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111TH CONGRESS " !
2d Session LEGISLATIVE COUNSEL PRINT 111–1
COMPILATION OF PATIENT PROTECTION
AND AFFORDABLE CARE ACT
[As Amended Through May 1, 2010]
INCLUDING
PATIENT PROTECTION AND AFFORDABLE CARE ACT
HEALTH-RELATED PORTIONS OF THE HEALTH CARE AND
EDUCATION RECONCILIATION ACT OF 2010
PREPARED BY THE
Office of the Legislative Counsel
FOR THE USE OF THE
U.S. HOUSE OF REPRESENTATIVES
MAY 2010
June 9, 2010
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OFFICE OF THE LEGISLATIVE COUNSEL
SANDRA L. STROKOFF, Legislative Counsel
EDWARD G. GROSSMAN, Deputy Legislative Counsel
Prepared by
EDWARD G. GROSSMAN, Deputy Legislative Counsel
with the assistance of
CRAIG A. STERKX, Publications Coordinator
ELONDA C. BLOUNT, Staff Assistant
EMILY M. VOLBERDING, Staff Assistant
This document is of the Patient Protection and Affordable Care
Act (‘‘PPACA’’; Public Law 111–148) consolidating the amendments
made by title X of the Act and the Health Care and Education Rec-
onciliation Act of 2010 (‘‘HCERA’’; Public Law 111–152). The text
of the Indian Health Care Improvement Reauthorization and Ex-
tension Act of 2009 (S. 1790), as enacted (in amended form) by sec-
tion 10221 of PPACA, is shown in a separate, accompanying docu-
ment.
Preparation of document.—This document was prepared by
the attorneys and staff of the House Office of the Legislative Coun-
sel (HOLC) for the use of its attorneys and clients. It is not an offi-
cial document of the House of Representatives or its committees
and may not be cited as ‘‘the law’’. At the request of the Leader-
ship, it is being made available to the public through Congressional
websites and may be downloaded at http://docs.house.gov/
energycommerce/ppacacon.pdf. Errors in this document are solely
the responsibility of HOLC. Please email any corrections to
‘‘hlccomments@mail.house.gov’’. This document (originally dated
May 24, 2010) may be updated to reflect corrections of errors or
subsequent changes in law.
United States Code citations.—United States Code section
numbers assigned to sections in PPACA are specified in brackets
after the section numbers in the heading of each section, viz., 2711
ø42 U.S.C. 300gg–11¿.
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C O N T E N T S
[For continuous pagination in electronic, PDF version, add 19 pages]
Page
Patient Protection and Affordable Care Act (Public Law 111–148) .................... 1
Sec. 1. Short title; table of contents .............................................................. 1
TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
Subtitle A—Immediate Improvements in Health Care Coverage for All Americans
Sec. 1001. Amendments to the Public Health Service Act .......................... 13
Sec. 1002. Health insurance consumer information .................................... 27
Sec. 1003. Ensuring that consumers get value for their dollars ................. 28
Sec. 1004. Effective dates ............................................................................... 30
Subtitle B—Immediate Actions to Preserve and Expand Coverage
Sec. 1101. Immediate access to insurance for uninsured individuals with
a preexisting condition ................................................................................. 30
Sec. 1102. Reinsurance for early retirees ..................................................... 33
Sec. 1103. Immediate information that allows consumers to identify af-
fordable coverage options ............................................................................. 36
Sec. 1104. Administrative simplification ...................................................... 37
Sec. 1105. Effective date ................................................................................. 44
Subtitle C—Quality Health Insurance Coverage for All Americans
PART 1—HEALTH INSURANCE MARKET REFORMS
Sec. 1201. Amendment to the Public Health Service Act ............................ 45
PART 2—OTHER PROVISIONS
Sec. 1251. Preservation of right to maintain existing coverage .................. 55
Sec. 1252. Rating reforms must apply uniformly to all health insurance
issuers and group health plans .................................................................... 56
Sec. 1253. Annual report on self-insured plans ............................................ 56
Sec. 1254. Study of large group market ........................................................ 57
Sec. 1255. Effective dates ............................................................................... 57
Subtitle D—Available Coverage Choices for All Americans
PART 1—ESTABLISHMENT OF QUALIFIED HEALTH PLANS
Sec. 1301. Qualified health plan defined ...................................................... 58
Sec. 1302. Essential health benefits requirements ...................................... 59
Sec. 1303. Special rules .................................................................................. 64
Sec. 1304. Related definitions ........................................................................ 68
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Page
PART 2—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH
BENEFIT EXCHANGES
Sec. 1311. Affordable choices of health benefit plans .................................. 69
Sec. 1312. Consumer choice ........................................................................... 80
Sec. 1313. Financial integrity ........................................................................ 83
PART 3—STATE FLEXIBILITY RELATING TO EXCHANGES
Sec. 1321. State flexibility in operation and enforcement of Exchanges
and related requirements ............................................................................. 85
Sec. 1322. Federal program to assist establishment and operation of non-
profit, member-run health insurance issuers ............................................. 86
Sec. 1323. Community health insurance option østricken¿ ......................... 92
Sec. 1323. Funding for the territories ........................................................... 92
Sec. 1324. Level playing field ........................................................................ 93
PART 4—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS
Sec. 1331. State flexibility to establish basic health programs for low-
income individuals not eligible for Medicaid .............................................. 93
Sec. 1332. Waiver for State innovation ......................................................... 98
Sec. 1333. Provisions relating to offering of plans in more than one
State ............................................................................................................... 100
Sec. 1334. Multi-State plans .......................................................................... 101
PART 5—REINSURANCE AND RISK ADJUSTMENT
Sec. 1341. Transitional reinsurance program for individual market in
each State ...................................................................................................... 105
Sec. 1342. Establishment of risk corridors for plans in individual and
small group markets ..................................................................................... 108
Sec. 1343. Risk adjustment ............................................................................ 109
Subtitle E—Affordable Coverage Choices for All Americans
PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
Sec. 1401. Refundable tax credit providing premium assistance for cov-
erage under a qualified health plan ............................................................ 110
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified
health plans ................................................................................................... 119
SUBPART B—ELIGIBILITY DETERMINATIONS
Sec. 1411. Procedures for determining eligibility for Exchange participa-
tion, premium tax credits and reduced cost-sharing, and individual
responsibility exemptions ............................................................................. 123
Sec. 1412. Advance determination and payment of premium tax credits
and cost-sharing reductions ......................................................................... 131
Sec. 1413. Streamlining of procedures for enrollment through an ex-
change and State Medicaid, CHIP, and health subsidy programs ........... 133
Sec. 1414. Disclosures to carry out eligibility requirements for certain
programs ........................................................................................................ 135
Sec. 1415. Premium tax credit and cost-sharing reduction payments dis-
regarded for Federal and Federally-assisted programs ............................. 137
Sec. 1416. Study of geographic variation in application of FPL ................. 137
PART II—SMALL BUSINESS TAX CREDIT
Sec. 1421. Credit for employee health insurance expenses of small busi-
nesses ............................................................................................................. 138
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