; and (2) in subsection (d)(5)(A)— (A) by striking In establishing an Exchange under this section and inserting (i) I n general.— In establishing an Exchange under this section (other than in establishing an Exchange pursuant to subsection (a)(6)) ; and (B) by adding at the end the following: (ii) Additional planning and establishment grants In establishing an Exchange pursuant to subsection (a)(6), the State shall ensure that such Exchange is self-sustaining beginning on January 1, 2024, including allowing the Exchange to charge assessments or user fees to participating health insurance issuers, or to otherwise generate funding, to support its operations. . (b) Clarification regarding failure To establish Exchange or implement requirements Section 1321(c) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18041(c) ) is amended— (1) in paragraph (1), by striking If and inserting Subject to paragraph (3), if ; and (2) by adding at the end the following new paragraph: (3) Clarification This subsection shall not apply in the case of a State that elects to apply the requirements described in subsection (a) and satisfies the requirement described in subsection (b) on or after January 1, 2014. .