Page:United States Statutes at Large Volume 124.djvu/226

124 STAT. 200 PUBLIC LAW 111–148—MAR. 23, 2010 enrolled in the applicable second lowest cost silver plan (as defined in section 36B(b)(3)(B) of the Internal Revenue Code of 1986) offered to the individual through an Exchange; and (ii) that the cost-sharing an eligible individual is required to pay under the standard health plan does not exceed— (I) the cost-sharing required under a platinum plan in the case of an eligible individual with household income not in excess of 150 percent of the poverty line for the size of the family involved; and (II) the cost-sharing required under a gold plan in the case of an eligible individual not described in subclause (I); and (B) the benefits provided under the standard health plans offered through the program cover at least the essen- tial health benefits described in section 1302(b). For purposes of subparagraph (A)(i), the amount of the monthly premium an individual is required to pay under either the standard health plan or the applicable second lowest cost silver plan shall be determined after reduction for any premium tax credits and cost-sharing reductions allowable with respect to either plan. (b) STANDARD HEALTH PLAN.—In this section, the term ‘‘standard heath plan’’ means a health benefits plan that the State contracts with under this section— (1) under which the only individuals eligible to enroll are eligible individuals; (2) that provides at least the essential health benefits described in section 1302(b); and (3) in the case of a plan that provides health insurance coverage offered by a health insurance issuer, that has a med- ical loss ratio of at least 85 percent. (c) CONTRACTING PROCESS.— (1) IN GENERAL.—A State basic health program shall estab- lish a competitive process for entering into contracts with standard health plans under subsection (a), including negotia- tion of premiums and cost-sharing and negotiation of benefits in addition to the essential health benefits described in section 1302(b). (2) SPECIFIC ITEMS TO BE CONSIDERED.—A State shall, as part of its competitive process under paragraph (1), include at least the following: (A) INNOVATION.—Negotiation with offerors of a standard health plan for the inclusion of innovative fea- tures in the plan, including— (i) care coordination and care management for enrollees, especially for those with chronic health conditions; (ii) incentives for use of preventive services; and (iii) the establishment of relationships between providers and patients that maximize patient involve- ment in health care decision-making, including pro- viding incentives for appropriate utilization under the plan. Definition.