377 
HR 3590 EAS/PP 
(ii) in paragraph (3), by striking 
‘‘issuer’’ and inserting ‘‘health insurance 
issuer’’; and 
(D) in subsection (e), by striking ‘‘health 
insurance issuer offering group health insurance 
coverage’’ and inserting ‘‘health insurance issuer 
offering group or individual health insurance 
coverage’’; 
(4) in section 2726 (42 U.S.C. 300gg–5), as so 
redesignated by section 1001(2)— 
(A) in subsection (a), by striking ‘‘(or 
health insurance coverage offered in connection 
with such a plan)’’ each place that such term ap-
pears and inserting ‘‘or a health insurance 
issuer offering group or individual health insur-
ance coverage’’; 
(B) in subsection (b), by striking ‘‘(or 
health insurance coverage offered in connection 
with such a plan)’’ each place that such term ap-
pears and inserting ‘‘or a health insurance 
issuer offering group or individual health insur-
ance coverage’’; and 
(C) in subsection (c)— 
(i) in paragraph (1), by striking ‘‘(and 
group health insurance coverage offered in 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00377
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
378 
HR 3590 EAS/PP 
connection with a group health plan)’’ and 
inserting ‘‘and a health insurance issuer of-
fering group or individual health insurance 
coverage’’; 
(ii) in paragraph (2), by striking ‘‘(or 
health insurance coverage offered in connec-
tion with such a plan)’’ each place that 
such term appears and inserting ‘‘or a 
health insurance issuer offering group or in-
dividual health insurance coverage’’; 
(5) in section 2727 (42 U.S.C. 300gg–6), as so 
redesignated by section 1001(2), by striking ‘‘health 
insurance issuers providing health insurance coverage 
in connection with group health plans’’ and inserting 
‘‘and health insurance issuers offering group or indi-
vidual health insurance coverage’’; 
(6) in section 2728 (42 U.S.C. 300gg–7), as so 
redesignated by section 1001(2)— 
(A) in subsection (a), by striking ‘‘health 
insurance coverage offered in connection with 
such plan’’ and inserting ‘‘individual health in-
surance coverage’’; 
(B) in subsection (b)— 
(i) in paragraph (1), by striking ‘‘or a 
health insurance issuer that provides health 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00378
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
379 
HR 3590 EAS/PP 
insurance coverage in connection with a 
group health plan’’ and inserting ‘‘or a 
health insurance issuer that offers group or 
individual health insurance coverage’’; 
(ii) in paragraph (2), by striking 
‘‘health insurance coverage offered in con-
nection with the plan’’ and inserting ‘‘indi-
vidual health insurance coverage’’; and 
(iii) in paragraph (3), by striking 
‘‘health insurance coverage offered by an 
issuer in connection with such plan’’ and 
inserting ‘‘individual health insurance cov-
erage’’; 
(C) in subsection (c), by striking ‘‘health in-
surance issuer providing health insurance cov-
erage in connection with a group health plan’’ 
and inserting ‘‘health insurance issuer that offers 
group or individual health insurance coverage’’; 
and 
(D) in subsection (e)(1), by striking ‘‘health 
insurance coverage offered in connection with 
such a plan’’ and inserting ‘‘individual health 
insurance coverage’’; 
(7) by striking the heading for subpart 3; 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00379
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
380 
HR 3590 EAS/PP 
(8) in section 2731 (42 U.S.C. 300gg–11), as so 
redesignated by section 1001(3)— 
(A) by striking the section heading and all 
that follows through subsection (b); 
(B) in subsection (c)— 
(i) in paragraph (1)— 
(I) in the matter preceding sub-
paragraph (A), by striking ‘‘small 
group’’ and inserting ‘‘group and indi-
vidual’’; and 
(II) in subparagraph (B)— 
(aa) in the matter preceding 
clause (i), by inserting ‘‘and indi-
viduals’’ after ‘‘employers’’; 
(bb) in clause (i), by insert-
ing ‘‘or any additional individ-
uals’’ after ‘‘additional groups’’; 
and 
(cc) in clause (ii), by strik-
ing ‘‘without regard to the claims 
experience of those employers and 
their employees (and their de-
pendents) or any health status-re-
lated factor relating to such’’ and 
inserting ‘‘and individuals with-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00380
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
381 
HR 3590 EAS/PP 
out regard to the claims experi-
ence of those individuals, employ-
ers and their employees (and their 
dependents) or any health status- 
related factor relating to such in-
dividuals’’; and 
(ii) in paragraph (2), by striking 
‘‘small group’’ and inserting ‘‘group or in-
dividual’’; 
(C) in subsection (d)— 
(i) by striking ‘‘small group’’ each 
place that such appears and inserting 
‘‘group or individual’’; and 
(ii) in paragraph (1)(B)— 
(I) by striking ‘‘all employers’’ 
and inserting ‘‘all employers and indi-
viduals’’; 
(II) by striking ‘‘those employers’’ 
and inserting ‘‘those individuals, em-
ployers’’; and 
(III) by striking ‘‘such employees’’ 
and inserting ‘‘such individuals, em-
ployees’’; 
(D) by striking subsection (e); 
(E) by striking subsection (f); and 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00381
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
383 
HR 3590 EAS/PP 
tribution or group participation rules, pursuant to 
applicable State law.’’; 
(C) in subsection (c)— 
(i) in paragraph (1)— 
(I) in the matter preceding sub-
paragraph (A), by striking ‘‘group 
health insurance coverage offered in the 
small or large group market’’ and in-
serting ‘‘group or individual health in-
surance coverage’’; 
(II) in subparagraph (A), by in-
serting ‘‘or individual, as applicable,’’ 
after ‘‘plan sponsor’’; 
(III) in subparagraph (B)— 
(aa) by inserting ‘‘or indi-
vidual, as applicable,’’ after ‘‘plan 
sponsor’’; and 
(bb) by inserting ‘‘or indi-
vidual health insurance coverage’’; 
and 
(IV) in subparagraph (C), by in-
serting ‘‘or individuals, as applicable,’’ 
after ‘‘those sponsors’’; and 
(ii) in paragraph (2)(A)— 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00383
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
384 
HR 3590 EAS/PP 
(I) in the matter preceding clause 
(i), by striking ‘‘small group market or 
the large group market, or both mar-
kets,’’ and inserting ‘‘individual or 
group market, or all markets,’’; and 
(II) in clause (i), by inserting ‘‘or 
individual, as applicable,’’ after ‘‘plan 
sponsor’’; and 
(D) by transferring such section (as amend-
ed by this paragraph) to appear at the end of 
section 2703 (as added by section 1001(4)); 
(10) in section 2733 (42 U.S.C. 300gg–13), as so 
redesignated by section 1001(4)— 
(A) in subsection (a)— 
(i) in the matter preceding paragraph 
(1), by striking ‘‘small employer’’ and in-
serting ‘‘small employer or an individual’’; 
(ii) in paragraph (1), by inserting ‘‘, 
or individual, as applicable,’’ after ‘‘em-
ployer’’ each place that such appears; and 
(iii) in paragraph (2), by striking 
‘‘small employer’’ and inserting ‘‘employer, 
or individual, as applicable,’’; 
(B) in subsection (b)— 
(i) in paragraph (1)— 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00384
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
385 
HR 3590 EAS/PP 
(I) in the matter preceding sub-
paragraph (A), by striking ‘‘small em-
ployer’’ and inserting ‘‘employer, or 
individual, as applicable,’’; 
(II) in subparagraph (A), by add-
ing ‘‘and’’ at the end; 
(III) by striking subparagraphs 
(B) and (C); and 
(IV) in subparagraph (D)— 
(aa) by inserting ‘‘, or indi-
vidual, as applicable,’’ after ‘‘em-
ployer’’; and 
(bb) by redesignating such 
subparagraph as subparagraph 
(B); 
(ii) in paragraph (2)— 
(I) by striking ‘‘small employers’’ 
each place that such term appears and 
inserting ‘‘employers, or individuals, 
as applicable,’’; and 
(II) by striking ‘‘small employer’’ 
and inserting ‘‘employer, or indi-
vidual, as applicable,’’; and 
(C) by redesignating such section (as 
amended by this paragraph) as section 2709 and 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00385
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
386 
HR 3590 EAS/PP 
transferring such section to appear after section 
2708 (as added by section 1001(5)); 
(11) by redesignating subpart 4 as subpart 2; 
(12) in section 2735 (42 U.S.C. 300gg–21), as so 
redesignated by section 1001(4)— 
(A) by striking subsection (a); 
(B) by striking ‘‘subparts 1 through 3’’ each 
place that such appears and inserting ‘‘subpart 
1’’; 
(C) by redesignating subsections (b) through 
(e) as subsections (a) through (d), respectively; 
and 
(D) by redesignating such section (as 
amended by this paragraph) as section 2722; 
(13) in section 2736 (42 U.S.C. 300gg–22), as so 
redesignated by section 1001(4)— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking 
‘‘small or large group markets’’ and insert-
ing ‘‘individual or group market’’; and 
(ii) in paragraph (2), by inserting ‘‘or 
individual health insurance coverage’’ after 
‘‘group health plans’’; 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00386
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
387 
HR 3590 EAS/PP 
(B) in subsection (b)(1)(B), by inserting 
‘‘individual health insurance coverage or’’ after 
‘‘respect to’’; and 
(C) by redesignating such section (as 
amended by this paragraph) as section 2723; 
(14) in section 2737(a)(1) (42 U.S.C. 300gg–23), 
as so redesignated by section 1001(4)— 
(A) by inserting ‘‘individual or’’ before 
‘‘group health insurance’’; and 
(B) by redesignating such section(as amend-
ed by this paragraph) as section 2724; 
(15) in section 2762 (42 U.S.C. 300gg–62)— 
(A) in the section heading by inserting 
‘‘AND APPLICATION’’ before the period; and 
(B) by adding at the end the following: 
‘‘(c) APPLICATION OF PART A PROVISIONS.— 
‘‘(1) IN
GENERAL.—The provisions of part A 
shall apply to health insurance issuers providing 
health insurance coverage in the individual market in 
a State as provided for in such part. 
‘‘(2) CLARIFICATION.—To the extent that any 
provision of this part conflicts with a provision of 
part A with respect to health insurance issuers pro-
viding health insurance coverage in the individual 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00387
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
388 
HR 3590 EAS/PP 
market in a State, the provisions of such part A shall 
apply.’’; and 
(16) in section 2791(e) (42 U.S.C. 300gg– 
91(e))— 
(A) in paragraph (2), by striking ‘‘51’’ and 
inserting ‘‘101’’; and 
(B) in paragraph (4)— 
(i) by striking ‘‘at least 2’’ each place 
that such appears and inserting ‘‘at least 
1’’; and 
(ii) by striking ‘‘50’’ and inserting 
‘‘100’’. 
(d) APPLICATION.—Notwithstanding any other provi-
sion of the Patient Protection and Affordable Care Act, 
nothing in such Act (or an amendment made by such Act) 
shall be construed to— 
(1) prohibit (or authorize the Secretary of 
Health and Human Services to promulgate regula-
tions that prohibit) a group health plan or health in-
surance issuer from carrying out utilization manage-
ment techniques that are commonly used as of the 
date of enactment of this Act; or 
(2) restrict the application of the amendments 
made by this subtitle. 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00388
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
389 
HR 3590 EAS/PP 
(e) TECHNICAL AMENDMENT TO THE EMPLOYEE RE-
TIREMENT INCOME SECURITY ACT OF 1974.—Subpart B of 
part 7 of subtitle A of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1181 et. seq.) is 
amended, by adding at the end the following: 
‘‘SEC. 715. ADDITIONAL MARKET REFORMS. 
‘‘(a) GENERAL RULE.—Except as provided in sub-
section (b)— 
‘‘(1) the provisions of part A of title XXVII of 
the Public Health Service Act (as amended by the Pa-
tient Protection and Affordable Care Act) shall apply 
to group health plans, and health insurance issuers 
providing health insurance coverage in connection 
with group health plans, as if included in this sub-
part; and 
‘‘(2) to the extent that any provision of this part 
conflicts with a provision of such part A with respect 
to group health plans, or health insurance issuers pro-
viding health insurance coverage in connection with 
group health plans, the provisions of such part A 
shall apply. 
‘‘(b) EXCEPTION.—Notwithstanding subsection (a), the 
provisions of sections 2716 and 2718 of title XXVII of the 
Public Health Service Act (as amended by the Patient Pro-
tection and Affordable Care Act) shall not apply with re-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00389
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
390 
HR 3590 EAS/PP 
spect to self-insured group health plans, and the provisions 
of this part shall continue to apply to such plans as if such 
sections of the Public Health Service Act (as so amended) 
had not been enacted.’’. 
(f) TECHNICAL AMENDMENT TO THE INTERNAL REV-
ENUE CODE OF 1986.—Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by adding at 
the end the following: 
‘‘SEC. 9815. ADDITIONAL MARKET REFORMS. 
‘‘(a) GENERAL RULE.—Except as provided in sub-
section (b)— 
‘‘(1) the provisions of part A of title XXVII of 
the Public Health Service Act (as amended by the Pa-
tient Protection and Affordable Care Act) shall apply 
to group health plans, and health insurance issuers 
providing health insurance coverage in connection 
with group health plans, as if included in this sub-
chapter; and 
‘‘(2) to the extent that any provision of this sub-
chapter conflicts with a provision of such part A with 
respect to group health plans, or health insurance 
issuers providing health insurance coverage in connec-
tion with group health plans, the provisions of such 
part A shall apply. 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00390
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
391 
HR 3590 EAS/PP 
‘‘(b) EXCEPTION.—Notwithstanding subsection (a), the 
provisions of sections 2716 and 2718 of title XXVII of the 
Public Health Service Act (as amended by the Patient Pro-
tection and Affordable Care Act) shall not apply with re-
spect to self-insured group health plans, and the provisions 
of this subchapter shall continue to apply to such plans as 
if such sections of the Public Health Service Act (as so 
amended) had not been enacted.’’. 
SEC. 1563. SENSE OF THE SENATE PROMOTING FISCAL RE-
SPONSIBILITY. 
(a) FINDINGS.—The Senate makes the following find-
ings: 
(1) Based on Congressional Budget Office (CBO) 
estimates, this Act will reduce the Federal deficit be-
tween 2010 and 2019. 
(2) CBO projects this Act will continue to reduce 
budget deficits after 2019. 
(3) Based on CBO estimates, this Act will extend 
the solvency of the Medicare HI Trust Fund. 
(4) This Act will increase the surplus in the So-
cial Security Trust Fund, which should be reserved to 
strengthen the finances of Social Security. 
(5) The initial net savings generated by the 
Community Living Assistance Services and Supports 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00391
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
392 
HR 3590 EAS/PP 
(CLASS) program are necessary to ensure the long- 
term solvency of that program. 
(b) SENSE OF THE SENATE.—It is the sense of the Sen-
ate that— 
(1) the additional surplus in the Social Security 
Trust Fund generated by this Act should be reserved 
for Social Security and not spent in this Act for other 
purposes; and 
(2) the net savings generated by the CLASS pro-
gram should be reserved for the CLASS program and 
not spent in this Act for other purposes. 
TITLE II—ROLE OF PUBLIC 
PROGRAMS 
Subtitle A—Improved Access to 
Medicaid 
SEC. 2001. MEDICAID COVERAGE FOR THE LOWEST INCOME 
POPULATIONS. 
(a) COVERAGE FOR INDIVIDUALS WITH INCOME AT OR 
BELOW 133 PERCENT OF THE POVERTY LINE.— 
(1) BEGINNING 2014.—Section 1902(a)(10)(A)(i) 
of the Social Security Act (42 U.S.C. 1396a) is 
amended— 
(A) by striking ‘‘or’’ at the end of subclause 
(VI); 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00392
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
393 
HR 3590 EAS/PP 
(B) by adding ‘‘or’’ at the end of subclause 
(VII); and 
(C) by inserting after subclause (VII) the 
following: 
‘‘(VIII) beginning January 1, 
2014, who are under 65 years of age, 
not pregnant, not entitled to, or en-
rolled for, benefits under part A of title 
XVIII, or enrolled for benefits under 
part B of title XVIII, and are not de-
scribed in a previous subclause of this 
clause, and whose income (as deter-
mined under subsection (e)(14)) does 
not exceed 133 percent of the poverty 
line (as defined in section 2110(c)(5)) 
applicable to a family of the size in-
volved, subject to subsection (k);’’. 
(2) PROVISION OF AT LEAST MINIMUM ESSEN-
TIAL COVERAGE.— 
(A) IN GENERAL.—Section 1902 of such Act 
(42 U.S.C. 1396a) is amended by inserting after 
subsection (j) the following: 
‘‘(k)(1) The medical assistance provided to an indi-
vidual described in subclause (VIII) of subsection 
(a)(10)(A)(i) shall consist of benchmark coverage described 
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00393
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS
394 
HR 3590 EAS/PP 
in section 1937(b)(1) or benchmark equivalent coverage de-
scribed in section 1937(b)(2). Such medical assistance shall 
be provided subject to the requirements of section 1937, 
without regard to whether a State otherwise has elected the 
option to provide medical assistance through coverage under 
that section, unless an individual described in subclause 
(VIII) of subsection (a)(10)(A)(i) is also an individual for 
whom, under subparagraph (B) of section 1937(a)(2), the 
State may not require enrollment in benchmark coverage 
described in subsection (b)(1) of section 1937 or benchmark 
equivalent coverage described in subsection (b)(2) of that 
section.’’. 
(B) 
CONFORMING
AMENDMENT.—Section 
1903(i) of the Social Security Act, as amended 
by section 6402(c), is amended— 
(i) in paragraph (24), by striking ‘‘or’’ 
at the end; 
(ii) in paragraph (25), by striking the 
period and inserting ‘‘; or’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(26) with respect to any amounts expended for 
medical assistance for individuals described in sub-
clause (VIII) of subsection (a)(10)(A)(i) other than 
medical assistance provided through benchmark cov-
VerDate Nov 24 2008 
09:39 Dec 29, 2009
Jkt 089200
PO 00000
Frm 00394
Fmt 6652
Sfmt 6203
E:\SENENR\H3590.EAS
H3590
wwoods2 on DSK1DXX6B1PROD with BILLS