The Secretary shall determine the applicable second 
lowest cost silver plan which shall apply to coverage 
provided through enrollment under this section for 
purposes of section 36B of such Code. 
‘‘(3) ELIGIBILITY
FOR
COST-SHARING
SUB-
SIDIES.—For purposes of applying section 1402 of 
the Patient Protection and Affordable Care Act— 
‘‘(A) coverage provided through enrollment 
under this part and parts B and D pursuant to 
this section shall be treated as coverage under 
a qualified health plan in the silver level of cov-
erage in the individual market offered through 
an Exchange; and 
‘‘(B) the Secretary shall be treated as the 
issuer of such plan. 
‘‘(4) USE OF EXCHANGES.—Coverage provided 
through enrollment under this section shall be 
deemed to be coverage under a qualified health plan 
for purposes of section 1311(d)(4)(C) of the Patient 
Protection and Affordable Care Act and shall be 
made available for enrollment, information compari-
son, and otherwise as such a plan through any 
Internet website maintained by an Exchange estab-
lished under title I of such Act (as described in such 
section). 
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‘‘(5) ACCESS TO MEDIGAP.—Coverage provided 
through medicare supplemental policies certified 
under section 1882 shall be made available to indi-
viduals eligible for enrollment pursuant to this sec-
tion for enrollment, information, comparison, and 
otherwise as such a policy through any Internet 
website described in paragraph (4). 
‘‘(h) OVERSIGHT.—There is established an advisory 
committee to be known as the ‘Medicare Buy In Oversight 
Board’ to monitor and oversee the implementation of this 
section, including the experience of the individuals enroll-
ing under this section. The Medicare Buy In Oversight 
Board shall make periodic recommendations for the con-
tinual improvement of the implementation of this section 
as well as the relationship of enrollment under this section 
to other health care programs. 
‘‘(i) OUTREACH AND ENROLLMENT.— 
‘‘(1) IN GENERAL.—During the period that be-
gins on January 1, 2018, and ends on December 31, 
2020, the Secretary shall award grants to eligible 
entities for the following purposes: 
‘‘(A) OUTREACH AND ENROLLMENT.—To 
carry out outreach, public education activities, 
and enrollment activities to raise awareness of 
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the availability of, and encourage, enrollment 
under this section. 
‘‘(B) ASSISTING INDIVIDUALS TRANSITION 
UNDER THIS SECTION.—To provide assistance 
to individuals to enroll under this section. 
‘‘(C) RAISING
AWARENESS
OF
PREMIUM 
ASSISTANCE
AND
COST-SHARING
REDUC-
TIONS.—To distribute fair and impartial infor-
mation concerning enrollment under this section 
and the availability of premium assistance tax 
credits under section 36B of the Internal Rev-
enue Code of 1986 and cost-sharing reductions 
under section 1402 of the Patient Protection 
and Affordable Care Act, and to assist eligible 
individuals in applying for such tax credits and 
cost-sharing reductions. 
‘‘(2) ELIGIBLE ENTITIES.— 
‘‘(A) IN GENERAL.—In this subsection, the 
term ‘eligible entity’ means— 
‘‘(i) a State; or 
‘‘(ii) a nonprofit community-based or-
ganization. 
‘‘(B) ENROLLMENT AGENTS.—Such term 
includes a licensed independent insurance agent 
or broker that has an arrangement with a State 
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or nonprofit community-based organization to 
enroll eligible individuals under this section. 
‘‘(C) EXCLUSIONS.—Such term does not 
include an entity that— 
‘‘(i) is a health insurance issuer; or 
‘‘(ii) receives any consideration, either 
directly or indirectly, from any health in-
surance issuer in connection with the en-
rollment of any individuals under this sec-
tion. 
‘‘(3) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to 
awarding grants to States or eligible entities in 
States that have geographic rating areas at risk of 
having no qualified health plans in the individual 
market. 
‘‘(4) FUNDING.—Out of any moneys in the 
Treasury not otherwise appropriated, $500,000,000 
is appropriated to the Secretary for each of calendar 
years 2018 through 2020, to carry out this sub-
section. 
‘‘(j) IMPLEMENTATION.— 
‘‘(1) CONSULTATION.—In carrying out this sec-
tion, the Secretary shall— 
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‘‘(A) consult with other Federal agencies, 
including the Department of the Treasury, the 
Department of Labor, the Department of Vet-
erans Affairs, the Department of Defense, and 
the Office of Personnel Management; and 
‘‘(B) incorporate significant public con-
sultation and feedback, through public forums, 
notice and comment rulemaking, and any other 
appropriate mediums. 
‘‘(2) REPORT.—No later than one year after 
the date of the enactment of this section, the Sec-
retary shall submit to Congress a report establishing 
the administrative parameters for the implementa-
tion of this section. 
‘‘(k) FEASIBILITY STUDY.—The Secretary shall con-
duct a study on the feasibility of applying this section with 
respect to individuals residing in States that are not with-
in the 50 States or the District of Columbia.’’. 
(b) MEDIGAP.—Section 1882 of the Social Security 
Act is amended by adding at the end the following new 
subsection: 
‘‘(aa) DEVELOPMENT OF NEW STANDARDS FOR CER-
TAIN MEDICARE SUPPLEMENTAL POLICIES RELATING TO 
BUY-IN OPTION.—The Secretary shall request the Na-
tional Association of Insurance Commissioners to review 
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and revise the standards for benefit packages described 
in subsection (p)(1), to otherwise update standards to in-
clude requirements for each medicare supplemental policy 
that offers such a policy in a State, with respect to each 
year, to accept every individual in the State who is eligible 
for enrollment pursuant to section 1899C and who applies 
for such coverage for such year if the individual applies 
for enrollment in such policy during the 30-day period fol-
lowing the date of enrollment pursuant to section 1899C 
and to accept every such individual during a period of 
transition from enrollment pursuant to such section to en-
rollment under this title pursuant to eligibility other than 
under such section. Such revisions shall be made con-
sistent with the rules applicable under subsection 
(p)(1)(E) with the reference to the ‘1991 NAIC Model 
Regulation’ deemed a reference to the NAIC Model Regu-
lation as published in the Federal Register on December 
4, 1998, and as subsequently updated by the National As-
sociation of Insurance Commissioners to reflect previous 
changes in law and the reference to ‘date of enactment 
of this subsection’ deemed a reference to the date of enact-
ment of this subsection (aa).’’. 
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SEC. 3. NEGOTIATION OF LOWER COVERED PART D DRUG 
PRICES ON BEHALF OF MEDICARE BENE-
FICIARIES. 
(a) NEGOTIATION BY SECRETARY.—Section 1860D– 
11 of the Social Security Act (42 U.S.C. 1395w–111) is 
amended by striking subsection (i) (relating to noninter-
ference) and inserting the following: 
‘‘(i) NEGOTIATION OF LOWER DRUG PRICES.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary shall negotiate with 
pharmaceutical manufacturers the prices (including 
discounts, rebates, and other price concessions) that 
may be charged to PDP sponsors and MA organiza-
tions for covered part D drugs for part D eligible in-
dividuals who are enrolled under a prescription drug 
plan or under an MA–PD plan. 
‘‘(2) 
NO
CHANGE
IN
RULES
FOR 
FORMULARIES.— 
‘‘(A) IN GENERAL.—Nothing in paragraph 
(1) shall be construed to authorize the Sec-
retary to establish or require a particular for-
mulary. 
‘‘(B) CONSTRUCTION.—Subparagraph (A) 
shall not be construed as affecting the Sec-
retary’s authority to ensure appropriate and 
adequate access to covered part D drugs under 
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prescription drug plans and under MA–PD 
plans, including compliance of such plans with 
formulary requirements under section 1860D– 
4(b)(3). 
‘‘(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as preventing the sponsor 
of a prescription drug plan, or an organization offer-
ing an MA–PD plan, from obtaining a discount or 
reduction of the price for a covered part D drug 
below the price negotiated under paragraph (1). 
‘‘(4) SEMI-ANNUAL REPORTS TO CONGRESS.— 
Not later than June 1, 2018, and every 6 months 
thereafter, the Secretary shall submit to the Com-
mittees on Ways and Means, Energy and Commerce, 
and Oversight and Government Reform of the House 
of Representatives and the Committee on Finance of 
the Senate a report on negotiations conducted by the 
Secretary to achieve lower prices for Medicare bene-
ficiaries, and the prices and price discounts achieved 
by the Secretary as a result of such negotiations.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act and shall first apply to negotiations and 
prices for plan years beginning on January 1, 2018. 
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SEC. 4. INDIVIDUAL MARKET REINSURANCE FUND. 
(a) ESTABLISHMENT OF FUND.— 
(1) IN GENERAL.—There is established the ‘‘In-
dividual Market Reinsurance Fund’’ (in this section 
referred to as the ‘‘Fund’’) to be administered by 
the Secretary to provide funding for an individual 
market stabilization reinsurance program in each 
State that complies with the requirements of this 
section. 
(2) FUNDING.—Amounts made available to the 
Fund shall consist of the funds deposited into the 
Fund under paragraph (3) and shall be used to 
carry out this section (other than subsection (c)) for 
each calendar year beginning with 2018. Amounts 
made available to the Fund shall remain available 
without fiscal or calendar year limitation to carry 
out this section. 
(3) COST-SHARING IN COSTS OF PROGRAM.— 
(A) IN GENERAL.—A qualified health plan 
that participates in the reinsurance program es-
tablished under subsection (b) shall pay the fee 
established under subparagraph (B). 
(B) AUTHORIZATION.—The Secretary is 
authorized to charge a fee to each qualified 
health plan that participates in the reinsurance 
program established under subsection (b). Any 
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amounts collected pursuant to this paragraph 
shall be deposited into the Fund for purposes of 
payments under subsection (b). 
(C) REQUIREMENTS.—In establishing the 
fee under subparagraph (B)— 
(i) the Secretary shall consult with in-
terested parties; and 
(ii) shall ensure that the amount of 
such fee is not excessive so as to unduly 
discourage qualified health plans from par-
ticipating in the reinsurance program. 
(b) 
INDIVIDUAL
MARKET
REINSURANCE
PRO-
GRAM.— 
(1) USE OF FUNDS.—The Secretary shall use 
amounts in the Fund to establish a reinsurance pro-
gram under which the Secretary shall make reinsur-
ance payments, subject to subsection (a)(3), to 
health insurance issuers with respect to high-cost in-
dividuals enrolled in qualified health plans offered by 
such issuers that are not grandfathered health plans 
or transitional health plans for any plan year begin-
ning with the 2018 plan year. This subsection con-
stitutes budget authority in advance of appropria-
tions Acts and represents the obligation of the Sec-
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retary to provide payments from the Fund in ac-
cordance with this subsection. 
(2) AMOUNT
OF
PAYMENT.—The payment 
made to a health insurance issuer under paragraph 
(1) with respect to each high-cost individual enrolled 
in a qualified health plan issued by the issuer that 
is not a grandfathered health plan or a transitional 
health plan shall equal 80 percent of the lesser of— 
(A) the amount (if any) by which the indi-
vidual’s claims incurred during the plan year 
exceeds— 
(i) in the case of the 2018, 2019, or 
2020 plan year, $50,000; and 
(ii) in the case of any other plan year, 
$100,000; or 
(B) for plan years described in— 
(i) subparagraph (A)(i), $450,000; 
and 
(ii) subparagraph (A)(ii), $400,000. 
(3) INDEXING.—In the case of plan years be-
ginning after 2018, the dollar amounts that appear 
in subparagraphs (A) and (B) of paragraph (2) shall 
each be increased by an amount equal to— 
(A) such amount; multiplied by 
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(B) the premium adjustment percentage 
specified under section 1302(c)(4) of the Af-
fordable Care Act, but determined by sub-
stituting ‘‘2018’’ for ‘‘2013’’. 
(4) PAYMENT METHODS.— 
(A) IN
GENERAL.—Payments under this 
subsection shall be based on such a method as 
the Secretary determines. The Secretary may 
establish a payment method by which interim 
payments of amounts under this subsection are 
made during a plan year based on the Sec-
retary’s best estimate of amounts that will be 
payable after obtaining all of the information. 
(B) REQUIREMENT FOR PROVISION OF IN-
FORMATION.— 
(i) REQUIREMENT.—Payments under 
this subsection to a health insurance issuer 
are conditioned upon the furnishing to the 
Secretary, in a form and manner specified 
by the Secretary, of such information as 
may be required to carry out this sub-
section. 
(ii) RESTRICTION ON USE OF INFOR-
MATION.—Information disclosed or ob-
tained pursuant to clause (i) is subject to 
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the HIPAA privacy and security law, as 
defined in section 3009(a) of the Public 
Health Service Act (42 U.S.C. 300jj– 
19(a)). 
(5) SECRETARY
FLEXIBILITY
FOR
BUDGET 
NEUTRAL
REVISIONS
TO
REINSURANCE
PAYMENT 
SPECIFICATIONS.—If the Secretary determines ap-
propriate, the Secretary may substitute higher dollar 
amounts for the dollar amounts specified under sub-
paragraphs (A) and (B) of paragraph (2) (and ad-
justed under paragraph (3), if applicable) if the Sec-
retary certifies that such substitutions, considered 
together, neither increase nor decease the total pro-
jected payments under this subsection. 
(c) REPORTS TO CONGRESS.— 
(1) ANNUAL
REPORT.—The Secretary shall 
submit a report to Congress, not later than January 
21, 2019, and each year thereafter, that contains 
the following information for the most recently 
ended year: 
(A) The number and types of plans in each 
State’s individual market, specifying the num-
ber that are qualified health plans, grand-
fathered health plans, or health insurance cov-
erage that is not a qualified health plan. 
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(B) The impact of the reinsurance pay-
ments provided under this section on the avail-
ability of coverage, cost of coverage, and cov-
erage options in each State. 
(C) The amount of premiums paid by indi-
viduals in each State by age, family size, geo-
graphic area in the State’s individual market, 
and category of health plan (as described in 
subparagraph (A)). 
(D) The process used to award funds for 
outreach and enrollment activities awarded to 
eligible entities under subsection (c), the 
amount of such funds awarded, and the activi-
ties carried out with such funds. 
(E) Such other information as the Sec-
retary deems relevant. 
(2) EVALUATION REPORT.—Not later than Jan-
uary 31, 2022, the Secretary shall submit to Con-
gress a report that— 
(A) analyzes the impact of the funds pro-
vided under this section on premiums and en-
rollment in the individual market in all States; 
and 
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(B) contains a State-by-State comparison 
of the design of the programs carried out by 
States with funds provided under this section. 
(d) DEFINITIONS.—In this section: 
(1) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of the Department of Health and 
Human Services. 
(2) FUND.—The term ‘‘Fund’’ means the Indi-
vidual Market Reinsurance Fund established under 
subsection (a). 
(3) GRANDFATHERED
HEALTH
PLAN.—The 
term ‘‘grandfathered health plan’’ has the meaning 
given that term in section 1251(e) of the Patient 
Protection and Affordable Care Act. 
(4) HIGH-COST INDIVIDUAL.—The term ‘‘high- 
cost individual’’ means an individual enrolled in a 
qualified health plan (other than a grandfathered 
health plan or a transitional health plan) who incurs 
claims in excess of $50,000 during a plan year. 
(5) STATE.—The term ‘‘State’’ means each of 
the 50 States and the District of Columbia. 
(6) TRANSITIONAL HEALTH PLAN.—The term 
‘‘transitional health plan’’ means a plan continued 
under the letter issued by the Centers for Medicare 
& Medicaid Services on November 14, 2013, to the 
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State Insurance Commissioners outlining a transi-
tional policy for coverage in the individual and small 
group markets to which section 1251 of the Patient 
Protection and Affordable Care Act does not apply, 
and under the extension of the transitional policy for 
such coverage set forth in the Insurance Standards 
Bulletin Series guidance issued by the Centers for 
Medicare & Medicaid Services on March 5, 2014, 
February 29, 2016, and February 13, 2017. 
SEC. 5. REAUTHORIZATION OF RISK CORRIDORS. 
Section 1342(a) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18062(a)) is amended by 
inserting ‘‘and calendar years 2018 through 2020’’ after 
‘‘2016’’. 
SEC. 6. ENHANCEMENTS FOR REDUCED COST SHARING. 
(a) MODIFICATION OF AMOUNT.— 
(1) IN
GENERAL.—Section 1402(c)(2) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18071(c)(2)) is amended to read as follows: 
‘‘(2) ADDITIONAL REDUCTION.—The Secretary 
shall establish procedures under which the issuer of 
a qualified health plan to which this section applies 
shall further reduce cost-sharing under the plan in 
a manner sufficient to— 
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‘‘(A) in the case of an eligible insured 
whose household income is not less than 100 
percent but not more than 200 percent of the 
poverty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 95 
percent of such costs; 
‘‘(B) in the case of an eligible insured 
whose household income is more than 200 per-
cent but not more than 300 percent of the pov-
erty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 90 
percent of such costs; and 
‘‘(C) in the case of an eligible insured 
whose household income is more than 300 per-
cent but not more than 400 percent of the pov-
erty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 85 
percent of such costs.’’. 
(2) CONFORMING AMENDMENT.—Clause (i) of 
section 1402(c)(1)(B) of such Act (42 U.S.C. 
18071(c)(1)(B)) is amended to read as follows: 
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‘‘(i) IN
GENERAL.—The Secretary 
shall ensure the reduction under this para-
graph shall not result in an increase in the 
plan’s share of the total allowed costs of 
benefits provided under the plan above— 
‘‘(I) 95 percent in the case of an 
eligible insured described in para-
graph (2)(A); 
‘‘(II) 90 percent in the case of an 
eligible insured described in para-
graph (2)(B); and 
‘‘(III) 85 percent in the case of 
an eligible insured described in para-
graph (2)(C).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to plan years begin-
ning after December 31, 2017. 
(b) FUNDING.—Section 1402 of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 18071) is amend-
ed by adding at the end the following new subsection: 
‘‘(g) FUNDING.—Out of any funds in the Treasury 
not otherwise appropriated, there are appropriated to the 
Secretary such sums as may be necessary for payments 
under this section.’’. 
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SEC. 7. TECHNICAL ADVISORY COMMITTEE ON HEALTH 
CARE DELIVERY SYSTEM REFORM AND PRO-
GRAM INTEGRITY. 
(a) ESTABLISHMENT.—There is established a com-
mittee to be known as the Committee on Delivery System 
Reform and Program Integrity. 
(b) MEMBERSHIP.—The Committee shall be com-
posed of 11 members appointed by the Comptroller Gen-
eral of the United States. Such members shall include in-
dividuals with national recognition for their expertise in 
health care delivery system reform and the related delivery 
of health care. Health care providers and patient advo-
cates shall have adequate representation on the Com-
mittee. 
(c) DUTIES.—The Committee shall periodically sub-
mit to the Secretary of Health and Human Services and 
the Congress written recommendations, provided in a com-
prehensive report format, to further the goals of health 
care delivery system reform that generally aim to improve 
the quality of patient care, improve the health of popu-
lations, and reduce the cost of care. The origin of these 
proposals can be derived from any initiative underway be-
tween the Department of Health and Human Services and 
any party, or other initiatives, national or regional in 
scope, that offer promise to accelerate the goals of delivery 
system reform or improve program integrity toward the 
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goal of providing further stability to the appropriate Trust 
Funds under title XVIII of the Social Security Act. 
Æ 
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