Thursday, December 24, 2009
$100M For Louisiana - HR3200
SEC. 2006. SPECIAL ADJUSTMENT TO FMAP DETERMINATION FOR CERTAIN STATES RECOVERING FROM A MAJOR DISASTER.
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 2001(a)(3) and
2001(b)(2), is amended— (1) in subsection (b), in the first sentence, by striking ‘‘subsection (y)’’ and inserting ‘‘subsections (y) and (aa)’’; and (2) by adding at the end the following new subsection:
‘‘(aa)(1) Notwithstanding subsection (b), beginning January 1, 2011, the Federal medical assistance percentage for a fiscal year for a disaster-recovery FMAP adjustment State shall be equal to the following:
‘(A) In the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the Federal medical assistance percentage determined for the fiscal year without regard to this subsection and subsection (y), increased by 50 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5.
‘‘(B) In the case of the second or any succeeding fiscal year for which this subsection applies to the State, the Federal medical assistance percentage determined for the preceding fiscal year under this subsection for the State, increased by 25 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection.
‘‘(2) In this subsection, the term ‘disaster-recovery FMAP adjustment State’ means a State that is one of
the 50 States or the District of Columbia, for which, at any time during the preceding 7 fiscal years, the President has declared a major disaster under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act and determined as a result of such disaster that every county or parish in the State warrant individual and public assistance or public assistance from the Federal Government under such Act and for which— ‘‘(A) in the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5, by at least 3 percentage points; and ‘‘(B) in the case of the second or any succeeding fiscal year for which this subsection applies to the State, the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection by at least 3 percentage points.
‘‘(3) The Federal medical assistance percentage determined for a disaster-recovery FMAP adjustment State under paragraph (1) shall apply for purposes of this title (other than with respect to disproportionate share hospital payments described in section 1923 and payments under this title that are based on the enhanced FMAP described in 2105(b)) and shall not apply with respect to payments under title IV (other than under part E of title IV) or payments under title XXI.’’.
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 2001(a)(3) and
2001(b)(2), is amended— (1) in subsection (b), in the first sentence, by striking ‘‘subsection (y)’’ and inserting ‘‘subsections (y) and (aa)’’; and (2) by adding at the end the following new subsection:
‘‘(aa)(1) Notwithstanding subsection (b), beginning January 1, 2011, the Federal medical assistance percentage for a fiscal year for a disaster-recovery FMAP adjustment State shall be equal to the following:
‘(A) In the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the Federal medical assistance percentage determined for the fiscal year without regard to this subsection and subsection (y), increased by 50 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5.
‘‘(B) In the case of the second or any succeeding fiscal year for which this subsection applies to the State, the Federal medical assistance percentage determined for the preceding fiscal year under this subsection for the State, increased by 25 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection.
‘‘(2) In this subsection, the term ‘disaster-recovery FMAP adjustment State’ means a State that is one of
the 50 States or the District of Columbia, for which, at any time during the preceding 7 fiscal years, the President has declared a major disaster under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act and determined as a result of such disaster that every county or parish in the State warrant individual and public assistance or public assistance from the Federal Government under such Act and for which— ‘‘(A) in the case of the first fiscal year (or part of a fiscal year) for which this subsection applies to the State, the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5, by at least 3 percentage points; and ‘‘(B) in the case of the second or any succeeding fiscal year for which this subsection applies to the State, the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection and subsection (y), is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection by at least 3 percentage points.
‘‘(3) The Federal medical assistance percentage determined for a disaster-recovery FMAP adjustment State under paragraph (1) shall apply for purposes of this title (other than with respect to disproportionate share hospital payments described in section 1923 and payments under this title that are based on the enhanced FMAP described in 2105(b)) and shall not apply with respect to payments under title IV (other than under part E of title IV) or payments under title XXI.’’.
Capps Amendment
Add at the end of section 122 the following new subsection:
(d) ABORTION COVERAGE PROHIBITED AS PART OF MINIMUM BENEFITS PACKAGE.
(1) PROHIBITION OF REQUIRED COVERAGE.
The Health Benefits Advisory Committee may not recommend under section 123 (b) and the Secretary may not adopt in standards under section 124(b), the services described in paragraph (4)(A) or (4) (B) as part of the essential benefits package and the Commissioner may not require such services for qualified health benefits plans to participate in the Health Insurance Exchange.
(2) VOLUNTARY CHOICE OF COVERAGE BY PLAN.-In the case of a qualified health benefits plan, the plan is not required (or prohibited) under this Act from providing coverage of services described in paragraph (4) (A) or (4)(B) and the , QHBP offering entity shall determine whether such coverage is provided.
(3) COVERAGE UNDER PUBLIC HEALTH INSURANCE OPTION.-The public health insurance option shall provide coverage for services described in paragraph (4)(B). Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4) (A).
(4) ABORTION SERVICES.(A) ABORTIONS FOR WHICH PUBLIC FUNDING IS PROIDBITED.-The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is not permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.
(B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.-The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.
In section 123(b)(4)(A), insert after "cost sharing" the following: "consistent with subsection (d) of such section".
In section 124(b)(3), insert "(including subsection (d))" after "sections 122".
Add at the end of section 203 the following:
(e) RULES REGARDING COVERAGE OF AND AFFORDABILITY CREDITS FOR SPECIFIED SERVICES. (1) ASSURED AVAILABILITY OF VARIED COVERAGE THROUGH THE HEALTH INSURANCE EXCHANGE.-The Commissioner shall assure· that, of the Exchange participating health benefits plan offered in each premium rating area of the Health Insurance Exchange (A) there is at least one such plan that provides coverage of services described in sub paragraphs (A) and (B) of section 122(d)(4); and (B) there is at least one such plan that does not provide coverage of services described in section 122(d)(4)(A) which plan may also be one that does not provide coverage of services described in section 122(d)(4) (B) .
(2) SEGREGATION OF FUNDS.-If a qualified health benefits plan provides coverage of services described in section 122(d)(4)(A), the plan shall provide assurances satisfactory to the Commissioner that (A) any affordability credits provided under subtitle C of title II are not used for purposes of paying for such services; and (B) only premium amounts attributable to the actuarial value described in section 113(b) are used for such purpose.
In section 113, redesignate subsection (b) as sub-section (c) and insert after subsection (a) the following new subsection:
(b) ACTUARIAL VALUE OF OPTIONAL SERVICE COVERAGE. (1) IN GENERAL.-The Commissioner shall estimate the basic per enrollee, per month cost, determined on an average actuarial basis, for including coverage under a basic plan of the services described in section 122(d)(4)(A).
(2) CONSIDERATIONS.-In making such estimate the Commissioner (A) may take into account the impact on overall costs of the inclusion of such coverage, but may not take into account any cost reduction estimated to result from such services, including prenatal care, delivery, or postnatal care; (B) shall estimate such costs as if such coverage were included for the entire population covered; and (C) may not estimate such a cost at less than $1 per enrollee, per month.
Add at the end of section 204 the following new subsection:
(d) No DISCRIMINATION ON THE BASIS OF PROVISION OF ABORTION.-No Exchange participating health benefits plan may discriminate against any individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.
In section 241(c), add at the end the following new paragraph:
(3) PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE.-An affordability credit may not be used for payment for services described in section 122(d)(4)(A).
Insert at the appropriate place (in the matter immediately preceding division A) the following section:
SEC. 2. APPLICATION OF STATE AND FEDERAL LAWS REGARDING ABORTION.
(a) No PREEMPTION OF STATE LAWS REGARDING ABoRTION.-Nothing in this Act shall be construed to preempt or otherwise have any effect on State laws regarding the prohibition of (or requirement of) coverage, funding, or procedural requirements on abortions, including parental notification or consent for the performance of an abortion on a minor.
(b) No EFFECT ON FEDERAl. LAws REGARDING ABORTION. (1) IN GENERAL.-Nothing in this Act shall be construed to have any effect on Federal laws regarding (A) conscience protection; (B) willingness or refusal to provide abortion; and (C) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.
(c) No EFFECT ON FEDERAL CIVIL RIGHTS LAW. Nothing in this section shall alter the rights and obligations of employees and employers under title VII of the Civil Rights Act of 1964.
Add at the end of title IX of division B the following:
SEC. 1906. APPLICATION OF EMERGENCY SERVICES LAWS. Nothing in this Act shall be construed to relieve any health care provider from providing emergency services as required by State or Federal law, including section 1867 of the Social Security Act (popularly known as "EMTALA").
(d) ABORTION COVERAGE PROHIBITED AS PART OF MINIMUM BENEFITS PACKAGE.
(1) PROHIBITION OF REQUIRED COVERAGE.
The Health Benefits Advisory Committee may not recommend under section 123 (b) and the Secretary may not adopt in standards under section 124(b), the services described in paragraph (4)(A) or (4) (B) as part of the essential benefits package and the Commissioner may not require such services for qualified health benefits plans to participate in the Health Insurance Exchange.
(2) VOLUNTARY CHOICE OF COVERAGE BY PLAN.-In the case of a qualified health benefits plan, the plan is not required (or prohibited) under this Act from providing coverage of services described in paragraph (4) (A) or (4)(B) and the , QHBP offering entity shall determine whether such coverage is provided.
(3) COVERAGE UNDER PUBLIC HEALTH INSURANCE OPTION.-The public health insurance option shall provide coverage for services described in paragraph (4)(B). Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4) (A).
(4) ABORTION SERVICES.(A) ABORTIONS FOR WHICH PUBLIC FUNDING IS PROIDBITED.-The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is not permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.
(B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.-The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.
In section 123(b)(4)(A), insert after "cost sharing" the following: "consistent with subsection (d) of such section".
In section 124(b)(3), insert "(including subsection (d))" after "sections 122".
Add at the end of section 203 the following:
(e) RULES REGARDING COVERAGE OF AND AFFORDABILITY CREDITS FOR SPECIFIED SERVICES. (1) ASSURED AVAILABILITY OF VARIED COVERAGE THROUGH THE HEALTH INSURANCE EXCHANGE.-The Commissioner shall assure· that, of the Exchange participating health benefits plan offered in each premium rating area of the Health Insurance Exchange (A) there is at least one such plan that provides coverage of services described in sub paragraphs (A) and (B) of section 122(d)(4); and (B) there is at least one such plan that does not provide coverage of services described in section 122(d)(4)(A) which plan may also be one that does not provide coverage of services described in section 122(d)(4) (B) .
(2) SEGREGATION OF FUNDS.-If a qualified health benefits plan provides coverage of services described in section 122(d)(4)(A), the plan shall provide assurances satisfactory to the Commissioner that (A) any affordability credits provided under subtitle C of title II are not used for purposes of paying for such services; and (B) only premium amounts attributable to the actuarial value described in section 113(b) are used for such purpose.
In section 113, redesignate subsection (b) as sub-section (c) and insert after subsection (a) the following new subsection:
(b) ACTUARIAL VALUE OF OPTIONAL SERVICE COVERAGE. (1) IN GENERAL.-The Commissioner shall estimate the basic per enrollee, per month cost, determined on an average actuarial basis, for including coverage under a basic plan of the services described in section 122(d)(4)(A).
(2) CONSIDERATIONS.-In making such estimate the Commissioner (A) may take into account the impact on overall costs of the inclusion of such coverage, but may not take into account any cost reduction estimated to result from such services, including prenatal care, delivery, or postnatal care; (B) shall estimate such costs as if such coverage were included for the entire population covered; and (C) may not estimate such a cost at less than $1 per enrollee, per month.
Add at the end of section 204 the following new subsection:
(d) No DISCRIMINATION ON THE BASIS OF PROVISION OF ABORTION.-No Exchange participating health benefits plan may discriminate against any individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.
In section 241(c), add at the end the following new paragraph:
(3) PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE.-An affordability credit may not be used for payment for services described in section 122(d)(4)(A).
Insert at the appropriate place (in the matter immediately preceding division A) the following section:
SEC. 2. APPLICATION OF STATE AND FEDERAL LAWS REGARDING ABORTION.
(a) No PREEMPTION OF STATE LAWS REGARDING ABoRTION.-Nothing in this Act shall be construed to preempt or otherwise have any effect on State laws regarding the prohibition of (or requirement of) coverage, funding, or procedural requirements on abortions, including parental notification or consent for the performance of an abortion on a minor.
(b) No EFFECT ON FEDERAl. LAws REGARDING ABORTION. (1) IN GENERAL.-Nothing in this Act shall be construed to have any effect on Federal laws regarding (A) conscience protection; (B) willingness or refusal to provide abortion; and (C) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.
(c) No EFFECT ON FEDERAL CIVIL RIGHTS LAW. Nothing in this section shall alter the rights and obligations of employees and employers under title VII of the Civil Rights Act of 1964.
Add at the end of title IX of division B the following:
SEC. 1906. APPLICATION OF EMERGENCY SERVICES LAWS. Nothing in this Act shall be construed to relieve any health care provider from providing emergency services as required by State or Federal law, including section 1867 of the Social Security Act (popularly known as "EMTALA").
Stupak Anti Abortion Amendment
(a) IN GENERAL.—No funds authorized or
appropriated by this Act (or an amendment
made by this Act) may be used to pay for any
abortion or to cover any part of the costs of
any health plan that includes coverage of
abortion, except in the case where a woman
suffers from a physical disorder, physical injury,
or physical illness that would, as certified
by a physician, place the woman in
danger of death unless an abortion is performed,
including a life-endangering physical
condition caused by or arising from the pregnancy
itself, or unless the pregnancy is the
result of an act of rape or incest.
(b) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL
COVERAGE OR PLAN.—Nothing in this
section shall be construed as prohibiting any
nonfederal entity (including an individual or
a State or local government) from purchasing
separate supplemental coverage for
abortions for which funding is prohibited
under this section, or a plan that includes
such abortions, so long as—
(1) such coverage or plan is paid for entirely
using only funds not authorized or appropriated
by this Act; and
(2) such coverage or plan is not purchased
using—
(A) individual premium payments required
for a Exchange-participating health benefits
plan towards which an affordability credit is
applied; or
(B) other nonfederal funds required to receive
a federal payment, including a State’s
or locality’s contribution of Medicaid matching
funds.
(c) OPTION TO OFFER SEPARATE SUPPLEMENTAL
COVERAGE OR PLAN.—Notwithstanding
section 303(b), nothing in this section
shall restrict any nonfederal QHBP offering
entity from offering separate supplemental
coverage for abortions for which
funding is prohibited under this section, or a
plan that includes such abortions, so long
as—
(1) premiums for such separate supplemental
coverage or plan are paid for entirely
with funds not authorized or appropriated by
this Act;
(2) administrative costs and all services offered
through such supplemental coverage or
plan are paid for using only premiums collected
for such coverage or plan; and
(3) any nonfederal QHBP offering entity
that offers an Exchange-participating health
benefits plan that includes coverage for
abortions for which funding is prohibited
under this section also offers an Exchange participating
health benefits plan that is
identical in every respect except that it does
not cover abortions for which funding is prohibited
under this section.
appropriated by this Act (or an amendment
made by this Act) may be used to pay for any
abortion or to cover any part of the costs of
any health plan that includes coverage of
abortion, except in the case where a woman
suffers from a physical disorder, physical injury,
or physical illness that would, as certified
by a physician, place the woman in
danger of death unless an abortion is performed,
including a life-endangering physical
condition caused by or arising from the pregnancy
itself, or unless the pregnancy is the
result of an act of rape or incest.
(b) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL
COVERAGE OR PLAN.—Nothing in this
section shall be construed as prohibiting any
nonfederal entity (including an individual or
a State or local government) from purchasing
separate supplemental coverage for
abortions for which funding is prohibited
under this section, or a plan that includes
such abortions, so long as—
(1) such coverage or plan is paid for entirely
using only funds not authorized or appropriated
by this Act; and
(2) such coverage or plan is not purchased
using—
(A) individual premium payments required
for a Exchange-participating health benefits
plan towards which an affordability credit is
applied; or
(B) other nonfederal funds required to receive
a federal payment, including a State’s
or locality’s contribution of Medicaid matching
funds.
(c) OPTION TO OFFER SEPARATE SUPPLEMENTAL
COVERAGE OR PLAN.—Notwithstanding
section 303(b), nothing in this section
shall restrict any nonfederal QHBP offering
entity from offering separate supplemental
coverage for abortions for which
funding is prohibited under this section, or a
plan that includes such abortions, so long
as—
(1) premiums for such separate supplemental
coverage or plan are paid for entirely
with funds not authorized or appropriated by
this Act;
(2) administrative costs and all services offered
through such supplemental coverage or
plan are paid for using only premiums collected
for such coverage or plan; and
(3) any nonfederal QHBP offering entity
that offers an Exchange-participating health
benefits plan that includes coverage for
abortions for which funding is prohibited
under this section also offers an Exchange participating
health benefits plan that is
identical in every respect except that it does
not cover abortions for which funding is prohibited
under this section.
Ben Nelson Nebraska Exemption Text
“Notwithstanding subsection (b) and paragraphs (1) and (2) of this subsection, the Federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year that begins on or after January 1, 2017, for the State of Nebraska, with respect to amounts expended for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be determined as provided for under subsection (y)(1)(A) (notwithstanding the period provided for in such paragraph).” (Manager’s Amendment To H.R. 3590, Pg. 98)
* “(Y) INCREASED FMAP FOR MEDICAL ASSISTANCE FOR NEWLY ELIGIBLE MANDATORY INDIVIDUALS.— “(1) AMOUNT OF INCREASE.— “(A) 100 PERCENT FMAP.—during the period that begins on January 1, 2014, and ends on December 31, 2016, notwithstanding subsection (b), the Federal medical assistance percentage determined for a State that is one of the 50 States or the District of Columbia for each fiscal year occurring during that period with respect to amounts expended for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) shall be equal to 100 percent.” (S.Amdt 2786 To H.R. 3590, “Patient Protection And Affordable Care Act,” P. 399)
* “(Y) INCREASED FMAP FOR MEDICAL ASSISTANCE FOR NEWLY ELIGIBLE MANDATORY INDIVIDUALS.— “(1) AMOUNT OF INCREASE.— “(A) 100 PERCENT FMAP.—during the period that begins on January 1, 2014, and ends on December 31, 2016, notwithstanding subsection (b), the Federal medical assistance percentage determined for a State that is one of the 50 States or the District of Columbia for each fiscal year occurring during that period with respect to amounts expended for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) shall be equal to 100 percent.” (S.Amdt 2786 To H.R. 3590, “Patient Protection And Affordable Care Act,” P. 399)
Ben Nelson Abortion Amendment Text
a) Special Rules Relating to Coverage of Abortion Services.—
(1) IN GENERAL.—Subject to paragraph (2), nothing in this Act (or any amendment made by this Act) shall be construed to require any health plan to provide coverage of abortion services or to allow the Secretary or any other person or entity implementing this Act (or amendment) to require coverage of such services.
(2) COMMUNITY HEALTH INSURANCE OPTION.—The Secretary may not provide coverage of abortion services in the community health insurance option established under section 1323, except in the case where use of funds authorized or appropriated by this Act is permitted for such services under subsection (b)(1).
(3) NO DISCRIMINATION ON THE BASIS OF PROVISION OF ABORTION.—No Exchange participating health benefits plan may discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.
(b) Limitation on Abortion Funding.—
(1) IN GENERAL.—No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest.
(2) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN.—Nothing in this subsection shall be construed as prohibiting any non-Federal entity (including an individual or a State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this subsection, or a plan that includes such abortions, so long as—
(A) such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and
(B) such coverage or plan is not purchased using—
(i) individual premium payments required for a qualified health plan offered through the Exchange towards which a credit is applied under section 36B of the Internal Revenue Code of 1986; or
(ii) other non-Federal funds required to receive a Federal payment, including a State’s or locality’s contribution of Medicaid matching funds.
(3) OPTION TO OFFER SUPPLEMENTAL COVERAGE OR PLAN.—Nothing in this subsection shall restrict any non-Federal health insurance issuer offering a qualified health plan from offering separate supplemental coverage for abortions for which funding is prohibited under this subsection, or a plan that includes such abortions, so long as—
(A) premiums for such separate supplemental coverage or plan are paid for entirely with funds not authorized or appropriated by this Act;
(B) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and
(C) any such non-Federal health insurance issuer that offers a qualified health plan through the Exchange that includes coverage for abortions for which funding is prohibited under this subsection also offers a qualified health plan through the Exchange that is identical in every respect except that it does not cover abortions for which funding is prohibited under this subsection.
(1) IN GENERAL.—Subject to paragraph (2), nothing in this Act (or any amendment made by this Act) shall be construed to require any health plan to provide coverage of abortion services or to allow the Secretary or any other person or entity implementing this Act (or amendment) to require coverage of such services.
(2) COMMUNITY HEALTH INSURANCE OPTION.—The Secretary may not provide coverage of abortion services in the community health insurance option established under section 1323, except in the case where use of funds authorized or appropriated by this Act is permitted for such services under subsection (b)(1).
(3) NO DISCRIMINATION ON THE BASIS OF PROVISION OF ABORTION.—No Exchange participating health benefits plan may discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.
(b) Limitation on Abortion Funding.—
(1) IN GENERAL.—No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest.
(2) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN.—Nothing in this subsection shall be construed as prohibiting any non-Federal entity (including an individual or a State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this subsection, or a plan that includes such abortions, so long as—
(A) such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and
(B) such coverage or plan is not purchased using—
(i) individual premium payments required for a qualified health plan offered through the Exchange towards which a credit is applied under section 36B of the Internal Revenue Code of 1986; or
(ii) other non-Federal funds required to receive a Federal payment, including a State’s or locality’s contribution of Medicaid matching funds.
(3) OPTION TO OFFER SUPPLEMENTAL COVERAGE OR PLAN.—Nothing in this subsection shall restrict any non-Federal health insurance issuer offering a qualified health plan from offering separate supplemental coverage for abortions for which funding is prohibited under this subsection, or a plan that includes such abortions, so long as—
(A) premiums for such separate supplemental coverage or plan are paid for entirely with funds not authorized or appropriated by this Act;
(B) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and
(C) any such non-Federal health insurance issuer that offers a qualified health plan through the Exchange that includes coverage for abortions for which funding is prohibited under this subsection also offers a qualified health plan through the Exchange that is identical in every respect except that it does not cover abortions for which funding is prohibited under this subsection.
Essential Benefits
SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED.
(a) In General- In this division, the term `essential benefits package' means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that--
(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;
(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);
(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;
(4) complies with section 115(a) (relating to network adequacy); and
(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.
(b) Minimum Services To Be Covered- The items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.
(c) Requirements Relating to Cost-sharing and Minimum Actuarial Value-
(1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.
(2) ANNUAL LIMITATION-
(A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).
(B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
(C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.
(3) MINIMUM ACTUARIAL VALUE-
(A) IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
(B) REFERENCE BENEFITS PACKAGE DESCRIBED- The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.
(a) In General- In this division, the term `essential benefits package' means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that--
(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;
(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);
(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;
(4) complies with section 115(a) (relating to network adequacy); and
(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.
(b) Minimum Services To Be Covered- The items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.
(c) Requirements Relating to Cost-sharing and Minimum Actuarial Value-
(1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.
(2) ANNUAL LIMITATION-
(A) ANNUAL LIMITATION- The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).
(B) APPLICABLE LEVEL- The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
(C) USE OF COPAYMENTS- In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.
(3) MINIMUM ACTUARIAL VALUE-
(A) IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
(B) REFERENCE BENEFITS PACKAGE DESCRIBED- The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.
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