COMPILATION OF PATIENT PROTECTION AND AFFORDABLE …

111TH CONGRESS

"

2d Session

LEGISLATIVE COUNSEL

!

PRINT 111¨C1

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

EDUCATION RECONCILIATION ACT OF 2010

AND

PREPARED BY THE

Office of the Legislative Counsel

FOR THE USE OF THE

U.S. HOUSE OF REPRESENTATIVES

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MAY 2010

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¨C148) consolidating the amendments

made by title X of the Act and the Health Care and Education Reconciliation Act of 2010 (¡®¡®HCERA¡¯¡¯; Public Law 111¨C152). 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.¡ªThis 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.¡ªUnited 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¨C11?.

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CONTENTS

[For continuous pagination in electronic, PDF version, add 19 pages]

Page

Patient Protection and Affordable Care Act (Public Law 111¨C148) ....................

1

Sec. 1. Short title; table of contents ..............................................................

1

TITLE I¡ªQUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

Subtitle A¡ªImmediate Improvements in Health Care Coverage for All Americans

Sec.

Sec.

Sec.

Sec.

1001.

1002.

1003.

1004.

Amendments to the Public Health Service Act ..........................

Health insurance consumer information ....................................

Ensuring that consumers get value for their dollars .................

Effective dates ...............................................................................

13

27

28

30

Subtitle B¡ªImmediate Actions to Preserve and Expand Coverage

Sec. 1101. Immediate access to insurance for uninsured individuals with

a preexisting condition .................................................................................

Sec. 1102. Reinsurance for early retirees .....................................................

Sec. 1103. Immediate information that allows consumers to identify affordable coverage options .............................................................................

Sec. 1104. Administrative simplification ......................................................

Sec. 1105. Effective date .................................................................................

30

33

36

37

44

Subtitle C¡ªQuality Health Insurance Coverage for All Americans

PART 1¡ªHEALTH INSURANCE MARKET REFORMS

Sec. 1201. Amendment to the Public Health Service Act ............................

45

PART 2¡ªOTHER PROVISIONS

Sec. 1251. Preservation of right to maintain existing coverage ..................

Sec. 1252. Rating reforms must apply uniformly to all health insurance

issuers and group health plans ....................................................................

Sec. 1253. Annual report on self-insured plans ............................................

Sec. 1254. Study of large group market ........................................................

Sec. 1255. Effective dates ...............................................................................

55

56

56

57

57

Subtitle D¡ªAvailable Coverage Choices for All Americans

PART 1¡ªESTABLISHMENT

Sec.

Sec.

Sec.

Sec.

1301.

1302.

1303.

1304.

OF

QUALIFIED HEALTH PLANS

Qualified health plan defined ......................................................

Essential health benefits requirements ......................................

Special rules ..................................................................................

Related definitions ........................................................................

58

59

64

68

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Page

PART 2¡ªCONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH

BENEFIT EXCHANGES

Sec. 1311. Affordable choices of health benefit plans ..................................

Sec. 1312. Consumer choice ...........................................................................

Sec. 1313. Financial integrity ........................................................................

PART 3¡ªSTATE FLEXIBILITY RELATING

TO

EXCHANGES

Sec. 1321. State flexibility in operation and enforcement of Exchanges

and related requirements .............................................................................

Sec. 1322. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers .............................................

Sec. 1323. Community health insurance option ?stricken? .........................

Sec. 1323. Funding for the territories ...........................................................

Sec. 1324. Level playing field ........................................................................

PART 4¡ªSTATE FLEXIBILITY

TO

69

80

83

85

86

92

92

93

ESTABLISH ALTERNATIVE PROGRAMS

Sec. 1331. State flexibility to establish basic health programs for lowincome individuals not eligible for Medicaid ..............................................

Sec. 1332. Waiver for State innovation .........................................................

Sec. 1333. Provisions relating to offering of plans in more than one

State ...............................................................................................................

Sec. 1334. Multi-State plans ..........................................................................

PART 5¡ªREINSURANCE

AND

93

98

100

101

RISK ADJUSTMENT

Sec. 1341. Transitional reinsurance program for individual market in

each State ......................................................................................................

Sec. 1342. Establishment of risk corridors for plans in individual and

small group markets .....................................................................................

Sec. 1343. Risk adjustment ............................................................................

105

108

109

Subtitle E¡ªAffordable Coverage Choices for All Americans

PART I¡ªPREMIUM TAX CREDITS

AND

COST-SHARING REDUCTIONS

SUBPART A¡ªPREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS

Sec. 1401. Refundable tax credit providing premium assistance for coverage under a qualified health plan ............................................................

Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified

health plans ...................................................................................................

110

119

SUBPART B¡ªELIGIBILITY DETERMINATIONS

Sec. 1411. Procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost-sharing, and individual

responsibility exemptions .............................................................................

Sec. 1412. Advance determination and payment of premium tax credits

and cost-sharing reductions .........................................................................

Sec. 1413. Streamlining of procedures for enrollment through an exchange and State Medicaid, CHIP, and health subsidy programs ...........

Sec. 1414. Disclosures to carry out eligibility requirements for certain

programs ........................................................................................................

Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded for Federal and Federally-assisted programs .............................

Sec. 1416. Study of geographic variation in application of FPL .................

123

131

133

135

137

137

PART II¡ªSMALL BUSINESS TAX CREDIT

Sec. 1421. Credit for employee health insurance expenses of small businesses .............................................................................................................

138

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Subtitle F¡ªShared Responsibility for Health Care

PART I¡ªINDIVIDUAL RESPONSIBILITY

Sec. 1501. Requirement to maintain minimum essential coverage ............

Sec. 1502. Reporting of health insurance coverage ......................................

143

151

PART II¡ªEMPLOYER RESPONSIBILITIES

Sec. 1511. Automatic enrollment for employees of large employers ...........

Sec. 1512. Employer requirement to inform employees of coverage options ................................................................................................................

Sec. 1513. Shared responsibility for employers ............................................

Sec. 1514. Reporting of employer health insurance coverage .....................

Sec. 1515. Offering of Exchange-participating qualified health plans

through cafeteria plans ................................................................................

154

154

155

159

161

Subtitle G¡ªMiscellaneous Provisions

Sec. 1551. Definitions .....................................................................................

Sec. 1552. Transparency in government .......................................................

Sec. 1553. Prohibition against discrimination on assisted suicide .............

Sec. 1554. Access to therapies ........................................................................

Sec. 1555. Freedom not to participate in Federal health insurance programs .............................................................................................................

Sec. 1556. Equity for certain eligible survivors ............................................

Sec. 1557. Nondiscrimination ........................................................................

Sec. 1558. Protections for employees .............................................................

Sec. 1559. Oversight .......................................................................................

Sec. 1560. Rules of construction ....................................................................

Sec. 1561. Health information technology enrollment standards and protocols ..............................................................................................................

Sec. 1562. GAO study regarding the rate of denial of coverage and enrollment by health insurance issuers and group health plans ..................

Sec. 1563. Small business procurement ........................................................

Sec. 1563 [sic]. Conforming amendments .....................................................

Sec. 1563 [sic]. Sense of the Senate promoting fiscal responsibility ...........

164

164

164

165

165

165

166

166

167

167

168

170

170

171

178

TITLE II¡ªROLE OF PUBLIC PROGRAMS

Subtitle A¡ªImproved Access to Medicaid

Sec. 2001. Medicaid coverage for the lowest income populations ...............

Sec. 2002. Income eligibility for nonelderly determined using modified

gross income ..................................................................................................

Sec. 2003. Requirement to offer premium assistance for employer-sponsored insurance .............................................................................................

Sec. 2004. Medicaid coverage for former foster care children .....................

Sec. 2005. Payments to territories .................................................................

Sec. 2006. Special adjustment to FMAP determination for certain States

recovering from a major disaster .................................................................

Sec. 2007. Medicaid Improvement Fund rescission .....................................

179

186

190

191

191

192

193

Subtitle B¡ªEnhanced Support for the Children¡¯s Health Insurance Program

Sec. 2101. Additional federal financial participation for CHIP ..................

Sec. 2102. Technical corrections ....................................................................

194

197

Subtitle C¡ªMedicaid and CHIP Enrollment Simplification

Sec. 2201. Enrollment Simplification and coordination with State Health

Insurance Exchanges ....................................................................................

198

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