S.Amdt. 2216

SA 2216. Ms. COLLINS (for herself, Mr. Alexander, Mr. Graham, Mr.
Rounds, Ms. Murkowski, Mr. Isakson, and Mr. McConnell) submitted an
amendment intended to be proposed by her to the bill H.R. 1625, to
amend the State Department Basic Authorities Act of 1956 to include
severe forms of trafficking in persons within the definition of
transnational organized crime for purposes of the rewards program of
the Department of State, and for other purposes; which was ordered to
lie on the table; as follows:

In division H, after section 229, insert the following:

SEC. 230. WAIVERS FOR STATE INNOVATION; COST-SHARING
PAYMENTS.

(a) Waivers for State Innovation.--
(1) Streamlining the state application process.--Section
1332 of the Patient Protection and Affordable Care Act (42
U.S.C. 18052) is amended--
(A) in subsection (a)(1)(C), by striking ``the law'' and
inserting ``a law or has in effect a certification''; and
(B) in subsection (b)(2)--
(i) in the paragraph heading, by inserting ``or certify''
after ``law'';
(ii) in subparagraph (A)--

(I) by striking ``A law'' and inserting the following:

[[Page S1957]]

``(i) Laws.--A law''; and

(II) by adding at the end the following:

``(ii) Certifications.--A certification described in this
paragraph is a document, signed by the Governor of the State,
that certifies that such Governor has the authority under
existing Federal and State law to take action under this
section, including implementation of the State plan under
subsection (a)(1)(B).''; and
(iii) in subparagraph (B)--

(I) in the subparagraph heading, by striking ``of opt
out''; and
(II) by striking ``may repeal a law'' and all that follows
through the period at the end and inserting the following:
``may terminate the authority provided under the waiver with
respect to the State by--

``(i) repealing a law described in subparagraph (A)(i); or
``(ii) terminating a certification described in
subparagraph (A)(ii), through a certification for such
termination signed by the Governor of the State.''.
(2) Giving states more funding flexibility, to establish
reinsurance, invisible high risk pools, insurance stability
funds and other programs.--
(A) State grants under waivers.--Section 1332(a) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18052(a)) is amended--
(i) in paragraph (3)--

(I) in the first sentence--

(aa) by inserting ``or would qualify for a reduced portion
of'' after ``would not qualify for'';
(bb) by inserting ``, or the State would not qualify for or
would qualify for a reduced portion of basic health program
funds under section 1331,'' after ``subtitle E'';
(cc) by inserting ``, or basic health program funds the
State would have received,'' after ``this title''; and
(dd) by inserting ``or for implementing the basic health
program established under section 1331'' before the period;

(II) in the second sentence, by inserting before the period
``, and with respect to participation in the basic health
program and funds provided to such other States under section
1331''; and
(III) by adding after the second sentence the following:
``A State may request that all of, or any portion of, such
aggregate amount of such credits, reductions, or funds be
paid to the State as described in the first sentence.'';

(ii) by redesignating paragraphs (4), (5), and (6) as
paragraphs (5), (6), and (7), respectively; and
(iii) by inserting after paragraph (3) the following:
``(4) Federal funding for invisible high-risk pool and
reinsurance programs.--
``(A) Allocations.--Not later than 45 days after the date
of enactment of the Department of Health and Human Services
Appropriations Act, 2018, the Secretary, in consultation with
the National Association of Insurance Commissioners, shall
specify an allocation methodology for determining the amount
of funds appropriated under section 230(a)(2)(B) of the
Department of Health and Human Services Appropriations Act,
2018 for a fiscal year to be allocated for each State for
purposes of subparagraph (B) and section 230(a)(2)(C) of the
Department of Health and Human Services Appropriations Act,
2018.
``(B) State grants.--From amounts appropriated under
section 230(a)(2)(B) of the Department of Health and Human
Services Appropriations Act, 2018 for a fiscal year, the
Secretary shall award grants to States for each of fiscal
years 2018 through 2021, in amounts determined in accordance
with the allocation methodology under subparagraph (A), for
the following purposes:
``(i) For fiscal year 2018, for administrative costs of the
State associated with preparing and submitting information
described in subsection (a)(1)(B) that includes an invisible
high-risk pool or reinsurance program that meets the
requirements of subsection (g)(2), or costs associated with
the establishment of such invisible high-risk pool or
reinsurance program.
``(ii) For each of fiscal years 2019, 2020, and 2021, for
the establishment or maintenance of invisible high-risk pools
and reinsurance programs that meet the requirements of
subsection (g)(2) and for which the State has received a
waiver under this section.
``(C) Budget neutrality.--Funds awarded to a State under a
grant awarded under subparagraph (B) shall not be taken into
account for purposes of determining under paragraph (1)
whether the State waiver is budget neutral, or determining
under subsection (b)(1) whether the State waiver increases
the Federal deficit.''.
(B) Appropriations.--
(i) In general.--There are authorized to be appropriated,
and there are appropriated, to the Secretary of Health and
Human Services, for the purposes described in section
1332(a)(4)(B) of the Patient Protection and Affordable Care
Act and subparagraph (C), out of any funds in the Treasury
not otherwise appropriated--

(I) $500,000,000 for fiscal year 2018; and
(II) $10,000,000,000 for each of fiscal years 2019, 2020,
and 2021.

(ii) Available until expended.--Amounts appropriated under
this paragraph shall remain available until expended.
(C) Default federal safeguard.--
(i) In general.--For purposes of plan year 2019, in the
case of a State that does not, by a date specified by the
Secretary of Health and Human Services (referred to in this
paragraph as the ``Secretary''), in consultation with the
National Association of Insurance Commissioners, have in
effect a waiver under section 1332 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18052) that includes an
invisible high-risk pool or reinsurance program that meets
the requirements of subsection (g)(2) of such section 1332,
the Secretary shall, from amounts appropriated under
subparagraph (B), use the allocation determined for the State
under subsection (a)(4)(B) of such section 1332 for plan year
2019 for the purpose described in clause (ii) for such State.
(ii) Required use for market stabilization payments to
issuers.--The Secretary shall use any allocation for a State
made pursuant to clause (i) to provide incentives to
appropriate entities to enter into arrangements with the
State to help stabilize premiums for health insurance
coverage in the individual market in such State by providing
payments to such appropriate entities using payment
parameters and a methodology determined by the Secretary.
(3) Ensuring patient access to more flexible health
plans.--Section 1332 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18052) is amended--
(A) in subsection (b)--
(i) in paragraph (1)--

(I) in subparagraph (B), by striking ``at least as
affordable'' and inserting ``of comparable affordability,
including for low-income individuals, individuals with
serious health needs, and other vulnerable populations,'';
and
(II) by amending subparagraph (D) to read as follows:

``(D)(i) will not increase the Federal deficit over the
term of the waiver; and
``(ii) will not increase the Federal deficit over the term
of the 10-year budget plan submitted under subsection
(a)(1)(B)(ii).'';
(ii) by redesignating paragraph (2) (as amended by
paragraph (1)) as paragraph (3); and
(iii) by inserting after paragraph (1) the following:
``(2) Budgetary effect.--
``(A) In general.--In determining whether a State plan
submitted under subsection (a) meets the deficit neutrality
requirements of paragraph (1)(D), the Secretary may take into
consideration the direct budgetary effect of the provisions
of such plan on sources of Federal funding other than the
funding described in subsection (a)(3).
``(B) Limitation.--A determination made by the Secretary
under subparagraph (A)--
``(i) shall not be construed to affect any waiver process
or standards or terms and conditions in effect on the date of
enactment of the Department of Health and Human Services
Appropriations Act, 2018 under title XI, XVIII, XIX, or XXI
of the Social Security Act, or any other Federal law relating
to the provision of health care items or services; and
``(ii) shall be made without regard to any changes in
policy with respect to any waiver process or provision of
health care items or services described in clause (i).''; and
(B) in subsection (a)(1)(C), by striking ``subsection
(b)(2)'' and inserting ``subsection (b)(3)''.
(4) Providing expedited approval of state waivers.--Section
1332(d) of the Patient Protection and Affordable Care Act (42
U.S.C. 18052(d)) is amended--
(A) in paragraph (1) by striking ``180'' and inserting
``120''; and
(B) by adding at the end the following:
``(3) Expedited determination.--
``(A) In general.--With respect to any application under
subsection (a)(1) submitted on or after the date of enactment
of the Department of Health and Human Services Appropriations
Act, 2018 or any such application submitted prior to such
date of enactment and under review by the Secretary on such
date of enactment, the Secretary shall make a determination
on such application, using the criteria for approval
otherwise applicable under this section, not later than 45
days after the receipt of such application, and shall allow
the public notice and comment at the State and Federal levels
described under subsection (a)(5) to occur concurrently if
such State application--
``(i) is submitted in response to an urgent situation, with
respect to areas in the State that the Secretary determines
are at risk for excessive premium increases or having no
health plans offered in the applicable health insurance
market for the current or following plan year;
``(ii) is for a waiver that is the same or substantially
similar to a waiver that the Secretary already has approved
for another State; or
``(iii) is for a waiver that includes an invisible high-
risk pool or reinsurance program described in subparagraph
(A), (B), or (D) of subsection (g)(2).
``(B) Approval.--
``(i) Urgent situations.--

``(I) Provisional approval.--A waiver approved under the
expedited determination process under subparagraph (A)(i)
shall be in effect for a period of 3 years, unless the State
requests a shorter duration.
``(II) Full approval.--Subject to the requirements for
approval otherwise applicable under this section, not later
than 1 year before the expiration of a provisional waiver
period described in subclause (I) with respect to an
application described in subparagraph (A)(i), the Secretary
shall make a determination on whether to extend the approval
of such waiver for the full term of the waiver requested by
the State, for a total approval

[[Page S1958]]

period not to exceed 6 years. The Secretary may request
additional information as the Secretary determines
appropriate to make such determination.

``(ii) Approval of same or similar applications.--An
approval of a waiver under subparagraph (A)(ii) shall be
subject to the terms of subsection (e).
``(C) Gao study.--Not later than 5 years after the date of
enactment of the Department of Health and Human Services
Appropriations Act, 2018, the Comptroller General of the
United States shall conduct a review of all waivers approved
pursuant to subparagraph (A)(ii) to evaluate whether such
waivers met the requirements of subsection (b)(1) and whether
the applications should have qualified for such expedited
process.''.
(5) Providing certainty for state-based reforms.--Section
1332(e) of the Patient Protection and Affordable Care Act (42
U.S.C. 18052(e)) is amended by striking ``No waiver'' and all
that follows through the period at the end and inserting the
following: ``A waiver under this section--
``(1) shall be in effect for a period of 6 years unless the
State requests a shorter duration;
``(2) may be renewed, subject to the State meeting the
criteria for approval otherwise applicable under this
section, for unlimited additional 6-year periods upon
application by the State; and
``(3) may not be suspended or terminated, in whole or in
part, by the Secretary at any time before the date of
expiration of the waiver period (including any renewal period
under paragraph (2)), unless the Secretary determines that
the State materially failed to comply with the terms and
conditions of the waiver.''.
(6) Guidance and regulations.--Section 1332 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18052) is
amended--
(A) by adding at the end the following:
``(f) Guidance and Regulations.--
``(1) In general.--With respect to carrying out this
section, the Secretary shall--
``(A) issue guidance, not later than 60 days after the date
of enactment of the Department of Health and Human Services
Appropriations Act, 2018, that includes initial examples of
model State plans that meet the requirements for approval
under this section; and
``(B) periodically review the guidance issued under
subparagraph (A) and when appropriate, issue additional
examples of model State plans that meet the requirements for
approval under this section, which may include--
``(i) State plans establishing reinsurance or invisible
high-risk pool arrangements for purposes of covering the cost
of high-risk individuals;
``(ii) State plans expanding insurer participation, access
to affordable health plans, network adequacy, and health plan
options over the entire applicable health insurance market in
the State;
``(iii) waivers encouraging or requiring health plans in
such State to deploy value-based insurance designs which
structure enrollee cost-sharing and other health plan design
elements to encourage enrollees to consume high-value
clinical services;
``(iv) State plans allowing for significant variation in
health plan benefit design; or
``(v) any other State plan as the Secretary determines
appropriate.
``(2) Rescission of previous regulations and guidance.--
Beginning on the date of enactment of the Department of
Health and Human Services Appropriations Act, 2018, the
regulations promulgated, and the guidance issued, under this
section prior to the date of enactment of the Department of
Health and Human Services Appropriations Act, 2018 shall have
no force or effect.''; and
(B) in subsection (a)(5) (as redesignated by paragraph
(2)(A)(ii))--
(i) in subparagraph (A), by inserting ``, as applicable''
before the period; and
(ii) in subparagraph (B), by striking ``Not later than 180
days after the date of enactment of this Act, the Secretary
shall'' and inserting ``The Secretary may''.
(7) Invisible high risk pools and reinsurance programs.--
Section 1332 of the Patient Protection and Affordable Care
Act (42 U.S.C. 18052), as amended by paragraph (6), is
further amended by adding at the end the following:
``(g) Invisible High Risk Pools and Reinsurance Programs.--
``(1) Funding.--With respect to a State that has received a
waiver under this section to establish an invisible high-risk
pool or reinsurance program described in paragraph (2), the
State may fund such program, in whole or in part, using one
or both of the following:
``(A) Amounts received through a grant described in
subsection (a)(4)(B).
``(B) All of, or a portion of, the payments made to the
State as described in subsection (a)(3), consistent with the
information the State provides under subsection (a)(1)(B).
``(2) Program design.--An invisible high-risk pool or
reinsurance program described in this paragraph is a program
that meets any of the following:
``(A) An invisible high-risk pool, as defined by the State,
under which health insurance issuers, with respect to
designated individuals who experience higher than average
health costs as determined by the State, and are enrolled in
health insurance coverage offered in the individual market,
cede risk to the pool, without affecting the premium paid by
the designated individuals or their terms of coverage. With
respect to such pool, the State, or an entity operating the
pool on behalf of the State, shall establish--
``(i) the premium amount the ceding issuer shall pay to the
reinsurance pool;
``(ii) the applicable attachment points or coinsurance
percentages if the ceding issuer retains any portion of the
risk under ceded policies; and
``(iii) the mechanism by which high-risk individuals are
designated for cession to the pool, which may include a list
of designated high-cost health conditions.
``(B) A reinsurance program, as defined by the State, that
assumes a portion of the risk for individuals who experience
higher than average health costs as determined by the State,
in a manner substantially similar to the reinsurance program
that operated in the State in accordance with section 1341.
``(C) A reinsurance program established by the State not
otherwise described in this paragraph.
``(D) A program based on another State's reinsurance
program--
``(i) described in subparagraph (A), (B), or (C), for which
an application has been approved under this subsection; or
``(ii) which was implemented prior to September 1, 2017,
and which the Secretary determines meets the requirements of
subparagraph (A).''.
(8) Applicability.--The amendments made by this Act to
section 1332 of the Patient Protection and Affordable Care
Act (42 U.S.C. 18052)--
(A) with respect to applications for waivers under such
section 1332 submitted after the date of enactment of this
Act and applications for such waivers submitted prior to such
date of enactment and under review by the Secretary on the
date of enactment, shall take effect on the date of enactment
of this Act; and
(B) with respect to applications for waivers approved under
such section 1332 before the date of enactment of this Act,
shall not require reconsideration of whether such
applications meet the requirements of such section 1332,
except that, at the request of a State, the Secretary shall
recalculate the amount of funding provided under subsection
(a)(3) of such section.
(9) Clarifying budget neutrality.--Section 1332(a)(1)(B) of
the Patient Protection and Affordable Care Act (42 U.S.C.
18052(a)(1)(B)) is amended--
(A) in clause (i), by inserting ``, including, as
applicable, a description of the State's plan to use any
amounts awarded to the State under paragraph (4) to support
an invisible high-risk pool or reinsurance program consistent
with subsection (g) and such information about such program
as the Secretary may require'' before the semicolon; and
(B) in clause (ii), by inserting ``over both the term of
the proposed waiver and the term of the 10-year budget plan''
after ``Government''.
(b) Cost-sharing Payments.--
(1) In general.--There is appropriated to the Secretary of
Health and Human Services (referred to in this section as the
``Secretary''), out of any funds in the Treasury not
otherwise obligated, such sums as may be necessary for
payments for cost-sharing reductions, as authorized by
section 1402 of the Patient Protection and Affordable Care
Act (42 U.S.C. 18071) for the portion of plan year 2017 that
begins on October 1, 2017, and ends on December 31, 2017, and
for plan years 2019, 2020, and 2021.
(2) Special rules for cost-sharing reductions.--
(A) Basic health plan.--For plan year 2018, there is
appropriated to the Secretary, out of any funds in the
Treasury not otherwise obligated, such sums as may be
necessary for, with respect to States that have in effect a
basic health plan on January 1, 2018, the portion of
transfers pursuant to section 1331(d) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18051(d))
attributable to the cost-sharing reductions under section
1402 of the Patient Protection and Affordable Care Act (42
U.S.C. 18071) that would have been provided for plan year
2018 with respect to eligible individuals enrolled in
standard health plans in such States.
(B) Hold harmless.--
(i) In general.--For plan year 2018, there is appropriated
to the Secretary, out of any funds in the Treasury not
otherwise obligated, such sums as may be necessary for
payments for cost-sharing reductions authorized by section
1402 of the Patient Protection and Affordable Care Act (42
U.S.C. 18071) with respect to qualified health plans
described in clause (ii).
(ii) Qualified health plans described.--A qualified health
plan described in this clause is a qualified health plan for
which the Secretary determines, based on a certification and
appropriate documentation from the issuer of such plan and a
certification from the applicable State regulator, that the
health insurance issuer of such plan has not increased
premium rates for plan year 2018 on account of the issuer
assuming, or being instructed by applicable State regulators
to assume, that the issuer would receive payments under such
section 1402.
(C) Clarification of obligations.--
(i) No requirements to make payments.--Notwithstanding any
other provision of law, there shall be no obligation under
this Act or any other Act, including the Patient Protection
and Affordable Care Act (Public Law 111-148), to make
payments for cost-sharing reductions under section 1402(c)(3)
of the Patient Protection and Affordable Care Act (42 U.S.C.
18071(c)(3)) or advance payments for such cost-sharing
reductions under section

[[Page S1959]]

1412 of the Patient Protection and Affordable Care Act (42
U.S.C. 18082) for plan year 2018, except for such payments
for which amounts are appropriated under subparagraphs (A)
and (B). Nothing in this clause shall be construed as
affecting the requirements under section 1402 of the Patient
Protection and Affordable Care Act for issuers to reduce
cost-sharing.
(ii) No obligation to reconcile payments.--Notwithstanding
any other provision of law, there shall be no obligation
under this Act or any other Act, including the Patient
Protection and Affordable Care Act (Public Law 111-148), to
make payments on or after October 1, 2017, for the purpose of
reconciling any cost-sharing reduction payments by the
Secretary under section 1402(c)(3) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18071(c)(3)) made for plan
year 2016 or the plan year beginning January 1, 2017, through
September 30, 2017.
(D) Treatment of previous payments.--Notwithstanding any
other provision of law, payments made for cost-sharing
reductions under section 1402 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18071) during the period
beginning on January 1, 2014, and ending on September 30,
2017, shall be treated in the same manner as a refund due
from the credit allowed under section 36B of the Internal
Revenue Code of 1986 for the purposes of section 1324 of
title 31, United States Code.
(c) Health Benefits Coverage.--Notwithstanding any other
provision of law, including any other definition of ``health
benefits coverage'' for purposes of subsection (b) and (c) of
section 506, any use made of funds appropriated under
subsection (b) starting in plan year 2019, and subsection
(a)(2)(B) starting in plan year 2018, and any program,
activity, plan, or coverage funded or supported by such
funds, shall constitute ``health benefits coverage''.
(d) Limitations.--The following shall apply:
(1) Nothing in this section shall be construed to limit the
applicability of subsection (a), (b), or (d) of section 507.
(2) For purposes of this section, a health insurance issuer
expending State, local, or private funds, shall be treated in
the same manner as a managed care provider described in
section 507(c).

SEC. 231. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH
INSURANCE IN THE INDIVIDUAL MARKET THE OPTION
TO PURCHASE A LOWER PREMIUM COPPER PLAN.

(a) In General.--Section 1302(e) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18022(e)) is amended--
(1) in paragraph (1)--
(A) by redesignating clauses (i) and (ii) of subparagraph
(B) as subparagraphs (A) and (B), respectively, and adjusting
the margins accordingly;
(B) by striking ``plan year if--'' and all that follows
through ``the plan provides--'' and inserting ``plan year if
the plan provides--''; and
(C) in subparagraph (A), as redesignated by paragraph (1),
by striking ``clause (ii)'' and inserting ``subparagraph
(B)'';
(2) by striking paragraph (2); and
(3) by redesignating paragraph (3) as paragraph (2).
(b) Risk Pools.--Section 1312(c)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(c)) is
amended by inserting ``and including enrollees in
catastrophic plans described in section 1302(e)'' after
``Exchange''.
(c) Conforming Amendment.--Section 1312(d)(3)(C) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18032(d)(3)(C)) is amended by striking ``, except that in the
case of a catastrophic plan described in section 1302(e), a
qualified individual may enroll in the plan only if the
individual is eligible to enroll in the plan under section
1302(e)(2)''.
(d) Effective Date.--The amendments made by subsections
(a), (b), and (c) shall apply with respect to plan years
beginning on or after January 1, 2019.

SEC. 232. CONSUMER OUTREACH, EDUCATION, AND ASSISTANCE.

(a) Open Enrollment Reports.--For plan years 2019 and 2020,
the Secretary of Health and Human Services (referred to in
this section as the ``Secretary''), in coordination with the
Secretary of the Treasury and the Secretary of Labor, shall
issue biweekly public reports during the annual open
enrollment period on the performance of the Federal Exchange
and the Small Business Health Options Program (SHOP)
Marketplace. Each such report shall include a summary,
including information on a State-by-State basis where
available, of--
(1) the number of unique website visits;
(2) the number of individuals who create an account;
(3) the number of calls to the call center;
(4) the average wait time for callers contacting the call
center;
(5) the number of individuals who enroll in a qualified
health plan; and
(6) the percentage of individuals who enroll in a qualified
health plan through each of--
(A) the website;
(B) the call center;
(C) navigators;
(D) agents and brokers;
(E) the enrollment assistant program;
(F) directly from issuers or web brokers; and
(G) other means.
(b) Open Enrollment After Action Report.--For plan years
2019 and 2020, the Secretary, in coordination with the
Secretary of the Treasury and the Secretary of Labor, shall
publish an after action report not later than 3 months after
the completion of the annual open enrollment period regarding
the performance of the Federal Exchange and the Small
Business Health Options Program (SHOP) Marketplace for the
applicable plan year. Each such report shall include a
summary, including information on a State-by-State basis
where available, of--
(1) the open enrollment data reported under subsection (a)
for the entirety of the enrollment period; and
(2) activities related to patient navigators described in
section 1311(i) of the Patient Protection and Affordable Care
Act (42 U.S.C. 18031(i)), including--
(A) the performance objectives established by the Secretary
for such patient navigators;
(B) the number of consumers enrolled by such a patient
navigator;
(C) an assessment of how such patient navigators have met
established performance metrics, including a detailed list of
all patient navigators, funding received by patient
navigators, and whether established performance objectives of
patient navigators were met; and
(D) with respect to the performance objectives described in
subparagraph (A)--
(i) whether such objectives assess the full scope of
patient navigator responsibilities, including general
education, plan selection, and determination of eligibility
for tax credits, cost-sharing reductions, or other coverage;
(ii) how the Secretary worked with patient navigators to
establish such objectives; and
(iii) how the Secretary adjusted such objectives for case
complexity and other contextual factors.
(c) Report on Advertising and Consumer Outreach.--Not later
than 3 months after the completion of the annual open
enrollment period for the 2019 plan year, the Secretary shall
issue a report on advertising and outreach to consumers for
the open enrollment period for the 2019 plan year. Such
report shall include a description of--
(1) the division of spending on individual advertising
platforms, including television and radio advertisements and
digital media, to raise consumer awareness of open
enrollment;
(2) the division of spending on individual outreach
platforms, including email and text messages, to raise
consumer awareness of open enrollment; and
(3) whether the Secretary conducted targeted outreach to
specific demographic groups and geographic areas.
(d) Outreach and Enrollment Activities.--
(1) Open enrollment.--Of the amounts collected through the
user fees on participating health insurance issuers pursuant
to section 156.50 of title 45, Code of Federal Regulations
(or any successor regulations), the Secretary shall obligate
$105,800,000 for outreach and enrollment activities for each
of the open enrollment periods for plan years 2019 and 2020.
(2) Outreach and enrollment activities.--
(A) In general.--For purposes of this subsection, the term
``outreach and enrollment activities'' means--
(i) activities to educate consumers about coverage options
or to encourage consumers to enroll in or maintain health
insurance coverage (excluding allocations to the call center
for the Federal Exchange); and
(ii) activities conducted by an in-person consumer
assistance program that does not have a conflict of interest
and that, among other activities, facilitates enrollment of
individuals through the Federal Exchange, and distributes
fair and impartial information concerning enrollment through
such Exchange and the availability of tax credits and cost-
sharing reductions.
(B) Connection with federal exchange.--Activities conducted
under this subsection shall be in connection with the
operation of the Federal Exchange, to provide special
benefits to health insurance issuers participating in the
Federal Exchange.
(3) Contract authority.--The Secretary may contract with a
State to conduct outreach and enrollment activities for plan
years 2019 and 2020. Any outreach and enrollment activities
conducted by a State or other entity at the direction of the
State, in accordance with such a contract, shall be treated
as Federal activities to provide special benefits to
participating health insurance issuers consistent with OMB
Circular No. A-25R.
(4) Clarifications.--
(A) Prior funding.--Nothing in this subsection should be
construed as rescinding or cancelling any funds already
obligated on the date of enactment of this Act for outreach
and enrollment activities for plan year 2019.
(B) Availability of funding.--The Secretary shall ensure
that outreach and enrollment activities are conducted in all
applicable States, including, as necessary, by providing for
such activities through contracts described in paragraph (3).

SEC. 233. OFFERING HEALTH PLANS IN MORE THAN ONE STATE.

Not later than 1 year after the date of enactment of this
Act, the Secretary of Health and Human Services, in
consultation with the National Association of Insurance
Commissioners, shall issue regulations for the implementation
of health care choice compacts established under section 1333
of the Patient Protection and Affordable Care Act

[[Page S1960]]

(42 U.S.C. 18053) to allow for the offering of health plans
in more than one State.

SEC. 234. CONSUMER NOTIFICATION.

In addition to any applicable Federal requirements with
respect to short-term limited duration insurance, a State
insurance commissioner shall require the issuer of short-
term, limited duration insurance approved for sale in the
State to display prominently in marketing materials, the
contract, and application materials provided in connection
with enrollment in such insurance a notice to consumers that
includes such information as the State insurance commissioner
determines sufficient to inform the individual that coverage
and benefits under such insurance differ from coverage and
benefits under qualified health plans.
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