Sec. 11. Grants for health insurance risk adjustment mechanisms
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/bill/113/hr/2165/ih/section-11·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
The Secretary of Health and Human Services shall make grants to States for planning for the establishment and implementation of health insurance risk adjustment mechanisms. The Secretary shall determine the amount of a grant made to a State under this section pursuant to a formula, issued by rule not later than one year after the date of the enactment of the PPACA repeal legislation described in section 2(b), that takes into account the number of high-risk individuals in such State.
The amount of a grant made to a State under this section shall not exceed $1,000,000 for any fiscal year. The grant funds made available to a State under this section may only be used by a State for the cost associated with planning for the establishment and implementation of health insurance risk adjustment mechanisms. Such funds may not be used for costs related to administering such mechanisms. For purposes of this section: The term high-risk individual means an individual who— is a citizen or national of the United States or is lawfully present in the United States; has not been covered under creditable coverage (as defined in section 2701(c)(1) of the Public Health Service Act as in effect on March 22, 2010) during the previous 6-month period; and has a preexisting condition, as determined in a manner consistent with guidance issued by the Secretary.
With respect to a State, the term health insurance risk-adjustment mechanism shall be a mechanism that applies to— all health insurance issuers who offer health insurance coverage in such State; and all covered lives for health insurance coverage offered in such State that is subject to the requirements of section 2711 or section 2741 of the Public Health Service Act, as added by section 3 of this Act. With respect to a State, any further definition of such term shall be determined by the State insurance commissioner, acting in cooperation with health insurance issuers who offer health insurance coverage in such State.
The term State means each of the 50 States and the District of Columbia. The Secretary may not make any grants under this section after the date that is 2 years after the date of the enactment of the PPACA repeal legislation described in section 2(b).