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‘‘SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS 
REGARDING HEALTH COVERAGE. 
‘‘(a) LARGE EMPLOYERS NOT OFFERING HEALTH 
COVERAGE.—If— 
‘‘(1) any applicable large employer fails to offer 
to its full-time employees (and their dependents) the 
opportunity to enroll in minimum essential coverage 
under an eligible employer-sponsored plan (as defined 
in section 5000A(f)(2)) for any month, and 
‘‘(2) at least one full-time employee of the appli-
cable large employer has been certified to the em-
ployer under section 1411 of the Patient Protection 
and Affordable Care Act as having enrolled for such 
month in a qualified health plan with respect to 
which an applicable premium tax credit or cost-shar-
ing reduction is allowed or paid with respect to the 
employee, 
then there is hereby imposed on the employer an assessable 
payment equal to the product of the applicable payment 
amount and the number of individuals employed by the em-
ployer as full-time employees during such month. 
‘‘(b) LARGE EMPLOYERS WITH WAITING PERIODS EX-
CEEDING 30 DAYS.— 
‘‘(1) IN GENERAL.—In the case of any applicable 
large employer which requires an extended waiting 
period to enroll in any minimum essential coverage 
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under an employer-sponsored plan (as defined in sec-
tion 5000A(f)(2)), there is hereby imposed on the em-
ployer an assessable payment, in the amount specified 
in paragraph (2), for each full-time employee of the 
employer to whom the extended waiting period ap-
plies. 
‘‘(2) AMOUNT.—For purposes of paragraph (1), 
the amount specified in this paragraph for a full-time 
employee is— 
‘‘(A) in the case of an extended waiting pe-
riod which exceeds 30 days but does not exceed 
60 days, $400, and 
‘‘(B) in the case of an extended waiting pe-
riod which exceeds 60 days, $600. 
‘‘(3) EXTENDED
WAITING
PERIOD.—The term 
‘extended waiting period’ means any waiting period 
(as defined in section 2701(b)(4) of the Public Health 
Service Act) which exceeds 30 days. 
‘‘(c) LARGE EMPLOYERS OFFERING COVERAGE WITH 
EMPLOYEES WHO QUALIFY FOR PREMIUM TAX CREDITS 
OR COST-SHARING REDUCTIONS.— 
‘‘(1) IN GENERAL.—If— 
‘‘(A) an applicable large employer offers to 
its full-time employees (and their dependents) the 
opportunity to enroll in minimum essential cov-
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erage under an eligible employer-sponsored plan 
(as defined in section 5000A(f)(2)) for any 
month, and 
‘‘(B) 1 or more full-time employees of the 
applicable large employer has been certified to 
the employer under section 1411 of the Patient 
Protection and Affordable Care Act as having en-
rolled for such month in a qualified health plan 
with respect to which an applicable premium tax 
credit or cost-sharing reduction is allowed or 
paid with respect to the employee, 
then there is hereby imposed on the employer an as-
sessable payment equal to the product of the number 
of full-time employees of the applicable large employer 
described in subparagraph (B) for such month and 
400 percent of the applicable payment amount. 
‘‘(2) 
OVERALL
LIMITATION.—The 
aggregate 
amount of tax determined under paragraph (1) with 
respect to all employees of an applicable large em-
ployer for any month shall not exceed the product of 
the applicable payment amount and the number of 
individuals employed by the employer as full-time 
employees during such month. 
‘‘(d) DEFINITIONS AND SPECIAL RULES.—For pur-
poses of this section— 
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‘‘(1) APPLICABLE PAYMENT AMOUNT.—The term 
‘applicable payment amount’ means, with respect to 
any month, 1⁄12 of $750. 
‘‘(2) APPLICABLE LARGE EMPLOYER.— 
‘‘(A) IN
GENERAL.—The term ‘applicable 
large employer’ means, with respect to a cal-
endar year, an employer who employed an aver-
age of at least 50 full-time employees on business 
days during the preceding calendar year. 
‘‘(B) EXEMPTION
FOR
CERTAIN
EMPLOY-
ERS.— 
‘‘(i) IN GENERAL.—An employer shall 
not be considered to employ more than 50 
full-time employees if— 
‘‘(I) the employer’s workforce ex-
ceeds 50 full-time employees for 120 
days or fewer during the calendar 
year, and 
‘‘(II) the employees in excess of 50 
employed during such 120-day period 
were seasonal workers. 
‘‘(ii) DEFINITION OF SEASONAL WORK-
ERS.—The term ‘seasonal worker’ means a 
worker who performs labor or services on a 
seasonal basis as defined by the Secretary of 
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Labor, including workers covered by section 
500.20(s)(1) of title 29, Code of Federal 
Regulations and retail workers employed ex-
clusively during holiday seasons. 
‘‘(C) RULES FOR DETERMINING EMPLOYER 
SIZE.—For purposes of this paragraph— 
‘‘(i) APPLICATION
OF
AGGREGATION 
RULE FOR EMPLOYERS.—All persons treated 
as a single employer under subsection (b), 
(c), (m), or (o) of section 414 of the Internal 
Revenue Code of 1986 shall be treated as 1 
employer. 
‘‘(ii) EMPLOYERS NOT IN EXISTENCE 
IN PRECEDING YEAR.—In the case of an em-
ployer which was not in existence through-
out the preceding calendar year, the deter-
mination of whether such employer is an 
applicable large employer shall be based on 
the average number of employees that it is 
reasonably expected such employer will em-
ploy on business days in the current cal-
endar year. 
‘‘(iii) PREDECESSORS.—Any reference 
in this subsection to an employer shall in-
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clude a reference to any predecessor of such 
employer. 
‘‘(3) APPLICABLE
PREMIUM
TAX
CREDIT
AND 
COST-SHARING
REDUCTION.—The term ‘applicable 
premium tax credit and cost-sharing reduction’ 
means— 
‘‘(A) any premium tax credit allowed under 
section 36B, 
‘‘(B) any cost-sharing reduction under sec-
tion 1402 of the Patient Protection and Afford-
able Care Act, and 
‘‘(C) any advance payment of such credit or 
reduction under section 1412 of such Act. 
‘‘(4) FULL-TIME EMPLOYEE.— 
‘‘(A) IN GENERAL.—The term ‘full-time em-
ployee’ means an employee who is employed on 
average at least 30 hours of service per week. 
‘‘(B) HOURS OF SERVICE.—The Secretary, 
in consultation with the Secretary of Labor, 
shall prescribe such regulations, rules, and guid-
ance as may be necessary to determine the hours 
of service of an employee, including rules for the 
application of this paragraph to employees who 
are not compensated on an hourly basis. 
‘‘(5) INFLATION ADJUSTMENT.— 
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‘‘(A) IN GENERAL.—In the case of any cal-
endar year after 2014, each of the dollar 
amounts in subsection (b)(2) and (d)(1) shall be 
increased by an amount equal to the product 
of— 
‘‘(i) such dollar amount, and 
‘‘(ii) the premium adjustment percent-
age (as defined in section 1302(c)(4) of the 
Patient Protection and Affordable Care Act) 
for the calendar year. 
‘‘(B) ROUNDING.—If the amount of any in-
crease under subparagraph (A) is not a multiple 
of $10, such increase shall be rounded to the next 
lowest multiple of $10. 
‘‘(6) OTHER DEFINITIONS.—Any term used in 
this section which is also used in the Patient Protec-
tion and Affordable Care Act shall have the same 
meaning as when used in such Act. 
‘‘(7) TAX NONDEDUCTIBLE.—For denial of de-
duction for the tax imposed by this section, see section 
275(a)(6). 
‘‘(e) ADMINISTRATION AND PROCEDURE.— 
‘‘(1) IN GENERAL.—Any assessable payment pro-
vided by this section shall be paid upon notice and 
demand by the Secretary, and shall be assessed and 
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collected in the same manner as an assessable penalty 
under subchapter B of chapter 68. 
‘‘(2) TIME FOR PAYMENT.—The Secretary may 
provide for the payment of any assessable payment 
provided by this section on an annual, monthly, or 
other periodic basis as the Secretary may prescribe. 
‘‘(3) COORDINATION WITH CREDITS, ETC..—The 
Secretary shall prescribe rules, regulations, or guid-
ance for the repayment of any assessable payment 
(including interest) if such payment is based on the 
allowance or payment of an applicable premium tax 
credit or cost-sharing reduction with respect to an 
employee, such allowance or payment is subsequently 
disallowed, and the assessable payment would not 
have been required to be made but for such allowance 
or payment.’’. 
(b) CLERICAL AMENDMENT.—The table of sections for 
chapter 43 of such Code is amended by adding at the end 
the following new item: 
‘‘Sec. 4980H. Shared responsibility for employers regarding health coverage.’’. 
(c) STUDY AND REPORT OF EFFECT OF TAX ON WORK-
ERS’ WAGES.— 
(1) IN GENERAL.—The Secretary of Labor shall 
conduct a study to determine whether employees’ 
wages are reduced by reason of the application of the 
assessable payments under section 4980H of the Inter-
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nal Revenue Code of 1986 (as added by the amend-
ments made by this section). The Secretary shall 
make such determination on the basis of the National 
Compensation Survey published by the Bureau of 
Labor Statistics. 
(2) REPORT.—The Secretary shall report the re-
sults of the study under paragraph (1) to the Com-
mittee on Ways and Means of the House of Represent-
atives and to the Committee on Finance of the Senate. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to months beginning after December 31, 
2013. 
SEC. 1514. REPORTING OF EMPLOYER HEALTH INSURANCE 
COVERAGE. 
(a) IN GENERAL.—Subpart D of part III of subchapter 
A of chapter 61 of the Internal Revenue Code of 1986, as 
added by section 1502, is amended by inserting after section 
6055 the following new section: 
‘‘SEC. 6056. LARGE EMPLOYERS REQUIRED TO REPORT ON 
HEALTH INSURANCE COVERAGE. 
‘‘(a) IN GENERAL.—Every applicable large employer 
required to meet the requirements of section 4980H with 
respect to its full-time employees during a calendar year 
shall, at such time as the Secretary may prescribe, make 
a return described in subsection (b). 
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‘‘(b) FORM AND MANNER OF RETURN.—A return is de-
scribed in this subsection if such return— 
‘‘(1) is in such form as the Secretary may pre-
scribe, and 
‘‘(2) contains— 
‘‘(A) the name, date, and employer identi-
fication number of the employer, 
‘‘(B) a certification as to whether the em-
ployer offers to its full-time employees (and their 
dependents) the opportunity to enroll in min-
imum essential coverage under an eligible em-
ployer-sponsored plan (as defined in section 
5000A(f)(2)), 
‘‘(C) if the employer certifies that the em-
ployer did offer to its full-time employees (and 
their dependents) the opportunity to so enroll— 
‘‘(i) the length of any waiting period 
(as defined in section 2701(b)(4) of the Pub-
lic Health Service Act) with respect to such 
coverage, 
‘‘(ii) the months during the calendar 
year for which coverage under the plan was 
available, 
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‘‘(iii) the monthly premium for the 
lowest cost option in each of the enrollment 
categories under the plan, and 
‘‘(iv) the applicable large employer’s 
share of the total allowed costs of benefits 
provided under the plan, 
‘‘(D) the number of full-time employees for 
each month during the calendar year, 
‘‘(E) the name, address, and TIN of each 
full-time employee during the calendar year and 
the months (if any) during which such employee 
(and any dependents) were covered under any 
such health benefits plans, and 
‘‘(F) such other information as the Sec-
retary may require. 
‘‘(c) STATEMENTS TO BE FURNISHED TO INDIVIDUALS 
WITH RESPECT TO WHOM INFORMATION IS REPORTED.— 
‘‘(1) IN
GENERAL.—Every person required to 
make a return under subsection (a) shall furnish to 
each full-time employee whose name is required to be 
set forth in such return under subsection (b)(2)(E) a 
written statement showing— 
‘‘(A) the name and address of the person re-
quired to make such return and the phone num-
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‘‘(HH) section 6056(c) (relating to state-
ments relating to large employers required to re-
port on health insurance coverage).’’. 
(c) CONFORMING AMENDMENT.—The table of sections 
for subpart D of part III of subchapter A of chapter 61 
of such Code, as added by section 1502, is amended by add-
ing at the end the following new item: 
‘‘Sec. 6056. Large employers required to report on health insurance coverage.’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to periods beginning after December 31, 
2013. 
SEC. 1515. OFFERING OF EXCHANGE-PARTICIPATING QUALI-
FIED HEALTH PLANS THROUGH CAFETERIA 
PLANS. 
(a) IN GENERAL.—Subsection (f) of section 125 of the 
Internal Revenue Code of 1986 is amended by adding at 
the end the following new paragraph: 
‘‘(3) CERTAIN EXCHANGE-PARTICIPATING QUALI-
FIED HEALTH PLANS NOT QUALIFIED.— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
benefit’ shall not include any qualified health 
plan (as defined in section 1301(a) of the Pa-
tient Protection and Affordable Care Act) offered 
through an Exchange established under section 
1311 of such Act. 
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‘‘(B) EXCEPTION FOR EXCHANGE-ELIGIBLE 
EMPLOYERS.—Subparagraph (A) shall not apply 
with respect to any employee if such employee’s 
employer is a qualified employer (as defined in 
section 1312(f)(2) of the Patient Protection and 
Affordable Care Act) offering the employee the 
opportunity to enroll through such an Exchange 
in a qualified health plan in a group market.’’. 
(b) CONFORMING AMENDMENTS.—Subsection (f) of sec-
tion 125 of such Code is amended— 
(1) by striking ‘‘For purposes of this section, the 
term’’ and inserting ‘‘For purposes of this section— 
‘‘(1) IN GENERAL.—The term’’, and 
(2) by striking ‘‘Such term shall not include’’ 
and inserting the following: 
‘‘(2) LONG-TERM CARE INSURANCE NOT QUALI-
FIED.—The term ‘qualified benefit’ shall not include’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2013. 
Subtitle G—Miscellaneous 
Provisions 
SEC. 1551. DEFINITIONS. 
Unless specifically provided for otherwise, the defini-
tions contained in section 2791 of the Public Health Service 
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Act (42 U.S.C. 300gg–91) shall apply with respect to this 
title. 
SEC. 1552. TRANSPARENCY IN GOVERNMENT. 
Not later than 30 days after the date of enactment of 
this Act, the Secretary of Health and Human Services shall 
publish on the Internet website of the Department of Health 
and Human Services, a list of all of the authorities pro-
vided to the Secretary under this Act (and the amendments 
made by this Act). 
SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON AS-
SISTED SUICIDE. 
(a) IN GENERAL.—The Federal Government, and any 
State or local government or health care provider that re-
ceives Federal financial assistance under this Act (or under 
an amendment made by this Act) or any health plan cre-
ated under this Act (or under an amendment made by this 
Act), may not subject an individual or institutional health 
care entity to discrimination on the basis that the entity 
does not provide any health care item or service furnished 
for the purpose of causing, or for the purpose of assisting 
in causing, the death of any individual, such as by assisted 
suicide, euthanasia, or mercy killing. 
(b) DEFINITION.—In this section, the term ‘‘health care 
entity’’ includes an individual physician or other health 
care professional, a hospital, a provider-sponsored organi-
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zation, a health maintenance organization, a health insur-
ance plan, or any other kind of health care facility, organi-
zation, or plan. 
(c) CONSTRUCTION
AND TREATMENT
OF CERTAIN 
SERVICES.—Nothing in subsection (a) shall be construed to 
apply to, or to affect, any limitation relating to— 
(1) the withholding or withdrawing of medical 
treatment or medical care; 
(2) the withholding or withdrawing of nutrition 
or hydration; 
(3) abortion; or 
(4) the use of an item, good, benefit, or service 
furnished for the purpose of alleviating pain or dis-
comfort, even if such use may increase the risk of 
death, so long as such item, good, benefit, or service 
is not also furnished for the purpose of causing, or the 
purpose of assisting in causing, death, for any reason. 
(d) ADMINISTRATION.—The Office for Civil Rights of 
the Department of Health and Human Services is des-
ignated to receive complaints of discrimination based on 
this section. 
SEC. 1554. ACCESS TO THERAPIES. 
Notwithstanding any other provision of this Act, the 
Secretary of Health and Human Services shall not promul-
gate any regulation that— 
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(1) creates any unreasonable barriers to the abil-
ity of individuals to obtain appropriate medical care; 
(2) impedes timely access to health care services; 
(3) interferes with communications regarding a 
full range of treatment options between the patient 
and the provider; 
(4) restricts the ability of health care providers 
to provide full disclosure of all relevant information 
to patients making health care decisions; 
(5) violates the principles of informed consent 
and the ethical standards of health care professionals; 
or 
(6) limits the availability of health care treat-
ment for the full duration of a patient’s medical 
needs. 
SEC. 1555. FREEDOM NOT TO PARTICIPATE IN FEDERAL 
HEALTH INSURANCE PROGRAMS. 
No individual, company, business, nonprofit entity, or 
health insurance issuer offering group or individual health 
insurance coverage shall be required to participate in any 
Federal health insurance program created under this Act 
(or any amendments made by this Act), or in any Federal 
health insurance program expanded by this Act (or any 
such amendments), and there shall be no penalty or fine 
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imposed upon any such issuer for choosing not to partici-
pate in such programs. 
SEC. 1556. EQUITY FOR CERTAIN ELIGIBLE SURVIVORS. 
(a) REBUTTABLE PRESUMPTION.—Section 411(c)(4) 
of the Black Lung Benefits Act (30 U.S.C. 921(c)(4)) is 
amended by striking the last sentence. 
(b) CONTINUATION OF BENEFITS.—Section 422(l) of 
the Black Lung Benefits Act (30 U.S.C. 932(l)) is amended 
by striking ‘‘, except with respect to a claim filed under 
this part on or after the effective date of the Black Lung 
Benefits Amendments of 1981’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to claims filed under part 
B or part C of the Black Lung Benefits Act (30 U.S.C. 
921 et seq., 931 et seq.) after January 1, 2005, that are 
pending on or after the date of enactment of this Act. 
SEC. 1557. NONDISCRIMINATION. 
(a) IN GENERAL.—Except as otherwise provided for 
in this title (or an amendment made by this title), an indi-
vidual shall not, on the ground prohibited under title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), 
title IX of the Education Amendments of 1972 (20 U.S.C. 
1681 et seq.), the Age Discrimination Act of 1975 (42 
U.S.C. 6101 et seq.), or section 504 of the Rehabilitation 
Act of 1973 (29 U.S.C. 794), be excluded from participation 
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in, be denied the benefits of, or be subjected to discrimina-
tion under, any health program or activity, any part of 
which is receiving Federal financial assistance, including 
credits, subsidies, or contracts of insurance, or under any 
program or activity that is administered by an Executive 
Agency or any entity established under this title (or amend-
ments). The enforcement mechanisms provided for and 
available under such title VI, title IX, section 504, or such 
Age Discrimination Act shall apply for purposes of viola-
tions of this subsection. 
(b) CONTINUED APPLICATION OF LAWS.—Nothing in 
this title (or an amendment made by this title) shall be 
construed to invalidate or limit the rights, remedies, proce-
dures, or legal standards available to individuals aggrieved 
under title VI of the Civil Rights Act of 1964 (42 U.S.C. 
2000d et seq.), title VII of the Civil Rights Act of 1964 (42 
U.S.C. 2000e et seq.), title IX of the Education Amendments 
of 1972 (20 U.S.C. 1681 et seq.), section 504 of the Rehabili-
tation Act of 1973 (29 U.S.C. 794), or the Age Discrimina-
tion Act of 1975 (42 U.S.C. 611 et seq.), or to supersede 
State laws that provide additional protections against dis-
crimination on any basis described in subsection (a). 
(c) REGULATIONS.—The Secretary may promulgate 
regulations to implement this section. 
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SEC. 1558. PROTECTIONS FOR EMPLOYEES. 
The Fair Labor Standards Act of 1938 is amended by 
inserting after section 18B (as added by section 1512) the 
following: 
‘‘SEC. 18C. PROTECTIONS FOR EMPLOYEES. 
‘‘(a) PROHIBITION.—No employer shall discharge or in 
any manner discriminate against any employee with re-
spect to his or her compensation, terms, conditions, or other 
privileges of employment because the employee (or an indi-
vidual acting at the request of the employee) has— 
‘‘(1) received a credit under section 36B of the 
Internal Revenue Code of 1986 or a subsidy under 
section 1402 of this Act; 
‘‘(2) provided, caused to be provided, or is about 
to provide or cause to be provided to the employer, the 
Federal Government, or the attorney general of a 
State information relating to any violation of, or any 
act or omission the employee reasonably believes to be 
a violation of, any provision of this title (or an 
amendment made by this title); 
‘‘(3) testified or is about to testify in a pro-
ceeding concerning such violation; 
‘‘(4) assisted or participated, or is about to assist 
or participate, in such a proceeding; or 
‘‘(5) objected to, or refused to participate in, any 
activity, policy, practice, or assigned task that the 
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employee (or other such person) reasonably believed to 
be in violation of any provision of this title (or 
amendment), or any order, rule, regulation, standard, 
or ban under this title (or amendment). 
‘‘(b) COMPLAINT PROCEDURE.— 
‘‘(1) IN
GENERAL.—An employee who believes 
that he or she has been discharged or otherwise dis-
criminated against by any employer in violation of 
this section may seek relief in accordance with the 
procedures, notifications, burdens of proof, remedies, 
and statutes of limitation set forth in section 2087(b) 
of title 15, United States Code. 
‘‘(2) NO LIMITATION ON RIGHTS.—Nothing in 
this section shall be deemed to diminish the rights, 
privileges, or remedies of any employee under any 
Federal or State law or under any collective bar-
gaining agreement. The rights and remedies in this 
section may not be waived by any agreement, policy, 
form, or condition of employment.’’. 
SEC. 1559. OVERSIGHT. 
The Inspector General of the Department of Health 
and Human Services shall have oversight authority with 
respect to the administration and implementation of this 
title as it relates to such Department. 
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SEC. 1560. RULES OF CONSTRUCTION. 
(a) NO EFFECT ON ANTITRUST LAWS.—Nothing in 
this title (or an amendment made by this title) shall be 
construed to modify, impair, or supersede the operation of 
any of the antitrust laws. For the purposes of this section, 
the term ‘‘antitrust laws’’ has the meaning given such term 
in subsection (a) of the first section of the Clayton Act, ex-
cept that such term includes section 5 of the Federal Trade 
Commission Act to the extent that such section 5 applies 
to unfair methods of competition. 
(b) RULE OF CONSTRUCTION REGARDING HAWAII’S 
PREPAID HEALTH CARE ACT.—Nothing in this title (or an 
amendment made by this title) shall be construed to modify 
or limit the application of the exemption for Hawaii’s Pre-
paid Health Care Act (Haw. Rev. Stat. §§ 393–1 et seq.) 
as provided for under section 514(b)(5) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1144(b)(5)). 
(c) STUDENT HEALTH INSURANCE PLANS.—Nothing 
in this title (or an amendment made by this title) shall 
be construed to prohibit an institution of higher education 
(as such term is defined for purposes of the Higher Edu-
cation Act of 1965) from offering a student health insurance 
plan, to the extent that such requirement is otherwise per-
mitted under applicable Federal, State or local law. 
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(d) NO EFFECT ON EXISTING REQUIREMENTS.—Noth-
ing in this title (or an amendment made by this title, unless 
specified by direct statutory reference) shall be construed 
to modify any existing Federal requirement concerning the 
State agency responsible for determining eligibility for pro-
grams identified in section 1413. 
SEC. 1561. HEALTH INFORMATION TECHNOLOGY ENROLL-
MENT STANDARDS AND PROTOCOLS. 
Title XXX of the Public Health Service Act (42 U.S.C. 
300jj et seq.) is amended by adding at the end the following: 
‘‘Subtitle C—Other Provisions 
‘‘SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLL-
MENT STANDARDS AND PROTOCOLS. 
‘‘(a) IN GENERAL.— 
‘‘(1) STANDARDS
AND
PROTOCOLS.—Not later 
than 180 days after the date of enactment of this title, 
the Secretary, in consultation with the HIT Policy 
Committee and the HIT Standards Committee, shall 
develop interoperable and secure standards and proto-
cols that facilitate enrollment of individuals in Fed-
eral and State health and human services programs, 
as determined by the Secretary. 
‘‘(2) METHODS.—The Secretary shall facilitate 
enrollment in such programs through methods deter-
mined appropriate by the Secretary, which shall in-
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clude providing individuals and third parties author-
ized by such individuals and their designees notifica-
tion of eligibility and verification of eligibility re-
quired under such programs. 
‘‘(b) CONTENT.—The standards and protocols for elec-
tronic enrollment in the Federal and State programs de-
scribed in subsection (a) shall allow for the following: 
‘‘(1) Electronic matching against existing Fed-
eral and State data, including vital records, employ-
ment history, enrollment systems, tax records, and 
other data determined appropriate by the Secretary to 
serve as evidence of eligibility and in lieu of paper- 
based documentation. 
‘‘(2) Simplification and submission of electronic 
documentation, digitization of documents, and sys-
tems verification of eligibility. 
‘‘(3) Reuse of stored eligibility information (in-
cluding documentation) to assist with retention of eli-
gible individuals. 
‘‘(4) Capability for individuals to apply, recer-
tify and manage their eligibility information online, 
including at home, at points of service, and other 
community-based locations. 
‘‘(5) Ability to expand the enrollment system to 
integrate new programs, rules, and functionalities, to 
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operate at increased volume, and to apply stream-
lined verification and eligibility processes to other 
Federal and State programs, as appropriate. 
‘‘(6) Notification of eligibility, recertification, 
and other needed communication regarding eligi-
bility, which may include communication via email 
and cellular phones. 
‘‘(7) Other functionalities necessary to provide 
eligibles with streamlined enrollment process. 
‘‘(c) APPROVAL AND NOTIFICATION.—With respect to 
any standard or protocol developed under subsection (a) 
that has been approved by the HIT Policy Committee and 
the HIT Standards Committee, the Secretary— 
‘‘(1) shall notify States of such standards or pro-
tocols; and 
‘‘(2) may require, as a condition of receiving 
Federal funds for the health information technology 
investments, that States or other entities incorporate 
such standards and protocols into such investments. 
‘‘(d) GRANTS FOR IMPLEMENTATION OF APPROPRIATE 
ENROLLMENT HIT.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
grant to eligible entities to develop new, and adapt 
existing, technology systems to implement the HIT en-
rollment standards and protocols developed under 
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subsection (a) (referred to in this subsection as ‘ap-
propriate HIT technology’). 
‘‘(2) ELIGIBLE ENTITIES.—To be eligible for a 
grant under this subsection, an entity shall— 
‘‘(A) be a State, political subdivision of a 
State, or a local governmental entity; and 
‘‘(B) submit to the Secretary an application 
at such time, in such manner, and containing— 
‘‘(i) a plan to adopt and implement 
appropriate enrollment technology that in-
cludes— 
‘‘(I) proposed reduction in main-
tenance costs of technology systems; 
‘‘(II) elimination or updating of 
legacy systems; and 
‘‘(III) demonstrated collaboration 
with other entities that may receive a 
grant under this section that are lo-
cated in the same State, political sub-
division, or locality; 
‘‘(ii) an assurance that the entity will 
share such appropriate enrollment tech-
nology in accordance with paragraph (4); 
and 
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‘‘(iii) such other information as the 
Secretary may require. 
‘‘(3) SHARING.— 
‘‘(A) IN GENERAL.—The Secretary shall en-
sure that appropriate enrollment HIT adopted 
under grants under this subsection is made 
available to other qualified State, qualified polit-
ical subdivisions of a State, or other appropriate 
qualified entities (as described in subparagraph 
(B)) at no cost. 
‘‘(B) QUALIFIED ENTITIES.—The Secretary 
shall determine what entities are qualified to re-
ceive enrollment HIT under subparagraph (A), 
taking into consideration the recommendations 
of the HIT Policy Committee and the HIT 
Standards Committee.’’. 
SEC. 1562. CONFORMING AMENDMENTS. 
(a) APPLICABILITY.—Section 2735 of the Public 
Health Service Act (42 U.S.C. 300gg–21), as so redesig-
nated by section 1001(4), is amended— 
(1) by striking subsection (a); 
(2) in subsection (b)— 
(A) in paragraph (1), by striking ‘‘1 
through 3’’ and inserting ‘‘1 and 2’’; and 
(B) in paragraph (2)— 
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(5) Section 2105(c)(9)(B) of the Social Security 
Act (42 U.S.C. 1397e(c)(9)(B)), as added by section 
211(c)(1) of CHIPRA, is amended by striking ‘‘sec-
tion 
1903(a)(3)(F)’’ 
and 
inserting 
‘‘section 
1903(a)(3)(G)’’. 
(6) Section 2109(b)(2)(B) of the Social Security 
Act (42 U.S.C. 1397ii(b)(2)(B)), as added by section 
602 of CHIPRA, is amended by striking ‘‘the child 
population 
growth 
factor 
under 
section 
2104(m)(5)(B)’’ and inserting ‘‘a high-performing 
State under section 2111(b)(3)(B)’’. 
(7) Section 2110(c)(9)(B)(v) of the Social Secu-
rity Act (42 U.S.C. 1397jj(c)(9)(B)(v)), as added by 
section 505(b) of CHIPRA, is amended by striking 
‘‘school or school system’’ and inserting ‘‘local edu-
cational agency (as defined under section 9101 of the 
Elementary and Secondary Education Act of 1965’’. 
(8) Section 211(a)(1)(B) of CHIPRA is amend-
ed— 
(A) by striking ‘‘is amended’’ and all that 
follows through ‘‘adding’’ and inserting ‘‘is 
amended by adding’’; and 
(B) by redesignating the new subparagraph 
to be added by such section to section 1903(a)(3) 
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