I 
114TH CONGRESS 
1ST SESSION H. R. 2635 
To amend titles XVIII and XIX of the Social Security Act to make improve-
ments to the treatment of the United States territories under the Medi-
care and Medicaid programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 3, 2015 
Mr. PIERLUISI
(for himself, Ms. BORDALLO, Mr. SABLAN, and Ms. 
PLASKETT) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to make improvements to the treatment of the United 
States territories under the Medicare and Medicaid pro-
grams, and for other purposes. 
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 
‘‘Improving the Treatment of the U.S. Territories Under 
Federal Health Programs Act of 2015’’. 
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(2) by striking ‘‘American Samoa or the North-
ern Mariana Islands’’ and inserting ‘‘Puerto Rico, 
the Virgin Islands of the United States, Guam, the 
Northern Mariana Islands, or American Samoa’’; 
(3) by inserting ‘‘(1)’’ after ‘‘(j)’’; 
(4) by inserting ‘‘except as otherwise provided 
in this subsection,’’ after ‘‘Notwithstanding any 
other requirement of this title’’; and 
(5) by adding at the end the following: 
‘‘(2) The Secretary may not waive under this sub-
section the requirement of subsection (a)(10)(A)(i)(IX) 
(relating to coverage of adults formerly under foster care) 
with respect to any territory.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply beginning October 1, 2016. 
SEC. 104. APPLICATION OF 100 PERCENT FEDERAL POV-
ERTY LINE (FPL) LIMITATION TO TERRI-
TORIES. 
(a) IN GENERAL.—Section 1902(a)(10)(A)(i)(VIII) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(i)(VIII)) is amended— 
(1) by inserting ‘‘(or, subject to subsection (j), 
100 percent in the case of Puerto Rico, the Virgin 
Islands of the United States, Guam, the Northern 
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Mariana Islands, and American Samoa)’’ after ‘‘133 
percent’’; and 
(2) in subsection (j), as amended by section 
103, by adding at the end the following new para-
graph: 
‘‘(3)(A) Notwithstanding any other provision of law, 
Federal financial participation shall not be available to a 
territory for medical assistance for an individual whose 
family income exceeds 100 percent of the official poverty 
line for a family of the size involved, except in the case 
of individuals qualifying for medical assistance under sub-
section (a)(10)(A)(i)(IX) and except as authorized under 
a waiver under this subsection or section 1115. 
‘‘(B) The Secretary may, under paragraph (1) or sec-
tion 1115, waive the limitation under subparagraph (A) 
but only in the case of a territory other than Puerto Rico. 
In carrying out this subparagraph, the Secretary shall 
take into account the eligibility levels established under 
the State plan of the territory involved before the date 
of the enactment of this paragraph.’’. 
(b) NOT APPLYING 5 PERCENT DISREGARD.—Sub-
paragraph (I) of section 1902(a)(14) of the Social Secu-
rity Act (42 U.S.C. 1396b(a)(14)) is amended by adding 
at the end the following: 
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‘‘The previous sentence shall only apply to a 
State that is one of the 50 States or the Dis-
trict of Columbia.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to eligibility deter-
minations made with respect to items and services fur-
nished on or after October 1, 2016. 
SEC. 105. PERMITTING MEDICAID DSH ALLOTMENTS FOR 
TERRITORIES. 
Section 1923(f) of the Social Security Act (42 U.S.C. 
1396) is amended— 
(1) in paragraph (6), by adding at the end the 
following new subparagraph: 
‘‘(C) TERRITORIES.— 
‘‘(i) FISCAL
YEAR
2017.—For fiscal 
year 2017, the DSH allotment for Puerto 
Rico, the Virgin Islands of the United 
States, Guam, the Northern Mariana Is-
lands, and American Samoa shall bear the 
same ratio to $150,000,000 as the ratio of 
the number of individuals who are low-in-
come or uninsured and residing in such re-
spective territory (as estimated from time 
to time by the Secretary) bears to the 
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sums of the number of such individuals re-
siding in all of the territories. 
‘‘(ii) SUBSEQUENT
FISCAL
YEAR.— 
For each subsequent fiscal year, the DSH 
allotment for each such territory is subject 
to an increase in accordance with para-
graph (2).’’; and 
(2) in paragraph (9), by inserting before the pe-
riod at the end the following: ‘‘, and includes, begin-
ning with fiscal year 2017, Puerto Rico, the Virgin 
Islands of the United States, Guam, the Northern 
Mariana Islands, and American Samoa’’. 
TITLE II—MEDICARE 
Subtitle A—Part A 
SEC. 201. MODIFICATION OF MEDICARE INPATIENT HOS-
PITAL PAYMENT RATE FOR PUERTO RICO 
HOSPITALS. 
Section 1886(d)(9)(E) of the Social Security Act (42 
U.S.C. 1395ww(d)(9)(E)) is amended— 
(1) by striking ‘‘and’’ at the end of clause (iii); 
(2) in clause (iv)— 
(A) by inserting ‘‘and before October 1, 
2015,’’ after ‘‘2004,’’; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
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(3) by adding at the end the following new 
clause: 
‘‘(v) on or after October 1, 2015, the applicable 
Puerto Rico percentage is 0 percent and the applica-
ble Federal percentage is 100 percent.’’. 
SEC. 202. APPLICATION OF MEDICARE HITECH PAYMENTS 
TO HOSPITALS IN PUERTO RICO. 
(a) IN GENERAL.—Subsection (n)(6)(B) of section 
1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended by striking ‘‘subsection (d) hospital’’ and insert-
ing ‘‘hospital that is a subsection (d) hospital or a sub-
section (d) Puerto Rico hospital’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Subsection (b)(3)(B)(ix) of section 1886 of 
the Social Security Act (42 U.S.C. 1395ww) is 
amended— 
(A) 
in 
subclause 
(I), 
by 
striking 
‘‘(n)(6)(A)’’ and inserting ‘‘(n)(6)(B)’’; and 
(B) in subclause (II), by striking ‘‘a sub-
section (d) hospital’’ and inserting ‘‘an eligible 
hospital’’. 
(2) Paragraphs (2) and (4)(A) of section 
1853(m) of the Social Security Act (42 U.S.C. 
1395w–23(m)) are each amended by striking 
‘‘1886(n)(6)(A)’’ and inserting ‘‘1886(n)(6)(B)’’. 
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(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by this 
section by program instruction or otherwise. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply as if included in the enactment 
of the American Recovery and Reinvestment Act of 2009 
(Public Law 111–5), except that, in order to take into ac-
count delays in the implementation of this section, in ap-
plying 
subsections 
(b)(3)(B)(ix), 
(n)(2)(E)(ii), 
and 
(n)(2)(G)(i) of section 1886 of the Social Security Act, 
as amended by this section, any reference in such sub-
sections to a particular year shall be treated with respect 
to a subsection (d) Puerto Rico hospital as a reference 
to the year that is 5 years after such particular year (or 
7 years after such particular year in the case of applying 
subsection (b)(3)(B)(ix) of such section). 
SEC. 203. CALCULATION OF MEDICARE DSH PAYMENTS FOR 
IPPS HOSPITALS IN PUERTO RICO. 
Section 1886(d)(9)(D)(iii) of the Social Security Act 
(42 U.S.C. 1395ww(d)(9)(D)(iii)) is amended to read as 
follows: 
‘‘(iii) Subparagraph (F) (relating to dispropor-
tionate share payments), including application of 
subsection (r), except that for this purpose— 
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‘‘(I) the sum described in clause (ii) of this 
subparagraph shall be substituted for the sum 
referred to in paragraph (5)(F)(ii)(I); and 
‘‘(II) for discharges occurring on or after 
October 1, 2015, subclause (I) of paragraph 
(5)(F)(vi) shall be applied by substituting for 
the numerator described in such subclause the 
number of subsection (d) Puerto Rico hospital’s 
patient days for the cost reporting period in-
volved which were made up of patients who (for 
such days) were entitled to benefits under part 
A of this title and were— 
‘‘(aa) entitled to supplementary secu-
rity income benefits (excluding any State 
supplementation) under title XVI of this 
Act; 
‘‘(bb) eligible for medical assistance 
under a State plan under title XIX; or 
‘‘(cc) receiving aid or assistance under 
any plan of the State approved under title 
I, X, XIV, or XVI.’’. 
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Subtitle B—Part B 
SEC. 211. APPLICATION OF PART B DEEMED ENROLLMENT 
PROCESS TO RESIDENTS OF PUERTO RICO; 
SPECIAL ENROLLMENT PERIOD AND LIMIT 
ON LATE ENROLLMENT PENALTIES. 
(a) APPLICATION OF PART B DEEMED ENROLLMENT 
PROCESS
TO RESIDENTS
OF PUERTO RICO.—Section 
1837(f)(3) of the Social Security Act (42 U.S.C. 
1395p(f)(3)) is amended by striking ‘‘, exclusive of Puerto 
Rico’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to individuals whose initial en-
rollment period under section 1837(d) of the Social Secu-
rity Act begins on or after the first day of the effective 
month, specified by the Secretary of Health and Human 
Services under section 1839(j)(1)(C) of such Act, as added 
by subsection (c)(2). 
(c) TRANSITION PROVIDING SPECIAL ENROLLMENT 
PERIOD AND LIMIT ON LATE ENROLLMENT PENALTIES 
FOR CERTAIN MEDICARE BENEFICIARIES.—Section 1839 
of the Social Security Act (42 U.S.C. 1395r) is amend-
ed— 
(1) in the first sentence of subsection (b), by in-
serting ‘‘subject to section 1839(j)(2),’’ after ‘‘sub-
section (i)(4) or (l) of section 1837,’’; and 
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(2) by adding at the end the following new sub-
section: 
‘‘(j) SPECIAL RULES FOR CERTAIN RESIDENTS OF 
PUERTO RICO.— 
‘‘(1) SPECIAL ENROLLMENT PERIOD, COVERAGE 
PERIOD FOR RESIDENTS WHO ARE ELIGIBLE BUT 
NOT ENROLLED.— 
‘‘(A) IN GENERAL.—In the case of a tran-
sition individual (as defined in paragraph (3)) 
who is not enrolled under this part as of the 
day before the first day of the effective month 
(as defined in subparagraph (C)), the Secretary 
shall provide for a special enrollment period 
under section 1837 of 7 months beginning with 
such effective month during which the indi-
vidual may be enrolled under this part. 
‘‘(B) COVERAGE PERIOD.—In the case of 
such an individual who enrolls during such spe-
cial enrollment period, the coverage period 
under section 1838 shall begin on the first day 
of the second month after the month in which 
the individual enrolls. 
‘‘(C) EFFECTIVE
MONTH
DEFINED.—In 
this section, the term ‘effective month’ means a 
month, not earlier than October 2016 and not 
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later than January 2017, specified by the Sec-
retary. 
‘‘(2) REDUCTION IN LATE ENROLLMENT PEN-
ALTIES
FOR
CURRENT
ENROLLEES
AND
INDIVID-
UALS ENROLLING DURING TRANSITION.— 
‘‘(A) IN GENERAL.—In the case of a tran-
sition individual who is enrolled under this part 
as of the day before the first day of the effec-
tive month or who enrolls under this part on or 
after the date of the enactment of this sub-
section but before the end of the special enroll-
ment period under paragraph (1)(A), the 
amount of the late enrollment penalty imposed 
under section 1839(b) shall be recalculated by 
reducing the penalty to 15 percent of the pen-
alty otherwise established. 
‘‘(B) APPLICATION.—Subparagraph (A) 
shall be applied in the case of a transition indi-
vidual who— 
‘‘(i) is enrolled under this part as of 
the month before the effective month, for 
premiums for months beginning with such 
effective month; or 
‘‘(ii) enrolls under this part on or 
after the date of the enactment of this Act 
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and before the end of the special enroll-
ment period under paragraph (1)(A), for 
premiums for months during the coverage 
period under this part which occur during 
or after the effective month. 
‘‘(C) LOSS OF REDUCTION IF INDIVIDUAL 
TERMINATES
ENROLLMENT.—Subparagraph 
(A) shall not apply to a transition individual if 
the individual terminates enrollment under this 
part after the end of the special enrollment pe-
riod under paragraph (1). 
‘‘(3) TRANSITION
INDIVIDUAL
DEFINED.—In 
this section, the term ‘transition individual’ means 
an individual who resides in Puerto Rico and who 
would have been deemed enrolled under this part 
pursuant to section 1837(f) before the first day of 
the effective month but for the fact that the indi-
vidual was a resident of Puerto Rico, regardless of 
whether the individual is enrolled under this part as 
of such first day.’’. 
SEC. 212. PUERTO RICO PRACTICE EXPENSE GPCI IM-
PROVEMENT. 
Section 1848(e)(1) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)) is amended— 
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(1) in subparagraph (A), by striking ‘‘and (I)’’ 
and inserting ‘‘(I), and (J)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(J) FLOOR
FOR
PRACTICE
EXPENSE 
INDEX FOR SERVICES FURNISHED IN PUERTO 
RICO.— 
‘‘(i) IN
GENERAL.—For purposes of 
payment for services furnished in Puerto 
Rico in a year (beginning with 2016), after 
calculating the practice expense index in 
subparagraph (A)(i) for Puerto Rico, if 
such index is below the reference index (as 
defined in clause (ii)) for the year, the Sec-
retary shall increase such index for Puerto 
Rico to equal the value of the reference 
index for the year. The preceding sentence 
shall not be applied in a budget neutral 
manner. 
‘‘(ii) REFERENCE INDEX DEFINED.— 
In this subparagraph, the term ‘reference 
index’ means, with respect to a year, 0.800 
or, if less, the lowest practice expense 
index value for the year for any area in the 
50 States or the District of Columbia.’’. 
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Subtitle C—Medicare Advantage 
(Part C) 
SEC. 221. ADJUSTMENT IN BENCHMARK FOR LOW BASE 
PAYMENT COUNTIES IN PUERTO RICO. 
Section 1853(n) of the Social Security Act (42 U.S.C. 
1395w–103(n)) is amended— 
(1) in paragraph (1), by striking ‘‘and (5)’’ and 
inserting ‘‘, (5), and (6)’’; 
(2) in paragraph (4), by striking ‘‘In no case’’ 
and inserting ‘‘Subject to paragraph (6), in no 
case’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL
RULES
FOR
BLENDED
BENCH-
MARK AMOUNT FOR TERRITORIES.— 
‘‘(A) IN GENERAL.—Subject to paragraph 
(2), the blended benchmark amount for an area 
in a territory for a year (beginning with 2016) 
shall not be less than 80 percent of the national 
average of the base payment amounts specified 
in subparagraph (2)(E) for such year for areas 
within the 50 States and the District of Colum-
bia. 
‘‘(B) LIMITATION.—In no case shall the 
blended benchmark amount for an area in a 
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territory for a year under subparagraph (A) ex-
ceed the lowest blended benchmark amount for 
any area within the 50 States and the District 
of Columbia for such year.’’. 
Subtitle D—Part D 
SEC. 231. IMPROVED USE OF ALLOCATED PRESCRIPTION 
DRUG FUNDS BY TERRITORIES. 
Section 1935(e) of the Social Security Act (42 U.S.C. 
1396u–5(e)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(5) IMPROVED USE OF FUNDS FOR LOW-IN-
COME PART D ELIGIBLE INDIVIDUALS.—This sub-
section shall be applied beginning with fiscal year 
2016 as follows, notwithstanding any other provision 
of this title: 
‘‘(A) CLARIFYING STATE FLEXIBILITY TO 
COVER
NON-DUAL-ELIGIBLE
INDIVIDUALS.—In 
this title, the term ‘medical assistance’ includes 
financial assistance furnished by a State under 
this subsection to part D eligible individuals 
who, if they were residing in one of the 50 
States or the District of Columbia, would qual-
ify as subsidy eligible individuals under section 
1860D–14(a)(3), and without regard to wheth-
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er such individuals otherwise qualify for medical 
assistance under this title. 
‘‘(B) 100 PERCENT FMAP TO REFLECT NO 
STATE MATCHING REQUIRED FOR PART D LOW 
INCOME SUBSIDIES.—The Federal medical as-
sistance percentage applicable to the assistance 
furnished under this subsection is 100 percent. 
‘‘(C) LIMITED
FUNDING
FOR
SPECIAL 
RULES.—Subparagraphs (A) and (B), and the 
provision of medical assistance for covered part 
D drugs to low-income part D eligible individ-
uals for a State and period under this sub-
section, is limited to the amount specified in 
paragraph (3) for such State and period, with-
out regard to the application of subsection (f) 
or (g) of section 1108.’’. 
SEC. 232. REPORT ON TREATMENT OF TERRITORIES 
UNDER MEDICARE PART D. 
Paragraph (4) of section 1935(e) of the Social Secu-
rity Act (42 U.S.C. 1396u–5(e)) is amended to read as 
follows: 
‘‘(4) REPORT
ON
APPLICATION
OF
SUB-
SECTION.— 
‘‘(A) IN GENERAL.—Not later than Feb-
ruary 1, 2018, the Secretary shall submit to 
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Congress a report on the application of this 
subsection during the period beginning fiscal 
year 2006 and ending fiscal year 2017. 
‘‘(B) INFORMATION TO BE INCLUDED IN 
REPORT.—Such report shall include— 
‘‘(i) program guidance issued by the 
Secretary to implement this subsection; 
‘‘(ii) for each territory, information on 
the increased amount under paragraph (3) 
and how the territory has applied such 
amount, including the territory’s program 
design, expenditures, and number of indi-
viduals (and dual-eligible individuals) as-
sisted; and 
‘‘(iii) differences between how such 
territories are treated under part D of title 
XVIII and under this title compared with 
the treatment of the 50 States and the 
District of Columbia under such part and 
this title for different fiscal years within 
the period covered under the report. 
‘‘(C) RECOMMENDATIONS.—Such report 
shall include recommendations for improving 
prescription drug coverage for low-income indi-
viduals 
in 
each 
territory, 
including 
rec-
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ommendations regarding each of the following 
alternative approaches: 
‘‘(i) Adjusting the aggregate amount 
specified in paragraph (3)(B). 
‘‘(ii) Allowing residents of the terri-
tories to be subsidy eligible individuals 
under section 1860D–14, notwithstanding 
subsection (a)(3)(F) of such section, or 
providing substantially equivalent low-in-
come prescription drug subsidies to such 
residents.’’. 
TITLE III—MISCELLANEOUS 
SEC. 301. MODIFIED TREATMENT OF TERRITORIES WITH 
RESPECT TO APPLICATION OF ACA ANNUAL 
HEALTH INSURANCE PROVIDER FEES. 
Section 9010 of the Patient Protection and Afford-
able Care Act (26 U.S.C. 4001 note prec.) is amended— 
(1) in subsection (b)(1), by inserting ‘‘subject 
to subsection (j)(1),’’ after ‘‘With respect to each 
covered entity,’’; and 
(2) by striking subsection (j) and inserting the 
following: 
‘‘(j) SPECIAL RULES FOR TREATMENT OF TERRI-
TORIES.— 
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‘‘(1) IN
GENERAL.—In applying this section 
with respect to United States health risks located 
outside of the 50 States or the District of Columbia 
for years beginning with 2016— 
‘‘(A) the amount of the fee under sub-
section (b) shall be 50 percent of the amount 
of the fee otherwise determined; 
‘‘(B) the Secretary shall deposit the 
amount of such fees collected for each territory 
into a separate account; and 
‘‘(C) amounts in such an account for a ter-
ritory for a year are appropriated and shall be 
available to the territory in accordance with 
paragraph (2). 
‘‘(2) AVAILABILITY OF FUNDS.—Amounts made 
available to a territory under paragraph (1)(C) with 
respect to a territory for a year shall be made avail-
able to the territory, upon application of the terri-
tory to the Secretary of Health and Human Serv-
ices, only for the following purposes, as elected by 
the territory in such application: 
‘‘(A) INCREASED PRESCRIPTION DRUG AS-
SISTANCE FOR LOW-INCOME PART D ELIGIBLE 
INDIVIDUALS.—For increasing the amount of 
funds made available to the territory under sec-
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tion 1935(e)(3) of the Social Security Act (42 
U.S.C. 1396u–5(e)(3)) for assistance for low-in-
come part D eligible individuals in obtaining 
part D covered drugs. 
‘‘(B) 
SATISFYING
STATE
MEDICAID 
MATCHING
REQUIREMENT.—For purposes of 
the territory meeting non-Federal matching re-
quirements imposed with respect to obtaining 
Federal financial participation under title XIX 
of the Social Security Act.’’. 
SEC. 302. MEDICAID AND CHIP TERRITORY TRANSPARENCY 
AND INFORMATION. 
(a) PUBLICATION OF INFORMATION ON FEDERAL 
EXPENDITURES UNDER MEDICAID AND CHIP IN THE 
TERRITORIES.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall publish, and periodically update, on 
the Internet site of the Centers for Medicare & Medicaid 
Services information on Medicaid and CHIP carried out 
in the territories of the United States. Such information 
shall include, with respect to each such territory— 
(1) the income levels established by the terri-
tory for purposes of eligibility of an individual to re-
ceive medical assistance under Medicaid or child 
health assistance under CHIP; 
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(2) the number of individuals enrolled in Med-
icaid and CHIP in such territory; 
(3) any State plan amendments in effect to 
carry out Medicaid or CHIP in such territory; 
(4) any waiver of the requirements of title XIX 
or title XXI issued by the Secretary to carry out 
Medicaid or CHIP in the territory, including a waiv-
er under section 1115 of the Social Security Act (42 
U.S.C. 1315), any application for such a waiver, and 
any documentation related to such application (in-
cluding correspondence); 
(5) the amount of the Federal and non-Federal 
share of expenditures under Medicaid and CHIP in 
such territory; 
(6) the systems in place for the furnishing of 
health care items and services under Medicaid and 
CHIP in such territory; 
(7) the design of CHIP in such territory; and 
(8) other information regarding the carrying 
out of Medicaid and CHIP in the territory that is 
published on such Internet site with respect to car-
rying out Medicaid and CHIP in each State and the 
District of Columbia. 
(b) DEFINITIONS.—In this section: 
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(1) CHIP.—The term ‘‘CHIP’’ means the 
State Children’s Health Insurance Program under 
title XXI of the Social Security Act. 
(2) MEDICAID.—The term ‘‘Medicaid’’ means 
the Medicaid program under title XIX of the Social 
Security Act. 
(3) TERRITORY.—The term ‘‘territory of the 
United States’’ includes Puerto Rico, the Virgin Is-
lands of the United States, Guam, the Northern 
Mariana Islands, and American Samoa. 
SEC. 303. REPORT ON EXCLUSION OF TERRITORIES FROM 
EXCHANGES. 
(a) IN GENERAL.—Not later than February 1, 2018, 
the Secretary of Health and Human Services shall submit 
to Congress a report that details the adverse impacts in 
each territory from the practical exclusion of the terri-
tories from the provisions of part II of subtitle D of title 
I of the Patient Protection and Affordable Care Act inso-
far as such provisions provide for the establishment of an 
American Health Benefit Exchange or the administration 
of a federally facilitated Exchange in each State and in 
the District of Columbia for the purpose of making health 
insurance more affordable and accessible for individuals 
and small businesses. 
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(b) INFORMATION IN REPORT.—The report shall in-
clude information on the following: 
(1) An estimate of the total number of unin-
sured and underinsured individuals residing in each 
territory with respect to health insurance coverage. 
(2) A description of the number of health insur-
ance issuers in each territory and the health insur-
ance plans these issuers offer. 
(3) An estimate of the number of individuals re-
siding in each territory who are denied premium and 
cost-sharing assistance that would otherwise be 
available to them for obtaining health insurance cov-
erage through an Exchange if they resided in one of 
the 50 States or in the District of Columbia. 
(4) An estimate of the amount of Federal as-
sistance described in paragraph (3) that is not being 
made available to residents of each territory. 
(5) An estimate of the number of small employ-
ers in each territory that would be eligible to pur-
chase health insurance coverage through a Small 
Business Health Options Program (SHOP) Market-
place that would operate as part of an Exchange if 
the employers were in one of the 50 States or in the 
District of Columbia. 
Æ 
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