Page:United States Statutes at Large Volume 124.djvu/220

124 STAT. 194 PUBLIC LAW 111–148—MAR. 23, 2010 insurance option for a service otherwise not included as an essential health benefit. (F) PROTECTING ACCESS TO END OF LIFE CARE.—A community health insurance option offered under this sec- tion shall be prohibited from limiting access to end of life care. (4) COST SHARING.—A community health insurance option shall offer coverage at each of the levels of coverage described in section 1302(d). (5) PREMIUMS.— (A) PREMIUMS SUFFICIENT TO COVER COSTS.—The Sec- retary shall establish geographically adjusted premium rates in an amount sufficient to cover expected costs (including claims and administrative costs) using methods in general use by qualified health plans. (B) APPLICABLE RULES.—The provisions of title XXVII of the Public Health Service Act relating to premiums shall apply to community health insurance options under this section, including modified community rating provi- sions under section 2701 of such Act. (C) COLLECTION OF DATA.—The Secretary shall collect data as necessary to set premium rates under subpara- graph (A). (D) NATIONAL POOLING.—Notwithstanding any other provision of law, the Secretary may treat all enrollees in community health insurance options as members of a single pool. (E) CONTINGENCY MARGIN.—In establishing premium rates under subparagraph (A), the Secretary shall include an appropriate amount for a contingency margin. (6) REIMBURSEMENT RATES.— (A) NEGOTIATED RATES.—The Secretary shall negotiate rates for the reimbursement of health care providers for benefits covered under a community health insurance option. (B) LIMITATION.—The rates described in subparagraph (A) shall not be higher, in aggregate, than the average reimbursement rates paid by health insurance issuers offering qualified health plans through the Exchange. (C) INNOVATION.—Subject to the limits contained in subparagraph (A), a State Advisory Council established or designated under subsection (d) may develop or encour- age the use of innovative payment policies that promote quality, efficiency and savings to consumers. (7) SOLVENCY AND CONSUMER PROTECTION.— (A) SOLVENCY.—The Secretary shall establish a Fed- eral solvency standard to be applied with respect to a community health insurance option. A community health insurance option shall also be subject to the solvency standard of each State in which such community health insurance option is offered. (B) MINIMUM REQUIRED.—In establishing the standard described under subparagraph (A), the Secretary shall require a reserve fund that shall be equal to at least the dollar value of the incurred but not reported claims of a community health insurance option. Standard.