United States. Congress

“ Outreach.—The Secretaries of Health and Human Services and Labor, in conjunction with other appropriate agencies and members of the business community, shall jointly institute an outreach program to inform businesses about the availability of the wellness program grant as well as to educate businesses on how to develop programs according to recognized and promising practices and on how to measure the success of implemented programs. ”

“ For a State without a high-risk pool program, the Secretary may work with the State to coordinate with other forms of coverage expansions, such as State public-private partnerships. (c) Eligibility.— For purposes of this section, the term “eligible individual” means an individual who meets the requirements of subsection (i) (1) — (1) who— (A) is not eligible for— (i) benefits under title XVIII, XIX, or XXI of the Social Security Act; or (ii) coverage under an employment-based health plan (not including coverage under a COBRA continuation provision, as defined in section 107 (d) (1) ) ”

“ PREMIUM.— The monthly premium charged to eligible individuals for coverage under the program— (A) may vary by age so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1; (B) shall be set at a level that does not exceed 125 percent of the prevailing standard rate for comparable coverage in the individual market; and (C) shall be adjusted for geographic variation in costs. Health insurance issuers shall provide such information as the Secretary may require to determine prevailing standard rates under this paragraph. ”

“ STATE CONTRIBUTION, MAINTENANCE OF EFFORT.— As a condition of providing health benefits under this section to eligible individual residing in a State— (A) in the case of a State in which a qualified high-risk pool (as defined under section 2744 (c) (2) of the Public Health Service Act) was in effect as of July 1, 2009, the Secretary shall require the State make a maintenance of effort payment each year that the high-risk pool is in effect equal to an amount not less than the amount of all sources of funding for high-risk pool coverage made by that State in the year ending July 1, 2009 ”

“ Standards for claims attachments and coordination of benefits.— (1) STANDARD FOR HEALTH CLAIMS ATTACHMENTS.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate an interim, final rule to establish a standard for health claims attachment transaction described in section 1173 (a) (2) (B) of the Social Security Act (42 U.S.C. 1320d–2 (a) (2) (B) ) and coordination of benefits. ”

“ OPERATING RULES.—The term ‘operating rules’ means business rules for using and processing transactions, such as service level requirements, which do not impact the implementation specifications or other data content requirements.”.
(3) CONFORMING AMENDMENT.—Section 1179 (a) of such Act (42 U.S.C. 1320d–8 (a) ) is amended, in the matter before paragraph (1) — (A) by inserting “on behalf of an individual” after “1978) ”; and (B) by inserting “on behalf of an individual” after “for a financial institution”. ”

“ The entity uses a multistakeholder process that creates consensus-based companion guides, including operating rules using a voting process that ensures balanced representation by the critical stakeholders (including health plans and health care providers) so that no one group dominates the entity and shall include others such as standards development organizations, and relevant Federal or State agencies. ”

“ ON-SITE POLICIES.—Policies and services at the worksite which promote a healthy lifestyle, including policies relating to— (i) tobacco use at the worksite; (ii) the nutrition of food available at the worksite through cafeterias and vending options; (iii) minimizing stress and promoting positive mental health in the workplace ”

“ Medically Eligible Requirements.— For purposes of subsection (c) (1) (B) (ii) , an individual described in this subsection is an individual— (1) who, during the 6-month period ending on the date the individual applies for high-risk pool coverage under this section applied for individual health insurance coverage and— (A) was denied such coverage because of a preexisting condition or health status ”

“ Protection against postretirement reduction of retiree health benefits.”.
(c) Waiver.— An employer may, in a form and manner which shall be prescribed by the Secretary of Labor, apply for a waiver from this provision if the employer can reasonably demonstrate that meeting the requirements of this section would impose an undue hardship on the employer. (d) Effective Date.— The amendments made by this section shall take effect on the date of the enactment of this Act. ”