Page:United States Statutes at Large Volume 124.djvu/171

 124 STAT. 145 PUBLIC LAW 111–148—MAR. 23, 2010 employment-based plan shall take into account any nego- tiated price concessions (such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunera- tions) obtained by such plan with respect to such health benefit. For purposes of determining the amount of any such claim, the costs paid by the early retiree or the retiree’s spouse, surviving spouse, or dependent in the form of deductibles, co-payments, or co-insurance shall be included in the amounts paid by the participating employ- ment-based plan. (2) PROGRAM PAYMENTS.—If the Secretary determines that a participating employment-based plan has submitted a valid claim under paragraph (1), the Secretary shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that exceed $15,000, subject to the limits con- tained in paragraph (3). (3) LIMIT.—To be eligible for reimbursement under the program, a claim submitted by a participating employment- based plan shall not be less than $15,000 nor greater than $90,000. Such amounts shall be adjusted each fiscal year based on the percentage increase in the Medical Care Component of the Consumer Price Index for all urban consumers (rounded to the nearest multiple of $1,000) for the year involved. (4) USE OF PAYMENTS.—Amounts paid to a participating employment-based plan under this subsection shall be used to lower costs for the plan. Such payments may be used to reduce premium costs for an entity described in subsection (a)(2)(B)(i) or to reduce premium contributions, co-payments, deductibles, co-insurance, or other out-of-pocket costs for plan participants. Such payments shall not be used as general reve- nues for an entity described in subsection (a)(2)(B)(i). The Sec- retary shall develop a mechanism to monitor the appropriate use of such payments by such entities. (5) PAYMENTS NOT TREATED AS INCOME.—Payments received under this subsection shall not be included in deter- mining the gross income of an entity described in subsection (a)(2)(B)(i) that is maintaining or currently contributing to a participating employment-based plan. (6) APPEALS.—The Secretary shall establish— (A) an appeals process to permit participating employ- ment-based plans to appeal a determination of the Sec- retary with respect to claims submitted under this section; and (B) procedures to protect against fraud, waste, and abuse under the program. (d) AUDITS.—The Secretary shall conduct annual audits of claims data submitted by participating employment-based plans under this section to ensure that such plans are in compliance with the requirements of this section. (e) FUNDING.—There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to carry out the program under this section. Such funds shall be available without fiscal year limitation. (f) LIMITATION.—The Secretary has the authority to stop taking applications for participation in the program based on the avail- ability of funding under subsection (e).