I 
111TH CONGRESS 
1ST SESSION H. R. 3713 
To provide bipartisan solutions to lower health costs, increase access to 
affordable coverage, and give patients more choices and control. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 1, 2009 
Mr. ROGERS of Michigan (for himself, Mrs. BLACKBURN, Mr. SHIMKUS, Mr. 
PITTS, Mrs. MYRICK, Mrs. BONO MACK, Mr. BUYER, Mr. UPTON, and 
Mr. HALL of Texas) introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Commit-
tees on Ways and Means, Education and Labor, Appropriations, and the 
Judiciary, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To provide bipartisan solutions to lower health costs, increase 
access to affordable coverage, and give patients more 
choices and control. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘American Health Care Solutions Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
Sec. 1. Short title; table of contents. 
Sec. 2. Rule of construction regarding prohibition on authority to ration health 
care. 
TITLE I—EXPANDING ACCESS TO COVERAGE 
Subtitle A—Protecting Affordability Through Reinsurance or High Risk 
Pooling 
Sec. 101. Ensuring affordability for all through special pooling of cost for those 
with pre-existing conditions and many health care needs. 
Subtitle B—Individual Membership Associations 
Sec. 111. Expansion of access and choice of health insurance coverage through 
individual membership associations (IMAs). 
Subtitle C—Association Health Plans 
Sec. 121. Rules governing association health plans. 
Sec. 122. Clarification of treatment of single employer arrangements. 
Sec. 123. Enforcement provisions relating to association health plans. 
Sec. 124. Cooperation between Federal and State authorities. 
Sec. 125. Effective date and transitional and other rules. 
Subtitle D—Purchasing Insurance Across State Lines 
Sec. 131. Cooperative governing of individual health insurance coverage. 
Sec. 132. Severability. 
Subtitle E—Protecting Patients From Rescissions 
Sec. 141. Opportunity for independent, external third party reviews of certain 
nonrenewals and discontinuations, including rescissions, of in-
dividual health insurance coverage. 
TITLE II—PROMOTING PATIENT CHOICE 
Subtitle A—Credit for Small Employers Adopting Auto-Enrollment and 
Defined Contribution Options 
Sec. 201. Credit for small employers adopting auto-enrollment and defined con-
tribution options. 
Subtitle B—Tax Incentives for Long-Term Care Insurance 
Sec. 211. Treatment of premiums on qualified long-term care insurance con-
tracts. 
Sec. 212. Credit for taxpayers with long-term care needs. 
Sec. 213. Additional consumer protections for long-term care insurance. 
Subtitle C—Comparative Effectiveness Research 
Sec. 221. Prohibition on Certain Uses of Data Obtained from Comparative Ef-
fectiveness Research; Accounting for Personalized Medicine 
and Differences in Patient Treatment Response. 
Subtitle D—Programs of Health Promotion or Disease Prevention 
Sec. 231. Programs of health promotion or disease prevention. 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6211
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
TITLE III—STRENGTHENING SAFETY NET PROGRAMS 
Subtitle A—Beneficiary Choice Under Medicaid and SCHIP 
Sec. 301. Easing administrative barriers to State cooperation with employer- 
sponsored insurance coverage. 
Sec. 302. Improving beneficiary choice in SCHIP. 
Sec. 303. Application to Medicaid. 
Sec. 304. Expansion of health opportunity account program. 
Sec. 305. Verification requirements to prevent illegal aliens from receiving Med-
icaid benefits. 
Subtitle B—Community Health Centers 
Sec. 311. Increased funding. 
TITLE IV—EXPANDING HEALTH SAVINGS ACCOUNTS 
Sec. 401. Allow both spouses to make catch-up contributions to the same HSA 
account. 
Sec. 402. Provisions relating to Medicare. 
Sec. 403. Individuals eligible for veterans benefits for a service-connected dis-
ability. 
Sec. 404. Individuals eligible for Indian Health Service assistance. 
Sec. 405. FSA and HRA termination to fund HSAS. 
Sec. 406. Purchase of health insurance from HSA account. 
Sec. 407. Special rule for certain medical expenses incurred before establish-
ment of account. 
Sec. 408. Preventive care prescription drug clarification. 
Sec. 409. Qualified medical expenses. 
TITLE V—MEDICAL LIABILITY REFORM 
Subtitle A—Medical Liability 
Sec. 501. Encouraging speedy resolution of claims. 
Sec. 502. Compensating patient injury. 
Sec. 503. Maximizing patient recovery. 
Sec. 504. Additional health benefits. 
Sec. 505. Punitive damages. 
Sec. 506. Authorization of payment of future damages to claimants in 
HEALTH care lawsuits. 
Sec. 507. Definitions. 
Sec. 508. Effect on other laws. 
Sec. 509. State flexibility and protection of states’ rights. 
Sec. 510. Applicability; effective date. 
Sec. 511. Sense of Congress. 
Subtitle B—Liability Protection for Community Health Center Volunteers 
Sec. 521. Health centers under Public Health Service Act; liability protections 
for volunteer practitioners. 
TITLE VI—MISCELLANEOUS 
Subtitle A—Fighting Fraud and Abuse 
Sec. 601. Provide adequate funding to HHS OIG and HCFAC. 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6211
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
Sec. 602. Increased civil money penalties and criminal fines for Medicare fraud 
and abuse. 
Sec. 603. Increased sentences for felonies involving Medicare fraud and abuse. 
Sec. 604. Illegal distribution of a Medicare or Medicaid beneficiary identifica-
tion or provider number. 
Sec. 605. Use of technology for real-time data review. 
Subtitle B—State Transparency Plan Portal 
Sec. 611. Providing information on health coverage options and health care 
providers. 
Sec. 612. Establishment of performance-based quality measures. 
Subtitle C—Medicare Accountable Care Organization Demonstration Program 
Sec. 621. Medicare Accountable Care Organization demonstration program. 
Subtitle D—Repeal of Unused Stimulus Funds 
Sec. 631. Rescission and repeal in ARRA. 
SEC. 2. RULE OF CONSTRUCTION REGARDING PROHIBI-
TION ON AUTHORITY TO RATION HEALTH 
CARE. 
Nothing in this Act may be construed to authorize 
the Federal Government to ration health care for the 
American people. 
TITLE I—EXPANDING ACCESS TO 
COVERAGE 
Subtitle 
A—Protecting 
Afford-
ability Through Reinsurance or 
High Risk Pooling 
SEC. 101. ENSURING AFFORDABILITY FOR ALL THROUGH 
SPECIAL POOLING OF COST FOR THOSE WITH 
PRE-EXISTING 
CONDITIONS 
AND 
MANY 
HEALTH CARE NEEDS. 
(a) STATE REQUIREMENT.— 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
(1) IN GENERAL.—Not later than 2 years after 
the date of the enactment of this Act, each State 
shall ensure an adequate financial backstop to miti-
gate the cost of high risk individuals in the State 
through— 
(A) a qualified State reinsurance program 
described in subsection (b); or 
(B) a qualifying State high risk pool de-
scribed in subsection (c)(1); and 
(C) subject to paragraph (4), contribute to 
the ongoing stability of the arrangement 
through State assessments or allocation of 
other State funds that are not otherwise used 
on State health care programs. 
(2) PREFERENCE.—Beginning 3 years after the 
date of the enactment of this Act, the Secretary, in 
awarding any competitive grant and for which only 
States are eligible to apply, shall give preference to 
a State with a program that meets the requirements 
of paragraph (1). 
(3) RELATION TO CURRENT QUALIFIED HIGH 
RISK POOL PROGRAM OPERATING A QUALIFIED HIGH 
RISK POOL.—In the case of a State that is operating 
a current section 2745 qualified high risk pool as of 
the date of the enactment of this Act— 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
(A) as of the date that is 2 years after the 
date of the enactment of this Act, such a pool 
shall not be treated as a qualified high risk pool 
under section 2745 of the Public Health Service 
Act (42 U.S.C. 300gg–45) unless the pool is a 
qualifying State high risk pool described in sub-
section (c)(1); and 
(B) current funding sources may be used 
to transition from operation of such a pool to 
operation of a qualified State reinsurance pro-
gram described in subsection (b). 
(4) APPLICATION OF FUNDS.—If the program 
or pool operated under paragraph (1)(A) is in sound 
financial condition as demonstrated by audited fi-
nancial statements and actuarial certification and is 
approved as an appropriate financial backstop by the 
State Insurance Commissioner involved, the require-
ment of paragraph (1)(C) shall be waived. 
(b) QUALIFIED STATE REINSURANCE PROGRAM.— 
(1) FORM OF PROGRAM.—A qualified State re-
insurance program may provide reinsurance— 
(A) on a prospective or retrospective basis; 
and 
(B) on a basis that protects health insur-
ance issuers against the annual aggregate 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
spending of their enrollees as well as purchase 
protection against individual catastrophic costs. 
(2) SATISFACTION OF HIPAA REQUIREMENT.— 
A qualified State reinsurance program shall be 
deemed, for purposes of section 2745 of the Public 
Health Service Act (42 U.S.C. 300gg–45), to be a 
qualified high-risk pool under such section. 
(c) QUALIFYING STATE HIGH RISK POOL.— 
(1) IN GENERAL.—A qualifying State high risk 
pool described in this subsection means a current 
section 2745 qualified high risk pool that meets the 
following requirements: 
(A) The pool offers assistance to low-in-
come individuals as applicable and may incor-
porate applicable Federal and State programs 
for eligible individuals to meet this purpose. 
(B) The pool provides a variety of coverage 
options, one of which must be a high deductible 
health plan that may be coupled with a health 
savings account. 
(C) The pool is funded with a stable fund-
ing source that is not solely dependent on an 
appropriation from a State legislature. 
(D) The pool eliminates waiting lists and 
pre-existing conditions exclusionary periods so 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
that all eligible residents who are seeking cov-
erage through the pool can receive coverage 
through the pool. 
(E) The pool allows for coverage of individ-
uals who, but for the 24-month disability wait-
ing period under section 226(b) of the Social 
Security Act, would be eligible for Medicare 
during the period of such waiting period. 
(F) The pool does not charge participants 
more than 150 percent of the average premium 
for individual market coverage in that State. 
(G) The pool conducts education and out-
reach initiatives so that residents and brokers 
understand that the pool is available to eligible 
residents. 
(H) The pool does not impose lifetime or 
annual limits on benefits. 
(2) RELATION
TO
SECTION
2745.—As of the 
date that is 2 years after the date of the enactment 
of this Act, a pool shall not qualify as a qualified 
high risk pool under section 2745 of the Public 
Health Service Act (42 U.S.C. 300gg–45) unless the 
pool is a qualifying State high risk pool described in 
paragraph (1). 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
(d) WAIVERS.—In order to accommodate new and in-
novative programs, the Secretary may waive such require-
ments of this section for qualified State reinsurance pro-
grams and for qualifying State high risk pools as the Sec-
retary deems appropriate. 
(e) FUNDING.—In addition to any other amounts ap-
propriated, there are authorized to be appropriated to 
carry out section 2745 of the Public Health Service Act 
(42 U.S.C. 300gg–45) (including through a program or 
pool described in subsection (a)(1)), $20,000,000,000 for 
Fiscal Years 2010 through 2019 to carry out this section. 
(f) DEFINITIONS.—In this section: 
(1) CURRENT SECTION 2745 QUALIFIED HIGH 
RISK POOL.—The term ‘‘current section 2745 quali-
fied high risk pool’’ has the meaning given the term 
‘‘qualified high risk pool’’ under section 2745(g) of 
the Public Health Service Act (42 U.S.C. 300gg– 
45(g)) as in effect as of the date of the enactment 
of this Act. 
(2) HEALTH INSURANCE COVERAGE.—The term 
‘‘health insurance coverage’’ has the meaning given 
such term in section 2791 of the Public Health 
Service Act (42 U.S.C. 300gg–91). 
(3) HEALTH
INSURANCE
ISSUER.—The term 
‘‘health insurance issuer’’ has the meaning given 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
such term in section 2791 of the Public Health 
Service Act (42 U.S.C. 300gg–91). 
(4) QUALIFIED
STATE
REINSURANCE
PRO-
GRAM.—The term ‘‘qualified State reinsurance pro-
gram’’ means a program operated by a State or a 
State authorized program that provides reinsurance 
for health insurance coverage offered in the indi-
vidual or the small group market in accordance with 
the model for such a program established (as of the 
date of the enactment of this Act). 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(6) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act. 
Subtitle B—Individual Membership 
Associations 
SEC. 111. EXPANSION OF ACCESS AND CHOICE OF HEALTH 
INSURANCE 
COVERAGE 
THROUGH 
INDI-
VIDUAL MEMBERSHIP ASSOCIATIONS (IMAS). 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following new 
title: 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
‘‘TITLE XXXI—INDIVIDUAL 
MEMBERSHIP ASSOCIATIONS 
‘‘SEC. 3101. DEFINITION OF INDIVIDUAL MEMBERSHIP AS-
SOCIATION (IMA). 
‘‘(a) IN GENERAL.—For purposes of this title, the 
terms ‘individual membership association’ and ‘IMA’ 
mean a legal entity that meets the following requirements: 
‘‘(1) ORGANIZATION.—The IMA is an organiza-
tion operated under the direction of an association 
(as defined in section 3104(1)). 
‘‘(2) 
OFFERING
HEALTH
BENEFITS
COV-
ERAGE.— 
‘‘(A) DIFFERENT GROUPS.—The IMA, in 
conjunction with those health insurance issuers 
that offer health benefits coverage through the 
IMA, makes available health benefits coverage 
in the manner described in subsection (b) to all 
members of the IMA and the dependents of 
such members in the manner described in sub-
section (c)(2) at rates that are established by 
the health insurance issuer on a policy or prod-
uct specific basis and that may vary only as 
permissible under State law. 
‘‘(B) NONDISCRIMINATION
IN
COVERAGE 
OFFERED.— 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the IMA may not offer health benefits 
coverage to a member of an IMA unless 
the same coverage is offered to all such 
members of the IMA. 
‘‘(ii) 
CONSTRUCTION.—Nothing 
in 
this title shall be construed as requiring or 
permitting a health insurance issuer to 
provide coverage outside the service area of 
the issuer, as approved under State law, or 
requiring a health insurance issuer from 
excluding or limiting the coverage on any 
individual, subject to the requirement of 
section 2741. 
‘‘(C) NO FINANCIAL UNDERWRITING.—The 
IMA provides health benefits coverage only 
through contracts with health insurance issuers 
and does not assume insurance risk with re-
spect to such coverage. 
‘‘(3) GEOGRAPHIC AREAS.—Nothing in this title 
shall be construed as preventing the establishment 
and operation of more than one IMA in a geographic 
area or as limiting the number of IMAs that may 
operate in any area. 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
‘‘(4) PROVISION OF ADMINISTRATIVE SERVICES 
TO PURCHASERS.— 
‘‘(A) IN GENERAL.—The IMA may provide 
administrative services for members. Such serv-
ices may include accounting, billing, and enroll-
ment information. 
‘‘(B) CONSTRUCTION.—Nothing in this 
subsection shall be construed as preventing an 
IMA from serving as an administrative service 
organization to any entity. 
‘‘(5) FILING
INFORMATION.—The IMA files 
with the Secretary information that demonstrates 
the IMA’s compliance with the applicable require-
ments of this title. 
‘‘(b) HEALTH
BENEFITS
COVERAGE
REQUIRE-
MENTS.— 
‘‘(1) COMPLIANCE
WITH
CONSUMER
PROTEC-
TION REQUIREMENTS.—Any health benefits coverage 
offered through an IMA shall— 
‘‘(A) be underwritten by a health insurance 
issuer that— 
‘‘(i) is licensed (or otherwise regu-
lated) under State law, and 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
‘‘(ii) meets all applicable State stand-
ards relating to consumer protection, sub-
ject to section 3002(b), and 
‘‘(B) subject to paragraph (2), be approved 
or otherwise permitted to be offered under 
State law. 
‘‘(2) EXAMPLES OF TYPES OF COVERAGE.—The 
benefits coverage made available through an IMA 
may include, but is not limited to, any of the fol-
lowing if it meets the other applicable requirements 
of this title: 
‘‘(A) Coverage through a health mainte-
nance organization. 
‘‘(B) Coverage in connection with a pre-
ferred provider organization. 
‘‘(C) Coverage in connection with a li-
censed provider-sponsored organization. 
‘‘(D) Indemnity coverage through an insur-
ance company. 
‘‘(E) Coverage offered in connection with a 
contribution into a medical savings account, 
health savings account, or flexible spending ac-
count. 
‘‘(F) Coverage that includes a point-of- 
service option. 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
‘‘(G) Any combination of such types of 
coverage. 
‘‘(3) WELLNESS BONUSES FOR HEALTH PRO-
MOTION.—Nothing in this title shall be construed as 
precluding a health insurance issuer offering health 
benefits coverage through an IMA from establishing 
premium discounts or rebates for members or from 
modifying 
otherwise 
applicable 
copayments 
or 
deductibles in return for adherence to programs of 
health promotion and disease prevention so long as 
such programs are agreed to in advance by the IMA 
and comply with all other provisions of this title and 
do not discriminate among similarly situated mem-
bers. 
‘‘(c) MEMBERS; HEALTH INSURANCE ISSUERS.— 
‘‘(1) MEMBERS.— 
‘‘(A) IN
GENERAL.—Under rules estab-
lished to carry out this title, with respect to an 
individual who is a member of an IMA, the in-
dividual may enroll for health benefits coverage 
(including coverage for dependents of such indi-
vidual) offered by a health insurance issuer 
through the IMA. 
‘‘(B) RULES FOR ENROLLMENT.—Nothing 
in this paragraph shall preclude an IMA from 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
establishing rules of enrollment and reenroll-
ment of members. Such rules shall be applied 
consistently to all members within the IMA and 
shall not be based in any manner on health sta-
tus-related factors. 
‘‘(2) HEALTH INSURANCE ISSUERS.—The con-
tract between an IMA and a health insurance issuer 
shall provide, with respect to a member enrolled with 
health benefits coverage offered by the issuer 
through the IMA, for the payment of the premiums 
collected by the issuer. 
‘‘SEC. 3102. APPLICATION OF CERTAIN LAWS AND REQUIRE-
MENTS. 
‘‘State laws insofar as they relate to any of the fol-
lowing are superseded and shall not apply to health bene-
fits coverage made available through an IMA: 
‘‘(1) Benefit requirements for health benefits 
coverage offered through an IMA, including (but not 
limited to) requirements relating to coverage of spe-
cific providers, specific services or conditions, or the 
amount, duration, or scope of benefits, but not in-
cluding requirements to the extent required to imple-
ment title XXVII or other Federal law and to the 
extent the requirement prohibits an exclusion of a 
specific disease from such coverage. 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
‘‘(2) Any other requirements (including limita-
tions on compensation arrangements) that, directly 
or indirectly, preclude (or have the effect of pre-
cluding) the offering of such coverage through an 
IMA, if the IMA meets the requirements of this 
title. 
Any State law or regulation relating to the composition 
or organization of an IMA is preempted to the extent the 
law or regulation is inconsistent with the provisions of this 
title. 
‘‘SEC. 3103. ADMINISTRATION. 
‘‘(a) IN GENERAL.—The Secretary shall administer 
this title and is authorized to issue such regulations as 
may be required to carry out this title. Such regulations 
shall be subject to Congressional review under the provi-
sions of chapter 8 of title 5, United States Code. The Sec-
retary shall incorporate the process of ‘deemed file and 
use’ with respect to the information filed under section 
3001(a)(5)(A) and shall determine whether information 
filed by an IMA demonstrates compliance with the applica-
ble requirements of this title. The Secretary shall exercise 
authority under this title in a manner that fosters and 
promotes the development of IMAs in order to improve 
access to health care coverage and services. 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS
‘‘(b) PERIODIC REPORTS.—The Secretary shall sub-
mit to Congress a report every 30 months, during the 10- 
year period beginning on the effective date of the rules 
promulgated by the Secretary to carry out this title, on 
the effectiveness of this title in promoting coverage of un-
insured individuals. The Secretary may provide for the 
production of such reports through one or more contracts 
with appropriate private entities. 
‘‘SEC. 3104. DEFINITIONS. 
‘‘For purposes of this title: 
‘‘(1) ASSOCIATION.—The term ‘association’ 
means, with respect to health insurance coverage of-
fered in a State, an association which— 
‘‘(A) has been actively in existence for at 
least 5 years; 
‘‘(B) has been formed and maintained in 
good faith for purposes other than obtaining in-
surance; 
‘‘(C) does not condition membership in the 
association on any health status-related factor 
relating to an individual (including an employee 
of an employer or a dependent of an employee); 
and 
‘‘(D) does not make health insurance cov-
erage offered through the association available 
VerDate Nov 24 2008 
04:40 Oct 03, 2009
Jkt 089200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H3713.IH
H3713
jbell on DSKDVH8Z91PROD with BILLS