I 

112TH CONGRESS 

1ST SESSION H. R. 3072 

To amend the Patient Protection and Affordable Care Act to provide State 

flexibility for the offering of health benefits through alternative health 

arrangements. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 29, 2011 

Mr. HALL introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To amend the Patient Protection and Affordable Care Act 

to provide State flexibility for the offering of health 

benefits through alternative health arrangements. 

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 ‘‘State Authorized Alter5 native Health Arrangement Act of 2011’’. 

6 SEC. 2. ALTERNATIVE HEALTH ARRANGEMENTS FOR THE 

7 PROVISION OF HEALTH BENEFITS. 

8 Section 1311(f) of the Patient Protection and Afford9 able Care Act (42 U.S.C. 18031(f); Public Law 111–148) 


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1 is amended by adding at the end the following new para2 graph: 

3 ‘‘(4) ALTERNATIVE HEALTH ARRANGEMENTS

4 FOR THE PROVISION OF HEALTH BENEFITS.— 

5 ‘‘(A) ESTABLISHMENT OF ALTERNATIVE

6 HEALTH ARRANGEMENTS.— 

7 ‘‘(i) IN GENERAL.—A State may es8 tablish one or more alternative health ar9 rangements (each referred to in this sub10 section as an ‘alternative health arrange11 ment’) that serve the beneficiaries of one 

12 or more qualified benefits programs (as de13 fined in subparagraph (B)(i)) if the num14 ber of participants served by each such ar15 rangement is determined by the State to 

16 be adequate for purposes of carrying out 

17 the requirements of this title. 

18 ‘‘(ii) DESIGNATION OF QUALIFIED

19 BENEFITS PROGRAMS TO BE OFFERED.—A 

20 State that establishes an alternative health 

21 arrangement shall designate one or more 

22 qualified benefits programs to be offered 

23 through such arrangement. 

24 ‘‘(iii) TREATMENT AS SEPARATE EX25 CHANGE.—An alternative health arrangeVerDate Mar 15 2010 22:40 Sep 29, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3072.IH H3072

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1 ment shall be in addition to an Exchange 

2 or a subsidiary Exchange under this sec3 tion. 

4 ‘‘(iv) CRITERIA APPLICABLE TO AL5 TERNATIVE HEALTH ARRANGEMENT.—An 

6 alternative health arrangement shall be 

7 deemed to be an Exchange under this title, 

8 except that— 

9 ‘‘(I) the requirement of section 

10 1311(d)(2) (relating to the offering of 

11 coverage) shall only apply, with re12 spect to such an arrangement, to the 

13 offering of qualified benefits programs 

14 and only to beneficiaries served by 

15 such programs; and 

16 ‘‘(II) the requirements of section 

17 1311(e)(1) (relating to certification of 

18 health plans) shall be deemed to have 

19 been satisfied with respect to qualified 

20 benefits programs offered through the 

21 arrangement by the designation of 

22 such programs by the State under 

23 clause (ii). 

24 ‘‘(B) QUALIFIED BENEFITS PROGRAMS.— 


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1 ‘‘(i) DEFINITION.—In this paragraph, 

2 the term ‘qualified benefits program’ 

3 means an entity or arrangement (such as 

4 a program created by a group of govern5 ment agencies, instrumentalities, or polit6 ical subdivisions by interlocal agreement or 

7 other method authorized by State law) 

8 that— 

9 ‘‘(I) is established, authorized, 

10 and operating pursuant to State law 

11 to provide or administer health cov12 erage for officials, employees, and re13 tirees (and dependents of such offi14 cials, employees, and retirees) of a 

15 group of employers; and 

16 ‘‘(II) the State finds, subject to 

17 clause (ii), satisfies criteria under this 

18 title to be a qualified health plan. 

19 ‘‘(ii) SATISFACTION OF CERTAIN RE20 QUIREMENTS.—In applying this title with 

21 respect to a qualified benefits program 

22 that is designated by a State under sub23 paragraph (A)(ii) and offered through an 

24 alternative health arrangement, the fol25 lowing special rules apply: 


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1 ‘‘(I) The entity offering such cov2 erage shall be deemed to meet the re3 quirement of section 1301(a)(1)(C)(i) 

4 (relating to licensure as a health in5 surance issuer). 

6 ‘‘(II) Section 1301(a)(1)(C)(iii) 

7 (relating to uniform premium rates) 

8 shall be applied separately to each dif9 ferent health benefits option offered 

10 under the qualified benefits program 

11 through the arrangement. 

12 ‘‘(III) Section 1311(c)(1)(D) (re13 lating to accreditation) shall be 

14 deemed to have been satisfied by vir15 tue of the designation by the State 

16 under subparagraph (A)(ii). 

17 ‘‘(IV) Section 1311(e)(1) (relat18 ing to certification of health plans) 

19 shall not apply insofar as it applies to 

20 accreditation under section 

21 1311(c)(1)(D). 

22 ‘‘(V) Section 1311(e)(2) (relating 

23 to premium considerations) shall not 

24 apply insofar as it requires alternative 

25 health arrangements to display preVerDate Mar 15 2010 22:40 Sep 29, 2011 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3072.IH H3072

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1 mium information to the general pub2 lic or conduct an analysis of premium 

3 growth outside of the alternative 

4 health arrangement. 

5 ‘‘(iii) TREATMENT AS A HEALTH

6 PLAN, QUALIFIED HEALTH PLAN, AND IN7 DIVIDUAL INSURANCE COVERAGE.—A 

8 qualified benefits program offered through 

9 an alternative health arrangement shall be 

10 treated— 

11 ‘‘(I) subject to clause (ii), as 

12 meeting the definition of a health plan 

13 under section 1301(b) and as a quali14 fied health plan under this title; and 

15 ‘‘(II) as a health plan offered in 

16 the individual market for purposes of 

17 section 5000A(f)(1)(C) of the Internal 

18 Revenue Code. 

19 ‘‘(C) CONSTRUCTION.—Nothing in this 

20 paragraph shall be construed— 

21 ‘‘(i) to authorize or require an alter22 native health arrangement to offer health 

23 benefits to any individual other than a ben24 eficiary covered under such arrangement; 

25 or 


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1 ‘‘(ii) to authorize the offering of such 

2 health benefits through an Exchange.’’. 

Æ 


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