Index for HR3962: Affordable Health Care for America Act

ACCEPTABLE coverage ;   Secretary developing procedures to provide for transition of eligible individuals enrolled in health insurance coverage offered through high-risk pool established under section to be enrolled in

ACCEPTABLE coverage so long as Secretary of Labor determining that coverage for employees being substantially equivalent or greater than coverage provided for employees pursuant to essential benefits packaging ;   Coverage provided pursuant to Hawaii Prepaid Health Care Act to be treated as qualified health benefits planning providing

ACCEPTABLE coverage for purposes of division ;   Subparagraph of paragraph not applying to individual having coverage treating as acceptable coverage for purposes of section 59b(d)(2) of Internal Revenue Code of 1986 but not treated as

ACCEPTABLE coverage ;   Affordable credit eligible individual if resident being resident of one of 50 States to be treated as covered by

ACCEPTABLE coverage ;   Individual's responsibility to obtain

ACCEPTABLE coverage ;   Term qualified health coverage meaning

ACCIDENT benefits to members association and dependents ;   Purposes of providing for payment of sick and

ACCOUNT special circumstances of smaller plans, different types of plans and newer plans ;   Methodolology to be designed to take into

ACCOUNT ;   Participating employment-based plan taking into

ACCOUNT under subsection ;   Purposes of section, costs paid or incurred by employer for food or health insurance not to be taken into

ACCOUNT differences in risk characteristics of individuals and employees enrolled under different Exchange-participating health benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ;   Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into

ACCOUNT under section ;   Only amounts taking into account in connection with tax imposed under section 871(b) to be taken into

ACCOUNT under subparagraph to be reduced by amount of crediting or refunding ;   Amount of tax taking into

ACCOUNT economic relationships among entities ;   Treatment of member of foreign controlled group of entities as common parent of group if treatment being appropriate taking into

ACCOUNT innovation in health care and considering standards reducing health disparities ;   Committee taking into

ACCOUNTABILITY of QHBP offering entities in meeting Federal health insurance requirements ;   Commissioner undertaking activities in accordance with subtitle to promote

ACTUARIAL basis for including coverage under basic plan of services described in section 222(d)(4)(a) ;   Commissioner estimating basic per enrollee determined on average

ACTUARIAL services if doing so not involving restraint of trade ;   Performing

ACTUARIAL value described in section 213(b) used for purpose ;   Only premium amounting attributable to

ACTUARIAL value percentage specified in table under section 343(d) for income tier involved ;   Commissioner adjusting maximum out-of-pocket limits under paragraph to ensure that limits meeting

ACTUARIAL value percentages to be determined with respect to individual ;   Two

PAYMENTS and amount of payments shared with plan and description of percentage of prescriptions For which PBM receiving payments ;   Administrative and other payments from pharmaceutical manufacturers and description of types of

ADMINISTRATIVE action to increase use of electronic health records by small health care providers including use of public and private funding sources ;   Including recommendations for legislation or

ADMINISTRATIVE costs related to operating public health insurance option  ;  

ADMINISTRATIVE costs of conducting status verification under paragraph  ;  

ADMINISTRATIVE functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into contracts under subsection of section ;   Secretary entering into contracts for purpose of performing

PAYMENT rate or methodolology established under section or section 324 ;   No administrative or judicial review of

ADMINISTRATIVE simplification provisions under part C of title XI of Social Security Act with respect to qualified health benefits planing offers ;   QHBP offering entity required to comply with

ADOPTION of recommending and providing Committee with further opportunity to modify previous recommendations and submitting new recommendations to Secretary on timely basis ;   Secretary notifying Health benefiting Advisory Committee in writing of determining and reasons for not proposing

AFFIRMATIVE election before employer automatically enrolling employee plan ;   Employer providing employee with 30-day period to make

AFFORDABILITY if making eligible for coverage in Exchange ;   Improving benefits and

AFFORDABILITY cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's modified adjusted gross income  ;  

AFFORDABILITY credits provided under subtitle C of title II not used for purposes of paying for services  ;  

AFFORDABILITY credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of income verification for purposes of subtitle ;   Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for

AFFORDABILITY credits under subtitle B using same methodologies ;   Administering

AFFORDABILITY credits under subtitle not to be treated to be benefit provided under section 403 of title  ;  

AFFORDABILITY credits on behalf of individuals being not lawfully present in United States ;   Nothing in subtitle allowing Federal payments for

AFFORDABILITY premium credits under subtitle C as result of increase in premium in basic plans as result of application of requirement ;   State entering into arrangement satisfactory to Commissioner to reimburse Commissioner for amount of net increase in

ASSESSMENT against issuers for pool losses ;   Case of State required health insurance issuers to contribute to State high-risk pool or similar arrangement for

ASSESSMENT and brief counseling for domestic violence as part of behavioral health assessment or primary care visit and determining appropriate coverage for assessment and counseling ;   Secretary supporting need for

HEALTH care ;   Term advanced directive including living or durable power of attorney for

INFORMATION relating to violation ;   Attorney general of State

AUTOMATIC enrollment for Employer sponsored health Benefits  ;  

AUTOMATIC enrollment requirement under paragraph ;   Writing notice of employees' rights and obligations relating to

AUTOMATIC payroll deduction of employee contributions to employment-based health plan ;   Subsection superseding law of State preventing

BACK ;   Providers participating in Medicare choosing to opt out of participating in public health insurance option opting

BEHAVIORAL health treatments ;   Mental health and substance use disorder services including

COBRA continations coverage extended under section to State health benefits risking pool recognized by Commissioner for purposes of section solely by reason of extension of coverage beyond date on which coverage otherwise to have expired ;   Provision having effect of limiting or precluding access by qualified beneficiary whose

EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ;   Former employers or employee organizations or associations or voluntary

BENEFICIARY identification card or similar mechanism ;   Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan

JURISDICTION ;   Enforcement process including timely investigation of complaints, random audits to ensure compliance, civil monetary and programmatic penalties for noncompliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part and concurrent State enforcement

CAPITATION and direct contracting with providers ;   Bundling of services, differential payment rates, performance or utilization based payments, partial

CERTIFICATION under applicable State law ;   Act not to be construed as superseding laws of State or jurisdiction designed to prohibit qualified health benefits planning from discriminating with respect to participation, reimbursement, covered services, indemnification or related requirements under plan against health care provider acting within scope of provider's license or

ADMINISTRATIVE simplification provisions of part and Health Insurance Portability and Accountability Act of 1996 ;   Secretary promulgating annual audit and certification process to ensure that health plans and clearinghouses being syntactically and functionally compliant standard transactions mandated pursuant to

CHILD health assistance under title XXI of Social Security Act for period during Y1 not to be Exchange-eligible individual during period ;   Individual being eligible for

CHILD means with respect to principal enrollee in qualified health benefits planning ;   Term qualified

CHILD support order ;   Respect to period during that health coverage for child to be provided by individual pursuant to

CIVIL action in District Court of United States to collect civil penalty under subsection ;   Secretary bringing

CIVIL law identified by Secretary by regulation imposing sanctions with respect to waste, fraud and abuse under Medicare ;   Provisions of

CIVIL penalty against employer of $100 for day in period beginning on date ;   Secretary assessing

CIVIL penalty collected under section 502(c) of Employee Retirement Income Security Act of 1974 or sectioning 2793(g) of Public Health Service Act with respect to failure ;   Tax imposed under paragraph with respect to failure to be reduced by amount of

COBRA continations coverage after date of enactment of Act ;   Cobra continations coverage provision covered under

COBRA continations coverage after date of enactment of Act ;   Cobra continations coverage provision covered under

COBRA continations provision meaning provisions of law described in paragraph ;   Term

COERCIVE practices to force providers not to contract with other entities offering coverage through Health Insurance Exchange ;   Entity complying with other applicable requirements of title that including standards regarding billing and collection practices for premiums and related grace periods and including standards to ensure that entity not using

COINSURANCE, copayments and similar charges ;   Term cost-sharing including deductibles,

COLLECTIVE bargaining over terms or conditions of employment related to health care ;   Nothing in division to be construed to alter or supersede statutory or other obligation to engage in

COLLECTIVE bargaining agreement ;   Plan amendment making pursuant to collective bargaining agreement relating to plan amending plan solely to conform to requirement added by division not to be treated as termination of

HEALTH plan to be treated as amounts paid by employer ;   Contributions making pursuant to collective bargaining agreement or other agreement group

ROBUST requiring minimal augmentation by paper transactions or clarifiations by further communications ;   Efficient and

COMPARATIVE manner and including information on benefits premiums, cost-sharing, quality, provider networks and consumer satisfaction ;   Information to be provided in

COMPENSATION of employee not to be treated as amount paid by employer ;   Corresponding reduction in

COMPENSATION paid to employees being not subject to election ;   Subsection to be applied for period by taking into account only

COMPETITIVE disadvantage ;   Secretary delaying implementation reform in geographic areas in which implementation placing public health insurance option at

COMPETITIVE procedures to be used in awarding contracts under subtitle to extent  ;  

CIVIL monetary and programmatic penalties for noncompliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part and concurrent State enforcement jurisdiction ;   Enforcement process including timely investigation of complaints, random audits to ensure compliance,

COMPLIANCE with Federal requirements ;   Commissioner conducting audits of qualified health benefits planning

COMPLIANCE with standards for approval under section ;   Commissioner establishing process to work with State described in subparagraph to provide assistance necessary to assure that State's Exchange coming into

COMPLIANCE ;   Secretary taking timely enforcement action as appropriate to achieve

COMPLIANCE with health coverage participation requirements ;   Periodic investigations to determine

COMPLIANCE audits and targeted audits in response to complaints or other suspected noncompliance ;   Audits including random

COMPLIANCE procedures established by Commissioner ;   Determination by Commissioner to terminate contract to be made in accordance with formal investigation and

COMPLIANCE purposes and purpose of combating waste ;   Permitting State or Federal law enforcement authorities to use information provided for program

CONSENT of producer, manufacturer or importer referred in subparagraph to allowance of crediting or making of refund ;   Allowing or made only if seller filing with Secretary written

CONSTRAINTS for electronic transactions including companion guides ;   Permitting no additions or

CONTRACT health care service purchasing options for group plan sponsors ;   Business and consumer collaborative providing direct

CONSUMER focus including timeliness ;   Cooperative operating with strong

CONSUMER protections ;   Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other

CONSUMER protections under subtitle D of title II ;   Includ establishment of risk pooling mechanism under section 306 and

CONSUMER protections of residents and residents retaining right to bring claim in State court in State in which resident residing ;   Retaining responsibility for

CONSUMER satisfaction ;   Information to be provided in comparative manner and including information on benefits premiums, cost-sharing, quality, provider networks and

CONTRACT with QHBP offering entity under section 304(c) for offering of Exchange-participating health benefits planning in service area unless following requirements being met ;   Commissioner not entering into

CONTRACT between producer, manufacturer or importer of deviceing and person ;   Price at device being so sold determined in accordance with

CONTRACT health care service purchasing options for group plan sponsors ;   Business and consumer collaborative providing direct

CONTRACT sale of medical device ;   Case of crediting or refunding under section 6416 of tax imposed under section on specified

CONTRACT sale means with respect to medical device ;   Term specified

CONTRIBUTION specified in subsection for coverage ;   Employer timely paying to issuer of coverageing amount not less than employer required

CONTRIBUTION being equal to amount equal to 8 percent of average wages paid by employer during period of enrollment ;   Contribution being made in accordance with section with respect to employee if

COOPERATIVE ;   No member having more than 5 percent voting interest in

TAX under section 501(a) ;   Purposes of section term person including corporation being not organization exempt from

CREDIT determined under subsection to be reduced by amount  ;  

AFFORDABILITY credit amount otherwise applicable if individual enrolling in basic plan ;   Individual to be responsible for difference between premium for planning and

DEBT ;   Abilities to restructure

DEFICIT ;   Secretary making adjustments as necessary to eliminate

DENTAL ;   Nothing in division to be construed as prohibiting qualified health benefits planning from subcontracting with stand alone health insurance issuers or insurers for provision of

DISABILITIES, representatives of relevant governmental agencies and one practicing physician or other health professional and expert in child and adolescent health and representing balance among various sectors of health care system so ;   Labor, health insurance issuers, experts in health care financing and delivery, experts in oral health care, experts in racial and ethnic disparities, experts on health care needs and disparities of individuals with

DISALLOWANCE of claimed tax benefits by reason of transaction lacking economic substance or failing to meet requirements of similar rule of law  ;  

DISCRIMINATION in health benefits or benefit structures for qualifing health benefits ;   Qualified health benefits planning complying with standards established by Commissioner to prohibit

DISCRIMINATION in health Care ;   Sec 252 prohibiting

DISCRIMINATION by employer in violation of subsection bringing action governed by rules, procedures, legal burdens of proof and remedies setting forth in section 40(b) of Consumer Product Safety Act 15 USC 2087(b) ;   Employee covered by section alleging

DISCRIMINATION under Act ;   Provision of services by Indian health care provider exclusively to Indians and dependents not constituting

DISENROLL from health benefiting coverage prior to enrolling in program ;   Issuer or employment-based health plan to be responsible for reimbursing program for medical expenses incurred by program for individual Secretary finds encouraged by issuer to

INFORMATION as determined appropriate by Commissioner ;   QHBP offering entity offering Exchange-participating health benefits planning complying with standards established by Commissioner for accurate and timely disclosure to Commissioner and public of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other

DISENROLLMENT plan ;   Assistance to individuals with problems arising from

AFFORDABILITY premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating health benefits planing ;   Commissioner coordinating distribution of

DOCUMENTATION of actual costs of items and services For which claim submitted ;   Participating employment-based plan submitting claims for reimbursement to Secretary containing

ASSESSMENT and counseling ;   Secretary supporting need for assessment and brief counseling for domestic violence as part of behavioral health assessment or primary care visit and determining appropriate coverage for

DRUG having higher cost for QHBP offering entity ;   Information on percentage and number of cases under contract in which individuals switched because of PBM policies or direct or indirect control of PBM from prescribed drug having lower cost for QHBP offering entity to

DRUG costs under qualified health benefits planning ;   QHBP offering entity contracts with pharmacy benefit manager or other entity to manage prescription drug coverage or otherwise controlling prescription

DRUG costs under qualified health benefits planning ;   QHBP offering entity contracts with pharmacy benefit manager or other entity to manage prescription drug coverage or otherwise controlling prescription

DRUG plans ;   Heading of section 139a of Code amended by inserting and retiree health plans after prescription

DRUG prices and spending ;   Commissioner preparing public report providing industrywide aggregate or average information to be used in assessing overall impact of PBMS on prescription

DUTY of care owed by health care providers to patients in medical malpractice action or claim USC 11151(7) ;   Development, recognition or implementation of guideline or other standard under provision described in subsection not to be construed to establish standard of care or

ECONOMIC relationships among entities ;   Treatment of member of foreign controlled group of entities as common parent of group if treatment being appropriate taking into account

EDUCATIONAL activities to increase awareness of Health Insurance Exchange and available small employer health plan options  ;  

ELECTRONIC funds transferring under section 1173a ;   Payment being other than electronic funds transferring so long as Secretary adopting and implementing standard for

ELIGIBILITY for health plan and health claiming status under section to be adopted not later than October 1, 2011 ;   Including operating rules for transactions for

AFFORDABILITY credits under subtitle ;   Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for

ELIGIBILITY determinations making by Secretary under section ;   Respect to

ELIGIBILITY requirements for employer hardship waiver and safeguards being necessary to protect employees of employer ;   Secretaries and Commissioner submitting recommendations about criteria Congress including when developing

COLLECTIVE bargaining agreements between employee representatives and 1 or more employers ratified before date of enactment of Act ;   Case of group health plan maintained pursuant to 1 or more

CONTRIBUTIONS to fund plan ;   Active employee of employer maintaining plan or employer making making substantial

HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ;   Employee offered Exchange-participating

FELONY and fined or imprisoned ;   Officer or employee or former officer or employee of Health Choices Commissioner or officer or employee or former officer or employee of contractor of Health Choices Commissioner publishing or communicating information in individual's possession by reason of employing or positioning as officer to be guilty of

HEALTH benefits planning in accordance with section 412 ;   Employer offering employee individual and family coverage under qualified