TAM17J75 S.L.C. 115TH CONGRESS 1ST SESSION S. ll To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility. IN THE SENATE OF THE UNITED STATES llllllllll introduced the following bill; which was read twice and referred to the Committee on llllllllll A BILL To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility. 1 Be it enacted by the Senate and House of Representa- 2 tives of the United States of America in Congress assembled, 3 4 5 6 7 øSECTION 1. SHORT TITLE. This Act may be cited as the øxxx¿.¿ SEC. 2. WAIVERS FOR STATE INNOVATION. (a) STREAMLINING ESS.—Section THE STATE APPLICATION PROC- 1332 of the Patient Protection and Afford- 8 able Care Act (42 U.S.C. 18052) is amended— TAM17J75 S.L.C. 2 1 (1) in subsection (a)(1)(C), by striking ‘‘the 2 law’’ and inserting ‘‘a law or has in effect a certifi- 3 cation’’; and 4 (2) in subsection (b)(2)— 5 6 7 (A) in the paragraph heading, by inserting ‘‘OR CERTIFY’’ (B) in subparagraph (A)— 8 9 after ‘‘LAW’’; (i) by striking ‘‘A law’’ and inserting the following: 10 ‘‘(i) LAWS.—A law’’; and 11 (ii) by adding at the end the fol- 12 lowing: 13 ‘‘(ii) CERTIFICATIONS.—A certifi- 14 cation described in this paragraph is a doc- 15 ument, signed by the Governor of the 16 State, that certifies that such Governor 17 has the authority under existing Federal 18 and State law to take action under this 19 section, including implementation of the 20 State plan under subsection (a)(1)(B).’’; 21 and 22 (C) in subparagraph (B)— 23 24 (i) in the subparagraph heading, by striking ‘‘OF OPT OUT’’; and TAM17J75 S.L.C. 3 1 (ii) by striking ‘‘may repeal a law’’ 2 and all that follows through the period at 3 the end and inserting the following: ‘‘may 4 terminate the authority provided under the 5 waiver with respect to the State by— 6 ‘‘(i) repealing a law described in sub- 7 paragraph (A)(i); or 8 ‘‘(ii) terminating a certification de- 9 scribed in subparagraph (A)(ii), through a 10 certification for such termination signed by 11 the Governor of the State.’’. 12 (b) GIVING STATES MORE FUNDING FLEXIBILITY, 13 TO 14 IBLE HIGH RISK POOLS, INSURANCE STABILITY FUNDS 15 AND OTHER PROGRAMS.—Section 1332(a)(3) of the Pa- ESTABLISH REINSURANCE, HIGH RISK POOLS, INVIS- 16 tient Protection and Affordable Care Act (42 U.S.C. 17 18052(a)(3)) is amended— 18 (1) in the first sentence— 19 (A) by inserting ‘‘or would qualify for a re- 20 duced portion of’’ after ‘‘would not qualify for’’; 21 (B) by inserting ‘‘, or the State would not 22 qualify for or would qualify for a reduced por- 23 tion of basic health program funds under sec- 24 tion 1331,’’ after ‘‘subtitle E’’; TAM17J75 S.L.C. 4 1 (C) by inserting ‘‘, or basic health program 2 funds the State would have received,’’ after 3 ‘‘this title’’; and 4 (D) by inserting ‘‘or for implementing the 5 basic health program established under section 6 1331’’ before the period; 7 (2) in the second sentence, by inserting before 8 the period, ‘‘, and with respect to participation in 9 the basic health program and funds provided to such 10 other States under section 1331’’; and 11 (3) by adding after the second sentence the fol- 12 lowing: ‘‘A State may request that all of, or any por- 13 tion of, such aggregate amount of such credits, re- 14 ductions, or funds be paid to the State as described 15 in the first sentence.’’. 16 (c) ENSURING PATIENT ACCESS TO MORE FLEXIBLE 17 HEALTH PLANS.—Section 1332 of the Patient Protection 18 and Affordable Care Act (42 U.S.C. 18052) is amended— 19 20 (1) in subsection (b)— (A) in paragraph (1)— 21 (i) in subparagraph (B), by striking 22 ‘‘at least as affordable’’ and inserting ‘‘of 23 comparable affordability, including for low- 24 income individuals, individuals with serious TAM17J75 S.L.C. 5 1 health needs, and other vulnerable popu- 2 lations,’’; and 3 (ii) by amending subparagraph (D) to 4 read as follows: 5 ‘‘(D)(i) will not increase the Federal deficit 6 over the term of the waiver; and 7 ‘‘(ii) will not increase the Federal deficit 8 over the term of the 10-year budget plan sub- 9 mitted under subsection (a)(1)(B)(ii).’’; 10 (B) by redesignating paragraph (2) (as 11 amended by subsection (a)) as paragraph (3); 12 and 13 (C) by inserting after paragraph (1) the 14 following: 15 ‘‘(2) BUDGETARY 16 ‘‘(A) IN EFFECT.— GENERAL.—In determining wheth- 17 er a State plan submitted under subsection (a) 18 meets the budget neutrality requirements of 19 paragraph (1)(D), the Secretary may take into 20 consideration the direct budgetary effect of the 21 provisions of such plan on sources of Federal 22 funding other than the funding described in 23 subsection (a)(3). 24 25 ‘‘(B) LIMITATION.—A determination made by the Secretary under subparagraph (A)— TAM17J75 S.L.C. 6 1 ‘‘(i) shall not be construed to affect 2 any waiver process or standards in effect 3 on the date of enactment of the øshort 4 title¿ under title XVIII, XIX, or XXI of 5 the Social Security Act, or any other Fed- 6 eral law relating to the provision of health 7 care items or services; and 8 ‘‘(ii) shall be made without regard to 9 any changes in policy with respect to any 10 waiver process or provision of health care 11 items or services described in clause (i).’’; 12 and 13 (2) in subsection (a)(1)(C), by striking ‘‘sub- 14 section (b)(2)’’ and inserting ‘‘subsection (b)(3)’’. 15 (d) PROVIDING EXPEDITED APPROVAL OF STATE 16 WAIVERS.—Section 1332(d) of the Patient Protection and 17 Affordable Care Act (42 U.S.C. 18052(d)) is amended— 18 19 (1) in paragraph (1) by striking ‘‘180’’ and inserting ‘‘90’’; and 20 (2) by adding at the end the following: 21 ‘‘(3) EXPEDITED 22 ‘‘(A) IN DETERMINATION.— GENERAL.—With respect to any 23 application under subsection (a)(1) submitted 24 on or after the date of enactment of the øshort 25 title¿ or any such application submitted prior to TAM17J75 S.L.C. 7 1 such date of enactment and under review by the 2 Secretary on such date of enactment, the Sec- 3 retary shall make a determination on such ap- 4 plication, using the criteria for approval other- 5 wise applicable under this section, not later 6 than 45 days after the receipt of such applica- 7 tion, and shall allow the public notice and com- 8 ment at the State and Federal levels described 9 under subsection (a)(4) to occur concurrently if 10 such State application— 11 ‘‘(i) is submitted in response to an ur- 12 gent situation, with respect to areas in the 13 State that the Secretary determines are at 14 risk for excessive premium increases or 15 having no health plans offered in the appli- 16 cable health insurance market for the cur- 17 rent or following plan year; or 18 ‘‘(ii) is for a waiver that is the same 19 or substantially similar to a waiver that 20 the Secretary already has approved for an- 21 other State. 22 ‘‘(B) APPROVAL.— 23 24 25 ‘‘(i) URGENT SITUATIONS.— ‘‘(I) PROVISIONAL APPROVAL.—A waiver approved under the expedited TAM17J75 S.L.C. 8 1 determination process under subpara- 2 graph (A)(i) shall be in effect for a 3 period of 3 years, unless the State re- 4 quests a shorter duration. 5 ‘‘(II) FULL APPROVAL.—Subject 6 to the requirements for approval oth- 7 erwise applicable under this section, 8 not later than 1 year before the expi- 9 ration of a provisional waiver period 10 described in subclause (I) with respect 11 to an application described in sub- 12 paragraph (A)(i), the Secretary shall 13 make a determination on whether to 14 extend the approval of such waiver for 15 the full term of the waiver requested 16 by the State, for a total approval pe- 17 riod not to exceed 6 years. The Sec- 18 retary may request additional infor- 19 mation as the Secretary determines 20 appropriate to make such determina- 21 tion. 22 ‘‘(ii) APPROVAL OF SAME OR SIMILAR 23 APPLICATIONS.—An approval of a waiver 24 under subparagraph (A)(ii) shall be subject 25 to the terms of subsection (e). TAM17J75 S.L.C. 9 1 ‘‘(C) GAO STUDY.—Not later than 5 years 2 after the date of enactment of the øshort title¿, 3 the Comptroller General of the United States 4 shall conduct a review of all waivers approved 5 pursuant to an application under subparagraph 6 (A)(ii) to evaluate whether such waivers met 7 the requirements of subsection (b)(1) and 8 whether the applications should have qualified 9 for such expedited process.’’. 10 11 (e) PROVIDING CERTAINTY FORMS.—Section FOR STATE-BASED RE- 1332(e) of the Patient Protection and 12 Affordable Care Act (42 U.S.C. 18052(e)) is amended by 13 striking ‘‘No waiver’’ and all that follows through the pe14 riod at the end and inserting the following: ‘‘A waiver 15 under this section— 16 17 ‘‘(1) shall be in effect for a period of 6 years unless the State requests a shorter duration; 18 ‘‘(2) may be renewed, subject to the State meet- 19 ing the criteria for approval otherwise applicable 20 under this section, for unlimited additional 6-year 21 periods upon application by the State; and 22 ‘‘(3) may not be suspended or terminated, in 23 whole or in part, by the Secretary at any time before 24 the date of expiration of the waiver period (including 25 any renewal period under paragraph (2)), unless the TAM17J75 S.L.C. 10 1 Secretary determines that the State materially failed 2 to comply with the terms and conditions of the waiv- 3 er.’’. 4 (f) GUIDANCE AND REGULATIONS.—Section 1332 of 5 the Patient Protection and Affordable Care Act (42 6 U.S.C. 18052) is amended— 7 8 9 10 (1) by adding at the end the following: ‘‘(f) GUIDANCE AND REGULATIONS.— ‘‘(1) IN GENERAL.—With respect to carrying out this section, the Secretary shall— 11 ‘‘(A) issue guidance, not later than 30 12 days after the date of enactment of the øshort 13 title¿, that includes initial examples of model 14 State plans that meet the requirements for ap- 15 proval under this section; and 16 ‘‘(B) periodically review the guidance 17 issued under subparagraph (A) and when ap- 18 propriate, issue additional examples of model 19 State plans that meet the requirements for ap- 20 proval under this section, which may include— 21 ‘‘(i) State plans establishing reinsur- 22 ance or invisible high-risk pool arrange- 23 ments for purposes of covering the cost of 24 high-risk individuals; TAM17J75 S.L.C. 11 1 ‘‘(ii) State plans expanding insurer 2 participation, access to affordable health 3 plans, network adequacy, and health plan 4 options over the entire applicable health in- 5 surance market in the State; 6 ‘‘(iii) waivers encouraging or requiring 7 health plans in such State to deploy value- 8 based insurance designs which structure 9 enrollee cost-sharing and other health plan 10 design elements to encourage enrollees to 11 consume high-value clinical services; 12 ‘‘(iv) State plans allowing for signifi- 13 cant variation in health plan benefit de- 14 sign; or 15 16 17 ‘‘(v) any other State plan as the Secretary determines appropriate. ‘‘(2) RESCISSION OF PREVIOUS REGULATIONS 18 AND GUIDANCE.—Beginning 19 ment of the øshort title¿, the regulations promul- 20 gated, and the guidance issued, under this section 21 prior to the date of enactment of the øshort title¿ 22 shall have no force or effect.’’; and 23 (2) in subsection (b)(4)— 24 25 on the date of enact- (A) in subparagraph (A), by inserting ‘‘, as applicable’’ before the semicolon; and TAM17J75 S.L.C. 12 1 (B) in subparagraph (B), by striking ‘‘Not 2 later than 180 days after the date of enactment 3 of this Act, the Secretary shall’’ and inserting 4 ‘‘The Secretary may’’. 5 (g) APPLICABILITY.—The amendments made by this 6 Act to section 1332 of the Patient Protection and Afford7 able Care Act (42 U.S.C. 18052)— 8 (1) with respect to applications for waivers 9 under such section 1332 submitted after the date of 10 enactment of this Act and applications for such 11 waivers submitted prior to such date of enactment 12 and under review by the Secretary on the date of en- 13 actment, shall take effect on the date of enactment 14 of this Act; and 15 (2) with respect to applications for waivers ap- 16 proved under such section 1332 before the date of 17 enactment of this Act, shall not require reconsider- 18 ation of whether such applications meet the require- 19 ments of such section 1332, except that, at the re- 20 quest of a State, the Secretary shall recalculate the 21 amount of funding provided under subsection (a)(3) 22 of such section. 23 (h) CLARIFYING BUDGET NEUTRALITY.—Section 24 1332(a)(1)(B)(ii) of the Patient Protection and Affordable 25 Care Act (42 U.S.C. 18052(a)(1)(B)(ii)) is amended by TAM17J75 S.L.C. 13 1 inserting ‘‘over both the term of the proposed waiver and 2 the term of the 10-year budget plan’’ after ‘‘Government’’. 3 4 SEC. 3. COST-SHARING PAYMENTS. (a) IN GENERAL.—There is appropriated to the Sec- 5 retary of Health and Human Services (referred to in this 6 section as the ‘‘Secretary’’), out of any funds in the Treas7 ury not otherwise obligated, such sums as may be nec8 essary for payments for cost-sharing reductions authorized 9 by section 1402 of the Patient Protection and Affordable 10 Care Act (42 U.S.C. 18071) for the portion of plan year 11 2017 that begins on the date of enactment of this Act 12 and ends on December 31, 2017, and for plan years 2018 13 and 2019. 14 15 16 17 ø(b) ENSURING CONSUMER BENEFIT IN 2018.—¿ ø(1) COST-SHARING ø(A) IN PAYMENTS.— GENERAL.— ø(i) AVAILABILITY OF FUNDS.—For 18 plan year 2018, except with respect to 19 issuers of qualified health plans in a State 20 described in clause (ii)(I), amounts appro- 21 priated under subsection (a) shall be made 22 available for payments for cost-sharing re- 23 ductions under such section 1402 to 24 issuers of qualified health plans.¿ 25 ø(ii) STATE FLEXIBILITY.— TAM17J75 S.L.C. 14 1 ø(I) STATE DESCRIBED.—A 2 State described by this clause is a 3 State in which the State insurance 4 regulator, before the date of enact- 5 ment of this Act, directed issuers of 6 qualified health plans to decline cost- 7 sharing reduction payments under 8 section 1402 of the Patient Protection 9 and Affordable Care Act (42 U.S.C. 10 18071) for the 2018 plan year, 11 through a formal notice or cor- 12 respondence.¿ 13 ø(II) STATE 14 DIRECTIVE.—Nothing 15 shall prevent a State insurance regu- 16 lator from reversing a directive de- 17 scribed in subclause (I).¿ 18 ø(B) STATE 19 ø(i) IN OPTION TO REVERSE in this clause PLAN.— GENERAL.—Not later than 60 20 days after the date of enactment of this 21 Act, each State insurance regulator not de- 22 scribed in subparagraph (A)(ii)(I) shall 23 submit to the Secretary of Health and 24 Human Services a certification that, with 25 respect to plan year 2018, the State will TAM17J75 S.L.C. 15 1 ensure that each applicable issuer of a 2 qualified health plan in the State provides 3 a direct financial benefit to consumers and 4 the Federal Government, as applicable, 5 and a State plan for so ensuring such ben- 6 efit. The Secretaries of the Treasury and 7 of Health and Human Services shall assist 8 the States in developing and implementing 9 plans as needed, including by providing 10 11 12 technical assistance.¿ ø(ii) CONTENT.—A State plan under clause (i) shall include, as applicable—¿ 13 ø(I) providing monthly rebates to 14 affected consumers and the Federal 15 Government;¿ 16 ø(II) one-time rebates for con- 17 sumers to affected consumers and the 18 Federal Government;¿ 19 ø(III) after-the-year rebates for 20 affected consumers and the Federal 21 Government;¿ 22 ø(IV) rebates paid through the 23 process under section 2718 of the 24 Public Health Service Act (42 U.S.C. 25 300gg–18), allowing for the appro- TAM17J75 S.L.C. 16 1 priate portion of rebates to be pro- 2 vided to the Federal Government; 3 and¿ 4 ø(V) other means of providing a 5 direct financial benefit to consumers 6 and the Federal Government approved 7 by the State insurance regulator, pro- 8 vided such means of providing a fi- 9 nancial benefit does not result in in- 10 creased costs for applicable taxpayers 11 described in section 36B of the Inter- 12 nal Revenue Code of 1986 or the Fed- 13 eral Government.¿ 14 ø(iii) CONSIDERATIONS.—Any rebate 15 amount described in clause (ii)(I)—¿ 16 ø(I) shall be treated as part of 17 the premium, but the premium under 18 section 36B(b)(2) of the Internal Rev- 19 enue 20 36B(f)(3)(B) of such Code shall not 21 be affected by the rebate amount;¿ Code of 1986 or section 22 ø(II) shall be treated as if it were 23 an expenditure described in paragraph 24 (1) or (2) of section 2718(a) of the TAM17J75 S.L.C. 17 1 Public Health Service Act (42 U.S.C. 2 300gg–18); and¿ 3 ø(III) shall be accounted for by 4 the Secretary in calculating risk ad- 5 justment and reconciling any other 6 relevant downstream financial calcula- 7 tions.¿ 8 ø(iv) NOTICE REQUIREMENTS.— 9 States that adopt a State plan under this 10 subparagraph shall prominently post a no- 11 tice that enrollees may qualify for rebates 12 or other means and explain how such re- 13 bates will be provided.¿ 14 ø(2) REPORT.—Not later than 90 days after 15 the date of enactment of this Act, the Secretary of 16 Health and Human Services shall issue a report de- 17 scribing the activities taken by issuers of qualified 18 health plans in States that submitted certifications 19 and State plans under paragraph (1)(B) to provide 20 a direct financial benefit to individuals enrolled in a 21 qualified health plan and the Federal Government, 22 as applicable, for the 2018 plan year.¿ TAM17J75 S.L.C. 18 1 SEC. 4. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH 2 INSURANCE IN THE INDIVIDUAL MARKET 3 THE OPTION TO PURCHASE A LOWER PRE- 4 MIUM COPPER PLAN. 5 (a) IN GENERAL.—Section 1302(e) of the Patient 6 Protection and Affordable Care Act (42 U.S.C. 18022(e)) 7 is amended— 8 (1) in paragraph (1)— 9 (A) by redesignating clauses (i) and (ii) of 10 subparagraph (B) as subparagraphs (A) and 11 (B), respectively, and adjusting the margins ac- 12 cordingly; 13 (B) by striking ‘‘plan year if—’’ and all 14 that follows through ‘‘the plan provides—’’ and 15 inserting ‘‘plan year if the plan provides—’’; 16 and 17 (C) in subparagraph (A), as redesignated 18 by paragraph (1), by striking ‘‘clause (ii)’’ and 19 inserting ‘‘subparagraph (B)’’; 20 (2) by striking paragraph (2); and 21 (3) by redesignating paragraph (3) as para- 22 graph (2). 23 (b) RISK POOLS.—Section 1312(c)(1) of the Patient 24 Protection and Affordable Care Act (42 U.S.C. 18032(c)) 25 is amended by inserting ‘‘and including enrollees in cata- TAM17J75 S.L.C. 19 1 strophic plans described in section 1302(e)’’ after ‘‘Ex2 change’’. 3 (c) CONFORMING AMENDMENT.—Section 4 1312(d)(3)(C) of the Patient Protection and Affordable 5 Care Act (42 U.S.C. 18032(d)(3)(C)) is amended by strik6 ing ‘‘, except that in the case of a catastrophic plan de7 scribed in section 1302(e), a qualified individual may en8 roll in the plan only if the individual is eligible to enroll 9 in the plan under section 1302(e)(2)’’. 10 (d) EFFECTIVE DATE.—The amendments made by 11 subsections (a), (b), and (c) shall apply with respect to 12 plan years beginning on or after January 1, 2019. 13 14 15 SEC. 5. CONSUMER OUTREACH, EDUCATION, AND ASSISTANCE. (a) OPEN ENROLLMENT REPORTS.—For plan years 16 2018 and 2019, the Secretary of Health and Human Serv17 ices (referred to in this section as the ‘‘Secretary’’), in co18 ordination with the Secretary of the Treasury and the Sec19 retary of Labor, shall issue biweekly public reports during 20 the annual open enrollment period on the performance of 21 the Federal Exchange and the Small Business Health Op22 tions Program (SHOP) Marketplace. Each such report 23 shall include a summary, including information on a 24 State-by-State basis where available, of— 25 (1) the number of unique website visits; TAM17J75 S.L.C. 20 1 2 (2) the number of individuals who create an account; 3 (3) the number of calls to the call center; 4 (4) the average wait time for callers contacting 5 6 7 the call center; (5) the number of individuals who enroll in a qualified health plan; and 8 (6) the percentage of individuals who enroll in 9 a qualified health plan through each of the following 10 channels— 11 (A) the website; 12 (B) the call center; 13 (C) navigators; 14 (D) agents and brokers; 15 (E) the enrollment assistant program; 16 (F) directly from issuers or web brokers; 17 18 19 or (G) by other means. (b) OPEN ENROLLMENT AFTER ACTION REPORT.— 20 For plan years 2018 and 2019, the Secretary, in coordina21 tion with the Secretary of the Treasury and the Secretary 22 of Labor, shall publish an after action report not later 23 than 3 months after the completion of the annual open 24 enrollment period regarding the performance of the Fed25 eral Exchange and the Small Business Health Options TAM17J75 S.L.C. 21 1 Program (SHOP) Marketplace for the applicable plan 2 year. Each such report shall include a summary, including 3 information on a State-by-State basis where available, 4 of— 5 (1) the open enrollment data reported under 6 subsection (a) for the entirety of the enrollment pe- 7 riod; and 8 (2) activities related to patient navigators de- 9 scribed in section 1311(i) of the Patient Protection 10 and Affordable Care Act (42 U.S.C. 18031(i)), in- 11 cluding— 12 13 14 15 (A) the performance objectives established by the Secretary for such patient navigators; (B) the number of consumers enrolled by such a patient navigator; 16 (C) an assessment of how such patient 17 navigators have met established performance 18 metrics, including a detailed list of all patient 19 navigators, funding received by patient naviga- 20 tors, and whether established performance ob- 21 jectives of patient navigators were met; and 22 23 (D) with respect to the performance objectives described in subparagraph (A)— 24 (i) whether such objectives assess the 25 full scope of patient navigator responsibil- TAM17J75 S.L.C. 22 1 ities, including general education, plan se- 2 lection, and determination of eligibility for 3 tax credits, cost-sharing reductions, or 4 other coverage; 5 (ii) how the Secretary worked with pa- 6 tient navigators to establish such objec- 7 tives; and 8 (iii) how the Secretary adjusted such 9 objectives for case complexity and other 10 contextual factors. 11 12 (c) REPORT REACH.—Not ON ADVERTISING AND CONSUMER OUT- later than 3 months after the completion of 13 the annual open enrollment period for the 2018 plan year, 14 the Secretary shall issue a report on advertising and out15 reach to consumers for the open enrollment period for the 16 2018 plan year. Such report shall include a description 17 of— 18 (1) the division of spending on individual adver- 19 tising platforms, including television and radio ad- 20 vertisements and digital media, to raise consumer 21 awareness of open enrollment; 22 (2) the division of spending on individual out- 23 reach platforms, including email and text messages, 24 to raise consumer awareness of open enrollment; and TAM17J75 S.L.C. 23 1 (3) whether the Secretary conducted targeted 2 outreach to specific demographic groups and geo- 3 graphic areas. 4 (d) OUTREACH AND ENROLLMENT ACTIVITIES.— 5 (1) OPEN ENROLLMENT.—Of the amounts col- 6 lected through the user fees on participating health 7 insurance issuers pursuant to section 156.60 of title 8 45, Code of Federal Regulations (or any successor 9 regulations), the Secretary shall obligate 10 ø$105,800,000¿ for outreach and enrollment activi- 11 ties for each of the open enrollment periods for plan 12 years 2018 and 2019. 13 (2) OUTREACH 14 15 AND ENROLLMENT ACTIVI- TIES.— (A) IN GENERAL.—For purposes of this 16 subsection, the term ‘‘outreach and enrollment 17 activities’’ means— 18 (i) activities to educate consumers 19 about coverage options or to encourage 20 consumers to enroll in or maintain health 21 insurance coverage (excluding allocations 22 to the øcall center for the Federal or State 23 Exchanges¿); or 24 (ii) activities conducted by an in-per- 25 son consumer assistance program that does TAM17J75 S.L.C. 24 1 not have a conflict of interest and that, 2 among other activities, facilitates enroll- 3 ment of individuals through the Federal 4 Exchange or State Exchanges, and distrib- 5 utes fair and impartial information con- 6 cerning 7 changes and the availability of tax credits 8 and cost-sharing reductions. 9 (B) CONNECTION enrollment through WITH such FEDERAL Ex- EX- 10 CHANGE.—Activities 11 tion shall be in connection with the operation of 12 the Federal Exchange, to provide special bene- 13 fits to health insurance issuers participating in 14 the Federal Exchange. 15 (3) CONTRACT conducted under this sec- AUTHORITY.—The Secretary 16 may contract with a State to conduct outreach and 17 enrollment activities for plan years 2018 and 2019. 18 Any outreach and enrollment activities conducted by 19 a State or other entity at the direction of the State, 20 in accordance with such a contract, shall be treated 21 as Federal activities to provide special benefits to 22 participating health insurance issuers consistent 23 with OMB Circular No. A–25R. 24 (4) CLARIFICATIONS.— TAM17J75 S.L.C. 25 1 (A) PRIOR FUNDING.—Nothing in this 2 subsection should be construed as rescinding or 3 cancelling any funds already obligated on the 4 date of enactment of this Act for outreach and 5 enrollment activities for plan year 2018. 6 (B) AVAILABILITY OF FUNDING.—The 7 Secretary shall ensure that outreach and enroll- 8 ment activities are conducted in all applicable 9 States, including, as necessary, by providing for 10 such activities through contracts described in 11 paragraph (3). 12 13 14 SEC. 6. OFFERING HEALTH PLANS IN MORE THAN ONE STATE. Not later than 1 year after the date of enactment 15 of this Act, the Secretary of Health and Human Services, 16 in consultation with the National Association of Insurance 17 Commissioners, shall issue regulations for the implemen18 tation of health care choice compacts established under 19 section 1333 of the Patient Protection and Affordable 20 Care Act (42 U.S.C. 18053) to allow for the offering of 21 health plans in more than one State.