kennedy_healthcare_bill_draft.pdf (application/pdf Object)
The health care bill has been leaked.
From a quick glance there are quite a few MANDATORY issues that everyone will have to pay for.
Child care issues? Even if you dont have a child.
Gynecological exams .... should help out a 20 year old male how?
This is the WORST Thing that can happen. It will drive small business right out in a crushing fashion.
This was crafted by Kennedy alright, apparently after his brain tumor had done the damage.
We can not allow this to happen people.
Stand up and shout, NO GOVERNMENT HEALTH CARE!
The only thing about this Affordable Health care for all Americans
being Affordable and Health Care for all Americans is the title.
- .. ~ 1 J I"".,.
2
1 TITLE I-QUALITY, AFFORDABLE
2 HEALTH CARE FOR ALL
3 AMERICANS
4 Subtitle A-Effective Coverage for
5 All Americans
6 [Note: Further revisions are needed to complete the
7 work of int~, grating provisions into the existing IDPA A
8 structure]
,",
9 PART I-PROVISIONS APPLIC:, '..LE TO THE
10 INDIVIDUAL AND GROUP MARKETS
11 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE
12 ACT.
13 Part A of title XXVII of the Public Health Service
14 Act (42 U.S.C. 300gg et seq.) is amended-
15 (1) by striking the part heading and inserting
16 the following:
17 ''PART A-INDIVIDUAL AND GROUP MARKET
18 REFORMS";
19 (2) in section 2701 (42 U.S.C. 300gg)-
20 (A) by striking the section heading and
21 subsection (a) and inserting the following:
1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
2 (a) SHORT TITLE.-This Act may be cited as the
3 "American Health Choices Act".
4 (b) TABLE OF CONTENTS.-The table of contents of
5 this Act is as follows: [to be supplied]
6 SEC. 2. DECURATION OF RIGHTS.
7 (a) RIGHTS OF PATIENTS TO CHOOSE THEIR Doc-
8 TOR.-It is the right of patients to select the doctor of
9 their choice.
10 (b) DOCTOR-PATIENT RELATIONSHIP.-A strong
11 doctor-patient relationship is essential to the practice of
12 medicine, and patients have a right to an effective doctor-
13 patient relationship.
14 (c) HEALTH PROFESSIONALS SHOULD JUDGE WHAT
15 Is BEST FOR THEIR P ATIENTS.-Doctors, nur~es, and
16 other health professionals have the right to judge what
17 is best for their patients.
18 (d) No INTERFERENCE WITH THESE RIGHTS.-
19 Nothing in the this Act or the amendments made by this
20 Act interferes v.rith the rights described in this section.
3
1 "SEC. 2705. PROHmITION OF PREEXISTING CONDITION EX-
2 CLUSIONS OR OTHER DISCRIMINATION
3 BASED ON HEALTH STATUS.
4 "(a) IN GENERAL.-A group health plan and a health
5 insurance issuer offering group or individual health insur-
6 ance coverage may not impose any preexisting condition
7 exclusion with respect to such plan or coverage."; and
8 ,\} by transferring such section so as to
9 appe' after the section 2704 as added by para-
10 graph (3);
11 (3) by redesignating existing sections 2704
12 through 2707 as sections 2715 through 2718; and
13 (4) by amending the remainder of subpart 1 of
14 such part to read as follows:
15 "Subpart I-General Reform
16 "SEC. 2701. FAIR INSURANCE COVERAGE.
17 "(a) IN GENERAL.-With respect to the premmm
18 rate charged by a health insurance issuer for health insur-
19 ance coverage offered in the individual or group market-
20
21
22
23
24
25
"(1) such rate shall vary only by"(
A) family structure;
"(B) community rating area;
"(C) the actuarial value of the benefit;
"(D) age, except that such rate shall not
vary by more than [2 to 1]; and
4
1 "(2) such rate shall not vary by health status-
2 related factors, gender, class of business, claims ex-
3 perience, or any other factor not described in para-
4 graph (1).
5 "(b) COMMUNITY RATING AREA.-[Taking into ac-
6 count the applicable recommendations of the National &-
7 sociation of Insurance Commissioners, the Secretary shall
8 by regulatio:1:t establish a minimum size for community rat-
9 ing areas for purposes of this section./A State shall define
10 the size of a community rating area, provided that no such
11 area is smaller than [an MSA~l.]
12 "[Further conforming changes to section 2701 may
13 be needed]
14 "SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE.
15 "(a) ISSUANCE OF COVERAGE IN THE INDIVIDUAL
16 AND GROUP liARKET.-Subject to subsections (b)
17 through (e), each health insurance issuer that offers
18 health insurance coverage in the individual or group mar-
19 ket in a State must accept every employer and individual
20 in the State that applies for such coverage.
21 "(b) E:NROLLMENT.-
22 "(1) RESTRICTION.-A health insurance issuer
23 described in subsection (a) may restrict enrolhnent
24 in coverage described in such subsection to open or
25 special enrollment periods.
5
1 "(2) ESTABLISHMENT.-A health msurance
2 issuer described in subsection (a) shall, in accord-
3 ance with the regulations promulgated under para-
4 graph (3), establish special enrollment period for
5 qualifying life events (under section 125 of the In-
6 ternal Revenue Code of 1986).
7 "(3) REGULATIONs.-The Secretary shall pro-
8 mulgate regulations with respect to enrollment peri-
9 ods under paragraphs (1) and (2).
10 "[Further conforming changes to section 2 7 02
11 may be needed]
12 "SEC. 2703. GUARANTEED RENEWABILITY OF COVERAGE.
13 "Except as provided in this section, if a health insur-
14 ance issuer offers health insurance coverage in the indi-
15 vidual or group market, the issuer must renew or continue
16 in force such coverage at the option of the plan sponsor
17 of the plan, or the individual, as applicable.
18 "[Further conforming changes to section 2703 may
19 be needed.]
20 "SEC. 2704. BRINGING DOWN THE COST OF HEALTH CARE
21 COVERAGE.
22 "(a) CLEAR ACCOUNTING FOR COSTs.-A health in-
23 surance issuer offering group or individual health insur-
24 ance coverage shall submit to the Secretary a report con6
1 cerning the percentage of total premium revenue that such
2 coverage expends-
3 "(1) on reimbursement for clinical services pro-
4 vided to enrollees under such plan or coverage;
5 "(2) for activities that improve health care
6 quality; and
7 "( 3) on all other non -claims costs, including an
8 explana'tion of the nature of such costs.
9 "(b) ENSURING THAT CONSUMERS RECEIVE VALUE
10 FOR THEIR PREMIUM PAYlI1ENTS.-
11 "(1) REQUIREMENT TO PROVIDE VALUE FOR
12 PREMIUM PAYMENTS.-A health insurance issuer of-
13 fering group or individual health insurance coverage
14 shall provide an annual rebate to each enrollee under
15 such plan or coverage on a pro rata basis in the
16 amount by which the amount of premium revenue
17 expended on activities described in subsection (a)(3)
18 exceeds-
19 "(A) with respect to a health insurance
20 issuer offering group insurance coverage, 20
21 percent, or such lower percentage as the Sec-
22 retary may by regulation determine; or
23 "(B) with respect to a health insurance
24 issuer offering individual insurance coverage, 25
.anlllll ... _
7
1 percent, or such lower percentage as the Sec-
2 retary may by regulation determine
3 "(c) DEFINITION.-In this section, the term 'activi-
4 ties to improve health care quality' means activities de-
5 scribed in section 2705.
6 "(d) NOTIFICATION BY PLANS NOT PROVIDING MIN-
7 Il\ruM QUALIFYING COVERAGE.-Not later than 1 year
8 after the date on which the recommendation of the Coullcil
9 'with respect to minimum qualifying coverage become ef-
10 fective under section 3103, each health plan that fails to
11 provide such minimum qualifying coverage to enrollees
12 shall notify such enrollees of such failure prior to any such
13 enrollment restriction.
14 "(e) EFFECTIVE DATE.-This section shall take ef-
15 fect on the date of enactment of this section.
16 "SEC. 2706. PROHmITING DISCRIMINATION AGAINST INDI·
17 VIDUAL PARTICIPANTS AND BENEFICIARIES
18 BASED ON HEALTH STATUS.
19 "A group health plan and a health insurance issuer
20 offering group or individual health insurance coverage,
21 may not establish rules for eligibility (including continued
22 eligibility) of any individual to enroll under the terms of
23 the plan or coverage based on any of the following health
24 status-related factors in relation to the individual or a de-
25 pendent of the individual:
8
1 "(1) Health status.
2 "(2) Medical condition (including both physical
3 and mental illnesses).
4 "(3) Claims experience.
5 "( 4) Receipt of health care.
6 "( 5) Medical history.
7 "( 6) Genetic information.
8 "(7) Evidence of insurability (including condi-
9 tions arising out of acts of domestic violence).
10 "( 8) Disability.
11 "[Further conforming changes to section 2706
12 may be needed]
13 "SEC. 2707. ENSURING THE QUALITY OF CARE.
14 "(a) IN GENERAL.-A group health plan and a health
15 insurance issuer offering group or individual health insur-
16 ance coverage shall develop and implement a reimburse-
17 ment structure that provides incentives for-
18 "( 1) the provision of high quality health care
19 under the plan or coverage in a manner that in-
20 cludes-
21 "(A) the implementation of case manage-
22 ment, care coordination, and chronic disease
23 management activities for treatment or services
24 under the plan or coverage;
.. _--,. L
9
1 "(B) the implementation of activities to re-
2 duce preventable hospital readmissions through
3 discharge planning under the plan or coverage;
4 "(C) the implementation of activities to
5 improve patient safety and reduce medical er-
6 rors through the appropriate use of best clinical
7 practices, evidence based medicine, and health
8 information technology under the plan or cov-
9 erage;
10 "(D) the implementation of wellness and
11 health promotion activities;
12 "(E) child health measures under section
13 1139A of the Social Security Act; and
14 "(F) culturally and linguistically appro-
15 priate care, as defined by the Secretary; and
16 "(2) substantially reflects the payment policy of
17 the Medicare program under title XVIII of the So-
18 cial Security Act and the Children's Health Insur-
19 ance Program under title XXI of such Act with Te-
20 speet to any generally implemented incentive policy
21 to promote high quality health care.
22 "(b) REGULATIONS.-Not later than [ ] after
23 the date of enactment of the American Health Choices
24 Act, the Secretary shall promulgate regulations10
1 "(1) that define the term 'generally imple-
2 mented' for purposes of subsection (a)(2); and
3 "(2) that require the expiration of a minimum
4 period of time between the date on which a policy
5 is generally implemented for purposes of subsection
6 (a)(2) and the date on which such policy shall apply
7 with respect to health insurance coverage offered in
8 the indi~dual or group market.
9 "SEC. 2708. COVERAGE OF PREVENTIVE HEALTH SERVICES.
10 "(a) IN GENERAL.-A group health plan and a health
11 insurance issuer offering group or individual health insur-
12 ance coverage shall provide coverage for and shall not im-
13 pose any cost sharing requirements (other than minimal
14 cost sharing in accordance with guidelines developed by
15 the Secretary) for-
16 "(1) items or services that have in effect a rat-
17 ing of 'A' or 'B' in the current recommendations of
18 the United States Preventive Services Task Force;
19 "(2) immunizations that have in effect a rec-
20 ommendation from the Advisory Committee on Im-
21 munization Practices of the Centers for Disease
22 Control and Prevention with respect to the indi-
23 vidual involved; and
24 "(3) 'with respect to infants, children and ado-
25 lescents, preventive care and screenings provided for
11
1 m the comprehensive guidelines supported by the
2 Health Resources and Services Administration.
3 "(b) SITES OF GARE.-Nothing in subsection (a)
4 shall be construed to prohibit a group health plan or a
5 health insurance issuer offering group or individual health
6 insurance coverage from establishing conditions for cov-
7 erage for the services described in subsection (a) that re-
8 quires that such services be [performed by providers with
9 appropriate expertisen.
10 "(c) INTERVAL.-
11 "(1) IN GENERAL.-The Secretary shall estab-
12 lish a minimum interval between the date on which
13 a recommendation described in subsection (a)(l) or
14 (a)(2) or a guideline under subsection (a)(3) IS
15 issued and the date on which the requirement de-
16 scribed in subsection (a) is effective with respect to
17 the service described in such recommendation or
18 guideline.
19 "(2) MINIMulII.-The Secretary shall provide
20 that the interval described in paragraph (1) is not
21 less than [_·_l
22 "SEC. 2709. EXTENSION OF DEPENDENT COVERAGE.
23 "(a) IN GENERAL.-A group health plan and a health
24 insurance issuer offering group or individual health insur-
25 ance coverage that provides dependant coverage of chil12
1 men shall make available such coverage for children who
2 are not more than 26 years of age.
3 "(b) REGULATIONS.-The Secretary shall promul-
4 gate regulations to define the scope of the dependants to
5 which coverage shall be made available under subsection
6 (a).
7 "SEC. 2710. NO LIFETIME OR ANNUAL LIMITS.
8 "A groJp health plan and a health insurance issuer
9 offering group or individual health insurance coverage
10 may not establish lifetime or annual limits on benefits for
11 any participant or beneficiary.".
12 PART II-PROVISION APPLICABLE TO THE
13 GROUP MARKET
14 SEC. 121. AMENDMENT TO THE PUBLIC HEALTH SERVICE
15 ACT.
16 (a) IN GENERAL.-Subpart 2 of part A of title
17 xx:vn of the Public Health Service Act (42 U.S.C.
18 300gg-4 et seq.) is amended by adding at the end the fol-
19 lowing:
20 "SEC. 2719. PROHIBITION OF DISCRIMINATION BASED ON
21 SALARY.
22 "(a) IN GENERAL.-A group health plan and a health
23 insurance issuer offering group health insurance coverage
24 may not establish rules relating to the health insurance
25 coverage eligibility (including continued eligibility) of any
13
1 full-time employee under the terms of the plan that are
2 based on the total hourly or annual salary of the employee.
3 "(b) LIMITATION.-Subsection (a) shall not be con-
4 strued to prohibit a group health plan or health insurance
5 issuer from establishing contribution requirements for en-
6 rollment in the plan or coverage that provide for the pay-
7 ment by employees with lower hourly or annual compensa-
8 tion of a 100~er dollar or percentage contribution than the
9 payment required of a similarly situated employees with
10 a higher hourly or annual compensation.".
11 (b) TECHNICAL AMENDMENTS.-Subpart 3 of part
12 A of title XXVII of the Public Health Service Act (42
13 U.S.C. 300gg-11 et seq.) is repealed.
14 PART III-OTHER PROVISIONS
15 SEC. 131. APPLICABILITY.
16 (a) EXCLUSION OF CERTAIN PLANs.-Section 2721
17 of the Public Health Service Act (42 U.S.C. 300gg-21)
18 is amended-
19
20
21
22
23
(1) by striking subsection (a);
(2) in subsection (b)-
(A) in paragraph (1), by striking "1
through 3" and inserting "1 and 2"; and
(B) in paragraph (2)-
14
1 (i) in subparagraph (A), by striking
2 "subparagraph (D)" and inserting "sub-
3 paragraph (D) or (E)";
4 (ii) by striking "1 through 3" and in-
S serting "1 and 2"; and
6 (iii) by adding at the end the fol-
7 lovving:
8 ; "(E) ELECTION NOT APPLICABLE.-The
9 election described in subparagraph (A) shall not
lObe available with respect to the provisions of
11 subpart 1.";
12 (3) in subsection (c), by striking "1 through 3
13 shall not apply to any group" and inserting "1 and
14 2 shall not apply to any individual coverage or any
15 group"; and
16 (4) in subsection (d)-
17 (A) in paragraph (1), by striking "1
18 through 3 shall not apply to any group" and in-
19 serting "1 and 2 shall not apply to any indi-
20 vidual coverage or any group";
21 (E) in paragraph (2)-
22 (i) in the matter preceding subpara-
23 graph (A), by striking "1 through 3 shall
24 not apply to any group" and inserting "1
1
2
3
4
5
6
7
8
9
10
.--_L_ .....
15
and 2 shall not apply to any individual coverage
or any group"; and
(ii) in subparagraph (C), by inserting
"or, with respect to individual coverage,
under any health insurance coverage maintained
by the same health insurance
issuer"; and
(C) in paragraph (3), by striking "any
group" and inserting "any individual coverage
or any group".
11 (b) ENFORCEMENT.-Section 2722(a) of the Public
12 Health Service Act (42 U.S.C. 300gg-22(a)) is amended-
13 (1) in paragraph (1), by striking "the small or"
14 and inserting "the individual, small, or"; and
15 (2) in paragraph (2), by inserting "or individual
16 health insurance coverage" after "group health
17 plans".
18 (c) PREEMPTION; STATE FIJEXIBIUTY; CONSTRUC-
19 TION.-Section 2723(a)(1) of the Public Health Service
20 Act (42 U.S.C. 300gg-23(a)(1)) is amended by striking
21 "group" and inserting "individual or group".
22 . (d) No CHANGES TO EXISTING POLICIES.-
23 (1) OPTION TO RETAIN CURRENT INSURANCE
24 COVERAGE.-With respect to a group health plan or
25 health insurance coverage in which an individual was
16
1 enrolled prior to the effective date of this title, this
2 subtitle (and the amendments made by this subtitle)
3 shall not apply to such plan or coverage.
4 (2) ALLOWANCE FOR FAMILY MEl\IBERS TO
5 JOIN CURRENT COVERAGE.-With respect to a group
6 health plan or health insurance coverage in which an
7 individual was enrolled prior to the effective date of
8 this titl~ and which is renewed after such date, fam-
9 ily members of such individual shall be permitted to
10 enroll in such plan coverage.
11 (3) No ADDITIONAL BENEFIT.-Paragraph (1)
12 shall only apply to individuals described in such
13 paragraph and the family members of such individ-
14 uals (as provided for in paragraph (2)).
15 SEC. 132. LIMITATION ON SELF·INSURING.
16 Subpart 2 of part A of title XXVII of the Public
17 Health Service Act (42 U.S.C. 300gg-4 et seq.), as amend-
18 ed by section 121, is further amended by adding at the
19 end the following:
20 "SEC. 2720. LIMITATION ON SELF-INSURING.
21 "A group health plan that has 250 or fewer members
22 of the group shall not self-insure such group. The Sec-
23 retary shall establish guidelines for determining the num-
24 ber of members in a group for purposes of this section.".
.--.. ....a: __. ..& ......
17
1 SEC. 133. CONFORMING AMENDMENTS.
2 (a) EMPLOYEE RETIREMENT INCOME SECURITY ACT
3 OF 1974.-Subpart C of part 7 of subtitle B of title I
4 of the Employee Retirement Income Security Act of 1974
5 (29 U.S.C. 1191 et seq.) is amended by adding at the end
6 the following: [Note, additional conforming changes to
7 ERISA could go here.]
8 "SEC. 735. AP,P LICATION OF CERTAIN SUPERCEDING PRO·
9 VISIONS.
10 "Except as otherwise provided in part A title XXVII
11 of the Public Health Service Act, effective beginning J anu-
12 ary 1, 20-----, any provision of this part that conflicts
13 with a provisions of such part A shall be superceded by
14 such provision of such part A.".
15 (b) INTERNAL REVENUE CODE OF 1986.-
16 (1) IN GENERAL.-Subchapter C of chapter
17 100 of the Internal Revenue Code of 1986 is amend-
18 ed by adding at the end the following: [Note, addi-
19 tional conforming changes to the IRC could go
20 here.]
21 "SEC. 9835. APPLICATION OF CERTAIN SUPERCEDING PRO-
22 VISIONS.
23 "Except as otherwise provided in part A of title
24 XXVII of the Public Health Service Act, effective begin-
25 ning January 1, 20 __ , any provision of this subchapter
18
1 that conflicts with a provisions of such part A shall be
2 superceded by such provision of such part A." .
3 (2) CLERICAL AMENDMENT.-The table of sec-
4 tions for subchapter C of chapter 100 of the Inter-
S nal Revenue Code of 1986 is amended by adding at
6 the end the following new item:
"Sec. 9835. Application of certain superceding provisions.".
7 SEC. 134. MISCELLANEOUS.
8 (a) IN GENERAL.-Except as otherwise provided in
9 subsection (b), tIns subtitle (and the amendments made
10 by this subtitle) shall become effective with respect to a
11 State on the earlier of-
12 (1) the date that such State enacts or modifies
13 their State laws to conform such laws to the require-
14 ments of this subtitle (and amendments); or
15 (2) the date that is [_] years after the date
16 of enactment of this Act.
17 (b) IMMEDIATE APPLICABILITY.-Section 2704 of
18 the Public Health Service Act (as added by section 101)
19 shall become effective on the date of enactment of this
20 section.
21 (c) SPECiAL RULE FOR COLLECTIVE BARGAINING
22 AGREEMENTS.-In the case of health insurance coverage
23 maintained pursuant to one or more collective bargaining
24 agreements between employee representatives and one or
25 more employers ratified before the date of the enactment
19
1 of this Act, the provisions of this subtitle (and the amend-
2 ments made by this subtitle) shall not apply to plan years
3 beginning before the later of-
4 (1) the date on which the last of the collective
5 bargaining agreements relating to the coverage ter-
6 minates (determined without regard to any extension
7 thereof agreed to after the date of the enactment of
;
8 this Act); or
9 (2) the date that is after the end of the 12th
10 calendar month following the date of enactment of
11 this Act.
12 For purposes of paragraph (1), any coverage amendment
13 made pursuant to a collective bargaining agreement relat-
14 ing to the coverage which amends the coverage solely to
15 conform to any requirement added by tIns subtitle (or
16 amendments) shall not be treated as a termination of such
17 collective bargaining agreement.
18 Subtitle B-Available Coverage for
19 All Americans
20 SEC. 141. BUILDING ON THE SUCCESS OF THE FEDERAL
21 EMPLOYEES HEALTH BENEFIT PROGRAM SO
22 ALL AMERICANS HAVE AFFORDABLE HEALTH
23 BENEFIT CHOICES.
24 (a) FIl\T})INGS.-The Senate finds that20
1 (1) the Federal employees health benefits pro-
2 gram under chapter 89 of title 5, United States
3 Code, allows Members of Congress to have afford-
4 able choices among competing health benefit plans;
5 (2) the Federal employees health benefits pro-
6 gram ensures that the health benefit plans available
7 to Memb,e rs of Congress meet minimum standards of
8 quality and effectiveness;
9 (3) millions of Americans have no meaningful
10 choice in health benefits, because health benefit
11 plans are either unavailable or unaffordable; and
12 (4) all Americans should have the same kinds
13 of meaningful choices of health benefit plans that
14 Members of Congress, as Federal employees, enjoy
15 through the Federal employees health benefits pro-
16 gram.
17 (b) SENSE OF THE SENATE.-It is the sense of the
18 Senate that Congress should establish a means for all
19 Americans to enjoy affordable choices in health benefit
20 plans, in the same manner that Members of Congress have
21 such choices through the Federal employees health bene-
22 fits program.
21
1 SEC. 142. AFFORDABLE HEALTH CHOICES FOR ALL AMERI-
2 CANS.
3 (a) PURPOSE.-It is the purpose of this section to
4 facilitate the establishment of Affordable Health Benefit
5 Gateways in each State, with appropriate flexibility for
6 States in establishing and administering the Gateways.
7 (b) AMERICAN HEALTH BENEFIT GATEWAYS.-The
8 Public Health Service Act ( 42 U.S.C. 201 et seq.) is
9 amended by adding at the end the following:
10 "TITLE XXXI-AFFORDABLE
11 HEALTH CHOICES FOR ALL
12 AMERICANS
13 "Subtitle A-Affordable Choices
14 "SEC. 3101. AFFORDABLE CHOICES OF HEALTH BENEFIT
15 PLANS.
16 "(a) AsSISTANCE TO STATES TO ESTABLISH AMER-
17 ICAN HEALTH BENEFIT GATEWAYS.-
18 "(1) PLANNING AND ESTABLISHMENT
19 GRANTS.-Not later than 60 days after the date of
20 enactment of this section, the Secretary shall make
21 awards, from amounts appropriated under para-
22 graph (5), to States in the amount specified in para-
23 graph (2) for the uses described in paragraph (3).
24 "(2) AMOUNT SPECIFIED.-
25 "(A) TOTAL DETERMINED.-For each fis-
26 cal year, the Secretary shall determine the total
1
2
3
4
5
6
7
8
9
10
22
amount that the Secretary will make available
for grants under this subsection.
"(B) STATE AMOUNT.-For each State
that is awarded a grant under paragraph (1),
the amount of such grants shall be based on a
formula established by the Secretary under
which each State shall receives an award in an
;
amount that is based on the following two components:
"(i) A mlmmum amount for each
11 State.
12 "(ii) An additional amount based on
13 population.
14 "(3) USE OF FUNDs.-A State shall use
15 amounts awarded under this subsection for activities
16 (including planning activities) related to establishing
17 an American Health Benefit Gateway, as described
18 in subsection (b).
19 "(4) RENEWABILITY OF GRANT.-
20 "(A) IN GEl\TERAL.-The Secretary may
21 renew a grant awarded under paragraph (1) if
22 the State recipient of such grant-
23 "(i) is making progress, as determined
24 by the Secretary, toward-
25 "(I) establishing a Gateway; and
23
1 "(II) implementing the reforms
2 described subtitle A of title I of the
3 .American Health Choices Act; and
4 "(ii) is meeting such other bench-
5 marks as the Secretary may establish.
6 "(B) LIMITATION.-If a State is an estab-
7 lishing State or a participating State (as de-
8 firied in section ), such State shall not be
9 eligible for a grant renewal under subparagraph
10 (A) as of the second fiscal year following the
11 date on which such State was deemed to be an
12 establishing State or a participating State.
13 "(5) AUTHORIZATION OF APPROPRIATIONS.-
14 There are authorized to be appropriated such sums
15 as may be necessary to carry out this subsection in
16 each of fiscal years 2009 through [20 __ 1-
17 "(b) A1VIERICAN HEALTH BENEFIT GATEWAY8.-An
18 American Health Benefit Gateway (referred to in this sec-
19 tion as a 'Gatewai) means a mechanism that-
20 "(1) facilitates the purchase of health insurance
21 coverage and related insurance products through the
22 Gateway at an affordable price by qualified individ-
23 uals and qualified employer groups; and
24 "(2) meets the requirements of subsection (c).
25 "(c) REQUIREMENTS.-
24
1 "(1) VOLUNTARY NATURE OF GATEWAY.-
2 "(A) CHOICE TO ENROLL OR NOT TO EN-
3 ROLL.-A qualified individual shall have the
4 choice to enroll or not to enroll in a qualified
5 health plan or to participate in a Gateway.
6 "(B) PROHIBITION ON COMPELLED EN-
7 ROL,L MENT.-No individual shall be compelled
8 to enroll in a qualified health plan or to partici-
9 pate in a Gateway.
10 "(2) ESTABLISID!.ENT.-A Gateway shall be es-
11 tablished by-
12 "(A) a State, in the case of an establishing
13 State (as described in section 3104); or
14 "(B) the Secretary, in the case of a par-
15 ticipating State (as described in section 3104).
16 "(3) OFFERING OF Cov"'ERA.GE.-
17 "(A) IN GENERAL.-A Gateway shall make
18 available qualified health plans to qualified indi-
19 viduals and qualified employers.
20 "(B) INCLUsION.-In making available
21 coverage pursuant to subparagraph (A), a Gate-
22 way shall include 1 or more affordable access
23 plans.
24 "(C) LIMITATION.-A Gateway may not
25 make available any health plan or other health
Lii3 .J ]j
25
1 insurance coverage that is not a qualified health
2 plan.
3 "(D) ALLOWANCE TO OFFER.-A Gateway
4 may make available a qualified health plan not-
5 withstanding any provision of law that may re-
6 quire benefits other than the essential health
7 ben,e fits specified under section 3103(h).
8 "(4) FUNCTIONS.-A Gateway shall, at a min-
9 Imum-
10 "(A) establish procedures for the certifi-
11 cation of qualified health plans for the offering
12 of such plans through the Gateway;
13 "(B) carry out the activities described 111
14 paragraph (7);
15 "(e) develop and make available tools to
16 allow consumers to receive accurate information
17 on-
18 "(i) expected premlUms and out of
19 pocket expenses;
20 "(ii) the availability of in-network and
21 out-of-network providers;
22 "(iii) the costs of any surcharge as-
23 sessed under paragraph (5); and
24 "(iv) such other matters relating to
25 consumer costs and expected experience
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under the plan as a Gateway may deternnne
necessary;
"(D) utilize the administrative simplification
measures and standards developed under
section [ 1;
"(E) enter into agreements, to the extent
determined appropriate by the Gateway, with
navigators, as described in section 3105;
"(F) facilitate the purchase of coverage for
long-term services and supports; and
"(G) collect, analyze, and respond to complaints
and concerns from enrollees regarding
coverage provided through the Gateway.
"(5) SURCHARGES.-
"(A) IN GENERAL.-A Gateway may assess
a surcharge on all health insurance issuers
offering qualified health plans through the
Gateway to pay for the administrative and operational
expenses of the Gateway.
"(B) LIMITATION.-A surcharge described
in subparagraph (A) may not exceed [_] percent
of the premiums collected by a qualified
health plan.
"(6) RISK ADJUSTMENT PAYMENT."(
A) ESTABLISHING STATES.-
' .. 2--
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"(i) Low ACTUARIAL RISK PLAN8.Using
the criteria and methods developed
under subparagraph (B), each establishing
State or participating State (as defined in
section 3104) shall assess a charge on
health plans and health insurance issuers
(with respect to health insurance coverage)
if the actuarial risk of the enrollees of such
plans or coverage for a year is less than
the average actuarial risk of all enrollees in
all plans or coverage in such State for such
year that are not self-insured group health
plans (which are subject to the provisions
of the Employee Retirement Income Security
Act of 1974).
"(ii) HIGH ACTUARIAL RISK PLANS.U
sing the criteria and methods developed
under subparagraph (B), each establishing
State or participating State (as defined in
section 3104) shall provide a payment to
health plans. and health insurance issuers
(with respect to health insurance coverage)
if the actuarial risk of the enrollees of such
plans or coverage for a year is greater
than the average actuarial risk of all en1
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rollees in all plans and coverage in such
State for such year that are not self-insured
group health plans (which are subject
to the provisions of the Employee Retirement
Income Security Act of 1974).
"(B) CRITERIA AND METHODs.-The Secretary,
in consultation with States shall establish
criteria and methods to be used in carrying
out the risk adjustment activities under this
paragraph. The Secretary may utilize criteria
and methods sinrilar to the criteria and methods
utilized under part D of title XVIII of the
Social Security Act.
"(C) RETROSPECTIVE ·ADJUSTMENT.-The
criteria and methods developed under subparagraph
(B) shall provide for payments under
subparagraph (A) to be calculated on a retrospective
basis.
"(7) FACILITATING ENROLLMENT.-
"(A) IN GENERAL.-A Gateway shall implement
policies and procedures to-
"(i) facilitate the identification of individuals
who lack qualifYing coverage; and
"(ii) assist such individuals in enrollmgm1
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".SIl2111.1111 __ IIIJIiIIIi,II. ~.
29
"(I) a qualified health plan that
is affordable and available to such individual,
if such individual is a qualified
individual;
"(II) the medicaid program
under title XIX of the Social Security
Act, if such individual is eligible for
such program;
"(III) the CHIP program under
title XXI of the Social Security Act, if
such individual is eligible for such
program; or
"(IV) other Federal health care
programs including low-income costsharing
programs provided under titles
XVIII and XIX of the Social Security
Act.
"(B) CHOICE FOR INDIVIDUAl,S EI,IGIBI,E
FOR CHIP.-A qualified individual who is eligible
for the Children's Health Insurance Program
under title XXI of the Social Security Act
may elect to enroll in such program or in a
qualified health plan. Where such individual is
a minor child, such election shall be made by
the parent or guardian of such child.
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"(C) o-VERSIGHT.-The Secretary shall
oversee the implementation of subparagraph
(A)(iii) to ensure that individuals are directed
to enroll in the program most appropriate
under such subparagraph for each such individual.
"(D) ACCESSIBILITY OF UATERIALS.-Any
;
Inaterials used by a Gateway to carry out this
paragraph shall be provided in a form and manner
calculated to be understood by individuals
who may apply to be enrollees in a qualified
health plan, taking into account potential language
barriers and disabilities of individuals.
"(8) CONSULTATION.-
"(A) IN GENERAL.-A Gateway shall consult
with stakeholders relevant to carrying out
the activities under this subsection, including"(
i) consumers who are enrollees in
qualified health plans;
"(ii) individuals with experience in facilitating
enrollment :in plans described in
section [ 1;
"(iii) State Medicaid offices; and
"(iv) advocates for enrolling hard to
reach populations.
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"(B) PROCESS.-[Note that someone
wanted a process here]
"(9) LINKAGE.-A Gateway shall (through, to
the extent practicable, the use of information technology)
implement procedures and policies to facilitate
the enrollment of individuals, where eligible, in
other public programs, such as the Temporary As-
; .
sistance for Needy Families program established
under part A of title IV of the Social Security Act,
and the supplemental nutrition assistance program
established under the Food and Nutrition Act of
2008, or other Federal program identified by the
Secretary ..
"(10) STANDARDS AND PROTOCOLS.-The Secretary,
in consultation with the Office of the National
Coordinator for Health Information Technology,
shall develop interoperable and secure standards
and protocols that facilitate enrollment of individuals
in Federal and State health and human services
programs. The Secretary shall facilitate enrollment
of individuals in such programs through methods
which shall include--
"(A) electronic matching against existing
Federal and State data to serve as evidence of
32
1 eligibility and in lieu of paper-based documenta-
2 tion;
3 "(B) capability for individuals to apply, re-
4 certify, and manage eligibility information on-
5 line; and
6 "( C) other functionalities necessary to pro-
7 vide, eligible individuals with a streamlined en-
8 rollment process.
9 "(11) NOTIFICATION.-With respect to the
10 standards and protocols developed under subsection
11 (11), the Secretary-
12 "(A) shall notify States of such standards
13 and protocols; and
14 "(B) may require, as a condition of receiv-
15 ing Federal funds, that States or other entities
16 incorporate such standards and protocols into
17 such investments.
18 "(d) CERTIFICATION.-
19 "(1) HEALTH PLANs.-A Gateway may certify
20 a health plan if-
21 "(A) such health plan meets the reqmre-
22 ments of section [ 1; and
23 "(B) the Gateway determines that making
24 available such health plan through such Gate-
25 way is in the interests of qualified individuals
33
1 and qualified employers in the States or States
2 in which such Gateway operates.
3 "(2) AFFORDABLE ACCESS PLANS.-An afford-
4 able access plan is deemed to have a certification
5 under paragraph (1) with respect to each Gateway.
6 "(e) GUIDANCE.-The Secretary shall develop guid-
7 ance that may be used by a Gateway to carry out the ac- ,
8 tivities described in subsection (c).
9 "(f) FLEXIBILITY.-
lO "(1) REGIONAL OR OTHER INTERSTATE GATE-
11 WAys.-A Gateway may operate in more than one
12 State, provided that each State in which such Gatel3
way operates permits such operation.
14 "(2) SUBSIDIARY GATEWAYS.-A State may es-
15 tablish one or more subsidiary Gateway, provided
16 that-
17 "(A) each such Gateway serves a geo-
18 graphically distinct area; and
19 "(B) the area served by each such Gate-
20 way is at least as large as a community rating
21 area described in [section __ 1-
22 "(g) PORTALS TO STATE GATEWAY.-The Secretary
23 shall establish a mechanism, including an Internet
24 website, through which a resident of any State may iden-
25 tify any Gateway operating in such State.
34
1 "(h) CHOICE.-
2 "(1) QUALIFIED INDIVIDUALS.-A qualified in-
3 dividual may enroll in any qualified health plan
4 available to such individual.
5 "(2) QUALIFIED EMPLOYERS .. -A qualified em-
6 ployer may choose to offer to employees any quali-
7 fied hea,lt h plan.
8 "(3) SELF-EMPLOYED INDIVIDUALS.-
9 "(A) DEEMING.-An individual who is self-
10 employed (as defined for purposes of the Inter-
11 nal Revenue Code of 1986) shall be deemed to
12 be a qualified employer unless such individual
13 notifies the applicable Gateway that such indi-
14 vidual elects to be considered a qualified indi-
15 vidual.
16 "(B) ELIGIBILITY.-In the case of a self-
17 employed individual making the election de-
18 scribed in subparagraph (A)-
19 "(i) the income of such individual for
20 purposes of section 3111 shall be deemed
21 to be the total business income of such in-
22 dividual as described in [IRC definition to
23 be supplied}; and
24 "(ii) premium payments made by such
25 individual to a qualified health plan shall
35
1 riot be treated as mcome for purposes of
2 [insert appropriate reference to Internal
3 Revenue Code of 1986].
4 "(i) PAYMENT OF PREMIUMS BY QUALIFIED INDI-
5 VIDUAloS.-A qualified individual enrolled in any qualified
6 health plan may pay any applicable premium owed by such
7 individual to the health msurance Issuer issuing such
8 qualified he~lth plan.
9 "(j) SINGLE RISK POOL.-A health insurance issuer
10 shall consider each enrollee in [ ____ .] to be a mem-
11 ber of a single risk pool.
12 "(k) EMPOWERING CONSUMER CHOICE.-
13 "(1) CONTIl\TUED OPERATION OF MARKET OUT-
14 SIDE GATEWAYS.-Nothing in this title shall be con-
15 strued to prohibit a health insurance issuer from of-
16 fering a health insurance policy or providing cov-
17 erage under such policy to a qualified individual
18 where such policy is not a qualified health plan.
19 "(2) CONSUlV!ER CHOICE OF PLAN.-Nothing in
20 this title shall be construed to prohibit a qualified
21 individual from enrolling in a health insurance plan
22 where such plan is not a qualified health plan.
23 "(3) CONTINUED OPERATED OF STATE BEN-
24 EFIT REQUIREMENTs.-Nothing in this title shall be
25 construed to terminate, abridge, or limit the oper36
1 ation of any requirement under State law with re-
2 spect to any policy or plan that is not a qualified
3 health plan to offer benefits required under State
4 law.
5 "(1) REGUIATIONs.-The Secretary shall issue regu-
6 lations with respect to qualified health plans regarding at
7 least the following:
8 "(1) Marketing practices.
9 "(2) Methods to ensure that insurance products
10 are simple, comparable, and structnred for ease of
11 consumer choice.
12 "(3) Network adequacy.
13 "[Note: The following subsection IS a
14 placeholder; more discussion is needed regarding
15 State and Federal roles.]
16 "(m) No INTERFERENCE WITH STATE REGUUTORY
17 AUTHORITY.-N otlling in this title shall be construed to
18 preempt any State law regarding market conduct or re-
19 lated consumer protections.
20 "(n) RESPONSIBILITY OF THE SECRETARY TO FA-
21 CILITATE ENROLL:MENT.-
22 "(1) El\TROLLMENT.-The Secretary shall lill-
23 plement policies and procedures to-
24 "(A) facilitate the identification of individ-
25 uals who lack qualifying coverage;
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"(B) assist in the enrollment of an individual
identified under subparagraph (A) in a
qualified health plan that is affordable and
available to such individual if such individual is
a qualified individual;
"(C) facilitate enrollment m health plans
offered through a Gateway through existing
pr~grams supported or administered by the
Federal government, where appropriate;
"(D) facilitate the enhanced use of electronic
enrollment, including overseeing the establishment
of Federal standards for computerbased
screening and enrolhnent, including electronic
signature requirements;
"(E) provide grants to enhance community-
based enrollment to-
"(i) States to assist such States in"(
I) contracting with qualified
technology vendors to develop electronic
enrollment software systems;
"(II) establishing Statewide
helplines for enrolhnent assistance
and referrals; and
"(III) establishing public education
campaigns through grants to
38
1 States and qualifying organizations to
2 design and implement public edu-
3 cation campaigns targeting uninsured
4 and traditionally underserved commu-
5 nities; and
6 "(ii) community-based organizations
7 for infrastructure and training to establish
8 electronic assistance programs.
9 "(2) VOLUNTARY CERTIFICATION.-
10 "(A) VOLUNTARY REQUESTS.-A health
11 plan or health insurance issuer may request
12 that the Secretary certify that such health plan
13 is a qualified health plan.
14 "(B) METHODs.-The Secretary may es-
15 tablish common processes for providing the cer-
16 tifications described in subparagraph (A).
17 "(C) FEEs.-The Secretary may charge a
18 reasonable fee for conducting providing a cer-
19 tification described in subparagraph (A).
20 "( 0) QUALITY IMPROVEMENT.-
21 "(1) ENHANCING PATIENT SAFETY.-Beginning
22 on January 1, [20_~] a qualified health plan may
23 contract with-
24 "(A) a hospital with greater than [_~]
25 beds only if such hospitalLiQ
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'i. ~----..
"(i) utilizes a patient safety evaluation
system as described in part C of title IX;
and
"(ii) implements a mechanism to ensure
that each patient receives counseling
and comprehensive discharge planning that
includes an after-care plan by an appropriate
health care professional; or
"(B) a health care provider if such provider
implements such mechanisms to improve
health care quality as the Secretary may by regulation
require.
"(2) EXCEPTIONs.-The Secretary may establish
reasonable exceptions to the requirements described
in paragraph (1).
16 "SEC. 3102. FINANCIAL INTEGRITY.
17 "(a) ACCOUNTING FOR EXPENDITURES.-
18 "(1) IN GENERAL.-A State shall keep an accu-
19 rate accounting of all activities, receipts, and ex-
20 penditures of any Gateway operating in such State
21 and shall annually submit to the Secretary a report
22 concerning such accountings.
23 "(2) II\TVESTIGATIONs.-The Secretary may in-
24 vestigate the affairs of a Gateway, may examine the
25 properties and records of a Gateway, and may re40
1 quire periodical reports m relation to activities un-
2 dertaken by a Gateway. A Gateway shall fully co-
3 operate in any investigation conducted under this
4 paragraph.
5 "(3) AUDITS.-A Gateway shall be subject to
6 annual audits by the Secretary.
7 "(4) PATTERN OF ABusE.-If the Secretary de-
8 termines that a Gateway or a State has engaged in
9 repeated acts of serious misconduct with respect to
10 compliance with, or carrying out activities required,
11 under this title, the Secretary may rescind from pay-
12 ments otherwise due to such State involved under
13 this or any other Act administered by the Secretary
14 an amount not to exceed 1 percent of such payments
15 per year until corrective actions are taken by the
16 State that are determined to be adequate by the
17 Secretary.
18 "(5) PROTEOTIONS AGAINST FR.'\.UD AND
19 ABusE.-With respect to activities carried out under
20 this title, the Secretary shall implement any measure
21 or procedure that-
22 "(A) the Secretary determines is appro-
23 priate to reduce fraud and abuse in the admin-
24 istration ofthis title; and
41
"(B) the Secretary has authority for under
this title or any other Act;
1
2
3 "(b) GAO OVERSIGHT .-N ot later than [.~~_],
4 the Comptroller General shall conduct an ongoing study
5 of Gateway activities and the enrollees in qualified health
6 plans offered through Gateways. Such study shall re-
7 VIew-
8 "(1) the operations and administration of Gate-
9 ways, including surveys and reports of qualified
10 health plans offered through Gateways and on the
11 experience of such plans (including data on enrollees
12 in Gateways and individuals pnrchasing health in-
13 snrance coverage outside of Gateways), the expenses
14 of Gateways, claims statistics relating to qualified
15 health plans, complaints data relating to such plans,
16 and the manner in which Gateways meets their
17 goals;
18 "(2) any significant observations regarding the
19 utilization and adoption of Gateways; and
20 "(3) where appropriate, recommendations for
21 improvements in the operations or policies of Gate-
22 ways.
23 "SEC. 3103. SEEKING THE BEST MEDICAL ADVICE.
24 "(a) SEEKING THE BEST MEDICAL ADVICE.-Sec-
25 retary, in consultation with medical experts at the Na.~.
42
1 tional Institutes of Health, the Centers for Disease Con-
2 trol and Prevention, and other centers of excellence,
3 shall-
4 "( 1) establish a council to be known as the
5 'Medical Advisory Council' (referred to in tIlls sec-
6 tion as the 'Council') to make recommendations to
7 the Se,c retary on the matters described in sub-
8 sections (h) and (i); or
9 "(2) contract with the Institute of Medicine of
10 the National Academies of Science to establish the
11 Council described in paragraph (1).
12 "(b) COMPOSITION.-
13 "(1) IN GENERAL.-The Council shall be com-
14 posed of members with appropriate expertise m
15 order to carry out subsections (h) and (i).
16 "(2) TERMs.-Each member appointed to the
17 Council shall serve for a term of [ __ ] years, ex-
18 cept that an individual appointed to fill a vacancy on
19 the Council shall serve for the unexpired term of the
20 vacancy for which such individual is appointed. A
21 member may be reappointed to the Council.
22 "(c) ADMINISTRATIVE PROVISIONS.-
23 "(1) QuoRuM.-A majority of the members of
24 the Council shall constitute a quorum for purposes
25 of conducting business, and the affirmative vote of
43
1 a majority of .members shall be necessary and suffi-
2 cient for any action taken. No vacancy in the mem-
3 bership of the Council shall impair the right of a
4 quorum to exercise all the rights and duties of the
5 Council.
6 "(2) COMPENSATION AND EXPENSES.-Mem-
7 bers of the Council shall serve without compensation,
8 except'that while serving away from home and the
9 member's regular place of business, such a member
10 may be allowed travel expenses, as authorized by the
11 Chairperson of the Council.
12 "(3) STAFF, ETc .. -The Council shall have the
13 authority to employ such staff as may be necessary
14 to carry out its duties under this section.
15 "(4) DETAIL OF FEDERAL GOVERNMENT EM-
16 PLOYEES.-An employee of the Federal Government
17 may be detailed to the Council without reimburse-
18 ment. The detail of the employee shall be without
19 interruption or loss of civil service status or privi-
20 lege.
21 "(5) HEARINGS.-The Council may hold such
22 hearings, sit and act at such times and places, take
23 such testimony, and receive such evidence as the
24 Council considers advisable to carry out this title.
44
1 "(d) SUBMISSION OF REPORTS.-Not later than
2 [ ] after the date of enactment of this title, and
3 annually thereafter, the Council shall submit to the Sec-
4 retary a report containing the recommendations described
5 in subsection (a).
6 "(e) REVIEW OF REPORTS BY SECRETARY.-
7 "(1) SCIENTIFIC AND MEDICAL VALIDITY.-Not
8 later than 30 days after receiving a report under
9 subsection (d), the Secretary, in consultation with
10 medical experts at the National Institutes of Health,
11 the Centers for Disease Control and Prevention, and
12 other centers of excellence, shall review such report
l3 for scientific and medical validity.
14 "(2) REVISION REQUESTED.-If the Secretary
15 determines that any recommendation contained in a
16 report received under subsection (d) is not scientif-
17 ically or medically valid, the Secretary may request
18 revisions to such report.
19 "(3) REVISED REPORT.-Not later than 30
20 days after the receipt of a request for revisions from
21 the Secretary, as described in paragraph (2), the
22 Council shall submit a report which may contain
23 modifications to the recommendations made by the
24 Council in response to such request.
45
1 "(f) SUBMISSION OF REPORT TO CONGRESS.-Not
2 later than [ __ ] days after receipt of a report as de-
3 scribed in subsection (e)(l)(B) or subsection (e)(3), the
4 Secretary shall formally submit such report to-
5 "(1) the Committee on Education and Labor,
6 the Committee on Energy and Commerce, and the
7 Committee on Ways and Means of the House Rep-
8 resentatives; and
9 "(2) the Committee on Health, Education,
10 Labor, and Pensions and the Committee on Finance
11 of the Senate.
12 "(g) CONGRESSIONAL REVIEW.-
13 "(1) RESOLUTION OF DISAPPROVAL.-For plan
14 years beginning in the year described in paragraph
15 (3), the recommendations contained in a report sub-
16 mitted under subsection (f) shall be considered to be
17 applicable unless, within [ __ ] calendar days after
18 the date on which Congress receives such report,
19 there is enacted into law a joint resolution dis-
20 approving such report in its entirety.
21 "(2) CONTENTs.-For the purpose of this sec-
22 tion, the term 'joint resolution' means only a joint
23 resolution-
24
25
"(A) that is introduced not later than
[ __ ] calendar days after the date on which
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46
the report referred to in subsection (f) are received
by Congress;
"(B) which does not have a preamble;
"(C) the title of which is as follows: [insert
title language (Joint resolution relating to
the disapproval of ___ )]; and
"(D) the matter after the resolving clause
;
of which is as follows: 'That Congress disapproves
the recommendations submitted by the
"(3) YEAR DESCRIBED.-
"(A) TRANSMISSION BEFORE [D.I\.TE].-If
a report is submitted to Congress under subsection
(f) not later than [date], then the year
described in this paragraph is the year following
the year in which the report is submitted.
"(B) TRANSMISSION AFTER [DATE] .-If
the report is submitted to Congress under subsection
(f) after [date], then the year described
in this paragraph is the second year follovving
the year in which the report is transmitted.
"(4) EFFECT OF DISAPPROVAL.-
"(A) GENERAL RULE.-If Congress disapproves
a report submitted under subsection
(f), then the recommendations contained in the
47
1 most previous report that was not disapproved
2 under this subsection shall continue to apply.
3 "(B) DISAPPROVAL OF INITIAL REPORT.-
4 If Congress disapproves the initial report sub-
S mitted under subsection (f) in accordance with
6 this subsection, the Secretary shall submit a re-
7 port directly to Congress (and this section shall
8 ap~ly to such report).
9 "(h) ELEMENTS OF REPORT.-The report of the
10 Council described in subsection (d) shall contain rec-
11 ommendations on at least the following:
12 "(1) The schedule of items and services (includ-
13 ing the amount, duration, and scope of such items
14 and services) that constitute the essential health
15 care benefits eligible for credits under section 3111,
16 where such schedule shall include items and services
17 in at least the following general categories:
18 "(A) Ambulatory patient services.
19 "(B) Emergency services.
20 "(C) Hospitalization.
21 "(D) Maternity and newborn care.
22 "(E) Medical and surgical care.
23 "(F) Mental health and substance abuse
24 servIces.
25 "(G) Prescription drugs.
48
1 "(H) Rehabilitative, habilitative, and lab-
2 oratory services.
3 "(I) Preventive and wellness services.
4 "(J) Pediatric services.
5 "(2) The criteria that coverage must meet to be
6 considered minimum qualifying coverage.
7 "(3), T he conditions under which coverage shall
8 be considered affordable and available coverage for
9 individuals and families at differentincome levels.
10 "(i) REQUIRED ELEMENTS FOR CONSIDERATION.-
11 "(1) ESSENTIAL BEl\TEFITS.-In issuing rec-
12 ommendations on the matter described in subsection
13 (h) (1), the Council shall-
14 "(A) ensure that recommendations on the
15 matter described in subsection (h) (1) reflect an
16 appropriate balance among the categories de-
17 scribed in such subsection, so that benefits are
18 not unduly weighted toward any category; and
19 "(B) take into account the health care
20 needs of diverse segments of the population, in-
21 cluding women, children, persons with disabil-
22 ities, and other groups.
23 "(2) MINIMUM QUALIFYING COVERAGE.-In
24 considering the matter described in subsection
25 (h)(2), the Council1
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6
7
8
9
10
11
12
l3
14
15
16
17
18
19
20
21
22
23
24
49
"(A) shall-
"(i) exclude from meeting such CrIteria
any coverage that--
"(I) provides reimbursement for
the treatment or mitigation of-
"(aa) a single disease or
condition; or
"(bb) an unreasonably limited
set of diseases or conditions;
or
"(II) has an out of pocket limit
that exceeds the amount described in
section 223 of the Internal Revenue
Code of 1986 for the year involved;
and
"(ii) establish such criteria (taking
into account the requirements established
under clause (i)) in a manner that results
in the least practicable disl1lption of the
health care marketplace, consistent with
the g'oals and activities under this title;
and
"(B) may provide for the application of
different criteria with respect to young adults,
50
1 "(3) PROHIBITING DISCRIMINATORY BENEFIT
2 DESIGN.-[Cross reference from part Dn
3 "(j) DEFINITIONS.-In this title:
4 "(1) QUALIFYING COVERA.GE.-The term 'quali-
5 rying coverage' means-·
6 "(A) a group health plan or health insur-
7 ance coverage-
\
8 "(i) that an individual is enrolled in
9 on the date of enactment of this title; or
10 "(ii) that is described in clause (i) and
11 that is renewed by an enrollee;
12 "(B) a group health plan or health insur-
13 ance coverage that-
14 "(i) is not described in subparagraph
15 (A); and
16 "(ii) meets or exceeds the criteria for
17 minimum qualirying coverage (as defined
18 in subsection (d));
19 "(C) Medicare coverage under parts A and
20 B of title XVIII of the Social Security Act or
21 under part C of such title;
22 "(D) Medicaid coverage under a State plan
23 under title XIX of the Social Security Act,
24 other than coverage consisting solely of benefits
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
51
under section 1928 of such Act; [may need additional
elements listed]
"(E) coverage under the SCHIP program
under title XXI of the Social Security Act;
"(F) coverage under the TRICARE program
under chapter 55 of title 10, United
States Code;
, "(G) coverage under the veteran's health
care program under chapter 17 of title 38,
United States Code, but only if the coverage for
the individual involved is determined by the
Secretary to be not less than the coverage provided
under a qualified health plan, based on
the individual's priority for services as provided
under section 1705(a) of such title;
"(H) coverage under the Federal employees
health benefits program under chapter 89 of
title 5, United States Code;
"(I) a medical care program of the Indian
Health Service or of a tribal organization;
"(J) a State health benefits high risk pool;
"(K) a health benefit plan under section
2504(e) of title 22, United States Code; or
"(L) coverage under a qualified health
plan.
52
1 "(2) RELIGIOUS EXEMPTION.-For purposes of
2 this section, individual shall be deemed to have
3 qualifying coverage if such individual is an individual
4 described in section 1402(e) and (g) of the Internal
5 Revenue Code of 1986.
6 "SEC. 3104. ALLOWING STATE FLEXIBILITY.
7 "(a) OPTIONAL STATE ESTABLISHMENT OF GATE-
;
8 wAY.-During the [_l-year period following the date of
9 enactment of this section, a State may-
10 "(l)(A) establish a Gateway (as defined for
11 purposes of section 3101); .
12 "(B) adopt the insurance reform provisions as
13 provided for in title [fair insurance title); and
14 "(C) agree to make employers who are State or
15 local govermnents subject to section 3113 and 3114.
16 "(2)(A) request that the Secretary operate (for
17 a minimum period of 5 years) a Gateway in such
18 State;
19 "(B) adopt the insurance reform provisions as
20 provided for in subtitle A of title I of the American
21 Health Choices Act; and
22 "(C) agree to make employers who are state or
23 local governments subject to section 3113 and 3114;
24 or
It
53
1 "(.3) elect not to take the actions described in
2 paragraph (1) or (2).
3 "(b) ESTABLISHING STATES.-
4 "(1) IN GENERAL.-If the Secretary determines
5 that a State has taken the actions described in sub-
6 section (a)(l), any resident of that State who is an
7 eligible individual shall be eligible for credits under
8 section; [ ___ ] beginning on the date that IS
9 [ __ ] days after the date of such determination.
10 "(2) CONTINUED REVIEW.-The Secretary shall
11 est3;blish procedures to ensure continued review by
12 the Secretary of the compliance of a State with the
13 requirements of subsection (a). If the Secretary de-
14 termines that a State has failed to maintain compli-
15 ance with such requirements, the Secretary may re-
16 voke the determination under subparagraph (A).
17 "(3) DEEMING.-A State that is the subject of
18 a positive determination by the Secretary under
19 paragraph (1) (unless such determination is revoked
20 under paragraph (2)) shall be deemed to be an 'es-
21 tablishing State' beginning on the date that is
22 [. __ ~] days after the date of such determination.
23 "(c) REQUEST FOR THE SECRETARY TO ESTABLISH
24 A GATEWAY.-
54
1 "(1) IN GENERAL.-In the case of a State that
2 makes the request described in subsection (a)(2), the
3 Secretary shall determine whether the State has en-
4 acted and has in effect the insurance reforms pro-
5 vided for in subtitle A of title I of the American
6 Health Choices Act.
7 "(2), O PERATION OF GATEWAY.-
8 "(A) POSITIVE DETERMINATION.-If the
9 Secretary determines that the State has enacted
10 and has in effect the insurance reforms de-
11 scribed in paragraph (1), the Secretary shall es-
12 tablish a Gateway in such State as soon as
13 practicable after making such determination.
14 "(E) NEGATIVE DETERMINATION.-If the
15 Secretary determines that the State has not en-
16 acted or does not have in effect the insurance
17 reforms described in paragraph (1), the Sec-
18 retary shall establish a Gateway in such State
19 as soon as practicable after the Secretary deter-
20 mines that such State has enacted such re-
21 forms.
22 "(3) PARTICIPATING STATE.-The State shall
23 be deemed to be a 'participating State' on the date
24 on which the Gateway established by the Secretary
25 is in effect in such State.
55
1 "(4) ELIGIBILITY.-Any resident of a State de-
2 scribed in paragraph (3) who is an eligible individual
3 shall be eligible for credits under section 3111 begin-
4 ning on the date that is [~_] days after the date
5 on which such Gateway is established in such State.
6 "(d) FEDERAL FALLBACK IN THE CASE OF STATES
7 THAT REFU,S E TO IMPROVE HEALTH CARE COVERAGE.-
8 "(1) IN GENERAL.-Upon the expiration of the
9 []-year period following the date of enactment of
10 this section, in the case of a State that is not other-
11 wise a participating State or an establishing State-
12 "(.A) the Secretary shall establish and op-
13 erate a Gateway in such State;
14 "(B) the insurance reform provisions pro-
15 vided for in subtitle .A of title I of the .American
16 Health Choices .Act shall become effective in
17 such State, notwithstanding any contrary provi-
18 sion of State law;
19 "(C) the State shall be deemed to be a
20 'participating State'; and
21 "(D) the residents of that State who are
22 eligible individuals shall be eligible for credits
23 under section 3111 beginning on the date that
24 is [~_] days after the date on which such
25 Gateway is established, if the State agrees to
56
1 make employers who are State or local govern-
2 ments subject to section 3113 and 3114).
3 "(2) ELIGIBILITY OF INDIVIDUALS FOR CRED-
4 ITS.-With respect to a State that makes the elec-
5 tion described in subsection (a)( 3), the residents of
6 such State shall not be eligible for credits under sec-
7 tion 311,1 until such State becomes a participating
8 State under paragraph (1).
9 "SEC. 3105. NAVIGATORS.
10 "(a) IN GENERAL.-The Secretary shall award
11 grants to establishing States to enable the Gateway or
12 Gateways in such States to enter into agreements with pri-
13 vate and public entities under which such entities 'will
14 serve as navigators in accordance with this section.
15 "(b) ELIGIBILITY.-
16 "(1) IN GENERAL.-To be eligible to enter into
17 an agreement under subsection (a), an entity shall
18 demonstrate that the entity has existing relation-
19 ships with, or could readily establish relationships
20 Virith, employers and employees, and self-employed
21 individuals, likely to be eligible to participate in the
22 program under this title.
23 "(2) TYPEs.-Entities described in paragraph
24 (1) may include trade, industry and professional as-
25 sociations, commercial fishing industry organiza57
.- ... " ........ ~~~
1 tions, ranching and farming organizations, chambers
2 of commerce, unions, small business development
3 centers, and other entities that the Secretary deter-
4 mines to be capable of carrying out the duties de-
5 scribed in subsection (c).
6 "(c) DUTIES.-An entity that serves as a navigator
7 under an agreement under subsection (a) shall-
;
8 "( 1) conduct public education activities to raise
9 awareness of the program under this title;
10 "(2) distribute fair and impartial information
11 concerning enrollment in an the availability of cred-
12 its for qualified health plans;
13 "( 3) assist with enrollment in a qualified health
14 plan; and
15 "(4) provide information in a manner deter-
16 mined by the Secretary to be culturally and linguis-
17 tically appropriate to the needs of the population
18 served by the Gateway.
19 "(d) STANDARDS.-
20 "(1) IN GENERAL.-The Secretary shall estab-
21 lish standards for navigators under this section, in-
22 cluding provisions to avoid conflicts of interest.
23 Under such standards, a navigator may not-
24 "(A) be a health insurance issuer; or
58
1 "(B) receive any consideration directly or
2 indirectly from any health insurance issuer in
3 connection with the participation of any em-
4 ployer in the program under this title or the en-
5 rollment of any eligible employee in health in-
6 surance coverage under this title.
7 "(2) FAIR AND IMPARTIAL INFORMATION AND
;
8 SERVICEs.-The Secretary, in collaboration with
9 States, shall develop guidelines regarding the duties
10 described in subsection (c).".
11 (c) REQUIREMENT FOR MEDICARE PROVIDERS TO
12 ACCEPT AMOUNT OF PAYMENT UNDER AFFORDABLE Ac-
13 CESS PLAN.-
14 (1) IN GENERAL.-Section 1866(a)(1) of the
15 Social Security Act (42 U.S.C. 1395ccc(a)(1)) is
16 amended-
17
18
19
20
21
22
23
24
25
(A) III subparagraph (U), by striking
"and" at the end· ,
(B) in subparagraph (V), by striking the
period at the end and inserting ", and"; and
(C) by adding at the end the following new
subparagraph:
"(W) to accept as payment in full for an
item or service furnished to a qualified individual
(as defined in section 3100 of the Public
59
1 Health Service Act) under an affordable access
2 plan (as defined in such section) the amount of
3 payment for the item or service described under
4 such section.".
5 (2) EFFECTIVE DATE.-The amendments made
6 by this subsection shall apply to agreements entered
7 into or renewed on or after [to be supplied].
8 (d) MEDICAID STATE PLAN AMENDMENT.-
9 (1) IN GENERAL.-Section 1902(a) of the SolO
cial Security Act (42 U.S.C. 1396a(a» is amend-
11 ed-
12 (A) in paragraph (72), by striking "and"
13 after the semicolon;
14 (B) in paragraph (73), by striking the pe-
15 riod at the end and inserting "; and"; and
16 (C) by inserting after paragraph (73), the
17 following:
18 "(74) that, in the case of an individual who ap-
19 plies for medical assistance under the State plan or
20 for child health assistance or other health benefits
21 coverage under a State child health plan under title
22 XXI, and who is determined to not be eligible for as-
23 sistance under either such plan, the State shall es-
24 tablish procedures forIe
IItJ TIl? ..
60
1 "(A) advising the individual of their op-
2 tions for coverage under a qualified health plan
3 (as defined in section [31 ] of the Public
4 Health Service Act);
5 "(B) determining, in accordance with cri-
6 teria established under section [ __ ] of the
7 Public Health Service Act, whether the indi-
8 vidual is eligible for credits under section 3111
9 of such Act for coverage under a qualified
10 health plan and if so, the amount of such cred-
11 its; and
12 "(C) submitting to a qualified health plan
13 selected by the individual the information nec-
14 essary for the plan to enroll the individuaL".
15 (2) EFFECTIVE DATE.-The amendments made
16 by tIns subsection take effect on [ ___ .].
17 SEC. 143. KEY NATIONAL INDICATORS.
18 [To be supplied]
19 Subtitle C-Mfordable Coverage
20 for All Americans
21 SEC. 151. SUPPORT FOR AFFORDABLE HEALTH COVERAGE.
22 (a) IN GENERAL.-Title XXXI of the Public Health
23 Service Act, as added by section 142(a), is amended by
24 inserting after subtitle A the following:
61
1 "Subtitle B-Making Coverage
2 Mfordable
3 "SEC. 3111. SUPPORT FOR AFFORDABLE HEALTH cov-
4 ERAGE.
5 "(a) LEVELS OF COST SHARING.-
6 "(1) IN GENERAL.-The Secretary shall estab-
7 lish at least the following levels of cost sharing appli-
;
8 cable to qualified health plans:
9 "(A) A level of benefit that-
10 "(i) provides for an actuarial value
11 such that the cost sharing applicable to an
12 enrollee of such plan is between [ __ ]
13 and [ __ ] percent of the value of the
14 benefit provided (as determined by the
15 Secretary); and
16 "(ii) provides for a limit on out of
17
18
19
20
21
22
23
24
25
pocket expenditures that IS between
[ __ ] and [ ] percent of the income
of an individual v"ith a family income that
does not exceed [ __ ] percent of the
Federal poverty line for a family of the
size involved.
"(B) A level of benefit that-
"(i) provides for an actuarial value
such that the cost sharing applicable to an
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
"~""
62
enrollee of such plan is between [ ]
and [ __ ] percent of the value of the
benefit provided; and
"(ii) provides for a limit on out of
pocket expenditures that IS betw"een
[ ] and [ ] percent of the income
of an individual with a family income that
exceeds [_" _] percent, but not [ __ ]
percent, of the Federal poverty line for a
family of the size involved.
"(C) A level of benefit that-
"(i) provides for an actuarial value
such that the cost sharing applicable to an
enrollee of such plan is between [ ]
and [ __ ] percent of the value of the
benefit provided (as determined by the
Secretary); and
"(ii) provides for a limit on out of
pocket expenditures that IS between
[ __ ] and [ __ ] percent of the income
of an individual with a family income that
exceeds [ __ ] percent, but does not exceed
[ __ ] percent, of the Federal poverty
line for a family of the size involved
(as determined by the Secretary).
63
1 "(2) SELECTION OF VALUES WITIDN A
2 RANGE.-The Secretary shall determine--
3 "(A) the level of cost sharing applicable to
4 plans at the level described in subparagraphs
5 (A), (B), and (C) of paragraph (1) within the
6 range specified in clause (i) of each such sub-
7 paragraph, respectively; and
8 "(B) the limit on out of pocket expendi-
9 tures applicable to plans at the level described
10 in subparagraphs (A), (B), and (C) of para-
11 graph (1), within the range specified in clause
12 (ii) of each such subparagraph, respectively.
13 "(3) OUT OF POCKET.-For purposes of para-
14 graph (1), the term 'out of pocket' shall include all
15 expenditures for covered benefits (as provided for
16 with respect to high deductible health plans under
17 section 223(d)(2) of the Internal Revenue Code of
18 1986).
19 "(b) PAYIIIENT OF CREDITS.-
20 "(1) IN GENERAL.-The Secretary shall, with
21 respect to an eligible individual (as defined in sub-
22 section (i)) and on behalf of such individual, pay a
23 premium credit to the Gateway through which the
24 individual enrolled in the qualified health plan in-
25 volved. Such Gateway shall remit an amount equal
64
1 to such credit to the qualified health plan in which
2 such individual is enrolled. Subject to the limitation
3 described in paragraph (2), the amount of such
4 credit shall be-
5 "CA) with respect to an individual enrolling
6 in coverage whose income exceeds 150 percent,
7 but does not exceed 200 percent, of the poverty
\
8 line for a family of the size involved, an amount
9 equal to that portion of the reference premium
10 that exceeds [ ] percent of the income
11 (rounded to the nearest $100) of such indi-
12 vidual or family;
13 "(B) with respect to an individual enrolling
14 in coverage whose income exceeds 200 percent,
15 but does not exceed 250 percent, of the poverty
16 line for a family of the size involved, an amount
17 equal to that portion of the reference premium
18 paid by such individual that exceeds [ ]
19 percent of the income (rounded to the nearest
20 $100) of such individual or family;
21 "(0) with respect to an individual enrolling
22 in coverage whose income exceeds 250 percent,
23 but does not exceed 300 percent, of the poverty
24 line for a family of the size involved, an amount
25 equal to that portion of the reference premium
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
65
paid by such individual that exceeds [ __ ]
percent of the income (rounded to the nearest
$100) of such individual or family;
"(D) with respect to an individual enrolling
in coverage whose income exceeds 300 percent,
but does not exceed 350 percent, of the
poverty line for a family of the size involved, an
;
amount equal to that portion of the reference
premium paid by such individual that exceeds
[ __ ] percent of the income (rounded to the
nearest $100)of such individual or family;
"(E) with respect to an individual enrolling
in coverage whose income exceeds 350 percent,
but does not exceed 400 percent, of the poverty
line for a family of the size involved, an amount
equal to that portion of the reference premium
paid by such individual that exceeds [ __ ]
percent of the income (rounded to the nearest
$100) of such individual or family;
"(F) with respect to an individual enrolling
in coverage whose income exceeds 400 percent,
but does not exceed 450 percent, of the poverty
line for a family of the size involved, an amount
equal to that portion of the reference premium
paid by such individual that exceeds [ __ ]
66
1 percent of the income (rounded to the nearest
2 $100) of such individual or family; and
3 "(G) with respect to an individual enrolling
4 in coverage whose income exceeds 450 percent,
5 but does not exceed 500 percent, of the poverty
6 line for a family of the size involved, an amount
7 equal to that portion of the reference premium
8 paid by such individual that exceeds [ __ ]
9 percent of the income (rounded to the nearest
10 $100) of such individual or family.
11 "(2) REFERENCE PREMIUM.-In this section,
12 the term 'reference premium' means-
13 "(A) with respect to an individual de-
14 scribed in paragraph (l)(A), the weighted aver-
15 age annual premium of the 3 lowest cost quali-
16 fied health plans that-
17 "(i) meet the criteria for cost sharing
18 and out of pocket limits described in sub-
19 section (a)(l)(A); and
20 "(ii) are offered in the community rat-
21 ing area in which the individual resides;
22 "(B) with respect to an individual de-
23 scribed in paragraph (l)(B) or (l)(C), the
24 weighted average annual premium of the 3 low-
25 est cost qualified health plans that1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
;
67
"(i) meet the criteria for cost sharing
and out of pocket limits described in subsection
(a)(l)(B); and
"(ii) are offered in the community ratmg
area in which the individual resides;
and
"( C) with respect to an individual described
in paragraph (l)(E) through (G), the
weighted average annual premium of the 3 lowest
cost qualified health plans that-
"(i) meet the criteria for cost sharing
and out of pocket limits described in subsection
(a)(l)(C); and
"(ii) are offered in the community rating
area in which the individual resides.
"(3) METHOD OF CALCULATION.-
"(A) CALCULATION OF SUBSIDY BASED ON
ESSENTIAL BENEFITS.-In the case of a qualified
health plan that provides reimbursement
for items or services that are not described in
an applicable recommendation by the Medical
Advisory Council under section 3103, the reference
premium shall be determined for purposes
of paragraph (2) without regard to such
reimbursement.
68
1 "(B) RISK ADJ1JSTMENT.-The reference
2 premium shall be determined after the applica-
3 tion of any risk adjustment payment.
4 "(C) RULE IN CASE OF FEWER PLANS.-
5 In any case in which there are less than 3
6 qualified health plans offered in the community
7 ratin,g area in which the individual resides, the
8 determinations made under paragraph (2) shall
9 be based on the number of such qualified plans
10 that are actually offered in the area.
11 "(4) INDEXING.-The percentages described in
12 paragraph (1) that specify the portion of the ref-
13 erence premium that an individual or family is re-
14 sponsible for paying shall be annually adjusted based
15 on the percentage increase or decrease in the med-
16 ical care component of the Consumer Price Index for
17 all urban consumers (U.S. city average) during the
18 preceding fiscal year.
19 "(c) STATE FLEXIBILITY.-A State may make pay-
20 ments to or on behalf of an eligible individual that-
21 "(1) are greater than the amounts required
22 under this section; or
23 "(2) are intended to defray the costs of items
24 or services not described in an applicable rec69
1 o=endation by the Medical Advisory Council under
2 section 3103(h).
3 "(d) ELIGIBILITY DETERMINATIONS.-
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
"(1) RULE FOR ELIGIBILITY DETERMINATIONS.-
The Secretary shall, by regulation, establish
rules and procedures for-
"(A) the submission of applications for ,
payments under this section [including electronic
submission and documentation necessary
for application];
"(B) making determinations with respect
to the eligibility of individuals submitting applications
under subparagraph (A) for payments
under this section and informing individuals of
such determinations;
"(C) resolving appeals of such determinations;
"(D) redetermining eligibility on a periodic
basis, which shall be not more frequent than
once per [ __ ] and not less frequent than
once per [ __ ]; and
"(E) making payments under this section.
"(2) CALCULATION OF ELIGIBILITY.-For purposes
of paragraph (1), the Secretary shall establish
70
1 rules that permit eligibility to be calculated based
2 on-
3 "(A) the applicant's income for the pre-
4 vious tax year or the most recent period other-
5 wise practicable; or
6 "(B) the applicant's declaration of esti-
7 mated annual income for the year involved.
8 "(3) INFORMATION REQUIRED.-· For purposes
9 of paragraph (1), the Secretary may require, as a
10 condition of eligibility, that an individual has made
11 available the information described in section
12 6103(1)(21) of the Internal Revenue Code of 1986
13 (as added by section [ __ ] of the American Health
14 Choices Act).
15 "( 4) DETERMINING ELIGIBILITY.-
16 "(A) AUTHORITY OF THE SECRETARY.-
17 The Secretary shall have the authority to make
18 determinations (including redeterminations)
19 with respect to the eligibility of individuals sub-
20 mitting applications for credits under this sec-
21 tion.
22 "(B) DELEGATION OF AUTHORITY.-Ex-
23 cept under the conditions described in subpara-
24 graph (D), the Secretary shall delegate to a
25 Gateway (and, upon request from such State or
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
71
States, to the State or States in which such
Gateway operates) the authority to carry out
the activities described in subparagraph (A).
"(C) REQUIREMENT FOR CONSISTENCY.A
Gateway (and,. as applicable, the State or
States in which such Gateway operates) shall
carry out the activities described in subpara-
;
graph (B) in a manner that is consistent with
the regulations promulgated nnder paragraph
(1).
"(D) REVOCATION OF AUTHORITY.-If the
Secretary determines that a Gateway (or the
State or States in which such Gateway operates)
is carrying out the activities described in
subparagraph (A) in a manner that is substantially
inconsistent with the regulations promulgated
under paragraph (1), the Secretary may,
after notice and opportunity for a hearing, revoke
the delegation of authority ullder subparagraph
(A). If the Secretary revokes the delegatioll
of authority, the references to a Gateway
in subparagraph (E) and (F) shall be deemed
to be references to the Secretary.
"(E) REQUIREMENT TO REPORT CHANGE
IN STATUS.-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
72
"(i) IN GENERAL.-An individual that
has been determined to be eligible for subsides
shall notify the Gateway of any
changes that may affect such eligibility in
a manner specified by the Secretary.
"(ii) REDETERMINATION.-If the
Gateway receives a notice from an individual
under clause (i), the Gateway shall
promptly redetermine the individual's eligibility
for payments.
"(F) TERMINATION OF PAYMENTS.-The
Gateway shall terminate payments for an individual
(after providing notice to the individual)
if-
"(i) the individual fails to provide information
for purposes of subparagraph
(E)(i) on a timely basis; or
"(ii) the Gateway determines that the
individual is no longer eligible for such
payments.
"(5) APPLICATION.-
"(A) METHoDs.-The process established
under paragraph (l)(A) shall permit applications
in person, by mail, telephone, and the
Internet.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
73
"(B) FORM AND CONTENTS.-An application
under paragraph (1) (A) shall be in such
form and manner as specified by the Secretary,
and may require documentation ..
"(C) SUBMISSION.-An application under
paragraph (l)(A) may be submitted to the
Gateway, or to a State agency for a determinati~
n under this section.
"(D) AsSISTANCE.-A Gateway, or a State
agency under this section, shall assist individuals
in the filing of applications under paragraph
(l)(A).
"(6) RECONCILIATION.-
"(A) FILING OF STATEMENT.-In the case
of an individual who has received payments
under this section for a year and who is claiming
a significant decrease (as determined by the
Secretary) in income from such year, such individual
shall file with the Secretary an income
reconciliation statement, at such time, in such
manner, and containing such information as the
Secretary may require.
"(B) RECONCILIATION.-
"(i) IN GENERAL.-Based on and
using the income reported in the statement
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
74
filed by an individual under subparagraph
(A), the Secretary shall compute the
amount of payments that should have been
provided to the individual for the year involved.
"(ii) OVERPAYMENT OF PAYlIIENTS.If
the amount of payments provided to an
individual for a year under this section was
significantly greater (as determined by the
Secretary) than the amount computed
under clause (i), the individual shall be liable
to the Secretary for such excess
amount.
"(iii) UNDERPAYlI1ENT OF PAYMENTS.-
If the amount of payments provided
to an individual for a year under tins
section was less than the amount computed
under clause (i), the Secretary shall pay to
the individual the amount of such deficit.
"(C) FAILURE TO FILE.-In the case of an
individual who fails to file a statement for a
year as required under subparagraph (A), the
individual shall not be eligible for further payments
until such statement is filed. The Secretary
shall waive the application of this sub75
1 paragraph if the individual establishes, to the
2 satisfaction of the Secretary, good cause for the
3 failure to file the statement on a timely basis.
4 "(7) OUTREAcH.-The Gateway shall conduct
5 outreach activities to provide information to individ-
6 uals that may potentially be eligible for payments
7 under this section. Such activities shall include infor-
;
8 mation on the application process with respect to
9 such payments.
10 "(e) STATE DETERMINATIONS.-AB a condition of its
11 State plan under title XIX of the Social Security Act, and
12 the receipt of any Federal financial assistance under sec-
13 tion 1903(a) of such Act, a State shall assist in making
14 eligibility determinations under this title in accordance
15 with this section.
16 "(f) EXCLUSION FROM INCOME.-Amounts received
17 by an individual under this section shall not be considered
18 income for purposes of making eligibility determinations
19 based on income or assets with respect to any other
20 Federal program.
21 "(g) No FEDERAL FmUJING.-Nothing in this Act
22 shall allow Federal payments for individuals who are not
23 lawfully present in the United States.
24 "(h) APPROPRIATION.-Out of any funds in the
25 Treasury of the United States not othenvise appropriated,
76
1 there are appropriated such sums as may be necessary to
2 carry out this section for each fiscal year.".
3 (b) DISCLOSURE OF INFORMATION TO PROVIDE PRE-
4 MIUM PAYMENTS.-
5 (1) IN GENERAIo.-Subsection (1) of section
6 6103 of the Internal Revenue Code of 1986 is
7 amende,d by adding at the end the following new
8 paragraph:
9 "(21) VOLUNTARY AUTHORIZATION FOR IN-
10 COME VERIFICATION.-
11 "(A) VOLUNTARY AUTHORIZATION.-The
12 Secretary shall provide a mechanism for each
13 taxpayer to indicate whether such taxpayer au-
14 thorizes the Secretary to disclose to the Sec-
15 retary of Health and Human Services (or, pur-
16 suant to a delegation described in section
17 [ __ ], to a State or a Gateway (as defined in
18 section [ __ ] of the Public Health Service
19 Act) return information of a taxpayer who may
20 be eligible for credits under section 3111 of the
21 Public Health Service Act.
22 "(B) PROVISION OF INFORMATION.-If a
23 taxpayer authorizes the disclosure described in
24 subparagraph (A), the Secretary shall disclose
25 to the Secretary of Health and Hwnan Services
77
1 (or, pursuant to a delegation described in sec-
2 tion [ __ ], to a State or a Gateway) the min-
3 imum necessary amount of information nec-
4 essary to establish whether such individual is el-
5 igible for credits under section 3111 of the
6 Public Health Service Act.
7 "(C) RESTRICTION ON USE OF DISCLOSED
;
8 INFORl\IATloN.-Return information disclosed
9 under subparagraph (A) may be used by the
10 Secretary (or, pursuant to a delegation de-
II scribed in section [ __ ], a State or a Gate-
12 way) only for the purposes of, and to the extent
13
14
15
16
17
18
19
20
21
22
23
24
necessary In, establishing the appropriate
amount of any payments under section 3111 of
the Public Health Service Act.".
(2) CONFORML"JG AMENDMENTS.-
(A) Paragraph (3) of section 6103(a) of
such Code is amended by striking "or (20)"
and inserting "(20), or (21)".
(B) Paragraph (4) of section 6103(p) of
such Code is amended by striking "(1)(10),
(16), (18), (19), or (20)" each place it appears
and inserting "(1)(10), (16), (18), (19), (20), or
(21)" .
1
2
3
78
(C) Paragraph (2) of section 7213(a) of
such Code is amended by striking "or (20)"
and inserting "(20), or (21)".
4 SEC. 152. EXPANSION OF MEDICAID TO 150 PERCENT OF
5 THE FEDERAL POVERTY LEVEL .
. 6 [Language ,vill reflect the policy intent described in
7 the specs, lvith the addition that there is interest in de-
;
8 fraying some of the expenditures of States that have al-
9 ready expanded eligibility.]
10 SEC. 153. SMALL BUSINESS CREDIT.
11 Subtitle B of title XXXI of the Public Health Service
12 Act (as added by section 151) is amended by adding at
13 the end the follo,ving:
14 "SEC. 3112. SMALL BUSINESS CREDIT.
15 "(a) CALCULATION OF CREDIT.-For each calendar
16 year beginning in calendar year 2101, the Secretary shall
17 make a payment in the amount described in subsection
18 (b) to each qualified small employer that-
19 "(1) requests such credit; and
20 "(2) submits to the Secretary such materials
21 (in such manner as the Secretary may require) as
22 the Secretary may require to-
23 "(A) allow for the calculation of the credit
24 amount as described in subsection (b); and
79
1 "(B) determine whether such employer is a
2 qualified employer.
3 "(b) CREDIT AlImUNT.-For purposes of this section:
4 "(1) IN GENERAL.-The credit amount de-
5 . scribed in this subsection with respect to a qualified
6 small employer shall be equal to the product of-
7 "(A) the base credit (as determined under
;
8 paragraph (2));
9 "(B) a number equal to number of full
10 time employees of the employer that is making
11 a request for a credit under this section; and
12 "(C)(i) in the case of an employer that of-
13 fered health care coverage to at least [ __ ]
14 percent of the full-time employees of such em-
15 ployer in the year preceding the year in which
16 such employer requests a credit under this sec-
17 tion, 0.5; or
18 "(ii) in the case of an employer that did
19 not offer health care coverage to at least
20 [ __ ] percent of the full-time employees of
21 such employer in the year preceding the year in
22 which such employer requests a credit under
23 this section, 1.25.
24 "(2) BASE CREDIT AlImUNT.-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
80
"(A) BASE CREDIT.-The base credit
amount with respect to a qualified small employer
shall be an amount equal to the larger
of-
"(i) the amount described in subparagraph
(B) minus the amount described in
subparagraph (C); or
"(ii) zero.
"(B) AVERAGE CONTRIBUTION.-The
amount described in tlJis subparagraph with respect
to a qualified small employer shall be
equal to 50 percent of the average contribution
made by small employers for coverage offered
by such employer in the State in which the employer
requesting a credit under this section has
its primary place of business (calculated as described
in paragraph (5)).
"(C) REDUCTION.-The amount described
in this subparagraph with respect to a qualified
small employer is the sum of-
"(i) the product of the amount described
in subparagraph (B) and the employer
size factor described in paragraph
(3); and
81
1 "(ii) the product of the amount de-
2 scribed in subparagraph (B) and the wage
3 adjustment factor described in paragraph
4 (4).
5 "(3) EMPIJOYER SIZE FACTOR.-With respect to
6 a qualified small employer:
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
"(A) CA LCULATION.-F or purposes 0 f
p~ragraph (1), the employer size factor shall be
the percentage that is equal to 100 minus the
number described in subparagraph (B);
"(B) F ACTOR.-The number described m
this subparagraph shall be equal to 6 times the
size number described in subparagraph (C).
"(C) SIZE NUMBER.-The number described
in this subparagraph shall be equal to
the number by which the average number of
employees employed by the employer requesting
a credit under this section exceeds 10.
"(4) WAGE ADJUSTMENT FACTOR.-
"(A) CALCULATION.-For purposes of
paragraph (1), the wage adjustment factor shall
be the percentage that is equal to 100 minus
the number described in subparagraph (B).
1
2
3
4
5
6
7
8
9
10
11
12
13
82
"(B) FACTOR.-The number described in
this subparagraph shall be equal to 5 times the
number described in subparagraph (C).
"(C) FR.'\.CTION.-The number described
III tills subparagraph shall be equal to the
amount described in subparagraph (D) divided
by;1,, OOO.
"(D) AMOUNT.-The number described in
this subparagraph is the amount by which the
average arumal wage of the employer that is
making a request for a credit under tills section
exceeds $20,000.
"(5) EMPLOYER CONTRIBUTION CALCULA-
14 TION.-The Secretary of Labor shall annually con-
15 duct a survey of the average contribution made by
16 small employers to health care coverage on behalf of
17 their employees in each State. From the results of
18 the survey conducted as described in the preceding
19 sentence, the Secretary shall calculate the expected
20 amount of such contribution for purposes of para-
21 graph (2)(B).
22 "(c) DEFINITIONS AND SPECIAL RULES.-For pur-
23 poses of tills section:
24 "(1) QUALIFIED SMALL EMPLOYER.-The term
25 'qualified small employer' means an employer (as de83
1 fmed in section 3001(a) (4) of the Public Health
2 Service Act) that, ·with respect to the year for which
3 such employer is requesting a credit under this sec-
4 tion-
5 "(A) was-
6 "(i) an employer that employed an av-
7 erage of 27 or fewer full-time employees;
8 or
9 "(ii) a self-employed individual that
10 had not less than $5,000 in net earnings
11 or not less than $15,000 in gross earnings
12 from self-employment in the preceding tax:-
13 able year; and
14 "(B) had, as its primary place of business,
15 a location in an establishing State or a partici-
16 pating State.
17 "(2) SPECIAL RULE FOR SELF EMPLOYED INDI-
18 VIDUAI,s.-'IVlth respect to an employer requesting a
19 credit under this section that is a self-employed indi-
20 vidual, each reference to annual salary in this sec-
21 tion shall be deemed to be a reference to net earn-
22 mgs.
23 "(3) FULL-TIME EMPLOYEE.-The term 'full
24 time employee' means, with respect to any period, an
25 employee (as defined in section 3001(a)(3) of the
84
1 [ ___ ~] Act) of an employer if the average
2 number of hours worked by such employee in the
3 preceding taxable year for such employer was at
4 least 30 hours per week.
5 "(d) INFLATION ADJ1JSTMENT.-
6 "(1) IN GEJ\TERAL.-For each calendar year
7 after 2009, the dollar amounts specified in this sec-
\
8 tion (after the application of this paragraph) shall
9 be the amounts in effect in the preceding calendar
10 year or, if greater, the product of-
11 "(A) the corresponding dollar amount
12 specified in such subsection; and
13 "(B) the ratio of the index of wage infla-
14 tion (as determined by the Bureau of Labor
15 Statistics) for August of the preceding calendar
16 year to such index of wage inflation for August
17 of 2008.
18 "(2) ROUNDING.-If any amount determined
19 under paragraph (1) is not a multiple of $100, such
20 amount shall be rounded to the next lowest multiple
21 of $100.
22 "(e) APPLICATION OF CERTAIN RULES IN DETER-
23 MINATION OF EMPLOYER SrzE.-For purposes of this sec-
24 tion:
1 "(1) APPLICATION OF AGGREGATION RULE FOR
2 EMPLOYERS.-All persons treated as a single em-
3 ployer under subsection (b), (c), (m), or (0) of sec-
4 tion 414 of the Internal Revenue Code of 1986 shall
5 be treated as 1 employer.
6 "(2) EMPLOYERS NOT IN EXISTENCE IN PRE-
7 CEDING YEAR.-In the case of an employer which ,
8 was not in existence for the full preceding taxable
9 year, the determination of whether such employer
10 meets the requirements of this section shall be based
11 on the average number of full-time employees that it
12 is reasonably expected such employer will employ on
13 business days in the employer's first full taxable
14 year.
15 "(3) PREDECESSORS.-Any reference in this
16 subsection to an employer shall include a reference
17 to any predecessor of such employer.".
18 Subtitle D-Shared Responsibility
19 for Health Care
20 SEC. 161. INDIVIDUAL RESPONSmILITY.
21 (a) PAYMENTS.-
22 (1) IN GENERAL.-Subchapter A. of chapter 1
23 of the Internal Revenue Code of 1986 (relating to
24 determination of tax liability) is amended by adding
25 at the end the following new part:
86
1 "PART VIII-SHARED RESPONSIBILITY
2 PAYMENTS
"Sec. 5gB. Shared responsibility payments.
3 "SEC. 59B. SHARED RESPONSmILITY PAYMENTS.
4 "(a) PAYMENT.-
5 "(1) IN GENERAL.-In the case of any indi-
6 vidual w,h o did not have in effect qualifying coverage
7 (as defined in section 31 of the Public Health
8 Service Act) for any month during the taxable year,
9 there is hereby imposed for the taxable year, in addi-
10 tion to any other amount imposed by this subtitle,
11 an amount equal to the amount established under
12 paragraph (2).
13 "(2) AMOUNT ESTABLISHED.-
14 "(A) REQUIREMENT TO ESTABLISH.-Not
15 later than [date] of each calendar year, the Sec-
16 retary, in consultation with the Secretary of
17 Health and Human Services and with the
18 States, shall establish an amount for purposes
19 of paragraph (1).
20 "(B) EFFECTIVE DATE.-The amount es-
21 tablished under subparagraph (A) shall be ef-
22 fective with respect to the taxable year following
23 the date on which the amount under subpara-
24 graph (A) is established.
87
1 "(C) REQUIRED CONSIDERATION.-In es-
2 tablishing the amount under subparagraph CAl,
3 the Secretary shall seek to establish the min-
4 imum practicable amount that can accomplish
5 the goal of enhancing participation in qualifying
6 coverage (as so defined).
7 "(b) EX,E lVIPTIONS.-Subsection (a) shall not apply to
8 any individual-
9 "(1) with respect to any month if such month
10 occurs during any period in which such individual
11 did not have qualifying coverage (as so defined) for
12 a period of less than [ __ ] days,
13 "(2) who is a resident of a State that is not a
14 participating State or an establishing State (as such
15 terms are defined in section [ __ of the Public
16 Health Service Act]),
17 "(3) for whom affordable health care coverage
18 is not available (as such terms are defined in an ap-
19 plicable recommendation of the Medical Advisory
20 Council under section 3103 of the Public Health
21 Service Act), or
22 "(4) for whom a payment under subsection (a)
23 would otherwise represent an exceptional financial
24 hardship, as determined by the Secretary.
25 "( c) COORDINATION WITH OTHER PROVISIONS.-
88
1 "(1) NOT TREATED AS TAX FOR CERTAIN PUR-
2 PosEs.-The amount imposed by this section shall
3 not be treated as a tax imposed by this chapter for
4 purposes of determining-
5 "(A) the amount of any credit allowable
6 under tIns chapter, or
7 "(E) the amount of the minimum tax im-
8 posed by section 55.
9 "(2) TREATMENT UNDER SUBTITLE F.-For
10 purposes of subtitle F, the amount imposed by this
11 section shall be treated as if it were a tax imposed
12 by section 1.
13 "(3) SECTION 15 NOT TO APPLY.-Section 15
14 shall not apply to the amount imposed by this sec-
15 tion.
16 "(4) SECTION NOT TO AFFECT LIABILITY OF
17 POSSESSIONS, ETC.-This section shall not apply for
18 purposes of determining liability to any possession of
19 the United States. For purposes of section 932 and
20 7654, the amount imposed under this section shall
21 not be treated as a tax imposed by this chapter.
22 "(d) REGULATIONS.-The Secretary may prescribe
23 such regulations as' may be appropriate to carry out the
24 purposes of this section.".
89
1 (2) CLERICAL AMENDMENT.-The table of
2 parts for subchapter A of chapter 1 of such Code is
3 amended by adding at the end the following new
4 item:
"PART VIII-SILI.RED RERPON8IBILITY PAYMENTR".
5 (3) EFFECTIVE DATE.-The amendments made
6 by this section shall apply to taxable years beginning
7 after D'ecember 31,20[ __ ].
8 (b) REPORTING OF HEALTH INSURANCE COy-
9 ERAGE.-
10 (1) IN GENERAL.-Part III of subchapter A of
11 chapter 61 of the Internal Revenue Code of 1986 is
12 amended by inserting after subpart B the following
13 new subpart:
14 "Subpart D-Information Regarding Health
15 Insurance Coverage
"Sec. 6055. Reporting of health insurance coverage.
16 "SEC. 6055. REPORTING OF HEALTH INSURANCE COV-
17 ERAGE.
18 "(a) IN GENERAL.-Every person who provides
19 health insurance that is qualifying coverage shall make a
20 return described in subsection (b).
21 "(b) FORM Al'm MANNER OF RETURN.-A return is
22 described in this subsection if such return-
23 "(1) is in such form as the Secretary pre-
24 scribes,
90
1 "(2) contains-
2 "(A) the name, address, and taxpayer
3 identification number of each individual who is
4 covered under health insurance that is quali-
5 fying coverage provided by such person, and
6 "(B) the number of months during the cal-
7 endar year during which each such individual
;
8 was covered under such health insurance, and
9 "(3) such other information as the Secretary
10 may prescribe.
11 "(c) STATEMENTS TO BE FURNISHED TO INDIVID-
12 UALS WITH RESPECT TO WHOM INFORMATION Is RE-
13 PORTED.-
14 "(1) IN GENERAL.-Every person required to
15 make a return under subsection (a) shall furnish to
16 each individual whose name is required to be set
17 forth in such return a written statement showing-
18 "(A) the name, address, and phone num-
19 ber of the information contact of the person re-
20 quired to make such return, and
21 "(B) the number of months during the cal-
22 endar year during which such individual was
23 covered under health insurance that is quali-
24 fying coverage provided by such person.
91
1 "(2) TIME FOR FURNISHING STATEMENTS.-
2 The written statement required under paragraph (1)
3 shall be furnished on or before January 31 of the
4 year following the calendar year for which the return
5 under subsection (a) was required to be made.
6 "(d) QUALIFYING COVERAGE.-For purposes of this
7 section, the, term 'qualifying coverage' has the meaning
8 given such term under section 31 of the Public
9 Health Service Act. ".
10 (2) CONFORMING AMEl\TDMENTs.-The table of
11 subparts for part III of subchapter A of chapter 61
12 of such Code is amended by inserting after the item
13 relating to subpart C the following new item:
"SURPA.. RT D-HEALTH INSURANCE COVERAGE".
14 (3) EFFECTIVE DATE.-The amendments ,made
15 by this section shall apply to taxable years beginning
16 after December 31, 20[_~].
17 (c) NOTIFICATION OF NONENROLLMENT.-Not later
18 than [. ___ ~] of each year, the Secretary of the Treas-
19 ury, acting through the Internal RevenueService and in
20 consultation with the Secretary of Health and Human
21 Services, shall send a notification each individual who files
22 an individual income tax return and who is not enrolled
23 in qualifying coverage (as defined in section 31_~ of the
24 Public Health Service Act). Such notification shall contain
92
1 information on the services available through the Gateway
2 operating in the State in which such individual resides.
3 SEC. 162. SHARED RESPONSmILITY OF EMPLOYER.
4. The Fair Labor Standards Act of 1938 is amended
5 by inserting after section 18 (29 U.S.C. 218) the fol-
6 lowing:
7 "SEC. 18A. NO,T ICE TO EMPLOYEES.
8 "In accordance with guidelines prescribed by the Sec-
9 retary, an employer to which this Act applies, shall provide
10 to each employee at the time of hiring (or with respect
11 to current employee, ,vithin [ __ ] days of the date of
12 enactment of this section, written notice informing the em-
13 ployee of the existence of the American Health Benefits
14 Gateway, including a description of the services provided
15 by such Gateway and the manner in which the employee
16 may contact the Gateway to request assistance.".
17 SEC. 163. AMENDMENT TO PHSA REGARDING EMPLOYERS.
18 Subtitle B of title XXXI of the Public Health Service
19 Act, as amended by section 153, is further amended by
20 adding at the end the following:
21 "SEC. 3113. SHARED RESPONSmILITY OF EMPLOYERS.
22 "(a) EMPLOYEES NOT OFFERED COVERAGE.-An
23 employer shall make a payment to the Secretary in the
24 amount described in subsection (b) with respect to each
25 employee1
"(1) who is not offered qualifying coverage by
2 such employer during each month where such em-
3 ployee is not offered qualifying coverage; and
4 "(2) on behalf of whom such employer is not
5 contributing at least [ __ ] percent of the monthly
6 premiums for such coverage for each such month.
7 "(b) AMOUNT.-
8 "('1) IN GENERAL.-The amount described in
9 this subsection shall be equal to [$ ] for each
10 full-time employee described in subsection (a) for the
11 month involved.
12 "(2) PRO RATA APPLICATION FOR PART-TIME
l3 EMPLOYEEs.-The provisions of paragraph (1) shall
14 apply with respect to part-time employees employed
15 by the employer, except that the payment amounts
16 described in such paragraph shall be pro rated to re-
17 flect the number of hours worked per week by the
18 employee involved (as determined by the Secretary
19 based on a 30 hour workweek).
20 "(c) PRocEDUREs.-The Secretary shall develop pro-
21 cedures for making determinations with respect to quali-
22 fying coverage and for making the payments required
23 under subsection (a). Such procedures shall provide for
24 the making of payments on a quarterly basis.
94
1 "(d) USE OF FUNDs.-Amounts shall be collected
2 under subsection (a) and be available for obligation only
3 to the extent and in the amount provided in advance in
4 appropriations Acts. Such amounts are authorized to reS
main available until expended.
6 "(e) INFLATION ADJUSTMENT.-The amounts de-
7 scribed in subsection (b) shall be adjusted by the Secretary
;
8 by notice, published in the Federal Register, for each fiscal
9 year to reflect the total percentage change that occurred
lOin the Consumer Price Index for all urban consumers (all
11 items; U.S. city average) during the preceding fiscal year.
12 "(f) PAYMENTS TO DECLINE COVERAGE.-[Is a pro-
13 vision on tIns issue of valuen
14 "(g) EXEMPTION OF SMALL EMPLOYERS.-
15 "(1) IN GENERAL.-For purposes of this sec-
16 tion, the term 'employer' shall mean an employer-
17 "(A) that employs more than [ ] em-
18 ployees on business days during the preceding
19 calendar year; or
20 "(B )(i) that employs fewer than [ ]
21 employees on business days during the pre-
22 ceding calendar year; and
23 "(ii) that has an average annual wage for
24 all employees that exceed [$ __ ~].
95
1 "(2) APPLICATION OF AGGREGATION RULE FOR
2 EMPLOYERS.-all persons treated as a single em-
3 ployer under subsection (b), (c), (m), or (0) of sec-
4 tion 414 of the Internal Revenue Code of 1986 shall
5 be treated as 1 employer.
6 "(3) EMPLOYERS NOT IN EXISTENCE IN PRE-
7 CEDING YEAR.-In the case of an employer which
8 was ndt in existence throughout the preceding cal-
9 endar year, the determination of whether such em-
10 ployer is a small or large employer shall be based on
11 the average number of employees that it is reason-
12 ably expected such employer will employ on business
13 days in the current calendar year.
14 "(4) PREDECESSORS.-AlW reference in this
15 subsection to an employer shall include a reference
16 to any predecessor of such employer.
17 "(h) AUTHORITY TO VERIFY.-The Secretary, in col-
18 laboration with the Secretary of the Treasury and the Sec-
19 retary of Labor, shall establish procedures for determining
20 the number of employees of employers who are not offered
21 qualifying coverage.
22 "(i) LIMITATION.-This section shall not apply with
23 respect to any employee who has been employed by an em-
24 ployer for less than [ ] days.
96
1 "SEC. 3114. FREE RIDER PENALTY.
2 "(a) IN GENERAL.-An employer described in sub-
3 section (e) shall make a monthly payment to the Secretary
4 (in addition to any payment made under section 163) in
5 an amount described in subsection (c) for each employee
6 of the employer who is not offered qualifying coverage (as
7 defined in section [ __ ] by such employer during each
8 month wherJ such employee is not offered qualifying cov-
9 erage.
10 "(b) PROCEDUREs.-The Secretary shall develop pro-
11 cedures for making determinations with respect to quali-
12 fying coverage and for making the payments required
13 under subsection (a).
14 "(c) AlVIOUNT.-The amount described in this sub-
15 section with respect to an employee shall be equal to
16 [ __ ] percent of the amount provided to, or on behalf
17 of, the employee by the Federal Government for any
18 health care coverage for the month involved.
19 "(d) USE OF FUNDS.-Amounts shall be collected
20 under subsection (a) and be available for obligation only
21 to the extent and in the amount provided in advance in
22 appropriations Acts. Such amounts are authorized to re-
23 main available until expended.
24 "(e) DEFINITIONS.-
25 "(1) IN GENERllli.-For purposes of this sec-
26 tion, the term 'employer' means an employer that
97
1 employs more than [ __ ] employees on business
2 days during the preceding calendar year.
3 "(2) APPLICATION OF AGGREGATION RULES
4 FOR EMPLOYERS.-Ali persons treated as a single
5 employer under subsection (b), (c), (m), or (0) of
6 section 414 of the Internal Revenue Code of 1986
7 shall be treated as 1 employer.
;
8 "(3) EMPLOYERS NOT IN EXISTENCE IN PRE-
9 CEDING YEAR.-In the case of an employer which
10 was not in existence throughout the preceding cal-
II endar year, the determination of whether such em-
12 ployer is a small or large employer shall be based on
13 the average number of employees that it is reason-
14 ably expected such employer will employ on business
15 days in the current calendar year.
16 "(4) PREDECESSORS.-Any reference in this
17 subsection to an employer shall include a reference
18 to any predecessor of such employer.
19 "SEC. 3115. VOUCHER FOR TRANSFERRING EMPLOYEES.
20 "(a) VOUCHER.-An employer shall make a payment
21 to the Secretary in the amount described in subsection (b)
22 with respect to each employee who is-
23
24
"(1) described in section [ ]; and
"(2) is enrolled in a qualified health plan.
98
1 "(b) AMOUNT DESCRIBED.-The amount described
2 in this subsection shall be equal to the amount such em-
3 ployer would otherwise have paid for coverage on behalf
4 of each full-time employee described in subsection (a) had
5 such employee not enrolled in a qualified health plan.
6 "(c) PRocEDuREs.-The Secretary shall develop pro-
7 cedures for r,p .aking determinations ·with respect to making
8 the payments required under subsection (a). Such proce-
9 dures shall provide for the making of payments on a quar-
10 terly basis.
11 "(d) USE OF FUNDS.-Amounts shall be collected
12 under subsection (a) and be available for obligation only
13 to the extent and in the amount provided for in advance
14 in appropriations Acts. Such amounts are authorized to
15 remain available until expended.".
16 SEC. 164. RULE OF CONSTRUCTION REGARDING HAWAII'S
17 PREPAID HEALTH CARE ACT.
18 Nothing in this title (or an amendment made by this
19 title) shall be construed to modify or limit the application
20 of the exemption for Hawaii's Prepaid Health Care Act
21 (Haw. Rev. Stat. §§ 393-1 et seq.) as provided for under
22 section 514(b)(5) of the Employee Retirement Income Se-
23 curity Act of 1974 (29 U.S.C. 1144(b)(5)).
99
1 SEC. 165. DEFINITIONS.
2 Title XXXI of the Public Health Service Act, as
3 amended by section 163, is further amended by adding
4 at the end the following:
5 "Subtitle -Miscellaneous
6 Provisions
7 "SEC. 31_. DEFINITIONS.
8 "(a) IN'GENERAL.-In this title:
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
"(1) AFFORDABLE ACCESS PLAN.-
"(A) IN GENERAL.-The term 'affordable
access plan' means a qualified health plan offered
by the Secretary that meets the requirements
of subparagraph (B).
"(B) REQUIREIVIENTS.-
"(i) PAYMENT.-The amount of payment
for an item or service under an affordable
access plan shall be equal to the
amount of payment for such item or service
under the medicare program under title
XVIII of the Social Security Act plus 10
percent. For items or services not offered
under the medicare program, the Secretary
shall set a price consistent with the preceding
sentence. [Unresolved question
about incorporation of DME, IME, DSH
payments in calculation]
100
1 "(ii) LWENSE.-An affordable access
2 plan shall be deemed to be licensed and in
3 good standing in each State.
4 "(iii) PRElVIIUlVIs.-The premiums as-
5 sessed for an affordable access plan (and
6 any subsidized provided with respect to
7 such plan) shall be in an amount necessary
8 to cover the costs under the plan. The Sec-
9 retary may annually adjust such premium
10 amount to comply with the previous sen-
11 tence.
12 "(2) ELIGIBLE INDIVIDuAL.-The term 'eligible
13 individual' means an individual who is-
14 "(A) a citizen or national of the United
15 States or an alien lawfully admitted to the
16 United States for permanent residence or an
17 alien lawfully present in the United States;
18 "(B) a qualified individual;
19 "( C) enrolled in a qualified health plan;
20 and
21 "(D) not recelvrng full benefits coverage
22 under a State child health plan under title XXI
23 of the Social Security Act (42 U.S.C. 1397aa et
24 seq.) (or a waiver of such plan).
25 "(3) QUALIFIED ElVIPLOYER.-
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"(A) IN GENERAL.-The term 'qualified
employer' means an employer that-
"(i) elects to make all [full-time] employees
of such employer eligible for a
qualified health plan; and
"(ii) (I) in the case of an employer
that elects to enroll in a qualified health
plan made available through a Gateway in
an establishing State, meets criteria (including
criteria regarding the size of a
qualified employer) established by such
State; or
"(II) in the case of an employer that
elects to enroll in a qualified health plan
made available through a Gateway in a
participating State-
"(aa) employs fewer than the
number of employees specified in subparagraph
(B); and
"(bb) meets criteria established
by the Secretary.
"(B) NUMBER OF EMPLOYEES.-
"(i) ESTABLISHMENT.-The Secretary
may by regulation establish the number of
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employees described m subparagraph
(A)(ii)(II)(aa).
"(ii) DEFAULT.-If the Secretary
4 does not establish the number described in
5 subparagraph (A) (ii) (II) (aa), such number
6 shall be deemed to be [~_].
7 "(4) QUALIFIED HEALTH PLAN.-The term
8 'qualified health plan' means health plan that-
9 "(A) has in effect a certification (which
10 may include a seal or other indication of ap-
11 proval) described in section 3101(d) issued by
12 each Gateway through which such plan is of-
13 fered; and
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"(B) is offered by a health msurance
issuer that-
"(i) is licensed and in good standing
to offer health insurance coverage in each
State in which such issuer offers health insurance
coverage under this title;
"(ii) agrees to offer at least one qualified
health plan at the level of cost sharing
described in each of the following sections-
"(I) section3111(a)(1) (A);
"(II) section 3111(a)(1)(B); and
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"(III) section 3111(a)(1)(C).
"(iii) complies with the regulations developed
by the Secretary under section
3101(1) and such other requirements as an
applicable Gateway may establish; and
"(iv) agrees to pay any surcharge assessed
under section [ __ ].
"(C) makes available to individuals enrolled
in, or seeking to enroll in, such plan a detailed
description of-
"(i) benefits offered, including maxImums,
limitations (including differential
cost-sharing for out of network services),
exclusions and other benefit limitations;
"(ii) the service area;
"(iii) premiums;
" (iv) cost-sharing;
"(v) access to providers; and
"(vi) grievance and appeals procedures;
"(D) provides coverage for at least the essential
health care benefits established under
section 3103(h);
"(E) [discussion on whether a priority listing
or some kind of star or point system may
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substitute in whole or in part for some proVIsions
of (G) or (Hl;l
"(F)(i) is accredited by the National Committee
for Quality Assurance or by any other
entity recognized by the Secretary for the accreditation
of health insurance issuers or plans;
or
"(ii) receIves such accreditation within a
period established by a Gateway for such accreditation
that is applicable to all qualified
health plans;
"(G) implements incentives for high quality
care and improving health outcomes through
quality reporting, effective case management,
care coordination, chronic disease management,
medication and care compliance initiatives, and
prevention of hospital readmissions through
comprehensive discharge planning;
"(H) encourages patient safety and the reduction
of medical errors through the appropriate
use of best clinical practices, evidence
based medicine, and health information technology;
and
"(I) has adequate procedures in place for
appeals of coverage determinations.
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"(5) QUALIFIED INDIVIDUAL.-
"(A) IN GENERAL.-The term 'qualified
individual' means an individual who is-
"(i) residing in a participating State
or an establishing State (as defined in section
3104);
"(ii) not incarcerated;
"(iii) not entitled to coverage under
the Medicare program under part A of title
XVIII of the Social Security Act;
"(iv) not enrolled in coverage under
the Medicare program under part B of title
XVIII of the Social Security Act or under
part C of such title; and
"(v) not eligible for coverage under-
"(I) the Medicaid program under
a State plan under title XIX of the
Social Security Act (42 U.S.C. 1396
et seq.), or under a waiver under section
1115 of such Act;
"(II) the TRICARE program
under chapter 55 of title 10, United
States Code (as defined in section
1072(7) of such title);
106
1 "(III) the Federal employees
2 health benefits program under chapter
3 89 of title 5, United States Code; or
4 "(IV) employer-sponsored cov-
5 erage (except as provided under sub-
6 paragraph (B)).
7 "(B) EMPLOYEE.-An individual who is el-
8 igible for employer-sponsored coverage shall be
9 deemed to be a qualified individual under sub-
10 paragraph (A) if such coverage-
11 "(i) does not meet the criteria estab-
12 lished under section 3103 for minimum
13 qualifying coverage; or
14 "(ii) is not affordable (as such term is
15 defined under an applicable recommenda-
16 tion of the Council described in section
17 3103) for such employee.
18 "(C) AVAILABLE COVERAGE.-For pur-
19 poses of section 59B of the Internal Revenue
20 Code of 1986, a qualified health plan shall not
21 be considered to be available to an individual
22 described in subparagraph (B) unless such indi-
23 vidual is enrolled in a qualified health plan.
24 "(b) INCORPORATION OF ADDITIONAL DEFINI-
25 TIONS.-Unless specifically provided for otherwise, the
4111111!.ilIlU_Jl......... .~
107
1 definitions contained in section 2791 shall apply with re-
2 spect to this title.".
3 SEC. 166. HEALTH INFORMATION TECHNOLOGY ENROLL-
4 MENT STANDARDS AND PROTOCOLS.
5 Title XXX of the Public Health Service Act (42
6 U.S.C. 300jj et seq.) is amended by adding at the end
7 the following:
8 "Subtitle C-Other Provisions Re-
9 lated to Health Information
10 Technology
11 "SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLL-
12 MENT STANDARDS AND PROTOCOLS.
13 "(a) IN GENERAL.-
14 "(1) STANDARDS AND PROTOCOLS.-Not later
15 than [TED], the Secretary, in consultation with the
16 HIT Policy Committee and the HIT Standards
17 Committee, shall develop interoperable and secure
18 standards and protocols that facilitate enrolhnent of
19 individuals in Federal and State health and human
20 services programs, as determined by the Secretary.
21 "(2) METHODs.-The Secretary shall facilitate
22 enrollment in such programs through methods deter-
23 mined appropriate by the Secretary, which shall in-
24 elude providing [individuals and third parties au-
25 thorized by such individuals [Is this what you mean
• bT ra. 1
108
1 by applicants and authorized third parties~]] notifi-
2 cation of eligibility and verification of eligibility re-
3 quired under such programs.
4 "(b) CONTENT.-The standards and protocols for
5 electronic enrolhnent in the Federal and State programs
6 described in subsection (a) shall allow for the following:
7 "(1) Electronic matching against existing Fed-
8 eral and State data, including vital records, employ-
9 ment history, enrollment systems, tax records, and
10 other data determined appropriate by the Secretary
11 to serve as evidence of eligibility and in lieu of
12 paper-based documentation.
13 "(2) Simplification and submission of electronic
14 documentation, digitization of documents, and sys-
15 tems verification of eligibility.
16 "(3) Reuse of stored eligibility information (in-
17 eluding documentation) to assist with retention of el-
18 igible individuals.
19 " ( 4) Capability for individuals to apply, recer-
20 tify and manage their eligibility information online,
21 including at home, at points of service, and other
22 community-based locations.
23 "( 5) Ability to expand the enrollment system to
24 integrate new programs, rules, and functionalities, to
25 operate at increased volume, and to apply stream-
•
7 &i 412_IIIIIL at. t. ..S• .18 8.';
109
1 lined verification and eligibility processes to other
2 Federal and State programs, as appropriate.
3 "( 6) Notification of eligibility, recertification,
4 and other needed communication regarding eligi-
5 bility, which may include communication via email
6 and cellular phones.
7 "(7) Other functionality(ies1] necessary to pro-
;
8 vide eligibles with streamlined enrollment process.
9 "(c) APPROVAL AND NOTIFICATION.-Upon approval
10 by the HIT Policy Committee, the HIT Standards Com-
11 mittee, and the Secretary of the standards and protocols
12 developed under subsection (a), the Secretary-
13 "(1) shall notify States of such standards and
14 protocols; and
15 "(2) may reqUIre, as a condition of receiving
16 Federal funds for the health information technology
17 investments, that States or other entities incorporate
18 such standards and protocols into such investments.
19 "(d) GRANTS FOR IMPLEMENTATION OF APPRO-
20 PRIATE ENROLLMENT HIT.-
21 "(1) IN GENERAL.-The Secretary shall award
22 grant to eligible entities to develop new, and adapt
23 existing, technology systems to implement the HIT
24 enrollment standards and protocols developed under
.......7._ 1-:l·.ill ~
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1 subsection (a) (referred to in this subsection as 'ap-
2 propriate HIT technology').
3 "(2) ELIGIBLE ENTITIE8.-To be eligible for a
4 grant under this subsection, an entity shall-
5 "(A) be a State, political subdivision of a
6 State, or a local governmental entity; and
7 "(B) submit to the Secretary an applica-
8 tion at such time, in such manner, and con-
9 taining-
10 "(i) a plan to adopt and implement
11 appropriate enrollment technology that in-
12 cludes-
13 "(I) proposed reduction in main-
14 tenance costs of technology systems;
15 "(II) elimination or updating of
16 [legacy systems]/[outdated computer
17 systems or application programs]
18 [Would you like to define this term in
19 section 300m]; and
20 "(III) demonstrated collaboration
21 with other entities that may receive a
22 grant under this section that are 10-
23 cated in the same State, political sub-
24 division, or locality;
WI' j' •....
111
1 "(ii) an assurance that the entity will
2 share such appropriate enrollment tech-
3 nology in accordance with paragraph (4);
4 and
5 "(iii) such other information as the
6 Secretary may require.
7 "(3) AlIroUNT OF GRANT; TERMs.-A grant
;
8 under this subsection awarded to an eligible entity
9 for a fiscal year may not exceed [$XXX]. Notwith-
10 standing the preceding sentence, the Secretary may
11 adjust such amount annually for any recipient,
12 based on results under the grant to such recipient
13 in the preceding fiscal year and the recipient's re-
14 quest for such adjustment. [Do you want to specify
15 the terms of a grant - how many years?]
16 "(4) SHARING.-
17 "(A) IN GENERAL.-The Secretary shall
18 ensure that appropriate enrollment HIT adopt-
19 ed under grants under this subsection is made
20 available to other qualified State, qualified po-
21 litical subdivisions of a State, or other appro-
22 priate qualified entities (as described in sub-
23 paragraph (B)) at no cost.
24
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"(B) QUALIFIED ENTITIEs.-The Secretary
shall determine what entities are qualiF
112
7 :J1l: J U I ,.It_ '771
1 fied to receive enrollment HIT under subpara-
2 graph (A), taking into consideration the rec-
3 ommendations of the IDT Policy Committee
4 and the IDT Standards Connnittee.".
5 Subtitle E-Long-Term Services
6 and Supports
7 SEC. 171. SHO,R T TITLE OF SUBTITLE.
8 This subtitle may be cited as the "Community Living
9 Assistance Services and Supports Act" or the "CLASS
10 Act".
11 PART I-COMMUNITY LIVING ASSISTANCE
12 SERVICES AND SUPPORTS
13 SEC. 172. ESTABLISHMENT OF NATIONAL VOLUNTARY IN-
14 SURANCE PROGRAM FOR PURCHASING COM-
15 MUNITY LIVING ASSISTANCE SERVICES AND
16 SUPPORT.
17 (a) ESTABLISHMENT OF CLASS PROGRAM.-
18 (1) IN GENERAI,.-The Public Health Service
19 Act (42 U.S.C. 201 et seq.), as amended by section
20 142(b), is amended by adding at the end the fol-
21 lowing:
113
1 "TITLE XXII-COMMUNITY LIV·
2 ING ASSISTANCE SERVICES
3 AND SUPPORTS
4 "SEC. 3201. PURPOSE.
5 "The purpose of this title is to establish a national
6 voluntary insurance program for purchasing community
7 living assista, nce services and support in order to-
8 "(1) provide individuals with functional limita-
9 tions with tools that will allow them to maintain
10 their personal and financial independence and live in
11 the community through a new financing strategy for
12 community living assistance services and supports;
13 "(2) establish an infrastructure that will help
14 address the Nation's community living assistance
15 services and supports needs; and
16 "(3) alleviate burdens on family caregivers.
17 "SEC. 3202. DEFINITIONS.
18 "In this title:
19 "(1) ACTIVE ENROLLEE.-The term 'active en-
20 rollee' means an individual who is enrolled in the
21 CLASS program in accordance with section 3204
22 and who has paid any premiums due to maintain
23 such enrollment.
24 "(2) ACTIVELY AT WORK.-The term 'actively
25 at work' means an individual who~
•.
114
1 "(A) is reporting for work at the individ-
2 ual's usual place of employment or at another
3 location to which the individual's employer re-
4 quires the individual to travel (or in the case of
5 an individual who is a member of the uniformed
6 services, is on active duty and is physically able
7 to perform the duties of the individual's posi-
8 tion); and
9 "(B) is able to perform all the usual and
10 customary duties of the individual's employment
11 on the individual's regular work schedule.
12 "(3) ACTIVITIES OF DAILY LIVING.-The term
13 'activities of daily living' means each of the following
14 activities specified in section 7702B(c)(2)(B) of the
15 Internal Revenue Code of 1986:
16 "(A) Eating.
17 "(B) Toileting.
18 "(C) Transferring.
19 "(D) Bathing.
20 "(E) Dressing.
21 "(F) Continence.
22 "(4) CLASS PROGRAlI1.-The term 'CLASS
23 program' means the program established under this
24 title.
7 , iLi
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1 "(5) CRITICAL LIFE FUNCTIONS,-The term
2 'critical life functions' means each of the following
3 activities:
4 "(A) Communicating,
5 "(B) Taking medications,
6 "(C) Household management,
7 "(D) Basic money management,
8 "(6) DISABILITY DETERMINATION SERVICE.-
9 The term 'Disability Determination Service' means,
10 with respect to each State, the entity that has an
11 agreement with the Connnissioner of Social Security
12 to make disability determinations for purposes of
13 title II or XVI of the Social Security Act (42 U,S,C,
14 401 et seq" 1381 et seq,).
15 "(7) ELIGIBLE BENEFICIARY,-
16 "(A) IN GENERAL.-The term 'eligible
17 beneficiary' means any individual who is an ac-
18 tive enrollee in the CLASS program and, as of
19 the date described in subparagraph (B)-
20 "(i) has paid premiums for enrolhnent
21 m such program for at least 60 months;
22 and
23 "(ii) has paid premIUms for enroll-
24 ment in such program for at least 12 con-
25 secutive months, if a lapse in premium
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payments of more than 3 months has occurred
during the period that begins on the
date of the individual's enrollment and
ends on the date of such determination.
"(B) DATE DESCRIBED.-For purposes of
subparagraph (A), the date described in this
subparagraph is the date on which the individual
is determined to have a functional limitation
described in either of the following clauses
that is expected to last for a continuous period
of more than 90 days:
"(i) The individual is unable to perform
at least the minimum number of activities
of daily living or to require superVISIOn,
cueing, or hands-on assistance to
plan or perform at least the minimum
number of such activities as are required
to trigger the provision of benefits under
the CLASS Independence Benefit Plan.
"(ii) Due to a cognitive or psychiatric
impairment, the individual requires supervision,
cueing, or hands-on assistance to
engage in at least the minimum number of
critical life functions activities as are required
to trigger the provision of benefits
7
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121
viduals, but the same premium shall be established
for all such individuals who are
the same age.
"(iv) OTHER REQUIREMENTS.-The
premIUms satisfy the additional reqUlrements
specified in subsection (b).
"(B) VESTING PERIOD.-A 5-year vesting
pElriod for eligibility for benefits.
"( C) BENEFIT TRIGGERS.-A benefit trigger
for provision of benefits that requires a determination
that an individual has a functional
limitation described in either of the following
clauses that is expected to last for a continuous
period of more than 90 days:
"(i) The individual IS determined to
be unable to perform (or requires supervision,
cueing, or hands-on assistance to
plan or perform) not less than 2, but not
more than 3, activities of daily living.
"(ii) Due to a cognitive or psychiatric
impairment, the individual is determined to
require supervision, cueing, or hands-on
assistance to engage in not less than 2, but
not more than 3, critical life functions.
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"(D) CASH BENEFIT.-Payment of a cash
benefit that satisfies the following requirements:
"(i) MINIMUM REQUIRED AMOUNT.The
benefit amount provides an eligible
beneficiary with not less than an average
of $50 per day (as determined based on
the reasonably expected distribution of
\ beneficiaries receiving benefits at various
benefit levels).
"(ii) AMOUNT SCALED TO FUNCTIONAL
ABILITY.-The benefit amount is
varied based on a scale of functional ability,
with not less than 2, and not more
than 6, benefit level amounts.
"(iii) DAlLY OR WEEKLY.-The benefit
is paid on a daily or weekly basis.
"(iv) No LIFETIME OR AGGREGATE
UMIT.-The benefit is not subject to any
lifetime or aggregate limit.
"(E) COORDINATION WITH SUPPLEMENTAL
COVERAGE OBTAlNED THROUGH THE
EXCHANGE.-[Drafting note: will need to
amend definition of quaqualified health plan for
purposes of the Exchange to include a special
rule that permits coverage offered by a health in123
1 surance issuer that is supplemental coverage to
2 benefits provided under a CLASS Independence
3 Benefit Plan under title XXXIII of the
4 PHSA]The benefits allow for coordination with
5 any supplemental coverage purchased from a
6 health insurance issuer (as defined in section
7 2791) through the [American Health Benefit
8 Eichange] established under section [3101].
9 "(2) REVIEW AND RECOMMENDATION BY THE
10 CLASS INDEPENDENCE ADVISORY COUNCIL.-The
11 CLASS Independence Advisory Council shall-
12 "(A) evaluate the alternative benefit plans
13 developed under paragraph (1); and
14 "(B) recommend for designation as the
15 CLASS Independence Benefit Plan for offering
16 to the public the plan that the Council deter-
17 mines best balances price and benefits to meet
18 enrollees' needs in an actuarially sound manner,
19 while optimizing the probability of the long-
20 term sustainability of the CLASS program.
21 "(3) DESIGNATION BY THE SECRETARY.-Not
22 later than October 1, 2012, the Secretary, taking
23 into consideration the recommendation of the
24 CLASS Independence Advisory Council under para-
25 graph (2)(B), shall designate a benefit plan as the
124
1 CLASS Independence Benefit Plan. The Secretary
2 shall publish such designation, along with details of
3 the plan and the reasons for the selection by the
4 Secretary, in an interim final rule that allows for a
5 period of public comment and subsequent response
6 by the Secretary before being final.
7 "(b) ADDITIONAL PREMIUM REQUIREMENTS.- ,
8 "(1) ANNUAL ESTABLISHMENT OF PREMIUM
9 FOR NEW ENROLLEES AFTER FIRST YEAR OF THE
10 PROGRAM.-The Secretary shall am1Ually establish
11 the monthly premium for enrollment in the CLASS
12 program during any year after the first year in
13 which the program is in effect under this title. The
14 Secretary shall deternline such annual monthly pre-
15 mium based on the following:
16 "(A) The most recent report of the CLASS
17 Independence Fund Board of Trustees under
18 section 3105(d).
19 "(B) The advice and recommendations of
20 the CLASS Independence Advisory Council.
21
22
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25
"(C) The projected distribution and
amount of benefits under the CLASS program.
"(D) Such other factors as the Secretary
determines appropriate.
"(2) ADJUSTMENT OF PREMIUMS.-
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"(A) IN GENERAL.-Except as provided in
subparagraphs (B), (C), and (D), the amount
of the monthly premium determined for an individual
upon such individual's enrolhnent in the
CLASS program shall remain the same for as
long as the individual is an active enrollee in
the program.
"(B) RECALCULATED PREMIUM IF REQUIRED
FOR PROGRAM SOLVENCY.-
; h
"(i) IN GENERAL.-Subject to clause.
(ii), if the Secretary determines, based on
the most recent report of the Board of
Trustees of the CLASS Independence
Fund, the advice of the CLASS Independence
Advisory Council, or such other information
as the Secretary determines appropriate,
that the monthly premiums and income
to the CLASS Independence Fund
for a year are projected to be insufficient
with respect to the 20-year period that begins
with that year, the Secretary shall adjust
the monthly premiums for individuals·
enrolled in the CLASS program as necessary
(but maintaining a nominal premium
for enrollees whose income is below
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126
the poverty line or who are full-time students
actively at work).
"(ii) EXElYlPTION FROM INCREASE.Any
increase in a monthly premium unposed
as result of a determination described
in clause (i) shall not apply with
respect to the monthly premium of any active
enrollee who-
"(I) has attained age 65;
"(II) has paid premiums for enrollment
in the program for at least
20 years; and
"(III) is not actively at work.
"(C) RECALCULATED PREMIUM IF REENROLLMENT
AFTER MORE THAN A 3-MONTH
LAPSE.-
"(i) IN GENER..lli.-The reenrollment
of an individual after a gO-day period during
which the individual failed to pay the
monthly premium required to maintain the
individual's enrollment in the CLASS program
shall be treated as an initial enrollment
for purposes of age-adjusting the
premium for enrollment in the program.
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"(ii) CREDIT FOR PRIOR MONTHS.An
individual who reenrolls in the CLASS
program after such a 90-day period shall
be-
"(I) credited with any months of
paid premiums that accrued prior to
the individual's lapse in enrollment;
and
"(II) notwithstanding the total
amount of any such credited months,
required to satisfy section
3201(7)(A)(ii) before being eligible to
receive benefits.
"(D) No LONGER STATUS AS A FULL-TIME
STUDENT.-An individual subject to a nominal
premium on the basis of being described in subsection
(a)(l)(A)(ii)(I)(bb) who ceases to be described
in that subsection, beginning with the
first month following the month in which the
individual ceases to be so described, shall be
subject to the same monthly premium as the
monthly premium that applies to an individual
of the same age who first enrolls in the program
under the most similar circumstances as
the individual (such as the first year of eligi128
1 bility for enrollment in the program or in a sub-
2 sequent year).
3 "(3) ADMINISTRATIVE EXPENSES.-In deter-
4 mining the monthly premiums for the CLASS pro-
S gram the Secretary may factor in costs for admin-
6 istering the program, not to exceed-
7 "(A) in the case of the first 5 years in
\
8 which the program is in effect under this title,
9 an amount equal to 3 percent of all premiums
1 0 paid during each such year; and
11 "(B) in the case of subsequent years, an
12 amount equal to 5 percent of the total amount
13 of all expenditures (including benefits paid)
14 under this title with respect to that year.
15 "(4) No UNDERWRITING REQUIREMENTS.-No
16 underwriting (other than on the basis of age in ac-
17 cordance ,vith paragraph (3)) shall be used to-
18 "(A) determine the monthly premium for
19 enrollment in the CLASS program; or
20 "(B) prevent an individual from enrolling
21 in the program.
22 "(c) SELF-ATTESTATION AND VERIFICATION OF IN-
23 COME.-The Secretary shall establish procedures to-
24 " (1) permit an individual who is eligible for the
25 nominal premmm required under subsection
tdb ............ ~
~
129
1 (a)(l)(A)(ii), as part of their automatic enrollment
2 in the CLASS program, to self-attest that their in-
3 come does not exceed the poverty line or that their
4 status as a full-time student who is actively at work;
5 "(2) verify the validity of such self-attestation;
6 and
7 "(3) reqUlre an individual to confirm, on at
8 least a1 annual basis, that their income does not ex-
9 . ceed the poverty line or that they continue to main-
10 tain such status.
11 "SEC. 3204. ENROLLMENT AND DISENROLLMENT REQUIRE-
12 MENTS.
13 "(a) AUTOMATIC ENROLLMENT.-
14 "(1) IN GENERAL.-Subject to paragraph (2),
15 the Secretary shall establish procedures under which
16 each individual described in subsection (c) shall be
17 automatically enrolled in the CLASS program by an
18 employer of such individual in the same maImer as
19 an employer may elect to automatically enroll em-
20 ployees in a plan under section 401(k), 403(b), or
21 457 of the Internal Revenue Code of 1986.
22 "(2) ALTERNATIVE ENROLLMENT PROCE-
23 DUREs.-The procedures established under para-
24 graph (1) shall provide for an alternative enrollment
130
1 process for an individual described in subsection (c)
2 in the case of such an individual-
3 "(A) who is self-employed;
4 "(B) who has more than 1 employer;
5 "(C) whose employer does not elect to par-
6 ticipate in the automatic enrollment process es-
7 tablished by the Secretary; or
8 "(D) who is a spouse described m sub-
9 section (c)(2) of who is not subject to automatic
10 enrollment.
11 "(3) ADMINISTRATION.-
12 "(A) IN GENERAL.-The Secretary shall,
13 by regulation, establish procedures to-
14 "(i) ensure that an individual is not
15 automatically enrolled in the CLASS pro-
16 gram by more than 1 employer; and
17
18
19
20
21
22
23
24
"(ii) allow for an individual's employer
to deduct a premium for a spouse
described in subsection (c) (1) (B) who IS
not subject to automatic enrollment.
"(B) FORM.-Enrollment in the CLASS
program shall be made in such manner as the
Secretary may prescribe in order to ensure ease
of administration.
7 hi!
131
1 "(b) ELECTION TO OPT-OUT.-An individual de-
2 scribed in subsection (c) may elect to waive enrollment in
3 the CLASS program at any time in such form and manner
4 as the Secretary shall prescribe.
5 "(c) INDIVIDUAl, DESCRIBED.-For purposes of en-
6 rolling in the CLASS program, an individual described in
7 this paragraph is-
8
9
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17
18
19
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21
22
23
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\
"(1) an individual-
"(A) who has attained age 18;
"(B) who-
"(i) receives wages on which there is
imposed a tax under section 3201(a) of the
Internal Revenue Code of 1986; or
"(ii) derives self-employment mcome
on which there is imposed a tax under section
1401(a) of the Internal Revenue Code
of 1986;
"( C) who is actively at work; and
"(D) who is not-
"(i) a patient in a hospital or nursing
facility, an intermediate care facility for
the mentally retarded, or an institution for
mental diseases and receiving medical assistance
under Medicaid; or
1 7 r'17 71
132
1 "(ii) confined in a jail, prIson, other
2 penal institution or correctional facility, or
3 by court order pursuant to conviction of a
4 criminal offense or in connection with a
5 verdict or finding described in section
6 202(x)(I)(A)(ii) of the Social Security Act
7 (42 U.S.C. 402(x)(I)(A)(ii)); or
8 "(2) the spouse of an individual described 111
9 paragraph (1) and who would be an individual so de-
W scribed but for subparagraph (E) or (C) of that
11 paragraph.
12 "(d) RULE OF CONSTRUCTION.-Nothing in this title
13 shall be construed as requiring an active enrollee to con-
14 tinue to satisfy subparagraph (E) or (C) of subsection
15 (c) (1) in order to maintain enrollment in the CLASS pro-
16 gram.
17 "(e) PAYMENT.-
18 "(1) PAYROLl, DEDUCTION.-An amount equal
19 to the monthly premium for the enrollment in the
20 CLASS program of an individual shall be deducted
21 from the wages or self-employment income of such
22 individual in accordance with such procedures as the
23 Secretary, in consultation with the Secretary of the
24 Treasury, shall establish for employers who elect to
133
1 deduct and withhold such premiums on behalf of en-
2 rolled employees.
3 "(2) ALTERNATIVE PAYMENT MECHANISM.-
4 The Secretary shall establish alternative procedures
5 for the payment of monthly premiums by an indi-
6 vidual enrolled in the CLASS program-
7 "CA) who does not have an employer who
8 elects to deduct and withhold premiums in ac-
9 cordance with subparagraph (A); or
10 "(B) who does not earn wages or derive
11 self-employment income.
12 "Cf) TRANSFER OF PREMIUMS COLLECTED.-
13 "(1) IN GE1--.TERAL.-During each calendar year
14 the Secretary of the Treasury shall deposit into the
15 CLASS Independence Fund a total amount equal, in
16 the aggregate, to 100 percent of the premiums col-
17 lected during that year.
18 "(2) TRANSFERS BASED ON ESTIMATES.-The
19 amount deposited pursuant to paragraph (1) shall be
20 transferred in at least monthly payments to the
21 CLASS Independence Fund on the basis of esti-
22 mates by the Secretary and certified to the Sec-
23 retary of the Treasury of the amounts collected in
24 accordance with subparagraphs (A) and (B) of para-
25 graph (5). Proper adjustments shall be made in
•.. i,!.c ~r7
134
1 amounts subsequently transferred to the Fund to
2 the extent prior estimates were in excess of, or were
3 less than, actual amounts collected.
4 "(g) OTHER ENROLLMENT Al\1]) DISENROLLMENT
5 OPPORTUNITIEs.-The Secretary shall establish proce-
6 dures under which-
7 "(1) an individual who, in the year of the indi-
\
8 vidual's initial eligibility to enroll in the CLASS pro-
9 gram, has elected to waive enrollment in the pro-
10 gram, is eligible to elect to enroll in the program, in
11 such form and manner as the Secretary shall estab-
12 lish, only during an open enrollment period estab-
13 lished by the Secretary that is specific to the indi-
14 vidual and that may not occur more frequently than
15 biennially after the date on which the individual first
16 elected to waive enrollment in the program; and
17 "(2) an individual shall only be permitted to
18 disenroll from the program during an annual
19 disenrollment period established by the Secretary
20 and in such form and manner as the Secretary shall
21 establish.
22 "SEC. 3205. BENEFITS.
23 "(a) DETERMINATION OF ELIGIBILITY.-
24 "(1) APPLICATION FOR RECEIPT OF BENE-
25 FITS.-The Secretary shall establish procedures
£L
135
1 under which an active enrollee shall apply for receipt
2 of benefits under the CLASS Independence Benefit
3 Plan.
4 "(2) ELIGIBILITY ASSESSMENTS.-
5 "(A) IN GENERAI,.-Not later than Janu-
6 ary 1, 2012, the Secretary shall enter into
7 agreements with-
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17
18
19
20
21
22
23
24
25
"(i) the Disability Determination
Service for each State to provide for eligibility
assessments of active enrollees who
apply for receipt of benefits;
"(ii) the Protection and Advocacy
System for each State to provide advocacy
services in accordance with subsection (d);
and
"(iii) public and private entities to
provide advice and assistance counseling in
accordance with subsection (e).
"(B) 30-DAY 'PERIOD FOR APPROVAL OR
DISAPPROVAL.-An agreement under subparagraph
(A) shall require that a Disability Determination
Service determine within 30 days of
the receipt of an application for benefits under
the CLASS Independence Benefit Plan whether
an applicant is eligible for a cash benefit under
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the program and if so, the amount of the cash
benefit in accordance the sliding scale established
under the plan. An application that is
pending after 45 days shall be deemed approved.
"(C) PRESUJ\Il'PTIVE ELIGIBILITY POR CERTAIN
INSTITUTIONALIZED ENROLLEES PLANNING
TO DISCHARGE.-An active enrollee shall
be deemed presumptively eligible if the enrollee-
"(i) has applied for, and attests is eligible
for, the maximum cash benefit available
under the sliding scale established
under the CLASS Independence Benefit
Plan;
"(ii) is a patient in a hospital, nursing
facility, intermediate care facility for the
mentally retarded, or an institution for
mental diseases; and
"(iii) is in the process of, or about to
begin the process of, planning to discharge
from the hospital, facility, or institution.
"(D) APPEALs.-The Secretary shall establish
procedures under which an applicant for
benefits under the CLASS Independence Ben137
1 efit Plan shall be guaranteed the right to ap-
2 peal an adverse determination.
3 "(b) BENEFITS.-An eligible beneficiary shall receive
4 the following benefits under the CLASS Independence
5 Benefit Plan:
6 "(1) CASH BENEFIT.-A cash benefit estab-
7 lished by the Secretary in accordance with the re-
8 quirements of section 3203(a)(I)(D) that-
9 "(A) the first year in which beneficiaries
1 0 receive the benefits under the plan, is not less
11 than the average dollar amount specified in
12 clause (i) of such section; and
13 "(B) for any subsequent year, is not less
14 than the average per day dollar limit applicable
15 under this subparagraph for the preceding year,
16 increased by the percentage increase in the con-
17 sumer price index for all urban consumers
18 (U.S. city average) over the previous year.
19 "(2) ADVOCACY SERVICES.-Advocacy seI'Vlces
20 in accordance with subsection (d).
21 "(3) ADv1CE AND ASSISTANCE COUNSELING.-
22 Advice and assistance counseling in accordance with
23 subsection (e).
24 "(c) PAYMENT OF BENEFITS.-
25 "(1) LIFE INDEPENDENCE ACCOUNT.-
£)1
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3
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87I111illl;;.'.7 ___
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in.'; ..
"(A) IN GENERAL.-The Secretary shall
establish procedures for administering the provision
of benefits to eligible beneficiaries under
the CLASS Independence Benefit Plan, including
the payment of the cash benefit for the beneficiary
into a Life Independence Account established
by the Secretary on behalf of each eli-
;
gible beneficiary.
"(B) USE OF CASH BENEFITs.-Cash benefits
paid into a Life Independence Account of
an eligible beneficiary shall be used to purchase
nonmedical services and supports that the beneficiary
needs to maintain his or her independence
at home or in another residential setting
of their choice in the community, including (but
not limited to) home modifications, assistive
technology, accessible transportation, homemaker
services, respite care, personal assistance
services, home care aides, and nursing support.
"(C) ELECTRONIC MANAGEMENT OF
FUND8.-The Secretary shall establish procedures
for-
"(i) crediting an account established
on behalf of a beneficiary with the beneficiary's
cash daily benefit;
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139
"(ii) allowing the beneficiary to access
such account through debit cards; and
"(iii) accounting for withdrawals by
the beneficiary from such account.
"(D) PRIMARY PAYOR RULES FOR BENEFICIARIES
WHO ARE ENROLLED IN MEDICAID.-
In the case of an eligible beneficiary who is en;
rolled in Medicaid, the following payrnent rules
shall apply:
" (i) INSTITUTIONALIZED BENEFICIARy.-
If the beneficiary is a patient in
a hospital, nursing facility, intermediate
care facility for the mentally retarded, or
an institution for mental diseases, the beneficiary
shall retain an amount equal to 5
percent of the beneficiary's daily or weekly
cash benefit (as applicable) (which shall be
in addition to the amount of the beneficiary's
personal needs allowance provided
under Medicaid), and the remainder of
such benefit shall be applied toward the facility's
cost of providing the beneficiary's
care, and Medicaid shall provide secondary
coverage for such care.
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140
" (ii) BENEFICIARIES RECEIVING
HOME AND COMMUNITY-BASED SERVICES.-
"(I) 50 PERCENT OF BENEFIT
RETAINED BY BENEFICIARY.-If a
beneficiary is receiving medical assistance
under Medicaid for home and
community based services, the beneficiary
shall retain an amount equal to
50 percent of the beneficiary's daily or
weekly cash benefit (as applicable),
subject to subclause (II), and the remainder
of the daily or weekly cash
benefit shall be applied toward the
cost to the State of providing such assistance
(and shall not be used to
claim Federal matching funds under
Medicaid), and Medicaid shall provide
secondary coverage for the remainder
of any costs incurred in providing
such assistance.
"(II) REQUIREMENT FOR STATE
OFFSET.-A State shall be paid the
remainder of a beneficiary's daily or
weekly cash benefit under subclause
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2
3
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.0_1 11111.11., 1111111_ •• U
141
"'~'--- .'-•• _- .- ..-.~-, ~
(I) only if the State home and community-
based waiver under section
1115 of the Social Security Act (42
U,S.C. 1315) or subsection (c) or (d)
of section 1915 of such Act (42
U.S.C. 1396n), or the State plan
amendment under subsection (i) of
such section does not include a waiver
of the requirements of section
1902(a)(1) of the Social Security Act
(relating to statewideness) or of section
1902(a)(10)(B) of such Act (relating
to comparability) and the State
offers at a minimum case management
services, personal care services,
habilitation -services, and respite care
under such a waiver or State plan
amendment.
"(III) DEFINITION OF HOME AND
COMMUNITY-BASED SERVICES.-In
this clause, the term 'home and community-
based services' means any
services which may be offered under a
home and community-based WaIver
authorized for a State under section
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142
1115 of the Social Security Act (42
U.S.C. 1315) or subsection (c) or (d)
of section 1915 of such Act ( 42
U.S.C. 1396n) or under a State plan
amendment under subsection (i) of
such section.
"(2) AUTHORIZED REPRESENTATIVES.\
"(A) IN GENERAL.-The Secretary shall
establish procedures to allow access to a beneficiary's
cash benefits by an authorized representative
of the eligible beneficiary on whose
behalf such benefits are paid.
"(B) QUALITY ASSURANCE AND PROTECTION
AGAINST FRAUD AND ABUSE.-The procedures
established under subparagraph (A) shall
ensure that authorized representatives of eligible
beneficiaries comply with standards of conduct
established by the Secretary, including
standards requiring that such representatives
provide quality services on behalf of such beneficiaries,
do not have conflicts of interest, and
do not misuse benefits paid on behalf of such
beneficiaries or otherwise engage in fraud or
abuse.
La 7 J1L .. F I •. ~
143
1 "(3) COMMENCEMENT OF BENEFITS.-Benefits
2 shall be paid to, or on behalf of, an eligible bene-
3 ficiary beginning with the first month in which an
4 application for such benefits is approved.
5 "(4) ROr,r,OVER OPTION FOR r,UlVIP-SUM PAY-
6 MENT.-An eligible beneficiary may elect to-
7 "(A) defer payment of their daily or weekly
8 benefit and to rollover any such deferred bene-
9 fits from month-to-month, but not from year-tolD
year; and
11 "(B) receive a lump-sum payment of such
12 deferred benefits in an amount that may not
·13 exceed the lesser of-
14 "(i) the total amount of the accrued
15 deferred benefits; or
16 "(ii) the applicable annual benefit.
17 "(5) PERIOD FOR DETERMINATION OF ANNWIL
18 BENEFITS.-
19 "(A) IN GENERAL.-The applicable period
20 for determining with respect to an eligible bene-
21 ficiary the applicable annual benefit and the
22 amount of any accrued deferred benefits is the
23 12-month period that commences with the first
24 month in which the beneficiary began to receive
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3
4
5
6
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• sn IF '"Pe'ln
144
such benefits, and each 12-month period there,
after.
"(B) INCLUSION OF INCREASED BENEFITs.-
The Secretary shall establish procedures
under which cash benefits paid to an eligible
beneficiary that increase or decrease as a result
of a, change in the functional status of the beneficiary
before the end of a 12-month benefit period
shall be included in the determination of
the applicable annual benefit paid to the eligible
beneficiary.
"(e) RECOUPMENT OF UNPAID, ACCRUED
BENEFITS.-
"(i) IN ?-ENERAL.-The Secretary
shall recoup any accrued benefits in the
event of-
"(I) the death of a beneficiary; or
"(II) the failure of a beneficiary
to elect under paragraph (4)(B) to receive
such benefits as a lump-sum
payment before the end of the 12-
month period in which such benefits
accrued.
"(ii) PAYlIIENT INTO CLASS INDEPE:
t-.TJ)ENCE FUND.-Any benefits recouped
145
1 in accordance with clause (i) shall be paid
2 into the CLASS Independence Fund and
3 used in accordance with section 3206.
4 "(6) RE,Q UIREMENT TO RECERTIFY ELIGIBILITY
5 FOR RECEIPT OF BENEFITS.-An eligible beneficiary
6 shall periodically, as determined by the Secretary-
7 "(A) recertify by submission of medical
8 evidence the beneficiary's continued eligibility
9 for receipt of benefits; and
10 "(B) submit records of expenditures attrib-
11 utable to the aggregate cash benefit received by
12 the beneficiary during the preceding year.
13 "(7) SUPPLEMENT, NOT SUPPLANT OTHER
14 HEALTH CARE BENEFITS.-Subject to the Medicaid
15 payment rules under paragraph (1) (C), benefits re-
16 ceived by an eligible beneficiary shall supplement,
17 but not supplant, other health care benefits for
18 which the beneficiary is eligible under Medicaid or
19 any other Federally funded program that provides
20 health care benefits or assistance.
21 "(d) ADVOCACY SERVICES.-An agreement entered
22 into under subsection (a)(2)(A)(ii) shall require the Pro-
23 tection and Advocacy System for the State to-
24 "(1) assign, as needed, an advocacy counselor
25 to each eligible beneficiary that is covered by such
146
1 agreement and who shall provide an eligible bene-
2 ficiary with-
3 "(A) information regarding how to access
4 the appeals process established for the program;
5 "(B) assistance with respect to the annual
6 recertification and notification required under
7 subsection (c)(6); and
\
8 "(C) such other services as the Secretary,
9 by regulation, shall require; and
10 "(2) ensure that the System and such coun-
11 selors comply with the requirements of subsection
12 (i).
13 "(e) AD,'ICE AND AsSISTANCE COUNSELING.-An
14 agreement entered into under subsection (a)(2)(A) (iii)
15 shall require the entity to assign, as requested by an eligi-
16 ble beneficiary that is covered by such agreement, an ad-
17 vice and assistance counselor who shall provide an eligible
18 beneficiary with information regarding-
19 "( 1) accessing and coordinating long-term serv-
20 ices and supports in the most integrated setting;
21 "(2) possible eligibility for other benefits and
22 seI'Vlces;
23 "(3) development of a service and support plan;
147
1 "( 4) information about programs established
2 under the Assistive Technology Act of 1998 and the
3 services offered under such programs; and
4 "( 5) such other services as the Secretary, by
5 regulation, may require.
6 "(f) No EFFECT ON ELIGIBILITY FOR OTHER BENE-
7 FITs.-Benli,f its paid to an eligible beneficiary under the
8 CLASS program shall be disregarded for purposes of de-
9 termining or continuing the beneficiary's eligibility for re-
10 ceipt of benefits under any other Federal, State, or locally
11 funded assistance program, including benefits paid under
12 titles II, XVI, XVIII, XIX, or XXI of the Social Security
13 Act (42 U.S.C. 401 et seq., 1381 et seq., 1395 et seq.,
14 1396 et seq., 1397aa et seq.), under the laws administered
15 by the Secretary of Veterans Affairs, under low-income
16 housing assistance programs, or under the supplemental
17 nutrition assistance program established under the Food
18 and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.).
19 "(g) RULE OF CONSTRUCTION.-Nothing in this title
20 shall be construed as prohibiting benefits paid under the
21 CLASS Independence Benefit Plan from being used to
22 compensate a family caregiver for providing community
23 living assistance services and supports to an eligible bene-
24 ficiary.
",XZ Milt g,
148
1 "(h) PROTECTION AGAINST CONFLICT OF INTER-
2 ESTs.-The Secretary shall establish procedures to ensure
3 that the Disability Determination Service and Protection
4 and Advocacy System for a State, advocacy counselors for
5 eligible beneficiaries, and any other entities that provide
6 services to active enrollees and eligible beneficiaries under
7 the CLASS p,r ogram comply with the following:
8 "( 1) If the entity provides counseling or plan-
9 ning services, such services are provided in a manner
10 that fosters the best interests of the active enrollee
11 or beneficiary.
12 "(2) The entity has established operating proce-
13 dures that are designed to avoid or minimize con-
14 flicts of interest between the entity and an active en-
15 rollee or beneficiary.
16 "(3) The entity provides information about all
17 services and options available to the active enrollee
18 or beneficiary, to the best of its knowledge, including
19 services available through other entities or providers.
20 "( 4) The entity assists the active enrollee or
21 beneficiary to access desired services, regardless of
22 the provider.
23 "(5) The entity reports the number of active
24 enrollees and beneficiaries provided with assistance
25 by age, disability, and whether such enrollees and
In
149
1 beneficiaries received services from the entity or an-
2 other entity.
3 "(6) If the entity provides counseling or plan-
4 ning services, the entity ensures that an active en-
5 rollee or beneficiary is informed of any financial in-
6 terest that the entity has in a service provider.
7 "(7 , ) The entity provides an active enrollee or
8 beneficiary with a list of available service providers
9 that can meet the needs of the active enrollee or
10 beneficiary.
11 "SEC. 3206. CLASS INDEPENDENCE FUND.
12 "(a) ESTABLISHMENT OF CLASS INDEPENDENCE
13 FUND.-There is established in the Treasury of the
14 United States a trust fund to be known as the 'CLASS
15 Independence Fund'. The Secretary of the Treasury shall
16 serve as Managing Trustee of such Fund. The Fund shall
17 consist of all amounts derived from payments into the
18 Fund under sections 3204(f) and 3205(c)(5)(C)(ii), and
19 remaining after investment of such amounts under sub-
20 section (b), including additional amounts derived as in-
21 come from such investments. The amounts held in the
22 Fund are appropriated and shall remain available without
23 fiscal year limitation-
24 "(1) to be held for investment on behalf of indi-
25 viduals enrolled in the CLASS program;
tv
150
1 "(2) to pay the administrative expenses related
2 to the Fund and to investment under subsection (b);
3 and
4 "( 3) to pay cash benefits to eligible bene-
5 ficiaries under the CLASS Independence Benefit
6 Plan.
7 "(b) IN,:V ESTMENT OF FUND BALANcE.-The Sec-
8 retary of the Treasury shall invest and manage the
9 CLASS Independence Fund in the same mamler, and to
10 the same extent, as the Federal Supplementary Medical
11 Insurance Trust Fund may be invested and managed
12 under subsections (c), (d), and (e) of section 1841(d) of
13 the Social Security Act (42 U.S.C. 1395t).
14 "(c) OFF-BuDGET STATUS; LOCK-Box PROTEC-
15 TION.-
16 "(1) EXCLUSION OF TRUST FUNDS FROM ALL
17 BUDGETS.-N otwithstanding any other provision of
18 law, the amounts derived from payments into the
19 Fund and amounts paid from the Fund shall not be
20 counted as new budget authority, outlays, receipts,
21 or deficit or surplus for purposes of-
22 "(A) the budget of the United States Gov-
23 ernment, as submitted by the President;
24 "(B) the congressional budget; or
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151
"( C) the Balanced Budget and Emergency
Deficit Control Act of 1985.
"(2) LOCK-BOX PROTECTION.-
"(A) IN GENERAL.-N otwithstanding any
other provision of law, it shall not be in order
in the Senate or the House of Representatives
to\ consider any measure that would authorize
the payment or use of amounts in the Fund for
any purpose other than a purpose authorized
under this title.
"(B) 60-VOTE WAIVER REQUIRED IN THE
SENATE.-
"(i) IN GENERAL.-Subparagraph (A)
may be waived or suspended in the Senate
only by the affirmative vote of 31.0 of the
Members, duly chosen and sworn.
"(ii) APPEALS.-
"(I) PROCEDURE.-Appeals III
the Senate from the decisions of the
Chair relating to clause (i) shall be
limited to 1 hour, to be equally divided
between, and controlled by, the
mover and the manager of the measure
that would authorize the payment
or use of amounts in the Fund for a
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152
purpose other than a purpose authorized
under this title.
"(II) GO-VOTES REQUIRED.-An
affirmative vote of % of the Members,
duly chosen and sworn, shall be required
in the Senate to sustain an appeal
of the ruling of the Chair on a
point of order raised in relation to
clause (i).
"(C) RULES OF THE SENATE AND HOUSE
OF REPRESENTATIVES.-This section is enacted
by Congress-
"(i) as an exerCISe of the rulemaking
power of the Senate and House of Representatives,
respectively, and is deemed to
be part of the rules of each House, respectively,
but applicable only with respect to
the procedure to be followed in that House
in the case of a measure described in subparagraph
(A), and it supersedes other
rules only to the extent that it is inconsistent
with such rules; and
"(ii) with full recognition of the constitutional
right of either House to change
the rules (so far as they relate to the pro-_
ii •.' .. --~;'
153
1 cedure of that House) at any time, in the
2 same manner, and to the same extent as in
3 the case of any other rule of that House.
4 "(d) BOARD OF TRUSTEES.-
5 "(1) IN GENERAI,.-With respect to the CLASS
6 Independence Fund, there is hereby created a body
7 to be kn, own as the Board of Trustees of the CLASS
8 Independence Fund (hereinafter in this section re- .
9 ferred to as the 'Board of Trustees') composed of
10 the Connnissioner of Social Security, the Secretary
11 of the Treasury, the Secretary of Labor, and the
12 Secretary of Health and Human Services, all ex offi,
13 cio, and of two members of the public (both of whom
14 may not be from the same political party), who shall
15 be nominated by the President for a term of 4 years
16 and subject to confirmation by the Senate. A mem,
17 ber of the Board of Trustees serving as a member
18 of the public and nominated and confirmed to fill a
19 vacancy occurring during a term shall be nominated
20 and confirmed only for the remainder of such term.
21 An individual nominated and confirmed as a member
22 of the public may serve in such position after the ex-
23 piration of such member's term until the earlier of
24 the time at which the member's successor takes of,
25 fice or the time at which a report of the Board is
------ ~ 154
1 first issued under paragraph (2) after the expiration
2 of the member's term. The Secretary of the Treas-
3 ury shall be the Managing Trustee of the Board of
4 Trustees. The Board of Trustees shall meet not less
5 frequently than once each calendar year. A person
6 serving on the Board of Trustees shall not be con-
7 sidered ,.t o be a fiduciary and shall not be personally
8 liable for actions taken in such capacity with respect
9 to the Trust Fund.
10 "(2) DUTIES.-
11 "(A) IN GENERAL.-It shall be the duty of
12 the Board of Trustees to do the following;
13 "(i) Hold the CLASS Independence
14 Fund.
15 "(ii) Report to the Congress not later
16 than the first day of April of each year on
17 the operation and status of the CLASS
18 Independence Fund during the preceding
19 fiscal year and on its expected operation
20 and status during the current fiscal year
21 and the next 2 fiscal years.
22 "(iii) Report immediately to the Con-
23 gress whenever the Board is of the opinion
24 that the amount of the CLASS Independ-
25 ence Fund is unduly small.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
155
"(iv) Review the general policies followed
in managing the CLASS Independence
Fund, and recommend changes in
such policies, including necessary changes
in the provisions of law which govern the
way in which the CLASS Independence
Fund is to be managed.
"(B) REPoRT.-The report provided for in
subparagraph (A)(ii) shall-
"(i) include-
"(I) a statement of the assets of,
and the disbursements made from, the
CLASS Independence Fund during
the preceding fiscal year;
"(II) an estimate of the expected
income to, and disbursements to be
made from, the CLASS Independence
Fund during the current fiscal year
and each of the next 2 fiscal years;
"(III) a statement of the actuarial
status of the CLASS Independence
Fund for the current fiscal year,
each of the next 2 fiscal years, and as
projected over the 75-year period be1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
156
ginning 'with the current fiscal year;
and
"(IV) an actuarial opinion by the
Chief Actuary of the Social Security
Administration certifying that the
techniques and methodologies used
are generally accepted 'within the actuarial
profession and that the assumptions
and cost estimates used are
reasonable; and
"(ii) be printed as a House document
of the session of the Congress to which the
report is made.
"(C) RECOMMENDATIONS.-If the Board
of Trustees determines that enrollment trends
and expected future benefit claims on the
CLASS Independence Fund create expected financial
problems that are unlikely to be resolved
with reasonable premium increases or
through other means, the Board of Trustees
shall include in the report provided for in subparagraph
(A) (ii) recommendations for such
legislative action as the Board of Trustees determine
to be appropriate, including whether to
1
2
157
adjust monthly premiums or Impose a temporary
moratorium on new enrollments.
3 "SEC. 3207. CLASS INDEPENDENCE ADVISORY COUNCll..
4 "(a) ESTABLISHMENT.-There is hereby created an
5 Advisory Committee to be known as the 'CLASS Inde-
6 pendence Advisory Council' .
7 "(b) MEMBERSHIP.-
I
8 "(1) IN GENERAL.-The CLASS Independence
9 Advisory Council shall be composed of not more
10 than 15 individuals, not otherwise in the employ of
11 the United States-
12 "(A) who shall be appointed by the Presi-
13 dent without regard to the civil service laws and
14 regulations; and
15 "(B) a majority of whom shall be rep-
16 resentatives of individuals who participate or
17 are likely to participate in theCL.ASS program,
18 and shall include representatives of older and
19 younger workers, individuals with disabilities,
20 family caregivers of individuals who require
21 services and supports to maintain their inde-
22 pendence at home or in another residential set-
23 ting of their choice in the community, individ-
24 uals with expertise in long-term care or dis-
25 ability insurance, actuarial science, economics,
158
1 and other relevant disciplines, as determined by
2 the Secretary.
3 "(2) TERMS.-
4 "(A) IN GENERAL.-The members of the
5 CLASS Independence Advisory Council shall
6 serve overlapping terms of 3 years (unless ap-
7 poi,n ted to fill a vacancy occurring prior to the
8 expiration of a term, in which case the indi-
9 vidual shall serve for the remainder of the
10 term).
11 "(B) LIMITATION.-A member shall not be
12 eligible to serve for more than 2 consecutive
l3 terms.
14 "(3) CHAlR.-The President shall, from time to
15 time, appoint one of the members of the CLASS
16 Independence Advisory Council to serve as the
17 Chair.
18 "(c) DUTIEs.-The CLASS Independence Advisory
19 Council shall advise the Secretary on matters of general
20 policy in the administration of the CLASS program estab-
21 lished under this title and in the formulation of regula-
22 tions under this title including with respect to-
23 "(1) the development of the CLASS Independ-
24 ence Benefit Plan under section 3203; and
159
1 "(2) the determination of monthly premIUms
2 under such plan.
3 "(d) MEETINGS.-
4 "(1) IN GENERAL.-The CLASS Independence
5 Advisory Council shall meet at the call of the Chair
6 and as frequently as the Secretary deems necessary.
7 "(2) UPON REQuEsT.-The Chair shall call a
;
8 meeting of the CLASS Independence Advisory Coun-
9 cil upon request of at least 4 members of the Coun-
10 ciL
11 "(3) QUORUM.-A majority of the members of
12 the CLASS Independence Advisory Council shall
13 constitute a quorum but a lesser number may hold
14 hearings.
15 "(e) POVITERS.-
16 "(1) HEARINGs.-The CLASS Independence
17 Advisory Council may hold such hearings, sit and
18 act at such times and places, take such testimony,
19 and receive such evidence as the Council considers
20 advisable to carry out its duties.
21 "(2) I:t\1FORMATION FROM FEDERAL AGEN-
22 cIEs.-The CLASS Independence Advisory Council
23 may secure directly from any Federal department or
24 agency such information as the Council considers
25 necessary to carry out its duties. Upon request of
160
1 the Chair of the Council, the head of such depart-
2 ment or agency shall furnish such information to the
3 Council.
4 "(3) POSTAL SERVIcEs.-The CLASS Inde-
5 pendence Advisory Council may use the United
6 States mails in the same manner and under the
7 same cQ, nditions as other departments and agencies
8 of the Federal Government.
9 "(4) GIFTs.-The CLASS Independence Advi-
10 sory Council may accept, use, and dispose of gifts or
11 donations of services or property.
12 "(f) PERSONNEL.-
13 "(1) COMPENSATION OF MEMBERS.-Each
14 member of the CLASS Independence Advisory
15 Council shall be compensated at a rate equal to the
16 daily equivalent of the annual rate of basic pay pre-
17 scribed for level IV of the Executive Schedule under
18 section 5315 of title 5, United States Code, for each
19 day (including travel time) during which such mem-
20 ber is engaged in the performance of the duties of
21 the Council.
22 "(2) TRAVEL EXPENSES.-The members of the
23 CLASS Independence Advisory Council shall be 31-
24 lowed travel expenses, including per diem in lieu of
25 subsistence, at rates authorized for employees of
161
1 agencies under subchapter I of chapter 57 of title 5,
2 United States Code, while away from their homes or
3 regular places of business in the performance of
4 services for the Council.
5 "(3) STAFF.-
6 "(A) IN GENERAL.-The Chair of the
7 C~, SS Independence Advisory Council may,
8 without regard to the civil service laws and reg-
9 ulations, appoint and terminate an executive di-
10 rector and such other additional personnel as
11 may be necessary to enable the Council to per-
12 form its duties. The employment of an executive
13 director shall be subject to confirmation by the
14 Council.
15 "(B) COJV[PENSATION.-The Chair of the
16 CLASS Independence Advisory Council may fix
17 the compensation of the executive director and
18 other personnel without regard to chapter 51
19 and subchapter III of chapter 53 of title 5,
20 United States Code, relating to classification of
21 positions and General Schedule pay rates, ex-
22 cept that the rate of pay for the executive direc-
23 tor and other personnel may not exceed the rate
24 payable for level V of the Executive Schedule
25 under section 5316 of such title.
162
1 "(4) DETAIL OF GOVERNMENT EMPLOYEES.-
2 Any Federal Government employee may be detailed
3 to the CLASS Independence Advisory Council with-
4 out reimbursement, and such detail shall be without
5 interruption or loss of civil service status or privi-
6 lege.
7 "(1,5 ) PROCUREMENT OF TEMPORARY AND
8 INTERMITTENT SERVICES.-The Chair of the
9 CLASS Independence Advisory Council may procure
10 temporary and intermittent services under section
11 3109(b) of title 5, United States Code, at rates for
12 individuals which do not exceed the daily equivalent
13 of the annual rate of basic pay prescribed for level
14 V of the Executive Schedule under section 5316 of
15 such title.
16 "(g) AUTHORIZATION OF APPROPRIATIONS.-
17 "(1) IN GENERAL.-There are authorized to be
18 appropriated to the CLASS Independence Advisory
19 Council to carry out its duties under this section,
20 such sums as may be necessary for fiscal year 2011
21 and for each fiscal year thereafter.
22 "(2) AVAILABILITY.-Any sums appropriated
23 under the authorization contained in this section
24 shall remain available, 'without fiscal year limitation,
25 until expended.
,;~ __ ._~.o,
~
163
1 "SEC. 3208. REGULATIONS; ANNUAL REPORT.
2 "(a) REGULATIONs.-The Secretary shall promulgate
3 such regulations as are necessary to carry out the CLASS
4 program in accordance with this title. Such regulations
5 shall include provisions to prevent fraud and abuse under
6 the program.
7 "(b) ANNUAL REPORT.-Begi=ing January 1,2014,
8 the Secretary shall submit an annual report to Congress
9 on the CLASS program. Each report shall include the folIO
lowing:
11 "(1) The total number of enrollees in the pro-
12 gram.
13 "(2) The total number of eligible beneficiaries
14 during the fiscal year.
15 "(3) The total amount of cash benefits provided
16 during the fiscal year.
17 "(4) A description of instances of fraud or
18 abuse identified during the fiscal year.
19 "(5) Recommendations for such administrative
20 or legislative action as the Secretary determines is
21 necessary to improve the program or to prevent the
22 occurrence of fraud or abuse.
23 "SEC. 3209. TAX TREATMENT OF PROGRAM.
24 "The CLASS program shall be treated for purposes
25 of the Internal Revenue Code of 1986 in the same manner
164
1 as a qualified long-term care insurance contract for quali-
2 fied long-term care services." .
3 (2) CONFORMING AMENDMENTS TO MED-
4 ICAlD.-Section 1902(a) of the Social Security Act
5 (42 U.S.C. 1396a(a)), as amended by section
6 5006(e)(2)(A) of division B of Public Law 111-5, is
7 amended-
;
8 (A) in paragraph (72), by striking "and"
9 at the end;
10 (B) in paragraph (73)(B), by striking the
11 period and inserting "; and"; and
12 (C) by inserting after paragraph (73) the
13 following:
14 "(74) provide that the State will comply with
15 such regulations regarding the application of pri-
16 mary and secondary payor rules with respect to indi-
17 viduals who are eligible for medical assistance under
18 this title and are eligible beneficiaries under the
19 CLASS program established under title XXXII of
20 the Public Health Service Act as the Secretary shall
21 establish." .
22 (b) AsSURANCE OF ADEQUATE INFRASTRUCTURE
23 FOR THE PROVISION OF PERSONAL CARE ATTENDANT
24 WORKERs.-Section 1902(a) of the Social Security Act
~ ___" ".'i$ ~--".'."'.-. -. ' '.lII.:~ '.
165
1 (42 U,S,C. 1396a(a)), as amended by subsection (a)(2),
2 is amended-
3 (1) in paragraph (73)(B), by striking "and" at
4 the end;
5 (2) in paragraph (74), by striking the period at
6 the end and inserting "; and"; and
7 (3) by inserting after paragraph (74), the fol-
8 lowing:
9 " (75) provide that, not later than 2 years after
10 the date of enactment of the Community Living AE-
11 sistance Services and Supports Act, each State
12 shall-
13 "(A) assess the extent to which entities
14 such as providers of home care, home health
15 services, home and community service providers,
16 public authorities created to provide personal
17 care services to individuals eligible for medical
18 assistance under the State plan, and nonprofit
19 organizations, are serving or have the capacity
20 to serve as fiscal agents for, employers of, and
21 providers of employment-related benefits for,
22 personal care attendant workers who provide
23 personal care services to individuals receiving
24 benefits under the CLASS program established
T 1£
166
1 under title XXXII of the Public Health Service
2 Act, including in rural and underserved areas;
3 "(B) designate or create such entities to
4 serve as fiscal agents for, employers of, and
5 providers of employment-related benefits for,
6 such workers to ensure an adequate supply of
7 the workers for individuals receiving benefits ;
8 under the CLASS program, including in rural
9 and underserved areas; and
10 "(C) ensure that the designation or cre-
11 ation of such entities will not negatively alter or
12 impede existing programs, models, methods, or
13 administration of service delivery that provide
14 for consumer controlled or self-directed home
15 and community services and further ensure that
16 such entities will not impede the ability of indi-
17 viduals to direct and control their home and
18 community services, including the ability to se-
19 lect, manage, dismiss, co-employ, or employ
20 such workers or inhibit such individuals from
21 relying on family members for the provision of
22 personal care services.".
23 (c) PERSONAL CARE ATTEI\TDANTS WORKFORCE .A.D-
24 VISORY PANEL.-
.111 Jm as!?
167
1 (1) ESTABLISHMENT.-Not later than 90 days
2 after the date of enactment of this Act, the Sec-
3 retary of Health and Human Services shall establish
4 a Personal Care Attendants Workforce Advisory
5 Panel for the purpose of examining and advising the
6 Secretary and Congress on workforce issues related
7 to pers, onal care attendant workers, including with
8 respect to the adequacy of the number of such work-
9 ers, the salaries, wages, and benefits of such work-
10 ers, and access to the services provided by such
11 workers.
12 (2) MEMBERSHIP.-In appointing members to
13 the Personal Care Attendants \Vorkforce Advisory
14 Panel, the Secretary shall ensure that such members
15 include the following:
16 (A) Individuals with disabilities of all ages.
17 (B) Senior individuals.
18 (C) Representatives of individuals with dis-
19 abilities.
20 (D) Representatives of senior individuals.
21 (E) Representatives of workforce and labor
22 organizations.
23 (F) Representatives of home and commu-
24 nity-based service providers.
--.... , II
168
1 (G) Representatives of assisted living pro-
2 viders.
3 (d) EFFECTIVE DATE.-The amendments made by
4 this section take effect on January 1, 2011.
5 PART II-AMENDMENTS TO THE INTERNAL
6 REVENUE CODE OF 1986
7 . SEC. 175. CR~Drr FOR COSTS OF EMPLOYERS WHO ELECT .
8 TO AUTOMATICALLY ENROLL EMPLOYEES
9 AND WITHHOLD CLASS PREMIUMS FROM
10 WAGES.
11 (a) IN GENERAL.-Subpart D of part IV of sub-
12 chapter A. of chapter 1 of the Internal Revenue Code of
13 1986 (relating to business credits) is amended by inserting
14 after section 45Q the following:
15 "SEC. 45R. CREDIT FOR COSTS OF AUTOMATICALLY EN-
16 ROLLING EMPLOYEES AND WITHHOLDING
17 CLASS PREMIUMS FROM WAGES.
18 "(a) GENERAlJ RUIJE.-For purposes of section 38,
19 the CLASS automatic enrollment and premium with-
20 holding credit determined under this section for the tax-
21 able year is an amount equal to 25 percent of the total
22 amount paid or incurred by the taxpayer during the tax-
23 able year to169
1 "(1) automatically enroll employees in the
2 CLASS program established under title XXIX of the
3 Public Health Service Act, and
4 "(2) withhold monthly CLASS premiums on be-
5 half of an employee who is enrolled in that program.
6 "(b) DENIAL OF DOUBLE BENEFIT.-No deduction
7 shall be allowed under this chapter for any amount taken
8 into account in determining the credit under this section.
9 "(c) ELECTION NOT TO CLAIM CREDIT.-This sec-
10 tion shall not apply to a taxpayer for any taxable year
11 if such taxpayer elects to have this section not apply for
12 such taxable year.".
13 (b) CREDIT MADE PART OF GENERAL BUSINESS
14 CREDIT.-Subsection (b) of section 38 of the Internal
15 Revenue Code of 1986 (relating to general business credit)
16 is amended by striking "plus" at the end of paragraph
17 (34), by striking the period at the end of paragraph (35)
18 and inserting ii, plus", and by inserting after paragraph
19 (35) the following new paragraph:
20 "(36) the CLASS automatic enrollment and
21 premium withholding credit determined under sec-
22 tion 45R(a).".
23 (c) CLERICAL AlI1ENDMENT.-The table of sections
24 for subpart D of part IV of subchapter A of chapter 1
25 of the Internal Revenue Code of 1986 is amended by in170
1 serting after the item relating to section 45Q the following
2 new item:
"Sec. 45R. Credit for costs of automatically enrolling employees and withholding
CLASS premiums from wages.".
3 (d) EFFECTIVE DATE.-The amendments made by
4 this section shall apply to expenses paid or incurred after
5 December 31, 2010, in taxable years ending after such
6 date.
7 SEC. 176. LONG-TERM CARE INSURANCE INCLUDffiLE IN
8 CAFETERIA PLANS.
9 (a) IN GENERAL.-Section 125(f) of the Internal
10 Revenue Code of 1986 is amended by striking the last sen-
11 tence.
12 (b) EFFECTIVE DATE.-The amendment made by
13 this section shall apply to taxable years beginning after
14 December 31,2010.
15 Subtitle F-Affordable Health Care
16 Coverage for Retirees
17 Subtitle G-Miscellaneous
18 Provisions
19 SEC. _1. GENERAL DEFINITIONS.
20 In this title: [To be supplied].
21 (1) SECRETARY.-The term "Secretary" means
22 the Secretary of Health and Human Services (unless
23 specifically provided otherwise).
1 SEC. _2. REGULATIONS.
2 The Secretary of Health and Human Services shall
3 promulgated regulations to carry out this title.
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