View all text of Subpart 1 [§ 300gg-41 - § 300gg-46]
§ 300gg–45. Relief for high risk pools
(a) Seed grants to States
(b) Grants for operational losses
(1) In generalIn the case of a State that has established a qualified high risk pool that—
(A) restricts premiums charged under the pool to no more than 200 percent of the premium for applicable standard risk rates;
(B) offers a choice of two or more coverage options through the pool; and
(C) has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the State in connection with operation of the pool after the end of the last fiscal year for which a grant is provided under this paragraph;
the Secretary shall provide, from the funds appropriated under paragraphs (1)(B)(i) and (2)(A) of subsection (d) and allotted to the State under paragraph (2), a grant for the losses incurred by the State in connection with the operation of the pool.
(2) AllotmentSubject to paragraph (4), the amounts appropriated under paragraphs (1)(B)(i) and (2)(A) of subsection (d) for a fiscal year shall be allotted and made available to the States (or the entities that operate the high risk pool under applicable State law) that qualify for a grant under paragraph (1) as follows:
(A) An amount equal to 40 percent of such appropriated amount for the fiscal year shall be allotted in equal amounts to each qualifying State that is one of the 50 States or the District of Columbia and that applies for a grant under this subsection.
(B) An amount equal to 30 percent of such appropriated amount for the fiscal year shall be allotted among qualifying States that apply for such a grant so that the amount allotted to such a State bears the same ratio to such appropriated amount as the number of uninsured individuals in the State bears to the total number of uninsured individuals (as determined by the Secretary) in all qualifying States that so apply.
(C) An amount equal to 30 percent of such appropriated amount for the fiscal year shall be allotted among qualifying States that apply for such a grant so that the amount allotted to a State bears the same ratio to such appropriated amount as the number of individuals enrolled in health care coverage through the qualified high risk pool of the State bears to the total number of individuals so enrolled through qualified high risk pools (as determined by the Secretary) in all qualifying States that so apply.
(3) Special rule for pools charging higher premiums
(4) Limitation for territories
(c) Bonus grants for supplemental consumer benefits
(1) In general
(2) BenefitsA State shall use amounts received under a grant under this subsection to provide one or more of the following benefits:
(A) Low-income premium subsidies.
(B) A reduction in premium trends, actual premiums, or other cost-sharing requirements.
(C) An expansion or broadening of the pool of individuals eligible for coverage, such as through eliminating waiting lists, increasing enrollment caps, or providing flexibility in enrollment rules.
(D) Less stringent rules, or additional waiver authority, with respect to coverage of pre-existing conditions.
(E) Increased benefits.
(F) The establishment of disease management programs.
(3) Allotment; limitation
(4) Rule of construction
(d) Funding
(1) Appropriation for fiscal year 2006There are authorized to be appropriated for fiscal year 2006—
(A) $15,000,000 to carry out subsection (a); and
(B) $75,000,000, of which, subject to paragraph (4)—
(i) two-thirds of the amount appropriated shall be made available for allotments under subsection (b)(2); and
(ii) one-third of the amount appropriated shall be made available for allotments under subsection (c)(3).
(2) Authorization of appropriations for fiscal years 2007 through 2010There are authorized to be appropriated $75,000,000 for each of fiscal years 2007 through 2010, of which, subject to paragraph (4)—
(A) two-thirds of the amount appropriated for a fiscal year shall be made available for allotments under subsection (b)(2); and
(B) one-third of the amount appropriated for a fiscal year shall be made available for allotments under subsection (c)(3).
(3) Availability
(4) Reallotment
(5) No entitlement
(e) Applications
(f) Annual report
(g) DefinitionsIn this section:
(1) Qualified high risk pool
(A)1
1 So in original. No subpar. (B) has been enacted.
In general(2) Standard risk rateThe term “standard risk rate” means a rate—
(A) determined under the State high risk pool by considering the premium rates charged by other health insurers offering health insurance coverage to individuals in the insurance market served;
(B) that is established using reasonable actuarial techniques; and
(C) that reflects anticipated claims experience and expenses for the coverage involved.
(3) State
(July 1, 1944, ch. 373, title XXVII, § 2745, as added Pub. L. 107–210, div. A, title II, § 201(b), Aug. 6, 2002, 116 Stat. 959; amended Pub. L. 109–172, § 2, Feb. 10, 2006, 120 Stat. 185.)