Section 1 Preconditions for premium tax credits, reductions in cost-sharing, and funding of Navigators and related Exchange enrollment activities
In general— Notwithstanding any other provision of law, no premium tax credit shall be allowed under section 36B of the Internal Revenue Code of 1986, no reduction in cost-sharing shall be allowed under section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071), and no funds may be awarded under section 1311 of such Act (42 U.S.C. 18031) for the operation of a Navigator program under subsection (i) of such section or for facilitation or advocacy for enrollment under subsections (d)(6)(B) and (E) of such section, until—
1 year after the date the Secretary certifies to Congress that the ACA verification methods (as defined in subsection (c)(1))—
have been tested to verify their accuracy; and
have safeguards in place to protect personally identifiable information; and
the Inspector General of the Department of Health and Human Services reviews such verification methods and certifies to Congress—
the quality, accuracy, response time, and integrity of such verification methods; and
that the level of improper subsidy payments is not likely to exceed 3 percent of the level of the total subsidy payments (as defined in subsection (c)(3)).
Subsequent annual certification of verification methods—
In general— The Inspector General of the Department of Health and Human Services shall annually review the quality, accuracy, response time, and integrity of the ACA verification methods in order to determine the level of improper subsidy payments as a percentage of the level of total subsidy payments.
Suspension if excessive improper subsidy payments— If the Inspector General determines for a year as a result of such review that the level of improper subsidy payments is projected to exceed 3 percent of the level of total subsidy payments, for years beginning after the date of such determination awards shall be suspended until such time as the Secretary and the Inspector General certify that the level of improper subsidy payments is not likely to exceed 3 percent of the level of total subsidy payment.
Definitions— In this section:
The term ACA verification methods means the verification methods required under subsections (c)(4) and (d) of section 1411 of the Patient Protection and Affordable Care Act (42 U.S.C. 18081).
The term Secretary means the Secretary of Health and Human Services, acting in consultation with the Secretary of the Treasury and other appropriate Federal officials in implementing section 1411 of the Patient Protection and Affordable Care Act (42 U.S.C. 18081).
The term subsidy payments means premium tax credits allowed under section 36B of the Internal Revenue Code of 1986 and reductions in cost-sharing effected under section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071).