State Health Care Options Act of 2015
This bill amends the Patient Protection and Affordable Care Act (PPACA) and the Internal Revenue Code to modify the process for state innovation waivers.
(Under current law, the Department of Health and Human Services [HHS] and the Department of the Treasury may approve a state's request to waive specific provisions of PPACA if the state proposal provides health care access that is comparable to what would exist without a waiver and does not increase the federal deficit.)
The bill expedites the approval process for:
If a state submits to HHS a notice of its intent to implement one or both of the waivers, the waivers shall be deemed to be approved and effective. The notice must include the years for which the waiver shall be effective (which may be indefinite), an assurance the state will comply with reporting requirements, and other specified details.
A state may not waive PPACA requirements related to coverage for preexisting conditions and the extension of coverage for adult children.
States with exchange waivers may certify permissible health plans that residents may purchase outside of an exchange, if the plans meet specified requirements regarding benefits, levels of coverage, transparency of premium justifications, and information.
Taxpayers in waiver states that are living at or below 300% of the federal poverty level (400% under current law) may receive health insurance subsidies under PPACA.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3352 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 3352
To amend the Patient Protection and Affordable Care Act and the
Internal Revenue Code of 1986 to provide greater flexibility with
respect to waivers granted to States, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 29, 2015
Mr. Hultgren introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend the Patient Protection and Affordable Care Act and the
Internal Revenue Code of 1986 to provide greater flexibility with
respect to waivers granted to States, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``State Health Care Options Act of
2015''.
SEC. 2. INCREASING STATE FLEXIBILITY THROUGH PROVISION OF HEALTH-FLEX
AND EXCHANGE WAIVERS.
(a) State Options.--
(1) In general.--The Patient Protection and Affordable Care
Act is amended by inserting after section 1332 (42 U.S.C.
18052) the following:
``SEC. 1332A. OPTIONS FOR STATE FLEXIBILITY.
``(a) State Options.--
``(1) In general.--If a State provides to the Secretary a
notice (in this section referred to as a `waiver notice') of
intent to implement a health-flex waiver (described in
subsection (b)(1)), an exchange waiver (described in subsection
(b)(2)), or both, and such notice complies with paragraph (2),
the waiver shall be deemed to be approved and effective, except
as provided in paragraphs (5) and (6).
``(2) Contents of a waiver notice.--A waiver notice with
respect to a State shall include the following:
``(A) The years for which the waiver shall be
effective (which may be indefinite).
``(B) An assurance that the State will comply with
annual reporting requirements established by the
Secretary relating to the activities of the State under
the waiver, which reporting requirements shall include
information on affordability, access, and transparency.
``(C) In the case of a health-flex waiver--
``(i) the requirements to be waived;
``(ii) an assurance that there will be
available throughout the State one or more
health plans that provide the catastrophic
level of coverage described in subsection
(c)(1)(B)(i) for which an enrollee's required
contribution (as defined in section
5000A(e)(1)(B) of the Internal Revenue Code of
1986, determined on an annual basis) does not
exceed 6.5 percent of the median household
income (as defined in section 36B(d)(2)(A) of
such Code) of residents of the State for the
most recent taxable year for which information
on such median household income is available to
the Secretary; and
``(iii) an assurance that the certifying
entity (as defined in subsection (c)(2)) has a
process to certify health plans as permissible
health plans consistent with subsection (c).
``(D) In the case of an exchange waiver, assurances
that the State--
``(i) will be responsible for functions
that are necessary to carry out the waiver that
would otherwise be performed by an Exchange;
``(ii) will comply with subsection (d);
``(iii) has the capability to receive from
the Secretary subsidy eligibility information;
and
``(iv) has and is applying standards for
privacy, security, and data encryption for
subsidy eligibility information that are
determined to be satisfactory by the Secretary.
``(3) Effectiveness.--A waiver under this section shall be
effective for the years described in the waiver notice under
paragraph (2)(A), except that no waiver under this section
shall be effective for a year unless the waiver notice for such
waiver was submitted before November 1 of the previous year.
``(4) Modification or termination.--A State may modify or
terminate a waiver for the State under this section by
submitting to the Secretary a subsequent waiver notice with
respect to such waiver.
``(5) Disapproval authority.--If the Secretary determines
that a waiver notice fails to comply with paragraph (2) and
notifies the State of the reason for such determination not
later than 30 days after the date on which the State submits
the waiver notice, such waiver notice shall not be effective.
``(6) Revocation.--If the Secretary determines that a State
is in violation of an assurance submitted under paragraph (2)
and notifies the State of the reason for such determination,
the Secretary may revoke the waiver. Such revocation shall be
effective on the first day of the first year that begins after
the 60-day period that begins on the date on which notification
of the revocation occurs.
``(7) Construction.--Nothing in this section shall be
construed as requiring a State to enact a law in order to carry
out the provisions of this section.
``(b) Waivers.--
``(1) Health-flex waiver.--A waiver under this paragraph
(in this section referred to as a `health-flex waiver'), with
respect to a State, is a waiver of any of the requirements in
sections 1301 through 1303.
``(2) Exchange waiver.--A waiver under this paragraph (in
this section referred to as an `exchange waiver') permits a
State to elect to be responsible for certain Exchange
functions, including serving as the certifying entity for the
purposes of subsection (c).
``(3) No waiver of adult child coverage and preexisting
conditions.--Nothing in this subsection may be construed to
permit a State to waive the following:
``(A) Prohibition of preexisting condition
exclusion.--Section 2704 of the Public Health Service
Act (42 U.S.C. 300gg-3).
``(B) Extension of coverage for adult children.--
Section 2714 of the Public Health Service Act (42
U.S.C. 300gg-14).
``(c) Certifying Permissible Health Plans.--
``(1) Permissible health plan defined.--For the purposes of
this section, the term `permissible health plan' means, with
respect to a State, a health plan that is offered for sale in
the individual or small group market in the State and that is
certified by a certifying entity to meet the following
requirements:
``(A) Benefits.--The plan provides benefits for
items and services within each of the following
categories:
``(i) Ambulatory patient services.
``(ii) Emergency services.
``(iii) Hospitalization.
``(iv) Physician services.
``(B) Levels of coverage.--The plan provides a
level of coverage that complies with one of the
following levels of coverage (as established by the
State):
``(i) Catastrophic.
``(ii) Standard.
``(iii) High.
``(C) Transparency justifying premiums.--The issuer
of the plan makes available to the public information
about the demographics of the population enrolled under
the plan, the utilization of health care items and
services by such population under the plan, and other
factors that serve as a justification for the premium
levels (including any premium increases) under the
plan.
``(D) Information requirement.--The issuer of the
plan submits information as required under section
36B(g)(3)(C) of the Internal Revenue Code of 1986.
``(2) Certifying entity defined.--In this section, the term
`certifying entity' means--
``(A) in the case of a health plan that is offered
through an Exchange established by a State, such
Exchange; and
``(B) in the case of a health plan that is not so
offered, the State in which such plan is offered.
``(3) Effect of certifying permissible health plans.--With
respect to eligibility for premium assistance tax credits and
reduced cost-sharing for individuals enrolled in permissible
health plans, see section 36B(g) of the Internal Revenue Code
of 1986 and section 1402(f)(4) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18071), respectively.
``(d) Determining Subsidy Eligibility.--
``(1) In general.--In the case of a State that has in
effect an exchange waiver, the State shall determine the
eligibility of individuals residing in the State for the
assistance described in subparagraphs (A) and (B) of paragraph
(3).
``(2) Disclosure of federal information.--In the case of a
State that has in effect an exchange waiver, the Secretary or
the Secretary of the Treasury, as appropriate, shall make
subsidy eligibility information available to the State, but
only the minimum amount of information necessary to enable the
State to determine the amount of the assistance described in
subparagraphs (A) and (B) of paragraph (3) for which the
individual enrolled in a permissible health plan is eligible.
``(3) Subsidy eligibility information defined.--In this
subsection, the term `subsidy eligibility information' means
information concerning the eligibility of an enrollee or a
prospective enrollee in a health plan for--
``(A) a premium assistance credit under section
36B(a) of the Internal Revenue Code of 1986; and
``(B) reduced cost-sharing under section 1402.''.
(2) Reporting requirements.--The Secretary shall establish
annual reporting requirements under 1332A(a)(2)(B) of the
Patient Protection and Affordable Care Act that include
information on affordability, access, and transparency.
(3) Conforming amendment.--The table of contents of the
Patient Protection and Affordable Care Act is amended by
inserting after the item relating to section 1332 the
following:
``Sec. 1332A. Options for State flexibility.''.
(b) Subsidies for Individuals Enrolled in Permissible Health
Plans.--
(1) Premium assistance tax credits.--Section 36B of the
Internal Revenue Code of 1986 is amended--
(A) by redesignating subsection (g) as subsection
(h); and
(B) by inserting after subsection (f) the
following:
``(g) Special Rules in Case of Waivers Under Section 1332A of
PPACA.--
``(1) Limiting eligibility to taxpayers with income at or
below 300 percent of fpl.--In the case of a section 1332A
State, subsection (c)(1)(A) shall be applied by substituting
`300 percent' for `400 percent' for a taxpayer who obtains
coverage through a plan issued under the law of such State for
a year.
``(2) Permissible health plans.--In the case of a taxpayer
who obtains coverage with respect to a section 1332A State, for
a coverage month, a permissible health plan, as defined in
section 1332A(c)(1) of the Patient Protection and Affordable
Care Act, shall be treated as a qualified health plan with
respect to such taxpayer.
``(3) Adjusted monthly premium.--In the case of a State
that has in effect a health-flex waiver described in section
1332A(b)(1) of such Act, subsection (b)(3)(C) shall be applied
as if the adjusted monthly premium calculated under such
subsection were multiplied by the ratio of the full actuarial
value of the benefits provided under the plan being offered to
the full actuarial value of essential health benefits.
``(4) Eliminating certain requirements in the case of an
exchange waiver.--In the case of a State that has in effect an
exchange waiver described in section 1332A(b)(2) of such Act
for a coverage month, the following shall apply:
``(A) Eliminating exchange references.--Subsections
(b)(2)(A), (c)(2)(A)(i), (d)(3)(B), and (e)(3) shall be
applied by treating the permissible health plan as if
it were offered through an Exchange.
``(B) Applicable second lowest cost silver plan.--
Subsection (b)(3)(B) shall be applied by substituting--
``(i) `qualified health plan for which, if
the adjusted monthly premium, taking into
account subsection (g)(3), were multiplied by
the ratio of 70 percent to the level of
coverage expressed as a percent of the full
actuarial value of the benefits provided under
the plan, the product of such multiplication
would be the second lowest such product for any
plan offered in' for `second lowest cost silver
plan of', and
``(ii) `is offered in such rating area' for
`is offered through the same Exchange through
which the qualified health plans taken into
account under paragraph (2)(A) were offered'.
``(C) Information requirement.--In the case of a
permissible health plan which is not offered through an
Exchange, such plan shall provide to the Secretary and
to the individual enrolled in the plan the information
described in subsection (f)(3) with respect to such
plan and such individual.
``(5) Special rule for part-time resident taxpayers with
income above 300 percent of fpl.--In the case of a taxpayer
who, during a taxable year, obtains coverage with respect to a
1332A State and with respect to a State which is not a 1332A
State, paragraph (1) shall not apply and the premium assistance
amount (otherwise determined under subsection (b)(2)) for such
taxpayer for a coverage month shall be 0 if--
``(A) the household income of the taxpayer for the
taxable year equals or exceeds 300 percent of an amount
equal to the poverty line for a family of the size
involved, and
``(B) the taxpayer receives coverage with respect
to a section 1332A State for such coverage month.
``(6) Section 1332a state defined.--For purposes of this
subsection, the term `section 1332A State' means a State has in
effect a waiver under section 1332A of the Patient Protection
and Affordable Care Act.''.
(2) Reduced cost-sharing.--Section 1402(f) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071(f)) is
amended by adding at the end the following:
``(4) 1332A waivers.--If a State has in effect a waiver
under 1332A, the following shall apply with respect to a
coverage month with respect to individuals residing in the
State on the first of the month:
``(A) Eliminating reduced cost-sharing for
individuals with income above 300 percent of fpl.--No
individual whose household income exceeds 300 percent
of the poverty line for a family of the size involved
may be considered an eligible insured under this
section.
``(B) Permissible health plans.--For the purposes
of this section, a permissible health plan, as defined
in section 1332A(c)(A), shall be treated as a qualified
health plan.
``(C) Exchange waiver.--If a State has in effect an
exchange waiver described in section 1332A(b)(2),
subsections (b)(1), (d)(1), and (e)(3) shall apply as
if there were no references to an Exchange.''.
(c) Acceleration of Innovation Waivers.--Section 1332(a)(1) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18052) is
amended, in the matter preceding subparagraph (A), by striking
``January 1, 2017'' and inserting ``the date of the enactment of the
State Health Care Options Act of 2015''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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