S.Amdt. 2222

SA 2222. Mrs. MURRAY 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:

At the end, add the following:

DIVISION W--BIPARTISAN HEALTH CARE STABILIZATION

SECTION 1. SHORT TITLE.

This division may be cited as the ``Bipartisan Health Care
Stabilization Act of 2018''.

SEC. 2. 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:

``(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, high risk pools, 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 Bipartisan Health Care Stabilization Act
of 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 2(a)(2)(B) of the Bipartisan
Health Care Stabilization Act of 2018 for a fiscal year to be
allocated for each State for purposes of subparagraph (B).
Such methodology shall allocate funds in a manner that would
yield a similar level of premium reduction in all States if
all States applied for and received funding, taking into
account market stability and competition in the various
States. If not all States apply for and receive funding under
subparagraph (B), remaining funds shall be used to carry out
section 2(a)(2)(C) of the Bipartisan Health Care
Stabilization Act of 2018.
``(B) State grants.--From amounts appropriated under
section 2(a)(2)(B) of the Bipartisan Health Care
Stabilization Act of 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 years 2019 through
2021, in the case of a State that

[[Page S1961]]

does not, by a date specified by the Secretary of Health and
Human Services (referred to in this subparagraph 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 years 2019 through
2021 for the purpose described in clause (ii) for such State.
(ii) Required use for market stabilization payments to
issuers.--The Secretary shall enter into arrangements with
the State or appropriate non-profit entities to help
stabilize premiums for health insurance coverage in the
individual market, by providing payments to insurers with
respect to enrollees whose claims exceed a dollar amount
established by the Secretary, in an amount equal to 80
percent of the amount of such claims.
(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 Bipartisan Health Care Stabilization Act of
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 Bipartisan Health Care Stabilization Act of 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; or
``(ii) is for a waiver that is the same or substantially
similar to a waiver that the Secretary already has approved
for another State.
``(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 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 Bipartisan Health Care Stabilization Act of
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 Bipartisan Health Care Stabilization Act
of 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 Bipartisan Health
Care Stabilization Act of 2018, the regulations promulgated,
and the guidance issued, under this section prior to the date
of enactment of the Bipartisan Health Care Stabilization Act
of 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;

[[Page S1962]]

``(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 the date of enactment
of the Bipartisan Health Care Stabilization Act of 2018, and
which the Secretary determines meets the requirements of
subparagraph (A).
``(3) Single risk pool.--An invisible high-risk pool or
reinsurance program established in accordance with this
subsection shall not be considered a separate risk pool for
purposes of section 1312(c).''.
(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 plan years 2017, 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 specified qualified health
plans described in clause (ii).
(ii) Specified qualified health plans described.--A
specified qualified health plan described in this clause is a
qualified health plan--

(I) offered in a State that--

(aa) prohibited increasing premium rates to account for
non-payment of cost-sharing reductions under section 1402 of
the Patient Protection and Affordable Care Act; or
(bb) did not provide guidance on whether to increase
premiums to account for non-payment of cost-sharing reduction
under such section 1402; and

(II) 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.

(3) Protecting consumers from increased out-of-pocket
costs.--Section 1402 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18071) is amended by adding at the end,
the following:
``(g) Additional Reduction.--
``(1) Reduction for low income insureds.--For plan years
2019 through 2021, in addition to the cost-sharing reductions
under subsection (c), the Secretary shall establish
procedures under which the issuer of a qualified health plan
to which this section applies shall further reduce cost-
sharing under the plan in a manner sufficient to--
``(A) in the case of an eligible insured whose household
income is not less than 150 percent but not more than 250
percent of the poverty line for a family of the size
involved, increase the plan's share of the total allowed
costs of benefits provided under the plan to 87 percent of
such costs; and
``(B) in the case of an eligible insured whose household
income is not less than 250 percent but not more than 400
percent of the poverty line for a family of the size
involved, increase the plan's share of the total allowed
costs of benefits provided under the plan to 80 percent of
such costs.''.
``(2) Conforming amendment.--For plan years 2019 through
2021, in addition to the coordination with actuarial value
limits under subsection (c)(1)(B),the Secretary shall ensure
that the reductions under subsection (c)(1) do not result in
an increase in the plan's share of the total allowed costs of
benefits provided under the plan above--
``(A) 87 percent, in the case of an eligible insured
described in paragraph (1)(A); and
``(B) 80 percent, in the case of an eligible insured
described in paragraph (1)(B).''.

SEC. 3. 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. 4. CONSUMER OUTREACH, EDUCATION, AND ASSISTANCE.

(a) Open Enrollment Reports.--For plan years 2019 through
2021, 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 through 2021, 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--

[[Page S1963]]

(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 through
2021.
(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 through 2021. 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. 5. 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 (42 U.S.C.
18053) to allow for the offering of health plans in more than
one State.

SEC. 6. SHORT-TERM LIMITED DURATION HEALTH INSURANCE
POLICIES.

(a) Prohibition on Proposed Rule.--Notwithstanding any
other provision of law, the Secretary of Health and Human
Services, the Secretary of the Treasury, and the Secretary of
Labor may not take any action to implement, enforce, or
otherwise give effect to the proposed rule relating to the
definition of short-term limited-duration insurance (83 Fed.
Reg. 7437-7447, February 21, 2018), insofar as such proposed
rule relates to a revised definition of the term ``short-term
limited duration insurance'' and the Secretaries shall
implement, enforce, and otherwise give effect to the
definition of such term as applied by the Secretaries under
the regulations in effect on the date of enactment of this
Act (81 Fed. Reg. 75316), and such regulations shall continue
in effect with respect to policies until the effective date
described in subsection (b)(2).
(b) Standards.--
(1) In general.--Section 2791(b) of the Public Health
Service Act (42 U.S.C. 300gg-91) is amended by adding at the
end the following:
``(6) Short-term limited duration insurance.--The term
`short-term limited duration insurance' means health
insurance coverage provided pursuant to a contract with a
health insurance issuer that--
``(A) has a specified, limited duration not to exceed 93
days after the original effective date of the contract,
except that the health plan may permit coverage to continue
until the end of the period of hospitalization for a
condition for which the covered person was hospitalized on
the day that coverage would otherwise have ended;
``(B) is non-renewable and issued only to individuals who
have not been covered under a short-term limited duration
insurance policy from any health insurance issuer within the
prior 12 months;
``(C) displays prominently in marketing materials, the
contract, and in any application materials provided in
connection with enrollment in such insurance a notice to
consumers that includes such information which the State
insurance commissioner deems sufficient to inform the
individual that coverage and benefits are limited;
``(D) covers essential health benefits as set forth in
section 1302 of the Patient Protection and Affordable Care
Act;
``(E) meets the following requirements for individual
health insurance coverage as set forth in this title--
``(i) section 2701 (relating to fair health insurance
premiums);
``(ii) section 2702 (relating to guaranteed availability of
coverage), except as provided in paragraph (1) consistent
with the limitations of subsection (c);
``(iii) section 2704 (relating to the prohibition of pre-
existing condition exclusions or other discrimination based
on health status);
``(iv) section 2705 (relating to the prohibition of
discrimination against individual participants and
beneficiaries based on health status);
``(v) section 2706 (relating to nondiscrimination in health
care);
``(vi) section 2707 (relating to comprehensive health
insurance coverage);
``(vii) section 2711 (prohibiting lifetime and annual
limits);
``(viii) section 2712 (prohibiting rescissions);
``(ix) section 2713 (coverage of preventive health
services);
``(x) section 2714 (relating to coverage of dependents);
and
``(xi) section 2719 (relating to appeals); and
``(F) upon the issuance of a health insurance plan that an
issuer asserts to be short-term limited duration insurance,
the issuer of such plan shall provide documentation to the
Secretary and the State insurance commissioner, in a form
determined by the Secretary, regarding the individuals
covered by the plan and the duration of the plan which shall
be reviewed by the entity responsible for enforcement under
section 2722, together with documentation submitted by other
issuers, to determine whether the plan satisfies the
requirement under subparagraph (B) and, if not, such entity
shall take appropriate enforcement action.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to plan years beginning on or after January 1,
2019.

SEC. 7. FUNDING.

Notwithstanding any other provision of law related to the
services described in subsection (b)(1)(B) of section 1303 of
Public Law 111-148, amounts appropriated under this division
are subject to no requirements or limitations related to such
services other than the requirements or limitations
established under such section 1303, and, in the case of
amounts appropriated under section 2(a)(2)(B), such section
1303 shall apply to such amounts in the same manner and to
the same extent as if the purposes for which such amounts are
appropriated under section 2(a)(2)(B) were purposes specified
in subsection (b)(2)(A) of such section 1303.
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