(A) IN GENERAL.—In the case of a State 
not described in paragraph (1) for a year, sub-
ject to paragraphs (3) and (4), the Secretary 
shall compute an average per capita annual 
amount for the State for the year equal to— 
(i) the amount specified in subpara-
graph (B) for the State and year, divided 
by 
(ii) the average monthly number of 
deposit qualifying residents of the State in 
the year. 
(B) AMOUNT BASED ON PPACA AND MED-
ICAID PROJECTED FEDERAL EXPENDITURES.— 
The amount specified in this subparagraph for 
a State for a year is equal to the sum of— 
(i) 95 percent of the Secretary’s esti-
mate of the total payments that would 
have been made (assuming the existence of 
a State-established Exchange in the State) 
under section 36B of the Internal Revenue 
Code of 1986 and under section 1402 of 
PPACA with respect to all qualified resi-
dents in the year (or taxable year ending 
with such year, if applicable); and 
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(ii) the Secretary’s estimate of the 
total payments that would have been made 
to the State under title XIX of the Social 
Security Act for individuals eligible to be 
covered 
under 
section 
1902(a)(10)(A)(i)(VIII) of the Social Secu-
rity Act assuming the election of a State to 
provide Medicaid coverage under such sec-
tion and assuming the applicable Federal 
medical assistance percentage were 95 per-
cent with respect to such individuals. 
(3) BUDGET NEUTRAL ADJUSTMENT IN PAY-
MENTS TO TAKE INTO ACCOUNT ELECTION OF HIGH-
ER DEPOSITS TO MAINTAIN ACA SUBSIDY LEVELS.— 
If a State makes the election described in subsection 
(a)(3) with respect to providing higher deposit 
amounts for certain individuals described in such 
subsection, then the Secretary shall adjust the aver-
age per capita annual amount under paragraph (1) 
or (2), as applicable to the State, by— 
(A) reducing the amount described in 
paragraph (1)(B) (or, if applicable, paragraph 
(2)(B)(i)) by an amount equal to 95 percent of 
the aggregate increased deposit level attrib-
utable to subsection (a)(3); and 
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(B) not counting such an individual as a 
qualifying resident for purposes of paragraph 
(1)(A)(ii) 
(or, 
if 
applicable, 
paragraph 
(2)(A)(ii)). 
(4) ADJUSTMENT FOR COSTS OF PARTIAL DE-
POSITS
FOR
LOW-INCOME
ESI
INDIVIDUALS.—The 
Secretary shall adjust the average per capita annual 
amount under paragraph (1) or (2), as applicable to 
the State, by— 
(A) reducing the amount described in 
paragraph (1)(B) (or, if applicable, paragraph 
(2)(B)(i)) by an amount equal to 95 percent of 
the amount of payments under this section that 
are attributable to individuals described in sub-
section (a)(4); and 
(B) not counting any individual described 
in subsection (a)(4) as a qualifying resident for 
purposes of paragraph (1)(A)(ii) (or, if applica-
ble, paragraph (2)(A)(ii)). 
(c) ADJUSTMENT FOR AGE, GEOGRAPHIC AREA, AND 
INCOME DISTRIBUTION WITHIN STATE.— 
(1) IN GENERAL.—The Secretary shall apply 
such adjustments to the per capita amount com-
puted under subsection (b) as is designed to take 
into account, in a budget neutral manner and based 
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on the costs estimated under paragraph (2), actu-
arial differences in health care costs attributable to 
individuals in different age categories and different 
geographic locations of primary residences in the 
State and the reductions based on income under 
subsection (d). No such adjustment shall be made 
based on sex. 
(2) DATA ON AVERAGE COSTS OF SERVICES.— 
Not later than December 15 before the beginning of 
each year, the Agency for Healthcare Research and 
Quality shall estimate the average cost of health 
care for such year for individuals under 65 years of 
age and may estimate how such average varies for 
different populations of individuals under age 65. 
The adjustments under paragraph (1) for age cat-
egories for a year shall be based on such estimates 
made. Not later than such date, the Secretary shall 
prescribe tables for purposes of making adjustments 
based on age under paragraph (1) based on such de-
termination which shall apply for taxable years be-
ginning in the succeeding calendar year. 
(d) INCOME-RELATED PHASE-OUT.— 
(1) IN GENERAL.—The per capita amount as 
computed under subsection (b) and adjusted and ap-
plied to a deposit qualifying individual under sub-
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section (c) shall be multiplied by a phase-out per-
centage equal to 100 percent reduced by 1 percent-
age point for each $1,000 (or fraction thereof) by 
which the taxpayer’s modified adjusted gross income 
for the taxable year exceeds $90,000 (or, in the case 
of a joint return, $150,000), multiplied, for a tax-
able year ending in a year beginning after December 
31, 2015, by the cost-of-living adjustment for the 
year as described in section 1(f)(3) of the Internal 
Revenue Code of 1986, but substituting ‘‘2015’’ for 
‘‘1992’’ in subparagraph (B) of such section. 
(2) ZERO PER CAPITA AMOUNT FOR MARRIED 
FILING SEPARATELY.—The per capita amount under 
this section shall be zero in the case of a married 
couple filing separately. 
SEC. 104. STATE OPTIONS FOR IMPROVED ACCESS TO 
HEALTH INSURANCE COVERAGE IN EACH 
STATE. 
(a) STATE OPTIONS TO IMPROVE ACCESS.— 
(1) IN GENERAL.—Each State may carry out 
any of the functions described in succeeding sub-
sections in order to improve the access of residents 
of the State to health insurance coverage. 
(2) 
REPURPOSING
STATE
EXCHANGES.—A 
State may use or adapt an Exchange that the State 
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has established under title I of PPACA to carry out 
the any of such functions. 
(3) REPURPOSING FEDERAL EXCHANGE.—The 
Federal Government shall make available to States 
current capabilities of the Federal Exchange, includ-
ing the Federal Data Services Hub and Agent 
Broker Portal, to the extent requested by a State for 
activities related to enrollment of citizens of the 
State into health insurance coverage. 
(b) TRANSPARENCY PORTAL.—Each State may es-
tablish and operate an open and transparent marketplace 
mechanism whereby qualified residents of the State can 
readily compare, through the use of the Internet, the bene-
fits and prices between different health insurance coverage 
options made available to them. 
(c) ENROLLMENT, SUBJECT TO INDIVIDUAL OPT- 
OUT.— 
(1) IN GENERAL.—Subject to paragraph (2), a 
State may provide for the enrollment of qualified 
residents of the State who are uninsured in default 
health insurance coverage offered under section 
105(c) and establishing an HSA for such residents 
who do not have an HSA unless the resident has af-
firmatively elected not to be so enrolled and not to 
have an HSA, respectively. Any such enrollment 
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under this paragraph shall be coordinated with the 
annual open enrollment periods provided under sec-
tion 105(b). 
(2) SIMPLE PROCESS FOR INDIVIDUALS TO OPT- 
OUT.—As a condition of a State providing for the 
enrollment function described in paragraph (1), the 
State must establish an easy-to-use and transparent 
means by which individuals may elect not to be en-
rolled in default health insurance coverage or to 
have an HSA established on the individual’s behalf, 
or both. 
(d) RISK MITIGATION MECHANISMS AND REINSUR-
ANCE AND RISK-CORRIDOR PROGRAMS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of this title or section 223(c)(2) of the In-
ternal Revenue Code of 1986, a State may estab-
lish— 
(A) mechanisms for risk mitigation or risk 
adjustment in order to limit volatility in the 
premiums based on health experience to class- 
average premiums; and 
(B) a reinsurance and risk-corridor pro-
gram that involves no Federal funds with re-
spect to coverage both in the individual market 
and in the small group market. 
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(2) BASIS
FOR
RISK
ADJUSTMENT.—Mecha-
nisms and programs under paragraph (1) may be 
based on the health status score of each individual 
enrolled in health insurance coverage in the indi-
vidual market and not solely based on the aggregate 
risk of the risk pool with respect to each plan of 
health insurance coverage. 
SEC. 105. EXPANDED ACCESS AND PATIENT PROTECTIONS. 
(a) IN GENERAL.—As a condition for the election of 
the alternative option under section 102 in a State, the 
State must meet the requirements of this section. 
(b) ANNUAL AND OTHER OPEN ENROLLMENT PERI-
ODS.— 
(1) IN GENERAL.—The State shall require, in 
connection with the offering of health insurance cov-
erage in the individual market in the State, that 
there are uniform annual and other open enrollment 
periods (such as those for changes in life events, 
changes in State residency, and involuntary changes 
in eligibility for coverage under a group health plan) 
in order to permit qualified residents to enroll in 
qualified health plan coverage in a manner that pro-
motes continuity of coverage. Such periods shall be 
consistent with the open enrollment periods estab-
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lished under title I of PPACA, as in effect before the 
date of the enactment of this Act. 
(2) INITIAL OPEN ENROLLMENT PERIOD.—In 
addition, the State shall establish an initial open en-
rollment period during which qualified residents may 
enroll in qualified health plan coverage without the 
imposition of any underwriting described in sub-
section (d)(1)(B). Such period shall be a period of 
not less than 45 days and shall provide for enroll-
ment to become effective on January 1 of the year 
specified by the State in which such State election 
first becomes effective. 
(c) OFFERING OF DEFAULT HEALTH INSURANCE 
COVERAGE.— 
(1) IN GENERAL.—The State shall provide for 
the offering, through one or more contracts with one 
or more health insurance issuers in the State, of de-
fault health insurance coverage (as defined in para-
graph (2)) to qualified residents of the State who 
are otherwise uninsured. Such default coverage shall 
be made available on a continuous basis during a 
year. Failure of a qualified resident to enroll in such 
default coverage or other creditable coverage during 
a year results in adverse consequences described in 
subsection (d)(1)(B) to the resident. 
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(2) DEFAULT HEALTH INSURANCE PLAN DE-
FINED.—In this title, the term ‘‘default health in-
surance plan’’ means, with respect to a State, health 
insurance coverage that— 
(A) is a high deductible health plan (within 
the meaning of section 223(c)(2) of the Internal 
Revenue Code of 1986) with prescription drug 
coverage limited to generic drugs for a limited 
number of chronic conditions (commonly re-
ferred to as tier I pharmacy benefit); 
(B) meets such requirements as may apply 
to qualify for the payment of plan premiums 
from a health savings account under section 
223 of such Code (such as age-related pre-
miums and limitation on imposition of pre-
existing condition exclusions); 
(C) has a provider network for covered 
benefits that is adequate (as determined con-
sistent with guidelines issued by the Secretary) 
to ensure access to health benefits under such 
plan; 
(D) provides for coverage of childhood im-
munizations without cost sharing requirements 
to the extent such immunizations have in effect 
a recommendation from the Advisory Com-
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mittee on Immunization Practices of the Cen-
ters for Disease Control and Prevention with 
respect to the individual involved; and 
(E) meets such other requirements as the 
State may specify. 
(d) CONSEQUENCES RESPECTING CONTINUOUS COV-
ERAGE.— 
(1) CONSEQUENCES
FOR
NOT
MAINTAINING 
CONTINUOUS COVERAGE.— 
(A) AVOIDANCE
OF
CONSEQUENCES
BY 
MAINTAINING
CONTINUOUS
COVERAGE.—All 
qualified residents of a State are eligible during 
the initial open enrollment period provided 
under subsection (b)(2) to enroll in qualified 
health plan coverage and, thereafter, to main-
tain continuous coverage in order to avoid the 
adverse consequences described in the suc-
ceeding provisions of this paragraph. 
(B) UNDERWRITING PERMITTED.—In the 
case of a qualified resident of the State who 
fails to maintain continuous creditable coverage 
(not including any breaks in coverage of less 
than 63 days), the State shall— 
(i) permit health insurance issuers for 
the period specified in subparagraph (C) to 
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medically underwrite (through denial of 
health insurance coverage, application of 
preexisting condition limitations, differen-
tial premiums, or otherwise) the issuance 
of health insurance coverage, other than 
with respect to the issuance of default 
health insurance coverage under subsection 
(c); and 
(ii) require health insurance issuers, 
during the subsequent 2-year period in the 
case of issuance of health insurance cov-
erage other than such default health insur-
ance coverage, to impose a monthly late 
enrollment penalty in the amount specified 
in subparagraph (D)(i) and to remit the 
amount of such penalty collected to the 
Federal Treasury in accordance with sub-
paragraph (D)(ii). 
(C) PERIOD FOR APPLICATION OF UNDER-
WRITING.—For 
purposes 
of 
subparagraph 
(B)(i), the period specified in this subparagraph 
is, with respect to an uninsured individual as of 
a date, a period (not to exceed 18 months) 
equivalent to number of months in the previous 
18-month period in which the individual did not 
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have continuous creditable coverage described in 
subparagraph (B). 
(D) MONTHLY
LATE
ENROLLMENT
PEN-
ALTY AMOUNT.— 
(i) IN
GENERAL.—The monthly late 
enrollment penalty amount specified in this 
clause for a month is equal to the lesser of 
10 percent or the product of— 
(I) 1 percent of the monthly pre-
mium amount for default health in-
surance coverage with respect to the 
individual and month; and 
(II) the number of months dur-
ing the 2-year period (preceding the 
18-month period described in subpara-
graph (B)(i)) in which the resident 
failed to maintain the continuous cov-
erage described in paragraph (1)(D). 
(ii) PAYMENT OF PENALTY AMOUNT 
TO FEDERAL TREASURY.—The amount of 
the monthly late enrollment penalty col-
lected under this subparagraph shall be 
paid to the Treasury of the United States 
in a form and manner specified by the Sec-
retary of the Treasury. 
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(2) CHANGES
IN
ENROLLMENT
PERMITTED 
WITHOUT MEDICAL UNDERWRITING DURING ANNUAL 
OPEN ENROLLMENT PERIODS FOR THOSE MAINTAIN-
ING CONTINUOUS COVERAGE.— 
(A) DURING SECOND OPEN ENROLLMENT 
PERIOD.—In the case of a qualified resident 
who maintains continuous coverage (not includ-
ing any breaks in coverage of less than 63 
days) during the period after the initial open 
enrollment period under subsection (b)(2) and 
through the second annual open enrollment pe-
riod established by the State consistent with 
subsection (b)(1), the State shall require health 
insurance issuers to permit such residents dur-
ing such second annual open enrollment period 
to change the qualified health plan coverage in 
which the individual is enrolled without medical 
underwriting. 
(B) DURING
THIRD
AND
SUBSEQUENT 
OPEN ENROLLMENT PERIODS.—In the case of a 
qualified resident who maintains continuous 
coverage for a period of 18 months or longer 
(not including any breaks in coverage of less 
than 63 days) as of the initial date of a third 
or subsequent annual open enrollment period 
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established by the State under subsection 
(b)(1), the State shall require health insurance 
issuers to permit such residents during such an 
open enrollment period to change the qualified 
health plan coverage in which the individual is 
enrolled without medical underwriting. 
SEC. 106. SUNSETTING CERTAIN ACA PROVISIONS; CON-
TINUATION 
OF 
POLICIES 
OF 
COVERING 
ADULT CHILDREN AND NOT APPLYING LIFE-
TIME OR ANNUAL LIMITS. 
(a) IN GENERAL.—Subject to subsections (b) and (c), 
title I of the Patient Protection and Affordable Care Act 
(including the amendments made by such title) shall not 
apply (and the provisions of law amended by such title 
are restored as if such title had not been enacted) in the 
case of any State that does not have in effect the election 
described in section 101(a)(1). 
(b) CONTINUATION OF POLICIES FOR EXTENSION OF 
DEPENDENT COVERAGE
FOR ADULT CHILDREN
AND 
PROHIBITION
OF LIFETIME
AND ANNUAL COVERAGE 
LIMITS.—Subsection (a) shall not apply with respect to 
the following: 
(1) Section 2711 of the Public Health Service 
Act (relating to no lifetime or annual limits). 
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(2) Section 2714 of such Act (relating to exten-
sion of dependent coverage). 
(c) CONTINUATION
OF
POLICIES
FOR
CERTAIN 
STATES OPERATING EXCHANGES.—Subsection (a) shall 
not apply with respect to health insurance coverage in a 
State that has in effect the election described in section 
101(a)(1). 
Subtitle B—Medicaid 
SEC. 111. APPLICATION OF HEALTH SAVINGS ACCOUNTS IN 
RELATION TO MEDICAID. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) is amended by adding at 
the end the following new section: 
‘‘SEC. 1947. PROVISIONS RELATING TO HEALTH SAVINGS 
ACCOUNTS. 
‘‘(a) DISREGARDING HSA IN DETERMINING ASSETS 
AND INCOME FOR MEDICAID ELIGIBILITY DETERMINA-
TIONS OTHER THAN FOR LONG-TERM CARE SERVICES.— 
The assets in a health savings account under section 223 
of the Internal Revenue Code of 1986, and any income 
from such assets in such account, shall be disregarded for 
purposes of determining eligibility and amount of medical 
assistance under this title, other than for purposes of de-
termining eligibility and the amount of medical assistance 
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for long-term care services (described in section 
1917(c)(1)(C)(i)). 
‘‘(b) NOTIFICATIONS OF TREASURY OF MEDICAID 
ELIGIBILITY.—In order to meet the requirements of this 
subsection (for purposes of section 1902(a)(78)), a State 
shall provide such notice to the Secretary of the Treasury, 
in such form and manner as such Secretary shall specify, 
as may be necessary to identify individuals who are eligible 
for, and receiving, medical assistance under this title in 
a month in order to carry out section 223 of the Internal 
Revenue Code of 1986.’’. 
(b) IMPLEMENTATION OF NOTIFICATION REQUIRE-
MENT THROUGH STATE PLAN.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a(a)) is amended by 
inserting after paragraph (77) the following new para-
graph: 
‘‘(78) provide for notice in accordance with sec-
tion 1947(b) to the Secretary of the Treasury of the 
identity of individuals who are determined eligible 
for (and receiving) medical assistance under this 
title;’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to eligibility determinations with 
respect to medical assistance for periods beginning on or 
after January 1, 2016. 
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Subtitle C—Provider Price 
Transparency 
SEC. 121. ENSURING ACCESS TO EMERGENCY SERVICES 
WITHOUT EXCESSIVE CHARGES FOR OUT-OF- 
NETWORK SERVICES. 
(a) IN GENERAL.—Section 1867 of the Social Secu-
rity Act (42 U.S.C. 1395dd) is amended— 
(1) in subsection (d), by adding at the end the 
following new paragraph: 
‘‘(5) ENFORCEMENT WITH RESPECT TO EXCES-
SIVE CHARGES.—A hospital, physician, or other enti-
ty that violates the requirements of subsection (j)(1) 
with respect to the furnishing of items and services 
is subject to a civil money penalty of not more than 
$25,000 for each such violation. The provisions of 
section 1128A (other than subsections (a) and (b)) 
shall apply to a civil money penalty under this para-
graph in the same manner as such provisions apply 
with respect to a penalty or proceeding under section 
1128A(a).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(j) PROTECTIONS AGAINST EXCESSIVE OUT-OF- 
NETWORK CHARGES FOR EMERGENCY SERVICES.— 
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‘‘(1) IN
GENERAL.—If items or services to 
screen or treat an emergency medical condition are 
furnished under this section in a participating hos-
pital with respect to an individual and the individual 
has not, directly or through a health insurance 
issuer, group health plan, or other third party, nego-
tiated a payment rate for such items and services, 
subject to paragraph (2), the charges imposed for 
such items and services may not be in excess of the 
following: 
‘‘(A) PHYSICIANS’ AND
OTHER
PROFES-
SIONAL SERVICES.—For physicians’ services or 
services of a health care provider to which sec-
tion 223(e)(9) of the Internal Revenue Code of 
1986 
applies 
(and 
including 
drugs 
and 
biologicals furnished in conjunction with and 
billed as part of such services), the lesser of— 
‘‘(i) the cash price for such services 
posted pursuant to such section; or 
‘‘(ii) 85 percent of the usual, cus-
tomary, and reasonable (UCR) charge for 
such services, as determined under rules 
established by the department of insurance 
for the State in which the services are fur-
nished. 
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‘‘(B) HOSPITAL SERVICES.—For inpatient 
and outpatient hospital services for which pay-
ment rates are established under this title (and 
including drugs and biologicals furnished in 
conjunction with and billed as part of such 
services), the lesser of— 
‘‘(i) the cash price for such services 
posted pursuant to section 223(e)(9) of the 
Internal Revenue Code of 1986; or 
‘‘(ii) 110 percent of the payment rate 
applicable to such services in the case of 
an individual entitled to benefits under 
part A and enrolled under part B. 
‘‘(C) 
DRUGS
AND
BIOLOGICALS.—For 
drugs and other pharmaceuticals furnished to 
which a previous subparagraph does not apply, 
the lesser of— 
‘‘(i) twice the acquisition cost to the 
hospital or other provider for the dose in-
volved; or 
‘‘(ii) the acquisition cost to the hos-
pital or other provider plus $250. 
The dollar amount in clause (ii) shall be in-
creased from year to year (beginning with the 
year after the first year in which this subsection 
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applies) by the same percentage as the percent-
age increase in the consumer price index for all 
urban consumers (all items; U.S. city average) 
for the year involved (as determined by the Sec-
retary). Any such dollar amount as so increased 
that is not a multiple of $5 shall be rounded to 
the nearest multiple of $5 (or, if a multiple of 
$2.50, to the next highest multiple of $5). 
‘‘(D) OTHER ITEMS AND SERVICES.—For 
any other items or services, the lesser of— 
‘‘(i) the cash price for such items and 
services 
posted 
pursuant 
to 
section 
223(e)(9) of the Internal Revenue Code of 
1986; or 
‘‘(ii) 110 percent of the payment basis 
that would be applicable to payment for 
such items and services under this title in 
the case of an individual entitled to bene-
fits under part A and enrolled under part 
B. 
‘‘(2) SPECIAL RULE FOR ITEMS AND SERVICES 
FURNISHED AS A BUNDLE.—In the case of items 
and services for which there is a single price for a 
group or bundle of such items and services, the max-
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imum charge permitted under paragraph (1) may 
not exceed the lesser of— 
‘‘(A) the price charged for such bundled 
services; or 
‘‘(B) the aggregate of the maximum 
charges permitted under paragraph (1) with re-
spect to items and services included in such 
bundle.’’. 
(b) REFERENCE
TO PRICE DISCLOSURE PROVI-
SION.—For requirements relating to the posting of health 
care prices on the Internet, see section 223(e)(9) of the 
Internal Revenue Code of 1986, as added by section 
204(a). 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to charges imposed for items and 
services furnished on or after January 1, 2016. 
TITLE II—REFORM OF TAX PRO-
VISIONS 
RELATING 
TO 
HEALTH CARE 
Subtitle A—Promotion of Health 
Savings Accounts 
SEC. 201. REPEAL OF HIGH DEDUCTIBLE HEALTH PLAN RE-
QUIREMENT. 
(a) IN GENERAL.—Section 223(a) of the Internal 
Revenue Code of 1986 is amended to read as follows: 
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‘‘(a) DEDUCTION ALLOWED.—In the case of an indi-
vidual, there shall be allowed as a deduction for a taxable 
year an amount equal to the aggregate amount paid in 
cash during such taxable year by or on behalf of such indi-
vidual to a health savings account of such individual.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 223(b)(1) of such Code is amended 
by striking ‘‘that the individual is an eligible indi-
vidual’’. 
(2) Section 223(b)(2) of such Code is amended 
by striking ‘‘under a high deductible health plan’’ 
each place it appears. 
(3) Section 223(b) of such Code is amended by 
striking paragraph (8). 
(4) Section 223 of such Code is amended by 
striking subsection (c) and redesignating subsections 
(d) through (h) as subsections (c) through (g), re-
spectively. 
(5) Section 223(c)(1)(A) of such Code, as re-
designated by this Act, is amended by striking ‘‘sub-
section (f)(5)’’ and inserting ‘‘subsection (e)(5)’’. 
(6) Section 223(f)(1) of such Code, as redesig-
nated by this Act, is amended— 
(A) by striking ‘‘subsections (b)(2) and 
(c)(2)(A)’’ and inserting ‘‘subsection (b)(2)’’, 
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(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply with respect to interests acquired 
after the date of the enactment of this Act. 
SEC. 203. PURCHASE OF HEALTH INSURANCE FROM HSA 
ACCOUNT. 
(a) IN GENERAL.—Section 223(c)(2) of the Internal 
Revenue Code of 1986, as redesignated by section 
201(c)(3), is amended— 
(1) in subparagraph (C)— 
(A) by striking ‘‘or’’ at the end of clause 
(iii), 
(B) by striking the period at the end of 
clause (iv) and inserting ‘‘, and’’, and 
(C) by adding at the end the following new 
clause: 
‘‘(v) in the case of health insurance 
that meets the requirements of subpara-
graph (D).’’; and 
(2) by adding at the end the following new sub-
paragraphs: 
‘‘(D) REQUIREMENTS.—The requirements 
of this subparagraph are as follows: 
‘‘(i) OPEN
ENROLLMENT
WITHOUT 
PREEXISTING
CONDITION
EXCLUSIONS.— 
The health insurance coverage or group 
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health plan must permit, during uniform 
initial and annual open enrollment periods 
and for special enrollment periods (such as 
the loss of coverage through the loss of 
employment) specified in carrying out sec-
tion 105(b) of the Patient Freedom Act of 
2015, any individual who has period of 
continuous coverage of not less than 18 
months who is otherwise eligible to enroll 
under such coverage or plan to be so en-
rolled without the imposition of any pre-
existing condition exclusion (as defined for 
purposes of title XXVII of the Public 
Health Service Act). 
‘‘(ii) CLASS
BASED
PREMIUMS
FOR 
BASIC BENEFITS.— 
‘‘(I) IN GENERAL.—The premium 
for such coverage or plan shall be es-
tablished based on class-average sta-
tus and may vary by age and geo-
graphic area, but may not vary based 
upon the health status of the indi-
vidual, except that in the case of an 
individual without continuous cov-
erage for a period of 42 months, such 
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premium may be increased above the 
class-average in the manner and for 
the time period specified in section 
105(d)(1)(A)(ii) of the Patient Free-
dom Act of 2015. 
‘‘(II) ESTABLISHMENT OF ACTU-
ARIAL TABLES.—In carrying out sub-
clause (I), the Secretary shall enter 
into a contract with a qualified orga-
nization, such as the Academy of Ac-
tuaries, for the development of actu-
arial tables to calculate class-average 
rates based on age and geography. 
‘‘(E) CONTINUOUS COVERAGE.—For pur-
poses of this paragraph, an individual shall be 
considered to have continuous coverage as of a 
time if the individual has no continuous period 
in which the individual is uninsured (as defined 
in section 100 of the Patient Freedom Act of 
2015) for longer than 63 days beginning after 
the date of the enactment of such Act.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2015. 
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SEC. 204. PUBLISHING OF CASH PRICE FOR CARE PAID 
THROUGH HEALTH SAVINGS ACCOUNTS. 
(a) IN GENERAL.—Section 223(e) of the Internal 
Revenue Code of 1986, as redesignated by section 
201(c)(3), is amended by adding at the end the following 
new paragraph: 
‘‘(9) CASH
PRICE
TRANSPARENCY
REQUIRED 
FOR PAYMENTS TO HEALTH CARE PROVIDERS.— 
‘‘(A) IN GENERAL.—A payment to a health 
care provider with respect to the furnishing of 
health care items and services by such provider 
shall not be treated as a qualified medical ex-
pense unless the health care provider provides 
for continuing disclosure (such as through post-
ing on a publicly accessible website) of the cash 
price the health care provider charges for the 
furnishing of such items and services. 
‘‘(B) FORM OF DISCLOSURE.—The disclo-
sure of prices under this subsection shall be in 
a form and manner specified by the Secretary 
of Health and Human Services, in consultation 
with the Secretary, and shall be designed— 
‘‘(i) to establish a single price for re-
lated items and services in a manner simi-
lar to the manner in which pricing and 
payment for such items and services is pro-
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vided under the Medicare program under 
title XVIII of the Social Security Act, and 
‘‘(ii) to make it easy for consumers to 
compare the prices for similar items and 
services furnished by different providers. 
‘‘(C) FAILURE TO FURNISH SERVICES OR 
CHARGE
IN
EXCESS
OF
STATED
PRICE.—A 
health care provider shall be treated as not 
meeting the requirement of subparagraph (A), 
in the case of items and services for which the 
provider is disclosing a cash price, if the pro-
vider— 
‘‘(i) refuses to furnish such items or 
services at the price listed, or 
‘‘(ii) charges more than the price list-
ed for the furnishing of the items and serv-
ices.’’. 
(b) ENFORCEMENT.—If the Secretary of Health and 
Human Services determines that a health care provider 
has not provided for continuing disclosure of the cash 
price of health care provider charges under section 
223(e)(9) of the Internal Revenue Code of 1986, the Sec-
retary may instruct the Secretary of the Treasury that 
payments made to such provider shall be not treated, for 
purposes of section 223 of the Internal Revenue Code of 
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1986, as an amount used for a qualified medical expense 
for a period of not to exceed 1 year. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2015. 
Subtitle B—Health Care Tax 
Credits 
SEC. 211. LIMITED APPLICATION OF PPACA HEALTH PRE-
MIUM CREDIT. 
(a) IN GENERAL.—Section 36B(c)(1) of the Internal 
Revenue Code of 1986 is amended by adding at the end 
the following: 
‘‘(E) SPECIAL RULE FOR RESIDENTS OF 
STATES
CONTINUING
PPACA
IMPLEMENTA-
TION.—No credit shall be allowed under this 
section to any individual who is not a qualified 
resident (as defined in section 100(14) of the 
Patient Freedom Act of 2015) of a State that 
has elected the option under section 101(a)(1) 
of such Act in relation to the implementation of 
title I of the Patient Protection and Affordable 
Care Act.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
December 31, 2015. 
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(b) CLERICAL AMENDMENT.—The table of sections 
for such subpart is amended by adding at the end the fol-
lowing: 
‘‘Sec. 36C. HSA credit.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2015. 
Æ 
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