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‘‘SEC. 1334. MULTI-STATE PLANS. 
‘‘(a) OVERSIGHT BY THE OFFICE OF PERSONNEL MAN-
AGEMENT.— 
‘‘(1) IN GENERAL.—The Director of the Office of 
Personnel Management (referred to in this section as 
the ‘Director’) shall enter into contracts with health 
insurance issuers (which may include a group of 
health insurance issuers affiliated either by common 
ownership and control or by the common use of a na-
tionally licensed service mark), without regard to sec-
tion 5 of title 41, United States Code, or other stat-
utes requiring competitive bidding, to offer at least 2 
multi-State qualified health plans through each Ex-
change in each State. Such plans shall provide indi-
vidual, or in the case of small employers, group cov-
erage. 
‘‘(2) TERMS.—Each contract entered into under 
paragraph (1) shall be for a uniform term of at least 
1 year, but may be made automatically renewable 
from term to term in the absence of notice of termi-
nation by either party. In entering into such con-
tracts, the Director shall ensure that health benefits 
coverage is provided in accordance with the types of 
coverage provided for under section 2701(a)(1)(A)(i) 
of the Public Health Service Act. 
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‘‘(3) NON-PROFIT
ENTITIES.—In entering into 
contracts under paragraph (1), the Director shall en-
sure that at least one contract is entered into with a 
non-profit entity. 
‘‘(4) ADMINISTRATION.—The Director shall im-
plement this subsection in a manner similar to the 
manner in which the Director implements the con-
tracting provisions with respect to carriers under the 
Federal employees health benefit program under chap-
ter 89 of title 5, United States Code, including 
(through negotiating with each multi-state plan)— 
‘‘(A) a medical loss ratio; 
‘‘(B) a profit margin; 
‘‘(C) the premiums to be charged; and 
‘‘(D) such other terms and conditions of 
coverage as are in the interests of enrollees in 
such plans. 
‘‘(5) AUTHORITY TO PROTECT CONSUMERS.—The 
Director may prohibit the offering of any multi-State 
health plan that does not meet the terms and condi-
tions defined by the Director with respect to the ele-
ments described in subparagraphs (A) through (D) of 
paragraph (4). 
‘‘(6) ASSURED
AVAILABILITY
OF
VARIED
COV-
ERAGE.—In entering into contracts under this sub-
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section, the Director shall ensure that with respect to 
multi-State qualified health plans offered in an Ex-
change, there is at least one such plan that does not 
provide coverage of services described in section 
1303(b)(1)(B)(i). 
‘‘(7) WITHDRAWAL.—Approval of a contract 
under this subsection may be withdrawn by the Direc-
tor only after notice and opportunity for hearing to 
the issuer concerned without regard to subchapter II 
of chapter 5 and chapter 7 of title 5, United States 
Code. 
‘‘(b) ELIGIBILITY.—A health insurance issuer shall be 
eligible to enter into a contract under subsection (a)(1) if 
such issuer— 
‘‘(1) agrees to offer a multi-State qualified health 
plan that meets the requirements of subsection (c) in 
each Exchange in each State; 
‘‘(2) is licensed in each State and is subject to 
all requirements of State law not inconsistent with 
this section, including the standards and require-
ments that a State imposes that do not prevent the 
application of a requirement of part A of title XXVII 
of the Public Health Service Act or a requirement of 
this title; 
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‘‘(3) otherwise complies with the minimum 
standards prescribed for carriers offering health bene-
fits plans under section 8902(e) of title 5, United 
States Code, to the extent that such standards do not 
conflict with a provision of this title; and 
‘‘(4) meets such other requirements as determined 
appropriate by the Director, in consultation with the 
Secretary. 
‘‘(c) REQUIREMENTS FOR MULTI-STATE QUALIFIED 
HEALTH PLAN.— 
‘‘(1) IN
GENERAL.—A multi-State qualified 
health plan meets the requirements of this subsection 
if, in the determination of the Director— 
‘‘(A) the plan offers a benefits package that 
is uniform in each State and consists of the es-
sential benefits described in section 1302; 
‘‘(B) the plan meets all requirements of this 
title with respect to a qualified health plan, in-
cluding requirements relating to the offering of 
the bronze, silver, and gold levels of coverage and 
catastrophic coverage in each State Exchange; 
‘‘(C) except as provided in paragraph (5), 
the issuer provides for determinations of pre-
miums for coverage under the plan on the basis 
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of the rating requirements of part A of title 
XXVII of the Public Health Service Act; and 
‘‘(D) the issuer offers the plan in all geo-
graphic regions, and in all States that have 
adopted adjusted community rating before the 
date of enactment of this Act. 
‘‘(2) STATES
MAY
OFFER
ADDITIONAL
BENE-
FITS.—Nothing in paragraph (1)(A) shall preclude a 
State from requiring that benefits in addition to the 
essential health benefits required under such para-
graph be provided to enrollees of a multi-State quali-
fied health plan offered in such State. 
‘‘(3) CREDITS.— 
‘‘(A) IN GENERAL.—An individual enrolled 
in a multi-State qualified health plan under this 
section shall be eligible for credits under section 
36B of the Internal Revenue Code of 1986 and 
cost sharing assistance under section 1402 in the 
same manner as an individual who is enrolled 
in a qualified health plan. 
‘‘(B) NO
ADDITIONAL
FEDERAL
COST.—A 
requirement by a State under paragraph (2) 
that benefits in addition to the essential health 
benefits required under paragraph (1)(A) be pro-
vided to enrollees of a multi-State qualified 
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health plan shall not affect the amount of a pre-
mium tax credit provided under section 36B of 
the Internal Revenue Code of 1986 with respect 
to such plan. 
‘‘(4) STATE MUST ASSUME COST.—A State shall 
make payments— 
‘‘(A) to an individual enrolled in a multi- 
State qualified health plan offered in such State; 
or 
‘‘(B) on behalf of an individual described in 
subparagraph (A) directly to the multi-State 
qualified health plan in which such individual is 
enrolled; 
to defray the cost of any additional benefits described 
in paragraph (2). 
‘‘(5) APPLICATION OF CERTAIN STATE RATING 
REQUIREMENTS.—With respect to a multi-State 
qualified health plan that is offered in a State with 
age rating requirements that are lower than 3:1, the 
State may require that Exchanges operating in such 
State only permit the offering of such multi-State 
qualified health plans if such plans comply with the 
State’s more protective age rating requirements. 
‘‘(d) PLANS DEEMED TO BE CERTIFIED.—A multi- 
State qualified health plan that is offered under a contract 
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under subsection (a) shall be deemed to be certified by an 
Exchange for purposes of section 1311(d)(4)(A). 
‘‘(e) PHASE-IN.—Notwithstanding paragraphs (1) and 
(2) of subsection (b), the Director shall enter into a contract 
with a health insurance issuer for the offering of a multi- 
State qualified health plan under subsection (a) if— 
‘‘(1) with respect to the first year for which the 
issuer offers such plan, such issuer offers the plan in 
at least 60 percent of the States; 
‘‘(2) with respect to the second such year, such 
issuer offers the plan in at least 70 percent of the 
States; 
‘‘(3) with respect to the third such year, such 
issuer offers the plan in at least 85 percent of the 
States; and 
‘‘(4) with respect to each subsequent year, such 
issuer offers the plan in all States. 
‘‘(f) APPLICABILITY.—The requirements under chapter 
89 of title 5, United States Code, applicable to health bene-
fits plans under such chapter shall apply to multi-State 
qualified health plans provided for under this section to the 
extent that such requirements do not conflict with a provi-
sion of this title. 
‘‘(g) CONTINUED SUPPORT FOR FEHBP.— 
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‘‘(1) MAINTENANCE
OF
EFFORT.—Nothing in 
this section shall be construed to permit the Director 
to allocate fewer financial or personnel resources to 
the functions of the Office of Personnel Management 
related to the administration of the Federal Employ-
ees Health Benefit Program under chapter 89 of title 
5, United States Code. 
‘‘(2) SEPARATE RISK POOL.—Enrollees in multi- 
State qualified health plans under this section shall 
be treated as a separate risk pool apart from enrollees 
in the Federal Employees Health Benefit Program 
under chapter 89 of title 5, United States Code. 
‘‘(3) AUTHORITY TO ESTABLISH SEPARATE ENTI-
TIES.—The Director may establish such separate 
units or offices within the Office of Personnel Man-
agement as the Director determines to be appropriate 
to ensure that the administration of multi-State 
qualified health plans under this section does not 
interfere with the effective administration of the Fed-
eral Employees Health Benefit Program under chap-
ter 89 of title 5, United States Code. 
‘‘(4) EFFECTIVE OVERSIGHT.—The Director may 
appoint such additional personnel as may be nec-
essary to enable the Director to carry out activities 
under this section. 
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‘‘(5) ASSURANCE OF SEPARATE PROGRAM.—In 
carrying out this section, the Director shall ensure 
that the program under this section is separate from 
the Federal Employees Health Benefit Program under 
chapter 89 of title 5, United States Code. Premiums 
paid for coverage under a multi-State qualified health 
plan under this section shall not be considered to be 
Federal funds for any purposes. 
‘‘(6) FEHBP PLANS NOT REQUIRED TO PARTICI-
PATE.—Nothing in this section shall require that a 
carrier offering coverage under the Federal Employees 
Health Benefit Program under chapter 89 of title 5, 
United States Code, also offer a multi-State qualified 
health plan under this section. 
‘‘(h) ADVISORY BOARD.—The Director shall establish 
an advisory board to provide recommendations on the ac-
tivities described in this section. A significant percentage 
of the members of such board shall be comprised of enrollees 
in a multi-State qualified health plan, or representatives 
of such enrollees. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated, such sums as may be nec-
essary to carry out this section.’’. 
(r) Section 1341 of this Act is amended— 
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(1) in the section heading, by striking ‘‘AND 
SMALL GROUP MARKETS’’ and inserting ‘‘MAR-
KET’’; 
(2) in subsection (b)(2)(B), by striking ‘‘para-
graph (1)(A)’’ and inserting ‘‘paragraph (1)(B)’’; and 
(3) in subsection (c)(1)(A), by striking ‘‘and 
small group markets’’ and inserting ‘‘market’’. 
SEC. 10105. AMENDMENTS TO SUBTITLE E. 
(a) Section 36B(b)(3)(A)(ii) of the Internal Revenue 
Code of 1986, as added by section 1401(a) of this Act, is 
amended by striking ‘‘is in excess of’’ and inserting ‘‘equals 
or exceeds’’. 
(b) Section 36B(c)(1)(A) of the Internal Revenue Code 
of 1986, as added by section 1401(a) of this Act, is amended 
by inserting ‘‘equals or’’ before ‘‘exceeds’’. 
(c) Section 36B(c)(2)(C)(iv) of the Internal Revenue 
Code of 1986, as added by section 1401(a) of this Act, is 
amended by striking ‘‘subsection (b)(3)(A)(ii)’’ and insert-
ing ‘‘subsection (b)(3)(A)(iii)’’. 
(d) Section 1401(d) of this Act is amended by adding 
at the end the following: 
‘‘(3) Section 6211(b)(4)(A) of the Internal Rev-
enue Code of 1986 is amended by inserting ‘36B,’ 
after ‘36A,’.’’. 
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(e)(1) Subparagraph (B) of section 45R(d)(3) of the 
Internal Revenue Code of 1986, as added by section 1421(a) 
of this Act, is amended to read as follows: 
‘‘(B) DOLLAR
AMOUNT.—For purposes of 
paragraph (1)(B) and subsection (c)(2)— 
‘‘(i) 2010, 2011, 2012, AND 2013.—The 
dollar amount in effect under this para-
graph for taxable years beginning in 2010, 
2011, 2012, or 2013 is $25,000. 
‘‘(ii) SUBSEQUENT
YEARS.—In the 
case of a taxable year beginning in a cal-
endar year after 2013, the dollar amount in 
effect under this paragraph shall be equal to 
$25,000, multiplied by the cost-of-living ad-
justment under section 1(f)(3) for the cal-
endar year, determined by substituting ‘cal-
endar year 2012’ for ‘calendar year 1992’ 
in subparagraph (B) thereof.’’. 
(2) Subsection (g) of section 45R of the Internal Rev-
enue Code of 1986, as added by section 1421(a) of this Act, 
is amended by striking ‘‘2011’’ both places it appears and 
inserting ‘‘2010, 2011’’. 
(3) Section 280C(h) of the Internal Revenue Code of 
1986, as added by section 1421(d)(1) of this Act, is amended 
by striking ‘‘2011’’ and inserting ‘‘2010, 2011’’. 
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(4) Section 1421(f) of this Act is amended by striking 
‘‘2010’’ both places it appears and inserting ‘‘2009’’. 
(5) The amendments made by this subsection shall take 
effect as if included in the enactment of section 1421 of this 
Act. 
(f) Part I of subtitle E of title I of this Act is amended 
by adding at the end of subpart B, the following: 
‘‘SEC. 1416. STUDY OF GEOGRAPHIC VARIATION IN APPLICA-
TION OF FPL. 
‘‘(a) IN GENERAL.—The Secretary shall conduct a 
study to examine the feasibility and implication of adjust-
ing the application of the Federal poverty level under this 
subtitle (and the amendments made by this subtitle) for dif-
ferent geographic areas so as to reflect the variations in 
cost-of-living among different areas within the United 
States. If the Secretary determines that an adjustment is 
feasible, the study should include a methodology to make 
such an adjustment. Not later than January 1, 2013, the 
Secretary shall submit to Congress a report on such study 
and shall include such recommendations as the Secretary 
determines appropriate. 
‘‘(b) INCLUSION OF TERRITORIES.— 
‘‘(1) IN GENERAL.—The Secretary shall ensure 
that the study under subsection (a) covers the terri-
tories of the United States and that special attention 
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