SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a)
SHORT TITLE.-This Act may be cited as the Affordable Health Choices Act.

(b)
TABLE OF CONTENTS.-The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I-QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

Subtitle A-Effective Coverage for All Americans

PART I-PROVISIONS APPLICABLE TO THE INDIVIDUAL AND GROUPMARKETS

Sec. 101. Amendment to the Public Health Service Act. Sec. 2705. Prohibition of preexisting condition exclusions or other dis

crimination based on health status. Sec. 2701. Fair insurance coverage. Sec. 2702. Guaranteed availability of coverage. Sec. 2703. Guaranteed renewability of coverage. Sec. 2704. Bringing down the cost of health care coverage. Sec. 2706. Prohibiting discrimination against individual participants and

beneficiaries based on health status. Sec. 2707. Ensuring the quality of care. Sec. 2708. Coverage of preventive health services. Sec. 2709. Extension of dependent coverage. Sec. 2710. No lifetime or annual limits.

PART II-PROVISION APPLICABLE TO THE GROUP MARKET

Sec. 121. Amendment to the Public Health Service Act. Sec. 2719. Prohibition of discrimination based on salary.

PART III-OTHER PROVISIONS

Sec. 131. No changes to existing coverage. Sec. 132. Applicability. Sec. 133. Conforming amendments. Sec. 134. Effective dates.

Subtitle B-Available Coverage for All Americans

Sec. 141. Assumptions regarding medicaid.

Sec. 142. Building on the success of the Federal Employees Health Benefit Program so all americans have affordable health benefit choices.

Sec. 143. Affordable health choices for all americans.

TITLE XXXI-AFFORDABLE HEALTH CHOICES FOR ALL AMERICANS

Subtitle A-Affordable Choices

Sec. 3101. Affordable choices of health benefit plans. Sec. 3102. Financial integrity. Sec. 3103. Seeking the best medical advice. Sec. 3104. Allowing State flexibility. Sec. 3105. Navigators.

Subtitle C-Affordable Coverage for All Americans

Sec. 151. Support for affordable health coverage.

Subtitle B-Making Coverage Affordable

Sec. 3111. Support for affordable health coverage. Sec. 3112. Small business health options program credit. Sec. 152. Non-discrimination in health care.

Subtitle D-Shared Responsibility for Health Care

Sec. 161. Individual responsibility. Sec. 162. Notification on the availability of affordable health choices. Sec. 163. Shared responsibility of employers.

Sec. 3115. Shared responsibility of employers. Sec. 3116. Definitions.

Subtitle E-Improving Access to Health Care Services

Sec. 171. Spending for Federally Qualified Health Centers (FQHCs). Sec. 172. Other provisions. Sec. 173. Funding for National Health Service Corps. Sec. 174. Negotiated rulemaking for development of methodology and criteria

for designating medically underserved populations and health

professions shortage areas. Sec. 175. Equity for certain eligible survivors. Sec. 176. Reauthorization of emergency medical services for children program.

Subtitle F-Making Health Care More Affordable for Retirees

Sec. 181. Reinsurance for retirees.

Subtitle G-Improving the Use of Health Information Technology for Enrollment; Miscellaneous Provisions

Sec. 185. Health information technology enrollment standards and protocols. Sec. 186. Rule of construction regarding Hawaiis Prepaid Health Care Act. Sec. 187. Key National indicators.

Subtitle H-CLASS Act

Sec. 190. Short title of subtitle.

PART I-COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

Sec. 191. Establishment of national voluntary insurance program for purchasing community living assistance services and support.

TITLE XXXII-COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

Sec. 3201. Purpose. Sec. 3202. Definitions. Sec. 3203. CLASS Independence Benefit Plan. Sec. 3204. Enrollment and disenrollment requirements. Sec. 3205. Benefits. Sec. 3206. CLASS Independence Fund. Sec. 3207. CLASS Independence Advisory Council. Sec. 3208. Regulations; annual report. Sec. 3209. Tax treatment of program.

PART II-AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986

Sec. 195. Credit for costs of employers who elect to automatically enroll em

ployees and withhold class premiums from wages. Sec. 196. Long-term care insurance includible in cafeteria plans.

TITLE II-IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

Subtitle A-National Strategy to Improve Health Care Quality

Sec. 201. National strategy. Sec. 202. Interagency Working Group on Health Care Quality. Sec. 203. Quality measure development. Sec. 204. Quality measure endorsement; public reporting; data collection. Sec. 205. Collection and analysis of quality measure data.

Subtitle B-Health Care Quality Improvements

Sec. 211. Health care delivery system research; Quality improvement technical assistance. Sec. 212. Grants to establish community health teams to support a medical home model. Sec. 213. Grants to implement medication management services in treatment of chronic disease. Sec. 214. Design and implementation of regionalized systems for emergency

care. Sec. 215. Trauma care centers and service availability. Sec. 216. Reducing and reporting hospital readmissions. Sec. 217. Program to facilitate shared decision-making. Sec. 218. Presentation of drug information. Sec. 219. Center for health outcomes research and evaluation. Sec. 220. Demonstration program to integrate quality improvement and patient

safety training into clinical education of health professionals. Sec. 221. Office of womens health. Sec. 222. Administrative simplification.

TITLE III-IMPROVING THE HEALTH OF THE AMERICAN PEOPLE

Subtitle A-Modernizing Disease Prevention of Public Health Systems

Sec. 301. National Prevention, Health Promotion and public health council. Sec. 302. Prevention and Public Health Investment Fund. Sec. 303. Clinical and community Preventive Services. Sec. 304. Education and outreach campaign regarding preventive benefits.

Subtitle B-Increasing Access to Clinical Preventive Services

Sec. 311. Right choices program. Sec. 312. School-based health clinics. Sec. 313. Oral healthcare prevention activities. Sec. 314. Oral health improvement.

Subtitle C-Creating Healthier Communities

Sec. 321. Community transformation grants. Sec. 322. Healthy aging, living well. Sec. 323. Wellness for individuals with disabilities. Sec. 324. Immunizations.

Sec. 325. Nutrition labeling of standard menu items at Chain Restaurants and

of articles of food sold from vending machines.

Subtitle D-Support for Prevention and Public Health Information

Sec. 331. Research on optimizing the delivery of public health services. Sec. 332. Understanding health disparities: data collection and analysis. Sec. 333. Health impact assessments. Sec. 334. CDC and employer-based wellness programs.

TITLE IV-HEALTH CARE WORKFORCE

Subtitle A-Purpose and Definitions

Sec. 401. Purpose. Sec. 402. Definitions.

Subtitle B-Innovations in the Health Care Workforce

Sec. 411. National health care workforce commission. Sec. 412. State health care workforce development grants. Sec. 413. Health care workforce program assessment.

Subtitle C-Increasing the Supply of the Health Care Workforce

Sec. 421. Federally supported student loan funds. Sec. 422. Nursing student loan program. Sec. 423. Health care workforce loan repayment programs. Sec. 424. Public health workforce recruitment and retention programs. Sec. 425. Allied health workforce recruitment and retention programs. Sec. 426. Grants for State and local programs. Sec. 427. Funding for National Health Service Corps. Sec. 428. Nurse-managed health clinics. Sec. 429. Elimination of cap on commissioned corp. Sec. 430. Establishing a Ready Reserve Corps.

Subtitle D-Enhancing Health Care Workforce Education and Training

Sec. 431. Training in family medicine, general internal medicine, general pedi

atrics, and physician assistantship. Sec. 432. Training opportunities for direct care workers. Sec. 433. Training in general, pediatric, and public health dentistry. Sec. 434. Alternative dental health care providers demonstration project. Sec. 435. Geriatric education and training; career awards; comprehensive geri

atric education. Sec. 436. Mental and behavioral health education and training grants. Sec. 437. Cultural competency, prevention and public health and individuals

with disabilities training. Sec. 438. Advanced nursing education grants. Sec. 439. Nurse education, practice, and retention grants. Sec. 440. Loan repayment and scholarship program. Sec. 441. Nurse faculty loan program. Sec. 442. Authorization of appropriations for parts B through D of title VIII. Sec. 443. Grants to promote the community health workforce. Sec. 444. Youth public health program. Sec. 445. Fellowship training in public health.

Subtitle E-Supporting the Existing Health Care Workforce

Sec. 451. Centers of excellence. Sec. 452. Health care professionals training for diversity. Sec. 453. Interdisciplinary, community-based linkages. Sec. 454. Workforce diversity grants. Sec. 455. Primary care extension program.

Subtitle F-General Provisions Sec. 461. Reports. TITLE V-PREVENTING FRAUD AND ABUSE Subtitle A-Establishment of New Health and Human Services and Department of Justice Health Care Fraud Positions Sec. 501. Health and Human Services Senior Advisor. Sec. 502. Department of Justice Position. Subtitle B-Health Care Program Integrity Coordinating Council Sec. 511. Establishment. Subtitle C-False Statements and Representations Sec. 521. Prohibition on false statements and representations. Subtitle D-Federal Health Care Offense Sec. 531. Clarifying definition. Subtitle E-Uniformity in Fraud and Abuse Reporting Sec. 541. Development of model uniform report form. Subtitle F-Applicability of State Law to Combat Fraud and Abuse Sec. 551. Applicability of State law to combat fraud and abuse. Subtitle G-Enabling the Department of Labor to Issue Administrative Sum-mary Cease and Desist Orders and Summary Seizures Orders Against Plans That Are in Financially Hazardous Condition Sec. 561. Enabling the Department of Labor to issue administrative summary cease and desist orders and summary seizures orders against plans that are in financially hazardous condition. Subtitle H-Requiring Multiple Employer Welfare Arrangement (MEWA) Plans to File a Registration Form With the Department of Labor Prior to Enrolling Anyone in the Plan

Sec. 571. MEWA plan registration with Department of Labor. Subtitle I-Permitting Evidentiary Privilege and Confidential Communications Sec. 581. Permitting evidentiary privilege and confidential communications.

TITLE VI-IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES Subtitle A-Biologics Price Competition and Innovation

Subtitle B-More Affordable Medicines for Children and Underserved Communities

Sec. 611. Expanded participation in 340B program. Sec. 612. Improvements to 340B program integrity.

1TITLE I-QUALITY, AFFORDABLE 2HEALTH CARE FOR ALL 3AMERICANS 4Subtitle A-Effective Coverage for 5All Americans 6PART I-PROVISIONS APPLICABLE TO THE 7INDIVIDUAL AND GROUP MARKETS 8SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 9ACT. 10Part A of title XXVII of the Public Health Service 11Act (42 U.S.C. 300gg et seq.) is amended- 12(1) by striking the part heading and inserting 13the following: 14"PART A-INDIVIDUAL AND GROUP MARKET 15REFORMS"; 16(2) in section 2701 (42 U.S.C. 300gg)- 17(A) by striking the section heading and 18subsection (a) and inserting the following: 19"SEC. 2705. PROHIBITION OF PREEXISTING CONDITION EX-20CLUSIONS OR OTHER DISCRIMINATION 21BASED ON HEALTH STATUS. 22(a) IN GENERAL.-A group health plan and a health 23insurance issuer offering group or individual health insur-

ance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.; and

(B) by transferring such section so as to appear after the section 2704 as added by paragraph (3);

(3)
by redesignating existing sections 2704 through 2707 as sections 2715 through 2718; and

(4)
by amending the remainder of subpart 1 of such part to read as follows:

"Subpart 1-General Reform "SEC. 2701. FAIR INSURANCE COVERAGE.

(a) IN GENERAL.-With respect to the premium rate charged by a health insurance issuer for health insur-ance coverage offered in the individual or group market-

(1) such rate shall vary only by- (A) family structure; (B) community rating area; (C) the actuarial value of the benefit; (D) age, except that such rate shall not

vary by more than 2 to 1; and

(2) such rate shall not vary by health status-related factors, gender, class of business, claims experience, or any other factor not described in paragraph (1).

(b) COMMUNITY RATING AREA.-Taking into ac-count the applicable recommendations of the National As-sociation of Insurance Commissioners, the Secretary shall by regulation establish a minimum size for community rat-ing areas for purposes of this section.