COMPILATION OF PATIENT PROTECTION AND AFFORDABLE …
111TH CONGRESS 2d Session
"
LEGISLATIVE COUNSEL
! PRINT 111?1
COMPILATION OF PATIENT PROTECTION AND AFFORDABLE CARE ACT
[As Amended Through May 1, 2010]
INCLUDING
PATIENT PROTECTION AND AFFORDABLE CARE ACT HEALTH-RELATED PORTIONS OF THE HEALTH CARE AND
EDUCATION RECONCILIATION ACT OF 2010
PREPARED BY THE
Office of the Legislative Counsel
FOR THE USE OF THE
U.S. HOUSE OF REPRESENTATIVES
MAY 2010
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OFFICE OF THE LEGISLATIVE COUNSEL SANDRA L. STROKOFF, Legislative Counsel
EDWARD G. GROSSMAN, Deputy Legislative Counsel
Prepared by EDWARD G. GROSSMAN, Deputy Legislative Counsel
with the assistance of CRAIG A. STERKX, Publications Coordinator
ELONDA C. BLOUNT, Staff Assistant EMILY M. VOLBERDING, Staff Assistant
This document is of the Patient Protection and Affordable Care Act (``PPACA''; Public Law 111?148) consolidating the amendments made by title X of the Act and the Health Care and Education Reconciliation Act of 2010 (``HCERA''; Public Law 111?152). The text of the Indian Health Care Improvement Reauthorization and Extension Act of 2009 (S. 1790), as enacted (in amended form) by section 10221 of PPACA, is shown in a separate, accompanying document.
Preparation of document.--This document was prepared by the attorneys and staff of the House Office of the Legislative Counsel (HOLC) for the use of its attorneys and clients. It is not an official document of the House of Representatives or its committees and may not be cited as ``the law''. At the request of the Leadership, it is being made available to the public through Congressional websites and may be downloaded at energycommerce/ppacacon.pdf. Errors in this document are solely the responsibility of HOLC. Please email any corrections to ``hlccomments@mail.''. This document (originally dated May 24, 2010) may be updated to reflect corrections of errors or subsequent changes in law.
United States Code citations.--United States Code section numbers assigned to sections in PPACA are specified in brackets after the section numbers in the heading of each section, viz., 2711 ?42 U.S.C. 300gg?11?.
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C O N T E N T S
[For continuous pagination in electronic, PDF version, add 19 pages]
Page
Patient Protection and Affordable Care Act (Public Law 111?148) .................... 1 Sec. 1. Short title; table of contents .............................................................. 1
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS Subtitle A--Immediate Improvements in Health Care Coverage for All Americans
Sec. 1001. Amendments to the Public Health Service Act .......................... 13 Sec. 1002. Health insurance consumer information .................................... 27 Sec. 1003. Ensuring that consumers get value for their dollars ................. 28 Sec. 1004. Effective dates ............................................................................... 30
Subtitle B--Immediate Actions to Preserve and Expand Coverage Sec. 1101. Immediate access to insurance for uninsured individuals with
a preexisting condition ................................................................................. 30 Sec. 1102. Reinsurance for early retirees ..................................................... 33 Sec. 1103. Immediate information that allows consumers to identify af-
fordable coverage options ............................................................................. 36 Sec. 1104. Administrative simplification ...................................................... 37 Sec. 1105. Effective date ................................................................................. 44
Subtitle C--Quality Health Insurance Coverage for All Americans PART 1--HEALTH INSURANCE MARKET REFORMS
Sec. 1201. Amendment to the Public Health Service Act ............................ 45
PART 2--OTHER PROVISIONS Sec. 1251. Preservation of right to maintain existing coverage .................. 55 Sec. 1252. Rating reforms must apply uniformly to all health insurance
issuers and group health plans .................................................................... 56 Sec. 1253. Annual report on self-insured plans ............................................ 56 Sec. 1254. Study of large group market ........................................................ 57 Sec. 1255. Effective dates ............................................................................... 57
Subtitle D--Available Coverage Choices for All Americans PART 1--ESTABLISHMENT OF QUALIFIED HEALTH PLANS
Sec. 1301. Qualified health plan defined ...................................................... 58 Sec. 1302. Essential health benefits requirements ...................................... 59 Sec. 1303. Special rules .................................................................................. 64 Sec. 1304. Related definitions ........................................................................ 68
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PART 2--CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH BENEFIT EXCHANGES
Sec. 1311. Affordable choices of health benefit plans .................................. 69 Sec. 1312. Consumer choice ........................................................................... 80 Sec. 1313. Financial integrity ........................................................................ 83
PART 3--STATE FLEXIBILITY RELATING TO EXCHANGES
Sec. 1321. State flexibility in operation and enforcement of Exchanges and related requirements ............................................................................. 85
Sec. 1322. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers ............................................. 86
Sec. 1323. Community health insurance option ?stricken? ......................... 92 Sec. 1323. Funding for the territories ........................................................... 92 Sec. 1324. Level playing field ........................................................................ 93
PART 4--STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS
Sec. 1331. State flexibility to establish basic health programs for lowincome individuals not eligible for Medicaid .............................................. 93
Sec. 1332. Waiver for State innovation ......................................................... 98 Sec. 1333. Provisions relating to offering of plans in more than one
State ............................................................................................................... 100 Sec. 1334. Multi-State plans .......................................................................... 101
PART 5--REINSURANCE AND RISK ADJUSTMENT
Sec. 1341. Transitional reinsurance program for individual market in each State ...................................................................................................... 105
Sec. 1342. Establishment of risk corridors for plans in individual and small group markets ..................................................................................... 108
Sec. 1343. Risk adjustment ............................................................................ 109
Subtitle E--Affordable Coverage Choices for All Americans
PART I--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
SUBPART A--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
Sec. 1401. Refundable tax credit providing premium assistance for coverage under a qualified health plan ............................................................ 110
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans ................................................................................................... 119
SUBPART B--ELIGIBILITY DETERMINATIONS
Sec. 1411. Procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions ............................................................................. 123
Sec. 1412. Advance determination and payment of premium tax credits and cost-sharing reductions ......................................................................... 131
Sec. 1413. Streamlining of procedures for enrollment through an exchange and State Medicaid, CHIP, and health subsidy programs ........... 133
Sec. 1414. Disclosures to carry out eligibility requirements for certain programs ........................................................................................................ 135
Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded for Federal and Federally-assisted programs ............................. 137
Sec. 1416. Study of geographic variation in application of FPL ................. 137
PART II--SMALL BUSINESS TAX CREDIT
Sec. 1421. Credit for employee health insurance expenses of small businesses ............................................................................................................. 138
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Subtitle F--Shared Responsibility for Health Care
PART I--INDIVIDUAL RESPONSIBILITY
Sec. 1501. Requirement to maintain minimum essential coverage ............ 143 Sec. 1502. Reporting of health insurance coverage ...................................... 151
PART II--EMPLOYER RESPONSIBILITIES
Sec. 1511. Automatic enrollment for employees of large employers ........... 154 Sec. 1512. Employer requirement to inform employees of coverage op-
tions ................................................................................................................ 154 Sec. 1513. Shared responsibility for employers ............................................ 155 Sec. 1514. Reporting of employer health insurance coverage ..................... 159 Sec. 1515. Offering of Exchange-participating qualified health plans
through cafeteria plans ................................................................................ 161
Subtitle G--Miscellaneous Provisions
Sec. 1551. Definitions ..................................................................................... 164 Sec. 1552. Transparency in government ....................................................... 164 Sec. 1553. Prohibition against discrimination on assisted suicide ............. 164 Sec. 1554. Access to therapies ........................................................................ 165 Sec. 1555. Freedom not to participate in Federal health insurance pro-
grams ............................................................................................................. 165 Sec. 1556. Equity for certain eligible survivors ............................................ 165 Sec. 1557. Nondiscrimination ........................................................................ 166 Sec. 1558. Protections for employees ............................................................. 166 Sec. 1559. Oversight ....................................................................................... 167 Sec. 1560. Rules of construction .................................................................... 167 Sec. 1561. Health information technology enrollment standards and pro-
tocols .............................................................................................................. 168 Sec. 1562. GAO study regarding the rate of denial of coverage and en-
rollment by health insurance issuers and group health plans .................. 170 Sec. 1563. Small business procurement ........................................................ 170 Sec. 1563 [sic]. Conforming amendments ..................................................... 171 Sec. 1563 [sic]. Sense of the Senate promoting fiscal responsibility ........... 178
TITLE II--ROLE OF PUBLIC PROGRAMS
Subtitle A--Improved Access to Medicaid
Sec. 2001. Medicaid coverage for the lowest income populations ............... 179 Sec. 2002. Income eligibility for nonelderly determined using modified
gross income .................................................................................................. 186 Sec. 2003. Requirement to offer premium assistance for employer-spon-
sored insurance ............................................................................................. 190 Sec. 2004. Medicaid coverage for former foster care children ..................... 191 Sec. 2005. Payments to territories ................................................................. 191 Sec. 2006. Special adjustment to FMAP determination for certain States
recovering from a major disaster ................................................................. 192 Sec. 2007. Medicaid Improvement Fund rescission ..................................... 193
Subtitle B--Enhanced Support for the Children's Health Insurance Program
Sec. 2101. Additional federal financial participation for CHIP .................. 194 Sec. 2102. Technical corrections .................................................................... 197
Subtitle C--Medicaid and CHIP Enrollment Simplification
Sec. 2201. Enrollment Simplification and coordination with State Health Insurance Exchanges .................................................................................... 198
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