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42 U.S.C. § 18043 — Funding for the territories

Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18043 — Funding for the territories

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Source location: Title 42, Chapter 157, § 18043; chapter-157-quality-affordable-health-care-for-all-americans.md

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**(a) In general** A territory that— (1) elects consistent with subsection (b) to establish an Exchange in accordance with part B of this subchapter 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1308&num=0&edition=prelim)) 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 18041 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18041&num=0&edition=prelim) 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 [[42 U.S.C. 1396](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396&num=0&edition=prelim) et seq.] 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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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1396 — Medicaid and CHIP Payment and Access Commission

**(a) Establishment** There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as “MACPAC”). **(b) Duties** (1) **Review of access policies for all States and annual reports** — MACPAC shall— (A) review policies of the Medicaid program established under this subchapter (in this section referred to as “Medicaid”) and the State Children’s Health Insurance Program established under subchapter XXI (in this section referred to as “CHIP”) affecting access to covered items and services, including topics described in paragraph (2); (B) make recommendations to Congress, the Secretary, and States concerning such access policies; (C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such reviews and MACPAC’s recommendations concerning such policies; and (D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs. (2) **Specific topics to be reviewed** — Specifically, MACPAC shall review and assess the following: (A) *Medicaid and CHIP payment policies* — Payment policies under Medicaid and CHIP, including— (i) the factors affecting expenditures for the efficient provision of items and services in different sectors, including the process for updating payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of ot

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1308 — Additional grants to Puerto Rico, Virgin Islands, Guam, and American Samoa; limitation on total payments

**(a) Limitation on total payments to each territory** (1) **In general** — Notwithstanding any other provision of this chapter (except for paragraph (2) of this subsection), the total amount certified by the Secretary of Health and Human Services under subchapters I, X, XIV, and XVI, under parts A and E of subchapter IV, and under subsection (b) of this section, for payment to any territory for a fiscal year shall not exceed the ceiling amount for the territory for the fiscal year. (2) **Certain payments disregarded** — Paragraph (1) of this subsection shall be applied without regard to any payment made under section 603(a)(2), 603(a)(4), 603(a)(5), 606, 613(f), or 674(a)(6) of this title. **(b) Entitlement to matching grant** (1) **In general** — Each territory shall be entitled to receive from the Secretary for each fiscal year a grant in an amount equal to 75 percent of the amount (if any) by which— (A) the total expenditures of the territory during the fiscal year under the territory programs funded under parts A and E of subchapter IV, including any amount paid to the State under part A of subchapter IV that is transferred in accordance with [section 604(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section604/d&num=0&edition=prelim) and expended under the program to which transferred; exceeds (B) the sum of— (i) the amount of the family assistance grant payable to the territory without regard to [section 609 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section609&num=0&edition=prelim); and (ii) the total amount expended by the territory during fiscal year 1995 pursuant to parts A and F of subchapter IV (as so in effect), other than for child care. (2) **Appropriat

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1308

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1305 — Short title of chapter

This chapter may be cited as the “Social Security Act”.

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18041 — State flexibility in operation and enforcement of Exchanges and related requirements

**(a) Establishment of standards** (1) **In general** — The Secretary shall, as soon as practicable after March 23, 2010, issue regulations setting standards for meeting the requirements under this title,11 See References in Text note below. and the amendments made by this title,1 with respect to— (A) the establishment and operation of Exchanges (including SHOP Exchanges); (B) the offering of qualified health plans through such Exchanges; (C) the establishment of the reinsurance and risk adjustment programs under part E; and (D) such other requirements as the Secretary determines appropriate. The preceding sentence shall not apply to standards for requirements under subtitles A and C (and the amendments made by such subtitles) for which the Secretary issues regulations under the Public Health Service Act [[42 U.S.C. 201](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section201&num=0&edition=prelim) et seq.]. (2) **Consultation** — In issuing the regulations under paragraph (1), the Secretary shall consult with the National Association of Insurance Commissioners and its members and with health insurance issuers, consumer organizations, and such other individuals as the Secretary selects in a manner designed to ensure balanced representation among interested parties. **(b) State action** Each State that elects, at such time and in such manner as the Secretary may prescribe, to apply the requirements described in subsection (a) shall, not later than January 1, 2014, adopt and have in effect— (1) the Federal standards established under subsection (a); or (2) a State law or regulation that the Secretary determines implements the standards within the State. **(c) Failure to establish Exchange or implement requirements** (1) **In gen

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18041

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18021 — Qualified health plan defined

**(a) Qualified health plan** In this title: 11 See References in Text note below. (1) **In general** — The term “qualified health plan” means a health plan that— (A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in [section 18031(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18031/c&num=0&edition=prelim) issued or recognized by each Exchange through which such plan is offered; (B) provides the essential health benefits package described in [section 18022(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18022/a&num=0&edition=prelim); and (C) is offered by a health insurance issuer that— (i) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title; 1 (ii) agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange; (iii) agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and (iv) complies with the regulations developed by the Secretary under [section 18031(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18031/d&num=0&edition=prelim) and such other requirements as an applicable Exchange may establish. (2) **Inclusion of CO–OP plans and multi-State qualified health plans** — Any reference in this title 1 to a qualified health plan shall be deemed to include a quali

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18044 — Level playing field

**(a) In general** Notwithstanding any other provision of law, any health insurance coverage offered by a private health insurance issuer shall not be subject to any Federal or State law described in subsection (b) if a qualified health plan offered under the Consumer Operated and Oriented Plan program under [section 18042 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18042&num=0&edition=prelim), or a multi-State qualified health plan under [section 18054 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18054&num=0&edition=prelim), is not subject to such law. **(b) Laws described** The Federal and State laws described in this subsection are those Federal and State laws relating to— (1) guaranteed renewal; (2) rating; (3) preexisting conditions; (4) non-discrimination; (5) quality improvement and reporting; (6) fraud and abuse; (7) solvency and financial requirements; (8) market conduct; (9) prompt payment; (10) appeals and grievances; (11) privacy and confidentiality; (12) licensure; and (13) benefit plan material or information.

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18044

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1308 — Additional grants to Puerto Rico, Virgin

Page 2560 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1308 this chapter, of chapter 2, 21, or 23 of the Inter- nal Revenue Code of 1986, or of any provision of subtitle F of such Code which corresponds (with- in the meaning of section 7852(b) of such Code) to a provision contained in subchapter E of chapter 9 of the Internal Revenue Code of 1939, or of any rules or regulations issued thereunder, knowing such representations to be false, shall be deemed guilty of a misdemeanor, and, upon conviction thereof, shall be punished by a fine not exceeding $1,000, or by imprisonment not ex- ceeding one year, or both. (b) Whoever, with the intent to elicit informa- tion as to the social security account number, date of birth, employment, wages, or benefits of any individual (1) falsely represents to the Com- missioner of Social Security or the Secretary that he is such individual, or the wife, husband, widow, widower, divorced wife, divorced hus- band, surviving divorced wife, surviving di- vorced husband, surviving divorced mother, sur- viving divorced father, child, or parent of such individual, or the duly authorized agent of such individual, or of the wife, husband, widow, wid- ower, divorced wife, divorced husband, surviving divorced wife, surviving divorced husband, sur- viving divorced mother, surviving divorced fa- ther, child, or parent of such individual, or (2) falsely represents to any person that he is an employee or agent of the United States, shall be deemed guilty of a felony, and, upon conviction thereof, shall be punished by a fine not exceed- ing $10,000 for each occurrence of a violation, or by imprisonment not exceeding 5 years, or both. (Aug. 14, 1935, ch. 531, title XI, § 1107, as added Aug. 10, 1939, ch. 666, title VIII, § 802, 53 Stat.

Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1308

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1396 — Medicaid and CHIP Payment and Access

Page 4009 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396 of the enactment of this Act [Oct. 6, 2014], the Sec- retary shall develop and report to Congress on a stra- tegic plan for collecting or otherwise accessing data on race and ethnicity for purposes of specifying quality measures and resource use and other measures under subsections (c) and (d) of section 1899B of the Social Se- curity Act, as added by subsection (a), and, as the Sec- retary determines appropriate, other similar provisions of, including payment adjustments under, title XVIII of such Act (42 U.S.C. 1395 et seq.).’’ SUBCHAPTER XIX—GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS § 1396. Medicaid and CHIP Payment and Access Commission (a) Establishment There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as ‘‘MACPAC’’). (b) Duties (1) Review of access policies for all States and annual reports MACPAC shall— (A) review policies of the Medicaid pro- gram established under this subchapter (in this section referred to as ‘‘Medicaid’’) and the State Children’s Health Insurance Pro- gram established under subchapter XXI (in this section referred to as ‘‘CHIP’’) affecting access to covered items and services, includ- ing topics described in paragraph (2); (B) make recommendations to Congress, the Secretary, and States concerning such access policies; (C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such re- views and MACPAC’s recommendations con- cerning such policies; and (D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, includ- ing the impli

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 18043 — Funding for the territories

Page 9117 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 18044 advisory board, except that section 14 of such Act’’ in text. 2010—Subsec. (b)(3), (4). Pub. L. 111–148, § 10104(l), added par. (3) and redesignated former par. (3) as (4). Statutory Notes and Related Subsidiaries CONSUMER OPERATED AND ORIENTED PLAN PROGRAM CONTINGENCY FUND Pub. L. 112–240, title VI, § 644, Jan. 2, 2013, 126 Stat. 2362, provided that: ‘‘(a) ESTABLISHMENT.—The Secretary of Health and Human Services shall establish a fund to be used to provide assistance and oversight to qualified nonprofit health insurance issuers that have been awarded loans or grants under section 1322 of the Patient Protection and Affordable Care Act (42 U.S.C. 18042) prior to the date of enactment of this Act [Jan. 2, 2013]. ‘‘(b) TRANSFER AND RESCISSION.— ‘‘(1) TRANSFER.—From the unobligated balance of funds appropriated under section 1322(g) of the Pa- tient Protection and Affordable Care Act (42 U.S.C. 18042(g)), 10 percent of such sums are hereby trans- ferred to the fund established under subsection (a) to remain available until expended. ‘‘(2) RESCISSION.—Except as provided for in para- graph (1), amounts appropriated under section 1322(g) of the Patient Protection and Affordable Care Act (42 U.S.C. 18042(g)) that are unobligated as of the date of enactment of this Act [Jan. 2, 2013] are rescinded.’’ § 18043. Funding for the territories (a) In general A territory that— (1) elects consistent with subsection (b) to establish an Exchange in accordance with part B of this subchapter 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 sub- section (c); o

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