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Added by section 1204 of HCERA. Provides that territories electing to establish an Exchange will be treated as States for such purposes and entitled for Federal funding and that territories not making this election will be given an increase in the Federal dollar limitation for Medicaid funding.
Specifies terms and conditions for territories electing to establish Exchanges and appropriates $1B between 2014 and 2019, $925M of which is for Puerto Rico.
A dedicated CCIIO page lists territories receiving Exchange establishment grants.
On December 10, 2012, an HHS letter to territories outlined the ACA’s applicability to territories, including funding options under section 1323.
On Nov. 25, 2013 HHS issued a proposed rule establishing the CY 2015 benefit and payment parameters for the cost-sharing reductions (including the annual limitation on cost-sharing for stand-alone dental plans), advance premium tax credit, reinsurance, and risk adjustment programs as required by the ACA. In addition, the proposed rule establishes the user fees for the Federally-facilitated Exchanges (FFEs), the annual open enrollment period for 2015, the actuarial value (AV) calculator, and other key provisions as required by the law. Note that the rule allows for adjustments to the risk corridors and other premium stabilization programs in 2014 to account for the “transitional policy” (see the Nov. 14 CCIIO letter to Insurance Commissioners) that addressed plan cancellations, which could equate to broader risk corridors and thus higher stabilization payments to plans. Comments are due by Dec. 26, 2013.
SEC. 1323 [42 U.S.C. 18043]. FUNDING FOR THE TERRITORIES.
[New section 1323 inserted by section 1204(a) of HCERA]
(a) IN GENERAL.—A territory that—
(1) elects consistent with subsection (b) to establish an Exchange
in accordance with part II of this subtitle and establishes
such an Exchange in accordance with such part shall be
treated as a State for purposes of such part and shall be entitled
to payment from the amount allocated to the territory
under subsection (c); or
(2) does not make such election shall be entitled to an increase
in the dollar limitation applicable to the territory under
subsections (f) and (g) of section 1108 of the Social Security Act
(42 U.S.C. 1308) for such period in such amount for such territory
and such increase shall not be taken into account in computing
any other amount under such subsections.
(b) TERMS AND CONDITIONS.—An election under subsection
(a)(1) shall—
(1) not be effective unless the election is consistent with
section 1321 and is received not later than October 1, 2013;
and
(2) be contingent upon entering into an agreement between
the territory and the Secretary that requires that—
(A) funds provided under the agreement shall be used
only to provide premium and cost-sharing assistance to
residents of the territory obtaining health insurance coverage
through the Exchange; and
(B) the premium and cost-sharing assistance provided
under such agreement shall be structured in such a manner
so as to prevent any gap in assistance for individuals
between the income level at which medical assistance is
available through the territory’s Medicaid plan under title
XIX of the Social Security Act and the income level at
which premium and cost-sharing assistance is available
under the agreement.
(c) APPROPRIATION AND ALLOCATION.—
(1) APPROPRIATION.—Out of any funds in the Treasury not
otherwise appropriated, there is appropriated for purposes of
payment pursuant to subsection (a) $1,000,000,000, to be available
during the period beginning with 2014 and ending with
2019.
(2) ALLOCATION.—The Secretary shall allocate the amount
appropriated under paragraph (1) among the territories for
purposes of carrying out this section as follows:
(A) For Puerto Rico, $925,000,000.
(B) For another territory, the portion of $75,000,000
specified by the Secretary
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