(C) required capital investments and pro-
jected costs for operation and maintenance of 
new equipment required to be installed; and 
(D) the global economic competitiveness of 
the United States. 
(3) The amount of greenhouse gas emissions 
that such rule or guidelines are projected to reduce 
as compared to overall global greenhouse gas emis-
sions. 
(d) CONSULTATION.—In carrying out subsection (c), 
the Administrator of the Environmental Protection Agen-
cy shall consult with the Administrator of the Energy In-
formation Administration, the Comptroller General of the 
United States, the Director of the National Energy Tech-
nology Laboratory, and the Under Secretary of Commerce 
for Standards and Technology. 
SEC. 514. REPEAL OF EARLIER RULES AND GUIDELINES. 
The following rules and guidelines shall be of no force 
or effect, and shall be treated as though such rules and 
guidelines had never been issued: 
(1) The proposed rule— 
(A) entitled ‘‘Standards of Performance 
for Greenhouse Gas Emissions for New Sta-
tionary Sources: Electric Utility Generating 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00087
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
Units’’, published at 77 Fed. Reg. 22392 (April 
13, 2012); and 
(B) withdrawn pursuant to the notice enti-
tled ‘‘Withdrawal of Proposed Standards of 
Performance for Greenhouse Gas Emissions 
From New Stationary Sources: Electric Utility 
Generating Units’’, published at 79 Fed. Reg. 
1352 (January 8, 2014). 
(2) The proposed rule entitled ‘‘Standards of 
Performance for Greenhouse Gas Emissions From 
New Stationary Sources: Electric Utility Generating 
Units’’, published at 79 Fed. Reg. 1430 (January 8, 
2014). 
(3) With respect to the proposed rules described 
in paragraphs (1) and (2), any successor or substan-
tially similar proposed or final rule that— 
(A) is issued prior to the date of the enact-
ment of this Act; 
(B) is applicable to any new source that is 
a fossil fuel-fired electric utility generating unit; 
and 
(C) does not meet the requirements under 
subsections (b) and (c) of section 512. 
(4) The proposed rule entitled ‘‘Carbon Pollu-
tion Emission Guidelines for Existing Stationary 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00088
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
Sources: Electric Utility Generating Units’’, pub-
lished at 79 Fed. Reg. 34830 (June 18, 2014). 
(5) The proposed rule entitled ‘‘Carbon Pollu-
tion Standards for Modified and Reconstructed Sta-
tionary Sources: Electric Utility Generating Units’’, 
published at 79 Fed. Reg. 34960 (June 18, 2014). 
(6) With respect to the proposed rules described 
in paragraphs (4) and (5), any successor or substan-
tially similar proposed or final rule that— 
(A) is issued prior to the date of the enact-
ment of this Act; and 
(B) is applicable to any existing, modified, 
or reconstructed source that is a fossil fuel-fired 
electric utility generating unit. 
SEC. 515. DEFINITIONS. 
In this chapter: 
(1) DEMONSTRATION
PROJECT.—The term 
‘‘demonstration project’’ means a project to test or 
demonstrate the feasibility of carbon capture and 
storage technologies that has received Federal Gov-
ernment funding or financial assistance. 
(2) EXISTING
SOURCE.—The term ‘‘existing 
source’’ has the meaning given such term in section 
111(a) of the Clean Air Act (42 U.S.C. 7411(a)), 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00089
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
except such term shall not include any modified 
source. 
(3) GREENHOUSE GAS.—The term ‘‘greenhouse 
gas’’ means any of the following: 
(A) Carbon dioxide. 
(B) Methane. 
(C) Nitrous oxide. 
(D) Sulfur hexafluoride. 
(E) Hydrofluorocarbons. 
(F) Perfluorocarbons. 
(4) MODIFICATION.—The term ‘‘modification’’ 
has the meaning given such term in section 111(a) 
of the Clean Air Act (42 U.S.C. 7411(a)). 
(5) MODIFIED SOURCE.—The term ‘‘modified 
source’’ means any stationary source, the modifica-
tion of which is commenced after the date of the en-
actment of this Act. 
(6) NEW SOURCE.—The term ‘‘new source’’ has 
the meaning given such term in section 111(a) of 
the Clean Air Act (42 U.S.C. 7411(a)), except that 
such term shall not include any modified source. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00090
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
Subtitle B—LNG Permitting 
Certainty and Transparency 
SEC. 521. SHORT TITLE. 
This subtitle may be cited as the ‘‘LNG Permitting 
Certainty and Transparency Act’’. 
SEC. 522. ACTION ON APPLICATIONS. 
(a) DECISION DEADLINE.—For proposals that must 
also obtain authorization from the Federal Energy Regu-
latory Commission or the United States Maritime Admin-
istration to site, construct, expand, or operate LNG export 
facilities, the Department of Energy shall issue a final de-
cision on any application for the authorization to export 
natural gas under section 3 of the Natural Gas Act (15 
U.S.C. 717b) not later than 30 days after the later of— 
(1) the conclusion of the review to site, con-
struct, expand, or operate the LNG facilities re-
quired by the National Environmental Policy Act of 
1969 (42 U.S.C. 4321 et seq.); or 
(2) the date of enactment of this Act. 
(b) CONCLUSION OF REVIEW.—For purposes of sub-
section (a), review required by the National Environ-
mental Policy Act of 1969 shall be considered concluded— 
(1) for a project requiring an Environmental 
Impact Statement, 30 days after publication of a 
Final Environmental Impact Statement; 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00091
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
(2) for a project for which an Environmental 
Assessment has been prepared, 30 days after publi-
cation by the Department of Energy of a Finding of 
No Significant Impact; and 
(3) upon a determination by the lead agency 
that an application is eligible for a categorical exclu-
sion pursuant to the National Environmental Policy 
Act of 1969 implementing regulations. 
(c) JUDICIAL ACTION.—(1) The United States Court 
of Appeals for the circuit in which the export facility will 
be located pursuant to an application described in sub-
section (a) shall have original and exclusive jurisdiction 
over any civil action for the review of— 
(A) an order issued by the Department of En-
ergy with respect to such application; or 
(B) the Department of Energy’s failure to issue 
a final decision on such application. 
(2) If the Court in a civil action described in para-
graph (1) finds that the Department of Energy has failed 
to issue a final decision on the application as required 
under subsection (a), the Court shall order the Depart-
ment of Energy to issue such final decision not later than 
30 days after the Court’s order. 
(3) The Court shall set any civil action brought under 
this subsection for expedited consideration and shall set 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00092
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
the matter on the docket as soon as practical after the 
filing date of the initial pleading. 
SEC. 523. PUBLIC DISCLOSURE OF EXPORT DESTINATIONS. 
Section 3 of the Natural Gas Act (15 U.S.C. 717b) 
is amended by adding at the end the following: 
‘‘(g) PUBLIC DISCLOSURE OF LNG EXPORT DES-
TINATIONS.—As a condition for approval of any authoriza-
tion to export LNG, the Secretary of Energy shall require 
the applicant to publicly disclose the specific destination 
or destinations of any such authorized LNG exports.’’. 
Subtitle 
C—Preventing 
Govern-
ment Waste and Protecting Coal 
Mining Jobs in America 
SEC. 531. SHORT TITLE. 
This subtitle may be cited as the ‘‘Preventing Govern-
ment Waste and Protecting Coal Mining Jobs in Amer-
ica’’. 
SEC. 532. INCORPORATION OF SURFACE MINING STREAM 
BUFFER ZONE RULE INTO STATE PROGRAMS. 
(a) IN GENERAL.—Section 503 of the Surface Min-
ing Control and Reclamation Act of 1977 (30 U.S.C. 
1253) is amended by adding at the end the following: 
‘‘(e) STREAM BUFFER ZONE MANAGEMENT.— 
‘‘(1) IN GENERAL.—In addition to the require-
ments under subsection (a), each State program 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00093
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
shall incorporate the necessary rule regarding excess 
spoil, coal mine waste, and buffers for perennial and 
intermittent streams published by the Office of Sur-
face Mining Reclamation and Enforcement on De-
cember 12, 2008 (73 Fed. Reg. 75813 et seq.), 
which complies with the Endangered Species Act of 
1973 (16 U.S.C. 1531 et seq.) in view of the 2006 
discussions between the Director of the Office of 
Surface Mining and the Director of the United 
States Fish and Wildlife Service, and the Office of 
Surface Mining Reclamation and Enforcement’s con-
sideration and review of comments submitted by the 
United States Fish and Wildlife Service during the 
rulemaking process in 2007. 
‘‘(2) STUDY OF IMPLEMENTATION.—The Sec-
retary shall— 
‘‘(A) at such time as the Secretary deter-
mines all States referred to in subsection (a) 
have fully incorporated the necessary rule re-
ferred to in paragraph (1) of this subsection 
into their State programs, publish notice of 
such determination; 
‘‘(B) during the 5-year period beginning on 
the date of such publication, assess the effec-
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00094
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
tiveness of implementation of such rule by such 
States; 
‘‘(C) carry out all required consultation on 
the benefits and other impacts of the implemen-
tation of the rule to any threatened species or 
endangered species, with the participation of 
the United States Fish and Wildlife Service and 
the United States Geological Survey; and 
‘‘(D) upon the conclusion of such period, 
submit a comprehensive report on the impacts 
of such rule to the Committee on Natural Re-
sources of the House of Representatives and the 
Committee on Energy and Natural Resources of 
the Senate, including— 
‘‘(i) an evaluation of the effectiveness 
of such rule; 
‘‘(ii) an evaluation of any ways in 
which the existing rule inhibits energy pro-
duction; and 
‘‘(iii) a description in detail of any 
proposed changes that should be made to 
the rule, the justification for such changes, 
all comments on such changes received by 
the Secretary from such States, and the 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00095
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
projected costs and benefits of such 
changes. 
‘‘(3) LIMITATION ON NEW REGULATIONS.—The 
Secretary may not issue any regulations under this 
Act relating to stream buffer zones or stream protec-
tion before the date of the publication of the report 
under paragraph (2), other than a rule necessary to 
implement paragraph (1).’’. 
(b) DEADLINE FOR STATE IMPLEMENTATION.—Not 
later than 2 years after the date of the enactment of this 
Act, a State with a State program approved under section 
503 of the Surface Mining Control and Reclamation Act 
of 1977 (30 U.S.C. 1253) shall submit to the Secretary 
of the Interior amendments to such program pursuant to 
part 732 of title 30, Code of Federal Regulations, incor-
porating the necessary rule referred to in subsection (e)(1) 
of such section, as amended by this section. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00096
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
TITLE 
VI—REDUCING 
HEALTH 
CARE BURDENS AND IMPROV-
ING PATIENT COVERAGE 
SEC. 601. REPEAL OF THE HEALTH CARE LAW AND HEALTH 
CARE-RELATED PROVISIONS IN THE HEALTH 
CARE AND EDUCATION RECONCILIATION ACT 
OF 2010. 
(a) HEALTH CARE LAW.—Effective as of the enact-
ment of Public Law 111–148, such Act is repealed, and 
the provisions of law amended or repealed by such Act 
are restored or revived as if such Act had not been en-
acted. 
(b) HEALTH CARE-RELATED PROVISIONS IN THE 
HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 
2010.—Effective as of the enactment of the Health Care 
and Education Reconciliation Act of 2010 (Public Law 
111–152), title I and subtitle B of title II of such Act 
are repealed, and the provisions of law amended or re-
pealed by such title or subtitle, respectively, are restored 
or revived as if such title and subtitle had not been en-
acted. 
SEC. 602. NO LIFETIME LIMITS. 
Part A of title XXVII of the Public Health Service 
Act, as restored under section 601(a), is amended by in-
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00097
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
serting after section 2702 (42 U.S.C. 300gg–1) the fol-
lowing: 
‘‘SEC. 2703. NO LIFETIME LIMITS. 
‘‘A group health plan and a health insurance issuer 
offering group or individual health insurance coverage 
may not establish lifetime limits on the dollar value of ben-
efits for any individual.’’. 
SEC. 603. ESTABLISH UNIVERSAL ACCESS PROGRAMS TO 
IMPROVE HIGH RISK POOLS AND REINSUR-
ANCE MARKETS. 
(a) STATE REQUIREMENT.— 
(1) IN GENERAL.—Not later than January 1, 
2017, each State shall, subject to paragraph (3)— 
(A) operate— 
(i) a qualified State reinsurance pro-
gram described in subsection (b); or 
(ii) a qualifying State high risk pool 
described in subsection (c)(1); and 
(B) apply to the operation of such a pro-
gram from State funds an amount equivalent to 
the portion of State funds derived from State 
premium assessments (as defined by the Sec-
retary) that are not otherwise used on State 
health care programs. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00098
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
100 
Health Service Act unless the pool is a 
qualifying State high risk pool described in 
subsection (c)(1); and 
(ii) the State may use premium as-
sessment funds described in paragraph 
(1)(B) to transition from operation of such 
a pool to operation of a qualified State re-
insurance program described in subsection 
(b). 
(3) APPLICATION OF FUNDS.—If the program 
or pool operated under paragraph (1)(A) is in strong 
fiscal health, as determined in accordance with 
standards established by the National Association of 
Insurance Commissioners and as approved by the 
State Insurance Commissioner involved, the require-
ment of paragraph (1)(B) shall be deemed to be 
met. 
(b) QUALIFIED STATE REINSURANCE PROGRAM.— 
(1) IN GENERAL.—For purposes of this section, 
the term ‘‘qualified State reinsurance program’’ 
means a program operated by a State program that 
provides reinsurance for health insurance coverage 
offered in the small group market in accordance 
with the model for such a program established (as 
of the date of the enactment of this Act). 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00100
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
101 
(2) FORM OF PROGRAM.—A qualified State re-
insurance program may provide reinsurance— 
(A) on a prospective or retrospective basis; 
and 
(B) on a basis that protects health insur-
ance issuers against the annual aggregate 
spending of their enrollees as well as purchase 
protection against individual catastrophic costs. 
(3) SATISFACTION OF HIPAA REQUIREMENT.— 
A qualified State reinsurance program shall be 
deemed, for purposes of section 2745 of the Public 
Health Service Act, to be a qualified high risk pool 
under such section. 
(c) QUALIFYING STATE HIGH RISK POOL.— 
(1) IN GENERAL.—A qualifying State high risk 
pool described in this subsection means a current 
section 2745 qualified high risk pool that meets the 
following requirements: 
(A) The pool provides at least two coverage 
options, one of which is a high deductible health 
plan coupled with a health savings account. 
(B) The pool is funded with a stable fund-
ing source. 
(C) The pool eliminates any waiting lists 
so that all eligible residents who are seeking 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00101
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
102 
coverage through the pool should be allowed to 
receive coverage through the pool. 
(D) The pool allows for coverage of indi-
viduals who, but for the 24-month disability 
waiting period under section 226(b) of the So-
cial Security Act, would be eligible for Medicare 
during the period of such waiting period. 
(E) The pool limits the pool premiums to 
no more than 150 percent of the average pre-
mium for applicable standard risk rates in that 
State. 
(F) The pool conducts education and out-
reach initiatives so that residents and brokers 
understand that the pool is available to eligible 
residents. 
(G) The pool provides coverage for preven-
tive services and disease management for chron-
ic diseases. 
(2) VERIFICATION OF CITIZENSHIP OR ALIEN 
QUALIFICATION.— 
(A) IN
GENERAL.—Notwithstanding any 
other provision of law, only citizens and nation-
als of the United States shall be eligible to par-
ticipate in a qualifying State high risk pool that 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00102
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
103 
receives funds under section 2745 of the Public 
Health Service Act or this section. 
(B) CONDITION OF PARTICIPATION.—As a 
condition of a State receiving such funds, the 
Secretary shall require the State to certify, to 
the satisfaction of the Secretary, that such 
State requires all applicants for coverage in the 
qualifying State high risk pool to provide satis-
factory documentation of citizenship or nation-
ality in a manner consistent with section 
1903(x) of the Social Security Act. 
(C) RECORDS.—The Secretary shall keep 
sufficient records such that a determination of 
citizenship or nationality only has to be made 
once for any individual under this paragraph. 
(3) RELATION TO SECTION 2745.—As of Janu-
ary 1, 2017, a pool shall not qualify as qualified 
high risk pool under section 2745 of the Public 
Health Service Act unless the pool is a qualifying 
State high risk pool described in paragraph (1). 
(4) WAIVERS.—In order to accommodate new 
and innovative programs, the Secretary may waive 
such requirements of this section for qualified State 
reinsurance programs and for qualifying State high 
risk pools as the Secretary deems appropriate. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00103
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
104 
(5) FUNDING.—In addition to any other 
amounts appropriated, there is appropriated to carry 
out section 2745 of the Public Health Service Act 
(including through a program or pool described in 
subsection (a)(1))— 
(A) $15,000,000,000 for the period of fis-
cal years 2017 through 2026; and 
(B) an additional $10,000,000,000 for the 
period of fiscal years 2022 through 2026. 
(d) DEFINITIONS.—In this section: 
(1) HEALTH INSURANCE COVERAGE; HEALTH 
INSURANCE ISSUER.—The terms ‘‘health insurance 
coverage’’ and ‘‘health insurance issuer’’ have the 
meanings given such terms in section 2791 of the 
Public Health Service Act. 
(2) CURRENT SECTION 2745 QUALIFIED HIGH 
RISK POOL.—The term ‘‘current section 2745 quali-
fied high risk pool’’ has the meaning given the term 
‘‘qualified high risk pool’’ under section 2745(g) of 
the Public Health Service Act as in effect as of the 
date of the enactment of this Act. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(4) STANDARD RISK RATE.—The term ‘‘stand-
ard risk rate’’ means a rate that— 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00104
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
105 
(A) is determined under the State high 
risk pool by considering the premium rates 
charged by other health insurance issuers offer-
ing health insurance coverage to individuals in 
the insurance market served; 
(B) is established using reasonable actu-
arial techniques; and 
(C) reflects anticipated claims experience 
and expenses for the coverage involved. 
(5) STATE.—The term ‘‘State’’ means any of 
the 50 States or the District of Columbia. 
SEC. 604. ELIMINATION OF CERTAIN REQUIREMENTS FOR 
GUARANTEED AVAILABILITY IN INDIVIDUAL 
MARKET. 
Section 2741(b) of the Public Health Service Act (42 
U.S.C. 300gg–41(b)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘(1)(A)’’ and inserting 
‘‘(1)’’; and 
(B) by striking ‘‘and (B)’’ and all that fol-
lows up to the semicolon at the end; 
(2) by adding ‘‘and’’ at the end of paragraph 
(2); 
(3) in paragraph (3)— 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00105
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
106 
(A) by striking ‘‘(1)(A)’’ and inserting 
‘‘(1)’’; and 
(B) by striking the semicolon at the end 
and inserting a period; and 
(4) by striking paragraphs (4) and (5). 
SEC. 605. PREVENTING UNJUST CANCELLATION OF INSUR-
ANCE COVERAGE. 
(a) CLARIFICATION REGARDING APPLICATION
OF 
GUARANTEED RENEWABILITY OF INDIVIDUAL HEALTH 
INSURANCE COVERAGE.—Section 2742 of the Public 
Health Service Act (42 U.S.C. 300gg–42) is amended— 
(1) in its heading, by inserting ‘‘, CONTINU-
ATION IN FORCE, INCLUDING PROHIBITION OF 
RESCISSION,’’ 
after 
‘‘GUARANTEED
RENEW-
ABILITY’’; 
(2) in subsection (a), by inserting ‘‘, including 
without rescission,’’ after ‘‘continue in force’’; and 
(3) in subsection (b)(2), by inserting before the 
period at the end the following: ‘‘, including inten-
tional concealment of material facts regarding a 
health condition related to the condition for which 
coverage is being claimed’’. 
(b) OPPORTUNITY FOR INDEPENDENT, EXTERNAL 
THIRD PARTY REVIEW IN CERTAIN CASES.—Subpart 1 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00106
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
107 
of part B of title XXVII of the Public Health Service Act 
is amended by adding at the end the following new section: 
‘‘SEC. 2746. OPPORTUNITY FOR INDEPENDENT, EXTERNAL 
THIRD PARTY REVIEW IN CERTAIN CASES. 
‘‘(a) NOTICE AND REVIEW RIGHT.—If a health in-
surance issuer determines to nonrenew or not continue in 
force, including by rescission, health insurance coverage 
for an individual in the individual market on the basis de-
scribed in section 2742(b)(2) before such nonrenewal, dis-
continuation, or rescission, may take effect the issuer shall 
provide the individual with notice of such proposed non-
renewal, discontinuation, or rescission and an opportunity 
for a review of such determination by an independent, ex-
ternal third party under procedures specified by the Sec-
retary. 
‘‘(b) INDEPENDENT DETERMINATION.—If the indi-
vidual requests such review by an independent, external 
third party of a nonrenewal, discontinuation, or rescission 
of health insurance coverage, the coverage shall remain in 
effect until such third party determines that the coverage 
may be nonrenewed, discontinued, or rescinded under sec-
tion 2742(b)(2).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply after the date of the enactment 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00107
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
108 
of this section with respect to health insurance coverage 
issued before, on, or after such date. 
TITLE VII—LOWERING HEALTH 
CARE COSTS 
Subtitle A—Cooperative Governing 
of Individual Health Insurance 
Coverage 
SEC. 
701. 
COOPERATIVE 
GOVERNING 
OF 
INDIVIDUAL 
HEALTH INSURANCE COVERAGE. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.) is amended by add-
ing at the end the following new part: 
‘‘PART D—COOPERATIVE GOVERNING OF 
INDIVIDUAL HEALTH INSURANCE COVERAGE 
‘‘SEC. 2795. DEFINITIONS. 
‘‘In this part: 
‘‘(1) PRIMARY
STATE.—The term ‘primary 
State’ means, with respect to individual health insur-
ance coverage offered by a health insurance issuer, 
the State designated by the issuer as the State 
whose covered laws shall govern the health insurance 
issuer in the sale of such coverage under this part. 
An issuer, with respect to a particular policy, may 
only designate one such State as its primary State 
with respect to all such coverage it offers. Such an 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00108
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
109 
issuer may not change the designated primary State 
with respect to individual health insurance coverage 
once the policy is issued, except that such a change 
may be made upon renewal of the policy. With re-
spect to such designated State, the issuer is deemed 
to be doing business in that State. 
‘‘(2) SECONDARY STATE.—The term ‘secondary 
State’ means, with respect to individual health insur-
ance coverage offered by a health insurance issuer, 
any State that is not the primary State. In the case 
of a health insurance issuer that is selling a policy 
in, or to a resident of, a secondary State, the issuer 
is deemed to be doing business in that secondary 
State. 
‘‘(3) HEALTH INSURANCE ISSUER.—The term 
‘health insurance issuer’ has the meaning given such 
term in section 2791(b)(2), except that such an 
issuer must be licensed in the primary State and be 
qualified to sell individual health insurance coverage 
in that State. 
‘‘(4) INDIVIDUAL
HEALTH
INSURANCE
COV-
ERAGE.—The term ‘individual health insurance cov-
erage’ means health insurance coverage offered in 
the individual market, as defined in section 
2791(b)(5). 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00109
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
110 
‘‘(5) APPLICABLE
STATE
AUTHORITY.—The 
term ‘applicable State authority’ means, with respect 
to a health insurance issuer in a State, the State in-
surance commissioner or official or officials des-
ignated by the State to enforce the requirements of 
this title for the State with respect to the issuer. 
‘‘(6) HAZARDOUS FINANCIAL CONDITION.—The 
term ‘hazardous financial condition’ means that, 
based on its present or reasonably anticipated finan-
cial condition, a health insurance issuer is unlikely 
to be able— 
‘‘(A) to meet obligations to policyholders 
with respect to known claims and reasonably 
anticipated claims; or 
‘‘(B) to pay other obligations in the normal 
course of business. 
‘‘(7) COVERED LAWS.— 
‘‘(A) IN
GENERAL.—The term ‘covered 
laws’ means the laws, rules, regulations, agree-
ments, and orders governing the insurance busi-
ness pertaining to— 
‘‘(i) individual health insurance cov-
erage issued by a health insurance issuer; 
‘‘(ii) the offer, sale, rating (including 
medical 
underwriting), 
renewal, 
and 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00110
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
111 
issuance of individual health insurance cov-
erage to an individual; 
‘‘(iii) the provision to an individual in 
relation to individual health insurance cov-
erage of health care and insurance related 
services; 
‘‘(iv) the provision to an individual in 
relation to individual health insurance cov-
erage of management, operations, and in-
vestment activities of a health insurance 
issuer; and 
‘‘(v) the provision to an individual in 
relation to individual health insurance cov-
erage of loss control and claims adminis-
tration for a health insurance issuer with 
respect to liability for which the issuer pro-
vides insurance. 
‘‘(B) EXCEPTION.—Such term does not in-
clude any law, rule, regulation, agreement, or 
order governing the use of care or cost manage-
ment techniques, including any requirement re-
lated to provider contracting, network access or 
adequacy, health care data collection, or quality 
assurance. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00111
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
112 
‘‘(8) STATE.—The term ‘State’ means the 50 
States and includes the District of Columbia, Puerto 
Rico, the Virgin Islands, Guam, American Samoa, 
and the Northern Mariana Islands. 
‘‘(9) UNFAIR
CLAIMS
SETTLEMENT
PRAC-
TICES.—The term ‘unfair claims settlement prac-
tices’ means only the following practices: 
‘‘(A) Knowingly misrepresenting to claim-
ants and insured individuals relevant facts or 
policy provisions relating to coverage at issue. 
‘‘(B) Failing to acknowledge with reason-
able promptness pertinent communications with 
respect to claims arising under policies. 
‘‘(C) Failing to adopt and implement rea-
sonable standards for the prompt investigation 
and settlement of claims arising under policies. 
‘‘(D) Failing to effectuate prompt, fair, 
and equitable settlement of claims submitted in 
which liability has become reasonably clear. 
‘‘(E) Refusing to pay claims without con-
ducting a reasonable investigation. 
‘‘(F) Failing to affirm or deny coverage of 
claims within a reasonable period of time after 
having completed an investigation related to 
those claims. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00112
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
113 
‘‘(G) A pattern or practice of compelling 
insured individuals or their beneficiaries to in-
stitute suits to recover amounts due under its 
policies by offering substantially less than the 
amounts ultimately recovered in suits brought 
by them. 
‘‘(H) A pattern or practice of attempting 
to settle or settling claims for less than the 
amount that a reasonable person would believe 
the insured individual or his or her beneficiary 
was entitled by reference to written or printed 
advertising material accompanying or made 
part of an application. 
‘‘(I) Attempting to settle or settling claims 
on the basis of an application that was materi-
ally altered without notice to, or knowledge or 
consent of, the insured. 
‘‘(J) Failing to provide forms necessary to 
present claims within 15 calendar days of a re-
quest with reasonable explanations regarding 
their use. 
‘‘(K) Attempting to cancel a policy in less 
time than that prescribed in the policy or by the 
law of the primary State. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00113
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
114 
‘‘(10) FRAUD AND ABUSE.—The term ‘fraud 
and abuse’ means an act or omission committed by 
a person who, knowingly and with intent to defraud, 
commits, or conceals any material information con-
cerning, one or more of the following: 
‘‘(A) Presenting, causing to be presented 
or preparing with knowledge or belief that it 
will be presented to or by an insurer, a rein-
surer, broker or its agent, false information as 
part of, in support of or concerning a fact ma-
terial to one or more of the following: 
‘‘(i) An application for the issuance or 
renewal of an insurance policy or reinsur-
ance contract. 
‘‘(ii) The rating of an insurance policy 
or reinsurance contract. 
‘‘(iii) A claim for payment or benefit 
pursuant to an insurance policy or reinsur-
ance contract. 
‘‘(iv) Premiums paid on an insurance 
policy or reinsurance contract. 
‘‘(v) Payments made in accordance 
with the terms of an insurance policy or 
reinsurance contract. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00114
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
115 
‘‘(vi) A document filed with the com-
missioner or the chief insurance regulatory 
official of another jurisdiction. 
‘‘(vii) The financial condition of an in-
surer or reinsurer. 
‘‘(viii) The formation, acquisition, 
merger, 
reconsolidation, 
dissolution 
or 
withdrawal from one or more lines of in-
surance or reinsurance in all or part of a 
State by an insurer or reinsurer. 
‘‘(ix) The issuance of written evidence 
of insurance. 
‘‘(x) The reinstatement of an insur-
ance policy. 
‘‘(B) Solicitation or acceptance of new or 
renewal insurance risks on behalf of an insurer 
reinsurer or other person engaged in the busi-
ness of insurance by a person who knows or 
should know that the insurer or other person 
responsible for the risk is insolvent at the time 
of the transaction. 
‘‘(C) Transaction of the business of insur-
ance in violation of laws requiring a license, cer-
tificate of authority or other legal authority for 
the transaction of the business of insurance. 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00115
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
116 
‘‘(D) Attempt to commit, aiding or abet-
ting in the commission of, or conspiracy to com-
mit the acts or omissions specified in this para-
graph. 
‘‘SEC. 2796. APPLICATION OF LAW. 
‘‘(a) IN GENERAL.—The covered laws of the primary 
State shall apply to individual health insurance coverage 
offered by a health insurance issuer in the primary State 
and in any secondary State, but only if the coverage and 
issuer comply with the conditions of this section with re-
spect to the offering of coverage in any secondary State. 
‘‘(b) EXEMPTIONS FROM COVERED LAWS IN A SEC-
ONDARY STATE.—Except as provided in this section, a 
health insurance issuer with respect to its offer, sale, rat-
ing (including medical underwriting), renewal, and 
issuance of individual health insurance coverage in any 
secondary State is exempt from any covered laws of the 
secondary State (and any rules, regulations, agreements, 
or orders sought or issued by such State under or related 
to such covered laws) to the extent that such laws would— 
‘‘(1) make unlawful, or regulate, directly or in-
directly, the operation of the health insurance issuer 
operating in the secondary State, except that any 
secondary State may require such an issuer— 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00116
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
117 
‘‘(A) to pay, on a nondiscriminatory basis, 
applicable premium and other taxes (including 
high risk pool assessments) which are levied on 
insurers and surplus lines insurers, brokers, or 
policyholders under the laws of the State; 
‘‘(B) to register with and designate the 
State insurance commissioner as its agent solely 
for the purpose of receiving service of legal doc-
uments or process; 
‘‘(C) to submit to an examination of its fi-
nancial condition by the State insurance com-
missioner in any State in which the issuer is 
doing business to determine the issuer’s finan-
cial condition, if— 
‘‘(i) the State insurance commissioner 
of the primary State has not done an ex-
amination within the period recommended 
by the National Association of Insurance 
Commissioners; and 
‘‘(ii) any such examination is con-
ducted in accordance with the examiners’ 
handbook of the National Association of 
Insurance Commissioners and is coordi-
nated to avoid unjustified duplication and 
unjustified repetition; 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00117
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
118 
‘‘(D) to comply with a lawful order 
issued— 
‘‘(i) in a delinquency proceeding com-
menced by the State insurance commis-
sioner if there has been a finding of finan-
cial impairment under subparagraph (C); 
or 
‘‘(ii) in a voluntary dissolution pro-
ceeding; 
‘‘(E) to comply with an injunction issued 
by a court of competent jurisdiction, upon a pe-
tition by the State insurance commissioner al-
leging that the issuer is in hazardous financial 
condition; 
‘‘(F) to participate, on a nondiscriminatory 
basis, in any insurance insolvency guaranty as-
sociation or similar association to which a 
health insurance issuer in the State is required 
to belong; 
‘‘(G) to comply with any State law regard-
ing fraud and abuse (as defined in section 
2795(10)), except that if the State seeks an in-
junction regarding the conduct described in this 
subparagraph, such injunction must be obtained 
from a court of competent jurisdiction; 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00118
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
119 
‘‘(H) to comply with any State law regard-
ing unfair claims settlement practices (as de-
fined in section 2795(9)); or 
‘‘(I) to comply with the applicable require-
ments for independent review under section 
2798 with respect to coverage offered in the 
State; 
‘‘(2) require any individual health insurance 
coverage issued by the issuer to be countersigned by 
an insurance agent or broker residing in that sec-
ondary State; or 
‘‘(3) otherwise discriminate against the issuer 
issuing insurance in both the primary State and in 
any secondary State. 
‘‘(c) CLEAR
AND CONSPICUOUS DISCLOSURE.—A 
health insurance issuer shall provide the following notice, 
in 12-point bold type, in any insurance coverage offered 
in a secondary State under this part by such a health in-
surance issuer and at renewal of the policy, with the 5 
blank spaces therein being appropriately filled with the 
name of the health insurance issuer, the name of the pri-
mary State, the name of the secondary State, the name 
of the secondary State, and the name of the secondary 
State, respectively, for the coverage concerned: 
‘‘Notice 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00119
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
120 
‘‘ ‘This policy is issued by lllll and is 
governed by the laws and regulations of the State of 
lllll, and it has met all the laws of that 
State as determined by that State’s Department of 
Insurance. This policy may be less expensive than 
others because it is not subject to all of the insur-
ance laws and regulations of the State of 
lllll, including coverage of some services or 
benefits mandated by the law of the State of 
lllll. Additionally, this policy is not subject 
to all of the consumer protection laws or restrictions 
on rate changes of the State of lllll. As with 
all insurance products, before purchasing this policy, 
you should carefully review the policy and determine 
what health care services the policy covers and what 
benefits it provides, including any exclusions, limita-
tions, or conditions for such services or benefits.’. 
‘‘(d) PROHIBITION ON CERTAIN RECLASSIFICATIONS 
AND PREMIUM INCREASES.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, a health insurance issuer that provides indi-
vidual health insurance coverage to an individual 
under this part in a primary or secondary State may 
not upon renewal— 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00120
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
121 
‘‘(A) move or reclassify the individual in-
sured under the health insurance coverage from 
the class such individual is in at the time of 
issue of the contract based on the health-status 
related factors of the individual; or 
‘‘(B) increase the premiums assessed the 
individual for such coverage based on a health 
status-related factor or change of a health sta-
tus-related factor or the past or prospective 
claim experience of the insured individual. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph 
(1) shall be construed to prohibit a health insurance 
issuer— 
‘‘(A) from terminating or discontinuing 
coverage or a class of coverage in accordance 
with subsections (b) and (c) of section 2742; 
‘‘(B) from raising premium rates for all 
policyholders within a class based on claims ex-
perience; 
‘‘(C) from changing premiums or offering 
discounted premiums to individuals who engage 
in wellness activities at intervals prescribed by 
the issuer, if such premium changes or incen-
tives— 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00121
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
122 
‘‘(i) are disclosed to the consumer in 
the insurance contract; 
‘‘(ii) are based on specific wellness ac-
tivities that are not applicable to all indi-
viduals; and 
‘‘(iii) are not obtainable by all individ-
uals to whom coverage is offered; 
‘‘(D) from reinstating lapsed coverage; or 
‘‘(E) from retroactively adjusting the rates 
charged an insured individual if the initial rates 
were set based on material misrepresentation by 
the individual at the time of issue. 
‘‘(e) PRIOR OFFERING
OF POLICY
IN PRIMARY 
STATE.—A health insurance issuer may not offer for sale 
individual health insurance coverage in a secondary State 
unless that coverage is currently offered for sale in the 
primary State. 
‘‘(f) LICENSING
OF AGENTS
OR BROKERS
FOR 
HEALTH INSURANCE ISSUERS.—Any State may require 
that a person acting, or offering to act, as an agent or 
broker for a health insurance issuer with respect to the 
offering of individual health insurance coverage obtain a 
license from that State, with commissions or other com-
pensation subject to the provisions of the laws of that 
State, except that a State may not impose any qualifica-
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00122
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS
123 
tion or requirement which discriminates against a non-
resident agent or broker. 
‘‘(g) DOCUMENTS FOR SUBMISSION TO STATE IN-
SURANCE COMMISSIONER.—Each health insurance issuer 
issuing individual health insurance coverage in both pri-
mary and secondary States shall submit— 
‘‘(1) to the insurance commissioner of each 
State in which it intends to offer such coverage, be-
fore it may offer individual health insurance cov-
erage in such State— 
‘‘(A) a copy of the plan of operation or fea-
sibility study or any similar statement of the 
policy being offered and its coverage (which 
shall include the name of its primary State and 
its principal place of business); 
‘‘(B) written notice of any change in its 
designation of its primary State; and 
‘‘(C) written notice from the issuer of the 
issuer’s compliance with all the laws of the pri-
mary State; and 
‘‘(2) to the insurance commissioner of each sec-
ondary State in which it offers individual health in-
surance coverage, a copy of the issuer’s quarterly fi-
nancial statement submitted to the primary State, 
which statement shall be certified by an independent 
VerDate Sep 11 2014 
04:09 Oct 08, 2015
Jkt 059200
PO 00000
Frm 00123
Fmt 6652
Sfmt 6201
E:\BILLS\H3682.IH
H3682
smartinez on DSK4TPTVN1PROD with BILLS