Statutory Text
SEC. 1563 [sic]. CONFORMING AMENDMENTS.
(a) APPLICABILITY.—Section 2735 of the Public Health Service
Act (42 U.S.C. 300gg–21), as so redesignated 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)—
(i) in subparagraph (A), by striking ‘‘subparagraph
(D)’’ and inserting ‘‘subparagraph (D) or (E)’’;
(ii) by striking ‘‘1 through 3’’ and inserting ‘‘1 and
2’’; and
(iii) by adding at the end the following: [Provision
likely amended by section 10107(a)]
‘‘(E) ELECTION NOT APPLICABLE.—The election described
in subparagraph (A) shall not be available with respect
to the provisions of subparts I and II.’’;
(3) in subsection (c), by striking ‘‘1 through 3 shall not
apply to any group’’ and inserting ‘‘1 and 2 shall not apply to
any individual coverage or any group’’; and
(4) in subsection (d)—
(A) in paragraph (1), by striking ‘‘1 through 3 shall not
apply to any group’’ and inserting ‘‘1 and 2 shall not apply
to any individual coverage or any group’’;
(B) in paragraph (2)—
(i) in the matter preceding subparagraph (A), by
striking ‘‘1 through 3 shall not apply to any group’’
and inserting ‘‘1 and 2 shall not apply to any individual
coverage or any group’’; and
(ii) in subparagraph (C), by inserting ‘‘or, with respect
to individual coverage, under any health insurance
coverage maintained by the same health insurance
issuer’’; and
(C) in paragraph (3), by striking ‘‘any group’’ and inserting
‘‘any individual coverage or any group’’.
(b) DEFINITIONS.—Section 2791(d) of the Public Health Service
Act (42 U.S.C. 300gg–91(d)) is amended by adding at the end the
following:
‘‘(20) QUALIFIED HEALTH PLAN.—The term ‘qualified health
plan’ has the meaning given such term in section 1301(a) of
the Patient Protection and Affordable Care Act.
‘‘(21) EXCHANGE.—The term ‘Exchange’ means an American
Health Benefit Exchange established under section 1311
of the Patient Protection and Affordable Care Act.’’.
(c) TECHNICAL AND CONFORMING AMENDMENTS.—Title XXVII of
the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended—
(1) in section 2704 (42 U.S.C. 300gg), as so redesignated by
section 1201(2)—
(A) in subsection (c)—
(i) in paragraph (2), by striking ‘‘group health
plan’’ each place that such term appears and inserting
‘‘group or individual health plan’’; and
(ii) in paragraph (3)—
(I) by striking ‘‘group health insurance’’ each
place that such term appears and inserting ‘‘group
or individual health insurance’’; and
(II) in subparagraph (D), by striking ‘‘small or
large’’ and inserting ‘‘individual or group’’;
(B) in subsection (d), by striking ‘‘group health insurance’’
each place that such term appears and inserting
‘‘group or individual health insurance’’; and
(C) in subsection (e)(1)(A), by striking ‘‘group health
insurance’’ and inserting ‘‘group or individual health insurance’’;
(2) by striking the second heading for subpart 2 of part A
(relating to other requirements);
(3) in section 2725 (42 U.S.C. 300gg–4), as so redesignated
by section 1001(2)—
(A) in subsection (a), by striking ‘‘health insurance
issuer offering group health insurance coverage’’ and inserting
‘‘health insurance issuer offering group or individual
health insurance coverage’’;
(B) in subsection (b)—
(i) by striking ‘‘health insurance issuer offering
group health insurance coverage in connection with a
group health plan’’ in the matter preceding paragraph
(1) and inserting ‘‘health insurance issuer offering
group or individual health insurance coverage’’; and
(ii) in paragraph (1), by striking ‘‘plan’’ and inserting
‘‘plan or coverage’’;
(C) in subsection (c)—
(i) in paragraph (2), by striking ‘‘group health insurance
coverage offered by a health insurance issuer’’
and inserting ‘‘health insurance issuer offering group
or individual health insurance coverage’’; and
(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 appears and inserting ‘‘or a health insurance
issuer offering group or individual health insurance
coverage’’;
(B) in subsection (b), by striking ‘‘(or health insurance
coverage offered in connection with such a plan)’’ each
place that such term appears and inserting ‘‘or a health insurance
issuer offering group or individual health insurance
coverage’’; and
(C) in subsection (c)—
(i) in paragraph (1), by striking ‘‘(and group health
insurance coverage offered in connection with a group
health plan)’’ and inserting ‘‘and a health insurance
issuer offering group or individual health insurance
coverage’’;
(ii) in paragraph (2), by striking ‘‘(or health insurance
coverage offered in connection with such a plan)’’
each place that such term appears and inserting ‘‘or a
health insurance issuer offering group or individual
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 individual 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 insurance coverage’’;
(B) in subsection (b)—
(i) in paragraph (1), by striking ‘‘or a health insurance
issuer that provides health 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 connection with the plan’’ and inserting
‘‘individual 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
coverage’’;
(C) in subsection (c), by striking ‘‘health insurance
issuer providing health insurance coverage 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;
(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 subparagraph (A),
by striking ‘‘small group’’ and inserting ‘‘group
and individual’’; and
(II) in subparagraph (B)—
(aa) in the matter preceding clause (i), by
inserting ‘‘and individuals’’ after ‘‘employers’’;
(bb) in clause (i), by inserting ‘‘or any additional
individuals’’ after ‘‘additional groups’’;
and
(cc) in clause (ii), by striking ‘‘without regard
to the claims experience of those employers
and their employees (and their dependents)
or any health status-related factor relating
to such’’ and inserting ‘‘and individuals
without regard to the claims experience of
those individuals, employers and their employees
(and their dependents) or any health
status-related factor relating to such individuals’’;
and
(ii) in paragraph (2), by striking ‘‘small group’’ and
inserting ‘‘group or individual’’;
(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 individuals’’;
(II) by striking ‘‘those employers’’ and inserting
‘‘those individuals, employers’’; and
(III) by striking ‘‘such employees’’ and inserting
‘‘such individuals, employees’’;
(D) by striking subsection (e);
(E) by striking subsection (f); and
(F) by transferring such section (as amended by this
paragraph) to appear at the end of section 2702 (as added
by section 1001(4));
(9) in section 2732 (42 U.S.C. 300gg–12), as so redesignated
by section 1001(3)—
(A) by striking the section heading and all that follows
through subsection (a);
(B) in subsection (b)—
(i) in the matter preceding paragraph (1), by striking
‘‘group health plan in the small or large group
market’’ and inserting ‘‘health insurance coverage offered
in the group or individual market’’;
(ii) in paragraph (1), by inserting ‘‘, or individual,
as applicable,’’ after ‘‘plan sponsor’’;
(iii) in paragraph (2), by inserting ‘‘, or individual,
as applicable,’’ after ‘‘plan sponsor’’; and
(iv) by striking paragraph (3) and inserting the
following:
‘‘(3) VIOLATION OF PARTICIPATION OR CONTRIBUTION
RATES.—In the case of a group health plan, the plan sponsor
has failed to comply with a material plan provision relating to
employer contribution or group participation rules, pursuant to
applicable State law.’’;
(C) in subsection (c)—
(i) in paragraph (1)—
(I) in the matter preceding subparagraph (A),
by striking ‘‘group health insurance coverage offered
in the small or large group market’’ and inserting
‘‘group or individual health insurance coverage’’;
(II) in subparagraph (A), by inserting ‘‘or individual,
as applicable,’’ after ‘‘plan sponsor’’;
(III) in subparagraph (B)—
(aa) by inserting ‘‘or individual, as applicable,’’
after ‘‘plan sponsor’’; and
(bb) by inserting ‘‘or individual health insurance
coverage’’; and
(IV) in subparagraph (C), by inserting ‘‘or individuals,
as applicable,’’ after ‘‘those sponsors’’;
and
(ii) in paragraph (2)(A)—
(I) in the matter preceding clause (i), by striking
‘‘small group market or the large group market,
or both markets,’’ 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 amended 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 inserting ‘‘small employer or
an individual’’;
(ii) in paragraph (1), by inserting ‘‘, or individual,
as applicable,’’ after ‘‘employer’’ 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)—
(I) in the matter preceding subparagraph (A),
by striking ‘‘small employer’’ and inserting ‘‘employer,
or individual, as applicable,’’;
(II) in subparagraph (A), by adding ‘‘and’’ at
the end;
(III) by striking subparagraphs (B) and (C);
and
(IV) in subparagraph (D)—
(aa) by inserting ‘‘, or individual, as applicable,’’
after ‘‘employer’’; 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 individual, as applicable,’’; and
(C) by redesignating such section (as amended by this
paragraph) as section 2709 and 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 inserting ‘‘individual or group
market’’; and
(ii) in paragraph (2), by inserting ‘‘or individual
health insurance coverage’’ after ‘‘group health plans’’;
(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 amended 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 providing health insurance coverage
in the individual 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.—ø42 U.S.C. 18120¿ Notwithstanding any
other provision 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 regulations that prohibit) a
group health plan or health insurance issuer from carrying out
utilization management 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.
(e) TECHNICAL AMENDMENT TO THE EMPLOYEE RETIREMENT 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 ø29 U.S.C. 1185d¿. ADDITIONAL MARKET REFORMS.
‘‘(a) GENERAL RULE.—Except as provided in subsection (b)—
‘‘(1) the provisions of part A of title XXVII of the Public
Health Service Act (as amended by the Patient 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
subpart; 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 providing 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 Protection and Affordable
Care Act) shall not apply with respect 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 REVENUE 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 subsection (b)—
‘‘(1) the provisions of part A of title XXVII of the Public
Health Service Act (as amended by the Patient 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
subchapter; and
‘‘(2) to the extent that any provision of this subchapter conflicts
with a provision of such part A with respect to group
health plans, or health insurance issuers providing 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 Protection and Affordable
Care Act) shall not apply with respect 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.’’.