Title I, SEC. 1402. REQUIREMENTS RELATING TO ENROLLMENT AND COVERAGE. 
      (a) No Underwriting. 

        (1) In general. Subject to paragraph (2), each health plan offered by a 
      regional alliance or a corporate alliance must accept for enrollment 
      every alliance eligible individual who seeks such enrollment. No plan may 
      engage in any practice that has the effect of attracting or limiting 
      enrollees on the basis of personal characteristics, such as health 
      status, anticipated need for health care, age, occupation, or affiliation 
      with any person or entity. 

        (2) Capacity limitations. With the approval of the applicable 
      regulatory authority, a health plan may limit enrollment because of the 
      plan's capacity to deliver services or to maintain financial stability. 
      If such a limitation is imposed, the limitation may not be imposed on a 
      basis referred to in paragraph (1). 

      (b) No Limits on Coverage; No Pre-Existing Condition Limits. A health 
    plan may not 

        (1) terminate, restrict, or limit coverage for the comprehensive 
      benefit package  in any portion of the plan's service area for any 
      reason, including nonpayment of premiums; 

        (2) cancel coverage for any alliance eligible individual until that 
      individual is enrolled in another applicable health plan; 

        (3) exclude coverage of an alliance eligible individual because of 
      existing medical conditions; 

        (4) impose waiting periods before coverage begins; or 

        (5) impose a rider that serves to exclude coverage of particular 
      eligible individuals. 

      (c) Anti-Discrimination. 

        (1) In general. No health plan may engage (directly or through 
      contractual arrangements) in any activity, including the selection of a 
      service area, that has the effect of discriminating against an individual 
      on the basis of race, national origin, gender, income, health status, or 
      anticipated need for health services. 

        (2) Selection of providers for plan network. In selecting among 
      providers of health services for membership in a provider network, or in 
      establishing the terms and conditions of such membership, a health plan 
      may not engage in any practice that has the effect of discriminating 
      against a provider 

          (A) based on the race, national origin, or gender of the provider; or 

          (B) based on the income, health status, or anticipated need for 
        health services of a patient of the provider. 

        (3) Normal Operation of Health Plan. Except in the case of intentional 
      discrimination, it shall not be a violation of this subsection, or of any 
      regulation issued under this subsection, for any person to take any 
      action otherwise prohibited under this subsection, if the action is 
      necessary to the normal operation of the health plan. 

        (4) Regulations. Not later than 1 year after the date of the enactment 
      of this Act, the Secretary of Health and Human Services shall issue 
      regulations in an accessible form to carry out this subsection. 

      (d) Requirements for Plans Offering Lower Cost Sharing. Each health plan 
    that offers enrollees the lower cost sharing schedule referred to in 
    section 1131 

        (1) shall apply such schedule to all items and services in the 
      comprehensive benefit package; 

        (2) shall offer enrollees the opportunity to obtain coverage for 
      out-of-network items and services (as described in subsection (f)(2)); 
      and 

        (3) notwithstanding section 1403, in the case of an enrollee who 
      obtains coverage for such items and services, may charge an alternative 
      premium to take into account such coverage. 

      (e) Treatment of Cost Sharing. Each health plan, in providing benefits in 
    the comprehensive benefit package 

        (1) shall include in its payments to providers, such additional 
      reimbursement as may be necessary to reflect cost sharing reductions to 
      which individuals are entitled under section 1371, and 

        (2) shall maintain such claims or encounter records as may be necessary 
      to audit the amount of such additional reimbursements and the individuals 
      for which such reimbursement is provided. 

      (f) In-Network and Out-of-Network Items and Services Defined. 

        (1) In-network items and services. For purposes of this Act, the term 
      ``in-network'', when used with respect to items or services described in 
      this subtitle, means items or services provided to an individual enrolled 
      under a health plan by a health care provider who is a member of a 
      provider network of the plan (as defined in paragraph (3)). 

        (2) Out-of-network items and services. For purposes of this Act, the 
      term ``out-of network'', when used with respect to items or services 
      described in this subtitle, means items or services provided to an 
      individual enrolled under a health plan by a health care provider who is 
      not a member of a provider network of the plan (as defined in paragraph 
      (3)). 

        (3) Provider network defined. A ``provider network'' means, with 
      respect to a health plan, providers who have entered into an agreement 
      with the plan under which such providers are obligated to provide items 
      and services in the comprehensive benefit package to individuals enrolled 
      in the plan, or have an agreement to provide services on a 
      fee-for-service basis. 

      (g) Relation to Detention. A health plan is not required to provide any 
    reimbursement to any detention facility for services performed in that 
    facility for detainees in the facility.