Page:United States Statutes at Large Volume 124.djvu/235

 124 STAT. 209 PUBLIC LAW 111–148—MAR. 23, 2010 (1) include in the Federal standards or State law or regula- tion the State adopts and has in effect under section 1321(b) the provisions described in subsection (b); and (2) establish (or enter into a contract with) 1 or more applicable reinsurance entities to carry out the reinsurance program under this section. (b) MODEL REGULATION.— (1) IN GENERAL.—In establishing the Federal standards under section 1321(a), the Secretary, in consultation with the National Association of Insurance Commissioners (the ‘‘NAIC’’), shall include provisions that enable States to establish and maintain a program under which— (A) health insurance issuers, and third party adminis- trators on behalf of group health plans, are required to make payments to an applicable reinsurance entity for any plan year beginning in the 3-year period beginning January 1, 2014 (as specified in paragraph (3); and (B) the applicable reinsurance entity collects payments under subparagraph (A) and uses amounts so collected to make reinsurance payments to health insurance issuers described in subparagraph (A) that cover high risk individ- uals in the individual market (excluding grandfathered health plans) for any plan year beginning in such 3-year period. (2) HIGH-RISK INDIVIDUAL; PAYMENT AMOUNTS.—The Sec- retary shall include the following in the provisions under para- graph (1): (A) DETERMINATION OF HIGH-RISK INDIVIDUALS.—The method by which individuals will be identified as high risk individuals for purposes of the reinsurance program established under this section. Such method shall provide for identification of individuals as high-risk individuals on the basis of— (i) a list of at least 50 but not more than 100 medical conditions that are identified as high-risk conditions and that may be based on the identification of diagnostic and procedure codes that are indicative of individuals with pre-existing, high-risk conditions; or (ii) any other comparable objective method of identification recommended by the American Academy of Actuaries. (B) PAYMENT AMOUNT.—The formula for determining the amount of payments that will be paid to health insur- ance issuers described in paragraph (1)(A) that insure high- risk individuals. Such formula shall provide for the equi- table allocation of available funds through reconciliation and may be designed— (i) to provide a schedule of payments that specifies the amount that will be paid for each of the conditions identified under subparagraph (A); or (ii) to use any other comparable method for deter- mining payment amounts that is recommended by the American Academy of Actuaries and that encourages the use of care coordination and care management programs for high risk conditions. (3) DETERMINATION OF REQUIRED CONTRIBUTIONS.— Effective date. Time period. Contracts.