Premium Relief Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 689 To amend the Public Health Service Act to provide for a Patient and State Stability Fund. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 2, 2021 Mr. BURGESS introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend the Public Health Service Act to provide for a Patient and State Stability Fund. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Premium Relief Act 4 of 2021’’. 5 SEC. 2. PATIENT AND STATE STABILITY. 6 The Public Health Service Act (42 U.S.C. 201 et 7 seq.) is amended by adding at the end the following new 8 title: 9 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 689 IH ‘‘TITLE XXXIV—PATIENT AND 1 STATE STABILITY FUND 2 ‘‘SEC. 3401. ESTABLISHMENT OF PROGRAM. 3 ‘‘There is hereby established the ‘Patient and State 4 Stability Fund’ to be administered by the Secretary, act- 5 ing through the Administrator of the Centers for Medicare 6 & Medicaid Services (in this title referred to as the ‘Ad- 7 ministrator’), to provide health benefits coverage funding, 8 in accordance with this title, to the 50 States and the Dis- 9 trict of Columbia (each referred to in this section as a 10 ‘State’) during the period, subject to section 3404(c), be- 11 ginning on January 1, 2022, and ending on December 31, 12 2024, for the purposes described in section 3402. 13 ‘‘SEC. 3402. USE OF FUNDS. 14 ‘‘A State may use the funds allocated to the State 15 under this title for any of the following purposes: 16 ‘‘(1) Helping, through the provision of financial 17 assistance, high-risk individuals who do not have ac- 18 cess to health insurance coverage offered through an 19 employer enroll in health insurance coverage in the 20 individual market in the State, as such market is de- 21 fined by the State (whether through the establish- 22 ment of a new mechanism or maintenance of an ex- 23 isting mechanism for such purpose). 24 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 689 IH ‘‘(2) Providing incentives to appropriate entities 1 to enter into arrangements with the State to help 2 stabilize premiums for health insurance coverage in 3 the individual market, as such markets are defined 4 by the State. 5 ‘‘(3) Reducing the cost for providing health in- 6 surance coverage in the individual market and small 7 group market, as such markets are defined by the 8 State, to individuals who have, or are projected to 9 have, a high rate of utilization of health services (as 10 measured by cost) and to individuals who have high 11 costs of health insurance coverage due to the low 12 density population of the State in which they reside. 13 ‘‘(4) Promoting participation in the individual 14 market and small group market in the State and in- 15 creasing health insurance options available through 16 such market. 17 ‘‘(5) Promoting access to preventive services; 18 dental care services (whether preventive or medically 19 necessary); vision care services (whether preventive 20 or medically necessary); or any combination of such 21 services. 22 ‘‘(6) Maternity coverage and newborn care. 23 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 689 IH ‘‘(7) Prevention, treatment, or recovery support 1 services for individuals with mental or substance use 2 disorders, focused on either or both of the following: 3 ‘‘(A) Direct inpatient or outpatient clinical 4 care for treatment of addiction and mental ill- 5 ness. 6 ‘‘(B) Early identification and intervention 7 for children and young adults with serious men- 8 tal illness. 9 ‘‘(8) Providing payments, directly or indirectly, 10 to health care providers for the provision of such 11 health care services as are specified by the Adminis- 12 trator. 13 ‘‘(9) Providing assistance to reduce out-of-pock- 14 et costs, such as copayments, coinsurance, pre- 15 miums, and deductibles, of individuals enrolled in 16 health insurance coverage in the State. 17 ‘‘SEC. 3403. STATE ELIGIBILITY AND APPROVAL; DEFAULT 18 SAFEGUARD. 19 ‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA- 20 TIONS.— 21 ‘‘(1) IN GENERAL.—To be eligible for an alloca- 22 tion of funds under this title for a year during the 23 period described in section 3401 for use for one or 24 more purposes described in section 3402, a State 25 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 689 IH shall submit to the Administrator an application at 1 such time (but not later than March 31 of the pre- 2 vious year) and in such form and manner as speci- 3 fied by the Administrator and containing— 4 ‘‘(A) a description of how the funds will be 5 used for such purposes; and 6 ‘‘(B) such other information as the Admin- 7 istrator may require. 8 ‘‘(2) AUTOMATIC APPROVAL.—An application so 9 submitted is approved unless the Administrator noti- 10 fies the State submitting the application, not later 11 than 60 days after the date of the submission of 12 such application, that the application has been de- 13 nied for not being in compliance with any require- 14 ment of this title and of the reason for such denial. 15 ‘‘(3) ONE-TIME APPLICATION.—If an applica- 16 tion of a State is approved for a year, with respect 17 to a purpose described in section 3402, such applica- 18 tion shall be treated as approved, with respect to 19 such purpose, for each subsequent year through 20 2024. 21 ‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 22 ‘‘(1) IN GENERAL.—In the case of a State that 23 does not have in effect an approved application 24 under this section for 2022, 2023, or 2024, the Ad- 25 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 689 IH ministrator, in consultation with the State insurance 1 commissioner, shall use the allocation that would 2 otherwise be provided to the State under this title 3 for such year, in accordance with paragraph (2), for 4 such State. 5 ‘‘(2) REQUIRED USE FOR MARKET STABILIZA- 6 TION PAYMENTS TO ISSUERS.—Subject to section 7 3404(a), an allocation for a State made pursuant to 8 paragraph (1) for a year shall be used to carry out 9 the purpose described in section 3402(2) in such 10 State by providing payments to appropriate entities 11 described in such section with respect to claims that 12 exceed $50,000 (or, with respect to allocations made 13 under this title for 2023 or a subsequent year dur- 14 ing the period specified in section 3401, such dollar 15 amount specified by the Administrator), but do not 16 exceed $350,000 (or, with respect to allocations 17 made under this title for 2023 or a subsequent year 18 during such period, such dollar amount specified by 19 the Administrator), in an amount equal to 75 per- 20 cent (or, with respect to allocations made under this 21 title for 2023 or a subsequent year during such pe- 22 riod, such percentage specified by the Administrator) 23 of the amount of such claims. 24 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 689 IH ‘‘SEC. 3404. ALLOCATIONS. 1 ‘‘(a) APPROPRIATION.—For the purpose of providing 2 allocations for States (including pursuant to section 3 3403(b)) under this title there is appropriated, out of any 4 money in the Treasury not otherwise appropriated, 5 $2,500,000,000 for each of years 2022 through 2024. 6 ‘‘(b) ALLOCATIONS.— 7 ‘‘(1) PAYMENT.—From amounts appropriated 8 under subsection (a) for a year (beginning with 9 2022 and ending with 2024), the Administrator 10 shall, with respect to a State and not later than 11 January 1 of such year, allocate for such State (in- 12 cluding pursuant to section 3403(b)) the amount de- 13 termined for such State and year under paragraph 14 (2). 15 ‘‘(2) ALLOCATION AMOUNT DETERMINA- 16 TIONS.—For purposes of paragraph (1), the amount 17 determined under this paragraph for a year for a 18 State is an amount determined in accordance with 19 an allocation methodology specified by the Adminis- 20 trator. 21 ‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS YEAR’S 22 REMAINING FUNDS.—In carrying out subsection (b), the 23 Administrator shall, with respect to a year (beginning with 24 2023 and ending with 2025), not later than March 31 of 25 such year— 26 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 689 IH ‘‘(1) determine the amount of funds, if any, 1 from the amounts appropriated under subsection (a) 2 for the previous year but not allocated for such pre- 3 vious year; and 4 ‘‘(2) if the Administrator determines that any 5 funds were not so allocated for such previous year, 6 allocate such remaining funds, in accordance with 7 the allocation methodology specified pursuant to 8 subsection (b)(2)— 9 ‘‘(A) to States that have submitted an ap- 10 plication approved under section 3403(a) for 11 such previous year for any purpose for which 12 such an application was approved; and 13 ‘‘(B) for States for which allocations were 14 made pursuant to section 3403(b) for such pre- 15 vious year, to be used by the Administrator for 16 such States, to carry out the purpose described 17 in section 3402(2) in such State by providing 18 payments to appropriate entities described in 19 such section 3402(2) with respect to claims that 20 exceed $1,000,000, 21 with, respect to a year before 2025, any remaining 22 funds being made available for allocations to States 23 for the subsequent year. 24 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 689 IH ‘‘(d) AVAILABILITY.—Amounts appropriated under 1 subsection (a) for a year and allocated to States in accord- 2 ance with this section shall remain available for expendi- 3 ture through December 31, 2025. 4 ‘‘(e) LIMITATION.—Amounts appropriated under 5 subsection (a) for a year (beginning with 2022 and ending 6 with 2024) are subject to the requirements and limitations 7 under sections 506 and 507 of division H of Public Law 8 115–31 in the same manner and to the same extent as 9 if such amounts for such year were appropriated under 10 such division.’’. 11 SEC. 3. ALIGNING QUALIFIED HEALTH PLAN GRACE PE- 12 RIOD REQUIREMENTS WITH STATE LAW 13 GRACE PERIOD REQUIREMENTS. 14 Section 1412(c)(2) of the Patient Protection and Af- 15 fordable Care Act (42 U.S.C. 18082(c)(2)) is amended— 16 (1) in subparagraph (B)(iv)(II), by striking ‘‘a 17 3-month grace period’’ and inserting ‘‘a grace period 18 specified in subparagraph (C)’’; and 19 (2) by adding at the end the following new sub- 20 paragraph: 21 ‘‘(C) GRACE PERIOD SPECIFIED.—For pur- 22 poses of subparagraph (B)(iv)(II), the grace pe- 23 riod specified in this subparagraph is— 24 VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 689 IH ‘‘(i) for plan years beginning before 1 January 1, 2022, a 3-month grace period; 2 and 3 ‘‘(ii) for plan years beginning during 4 2022 or a subsequent year, such grace pe- 5 riod for non-payment of premiums before 6 discontinuing coverage as is applicable 7 under the State law of the State in which 8 the Exchange operates to health insurance 9 coverage offered in the individual market 10 (or, in the case such a State law is not in 11 place for the State involved, a 1-month 12 grace period).’’. 13 Æ VerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H689.IH H689 pbinns on DSKJLVW7X2PROD with BILLS