I
118THCONGRESS
1
STSESSION H. R. 3129
To ensure health care fairness and affordability for all Americans through
universal access to equitable health insurance tax credits, reformed health
savings accounts, and strengthened consumer protections, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
MAY9, 2023
Mr. S
ESSIONSintroduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on
Ways and Means, and Education and the Workforce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee con-
cerned
A BILL
To ensure health care fairness and affordability for all Amer-
icans through universal access to equitable health insur-
ance tax credits, reformed health savings accounts, and
strengthened consumer protections, and for other pur-
poses.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 2
•HR 3129 IH
SECTION 1. SHORT TITLE; PURPOSES; TABLE OF CON-1
TENTS. 2
(a) S
HORTTITLE.—This Act may be cited as the 3
‘‘Health Care Fairness for All Act’’. 4
(b) P
URPOSES.—The purposes of this Act are as fol-5
lows: 6
(1) E
LIMINATION OF INDIVIDUAL AND EM -7
PLOYER MANDATES .—To eliminate mandates on in-8
dividuals and employers, and other tax requirements, 9
imposed under Public Law 111–148. 10
(2) P
ROVIDING STATES WITH ALTERNATIVE , 11
AFFORDABLE COVERAGE OPTIONS .—To provide 12
greater flexibility in providing States with options in 13
making affordable health insurance coverage avail-14
able by eliminating certain mandates under Public 15
Law 111–148, while retaining essential consumer 16
protections, by promoting health savings accounts to 17
pay for such coverage and long-term care coverage, 18
while permitting States to continue coverage as pro-19
vided under such public law. 20
(c) T
ABLE OFCONTENTS.—The table of contents of 21
this Act is as follows: 22
Sec. 1. Short title; purposes; table of contents.
Sec. 2. Definitions.
TITLE I—REVISION OF FEDERAL HEALTH LAW
Subtitle A—Elimination of Employer and Individual Mandates
Sec. 101. Repeal of individual health insurance mandate.
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 3
•HR 3129 IH
Sec. 102. Repeal of employer health insurance mandate.
Sec. 103. Clarifying employer’s ability to reimburse employee premiums for
purchase of individual health insurance coverage.
Subtitle B—Limitation on Application of Federal Health Plan Requirements
Sec. 121. Limiting application of requirements to consumer protections.
Sec. 122. Offering of basic health insurance; protection of assets from liability
or attachment or seizure.
Sec. 123. Ensuring access to short-term limited duration insurance.
Sec. 124. Making telehealth flexibilities permanent.
Subtitle C—Health Insurance Tax Benefit
Sec. 131. Health insurance tax benefit.
Sec. 132. Application of portion of unused tax credits by States for indigent
health care.
Sec. 133. Medicaid option of enrollment under private plan and contribution to
an HSA.
Sec. 134. Repeal of reporting requirements relating to employee health insur-
ance premiums and health plan benefits.
Sec. 135. Report.
Subtitle D—Medicare Reforms
Sec. 141. Physician-owned hospitals.
Sec. 142. Prohibiting the use of an inpatient-only list in designating hospital
outpatient services under the Medicare program.
Sec. 143. Promoting Medicare site-neutral payments.
Sec. 144. Medicare Advantage contributions to Roth HSAs for chronically ill
enrollees.
Sec. 145. Extending acute hospital care at home waiver flexibilities.
TITLE II—IMPROVING HEALTH SAVINGS ACCOUNTS TO PROMOTE
ACCOUNTABILITY
Sec. 201. Transition to non-deductible HSAs.
Sec. 202. Elimination of medical expense deduction.
Sec. 203. Treatment of HSA after death of account beneficiary.
Sec. 204. Treatment of direct patient care arrangements.
TITLE III—STATE FLEXIBILITY IN REGULATION OF HEALTH
INSURANCE COVERAGE
Sec. 301. State flexibility in regulation of health insurance coverage.
TITLE IV—MEDICAID PAYMENT REFORM
Sec. 401. Medicaid payment reform to ensure equitable access to care.
TITLE V—PRICE TRANSPARENCY
Sec. 501. Promoting transparent hospital prices for consumers.
SEC. 2. DEFINITIONS.
1
Except as otherwise provided, in this Act: 2
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 4
•HR 3129 IH
(1) BASIC HEALTH INSURANCE .—The term 1
‘‘basic health insurance’’ is defined in section 2
122(a). 3
(2) D
EFAULT HEALTH INSURANCE COV -4
ERAGE.—The term ‘‘default health insurance cov-5
erage’’ is defined in section 121(b)(4)(B). 6
(3) E
XCHANGE.—The term ‘‘Exchange’’ means 7
an Exchange established under title I of Public Law 8
111–148. 9
(4) H
EALTH INSURANCE COVERAGE ; GROUP 10
HEALTH PLAN, ETC.—The terms defined in section 11
2791 of the Public Health Service Act, including 12
‘‘health insurance coverage’’, ‘‘group health plan’’ 13
‘‘individual market’’, shall apply. 14
(5) L
IMITED BENEFIT INSURANCE .—The term 15
‘‘limited benefit insurance’’ is defined in section 16
122(b). 17
(6) S
ECRETARY.—The term ‘‘Secretary’’ means 18
the Secretary of Health and Human Services. 19
(7) S
TATE.—The term ‘‘State’’ includes the 20
District of Columbia, Puerto Rico, the United States 21
Virgin Islands, American Samoa, Guam, and the 22
Northern Mariana Islands. 23
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 5
•HR 3129 IH
TITLE I—REVISION OF FEDERAL 1
HEALTH LAW 2
Subtitle A—Elimination of 3
Employer and Individual Mandates 4
SEC. 101. REPEAL OF INDIVIDUAL HEALTH INSURANCE 5
MANDATE. 6
Section 5000A of the Internal Revenue Code of 1986 7
is amended by adding at the end the following new sub-8
section: 9
‘‘(h) T
ERMINATION.—This section shall not apply to 10
months beginning after December 31, 2022.’’. 11
SEC. 102. REPEAL OF EMPLOYER HEALTH INSURANCE MAN-12
DATE. 13
(a) I
NGENERAL.—Chapter 43 of the Internal Rev-14
enue Code of 1986 is amended— 15
(1) by striking section 4980H, and 16
(2) by striking the item relating to section 17
4980H from the table of sections for such chapter. 18
(b) R
EPEAL OFRELATEDREPORTINGREQUIRE-19
MENTS.—Subpart D of part III of subchapter A of chap-20
ter 61 of such Code is amended by striking section 6056 21
and by striking the item relating to section 6056 in the 22
table of sections for such subpart. 23
(c) C
ONFORMINGAMENDMENTS.— 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 6
•HR 3129 IH
(1) Section 6724(d)(1)(B) of such Code is 1
amended by striking clause (xxv). 2
(2) Section 6724(d)(2) of such Code is amend-3
ed by striking subparagraph (HH). 4
(3) Section 1513 of Public Law 111–148 is 5
amended by striking subsection (c). 6
(d) E
FFECTIVEDATES.— 7
(1) I
N GENERAL.—Except as otherwise pro-8
vided in this subsection, the amendments made by 9
this section shall apply to months and other periods 10
beginning more than 30 days after the date of the 11
enactment of this Act. 12
(2) R
EPEAL OF STUDY AND REPORT .—The 13
amendment made by subsection (c)(3) shall take ef-14
fect on the date of the enactment of this Act. 15
SEC. 103. CLARIFYING EMPLOYER’S ABILITY TO REIM-16
BURSE EMPLOYEE PREMIUMS FOR PUR-17
CHASE OF INDIVIDUAL HEALTH INSURANCE 18
COVERAGE. 19
An employer health care arrangement, such as a 20
health or medical reimbursement arrangement (HRA) or 21
other employment plans, under which an employer reim-22
burses an employee for the premiums for the purchase of 23
individual health insurance coverage does not constitute 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 7
•HR 3129 IH
a group health plan for any purposes, including for pur-1
poses of applying any of the following: 2
(1) The Public Health Service Act (including 3
sections 2711 and 2714 of such Act, 42 U.S.C. 4
300gg–11, 300gg–14). 5
(2) Public Law 111–148. 6
(3) The Internal Revenue Code of 1986 (other 7
than for purposes of section 36B of such Code). 8
(4) The Employee Retirement Income Security 9
Act of 1974. 10
(5) The HIPAA privacy regulations (as defined 11
in section 1180(b)(3) of the Social Security Act, 42 12
U.S.C. 1320d–9(b)(3)). 13
(6) The Health Insurance Portability and Ac-14
countability Act of 1996. 15
(7) COBRA continuation coverage under title 16
XXII of the Public Health Service Act (42 U.S.C. 17
300bb–1 et seq.), section 4980B of the Internal Rev-18
enue Code of 1986, or title VI of the Employee Re-19
tirement Income Security Act of 1974 (29 U.S.C. 20
1161 et seq.). 21
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 8
•HR 3129 IH
Subtitle B—Limitation on Applica-1
tion of Federal Health Plan Re-2
quirements 3
SEC. 121. LIMITING APPLICATION OF REQUIREMENTS TO 4
CONSUMER PROTECTIONS. 5
(a) R
EMOVAL OFPUBLICLAW111–148 PLANRE-6
QUIREMENTS, OTHERTHANCERTAINCONSUMERPRO-7
TECTIONS.— 8
(1) I
N GENERAL.—Notwithstanding any other 9
provision of law, with respect to group health plans 10
and health insurance coverage whether or not of-11
fered through an Exchange, except as provided in 12
paragraphs (2) and (3), the provisions of title 13
XXVII of the Public Health Service Act (42 U.S.C. 14
300gg et seq.) as in effect on the day before the date 15
of the enactment of Public Law 111–148 shall apply 16
instead of the provisions of such title as in effect 17
after such date. 18
(2) P
UBLIC LAW 111–148 CONSUMER PROTEC -19
TIONS CONTINUING TO BE APPLIED .—The following 20
sections of the Public Health Service Act, that were 21
added or amended by subtitles A and C of title I of 22
Public Law 111–148, shall continue to apply to 23
group health plans and to health insurance coverage 24
offered in the individual and group market: 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 9
•HR 3129 IH
(A) NO LIFETIME OR ANNUAL LIMITS .— 1
Section 2711 (42 U.S.C. 300gg–11; relating to 2
no lifetime or annual limits), except in the case 3
of limited benefit insurance (as defined in sec-4
tion 122(b)). 5
(B) D
EPENDENT COVERAGE THROUGH 6
AGE 26.—Section 2714 (42 U.S.C. 300bb–14; 7
relating to extension of dependent coverage). 8
(C) M
ODIFIED GUARANTEED AVAIL -9
ABILITY.—Section 2702 (42 U.S.C. 300gg–1; 10
relating to guaranteed availability of coverage), 11
subject to paragraph (3) and subsection (c). 12
(D) G
UARANTEED RENEWABILITY .—Sec-13
tion 2703 (42 U.S.C. 300gg–2; relating to 14
guaranteed renewability of coverage). 15
(E) P
ROHIBITING PRE-EXISTING CONDI-16
TION EXCLUSIONS.—Section 2704 (42 U.S.C. 17
300gg–3; relating to prohibition on preexisting 18
conditions). 19
(F) P
ROHIBITING DISCRIMINATION BASED 20
ON HEALTH STATUS .—Section 2705 (42 U.S.C. 21
300gg–4; relating to prohibiting discrimination 22
against individual participants and beneficiaries 23
based on health status), subject to subsection 24
(c). 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 10
•HR 3129 IH
(G) NON-DISCRIMINATION IN HEALTH 1
CARE.—Section 2706 (42 U.S.C. 300gg–5; re-2
lating to non-discrimination in health care). 3
(3) A
PPLICATION OF A LATE ENROLLMENT 4
PENALTY FOR THOSE WITHOUT CONTINUOUS COV -5
ERAGE.— 6
(A) I
N GENERAL.—In the case of an indi-7
vidual who seeks to enroll in health insurance 8
coverage and who, as of the effective date of 9
such enrollment, does not have a continuous pe-10
riod of at least 12 months of creditable cov-11
erage, there shall be imposed a late enrollment 12
penalty in the form of an increase in the 13
monthly premiums for coverage of under the 14
plan of 20 percent of the monthly premium oth-15
erwise determined for each consecutive full 12- 16
month period (ending before such effective 17
date) in which the individual was not enrolled 18
in creditable coverage. Such increase shall apply 19
during a period, to be specified under regula-20
tions of the Secretary but in no case longer 21
than 3 times the length of the most recent pe-22
riod in which the individual did not have contin-23
uous coverage. 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 11
•HR 3129 IH
(B) STATE WAIVER.—A State may apply 1
to the Secretary for a waiver of the provisions 2
of subparagraph (A) and the application of al-3
ternative provisions providing incentives for 4
State residents to enroll in creditable coverage 5
and maintain continuous creditable coverage. 6
The Secretary shall approve such waiver if the 7
Secretary determines that the alternative provi-8
sions provide similar or greater incentives for 9
such enrollment than the incentives otherwise 10
applicable. 11
(4) C
OORDINATING IMPLEMENTATION OF PRE - 12
PUBLIC LAW 111–148 PHSA PROVISIONS WITH PUBLIC 13
LAW 111–148 CONSUMER PROTECTIONS .— 14
(A) I
N GENERAL.—In applying this sub-15
section, the provisions described in paragraph 16
(2) shall be treated as if they were included in 17
title XXVII of the Public Health Service Act, 18
as in effect before the date of enactment of 19
Public Law 111–148, and, with respect to 20
group health plans and health insurance cov-21
erage offered in connection with such plans, in 22
part 7 of subtitle B of title I of the Employee 23
Retirement and Income Security Act of 1974 24
(29 U.S.C. 1181 et seq.), and, with respect to 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 12
•HR 3129 IH
group health plans, in chapter 100 of the Inter-1
nal Revenue Code of 1986 as follows: 2
(i) L
IFETIME LIMITS; DEPENDENT 3
COVERAGE.—The provisions described in 4
paragraphs (2)(A) and (2)(B) shall be 5
treated as included— 6
(I) with respect to group health 7
plans (and health insurance coverage 8
offered with respect to such plans), 9
under subpart 2 of part A of title 10
XXVII of the Public Health Service 11
Act (42 U.S.C. 300gg–11 et seq.) and 12
subpart B of part 7 of subtitle B of 13
title I of the Employee Retirement 14
and Income Security Act of 1974 (29 15
U.S.C. 1181 et seq.); 16
(II) also with respect to group 17
health plans, under subchapter B of 18
chapter 100 of the Internal Revenue 19
Code of 1986; and 20
(III) with respect to individual 21
health insurance coverage, under sub-22
part 2 of part B of title XXVII of the 23
Public Health Service Act (42 U.S.C. 24
300gg–15 et seq.). 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 13
•HR 3129 IH
(ii) REMAINING PROVISIONS .—The 1
provision described in paragraph (2) (other 2
than in subparagraph (A) or (B) of such 3
paragraph) shall be treated as included— 4
(I) with respect to group health 5
plans (and health insurance coverage 6
offered with respect to such plans), 7
under subpart 1 of part A of title 8
XXVII of the Public Health Service 9
Act (42 U.S.C. 300gg et seq.) and 10
subpart A of part 7 of subtitle B of 11
title I of the Employee Retirement 12
and Income Security Act of 1974 (29 13
U.S.C. 1181 et seq.); 14
(II) also with respect to group 15
health plans, under subchapter A of 16
chapter 100 of the Internal Revenue 17
Code of 1986; and 18
(III) with respect to individual 19
health insurance coverage, under sub-20
part 1 of part B of title XXVII of the 21
Public Health Service Act (42 U.S.C. 22
300gg–41 et seq.). 23
(B) C
ONFLICTING PROVISIONS .—In the 24
case described in paragraph (1) where there is 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 14
•HR 3129 IH
a conflict between a provision described in para-1
graph (2) and a provision of law described in 2
paragraph (1), the provision described in para-3
graph (2) shall control and the Secretary, in 4
consultation with the Secretary of the Treasury 5
and the Secretary of Labor, shall establish such 6
rules as may be necessary to carry out this sub-7
paragraph. 8
(5) C
ONFORMING AMENDMENTS .— 9
(A) ERISA.—Section 715 of the Employee 10
Retirement Income Security Act of 1974 (29 11
U.S.C. 1185d) is amended— 12
(i) in subsection (a), by striking ‘‘sub-13
section (b)’’ and inserting ‘‘subsections (b) 14
and (c)’’; and 15
(ii) by adding at the end the following 16
new subsection: 17
‘‘(c) A
DDITIONALEXCEPTION.—Pursuant to section 18
121 of the Health Care Fairness for All Act, the provi-19
sions of part A of title XXVII of the Public Health Service 20
Act referred to in subsection (a), other than those provi-21
sions specified in section 121(a)(2) of the Health Care 22
Fairness for All Act, shall not apply to plans and coverage 23
described in subsection (a), whether or not the plans or 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 15
•HR 3129 IH
coverage are offered through an Exchange established by 1
Public Law 111–148.’’. 2
(B) IRC.—Section 9815 of the Internal 3
Revenue Code of 1986 is amended— 4
(i) in subsection (a), by striking ‘‘sub-5
section (b)’’ and inserting ‘‘subsections (b) 6
and (c)’’; and 7
(ii) by adding at the end the following 8
new subsection: 9
‘‘(c) A
DDITIONALEXCEPTION.—Pursuant to section 10
121 of the Health Care Fairness for All Act, the provi-11
sions of part A of title XXVII of the Public Health Service 12
Act referred to in subsection (a), other than those provi-13
sions specified in section 121(a)(2) of the Health Care 14
Fairness for All Act, shall not apply to plans described 15
in subsection (a).’’. 16
(b) S
TATEFLEXIBILITY INENSURINGORDERLY 17
H
EALTHINSURANCEMARKETOUTSIDE OF AN EX-18
CHANGE.— 19
(1) I
N GENERAL.—With respect to health insur-20
ance coverage offered in a State, the State may, in 21
consultation with the Secretary, take such steps, 22
such as limiting the availability of general open en-23
rollment periods, imposing delays in the effectiveness 24
for coverage, permitting differentials in premiums 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 16
•HR 3129 IH
based on age and other factors, as the State deter-1
mines necessary in order to ensure an orderly mar-2
ket for health insurance coverage in the State that 3
is not offered through an Exchange. Such steps may 4
include the establishment of such initial open enroll-5
ment period during which qualified residents may 6
enroll in health insurance coverage without the im-7
position of any underwriting as the State determines 8
to be appropriate in ensuring initial access to such 9
coverage. 10
(2) F
LEXIBILITY IN IMPOSING ADDITIONAL RE -11
QUIREMENTS.—Subject to paragraph (5), nothing in 12
this section shall be construed as preventing a State 13
from continuing to apply, to health insurance cov-14
erage issued in the State, requirements under the 15
provisions of title XXVII of the Public Health Serv-16
ice Act (as amended by subtitles A and C of title I 17
of Public Law 111–148) that are not continued 18
under subsection (a). 19
(3) S
TATE FLEXIBILITY WITH RESPECT TO EX -20
CHANGES.—A State may waive such provisions of 21
part II of subtitle D of title I of Public Law 111– 22
148 (42 U.S.C. 18031 et seq.), in relation to the es-23
tablishment of an Exchange in such State, as the 24
State determines appropriate in order for the State 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 17
•HR 3129 IH
to implement and administer a market-based system 1
for the availability of health insurance coverage 2
throughout the State. 3
(4) S
TATE DEFAULT ENROLLMENT OPTION .— 4
(A) E
NROLLMENT, SUBJECT TO INDI -5
VIDUAL OPT-OUT.—Subject to subparagraph 6
(D), a State may elect to provide for the enroll-7
ment of residents of the State who are unin-8
sured in default health insurance coverage (as 9
defined in subparagraph (B)) and establishing a 10
Roth HSA for such residents who do not have 11
a Roth HSA unless the resident has affirma-12
tively elected not to be so enrolled and not to 13
have such an account, respectively. If a State 14
makes such an election, the State shall permit 15
eligible residents to enroll in such coverage on 16
a continuous basis. 17
(B) D
EFAULT HEALTH INSURANCE COV -18
ERAGE DEFINED.—In this paragraph, the term 19
‘‘default health insurance coverage’’ means, 20
with respect to a State, health insurance cov-21
erage that— 22
(i) is a high deductible health plan 23
(within the meaning of section 223(c)(2) of 24
the Internal Revenue Code of 1986) with 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 18
•HR 3129 IH
prescription drug coverage limited to ge-1
neric drugs for a limited number of chronic 2
conditions (commonly referred to as tier I 3
pharmacy benefit); 4
(ii) meets such requirements as may 5
apply to qualify for the payment of plan 6
premiums from a health savings account 7
under section 223 of such Code (such as 8
age-related premiums and limitation on 9
imposition of preexisting condition exclu-10
sions); 11
(iii) has a provider network for cov-12
ered benefits that is adequate (as deter-13
mined consistent with guidelines issued by 14
the Secretary) to ensure access to health 15
benefits under such plan; 16
(iv) provides for coverage of childhood 17
immunizations without cost sharing re-18
quirements to the extent such immuniza-19
tions have in effect a recommendation 20
from the Advisory Committee on Immuni-21
zation Practices of the Centers for Disease 22
Control and Prevention with respect to the 23
individual involved; and 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 19
•HR 3129 IH
(v) meets such other requirements as 1
the State may specify. 2
(C) R
OTH HSA.—In this paragraph, the 3
term ‘‘Roth HSA’’ shall have the meaning given 4
such term by section 530A(c) of the Internal 5
Revenue Code of 1986, as added by section 6
201(a) of this Act. 7
(D) S
IMPLE PROCESS FOR INDIVIDUALS TO 8
OPT OUT.—As a condition of a State providing 9
for the enrollment function described in sub-10
paragraph (A), the State must establish an 11
easy-to-use and transparent means by which in-12
dividuals may elect not to be enrolled in default 13
health insurance coverage or to have a Roth 14
HSA established on the individual’s behalf, or 15
both. 16
(5) M
INIMUM AGE VARIATION PERMITTED FOR 17
PREMIUM RATES.—With respect to the premium rate 18
charged by a health insurance issuer for health in-19
surance coverage offered in the individual or small 20
group market, a State may not limit the variation by 21
age in such rate with respect to a particular plan or 22
coverage involved by less than a factor of 5 to 1 for 23
adults. The previous sentence shall be treated as if 24
it were included in subpart I of part A of title 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 20
•HR 3129 IH
XXVII of the Public Health Service Act (42 U.S.C. 1
300gg et seq.). 2
(c) I
NAPPLICABILITY OF REQUIREDESSENTIAL 3
H
EALTHBENEFITS.— 4
(1) I
N GENERAL.—Notwithstanding any other 5
provision of law, no health benefits plan shall be re-6
quired by reason of Federal law to comply with the 7
requirements of sections 1301(a)(1)(B) and 1302 of 8
Public Law 111–148 (42 U.S.C. 18021(a)(1)(B), 9
18022). 10
(2) S
TATE FLEXIBILITY.—Nothing in this sub-11
section shall be construed as preventing a State 12
from applying, at its option with respect to health 13
insurance coverage offered through an Exchange or 14
otherwise in the State, the requirements referred to 15
in paragraph (1). 16
(d) E
FFECTIVEDATE; TRANSITION.— 17
(1) I
N GENERAL.—Subsection (a), (b), and (c) 18
shall apply to plan years beginning after the date of 19
the enactment of this Act. 20
(2) S
UNSETTING REQUIRED CONTRIBUTION FOR 21
ACA REINSURANCE PROGRAM .—No contribution shall 22
be required under section 1341 of Public Law 111– 23
148 (42 U.S.C. 18061) from any group health plan 24
or health insurance issuer for portions of plans years 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 21
•HR 3129 IH
occurring in months beginning more than 30 days 1
after the date of the enactment of this Act. 2
(e) S
ECRETARIALGUIDANCE.—The Secretary of 3
Health and Human Services, in coordination with the Sec-4
retary of Labor and the Secretary of the Treasury, shall 5
provide such guidance as may be necessary for the coordi-6
nated implementation of this section on a timely basis. 7
(f) T
RANSFERRINGHEALTHPLANRECORDSUPON 8
C
HANGINGPLANS.— 9
(1) I
N GENERAL.—In the case of an individual 10
who is covered under health insurance coverage or as 11
a beneficiary or participant in a group health plan 12
(as such terms are defined in section 2791 of the 13
Public Health Service Act, 42 U.S.C. 300gg–91), if 14
such coverage is ended and the individual obtains 15
other health insurance coverage, group health plan 16
coverage, or other creditable coverage (as defined for 17
purposes of title XXVII of such Act), the issuer of 18
the prior coverage or administrator of the prior plan 19
shall forward information respecting such prior cov-20
erage to the issuer of the new coverage or adminis-21
trator of the new plan or coverage, as the case may 22
be, subject to such rules as the Secretary establishes 23
regarding the right of the beneficiary or participant 24
to object to such forwarding of information. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 22
•HR 3129 IH
(2) TREATMENT AS PLAN REQUIREMENT 1
UNDER PHSA, ERISA, IRC.—The requirement of 2
paragraph (1) shall apply as if it were a section 3
under part A of title XXVII of the Public Health 4
Service Act, including for purposes of applying sec-5
tion 715 of the Employee Retirement Income Secu-6
rity Act of 1976 (29 U.S.C. 1185d) and section 7
9815 of the Internal Revenue Code of 1986. 8
(g) A
PPLICATION OFRISKADJUSTMENT.— 9
(1) I
N GENERAL.—Any issuer that offers health 10
insurance coverage in the individual market in any 11
of the 50 States or the District of Columbia shall 12
participate in a risk adjustment mechanism under 13
this subsection with respect to any health insurance 14
coverage it so offers in such market, whether or not 15
such coverage is offered through an Exchange. 16
(2) F
ORM AND DESIGN OF RISK ADJUSTMENT 17
MECHANISM.—The Secretary shall, in consultation 18
with the National Association of Insurance Commis-19
sioners and other interested parties, develop a mech-20
anism to permit the adjustment of risk among 21
health insurance coverage offered in the individual 22
market throughout the 50 States and the District of 23
Columbia. Such mechanism shall be designed to ef-24
fect the same type of risk adjustment among such 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 23
•HR 3129 IH
coverage that is applicable to risk adjustment of 1
payments among Medicare Advantage organizations 2
under part C of title XVIII of the Social Security 3
Act (42 U.S.C. 1395w–21 et seq.). 4
(3) T
RANSITION FOR NEW COVERAGE .—The 5
mechanism developed under paragraph (2) shall pro-6
vide for transitional protection, over a 3-year period, 7
in the case of health insurance coverage that has not 8
been previously marketed. 9
(4) D
EVELOPMENT OF FURTHER RISK ADJUST -10
MENT MECHANISM .—The Secretary shall request the 11
National Association of Insurance Commissioners to 12
develop a permanent model for adjustment of risk 13
among health insurance issuers with respect to 14
health insurance coverage offered in the individual 15
market, with the intention that such a model would 16
substitute for the mechanism developed under para-17
graph (2). 18
(5) T
REATMENT AS PLAN REQUIREMENT 19
UNDER PHSA, ERISA, IRC.—The requirement of 20
paragraph (1) shall apply as if it were a section 21
under part A of title XXVII of the Public Health 22
Service Act (42 U.S.C. 300gg et seq.), including for 23
purposes of applying section 715 of the Employee 24
Retirement Income Security Act of 1976 (29 U.S.C. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 24
•HR 3129 IH
1185d) and section 9815 of the Internal Revenue 1
Code of 1986. 2
SEC. 122. OFFERING OF BASIC HEALTH INSURANCE; PRO-3
TECTION OF ASSETS FROM LIABILITY OR AT-4
TACHMENT OR SEIZURE. 5
(a) R
EQUIREMENT FOR EXCHANGES.— 6
(1) I
N GENERAL.—No tax credit shall be allow-7
able under section 36B or 36C of the Internal Rev-8
enue Code of 1986 for residents of a State unless 9
any Exchange established in the State provides for 10
the offering of basic health insurance in all areas of 11
the State. 12
(2) B
ASIC HEALTH INSURANCE DEFINED .—In 13
this subsection, the term ‘‘basic health insurance’’ 14
means, with respect to a State, such health insur-15
ance coverage as the State may specify and includes 16
limited benefit insurance (as defined in subsection 17
(b)). 18
(b) L
IMITEDBENEFITINSURANCEDEFINED.— 19
(1) I
N GENERAL.—In this title, the term ‘‘lim-20
ited benefit insurance’’ means individual health in-21
surance coverage that, with respect to a plan year, 22
imposes (consistent with paragraph (2)) an annual 23
limit on the amounts that may be payable under the 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 25
•HR 3129 IH
coverage with respect to expenses incurred for items 1
and services furnished in that plan year. 2
(2) S
PECIFICATION OF ANNUAL LIMIT ; VARI-3
ATION IN LIMIT FOR INDIVIDUAL AND FAMILY COV -4
ERAGE.—The Secretary shall specify, from year to 5
year, the annual limit (or range of annual limits) 6
that may be applied under paragraph (1). Such a 7
limit may distinguish between coverage that is only 8
provided for an individual and coverage that is pro-9
vided also for family members of the individual. 10
(c) P
ROTECTION OFCERTAINASSETS INCASE OF 11
I
NDIVIDUALSCOVEREDUNDERLIMITEDBENEFITIN-12
SURANCE.— 13
(1) I
N GENERAL.—Notwithstanding any other 14
provision of law, if an individual is covered under 15
limited benefit insurance for a plan year and bene-16
fits under such insurance have reached the annual 17
limit under such insurance for items and services 18
furnished in the plan year, the individual is not lia-19
ble for debt incurred and arising from the provision 20
of subsequently furnished items and services during 21
the plan year, regardless of whether benefits are oth-22
erwise covered for such items and services under 23
such policy, insofar as the liability attributable to 24
such items and services exceeds— 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 26
•HR 3129 IH
(A) the bankruptcy valuation of the indi-1
vidual’s property at the time the debt is in-2
curred; reduced by 3
(B) such annual limit of benefits under the 4
limited benefit insurance for the plan year. 5
Property in the amount so protected from liability 6
shall be exempt and immune from attachment or sei-7
zure with respect to any judgment related to such 8
debt. 9
(2) B
ANKRUPTCY VALUATION DEFINED .—In 10
this subsection, the term ‘‘bankruptcy valuation’’ 11
means, with respect to property of an individual as 12
of a date, the value of the property as of such date 13
as determined as if the individual were a debtor in 14
a bankruptcy case that could have been filed under 15
title 11 of the United States Code and the property 16
could not be exempt under section 522 of such title. 17
(3) N
O REQUIREMENT FOR PROVIDERS TO FUR -18
NISH SUBSEQUENT SERVICES WITHOUT ENSURING 19
PAYMENT.—Except as may be explicitly provided in 20
other law (such as under section 1867 of the Social 21
Security Act, 42 U.S.C. 1395dd; popularly known as 22
EMTALA), a health care provider is not required to 23
furnish any items or services to an individual who 24
has exhausted benefits under limited benefit insur-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 27
•HR 3129 IH
ance for a plan year without the individual (or an-1
other person on the individual’s behalf) providing for 2
such advance or guarantee of payment for such 3
items and services as may be arranged between the 4
health care provider and the individual. 5
SEC. 123. ENSURING ACCESS TO SHORT-TERM LIMITED DU-6
RATION INSURANCE. 7
Section 2791(b)(5) of the Public Health Service Act 8
(42 U.S.C. 300gg–91(b)(5)) is amended by inserting ‘‘(as 9
defined in the rule entitled ‘Short-Term, Limited Duration 10
Insurance’ (83 Fed. Reg. 38212 (August 3, 2018)))’’ after 11
‘‘short-term limited duration insurance’’. 12
SEC. 124. MAKING TELEHEALTH FLEXIBILITIES PERMA-13
NENT. 14
Notwithstanding any other provision of law, in the 15
case of any provision of section 1834(m) of the Social Se-16
curity Act (42 U.S.C. 1395m(m)) that would, absent this 17
section, end on the last day of the emergency period de-18
scribed in section 1135(g)(1)(B) of the Social Security Act 19
(42 U.S.C. 1320b–5(a)(1)(B)) or December 1, 2024, such 20
provision shall be deemed to continue to apply on or after 21
such last day or such date (as applicable). 22
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 28
•HR 3129 IH
Subtitle C—Health Insurance Tax 1
Benefit 2
SEC. 131. HEALTH INSURANCE TAX BENEFIT. 3
(a) I
NGENERAL.—Subpart C of part IV of sub-4
chapter A of chapter 1 of the Internal Revenue Code of 5
1986 is amended by inserting after section 36B the fol-6
lowing new section: 7
‘‘SEC. 36C. HEALTH INSURANCE TAX CREDIT. 8
‘‘(a) I
NGENERAL.—In the case of an individual who 9
is a qualified resident, there shall be allowed as a credit 10
against the tax imposed by this subtitle for any taxable 11
year an amount equal to the health credit amount of the 12
taxpayer for the taxable year. 13
‘‘(b) H
EALTHCREDITAMOUNT.—For purposes of 14
this section— 15
‘‘(1) I
N GENERAL.—The term ‘health credit 16
amount’ means the sum of the amounts determined 17
under paragraph (2) with respect to all months of 18
the taxpayer for the taxable year. 19
‘‘(2) M
ONTHLY CREDIT AMOUNT .— 20
‘‘(A) I
N GENERAL.—Subject to paragraph 21
(4), the amount determined under this para-22
graph with respect to any month shall be an 23
amount equal to the sum of— 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 29
•HR 3129 IH
‘‘(i)
1
∕12of $4,000 in the case of any 1
month the first day of which the taxpayer 2
is a qualified resident and is covered by 3
creditable coverage (twice such amount in 4
the case of a joint return if both spouses 5
are so covered by creditable coverage and 6
are qualified residents), plus 7
‘‘(ii)
1
∕12of an amount equal to 8
$2,000 multiplied by the number of quali-9
fying children (within the meaning of sec-10
tion 152) who are qualified residents 11
and— 12
‘‘(I) for whom the taxpayer is al-13
lowed a deduction under section 151 14
for the taxable year in which such 15
month ends, and 16
‘‘(II) who are covered by cred-17
itable coverage on the first day of 18
such month. 19
‘‘(B) C
ARRYFORWARD OF MONTHLY CRED -20
IT AMOUNT IN CASE CREDIT AMOUNT EXCEEDS 21
HSA CONTRIBUTIONS AND PREMIUM PAY -22
MENTS.—In the case of any month for which 23
the credit amount determined with respect to 24
the taxpayer under subparagraph (A) exceeds 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 30
•HR 3129 IH
the limitation amount determined with respect 1
to the taxpayer for such month under para-2
graph (3), such excess may be carried forward 3
to any subsequent month during the taxable 4
year for purposes of determining the credit 5
amount for such month under this paragraph. 6
‘‘(3) M
ONTHLY LIMITATION.— 7
‘‘(A) I
N GENERAL.—The amount deter-8
mined under paragraph (2) for any month of 9
the taxpayer shall not exceed the sum of— 10
‘‘(i) the amounts contributed to a 11
health savings account of the taxpayer for 12
such month, plus 13
‘‘(ii) the premiums paid by the tax-14
payer for creditable coverage. 15
‘‘(B) C
ARRYFORWARD OF MONTHLY LIMI -16
TATION IN CASE HSA CONTRIBUTIONS AND PRE -17
MIUM PAYMENTS EXCEED MONTHLY CREDIT 18
AMOUNT.—In the case of any month for which 19
the amount determined with respect to the tax-20
payer under subparagraph (A) exceeds the cred-21
it amount determined with respect to the tax-22
payer for such month under paragraph (2), 23
such excess may be carried forward to any sub-24
sequent month during the taxable year for pur-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 31
•HR 3129 IH
poses of determining the limitation under sub-1
paragraph (A). 2
‘‘(4) A
DJUSTMENT FOR LIMITED BENEFIT IN -3
SURANCE.—In the case of a taxpayer whose only 4
health insurance coverage for a month is limited 5
benefit insurance (as defined in section 123(b) of the 6
Health Care Fairness for All Act), the amount de-7
termined under paragraph (2) shall be decreased by 8
such proportion as the Secretary, in consultation 9
with the Secretary of Health and Human Services, 10
determines appropriate, taking into account the ratio 11
of the actuarial value of such limited benefit insur-12
ance to the average actuarial value of health insur-13
ance coverage that is not limited benefit insurance. 14
‘‘(c) C
OORDINATION WITHEMPLOYER-PROVIDED 15
H
EALTHINSURANCETAXSUBSIDY.— 16
‘‘(1) C
REDIT LIMITED BY EMPLOYER -PROVIDED 17
HEALTH INSURANCE TAX SUBSIDY .—The credit al-18
lowed under this section for any taxable year shall 19
not exceed an amount equal to the excess (if any) 20
of— 21
‘‘(A) the maximum credit which would be 22
allowed for all months of the taxpayer during 23
the taxable year (determined under subsection 24
(b)(2) and without regard to this subsection, 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 32
•HR 3129 IH
the limitation under subsection (b)(3), and any 1
reduction under subsection (d)(1)), over 2
‘‘(B) the taxpayer’s employer-provided 3
health insurance tax subsidy for the taxable 4
year. 5
‘‘(2) E
XCESS EMPLOYER-PROVIDED HEALTH IN -6
SURANCE TAX SUBSIDY INCLUDED IN GROSS IN -7
COME.—In the case of a taxpayer for whom sub-8
paragraph (B) of paragraph (1) exceeds subpara-9
graph (A) of such paragraph for the taxable year, 10
the tax imposed by this chapter shall be increased 11
for such taxable year by the amount of such excess. 12
‘‘(3) E
MPLOYER-PROVIDED HEALTH INSURANCE 13
TAX SUBSIDY.—For purposes of this subsection— 14
‘‘(A) I
N GENERAL.—The term ‘employer- 15
provided health insurance tax subsidy’ means, 16
with respect to any taxpayer for a taxable year, 17
the sum of— 18
‘‘(i) the Federal income tax subsidy of 19
the taxpayer for the taxable year, plus 20
‘‘(ii) the Federal payroll tax subsidy 21
of the taxpayer for the taxable year. 22
‘‘(B) F
EDERAL INCOME TAX SUBSIDY .— 23
The term ‘Federal income tax subsidy’ means, 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 33
•HR 3129 IH
with respect to any taxpayer for the taxable 1
year, the excess (if any) of— 2
‘‘(i) the amount of tax that would 3
have been imposed by this chapter for the 4
taxable year had such tax been determined 5
without regard to this section and by in-6
cluding amounts otherwise excluded from 7
gross income which were paid by or on be-8
half of the taxpayer for employer-provided 9
insurance that constitutes medical care, 10
over 11
‘‘(ii) the amount of tax imposed by 12
this chapter for the taxable year (deter-13
mined without regard to this section). 14
‘‘(C) F
EDERAL PAYROLL TAX SUBSIDY .— 15
The term ‘Federal payroll tax subsidy’ means, 16
with respect to any taxpayer for the taxable 17
year, the excess (if any) of— 18
‘‘(i) the sum of— 19
‘‘(I) the amount of tax that 20
would have been imposed by chapter 21
21 with respect to any wages of the 22
taxpayer paid during the taxable year 23
had such tax been determined by in-24
cluding amounts otherwise excluded 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 34
•HR 3129 IH
from wages which were paid by or on 1
behalf of the taxpayer during the tax-2
able year for employer-provided insur-3
ance that constitutes medical care, 4
plus 5
‘‘(II) the amount of tax that 6
would have been imposed by chapter 2 7
on any self-employment income of the 8
taxpayer for such taxable year had 9
self-employment income been deter-10
mined without regard to any deduc-11
tion from gross income for amounts 12
paid for insurance which constitutes 13
medical care for the taxpayer, the tax-14
payer’s spouse, and any qualifying 15
children (within the meaning of sec-16
tion 152) for whom the taxpayer is al-17
lowed a deduction under section 151 18
for the taxable year, over 19
‘‘(ii) the amount of tax imposed with 20
respect to the taxpayer during such taxable 21
year under chapter 21 and for such taxable 22
year under chapter 2. 23
‘‘(d) R
ECONCILIATION OF CREDIT ANDADVANCE 24
C
REDIT.— 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 35
•HR 3129 IH
‘‘(1) IN GENERAL.—The amount of the credit 1
allowed under this section for any taxable year (after 2
the application of subsections (b) and (c)) shall be 3
reduced (but not below zero) by the amount of any 4
advance payment of such credit under subsection 5
(e)(1). 6
‘‘(2) E
XCESS ADVANCE PAYMENTS .— 7
‘‘(A) I
N GENERAL.—If the advance pay-8
ments to a taxpayer under subsection (e)(1) for 9
a taxable year exceed the credit allowed by this 10
section (determined without regard to para-11
graph (1)), the tax imposed by this chapter for 12
the taxable year shall be increased by the 13
amount of such excess. 14
‘‘(B) L
IMITATION ON INCREASE .—In the 15
case of a taxpayer whose household income is 16
less than 400 percent of the poverty line for the 17
size of the family involved for the taxable year, 18
the amount of the increase under subparagraph 19
(A) shall in no event exceed an amount equal 20
to the applicable percentage of the amount of 21
the credit allowed under this section for the 22
taxable year, determined in accordance with the 23
following table (one-half of such amount so de-24
termined in the case of a taxpayer whose tax is 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 36
•HR 3129 IH
determined under section 1(c) for the taxable 1
year): 2
‘‘If the household income
(expressed as a percent
of poverty line) is:
The applicable
percentage
is:
Less than 200% .............................................................. 30%
At least 200% but less than 300% ................................ 50%
At least 300% but less than 400% ................................ 80%
‘‘(e) SPECIALRULES.—For purpose of this section— 3
‘‘(1) A
DVANCE PAYMENT PROGRAM .— 4
‘‘(A) I
N GENERAL.—The Secretary of the 5
Treasury, in consultation with the Secretary of 6
Health and Human Services, shall establish a 7
program— 8
‘‘(i) to make advance determinations 9
with respect to the eligibility of individuals 10
for the credit allowed under this section, 11
and 12
‘‘(ii) to make advance payments of the 13
credit allowed under this section, at the 14
election of any such individual so eligible, 15
directly to the health savings account of 16
any such individual, or, as a subsidy to the 17
cost of health insurance coverage provided 18
to any such individual, to the health insur-19
ance issuer providing such coverage or the 20
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 37
•HR 3129 IH
person that administers the plan benefits 1
with respect to such coverage. 2
‘‘(B) P
ROGRAM REQUIREMENTS .—Such 3
program shall be established under rules similar 4
to the rules of section 1412 of Public Law 111– 5
148, as in effect on the day before the date of 6
the enactment of this section, except that ad-7
vance determinations and advance payments 8
shall be made on request of the individual with 9
respect to whom the determination is to be 10
made. 11
‘‘(2) I
NFORMATION REQUIREMENTS .— 12
‘‘(A) I
N GENERAL.—Each person providing 13
health insurance coverage which constitutes 14
medical care, and each trustee of a health sav-15
ings account, shall provide the following infor-16
mation to the Secretary and to the taxpayer 17
with respect to such coverage or such account: 18
‘‘(i) The total premium for the cov-19
erage without regard to the credit under 20
this section. 21
‘‘(ii) The aggregate amount of any ad-22
vance payment of such credit made with 23
respect to such coverage or to such ac-24
count. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 38
•HR 3129 IH
‘‘(iii) The name, address, age, and 1
TIN of the primary insured or account 2
holder (as the case may be) and the name, 3
age, and TIN of each other individual ob-4
taining coverage under such policy of in-5
surance. 6
‘‘(iv) Any information provided to 7
such person necessary to determine eligi-8
bility for, and the amount of, such credit. 9
‘‘(v) Information necessary to deter-10
mine whether a taxpayer has received ex-11
cess advance payments. 12
‘‘(B) E
XCEPTION.—Subparagraph (A) 13
shall not apply to any coverage with respect to 14
which reporting under section 6051 is required. 15
‘‘(3) I
NDEXING.— 16
‘‘(A) I
N GENERAL.—In the case of any cal-17
endar year beginning after 2024, each of the 18
dollar amounts in subsection (b)(2) and in the 19
table contained under subsection (d)(2)(B) shall 20
be equal to such dollar amount multiplied by 21
the ratio of— 22
‘‘(i) the current dollar gross domestic 23
product (as determined based on the third 24
estimate of the Bureau of Economic Anal-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 39
•HR 3129 IH
ysis of the Department of Commerce for 1
the second quarter of the previous year), to 2
‘‘(ii) the current dollar gross domestic 3
product (as so determined) for the second 4
quarter of 2023. 5
‘‘(B) R
OUNDING.—If the amount of any 6
change under subparagraph (A) is not a mul-7
tiple of $50, such change shall be rounded to 8
the next lowest multiple of $50. 9
‘‘(f) D
EFINITIONS.—For purposes of this section— 10
‘‘(1) C
REDITABLE COVERAGE .— 11
‘‘(A) I
N GENERAL.—The term ‘creditable 12
coverage’ has the meaning given such term for 13
purposes of title XXVII of the Public Health 14
Service Act. Such term shall not include cov-15
erage under any health plan that includes cov-16
erage for abortions (other than any abortion de-17
scribed in subparagraph (B)). 18
‘‘(B) E
XCEPTION.—The second sentence of 19
subparagraph (A) shall not apply to an abor-20
tion— 21
‘‘(i) if the pregnancy is the result of 22
an act of rape or incest, or 23
‘‘(ii) in the case where a woman suf-24
fers from a physical disorder, physical in-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 40
•HR 3129 IH
jury, or physical illness that would, as cer-1
tified by a physician, place the woman in 2
danger of death unless an abortion is per-3
formed, including a life-endangering phys-4
ical condition caused by or arising from 5
the pregnancy itself. 6
‘‘(C) S
EPARATE ABORTION COVERAGE OR 7
PLAN ALLOWED.— 8
‘‘(i) O
PTION TO PURCHASE SEPARATE 9
COVERAGE OR PLAN.—Nothing in subpara-10
graph (A) shall be construed as prohibiting 11
any individual from purchasing separate 12
coverage for abortions described in such 13
subparagraph, or a health plan that in-14
cludes such abortions, so long as no credit 15
is allowed under this section with respect 16
to the premiums for such coverage or plan. 17
‘‘(ii) O
PTION TO OFFER COVERAGE OR 18
PLAN.—Nothing in subparagraph (A) shall 19
restrict any non-Federal health insurance 20
issuer offering a health plan from offering 21
separate coverage for abortions described 22
in such subparagraph, or a plan that in-23
cludes such abortions, so long as premiums 24
for such separate coverage or plan are not 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 41
•HR 3129 IH
paid for with any amount attributable to 1
the credit allowed under this section (or 2
the amount of any advance payment of the 3
credit). 4
‘‘(2) Q
UALIFIED RESIDENT.—The term ‘quali-5
fied resident’ means an individual who is a citizen or 6
national of the United States or otherwise lawfully 7
residing in the United States under color of law.’’. 8
(b) D
ISQUALIFICATIONFROMEXCHANGEPLANSUB-9
SIDIES FORINDIVIDUALONCETHEYELECTTAXBENE-10
FITS.—Section 36B(c)(1) of such Code is amended by 11
adding at the end the following new subparagraph: 12
‘‘(F) D
ENIAL OF CREDIT FOR THOSE 13
ELECTING UNIVERSAL CREDIT .—In the case of 14
an individual who is allowed a credit under sec-15
tion 36C for any taxable year, no credit shall be 16
allowed under this section to such individual for 17
such taxable year or any subsequent taxable 18
year.’’. 19
(c) G
UIDANCE.—The Secretary of the Treasury shall 20
issue such guidance as is necessary— 21
(1) to assist employees and employers in adjust-22
ing Federal income tax withholding to take into ac-23
count the health insurance tax credit under section 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 42
•HR 3129 IH
36C of the Internal Revenue Code of 1986 (and any 1
advance payment thereof), and 2
(2) to require employers to report to each em-3
ployee with respect to periods not longer than quar-4
terly the employer-provided health insurance tax 5
subsidy (as defined in section 36C(c)(2) of such 6
Code) with respect to such employee for such period. 7
(d) T
RANSFERS TOFEDERALOLD-AGE ANDSUR-8
VIVORSINSURANCETRUSTFUND.—With respect to each 9
individual for whom tax is increased under section 10
36C(c)(2), there are hereby appropriated to the Federal 11
Old Age and Survivors Trust Fund and the Disability In-12
surance Trust Fund established under section 201 of the 13
Social Security Act amounts equal to the amount which 14
bears the same ratio to the amount of such increase as— 15
(1) the Federal payroll tax subsidy (as defined 16
in section 36C(c)(3)) of such individual for the tax-17
able year, bears to 18
(2) the employer-provided health insurance tax 19
subsidy (as defined in such section) of the individual 20
for the taxable year. 21
(e) C
LERICALAMENDMENT.—The table of sections 22
for subpart C of part IV of subchapter A of chapter 1 23
of the Internal Revenue Code of 1986 is amended by in-24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 43
•HR 3129 IH
serting after the item relating to section 36B the following 1
new item: 2
‘‘Sec. 36C. Health insurance tax credit.’’.
(f) EFFECTIVEDATE.—The amendments made by 3
this section shall apply to taxable years beginning after 4
December 31, 2023. 5
SEC. 132. APPLICATION OF PORTION OF UNUSED TAX 6
CREDITS BY STATES FOR INDIGENT HEALTH 7
CARE. 8
(a) C
OMPUTATION OF UNUSEDCREDITS.—The Sec-9
retary, in consultation with the Secretary of the Treasury, 10
shall calculate for each State for each year, beginning with 11
2024, using the most recent data available — 12
(1) the maximum aggregate amount of credits 13
under section 36C of the Internal Revenue Code of 14
1986 that would have been allowed for the year for 15
qualified residents of the State for taxable years 16
ending in the year if all eligible qualified residents 17
had qualified for such credits; 18
(2) the aggregate amount of credits under such 19
section that were allowed for taxable years ending in 20
the year by qualified residents of such State; and 21
(3) 25 percent of the amount by which— 22
(A) the amount determined under para-23
graph (1) with respect to qualified residents of 24
the State for such year; exceeds 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 44
•HR 3129 IH
(B) the amount determined under para-1
graph (2) for such State for that year. 2
(b) A
PPROPRIATION.—For the purpose of making 3
grants to States under this section, there is hereby appro-4
priated to the Secretary, out of any funds in the Treasury 5
not otherwise appropriated, for each year (beginning with 6
2023) an amount equivalent to the amount determined 7
under subsection (a)(3) for all States under subsection (a) 8
for the year in which such fiscal year ends, subject to ad-9
justment under subsection (d)(2). 10
(c) G
RANTS TOSTATES FOR INDIGENTASSIST-11
ANCE.— 12
(1) A
PPLICATION.—A State may file with the 13
Secretary (in a form and manner specified by the 14
Secretary) an application to provide assistance in 15
furnishing health services to indigent individuals re-16
siding in the State. Such application shall dem-17
onstrate the manner in which such assistance is fur-18
nished in an equitable manner to individuals residing 19
in all parts of the State. 20
(2) A
MOUNT OF FUNDS .—From the funds ap-21
propriated under subsection (b) for a year, the 22
amount of funds paid to any State in any year 23
under this section with an application filed in ac-24
cordance with paragraph (1) is equal to an amount 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 45
•HR 3129 IH
specified in the application, but not to exceed the 1
amount computed under subsection (a)(3) for the 2
State and the year. 3
(3) U
SE OF FUNDS.—Funds paid to a State 4
under this subsection may be used only to assist in 5
the furnishing of health services to uninsured indi-6
viduals residing in the State or for purposes of in-7
creasing the payment adjustments made under sec-8
tions 1886(d)(5)(F) and 1923 of the Social Security 9
Act (42 U.S.C. 1395ww(d)(5)(F), 1396r–4) to hos-10
pitals that serve a disproportionate share of such in-11
dividuals in the State. 12
(d) I
NITIALESTIMATE; FINALCALCULATION AND 13
R
ECONCILIATION.— 14
(1) U
SE OF ESTIMATES .—The calculations 15
under subsection (a) for a year shall initially be esti-16
mated before the beginning of the year. Payments 17
under this section to a State for a year shall be 18
made, subject to reconciliation under paragraph (2), 19
based on the amount so estimated. 20
(2) R
ECONCILIATION BASED ON FINAL CAL -21
CULATION.—The calculations under subsection (a) 22
for a year shall also be made after the end of the 23
year. Insofar as the amount calculated under this 24
paragraph for subsection (a)(3) for a State for a 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 46
•HR 3129 IH
year exceeds (or is less than) by a material amount 1
from the amount for subsection (a)(3) estimated and 2
applied for the State and year under paragraph (1), 3
the amount calculated under subsection (a)(3) for 4
the State for the 2nd year beginning after such year, 5
shall be reduced or increased, respectively by the 6
amount of such excess or deficit. 7
SEC. 133. MEDICAID OPTION OF ENROLLMENT UNDER PRI-8
VATE PLAN AND CONTRIBUTION TO AN HSA. 9
(a) I
NGENERAL.—Notwithstanding any other provi-10
sion of law, a State plan under title XIX of the Social 11
Security Act (42 U.S.C. 1396 et seq.) may make available 12
to an individual, who is entitled to medical assistance for 13
a full range of acute care items and services under such 14
title and at the individual’s option, instead of the medical 15
assistance otherwise provided, medical assistance con-16
sisting of coverage under a health plan that qualifies for 17
a tax credit under section 36C of the Internal Revenue 18
Code of 1986, but only if the State provides for the indi-19
vidual medical assistance, in the form of a deposit into 20
a health savings account for the individual, an amount 21
equivalent to the amount by which the amount of tax cred-22
it for the individual under such section exceeds the cost 23
of coverage of the individual under the plan. 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 47
•HR 3129 IH
(b) FFP TREATMENT.—The payments by a State de-1
scribed in subsection (a) for coverage under a health plan 2
and for deposit into a health savings account shall be 3
treated as medical assistance for purposes of section 1903 4
of the Social Security Act (42 U.S.C. 1396b) and subject 5
to Federal financial participating, including the applica-6
tion of State matching payments, in the same manner as 7
other medical assistance furnished under title XIX of such 8
Act, except that such amount shall be reduced by the 9
amount of any health insurance credits provided under 10
section 36C of the Internal Revenue Code of 1986 with 11
respect to such coverage or deposit. 12
SEC. 134. REPEAL OF REPORTING REQUIREMENTS RELAT-13
ING TO EMPLOYEE HEALTH INSURANCE PRE-14
MIUMS AND HEALTH PLAN BENEFITS. 15
(a) R
EPORTINGREQUIREMENTS.—Section 6051(a) 16
of the Internal Revenue Code of 1986 is amended by strik-17
ing paragraph (14) and by redesignating paragraphs (15), 18
(16), and (17) as paragraphs (14), (15), and (16), respec-19
tively. 20
(b) E
FFECTIVEDATES.—The amendment made by 21
this section shall apply to calendar years beginning after 22
December 31, 2018. 23
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 48
•HR 3129 IH
SEC. 135. REPORT. 1
For each year beginning on or after the date of the 2
enactment of this Act, the Secretary of Health and 3
Human Services shall submit to Congress a report on the 4
extent to which health insurance tax credits allowed under 5
section 36C of the Internal Revenue Code of 1986, as 6
added by this Act, are sufficient to cover the cost of health 7
insurance coverage for individuals electing to purchase 8
such coverage. 9
Subtitle D—Medicare Reforms 10
SEC. 141. PHYSICIAN-OWNED HOSPITALS. 11
The amendments made by section 6001 of Public 12
Law 111–148 are repealed and the provisions amended 13
by such section are restored as if such amendments had 14
never occurred. 15
SEC. 142. PROHIBITING THE USE OF AN INPATIENT-ONLY 16
LIST IN DESIGNATING HOSPITAL OUT-17
PATIENT SERVICES UNDER THE MEDICARE 18
PROGRAM. 19
Section 1833(t)(1) of the Social Security Act (42 20
U.S.C. 1395l(t)(1)) is amended by adding at the end the 21
following new subparagraph: 22
‘‘(C) P
ROHIBITION ON USE OF AN INPA -23
TIENT-ONLY LIST.—In designating outpatient 24
hospital services pursuant to subparagraph 25
(B)(i), the Secretary may not refuse to so des-26
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 49
•HR 3129 IH
ignate such a service based solely on the Sec-1
retary’s determination that such service may 2
only be safely furnished in an inpatient set-3
ting.’’. 4
SEC. 143. PROMOTING MEDICARE SITE-NEUTRAL PAY-5
MENTS. 6
(a) R
EMOVINGCERTAINEXCEPTIONS TO THE DEFI-7
NITION OF ANOFF-CAMPUSOUTPATIENTDEPARTMENT 8
OF APROVIDER.— 9
(1) I
N GENERAL.—Section 1833(t)(21)(B) of 10
the Social Security Act (42 U.S.C. 1395l(t)(21)(B)) 11
is amended to read as follows: 12
‘‘(B) O
FF-CAMPUS OUTPATIENT DEPART -13
MENT OF A PROVIDER .—For purposes of para-14
graph (1)(B)(v) and this paragraph, the term 15
‘off-campus outpatient department of a pro-16
vider’ means a department of a provider (as de-17
fined in section 413.65(a)(2) of title 42 of the 18
Code of Federal Regulations, as in effect as of 19
the date of the enactment of the Bipartisan 20
Budget Act of 2015) that is not located— 21
‘‘(i) on the campus (as defined in such 22
section 413.65(a)(2)) of such provider; or 23
‘‘(ii) within the distance (described in 24
such definition of campus) from a remote 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 50
•HR 3129 IH
location of a hospital facility (as defined in 1
such section 413.65(a)(2)).’’. 2
(2) E
FFECTIVE DATE.—The amendment made 3
by paragraph (1) shall apply with respect to items 4
and services furnished on or after January 1, 2024. 5
(3) R
EMOVING SITE-NEUTRAL EXCEPTION FOR 6
OFF-CAMPUS EMERGENCY DEPARTMENTS .—Section 7
1833(t)(21)(A) of the Social Security Act (42 8
U.S.C. 1395l(t)(21)(A)) is amended by inserting 9
‘‘before January 1, 2024’’ after ‘‘furnished’’. 10
(4) C
LARIFYING SECRETARIAL AUTHORITY TO 11
PROMOTE SITE -NEUTRAL PAYMENTS .—Section 12
1833(t)(2)(F) of the Social Security Act (42 U.S.C. 13
1395l(t)(2)(F)) is amended by adding at the end the 14
following new sentence: ‘‘Such method may include 15
actions determined appropriate by the Secretary to 16
promote site-neutral payment policies to reduce ex-17
penditures attributable to items and services fur-18
nished under this part, such as actions to prevent 19
hospitals from billing for items and services fur-20
nished at an off-campus outpatient department of a 21
provider as if such items and services were furnished 22
at such hospital.’’. 23
(b) E
NSURINGSEPARATENPIS FOROFF-CAMPUS 24
O
UTPATIENTDEPARTMENTS OF APROVIDER.— 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 51
•HR 3129 IH
(1) IN GENERAL.—Section 1173(b) of the So-1
cial Security Act (42 U.S.C. 1320d–2(b)) is amend-2
ed by adding at the end the following new para-3
graph: 4
‘‘(3) E
NSURING SEPARATE NPIS FOR OFF -CAM-5
PUS OUTPATIENT DEPARTMENTS OF A PROVIDER .— 6
The standards specified under paragraph (1) shall 7
ensure that, not later than January 1, 2024, each 8
off-campus outpatient department of a provider (as 9
defined in section 1833(t)(21)(B)) is assigned a sep-10
arate unique health identifier from such provider.’’. 11
(2) T
REATMENT OF CERTAIN DEPARTMENTS AS 12
SUBPARTS OF A HOSPITAL .—Not later than January 13
1, 2024, the Secretary of Health and Human Serv-14
ices shall revise sections 162.408 and 162.410 of 15
title 45, Code of Federal Regulations, to ensure that 16
each off-campus outpatient department of a provider 17
(as defined in section 1833(t)(21)(B) of the Social 18
Security Act (42 U.S.C. 1395l(t)(21)(B))) is treated 19
as a subpart (as described in such sections) of such 20
provider and assigned a unique health identifier pur-21
suant to section 1173(b)(3) of such Act (as added 22
by paragraph (1)). 23
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 52
•HR 3129 IH
SEC. 144. MEDICARE ADVANTAGE CONTRIBUTIONS TO 1
ROTH HSAS FOR CHRONICALLY ILL ENROLL-2
EES. 3
Section 1852(a)(3)(D) of the Social Security Act (42 4
U.S.C. 1395w–22(a)(3)(D)) is amended— 5
(1) by striking ‘‘are supplemental benefits’’ and 6
inserting the following: ‘‘are 7
‘‘(aa) supplemental bene-8
fits’’; 9
(2) by striking the period at the end of item 10
(aa), as inserted by paragraph (1), and inserting ‘‘; 11
and’’; and 12
(3) by adding at the end the following new 13
item: 14
‘‘(bb) deposits made to a 15
Roth HSA (as described in sec-16
tion 530A of the Internal Rev-17
enue Code of 1986) of a chron-18
ically ill enrollee.’’. 19
SEC. 145. EXTENDING ACUTE HOSPITAL CARE AT HOME 20
WAIVER FLEXIBILITIES. 21
Section 1812 of the Social Security Act (42 U.S.C. 22
1395d) is amended— 23
(1) by redesignating subsection (g) as sub-24
section (h); and 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 53
•HR 3129 IH
(2) by inserting after subsection (f) the fol-1
lowing new subsection: 2
‘‘(g)(1) Beginning on the date of the enactment of 3
this subsection, inpatient hospital services or inpatient 4
critical access hospital services described in subsection 5
(a)(1) shall include services (including telehealth services 6
as defined in section 1834(m)) furnished to an individual 7
by an Acute Hospital Care at Home Program (as defined 8
by the Secretary). 9
‘‘(2) With respect to telehealth services furnished by 10
an Acute Hospital Care at Home Program described in 11
paragraph (1), the requirements described in section 12
1834(m)(4)(C)(i) shall not apply and the sites described 13
in section 1834(m)(4)(C)(ii) shall include the home or 14
temporary residence of the individual. 15
‘‘(3) With respect to services furnished in the home 16
or temporary residence of the individual through an Acute 17
Hospital Care at Home Program, the requirement for pro-18
viding 24-hour nursing services and immediate availability 19
of nursing services as conditions of participation shall also 20
be satisfied by providing virtual access to nurses, advanced 21
practice providers, or physicians 24 hours per day. 22
‘‘(4) With respect to services furnished in the home 23
or temporary residence of the individual through an Acute 24
Hospital Care at Home Program, life safety code require-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 54
•HR 3129 IH
ments shall be deemed satisfied for homes or temporary 1
residences determined to be safe and appropriate for this 2
care by the Acute Hospital Care at Home Program. 3
‘‘(5) Not later than 12 months after the date of the 4
enactment of this subsection, the Secretary shall issue reg-5
ulations establishing health and safety requirements for 6
Acute Hospital Care at Home Programs.’’. 7
TITLE II—IMPROVING HEALTH 8
SAVINGS ACCOUNTS TO PRO-9
MOTE ACCOUNTABILITY 10
SEC. 201. TRANSITION TO NON-DEDUCTIBLE HSAS. 11
(a) N
ON-DEDUCTIBLEHSAS.—Subchapter F of 12
chapter 1 of the Internal Revenue Code of 1986 is amend-13
ed by adding at the end the following new part: 14
‘‘PART IX—ROTH HEALTH SAVINGS ACCOUNTS 15
‘‘Sec. 530A. Roth HSAs.
‘‘SEC. 530A. ROTH HSAS.
16
‘‘(a) I
NGENERAL.—A Roth HSA shall be exempt 17
from taxation under this subtitle. Notwithstanding the 18
preceding sentence, the Roth HSA shall be subject to the 19
taxes imposed by section 511 (relating to imposition of 20
tax on unrelated business income of charitable organiza-21
tions). No deduction shall be allowed for any contribution 22
to a Roth HSA. 23
‘‘(b) D
OLLARLIMITATION.— 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 55
•HR 3129 IH
‘‘(1) IN GENERAL.—The aggregate amount of 1
contributions for any taxable year to all Roth HSAs 2
maintained for the benefit of an individual shall not 3
exceed the sum of the monthly limitations for any 4
month during such taxable year that the individual 5
is an eligible individual. 6
‘‘(2) M
ONTHLY LIMITATION.—The monthly lim-7
itation for any month is
1
∕12of— 8
‘‘(A) in the case of an eligible individual 9
who has self-only creditable coverage as of the 10
first day of such month, $5,000, and 11
‘‘(B) in the case of an eligible individual 12
who has family creditable coverage as of the 13
first day of such month, the amount in effect 14
under subparagraph (A) for the taxable year 15
multiplied by the number of individuals (includ-16
ing the eligible individual) covered under such 17
family creditable coverage as of such day. 18
‘‘(3) A
DDITIONAL CONTRIBUTIONS FOR INDI -19
VIDUALS 55 OR OLDER.—In the case of an individual 20
who has attained age 55 before the close of the tax-21
able year, the applicable limitation under subpara-22
graphs (A) and (B) of paragraph (2) shall be in-23
creased by $1,000. 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 56
•HR 3129 IH
‘‘(4) COORDINATION WITH OTHER CONTRIBU -1
TIONS.—The limitation which would (but for this 2
paragraph) apply under this subsection to an indi-3
vidual for any taxable year shall be reduced (but not 4
below zero) by the sum of— 5
‘‘(A) the aggregate amount paid for such 6
taxable year to Archer MSAs of such individual, 7
‘‘(B) the aggregate amount contributed to 8
Roth HSAs of such individual which is exclud-9
able from the taxpayer’s gross income for such 10
taxable year under section 106(d) (and such 11
amount shall not be allowed as a deduction 12
under subsection (a)), and 13
‘‘(C) the aggregate amount contributed to 14
Roth HSAs of such individual for such taxable 15
year under section 408(d)(9) (and such amount 16
shall not be allowed as a deduction under sub-17
section (a)). 18
Subparagraph (A) shall not apply with respect to 19
any individual to whom paragraph (5) applies. 20
‘‘(5) S
PECIAL RULE FOR MARRIED INDIVID -21
UALS.—In the case of individuals who are married 22
to each other, if either spouse has family coverage— 23
‘‘(A) both spouses shall be treated as hav-24
ing only such family coverage (and if such 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 57
•HR 3129 IH
spouses each have family coverage under dif-1
ferent plans, as having the family coverage with 2
the lowest annual deductible), and 3
‘‘(B) the limitation under paragraph (1) 4
(after the application of subparagraph (A) and 5
without regard to any additional contribution 6
amount under paragraph (3))— 7
‘‘(i) shall be reduced by the aggregate 8
amount paid to Archer MSAs of such 9
spouses for the taxable year, and 10
‘‘(ii) after such reduction, shall be di-11
vided equally between them unless they 12
agree on a different division. 13
‘‘(6) D
ENIAL OF DEDUCTION TO DEPEND -14
ENTS.—No contribution may be made to a Roth 15
HSA under this section by any individual with re-16
spect to whom a deduction under section 151 is al-17
lowable to another taxpayer for a taxable year begin-18
ning in the calendar year in which such individual’s 19
taxable year begins. 20
‘‘(7) I
NCREASE IN LIMIT FOR INDIVIDUALS BE -21
COMING ELIGIBLE INDIVIDUALS AFTER THE BEGIN -22
NING OF THE YEAR.— 23
‘‘(A) I
N GENERAL.—For purposes of com-24
puting the limitation under paragraph (1) for 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 58
•HR 3129 IH
any taxable year, an individual who is an eligi-1
ble individual during the last month of such 2
taxable year shall be treated— 3
‘‘(i) as having been an eligible indi-4
vidual during each of the months in such 5
taxable year, and 6
‘‘(ii) as having been enrolled, during 7
each of the months such individual is 8
treated as an eligible individual solely by 9
reason of clause (i), in the same high de-10
ductible health plan in which the individual 11
was enrolled for the last month of such 12
taxable year. 13
‘‘(B) F
AILURE TO MAINTAIN CREDITABLE 14
COVERAGE.— 15
‘‘(i) I
N GENERAL.—If, at any time 16
during the testing period, the individual is 17
not an eligible individual, then— 18
‘‘(I) gross income of the indi-19
vidual for the taxable year in which 20
occurs the first month in the testing 21
period for which such individual is not 22
an eligible individual is increased by 23
the aggregate amount of all contribu-24
tions to the Roth HSA of the indi-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 59
•HR 3129 IH
vidual which could not have been 1
made but for subparagraph (A), and 2
‘‘(II) the tax imposed by this 3
chapter for any taxable year on the 4
individual shall be increased by 10 5
percent of the amount of such in-6
crease. 7
‘‘(ii) E
XCEPTION FOR DISABILITY OR 8
DEATH.—Subclauses (I) and (II) of clause 9
(i) shall not apply if the individual ceased 10
to be an eligible individual by reason of the 11
death of the individual or the individual 12
becoming disabled (within the meaning of 13
section 72(m)(7)). 14
‘‘(iii) T
ESTING PERIOD.—The term 15
‘testing period’ means the period beginning 16
with the last month of the taxable year re-17
ferred to in subparagraph (A) and ending 18
on the last day of the 12th month fol-19
lowing such month. 20
‘‘(c) R
OTHHSA.—For purposes of this section— 21
‘‘(1) I
N GENERAL.—The term ‘Roth HSA’ 22
means a trust created or organized in the United 23
States as a Roth HSA exclusively for the purpose of 24
paying the qualified medical expenses of the account 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 60
•HR 3129 IH
beneficiary, but only if the written governing instru-1
ment creating the trust meets the following require-2
ments: 3
‘‘(A) Except in the case of a rollover con-4
tribution described in subsection (f)(5) or sec-5
tion 220(f)(5), no contribution will be accept-6
ed— 7
‘‘(i) unless it is in cash, or 8
‘‘(ii) to the extent such contribution, 9
when added to previous contributions to 10
the trust for the calendar year, exceeds the 11
sum of— 12
‘‘(I) the dollar amount in effect 13
under subsection (b)(2)(B), and 14
‘‘(II) the dollar amount in effect 15
under subsection (b)(3). 16
‘‘(B) The trustee is a bank (as defined in 17
section 408(n)), an insurance company (as de-18
fined in section 816), or another person who 19
demonstrates to the satisfaction of the Sec-20
retary that the manner in which such person 21
will administer the trust will be consistent with 22
the requirements of this section. 23
‘‘(C) No part of the trust assets will be in-24
vested in life insurance contracts. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 61
•HR 3129 IH
‘‘(D) The assets of the trust will not be 1
commingled with other property except in a 2
common trust fund or common investment 3
fund. 4
‘‘(E) The interest of an individual in the 5
balance in his account is nonforfeitable. 6
‘‘(2) Q
UALIFIED MEDICAL EXPENSES .—For 7
purposes of this section— 8
‘‘(A) I
N GENERAL.—The term ‘qualified 9
medical expenses’ means, with respect to an ac-10
count beneficiary, amounts paid by such bene-11
ficiary for medical care (as defined in section 12
213(d)) for such individual, the spouse of such 13
individual, and any dependent (as defined in 14
section 152, determined without regard to sub-15
sections (b)(1), (b)(2), and (d)(1)(B) thereof) 16
of such individual, but only to the extent such 17
amounts are not compensated for by insurance 18
or otherwise. 19
‘‘(B) L
IMITATION ON HEALTH INSURANCE 20
PURCHASED FROM ACCOUNT .—Such term shall 21
not include any payment for health benefits cov-22
erage that is not creditable coverage (as defined 23
in section 36C). 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 62
•HR 3129 IH
‘‘(C) EXCEPTIONS.—Subparagraph (B) 1
shall not apply to any expense for coverage 2
under— 3
‘‘(i) a health plan during any period 4
of continuation coverage required under 5
any Federal law, 6
‘‘(ii) a qualified long-term care insur-7
ance contract (as defined in section 8
7702B(b)), 9
‘‘(iii) a health plan during a period in 10
which the individual is receiving unemploy-11
ment compensation under any Federal or 12
State law, or 13
‘‘(iv) in the case of an account bene-14
ficiary who has attained the age specified 15
in section 1811 of the Social Security Act, 16
any health insurance other than a medi-17
care supplemental policy (as defined in sec-18
tion 1882 of the Social Security Act). 19
‘‘(3) A
CCOUNT BENEFICIARY .—The term ‘ac-20
count beneficiary’ means the individual on whose be-21
half the Roth HSA was established. 22
‘‘(4) C
ERTAIN RULES TO APPLY .—Rules similar 23
to the following rules shall apply for purposes of this 24
section: 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 63
•HR 3129 IH
‘‘(A) Section 219(f)(3) (relating to time 1
when contributions deemed made). 2
‘‘(B) Except as provided in section 106(d), 3
section 219(f)(5) (relating to employer pay-4
ments). 5
‘‘(C) Section 408(g) (relating to commu-6
nity property laws). 7
‘‘(D) Section 408(h) (relating to custodial 8
accounts). 9
‘‘(d) E
LIGIBLEINDIVIDUAL; CREDITABLE COV-10
ERAGE.—For purposes of this section— 11
‘‘(1) E
LIGIBLE INDIVIDUAL.— 12
‘‘(A) I
N GENERAL.—The term ‘eligible in-13
dividual’ means, with respect to any month, any 14
individual if such individual is covered under 15
creditable coverage as of the first day of such 16
month. 17
‘‘(B) E
XCEPTION.—An individual shall not 18
be treated as an eligible individual for any 19
month for which a credit is determined with re-20
spect to the individual under section 36B. 21
‘‘(2) C
REDITABLE COVERAGE .—The term ‘cred-22
itable coverage’ shall have the meaning given such 23
term in section 36C(f). 24
‘‘(e) T
AXTREATMENT OFDISTRIBUTIONS.— 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 64
•HR 3129 IH
‘‘(1) AMOUNTS USED FOR QUALIFIED MEDICAL 1
EXPENSES.—Any amount paid or distributed out of 2
a Roth HSA which is used exclusively to pay quali-3
fied medical expenses of any account beneficiary 4
shall not be includible in gross income. 5
‘‘(2) I
NCLUSION OF AMOUNTS NOT USED FOR 6
QUALIFIED MEDICAL EXPENSES .—Any amount paid 7
or distributed out of a Roth HSA which is not used 8
exclusively to pay the qualified medical expenses of 9
the account beneficiary shall be included in the gross 10
income of such beneficiary. 11
‘‘(3) E
XCESS CONTRIBUTIONS RETURNED BE -12
FORE DUE DATE OF RETURN .— 13
‘‘(A) I
N GENERAL.—If any excess con-14
tribution is contributed for a taxable year to 15
any Roth HSA of an individual, paragraph (2) 16
shall not apply to distributions from the Roth 17
HSAs of such individual (to the extent such dis-18
tributions do not exceed the aggregate excess 19
contributions to all such accounts of such indi-20
vidual for such year) if— 21
‘‘(i) such distribution is received by 22
the individual on or before the last day 23
prescribed by law (including extensions of 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 65
•HR 3129 IH
time) for filing such individual’s return for 1
such taxable year, and 2
‘‘(ii) such distribution is accompanied 3
by the amount of net income attributable 4
to such excess contribution. 5
Any net income described in clause (ii) shall be 6
included in the gross income of the individual 7
for the taxable year in which it is received. 8
‘‘(B) E
XCESS CONTRIBUTION .—For pur-9
poses of subparagraph (A), the term ‘excess 10
contribution’ means any contribution (other 11
than a rollover contribution described in para-12
graph (5) or section 220(f)(5)) which exceeds 13
the contribution limitation with respect to the 14
individual for the taxable year. 15
‘‘(4) A
DDITIONAL TAX ON DISTRIBUTIONS NOT 16
USED FOR QUALIFIED MEDICAL EXPENSES .— 17
‘‘(A) I
N GENERAL.—The tax imposed by 18
this chapter on the account beneficiary for any 19
taxable year in which there is a payment or dis-20
tribution from a Roth HSA of such beneficiary 21
which is includible in gross income under para-22
graph (2) shall be increased by 10 percent of 23
the amount which is so includible. 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 66
•HR 3129 IH
‘‘(B) EXCEPTION FOR DISABILITY OR 1
DEATH.—Subparagraph (A) shall not apply if 2
the payment or distribution is made after the 3
account beneficiary becomes disabled within the 4
meaning of section 72(m)(7) or dies. 5
‘‘(C) E
XCEPTION FOR DISTRIBUTIONS 6
AFTER MEDICARE ELIGIBILITY .—Subparagraph 7
(A) shall not apply to any payment or distribu-8
tion after the date on which the account bene-9
ficiary attains the age specified in section 1811 10
of the Social Security Act. 11
‘‘(5) R
OLLOVER CONTRIBUTION .—An amount is 12
described in this paragraph as a rollover contribu-13
tion if it meets the requirements of subparagraphs 14
(A) and (B). 15
‘‘(A) I
N GENERAL.—Paragraph (2) shall 16
not apply to any amount paid or distributed 17
from a health savings account (as defined in 18
section 223) or a Roth HSA to the account 19
beneficiary to the extent the amount received is 20
paid into a Roth HSA for the benefit of such 21
beneficiary not later than the 60th day after 22
the day on which the beneficiary receives the 23
payment or distribution. 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 67
•HR 3129 IH
‘‘(B) LIMITATION.—This paragraph shall 1
not apply to any amount described in subpara-2
graph (A) received by an individual from a 3
health savings account or a Roth HSA if, at 4
any time during the 1-year period ending on the 5
day of such receipt, such individual received any 6
other amount described in subparagraph (A) 7
from a health savings account or Roth HSA 8
which was not includible in the individual’s 9
gross income because of the application of this 10
paragraph. 11
‘‘(6) T
RANSFER OF ACCOUNT INCIDENT TO DI -12
VORCE.—The transfer of an individual’s interest in 13
a Roth HSA to an individual’s spouse or former 14
spouse under a divorce or separation instrument de-15
scribed in subparagraph (A) of section 71(b)(2) shall 16
not be considered a taxable transfer made by such 17
individual notwithstanding any other provision of 18
this subtitle, and such interest shall, after such 19
transfer, be treated as a Roth HSA with respect to 20
which such spouse is the account beneficiary. 21
‘‘(7) T
REATMENT AFTER DEATH OF ACCOUNT 22
BENEFICIARY.—If an individual acquires an account 23
beneficiary’s interest in a health savings account by 24
reason of the death of the account beneficiary, such 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 68
•HR 3129 IH
health savings account shall be treated as if the indi-1
vidual were the account beneficiary. 2
‘‘(f) C
OST-OF-LIVINGADJUSTMENT.— 3
‘‘(1) I
N GENERAL.—In the case of any calendar 4
year beginning after 2024, the $5,000 dollar amount 5
in subsection (b)(2) shall be increased by an amount 6
equal to— 7
‘‘(A) such dollar amount, multiplied by 8
‘‘(B) the cost-of-living adjustment deter-9
mined under section 1(f)(3) for the calendar 10
year, determined— 11
‘‘(i) by substituting ‘calendar year 12
2023’ for ‘calendar year 1992’ in subpara-13
graph (B) thereof, and 14
‘‘(ii) by substituting ‘CPI medical care 15
component’ for ‘CPI’. 16
‘‘(2) CPI
MEDICAL CARE COMPONENT .—For 17
purposes of this paragraph, the term ‘CPI medical 18
care component’ means the medical care component 19
for the Consumer Price Index for All Urban Con-20
sumers published by the Department of Labor. 21
‘‘(3) R
OUNDING.—If the amount of any in-22
crease under the preceding sentence is not a mul-23
tiple of $50, such increase shall be rounded to the 24
next lowest multiple of $50. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 69
•HR 3129 IH
‘‘(g) REPORTS.—The Secretary may require— 1
‘‘(1) the trustee of a Roth HSA to make such 2
reports regarding such account to the Secretary and 3
to the account beneficiary with respect to contribu-4
tions, distributions, the return of excess contribu-5
tions, and such other matters as the Secretary deter-6
mines appropriate, and 7
‘‘(2) any person who provides an individual with 8
creditable coverage to make such reports to the Sec-9
retary and to the account beneficiary with respect to 10
such plan as the Secretary determines appropriate. 11
The reports required by this subsection shall be filed at 12
such time and in such manner and furnished to such indi-13
viduals at such time and in such manner as may be re-14
quired by the Secretary. 15
‘‘(h) C
ROSS-REFERENCE.—For contributions from 16
Medicare Advantage plans of chronically ill enrollees, see 17
section 1852(a)(3)(D)(ii)(I) of the Social Security Act.’’. 18
(b) L
IMIT ONCONTRIBUTIONS TO DEDUCTIBLE 19
H
EALTHSAVINGSACCOUNTS.—Section 223 of such Code 20
is amended by adding at the end the following new sub-21
section: 22
‘‘(i) L
IMITEDCONTRIBUTIONSAFTER2023.— 23
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 70
•HR 3129 IH
‘‘(1) IN GENERAL.—No contribution may be ac-1
cepted by a health savings account after December 2
31, 2023. 3
‘‘(2) E
XCEPTIONS.—Paragraph (1) shall not 4
apply— 5
‘‘(A) in the case of a rollover contribution 6
described in subsection (f)(5) or section 7
220(f)(5), or 8
‘‘(B) in the case of a month for which an 9
individual is covered by insurance that con-10
stitutes medical care and that is provided by an 11
employer with respect to which an election is in 12
effect for such month under section 131(b) of 13
the Health Care Fairness for All Act.’’. 14
(c) C
LERICALAMENDMENT.—The table of parts for 15
subchapter F of chapter 1 of such Code is amended by 16
adding at the end the following new item: 17
‘‘PARTIX. ROTHHEALTHSAVINGSACCOUNTS’’.
(d) EFFECTIVEDATE.—The amendments made by 18
this section shall apply to taxable years beginning after 19
December 31, 2023. 20
SEC. 202. ELIMINATION OF MEDICAL EXPENSE DEDUCTION. 21
Section 213 of the Internal Revenue Code of 1986 22
is amended by adding at the end the following new sub-23
section: 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 71
•HR 3129 IH
‘‘(f) TERMINATION.—Except in the case of long-term 1
care premiums (as defined in subsection (d)(10)), sub-2
section (a) shall not apply to any amounts paid during 3
any taxable year beginning after December 31, 2023.’’. 4
SEC. 203. TREATMENT OF HSA AFTER DEATH OF ACCOUNT 5
BENEFICIARY. 6
(a) I
NGENERAL.—Section 223(f)(8) of the Internal 7
Revenue Code of 1986 is amended to read as follows: 8
‘‘(8) T
REATMENT AFTER DEATH OF ACCOUNT 9
BENEFICIARY.—If an individual acquires an account 10
beneficiary’s interest in a health savings account by 11
reason of the death of the account beneficiary, such 12
health savings account shall be treated as if the indi-13
vidual were the account beneficiary.’’. 14
(b) E
FFECTIVEDATE.—The amendment made by 15
this section shall apply with respect to interests acquired 16
after the date of the enactment of this Act. 17
SEC. 204. TREATMENT OF DIRECT PATIENT CARE AR-18
RANGEMENTS. 19
(a) HSA
S.— 20
(1) R
OTH HSA.—Section 530A(c)(2)(A) of the 21
Internal Revenue Code of 1986, as added by section 22
201 of this Act, is amended by adding at the end 23
the following: ‘‘Such term shall include the payment 24
of a monthly or other prepaid amount for the fur-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 72
•HR 3129 IH
nishing (or access to the furnishing) by a physician 1
or group of physicians of physician professional serv-2
ices (and ancillary services).’’. 3
(2) HSA.—Section 223(d)(2)(A) of such Code 4
is amended by adding at the end the following: ‘‘The 5
term ‘qualified medical expenses’ shall include the 6
payment of a monthly or other prepaid amount for 7
the furnishing (or access to the furnishing) by a 8
physician or group of physicians of physician profes-9
sional services (and ancillary services).’’. 10
(b) N
OTTREATED ASHEALTHINSURANCECOV-11
ERAGE.— 12
(1) I
N GENERAL.—For purposes of title XXVII 13
of the Public Health Service Act (42 U.S.C. 300gg), 14
subtitle B of title I of the Employee Retirement and 15
Income Security Act of 1974 (29 U.S.C. 1021 et 16
seq.), Public Law 111–148, and this Act, the offer-17
ing of direct patient care arrangements shall not be 18
treated as the offering of health insurance coverage 19
and shall not be subject to regulations as such cov-20
erage under such Acts. 21
(2) D
IRECT PATIENT CARE ARRANGEMENT DE -22
FINED.—In this subsection, the term ‘‘direct patient 23
care arrangement’’ means the furnishing (or access 24
to the furnishing) by a physician or group of physi-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 73
•HR 3129 IH
cians of physician professional services (and ancil-1
lary services) in return for payment of a monthly or 2
other prepaid amount. 3
TITLE III—STATE FLEXIBILITY 4
IN REGULATION OF HEALTH 5
INSURANCE COVERAGE 6
SEC. 301. STATE FLEXIBILITY IN REGULATION OF HEALTH 7
INSURANCE COVERAGE. 8
(a) I
NGENERAL.—States are given the flexibility 9
under section 122(b) to revise their regulations of the 10
health insurance marketplace, without regard to many of 11
the requirements imposed under Public Law 111–148, in 12
order to promote freedom of choice of affordable health 13
insurance coverage options offered outside of an Ex-14
change. 15
(b) C
ONSTRUCTION.—Nothing in the Employee Re-16
tirement and Income Security Act of 1974 (29 U.S.C. 17
1001 et seq.) or of any amendments made by the Health 18
Insurance Portability and Accountability Act of 1996 19
(Public Law 104–191) shall be interpreted as preventing 20
an employer from offering, or making an employer con-21
tribution towards, individual health insurance coverage for 22
employees and dependent family members. 23
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 74
•HR 3129 IH
(c) ASSOCIATIONHEALTHPLANS.—Nothing in this 1
Act shall be construed as prohibiting the formation of as-2
sociation health plans (as defined under State law). 3
(d) H
IGH-RISKPOOLS.—Nothing in this Act shall be 4
construed as prohibiting States from establishing pooling 5
arrangements for high-risk individuals. 6
TITLE IV—MEDICAID PAYMENT 7
REFORM 8
SEC. 401. MEDICAID PAYMENT REFORM TO ENSURE EQUI-9
TABLE ACCESS TO CARE. 10
(a) I
NGENERAL.—Title XIX of the Social Security 11
Act (42 U.S.C. 1396 et seq.) is amended by inserting after 12
section 1903 the following section: 13
‘‘SEC. 1903A. REFORMED PAYMENT TO STATES. 14
‘‘(a) R
EFORMEDPAYMENTSYSTEM.— 15
‘‘(1) I
N GENERAL.—For quarters beginning on 16
or after the implementation date (as defined in sub-17
section (k)(1)), in lieu of amounts otherwise payable 18
to a State under this title (including any payments 19
attributable to section 1923), except as otherwise 20
provided in this section, the amount payable to such 21
State shall be equal to the sum of the following: 22
‘‘(A) A
DJUSTED AGGREGATE BENE -23
FICIARY-BASED AMOUNT.—The aggregate bene-24
ficiary-based amount specified in subsection (b) 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 75
•HR 3129 IH
for the quarter and the State, adjusted under 1
subsection (e). 2
‘‘(B) C
HRONIC CARE QUALITY BONUS .— 3
The amount (if any) of the chronic care quality 4
bonus payment specified in subsection (f) for 5
the quarter for the State. 6
‘‘(2) R
EQUIREMENT OF STATE SHARE .— 7
‘‘(A) I
N GENERAL.—A State shall make, 8
from non-Federal funds, expenditures in an 9
amount equal to its State share (as determined 10
under subparagraph (B)) for a quarter for 11
items, services, and other costs for which, but 12
for paragraph (1), Federal funds would have 13
been payable under this title. 14
‘‘(B) S
TATE SHARE.—The State share for 15
a State for a quarter in a fiscal year is equal 16
to the product of— 17
‘‘(i) the aggregate beneficiary-based 18
amount specified in subsection (b) for the 19
quarter and the State; and 20
‘‘(ii) the ratio of— 21
‘‘(I) the State percentage de-22
scribed in subparagraph (D)(ii) for 23
such State and fiscal year; to 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 76
•HR 3129 IH
‘‘(II) the Federal percentage de-1
scribed in subparagraph (D)(i) for 2
such State and fiscal year. 3
‘‘(C) N
ONPAYMENT FOR FAILURE TO PAY 4
STATE SHARE.— 5
‘‘(i) I
N GENERAL.—If a State fails to 6
expend the amount required under sub-7
paragraph (A) for a quarter in a fiscal 8
year, the amount payable to the State 9
under paragraph (1) shall be reduced by 10
the product of the amount by which the 11
State payment is less than the State share 12
and the ratio of— 13
‘‘(I) the Federal percentage de-14
scribed in subparagraph (D)(i) for 15
such State and fiscal year; to 16
‘‘(II) the State percentage de-17
scribed in subparagraph (D)(ii) for 18
such State and fiscal year. 19
‘‘(ii) G
RACE PERIOD.—A State shall 20
not be considered to have failed to provide 21
payment of its required State share for a 22
quarter under subparagraph (A) if the ag-23
gregate State payment towards the State’s 24
required State share for the 4-quarter pe-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 77
•HR 3129 IH
riod beginning with such quarter exceeds 1
the required State share amount for such 2
4-quarter period. 3
‘‘(D) F
EDERAL AND STATE PERCENT -4
AGES.—In this paragraph, with respect to a 5
State and a fiscal year: 6
‘‘(i) F
EDERAL PERCENTAGE .—The 7
Federal percentage described in this clause 8
is 75 percent or, if higher, the Federal 9
medical assistance percentage for such 10
State for such fiscal year. 11
‘‘(ii) S
TATE PERCENTAGE.—The State 12
percentage described in this clause is 100 13
percent minus the Federal percentage de-14
scribed in clause (i). 15
‘‘(E) R
ULES FOR CREDITING TOWARD 16
STATE SHARE.— 17
‘‘(i) G
ENERAL LIMITATION TO MATCH -18
ABLE EXPENDITURES .—A payment for ex-19
penditures shall not be counted toward the 20
State share under subparagraph (A) unless 21
Federal payments may be used for such 22
expenditures consistent with paragraph 23
(3)(B). 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 78
•HR 3129 IH
‘‘(ii) FURTHER LIMITATIONS ON AL -1
LOWABLE EXPENDITURES .—A payment for 2
expenditures shall not be counted towards 3
the State share under subparagraph (A) if 4
the expenditure is for any of the following: 5
‘‘(I) A
BORTION.—Expenditures 6
for an abortion. 7
‘‘(II) I
NTERGOVERNMENTAL 8
TRANSFERS.—An expenditure that is 9
attributable to an intergovernmental 10
transfer. 11
‘‘(III) C
ERTIFIED PUBLIC EX -12
PENDITURES.—An expenditure that is 13
attributable to certified public expend-14
itures. 15
‘‘(iii) C
REDITING FRAUD AND ABUSE 16
RECOVERIES.—Amounts recovered by a 17
State through the operation of its Medicaid 18
fraud and abuse control unit described in 19
section 1903(q) shall be fully counted to-20
ward the State share under subparagraph 21
(A). 22
‘‘(F) C
ONSTRUCTION.—Nothing in the 23
paragraph shall be construed as preventing a 24
State from expending, from non-Federal funds, 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 79
•HR 3129 IH
an amount under this title in excess of the 1
amount of the State share. 2
‘‘(G) D
ETERMINATION BASED UPON SUB -3
MITTED CLAIMS.—In applying this paragraph 4
with respect to expenditures of a State for a 5
quarter, the determination of the expenditures 6
for such State for such quarter shall be made 7
after the end of the period (which, as of the 8
date of the enactment of this section, is 2 9
years) for which the Secretary accepts claims 10
for payment under this title with respect to 11
such quarter. 12
‘‘(3) U
SE OF FEDERAL PAYMENTS .— 13
‘‘(A) A
PPLICATION OF MEDICAID LIMITA -14
TIONS.—A State may only use Federal pay-15
ments received under subsection (a) for expend-16
itures for which Federal funds would have been 17
payable under this title but for this section. 18
‘‘(B) L
IMITATION FOR CERTAIN ELIGI -19
BLES.— 20
‘‘(i) A
PPLICATION OF 100 PERCENT 21
FEDERAL POVERTY LINE LIMIT ON ELIGI -22
BILITY.—Subject to clause (iii), a State 23
may not use such Federal payments to 24
provide medical assistance for an indi-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 80
•HR 3129 IH
vidual who has an income (as determined 1
under clause (ii)) that exceeds 100 percent 2
of the poverty line (as defined in section 3
2110(c)(5)) applicable to a family of the 4
size involved. 5
‘‘(ii) D
ETERMINATION OF INCOME 6
USING MODIFIED ADJUSTED GROSS IN -7
COME WITHOUT ANY 5 PERCENT IN -8
CREASE.—In determining income for pur-9
poses of clause (i) under section 10
1902(e)(14) (relating to modified adjusted 11
gross income), the following rules shall 12
apply: 13
‘‘(I) A
PPLICATION OF SPEND 14
DOWN.—The State shall take into ac-15
count the costs incurred for medical 16
care or for any other type of remedial 17
care recognized under State law in the 18
same manner and to the same extent 19
that such State takes such costs into 20
account for purposes of section 21
1902(a)(17). 22
‘‘(II) D
ISREGARD OF 5 PERCENT 23
INCREASE.—Subparagraph (I) of sec-24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 81
•HR 3129 IH
tion 1902(e)(14) (relating to a 5 per-1
cent reduction) shall not apply. 2
‘‘(iii) E
XCEPTION.—Clause (i) shall 3
not apply to an individual who is— 4
‘‘(I) a woman described in clause 5
(i) of section 1903(v)(4)(A); 6
‘‘(II) a child who is an individual 7
described in clause (i) of section 8
1905(a); 9
‘‘(III) enrolled in a State plan 10
under this title as of the date of the 11
enactment of this section for the pe-12
riod of continuous enrollment; or 13
‘‘(IV) described in section 14
1902(e)(14)(D) (relating to modified 15
adjusted gross income). 16
‘‘(iv) C
LARIFICATION RELATED TO 17
COMMUNITY SPOUSE .—Nothing in this 18
subparagraph shall supersede the applica-19
tion of section 1924 (related to community 20
spouse income and assets). 21
‘‘(4) E
XCEPTIONS FOR PASS -THROUGH PAY-22
MENTS.— 23
‘‘(A) I
N GENERAL.—Paragraph (1) shall 24
not apply, and amounts shall continue to be 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 82
•HR 3129 IH
payable under this title (and not under sub-1
section (a)), in the case of the following pay-2
ments (and related administrative costs and ex-3
penditures): 4
‘‘(i) P
AYMENTS TO TERRITORIES .— 5
Payments to a State other than the 50 6
States and the District of Columbia. 7
‘‘(ii) M
EDICARE COST SHARING .— 8
Payments attributable to Medicare cost 9
sharing under section 1905(p). 10
‘‘(iii) P
EDIATRIC VACCINES .—Pay-11
ments attributable to section 1928. 12
‘‘(iv) E
MERGENCY SERVICES FOR CER -13
TAIN INDIVIDUALS.—Payments for treat-14
ment of emergency medical conditions at-15
tributable to the application of section 16
1903(v)(2). 17
‘‘(v) I
NDIAN HEALTH CARE FACILI -18
TIES.—Payments for medical assistance 19
described in the third sentence of section 20
1905(b). 21
‘‘(vi) E
MPLOYER-SPONSORED INSUR -22
ANCE (ESI).—Payments for medical assist-23
ance attributable to payments to employers 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 83
•HR 3129 IH
for employer-sponsored health benefits cov-1
erage. 2
‘‘(vii) O
THER POPULATIONS WITH 3
LIMITED BENEFIT COVERAGE .—Other pay-4
ments that are determined by the Sec-5
retary to be related to a specified popu-6
lation for which the medical assistance 7
under this title is limited and does not in-8
clude any inpatient, nursing facility, or 9
long-term care services. 10
‘‘(B) C
ERTAIN EXPENSES.—Paragraph (1) 11
shall not apply, and amounts shall continue to 12
be payable under this title (and not under sub-13
section (a)), in the case of the following: 14
‘‘(i) A
DMINISTRATION OF MEDICARE 15
PRESCRIPTION DRUG BENEFIT .—Expendi-16
tures described in section 1935(b) (relating 17
to administration of the Medicare prescrip-18
tion drug benefit). 19
‘‘(ii) P
AYMENTS FOR HIT BONUSES .— 20
Payments under section 1903(a)(3)(F) (re-21
lating to payments to encourage the adop-22
tion and use of certified EHR technology). 23
‘‘(iii) P
AYMENTS FOR DESIGN , DEVEL-24
OPMENT, AND INSTALLATION OF MMIS AND 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 84
•HR 3129 IH
ELIGIBILITY SYSTEMS.—Payments under 1
subparagraphs (A)(i) and (H)(i) of section 2
1903(a)(3) for expenditures for design, de-3
velopment, and installation of the Medicaid 4
management information systems and 5
mechanized verification and information 6
retrieval systems (related to eligibility). 7
‘‘(5) P
AYMENT OF AMOUNTS .— 8
‘‘(A) I
N GENERAL.—Except as the Sec-9
retary may otherwise provide, amounts shall be 10
payable to a State under subsection (a) in the 11
same manner as amounts are payable under 12
subsection (d) of section 1903 to a State under 13
subsection (a) of such section. 14
‘‘(B) I
NFORMATION AND FORMS .— 15
‘‘(i) S
UBMISSION.—As a condition of 16
receiving payment under subsection (a), a 17
State shall submit such information, in 18
such form, and manner, as the Secretary 19
shall specify, including information nec-20
essary to make the computations under 21
subsections (c)(2)(C) and (e). 22
‘‘(ii) U
NIFORM REPORTING .—The 23
Secretary shall develop such forms as may 24
be needed to assure a system of uniform 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 85
•HR 3129 IH
reporting of such information across 1
States. 2
‘‘(C) R
EQUIRED REPORTING OF INFORMA -3
TION ON MEDICAL LOSS RATIOS FOR MANAGED 4
CARE.—The information required to be reported 5
under subparagraph (B)(i) shall include infor-6
mation on the medical loss ratio with respect to 7
coverage provided under each Medicaid man-8
aged care plan with a contract with the State 9
under section 1903(m) or 1932. 10
‘‘(b) A
GGREGATEBENEFICIARY-BASEDAMOUNT.— 11
‘‘(1) I
N GENERAL.—The aggregate beneficiary- 12
based amount specified in this subsection for a State 13
for a quarter is equal to the sum of the products, 14
for each of the categories of Medicaid beneficiaries 15
specified in paragraph (2), of the following: 16
‘‘(A) B
ENEFICIARY-BASED QUARTERLY 17
AMOUNT.—The beneficiary-based quarterly 18
amount for such category computed under sub-19
section (c) for such State for such quarter. 20
‘‘(B) N
UMBER OF INDIVIDUALS IN CAT -21
EGORY.—Subject to subsection (d), the average 22
number of Medicaid beneficiaries enrolled in 23
such category in the State in such quarter. 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 86
•HR 3129 IH
‘‘(2) CATEGORIES.—The categories specified in 1
this paragraph are the following: 2
‘‘(A) E
LDERLY.—A category of Medicaid 3
beneficiaries who are 65 years of age or older. 4
‘‘(B) B
LIND OR DISABLED.—A category of 5
Medicaid beneficiaries not described in subpara-6
graph (A) who are described in section 7
1937(a)(2)(B)(ii). 8
‘‘(C) C
HILDREN.—A category of Medicaid 9
beneficiaries not described in subparagraph (B) 10
who are under 21 years of age. 11
‘‘(D) O
THER ADULTS.—A category of any 12
Medicaid beneficiaries who are not described in 13
a previous subparagraph of this paragraph. 14
‘‘(c) C
OMPUTATION OFPERBENEFICIARY, PERCAT-15
EGORYQUARTERLYAMOUNT.— 16
‘‘(1) I
N GENERAL.—For a State, for each cat-17
egory of beneficiary for a quarter— 18
‘‘(A) F
IRST REFORM YEAR.—For quarters 19
in the first reform year (as defined in sub-20
section (k)(2)), the beneficiary-based quarterly 21
amount is equal to
1
∕4of the base average per 22
beneficiary Federal payments for such State for 23
such category determined under paragraph (2), 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 87
•HR 3129 IH
increased by a factor that reflects the sum of 1
the following: 2
‘‘(i) H
ISTORICAL MEDICAL CARE COM -3
PONENT OF CPI THROUGH PREVIOUS RE -4
FORM YEAR.—The percentage increase in 5
the historical medical care component of 6
the Consumer Price Index for all urban 7
consumers (U.S. city average) from the 8
midpoint of the base fiscal year (as defined 9
in paragraph (6)) to the midpoint of the 10
fiscal year preceding the first reform year. 11
‘‘(ii) P
ROJECTED MEDICAL CARE COM -12
PONENT OF CPI FOR THE FIRST REFORM 13
YEAR.—The percentage increase in the 14
projected medical care component of the 15
Consumer Price Index for all urban con-16
sumers (U.S. city average) from the mid-17
point of the previous fiscal year referred to 18
in clause (i) to the midpoint of the first re-19
form year. 20
‘‘(B) S
ECOND AND THIRD REFORM 21
YEARS.—The beneficiary-based quarterly 22
amount for a State for a category for quarters 23
in the second reform year or the third reform 24
year is equal to the beneficiary-based quarterly 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 88
•HR 3129 IH
amount under this paragraph for such State 1
and category for the previous reform year in-2
creased by the per beneficiary percentage in-3
crease (as defined in subparagraph (E)) for 4
such category and reform year. 5
‘‘(C) F
OURTH THROUGH TENTH REFORM 6
YEARS.—The beneficiary-based quarterly 7
amount for a State for a category for quarters 8
in a reform year beginning with the fourth re-9
form year and ending with the tenth reform 10
year is— 11
‘‘(i) in the case of a State that is a 12
high per beneficiary State or a low per 13
beneficiary State (as defined in paragraph 14
(4)(B)(iii)) for the category, the amount 15
determined under clause (i) or (ii) of para-16
graph (4)(B) for such State, category, and 17
reform year; or 18
‘‘(ii) in the case of any other State, 19
the beneficiary-based quarterly amount 20
under this paragraph for such State and 21
category for the previous reform year in-22
creased by the per beneficiary percentage 23
increase for such category and reform 24
year. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 89
•HR 3129 IH
‘‘(D) ELEVENTH REFORM YEAR AND SUB -1
SEQUENT REFORM YEARS .—The beneficiary- 2
based quarterly amount for a State for a cat-3
egory for quarters in a reform year beginning 4
with the eleventh reform year is equal to the 5
beneficiary-based quarterly amount under this 6
paragraph for such State and category for the 7
previous reform year increased by the per bene-8
ficiary percentage increase for such category 9
and reform year. 10
‘‘(E) A
NNUAL PERCENTAGE INCREASE BE -11
GINNING WITH SECOND REFORM YEAR .—For 12
purposes of this subsection, the term ‘per bene-13
ficiary percentage increase’ means, for a reform 14
year, the sum of— 15
‘‘(i) the projected percentage change 16
in nominal gross domestic product from 17
the midpoint of the previous reform year to 18
the midpoint of the reform year for which 19
the percentage increase is being applied; 20
and 21
‘‘(ii) one percentage point. 22
‘‘(2) B
ASE PER BENEFICIARY , PER CATEGORY 23
AMOUNT FOR EACH STATE .— 24
‘‘(A) A
VERAGE PER CATEGORY .— 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 90
•HR 3129 IH
‘‘(i) IN GENERAL.—The Secretary 1
shall determine, consistent with this para-2
graph and paragraph (3), a base per bene-3
ficiary, per category amount for each of 4
the 50 States and the District of Columbia 5
equal to the average amount, per Medicaid 6
beneficiary, of Federal payments under 7
this title, including payments attributable 8
to disproportionate share hospital pay-9
ments under section 1923, for each of the 10
categories of beneficiaries under subsection 11
(b)(2) for the base fiscal year for each of 12
the 50 States and the District of Colum-13
bia. 14
‘‘(ii) B
EST AVAILABLE DATA .—The 15
determination under clause (i) shall ini-16
tially be estimated by the Secretary, based 17
upon the best available data at the time 18
the determination is made. 19
‘‘(iii) U
PDATES.—The determination 20
under clause (i) shall be updated by the 21
Secretary on an annual basis based upon 22
improved data. The Secretary shall adjust 23
the amounts under subsection (a)(1)(A) to 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 91
•HR 3129 IH
reflect changes in the amounts so deter-1
mined based on such updates. 2
‘‘(B) E
XCLUSION OF PASS-THROUGH PAY-3
MENTS.—In computing base per beneficiary, 4
per category amounts under subparagraph 5
(A)(i) the Secretary shall exclude payments de-6
scribed in subsection (a)(4). 7
‘‘(C) S
TANDARDIZATION.— 8
‘‘(i) I
N GENERAL.—In computing each 9
such amount, the Secretary shall stand-10
ardize the amount in order to remove the 11
variation attributable to the following: 12
‘‘(I) R
ISK FACTORS.—Such risk 13
factors as age, health and disability 14
status (including high cost medical 15
conditions), gender, institutional sta-16
tus, and such other factors as the 17
Secretary determines to be appro-18
priate, so as to ensure actuarial 19
equivalence. 20
‘‘(II) G
EOGRAPHIC.—Variations 21
in costs on a county-by-county basis. 22
‘‘(ii) M
ETHOD OF STANDARDIZA -23
TION.— 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 92
•HR 3129 IH
‘‘(I) CONSULTATION IN DEVEL -1
OPMENT OF RISK STANDARDIZA -2
TION.—In developing the methodology 3
for risk standardization for purposes 4
of clause (i)(I), the Secretary shall 5
consult with the Medicaid and CHIP 6
Payment and Access Commission, the 7
Medicare Payment Advisory Commis-8
sion, and the National Association of 9
Medicaid Directors. 10
‘‘(II) M
ETHOD FOR RISK STAND -11
ARDIZATION.—In carrying out clause 12
(i)(I), the Secretary may apply the 13
hierarchal condition category method-14
ology under section 1853(a)(1)(C). If 15
the Secretary uses such methodology, 16
the Secretary shall adjust the applica-17
tion of such methodology to take into 18
account the differences in services 19
provided under this title compared to 20
title XVIII, such as the coverage of 21
long term care, pregnancy, and pedi-22
atric services. 23
‘‘(III) M
ETHOD FOR GEOGRAPHIC 24
STANDARDIZATION.—The Secretary 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 93
•HR 3129 IH
shall apply the standardization under 1
clause (i)(II) in a manner similar to 2
that applied under section 3
1853(c)(4)(A)(iii). 4
‘‘(iii) A
PPLICATION ON A NATIONAL , 5
BUDGET NEUTRAL BASIS .—The standard-6
ization under clause (i) shall be designed 7
and implemented on a uniform national 8
basis and shall be budget neutral so as to 9
not result in any aggregate change in pay-10
ments under subsection (a). 11
‘‘(iv) R
ESPONSE TO NEW RISK .—Sub-12
ject to clause (iii), the Secretary may ad-13
just the standardization under clause (i) to 14
respond promptly to new instances of com-15
municable diseases and other public health 16
hazards. 17
‘‘(v) R
EFERENCE TO APPLICATION OF 18
RISK ADJUSTMENT.—For rules related to 19
the application of risk adjustment to 20
amounts under subsection (a)(1)(A), see 21
subsection (e). 22
‘‘(D) A
DJUSTMENT FOR TEMPORARY FMAP 23
INCREASES.—In computing each base per bene-24
ficiary, per category amounts under subpara-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 94
•HR 3129 IH
graph (A)(i) the Secretary shall disregard por-1
tions of payments that are attributable to a 2
temporary increase in the Federal matching 3
rates, including those attributable to the fol-4
lowing: 5
‘‘(i) P
UBLIC LAW 111–148 DISASTER 6
FMAP.—Section 1905(aa). 7
‘‘(ii) ARRA.—Section 5001 of the 8
American Recovery and Reinvestment Act 9
of 2009 (42 U.S.C. 1396d note). 10
‘‘(iii) E
XTRAORDINARY EMPLOYER 11
PENSION CONTRIBUTION .—Section 614 of 12
the Children’s Health Insurance Program 13
Reauthorization Act of 2009 (42 U.S.C. 14
1396d note). 15
‘‘(3) A
LLOCATION OF NONMEDICAL ASSISTANCE 16
PAYMENTS.—The Secretary shall establish rules for 17
the allocation of payments under this title (other 18
than those payments described in paragraph (1) or 19
(5) of section 1903(a) and including such payments 20
attributable to section 1923)— 21
‘‘(A) among different categories of bene-22
ficiaries; and 23
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 95
•HR 3129 IH
‘‘(B) between payments included under 1
subsection (a)(1) and payments described in 2
subsection (a)(4). 3
‘‘(4) T
RANSITION TO A CORRIDOR AROUND THE 4
NATIONAL AVERAGE.— 5
‘‘(A) D
ETERMINATION OF NATIONAL AVER -6
AGE BASE PER BENEFICIARY , PER CATEGORY 7
AMOUNT.—Subject to subparagraph (C), the 8
Secretary shall determine a national average 9
base per beneficiary, per category amount equal 10
to the average of the base per beneficiary, per 11
category amounts for each of the 50 States and 12
the District of Columbia determined under 13
paragraph (2), weighted by the average number 14
of beneficiaries in each such category and State 15
as determined by the Secretary consistent with 16
subsection (d) for the base fiscal year. 17
‘‘(B) T
RANSITION ADJUSTMENT .— 18
‘‘(i) H
IGH PER BENEFICIARY 19
STATES.—In the case of a high per bene-20
ficiary State (as defined in clause (iii)(I)) 21
for a category, the beneficiary-based quar-22
terly amount for such State and category 23
for a quarter in a reform year (beginning 24
with the fourth reform year and ending 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 96
•HR 3129 IH
with the tenth reform year) is equal to the 1
sum of— 2
‘‘(I) the product of the State-spe-3
cific factor for such reform year (as 4
defined in clause (iv)) and the bene-5
ficiary-based quarterly amount that 6
would otherwise be determined under 7
paragraph (1) for such State and cat-8
egory if the State were a State de-9
scribed in clause (ii) of paragraph 10
(1)(C), instead of a State described in 11
clause (i) of such paragraph; and 12
‘‘(II) the product of 1 minus the 13
State-specific factor for such reform 14
year and the beneficiary-based quar-15
terly amount that would otherwise be 16
determined under paragraph (1) for a 17
State and category if the base per 18
beneficiary, per category amount de-19
termined under paragraph (2) for the 20
State and category were equal to 110 21
percent of the national average base 22
per beneficiary, per category amount 23
determined under subparagraph (A) 24
for such category. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 97
•HR 3129 IH
‘‘(ii) LOW PER BENEFICIARY 1
STATES.—In the case of a low per bene-2
ficiary State (as defined in clause (iii)(II)) 3
for a category, the beneficiary-based quar-4
terly amount for such State and category 5
for a quarter in a reform year (beginning 6
with the fourth reform year and ending 7
with the tenth reform year) is equal to the 8
sum of— 9
‘‘(I) the product of the State-spe-10
cific factor for such reform year and 11
the beneficiary-based quarterly 12
amount that would otherwise be deter-13
mined under paragraph (1) for such 14
State and category if the State were 15
a State described in clause (ii) of 16
paragraph (1)(C), instead of a State 17
described in clause (i) of such para-18
graph; and 19
‘‘(II) the product of 1 minus the 20
State-specific factor for such reform 21
year and the beneficiary-based quar-22
terly amount that would otherwise be 23
determined under paragraph (1) for a 24
State and category if the base per 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 98
•HR 3129 IH
beneficiary, per category amount de-1
termined under paragraph (2) for the 2
State and category were equal to 90 3
percent of the national average base 4
per beneficiary, per category amount 5
determined under subparagraph (A) 6
for such category. 7
‘‘(iii) H
IGH AND LOW PER BENE -8
FICIARY STATES DEFINED .—In this sub-9
paragraph: 10
‘‘(I) H
IGH PER BENEFICIARY 11
STATE.—The term ‘high per bene-12
ficiary State’ means, with respect to a 13
category, a State for which the base 14
per beneficiary, per category amount 15
determined under paragraph (2) for 16
such category is greater than 110 per-17
cent of the national average base per 18
beneficiary, per category amount de-19
termined under subparagraph (A) for 20
such category. 21
‘‘(II) L
OW PER BENEFICIARY 22
STATE.—The term ‘low per bene-23
ficiary State’ means, with respect to a 24
category, a State for which the base 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 99
•HR 3129 IH
per beneficiary, per category amount 1
determined under paragraph (2) for 2
such category is less than 90 percent 3
of the national average base per bene-4
ficiary, per category amount deter-5
mined under subparagraph (A) for 6
such category. 7
‘‘(iv) S
TATE-SPECIFIC FACTOR.—In 8
this subparagraph, the term ‘State-specific 9
factor’ means— 10
‘‘(I) for the fourth reform year, 11
7
∕8; and 12
‘‘(II) for a subsequent reform 13
year, the State-specific factor under 14
this clause for the previous reform 15
year minus
1
∕8. 16
‘‘(C) N
O ADDITIONAL EXPENDITURES .— 17
‘‘(i) D
ETERMINATION OF INCREASE IN 18
FEDERAL EXPENDITURES .—For each cat-19
egory for each reform year (beginning with 20
the fourth reform year and ending with the 21
tenth reform year), the Secretary shall de-22
termine whether the application of this 23
paragraph— 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 100
•HR 3129 IH
‘‘(I) to the category for the re-1
form year will result in an aggregate 2
increase in the aggregate Federal ex-3
penditures under subsection (a); and 4
‘‘(II) to all the categories for the 5
reform year will result in a net aggre-6
gate increase in the aggregate Federal 7
expenditures under subsection (a). 8
‘‘(ii) A
DJUSTMENT.—If the Secretary 9
determines under clause (i)(II) that the 10
application of this paragraph to all the cat-11
egories for a reform year will result in a 12
net aggregate increase in the aggregate 13
Federal expenditures under subsection (a), 14
the Secretary shall reduce the national av-15
erage base per beneficiary, per category 16
amount computed under subparagraph (A) 17
for each of the categories determined 18
under clause (i)(I) for which there will be 19
an aggregate increase in the aggregate 20
Federal expenditures under subsection (a) 21
by such uniform percentage as will ensure 22
that there is no net aggregate Federal ex-23
penditure increase described in clause 24
(i)(II) for the reform year. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 101
•HR 3129 IH
‘‘(5) REPORTS ON PER BENEFICIARY RATES ; 1
APPEALS.— 2
‘‘(A) R
EPORT TO STATES.—Not later than 3
8 months after the date of the enactment of 4
this section, the Secretary shall submit to each 5
State the Secretary’s initial determination of— 6
‘‘(i) the base per beneficiary, per cat-7
egory amounts under paragraph (2) for 8
such State; and 9
‘‘(ii) the national average base per 10
beneficiary, per category amounts under 11
paragraph (4)(A). 12
‘‘(B) O
PPORTUNITY TO APPEAL .—Not 13
later than 3 months after the date a State re-14
ceives notice of the Secretary’s initial deter-15
mination of such base per beneficiary, per cat-16
egory amounts for such State under subpara-17
graph (A)(i), the State may file with the Sec-18
retary, in a form and manner specified by the 19
Secretary, an appeal of such determination. 20
‘‘(C) D
ETERMINATION ON APPEAL .—Not 21
later than 3 months after receiving such an ap-22
peal, the Secretary shall make a final deter-23
mination on such amounts for such State. If no 24
such appeal is received for a State, the Sec-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 102
•HR 3129 IH
retary’s initial determination under subpara-1
graph (A)(i) shall become final. 2
‘‘(6) B
ASE FISCAL YEAR DEFINED .—In this 3
section, the term ‘base fiscal year’ means the latest 4
fiscal year, ending before the date of the enactment 5
of this section, for which the Secretary determines 6
that adequate data are available to make the com-7
putations required under this subsection. 8
‘‘(d) N
OTCOUNTINGINDIVIDUALSTOACCOUNT FOR 9
E
XCLUDEDPAYMENTS.—Under rules specified by the 10
Secretary, individuals shall not be counted as Medicaid 11
beneficiaries for purposes of subsection (b)(1)(B) and sub-12
section (c)(2)(A) in proportion to the extent that such in-13
dividuals are receiving medical assistance for which pay-14
ments described under subsection (a)(4)(A) are made. 15
‘‘(e) R
ISKADJUSTMENT.— 16
‘‘(1) I
N GENERAL.—The amount under sub-17
section (a)(1)(A) shall be adjusted under this sub-18
section in an appropriate manner, specified by the 19
Secretary and consistent with paragraph (2), to take 20
into account— 21
‘‘(A) the factors described in subsection 22
(c)(2)(C)(i)(I) within a category of bene-23
ficiaries; and 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 103
•HR 3129 IH
‘‘(B) variations in costs on a county-by- 1
county basis for medical assistance and admin-2
istrative expenses. 3
‘‘(2) M
ETHOD OF ADJUSTMENT .— 4
‘‘(A) I
N GENERAL .—The adjustments 5
under paragraph (1) shall be made in a manner 6
similar to the manner in which similar adjust-7
ments are made under subsection (c)(2)(C) and 8
consistent with the requirements of clause (iii) 9
of such subsection and subparagraph (B). 10
‘‘(B) B
IANNUAL UPDATE OF RISK ADJUST -11
MENT METHODOLOGY .—In applying clause 12
(i)(I) of subsection (c)(2)(C) for purposes of 13
subparagraph (A), the Secretary shall, in con-14
sultation with the entities described in clause 15
(ii)(I) of such subsection, update the risk ad-16
justment methodology applied as appropriate 17
not less often than every 2 years. 18
‘‘(f) C
HRONICCAREQUALITYBONUSPAYMENTS.— 19
‘‘(1) D
ETERMINATION OF BONUS PAYMENTS .— 20
If the Secretary determines that, based on the re-21
ports under paragraph (5), with respect to cat-22
egories of chronic disease for which chronic care per-23
formance targets had been established under para-24
graph (3) for each category of Medicaid beneficiaries 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 104
•HR 3129 IH
specified under subsection (b)(2) such targets have 1
been met by a State for a reform year, the Secretary 2
shall make an additional payment to such State in 3
the amount specified in paragraph (6) for each quar-4
ter in the succeeding reform year. Such payments 5
shall be made in a manner specified by the Secretary 6
and may only be used consistent with subsection 7
(a)(3). 8
‘‘(2) I
DENTIFICATION OF CATEGORIES OF 9
CHRONIC DISEASE.—The Secretary shall determine 10
the categories of chronic disease for which bonus 11
payments may be available under this subsection for 12
each category of Medicaid beneficiaries. 13
‘‘(3) A
DOPTION OF QUALITY MEASUREMENT 14
SYSTEM AND IDENTIFICATION OF PERFORMANCE 15
TARGETS.— 16
‘‘(A) S
YSTEM AND DATA.—With respect to 17
the categories of chronic disease under para-18
graph (2), the Secretary shall adopt a quality 19
measurement system that uses data described 20
in paragraph (4) and is similar to the Five-Star 21
Quality Rating System used to indicate the per-22
formance of Medicare Advantage plans under 23
part C of title XVIII. 24
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 105
•HR 3129 IH
‘‘(B) TARGETS.—Using such system and 1
data, the Secretary shall establish for each re-2
form year the chronic care performance targets 3
for purposes of the payments under paragraph 4
(1). Such performance targets shall be estab-5
lished in consultation with States, associations 6
representing individuals with chronic illnesses, 7
entities providing treatment to such individuals 8
for such chronic illnesses, and other stake-9
holders, including the National Association of 10
Medicaid Directors and the National Governors 11
Association. 12
‘‘(4) D
ATA TO BE USED.—The data to be used 13
under paragraph (3) shall include— 14
‘‘(A) data collected through methods such 15
as— 16
‘‘(i) the ‘Healthcare Effectiveness 17
Data and Information Set’ (also known as 18
‘HEDIS’) (or an appropriate successor 19
performance measurement tool); 20
‘‘(ii) the ‘Consumer Assessment of 21
Healthcare Providers and Systems’ (also 22
known as ‘CAHPS’) (or an appropriate 23
successor performance measurement tool); 24
and 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 106
•HR 3129 IH
‘‘(iii) the ‘Health Outcomes Survey’ 1
(also known as ‘HOS’) (or an appropriate 2
successor performance measurement tool); 3
and 4
‘‘(B) other data collected by the State. 5
‘‘(5) R
EPORTS.— 6
‘‘(A) I
N GENERAL.—Each State shall col-7
lect, analyze, and report to the Secretary, at a 8
frequency and in a manner to be established by 9
the Secretary, data described in paragraph (4) 10
that permit the Secretary to monitor the State’s 11
performance relative to the chronic care per-12
formance targets established under paragraph 13
(3). 14
‘‘(B) R
EVIEW AND VERIFICATION .—The 15
Secretary may review the data collected by the 16
State under subparagraph (A) to verify the 17
State’s analysis of such data with respect to the 18
performance targets under paragraph (3). 19
‘‘(6) A
MOUNT OF BONUS PAYMENTS .— 20
‘‘(A) I
N GENERAL.—Subject to subpara-21
graphs (B) and (C), with respect to each cat-22
egory of Medicaid beneficiaries, in the case of 23
a State that the Secretary determines, based on 24
the chronic care performance targets set under 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 107
•HR 3129 IH
paragraph (3) for a reform year for such cat-1
egory, performs— 2
‘‘(i) in the top five States in such cat-3
egory, subject to subparagraph (C)(ii), the 4
amount of the bonus for each quarter in 5
the succeeding reform year shall be 10 per-6
cent of the payment amount otherwise paid 7
to the State under subsection (a) for indi-8
viduals enrolled under the plan within such 9
category; 10
‘‘(ii) in the next five States in such 11
category, subject to subparagraph (C)(ii), 12
the amount of the bonus for each such 13
quarter shall be 5 percent of the payment 14
amount otherwise paid to the State under 15
subsection (a) for individuals enrolled 16
under the plan within such category; 17
‘‘(iii) in the next five States in such 18
category, subject to clauses (i) and (iii) of 19
subparagraph (C), the amount of the 20
bonus for each such quarter shall be 3 per-21
cent of the payment amount otherwise paid 22
to the State under subsection (a) for indi-23
viduals enrolled under the plan within such 24
category; 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 108
•HR 3129 IH
‘‘(iv) in the next five States in such 1
category, subject to clauses (i) and (iii) of 2
subparagraph (C), the amount of the 3
bonus for each such quarter shall be 2 per-4
cent of the payment amount otherwise paid 5
to the State under subsection (a) for indi-6
viduals enrolled under the plan within such 7
category; and 8
‘‘(v) in the next five States in such 9
category, subject to clauses (i) and (iii) of 10
subparagraph (C), the amount of the 11
bonus for each such quarter shall be 1 per-12
cent of the payment amount otherwise paid 13
to the State under subsection (a) for indi-14
viduals enrolled under the plan within such 15
category. 16
‘‘(B) A
GGREGATE ANNUAL LIMIT FOR 17
EACH CATEGORY OF MEDICAID BENE -18
FICIARIES.— 19
‘‘(i) I
N GENERAL.—In no case may 20
the aggregate amount of bonuses under 21
this subsection for quarters in a reform 22
year for a category of Medicaid bene-23
ficiaries exceed the limit specified in clause 24
(ii) for the reform year. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 109
•HR 3129 IH
‘‘(ii) LIMIT.—The limit specified in 1
this clause— 2
‘‘(I) for the second reform year is 3
equal to $250,000,000; or 4
‘‘(II) for a subsequent reform 5
year is equal to the limit specified in 6
this clause for the previous reform 7
year increased by the per beneficiary 8
percentage increase determined under 9
paragraph (1)(E) of subsection (c). 10
‘‘(C) L
IMITATION AND PRORATION OF BO -11
NUSES BASED ON APPLICATION OF AGGREGATE 12
LIMIT.— 13
‘‘(i) N
O BONUS FOR THIRD OR SUBSE -14
QUENT TIERS UNLESS AGGREGATE LIMIT 15
NOT REACHED ON FIRST TWO TIERS .—No 16
bonus shall be payable under clause (iii), 17
(iv), or (v) of subparagraph (A) for a cat-18
egory of Medicaid beneficiaries for a quar-19
ter in a reform year unless the aggregate 20
amount of bonuses under clauses (i) and 21
(ii) of such subparagraph for such category 22
and reform year is less than the limit spec-23
ified in subparagraph (B)(ii) for the re-24
form year. 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 110
•HR 3129 IH
‘‘(ii) PRORATION FOR FIRST TWO 1
TIERS.—If the aggregate amount of bo-2
nuses under clauses (i) and (ii) of subpara-3
graph (A) for a category of Medicaid bene-4
ficiaries for quarters in a reform year ex-5
ceeds the limit specified in subparagraph 6
(B)(ii) for the reform year, the amount of 7
each such bonus shall be prorated in a 8
manner so the aggregate amount of such 9
bonuses is equal to such limit. 10
‘‘(iii) P
RORATION FOR NEXT THREE 11
TIERS.—If the aggregate amount of bo-12
nuses under clauses (i) and (ii) of subpara-13
graph (A) for a category of Medicaid bene-14
ficiaries for quarters in a reform year is 15
less than the limit specified in subpara-16
graph (B)(ii) for the reform year, but the 17
aggregate amount of bonuses under clauses 18
(i) through (v) of subparagraph (A) for the 19
category and such quarters in the reform 20
year exceeds the limit specified in subpara-21
graph (B)(ii) for the reform year, the 22
amount of each bonus in clauses (iii), (iv), 23
and (v) of subparagraph (A) shall be pro-24
rated in a manner so the aggregate 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 111
•HR 3129 IH
amount of all the bonuses under subpara-1
graph (A) is equal to such limit. 2
‘‘(g) S
TATEOPTION FORRECEIVINGMEDICAREPAY-3
MENTS FOR FULL-BENEFITDUALELIGIBLEINDIVID-4
UALS.— 5
‘‘(1) I
N GENERAL.—Under this subsection a 6
State may elect for quarters beginning on or after 7
the implementation date in a reform year to receive 8
payment from the Secretary under paragraph (3). 9
As a condition of receiving such payment, the State 10
shall agree to provide to full-benefit dual eligible in-11
dividuals eligible for medical assistance under the 12
State plan— 13
‘‘(A) the medical assistance to which such 14
eligible individuals would otherwise be entitled 15
under this title; and 16
‘‘(B) any items and services which such eli-17
gible individuals would otherwise receive under 18
title XVIII. 19
‘‘(2) P
ROVIDER PAYMENT REQUIREMENT .— 20
‘‘(A) I
N GENERAL.—A State electing the 21
option under this subsection shall provide pay-22
ment to health care providers for the items and 23
services described under paragraph (1)(B) at a 24
rate that is not less than the rate at which pay-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 112
•HR 3129 IH
ments would be made to such providers for such 1
items and services under title XVIII. 2
‘‘(B) F
LEXIBILITY IN PAYMENT METH -3
ODS.—Nothing in subparagraph (A) shall be 4
construed as preventing a State from using al-5
ternative payment methodologies (such as bun-6
dled payments or the use of accountable care 7
organizations (as such term is used in section 8
1899)) for purposes of making payments to 9
health care providers for items and services pro-10
vided to dual eligible individuals in the State 11
under the option under this subsection. 12
‘‘(3) P
AYMENTS TO STATES IN LIEU OF MEDI -13
CARE PAYMENTS .—With respect to a full-benefit 14
dual eligible individual, in the case of a State that 15
elects the option under paragraph (1) for quarters in 16
a reform year— 17
‘‘(A) the Secretary shall not make any pay-18
ment under title XVIII for items and services 19
furnished to such individual for such quarters; 20
and 21
‘‘(B) the Secretary shall pay to the State, 22
in addition to the amounts paid to such State 23
under subsection (a), the amount that the Sec-24
retary would, but for this subsection, otherwise 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 113
•HR 3129 IH
pay under title XVIII for items and services 1
furnished to such an individual in such State 2
for such quarters. 3
‘‘(4) F
ULL-BENEFIT DUAL ELIGIBLE INDI -4
VIDUAL DEFINED.—In this subsection, the term 5
‘full-benefit dual eligible individual’ means an indi-6
vidual who meets the requirements of section 7
1935(c)(6)(A)(ii). 8
‘‘(h) A
UDITS.—The Secretary shall conduct such au-9
dits on the number and classification of Medicaid bene-10
ficiaries under such subsections and expenditures under 11
this section as may be necessary to ensure appropriate 12
payments under this section. 13
‘‘(i) T
REATMENT OFWAIVERS.— 14
‘‘(1) N
O IMPACT ON CURRENT WAIVERS .—In 15
the case of a waiver of requirements of this title pur-16
suant to section 1115 or other law that is in effect 17
as of the date of the enactment of this section, noth-18
ing in this section shall be construed to affect such 19
waiver for the period of the waiver as approved as 20
of such date. 21
‘‘(2) A
PPLICATION OF BUDGET NEUTRALITY TO 22
SUBSEQUENT WAIVERS AND RENEWALS TAKING SEC -23
TION INTO ACCOUNT.—In the case of a waiver of re-24
quirements of this title pursuant to section 1115 or 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 114
•HR 3129 IH
other law that is approved or renewed after the date 1
of the enactment of this section, to the extent that 2
such approval or renewal is conditioned upon a dem-3
onstration of budget neutrality, budget neutrality 4
shall be determined taking into account the applica-5
tion of this section. 6
‘‘(j) R
EPORT TOCONGRESS.—Not later than Janu-7
ary 1 of the second reform year, the Secretary shall submit 8
to Congress a report on the implementation of this section. 9
‘‘(k) D
EFINITIONS.—In this section: 10
‘‘(1) I
MPLEMENTATION DATE .—The term ‘im-11
plementation date’ means— 12
‘‘(A) July 1, 2022, if this section is en-13
acted on or before July 1, 2021; or 14
‘‘(B) July 1, 2022, if this section is en-15
acted after July 1, 2021. 16
‘‘(2) R
EFORM YEARS.— 17
‘‘(A) The term ‘reform year’ means a fiscal 18
year beginning with the first reform year. 19
‘‘(B) The term ‘first reform year’ means 20
the fiscal year in which the implementation date 21
occurs. 22
‘‘(C) The terms ‘second’, ‘third’, and suc-23
cessive similar terms mean, with respect to a 24
reform year, the second, third, or successive re-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 115
•HR 3129 IH
form year, respectively, succeeding the first re-1
form year.’’. 2
(b) C
ONFORMINGAMENDMENTS.— 3
(1) C
ONTINUED APPLICATION OF CLAWBACK 4
PROVISIONS.— 5
(A) C
ONTINUED APPLICATION .—Sub-6
sections (a) and (c)(1)(C) of section 1935 of 7
such Act (42 U.S.C. 1396u–5) are each amend-8
ed by inserting ‘‘or 1903A(a)’’ after ‘‘1903(a)’’. 9
(B) T
ECHNICAL AMENDMENT .—Section 10
1935(d)(1) of the Social Security Act (42 11
U.S.C. 1396u–5(d)(1)) is amended by inserting 12
‘‘except as provided in section 1903A(g)’’ after 13
‘‘any other provision of this title’’. 14
(2) P
AYMENT RULES UNDER SECTION 1903 .— 15
(A) Section 1903(a) of the Social Security 16
Act (42 U.S.C. 1396b(a)) is amended, in the 17
matter before paragraph (1), by inserting ‘‘and 18
section 1903A’’ after ‘‘except as otherwise pro-19
vided in this section’’. 20
(B) Section 1903(d) of such Act (42 21
U.S.C. 1396b(d)) is amended— 22
(i) in paragraph (1), by inserting 23
‘‘and under section 1903A’’ after ‘‘sub-24
sections (a) and (b)’’; 25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 116
•HR 3129 IH
(ii) in paragraph (2)— 1
(I) in subparagraph (A), by in-2
serting ‘‘or section 1903A’’ after ‘‘was 3
made under this section’’; and 4
(II) in subparagraph (B), by in-5
serting ‘‘or section 1903A’’ after 6
‘‘under subsection (a)’’; 7
(iii) in paragraph (4)— 8
(I) by striking ‘‘under this sub-9
section’’ and inserting ‘‘, with respect 10
to this section or section 1903A, 11
under this subsection’’; and 12
(II) by striking ‘‘under this sec-13
tion’’ and inserting ‘‘under the respec-14
tive section’’; and 15
(iv) in paragraph (5), by inserting ‘‘or 16
section 1903A’’ after ‘‘overpayment under 17
this section’’. 18
(3) C
ONFORMING WAIVER AUTHORITY .—Section 19
1115(a)(2)(A) of the Social Security Act (42 U.S.C. 20
1315(a)(2)(A)) is amended by striking ‘‘or 1903’’ 21
and inserting ‘‘1903, or 1903A’’. 22
(4) R
EPORT ON ADDITIONAL CONFORMING 23
AMENDMENTS NEEDED .—Not later than 6 months 24
after the date of the enactment of this Act, the Sec-25
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB 117
•HR 3129 IH
retary of Health and Human Services shall submit 1
to Congress a report that includes a description of 2
any additional technical and conforming amend-3
ments to law that are required to properly carry out 4
this Act. 5
TITLE V—PRICE TRANSPARENCY 6
SEC. 501. PROMOTING TRANSPARENT HOSPITAL PRICES 7
FOR CONSUMERS. 8
The provisions of the rule entitled ‘‘Price Trans-9
parency Requirements for Hospitals to Make Standard 10
Charges Public’’ published by the Department of Health 11
and Human Services on November 27, 2019 (85 Fed. Reg. 12
65524) shall have the force and effect of law. 13
Æ
VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6301 E:\BILLS\H3129.IH H3129
pbinns on DSKJLVW7X2PROD with $$_JOB