THE PATIENT PROTECTION AND AFFORDABLE …

1 THE PATIENT PROTECTION AND AFFORDABLE care ACT. 111-148. SELECTED HEALTH INSURANCE provisions INCORPORATING. CHANGES IN THE MANAGER S AMENDMENT AND THE. HEALTH care AND EDUCATION RECONCILIATION ACT ( 111-152). TITLE I QUALITY; AFFORDABLE HEALTH care FOR ALL AMERICANS .. 1. SUBTITLE A--IMMEDIATE IMPROVEMENTS IN HEALTH care COVERAGE FOR ALL AMERICANS ..1. Sec. 1001. Amendments to the Public Health Service Act.. 1. PHSA Part A Individual and Group Market Reforms.';.. 1. PHSA Subpart II--Improving Coverage .. 1. PHSA Sec. 2711. No Lifetime or Annual 1. PHSA Sec. 2712. Prohibition on 2. PHSA Sec. 2713. Coverage of Preventive Health 2. PHSA Sec. 2714. Extension of Dependent 3. PHSA Sec. 2715. Development and Utilization of Uniform Explanation of Coverage Documents & Standardized Definitions. 3. PHSA Sec. 2715A. Provision of Additional 5. PHSA Sec. 2716. Prohibition of Discrimination Based on 5. PHSA Sec. 2717. Ensuring the Quality of 5.

2 PHSA Sec. 2718. Bringing Down the Cost of Health care Coverage. [Medical Loss Ratio].. 7. PHSA Sec. 2719. Appeals 8. PHSA Sec. 2719A. PATIENT 9. Sec. 1002. Health Insurance Consumer 11. PHSA Sec. 2793. Health Insurance Consumer Information.. 11. Sec. 1003. Ensuring that Consumers Get Value for Their 12. PHSA Sec. 2794. Ensuring that Consumers Get Value for Their Dollars.[Rate Review].. 12. Sec. 1004. Effective Dates.. 14. SUBTITLE B--IMMEDIATE ACTIONS TO PRESERVE AND EXPAND COVERAGE ..14. Sec. 1101. Immediate Access to Insurance for Uninsured Individuals with a Preexisting 14. Sec. 1102. Reinsurance for Early Retirees.. 16. Sec. 1103. Immediate Information that Allows Consumers to Identify AFFORDABLE Coverage Options [Web Portal].. 18. Sec. 1104. Administrative 19. Sec. 1105. Effective 25. SUBTITLE C--QUALITY HEALTH INSURANCE COVERAGE FOR ALL AMERICANS ..25. Part I Health Insurance Market Reforms .. 25. Sec. 1201.

3 Amendment to the Public Health Service 25. PHSA Subpart I--General Reform'; .. 25. PHSA Sec. 2704. Prohibition of Preexisting Condition Exclusions or Other Discrimination Based on Health Status.. 25. PHSA Sec. 2701. Fair Health Insurance Premiums [Rating Rules].. 26. PHSA Sec. 2702. Guaranteed Availability of Coverage.. 26. PHSA Sec. 2703. Guaranteed Renewability of Coverage.. 27. PHSA Sec. 2705. Prohibiting Discrimination Against Individual Participants and Beneficiaries Based on Health Status.. 27. PHSA SEC. 2706. Non-Discrimination in Health 30. PHSA Sec. 2707. Comprehensive Health Insurance Coverage.. 30. PHSA Sec. 2701. Prohibition on Excessive Waiting 31. PHSA Sec. 2709. Coverage for Individuals Participating in Approved Clinical 31. Part II Other 33. Sec. 1251. Preservation of Right to Maintain Existing 33. Sec. 1252. Rating Reforms Must Apply Uniformly to All Health Insurance Issuers and Group Health Plans.

4 34. Sec. 1253. Annual Report on Self-Insured 34. Sec. 1254. Study of Large Group Market.. 34. Sec. 1255. Effective Dates.. 35. SUBTITLE D--AVAILABLE COVERAGE CHOICES FOR ALL AMERICANS ..35. Part I Establishment of Qualified Health Plans .. 35. Sec. 1301. Qualified Health Plan 35. Sec. 1302. Essential Health Benefits 36. Sec. 1303. Special 40. Sec. 1304. Related 42. i Part II Consumer Choices and Insurance Competition through Health Benefit Exchanges .. 44. Sec. 1311. AFFORDABLE Choices of Health Benefit 44. Sec. 1312. Consumer 51. Sec. 1313. Financial Integrity.. 53. Part III State Flexibility Relating to Exchanges .. 54. Sec. 1321. State Flexibility in Operation and Enforcement of Exchanges and Related Requirements.. 54. Sec. 1322. Federal Program to Assist Establishment and Operation of Nonprofit, Member-Run Health Insurance Issuers [CO-Ops].. 56. Sec. 1324. Level Playing Field.. 60. Part IV State Flexibility to Establish Alternative Programs.

5 60. Sec. 1331. State Flexibility to Establish Basic Health Programs For Low-Income Individuals Not Eligible for Medicaid.. 60. Sec. 1332. Waiver for State Innovation.. 63. Sec. 1333. provisions Relating to Offering of Plans in More Than One State.. 66. Sec. 1334. Multi-State 66. Part V Reinsurance and Risk Adjustment .. 69. Sec. 1341. Transitional Reinsurance Program for Individual Market in Each 69. Sec. 1342. Establishment of Risk-Corridors for Plans in Individual and Small Group Markets.. 71. Sec. 1343. Risk 72. SUBTITLE E-- AFFORDABLE COVERAGE CHOICES FOR ALL AMERICANS ..72. Part I Premium Tax Credits and Cost-Sharing 73. SUBPART A--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS .. 73. Sec. 1401. Refundable Tax Credit Providing Premium Assistance for Coverage Under a Qualified Health Plan.. 73. IRC Sec. 36B. Refundable Credit for Coverage Under a Qualified Health 73. Sec. 1402. Reduced Cost-Sharing for Individuals Enrolling in Qualified Health 79.

6 SUBPART B--ELIGIBILITY DETERMINATIONS .. 82. Sec. 1411. Procedures for Determining Eligibility for Exchange Participation , Premium Tax Credits and Reduced Cost-Sharing, and Individual Responsibility 82. Sec. 1412. Advance Determination and Payment of Premium Tax Credits and Cost-Sharing Reductions.. 88. Sec. 1413. Streamlining of Procedures for Enrollment Through an Exchange and State Medicaid, CHIP, and Health Subsidy Programs.. 90. Sec. 1414. Disclosures to Carry Out Eligibility Requirements for Certain Programs.. 91. Sec. 1415. Premium Tax Credit and Cost-Sharing Reduction Payments Disregarded for Federal and Federally-Assisted Programs.. 93. Sec. 1416. Study of Geographic Variation in Application of FPL.. 93. Part II Small Business Tax 93. Sec. 1421. Credit for Employee Health Insurance Expenses of Small 93. IRC Sec. 45R. Employee Health Insurance Expenses of Small Employers.. 94. SUBTITLE F--SHARED RESPONSIBILITY FOR HEALTH care .

7 97. Part I Individual Responsibility .. 97. Sec. 1501. Requirement to Maintain Minimum Essential 97. IRC Chapter 48 Maintenance of Minimum Essential 99. IRC Sec. 5000A. Requirement to Maintain Minimum Essential Coverage.. 99. Sec. 1502. Reporting of Health Insurance 103. IRC Subpart D--Information Regarding Health Insurance Coverage .. 104. IRC Sec. 6055. Reporting of Health Insurance Coverage.. 104. Part II Employer Responsibilities .. 105. Sec. 1511. Automatic Enrollment for Employees of Large Employers .. 105. FLSA Sec. 18A. Automatic Enrollment for Employees of Large Employers.. 105. Sec. 1512. Employer Requirement to Inform Employees of Coverage 106. FLSA Sec. 18B. Notice to 106. Sec. 1513. Shared Responsibility for Employers.. 106. FLSA Sec. 4980H. Shared Responsibility for Employers Regarding Health Coverage.. 106. Sec. 1514. Reporting of Employer Health Insurance Coverage.. 109. IRC Sec. 6056. Large Employers Required to Report on Health Insurance 109.

8 Sec. 1515. Offering of Exchange Participating Qualified Health Plans Through Cafeteria Plans.. 111. SUBTITLE G--MISCELLANEOUS provisions .. 111. Sec. 1551. 111. Sec. 1552. Transparency in 111. Sec. 1553. Prohibition Against Discrimination on Assisted 111. Sec. 1554. Access to 112. Sec. 1555. Freedom Not to Participate in Federal Health Insurance 112. Sec. 1556. Equity for Certain Eligible 112. Sec. 1557. 112. Sec. 1558. Protections for Employees.. 113. FLSA Sec. 18C. Protections for Employees.. 113. Sec. 1559. 114. Sec. 1560. Rules of 114. ii Sec. 1561. Health Information Technology Enrollment Standards and Protocols.. 114. PHSA Subtitle C--Other provisions .. 114. PHSA Sec. 3021. Health Information Technology Enrollment Standards and 114. Sec. 1562. GAO Study Regarding the Rate of Denial of Coverage and Enrollment by Health Insurance Issuers and Group Health Plans.. 115. Sec. 1563. Small Business 116. Sec. 1563.

9 Conforming Amendments.. 116. ERISA Sec. 715. Additional Market 121. IRC Sec. 9815. Additional Market Reforms.. 122. Sec. 1563. Sense of the Senate Promoting Fiscal 122. TITLE III IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH care .. 123. SUBTITLE C-- provisions RELATING TO PART 123. Sec. 3210. Development of New Standards for Certain 123. TITLE VI TRANSPARENCY AND PROGRAM INTEGRITY .. 124. SUBTITLE G--ADDITIONAL PROGRAM INTEGRITY provisions .. 124. Sec. 6601. Prohibition on False Statements and Representations.. 124. ERISA Sec. 519. Prohibition on False Statements and 124. Sec. 6602. Clarifying Definition.. 124. Sec 6603. Development of Model Uniform Report Form.. 124. PHSA Sec. 2794. Uniform Fraud and Abuse Referral Format.. 124. Sec. 6604. Applicability of State Law to Combat Fraud and Abuse.. 125. ERISA Sec. 520. Applicability of State Law to Combat Fraud and 125. Sec. 6605. Enabling the Department of Labor to Issue Administrative Summary Cease and Desist Orders and Summary Seizures Orders Against Plans that are in Financially Hazardous 125.

10 ERISA Sec. 521. Administrative Summary Cease and Desist Orders and Summary Seizure Orders Against Multiple Employer Welfare Arrangements in Financially Hazardous 125. Sec. 6606. MEWA Plan Registration with Department of 126. Sec. 6607. Permitting Evidentiary Privilege and Confidential Communications.. 126. TITLE X STRENGTHENING QUALITY AFFORDABLE HEALTH care FOR ALL AMERICANS .. 127. SUBTITLE A-- provisions RELATING TO TITLE 127. Sec. 10104. Amendments to Subtitle D.. 127. Sec. 10108. Free Choice 128. IRC Sec. 139D. Free Choice 129. Sec. 10109. Development of Standards for Financial and Administrative 130. RECONCILIATION CHANGES .. 133. Sec. 1005. Implementation Funding.. 133. Abbreviations: PHSA Public Health Service Act IRC Internal Revenue Code ERISA Employee Retirement Income Security Act FLSA Fair Labor Standards Act iii December 24, 2009. Ordered to be printed as passed HR 3590 EAS/PP. In the Senate of the United States, December 24, 2009.