Premium Relief Act of 2021
This bill establishes and provides funding through FY2024 for the Patient and State Stability Fund, which shall be used to support specified state efforts to increase access to health-insurance coverage and help stabilize the individual market. Specifically, states may use the funds to (1) lower the cost for individuals to purchase coverage, (2) lower out-of-pocket costs for individuals with insurance, (3) pay health care providers, (4) cover or provide additional specified services, and (5) otherwise increase coverage options and stabilize premiums in the state's insurance market.
If a state does not apply for funds under the program, the Centers for Medicare & Medicaid Services, in consultation with the state, must use the funds to stabilize premiums by partially reimbursing insurers for claims in a specified cost range.
The bill also revises the grace period that health insurers must provide to recipients of premium subsidies before discontinuing health coverage for nonpayment of premiums. The grace period is shortened from 3 months to 30 days unless state law includes an applicable grace period.

To amend the Public Health Service Act to provide for a Patient and 
                         State Stability Fund.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Premium Relief Act of 2021''.

SEC. 2. PATIENT AND STATE STABILITY.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following new title:

            ``TITLE XXXIV--PATIENT AND STATE STABILITY FUND

``SEC. 3401. ESTABLISHMENT OF PROGRAM.

    ``There is hereby established the `Patient and State Stability 
Fund' to be administered by the Secretary, acting through the 
Administrator of the Centers for Medicare & Medicaid Services (in this 
title referred to as the `Administrator'), to provide health benefits 
coverage funding, in accordance with this title, to the 50 States and 
the District of Columbia (each referred to in this section as a 
`State') during the period, subject to section 3404(c), beginning on 
January 1, 2022, and ending on December 31, 2024, for the purposes 
described in section 3402.

``SEC. 3402. USE OF FUNDS.

    ``A State may use the funds allocated to the State under this title 
for any of the following purposes:
            ``(1) Helping, through the provision of financial 
        assistance, high-risk individuals who do not have access to 
        health insurance coverage offered through an employer enroll in 
        health insurance coverage in the individual market in the 
        State, as such market is defined by the State (whether through 
        the establishment of a new mechanism or maintenance of an 
        existing mechanism for such purpose).
            ``(2) Providing incentives to appropriate entities to enter 
        into arrangements with the State to help stabilize premiums for 
        health insurance coverage in the individual market, as such 
        markets are defined by the State.
            ``(3) Reducing the cost for providing health insurance 
        coverage in the individual market and small group market, as 
        such markets are defined by the State, to individuals who have, 
        or are projected to have, a high rate of utilization of health 
        services (as measured by cost) and to individuals who have high 
        costs of health insurance coverage due to the low density 
        population of the State in which they reside.
            ``(4) Promoting participation in the individual market and 
        small group market in the State and increasing health insurance 
        options available through such market.
            ``(5) Promoting access to preventive services; dental care 
        services (whether preventive or medically necessary); vision 
        care services (whether preventive or medically necessary); or 
        any combination of such services.
            ``(6) Maternity coverage and newborn care.
            ``(7) Prevention, treatment, or recovery support services 
        for individuals with mental or substance use disorders, focused 
        on either or both of the following:
                    ``(A) Direct inpatient or outpatient clinical care 
                for treatment of addiction and mental illness.
                    ``(B) Early identification and intervention for 
                children and young adults with serious mental illness.
            ``(8) Providing payments, directly or indirectly, to health 
        care providers for the provision of such health care services 
        as are specified by the Administrator.
            ``(9) Providing assistance to reduce out-of-pocket costs, 
        such as copayments, coinsurance, premiums, and deductibles, of 
        individuals enrolled in health insurance coverage in the State.

``SEC. 3403. STATE ELIGIBILITY AND APPROVAL; DEFAULT SAFEGUARD.

    ``(a) Encouraging State Options for Allocations.--
            ``(1) In general.--To be eligible for an allocation of 
        funds under this title for a year during the period described 
        in section 3401 for use for one or more purposes described in 
        section 3402, a State shall submit to the Administrator an 
        application at such time (but not later than March 31 of the 
        previous year) and in such form and manner as specified by the 
        Administrator and containing--
                    ``(A) a description of how the funds will be used 
                for such purposes; and
                    ``(B) such other information as the Administrator 
                may require.
            ``(2) Automatic approval.--An application so submitted is 
        approved unless the Administrator notifies the State submitting 
        the application, not later than 60 days after the date of the 
        submission of such application, that the application has been 
        denied for not being in compliance with any requirement of this 
        title and of the reason for such denial.
            ``(3) One-time application.--If an application of a State 
        is approved for a year, with respect to a purpose described in 
        section 3402, such application shall be treated as approved, 
        with respect to such purpose, for each subsequent year through 
        2024.
    ``(b) Default Federal Safeguard.--
            ``(1) In general.--In the case of a State that does not 
        have in effect an approved application under this section for 
        2022, 2023, or 2024, the Administrator, in consultation with 
        the State insurance commissioner, shall use the allocation that 
        would otherwise be provided to the State under this title for 
        such year, in accordance with paragraph (2), for such State.
            ``(2) Required use for market stabilization payments to 
        issuers.--Subject to section 3404(a), an allocation for a State 
        made pursuant to paragraph (1) for a year shall be used to 
        carry out the purpose described in section 3402(2) in such 
        State by providing payments to appropriate entities described 
        in such section with respect to claims that exceed $50,000 (or, 
        with respect to allocations made under this title for 2023 or a 
        subsequent year during the period specified in section 3401, 
        such dollar amount specified by the Administrator), but do not 
        exceed $350,000 (or, with respect to allocations made under 
        this title for 2023 or a subsequent year during such period, 
        such dollar amount specified by the Administrator), in an 
        amount equal to 75 percent (or, with respect to allocations 
        made under this title for 2023 or a subsequent year during such 
        period, such percentage specified by the Administrator) of the 
        amount of such claims.

``SEC. 3404. ALLOCATIONS.

    ``(a) Appropriation.--For the purpose of providing allocations for 
States (including pursuant to section 3403(b)) under this title there 
is appropriated, out of any money in the Treasury not otherwise 
appropriated, $2,500,000,000 for each of years 2022 through 2024.
    ``(b) Allocations.--
            ``(1) Payment.--From amounts appropriated under subsection 
        (a) for a year (beginning with 2022 and ending with 2024), the 
        Administrator shall, with respect to a State and not later than 
        January 1 of such year, allocate for such State (including 
        pursuant to section 3403(b)) the amount determined for such 
        State and year under paragraph (2).
            ``(2) Allocation amount determinations.--For purposes of 
        paragraph (1), the amount determined under this paragraph for a 
        year for a State is an amount determined in accordance with an 
        allocation methodology specified by the Administrator.
    ``(c) Annual Distribution of Previous Year's Remaining Funds.--In 
carrying out subsection (b), the Administrator shall, with respect to a 
year (beginning with 2023 and ending with 2025), not later than March 
31 of such year--
            ``(1) determine the amount of funds, if any, from the 
        amounts appropriated under subsection (a) for the previous year 
        but not allocated for such previous year; and
            ``(2) if the Administrator determines that any funds were 
        not so allocated for such previous year, allocate such 
        remaining funds, in accordance with the allocation methodology 
        specified pursuant to subsection (b)(2)--
                    ``(A) to States that have submitted an application 
                approved under section 3403(a) for such previous year 
                for any purpose for which such an application was 
                approved; and
                    ``(B) for States for which allocations were made 
                pursuant to section 3403(b) for such previous year, to 
                be used by the Administrator for such States, to carry 
                out the purpose described in section 3402(2) in such 
                State by providing payments to appropriate entities 
                described in such section 3402(2) with respect to 
                claims that exceed $1,000,000,
        with, respect to a year before 2025, any remaining funds being 
        made available for allocations to States for the subsequent 
        year.
    ``(d) Availability.--Amounts appropriated under subsection (a) for 
a year and allocated to States in accordance with this section shall 
remain available for expenditure through December 31, 2025.
    ``(e) Limitation.--Amounts appropriated under subsection (a) for a 
year (beginning with 2022 and ending with 2024) are subject to the 
requirements and limitations under sections 506 and 507 of division H 
of Public Law 115-31 in the same manner and to the same extent as if 
such amounts for such year were appropriated under such division.''.

SEC. 3. ALIGNING QUALIFIED HEALTH PLAN GRACE PERIOD REQUIREMENTS WITH 
              STATE LAW GRACE PERIOD REQUIREMENTS.

    Section 1412(c)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18082(c)(2)) is amended--
            (1) in subparagraph (B)(iv)(II), by striking ``a 3-month 
        grace period'' and inserting ``a grace period specified in 
        subparagraph (C)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Grace period specified.--For purposes of 
                subparagraph (B)(iv)(II), the grace period specified in 
                this subparagraph is--
                            ``(i) for plan years beginning before 
                        January 1, 2022, a 3-month grace period; and
                            ``(ii) for plan years beginning during 2022 
                        or a subsequent year, such grace period for 
                        non-payment of premiums before discontinuing 
                        coverage as is applicable under the State law 
                        of the State in which the Exchange operates to 
                        health insurance coverage offered in the 
                        individual market (or, in the case such a State 
                        law is not in place for the State involved, a 
                        1-month grace period).''.
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Premium Relief Act of 2021
To amend the Public Health Service Act to provide for a Patient and State Stability Fund.
Premium Relief Act of 2021
Rep. Burgess, Michael C.