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 Committee 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Premium Relief Act 

5 of 2021’’. 

6 SEC. 2. PATIENT AND STATE STABILITY. 

7 The Public Health Service Act (42 U.S.C. 201 et 

8 seq.) is amended by adding at the end the following new 

9 title: 


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1 ‘‘TITLE XXXIV—PATIENT AND 

2 STATE STABILITY FUND 

3 ‘‘SEC. 3401. ESTABLISHMENT OF PROGRAM. 

4 ‘‘There is hereby established the ‘Patient and State 

5 Stability Fund’ to be administered by the Secretary, act6 ing through the Administrator of the Centers for Medicare 

7 & Medicaid Services (in this title referred to as the ‘Ad8 ministrator’), to provide health benefits coverage funding, 

9 in accordance with this title, to the 50 States and the Dis10 trict of Columbia (each referred to in this section as a 

11 ‘State’) during the period, subject to section 3404(c), be12 ginning on January 1, 2022, and ending on December 31, 

13 2024, for the purposes described in section 3402. 

14 ‘‘SEC. 3402. USE OF FUNDS. 

15 ‘‘A State may use the funds allocated to the State 

16 under this title for any of the following purposes: 

17 ‘‘(1) Helping, through the provision of financial 

18 assistance, high-risk individuals who do not have ac19 cess to health insurance coverage offered through an 

20 employer enroll in health insurance coverage in the 

21 individual market in the State, as such market is de22 fined by the State (whether through the establish23 ment of a new mechanism or maintenance of an ex24 isting mechanism for such purpose). 


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1 ‘‘(2) Providing incentives to appropriate entities 

2 to enter into arrangements with the State to help 

3 stabilize premiums for health insurance coverage in 

4 the individual market, as such markets are defined 

5 by the State. 

6 ‘‘(3) Reducing the cost for providing health in7 surance coverage in the individual market and small 

8 group market, as such markets are defined by the 

9 State, to individuals who have, or are projected to 

10 have, a high rate of utilization of health services (as 

11 measured by cost) and to individuals who have high 

12 costs of health insurance coverage due to the low 

13 density population of the State in which they reside. 

14 ‘‘(4) Promoting participation in the individual 

15 market and small group market in the State and in16 creasing health insurance options available through 

17 such market. 

18 ‘‘(5) Promoting access to preventive services; 

19 dental care services (whether preventive or medically 

20 necessary); vision care services (whether preventive 

21 or medically necessary); or any combination of such 

22 services. 

23 ‘‘(6) Maternity coverage and newborn care. 


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1 ‘‘(7) Prevention, treatment, or recovery support 

2 services for individuals with mental or substance use 

3 disorders, focused on either or both of the following: 

4 ‘‘(A) Direct inpatient or outpatient clinical 

5 care for treatment of addiction and mental ill6 ness. 

7 ‘‘(B) Early identification and intervention 

8 for children and young adults with serious men9 tal illness. 

10 ‘‘(8) Providing payments, directly or indirectly, 

11 to health care providers for the provision of such 

12 health care services as are specified by the Adminis13 trator. 

14 ‘‘(9) Providing assistance to reduce out-of-pock15 et costs, such as copayments, coinsurance, pre16 miums, and deductibles, of individuals enrolled in 

17 health insurance coverage in the State. 

18 ‘‘SEC. 3403. STATE ELIGIBILITY AND APPROVAL; DEFAULT 

19 SAFEGUARD. 

20 ‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA21 TIONS.— 

22 ‘‘(1) IN GENERAL.—To be eligible for an alloca23 tion of funds under this title for a year during the 

24 period described in section 3401 for use for one or 

25 more purposes described in section 3402, a State 


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1 shall submit to the Administrator an application at 

2 such time (but not later than March 31 of the pre3 vious year) and in such form and manner as speci4 fied by the Administrator and containing— 

5 ‘‘(A) a description of how the funds will be 

6 used for such purposes; and 

7 ‘‘(B) such other information as the Admin8 istrator may require. 

9 ‘‘(2) AUTOMATIC APPROVAL.—An application so 

10 submitted is approved unless the Administrator noti11 fies the State submitting the application, not later 

12 than 60 days after the date of the submission of 

13 such application, that the application has been de14 nied for not being in compliance with any require15 ment of this title and of the reason for such denial. 

16 ‘‘(3) ONE-TIME APPLICATION.—If an applica17 tion of a State is approved for a year, with respect 

18 to a purpose described in section 3402, such applica19 tion shall be treated as approved, with respect to 

20 such purpose, for each subsequent year through 

21 2024. 

22 ‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 

23 ‘‘(1) IN GENERAL.—In the case of a State that 

24 does not have in effect an approved application 

25 under this section for 2022, 2023, or 2024, the AdVerDate Sep 11 2014 23:55 Feb 21, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H689.IH H689

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1 ministrator, in consultation with the State insurance 

2 commissioner, shall use the allocation that would 

3 otherwise be provided to the State under this title 

4 for such year, in accordance with paragraph (2), for 

5 such State. 

6 ‘‘(2) REQUIRED USE FOR MARKET STABILIZA7 TION PAYMENTS TO ISSUERS.—Subject to section 

8 3404(a), an allocation for a State made pursuant to 

9 paragraph (1) for a year shall be used to carry out 

10 the purpose described in section 3402(2) in such 

11 State by providing payments to appropriate entities 

12 described in such section with respect to claims that 

13 exceed $50,000 (or, with respect to allocations made 

14 under this title for 2023 or a subsequent year dur15 ing the period specified in section 3401, such dollar 

16 amount specified by the Administrator), but do not 

17 exceed $350,000 (or, with respect to allocations 

18 made under this title for 2023 or a subsequent year 

19 during such period, such dollar amount specified by 

20 the Administrator), in an amount equal to 75 per21 cent (or, with respect to allocations made under this 

22 title for 2023 or a subsequent year during such pe23 riod, such percentage specified by the Administrator) 

24 of the amount of such claims. 


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1 ‘‘SEC. 3404. ALLOCATIONS. 

2 ‘‘(a) APPROPRIATION.—For the purpose of providing 

3 allocations for States (including pursuant to section 

4 3403(b)) under this title there is appropriated, out of any 

5 money in the Treasury not otherwise appropriated, 

6 $2,500,000,000 for each of years 2022 through 2024. 

7 ‘‘(b) ALLOCATIONS.— 

8 ‘‘(1) PAYMENT.—From amounts appropriated 

9 under subsection (a) for a year (beginning with 

10 2022 and ending with 2024), the Administrator 

11 shall, with respect to a State and not later than 

12 January 1 of such year, allocate for such State (in13 cluding pursuant to section 3403(b)) the amount de14 termined for such State and year under paragraph 

15 (2). 

16 ‘‘(2) ALLOCATION AMOUNT DETERMINA17 TIONS.—For purposes of paragraph (1), the amount 

18 determined under this paragraph for a year for a 

19 State is an amount determined in accordance with 

20 an allocation methodology specified by the Adminis21 trator. 

22 ‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS YEAR’S

23 REMAINING FUNDS.—In carrying out subsection (b), the 

24 Administrator shall, with respect to a year (beginning with 

25 2023 and ending with 2025), not later than March 31 of 

26 such year— 


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1 ‘‘(1) determine the amount of funds, if any, 

2 from the amounts appropriated under subsection (a) 

3 for the previous year but not allocated for such pre4 vious year; and 

5 ‘‘(2) if the Administrator determines that any 

6 funds were not so allocated for such previous year, 

7 allocate such remaining funds, in accordance with 

8 the allocation methodology specified pursuant to 

9 subsection (b)(2)— 

10 ‘‘(A) to States that have submitted an ap11 plication approved under section 3403(a) for 

12 such previous year for any purpose for which 

13 such an application was approved; and 

14 ‘‘(B) for States for which allocations were 

15 made pursuant to section 3403(b) for such pre16 vious year, to be used by the Administrator for 

17 such States, to carry out the purpose described 

18 in section 3402(2) in such State by providing 

19 payments to appropriate entities described in 

20 such section 3402(2) with respect to claims that 

21 exceed $1,000,000, 

22 with, respect to a year before 2025, any remaining 

23 funds being made available for allocations to States 

24 for the subsequent year. 


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1 ‘‘(d) AVAILABILITY.—Amounts appropriated under 

2 subsection (a) for a year and allocated to States in accord3 ance with this section shall remain available for expendi4 ture through December 31, 2025. 

5 ‘‘(e) LIMITATION.—Amounts appropriated under 

6 subsection (a) for a year (beginning with 2022 and ending 

7 with 2024) are subject to the requirements and limitations 

8 under sections 506 and 507 of division H of Public Law 

9 115–31 in the same manner and to the same extent as 

10 if such amounts for such year were appropriated under 

11 such division.’’. 

12 SEC. 3. ALIGNING QUALIFIED HEALTH PLAN GRACE PE13 RIOD REQUIREMENTS WITH STATE LAW 

14 GRACE PERIOD REQUIREMENTS. 

15 Section 1412(c)(2) of the Patient Protection and Af16 fordable Care Act (42 U.S.C. 18082(c)(2)) is amended— 

17 (1) in subparagraph (B)(iv)(II), by striking ‘‘a 

18 3-month grace period’’ and inserting ‘‘a grace period 

19 specified in subparagraph (C)’’; and 

20 (2) by adding at the end the following new sub21 paragraph: 

22 ‘‘(C) GRACE PERIOD SPECIFIED.—For pur23 poses of subparagraph (B)(iv)(II), the grace pe24 riod specified in this subparagraph is— 


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1 ‘‘(i) for plan years beginning before 

2 January 1, 2022, a 3-month grace period; 

3 and 

4 ‘‘(ii) for plan years beginning during 

5 2022 or a subsequent year, such grace pe6 riod for non-payment of premiums before 

7 discontinuing coverage as is applicable 

8 under the State law of the State in which 

9 the Exchange operates to health insurance 

10 coverage offered in the individual market 

11 (or, in the case such a State law is not in 

12 place for the State involved, a 1-month 

13 grace period).’’. 

Æ 


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