Patient Protection and Affordable Care Act/Title I/Subtitle G

by United States Congress

Subtitle G--Miscellaneous Provisions

SEC. 1551. DEFINITIONS.

Unless specifically provided for otherwise, the definitions contained in section 2791 of the Public Health Service Act (42 U.S.C. 300gg-91) shall apply with respect to this title.

SEC. 1552. TRANSPARENCY IN GOVERNMENT.

Not later than 30 days after the date of enactment of this Act, the Secretary of Health and Human Services shall publish on the Internet website of the Department of Health and Human Services, a list of all of the authorities provided to the Secretary under this Act (and the amendments made by this Act).

SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE.

(a) In General- The Federal Government, and any State or local government or health care provider that receives Federal financial assistance under this Act (or under an amendment made by this Act) or any health plan created under this Act (or under an amendment made by this Act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.

(b) Definition- In this section, the term `health care entity' includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.

(c) Construction and Treatment of Certain Services- Nothing in subsection (a) shall be construed to apply to, or to affect, any limitation relating to--

(1) the withholding or withdrawing of medical treatment or medical care;

(2) the withholding or withdrawing of nutrition or hydration;

(3) abortion; or

(4) the use of an item, good, benefit, or service furnished for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason.

(d) Administration- The Office for Civil Rights of the Department of Health and Human Services is designated to receive complaints of discrimination based on this section.

SEC. 1554. ACCESS TO THERAPIES.

Notwithstanding any other provision of this Act, the Secretary of Health and Human Services shall not promulgate any regulation that--

(1) creates any unreasonable barriers to the ability of individuals to obtain appropriate medical care;

(2) impedes timely access to health care services;

(3) interferes with communications regarding a full range of treatment options between the patient and the provider;

(4) restricts the ability of health care providers to provide full disclosure of all relevant information to patients making health care decisions;

(5) violates the principles of informed consent and the ethical standards of health care professionals; or

(6) limits the availability of health care treatment for the full duration of a patient's medical needs.

SEC. 1555. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE PROGRAMS.

No individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendments), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.

SEC. 1556. EQUITY FOR CERTAIN ELIGIBLE SURVIVORS.

(a) Rebuttable Presumption- Section 411(c)(4) of the Black Lung Benefits Act (30 U.S.C. 921(c)(4)) is amended by striking the last sentence.

(b) Continuation of Benefits- Section 422(l) of the Black Lung Benefits Act (30 U.S.C. 932(l)) is amended by striking `, except with respect to a claim filed under this part on or after the effective date of the Black Lung Benefits Amendments of 1981'.

(c) Effective Date- The amendments made by this section shall apply with respect to claims filed under part B or part C of the Black Lung Benefits Act (30 U.S.C. 921 et seq., 931 et seq.) after January 1, 2005, that are pending on or after the date of enactment of this Act.

SEC. 1557. NONDISCRIMINATION.

(a) In General- Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), or section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments). The enforcement mechanisms provided for and available under such title VI, title IX, section 504, or such Age Discrimination Act shall apply for purposes of violations of this subsection.

(b) Continued Application of Laws- Nothing in this title (or an amendment made by this title) shall be construed to invalidate or limit the rights, remedies, procedures, or legal standards available to individuals aggrieved under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or the Age Discrimination Act of 1975 (42 U.S.C. 611 et seq.), or to supersede State laws that provide additional protections against discrimination on any basis described in subsection (a).

(c) Regulations- The Secretary may promulgate regulations to implement this section.

SEC. 1558. PROTECTIONS FOR EMPLOYEES.

The Fair Labor Standards Act of 1938 is amended by inserting after section 18B (as added by section 1512) the following:

`SEC. 18C. PROTECTIONS FOR EMPLOYEES.

`(a) Prohibition- No employer shall discharge or in any manner discriminate against any employee with respect to his or her compensation, terms, conditions, or other privileges of employment because the employee (or an individual acting at the request of the employee) has--

`(1) received a credit under section 36B of the Internal Revenue Code of 1986 or a subsidy under section 1402 of this Act;

`(2) provided, caused to be provided, or is about to provide or cause to be provided to the employer, the Federal Government, or the attorney general of a State information relating to any violation of, or any act or omission the employee reasonably believes to be a violation of, any provision of this title (or an amendment made by this title);

`(3) testified or is about to testify in a proceeding concerning such violation;

`(4) assisted or participated, or is about to assist or participate, in such a proceeding; or

`(5) objected to, or refused to participate in, any activity, policy, practice, or assigned task that the employee (or other such person) reasonably believed to be in violation of any provision of this title (or amendment), or any order, rule, regulation, standard, or ban under this title (or amendment).

`(b) Complaint Procedure-

`(1) IN GENERAL- An employee who believes that he or she has been discharged or otherwise discriminated against by any employer in violation of this section may seek relief in accordance with the procedures, notifications, burdens of proof, remedies, and statutes of limitation set forth in section 2087(b) of title 15, United States Code.

`(2) NO LIMITATION ON RIGHTS- Nothing in this section shall be deemed to diminish the rights, privileges, or remedies of any employee under any Federal or State law or under any collective bargaining agreement. The rights and remedies in this section may not be waived by any agreement, policy, form, or condition of employment.'.

SEC. 1559. OVERSIGHT.

The Inspector General of the Department of Health and Human Services shall have oversight authority with respect to the administration and implementation of this title as it relates to such Department.

SEC. 1560. RULES OF CONSTRUCTION.

(a) No Effect on Antitrust Laws- Nothing in this title (or an amendment made by this title) shall be construed to modify, impair, or supersede the operation of any of the antitrust laws. For the purposes of this section, the term `antitrust laws' has the meaning given such term in subsection (a) of the first section of the Clayton Act, except that such term includes section 5 of the Federal Trade Commission Act to the extent that such section 5 applies to unfair methods of competition.

(b) Rule of Construction Regarding Hawaii's Prepaid Health Care Act- Nothing in this title (or an amendment made by this title) shall be construed to modify or limit the application of the exemption for Hawaii's Prepaid Health Care Act (Haw. Rev. Stat. 393-1 et seq.) as provided for under section 514(b)(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(5)).

(c) Student Health Insurance Plans- Nothing in this title (or an amendment made by this title) shall be construed to prohibit an institution of higher education (as such term is defined for purposes of the Higher Education Act of 1965) from offering a student health insurance plan, to the extent that such requirement is otherwise permitted under applicable Federal, State or local law.

(d) No Effect on Existing Requirements- Nothing in this title (or an amendment made by this title, unless specified by direct statutory reference) shall be construed to modify any existing Federal requirement concerning the State agency responsible for determining eligibility for programs identified in section 1413.

SEC. 1561. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.

Title XXX of the Public Health Service Act (42 U.S.C. 300jj et seq.) is amended by adding at the end the following:

`Subtitle C--Other Provisions

`SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.

`(a) In General-

`(1) STANDARDS AND PROTOCOLS- Not later than 180 days after the date of enactment of this title, the Secretary, in consultation with the HIT Policy Committee and the HIT Standards Committee, shall develop interoperable and secure standards and protocols that facilitate enrollment of individuals in Federal and State health and human services programs, as determined by the Secretary.

`(2) METHODS- The Secretary shall facilitate enrollment in such programs through methods determined appropriate by the Secretary, which shall include providing individuals and third parties authorized by such individuals and their designees notification of eligibility and verification of eligibility required under such programs.

`(b) Content- The standards and protocols for electronic enrollment in the Federal and State programs described in subsection (a) shall allow for the following:

`(1) Electronic matching against existing Federal and State data, including vital records, employment history, enrollment systems, tax records, and other data determined appropriate by the Secretary to serve as evidence of eligibility and in lieu of paper-based documentation.

`(2) Simplification and submission of electronic documentation, digitization of documents, and systems verification of eligibility.

`(3) Reuse of stored eligibility information (including documentation) to assist with retention of eligible individuals.

`(4) Capability for individuals to apply, recertify and manage their eligibility information online, including at home, at points of service, and other community-based locations.

`(5) Ability to expand the enrollment system to integrate new programs, rules, and functionalities, to operate at increased volume, and to apply streamlined verification and eligibility processes to other Federal and State programs, as appropriate.

`(6) Notification of eligibility, recertification, and other needed communication regarding eligibility, which may include communication via email and cellular phones.

`(7) Other functionalities necessary to provide eligibles with streamlined enrollment process.

`(c) Approval and Notification- With respect to any standard or protocol developed under subsection (a) that has been approved by the HIT Policy Committee and the HIT Standards Committee, the Secretary--

`(1) shall notify States of such standards or protocols; and

`(2) may require, as a condition of receiving Federal funds for the health information technology investments, that States or other entities incorporate such standards and protocols into such investments.

`(d) Grants for Implementation of Appropriate Enrollment HIT-

`(1) IN GENERAL- The Secretary shall award grant to eligible entities to develop new, and adapt existing, technology systems to implement the HIT enrollment standards and protocols developed under subsection (a) (referred to in this subsection as `appropriate HIT technology').

`(2) ELIGIBLE ENTITIES- To be eligible for a grant under this subsection, an entity shall--

`(A) be a State, political subdivision of a State, or a local governmental entity; and

`(B) submit to the Secretary an application at such time, in such manner, and containing--

`(i) a plan to adopt and implement appropriate enrollment technology that includes--

`(I) proposed reduction in maintenance costs of technology systems;

`(II) elimination or updating of legacy systems; and

`(III) demonstrated collaboration with other entities that may receive a grant under this section that are located in the same State, political subdivision, or locality;

`(ii) an assurance that the entity will share such appropriate enrollment technology in accordance with paragraph (4); and

`(iii) such other information as the Secretary may require.

`(3) SHARING-

`(A) IN GENERAL- The Secretary shall ensure that appropriate enrollment HIT adopted under grants under this subsection is made available to other qualified State, qualified political subdivisions of a State, or other appropriate qualified entities (as described in subparagraph (B)) at no cost.

`(B) QUALIFIED ENTITIES- The Secretary shall determine what entities are qualified to receive enrollment HIT under subparagraph (A), taking into consideration the recommendations of the HIT Policy Committee and the HIT Standards Committee.'.

SEC. 1562. 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:

`(E) ELECTION NOT APPLICABLE- The election described in subparagraph (A) shall not be available with respect to the provisions of subpart 1.';

(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- 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. 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.'.

SEC. 1563. SENSE OF THE SENATE PROMOTING FISCAL RESPONSIBILITY.

(a) Findings- The Senate makes the following findings:

(1) Based on Congressional Budget Office (CBO) estimates, this Act will reduce the Federal deficit between 2010 and 2019.

(2) CBO projects this Act will continue to reduce budget deficits after 2019.

(3) Based on CBO estimates, this Act will extend the solvency of the Medicare HI Trust Fund.

(4) This Act will increase the surplus in the Social Security Trust Fund, which should be reserved to strengthen the finances of Social Security.

(5) The initial net savings generated by the Community Living Assistance Services and Supports (CLASS) program are necessary to ensure the long-term solvency of that program.

(b) Sense of the Senate- It is the sense of the Senate that--

(1) the additional surplus in the Social Security Trust Fund generated by this Act should be reserved for Social Security and not spent in this Act for other purposes; and

(2) the net savings generated by the CLASS program should be reserved for the CLASS program and not spent in this Act for other purposes.