social ,security ,act is am5d$ by add+ at ! end ! foll[+ new subsection3 7aa7 ,developm5t ( new /&>ds = c]ta9 ,m$ic>e supplem5tal policies relat+ to buy-,9 option ,! ,secret>y %all reque/ ! ,national ,association ( ,insurance ,commission]s to review & revise ! /&>ds = b5efit packages describ$ 9 subsection 7p77#a71 to o!rwise update /&>ds to include requirem5ts = ea* m$ic>e supplem5tal policy t (f]s su* a policy 9 a ,/ate1 ) respect to ea* ye>1 to accept e individual 9 ! ,/ate :o is eligible = enrollm5t pursuant to section #ahii;,d & :o applies = su* cov]age = su* ye> if ! individual applies = enrollm5t 9 su* policy dur+ ! #cj-;day p]iod foll[+ ! date ( enrollm5t pursuant to section #ahii;,d & to accept e su* individual dur+ a p]iod ( transition f enrollm5t pursuant to su* section to enrollm5t "u ?is title pursuant to eligibility o!r ?an "u su* section4 ,su* revisions %all be made consi/5t ) ! rules applicable "u subsection 7p77#a77;,e7 ) ! ref]5ce to ! #aiia ,,naic ,model ,regulation deem$ a ref]5ce to ! ,,naic ,model ,regulation z publi%$ 9 ! ,f$]al ,regi/] on ,decemb] #d1 #aiih1 & z subsequ5tly updat$ by ! ,national ,association ( ,insurance ,commission]s to reflect previ\s *anges 9 law & ! ref]5ce to date ( enactm5t ( ?is subsection deem$ a ref]5ce to ! date ( enactm5t ( ?is subsection 7aa74 4 #d4 ,m$ic>e direct supplem5tal insurance option 7a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act is am5d$ by ins]t+ aft] section #ahhb 7#db ,u4,s4,c4 #aciess7 ! foll[+ new section3 #ahhb;,a4 ,m$ic>e direct supplem5tal insurance option 7a7 ,9 g5]al ,! ,secret>y %all provide = ! (f]+ "u ?is section ( a volunt>y program to supplem5t ! b5efits provid$ to individuals "u p>ts ,a & ,b ( ?is title4 7b7 ,eligibility2 enrollm5t ,! ,secret>y %all provide proc$ures = ! enrollm5t "u ! program "u ?is section ( individuals :o are entitl$ to b5efits "u "p ,a & enroll$ "u "p ,b1 b :o are n enroll$ 9 a ,m$ic>e ,advantage plan 7or 9 a plan "u section #ahgf74 ,su* proc$ures %all be consi/5t ) ! foll[+3 7#a7 ,!re %all be an initial enrollm5t p]iod dur+ ! la/ cal5d> qu>t] ( #bjbg t p]mits all individuals :o are eligible to enroll at t "t "u ?is subsection to enroll & obta9 b5efits effective on ,janu>y #a1 #bjbh4 7#b7 ,= individuals :o are n eligible to enroll at su* "t b :o subsequ5tly become eligible1 !re %all be an individual enrollm5t p]iod :i* is ! #f-mon? p]iod describ$ 9 section #ahhb7s77#b77;,a74 7#c7 ,! ,secret>y %all p]mit eligible individuals to enroll at o!r times 7& n less frequ5tly ?an annually7 9 a uni=m mann]1 b su* enrollm5t %all be subject to a late enrollm5t p5alty "u subsection 7d77#b77;,b74 7c7 ,b5efits 7#a7 ,9 g5]al ,! b5efits provid$ "u ! program "u ?is section %all consi/ ( paym5t ( ! co/ ( d$uctibles1 copaym5ts1 & o!r co/-%>+ am\nts 7includ+ am\nts attributable to & p]mitt$ z balance bill+7 o!rwise impos$ or p]mitt$ "u ?is title1 subject to an annual d$uctible ( #ajj4 7#b7 ,adm9i/ration ,! ,secret>y %all coord9ate paym5t ( b5efits "u ?is "p ) ^? "u p>ts ,a & ,b & may1 = su* purpose1 ent] into appropriate arrangem5ts ) qualifi$ entities 7:i* may include fiscal int]m$i>ies & c>ri]s74 7#c7 ,no pre-exi/+ condition limitations ,! b5efits "u ?is section %all n be subject to any pre-exi/+ condition or simil> und]writ+ limitation4 7d7 ,premiums 7#a7 ,actu>ial co/ ,! ,secret>y %all1 dur+ ,septemb] ( ea* ye> beg9n+ ) #bjbg1 det]m9e a mon?ly actu>ial rate = all enrollees "u ?is section1 :i* rate %all be applicable = mon?s 9 ! succe$+ cal5d> ye>4 ,su* actu>ial rate %all be ! am\nt ! ,secret>y e/imates to be necess>y s t ! aggregate am\nt = su* cal5d> ye> ) respect to ^? enrollees w equal ! total am\nt :i* ! ,secret>y e/imates w be payable "u ?is section = b5efits accru$ 7includ+ s]vices p]=m$ & relat$ adm9i/rative co/s incurr$7 9 su* cal5d> ye> "u ! program "u ?is section4 ,9 calculat+ ! mon?ly actu>ial rate1 ! ,secret>y %all make adju/m5ts to take into acc\nt errors 9 e/imations "u ?is p>agraph = previ\s ye>s & %all include an appropriate am\nt = a cont+5cy m>g94 7#b7 ,premium 7,a7 ,9 g5]al ,! mon?ly premium ( ea* individual enroll$ "u ?is section = a mon? 9 a ye> %all be ! mon?ly actu>ial rate det]m9$ "u p>agraph 7#a7 = mon?s 9 su* ye>4 ,su* premium %all be community-rat$ & %all n v>y among enrollees bas$ ^u ! age1 place ( resid5ce1 or any o!r factors1 except z provid$ "u subp>agraph 7,b74 7,b7 ,p5alty = late enrollm5t ,9 ! case ( an individual :o does n enroll "u ?is section 9 a p]iod provid$ "u p>agraph 7#a7 or 7#b7 ( subsection 7b71 ! ,secret>y %all increase ! mon?ly premium 79 a mann] simil> to t appli$ "u "p ,b pursuant to section #ahci7;b77 ( #aj p]c5t = ea* full #ab mon?s 9 :i* ! individual c\ld h be5 b 0 n s enroll$4 ,9 apply+ su* an increase-- 7i7 ! aggregate p]c5tage increase may n exce$ #ajj p]c5t2 & 7ii7 p]iods ( "t 9 :i* an individual is enroll$ "u an employee welf>e b5efit plan describ$ 9 section #ahhb7s77#c77;,b77i71 "u a ,m$ic>e ,advantage plan1 ) an organization describ$ 9 section #ahhb7s77#c77;,b77iii71 or "u a ,,pace program "u section #ahid %all n be tak5 into acc\nt4 7#c7 ,collection ,! ,secret>y %all provide = ! collection ( premiums = enrollees "u ?is "p 9 ! same mann] z premiums "u "p ,b are collect$ "u section #ahdj1 except t any ref]5ce 9 su* section to ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund %all be deem$ a ref]5ce to an acc\nt 7to be kn[n z ! ,direct ,m$ic>e ,supplem5tal ,insurance ,acc\nt7 to be e/abli%$ 9 ! ,treasury by ! ,secret>y to c>ry out ! program "u ?is section4 ,am\nts 9 su* acc\nt may be inve/$ & draw int]e/ 9 ! same mann] z su* ,tru/ ,fund "u section #ahdj7;c74 7#d7 ,use ( funds ,premium am\nts deposit$ into ! acc\nt e/abli%$ "u p>agraph 7#c7 %all be available )\t reg>d to appropriations to ! ,secret>y to make paym5t = b5efits & adm9i/rative co/s incurr$ 9 c>ry+ out ?is section4 7e7 ,nonduplication ( cov]age ,= purposes ( apply+ section #ahhb7;d77#c77;,a71 cov]age "u ?is section %all be treat$ z cov]age "u a ,m$ic>e supplem5tal policy4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ! date ( ! enactm5t ( ?is ,act & %all apply to b5efits = mon?s beg9n+ ) ,janu>y #bjbg4 #e4 ,negotiation ( l[] cov]$ "p ,d drug prices on behalf ( m$ic>e b5efici>ies 7a7 ,negotiation by secret>y ,section #ahfj;,d-#aa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aaa7 is am5d$ by /rik+ subsection 7i7 7relat+ to non9t]f]5ce7 & ins]t+ ! foll[+3 7i7 ,negotiation ( ,l[] ,drug ,prices 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y %all negotiate ) ph>maceutical manufactur]s ! prices 7includ+ disc\nts1 rebates1 & o!r price concessions7 t may be *>g$ to ,,pdp sponsors & ,,ma organizations = cov]$ "p ,d drugs = "p ,d eligible individuals :o are enroll$ "u a prescription drug plan or "u an ,,ma-,,pd plan4 7#b7 ,no *ange 9 rules = =mul>ies 7,a7 ,9 g5]al ,no?+ 9 p>agraph 7#a7 %all be con/ru$ to au?orize ! ,secret>y to e/abli% or require a p>ticul> =mul>y4 7,b7 ,con/ruction ,subp>agraph 7,a7 %all n be con/ru$ z affect+ ! ,secret>y's au?ority to ensure appropriate & adequate access to cov]$ "p ,d drugs "u prescription drug plans & "u ,,ma-,,pd plans1 includ+ compliance ( su* plans ) =mul>y requirem5ts "u section #ahfj;,d-#d7;b77#c74 7#c7 ,con/ruction ,no?+ 9 ?is subsection %all be con/ru$ z prev5t+ ! sponsor ( a prescription drug plan1 or an organization (f]+ an ,,ma-,,pd plan1 f obta9+ a disc\nt or r$uction ( ! price = a cov]$ "p ,d drug bel[ ! price negotiat$ "u p>agraph 7#a74 7#d7 ,semi-annual reports to ,congress ,n lat] ?an ,june #a1 #bjbi1 & e #f mon?s !reaft]1 ! ,secret>y %all submit to ! ,committees on ,ways & ,means1 ,en]gy & ,comm]ce1 & ,ov]sight & ,re=m ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report on negotiations conduct$ by ! ,secret>y to a*ieve l[] prices = ,m$ic>e b5efici>ies1 & ! prices & price disc\nts a*iev$ by ! ,secret>y z a result ( su* negotiations4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ! date ( ! enactm5t ( ?is ,act & %all fir/ apply to negotiations & prices = plan ye>s beg9n+ on ,janu>y #a1 #bjbi4 #f4 ,individual ,m>ket ,re9surance ,fund 7a7 ,e/abli%m5t ( ,fund 7#a7 ,9 g5]al ,!re is e/abli%$ ! ,individual ,m>ket ,re9surance ,fund 79 ?is section ref]r$ to z ! ,fund7 to be adm9i/]$ by ! ,secret>y to provide fund+ = an individual m>ket /abilization re9surance program 9 ea* ,/ate t complies ) ! requirem5ts ( ?is section4 7#b7 ,fund+ ,am\nts made available to ! ,fund %all consi/ ( ! funds deposit$ into ! ,fund "u p>agraph 7#c7 & %all be us$ to c>ry out ?is section 7o!r ?an subsection 7c77 = ea* cal5d> ye> beg9n+ ) #bjbi4 ,am\nts made available to ! ,fund %all rema9 available )\t fiscal or cal5d> ye> limitation to c>ry out ?is section4 7#c7 ,co/-%>+ 9 co/s ( ,program 7,a7 ,9 g5]al ,a qualifi$ heal? plan t p>ticipates 9 ! re9surance program e/abli%$ "u subsection 7b7 %all pay ! fee e/abli%$ "u subp>agraph 7,b74 7,b7 ,au?orization ,! ,secret>y is au?oriz$ to *>ge a fee to ea* qualifi$ heal? plan t p>ticipates 9 ! re9surance program e/abli%$ "u subsection 7b74 ,any am\nts collect$ pursuant to ?is p>agraph %all be deposit$ into ! ,fund = purposes ( paym5ts "u subsection 7b74 7,c7 ,requirem5ts ,9 e/abli%+ ! fee "u subp>agraph 7,b7-- 7i7 ! ,secret>y %all consult ) int]e/$ p>ties2 & 7ii7 %all ensure t ! am\nt ( su* fee is n excessive s z to unduly disc\rage qualifi$ heal? plans f p>ticipat+ 9 ! re9surance program4 7b7 ,individual ,m>ket re9surance program 7#a7 ,use ( funds ,! ,secret>y %all use am\nts 9 ! ,fund to e/abli% a re9surance program "u :i* ! ,secret>y %all make re9surance paym5ts1 subject to subsection 7a77#c71 to heal? insurance issu]s ) respect to high-co/ individuals enroll$ 9 qualifi$ heal? plans (f]$ by su* issu]s t are n gr&fa!r$ heal? plans or transitional heal? plans = any plan ye> beg9n+ ) ! #bjbe plan ye>4 ,?is subsection con/itutes budget au?ority 9 advance ( appropriations ,acts & repres5ts ! obligation ( ! ,secret>y to provide paym5ts f ! ,fund 9 accordance ) ?is subsection4 7#b7 ,am\nt ( paym5t ,! paym5t made to a heal? insurance issu] "u p>agraph 7#a7 ) respect to ea* high-co/ individual enroll$ 9 a qualifi$ heal? plan issu$ by ! issu] t is n a gr&fa!r$ heal? plan or a transitional heal? plan %all equal #hj p]c5t ( ! less] (-- 7,a7 ! am\nt 7if any7 by :i* ! individual's claims incurr$ dur+ ! plan ye> exce$s-- 7i7 9 ! case ( ! #bjbf1 #bjbg1 or #bjbh plan ye>1 #ej1jjj2 & 7ii7 9 ! case ( any o!r plan ye>1 #ajj1jjj2 or 7,b7 = plan ye>s describ$ 9-- 7i7 subp>agraph 7,a77i71 #dej1jjj2 & 7ii7 subp>agraph 7,a77ii71 #djj1jjj4 7#c7 ,index+ ,9 ! case ( plan ye>s beg9n+ aft] #bjbf1 ! doll> am\nts t appe> 9 subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7 %all ea* be increas$ by an am\nt equal to-- 7,a7 su* am\nt2 multipli$ by 7,b7 ! premium adju/m5t p]c5tage specifi$ "u section #acjb7;c77#d7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;c77#d771 b det]m9$ by sub/itut+ #bjbd = #bjac4 7#d7 ,paym5t me?ods 7,a7 ,9 g5]al ,paym5ts "u ?is subsection %all be bas$ on su* a me?od z ! ,secret>y det]m9es4 ,! ,secret>y may e/abli% a paym5t me?od by :i* int]im paym5ts ( am\nts "u ?is subsection are made dur+ a plan ye> bas$ on ! ,secret>y's be/ e/imate ( am\nts t w be payable aft] obta9+ all ( ! in=mation4 7,b7 ,requirem5t = provision ( in=mation 7i7 ,requirem5t ,paym5ts "u ?is subsection to a heal? insurance issu] are condition$ ^u ! furni%+ to ! ,secret>y1 9 a =m & mann] specifi$ by ! ,secret>y1 ( su* in=mation z may be requir$ to c>ry out ?is subsection4 7ii7 ,re/riction on use ( in=mation ,in=mation disclos$ or obta9$ pursuant to clause 7i7 is subject to ! ,,hipaa privacy & security law1 z def9$ 9 section #cjji7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;a774 7#e7 ,secret>y flexibility = budget neutral revisions to re9surance paym5t specifications ,if ! ,secret>y det]m9es appropriate1 ! ,secret>y may sub/itute high] doll> am\nts = ! doll> am\nts specifi$ "u subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7 7& adju/$ "u p>agraph 7#c71 if applicable7 if ! ,secret>y c]tifies t su* sub/itutions1 consid]$ toge!r1 nei!r increase nor decease ! total project$ paym5ts "u ?is subsection4 7c7 ,reports to ,congress 7#a7 ,annual report ,! ,secret>y %all submit a report to ,congress1 n lat] ?an ,janu>y #ba1 #bjbf1 & ea* ye> !reaft]1 t conta9s ! foll[+ in=mation = ! mo/ rec5tly end$ ye>3 7,a7 ,! numb] & types ( plans 9 ea* ,/ate's individual m>ket1 specify+ ! numb] t are qualifi$ heal? plans1 gr&fa!r$ heal? plans1 or heal? insurance cov]age t is n a qualifi$ heal? plan4 7,b7 ,! impact ( ! re9surance paym5ts provid$ "u ?is section on ! availability ( cov]age1 co/ ( cov]age1 & cov]age options 9 ea* ,/ate4 7,c7 ,! am\nt ( premiums paid by individuals 9 ea* ,/ate by age1 family size1 geographic area 9 ! ,/ate's individual m>ket1 & category ( heal? plan 7z describ$ 9 subp>agraph 7,a774 7,d7 ,! process us$ to aw>d funds = outrea* & enrollm5t activities aw>d$ to eligible entities "u subsection 7c71 ! am\nt ( su* funds aw>d$1 & ! activities c>ri$ out ) su* funds4 7,e7 ,su* o!r in=mation z ! ,secret>y deems relevant4 7#b7 ,evaluation report ,n lat] ?an ,janu>y #ca1 #bjbi1 ! ,secret>y %all submit to ,congress a report t-- 7,a7 analyzes ! impact ( ! funds provid$ "u ?is section on premiums & enrollm5t 9 ! individual m>ket 9 all ,/ates2 & 7,b7 conta9s a ,/ate-by-,/ate comp>ison ( ! design ( ! programs c>ri$ out by ,/ates ) funds provid$ "u ?is section4 7d7 ,def9itions ,9 ?is section3 7#a7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#b7 ,fund ,! t]m ,fund means ! ,individual ,m>ket ,re9surance ,fund e/abli%$ "u subsection 7a74 7#c7 ,gr&fa!r$ heal? plan ,! t]m gr&fa!r$ heal? plan has ! mean+ giv5 t t]m 9 section #abea7;e7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjaa7;e774 7#d7 ,high-co/ individual ,! t]m high-co/ individual means an individual enroll$ 9 a qualifi$ heal? plan 7o!r ?an a gr&fa!r$ heal? plan or a transitional heal? plan7 :o incurs claims 9 excess ( #ej1jjj dur+ a plan ye>4 7#e7 ,/ate ,! t]m ,/ate means ea* ( ! #ej ,/ates & ! ,di/rict ( ,columbia4 7#f7 ,transitional heal? plan ,! t]m transitional heal? plan means a plan cont9u$ "u ! lett] issu$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices on ,novemb] #ad1 #bjac1 to ! ,/ate ,insurance ,commission]s outl9+ a transitional policy = cov]age 9 ! individual & small gr\p m>kets to :i* section #abea ( ! ,pati5t ,protection & ,af=dable ,c>e ,act does n apply1 & "u ! ext5sion ( ! transitional policy = su* cov]age set =? 9 ! ,insurance ,/&>ds ,bullet9 ,s]ies guidance issu$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices on ,m>* #e1 #bjad1 ,febru>y #bi1 #bjaf1 & ,febru>y #ac1 #bjag4 #g4 ,reau?orization ( risk corridors ,section #acdb7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjfb7;a77 is am5d$ by ins]t+ & cal5d> ye>s #bjbh ?r\gh #bjca aft] #bjaf4 #h4 ,integration ( individuals ag$ #ej to #fd into heal? demon/rations ,! ,c5t] = ,m$ic>e & ,m$icaid ,innovation "u section #aaae;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is au?oriz$ to include ! individuals enroll$ "u title ,,xviii ( ! ,social ,security ,act pursuant to section #ahii;,d ( su* ,act1 z add$ by section #c1 into exi/+ & future demon/rations conduct$ by su* ,c5t]4 #i4 ,repeal ( reconciliation heal? provisions ,subtitle ,b ( title ,,vii ( ,an ,act to provide = reconciliation pursuant to title ,,ii ( ,h4 ,con4 ,res4 #ad 7,public ,law #aai-ba7 is repeal$ & any law or regulation ref]r$ to 9 su* subtitle %all be appli$ z if su* subtitle & ! am5dm5ts made by su* subtitle _h n be5 enact$4 #aj4 ,increase 9 eligibility = premium tax cr$it 7a7 ,9 g5]al ,section #cf;,b7c77#a77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ b does n exce$ #djj p]c5t4 7b7 ,applicable p]c5tages 7#a7 ,9 g5]al ,section #cf;,b7b77#c77;,a7 ( su* ,code is am5d$ to read z foll[s3 7,a7 ,applicable p]c5tage ,! applicable p]c5tage = any taxable ye> %all be ! p]c5tage su* t ! applicable p]c5tage = any taxpay] ^: h\sehold income is )9 an income ti] specifi$ 9 ! foll[+ table %all increase1 on a slid+ scale 9 a l9e> mann]1 f ! initial premium p]c5tage to ! f9al premium p]c5tage specifi$ 9 su* table = su* income ti]3 ,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 #aej p]c5t#jj #aej p]c5t up to #bjj p]c5t#jb4j #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 & high]#h4eh4e4 4 7#b7 ,con=m+ am5dm5ts relat+ to af=dability ( cov]age 7,a7 ,section #cf;,b7c77#a7 ( su* ,code is am5d$ by /rik+ subp>agraph 7,e74 7,b7 ,section #cf;,b7c77#b77;,c7 ( su* ,code is am5d$ by /rik+ clause 7iv74 7,c7 ,section #cf;,b7c77#d7 ( su* ,code is am5d$ by /rik+ subp>agraph 7,f74 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbf4