Page:United States Statutes at Large Volume 124.djvu/228

124 STAT. 202 PUBLIC LAW 111–148—MAR. 23, 2010 Revenue Code of 1986, and the cost-sharing reductions under section 1402, that would have been provided for the fiscal year to eligible individuals enrolled in standard health plans in the State if such eligible individuals were allowed to enroll in qualified health plans through an Exchange established under this sub- title. (ii) SPECIFIC REQUIREMENTS.—The Secretary shall make the determination under clause (i) on a per enrollee basis and shall take into account all relevant factors necessary to determine the value of the pre- mium tax credits and cost-sharing reductions that would have been provided to eligible individuals described in clause (i), including the age and income of the enrollee, whether the enrollment is for self- only or family coverage, geographic differences in aver- age spending for health care across rating areas, the health status of the enrollee for purposes of deter- mining risk adjustment payments and reinsurance pay- ments that would have been made if the enrollee had enrolled in a qualified health plan through an Exchange, and whether any reconciliation of the credit or cost-sharing reductions would have occurred if the enrollee had been so enrolled. This determination shall take into consideration the experience of other States with respect to participation in an Exchange and such credits and reductions provided to residents of the other States, with a special focus on enrollees with income below 200 percent of poverty. (iii) CERTIFICATION.—The Chief Actuary of the Centers for Medicare & Medicaid Services, in consulta- tion with the Office of Tax Analysis of the Department of the Treasury, shall certify whether the methodology used to make determinations under this subparagraph, and such determinations, meet the requirements of clause (ii). Such certifications shall be based on suffi- cient data from the State and from comparable States about their experience with programs created by this Act. (B) CORRECTIONS.—The Secretary shall adjust the pay- ment for any fiscal year to reflect any error in the deter- minations under subparagraph (A) for any preceding fiscal year. (4) APPLICATION OF SPECIAL RULES.—The provisions of sec- tion 1303 shall apply to a State basic health program, and to standard health plans offered through such program, in the same manner as such rules apply to qualified health plans. (e) ELIGIBLE INDIVIDUAL.— (1) IN GENERAL.—In this section, the term ‘‘eligible indi- vidual’’ means, with respect to any State, an individual— (A) who a resident of the State who is not eligible to enroll in the State’s medicaid program under title XIX of the Social Security Act for benefits that at a minimum consist of the essential health benefits described in section 1302(b); Definition.