H.R. 3072 (112th): State Authorized Alternative Health Arrangement Act of 2011

HR 3072 IH

To amend the Patient Protection and Affordable Care Act to provide State flexibility for the offering of health benefits through alternative health arrangements.

September 29, 2011

Mr. HALL introduced the following bill; which was referred to the Committee on Energy and Commerce

To amend the Patient Protection and Affordable Care Act to provide State flexibility for the offering of health benefits through alternative health arrangements.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘State Authorized Alternative Health Arrangement Act of 2011’.

SEC. 2. ALTERNATIVE HEALTH ARRANGEMENTS FOR THE PROVISION OF HEALTH BENEFITS.

Section 1311(f) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(f); Public Law 111-148) is amended by adding at the end the following new paragraph:

‘(4) ALTERNATIVE HEALTH ARRANGEMENTS FOR THE PROVISION OF HEALTH BENEFITS-

‘(A) ESTABLISHMENT OF ALTERNATIVE HEALTH ARRANGEMENTS-

‘(i) IN GENERAL- A State may establish one or more alternative health arrangements (each referred to in this subsection as an ‘alternative health arrangement’) that serve the beneficiaries of one or more qualified benefits programs (as defined in subparagraph (B)(i)) if the number of participants served by each such arrangement is determined by the State to be adequate for purposes of carrying out the requirements of this title.

‘(ii) DESIGNATION OF QUALIFIED BENEFITS PROGRAMS TO BE OFFERED- A State that establishes an alternative health arrangement shall designate one or more qualified benefits programs to be offered through such arrangement.

‘(iii) TREATMENT AS SEPARATE EXCHANGE- An alternative health arrangement shall be in addition to an Exchange or a subsidiary Exchange under this section.

‘(iv) CRITERIA APPLICABLE TO ALTERNATIVE HEALTH ARRANGEMENT- An alternative health arrangement shall be deemed to be an Exchange under this title, except that--

‘(I) the requirement of section 1311(d)(2) (relating to the offering of coverage) shall only apply, with respect to such an arrangement, to the offering of qualified benefits programs and only to beneficiaries served by such programs; and

‘(II) the requirements of section 1311(e)(1) (relating to certification of health plans) shall be deemed to have been satisfied with respect to qualified benefits programs offered through the arrangement by the designation of such programs by the State under clause (ii).

‘(B) QUALIFIED BENEFITS PROGRAMS-

‘(i) DEFINITION- In this paragraph, the term ‘qualified benefits program’ means an entity or arrangement (such as a program created by a group of government agencies, instrumentalities, or political subdivisions by interlocal agreement or other method authorized by State law) that--

‘(I) is established, authorized, and operating pursuant to State law to provide or administer health coverage for officials, employees, and retirees (and dependents of such officials, employees, and retirees) of a group of employers; and

‘(II) the State finds, subject to clause (ii), satisfies criteria under this title to be a qualified health plan.

‘(ii) SATISFACTION OF CERTAIN REQUIREMENTS- In applying this title with respect to a qualified benefits program that is designated by a State under subparagraph (A)(ii) and offered through an alternative health arrangement, the following special rules apply:

‘(I) The entity offering such coverage shall be deemed to meet the requirement of section 1301(a)(1)(C)(i) (relating to licensure as a health insurance issuer).

‘(II) Section 1301(a)(1)(C)(iii) (relating to uniform premium rates) shall be applied separately to each different health benefits option offered under the qualified benefits program through the arrangement.

‘(III) Section 1311(c)(1)(D) (relating to accreditation) shall be deemed to have been satisfied by virtue of the designation by the State under subparagraph (A)(ii).

‘(IV) Section 1311(e)(1) (relating to certification of health plans) shall not apply insofar as it applies to accreditation under section 1311(c)(1)(D).

‘(V) Section 1311(e)(2) (relating to premium considerations) shall not apply insofar as it requires alternative health arrangements to display premium information to the general public or conduct an analysis of premium growth outside of the alternative health arrangement.

‘(iii) TREATMENT AS A HEALTH PLAN, QUALIFIED HEALTH PLAN, AND INDIVIDUAL INSURANCE COVERAGE- A qualified benefits program offered through an alternative health arrangement shall be treated--

‘(I) subject to clause (ii), as meeting the definition of a health plan under section 1301(b) and as a qualified health plan under this title; and

‘(II) as a health plan offered in the individual market for purposes of section 5000A(f)(1)(C) of the Internal Revenue Code.

‘(C) CONSTRUCTION- Nothing in this paragraph shall be construed--

‘(i) to authorize or require an alternative health arrangement to offer health benefits to any individual other than a beneficiary covered under such arrangement; or

‘(ii) to authorize the offering of such health benefits through an Exchange.’.

Loading...