I 
115TH CONGRESS 
1ST SESSION H. R. 4666 
To amend the Public Health Service Act to provide for a Patient and State 
Stability Fund. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 18, 2017 
Mr. COSTELLO of Pennsylvania introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to provide for 
a Patient and State Stability Fund. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Premium Relief Act 
of 2017’’. 
SEC. 2. PATIENT AND STATE STABILITY. 
(a) PATIENT AND STATE STABILITY FUND.—The 
Public Health Service Act (42 U.S.C. 201 et seq.) is 
amended by adding at the end the following new title: 
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‘‘TITLE XXXIV—PATIENT AND 
STATE STABILITY FUND 
‘‘SEC. 3401. ESTABLISHMENT OF PROGRAM. 
‘‘There is hereby established the ‘Patient and State 
Stability Fund’ to be administered by the Secretary, act-
ing through the Administrator of the Centers for Medicare 
& Medicaid Services (in this title referred to as the ‘Ad-
ministrator’), to provide health benefits coverage funding, 
in accordance with this title, to the 50 States and the Dis-
trict of Columbia (each referred to in this section as a 
‘State’) during the period, subject to section 3404(c), be-
ginning on January 1, 2019, and ending on December 31, 
2021, for the purposes described in section 3402. 
‘‘SEC. 3402. USE OF FUNDS. 
‘‘A State may use the funds allocated to the State 
under this title for any of the following purposes: 
‘‘(1) Helping, through the provision of financial 
assistance, high-risk individuals who do not have ac-
cess to health insurance coverage offered through an 
employer enroll in health insurance coverage in the 
individual market in the State, as such market is de-
fined by the State (whether through the establish-
ment of a new mechanism or maintenance of an ex-
isting mechanism for such purpose). 
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‘‘(2) Providing incentives to appropriate entities 
to enter into arrangements with the State to help 
stabilize premiums for health insurance coverage in 
the individual market, as such markets are defined 
by the State. 
‘‘(3) Reducing the cost for providing health in-
surance coverage in the individual market and small 
group market, as such markets are defined by the 
State, to individuals who have, or are projected to 
have, a high rate of utilization of health services (as 
measured by cost) and to individuals who have high 
costs of health insurance coverage due to the low 
density population of the State in which they reside. 
‘‘(4) Promoting participation in the individual 
market and small group market in the State and in-
creasing health insurance options available through 
such market. 
‘‘(5) Promoting access to preventive services; 
dental care services (whether preventive or medically 
necessary); vision care services (whether preventive 
or medically necessary); or any combination of such 
services. 
‘‘(6) Maternity coverage and newborn care. 
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‘‘(7) Prevention, treatment, or recovery support 
services for individuals with mental or substance use 
disorders, focused on either or both of the following: 
‘‘(A) Direct inpatient or outpatient clinical 
care for treatment of addiction and mental ill-
ness. 
‘‘(B) Early identification and intervention 
for children and young adults with serious men-
tal illness. 
‘‘(8) Providing payments, directly or indirectly, 
to health care providers for the provision of such 
health care services as are specified by the Adminis-
trator. 
‘‘(9) Providing assistance to reduce out-of-pock-
et costs, such as copayments, coinsurance, pre-
miums, and deductibles, of individuals enrolled in 
health insurance coverage in the State. 
‘‘SEC. 3403. STATE ELIGIBILITY AND APPROVAL; DEFAULT 
SAFEGUARD. 
‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA-
TIONS.— 
‘‘(1) IN GENERAL.—To be eligible for an alloca-
tion of funds under this title for a year during the 
period described in section 3401 for use for one or 
more purposes described in section 3402, a State 
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shall submit to the Administrator an application at 
such time (but not later than March 31 of the pre-
vious year) and in such form and manner as speci-
fied by the Administrator and containing— 
‘‘(A) a description of how the funds will be 
used for such purposes; and 
‘‘(B) such other information as the Admin-
istrator may require. 
‘‘(2) AUTOMATIC APPROVAL.—An application so 
submitted is approved unless the Administrator noti-
fies the State submitting the application, not later 
than 60 days after the date of the submission of 
such application, that the application has been de-
nied for not being in compliance with any require-
ment of this title and of the reason for such denial. 
‘‘(3) ONE-TIME APPLICATION.—If an applica-
tion of a State is approved for a year, with respect 
to a purpose described in section 3402, such applica-
tion shall be treated as approved, with respect to 
such purpose, for each subsequent year through 
2021. 
‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 
‘‘(1) IN GENERAL.—In the case of a State that 
does not have in effect an approved application 
under this section for 2019, 2020, or 2021, the Ad-
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ministrator, in consultation with the State insurance 
commissioner, shall use the allocation that would 
otherwise be provided to the State under this title 
for such year, in accordance with paragraph (2), for 
such State. 
‘‘(2) REQUIRED USE FOR MARKET STABILIZA-
TION
PAYMENTS
TO
ISSUERS.—Subject to section 
3404(a), an allocation for a State made pursuant to 
paragraph (1) for a year shall be used to carry out 
the purpose described in section 3402(2) in such 
State by providing payments to appropriate entities 
described in such section with respect to claims that 
exceed $50,000 (or, with respect to allocations made 
under this title for 2020 or a subsequent year dur-
ing the period specified in section 3401, such dollar 
amount specified by the Administrator), but do not 
exceed $350,000 (or, with respect to allocations 
made under this title for 2020 or a subsequent year 
during such period, such dollar amount specified by 
the Administrator), in an amount equal to 75 per-
cent (or, with respect to allocations made under this 
title for 2020 or a subsequent year during such pe-
riod, such percentage specified by the Administrator) 
of the amount of such claims. 
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‘‘SEC. 3404. ALLOCATIONS. 
‘‘(a) APPROPRIATION.—For the purpose of providing 
allocations for States (including pursuant to section 
3403(b)) under this title there is appropriated, out of any 
money in the Treasury not otherwise appropriated— 
‘‘(1) for 2019, $10,000,000,000; 
‘‘(2) for 2020, $10,000,000,000; and 
‘‘(3) for 2021, $10,000,000,000. 
‘‘(b) ALLOCATIONS.— 
‘‘(1) PAYMENT.—From amounts appropriated 
under subsection (a) for a year (beginning with 
2019 and ending with 2021), the Administrator 
shall, with respect to a State and not later than 
January 1 of such year, allocate for such State (in-
cluding pursuant to section 3403(b)) the amount de-
termined for such State and year under paragraph 
(2). 
‘‘(2) 
ALLOCATION
AMOUNT
DETERMINA-
TIONS.—For purposes of paragraph (1), the amount 
determined under this paragraph for a year for a 
State is an amount determined in accordance with 
an allocation methodology specified by the Adminis-
trator. 
‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS YEAR’S 
REMAINING FUNDS.—In carrying out subsection (b), the 
Administrator shall, with respect to a year (beginning with 
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2020 and ending with 2022), not later than March 31 of 
such year— 
‘‘(1) determine the amount of funds, if any, 
from the amounts appropriated under subsection (a) 
for the previous year but not allocated for such pre-
vious year; and 
‘‘(2) if the Administrator determines that any 
funds were not so allocated for such previous year, 
allocate such remaining funds, in accordance with 
the allocation methodology specified pursuant to 
subsection (b)(2)— 
‘‘(A) to States that have submitted an ap-
plication approved under section 3403(a) for 
such previous year for any purpose for which 
such an application was approved; and 
‘‘(B) for States for which allocations were 
made pursuant to section 3403(b) for such pre-
vious year, to be used by the Administrator for 
such States, to carry out the purpose described 
in section 3402(2) in such State by providing 
payments to appropriate entities described in 
such section 3402(2) with respect to claims that 
exceed $1,000,000, 
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with, respect to a year before 2022, any remaining 
funds being made available for allocations to States 
for the subsequent year. 
‘‘(d) AVAILABILITY.—Amounts appropriated under 
subsection (a) for a year and allocated to States in accord-
ance with this section shall remain available for expendi-
ture through December 31, 2022. 
‘‘(e) LIMITATION.—Amounts appropriated under 
subsection (a) for a year (beginning with 2019 and ending 
with 2021) are subject to the requirements and limitations 
under sections 506 and 507 of division H of Public Law 
115–31 in the same manner and to the same extent as 
if such amounts for such year were appropriated under 
such division.’’. 
(b) COST-SHARING REDUCTION PAYMENTS.—Section 
1402 of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18071) is amended by adding at the end the 
following new subsection: 
‘‘(g) FUNDING.— 
‘‘(1) APPROPRIATIONS.—There is appropriated, 
from any money in the Treasury not otherwise ap-
propriated, such sums as may be necessary to, sub-
ject to paragraph (2), provide health benefits cov-
erage through payment to issuers (under this section 
or through advance payment by the Secretary of the 
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Treasury under section 1412(c)(3)) of the amounts 
computed under this section for the last quarter of 
plan year 2017 and each of plan years 2019 and 
2020. 
‘‘(2) 
ADJUSTMENTS.—Notwithstanding 
any 
other provision of law, payments and other actions 
for adjustments to obligations incurred prior to De-
cember 31, 2020, may be made through December 
31, 2021. 
‘‘(3) 
LIMITATION.—Amounts 
appropriated 
under paragraph (1) for the last quarter of plan 
year 2017 and each of plan years 2019 and 2020 
are subject to the requirements and limitations 
under sections 506 and 507 of division H of Public 
Law 115–31 in the same manner and to the same 
extent as if such amounts for such quarter and each 
such year were appropriated under such division.’’. 
Æ 
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