G:\P\15\HT\REC1\ECTITLE_16.XML COMMITTEE PRINT Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Act 1 2 3 4 5 6 TITLE I—ENERGY AND COMMERCE Subtitle A—Patient Access to Public Health Programs SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND. (a) IN GENERAL.—Subsection (b) of section 4002 of 7 the Patient Protection and Affordable Care Act (42 8 U.S.C. 300u–11), as amended by section 5009 of the 21st 9 Century Cures Act, is amended— 10 11 (1) in paragraph (2), by adding ‘‘and’’ at the end; 12 (2) in paragraph (3)— 13 (A) by striking ‘‘each of fiscal years 2018 14 and 2019’’ and inserting ‘‘fiscal year 2018’’; 15 and 16 (B) by striking the semicolon at the end 17 and inserting a period; and 18 (3) by striking paragraphs (4) through (8). g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 2 1 (b) RESCISSION OF UNOBLIGATED FUNDS.—Of the 2 funds made available by such section 4002, the unobli3 gated balance at the end of fiscal year 2018 is rescinded. 4 5 SEC. 102. COMMUNITY HEALTH CENTER PROGRAM. Effective as if included in the enactment of the Medi- 6 care Access and CHIP Reauthorization Act of 2015 (Pub7 lic Law 114–10, 129 Stat. 87), paragraph (1) of section 8 221(a) of such Act is amended by inserting ‘‘, and an ad9 ditional $422,000,000 for fiscal year 2017’’ after ‘‘2017’’. 10 11 SEC. 103. FEDERAL PAYMENTS TO STATES. (a) IN GENERAL.—Notwithstanding section 504(a), 12 1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 13 2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 14 1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 15 1397bb(a)(7), 1397ee(a)(1)), or the terms of any Med16 icaid waiver in effect on the date of enactment of this Act 17 that is approved under section 1115 or 1915 of the Social 18 Security Act (42 U.S.C. 1315, 1396n), for the 1-year pe19 riod beginning on the date of the enactment of this Act, 20 no Federal funds provided from a program referred to in 21 this subsection that is considered direct spending for any 22 year may be made available to a State for payments to 23 a prohibited entity, whether made directly to the prohib24 ited entity or through a managed care organization under 25 contract with the State. g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 3 1 (b) DEFINITIONS.—In this section: 2 (1) PROHIBITED term ‘‘prohib- 3 ited entity’’ means an entity, including its affiliates, 4 subsidiaries, successors, and clinics— 5 (A) that, as of the date of enactment of 6 this Act— 7 (i) is an organization described in sec- 8 tion 501(c)(3) of the Internal Revenue 9 Code of 1986 and exempt from tax under 10 section 501(a) of such Code; 11 (ii) is an essential community provider 12 described in section 156.235 of title 45, 13 Code of Federal Regulations (as in effect 14 on the date of enactment of this Act), that 15 is primarily engaged in family planning 16 services, reproductive health, and related 17 medical care; and 18 (iii) provides for abortions, other than 19 an abortion— 20 (I) if the pregnancy is the result 21 of an act of rape or incest; or 22 (II) in the case where a woman 23 suffers from a physical disorder, phys- 24 ical injury, or physical illness that 25 would, as certified by a physician, g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 ENTITY.—The 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 4 1 place the woman in danger of death 2 unless an abortion is performed, in- 3 cluding a life-endangering physical 4 condition caused by or arising from 5 the pregnancy itself; and 6 (B) for which the total amount of Federal 7 and State expenditures under the Medicaid pro- 8 gram under title XIX of the Social Security Act 9 in fiscal year 2014 made directly to the entity 10 and to any affiliates, subsidiaries, successors, or 11 clinics of the entity, or made to the entity and 12 to any affiliates, subsidiaries, successors, or 13 clinics of the entity as part of a nationwide 14 health 15 $350,000,000. 16 (2) DIRECT provider network, SPENDING.—The exceeded term ‘‘direct 17 spending’’ has the meaning given that term under 18 section 250(c) of the Balanced Budget and Emer- 19 gency Deficit Control Act of 1985 (2 U.S.C. 900(c)). 20 Subtitle B—Medicaid Program Enhancement 21 22 23 SEC. 111. REPEAL OF MEDICAID PROVISIONS. The Social Security Act is amended— 24 (1) in section 1902 (42 U.S.C. 1396a)— g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 care 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 5 1 (A) in subsection (a)(47)(B), by inserting 2 ‘‘and provided that any such election shall cease 3 to be effective on January 1, 2020, and no such 4 election shall be made after that date’’ before 5 the semicolon at the end; and 6 (B) in subsection (l)(2)(C), by inserting 7 ‘‘and ending December 31, 2019,’’ after ‘‘Janu- 8 ary 1, 2014,’’; 9 (2) in section 1915(k)(2) (42 U.S.C. 10 1396n(k)(2)), by striking ‘‘during the period de- 11 scribed in paragraph (1)’’ and inserting ‘‘on or after 12 the date referred to in paragraph (1) and before 13 January 1, 2020’’; and 14 (3) in section 1920(e) (42 U.S.C. 1396r–1(e)), 15 by striking ‘‘under clause (i)(VIII), clause (i)(IX), or 16 clause (ii)(XX) of subsection (a)(10)(A)’’ and insert- 17 ing ‘‘under clause (i)(VIII) or clause (ii)(XX) of sec- 18 tion 1902(a)(10)(A) before January 1, 2020, section 19 1902(a)(10)(A)(i)(IX),’’. 20 SEC. 112. REPEAL OF MEDICAID EXPANSION. 21 (a) IN GENERAL.—Section 1902(a)(10)(A) of the So- 22 cial Security Act (42 U.S.C. 1396a(a)(10)(A)) is amend23 ed— 24 25 (1) in clause (i)(VIII), by inserting ‘‘at the option of a State,’’ after ‘‘January 1, 2014,’’; and g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 6 1 (2) in clause (ii)(XX), by inserting ‘‘and ending 2 December 31, 2019,’’ after ‘‘2014,’’. 3 (b) TERMINATION 4 PANSION OF EFMAP FOR NEW ACA EX- ENROLLEES.—Section 1905 of the Social Secu- 5 rity Act (42 U.S.C. 1396d) is amended— 6 (1) in subsection (y)(1), in the matter preceding 7 subparagraph (A), by striking ‘‘with respect to’’ and 8 all that follows through ‘‘shall be’’ and inserting 9 ‘‘with respect to amounts expended before January 10 1, 2020, by such State for medical assistance for 11 newly eligible individuals described in subclause 12 (VIII) of section 1902(a)(10)(A)(i) who are enrolled 13 under the State plan (or a waiver of the plan) before 14 such date and with respect to amounts expended 15 after such date by such State for medical assistance 16 for individuals described in such subclause who were 17 enrolled under such plan (or waiver of such plan) as 18 of December 31, 2019, and who do not have a break 19 in eligibility for medical assistance under such State 20 plan (or waiver) for more than one month after such 21 date, shall be’’; and 22 (2) in subsection (z)(2)— 23 (A) in subparagraph (A), by striking 24 ‘‘medical assistance for individuals’’ and all that 25 follows g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 through ‘‘shall be’’ and inserting (653419 4) PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 7 1 ‘‘amounts expended before January 1, 2020, by 2 such State for medical assistance for individuals 3 described in section 1902(a)(10)(A)(i)(VIII) 4 who are nonpregnant childless adults with re- 5 spect to whom the State may require enrollment 6 in benchmark coverage under section 1937 and 7 who are enrolled under the State plan (or a 8 waiver of the plan) before such date and with 9 respect to amounts expended after such date by 10 such State for medical assistance for individuals 11 described in such section, who are nonpregnant 12 childless adults with respect to whom the State 13 may require enrollment in benchmark coverage 14 under section 1937, who were enrolled under 15 such plan (or waiver of such plan) as of Decem- 16 ber 31, 2019, and who do not have a break in 17 eligibility for medical assistance under such 18 State plan (or waiver) for more than one month 19 after such date, shall be’’ ; and 20 (B) in subparagraph (B)(ii)— 21 (i) in subclause (III), by adding 22 ‘‘and’’ at the end; and 23 (ii) by striking subclauses (IV), (V), 24 and (VI) and inserting the following new 25 subclause: g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 8 1 ‘‘(IV) 2017 and each subsequent year is 80 2 percent.’’. 3 (c) SUNSET 4 QUIREMENT.—Section OF ESSENTIAL HEALTH BENEFITS RE1937(b)(5) of the Social Security 5 Act (42 U.S.C. 1396u–7(b)(5)) is amended by adding at 6 the end the following: ‘‘This paragraph shall not apply 7 after December 31, 2019.’’. 8 9 SEC. 113. ELIMINATION OF DSH CUTS. Section 1923(f) of the Social Security Act (42 U.S.C. 10 1396r–4(f)) is amended— 11 (1) in paragraph (7)— 12 (A) in subparagraph (A)— 13 (i) in clause (i)— 14 (I) in the matter preceding sub- 15 clause (I), by striking ‘‘2025’’ and in- 16 serting ‘‘2019’’; and 17 (ii) in clause (ii)— 18 (I) in subclause (I), by adding 19 ‘‘and’’ at the end; 20 (II) in subclause (II), by striking 21 the semicolon at the end and inserting 22 a period; and 23 (III) by striking subclauses (III) 24 through (VIII); and g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 9 1 (B) by adding at the end the following new 2 subparagraph: 3 ‘‘(C) EXEMPTION 4 NON-EXPANSION STATES.— 5 ‘‘(i) IN GENERAL.—In the case of a 6 State that is a non-expansion State for a 7 fiscal year, subparagraph (A)(i) shall not 8 apply to the DSH allotment for such State 9 and fiscal year. 10 ‘‘(ii) NO CHANGE IN REDUCTION FOR 11 EXPANSION 12 State that is an expansion State for a fis- 13 cal year, the DSH allotment for such State 14 and fiscal year shall be determined as if 15 clause (i) did not apply. 16 STATES.—In the case of a ‘‘(iii) NON-EXPANSION 17 AND EXPAN- SION STATE DEFINED.— 18 ‘‘(I) The term ‘expansion State’ 19 means with respect to a fiscal year, a 20 State that, as of July 1 of the pre- 21 ceding fiscal year, provides for eligi- 22 bility 23 (ii)(XX) of section 1902(a)(10)(A) for 24 medical assistance under this title (or g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 FROM EXEMPTION FOR 16:39 Mar 06, 2017 Jkt 000000 under clause (i)(VIII) or (653419 4) PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 10 1 a waiver of the State plan approved 2 under section 1115). 3 ‘‘(II) The term ‘non-expansion 4 State’ means, with respect to a fiscal 5 year, a State that is not an expansion 6 State.’’; and 7 8 9 10 (2) in paragraph (8), by striking ‘‘fiscal year 2025’’ and inserting ‘‘fiscal year 2019’’. SEC. 114. REDUCING STATE MEDICAID COSTS. (a) LETTING STATES DISENROLL HIGH DOLLAR 11 LOTTERY WINNERS.— 12 13 (1) IN 1902 of the Social Security Act (42 U.S.C. 1396a) is amended— 14 (A) in subsection (a)(17), by striking 15 ‘‘(e)(14), 16 (e)(15)’’; and 17 (e)(14)’’ and inserting ‘‘(e)(14), (B) in subsection (e)— 18 (i) in paragraph (14) (relating to 19 modified adjusted gross income), by adding 20 at the end the following new subparagraph: 21 ‘‘(J) TREATMENT OF CERTAIN LOTTERY 22 WINNINGS AND INCOME RECEIVED AS A LUMP 23 SUM.— 24 ‘‘(i) IN 25 16:39 Mar 06, 2017 GENERAL.—In the case of an individual who is the recipient of qualified g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 GENERAL.—Section Jkt 000000 (653419 4) PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 11 1 lottery winnings (pursuant to lotteries oc- 2 curring on or after January 1, 2020) or 3 qualified lump sum income (received on or 4 after such date) and whose eligibility for 5 medical assistance is determined based on 6 the application of modified adjusted gross 7 income under subparagraph (A), a State 8 shall, in determining such eligibility, in- 9 clude such winnings or income (as applica- 10 ble) as income received— 11 ‘‘(I) in the month in which such 12 winnings or income (as applicable) is 13 received 14 winnings or income is less than 15 $80,000; the amount of such 16 ‘‘(II) over a period of 2 months 17 if the amount of such winnings or in- 18 come (as applicable) is greater than or 19 equal to $80,000 but less than 20 $90,000; 21 ‘‘(III) over a period of 3 months 22 if the amount of such winnings or in- 23 come (as applicable) is greater than or 24 equal to $90,000 but less than 25 $100,000; and g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 if 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 12 1 ‘‘(IV) over a period of 3 months 2 plus 1 additional month for each in- 3 crement of $10,000 of such winnings 4 or income (as applicable) received, not 5 to exceed a period of 120 months (for 6 winnings or income of $1,260,000 or 7 more), if the amount of such winnings 8 or income is greater than or equal to 9 $100,000. 10 ‘‘(ii) COUNTING 11 MENTS.—For 12 (III), and (IV) of clause (i), winnings or 13 income to which such subclause applies 14 shall be counted in equal monthly install- 15 ments over the period of months specified 16 under such subclause. 17 ‘‘(iii) HARDSHIP purposes of subclauses (II), EXEMPTION.—An in- 18 dividual whose income, by application of 19 clause (i), exceeds the applicable eligibility 20 threshold established by the State, may 21 continue to be eligible for medical assist- 22 ance to the extent that the State deter- 23 mines, under procedures established by the 24 State under the State plan (or in the case 25 of a waiver of the plan under section 1115, g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 IN EQUAL INSTALL- 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 13 1 incorporated in such waiver), or as other- 2 wise established by such State in accord- 3 ance with such standards as may be speci- 4 fied by the Secretary, that the denial of eli- 5 gibility of the individual would cause an 6 undue medical or financial hardship as de- 7 termined on the basis of criteria estab- 8 lished by the Secretary. 9 ‘‘(iv) NOTIFICATIONS ASSIST- 10 ANCE REQUIRED IN CASE OF LOSS OF ELI- 11 GIBILITY.—A 12 an individual who loses eligibility for med- 13 ical assistance under the State plan (or a 14 waiver of such plan) by reason of clause 15 (i), before the date on which the individual 16 loses such eligibility, inform the individual 17 of the date on which the individual would 18 no longer be considered ineligible by reason 19 of such clause to receive medical assistance 20 under the State plan or under any waiver 21 of such plan and the date on which the in- 22 dividual would be eligible to reapply to re- 23 ceive such medical assistance. 24 DEFINED.—In g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) 16:39 Mar 06, 2017 State shall, with respect to ‘‘(v) QUALIFIED 25 VerDate 0ct 09 2002 AND Jkt 000000 LOTTERY WINNINGS this subparagraph, the term (653419 4) PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 14 1 ‘qualified lottery winnings’ means winnings 2 from a sweepstakes, lottery, or pool de- 3 scribed in paragraph (3) of section 4402 of 4 the Internal Revenue Code of 1986 or a 5 lottery operated by a multistate or multi- 6 jurisdictional lottery association, including 7 amounts awarded as a lump sum payment. 8 ‘‘(vi) QUALIFIED 9 DEFINED.—In this subparagraph, the term 10 ‘qualified lump sum income’ means income 11 that is received as a lump sum from one 12 of the following sources: 13 ‘‘(I) Monetary winnings from 14 gambling (as defined by the Secretary 15 and including monetary winnings from 16 gambling activities described in sec- 17 tion 1955(b)(4) of title 18, United 18 States Code). 19 ‘‘(II) Income received as liquid 20 assets from the estate (as defined in 21 section 1917(b)(4)) of a deceased in- 22 dividual.’’; and 23 (ii) by striking ‘‘(14) EXCLUSION’’ 24 and inserting ‘‘(15) EXCLUSION’’. 25 (2) RULES g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 LUMP SUM INCOME 16:39 Mar 06, 2017 Jkt 000000 OF CONSTRUCTION.— (653419 4) PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 15 1 (A) INTERCEPTION 2 ALLOWED.—Nothing 3 by paragraph (1)(B)(i) shall be construed as 4 preventing a State from intercepting the State 5 lottery winnings awarded to an individual in the 6 State to recover amounts paid by the State 7 under the State Medicaid plan under title XIX 8 of the Social Security Act for medical assistance 9 furnished to the individual. 10 in the amendment made (B) APPLICABILITY LIMITED TO ELIGI- 11 BILITY OF RECIPIENT OF LOTTERY WINNINGS 12 OR LUMP SUM INCOME.—Nothing 13 ment made by paragraph (1)(B)(i) shall be con- 14 strued, with respect to a determination of 15 household income for purposes of a determina- 16 tion of eligibility for medical assistance under 17 the State plan under title XIX of the Social Se- 18 curity Act (42 U.S.C. 1396 et seq.) (or a waiver 19 of such plan) made by applying modified ad- 20 justed gross income under subparagraph (A) of 21 section 1902(e)(14) of such Act (42 U.S.C. 22 1396a(e)(14)), as limiting the eligibility for 23 such medical assistance of any individual that is 24 a member of the household other than the indi- 25 vidual (or the individual’s spouse) who received g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 OF LOTTERY WINNINGS 16:39 Mar 06, 2017 Jkt 000000 in the amend- (653419 4) PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 16 1 qualified lottery winnings or qualified lump-sum 2 income (as defined in subparagraph (J) of such 3 section 1902(e)(14), as added by paragraph 4 (1)(B)(i) of this subsection). 5 (b) REPEAL OF RETROACTIVE ELIGIBILITY.— 6 (1) IN 7 (A) STATE PLAN REQUIREMENTS.—Section 8 1902(a)(34) of the Social Security Act (42 9 U.S.C. 1396a(a)(34)) is amended by striking 10 ‘‘in or after the third month before the month 11 in which he made application’’ and inserting ‘‘in 12 or after the month in which the individual made 13 application’’. 14 (B) DEFINITION OF MEDICAL ASSIST- 15 ANCE.—Section 16 Act (42 U.S.C. 1396d(a)) is amended by strik- 17 ing ‘‘in or after the third month before the 18 month in which the recipient makes application 19 for assistance’’ and inserting ‘‘in or after the 20 month in which the recipient makes application 21 for assistance’’. 22 (2) EFFECTIVE 1905(a) of the Social Security DATE.—The amendments made 23 by paragraph (1) shall apply to medical assistance 24 with respect to individuals whose eligibility for such 25 assistance is based on an application for such assist- g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 GENERAL.— 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 17 1 ance made (or deemed to be made) on or after Octo- 2 ber 1, 2017. 3 (c) ENSURING STATES ARE NOT FORCED 4 FOR INDIVIDUALS INELIGIBLE FOR THE 5 (1) IN GENERAL.—Section TO PAY PROGRAM.— 1137(f) of the Social 6 Security Act (42 U.S.C. 1320b–7(f)) is amended— 7 (A) by striking ‘‘Subsections (a)(1) and 8 (d)’’ and inserting ‘‘(1) Subsections (a)(1) and 9 (d)’’; and 10 (B) by adding at the end the following new 11 12 paragraph: ‘‘(2)(A) Subparagraphs (A) and (B)(ii) of subsection 13 (d)(4) shall not apply in the case of an initial determina14 tion made on or after the date that is 6 months after the 15 date of the enactment of this paragraph with respect to 16 the eligibility of an alien described in subparagraph (B) 17 for benefits under the program listed in subsection (b)(2). 18 ‘‘(B) An alien described in this subparagraph is an 19 individual declaring to be a citizen or national of the 20 United States with respect to whom a State, in accordance 21 with section 1902(a)(46)(B), requires— 22 23 ‘‘(i) pursuant to 1902(ee), the submission of a social security number; or g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 18 1 ‘‘(ii) pursuant to 1903(x), the presentation of 2 satisfactory documentary evidence of citizenship or 3 nationality.’’. 4 (2) NO 5 PROVIDED BEFORE PRESENTATION OF EVIDENCE.— 6 Section 1903(i)(22) of the Social Security Act (42 7 U.S.C. 1396b(i)(22)) is amended— 8 (A) by striking ‘‘with respect to amounts 9 expended’’ and inserting ‘‘(A) with respect to 10 amounts expended’’; 11 (B) by inserting ‘‘and’’ at the end; and 12 (C) by adding at the end the following new 13 subparagraph: 14 ‘‘(B) in the case of a State that elects to pro- 15 vide a reasonable period to present satisfactory doc- 16 umentary evidence of such citizenship or nationality 17 pursuant to paragraph (2)(C) of section 1902(ee) or 18 paragraph (4) of subsection (x) of this section, for 19 amounts expended for medical assistance for such an 20 individual (other than an individual described in 21 paragraph (2) of such subsection (x)) during such 22 period;’’. 23 (3) CONFORMING AMENDMENTS.—Section 24 1137(d)(4) of the Social Security Act (42 U.S.C. 25 1320b–7(d)(4)) is amended— g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 PAYMENTS FOR MEDICAL ASSISTANCE 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 19 1 (A) in subparagraph (A), in the matter 2 preceding clause (i), by inserting ‘‘subject to 3 subsection (f)(2),’’ before ‘‘the State’’; and 4 (B) in subparagraph (B)(ii), by inserting 5 ‘‘subject to subsection (f)(2),’’ before ‘‘pending 6 such verification’’. 7 8 (d) UPDATING ALLOWABLE HOME EQUITY LIMITS IN MEDICAID.— 9 (1) IN 1917(f)(1) of the 10 Social Security Act (42 U.S.C. 1396p(f)(1)) is 11 amended— 12 (A) in subparagraph (A), by striking ‘‘sub- 13 paragraphs (B) and (C)’’ and inserting ‘‘sub- 14 paragraph (B)’’; 15 (B) by striking subparagraph (B); 16 (C) by redesignating subparagraph (C) as 17 subparagraph (B); and 18 (D) in subparagraph (B), as so redesig- 19 nated, by striking ‘‘dollar amounts specified in 20 this paragraph’’ and inserting ‘‘dollar amount 21 specified in subparagraph (A)’’. 22 (2) EFFECTIVE 23 (A) IN DATE.— GENERAL.—The amendments made 24 by paragraph (1) shall apply with respect to eli- 25 gibility determinations made after the date that g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 GENERAL.—Section 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 20 1 is 180 days after the date of the enactment of 2 this section. 3 (B) EXCEPTION STATE LEGISLA- 4 TION.—In 5 XIX of the Social Security Act that the Sec- 6 retary of Health and Human Services deter- 7 mines requires State legislation in order for the 8 respective plan to meet any requirement im- 9 posed by amendments made by this subsection, 10 the respective plan shall not be regarded as fail- 11 ing to comply with the requirements of such 12 title solely on the basis of its failure to meet 13 such an additional requirement before the first 14 day of the first calendar quarter beginning after 15 the close of the first regular session of the 16 State legislature that begins after the date of 17 the enactment of this Act. For purposes of the 18 previous sentence, in the case of a State that 19 has a 2-year legislative session, each year of the 20 session shall be considered to be a separate reg- 21 ular session of the State legislature. g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 FOR 16:39 Mar 06, 2017 Jkt 000000 the case of a State plan under title (653419 4) PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 21 1 SEC. 115. SAFETY NET FUNDING FOR NON-EXPANSION 2 3 STATES. Title XIX of the Social Security Act is amended by 4 inserting after section 1923 (42 U.S.C. 1396r–4) the fol5 lowing new section: 6 ‘‘ADJUSTMENT 7 8 IN PAYMENT FOR SERVICES OF SAFETY NET PROVIDERS IN NON-EXPANSION STATES ‘‘SEC. 1923A. (a) IN GENERAL.—Subject to the limi- 9 tations of this section, for each year during the period be10 ginning with 2018 and ending with 2021, each State that 11 is one of the 50 States or the District of Columbia and 12 that, as of July 1 of the preceding year, did not provide 13 for eligibility under clause (i)(VIII) or (ii)(XX) of section 14 1902(a)(10)(A) for medical assistance under this title (or 15 a waiver of the State plan approved under section 1115) 16 (each such State or District referred to in this section for 17 the year as a ‘non-expansion State’) may adjust the pay18 ment amounts otherwise provided under the State plan 19 under this title (or a waiver of such plan) to health care 20 providers that provide health care services to individuals 21 enrolled under this title (in this section referred to as ‘eli22 gible providers’). 23 ‘‘(b) INCREASE IN APPLICABLE FMAP.—Notwith- 24 standing section 1905(b), the Federal medical assistance 25 percentage applicable with respect to expenditures attrib26 utable to a payment adjustment under subsection (a) for g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 22 1 which payment is permitted under subsection (c) shall be 2 equal to— 3 4 ‘‘(1) 100 percent for calendar quarters in calendar years 2018, 2019, 2020, and 2021; and 5 ‘‘(2) 95 percent for calendar quarters in cal- 6 endar year 2022. 7 ‘‘(c) LIMITATIONS; DISQUALIFICATION OF STATES.— 8 ‘‘(1) ANNUAL 9 ment under section 1903(a) shall not be made to a 10 State with respect to any payment adjustment made 11 under this section for all calendar quarters in a year 12 in excess of the $2,000,000,000 multiplied by the 13 ratio of— 14 ‘‘(A) the population of the State with in- 15 come below 138 percent of the poverty line in 16 2015 (as determined based the table entitled 17 ‘Health Insurance Coverage Status and Type 18 by Ratio of Income to Poverty Level in the Past 19 12 Months by Age’ for the universe of the civil- 20 ian noninstitutionalized population for whom 21 poverty status is determined based on the 2015 22 American Community Survey 1-Year Estimates, 23 as published by the Bureau of the Census), to 24 ‘‘(B) the sum of the populations under 25 subparagraph (A) for all non-expansion States. g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 ALLOTMENT LIMITATION.—Pay- 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 23 1 ‘‘(2) LIMITATION ON PAYMENT ADJUSTMENT 2 AMOUNT FOR INDIVIDUAL PROVIDERS.—The 3 of a payment adjustment under subsection (a) for an 4 eligible provider may not exceed the provider’s costs 5 incurred in furnishing health care services (as deter- 6 mined by the Secretary and net of payments under 7 this title, other than under this section, and by unin- 8 sured patients) to individuals who either are eligible 9 for medical assistance under the State plan (or 10 under a waiver of such plan) or have no health in- 11 surance or health plan coverage for such services. 12 ‘‘(d) DISQUALIFICATION 13 ERAGE IN CASE OF amount STATE COV- EXPANSION.—If a State is a non-expansion for a 14 year and provides eligibility for medical assistance de15 scribed in subsection (a) during the year, the State shall 16 no longer be treated as a non-expansion State under this 17 section for any subsequent years.’’. 18 SEC. 116. PROVIDING INCENTIVES FOR INCREASED FRE- 19 QUENCY 20 TIONS. 21 OF ELIGIBILITY REDETERMINA- (a) IN GENERAL.—Section 1902(e)(14) of the Social 22 Security Act (42 U.S.C. 1396a(e)(14)) (relating to modi23 fied adjusted gross income), as amended by section 24 114(a)(1), is further amended by adding at the end the 25 following: g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 24 1 ‘‘(K) FREQUENCY 2 TERMINATIONS.—Beginning 3 2017, and notwithstanding subparagraph (H), 4 in the case of an individual whose eligibility for 5 medical assistance under the State plan under 6 this title (or a waiver of such plan) is deter- 7 mined based on the application of modified ad- 8 justed gross income under subparagraph (A) 9 and who is so eligible on the basis of clause 10 (i)(VIII) or clause (ii)(XX) of subsection 11 (a)(10)(A), a State shall redetermine such indi- 12 vidual’s eligibility for such medical assistance 13 no less frequently than once every 6 months.’’. 14 (b) CIVIL MONETARY PENALTY.—Section 1128A(a) OF ELIGIBILITY REDE- on October 1, 15 of the Social Security Act (42 U.S.C. 1320a–7(a)) is 16 amended, in the matter following paragraph (10), by strik17 ing ‘‘(or, in cases under paragraph (3)’’ and inserting the 18 following: ‘‘(or, in cases under paragraph (1) in which an 19 individual was knowingly enrolled on or after October 1, 20 2017, pursuant to section 1902(a)(10)(A)(i)(VIII) for 21 medical assistance under the State plan under title XIX 22 whose income does not meet the income threshold specified 23 in such section or in which a claim was presented on or 24 after October 1, 2017, as a claim for an item or service 25 furnished to an individual described in such section but g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 25 1 whose enrollment under such State plan is not made on 2 the basis of such individual’s meeting the income threshold 3 specified in such section, $20,000 for each such individual 4 or claim; in cases under paragraph (3)’’. 5 6 (c) INCREASED ADMINISTRATIVE MATCHING PERCENTAGE.—For each calendar quarter during the period 7 beginning on October 1, 2017, and ending on December 8 31, 2019, the Federal matching percentage otherwise ap9 plicable under section 1903(a) of the Social Security Act 10 (42 U.S.C. 1396b(a)) with respect to State expenditures 11 during such quarter that are attributable to meeting the 12 requirement of section 1902(e)(14) (relating to determina13 tions of eligibility using modified adjusted gross income) 14 of such Act shall be increased by 5 percentage points with 15 respect to State expenditures attributable to activities car16 ried out by the State (and approved by the Secretary) to 17 increase the frequency of eligibility redeterminations re18 quired by subparagraph (K) of such section (relating to 19 eligibility redeterminations made on a 6-month basis) (as 20 added by subsection (a)). 22 Subtitle C—Per Capita Allotment for Medical Assistance 23 SEC. 121. PER CAPITA ALLOTMENT FOR MEDICAL ASSIST- 21 24 25 ANCE. Title XIX of the Social Security Act is amended— g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 26 1 (1) in section 1903 (42 U.S.C. 1396b)— 2 (A) in subsection (a), in the matter before 3 paragraph (1), by inserting ‘‘and section 4 1903A(a)’’ after ‘‘except as otherwise provided 5 in this section’’; and 6 (B) in subsection (d)(1), by striking ‘‘to 7 which’’ and inserting ‘‘to which, subject to sec- 8 tion 1903A(a),’’; and 9 (2) by inserting after such section 1903 the fol- 10 11 lowing new section: ‘‘SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR 12 13 14 MEDICAL ASSISTANCE. ‘‘(a) APPLICATION MENTS FOR 15 PER CAPITA CAP ON PAY- MEDICAL ASSISTANCE EXPENDITURES.— ‘‘(1) IN GENERAL.—If a State has excess ag- 16 gregate medical assistance expenditures (as defined 17 in paragraph (2)) for a fiscal year (beginning with 18 fiscal year 2020), the amount of payment to the 19 State under section 1903(a)(1) for each quarter in 20 the following fiscal year shall be reduced by 1⁄4 of 21 the excess aggregate medical assistance payments 22 (as defined in paragraph (3)) for that previous fiscal 23 year. In this section, the term ‘State’ means only the 24 50 States and the District of Columbia. g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 OF 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 27 1 ‘‘(2) EXCESS 2 EXPENDITURES.—In 3 cess aggregate medical assistance expenditures’ 4 means, for a State for a fiscal year, the amount (if 5 any) by which— this subsection, the term ‘ex- 6 ‘‘(A) the amount of the adjusted total med- 7 ical assistance expenditures (as defined in sub- 8 section (b)(1)) for the State and fiscal year; ex- 9 ceeds 10 ‘‘(B) the amount of the target total med- 11 ical assistance expenditures (as defined in sub- 12 section (c)) for the State and fiscal year. 13 ‘‘(3) EXCESS AGGREGATE MEDICAL ASSISTANCE 14 PAYMENTS.—In 15 gregate medical assistance payments’ means, for a 16 State for a fiscal year, the product of— this subsection, the term ‘excess ag- 17 ‘‘(A) the excess aggregate medical assist- 18 ance expenditures (as defined in paragraph (2)) 19 for the State for the fiscal year; and 20 ‘‘(B) the Federal average medical assist- 21 ance matching percentage (as defined in para- 22 graph (4)) for the State for the fiscal year. 23 ‘‘(4) FEDERAL AVERAGE MEDICAL ASSISTANCE 24 MATCHING PERCENTAGE.—In 25 term ‘Federal average medical assistance matching g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 AGGREGATE MEDICAL ASSISTANCE 16:39 Mar 06, 2017 Jkt 000000 this subsection, the (653419 4) PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 28 1 percentage’ means, for a State for a fiscal year, the 2 ratio (expressed as a percentage) of— 3 ‘‘(A) the amount of the Federal payments 4 that would be made to the State under section 5 1903(a)(1) for medical assistance expenditures 6 for calendar quarters in the fiscal year if para- 7 graph (1) did not apply; to 8 ‘‘(B) the amount of the medical assistance 9 expenditures for the State and fiscal year. 10 ‘‘(b) ADJUSTED TOTAL MEDICAL ASSISTANCE EX- 11 PENDITURES.—Subject to subsection (g), the following 12 shall apply: 13 ‘‘(1) IN this section, the term 14 ‘adjusted total medical assistance expenditures’ 15 means, for a State— 16 ‘‘(A) for fiscal year 2016, the product of— 17 ‘‘(i) the amount of the medical assist- 18 ance expenditures (as defined in paragraph 19 (2)) for the State and fiscal year, reduced 20 by the amount of any excluded expendi- 21 tures (as defined in paragraph (3)) for the 22 State and fiscal year otherwise included in 23 such medical assistance expenditures; and g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 GENERAL.—In 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 29 1 ‘‘(ii) the 1903A FY16 population per- 2 centage (as defined in paragraph (4)) for 3 the State; or 4 ‘‘(B) for fiscal year 2019 or a subsequent 5 fiscal year, the amount of the medical assist- 6 ance expenditures (as defined in paragraph (2)) 7 for the State and fiscal year that is attributable 8 to 1903A enrollees, reduced by the amount of 9 any excluded expenditures (as defined in para- 10 graph (3)) for the State and fiscal year other- 11 wise included in such medical assistance ex- 12 penditures. 13 ‘‘(2) MEDICAL 14 In this section, the term ‘medical assistance expendi- 15 tures’ means, for a State and fiscal year, the med- 16 ical assistance payments as reported by medical 17 service category on the Form CMS-64 quarterly ex- 18 pense report (or successor to such a report form, 19 and including enrollment data and subsequent ad- 20 justments to any such report, in this section referred 21 to collectively as a ‘CMS-64 report’) that directly re- 22 sult from providing medical assistance under the 23 State plan (including under a waiver of the plan) for 24 which payment is (or may otherwise be) made pur- 25 suant to section 1903(a)(1). g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 ASSISTANCE EXPENDITURES.— 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 30 1 ‘‘(3) EXCLUDED this sec- 2 tion, the term ‘excluded expenditures’ means, for a 3 State and fiscal year, expenditures under the State 4 plan (or under a waiver of such plan) that are at- 5 tributable to any of the following: 6 ‘‘(A) DSH.—Payment adjustments made 7 for disproportionate share hospitals under sec- 8 tion 1923. 9 ‘‘(B) MEDICARE COST-SHARING.—Pay- 10 ments made for medicare cost-sharing (as de- 11 fined in section 1905(p)(3)). 12 ‘‘(C) SAFETY NET PROVIDER PAYMENT AD- 13 JUSTMENTS IN NON-EXPANSION STATES.—Pay- 14 ment adjustments under subsection (a) of sec- 15 tion 1923A for which payment is permitted 16 under subsection (c) of such section. 17 ‘‘(4) 1903A FY 16 POPULATION PERCENTAGE.— 18 In this subsection, the term ‘1903A FY16 popu- 19 lation percentage’ means, for a State, the Sec- 20 retary’s calculation of the percentage of the actual 21 medical assistance expenditures, as reported by the 22 State on the CMS–64 reports for calendar quarters 23 in fiscal year 2016, that are attributable to 1903A 24 enrollees (as defined in subsection (e)(1)). g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 EXPENDITURES.—In 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 31 1 2 ‘‘(c) TARGET TOTAL MEDICAL ASSISTANCE EXPENDITURES.— 3 ‘‘(1) CALCULATION.—In this section, the term 4 ‘target total medical assistance expenditures’ means, 5 for a State for a fiscal year, the sum of the prod- 6 ucts, for each of the 1903A enrollee categories (as 7 defined in subsection (e)(2)), of— 8 ‘‘(A) the target per capita medical assist- 9 ance expenditures (as defined in paragraph (2)) 10 for the enrollee category, State, and fiscal year; 11 and 12 ‘‘(B) the number of 1903A enrollees for 13 such enrollee category, State, and fiscal year, as 14 determined under subsection (e)(4). 15 ‘‘(2) TARGET 16 EXPENDITURES.—In 17 get per capita medical assistance expenditures’ 18 means, for a 1903A enrollee category, State, and a 19 fiscal year, an amount equal to— this subsection, the term ‘tar- 20 ‘‘(A) the provisional FY19 target per cap- 21 ita amount for such enrollee category (as cal- 22 culated under subsection (d)(5)) for the State; 23 increased by 24 ‘‘(B) the percentage increase in the med- 25 ical care component of the consumer price index g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 PER CAPITA MEDICAL ASSISTANCE 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 32 1 for all urban consumers (U.S. city average) 2 from September of 2019 to September of the 3 fiscal year involved. 4 ‘‘(d) CALCULATION OF FY19 PROVISIONAL TARGET 5 AMOUNT FOR EACH 1903A ENROLLEE CATEGORY.—Sub6 ject to subsection (g), the following shall apply: 7 ‘‘(1) CALCULATION 8 CAL YEAR 2016.—For 9 calculate (and provide notice to the State not later 10 each State the Secretary shall than April 1, 2018, of) the following: 11 ‘‘(A) The amount of the adjusted total 12 medical assistance expenditures (as defined in 13 subsection (b)(1)) for the State for fiscal year 14 2016. 15 ‘‘(B) The number of 1903A enrollees for 16 the State in fiscal year 2016 (as determined 17 under subsection (e)(4)). 18 ‘‘(C) The average per capita medical as- 19 sistance expenditures for the State for fiscal 20 year 2016 equal to— 21 ‘‘(i) the amount calculated under sub- 22 paragraph (A); divided by 23 ‘‘(ii) the number calculated under sub- 24 paragraph (B). g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 OF BASE AMOUNTS FOR FIS- 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 33 1 ‘‘(2) FISCAL 2 AMOUNT BASED ON INFLATING THE FISCAL YEAR 3 2016 AMOUNT TO FISCAL YEAR 2019 BY CPI-MED- 4 ICAL.—The 5 2019 average per capita amount for each State 6 equal to— Secretary shall calculate a fiscal year 7 ‘‘(A) the average per capita medical assist- 8 ance expenditures for the State for fiscal year 9 2016 (calculated under paragraph (1)(C)); in- 10 creased by 11 ‘‘(B) the percentage increase in the med- 12 ical care component of the consumer price index 13 for all urban consumers (U.S. city average) 14 from September, 2016 to September, 2019. 15 ‘‘(3) AGGREGATE AND AVERAGE EXPENDI- 16 TURES PER CAPITA FOR FISCAL YEAR 2019.—The 17 Secretary shall calculate for each State the fol- 18 lowing: 19 ‘‘(A) The amount of the adjusted total 20 medical assistance expenditures (as defined in 21 subsection (b)(1)) for the State for fiscal year 22 2019. 23 ‘‘(B) The number of 1903A enrollees for 24 the State in fiscal year 2019 (as determined 25 under subsection (e)(4)). g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 YEAR 2019 AVERAGE PER CAPITA 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 34 1 ‘‘(4) PER 2 YEAR 2019 FOR EACH 1903A ENROLLEE CATEGORY.— 3 The Secretary shall calculate (and provide notice to 4 each State not later than January 1, 2020, of) the 5 following: 6 ‘‘(A)(i) For each 1903A enrollee category, 7 the amount of the adjusted total medical assist- 8 ance expenditures (as defined in subsection 9 (b)(1)) for the State for fiscal year 2019 for in- 10 dividuals in the enrollee category, calculated by 11 excluding from medical assistance expenditures 12 those expenditures attributable to expenditures 13 described in clause (iii) or non-DSH supple- 14 mental expenditures (as defined in clause (ii)). 15 ‘‘(ii) In this paragraph, the term ‘non- 16 DSH supplemental expenditure’ means a pay- 17 ment to a provider under the State plan (or 18 under a waiver of the plan) that— 19 ‘‘(I) is not made under section 1923; 20 ‘‘(II) is not made with respect to a 21 specific item or service for an individual; 22 ‘‘(III) is in addition to any payments 23 made to the provider under the plan (or 24 waiver) for any such item or service; and g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 CAPITA EXPENDITURES FOR FISCAL 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 35 1 ‘‘(IV) complies with the limits for ad- 2 ditional payments to providers under the 3 plan (or waiver) imposed pursuant to sec- 4 tion 1902(a)(30)(A), including the regula- 5 tions specifying upper payment limits 6 under the State plan in part 447 of title 7 42, Code of Federal Regulations (or any 8 successor regulations). 9 ‘‘(iii) An expenditure described in this 10 clause is an expenditure that meets the criteria 11 specified in subclauses (I), (II), and (III) of 12 clause (ii) and is authorized under section 1115 13 for the purposes of funding a delivery system 14 reform pool, uncompensated care pool, a des- 15 ignated state health program, or any other 16 similar expenditure (as defined by the Sec- 17 retary). 18 ‘‘(B) For each 1903A enrollee category, 19 the number of 1903A enrollees for the State in 20 fiscal year 2019 in the enrollee category (as de- 21 termined under subsection (e)(4)). 22 ‘‘(C) For fiscal year 2016, the State’s non- 23 DSH supplemental payment percentage is equal 24 to the ratio (expressed as a percentage) of— g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 36 1 ‘‘(i) the total amount of non-DSH 2 supplemental expenditures (as defined in 3 subparagraph (A)(ii)) for the State for fis- 4 cal year 2016; to 5 ‘‘(ii) the amount described in sub- 6 section (b)(1)(A) for the State for fiscal 7 year 2016. 8 ‘‘(D) For each 1903A enrollee category an 9 average medical assistance expenditures per 10 capita for the State for fiscal year 2019 for the 11 enrollee category equal to— 12 ‘‘(i) the amount calculated under sub- 13 paragraph (A) for the State, increased by 14 the non-DSH supplemental payment per- 15 centage for the State (as calculated under 16 subparagraph (C)); divided by 17 ‘‘(ii) the number calculated under sub- 18 paragraph (B) for the State for the en- 19 rollee category. 20 ‘‘(5) PROVISIONAL 21 AMOUNT FOR EACH 1903A ENROLLEE CATEGORY.— 22 Subject to subsection (f)(2), the Secretary shall cal- 23 culate for each State a provisional FY19 per capita 24 target amount for each 1903A enrollee category 25 equal to the average medical assistance expenditures g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 FY19 PER CAPITA TARGET 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 37 1 per capita for the State for fiscal year 2019 (as cal- 2 culated under paragraph (4)(D)) for such enrollee 3 category multiplied by the ratio of— 4 ‘‘(A) the product of— 5 ‘‘(i) the fiscal year 2019 average per 6 capita amount for the State, as calculated 7 under paragraph (2); and 8 ‘‘(ii) the number of 1903A enrollees 9 for the State in fiscal year 2019, as cal- 10 culated under paragraph (3)(B); to 11 ‘‘(B) the amount of the adjusted total 12 medical assistance expenditures for the State 13 for fiscal year 2019, as calculated under para- 14 graph (3)(A). 15 16 ‘‘(e) 1903A ENROLLEE; 1903A ENROLLEE CATEGORY.—Subject to subsection (g), for purposes of this 17 section, the following shall apply: 18 ‘‘(1) 1903A term ‘1903A en- 19 rollee’ means, with respect to a State and a month, 20 any Medicaid enrollee (as defined in paragraph (3)) 21 for the month, other than such an enrollee who for 22 such month is in any of the following categories of 23 excluded individuals: 24 ‘‘(A) CHIP.—An individual who is pro- 25 vided, under this title in the manner described g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 ENROLLEE.—The 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 38 1 in section 2101(a)(2), child health assistance 2 under title XXI. 3 ‘‘(B) IHS.—An individual who receives 4 any medical assistance under this title for serv- 5 ices for which payment is made under the third 6 sentence of section 1905(b). 7 ‘‘(C) BREAST CERVICAL CANCER 8 SERVICES 9 vidual who is entitled to medical assistance 10 under this title only pursuant to section 11 1902(a)(10)(A)(ii)(XVIII). 12 ELIGIBLE INDIVIDUAL.—An ‘‘(D) PARTIAL-BENEFIT 13 indi- ENROLLEES.—An individual who— 14 ‘‘(i) is an alien who is entitled to med- 15 ical assistance under this title only pursu- 16 ant to section 1903(v)(2); 17 ‘‘(ii) is entitled to medical assistance 18 under this title only pursuant to subclause 19 (XII) 20 1902(a)(10)(A)(ii) (or pursuant to a waiv- 21 er that provides only comparable benefits); 22 ‘‘(iii) is a dual eligible individual (as 23 defined in section 1915(h)(2)(B)) and is 24 entitled to medical assistance under this 25 title (or under a waiver) only for some or g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 AND 16:39 Mar 06, 2017 Jkt 000000 or (XXI) of section (653419 4) PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 39 1 all of medicare cost-sharing (as defined in 2 section 1905(p)(3)); or 3 ‘‘(iv) is entitled to medical assistance 4 under this title and for whom the State is 5 providing a payment or subsidy to an em- 6 ployer for coverage of the individual under 7 a group health plan pursuant to section 8 1906 or section 1906A (or pursuant to a 9 waiver that provides only comparable bene- 10 fits). 11 ‘‘(2) 1903A term 12 ‘1903A enrollee category’ means each of the fol- 13 lowing: 14 ‘‘(A) ELDERLY.—A category of 1903A en- 15 rollees who are 65 years of age or older. 16 ‘‘(B) BLIND AND DISABLED.—A category 17 of 1903A enrollees (not described in the pre- 18 vious subparagraph) who are eligible for med- 19 ical assistance under this title on the basis of 20 being blind or disabled. 21 ‘‘(C) CHILDREN.—A category of 1903A 22 enrollees (not described in a previous subpara- 23 graph) who are children under 19 years of age. 24 ‘‘(D) EXPANSION 25 16:39 Mar 06, 2017 ENROLLEES.—A cat- egory of 1903A enrollees (not described in a g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 ENROLLEE CATEGORY.—The Jkt 000000 (653419 4) PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 40 1 previous subparagraph) for whom the amounts 2 expended for medical assistance are subject to 3 an increase or change in the Federal medical 4 assistance percentage under subsection (y) or 5 (z)(2), respectively, of section 1905. 6 ‘‘(E) OTHER 7 NON-EXPANSION 8 1903A enrollees who are not described in any 9 previous subparagraph. 10 ‘‘(3) MEDICAID ADULTS.—A category ENROLLEE.—The of term ‘Med- 11 icaid enrollee’ means, with respect to a State for a 12 month, an individual who is eligible for medical as- 13 sistance for items or services under this title and en- 14 rolled under the State plan (or a waiver of such 15 plan) under this title for the month. 16 ‘‘(4) DETERMINATION OF NUMBER OF 1903A 17 ENROLLEES.—The 18 State and fiscal year, and, if applicable, for a 1903A 19 enrollee category, is the average monthly number of 20 Medicaid enrollees for such State and fiscal year 21 (and, if applicable, in such category) that are re- 22 ported through the CMS–64 report under (and sub- 23 ject to audit under) subsection (h). 24 ‘‘(f) SPECIAL PAYMENT RULES.— g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 NONELDERLY, NONDISABLED, 16:39 Mar 06, 2017 Jkt 000000 number of 1903A enrollees for a (653419 4) PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 41 1 ‘‘(1) APPLICATION 2 DEMONSTRATION PROJECTS AND OTHER WAIVERS.— 3 In the case of a State with a waiver of the State 4 plan approved under section 1115, section 1915, or 5 another provision of this title, this section shall 6 apply to medical assistance expenditures and medical 7 assistance payments under the waiver, in the same 8 manner as if such expenditures and payments had 9 been made under a State plan under this title and 10 the limitations on expenditures under this section 11 shall supersede any other payment limitations or 12 provisions (including limitations based on a per cap- 13 ita limitation) otherwise applicable under such a 14 waiver. 15 ‘‘(2) TREATMENT OF STATES EXPANDING COV- 16 ERAGE AFTER FISCAL YEAR 2016.—In 17 State that did not provide for medical assistance for 18 the 1903A enrollee category described in subsection 19 (e)(2)(D) during fiscal year 2016 but which provides 20 for such assistance for such category in a subse- 21 quent year, the provisional FY19 per capita target 22 amount for such enrollee category under subsection 23 (d)(5) shall be equal to the provisional FY19 per 24 capita target amount for the 1903A enrollee cat- 25 egory described in subsection (e)(2)(E). g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 IN CASE OF RESEARCH AND 16:39 Mar 06, 2017 Jkt 000000 the case of a (653419 4) PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 42 1 ‘‘(3) IN CASE OF STATE FAILURE TO REPORT 2 NECESSARY DATA.—If 3 fiscal year (beginning with fiscal year 2019) fails to 4 satisfactorily submit data on expenditures and en- 5 rollees in accordance with subsection (h)(1), for such 6 fiscal year and any succeeding fiscal year for which 7 such data are not satisfactorily submitted— a State for any quarter in a 8 ‘‘(A) the Secretary shall calculate and 9 apply subsections (a) through (e) with respect 10 to the State as if all 1903A enrollee categories 11 for which such expenditure and enrollee data 12 were not satisfactorily submitted were a single 13 1903A enrollee category; and 14 ‘‘(B) the growth factor otherwise applied 15 under subsection (c)(2)(B) shall be decreased 16 by 1 percentage point. 17 ‘‘(g) RECALCULATION OF CERTAIN AMOUNTS FOR 18 DATA ERRORS.—The amounts and percentage calculated 19 under paragraphs (1) and (4)(C) of subsection (d) for a 20 State for fiscal year 2016, and the amounts of the ad21 justed total medical assistance expenditures calculated 22 under subsection (b) and the number of Medicaid enrollees 23 and 1903A enrollees determined under subsection (e)(4) 24 for a State for fiscal year 2016, fiscal year 2019, and any 25 subsequent fiscal year, may be adjusted by the Secretary g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 43 1 based upon an appeal (filed by the State in such a form, 2 manner, and time, and containing such information relat3 ing to data errors that support such appeal, as the Sec4 retary specifies) that the Secretary determines to be valid, 5 except that any adjustment by the Secretary under this 6 subsection for a State may not result in an increase of 7 the target total medical assistance expenditures exceeding 8 2 percent. 9 ‘‘(h) REQUIRED REPORTING AND AUDITING 10 CMS–64 DATA; TRANSITIONAL INCREASE 11 MATCHING PERCENTAGE FOR IN OF FEDERAL CERTAIN ADMINISTRATIVE 12 EXPENSES.— 13 ‘‘(1) REPORTING.—In addition to the data re- 14 quired on form Group VIII on the CMS–64 report 15 form as of January 1, 2017, in each CMS-64 report 16 required to be submitted (for each quarter beginning 17 on or after October 1, 2018), the State shall include 18 data on medical assistance expenditures within such 19 categories of services and categories of enrollees (in- 20 cluding each 1903A enrollee category and each cat- 21 egory of excluded individuals under subsection 22 (e)(1)) and the numbers of enrollees within each of 23 such enrollee categories, as the Secretary determines 24 are necessary (including timely guidance published 25 as soon as possible after the date of the enactment g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 44 1 of this section) in order to implement this section 2 and to enable States to comply with the requirement 3 of this paragraph on a timely basis. 4 ‘‘(2) AUDITING.—The Secretary shall conduct 5 for each State an audit of the number of individuals 6 and expenditures reported through the CMS–64 re- 7 port for fiscal year 2016, fiscal year 2019, and each 8 subsequent fiscal year, which audit may be con- 9 ducted on a representative sample (as determined by 10 the Secretary). 11 ‘‘(3) INCREASE IN FEDERAL SUPPORT IMPROVED 12 MATCHING 13 DATA REPORTING SYSTEMS FOR FISCAL YEARS 2018 14 AND 2019.—For 15 quarters beginning on or after October 1, 2017, and 16 before October 1, 2019— PERCENTAGE TO amounts expended during calendar 17 ‘‘(A) the Federal matching percentage ap- 18 plied under section 1903(a)(3)(A)(i) shall be in- 19 creased by 10 percentage points to 100 percent; 20 ‘‘(B) the Federal matching percentage ap- 21 plied under section 1903(a)(3)(B) shall be in- 22 creased by 25 percentage points to 100 percent; 23 and 24 ‘‘(C) the Federal matching percentage ap- 25 plied under section 1903(a)(7) shall be in- g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 TEMPORARY 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 45 1 creased by 10 percentage points to 60 percent 2 but only with respect to amounts expended that 3 are attributable to a State’s additional adminis- 4 trative expenditures to implement the data re- 5 quirements of paragraph (1).’’. 6 7 8 9 Subtitle D—Patient Relief and Health Insurance Market Stability SEC. 131. REPEAL OF COST-SHARING SUBSIDY. (a) IN GENERAL.—Section 1402 of the Patient Pro- 10 tection and Affordable Care Act is repealed. 11 (b) EFFECTIVE DATE.—The repeal made by sub- 12 section (a) shall apply to cost-sharing reductions (and pay13 ments to issuers for such reductions) for plan years begin14 ning after December 31, 2019. 15 16 SEC. 132. PATIENT AND STATE STABILITY FUND. The Social Security Act (42 U.S.C. 301 et seq.) is 17 amended by adding at the end the following new title: 18 19 20 21 ‘‘TITLE XXII—PATIENT AND STATE STABILITY FUND ‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM. ‘‘There is hereby established the ‘Patient and State 22 Stability Fund’ to be administered by the Secretary of 23 Health and Human Services, acting through the Adminis24 trator of the Centers for Medicare & Medicaid Services 25 (in this section referred to as the ‘Administrator’), to pro- g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 46 1 vide funding, in accordance with this title, to the 50 States 2 and the District of Columbia (each referred to in this sec3 tion as a ‘State’) during the period, subject to section 4 2204(c), beginning on January 1, 2018, and ending on 5 December 31, 2026, for the purposes described in section 6 2202. 7 8 ‘‘SEC. 2202. USE OF FUNDS. ‘‘A State may use the funds allocated to the State 9 under this title for any of the following purposes: 10 ‘‘(1) Helping, through the provision of financial 11 assistance, high-risk individuals who do not have ac- 12 cess to health insurance coverage offered through an 13 employer enroll in health insurance coverage in the 14 individual market in the State, as such market is de- 15 fined by the State (whether through the establish- 16 ment of a new mechanism or maintenance of an ex- 17 isting mechanism for such purpose). 18 ‘‘(2) Providing incentives to appropriate entities 19 to enter into arrangements with the State to help 20 stabilize premiums for health insurance coverage in 21 the individual market, as such markets are defined 22 by the State. 23 ‘‘(3) Reducing the cost for providing health in- 24 surance coverage in the individual market and small 25 group market, as such markets are defined by the g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 47 1 State, to individuals who have, or are projected to 2 have, a high rate of utilization of health services (as 3 measured by cost). 4 ‘‘(4) Promoting participation in the individual 5 market and small group market in the State and in- 6 creasing health insurance options available through 7 such market. 8 ‘‘(5) Promoting access to preventive services; 9 dental care services (whether preventive or medically 10 necessary); vision care services (whether preventive 11 or medically necessary); prevention, treatment, or re- 12 covery support services for individuals with mental 13 or substance use disorders; or any combination of 14 such services. 15 ‘‘(6) Providing payments, directly or indirectly, 16 to health care providers for the provision of such 17 health care services as are specified by the Adminis- 18 trator. 19 ‘‘(7) Providing assistance to reduce out-of-pock- 20 et costs, such as copayments, coinsurance, pre- 21 miums, and deductibles, of individuals enrolled in 22 health insurance coverage in the State. g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 48 1 ‘‘SEC. 2203. STATE ELIGIBILITY AND APPROVAL; DEFAULT 2 3 4 SAFEGUARD. ‘‘(a) ENCOURAGING STATE OPTIONS ALLOCA- TIONS.— 5 ‘‘(1) IN GENERAL.—To be eligible for an alloca- 6 tion of funds under this title for a year during the 7 period described in section 2201 for use for one or 8 more purposes described in section 2202, a State 9 shall submit to the Administrator an application at 10 such time (but, in the case of allocations for 2018, 11 not later than 45 days after the date of the enact- 12 ment of this title and, in the case of allocations for 13 a subsequent year, not later than March 31 of the 14 previous year) and in such form and manner as 15 specified by the Administrator and containing— 16 ‘‘(A) a description of how the funds will be 17 used for such purposes; 18 ‘‘(B) a certification that the State will 19 make, from non-Federal funds, expenditures for 20 such purposes in an amount that is not less 21 than the State percentage required for the year 22 under section 2204(e)(1); and 23 ‘‘(C) such other information as the Admin- 24 istrator may require. 25 ‘‘(2) AUTOMATIC 26 16:39 Mar 06, 2017 APPROVAL.—An application so submitted is approved unless the Administrator noti- g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 FOR Jkt 000000 (653419 4) PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 49 1 fies the State submitting the application, not later 2 than 60 days after the date of the submission of 3 such application, that the application has been de- 4 nied for not being in compliance with any require- 5 ment of this title and of the reason for such denial. 6 ‘‘(3) ONE-TIME an applica- 7 tion of a State is approved for a year, with respect 8 to a purpose described in section 2202, such applica- 9 tion shall be treated as approved, with respect to 10 such purpose, for each subsequent year through 11 2026. 12 ‘‘(4) TREATMENT AS A STATE HEALTH CARE 13 PROGRAM.—Any 14 allocation for a State under this title, including pur- 15 suant to subsection (b), shall be considered to be a 16 ‘State health care program’ for purposes of sections 17 1128, 1128A, and 1128B. 18 ‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 19 ‘‘(1) IN program receiving funds from an GENERAL.— 20 ‘‘(A) 2018.—For allocations made under 21 this title for 2018, in the case of a State that 22 does not submit an application under subsection 23 (a) by the 45-day submission date applicable to 24 such year under subsection (a)(1)and in the 25 case of a State that does submit such an appli- g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 APPLICATION.—If 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 50 1 cation by such date that is not approved, sub- 2 ject to section 2204(e), the Administrator, in 3 consultation with the State insurance commis- 4 sioner, shall use the allocation that would other- 5 wise be provided to the State under this title 6 for such year, in accordance with paragraph 7 (2), for such State. 8 ‘‘(B) 2019 the case of 9 a State that does not have in effect an approved 10 application under this section for 2019 or a 11 subsequent year beginning during the period 12 described in section 2201, subject to section 13 2204(e), the Administrator, in consultation with 14 the State insurance commissioner, shall use the 15 allocation that would otherwise be provided to 16 the State under this title for such year, in ac- 17 cordance with paragraph (2), for such State. 18 ‘‘(2) REQUIRED USE FOR MARKET STABILIZA- 19 TION PAYMENTS TO ISSUERS.—An 20 State made pursuant to paragraph (1) for a year 21 shall be used to carry out the purpose described in 22 section 2202(2) in such State by providing payments 23 to appropriate entities described in such section with 24 respect to claims that exceed $50,000 (or, with re- 25 spect to allocations made under this title for 2020 g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 THROUGH 2026.—In 16:39 Mar 06, 2017 Jkt 000000 allocation for a (653419 4) PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 51 1 or a subsequent year during the period specified in 2 section 2201, such dollar amount specified by the 3 Administrator), but do not exceed $350,000 (or, 4 with respect to allocations made under this title for 5 2020 or a subsequent year during such period, such 6 dollar amount specified by the Administrator), in an 7 amount equal to 75 percent (or, with respect to allo- 8 cations made under this title for 2020 or a subse- 9 quent year during such period, such percentage 10 specified by the Administrator) of the amount of 11 such claims. 12 13 ‘‘SEC. 2204. ALLOCATIONS. ‘‘(a) APPROPRIATION.—For the purpose of providing 14 allocations for States (including pursuant to section 15 2203(b)) under this title there is appropriated, out of any 16 money in the Treasury not otherwise appropriated— 17 ‘‘(1) for 2018, $15,000,000,000; 18 ‘‘(2) for 2019, $15,000,000,000; 19 ‘‘(3) for 2020, $10,000,000,000; 20 ‘‘(4) for 2021, $10,000,000,000; 21 ‘‘(5) for 2022, $10,000,000,000; 22 ‘‘(6) for 2023, $10,000,000,000; 23 ‘‘(7) for 2024, $10,000,000,000; 24 ‘‘(8) for 2025, $10,000,000,000; and 25 ‘‘(9) for 2026, $10,000,000,000. g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 52 1 ‘‘(b) ALLOCATIONS.— 2 ‘‘(1) PAYMENT.— 3 ‘‘(A) IN amounts appro- 4 priated under subsection (a) for a year, the Ad- 5 ministrator shall, with respect to a State and 6 not later than the date specified under subpara- 7 graph (B) for such year, allocate, subject to 8 subsection (e), for such State (including pursu- 9 ant to section 2203(b)) the amount determined 10 for such State and year under paragraph (2). 11 ‘‘(B) SPECIFIED DATE.—For purposes of 12 subparagraph (A), the date specified in this 13 clause is— 14 ‘‘(i) for 2018, the date that is 45 days 15 after the date of the enactment of this 16 title; and 17 ‘‘(ii) for 2019 and subsequent years, 18 January 1 of the respective year. 19 ‘‘(2) 20 TIONS.— 21 ALLOCATION ‘‘(A) FOR 22 AMOUNT DETERMINA- 2018 AND 2019.— ‘‘(i) IN GENERAL.—For purposes of 23 paragraph (1), the amount determined 24 under this paragraph for 2018 and 2019 g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 GENERAL.—From 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 53 1 for a State is an amount equal to the sum 2 of— 3 ‘‘(I) the relative incurred claims 4 amount described in clause (ii) for 5 such State and year; and 6 ‘‘(II) the relative uninsured and 7 issuer participation amount described 8 in clause (iv) for such State and year. 9 ‘‘(ii) RELATIVE CLAIMS 10 AMOUNT.—For 11 relative incurred claims amount described 12 in this clause for a State for 2018 and 13 2019 is the product of— purposes of clause (i), the 14 ‘‘(I) 85 percent of the amount 15 appropriated under subsection (a) for 16 the year; and 17 ‘‘(II) the relative State incurred 18 claims proportion described in clause 19 (iii) for such State and year. 20 ‘‘(iii) RELATIVE STATE INCURRED 21 CLAIMS PROPORTION.—The 22 incurred claims proportion described in 23 this clause for a State and year is the 24 amount equal to the ratio of— g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 INCURRED 16:39 Mar 06, 2017 Jkt 000000 relative State (653419 4) PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 54 1 ‘‘(I) the adjusted incurred claims 2 by the State, as reported through the 3 medical loss ratio annual reporting 4 under section 2718 of the Public 5 Health Service Act for the third pre- 6 vious year; to 7 ‘‘(II) the sum of such adjusted 8 incurred claims for all States, as so 9 reported, for such third previous year. 10 ‘‘(iv) UNINSURED AND 11 ISSUER 12 purposes of clause (i), the relative unin- 13 sured and issuer participation amount de- 14 scribed in this clause for a State for 2018 15 and 2019 is the product of— PARTICIPATION AMOUNT.—For 16 ‘‘(I) 15 percent of the amount 17 appropriated under subsection (a) for 18 the year; and 19 ‘‘(II) the relative State uninsured 20 and issuer participation proportion de- 21 scribed in clause (v) for such State 22 and year. 23 ‘‘(v) RELATIVE 24 AND 25 TION.—The g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 RELATIVE 16:39 Mar 06, 2017 Jkt 000000 ISSUER STATE UNINSURED PARTICIPATION PROPOR- relative State uninsured and (653419 4) PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 55 1 issuer participation proportion described in 2 this clause for a State and year is— 3 ‘‘(I) in the case of a State not 4 described in clause (vi) for such year, 5 0; and 6 ‘‘(II) in the case of a State de- 7 scribed in clause (vi) for such year, 8 the amount equal to the ratio of— 9 ‘‘(aa) the number of individ- 10 uals residing in such State who 11 for the third preceding year were 12 not enrolled in a health plan or 13 otherwise did not have health in- 14 surance 15 through 16 health program) and whose in- 17 come is below 100 percent of the 18 poverty line applicable to a family 19 of the size involved; to a Federal (including or State 20 ‘‘(bb) the sum of the num- 21 ber of such individuals for all 22 States described in clause (vi) for 23 the third preceding year. 24 ‘‘(vi) STATES 25 16:39 Mar 06, 2017 DESCRIBED.—For pur- poses of clause (v), a State is described in g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 coverage Jkt 000000 (653419 4) PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 56 1 this clause, with respect to 2018 and 2019, 2 if the State satisfies either of the following 3 criterion: 4 ‘‘(I) The number of individuals 5 residing in such State and described 6 in clause (v)(II)(aa) was higher in 7 2015 than 2013. 8 ‘‘(II) The State have fewer than 9 three health insurance issuers offering 10 qualified health plans through the Ex- 11 change for 2017. 12 ‘‘(B) FOR pur- 13 poses of paragraph (1), the amount determined 14 under this paragraph for a year (beginning with 15 2020) during the period described in section 16 2201 for a State is an amount determined in 17 accordance with an allocation methodology spec- 18 ified by the Administrator which— 19 ‘‘(i) takes into consideration the ad- 20 justed incurred claims of such State, the 21 number of residents of such State who for 22 the previous year were not enrolled in a 23 health plan or otherwise did not have 24 health 25 through a Federal or State health pro- g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 2020 THROUGH 2026.—For 16:39 Mar 06, 2017 Jkt 000000 insurance coverage (including (653419 4) PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 57 1 gram) and whose income is below 100 per- 2 cent of the poverty line applicable to a 3 family of the size involved, and the number 4 of health insurance issuers participating in 5 the insurance market in such State for 6 such year; 7 ‘‘(ii) is established after consultation 8 with health care consumers, health insur- 9 ance issuers, State insurance commis- 10 sioners, and other stakeholders and after 11 taking into consideration additional cost 12 and risk factors that may inhibit health 13 care consumer and health insurance issuer 14 participation; and 15 ‘‘(iii) reflects the goals of improving 16 the health insurance risk pool, promoting a 17 more competitive health insurance market, 18 and increasing choice for health care con- 19 sumers. 20 ‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS YEAR’S 21 REMAINING FUNDS.— In carrying out subsection (b), the 22 Administrator shall, with respect to a year (beginning with 23 2020 and ending with 2027), not later than March 31 of 24 such year— g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 58 1 ‘‘(1) determine the amount of funds, if any, 2 from the amounts appropriated under subsection (a) 3 for the previous year but not allocated for such pre- 4 vious year; and 5 ‘‘(2) if the Administrator determines that any 6 funds were not so allocated for such previous year, 7 allocate such remaining funds, in accordance with 8 the allocation methodology specified pursuant to 9 subsection (b)(2)(B)— 10 ‘‘(A) to States that have submitted an ap- 11 plication approved under section 2203(a) for 12 such previous year for any purpose for which 13 such an application was approved; and 14 ‘‘(B) for States for which allocations were 15 made pursuant to section 2203(b) for such pre- 16 vious year, to be used by the Administrator for 17 such States, to carry out the purpose described 18 in section 2202(2) in such States by providing 19 payments to appropriate entities described in 20 such section with respect to claims that exceed 21 $1,000,000; 22 with, respect to a year before 2027, any remaining 23 funds being made available for allocations to States 24 for the subsequent year. g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 59 1 ‘‘(d) AVAILABILITY.—Amounts appropriated under 2 subsection (a) for a year and allocated to States in accord3 ance with this section shall remain available for expendi4 ture through December 31, 2027. 5 6 ‘‘(e) CONDITIONS CEIPT OF FOR AND LIMITATIONS ON RE- FUNDS.—The Secretary may not make an allo- 7 cation under this title for a State, with respect to a pur8 pose described in section 2202— 9 ‘‘(1) in the case of an allocation that would be 10 made to a State pursuant to section 2203(a), if the 11 State does not agree that the State will make avail- 12 able non-Federal contributions towards such purpose 13 in an amount equal to— 14 ‘‘(A) for 2020, 7 percent of the amount al- 15 located under this subsection to such State for 16 such year and purpose; 17 ‘‘(B) for 2021, 14 percent of the amount 18 allocated under this subsection to such State 19 for such year and purpose; 20 ‘‘(C) for 2022, 21 percent of the amount 21 allocated under this subsection to such State 22 for such year and purpose; 23 ‘‘(D) for 2023, 28 percent of the amount 24 allocated under this subsection to such State 25 for such year and purpose; g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 60 1 ‘‘(E) for 2024, 35 percent of the amount 2 allocated under this subsection to such State 3 for such year and purpose; 4 ‘‘(F) for 2025, 42 percent of the amount 5 allocated under this subsection to such State 6 for such year and purpose; and 7 ‘‘(G) for 2026, 50 percent of the amount 8 allocated under this subsection to such State 9 for such year and purpose; 10 ‘‘(2) in the case of an allocation that would be 11 made for a State pursuant to section 2203(b), if the 12 State does not agree that the State will make avail- 13 able non-Federal contributions towards such purpose 14 in an amount equal to— 15 ‘‘(A) for 2020, 10 percent of the amount 16 allocated under this subsection to such State 17 for such year and purpose; 18 ‘‘(B) for 2021, 20 percent of the amount 19 allocated under this subsection to such State 20 for such year and purpose; and 21 ‘‘(C) for 2022, 30 percent of the amount 22 allocated under this subsection to such State 23 for such year and purpose; g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 61 1 ‘‘(D) for 2023, 40 percent of the amount 2 allocated under this subsection to such State 3 for such year and purpose; 4 ‘‘(E) for 2024, 50 percent of the amount 5 allocated under this subsection to such State 6 for such year and purpose; 7 ‘‘(F) for 2025, 50 percent of the amount 8 allocated under this subsection to such State 9 for such year and purpose; and 10 ‘‘(G) for 2026, 50 percent of the amount 11 allocated under this subsection to such State 12 for such year and purpose; or 13 ‘‘(3) if such an allocation for such purpose 14 would not be permitted under subsection (c)(7) of 15 section 2105 if such allocation were payment made 16 under such section.’’. 17 SEC. 133. CONTINUOUS HEALTH INSURANCE COVERAGE IN- 18 19 CENTIVE. Subpart I of part A of title XXVII of the Public 20 Health Service Act is amended— 21 (1) in section 2701(a)(1)(B), by striking ‘‘such 22 rate’’ and inserting ‘‘subject to section 2711, such 23 rate’’; 24 25 (2) by redesignating the second section 2709 as section 2710; and g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 62 1 2 3 (3) by adding at the end the following new section: ‘‘SEC. 2711. ENCOURAGING CONTINUOUS HEALTH INSUR- 4 5 ANCE COVERAGE. ‘‘(a) PENALTY APPLIED.— 6 ‘‘(1) IN section 7 2701, subject to the succeeding provisions of this 8 section, a health insurance issuer offering health in- 9 surance coverage in the individual or small group 10 market shall, in the case of an individual who is an 11 applicable policyholder of such coverage with respect 12 to an enforcement period applicable to enrollments 13 for a plan year beginning with plan year 2019 (or, 14 in the case of enrollments during a special enroll- 15 ment period, beginning with plan year 2018), in- 16 crease the monthly premium rate otherwise applica- 17 ble to such individual for such coverage during each 18 month of such period, by an amount determined 19 under paragraph (2). 20 ‘‘(2) AMOUNT OF PENALTY.—The amount de- 21 termined under this paragraph for an applicable pol- 22 icyholder enrolling in health insurance coverage de- 23 scribed in paragraph (1) for a plan year, with re- 24 spect to each month during the enforcement period 25 applicable to enrollments for such plan year, is the g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 GENERAL.—Notwithstanding 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 63 1 amount that is equal to 30 percent of the monthly 2 premium rate otherwise applicable to such applicable 3 policyholder for such coverage during such month. 4 ‘‘(b) DEFINITIONS.—For purposes of this section: 5 ‘‘(1) APPLICABLE term 6 ‘applicable policyholder’ means, with respect to 7 months of an enforcement period and health insur- 8 ance coverage, an individual who— 9 ‘‘(A) is a policyholder of such coverage for 10 such months; 11 ‘‘(B) cannot demonstrate (through presen- 12 tation of certifications described in section 13 2704(e) or in such other manner as may be 14 specified in regulations, such as a return or 15 statement made under section 6055(d) or 36C 16 of the Internal Revenue Code of 1986), during 17 the look-back period that is with respect to such 18 enforcement period, there was not a period of 19 at least 63 continuous days during which the 20 individual did not have creditable coverage (as 21 defined in paragraph (1) of section 2704(c) and 22 credited in accordance with paragraphs (2) and 23 (3) of such section); and 24 ‘‘(C) in the case of an individual who had 25 been enrolled under dependent coverage under a g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 POLICYHOLDER.—The 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 64 1 group health plan or health insurance coverage 2 by reason of section 2714 and such dependent 3 coverage of such individual ceased because of 4 the age of such individual, is not enrolling dur- 5 ing the first open enrollment period following 6 the date on which such coverage so ceased. 7 ‘‘(2) LOOK-BACK term ‘look-back 8 period’ means, with respect to an enforcement period 9 applicable to an enrollment of an individual for a 10 plan year beginning with plan year 2019 (or, in the 11 case of an enrollment of an individual during a spe- 12 cial enrollment period, beginning with plan year 13 2018) in health insurance coverage described in sub- 14 section (a)(1), the 12-month period ending on the 15 date the individual enrolls in such coverage for such 16 plan year. 17 18 ‘‘(3) ENFORCEMENT PERIOD.—The term ‘en- forcement period’ means— 19 ‘‘(A) with respect to enrollments during a 20 special enrollment period for plan year 2018, 21 the period beginning with the first month that 22 is during such plan year and that begins subse- 23 quent to such date of enrollment, and ending 24 with the last month of such plan year; and g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 PERIOD.—The 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 65 1 ‘‘(B) with respect to enrollments for plan 2 year 2019 or a subsequent plan year, the 12- 3 month period beginning on the first day of the 4 respective plan year.’’. 5 SEC. 134. INCREASING COVERAGE OPTIONS. 6 Section 1302 of the Patient Protection and Afford- 7 able Care Act (42 U.S.C. 18022) is amended— 8 (1) in subsection (a)(3), by inserting ‘‘and with 9 respect to a plan year before plan year 2020’’ after 10 ‘‘subsection (e)’’; and 11 12 (2) in subsection (d), by adding at the end the following: 13 ‘‘(5) SUNSET.—The provisions of this sub- 14 section shall not apply after December 31, 2019, 15 and after such date any reference to this subsection 16 or level of coverage or plan described in this sub- 17 section and any requirement under law applying 18 such a level of coverage or plan shall have no force 19 or effect (and such a requirement shall be applied as 20 if this section had been repealed).’’. 21 SEC. 135. CHANGE IN PERMISSIBLE AGE VARIATION IN 22 23 HEALTH INSURANCE PREMIUM RATES. Section 2701(a)(1)(A)(iii) of the Public Health Serv- 24 ice Act (42 U.S.C. 300gg(a)(1)(A)(iii)), as inserted by sec25 tion 1201(4) of Public Law 111–148, is amended by in- g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\P\15\HT\REC1\ECTITLE_16.XML 66 1 serting after ‘‘3 to 1 for adults (consistent with section 2 2707(c))’’ the following: ‘‘or, for plan years beginning on 3 or after January 1, 2018, as the Secretary may implement 4 through interim final regulation, 5 to 1 for adults (con5 sistent with section 2707(c)) or such other ratio for adults 6 (consistent with section 2707(c)) as the State involved 7 may provide’’. ◊ g:\VHLC\030617\030617.310.xml March 6, 2017 (4:32 p.m.) VerDate 0ct 09 2002 16:39 Mar 06, 2017 Jkt 000000 (653419 4) PO 00000 Frm 00066 Fmt 6652 Sfmt 6301 C:\USERS\JRSHAP~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\ECTITL~1.XM G:\M\15\BRADTX\BRADTX_005.XML COMMITTEE PRINT Budget Reconciliation Legislative Recommendations Relating to Remuneration from Certain Insurers Subtitle ll—Remuneration From Certain Insurers 1 2 3 SEC. l1. REMUNERATION FROM CERTAIN INSURERS. 4 Paragraph (6) of section 162(m) of the Internal Rev- 5 enue Code of 1986 is amended by adding at the end the 6 following new paragraph: 7 ‘‘(I) TERMINATION.—This paragraph shall 8 not apply to taxable years beginning after De- 9 cember 31, 2017.’’. ◊ g:\VHLC\030617\030617.061.xml March 6, 2017 (11:32 a.m.) VerDate Nov 24 2008 11:32 Mar 06, 2017 Jkt 000000 (653172 2) PO 00000 Frm 00001 Fmt 6652 Sfmt 6301 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_003.XML COMMITTEE PRINT Budget Reconciliation Legislative Recommendations Relating to Repeal of Tanning Tax Subtitle ll—Repeal of Tanning Tax 1 2 3 SEC. l1. REPEAL OF TANNING TAX. 4 (a) IN GENERAL.—The Internal Revenue Code of 5 1986 is amended by striking chapter 49. 6 (b) EFFECTIVE DATE.—The amendment made by 7 this subsection shall apply to services performed after De8 cember 31, 2017. ◊ g:\VHLC\030617\030617.087.xml March 6, 2017 (11:55 a.m.) VerDate Nov 24 2008 11:55 Mar 06, 2017 Jkt 000000 (653164 4) PO 00000 Frm 00001 Fmt 6652 Sfmt 6301 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_010.XML COMMITTEE PRINT Budget Reconciliation Legislative Recommendations Relating to Repeal of Certain Consumer Taxes 2 Subtitle ll—Repeal of Certain Consumer Taxes 3 SEC. l1. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS. 4 Section 9008 of the Patient Protection and Afford- 1 5 able Care Act is amended by adding at the end the fol6 lowing new subsection: ‘‘(l) TERMINATION.—No fee shall be imposed under 7 8 subsection (a)(1) with respect to any calendar year begin9 ning after December 31, 2017.’’. 10 SEC. l2. REPEAL OF HEALTH INSURANCE TAX. 11 Section 9010 of the Patient Protection and Afford- 12 able Care Act is amended by adding at the end the fol13 lowing new section: 14 ‘‘(k) TERMINATION.—No fee shall be imposed under 15 subsection (a)(1) with respect to any calendar year begin16 ning after December 31, 2017.’’. ◊ g:\VHLC\030617\030617.287.xml March 6, 2017 (4:11 p.m.) VerDate Nov 24 2008 16:11 Mar 06, 2017 Jkt 000000 (653477 4) PO 00000 Frm 00001 Fmt 6652 Sfmt 6301 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_004.XML COMMITTEE PRINT Budget Reconciliation Legislative Recommendations Relating to Repeal of Net Investment Income Tax 2 Subtitle ll—Repeal of Net Investment Income Tax 3 SEC. l1. REPEAL OF NET INVESTMENT INCOME TAX. 1 4 (a) IN GENERAL.—Subtitle A of the Internal Rev- 5 enue Code of 1986 is amended by striking chapter 2A. 6 (b) EFFECTIVE DATE.—The amendment made by 7 this subsection shall apply to taxable years beginning after 8 December 31, 2017. ◊ g:\VHLC\030617\030617.097.xml March 6, 2017 (12:06 p.m.) VerDate Nov 24 2008 12:06 Mar 06, 2017 Jkt 000000 (653171 2) PO 00000 Frm 00001 Fmt 6652 Sfmt 6301 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML COMMITTEE PRINT Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of Health-Related Tax Policy 2 Subtitle ll—Repeal and Replace of Health-Related Tax Policy 3 SEC. l01. RECAPTURE EXCESS ADVANCE PAYMENTS OF 1 4 PREMIUM TAX CREDITS. Subparagraph (B) of section 36B(f)(2) of the Inter- 5 6 nal Revenue Code of 1986 is amended by adding at the 7 end the following new clause: ‘‘(iii) NONAPPLICABILITY 8 TION.—This 9 OF LIMITA- subparagraph shall not apply 10 to taxable years beginning after December 11 31, 2017, and before January 1, 2020.’’. 12 SEC. l02. ADDITIONAL MODIFICATIONS TO PREMIUM TAX 13 14 CREDIT. (a) MODIFICATION OF DEFINITION OF QUALIFIED 15 HEALTH PLAN.— (1) IN 16 17 36B(c)(3)(A) of the Internal Revenue Code of 1986 is amended— 18 (A) by inserting ‘‘(determined without re- 19 gard to subparagraphs (A), (C)(ii), and (C)(iv) 20 of paragraph (1) thereof and without regard to 21 whether the plan is offered on an Exchange)’’ g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 GENERAL.—Section 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 2 1 after ‘‘1301(a) of the Patient Protection and 2 Affordable Care Act’’, and 3 (B) by striking ‘‘shall not include’’ and all 4 that follows and inserting ‘‘shall not include any 5 health plan that— ‘‘(i) is a grandfathered health plan or 6 a grandmothered health plan, or 7 8 ‘‘(ii) includes coverage for abortions 9 (other than any abortion necessary to save 10 the life of the mother or any abortion with 11 respect to a pregnancy that is the result of 12 an act of rape or incest).’’. (2) DEFINITION 13 14 PLAN.—Section 15 by adding at the end the following new subpara- 16 graph: 36B(c)(3) of such Code is amended ‘‘(C) GRANDMOTHERED 17 ‘‘(i) 18 IN HEALTH PLAN.— GENERAL.—The term 19 ‘grandmothered health plan’ means health 20 insurance coverage which is offered in the 21 individual health insurance market as of 22 January 1, 2013, and is permitted to be 23 offered in such market after January 1, 24 2014, as a result of CCIIO guidance. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 OF GRANDMOTHERED HEALTH 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 3 ‘‘(ii) CCIIO 1 2 The term ‘CCIIO guidance’ means the let- 3 ter issued by the Centers for Medicare & 4 Medicaid Services on November 14, 2013, 5 to the State Insurance Commissioners out- 6 lining a transitional policy for non-grand- 7 fathered coverage in the individual health 8 insurance market, as subsequently ex- 9 tended and modified (including by a com- 10 munication entitled ‘Insurance Standards 11 Bulletin 12 tension of Transitional Policy through Cal- 13 endar Year 2017’ issued on February 29, 14 2016, by the Director of the Center for 15 Consumer Information & Insurance Over- 16 sight of such Centers). Series—INFORMATION—Ex- ‘‘(iii) INDIVIDUAL 17 MARKET.—The HEALTH term INSUR- ‘individual 18 ANCE 19 health insurance market’ means the mar- 20 ket for health insurance coverage (as de- 21 fined in section 9832(b)) offered to individ- 22 uals other than in connection with a group 23 health plan (within the meaning of section 24 5000(b)(1)).’’. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 GUIDANCE DEFINED.— 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 4 (3) CONFORMING 1 2 ABORTION COVERAGE.—Section 3 Code, as amended by paragraph (2), is amended by 4 adding at the end the following new subparagraph: ‘‘(D) CERTAIN 5 36B(c)(3) of such RULES RELATED TO ABOR- TION.— 6 ‘‘(i) OPTION 7 TO PURCHASE SEPARATE 8 COVERAGE OR PLAN.—Nothing 9 graph (A) shall be construed as prohibiting 10 any individual from purchasing separate 11 coverage for abortions described in such 12 subparagraph, or a health plan that in- 13 cludes such abortions, so long as no credit 14 is allowed under this section with respect 15 to the premiums for such coverage or plan. ‘‘(ii) OPTION 16 in subpara- TO OFFER COVERAGE OR 17 PLAN.—Nothing 18 restrict any health insurance issuer offer- 19 ing a health plan from offering separate 20 coverage for abortions described in such 21 subparagraph, or a plan that includes such 22 abortions, so long as premiums for such 23 separate coverage or plan are not paid for 24 with any amount attributable to the credit 25 allowed under this section (or the amount g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 AMENDMENT RELATED TO 16:39 Mar 06, 2017 Jkt 000000 in subparagraph (A) shall (653161 7) PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 5 1 of any advance payment of the credit 2 under section 1412 of the Patient Protec- 3 tion and Affordable Care Act). ‘‘(iii) 4 OTHER TREATMENTS.—The 5 treatment of any infection, injury, disease, 6 or disorder that has been caused by or ex- 7 acerbated by the performance of an abor- 8 tion shall not be treated as an abortion for 9 purposes of subparagraph (A).’’. (4) CONFORMING 10 11 AMENDMENTS RELATED TO OFF-EXCHANGE COVERAGE.— (A) ADVANCE 12 PAYMENT NOT APPLICA- 13 BLE.—Section 14 and Affordable Care Act is amended by adding 15 at the end the following new subsection: 16 ‘‘(f) EXCLUSION 1412 of the Patient Protection OF OFF-EXCHANGE COVERAGE.— 17 Advance payments under this section (and advance deter18 minations under section 1411) shall not be made with re19 spect to any health plan which is not enrolled in through 20 an Exchange.’’. 21 (B) REPORTING.—Section 6055(b) of the 22 Internal Revenue Code of 1986 is amended by 23 adding at the end the following new paragraph: 24 ‘‘(3) INFORMATION 25 16:39 Mar 06, 2017 TO OFF-EX- CHANGE PREMIUM CREDIT ELIGIBLE COVERAGE.—If g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 RELATING Jkt 000000 (653161 7) PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 6 1 minimum essential coverage provided to an indi- 2 vidual under subsection (a) consists of a qualified 3 health plan (as defined in section 36B(c)(3)) which 4 is not enrolled in through an Exchange established 5 under title I of the Patient Protection and Afford- 6 able Care Act, a return described in this subsection 7 shall include— ‘‘(A) a statement that such plan is a quali- 8 fied 9 plan (as defined in section 36B(c)(3)), 10 ‘‘(B) the premiums paid with respect to 11 such coverage, 12 ‘‘(C) the months during which such cov- 13 erage is provided to the individual, 14 15 ‘‘(D) the adjusted monthly premium for 16 the applicable second lowest cost silver plan (as 17 defined in section 36B(b)(3)) for each such 18 month with respect to such individual, and ‘‘(E) such other information as the Sec- 19 retary may prescribe. 20 21 This paragraph shall not apply with respect to cov- 22 erage provided for any month beginning after De- 23 cember 31, 2019.’’. (C) OTHER 24 g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 health 16:39 Mar 06, 2017 Jkt 000000 CONFORMING AMENDMENTS.— (653161 7) PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 7 1 (i) Section 36B(b)(2)(A) is amended 2 by striking ‘‘and which were enrolled’’ and 3 all that follows and inserting ‘‘, or’’. 4 (ii) Section 36B(b)(3)(B)(i) is amend- 5 ed by striking ‘‘the same Exchange’’ and 6 all that follows and inserting ‘‘the Ex- 7 change through which such taxpayer is 8 permitted to obtain coverage, and’’. 9 (b) MODIFICATION APPLICABLE PERCENTAGE.— OF 10 Section 36B(b)(3)(A) of such Code is amended to read 11 as follows: 12 ‘‘(A) APPLICABLE 13 ‘‘(i) IN GENERAL.—The applicable 14 percentage for any taxable year shall be 15 the percentage such that the applicable 16 percentage for any taxpayer whose house- 17 hold income is within an income tier speci- 18 fied in the following table shall increase, on 19 a sliding scale in a linear manner, from the 20 initial percentage to the final percentage 21 specified in such table for such income tier 22 with respect to a taxpayer of the age in- 23 volved: g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 PERCENTAGE.— 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 8 ‘‘In the case of household income (expressed as a percent of the poverty line) within the following income tier: Up to Age 29 Age 40-49 Age 50-59 Over Age 59 Initial % Final % Initial % Final % Initial % Final % Initial % Final % Initial % Final % 2 3 4 4.3 4.3 4.3 2 4 4.3 4.3 4.3 4.3 2 3 4 5.3 5.9 5.9 2 4 5.3 5.9 5.9 5.9 2 3 4 6.3 8.05 8.35 2 4 6.3 8.05 8.35 8.35 2 3 4 7.3 9 10.5 2 4 7.3 9 10.5 10.5 2 3 4 8.3 10 11.5 2 4 8.3 10 11.5 11.5 Up to 133% 133%-150% 150%-200% 200%-250% 250%-300% 300%-400% ‘‘(ii) AGE 1 DETERMINATIONS.— ‘‘(I) IN 2 GENERAL.—For purposes 3 of clause (i), the age of the taxpayer 4 taken into account under clause (i) 5 with respect to any taxable year is the 6 age attained by such taxpayer before 7 the close of such taxable year. ‘‘(II) JOINT 8 RETURNS.—In the 9 case of a joint return, the age of the 10 older spouse shall be taken into ac- 11 count under clause (i). 12 ‘‘(iii) INDEXING.—In the case of any 13 taxable year beginning in calendar year 14 2019, the initial and final percentages con- 15 tained in clause (i) shall be adjusted to re- 16 flect— 17 ‘‘(I) the excess (if any) of the 18 rate of premium growth for the period 19 beginning with calendar year 2013 20 and ending with calendar year 2018, g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 Age 30-39 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 9 1 over the rate of income growth for 2 such period, and 3 ‘‘(II) in addition to any adjust- 4 ment under subclause (I), the excess 5 (if any) of the rate of premium 6 growth for calendar year 2018, over 7 the rate of growth in the consumer 8 price index for calendar year 2018. 9 ‘‘(iv) FAILSAFE.—Clause (iii)(II) shall 10 apply for only if the aggregate amount of 11 premium tax credits under this section and 12 cost-sharing reductions under section 1402 13 of the Patient Protection and Affordable 14 Care Act for calendar year 2018 exceeds 15 an amount equal to 0.504 percent of the 16 gross domestic product for such calendar 17 year.’’. 18 (b) EFFECTIVE DATE.— (1) IN 19 as otherwise pro- 20 vided in this subsection, the amendments made by 21 this section shall apply to taxable years beginning 22 after December 31, 2017. (2) ADVANCE 23 24 16:39 Mar 06, 2017 PAYMENT NOT APPLICABLE TO OFF-EXCHANGE COVERAGE.—The g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 GENERAL.—Except Jkt 000000 amendment made (653161 7) PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 10 1 by subsection (a)(4)(A) shall take effect on January 2 1, 2018. 3 (3) REPORTING.—The amendment made by 4 subsection (a)(4)(B) shall apply to coverage provided 5 for months beginning after December 31, 2017. (4) MODIFICATION 6 OF APPLICABLE PERCENT- 7 AGE.—The 8 apply to taxable years beginning after December 31, 9 2018. 10 amendment made by subsection (b) shall SEC. l03. PREMIUM TAX CREDIT. (a) REPEAL 11 OF PREMIUM TAX CREDIT.—Section 12 36B of the Internal Revenue Code of 1986 is amended 13 by adding at the end the following new subsection: ‘‘(h) TERMINATION.—No credit shall be allowed 14 15 under this section with respect to any coverage month 16 which begins after December 31, 2019.’’. (b) REPEAL 17 18 BILITY OF ADVANCE PAYMENT DETERMINATION FOR, OF, AND ELIGI- PREMIUM TAX CREDIT.— 19 Section 1412 of the Patient Protection and Affordable 20 Care Act is amended by adding at the end the following 21 new subsection: 22 ‘‘(f) TERMINATION WITH RESPECT TO PREMIUM 23 TAX CREDIT.—Effective January 1, 2020, no provision of 24 this section or section 1411 shall apply to the credit al25 lowed under section 36B of the Internal Revenue Code of g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 11 1 1986 (or to the advance payment of, or determination of 2 eligibility for, such credit or payment).’’. (c) EFFECTIVE DATES.— 3 (1) PREMIUM 4 TAX CREDIT.—The amendment 5 made by subsection (a) shall apply to months begin- 6 ning after December 31, 2019, in taxable years end- 7 ing after such date. (2) 8 DETERMINATIONS.—The amendment made by subsection (b) shall take effect 9 on January 1, 2020. 10 11 ELIGIBILITY SEC. l04. SMALL BUSINESS TAX CREDIT. (a) IN GENERAL.—Section 45R of the Internal Rev- 12 13 enue Code of 1986 is amended by adding at the end the 14 following new subsection: ‘‘(j) SHALL NOT APPLY.—This section shall not 15 16 apply with respect to amounts paid or incurred in taxable 17 years beginning after December 31, 2019.’’. (b) DISALLOWANCE 18 OF SMALL EMPLOYER HEALTH 19 INSURANCE EXPENSE CREDIT 20 CLUDES COVERAGE FOR FOR PLAN WHICH IN- ABORTION.—Subsection (h) of 21 section 45R of the Internal Revenue Code of 1986 is 22 amended— (1) by striking ‘‘Any term’’ and inserting the 23 24 following: ‘‘(1) IN 25 g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 GENERAL.—Any term’’; and (653161 7) PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 12 (2) by adding at the end the following new 1 2 paragraph: ‘‘(2) EXCLUSION 3 4 COVERAGE FOR ABORTION.— ‘‘(A) IN 5 GENERAL.—The term ‘qualified 6 health plan’ does not include any health plan 7 that includes coverage for abortions (other than 8 any abortion necessary to save the life of the 9 mother or any abortion with respect to a preg- 10 nancy that is the result of an act of rape or in- 11 cest) . ‘‘(B) CERTAIN 12 RULES RELATED TO ABOR- TION.— 13 ‘‘(i) OPTION 14 TO PURCHASE SEPARATE 15 COVERAGE OR PLAN.—Nothing 16 graph (A) shall be construed as prohibiting 17 any employer from purchasing for its em- 18 ployees separate coverage for abortions de- 19 scribed in such subparagraph, or a health 20 plan that includes such abortions, so long 21 as no credit is allowed under this section 22 with respect to the employer contributions 23 for such coverage or plan. ‘‘(ii) OPTION 24 PLAN.—Nothing 25 g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 OF HEALTH PLANS INCLUDING 16:39 Mar 06, 2017 Jkt 000000 in subpara- TO OFFER COVERAGE OR in subparagraph (A) shall (653161 7) PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 13 1 restrict any health insurance issuer offer- 2 ing a health plan from offering separate 3 coverage for abortions described in such 4 subparagraph, or a plan that includes such 5 abortions, so long as such separate cov- 6 erage or plan is not paid for with any em- 7 ployer contribution eligible for the credit 8 allowed under this section. ‘‘(iii) 9 TREATMENTS.—The 10 treatment of any infection, injury, disease, 11 or disorder that has been caused by or ex- 12 acerbated by the performance of an abor- 13 tion shall not be treated as an abortion for 14 purposes of subparagraph (A).’’. 15 (c) EFFECTIVE DATES.— (1) IN 16 GENERAL.—The amendment made by 17 subsection (a) shall apply to taxable years beginning 18 after December 31, 2019. 19 (2) DISALLOWANCE OF SMALL EMPLOYER 20 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 21 WHICH INCLUDES COVERAGE FOR ABORTION.—The 22 amendments made by subsection (b) shall apply to 23 taxable years beginning after December 31, 2017. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 OTHER 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 14 1 SEC. l05. INDIVIDUAL MANDATE. (a) IN GENERAL.—Section 5000A(c) of the Internal 2 3 Revenue Code of 1986 is amended— (1) in paragraph (2)(B)(iii), by striking ‘‘2.5 4 percent’’ and inserting ‘‘Zero percent’’, and 5 (2) in paragraph (3)— 6 (A) by striking ‘‘$695’’ in subparagraph 7 (A) and inserting ‘‘$0’’, and 8 9 (B) by striking subparagraph (D). 10 (b) EFFECTIVE DATE.—The amendments made by 11 this section shall apply to months beginning after Decem12 ber 31, 2015. 13 SEC. l06. EMPLOYER MANDATE. 14 (a) IN GENERAL.— 15 (1) Paragraph (1) of section 4980H(c) of the 16 Internal Revenue Code of 1986 is amended by in- 17 serting ‘‘($0 in the case of months beginning after 18 December 31, 2015)’’ after ‘‘$2,000’’. 19 (2) Paragraph (1) of section 4980H(b) of the 20 Internal Revenue Code of 1986 is amended by in- 21 serting ‘‘($0 in the case of months beginning after 22 December 31, 2015)’’ after ‘‘$3,000’’. 23 (b) EFFECTIVE DATE.—The amendments made by 24 this section shall apply to months beginning after Decem25 ber 31, 2015. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 15 1 SEC. l07. REPEAL OF THE TAX ON EMPLOYEE HEALTH IN- 2 SURANCE 3 BENEFITS. PREMIUMS AND HEALTH PLAN Section 4980I of the Internal Revenue Code of 1986 4 5 is amended by adding at the end the following new sub6 section: ‘‘(h) SHALL NOT APPLY.—No tax shall be imposed 7 8 under this section with respect to any taxable period be9 ginning after December 31, 2019, and before January 1, 10 2025.’’. 11 SEC. l08. REPEAL OF TAX ON OVER-THE-COUNTER MEDI- 12 CATIONS. (a) HSAS.—Subparagraph (A) of section 223(d)(2) 13 14 of the Internal Revenue Code of 1986 is amended by strik15 ing ‘‘Such term’’ and all that follows through the period. (b) ARCHER MSAS.—Subparagraph (A) of section 16 17 220(d)(2) of the Internal Revenue Code of 1986 is amend18 ed by striking ‘‘Such term’’ and all that follows through 19 the period. (c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS 20 21 HEALTH REIMBURSEMENT ARRANGEMENTS.—Sec- AND 22 tion 106 of the Internal Revenue Code of 1986 is amended 23 by striking subsection (f) and by redesignating subsection 24 (g) as subsection (f). 25 (d) EFFECTIVE DATES.— g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 16 (1) 1 DISTRIBUTIONS FROM SAVINGS AC- 2 COUNTS.—The amendments made by subsections (a) 3 and (b) shall apply to amounts paid with respect to 4 taxable years beginning after December 31, 2017. 5 (2) REIMBURSEMENTS.—The amendment made 6 by subsection (c) shall apply to expenses incurred 7 with respect to taxable years beginning after Decem- 8 ber 31, 2017. 9 SEC. l09. REPEAL OF INCREASE OF TAX ON HEALTH SAV- 10 INGS ACCOUNTS. (a) HSAS.—Section 223(f)(4)(A) of the Internal 11 12 Revenue Code of 1986 is amended by striking ‘‘20 per13 cent’’ and inserting ‘‘10 percent’’. (b) ARCHER MSAS.—Section 220(f)(4)(A) of the In- 14 15 ternal Revenue Code of 1986 is amended by striking ‘‘20 16 percent’’ and inserting ‘‘15 percent’’. (c) EFFECTIVE DATE.—The amendments made by 17 18 this section shall apply to distributions made after Decem19 ber 31, 2017. 20 SEC. l10. REPEAL OF LIMITATIONS ON CONTRIBUTIONS 21 TO FLEXIBLE SPENDING ACCOUNTS. 22 (a) IN GENERAL.—Section 125 of the Internal Rev- 23 enue Code of 1986 is amended by striking subsection (i). g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 17 (b) EFFECTIVE DATE.—The amendment made by 1 2 this section shall apply to taxable years beginning after 3 December 31, 2017. 4 SEC. l11. REPEAL OF MEDICAL DEVICE EXCISE TAX. Section 4191 of the Internal Revenue Code of 1986 5 6 is amended by adding at the end the following new sub7 section: ‘‘(d) APPLICABILITY.—The tax imposed under sub- 8 9 section (a) shall not apply to sales after December 31, 10 2017.’’. 11 SEC. l12. REPEAL OF ELIMINATION OF DEDUCTION FOR 12 EXPENSES ALLOCABLE TO MEDICARE PART D 13 SUBSIDY. 14 (a) IN GENERAL.—Section 139A of the Internal Rev- 15 enue Code of 1986 is amended by adding at the end the 16 following new sentence: ‘‘This section shall not be taken 17 into account for purposes of determining whether any de18 duction is allowable with respect to any cost taken into 19 account in determining such payment.’’. 20 (b) EFFECTIVE DATE.—The amendment made by 21 this section shall apply to taxable years beginning after 22 December 31, 2017. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 18 1 SEC. l13. REPEAL OF INCREASE IN INCOME THRESHOLD 2 FOR DETERMINING MEDICAL CARE DEDUC- 3 TION. (a) IN GENERAL.—Subsection (a) of section 213 of 4 5 the Internal Revenue Code of 1986 is amended by striking 6 ‘‘10 percent’’ and inserting ‘‘7.5 percent’’. (b) EXTENSION 7 OF SPECIAL RULE.—Subsection (f) 8 of section 213 of such Code is amended— (1) by striking ‘‘2017’’ and inserting ‘‘2018’’, 9 and 10 (2) by striking ‘‘AND 2016’’ and inserting 11 12 ‘‘2016, 13 (c) EFFECTIVE DATE.— AND (1) IN 14 2017’’. GENERAL.—The amendment made by 15 subsection (a) shall apply to taxable years beginning 16 after December 31, 2017. (2) 17 EXTENSION OF SPECIAL RULE.—The 18 amendments made by subsection (b) shall apply to 19 taxable years beginning after December 31, 2016. 20 SEC. l14. REPEAL OF MEDICARE TAX INCREASE. 21 (a) IN GENERAL.—Subsection (b) of section 3101 of 22 the Internal Revenue Code of 1986 is amended to read 23 as follows: 24 ‘‘(b) HOSPITAL INSURANCE.—In addition to the tax 25 imposed by the preceding subsection, there is hereby im26 posed on the income of every individual a tax equal to 1.45 g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 19 1 percent of the wages (as defined in section 3121(a)) re2 ceived by such individual with respect to employment (as 3 defined in section 3121(b).’’. (b) SECA.—Subsection (b) of section 1401 of the In- 4 5 ternal Revenue Code of 1986 is amended to read as fol6 lows: ‘‘(b) HOSPITAL INSURANCE.—In addition to the tax 7 8 imposed by the preceding subsection, there shall be im9 posed for each taxable year, on the self-employment in10 come of every individual, a tax equal to 2.9 percent of the 11 amount of the self-employment income for such taxable 12 year.’’. (c) EFFECTIVE DATE.—The amendments made by 13 14 this section shall apply with respect to remuneration re15 ceived after, and taxable years beginning after, December 16 31, 2017. 17 SEC. l15. REFUNDABLE TAX CREDIT FOR HEALTH INSUR- 18 ANCE COVERAGE. (a) IN GENERAL.—Subpart C of part IV of sub- 19 20 chapter A of chapter 1 of the Internal Revenue Code of 21 1986 is amended by inserting after section 36B the fol22 lowing new section: 23 ‘‘SEC. 36C. HEALTH INSURANCE COVERAGE. 24 ‘‘(a) IN GENERAL.—In the case of an individual, 25 there shall be allowed as a credit against the tax imposed g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 20 1 by this subtitle for the taxable year the sum of the month2 ly credit amounts with respect to such taxpayer for cal3 endar months during such taxable year. 4 ‘‘(b) MONTHLY CREDIT AMOUNTS.— ‘‘(1) IN 5 monthly credit amount 6 with respect to any taxpayer for any calendar month 7 is the lesser of— 8 ‘‘(A) the sum of the monthly limitation 9 amounts determined under subsection (c) with 10 respect to the taxpayer and the taxpayer’s 11 qualifying family members for such month, or 12 ‘‘(B) the amount paid for eligible health 13 insurance for the taxpayer and the taxpayer’s 14 qualifying family members for such month. 15 ‘‘(2) ELIGIBLE COVERAGE MONTH REQUIRE- 16 MENT.—No 17 under subparagraph (A) or (B) of paragraph (1) 18 with respect to any individual for any month unless 19 such month is an eligible coverage month with re- 20 spect to such individual. 21 ‘‘(c) MONTHLY LIMITATION AMOUNTS.— amount shall be taken into account ‘‘(1) IN 22 GENERAL.—The monthly limitation 23 amount with respect to any individual for any eligi- 24 ble coverage month during any taxable year is 1⁄12 25 of— g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 GENERAL.—The 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 21 1 ‘‘(A) $2,000 in the case of an individual 2 who has not attained age 30 as of the begin- 3 ning of such taxable year, 4 ‘‘(B) $2,500 in the case of an individual 5 who has attained age 30 but who has not at- 6 tained age 40 as of such time, 7 ‘‘(C) $3,000 in the case of an individual 8 who has attained age 40 but who has not at- 9 tained age 50 as of such time, 10 ‘‘(D) $3,500 in the case of an individual 11 who has attained age 50 but who has not at- 12 tained age 60 as of such time, and ‘‘(E) $4,000 in the case of an individual 13 14 who has attained age 60 as of such time. 15 ‘‘(2) LIMITATION 16 JUSTED GROSS INCOME.— 17 ‘‘(A) IN ON GENERAL.—The MODIFIED AD- amount otherwise 18 determined under subsection (b)(1)(A) (without 19 regard to this subparagraph but after any other 20 adjustment of such amount under this section) 21 for the taxable year shall be reduced (but not 22 below zero) by 10 percent of the excess (if any) 23 of— ‘‘(i) the taxpayer’s modified adjusted 24 gross income for such taxable year, over 25 g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 BASED 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 22 ‘‘(ii) $75,000 (twice such amount in 1 2 the case of a joint return). 3 ‘‘(B) MODIFIED GROSS IN- 4 COME.—For 5 term ‘modified adjusted gross income’ means 6 adjusted gross income increased by— purposes of this paragraph, the ‘‘(i) any amount excluded from gross 7 income under section 911, 8 9 ‘‘(ii) any amount of interest received 10 or accrued by the taxpayer during the tax- 11 able year which is exempt from tax, and 12 ‘‘(iii) an amount equal to the portion 13 of the taxpayer’s social security benefits 14 (as defined in section 86(d)) which is not 15 included in gross income under section 86 16 for the taxable year. ‘‘(3) OTHER 17 LIMITATIONS.— ‘‘(A) AGGREGATE 18 DOLLAR LIMITATION.— 19 The sum of the monthly limitation amounts 20 taken into account under this section with re- 21 spect to any taxpayer for any taxable year shall 22 not exceed $14,000. ‘‘(B) MAXIMUM 23 NUMBER OF INDIVIDUALS 24 TAKEN INTO ACCOUNT.—With 25 taxpayer for any month, monthly limitation g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 ADJUSTED 16:39 Mar 06, 2017 Jkt 000000 respect to any (653161 7) PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 23 1 amounts shall be taken into account under this 2 section only with respect to the 5 oldest individ- 3 uals with respect to whom monthly limitation 4 amounts could (without regard to this subpara- 5 graph) otherwise be so taken into account. 6 ‘‘(d) ELIGIBLE COVERAGE MONTH.—For purposes of 7 this section, the term ‘eligible coverage month’ means, 8 with respect to any individual, any month if, as of the first 9 day of such month, the individual— 10 ‘‘(1) is covered by eligible health insurance, 11 ‘‘(2) is not eligible for other specified coverage, 12 ‘‘(3) is either— ‘‘(A) a citizen or national of the United 13 States, or 14 15 ‘‘(B) a qualified alien (within the meaning 16 of section 431 of the Personal Responsibility 17 and Work Opportunity Reconciliation Act of 18 1996 (8 U.S.C. 1641)), and 19 ‘‘(4) is not incarcerated, other than incarcer- 20 ation pending the disposition of charges. 21 ‘‘(e) QUALIFYING FAMILY MEMBER.—For purposes 22 of this section, the term ‘qualifying family member’ 23 means— ‘‘(1) in the case of a joint return, the taxpayer’s 24 25 spouse, g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 24 1 ‘‘(2) any dependent of the taxpayer, and 2 ‘‘(3) with respect to any eligible coverage 3 month, any child (as defined in section 152(f)(1)) of 4 the taxpayer who as of the end of the taxable year 5 has not attained age 27 if such child is covered for 6 such month under eligible health insurance which 7 also covers the taxpayer (in the case of a joint re- 8 turn, either spouse). 9 ‘‘(f) ELIGIBLE HEALTH INSURANCE.—For purposes 10 of this section— ‘‘(1) IN 11 term ‘eligible health 12 insurance’ means any health insurance coverage (as 13 defined in section 9832(b)) if— ‘‘(A) such coverage is either— 14 ‘‘(i) offered in the individual health 15 insurance market within a State, or 16 ‘‘(ii) is unsubsidized COBRA continu- 17 18 ation coverage, 19 ‘‘(B) such coverage is not a grandfathered 20 health plan (as defined in section 1251 of the 21 Patient Protection and Affordable Care Act) or 22 a grandmothered health plan, 23 ‘‘(C) substantially all of such coverage is 24 not of excepted benefits described in section 25 9832(c), g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 GENERAL.—The 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 25 1 ‘‘(D) such coverage does not include cov- 2 erage for abortions (other than any abortion 3 necessary to save the life of the mother or any 4 abortion with respect to a pregnancy that is the 5 result of an act of rape or incest), and 6 ‘‘(E) the State in which such insurance is 7 offered certifies that such coverage meets the 8 requirements of this paragraph. 9 ‘‘(2) RULES 10 TO STATE CERTIFI- CATION.— ‘‘(A) CERTIFICATION 11 MADE AVAILABLE TO 12 PUBLIC.—A 13 account under paragraph (1)(E) unless such 14 certification is made available to the public and 15 meets such other requirements as the Secretary 16 may provide. certification shall not be taken into ‘‘(B) SPECIAL 17 RULE FOR UNSUBSIDIZED 18 COBRA CONTINUATION COVERAGE.—In 19 of unsubsidized COBRA continuation cov- 20 erage— the case 21 ‘‘(i) paragraph (1)(E) shall be applied 22 by substituting ‘the plan administrator (as 23 defined in section 414(g)) of the health 24 plan’ for ‘the State in which such insur- 25 ance is offered’, and g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 RELATED 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 26 1 ‘‘(ii) the requirements of subpara- 2 graph (A) shall be treated as satisfied if 3 the certification meets such requirements 4 as the Secretary may provide. ‘‘(3) GRANDMOTHERED 5 ‘‘(A) 6 GENERAL.—The term 7 ‘grandmothered health plan’ means health in- 8 surance coverage which is offered in the indi- 9 vidual health insurance market as of January 1, 10 2013, and is permitted to be offered in such 11 market after January 1, 2014, as a result of 12 CCIIO guidance. ‘‘(B) CCIIO 13 GUIDANCE DEFINED.—The 14 term ‘CCIIO guidance’ means the letter issued 15 by the Centers for Medicare & Medicaid Serv- 16 ices on November 14, 2013, to the State Insur- 17 ance Commissioners outlining a transitional pol- 18 icy for non-grandfathered coverage in the indi- 19 vidual health insurance market, as subsequently 20 extended and modified (including by a commu- 21 nication entitled ‘Insurance Standards Bulletin 22 Series—INFORMATION—Extension of Tran- 23 sitional Policy through Calendar Year 2017’ 24 issued on February 29, 2016, by the Director g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 IN HEALTH PLAN.— 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 27 1 of the Center for Consumer Information & In- 2 surance Oversight of such Centers). 3 ‘‘(4) INDIVIDUAL HEALTH INSURANCE MAR- 4 KET.—The term ‘individual health insurance mar- 5 ket’ means the market for health insurance coverage 6 (as defined in section 9832(b)) offered to individuals 7 other than in connection with a group health plan 8 (within the meaning of section 5000(b)(1)). 9 ‘‘(g) OTHER SPECIFIED COVERAGE.—For purposes 10 of this section— ‘‘(1) IN 11 12 term ‘other specified coverage’ means any of the following: 13 ‘‘(A) Coverage under a group health plan 14 (within the meaning of section 5000(b)(1)) 15 other than— 16 ‘‘(i) coverage under a plan substan- 17 tially all of the coverage of which is of ex- 18 cepted 19 9832(c), and benefits described in section ‘‘(ii) COBRA continuation coverage. 20 21 ‘‘(B) Coverage under the Medicare pro- 22 gram under part A of title XVIII of the Social 23 Security Act. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 GENERAL.—The 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 28 1 ‘‘(C) Coverage under the Medicaid pro- 2 gram under title XIX of the Social Security 3 Act. ‘‘(D) Coverage under the CHIP program 4 under title XXI of the Social Security Act. 5 6 ‘‘(E) Medical coverage under chapter 55 of 7 title 10, United States Code, including coverage 8 under the TRICARE program. 9 ‘‘(F) Coverage under a health care pro- 10 gram under chapter 17 or 18 of title 38, United 11 States Code, as determined by the Secretary of 12 Veterans Affairs, in coordination with the Sec- 13 retary of Health and Human Services and the 14 Secretary of the Treasury. 15 ‘‘(G) Coverage under a health plan under 16 section 2504(e) of title 22, United States Code 17 (relating to Peace Corps volunteers). 18 ‘‘(H) Coverage under the Nonappropriated 19 Fund Health Benefits Program of the Depart- 20 ment of Defense, established under section 349 21 of the National Defense Authorization Act for 22 Fiscal Year 1995 (Public Law 103–337; 10 23 U.S.C. 1587 note). 24 ‘‘(2) SPECIAL 25 ERANS HEALTH PROGRAMS.—In g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 RULE WITH RESPECT TO VET- Jkt 000000 the case of other (653161 7) PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 29 1 specified coverage described in paragraph (1)(F), an 2 individual shall not be treated as eligible for such 3 coverage unless such individual is enrolled in such 4 coverage. 5 ‘‘(h) UNSUBSIDIZED COBRA CONTINUATION COV- 6 ERAGE.—For ‘‘(1) IN 7 GENERAL.—The term ‘unsubsidized 8 COBRA continuation coverage’ means COBRA con- 9 tinuation coverage no portion of the premiums for 10 which are subsidized by the employer. ‘‘(2) COBRA 11 CONTINUATION COVERAGE.—The 12 term ‘COBRA continuation coverage’ means con- 13 tinuation coverage provided pursuant to part 6 of 14 subtitle B of title I of the Employee Retirement In- 15 come Security Act of 1974 (other than under section 16 609), title XXII of the Public Health Service Act, 17 section 4980B of the Internal Revenue Code of 1986 18 (other than subsection (f)(1) of such section insofar 19 as it relates to pediatric vaccines), or section 8905a 20 of title 5, United States Code, or under a State pro- 21 gram that provides comparable continuation cov- 22 erage. Such term shall not include coverage under a 23 health flexible spending arrangement. 24 ‘‘(i) SPECIAL RULES.— g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 purposes of this section— 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 30 ‘‘(1) MARRIED 1 2 TURN.—If 3 ing of section 7703) at the close of the taxable year, 4 no credit shall be allowed under this section to such 5 taxpayer unless such taxpayer and the taxpayer’s 6 spouse file a joint return for such taxable year. the taxpayer is married (within the mean- 7 ‘‘(2) DENIAL 8 ‘‘(A) IN OF CREDIT TO DEPENDENTS.— GENERAL.—No credit shall be al- 9 lowed under this section to any individual who 10 is a dependent with respect to another taxpayer 11 for a taxable year beginning in the calendar 12 year in which such individual’s taxable year be- 13 gins. ‘‘(B) COORDINATION 14 WITH RULE FOR 15 OLDER CHILDREN.—In 16 vidual who is a qualifying family member de- 17 scribed in subsection (e)(3) with respect to an- 18 other taxpayer for any month, in determining 19 the amount of any credit allowable to such indi- 20 vidual under this section for any taxable year of 21 such individual which includes such month, the 22 monthly limitation amount with respect to such 23 individual for such month shall be zero and no 24 amount paid for eligible health insurance with g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 COUPLES MUST FILE JOINT RE- 16:39 Mar 06, 2017 Jkt 000000 the case of any indi- (653161 7) PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 31 1 respect to such individual for such month shall 2 be taken into account. 3 ‘‘(3) COORDINATION 4 DEDUCTION.—Amounts 5 (b)(1)(B) with respect to any month shall not be 6 taken into account in determining the deduction al- 7 lowed under section 213 except to the extent that 8 such amounts exceed the amount described in sub- 9 section (b)(1)(A) with respect to such month. ‘‘(4) INSURANCE 10 described in subsection WHICH COVERS OTHER INDI- 11 VIDUALS.—For 12 lar to the rules of section 213(d)(6) shall apply with 13 respect to any contract for eligible health insurance 14 under which amounts are payable for coverage of an 15 individual other than the taxpayer and the tax- 16 payer’s qualifying family members. 18 purposes of this section, rules simi- ‘‘(5) COORDINATION 17 OF CREDIT.—With WITH ADVANCE PAYMENTS respect to any taxable year— 19 ‘‘(A) the amount which would (but for this 20 subsection) be allowed as a credit to the tax- 21 payer under subsection (a) shall be reduced 22 (but not below zero) by the aggregate amount 23 paid on behalf of such taxpayer under section 24 7529 for months beginning in such taxable 25 year, and g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 WITH MEDICAL EXPENSE 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 32 1 ‘‘(B) the tax imposed by section 1 for such 2 taxable year shall be increased by the excess (if 3 any) of— 4 ‘‘(i) the aggregate amount paid on be- 5 half of such taxpayer under section 7529 6 for months beginning in such taxable year, 7 over 8 ‘‘(ii) the amount which would (but for 9 this subsection) be allowed as a credit to the taxpayer under subsection (a). 10 ‘‘(6) SPECIAL 11 12 EMPLOYER 13 MENTS.— REIMBURSEMENT GENERAL.—If ARRANGE- the taxpayer or any 15 qualifying family member of the taxpayer is 16 provided a qualified small employer health reim- 17 bursement arrangement for any eligible cov- 18 erage month, the sum determined under sub- 19 section (b)(1)(A) with respect to the taxpayer 20 for such month shall be reduced (but not below 21 zero) by 1⁄12 of the permitted benefit (as de- 22 fined in section 9831(d)(3)(C)) under such ar- 23 rangement. ‘‘(B) 24 25 HEALTH g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 HEALTH ‘‘(A) IN 14 RULES FOR QUALIFIED SMALL 16:39 Mar 06, 2017 Jkt 000000 QUALIFIED SMALL REIMBURSEMENT EMPLOYER ARRANGEMENT.— (653161 7) PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 33 1 For purposes of this paragraph, the term 2 ‘qualified small employer health reimbursement 3 arrangement’ has the meaning given such term 4 by section 9831(d)(2). ‘‘(C) COVERAGE 5 6 YEAR.—In 7 vided a qualified small employer health reim- 8 bursement arrangement for less than an entire 9 year, subparagraph (A) shall be applied by sub- 10 stituting ‘the number of months during the year 11 for which such arrangement was provided’ for 12 ‘12’. 13 ‘‘(7) CERTAIN 14 the case of an employee who is pro- RULES RELATED TO ABOR- TION.— ‘‘(A) OPTION 15 TO PURCHASE SEPARATE 16 COVERAGE OR PLAN.—Nothing 17 (f)(1)(D) shall be construed as prohibiting any 18 individual from purchasing separate coverage 19 for abortions described in such subparagraph, 20 or a health plan that includes such abortions, so 21 long as no credit is allowed under this section 22 with respect to the premiums for such coverage 23 or plan. ‘‘(B) OPTION 24 PLAN.—Nothing 25 g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 FOR LESS THAN ENTIRE 16:39 Mar 06, 2017 Jkt 000000 in subsection TO OFFER COVERAGE OR in subsection (f)(1)(D) shall (653161 7) PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 34 1 restrict any health insurance issuer offering a 2 health plan from offering separate coverage for 3 abortions described in such clause, or a plan 4 that includes such abortions, so long as pre- 5 miums for such separate coverage or plan are 6 not paid for with any amount attributable to 7 the credit allowed under this section. ‘‘(C) OTHER 8 treat- 9 ment of any infection, injury, disease, or dis- 10 order that has been caused by or exacerbated 11 by the performance of an abortion shall not be 12 treated as an abortion for purposes of sub- 13 section (f)(1)(D). 14 ‘‘(8) INFLATION ‘‘(A) IN 15 ADJUSTMENT.— GENERAL.—In the case of any 16 taxable year beginning in a calendar year after 17 2020, each dollar amount in subsection (c)(1), 18 the $75,000 amount in subsection (c)(2)(A)(ii), 19 and the dollar amount in subsection (c)(3)(A), 20 shall be increased by an amount equal to— 21 ‘‘(i) such dollar amount, multiplied by 22 ‘‘(ii) the cost-of-living adjustment de- 23 termined under section 1(f)(3) for the cal- 24 endar year in which the taxable year be- 25 gins, determined— g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 TREATMENTS.—The 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 35 1 ‘‘(I) by substituting ‘calendar 2 year 2019’ for ‘calendar year 1992’ in 3 subparagraph (B) thereof, and 4 ‘‘(II) by substituting for the CPI 5 referred to section 1(f)(3)(A) the 6 amount that such CPI would have 7 been if the annual percentage increase 8 in CPI with respect to each year after 9 2019 had been one percentage point 10 greater. 11 ‘‘(B) TERMS 12 ‘‘(i) 13 CREASE.—For 14 (A)(ii)(II), the term ‘annual percentage in- 15 crease’ means the percentage (if any) by 16 which CPI for any year exceeds CPI for 17 the prior year. ANNUAL PERCENTAGE IN- purposes of subparagraph ‘‘(ii) OTHER 18 TERMS.—Terms used in 19 this paragraph which are also used in sec- 20 tion 1(f)(3) shall have the same meanings 21 as when used in such section. 22 ‘‘(C) ROUNDING.—Any increase deter- 23 mined under subparagraph (A) shall be rounded 24 to the nearest multiple of $50. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 RELATED TO CPI.— 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 36 1 ‘‘(9) REGULATIONS.—The Secretary may pre- 2 scribe such regulations and other guidance as may 3 be necessary or appropriate to carry out this section, 4 section 6050W, and section 7529.’’. 5 (b) ADVANCE PAYMENT OF CREDIT; EXCESS 6 HEALTH INSURANCE COVERAGE CREDIT PAYABLE TO 7 HEALTH SAVINGS ACCOUNT.—Chapter 77 of such Code 8 is amended by adding at the end the following: 9 ‘‘SEC. 7529. ADVANCE PAYMENT OF HEALTH INSURANCE 10 11 COVERAGE CREDIT. ‘‘(a) GENERAL RULE.—Not later than January 1, 12 2020, the Secretary, in consultation with the Secretary of 13 Health and Human Services, the Secretary of Homeland 14 Security, and the Commissioner of Social Security, shall 15 establish a program (hereafter in this section referred to 16 as the ‘advance payment program’) for making payments 17 to providers of eligible health insurance on behalf of tax18 payers eligible for the credit under section 36C. 19 ‘‘(b) LIMITATION.—The aggregate payments made 20 under this section with respect to any taxpayer, deter21 mined as of any time during any calendar year, shall not 22 exceed the monthly credit amounts determined with re23 spect to such taxpayer under section 36C for months dur24 ing such calendar year which have ended as of such time. 25 ‘‘(c) ADMINISTRATION.— g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 37 ‘‘(1) IN 1 advance payment pro- 2 gram shall, to the greatest extent practicable, use 3 the methods and procedures used to administer the 4 programs created under sections 1411 and 1412 of 5 the Patient Protection and Affordable Care Act (de- 6 termined without regard to section 1412(f) of such 7 Act) and each entity that is authorized to take any 8 actions under the programs created under such sec- 9 tions (as so determined) shall, at the request of the 10 Secretary, take such actions to the extent necessary 11 to carry out this section. 12 ‘‘(2) APPLICATION TO OFF-EXCHANGE COV- 13 ERAGE.—Except 14 retary, for purposes of applying this subsection in 15 the case of eligible health insurance which is not en- 16 rolled in through an Exchange established under 17 title I of the Patient Protection and Affordable Care 18 Act, the sections referred to in paragraph (1) shall 19 be applied by treating references in such sections to 20 an Exchange as references to the provider of such 21 eligible health insurance (or, as the Secretary deter- 22 mines appropriate, to the licensed agent or broker 23 with respect to such insurance), except that the Sec- 24 retary of Health and Human Services shall carry out 25 the responsibilities of the Exchange under section g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 GENERAL.—The 16:39 Mar 06, 2017 Jkt 000000 as otherwise provided by the Sec- (653161 7) PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 38 1 1411(e)(4) of the Patient Protection and Affordable 2 Care Act (determined without regard to section 3 1412(f) of such Act) in the case of such insurance. ‘‘(3) 4 5 DOCUMENTATION REGARDING OTHER SPECIFIED COVERAGE.— ‘‘(A) IN 6 GENERAL.—The advance payment 7 program shall provide that any individual ap- 8 plying to have payments made on their behalf 9 under such program shall, if such individual (or 10 any qualifying family member of such individual 11 taken into account in determining the amount 12 of the credit allowable under section 36C) is 13 employed, submit a written statement from 14 each employer of such individual or such quali- 15 fying family member stating whether such indi- 16 vidual or qualifying family member (as the case 17 may be) is eligible for other specified coverage 18 in connection with such employment. ‘‘(B) ISSUANCE 19 OF STATEMENTS.—An em- 20 ployer shall, at the request of any employee, 21 provide the statement under subparagraph (A) 22 at such time, and in such form and manner, as 23 the Secretary may provide. 24 ‘‘(d) DEFINITIONS.—For purposes of this section, 25 terms used in this section which are also used in section g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 39 1 36C shall have the same meaning as when used in section 2 36C. 3 ‘‘SEC. 7530. EXCESS HEALTH INSURANCE COVERAGE CRED- 4 5 IT PAYABLE TO HEALTH SAVINGS ACCOUNT. ‘‘(a) IN GENERAL.—At the request of an eligible tax- 6 payer, the Secretary shall make a payment to the trustee 7 of the designated health savings account with respect to 8 such taxpayer in an amount equal to the sum of the ex9 cesses (if any) described in subsection (c)(2) with respect 10 to months in the taxable year. 11 ‘‘(b) DESIGNATED HEALTH SAVINGS ACCOUNT.— 12 The term ‘designated health savings account’ means a 13 health savings account of an individual described in sub14 section (c)(3) which is identified by the eligible taxpayer 15 for purposes of this section. 16 ‘‘(c) ELIGIBLE TAXPAYER.—The term ‘eligible tax- 17 payer’ means, with respect to any taxable year, any tax18 payer if— ‘‘(1) such taxpayer is allowed a credit under 19 20 section 36C for such taxable year, 21 ‘‘(2) the amount described in subparagraph (A) 22 of section 36C(b)(1) exceeds the amount described 23 in subparagraph (B) of such section with respect to 24 such taxpayer applied with respect to any month 25 during such taxable year, and g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 40 1 ‘‘(3) the taxpayer or one or more of the tax- 2 payer’s qualifying family members (as defined in 3 section 36C(e)) were eligible individuals (as defined 4 in section 223(c)(1)) for one or more months during 5 such taxable year. 6 ‘‘(d) CONTRIBUTIONS TREATED 7 AS ROLLOVERS, ETC.— ‘‘(1) IN 8 GENERAL.—Any amount paid the Sec- 9 retary to a health savings account under this section 10 shall be treated for purposes of this title in the same 11 manner as a rollover contribution described in sec- 12 tion 223(f)(5). ‘‘(2) COORDINATION 13 WITH LIMITATION ON 14 ROLLOVERS.—Any 15 (1) shall not be taken into account in applying sec- 16 tion 223(f)(5)(B) with respect to any other amount 17 and the limitation of section 223(f)(5)(B) shall not 18 apply with respect to the application of paragraph 19 (1). 20 ‘‘(e) FORM AND amount described in paragraph MANNER OF REQUEST.—The re- 21 quest referred to in subsection (a) shall be made at such 22 time and in such form and manner as the Secretary may 23 provide. To the extent that the Secretary determines fea24 sible, such request may identify more than one designated 25 health savings account (and the amount to be paid to each g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 41 1 such account) provided that the aggregate of such pay2 ments with respect to any taxpayer for any taxable year 3 do not exceed the excess described in subsection (c)(2). 4 ‘‘(f) TAXPAYERS WITH SERIOUSLY DELINQUENT 5 TAX DEBT.—In the case of an individual who has a seri6 ously delinquent tax debt (as defined in section 7345(b)) 7 which has not been fully satisfied— 8 ‘‘(1) if such individual is the eligible taxpayer 9 (or, in the case of a joint return, either spouse), the 10 Secretary shall not make any payment under this 11 section with respect to such taxpayer, and 12 ‘‘(2) if such individual is the account bene- 13 ficiary (as defined in section 223(d)(3)) of any 14 health savings account, the Secretary shall not make 15 any payment under this section to such health sav- 16 ings account. 17 ‘‘(g) ADVANCE PAYMENT.—To the extent that the 18 Secretary determines feasible, payment under this section 19 may be made in advance on a monthly basis under rules 20 similar to the rules of sections 7529 and 36C(i)(5)(B).’’. 21 (c) INFORMATION REPORTING.— (1) REPORTING 22 23 VIDERS.—Subpart 24 chapter 61 of such Code is amended by adding at 25 the end the following new sections: g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 BY HEALTH INSURANCE PRO- 16:39 Mar 06, 2017 Jkt 000000 B of part III of subchapter A of (653161 7) PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 42 1 ‘‘SEC. 6050X. RETURNS BY HEALTH INSURANCE PROVIDERS 2 RELATING 3 ERAGE CREDIT. 4 TO ‘‘(a) REQUIREMENT OF HEALTH INSURANCE COV- REPORTING.—Every person 5 who provides eligible health insurance for any month of 6 any calendar year with respect to any individual shall, at 7 such time as the Secretary may prescribe, make the return 8 described in subsection (b) with respect to each such indi9 vidual. With respect to any individual with respect to 10 whom payments under section 7529 are made by the Sec11 retary, the reporting under subsection (b) shall be made 12 on a monthly basis. 13 ‘‘(b) FORM AND MANNER OF RETURNS.—A return 14 is described in this subsection if such return— ‘‘(1) is in such form as the Secretary may pre- 15 16 scribe, and ‘‘(2) contains, with respect to each policy of eli- 17 18 gible health insurance— ‘‘(A) the name, address, and TIN of each 19 individual covered under such policy, 20 ‘‘(B) the premiums paid with respect to 21 such policy, 22 23 ‘‘(C) the amount of advance payments 24 made on behalf of the individual under section 25 7529, g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 43 ‘‘(D) the months during which such health 1 insurance is provided to the individual, 2 3 ‘‘(E) whether such policy constitutes a 4 high deductible health plan (as defined in sec- 5 tion 223(c)(2)), and ‘‘(F) such other information as the Sec- 6 retary may prescribe. 7 ‘‘(c) STATEMENTS 8 9 10 UALS WITH RESPECT QUIRED.—Every TO TO BE FURNISHED TO INDIVID- WHOM INFORMATION IS RE- person required to make a return under 11 subsection (a) shall furnish to each individual whose name 12 is required to be set forth in such return a written state13 ment showing— 14 ‘‘(1) the name and address of the person re- 15 quired to make such return and the phone number 16 of the information contact for such person, and ‘‘(2) the information required to be shown on 17 18 the return with respect to such individual. 19 The written statement required under the preceding sen20 tence shall be furnished on or before January 31 of the 21 year following the calendar year to which such statement 22 relates. 23 ‘‘(d) DEFINITIONS.—For purposes of this section, 24 terms used in this section which are also used in section g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 44 1 36C shall have the same meaning as when used in section 2 36C.’’. (2) 3 BY EMPLOYERS.—Section 4 6051(a) of such Code is amended by striking ‘‘and’’ 5 at the end of paragraph (14), by striking the period 6 at the end of paragraph (15) and inserting ‘‘, and’’, 7 and by inserting after paragraph (15) the following 8 new paragraph: 9 ‘‘(16) each month with respect to which the em- 10 ployee is eligible for other specified coverage (as de- 11 fined in section 36C(g)) in connection with employ- 12 ment with the employer.’’. 13 (3) ASSESSABLE PENALTIES.— 14 (A) Section 6724(d)(1)(B) of such Code is 15 amended by striking ‘‘or’’ at the end of clause 16 (xxiv), by inserting ‘‘or’’ at the end of clause 17 (xxv), and by inserting after clause (xxv) the 18 following new clause: 19 ‘‘(xxvi) section 6050X (relating to re- 20 turns relating to health insurance coverage 21 credit),’’. 22 (B) Section 6724(d)(2) of such Code is 23 amended by striking ‘‘or’’ at the end of sub- 24 paragraph (HH), by striking the period at the 25 end of subparagraph (II) and inserting a g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 REPORTING 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 45 1 comma, and by adding after subparagraph (II) 2 the following new subparagraphs: 3 ‘‘(JJ) section 6050X (relating to returns 4 relating to health insurance coverage credit), or 5 ‘‘(KK) section 7529(c)(3) (relating to doc- 6 umentation 7 erage).’’. (d) 8 regarding other DISCLOSURES.—Paragraph specified (21) of cov- section 9 6103(l) of the Internal Revenue Code of 1986 is amend10 ed— (1) in subparagraph (A)— 11 12 (A) by striking ‘‘any premium tax credit 13 under section 36B or any cost-sharing reduc- 14 tion under section 1402 of the Patient Protec- 15 tion and Affordable Care Act or’’ and inserting 16 ‘‘any credit under section 36C’’, 17 (B) by striking ‘‘, a State’s children’s 18 health insurance program under title XXI of 19 the Social Security Act, or a basic health pro- 20 gram under section 1331 of Patient Protection 21 and Affordable Care Act’’ and inserting ‘‘or a 22 State’s children’s health insurance program 23 under title XXI of the Social Security Act’’, g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 46 1 (C) by striking ‘‘(as defined in section 2 36B)’’ in clause (iv) and inserting ‘‘(as defined 3 in section 36C(c)(2)(B))’’, and (D) by striking ‘‘or reduction’’ in clause 4 5 (v), 6 (2) in subparagraph (B)— (A) by striking ‘‘may disclose to an Ex- 7 change’’ and inserting ‘‘may disclose— 8 ‘‘(i) to an Exchange’’, and 9 (B) by striking the period at the end and 10 inserting ‘‘, and’’, and 11 (C) by adding at the end the following new 12 clause: 13 14 ‘‘(ii) in the case of any credit under 15 section 36C with respect to any health in- 16 surance, the amount of such credit (or the 17 amount of any advance payment of such 18 credit) to the provider of such insurance 19 (or, as the Secretary determines appro- 20 priate, the licensed agent or broker with 21 respect to such insurance).’’, and 22 (3) in subparagraph (C)(i), by striking ‘‘amount 23 of, any credit or reduction’’ and inserting ‘‘amount 24 of any credit’’. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 47 1 (e) INCREASED PENALTY ON ERRONEOUS CLAIMS OF 2 CREDIT.—Section 6676(a) of such Code is amended by 3 inserting ‘‘(25 percent in the case of a claim for refund 4 or credit relating to the health insurance coverage credit 5 under section 36C)’’. 6 (f) CONFORMING AMENDMENTS.— (1) Section 35(g) of such Code is amended by 7 8 adding at the end the following new paragraph: 9 ‘‘(14) COORDINATION 10 ANCE COVERAGE CREDIT.— 11 ‘‘(A) IN GENERAL.—An eligible coverage 12 month to which the election under paragraph 13 (11) applies shall not be treated as an eligible 14 coverage month (as defined in section 36C(d)) 15 for purposes of section 36C with respect to the 16 taxpayer or any of the taxpayer’s qualifying 17 family members (as defined in section 36C(e)). ‘‘(B) COORDINATION 18 WITH ADVANCE PAY- 19 MENTS 20 CREDIT.—In 21 the election under paragraph (11) with respect 22 to any eligible coverage month in a taxable year 23 or on behalf of whom any advance payment is 24 made under section 7527 with respect to any 25 month in such taxable year— g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 WITH HEALTH INSUR- 16:39 Mar 06, 2017 Jkt 000000 OF HEALTH INSURANCE COVERAGE the case of a taxpayer who makes (653161 7) PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 48 1 ‘‘(i) the tax imposed by this chapter 2 for the taxable year shall be increased by 3 the excess, if any, of— 4 ‘‘(I) the sum of any advance pay- 5 ments made on behalf of the taxpayer 6 under sections 7527 and 7529 for 7 months during such taxable year, over 8 ‘‘(II) the sum of the credits al- 9 lowed under this section (determined 10 without regard to paragraph (1)) and 11 section 36C (determined without re- 12 gard to subsection (i)(5)(A) thereof) 13 for such taxable year, and 14 ‘‘(ii) section 36C(i)(5)(B) shall not 15 apply with respect to such taxpayer for 16 such taxable year.’’. (2) Section 162(l) of such Code is amended by 17 18 adding at the end the following new paragraph: 19 ‘‘(6) COORDINATION WITH HEALTH INSURANCE 20 COVERAGE CREDIT.—The deduction otherwise allow- 21 able to a taxpayer under paragraph (1) for any tax- 22 able year shall be reduced (but not below zero) by 23 the sum of— 24 ‘‘(A) the amount of the credit allowable to 25 such taxpayer under section 36C (determined g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 49 1 without regard to subsection (i)(5)(A) thereof) 2 for such taxable year, plus 3 ‘‘(B) the aggregate payments made with 4 respect to the taxpayer under section 7530 for 5 months during such taxable year.’’. 6 (3) Section 1324(b)(2) of title 31, United States Code is amended— 7 8 (A) by inserting ‘‘36C,’’ after ‘‘36B,’’, and 9 (B) by striking ‘‘or 6431’’ and inserting 10 ‘‘6431, or 7530’’. 11 (4) The table of sections for subpart C of part 12 IV of subchapter A of chapter 1 of the Internal Rev- 13 enue Code of 1986 is amended by inserting after the 14 item relating to section 36B the following new item: ‘‘Sec. 36C. Health insurance coverage.’’. 15 (5) The table of sections for subpart B of part 16 III of subchapter A of chapter 61 of such Code is 17 amended by adding at the end the following new 18 item: ‘‘Sec. 6050X. Returns relating to health insurance coverage credit.’’. 19 (6) The table of sections for chapter 77 of such 20 Code is amended by adding at the end the following 21 new items: ‘‘Sec. 7529. Advance payment of health insurance coverage credit. ‘‘Sec. 7530. Excess health insurance coverage credit payable to health savings account.’’. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00049 Fmt 6652 Sfmt 6211 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 50 (g) EFFECTIVE DATE.—The amendments made by 1 2 this section shall apply to months beginning after Decem3 ber 31, 2019, in taxable years ending after such date. 4 SEC. l16. MAXIMUM CONTRIBUTION LIMIT TO HEALTH 5 SAVINGS ACCOUNT INCREASED TO AMOUNT 6 OF DEDUCTIBLE AND OUT-OF-POCKET LIMI- 7 TATION. 8 (a) SELF-ONLY COVERAGE.—Section 223(b)(2)(A) 9 of the Internal Revenue Code of 1986 is amended by strik10 ing ‘‘$2,250’’ and inserting ‘‘the amount in effect under 11 subsection (c)(2)(A)(ii)(I)’’. 12 (b) FAMILY COVERAGE.—Section 223(b)(2)(B) of 13 such Code is amended by striking ‘‘$4,500’’ and inserting 14 ‘‘the amount in effect under subsection (c)(2)(A)(ii)(II)’’. 15 (c) CONFORMING AMENDMENTS.—Section 223(g)(1) 16 of such Code is amended— (1) by striking ‘‘subsections (b)(2) and’’ both 17 18 places it appears and inserting ‘‘subsection’’, and 19 (2) in subparagraph (B), by striking ‘‘deter- 20 mined by’’ and all that follows through ‘‘ ‘calendar 21 year 2003’.’’ and inserting ‘‘determined by sub- 22 stituting ‘calendar year 2003’ for ‘calendar year 23 1992’ in subparagraph (B) thereof .’’. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 51 (d) EFFECTIVE DATE.—The amendments made by 1 2 this section shall apply to taxable years beginning after 3 December 31, 2017. 4 SEC. l17. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CON- 5 TRIBUTIONS TO THE SAME HEALTH SAVINGS 6 ACCOUNT. 7 (a) IN GENERAL.—Section 223(b)(5) of the Internal 8 Revenue Code of 1986 is amended to read as follows: ‘‘(5) SPECIAL 9 10 WITH FAMILY COVERAGE.— 11 ‘‘(A) IN GENERAL.—In the case of individ- 12 uals who are married to each other, if both 13 spouses are eligible individuals and either 14 spouse has family coverage under a high de- 15 ductible health plan as of the first day of any 16 month— 17 ‘‘(i) the limitation under paragraph 18 (1) shall be applied by not taking into ac- 19 count any other high deductible health 20 plan coverage of either spouse (and if such 21 spouses both have family coverage under 22 separate high deductible health plans, only 23 one such coverage shall be taken into ac- 24 count), g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 RULE FOR MARRIED INDIVIDUALS 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 52 1 ‘‘(ii) such limitation (after application 2 of clause (i)) shall be reduced by the ag- 3 gregate amount paid to Archer MSAs of 4 such spouses for the taxable year, and 5 ‘‘(iii) such limitation (after application 6 of clauses (i) and (ii)) shall be divided 7 equally between such spouses unless they 8 agree on a different division. 9 ‘‘(B) TREATMENT OF ADDITIONAL CON- 10 TRIBUTION AMOUNTS.—If 11 to in subparagraph (A) have attained age 55 12 before the close of the taxable year, the limita- 13 tion referred to in subparagraph (A)(iii) which 14 is subject to division between the spouses shall 15 include the additional contribution amounts de- 16 termined under paragraph (3) for both spouses. 17 In any other case, any additional contribution 18 amount determined under paragraph (3) shall 19 not be taken into account under subparagraph 20 (A)(iii) and shall not be subject to division be- 21 tween the spouses.’’. 22 both spouses referred (b) EFFECTIVE DATE.—The amendment made by 23 this section shall apply to taxable years beginning after 24 December 31, 2017. g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1. G:\M\15\BRADTX\BRADTX_002.XML 53 1 SEC. l18. SPECIAL RULE FOR CERTAIN MEDICAL EX- 2 PENSES INCURRED BEFORE ESTABLISHMENT 3 OF HEALTH SAVINGS ACCOUNT. 4 (a) IN GENERAL.—Section 223(d)(2) of the Internal 5 Revenue Code of 1986 is amended by adding at the end 6 the following new subparagraph: ‘‘(D) TREATMENT 7 OF CERTAIN MEDICAL 8 EXPENSES INCURRED BEFORE ESTABLISHMENT 9 OF ACCOUNT.—If a health savings account is 10 established during the 60-day period beginning 11 on the date that coverage of the account bene- 12 ficiary under a high deductible health plan be- 13 gins, then, solely for purposes of determining 14 whether an amount paid is used for a qualified 15 medical expense, such account shall be treated 16 as having been established on the date that 17 such coverage begins.’’. 18 (b) EFFECTIVE DATE.—The amendment made by 19 this subsection shall apply with respect to coverage begin20 ning after December 31, 2017. ◊ g:\VHLC\030617\030617.309.xml March 6, 2017 (4:39 p.m.) VerDate Nov 24 2008 16:39 Mar 06, 2017 Jkt 000000 (653161 7) PO 00000 Frm 00053 Fmt 6652 Sfmt 6301 C:\USERS\HWCHRI~1\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BRADTX~1.